NUR 4500-All Med Surge Exams and Quizzes (Quiz ).

NUR 4500-All Med Surge Exams and Quizzes (Quiz ). 1. A nurse is admitting a patient with an immunodeficiency to the medical unit. In planning the care of this patient, the nurse should assess for what common sign of immunodeficiency? a. Chronic diarrhea 2. A nurse is caring for a patient who has an immunodeficiency. What assessment finding should prompt the nurse to consider the possibility that the patient is developing an infection? a. Persistent diarrhea 3. The nurse is applying standard precautions in the care of a patient who has an immunodeficiency. What are key elements of standard precautions? Select all that apply. a. Using appropriate personal protective equipment b. Using safe injection practices c. Performing hand hygiene 4. A home health nurse is reinforcing health education with a patient who is immunosuppressed and his family. What statement best suggests that the patient has understood the nurse's teaching? a. “My family needs to understand that I'll probably need lifelong treatment.” 5. The nurse is preparing to administer IVIG to a patient who has an immunodeficiency. What nursing guideline should the nurse apply? a. Administer pretreatment medications as ordered 30 minutes prior to infusion. 6. A nurse has created a plan of care for an immunodeficient patient, specifying that care providers take the patient's pulse and respiratory rate for a full minute. What is the rationale for this aspect of care? a. These patients' blunted inflammatory responses can cause subtle changes in status. 7. A nurse is providing health education regarding self-care to a patient with an immunodeficiency. What teaching point should the nurse emphasize? a. The need for thorough oral hygiene 8. A patient's primary immunodeficiency disease is characterized by the inability of white blood cells to initiate an inflammatory response to infectious organisms. What is this patient's most likely diagnosis? a. Hyperimmunoglobulinemia E syndrome 9. A nurse is working with a patient who was diagnosed with HIV several months earlier. The nurse should recognize that a patient with HIV is considered to have AIDS at the point when the CD4+ T-lymphocyte cell count drops below what threshold? a. 200 cells/mm3 of blood 10. A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient? a. Obtain a stool culture to identify possible pathogens. 11. An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response? a. “It's possible that your baby could contract HIV, either before, during, or after delivery.” 12. Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV? a. Gay, bisexual, and other men who have sex with men 13. A hospital patient is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? a. Arrange for a portable x-ray machine to be used 14. A patient's current antiretroviral regimen includes nucleoside reverse transcriptase inhibitors (NRTIs). What dietary counseling will the nurse provide based on the patient's medication regimen? a. Take this medication without regard to meals. 15. A nurse is performing the admission assessment of a patient who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. a. Current medication regimen b. Identification of patient's support system c. Immune system function d. History of sexual practices 16. A patient is in the primary infection stage of HIV. What is true of this patient's current health status? a. The patient is infected with HIV but lacks HIV-specific antibodies. 17. A nurse is aware of the need to assess patients' risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis? a. Computed tomography with contrast solution 18. A patient with multiple food and environmental allergies tells the nurse that he is frustrated and angry about having to be so watchful all the time and wonders if it is really worth it. What would be the nurse's best response? a. “I can only imagine how you feel. Would you like to talk about it? 19. A nurse is caring for a patient who has allergic rhinitis. What intervention would be most likely to help the patient meet the goal of improved breathing pattern? a. Modify the environment to reduce the severity of allergic symptoms. 20. The nurse in an allergy clinic is educating a new patient about the pathology of the patient's health problem. What response should the nurse describe as a possible consequence of histamine release? a. Contraction of bronchial smooth muscle 21. A patient has presented with signs and symptoms that are consistent with contact dermatitis. What aspect of care should the nurse prioritize when working with this patient? a. Identifying the offending agent, if possible 22. A patient's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patient's drug regimen. What principle will guide this aspect of the patient's treatment? a. The drug should be used for as short a time as possible. 23. A patient with SLE has come to the clinic for a routine check-up. When auscultating the patient's apical heart rate, the nurse notes the presence of a distinct “scratching” sound. What is the nurse's most appropriate action? a. Inform the primary care provider that a friction rub may be present. 