Test Bank Prioritization Delegation and Assignment 4th Edition LaCharity

Test Bank Prioritization Delegation and Assignment 4th Edition LaCharity Table of Contents Chapter 1. Pain ........................................................................................................................... 2 Chapter 2. Cancer ....................................................................................................................... 9 Chapter 3. Immunologic Problems ............................................................................................ 16 Chapter 4. Fluid, Electrolyte, and Acid-Base Balance Problems ................................................ 23 Chapter 5. Safety and Infection Control ..................................................................................... 30 Chapter 6. Respiratory Problems .............................................................................................. 36 Chapter 7. Cardiovascular Problems ......................................................................................... 45 Chapter 8. Hematologic Problems ............................................................................................. 50 Chapter 9. Neurologic Problems ................................................................................................ 55 Chapter 10. Visual and Auditory Problems ................................................................................ 61 Chapter 11. Musculoskeletal Problems ..................................................................................... 68 Chapter 12. Gastrointestinal and Nutritional Problems ............................................................... 75 Chapter 13. Diabetes Mellitus .................................................................................................... 81 Chapter 14. Other Endocrine Problems ..................................................................................... 88 Chapter 15. Integumentary Problems ........................................................................................ 93 Chapter 16. Renal and Urinary Problems .................................................................................. 98 Chapter 17. Reproductive Problems ........................................................................................ 105 Chapter 18. Problems in Pregnancy and Childbearing............................................................. 111 Chapter 19. Pediatric Problems ............................................................................................... 118 Chapter 20. Pharmacology ...................................................................................................... 126 Chapter 21. Emergencies and Disasters ................................................................................. 134 Chapter 22. Psychiatric–Mental Health Problems .................................................................... 140 1 | P a g eChapter 1. Pain MULTIPLE CHOICE 1.A client tells the nurse that she rarely experiences pain, but when she does, she seeks medical attention. The nurse realizes this client understands that pain is important because it: 1. 2. 3. 4. is a protective system. includes the automatic withdrawal reflex. creates sensitivity to pain. helps with healing. ANS: 1 Pain is a protective system that includes protection from unsafe behaviors by use of reflexes, memory, and avoidance. Even though the automatic withdrawal reflex is a part of the pain response, it does not explain why pain is important. Pain does not create sensitivity to pain. Pain does not help with healing. PTS: 1 DIF: Analyze REF: Definitions and Implications of Pain 2.A client complains that the bed sheets touching his skin are extremely painful. The nurse realizes this client is experiencing: 1. 2. 3. 4. allodynia. modulation. kinesthesia. proprioception. ANS: 1 Allodynia or hyperalgesia is a state where a slight or nonpainful stimulus is interpreted as very painful. Kinesthesia is the awareness of movement. Proprioception is the awareness of body position. Modulation is an influencing factor in the perception of pain. PTS: 1 DIF: Analyze REF: Peripheral Nervous System 3.A client is complaining of severe abdomen pain. The nurse realizes this client is experiencing which type of pain? 1. 2. 3. 4. Neuralgia Pathological Somatic Visceral ANS: 4 Visceral pain is pain arising from the body organs or gastrointestinal tract. Somatic pain is pain that originates from the bone, joints, muscles, skin, or connective pain. Neuralgia and pathological pain are both types of pain that result from injury to a nerve or malfunction of the neuronal transmission process or due to impaired regulation. PTS:1DIF:AnalyzeREF:Types of Pain 4.A client, diagnosed with acute appendicitis, is experiencing abdominal pain. The best 2 | P a g eway for the nurse to describe this clients pain would be: 1. chronic. 