211 test 3 practice questions

The nurse is teaching the family of an 8-year-old client with inflammatory bowel disease on the administration of prednisone at home. At which time should the nurse instruct the parents to provide the medication to the client? A) 1 hour before meals B) At bedtime C) With meals D) Between meals

C) With meals

A nurse is caring for a client with HIV who just learned she is several weeks pregnant. The client states that she is concerned about how her HIV diagnosis might affect the health of her child. Which of the following statements should the nurse include in her teaching for this client? A) "One way to reduce the risk of transmitting the virus to your child is to opt for vaginal birth rather than cesarean delivery." B) "Although infants can acquire HIV from their mothers at birth, the virus cannot cross the placenta during pregnancy." C) "Most HIV medications are safe during pregnancy, and taking them can reduce the risk of transmitting the virus to the fetus." D) "Women with HIV are no more likely than uninfected women to experience miscarriage or fetal loss."

C. "Most HIV medications are safe during pregnancy, and taking them can reduce the risk of transmitting the virus to the fetus."

The nurse is caring for a client with a history of latex allergies. The client develops audible wheezing, pruritus, urticaria, and signs of angioedema. Which of the following is the priority intervention for this client? A) Teach the client regarding use of a kit that contains treatment for allergic reactions. B) Administer diphenhydramine (Benadryl) by mouth every 4 hours per the healthcare provider's orders. C) Administer epinephrine 1:1000 by subcutaneous injection per the healthcare provider's orders. D) Collect a detailed history from the client regarding the history of latex allergies.

C. Administer epinephrine 1:1000 by subcutaneous injection per the healthcare provider's orders.

The nurse is caring for a client who has come to an urgent care clinic due to an arm infection. The client reports being bitten by a raccoon on a recent camping trip. Based on this data, which treatment option does the nurse anticipate for this client? A) Injection of rabies immunoglobulin only B) Administration of rabies vaccine only C) Both injection of rabies immunoglobulin and administration of rabies vaccine D) Neither injection of rabies immunoglobulin nor administration of rabies vaccine

C. Both injection of rabies immunoglobulin and administration of rabies vaccine

A nurse is developing a plan of care for a client who was recently diagnosed with human immunodeficiency virus (HIV). The client states, "I don't plan on giving up sex just because I am HIV positive." Based on this data, which nursing diagnosis is the priority for this client? A) Risk for Infection B) Death Anxiety C) Deficient Knowledge D) Social Isolation

C. Deficient Knowledge

The nurse is assessing a client who is receiving IV antibiotics. Which item in the client's health history increases the risk for experiencing a hypersensitivity reaction? A) 26 years of age B) Caucasian race C) Previous antibiotic therapy D) Concurrent chronic illness

C. Previous antibiotic therapy

Which type of precaution should the nurse implement when providing direct care in the intensive care unit (ICU) to a client diagnosed with acquired immunodeficiency syndrome (AIDS)? A) Droplet B) Reverse C) Standard D) Contact

C. Standard

Based on gender and age alone, which of the following clients is most likely to experience the new onset of rheumatoid arthritis (RA)? A) A 31-year-old man B) A 42-year-old woman C) A 65-year-old woman D) An 18-year-old man

B. A 42-year-old woman

What is the most commonly observed opportunistic infection in clients with AIDS? A) Tuberculosis B) Pneumocystis jiroveci pneumonia C) Candida albicans infection D) Mycobacterium avium complex

B. Pneumocystis jiroveci pneumonia

A client with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress checkup. Which of the following statements on the part of the client suggests that she has met a goal of treatment? A) "I sleep for 10 hours at night." B) "I have increased pain in my joints all the time now." C) "I have delegated many household chores to my children and spouse." D) "I do not perform household chores at all anymore."

C. "I have delegated many household chores to my children and spouse."

A nurse is caring for a client with who is experiencing leukocytosis. When providing care to this client, which action by the nurse is most appropriate? A) Instructing the client on the use of an electric razor and soft toothbrush B) Evaluating the client for bleeding and bruising C) Assessing the client for the source of infection D) Placing the client in reverse isolation

C. Assessing the client for the source of infection

Which of the following cells would be classified as granulocytes? A) Helper T cells B) Macrophages C) Natural killer (NK) cells D) Eosinophils

D. Eosinophils

The nurse instructs an older client with arthritis on the side effects of nonsteroidal anti-inflammatory drug (NSAID) therapy. Which client statement would indicate that teaching had been effective? A) "I will Report any abnormal bruising." B) "Caffeine will decrease the effectiveness of the medication." C) "I cannot take other medications." D) "If I have a change in my mood I will call the prescriber."

A) "I will Report any abnormal bruising."

Two hours later, the patient reports difficulty swallowing because of sores in her mouth. What does the nurse suspect is the problem with the patient's mouth? What nursing interventions should be implemented?

1. The patient is most likely experiencing mucositis (sores in mucous membranes). With chemotherapy, mucous membrane cells are killed more rapidly than they are replaced, resulting in the formation of mouth sores. Mouth sores are painful and interfere with eating. 2. Examine the mouth and between the teeth every 4 hr for fissures, blisters, lesions, or drainage. Document the findings. Provide frequent good mouth care. Encourage the patient to avoid mouthwashes that contain alcohol. For mouth care, use a soft-bristled toothbrush or disposable mouth sponges. Do not use dental floss or pressure gum cleaners. Rinse the mouth with ½ peroxide and ½ normal saline every 8 hr. Normally the patient should drink at least 2 L of fluids, but due to the patient's nausea and vomiting, this isn't possible. Continue to monitor IV fluid replacement.

A patient who is receiving radiation therapy for breast cancer is most likely to experience which side effect? Fatigue Mucositis Hair loss Nausea and vomiting

A patient who is receiving radiation therapy for breast cancer is most likely to experience which side effect? Fatigue Mucositis Hair loss Nausea and vomiting

The nurse provides teaching on the diagnosis Risk for Deficient Fluid Volume to a client with ulcerative colitis. Which client statement indicates understanding of this information? A) "I will drink 1 liter of fluid each day." B) "I will continue to use a moisturizer on my skin." C) "I should report dry patches of skin immediately to my doctor." D) "If I have two liquid stools in any day, I will report this to my health care provider."

