NR 464 – EXAM 3 (SAUNDERS) | 2026
b b b b b b b b
ADVANCED NURSING 120 QUESTIONS WITH
b b b b b
Answers and explanations FOR IMMUNE DISOR
b b b b bb
DERS & COMPLEX CARE WITH MOST TESTED Q
b b b b b bb b
UESTIONS INCLUDED b
bThebnursebprovidesbhomebcarebinstructionsbtobabclientbwithbsystemicblupusberythematosusbandbtellsbt
hebclientbaboutbmethodsbtobmanagebfatigue.bWhichbstatementbbybthebclientbindicatesbabneedbforbfur
therbinstruction?
1. "Ibshouldbtakebhotbbathsbbecausebtheybarebrelaxing."
2. "Ibshouldbsitbwheneverbpossiblebtobconservebmybenergy."
3. "Ibshouldbavoidblongbperiodsbofbrestbbecausebitbcausesbjointbstiffness."
4. "Ibshouldbdobsomebexercises,bsuchbasbwalking,bwhenbIbambnotbfatigued."b-bANS>>-
1.b"Ib shouldbtakebhotbbathsbbecausebtheybarebrelaxing."
Tobhelpbreducebfatiguebinbthebclientbwithbsystemicblupusberythematosus,bthebnursebshouldbinstructbthe
bclientbtobsitbwheneverbpossible,bavoidbhotbbathsb(becausebtheybexacerbatebfatigue),bschedulebmoder
ateblow-
impactbexercisesbwhenbnotbfatigued,bandbmaintainbabbalancedbdiet.bThebclientbisbinstructedbtobavoidbl
ongbperiodsbofbrestbbecausebitbpromotesbjointbstiffness.
Thebnursebisbassistingbinbplanningbcarebforbabclientbwithbabdiagnosisbofbimmunodeficiencybandbshouldbinc
orporatebwhichbactionbasbabprioritybinbthebplan?
1. Protectingbthebclientbfrombinfection
2. Providingbemotionalbsupportbtobdecreasebfear
3. Encouragingbdiscussionbaboutblifestyleb changes
4. Identifyingbfactorsbthatbdecreasedbthebimmunebfunctionb-bANS>>-
1.bProtectingbtheb clientbfrombinfection
Thebclientbwithbimmunodeficiencybhasbinadequateborbanbabsencebofbimmunebbodiesbandbisbatbriskbfor
binfection.bThebprioritybnursingbinterventionbwouldbbebtobprotectbthebclientbfrombinfection.bOptionsb2
,b3,bandb4bmaybbebcomponentsbofbcarebbutbarebnotbthebpriority.
ThebclientbwithbacquiredbimmunodeficiencybsyndromebisbdiagnosedbwithbcutaneousbKaposi'sbsarcoma.
bBasedbonbthisbdiagnosis,bthebnursebunderstandsbthatbthisbhasbbeenbconfirmedbbybwhichbfinding?
1. Swellingbinbthebgenitalbarea
,2. Swellingbinbtheblowerbextremities
3. Positivebpunchbbiopsybofbthebcutaneousblesions
4. Appearancebofbreddish-blueblesionsbnotedbonbthebskinb-bANS>>-
3.bPositivebpunchb biopsybofbthebcutaneousblesions
Kaposi'sbsarcomablesionsbbeginbasbred,bdarkbblue,borbpurplebmaculesbonbtheblowerblegsbthatbchangebin
tobplaques.bTheseblargebplaquesbulcerateborbopenbandbdrain.bTheblesionsbspreadbbybmetastasisbthro
ughbthebupperbbodybandbthenbtobthebfacebandboralbmucosa.bTheybcanbmovebtobtheblymphaticbsystem
,blungs,bandbgastrointestinalbtract.bLatebdiseasebresultsbinbswellingbandbpainbinbtheblowerbextremities
,bpenis,bscrotum,borbface.bDiagnosisbisbmadebbybpunchbbiopsybofbcutaneousblesionsbandbbiopsybofbpul
monarybandbgastrointestinalblesions.