2. 3. 4. neuropathic. referred. acute. ANS: 4 Acute pain onset is sudden and of short duration. Chronic pain is a sudden or slow onset of mild to severe pain that lasts longer than 6 months. Referred pain is the result of the transfer of visceral pain sensations to a body surface at a distance from the actual origin. Neuropathic pain is paroxysmal pain that occurs along the branches of a nerve. PTS:1DIF:ApplyREF:Types of Pain 5.A client is observed holding a pillow over the abdominal region with both knees flexed in a side-lying position. Vital signs assessment reveals an elevated blood pressure and heart rate. Which of the following should the nurse say to this client? 1. 2. 3. 4. Can I get you anything? Would you like something for pain? You look comfortable. Your blood pressure is up. ANS: 2 Sympathetic responses to pain include elevated blood pressure and heart rate. And since the client is hugging a pillow over the abdominal region with both knees flexed in a side- lying position, the best thing for the nurse to say to this client is Would you like something for pain? The other responses are incorrect because they do not acknowledge that the client is experiencing pain. PTS: 1 DIF: Apply REF: Assessing the Clinical Manifestations of Pain 6.A client experiencing chronic pain asks the nurse why she is not prescribed Demerol like she received when she had a total knee replacement. Which of the following should the nurse respond to this client? 1. 2. 3. 4. You dont need something that strong. That medication does not exist anymore. That medication does not last very long. It can cause you have high blood pressure. ANS: 3 Meperidine is no longer a major drug for acute or chronic pain due to its short analgesic duration of 2 to 3 hours and the potential for accumulative toxic effects of its metabolite, normeperidine. The best response for the nurse to make to the client would be that medication does not last very long. The other responses are inaccurate. PTS:1DIF:ApplyREF:Opioid Analgesics 7.A client is informed that a tricyclic antidepressant medication is going to help control 3 | P a g ehis chronic pain. The nurse would expect the physician to prescribe: 1. Amitriptyline. 2. 3. 4. Baclofen. Gabapentin. Diazepam. ANS: 1 Amitriptyline is an antidepressant. Gabapentin is an anticonvulsant. Baclofen is a muscle relaxant. Diazepam is a benzodiazepine. PTS: 1 DIF: Analyze REF: Adjuvant Medications 8.A client receiving around-the-clock medication for terminal cancer experiences additional pain when performing activities of daily living. The nurse realizes this client is experiencing: 1. 2. 3. 4. breakthrough pain. intractable pain. psychosomatic pain. acute pain. ANS: 1 Breakthrough pain is commonly seen in the advanced stages of cancer. It is spontaneous, unpredictable, and can be initiated by certain activities such as during activities of daily living. Intractable pain is resistant to some or all forms of therapy. Psychosomatic pain is that which has a psychological origin. The client is diagnosed with terminal cancer. Acute pain has a sudden onset and resolves within 6 months. PTS:1DIF:AnalyzeREF:Breakthrough Pain 9.A client recovering from surgery tells the nurse that she is nauseated and is experiencing an increase in pain. Which of the following does this clients symptoms suggest to the nurse? 1 . 2 . 3 . The client is becoming dependent upon the pain medication. The clients pain threshold is lower when experiencing nausea. The client is experiencing withdrawal symptoms from pain medication. 4 | P a g e4 . The client is experiencing referred pain. ANS: 2 Pain threshold is influenced by nausea, fatigue, and lack of sleep. The client experiencing an increase in pain during nausea is demonstrating an alteration in the pain threshold. The client is not becoming dependent upon the pain medication. The client is not experiencing withdrawal symptoms. The client is also not experiencing referred pain. PTS: 1 DIF: Analyze REF: Pain Threshold and Pain Tolerance 10.A client with a history of malingering pain tells the nurse that he needs a prescription for pain medication. Which of the following should the nurse do first to assist this client? 1 . 2 . 3 . 