What are the symptoms of a mild and severe latex glove allergy quizlet

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NCLEX Exam: Integumentary Disorders 1 (60 Items)

Congratulations — you own completed NCLEX Exam: Integumentary Disorders 1 (60 Items).

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682 Matching questions

  • «A 30-year-old client whose mom died of breast cancer at age 44 and whose sister has ovarian cancer is concerned about developing cancer. A nurse who is a member of the oncology multidisciplinary team should propose that the client enquire the physician about which of the following actions?
  • Impaired Skin Integrity, Related to Open Lesions (Herpes Simplex)
  • pneumonia
    c/b H. influenze typ b
  • What is the gold standard test for colon cancer?
  • Development Stage: Skin Adolescence
  • A client with metastatic cancer is experiencing neuropathic pain.

    Which alternative therapy is most beneficial in treating this type of pain?

  • On the burn pt who has myoglobin in their urine, what drug might be ordered to flush the kidneys?
  • A patient has a scald burn on the arm that is bright red, moist, and has several blisters. The nurse would classify this burn as which of the following?
    Select every that apply.
    1. a superficial partial-thickness burn
    2. a thermal burn
    3. a superficial burn
    4. a deep partial-thickness burn
    5. a full-thickness burn
  • What is a type D fire extinguisher used for?
  • A nurse is teaching a class of older adults at a senior middle about household cleaning agents that may cause burns.

    Which agents should be included in these instructions?
    (Select every that apply)
    1. drain cleaners
    2. household ammonia
    3. oven cleaner
    4. toiler bowl cleaner
    5. lemon oil furniture polish

  • meningitis
    c/b H. influenzae
  • A patient is admitted to the emergency department with deep partial-thickness burns over 35 % of the body. What IV solution will be started initially?
    1. warmed lactated Ringer’s solution
    2. dextrose 5% with saline solution
    3.

    dextrose 5% with water
    4. normal saline solution
    5. 0.45% saline solution

  • Types of diseases where contact precautions is necessary
  • T or F?
    African Americans own a greater incidence of cancer than Caucasians.
  • A patient with ovarian cancer is being treated with cisplatin and taxotere and is receiving the second in a series of treatments. During the first hour of treatment, the patient complains of dizziness, urticaria, and chest pain. The first and priority intervention for the nurse to initiate is to:
  • List 6 suspected dietary causes of cancer?
  • A normal, healthy nail appears…
  • What are S&S of ovarian CA?
  • A nurse is caring for patients with a variety of wounds.

    Which would will most likely heal by primary intention?

    1. Cut in the skin from a kitchen knife
    2. Excoriated perineal area
    3. Abrasion of the skin
    4. Pressure ulcer

  • Radioactive iodine
  • How can breast cancer prevention programs best serve women who are at risk and come from lower socioeconomic backgrounds?
  • Hypodermis (Subcutaneous Tissues)
  • «A client with stage II ovarian cancer undergoes a entire abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which data collection finding would lift concern in the nurse?
  • A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity.

    Which intervention should be part of this client’s plan of care?

  • localized herpes zoster (shingles),
    immunocompromised person
  • hepatitis E
  • Scar
  • What are appropriate nursing interventions for a burn patient?
  • Immune globulin: ponder ______________ protection d/t ______________ immunity.
  • The family of a patient with third-degree burns wants to know why the «scabs are being cut off» of the patient’s leg. What is the most appropriate response by the nurse to this family?
    1.

    «The scabs are really ancient burned tissue and need to be removed to promote healing.»
    2. «I’ll enquire the doctor to come and talk with you about the treatment plan.»
    3. «The patient asked for the scabs to be removed.»
    4. «The scabs are removed to check for blood flow to the burned area.»

  • T or F?
    The nurse should only care for 2 pts with radiation implants in a given shift.
  • MISC. FACTS
  • influenza (flu)
  • Assessment of Herpes Simplex
  • How is it spread
  • 25. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer.

    Which statement by the patient may indicate a need for a change in treatment?
    a. «I own frequent muscle aches and pains.»
    b. «I rarely own the energy to get out of bed.»
    c. «I take acetaminophen (Tylenol) every 4 hours.»
    d. «I experience chills after I inject the interferon.»

  • pneumonia
    c/b S. aureus
  • Hep B transmission
  • How numerous doses of the INITIAL influenza vaccination are recommended for children?
  • During posttest counseling for a patient who has positive testing for HIV, the patient is anxious and does not appear to hear what the nurse is saying.

    At this time, it is most significant that the nurse
    a. inform the patient how to protect sexual and needle-sharing partners.
    b. teach the patient about the medications available for treatment.
    c. enquire the patient to notify individuals who own had risky contact with the patient.
    d. remind the patient about the need to return for retesting to verify the results.

  • What would you question with a c diff pt
  • What are the s/s of colon cancer?
  • What drug will enhance immune system for use in cancer patients?
  • C — A 1-inch margin is considered unsterile and is the barrier spacing between the sterile field in the middle of the drape and the edge of the drape.

    Liquids spilled on a waterproof drape will not absorb from or be contaminated from the surface beneath. Although such a situation could be messy, bacteria would not cross from the unsterile to the sterile side. The edge of the table and the 1-inch border create the edge of the sterile field. Anything under the edge, including the side of the drape, becomes unsterile. Reaching over a sterile field is always a source of contamination and should not be done.

  • 2 Primary Layers of Skin
  • After being in remission from Hodgkin’s disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to law out advancing Hodgkin’s disease and infection.

    Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain and rigidity, and seems increasingly confused. The nurse suspects that these findings result from:

  • removing personal protective equipment (PPE)
  • Collagenase should not be applied where? (4)
  • A patient with colon cancer who has completed two rounds of chemotherapy has been admitted for acute cholecystistis and will undergo surgical cholecystectomy.

    Which of the following laboratory values would the nurse question and relate to the physician?

  • After a physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond?
  • «For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
  • airborne precautions
  • What should you tell the pt to prepare for the GUAIAC test
  • What is the Parkland formula?

    And how is it istered?

  • A burn pt has an order for morphine that states: «Morphine 2mg IVP or Morphine 4mg IVP Q 2 hrs PRN pain». If the pt is complaining of 4/10 pain, what dosage should the RN give to the pt?
  • A 24-year-old lady who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse informs the patient that the best way to reduce the risk of HIV infection from drug use is to
    a. participate in a needle-exchange program.
    b. clean drug injection equipment before use.
    c. enquire those who share equipment to be tested for HIV.
    d. avoid sexual intercourse when using injectable drugs.
  • A patient arrives at the emergency department with an electrical burn.

    What assessment questions should the nurse enquire in determining the possible severity of the burn injury? Select every that apply.
    1. What type of current was involved?
    2. How endless was the patient in contact with the current?
    3. How much voltage was involved?
    4. Where was the patient when the burn occurred?
    5. What was the point of contact with the current?

