Uworld immunology
The nurse is assessing a client with rheumatoid arthritis who is being considered for adalimumab therapy. Which statement made by the client needs further investigation?
"I am taking an antibiotic for a urinary tract infection." Infliximab, adalimumab, and etanercept are tumor necrosis factor (TNF) inhibitors that suppress the inflammatory response in autoimmune diseases such as rheumatoid arthritis, Crohn disease, and psoriasis. Due to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection. A client with current, recent, or chronic infection should not take a TNF inhibitor.
The clinic nurse is preparing to administer an allergy immunotherapy injection to a client recently initiated on the therapy. Which statement by the client indicates a need for further teaching?
"I can leave right after the shot as I didn't have a reaction last time."
The nurse provides teaching about methotrexate to a 28-year-old client with rheumatoid arthritis. Which client statement indicates the need for further instruction regarding this drug?
"I will have an eye examination every 6 months to check for damage caused by my medication.":
A client with fibromyalgia refuses to take the prescribed drug duloxetine. When the nurse asks, why, the client responds, "Because I'm not depressed!" What is the nurse's most appropriate response?
"It can relieve your chronic pain and help you sleep better at night.
A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 (17.0 x 109/L). Which statement by the child is of most concern to the nurse?
"My belly doesn't hurt anymore." - appendicitis pain results from swelling and inflammation of the appendix, once the appendix ruptures, pain is relieved only temporarily and will return with full-blown peritonitis and sepsis.
The nurse has provided education about proper use of an epinephrine auto-injector to a client with a history of a severe hypersensitivity reaction to bee stings. Which of the following client statements indicate that teaching has been effective? Select all that apply.
1. "I may have a rapid heartbeat and palpitations after injecting the medication." 2. "I must call an ambulance or go to the nearest hospital following an injection.": 3. "I should avoid storing my device in extremely hot or cold temperatures." 5. "The medication is injected at a 90-degree angle into the outer thigh."
The nurse is providing education to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by dust and pollen. Which of the following statement by the parents indicate that the teaching has been effective. Select all that apply.
1. "We are planning to purchase a vacuum with a high-efficiency particulate air filter." 3. "We should place hypoallergenic covers on our child's mattress and pillow." 4. "We will dust out furniture with a damp washcloth every week."
The nurse is caring for a child who had a tonsillectomy. Which of the following are appropriate nursing interventions? Select all that apply.
1. Anticipate ear pain and give acetaminophen as needed. 2. Educate parents to expect the child to develop bad breath postoperatively 4. Notify the health care provider about frequent, increased swallowing.
The nurse reviews the serum laboratory results and medication administration records for assigned clients. Which prescriptions should the nurse question and validate with the health care provider before administering? select all that apply.
1. Bumetanide in the client with heart failure who has hypokalemia - a potent loop diuretic used to treat edema associated with heart failure and liver disease - inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water and potassium 4. Isoniazid in the client with latent tuberculosis who has elevated liver enzymes - a first-line antitubercular drug used to treat latent or active TB. Increased liver function tests can indicate development of drug-induced hepatitis.
The nurse is planning teaching for a client newly diagnosed with Sjogren's syndrome. Which measures will the nurse include in the teaching plan. Select all that apply.
1. Chewing sugar-free gum or using artificial saliva. 2. Scheduling regular dental appointments. 3. Showering with lukewarm water and avoiding harsh soaps. 5. Using over-the-counter lubricants to ease vaginal dryness Sjogren's syndrome is a chronic autoimmune disorder in which moisture-producing exocrine glands are attacked by white blood cells. - eye dryness - dry mouth - dry skin and rashed - chronic dry cough - vaginal dryness and painful intercourse
A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client concerning this drug? Select all that apply.
1. Drinking 8 glasses of water daily 4. Taking folic acid supplements 5. Wearing sunscreen when outdoors. Sulfasalazine - antirheumatic drug - inhibits the production of prostglandin, a mediator in the body's inflammatory response. - crystalluria - photosensitivity - folic acid deficiency - agranulocytosis - Steven Johnson syndrome: stop the med if rash develops
A parent calls the nurse telehealth triage line with concerns about an allergic reaction to something a child ate. Which symptoms should the nurse instruct the parent to assess for to determine if the child is having an anaphylactic reaction? Select all that apply.
1. dyspnea 3. lightheadedness 4. skin rash (hives) 5. wheezing
A client allergic to bee stings was stung about 20 minutes ago at a picnic. Based on the assessment data, the nurse anticipates which immediate actions? Select all that apply.
1. inhaled albuterol 2. intramuscular epinephrine 3. intravenous methylprednisolone
A clinic nurse examines a client with a tentative diagnosis of primary Sjogren's syndrome. Which finding observed by the nurse would most likely be associated with this syndrome?
Dry eyes and mouth
The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia. Which instructions should the clinic nurse provide to the student? Select all that apply.
2. Administer vaccines via the subcutaneous route 4. Hold firm pressure on the site for 5 minutes
The clinic nurse reinforces teaching to a client with systemic lupus erythematosus. Which instructions will the nurse include? Select all that apply.
