Lewis - Chapter 15: HIV, N380 Exam 2: Hematologic Problems, Palliative Care, HIV
To evaluate the effectiveness of ART, the nurse will schedule the patient for a. viral load testing. b. enzyme immunoassay. c. rapid HIV antibody testing. d. immunofluorescence assay.
A
Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. "I will call my health care provider if my stools turn black." b. "I will take a stool softener if I feel constipated occasionally." c. "I should take the iron with orange juice about an hour before eating." d. "I should increase my fluid and fiber intake while I am taking iron tablets."
A
The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.
A, B, E
Which instructions should the nurse include when teaching preexposure prophylaxis (PrEP) to a group of adults at high risk of sexually acquired HIV infection? Select all that apply. A. Safe sex practices B. Regular HIV testing C. Frequent hand washing D. Discreet use of antibiotics E. risk reduction counseling
A, B, E
The caregiver children of an elderly patient whose death is imminent have not left the bedside for the past 36 hours. In your assessment of the family, which of the following findings indicates the potential for an abnormal grief reaction by family members (select all that apply)? A. Family members cannot express their feelings to one another. B. The dying patient is becoming more restless and agitated. C. A family member is going through a difficult divorce. D. The family talks with and reassures the patient at frequent intervals. E. Siblings who were estranged from each other have now reunited.
A, C
A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the a. platelet count. b. bleeding time. c. thrombin time. d. prothrombin time.
B
A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.
B
A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly."
B
A mother does not want her child to have any extra immunizations for diseases that no longer occur. What teaching about immunizations should the nurse provide this mother? A. There is currently no need for those older vaccines. B. There is a reemergence of some of the infections, such as pertussis. C. There is no longer an immunization available for some of those diseases. D. The only way to protect your child is to have the federally required vaccines
B
The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. The nurse interprets that the patient has a general prognosis of which of the following? A. 3 months or less to live B. 6 months or less to live C. 12 months or less to live D. 18 months or less to live
B
A deathly ill patient from a culture different than the nurse's is admitted. Which question is appropriate to help the nurse provide culturally competent care? a. "If you die, will you want an autopsy?" b. "Are you interested in learning about palliative or hospice care?" c. "Do you have any preferences for what happens if you are dying?" d. "Tell me about your expectations of care during this hospitalization."
D
A patient diagnosed with a staph infection is started on vancomycin. What should the nurse educate the patient on to decrease resistance to the medications? Select all that apply. A. "Make sure you take all of the medication as prescribed." B. "Wash your hands frequently, so you do not spread the infection." C. "You can skip doses, and double the dose at the next scheduled dose." D. "It is okay to save unused doses for later if you do not use all of them." E. "If you have a cold or the flu, this medication will help treat them as well."
A, B
Nursing interventions for a patient with severe anemia related to peptic ulcer disease would include (select all that apply): A. monitoring stools for guaiac B. instruction for a high iron diet C. taking vital signs every 8 hours D. teaching self injection of erythropoietin E. administration of cobalamin (vit B12) injections
A, B
A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to include a. a hematocrit (Hct) of 38%. b. an RBC count of 4,500,000/L. c. normal red blood cell (RBC) indices. d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).
D
A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output.
D
15. A patient who has been treated for HIV infection for 7 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. The nurse will anticipate teaching the patient about a. the benefits of daily exercise. b. foods that are higher in protein. c. treatment with antifungal agents. d. a change in antiretroviral therapy.
D
A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. The platelet count is 42,000/L. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.
A
A nurse is asked to teach a human immunodeficiency virus (HIV) positive patient about the measures to be taken to prevent resistance to antibiotics and infections. What information should the nurse give? Select all that apply. 1 Advise patient to avoid requesting an antibiotic for flu or colds. 2 Advise patient to avoid skipping antibiotic doses. 3 Advise patient to wash hands properly and regularly. 4 Advise patient to save unfinished antibiotics for later use. 5 Advise patient to only take antibiotics until the patient feels better
1, 2, 3 Antibiotics are effective against bacterial infections but not viruses, which cause colds and flu. Therefore, antibiotics should not be requested for flu or colds. Hand washing is the single most important thing to do to prevent infection. The patient should not skip antibiotic doses, as doing so can lead to development of resistance. A person should never stop taking antibiotics when feeling better. If an antibiotic is stopped early, the hardiest bacteria survive and multiply. Eventually, the patient could develop an infection resistant to many antibiotics. It is also important to never have leftover antibiotics. Text Reference - p. 230
A 24-year-old woman who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse informs the patient that the best way to reduce the risk of HIV infection from drug use is to a. participate in a needle-exchange program. b. clean drug injection equipment before use. c. ask those who share equipment to be tested for HIV. d. avoid sexual intercourse when using injectable drugs.