A) "I will drink 1 liter of fluid each day."

A client was admitted with complaints of an elevated temperature,, nausea, and pain and tenderness in the lower right quadrant of the abdomen. After receiving pain medication, the client continues to complain of pain at a level of 8 of 10 on the pain scale. Pain medications are not due for at least another 2 hours. What should the nurse say? A) "I will inform the physician about your continued pain." B) "I do not have any medications ordered for you at this time." C) "Why don't you try to rest for a while longer until it is time?" D) "Let's try a heating pad or warm blanket."

A) "I will inform the physician about your continued pain."

An 18-year-old client with complications related to ulcerative colitis is scheduled for an ileostomy. The client is concerned about the effect of the procedure on his social life and asks the nurse what to expect related to bowel function and care after surgery. What should the nurse respond about the client's concerns? Select all that apply. A) "The stoma will require that you wear a collection device all the time." B) "The drainage tends to be liquid but certain foods can cause it to be paste-like." C) "The drainage will gradually become semi-solid and formed." D) "After the stoma heals, you can irrigate your bowel so you won't have to wear a pouch." E) "You will be able to have some control over your bowel movements."

A) "The stoma will require that you wear a collection device all the time." B) "The drainage tends to be liquid but certain foods can cause it to be paste-like."

A nurse is receiving a client from the Emergency Department diagnosed with an acute exacerbation of ulcerative colitis (UC). The nurse anticipates the client may present with which clinical characteristics? Select all that apply. A) 5-30 diarrhea stools per day with blood and mucus B) Steady right lower quadrant or periumbilical pain C) Cramping in left lower quadrant; relieved by defecation D) Tenderness and mass noted in right lower quadrant E) Fever, malaise, fatigue

A) 5-30 diarrhea stools per day with blood and mucus C) Cramping in left lower quadrant; relieved by defecation E) Fever, malaise, fatigue

What could the nurse do to decrease the inflammation? A) Anti-inflammatory medication B) Diuretics C) Opioid medication D) Antibiotics

A) Anti-inflammatory medication

A client with appendicitis is highly agitated and states that there is a great deal of pain. Which intervention will decrease the client's anxiety? A) Assess pain levels every 2 hours and administer ordered medication. B) Provide reading material to help distract the client. C) Distract the client with ambulation. D) Administer pain medications when the client complains of pain.

A) Assess pain levels every 2 hours and administer ordered medication.

A client is being scheduled for diagnostic tests to determine the presence of ulcerative colitis. For which diagnostic tests should the nurse plan to provide teaching? Select all that apply. A) Barium enema B) Intravenous pyelogram C) Colonoscopy D) Upper endoscopy E) Barium swallow

A) Barium enema C) Colonoscopy E) Barium swallow

A nurse caring for a pediatric client with inflammatory bowel disease (IBD) understands that there are variances in the presentation of IBD between children and adults. These include: Select all that apply. A) Children suffer from Crohn disease more frequently than ulcerative colitis; the opposite is true of adults. B) Adults with Crohn disease usually present with inflammatory disease; pediatric clients often present with fistulizing or stricturing disease. C) Adults with Crohn disease usually present with terminal ileal disease without colonic involvement; pediatric clients usually have colonic involvement. D) Adults with UC usually present with pancolitis, whereas pediatric clients more often present with left-sided colitis. E) IBD is more common in females than males in the pediatric population; equal numbers of adult males and females have IBD.

A) Children suffer from Crohn disease more frequently than ulcerative colitis; the opposite is true of adults. C) Adults with Crohn disease usually present with terminal ileal disease without colonic involvement; pediatric clients usually have colonic involvement.

A client who is 4 days post-cholecystectomy has T-tube drainage totaling 600 mL in 24 hours. What should the nurse do? Select all that apply. A) Notify the physician. B) Place the client in a supine position. C) Assess drainage characteristics. D) Clamp the tube q 2 hours for 30 minutes. E) Encourage an increased fluid intake.

A) Notify the physician C) Assess drainage characteristics.

The nurse is caring for a client who is newly diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse whether there are ways to protect the client's life partner from getting the virus. After the nurse provides the client with teaching related to this topic, which statement on the part of the client would indicate a need for further education? A) "I know to use an oil-based lubricant to prevent spread of the virus to my partner." B) "I can still kiss and hug my partner to show affection." C) "I will not share my razor with my partner." D) "I know I have to practice safer sex with my partner by using a latex condom."

A. "I know to use an oil-based lubricant to prevent spread of the virus to my partner."

The nurse is collecting a health history for a client being seen in an outpatient clinic who complains of joint pain and swelling that have lasted for about 2 months. The client is diagnosed with rheumatoid arthritis (RA). Which of the following statements made by this client supports the nursing diagnosis of Activity Intolerance? A) "I seem to get tired early in the day and require a nap." B) "My joints are stiffest at night before I go to sleep." C) "I find it difficult to move when I first get up in the morning." D) "I take ibuprofen for the pain as needed."

A. "I seem to get tired early in the day and require a nap."

A pediatric client with a history of anaphylactic hypersensitivity reactions will be discharged with a prescription for an EpiPen. Which statements are appropriate for the nurse to include in the discharge instructions for this client and family? Select all that apply. A) "It is recommended that the child wear a medical alert bracelet." B) "This medication does not come prefilled and must be measured." C) "Keep the medication in the car at all times." D) "Frequently check the expiration date of the medication." E) "Keep the medication in one location that is easy to remember."

A. "It is recommended that the child wear a medical alert bracelet." D. "Frequently check the expiration date of the medication."

