Nurs 172 - Exam 4

Which of the following instructions by the nurse is most appropriate for a client using contact lenses who is diagnosed with bacterial conjunctivitis? A. Discard all open or used lens care products. B. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. C. Put all cosmetics in a plastic bag for 1 week to kill any bacteria before reusing. D. Disinfect all lens care products with the prescribed antibiotic drops for 1 week after infection.

Discard all open or used lens care products.

Epinephrine (EpiPen) A. Can be administered through clothing B. Is expired if liquid is amber in color C. Should be administered in the outer thigh while holding for count of 3 D. Is available in two dosages: Epi Pen (0.3mg) and Epi Pen Junior (0.15 mg) E. All of the above

E. All of the above

A homeless man presents to the emergency room with hypothermia. He tells the nurse that he is positive for human immunodeficiency virus (HIV) and sought revenge by deliberately having sex with his significant other, who does not know of his HIV status. This patient is violating which ethical principle? a. Veracity b. Beneficence c. Nonmaleficence d. Autonomy

Nonmaleficence

Why is it important for the patient to have two EpiPen Auto Injectors available at all times?

Reactions could be so severe you may need two doses.

It is important for the patient to know to refill the EpiPen prescription before their EpiPen expires. _____True ______False

TRUE

The effects of an EpiPen only lasts 15-20 minutes. _____True _____False

TRUE - if symptoms occur give another injection and call 911

Clinical manifestations exhibited during an anaphylactic reaction include: (Select all that apply)(There are five correct answers) _____ Hypertension _____Wheezing _____Dypsnea _____Urticaria _____Tachycardia _____Feeling of impending doom

Wheezing Dypsnea Urticaria Tachycardia Feeling of impending doom It would be HYPOtension not hypertension!!!!

The ________-_____ rash occurs in 80% of infected persons. It appears at the site of the tick bite within _____ month after exposure.

bulls-eye rash and one month

Most tympanostomy tubes fall out within ______ to ___________ months.

6 to 12 months

Anaphylaxis is a potentially severe or life-threatening allergic reaction that can occur very quickly-as fast as within a couple of minutes of exposure to the allergen. _____ True _____ False

A - TRUE

Which nursing intervention would be most helpful in managing a patient newly admitted with cellulitis of the right foot? A. Applying warm, moist heat B. Wrapping the foot snugly in blankets C. Limiting ambulation to three times daily D. Keeping the foot at or below heart level

A. Applying warm, moist heat The application of warm, moist heat speeds the resolution of inflammation and infection when accompanied by appropriate antibiotic therapy. It does this by increasing local circulation to the affected area to bring macrophages to the area and carry off cellular debris. Immobilization and elevation is also used. Snug blankets would not be helpful and could decrease circulation to this sensitive tissue.

The nurse would assess a patient admitted with cellulitis for what localized manifestation? A. Pain B. Fever C. Chills D. Malaise

A. Pain Pain, redness, heat, and swelling are all localized manifestation of cellulitis. Fever, chills, and malaise are generalized, systemic manifestations of inflammation and infection.

Three friends arrive at the camp infirmary with lesions they said were oozing and painful at first and now are terribly itchy, swollen, red blisters. What should the nurse do initially? A. Put on a pair of unsterile gloves. B. Ask where the campers have been. C. Rub the lesions with alcohol wipes. D. Scrub the area with antibacterial soap.

A. Put on a pair of unsterile gloves.

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? A. Redness and swelling B. Pallor and poor turgor C. Cyanosis and coolness D. Edema and brown skin discoloration

A. Redness and swelling Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by redness, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario) 1. This child exhibits manifestations of Stage _____ Lyme disease. 2. The child's mother asks the nurse how her son could have gotten such a serious disease. What is the appropriate response by the nurse? 3. The mother tells the nurse that she has two other children at home. She tells the nurse that her family recently moved to a new home, and the back yard has a lot of trees and grassy areas. List several suggestions the nurse might offer the mother to help prevent tick infestations in her children (other than staying inside). 4. List the manifestations of Stage 1 Lyme disease for which children should be instructed to observe in to prevent Stage 2 disease.

