Immunity

The 58-year-old patient with chronic obstructive pulmonary disorder (COPD) presents to the clinic requesting the pneumococcal vaccine. Which response by the nurse is appropriate?

Which food item, if selected by the patient, would prompt the nurse to provide additional education? Review the patient’s chart to make selection.

Following a major natural disaster, the charge nurse receives instruction from superiors to pair patients as roommates to increase the number of available rooms. The first patient to be paired is a 42-year-old patient with cellulitis who has a 103°C fever and tachycardia. The charge nurse places her in a room with which patient?

The patient receiving which medication is most likely to also require a prescription for miconazole?

The 60-year-old patient who was recently laid off from his factory job of 38 years presents to the emergency department complaining of severe superficial pain over the flank. Which assessment will be most important for diagnosis?

The 74-year-old otherwise healthy patient presents to the clinic complaining of severe pain and burning of the skin over the right flank. Upon assessment, the nurse notes two lines of vesicles that curve laterally away from the spine on the right side. The nurse provides which instruction to the patient regarding treatment?

The 24-year-old patient presents to the emergency department complaining of malaise and intractable sore throat with onset 24 hours previously. Upon assessment, the nurse notes swollen cervical lymph nodes and a temperature of 39.3°C. The patient denies nasal discharge or cough. Which question by the nurse is most important?

The 15-year-old emancipated minor patient who weighs 32 kg presents to the emergency department with fever, malaise, cervical lymphadenopathy, and severe throat pain that was not preceded by an upper respiratory infection. The nurse anticipates providing teaching about which prescription?

The 12-year-old child is brought to the emergency room after being bitten by a family friend’s tarantula. The child is healthy and has received all scheduled vaccinations. Which medication must be given as soon as possible?

The patient seeking medical care for a spider bite asks the nurse why the Diphtheria, Tetanus, and Pertussis (DTaP) vaccine has been prescribed. Which response by the nurse is most appropriate?

The patient in Arizona calls the nurse line to report being stung by a scorpion. Which follow-up question by the nurse is most important?

The nurse is providing education to the parents of a child who experienced anaphylaxis following a bee sting. Which statement by the parents indicates a need for further teaching?

An individual calls the nurse line to report his friend has been bitten by a water moccasin snake on the hand. Which statement by the individual requires correction by the nurse?

The nurse more closely assesses patients with which conditions for signs of pernicious anemia? Select all that apply.  

Which patient characteristic increases the risk for pernicious anemia following a subtotal gastrectomy?  

Four hours after a rectal resection for treatment of rectal cancer, the patient is noted to be pale and diaphoretic. Which assessments are the priority? Select all that apply.  

The nurse most closely monitors the temperature for the patient who underwent which procedure?  

The patient with severe psoriasis has been prescribed methotrexate. The nurse instructs the patient to schedule which follow-up tests? Select all that apply.   

The patient who has been prescribed methotrexate for the treatment of severe psoriasis has received medication teaching. Which statements indicate the teaching was effective? Select all that apply.

The patient on bowel rest has been prescribed 10% dextrose total parenteral nutrition at 50 mL/h, intravenous lipids 3 grams/kg/day, and 10 mg intravenous famotidine every other day. Which information in the patient’s chart prompts the nurse to contact the provider? 

The nurse is caring for a patient in the intensive care unit with breast cancer who has a radiation implant in the right breast. The patient is also receiving a chemotherapy regimen. Which additional patient is most appropriate to be assigned to the nurse?

The nurse is caring for the patient who is at the nadir for bone marrow suppression. Which order does the nurse clarify with the provider?  

The nurse is providing health promotion teaching to the parents of a child recently diagnosed with sickle cell anemia. Which statement does the nurse include in teaching? 

The nurse is providing health promotion and disease prevention education to the 15-year-old patient receiving chemotherapy. Which statement does the nurse include?  

The patient is admitted to the hospital after fainting at home. Blood tests reveal a hypochromic, microcytic anemia with a large amount of fetal hemoglobin. Thrombocytopenia is noted as well. The lymph nodes, spleen, and liver are all within normal limits for size and consistency. A blood transfusion and platelet transfusion are administered, with less than expected results. The nurse anticipates administering antithymocyte globulin in response to which result?   

The 18-year-old patient presents with pallor, shortness of breath, and bleeding from the gums. Extensive testing is performed and a diagnosis of very severe aplastic anemia is made. Which additional information is most important to direct treatment? 

The patient is hospitalized after being diagnosed with aplastic anemia. Which question is most important to ask the patient?   