4 . Ask the physician for a pain medication prescription for the client. Remind the client that he does not have pain but just wants the medication. Thoroughly assess the client for pain. Suggest the client seek counseling for his pain medication-seeking behavior. ANS: 3 Pain of a psychological origin is when an individual seeks treatment for pain when no actual pain exists. This is also referred to as malingering or pretending pain. The nurse should not assume that the pain does not exist but rather should conduct a thorough pain assessment to rule out an actual physiological problem. The nurse should not immediately ask the physician for pain medication. The nurse should not remind the client that he does not have pain but just wants the medication. The nurse should also not suggest the client seek counseling for pain medication- seeking behavior. PTS: 1 DIF: Apply REF: Box 16-1 Pain Descriptions 11.The nurse is implementing the five Cs of pain management for a client. Which of the following is included in this intervention? 1 . 2 . 3 . 4 . Caring for the client in a holistic manner Creating a calm environment Comparing the degree of pain reported with previous episodes Continuously assessing the clients pain ANS: 4 The five Cs of pain management include comprehensive assessment, consistent use of assessment tools, continuous reassessment, customize the plan of care, and collaborate with other health care providers to plan pain management. The other choices are not 5 | P a g eincluded in the five Cs of pain management. PTS: 1 DIF: Apply REF: Planning and Implementation 12.A client, diagnosed with arthritis, should be instructed to avoid the use of NSAIDs because of which of the following prescribed medications? 1. 2. 3. 4. Penicillin Coumadin Digoxin Diazide ANS: 2 Persons at greatest risk for adverse reactions to NSAIDs include those who are prescribed warfarin (Coumadin) since the NSAID can increase the effects of the Coumadin and promote bleeding. PTS: 1 DIF: Apply REF: Box 16-2 Groups of NSAID Drugs MULTIPLE RESPONSE 1. Prior to hospitalization, a client had been ingesting high doses of oxycodone. The nurse suspects the client is experiencing symptoms of withdrawal when which of the following are assessed? (Select all that apply.) 1. 2. 3. 4. 5. 6. Muscle twitching and spasms Restlessness Increased heart rate Drop in blood pressure Increase in blood pressure Irritability ANS: 1, 2, 3, 5, 6 Withdrawal symptoms include myoclonus or muscle twitching and spasms, restlessness, irritability, increased heart rate, and increased blood pressure. A decrease in blood pressure is not a symptom of narcotic medication withdrawal. PTS:1DIF:Analyze REF: Potential and Actual Side Effects of Opioid Analgesics 2. The nurse would be concerned that a client is at risk for developing chronic pain when which of the following health problems are diagnosed? (Select all that apply.) 1. 2. 3. Osteoarthritis Osteoporosis Heart disease 6 | P a g e4. 5. 6. Diabetes mellitus Chronic pulmonary disease Anemia ANS: 1, 2, 5 Common health problems associated with chronic pain include osteoarthritis, osteoporosis, and chronic pulmonary disease. Heart disease, diabetes mellitus, and anemia are not associated with chronic pain. PTS:1DIF:AnalyzeREF:Chronic Pain 3. An 84-year-old client is experiencing severe arthritis pain. The nurse realizes that which of the following pain management approaches would be the most beneficial for this client? (Select all that apply.) 1. 2. 3. 4. 5. 6. Avoid NSAIDs. Utilize morphine or morphine-like medication. Provide medication through the oral route. Utilize diazepam. Suggest Darvocet. Provide medication through the intramuscular route. ANS: 1, 2, 3 When providing pain medication to a geriatric client, pain management approaches include the utilization of morphine or morphine-like medication to control pain and provide medication using the oral route. NSAIDs should also be avoided because of the risk of gastrointestinal bleeding. Diazepam should be avoided because of a long half-life. Darvocet should be avoided because of toxic effects with renal insufficiency. Medication should not be provided using the intramuscular route because of muscle wasting and loss of fatty tissue in the elderly client. PTS: 1 DIF: Apply REF: Geriatric Considerations 4.A client with severe pain from spinal stenosis is prescribed Methadone. The nurse realizes that the advantages of this medication are what? (Select all that apply.) 1. 2. 3. 4. 5. 6. Decrease in the need for antidepressant adjuvant medication Less frequent dosing schedule Long half-life Inexpensive Can be used for intermittent pain Does not cause respiratory depression ANS: 1, 2, 4 The advantages of methadone include that it decreases the need for antidepressant adjuvant medication because it increases the release of serotonin and norepinephrine, dosing is every 12 hours, and it is inexpensive. Disadvantages of this medication include: it has a long half- 7 | P a g elife; it cannot be used for intermittent pain management; and it does cause respiratory depression. PTS:1DIF:AnalyzeREF:Intractable Pain 5.The nurse is using the PAINAID Scale to assess a clients level of pain. Which of the following are assessed with this pain scale? (Select all that apply.) 