NCLEX 3500: Hematological and Immune Disorders Exam Questions With 100% Correct Answers

NCLEX 3500: Hematological and Immune Disorders Exam Questions With 100% Correct Answers A client with rheumatoid arthritis is being discharged with a prescription for aspirin (Ecotrin), 600 mg P.O. every 6 hours. The nurse should instruct the client to notify the physician if which adverse drug reaction occurs? 1. Dysuria 2. Tinnitus 3. Leg cramps 4. Constipation - answerAnswer 2: RATIONALES: The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity, such as tinnitus (ringing in the ears). The other options aren't associated with aspirin use or toxicity. A client with acquired immunodeficiency syndrome (AIDS) is admitted with Pneumocystis carinii pneumonia. During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and calling. What should the nurse do? 1. Continue with the bath and tell the client not to worry. 2. Ask the physician to obtain a psychiatric consultation. 3. Listen and show interest as the client expresses feelings. 4. State that these friends' behavior shows that they aren't true friends. - answerAnswer: 3 RATIONALES: The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only after further assessment. Stating that the client's friends aren't true friends would discount the client's feelings. Which nonpharmacologic interventions should the nurse include in the care plan for a client who has moderate rheumatoid arthritis (RA)? 1. Massaging inflamed joints 2. Avoiding range-of-motion (ROM) exercises 3. Applying splints to inflamed joints 4. Using assistive devices at all times 5. Selecting clothing that has Velcro fasteners 6. Applying moist heat to joints - answerAnswer 3,5,6 RATIONALES: Supportive, nonpharmacologic measures for the client with RA include applying splints to rest inflamed joints, using Velcro fasteners on clothes to aid in dressing, and applying moist heat to joints to relax muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate inflammation. A physical therapy program, including ROM exercises and carefully individualized therapeutic exercises, prevents loss of joint function. Assistive devices should be used only when marked loss of ROM occurs. A 40-year-old client with mild dementia related to end-stage acquired immunodeficiency syndrome (AIDS) is preparing for discharge. She has decided against further curative treatment and wishes to return home. Before discharge, she develops ocular cytomegalovirus (CMV). Her physician recommends treatment with a Ganciclovir-impregnated implant (Vitrasert), which requires a surgical procedure. The client 's husband feels the implant won't help the patient and asks the nurse if the implant will cure CMV. Which answer from the nurse best answers the husband's question reflecting client advocacy? 1. "The implant won't cure the virus. I'll tell the physician that you don't want her to have the procedure." 2. "The implant won't cure the virus but it may protect her sight. Just because your wife has dementia doesn't mean she shouldn't be given the opportunity to see." 3. "The implant won't cure the virus in your wife's eye. T - answerAnswer 4: RATIONALES: In option 4, the nurse is advocating for the client's wishes. She is explaining the client's wishes for no further curative treatment, yet promoting an improved quality of life and safety while the client is being cared for at home. Option 1 answers the husband's question, but it doesn't advocate for the client's needs. Option 2 provides factual information, but it's delivered in a confrontational manner. Option 3 also provides factual information but doesn't show client advocacy. A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below: 1. 135,000/μl. 2. 75,000/μl. 3. 20,000/μl. 4. 500/μl. - answerAnswer 4: RATIONALES: The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls below 500/μl. A platelet count of 135,000/μl is normal and wouldn't occur in a client with ITP. Although platelet counts of 75,000/μl and 20,000/μl are below normal and increase the client's risk for bleeding, they don't increase the risk as much as a platelet count below 500/μl. The nurse is planning care for a client with human immunodeficiency virus (HIV). She's being assisted by a licensed practical nurse (LPN). Which statements by the LPN indicate her understanding of HIV transmission? 1. "I'll wear a gown, mask, and gloves for all client contact." 2. "I don't need to wear any personal protective equipment because nurses have a low risk of occupational exposure." 3. "I'll wear a mask if the client has a cough caused by an upper respiratory infection." 4. "I'll wear a mask, gown, and gloves when splashing of body fluids is likely." 5. "I'll wash my hands after client care." - answerAnswer 4,5: RATIONALES: Standard precautions include wearing gloves for any known or anticipated contact with blood or other body fluids, tissue, mucous membranes, or nonintact skin. If the task may result in splashing or splattering of blood or body fluids to the face, a mask and goggles or face shield should be worn. If the task may result in splashing or splattering of blood or body fluids to the body, a fluid-resistant gown or apron should be worn. Hands should be washed before and after client care and after removing gloves. A gown, mask, and gloves aren't necessary for client care unless contact with body fluids, tissue, mucous membranes, or nonintact skin is expected. Nurses have an increased, not decreased, risk of occupational exposure to blood-borne pathogens. HIV isn't transmitted in sputum unless blood is present. The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Autoimmunity has been linked to excessive ingestion of: 1. protein. 2. fat. 3. vitamin A. 4. zinc. - answerAnswer 2: RATIONALES: A diet containing excessive fat seems to contribute to autoimmunity — overreaction of the body against constituents of its own tissues. Immune dysfunction has been linked to deficient — not excessive — intake of protein, vitamin A, and zinc. Which white blood cells are involved in releasing histamine during an allergic reaction? 1. Basophils 2. Eosinophils 3. Monocytes 4. Neutrophils - answerAnswer 1: RATIONALES: Basophils are responsible for releasing histamine. Eosinophils' major function is phagocytosis of antigen-antibody complexes that are formed in allergic reactions. Monocytes and neutrophils are predominately phagocytic. The nurse practitioner assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? 1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss 2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers 3. Weight gain, hypervigilance, hypothermia, and edema of the legs 4. Hypothermia, weight gain, lethargy, and edema of the arms - answerAnswer 1: RATIONALES: An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, the classic butterfly rash. SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE. A client with allergic rhinitis is prescribed loratadine (Claritin). On a follow-up visit, the client tells the nurse, "I take one 10-mg tablet of Claritin with a glass of water two times daily." The nurse concludes that the client requires additional teaching about this medication because: 1. loratadine isn't available in 10-mg tablets. 2. loratadine should be taken on an empty stomach. 3. loratadine should be taken once daily for allergic rhinitis. 4. Claritin isn't the trade name for loratadine. - answerAnswer 3: RATIONALES: When prescribed for allergic rhinitis, loratadine is usually taken once, not twice, daily. Loratadine is available in 10-mg tablets, should be taken on an empty stomach, and is dispensed under the trade name Claritin. Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child?