NRSG 4580 | Exam 4 Practice Questions

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many mgs will the nurse prepare per dose for the client?

50 mg

Which of the following statements indicate that the patient has an understanding of the treatment for their newly diagnosed HIV? A) "I want my viral load to be low." B) "I want my viral load to be high." C) "I want my CD4 count levels to be low." D) "I can become cured after several years of treatment."

A) "I want my viral load to be low." With patients with HIV, the goal is for their viral count levels to be low and the CD4 count levels to be high. HIV cannot be cured once the patient has it. They can become undetectable, but still have the virus inside their body.

A client presents to the clinic with a craving for eating chalk. The nurse suspects that the client may have what type of anemia? A) Iron deficiency anemia (IDA) B) Sickle cell anemia C) Aplastic anemia D) Megaloblastic anemia

A) Iron deficiency anemia (IDA) Clients with IDA may suffer from pica which is a craving for non food items.

A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? A) Vitamin B12 deficiency B) Folic acid deficiency C) Iron deficiency anemia D) Sickle cell anemia

A) Vitamin B12 deficiency Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.

The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply. A) Wear a medic alert bracelet. B) Food labels on baked items are the only labels that need to be read. C) Carry EpiPen autoinjector at all times. D) List symptoms of peanut allergy. E) Identify ways to manage allergy while dining out.

A, C, D, E

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. A) chemical agents B) hormone replacement therapy C) viruses D) environmental factors E) defective genes F) dietary substances

ALL OF THE ABOVE

An adult client with leukemia will soon begin chemotherapy. Knowing the most common adverse reaction to chemotherapy, the nurse plans to administer which of the following? A) Administer Bleomycin (Blenoxanen). B) Administer Methotrexate (Trexall). C) Administer Ondansetron (Zofran). D) Administer an Warfarin (Coumadin).

C) Administer Ondansetron (Zofran). Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy.

An adult client has had mumps when the client was a child. The client had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect? A) Passive immunity B) Natural passive immunity C) Naturally acquired active immunity D) Artificially acquired active immunity

C) Naturally acquired active immunity

What pathophysiological concept related to sickle cell disease predisposes a client with sickle cell disease to pneumonia? A) Sequestration of sickled cells lead to infection in the area distal to the sequestration. B) Sequestration of sickled cells lead to infection in the area of sequestration. C) Damage to the lymphatic system increases the risk for infection. D) Damage to the spleen increases the risk for infection.

D) Damage to the spleen increases the risk for infection. Sickle cell disease can damage the spleen by thrombosis and subsequent damage or necrosis of tissue. This damage to the spleen increases the risk for infection, predisposing the client to pneumonia and acute chest syndrome. Sequestration causes thrombosis, not infection.

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A) Risk reduction B) Disease prophylaxis C) Tertiary prevention D) Secondary prevention

D) Secondary prevention SCREENING**

A nurse is caring for a client newly diagnosed with cancer. Which therapies are used to treat cancer? Select all that apply. A) Surgery B) Hyperthermia C) Radiation therapy D) Chemotherapy E) Electroconvulsive Therapy

EVERYTHING EXCEPT FOR E Cancer is frequently treated with a combination of therapies using standardized protocols. The basic methods used to treat cancer are surgery, radiation therapy, hyperthermia, and chemotherapy. Electroconvulsive therapy is a method of treatment for mental distress or illness.

