Literally Exam 4 NUR265 (Answered with RATIONARE) Complete Solution updated april 2023
NUR265 Literally Exam 4 (100% Correct Answers with
... [Show More] Rationale)
The nurse working in the ED is triaging a client who has presented with chest pain, shortness of breath, a productive cough, and reports nights sweats. That clients health history includes the presence of acquired immunodeficiency syndrome (AIDS) and the recent laboratory results that reveal a low CD4+ count. Airborne precautions have been initiated. Which of the following actions should the nurse take next?
ANSWER: Check the client’s temperature
RATIONALE: A fever is a symptom of AIDS exacerbation.
The newly hired nurse is developing a plan of care for a client who has acquired AIDS and was just diagnosed with pneumocystis jiroveci pneumonia and pain. Which of the following interventions should the nurse preceptor question?
ANSWER: Placing the client on a pressure-relieving mattress
RATIONALE: That is not an appropriate intervention.
The nurse had provided medication instructions to a client who has human immunodeficiency virus (HIV) and has been prescribed combination antiretroviral therapy (cART). Which of the following client statements indicates a correct understanding of the teaching?
ANSWER:“I can avoid developing drug resistance if I take 90% of my drugs on time.”
RATIONALE: Pg. 976. It is important to teach patients to take at least 90% of their meds on time to prevent drug resistance.
The nurse is precepting a newly hired nurse who is caring for a client who has AIDS and has developed Kaposil’s sarcoma. It requires additional teaching by the preceptor if the newly hired nurse
ANSWER: Applies a surgical mask before entering the client’s room. RATIONALE: Pg.983. This is not an appropriate intervention.
The nurse is caring for a client who had a lung transplant 10 days ago. It would be a priority for the nurse to notify the PHCP if the client has
ANSWER: Developed sputum that is yellow tinged
RATIONALE: This is a sign of infection. KEY WORD: “DEVELOPED”
The nurse is caring for a client who had a liver transplant 48 hours ago, which findings from the box below is a priority for the nurse to report to the PCHP?
ANSWER: 2,4,5,6
RATIONALE: An increase in AST, increase in PT, INR, and bilirubin levels. PT: 11-13.5
INR: 0.8-1.1
The nurse is caring for a client who had a kidney transplant two weeks ago. Which of the following findings should the nurse correlate to possible organ rejection?
RATIONALE: Pg.3615. Vital signs with special attention to BP.
The nurse working in a primary health care providers office has just administer a routine immunization to a client. The client is asked to wait in the waiting room for the next 15 mins. 5 mins later the time client developed swelling of the eyes and reports feeling anxious, SOB, and dizzy. Which of the following actions should the nurse take first?
ANSWER: Perform a respiratory assessment
RATIONALE: Pg.1009. Immediately assess the respiratory status
The newly hired nurse as attended a continuing education conference regarding anaphylaxis work allergen exposure. Which of the following statements by the newly hired nurse indicates a correct understanding of assessment findings in t [Show Less]