  • Standard Precations are defined as
  • pertussis (Whooping Cough)
  • «A few minutes after beginning a blood transfusion, the nurse notes that the client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing:
  • During the acute phase of burn treatment, significant goals of patient care include which of the following?
    Select every that apply.
    1.

    providing for patient comfort
    2. preventing infection
    3. providing adequate nutrition for healing to occur
    4. splinting, positioning, and exercising affected joints
    5. assessing home maintenance management

  • Development Stage: Skin Adult
  • What are the S/S for Botulism
  • The condition of a patient’s hands and feet can show what??
  • Acyclovir
  • When receiving a report at the beginning of your shift, you study that your assigned client has a surgical incision that is healing by primary intention. You know that your client’s incision is:

    1. Well approximated, with minimal or no drainage.
    2.

    Going to take a little longer than usual to heal.
    3. Going to own more scarring than most incisions.
    4. Draining some serosanguineous drainage.

  • Wheal
  • The client who has undergone colon resection with permanent colostomy for diagnosis of colon cancer refuses to engage in care of the ostomy. She states that she will never be capable to go out in public again. An appropriate referral by the nurse is to:
  • At how numerous months should the Hep B vaccination be given? (3 doses)
  • What are the characteristics of the prodromal phase of infection?
  • Always follow these guidelines when giving a patient a bath
  • Following surgical debridement, a patient with third-degree burns does not bleed.

    The nurse realizes that this patient
    1. will need to own the procedure repeated.
    2. will no longer need this procedure.
    3. will need to be premedicated prior to the next procedure.
    4. should own an escharotomy instead.

  • A patient develops food poisoing from conaminated potato salad. what is the means of transmission for the infection organism?
    a. direct contact
    b. vector
    c.

    vehicle
    d. airborne

  • What are the risk factors for uterine cancer? (5)
  • A patient, experiencing a burn that is pale and waxy with large flat blisters, asks the nurse about the severity of the burn and how endless it will take to heal. With which of the following should the nurse reply to this patient?
    1. The wound is a deep partial-thickness burn, and will take more than three weeks to heal.
    2. The wound is a partial-thickness burn, and could take up to two weeks to heal.
    3. The wound is a superficial burn, and will take up to three weeks to heal.
    4.

    The wound is a full-thickness burn and will take one to two weeks to heal.
    5. Wound healing is individualized.

  • A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client’s history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis?
  • What is the greatest risk factor for bladder cancer?
  • The layer under the dermis
  • TORCH infections
  • When designing a program to decrease the incidence of HIV infection in the community, the nurse will prioritize education about
    a.

    how to prevent transmission between sexual partners.
    b. methods to prevent perinatal HIV transmission.
    c. ways to sterilize needles used by injectable drug users.
    d. means to prevent transmission through blood transfusions.

  • What are S&S of stomach CA?
  • «For a client with newly diagnosed cancer, the nurse assists in formulating a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?
  • What are S&S of breast CA?
  • Fissure
  • pediculosis (lice)
  • What are risk factors for breast CA?
  • A — The blood is a reservoir for pathogens in hepatitis B and C.

    Neither organism can survive in the urinary, reproductive, or respiratory tract.

  • What other ATB might be prescribed to treat c diff
  • What does plasma seep out into the tissue after a burn? And when does it occur?
  • Herpes Zoster Diagnostics
  • When should a pt with a ileal conduit change their appliance? and why?
  • Which of the following items are used to act out wound care irrigation?

    Select every that apply.

    1. Clean gloves
    2. Sterile gloves
    3. Refrigerated irrigating solution
    4. 60-mL syringe

  • A 35-year-old female client is requesting information about mammograms and breast cancer. She isn’t considered at high risk for breast cancer. What should the nurse tell this client?
  • CONDITIONS REQUIRED SEIZURE PRECAUTIONS
  • Functions of the Skin
  • A client has a diabetic stasis ulcer on the lower leg. The nurse uses a hydrocolloid dressing to cover it.

    The procedure for application includes:

    1. Cleaning the skin and wound with betadine
    2. Removing every traces of residues for the ancient dressing
    3. Choosing a dressing no more than quarter-inch larger than the wound size
    4. Holding in put for one minute to permit it to adhere

  • Assess Dark Skin
  • A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include:
  • In addition to standard precautions, the nurse caring for a patient with rubella would plan to implement what type of precautions?
    a.

    droplet precautions
    b. airborne precautions
    c. Contact precautions
    d. universal precautions

  • The nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia (ALL). The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates an understanding of the physician’s description of the diagnosis and treatment?
  • A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse assists with formulating a nursing diagnosis of Risk for injury. Which «related-to» phrase is appropriate for the nurse to add to finish the nursing diagnosis statement?
  • Describe precautions used with internal radiation.
  • diphtheria
  • Why is it significant to know what time the burn occurred?
  • What are the characteristics of the invasive phase of infection?
  • Is there more death with upper or lower body burns?
  • In what order should PPE be put on?
  • Erosion
  • hepatitis B
  • What is the minimum SBP needed for adequate organ perfusion?
  • What disease are contact precautions?
  • Oral care for patients with Diabetes
  • A patient recovering from a major burn injury is complaining of pain.

    Which of the following medications will be most therapeutic to the patient?
    1. morphine 4 mg IV every 5 minutes
    2. morphine 10 mg IM ever 3-4 hours
    3. meperidine 75 mg IM every 3-4 hours
    4. meperidine 50 mg PO every 3-4 hours
    5. fentanyl citrate (Duragesic) 75 mcg patch every 3 days

  • HIV/AIDS
  • Which of the following would you select to determine if a pt’s fluid volume is adequate…urine output or weight?
  • Contact Precautions
  • What should you teach to someone undergoing chemo about chemo-induced N&V?
  • When working with an older person, you would hold in mind that the older person is most likely to experience which of following changes with aging?

    1.

    Thinning of the epidermis
    2. Thickening of the epidermis
    3. Oiliness of the skin
    4.

    What are the symptoms of a mild and severe latex glove allergy quizlet

    Increased elasticity of the skin

  • A patient is being evaluated for a suspicious lesion of the lung and asks why the doctor cannot just take it out instead of doing a bronchoscopy. The best response by the nurse is:
  • Medical Management Herpes Simplex
  • At what ages should the IPV (Polio) vaccination be given to children? (4 doses)
  • A client was recently enrolled in a clinical trial for lung cancer. The client’s health insurance provider asks the nurse caring for the client about the client’s status, treatment regimen, and possible adverse effects of the medication she is taking.

    How can the nurse best respond?

  • A pregnant lady with a history of asymptomatic HIV infection is seen at the clinic. Which information will the nurse include when teaching the patient?
    a. Although infants of HIV-infected mothers always test positive for HIV antibodies, most infants are not infected with the virus.
    b. Because she has not developed AIDS, the baby will not contract HIV during intrauterine life.
    c. The baby will be started on zidovudine (AZT) after delivery to prevent HIV infection.
    d. It is likely that her newborn will develop HIV infection unless she takes antiretroviral drugs during the pregnancy.
  • «A 43-year-old black client without a family history of prostate cancer asks the nurse when he should own a prostate-specific antigen (PSA) test and a digital rectal examination (DRE) performed.

    Which response by the nurse is appropriate?

  • How would you take off Personal protective gear?
  • plague bubonic
  • A nurse is preparing a client for discharge after a prolonged hospitalization in which the client had a colon resection and colostomy formation for treatment of colon cancer. The client’s family has concerns about managing his care at home. Which factor is most significant in ensuring successful home care?
  • The CDC standard precaution recommendations apply to which of the following?
    a.

    only patients with diagnosed infections
    b. only blood and body fluids with visible blood
    c. every body fluids including sweat
    d. every pateints receiving care in hospitals

  • What are risk factors for colon CA?
  • Vesicle
  • The nurse is preparing to give the following medications to an HIV-positive patient who is hospitalized with PCP. Which is most significant to ister at the correct time?
    a. Nystatin (Mycostatin) tablet for vaginal candidiasis
    b. Aerosolized pentamadine (NebuPent) for PCP infection
    c.