A
CD4+ T-cells are an important component of the immune system. What is the minimum count of CD4+ T-cells to maintain a healthy immune function? Record your answer using a whole number.
500
A patient who has a history of having multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient? 1 The patient does not have HIV infection. 2 The test might give a false negative report. 3 The test should be repeated at 3 weeks, 6 weeks, and 3 months. 4 The patient is HIV positive, but the viral load is not detectable
3 An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at 3 weeks, 6 weeks, and 3 months. The test is unlikely to give a false negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he is HIV positive. Text Reference - p. 236
A 74-year-old female admitted for pneumonia tells the nurse that she does not want health care professionals to attempt CPR. What is important for the nurse to verify in the medical record related to the patient's directive? A. The physician has written and signed the DNR order. B. The living will is signed by the patient and two witnesses. C. The patient's durable power of attorney agrees with the decision. D. There is an advance directive related to artificial nutrition and hydration.
A
A complication of the hyperviscosity of polycythemia is: A. thrombosis B. cardiomyopathy C. pulmonary edema D. disseminated intravascular coagulation (DIC)
A
A female patient who is HIV positive is prescribed Efavirenz (Sustiva) in large doses. What question should the nurse ask of the patient before administering the therapy to ensure drug safety? A. "Are you pregnant?" B. "Is your partner HIV positive?" C. "Are you on your menses?" D. "Have you ever had a blood transfusion?"
A
A hospice nurse is visiting with a dying patient. During the interaction, the patient is silent for some time. What is the best response? A. Recognize the patient's need for silence, and sit quietly at the bedside. B. Try distraction with the patient. C. Change the subject, and try to stimulate conversation. D. Leave the patient alone for a period.
A
A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is: 1 Hyperthermia 2 Social isolation 3 Impaired memory 4 Sexual dysfunction
A
A patient who has vague symptoms of fatigue and headaches is found to have a positive enzyme immunoassay (EIA) for human immunodeficiency virus (HIV) antibodies. In discussing the test results with the patient, the nurse informs the patient that a. the EIA test will need to be repeated to verify the results. b. a viral culture will be done to determine the progress of the disease. c. it will probably be 10 or more years before the patient develops acquired immunodeficiency syndrome (AIDS). d. the Western blot test will be done to determine whether AIDS has developed.
A
A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."
A
A patient with terminal cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the most appropriate response by the nurse? A. "What are your feelings about being so sick and thinking you may die soon?" B. "None of us know when we are going to die. Is this a particularly difficult day?" C. "Would you like for me to call your spiritual advisor so you can talk about your feelings?" D. "Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you."
A
A patient with terminal cancer tells you, "I know I am going to die pretty soon, perhaps in the next month." Which of the following is your most appropriate response? A. "What are your feelings about being so sick and thinking you may die soon?" B. "None of us knows when we are going to die. Is this a particularly difficult day?" C. "Would you like for me to call your spiritual advisor so you can talk about your feelings?" D. "Perhaps you are depressed about your illness; I will speak to the doctor about getting some medications for you."
A
A terminally ill man tells the nurse, "I have never believed there is a God or an afterlife, but now it is too terrible to imagine that I will not exist. Why was I here in the first place?" What does this comment help the nurse recognize about the patient's needs? a. He is experiencing spiritual distress. b. This man most likely will not have a peaceful death. c. He needs to be reassured that his feelings are normal. d. This patient should be referred to a clergyman for a discussion of his beliefs.
A
An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.
A
An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.
A
In severely anemic patients, the nurse would expect to find: A. dyspnea and tachycardia B. cyanosis and pulmonary edema C. cardiomegaly and pulmonary fibrosis D. ventricular dysrhythmia and wheezing
A
Priority Decision: The husband and daughter of a Hispanic woman dying from pancreatic cancer refuse to consider using hospice care. What is the first thing the nurse should do? a. Assess their understanding of what hospice care services are. b. Ask them how they will care for the patient without hospice care. c. Talk directly to the patient and family to see if she can change their minds. d. Accept their decision since they are Hispanic and prefer to care for their own.
A
The hospice nurse identifies an abnormal grief reaction in the wife of a dying patient who says, A. "I don't think that I can live without my husband to take care of me." B. "I wonder if expressing my sadness makes my husband feel worse." C. "We have shared so much that it is hard to realize that I will be alone." D. "I feel guilty about leaving him to go to lunch with my friends."
A
The human immunodeficiency virus (HIV)-infected patient is taught health promotion activities, including good nutrition, avoiding alcohol, tobacco, drug use, and exposure to infectious agents, keeping up to date with vaccines, getting adequate rest, and stress management. The nurse knows that the rationale behind these interventions is best described as? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities
A
The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will a. immobilize the joint. b. apply heat to the knee. c. assist the patient with light weight bearing. d. perform passive range of motion to the knee.
