Unit 2- Immunity, Infection & Cancer

E - 16 What type of health problem will the nurse expect to see in a client who has very few regulator T cells? A - Increased severity of allergic and other hypersensitivity reactions B - Decreased ability to recognize non-self cells C - Decreased immunoglobulin production D - Increased risk for cancer development

A - Increased severity of allergic and other hypersensitivity reactions Rational Regulator T-cells (Tregs) function to limit the actions of general and specific responses. These cells prevent over-responses to the presence of "foreign proteins" within a person's environment. People who are deficient in these cells have more severe hypersensitivity reactions, allergies, and autoimmune responses.

ATI 35-3 A nurse is teaching a client about a new prescription for celecoxib. Which of the following information should the nurse include in the teaching? A - Increases the risk for a myocardial infarction B - Decreases the risk of stroke C - Inhibits COX-2 D - Increases platelet aggregation

A - Increases the risk for a myocardial infarction

E - 20 When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? A - Infection B - Drug toxicity C - Polycythemia D - Dose-limiting side effects

A - Infection Rational The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase.Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction.

ATI 38-2 A nurse is planning care for a client who is to receiving tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan of care? A - Keep the client NPO until pharyngeal responses return B - Monitor the insertion site for a hematoma C - Palpate the bladder to detect urinary retention D - Maintain the client on bed rest for 12 hr following the procedure

A - Keep the client NPO until pharyngeal responses return

ATI 86 A nurse is assessing a client or HIV. The nurse should identify that which of the following are risk factors associated with the virus? Select all A - Perinatal exposure B - Pregnancy C - Monogamous sex partner D - Older adult woman E - Occupational exposure

A - Perinatal exposure D - Older adult woman E - Occupational exposure

ATI 84 A nurse is reviewing the laboratory findings of a client who has measles. The nurse should expect to find an increase in which of the following types of WBCs? A - Neutrophils B - Basophils C - Lymphocytes D - Eosinophils

C - Lymphocytes Rational A - neutrophils increase with an acute bacterial infection B - Basophils increase with leukemia C - Lymphocytes increase with viral infections D - Eosinophils increase with allergic reactions

ATI 91 A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? select all A - Permit visitors to stay with the client 30 min at a time B - Warn pregnant individuals to visit the room only once daily C - Wear a dosimeter when in the client's room D - Place soiled dressings in a biohazard bag before discarding in the regular trash E - Dispose soiled linen in the hamper outside the client's room

A - Permit visitors to stay with the client 30 min at a time C - Wear a dosimeter when in the client's room

E - 19 Which warning signs of cancer would the nurse specifically teach in a wellness course directed to a group of older adults? Select all that apply. A - Persistent hoarseness B - Severe heartburn C - Chronic diarrhea D - Loss of skin turgor E - Curd-like vaginal discharge F - Difficulty swallowing with meals

A - Persistent hoarseness B - Severe heartburn C - Chronic diarrhea F - Difficulty swallowing with meals

E - 16 With which client conditions will the nurse expect an inflammatory response without infection? (Select all that apply.) Select all that apply. A - Poison ivy rash B - Otitis media C - Welt formation after a bee sting D - Blister formation from a burn E - Blister from a cold sore F - Acute myocardial infarction

A - Poison ivy rash C - Welt formation after a bee sting D - Blister formation from a burn F - Acute myocardial infarction Rational Inflammation is nonspecific response to tissue injury, irritation, and invasion by organisms or allergens. Options A, B, C, and E have tissue injury, irritation, or invasion as the pathophysiologic mechanism causing the response. Otitis media is an inflammation occurring with a bacterial or viral infection. Blister formation with a cold sore occurs as in response to the presence of the Herpes simplex virus and is highly infectious.

ATI 87 A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reprots fatigue, joint tenderness, swelling, and difficult urinating. Which of the following laboratory findings should the nurse anticipate? Select all A - Positive ANA titer B - Increased hemoglobin C - 2+ urine protein D - Increased serum C3 and C4 E - Elevated BUN

A - Positive ANA titer C - 2+ urine protein E - Elevated BUN

ATI 93 A nurse is caring for a client who has chronic cancer pain and has a permanent epidural catheter for administration of a fentanyl/bupivacaine solution. The nurse should monitor the client for which of the following findings? Select all A - Respiratory depression B - Hypotension C - Sedation D - Muscle spasticity E - Sensory blockage

A - Respiratory depression B - Hypotension C - Sedation E - Sensory blockage

ATI 89 A nurse is reveiwing the medical record of a client who has surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the pathology report: T2-N 3-MX. Which of the following findings should the nurse identify as a supporting diagnosis? A - The tumor is moderate in size B - No lymph nodes contain cancer cells C - The tumor is receptive to current medication therapy D - The cancer has metastasized to other areas in the body

A - The tumor is moderate in size

E - 17 Which laboratory results does the nurse expect to decrease in a client who has untreated HIV-III (AIDS)? Select all that apply. A - Total white blood cell count B - Viral load C - CD8+ T-cell D - HIV antibodies E - CD4+ T-cell F - Lymphocytes

A - Total white blood cell count E - CD4+ T-cell F - Lymphocytes Rational The immune target of HIV is the CD4+ T-cell. With infection of this cell, its circulating levels decline and immune function is reduced over time. As a result, total white blood cell counts decrease and circulating lymphocytes decrease. CD8+ T-cell counts are unaffected. HIV antibodies and viral load increase.

ATI A nurse is reviewing the daily laboratory results for a female client who has acute leukemia. Which of the following values is an expected finding? A - WBC count 21,000/mm3 B - Hgb 14 g/dL C - Hct 40% D - Platelets 170,000/mm3

A - WBC count 21,000/mm3 Rational B - Decreased Hgb C - decreased Hct D - Decreased platelet

E - 19 A nurse is giving a group presentation on cancer prevention and factors that cause cancer. Which statement by a client indicates understanding the education provided? A - "Nearly 1/3 of cancers in the United States are related to tobacco use." B - "Red meat helps to prevent cancer development." C - "If I eat a healthy diet and exercise I will not develop cancer." D - "Most cancer is hereditary."

A - "Nearly 1/3 of cancers in the United States are related to tobacco use." Rational Tobacco can be linked directly to the development of about 30% of all cancers in North America.Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop

E - 17 Which signs and symptoms does the nurse expect to find in a client diagnosed with Pneumocystis jiroveci infection? A - Dyspnea, tachypnea, persistent dry cough, and fever B - Substernal chest pain and difficulty swallowing C - Fever, persistent cough, and vomiting blood D - Cough with copious thick sputum, fever, and dyspnea

A - Dyspnea, tachypnea, persistent dry cough, and fever Rational P. jiroveci causes pneumonia with dry cough, shortness of breath, breathlessness, and fever. Thick sputum and vomiting blood are not present. Substernal chest pain and difficulty swallowing are associated with an oral and esophageal candida infection. Vomiting blood is not associated with any type of pneumonia.

ATI - P A nurse is instructing a client how to self-administer enfuvirtide. Which of the following instructions should the nurse include? A - "Allow the vial to sit until the solution is completely clear and without particulates." B - "After reconstituting with sterile water, vigorously shake the vial to mix the solution." C - "Use the medication immediately upon removing from the refrigerator." D - "Use the same location for five injections before rotating to a new site."

A - "Allow the vial to sit until the solution is completely clear and without particulates."

E - 17 The client who wants to use Truvada for preexposure prophylaxis (PreP) asks the nurse why testing is needed for HIV status before starting this drug. How does the nurse respond? A - "Although this drug can help prevent HIV infection, it is not enough by itself to control "the disease if you are HIV positive." B - "The side effects of this drug are worse if you have a detectable HIV viral load." C - "If you take this drug and are HIV positive, your risk for co-infection with the hepatitis B virus is increased." D - Some people have a genetic mutation that increases the risk for life-threatening reactions "while taking this drug if they are also HIV positive."

A - "Although this drug can help prevent HIV infection, it is not enough by itself to control "the disease if you are HIV positive." Rational The drug can help prevent HIV infection, but alone does not adequately suppress viral replication. In addition, taking it when HIV positive often leads to drug resistance. None of the other statements are true.

ATI A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following client statements indicates an understanding of the teaching? A - "I will avoid being in large crowds while taking this medication." B - "I should expect symptoms to subside in 1 to 2 weeks after starting this medication." C - "I will increase my intake of vitamin D while taking this medication." D - "I should expect to experience constipation while taking this medication."

A - "I will avoid being in large crowds while taking this medication." Rational A - The nurse should instruct the client to avoid crowds when taking methotrexate. Methotrexate can cause leukopenia due to bone marrow suppression, which can increase the client's risk for infection B -The nurse should inform the client that it takes 4 to 6 weeks for the manifestations of rheumatoid arthritis to respond to methotrexate therapy. C - increase their intake of folic acid, not vitamin D, to help decrease the adverse effects of methotrexate. D - diarrhea is an adverse effect of methotrexate.

ATI A nurse is providing teaching to a client who takes an oral contraceptive and has a new prescription for amoxicillin. Which of the following statements by the client indicates an understanding of the teaching? A - "I will use a backup method of birth control while I am taking this medication." B - "I should take this medication on an empty stomach." C - "I should expect to have constipation while taking this medication." D - "I will keep taking this medication until I feel better."

A - "I will use a backup method of birth control while I am taking this medication."

ATI - A nurse is teaching a client about maraviroc. Which of the following instructions should the nurse include? A - "It is important to report any noticeable rash immediately as it might indicate an issue with your liver." B - "Make sure you take this medication without any other medications first thing in the morning." C - "You might experience flu-like symptoms for which you can take any over-the-counter medication." D - "The side effects of this medication are minimal, so you can continue to work and drive as normal."

A - "It is important to report any noticeable rash immediately as it might indicate an issue with your liver."

ATI 93 A nurse is caring for a client who will undergo a neurolytic ablation. The client asks the nurse the reason for this procedure. Which of the following responses should the nurse make? A - "It should provide permanent pain relief." B - "It reduces the adverse effects of your pain medication." C - "It increases your ability to fight infections." D - "It increases cells that stop bleeding."

A - "It should provide permanent pain relief."

E - 18 What is the nurse's best response to a client newly diagnosed with systemic lupus erythematosus (SLE) who asks why nicotine use, especially cigarette smoking or vaping, should be avoided? A - "Nicotine reduces blood flow to your organs and increases the risk for permanent damage." B - "Using nicotine in any form reduces the effectiveness of drug therapy for lupus." C - "Nicotine promotes muscle cell loss, increases joint inflammation, and reduces functional mobility." D - "Smoking or vaping increases your risk for lung cancer development."

A - "Nicotine reduces blood flow to your organs and increases the risk for permanent damage." Rational Nicotine in any form constricts blood vessels and reduces perfusion. Perfusion is already reduced by the vasculitis that is part of the disease. Thus, use of nicotine greatly increases the risk for necrosis of many tissues and organs. Although smoking or vaping do increase the risk for lung cancer, their effects on blood vessels are a greater issue for the client with SLE. Nicotine neither reduces the effectiveness of drug therapy nor promotes muscle cell loss.

ATI 88 A nurse is teaching a client who has a new diagnosis of rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? A - "You can experience morning stiffness when you get out of bed" B - "You can experience abdominal pain." C - "You can experience weight gain" D - "You can experience low blood sugar."

A - "You can experience morning stiffness when you get out of bed"

ATI - P A nurse is teaching a client about immunizations. Which of the following information should the nurse include in the teaching? A - "You should receive a tetanus booster every 10 years." B - "You should not receive the influenza immunization if you have a common cold." C - "You do not have to receive the shingles vaccine if you have received two doses of the varicella virus vaccine." D - "As long as you don't have risk factors, you will start receiving the pneumococcal vaccine when you are 50 years old."

A - "You should receive a tetanus booster every 10 years."

ATI - P A nurse is teaching a guardian of a child about the recommended age range to receive the human papillomavirus (HPV) vaccine. Which of the following age ranges should the nurse include? A - 11 to 12 years old B - 7 to 9 years old C - 13 to 15 years old D - 15 to 17 years old

A - 11 to 12 years old

E - 18 For which hypersensitivity situation will the nurse prepare a client for management with plasmapheresis? A - A 35 year old with drug-induced hemolytic anemia B - A 30 year old with poison ivy lesions on 60% of the body C - A 25 year old with penicillin-induced anaphylaxis D - A 40 year old with angioedema and tongue swelling

A - A 35 year old with drug-induced hemolytic anemia Rational Drug-induced hemolytic anemia is a type II hypersensitivity reaction in which the body makes autoantibodies directed against red blood cells that have foreign proteins from the drug attached to them. In this type of reaction, the autoantibody binds to red blood cells, forming immune complexes that destroy red blood cells along with the attached protein. Management starts with discontinuing the offending drug and, performing plasmapheresis (filtration of the plasma to remove specific substances) to remove the formed autoantibodies. Plasmapheresis is not beneficial with other types of hypersensitivity reactions.

E -21 Which client is at greatest risk for developing an infection? A - A 65-year-old woman who had heart surgery 4 days ago B - A 54-year-old man with hypertension C - A 21-year-old woman with a fractured tibia in a cast D - A 71-year-old man in a nursing home

A - A 65-year-old woman who had heart surgery 4 days ago Rational Older clients such as the 65-year-old woman with compromised skin (surgical incision) are at the highest risk for infection.No coexisting conditions are present for the client with hypertension to be at risk for infection. The 71-year-old client in a nursing home is not at highest risk because no coexisting conditions make this client most vulnerable to infection.

E -21 A client is preparing to give a client an antipyretic drug for a temperature of 101° F (38.3° C). What drug would be the most appropriate for the nurse to administer? A - Acetaminophen B - Aspirin C - Doxycycline D - Ibuprofen

A - Acetaminophen Rational While all of these drugs may reduce fever, acetaminophen is an antipyretic and analgesic agent that has less side/adverse effects than the other drugs. Doxycycline is an antibiotic which may treat infection and thus reduce fever.

ATI 35-2 A nurse is admitting a client to the hospital following acetaminophen toxicity. Which of the following medications should the nurse expect to administer to this client? A - Acetylcysteine B - Pegfilgrastim C - Misoprostol D - Naltrexone

A - Acetylcysteine

ATI - P A nurse is preparing to administer enfuvirtide to a client. Which of the following actions should the nurse should plan to perform? (Select all that apply.) A - Administer the drug subcutaneously. B - Discard the unused portion. C - Roll the vial gently to reconstitute the solution. D - Inject the solution at room temperature. E - Expect a cloudy solution.

A - Administer the drug subcutaneously. C - Roll the vial gently to reconstitute the solution. D - Inject the solution at room temperature. Rational A - The nurse should administer enfuvirtide, a fusion inhibitor, subcutaneously, twice per day. This is the only appropriate route of administration for the drug. B - The nurse should refrigerate the unused portion. The nurse should also warm the solution to room temperature prior to giving the next dose out of the vial. C - The nurse should roll the vial of enfuvirtide gently between the palms of the hands after adding sterile water for injection. This reconstitutes the drug. D - The nurse can store unused solutions of enfuvirtide in a refrigerator up to 24 hr but should restore it to room temperature before injection. E - Enfuvirtide should be clear and without particulates after reconstitution. The nurse should not administer a cloudy solution.

ATI 89 A nurse is planning care for a client who has malnutrition due to cancer. Which of the following interventions should the nurse include in the plan of care? Select all A - Advise the client to keep a food diary B - Encourage the client to brush teeth before and after meals C - Assess the laboratory report of ferritin D - Eat nutrient dense foods last at meal time E - Encourage the client to limit drinking fluids during meals.

A - Advise the client to keep a food diary B - Encourage the client to brush teeth before and after meals C - Assess the laboratory report of ferritin E - Encourage the client to limit drinking fluids during meals.

ATI A nurse is caring for a client who reports a skin change. Which of the following findings should the nurse report to the provider? A - An asymmetrical papule that is pigmented B - A patch of silvery-white scales with a red epidermal base C - A collection of irregular, dry papules that are black D - An elevated red lesion that arises from a scar

A - An asymmetrical papule that is pigmented Rationial A - The nurse should identify an asymmetrical papule that is pigmented as an indication of a malignant melanoma. B - The nurse should identify a patch of silvery-white scales with a red epidermal base as a manifestation of psoriasis, which does not need to be reported to the provider. C - The nurse should identify a collection of irregular, dry papules that are black in color as a manifestation of seborrheic keratosis, which does not need to be reported to the provider. D - The nurse should identify an elevated red lesion that arises from a scar as a manifestation of a keloid, which does not need to be reported to the provider.