    Oral acyclovir ((Zovirax to treat systemic herpes simplex
    d. Oral saquinavir (Inverase) to suppress HIV infection

  • Which nursing intervention is most appropriate for a client with multiple myeloma
  • «A client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?
  • 7. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient understands the purpose of a biopsy?
    a. «The biopsy will tell the doctor whether the cancer has spread to my other organs.»
    b.

    «The biopsy will assist the doctor decide what treatment to use for my enlarged prostate.»
    c. «The biopsy will determine how much longer I own to live.»
    d. «The biopsy will indicate the effect of the cancer on my life.»

  • When can a kid start receiving the annually influenza vaccination?
  • Signs of Peripheral Neuropathy
  • What position should the neck be in for the burn pt?
  • What common ailments of the feet are there?
  • A client becomes neutropenic 11 days after his final chemotherapy cycle.

    It’s obvious that the client understands his condition when he states:

  • Pneumocystis jiroveci
  • adenovirus
  • disseminated herpes zoster (shingles)
  • Group B beta-hemolytic streptococcus
  • A 46 year ancient patient with a diagnosis of breast cancer agrees to participate in a study involving potential noncytotoxic nutrients and pharmacologic chemoprotective agent. What is significant for the patient to understand before participating in the study?
  • What are S&S of bladder CA?
  • «A client with uterine cancer asks the nurse, «»Which type of cancer causes the most deaths in women?»» How should the nurse respond?
  • 21.

    A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin’s lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient’s concerns is
    a. «Radiation does not cause the problems with sexual functioning that happen with chemotherapy or surgical procedures used to treat cancer.»
    b.

    What are the symptoms of a mild and severe latex glove allergy quizlet

    «It is possible you may own some changes in your sexual function, and you may desire to consider pretreatment harvesting of sperm if you desire children.»
    c. «The radiation will make you sterile, but your ability to own sexual intercourse will not be changed by the treatment.»
    d. «You may own some temporary impotence during the course of the radiation, but normal sexual function will return.»

  • A client is admitted to an acute care facility with esophageal cancer.

    The incidence of esophageal cancer is highest in:

  • Can exposed individuals spread the plague?
  • How is Salmonella transmitted
  • When caring for an obese client 4 to 5 days post-surgery, who has nausea and occasional vomiting and is not keeping fluids below well, which of the following would you be most concerned about?

    1. Post surgical hemorrhage and anemia
    2. Wound dehiscence and evisceration
    3. Impaired skin integrity and decubitus ulcers
    4.

    Loss of motility and paralytic illeus

  • A patient is being evaluated after experiencing severe burns to his torso and upper extremities. The nurse notes edema at the burned areas. Which of the following best describes the underlying cause for this assessment finding?
    1. inability of the damaged capillaries to maintain fluids in the cell walls
    2. reduced vascular permeability at the site of the burned area
    3. decreased osmotic pressure in the burned tissue
    4.

    increased fluids in the extracellular compartment
    5. the IV fluid being istered too quickly

  • Predisposed Dark Skin
  • What can cause changes in hair follicles?
  • In assessing a postmastectomy client, the nurse determines that the client is in denial. The nurse can best reply by:
  • severe acute respiratory syndrome (SARS)
  • -mycin drugs are ___________ toxic.
  • A client with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
  • The ABCD method offers one way to assess skin lesions for possible skin cancer.

    What does the A stand for?

  • Which of the following should the client undergoing radiation therapy for diagnosis of squamous cell cancer of the head and neck be cautioned avoid?
  • What is dumping syndrome?
  • Hair growth indicates
  • What is the #1 cause of preventible cancer?
  • Assess Mucous Membranes
  • How often is chemotherapy scheduled?
  • Keloid
  • What are the smallest infectious agents capable of causing an infection?
    a. bacteria
    b. viruses
    c. molds
    d. yeast
  • What is a GUAIAC test?
  • When evaluating the laboratory values of the burn-injured patient, which of the following can be anticipated?
    1.

    decreased hemoglobin and elevated hematocrit levels
    2.

    What are the symptoms of a mild and severe latex glove allergy quizlet

    elevated hemoglobin and elevated hematocrit levels
    3. elevated hemoglobin and decreased hematocrit levels
    4. decreased hemoglobin and decreased hematocrit levels
    5. hemoglobin and hematocrit levels within normal ranges

  • Primary skin lesions
  • What should a Contact Precaution pt have
  • 13. Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching?
    a.

    The patient swims a mile 5 days a week.
    b. The patient eats frequently during the day.
    c. The patient showers with Dove soap daily.
    d. The patient has a history of dental caries.

  • 1. While being prepared for a biopsy of a lump in the correct breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors
    a. do not cause damage to adjacent tissue.
    b.

    do not spread to other tissues and organs.
    c. are simply an overgrowth of normal cells.
    d. frequently recur in the same site.

  • What pt’s would be ok for a pregnant nurse to care for
  • Herpes Simplex
  • What are risk factors for esophagus CA?
  • While teaching community groups about AIDS, the nurse informs people that the most common method of transmission of the HIV virus currently is
    a. perinatal transmission to the fetus.
    b. sharing equipment to inject illegal drugs.
    c. transfusions with HIV-contaminated blood.
    d. sexual contact with an infected partner.
  • «The nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction.

    She’s in her 30s and has two young children. Although she’s worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?

  • At what ages should the PCV (pneumococcal) vaccination be given to children? (4 doses)
  • A nurse is working with a dying client and his family. Which communication technique is most significant to use?
  • The nurse is evaluating the adequacy of a burn-injured patient’s nutritional intake. Which of the following laboratory values is the best indicator of a need to adjust the nutritional program?
    1.

    glycosuria
    2. creatine phosphokinase (CPK)
    3. BUN levels
    4. hemoglobin
    5. serum sodium levels

  • What is the law of 9s?
  • How can you prevent Salmonella
  • What physiological conditions are contraindicated for using heat as a therapy? (Select every that apply.)

    1. The first 24 hours of injury
    2. Athletic hemorrhage
    3. Noninflammatory edema
    4. Localized malignant tumor

  • A patient comes into the emergency department with a chemical burn from contact with lye.Assessment and treatment of this patient will be based on what knowledge regarding this type of burn?

    (Select every that apply)
    1. This is an alkali burn.
    2. This type of burn tends to be deeper.
    3. This is an acid burn.
    4. This type of burn will be easier to neutralize.
    5. This type of burn tends to be more superficial.

  • In regards to cancer, what does the acronym C-A-U-T-I-O-N stand for?
  • What is the most significant postoperative instruction the nurse must give a client who has just returned from the operating room after receiving a subarachnoid block?
  • Legionnaire’s disease
  • A patient is brought to the emergency department with the following burn injuries: a blistered and reddened anterior trunk, reddened lower back, and pale, waxy anterior correct arm.

    Calculate the extent of the burn injury (TBSA) using the law of nines.

  • What is an indication of proper use of a triangle arm sling?

