401 all exemplar combined

A nurse is caring for a pediatric client who is receiving an infusion of intravenous antibiotic at the ambulatory clinic. Which clinical manifestation indicates that the client is experiencing a type I hypersensitivity reaction?

A) Erythema

B) Fever

C) Joint pain

D) Hypotension

D

Clinical manifestations associated with a type I hypersensitivity reaction include hypotension, wheezing, gastrointestinal or uterine spasm, stridor, and urticaria. Erythema and fever are associated with type IV hypersensitivity reactions. Fever and joint pain are associated with type III hypersensitivity reactions.

The nurse is assessing a client who is receiving IV antibiotics. Which item in the client's health history increases the risk for experiencing a hypersensitivity reaction?

A) 26 years of age

B) Caucasian race

C) Previous antibiotic therapy

D) Concurrent chronic illness

C

Anyone can have a hypersensitivity reaction. However, risk generally increases with previous exposure, because antigens must be formed with the first exposure before hypersensitivity is likely to occur. Age, sex, concurrent illnesses, and previous reactions to related substances have all been identified as having a role in risk for hypersensitivity; however, previous exposure presents the greatest risk.

The nurse is admitting a pediatric client to the hospital with a ventriculoperitoneal (VP) shunt malfunction. When gathering the history, the nurse learns that the client received the shunt at birth after a meningocele repair. Based on this data, which product should be avoided when providing care to this client?

A) Synthetic rubber gloves

B) Polyethylene gloves

C) Non-powdered nitrile gloves

D) Latex gloves

D

The nurse is caring for a client in an allergy clinic. After completing the client history, the nurse selects the nursing diagnosis of Risk for Shock. Which item in the client's history supports the need for this nursing diagnosis?

A) Anaphylactic reaction to shellfish

B) A drug reaction to penicillin causing a rash

C) Glomerulonephritis

D) Dermatitis resulting from a response to laundry detergent

A

Type I hypersensitivities, such as anaphylactic reactions, occur immediately and may be life-threatening. Because the client has a history of this type of reaction, Risk for Shock is an appropriate nursing diagnosis. The other items would not necessitate the need for this nursing diagnosis.

The nurse is preparing to assess a client when one of the client's family members begins showing symptoms of latex sensitivity. Which action by the nurse is the most appropriate?

A) Ask the family member to leave the unit.

B) Transfer the client to a department that does not use latex products.

C) Wait until Monday to report the problem to the unit supervisor.

D) Obtain latex-free products for the client's room.

D

When symptoms of sensitivity to latex occur on exposure, latex-free products should be supplied. Transferring the client to a department that does not use latex products is not realistic because the family member might experience exposure on another unit. (No hospital unit can be completely latex-free.) Waiting until Monday does not solve the problem. Asking the family member to leave would be a violation of the client's rights.

The nurse is caring for a client who is experiencing anaphylactic shock following the administration of a medication. Based on this data, which position is the most appropriate for the nurse to place the client?

A) Trendelenburg position

B) Flat, with legs slightly elevated

C) Supine position

D) High-Fowler position

D

The Trendelenburg position elevates the foot of the bed and is no longer recommended for the treatment of shock, as it causes the abdominal organs to press against the diaphragm, which impedes respirations and decreases coronary artery filling. Lying flat is not recommended. A person in a supine position may not be able to maintain an open airway. Instead, placing the client in Fowler or high-Fowler position allows optimal lung expansion and ease of breathing.

The nurse is caring for a client with a history of latex allergies. The client develops audible wheezing, pruritus, urticaria, and signs of angioedema. Which of the following is the priority intervention for this client?

A) Teach the client regarding use of a kit that contains treatment for allergic reactions.

B) Administer diphenhydramine (Benadryl) by mouth every 4 hours per the healthcare provider's orders.

C) Administer epinephrine 1:1000 by subcutaneous injection per the healthcare provider's orders.

D) Collect a detailed history from the client regarding the history of latex allergies.

C

For reactions with wheezing, pruritus, urticaria, and angioedema, a subcutaneous injection of 0.3-0.5 mL of 1:1000 epinephrine is generally sufficient. The nurse should give the epinephrine first due to the nature and severity of symptoms. Diphenhydramine may also be given, but it would likely be administered by injection rather than mouth due to the need for rapid drug onset. Although providing client teaching and collecting a detailed history are also important, the nurse does not have time to do these things until the client's immediate and potentially dangerous physical symptoms are addressed.

A nurse is working in a summer camp for children. One of the children comes to the clinic with several bee stings. Which clinical manifestations would necessitate injecting the child with epinephrine (EpiPen)? Select all that apply.

A) Skin that is cold and clammy to the touch

B) Skin that is warm and dry to the touch

C) Hyperverbal behavior

D) Extreme anxiety and agitation

E) Facial swelling

A D E

A) General symptoms of shock that would necessitate an epinephrine injection include cold and clammy skin (which is indicative of decreased perfusion), extreme anxiety and agitation, and facial angioedema. Clients who are experiencing shock are unlikely to be hyperverbal due to respiratory symptoms that make breathing and speaking difficult.

D) General symptoms of shock that would necessitate an epinephrine injection include cold and clammy skin (which is indicative of decreased perfusion), extreme anxiety and agitation, and facial angioedema. Clients who are experiencing shock are unlikely to be hyperverbal due to respiratory symptoms that make breathing and speaking difficult.