A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse to explain the difference is between RA and osteoarthritis (OA). Which responses by the nurse are most appropriate? Select all that apply. A) "The onset of OA is gradual, whereas the onset of RA may be rapid." B) "With OA, multiple joints are symmetrically affected; RA affects one joint at a time." C) "The affected joints in RA feel cold to the touch, whereas the affected joints in OA are warm or hot to the touch." D) "OA is slowly progressive, whereas RA is characterized by exacerbations and remissions." E) "With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising."

A. "The onset of OA is gradual, whereas the onset of RA may be rapid." D. "OA is slowly progressive, whereas RA is characterized by exacerbations and remissions."

A nurse who works in the emergency department is providing care for a group of clients. Which client demonstrates a declining immune response that typically occurs with the aging process? A) An 88-year-old client with pneumonia who has a temperature of 99.5°F B) A 70-year-old client who has swelling and redness around an abdominal incision from an open appendectomy C) A 58-year-old client who complains of redness and itching after developing a rash from contact with poison ivy D) A 56-year-old client who has 8 mm induration at the site of a PPD skin test administered 72 hours earlier

A. An 88-year-old client with pneumonia who has a temperature of 99.5°F

The nurse is caring for a client in an allergy clinic. After completing the client history, the nurse selects the nursing diagnosis of Risk for Shock. Which item in the client's history supports the need for this nursing diagnosis? A) Anaphylactic reaction to shellfish B) A drug reaction to penicillin causing a rash C) Glomerulonephritis D) Dermatitis resulting from a response to laundry detergent

A. Anaphylactic reaction to shellfish

The nurse is conducting a physical assessment for a client with a compromised immune system. Which actions by the nurse are appropriate? Select all that apply. A) Assessing general appearance B) Recommending increased fluid intake C) Inspecting the mucous membranes of the nose and mouth D) Palpating the cervical lymph nodes E) Checking joint range of motion (ROM), including that of the spine

A. Assessing general appearance C. Inspecting the mucous membranes of the nose and mouth D. Palpating the cervical lymph nodes E. Checking joint range of motion (ROM), including that of the spine

The nurse is reviewing the laboratory results of a client who is newly diagnosed with acquired immunodeficiency syndrome (AIDS). Which result would be considered potentially problematic and should be reported to the client's healthcare provider? A) CD4 cell count of 195/mm3 B) Viral load 6500 copies/mL C) Negative tuberculin skin test D) WBC count of 6500/mm3

A. CD4 cell count of 195/mm3

Which of the following statements is false and should not be included in client teaching about how to reduce the risk of contracting HIV? A) Clients who will require blood transfusions during surgery should encourage their family members to donate the blood they will receive. B) The only totally safe sex practices are abstinence; long-term, mutually monogamous sexual relations between uninfected individuals; and mutual masturbation without direct contact. C) When possible, autologous transfusion is a good risk reduction strategy for clients who are undergoing surgery. D) Clients should use condoms during every sexual encounter involving vaginal, oral, or anal intercourse.

A. Clients who will require blood transfusions during surgery should encourage their family members to donate the blood they will receive.

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is on antiretroviral therapy. The client complains of nausea, fever, severe diarrhea, and anorexia. Which of the following prescribed medications does the nurse anticipate in order to relieve the anorexia and stimulate the client's appetite? Select all that apply. A) Dronabinol (Marinol) B) Zidovudine (Retrovir, AZT) C) Abacavir (Ziagen) D) Ciprofloxacin (Cipro) E) Megestrol (Megace)

A. Dronabinol (Marinol) E. Megestrol (Megace)

The nurse is providing care to a client with a compromised immune system. Which independent nursing intervention is appropriate for the nurse to include in the client's plan of care? A) Educating the client on the importance of a nutritious diet B) Administering corticosteroids per order C) Prescribing prophylactic antibiotic therapy D) Recommending gene transfer therapy

A. Educating the client on the importance of a nutritious diet

Which of the following complications is not associated with a diagnosis of rheumatoid arthritis (RA)? A) Increased risk of cesarean delivery B) Increased risk of pleural effusion C) Increased likelihood of uveitis D) Increased risk of anemia

A. Increased risk of cesarean delivery

The nurse is providing care to a client who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis. When providing care to this client, which actions by the nurse are appropriate? Select all that apply. A) Monitoring for signs of allergic reaction B) Assuring the client that NSAIDs are safe for clients with cardiovascular disease C) Encouraging the client to take NSAIDs with a small snack to help avoid GI distress D) Monitoring for signs of renal problems E) Inquire about the use of herbal supplements such as feverfew, garlic, ginger, or ginkgo

A. Monitoring for signs of allergic reaction C. Encouraging the client to take NSAIDs with a small snack to help avoid GI distress D. Monitoring for signs of renal problems E. Inquire about the use of herbal supplements such as feverfew, garlic, ginger, or ginkgo

Which form of juvenile idiopathic arthritis (JIA) primarily affects the knees, ankles, and elbows? A) Pauciarticular arthritis B) Polyarticular arthritis C) Systemic arthritis D) Osteoarthritis

A. Pauciarticular arthritis

Why are proton pump inhibitors often included as part of the pharmacologic treatment regimen for clients with rheumatoid arthritis (RA)? A) Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of medications used in the treatment of RA. B) Proton pump inhibitors can dramatically decrease both inflammation and immune reactions and appear to slow the progression of joint destruction in RA. C) Proton pump inhibitors help reduce the body's autoimmune response, thereby limiting the effects of the autoimmune disease process that underlies RA. D) Proton pump inhibitors help reduce the risk of retinitis and vision loss in clients who are taking antimalarial agents as part of their therapeutic regimen for RA.

A. Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of medications used in the treatment of RA.

