Final Exam Flashcards
The public health nurse is presenting a health-promotion class to a group at a local
community center. Which intervention most directly addresses the leading cause of
cancer deaths in North America?
A) Monthly self-breast exams
B) Smoking cessation
C) Annual colonoscopies
D) Monthly testicular exams
B) Smoking cessation
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-
month follow-up appointment following chemotherapy. The nurse notes that the
patient’s skin appears yellow. Which blood tests should be done to further explore this
clinical sign?
A) Liver function tests (LFTs)
B) Complete blood count (CBC)
C) Platelet count
D) Blood urea nitrogen and creatinine
A) Liver function tests (LFTs)
The school nurse is teaching a nutrition class in the local high school. One student
states that he has heard that certain foods can increase the incidence of cancer. The
nurse responds, ìResearch has shown that certain foods indeed appear to increase the
risk of cancer.î Which of the following menu selections would be the best choice for
potentially reducing the risks of cancer?
A) Smoked salmon and green beans
B) Pork chops and fried green tomatoes
C) Baked apricot chicken and steamed broccoli
D) Liver, onions, and steamed peas
C) Baked apricot chicken and steamed broccoli
Traditionally, nurses have been involved with tertiary cancer prevention. However, an
increasing emphasis is being placed on both primary and secondary prevention. What
would be an example of primary prevention?
A) Yearly Pap tests
B) Testicular self-examination
C) Teaching patients to wear sunscreen
D) Screening mammograms
C) Teaching patients to wear sunscreen
The nurse is caring for a 39-year-old woman with a family history of breast cancer. She
requested a breast tumor marking test and the results have come back positive. As a
result, the patient is requesting a bilateral mastectomy. This surgery is an example of
what type of oncologic surgery?
A) Salvage surgery
B) Palliative surgery
C) Prophylactic surgery
D) Reconstructive surgery
C) Prophylactic surgery
The nurse is caring for a patient who is to begin receiving external radiation for a
malignant tumor of the neck. While providing patient education, what potential adverse
effects should the nurse discuss with the patient?
A) Impaired nutritional status
B) Cognitive changes
C) Diarrhea
D) Alopecia
A) Impaired nutritional status
While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer,
the nurse observes swelling and pain at the IV site. The nurse should prioritize what
action?
A) Stopping the administration of the drug immediately
B) Notifying the patient’s physician
C) Continuing the infusion but decreasing the rate
D) Applying a warm compress to the infusion site
A) Stopping the administration of the drug immediately
A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment
and the nurse is providing anticipatory guidance about potential adverse effects. When
addressing the most common adverse effect, what should the nurse describe?
A) Pruritis (itching)
B) Nausea and vomiting
C) Altered glucose metabolism
D) Confusion
B) Nausea and vomiting
A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the
nurse is aware that a significant side effect of this medication is thrombocytopenia.
Which symptom should the nurse assess for in patients at risk for thrombocytopenia?
A) Interrupted sleep pattern
B) Hot flashes
C) Epistaxis (nose bleed)
D) Increased weight
C) Epistaxis (nose bleed)
The nurse is orienting a new nurse to the oncology unit. When reviewing the safe
administration of antineoplastic agents, what action should the nurse emphasize?
A) Adjust the dose to the patient’s present symptoms.
B) Wash hands with an alcohol-based cleanser following administration.
C) Use gloves and a lab coat when preparing the medication.
D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.
D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.
A nurse provides care on a bone marrow transplant unit and is preparing a female
patient for a hematopoietic stem cell transplantation (HSCT) the following day. What
information should the nurse emphasize to the patient’s family and friends?
A) ìYour family should likely gather at the bedside in case there’s a negative
outcome.î
B) ìMake sure she doesn’t eat any food in the 24 hours before the procedure.î
C) ìWear a hospital gown when you go into the patient’s room.î
D) ìDo not visit if you’ve had a recent infection.
D) ìDo not visit if you’ve had a recent infection.