E) General symptoms of shock that would necessitate an epinephrine injection include cold and clammy skin (which is indicative of decreased perfusion), extreme anxiety and agitation, and facial angioedema. Clients who are experiencing shock are unlikely to be hyperverbal due to respiratory symptoms that make breathing and speaking difficult.

Which of the following statements is true with regard to food allergies and children?

A) Over the past decade, the prevalence of peanut allergy has decreased in the pediatric population.

B) Many children eventually outgrow egg, milk, and soy allergies.

C) Teenagers with food allergies are at lower risk for an allergic reaction than younger clients because they are more aware of their trigger foods and how to avoid them.

D) Peanut allergies are most common in pediatric clients over 5 years of age.

B

It is not uncommon for people to outgrow allergies to egg, milk, soy, and wheat as they age; however, allergies to shellfish, peanuts, and fish usually persist throughout an individual's life. Among pediatric clients, the prevalence of peanut allergy has increased in recent years, with children under age 3 most commonly affected. As compared to younger children, teenagers with food allergies have the highest risk for an allergic reaction because they have a greater tendency to eat meals outside the home and are less likely to carry their medication.

A pediatric client with a history of anaphylactic hypersensitivity reactions will be discharged with a prescription for an EpiPen. Which statements are appropriate for the nurse to include in the discharge instructions for this client and family? Select all that apply.

A) "It is recommended that the child wear a medical alert bracelet."

B) "This medication does not come prefilled and must be measured."

C) "Keep the medication in the car at all times."

D) "Frequently check the expiration date of the medication."

E) "Keep the medication in one location that is easy to remember."

A D

A) An EpiPen is a prefilled syringe-and-needle medication system used to treat an anaphylactic reaction. Because an anaphylactic reaction is a medical emergency, it is essential that the nurse provide thorough teaching regarding use of the EpiPen. The nurse should recommend that the client wear a medical alert bracelet. The medication should not be kept in the car at all times, as it needs to be stored away from high heat and direct sunlight. The client should have multiple EpiPens and they should be kept in multiple areas, not one location. Also, the EpiPens' expiration dates should be checked frequently to ensure accurate strength.

D) An EpiPen is a syringe-and-needle medication system used to treat an anaphylactic reaction. An EpiPen is a prefilled syringe-and-needle medication system used to treat an anaphylactic reaction. Because an anaphylactic reaction is a medical emergency, it is essential that the nurse provide thorough teaching regarding use of the EpiPen. The nurse should recommend that the client wear a medical alert bracelet. The medication should not be kept in the car at all times, as it needs to be stored away from high heat and direct sunlight. The client should have multiple EpiPens and they should be kept in multiple areas, not one location. Also, the EpiPens' expiration dates should be checked frequently to ensure accurate strength.

A nurse is caring for a client with seasonal hypersensitivity reactions. What teachings should the nurse provide to improve this client's comfort? Select all that apply.

A) Keep doors and windows open on high-allergen days to circulate air.

B) Remain indoors if possible on high-allergen days.

C) Maintain a clean, dust-free environment.

D) Take antihistamine and leukotriene medications as ordered.

E) Stop taking oral corticosteroids immediately once symptoms disappear.

B C

B) A client with seasonal hypersensitivity should be educated regarding prevention and comfort measures. The nurse should instruct the client to keep doors and windows closed on high-allergen days and to remain indoors if possible. The nurse should also include teaching on maintaining a clean, dust-free environment. Medication instruction should include information about taking antihistamine and antileukotriene medications, not leukotriene medications. The client should also be instructed to taper oral corticosteroids as ordered, not to immediately stop taking them.

C) A client with seasonal hypersensitivity should be educated regarding prevention and comfort measures. The nurse should instruct the client to keep doors and windows closed on high-allergen days and to remain indoors if possible. The nurse should also include teaching on maintaining a clean, dust-free environment. Medication instruction should include information about taking antihistamine and antileukotriene medications, not leukotriene medications. The client should also be instructed to taper oral corticosteroids as ordered, not to immediately stop taking them.

The nurse suspects that the client is experiencing a reaction to a specific antigen. Which laboratory result supports the conclusion made by the nurse?

A) Indirect Coombs test showing no agglutination

B) Patch test with a 1-inch area of erythema

C) 2% eosinophils in the WBC count

D) Rh antigen test with negative results

B

An area of erythema after a patch test indicates a positive response to a specific antigen. In contrast, an indirect Coombs test detects the presence of circulating antibodies against RBCs; no agglutination is considered a normal finding. Similarly, an eosinophil count of 2% is within the normal range. Finally, an Rh antigen test with a negative result indicates that the client does not carry the antigen; accordingly, this result is not an indicator of a reaction to a specific antigen.

In what ways do type IV hypersensitivity reactions differ from other types of hypersensitivity reactions?

A) Unlike other types of hypersensitivity reactions, type IV reactions are antibody-mediated responses and develop almost immediately.

B) Unlike other types of hypersensitivity reactions, type IV reactions are cell-mediated responses and develop almost immediately.

C) Unlike other types of hypersensitivity reactions, type IV reactions are antibody-mediated responses and take 24 hours or more to develop.

D) Unlike other types of hypersensitivity reactions, type IV reactions are cell-mediated responses and take 24 hours or more to develop.

D

Type IV reactions differ from other hypersensitivity responses in two ways. First, they are cell-mediated immune responses, not antibody-mediated responses, that involve the T cells of the immune system. Second, type IV reactions are delayed rather than immediate, developing 24-48 hours after exposure to an antigen.