24. A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? a. Limiting intake of alcohol 25. A nurse is planning the care of a patient who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this woman's care needs? a. Ineffective Role Performance Related to Pain Test Bank Questions Not On Quiz 1 CHP 36 1. A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics. He then develops osteomyelitis of the right knee, prompting a detailed diagnostic workup that reveals a phagocytic disorder. This patient faces an increased risk of what complication? a. Neutropenia 2. A patient is admitted for the treatment of a primary immunodeficiency and intravenous immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse effect of IVIG administration? a. Anaphylaxis 3. A young couple visits the nurse practitioner stating that they want to start a family. The husband states that his brother died of a severe infection at age 6 months. He says he never knew what was wrong but his mother had him undergo ìblood testingî as a child. Based on these statements, what health problem should the nurse practitioner suspect? a. X-linked agammaglobulinemia 4. The parents of a 1-month-old infant bring their child to the pediatrician with symptoms of congestive heart failure. The infant is ultimately diagnosed with DiGeorge syndrome. What will prolong this infant's survival? a. Thymus gland transplantation 5. A patient who has received a heart transplant is taking cyclosporine, an immunosuppressant. What should the nurse emphasize during health education about infection prevention? a. Perform frequent hand-washing 6. The nurse is caring for a patient who has a diagnosis of paroxysmal nocturnal hemoglobinuria. When planning this patient's care, the nurse should recognize the patient's heightened risk of what complication? a. Venous thromboembolism 7. A patient diagnosed with common variable immune deficiency (CVID) has been admitted to the acute medicine unit. When reviewing this patient's laboratory findings, the nurse should prioritize what values? a. Hemoglobin and vitamin B12 8. Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines? a. Cook all food thoroughly 9. A nurse has admitted a patient diagnosed with severe combined immunodeficiency disease (SCID) to the unit. The patient's orders include IVIG. How will the patient's dose of IVIG be determined? a. The dose will be determined by the patient's response 10. IVIG has been ordered for the treatment of a patient with an immunodeficiency. Which of the following actions should the nurse perform before administering this blood product? a. Weigh the patient before administration to verify the correct dose. 11. A patient with a diagnosis of common variable immunodeficiency begins to develop thick, sticky, tenacious sputum. The patient has a history of episodes of pneumonia at least one time per year for the last 10 years. What does the nurse suspect the patient is developing? a. Bronchiectasis 12. A nurse is admitting an adolescent patient with a diagnosis of ataxiatelangiectasis. Which of the following nursing diagnoses should the nurse include in the patient's plan of care? a. Risk for Falls Due to Loss of Muscle Coordination 13. A 20-year-old patient with an immunodeficiency is admitted to the unit with an acute episode of upper airway edema. This is the fifth time in the past 3 months that the patient has had such as episode. As the nurse caring for this patient, you know that the patient may have a deficiency of what? a. C1esterase inhibitor 14. A patient with Wiskott-Aldrich syndrome is admitted to the medical unit. The nurse caring for the patient should prioritize which of the following? a. Protective isolation 15. The nurse is admitting a patient to the unit with a diagnosis of ataxiatelangiectasia. The nurse's assessment should reflect the patient's increased risk for what complication? a. Cancer 16. The nurse is working with the interdisciplinary team to care for a patient who has recently been diagnosed with severe combined immunodeficiency disease (SCID). What treatment is likely of most benefit to this patient? a. Hematopoietic stem cell transplantation (HSCT) 17. A patient has been admitted with a phagocytic cell disorder and the nurse is reviewing the most common health problems that accompany these disorders. The nurse should identify which of the following? Select all that apply. a. Chronic otitis media b. Cutaneous abscesses c. Pneumonia 18. A nurse is caring for a patient with a phagocytic cell disorder. The patient states, ìMy specialist says that I will likely be cured after I get my treatment tomorrow. To what treatment is the patient most likely referring? a. Hematopoietic stem cell transplantation 19. A nurse educator is explaining that patients with primary immunodeficiencies are living longer than in past decades because of advances in medical treatment. This increased longevity is associated with an increased risk of what? a. Cancer 20. The nurse educator is differentiating primary immunodeficiency diseases from secondary immunodeficiencies. What is the defining characteristic of primary immunodeficiency diseases? a. They have a genetic origin 21. The nurse is caring for a patient with an immunodeficiency who has experienced sudden malaise. The nurse's colleague states, ìI'm pretty sure that it's not an infection, because the most recent blood work looks fine.