Ch 84 Allergic, Immune, and Autoimmune Disorders

Write the correct sequence for symptoms that are manifested in a client with latex sensitivity. (Read carefully, Sequence may be different from the workbook) 1-sExhibits vesicles, papules, and crusting of the skin 2- Exhibits warning signs and symptoms of cardiac arrest. 3-Demonstrates pruritis,erythema, and edema. 4-Develops wheezing, dyspnea, and bronchial spasm.

3,1,4,2

A nurse is reviewing information about a new prescription for corticosteroid cream with a client who has mild psoriasis. Which of the following instructions should the nurse include? Select all that apply A- Apply an occlusive dressing after application B- Apply three to four times per day C- Wear gloves after application to lesions on the hands D- Avoid applying in skin folds E- Use medication continuously over a period of several months

A- Apply an occlusive dressing after application C- Wear gloves after application to lesions on the hands D- Avoid applying in skin folds

A nurse is collecting date from a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? Select all that apply A- Areas of paresthesia B- Involuntary eye movements C- Alopecia D- Increased salivation E- Ataxia

A- Areas of paresthesia B- Involuntary eye movements E- Ataxia

A nurse is reinforcing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include? A- Avoid foods that trigger exacerbation B- Consume 15 to 20 g of fiber daily C- Plan three moderate to large meals per day D- Limit fluid intake to 1 L each day

A- Avoid foods that trigger exacerbation

A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse expect? Select all that apply A- Positive ANA titer B- Increased hemoglobin C- 2+ urine protein D- Increased serum C3 and C4 E- Elevated BUN

A- Positive ANA titer C- 2+ urine protein E- Elevated BUN

At the beginning of a shift, a nurse is collecting data on a client who has Cushing's disease. Which of the following findings is the nurse's priority? A- Weight gain B- Fatigue C- Fragile skin D- Joint pain

A- Weight gain

A nurse is reinforcing teaching with a client who has a history of psoriasis about photochemotherapy and ultraviolet light (PUVA) treatments. Which of the following instructions should the nurse include in the teaching? A- Apply vitamin A cream before each treatment B- Administer a psoralen medication before the treatment C- Use the treatment every evening D- Remove the scales gently following each treatment

B- Administer a psoralen medication before the treatment

A nurse in an outpatient clinic is collecting data from a client who has rheumatoid arthritis (RA_. The client reports increased joint tenderness and swelling. which of the following findings should the nurse expect? Select all that apply A- Recent influenza B- Decreased range of motion C- Hypersalivation D- Increased blood pressure E- Pain at rest

B- Decreased range of motion E- Pain at rest

A client is caring for a client who experienced an anaphylactic reaction after a bee sting. Which measure should the nurse employ to open the client's airway? A-Initiate cardiopulmonary resuscitation B-Make use of an endotracheal tube C-Administer antihistamines as ordered D-Place the client in the Trendelenberg position

B-Make use of an endotracheal tube

A nurse is required to observe a client with a suspected immune disorder. What should the nurse look for? Select all that apply. A-Impaired gas exchange B-Recurrent infections C-Visual disturbances D-Impaired hearing E-Slow wound healing

B-Recurrent infections C-Visual disturbances E-Slow wound healing

__________asthma is characterized by recurring paroxysms of dyspnea of the wheezing type.

Bronchial

A nurse is preparing to administer a varicella immunization to a client. which of the following questions should the nurse ask? A- Are you allergic to eggs? B- Are you allergic to baker's yeast? C- Are you pregnant? D- Do you have a history of Guillain-Barre syndrome?

C- Are you pregnant?