A
The nurse is reviewing the chart for a patient who is scheduled for an annual physical exam. Which information will be most important in determining whether the patient needs HIV testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation
A
To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay
A
When providing care for a patient with thrombocytopenia, the nurse instructs the patient to: A. dab his or her nose instead of blowing B. be careful when shaving with a safety razor C. continue with physical activities to stimulate thrombopoiesis D. avoid t aspirin because it may mask the fever that occurs with thrombocytopenia
A
When teaching a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."
A
When the nurse is caring for a patient whose HIV status in unknown, which of these patient exposures is most likely to require postexposure prophylaxis? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure
A
Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation.
A
Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.
A
Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation
A
Which menu choice indicates that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice
A
Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure
A
Which patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains
A
Which statement made by the graduate nurse working in the hospice unit with a patient near the end of life requires intervention by the preceptor nurse? A. "The patient has eaten only small amounts the past 48 hours; will the physician consider placing a feeding tube?" B. "The family seems comfortable with the long periods of silence." C. "The physician ordered an increase in the dosage of morphine; I will administer the new dose right away." D. "The blood pressure is lower this afternoon than it was this morning; I will communicate the changes to the family."
A
A nurse is taking a blood sample with a syringe and large bore needle from a patient with chronic human immunodeficiency virus (HIV) who has a CD4+ T-cell count of 123/μL. If the nurse gets a needle injury, what factors may affect the transmission of HIV infection? Select all that apply. 1 Viral load 2 Age of the nurse 3 Volume of blood exposed to 4 Age of the patient 5 Immune status of nurse
A, B, C
The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
A, B, C
When caring for a patient who has just been diagnosed with early chronic HIV infection, which prophylactic measures will the nurse anticipate being included in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
A, B, C
Priority nursing actions when caring for a hospitalized patient with a new onset temperature of 102.2*F and severe neutropenia include: (check all that apply): A. administering the prescribed antibiotic STAT B. drawing peripheral and ventral line blood cultures C. ongoing monitoring of the patient's vitals for signs of septic shock D. taking a full set of vital signs and notifying the physician immediately E. administering infusions of WBCs treated to decrease immunogenicity
A, B, C, D
The dying patient and family have many interrelated psychosocial and physical care needs. Which ones can the nurse begin to manage with the patient and family (select all that apply)? a. Anxiety b. Fear of pain c. The dying process d. Care being provided e. Anger toward the nurse f. Feeling powerless and hopeless
A, B, C, D, E, F
A nurse is conducting a class for human immunodeficiency virus (HIV) positive pregnant women. What information should the nurse give them about routes of transmission and infective periods? Select all that apply. A. HIV can be transmitted by breastfeeding. B. HIV can be transmitted even before it is detected on a screening test. C. HIV can be transmitted by contact with vomitus. D. HIV can be transmitted lifelong once a person is HIV-positive. E. HIV can be transmitted by hugging and dry kissing.
A, B, D
The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's white blood cell (WBC) count
C
The children caregivers of an elderly patient whose death is imminent have not left the bedside for the past 36 hours. In the nurse's assessment of the family, what findings indicate the potential for an abnormal grief reaction to occur(SATA)? a. family cannot express their feelings to one another b. dying patient is becoming more restless and agitated c. a family member is going through a difficult divorce d. Family talks with and reassures the patient at frequent intervals e. siblings who were estranged from each other have now reunited
A, C
The nurse is caring for a patient who is being treated with antibiotics. The nurse recalls that what factors lead to antibiotic resistance? Select all that apply. A. Skipping of doses B. Continuing antibiotic use beyond symptomatic relief C. Administering antibiotics for viral infections D. Using narrow spectrum antibiotics E. Saving unused antibiotics
A, C, E
An 80 year female patient is receiving palliative care for heart failure. Primary purpose(s) of her receiving palliative care is (are) to... (Select all that apply). a. improve her quality of life b. asses her coping ability with disease c. have time to teach patient and family about disease. d. focus on reducing the severity of disease symptoms e. provide care that the family is unwilling or unable to give
A, D
An 80-year-old patient is receiving palliative care for heart failure. What are the primary purposes of her receiving palliative care (select all that apply)? A. Improve her quality of life. B. Assess her coping ability with disease. C. Have time to teach patient and family about disease. D. Focus on reducing the severity of disease symptoms. E. Provide care that the family is unwilling or unable to give.