E - 18 Which assessment findings will the nurse expect to see in a client who is suspected to have systemic lupus erythematosus (SLE)? Select all that apply. A - Anemia B - Joint pain and swelling C - Hair loss D - Fever E - Fatigue F - Facial redness

A - Anemia B - Joint pain and swelling C - Hair loss D - Fever E - Fatigue F - Facial redness Rational Each of these assessment findings has been associated with systemic lupus erythematosus (SLE).

The nurse is caring for a postoperative client with total hip arthroplasty. What actions would the nurse take to prevent venous thromboembolism (VTE) postoperatively? Select all that apply. A - Apply pneumatic or sequential compression devices. B - Administer anticoagulant therapy. C - Ambulate the client on the day of surgery. D - Elevate the client's legs. E - Keep the legs slightly abducted.

A - Apply pneumatic or sequential compression devices. B - Administer anticoagulant therapy. C - Ambulate the client on the day of surgery. Rational Preventive postoperative actions that help prevent VTE include pharmacology (anticoagulants), ambulation, and compression.

ATI 91 A nurse is planning care for a client who has a platelet count of 10,000/mm3. Which of the following interventions should the nurse include in the plan of care? A - Apply prolonged pressure to puncture site after blood sampling B - Administer epoetin alfa as prescribed. C - Place the client in a private room D - Have the client use an oral topical anesthetic before meals

A - Apply prolonged pressure to puncture site after blood sampling

ATI - P A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to a child. The nurse should recognize that the MMR vaccine provides which of the following types of immunity? A - Artificial active immunity B - Active C - Passive D - Artificial passive immunity

A - Artificial active immunity

E - 19 Which cancer screening or prevention activity is most important for the nurse to include when assessing a 20-year-old client who has Down syndrome? A - Assessing his skin for bruises and petechaie B - Teaching him how to perform self-testicular examination C - Testing his stool for occult blood D - Encouraging him to eat more fruit and leafy, green vegetables

A - Assessing his skin for bruises and petechaie Rational All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia.

ATI 89 A nurse is caring for a client who has lung cancer and is exhibiting manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report to the provider? Select all A - Behavior changes B - Client report of headache C - Urine output 40 mL/hr D - Client report so nausea E - Increased urine specific gravity

A - Behavior changes B - Client report of headache D - Client report so nausea

E - 20 When caring for the client receiving chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? Select all that apply. A - Bruises B - Fever C - Epistaxis D - Pallor E - Petechiae

A - Bruises C - Epistaxis E - Petechiae Rational Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count (thrombocytopenia).Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

E - 18 What is the pathophysiologic basis for Lyme disease progression to stage III? A - Changing the organism's surface antigens leading to chronic inflammation and elevated cytokine levels B - Failure of the immune system to recognize the causative organism as non-self, allowing it to become a systemic infection C - Triggering of antibodies against infected cells that lead to autoimmune disease D - The special ability of Borrelia burgdorferi to burrow deeply into joint, cardiac, and neurons causing direct damage to these tissues.

A - Changing the organism's surface antigens leading to chronic inflammation and elevated cytokine levels Rational The causative organisms can switch out parts of its unique surface proteins, which changes the ability of immune sensitized system cells and antibodies to recognize the existing infecting organism allowing it to "hide." Every time a switch occurs, the immune system treats them like a new infection, and develops new antibodies and inflammatory responses to them, resulting in keeping all general and specific immunity actions in continual but ineffective attack mode through all stages of the disease process. This prolonged and continuous process results in persistent and enhanced damage to a variety of tissues and organs.

ATI - P A nurse is teaching a client who has a new prescription for imatinib to treat chronic myeloid leukemia. Which of the following instructions should the nurse include? (Select all that apply.) A - Clean fruits and vegetables thoroughly. B - Increase calcium intake. C - Weigh yourself daily. D - Perform hand hygiene frequently. E - Avoid grapefruit and grapefruit juice

A - Clean fruits and vegetables thoroughly. C - Weigh yourself daily. D - Perform hand hygiene frequently. E - Avoid grapefruit and grapefruit juice Rational B - Imatinib is more likely to cause hypokalemia than hypocalcemia or bone loss.

E - 20 When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? Select all that apply. A - Encourage the client to participate in changing the ostomy. B - Encourage the client and family members to express their feelings and concerns. C - Offer to have a person who is coping with a colostomy visit with the client. D - Explain to the client that the colostomy is only temporary. E - Obtain a psychiatric consultation.

A - Encourage the client to participate in changing the ostomy. B - Encourage the client and family members to express their feelings and concerns. C - Offer to have a person who is coping with a colostomy visit with the client.

E - 17 Which statements about the transmission of HIV are true? Select all that apply. A - Clients with HIV-III and no drug therapy are very infectious. B - Even with appropriate drug therapy, most clients infected with HIV live only about 5 years after diagnosis. C - HIV may be transmitted only during the end stages of the disease. D - The most common transmission route is casual contact. E - Newly infected clients with a high viral load are very infectious. F - HIV-positive clients who have an undetectable viral load appear to not transmit the disease.

A - Clients with HIV-III and no drug therapy are very infectious. E - Newly infected clients with a high viral load are very infectious. F - HIV-positive clients who have an undetectable viral load appear to not transmit the disease. Rational In the first 4 to 6 weeks after infection, the viral numbers in the bloodstream and genital tract are high and sexual transmission is possible. Clients at the end stage of HIV disease (HIV-III [AIDS]) without drug therapy have a high viral load and are particularly infectious. An undetectable viral load now means noninfectious and therefore, not transmittable. Casual contact does not transmit the infection. With appropriate drug therapy, clients with HIV disease live for decades.

E - 20 Which instruction is appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? A - Consume a diet high in fiber. B - Bathe in cold water. C - Wear cotton gloves when cooking. D - Make sure shoes are snug.

A - Consume a diet high in fiber. Rational A high-fiber diet will assist with constipation related to neuropathy.The client should bathe in warm not cold water, not hotter than 96° F. Cotton gloves may prevent harm from scratching, but protective gloves should be worn for cooking, washing dishes, and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

ATI 42 A nurse is caring for a client who has breast cancer and asks why the treatment plan contains a combination therapy of cyclophosphamide, methotrexate, and fluorouracil. The response by the nurse should include that combination chemotherapy is used to do which of the following? select all A - Decrease medication resistance B - Attack cancer cells at different stages of cell growth C - Block chemotherapy agent from entering healthy cells D - Stimulate immune system E - Decrease injury to normal body cells

A - Decrease medication resistance B - Attack cancer cells at different stages of cell growth E - Decrease injury to normal body cells

ATI - P A nurse is teaching a client who has a new diagnosis of breast cancer about the drug tamoxifen. The nurse should tell the client that which of the following conditions is a contraindication for taking tamoxifen? A - Deep-vein thrombosis B - COPD C - Diabetes mellitus D - Alcohol use disorder

A - Deep-vein thrombosis Rational A - Tamoxifen, an estrogen receptor blocker, can cause thromboembolism. Its use requires cautious use with clients who have deep-vein thrombosis. B -Trastuzumab is an immune system drug that requires cautious use with clients who have pulmonary disease. C -Interferon Alfa-2a is an immune system drug that requires cautious use with clients who have diabetes. D - Zidovudine is an immune system drug that requires cautious use with clients who have alcohol use disorder.

ATI 90 A nurse is planning care for a client who is scheduled for genetic testing for suspected cancer. Which of the following interventions should the nurse include in the plan of care? A - Determine the need for informed consent B - Send testing results to the client's insurance agency C - Verify the prescription for a tumor marker assay D - Ensure the client is placed in a recovery position after testing

A - Determine the need for informed consent

ATI 37-2 A nurse is planning care for a client who has brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client? A - Dexamethasone B - Methylphenidate C - Hydroxyzine D - Amitriptyline

A - Dexamethasone

ATI 87 A nurse is discussing gout with a client who is concerned about developing the disorder. Which of the following findings should the nurse identify as risk factors for this disease? Select all A - Diuretic use B - Obesity C - Deep sleep deprivation D - Depression E - Cardiovascular disease

A - Diuretic use B - Obesity E - Cardiovascular disease

ATI 35 -1 A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect?Select all A - Dizziness B - Diarrhea C - Jaundice D - Tinnitus E - Headache

A - Dizziness D - Tinnitus E - Headache

E - 20 The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which intervention does the nurse plan to implement? Select all that apply. A - Do not permit fresh flowers or plants in the room. B - Do not allow the client's 16-year-old son to visit. C - Observe for bleeding. D - Teach the client to omit raw fruits and vegetables from the diet. E - Administer pegfilgrastim. F - Assess for fever.

A - Do not permit fresh flowers or plants in the room. D - Teach the client to omit raw fruits and vegetables from the diet. E - Administer pegfilgrastim. F - Assess for fever. Rational Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim and pegfilgrastim, is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms.Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

ATI 90 A nurse in a clinic is talking with a client scheduled for a sentinel lymph node biopsy. Which of the following information should the nurse include? A - Dye is used during the procedure B - The lymph nodes closest to the tumor are removed during the biopsy C - A small amount of chemotherapy is used to test the lymph node response D - A 2 mm plug of tissue is removed during the biopsy

A - Dye is used during the procedure

The nurse recognizes that a client who has persistent pain may have difficulty with pain management after a total joint arthroplasty. What collaborative interventions are needed to help the client manage postoperative pain? Select all that apply. A - Establish trust and explain the postoperative pain management plan. B - Consult the pain management team if needed and available. C - Plan continuing pain management after discharge. D - Use multimodal and alternative pain management modalities. E - Identify at-risk clients preoperatively using a comprehensive assessment.

A - Establish trust and explain the postoperative pain management plan. B - Consult the pain management team if needed and available. C - Plan continuing pain management after discharge. D - Use multimodal and alternative pain management modalities. E - Identify at-risk clients preoperatively using a comprehensive assessment. Rational All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain.

E - 20 The nurse is teaching a client undergoing radiation therapy for laryngeal cancer. Which potential side effects will the nurse include? Select all that apply. A - Fatigue B - Difficulty urinating C - Change in taste D - Difficulty swallowing E - Changes in hair color F - Changes in skin of the neck

A - Fatigue C - Change in taste D - Difficulty swallowing F - Changes in skin of the neck

ATI - P A nurse is preparing to administer paclitaxel IV to a client who has ovarian cancer. Which of the following actions should the nurse take? (Select all that apply.) A - Give the client an antihistamine. B - Infuse the drug over 1 hr. C - Administer the drug through non-PVC tubing. D - Use an in-line filter. E - Add heparin to the paclitaxel solution.

A - Give the client an antihistamine. C - Administer the drug through non-PVC tubing. D - Use an in-line filter. Rational A - Prior to administering paclitaxel, an antimitotic drug, the nurse should give the client an antihistamine, such as diphenhydramine, a proton-pump inhibitor, such as cimetidine, and a glucocorticoid, such as dexamethasone, to prevent a hypersensitivity reaction. B - The nurse should infuse paclitaxel over 3 hr, not 1 hr. C - Paclitaxel is incompatible with PVC tubing. D - Paclitaxel requires administration through an in-line filter. E - The nurse should not mix paclitaxel with any other drugs. Heparin and other anticoagulants increase the risk for bleeding.

ATI - P A nurse is teaching the guardian of a 4-month-old infant about recommended immunizations for the infant. Which of the following immunizations should the nurse include? A - Haemophilus influenzae type B vaccine (Hib) B - Varicella vaccine C - Meningococcal conjugate vaccine (MCV4) D - Tetanus-diphtheria-acelluar pertussis vaccine (Tdap)

A - Haemophilus influenzae type B vaccine (Hib)

E - 19 Which conditions does the nurse teach a client are some of the seven warning signs of cancer? Select all that apply. A - Heavy nosebleeds independent of trauma to the nasal mucosa B - Menstrual bleeding that has decreased C - Increased pigmentation with deeper coloring in a mole D - Difficulty starting the stream of urine for the past 6 months E - Indigestion regardless of food type eaten F - Thickening of breast tissue in one area

A - Heavy nosebleeds independent of trauma to the nasal mucosa C - Increased pigmentation with deeper coloring in a mole D - Difficulty starting the stream of urine for the past 6 months E - Indigestion regardless of food type eaten F - Thickening of breast tissue in one area

ATI-P A nurse is caring for a client who is prescribed zidovudine. Which of the following laboratory values should the nurse report to the provider? A - Hemoglobin 7.1 g/dL B - RBC count 5.2/mm3 C - Neutrophil 57% D - Triglycerides 125 mg/dL

A - Hemoglobin 7.1 g/dL Rational A - The provider might consider dose reduction, discontinuation of therapy, or blood transfusions if the client's hemoglobin is less than 7.5 g/dL or has a reduction of greater than 25% from baseline. B - An RBC count of 5.2/mm3 is within the expected reference range and does not need to be reported to the provider. C - A neutrophil count of 57% is within the expected reference range and does not need to be reported to the provider. D - A triglyceride level of 125 mg/dL is within the expected reference range and does not need to be reported to the provider.

E - 20 The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? A - Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% B - 5000 white blood cells/mm3 (5 × 109/L) C - 250,000 platelets/mm3 (250 × 109/L) D - Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea

A - Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% Rational Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% has anemia demonstrated by low hemoglobin and hematocrit levels.The client with diarrhea and a potassium level of 2.9 mEq/L (2.9 mmol/L) has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 (250 × 109/L), and the client with 5000 white blood cells/mm3 (5 × 109/L) demonstrate normal values.

E -21 The nurse is teaching a group of senior citizens about recommended immunizations. What immunizations would the nurse include? Select all that apply. A - Herpes zoster vaccine B - Pneumococcal vaccine polyvalent vaccine C - Adult Tdap with Td booster every 10 years D - Annual influenza vaccine E - Pneumococcal 13-valent conjugate vaccine

A - Herpes zoster vaccine B - Pneumococcal vaccine polyvalent vaccine C - Adult Tdap with Td booster every 10 years D - Annual influenza vaccine E - Pneumococcal 13-valent conjugate vaccine Rational All of these immunizations are very important for people over 65 years of age to obtain due to the high risk of the diseases that they help prevent.

ATI 34 A nurse is providing teaching to a client who iis taking raloxifene to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this medication? Select all A - Hot flashes B - Lump in breast C - Swelling or redness in calf D - Shortness of breath E - Difficult swallowing

A - Hot flashes C - Swelling or redness in calf D - Shortness of breath

E -21 The nurse recognizes that handwashing is the best method for preventing infection. Which action(s) by the Centers for Disease Control (CDC) about hand hygiene are recommended? Select all that apply. A - If hands are not visibly soiled, use an alcohol-based hand rub. B - Wash hands before and after wearing gloves. C - If hands are visibly soiled, wash them with soap and water. D - Use only soap and water for hand hygiene when planning client contact. E - Wash hands before performing any invasive client procedure.

A - If hands are not visibly soiled, use an alcohol-based hand rub. B - Wash hands before and after wearing gloves. C - If hands are visibly soiled, wash them with soap and water. E - Wash hands before performing any invasive client procedure.

E - 18 After a client is hospitalized for an anaphylactic reaction to a bee sting, a nurse is teaching the client about the use of an epinephrine autoinjector. Which instruction/ instructions should be included in client education? (Select all that apply.) Select all that apply. A - Keep the device with you at all times. B - After administering the device, hospital monitoring is necessary. C - Use the device before calling 911. D - If the drug becomes discolored, order a replacement device. E -The device CANNOT be given through clothing. F - Inject the device into your arm or your leg.

A - Keep the device with you at all times. B - After administering the device, hospital monitoring is necessary. C - Use the device before calling 911. D - If the drug becomes discolored, order a replacement device. Rational Instruct the client to utilize the device at the first symptom of anaphylactic reaction before calling 911. Hospital monitoring is always necessary after utilizing epinephrine for anaphylaxis. The device should be available at all times, as allergens can be encountered in all life situations. For client safety if the drug becomes discolored, it needs to be replaced.The device CAN be given through a thin layer of clothing. The ideal injection site for an epinephrine automatic injector is in the upper thigh.

ATI A nurse is providing teaching to a group of clients regarding skin cancer prevention. Which of the following risk factors should the nurse include in the teaching? A - Light skin pigmentation B - Psoriasis C - History of frostbite D - Immunodeficiency disorder

A - Light skin pigmentation

E - 19 Which common cancers will the nurse inform clients are related to tobacco use? Select all that apply. A - Lung cancer B - Cancer of the larynx C - Bladder cancer D - Cancer of the tongue E - Skin cancer F - Cardiac cancer

A - Lung cancer B - Cancer of the larynx C - Bladder cancer D - Cancer of the tongue Rational Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco.The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.

