Unit 2 Med/Surg

Reservoir/Source of infectious agent

A reservoir is the principal habitat in which a pathogen lives, flourishes and is able to multiply. Common reservoirs for infectious agents include humans, animals or insects and the environment.

AIDS

A viral disease caused by HIV, which destroys T cells, thereby increasing susceptibility to infection and malignancy. The syndrome s manifested clinically by opportunistic infections and unusual neoplasms. AIDS is considered a chronic illness. The disease has a long incubation period, sometimes 10 yrs or longer.

HIV positive + Opportunistic infection=

AIDS

Multidrug-resistant organism Infection/ CRE Carbapenem resistance enterococcus

Abdominal infection/peritonitis/Lebsiella/E.Coli Contact precautions Chlorhexidine baths (CHG)

GI manifestations: Systemic Lupus Erythematosus (SLE)

Abdominal pain

Drug therapy Gout

Acute- colchicine, indomethacin, ibuprofen Chronic- Allopurinol, febuxostat, probenecid (take after meals w/ full glass of water. Periodic labs to ck. liver and kidney function) Severe-pegloticase: after all treatment fails; IV Q2 wks., watch for reaction as protein is foreign to body.

A client is diagnosed with scleroderma. Which intervention should the nurse anticipate to be prescribed? 1. Maintain bed rest as much as possible. 2. Administer corticosteroids as prescribed for inflammation 3. Advise the client to remain supine for 1 to 2 hrs. after meals. 4. Keep the rm. temp. warm during the day and cool at night.

Answer - 2 Scleroderma is a chronic connective tissue disease similar to systemic lupus erythematosus. Corticosteroids may be prescribed to treat inflammation. Topical agents may provide some relief from joint pain. Activity is encouraged as tolerated and the rm. temp. needs to be constant. Clients need to sit up for 1 to 2 hrs. after meals if esophageal involvement is present.

The nurse is performing an assessment on a client who has been diagnosed with an allergy to latex. In determining the clients' risk factors, the nurse should question the client about an allergy to which food item? 1. Eggs 2. Milk 3. Yogurt 4. Bananas

Answer - 4 Rationale: Individuals who are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, or water chestnuts are at risk for developing a latex allergy. This is thought to be the result of a possible cross- reaction between the food and the latex allergen. Options 1, 2, and 3 are unrelated to latex allergy.

The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse understand that this has been confirmed by which finding? 1. Swelling in the genital area 2. Swelling in the lower extremities 3. Positive punch biopsy of the cutaneous lesions 4. Appearance of reddish-blue lesions noted on the skin

Answer -3 Rationale: Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques lacerate or open and drain. The lesions spread by metastasis through the upper body and then the face and oral mucosa. The can move to the lymphatic system, lungs, and gastrointestinal tract. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is made by punch biopsy of cutaneous lesions and biopsy of pulmonary and gastrointestinal lesions.

With which activities does the nurse teach unlicensed assistive personnel (UAP) and nursing students caring for a client who is HIV positive to wear gloves to prevent disease transmission? Select all that apply A. Applying lotion during a back rub B. Brushing the client's teeth C. Emptying a Foley catheter reservoir D. Feeding the client E. Filing the client's fingernails F. Providing perineal care

Answer B, C, F

The community health nurse is conduction a research study and is identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy? 1. Hairdressers 2.The homeless 3. Children in day care centers 4. Individuals living in a group home

Answer is 1 Rationale: Individuals most at risk for developing a latex allergy include health care workers; individuals who work in the rubber industry; or those who have had multiple surgeries, have spina bifida, wear gloves frequently (such as food handlers, hairdressers, and auto mechanics), or are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, or water chestnuts.

The nurse is assisting in planning care of a client with a diagnosis of immunodeficiency and should incorporate which action as a PRIORITY in the plan? 1. Protecting the client from infection 2. Providing emotional support to decrease fear 3. Encouraging discussion about lifestyle changes 4. Identifying factors that decreased the immune function

Answer is 1 Rationale: The client with immunodeficiency has inadequate or absence of immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Options 2, 3, and 4 may be components of care but are not the priority.

A client develops an anaphylactic reaction after receiving morphine. The nurse should plan to institute which actions? SELECT ALL THAT APPLY 1. Administer oxygen 2. Quickly assess the client's respiratory status. 3. Document the event, interventions, and clients response. 4. Leave the client briefly to contact a HCP. 5. Keep the client supine regardless of the bp readings 6. Start an IV infusion of D5W and administer a 500ml bolus.