A nurse is working in a summer camp for children. One of the children comes to the clinic with several bee stings. Which clinical manifestations would necessitate injecting the child with epinephrine (EpiPen)? Select all that apply. A) Skin that is cold and clammy to the touch B) Skin that is warm and dry to the touch C) Hyperverbal behavior D) Extreme anxiety and agitation E) Facial swelling

A. Skin that is cold and clammy to the touch D. Extreme anxiety and agitation E. Facial swelling

The nurse is completing a health screening for a school-age child with rheumatoid arthritis (RA). The parents ask the nurse to recommend activities that will promote exercise for their child. Which recommendation by the nurse is most appropriate? A) Swimming B) Football C) Softball D) Basketball

A. Swimming

Once inside the body, human immunodeficiency virus (HIV) infects and destroys several types of cells, including helper T cells. List each of the events in this process in the order in which they occur. A) Virus recognizes and invades helper T cell B) Viral RNA is acted upon by reverse transcriptase C) Viral DNA integrates with helper T cell DNA D) Virus disrupts cell membrane of helper T cell, leading to its destruction E) Virus sheds its protein coat

A. Virus recognizes and invades helper T cell Virus sheds its protein coat B. Viral RNA is acted upon by reverse transcriptase C. Viral DNA integrates with helper T cell DNA D. Virus disrupts cell membrane of helper T cell, leading to its destruction

A home health nurse is evaluating a client who had a colostomy placed 6 weeks ago for the treatment of ulcerative colitis. Which assessment will cause the nurse to conclude that teaching goals for this client have been met? A) A colostomy pouch that is clean and dry B) Vital signs that reveal a normal temperature C) A stoma that is pink and intact D) The client experiences pain with certain types of food.

C) A stoma that is pink and intact

Match each chemotherapy side effect below with the correct intervention. A. Anemia B. Neutropenia C. Thrombocytopenia 1. Inspect IV sites every 4 hours for signs of infection. 2. Avoid IM injections and venipunctures. 3. Administer epoetin alfa subcutaneously once a week.

ANS: A (Anemia) = 3 (Administer epoetin alfa subcutaneously once a week.) B (Neutropenia) = 1 (Inspect IV sites every 4 hours for signs of infection.) C (Thrombocytopenia) = 2 (Avoid IM injections and venipunctures.)

After lunch, the patient asks the nurse how she could have contracted the MRSA infection. What is the nurse's best response? "MRSA is spread by direct contact in hospitals and communities." "People who travel to third-world countries always return with MRSA." "In the community, MRSA is transmitted by the airborne route carried by droplets." "The most common way for MRSA to spread is through coughing illnesses such as flu."

ANS: A MRSA is spread by direct contact, such as with indwelling catheters, vascular access devices, and endotracheal tubes, in the hospital and community settings.

A 30-year-old man with HIV is admitted to the acute care unit. Which assessment findings does the nurse recognize that may indicate that the patient currently has AIDS? (Select all that apply.) Kaposi's sarcoma HIV-positive status Wasting syndrome Esophageal candidiasis Persistent generalized lymphadenopathy

ANS: A, C, D Everyone who has AIDS has HIV infection; however, not everyone who has HIV infection has AIDS. Table 19-1 (in textbook, p. 329) describes the CDC classification system for AIDS-defining conditions. Persistent generalized lymphadenopathy and HIV-positive status are characteristics of HIV infection only.

After the patient is settled in her room, what special precautions does the nurse implement based on the patient's diagnosis? (Select all that apply.) Keep the door closed at all times. Wear gloves when entering the room. Wear a mask when working within 3 feet of the patient. Wear a gown to prevent contact with contaminated items. Dedicated equipment should be used for this patient alone.

ANS: B, D, E The patient should be taught to perform frequent handwashing. Health care personnel and visitors should wear gloves upon entering the room to prevent contact with the patient, contaminated items, or uncontrolled body fluids. Handwashing should be performed before leaving the room. There should also be dedicated equipment for this patient to prevent the spread of infection. A mask should be worn with Airborne and Droplet Precautions. The door should be kept closed with Airborne Precautions, not Contact Precautions.

Which of the provider's orders should the nurse implement first? Feed clear liquid diet Apply support stockings Administer D5½NS at 125 mL/hr Obtain CBC, Ca level, and basic metabolic panel

ANS: C Based on the patient's diagnosis, IV fluids should be started first. The patient is admitted with dehydration, so the Groshong port should be accessed and IV fluids initiated immediately. The provider has ordered clear liquids, but because the patient has been experiencing nausea and vomiting, she may not be able to ingest enough fluids to correct the dehydration. The laboratory values are ordered for the morning, so they should not be obtained until then. The support stockings can be obtained by the UAP while IV fluids are started.

An hour later, the nurse is preparing to administer the patient's medications. Which drug was likely ordered by the provider to combat the patient's MRSA? Amoxicillin (Amoxil) Ciprofloxacin (Cipro) Vancomycin (Vancocin) Erythromycin (Erythrocin)

ANS: C MRSA is susceptible to only a few antibiotics such as vancomycin (Vancocin) and linezolid (Zyvox), as well as ceftaroline fosamil.

An example of a primary prevention strategy for reducing cancer risk is: Regular physical exercise Fecal occult blood annually for adults of all ages Yearly mammography for women older than 40 years Colonoscopy at age 50 years and then every 10 years

Answer: A Rationale: Primary prevention of cancer involves avoiding exposure to known causes of cancer. Other factors include habits for a healthy lifestyle to include regular physical exercise, a healthy diet that minimizes red meats, and maintaining a healthy weight. The other choices listed are secondary prevention strategies, which involve screening for early detection of cancer.

When is the patient with acute leukemia at greatest risk of developing tumor lysis syndrome? After the first cycle of chemotherapy After the second cycle of chemotherapy After the last cycle of chemotherapy Anytime during the patient's treatment course

Answer: A Rationale: Tumor lysis syndrome can be a serious side effect of chemotherapy. It is most common in patients who had large numbers of leukemia cells in the body before treatment. It happens most often with the first cycle of chemotherapy.

The nurse understands that normal cells and benign cells share which characteristics? (Select all that apply.) No migration Orderly growth Tight adherence Specific morphology Large nuclear-to-cytoplasmic ratio

Answer: A, B, C, D Rationale: Normal cells and benign cells do not migrate, have orderly growth, demonstrate tight adherence, and have specific morphology. A cancerous (malignant) cell's nucleus is larger than that of a normal cell and the cancer cell is smaller than a normal cell. The nucleus occupies much of the space within the cancer cell, creating a large nuclear-to-cytoplasmic ratio.