E - 19 Which client assessment findings indicate to the nurse that leukemia may be present? Select all that apply. A - Multiple bruises B - Night sweats C - Severe epistaxis D - Fever E - Frequent colds F - Fatigue

A - Multiple bruises B - Night sweats D - Fever E - Frequent colds F - Fatigue

ATI 37-1 A nurse is caring for a client who has cancer and is taking morphine and carbamazepine for pain. Which of the following effects should the nurse monitor for when giving the medications together? Select all A - Need for reduced dosage of the opioid B - Reduced adverse effects of the opioid C - Increase analgesic effects D - Enhanced CNS stimulationE - Increases opioid tolerance

A - Need for reduced dosage of the opioid B - Reduced adverse effects of the opioid C - Increase analgesic effects

E -21 Which nursing actions aid in the prevention and early detection of infection in a client at risk? Select all that apply. A - Obtain cultures as needed. B - Remove unnecessary medical devices. C - Monitor the red blood cell (RBC) count. D - Inspect the skin for coolness and pallor. E - Promote sufficient nutritional intake. F - Encourage fluid intake, as appropriate.

A - Obtain cultures as needed. B - Remove unnecessary medical devices. E - Promote sufficient nutritional intake. Rational Promoting sufficient nutritional intake helps prevent and detect early infection in at risk clients. Nutrition has a direct correlation to improvement of general health. Malnutrition, especially protein-calorie malnutrition, places clients at increased risk for infection. Blood cultures would be used to detect a possible systemic infection. Advocating for the removal of unnecessary medical devices (e.g., intravascular or urinary catheters, endotracheal tubes, synthetic implants) may also interfere with normal host defense mechanisms and may help prevent infection.Inspecting the skin does not prevent or detect systemic infections. Fluid intake is important but does not directly relate to prevention or detection of infection. Monitoring the RBC count does not prevent, nor would it detect, infection.

ATI - P A nurse is caring for a client who has a new prescription for maraviroc therapy. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) A - Paresthesia B - Cough C - Tinnitus D - Jaundice E - Fever

A - Paresthesia B - Cough D - Jaundice E - Fever Rational Maraviroc is unlikely to cause tinnitus. Cisplatin, a platinum compound, is an immune system drug that can cause ototoxicity and hearing loss.

ATI - P A nurse is caring for a client who has a new prescription for cisplatin to treat testicular cancer. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) A - Paresthesia B - Sore throat C - Flank pain D - Tinnitus E - Conjunctivitis

A - Paresthesia B - Sore throat C - Flank pain D - Tinnitus Rational E - Cisplatin is unlikely to cause conjunctivitis, although it can cause blurred vision, papilledema, and optic neuritis.

E - 19 What effect does a "passenger" mutation in a gene have on cancer development? A - Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies. B - These mutations enhance the effectiveness of carcinogens causing direct DNA damage of a normal cell, increasing the likelihood of cancer development. C - These mutations protect against cancer development by reversing the effects of initiation. D - Passenger mutations are another term for proto-oncogene gene mutations.

A - Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies. Rational Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies.

ATI 86 A nurse in an outpatient clinic is assessing a client who reports night sweats and fatigue. The client reports having a cough along with nausea and diarrhea. Their temp is 38.1°C (100.6°F) orally. The client is concerned about the possibility of having HIV. Which of the following actions should the nurse take? Select all A - Perform a physical assessment B - Determine when manifestations began C - Teach the client about HIV transmission D - Draw blood for HIV testing E - Obtain a sexual history

A - Perform a physical assessment B - Determine when manifestations began E - Obtain a sexual history

E - 20 Which client problem does the nurse determine as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A - Potential for injury related to sensory and motor deficits B - Altered sexual function related to erectile dysfunction C - Potential for lack of understanding related to side effects of chemotherapy D - Potential for ineffective coping strategies related to loss of motor control

A - Potential for injury related to sensory and motor deficits Rational The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities.Every chemotherapy client needs to be taught related side effects of chemotherapy. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

ATI 92 A nurse is reviewing the medical record for a client who has suspected ovarian cancer. Which of the following findings should the nurse identify as a risk factor for ovarian cancer? Select all A - Previous treatment for endometriosis B - Family history of colon cancer C - First pregnancy a age 24 D - Report of first period at age 14 E - Use of oral contraceptives for 10 years

A - Previous treatment for endometriosis B - Family history of colon cancer

E - 20 The nurse is teaching the client about skin protection during radiation therapy. What teaching will the nurse include? Select all that apply. A - Protect the area by wearing clothing. B - Avoid all lotions to the area. C - Avoid exposure to sun and heat. D - Do not remove the ink markings on your skin. E - Try to take walks in the early morning or later evening. F - Do not wash the irradiated area.

A - Protect the area by wearing clothing. C - Avoid exposure to sun and heat. D - Do not remove the ink markings on your skin. E - Try to take walks in the early morning or later evening.

ATI 42 A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkin's disease. Which of the following medications should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse of cyclophosphamide? A - Protectant agent, such as mesna B - Opioid, such as morphine C - Loop diuretic, such as furosemide D - H1 receptor antagonist, such as diphenhydramine

A - Protectant agent, such as mesna

E - 20 When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? A - Providing oral care with a disposable mouth swab B - Maintaining NPO until the lesions have resolved C - Encouraging oral care with commercial mouthwash D - Administering a biological response modifier

A - Providing oral care with a disposable mouth swab Rational The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care.Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.

ATI - P A nurse is caring for a client who has a new prescription for delavirdine therapy to treat HIV-1. The nurse should instruct the client to report which of the following adverse reactions to the drug? A - Rash B - Insomnia C - Rhinitis D - Alopecia

A - Rash Rationial A - Delavirdine, a non-nucleoside reverse transcriptase inhibitor, can cause a rash. The nurse should instruct the client to report a rash, which can occur 1 to 3 weeks after therapy, because it can develop into Stevens-Johnson syndrome, a potentially life-threatening complication. B - more likely to cause fatigue and dizziness than insomnia. C - more likely to cause bronchitis than rhinitis. D - Vincristine, an antimitotic, is an immune system drug that can cause alopecia.

ATI 88 A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? Select all A - Recent influenza B - Decreased range of motion C - Hypersalivation D - Increased blood pressure E - Pain at rest

A - Recent influenza B - Decreased range of motion E - Pain at rest

ATI 93 A nurse is caring for a client who has cancer and has a prescription for transcutaneous electrical nerve stimulation (TENS) for pain management. Which of the following actions should the nurse take? A - Remove hair before applying the electrodes from the TENS unit on the skin B - Apply alcohol to the cline's skin before attaching the electrodes from the TENS unit C - Attach the electrodes form the TENS unit over painful incisions or skin damage D - Avoid other pain medications when using the TENS unit.

A - Remove hair before applying the electrodes from the TENS unit on the skin

E - 16 Which precautions are most important for the nurse to teach as part of health promotion for inflammation and immunity to an 88-year-old client? (Select all that apply.) Select all that apply. A - Report any temperature elevation to your primary health care provider immediately. B - Get an influenza vaccination every year. C - Wear gloves when working in your garden. D - Avoid performing any level of aerobic exercise. E - Consider moving into an assisted living facility. F - Be sure to have a tuberculosis skin test every year.

A - Report any temperature elevation to your primary health care provider immediately. B - Get an influenza vaccination every year. C - Wear gloves when working in your garden. Rational Older clients have overall reduced immunity and a higher risk for developing influenza and any other respiratory tract infection. They should receive annual influenza vaccinations. The skin of older adults is thinner, drier, and a greater risk for injury and infection. Wearing gloves when gardening can help prevent injury and reduce the risk for infection. Older clients often do not have greatly elevated temperatures during infection, which contributes to the infection being overlooked until it becomes serious. Thus, older clients should report any increase in temperature above their normal range to identify infections at earlier stages. TB skin tests may be falsely negative in older clients with reduced immunity and annual testing is of no real benefit. Healthy older clients who are cognitively intact and able to care for themselves have no need to change their living arrangements unless they so desire. Older clients can still engage in low-impact aerobic exercise under the supervision of their primary health care provider.

E - 18 Which precaution is a priority to prevent harm for the nurse to teach a client with systemic lupus erythematosus (SLE) who is newly prescribed to take hydroxychloroquine for disease management? A - See your ophthalmologist for visual field testing every 6 months. B - Report a reduction of joint swelling to your rheumatology health care provider immediately. C - Report a worsening of joint swelling to your rheumatology health care provider immediately. D - See your ophthalmologist for intraocular pressure measurement every 6 months.

A - See your ophthalmologist for visual field testing every 6 months. Rational Hydroxychloroquine has both immunomodulating and anticlotting effects that can be beneficial to clients with SLE. A major complication of this drug is its toxicity to retinal cells causing retinitis that can lead to an irreversible loss of central vision. Clients prescribed hydroxychloroquine are instructed to have frequent eye examinations with visual field testing (before starting the drug and every 6 months thereafter). If retinal toxicity is suspected, the drug is discontinued to preserve the remaining vision.

ATI 38-3 A nurse is caring for a client who is receiving a local anesthetic of lidocaine during the repair of a skin laceration. For which of the following manifestations should the nurse monitor as an adverse reaction to the anesthetic? A - Seizures B - Tachycardia C - Hypertension D - Fever

A - Seizures

ATI 34 A nurse is caring for a client who has a new prescription for calcitonin-salmon for osteoporosis. Which of the following tests should the nurse tell the client to expect before beginning this medication? A - Skin test for allergy to the medication B - ECG to rule out cardiac dysrhythmias C - Mantoux test to rule out exposure to tuberculosis D - Liver function tests to assess risk for medication toxicity

A - Skin test for allergy to the medication

ATI A nurse is assessing a client who has HIV. Which of the following findings should cause the nurse to suspect that the client's diagnosis has progressed to AIDS? A - Small, purple-colored skin lesions B - Fever and diarrhea lasting longer than 1 month C - Persistent, generalized lymphadenopathy D - CD4-T-cells decreased to 750 cells/mm3

A - Small, purple-colored skin lesions Rational A - The nurse should identify the presence of small, purple-colored skin lesions as an indication that the client has acquired Kaposi's sarcoma, which is an AIDS-defining illness. B - identify fever and diarrhea as manifestations of HIV. C - persistent, generalized lymphadenopathy as a manifestation of HIV. D - The nurse should identify a CD4-T-cell count of 750 cells/mm3 as an indication that the client has HIV. A diagnosis of AIDS requires the CD4-T-cell count to be below 200 cells/mm3.

ATI 34 A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following instructions should the nurse provide? Select all A - Take medication in the morning before eating B - Chew tablets to increase bioavailability C - Drink an 8 oz glass of water with each tablet D - Take medications with an antacid if heartburn occurs E - Avoid lying down after taking this medication.

A - Take medication in the morning before eating C - Drink an 8 oz glass of water with each tablet E - Avoid lying down after taking this medication.

E -21 A client who was treated last month for a severe respiratory infection reports many of the same symptoms today. Which factor in the client's use of antibiotic therapy most likely caused the client's relapse? A - Taking the antibiotic most days B - Taking the antibiotic as prescribed C - Taking the antibiotic before jogging 2 miles daily D - Taking the antibiotic with a full glass of water

A - Taking the antibiotic most days Rational Antibiotics not taken as prescribed can result in recurring symptoms, as well as the development of drug-resistant infections and other emerging infections.Taking the antibiotic before jogging is not a contributing factor to the client's relapse. The client who is taking antibiotics as prescribed is not likely to develop recurring symptoms. Taking antibiotics with a full glass of water is a positive action and neither hinders nor promotes antimicrobial therapy.

The nurse is preparing to give apixaban for a client who recently had a total knee arthroplasty. What does the nurse recognize as the advantage of this drug over other anticoagulants? A - The client does not need to have labs drawn for PT or INR. B - The client only needs to take the drug while in the hospital. C - The client is not at risk for bleeding or bruising. D - The client does not need to wear sequential compression devices.

A - The client does not need to have labs drawn for PT or INR. Rational Apixaban is a newer factor Xa inhibitor that helps to prevent venous thromboembolism in clients who have a total knee arthroplasty. The client taking this drug will need to continue for several weeks after surgery and is at risk for bleeding or bruising. However, the drug does not affect PT or INR, so that the client does not need to have labs drawn.

ATI A nurse is caring for a client who has neutropenia. Which of the following findings indicates a need for intervention? A - The client's grandchild is visiting and telling the client about the first day of kindergarten. B - The client has a grilled ham and cheese sandwich, a banana, and yogurt on their lunch tray. C - The client's family brings in a silk flower arrangement. D - The client's assistive personnel places paper cups and plastic utensils in the client's room.

A - The client's grandchild is visiting and telling the client about the first day of kindergarten.

E - 18 Which statement(s) regarding type IV hypersensitivity reactions is/are true? Select all that apply. A - The major mechanism of the reaction is the release of mediators from sensitized T-cells that trigger antigen destruction by macrophages. B - Type IV responses are usually directed against non-self but the response is excessive. C - The second phase of the reaction with accumulation of excess bradykinin is responsible for development of angioedema. D - The secondary phase, when prolonged, is primarily responsible for autoimmune disorders. E - Rashes and blister formation from poison ivy exposure are a typical response for this type of hypersensitivity reaction. F - Antihistamines are of minimal benefit because the reactions are mediated by IgE rather than histamine.

A - The major mechanism of the reaction is the release of mediators from sensitized T-cells that trigger antigen destruction by macrophages. B - Type IV responses are usually directed against non-self but the response is excessive. E - Rashes and blister formation from poison ivy exposure are a typical response for this type of hypersensitivity reaction. F - Antihistamines are of minimal benefit because the reactions are mediated by IgE rather than histamine.

ATI - P A nurse is considering drug therapy options for a client who has metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2). Which of the following drugs should the nurse expect the provider to prescribe? A - Trastuzumab B - Imatinib C - Leuprolide D - Flutamide

A - Trastuzumab Rational A - Trastuzumab, a monoclonal antibody and a pregnancy risk category D drug, treats and helps control the cell growth of metastatic breast cancer with tumors that overexpress HER2. This form of breast cancer accounts for up to 30% of metastatic breast tumors. B - Imatinib, a targeted antineoplastic drug, provides initial treatment of chronic myeloid leukemia, certain metastatic gastrointestinal tumors, and acute lymphoblastic leukemia, not metastatic breast cancer that is positive for HER2. C - Leuprolide, a gonadotropin-releasing hormone agonist, provides palliative treatment of prostate cancer, uterine fibroids, and endometriosis, not metastatic breast cancer that is positive for HER2. D - Flutamide, an androgen receptor blocker, treats early and metastatic prostate cancer, not metastatic breast cancer that is positive for HER2.

The nurse is caring for a client with osteoarthritis (OA) in the left knee. What factor does the nurse suspect is the most likely cause of this client's OA? A - Trauma to the joint B - Aging C - Osteoporosis D- Familial history

A - Trauma to the joint Rational The client has OA in one knee which suggests that the client has secondary OA rather than primary disease. Secondary OA occurs as a result of joint injury or obesity.

E -21 The nurse is preparing to draw blood from a client receiving a course of vancomycin about 30 minutes before the next scheduled dose. For what laboratory test would the blood specimen be most likely tested? A - Trough drug level B - Blood culture and sensitivity C - White blood cell (WBC) count D - Peak drug level

A - Trough drug level Rational When clients receive some intravenous antibiotics, it is essential that the levels of the drug stay consistent within a therapeutic range. To determine if that is the case, peak and trough levels are drawn. A trough level indicates the lowest level of drug available in the blood and is drawn shortly before the next scheduled drug dose. A peak level is assessed 30 to 60 minutes after the drug is given. A culture and sensitivity would not be done while the client is on antibiotics. The WBC count should be decreasing as a result of antibiotic therapy.

E - 18 Which type of hypersensitivity reaction will the nurse suspect in a client who develops as circular rash on the skin underneath a new necklace worn for 3 days? A - Type IV B - Type I C - Type II D - Type III

A - Type IV Rational A type IV delayed hypersensitivity reaction occurs when sensitized T-cells respond to an antigen by releasing chemical mediators and triggering macrophages. This reaction causes a rash as seen in a metal allergy exposure.A type I reaction occurs rapidly after exposure and is mediated by immunoglobulin E (IgE). Type II reactions occur when the body makes autoantibodies directed against self-cells and attack those cells. Type III reactions occur when an abundance of immune complexes are made and they get stuck in small vessels causing inflammation.

E - 16 Which types of problems will the nurse expect to find more frequently in a client who does not make adequate amounts of immunoglobulin A (IgA)? (Select all that apply.) Select all that apply. A - Upper respiratory infections B - Cystitis C - Excessive bleeding D - Contact dermatitis E - Anaphylaxis F - Diarrhea

A - Upper respiratory infections B - Cystitis F - Diarrhea Rational IgA is the secretory immunoglobulin that is present in highest concentrations in the secretions of the mouth, gastrointestinal tract, and genitourinary tract. IgA helps prevent infections in these body areas and does not circulate in significant amounts. It is not associated with any types of allergic reactions such as anaphylaxis or contact dermatitis. It plays no role in the blood clotting cascade.

