NUR 211 Test 2- Practice Questions
A client is admitted with a possible diagnosis of rheumatoid arthritis (RA). Which of the following screening tests should the nurse expect to be ordered? 1. Antinuclear antibody (ANA) titer 2. Complete blood count (CBC) 3. Erythrocyte sedimentation rate (ESR) 4. Rheumatoid factor (RF)
1. ANA is commonly used as a screening tool rather than a diagnostic tool for RA because many people without RA can have elevated titers. CBC, ESR, and RF are all used as diagnostic tools and to monitor progress of the disease or response to therapy.
The nurse is instructing a client regarding transmission of human immunodeficiency virus (HIV). The nurse instructs the client that the most likely route of virus transmission is: 1. blood. 2. feces. 3. saliva. 4. urine.
1. HIV is transmitted by contact with infected blood. It exists in all body fluids, but transmission through saliva, urine, and feces is much less likely to occur than through blood.
A mother infected with human immunodeficiency virus (HIV) inquires about the possibility of breastfeeding her newborn. What is the most appropriate response by the nurse? 1. "Breastfeeding isn't an option." 2. "Breastfeeding would be best for your baby." 3. "Breastfeeding is only an option if the mother is taking zidovudine (Retrovir)." 4. "Breastfeeding is an option if milk is expressed and fed by a bottle."
1. Mothers infected with HIV are unable to breastfeed because HIV has been isolated in breast milk and could be transmitted to the infant. Taking zidovudine doesn't prevent transmission. The risk of breastfeeding isn't associated with direct contact with the breast but with the possibility of HIV contained in the breast milk.
The nurse is reviewing first-line therapy medications of a client recently diagnosed with rheumatoid arthritis. Which medication does the nurse anticipate will be included? 1. Aspirin 2. Cytoxan 3. Ferrous sulfate 4. Prednisone
1. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin are considered first-line therapy by some physicians. Cytoxan may be used in cases of severe synovitis, rather than as first-line therapy. Ferrous sulfate isn't used to treat rheumatoid arthritis. Prednisone may be used to control inflammation when NSAIDs aren't tolerated.
The nurse in the public health clinic would provide preventive therapy for tuberculosis (TB) to which of the following clients? 1. Clients with human immunodeficiency virus (HIV) infection 2. Clients with recent tuberculin skin tests and low risk 3. Persons with no contact with infectious TB clients 4. Clients with abnormal chest X-rays
1. Preventive therapy should be initiated for clients infected with HIV because latent TB can become active if the immune system is weakened. Clients with low risk and negative skin tests are unlikely to be infected with TB or to progress if infected. Clients with no contact with infectious TB cases aren't at high risk for developing TB. Although clients with active TB may have abnormal chest X-rays, many other conditions can cause abnormalities.
A client with a productive cough, chills, and night sweats is suspected of having active tuberculosis (TB). The most important intervention by the nurse would be? 1. Maintain the client on respiratory isolation. 2. Prepare the client to be discharged on bed rest. 3. Administer the tuberculin test ordered by the physician. 4. Administer the isoniazid ordered by the physician immediately before discharge.
1. This client is showing signs and symptoms of active TB and, because of the productive cough, is highly contagious. He should be admitted to the hospital and placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, and then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they're negative, he would be considered noncontagious and may be sent home, although he'll continue to take the antitubercular drugs for 9 to 12 months.
A client is human immunodeficiency virus (HIV)-positive. She states that besides her significant other, her family doesn't know about her health status. Which action should the nurse take to keep the client's health status confidential? 1. Ask the client's family (except for her significant other) to wait outside when educating the client. 2. Discuss the case with the client's mother because she's an immediate family member. 3. Discuss the case at lunch to educate the other staff members on your team. 4. Keep a log of all HIV-infected patients on the floor for statistics used in research
1. To protect client confidentiality, speak only to the client and any other person designated by the client. The nurse should never discuss any client with anyone who doesn't have direct care with that client. Any family member not designated by the client shouldn't be given information about the client's condition. A log of all HIV-infected patients isn't acceptable practice.
A nurse should include which fact when teaching an adolescent group about the human immunodeficiency virus (HIV)? 1. The incidence of HIV in the adolescent population has declined since 1995. 2. The virus can be spread through many routes, including sexual contact. 3. Knowledge about HIV spread and transmission has led to a decrease in the spread of the virus among adolescents. 4. About 50% of all new HIV infections in the United States occur in people under age 22
2. HIV can be spread through many routes, including sexual contact and contact with infected blood or other body fluids. The incidence of HIV in the adolescent population has increased since 1995, even though more information about the virus is targeted to reach the adolescent population. Only about 25% of all new HIV infections in the United States occur in people under age 22.