A, D
Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply)? A. Strong spiritual beliefs B. Medical diagnosis of the patient C. Advanced age of the patient D. Acceptance of the expected death of the patient E. Adequate time for the caregiver to prepare for the death
A, D, C
Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply)? A. Strong spiritual beliefs B. Medical diagnosis of the patient C. Advanced age of the palliative patient D. Acceptance of the expected death of the patient E. Adequate time for the caregiver to prepare for the death
A, D, E
A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient? a. Infuse the PRBCs slowly over 4 hours. b. Transfuse only leukocyte-reduced PRBCs. c. Administer the scheduled diuretic before the transfusion. d. Give the PRN dose of antihistamine before the transfusion.
B
A patient with advanced cancer is referred for hospice care. The nurse explains to the patient and the family that the goal of hospice care differs from the goal of traditional care in that hospice care A. Provides for more complete pain control. B. Focuses on helping the patient and family prepare for death. C. More readily recognizes advance directives related to "right to die." D. Is delivered in the home and does not rely on the technology of hospitals.
B
A patient with end-stage liver failure tells the nurse, "If I can just live to see my first grandchild who is expected in 5 months, then I can die happy." The nurse recognizes that the patient is demonstrating which of the following stages of grieving? a. Prolonged grief disorder b. Kübler-Ross's stage of bargaining c. Kübler-Ross's stage of depression d. The new normal stage of the Grief Wheel
B
A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Avoid venipunctures. b. Notify the patient's physician. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.
B
The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions
C
A 39-year-old woman near death from metastatic cancer becomes restless and confused. What interventions would be the most appropriate for the nursing management of these symptoms? A. Avoid administering pain medication until the patient is calm and alert. B. Stay physically close to the patient and use a soothing voice and soft touch. C. Turn on the television to provide a distraction, and contact the hospital chaplain. D. Restrain the patient to prevent injury, and ask family and visitors to leave the room.
B
A 67 year old woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating? a. peacefulness b. decreased socialization c. decreased decision making d. anxiety about unfinished business
B
A 67-year-old woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis, she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common end-of-life (EOL) psychologic manifestation is she most likely demonstrating? A. Peacefulness B. Decreased socialization C. Decreased decision-making D. Anxiety about unfinished business
B
A patient is being placed on efavirenz (Sustiva) with a once-a-day dose. Which instructions should the nurse give to help the patient cope with the side effects? A. Use electronic reminders, timers, and beepers. B. Take the dose at bedtime before going to sleep. C. Have tests regularly to assess viral load in the body. D. Inform the health care provider about other drugs being taken.
B
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a. iron. b. folic acid. c. cobalamin (vitamin B12). d. ascorbic acid (vitamin C).
B
A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."
B
You are visiting with the wife of a patient who is having difficulty making the transition to palliative care for her dying husband. What is the most desirable outcome for the couple? A. They express hope for a cure. B. They comply with treatment options. C. They set additional goals for the future. D. They acknowledge the symptoms and prognosis.
D
A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).
B
A pregnant woman with a history of early chronic HIV infection is seen at the clinic. Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Since she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral drug therapy (ART).
B
A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about a. blood transfusion b. bone marrow biopsy. c. filgrastim (Neupogen) administration. d. erythropoietin (Epogen) administration.
B
After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. 56-year-old with frequent explosive diarrhea b. 33-year-old with a fever of 100.8° F (38.2° C) c. 66-year-old who has white pharyngeal lesions d. 23-year old who is complaining of severe fatigue
B
An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to a. provide a diet high in vitamin K. b. alternate periods of rest and activity. c. teach the patient how to avoid injury. d. place the patient on protective isolation.
B
Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).
B
Priority Decision: A terminally ill patient is unresponsive and has cold, clammy skin with mottling on the extremities. The patient's husband and two grown children are arguing at the bedside about where the patient's funeral should be held. What should the nurse do first? a. Ask the family members to leave the room if they are going to argue. b. Take the family members aside and explain that the patient may be able to hear them. c. Tell the family members that this decision is premature because the patient has not yet died. d. Remind the family that this should be the patient's decision and to ask her if she regains consciousness.
B
Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 44-year-old with sickle cell anemia who says "my eyes always look sort of yellow" b. 23-year-old with no previous health problems who has a nontender lump in the axilla c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement
B
The dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs? A. Encourage more physical activity. B. Assess for pain, constipation, and urinary retention. C. Assess for spiritual distress and restrain in varying positions. D. Assess for quality, intensity, location, and contributing factors of discomfort.
B
The home health nurse visits a 40 year old patient with metastatic breast cancer who is receiving palliative care. The patient is experiencing pain at a level of 7 (on a 10point scale). In prioritizing activities for the visit, the nurse would do which first? a. auscultate for breath sounds b. administer PRN pain medication c. check pressure points for skin breakdown d. ask family about patients's food and fluid intake
B
The home health nurse visits a 40-year-old breast cancer patient with metastatic breast cancer who is receiving palliative care. The patient is experiencing pain at a level of 7 (on a 10-point scale). In prioritizing activities for the visit, you would do which of the following first? A. Auscultate for breath sounds. B. Administer prn pain medication. C. Check pressure points for skin breakdown. D. Ask family members about patient's dietary intake.
