471 Exam 1

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A certified Wound, Ostomy, and Continence Nurse is teaching a client about caring for a new ileostomy. What information is most important to include? A. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." B. "Call the health care provider if your stoma has a bluish or pale look." C, "Notify the health care provider if output from your stoma has a sweetish odor." D. "Remember that you must wear a pouch system at all times."

A client diagnosed with exacerbation of systemic sclerosis (SSc) asks the nurse why a foot board and a bed cradle have been placed on the bed. The nurse explains that they are used for what purpose? A. Inspect skin for lesions or changes B. Promote comfort from Raynaud's phenomenon C. Prevent foot drop and contractures D. Decrease chilling of the extremities

A client diagnosed with human immune deficiency virus is concerned about getting opportunistic infections and asks the nurse how to prevent them. Which interventions does the nurse recommend to the client? A. Clean toothbrushes once a week. B. Bathe daily using an antimicrobial soap. C. Eat salad at least once a day. D. Wash dishes in cool water.

A client diagnosed with human immune deficiency virus is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon). The client asks the nurse what will happen if the prescriptions are not refilled on time, or if a few doses of one of the medications are missed. What is the nurse's best response? A. "This will not make any difference in the viral load." B. "Blood concentrations will be decreased, which will lead to increased viral replication." C. "If only one dose of medication is missed, this will not make a difference." D. "This will cause an increase in opportunistic infections."

A client has been admitted for a pulmonary embolism and is receiving heparin infusion. What safety priority does the nurse include in the plan of care? A. Teach the client to avoid using dental floss. B. Monitor the platelet count daily. C. Ensure adequate staffing for the unit. D. Notify radiology of an impending scan.

A client has been diagnosed with asthma. Which statement below indicates that the client correctly understands how to use an inhaler with a spacer? A. "I don't have to wait between the two puffs if I use a spacer." B. "If the spacer makes a whistling sound, I am breathing in too rapidly." C. "I should rinse my mouth and then swallow the water to get all of the medicine." D. "I should shake the inhaler only if I want to see whether it is empty."

A client has developed gastroenteritis while traveling outside the country. What is the likely cause of the client's symptoms? A. Bacteria on the client's hands B. Ingestion of parasites in the water C. Insufficient vaccinations D. Overcooked food

A client has symptoms of rheumatoid arthritis (RA). Which laboratory finding indicates to the nurse that the client may have RA? A. Total serum complement, 75 units/mL B. Positive total antinuclear antibody (ANA) C. Erythrocyte sedimentation rate (ESR), 20 mm/hr D. Beta-globulin level, 1.0 g/dL

A client is admitted to the hospital for chronic obstructive pulmonary disease (COPD), and the health care provider requests oxygen via nasal cannula at 2 L/min. Within 30 minutes, the client's color improves. What does the nurse continue to monitor that may require immediate attention? A. Increasing carbon dioxide levels B. Decreasing respiratory rate C. Increasing adventitious breath sounds D. Increased coughing

A client is admitted with severe viral gastroenteritis caused by norovirus. The client asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? A. "You may have contracted it from an infected infant." B. "You may have consumed contaminated food or water." C. "You may have come into contact with an infected animal." D. "You may have had contact with the blood of an infected person."

A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? A. "You are not contagious unless you stop taking your medication." B. "You will not be contagious to the people you have been living with." C. "You will have to take these medications for at least 1 year." D. "Your sputum may turn a rust color as your condition gets better."

A client is scheduled for a total laryngectomy. Which statement by the client indicates the need for further teaching about the procedure? A. "I hope I can learn esophageal speech." B. "I will have to take special care not to aspirate while eating." C. "I won't be able to breathe through my nose anymore." D. "It is hard to believe that I will never hear my own voice again."

A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? A. Preventing hypotension B. Keeping the T-tube in a dependent position C. Administering antibiotic vaccinations D. Administering immune-suppressant drugs

A client who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the client to do in the meantime? A. "Avoid all solid foods to allow complete bowel rest." B. "Consume extra fluids to replace fluid losses." C. "Take an over-the-counter antidiarrheal medication." D. "Contact your provider for an antibiotic medication."

A client who has fallen off a roof arrives in the emergency department with possible head, neck, and chest trauma. All of these health care provider requests are received. Which action will the nurse take first? A. Give oxygen to keep O2 saturation greater than 93%. B. Immobilize the neck with a cervical collar. C. Infuse normal saline by large-bore IV catheter. D. Obtain computed tomography (CT) scan of head, neck, and chest.

A client who is concerned about getting a tracheostomy says, "I will be ugly, with a hole in my neck." What is the nurse's best response? A. "But you know you need this to breathe, right?" B. "Do you have a scarf or a large loose collar that you could place over it?" C. "Your family and friends probably won't even care." D. "It won't take you long to learn to manage."

A client who is exposed to invading organisms recovers rapidly after the invasion without damage to healthy body cells. How has the immune response protected the client? A) Intact skin and mucous membranes B) Self-tolerance C) Inflammatory response against invading foreign proteins D) Antibody-antigen interaction

A client who is human immune deficiency virus positive is experiencing anorexia and diarrhea. Which nursing actions does the nurse delegate to a nursing assistant? A. Collaborate with the client to select foods that are high in calories. B. Provide oral care to the client before meals to enhance appetite. C. Assess the perianal area every 8 hours for signs of skin breakdown. D. Discuss the need to avoid foods that are spicy or irritating.

A client with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? A. Asks the client whether family members could be trained in stoma care B. Has another client with a stoma who performs self-care talk with the client C. Requests that the health care provider request antidepressants and a psychiatric consult D. Suggests that the health care provider request a home health consultation so stoma care can be performed by a home health nurse

A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which health care provider order should the nurse implement first? A. Administer levofloxacin (Levaquin) 500 mg IV. B. Draw aerobic and anaerobic blood cultures. C. Give lorazepam (Ativan) as needed for agitation. D. Refer to social worker for alcohol counseling.

A new graduate RN discovers that her client, who had a tracheostomy placed the previous day, has completely dislodged both the obturator and the tracheostomy tube. Which action should the nurse take first? A. Auscultate the client's breath sounds while applying a nasal cannula. B. Direct someone to call the Rapid Response Team while using a resuscitation bag and facemask. C. Apply a 100% non-rebreather mask while administering high-flow oxygen. D. Replace the obturator while reinserting the tracheostomy tube.

A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client? A. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." B. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." C. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." D. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

A ventilated client in the intensive care unit (ICU) begins to pick at the bedcovers. Which action should the nurse take next? A. Increase the sedation. B. Assess for adequate oxygenation. C. Explain to the client that he has a tube in his throat to help him breathe. D. Request that the family leave to decrease the client's agitation.

An older adult client is being discharged home with a tracheostomy. Which nursing action is an acceptable assignment for an experienced LPN/LVN? A. Complete the referral form for a home health agency. B. Suction the tracheostomy using sterile technique. C. Teach the client and spouse about tracheostomy care. D. Consult with the health care provider about using a fenestrated tube.

An older client presents to the emergency department with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The client never had a pneumococcal vaccine. The client's chest x-ray shows density in both bases. The client has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this client? A. It would not be beneficial for this client. B. It would help decrease the bronchospasm. C. It would clear up the density in the bases of the client's lungs. D. It would decrease the client's pain on inspiration.

Because of a flu epidemic, the respiratory floor of a hospital does not have any open beds. Which client does the nurse determine is ready for discharge at the request of the discharge planner? A) Older adult client with a history of congestive heart failure, oxygen saturation of 91%, and on O2 at 2 L, with white blood cell count (WBC) 15.5, segmented neutrophils (segs) 8.0, bands 5, lungs with slight crackles in bases, able to assist with activities of daily living, and afebrile B) Middle-aged client with history of multiple sclerosis, decreased ability to ambulate since hospitalization, lungs clear, WBC count 9.5, segs 6.0, bands 1.0, oxygen saturation of 93% on room air, and afebrile C) Young adult client with crackles in all lung lobes, with productive cough of copious amounts of thick yellow sputum, WBC count 20.0, segs 7.0, bands 10.0, oxygen saturation of 95% on O2 at 2 L, and temperature of 100.4° F (38° C) D) Older adult client with recent history of right hip replacement, with productive cough, WBC count 3.4, segs 6.2, bands 5, lungs with crackles right mid-lobe posterior chest wall, oxygen saturation of 89% with O2 at 2 L, and afebrile

Before administering prednisone IV push to a middle-aged adult with rheumatoid arthritis (RA), the nurse notes that the client's random blood glucose level is 139. Which action is most important for the nurse to take? A. Instruct the client to drink diet soda to prevent elevation of blood sugar. B. Administer the prescribed prednisone on schedule. C. Notify the health care provider of the random blood glucose result. D. Review the client's antinuclear antibody (ANA) level.

In assessing the client's respiratory status, arterial blood gas (ABG) test results reveal pH of 7.50, PaO2 of 99 mm Hg, PaCO2 of 29 mm Hg, and HCO3- of 22 mEq/L. What action does the nurse need to take first? A. Call the health care provider. B. Encourage the client to slow his breathing rate. C. Nothing; these results are within the normal range. D. Provide oxygen support.

In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? A. Increased blood pressure, increased respiratory rate B. Decreased blood pressure, increased heart rate C. Increased respiratory rate, increased apical pulse, pallor D. Tachypnea, diaphoresis, increased blood pressure

In teaching a client with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include? A. "Limit your intake of fruits and vegetables." B. "Weight Watchers has healthy meal plans." C. "Limit fluid intake to 1500 mL/day." D. "Discuss with your health care provider about having your estrogen and progesterone levels checked to see where you are in menopause."

The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? A. Client with ascites who had a paracentesis 2 hours ago and is reporting a headache B. Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse C. Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL and thrombocytopenia D. Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

The RN receives a change-of-shift report about four clients. Which client does the nurse assess first? A. A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift B. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F C. A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it D. A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

The change-of-shift report has just been completed on the medical-surgical unit. Which client will the oncoming nurse plan to assess first? A. Client with chronic obstructive pulmonary disease (COPD) who is ready for discharge, but is not able to pay for prescribed home medications. B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min. C. Hospice client with terminal pulmonary fibrosis and an oxygen saturation level of 89%. D. Client with lung cancer who needs an IV antibiotic administered

The client returns to the medical unit after a therapeutic bronchoscopy. Which intervention does the nurse apply first? A. Assess the puncture site for drainage. B. Implement nothing-by-mouth (NPO) status. C. Monitor for signs of anaphylaxis. D. Perform aggressive chest physiotherapy.

The client says, "I hate this stupid COPD." What is the best response by the nurse? A. "Then you need to stop smoking." B. "What is bothering you?" C. "Why do you feel this way?" D. "You will get used to it."

The client with which condition is in greatest need of immediate intubation? A. Difficulty swallowing oral secretions B. Hypoventilation and decreased breath sounds C. O2 saturation of 90% D. Thick, purulent secretions and crackles

The home health nurse is making an initial home visit to a client currently living with family members after being hospitalized with pneumonia and newly diagnosed with acquired immune deficiency syndrome (AIDS). Which statement by the nurse best acknowledges the client's fear of discovery by his family? A. "Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?" B. "Is there somewhere private in the home where we can go and talk?" C. "I hope that all of your family members know about your disease and how you need to be protected, because you have been so sick." D. "It is your duty to protect your family members from getting AIDS."