A nurse is creating a plan of care for an oncology patient and one of the identified
nursing diagnoses is risk for infection related to myelosuppression. What intervention
addresses the leading cause of infection-related death in oncology patients?
A) Encourage several small meals daily.
B) Provide skin care to maintain skin integrity.
C) Assist the patient with hygiene, as needed.
D) Assess the integrity of the patient’s oral mucosa regularly.
B) Provide skin care to maintain skin integrity.
You are caring for an adult patient who has developed a mild oral yeast infection
following chemotherapy. What actions should you encourage the patient to perform?
Select all that apply.
A) Use a lip lubricant.
B) Scrub the tongue with a firm-bristled toothbrush.
C) Use dental floss every 24 hours.
D) Rinse the mouth with normal saline.
E) Eat spicy food to aid in eradicating the yeast.
A) Use a lip lubricant.
C) Use dental floss every 24 hours.
D) Rinse the mouth with normal saline.
The nurse on a bone marrow transplant unit is caring for a patient with cancer who is
preparing for HSCT. What is a priority nursing diagnosis for this patient?
A) Fatigue related to altered metabolic processes
B) Altered nutrition: less than body requirements related to anorexia
C) Risk for infection related to altered immunologic response
D) Body image disturbance related to weight loss and anorexia
C) Risk for infection related to altered immunologic response
An oncology nurse is caring for a patient who has developed erythema following
radiation therapy. What should the nurse instruct the patient to do?
A) Periodically apply ice to the area.
B) Keep the area cleanly shaven.
C) Apply petroleum jelly to the affected area.
D) Avoid using soap on the treatment area.
D) Avoid using soap on the treatment area.
The nurse is caring for a patient has just been given a 6-month prognosis following a
diagnosis of extensive stage small-cell lung cancer. The patient states that he would like
to die at home, but the team believes that the patient’s care needs are unable to be met
in a home environment. What might you suggest as an alternative?
A) Discuss a referral for rehabilitation hospital.
B) Panel the patient for a personal care home.
C) Discuss a referral for acute care.
D) Discuss a referral for hospice care.
D) Discuss a referral for hospice care.
The clinic nurse is caring for a 42-year-old male oncology patient. He complains of
extreme fatigue and weakness after his first week of radiation therapy. Which response
by the nurse would best reassure this patient?
A) ìThese symptoms usually result from radiation therapy; however, we will
continue to monitor your laboratory and x-ray studies.
B) ìThese symptoms are part of your disease and are an unfortunately inevitable part
of living with cancer.î
C) ìTry not to be concerned about these symptoms. Every patient feels this way after
having radiation therapy.î
D) ìEven though it is uncomfortable, this is a good sign. It means that only the
cancer cells are dying.
A) ìThese symptoms usually result from radiation therapy; however, we will
continue to monitor your laboratory and x-ray studies.
A 16-year-old female patient experiences alopecia resulting from chemotherapy,
prompting the nursing diagnoses of disturbed body image and situational low selfesteem.
What action by the patient would best indicate that she is meeting the goal of
improved body image and self-esteem?
A) The patient requests that her family bring her makeup and wig.
B) The patient begins to discuss the future with her family.
C) The patient reports less disruption from pain and discomfort.
D) The patient cries openly when discussing her disease.
A) The patient requests that her family bring her makeup and wig.
A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the
nurse do to combat the most common adverse effects of chemotherapy?
A) Administer an antiemetic.
B) Administer an antimetabolite.
C) Administer a tumor antibiotic.
D) Administer an anticoagulant.
A) Administer an antiemetic.
A 58-year-old male patient has been hospitalized for a wedge resection of the left lower
lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks
if he can smoke. Which statement by the nurse would be most therapeutic?
A) ìSmoking is the reason you are here.î
B) ìThe doctor left orders for you not to smoke.î
C) ìYou are anxious about the surgery. Do you see smoking as helping?