B
The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. The nurse interprets that the patient has a general prognosis of ___________. A. 3 months or less to live B. 6 months or less to live C. 12 months or less to live D. 18 months or less to live
B
The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Verify the patient identification (ID) according to hospital policy. b. Obtain the temperature, blood pressure, and pulse before the transfusion. c. Double-check the product numbers on the PRBCs with the patient ID band. d. Monitor the patient for shortness of breath or chest pain during the transfusion.
B
The nurse is preparing to give the following medications to an HIV-positive patient who is hospitalized with Pneumocystis jiroveci pneumonia (PCP). Which is most important to administer at the right time? a. Nystatin (Mycostatin) tablet for vaginal candidiasis b. Oral saquinavir (Inverase) to suppress HIV infection c. Aerosolized pentamidine (NebuPent) for PCP infection d. Oral acyclovir (Zovirax) to treat systemic herpes simplex
B
The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family? A. The patient will be incontinent of urine after frequent seizures. B. The skin will feel cold and clammy, with mottling on the extremities. C. The patient will have increased pain, and the sense of touch will be enhanced. D. The gag reflex is exaggerated, and the patient will exhibit deep, rapid respirations.
B
The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the a. Schilling test. b. bilirubin level. c. stool occult blood test. d. gastric analysis testing.
B
The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)
B
The nurse understands that a patient with human immunodeficiency virus (HIV) starts to develop immune problems when their CD4 count: A. Drops below 200 B. Drops below 500 C. Is greater than 500 D. Falls between 800 to 1200
B
The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager
B
The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.
B
When designing a program to decrease the incidence of HIV infection in the community, the nurse will prioritize teaching about a. methods to prevent perinatal HIV transmission. b. how to prevent transmission between sexual partners. c. ways to sterilize needles used by injectable drug users. d. means to prevent transmission through blood transfusions.
B
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about: A. folic acid intake B. dietary intake of iron C. a history of gastric surgery D. a history of sickle cell anemia
B
When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death? A. The patient responds to noises. B. The patient's skin is mottled and waxlike. C. The heart rate and blood pressure increase. D. The patient is reviewing his life with his family.
B
Which action can the nurse delegate to nursing assistive personnel (NAP) who help with the care of a patient admitted with tuberculosis and placed on airborne precautions? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.
B
Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.
B
Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema
B
Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/µL. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.
B
Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a soft toothbrush for oral care. d. Restrict activity to passive and active range of motion.
B
Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours d. The patient with thrombocytopenia who has oozing after having a tooth extracted
B
Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician? a. Leg bruises b. Tarry stools c. Skin abrasions d. Bleeding gums
B
While caring for his dying wife, the husband states that his wife is a devout Roman Catholic but he is a Baptist. Who is considered the most reliable source for spiritual preferences concerning EOL care for the dying if? a. a priest b. dying wife c. hospice staff d. husband of dying wife
B
Your 88 year old pt with terminal lung cancer is visited frequently by his spouse, 46 year old daughter and her 23 year old son. In view of the client's extreme weakness and dyspnea, client care plans should include: A. Allowing self-activity whenever possible B. Encouraging family members to feed and assist the client. C. Limiting family visiting hours to the evening before the client sleeps. D. Planning all necessary care at one time with long rest periods in between.
B
A patient is on first-line therapy for a chronic bacterial infection. The health care provider has prescribed the full course of treatment for 10 days. The patient has skipped one tablet on the morning of the 2nd day but took 2 tablets that night instead of one. After 7 days, the patient felt well and stopped taking tablets. What could be the possible causes for development of drug resistance in this patient? Select all that apply. A. Associated viral infection B. Poor drug compliance C. Skipping the dose D. First-line antibiotics E. Diabetes
B, C
According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile (select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection
B, C
A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I... a. need to start eating more red meat and liver." b. will stop having a glass of wine with dinner." c. could choose nasal spray rather than injections of vitamin B12." d. will need to take a proton pump inhibitor like omeprazole (Prilosec)."
C
A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.
C
A client with a terminal illness reaches the stage of "acceptance". The client has been hostile towards staff and difficult to work with during his hospitalization. The nurse can best help the client during this stage by: A. Verbal defense of the staff's actions. B. Reasonable exploration of the situation. C. Silent acceptance of the client's behavior. D. Complete physical withdrawal from the client
C
A man died at the age of 71 following a myocardial infarction that he experienced while performing yard work. What would indicate that his wife is experiencing prolonged grief disorder? A. Initially she denied that he died. B. Talking about her husband extensively in year following his death C. Stating that she expects him home soon on the anniversary of his death D. Crying uncontrollably and unpredictably in the weeks following her husband's death
C
A nurse has been working full time with terminally ill patients for 3 years. He has been experiencing irritability and mixed emotions when expressing sadness since four of his patients died on the same day. To optimize the quality of his nursing care, he should examine his own. a. full-time work schedule b. past feelings toward death c. patterns for dealing with grief d. demands for involvement in patient care.