A nurse has volunteered for a mission trip to an area with a high incidence of HIV. Part of the responsibility will be teaching a class about HIV. The next question in the PowerPoint presentation is, "Which body substances most easily transmit human immunodeficiency virus (HIV)?" Which of the following options would you include in your next PowerPoint slide to answer that question? 1. Feces and saliva 2. Blood and semen 3. Breast milk and tears 4. Vaginal secretions and urine
2. HIV is most easily transmitted in blood, semen, and vaginal secretions. However, it has also been found in urine, feces, saliva, tears, and breast milk
A client has experienced an exacerbation of systemic lupus erythematosus (SLE). The nurse determines further teaching is necessary when the client makes which statement? 1. "I need to stay away from sunlight." 2. "I don't have to worry if I get a strep throat." 3. "I need to work on managing stress in my life." 4. "I don't have to worry about changing my diet."
2. Infection may cause an exacerbation of SLE. Other factors that can precipitate an exacerbation are immunizations, sunlight exposure, and stress.
An elderly client with rheumatoid arthritis is being treated with prednisone (Deltasone). The nurse is aware that complications occurring with long-term therapy include which of the following? 1. Breast and uterine cancer 2. Osteoporosis and diabetes mellitus 3. Weight loss and lactose intolerance 4. Deep vein thrombosis (DVT), pulmonary embolus, and stroke
2. Long-term prednisone therapy can increase the loss of calcium from bones, slow down the formation of new bone tissue (resulting in osteoporosis), and alter glucose metabolism (resulting in diabetes mellitus). Breast and uterine cancer, DVT, pulmonary embolus, stroke, weight loss, and lactose intolerance are not common adverse effects of prednisone.
A nurse is teaching a community education class on human immunodeficiency virus (HIV). The nurse explains to her clients that the group or factor linked to higher morbidity and mortality in HIV-infected clients is: 1. homosexual men. 2. lower socioeconomic status. 3. treatment in a large teaching hospital. 4. treatment by a physician who specializes in HIV infection.
2. Morbidity and mortality have been associated with lower socioeconomic status, receiving care in a community hospital or by a physician 172 without much experience with HIV infections, and lack of access to adequate health care.
The nurse is caring for a client with systemic lupus erythematosus (SLE). The nurse is aware that a sign of neurologic involvement in SLE would be? 1. Facial tic 2. Psychosis 3. Extremity weakness 4. Cerebrovascular accidents
2. Neurologic involvement may be shown by psychosis, seizures, and headaches. Tics and cerebrovascular accidents aren't related to SLE. Weakness may be present, but it's usually related to muscle atrophy, not neurologic involvement.
The nurse is attending the annual neighborhood picnic. A neighbor tells the nurse that a friend was recently diagnosed with systemic lupus erythematosus (SLE) and she is afraid she will contract it. Which of the following clients is most at risk for SLE? 1. A 20-year-old White man 2. A 25-year-old Black woman 3. A 45-year-old Hispanic man 4. A 65-year-old Black woman
2. SLE affects women eight times more often than men and usually strikes during childbearing age. It's three times more common in Black women than in White women.
A nurse teaches a group of police officers about the spread of tuberculosis (TB). Which statement by an officer indicates that the nurse's teaching has been effective? 1. "I could get TB by being in close proximity for a brief time with someone who has the disease." 2. "I could get TB if I inhale infected droplets when an infected individual coughs." 3. "I could get TB if I search the home of someone infected with TB." 4. "I could get TB if I come in contact with blood from an infected person."
2. TB infection typically occurs from inhaling infected droplets after a person with TB coughs. Transmission usually requires close, frequent, prolonged contact. Human immunodeficiency virus—not TB—is spread through contact with an infected person's blood.
A nurse is assigned to care for a 70-year-old client with acute rheumatoid arthritis. Which assessment finding should the nurse expect to find during the physical examination? 1. Radial deviation of the distal phalanges 2. Tender, painful, and stiff joints 3. Heberden's nodes 4. Bouchard's nodes
2. Tender, painful, and stiff joints characterize acute rheumatoid arthritis. The other assessment findings characterize osteoarthritis, including nodules on the dorsolateral aspects of the distal interphalangeal joints (Heberden's nodules), flexion and deviation deformities, like radial deviation of the distal phalanges, and nodules on the proximal interphalangeal joints (Bouchard's nodes).
Immediately after giving an injection, a nurse is accidentally stuck with the needle. The nurse is aware that testing for human immunodeficiency virus (HIV) antibodies should occur: 1. immediately and then again in 6 weeks. 2. immediately and then again in 3 months. 3. in 2 weeks and then again in 6 months. 4. in 2 weeks and then again in 1 year.