The inner layer that surrounds the lung itself is called the? A. Parietal Pleura B. Visceral Pleura C. Pleuracardium D. Lobar Bronchi

The nurse is assessing a client who is receiving mechanical ventilation with positive end-expiratory pressure. Which findings would cause the nurse to suspect a left-sided tension pneumothorax? A. The chest caves in on inspiration and "puffs out" on expiration. B. The trachea is deviated to the right side and cyanosis is present. C. The left lung field is dull to percussion with crackles present on auscultation. D. The client has bloody sputum and wheezes.

The nurse is assigned to care for four clients. Which client does the nurse assess first? A. Client with human immune deficiency virus (HIV) and Kaposi's sarcoma who has increased swelling of a sarcoma lesion on the right arm B. Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature C. Client who has been admitted to receive a monthly dose of serum immune globulin to treat Bruton's agammaglobulinemia D. Client who has been receiving radiation to the abdomen and has a decreased total lymphocyte count

The nurse is caring for a client with impending respiratory failure who refuses intubation and mechanical ventilation. Which method provides an alternative to mechanical ventilation? A. Oropharyngeal airway B. Bi-level positive airway pressure (BiPAP) C. Non-rebreather mask with 100% oxygen D. Positive end-expiratory pressure (PEEP)

The nurse is caring for an older adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? A. "I do not know how long my wife will be able to take care of me at home." B. "The bus is coming to pick me up from the senior center three times a week so I can play cards." C. "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." D. "I do not know how much longer my neighbor can continue to help clean my house."

The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? A. Client with hepatitis A reporting severe and ongoing itching B. Client with severe ascites who has a temperature of 101.4° F (38° C) C. Client with cirrhosis who has had a 3-pound weight gain over 2 days D. Client with esophageal varices and mild right upper quadrant pain

The nurse is overseeing a nursing student who is administering medications to a group of clients with pulmonary disorders. Which statement by the student nurse indicates a correct understanding about thrombolytic therapy? A. "You will receive a dose of enoxaparin (Lovenox) intramuscularly for 3 days." B. "Therapy with warfarin (Coumadin) is effective when your INR is between 2 and 3." C. "Once the health care provider orders warfarin (Coumadin), we will discontinue the intravenous heparin." D. "If bleeding develops, we will give you platelets to reverse the anticoagulant."

The nurse is performing a client assessment for the client's potential employer. The client reports dyspnea when climbing stairs but is not dyspneic at rest. Which dyspnea classification does the nurse assign to this client in the report to the employer? A. Class I, can perform manual labor B. Class II, can perform desk job C. Class III, minimally employable D. Class IV, must remain at home

The nurse is planning care for the non-English-speaking client who is on complete voice rest. What alternative method of communication does the nurse implement? A. Alphabet board B. Picture board C. Translator at the bedside D. Word board

The nurse is providing care to a client with impaired oxygenation related to anemia. Which nursing intervention has the highest priority? A. Administer antibiotics as prescribed. B. Transfuse ordered packed red blood cells. C. Teach pursed-lip breathing. D. Encourage increased fluid intake.

The standard laryngectomy plan of care for a client admitted with laryngeal cancer includes these interventions. Which intervention will be most important for the nurse to accomplish before the surgery? A. Educate the client about ways to avoid aspiration when swallowing after the surgery. B. Establish a means for communicating during the immediate postoperative period, such as a Magic Slate or an alphabet board. C. Discuss appropriate clothing to wear that will help cover the laryngectomy stoma and decrease social isolation after surgery. D. Teach the client and significant others about how to suction and do wound care of the stoma.

What does the nurse do first when setting up a safe environment for the new client on oxygen? A. Ensures that staff members wear protective clothing B. Ensures that no combustion hazards are present in the room C. Sets the oxygen delivery to maintain no fewer than 16 breaths/min D. Uses a pulse oximetry unit

What is the function of the turbinates? A. They decrease the weight of the skull on the neck. B. They increase the surface area of the nose for heating and filtering. C. They move inspired particles from nose to throat for removal. D. They separate two nasal passages down the middle.

When caring for a client with pulmonary embolism (PE), which arterial blood gas results does the nurse anticipate early in the course of the disease? A. pH 7.24, PaCO2 55 mm Hg, HCO3- 26 mEq/L, PaO2 56 mm Hg B. pH 7.46, PaCO2 30 mm Hg, HCO3- 26 mEq/L, PaO2 68 mm Hg C. pH 7.35, PaCO2 45 mm Hg, HCO3- 24 mEq/L, PaO2 80 mm Hg D. pH 7.47, PaCO2 35 mm Hg, HCO3- 30 mEq/L, PaO2 75 mm Hg

When preparing a client newly diagnosed with human immune deficiency virus (HIV) and the significant other for discharge, which explanation by the nurse accurately describes proper condom use? A. "Condoms should be used when lesions are present on the penis." B. "Always position the condom with a space at the tip of an erect penis." C. "Make sure it fits loosely to allow for penile erection." D. "Use adequate lubrication, such as petroleum jelly."

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? A. Clients who work with shellfish B. Men who prefer sex with men C. Clients traveling to a third-world country D. Clients with elevations of aspartate aminotransferase and alanine aminotransferase

When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? A. Having a larger meal early in the morning B. Consuming increased carbohydrates and moderate protein C. Restricting fluids to 1500 mL/day D. Limiting alcoholic beverages to once weekly

Which activity by the nurse will best relieve symptoms associated with ascites? A. Administering oxygen B. Elevating the head of the bed C. Monitoring serum albumin levels D. Administering intravenous fluids

Which assessment finding is of greatest concern in a client with emphysema? A. Barrel-shaped chest B. Bronchial breath sounds heard at the bases C. Hyperresonance to percussion of the chest D. Ribs lying horizontal

Which client does the charge nurse assign to an experienced LPN/LVN? A. A 28-year-old who requires teaching about how to catheterize a Kock ileostomy B. A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy C. A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 D. A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

Which client needs immediate attention by the nurse? A. A 40-year-old who is receiving continuous positive airway pressure and has intermittent wheezing B. A 54-year-old who is mechanically ventilated and has tracheal deviation C. A 57-year-old who was recently extubated and is reporting a sore throat D. A 60-year-old who is receiving O2 by facemask and whose respiratory rate is 24 breaths/min

Which element is a risk factor for osteoarthritis (OA)? A. Thin build B. Obesity C. Nonsmoker D. Male

Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)? A. Feeling tired and having a temperature that runs about 100° F (37.8° C) during the day B. Disfiguring and embarrassing rash C. Peripheral neuropathies and cranial nerve palsies D> High risk for renal inflammation

Which factor relates most directly to a diagnosis of primary immune deficiency? A. History of viral infection B. Full-term infant surfactant deficiency C. Contact with anthrax toxin D. Corticosteroid therapy

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? A. Clients with CD experience about 20 loose, bloody stools daily. B. Clients with UC may experience hemorrhage. C. The peak incidence of UC is between 15 and 40 years of age. D. Very few complications are associated with CD.

Which method is the best way to prevent outbreaks of pandemic influenza? A. Avoiding public gatherings at all times B. Early recognition and quarantine C. Vaccinating everyone with pneumonia vaccine D. Widespread distribution of antiviral drugs

Which nursing activity can the nurse delegate to a home health aide? A. Changing the dressing for a client with a low absolute neutrophil count B. Assisting with bathing for a client with chronic rejection of a liver transplant C. Teaching a client with bacterial pneumonia how to take the prescribed antibiotic D. Assessing incisional tenderness for a client who had a recent kidney transplant

Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? A. Client with group A beta-hemolytic streptococcal pharyngitis who has stridor B. Client with pulmonary tuberculosis who is receiving multiple medications C. Client with sinusitis who has just arrived after having endoscopic sinus surgery D. Client with tonsillitis who has a thick-sounding voice and difficulty swallowing

Which postoperative kidney transplantation client does the nurse assess first for signs and symptoms of hyperacute rejection? A. Older adult with Parkinson disease receiving a donation from an identical twin B. Grand multipara female with a history of subsequent blood transfusions C. Middle-aged man with a 20-pack-year history D. Young adult with type 1 diabetes

Which statement by a client with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction? A. "I don't need to use my oxygen all the time." B. "I don't need to get a flu shot." C. "I need to eat more protein." D. "It is normal to feel more tired than I used to."

Which statement made to the nurse by a health care worker assigned to care for a client with human immune deficiency virus (HIV) indicates a breach of confidentiality and requires further education by the nurse? A. "I told family members they need to wash their hands when they enter and leave the room." B. "The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." C. "Yes, I understand the reasons why I have to wear gloves when I bathe the client." D. "The client's spouse told me she got HIV from a blood transfusion."

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply: A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

B and D. Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

Which components belong to the ventilator bundle approach to prevent ventilator-associated pneumonia (VAP)? (Select all that apply.) A. Administering antibiotic prophylaxis B. Continuous removal of subglottic secretions C. Elevating the head of the bed at least 30 degrees whenever possible D. Handwashing before and after contact with the client E. Placing a nasogastric tube F. Placing the client in a negative-airflow room

B, C, D

The nurse coming on shift prepares to perform an initial assessment of a sedated, ventilated client. Which are priorities for the nurse to carry out? (Select all that apply.) A. Ask visitors to leave. B. Assess the client's color and respirations. C. Confirm alarms and ventilator settings. D. Ensure that the tube cuff is inflated and is in the proper position. E. Listen for bilateral breath sounds. F. Provide routine tracheotomy and endotracheotomy and mouth care.

B, C, D, E

The nurse is assessing a client with possible pulmonary embolism (PE). For which symptoms should the nurse assess? (Select all that apply.) A. Dizziness and fainting B. Shortness of breath (SOB) worsening over the last 2 weeks C. Inspiratory chest pain D. Productive cough E. Pink, frothy sputum

B, C, E

Select all the ways a person can become infected with Hepatitis B: A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

A 30-year-old patient is in the Acute Stage of HIV. What findings below correlate with this stage of HIV? Select all that apply: A. CD4 level <500 cells/mm3 B. No present of Opportunistic Infections C. High viral load D. Patient reports flu-like symptoms E. Patient is asymptomatic

B, C, and D. The Acute Stage of HIV is the first stage and tends to occur a couple of weeks to a month after becoming infected. The patient's viral load is very HIGH during this time, but the CD4 count should be greater than 500 cells/mm3. Therefore, NO opportunistic infections are present during this time (the CD4 count is high enough to fight off these types of infections/diseases). In addition, the patient may report flu-like symptoms (aches, joint pain, headache, fever, fatigue, sore throat, swollen lymph nodes, GI upset, and rash). The patient is usually asymptomatic in the 2nd stage (Chronic Stage of HIV).

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply: A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? A. Abdominal pain relieved by bending the knees B. Chronic diarrhea, abdominal pain, and fever C. Epigastric cramping D. Hypotension with vomiting

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective. A. 2 weeks B. 24 hours C. 1 month D. 7 days

B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection? A. A 45-year-old male with diabetes. B. A 26-year-old female in the 3rd trimester of pregnancy. C. A 12-year-old female with a ventricle septal defect. D. A 63-year-old male with cardiovascular disease.

B. Patients who are in the 3rd trimester of pregnancy are at a HIGH risk of developing a complication related to a Hepatitis E infection.

You're providing education to a patient with AIDS on how to prevent opportunistic infections. Which statement below requires the nurse to re-educate the patient about this topic? A. "I'm traveling to Puerto Rico next week and will be sure to pack bottled water." B. "I've switched to buying raw organic milk." C. "Last month I received the Pneumovax." D. "My neighbor bought a cat last week."