A nurse is collecting data from a client who has SLE. Which of the following findings should the nurse expect? A- Weight gain B- Petechiae on thighs C- Systolic murmur D- Alopecia

D- Alopecia

Which individual is least at risk for the development of Kaposi's sarcoma? A- A kidney transplant patient B- A male with a history of same sex partners C- A client receiving antineoplastic medications D- An individual working in an environmental where exposure to asbestos exists

D- An individual working in an environmental where exposure to asbestos exists

The client is suspected of having systemic lupus erythematous (SLE). The nurse monitors the client, knowing that which is one of the initial characteristic sign of SLE? A- weight gain B- subnormal temperature C- elevated red blood cell count D- Rash on the face across the nose and on the cheeks

D- Rash on the face across the nose and on the cheeks

The nurse is assigned to care for the client diagnosed with cytomegalovirus retinitis and acquired AIDS who is receiving foscarnet. The nurse should monitor the results of which laboratory study while the client is taking this medication? A- CD4+ cell count B- Lymphocyte count C- Serum albumin level D- Serum creatinine level

D- Serum creatinine level

The nurse is assisting with the administration of immunizations at a health care clinic. The nurse should understand that immunization provides which protection? A- protection from all diseases B- innate immunity from disease C- natural immunity from disease D- acquired immunity from disease

D- acquired immunity from disease

A nurse is caring for a client with an immune disorder. Which cardiovascular symptom should the nurse assess in this client? A-Stridor B-Dyspnea C-Hypertension D-Syncope

D-Syncope

Bronchial asthma

Exercise

True or False Histamines are 100 to 1,000 times more potent than leukotrienes in causing bronchospasm.

False

True or False Periods of decreased pulse rate and respirations are seen in clients with bronchial asthma.

False

True or False If desensitization is done to treat a seasonal allergy, it must start at least 3 weeks before the specific allergy season.

False

Urticaria

Parasitic Infections

Contact dermatitis

Poison Ivy

Allergic rhinitis

Pollen Grains

True or False Antigens that cause an immune response in the body are known as immunogens.

True

True or False Immunotherapy consists of giving minute doses of allergens subcutaneously.

True

A client arrives in the emergency department reporting severe hives and wheezing after eating shrimp. The nurse observes the client experiencing symptoms of laryngeal edema. What is the priority action by the nurse? a. Administer epinephrine. b. Administer montelukast. c. Administer loratadine. d. Administer pseudoephedrine.

a. Administer epinephrine.

A client is taking methotrexate for the treatment of rheumatoid arthritis. What expected finding does the nurse observe when reviewing laboratory results? a. Low neutrophil count b. Low hemoglobin c. Elevated leukocyte count d. Elevated sedimentation rate

a. Low neutrophil count

antigen that causes a tissue reaction

allergen

hypersensitivity to one or more substances

allergy

hypersensitive reaction to an antigen

anaphylaxis

development of urticaria and edema in areas of skin and mucous membrane

angioedema

Treatment of allergies is directed toward removal of the allergen and controlling the ________________ response.

antibody

foreign protein substance

antigen

produced in the body in the to protect itself against antigens

antobody

the body doesnt recognize itself as self and begins to produce antibodies against its own healthy cells or inhibit normal cell function

autoimmunity

A client suspects an allergy to latex. When gathering data from the client, what questions would be appropriate for the nurse to ask? Select all that apply. a. "Are you allergic to dairy products?" b. "Are you allergic to bananas?" c. "Are you allergic to kiwi?" d. "Are you allergic to chestnuts?" e. "Are you allergic to avocados?"

b. "Are you allergic to bananas?" c. "Are you allergic to kiwi?" d. "Are you allergic to chestnuts?" e. "Are you allergic to avocados?"

allergic skin condition characterized by tiny blisters that cover the body and itch and ooze

eczema

Emergency airway management and ___________ need to be available in case of severe or anaphylactic reactions.

epinephrine

chemical mediator that is released during the antigen antibody reaction

histamine

allergic skin reaction, also known as urticaria

hives

the body's normal adaptive state designed to protect itself from disease

immunity

antigen that causes an immune response in the body

immunogen

depression of the immune system

immunosuppression

desensitization by giving minute doses of allergens subcutaneously

immunotherapy

lump, wheal, or edema

induration

The unit of measurement commonly used to measure the degree of edema is ____________.