D) ìSmoking is OK right now, but after your surgery it is contraindicated.
C) ìYou are anxious about the surgery. Do you see smoking as helping?
An oncology nurse educator is providing health education to a patient who has been
diagnosed with skin cancer. The patient’s wife has asked about the differences between
normal cells and cancer cells. What characteristic of a cancer cell should the educator
cite?
A) Malignant cells contain more fibronectin than normal body cells.
B) Malignant cells contain proteins called tumor-specific antigens.
C) Chromosomes contained in cancer cells are more durable and stable than those of
normal cells.
D) The nuclei of cancer cells are unusually large, but regularly shaped.
B) Malignant cells contain proteins called tumor-specific antigens.
A patient’s most recent diagnostic imaging has revealed that his lung cancer has
metastasized to his bones and liver. What is the most likely mechanism by which the
patient’s cancer cells spread?
A) Hematologic spread
B) Lymphatic circulation
C) Invasion
D) Angiogenesis
B) Lymphatic circulation
The nurse is describing some of the major characteristics of cancer to a patient who has
recently received a diagnosis of malignant melanoma. When differentiating between
benign and malignant cancer cells, the nurse should explain differences in which of the
following aspects? Select all that apply.
A) Rate of growth
B) Ability to cause death
C) Size of cells
D) Cell contents
E) Ability to spread
A) Rate of growth
B) Ability to cause death
E) Ability to spread
A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis
with the nurse. The patient states, ìThey tell me my cancer is malignant, while my
coworker’s breast tumor was benign. I just don’t understand at all.î When preparing a
response to this patient, the nurse should be cognizant of what characteristic that
distinguishes malignant cells from benign cells of the same tissue type?
A) Slow rate of mitosis of cancer cells
B) Different proteins in the cell membrane
C) Differing size of the cells
D) Different molecular structure in the cells
B) Different proteins in the cell membrane
An oncology patient will begin a course of chemotherapy and radiation therapy for the
treatment of bone metastases. What is one means by which malignant disease processes
transfer cells from one place to another?
A) Adhering to primary tumor cells
B) Inducing mutation of cells of another organ
C) Phagocytizing healthy cells
D) Invading healthy host tissues
D) Invading healthy host tissues
The nurse is performing an initial assessment of an older adult resident who has just
relocated to the long-term care facility. During the nurse’s interview with the patient,
she admits that she drinks around 20 ounces of vodka every evening. What types of
cancer does this put her at risk for? Select all that apply.
A) Malignant melanoma
B) Brain cancer
C) Breast cancer
D) Esophageal cancer
E) Liver cancer
C) Breast cancer
D) Esophageal cancer
E) Liver cancer
The clinic nurse is caring for a patient whose grandmother and sister have both had
breast cancer. She requested a screening test to determine her risk of developing breast
cancer and it has come back positive. The patient asks you what she can do to help
prevent breast cancer from occurring. What would be your best response?
A) ìResearch has shown that eating a healthy diet can provide all the protection you
need against breast cancer.î
B) ìResearch has shown that taking the drug tamoxifen can reduce your chance of
breast cancer.
C) ìResearch has shown that exercising at least 30 minutes every day can reduce
your chance of breast cancer.î
D) ìResearch has shown that there is little you can do to reduce your risk of breast
cancer if you have a genetic predisposition.
B) ìResearch has shown that taking the drug tamoxifen can reduce your chance of
breast cancer.
A public health nurse has formed an interdisciplinary team that is developing an
educational program entitled Cancer: The Risks and What You Can Do About Them.
Participants will receive information, but the major focus will be screening for relevant
cancers. This program is an example of what type of health promotion activity?
A) Disease prophylaxis
B) Risk reduction
C) Secondary prevention
D) Tertiary prevention
C) Secondary prevention
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial
mastectomy. The oncology nurse explained that the surgeon will want to take tissue
samples to ensure the disease has not spread to adjacent axillary lymph nodes. The
patient has asked if she will have her lymph nodes dissected, like her mother did
several years ago. What alternative to lymph node dissection will this patient most
likely undergo?