Why are second-generation antihistamines often preferred to first-generation histamines in the treatment of hypersensitivity reactions?

A) Second-generation antihistamines are faster acting than first-generation antihistamines.

B) Second-generation antihistamines are less likely than first-generation antihistamines to cause drowsiness.

C) Second-generation antihistamines are available over the counter, whereas first-generation antihistamines require a prescription.

D) Second-generation antihistamines can be administered either orally or parenterally, whereas first-generation antihistamines can only be given via the oral route.

B

An important difference between first- and second-generation antihistamines is that unlike the first-generation drugs, the newer second-generation drugs do not cause drowsiness. Both first- and second-generation antihistamines are available by prescription and over the counter. The preferred route of administration for both first- and second-generation antihistamines is oral, although diphenhydramine (a first-generation drug) and some other medications may be given parenterally. Second-generation antihistamines are not universally faster-acting than their first-generation counterparts.

1) The client enters the outpatient clinic and states to the triage nurse, "I think I have the flu. I'm so tired, I have no appetite, and everything hurts." The triage nurse assesses the client and finds a butterfly rash over the bridge of the nose and on the cheeks. Based on this data, which diagnosis should the nurse anticipate?

A) Systemic lupus erythematosus

B) Fibromyalgia

C) Lyme disease

D) Gout

A

2) A client asks the nurse whether there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which response by the nurse is the most appropriate?

A) "Conditions that cause hypotension often worsen SLE."

B) "GI upset is often associated with SLE exacerbation."

C) "Pregnancy is often associated with a worsening of SLE."

D) "Fever is a known trigger for SLE exacerbation."

C

3) A nurse is providing health education at several neighborhood community centers. The nurse adjusts the teaching plan based on the demographic characteristics of the clients that each center serves. For which of the following community centers should the nurse plan on providing information about signs and symptoms of systemic lupus erythematosus (SLE)?

A) A community center that primarily serves young female children

B) A community center that primarily serves young males of African American descent

C) A community center that primarily serves Caucasian women

D) A community center that primarily serves females of Asian descent

D

4) The nurse is caring for a client who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the client's lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which of the following is a priority nursing diagnosis for this client?

A) Risk for Infection

B) Ineffective Health Maintenance

C) Ineffective Individual Coping

D) Risk for Impaired Skin Integrity

A

5) A female client with systemic lupus erythematosus (SLE) is being treated with immunosuppressant drugs and corticosteroids. When providing teaching to this client, which of the following points are appropriate for the nurse to include? Select all that apply.

A) Avoid large crowds.

B) Don't get a flu shot.

C) Use contraception to prevent pregnancy.

D) Refrain from taking aspirin products.

E) Report any signs of infection to the healthcare provider.

A, C, D, E

6) A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry, stating, "I am afraid I will be disfigured because of all of these lesions." Which interventions should the nurse plan to teach this client to minimize the risk of skin infections associated with SLE? Select all that apply.

A) Use sunscreen with an SPF of 15 or greater.

B) Remain indoors on sunny days.

C) Avoid swimming in a pool or the ocean.

D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m.

E) Use fluorescent lighting indoors.

A, D

7) A nurse is caring for a client diagnosed with discoid lupus erythematosus. The nurse is collaborating with this client to set goals for the nursing plan of care. Based on the information given here, which of the following would be an appropriate goal for this client?

A) Learn strategies to cope with death and the dying process.

B) Remain compliant with a sun protection plan.

C) Gain weight to within 10 pounds of normal for height.

D) Report pain no higher than 4 on a scale of 0 to 10.

B

8) The nurse is planning care for an adolescent client who has systemic lupus erythematosus (SLE). Which action by the client indicates the implemented plan of care is appropriate?

A) Refusing to attend school

B) Refraining from attending social functions

C) Discussing skin changes with the healthcare provider

D) Discussing skin changes with a good friend

D

9) The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which statement on the part of the client indicates an appropriate understanding of the plan of care?

A) "I will take birth control pills while I am taking cytotoxic

medications."

B) "I do not need to contact the doctor if I develop a fever or rash."

C) "I plan to go to a concert this weekend so that I get out of the house."

D) "I can take aspirin as indicated for pain."

A

10) A nurse is caring for a client with systemic lupus erythematosus (SLE) who is taking hydroxychloroquine (Plaquenil). When providing care for this client, the nurse should monitor for which adverse effect associated with this medication?

A) Pulmonary fibrosis

B) Cushingoid effects

C) Retinal toxicity

D) Renal toxicity

C

11) A nurse is caring for a client with systemic lupus erythematosus (SLE) who is prescribed immunosuppressive therapy. When providing teaching for this client, which statements are appropriate for the nurse to include? Select all that apply.

A) "Avoid large crowds and situations that increase your exposure to infection."

B) "Report any cough or difficulty breathing to the physician if you are taking cyclophosphamide."

C) "Use aspirin instead of acetaminophen if you develop a fever."

D) "Heavy menstrual bleeding may occur during therapy."

E) "Be sure to drink plenty of liquids."

A, B, E

12) Which of the following manifestations is not associated with systemic lupus erythematosus (SLE)?

A) Symmetric polyarthritis

B) Excess hair growth

C) Thrombocytopenia

D) Pleural effusions

B

13) Why is kidney damage often observed in clients with systemic lupus erythematosus (SLE)?