î What principle should guide the nurse's response to the colleague? a. Immunodeficient patients will usually exhibit subtle and atypical signs of infection 22. A patient with a diagnosis of primary immunodeficiency informs the nurse that he has been experiencing a new onset of a dry cough and occasional shortness of breath. After determining that the patient's vital signs are within reference ranges, what action should the nurse take? a. Assess the patient for signs and symptoms of infection 23. A nurse is preparing to administer a scheduled dose of IVIG to a patient who has a diagnosis of severe combined immunodeficiency disease (SCID). What medication should the nurse administer prior to initiating the infusion? a. Diphenhydramine 24. An immunocompromised patient is being treated in the hospital. The nurse's assessment reveals that the patient's submandibular lymph nodes are swollen, a finding that represents a change from the previous day. What is the nurse's most appropriate action? a. Inform the patient's primary care provider of this finding 25. A nurse caring for a patient who has an immunosuppressive disorder knows that continual monitoring of the patient is critical. What is the primary rationale behind the need for continual monitoring? a. So that early signs of impending infection can be detected and treated 26. A nurse is planning the care of a patient who requires immunosuppression to ensure engraftment of depleted bone marrow during a transplantation procedure. What is the most important component of infection control in the care of this patient? a. Thorough and consistent hand hygiene 27. A home health nurse is caring for a patient who has an immunodeficiency. What is the nurse's priority action to help ensure successful outcomes and a favorable prognosis? a. Encourage the patient and family to be active partners in the management of theimmunodeficiency 28. A nurse is preparing to discharge a patient with an immunodeficiency. When preparing the patient for self-infusion of IVIG in the home setting, what education should the nurse prioritize? a. Signs and symptoms of adverse reactions 29. A home health nurse will soon begin administering IVIG to a new patient on a regular basis. What teaching should the nurse provide to the patient? a. Expected benefits and outcomes of the treatment 30. The home health nurse is assessing a patient who is immunosuppressed following a liver transplant. What is the most essential teaching for this patient and the family? a. The need to report any slight changes in the patient's health status 31. Family members of an immunocompromised patient have asked the nurse why antibiotics are not being given to the patient in order to prevent infection. How should the nurse best respond? a. Using antibiotics to prevent infections can cause the growth of drug-resistant bacteria 32. A 6-month-old infant has been diagnosed with X-linked agammaglobulinemia and the parents do not understand why their baby did not develop an infection during the first months of life. The nurse should describe what phenomenon? a. Passive acquired immunity CHP 37 1. A clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication? a. HIV encephalopathy 2. A nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? a. Tachypnea and restlessness 3. A patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what? a. The patient has been infected with HIV 4. The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the patient? a. Can you tell me what concerns you most about dying? 5. The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? a. Hold the condom by the cuff upon withdrawal 6. A nurse is planning the care of a patient with AIDS who is admitted to the unit with Pneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this patient? a. Ineffective Airway Clearance 7. A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize which of the following interventions? a. Educational programs that focus on control and prevention 8. During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection? a. Pneumocystis pneumonia 9. A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patient's gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis? a. Diarrhea 10. A patient with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? a. Many patients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks 11. A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? a. Western blot test 12. The nurse's plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk? a. Providing thorough oral care before and after meals 13. A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? a. Administer antidiarrheal medications on a scheduled basis, as ordered 14. A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the patient and privately asks the nurse about the risk of contracting HIV when visiting the patient. What is the nurse's best response? a. AIDS isn't transmitted by casual contact 15. A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk? a. Utilize a pressure-reducing mattress (or low-air loss beds) 16. A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which of the following behaviors? a. The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure 17. A nurse is addressing the incidence and prevalence of HIV infection among older adults. What principle should guide the nurse's choice of educational interventions? a. Many older adults do not see themselves as being at risk for HIV infection 18. A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurse's best response? a. Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV 19. A patient's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the patient's immune response. This physiologic state is known as which of the following? a. Viral set point 20. A patient with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? a. Importance of personal hygiene 21. A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? a. Addressing possible barriers to adherence 22. The nurse is caring for a patient who has been admitted for the treatment of AIDS. In the morning, the patient tells the nurse that he experienced night sweats and recently ìcoughed up some blood.î What is the nurse's most appropriate action? a. Place the patient on respiratory isolation and inform the physician (Note: this is a sign of possible TB) 23. A patient has come into contact with HIV. As a result, HIV glycoproteins have fused with the patient's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle? a. Attachment 24. An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/μL, and the nurse recognizes the patient's increased risk for Mycobacterium avium complex (MAC disease). The nurse should anticipate the administration of what drug? a. Azithromycin 25. A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this patient should expect the physician to order what drug for the management of the patient's diarrhea? a. Sandostatin 26. A patient with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in AIDS patients by increasing body fat stores? a. Megestrol 27. A nurse is completing a nutritional status of a patient who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. a. Serum albumin level b. Weight history c. BMI d. BUN level 28. A nurse is assessing the skin integrity of a patient who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? a. Peri-anal region and oral mucosa 29. A hospital nurse has experienced percutaneous exposure to an HIV-positive patient's blood as a result of a needlestick injury. The nurse has informed the supervisor and identified the patient. What action should the nurse take next? a. Report to the emergency department or employee health department 30. The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care? a. Keep the patient's bed linens free of wrinkles 31. A patient who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? a. Teach the patient guided imagery 32. A patient who has AIDS has been admitted for the treatment of Kaposi's sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? a. Impaired Skin Integrity Related to Kaposi's Sarcoma b. (This is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it doesn’t constitute a risk for disuse syndrome) CHP 38 1. A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin? a. Immunoglobulin E 2. An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity? a. Anaphylactic (type 1) 3. A patient is learning about his new diagnosis of asthma with the asthma nurse. What medication has the ability to prevent the onset of acute asthma exacerbations? a. Montelukast (Singulair) 4. A nurse is preparing a patient for allergy skin testing. Which of the following precautionary steps is most important for the nurse to follow? a. Emergency equipment should be readily available 5. A patient who is scheduled for a skin test informs the nurse that he has been taking corticosteroids to help control his allergy symptoms. What nursing intervention should the nurse implement? a. The patient's test should be cancelled until he is off his corticosteroids (and/or antihistamines, including OTC allergy meds b/c all of these suppress skin test reactivity and should be stopped 48 to 96 hours before testing, depending on the duration of their activity) 6. A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the nurse teach the patient to do? a. Keep her hands well-moisturized at all times (powdered latex gloves can cause contact dermatitis) 7. A patient with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the patient about this treatment? a. The patient will remain in the clinic to be monitored for 30 minutes following theinjection 8. The nurse is providing care for a patient who has experienced a type I hypersensitivity reaction. What condition is an example of such a reaction? a. Anaphylactic reaction after a bee sting Feedback:Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by IgE antibodies and requires previous exposure to the specific antigen. Skin reactions are more commonly type IV and myasthenia gravis is thought to be a type II reaction. Rheumatoid arthritis is not a type I hypersensitivity reaction. 9. A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patient's discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self- administer epinephrine in what site? a. Thigh 10. A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a patient's plan of care. The presence of what chronic health problem would most likely prompt this diagnosis? a. Spina bifida 11. A patient has a documented history of allergies presents to the clinic. She states that she is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability to concentrate. The nurse should identify which of the following nursing diagnoses? a. Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification 12. A patient's decline in respiratory and renal function has been attributed to Goodpasture syndrome, which is a type II hypersensitivity reaction. What pathologic process underlies the patient's health problem? a. The patient's body has mistakenly identified a normal constituent of the body as foreign 13. A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens? a. Eggs and wheat The most common causes of food allergies are seafood (lobster, shrimp, crab, clams, fish), legumes (peanuts, peas, beans, licorice), seeds (sesame, cottonseed, caraway, mustard, flaxseed, sunflower seeds), tree nuts, berries, egg white, buckwheat, milk, and chocolate. 14. A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values? a. Increased eosinophils 15. After the completion of testing, a child's allergies have been attributed to her family's cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action? a. Removing the cat from the family's home 16. The nurse is providing health education to the parents of a toddler who has been diagnosed with food allergies. What should the nurse teach this family about the child's health problem? a. Many children outgrow their food allergies in a few years if they avoid the offending foods 17. A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is a priority for health education? a. The need for the parents to carry an epinephrine pen 18. An adolescent patient's history of skin hyperreactivity and inflammation has been attributed to atopic dermatitis. The nurse should recognize that this patient consequently faces an increased risk of what health problem? a. Asthma 19. The nurse is planning the care of a patient who has a diagnosis of atopic dermatitis, which commonly affects both of her hands and forearms. What risk nursing diagnosis should the nurse include in the patient's care plan? a. Risk for Disturbed Body Image Related to Skin Lesions 20. A patient has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patient's condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply a. Foods b. Medications c. Insect stings 21. A school nurse is caring for a child who appears to be having an allergic response. What should be the initial action of the school nurse? a. Assess for signs and symptoms of anaphylaxis 22. A patient is receiving a transfusion of packed red blood cells. Shortly after initiation of the transfusion, the patient begins to exhibit signs and symptoms of a transfusion reaction. The patient is suffering from which type of hypersensitivity? a. Cytotoxic (type II) 23. Which of the following individuals would be the most appropriate candidate for immunotherapy? a. A patient with severe allergies to grass and tree pollen 24. A nurse has asked the nurse educator if there is any way to predict the severity of a patient's anaphylactic reaction. What would be the nurse's best response? a. The faster the onset of symptoms, the more severe the reaction 25. A nurse knows of several patients who have achieved adequate control of their allergy symptoms using over-the-counter antihistamines. Antihistamines would be contraindicated in the care of which patient? a. A pregnant woman at 30 weeks' gestation 26. A patient has been living with seasonal allergies for many years, but does not take antihistamines, stating, ìWhen I was young I used to take antihistamines, but they always put me to sleep.î How should the nurse best respond? a. The newer antihistamines are different than in years past, and cause lesssedation 27. A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patient's respiratory status. How should the nurse evaluate the patient's respiratory status? Select all that apply. a. Assess breath sounds b. Measure the child’s oxygen saturation by oximeter c. Monitor the child’s respiratory pattern d. Assess the child’s respiratory rate 28. A nurse at an allergy clinic is providing education for a patient starting immunotherapy for the treatment of allergies. What education should the nurse prioritize? a. The importance of keeping appointments for desensitization procedures (b/c dosages are adjusted on a weekly basis, and missed appts may interfere w/the dosage adjustment) 29. A patient was prescribed an oral antibiotic for the treatment of sinusitis. The patient has now stopped, stating she developed a rash shortly after taking the first dose of the drug. What is the nurse's most appropriate response? a. Refer the woman to her primary care provider to have the medication changed 30. A patient has sought care, stating that she developed hives overnight. The nurse's inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed? a. Type I 31. The nurse is providing care for a patient who has a diagnosis of hereditary angioedema. When planning this patient's care, what nursing diagnosis should be prioritized? a. Risk for Impaired Gas Exchange Related to Airway Obstruction 32. A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. What should the nurse suspect? a. Anaphylaxis due to a latex allergy 33. The nurse is creating a care plan for a patient suffering from allergic rhinitis. Which of the