58.PRACTICE QUESTIONS 1. A client is suspected of having systemic lupus erythematous (SLE).

The nurse monitors the client knowing that which of the following is a characteristic sign of SLE? 1 Rash on the face across the bridge of the nose and on the cheeks 2 Fatigue 3 Fever 4 Elevated red blood cell count 2. The nurse is caring for a client with systemic lupus erythematous (SLE). Which of the following is not a component of the teaching plan for the client to manage fatigue? 1 Avoid long periods of rest 2 To sit whenever possible 3 To take a hot bath in the evening 4 To engage in moderate low-impact exercise when not fatigued 3. The client has requested and undergone testing for human immunodeficiency virus (HIV). The client now asks what will be done next, since the results of two enzyme-linked immunosorbent assay (ELISA) tests have been positive. The nurse's response is based on the understanding that 1 The client will probably have a bone marrow biopsy done 2 A Western blot will be done to confirm these findings 3 A CD4 cell count will be done to measure T-helper lymphocytes 4 The client will be definitively diagnosed as HIV positive at this point 4. The nurse is caring for the client with acquired immunodeficiency syndrome (AIDS). The nurse detects early infection with Pneumocystis carinii by monitoring the client for which of the following clinical manifestations? 1 Dyspnea on exertion 2 Dyspnea at rest 3 Fever 4 Cough 5. The client with acquired immunodeficiency syndrome (AIDS) has a concurrent diagnosis of histoplasmosis. The nurse notes during data collection that the client has enlarged lymph nodes.The nurse interprets that 1 The client has disseminated histoplasmosis 2 This is a side effect of the medications given to treat AIDS 3 This indicates that the histoplasmosis is resolving 4 The client probably has yet another infection that is developing 6. The nurse is caring for the client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which of the following nursing interventions is the least helpful in managing this symptom? 1 Keep a change of bed linens nearby in case they are needed 2 Administer an antipyretic after the client spikes the fever 3 Make sure the pillow has a plastic cover 4 Keep liquids at the bedside 7. The client exposed to human immunodeficiency virus (HIV) approximately 3 months ago has seroconverted to HIV-positive status. The nurse anticipates that the client will experience which of the following at this time? 1 Oral lesions 2 Purplish skin lesions 3 Chronic cough 4 No signs and symptoms 8. The client with acquired immunodeficiency syndrome (AIDS) has raised, dark purplish lesions on the trunk of the body. The nurse anticipates that which of the following procedures will be done to confirm whether these lesions are due to Kaposi's sarcoma?
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1 Enzyme-linked immunosorbent assay (ELISA) 2 Western blot 3 Skin biopsy 4 Lung biopsy 9. The nurse participating in a health fair is setting up a booth on prevention of human immunodeficiency virus (HIV) transmission. A poster is planned that will list sexual behaviors in one of two columns, rated "safe" and "not safe." Which of the following behaviors does the nurse place in the "not safe" column? 1 Use of latex condoms 2 Use of "natural skin" condoms 3 Abstinence 4 Mutual monogamy 10. The client with acquired immunodeficiency syndrome (AIDS) is experiencing nausea and vomiting. The nurse makes which of the following dietary alterations for this client to enhance nutritional intake? 1 Avoid dairy products and red meat 2 Plan large, nutritious meals 3 Add spices to food for added flavor 4 Serve foods while they are very warm 11. The client with acquired immunodeficiency syndrome (AIDS) has diarrhea from lactose intolerance and a respiratory infection from Pneumocystis carinii. In evaluating the documented plan of care for the nursing diagnosis Impaired Gas Exchange,which of the following is not considered by the nurse to be a positive outcome criterion for this client? 1 No complaints of shortness of breath 2 Expectorates secretions easily 3 Has clear breath sounds 4 Limits fluid intake 12. A client with pemphigus vulgaris is being seen in the clinic on a regular basis. The nurse plans care based on which of the following descriptions of this condition? 1 The presence of skin vesicles found along the nerve caused by a virus 2 An autoimmune disorder that causes blistering in the epidermis 3 The presence of red raised papules and large plaques covered by silvery scales 4 The presence of tiny red vesicles 13. The nurse is providing dietary instructions to the client with systemic lupus erythematosus (SLE). Which of the following dietary items does the nurse instruct the client to avoid? 1 Cantaloupe 2 Broccoli 3 Turkey 4 Steak 14. The client is brought to the emergency department and is experiencing an anaphylaxis reaction from eating shellfish. The nurse prepares for which of the following initial actions? 1 Administration of epinephrine (Adrenalin) 2 Administration of a corticosteroid 3 Maintaining a patent airway 4 Instructing the client on the importance of obtaining a Medic-Alert bracelet 15. The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse incorporates which of the following as a priority in the plan of care? 1 Emotional support to decrease fear 2 Protecting the client from infection 3 Encouraging discussion about lifestyle changes 4 Identifying factors that decreased the immune function 16. A client calls the nurse in the emergency department and tells the nurse that he/she was just stung by a
