ATI Medical-Surgical Test Prep: Immune and Infectious, Exam Questions & Answers-A nurse is collecting data from a client who has had systemic scleroderma f... [Show More] or 5 years. In addition to skin changes, which of the following findings should the nurse expect?
A. Excessive salivation
B. Finger contractures
C. Periorbital edema
D. Alopecia - B. Finger contractures
Scleroderma is a chronic disease that can cause thickening, hardening or tightening of the skin, blood vessels and internal organs. There are 2 types: localized scleroderma, which mainly affects the skin, and systemic scleroderma which may affect many internal organs. The symptoms include skin changes, Raynaud's disease, arthritis, muscle weakness, and dry mucous membranes. With scleroderma, the body produces and deposits too much collagen, causing thickening and hardening. in addition to the clients skin and subcutaneous tissues becoming increasing hard and rigid, the extremities stiffen and lose mobility. Contractures develop with advanced systemic scleroderma unless clients follow a regimen of range of motion and muscle strengthening exercises
A nurse is caring for a client who is HIV-positive is reinforcing teaching about the earliest manifestations of AIDS. The nurse explains that they include which of the following?
A. Persistent fever, swollen glands, diarrhea, weight loss, and fatigue
B. Elevated WBC count
C. Increased blood pressure, tachycardia, dyspnea and edema
D. Influenza-like symptoms including fatigue, sore throat, muscle pain, headache and swollen glands - A. Persistent fever, swollen glands, diarrhea, weight loss, and fatigue
A client diagnosed with systemic lupus erythematosus (SLE) is concerned about skin lesions on the face and neck. the client asks the nurse, "what should I do about these spots?" which of the following nursing responses is appropriate?
A. "Keep the lesions covered with a light sterile dressing when going outdoors"
B. "There is not much you can do. The lesions will go away when your disease is in remission"
C. "Apply moisturizer after bathing the lesions with warm water"
D. "Apply antibiotic cream twice a day until scabs form on the lesions" - C. "Apply moisturizer after bathing the lesions with warm water"
A client who tests positive for the human immmunodeficiency virus (HIV) asks the nurse, " should i tell my partner that I am an HIV positive/" which of the following is appropriate nursing response?
A. "That is your decision alone"
B. "I would if I were you"
C. "You aren't sure what to say to your partner?"
D. "We are required by law to notify your partner" - C. "You aren't sure what to say to your partner?"
A nurse has prepared a sign to hang outside of the room of a client who is on contact precautions because of a confirmed MRSA infection. Which sign, if prepared by the nurse, would indicate a knowledge deficit? - Graphic 4: isolation mask is not necessary with contact precautions
A client with reactive airway disease is tested and found to have an allergy to dust mites. The nurse determines that the client understands how to reduce her exposure to this allergen when she states which of the following?
A. "I'll run a room humidifier in my bedroom every night"
B. "Carpeting the entire house will be very expensive, but it will be worth it"
C. "Washing all the bed linens in hot water every week will be time-consuming"
D. "I'll apply insect repellent sparingly to any exposed parts when I'm outdoors" - C. "Washing all the bed linens in hot water every week will be time-consuming"
Dust mites are vulnerable to high temperatures and because a client may spend up to 1/3 of the day in bed, actions to reduce exposure in bedroom are essential
A client has been diagnosed with Raynaud's disease, when reinforcing teaching with the client, the nurse should include information about which of the following?
A. Protecting against cold with layers of clothing
B. Starting a regular exercise program of 2-mile walks daily
C. Increasing niacin and pyridoxine in the diet
D. Elevating the hands above heart level during an acute attack - A. Protecting against cold with layers of clothing
Extreme cold can lead to tissue damage, and clients with Raynaud's are prone to more frequent attacks during cold weather.
Allergy testing indicates that a client has several environmental allergies and the provider recommends allergy desensitization. after explaining the procedure, the nurse determines that the reinforcement of teaching has been effective when the client states which of the following?
A. "At each visit, I'll receive an allergy shot with a little bit less of the allergen than I received before"
B. "I'll need to remain in the clinic for 30 minutes after each shot in case I have a bad reaction"
C. "Any type of reaction at the injection site is abnormal, and I will need to receive an epinephrine shot"
D. "Once my dose is established, I'll be taught how to give myself the allergy shots at home daily" - B. "I'll need to remain in the clinic for 30 minutes after each shot in case I have a bad reaction"
After desensitization injection is administered, observation for a minimum of 30 minutes is required to monitor the client for any manifestations of an anaphylactic reaction [Show Less]