following outcomes should the nurse identify? a. Improved coping with lifestyle modifications 34. A 5-year-old boy has been diagnosed with a severe food allergy. What is an important parameter to address when educating the parents of this child about his allergy and care? a. Wear a medical identification bracelet 35. A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurse's priority for care? a. Protect the patient's airway CHP 39 1. A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved? a. Arthocentesis 2. A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? a. Methotrexate (Rheumatrex) 3. A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection? a. Butterfly rash 4. A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following? a. Increased uric acid levels 5. A patient's decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem? a. Rheumatoid arthritis (RA) 6. A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? a. Joint stiffness, especially in the morning 7. A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should address what potential adverse effect? a. Infection 8. A clinic nurse is caring for a patient newly diagnosed with fibromyalgia. When developing a care plan for this patient, what would be a priority nursing diagnosis for this patient? a. Fatigue Related to Pain 9. A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor? a. The patient's body mass index is 34 (obese). 10. A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? a. OA is a considered a noninflammatory joint disease. RA is characterized byinflamed, swollen joints 11. A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? a. I'll make sure to monitor my body temperature on a regular basis 12. A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses angerand irritation when her call bell isn't answered immediately. What would be the most appropriate response? a. "You seem like you're feeling angry. Is that something that we could talk about?" 13. A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patient's care, what goal should the nurse include? a. The patient will express satisfaction with her ability to perform ADLs 14. A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care? a. Fatigue Related to Anemia 15. The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome? a. Raynaud's phenomenon 16. Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? a. Decreased platelets 17. A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications? a. Gold-containing compounds (Stomatitis is associated with gold therapy) 18. A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect? a. Visual changes (caused by anti-malaria meds, so regular ophthalmologic exams are necessary) 19. A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug? a. “I have this ringing in my ears that just won’t go away” (Tinnitis is associated with salicylate therapy) 20. Patient develops hirsutism, what is this associated with? a. Corticosteroid therapy 21. A patient has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of what aspects of PMR? Select all that apply. a. PMR has an association with the genetic marker HLA-DR4 b. Immunoglobulin deposits occur in PMR c. PMR occurs predominately in Caucasians 22. A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize? a. Assessment for headaches and jaw pain 23. A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply. a. Erythrocyte sedimentation rate b. C-reactive protein 24. A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patient's health should the nurse focus most closely during the visit? a. The patients functional status 25. A 21-year-old male has just been diagnosed with a spondyloarthropathy. What will be a priority nursing intervention for this patient? a. Teaching about symptom management 26. A patient with SLE asks the nurse why she has to come to the office so often for ìcheck-ups.î What would be the nurse's best response? a. Taking care of you in the best way involves monitoring your disease activity andhow well the prescribed treatment is working 27. A patient is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this patient is that he will stop taking the medication as soon as he starts to feel better. Why must the nurse emphasize the need for continued adherence to the prescribed medication? a. To avoid complications such as blindness 28. A patient with polymyositisis experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action? a. Facilitate referrals to occupational and physical therapy 29. A nurse is creating a teaching plan for a patient who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply. a. Managing Raynaud’s-type symptoms b. Smoking cessation c. The importance of vigilant skin care 30. A 40-year-old woman was diagnosed with Raynaud's phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are ìstiff, like the skin is being stretched from all directions.î The nurse should recognize the need for medical referral for the assessment of what health problem? a. Scleroderma Scleroderma starts insidiously with Raynaud's phenomenon and swelling in the hands. Later, the skin and the subcutaneous tissues become increasingly hard and rigid and cannot be pinched up from the underlying structures. This progression of symptoms is inconsistent with GCA, FM, or RA