A patient tells the nurse that she has recently engaged in unprotected sexual intercourse. The nurse recognizes that which symptom(s) may be consistent with an acute infection, following infection with HIV? (Select all that apply) Fever Chills Headache Night sweats Muscular aches

Answer: A, B, C, D, E Rationale: Some people who are infected with HIV develop an acute infection within 4 weeks. Manifestations of this acute HIV infection can be fever, night sweats, chills, headache, and muscle aches. Sore throat and rash can also accompany this acute HIV infection. All of these problems can be caused by exposure to almost any virus, such as influenza—not just to HIV.

The nurse is caring for a patient who is concerned about developing cancer. The nurse recognizes that cancer occurs how frequently in people currently living in North America? 1 in every 2 people 1 in every 3 people 1 in every 4 people 1 in every 5 people

Answer: B Rationale: Cancer will occur in about 1 of every 3 people currently living in North America (ACS, 2013b; Canadian Cancer Society, 2013), although cancer risk differs for each person. More than 13 million Americans with a history of cancer are alive today (ACS, 2013b). (American Cancer Society [ACS], 2013b). Cancer facts and figures—2013. Report No. 00-300M-No. 5008.11. Atlanta: Author. Canadian Cancer Society, Statistics Canada. (2013). Canadian Cancer Statistics, 2013. Toronto: Canadian Cancer Society.)

The nurse is caring for four patients, and understands that which is at greatest risk of infection? 19-year old with stomach pain 24-year old with chronic kidney disease 36-year-old prescribed a 10-day steroid tapper 64-year-old with history of prostate hyperplasia

Answer: B Rationale: The patient's immune status plays a large role in determining risk for infection. Congenital abnormalities, acquired health problems (for example, kidney injury, steroid dependence, cancer, AIDS) and advancing age can increase a patient's risk of developing immunologic deficiencies. Chronic physical and psychological stress can also depress the immune system, making the patient more susceptible to infection.

True or False: Inflammation means that an infection is always present. True False

Answer: B (False) Rationale: Infection is usually accompanied by inflammation. However, inflammation can occur without infection. Examples of inflammation caused by noninfectious invasion by foreign proteins include allergic rhinitis, contact dermatitis, and other allergic reactions. Inflammation does not always mean that an infection is present.

True or False: Genetic testing has no benefit in the treatment plan of a patient with HIV. True False

Answer: B (False) Rationale: The HIV genotype test is used to determine whether any mutations exist in the strain of HIV that has infected the patient. This test is useful before starting antiretroviral therapy to learn whether the patient is infected with a resistant strain of HIV. If so, the test will help the clinician choose which antiretroviral drugs are likely to be effective against viral replication and to which drugs the virus is resistant. It is also useful in patients who are started on antiretroviral therapy and demonstrate an initial success, but then fail.

Cleansing hands with an alcohol-based hand rub is appropriate in which situation? After using the bathroom To cleanse visibly soiled or sticky hands After handing oral medications to a patient After working with a patient who has diarrhea due to Clostridium difficile

Answer: C Rationale: Alcohol-based hand rubs (ABHRs) are not appropriate if one's hands are visibly dirty, soiled, or feel sticky, or if you have just toileted. In these cases, wash your hands instead of using ABHRs. ABHRs are also ineffective against spore-forming organisms such as C. difficile.

What is the expected outcome related to hair loss for a patient who is undergoing chemotherapy? Hair loss may be permanent. Viable treatments exist for the prevention of alopecia. Hair regrowth usually begins about 1 month after completion of chemotherapy. New hair growth will likely be identical to previous hair growth in color and texture.

Answer: C Rationale: Chemotherapy-induced hair loss is usually temporary, and regrowth usually begins 1 month after chemotherapy is finished. New hair growth may differ from the original hair in color, texture, and thickness. No known treatment completely prevents alopecia.

Immune function is most efficient when people are which age? Infancy Teen years 20 to 30 years 50 years and older

Answer: C Rationale: Immune function is most efficient when people are in their 20s and 30s and slowly declines with increasing age. The immune system is developing and changing during infancy and teen years.

Which population group is most likely to be diagnosed with fibromyalgia syndrome? Men between 30 and 50 years of age Men between 50 and 70 years of age Women between 30 and 50 years of age Women between 50 and 70 years of age

Answer: C Rationale: Most patients diagnosed with fibromyalgia syndrome are women between 30 and 50 years of age.

A patient is fearful that he has been infected with HIV. The nurse recognizes which as the first symptom associated with possible HIV infection? Lymphocytopenia Opportunistic infection Fever, night sweats, muscle aches Reduced numbers of CD4+ T-cells

Answer: C Rationale: When a person is infected with HIV, the first manifestations are fever, night sweats, chills, headache, and muscle aches. As time passes, CD4+ T-cells are infected and taken out of service. This cell count drops to below-normal levels, and those that remain may not function normally. Lymphocytopenia (decreased lymphocyte counts) occurs as a result. Also, as the CD4+ T-cell level drops, the patient is at risk for bacterial, fungal, and viral infections, as well as some opportunistic cancers.

The nurse is assessing a patient who has undergone total knee arthroplasty for which continuous femoral nerve blockade was utilized. The nurse notes that the patient is anxious. Vital signs include BP 92/58, HR 62, RR 12, and SpO2 89%. What is the priority nursing intervention? Take vital signs every 10 minutes. Notify physician of the vital signs. Anticipate administering IV fluids. Notify the Rapid Response Team.

Answer: D Rationale: Although patients having continuous femoral nerve blockade after TKA have been found to require fewer opioids and antiemetics postoperatively, symptoms that may indicate the local anesthetic is getting into the patient's system include metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, and seizures. This patient's vital signs suggest instability, and a Rapid Response Team should be activated immediately.