1. 2. 3. 4. 5. 6. Breathing rate Assign a number to the degree of pain Negative vocalizations Assign a facial expression to the degree of pain Facial expression Body language ANS: 1, 3, 5, 6 The PAINAID scale assesses breathing, negative vocalizations, facial expression, body language, and comfort. The Numerical Rating Scale assigns a number to the degree of pain. The Wong- Baker FACES Scale assigns a facial expression to the degree of pain. PTS: 1 DIF: Apply REF: Skills 360: Pain Assessment Tools 6.A client diagnosed with severe arthritis tells the nurse that she always has some degree of pain. Which of the following could explain this clients poor pain management? (Select all that apply.) 1. 2. 3. 4. 5. 6. Client does not appear to be in pain. Client does not report pain. Client cannot afford pain medication. Client is fearful of becoming addicted to pain medication. Client believes pain medication means the condition is worse. Client has a high pain tolerance. ANS: 1, 2, 4, 5 Barriers to pain assessment and management include that the client is not demonstrating overt signs of pain, and therefore she does not need pain medication; the client does not report pain, so therefore she does not need pain medication; the client is fearful of becoming addicted to pain medication; and the client believes pain medication means the condition is worse. The fact that the client is unable to afford pain medication and is having a high pain tolerance are not identified barriers to pain assessment and management. PTS: 1 DIF: Analyze REF: Barrier to Pain Assessment and Pain Management 7.The nurse determines that a client is experiencing chronic pain when which of the following is assessed? (Select all that apply.) 1. Suffering 8 | P a g e2. 3. 4. 5. 6. Fatigue Sleeplessness Apathy Sadness Anger ANS: 1, 3, 5 The descriptor triad for chronic pain is suffering, sleeplessness, and sadness. Fatigue, apathy, and anger do not describe chronic pain. Chapter 2. Cancer MULTIPLE CHOICE 1.The nurse realizes that for a cell to become cancer, it needs to progress through four stages. Which of the following is not a stage of this process? 1. 2. 3. 4. Initiation Metastasis Progression Stimulation ANS: 4 The four stages of oncogenesis or carcinogenesis are: 1) initiation, 2) promotion, 3) progression, and 4) metastasis. Stimulation is not a stage of carcinogenesis. PTS:1DIF:AnalyzeREF:Carcinogenesis 2.A clients most recent prostate-specific antigen level has decreased since starting treatment for prostate cancer. The nurse realizes this level would indicate that the client: 1. 2. 3. 4. no longer has the disease. has an increase in the severity of the disease process. is responding to treatment. should be retested. ANS: 3 A decrease in a tumor marker is important in the assessment of cancer, monitoring tumor response during treatment strategies, and diagnosis of recurrence of disease. A decrease in the prostate-specific antigen level once treatment has begun for prostate cancer would indicate that the client is responding to treatment. A drop in the level does not mean that the client no longer has the disease, that the disease is progressing, or that the client needs to be retested. PTS:1DIF:AnalyzeREF:Laboratory Tests 3.A clients tumor was staged using the TNM system. The tumor was staged as T4,N1,Mx. The nurse realizes that this staging means: 9 | P a g e1 . 2 . 3 . 4 . tumor in situ, minimal node involvement, no presence of metastasis. large tumor, no node involvement, presence of metastasis. medium tumor, multiple nodes involvement, no presence of metastasis. large tumor, single node involvement, unable to assess metastasis. ANS: 4 The larger the number in the TNM staging system, the increasing involvement or larger size of the tumor, node, and metastasis. T4 reflects the size of the tumor. N1 describes the regional node involvement. Mx signals the inability to assess the presence or absence of distant metastasis. PTS:1DIF:AnalyzeREF:Staging and Grading 4.Which of the following statements made by a client after receiving instruction regarding internal radiation would indicate that teaching has been successful? 1 . 2 . 3 . 4 . My children can come visit me after school. Individuals will need to keep at least 3 feet away when possible. I will be sharing a room near the nursing station. The hospital staff will limit the amount of time in my room. ANS: 4 General guidelines include assigning the patient to a private room; postradiation precaution signage; limiting the amount of time in the room; observing a distance of at least 6 feet from the source when possible; and prohibiting pregnant staff, family, visitors, and children from interacting or visiting with the patient. The other choices would indicate the need for additional instruction and are incorrect. PTS:1DIF:AnalyzeREF:Internal Radiation 5.A client, prescribed to begin chemotherapy, asks the nurse How does chemotherapy work? Which of the following should the nurse respond to this client? 