A) SLE involves unusually high levels of circulating antigens. Because the kidneys play a critical role in filtering these antigens from the blood, they are under excess stress in clients with SLE.

B) SLE is commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Because these medications carry a high risk of nephrotoxicity, their use often leads to kidney damage in clients with SLE.

C) SLE involves deposition of immune complexes in the body's connective tissues. Because connective tissue makes up a significant portion of the kidneys, these organs are a frequent site of damage in SLE.

D) SLE involves unusually high levels of circulating antibodies. Because the kidneys play a critical role in filtering these antibodies from the blood, they are under excess stress in clients with SLE.

C

14) Which of the following hormonal changes would most likely result in an exacerbation of systemic lupus erythematosus (SLE)?

A) Increase in testosterone levels

B) Increase in estrogen levels

C) Increase in overall androgen levels

D) Increase in serotonin levels

B

The nurse is caring for a client who is hospitalized on a medical unit for a systemic infection. The client asks the nurse which defenses the body has against infection. Which physiologic barriers that protect the body against microorganisms should the nurse include in the response to the client? Select all that apply.

A) The spleen

B) Adequate urinary output

C) Intact skin

D) Generalized inflammation

E) The thymus gland

B C

A client receives the yellow fever vaccine before traveling to the Amazon Basin and asks the nurse how the vaccine provides protection. Which responses by the nurse are most appropriate? Select all that apply.

A) "Human macrophages engulf the weakened vaccine virus as if it is dangerous, and antigens stimulate the immune system to attack it."

B) "In the lymph nodes, which are part of the lymphoid system, the macrophages present yellow fever antigens to T cells and B cells."

C) "A response from yellow fever-specific T cells is activated. B cells secrete yellow fever antibodies."

D) "The vaccine contains large amounts of protective antibodies that were produced in another host organism, so it provides immediate protection against yellow fever."

E) "The initial weak infection is eliminated and the client is left with a supply of memory T and B cells for future protection against yellow fever."

A B C E

A nurse who works in the emergency department is providing care for a group of clients. Which client demonstrates a declining immune response that typically occurs with the aging process?

A) An 88-year-old client with pneumonia who has a temperature of 99.5°F

B) A 70-year-old client who has swelling and redness around an abdominal incision from an open appendectomy

C) A 58-year-old client who complains of redness and itching after developing a rash from contact with poison ivy

D) A 56-year-old client who has 8 mm induration at the site of a PPD skin test administered 72 hours earlier

A

The nurse is conducting a physical assessment for a client with a compromised immune system. Which actions by the nurse are appropriate? Select all that apply.

A) Assessing general appearance

B) Recommending increased fluid intake

C) Inspecting the mucous membranes of the nose and mouth

D) Palpating the cervical lymph nodes

E) Checking joint range of motion (ROM), including that of the spine

A C D E

The nurse is caring for a client who has come to an urgent care clinic due to an arm infection. The client reports being bitten by a raccoon on a recent camping trip. Based on this data, which treatment option does the nurse anticipate for this client?

A) Injection of rabies immunoglobulin only

B) Administration of rabies vaccine only

C) Both injection of rabies immunoglobulin and administration of rabies vaccine

D) Neither injection of rabies immunoglobulin nor administration of rabies vaccine

C

The nurse is providing care to a client with a compromised immune system. Which independent nursing intervention is appropriate for the nurse to include in the client's plan of care?

A) Educating the client on the importance of a nutritious diet

B) Administering corticosteroids per order

C) Prescribing prophylactic antibiotic therapy

D) Recommending gene transfer therapy

A

A nurse is caring for a client with who is experiencing leukocytosis. When providing care to this client, which action by the nurse is most appropriate?

A) Instructing the client on the use of an electric razor and soft toothbrush

B) Evaluating the client for bleeding and bruising

C) Assessing the client for the source of infection

D) Placing the client in reverse isolation

C

The nurse is providing care to an adolescent client who presents at the clinic for a routine health assessment. Which immunizations should the nurse anticipate administering to the client during this visit? Select all that apply.

A) Herpes zoster vaccine

B) Papillomavirus vaccine

C) Rotavirus vaccine

D) Meningococcal vaccine

E) Hepatitis B vaccine

B D

Which of the following statements best explains why young children develop infections more often than older children and adolescents?

A) Cell-mediated immunity doesn't achieve full function until a child is roughly 5 years old.

B) The thymus doesn't begin to function until adolescence, so prior to this time, children don't produce enough T cells to adequately protect them from infectious agents.

C) Children don't develop all of the immunoglobulins they need to protect against infection until they are about 6 or 7 years of age.

D) Young children have comparatively small lymphoid tissues, which means they are less able to fight infection than are older children.

C

Which of the following cells would be classified as granulocytes?

A) Helper T cells

B) Macrophages

C) Natural killer (NK) cells

D) Eosinophils

D

Three weeks after receiving a donor liver, a client begins to experience fever, tachycardia, right upper quadrant pain, and increased accumulation of fluid in the abdomen. The transplanted liver also becomes dangerously enlarged. In this scenario, the client is likely experiencing which of the following conditions?

A) Hyperacute rejection

B) Chronic rejection

C) Acute rejection

D) Delayed rejection

C

What is the largest lymphoid organ in the human body?

A) Thymus gland

B) Bone marrow

C) Tonsils

D) Spleen

D

Transfusion reactions and Rh incompatibility are both examples of which type of hypersensitivity reaction?