2. The employer will want to test the nurse immediately to determine whether a preexisting infection is present, and then again in 3 months to detect seroconversion as a result of the needle stick. Waiting 2 weeks to perform the first test is too late to detect preexisting infection. Testing sooner than 3 months may yield false-negative results. CN: Health promotion and maintenance;
A nurse determines that which client is at greatest risk for developing acquired immunodeficiency syndrome (AIDS)? 1. A client who lives in crowded housing with poor ventilation 2. A young sexually active client with multiple partners 3. An adolescent who's homeless and lives in shelters 4. A young sexually active client with one partner
2. The younger the client when sexual activity begins, the higher the incidence is of HIV and AIDS. Also, the more sexual partners he or she has, the higher the incidence of these diseases. Neither crowded living environments nor homeless environments by themselves lead to an increase in the incidence of AIDS.
A client has learned that his gay roommate has tested positive for human immunodeficiency virus (HIV). The client asks the nurse about moving to another room on the psychiatric unit because the client doesn't feel "safe" now. What is the most appropriate action by the nurse? 1. Move the client to another room. 2. Ask the client to describe any fears. 3. Move the client's roommate to a private room. 4. Explain that such a move wouldn't be therapeutic for the client or his roommate.
2. To intervene effectively, the nurse must first understand the client's fears. After exploring the client's fears, the nurse may move the client or his roommate or explain why such a move wouldn't be therapeutic.
The nurse initiates the treatment for a delayed hypersensitivity reaction. What is the most appropriate treatment? 1. Intravenous epinephrine 2. Breathing treatment with albuterol 3. Corticosteroids 4. Benadryl
3. Delayed hypersensitivity reactions are inflammatory reactions not histamine reactions.
A nurse is reviewing the physician's orders for a client with systemic lupus erythematosus (SLE). The nurse determines that the medication most appropriate for the treatment plan is: 1. morphine. 2. ketoconazole. 3. hydroxychloroquine. 4. dimenhydrinate.
3. Hydroxychloroquine is used in the treatment of SLE to prevent inflammation. Pharmacological treatment of SLE also involves nonsteroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive agents. Morphine is an opioid analgesic, ketoconazole is an antifungal agent, and dimenhydrinate is an antiemetic.
A client is diagnosed with uncomplicated rheumatoid arthritis. The nurse explains to the client that nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the treatment plan. Which NSAID medication is used to treat rheumatoid arthritis? 1. Furosemide 2. Haloperidol 3. Ibuprofen 4. Methotrexate
3. Ibuprofen, fenoprofen, naproxen, piroxicam, and indomethacin are NSAIDs used for clients with rheumatoid arthritis. Furosemide is a loop diuretic and haloperidol is an antipsychotic agent, neither of which is used to treat rheumatoid arthritis. Methotrexate is an immunosuppressant used in the early treatment of rheumatoid arthritis.
A client has a positive Mantoux test, and a chest X-ray is ordered. The client asks the nurse the reason for the X-ray. What is the best response by the nurse? 1. To confirm the diagnosis 2. To determine if a repeat skin test is needed 3. To determine the extent of lesions 4. To determine if this is a primary or secondary infection
3. If the lesions are large enough, the chest X-ray will show their presence in the lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-negative skin test results. A chest X-ray can't determine if this is a primary or secondary infection.
The nurse is preparing to administer an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified protein derivative to a client with a suspected case of tuberculosis. What is the most appropriate needle for the nurse to select? 1. ⅝″ to ½″ 25G to 27G needle 2. 1″ to 3″ 20G to 25G needle 3. ½″ to ⅜″ 26G or 27G needle 4. 1″ 20G needle
3. Intradermal injections like those used in tuberculin skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a local effect. A tuberculin syringe with a ½″ to ⅜″ 26G or 27G needle should be inserted about ⅛″ below the epidermis. A ⅝″ to ½″ 25G to 27G needle is appropriate for a subcutaneous injection; a 1″ to 3″ 20G to 25G needle, for an I.M. injection; and a 1″ 20G needle, for an I.V. bolus injection.
A nurse suspects a diagnosis of systemic lupus erythematosus (SLE). The nurse is most concerned when lab results identify: 1. elevated serum complement level. 2. thrombocytosis, elevated sedimentation rate. 3. pancytopenia, elevated antinuclear antibody (ANA) titer. 4. leukocytosis, elevated blood urea nitrogen (BUN) and creatinine levels
3. Laboratory findings for clients with SLE usually show pancytopenia, elevated ANA titer, and decreased serum complement levels. Clients may have elevated BUN and creatinine levels from nephritis, but the increase does not indicate SLE.