millimiters

autoimmune disorder that affects one or more organs

non organ specific

autoimmune disorder that affects one organ

organ specific

treating symptoms as they occur, rather than treating the underlying condition

symptomatic

autoimmune disorders that affect the entire body

systemic

allergic skin reaction characterized by wheals and often accompanied by itching

uticaria

A nurse is discussing gout with a client who is concerned about developing the disorder. Which of the following findings should the nurse identify as risk factors? Select all that apply A- Diuretic use B- Obesity C- Deep sleep deprivation D- Depression E- Cardiovascular disease

A- Diuretic use B- Obesity E- Cardiovascular disease

Which measure should the nurse employ when caring for a client diagnosed with contact dermatitis? A-Encourage the client to dry the area by patting it lightly. B-Apply warm compresses over the affected area. C-Bandage and keep the area covered. D-Teach the client to use hourly topical corticosteroids appropriately.

A-Encourage the client to dry the area by patting it lightly.

A college student is being seen in a health services with contact dermatitis. Which allergen can be a cause of contact dermatitis? A-Poison ivy B-Insect stings C-Animal dander D-Chocolate

A-Poison ivy

The nurse is assisting with a skin test for a client suspected of having allergies to animal dander. Which is a sign of a positive reaction? A-Red wheal B-Flat macule C-Bruising D-Bleeding

A-Red wheal

A nurse is reviewing strategies to promote comfort with a client who received an immunization. Which of the following information should the nurse include? Select all that apply A- Massage the injection site B- Apply a cool compress to the injection site C- Take acetaminophen or ibuprofen D- Use the affected extremity E- Apply an antimicrobial ointment to the injection site

B- Apply a cool compress to the injection site C- Take acetaminophen or ibuprofen D- Use the affected extremity

The nurse is caring for a client who has a WBC count of 20,000/mm3. Which of the following WBC abnormalities is consistent with this finding? A- Neutropenia B- Leukocytosis C- Left shift D- Leukopenia

B- Leukocytosis

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A- fluctuations in blood pressure B- Loss of cognitive function C- Ineffective cough D- Drooping eye lids

B- Loss of cognitive function

A nurse is reviewing the laboratory findings of a client who has measles. The nurse should expect an increase in which of the following types of WBCs? A- Neutrophils B- Basophils C- Lymphocytes D- Eosinophils

C- Lymphocytes

A nurse is caring for a client with multiple sclerosis (MS). Which should the nurse include in the nursing care plan for this client? A-Airway clearance B-Level of consciousness C-Physical mobility D-Aid in hearing

C-Physical mobility

Nasal edema and ____________ are important physical examination findings for diagnosing allergies and immune problems.

congestion

A nurse is reinforcing teaching with a female client on the use of calcipotriene topical medication for the treatment of psoriasis. Which of the following information should the nurse include? Select all that apply A- Recommended for facial lesions B- Expect a stinging sensation upon application C- Apply to the scalp D- Obtain a pregnancy test E- Limit application to skin folds

B- Expect a stinging sensation upon application C- Apply to the scalp D- Obtain a pregnancy test E- Limit application to skin folds

The client calls the office of the primary health car provider (PHCP) and states to the nurse that they were just stung by a bumbleebee while gardening. The client is afraid of a severe reaction because their neighbor experienced such a reaction just 1 week ago. Which should be the appropriate nursing action? A- advise the client to soak the site in hydrogen peroxide B- ask the client is they ever sustained a bee sting in the past C- tell the client to call an ambulance for transport to the emergency room D- tell the client not to worry about the sting unless difficulty with breathing occurs

B- ask the client is they ever sustained a bee sting in the past

A nurse is required to assist a healthcare provider performing an intradermal skin test on a client. What information does the skin test provide? A-Risk of anaphylactic reaction B-Rate of antigen absorption C-Cause of allergic reactions D-Response to antiallergic therapy

C-Cause of allergic reactions

Which statement accurately describes a function of the immune system? A-An allergic reaction may occur at the first exposure to an antigen. B-The antigenantibody reaction releases chemical mediators known as allergies. C-When an antigen enters the body, the body responds by producing antibodies. D-Normally, the body is not able to distinguish self from not self.

C-When an antigen enters the body, the body responds by producing antibodies.

