Medical-Surgical: Immune and Infectious Quiz

A nurse is teaching a client who has genital herpes about self-management. Which of the following instructions should the nurse include in the teaching? a. Use an alcohol-based to clean lesions. b. Wear a condom during sexual activity when lesions are present. c. Take a sitz bath once per day. d. Apply a warm compress to the lesions.

d. Apply a warm compress to the lesions. Rationale - The nurse should instruct the client to apply a warm compares to the lesions to relieve discomfort.

A nurse is teaching a client who has HIV about the early manifestations of AIDS. Which of the following statements should the nurse include in the teaching? a. "You can expect a persistent fever and swollen glands." b. "You can expect an elevated white blood cell count." c. "You can expect an increase in blood pressure and edema." d. "You can expect weight gain."

a. "You can expect a persistent fever and swollen glands." Rationale - Clients who have AIDS can have persistent fever, swollen glands, diarrhea, weight loss, and fatigue. These manifestations indicate the onset of AIDS.

A nurse is caring for a client who is 2 days postoperative. Which of the following findings should alert the nurse that the client is developing an infection? a. Temperature 37.8 C (100 F) b. Erythema at the incision site c. WBC count 9,000/mm^3 d. Pain reported as 6 on a scale of 0 to 10.

b. Erythema at the incision site. Rationale - Redness, or erythema, at the incision site is an initial sign of a wound infection and requires intervention by the nurse.

A nurse is caring for a client who has human immunodeficiency virus. Which of the following types of isolation should the nurse implement to prevent transmission of HIV? a. Protective isolation b. Droplet isolation c. Standard isolation d. Airborne isolation

c. Standard isolation Rationale - Standard precautions should be implemented with every client, to prevent the spread of infection transmitted by direct or indirect contact with infectious blood or body fluids. Because HIV is spread through blood and bodily fluid, standard precautions are appropriate.

A nurse is teaching a client about manifestations of an allergic reaction. The nurse should explain that histamine release causes which of the following reactions? a. Increased mucus secretion b. Bronchial dilation c. Bradycardia d. Vertigo

a. Increased mucus secretion Rationale - The nurse should instruct the client that increased mucus secretion is a manifestation of histamine release. Histamine is the neurotransmitter the body produces during an allergic reaction.

A nurse is caring for a client who is concerned about the possibility of contracting lyme disease after receiving a tick bite. For which of the following early manifestations of Lyme disease should the nurse asses the client? a. A diffuse maculopapular rash b. Dyspnea c. Double vision d. A progressive, circular rash

d. A progressive, circular rash Rationale - Early Lyme Disease is characterized by fever, influenza-like manifestations, and erythema migraines, a distinct progressive circular or bulls-eye rash that often develops at the bite site, but can also develop at other sites, such as the thighs and knees.

A nurse is providing discharge instructions to a client who is being treated for genital warts. Which of the following statements indicates that the client understands how to prevent transmission of the STI? a. "I will bring my sexual partner in for treatment." b. "Now that I've had my first dose of medicine, I can resume sexual activity" c. "Once I have been treated, it is no longer necessary to use condoms." d. Once treatment is completed and I am free of symptoms, I don't have to return to the clinic."

a. "I will bring my sexual partner in for treatment." Rationale - The client should bring his partner in to be screened for genital warts and treated.

A nurse is providing discharge teaching to a client who has AIDS about preventing infection while at home. Which of the following instructions should the nurse include in the teaching? a. "Wash your genitalia using an antimicrobial soap." b. "Rinse your dishes with cold water." c. "Clean your toothbrush once per month." d. "Incorporate raw fruits and vegetables into your diet."

a. "Wash your genitalia using an antimicrobial soap." Rationale - The nurse should instruct the client to bathe daily using an antimicrobial soap to prevent the spread of infection. If bathing is not possible, washing the genitalia using an antimicrobial soap is recommended.

A nurse is teaching a female client who has a new diagnosis of system lupus erythematosus (SLE) about factors that can trigger an exacerbation of SLE. The nurse should determine that the client needs more teaching when she identifies which of the following as a factor that can exacerbate SLE? a. Exercise b. Pregnancy c. Infection d. Sunlight

a. Exercise Rationale - SLE is a chronic autoimmune disease that develops when the immune system becomes hyperactive and attacks healthy body tissue. This attack results in generalized inflammation and the manifestations associated with the specific involved tissues. Most clients who have SLE can follow an exercise program to increase the aerobic capacity of cells and improve immune function, and the client should develop such a program with her provider's assistance. This client needs additional teaching about the importance of exercise to keep her muscles and joints active.