Thebhomebcarebnursebisbpreparingbtobvisitbabclientbwhobhasbundergonebrenalbtransplantation.bThebn
ursebdevelopsbabplanbofbcarebthatbincludesbmonitoringbthebclientbforbsignsbofbacutebgraftbrejection.bTh
ebnursebdocumentsbinbthebplanbtobassessbthebclientbforbwhichbsignsbofbacutebgraftbrejection?
1. Fever,bhypotension,bandbpolyuria
2. Hypertension,bpolyuria,bandbthirst
3. Fever,bhypertension,bandbgraftbtenderness
4. Hypotension,bgraftbtenderness,bandbhypothermiab-bANS>>-
3.bFever,bhypertension,bandb graftbtenderness
Abclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bhasbbeenbstartedbonbtherapybwithbzidovu
dine.bThebnursebshouldbmonitorbthebresultsbofbwhichblaboratorybbloodbstudybforbadversebeffectsbofbthe
rapy?
1. Creatinineblevel
2. Potassiumbconcentration
3. Completebbloodbcellb(CBC)bcount
4. Bloodbureabnitrogenb(BUN)blevelb-bANS>>-3.bCompletebbloodbcellb(CBC)bcount
Acquiredbimmunodeficiencybsyndromebisbabviralbdiseasebcausedbbybthebhumanbimmunodeficiencybvir
usb(HIV),bwhichbdestroysbTbcells,btherebybincreasingbsusceptibilitybtobinfectionbandbmalignancy.bCom
monbadversebeffectsbofbzidovudinebarebagranulocytopeniabandbanemia.bThebnursebshouldbmonitorbt
hebCBCbcountbforbthesebchanges.bCreatinine,bpotassium,bandbBUNbarebunrelatedbtobthisbmedication.
Thebnursebisbperformingbanbassessmentbonbabfemalebclientbwhobcomplainsbofbfatigue,bweakness,bmus
clebandbjointbpain,banorexia,bandbphotosensitivity.bSystemicblupusberythematosusb(SLE)bisbsuspected
.bWhatbshouldbthebnursebfurtherbassessbforbthatbalsobisbindicativebofbSLE?
,1. Ascites
2. Emboli
3. Facialbrash
4. TwobhemoglobinbSbgenesb-bANS>>-3.bFacialbrash
Systemicblupusberythematosusbisbabchronic,bprogressive,binflammatorybconnectivebtissuebdisorderbt
hatbcanbcausebmajorbbodyborgansbandbsystemsbtobfail.bAbbutterflybrashbonbthebcheeksbandbbridgebofbt
hebnosebisbanbessentialbsignbofbSLE.bAscitesbandbembolibarebfoundbinbmanybconditionsbbutbarebnotbas
sociatedbwithbSLE.bTwobhemoglobinbSbgenesbarebfoundbinbsicklebcellbanemia.
Abclientbhasbrequestedbandbundergonebtestingbforbhumanbimmunodeficiencybvirusb(HIV)binfection.bThebc
lientbasksbwhatbwillbbebdonebnextbbecausebthebresultbofbthebenzyme-
linkedbimmunosorbentbassayb(ELISA)bhasbbeenbpositive.bWhichbdiagnosticbstudybshouldbthebnursebbeba
warebofbbeforebrespondingbtobthebclient?
1. Nobfurtherbdiagnosticbstudiesbarebneeded.
2. AbWesternbblotbwillbbebdonebtobconfirmbthesebfindings.
3. Thebclientbprobablybwillbhavebabbonebmarrowbbiopsybdone.
4. AbCD4+bcellbcountbwillbbebdonebtobmeasurebTbhelperblymphocytes.b-bANS>>-
2.bAb Westernbblotbwillbbebdonebtobconfirmbthesebfindings.
Thebnursebisbcaringbforbabclientbwithbacquiredbimmunodeficiencybsyndromebandbdetectsbearlybinfecti
onbwithbPneumocystisbjirovecibbybmonitoringbthebclientbforbwhichbclinicalbmanifestation?