A client asks the nurse, "What is the difference between rheumatoid arthritis and osteoarthritis?" What is the most appropriate response by the nurse? 1. Osteoarthritis is gender specific; rheumatoid arthritis is not. 2. Osteoarthritis is a systemic disease; rheumatoid arthritis is localized. 3. Osteoarthritis is a localized disease; rheumatoid arthritis is systemic. 4. Osteoarthritis has dislocations and subluxations; rheumatoid arthritis does not.
3. Osteoarthritis is a localized disease, whereas rheumatoid arthritis is systemic. Osteoarthritis is not gender specific, but rheumatoid arthritis is gender specific. Clients have dislocations and subluxations in both disorders.
While preparing a case study, the nurse notes that which client is most likely to develop rheumatoid arthritis? 1. A 25-year-old woman 2. A 40-year-old man 3. A 65-year-old woman 4. A 70-year-old man
3. Rheumatoid arthritis affects women three times more often than men. The average age of onset is 55.
A client has been diagnosed with active tuberculosis (TB) and asks the nurse if he will be admitted to the hospital. The nurse responds that hospitalization would be most likely to occur: 1. to evaluate his condition. 2. to determine his compliance. 3. to prevent spread of the disease. 4. to determine the need for antibiotic therapy.
3. The client with active TB is highly contagious until three consecutive 240sputum cultures are negative, so he's put in respiratory isolation in the hospital. Neither assessment of physical condition, determinations of compliance, nor antibiotic therapy is a primary reason for hospitalization in this case.
The nurse is developing a plan of care for a client diagnosed with rheumatoid arthritis. What is the goal of treatment? 1. To cure the disease 2. To prevent osteoporosis 3. To control inflammation 4. To encourage bone regeneration
3. The primary goal in the treatment of rheumatoid arthritis is to control inflammation and slow the progression of the disease. There is no cure for rheumatoid arthritis. Rheumatoid arthritis causes bone erosion at the joints, not osteoporosis. Medications aren't available to replace bone lost through erosion.
A client has received a preliminary diagnosis of tuberculosis. In order to obtain a definitive diagnosis, the nurse anticipates that the physician will order which test? 1. Chest X-ray 2. Mantoux test 3. Sputum culture 4. Tuberculin test
3. The sputum culture for Mycobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on X-ray. Skin tests may be falsely positive or falsely negative.
A potential exposure to tuberculosis has occurred at a large, rural high school. The school nurse provides instruction to a group of community nurses who have volunteered to assist in the administration of the Mantoux test for the students. The school nurse determines that further instructions are not required when a volunteer nurse makes which statement? 1. "Use the deltoid muscle." 2. "Rub the site to help absorption." 3. "Read the results within 72 hours." 4. "Read the results by checking for a rash."
3. The test results should be read 48 to 72 hours after placement by measuring the diameter of the induration that develops at the site. The Mantoux test is injected intradermally on the volar surface of the forearm, not I.M. 710Rubbing the site could cause leakage from the injection site. An induration develops, not a rash
A client has recently been diagnosed with tuberculosis (TB). The nurse caring for the client anticipates that the client will develop: 1. active TB within 2 weeks. 2. active TB within 1 month. 3. a fever that requires hospitalization. 4. a positive skin test.
4. A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. The general population has a 10% risk of developing active TB over their lifetime, in many cases because of a break in the body's immune defenses. The active stage shows the classic symptoms of TB: fever, hemoptysis, and night sweats.
A 57-year-old client is admitted with acute bronchitis. During the admission interview, he tells the nurse he's allergic to bananas. The nurse is aware that the client may also be allergic to: 1. iodine-containing drugs. 2. cephalosporins. 3. penicillins. 4. latex.
4. Clients who are allergic to certain cross-reactive foods—including apricots, avocados, bananas, cherries, chestnuts, grapes, kiwis, passion fruit, peaches, and tomatoes—may also be allergic to latex. When exposed to latex, they may have an allergic response similar to the one these foods produce. Clients with allergies to shellfish may be allergic to iodine-containing drugs. Hypersensitivity reactions to cephalosporins are more common in clients with penicillin allergy. There's no link between food allergies and penicillin.