A nurse is monitoring a newly licensed nurse who is caring for a client. The client has active pulmonary tuberculosis, was placed on airborne precautions, and is scheduled for a chest x-ray. The nurse should instruct the newly licensed nurse to take which of the following actions? a. Have the client wear a surgical mask b. Wear gown for protection from the client's infection. c. Ask the radiology staff to perform a portable chest x-ray in the client's room. d. Place an N95 respirator on the client.

a. Have the client wear a surgical mask. Rationale - The nurse should instruct the client to wear a surgical mask. The mask will protect anyone who comes into contact with the client, including the nurse.

A nurse is teaching a client who has Raynaud's disease. Which of the following information should the nurse include in the teaching? a. Protect against the cold by wearing layers of clothing b. Beging an exercise program of 2-mile walks once per week c. Increase vitamin A in the diet

a. Protect against the cold by wearing layers of clothing. Rationale - Clients who have Raynaud's disease are prone to attacks during cold weather. Extreme cold can lead to tissue damage. Therefore, the client needs to be protected with layers of clothing to promote warmth and increase circulation to the extremities.

A nurse teaching a client who has human immunodeficiency virus about how the virus is transmitted. Which of the following statements should the nurse include in the teaching? a. "HIV can be transmitted as soon as a person develops manifestations." b. "HIV can be transmitted to anyone who has had contact with the infected blood." c. "HIV is transmitted through the respiratory route through droplets." d. "HIV is transmitted only during the active phase of the virus."

b. "HIV can be transmitted to anyone who has had contact with the infected blood." Rationale - The concentration of the virus is highest in blood but also has been isolated in other body fluids, including sputum, saliva, cerebrospinal fluid, urine and semen. Clients who have HIV are cautioned to practice safe sex, avoid donating blood, and abstain from sharing needles with others.

A nurse is providing discharge teaching to the partner of a client who has acquired immune deficiency syndrome. Which of the following statements by the client's partner indicates the need for further testing? a. "I will dispose soiled tissues in separate plastic bags." b. "I'll clean up blood spills immediately with hot water." c. "I know that hand washing is an important preventive measure." d. "I will wash soiled clothes in hot water

b. "I'll clean up blood spills immediately with hot water." Rationale - The client's partner should clean blood or potentially contaminated body substances with a bleach solution and wear gloves when coming into contact with blood products.

The nurse is reviewing the laboratory results for a client who reports bilateral pain and swelling in her finger joints, with stiffness in the morning. The nurse should recognize that an increase in which of the following laboratory tests can indicate arthritis? a. Reticulocyte count b. Rheumatoid factor c. Direct Coomb's test d. Platelet count

b. Rheumatoid factor Rationale - An increase in the client's rheumatoid factor can indicate rheumatoid arthritis or other connective tissue diseases.

A nurse is caring for a client who has systemic lupus erythematosus (SLE) and is concerned about the skin lesions on her face and neck. The client asks the nurse, "What should I do about these spots?" Which of the following responses should the nurse give? a. "Keep the lesions covered with a light sterile dressing when going outside." b. "Rub lesions with a washcloth to dry after washing." c. "Apply moisturizer after bathing the lesions with warm water." d. "Apply antibiotic cream twice per day until scabs form on the lesions."

c. "Apply moisturizer after bathing the lesions with warm water." Rationale - The nurse should instruct the client to clean, dry, and moisturize the skin using warm (not hot) water, along with an unscented lotion.

A nurse is teaching a client who has tuberculosis about a new prescription for rifampin. Which of the following statements by the client indicates an underling of the teaching? a. "I should take this medication with food." b. "I need to take B-complex vitamin while taking this medication." c. "I can expect this medication to turn my skin orange." d. I can expect this medication to make my vision blurry."

c. "I can expect this medication to turn my skin orange." Rationale - The nurse should instruct the client to expect his skin and urine to turn a reddish-orange tinge which taking rifampin.