1. Fever
2. Cough
3. Dyspneabatbrest
4. Dyspneabonbexertionb-bANS>>-2.bCough
Pneumocystisbjirovecibpneumoniab(PCP)bisbabfungalbinfectionbandbisbabcommonbopportunisticbinfecti
on.bThebclientbwithbP.bjirovecibinfectionbusuallybhasbabcoughbasbthebfirstbsign.bThebcoughbbeginsbasbnon
productivebandbthenbprogressesbtobproductive.bLaterbsignsbandbsymptomsbincludebfever,bdyspneabo
nbexertion,bandbfinallybdyspneabatbrest.
Abclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bhasbabconcurrentbdiagnosisbofbhistoplas
mosis.bDuringbthebassessment,bthebnursebnotesbthatbthebclientbhasbenlargedblymphbnodes.bHowbshoul
dbthebnursebinterpretbthisbassessmentbfinding?
1. Thebhistoplasmosisbisbresolving.
2. Thebclientbhasbdisseminatedbhistoplasmosisbinfection.
3. ThisbisbabsidebeffectbofbthebmedicationsbgivenbtobtreatbAIDS.
, 4. Thebclientbprobablybhasbanotherbinfectionbthatbisbdeveloping.b-bANS>>-
2.bThebclientbhasbdisseminatedbhistoplasmosisbinfection.
HistoplasmosisbisbcausedbbybHistoplasmabcapsulatumbandbusuallybstartsbasbabrespiratorybinfectionbin
bthebclientbwithbAIDSbandbthenbbecomesbabdisseminatedbinfection,bwithbenlargementbofblymphbnodes
,bspleen,bandbliver.bThebclientbexperiencesbdyspnea,bfever,bcough,bandbweightbloss.bThebremainingbo
ptionsbarebincorrect.
Thebnursebisbcaringbforbabclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bwhobisbexperiencingb
nightbfeverbandbnightbsweats.bWhichbnursingbinterventionsbwouldbbebhelpfulbinbmanagingbthisbsympto
m?bSelectballbthatbapply.
1. Keepbliquidsbatbthebbedside.
2. Placebabtowelboverbthebpillowcase.
3. Makebsurebthebpillowbhasbabplasticbcover.
4. Keepbabchangebofbbedblinensbnearbybinbcasebtheybarebneeded.
5. Administerbanbantipyreticbafterbthebclientbhasbabspikebinbtemperature.b-bANS>>-
1.bKeepb liquidsbatbthebbedside.
2. Placebabtowelboverbthebpillowcase.
3. Makebsurebthebpillowbhasbabplasticbcover.
4. Keepbabchangebofbbedblinensbnearbybinbcasebtheybarebneeded.
ForbclientsbwithbAIDSbwhobexperiencebnightbfeverbandbnightbsweats,bthebnursebmaybofferbthebclientbanba
ntipyreticbofbchoicebbeforebthebclientbgoesbtobsleepbratherbthanbwaitingbuntilbthebclientbspikesbabtempe
rature.bKeepingbabchangebofbbedblinensbandbnightbclothesbnearbybforbusebalsobisbhelpful.bThebpillowbsh
ouldbhavebabplasticbcover,bandbabtowelbmaybbebplacedboverbthebpillowcasebifbdiaphoresisbisbprofuse.bTh
ebclientbshouldbhavebliquidsbatbthebbedsidebtobdrink.
Abclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bisbexperiencingbnauseabandbvomiting.bTheb
nursebshouldbincludebwhichbmeasurebinbthebdietarybplan?
1. Provideblarge,bnutritiousbmeals.
2. Servebfoodsbwhilebtheybarebhot.
3. Addbspicesbtobfoodbforbaddedbflavor.
4. Removebdairybproductsbandbredbmeatbfrombthebmeal.b-bANS>>-
4.bRemovebdairyb productsbandbredbmeatbfrombthebmeal.