A nurse working in a public health clinic is planning tuberculosis (TB) screening. The nurse understands that which is the priority group to screen for TB? 1. All clients coming into the clinic 2. People living in a homeless shelter 3. Clients who haven't received the TB vaccine 4. Clients suspected of having human immunodeficiency virus (HIV)
4. Clients with HIV infection or suspected of having HIV are at greater risk for developing TB. A screening test should be done and, if positive, treatment with isoniazid (Nydrazid) given. Clients coming to the clinic don't need to be tested unless they're at high risk—for example, living with someone infected with TB, abusing I.V. drugs, or suffering from chronic health conditions, such as diabetes mellitus and end-stage renal disease. Clients living in a homeless shelter aren't necessarily at greater risk unless other residents in the shelter have TB. The TB vaccine isn't widely used in the United States.
A client is diagnosed with active tuberculosis and started on triple antibiotic therapy. The nurse would be concerned if the client demonstrates which of the following? 1. Decreased shortness of breath 2. Improved chest X-ray 3. Nonproductive cough 4. Positive acid-fast bacilli in a sputum sample after 2 months of treatment
4. Continuing to have acid-fast bacilli in the sputum after 2 months indicates continued infection. The other choices would all indicate improvement with therapy.
A client undergoes screening for sexually transmitted diseases. The results of an enzyme-linked immunosorbent assay (ELISA) are positive. The client asks the nurse to explain the meaning of test results. How should the nurse respond? 1. "Test results indicate that the human immunodeficiency virus is in your blood." 2. "These test results are early evidence of acquired immunodeficiency syndrome." 3. "Test results suggest that you have contracted a viral sexually transmitted disease. The specific disease needs to be identified." 4. "Test results indicate the possibility that you have contracted the human immunodeficiency virus."
4. ELISA is a screening test for presence of the human immunodeficiency virus (HIV). A positive result implies exposure to HIV, but confirmation requires a Western blot analysis
The nurse is teaching a client about the method of human immunodeficiency virus (HIV) transmission that carries the most risk. The client demonstrates understanding of exposure risks by making which of the following statements? 1. "I can have routine teeth cleaning at the dentist's office." 2. "I may have intercourse with my spouse." 3. "I may engage in unprotected, noninsertive sexual contact." 4. "I should not engage in intercourse with a new partner without a condom."
4. Having intercourse with a new partner is risky because of the unknown I.V. drug use and sexual history. Use of a condom may increase the protection against HIV exposure. Absolutely safe sex practices include autosexual activities, abstinence, and intercourse within a monogamous, uninfected couple. Very safe practices include noninsertive sexual contact. Having your teeth cleaned isn't a risk factor if the dental office properly sterilizes the equipment.
An 80-year-old client with pneumonia is admitted to the hospital. The client has a past medical history that includes chronic rheumatoid arthritis. Which assessment finding should the nurse expect during the physical examination? 1. Thickened plaque overlying the flexor tendon of the ring finger 2. Cystic swelling on the dorsum of the wrist 3. Flattened thenar eminence 4. Swan-neck deformity
4. In chronic rheumatoid arthritis, the fingers may show hyperextension of the proximal interphalangeal joints with fixed flexion of the distal interphalangeal joints, referred to as swan-neck deformities. Flattened thenar eminence characterizes thenar atrophy, a condition that suggests an ulnar nerve disorder. The first sign of a Dupuytren's contracture is a thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger at the level of the distal palmar crease. Ganglia are cystic, round, usually nontender swellings located along tendon sheaths or joint capsules; ganglia frequently involve the dorsum of the wrist.
A client who is positive for human immunodeficiency virus (HIV) tells a nurse she would like to breastfeed. Which is the best response by the nurse? 1. "Breastfeeding will help reduce the risk of hemorrhage." 2. "Breast milk is better than formula for the baby." 3. "Breastfeeding will help with bonding." 4. "Breast milk can transmit HIV to the baby."
4. Since HIV can be transmitted to the baby through breast milk, the client shouldn't breastfeed. Breastfeeding does stimulate uterine contractions, but in this case, breastfeeding should be discouraged. It wouldn't be appropriate to tell a client who shouldn't breastfeed that breast milk is best for the baby. In this case, formula is best. The client should be shown other ways to bond with her baby, such as holding, playing, and talking to the baby.
A nursing student is assigned an HIV-positive client. The student asks the staff nurse what precautions are necessary when taking the clients blood pressure. The nurse instructs the student to: 1. wear gloves. 2. wear a gown. 3. use contact precautions. 4. wash hands.
4. Since taking a client's blood pressure doesn't involve contact with his blood or secretions, washing hands is all that is necessary.
The nurse determines that the initial blood test used to identify a response to human immunodeficiency virus (HIV) infection would be? 1. Western blot 2. CD4+ T-cell count 3. Erythrocyte sedimentation rate 4. Enzyme-linked immunosorbent assay (ELISA)
4. The ELISA is the first screening test for HIV. A Western blot test confirms a positive ELISA test. Other blood tests that support the diagnosis of HIV include CD4+ and CD8+ counts, complete blood counts, immunoglobulin levels, p24 antigen assay, and quantitative ribonucleic acid assays.