C
A nurse is aware that characteristic behavior in the initial stage of coping with dying includes: A. Crying uncontrollably. B. Criticizing medical care. C. Refusing to receive visitors. D. Asking for additional medical consultations.
C
A patient is receiving care to manage symptoms of a terminal illness when the disease no longer responds to treatment. What is this type of care known as? a. Terminal care b. Supportive care c. Palliative care d. Maintenance care
C
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.
C
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."
C
A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.
C
A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate: A. hyperkalemia B. hyperuricemia C. hypercalcemia D. CNS myeloma
C
A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies.
C
A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Give the PRN diphenhydramine (Benadryl).
C
A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.
C
After an 18-year-old patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient? A. Maintain daily contact with the adolescent's family for the next 2 to 3 months. B. Request a prescription for an anxiolytic to aid in dealing with the death of this patient. C. Attend a debriefing session with health team members to allow expression of feelings. D. Avoid caring for any other patients who are terminally ill until the feelings of grief subside.
C
During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness? A. Frustration with pain B. Anorexia and nausea C. Feelings of hopelessness D. Inability to carry out activities of daily living
C
During admission of a patient diagnosed with metastatic lung cancer, you assess for which of the following as a key indicator of clinical depression related to terminal illness? A. Frustration with pain B. Anorexia and nausea C. Feelings of hopelessness D. Inability to carry out activities of daily living
C
How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient's life? A. Assess the individual patient's wishes. B. Call a pastor or priest for the family to help them cope. C. Assess the beliefs and preferences of the patient and family. D. Do not insult African Americans by suggesting hospice care.
C
Mr. Johansen died at the age of 71 after a myocardial infarction that he experienced while performing yard work. What indicates that Mrs. Johansen is experiencing prolonged grief disorder? A. She initially denied that Mr. Johansen died. B. She talked about her husband extensively in the years after his death. C. She stated that she expects him home soon on the anniversary of his death. D. She cried uncontrollably and unpredictably in the weeks after her husband's death.
C
Ten years after seroconversion, an HIV-infected patient has a CD4+ cell count of 800/µl and an undetectable viral load. What is the priority nursing intervention at this time? a. Monitor for symptoms of AIDS. b. Teach about the effects of antiretroviral agents. c. Encourage adequate nutrition, exercise, and sleep. d. Discuss likelihood of increased opportunistic infections.
C
The family attorney informed a patient's adult children and wife that he did not have an advance directive after he suffered a serious stroke. Who is responsible for identifying end-of-life (EOL) measures to be instituted when the patient cannot communicate his or her specific wishes? A. Notary and attorney B. Physician and family C. Wife and adult children D. Physician and nursing staff
C
The family attorney informed a patient's adult children and wife that the patient did not have an advance directive after he suffered a serious stroke. Who is responsible for making the decision about EOL measures when the patient cannot communicate his or her specific wishes? a. notary and attorney b. physician and family c. wife and adult children d. physician and nursing staff
C
The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is: A. Hodgkin's lymphoma only occurs in young adults B. Hodgkin's lymphoma is considered potentially curable C. non-Hodgkin's lymphoma can manifest in multiple organs D. non-Hodgkin's lymphoma is treated only with radiation therapy
C
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.
C
The nurse provides education to a patient who has expressed concern about HIV infection. Which statement indicates that the patient understands the teaching? A. "I can't contract HIV unless there's an opportunistic infection present." B. "Using a condom with a spermicide will give 100% protection from HIV." C. "Using a condom with a spermicide will reduce my risk of contracting HIV." D. "Kaposi's sarcoma is one of the first opportunistic infections to show up in someone with HIV."
C
When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care? a. Discourage deep breathing to reduce risk for splenic rupture. b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain. c. Schedule immunization with the pneumococcal vaccine (Pneumovax). d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.
C
When assessing an individual who has been diagnosed with early chronic HIV infection and has a normal CD4+ count, the nurse will a. check neurologic orientation. b. ask about problems with diarrhea. c. palpate the regional lymph nodes. d. examine the oral mucosa for lesions.
C
When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue? A. Euthanasia B. Organ donor card C. Advance directives D. Do not resuscitate (DNR)
C
Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Administering subcutaneous filgrastim (Neupogen) injection d. Developing a discharge teaching plan for the patient and family
C
Which action will the nurse include in the plan of care for a patient who has thalassemia major? a. Teach the patient to use iron supplements. b. Avoid the use of intramuscular injections. c. Administer iron chelation therapy as needed. d. Notify health care provider of hemoglobin 11g/dL.