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bumblebee while gardening. The client is afraid of a severe reaction because the client's neighbor experienced such a reaction the previous week. The most appropriate nursing action is to 1 Ask the client if he/she ever received a bee sting in the past 2 Tell the client to call an ambulance for transport to the emergency department 3 Advise the client to soak the site in hydrogen peroxide 4 Tell the client not to worry about the sting unless difficult breathing occurs 17. The nurse is assisting in administering immunizations at a health care clinic. The nurse understands that an immunization will provide 1 Natural immunity from disease 2 Acquired immunity from disease 3 Innate immunity from disease 4 Protection from all diseases 18. The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is 1 A local rash that occurs as a result of allergy 2 An inflammatory disease of collagen contained in connective tissue 3 A disease caused by a tick bite 4 A disease caused by the continuous release of histamine in the body 19. The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the physician's orders expecting to note that which of the following medications is prescribed? 1 Antibiotic 2 Narcotic analgesic 3 Antidiarrheal 4 Corticosteroid 20. The nurse administers an injection to a client with a diagnosis of acquired immunodeficiency syndrome (AIDS). After administering the medication, the nurse disposes the used needle by 1 Placing it in a puncture-resistant container 2 Laying the needle and syringe on the bedside table and carefully recapping the needle 3 Asking the client to recap the needle 4 Recapping the needle before placing it in a puncture-resistant container ANSWERS 1. 1 RATIONALE: Skin lesions or rash on the face across the bridge of the nose and on the cheeks is a characteristic sign of SLE. Fever and fatigue may potentially occur before and during exacerbation. Anemia is most likely to occur in SLE. TEST-TAKING STRATEGY: Note the key words "characteristic sign." Knowledge regarding the manifestations associated with SLE will easily direct you to option 1. If you are unfamiliar with this important disorder, review now. 2.3 RATIONALE: To help reduce fatigue in the client with SLE, the nurse should instruct the client to sit whenever possible, to avoid hot baths, to schedule moderate lowimpact exercises when not fatigued, and to maintain a balanced diet. The client is instructed not to rest for long periods because it promotes joint stifmess. TEST-TAKING STRATEGY: Note the key words "not" and "manage fatigue." By the process of elimination, you should easily be directed to option 3 as being the action that would exacerbate fatigue. If you had difficulty with this question, take rime now to review measures to prevent fatigue. 3.2 RATIONALE: If the results of two ELISA tests are positive,the Western blot is done to confirm the
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findings. If the result of the Western blot is positive, then the client is considered to be positive for HIV, and infected with the HIV virus. TEST-TAKING STRATEGY: Knowledge of the procedural steps in diagnosing HIV is needed to answer this question. Review these now if they are unfamiliar to you. This is a subject of great concern to clients, and you want to have the appropriate information to share. The increasing incidence of HIV as a major health problem also makes it a reasonably popular area for testing. 4.4 RATIONALE: The client with Pneumocystis carinii infection usually has a cough as the first symptom, which begins as nonproductive, then progresses to productive. Later signs include fever, dyspnea on exertion, and finally dyspnea at rest. TEST-TAKING STRATEGY: The key word in the stem of this question is "early." While all of these symptoms may appear at some point in the client with P. carinii, knowing sthat the cough appears first helps to you eliminate each of the other options. Review the early signs of P. carinii infection now, if you had difficulty with this question. 5. 