A) Lymphadenectomy
B) Needle biopsy
C) Open biopsy
D) Sentinel node biopsy
D) Sentinel node biopsy
You are caring for a patient who has just been told that her stage IV colon cancer has
recurred and metastasized to the liver. The oncologist offers the patient the option of
surgery to treat the progression of this disease. What type of surgery does the
oncologist offer?
A) Palliative
B) Reconstructive
C) Salvage
D) Prophylactic
A) Palliative
The nurse is caring for a patient with an advanced stage of breast cancer and the patient
has recently learned that her cancer has metastasized. The nurse enters the room and
finds the patient struggling to breath and the nurse’s rapid assessment reveals that the
patient’s jugular veins are distended. The nurse should suspect the development of what
oncologic emergency?
A) Increased intracranial pressure
B) Superior vena cava syndrome (SVCS)
C) Spinal cord compression
D) Metastatic tumor of the neck
B) Superior vena cava syndrome (SVCS)
The hospice nurse is caring for a patient with cancer in her home. The nurse has
explained to the patient and the family that the patient is at risk for hypercalcemia and
has educated them on that signs and symptoms of this health problem. What else should
the nurse teach this patient and family to do to reduce the patient’s risk of
hypercalcemia?
A) Stool softeners are contraindicated.
B) Laxatives should be taken daily.
C) Consume 2 to 4 L of fluid daily.
D) Restrict calcium intake.
C) Consume 2 to 4 L of fluid daily.
The home health nurse is performing a home visit for an oncology patient discharged 3
days ago after completing treatment for non-Hodgkin lymphoma. The nurse’s
assessment should include examination for the signs and symptoms of what
complication?
A) Tumor lysis syndrome (TLS)
B) Syndrome of inappropriate antiduretic hormone (SIADH)
C) Disseminated intravascular coagulation (DIC)
D) Hypercalcemia
A) Tumor lysis syndrome (TLS)
The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads
in the electronic health record that the patient has just finished radiation therapy. With
knowledge of the consequent health risks, the nurse should prioritize assessments
related to what health problem?
A) Cognitive deficits
B) Impaired wound healing
C) Cardiac tamponade
D) Tumor lysis syndrome
B) Impaired wound healing
An oncology patient has just returned from the postanesthesia care unit after an open
hemicolectomy. This patient’s plan of nursing care should prioritize which of the
following?
A) Assess the patient hourly for signs of compartment syndrome.
B) Assess the patient’s fine motor skills once per shift.
C) Assess the patient’s wound for dehiscence every 4 hours.
D) Maintain the patient’s head of bed at 45 degrees or more at all times.
C) Assess the patient’s wound for dehiscence every 4 hours.
The hospice nurse has just admitted a new patient to the program. What principle
guides hospice care?
A) Care addresses the needs of the patient as well as the needs of the family.
B) Care is focused on the patient centrally and the family peripherally.
C) The focus of all aspects of care is solely on the patient.
D) The care team prioritizes the patient’s physical needs and the family is
responsible for the patient’s emotional needs.
A) Care addresses the needs of the patient as well as the needs of the family.
A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an
interstitial implant for high-dose radiation (HDR). What safety measure should the
nurse include in this patient’s subsequent plan of care?
A) Limit the time that visitors spend at the patient’s bedside.
B) Teach the patient to perform all aspects of basic care independently.
C) Assign male nurses to the patient’s care whenever possible.
D) Situate the patient in a shared room with other patients receiving brachytherapy.
A) Limit the time that visitors spend at the patient’s bedside.
An oncology patient has begun to experience skin reactions to radiation therapy,
prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous
reaction to radiation therapy. What intervention best addresses this nursing diagnosis?