A) Type I

B) Type II

C) Type III

D) Type IV

B

Why does breastfeeding confer some degree of passive immunity to an infant?

A) The infant receives maternal antibodies via breastmilk, and these antibodies stimulate the infant's immune system to begin producing antibodies of its own.

B) Consumption of breastmilk introduces certain antigens into the infant's body, thereby stimulating the infant's immune system to begin producing antibodies to these antigens.

C) The infant receives maternal antibodies via breastmilk, and these antibodies provide the infant with immediate protection against specific antigens.

D) Consumption of breastmilk introduces certain antigens into the infant's body, thereby stimulating the infant's immune system to begin producing antigens of its own.

C

Development of leukopenia suggests that an individual

A) is immunocompetent.

B) is experiencing an infection somewhere in the body.

C) may have suppressed bone marrow activity.

D) has an abnormally high number of circulating leukocytes.

C

Which of the following complications is not associated with a diagnosis of rheumatoid arthritis (RA)?

A) Increased risk of cesarean delivery

B) Increased risk of pleural effusion

C) Increased likelihood of uveitis

D) Increased risk of anemia

A

A client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. What information should the nurse include when teaching this client about ways to decrease the likelihood of crippling deformities? Select all that apply.

A) Ignore pain as a warning signal.

B) Type instead of hand-writing items if possible.

C) Use the strongest joints possible to complete most tasks.

D) Avoid stress to any current area of deformity.

E) Stop an activity immediately if it is beyond your ability to perform.

B C D E

Based on gender and age alone, which of the following clients is most likely to experience the new onset of rheumatoid arthritis (RA)?

A) A 31-year-old man

B) A 42-year-old woman

C) A 65-year-old woman

D) An 18-year-old man

B

The nurse is collecting a health history for a client being seen in an outpatient clinic who complains of joint pain and swelling that have lasted for about 2 months. The client is diagnosed with rheumatoid arthritis (RA). Which of the following statements made by this client supports the nursing diagnosis of Activity Intolerance?

A) "I seem to get tired early in the day and require a nap."

B) "My joints are stiffest at night before I go to sleep."

C) "I find it difficult to move when I first get up in the morning."

D) "I take ibuprofen for the pain as needed."

A

The nurse is completing a health screening for a school-age child with rheumatoid arthritis (RA). The parents ask the nurse to recommend activities that will promote exercise for their child. Which recommendation by the nurse is most appropriate?

A) Swimming

B) Football

C) Softball

D) Basketball

A

A client with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress checkup. Which of the following statements on the part of the client suggests that she has met a goal of treatment?

A) "I sleep for 10 hours at night."

B) "I have increased pain in my joints all the time now."

C) "I have delegated many household chores to my children and spouse."

D) "I do not perform household chores at all anymore."

C

The nurse is caring for a client who was diagnosed with rheumatoid arthritis (RA) last year. The client has just been prescribed methotrexate as part of his RA treatment regimen. The nurse is teaching the client about use of this medication. Which client statement indicates that this teaching was successful?

A) "It's not safe for me to take nonsteroidal anti-inflammatory drugs (NSAIDs) while on methotrexate therapy."

B) "I can help control the side effects of methotrexate by taking folic acid."

C) "I should expect to see beneficial results within 3 to 5 days of starting methotrexate therapy."

D) "It's important that I take my methotrexate at the same time every day."

B

A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis (RA). The client reports that her pain is a 3 on a scale from 0 (none) to 10 (high) today. Which nonpharmacologic interventions can the nurse provide to enhance the client's comfort? Select all that apply.

A) Discourage any position changes.

B) Encourage relaxation techniques.

C) Immobilize the extremity.

D) Offer heat and/or cold packs.

E) Provide distraction activities.

B D E

A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). Based on this data, what should the nurse anticipate when providing care to this client?

A) A higher risk for preterm delivery

B) An increased need for medication

C) An acute exacerbation of symptoms

D) A continued risk for anemia

D

A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse to explain the difference is between RA and osteoarthritis (OA). Which responses by the nurse are most appropriate? Select all that apply.

A) "The onset of OA is gradual, whereas the onset of RA may be rapid."

B) "With OA, multiple joints are symmetrically affected; RA affects one joint at a time."

C) "The affected joints in RA feel cold to the touch, whereas the affected joints in OA are warm or hot to the touch."

D) "OA is slowly progressive, whereas RA is characterized by exacerbations and remissions."

E) "With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising."

A D

The nurse is providing care to a client who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis. When providing care to this client, which actions by the nurse are appropriate? Select all that apply.

A) Monitoring for signs of allergic reaction

B) Assuring the client that NSAIDs are safe for clients with cardiovascular disease

C) Encouraging the client to take NSAIDs with a small snack to help avoid GI distress

D) Monitoring for signs of renal problems

E) Inquire about the use of herbal supplements such as feverfew, garlic, ginger, or ginkgo

A C D E

Which form of juvenile idiopathic arthritis (JIA) primarily affects the knees, ankles, and elbows?

A) Pauciarticular arthritis

B) Polyarticular arthritis

C) Systemic arthritis

D) Osteoarthritis

A

Why are proton pump inhibitors often included as part of the pharmacologic treatment regimen for clients with rheumatoid arthritis (RA)?

A) Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of medications used in the treatment of RA.