1. Stage 3 2. Lyme disease is transmitted by the bite of an infected deer tick. 3. Do not walk in tall grass or brush, do not sit on logs, tuck shirt in, close toed shoes, check for ticks, tick collars on pets, long sleeves and pants. 4. Stage 1: bulls eye raised rash; stage 2: flu-like symptoms

Dog bites usually occur on the _________1___________. _____2_____ bites are common in small children. Cat bites result in deep _____3__________ wounds which can involve tendons and joint capsules. _____4______ arthritis, osteomyelitis, and tenosynovitis can occur. The most common infectious organisms from dog and cat bites are the ________5_________ species. Most healthy cats and dogs carry this organism in the mouth.

1. extremities 2. facial 3. punctured 4. septic 5. pasteurella

The series of ___1____ injections of rabies vaccine (human diploid cell rabies vaccine-HDCV, Imovax Rabies) are given on days 0, 3, 7, and 14 to provide active immunity. Also, an initial weight-based dose of rabies immune globulin (RIG-HyerRab S/D) is given at the same time as the first dose of the vaccine. This rabies immune globulin provides _____2______ immunity. Since rabies is nearly always _____3_____, management efforts are directed at preventing the transmission and onset of the disease.

1. four 2. passive 3. fatal

Human bites can cause laceration, puncture, crush injury, soft tissue tearing and even amputation. The most common sites of human bites are hands, fingers, ears, nose, vagina, and penis. Often these injuries are due to violence or sexual activity. There is a high risk for ______1____________ from oral flora, most often _______2____________ aureus, ________3_______, and _______4______ virus. Infection rates are as high as ___5_____% when victims do not seek medical care within 24 hours of injury. Initial treatment for animal and human bites includes cleaning, _____6_______ irrigation, debridement, tetanus prophylaxis, and analgesics as needed. _________7___________ antibiotics are used for animal and human bites at risk for infection such as wounds over joints, puncture wounds, and bites of the hand or foot. Puncture wounds are left ____8____. Lacerations may be loosely ____9_______. Plastic surgery consultation may be needed for disfiguring facial wounds. Report animal and human bites to the police as required.

1. infection 2. staphlococcus 3. streptococcus 4. hepatitis 5. 50 6. copious 7. prophylactic 8. open 9. sutured

Rabies is caused by a _______1_______ virus in the saliva of an infected animal. Most rabies carriers are ______2_____ animals, like raccoons, skunks, bats, foxes, and coyotes. Rabies is usually transmitted through the saliva via a ____3_____ by the infected animal. The virus spreads through the _____4_________ nervous system via peripheral nerves. People who develop rabies may have ___5___-______ symptoms, confusion, paresthesias, or numbness resulting in death. Always provide postexposure vaccinations when the animal is not found, or a wild animal causes the bite.

1. neurotoxic 2. wild 3. bite 4. central 5. flu-like

What should you do if a child has a tick (how to remove)?

1. use tweezers and pull straight up 2. NO vasoline and do NOT burn it off 3. make sure you have the whole tick, put in jar of alcohol in case it needs checked

Which of the following care measures should the nurse include when teaching home-care of a child who has bilateral bacterial conjunctivitis. (Select all that apply-3 correct answers.) A. Use of warm, most disposable compresses to remove crusting. B. Use of oral antihistamine medication to relieve eye itching. C. Use of topical anesthetics applied to relieve discomfort. D. Teach the parents to administer the antibiotic eye medication. E. Teach the child to wash hands frequently throughout the day.

A. Use of warm, most disposable compresses to remove crusting. D. Teach the parents to administer the antibiotic eye medication. E. Teach the child to wash hands frequently throughout the day.

A 12-year-old comes to the infirmary 4 days after returning from sleeping out in the woods with the rest of his group. A small, red rash has appeared near an area where he may have been bitten. He denies seeing anything bite him. What would the nurse expect to do for the patient after the physician sees him? (Select all that apply) A. Wash off the affected area with an antibacterial soap. B. Administer an initial dose of doxycycline. C. Apply an antiseptic cream to the area with the rash. D. Monitor the boy for signs and symptoms of tick-borne diseases.

A. Wash off the affected area with an antibacterial soap. B. Administer an initial dose of doxycycline.

The nurse conducts a briefing for the camp on the prevention of Lyme disease. What information should be included in the presentation? A. Wear dark clothing, tightly tucked in, with dark socks and dark shoes. B. Apply insect repellents containing diethyltoluamide (DEET) to the face and hands. C. Dress in light-colored clothing so that any ticks can be spotted fairly easily. D. Scrub vigorously in the shower immediately after returning from the woods.