Answer is 1, 2, 3 Rationale: An anaphylactic reaction requires immediate actions, starting with quickly assessing the client's respiratory status. Although the HCP and the Rapid Response Team must be notified immediately, the nurse must stay with the client. Oxygen is administered and an IV and NS is started and infused per HCP prescription. Documentation of the event, actions taken, and client outcomes needs to be done. The of the bed should be elevated if the client's bp is normal.

Which interventions apply in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply 1. Use nonlatex gloves 2. Use medications from glass ampules. 3. Place the client in a private rm. only 4. Keep a latex-safe supply care available in the clients area. 5. Use a bp cuff from an electronic device only to measure the bp

Answer is 1,2,4,5 Rationale: If a client is allergic to latex and is high risk for an allergic response, the nurse would use nonlatex gloves and latex safe supplies, and would keep a latex-safe supply care available in the clients area. Any supplies or materials that contain latex would be avoided. These include bp cuffs and medication vials with rubber stoppers that required punctures with a needle. It is not necessary to place the client in a private rm.

A client calls the nurse in the emergency department and states that he was just stung by a bumblebee while gardening. The client is afraid of a severe reaction because the client's neighbor experience such a reaction just 1 wk. ago. Which action should the nurse take? 1. Advise the client to soak the site in hydrogen peroxide 2. Ask the client if he ever sustained a bed sting in the past. 3. Tell the client to call an ambulance for transport to the emergency department. 4. Tell the client not to worry about the sting unless difficulty with breathing occurs.

Answer is 2 Rationale: In some types of allergies, a reaction occurs only on second and subsequent contacts with the allergen. The appropriate action, therefore, would be to ask the client if he ever experienced a bee sting in the past. Option 1 is not appropriate advice. Option 3 is unnecessary. The cleint should not be told "not to worry."

A client presents at the health care provider's office with complaints of a ring-like rash on his upper leg. Which question should the nurse ask FIRST? 1. Do you have any cats in your home? 2. Have you been camping in the last month? 3. Have you or close contacts had any flu-like symptoms within the last few wks.? 4. Have you been in physical contact with anyone who has the same type of rash?

Answer is 2 Rationale: The nurse should ask questions to assist in identifying a cause of Lyme disease, which is a multisystem infection that results from a bite by a tick carried by several species of deer. The rash from a tick bite can be a ring-like rash occurring 3 to 4 wks. after a bite and is commonly seen on the groins, buttocks, axillae, trunk, and upper arms or legs. Option 1 is referring to toxoplasmosis, which is caused by the inhalation of cysts form contaminated cat feces. Lyme disease cannot be transmitted form one person to another.

The nurse proves home care instructions to a client with systemic lupus erythematosus and tell the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction? 1. I should take hot bath because they are relaxing. 2. I should sit whenever possible to conserve my energy 3. I should avoid long periods of rest because it causes joint stiffness. 4. I should do some exercises, such as walking, when I am not fatigued.

Answer is 2 Rationale: To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible, avoid hot baths (because the exacerbate fatigue), schedule moderate low-impact exercised when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness.

The nurse prepares to give a bath and change the bed linens of a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amt. of serous fluid. Which would the nurse incorporate into the plan during the bathing of this clients? 1. Wearing gloves 2. Wearing a gown and gloves 3. Wearing a gown, gloves, and a mask 4. Wearing a gown and gloves to changes the bed linens, and gloves only for the bath

Answer is 2 Rationale: Gowns and gloves are required if the nurse anticipates contact with soiled items such as those with wound drainage, or is caring for a client who is incontinent with diarrhea or a client who ahs an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amt. of wound drainage, a gown and gloves must be worn.

The nurse is conducting a teaching session with a client on their diagnosis of pemphigus. Which statement by the client indicates that the client understands the diagnosis? 1. My skin will have tiny red vesicles. 2. The presence of the skin vesicles is caused by a virus 3. I have an autoimmune disease that causes blistering in the epidermis. 4. The presence of red, raised papules and large plaques covered by silvery scales will be present on my skin.

Answer is 3 Rationale: Pemphigus is an autoimmune disease that causes blistering in the epidermis. The client has large flaccid blisters (bullae). Because the blisters are in the epidermis, they have a thin covering of skin and break easily, leaving large denuded areas of skin. On initial examination, clients may have crusting areas instead of intact blisters. Option 1 describes eczema, Option 2 describes herpes zoster, and option 4 describes psoriasis.