B. Patients with AIDS should AVOID raw, undercooked, and unpasteurized foods and beverages. These items could contain organisms that could cause serious infections to a person with a compromised immune system.

The Human Immunodeficiency Virus (HIV) mainly attacks what type of cells in the human body? A. Red Blood Cells B. CD4 positive cells C. Stem Cells D. Platelets

B. The HIV virus attacks the human body's immune system, specifically the CD4 positive cells...mainly the helper t cells. These cells are white blood cells that help the immune system fight infection.

. The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver. A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver.

A 25-year-old patient reports that they engage in high risk activities that could lead to an HIV infection. The patient's test results show the patient is HIV-negative. The nurse should provide the patient with education about? A. PEP B. PrEP C. Opportunistic Infections D. Nucleic Acid Test (NAT)

B. The nurse should provide the patient with education about PrEP (Pre-Exposure Prophylaxis). These medications are taken BEFORE a possible encounter with HIV, which helps prevent a possible HIV infection. The patient must be HIV-negative before taking these medications.

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as? A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment? A. HCO3 26 mmHg B. Blood pressure 70/45 C. PaO2 80 mmHg D. PaCO2 38 mmH

B. Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and decrease the cardiac output (watch out for a low blood pressure) along with hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs are leaking air).

During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to? A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema

B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.

A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication? A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort. C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order.

B. The patient should use the bronchodilator first which is the Spiriva to open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation.

What sign and symptoms in your patient with HIV indicates the disease is worsening and the immune system is severely compromised? A. Open, oozing lesions around the mouth B. White hair like spots on the side of the tongue C. Cheesy white film on the tonsils and inside cheeks D. Vision changes

B. This is known as oral hairy leukoplakia. It occurs when the immune system is extremely compromised like with HIV and the Epstein-Barr virus. It is a signal the HIV is getting worse.

A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.

B. This is the only correct statement. Option A is wrong because smoking cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong because the patient may develop HIGH LEVELS of red blood cells due to the body trying to compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.

A 48-year-old patient is HIV positive. The patient has no signs and symptoms and has a CD4 count of 400 cells/mm3. In addition, no opportunistic infections or diseases are present. These findings correlate with what stage of HIV? A. Acute B. Chronic/Asymptomatic C. AIDS

B: Chronic. These findings correlate with the Chronic Stage (also called the Asymptomatic Stage) of HIV. Signs and symptoms may not be experienced, the viral load is lower than the Acute Stage, but the virus is still replicating and destroying the cells. The patient can still transmit the virus to others. In addition, the CD4 count should be more than 200 cells/mm3 to about 500 cells/mm3. In addition, no opportunistic infections or diseases should be present.

A client admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this client? A. Applying hydrocortisone cream B. Cleaning the area with soap and hot water C. Using sitz baths three times daily D. Wearing absorbent cotton underwear

A client comes to the emergency department with a productive cough. Which symptom does the nurse look for that will require immediate attention? A. Blood in the sputum B. Mucoid sputum C. Pink, frothy sputum D. Yellow sputum

A client diagnosed with rheumatoid arthritis (RA) is started on methotrexate (Rheumatrex). Which statement made by the client indicates to the nurse that further teaching is needed regarding drug therapy? A. "Drinking alcoholic beverages should be avoided." B. The health care provider should be notified 3 months before a planned pregnancy." C. Any side effects of this drug will be mild." D. "I will avoid any live vaccines."

A client had a thoracentesis 1 day ago. He calls the home health agency and tells the nurse that he is very short of breath and anxious. What is the major concern of the nurse? A. Abscess B. Pneumonia C. Pneumothorax D. Pulmonary embolism

A client has a fever of 104° F (40° C). In which direction, if any, does this shift the oxygen-hemoglobin dissociation curve? A. Down B. To the left C. To the right D. Will not shift

A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices? A. "Drinking carbonated beverages will help with your abdominal distress." B. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." C. "Lactose-containing foods should be reduced or eliminated from your diet." D. "Raw vegetables and high-fiber foods may help to diminish your symptoms."

A client has just arrived in the postanesthesia care unit following a successful tracheostomy procedure. Which nursing action must be taken first? A. Suction as needed. B. Clean the tracheostomy inner cannula and stoma. C. Listen to lung sounds. D. Change the tracheostomy dressing as needed.

A client is 1 day postoperative from a total laryngectomy for cancer. He has indicated to the nurse that he is experiencing pain. Pain management for him is best achieved with which medication? A. IV ketorolac (Toradol) B. IV midazolam (Versed) C. IV morphine sulfate (Morphine) D. Oral acetaminophen (Tylenol)

A client is admitted to the emergency department (ED) with a possible diagnosis of avian influenza ("bird flu"). Which of these actions included in the hospital protocol for avian influenza will the nurse take first? A. Ensure that ED staff members receive oseltamivir (Tamiflu). B. Obtain specimens for the H5 polymerase chain reaction test. C. Place the client in a negative air pressure room. D. Start an IV line and administer rehydration therapy.

A client is admitted to the surgical floor with chest pain, shortness of breath, and hypoxemia after having a knee replacement. What diagnostic test does the nurse expect to help confirm the diagnosis? A. Bronchoscopy B. Chest x-ray C. Computed tomography (CT) scan D. Thoracoscopy

A client who had an earlier bronchoscopy has the following vital signs: heart rate 132 beats/min, respiratory rate 26 breaths/min, and blood pressure 98/50 mm Hg. The client is anxious and his skin is cyanotic. What is the nurse's first action? A. Call the Rapid Response Team. B. Give methylene blue 1% 1 to 2 mg/kg by IV injection. C. Administer oxygen. D. Notify the health care provider immediately.

A client who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? A. Contact the health care provider for tuberculosis (TB) medications. B. Perform a TB skin test. C. Place a respiratory mask on the client. D. Test all family members for TB.

A client who is human immune deficiency virus (HIV) positive and has a CD4+ count of 15 has just been admitted with a fever and abdominal pain. Which health care provider request does the nurse implement first? A. Obtain a 12-lead electrocardiogram (ECG). B. Call for a portable chest x-ray. C. Obtain blood cultures from two sites. D. Give cefazolin (Kefzol) 500 mg IV.

A client who recently underwent total hip arthroplasty and is on anticoagulants is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the client and caregiver? A. Use an abduction pillow between the legs. B. Keep heels off the bed. C. Avoid using a straight razor. D. Re-orient frequently.

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? A. Obtain the charts from the previous admission. B. Listen for bowel sounds in all quadrants. C. Obtain pulse and blood pressure. D. Ask about abdominal pain.

A client with respiratory failure has been intubated and placed on a ventilator and is requiring 100% oxygen delivery to maintain adequate oxygenation. Twenty-four hours later, the nurse notes new-onset crackles and decreased breath sounds, and the most recent arterial blood gases (ABGs) show a PaO2 level of 95 mm Hg. The ventilator is not set to provide positive end-expiratory pressure (PEEP). Why is the nurse concerned? A. The low PaO2 level may result in oxygen toxicity. B. The 100% oxygen delivery requirement indicates immediate extubation. C. Lung sounds may indicate absorption atelectasis. D. The level of oxygen delivery may indicate absorption atelectasis.

A home health client has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the client with self-care? A. Instructing the client about the use of electrolyte-containing oral rehydration products B. Administering loperamide (Imodium) 4 mg from the client's medicine cabinet C. Checking and reporting the client's heart rate and blood pressure in lying, sitting, and standing positions D. Teaching the client how to clean the perineal area after each loose stool

A local hunter is admitted to the intensive care unit with a diagnosis of inhalation anthrax. Which medications does the RN anticipate the health care provider will order? A. Amoxicillin (Amoxil, Triamox) 500 mg orally every 8 hours B. Ceftriaxone (Rocephin) 2 g IV every 8 hours C. Ciprofloxacin (Cipro) 400 mg IV every 12 hours D. Pyrazinamide (Zinamide) 1000 to 2000 mg orally every day

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions? A. "Asthma drugs help everybody breathe better." B. "I must carry my emergency inhaler only when activity is anticipated." C. "I must have my emergency inhaler with me at all times." D. "Preventive drugs can stop an attack."

An obese client is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the client's home health nurse requires immediate action? A. Pain when coughing B. States, "I am too tired to walk very much" C. States, "I feel like the incision is splitting open" D. Temperature of 100.8° F (38.2° C).

Assessment findings reveal that an older adult client with severe osteoarthritis of the left hip can no longer perform activities of daily living (ADLs) and has had several falls in the home over the past month. To which community resource does the nurse refer the client? A. Local senior citizen center B. Citizens for Better Care C. Home health care agency D. Meals on Wheels

Four clients arrive in the emergency department simultaneously with chest pain. The client with which type of chest pain requires immediate attention by the nurse? A. Pain on deep inspiration B. Pain on palpation C. Pain radiating to the shoulder D. Pain that is rubbing in nature

Gas exchange in the lungs occurs in the? A. Bronchioles B. Alveolar sinus C. Alveolar sacs D. Segmental Bronchi

In planning care for a client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority? A. Loss of social contact related to misunderstanding of transmission of acquired secondary immune deficiency and the social stigma B. Mouth sores related to Candida albicans secondary to acquired secondary immune deficiency C. Potential for infection transmission related to recurring opportunistic infections D. High risk for inadequate nutrition related to acquired secondary immune deficiency and Candida albicans

The medical-surgical unit has one negative-airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room? A. Client with bacterial pneumonia and a cough productive of green sputum B. Client with neutropenia and pneumonia caused by Candida albicans C. Client with possible pulmonary tuberculosis who currently has hemoptysis D. Client with right empyema who has a chest tube and a fever of 103.2° F

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? A. Provides enzymes necessary to digest dairy products B. Reduces portal pressure C. Promotes gastrointestinal (GI) excretion of ammonia D. Decreases GI bleeding

The nurse has been teaching improved airflow techniques to the client, who has continued to have restrictive breathing problems. Which is the best indicator of success? A. Peak flowmeter readings that are yellow after the third reading B. Productive cough C. SpO2 level of 92% after ambulating 50 feet D. Stable arterial blood gases (ABGs)

The nurse is assessing a client who underwent nasoseptoplasty 24 hours ago. Which finding requires immediate intervention by the nurse? A. Ecchymosis B. Edema C. Excessive swallowing D. Sore throat

The nurse is caring for a client who is receiving mechanical ventilation and hears the high-pressure alarm. Which action should the nurse take first? A. Check the ventilator alarm settings. B. Assess the set tidal volume. C. Listen to the client's breath sounds. D. Call the respiratory therapist.

The nurse is caring for a group of clients. Which person does the nurse identify as having the highest risk for pulmonary embolism (PE)? A. A client with diabetes and cellulitis of the leg B. A client receiving IV fluids through a peripheral line C. A client returning from an open reduction and internal fixation of the tibia D. A client with hypokalemia receiving potassium supplements

The nurse is caring for a middle-aged client diagnosed with rheumatoid arthritis. Which client statement requires further assessment for unproductive coping strategies? A. "I'm letting my husband do most of the cooking, but I help plan the menus." B. Since I started taking etanercept (Enbrel), I can walk up and down the stairs of my home easier." C. "My husband is getting used to having sex only once a month." D. "I worry about what's going to happen to me if my husband cannot take care of me, but he says he'll hire someone if he must."