Acquiredbimmunodeficiencybsyndromebisbabviralbdiseasebcausedbbybthebhumanbimmunodeficiencybvir
usb(HIV),bwhichbdestroysbTbcells,btherebybincreasingbsusceptibilitybtobinfectionbandbmalignancy.bThebclie
ntbwithbAIDSbwhobhasbnauseabandbvomitingbshouldbavoidbfattybproductsbsuchbasbdairybproductsbandbr
edbmeat.bMealsbshouldbbebsmallbandbfrequentbtoblessenbthebchancebofbvomiting.bThebclient
b b b b b b b b
ADVANCED NURSING 120 QUESTIONS WITH
b b b b b
Answers and explanations FOR IMMUNE DISOR
b b b b bb
DERS & COMPLEX CARE WITH MOST TESTED Q
b b b b b bb b
UESTIONS INCLUDED b
bThebnursebprovidesbhomebcarebinstructionsbtobabclientbwithbsystemicblupusberythematosusbandbtellsbt
hebclientbaboutbmethodsbtobmanagebfatigue.bWhichbstatementbbybthebclientbindicatesbabneedbforbfur
therbinstruction?
1. "Ibshouldbtakebhotbbathsbbecausebtheybarebrelaxing."
2. "Ibshouldbsitbwheneverbpossiblebtobconservebmybenergy."
3. "Ibshouldbavoidblongbperiodsbofbrestbbecausebitbcausesbjointbstiffness."
4. "Ibshouldbdobsomebexercises,bsuchbasbwalking,bwhenbIbambnotbfatigued."b-bANS>>-
1.b"Ib shouldbtakebhotbbathsbbecausebtheybarebrelaxing."
Tobhelpbreducebfatiguebinbthebclientbwithbsystemicblupusberythematosus,bthebnursebshouldbinstructbthe
bclientbtobsitbwheneverbpossible,bavoidbhotbbathsb(becausebtheybexacerbatebfatigue),bschedulebmoder
ateblow-
impactbexercisesbwhenbnotbfatigued,bandbmaintainbabbalancedbdiet.bThebclientbisbinstructedbtobavoidbl
ongbperiodsbofbrestbbecausebitbpromotesbjointbstiffness.
Thebnursebisbassistingbinbplanningbcarebforbabclientbwithbabdiagnosisbofbimmunodeficiencybandbshouldbinc
orporatebwhichbactionbasbabprioritybinbthebplan?
1. Protectingbthebclientbfrombinfection
2. Providingbemotionalbsupportbtobdecreasebfear
3. Encouragingbdiscussionbaboutblifestyleb changes
4. Identifyingbfactorsbthatbdecreasedbthebimmunebfunctionb-bANS>>-
1.bProtectingbtheb clientbfrombinfection
Thebclientbwithbimmunodeficiencybhasbinadequateborbanbabsencebofbimmunebbodiesbandbisbatbriskbfor
binfection.bThebprioritybnursingbinterventionbwouldbbebtobprotectbthebclientbfrombinfection.bOptionsb2
,b3,bandb4bmaybbebcomponentsbofbcarebbutbarebnotbthebpriority.
ThebclientbwithbacquiredbimmunodeficiencybsyndromebisbdiagnosedbwithbcutaneousbKaposi'sbsarcoma.
bBasedbonbthisbdiagnosis,bthebnursebunderstandsbthatbthisbhasbbeenbconfirmedbbybwhichbfinding?
1. Swellingbinbthebgenitalbarea
,2. Swellingbinbtheblowerbextremities
3. Positivebpunchbbiopsybofbthebcutaneousblesions
4. Appearancebofbreddish-blueblesionsbnotedbonbthebskinb-bANS>>-
3.bPositivebpunchb biopsybofbthebcutaneousblesions
Kaposi'sbsarcomablesionsbbeginbasbred,bdarkbblue,borbpurplebmaculesbonbtheblowerblegsbthatbchangebin
tobplaques.bTheseblargebplaquesbulcerateborbopenbandbdrain.bTheblesionsbspreadbbybmetastasisbthro
ughbthebupperbbodybandbthenbtobthebfacebandboralbmucosa.bTheybcanbmovebtobtheblymphaticbsystem
,blungs,bandbgastrointestinalbtract.bLatebdiseasebresultsbinbswellingbandbpainbinbtheblowerbextremities
,bpenis,bscrotum,borbface.bDiagnosisbisbmadebbybpunchbbiopsybofbcutaneousblesionsbandbbiopsybofbpul
monarybandbgastrointestinalblesions.