Which part of the HIV infection process is disrupted by the antiretroviral drug class of entry inhibitors? A. Activation the viral enzyme "integrase" within the infected host's cells B. Binding the virus to the CD4+ receptor and either of the two co-receptors C. Clipping the newly generated viral proteins into smaller functional pieces D. Fusing the newly created viral particle with the infected cells' membrane

Answer is B

A client diagnosed with AIDS who is receiving combination antiretroviral therapy (cART) now has a CD4+ T-cell count of 525 cells/mm3. How will the nurse interpret this result? A. The client can reduce the dosages of the prescribed drugs B. The virus is resistant to the current combination of drugs C. The client no longer has AIDS D. The drug therapy is now effective

Answer is D

The nurse is conducting allergy skin testing on a client. Which post-procedure interventions are most appropriate? Select all that apply 1. Record site, date, and time of the test. 2. Give the client a list of potential allergens if identified. 3. Estimate the size of the wheal and document the findings 4. Tell the client to return to have the site inspected only if there is a reaction

Answer- 1, 2 Rationale: Skin testing involves administration of an allergen to the surface of the skin or into the dermis. Site, date, and time of the test must be recorded, and the client must return at a specific date and time for a follow up site evaluations, even if no reaction is suspected; a list of potential allergens is identified. For the follow up evaluations, the size of the site has to be measured and not estimated. After injections, clients only need to be monitored for about 30 minutes to assess for any adverse effects.

A client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which actions are most appropriate? Select all that apply. 1. Tell the client that testing is not necessary unless arthralgia develops. 2. Tell the client to avoid any woody, grassy areas that may contain ticks. 3. Instruct the client to immediately start to take the antibiotics that are prescribed. 4. Inform the client to plan to have a blood test 4 to 6 wks. after a bite to detect the presence of the disease. 5. Tell the client that is this happens again, to never removed the tick but vigorously scrub the area with an antiseptic.

Answer- 2,3,4 Rationale: A blood test is available to detect Lyme disease; however, the test is not reliable if performed before 4 to 6 wks. following the tick bite. Antibody formation takes place in the following manner. Immunoglobulin M is detected 3 to 4 wks. after Lyme disease onset, peaks at 6 to 8 wks., and then gradually disappears; immunoglobulin G is detected 2 to 3 mths. after infection and may remain elevated for yrs. Areas tat ticks inhabit need to be avoided. Ticks should be removed with tweezers and then the area is washed with an antiseptic. Options 1 & 5 are incorrect.

Which health teaching by the nurse is important for clients diagnosed with SLE? Select all that apply A. Take frequent rest periods to prevent fatigue. B. Avoid green leafy vegetables to prevent bleeding C. Avoid sun exposure to prevent disease flare-ups D. Report fever to your PCP immediately E. Use a mild soap for bathing to prevent skin irritation

Answer- A, C, D, E

The nurse is preparing to give medications to a group of clients. Which drug is not appropriate to treat the disease with which it is matched? A. Rheumatoid arthritis-leflunomide B. Osteoarthritis-Acetaminophen C. Acute gout- Allopurinol D. Systemic Lupus erythematosus- prednisone (we should not have any questions concerning osteoarthritis/rheumatoid arthritis-but will have questions associated with disease and which drug(s) is used to treat)

Answer- C

The nurse is preparing a group of Cub Scouts for an overnight camping trip and instructs the Scouts about the methods to prevent Lyme disease. Which statement by one of the Scouts indicates a need for further instruction? 1. I need to bring a hat to wear during the trip. 2. I should wear long-sleeved tops and long pants. 3. I should not use insect repellents because it will attract the ticks. 4. I need to wear closed shoes and socks that can be pulled up over my pants.

Answer-3 Rationale: In the prevention of Lyme disease, individuals need to be instructed to use an insect repellent on the skin and clothes when in an area where ticks are likely to be found Long-sleeved tops and long pants, closed shoes, and a hat or cap should be worn. If possible, heavily wooded areas or area with thick underbrush should be avoided. Socks can be pulled up and over the pant legs to prevent ticks form entering under clothing.

C diff contact precautions

*Hand-wash Can spread by indirect contact

What PPE is required for *contact* precautions?