A client with long-standing rheumatoid arthritis has frequent complaints of joint pain. The nurse's plan of treatment is based on the understanding that chronic pain is most effectively relieved when analgesics are administered in which way? 1. Conservatively 2. Intramuscular (I.M.) alternating with intravenous (I.V.) 3. On an as-needed basis 4. At regularly scheduled intervals
4. To control chronic pain and prevent cycled pain, regularly scheduled intervals are most effective. As-needed and conservative methods aren't effective means to manage chronic pain because the pain isn't relieved regularly. I.M. administration isn't practical on a long-term basis.
The nurse is caring for a client newly diagnosed with systemic lupus erythematosus (SLE). Which system is most affected by the disease? 1. Connective 2. Heart 3. Lung 4. Nerve
1. SLE is a chronic, inflammatory, autoimmune disorder that primarily affects connective tissue. It also affects the skin and kidneys and may affect the pulmonary, cardiac, neural, and renal systems.
A client was infected with tuberculosis (TB) bacillus 10 years ago but never developed the disease. He's now being treated for cancer. The client begins to develop signs of TB. The nurse suspects the client is exhibiting: 1. active infection. 2. latent infection. 3. superinfection. 4. tertiary infection.
1. Some people carry dormant TB infections that may develop into active disease. If there's no active infection, it's called a latent infection. The TB bacilli may remain latent for years and then activate when the client's resistance is lowered, as when a client is being treated for cancer. Superinfection doesn't apply in this case, and there's no such thing as tertiary infection.
The nurse determines that teaching a client about rheumatoid arthritis was successful when the client makes which statement? 1. "It will get better and worse again." 2. "Once it clears up, it will never come back." 3. "I will definitely have to have surgery for this." 4. "It will never get any better than it is right now."
1. The client with rheumatoid arthritis needs to understand it is a somewhat unpredictable disease characterized by periods of exacerbation and remission. There's no cure, but symptoms can be managed at times. Surgery may be indicated in some cases but not always.
A nurse is preparing a dietary teaching plan for a client with rheumatoid arthritis. Select the recommended supplement that will reduce inflammation for the client. 1. Fish oil 2. Vitamin D 3. Iron-rich foods 4. Calcium carbonate
1. The therapeutic effect of fish oil suppresses inflammatory mediator production (such as prostaglandins); how it works is unknown. Iron-rich foods are recommended to decrease the anemia associated with rheumatoid arthritis. Vitamin D and calcium supplements may help reduce bone resorption.
The nurse determines that teaching was successful when a client with a negative human immunodeficiency virus (HIV) antibody test makes which statement? 1. "I'm not infected with HIV." 2. "I haven't produced antibodies to HIV." 3. "I'm immune to HIV." 4. "I have antibodies to HIV."
2. A negative HIV antibody test means that HIV antibodies weren't in the client's blood at the time the test was performed. Antibodies may take 3 weeks to 6 months or longer to develop. A negative test result doesn't indicate immunity. If antibodies to HIV are present, the test result is positive.
The nurse explains to the client that a common but life-threatening complication of systemic lupus erythematosus (SLE) is: 1. arthritis. 2. nephritis. 3. pericarditis. 4. pleural effusion.
2. About 50% of the clients with SLE have some type of nephritis, and kidney failure is the most common cause of death for clients with SLE. Pericarditis is the most common cardiovascular manifestation of SLE, but it isn't usually life threatening. Arthritis is very common (95%), as are pleural effusions (50%), but neither is life threatening.
What is the most important information for the nurse to teach a client about hypersensitivity skin test results? 1. Wash the sites daily with a mild soap. 2. Have the sites read on the correct date. 3. Keep the skin test areas moist with a mild lotion. 4. Stay out of direct sunlight until the tests are read.
2. An important facet of evaluating skin tests is to read the skin test results at the proper time. Evaluating the skin test too late or too early will give inaccurate and unreliable results. Both the gauze and the saline must be sterile to reduce the risk of infection. There's no need to wash the sites with soap. The sites should be kept dry. Direct sunlight isn't prohibited.
A client has been diagnosed with active tuberculosis (TB). The nurse should assess the client for: 1. chest and lower back pain. 2. chills, fever, night sweats, and hemoptysis. 3. fever of more than 104.7° F (40.7° C) and nausea. 4. headache and photophobia.
2. Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing but isn't usual. Clients with TB typically have low-grade fevers, not higher than 102.7° F (38.97° C). Nausea, headache, and photophobia aren't usual TB symptoms.