A nurse assesses a client after 15 minutes from starting a packed red blood cell (PRBCs) transfusion. The nurse suspects that a client is suffering from a hemolytic transfusion reaction. Order the nursing interventions in order of priority. - Document client's reaction - Notify the provider - Notify the blood bank - Stop the infusion - Infuse 0.9% NaCL through new IV tubing

1. Stop the infusion 2. Infuse 0.9% NaCL through new IV tubing 3. Notify the provider 4. Notify the blood bank 5. Document client's reaction

A nurse is aware that a client receiving carmustine, a chemotherapy agent, is at risk for thrombocytopenia. This nurse knows to assess for what symptom? A) Epistaxis B) Increased weight C) Interrupted sleep pattern D) Hot flashes

A) Epistaxis BLEEDING

A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing client teaching prior to the client's discharge. In the event of an anaphylactic reaction, the nurse informs the client that she should self-administer epinephrine in what site? A) Thigh B) Abdomen C) Deltoid D) Forearm

A) Thigh

A nurse knows that the expected response of a patient receiving Filgrastim (Neupogen) is that the RBC count will increase. A) True B) False

B) False Filgrastim (Neupogen) increases the WBC count, specifically the neutrophils.

A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining? A) methotrexate B) ibuprofen C) sulfasalazine D) celecoxib

D) celecoxib The cyclooxygenase-2 inhibitors, such as celecoxib, have been shown to inhibit inflammatory processes but do not inhibit the protective prostaglandin synthesis in the gastointestinal (GI) tract. Therefore, patients who are at increased risk for gastrointestinal complications, especially GI bleeding, have been managed effectively with celecoxib. Ibuprofen, methotrexate, and sulfasalazine may cause GI irritation.

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client A) may be developing anemia. B) has thrombocytopenia. C) has leukopenia. D) may be developing an infection.

D) may be developing an infection. Less mature granulocytes have a single-lobed, elongated nucleus and are called band cells. Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. An increased number of band cells is sometimes called a left shift or shift to the left.

A nurse is working in a health clinic at a retirement community. What is the nurse's primary rationale for recommending HIV testing for older adults? A) Age-related immune system changes increase the risks of infections for older adults. B) Older gay men, feeling less inhibited by social mores, tend to have multiple sex partners. C) Older adults may have received HIV-infected blood transfusions before 1985. D) Older adults, who are sexually active don't use condoms.

A) Age-related immune system changes increase the risks of infections for older adults.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury? A) Install safety devices in the home. B) Get help when lifting objects. C) Wear protective devices when exercising. D) Wear worn, comfortable shoes.

A) Install safety devices in the home. Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises.

The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the client is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Palliative surgery B) Prophylactic surgery C) Reconstructive surgery D) Salvage surgery

B) Prophylactic surgery Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy? A) change in hair color B) fever C) elevated white blood cell count D) constipation

B) fever The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? A) Administer Acetaminophen (APAP) 500 mg PO, as ordered B) Administer Ibuprofen 600 mg PO, as ordered C) Notify the physician D) Administer Aspirin (ASA) 325 mg PO, as ordered

A) Administer Acetaminophen (APAP) 500 mg PO, as ordered After a marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., acetaminophen) may be useful. Aspirin-containing analgesic agents and NSAIDS should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

A nurse knows that what precautions should be taken with a client that has been newly diagnosed with AIDS based on the client having Wasting Syndrome attributed to HIV? A) Standard precautions B) Droplet precautions C) Airborne precautions D) Contact precautions

A) Standard precautions HIV/AIDS cannot be contracted by casual contact, therefore standard precautions are most appropriate with this client. Airborne and droplet precautions are not indicated. Neutropenia precautions may be initiated if the client has neutropenia.

A nurse is caring for a client that has been HIV positive for 10 years. The nurse knows that a client has progressed from stage 2 HIV to stage 3 HIV (AIDS) when the CD4 count is which of the following? A) CD4 cells < 800 B) CD4 cells < 200 C) CD4 cells < 400 D) CD4 cells < 600

B) CD4 cells < 200 For clients being HIV positive fro greater than 6 years, CD4 counts less than 200 indicate the progression to AIDS.

Aplastic anemia is a type of anemia that causes neurological symptoms such as confusion, paresthesias, and proprioception. A) True B) False

B) False The megaloblastic anemia vitamin B12 deficiency/pernicious anemia causes neurological symptoms.

