Immune and Hematologic disorders
Which nursing intervention takes priority for a client infected with pneumocystis carinii pneumonia?
auscultating breath sounds
A female client with human immunodeficiency virus (HIV) receives family-planning counseling. which statement made by the client about safer sex practices for persons with HIV is accurate?
" A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse."
A nurse is caring for a client with non-Hodgkin's lymphoma. Which statement indicates that the client diagnosed with non-Hodgkin's lymphoma needs further reinforcement from the education plan?
"If I stay healthy and eat right, I can cure this disease."
A parent asks the clinic nurse how often the influenza virus vaccine should be given to a child. Which response would be MOST accurate?
"the vaccine is usually given annually to children with certain risk factors."
A nurse is reinforcing nutritional counseling to the parent of a child with celiac disease. Which statement by the parent indicates understanding of the diet?
"I need to read food labels carefully to avoid gluten additives in foods."
A nurse is providing care for a client with deep, partial-thickness burns. Which findings predisposes the client for a reduced hematocrit level?
0.9% NS IV fluids at 250 cc/hour
A client arrives at the emergency department reporting chest and stomach pain and a history of black, tarry stools for the past 2 months. Which orders should the nurse anticipate?
ECG, complete blood count, testing for occult blood, and comprehensive serum metabolic panel
A client with hemophilia is admitted to the medical-surgical unit. When providing care for this client, which factor is most important?
Ensuring client safety
When a nurse removes an I.V. from an client with acquired immunodeficiency syndrome (AIDS), blood splashes into the nurse's eyes. What should the nurse do next?
Rinse their eyes with water, report the incident, and go to Employee Health
When a nurse removes an I.V. from an client with acquired immunodeficiency syndrome (AIDS), blood splashes into the nurse's eyes. What should the nurse do next?
Rinse their eyes with water, report the incident, and go to Employee Health.
After undergoing testing, a client comes to a physician's office for a follow-up appointment. During the appointment, the physician informs the client that she has systemic lupus erythematosus (SLE). Which resources might be helpful for a nurse to recommend to this client?
a support group for clients with SLE
A client is receiving chemotherapy and is not required to be in reverse isolation. What activity will the nurse recommend to the client?
activity as tolerated
A client with cirrhosis is admitted to the hospital in a hepatic coma. Which nursing action would be the nurse's priority?
check airway, breathing, and circulation
The nurse is caring for a client who is receiving antibiotics to treat a gram-negative bacterial infection. Because antibiotics destroy the body's normal flora, the nurse must monitor the client for:
diarrhea
Which aspect is MOST important for successful management of the child with Reye syndrome?
early diagnosis
a child is admitted to the hospital for an asthma exacerbation. The nursing history reveals this client was exposed to chicken pox 1 week ago. When would this client require isolation if he or she were to remain hospitalized?
immediate isolation is required
The nurse is working in the emergency department when a child is admitted in sickle cell crisis. Which intervention should the nurse expect to perform?
increase fluid intake and give analgesics
for a client with an exacerbation of rheumatoid arthritis, the physician prescribes the corticosteroid prednisone. When caring for this client, the nurse should monitor for which adverse drug reactions?
increased weight, hypertension, and insomnia
The nurse is reinforcing education for a client who has hemorrhagic cystitis caused by bladder irritation from chemotherapeutic medications. which suggestion can the nurse make to prevent this occurrence?
increasing fluid intake
During the admission process, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for:
joint abnormalities
Which factor is most important when planning care for a client with a bleeding disorder?
prioritization
A nurse is caring for a client with deep vein thrombosis (DVT). The client suddenly reports shortness of breath, blood-tinged sputum, and chest pain. The nurse suspects that the client has developed with complication?
pulmonary embolism
Which clinical manifestations should a nurse expect to see in a child in stage V of Reye syndrome?
seizures, flaccidity, and respiratory arrest
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. What should the nurse instruct the client to do?
sit upright, leaning slightly forward
A nurse obtains data from a client receiving a blood transfusion and determines that the client is wheezing, has chills, and back pain. What is the priority action of the nurse?
stop the transfusion
a child is considered immunocompromised. What education should the nurse reinforce to the parents concerning immunizations? Select all that apply
1. immunizations may be delayed 2. the child may be prescribed a modified schedule, changing the number of immunizations administered in a single visit.
A child is considered immunocompromised. What education should the nurse reinforce to the parents concerning immunizations? select all that apply
1. immunizations may be delayed 2. the child may be prescribed a modified schedule, changing the number or immunizations administered in a single visit.
a nurse is reinforcing discharge instructions to a client after treatment for a severe allergic reaction from a bee sting. What instructions should the nurse include? select all that apply
1. obtain diphenhydramine to take following a bee sting 2. fill the prescription for injectable epinephrine to carry with you
When discussing activities that are safe for the school-age child with hemophilia, which activities should the nurse encourage? select all that apply
1. swimming 2. leisure walking
The nurse is caring for a client with pneumonia. The health care provider orders 600 mg of ceftriaxone oral suspension to be given once per day. The medication label indicates that the strength is 125 mg/5 mL. How many milliliters of medication should the nurse administer? Record your answer using a whole number
24
A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse?
"I won't donate blood because I don't want to get AIDS"
The parents of an infant report they are concerned about giving their child immunizations due to their association with autism. Which response by the nurse is appropriate?
"Studies do not support a link between autism and immunizations."
A client with rheumatoid arthritis reports flatulence and heartburn after taking piroxicam. Which instruction should the nurse reinforce to address the client's concern?
"Take an antacid at the same time that you take the medication."
A child tests positive for the sickle cell trait, and the parents ask the nurse what this means. Which response by the nurse would be most appropriate?
"Your child is a carrier but doesn't have the disease."
A 27-year-old client with end-stage acquired immunodeficiency syndrome (AIDS) is being cared for by his wife at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about advance directives. At the next visit, the client states that since he and his wife filled out the advance directive form he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client's concerns?
"Your physician will continue to care for you. Advance directives document in writing your wishes regarding your care in case you're unable to communicate them to the physician yourself."
The nurse is observing a client with cerebral edema for evidence of increasing intracranial pressure. The client's current blood pressure is 170/80 mm Hg. What's the client's pulse pressure? Record your answer using a whole number
90
The nurse is caring for a client diagnosed with leukemia who is going to have a chemotherapy treatment. Which test would the nurse expect to be done to evaluate the client's ability to metabolize chemotherapeutic agents?
liver function studies
When caring for a client with sickle cell anemia in vaso-occlusive crisis, what does the nurse identify as the PRIORITY nursing intervention?
manage pain
a nurse administers etanercept by subcutaneous injection to a client with ankylosing spondylitis. which action should the nurse take to prevent a needle-stick injury?
place the uncapped needle in the designated puncture-resistant container