    1. The elbow is kept flexed at 90 degrees or more.
    2. The knot is placed on either side of the vertebrae of the neck.
    3. The sling extends to just proximal of the hand.
    4. The sling is removed q2h to assess for circulation and skin integrity.

  • Why are IV pain meds preferred over IM in pt’s with burns?
  • polychlorinated biphenyls
  • A patient who tested positive for HIV 3 years ago is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP).

    Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), the patient is diagnosed as having
    a. early chronic infection.
    b. HIV infection.
    c. AIDS.
    d. intermediate chronic infection.

  • INTERVENTION FOR PREVENT ASPIRATION
  • GENERAL RULES FOR VACCINES
  • What are risk factors for bladder CA?
  • Mucositis
  • pulmonary tuberculosis
  • D — Keeping the solution in drainage tubes draining away from the drainage site on the body reduces the risk for bacteria growth. Running any solution backward in the tubing puts the client at risk by bringing any bacteria that may be present lower in the system back to the body, and cross contamination will happen.

    As in surgical areas, anything under the waist should be considered at potential risk for infection. Needles are not to be recapped or cut because of the increased risk of experiencing puncture wounds while doing so. Not every dressings need to be placed in red bags; only dressings with moisture require placement in a red bag. Bottles of solution that are sitting in the client’s room should be closed to prevent airborne contaminants from entering and creating an unsterile situation.

  • What can impair saliva secretion
  • Your client states she is fearful that her mammogram will be abnormal and that she may die of breast cancer.

    Your best response is:

  • A — The cuff is folded and touched to apply the glove; thus, it becomes contaminated during application of the glove. Generally the cuff will drop below over the wrist, but if it does not, then it is considered unsterile and should not be touched during the procedure. Every of the outer part of the glove is sterile unless it has been contaminated. The inner wrapper that held the sterile glove is not contaminated unless one touches it.

    Therefore, the outer part of the glove can touch it without contamination. The powder is sterile and will not contaminate anything it touches.

  • A 25-year-old patient is admitted with partial-thickness injuries over 20% of the entire body surface area involving both lower legs. The nurse would classify this injury as being which of the following?
    1. a moderate burn
    2. a minor burn
    3. a major burn
    4. a severe burn
    5. an intermediate burn
  • What are the symptoms of viral hemorrhagic fevers?
  • Hep A transmission
  • Airborne Precautions
  • botulism
  • What should you teach the patient undergoing radiation about hygiene?
  • smallpox
  • Factors influencing Hygiene
  • What is a entire laryngectomy?
  • During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy.

    Which nursing intervention is most likely to decrease the pain of stomatitis?

  • Who is not capable to start PPE
  • What are contact precautions?
  • When giving a pt albumin, you know the vascular volume will do what to the heart? Why?
  • What must the body do to obtain athletic immunity?
  • Assess Presence
  • Is mucous in the urine normal with an ileal conduit?
  • What colors indicate blood in the stool when doing GUAIAC test
  • What is NL urine output for adults?
  • meningitis
    c/b N. meningitis
  • 30.

    After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient?
    a. Acute confusion related to infiltration of leukemia cells into the central nervous system
    b. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment
    c.

    Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis
    d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy

  • D — If the nurse touches a sheet (nonsterile) with sterile gloves, the gloves are contaminated. The other actions do not contaminate sterile gloves.
  • You are preparing a community education program about cancer prevention and early detection for a clinic serving a majority of African-American adults. Which types of cancer would be most significant to include?
  • What are S&S of colon CA?
  • What are the 4 disease states in the viral hemorrhagic fever family?
  • A patient has experienced a burn injury.

    Which of the following interventions by the nurse is of the highest priority at this time?
    1. determination of the type of burn injury
    2. determination of the types of home remedies attempted prior to the patient’s coming to the hospital
    3. assessment of past medical history
    4.

    What are the symptoms of a mild and severe latex glove allergy quizlet

    determination of body weight
    5. determination of nutritional status

  • DON’T TRANSFER WHICH PATIENT
  • What are the symptoms of pneumonic plague?
  • How is artificial acquired immunity brought about?
  • 3. A patient who smokes tells the nurse, «I desire to own a annually chest x-ray so that if I get cancer, it will be detected early.» Which response by the nurse is most appropriate?
    a. «Chest x-rays do not detect cancer until tumors are already at least a half-inch in size.»
    b. «Annual x-rays will increase your risk for cancer because of exposure to radiation.»
    c. «Insurance companies do not authorize annually x-rays just to detect early lung cancer.»
    d.

    «Frequent x-rays damage the lungs and make them more susceptible to cancer.»

  • Interventions such as promotion of nutrition, exercise, and stress reduction should be promoted by the nurse for patients who own HIV infection, primarily because these interventions will
    a. promote a feeling of well-being in the patient.
    b. prevent transmission of the virus to others.
    c. improve the patient’s immune function.
    d. increase the patient’s strength and self-care ability.
  • The nurse is assessing a 72 year ancient patient with finish stage chronic obstructive pulmonary disease for admission into a palliative care program.

    The patient shared concerns about the effects of ending treatment and the possibility of increasing symptoms. What is the nurse’s best response?

  • 12. A patient with Hodgkin’s lymphoma is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, the patient tells the nurse, «I am so tired I can hardly get out of bed in the morning.» An appropriate intervention for the nurse to plan with the patient is to
    a. exercise vigorously when fatigue is not as noticeable.
    b. consult with a psychiatrist for treatment of depression.
    c.

    establish a time to take a short stroll every day.
    d. maintain bed relax until the treatment is completed.

  • (SELECT Every THAT APPLY) After having a lobectomy for lung cancer, a client receives a chest tube connected to a three-chamber chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes which of the following?
  • honey crusted lesions
  • What are the s/s of cervical cancer? (5)
  • What are the symptoms of inhalation anthrax?
  • A nurse is caring for and obese 62 year ancient patient with arthritis who has developed an open reddened area over his sacrum.

    which of the following is a priority nursing diagnosis?
    a. imbalanced nutrition: more than body requirements related to immobility
    b. impaired physical mobility related to pain and discomfort
    c. Chronic Pain related to immobility
    d. risk for infection related to altered skin integrity

  • Where would you see a rash w/ Rocky mountain spotted fever?
  • What should you do if the c diff is linked to an ATB
  • Assess Health History
  • What are risk factors for ovarian CA?
  • Your client has a pressure ulcer over the sacral area that is believed to be due to shearing force.

    The client’s family asks you to explain shearing force. You would be most precise if you tell the family that shearing force involves:

    1. A tearing of the muscle tissue due to a considerable downward force.
    2. A sudden break in skin integrity due to being pulled against the bed linens.
    3. A superficial skin fold getting pinched, and tissues irritated by the pressure.
    4. Superficial skin surface relatively unmoving in relation to the bed surface.

  • A client is receiving chemotherapy to treat breast cancer. Which data collection finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
  • What should be done first with a pt who has a chemical burn?
  • «A client seeks care for hoarseness that has lasted for 1 month.

    To elicit the most appropriate information about this problem, the nurse should enquire which question?

  • Is a sputum specimen a sterile procedure?
  • How can the RN assist prevent dislodgement of a radiation implant?
  • To combat the most common adverse effects of chemotherapy, the nurse would ister an:
  • Varicella-Zoster (Chickenpox)
  • 48 hrs after the burn, what should the RN worry about?
  • Can someone who is immunocompromised own lettuce?
  • A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?
  • The nurse notes that a patient with third-degree burns is demonstrating a reduction in his serum potassium level.