A nurse in a provider's office is providing teaching to a client who has a recent diagnosis of rheumatoid arthritis and has a new prescription for naproxen tablets. Which of the following statements by the client requires further teaching? a. "This medication will take 4 weeks for me to notice relief in my joints." b. "I can take an antacid with this medication for indigestion." c. "I can take this medication with aspirin." d. "The naproxen goes down easier when i crush it and put it in applesauce."

c. "I can take this medication with aspirin." Rationale - The nurse should instruct the client to avoid taking this medication with any other NSAIDs, such as aspirin, because this can increase the risk for bleeding and gastrointestinal ulceration.

A nurse is teaching a client who was recently diagnosed with Raynaud's disease about preventing the onset of manifestations. Which of the following statements by the client indicates an understanding of the teaching? a. "I should limit my exposure to sunlight." b. "I should avoid drinking alcohol." c. "I should not smoke." d. "I should limit my intake of foods high in purine."

c. "I should not smoke." Rationale - Raynaud's disease is a disorder of the blood vessels that supply blood to the skin and cause the distal extremities to feel numb and cool in response to cold temperatures or stress. During a Raynaud's attack, these arteries narrow, limiting blood circulation to affected areas. Strong emotion or exposure to the cold causes these areas to become white, due to a lack of blood flow in the area. They then turn blue, as tiny blood vessels dilate to allow more blood to remain in the tissues. When the flow of blood returns, the area becomes red and then later returns to normal color. This can cause tingling, swelling, and painful throbbing. The attacks can last from minutes to hours. If the condition progresses, blood flow to the area could become permanently decreased, causing the fingers to become thin and tapered, with smooth, shiny skin and slow-growing nails. If an artery becomes blocked completely, gangrene or ulceration of the skin can occur. Smoking cessation, not just reduction, is an action the client should take to prevent the onset of the manifestations of Raynaud's disease.

A nurse is planning discharge teaching for a client who has systemic lupus erythematosus (SLE). Which of the following instructions should the nurse plan to include. a. "Avoid the use of NSAIDs b. "Stop taking the corticosteroids when your symptoms resolve." c. "Exposure to ultraviolet light with help control the skin rashes. d. "Monitor your body temperature and report any elevations promptly."

d. "Monitor your body temperature and report any elevations promptly." Rationale - SLE is a chronic autoimmune disorder the can affect any organ of the body. With SLE, the body's immune system becomes hyperactive, forming antibodies that attack tissues and organs, including the skin, joints, kidneys, brain, heart, lungs, and blood. SLE is characterized by periods of exacerbation and remissions. The nurse should teach the client to monitor body temperature and report any elevations promptly, as fever can suggest either an exacerbation or a potentially life-threatening infection.

A nurse is preparing to administer a Mantoux skin test to a client. The nurse should inform the client that the purpose of a Mantoux skin test using purified protein derivative (PPD) is to do which of the following actions? a. Identify if a client lacks immunity to tuberculosis b. Find out if a client has active tuberculosis c. Decrease the hypersensitivity of the client's reaction to PPD d. Identify if a client has been infected with mycobacterium tuberculosis.

d. Identify if a client has been infected with mycobacterium tuberculosis. Rationale - The nurse should inform the client that the Mantoux skin test is used to identify individuals who have been infected with mycobacterium tuberculosis.

A nurse is caring for a client who had radioallergosorbent (RAST) testing completed due to seasonal allergies. The nurse should anticipate an elevation in which of the following laboratory tests? a. IgM b. IgA c. IgG d. IgE

d. IgE Rationale - RAST testing involves measuring the quantity of IgE present in serum after exposure to specific antigens selected on a basis of the client's symptom history. An elevated IgE indicates a positive response and is common among clients who have a history of allergic manifestations, anaphylaxis, and asthma.

A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings should the nurse expect? a. A nonproductive cough, fever, and shortness of breath b. lesions of the retina that produce blurred vision. c. Onset of progressive dementia. d. Reddish-purple skin lesions.

d. Reddish-purple skin lesions Rationale - Kaposi's sarcoma is commonly associated with AIDS and manifests as hyper-pigmentated multi centric lesions that can be firm, flat, raised, or nodular. Following biopsy, the lesions are treated with radiation and/or chemotherapy.