The nurse is providing information to a client diagnosed with systemic lupus erythematosus (SLE). The client asks the nurse if any type of blood dyscrasia may develop. What is the best response by the nurse? 1. Dressler's syndrome 2. Polycythemia 3. Essential thrombocytopenia 4. von Willebrand's disease
3. Essential thrombocytopenia is linked to immunological disorders, such as SLE and human immunodeficiency virus. Dressler's syndrome is pericarditis that occurs after a myocardial infarction and isn't linked to SLE. Moderate to severe anemia is associated with SLE, not polycythemia. The disorder known as von Willebrand's disease is a type of hemophilia and isn't linked to SLE.
Which nonpharmacologic interventions are included in the care plan for a client who has moderate rheumatoid arthritis? Select all that apply. 1. Massaging inflamed joints 2. Avoiding range-of-motion (ROM) exercises 3. Applying splints to inflamed joints 4. Using assistive devices at all times 5. Selecting clothing that has Velcro fasteners 6. Applying moist heat to joints
3, 5, and 6. Supportive, nonpharmacologic measures for the client with rheumatoid arthritis include applying splints to rest inflamed joints, using Velcro fasteners on clothes to aid dressing, and applying moist heat to joints to relax muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate inflammation. A physical therapy program including ROM exercises and carefully individualized therapeutic exercises prevents loss of joint function. Assistive devices should be used only when marked loss of ROM occurs.
Which subjective assessment finding helps diagnose human immunodeficiency virus (HIV) infection in children? 1481 1. Excessive weight gain 2. Arrhythmia 3. Intermittent diarrhea 4. Tolerance of feedings
3. A differential diagnosis may be based on the presence of an underlying cellular immunodeficiency-related disease; symptoms include intermittent episodes of diarrhea, repeated respiratory infections, and the inability to tolerate feedings. Poor weight gain and failure to thrive are objective assessment findings that result from intolerance of feedings and frequent infections. Arrhythmia isn't associated with HIV.
A client is diagnosed with atopic dermatitis. He is upset and asks how to avoid another outbreak. The nurse determines that the client needs information regarding: 1. avoiding bacterial infections. 2. avoiding fungal infections. 3. hereditary factors. 4. avoiding viral infections.
3. Atopic dermatitis is a hereditary disorder associated with a family history of asthma, allergic rhinitis, or atopic dermatitis. Atopic dermatitis isn't a bacterial, fungal, or viral infection.
A nurse working in a rural county's Public Health Department has been alerted that there is an outbreak of tuberculosis (TB) in the area. The client most at risk for developing TB would be? 1. A 16-year-old female high school student 2. A 33-year-old day-care worker 3. A 43-year-old homeless man with a history of alcoholism 4. A 54-year-old businessman
3. Clients who are economically disadvantaged, malnourished, and have reduced immunity, such as a client with a history of alcoholism, are at extremely high risk for developing TB. A high school student, day-care worker, and businessman probably have a much lower risk of contracting TB.
Which intervention has the most impact in delaying the development of acquired immunodeficiency syndrome (AIDS) once a client has been infected with human immunodeficiency virus (HIV)? 1. Monthly plasmapheresis 2. Eating a balanced, nutritious diet 3. Compliance with complete therapeutic regimen 4. Getting adequate rest and sleep
3. Compliance with the complete therapeutic regimen includes adhering to a healthy lifestyle, taking prescribed medications, and reducing risks from other infections and is the most important intervention in delaying the onset of AIDS. Eating a balanced diet and getting adequate rest and sleep are part of the overall therapeutic regimen. Plasmapheresis isn't a treatment for HIV/AIDS.
A client received a purified protein derivative (PPD) test for tuberculosis (TB) on the right forearm. The site is reddened and raised about 3 mm. The nurse interprets this result as: 1. indeterminate. 2. needs to be redone. 3. negative. 4. positive.
3. This test would be classed as negative. A 3-mm raised area would be a positive result if the client had recent close contact with someone diagnosed with or suspected of having infectious TB. Follow-up should be done with this client, and a chest X-ray should be ordered. Indeterminate isn't a term used to describe results of a PPD test. The test can be redone in 6 months to see if the client's test results change. If the PPD test is reddened and raised 10 mm or more, it's considered positive according to the Centers for Disease Control and Prevention.
A client with clinically active pulmonary tuberculosis is ordered isoniazid, rifampin, pyrazinamide, and ethambutol. Which findings best indicate effectiveness of drug therapy? 1. Cavities are no longer evident on chest X-ray. 2. Tuberculin skin test is negative. 3. The client is afebrile and no longer coughing. 4. The sputum culture converts to negative.