The nurse is treating a client who presents in the ER with airway obstruction owing to laryngeal edema and vasodilation resulting in hypotension and hypoperfusion of the organs. Which condition is this client most likely experiencing? A-Graves disease B-Serum reaction C-Systemic lupus erythematosus D-Anaphylaxis

D-Anaphylaxis

A teenager is brought to the ER with symptoms of dyspnea, tightness in the chest, cyanosis, and increased pulse rate and respirations. Which diagnosis is supported by these signs and symptoms? A-Allergic rhinitis B-Serum reaction C-Food allergy D-Bronchial asthma

D-Bronchial asthma

A female client is confirmed to have a penicillin allergy. What measure should the nurse employ to ensure the client's protection? A-Prepare the client to deal anaphylaxis as the first point in client teaching. B-Ask the client to carry her medical records with her always. C-Encourage dietary modifications D-Encourage the client to wear a MedicAlert tag

D-Encourage the client to wear a MedicAlert tag

A client is experiencing respiratory complications related to asthma. What classification of medications is commonly prescribed for this condition? A-Sedating drugs B-Adrenergic decongestants C-Nonsedating drugs D-Leukotriene antagonists

D-Leukotriene antagonists

A nurse in a clinic is reinforcing teaching with a client who has ulcerative colitis. which of the following statements by the client indicates understanding of the teaching? A- I will plan to limit fiber in my diet B- I will restrict fluid intake during meals C- I will switch to black tea instead of drinking coffee D- I will try to eat three moderate to large meals a day

A- I will plan to limit fiber in my diet

A nurse is caring for a client who has Cushing's disease. Clients who have Cushing's disease are a increased risk for which of the following? Select all that apply A- Infection B- Gastric ulcer C- Renal calculi D- Bone fractures E- Dysphagia

A- Infection B- Gastric ulcer D- Bone fractures

The camp nurse prepares to instruct a group of children about Lyme disease. Which information should the nurse include in the instructions? A- Lyme disease is caused by a tick carried by deer B- Lyme disease is caused by contamination from car feces C- Lyme disease can be contagious by skin contact with an infected individual D- Lyme disease can be caused by the inhalation of spores from bird droppings

A- Lyme disease is caused by a tick carried by deer

A nurse is reinforcing teaching with a client who has a new diagnosis of rheumatoid arthritis. Which of the following instructions should the nurse give? A- You can experience morning stiffness when you get out of bed B- You can experience abdominal pain C- You can experience weight gain D- You can experience low blood sugar

A- You can experience morning stiffness when you get out of bed

Saquinavir is prescribed for the client who is diagnosed with HIV seropositive. The nurse should reinforce medication instructions about which health care measure to the client? A- avoid sun exposure B- eat low calorie foods C- eat foods that are low in fat D- take the medication on an empty stomach

A- avoid sun exposure

The client who is diagnosed with HIV seropositive has been taking stavudine. The nurse should monitor which parameter closely while the client is taking this medication? A- gait B- appetite C- level of consciousness D- hemoglobin and hematocrit blood levels

A- gait

A nurse is assisting a healthcare provider to perform a skin test in a client. Which of the following suggests the appearance of induration on the client's skin? Select all that apply. A- Lump B- Redness C- Wheel D- Edema E-Crust

A- lump C- wheel D- edema

The nurse is assisting with planning the care of a client with a diagnosis of immunodeficiency. The nurse should incorporate which intervention as a priority in the plan of care? A- protecting the client from infection B- providing emotional support to decrease fear C- encouraging discussion about lifestyle changes D- identifying factors that decreased the immune function

A- protecting the client from infection

The client diagnosed with AIDS is taking nevirapine. The nurse should monitor for which side/adverse effects of the medication? select all that apply. A- rash B- hepatotoxicity C- peripheral neuropathy D- reduced bone mineral density

A- rash B- hepatotoxicity

Which intervention should be implemented in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply A- use non latex gloves B- use medications from glass ampules C- place the client in a private room only D-do not puncture rubber stoppers with needles E- keep a latex safe supply cart available in the client's area F- use a blood pressure cuff from an electronic device only to measure the blood pressure