B) Proton pump inhibitors can dramatically decrease both inflammation and immune reactions and appear to slow the progression of joint destruction in RA.

C) Proton pump inhibitors help reduce the body's autoimmune response, thereby limiting the effects of the autoimmune disease process that underlies RA.

D) Proton pump inhibitors help reduce the risk of retinitis and vision loss in clients who are taking antimalarial agents as part of their therapeutic regimen for RA.

A

Once inside the body, human immunodeficiency virus (HIV) infects and destroys several types of cells, including helper T cells. List each of the events in this process in the order in which they occur.

A) Virus recognizes and invades helper T cell

B) Viral RNA is acted upon by reverse transcriptase

C) Viral DNA integrates with helper T cell DNA

D) Virus disrupts cell membrane of helper T cell, leading to its destruction

E) Virus sheds its protein coat

A E B C D

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is on antiretroviral therapy. The client complains of nausea, fever, severe diarrhea, and anorexia. Which of the following prescribed medications does the nurse anticipate in order to relieve the anorexia and stimulate the client's appetite? Select all that apply.

A) Dronabinol (Marinol)

B) Zidovudine (Retrovir, AZT)

C) Abacavir (Ziagen)

D) Ciprofloxacin (Cipro)

E) Megestrol (Megace)

A E

Which of the following statements is false and should not be included in client teaching about how to reduce the risk of contracting HIV?

A) Clients who will require blood transfusions during surgery should encourage their family members to donate the blood they will receive.

B) The only totally safe sex practices are abstinence; long-term, mutually monogamous sexual relations between uninfected individuals; and mutual masturbation without direct contact.

C) When possible, autologous transfusion is a good risk reduction strategy for clients who are undergoing surgery.

D) Clients should use condoms during every sexual encounter involving vaginal, oral, or anal intercourse.

A

What is the most commonly observed opportunistic infection in clients with AIDS?

A) Tuberculosis

B) Pneumocystis jiroveci pneumonia

C) Candida albicans infection

D) Mycobacterium avium complex

B

A nurse is developing a plan of care for a client who was recently diagnosed with human immunodeficiency virus (HIV). The client states, "I don't plan on giving up sex just because I am HIV positive." Based on this data, which nursing diagnosis is the priority for this client?

A) Risk for Infection

B) Death Anxiety

C) Deficient Knowledge

D) Social Isolation

C

The nurse is caring for a client who is newly diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse whether there are ways to protect the client's life partner from getting the virus. After the nurse provides the client with teaching related to this topic, which statement on the part of the client would indicate a need for further education?

A) "I know to use an oil-based lubricant to prevent spread of the virus to my partner."

B) "I can still kiss and hug my partner to show affection."

C) "I will not share my razor with my partner."

D) "I know I have to practice safer sex with my partner by using a latex condom."

A

The nurse is planning care for a pediatric client who is infected with the human immunodeficiency virus (HIV). The nurse selects Risk for Infection as a priority nursing diagnosis for this client. Based on this nursing diagnosis, which actions by the nurse are appropriate? Select all that apply.

A) Administering tuberculosis skin tests every 6 months

B) Teaching proper food-handling techniques to the family

C) Instructing on the importance of delaying vaccinations until adulthood

D) Assessing the health status of all visitors

E) Monitoring hand-washing techniques used by the family

B D E

The nurse is reviewing the laboratory results of a client who is newly diagnosed with acquired immunodeficiency syndrome (AIDS). Which result would be considered potentially problematic and should be reported to the client's healthcare provider?

A) CD4 cell count of 195/mm3

B) Viral load 6500 copies/mL

C) Negative tuberculin skin test

D) WBC count of 6500/mm3

A

A home health nurse is conducting home visits for several clients who are diagnosed with acquired immunodeficiency syndrome (AIDS). Which client would the nurse see first?

A) A client who is receiving lamivudine (Triumeq) because of a low CD4 cell count

B) A client with Pneumocystis jiroveci pneumonia who called the office this morning to report a new onset of fever, cough, and shortness of breath

C) A client with wasting syndrome who needs dietary modifications and education regarding these changes

D) A client who is receiving IV antibiotics daily for toxoplasmosis

B

A nurse is caring for a client with HIV who just learned she is several weeks pregnant. The client states that she is concerned about how her HIV diagnosis might affect the health of her child. Which of the following statements should the nurse include in her teaching for this client?

A) "One way to reduce the risk of transmitting the virus to your child is to opt for vaginal birth rather than cesarean delivery."

B) "Although infants can acquire HIV from their mothers at birth, the virus cannot cross the placenta during pregnancy."

C) "Most HIV medications are safe during pregnancy, and taking them can reduce the risk of transmitting the virus to the fetus."

D) "Women with HIV are no more likely than uninfected women to experience miscarriage or fetal loss."

C

Which type of precaution should the nurse implement when providing direct care in the intensive care unit (ICU) to a client diagnosed with acquired immunodeficiency syndrome (AIDS)?

A) Droplet

B) Reverse

C) Standard

D) Contact

C

A nurse working in the pediatric intensive care unit (PICU) is caring for a client with human immunodeficiency virus (HIV). The client is severely symptomatic with the additional diagnoses of lymphoma and wasting syndrome. Based on this data, which clinical stage of HIV does the nurse anticipate for this client?

A) Category N

B) Category C

C) Category A

D) Category B

B

nurse is screening a client for prostate cancer. Which assessment findings would cause the nurse to suspect that the client has prostate cancer? Select all that apply.