2. Avoid situations that cause physical and emotional stress. 3. Avoid sun exposure and ultraviolet light when possible 4. Notify the health care provider if you have a fever.
The nurse is caring for a client with immune thrombocytopenic purpura. Which client statements indicate a need for further teaching? Select all that apply.
3. "I use a safety razor and gentle shaving cream." 5. "When I have a headache, I take over-the-counter ibuprofen."
A client is prescribed with long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. Which intervention related to the drug's adverse effects should the nurse include in the teaching plan?
Have an ophthalmologic examination every 6 months
A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed? Select all that apply.
3. Measles, mumps, rubella (MMR) 5. Varicella - Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysms. Antibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccines. Therefore, live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity
A client receiving a first dose of IV cefazolin has developed a diffuse rash, hypotension, and shortness of breath. Place the nurse's subsequent actions in the correct order.
5. Stop the infusion and call for help. 2. Assess airway and place client on oxygen. 3. Give IM epinephrine and start IV normal saline 1. Administer diphenhydramine IV 4. Monitor vital signs for changes
The nurse is caring for a client with scleroderma. Which assessment finding indicates the most serious complication of the disease and requires priority intervention?
Abrupt onset hypertension and headache scleroderma is an overproduction of collagen that causes tightening and hardening of the skin and connective tissue. This is a progressive disease without a cure, and treatment is aimed at managing complications. Renal crisis is a life-threatening complication that causes malignant hypertension due to narrowing of the vessels that provide blood to the kidneys. Raynaud phenomenon secondary to scleroderma: color changes in the fingers, toes, ears, and nose. Pulmonary fibrosis progressive complication of scleroderma = scarring of lung tissue - reduced function, dry cough, and dyspnea Heart burn and dysphagia complications of scleroderma due to disease process of internal scarring
A nurse is caring for a client with a diagnosis of fibromyalgia. During care, the client reports having suicidal thoughts. What currently prescribed medication should the nurse question in regard to this new finding?
Amitriptyline - tricyclic antidepressant; can cause suicidal ideation and behaviors, especially during the initial few weeks.
The nurse is preparing medications for the following 4 clients. Which prescriptions should the nurse clarify with the health care provider before administration?
Azathioprine for a client with Crohn disease with leukopenia who is reporting malaise Azathioprine is an immunosuppressant drug that can cause bone marrow depression and increase the risk for infection. Leukopenia can be a severe adverse effect of the drug and should be reported
The clinic nurse performs an admission assessment on a client diagnosed with systemic lupus erythematosus (SLE). Which characteristic cutaneous manifestation of SLE would the nurse most likely assess?
Butterfly shape rash
The nurse reviews the most current laboratory results of assigned client. Which result should the nurse report to the health care provider immediately?
Client who is 1 month post kidney transplant with a urinalysis showing WBCs and bacteria
A child received the varicella immunization. The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injection site. What instruction would be appropriate for the nurse to provide to this parent?
Cover the vesicles with a small bandage until they are dry. - will reduce the risk of transmission from any exudate - use acetaminophen, not aspirin for injection discomfort for children - aspirin can cause Reye syndrome
The nurse reviews the serum laboratory results of a client who was seen in the clinic 2 days ago for worsening joint pain from a flare of systemic lupus erythematosus. Which result is of the greatest concern and prompts the nurse to notify the health care provider?
Creatinine of 1.8 mg/dL (159 mmol/L)
The nurse cares for a client with an exacerbation of inflammatory bowel disease (IBD). The client tells the nurse about being infected with tuberculosis (TB) 10 years ago but never being medicated. Which prescription is of concern and prompts the nurse to notify the health care provider (HCP)?
Prednisone Malignancy, immunosuppressant medications, including chemotherapy, and prolonged debilitating disease can convert LTBI to active disease.
The nurse just administered routine immunizations to a healthy 15-month-old. What information should the nurse provide the caregivers before they leave the clinic?
Redness at the injection sites and a mild fever are common.
Hydroxychloroquine recommendation
Regular eye examinations - can cause retinal damage
A client comes to the emergency department following a bee sting. The client has a diffuse rash, hypotension, and throat tightness. One injection of IM epinephrine does not improve the client's condition. What action should the nurse take next?
Repeat IM epinephrine injection.
The nurse provides teaching about methotrexate to a client with rheumatoid arthritis. It is most important to address which topic regarding this drug?
Risk for infection Methotrexate is classified as a folate antimetabolite, antineoplastic, immunosuppressant drug used to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug use to treat rheumatoid arthritis and psoriasis. Can cause bone marrow suppression resulting in anemia, leukopenia, and thrombocytopenia. - obtain routine killed vaccines - avoid crowds and persons with known infections - avoid alcohol (hepatotoxic)
Several 12-month-old infants are brought to the clinic for routine immunizations. Which situation would be most important for the nurse to clarify with the provider before administering the vaccination?
Varicella-zoster vaccine for client recently diagnosed with leukemia.