A 37-year-old man with polycystic kidney disease is on the kidney transplant list. He is to receive 2 units of leukocyte-poor packed red blood cells to treat a low hemoglobin. He asks the nurse why he needs this type of blood. What is the nurse's best response? "It causes fewer blood reactions for pre-transplant patients." "It is less likely to causes hemolysis, or destruction of the blood cells, after transfusion." "All pre-transplant patients receive leukocyte-poor blood because it is absorbed better by the body." "It will decrease the risk of obtaining white blood cells from the donor that could make it harder for your transplanted kidney to function."

Answer: D Rationale: Human leukocyte antigens (HLAs) are found on the surface of all body cells and serve as a "cellular fingerprint" recognizing self and non-self cells. When the HLAs of the immune system encounter a cell that is foreign, the immune system cell then takes action to neutralize, destroy, or eliminate this foreign invader. Transfusion of blood that contains leukocytes increases the number of HLAs introduced to the body. Evidence shows that leukocytes present in cellular blood products are the main component involved in the occurrence of HLA immunization, and several studies show that leukocyte-poor blood products are less able to induce it. HLA immunization through blood transfusion will make it harder to find an acceptable kidney transplant match for the patient (for example, HLA match for kidney transplant).

What health care-acquired infection (HCAI) occurs most frequently? Pneumonia Surgical site infection (SSI) Catheter-related bloodstream infection (CR-BSI) Catheter-associated urinary tract infection (CA-UTI)

Answer: D Rationale: Urinary tract infection (UTI) is one of the most common health care-acquired infections (HCAIs). More than half of patients in adult intensive care units (ICUs) have urinary catheters in place. Indwelling urinary catheters are a primary cause of CAUTIs (catheter-associated UTIs). The use of invasive catheters has decreased in all health care settings because patients, especially older adults, are very susceptible to infections. In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections, 32% of all HAIs were CA-UTIs, 22% were SSI, 15% were pneumonia, and 14% were CR-BSI.

The nurse is providing instructions to a client who has a prescription for a nonsteroidal anti-inflammatory drug (NSAID). What information is priority for the nurse to explain to the client about this medication? A) "Take your medication on an empty stomach." B) "Drink at least 8-10 glasses of water a day while taking your medication." C) "Constipation is common with your medication; include roughage in your diet." D) "Take your medication with food."

B) "Drink at least 8-10 glasses of water a day while taking your medication."

The nurse is caring for a client who is hospitalized on a medical unit for a systemic infection. The client asks the nurse which defenses the body has against infection. Which physiologic barriers that protect the body against microorganisms should the nurse include in the response to the client? Select all that apply. A) The spleen B) Adequate urinary output C) Intact skin D) Generalized inflammation E) The thymus gland

B) Adequate urinary output C) Intact skin

The nurse is caring for a teenage client who has been non-adherent with the medical plan of care to treat Crohn's disease. About which complication associated with Crohn disease should the nurse instruct the client in order to increase adherent behavior? A) Vomiting B) Bowel perforation C) Intestinal obstruction D) Diarrhea

B) Bowel perforation

A client is admitted with airway edema, bronchoconstriction, and increased mucus production after being exposed to an allergen. What care will the client need to address this inflammation to the respiratory system? Select all that apply. A) Turn and reposition every 2 hours. B) Monitor oxygen saturation. C) Administer oxygen as prescribed. D) Restrict fluids. E) Monitor lung sounds.

B) Monitor oxygen saturation. C) Administer oxygen as prescribed. E) Monitor lung sounds.

The nurse is caring for a client who receives H2-receptor antagonists for the treatment of peptic ulcer disease. Based on the nursing diagnosis Risk for Bleeding, which assessment finding should the nurse report immediately to the physician? A) The client who reports pain after 24 hours of treatment B) The client who reports episodes of melena C) The client who reports he is constipated D) The client who reports he took TUMS® antacids with his H2-receptor antagonist

B) The client who reports episodes of melena

The nurse is caring for a client who has experienced a sports-related injury to his knee. During the morning assessment, what signs of inflammation will the nurse most likely assess? Select all that apply. A) Pitting edema B) Pallor C) Swelling D) Warmth E) Pain

C) Swelling D) Warmth E) Pain

A home health nurse is conducting home visits for several clients who are diagnosed with acquired immunodeficiency syndrome (AIDS). Which client would the nurse see first? A) A client who is receiving lamivudine (Triumeq) because of a low CD4 cell count B) A client with Pneumocystis jiroveci pneumonia who called the office this morning to report a new onset of fever, cough, and shortness of breath C) A client with wasting syndrome who needs dietary modifications and education regarding these changes D) A client who is receiving IV antibiotics daily for toxoplasmosis

B. A client with Pneumocystis jiroveci pneumonia who called the office this morning to report a new onset of fever, cough, and shortness of breath

A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis (RA). The client reports that her pain is a 3 on a scale from 0 (none) to 10 (high) today. Which nonpharmacologic interventions can the nurse provide to enhance the client's comfort? Select all that apply. A) Discourage any position changes. B) Encourage relaxation techniques. C) Immobilize the extremity. D) Offer heat and/or cold packs. E) Provide distraction activities.

B. Encourage relaxation techniques. D. Offer heat and/or cold packs. E. Provide distraction activities.

The nurse is caring for a client who was diagnosed with rheumatoid arthritis (RA) last year. The client has just been prescribed methotrexate as part of his RA treatment regimen. The nurse is teaching the client about use of this medication. Which client statement indicates that this teaching was successful? A) "It's not safe for me to take nonsteroidal anti-inflammatory drugs (NSAIDs) while on methotrexate therapy." B) "I can help control the side effects of methotrexate by taking folic acid." C) "I should expect to see beneficial results within 3 to 5 days of starting methotrexate therapy." D) "It's important that I take my methotrexate at the same time every day."

