Med Surg Exam 3 Practice

9. The significant other of a client who is dying of acquired immunodeficiency syndrome (AIDS) tells the nurse, "Life is not worth living without my partner." What should the nurse plan to do to help the significant other cope with the impending death? a. Involve the significant other's support system. b. Explore the significant other's psychotic thoughts. c. Suggest a bereavement group to the significant other. d. Reinforce the current self-image of the significant other.

Answer A Rationale: Involving the support system will decrease the person's feelings of isolation. Anticipatory grieving does not involve psychotic thoughts. Suggesting a bereavement group to the significant other is premature. The concern is about loss and loneliness, not self-image.

The Occupational Health Nurse is teaching a class on risk factors for developing osteoarthritis (OA). Which is a modifiable risk factor for developing OA? a. Being Overweight b. Increasing Age c. Previous Joint Damage d. Genetic susceptibility

Answer A Obesity is a well-recognized risk factor for the development of OA and it is modifiable because the client can lose weight.

1. Which type of immunity will clients acquire through immunizations with live or killed vaccines? a. Natural Active Immunity b. Artificail active immunity c. Natural passixe immunity d. Artificail passive immunity

Answer: B. Rationale: Artificial active immunity is acquired through immunization with live or killed vaccines. Natural active immunity is acquired when there is natural contact with antigens through a clinical infection. Natural passive immunity is acquired through the transfer of colostrums from mother to child. Artificial passive immunity is acquired by injecting serum from an immune human.

12. A client who is exposed to pollens reports a runny, stuffy nose and itchy, watery eyes. The nasal examination reveals swollen and pink nasal mucosa. Which finding does the nurse suspect to be present in the client's laboratory reports? a. Immunoglobulin E (IgE) level of 150 IU/mL b. Eosinophil count of 2% c. Percentage of neutrophils of 80% d. Total white blood cell (WBC) count of 3 billion cells/L

Answers A Rationale: A runny, stuffy nose and itchy, watery eyes and swollen, pink mucosa indicate allergic rhinitis. A normal level of IgE is less than 100 IU/mL. Therefore the laboratory reports of a client with allergic rhinitis may have IgE level 150 IU/mL. The normal eosinophils count is 1% to 2%. The percentage of neutrophils remains normal (50% to 70%) in clients with allergic rhinitis. Total WBC count may be increased or remain normal in clients with allergic rhinitis. The normal range of WBC count lies between 3.5 and 10.5 billion cells/L. A WBC count of 3 billion cells/L indicates leukopenia.

14. What functions of leukocytes are involved in inflammation? a. Destruction of bacteria and cellular debris b. Selective attack and destruction of non-self cells c. Release of vasoactive amines during allergic reactions d. Secretion of immunoglobulins in response to a specific antigen e. Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines

Answers A and C Rationale: Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines during allergic reactions to limit these reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.

5. The nurse is reviewing blood screening tests of the immune system of a client with acquired immunodeficiency syndrome (AIDS). What does the nurse expect to find? a. A decrease in CD4 T cells b. An increase in thymic hormones c. An increase in immunoglobulin E d. A decrease in the serum level of glucose-6-phosphate dehydrogenase

Answer A Rationale: The human immunodeficiency virus (HIV) infects helper T-cell lymphocytes; therefore 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS. The thymic hormones necessary for T-cell growth are decreased. An increase in immunoglobulin E is associated with allergies and parasitic infections. A decrease in the serum level of glucose-6-phosphate dehydrogenase is associated with drug-induced hemolytic anemia and hemolytic disease of the newborn.

4. The nurse instructs a human immunodeficiency (HIV)-positive client about ways to prevent infections. During a follow-up visit, which statement made by the client indicates a need for more education? a. "I reuse cups after washing them." b. "I wash my hands with tap water after gardening." c. "I rinse my toothbrush in liquid laundry bleach every week." d. "I wash my armpits, groin, and genitals with antimicrobial soap twice a day."

Answer B Rationale: An HIV-positive client should refrain from digging in soil and performing gardening activities. Soil contains several infectious microorganisms. In unavoidable circumstances, the client should wear gloves and wash hands thoroughly with antimicrobial soap after gardening. The client should refrain from reusing cups without washing them. Weekly rinsing of a toothbrush in liquid laundry bleach helps prevent infectious pathogens from accumulating on the brush. The armpits, groin, and genitals tend to house higher amounts of microorganisms and should be cleaned twice a day with antimicrobial soap.