ATI 36-1 A nurse is preparing to administer an opioid agonist to a client who has acute pain. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A - Urinary retention B - Tachypnea C - Hypertension D - Irritating cough

A - Urinary retention

ATI - P A nurse is teaching a client who has a new prescription for mercaptopurine to treat leukemia. Which of the following instructions should the nurse include? (Select all that apply.) A - Use contraception if pregnancy is a risk. B - Perform oral hygiene frequently. C - Avoid activities that require mental alertness. D - Perform hand hygiene frequently. E - Avoid activities that can cause injury.

A - Use contraception if pregnancy is a risk. B - Perform oral hygiene frequently. D - Perform hand hygiene frequently. E - Avoid activities that can cause injury. Rational Mercaptopurine is unlikely to cause sedation or dizziness. Trastuzumab, a monoclonal antibody, is an immune system drug that can cause dizziness, which would require the client to avoid activities that require mental acuity.

E - 17 Which conditions or factors will the nurse teach at a community seminar as probable transmission routes for HIV? Select all that apply. A - Using injection drugs B - Sitting on public toilets C - Changing a diaper on an HIV positive child D - Having unprotected intercourse with multiple partners E - Breast-feeding F - Being bitten by mosquitos

A - Using injection drugs D - Having unprotected intercourse with multiple partners E - Breast-feeding

The nurse is teaching a client preparing to have a total knee replacement about interventions to help prevent surgical infection. What interventions would the nurse include in this teaching? Select all that apply. A - Using nasal mupirocin for at least a week before surgery B - Avoiding sleeping with pets in the client's bed C - Showering the night before and the morning of surgery with chlorhexidine D - Giving antibiotics before and after surgery for at least 3 days E - Sleeping on clean linen wearing clean nightwear

A - Using nasal mupirocin for at least a week before surgery B - Avoiding sleeping with pets in the client's bed C - Showering the night before and the morning of surgery with chlorhexidine E - Sleeping on clean linen wearing clean nightwear Rational All of these interventions are used to help prevent infection except for the use of long-term antibiotics. Long-term antibiotic therapy is used to treat rather than prevent postoperative infection.

E - 17 Which laboratory test does the nurse analyze to determine the effectiveness of combination antiretroviral drug therapy in an HIV-positive client? A - Viral load testing B - Enzyme-linked immunosorbent assay C - Fourth generation testing D - Western blot analysis

A - Viral load testing Rational Only viral load testing directly measures the actual amount of HIV viral RNA particles present in 1 mL of blood. Changes in the number indicate therapy effectiveness. Higher numbers indicate lack of effectiveness and lower numbers indicate the drugs are working. The other tests are used to determine whether the client is infected with HIV and do not change with therapy.

ATI A nurse is assessing a client who has a new prescription for clindamycin to treat acute pelvic inflammatory disease. The nurse should report which of the following findings to the provider immediately? A - Watery diarrhea B - Vaginitis C - Furry tongue D - Nausea and vomiting

A - Watery diarrhea Rational A - The greatest risk to this client is pseudomembranous colitis, which is manifested by watery diarrhea. Therefore, the priority finding is diarrhea. The nurse should report this finding to the provider immediately and discontinue the medication. B - Vaginitis can indicate the client has developed a superinfection such as Candida albicans, which is an adverse effect of clindamycin. However, another finding is the priority. C - Furry tongue can indicate the client has developed a superinfection such as Candida albicans, which is an adverse effect of clindamycin. However, another finding is the priority. D - Nausea and vomiting are adverse effects of clindamycin. However, another finding is the priority.

ATI - P A nurse is caring for a client who is receiving vincristine to treat lung cancer. The nurse should monitor the client and recognize which of the following manifestations as an indication that the client is experiencing an adverse effect of the drug. A - Weak hand grasps B - Constricted pupils C - Bradycardia D - Crackles

A - Weak hand grasps Rational A - Vincristine, a vinca alkaloid, can cause peripheral neuropathy. The nurse should monitor deep-tendon reflexes and the strength and movement of the hands and feet. The nurse should instruct the client to report paresthesia or reduced sensation in the hands or feet. B - can cause ptosis and diplopia. C - can cause hyperkalemia, as well as hypertension or hypotension. D - Imatinib is an immune system drug that can cause pulmonary edema, manifesting as crackles.

E -21 While in the hospital, a client developed a methicillin-resistant infection in an open foot ulcer. Which nursing action would be appropriate for this client? A - Wear a gown and gloves to prevent contact with the client or client-contaminated items. B - Have the client wear a surgical mask when being transported out of the room. C - Wear a mask when working within 3 feet (91 cm) of the client. D - Assign the client to a private room with a negative airflow.

A - Wear a gown and gloves to prevent contact with the client or client-contaminated items. Rational Caregivers should wear a gown and gloves to prevent contact with the client or contaminated items when caring for a client with this infection. This is the best way to prevent the spread of infection. Gloves should also be worn when entering the room.The client does not require a private room or respiratory isolation, and does not need to wear a surgical mask when being transported out of the room because the infection is not airborne. Use of a mask is not the best way to prevent the spread of this infection.

ATI 86 A nurse is caring for a client who is suspected of having HIV. The nurse should identify that which of the following diagnostic tests and laboratory values are used to confirm HIV infection? Select all A - Western blot B - Indirect immunofluorescent assay C - CD 4+ T lymphocyte count D - HIV RNA quantification test E - Cerebrospinal fluid analysis

A - Western blot B - Indirect immunofluorescent assay

ATI-P A nurse is assessing a client following a trastuzumab infusion to treat metastatic breast cancer. Which of the following findings should the nurse recognize as an indication that the client is experiencing an adverse reaction to the drug? (Select all that apply.) A - Wheezing B - Dysrhythmias C - Hypotension D - Fever E - Ascites

A - Wheezing B - Dysrhythmias C - Hypotension D - Fever Rational Ascites is incorrect. Trastuzumab is unlikely to cause ascites, although it can cause abdominal pain, nausea, and vomiting. The nurse should monitor the client's fluid and electrolyte balance.

ATI 41 A 12 month old child just received the measles, mumps, and rubella (MMR) vaccine. For which of the following findings are should the nurse instruct the family to monitor for as adverse effects of the MMR vaccine select all A - rash B - swollen glands C - bruising D - Headache E - Inconsolable crying

A - rash B - swollen glands C - bruising

ATI - P A nurse is teaching a client about recommended immunizations. Which of the following immunizations should the nurse recommend the client receive starting at 50 years of age? A- Herpes zoster vaccine B - Human papillomavirus vaccine (HPV) C - Pneumococcal vaccine D - Haemophilus influenzae type B vaccine (Hib)

A- Herpes zoster vaccine

E - 19 An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse's best response? A - "Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased." B - "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." C - "You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you." D - "Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history."

B - "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." Rational "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman.

E - 21 The nurse is assessing a young adult client who missed multiple work days this winter due to having pneumonia or other respiratory infection four times. What question would be most appropriate for the nurse to ask as part of the health interview? A - "Have you received your pneumonia vaccines?" B - "Do you have any environmental concerns at work?" C - "Did you have the flu before developing pneumonia?" D - "Do you travel out of the country a lot?"

B - "Do you have any environmental concerns at work?" Rational The client may be exposed to inanimate substances in the work environment, such as mold, toxic metals, or asbestos. This particulate matter exposure can cause respiratory infections and allergies. Traveling can also predispose a client to infections, but this factor is less likely to be a major risk factor. Pneumonia vaccines are usually given for clients who are over 65 years of age. Having influenza can lead to pneumonia is the client has a depressed immune system or does not take care of him- or herself.

E - 18 What response by the nurse would be most therapeutic when a client who has systemic lupus erythematosus (SLE) says, "My face has changed so much. I feel really ugly"? A - "I know what you mean, I feel that way sometimes too." B - "I bet that was hard to say. Thank you for trusting me with your feelings." C - "Don't worry, treatment will make everything better." D - "You look great. It's what is inside that counts."

B - "I bet that was hard to say. Thank you for trusting me with your feelings." Rational "I bet that was hard to say. Thank you for trusting me with your feelings" is an empathetic response in a hard conversation. It acknowledges the client's bravery for sharing and encourages further therapeutic communication."You look great. It's what is inside that counts" is dismissive of the client's feelings. "Don't worry we will make everything better" is considered false reassurance, this can discount the client's feelings. "I know what you mean, I feel that way sometimes too" is focused on the nurse at a time when the focus should be on the client. All three responses hinder a continued conversation and therapeutic communication.

ATI A nurse is providing discharge teaching to a client who has HIV. Which of the following statements by the client indicates an understanding of the teaching? A - "I will clean the bathroom surfaces with full-strength bleach." B - "I should discard open beverages that have been unrefrigerated for 1 hr." C - "I should wash laundry that is soiled with a body fluid in cool water." D - "I will work in the garden for exercise."

B - "I should discard open beverages that have been unrefrigerated for 1 hr."

E - 20 Which client statement allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment? A - "I may lose my hair during this treatment." B - "I will have a radioactive device in my body for a short time." C - "I must be positioned in the same way during each treatment." D - "I will be placed in a semiprivate room for company."

B - "I will have a radioactive device in my body for a short time." Rational Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific.Because radiation therapy is site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

E -21 The nurse is caring for a client who has methicillin-resistant staphylococcus aureus (MRSA) infection and is starting oral delafloxacin therapy. What health teaching would the nurse include about this drug? A - "Take the drug every day until you feel you better or until your fever does away." B - "Take the drug at least 2 hours before or 6 hours after any antacids or minerals." C - "Take the drug every other day as prescribed unless you feel nauseated." D - "If you forget a dose of the drug, wait until the next day to take the next dose."

B - "Take the drug at least 2 hours before or 6 hours after any antacids or minerals." Rational Delafloxacin interacts with metals such as magnesium and iron. Therefore, the drug must not be given when drugs containing metals are in the stomach.

E - 17 Which statement made to the nurse by an assistive personnel (AP) assigned to care for an HIV-positive client indicates a breach of confidentiality and requires further education by the nurse? A - "The client's spouse told me she got HIV from a blood transfusion." B - "The other assistive personnel and I were out in the hallway discussing our concern about getting HIV from our client." C - "I told family members they need to wash their hands when they enter and leave the room." D - "Yes, I understand the reasons why I have don't need to wear gloves when I feed the client."

B - "The other assistive personnel and I were out in the hallway discussing our concern about getting HIV from our client." Rational Discussing this client's illness outside of the client's room is a breach of confidentiality and requires further education by the nurse. Instruction on handwashing to family members or other visitors is not a breach of confidentiality. Understanding the reasons for when and when not to wear gloves when performing direct client care is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a breach of confidentiality.

E - 16 What is the nurse's best response to a 38-year-old client with a large wound who does not want to receive a tetanus toxoid vaccination because he had a tetanus shot just 1 year ago? A - "Tetanus is a more serious disease and a "booster" is required every year to ensure adequate immunity and protection against it." B - "You may not need this vaccination now, I will check with your health care provider." C - "You need this vaccination because the strain of tetanus changes every year." D - "Because antibody production slows down as you age, it is better to take this vaccination as a booster to the one you had a year ago."

B - "You may not need this vaccination now, I will check with your health care provider." Rational When people have been "boosting" their tetanus antibodies on a regularly scheduled basis, they should have sufficient circulating antibodies to mount a defense against exposure to tetanus. If this client's medical records substantiate that he did indeed receive a tetanus toxoid booster 1 year ago, he does not need another one now.

ATI 90 A nurse is teaching a client who is scheduled for nuclear imaging for suspected cancer. Which of the following statements should the nurse give? A - "The presence of a liver enzyme will be identified B - "You will be given an injection of a radioactive substance." C - "An endoscope will be inserted through you mouth" D - "The tumor will be aspirated"

B - "You will be given an injection of a radioactive substance."

E - 16 What is the most important precaution for the nurse to teach a client who has few natural killer cells and the natural killer cells are not very active? A - "You will need to avoid people with viral infections because it is harder now for you to develop antibodies." B - "You will need to have yearly checkups because your risk for cancer development is greater now." C - "You will be at an increased risk for developing allergies, so it will be necessary for you to avoid common allergens." D - "You will no longer develop a fever when you have an infection, so you must learn to identify other symptoms of infection."

B - "You will need to have yearly checkups because your risk for cancer development is greater now." Rational Natural killer cells provide protection against development of cancer by recognizing unhealthy or cancer cells as non-self and taking action to destroy them.

E - 19 A 40-year-old man who has a mother who was diagnosed with breast cancer at age 45, a father who was diagnosed with smoking-related lung cancer at age 55, a 33-year-old sister with breast cancer, and a 38-year-old sister with ovarian cancer, asks if he should be concerned for his cancer risk. What is the nurse's best response? A - "You have two first-degree relatives and two second-degree relatives with cancer, which increases your general risk for cancer." B - "Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history." C - "Your risk for cancer is affected by your parents' cancer development; your sisters' cancers have no bearing on your risk." D - "Your risk is not affected by this family history because most of the cancers arose in female sex-associated tissues."

B - "Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history." Rational This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association.

ATI 41 A nurse is caring for several clients who came to the clinic for a seasonal influenza immunization. The nurse should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an infection? A - 1 year old who has no health problems B - 17 year old who has hypersensitivity to penicillin C - 25 year old who is pregnant D - 52 year old who takes a multivitamin supplement

B - 17 year old who has hypersensitivity to penicillin

ATI 42 A nurse is teaching a client who has breast cancer about tamoxifen. Which of the following adverse effects of tamoxifen should the nurse discuss with the client? A - Irregular heart beat B - Abnormal uterine bleeding C - Yellow sclera or dark colored urine D - Difficult swallowing

B - Abnormal uterine bleeding

A client was recently diagnosed with osteoarthritis and asks the nurse which over-the-counter drug would be the best to take? What would the nurse's recommendation be? A - Ibuprofen B - Acetaminophen C - Tramadol D - Gabapentin

B - Acetaminophen Rational Several major medical organizations, including the American Pain Society and OARSI committee recommend acetaminophen as the primary drug of choice.

ATI 41 A nurse at a provider's office is preparing to administer RV, STap, Hib, PCV13, and PIV immunization to a 4 month-old infant. Which of the following actions should the nurse plan to take? select all A - Administer IPV orally B - Administer subcutaneous injections in the anterolateral thigh C - Administer IM injections in the deltoid muscle D - Give the infant a pacifier during vaccine injections E- Teach caregivers to give aspirin on a schedule for 24 hr after immunization

B - Administer subcutaneous injections in the anterolateral thigh D - Give the infant a pacifier during vaccine injections

E - 19 A 74-year-old client recovering from lung cancer surgery tells the nurse, "I don't understand why I have lung cancer. I have never even touched a cigarette." Which factor may explain the cause? A - A history of cardiac disease B - Advancing age C - A history of military service D - A diagnosis of diabetes

B - Advancing age Rational Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases.Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service.

E - 20 The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being prescribed? A - Radioactive iodine-131 B - Allopurinol C - Recombinant erythropoietin D - Potassium chloride

B - Allopurinol Rational The nurse expects allopurinol to be prescribed, because allopurinol decreases uric acid production and is indicated in TLS. TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances.Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous because the client is already hyperkalemic. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

E - 16 Which client health problems will the nurse identify as an infectious process along with inflammation rather than inflammation alone? (Select all that apply.) Select all that apply. A - Tendonitis B - Appendicitis C - Asthma D - Cystitis E - Anaphylaxis F - Sepsis

B - Appendicitis D - Cystitis F - Sepsis Rational Appendicitis is most commonly the result of an infectious process (usually bacterial), as is sepsis, although a widespread inflammatory response can accompany sepsis. Cystitis is a bladder infection most often with a bacterial infection cause. s are commonly caused by bacterial and viral infections. Tendonitis usually is a result of a closed or overuse injury and is characterized by inflammation without infection. Anaphylaxis is an allergic response, not an infection. Asthma is an irritant/allergic reaction, not an infection although a respiratory infection makes asthma worse.