A) Apply an ice pack or heating pad PRN to relieve pain and pruritis
B) Avoid skin contact with water whenever possible
C) Apply phototherapy PRN
D) Avoid rubbing or scratching the affected area
D) Avoid rubbing or scratching the affected area
A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and
fluid intake and her tumor location precludes the use of enteral feeding. What
intervention should the nurse identify as best meeting this patient’s nutritional needs?
A) Administration of parenteral feeds via a peripheral IV
B) TPN administered via a peripherally inserted central catheter
C) Insertion of an NG tube for administration of feeds
D) Maintaining NPO status and IV hydration until treatment completion
B) TPN administered via a peripherally inserted central catheter
An oncology nurse is contributing to the care of a patient who has failed to respond
appreciably to conventional cancer treatments. As a result, the care team is considering
the possible use of biologic response modifiers (BRFs). The nurse should know that
these achieve a therapeutic effect by what means?
A) Promoting the synthesis and release of leukocytes
B) Focusing the patient’s immune system exclusively on the tumor
C) Potentiating the effects of chemotherapeutic agents and radiation therapy
D) Altering the immunologic relationship between the tumor and the patient
D) Altering the immunologic relationship between the tumor and the patient
In the past three to four decades, nursing has moved into the forefront in providing care
for the dying. Which phenomenon has most contributed to this increased focus of care
of the dying?
A) Increased incidence of infections and acute illnesses
B) Increased focus of health care providers on disease prevention
C) Larger numbers of people dying in hospital settings
D) Demographic changes in the population
D) Demographic changes in the population
A nurse who works in the specialty of palliative care frequently encounters issues and
situations that constitute ethical dilemmas. What issue has most often presented
challenging ethical issues, especially in the context of palliative care?
A) The increase in cultural diversity in the United States
B) Staffing shortages in health care and questions concerning quality of care
C) Increased costs of health care coupled with inequalities in access
D) Ability of technology to prolong life beyond meaningful quality of life
D) Ability of technology to prolong life beyond meaningful quality of life
The nurse is caring for a patient who has been recently diagnosed with late stage
pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to
treatment. What is the most likely psychosocial purpose of this patient’s strategy?
A) The patient may be trying to protect loved ones from the emotional effects of the
illness.
B) The patient is being noncompliant in order to assert power over caregivers.
C) The patient may be skeptical of the benefits of the Western biomedical model of
health.
D) The patient thinks that treatment does not provide him comfort.
A) The patient may be trying to protect loved ones from the emotional effects of the
illness.
A nurse who sits on the hospital’s ethics committee is reviewing a complex case that
has many of the hallmarks of assisted suicide. Which of the following would be an
example of assisted suicide?
A) Administering a lethal dose of medication to a patient whose death is imminent
B) Administering a morphine infusion without assessing for respiratory depression
C) Granting a patient’s request not to initiate enteral feeding when the patient is
unable to eat
D) Neglecting to resuscitate a patient with a ìdo not resuscitateî order
A) Administering a lethal dose of medication to a patient whose death is imminent
A medical nurse is providing palliative care to a patient with a diagnosis of end-stage
chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse’s
care?
A) To improve the patient’s and family’s quality of life
B) To support aggressive and innovative treatments for cure
C) To provide physical support for the patient
D) To help the patient develop a separate plan with each discipline of the health care
team
A) To improve the patient’s and family’s quality of life
After contributing to the care of several patients who died in the hospital, the nurse has
identified some lapses in the care that many of these patients received toward the end of
their lives. What have research studies identified as a potential deficiency in the care of
the dying in hospital settings?
A) Families’ needs for information and support often go unmet.
B) Patients are too sedated to achieve adequate pain control.
C) Patients are not given opportunities to communicate with caregivers.
D) Patients are ignored by the care team toward the end of life.
A) Families’ needs for information and support often go unmet.
An adult oncology patient has a diagnosis of bladder cancer with metastasis and the
patient has asked the nurse about the possibility of hospice care. Which principle is
central to a hospice setting?