C
Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider? a. Hematocrit 55% b. Presence of plethora c. Calf swelling and pain d. Platelet count 450,000/L
C
Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs
C
Which piece of data is of highest priority for the nurse to verify to safely give a dose of cephalexin (Keflex) to a patient? A. Normal white blood cell count B. Patient is afebrile C. No allergy to penicillin D. Urine output is greater than 30 mL per hour
C
You have been working full time with terminally ill patients for 3 years. You are experiencing irritability and mixed emotions when expressing sadness since four of your patients died on the same day. To optimize the quality of your nursing care, you should examine your own A. full-time work schedule. B. past feelings toward death. C. patterns for dealing with grief. D. demands for involvement in patient care.
C
A woman is afraid she may get human immunodeficiency virus (HIV) from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis? Select all that apply. A. Take fluconazole (Diflucan) B. Take amphotericin B (Fungizone) C. Use condoms for risk-reducing sexual relations D. Take emtricitabine and tenofovir (Truvada) regularly E. Have regular HIV testing for herself and her husband
C, D, E
A 20-year-old female patient who is HIV-positive has a new prescription for efavirenz (Sustiva). Which information about the patient is most important to communicate to the prescribing physician before administering the efavirenz? a. The patient's CD4+ T cell count is 800 cells/μL. b. The patient already has etravirine (Intelence) prescribed. c. The patient states that the antiretroviral therapy (ART) frequently cause nausea. d. The patient is sexually active and does not use any contraception.
D
A human immunodeficiency virus (HIV) patient comes into the clinic for a follow-up appointment with a temperature of 102 degrees Fahrenheit. Which statement would the nurse report immediately? A. "I woke up this morning with a mild headache." B. I vomited once this morning." C. "I started coughing up some clear mucous when I woke up this morning." D. "I have a rash that appeared on my stomach this morning."
D
A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method? A. Shaking hands B. Sharing a toilet seat C. Eating from the same utensils D. Having unprotected sex
D
A patient has been receiving palliative care for the past several weeks in light of her worsening condition after a series of strokes. The caregiver has rung the call bell, stating that the patient "stops breathing for a while, then breathes fast and hard, and then stops again." You recognize that the patient is experiencing A. Apnea B. Bradypnea C. Death rattle D. Cheyne-Stokes respirations
D
A patient has been receiving palliative care for the past several weeks in light of her worsening condition following a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." What should the nurse recognize that the patient is experiencing? A. Apnea B. Bradypnea C. Death rattle D. Cheyne-Stokes respirations
D
A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.
D
A patient is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and HIV testing is positive. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), the patient is diagnosed as having a. acute infection. b. early chronic infection. c. intermediate chronic infection. d. late chronic infection or AIDS.
D
A patient receiving long-term antiretroviral therapy (ART) for HIV has developed lipodystrophy, hyperlipidemia, insulin resistance, and bone disease. Which should be the first intervention? 1 Suggest dietary changes to lower lipid levels. 2 Promote weight loss through exercise. 3 Advocate use of calcium supplements. 4 Change antiretroviral medications
D
A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? a. Use low-molecular-weight heparin (LMWH) only. b. Administer the warfarin (Coumadin) at the scheduled time. c. Teach the patient about the purpose of platelet transfusions. d. Discontinue heparin and flush intermittent IV lines using normal saline.
D
A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia b. Vomiting c. Oral ulcers d. Lip swelling
D
A patient who is diagnosed with AIDS tells the nurse, "I have lots of thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?
D
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"
D
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule
D
A patient with HIV infection has developed Mycobacterium avium complex infection. An appropriate outcome for the patient is that the patient will a. be free from injury. b. receive immunizations. c. have adequate oxygenation. d. maintain intact perineal skin.
D
A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.
D
Antiretroviral therapy (ART) is being considered for an HIV-infected patient who has a CD4+ cell count of 400/µl. Which factor is most important to consider when determining whether ART will be started for this patient? a. Patient social support system b. HIV genotype and phenotype c. Potential medication side effects d. Patient ability to comply with ART schedule
D
Because myelodysplastic syndrome arises from pluripotent hematopoietic stem cells in the bone marrow, laboratory results the nurse would expect to find include: A. an excess of T cells B. an excess of platelets C. a deficiency of granulocytes D. a deficiency of all cellular blood components
D
Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are A. chills and hemolysis B. leukostasis and neutrophilia C. fluid overload and pulmonary edema D. transmission of cytomegalovirus and fever
D
End-of-life palliative nursing care involves a. constant assessment for changes in physiologic functioning. b. administering large doses of analgesics to keep the patient sedated. c. providing as little physical care as possible to prevent disturbing the patient. d. encouraging the patient and family members to verbalize their feelings of sadness, loss, and forgiveness.