ATI 85 A nurse is reviewing strategies to promote comfort with a client who received an immunization. Which of the following information should the nurse include? Select all A - massage the injection site B - Apply a cool compress to the injection site C - Take acetaminophen or ibuprofen D - Use the affected extremity E - Apply an antimicrobial ointment to the injection site

B - Apply a cool compress to the injection site C - Take acetaminophen or ibuprofen D - Use the affected extremity

E - 18 Which action is the priority for the nurse to take to prevent harm for the alert 58-year-old client who is admitted to the emergency department with wheezing, dyspnea, angioedema, blood pressure of 70/52 mm Hg, and an irregular apical pulse of 122 beats/min? A - Asking about exposure to possible allergens B - Applying oxygen via a high-flow nonrebreather mask at 90% to 100% C - Reassuring the client that appropriate interventions are being instituted D - Starting an IV infusion of normal saline

B - Applying oxygen via a high-flow nonrebreather mask at 90% to 100% Rational The immediate priority is to apply oxygen in order to provide adequate oxygenation for the client who is in respiratory distress. Raising the lower extremities, starting an IV infusion, and reassuring the client are not the first priority for a client in respiratory distress.

E - 16 Which type of immunity will the nurse initiate by administering an infusion of IV immunoglobulin to a client? A - Natural active immunity B - Artificial passive immunity C - Artificial active immunity D - Natural passive immunity

B - Artificial passive immunity Rational The client will be receiving antibodies made in the body of another person and thus, is not actively involved in the production of these antibodies. That makes the immunity passive rather than active. Because the client is making the antibodies in response to an injection (vaccination) rather than in response to actually being sick with influenza, the immunity is artificial.

ATI 84 A nurse is preparing to administer a scratch test to a client who has possible food and environmental allergies. What of the following actions should the nurse prior to the procedure? select all A - Cleanse the client's skini with povidone-iodine B - Ask the client about previous reactions to allergens C - Ask the client about medications taken over the past several days D - Inform the client to expect itching at one site E - Obtain emergency resuscitation equipment.

B - Ask the client about previous reactions to allergens C - Ask the client about medications taken over the past several days D - Inform the client to expect itching at one site E - Obtain emergency resuscitation equipment. Rational A - use soap and water to cleanse the skin

ATI 37-3 A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering pamidronate? A - Inspect the skin for redness and irritation when changing the intradermal patch B - Assess the IV site for thrombophlebitis C - Instruct the. client to sit upright or stand for 30 min following oral administration D - Watch for manifestations of anaphylaxis for 20 min after IM administration

B - Assess the IV site for thrombophlebitis

ATI 92 A nurse is caring for a client 24 hr following a liver lobectomy for hepatocellular carcinoma. Which of the following laboratory reports should the nurse monitor? A - Urine specific gravity B - Blood glucose C - Serum amylase D - D-Dimer

B - Blood glucose

E - 19 The nurse recognizes that a client's hemangiosarcoma originated in which tissue? A - Epithelial tissue B - Blood vessel C - Skeletal muscle D - Cartilage

B - Blood vessel Rational The prefix "hemangio-" is included when cancers of the blood vessel are named.The prefix "rhabdo-" is used when cancers of the skeletal muscle are named.The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named.

ATI A nurse is performing a breast examination on a female client who is pregnant. Which of the following findings should the nurse report to the provider? A - Slight asymmetrical breast size B - Breast tissue with an orange-peel appearance C - Nipple inversion of one breast since puberty D - Elevated Montgomery's glands

B - Breast tissue with an orange-peel appearance Rational A - The nurse should identify that slight asymmetrical breast size is a common finding. The nurse should report a significant difference in breast size because this can indicate inflammation or a tumor. B - The nurse should report an orange-peel appearance of the client's skin because this can indicate a blockage of lymph channels, which is a manifestation of advanced breast cancer. C - The nurse should report a recent inversion of a client's nipple because it can indicate a malignant tumor; however, the nurse does not need to report a nipple inversion since puberty. D - The nurse should not report elevated Montgomery's glands because this is an expected finding for a client who is pregnant.

ATI 34 A nurse is caring for a client whose blood calcium is 8.8 mg/dL. Which of the following medications should the nurse anticipate administering to this client? A - Calcitonin-salmon B - Calcium carbonate C - Zoledronic acid D - Ibandronate

B - Calcium carbonate

ATI A nurse is providing teaching to a client who is scheduled for a Papanicolaou (Pap) test. The nurse should inform the client that the Pap test is used to screen for which of the following? A - Uterine cancer B - Cervical cancer C - Ovarian cysts D - Fibroids

B - Cervical cancer Rational A - The nurse should inform the client that a transvaginal ultrasound, along with an endometrial biopsy, is used to screen for uterine cancer. B - The nurse should inform the client that a Pap test is used to screen for cervical cancer. C - The nurse should inform the client that a pelvic examination, along with a transvaginal ultrasound, is used to screen for ovarian cysts. D - The nurse should inform the client that a pelvic examination, along with a transvaginal ultrasound, is used to screen for fibroids.

ATI A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect? (Select all that apply.) A - Subcutaneous nodules B - Decreased urine output C - Renal calculi D - Butterfly rash E - Joint inflammation

B - Decreased urine output D - Butterfly rash E - Joint inflammation Rational A -Subcutaneous nodules are manifestations of rheumatoid arthritis. B - Decreased urine output, due to kidney damage, is a manifestation of SLE. C - Lupus nephritis, not renal calculi, is a manifestation of SLE. D - A scaly rash on the face, commonly known as the "butterfly rash," is a common manifestation of SLE. E - Joint inflammation is a common manifestation of SLE.

ATI 36-5 A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. The nurse should identify that which of the following medications can cause an adverse effect when administered concurrently with fentanyl. A - Ampicillin B - Diazepam C - Furosemide D - Prednisone

B - Diazepam

E - 18 What precaution is most important for the nurse to teach the client with systemic lupus erythematosus (SLE) prescribed to take 45 mg of a corticosteroid daily for 2 weeks to manage an SLE flare? A - Check all your stools for the presence of blood or a black, tarry appearance. B - Do not suddenly stop taking the drug when your flare is over. C - Be sure to take this drug with food. D - Take 30 mg in the morning and 15 mg at night.

B - Do not suddenly stop taking the drug when your flare is over. Rational All of the precautions are correct and important. However, the most critical precaution is to not suddenly stop taking the drug, which could lead to acute adrenal insufficiency and even death. This dose of the drug (45 mg daily) would need to be tapered down over a period of weeks to prevent adrenal insufficiency.

ATI 91 A nurse is planning care for a client who is undergoing chemotherapy and is on neutropenic precautions. Which of the following interventions should be included in the plan of care? select all A - Encourage a high-fiber diet B - Eliminate standing water in the room C - Have the client wear a mask when leaving the room D - Have client specific equipment remain in the room E - Eliminate raw food from the client's diet

B - Eliminate standing water in the room C - Have the client wear a mask when leaving the room D - Have client specific equipment remain in the room E - Eliminate raw food from the client's diet

ATI A nurse in an emergency department is assessing a newly admitted client. Which of the following actions places the client at increased risk for contracting hepatitis B? A - Residing in an institutional setting B - Engaging in unprotected sexual intercourse C - Working with hazardous chemical waste materials D - Traveling to a foreign country

B - Engaging in unprotected sexual intercourse

ATI 88 A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? Select all A - Urinalysis B - Erythrocyte sedimentation rate (ESR) C - BUN D - Antinuclear antibody (ANA) titer E - WBC count

B - Erythrocyte sedimentation rate (ESR) D - Antinuclear antibody (ANA) titer E - WBC count

ATI 10 - child A nurse on a pediatric unit is caring for a toddler. Which of the following behaviors is an effect of hospitalization? Select all A - Believes the experiences is a punishment B - Experiences separation anxiety C - Displays intense emotions D - Exhibits regressive behaviors E - Manifests disturbance in body image

B - Experiences separation anxiety C - Displays intense emotions D - Exhibits regressive behaviors

E - 16 Which assessment finding on a client with no other health problems does the nurse consider the greatest potential threat to the client's immune system? A - Has old scar formation related to an appendectomy. B - Has poor oral hygiene and numerous dental caries. C - Displays orthostatic hypotension and is mildly dehydrated. D - Displays occasional skipped heartbeats during auscultation.

B - Has poor oral hygiene and numerous dental caries. Rational Poor oral hygiene and untreated dental carries are sources of infectious organisms with access to the blood (because mucous membranes are no longer intact). This is a potential threat to immunity because the condition can cause chronic inflammation and a constant transfer of microorganisms to the bloodstream, which increases the risk for systemic infection.

E - 19 Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? Select all that apply. A - Eating a diet high in fiber and low in animal fat B - Having a health checkup, including chest x-ray, annually C - Obtaining a colonoscopy every 5 years D - Electing to have both ovaries removed a person who has a BRCA2 mutation E - Getting a mammogram or breast MRI annually F - Having a mole removed from the neck

B - Having a health checkup, including chest x-ray, annually E - Getting a mammogram or breast MRI annually Rational Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection.

The nurse is caring for a client with osteoarthritis who reports severe pain in both knees. What nonpharmacologic intervention is the most appropriate for the nurse to recommend for this client? A - Massage and hypnosis. B - Hot compresses or moist heating pad. C - Glucosamine and chondroitin combination. D - Ice packs used every 3 to 4 hours during the day.

B - Hot compresses or moist heating pad. Rational Heat sources such as compresses and heating pads cause vasodilation which promotes healing in the affected joints. Ice is best for inflamed joints rather than those that are degenerative. Glucosamine and chondroitin are integrative therapies that help some clients but their effectiveness has not been validated. Massage would be painful and hypnosis may or may not be helpful, depending on the client.

ATI 3 8 - 1A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? Select all A - Take ergotamine as a prophylaxis to prevent a migraine headache B - Identify and avoid trigger factors C - Lie down in a dark quiet room at the onset of a migraine D - Avoid foods that contain tyramine E - Avoid exercise that can increase heart rate

B - Identify and avoid trigger factors C - Lie down in a dark quiet room at the onset of a migraine D - Avoid foods that contain tyramine

E - 16 Which client laboratory response indicates to the nurse that granulocyte colony-stimulating factor therapy is successful? A - Increased lymphocytes B - Increased white blood cells C - Increased platelets D - Increased red blood cells

B - Increased white blood cells Rational Granulocyte colony-stimulating factor is a growth factor that stimulates the increased production and maturation of neutrophils. This action increases the circulating number of neutrophils and has minimal effect on other blood cell types.

E - 17 With which antiretroviral drug class will the nurse teach clients to prevent harm by reporting any new onset muscle weakness and muscle pain to the immunity health care provider? A - Fusion inhibitors B - Integrase inhibitors C - Nucleoside reverse transcriptase inhibitors D - Protease inhibitors

B - Integrase inhibitors Rational The integrase inhibitor class of drugs can cause muscle breakdown (rhabdomyolysis) especially in adults taking a "statin" (type of lipid-lowering drug). The first symptoms of rhabdomyolysis are muscle pain and weakness. None of the other classes of antiretroviral drugs have this side effect.

A nurse is caring for a client who has viral pneumonia. Which of the following findings should the nurse report to the provider immediately? A - Negative blood culture B - Left shift in WBC differential C - Oxygen saturation 93% D - Crackles heard on auscultation

B - Left shift in WBC differential Rational A- A negative blood culture is nonurgent because it indicates that the client does not have a systemic infection caused by the pneumonia. Therefore, the nurse should report another finding first. B - When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a left shift in the client's WBC differential, which indicates that the pneumonia is of bacterial origin, rather than viral. The left shift can be a manifestation of sepsis, and the nurse should report this finding to the provider. C - An oxygen saturation of 93% is nonurgent because it is an expected finding for a client who has pneumonia. Tissues are adequately provided with oxygen when a client has an oxygen saturation of 92% to 100%. Therefore, the nurse should report another finding first. D - Crackles heard on auscultation is nonurgent because it is an expected finding for a client who has pneumonia. Therefore, the nurse should report another finding first.

ATI 84 A nurse is caring for a client who has a WBC count of 20,000/mm3. The nurse should conclude that the client has which of the following? A - Neutropenia B - Leukocytosis C - Left Shift D - Leukopenia

B - Leukocytosis

ATI 37-4 A nurse is planning care for a client who has cancer and is taking a glucocorticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse include in the plan of care? Select all A - Monitor for urination retention B - Monitor blood glucose C - Monitor blood potassium level D - Monitor for gastric bleeding E - Monitor for respiratory depression

B - Monitor blood glucose C - Monitor blood potassium level D - Monitor for gastric bleeding

E - 20 The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? A - Observe for motor deficits. B - Monitor weight. C - Monitor platelets. D - Trend red blood cells and hemoglobin and hematocrit.

B - Monitor weight. Rational Cachexia results in extreme body wasting, malnutrition, and severe weight loss.Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

ATI 42 A nurse is caring for a client who is being treated with interferon alfa-2b for malignant melanoma. For which of the following adverse effects should the nurse monitor? Select all A - Tinnitus B - Muscle aches C - Peripheral neuropathy D - Bone loss E - Depression

B - Muscle aches C - Peripheral neuropathy E - Depression

A nurse is preparing to document administration of a meningococcal vaccine to a client. Which of the following infection should the nurse include in the document? select all A - Age of client receiving the vaccine B - Name of vaccine manufacturer C - Vaccine expiration date D - Date of administration E - Serial number of the vaccine

B - Name of vaccine manufacturer C - Vaccine expiration date D - Date of administration

E - 20 Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? A - Naloxone B - Ondansetron C - Diazepam D - Morphine

B - Ondansetron Rational Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Lorazepam, a benzodiazepine, may also be given for nausea.Morphine is a narcotic analgesic or opiate and may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only.

ATI 87 A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? A - Swelling of joints of the fingers B - Pallor of toes with cold exposure C - Feet that become reddened with ambulation D - Client report of intense feelings of heat in fingers

B - Pallor of toes with cold exposure

ATI A nurse is reviewing the laboratory report for a client who has Hodgkin's lymphoma. Which of the following findings should the nurse expect? A - Overgrowth of B-lymphocyte plasma cells B - Reed-Sternberg cells C - Epstein-Barr virus D - Overproduction of blast phase cells

B - Reed-Sternberg cells Rational A - The nurse should expect a client who has multiple myeloma to have an overgrowth of B-lymphocyte plasma cells. B - The nurse should expect to find Reed-Sternberg cells, which are cancer cells specific to a client who has Hodgkin's lymphoma, in the client's lymph node C - The nurse should recognize that the Epstein-Barr virus is associated with the development of Burkitt's lymphoma and Hodgkin's lymphoma. However, it is not a diagnostic finding after the disease has occurred. D - The nurse should expect a client who has leukemia to have an overproduction of blast phase cells.

ATI 10 - Child A nurse is caring for a preschooler. Which of the following is an expected behavior of a preschool-age child A - Describing manifestations of illness B - Relating fears to magical thinking C - Understanding cause of illness D - Awareness of body functioning

B - Relating fears to magical thinking

E - 20 The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome will the nurse teach the client is the goal of palliative surgery? A - Prolonging the client's survival time B - Relief of symptoms or improved quality of life C - Allowing other therapies to be more effective D - Cure of the cancer

B - Relief of symptoms or improved quality of life Rational The focus and goal of palliative surgery is to help relieve symptoms of end-stage cancer and improve quality of life during the survival time.

ATI 90 A nurse is collecting information from a client in a provider's office. Which of the following findings should the nurse identify as an indication of possible cancer? Select all A - Temperature 102°F (38.9°C) for more than 48 hr B - Sore that does not heal C - Difficulty swallowing D - Unusual discharge E - Weight gain 4 lb (1.8 kg) in 2 weeks

B - Sore that does not heal C - Difficulty swallowing D - Unusual discharge E - Weight gain 4 lb (1.8 kg) in 2 weeks

E - 16 What is the nurse's interpretation of a laboratory result that indicates a client has a high blood concentration of IgG directed against the human papilloma virus? A - The client is at risk for major hypersensitivity reactions to attenuated vaccines. B - The client is mounting an appropriate response to a recurrent exposure to the virus. C - The client is in the midst of his or her first response to human papilloma infection. D - The client is at increased risk for becoming ill from opportunistic infectious organisms.

B - The client is mounting an appropriate response to a recurrent exposure to the virus. Rational When naive B-cells become sensitized to a specific microorganism, they divide forming plasma cells and memory cells, both of which retain the antigen sensitization. The plasma cell immediately begins to secrete antibodies in the form of immunoglobulin M (IgM) against the microorganism. Upon later re-exposure to the same antigen, memory cells will secrete immunoglobulin G (IgG) against it. Therefore the presence of high concentrations of specific IgG in the blood indicates a normal immune response to recurrent infection to the same viral infection. Option B is incorrect because IgG does not mediate hypersensitivity reactions. Option A is incorrect because an initial exposure would be indicated by increased IgM levels against the microorganism, not IgG. Option D is incorrect because the presence of high levels of IgG does not indicate a decline in the client's immune status.