A) The patient and family should be viewed as a single unit of care.
B) Persistent symptoms of terminal illness should not be treated.
C) Each member of the interdisciplinary team should develop an individual plan of
care.
D) Terminally ill patients should die in the hospital whenever possible.
A) The patient and family should be viewed as a single unit of care.
A clinic nurse is providing patient education prior to a patient’s scheduled palliative
radiotherapy to her spine. At the completion of the patient teaching, the patient
continues to ask the same questions that the nurse has already addressed. What is the
plausible conclusion that the nurse should draw from this?
A) The patient is not listening effectively.
B) The patient is noncompliant with the plan of care.
C) The patient may have a low intelligence quotient or a cognitive deficit.
D) The patient has not achieved the desired learning outcomes.
D) The patient has not achieved the desired learning outcomes.
The nurse is part of the health care team at an oncology center. A patient has been
diagnosed with leukemia and the prognosis is poor, but the patient is not yet aware of
the prognosis. How can the bad news best be conveyed to the patient?
A) Family should be given the prognosis first.
B) The prognosis should be delivered with the patient at eye level.
C) The physician should deliver the news to the patient alone.
D) The appointment should be scheduled at the end of the day.
B) The prognosis should be delivered with the patient at eye level.
A patient has just been told that her illness is terminal. The patient tearfully states, ìI
can’t believe I am going to die. Why me?î What is your best response?
A) ìI know how you are feeling.î
B) ìYou have lived a long life.î
C) ìThis must be very difficult for you.
D) ìLife can be so unfair.î
C) ìThis must be very difficult for you.
The nurse has observed that an older adult patient with a diagnosis of end-stage renal
failure seems to prefer to have his eldest son make all of his health care decisions.
While the family is visiting, the patient explains to you that this is a cultural practice
and very important to him. How should you respond?
A) Privately ask the son to allow the patient to make his own health care decisions.
B) Explain to the patient that he is responsible for his own decisions.
C) Work with the team to negotiate informed consent.
D) Avoid divulging information to the eldest son.
C) Work with the team to negotiate informed consent.
One aspect of the nurse’s comprehensive assessment when caring for the terminally ill
is the assessment of hope. The nurse is assessing a patient with liver failure for the
presence of hope. What would the nurse identify as a hope-fostering category?
A) Uplifting memories
B) Ignoring negative outcomes
C) Envisioning one specific outcome
D) Avoiding an actual or potential threat
A) Uplifting memories
A medical nurse is providing end-of-life care for a patient with metastatic bone cancer.
The nurse notes that the patient has been receiving oral analgesics for her pain with
adequate effect, but is now having difficulty swallowing the medication. What should
the nurse do?
A) Request the physician to order analgesics by an alternative route.
B) Crush the medication in order to aid swallowing and absorption.
C) Administer the patient’s medication with the meal tray.
D) Administer the medication rectally.
A) Request the physician to order analgesics by an alternative route.
A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has
metastasized to the patient’s liver and bones. For the past several hours, the patient has
been experiencing dyspnea. What nursing action is most appropriate to help to relive
the dyspnea the patient is experiencing?
A) Administer a bolus of normal saline, as ordered.
B) Initiate high-flow oxygen therapy.
C) Administer high doses of opioids.
D) Administer bronchodilators and corticosteroids, as ordered.
D) Administer bronchodilators and corticosteroids, as ordered.
The nurse is caring for a patient who has terminal lung cancer and is unconscious.
Which assessment finding would most clearly indicate to the nurse that the patient’s
death is imminent?
A) Mottling of the lower limbs
B) Slow, steady pulse
C) Bowel incontinence
D) Increased swallowing
A) Mottling of the lower limbs
A patient on the medical unit is dying and the nurse has determined that the family’s
psychosocial needs during the dying process need to be addressed. What is a cause of
many patient care dilemmas at the end of life?