- gloves + gowns; - private room; [can cohort w/same infection, just as long as each client has their own equipment] door does not have to remain closed

What PPE is required for *droplet* precautions?

- mask - private room; [can cohort w/same infection, just as long as each client has their own equipment]; - mask on patient for transport

Fibromyalgia Drug Therapy

Anticonvulsants- Gabapentin, Pregabalin (Lyrica) SNRI's- selective norepinephrine reuptake inhibitors - Duloxetine (Cymbalta) and milnacipran (Savella) Tricyclic Antidepressants- Amitriptyline and nortriptyline Muscle relaxants NSAIDS Opiate analgesics-Tramadol (should be last option-rarely needs because other treatments work good)

Scleroderma -assessment

Arthralgia: pain in joints Skin: Tight/shiny- pitting edema GI tract: Gerd/difficulty swallowing Cardiovascular system: mild cardio fibrosis, EKG changes, CP, Dysrhythmias Pulmonary system: Lung fibrosis, pulmonary hypertension Renal system: Malignant hypertension-really high bp, very fast ex 180/120 assess urine output

prevention and early detection of Lyme Disease

Avoid heavily wooded areas w/ thick underbrush Avoid dark clothing-ticks are more easily detected on light clothing Use insect repellent (DEET) on skin and clothes Wear long sleeved tops and long pants; tuck shirt into pants and your pants into your socks or boots Wear closed shoes or boots and hat/cap Bathe immediately after being in infected area Gently remove w tweezers or fingers covered with tissue or gloves any tick that you find (do not squeeze) Dispose of the tick by flushing down toilet (burning tick can spread infection) After removal, clean the area w/ antiseptic such as rubbing alcohol Wait 4-6 wks after bite before being tested for Lyme disease (testing before is not reliable) Report symptoms such as rash, or influenza-like illness to PCP

For the client with SLE, what level's are monitored frequently for signs or renal impairment?

Blood urea nitrogen and Creatinine levels

Neurological manifestations: Systemic Lupus Erythematosus (SLE)

CNS lupus

Systemic Sclerosis, remember CREST

Calcinosis (calcium deposits) Raynaud's Phenomenon (first symptom that occurs-remember fingers blue) Esophageal dysmotility (difficulty swallowing) Sclerodactyly (scleroderma of the digits) Telangiectasia (spider like hemangiomas)

fibromyalgia syndrome (FMS)

Chronic pain syndrome-(not an inflammatory disease) Symptoms: Burning/gnawing pain, tenderness/trigger points-Come and go but worsens with stress, increased activity, weather Suffers from fatigue, sleep disturbances, numbness or tingling in extremities Sensitive to odors, loud noises, bright lights. Headaches and jaw pain Women>men, women age 30-50 years (depression, sleep issues, digestive issues, sensitivity to touch, pelvic floor dysfunction, widespread pain-seems more like muscle than joint)

Evidence based practice for Skin Protection in Pts. with Lupus Erythematosus- Teach/Educate

Cleanse skin with mild soap (like ivory) Dry skin thoroughly by patting rather than rubbing Apply mild or non-perfumed lotion liberally to dry skin areas. Avoid powder and other drying agents such as rubbing alcohol Use cosmetics that contain moisturizers Avoid direct sunlight and any other type of ultraviolet lighting, including tanning beds Wear a large brimmed hat, long sleeves, and long pants when in the sun use sun block agent with at least 30 SPF Inspect your skin daily for open areas and rashes

Psoriatic arthritis

DIP joint involvement, rash w/ silvery scale on elbows and knees, pitting nails and swollen fingers. Mostly 30-50 aged men/women of all races Treatment focus is on managing joint pain, controlling skin lesions, and slowing progression

Increased risk factors for Older PT/ immune system

Decreased antibody production, lymphocytes, and fever response.

Increased risk factors for Older PT/ Respiratory system

Decreased cough and gag reflexes

Increased risk factors for Older PT/ GI system

Decreased gastric acid and intestinal motility

Increased risk factors for Older PT/ Chronic illness

Diabetes mellitus, chronic obstructive pulmonary disease, neurologic impairments

Disinfection

Does not kill spores and reduces organisms

Common Examples of Drug Therapy for HIV infection

Drug Category: Abacavir (Ziagen) Didanosine (Videx EC) Emtricitabine (Emtriva) Lamivudine (Epivir) Stavudine (Zerit) Tenofovir (Viread) Zidovdine (Retrovir) Nursing implications: Remind pts. to avoid fatty and fried foods with these drugs because they cause digestive upsets and may lead to pancreatitis when combine with NRTIs. Teach pts. to use precautions to prevent injury because these drugs induce peripheral neuropathy. Teach pts. taking abacavir to report flu-like symptoms to the provider immediately because these symptoms may indicate a hypersensitivity reaction that requires discontinuing the drug. Instruct to avoid or severely limit alcohol to reduce risk for liver damage while on drug Do not give abacavir if tests positive for the HLA-B tissue type because fatal allergic responses are likely

When being treated for Lyme disease, if client has allergy to PCNs, what can they take?

