520 Immunity

A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). What is the expected outcome of AZT for this client? a. Enable slow replication of the virus. b. Neutralize toxins produced by the virus. c. Enhance the body's antibody production. d. Destroy the virus.

a. Enable slow replication of the virus. Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus.

A client who had a splenectomy is being discharged. What should the nurse teach the client to do? a. Report early signs of infection. b. Make an appointment for the staples to be removed. c. Refrain from driving a car for 6 weeks. d. Alternate rest and activity.

a. Report early signs of infection. Clients who have had a splenectomy are especially prone to infection. The reduction of immunoglobulin M leaves the client especially at risk for immunologic deficiency infections. All clients who have had major abdominal surgery usually receive discharge instructions not to drive because the stomach muscles are not strong enough to brake hard or quickly after the abdominal muscles have been separated. All clients need to pace activity and rest when going home after major surgery. Rest and sleep allow the growth hormone to repair the tissue, and activity allows the energy and strength to build endurance and muscle strength. An appointment is usually made to see the surgeon in the office 1 week after discharge for follow-up and to remove sutures or staples if this has not already been done.

A client is taking nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain from rheumatoid arthritis. What instruction should the nurse give the client about NSAIDs? a. Take the prescribed medication with food and fluids. b. Gradually decrease the medication dosage. c. Rinse the mouth with water after taking NSAIDs. d. Avoid driving and using machinery while taking NSAIDs.

a. Take the prescribed medication with food and fluids. Gastric upset is an adverse effect of NSAIDs. Taking these drugs with food and fluids minimizes this effect. The dosage of NSAIDs does not need to be tapered. Because NSAIDs do not cause drowsiness or stomatitis, the patient does not need to restrict driving or rinse the mouth.

A client with end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. In planning the client's care, the nurse should focus on their need for a. fluid replacement. b. pain management. c. high-calorie nutrition. d. antiretroviral therapy.

a. fluid replacement. The protozoal enteric infection caused by Cryptosporidium results in profuse watery diarrhea. Because diarrhea will lead to dehydration, the nurse should focus on fluid replacement. Pain management is also a concern in the care of a client with AIDS. However, with Cryptosporidium, the main concern is hydration. Antiretroviral therapy is most useful when a client with human immunodeficiency virus doesn't have opportunistic infections. With the wasting associated with AIDS, high-calorie nutrition is important, but with Cryptosporidium-related diarrhea, hydration takes precedence.

Which is an appropriate outcome for a client with rheumatoid arthritis who is receiving anti-inflammatory drugs and physical therapy? The client will: a. manage joint pain and fatigue to perform activities of daily living. b. maintain full range of motion in joints. c. take anti-inflammatory medications as needed for pain. d. prevent the development of further pain and joint deformity.

a. manage joint pain and fatigue to perform activities of daily living. An appropriate outcome for the client with rheumatoid arthritis is that he will adopt self-care behaviors to manage joint pain, stiffness, and fatigue and be able to perform activities of daily living. Range-of-motion (ROM) exercises can help maintain mobility, but it may not be realistic to expect the client to maintain full ROM. Depending on the disease progression, there may be further development of pain and joint deformity, even with appropriate therapy. It is important for the client to understand the importance of taking the prescribed drug therapy even if symptoms have abated.

A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse? a. "A man should wear a latex condom during intimate sexual contact." b. "I won't donate blood because I don't want to get AIDS." c. "I've heard about people who got AIDS from blood transfusions." d. "I.V. drug users can get HIV from sharing needles."

b. "I won't donate blood because I don't want to get AIDS." HIV is transmitted through infected blood, semen, and certain other body fluids. Although a transfusion with infected blood may cause HIV infection in the recipient, a person cannot become infected by donating blood. The other options reflect accurate understanding of HIV transmission.

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a. "It will never get any better than it is right now." b. "It will get better and worse again." c. "I'll definitely need surgery for this." d. "When it clears up, it will never come back."

b. "It will get better and worse again." The client demonstrates understanding of rheumatoid arthritis when expressing that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases.

A client with rheumatoid arthritis reports GI irritation after taking piroxicam. To prevent GI upset, the nurse should provide which instruction? a. "Use the drug for a short time only." b. "Take piroxicam with food or an antacid." c. "Decrease the piroxicam dosage." d. "Space the administration every 4 hours."

b. "Take piroxicam with food or an antacid." Taking piroxicam with food or an antacid decreases the risk of GI upset. The client may take the full piroxicam dosage once daily or may divide it in half and take a smaller dose every 12 hours; dosing every 4 hours isn't recommended. Because piroxicam may not produce therapeutic effects for 2 to 4 weeks, the client should take it for more than a short time. The client shouldn't adjust the dosage of piroxicam or any medication unless directed to do so by a physician.