The nurse is conducting a health assessment interview with a client diagnosed with human immune deficiency virus (HIV). Which statement by the client does the nurse immediately address? A. "When I injected heroin, I was exposed to HIV." B. "I don't understand how the antiretroviral drugs work." C. "I remember to take my antiretroviral drugs almost every day." D. "My sex drive is weaker than it used to be since I started taking my antiretroviral medications."

The nurse is developing a plan of care for a client with pulmonary embolism (PE). Which client problem does the nurse establish as the priority? A. Inadequate nutrition related to food-drug interactions and anticoagulant therapy B. Potential for infection related to leukocytosis C. Hypoxemia related to ventilation-perfusion mismatch D. Insufficient knowledge related to the cause of PE

The nurse is preparing a client for discharge who has undergone percutaneous needle aspiration of a peritonsillar abscess. Which is most important to teach the client about follow-up care? A. Completing the antibiotic medication regimen B. Taking pain medications every 4 to 6 hours C. Contacting the provider if the throat feels more swollen D. Using warm saline gargles and irrigations

The nurse is teaching a client about cyclosporine (Sandimmune) therapy after liver transplantation. Which client statement indicates the need for further teaching? A. "I will be on this medicine for the rest of my life." B. "I must undergo regular kidney function tests." C. "I must regularly monitor my blood sugar." D. "My gums may become swollen because of this drug."

The nurse is teaching the family of a client who is receiving mechanical ventilation. Which statement reflects appropriate information that the nurse should communicate? A. "Sedation is needed so your loved one does not rip the breathing tube out." B. "Suctioning is important to remove organisms from the lower airway." C. "Paralysis and sedatives help decrease the demand for oxygen." D. "We are encouraging oral and IV fluids to keep your loved one hydrated."

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? A. Client who is taking lactulose and has diarrhea B. Client with hepatitis C who requires a dressing change C. Client with end-stage cirrhosis who needs teaching about a low-sodium diet D. Obtunded client with alcoholic encephalopathy who needs a blood draw

The older adult client with degenerative arthritis is admitted for tracheostomy surgery. What is the best communication method for this client during the postoperative period? A. Computer keyboard B. Magic Slate C. Picture board D. Pen and paper

The trachea splits at the _________ to form the ____________. A. Cricoid cartilage, secondary bronchi B. Thyroid cartilage, primary bronchi C. Carina, primary bronchi D. Hilum, secondary bronchi

What is a normal CD4 count? A. 200-500 cells/mm3 B. 1500-3500 cells/mm3 C. 500-1500 cells/mm3 D. <200 cells/mm3

What is the purpose of wearing fluoride gel trays during radiation therapy of the mouth? A. Keep the mouth moist during treatments B. Keep the teeth from turning yellow after treatment C. Prevent radiation scatter when the beam hits metal in the mouth D. Protect the taste buds on the tongue

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? A. The client must not consume alcohol. B. Avoid sharing the bathroom with the client. C. Members of the household must not share toothbrushes. D. Drink only bottled water and avoid ice.

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? A. Hemoglobin and hematocrit B. Leukocytes C. Alpha-fetoprotein D. Serum albumin

Which critically ill client has the greatest risk for developing acute respiratory distress syndrome (ARDS)? A. Client with diabetic ketoacidosis (DKA) B. Client with atrial fibrillation C. Client with aspiration pneumonia D. Client with acute kidney failure

Which nursing intervention is the priority in preparing a client for pulmonary function testing (PFT)? A. Administer bronchodilator medication on call. B. Encourage clear fluid intake 12 hours before the procedure. C. Ensure no smoking 6 hours before the test. D. Provide supplemental oxygen as testing begins.

Which problem for a client with cirrhosis takes priority? A. Insufficient knowledge related to the prognosis of the disease process B. Discomfort related to the progression of the disease process C. Potential for injury related to hemorrhage D. Inadequate nutrition related to an inability to tolerate usual dietary intake

Which statement indicates to the nurse that a client with fibromyalgia syndrome is using a complementary therapy to help relieve symptoms? A. "My Thera-Band really helps me loosen up my arms." B. "The brace on my lower leg is helping me walk better." C. "Focusing on the slow stretching movements and my breathing in tai chi helps me relax." D. Water aerobic exercises have helped me sleep better."

Which value indicates clinical hypoxemia and the need to increase oxygen delivery? A. Hemoglobin of 22 g/dL B. PaCO2 of 30 mm Hg C. PaO2 of 65 mm Hg D. Oxygen saturation of 88%

You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)? A. The patient is experiencing bradypnea. B. The patient is tired and confused. C. The patient's PaO2 remains at 45 mmHg. D. The patient's blood pressure is 180/96.

C A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.

Which statement below best describes the role of reverse transcriptase? A. It's an enzyme that helps cut up the long protein chains of HIV. B. It plays a key role in the maturity of the virus. C. Reverse transcriptase is an enzyme that turns viral RNA into viral DNA. D. Reverse transcriptase is an enzyme that allows the viral DNA to become part of the cell's DNA.

C Reverse transcriptase is an enzyme that turns viral RNA into viral DNA.

A client with ulcerative colitis is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the client's medication regimen? A. Corticosteroid therapy will be stopped. B. Sulfasalazine (Azulfidine) will be stopped. C. Corticosteroid therapy will be tapered. D. Sulfasalazine (Azulfidine) will be tapered.

C Sulfasalazine helps with inflammation

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply: A. Water B. Food C. Semen D. Blood

C and D. The most common source for transmission of Hepatitis A is water and food.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply: A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

C and D. The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

The Human Immunodeficiency Virus (HIV) can NOT be spread in what type of fluid below? Select all that apply: A. Breastmilk B. Blood C. Tears D. Semen E. Vaginal Fluid F. Sweat

C and F. HIV can NOT be spread in tears or sweat (unless blood is present which rarely occurs). HIV is spread in the following fluids: breastmilk, blood, semen, and vaginal fluid.

When assessing a client with hepatitis B, the nurse anticipates which assessment findings? (Select all that apply.) A. Recent influenza infection B. Brown stool C. Tea-colored urine D. Right upper quadrant tenderness E. Itching

C, D, E

As the nurse you know that acute respiratory distress syndrome (ARDS) can be caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS: A. Drowning B. Aspiration C. Sepsis D. Blood transfusion E. Pneumonia F. Pancreatitis

C, D, F Indirect causes are processes that can cause inflammation OUTSIDE of the lungs....so the issue arises somewhere outside the lungs. Therefore, sepsis (infection...as long as it is outside the lungs), blood transfusion, and pancreatitis are INDIRECT causes. Drowning, aspiration, and pneumonia are issues that arise in the lungs (therefore, they are DIRECT causes of lung injury).

The nurse is instructing an unlicensed health care worker on the care of a client with human immune deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker indicates effective teaching of Standard Precautions? 1. "I need to know my HIV status, so I must get tested before caring for any clients." 2. "Putting on a gown and gloves will cover up the itchy sores on my elbows." 3. "Washing my hands and putting on a gown and gloves is what I must do before starting care." 4. "I will wash my hands before going into the room, and then will put on a gown and gloves only for direct contact with the client's genitals."

Which statement below is not true regarding the role of the helper t cell? A. The helper T cell releases cytokines to help activate other immune system cells. B. The helper T cell is part of the adaptive immune system. C. The helper T cell is cytotoxic and kills invaders. D. The helper T cell has CD4 receptors found on its surface.

C. All the other options are true statements about the helper T cell. Option C is NOT true. Helper T cells are not cytotoxic and kill invaders (this is another type of t cells called cytotoxic t cell). Helper T cells are "helpers" in that they HELP the immune system by releasing cytokines, which help activate other immune system cells.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

C. Hand hygiene can help prevent ALL types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Remember Hepatitis A and E are spread only via fecal-oral routes.

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful? A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).

A patient with HIV is prescribed to start antiretroviral therapy. The nurse is providing education about these medications. Which statement below by the patient indicates they need re-education on these medications? A. "If I take these medications as prescribed my viral load will become undetectable, and I have a low risk of transmitting the virus to others." B. "Drug resistance is likely to develop if I'm non-compliant with my medications." C. "I currently take a medication called St. John's Wort to treat depression." D. "This therapy does not cure me from HIV but helps me live a healthier and longer life."

C. Patients who take ART should be educated about how these medications can interact with over-the-counter medications, especially herbal supplements like St. John's Wort. This medication is used to treat depression. The patient should be re-educated about this topic.

Which patient below is at MOST risk for developing ARDS and has the worst prognosis? A. A 52-year-old male patient with a pneumothorax. B. A 48-year-old male being treated for diabetic ketoacidosis. C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection. D. A 30-year-old female with cystic fibrosis.

C. Sepsis is the MOST common cause of ARDS because of systemic inflammation experienced. This is also true if the cause of the sepsis is a gram-negative bacterium (this also makes the infection harder to treat...hence poor prognosis). With sepsis, the immune cells that are present with the inflammation travel to the lungs and damage the alveolar capillary membrane leading to fluid to leak in the alveolar sacs.

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is? A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

A patient has been hospitalized in the ICU for a near drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS? A. infiltrates only on the upper lobes B. enlargement of the heart with bilateral lower lobe infiltrates C. white-out infiltrates bilaterally D. normal chest x-ray

C. This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.

The term" blue bloaters" is used to describe patients with? A. Pulmonary hypertension B. Left-sided heart failure C. Chronic Bronchitis D. Emphysema

C. "Blue bloaters" is used to describe patients with chronic bronchitis, and the term "pink puffers" is used to describe patients with emphysema

C. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.

A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia

C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels).

A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD? A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax

C. The key words to let you know the patient is experiencing chronic bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is sometimes referred to as "blue bloaters".

C. This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.

What is the greatest risk factor for lung cancer? Alcohol consumption Asbestos exposure Cigarette smoking Smoking marijuana

CIGARETTE SMOKING

The nurse auscultates popping, discontinuous sounds over the client's anterior chest. How does the nurse classify these sounds? Crackles Rhonchi Pleural friction rub Wheeze

CRACKLES

What do you call right ventricular enlargement that occurs with pulmonary HTN?

Cor Pulmonale- Heart has to pump against the resistance of the stiff lungs creating Right ventricle to enlarge and weaken- R. side HF

A client comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first? A. Chest x-ray B. Complete blood count (CBC) C. Tuberculosis (TB) skin test D. Throat culture

A client demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention? A. Assessing the client for changes in vital signs B. Medicating the client for pain C. Monitoring for changes in the client's mentation D. Preparing the client for emergency surgery

A client has an anal fissure. Which intervention most effectively promotes perineal comfort for the client? A. Administering a Fleet's enema when needed B. Applying heat to acute inflammation for pain relief C. Avoiding the use of bulk-forming agents D. Using hydrocortisone cream to relieve pain

A client has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this client? A. Mucolytics decrease secretion production. B. Mucolytics increase gas exchange in the lower airways. C. Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease. D. Mucolytics thin secretions, making them easier to expectorate.

A client has been diagnosed with oral and laryngeal cancer. He completed a course of radiation, and it is 2 days since he underwent a total laryngectomy. The client had been very anxious about his surgery. Which medications does the nurse expect to find on his home medication list? A. Amitriptyline (Elavil) B. Diazepam (Valium) C. Ketorolac (Toradol) D. Lorazepam (Ativan)

A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy. Which nursing task is best for the charge nurse to delegate to the experienced nursing assistant working in the PACU? A. Assess breath sounds. B. Check gag reflex. C. Determine level of consciousness. D. Monitor blood pressure and pulse.