The patient receiving chemotherapy for breast cancer develops a fever of 39.8°F and heart rate of 121 bpm. Within hours, the blood pressure drops from 128/89 mmHg to 91/54 mmHg, capillary refill time increases to 5 seconds, and urine output drops to less than 0.5 mL/kg/hour. Right-sided weakness, slurring of the words, and confusion occurs rapidly and subsides within 2 hours. Hemoptysis is also noted and the gums are oozing. Multiple transfusions are ordered. Which blood product does the nurse administer first?

The 8-month-old patient has had 4 skin abscesses in the past 3 months that have required draining. Each abscess drains less than 5 mL non-purulent fluid. The infant appears well otherwise and the parents deny respiratory infections. The infant’s complete blood count shows an elevated white blood cell count without bands or segmented cells. Immunoglobulin levels are appropriate for the age of the infant. The patient has a positive nitroblue test. The nurse plans care to include which intervention? 

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. The nurse prepares to perform which diagnostic test for this patient?  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which intervention is most important to prevent the spread of this condition to other patients? 

The patient with acquired immunodeficiency syndrome who has been noncompliant with highly active antiretroviral therapy (HAART) presents to the emergency department with a productive cough, fever, night sweats, and weight loss. The patient’s chest x-ray reveals diffuse infiltrates bilaterally and the CD4 count is 182 cells/µL. Which question by the nurse is most important?  

The 32-year-old patient presents complaining of severe itching on the arms that has gotten worse as her job has gotten more stressful. Upon assessment, the nurse observes erythematous lichen patches on the arms and in the antecubital fossa, where it is fissured and weeping. The nurse anticipates providing education about which medication?  

The nurse is preparing the otherwise healthy 54-year-old patient for a right knee replacement surgery and checks to see if the patient is allergic to which medication? 

The 20-year-old student went on a mission trip to Ghana to help at a local hospital. She presented to the clinic 12 days after her return; she began to experience anorexia, flu-like symptoms, and fatigue. Ten days later, she noticed her eyes and skin looked yellow. Her history, assessment, and vitals are within normal limits except her yellow sclera and jaundiced skin. Initial lab studies reveal a total bilirubin of 16, indirect bilirubin of 8, AST of 1320 and ALT of 1400. The nurse prepares the patient for which test next? 

The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient’s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient’s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient’s clinical picture? Select all that apply.  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient begins taking more shallow breaths and becomes confused. The patient is intubated and mechanically ventilated. Once the patient is stable, the nurse anticipates administering which medication? 

The patient with human immunodeficiency virus (HIV) presents with a disseminated rash. The nurse notes purple papules over the trunk, arms, and on mucous membranes. Some are scabbed. The patient’s CD4 count is 64. Although highly active antiretroviral therapy (HAART) has been prescribed, the patient reports being noncompliant because of intolerable side effects. The nurse suspects which infection is most responsible for this new rash? 

The 20-year-old patient with asthma presents to the emergency department with increased work of breathing and severe wheezing after exposure to household dust and mold. The patient used the albuterol inhaler 6 times in the previous 4 hours with minimal relief. Upon inspection, the nurse notes extensive accessory respiratory muscle use with moderate supraclavicular retractions and nasal flaring. The nurse auscultates expiratory wheezing in all lung fields. The patient is afebrile, normotensive, significantly tachypneic, and mildly tachycardic. The nurse anticipates which findings on a chest x-ray?

The 20-year-old patient with asthma presents to the emergency department with increased work of breathing and severe wheezing after exposure to household dust and mold. The patient used the albuterol inhaler 6 times in the previous 4 hours with minimal relief. Upon inspection, the nurse notes extensive accessory respiratory muscle use with moderate supraclavicular retractions and nasal flaring. The nurse auscultates expiratory wheezing in all lung fields. The patient is afebrile, normotensive, significantly tachypneic, and mildly tachycardic. The chest x-ray is clear. The nurse prepares to administer which medication first? 

The patient with human immunodeficiency virus and a CD4 count of 158 has a purified protein derivative (PPD) skin test performed and is found to have a 7-mm induration with circumferential erythema. Which statement does the nurse make to the patient?  

The 24-year-old patient presents with flu-like symptoms and a diffuse maculopapular rash across her chest, trunk, and palms of the hands. Upon palpation, cervical lymph nodes are enlarged. The patient uses intravenous drugs and reports having unprotected sex. The patient’s labs are notable for negative HIV test, positive human chorionic gonadotropin test, and positive rapid plasma reagin test. The patient reports a history of anaphylaxis with penicillin administration. The nurse educates the patient about which treatment? 

The patient who has received a heart transplant is prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) for Pneumocystis jiroveci pneumonia (PJP) prophylaxis. Which statements does the nurse provide to educate the patient about adverse effects of the TMP-SMZ? Select all that apply.