Which dietary strategy best meets the needs of a client with acquired immunodeficiency syndrome (AIDS)? a. Tell the client to prepare food in advance and leave it out to eat small amounts throughout the day. b. Instruct the client to cook foods thoroughly and adhere to safe food-handling practices. c. Encourage mega doses of nutritional supplements. d. Tell the client to eat large meals frequently.

b. Instruct the client to cook foods thoroughly and adhere to safe food-handling practices. A client with AIDS is immunocompromised, and food safety is an important concern. Food-borne illnesses and infections can be devastating to the client with AIDS. Large, frequent meals are not necessary. Mega doses of vitamins can result in toxicities that may aggravate the client's clinical condition. Leaving food out encourages growth of microorganisms.

When a nurse removes an I.V. from an client with acquired immunodeficiency syndrome (AIDS), blood splashes into the nurse's eyes. What should the nurse do next? a. Rinse their eyes, contact Employee Health and document their findings. b. Rinse their eyes with water, report the incident, and go to Employee Health. c. Wash their hands, complete an incident report, and see a physician as soon as possible. d. Rinse their eyes with water, record the incident on the client's chart, and see Employee Health.

b. Rinse their eyes with water, report the incident, and go to Employee Health. Transmission of the AIDS virus can occur through contact with mucous membranes, so it's vital that the nurse immediately flush their eyes with water. The nurse should properly report and document the incident in an incident report and seek follow-up care with a medical professional. The nurse shouldn't record this incident on the client's care record. A nurse who fails to rinse their may allow viral transmission through contact with the mucous membranes.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? a.Ineffective cerebral tissue perfusion b.Risk for injury c. Complicated grieving d. Bathing or hygiene self-care deficit

b. Risk for injury In a client with AIDS, central nervous system (CNS) deterioration can lead to AIDS-related dementia. This type of dementia impairs cognition and judgment, placing the client at risk for injury. Although Bathing or hygiene self-care deficit and Complicated grieving may be relevant in AIDS, these diagnoses don't take precedence in a client with AIDS-related dementia. Because CNS deterioration results from infection, Ineffective cerebral tissue perfusion isn't applicable.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a. nights sweats, weight loss, and diarrhea b. dyspnea, tachycardia, and pallor c. itching, rash, and jaundice d. nausea, vomiting, and anorexia

b. dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.

A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as a. abdominal cramps and diarrhea. b. fluid retention and weight gain. c. tetany and tremors. d. anorexia and weight loss.

b. fluid retention and weight gain. Common adverse reactions to prednisone and other steroids include sodium retention, fluid retention, and weight gain. Tetany and tremors are occasional adverse reactions to certain other drugs such as antipsychotics. Anorexia, abdominal cramps, and diarrhea are common adverse reactions to many drugs, but not to steroids.

When preparing a client with acquired immunodeficiency syndrome (AIDS) for discharge to home, the nurse should be sure to include which instruction? a. "Put on disposable gloves before bathing." b. "Sterilize all plates and utensils in boiling water." c. "Avoid sharing such articles as toothbrushes and razors." d. "Avoid eating foods from serving dishes shared by other family members."

c. "Avoid sharing such articles as toothbrushes and razors." The human immunodeficiency virus (HIV), which causes AIDS, is most concentrated in the blood. For this reason, the client shouldn't share personal articles that may be blood-contaminated, such as toothbrushes and razors, with other family members. HIV isn't transmitted by bathing or by eating from plates, utensils, or serving dishes used by a person with AIDS.

A client is admitted to the facility with an exacerbation of chronic systemic lupus erythematosus (SLE). The client gets angry when the call bell isn't answered immediately. What is the nurse's most appropriate response? a. "I know this is difficult for you but you should calm down. You know that stress will make your symptoms worse." b. "I can see you're angry but there is a lot going on right now. Please be patient and I will be back when I can." c. "You seem angry. Would you like to talk about it?" d. "I am sensing that you would like to talk about the problem, I will get the nursing supervisor to speak with you."

c. "You seem angry. Would you like to talk about it?" Verbalizing the observed behavior is a therapeutic communication technique in which the nurse acknowledges what the client is feeling. Offering to listen to the client express anger can help both the nurse and the client understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the client to calm down doesn't acknowledge the client's feelings. Offering to get the nursing supervisor also ignores the client's feelings. Ignoring the client's feelings by leaving suggests that the nurse has no interest in what the client has said.