C. Dress in light-colored clothing so that any ticks can be spotted fairly easily.

The nurse is teaching a patient with a latex allergy about preventing and treating allergic reactions. Which statement, if made by the patient, indicates a need for further teaching? A. "My dentist should be told about my latex allergy." B. "My reactions are not severe; I will not need an EpiPen." C. "I should avoid foods such as bananas, avocados, and kiwi." D. "I will use vinyl gloves for activities such as housekeeping."

B. "My reactions are not severe; I will not need an EpiPen."

When developing the postoperative plan of care for a child who is scheduled to have a tympanostomy tubes inserted into the right ear, which of the following interventions would the nurse identify to facilitate drainage? A. Applying warm compresses to the right ear. B. Positioning the child to lie on the right ear. C. Applying a gauze dressing to the left ear. D. Applying an ice pack to the left ear.

B. Position the child to lie on the right side. Positioning the child on the affected side, in this case the right side, will promote drainage from the middle ear by gravity. Application of heat, such as in the form of warm compresses, may facilitate drainage of exudate from the ear but only if the child is lying on the affected side.A gauze dressing is not applied after surgery. However, a loose wick may be inserted into the external ear canal to absorb drainage from the right, not left, ear.Application of an ice bag may help reduce pressure and edema. However, the ice bag would be applied to the right ear.

Which laboratory result is the best indicator that a patient with cellulitis is recovering from this infection? A. WBC of 2900/μL B. WBC of 8200/μL C. WBC of 12,700/μL D. WBC of 16,300/μL

B. WBC of 8200/μL The normal white blood cell count is generally 4000 to 11,000/μL. For this reason, the patient's level would be returning to normal if it was 8200/μL, indicating recovery from cellulitis. The 2900/µL is too low and indicates another problem is occurring. The 12,700/µL and 16,300/µL are evidence of continuing infection.

Following the insertion of tympanostomy tubes, offering liquid or soft foods to keep the child from chewing is written on the postoperative plan of care. Which of the following nursing diagnoses would this intervention address? A. Hyperthermia related to infectious process. B. Risk for Impaired Skin Integrity related to ear drainage. C. Pain related to the inflammatory process. D. Anxiety related to unfamiliar situation.

C. Pain related to the inflammatory process.

The most appropriate response by the nurse to the mother is: A. "Try one of the brand-name eye products available over-the-counter for the conjunctivitis, instilling drops every 2 hours for 8 hours. Call back if the eyes do not clear up in 24 hours." B. "Cleanse the eyes with warm soap and water, and apply continuous warm compresses. Call back in 24 hours if the eyes have not improved." C. "Cleanse the eyes using warm water and antibacterial soap, before applying an over-the-counter water-soluble lubricant to each eye several times during waking hours." D. "Cleanse the eyes from inside to outside with a clean washcloth and warm water; wash hands carefully before and after care. The child should see her pediatrician within 24 hours."

D. "Cleanse the eyes from inside to outside with a clean washcloth and warm water; wash hands carefully before and after care. The child should see her pediatrician within 24 hours."

When teaching the parents of a 1-year-old child who is scheduled for placement of tympanostomy tubes, which of the following would the nurse include as the purpose for these tubes? A. Allow distribution of antibiotic solution into the middle ear. B. Assist in shrinking the mucosal lining of the middle ear. C. Increase the pressure in the middle ear. D. Allow ventilation and drainage of the middle ear.

D. Allow ventilation and drainage of the middle ear.

What is the drug of choice for treating children experiencing anaphylaxis from a bee or wasp sting? A. Prednisone (Deltasone) B. Benadryl (diphenhydramine) C. Claritin (loratadine) D. Epinephrine (adrenalin)

D. Epinephrine (adrenalin) - EPI PEN

Prevention of sunburn is one of the major information sessions the nurse presents to the campers as well as the counselors. What information is most important for the nurse to stress during these sessions? A. Once sunscreens are applied, they are effective for 2 to 3 hours. B. Sunscreens without p-aminobenzoic acid (PABA) prevent fewer allergic reactions in children. C. A sunscreen with a sun protection factor (SPF) of 20 provides protection for approximately 200 minutes. D. Sunscreen must be reapplied at frequent intervals and in liberal amounts.

D. Sunscreen must be reapplied at frequent intervals and in liberal amounts.

6. The nurse is providing discharge teaching to a patient who has been diagnosed with a latex allergy. What should the nurse instruct the patient to avoid? a. Applying elastic bandages. b. Eating leafy green vegetables. c. Using cotton-tip applicators. d. Putting on vinyl gloves.

a. Applying elastic bandages.