1. 2. 3. 4. ANS: 1 Chemotherapy is the use of drugs that prevent, kill, or block the growth and spread of cancer cells. Some noncancerous cells can be damaged during chemotherapy. External 10 | P a g e It prevents the process of cell growth and replication. It kills only cancer cells. It treats the exposed area only with high-energy rays. Agents are implanted in an area to inhibit cancer tion treats an exposed area with high-energy rays. Internal radiation uses implanted agents. PTS:1DIF:ApplyREF:Chemotherapy 6.A client is prescribed interferon as part of treatment for cancer. Which of the following should the nurse instruct the client regarding this medication? 1. 2. 3. 4. Flu-like symptoms should be reported to the physician. General fatigue while receiving this medication is common. Seek emergency care with a high fever. Side effects are short term and will resolve in a few days. ANS: 2 Side effects vary by the type of biological agent, including a flu-like illness, high fever, headache, and general fatigue. These are expected effects and do not need to be reported to the physician. Side effects of these medications are long term and can vary in intensity during the course of treatment. PTS:1DIF:ApplyREF:Biological Therapy 7.A client recovering from bone marrow transplantation is experiencing vomiting, fatigue, and skin reactions. Which of the following should the nurse do to help this client? 1 . 2 . 3 . 4 . Prepare to administer platelets as prescribed. Prepare to administer red blood cells as prescribed. Limit fluids. Explain that the client is experiencing expected short-term side effects. ANS: 4 Clients who undergo bone marrow transplantation may experience short-term side effects, including nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions. These side effects are not treated with platelets or red blood cells. Limiting fluids can make the side effects worse. PTS: 1 DIF: Apply REF: Blood and Bone Marrow Transplantation 8.A client receiving chemotherapy for cancer has a hemoglobin level of 9.7 g/dL. Which of the following should the nurse anticipate as treatment for this client? 1. 2. 3. Place client in reverse isolation. Administer antibiotics as prescribed. Administer epoetin alfa as prescribed. 11 | P a g e4. Administer filgrastim as prescribed. ANS: 3 Treatment for moderate anemia in the client receiving chemotherapy for cancer would include the administration of epoetin alfa as prescribed. This medication elevates hemoglobin levels and improves the quality of life for clients. The other choices would be appropriate for the client diagnosed with neutropenia and not anemia. PTS: 1 DIF: Apply REF: Anemia 9.A client receiving chemotherapy has a platelet count of 85,000. Which of the following should the nurse do to assist this client? 1. 2. 3. 4. Assess for bruising and frank bleeding. Provide a razor for shaving. Remind the client to floss before brushing the teeth each day. Provide NSAIDs as prescribed. ANS: 1 A platelet count of less than 100,000 indicates thrombocytopenia, and the client should be assessed for bruising and frank bleeding. The client should avoid the use of a razor, avoid flossing, and NSAIDs should not be provided since they promote bleeding. PTS:1DIF:ApplyREF:Thrombocytopenia 10.A client receiving chemotherapy tells the nurse that he is concerned that he may be developing Alzheimers disease since he is having a new onset of memory loss. Which of the following should the nurse do to help this client? 1 . 2 . 3 . 4 . Discuss the clients memory issues with the physician. Suggest the client use a journal to aid with short-term chemo fog problems. Assess for signs of pending stroke. Notify the physician and plan for transferring the client to an intensive care area. ANS: 2 Twenty to 50% of cancer clients receiving chemotherapy describe cognitive changes such as being in a fog. To aid this client, the nurse should suggest the client keep a log or journal to document activities in order to identify when the fog is more acute. Chemo fog can last up to 2 years after treatment, but it is not permanent. The clients memory issues do not need to be discussed with a physician. The client is not experiencing a stroke. The client does not need to be transferred to an intensive care area. PTS:1DIF:ApplyREF:Cognitive Disorders 11.A client is experiencing nausea and vomiting 1 day after chemotherapy has begun for cancer treatment. The nurse realizes this clients nausea and vomiting would be considered: 12 | P a g e1. 2. 3. 