A client is admitted with asthma. How is this disease differentiated from other chronic lung disorders? A. It affects only young people. B. The client has dyspnea. C. The client is coughing. D. The client is symptom-free between exacerbations.

A client was intubated 30 minutes ago for acute respiratory distress syndrome and possible sepsis. The following orders have been given for the client. In what sequence would the nurse perform these orders for this client? 1. Infuse levofloxacin (Levaquin) 500 mg IV.2. Obtain baseline aerobic and anaerobic sputum cultures.3. Teach the client and family methods of communicating.4. Analyze postintubation arterial blood gases (ABGs). A. 2, 1, 3, 4 B. 4, 3, 1, 2 C. 3, 4, 2, 1 D. 4, 2, 1, 3

A client who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The client tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? A. A list of medical supply facilities where wound care supplies may be purchased B. Proper handwashing techniques to avoid cross-contamination of the client's wound C. The amount of pain medication that the client is allowed to take in each dose D. Written and oral instructions regarding symptoms to report to the health care provider

A client who has experienced a panic attack is being transferred to the medical-surgical ward. The transfer nurse reports that the client is doing much better after receiving bronchodilators via nebulizer and a small dose of oral diazepam (Valium) 4 hours ago in the emergency department. Vital signs are stable with oxygen delivered at 4 L/min via simple facemask. Why is this client at high risk for subsequent respiratory distress? A. The client is not being treated for asthma. B. The client has a mental disorder. C. The client received a dose of Valium. D. The client is receiving oxygen at 4 L/min.

A client with a new tracheostomy has a soiled dressing. What is the best nursing intervention? A. Cut a sterile 4 × 4 gauze to fit around the tracheostomy tube. B. Reinforce the dressing with a sterile 4 × 4 gauze. C. Replace the dressing with a clean, folded 4 × 4 gauze. D. Replace the dressing with a sterile, folded 4 × 4 gauze.

A client with an acquired immune deficiency is seen in the clinic for re-evaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider? A. Therapeutic highly active antiretroviral therapy (HAART) level B. Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot C. Positive Papanicolaou (Pap) test D. Improved CD4+ T-cell count and reduced viral load

A client's mother asks what is the most important thing she will need to know to care for her son, who is having an inner maxillary fixation completed as an outpatient. What does the nurse tell her? A. "Give him Phenergan (promethazine) by rectum around the clock so he does not vomit." B. "He can only drink milk and eat ice cream until the wires come off." C. "He must brush his teeth every 2 hours." D. "Make sure he always has wire cutters with him."

A complete blood count with differential is performed in a client with chronic sinusitis. Which finding does the nurse expect? A) Segmented neutrophils, 62% B) Lymphocytes, 28% C) Bands, 5% D) Basophils, 4%

A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? A. Requesting vaccination for hepatitis A B. Using a needleless system in daily work C. Getting the three-part hepatitis B vaccine D. Requesting an injection of immunoglobulin

A new client arrives in the medical-surgical unit with a flap after a total laryngectomy. The flap appears dusky in color. What is the nurse's first action? A. Apply a hot pack over the flap site. B. Massage the flap site vigorously. C. Place a tight dressing over the flap. D. Use a Doppler device to assess flow to the area.

A newly diagnosed client with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do? A. Nothing. This is in the green zone. B. Provide the rescue drug and reassess. C. Provide the rescue drug and seek emergency help. D. Repeat the peak flow test.

A patient with AIDS has dark purplish brown lesions on the mucus membranes of the mouth. As the nurse you know these lesions correlate with what type of opportunistic disease? A. Epstein-Barr Virus B. Herpes Simplex Virus C. Cytomegalovirus D. Kaposi's Sarcoma

A patient, who is in the Chronic Stage of HIV, has a CD4 count ordered. What does this test measure? A. Red blood cells B. B cells C. Cytotoxic T cells D. Helper T cells

An 80-year-old client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider request does the nurse implement first? A. Administer acetaminophen (Tylenol) 650 mg rectally. B. Draw blood for a complete blood count and serum electrolytes. C. Obtain a stool specimen for culture and sensitivity. D. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr

An environmental assessment of a factory finds inhalation exposure with a high level of particulate matter. What does the factory nurse do to generate the quickest compliance? A. Encourages proper building ventilation B. Refers workers to a tobacco cessation program C. Suggests that workers find another job D. Teaches workers how to use a mask

An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which client does the charge nurse assign to the float nurse? A. A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula B. A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas C. A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir D. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

Community health nurses are tasked with providing education on prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority? A. Homeless people B. Hospital staff C. Politicians D. Prison staff and inmates

Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the heath care provider? A. The dressing has a 2-cm area of serous drainage. B. The client's platelet count is 135,000/mm3. C. The client's albumin level is 2.8 mg/dL. D. The client's heart rate is 122 beats/min.

How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? A. Provides small frequent meals for the client B. Suggests taking daily potassium supplements C. Elevates the head of the bed in high-Fowler's position D. Requests a bedside commode for the client

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? A. Right shoulder pain B. Polyuria C. Bone marrow suppression D. Bleeding

Respirations of a sedated client with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressures. The ventilator tube is clear. What is the best immediate action by the nurse? A. Humidifying the oxygen source B. Increasing oxygenation C. Removing the inner cannula of the tracheostomy D. Suctioning the client

The RN and the LPN/LVN are working together to provide care for a client hospitalized with dyspnea who requires all of these nursing actions. Which action is best accomplished by the RN? A. Administer the purified protein derivative for tuberculosis testing. B. Assess vital signs and the puncture site after thoracentesis. C. Monitor oxygen saturation using pulse oximetry every 4 hours. D. Plan client and family teaching regarding upcoming pulmonary function testing.

The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing skin integrity and abdominal distention B. Drawing blood from a central venous line for electrolyte studies C. Evaluating laboratory study results for the presence of hypokalemia D. Placing the client in a semi-Fowler's position

The nurse answers a client's call light and realizes that the client has an upper airway obstruction. What is the nurse's first action? A. Attempt to remove the obstruction. B. Call the Rapid Response Team to intubate immediately. C. Call the Rapid Response Team to perform an emergency cricothyroidotomy. D. Determine the cause of the obstruction.

The nurse has taught a client about influenza infection control. Which client statement indicates the need for further teaching? A. "Handwashing is the best way to prevent transmission." B. "I should avoid kissing and shaking hands." C. "It is best to cough and sneeze into my upper sleeve." D. "The intranasal vaccine can be given to everybody in the family."

The nurse is caring for a client who was discharged 3 weeks ago after a diagnosis of pulmonary embolism (PE). He is currently admitted with gastrointestinal (GI) bleeding and an international normalized ratio (INR) of 6.9. For which factors should the nurse assess this client? A. Consumption of green leafy vegetables B. Prolonged exhalation C. Client has massaged his calves D. Use of aspirin or salicylates

The nurse is caring for a client with severe acute respiratory syndrome. What is the most important precaution the nurse should take when preparing to suction this client? A. Keeping the head of the bed elevated 30 to 45 degrees B. Performing oral care after suctioning the oropharynx C. Washing hands and donning gloves prior to the procedure D. Wearing a disposable particulate mask respirator and protective eyewear

The nurse is developing a teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? A. Begin a running program. B. Take up knitting to slow down joint degeneration. C. Eat at least 2 cups of yogurt per day. D. Wear supportive shoes.

The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. How will the nurse administer the oxygen for this client? A. By nasal cannula at a rate of no more than 1 to 3 L/min B. By nasal cannula at a rate of no more than 2 to 4 L/min C. By Venturi mask at a rate of at least 60% D. By maintaining oxygen saturations greater than 88%

The nurse is preparing to admit an adult client with pertussis. Which symptom does the nurse anticipate finding in this client? A. "Whooping" after a cough B. Hemoptysis C. Mild cold-like symptoms D. Post-cough emesis

The nurse is reviewing the medication history for a client diagnosed with rheumatoid arthritis (RA) who has been ordered to start sulfasalazine (Azulfidine) therapy. The nurse plans to contact the health care provider if the client has which condition? A. Glaucoma B. Hypertension C. Hypothyroidism D. Sulfa allergy ]

The nurse is working in an urgent care clinic. Which client needs to be evaluated first by the nurse? A. Client who is short of breath after walking up two flights of stairs B. Client with soreness of the arm after receiving purified protein derivative (Mantoux) skin test C. Client with sore throat and fever of 102.2° F (39° C) oral D. Client who is speaking in three-word sentences and has an SpO2 of 90% by pulse oximetry

The nurse manager at a long-term-care facility is planning care for a client who is receiving radiation therapy for laryngeal cancer. Which of these tasks will be best to delegate to a nursing assistant? A. Administering throat-numbing lozenges B. Assessing the mouth for inflammation and infection C. Teaching about skin care while receiving radiation D. Washing the skin with soap and water

The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do? A. Ensures that the client is wearing a mask B. Tells the visitor that the client cannot receive visitors at this time C. Provides a particulate air respirator to the visitor D. Provides a mask to the visitor

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? A. Vitamin K-containing products B. Potassium-sparing diuretics C. Nonabsorbable antibiotics D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which client does the charge nurse on the medical unit assign to an RN who has floated from the postanesthesia care unit (PACU)? A. Client with allergic rhinitis scheduled for skin testing B. Client with emphysema who needs teaching about pulmonary function testing C. Client with pancreatitis who needs a preoperative chest x-ray D. Client with pleural effusion who has had 1200 mL removed by thoracentesis

Which clinical manifestation in the client with facial trauma is the nurse's first priority? A. Bleeding B. Decreased visual acuity C. Pain D. Stridor

Which clinical manifestation requires immediate action by the nurse for a client with laryngeal trauma? A. Aphonia B. Hemoptysis C. Hoarseness D. Tachypnea

Which home health nurse should the nurse manager assign to care for an 18-year-old client with a kidney transplant who has many questions about the prescribed cyclosporine (Sandimmune)? A. RN who has worked for the home health agency for 5 years in maternal-child health B. RN who has extensive critical care nursing experience and has worked in home health for a year C. RN who transferred to the home health agency after working for 10 years in an outpatient dialysis unit D. RN who worked for 5 years in an organ transplant unit and has recently been hired by the home health agency

Which intervention is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today? A. Measure and record drainage. B. Monitor aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. C. Obtain informed consent for the procedure. D. Have the client void before the procedure is performed.

Which statement best exemplifies a client's protection from cancer provided by cell-mediated immunity (CMI) after exposure to asbestos? A) Cytotoxic and cytolytic T cells destroy cells that contain the major histocompatibility complex of a processed antigen. B) Helper and inducer T cells recognize self cells versus non-self cells and secrete lymphokines that can enhance the activity of white blood cells. C) Suppressor T cells prevent hypersensitivity when a client is exposed to non-self cells or to proteins. D) Balance elicits protection when helper or inducer T cells outnumber suppressor T cells by a ratio of 2:1.

Which statement by a client with a laryngectomy indicates a need for further discharge teaching? A. "I must avoid swimming." B. "I can clean the stoma with soap and water." C. "I can project mucus when I laugh or cough." D. "I can't put anything over my stoma to cover it."

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A. "Cirrhosis is a chronic disease that has scarred my liver." B. "The scars on my liver create problems with blood circulation." C. "Because of the scars on my liver, blood clotting and blood pressure are affected." D. "My liver is scarred, but the cells can regenerate themselves and repair the damage."