1 RATIONALE: Histoplasmosis usually starts as a respiratory infection in the client with AIDS. It then becomes a disseminated infection, with enlargement of lymph nodes, spleen, and liver. Options 2, 3, and 4 are incorrect. TEST-TAKING STRATEGY: Knowing that lymph nodes may enlarge with generalized infection helps you to narrow the plausible choices to options 1 and 4. Since the stem contains no information that indicates that option 4 is true,option 1 is the correct choice by elimination. Review disseminated infections in the client with AIDS now if you had difficulty with this question. 6.2 RATIONALE: For clients with AIDS who experience night fever and night sweats, it is useful to offer the client an antipyretic of choice prior to going to sleep. It is also helpful to keep a change of bed linens and nightclothes nearby for use. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if there is profuse diaphoresis. The client should have liquids at the bedside to drink. TEST-TAKING STRATEGY: The wording of the question guides you to look for a response that is not the best or most correct action. Options 1 and 3 are helpful from an environmental viewpoint, so they are eliminated first as answers to this question. Knowing that liquids will help prevent dehydration causes you to eliminate this option next. This leaves option 2 as the answer. Since night fever and sweats occur serially, it is most helpful to give the antipyretic before sleep as a prophylactic measure. 7.4 RATIONALE: The client in stage 1 (seroconversion) acute HIV infection has laboratory documentation of HIV-positive status, but is asymptomatic. Following introduction of the infection and seroconversion in stage 1, the client may remain asymptomatic for a period of 6 months to 11 years or more (stage 2: chronic asymptomatic status). The client's T4 cell count is normal during these two stages. The client will begin to show symptoms in stage 3: symptomatic stage,when the T4 cell count drops below 500/mm.3 At this time,the client experiences opportunistic infections, including oral (thrush) and skin lesions (Kaposi's sarcoma). The client may also experience signs of respiratory infection in stage 3. TEST-TAKING STRATEGY: The wording of the question tells you that there are clearly three incorrect options, while only one is correct. Use knowledge of concepts related to seroconversion to help you eliminate each of the incorrect options. 8. 3 RATIONALE: The skin biopsy is the procedure of choice to diagnose Kaposi's sarcoma, which frequently
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complicates the clinical picture of the client with AIDS. Lung biopsy would confirm Pneumocystis carinii infection. The ELISA and Western blot are tests to diagnose HIV status. TEST-TAKING STRATEGY: Begin to answer this question by eliminating options 1 and 2, which are used to diagnose whether the client is HIV positive. Knowledge of the meaning of Kaposi's sarcoma, or attention to the words "lesions' and "trunk" will help you to choose correctly between the remaining two options. Review the diagnostic testing to confirm Kaposi's sarcoma now if you had difficulty with this question. 9. 2 RATIONALE: Abstinence is the safest way to avoid HIV infection. The next most reliable method is participation in a mutually monogamous relationship. The use of latex condoms is considered safe, because the latex prevents the transmission of the HIV virus as long as the condom is used properly and remains in place. The use of natural skin condoms is not considered safe because the pores in the condom are large enough for the virus to pass through. TEST-TAKING STRATEGY: Use knowledge of transmission of sexually transmitted diseases and universal precautions to answer this question. The wording of the question tells you that there is one option that is dissimilar from the others, which in this case is the correct answer to the question. Review these preventive measures now if you had difficulty with this question. 10. 1 RATIONALE: The AIDS client with nausea and vomiting should avoid fatty products such as diary products and red meat. Meals should be small and frequent to lessen the chance of vomiting. Spices and odorous foods should be avoided, since they aggravate nausea. Foods are best tolerated either cold or at room temperature. TEST-TAKING STRATEGY: Use knowledge of the effects of AIDS on the GI tract and general principles for treating nausea and vomiting to answer this question. Doing so will guide you to eliminate each of the incorrect options systematically. Review nutritional support for the client with AIDS now if you had difficulty with this question. 11.4 RATIONALE: The status of the client with a diagnosis of Impaired Gas Exchange would be evaluated against the standard outcome criteria for this nursing diagnosis. These would include that the client states that breathing is easier,coughs up secretions effectively, and has clear breath.sounds. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration. The client with diarrhea should also not limit fluid intake because of the risk of dehydration. TEST-TAKING STRATEGY: Note that the stem of the question contains the key word "not." This tells you that the answer to the question is an incorrect goal for the client. Use knowledge related to airway management and fluid balance and the process of elimination to choose correctly. 