B. I can help control the side effects of methotrexate by taking folic acid."

Which of the following statements is true with regard to food allergies and children? A) Over the past decade, the prevalence of peanut allergy has decreased in the pediatric population. B) Many children eventually outgrow egg, milk, and soy allergies. C) Teenagers with food allergies are at lower risk for an allergic reaction than younger clients because they are more aware of their trigger foods and how to avoid them. D) Peanut allergies are most common in pediatric clients over 5 years of age.

B. Many children eventually outgrow egg, milk, and soy allergies.

A nurse is caring for a client with seasonal hypersensitivity reactions. What teachings should the nurse provide to improve this client's comfort? Select all that apply. A) Keep doors and windows open on high-allergen days to circulate air. B) Remain indoors if possible on high-allergen days. C) Maintain a clean, dust-free environment. D) Take antihistamine and leukotriene medications as ordered. E) Stop taking oral corticosteroids immediately once symptoms disappear.

B. Remain indoors if possible on high-allergen days. C. Maintain a clean, dust-free environment.

Why are second-generation antihistamines often preferred to first-generation histamines in the treatment of hypersensitivity reactions? A) Second-generation antihistamines are faster acting than first-generation antihistamines. B) Second-generation antihistamines are less likely than first-generation antihistamines to cause drowsiness. C) Second-generation antihistamines are available over the counter, whereas first-generation antihistamines require a prescription. D) Second-generation antihistamines can be administered either orally or parenterally, whereas first-generation antihistamines can only be given via the oral route.

B. Second-generation antihistamines are less likely than first-generation antihistamines to cause drowsiness.

The nurse is planning care for a pediatric client who is infected with the human immunodeficiency virus (HIV). The nurse selects Risk for Infection as a priority nursing diagnosis for this client. Based on this nursing diagnosis, which actions by the nurse are appropriate? Select all that apply. A) Administering tuberculosis skin tests every 6 months B) Teaching proper food-handling techniques to the family C) Instructing on the importance of delaying vaccinations until adulthood D) Assessing the health status of all visitors E) Monitoring hand-washing techniques used by the family

B. Teaching proper food-handling techniques to the family D. Assessing the health status of all visitors E. Monitoring hand-washing techniques used by the family

Transfusion reactions and Rh incompatibility are both examples of which type of hypersensitivity reaction? A) Type I B) Type II C) Type III D) Type IV

B. Type II

A client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. What information should the nurse include when teaching this client about ways to decrease the likelihood of crippling deformities? Select all that apply. A) Ignore pain as a warning signal. B) Type instead of hand-writing items if possible. C) Use the strongest joints possible to complete most tasks. D) Avoid stress to any current area of deformity. E) Stop an activity immediately if it is beyond your ability to perform.

B. Type instead of hand-writing items if possible. C. Use the strongest joints possible to complete most tasks. D. Avoid stress to any current area of deformity. E. Stop an activity immediately if it is beyond your ability to perform.

The patient is a 63-year-old woman admitted to the acute medical care unit. She is 5'4" and weighs 211 lb. Her medical history includes hypertension and GERD. On admission, she reports pain in her hands and joints that is unrelieved by OTC medications. What additional assessment data should you collect from the patient at this time?

Based on her age and reports of pain, the patient is most likely experiencing osteoarthritis, which may be precipitated by her weight. It is important to know when the pain started, and she should be asked to rate her pain on a 0-10 scale. Which OTC medications has she taken? How long has she experienced this pain? Does she have a family history?

The nurse is caring for a client from India who has extensive deep tissue damage. The nurse notes that the client is also vegan. Which dietary information should the nurse teach this client to enhance the healing process? A) "A low-fat, high-carbohydrate, low-protein diet is best for healing." B) "A high-fat, low-carbohydrate diet is best for healing." C) "A high-carbohydrate, high-protein diet is best for healing." D) "A diet high in protein and vitamin D is best for healing."

C) "A high-carbohydrate, high-protein diet is best for healing."

The nurse in a rheumatology clinic is managing care for clients who receive nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of their disease process. What are the primary laboratory tests the nurse will assess prior to initiation of therapy? Select all that apply. A) Serum amylase B) Electrolytes C) Creatine clearance D) Complete blood count (CBC) E) Liver function tests

C) Creatine clearance D) Complete blood count (CBC) E) Liver function tests

In what ways do type IV hypersensitivity reactions differ from other types of hypersensitivity reactions? A) Unlike other types of hypersensitivity reactions, type IV reactions are antibody-mediated responses and develop almost immediately. B) Unlike other types of hypersensitivity reactions, type IV reactions are cell-mediated responses and develop almost immediately. C) Unlike other types of hypersensitivity reactions, type IV reactions are antibody-mediated responses and take 24 hours or more to develop. D) Unlike other types of hypersensitivity reactions, type IV reactions are cell-mediated responses and take 24 hours or more to develop.

C. Unlike other types of hypersensitivity reactions, type IV reactions are cell-mediated responses and take 24 hours or more to develop.

Development of leukopenia suggests that an individual A) is immunocompetent. B) is experiencing an infection somewhere in the body. C) may have suppressed bone marrow activity. D) has an abnormally high number of circulating leukocytes.

C. may have suppressed bone marrow activity.

A client with H. pylori asks the nurse why bismuth (Pepto-Bismol) has been prescribed along with oral antibiotics for treatment. What should the nurse explain about the use of bismuth (Pepto-Bismol) for treatment of this health problem? Select all that apply. A) "It helps prevent the side effects of antibiotics." B) "It increases stomach acid to help kill bacteria." C) "It helps relieve ulcer-related constipation." D) "It is effective with inhibiting bacterial growth." E) "It keeps bacteria from sticking in your stomach."

D) "It is effective with inhibiting bacterial growth." E) "It keeps bacteria from sticking in your stomach."

The 25-year-old female is visiting family from Iran and develops signs and symptoms of appendicitis during the night. The client is brought to the Emergency Department by the family. Which nursing intervention is the most culturally sensitive for this client? A) Ask the physicians which one should see the client. B) Ask for a female doctor to assess the client. C) Ask for a male doctor to assess the client. D) Explain the assessment procedure and ask the family their preference.