Erythromycin

Other manifestations: Systemic Lupus Erythematosus (SLE)

Fever (indicates exacerbations) Fatigue Anorexia Weight loss Generalized weakness Vasculitis

NCLEX Test-taking strategy-latex allergy (apply to other similar worded questions)

Focus on the SUBJECT, a latex allergy, and not the strategic word, MOST. Recalling the sources of latex and of the allergic reaction will direct you easily to the correct option.

NCLEX Test-taking strategy-pemphigus (apply to other similar worded questions)

Focus on the SUBJECT, the characteristics of pemphigus. Think about the pathophysiology associated with this disorder and recall that pemphigus vulgaris is an autoimmune disorder

NCLEX Test-taking strategy-cause of Lyme disease (apply to other similar worded questions)

Focus on the strategic word, FIRST. Also focus on the data in the question. Eliminate options 3 and 4 because they are comparable or alike. It is important in the initial assessment for the nurse to determine the cause of the rash. IF the client sustained a bite while out in the woods. Lyme disease should be suspected.

NCLEX Test-taking strategy-Diagnostic measures for Kaposi's sarcoma (apply to other similar worded questions)

Focus on the subject, diagnosing Kaposi's sarcoma. Eliminate options 1 and 2 first because symptoms occur late in the development of Kaposi's sarcoma. Then, note the word, CONFIRMED in the question. This word will assist in directing you to the option that will confirm the diagnosis, the biopsy of the lesions.

NCLEX Test-taking strategy-The method of diagnosing Lyme disease (apply to other similar worded questions)

Focus on the subject, measure to take if Lyme disease is suspected. Also note the strategic words, MOST APPROPRIATE. Eliminate option 1 because treatment should begin before the arthralgia develops. Eliminate option 5 because ticks need to be removed.

NCLEX Test-taking strategy-care of the client with latex allergy (apply to other similar worded questions)

Focus on the subject, the client at high risk for an allergic response to latex. Recalling that items that contain rubber are likely to contain latex will direct you to the correct interventions. Also, noting the closed ended word ONLY in options 3 and 6 will assist in eliminating these options.

Multidrug-resistant organism Infection/VRE Vancomycin resistant enterococcus

Found in intestines/toilet seats/door handles Lives days to weeks Contact precautions

Multidrug-resistant organism Infection/ Most common-MRSA

Found on skin, perineum, nose Poor hygiene/non-intact skin Fastest growing/direct contact Chlorhexidine baths (CHG) Contact precautions Treat with: Vancomycin Zyvox Teflaro

Increased risk factors for Older PT/ Functional/cognitive impairments

Immobility, incontinence, dementia

Host Factor/Normal Flora

Increased Risk for Infection: Alteration of normal flora by antibiotic therapy

Host Factor/Natural immunity

Increased Risk for Infection: Congenital or acquired immune deficiencies

Host Factor/Age

Increased Risk for Infection: infants and older adults

Increased risk factors for Older PT/ Institutionalization

Increased person-to-person contact and transmission

Host factor/Phagocytosis

Increased risk for infection: Defective phagocytic function, circulatory disturbances, and neutropenia

Host Factor/Hormonal factors

Increased risk for infection: Diabetes mellitus, corticosteroid therapy, and adrenal insufficiency

Nursing Safety Priority: Action Alert Lupus

Instruct pts. to avoid prolonged exposure to sunlight and other forms of ultraviolet lightening, including certain types of fluorescent light. Remind them to wear long sleeves and a large-brimmed hat when outdoors. Pts. should use sun-blocking agents with a sun protection factor (SPF) of 30 or higher on exposed skin surfaces.

