Immune and Hematologic Disorders
Nurses were identified by the Centers for Disease Control and Prevention (CDC) as the people most likely to care for clients infected after the intentional release of the smallpox virus. Based on CDC guidelines, which group should volunteer to receive the smallpox vaccine? 1. Nurses age 50 and older who work in the emergency departments of community hospitals. 2. Nurses who served in the military and are now working in public heath settings. 3. Nurses born after 1971 who are employed as triage nurses in large medical center emergency departments. 4. Nurses vaccinated against smallpox as children who are now working in a pediatric unit.
1. Nurses age 50 and older who work in the emergency departments of community hospitals. RATIONALE: The CDC recommends the smallpox vaccine for nurses who received the vaccine as children (which include as this older than age 50) who work in the emergency department; emergency department nurses are more likely to care for those infected with the smallpox virus. Nurses born after 1971 weren't previously vaccinated against smallpox so the vaccine isn't currently recommended for those nurses. Military history doesn't dictate whether or not the vaccine is recommended. Nurses who work in the pediatric unit aren't at high risk for smallpox exposure; therefore, the vaccine isn't recommended for this group.
A client is diagnosed with rheumatoid arthritis, an autoimmune disorder. When teaching the client and family about autoimmune disorders, the nurse should provide which information? 1. Clients with autoimmune disorders may have false-negative but not false-positive serologic tests. 2. Advanced medical intervention can cure most autoimmune disorders. 3. Autoimmune disorders include connective tissue (collagen) disorders. 4. Autoimmune disorders are distinctive, aiding differential diagnosis.
3. Autoimmune disorders include connective tissue (collagen) disorders. RATIONALES: Connective tissue disorders are considered autoimmune disorders. Clients with autoimmune disorders may have either false-positive or false-negative serologic tests for syphilis. Other common laboratory findings in these clients include Coombs-positive hemolytic anemia, thrombocytopenia, leukopenia, immunoglobulin excesses or deficiencies, antinuclear antibodies, antibodies to deoxyribonucleic acid and ribonucleic acid, rheumatoid factors, elevated muscle enzymes, and changes in acute phase-reactive proteins. No cure exists for autoimmune disorders; treatment centers on controlling symptoms. Autoimmune disorders aren't distinctive; they share common features, making differential diagnosis difficult.
Which nursing intervention takes priority for a client infected with Pneumocystis carinii pneumonia? 1. Encouraging the client to be actively involved in his care 2. Keeping the client's skin clean and dry 3. Turning the client every 2 hours 4. Auscultating breath sounds
4. Auscultating breath sounds RATIONALES: Auscultating breath sounds takes priority for the client admitted with P. carinii pneumonia. Clients with this complication may suffer a rapid deterioration in respiratory status; therefore, their respiratory status must be monitored closely. The nurse should also encourage the client to participate in his care to promote self-esteem, keep the client's skin clean and dry, and turn the client every 2 hours to prevent skin breakdown. However these interventions shouldn't take priority over monitoring respiratory status.
The nurse collects data on a client shortly after kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? 1. Serum potassium level of 4.9 mEq/L 2. Serum sodium level of 135 mEq/L 3. Temperature of 99.2° F (37.3° C) 4. Urine output of 20 ml/hour
4. Urine output of 20 ml/hour RATIONALES: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. The other options are normal data collection findings.
A client seeks medical evaluation for fatigue, night sweats, and a 20-lb weight loss in 6 weeks. To confirm that the client has been infected with the human immunodeficiency virus (HIV), the nurse expects the physician to order: 1. E-rosette immunofluorescence. 2. quantification of T-lymphocytes. 3. enzyme-linked immunosorbent assay (ELISA). 4. Western blot test with ELISA.
4. Western blot test with ELISA. RATIONALES: HIV infection is detected by analyzing blood for antibodies to HIV, which form approximately 2 to 12 weeks after exposure to HIV and denote infection. The Western blot test — electrophoresis of antibody proteins — is more than 98% accurate in detecting HIV antibodies when used in conjunction with the ELISA. It isn't specific when used alone. E-rosette immunofluorescence is used to detect viruses in general; it doesn't confirm HIV infection. Quantification of T-lymphocytes is a useful monitoring test but isn't diagnostic for HIV. The ELISA test detects HIV antibody particles but may yield inaccurate results; a positive ELISA result must be confirmed by the Western blot test.