A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma? A) Polycythemia vera B) Increased urinary protein C) Decreased serum protein D) Decreased calcium level

B) Increased urinary protein A characteristic finding in multiple myeloma is protein in the urine. (RENAL INSUFFICENCY) Other laboratory findings include increased serum protein, hypercalcemia, anemia, and hyperuricemia. Polycythemia vera is not found in multiple myeloma.

A client has been diagnosed with a lymphoid stem cell defect. This client has the potential for a problem involving which of the following? A) Platelets B) Plasma cells C) Neutrophils D) Red blood cells

B) Plasma cells A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells (a more differentiated form of B lymphocyte), or natural killer (NK) cells.

Allopurinol has been prescribed for a client receiving treatment for gout. The nurse caring for this client knows to assess the client for bone marrow suppression, which may be manifested by what diagnostic finding? A) Hyperuricemia B) Elevated serum creatinine C) Decreased platelets D) Increased erythrocyte sedimentation rate

C) Decreased platelets Thrombocytopenia occurs in bone marrow suppression. Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.

A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? A) Losartan (Cozaar) B) Metoprolol (Lopressor) C) Lisinopril (Zestril) D) Amlodipine (Norvasc)

C) Lisinopril (Zestril)

The clinical nurse educator is presenting health promotion education to a client who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A) Avoiding grapefruit juice and fresh grapefruit B) Avoiding direct sun exposure in excess of 15 minutes daily C) Using an electric shaver rather than a razor D) Avoiding highly crowded public places

D) Avoiding highly crowded public places The risk of infection is significant for these clients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the client's medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.

A nurse knows that a client taking PrEP (Truvada) needs FURTHER education when they make which statement? A) "This medication regimen is over at 30 days." B) "I need to take this medication on a daily basis." C) "I need to get lab work every 3 months." D) "I take this medication to prevent contracting HIV."

A) "This medication regimen is over at 30 days." PrEP is taken on a daily basis with lab monitoring every 3 month. Patients do take the medication to prevent contracting HIV. PEP is the medication regimen that is over the course of 30 days.

An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which ICU client most likely faces the highest risk of DIC? A) A client who is being treated for septic shock B) A client who suffered multiple trauma in a workplace accident C) A client with extensive burns D) A client who has a diagnosis of acute respiratory distress syndrome

A) A client who is being treated for septic shock Sepsis is a common cause of DIC. A wide variety of acute illnesses can precipitate DIC, but sepsis is specifically identified as a cause.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? A) The client with a painful sore throat. B) The client with enlarged lymph nodes in the neck. C) The client with painful lymph nodes in the groin. D) The client with painful lymph nodes under the arm.

B) The client with enlarged lymph nodes in the neck. Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.

A client is receiving a blood transfusion and reports a new onset of slight dyspnea. The nurse's rapid assessment reveals bilateral lung crackles and elevated BP. What is the nurse's most appropriate action? A) Slow the infusion rate and monitor the client closely. B) Pause the transfusion and administer a 250 mL bolus of normal saline. C) Discontinue the transfusion and administer a beta-blocker, as prescribed. D) Discontinue the transfusion and begin resuscitation.

A) Slow the infusion rate and monitor the client closely. The client is showing early signs of hypervolemia; the nurse should slow the infusion rate and assess the client closely for any signs of exacerbation. At this stage, discontinuing the transfusion is not necessary. A bolus would worsen the client's fluid overload.

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? A) Severe thrombocytopenia B) Bone pain in the back of the ribs C) Debilitating fatigue D) Gradual muscle paralysis

B) Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? A) Assisting in prioritizing activities. B) Encouraging early and frequent activities. C) Breaking up interventions into smaller, more frequent tasks. D) Determining the balance between rest and activity.

A) Assisting in prioritizing activities. When planning care for a client with severe fatigue secondary to anemia, the nurse should act collaboratively with the client and assist in prioritizing activities. The client ultimately determines the balance between rest and activity, not the nurse. The nurse will balance activities and group nursing interventions in order to prevent client fatigue.