Musculoskeletal manifestations: Systemic Lupus Erythematosus (SLE)

Joint inflammation (polyarthritis) Myositis

Care of PT. with Systemic Sclerosis and Esophagitis

Keep the pts. head elevated at least 60 degrees during meals and for at least 1 hr. after each meal Provide small, frequent meals rather than 3 large meals each day Give the pt. small amts. of food for each bite and explain the importance of chewing each bite carefully before swallowing Provide semisoft foods - mashed potatoes, pudding custard, liquids are most likely to cause choking Collaborate with the dietitian about the pts. diet Teach the pt. to avoid foods that increase gastric secretion- caffeine, pepper, other spices Give antacids or histamine antagonists as needed.

Some pts., often children, have only skin involvement, or localized scleroderma, also called?

Linear scleroderma

Contact precautions

MRSA, VRE, Lice, Scabies, C.Diff (leave everything in the rm)

Airborne precautions

MTV or My chicken hez tb measles, chickenpox (varicella) Herpes zoster/shingles TB Negative air-flow rms, pt must wear mask if outside of rm for test. Nurses wear N95 masks and other PPE

*Critical Thinking* The nurse notes that a client with scleroderma (systemic sclerosis) is having difficulty swallowing. What should the nurse do?

Major organ damage can occur with diffuse scleroderma, with esophageal involvement being one complication. The nurse should continuously assess the client's ability to swallow. IF esophageal involvement is suspected, the nurse should collaborate with the health care provider about scheduling a swallowing study. The nurse should also collaborate with the nutritionist about dietary changes, such as the need for small, frequent meals and minimizing the intake of foods and liquids that stimulate gastric secreting (spicy foods, caffeine, alcohol) The client should also sit up for 1 to 2 hours after meals.

Psoriatic Arthritis treatment

Methotrexate Sulfasalazine Etanercept-teach how to self administer inj. Ustekinumab- decreases immunity Golimumab-prone to opportunistic infections/death Alefacept- decreases immunity Acitretin- once a day w/ meals/reg liver enzyme ck.

Droplet precautions

Must be followed for a patient known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking, or laughing. EX. Flu, mumps, pertussis, meningitis Can travel up to 3 feet. When pt leaves the rm. must wear mask

Renal Manifestations: Systemic Lupus Erythematosus (SLE)

Nephritis

NCLEX Test-taking strategy-Priority care in autoimmune pt. (apply to other similar worded questions)

Note the strategic word, PRIORITY. Use Maslow's Hierarchy of Needs theory to answer the question. Remember that physiological needs are the priority. This will direct you to the correct option.

NCLEX Test-taking strategy-Measures to prevent contact with ticks (apply to other similar worded questions)

Note the strategic words, NEED FOR FURTHER INSTRUCTION. These words indicate a NEGATIVE EVENT QUERY and ask you to select an option that is incorrect. Note that the correct option uses the words SHOULD NOT. Reading carefully will assist in directing you to this option.

NCLEX Test-taking strategy- lupus (apply to other similar worded questions)

Note the strategic words, NEED FOR FURTHER INSTRUCTION. These words indicate a NEGAVITVE EVENT QUERY and the need to select the incorrect client statement. Also, focus on the subject, FATIGUE. This will assist in directing you to the correct option as the action that would exacerbate fatigue.

Primary Gout caused by:

Overproduction of uric acid Sodium urate deposits in joint fluid causing inflammation Most often occurs in men age 40-50 usually family history

Cardiovascular manifestations: Systemic Lupus Erythematosus (SLE)

Pericarditis Raynaud's phenomenon

Pulmonary manifestations: Systemic Lupus Erythematosus (SLE)

Pleural effusions Pneumonia

Nursing Safety Priority Drug Alert- Pre-exposure prophylaxes does not replace the standard safer sex practices recommended to prevent HIV transmission. If this drug therapy is used in pts. who become infected with HIV-1, the risk for developing drug resistance greatly increases. Therefor educate/teach/remind

Prescribed Truvada to use the safer sex practices described previously and to adhere to and every 3 mth. HIV testing schedule along with monitoring for side effects of this drug.

Nursing Safety Priority Drug Alert Ensure that cART drugs are not missed, delayed, or administered in lower-than-prescribed doses in the inpatient setting. What do you teach?

Pt's. need to know the importance of taking the cART drugs exactly as prescried to maintain their effectiveness. Even a few missed doses per mth. can promote drug resistance

NCLEX Test-taking strategy-food items associated with at risk for latex allergy (apply to other similar worded questions)

Recall knowledge regarding the food items related to a latex allergy. Eliminate options 1, 2, and 3 because the are COMPARIBLE OR ALIKE and relate to dairy products.