Thebhomebcarebnursebisbpreparingbtobvisitbabclientbwhobhasbundergonebrenalbtransplantation.bThebn
ursebdevelopsbabplanbofbcarebthatbincludesbmonitoringbthebclientbforbsignsbofbacutebgraftbrejection.bTh
ebnursebdocumentsbinbthebplanbtobassessbthebclientbforbwhichbsignsbofbacutebgraftbrejection?
1. Fever,bhypotension,bandbpolyuria
2. Hypertension,bpolyuria,bandbthirst
3. Fever,bhypertension,bandbgraftbtenderness
4. Hypotension,bgraftbtenderness,bandbhypothermiab-bANS>>-
3.bFever,bhypertension,bandb graftbtenderness
Abclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bhasbbeenbstartedbonbtherapybwithbzidovu
dine.bThebnursebshouldbmonitorbthebresultsbofbwhichblaboratorybbloodbstudybforbadversebeffectsbofbthe
rapy?
1. Creatinineblevel
2. Potassiumbconcentration
3. Completebbloodbcellb(CBC)bcount
4. Bloodbureabnitrogenb(BUN)blevelb-bANS>>-3.bCompletebbloodbcellb(CBC)bcount
Acquiredbimmunodeficiencybsyndromebisbabviralbdiseasebcausedbbybthebhumanbimmunodeficiencybvir
usb(HIV),bwhichbdestroysbTbcells,btherebybincreasingbsusceptibilitybtobinfectionbandbmalignancy.bCom
monbadversebeffectsbofbzidovudinebarebagranulocytopeniabandbanemia.bThebnursebshouldbmonitorbt
hebCBCbcountbforbthesebchanges.bCreatinine,bpotassium,bandbBUNbarebunrelatedbtobthisbmedication.
Thebnursebisbperformingbanbassessmentbonbabfemalebclientbwhobcomplainsbofbfatigue,bweakness,bmus
clebandbjointbpain,banorexia,bandbphotosensitivity.bSystemicblupusberythematosusb(SLE)bisbsuspected
.bWhatbshouldbthebnursebfurtherbassessbforbthatbalsobisbindicativebofbSLE?
,1. Ascites
2. Emboli
3. Facialbrash
4. TwobhemoglobinbSbgenesb-bANS>>-3.bFacialbrash
Systemicblupusberythematosusbisbabchronic,bprogressive,binflammatorybconnectivebtissuebdisorderbt
hatbcanbcausebmajorbbodyborgansbandbsystemsbtobfail.bAbbutterflybrashbonbthebcheeksbandbbridgebofbt
hebnosebisbanbessentialbsignbofbSLE.bAscitesbandbembolibarebfoundbinbmanybconditionsbbutbarebnotbas
sociatedbwithbSLE.bTwobhemoglobinbSbgenesbarebfoundbinbsicklebcellbanemia.
Abclientbhasbrequestedbandbundergonebtestingbforbhumanbimmunodeficiencybvirusb(HIV)binfection.bThebc
lientbasksbwhatbwillbbebdonebnextbbecausebthebresultbofbthebenzyme-
linkedbimmunosorbentbassayb(ELISA)bhasbbeenbpositive.bWhichbdiagnosticbstudybshouldbthebnursebbeba
warebofbbeforebrespondingbtobthebclient?
1. Nobfurtherbdiagnosticbstudiesbarebneeded.
2. AbWesternbblotbwillbbebdonebtobconfirmbthesebfindings.
3. Thebclientbprobablybwillbhavebabbonebmarrowbbiopsybdone.
4. AbCD4+bcellbcountbwillbbebdonebtobmeasurebTbhelperblymphocytes.b-bANS>>-
2.bAb Westernbblotbwillbbebdonebtobconfirmbthesebfindings.
Thebnursebisbcaringbforbabclientbwithbacquiredbimmunodeficiencybsyndromebandbdetectsbearlybinfecti
onbwithbPneumocystisbjirovecibbybmonitoringbthebclientbforbwhichbclinicalbmanifestation?
1. Fever
2. Cough
3. Dyspneabatbrest
4. Dyspneabonbexertionb-bANS>>-2.bCough
Pneumocystisbjirovecibpneumoniab(PCP)bisbabfungalbinfectionbandbisbabcommonbopportunisticbinfecti
on.bThebclientbwithbP.bjirovecibinfectionbusuallybhasbabcoughbasbthebfirstbsign.bThebcoughbbeginsbasbnon
productivebandbthenbprogressesbtobproductive.bLaterbsignsbandbsymptomsbincludebfever,bdyspneabo
nbexertion,bandbfinallybdyspneabatbrest.
Abclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bhasbabconcurrentbdiagnosisbofbhistoplas
mosis.bDuringbthebassessment,bthebnursebnotesbthatbthebclientbhasbenlargedblymphbnodes.bHowbshoul
dbthebnursebinterpretbthisbassessmentbfinding?
1. Thebhistoplasmosisbisbresolving.
2. Thebclientbhasbdisseminatedbhistoplasmosisbinfection.
3. ThisbisbabsidebeffectbofbthebmedicationsbgivenbtobtreatbAIDS.
, 4. Thebclientbprobablybhasbanotherbinfectionbthatbisbdeveloping.b-bANS>>-
2.bThebclientbhasbdisseminatedbhistoplasmosisbinfection.
HistoplasmosisbisbcausedbbybHistoplasmabcapsulatumbandbusuallybstartsbasbabrespiratorybinfectionbin
bthebclientbwithbAIDSbandbthenbbecomesbabdisseminatedbinfection,bwithbenlargementbofblymphbnodes
,bspleen,bandbliver.bThebclientbexperiencesbdyspnea,bfever,bcough,bandbweightbloss.bThebremainingbo
ptionsbarebincorrect.
Thebnursebisbcaringbforbabclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bwhobisbexperiencingb
nightbfeverbandbnightbsweats.bWhichbnursingbinterventionsbwouldbbebhelpfulbinbmanagingbthisbsympto
m?bSelectballbthatbapply.
1. Keepbliquidsbatbthebbedside.
2. Placebabtowelboverbthebpillowcase.
3. Makebsurebthebpillowbhasbabplasticbcover.
4. Keepbabchangebofbbedblinensbnearbybinbcasebtheybarebneeded.
5. Administerbanbantipyreticbafterbthebclientbhasbabspikebinbtemperature.b-bANS>>-
1.bKeepb liquidsbatbthebbedside.
2. Placebabtowelboverbthebpillowcase.
3. Makebsurebthebpillowbhasbabplasticbcover.
4. Keepbabchangebofbbedblinensbnearbybinbcasebtheybarebneeded.
ForbclientsbwithbAIDSbwhobexperiencebnightbfeverbandbnightbsweats,bthebnursebmaybofferbthebclientbanba
ntipyreticbofbchoicebbeforebthebclientbgoesbtobsleepbratherbthanbwaitingbuntilbthebclientbspikesbabtempe
rature.bKeepingbabchangebofbbedblinensbandbnightbclothesbnearbybforbusebalsobisbhelpful.bThebpillowbsh
ouldbhavebabplasticbcover,bandbabtowelbmaybbebplacedboverbthebpillowcasebifbdiaphoresisbisbprofuse.bTh
ebclientbshouldbhavebliquidsbatbthebbedsidebtobdrink.
Abclientbwithbacquiredbimmunodeficiencybsyndromeb(AIDS)bisbexperiencingbnauseabandbvomiting.bTheb
nursebshouldbincludebwhichbmeasurebinbthebdietarybplan?
1. Provideblarge,bnutritiousbmeals.
2. Servebfoodsbwhilebtheybarebhot.
3. Addbspicesbtobfoodbforbaddedbflavor.
4. Removebdairybproductsbandbredbmeatbfrombthebmeal.b-bANS>>-
4.bRemovebdairyb productsbandbredbmeatbfrombthebmeal.
Acquiredbimmunodeficiencybsyndromebisbabviralbdiseasebcausedbbybthebhumanbimmunodeficiencybvir
usb(HIV),bwhichbdestroysbTbcells,btherebybincreasingbsusceptibilitybtobinfectionbandbmalignancy.bThebclie
ntbwithbAIDSbwhobhasbnauseabandbvomitingbshouldbavoidbfattybproductsbsuchbasbdairybproductsbandbr
edbmeat.bMealsbshouldbbebsmallbandbfrequentbtoblessenbthebchancebofbvomiting.bThebclient