You're precepting a nursing student who is assisting you care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your response is: A. "This pressure setting assists the patient with breathing in and out and helps improve air flow." B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs." C. "This pressure setting helps prevent fluid from filling the alveoli sacs." D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation."

_____________ delivers unoxygenated blood to the lungs. A. Pulmonary vein B. Aorta C. Left ventricle D. Pulmonary artery

Which statement below is not a true statement about Antiretroviral Treatment? A. "The patient starts out taking 3 medications from at least 2 drug classes." B. "ART decreases the amount of virus in the blood within about 6 months." C. "ART helps decrease the risk of developing an opportunistic infection." D. "Antiretroviral medications are taken when signs and symptoms appear and then tapered off."

D This option is false and all the others are true regarding ART. ART must be taken EXACTLY as prescribed (everyday, at the same time, at the right dosage etc.). It is not taken when signs and symptoms appear and tapered off. If ART is not taken as prescribed or doses are missed, drug resistance can develop. In other words, the medications will stop being effective against the HIV.

The patient is prescribed to take Enfuvirtide (Fuzeon). The nurse prepares to administer this medication via? A. Intravenous route B. Oral route C. Topical Route D. Subcutaneous Route

D Interferons typically given SQ may cause flu-like symptoms and risk of infection

The nurse is teaching a client about the difference between rheumatoid arthritis (RA) and osteoarthritis (OA). Which statement by the client indicates a need for further teaching? A. "RA is inflammatory. OA is degenerative." B. "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." C. "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in clients older than 60 years." D. "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."

D TIP *Even if you didn't know the difference in RA vs OA, look at the answers that are similar and pick the different one

The nurse is caring for a postoperative client with total joint arthroplasty. What actions does the nurse take to prevent venous thromboembolism (VTE) postoperatively? (Select all that apply.) A. Massage the legs. B. Keep the legs slightly abducted. C. Use the knee gatch on the bed. D. Apply elastic stockings. E. Administer anticoagulants.

D, E

A client with a tracheostomy is at increased risk for aspiration. Which nursing interventions will reduce this risk? (Select all that apply.) A. Encourage frequent sipping from a cup. B. Encourage water with meals. C. Inflate the tracheostomy cuff during meals. D. Maintain the client upright for 30 minutes after eating. E. Provide small, frequent meals. F. Teach the client to "tuck" the chin down in the forward position to swallow.

D, E, F

A client who smokes is being discharged home on oxygen. The client states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response? A. "You can quit when you are ready." B. "It's never too late to quit." C. "Just turn off your oxygen when you smoke." D. "You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous."

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B? A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

Which patient below is a candidate for PEP (Post-exposure Prophylaxis)? A. A 32-year-old patient who reports sharing IV drug injection devices with a person who is HIV-positive 5 days ago. B. A 28-year-old patient who engages in high risk activities on a regular basis that could lead to an HIV infection. C. A 55-year-old who is HIV-positive. D. A 30-year-old who was sexually assaulted two days ago.

D. PEP (post-exposure prophylaxis) is medication that is taken AFTER an encounter with an HIV infected person. These medications can help prevent becoming infected with HIV, if started within 72 HOURS of the exposure (option A is not a candidate). These medications are NOT for routine usage but for emergencies (sexual assault, needle stick etc.). If a patient is at high risk (as with the patient in option B), they should consider PrEP (pre-exposure prophylaxis). PEP is taken for 28 days.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient? A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition? A. "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs." B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs." C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space." D. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

D. ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. Option A describes cystic fibrosis, option B describes COPD, and option C describes a pneumothorax.

You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following: A. Increase the breathing rate to prevent hypoxemia B. Decrease the use of the abdominal muscles C. Encourages the use of accessory muscles to help with breathing D. Strengthen the diaphragm

D. Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm.

What is the MOST common transmission route of Hepatitis C? A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

D. IV drug use is the MOST common transmission route of Hepatitis C.

D. This setting of PEEP (it can range between 10 to 20 mmHg of water) and it helps to open the alveoli sacs that are collapsed, especially during exhalation.

A client is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? Ethambutol Isoniazid Pyrazinamide Rifampin

Ethambutol

True or False: COPD is reversible and tends to happens gradually. True False

FALSE. COPD IRREVERSIBLE and tends to happens gradually.

True or False: During inhalation, the diaphragm contracts upward to create positive pressure in the chest which allows the body to inhale oxygen. True False

FALSE. During inhalation, the diaphragm contracts DOWNWARD to create NEGATIVE pressure in the chest which allows the body to inhale oxygen.

True or False: The left lung has three lobes and the right lung has two lobes. True False

FALSE. The right lung has THREE lobes and the left lung has TWO lobes.

Which symptom of pneumonia may present differently in the older adult than in the younger adult? Crackles on auscultation Fever Headache Wheezing

Fever

What is the term for the opening between the vocal cords? Arytenoid cartilage Epiglottis Glottis Palatine tonsils

GLOTTIS

A client has asthma that gets worse during the summer. She tells the nurse that she takes a medication every day so she does not get short of breath when she walks to work. About which medicine does the nurse need to educate the client? Albuterol (Proventil) inhaler Guaifenesin (Organidin) Montelukast (Singulair) Omalizumab (Xolair)

MONTELEUKAST

The client is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler? Corticosteroids Long-acting beta agonists Nonsteroidal anti-inflammatory drugs (NSAIDs) Short-acting beta agonists

SHORT ACTING

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route? A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

The answer is C. This medication is administered subq.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is? A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

The answer is D. Hepatitis A is most commonly transmitted via the fecal-oral route.

Select all the types of viral Hepatitis that have preventive vaccines available in the United States? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

The answers are A and B. Currently there is only a vaccine for Hepatitis A and B in the U.S.

TRUE OR FALSE: The Center for Disease Control and Prevention (CDC) recommends that all people between the ages of 13-64 be tested at least once for HIV during a routine health visit, regardless of risk factors. True False

True

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear. True False

True

A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I just feel like ending it all." You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect: A. Atrovent B. Prednisone C. Monteleukast D. Theophylline

Interstitial Lung Dx is an example of a restrictive or obstructive lung dx?

restrictive- hard to breath IN due to stiff lungs

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) 1. Prolonged partial thromboplastin time 2. Icterus of skin 3. Swollen abdomen 4. Elevated magnesium 5. Currant jelly stool 6. Elevated amylase level

1, 2, 3

The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? 1. Positive Babinski's sign 2. Hyperreflexia 3. Kehr's sign 4. Asterixis

A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. What is the primary cause of the client's ascites? 1 A decrease in vitamins to maintain cell coenzyme functions 2 A decrease in iron to maintain adequate hemoglobin synthesis 3 A decrease in sodium to maintain its concentration in tissue fluid 4 A decrease in plasma protein to maintain adequate capillary-tissue circulation

4 Malnutrition and liver damage lead to a reduced serum albumin level and failure of the capillary fluid shift mechanism, resulting in ascites. Vitamins are unrelated to ascites. Iron promotes hemoglobin synthesis, which is unrelated to cirrhosis. The sodium level usually is excessive with cirrhosis.

A "do not resuscitate" (DNR) client has a non-rebreather oxygen mask, and breathing appears to be labored. What does the nurse do first? A. Ensure that the tubing is patent and that oxygen flow is high. B. Notify the chaplain and the family member of record. C. Call the Rapid Response Team and prepare to intubate. D. Comfort the client and confirm that signed DNR orders are in the chart.

A 70-year-old client has a complicated medical history, including chronic obstructive pulmonary disease. Which client statement indicates the need for further teaching about the disease? A. "I am here to receive the yearly pneumonia shot again." B. "I am here to get my yearly flu shot again." C. "I should avoid large gatherings during cold and flu season." D. "I should cough into my upper sleeve instead of my hand."

A client admitted for sleep apnea asks the nurse, "Why does it seem like I wake up every 5 minutes?" What is the nurse's best response? A. "Because your body isn't getting rid of carbon dioxide. This is what stimulates your body to wake up and breathe." B. "Because your body isn't getting enough oxygen. Not getting enough oxygen is what stimulates you to wake up and breathe." C. "Because your tongue may be blocking your throat, and you wake up because you are choking." D. "It isn't really that often. It just feels that way."

A client diagnosed with ulcerative colitis is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? A. "Be aware of the symptoms of toxic megacolon that we discussed." B. "If diarrhea increases, you should let your health care provider know." C. "Pregnancy should be avoided." D. "You will need to decrease your dose of sulfasalazine (Azulfidine)."

A client has just been admitted to the emergency department and requires high-flow oxygen therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device should the nurse use initially? A. Face tent B. Venturi mask C. Nasal cannula D. Non-rebreather mask

A client has just been admitted to the intensive care unit after having a left lower lobectomy with a video-assisted thoracoscopic surgery. Which of these requests will the nurse implement first? A. Adjust oxygen flow rate to keep O2 saturation at 93% to 100%. B. Administer 2 g of cephalothin (Keflin) IV now. C. Give morphine sulfate 4 to 6 mg IV for pain. D. Infuse 1 unit of packed red blood cells (PRBCs) over the next 2 hours.

A client has received packing for a posterior nosebleed. In reviewing the client's orders, which order does the nurse question? A. "Give ibuprofen 800 mg every 8 hours as needed for pain." B. "Encourage bedrest, with the head of the bed elevated 45 to 60 degrees." C. "Provide humidified air." D. "Suction at the bedside."

A client is admitted to the medical floor with a new diagnosis of lung cancer. How does the nurse assist the client initially with the anxiety associated with the new diagnosis? A. Encourage the client to ask questions and verbalize concerns. B. Leave the client alone to deal with his or her own feelings. C. Medicate the client with diazepam (Valium) for anxiety every 8 hours. D. Provide journals about cancer treatment.

A client is being admitted for pneumonia. The sputum culture is positive for streptococcus, and the client asks about the length of the treatment. On what does the nurse base the answer? A. The client will be treated for 5 to 7 days. B. The client will require IV antibiotics for 7 to 10 days. C. The client will complete 6 days of therapy. D. The client must be afebrile for 24 hours.

A client is being discharged home with a tracheostomy. Which statement by the client indicates the need for further teaching about correct tracheostomy care? A. "I can only take baths, but no showers." B. "I can put normal saline in my tracheostomy to keep the secretions from getting thick." C. "I should put cotton or foam over the tracheostomy hole." D. "I will have to learn to suction myself."

A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse? A. "With this treatment, I probably cannot spread this virus to others." B. "This treatment does not kill the virus." C. "This medication prevents the virus from replicating in my body." D. "Research has shown the effectiveness of this therapy if I do not forget to take any doses."