E - 16 How will the nurse interpret a client's white blood cell count that has a total count of 9000 cells/mm3 (9 x 109/L) with a lymphocyte count of 4200 cells/mm3 (4.2 × 109/L)? A - The count indicates the client has an increased risk for infection. B - The client most likely has a viral infection. C - The count is completely normal. D - The client most likely has a bacterial infection.

B - The client most likely has a viral infection. Rational Although the total white blood cell count is within the normal range, the lymphocyte count is elevated. The most common cause of lymphocyte count elevation is an actual viral infection. Bacterial infections are associated with higher total counts and higher neutrophil counts.

ATI 33 A nurse is caring for a client who has a new prescription for adalimumab for rheumatoid arthritis. Based on the route of administration of adalimumab, which of the following should the nurse plan to monitor? A - The vein for thrombophlebitis during IV administration B - The subcutaneous site for redness following injection C - The oral mucosa for ulceration after oral administration D - The skin for irritation following removal of transdermal patch

B - The subcutaneous site for redness following injection

E - 19 How will the nurse interpret the finding on a client's pathology report that a cancerous tumor has a mitotic index of 8%? A - The tumor has not yet undergone carcinogenesis. B - The tumor is slow-growing. C - Metastasis has already occurred. D - The tumor has an abnormal number of chromosomes.

B - The tumor is slow-growing. Rational A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index.

E - 20 Which intervention will the oncology nurse use to prevent disseminated intravascular coagulation (DIC)? A - Monitoring platelets B - Using strict aseptic technique to prevent infection C - Administering packed red blood cells D - Administering low-dose heparin therapy for clients on bedrest

B - Using strict aseptic technique to prevent infection Rational Sepsis is a major cause of DIC, especially in the oncology client. The oncology nurse must use strict asepsis to prevent any infection.Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

The nurse is assessing an older client who has bony nodules on finger joints (Heberden and Bouchard nodes). What priority question would the nurse want to ask as part of the client interview? A -"When did your bony nodules develop?" B - "How do you feel about having these bony nodules?" C - "Are you able to independently perform ADLs?" D - "Are your bony nodules painful or tender?"

C - "Are you able to independently perform ADLs?" Rational As a result of the client having bony nodules in his or her hands, the most important question for the nurse to ask is to determine if the client is ADL independent. The nurse would also ask the other questions, but they are not the first questions to be asked.

ATI 85 A nurse is preparing to administer a varicella immunization to a client. Which of the following questions by the nurse is appropriate? A - "Are you allergic to eggs." B - "Are you allergic to baker's yeast." C - "Are you pregnant" D - "Do you have a history of Guillain-Barre syndrome"

C - "Are you pregnant"

ATI A nurse is planning discharge teaching for a client who is receiving chemotherapy and has bone marrow suppression. Which of the following instructions should the nurse plan to include in the teaching? A - "Take aspirin for minor aches and pains." B - "Clean your toothbrush with warm water weekly." C - "Bathe with an antimicrobial soap twice per day." D - "Wear clothing that will minimize sun exposure."

C - "Bathe with an antimicrobial soap twice per day." Rational A - The nurse should instruct the client not to take aspirin or other platelet inhibitors because a client who has bone marrow suppression is at increased risk for bleeding. B - The nurse should instruct the client to clean their toothbrush weekly with liquid bleach or run the toothbrush through the dishwasher to destroy micro-organisms. A client who has bone marrow suppression is at increased risk for infection. C - The nurse should instruct the client to bathe twice per day with an antimicrobial soap to decrease their exposure to micro-organisms. A client who has bone marrow suppression is at increased risk for infection. D - Sun exposure does not pose a risk to a client who is receiving chemotherapy. However, the nurse should instruct the client to use skin protection when spending time in the sun. Furthermore, the nurse should instruct the client to wear clothing that does not rub to prevent bruising or bleeding.

ATI 92 A nurse is providing teaching about colon cancer to a group of females 45 to 65 years of age. Which of the following statements should the nurse include in the teaching? A - "Colonoscopy for individuals with no family history of cancer should begin at age 40" B - "A sigmoidoscopy is recommended every 5 years beginning at age 60." C - "Fecal occult blood tests should be done annually beginning at age 50" D - "An MRI provides a definitive diagnosis of colon cancer."

C - "Fecal occult blood tests should be done annually beginning at age 50"

The nurse is planning health teaching for a client starting hydroxychloroquine for rheumatoid arthritis. What instruction would the nurse include in the teaching? A - "Be aware that the drug may cause secondary types of cancer." B - "Expect nausea and vomiting for the first week after starting the drug." C - "Have eye examinations every 6 months while on the drug." D - "Keep this medication in the refrigerator at all times."

C - "Have eye examinations every 6 months while on the drug." Rational Hydroxychloroquine is an antimalarial drug with immune modulating and anti-inflammatory properties. Although side effects are usually mild, long-term use of the drug can cause vision problems. The client is taught to have an eye examination prior to starting the drug and every 6 months while on the drug to detect any visual changes.

E - 17 Which statement made by the nurse during an admission assessment for a client who is HIV positive demonstrates a nonjudgmental approach in discussing sexual practices and behaviors? A - "You must tell me all of your partners' names, so I can let them know about possibly being infected." B - "I hope you use condoms to protect your partners." C - "Have you had sex with men or women or both?" D - "You don't participate in anal intercourse, do you?"

C - "Have you had sex with men or women or both?" Rational The straightforward approach of asking the client about having sex with men or women is nonjudgmental and most appropriate. "I hope you use..." is a judgmental statement. Naming partners is voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. By stating the question about anal intercourse as a negative is very judgmental.

The nurse has provided health teaching for a female client starting on methotrexate (MTX) for early rheumatoid arthritis. What statement by the client indicates a need for further teaching? A - "I will try to avoid crowds because I could easily get an infection." B - "I will start folic acid supplements which can help decrease side effects." C - "I can drink alcohol in small amounts at night to help me relax." D - "I will use strict birth control while I am taking this drug."

C - "I can drink alcohol in small amounts at night to help me relax." Rational All of these statements are correct about MTX except that the client needs to avoid all alcoholic beverages to prevent liver toxicity.

ATI 87 A nurse is teaching a client who has SLE about self-care. Which of the following statements by the client indicated an understanding of the teaching? A - "I should limit my time to 10 minutes in the tanning bed" B - "I will apply powder to any skin rash" C - "I should use a mild hair shampoo" D - "I will inspect my skin once a month for rashes"

C - "I should use a mild hair shampoo"

ATI A nurse is providing teaching to a client who has systemic lupus erythematosus (SLE). Which of the following statements by the client indicates an understanding of the teaching? A - "I should use a sunscreen with an SPF of at least 15." B - "Long-term immunosuppressive therapy could cure this disease." C - "I should wear gloves when it is cold outside." D - "SLE should not affect my lungs or breathing."

C - "I should wear gloves when it is cold outside." Rational A - SPF of at least 30. B - lifelong chronic autoimmune disease. C - can cause painful vasoconstriction in the client's fingers when exposed to cold temperatures. D - can cause pleural effusions and pneumonia.

ATI 92 A nurse is reveiwing testicular self-examination with a client. Which of the following client statements indicates understanding? A - "It is best to examine the testicles before bathing." B - "It is not necessary to report small lumps, unless they are painful." C - "I will examine one testicle at a time." D - "I will use my palms to feel for abnormalities."

C - "I will examine one testicle at a time."

ATI 89 A nurse is teaching a client about screening preventions for cancer. Which of the following statements by the client indicates an understanding of the teaching? A - "I will need to have a mammogram every 2 years beginning at age 45" B - "I should have a colonoscopy every 15 years beginning at age 60" C - "I will need to have an annual breast examination every year after 40." D - "I should have a fecal occult test done every 3 years."

C - "I will need to have an annual breast examination every year after 40." Rational A - mammogram - annual after age 40 B - colonoscopy - every 10 years after age 50 D - fecal occult - every year

ATI 33 A nurse is evaluating teaching for a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following statements by the client indicates understanding of the teaching? A - "I will be sure to return to the clinic at least once a year to have my blood drawn while I'm taking methotrexate." B - "I can receive a live-virus vaccine while taking this medication." C - "I'll let the doctor know if I develop sores in my mouth while taking this medication." D - "I should stop taking oral contraceptives while I'm taking methotrexate."

C - "I'll let the doctor know if I develop sores in my mouth while taking this medication."

E - 18 What is the nurse's best response to a client who had a severe allergic reaction to shrimp states, "I have had shrimp once before and did not have a reaction. Why is this happening now?" A - "Allergies are tricky, and many reasons for responses are not known." B - "It is most likely that you didn't eat enough shrimp the first time to cause a reaction." C - "The first time your body recognized the shrimp as an allergen, and the second time it reacted to it." D - "This means you may be allergic to something else and not to shrimp."

C - "The first time your body recognized the shrimp as an allergen, and the second time it reacted to it." Rational Type I reactions have two parts. During the first exposure, the client makes antigen-specific IgE, and becomes sensitized to the allergen. When the sensitized client is re-exposed to the allergen, a more severe reaction occurs.To point out the amount of shrimp eaten is not helpful and could make the client believe that eating only a small amount of shrimp would not cause a reaction. The same is true for option C. Stating that allergies "are tricky" does not help to inform or educate the client about what he or she should do to prevent harm. This response may make the client afraid of everything in his or her environment.

ATI 36-2 A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's family member asks why the provider prescribed methylnaltrexone. Which of the following responses should thenurse make? A - "The medication will increase respirations." B - "The medication will prevent dependence on the morphine." C - "The medication will relieve constipation." D - "The medication works with the morphine to increase pain relief."

C - "The medication will relieve constipation."

ATI 85 A nurse is preparing to administer an IM injection of immune globulin to a client who has been exposed to hepatitis A. Which of the following statements by the nurse is appropriate? A - "This medication offers permanent immunity to hepatitis A" B - "This medication involves three injections over several months" C - "This medication provides you with an immune response more quickly than you body can produce it." D - "This medication contains an attenuated virus to help you body create antibodies."

C - "This medication provides you with an immune response more quickly than you body can produce it."

A nurse is caring for a client who is undergoing chemotherapy and reports severe nausea. Which of the following statements should the nurse make A - "You nausea will lessen with each course of chemotherapy." B - "Hot food is better tolerated due to the aroma" C - "Try eating several small meal throughout the day" D - "Increase your intake of red meat as tolerated."

C - "Try eating several small meal throughout the day"

E - 17 Which point is most important for the nurse to include when teaching assistive personnel (AP) about protecting themselves from HIV exposure when caring for HIV-positive clients? A - "Always wear a mask when entering an HIV-positive client's room." B - "Talk to the employee health nurse about starting preexposure prophylaxis." C - "Wear gloves when in contact with clients' mucous membranes or nonintact skin." D - "Wear full protective gear when providing any care to HIV-positive clients."

C - "Wear gloves when in contact with clients' mucous membranes or nonintact skin." Rational Standard Precautions are all that is needed when caring for any client, including those who have HIV. Masks and full protective gear are not needed. Preexposure prophylaxis is not used for potential occupational exposure.

E - 16 Which number will the nurse calculate as the absolute neutrophil count (ANC) for a client whose differential includes: total WBCs 5300/mm3 (5.3 × 109/L ); segs 2800/mm3 (2.8 × 109/L); bands 200/mm3 (0.20 × 109/L); monos 250/mm3 (0.25 × 109/L); lymphs 2000/mm3 (2.0 × 109/L); eosins 25/mm3 (0.025 × 109/L); basos 25 (0.025 × 109/L)? A - 2800/mm3 (2.8 × 109/L) B - 3200/mm3 (3.2 × 109/L) C - 3000/mm3 (3.0 × 109/L) D - 2300/mm3 (2.3 × 109/L)

C - 3000/mm3 (3.0 × 109/L) Rational The absolute neutrophil count is calculated by adding the mature neutrophil count (segs) with the slightly less mature band neutrophil count (which will mature within a matter of hours into segs). Monos, lymphs, eosins, and basos are not neutrophils.

E - 18 Which client with persistent joint and muscle pain will the nurse consider as most likely to have a systemic lupus erythematosus (SLE) diagnosis? A - A 33-year-old African-American man whose father died from a myocardial infarction. B - A 33-year-old white woman whose sister has Grave disease. C - A 33-year-old African-American woman whose mother has psoriasis. D - A 33-year-old man whose identical twin brother has acute myelogenous leukemia.

C - A 33-year-old African-American woman whose mother has psoriasis. Rational SLE is an autoimmune disorder that is much more common in women than in men and has a genetic predisposition related to tissue type. A client with SLE is very likely to have another close relative who also has an autoimmune disorder, such as psoriasis (myocardial infarction, type 2 diabetes mellitus, and thrombotic stroke are not autoimmune disorders). In addition, the incidence of SLE is about eight times greater for African-American women than for white women.

E - 20 The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? A - Lung B - Veins of the legs C - Abdominal cavity D - Heart

C - Abdominal cavity Rational Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

ATI - P A nurse should recognize that enfuvirtide can be prescribed to clients who have which of the following conditions? A - Advanced prostate cancer B - Primary brain tumors C - Advanced HIV D - Metastatic ovarian cancer

C - Advanced HIV Rational A - *Flutamide*, an androgen receptor blocker, treats early or metastatic prostate cancer. B - *Carmustine*, a nitrosourea drug, treats primary and metastatic brain tumors. C - Enfuvirtide, a fusion inhibitor, treats HIV that is advanced or resistant to other types of treatment. The nurse should always administer the drug with other antiretroviral drugs. D - *Topotecan*, a topoisomerase inhibitor, treats metastatic ovarian cancer.

E - 20 The nurse is caring for a client who is receiving rituximab for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? A - Alopecia B - Fever C - Allergy D - Chills

C - Allergy Rational Allergy is the most common side effect of monoclonal antibody therapy (rituximab), and the nurse must be aware of any allergic reactions the client may exhibit.Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

ATI 92 A nurse is caring for a client who has multiple types of skin lesions. Which of the following skin lesions are indicative of a malignant melanoma? Select all A - Diffuse vesicles B - Uniformly colored papule C - Area with asymmetric borders D - Rough, scaly patch E - Irregular colored mole

C - Area with asymmetric borders E - Irregular colored mole

ATI 42 A nurse is caring for a client who receives rituximab to treat non-Hodgkin's leukemia and who asks the nurse how rituximab works. Which of the following should the nurse include? A - Blocks hormone receptors B - Increases immune response C - Binds with specific antigens on tumor cells D - Stops DNA replication during cell division

C - Binds with specific antigens on tumor cells

E - 19 Which cancer type does the nurse interpret from a client's pathology report that indicates "stage 2 rhabdomyosarcoma"? A - Muscle B - Brain C - Bone D - Breast

C - Bone Rational The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma.

ATI A nurse is providing teaching to a client who has an allergy to peanuts. Which of the following instructions is the priority to include in the teaching? A - Inform other health care professionals of the allergy. B - Wear a medical identification tag. C - Carry an emergency anaphylaxis kit. D - Keep a food diary.

C - Carry an emergency anaphylaxis kit.

The nurse is caring for a client who has a continuous femoral nerve blockade following a total knee arthroplasty. What nursing assessment does the nurse need to perform to ensure client safety? A - Monitor vital signs frequently to detect early complications. B - Perform focused cardiovascular and respiratory assessments. C - Check that the client can dorsiflex and plantar flex the foot on the operative leg. D - Monitor for excessive blooding and bruising during the infusion.

C - Check that the client can dorsiflex and plantar flex the foot on the operative leg. Rational To ensure that the client is not receiving excessive anesthesia, the client should be able to dorsiflex and plantar flex the foot on the operative leg. The purpose of the continuous femoral nerve blockade is to help control postoperative pain.

E - 17 Which concept is the highest priority for the nurse to consider in planning care for the client with HIV-III who has candidial stomatitis? A - Cellular regulation B - Gas exchange C - Comfort D - Nutrition

C - Comfort Rational Candidial stomatitis causes considerable oral discomfort and difficulty eating and swallowing. Ice chips and cool liquids can help reduce the discomfort until prescribed antifungal agents have reduced the infection symptoms. Some clients may have pain to the point that opioid analgesics are needed. Gas exchange and cellular regulation are not directly affected by the problem. Although nutrition is negatively affected, it is the pain that interferes most with nutrition.

E -21 The nurse is caring for an older hospitalized client. Which physiologic age-relatedchange(s) increase(s) the client's risk for infection? Select all that apply. A - Increased cough and gag reflexes B - Urinary incontinence C - Decreased intestinal motility D - Decreased immune response E - Thinning skin

C - Decreased intestinal motility D - Decreased immune response E - Thinning skin Rational Older clients have a decreased immune system, decreased intestinal motility, and thinning skin which make them at risk for infection, especially when hospitalized. Urinary incontinence is not a physiologic change of aging; it is a health problem that can be managed. Cough and gag reflexes are decreased rather than increased, which makes older adults at high risk for respiratory infections.