12.2 RATIONALE; Pemphigus vulgaris is an autoimmune disease that causes blistering in the epidermis. The clients have large flaccid blisters (bullae). Because the blisters are in the epidermis, they have a very tiny covering of skin and break easily, leaving large denuded areas of skin. On initial examination, clients may have crusting areas instead of intact blisters. Option 1 describes herpes zoster. Option 3 describes psoriasis, and option 4 describes eczema. TEST-TAKING STRATEGY: Knowledge that pemphigus vulgaris is an autoimmune disorder will easily direct you to option 2. If you had difficulty with this question, take time now to review the characteristics of this disorder. 13.4 RATIONALE: The client with SLE is at risk for cardiovascular disorders, such as coronary artery disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking
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cessation, prevention of obesity, and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake. TEST-TAKING STRATEGY: Note the key word "avoid" in the question. Knowledge regarding the risks associated with SLE will assist you in answering this question. Use knowledge regarding basic nutritional components of food items to help direct you to option 4. If you had difficulty with this question, take time now to review therapeutic management of SLE. 14. 3 RATIONALE: The initial action is to maintain a patent airway. The client would then receive epinephrine. Corticosteroids may also be prescribed. The client will need to be instructed about wearing a Medic-Alert bracelet, but this is not the initial action. TEST-TAKING STRATEGY: Use the ABCs, airway, breathing, and circulation, to answer the question. Airway is always the priority. 15.2 RATIONALE: The client with immune deficiency has inadequate, or the absence of, immune bodies and is at risk for infection. The priority nursing intervention is to protect the client from infection. Options 1, 3, and 4 may be components of care but are not the priority, TEST-TAKING STRATEGY: Use Maslow's hierarchy of needs theory to answer the question. Remember that physiological needs are the priority. This will easily direct you to option 2. Review the care of a client with immune deficiency now, if you had difficulty with this question. 16. 1 RATIONALE: In all types of allergies, a reaction occurs only on second and subsequent contacts with the allergen. The most appropriate action therefore is to ask the client if he or she ever received a bee sting. Option 2 is unnecessary.Option 3 is not appropriate advice. The client should not be told "not to worry." TEST-TAKING STRATEGY: Use the steps of the nursing process to answer the question. Option 1 is the only option that addresses data collection. Review information related to allergic reactions now if you had difficulty with this question. 17.2 RATIONALE: Acquired immunity can occur by receiving an immunization that causes antibodies to a specific pathogen to form. Natural (innate) immunity is present at birth.There is not an immunization that protects the client from all diseases. TEST-TAKING STRATEGY: Use the process of elimination and knowledge regarding immunity to disease to answer the question. Eliminate option 4 first because of the absolute word "all." Next eliminate options 1 and 3 because they are similar. Review natural and acquired immunity now if you had difficulty with this question. 18. 2 RATIONALE: SLE is an inflammatory disease of collagen contained in connective tissue. Options 1, 3, and 4 are not associated with this disease. TEST-TAKING STRATEGY: Knowledge regarding the characteristics of SLE is required to answer this question. If you are unfamiliar with disorder, take time now to review. 19. 4 RATIONALE: Treatment of SLE is based on the systems involved and symptoms. Treatment normally consists of anti-inflammatories, orticosteroids, and immunosuppressants. Options 1, 2, and 3 are not a standard component of medication therapy. TEST-TAKING STRATEGY: Knowledge regarding the treatment for SLE is required to answer the question. If you are unfamiliar with the treatments normally prescribed in this disease, take time now to
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review. 20. 1 RATIONALE: The correct procedure for needle disposal is to dispose of uncapped needles and sharps in a hard-wall,puncture-resistant container immediately after use. Needles are not recapped. TEST-TAKING STRATEGY: Use the process of elimination and principles related to the safe disposal of needles and syringes to answer the question. Note that options 2,3, and 4 are similar in that they all address recapping the needle. Review these principles now if you had difficulty with this question.

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