A) Poor communication between the family and the care team
B) Denial of imminent death on the part of the family or the patient
C) Limited visitation opportunities for friends and family
D) Conflict between family members
A) Poor communication between the family and the care team
The nurse is assessing a 73-year-old patient who was diagnosed with metastatic
prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief, and
intense sadness. Based on this assessment data, the nurse will document that the patient
is most likely in what stage of death and dying?
A) Depression
B) Denial
C) Anger
D) Resignation
A) Depression
You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just
been told by the care team that his prognosis is poor. He is tearful and trying to express
his feelings, but he is having difficulty. What should you do first?
A) Ask if he would like you to sit with him while he collects his thoughts.
B) Tell him that you will leave for now but will be back shortly.
C) Offer to call pastoral care or a member of his chosen clergy.
D) Reassure him that you can understand how he is feeling.
A) Ask if he would like you to sit with him while he collects his thoughts.
The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia.
The child’s mother has been unable to eat or sleep and can talk only about her
impending loss and the guilt she feels about the child’s pain and suffering. What
intervention has the highest priority?
A) Allowing the patient to express her feelings without judging her
B) Helping the patient to understand the phases of the grieving process
C) Reassuring the patient that the child’s death is not her fault
D) Arranging for genetic counseling to inform the patient of her chances of having
another child with the disease
A) Allowing the patient to express her feelings without judging her
You are caring for a patient, a 42-year-old mother of two children, with a diagnosis of
ovarian cancer. She has just been told that her ovarian cancer is terminal. When you
admitted this patient, you did a spiritual assessment. What question would it have been
most important for you to evaluate during this assessment?
A) Is she able to tell her family of negative test results?
B) Does she have a sense of peace of mind and a purpose to her life?
C) Can she let go of her husband so he can make a new life?
D) Does she need time and space to bargain with God for a cure?
B) Does she have a sense of peace of mind and a purpose to her life?
A patient’s rapid cancer metastases have prompted a shift from active treatment to
palliative care. When planning this patient’s care, the nurse should identify what
primary aim?
A) To prioritize emotional needs
B) To prevent and relieve suffering
C) To bridge between curative care and hospice care
D) To provide care while there is still hope
B) To prevent and relieve suffering
The organization of a patient’s care on the palliative care unit is based on
interdisciplinary collaboration. How does interdisciplinary collaboration differ from
multidisciplinary practice?
A) It is based on the participation of clinicians without a team leader.
B) It is based on clinicians of varied backgrounds integrating their separate plans of
care.
C) It is based on communication and cooperation between disciplines.
D) It is based on medical expertise and patient preference with the support of nursing.
C) It is based on communication and cooperation between disciplines.
As the American population ages, nurses expect see more patients admitted to longterm
care facilities in need of palliative care. Regulations now in place that govern how
the care in these facilities is both organized and reimbursed emphasize what aspect of
care?
A) Ongoing acute care
B) Restorative measures
C) Mobility and socialization
D) Incentives to palliative care
B) Restorative measures
A patient with end-stage heart failure has participated in a family meeting with the
interdisciplinary team and opted for hospice care. On what belief should the patient’s
care in this setting be based?
A) Meaningful living during terminal illness requires technologic interventions.
B) Meaningful living during terminal illness is best supported in designated
facilities.
C) Meaningful living during terminal illness is best supported in the home.
D) Meaningful living during terminal illness is best achieved by prolonging
physiologic dying.
C) Meaningful living during terminal illness is best supported in the home.
A nurse who provides care on an acute medical unit has observed that physicians are
frequently reluctant to refer patients to hospice care. What are contributing factors that
are known to underlie this tendency? Select all that apply.