ATI A nurse is caring for a client who has HIV. Which of the following laboratory findings should suggest to the nurse that medication therapy is effective? A - WBC count 3,500/mm3 B - Lymphocyte 1,400/mm3 C - Decreased viral load D - Low CD4/CD8 ratio

C - Decreased viral load

ATI A nurse is caring for a client who has an elevated prostate-specific antigen level. The nurse should anticipate that the client will undergo which of the following diagnostic tests? A - Palpation of testes B - Human chorionic gonadotropin level C - Digital rectal examination D - Pelvic ultrasound

C - Digital rectal examination Rational A -The nurse should recognize that palpation of a client's testes is used to screen for testicular cancer, not prostate cancer. An elevated prostate-specific antigen level is a manifestation of prostate cancer. B - The nurse should recognize that human chorionic gonadotropin is used to diagnose testicular cancer. An elevated prostate-specific antigen level is a manifestation of prostate cancer. C - The nurse should recognize that a digital rectal examination is used to determine the size and consistency of the prostate, assisting with the differentiation between benign prostatic hypertrophy and prostate cancer. D - The nurse should recognize that a transrectal ultrasound, not a pelvic ultrasound, is used to screen for prostate cancer. An elevated prostate-specific antigen level is a manifestation of prostate cancer.

E - 19 When educating a client with B-cell lymphoma, a nurse tells the client that a virus can contribute to the development of their cancer. Which virus is linked with B-cell lymphoma? A - Human lymphotrophic virus type II B - Human papilloma virus C - Epstein-Barr virus D - Hepatitis B virus

C - Epstein-Barr virus Rational The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma.Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma

ATI A nurse is planning an education program about testicular cancer for a group of male adolescents. Which of the following information should the nurse include? A - Testicular cancer is more common in males who are older than 65. B - With early treatment, the survival rate is 50%. C - Examine the testicles immediately after showering. D - Schedule an annual ultrasound to screen for testicular cancer.

C - Examine the testicles immediately after showering. Rational A - Males who are between the ages of 15 to 39 have an increased risk for developing testicular cancer. B - The survival rate for testicular cancer, when diagnosed and treated early, is nearly 100%. C - The client should perform a testicular self-examination on a monthly basis by examining the testicles after a bath or shower to allow for easier palpation. D - Ultrasounds are not used to screen for testicular cancer. However, if there is a change in testicular size, shape, or texture, the provider might schedule an ultrasound.

E - 19 A client is diagnosed with melanoma. Which areas would the nurse anticipate that this client's tumor might metastasize? Select all that apply. A - Kidneys B - Liver C - Gastrointestinal tract D - Lymph nodes E - Brain F - Lungs

C - Gastrointestinal tract D - Lymph nodes E - Brain F - Lungs

The nurse is caring for a client with an inflamed, reddened, and severely painful first metatarsal joint. With what type of arthritis are these signs and symptoms associated? A - Rheumatoid arthritis B - Infectious arthritis C - Gouty arthritis D - Osteoarthritis

C - Gouty arthritis Rational Clients who have gout (also called gouty arthritis) experience severe inflammation in small joints, especially the metatarsal of the great (first) toe. Gout results when urate crystals created by errors in purine metabolism deposit in small synovial joints.

ATI - P A nurse is caring for a client who has a new prescription for topotecan therapy to treat resistant, small-cell lung cancer. The nurse should advise the client against taking which of the following types of over-the-counter drugs while receiving the therapy? A - Folic acid B - St. John's wort C - Ibuprofen D - Aluminum hydroxide

C - Ibuprofen Rational NSAIDs, anticoagulants, and antiplatelet drugs increase the client's risk for bleeding while receiving topotecan, a topoisomerase inhibitor. The nurse should advise the client against taking aspirin, ibuprofen, and other NSAIDs during therapy.

E - 17 Which practices are generally recommended to prevent sexual transmission of HIV? Select all that apply. A - Oral contraceptives taken consistently B - Natural-membrane condoms for genital and anal intercourse C - Latex gloves for finger or hand contact with the vagina or rectum D - Latex dental dam genital and anal intercourse E - Water-based lubricant with a latex condom F - Latex or polyurethane condoms for genital and anal intercourse

C - Latex gloves for finger or hand contact with the vagina or rectum D - Latex dental dam genital and anal intercourse E - Water-based lubricant with a latex condom F - Latex or polyurethane condoms for genital and anal intercourse Rational Latex or polyurethane condoms, dental dams, and gloves for genital and anal intercourse can prevent HIV from contacting susceptible tissues. Water-based lubricants must be used instead of oil-based or greasy lubricants because these can easily rub holes in the condoms. Oral contraceptives provide no protection against transmission of HIV or any other sexually transmitted infection.

E - 18 What is the most important action to prevent harm for the nurse to perform after a client's oral and facial swelling from an angiotensin-converting enzyme inhibitor (ACEI) have resolved? A - Teaching the client about symptoms to report immediately to the primary health care provider B - Instructing the client to discard the offending drug after being discharged C - Monitoring the client for return of symptoms for at least the next 2 to 4 hours D - Assessing the vein above the IV infusion site for a firm, cordlike texture

C - Monitoring the client for return of symptoms for at least the next 2 to 4 hours Rational All actions are important, although phlebitis is not likely to occur from IV therapy for angioedema. The ACEI class of drugs have a longer half-life and remain in the body longer than does the corticosteroid infusion used to treat the angioedema. As a result, symptoms can recur after first resolving when corticosteroid therapy is stopped. The client remains at risk and must be monitored for at least 2 to 4 hours for return of angioedema.

ATI 33 A nurse is providing teaching for a client how ahs gout and a new prescription for allopurinol. For which of the following adverse effects should the client be taught to monitor? Select all A - Stomatitis B - Insomnia C - Nausea D - Rash E - Increased gout pain

C - Nausea D - Rash E - Increased gout pain

E - 16 How do immune system cells differentiate between normal, healthy body cells and non-self cells within the body? A - All normal, healthy body cells are considered a part of the immune system. B - Immune system cells recognize normal healthy body cells by the presence of the nucleus, a structure that is lacking in non-self cells. C - Non-self cells express surface proteins that are different from normal, healthy body cells and are recognized as "foreign" by immune system cells. D - Non-self cells are easily identified by the immune system cells because non-self cells are much larger than normal, healthy body cells.

C - Non-self cells express surface proteins that are different from normal, healthy body cells and are recognized as "foreign" by immune system cells. Rational Normal, healthy body cells all express surface proteins that are unique to the person, coded by the major histocompatibility genes. Non-self cells express different cell surface proteins. Immune system cells can distinguish between their own surface proteins and all others.

ATI 91 A nurse is caring for a client who is receiving chemotherapy and has mucositis. Which of the following actions should the nurse take? A - Use a glycerin-soaked swab to clean the client's teech B - Encourage increased intake of citrus fruit juices C - Obtain a culture of the lesions D - Provide an alcohol-based mouthwash for oral hygiene

C - Obtain a culture of the lesions

ATI 38-5 A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine. For which of the following manifestations indicating a possible adverse reaction should the nurse instruct the client to stop taking the medication and notify the provider? Select all A - Nausea B - Visual disturbances C - Positive home pregnancy test D - Numbness and tingling in fingers E - Muscle pain

C - Positive home pregnancy testD - Numbness and tingling in fingersE - Muscle pain

E -21 Which information does the nurse include when teaching a client about antibiotic therapy for infection? A - Take antibiotics until symptoms subside, and then stop taking the drugs. B - Share antibiotics with family members who develop the same infection. C - Take all antibiotics as prescribed, unless adverse effects develop. D - Take antibiotics when symptoms of infection develop.

C - Take all antibiotics as prescribed, unless adverse effects develop. Rational Antibiotics should be taken as prescribed until they are gone. Teach the client about possible side effects and allergic manifestations. The primary health care provider must be contacted immediately if any adverse effects develop.Antibiotics must be taken until they are gone, even if the client feels better or when symptoms of infection appear. They should be taken only by the person for whom they are prescribed and not shared with anyone else.

ATI A nurse is educating a client who is scheduled for a kidney transplant. Which of the following information about hyperacute rejection should the nurse include in the teaching? A - Hyperacute rejection can occur during the first few weeks after the transplant. B - If hyperacute rejection occurs, the kidney can become enlarged. C - The organ will need to be removed if hyperacute rejection occurs. D - Immunosuppressive therapy is given to reverse hyperacute rejection.

C - The organ will need to be removed if hyperacute rejection occurs. Rational A - Hyperacute rejection occurs immediately following transplantation. Acute rejection occurs during the first few weeks following the client's transplant. B - Enlargement of the transplant kidney due to an inflammatory response is consistent with an acute rejection. C - Removing the transplanted organ is the only treatment for hyperacute rejection, due to the widespread clotting cascade that leads to ischemic necrosis of the transplant kidney. D - Immunosuppressive therapy is not used to reverse hyperacute rejection, but it can prevent chronic rejection of the transplanted kidney.

E - 17 What is the first action a nurse should take after sustaining a needlestick injury after injecting a client who is known to be HIV positive? A - Send the syringe and needle to the laboratory for analysis of viral load. B - Inform the charge nurse. C - Thoroughly scrub and flush the puncture site. D - Go to the employee clinic for postexposure prophylaxis.

C - Thoroughly scrub and flush the puncture site. Rational Although the nurse would also inform the charge nurse and go to the employee clinic to initiate postexposure prophylaxis, the first action is to clean the puncture site by washing it thoroughly with soap and water for at least 1 minute as recommended by the CDC. Viral load cannot be determined by analyzing the syringe and needle.

ATI A nurse is caring for a client who is admitted with enlarged lymph nodes and a fever. To confirm a diagnosis of bacterial pharyngitis, the nurse should anticipate which of the following diagnostic tests? A - Indirect laryngoscopy B - Chest x-ray C - Throat culture D - Monospot test

C - Throat culture Rational A - The nurse should recognize that an indirect laryngoscopy is used to visually assess pharyngeal structures. B -chest x-ray is used to identify disorders such as pneumonia and pleural effusions. C- used to confirm a diagnosis of bacterial pharyngitis by identifying specific micro-organisms present in the pharynx. D - used to detect mononucleosis, which is a viral infection.

ATI 35-4 A nurse is taking a history for a client who reports taking aspirin about four times a daily for a sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin. A - Digoxin B - Metformin C - Warfarin D - Nitroglycerin

C - Warfarin

E -21 Which precaution is appropriate for the nurse to take to prevent the transmission of Clostridium difficile infection? A - Carefully wash hands that are visibly soiled. B - Wear a mask with eye protection and perform proper handwashing. C - Wear gloves when in contact with the client's body secretions or fluids. D - Wear a mask and gloves when in contact with the client.

C - Wear gloves when in contact with the client's body secretions or fluids. Rational The nurse must wear gloves and wash hands before and after potential exposure to the client's body secretions or fluids. C. difficile infection requires Contact Precautions. Hands must be properly washed before and after any contact with the client with C. difficile infection. Alcohol-based hand rubs are not effective for hand hygiene in the care of clients with C. difficile.Hands must be washed even if not visibly soiled. It is not necessary to wear a mask when caring for clients with C. difficile infection. A mask and eye protection are not necessary to prevent transmission of C. difficile.

The nurse is developing a health teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? A - Take up knitting to slow down joint degeneration. B - Eat at least 2 yogurts every day. C - Wear supportive shoes at all times. D - Begin a jogging or running program.

C - Wear supportive shoes at all times. Rational Wearing supportive shoes will help prevent falls and damage to foot joints, especially metatarsal joints. Running and running promotes stress on joints and should be avoided. Repetitive stress activities such as knitting or typing should be avoided for prolonged periods. No single food can cure OA; a well-balanced diet should be recommended.

ATI 36-4 A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? A- Monitor for seizures and confusion with repeated doses B - Protect the client's skin from the severe diarrhea that occurs with morphine C - Withhold this medication if respiratory rate is less than 12/min D - Give morphine intermittent via IV bolus over 30 seconds or less

C - Withhold this medication if respiratory rate is less than 12/min

ATI 86 A nurse is providing teaching for a client who has stage 3 HIV disease. Which of the following statements by the client should indicate to the nurse an understanding of the teaching? A - "I will wear gloves while changing the pet litter box" B - "I will rinse raw fruit with water before eating them" C - "I will wear a mask when around family members who are ill D - "I will cook vegetables before eating them"

D - "I will cook vegetables before eating them"

ATI 33 A nurse is preparing to administer belimumab for a client who has systemic lupus erythematosus. Which of the following actions should the nurse plan to take? A - Warm the medication to room temperature over 1 hr before administering B - Administer the medication by IV bolus over 5 min C - Dilute the medication in 5% dextrose and water solution D - Monitor the client for hypersensitivity reactions

D - Monitor the client for hypersensitivity reactions

E - 16 Which differential count will the nurse report to the primary health care provider for a client whose white blood count indicates a total count of 10,000 cells/mm3 (10 × 109/L)? A - Eosinophils 200/mm3 (0.2 × 109/L) B - Lymphocytes 2100/mm3 (2.1 × 109/L) C - Segmented neutrophils 6000/mm3 (6 × 109/L) D - Monocytes 2000/mm3 (2 × 109/L)

D - Monocytes 2000/mm3 (2 × 109/L) Rational The normal monocyte population in peripheral blood should be not greater than 5%. A monocyte count of 2000 in 10,000 white blood cells represents 20% of the total and indicates a significant increase.

ATI 37-5 A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A - Decreased appetite B - Explosive diarrhea C - Decreased pulse rate D - Orthostatic hypotension

D - Orthostatic hypotension

E - 16 Which cell types provide protective responses during inflammation? A - Natural killer cell B - Basophils C - Eosinophils D - Platelets E - Macrophages F - Neutrophils

D - Platelets Rational Macrophages and neutrophils initiate and complete phagocytosis against invading microorganism, providing the body with protection against infection. Natural killer cells are not particularly active during inflammation. Eosinophils and basophils are responsible for vascular changes, not protection. Platelets have no direct role in the protection provided by inflammation.

E - 17 Which part of the HIV infection process is disrupted by the antiretroviral drug class of nucleoside reverse transcriptase inhibitors (NRTIs)? A - Clipping the newly generated viral proteins into smaller functional pieces B - Activating the viral enzyme "integrase" within the infected host's cells C - Binding of the virus's gp120 protein to one of the CD4+ coreceptors D - Forming counterfeit bases that prevent DNA synthesis and viral replication

D - Forming counterfeit bases that prevent DNA synthesis and viral replication Rational The NRTIs have a similar structure to the four bases of DNA, making them "counterfeit" bases. They fool the HIV enzyme reverse transcriptase into using these counterfeit bases so that viral DNA synthesis and replication are suppressed.

E - 18 Which of the drugs or supplements taken daily taken by a client who is newly diagnosed with drug-induced systemic lupus erythematosus (SLE) does the nurse suspect is most likely to have caused this problem? A - Vitamin D B - Lisonopril C - Aspirin D - Hydralazine

D - Hydralazine Rational Hydralazine is a blood pressure medication that has been found to cause drug-induced SLE. None of the other drugs are associated with drug-induced SLE, although lisinopril, an angiotensin-converting enzyme inhibitor, is associated with development of angioedema.

ATI 10 - Child A nurse is teaching a group of caregivers about separation anxiety. Which of the following information should the nurse include in the teaching? A - It is often observed in the school-age child B - Detachment is the stage exhibited in the hospital C - It results in prolonged issues of adaptability D - Kicking a stranger is an example

D - Kicking a stranger is an example

ATI 42 A nurse is preparing to administer leucovorin to a client who has cancer and is receiving chemotherapy with methotrexate. Which of the following responses should the nurse use when the client asks why leucovorin is being given? A - "Leucovorin reduces the risk for a transfusion reaction from methotrexate" B - "Leucovorin increase platelet production and prevents bleeding." C - "Leucovorin potentiates the cytotoxic effects of methotrexate" D - Leucovorin protects healthy cells from methotrexate toxic effect."

D - Leucovorin protects healthy cells from methotrexate toxic effect."

ATI 92 A nurse is reviewing the plan of care for a client who has leukemia and has developed thrombocytopenia. Which of the following actions should the nurse take first? A - Instruct the client to take rest periods through the day B - Encourage the client to reposition in bed every 2 hr C - Check temperature every 4hr D - Monitor platelet counts

D - Monitor platelet counts

E - 18 Which statement by a client who has systemic lupus erythematosus (SLE) indicates to the nurse that more education about the disorder and its management is needed? A - "My friend and I are going to start walking 2 miles daily." B - "Taking my temperature every day can help me recognize when a flair is starting." C - "If I still have a lot of pain after taking an NSAID, I can also take acetaminophen." D - "At the first sign of a flare, I will begin taking my medication again."