The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use? a. Administer medication following breakfast daily. b. Administer the medication with an antacid to prevent stomach upset. c. Contact the health care provider at first signs of an infection. d. Sprinkle the contents of the capsule on food.

c. Contact the health care provider at first signs of an infection. Mofetil is an organ rejection medication that diminishes the body's ability to identify and eliminate pathogens (immunosuppressant). Identifying symptoms of infection at an early state is helpful in treating the infection. This medication is administered on an empty stomach. Typically, capsules would not be opened dispensing medication at one time. Antacids may decrease the absorption of the medication.

A client with acquired immunodeficiency syndrome is admitted with Pneumocystis cariniipneumonia. During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and calling. What should the nurse do? a. Continue with the bath and tell the client not to worry. b. Ask the physician to obtain a psychiatric consultation. c. Listen and show interest as the client expresses feelings. d. State that his friends' behavior shows they aren't true friends.

c. Listen and show interest as the client expresses feelings. The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only after further assessment. Stating that the client's friends aren't true friends would discount the client's feelings.

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell? a. Basophil b. Monocyte c. Lymphocyte d. Neutrophil

c. Lymphocyte The lymphocyte provides humoral immunity — recognition of a foreign antigen and formation of memory cells against the antigen. Humoral immunity is mediated by B and T lymphocytes and can be acquired actively or passively. The neutrophil is crucial to phagocytosis. The basophil plays an important role in the release of inflammatory mediators. The monocyte functions in phagocytosis and monokine production.

A nurse in the infection prevention and control program is conducting an assessment of infection control practices. The nurse is evaluating the infection control actions taken on the unit for a client with a decreased white blood cell count. Which infection control practice does the nurse consider most important for this client? a. using antimicrobial soap when providing care b. implementing respiratory isolation procedures c. adhering diligently to aseptic technique d. requesting prophylactic antibiotic treatment

c. adhering diligently to aseptic technique The client in this scenario is neutropenic, which places the client at risk for contracting an infection. All measures of aseptic technique must be used to protect the client. The other options do not provide complete protection for the client.

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which activity observed by the nurse indicates the need for additional teaching? a. pushing with palms when rising from a chair b. holding packages close to the body c. carrying a laundry basket with clinched fingers and fists d. sliding objects

c. carrying a laundry basket with clinched fingers and fists Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

The nurse assesses the mouth and oral cavity of a client with human immunodeficiency virus (HIV) infection because the most common opportunistic infection initially presents with which symptom? a. cytomegalovirus (CMV) infection b. aphthae on the gingiva c. oral candidiasis d. herpes simplex virus (HSV) lesions on the lips

c. oral candidiasis The most common opportunistic infection in HIV infection initially presents as oral candidiasis, or thrush. The client with HIV should always have an oral assessment. HSV and CMV are opportunistic infections that present later in acquired immunodeficiency syndrome. Aphthous stomatitis, or recurrent canker sores, is not an opportunistic infection, although the sores are thought to occur more often when the client is under stress.

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for a. high-dose I.V. cyclosporine therapy. b. intra-abdominal instillation of methylprednisolone sodium succinate. c. removal of the transplanted kidney. d. bone marrow transplant.

c. removal of the transplanted kidney. Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given I.V. to treat acute organ rejection, but it's ineffective against hyperacute rejection.

A client with human immunodeficiency virus undergoes intradermal anergy testing using Candida and mumps antigen. During the 3 days following the tests, there is no induration or evidence of reaction at the intradermal injection sites. The most accurate conclusion the nurse can make is a. the client isn't allergic to the antigens and therefore doesn't react. b. the client has no previous exposure to the antigens injected. c. the client is immunodeficient and won't have a skin response. d. the client has antibodies to the antigens.

c. the client is immunodeficient and won't have a skin response. Anergy testing determines the level of immune response an individual has to common microbes. A normal response is a local skin reaction to all the antigens injected intradermally. Absence of a response within 3 days suggests the individual is immunodeficient and can't produce a normal immune response. It doesn't imply absence of exposure to the antigens, which are environmentally prevalent. A positive skin reaction demonstrates presence of antibodies to the antigens. An expected reaction to the antigens isn't considered an allergic or hypersensitive reaction.

