170-year-old client is diagnosed with cartilaginous A. Advise the client to take warm showers.
degeneration. Which action would the nurse take?
A. Advise the client to take warm showers.
B. Teach the client isometric exercises.
C. Provide the client with supportive armchairs.
D. Demonstrate weight-bearing exercises to the client.
After initiating antibiotic therapy on a client with syphilis, A. Fever with shaking chills
the nurse suspects a Jarisch-Herxheimer reaction. Which D. Generalized aches
clinical manifestations support the nurse's suspicion? Select E. Pain at the injection site
all that apply. One, some, or all responses may be correct.
A. Fever with shaking chills
B. Hypertensive crisis
C. Vasoconstriction
D. Generalized aches
E. Pain at the injection site
Arrange the steps required to stimulate antibody mediated 2, 5, 4, 3, 6, 1
immunity in its correct sequence.
1. Neutralization or elimination of the antigen Rationale
2. Invasion of new antigens in the body Antibody-mediated immunity reaction is stimulated when a new antigen invades the
3. Production of antibodies by B lymphocytes body. The antigen is recognized in the body by the interaction of macrophage and
4. Sensitization of B lymphocyte to the new antigen helper T cells. Then sensitization of B lymphocytes to the new antigen occurs.
5. Interaction of the macrophage and helper T cells to Antibodies against the antigens are produced by B lymphocytes. These antibodies
recognize the antigen bind to the antigen, and the immune complex is formed, which causes cellular events
6. Binding of antibodies to the antigen and formation of that result in neutralization or elimination of the antigen.
immune complex
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At which joint would the nurse be able to palpate spongy D. Temporomandibular joint
swelling caused by excess synovial fluid?
A. Biaxial joint
B. Pivotal joint
C. Synovial joint
D. Temporomandibular joint
A client diagnosed with acquired immunodeficiency D. "There is no cure for AIDS, but there are medications that can slow down the virus.
syndrome (AIDS) states, I'm not worried because they have
a cure for AIDS. Which response would the nurse use?
A. 'Repeated phlebotomies may be able to rid you of the
virus.
B. 'You may be cured of AIDS after prolonged
pharmacological therapy.
C. "Perhaps you should have worn condoms to prevent
contracting the virus.'
D. "There is no cure for AIDS, but there are medications that
can slow down the virus.
A client exhibits dysphasia, dry mouth, drooping eyelids, C. Botulism
blurred vision, vomiting, and diarrhea. Within 24 hours, the
client develops bilateral cranial nerve impairment and
descending weakness. Which bioterrorism agent presents
with these clinical manifestations?
A. Plague
B. Anthrax
C. Botulism
D. Smallpox
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A client had an annual tuberculin purified protein derivative C. The client has been exposed to the tubercle bacillus.
(PPD) test, and the area of induration was 10 mm within 48
hours after planting. Which
conclusion would the nurse make about the client's response
to this diagnostic?
A. The client has contracted clinical tuberculosis.
B. The client has passive immunity to tuberculosis.
C. The client has been exposed to the tubercle bacillus.
D. The client has developed a resistance to the tubercle
bacillus.
A client in the emergency department states, 'I was bitten by C. Cleanse the wound with soap and water.
a raccoon while repairing a water pipe under my house.
Which intervention would be an effective first-aid treatment
for the nurse to implement for this client?
A. Administer an antivenin.
B. Maintain a pressure dressing.
C. Cleanse the wound with soap and water.
D. Apply a tourniquet proximal to the wound.
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A client is diagnosed with hyperthyroidism and is treated A. Fatigue
with I-131. Before discharge the nurse teaches the client to B. Dry skin
observe for signs and symptoms of therapy-induced E. Progressive weight gain
hypothyroidism. Which signs and symptoms would be
included in the teaching? Select all that apply. One, some, or Rationale
all responses may be correct. Fatigue is caused by a decreased metabolic rate associated with hypothyroidism. Dry
A. Fatigue skin most likely is caused by decreased glandular function associated with
B. Dry skin hypothyroidism. Progressive weight gain is associated with hypothyroidism in
C. Insomnia response to a decrease in the metabolic rate because of insufficient thyroid hormone.
D. Intolerance to heat Insomnia is associated with hyperthyroidism, not hypothyroidism, in response to an
E. Progressive weight gain increase in the metabolic rate because of excessive thyroid hormone. Intolerance to
heat is associated with hyperthyroidism, not hypothyroidism, in response to an
increase in the metabolic rate because of excessive thyroid hormone.
A client receiving calcitonin therapy reports a stinging D. Total serum calcium of 8 mg/dL (2 mmol/L)
sensation in the hands and feet. Which finding will the nurse
observe in the client's laboratory results if the client is Rationale
experiencing a side effect of calcitonin therapy? Calcitonin therapy is associated with the risk of hypocalcemia, which is manifested by
A. Serum sodium of 139 mEq/L (mmol/L) tingling or numbness in the muscles. Normal levels of total calcium lie between 9.0 to
B. Serum creatinine of 0.4 mg/dL (35.36 umol/L) 10.5 mg/dL (2.25-2.75 mmol/L). Because the client's total serum calcium
C. Blood urea nitrogen of 17 mg/dL (6.07 mmol/L) concentration is 8 mg/dL (2 mmol/L), the nurse would conclude that the client has
D. Total serum calcium of 8 mg/dL (2 mmol/L) hypocalcemia. All the other values will not cause tingling or numbness in the muscles.
The normal range of
sodium in the serum ranges from 135 to 145 mEq/L (135-145 mmol/L). The normal
level of serum creatinine ranges from 0.6 to 1.2 mg/dL (53.04-106.08 mol/L);
although 0.4 mg/dL (35.36 umol/L) is low, it will not cause stinging sensation in the
hands and feet. The normal range of blood urea nitrogen lies between 7 and 20 mg/dL
(2.5-7.14 mmol/L), and 17 mg/dL (6.07 mmol/L) is considered normal.
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