4. anticipatory. acute. delayed. chronic. ANS: 3 Delayed nausea and vomiting occurs more than 24 hours after chemotherapy. Anticipatory nausea and vomiting occur before, during, or after chemotherapy, and they appear earlier than expected. Acute nausea and vomiting occur within 24 hours after starting chemotherapy. Chronic nausea and vomiting affect people with advanced cancer and is not well understood. PTS: 1 DIF: Analyze REF: GI System 12. The nurse is planning interventions to address the potential problem of mucositis for a client receiving chemotherapy. Which of the following assessment findings caused the nurse to identify the client as being at risk for this side effect? 1. 2. 3. 4. Client prescribed chemotherapy Client age 50 Client lives alone Client is fatigued ANS: 1 High risks for developing mucositis include age younger than 20, hematologic or head and neck cancer, preexisting oral disease, and chemotherapy and radiation. Age greater than 50, living arrangements, and level of fatigue do not increase a clients risk of developing mucositis. PTS: 1 DIF: Analyze REF: Mucositis 13. Even though a client has completed a course of chemotherapy and has been found to be cancer free at this time, she continues to experience fatigue. Which of the following should the nurse instruct this client? 1 . 2 . 3 . 4 . Fatigue is the first warning sign of cancer and should be reported to the physician. Fatigue indicates a poor diet. Fatigue is caused by poor fluid intake. Fatigue can persist after treatment ends, but it will eventually improve. ANS: 4 Fatigue is the most common symptom associated with cancer and cancer treatment. Fatigue is more often a result of the treatment than the cancer itself. The client should be informed that fatigue may persist after cancer therapy is completed, but it will eventually 13 | P a g eimprove. PTS: 1 DIF: Apply REF: Fatigue MULTIPLE RESPONSE 1.A client is diagnosed with cancer. The nurse realizes that which of the following are characteristics of this type of cell? (Select all that apply.) 1. 2. 3. 4. 5. 6. Aneuploid Cohesive Migratory Poorly differentiated Specific morphology Abnormal chromosomes ANS: 1, 3, 4, 6 Characteristics of malignant cells include uncontrolled cell division; large, variably shaped nuclei; anaplasia; poor differentiation; noncohesion; migration; lack of contact inhibition; aneuploidy; and abnormal chromosomes. Specific morphology and cohesiveness are characteristics of either benign or normal cells. PTS:1DIF:AnalyzeREF:Malignant Cells 2.A nurse is teaching at a health fair about the early warning signs of cancer. Which of the following would the nurse include as early warning signs? (Select all that apply.) 1. 2. 3. 4. 5. 6. A sore that does not heal Change in bladder or bowel habits Family history Unusual discharge Obvious change in nevus Nagging cough ANS: 1, 2, 4, 5, 6 Early warning signs can be easily remember using the acronym CAUTION: C, change in bladder or bowel habits; A, a sore that does not heal; U, unusual bleeding or discharge; T, presence of a lump or thickening; I, indigestion; O, obvious change in a wart or mole; and N, a nagging cough or hoarseness. PTS: 1 DIF: Apply REF: Box 15-1 Warning Signs of Cancer 3.A client is experiencing nausea and vomiting related to chemotherapy. Which of the following strategies can the nurse use to improve nutrition in this client? (Select all that apply.) 1. 2. Adding peppermint to foods Administering ondansetron 14 | P a g e3. 4. 5. 6. Drinking adequate fluids Drinking hot beverages Eating food at room temperature Sipping ice water ANS: 1, 2, 3, 5 Strategies to improve nutrition in the client experiencing nausea and vomiting from chemotherapy include using herbs such as peppermint, administering prescribed anti- emetics, ensuring an adequate intake of fluids, and ingesting foods at room temperature. Foods and fluids of extreme temperatures such as hot beverages and ice water should be avoided by the patient with nausea and vomiting. PTS: 1 DIF: Apply REF: Chemotherapy: Side Effects 4.A client asks the nurse what he can do to prevent the onset of cancer. The nurse realizes that which of the following contribute to the development of cancer? (Select all that apply.) 1. 2. 3. 4. 5. 6. Heredity Environment Lifestyle Stress Age Blood pressure ANS: 1, 2, 3, 5 The factors known to contribute to the development of cancer include heredity, environment, and lifestyle. Aging has a direct effect on ones risk of developing cancer. The longer one lives, the greater the risk for developing cancer. Stress and blood pressure are not factors known to contribute to the development of cancer. PTS: 1 DIF: Analyze REF: Etiology 5.The nurse is planning to instruct a client on strategies to lessen the impact of lifestyle on the development of cancer. Which of the following should the nurse include in these instructions? (Select all that apply.) 