A- use non latex gloves B- use medications from glass ampules D-do not puncture rubber stoppers with needles E- keep a latex safe supply cart available in the client's area

A nurse is preparing to administer a scratch test to a client who has possible food and environmental allergies. Which of the following actions should the nurse perform prior to the procedure? Select all that apply A- Cleanse the clients's skin with povidone-iodine B- Ask the client about previous reactions to allergens C- Ask the client about medications taken the past several days D- Inform the client to expect itching at one site E- Obtain emergency resuscitation equipment

B- Ask the client about previous reactions to allergens C- Ask the client about medications taken the past several days D- Inform the client to expect itching at one site E- Obtain emergency resuscitation equipment

A nurse is reinforcing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching? A- Decrease intake of calorie-dense foods B- Drink canned protein supplements C- Increase intake of high fiber foods D- Take a bulk-forming laxative daily

B- Drink canned protein supplements

A nurse is reviewing the serum laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following laboratory tests should the nurse expect to be elevated? Select all that apply A- Hematocrit B- ESR C- WBC D- Folic acid E- Albumin

B- ESR C- WBC

A nurse is reviewing the medical record of a client who has rheumatoid arthritis. The nurse should review which of the following laboratory results when monitoring this disease? Select all that apply A- Urinalysis B- ESR C- BUN D- antinuclear antibody (ANA) titer E- WBC count

B- ESR D- antinuclear antibody (ANA) titer E- WBC count

A nurse is preparing to document administration of a meningococcal vaccine to a client. Which of the following information should the nurse include in the documentation? Select all that apply A- Age of client receiving the vaccine B- Name of vaccine manufacturer C- Vaccine expiration date D- Date of administration E- Serial number of the vaccine

B- Name of vaccine manufacturer C- Vaccine expiration date D- Date of administration

A nurse is reinforcing teaching with a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? Select all that apply A- Take the medication on an empty stomach B- Notify the provider of any illness or stress C- Report any manifestations of weakness or dizziness D- Do not discontinue the medication suddenly E- Eat a low sodium diet

B- Notify the provider of any illness or stress C- Report any manifestations of weakness or dizziness D- Do not discontinue the medication suddenly

A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? A- Swelling of joints of the fingers B- Pallor or toes with cold exposure C- Feet that become reddened with ambulation D- client report of intense feeling of heat in the fingers

B- Pallor or toes with cold exposure

A nurse caring for a client who has contact dermatitis and a new prescription for diphenhydramine. For which of the following adverse effects should the nurse monitor? A- Elevated blood glucose levels B- Urinary retention C- Hyperpigmentation of the skin D- Insomnia

B- Urinary retention

The client diagnosed with pemphigus is being seen in the client regularly. The nurse should plan care based on which description of this condition? A- the presence of tiny red vesicles B- an autoimmune disease that causes blistering in the epidermis C- the presence of skin vesicles found along the nerve caused by a virus D- the presence of red, raised, papules,and large plaques covered by silvery scales.

B- an autoimmune disease that causes blistering in the epidermis

The client is diagnosed with stage I of Lyme disease. The nurse should check the client for which characteristic of this stage? A- arthralgia B- flu like symptoms C- enlarged and inflamed joint D- signs of neurological disorders

B- flu like symptoms

The client brought to the emergency department is experiencing an anaphylatic reaction from eating shellfish. The nurse should implement which immediate action? A- administer epinephrine B- maintaining a patent airway C- administering a corticosteroid D- instructing the client on the importance of obtaining a MedicAlert bracelet

B- maintaining a patent airway

Ketoconazole is prescribed for a client with a diagnosis of candidiasis . Which interventions should the nurse include when administering this medication? select all that apply A- restrict fluid intake B- monitor liver function studies C- instruct the client to avoid alcohol D- administer medication with an antacid E-instruct the client to avoid exposure to the sun F- administer the medication on an empty stomach

B- monitor liver function studies C- instruct the client to avoid alcohol E-instruct the client to avoid exposure to the sun