2. A nurse is caring for a 26-year-old client recently diagnosed with human immunodeficiency virus (HIV) and has a CD4 count of 150. The client needs an update on immunizations and asks which ones are needed. Which vaccines are required to comply with the recommended immunization schedule for a client with HIV? a. Influenza; measles, mumps, rubella (MMR); varicella; and hepatitis A vaccines b. Pneumococcal, MMR, influenza, and varicella vaccines c. Diphtheria, tetanus, hepatitis A, and hepatitis C vaccines d. Tetanus, hepatitis B, influenza, and pneumococcal vaccines

Answer D. Rationale: According to recent recommendations, adults with HIV should receive tetanus, influenza, hepatitis B, and pneumococcal vaccines. Live pathogen vaccines (MMR, varicella) are contraindicated for individuals who are immunosuppressed. Currently there is no immunization for hepatitis C, and the diphtheria vaccine is not recommended.

8. A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies? a. Infection b. Depression c. Social isolation d. Kaposi sarcoma

Answers A Rationale: The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society's fears and misconceptions; these are beyond the client's control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence.

13. What should be included when planning care to address the nutritional status of a client with AIDS? a. Offer ice chips throughout the day b. Instruct on the use of oral antifungal medication c. Collaborate with the dietitian for small frequent meals d. Emphasize an eating plan incorporating high-fat food items e. Schedule routine mouth care, avoiding alcohol-based mouthwashes

Answers A, B, C, E Rationale: Ice chips will keep the oral mucous membranes moist. Antifungal medication is often prescribed to treat oral candidiasis. Small frequent meals are better tolerated than large meals. Foods that are high in fat should be avoided because fat intolerance often occurs as a result of the disease and as a side effect of some antiretroviral drugs. Mouth care can improve appetite; however, alcohol-based mouthwashes should be avoided because of the drying action to the oral mucous membranes.

3. Which dietary changes does the nurse suggest for a client who has diarrhea associated with human immunodeficiency virus (HIV disease)? a. "Eat more fatty food." b. Eat much less roughage." c. Drink two cups of coffee daily." d. Eat more spicy and sweet food." e. "Drink plenty of fluids between meals."

Answers B and E Rationale: Clients infected with the HIV virus often suffer from diarrhea. Roughage should be limited in the diet of a client who has diarrhea associated with HIV disease, as it is not easy digestible. Drinking plenty of fluids helps to compensate for the fluid loss. Fatty foods are avoided as they alter the process of digestion. Coffee is avoided as it stimulates the gastrointestinal tract and leads to diarrhea. Spicy and sweet foods are avoided as they trigger the gastrointestinal tract and acidify the stomach contents that lead to diarrhea.

6. Which conditions result in humoral immunity? a. Tuberculosis b. Atopic diseases c. Bacterial infection d. Anaphylactic shock e. Contact dermatitis

Answers B, C, D Rationale: Atopic diseases, bacterial infections, and anaphylactic shock are disease conditions that trigger humoral immunity. Tuberculosis and contact dermatitis result in cell-mediated immunity.

10. Which statement indicates that a client understands the ways HIV is transmitted? a. "I can contract HIV by participating in oral sex." b. "I can contract HIV by eating from used utensils." c. "HIV is contracted by using contaminated needles." d. "I can contract HIV by using the bathroom of a person who is HIV positive." e. "Babies can contract HIV because of contact with maternal blood during birth."

Answers: A, C, E Rationale: HIV is transmitted sexually through oral sex. HIV is transmitted through the use of contaminated needles. HIV is transmitted by contact with maternal blood during the birthing process. HIV cannot be transmitted by sharing eating utensils or using the bathroom of a person who is HIV positive.

7. Which leukocytes should the nurse include when teaching about antibody-mediated immunity? . a. Monocyte b. Memory cell c. Helper T cell d. B-lymphocyte e. Cytotoxic T cell

Answers: B and D Rationale: Memory cells and B-lymphocytes are involved in antibody-mediated immunity. Monocytes are involved in inflammation. Helper T cells and cytotoxic T cells are involved in cell-mediated immunity.

11. A nurse is caring for a client with a diagnosis of acquired immunodeficiency syndrome (AIDS). The IV infiltrates and needs to be restarted. What is necessary to protect the nurse when restarting the IV? a. Mask b. Gown c. Gloves d. Face shield e. Hand hygiene

Answers: C and E Rationale: Wearing gloves protects the nurse from potential contamination. Gloves are appropriate when there is a risk of the hands coming into contact with a client's blood or body fluids. Hand hygiene is the most effective way to prevent the spread of microorganisms. Wearing a mask is necessary for procedures where splashing of body fluids is anticipated or a risk. Wearing a gown is necessary for procedures where splashing of body fluids is anticipated or a risk. Wearing a face shield is necessary for procedures where splashing of body fluids is anticipated.