A nurse is assessing a client who has systemic scleroderma. Which of the following findings should the nurse expect? a. Excessive salivation b. Finger contractures c. Periorbital edema d. Alopecia

b. Finger contractures Rationale - Scleroderma is a chronic disease that can cause thickening, hardening, or tightening of the skin, blood vessels, and internal organs. There are two types of scleroderma: localized scleroderma, which mainly affects the skin, and systemic scleroderma, which can affect internal organs. The manifestations include skin changes, Raynaud's phenomenon, arthritis, muscle weakness, and dry mucous membranes. With scleroderma, the body produces and deposits too much collagen, causing thickening and hardening. In addition to the client's skin and subcutaneous tissues becoming increasingly hard and rigid, the extremities stiffen and lose mobility. Contractors develop with advanced systemic scleroderma unless clients follow a regimen of range-of-motion and muscle-strengthening exercises.

A nurse is caring for a client who is experiencing an acute exacerbation of rheumatoid arthritis. The nurse should anticipate that the client's affected joints will require which of the following treatments? a. An assistive device to use when the client is ambulating. b. Heat paraffin therapy applied to client's joints. c. Gentle massage of the client's hands. d. Active range-of-motion exercises on the client's affected joints.

b. Heat paraffin therapy applied to client's joints. Rationale - The nurse should anticipate the use of heat paraffin to be prescribed as a non-pharmacologic intervention. The elevated ESR indicates an acute inflammatory process due to client's rheumatoid arthritis. The use of the warm paraffin relieves the stiffness of the client's joints and provides comfort.

A nurse is providing teaching to a client who has a diagnosis of Hepatitis A. Which of the following statements by the client indicates an understanding of the teaching? a. "I am unable to donate blood." b. "I will need to get a booster shot of immune serum globulin every year." c. "I should stop eating raw clams." d. "I can get this disease by getting a tattoo."

c. "I should stop eating raw clams." Rationale - Hepatitis A is transmitted via the fecal-oral route through consumption of contaminated fruits, vegetables, water, milk, or uncooked shellfish. Individuals who eat raw or steamed shellfish are at increased risk for acquiring hepatitis A.

A nurse is teaching a client who has tested positive for an allergy to dust. The nurse should determine that the client understands how to reduce her exposure to this allergen when she states which of the following? a. "I will begin vacuuming once a week." b. Carpeting the entire hose will be very expensive, but it will be worth it." c. I will apply a mattress cover to my bed." d. "Installing curtains on my windows will help control the dust in the house."

c. "I will apply a mattress cover to my bed." Rationale - The nurse should instruct the client to apply a hypoallergenic mattress cover that can be zipped over her bed to control the amount of dust. The client should remove the mattress cover periodically and machine wash to clean.

A nurse is caring for a client who has human immunodeficiency virus (HIV). The client asks the nurse, "Should I tell my partner that I am HIV positive?" Which of the following statements should the nurse give? a. "This is your decision alone." b. "I would if I were you." c. "It sounds like you are unsure what to say to your partner." d. 'Your provider is required by law to notify your partner."

c. "It sounds like you are unsure what to say to your partner." Rationale - This response uses the therapeutic communication tools of clarifying and restatement. It identifies that the client is unsure about if or how to approach the issue of being HIV positive with his partner, a common concern of clients due to fear of rejection. This response shows that the nurse is open to further communication with the client and encourages his expression of feelings.

A nurse is teaching a client who has AIDS about the transmission of Pneumocystis jiroveci pneumonia (PCP). Which of the following information should the nurse include in the teaching? a. "PCP is sexually transmitted from person to person." b. "You were most likely exposed to a contaminated surface, such as a drinking glass." c. "PCP results from an impaired immune system." d. "You may have contracted PCP from a family pet."

c. "PCP results from an impaired immune system." Rationale - The nurse should explain that the organism that causes PCP exists as part of the normal flora of the lungs and develops into a fungus. It becomes an aggressive pathogen when the immune system is compromised and the infection results from an impaired immune system.

A nurse is assessing a client who has an exacerbation of herpes zoster. Which of the following manifestations of the client's skin should the nurse expect? a. Confluent, honey-colored, crusted lesions b. Large, tender nodules located on a hair follicle c. Unilateral, localized, nodular skin lesions d. A fluid-filled vesicular rash in the genital region

c. Unilateral, localized, nodular skin lesions. Rationale - Herpes zoster, or shingles, results from the reactivation of a dormant varicella virus, It is the acute, unilateral inflammation of the dorsal root ganglion. The infection typically develops in adults and produces localized vesicular lesions confined to a dermatome. It produces unilateral, localized, nodular skin lesions.