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? a. "I stopped smoking last year; this year I'll quit drinking alcohol." b. "I won't go to see my siblings while they have a cold." c. "I won't go to see my cousins right after they gets their vaccines." d. "I can eat whatever I want as long as it's low in fat."

d. "I can eat whatever I want as long as it's low in fat." The client requires additional teaching if they state that they can eat whatever they want. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

A client diagnosed with acquired immunodeficiency syndrome (AIDS) is experiencing end-stage Kaposi's sarcoma. Concerned that the healthcare team is investing too much energy in keeping them alive, the client asks that they not attempt any more interventions. How should a nurse respond to this client? a. "I need to get your physician to make this recommendation and write an order." b. "You might consider consulting with a therapist to be sure this is what you really want." c. "AIDS is no longer an automatic death sentence. You might want to reconsider." d. "We have to make sure you've signed an advance directive."

d. "We have to make sure you've signed an advance directive." The nurse should tell the client that they must sign an advance directive to prevent future healthcare interventions. This client has lived with AIDS for many years; suggesting that the client talk with a therapist or reconsider this decision is disrespectful and disregards the client's experience of the disease. An advance directive doesn't require a physician's order.

The wife of a client with end-stage acquired immunodeficiency syndrome (AIDS) is caring for her husband at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about an advance directive. During the next day's visit, the client states that since he and his wife filled out the advance directive form, he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client's concerns? a. "You don't need to feel that way. Your physician is required by law to sign your orders and the hospice nurses will be contacting him with updates on your condition." b. "Many people first feel that way when they are admitted into hospice. Although the focus of your care has changed from curative to supportive, your physician will still continue directing it." c. "It's understandable to feel that way. But clients with end-stage AIDS who have advanced directives generally experience a less painful death that those individuals who don't." d. "Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so the physician will be able to provide it if you can't tell him yourself."

d. "Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so the physician will be able to provide it if you can't tell him yourself." Option 1 provides correct information about advance directives. The advance directive outlines the client's treatment wishes should he be unable to communicate his wishes at any time during his illness. The physician continues to provide care for clients admitted to hospice care. Option 2 invalidates the client's fears and doesn't emphasize the physician's role or the client's role in his care plan. Option 3 doesn't address the purpose of the advance directive, and it discusses treatment options that may not have been discussed with the client. Option 4 doesn't provide evidence-based information about advance directives.

A client is admitted with fatigue, shortness of breath, pale skin, and dried, cracked lips, tongue, and mouth. The hemoglobin is 9 g/dL (90 g/L), and red blood cell count is 3.5 million cells/mm3(3.5 × 1012/L). What should the nurse instruct the client to do? a. Limit fluid intake to 1,000 mL per day. b. Increase the amount of carbohydrates in the diet. c. Eat a serving of fish with high omega 3 content 2 times a week. d. Eat foods with good sources of iron.

d. Eat foods with good sources of iron. The client is demonstrating signs of anemia and should increase the iron in the diet. Foods such as red meats, beets, and cabbage are good sources of iron. The client should not limit the fluid intake to 1,000 mL per day, but should maintain an adequate fluid intake of about 3,000 mL per day. Carbohydrates will not provide the necessary dietary intake of iron. While fish is a healthy choice, beef, lamb, and iron-rich vegetables are more important in the diet at this time.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? a. Muscle wasting b. Hypertension c. Truncal obesity d. Osteoporosis

d. Osteoporosis Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.

A client infected with human immunodeficiency virus (HIV) has a low CD4+ level. What intervention should the nurse implement? a. Increase nutritional protein with each meal. b. Provide antibiotics as per order. c. Request human granulocyte colony-stimulating factor to improve WBC production. d. Place the client in reverse isolation.

d. Place the client in reverse isolation. CD4+ levels in the blood of an individual with HIV infection determine the extent of damage to the individual's immune system. The test indicates the individual's risk of an opportunistic infection, but does not identify specific infections. Viral loads and resistance to specific antigens are determined using other diagnostic tests. Because of the client's risk, isolation is recommended.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. Serum potassium level of 4.9 mEq/L b. Temperature of 99.2° F (37.3° C) c. Serum sodium level of 135 mEq/L d. Urine output of 20 ml/hour

d. Urine output of 20 ml/hour 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. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply. a. increased RBCs b. increased platelets c. increased white blood cells d. decreased white blood cells e. decreased platelets f. decreased RBCs

d. decreased white blood cells e. decreased platelets f. decreased RBCs Pancytopenia is a deficiency of all blood cells that includes a state of simultaneous leukopenia (decreased white blood cells), thrombocytopenia (decreased platelets), and anemia (decreased RBCs). Pancytopenia has widespread effects on the body by leading to oxygen shortage and immune function.