A client is scheduled for discharge after surgery for inflammatory bowel disease. The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and the spouse with regard to the client's home care? A. Ability of the client and spouse to perform incision care and dressing changes B. Effective coping mechanisms for the client and spouse after the surgical experience C. Knowledge about the client's requested pain medications D. Understanding of the importance of keeping scheduled follow-up appointments

A client recently diagnosed with human immune deficiency virus (HIV) is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client?A. Fluconazole (Diflucan) B. Trimethoprim/sulfamethoxazole (Bactrim) C. Rifampin (Rifadin) D. Acyclovir (Zovirax)

A client who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the client? A. Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Zinamide), ethambutol (Myambutol) B. Metronidazole (Flagyl), acyclovir (Zovirax), flunisolide (AeroBid), rifampin (Rifadin) C. Prednisone (Prednisone), guaifenesin (Organidin), ketorolac (Toradol), pyrazinamide (Zinamide) D. Salmeterol (Serevent), cromolyn sodium (Intal), dexamethasone (Decadron), isoniazid (INH)

A client who has had a recent laryngectomy continues to report pain. Which medication would be best used as an adjunct to a narcotic once the client can take oral nutrition? A. Liquid nonsteroidal anti-inflammatory drugs (NSAIDs) B. Liquid steroids C. Opioid antagonists D. Oral diazepam

A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? A. Colon cancer with metastasis to the liver B. Hypertension C. Hepatic encephalopathy D. Ascites and shortness of breath

A client with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the client's care does the nurse make certain to discuss with the health care provider before the client's discharge? A. Having a home health consultation for wound care B. Requesting an antianxiety medication C. Requesting pain medication for the client's osteoarthritis D. Placing the client in a skilled nursing facility for rehabilitation

A client with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first? A. Albuterol (Proventil) 2 inhalations B. Fluticasone (Flovent) 2 inhalations C. Ipratropium (Atrovent) 2 inhalations .D. Salmeterol (Serevent) 2 inhalations

A client with asthma reports shortness of breath. What is the nurse assessing when auscultating this client's chest? A. Adventitious breath sounds B. Fremitus C. Oxygenation status D. Respiratory excursion

A client with chronic obstructive pulmonary disease has a physician's prescription stating, "Adjust oxygen to keep SpO2 at 90% to 92%." Which nursing action can be delegated to a nursing assistant working under the supervision of an RN? A. Adjust the position of the oxygen tubing. B. Assess for signs and symptoms of hypoventilation. C. Change the O2 flow rate to keep SpO2 as prescribed. D. Choose which O2 delivery device should be used for the client.

A client with laryngeal cancer is admitted to the medical-surgical unit the morning before a scheduled total laryngectomy. Which preoperative intervention can be accomplished by an LPN/LVN working on the unit? A. Administering preoperative antibiotics and anxiolytics B. Assessing the client's nutritional status and need for nutrition supplements C. Having the client sign the operative consent form D. Teaching the client about the need for tracheal suctioning after surgery

A client with sleep apnea who has a new order for continuous positive airway pressure (CPAP) with a facemask returns to the outpatient clinic after 2 weeks with a report of ongoing daytime sleepiness. Which action should the nurse take first? A. Ask the client whether CPAP has been used consistently at night. B. Discuss the use of autotitrating positive airway pressure (APAP). C. Plan to teach the client about treatment with modafinil (Provigil). D. Suggest that a nasal mask be used instead of a full facemask.

A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? A. "It is usually ready to be closed in about 1 to 2 months." B. "This is something that you will have to discuss with your health care provider." C. "The period of time is indefinite—I am sorry that I cannot say." D. "You will probably have it for 6 months or longer, until things heal.

A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? A. "A change in position may be what is needed for you to have intercourse with your wife." B. "Have you considered going to see a marriage counselor with your wife?" C. "What has your wife said about your pouch system?" D. "You must get clearance from your health care provider before you attempt to have intercourse."

A newly hired RN with no previous emergency department (ED) experience has just completed a 1-month orientation. Which of these clients would be most appropriate to assign to this nurse? A. Client on warfarin (Coumadin) with epistaxis with profuse bleeding B. Client with facial burns caused by a mattress fire while sleeping C. Client with possible facial fractures after a motor vehicle collision (MVC) D. Client with suspected bilateral vocal cord paralysis and stridor

A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client? A. "Avoid large crowds and anyone who is sick." B. "Do not take the medication if you are allergic to foods with fatty acids." C. "Expect difficulty with wound healing while you are taking this drug." D. "Monitor your blood pressure and report any significant decrease in it."

After surgery for placement of a chest tube, the client reports burning in the chest. What does the nurse do first? A. Assess the airway, breathing, and circulation. B. Call for the Rapid Response Team. C. Check the patency of the chest tubes. D. Listen for breath sounds.

All of these clients are being cared for on the intensive care stepdown unit. Which client should the charge nurse assign to an RN who has floated from the pediatric unit? A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask. B. Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour. C. Client with emphysema who requires instruction about correct use of oxygen at home. D. Client with lung cancer who has just been transferred from the intensive care unit after having a left lower lobectomy the previous day.

All of these nursing actions are included in the plan of care for a client who has just been extubated. Which action should the nurse delegate to unlicensed assistive personnel (UAP)? A. Keep the head of the bed elevated. B. Teach about incentive spirometer use. C. Monitor vital signs every 5 minutes. D. Adjust the nasal oxygen flow rate.

An RN from the orthopedic unit has been floated to the medical unit. Which client assignment for the floated RN is the best? A. The client with a resolving pulmonary embolus who is receiving oxygen at 6 L/min through a nasal cannula B. The client with chronic lung disease who is being evaluated for possible home oxygen use C. The client with a newly placed tracheostomy who is receiving oxygen through a tracheostomy collar D. The client with chronic bronchitis who is receiving oxygen at 60% through a Venturi mask

An emergency nurse is preparing to care for a client arriving by ambulance after a motor vehicle crash. The client has severe facial and neck injuries and emergency airway measures have been taken. Which type of airway does the nurse prepare for? A. Cricothyroidotomy B. Endotracheal intubation C. Nasal bi-level positive airway pressure (BiPAP) D. Tracheotomy

An older adult resident in a long-term-care facility becomes confused and agitated, telling the nurse, "Get out of here! You're going to kill me!" Which action will the nurse take first? A. Check the resident's oxygen saturation. B. Do a complete neurologic assessment. C. Give the prescribed PRN lorazepam (Ativan). D. Notify the resident's primary care provider.

Before administering low-molecular-weight heparin (LMWH) to an older adult client after total knee arthroplasty, the nurse notes that the client's platelet count is 50,000/mm3. What action is most important for the nurse to take? A. Notify the health care provider of the platelet count. B. Administer the prescribed LMWH on schedule. C. Assess the activated partial thromboplastin time (aPTT). D. Assess the international normalized ratio (INR).

For client safety and quality care, which technique is best for the nurse to use when suctioning the client with a tracheostomy tube? A. Hyperoxygenate before and after suctioning. B. Repeat suctioning until the tube is clear. C. Apply suction during insertion of the tube. D. Suction for 30 seconds.

Four clients are sent back to the emergency department from triage at the same time. Which client requires the nurse's immediate attention? A. Client with acute allergic reaction B. Client with dyspnea on exertion C. Client with lung cancer with cough D. Client with sinus infection and fever

How is Hepatitis E transmitted? A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

In discharging a client diagnosed with acquired immune deficiency syndrome (AIDS), which statement by the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors? A. "Have you had sex with men or women or both?" B. "I hope you use condoms to protect your partners." C. "You must tell me all of your partners' names, so I can let them know about possibly having AIDS." D. You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know."

In the older adult client, which respiratory change requires no further assessment by the nurse? A. Increased anteroposterior (AP) diameter B. Increased respiratory rate C. Shortness of breath D. Sputum production

The RN has received report about all of these clients. Which client needs the most immediate assessment? A. Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry B. Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes C. Client with bronchogenic lung cancer who returned from bronchoscopy 3 hours ago D. Client with pleural effusion who has decreased breath sounds at the right base

The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin-addicted. Which action will be most effective in ensuring that the client completes treatment? A. Arrange for a health care worker to watch the client take the medication. B. Give the client written instructions about how to take prescribed medications. C. Have the client repeat medication names and side effects. D. Instruct the client about the possible consequences of nonadherence.

The home health nurse conducts a community presentation on Lyme disease for the residents of an assisted-living facility. Which statement from the audience indicates to the home health nurse that further instruction is needed? A. "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease." B. "It is best to walk in the center of the trail." C. "I should wait 4 to 6 weeks after being bitten by a tick to be tested for Lyme disease." D. "I'll wear light-colored clothes with long sleeves, long pants, closed shoes, and a hat when I am walking in the woods."

The home health nurse is assigned to visit all of these clients when a change in agency staffing requires that one of the clients be rescheduled for a visit on the following day. Which client would be best to reschedule? A. Client with emphysema who has been on home oxygen for a month and has SpO2 levels of 91% to 93% B. Client with history of a cough, weight loss, and night sweats who has just had a positive Mantoux test C. Client with newly diagnosed pleural effusion who needs an admission visit and an initial intake assessment D. Client with percutaneous lung biopsy yesterday who called in to report increased dyspnea

The medical-surgical unit nurse should call the Rapid Response Team to assess which client? A. Client with a diagnosed pulmonary embolism who is receiving IV heparin and has bright-red hemoptysis B. Client with deep vein thrombosis who is receiving low-molecular-weight heparin and has ongoing calf pain C. Client with a right pneumothorax who is being treated with a chest tube and has a pulse oximetry of 94% D. Client who was extubated 3 days ago and has decreased breath sounds at the posterior bases of both lungs

The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include? A. A slice of 5-grain bread B. Chuck steak patty (6 ounces) C. Strawberries (1 cup) D. Tomato (1 medium)

The nurse is preparing a client for discharge on postoperative day 1 after a modified radical mastectomy. Which instruction is most important for the nurse to include in this client's discharge plan? A) "Please report any increased redness, swelling, warmth, or pain to your health care provider." B) "Do not allow anyone to take your blood pressure or draw blood on the side where you had your breast removed." C) "A referral has been made to the American Cancer Society's Reach to Recovery program, and a volunteer will call you next week." D) "Avoid the prone and hunchback positions, and ask your health care provider for any other needed activity restrictions."

The nursing assistant has taken vital signs of the ventilated postoperative client who has had radical neck surgery. What does the nurse tell the assistant to be especially vigilant for? A. Continuous oozing of bright-red blood B. Decreased level of consciousness C. Effective pain management D. Heart rate and blood pressure trending up over several hours

The peak pressure alarm is sounding on the ventilator of a client with a recent tracheostomy. What intervention should be done first? A. Assess the client's respiratory status. B. Decrease the sensitivity of the alarm. C. Ensure that the connecting tubing is not kinked. D. Suction the client.

When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? A. Kidney failure B. Refractory ascites C. Fetor hepaticus D. Paracentesis scheduled for today

Which HIV test can give the earliest test results? A. Nucleic Acid Test (NAT) B. Antibody HIV Test C. Combination HIV antigen/antibody test D. CD4 count

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease? A. Barrel chest B. Cough C. Dyspnea D. Reduced gas exchange

Which client has the highest risk for developing a pulmonary embolism (PE)? A. A 25-year-old woman who frequently flies to different countries B. A 67-year-old man who works on a farm C. A 45-year-old man admitted for a heart attack D. A 23-year-old woman with a bleeding disorder

Which client has the most urgent need for frequent nursing assessment? A. An older adult client who was admitted 2 hours ago with emphysema and dyspnea and has a 45-year, 2-pack-per-day smoking history and is receiving 50% oxygen through a Venturi mask B. A young client who has had a tracheostomy for 1 week, who is on room air with SpO2 at percentages in the upper 90s, who has been receiving antibiotic therapy for 16 hours, and who has foul-smelling drainage on the tracheostomy ties C. An older adult client who is eager to go home with her new tank of oxygen and supply of nasal cannulas and is being discharged with a new prescription for home oxygen therapy D. A middle-aged client who was admitted yesterday with pneumonia and is receiving oxygen at 2 L/min through a nasal cannula

Which component of a client's family history is of particular importance to the home health nurse who is assessing a new client with asthma? A. Brother is allergic to peanuts. B. Father is obese. C. Mother is diabetic. D. Sister is pregnant.

