ATI Medical Surgical Immunity and Infection Exam Questions & Answers, With Rationales-A nurse is caring for a client who has human immunodeficiency virus
... [Show More] (HIV). The client asks the nurse, "Should I tell my partner that I am HIV positive?" Which of the following statements should the nurse give?
a. "This is your decision alone."
b. "I would if I were you."
c. "It sounds like you are unsure what to say to your partner."
d. 'Your provider is required by law to notify your partner." - c. "It sounds like you are unsure what to say to your partner."
Rationale
his response uses the therapeutic communication tools of clarifying and restatement. It identifies that the client is unsure about if or how to approach the issue of being HIV positive with his partner, a common concern of clients due to fear of rejection. This response shows that the nurse is open to further communication with the client and encourages his expression of feelings.
A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings should the nurse expect?
a. A nonproductive cough, fever, and shortness of breath
b. lesions of the retina that produce blurred vision.
c. Onset of progressive dementia.
d. Reddish-purple skin lesions. - d. Reddish-purple skin lesions
Rationale
Kaposi's sarcoma is commonly associated with AIDS and manifests as hyper-pigmentated multi centric lesions that can be firm, flat, raised, or nodular. Following biopsy, the lesions are treated with radiation and/or chemotherapy.
A nurse is caring for a client who had radioallergosorbent (RAST) testing completed due to seasonal allergies. The nurse should anticipate an elevation in which of the following laboratory tests?
a. IgM
b. IgA
c. IgG
d. IgE - d. IgE
Rationale
RAST testing involves measuring the quantity of IgE present in serum after exposure to specific antigens selected on a basis of the client's symptom history. An elevated IgE indicates a positive response and is common among clients who have a history of allergic manifestations, anaphylaxis, and asthma.
A nurse is caring for a client who is 2 days postoperative. Which of the following findings should alert the nurse that the client is developing an infection?
a. Temperature 37.8 C (100 F)
b. Erythema at the incision site
c. WBC count 9,000/mm^3
d. Pain reported as 6 on a scale of 0 to 10. - b. Erythema at the incision site.
Rationale
Redness, or erythema, at the incision site is an initial sign of a wound infection and requires intervention by the nurse.
A nurse is teaching a client who was recently diagnosed with Raynaud's disease about preventing the onset of manifestations. Which of the following statements by the client indicates an understanding of the teaching?
a. "I should limit my exposure to sunlight."
b. "I should avoid drinking alcohol."
c. "I should not smoke."
d. "I should limit my intake of foods high in purine." - c. "I should not smoke."
Rationale
Raynaud's disease is a disorder of the blood vessels that supply blood to the skin and cause the distal extremities to feel numb and cool in response to cold temperatures or stress. During a Raynaud's attack, these arteries narrow, limiting blood circulation to affected areas. Strong emotion or exposure to the cold causes these areas to become white, due to a lack of blood flow in the area. They then turn blue, as tiny blood vessels dilate to allow more blood to remain in the tissues. When the flow of blood returns, the area becomes red and then later returns to normal color. This can cause tingling, swelling, and painful throbbing. The attacks can last from minutes to hours. If the condition progresses, blood flow to the area could become permanently decreased, causing the fingers to become thin and tapered, with smooth, shiny skin and slow-growing nails. If an artery becomes blocked completely, gangrene or ulceration of the skin can occur. Smoking cessation, not just reduction, is an action the client should take to prevent the onset of the manifestations of Raynaud's disease. [Show Less]