A) Fatigue

B) Upper extremity weakness

C) Back pain

D) Hematuria

E) Scrotal edema

ACD

The nurse is preparing an educational program on risk factors for the development of prostate cancer. Which information will the nurse include as being the greatest risk factor for developing prostate cancer?

A) The client's age

B) A family history

C) A history of a vasectomy

D) A diet high in fat

A

While receiving discharge teaching, an adult client recovering from a prostatectomy is distressed to learn that episodes of incontinence may occur. Which should the nurse teach the client to help minimize incontinence?

A) Proper administration of incontinence medication

B) Steps to change the Foley catheter bag every day

C) Fluid restriction

D) Kegel exercises

D

The nurse is planning care for a client scheduled for a prostatectomy. The client's spouse wants to know if the client will have any limitations after the surgery. Which complications is the client likely to have that should be incorporated into his plan of care? Select all that apply.

A) Constipation

B) Gynecomastia

C) Impaired Urinary Elimination

D) Risk for Falls

E) Sexual Dysfunction

CE

nursing instructor is teaching a group of student nurses about the risk factors for prostate cancer. Which statement will the nursing instructor include?

A) "African American men are at lowest risk for prostate cancer."

B) "Asian American and Native American men have the highest risk for developing prostate cancer."

C) "Approximately one in eight men ages 70 and older will be diagnosed with prostate cancer."

D) "A diet low in dairy increases a man's risk for developing prostate cancer."

C

The nurse is assessing a client for symptoms of prostate cancer. Which symptoms would indicate the client is experiencing an enlarged prostate? Select all that apply.

A) Hematuria

B) Dysuria

C) Weight loss

D) Bone pain

E) Fatigue

AB

client with prostate cancer is being discharged from the hospital. Which educational topic is inappropriate for this client?

A) Provide information on doses of complementary herbs.

B) Teach the client and his family methods of pain control.

C) Stress the importance of keeping client appointments with healthcare providers.

D) Provide the client and the client's family information on support groups.

A

Which hormone(s) is (are) believed to have a role in the development of prostate cancer?

A) Prolactin

B) Endorphins

C) Estrogens

D) Androgens

D

What is the primary reason that prostate cancer rarely metastasizes to the bowel?

A) The capsular artery supplies blood to the bowel before the prostate.

B) The inferior vesical artery supplies blood to the bowel before the prostate.

C) The rectourethral fistula acts as a physical barrier to metastasis.

D) The Denonvilliers fascia acts as a physical barrier to metastasis.

D

What approach is appropriate for interpreting the prostate-specific antigen (PSA) level as a diagnostic factor for prostate cancer?

A) A PSA level higher than 4.0 ng/mL indicates prostate cancer.

B) A PSA level lower than 4.0 ng/mL indicates prostate cancer.

C) A fluctuating PSA level indicates prostate cancer.

D) An abnormal PSA level alone is not enough to diagnose prostate cancer.

D

nurse is caring for a 42-year-old male client who was recently diagnosed with prostate cancer. What characteristic of the prostate cancer does the nurse need to be aware of for a client of this age compared to older men with prostate cancer?

A) The cancer will likely be more aggressive for the younger client.

B) The cancer will likely grow more slowly in the younger client.

C) The cancer will likely be more responsive to treatment in the younger client.

D) The cancer will likely not metastasize as quickly in the younger client.

A

73-year-old man was just diagnosed with stage II prostate cancer. The client's wife hears the word "cancer" and immediately begins crying. She says, "How long does he have to live?" Which response by the nurse is appropriate?

A) "Don't worry about how long he will live. Just live every day to the fullest and enjoy the time you have left together."

B) "If we treat the cancer aggressively with surgery and radiation, he should live several more years."

C) "Prostate cancer is usually aggressive in older men, so he may only have a short time to live."

D) "Older men who are diagnosed with prostate cancer usually die from causes other than the cancer."

D

During a routine physical examination of a client's lungs, the nurse notes a pink papule that is flat and erythematous with surface crusting on the client's upper chest. The nurse should notify the physician of this finding because the nurse suspects the papule might indicate what?

A) Squamous cell carcinoma

B) Basal cell carcinoma

C) Actinic keratosis

D) Malignant melanoma

B

The nurse is teaching a group of community members about preventing skin cancer. Which participant would be at the greatest risk for skin cancer?

A) A 25-year-old lifeguard at the community pool who wears sunscreen

B) A baby underneath a large beach umbrella

C) A 60-year-old farmer who wears a cap when working

D) A teenager who wears a ski outfit when skiing

C

dark-skinned client tells the nurse of plans to bask in the sun on an upcoming vacation. The nurse questions the client about sunscreen use. Which response indicates the client needs further education?

A) "I don't need sunscreen because I am dark-skinned already."

B) "I will avoid the sun between the peak hours of 10 a.m. and 4 p.m."

C) "I can still experience sun damage despite my dark skin tones."

D) "The melanocytes in my skin provide me with increased protection from the sun."

A

The nurse is caring for an older adolescent client diagnosed with malignant melanoma. Which nursing diagnoses would be appropriate when planning this client's care? Select all that apply.

A) Impaired Skin Integrity

B) Risk for Compromised Human Dignity

C) Anxiety

D) Risk for Acute Confusion

E) Disturbed Body Image

ACE

The nurse is talking to a group of young adults about decreasing the risk for skin cancer. A young woman asks the nurse about the safety of ultraviolet light tanning salons. Which response by the nurse is most appropriate?