    The nurse realizes that this finding is consistent with which of the following?
    1. the resolution of burn shock
    2. the onset of burn shock
    3. the onset of renal failure
    4. the onset of liver failure

  • hepatitis C
  • What helpful of diet is needed for a PT with hepatitis A
  • A staff nurse on the oncology unit must teach a new unit assistant about infection control practices on the unit. The nurse should explain that the most significant measure to prevent the spread of infection is what?
  • A patient with a burn injury is prescribed silver nitrate. Which of the following nursing interventions should be included for the patient?
    Standard Text: Select every that apply.
    1.

    Monitor daily weight.
    2. Monitor the serum sodium levels.
    3. Prepare to change the dressings every two hours.
    4. Report black skin discolorations.
    5. Shove fluid intake.

  • cellulitis
    c/b group A strep.
  • (SELECT Every THAT APPLY) What diagnostic studies are recommended to be performed annually on every women older than age 40?
  • What is the NL urine output for kids?
  • Alopecia
  • Prognosis Herpes Simplex
  • What can be done to stop the burning process?
  • What is the most significant information that should be included in a breast cancer prevention program for college woman?
  • What is the law of palms?
  • 28. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices.

    Which snack choice by the patient indicates that the teaching has been effective?
    a. Unused fruit salad
    b. Orange sherbet
    c. Strawberry yogurt
    d.

    What are the symptoms of a mild and severe latex glove allergy quizlet

    French fries

  • What are the symptoms of ricin ingestion?
  • Why is the burn pt at risk for hyperkalemia?
  • What is significant to know about adverse reactions of external radiation to pelvis?
  • Your client has a Braden scale score of 17. Which is the most appropriate nursing action?

    1. Assess the client again in 24h; the score is within normal limits.
    2. Implement a turning schedule; the client is at increased risk for skin breakdown.
    3.

    Apply a transparent wound barrier to major pressure sites; the client is at moderate risk for skin breakdown.
    4. Request an order for a special low-air-loss bed; the client is at extremely high risk for skin breakdown.

  • When we a central line, there is a high risk of splashing of blood. We wear eye shields, gowns, gloves, masks-the whole bit. What type of precaution are we using?
  • The nurse is teaching a client who suspects that she has a lump in her breast.

    The nurse instructs the client that a diagnosis of breast cancer is confirmed by:

  • Are breast and ovarian cancer linked? Who is at greatest risk for getting these types of CA?
  • When assessing an individual who has been diagnosed with early chronic HIV infection and has a normal CD4+ count, the nurse will
    a. enquire about problems with diarrhea.
    b. examine the oral mucosa for lesions.
    c. check neurologic orientation.
    d. palpate the regional lymph nodes.
  • (SELECT Every THAT APPLY) A client with laryngeal cancer has undergone laryngectomy and is receiving radiation therapy to the head and neck. The nurse should monitor the client for which adverse effects of external radiation?
  • A client’s family asks you to explain some keloid scars that the client developed.

    The best explanation of the keloid scars would be that keloid scars are:

    1. Due to a relatively rare inherited tendency.
    2. Caused by an abnormal quantity of collagen being laid below in scar formation.
    3. Most common in pale-skinned people of Northern European ancestry.
    4. Caused by repeated and abrupt early disruption of eschar being formed.

  • Drug therapy is being considered for an HIV-infected patient who has a CD4+ cell count of 400/µl. The nursing assessment that is most significant in determining whether therapy will be used is the patient’s
    a. social support system offered by significant others and family.
    b.

    socioeconomic status and availability of medical insurance.
    c. understanding of the multiple side effects that the drugs may cause.
    d. willingness and ability to comply with stringent medication schedules.

  • Describe a superficial burn.
  • Why is there a higher incidence of cancer in people older than 60 y/o?
  • When teaching a patient with HIV infection about ART, the nurse explains that these drugs
    a. work in various ways to decrease viral replication in the blood.
    b. boost the ability of the immune system to destroy the virus.
    c. destroy intracellular virus as well as lowering the viral load.

ATI COMPREHENSIVE 2.

1.

Following abdominal surgery, a client's abdominal wound edges are separating, and the wound is draining a large quantity of serous drainage. Thenurse should put the client: Incorrect: This position is incorrect because it can increase tension on the suture line, and cause further wound separation and tearing (dehiscence).Incorrect: This position is incorrect because it can increase tension on thesuture line, and cause further wound separation and tearing (dehiscence).Correct: The semi-Fowler's position decreases tension on the wound, and it may prevent further separation and tearing of the wound(dehiscence).Incorrect: This position is incorrect because it can increase tension on the suture line, and cause further

ATI COMPREHENSIVE 2.

1.

Following abdominal surgery, a client's abdominal wound edges are separating, and the wound is draining a large quantity of serous drainage. Thenurse should put the client: Incorrect: This position is incorrect because it can increase tension on the suture line, and cause further wound separation and tearing (dehiscence).Incorrect: This position is incorrect because it can increase tension on thesuture line, and cause further wound separation and tearing (dehiscence).Correct: The semi-Fowler's position decreases tension on the wound, and it may prevent further separation and tearing of the wound(dehiscence).Incorrect: This position is incorrect because it can increase tension on the suture line, and cause further


determine dislodgement of pacer leads.

5.

The nurse is istering eye drops to a client. To prevent injury, the nurse should: Incorrect: The nurse should enquire the client to "look up" before instilling the eye drops. This action reduces stimulation of the corneal reflex and injury to the eye, should the client jerk away.Incorrect: Eye drops should never bedropped directly onto the cornea as this action may injure the cornea. The nurse should deposit the medication onto the lower conjunctiva.Correct: As a safety precaution, the nurse istering eye drops should relax his hand on the client's forehead. In case the client moves, the nurse's hand will move at the same time, lowering the risk that thedropper will hit the client's eye.Incorrect: When istering eye drops, it is essential to own an adequate quantity oflight.

However, the nurse should not shine a bright light directly into the client's eye. enquire the client to "look down" before instilling the eye drops. drop the eye drops directly onto the client's cornea. relax his hand on the client's forehead. shine a bright light into the client's eye.

6. Which statement is true regarding the behavior of clients who are in pain? Incorrect: Numerous clients avoid conversation and social contacts when they are experiencing pain.

Clients with chronic pain may become withdrawn and isolated.Incorrect: Clients' reactions to pain are often influenced by theircultural and ethnic background. The nurse needs to consider each client's cultural background when assessing a

client's pain.Incorrect: Clients often put their hands over the painful area as a self-protective or guardingmechanism to prevent further pain.Correct: Numerous clients fail to report or discuss their pain or discomfort with nursesand other caretakers. Thus, the PN needs to assess clients for pain on a routine basis.

Clients experiencing pain may engage in social activities for distraction. Clients from diverse cultures react to pain in the same way. Clients in pain generally avoid touching the painful area. Clients who are in pain may not report their pain to the nurse or other caretakers.

7. A client is being discharged from same-day surgery following cataract extraction from the correct eye. The nurse will instruct the client to: Correct: Lifting requires straining, which increases pressure in the eye and may disrupt suture lines.Incorrect: The client should not bend forward or lower the head. This action increases pressure in the eye and could disrupt suture lines.Incorrect: Mild pain is normal.