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? A) Interleukins B) Natural killer cells C) Cytokines D) Interferons

B) Natural killer cells Natural killer cells are lymphocyte-like cells that circulate throughout the body looking for virus-infected cells and cancer cells. Cytokines are chemical messengers released by lymphocytes, monocytes, and macrophages. Interleukins carry messages between leukocytes and tissues that form blood cells. Interferons are chemicals that primarily protect cells from viral infections.

A client has a known allergy to peanuts, meaning that the client's immune system has identified peanuts as a foreign invader and has produced specific cells to attack if the client should come in contact with peanuts again. The formation of these specific cells is known as: A) Memory response B) Inflammatory response C) Humoral response D) Cell-mediated response

C) Humoral response The B-cell lymphocytes mature in the bone marrow and migrate to the spleen and other lymphoid tissues such as the lymph nodes. When stimulated by T cells, the B cells become either plasma or memory cells. Plasma cells produce antibodies. Formation of antibodies is called a humoral response.

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment? A) Hypovolemia B) Vitamin B12 deficiency C) Iron overload D) Thrombocytopenia

C) Iron overload Clients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.

A client with rheumatoid arthritis comes to the clinic for a second dose of etanercept. The dose prescribed is 25 mg subcutaneously. The medication is available in 50 mg per milliliter. How many milliliters will the nurse administer to the client? Record your answer using one decimal place. _____ Ml

0.5

A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects the client has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition? A) Packed red blood cells (RBCs) B) Normal saline solution C) Lactated Ringer's solution D) Fresh frozen plasma (FFP)

A) Packed red blood cells (RBCs) Hide Feedback In a trauma situation, the first blood product given is unmatched (O negative) packed RBCs. Fresh frozen plasma is commonly used to replace clotting factors. Normal saline or lactated Ringer's solution is used to increase volume and blood pressure; however, too much colloid will hemodiluted the blood and doesn't improve oxygen-carrying capacity as well as packed RBCs do.

An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated? A) Macrophages B) Cytotoxic T cells C) Helper T cells D) B cells

B) Cytotoxic T cells Cytotoxic T cells (killer T cells) attack the antigen directly by altering the cell membrane and causing cell lysis (disintegration) and by releasing cytolytic enzymes and cytokines. Lymphokines can recruit, activate, and regulate other lymphocytes and white blood cells. These cells then assist in destroying the invading organism.

A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores? A) Chelation therapy B) Phlebotomy C) Blood transfusions D) Radiation

B) Phlebotomy The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient's iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.

A patient presents to the Emergency Department (ED) after being stung by a yellow jacket (wasp). The patient is having wheezes, tachypnea, tachycardia, and diaphoresis. Vital signs are HR 130, RR 35, SPO2 87%, BP 90/52. The nurse recognizes that the patient is experiencing a type 1 hypersensitivity. Intravenous access has been initiated. The nurse recognizes that which of the following is going to help this patient? A) Give the patient Diphenhydramine (Bendadryl) 50mg PO and Prednisone 50mg PO STAT. B) Prepare for endotracheal intubation. C) Administer oxygen via nasal cannula at 2L/min. D) Give the patient Diphenhydramine (Benadryl) 50mg PO and Famotidine (Pepcid) 20mg PO STAT.

B) Prepare for endotracheal intubation. During anaphylaxis, patients will need IV medication, not PO. Administering oxygen via nasal cannula is not going to help this patient. The patient would need 100% oxygen therapy via a non-rebreather. The patient needs to be prepared for intubation.

While a client is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action? A) Applying a warm compress to the infusion site B) Stopping the administration of the drug immediately C) Continuing the infusion but decreasing the rate D) Notifying the client's physician

B) Stopping the administration of the drug immediately Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the client's physician. Ice can be applied to the site once the drug therapy has stopped.