The nurse prepares to give a bath and change the bed linens for a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which should the nurse incorporate in the plan during the bathing of the client? A- wearing gloves B- wearing a gown and gloves C- wearing a gown, gloves and mask D-wearing a gown and gloves to change the bed linens and gloves only for the bath

B- wearing a gown and gloves

A nurse is caring for a client who is receiving antiserum for treatment of rabies. For what should the nurse assess in this client? A-Cyanosis and pallor B-Enlarged lymph nodes C-Migraine headaches D-Cold clammy extremities

B-Enlarged lymph nodes

A nurse is performing skin testing on a client suspected of having an allergic disorder. Which measure should the nurse employ when performing the injection? A-Insert the needle to the level under the dermis. B-Hold the needle nearly flat against the client's skin. C-Insert the needle approximately one fourth of an inch. D-Face the needle bevel downward during insertion.

B-Hold the needle nearly flat against the client's skin.

A nurse is required to assist a healthcare provider to perform intradermal skin test in a client. What information should the nurse provide the client about skin testing? A-Intradermal skin injections are extremely painful. B-The degree of edema indicates the severity of the reaction. C-Only a single antigen can be tested at one time. D-Signs of positive reaction will appear in 1 week.

B-The degree of edema indicates the severity of the reaction.

A nurse has been ordered to administer epinephrine to a client with an allergic disorder. When providing client education, what should the nurse say is the purpose of this injection? A-To reduce itching sensation B-To reduce bronchospasms C-To provide antiseptic effects D-To control spread of infection.

B-To reduce bronchospasms

A nurse in a clinic is caring for a client who is to receive an immunization. The client asks about contraindications to immunizations. Which of the following responses should the nurse make? A- The use of insulin is a contraindication B- An anaphylactic reaction is a contraindication for administration of any type of immunization C- The common cold is a contraindication for receiving an immunization D- The provider will weigh the risks if you have experienced any adverse effects

D- The provider will weigh the risks if you have experienced any adverse effects

A nurse is reinforcing teaching with a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A- This medication will help you with your tremors B- This medication will help you with your bladder function C- This medication may cause your skin to bruise easily D- This medication may cause your skin to appear yellow in color

D- This medication may cause your skin to appear yellow in color

The client with diagnosed AIDS and pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101 (38.3). The nurse continues to monitor the client knowing that this sign would most likely indicate which condition? A- the dose of medication is too low B- the client is experiencing toxic effects of the medication C- the client developed inadequacy of thermoregulation D- a result of another infection caused by the leukopenic effects of the medication

D- a result of another infection caused by the leukopenic effects of the medication

The client diagnosed with AIDS has begun therapy with zidovudine. The nurse should monitor which laboratory result during treatment with this medication? A- blood culture B- blood glucose level C- blood urea nitrogen D- complete blood count

D- complete blood count

The client arrives at the health care clinic and states to the nurse that they were just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse they removed the tick and flushed it down the toilet. Which nursing action is appropriate? A- refer the client for a blood test immediately. B- inform the client that there is not a test available for Lyme disease C- Tell the client that testing is not necessary unless arthralgia develops D- instruct the client return in 4-6 weeks to be tested, because testing before this time is not reliable

D- instruct the client return in 4-6 weeks to be tested, because testing before this time is not reliable

the nurse is assigned to care for a client diagnosed with systemic lupus erythematosus (SLE). The nurse should plan care considering which factor regarding this diagnosis? A- a local rash occurs as a result of allergy B- it is a disease caused by overexposure to sunlight C- a continuous release of histamine in the body causes the disease D- it is an inflammatory disease of collagen contained in the connective tissue

D- it is an inflammatory disease of collagen contained in the connective tissue

A client has been diagnosed with atopic dermatitis. What should the nurse look for in a client with atopic dermatitis? A-Bluish lips and fingernails B-Yellow mucous membranes C-Heavily pigmented skin D-Scaly, thickened skin

D-Scaly, thickened skin

A client is experiencing an allergic reaction to peanuts. For which signs and symptoms should the nurse assess? A-Profuse perspiration B-Bluish skin coloration C-Paroxysms of dyspnea D-Swelling of the lips and throat

D-Swelling of the lips and throat

The nurse is reinforcing education prior to discharge for a client that has had a kidney transplant. What statement made by the client indicates that education about rejection is understood? a. "I will take a laxative if I am unable to have a bowel movement." b. "I will report fever, chills, and profuse sweating to the primary care provider." c. "I will take my immunosuppressant drugs whenever I feel I am developing an infection." d. "I don't have to see my nephrologist any longer since I am cured of kidney disease."

b. "I will report fever, chills, and profuse sweating to the primary care provider."