However, moderate to severe pain should be reported to the surgeon.Incorrect: The client should sleep on the unaffected (left side) to reduce pressure in the eye. Increased pressure could disrupt the suture lines. avoid lifting anything heavier than five pounds until cleared by the surgeon. bend from the waist to pick up objects on the floor. call the surgeon immediately if he has any discomfort. sleep on his back or on his correct side.

8. Substance abuse is diagnosed when the person's involvement with drugs oralcohol:

Incorrect: Substance abuse is likely to cause or contribute to family conflict.

However, family conflict is not a diagnostic criterion for substance abuse.Incorrect: Substance abuse generally leads to physical health problems overtime. However, physical illness is not a diagnostic criterion for substance abuse.Correct: A client has a problem with substance abuse when that person begins to develop interpersonal difficulties, and is not capable to act out their roleadequately at work or at school.Incorrect: A person abusing substances may come to the attention of the law. However, the development of legal difficulties are not a diagnostic criterion for substance abuse.

causes family conflicts. causes physical illness. interferes with the person's ability to function. results in legal problems.

9. A newly employed nurse discovers that some medication doses are incorrect. Coworkers confess that changes in medication orders own not been processedcorrectly, but they advise the nurse to ister the medication anyway. The nurse should:

Incorrect: This action is an unsafe practice, and it violates the five rights of medication istration.Incorrect: Reporting the incident to the State Board of Nursing is not the first step in resolving theissue.Correct: The nurse needs to inform the nurse manager about the unsafe medication practice and incorrect medication dosages.

The nurse manager can then determine how to resolve this intradepartmental issue.Incorrect: Resigning will not resolve the issue and it will permit the unsafe practice to continue. give the dose that is available. report the incident with documentation to the State Board of Nursing. report this unsafe practice to the nurse manager. resign due to unsafe practices.

10. The nurse is teaching a client with tuberculosis about ways to reduce spreadof the disease to others. Teaching is effective when the client states: Incorrect: Tuberculosis is spread by droplet nuclei, and not through contact with the skin of an infected person.Incorrect: Tuberculosis is spread by droplet nuclei, and not through blood contact.Incorrect: Clients with tuberculosis need to cover their mouths when they giggle to reduce spread of the disease.Correct: Tuberculosis is spread by droplet nuclei.

Thus, covering the mouth when coughing decreases the release of droplet nuclei into the air, and the spread of the disease to other people. "I can transmit tuberculosis to others by touching them." "I can transmit tuberculosis to others through contact with my blood." "I don't need to cover my mouth when I laugh." "I'll cover my mouth with a tissue when I cough."

11.

The nurse performs a physical assessment on a newborn baby. Which finding, if noted, is abnormal and needs to be reported? Incorrect: Apnea lasting 5-15 seconds is periodic apnea, and is normal for the newborn. No intervention is required as endless as there is no change in the infant's heart rate.Incorrect: A blue color in the fingers and toes is called acrocyanosis, and it is a normal finding in the newborn in the first couple of days after birth.Incorrect: Gagging orchoking is common in the hours following birth because the baby was in a fluid-filled environment for the gestation. There should be a bulb syringe in the infant's crib at every times to suction the mouth, pharynx, and nose, and clear theairway as needed.Correct: Normal respirations range for the newborn is 30-60 respirations per minute.

Rapidbreathing is a sign of respiratory distress, which may indicate sepsis or other complications and should be reportedimmediately. Apnea lasting 5 to 15 seconds Blue color in the fingers and toes Gagging or choking Respirations of 80 per minute

12. The nurse is providing discharge teaching to a client who is at high risk forinfection. The client asks if there is any way to prevent getting a freezing. Whichresponse from the nurse is correct?

Incorrect: The common freezing is caused by a virus. Antibiotics are not prescribed for the common cold.Incorrect: This is not practical advice, and it does not necessarily eliminate exposure.Incorrect: A mask may decrease risk of infection, but it is not the most effective measure.Correct: Handwashing is the most effective preventive measure for a freezing. "Ask your doctor for an antibiotic that you can take."

"Stay indoors during the height of freezing and flu season." "Wear a mask when going outdoors during freezing and flu season." "Wash your hands frequently during freezing and flu season."

13.

The nurse is interviewing the wife of a client who is in the middle stage ofAlzheimer's. The wife tells the nurse that she wants to hold her husband at homeas endless as possible. Which response by the nurse is most helpful? Incorrect: This statement is not supportive of the wife. The wife may be fairly capable of providing care, especially with instruction and other assistance.Incorrect: Some clients with Alzheimer's disease become aggressive, but not every. If aggression occurs, the client can be treated with medication or behavioral interventions.Correct: Withsupport and education, a family caregiver may be capable to provide an appropriate home environment for the client with

Alzheimer's disease.

This reply accepts the wife's wishes and offers practical help.Incorrect: This comment is not supportive of the wife. It assumes that the nurse knows what is best in this situation. Realistically, only the wife can make this significant decision.

It is not realistic for a person your age to care for a client diagnosed with Alzheimer's disease." "Keeping your husband at home could be dangerous. Alzheimer's clients may become violent." "Let's talk about the assist you will need so you can continue to care for your husband at home." "To maintain your own health, you need to consider nursing home placement for your husband."

14.

The nurse is caring for a client with Buck's traction. In which situation mustthe nurse intervene in order to maintain effectiveness of the traction? Incorrect: This is a correct application of the traction boot. The Velcro straps hold the boot in put to promote effective traction pull.Correct: Effective traction requires the client to be in excellent body alignment. This positionis out of alignment and requires intervention. Improper body position may decrease the effectiveness of the tug from the traction.Incorrect: This is the correct position for the footplate because it promotes effective traction.

If the footplate is placed against the footboard of the bed, effective traction may not be achieved.Incorrect: This is a correct setup for the traction. If weights are resting on the bed or the floor, the force or line of tug of the traction is disrupted.


Exam Mode

InExam Mode:All questions are shown in random and the results, answers and rationales (if any) will only be givenafteryou’ve finished the quiz.You are given 1 minute per question, a entire of60 minutesfor this exam.


wound separation and tearing (dehiscence).

flat on the back with legs straight.

in high-Fowler's position with legs straight. in semi-Fowler's position with the knees slightly bent. on the left side with knees bent .

2. The PN is preparing to ister an enteral feeding to a client. To prevent gastric cramping and discomfort due to the feeding, the nurse should: Correct: Freezing formula can cause gastric discomfort. With enteral feedings, particularly via gastrostomy tube,

the formula reaches the stomach quickly, with little or no chance to be warmed, as oral feedings would as they pass through the mouth and esophagus.Incorrect: Tube placement is confirmed prior to beginning each feeding.

This action does not prevent gastric discomfort. However, checking tube placement does assist prevent the infusion of the formula into the lungs.Incorrect: To prevent gastric discomfort, the concentration of the tube feeding formula needs to be advanced gradually. Full-strength formula may cause gastric discomfort, especially when the first few feedings areistered.Incorrect: The head of the bed should be elevated at least 30 during the feeding and for at least 30 minutes after feeding.