A) "Using tanning beds without clothing contaminates skin and leads to infections."

B) "Tanning from ultraviolet light is safer than sunshine."

C) "Using sunscreen will prevent skin cancers, even in tanning beds."

D) "Exposure to ultraviolet light used in tanning beds can cause skin cancer."

D

client is scheduled to have a suspected cancerous lesion removed from the arm. When planning care for this client, which outcome would be a priority?

A) The client will make nutritional changes.

B) The client will experience minimal pain after healing.

C) The client will heal without signs of infection.

D) The client will not need to make lifestyle changes.

C

The nurse is reviewing the medical records for several clients who will be seen in the clinic today. According to the ABCD rule, which client may require removal of the skin lesion?

A) A client with a lesion that is symmetrical with an irregular border, a single color, and diameter change from 4 mm to 5 mm

B) A client with a lesion that is symmetrical, with a smooth border, a single color, and diameter that has stayed the same

C) A client with a lesion that is asymmetrical with a regular border, two colors, and diameter change from 4 mm to 3 mm

D) A client with a lesion that is asymmetrical with an irregular border, two colors, and diameter change from 5 mm to 7 mm

D

The nurse is caring for a client who has recently been diagnosed with skin cancer. The client is tearful and states, "How did I get skin cancer? I don't believe in tanning!" Which response by the nurse is indicated at this time?

A) "Can you tell me more about your feelings?"

B) "This is unusual, as skin cancer normally only occurs in sunbathers."

C) "Sun exposure can happen as we carry out our daily activities."

D) "We frequently never find out why cancer strikes."

C

nurse working in an outpatient dermatology clinic is caring for a client who has been diagnosed with a lentigo maligna. Which statement is inappropriate for the nurse to include in the client's teaching plan?

A) The lesion is also called Robertson freckle.

B) The lesion is a precursor to melanoma.

C) The lesion is a tan or black patch on the skin that looks like a freckle.

D) The lesion grows slowly, becoming mottled, dark, thick, and nodular.

A

Client presents to the primary care clinic for an annual physical. The nurse caring for the client notes that the client's healthcare provider uses the ABCD mnemonic to assess suspicious skin lesions. What does the "D" in ABCD represent?

A) Diameter of lesion greater than 8 mm

B) Distance of lesion to an additional lesion

C) Diameter of lesion greater than 6 mm

D) Depth of lesion

C

What is the most common cause of skin cancer?

A) Exposure to melanin

B) UV radiation from sunlight

C) Damage from chemicals

D) Inflammation from psoriasis

B

The nurse is assessing a 78-year-old client who was recently diagnosed with skin cancer. The physician has mentioned including topical treatments in the patient's treatment plan. What other assessments may the nurse need to conduct to help guide the physician when deciding whether to use topical treatments for this client?

A) An assessment for coagulation disorders

B) An assessment for dementia

C) An assessment for cardiovascular disease

D) An assessment for diabetes

B

Parents of a newborn infant are concerned that their baby may have sickle cell disease. The nurse reviews the medical record and finds that both parents have the sickle cell trait. Which is the best response for the nurse to give the parents?

A) "Since neither of you actually has sickle cell disease, your baby is not at risk."

B) "Your baby has the disease, as you both carry the trait."

C) "We are required to test all babies for sickle cell disease."

D) "Have you talked to a genetic counselor about your concerns?"

C

A nurse educator is teaching a group of parents how to prevent a sickle cell crisis in the child with sickle cell disease. What precipitating factors that could contribute to a sickle cell crisis should the nurse teach the parents? Select all that apply.

A) Increased fluid intake

B) High altitudes

C) Fever and infection

D) Emotional or physical stress

E) Warm temperatures

BCD

nurse is assigned to care for a client with sickle cell disease who is being admitted with splenic sequestration crisis. Which room would be the most appropriate for this client?

A) Private room

B) Semi-private room

C) Contact-isolation room

D) Airborne-isolation room

A

client in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. The client reports a pain level of 8 on a pain scale from 1 to 10. Which nursing diagnosis is a priority for this client?

A) Fluid Volume Excess

B) Risk for Self-Mutilation

C) Knowledge Deficit

D) Acute Pain

D

client is admitted to the emergency department in a sickle cell crisis. The nurse assesses the client and documents the following clinical findings: temperature 102°F, O2 saturation of 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority?

A) Apply oxygen per nasal cannula at 3 L/minute.

B) Assess and document peripheral pulses.

C) Administer morphine sulfate 10 mg IM.

D) Administer Tylenol 650 mg by mouth.

A

The nurse is planning care for a young child who is admitted with sickle cell crisis. The parents are with the child, and neither has much information about the disease. When planning care for this family, the nurse will set which goal with this family?

A) The child will drink adequate amounts of fluid each day.

B) The child will play outside in the sun.

C) The family will not have the child vaccinated.

D) The family will plan vacations in high-altitude areas.

A

The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis. Which medication should the nurse expect to administer to this client?

A) Acetaminophen (Tylenol)

B) Ibuprofen (Advil)

C) Meperidine (Demerol)

D) Hydroxyurea

D

The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease. The client is at risk for infection. Which medication does the nurse expect to administer to this client?

A) Acetaminophen

B) Penicillin

C) Morphine sulfate

D) Tamoxifen

B