A client presents with itching, swelling, redness, and wheals of superficial skin layers. What is the most likely type of allergy this client is displaying? A) Angioedema B) Urticaria C) Dermatitis medicamentosa D) Contact dermatitis

B) Urticaria Urticaria presents with itching, swelling, redness, and wheals of superficial skin layers. Dermatitis medicamentosa presents with sudden generalized bright red rash, itching, fever, malaise, headache, arthralgias. Contact dermatitis presents with itching, burning, redness, rash on contact with substance. Angioedema presents with itching, swelling, redness of deeper tissues and mucous membranes.

A client's most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the client's cancer cells spread? A) Angiogenesis B) Invasion C) Lymphatic circulation D) Apoptosis

C) Lymphatic circulation Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis. Apoptosis is programmed cellular death.

A client with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the client? A) Use the oral anesthetic 1 hour prior to meal time. B) Swallow slowly and deliberately. C) Brush teeth before and after eating. D) Chew with care to avoid inadvertently biting the tongue.

D) Chew with care to avoid inadvertently biting the tongue. If oral anesthetics are used, the client must be warned to chew with extreme care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would be metabolized by the time the client eats if it is used 1 hour prior to meals. There is no specific need to warn the client about brushing teeth or swallowing slowly because an oral anesthetic has been used.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? A) Oral (PO) B) Subcutaneous (SQ) C) Intravenous (IV) D) Intramuscular (IM)

D) Intramuscular (IM) A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.

A client has been living with seasonal allergies for many years, but does not take antihistamines, stating, "When I was young I used to take antihistamines, but they always put me to sleep." How should the nurse best respond? A) "Have you considered taking them at bedtime instead of in the morning?" B) "Most people find that they develop a tolerance to sedation after a few months." C) "Newer antihistamines are combined with a stimulant that offsets drowsiness." D) "The newer antihistamines are different than in years past, and cause less sedation."

D) "The newer antihistamines are different than in years past, and cause less sedation." Unlike first-generation H1 receptor antagonists, newer antihistamines bind to peripheral rather than central nervous system H1 receptors, causing less sedation, if at all. Tolerance to sedation did not usually occur with first-generation drugs and newer antihistamines are not combined with a stimulant.

An elderly client is diagnosed with cancer. While reviewing age-related changes in the immune system, what does the nurse identify as having contributed to this client's condition? A) Impaired ciliary action from exposure to environmental toxins B) Failure of immune system to differentiate "self" from "non-self" C) Decreased sensation and slowing of reflexes D) Failure of lymphocytes to recognize mutant cells

D) Failure of lymphocytes to recognize mutant cells Failure of lymphocytes to recognize mutant or abnormal cells contributes to an increased incidence of cancers in the elderly. Impaired ciliary action due to exposure to smoke and environmental toxins contributes to impaired clearance of pulmonary secretions and an increased incidence of respiratory infections in the elderly. Failure of immune system to differentiate "self" from "non-self" leads to an increase incidence of autoimmune diseases. Decreased sensation and slowing of reflexes leads to increased risk of skin injury, skin ulcers, abrasions, burns, and other trauma.

Which statement would alert the nurse to suspect a client is experiencing a mild anaphylactic reaction? A) "My throat feels like it's full." B) "I'm having tightness in my chest." C) "I feel like my face is so flushed." D) "I'm having difficulty swallowing."

A) "My throat feels like it's full." Manifestations of a mild anaphylactic reaction include peripheral tingling and a sensation of warmth, a sensation of fullness in the mouth and throat, nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes. Flushing, warmth, anxiety, and itching in addition to the mild symptoms indicate a moderate reaction. A severe systemic reaction begins abruptly with the mild and moderate symptoms rapidly progressing to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension as well as dysphagia, abdominal cramping, vomiting, diarreha, and possibly seizures.