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NUR265 Literally Exam 4 (100% Correct
Answers with Rationale)
The nurse working in the ED is triaging a client who has presented with chest pain,
shortness of breath, a productive cough, and reports nights sweats. That clients health
history includes the presence of acquired immunodeficiency syndrome (AIDS) and the
recent laboratory results that reveal a low CD4+ count. Airborne precautions have been
initiated. Which of the following actions should the nurse take next?
ANSWER: Check the client’s temperature
RATIONALE: A fever is a symptom of AIDS exacerbation.
The newly hired nurse is developing a plan of care for a client who has acquired AIDS
and was just diagnosed with pneumocystis jiroveci pneumonia and pain. Which of the
following interventions should the nurse preceptor question?
ANSWER: Placing the client on a pressure-relieving mattress
RATIONALE: That is not an appropriate intervention.
The nurse is caring for a client with AIDS who has just been diagnosed with cryptococcal meningitis. Which of the
following actions should the nurse take?
ANSWER: Initiate seizure precautions with padded side rails
RATIONALE: Pg.965. Patients may have seizures.
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The nurse had provided medication instructions to a client who has human
immunodeficiency virus (HIV) and has been prescribed combination antiretroviral
therapy (cART). Which of the following client statements indicates a correct
understanding of the teaching?
ANSWER:“I can avoid developing drug resistance if I take 90% of my drugs on time.”
RATIONALE: Pg. 976. It is important to teach patients to take at least 90% of their
meds on time to prevent drug resistance.
The nurse working in a community health center has instructed a group of clients who have acquired immune deficiency syndrome
ANSWER: “I will wear a surgical mask when I change my cat’s litter box.”
RATIONALE: Pg. 974. Do not change cat’s litter box. Wear gloves and immediately wash hands.
The nurse is precepting a newly hired nurse who is caring for a client who has AIDS and has
developed Kaposil’s sarcoma. It requires additional teaching by the preceptor if the newly
hired nurse
ANSWER: Applies a surgical mask before entering the
client’s room. RATIONALE: Pg.983. This is not an appropriate
The nurse is caring for a client who had a heart transplant 24 hours ago. Which of the following findings indicates the clients develo
ANSWER: Hypotension
RATIONALE: Pg.1842. Hypotension is a symptom of heart transplant rejection.
intervention.
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NUR265 Literally Exam 4 (100% Correct
Answers with Rationale)
The nurse working in the ED is triaging a client who has presented with chest pain,
shortness of breath, a productive cough, and reports nights sweats. That clients health
history includes the presence of acquired immunodeficiency syndrome (AIDS) and the
recent laboratory results that reveal a low CD4+ count. Airborne precautions have been
initiated. Which of the following actions should the nurse take next?
ANSWER: Check the client’s temperature
RATIONALE: A fever is a symptom of AIDS exacerbation.
The newly hired nurse is developing a plan of care for a client who has acquired AIDS
and was just diagnosed with pneumocystis jiroveci pneumonia and pain. Which of the
following interventions should the nurse preceptor question?
ANSWER: Placing the client on a pressure-relieving mattress
RATIONALE: That is not an appropriate intervention.
The nurse is caring for a client with AIDS who has just been diagnosed with cryptococcal meningitis. Which of the
following actions should the nurse take?
ANSWER: Initiate seizure precautions with padded side rails
RATIONALE: Pg.965. Patients may have seizures.
,2
The nurse had provided medication instructions to a client who has human
immunodeficiency virus (HIV) and has been prescribed combination antiretroviral
therapy (cART). Which of the following client statements indicates a correct
understanding of the teaching?
ANSWER:“I can avoid developing drug resistance if I take 90% of my drugs on time.”
RATIONALE: Pg. 976. It is important to teach patients to take at least 90% of their
meds on time to prevent drug resistance.
The nurse working in a community health center has instructed a group of clients who have acquired immune deficiency syndrome
ANSWER: “I will wear a surgical mask when I change my cat’s litter box.”
RATIONALE: Pg. 974. Do not change cat’s litter box. Wear gloves and immediately wash hands.
The nurse is precepting a newly hired nurse who is caring for a client who has AIDS and has
developed Kaposil’s sarcoma. It requires additional teaching by the preceptor if the newly
hired nurse
ANSWER: Applies a surgical mask before entering the
client’s room. RATIONALE: Pg.983. This is not an appropriate
The nurse is caring for a client who had a heart transplant 24 hours ago. Which of the following findings indicates the clients develo
ANSWER: Hypotension
RATIONALE: Pg.1842. Hypotension is a symptom of heart transplant rejection.
intervention.
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