. The nurse administers an "allergy shot" to a client in the clinic. What is the nurse's priority action? a. Have the client eat a small meal. b. Administer epinephrine before discharging the client. c. Have the client wait 20 minutes in the clinic after the injection. d. Administer ibuprofen 400 mg after injection for pain.

c. Have the client wait 20 minutes in the clinic after the injection.

The nurse, a Cub Scout leader, is preparing a group of Cub Scouts for an overnight camping trip and instructs them about the methods to prevent Lyme disease. Which statement by one of the Cub Scouts indicates a need for further teaching? A- "I need to bring a hat to wear during the trip" B-"I should wear long sleeved tops and long pants" C- " I should not use insect repellent because it will attract ticks" D- "I need to wear closed shoes and socks that can be pulled over my pants"

C- " I should not use insect repellent because it will attract ticks"

A nurse is collecting date from a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. The nurse should identify which of the following findings as the priority? A- client reports difficulty sleeping B- The client's urine is positive for glucose C- Client reports having an elevated body temperature D- Client reports gaining 4 lb in the last 6 months

C- Client reports having an elevated body temperature

A nurse is reinforcing teaching about self-care with a client who has SLE. Which of the following statements by the client indicates understanding? A- I should limit my time to 10 minutes in the tanning bed B- I will apply powder to any skin rash C- I should use a mild hair shampoo D- I will inspect my skin once a month for rashes

C- I should use a mild hair shampoo

A nurse is reinforcing teaching with a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching? A- Take the medication 2 hr after eating B- Discontinue this medication if your skin turns yellow-orange C- Notify the provider if you experience a sore throat D- Expect your stools to turn black

C- Notify the provider if you experience a sore throat

A nurse is reinforcing teaching with the parent of a child who has contact dermatitis. Which of the following information should the nurse include? A- Use fabric softener dryer sheets when drying the child's clothing B- Apply a warm, dry compress to the rash area C- Place the child in a bath with colloidal oatmeal D- Leave the child's hands uncovered during the night

C- Place the child in a bath with colloidal oatmeal

A nurse is preparing to administer an IM injection of immune globulin to a client following exposure to hepatitis A. Which of the following statements should the nurse make? A- This medication offers permanent immunity to hepatitis A B- This medication involves three injections over several months C- This medication provides an immune response more quickly than the body can produce it D- This medication contains an attenuated virus to help the body create antibodies

C- This medication provides an immune response more quickly than the body can produce it

The nurse is caring for a post renal transplantation client with prescription for cyclosporine. If the nurse notes an increase in one of the clients vital signs and the client is complaining of a headache, which vital sign is most likely increased? A- pulse B- respirations C- blood pressure D-pulse oximetry

C- blood pressure

Amikacin is prescribed for a client with diagnosed bacterial infection. The nurse instructs the client to contact the PHCP immediately if which occurs? A- nausea B- lethargy C- hearing loss D- muscle aches

C- hearing loss

The client with acquired immunodeficiency syndrome (AIDS) is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse should determine that this has been confirmed by which finding? A- swelling in the genital area B- swelling in the lower extremities C- punch biopsy of the cutaneous lesions D- appearance of reddish blue lesions on the skin

C- punch biopsy of the cutaneous lesions

The nurse is reviewing the results of serum laboratory studies drawn on a client diagnosed with AIDS who is receiving didanosine. The nurse determines that the client may have the medication discontinued by the PHCP if which significantly elevated result is noted? A- serum protein B- blood glucose C- serum amylase D- serum creatinine

C- serum amylase