4. A change in sputum culture from positive to negative is the best indication of the effectiveness of antitubercular medication. Cavities disappearing from the chest X-ray aren't a reliable indicator of drug effectiveness. Tuberculin skin tests don't convert from positive to negative. Disappearance of symptoms isn't the best indicator of the treatment's effectiveness because the causative organism may still be present.
A chest X-ray shows a client's lungs to be clear; however, the Mantoux test is positive with 10 mm of induration, and the previous test was negative. The nurse explains to the client that these test results are possible because: 1. he had tuberculosis (TB) in the past and no longer has it. 2. he was successfully treated for TB, but skin tests always stay positive. 3. he's a "seroconverter," meaning the TB has gotten to his bloodstream. 4. he's a "tuberculin converter," which means he has been infected with TB since his last skin test.
4. A tuberculin converter's skin test will be positive, meaning he has been exposed to and infected with TB and now has a cell-mediated immune response to the skin test. The client's blood and X-ray results may stay negative. It doesn't mean the infection has advanced to the active stage. Because his X-ray is negative, he should be monitored every 6 months to see if he develops changes in his chest X-ray or pulmonary examination. Being a seroconverter doesn't mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.
A nurse is aware that which of the following is a classic symptom of systemic lupus erythematosus (SLE)? 1. Fatigue and fever 2. Weight loss 3. Shortness of breath 4. Superficial lesions over the cheeks and nose
4. Although all of these symptoms can be signs of SLE, the classic sign is the butterfly rash over the cheeks and nose.
A client with a positive skin test for tuberculosis (TB) is not showing signs of active disease and is treated with isoniazid, 300 mg daily. The nurse explains to the client that the medication should be taken for how long? 1. 10 to 14 days 2. 2 to 4 weeks 3. 3 to 6 months 4. 9 to 12 months
4. Because of the increasing incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts from 9 to 12 months. Isoniazid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
The nurse is conducting a class for family members of clients diagnosed with tuberculosis (TB). The nurse determines that teaching is effective when the family member states: 1. "The disease is transmitted by sexual contact." 2. "The disease is transmitted by contaminated needles." 3. "The disease is transmitted through contaminated eating utensils." 4. "The disease is transmitted by droplets exhaled from an infected person."
4. The TB bacillus is airborne and carried in droplets exhaled by an infected person who is coughing, sneezing, laughing, or singing. Sexual contact and contaminated needles don't spread the TB bacillus but may spread other communicable diseases. It's never advisable to use contaminated utensils, but if they're cleaned normally, it isn't necessary to dispose of eating utensils used by someone infected with TB.
What is the priority instruction the nurse should give a client about his active tuberculosis (TB)? 1. "It's OK to miss a dose every day or two." 2. "If side effects occur, stop taking the medication." 3. "Only take the medication until you feel better." 4. "You must comply with the medication regimen to treat TB."
4. The regimen may last up to 24 months. It's essential that the client comply with therapy during that time or resistance will develop. At no time should he stop taking the medications before his physician tells him to.
A 27-year-old male who is an established client in the in the Family Medicine Clinic was recently diagnosed with acquired immunodeficiency syndrome (AIDS). When reviewing his chart, what does the nurse expect to find with this diagnosis? 1. Infection with human immunodeficiency virus (HIV), tuberculosis, and cytomegalovirus 2. Infection with HIV, an alternative lifestyle, and a T-cell count above 200 cells/μl 3. Infection with HIV, CD4+ count below 200 cells/μl, and a T-cell count above 400 cells/μl 4. Infection with HIV, a history of acute HIV infection, and a CD4+ T-cell count below 200 cells/μl
4. Three criteria must be met for an adult client to be diagnosed with AIDS. He must be HIV-positive, have a CD4+ T-cell count below 200 cells/μl, and have one or more specific conditions that include acute infection with HIV. Because HIV attaches to the CD4+ receptor sites of the T cell, a T-cell value alone is incorrect.
A client returns to the clinic 48 hours after receiving a Mantoux skin test. The area of induration at the injection site measures 18 mm. The client hasn't previously had a reaction to this test. The nurse's first action is to: 1. move the client to a negative pressure room. 2. have the client put on a face mask. 3. prepare the client to have a chest X-ray. 4. draw a blood sample to check the client's complete blood count (CBC) for an elevated white blood cell count.
A client with an initial positive reaction to a Mantoux test is at higher risk for active tuberculosis. Before taking him to another room or for a procedure such as a chest X-ray, he should be fitted with a mask to decrease the risk of disease transmission to others. Drawing blood for a CBC isn't necessary at this time.