D
Following successful treatment of Hodgkin's lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy
D
For the past 5 years Tom has repeatedly asked his mother to donate his deceased father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing? a. adaptive grief b. disruptive grief c. anticipatory grief d. prolonged grief disorder
D
For the past 5 years, Tom has repeatedly asked his mother to donate his deceased father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing? A. Adaptive grief B. Disruptive grief C. Anticipatory grief D. Prolonged grief disorder
D
Multiple drugs are often used in combination to treat leukemia and lymphoma because: A. there are fewer toxic side effects B. the chance that one drug will be effective is increased C. the drugs work more effectively without causing side effects D. the drugs work by different mechanisms to maximize killing of malignant cells
D
Priority Decision: A patient in the last stages of life is experiencing shortness of breath and air hunger. Based on practice guidelines, what is the most appropriate action by the nurse? a. Administer oxygen. b. Administer bronchodilators. c. Administer antianxiety agents. d. Use any methods that make the patient more comfortable.
D
The hospice nurse identifies an abnormal grief reaction by the wife of a dying patient, who says A. "I don't think that I can live without my husband to take care of me." B. "I wonder if expressing my sadness makes my husband feel worse." C. "We have shared so much that it is hard to realize that I will be alone." D. "I don't feel guilty about leaving him to go to lunch with my friends."
D
The most common type of leukemia in older adults is: A. acute myelocytic leukemia B. acute lymphocytic leukemia C. chronic myelocytic leukemia D. chronic lymphocytic leukemia
D
The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."
D
The nurse is evaluating whether a hospice referral is appropriate for a 69-year-old man with end-stage liver failure. What is one of the two criteria necessary for admission to a hospice program? A. The hospice medical director certifies admission to the program. B. The physician guarantees the patient has less than 6 months to live. C. The patient has completed both advance directives and a living will. D. The patient wants hospice care and agrees to terminate curative care.
D
The nurse reviews a plan of care for a patient who has sustained a deep laceration to an extremity. Which goal listed on the plan is inappropriate and should be questioned by the nurse? A. The patient will be free of signs and symptoms of infection. B. The patient will demonstrate how to change the sterile dressing on the laceration. C. The patient will report any change in sensation of the extremity distal to the laceration. D. The patient will stop taking the antibiotics after 2 days if he detects no signs of infection
D
The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis
D
The primary purpose of hospice is to a. allow patients to die at home b. provide better quality of care than the family can c. coordinate care for dying patients and their families d. provide comfort and support for dying patients and their family
D
What is the primary purpose of hospice? A. Allow patients to die at home. B. Provide better quality of care than the family can. C. Coordinate care for dying patients and their families. D. Provide comfort and support for dying patients and their families.
D
When reviewing the patient's hematologic laboratory values after a splenectomy, the nurse would expect to find: A. leukopenia B. RBC abnormalities C. decreased hemoglobin D. increased platelet count
D
Which information about an HIV-positive patient who is taking antiretroviral medications is most important for the nurse to address when planning care? a. The patient's blood glucose level is 168 mg/dl. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states "sometimes I miss a dose of zidovudine (AZT)."
D
Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time
D
Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count
D
Which nursing action will be most useful in assisting a 21-year-old college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the ART should be taken.
D
Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.
D
Which of these patients will the nurse working in an HIV testing and treatment clinic anticipate teaching about antiretroviral therapy (ART)? a. A patient who is currently HIV negative but has unprotected sex with multiple partners b. A patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µl c. An HIV-positive patient with a CD4+ count of 120/µl who drinks a fifth of whiskey daily d. A patient who tested positive for HIV 2 years ago and has cytomegalovirus (CMV) retinitis
D
Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a. Skin color b. Hematocrit c. Liver function d. Serum iron level
D
A medical team is conducting human immunodeficiency virus (HIV) screening in a community. Which finding would indicate a positive diagnosis for HIV infection? Select all that apply. A. A history of fever, diarrhea, candidiasis, or weight loss B. A history of intercourse with an HIV-positive woman or man C. A positive tuberculin test D. A positive Western blot test E. A positive enzyme immunoassay (EIA) test
D, E
After having a positive rapid-antibody test for HIV, a patient is anxious and does not appear to hear what the nurse is saying. At this time, it is most important that the nurse a. teach the patient about the medications available for treatment. b. inform the patient how to protect sexual and needle-sharing partners. c. remind the patient about the need to return for retesting to verify the results. d. ask the patient to notify individuals who have had risky contact with the patient.
Remind the patient about the need to return for retesting to verify the results After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.