This is done to reduce the risk of aspiration, however, not to prevent cramping and discomfort. permit time for the formula to reach room temperature prior to istration. determine tube placement once every 24 hours. prepare to ister full-strength rather than diluted formula. elevate the head of the bed during and after feedings.

3. The nurse is caring for a kid with cystic fibrosis (CF). Which intervention willhelp to prevent respiratory complications?

What are the symptoms of a mild and severe latex glove allergy quizlet

Incorrect: Clients with CF should not get cough suppressant syrups. These children need to cough frequently to clear lung secretions.Correct: Nebulization with mist or aerosol therapy followed by chest physiotherapyhelps to hold secretions free-flowing. The pulmonary effects of CF are progressive, and bronchial secretions must bekept moist.Incorrect: The kid should change positions frequently to promote drainage from the lungs, and promote aeration of the lungs.Incorrect: Children with CF can safely get the pertussis vaccine. These children need protection from pertussis because this infection causes severe respiratory complications.

Urge the use of cough suppressant syrup.

Give frequent nebulization treatments. Limit changing the child's position to conserve the child's need for oxygen. Withhold the vaccine for pertussis.

4. The nurse is caring for a client following insertion of a pacemaker. The client isplaced on continuous ECG monitoring because it will: Incorrect: This is incorrect because pacemaker voltage settings are adjusted manually at the time of insertion.Incorrect: A chest x-ray is used to check the placement of pacer wires after a pacemaker insertion.Correct: The heart rate may change following pacemaker insertion because the pacemaker fails to maintain the pre-set heartrate.

This problem can be detected immediately with continuous ECG monitoring.Incorrect: Fluoroscopy is used to determine dislodgement of pacer leads after a pacemaker insertion. Dislodgement can be prevented with bedrest andminimal arm and shoulder activity. permit the primary care provider to adjust voltage settings. check placement of the pacer wires. detect a dramatic change in heart rate.


The boot is secured by three Velcro straps around the leg.

The client is lying with hips midline and shoulders to the left of midline.

The traction footplate is resting 6 inches from the footboard. Traction weights are hanging freely at the foot of the bed.

15. What is the purpose of the Apgar score after birth? Incorrect: Apgar scores do not correlate with the gestational age, and are not used for this purpose.Incorrect: Although babies that score low on the Apgar may be transferred to the ICU, this is not the purpose of the Apgar.Correct: The one-minute and five-minute Apgar is a ten-point scoring tool used to assess the need for resuscitation systematically in the newborn. This score reflects the baby's physical condition at birth.Incorrect: Apgar scores are not used to assess the baby for long-term health needs or health problems.

To estimate gestational age To determine if the baby needs to be transferred to the intensive care unit (ICU).

To determine if the newborn needs resuscitation. To predict if the baby will own long-term problems.

16. A client with severe emphysema has a moon face and a buffalo hump related to long-term steroid treatment. The client states, "I glance so horrible." Whichresponse by the nurse is therapeutic? Incorrect: This is a judgmental statement, it has no bearing on disease etiology in this case, and it does not

address the client's anxiety about a distressing change in appearance.Incorrect: This is not a therapeutic response.

The client's symptoms are related to long-term steroid use and not overeating. Also, the nurse is not addressing the client's anxiety about a distressing change in appearance.Correct: This is a therapeutic response. This response indicates that the nurse is receptive to listening to the client's feelings about distressing body imagechanges.Incorrect: This is not a therapeutic response. The nurse is not addressing the client's anxiety about a distressing change in appearance.

"If you hadn't smoked every those years, this would not own happened." "I will refer you to the dietician for a weight-loss diet." "This must be extremely upsetting for you.

Would you love to talk about it?" "You must attempt to get used to your appearance as you need to take steroids."

17. A client develops wheals as a result of an allergic reaction to a medication. When documenting the reaction, the nurse correctly describes a wheal as: Incorrect: This is a description of a macule, not a wheal. Freckles or flat moles are examples of macules.Incorrect: This is a description of a papule, not a wheal. Warts or elevated nevi are examples of papules.Incorrect: This is a description of scales, not wheals. Dandruff or dry skin are examples of scales.Correct: This is the correct description of a wheal. Urticaria (or hives) is characterized by the development of wheals.

a flat, nonpalpable, brown lesion with an irregular boarder.

a slightly elevated, palpable mass with a clearly defined border. fine, silvery-white, irregularly-shaped flakes that adhere to the skin.


sharing IV drug needles."

28. The nursing assistant has reported a fever of 102.2 F (39 C) in a client withmeningitis. Which action by the nurse is appropriate? Incorrect: Analgesics do not necessarily own antipyretic properties, so these drugs may not lower body temperature.Incorrect: Rapid or excessive lowering of body temperature can cause shivering and cause bodytemperature to rise even more.Correct: An antipyretic acts to lower body temperature.

It is significant to reduce the client's temperature because fever increases the risk of seizures and increased intracranial pressure.Incorrect: Because of the risk of seizures, the client should not get into the shower. In addition, cool water can chill the client, resulting in shivering and a rebound increase in body temperature. ister prescribed analgesics. Apply ice packs to the client's axillae and groin. Check to see if there is an order for an antipyretic. Own the client take a shower in cool water.

29. The nurse is talking about the goals of therapy with a little group of clientson the inpatient unit.

The nurse notices that one client, who is generally communicative, isnot participating in the discussion. The nurse identifies this client behavior as: Incorrect: Antisocial behavior violates the rights of others. Although this client is not participating in the group discussion, the behavior is not antisocial.Incorrect: Histrionic behavior is extremely dramatic and brings attention to theclient. This client's behavior avoids attention to the self.Incorrect: Obsessive-compulsive behaviors include checking, ordering, counting, and undoing.

The client's behavior is not obsessive-compulsive.Correct: Passive behavior is

identified by a lack of athletic participation and involvement in discussions and activities that involve the individual. Thisclient is not actively participating in therapeutic group discussion. antisocial. histrionic. obsessive-compulsive. passive.

30. The nurse is assessing a client with diabetes mellitus who is at risk fordeveloping hypoglycemia. Which symptom occurs with hypoglycemia?

Incorrect: Deep, rapid respirations are a symptom of hyperglycemia, not hypoglycemia. Kussmaul's respirations are the body's attempt to "blow off" the additional acid produced with diabetic ketoacidosis.Correct: Diaphoresis is a symptom of hypoglycemia. The sympathetic nervous system is activated when there is a decrease in

the quantity of glucose available to the cells. Activation of the sympathetic nervous system produces profuse sweating.Incorrect: Excessive thirst is related to hyperglycemia, not hypoglycemia. When the blood contains higheramounts of glucose, the body attempts to dilute the blood with intracellular and extracellular fluid.

As a result, the tissues lose water, causing thirst.Incorrect: Frequent urination is related to hyperglycemia, not hypoglycemia. When the blood contains higher amounts of glucose, the body attempts to dilute the blood with intracellular and extracellularfluid. This additional fluid increases urine output.


an itchy, elevated, reddened mass with an irregular border and shape.

18. A 7-year-old kid arrives in the emergency department with multiple injuries and bruises that are in diverse stages of healing. The parents report that thechild received injuries on the legs and torso from falling off a bike. What is thelaw in this situation?