D) Explain the assessment procedure and ask the family their preference.

The nurse is caring for a child recovering from surgery for a perforated appendix. Which nursing diagnosis should the nurse use to guide this client's care during the immediate postoperative period? A) Risk for Chronic Pain B) Risk for Impaired Perfusion C) Risk for Deficient Fluid Volume D) Risk for Infection

D) Risk for Infection

The nurse is caring for a client with severe inflammation. Which assessment findings would indicate a systemic reaction to inflammation? Select all that apply. A) Erythema B) Edema C) Pain D) Tachypnea E) Tachycardia

D) Tachypnea E) Tachycardia

A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). Based on this data, what should the nurse anticipate when providing care to this client? A) A higher risk for preterm delivery B) An increased need for medication C) An acute exacerbation of symptoms D) A continued risk for anemia

D. A continued risk for anemia

The nurse is caring for a client who is experiencing anaphylactic shock following the administration of a medication. Based on this data, which position is the most appropriate for the nurse to place the client? A) Trendelenburg position B) Flat, with legs slightly elevated C) Supine position D) High-Fowler position

D. High-Fowler position

A nurse is caring for a pediatric client who is receiving an infusion of intravenous antibiotic at the ambulatory clinic. Which clinical manifestation indicates that the client is experiencing a type I hypersensitivity reaction? A) Erythema B) Fever C) Joint pain D) Hypotension

D. Hypotension

The nurse is admitting a pediatric client to the hospital with a ventriculoperitoneal (VP) shunt malfunction. When gathering the history, the nurse learns that the client received the shunt at birth after a meningocele repair. Based on this data, which product should be avoided when providing care to this client? A) Synthetic rubber gloves B) Polyethylene gloves C) Non-powdered nitrile gloves D) Latex gloves

D. Latex gloves

The nurse is preparing to assess a client when one of the client's family members begins showing symptoms of latex sensitivity. Which action by the nurse is the most appropriate? A) Ask the family member to leave the unit. B) Transfer the client to a department that does not use latex products. C) Wait until Monday to report the problem to the unit supervisor. D) Obtain latex-free products for the client's room.

D. Obtain latex-free products for the client's room

What is the largest lymphoid organ in the human body? A) Thymus gland B) Bone marrow C) Tonsils D) Spleen

D. Spleen

As the nurse is talking to the patient, the patient comments that he doesn't know why he must live with such a horrible disease, and states that he knows he will die soon. What is the appropriate nursing response?

The nurse should provide therapeutic communication and active listening. The patient should be encouraged to openly express his feelings about the disease. If the patient states he has thought about taking his own life, it is the responsibility of the nurse to notify the patient's health care provider.

A 27-year-old patient is admitted from the ED to the medical-surgical unit with cellulitis of the left leg. A culture result from her primary care provider's office indicated that the left leg wound was positive for MRSA. Based on this information provided during the SBAR report, what type of isolation room should the nurse prepare for the patient when she arrives on the unit?

The patient should be admitted to a private room under Contact Isolation precautions.

After 8 days, the patient is being discharged home, where he lives with his mother and father. The nurse is completing discharge instructions for him and his family. What infection control teaching should the nurse provide to the patient and family?

When the patient is discharged, one of the most important things for him or her to remember is Standard Precautions and good handwashing. When at home, the patient and family should have a good understanding that body fluids—including feces, vomitus, urine, blood, or any other body fluid—should be cleaned away with soap and water, and the area disinfected with a 1:10 bleach solution for at least 5 minutes. If bed linens or clothes become soiled, they should be washed in hot water with one cup of bleach added per load of laundry. Dispose of needles and other "sharps" in a labeled puncture-proof container to avoid needle stick injuries. (For a complete list, see Chart 19-8, p. 344 in the textbook.)

A 40-year-old woman was admitted to the oncology unit for severe dehydration from nausea and vomiting associated with chemotherapy 10 days ago. She has had two adjuvant treatments for breast cancer with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). She has a Groshong port that was inserted 2 months ago for chemotherapy administration. The health care provider's orders include: Strict I&O every 12 hours May use port for blood draws and IV fluids Call for vomiting or temp of 100º F or greater D5½NS at 125 mL/hr Ondansetron (Zofran) 8 mg IV every 8 hrs Clear liquid diet and progress as tolerated CBC, Ca level, and basic metabolic panel in AM Bed rest with bathroom privileges Knee-high support stockings What does the nurse understand to be the rationale for each of the provider's orders?

I&O: Because the patient was admitted with dehydration, it is very important to monitor intake and output (I&O). Using port for blood draws/IV fluids: When the patient has nausea and vomiting, you often see a decrease in electrolytes from the excessive fluid volume loss. Call for vomiting or ≥100° F temp: Any temperature elevation may be a sign of infection and should be reported immediately. D5½NS: This is to replace fluids. Ondansetron: This medication is to prevent nausea and vomiting caused by cancer chemotherapy. Clear liquid diet: This is to replace fluids and to provide some nutrition with decreased risk of nausea and vomiting. CBC, Ca, BMP: When the patient has nausea and vomiting, you often see a decrease in electrolytes from the excessive fluid volume loss. Bed rest, bathroom privileges: Because the patient is weak and dehydrated, these restrictions are for safety. Having bathroom privileges is often less stressful than using a bedpan. Knee-high stockings: There is a concern for DVT with prolonged bedrest, so support hose is ordered for the patient to increase venous return and prevent pooling of the blood.

The patient is very weak. During this admission he has experienced anorexia, painful swallowing, severe diarrhea, and occasional vomiting. Frequent mouth care is to be delegated to the unlicensed assistive personnel (UAP). What instructions should the nurse give the UAP?

Instruct the UAP to offer the patient rinses with sodium bicarbonate and normal saline every 2 hours. Tell the UAP to use a soft toothbrush and to remind the patient of the need to drink plenty of fluids. Also remind the UAP to report any mouth pain because analgesics or viscous lidocaine may need to be administered.