Which intervention for a client in the intensive care unit (ICU) will decrease the incidence of "ICU psychosis?" A. Decreasing nighttime disruptions B. Keeping the lights on to promote orientation C. Administering sedation D. Providing television or radio for stimulation

Which intervention will be most effective in reducing anxiety in a client with a pulmonary embolism (PE)? A. Remain with the client and provide oxygen in a calm manner. B. Have the client breathe into a brown paper bag using pursed lips. C. Offer the client a mild sedative. D. Allow a family member to remain in the room.

Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)? A. The dietary worker hands the disposable meal trays to the LPN assigned to the client. B. The social worker encourages the client to verbalize about stressors at home. C. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's room. D. The health care provider orders vital signs, including temperature, every 8 hours.

Which statement accurately explains otitis media? A) The inflammatory response is triggered by the invasion of foreign proteins. B) Phagocytosis by macrophages and neutrophils destroys and eliminates foreign invaders. C) It is caused by a left shift or increase in immature neutrophils. D) Many immune system cells released into the blood have specific effects.

Which two factors in combination are the greatest risk factors for head and neck cancer? A. Alcohol and tobacco use B. Chronic laryngitis and voice abuse C. Marijuana use and exposure to industrial chemicals D. Poor oral hygiene and use of chewing tobacco

While the nurse is talking with the postoperative thoracic surgery client, the client coughs and the chest tube collection water seal chamber bubbles. What does the nurse do? A. Calmly continues talking B. Checks the tube for blocks or kinks C. Immediately calls the health care provider D. Strips the chest tube

The nurse assesses a client diagnosed with Sjögren's syndrome. The nurse anticipates that the client will also have which common condition? A. Dry eyes B. Abdominal bloating after eating C. Excessive production of saliva in the mouth D. Intermittent episodes of diarrhea

A An immune system disorder characterized by dry eyes and dry mouth. With this disorder, the body's immune system attacks its own healthy cells that produce saliva and tears. Sjögren's often occurs with other such disorders, such as rheumatoid arthritis and lupus. The main symptoms are dry mouth and dry eyes. Treatments include eye drops, medications, and eye surgery.

A NORMAL 150,000-450,000

A client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. Which is a nursing priority? a) Institute fall prevention/safety measures. b) Monitor respiratory status. c) Measure abdominal girth daily. d) Test stool specimens for blood.

A The high ammonia levels contribute to deterioration of mental function and then to hepatic encephalopathy and hepatic coma; safety is the priority. Although the client may have dyspnea as a result of ascites, it is not life threatening; safety is the priority. Although measuring abdominal girth daily is done to monitor ascites, it is not the priority for a confused client; safety is the priority. Testing stool specimens for blood is not the priority; providing for client safety is the priority.

Select the criteria below that is used to help diagnosed a patient with Acquired Immunodeficiency Syndrome (AIDS): A. CD4 count <200 cells/mm3 B. Presence of opportunistic infection C. CD4 count >1500 cells/mm3 D. WBC 9500 E. Absence of opportunistic infection

A and B. A patient is diagnosed with AIDS if: CD4 count drops to less than 200 cells/mm3 or an opportunistic infection is present

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply: A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

Identify the correct statements about the anatomy of the Human Immunodeficiency Virus (HIV). Select all that apply: A. HIV is a retrovirus. B. Inside the virus is packaged DNA. C. The protein projections found on the virus' surface play a key role in attaching to the receptors on the helper t-cell. D. The glycoproteins (specifically GP140) are vital for engaging the receptors on the targeted cell.

A and C. Options B is an incorrect statement, it should say "Inside the virus is packaged RNA (not DNA)", and Option C is incorrect because it should say "The glycoproteins (specifically GP120...NOT GP140) are vital for engaging the CD4 receptor on the targeted cell.

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply: A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

A and C. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that prone positioning can be beneficial for some patients with this condition. Which findings below indicate this type of positioning was beneficial for your patient with ARDS? A. Improvement in lung sounds B. Development of a V/Q mismatch C. PaO2 increased from 59 mmHg to 82 mmHg D. PEEP needs to be titrated to 15 mmHg of water

A and C. Prone positioning helps improve PaO2 (82 mmHg is a good finding) without actually giving the patient high concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting the V/Q mismatch). In this position, the heart is no longer laying against the posterior part of the lungs (improves air flow...hence improvement of lung sounds) and it helps move secretions from other areas that were fluid filled and couldn't move in the supine position, hence helping improve atelectasis.

Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply: A. "It is best to eat three large meals a day that are relatively low in calories." B. "Avoid going outside during extremely hot or cold days." C. "It is important to receive the Pneumovax vaccine annually." D. "Smoking cessation can help improve your symptoms."

A and C. The patient needs to eat high calorie and protein rich meals that are small but frequent. The Pneumovax is definitely recommended for patients with COPD but is given every 5 years (not annually).

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply: A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and E. Only Hepatitis A and E cause ACUTE infections...not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

A client has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this client regarding medications? (Select all that apply.) A. Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. B. The medications may cause nausea. The client should take them at bedtime. C. The client is generally not contagious after 2 to 3 consecutive weeks of treatment. D. These medications must be taken for 2 years. E. These medications may cause kidney failure.

A, B

The nurse is caring for a group of clients. Which clients should be monitored closely for respiratory failure? (Select all that apply.) A. Client with a brainstem tumor B. Client with acute pancreatitis C. Client with a T3 spinal cord injury D. Client using patient-controlled analgesia E. Client experiencing cocaine intoxication

A, B, C, D

A patient arrives to the clinic and requests an HIV test. The patient had unprotected sexual intercourse 2 days ago with a person who may have HIV. As the nurse you know there is a window period for detecting an infection of HIV. What statements should you provide to the patient about this window period and testing for HIV? Select all that apply: A. No test is available at this time to show immediate infection. B. The window period is the time when you become infected with HIV to when a test can deliver positive results. C. Window periods vary depending on the type of HIV test administered. D. The absolute earliest an HIV test can detect HIV is about 3 months.

A, B, C. These are correct statement. Option D is incorrect because the NAT (nucleic acid test) can detect HIV the earliest of all the test types. It can detect around 10 days after exposure for some patients. It assesses for the virus' genetic material and measures the amount of virus present in the blood. It is not commonly ordered and is used only for high risk patients.

A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? (Select all that apply.) A. Combination drug therapy is effective in preventing transmission. B. Combination drug therapy is the most effective method of treating TB. C. Combination drug therapy will decrease the length of required treatment to 2 months. D. Multiple drug regimens destroy organisms as quickly as possible. E. The use of multiple drugs reduces the emergence of drug-resistant organisms.

A, B, D, E

People involved in which occupations or activities are encouraged to wear masks and to have adequate ventilation? (Select all that apply.) A. Bakers B. Coal miners C. Electricians D. Furniture refinishers E. Plumbers F. Potters

A, B, D, F

Which factors are possible transmission routes for human immune deficiency virus (HIV)? (Select all that apply.) A. Breast-feeding B. Anal intercourse C. Mosquito bites D. Toileting facilities E. Oral sex

A, B, E

The nurse presents a seminar on human immune deficiency virus (HIV) testing to a group of seniors and their caregivers in an assisted-living facility. Which responses fit the recommendations of the Centers for Disease Control and Prevention regarding HIV testing? (Select all that apply.) A. "I am 78 years old, and I was treated and cured of syphilis many years ago." B. "In 1986, I received a transfusion of platelets." C. "Seven years ago, I was released from a penitentiary." D. "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." E. "At 68, I am going to get married for the fourth time."

A, C, E

The nurse plays a vital role in screening patients for a possible HIV infection. What questions below could the nurse ask to help identify a patient who is at risk for HIV? Select all that apply: A. "How often do you use alcohol or drugs?" B. "Have you recently experienced an abusive relationship?" C. "If you are sexually active, do you or your partner use protection?" D. "In the past month, have you felt sad or unable to get out of bed?" E. "Have you ever been treated for a sexually transmitted infection?" F. "Do you ever experience intrusive or unwanted thoughts?"

A, C, E. The nurse should screen patients for HIV. Questions about sexual behavior (if the patient is sexually active, how often, treatment for STI, barrier devices used, and number of partners), drug/alcohol usage, and if they've had a blood transfusion before 1985, can all help the nurse identify patients who may need to undergo HIV testing.

When caring for a client with portal hypertension, the nurse assesses for which potential complications? (Select all that apply.) A. Esophageal varices B. Hematuria C. Fever D. Ascites E. Hemorrhoids

A, D, E

Select all the signs and symptoms associated with Hepatitis? A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

Which instructions for joint protection does the nurse recommend for a client with a connective tissue disease? (Select all that apply.) A. Use long-handled devices such as a reacher B. When getting out of bed, use fingers to push off. C. Sit in a low back chair. D. Bend at the waist while keeping the back straight. E. Use adaptive devices such as Velcro closures. F. Turn a doorknob clockwise.

A, E

Which interventions does the home health nurse teach to family members to reduce confusion in a client diagnosed with acquired immune deficiency syndrome (AIDS)-related dementia? (Select all that apply.) A. Change the decorations in the home according to the season. B. Put the bed close to the window. C. Write out detailed instructions, and have the client read them over before performing a task. D. Ask the client what time he or she prefers to shower or bathe. E. Mark off the days of the calendar, leaving open the current date.

A,B,D

A 25-year-old female is about to deliver a baby. The patient is HIV-positive and has been taking antiretroviral therapy during the pregnancy. What steps can be taken to help prevent transmitting the virus to the baby after birth? A. Substitute formula for breastfeeding. B. Administer antiretroviral treatment to the newborn for 2 weeks after birth. C. Avoid kissing and hugging the newborn. D. Stop taking antiretroviral therapy for 2 months postpartum.

A. Breastmilk can transmit the HIV virus. The patient should avoid breastfeeding but use formula instead. Option B is wrong because the newborn should receive antiretroviral treatment for 4-6 weeks after birth (NOT 2 weeks). The mother can kiss and hug her newborn (this does NOT transmit the virus), and the patient should not quit taking antiretroviral therapy during the postpartum period.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient? A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis? A. Icteric B. Posticteric C. Preicteric D. Convalescent

A. The Preicteric (prodromal) Phase: flulike symptoms...joint pain, fatigue, nausea vomiting, abdominal pain change in taste, liver enzymes and bilirubin increasing.... Icteric Phase: decrease in the flu-like symptoms but will have jaundice and dark urine (buildup of bilirubin) yellowing of skin and white part of the eyeball, clay-colored stool (bilirubin not going to stool to give it's normal brown color) enlarged liver and pain in this area.... Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis? A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26 C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29 D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body's way of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising? A. Prednisone B. Atrovent C. Flagyl D. Levaquin

A. Prednisone is a corticosterioid and can cause hyperglycemia and brusing.

An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be: A. Continue to monitor the patient B. Increase the patient's oxygen level to 3 L C. Notify the doctor for further orders D. Turn off the alarm settings

A. This patient is not in any distress from the description provided...therefore, you would continue to monitor the patient. Patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels. Therefore, it is normal for patients who have COPD to have an oxygen saturation between 88-93%.....any higher would decrease the stimulation to breathe and they may stop breathing. Therefore, you would not increase the oxygen level to 3 L, notify the doctor, or turn off the alarm settings.

Where does gas exchange occur? Acinus Alveolus Bronchus Carina

ALVEOLUS

What is the most important thing for proper gas exchange to occur?

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