Incorrect: It may be helpful for a counselor to interview the kid and the parents, and provide counseling. However, counseling is not a requirement in this situation.Incorrect: Any health care provider who observes suspicious injuries on a kid must report abuse. Reporting abuse is not the sole responsibility of primary careproviders.Incorrect: Bike safety is significant, but this child's injuries are more suspicious of abuse than a drop from abike.Correct: By law, suspicious injuries such as bruises on various parts of a child's body must be reported to the authorities. Kid Protective Services is the agency that oversees the protection of children from abuse.

A counselor must talk with the kid and the parents. A primary care provider must notify authorities of suspected abuse. The kid must be taught bike safety. The child's injuries must be reported to Kid Protective Services.

19. The nurse is caring for a client following a transurethral resection of theprostate (TURP). Which action reduces the risk of postoperative bleeding? Correct: CBI with normal saline helps to prevent bladder spasms, which may cause postoperative bleeding.Incorrect: The client should not remain in a supine position.

The client needs to turn, cough, and deep breathe to prevent respiratory complications.Incorrect: Urine output should be measured every 2 hours.Incorrect: Theclient needs to increase fluid intake to a minimum of 2000-2500 mL/day to hold the urine clear.

Adjusting the continuous bladder irrigation (CBI) fluid to maintain a colorless or light pinkdrainage return. Maintaining the client in a supine position for the first 24 hours after surgery. Measuring urine output every 4-6 hours Restricting fluid intake to less than 1800 mL/day

20. During the preoperative phase, nursing management for cardiac surgery isprimarily focused on: Correct: Client teaching during the preoperative period helps to reduce the client's anxiety.

The client is encouraged to enquire questions and discuss concerns. Family members should also be included in the teachingsessions.Incorrect: Diagnostic studies establish the baseline data that frolic a key role in determining the need forsurgery. These studies are not the primary nursing focus during the preoperative phase.Incorrect: Providing the client with information about blood transfusion, autotransfusion, and autologous blood donation is significant. However, teaching about blood transfusions is not the primary nursing focus during the preoperative phase.Incorrect: Physicalassessment is most significant during the postoperative phase of cardiac surgery. It is not the primary nursing focus during the preoperative phase.

client teaching. diagnostic studies. blood transfusion. physical assessment.

21. The role of the nurse who works in a rehabilitation unit is to: Correct: Nurses are responsible for coordinating client care with other departments.Incorrect: The nurse manager is responsible for the annual budget.Incorrect: The nurse manager is responsible for establishing the unit's goals with input from the staff.Incorrect: The nurse manager/supervisor is responsible for adequate staffing.

coordinate client care with physical and occupational therapy. develop an annual budget for the unit. establish goals for the unit. reassign personnel to other units to ensure adequate staffing.

22. The nurse is preparing an 11-year-old boy for removal of a skeletal traction pin and application of a hip spica cast. The boy says he wants his parents withhim during the procedure. The most appropriate nursing action is to:

Correct: The kid will be supported and comforted by the presence of his parents. However, the procedure may be too anxiety-producing for the parents to witness.Incorrect: The kid should be familiar with the staff in the procedure room, but parents should also accompany the kid to give support if possible.Incorrect: The presence of a nurse may be comforting, but children generally get the greatest sense of support from their parents.Incorrect: Generally parents are allowed and encouraged to accompany their kid during this type of procedure.

permit the parents to be with the kid. introduce the kid to the staff in the procedure room. explain to the kid that the nurse will be with him for support. explain to the kid why the parents cannot be present.

23. The best method for verifying the identity of a client prior to theistration of a medication is to: Incorrect: Identification tags at the finish of a client's bed are not dependable. The client may own become confused and moved into another bed, or the tag may belong to the previous client.Correct: Checking an intactidentification bracelet is the best method for verifying a client's identity prior to istering medications.Incorrect: This is an inappropriate method for identifying the client.

The names above the bed and exterior the room may be thatof a previous client.Incorrect: Asking clients to verify their identity is not a safe method for identification and may result in medication errors. Clients may be confused, anxious, or disoriented, and thus provide unreliable information aboutthemselves. check the identification tag located at the bottom of the client's bed. check the medication istration form against the client's identification bracelet.

compare the client name above the bed with the name plate exterior the room. state the client's name and enquire the client if he or she is that person.

24. An immobilized client requires passive range of motion (ROM) for each joint.

Which technique is correct when performing these exercises? Incorrect: It is safe to flex the joint until slight resistance is felt, but not beyond. Exercising a joint until full resistance is felt could damage the affected joint.Incorrect: Exercising a joint to the point of pain increases the risk for trauma to the joint. The nurse should note the point at which the client experiences pain and stop the exercise before this point is reached.Incorrect: Hyperextending the joint may increase the risk of injury to the joint and is thereforecontraindicated.Correct: Support of distal joints during passive ROM reduces the risk of injury and damage to affectedjoints.

Passive ROM exercises should be performed slowly and carefully to ensure support of the client's joints. Continue to flex the joint until full resistance is felt. Exercise the joint to the point of pain. Hyperextend healthy joints to increase flexibility. Support the client's joints that are distal to the joint exercised.

25. A nurse is providing home care for a 7-year-old client with muscular dystrophy. The client has been receiving home schooling. A care conference is planned to discuss if the client can attend regular school classes. What is thenurse's role in the conference?

Incorrect: This is not the role of the nurse during the conference. The home school teacher can provide

valuable information in this area.Incorrect: This is not the role of the nurse during this conference. The classroom teacher is the person who will assess the client and determine the classes the client can attend, based on theinformation provided by the nurse as to the child's capabilities and limitations.Incorrect: This is not the role of the nurse during this conference. The social worker is the person who assists the client and family with financial needs.Correct: The nurse can provide valuable information about the child's capabilities and limitations.

This information will help the other members of the conference to plan activities that will enhance the child's potential. Describing the client's usual method for learning Determining which regular school classes the client can attend Discussing the client's need for financial assistance for school supplies and activities Providing information about the child's capabilities and limitations

26. Which finding is an early symptom of poor oxygenation in the client who hasexperienced an acute myocardial infarction (MI)?

Incorrect: Cyanosis is a clinical sign that develops in the later stages of poor oxygenation. Hypoxia, or poor oxygenation, must be identified at an early stage.Incorrect: The heart rate tends to increase in the client with poor oxygenation.

The heart rate increases to compensate for inadequate oxygenation and to maintain cardiac output.Correct: Shortness of breath is an early indication of respiratory distress following an acute MI. Unlesspromptly identified and treated, poor oxygenation can result in cardiogenic shock.Incorrect: Venous stasis is not a manifestation of poor oxygenation. Pooling of blood results from inadequate circulation in the lower extremities.

What are the symptoms of a mild and severe latex glove allergy quizlet

People who are obese or own congestive heart failure are at risk for venous stasis. Cyanosis Slow heart rate Shortness of breath Venous stasis

27. The nurse is caring for a client with hepatitis A. The client asks how he acquired this type of hepatitis. Which response by the nurse is accurate? "Thetype of hepatitis you own can be transmitted through: Correct: Hepatitis A has a fecal-oral transmission route.Incorrect: Hepatitis B can be transmitted through exchange of body fluids.Incorrect: Hepatitis B and D can be transmitted through sexual contact.Incorrect: Hepatitis Cis transmitted through percutaneous exposure to blood and plasma.

The highest incidence occurs in IV drug users and individuals with hemophilia. contaminated food." body fluids." sexual contact."


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