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MedSurg Review II
MedSurg NCLEX review for Immunity
Question | Answer |
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The nurse is planning care for a pt w/ a dx of immunodeficiency. Which of the following would be in the plan | A. Protecting the client from infection B. Providing emotional support C. Encourage discussion about life changes. D. Identify factors that decrease immune function. |
Pt w/ AIDS is dx w/ cutaneous Kaposi's sarcoma. Based on this dx, the nurse understands this has been confirmed by: | A. Swelling in the genital area b. Swelling in lower extremeties C. Punch biopsy of the lesions D. Appearance of red-blue lesions |
C. Punch biopsy of cutaneous lesions | Begins as red, dark blue macules on lower legs that become plaques. Cancer then metastisis. |
Pt has been tested for HIV. Client asks what happens if his ELISA is positive. Nurse's best response is | A. A western blot will be done B. Client will have a bone marrow biopsy C. A CD4+ count will be done D. Client will be diagnosed as HIV positive |
A. A western blot will be done to confirm these findings. | If the ELISA is positive, the western blot is done as confirmation. |
Nurse is caring for pt w/ HIV and dectects early signs of P. jiroveci by monitoring the pt for what sign? | A. Fever B. Cough C. Dyspnea at rest D. Dyspnea on excertion |
B. Cough | Cough is the first sign of P. jiroveci. Begins as nonproductive. Later pt gets fever and dyspnea. |
Pt w/ AIDS has concurrent dx of histoplasmosis. Nurse notices enlarged lymph nodes. Nurse interprets this to mean that. | A. Histoplasmosis is resolving B. Client has disseminated histoplasmosis C. Client probably has a secondary infection. D. this is a SE of AIDS medications |
B. The client has disseminated histoplasmosis infection | Histo usually starts as a respiratory infection with aids, then become dissmeminated w/ enlarge lymph nodes. |
Pt w/ AIDS has night fever and night sweats. Which intervention would be least helpful? | A. Keep liquids at bedside B. make sure pillow has plastic cover C. Admin antipyretic D. Keep a change of bed linens nearby. |
C. Admin antipyretic. | this should be given before pt goes to bed. |
A client with AIDS has N/V. Nurse should include what in dietary teaching? | A. Provide large, nutritious meals. B. Serve food while it is warm C. Add spices to food for flavor D. Remove dairy products and red meat from meal. |
D. Remove dairy products and red meat from meal. | Pt w/ N/V should avoid fatty foods. |
Nurse caring for pt w/ AIDS who is having multiple opportunistic infections. Which lab test would help in reassessing tx? | A. Western blot B. B-lymphocyte count C. CD4+ cell or T-lymphocyte count D. ELISA |
C. CD4+ cell or T-lymphocyte count | This indicates whether client is responding to meds. |
A pt asks a nurse about a home HIV test. The nurse tells the client: | A. Home kits are reliable for determining HIV status B. Home kits are not available C. Home kits are not as reliable D. It is important to contact physician with any concern about HIV status. |
A negative HIV test result is not considered accurate during the first 6 months after exposure. T or F? | True |
A CD4+ count is performed in a client with HIV. This count is being performed to. | A. Establish stage of HIV B. Determine presence of HIV C. Confirm presence of HIV D. Identify the cell-associated proviral DNA |