1. 2. 3. 4. 5. 6. Follow a low-fat diet. Avoid prescribed medications. Exercise regularly. Limit sun exposure. Sleep less than 7 hours each night. Do not smoke or use any tobacco products. ANS: 1, 3, 4, 6 Strategies to lessen the impact of lifestyle on the development of cancer include following a low- 15 | P a g efat diet, exercising regularly, limiting sun exposure, and avoiding all use of tobacco products. Prescribed medications will not lessen the impact of lifestyle on the development of cancer. Sleeping less than 7 hours each night will not lessen the impact of lifestyle on the development of cancer. PTS: 1 DIF: Apply REF: Lifestyle 6.A client is prescribed a selective estrogen receptor modulator as treatment for ovarian cancer. Which of the following should the nurse instruct the client regarding side effects of this medication? (Select all that apply.) 1. 2. 3. 4. 5. 6. Hot flashes Blood clots Drop in blood pressure Reduce libido Increased risk of developing other cancer Weight gain ANS: 1, 2, 4, 5 Side effects of selective estrogen modulator medications include hot flashes, blood clots, loss of interest in sex, and a higher risk of other cancers. Drop in blood pressure and weight gain are not side effects associated with this classification of medication. Chapter 3. Immunologic Problems MULTIPLE CHOICE 1.A pregnant client diagnosed with human immunodeficiency virus (HIV) is asking about her babys risk of infection. Which of the following does put the newborn at risk? 1. 2. 3. 4. Bottle-feeding Changing diapers Kissing the baby Vaginal birth ANS: 4 Breastfeeding and vaginal birth put the newborn at risk for HIV. HIV cannot be transmitted by changing diapers (feces) or kissing the baby (saliva). PTS:1DIF:Apply REF: Human Immunodeficiency Virus Infection: Etiology 2.A health care provider has accidentally been stuck with a used needle. The health care provider is going to be tested for human immunodeficiency virus (HIV). Which of the following would be the testing schedule for the health care provider? 1. Tested at 2 months, 4 months, and then at 6 months 16 | P a g e2. 3. 4. Tested immediately and then again at 2 months Tested immediately and then again at 6 months Tested in 6 months and then again in 1 year ANS: 3 The health care provider should be tested immediately to show if any preexisting infection exists. Seroconversion usually occurs in 1 to 3 months but can take up to 6 months. Testing at 2 months is too late to discover a preexisting infection and can be too early to detect a new infection. Testing at 6 months or 1 year would not detect a preexisting infection. PTS:1DIF:Apply REF: Human Immunodeficiency Virus Infection: Etiology 3. Which of the following CD4+ count would be used to confirm the diagnosis of acquired immunodeficiency syndrome (AIDS)? 1. 2. 3. 4. 155 cells/mcL 255 cells/mcL 455 cells/mcL 755 cells/mcL ANS: 1 A CD4+ count of less than 200 cells/mcL is used as a criterion to establish the diagnosis of AIDS. In cell counts less than 500 to 600 cells/mcL, antiviral therapy should be initiated. Cell counts greater than 600 cells/mcL are in the normal range. PTS:1DIF:Analyze REF:Human Immunodeficiency Virus Infection: Pathophysiology 4. The nurse, planning care for a client diagnosed with human immunodeficiency virus, realizes that the most common infection that occurs in clients with this health problem is: 1. 2. 3. 4. cytomegalovirus infection. Mycobacterium tuberculosis. Pneumocystis carinii pneumonia. Streptococcus pneumoniae. ANS: 3 As the immune system becomes overpowered, opportunistic infections can occur. The most common infection is Pneumocystis carinii pneumonia. The other infections can also occur, but they occur less frequently. PTS:1DIF:Analyze REF: Human Immunodeficiency Virus Infection: Assessment with Clinical Manifestations 5.A client diagnosed with acquired immunodeficiency syndrome (AIDS) 6 years ago has a purple lesion located on the inner thigh. This lesion is most likely to be: 17 | P a g e1. 2. 3. 4. AIDS-related syndrome. Burkitts lymphoma. cachexia. Kaposis sarcoma. ANS: 4 Kaposis sarcoma presents as abnormal lesions that appear purple or blue-red in color. They can be found anywhere but are common on the feet, arms, thighs, perineal area, and face. Cachexia is tissue wasting. Burkitts lymphoma is characterized by enlarged lymph nodes. AIDS-related syndrome is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the HIV virus. PTS:1DIF:Analyze REF: Human Immunodeficiency Virus Infection: Assessment with Clinical Manifestations 6.The nurse realizes that which of the following tests can be used to initially identify the presence of human immunodeficiency virus (HIV) antibodies in a client? 1. 2. 3. 