Host factor/Medical interventions

Risk for infection Invasive therapy such as endoscopy, urinary catheters, IVs; chemotherapy;, radiation therapy, and steroid therapy (suppress immune system); surgery

Host factor/Nutrition

Risk for infection Malnutrition or dehydration

Host factor/Environmental factors

Risk for infection Tobacco and alcohol consumption and inhalation of toxic chemicals

Host factor Skin/mucous membranes/normal excretory secretions

Risk for infection: Break in skin or mucous membrane integrity; interference with flow of urine, tears, or salvia; interference with cough reflex or ciliary action; changes in gastric secretions

skin manifestations of Systemic Lupus Erythematosus (SLE)

Skin manifestations: Inflamed, red rash (on face known as butterfly rash) Discoid lesions

mode of transmission

Specific ways in which microorganisms travel from the reservoir to the suseptible host

primary gout:

Stage 1- Asymptomatic hyperuricemia Increased uric acid level; no treatment d/t no obvious signs Stage 2- Acute Gouty Arthritis 1st attack-excruciating pain and inflammation is one or more sm. joints; increased ESR Stage 3- Chronic tophaceous gout- Deposits of urate crystals under skin and within major organs (renal system) will most likely have kidney stones

gout nutritional therapy

Strict low purine diet- eat LESS shellfish, organ meats (liver), Alcohol, soft drinks Avoid ASA and diuretics Avoid excessive physical and emotional stress. Drink plenty of water to prevent kidney stones-water dilutes urine so sedimentation does not form.

Stage 1 Lyme Disease

Symptoms can occur several days to months following the bite. A small red pimple develops that may spread into a ring-shaped rash; it may occur anywhere on the body. Ring-shaped rash may be large or small, or may not occur at all. Flulike symptoms occur, such as headaches, stiff neck, muscle aches, and fatigue.

Priority Nursing Actions/Anaphylactic Reaction

The immediate reaction would be to assess the respiratory status quickly and maintain a patent airway. The HCP or Rapid Response Team is called. In the meantime, the nurse stays with the client and monitors the client's v/s and for signs of shock. An IV device is inserted if one is not already in place and NS is infused. The nurse then prepares for the administration of diphenhydramine and epinephrine and other meds as prescribed. The head of the bed is elevated-if the client's bp is NORMAL. The client's feet and legs may be raised if the bp is LOW. The nurse documents the event', actions taken, and the client's response.

Sterilization

The process that completely destroys all microbial life, including spores.

Increased risk factors for Older PT/ Integumentary system

Thinning skin, decreased subcutaneous tissue, decreased vascularity, slower wound healing

Everyone with AIDS has HIV but note everyone with HIV has AIDS. AIDS is something that progresses over time if HIV is not treated appropriately True False

True

Surgery or acute illness can trigger gout? True False

True

Increased risk factors for Older PT/ Invasive devices

Urinary catheters, feeding tubes, IV devices, tracheostomy tubes

NCLEX Test-taking strategy-bee sting response (apply to other similar worded questions)

Use the steps of the nursing process to answer the question. The correct option is the only one that addresses assessment.

What is used to treat MRSA?

Vancomycin

Suspectible host

a person likely to get an infection or disease, usually because body defenses are weak

Cultural/Spiritual considerations: Patient centered care Lupus

affects women 10 times more often than men; women of color are affected far more often than Euro-American's. The reason for this difference is unknown. The disease also occurs among American Indians, Asian Americans, and Hispanics

Pandemic

an epidemic that is geographically widespread

Healthcare-associated infection (HAI)

an infection that develops in a person cared for in any setting where health care is given; the infection is related to receiving health care (most common UTI)

Scleroderma

hardening of the skin

Standard Precautions

recommendations that must be followed to prevent transmission of pathogenic organisms by way of blood and body fluids Prevents spread of infection Hang hygiene Coughing etiquette PPE

epidemic

regional outbreak of a disease

Nursing Safety Priority: Drug Alert When pts. are taking steroids and/or immunosuppressants, stress/teach

the importance of avoiding large crowds and people who are ill. Teach pts. to report and early sign of infections to their PCP. Observe for side effects and toxic effects of these drugs and report their occurrence immediately. Remind pts. to take their medication early in the morning before breakfast because that is the time when the body's natural corticosteroid level is the lowest.