To help prevent hip flexion deformities associated with rheumatoid arthritis, the nurse should help the client assume which position in bed several times a day? a. modified Trendelenburg b. very low Fowler's c. side-lying d. prone

d. prone To help prevent flexion deformities, a client with rheumatoid arthritis should lie in a prone position in bed for about ½ hour several times a day. This positioning helps keep the hips and knees in an extended position and prevents joint flexion. Low Fowler's, modified Trendelenburg, and side-lying positions do not prevent hip flexion.

The nurse is examining an older adult woman with possible rheumatoid arthritis. The nurse should ask the client if she is having which symptom? a. limitation of movement b. dizziness c. fatigue d. nausea

c. fatigue Typical early signs of rheumatoid arthritis are nonspecific and not necessarily related to specific joint pain. Common early symptoms include fatigue, anorexia, weight loss, and generalized feelings of stiffness. Joint swelling and limitation of movement usually occur later as joint involvement becomes more specific. Dizziness is not a sign of rheumatoid arthritis. Nausea is not typically associated with the disease process but can be related to medications prescribed to treat rheumatoid arthritis.

Which type of white blood cell (WBC) is the most numerous? a. Lymphocyte b. Neutrophil c. Eosinophil d. Basophil

b. Neutrophil Neutrophils are the most numerous of the WBCs, comprising about 65%. Lymphocytes are the second most abundant. Eosinophils account for about 2%, whereas basophils are the least abundant.

At which time should the nurse instruct the client to take ibuprofen, prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? a. on arising b. immediately after a meal c. at bedtime d. on an empty stomach

b. immediately after a meal Drugs that cause gastric irritation, such as ibuprofen, are best taken after or with a meal, when stomach contents help minimize the local irritation. Taking the medication on an empty stomach at any time during the day will lead to gastric irritation. Taking the drug at bedtime with food may cause the client to gain weight, possibly aggravating the osteoarthritis. When the client arises, he is stiff from immobility and should use warmth and stretching until he gets food in his stomach.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest? a. keeping all joints aligned b. lying in a prone position c. maintaining the joints in a flexed position d. elevating the affected joints

c. maintaining the joints in a flexed position Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

Which is least likely a danger associated with pancytopenia? a. hypothyroidism b. bleeding c. infection d. anemia

a. hypothyroidism Hypothyroidism is not associated with pancytopenia. Various anemias are associated with pancytopenia owing to the reduction in all cellular elements of the blood. Bleeding and clotting difficulties can be associated with pancytopenia. Infection is a common danger associated with pancytopenia.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? a. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels b. Low levels of urine constituents normally excreted in the urine c. Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels d. Electrolyte imbalance that could affect the blood's ability to coagulate properly

a. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.

A client with severe arthritis has been receiving maintenance therapy of prednisone 10 mg/day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom? a. constipation b. joint pain c. joint swelling d. respiratory infection

d. respiratory infection Clients receiving chronic steroid therapy can become immunosuppressed and are prone to infections. Signs of infection can also be masked with prednisone. Signs and symptoms of infection should be reported immediately. Joint pain, constipation, and joint swelling are not related to the adverse effects of steroid therapy.

The nurse in the emergency department reports there is a possibility of having had direct contact with blood of a client who is suspected of having HIV/AIDS. The nurse requests that the client have a blood test. Consent for HIV testing can only be completed when which circumstances are present? Select all that apply. a. An emergency medical provider has been exposed to the client's blood or body fluids. b. Testing is ordered by a court, based on evidence that the client poses a threat to others. c. An HCP who is taking care of a client suspected of having HIV/AIDS requests a blood test. d. Testing is done on blood collected anonymously in an epidemiologic survey. e. Testing is prescribed by a health care provider (HCP) under emergency circumstances.

a. An emergency medical provider has been exposed to the client's blood or body fluids. e. Testing is prescribed by a health care provider (HCP) under emergency circumstances. b. Testing is ordered by a court, based on evidence that the client poses a threat to others. d. Testing is done on blood collected anonymously in an epidemiologic survey. Upon a HCP's written prescription requesting an HIV test for a client, consent for HIV testing must be obtained. Consent exceptions include the following: testing is prescribed by a HCP under emergency circumstances, and the test is medically necessary to diagnose or treat the client's condition; testing is prescribed by a court, based on clear and convincing evidence of a serious and present health threat to others posed by an individual; testing is done on blood collected or tested anonymously as part of an epidemiologic survey; or an emergency medical provider has been exposed to the client's blood or body fluids.