4. Enzyme-linked immunosorbent assay (ELISA) Platelet count Red blood cell count Western blot ANS: 1 The ELISA test detects HIV antibodies. The Western blot is used as a confirmatory test to a positive ELISA test. Red blood cell counts and platelet counts are part of standard blood studies. PTS:1DIF:Analyze REF:Human Immunodeficiency Virus Infection: Diagnostic Tests 7.A client diagnosed with acquired immunodeficiency syndrome (AIDS) is sitting alone crying. Which of the following is an appropriate response for the nurse to give? 1. 2. 3. 4. Everything will be okay. Let me call your doctor about your depression. Whats wrong now? Would you like to talk? ANS: 4 Asking the client if he would like to talk allows the client an opportunity to express his feelings. The other responses give the client false reassurance or put off the client. PTS:1DIF:Apply REF: Human Immunodeficiency Virus Infection: Planning and Implementation 8. The nurse is instructing a client on ways to reduce the risk of exposure to the human immunodeficiency virus. Which of the following activities would present the least risk of exposure to this virus? 18 | P a g e1. 2. 3. 4. Exposure to used needles Multiple sex partners Perinatal exposure Teeth cleaning ANS: 4 Teeth cleaning is a procedure in a dental office that routinely sterilizes its equipment and is not considered to present an increased risk of exposure to HIV. Exposure to used needles, multiple sex partners, and perinatal exposure during pregnancy and childbirth all would increase the clients risk of exposure to the virus. PTS:1DIF:Apply REF:Human Immunodeficiency Virus Infection: Epidemiology 9. The nurse is teaching a small group of clients about human immunodeficiency virus (HIV) at a health clinic. Which of the following statements by a group member will need further clarification? 1. 2. 3. 4. Condoms should be used during sexual contact. Exposure can occur to a baby during pregnancy. HIV-infected mothers can breastfeed their babies. Needles should never be reused or shared. ANS: 3 Exposure to HIV can occur while breastfeeding an infant. This is the statement that would necessitate further clarification. The other statements are correct. PTS:1DIF:Analyze REF:Human Immunodeficiency Virus Infection: Epidemiology 10. The nurse is caring for a client diagnosed with human immunodeficiency virus (HIV). Which of the following precautions is best in the care of the client? 1 . 2 . 3 . 4 . Gloves and an N-95 mask Gown, gloves, and mask if splashing with body fluids is likely Gown, gloves, mask, and placement into a negative-pressure room Only handwashing is needed ANS: 2 Standard precautions should be followed when handling any body fluids and blood. An N-95 mask and a negative-pressure room are not necessary. Handwashing is always recommended, but it should be accompanied by other precautions if contact with body fluids or blood is likely. PTS:1DIF:Apply REF: Human Immunodeficiency Virus Infection: Planning and Implementation 19 | P a g e11.A client receiving treatment for human immunodeficiency virus infection is demonstrating signs of resistance to the medication. Which of the following does this suggest to the nurse? 1 . 2 . 3 . 4 . The medication dosages need to be increased. The client needs to be taken off all medication. The client needs additional medication to treat side effects. The client is not adhering to the prescribed medication schedule. ANS: 4 Resistance to medication prescribed to treat human immunodeficiency virus infection can develop if the client does not adhere to the dose schedule for each drug. Resistance to the medication does not mean the dosages need to be increased. The client should not be taken off all medication. Signs of resistance to the medication are not the same as side effects. PTS:1DIF:Analyze REF:Human Immunodeficiency Virus Infection: Pharmacology 12.A client diagnosed with rheumatoid arthritis receives a prescription for indomethacin. Which of the following statements by the client would indicate the need for further instruction about this medication? 1 . 2 . 3 . 4 . I have to let my doctor know if I need to start blood pressure medications. I have to make sure I get my kidneys tested as scheduled. I need to get my eyes checked regularly. This medication shouldnt upset my stomach. ANS: 4 Indomethacin can cause nausea, dyspepsia, gastrointestinal pain, diarrhea, vomiting, constipation, and flatulence. This is the statement that would indicate the need for further instruction about this medication. The client should regularly have her eyes, kidneys, and liver checked for impairment. PTS:1DIF:Analyze REF: Table 42-2 Examples of Drugs Used for RA Therapy 13.The nurse is providing discharge instructions to a client diagnosed with systemic lupus erythematosus (SLE). Which of the following