The nurse believes that a patient who states he is in pain is "faking it" and is hoping to get "high." The nurse decides to give the patient a placebo instead of the pain medication that was ordered for the patient. The nurse is violating which principle(s) of ethics? (Select all that apply- 4 correct answers) a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas e. Veracity

a. Autonomy b. Utilitarianism c. Beneficence e. Veracity

5. Individuals who have latex allergy are known to experience cross-sensitization to all of the following foods except: a. Corn. b. Papayas. c. Bananas. d. Kiwis

a. Corn.

4. To help identify the risk of exposing a patient to latex, healthcare providers should: a. Give patients a written or verbal questionnaire prior to treatment. b. Test a patient's latex sensitivity by touching his or her hand with latex gloves. c. Ask for a detailed family history to determine genetic predisposition to latex allergies. d. Ask patients if they are currently taking any allergy medications.

a. Give patients a written or verbal questionnaire prior to treatment.

2. When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which foods? (Select all that apply.) a. Grapes b. Oranges c. Bananas d. Potatoes e. Tomatoes

a. Grapes c. Bananas d. Potatoes e. Tomatoes

The nurse calls the health care provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the HCP for several hours, and the medication is due to be administered. Which action should the nurse take? a. Hold the dose and contact the nursing supervisor. b. Administer the recommended dose until the HCP can be located. c. Hold the dose.

a. Hold the dose and contact the nursing supervisor.

A 28-year-old married woman received word that she is pregnant. Sadly, the patient is not able to carry the pregnancy because she suffers from long QT syndrome, which causes an abnormality of the heart, meaning any rush of adrenaline could prove fatal. The pregnant patient states, "I want to have this baby." The nurse realizes that this is a conflict that involves which ethical principle? a. Utilitarianism b. Deontology c. Autonomy d. Veracity

a. Utilitarianism

Oral antibiotics used for treating early-stage infection and preventing later stages of the disease are _____________________, ____________________, and ___________________.

amoxicillin, doxycycline, and cefuroxime

A woman takes the hospital elevator to the fifth floor to visit her husband who is a patient. The woman overhears two nurses speaking about her husband. The nurses are discussing his possible prognosis. What ethical principle have the nurses violated? a. Autonomy b. Confidentiality c. Beneficence d. Justice

b. Confidentiality

A patient and her husband used in vitro fertilization to become pregnant. The unused sperm were frozen so the couple could have more children later. The bore a little girl who was diagnosed with leukemia when she was 5 years old. The child now needs a bone marrow transplant (BMT). The best chance of a match for the BMT is a sibling. The couple would like to use the sperm to have another child so that they can increase the likelihood of a match. The nurse realizes that the unborn child poses an ethical dilemma involving which principle? a. Beneficence b. Human dignity c. Justice d. Veracity

b. Human dignity

The nurse who works on the night shift enters the medication room and finds a co-worker take a medication from the pyxis and put the medication in their mouth. Which is the most appropriate action by the nurse? a. Call security. b. Call the police c. Call the nursing supervisor. d. Lock the co-worker in the medication room until help is obtained.

c. Call the nursing supervisor.

Beneficence means: a. Freedom to make decisions for oneself. b. Doing no harm, either deliberately or unintentionally. c. Doing good for the benefit of others. d. Treating everyone equally, regardless of gender, race, religion, or disease.

c. Doing good for the benefit of others.

Which ethical term matches this statement: "A problem for which in order to do something right you have to do something wrong"? a. Justice b. Veracity c. Ethical dilemma d. Fidelity

c. Ethical dilemma

3. When receiving medical or dental treatment, individuals who suffer from latex allergy should: a. Refuse treatment in any office that uses rubber products. b. Wear a mask to prevent accidental inhalation of aerosol allergens. c. Inform healthcare providers of their allergy in advance. d. Wash their hands thoroughly with soap and water after treatment.

c. Inform healthcare providers of their allergy in advance.

Patients with certain neurologic or cardiac complications may need IV antibiotic therapy with ________________________ and ____________________.

ceftriaxone and penicillin

The greatest problems associated with animal bites are ________________ and mechanical destruction of skin, muscle, tendons, blood vessels, and bone. The bite may cause a simple __________________ or be associated with crush injury, puncture wound, or tearing of multiple layers of tissue.

infection and laceration

A __________ number of persons treated with antibiotics may have lingering fatigue or joint and muscle pain. Antibiotic treatment is then extended.

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