D - "At the first sign of a flare, I will begin taking my medication again." Rational The client's statement suggests that he or she believes that daily medication is not needed and would be required only during a flare. However, daily drug therapy is essential to slow the progression of the disease and organ damage.Low-impact exercise such as walking is highly recommended to maintain mobility and promote cardiovascular health. Fevers are often associated with a flare. There is no contraindication to taking both NSAIDs and acetaminophen.

ATI 86 A nurse is providing teaching for a client who has stage 2 HIV disease and is having difficulty maintaining a normal weight. Which of the following statements by the client should indicate to the nurse an understand of the teaching? A - "I will choose a diet high in fat to help gain weight." B - "I will be sure to eat three large meals daily." C - "I will drink up to 1 liter of liquid each day." D - "I will add high-protein foods to my diet."

D - "I will add high-protein foods to my diet."

ATI 90 A nurse is teaching a client who is scheduled for a shave biopsy for suspected cancer. Which of the following client statements indicates understanding of the procedure? A - "A test of my bone marrow will be performed." B - "A lymph node will be removed." C - "A needle will be inserted into the mass" D - "A small skin sample will be obtained."

D - "A small skin sample will be obtained."

ATI A nurse is providing teaching to a client who has rheumatoid arthritis and reports persistent pain. Which of the following responses should the nurse make? A - "Take a cool bath in the evening." B - "Exercise every other day." C - "Use pillows to support your joints while in bed." D - "Ask a friend or a family member to help with household chores."

D - "Ask a friend or a family member to help with household chores." Rational A - The nurse should instruct the client to take a warm shower instead of a tub bath due to the difficulty the client can experience getting in and out of the tub. A warm shower can also relax muscles and reduce pain. B - exercise daily but to balance activity with rest. C - use only one small pillow, placed behind the head, while in bed to prevent flexion contractures. D - The nurse should instruct the client to allow others to assist with household chores to reduce the risk for joint injury and to give the client the opportunity to rest.

E - 18 Which client statement about the use and care of an epinephrine autoinjector for a peanut allergy indicates to the nurse that more teaching is needed? A - "If I inject myself, I will still go immediately to the emergency department." B - "When needed, I can inject the drug right through my clothing." C - "My wife and I will both practice putting the device together." D - "If I keep the injector in the refrigerator, the drug will not expire as quickly."

D - "If I keep the injector in the refrigerator, the drug will not expire as quickly." Rational Although it is true that the drug may not deteriorate as quickly if refrigerated, the client needs to have the drug with him or her at all times to use as soon as symptoms of anaphylaxis occur in order to prevent death. All other statements for the use and care of an epinephrine autoinjector are correct.

ATI A nurse is planning an education program for a group of high school teachers who will be taking students on a hike. Which of the following information should the nurse include regarding Lyme disease? A - "If bitten by a tick, you should be tested immediately." B - "If you have a tick embedded in your skin, apply a lit match to remove it." C - "You should wear dark-colored clothing to deter ticks from biting." D - "If you develop pain and stiffness in your joints, you should see your doctor."

D - "If you develop pain and stiffness in your joints, you should see your doctor." Rational A - The nurse should instruct the group to be tested for Lyme disease 4 to 6 weeks after being bitten by a tick because earlier testing is not reliable. B -The nurse should instruct the group not to use a lit match to remove a tick because this action can increase the risk for spreading an infection. The nurse should instruct the group to gently remove ticks with tweezers. C - The nurse should instruct the group to wear light colors so ticks on the body can be seen easily. D - The nurse should inform the group that manifestations of stage 1 Lyme disease include influenza-like manifestations, a "bull's-eye" rash, muscle and joint pain, and stiffness. The nurse should instruct the group to report these findings to a provider.

The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? A - "I do not know how long my wife will be able to take care of me at home." B - "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." C - "I do not know how much longer my neighbor can continue to help clean my house." D - "The bus is coming to pick me up from the senior center three times a week so I can play cards."

D - "The bus is coming to pick me up from the senior center three times a week so I can play cards." Rational Participation in diversional activities is a way to cope with daily stressors of osteoarthritis and shows good use of available resources for support. Caregiving responsibilities can be a source of stress; the client worrying about his wife's caregiving abilities does not indicate that the client is effectively coping. Routine tasks, such as doing dishes and laundry, need to be reassigned or effective pain management should be instituted before activities are undertaken to demonstrate effective coping. Neighbors are not reliable resources for in-home needs, and asking a neighbor to help does not indicate that the client is coping effectively.

ATI 10 - child A nurse is teaching a guardian about parallel play in children. Which of the following statements should the nurse include in the teaching? A - "Children sit and observe others playing." B - "Children exhibits organized play with in a group." C - "The child plays alone." D - "The child plays independently when in a group."

D - "The child plays independently when in a group."

ATI 85 A nurse in a client is caring or a client who is to receive an immunization. The client asks about contraindications to immunizations. Which of the following responses should the nurse make? A - "The use of insulin is a contraindication." B - "An anaphylactic reaction is a contraindication for administration of any type of immunization." C - "The common cold is a contraindication for receiving an immunization. D - "Your provider will weigh the risks if you have experienced any adverse effects."

D - "Your provider will weigh the risks if you have experienced any adverse effects."

ATI 41 A nurse is caring for a group of clients who are not protected against varicella. The nurse should prepare to administer the varicella vaccine at this time to which of the following clients? A - 24-year-old client in the first trimester of pregnancy B - 12-year-old child how has a severe allergy to neomycin C - 2 month old infant who has no health problems D - 32-year-old client who has essential hypertension

D - 32-year-old client who has essential hypertension

E - 20 A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? A - Explain that this occurs in some clients and is usually permanent. B - Inform the client that a small glass of wine may help her relax. C - Protect the client from infection. D - Allow the client an opportunity to express her feelings.

D - Allow the client an opportunity to express her feelings. Rational Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client.Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

ATI 87 A nurse is assessing a client who has a new diagnosis of SLE. Which of the following findings should the nurse expect? A - Weight gain B - Petechiae on thighs C - Systolic murmur D - Alopecia

D - Alopecia

ATI 34 A nurse is providing instruction to a client who has a new prescription for calcitonin-salmon for postmenopausal osteoporosis. Which of the following instructions should the nurse include in the teaching? A - Swallow tablets on an empty stomach with plenty of water B - Watch for skin rash and redness when applying calcitonin-salmon topically C - Miix the liquid medication with juice and take it after meals D - Alternate nostril each time calcitonin-salmon is inhaled.

D - Alternate nostril each time calcitonin-salmon is inhaled.

ATI 38-4 A nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which of the following findings in the client history should the nurse report to the provider. A - The client had a prior myocardial infarction B - The client takes warfarin for atrial fibrillation C - The client takes an SSRI for depression D - An ECG indicates a first-degree heart block

D - An ECG indicates a first-degree heart block

ATI A nurse is caring for four clients. Which of the following clients is at the greatest risk for pneumonia? A - A school-age child who has a history of asthma B - A young adult client who is living in a college dormitory C - A middle adult client who is using an incentive spirometer following surgery D - An older adult client who has dysphagia

D - An older adult client who has dysphagia Rational A - A school-age child who has a history of asthma is at risk for pneumonia, especially if the child's equipment is not well-maintained and decontaminated. However, another client is at greater risk. B - A young adult client who is living in a college dormitory is at risk for pneumonia, especially when in a crowded area during influenza season. However, another client is at greater risk. C - A middle adult client who is postoperative is at risk for pneumonia. However, since the client is using an incentive spirometer to prevent pneumonia, another client is at greater risk. D - An older adult client who has dysphagia is at the greatest risk for pneumonia due to the increased risk for aspiration when eating.

E - 18 Which type of drug therapy will the nurse prepare a client in the early disseminated stage of Lyme disease to take for control or cure of this disease? A - Convalescent serum B - Corticosteroids C - Biological response modifiers D - Antibiotics

D - Antibiotics Rational The goal of therapy during the initial and disseminated stages of Lyme disease is to eradicate the organism causing the infection with antibiotic therapy. Common antibiotics prescribed, sometimes for up to 30 days, include doxycycline, amoxicillin, and erythromycin. None of the other types of therapy listed are focused on this outcome.

ATI A nurse is providing teaching to a client who has Hodgkin's lymphoma and is undergoing external radiation treatment. Which of the following instructions should the nurse include? A - Use an antibacterial soap to cleanse the skin. B - Wash the ink marking off when showering. C - Rub the skin with a towel when drying. D - Avoid direct sun exposure to the skin.

D - Avoid direct sun exposure to the skin. Rational A - cleanse their skin with mild soap and water B - not to remove the ink C - pat, rather than rub,

ATI 36-3 A nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. The nurse should identify which of the following information as true regarding butorphanol? A - Butorphanol has a great risk for abuse than morphine B - Butorphanol causes a higher incidence of respiration depression than morphine. C - Butorphanol cannot be reversed with an opioid antagonist D - Butorphanol can cause abstinence syndrome in opioid-dependent clients

D - Butorphanol can cause abstinence syndrome in opioid-dependent clients

The nurse is preparing a client for a total hip arthroplasty today. What IV antibiotic would the nurse likely administer if the client has no drug allergies? A - Penicillin B - Clindamycin C - Vancomycin D - Cefazolin

D - Cefazolin Rational Cephalosporins are the drug class of choice for clients without allergies who are having a total joint arthroplasty.

ATI - P A nurse should recognize that maraviroc is used in the treatment of which of the following conditions? A - Diabetes mellitus B - Meningeal infection C - Pancreatitis D - Chemokine receptor 5 (CCR5)-tropic HIV-1

D - Chemokine receptor 5 (CCR5)-tropic HIV-1 Rational Maraviroc, a CCR5 antagonist, acts by binding to CCR5 and preventing HIV-1 from entering the cell. It is used in the treatment of clients who have CCR5-tropic HIV-1.

E - 20 The RN working on an oncology unit has just received report on these clients. Which client will the nurse assess first? A - Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy. B - Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour. C - Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast. D - Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.

D - Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature. Rational The nurse should see the client with chemotherapy-induced neutropenia first. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people.The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

ATI - P A nurse is caring for a client who has a new prescription for intrathecal cytarabine therapy to treat meningeal leukemia. The nurse should inform the client that they will also receive which of the following drugs to reduce the risk of neurotoxicity? A - Diphenhydramine B - Leucovorin C - Folic acid D - Dexamethasone

D - Dexamethasone

ATI 93 A nurse is caring for a client who has a prescription for gabapentin for neuropathic pain. The nurse should monitor the client for which of the following adverse effects of this medication? A - Constipation B - Urinary retention C - Insomnia D - Dizziness

D - Dizziness

The nurse assesses a client diagnosed with Sjögren syndrome. The nurse anticipates that the client will also have which symptom? A - Excessive production of saliva in the mouth B - Intermittent episodes of diarrhea C - Abdominal bloating after eating D - Dry eyes

D - Dry eyes Rational Clients with Sjögren syndrome experience dry eyes (keratoconjunctivitis sicca), dry mouth, and if female, dry vagina.

ATI 33 A nurse is caring for a client who has a new diagnosis of fibromyalgia. Which of the following medications should the nurse expect to administer to this client? A - Colchicine B - Hydroxychloroquine C - Auranofini D - Duloxetine

D - Duloxetine

ATI A nurse is caring for a client who has non-Hodgkin's lymphoma and is receiving chemotherapy. Which of the following is the priority assessment finding? A - Loss of body hair B - Report of anorexia C - Mucositis of the oral cavity D - Erythema at the IV insertion site

D - Erythema at the IV insertion site Rational A - Loss of body hair is an expected adverse effect of chemotherapy. Therefore, another assessment finding is the priority. B - Anorexia and weight loss are expected adverse effects of chemotherapy. Therefore, another assessment finding is the priority. C - Sores in the mouth is an expected adverse effect of chemotherapy. Therefore, another assessment finding is the priority. D - The greatest risk to the client is injury to the tissue due to extravasation of chemotherapy. Erythema at the IV insertion site can indicate extravasation is occurring, which can lead to infection and tissue loss. This is the priority assessment finding.

ATI - P A nurse should recognize that raltegravir is used to treat clients who have which of the following conditions? A - Hairy cell leukemia B - Thyroid cancer C - Kaposi's sarcoma D - Resistant HIV

D - Resistant HIV Rational A - Interferon alfa-2a treats hairy cell leukemia and chronic myelogenous leukemia. B - Doxorubicin, an anthracycline, treats thyroid cancer. C - Paclitaxel, a taxane, treats Kaposi's sarcoma. D - Raltegravir, an integrase inhibitor, along with other antiretroviral drugs, treats HIV that is resistant to other drugs. The nurse should administer raltegravir with other antiretroviral drugs.

ATI 35-5 A nurse in an emergency department is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect? A - Body temperature 35° C (95° F) B - Lung crackles C - Cool, dry skin D - Respiratory depression

D - Respiratory depression

ATI 41 A nurse is teaching a group of new guardians about immunizations. The nurse should instruct the guardians that the series for which of the following vaccines is completed prior to the first birthday? A - Pneumococcal conjugate vaccine B - Meningococcal conjugate vaccine C - Varicella vaccine D - Rotavirus vaccine

D - Rotavirus vaccine

E - 19 Which client circumstance would prompt the nurse to create a three-generation pedigree to more fully explore the possibility of increased genetic risk for cancer? A - Smoked for 20 years but quit 5 years ago B - Personal history of excessive sun exposure C - Most family adult members are overweight D - Strong family history of breast cancer

D - Strong family history of breast cancer Rational Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk.

ATI A nurse is planning care for a client who has leukemia and a platelet count of 48,000/mm3. Which of the following interventions should the nurse include in the plan? A - Provide the client with a diet that is low in vitamin K. B - Place the client on contact precautions. C - Administer subcutaneous epoetin alfa. D - Test the client's urine and stool for occult blood.

D - Test the client's urine and stool for occult blood. Rational A - The nurse should not provide the client with a diet that is low in vitamin K because this can further decrease coagulation. B - The nurse should recognize that thrombocytopenia does not require contact precautions. However, the client might require neutropenic precautions and a private room. C- The nurse should not administer epoetin alfa because it is used to treat anemia and is not effective in increasing platelet production. D - A client who is thrombocytopenic is at risk for occult bleeding. Therefore, the nurse should test the client's urine and stool for occult blood.

E - 19 How will the nurse interpret the finding on a client's pathology report that indicates a cancerous tumor is aneuploid? A - The tumor is completely undifferentiated. B - The tumor is fast growing. C - Metastasis has already occurred. D - The tumor has an abnormal number of chromosomes.

D - The tumor has an abnormal number of chromosomes. Rational A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition.

ATI A nurse is teaching the parent of a child about administration guidelines for the human papilloma virus (HPV) vaccine. Which of the following information should the nurse include? A - One dose is administered at birth and another is administered at age 5. B - The vaccine does not protect males. C - The vaccine protects against chlamydia. D - Three doses are administered to adolescents who start the series after age 15.

D - Three doses are administered to adolescents who start the series after age 15.

ATI - P A nurse is caring for a client who has a new prescription for ritonavir and zidovudine therapy to treat HIV-1. The nurse should inform the client that zidovudine is prescribed with ritonavir for which of the following reasons? A - To prevent an infusion reaction B - To increase platelet production C - To protect healthy cells from the toxic effects of ritonavir D - To prevent drug resistance

D - To prevent drug resistance Rational A - Zidovudine, a nucleoside reverse transcriptase inhibitor, is unlikely to prevent an adverse reaction to an infusion of ritonavir, a protease inhibitor. Prior to the administration of paclitaxel, an antimitotic drug, administering an antihistamine, a proton-pump inhibitor, and a glucocorticoid can prevent a hypersensitivity reaction. B - Zidovudine, a nucleoside reverse transcriptase inhibitor, is unlikely to increase the production of platelets. Filgrastim, a colony-stimulating drug, can increase neutrophil production. C - Zidovudine, a nucleoside reverse transcriptase inhibitor, is unlikely to protect healthy cells from the toxic effects of ritonavir. The nurse should administer leucovorin rescue within 12 hr of high doses of methotrexate to protect healthy cells from the toxic effects of that drug. D - The nurse should explain that zidovudine, a nucleoside reverse transcriptase inhibitor, is administered along with ritonavir, a protease inhibitor, to reduce the risk for drug resistance and to increase drug effectiveness. Monotherapy with zidovudine quickly results in drug resistance, as is also the case with monotherapy with ritonavir.