A) Financial pressures on health care providers
B) Patient reluctance to accept this type of care
C) Strong association of hospice care with prolonging death
D) Advances in ìcurativeî treatment in late-stage illness
E) Ease of making a terminal diagnosis
A) Financial pressures on health care providers
B) Patient reluctance to accept this type of care
D) Advances in curative treatment in late-stage illness
A nurse is caring for an 87-year-old Mexican-American female patient who is in endstage
renal disease. The physician has just been in to see the patient and her family to
tell them that nothing more can be done for the patient and that death is not far. The
physician offers to discharge the patient home to hospice care, but the patient and
family refuse. After the physician leaves, the patient’s daughter approaches you and
asks what hospice care is. What would this lack of knowledge about hospice care be
perceived as?
A) Lack of an American education of the patient and her family
B) A language barrier to hospice care for this patient
C) A barrier to hospice care for this patient
D) Inability to grasp American concepts of health care
C) A barrier to hospice care for this patient
Patients who are enrolled in hospice care through Medicare are often felt to suffer
unnecessarily because they do not receive adequate attention for their symptoms of the
underlying illness. What factor most contributes to this phenomenon?
A) Unwillingness to overmedicate the dying patient
B) Rules concerning completion of all cure-focused medical treatment
C) Unwillingness of patients and families to acknowledge the patient is terminal
D) Lack of knowledge of patients and families regarding availability of care
B) Rules concerning completion of all cure-focused medical treatment
One of the functions of nursing care of the terminally ill is to support the patient and his
or her family as they come to terms with the diagnosis and progression of the disease
process. How should nurses support patients and their families during this process?
Select all that apply.
A) Describe their personal experiences in dealing with end-of-life issues.
B) Encourage the patient and family to ìkeep fightingî as a cure may come.
C) Try to appreciate and understand the illness from the patient’s perspective.
D) Assist patients with performing a life review.
E) Provide interventions that facilitate end-of-life closure.
C) Try to appreciate and understand the illness from the patient’s perspective.
D) Assist patients with performing a life review.
E) Provide interventions that facilitate end-of-life closure.
The nurse is admitting a 52-year-old father of four into hospice care. The patient has a
diagnosis of Parkinson’s disease, which is progressing rapidly. The patient has made
clear his preference to receive care at home. What interventions should the nurse
prioritize in the plan of care?
A) Aggressively continuing to fight the disease process
B) Moving the patient to a long-term care facility when it becomes necessary
C) Including the children in planning their father’s care
D) Supporting the patient’s and family’s values and choices
D) Supporting the patient’s and family’s values and choices
A patient has just died following urosepsis that progressed to septic shock. The patient’s
spouse says, ìI knew this was coming, but I feel so numb and hollow inside.î The nurse
should know that these statements are characteristic of what?
A) Complicated grief and mourning
B) Uncomplicated grief and mourning
C) Depression stage of dying
D) Acceptance stage of dying
B) Uncomplicated grief and mourning
A 67-year-old woman experienced the death of her husband from a sudden myocardial
infarction 5 weeks ago. The nurse recognizes that the woman will be going through the
process of mourning for an extended period of time. What processes of mourning will
allow the woman to accommodate the loss in a healthy way? Select all that apply.
A) Reiterating her anger at her husband’s care team
B) Reinvesting in new relationships at the appropriate time
C) Reminiscing about the relationship she had with her husband
D) Relinquishing old attachments to her husband at the appropriate time
E) Renewing her lifelong commitment to her husband
B) Reinvesting in new relationships at the appropriate time
C) Reminiscing about the relationship she had with her husband
D) Relinquishing old attachments to her husband at the appropriate time
A nurse has made a referral to a grief support group, knowing that many individuals
find these both comforting and beneficial after the death of a loved one. What is the
most important accomplishment available by attending a grief support group?
A) Providing a framework for incorporating the old life into the new life
B) Normalizing adaptation to a continuation of the old life
C) Aiding in adjusting to using old, familiar social skills
D) Normalization of feelings and experiences
D) Normalization of feelings and experiences
A patient’s daughter has asked the nurse about ìhelping him end his terrible suffering.î
The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly
states that nursing participation in assisted suicide is a violation of the Code for Nurses.
What does the Position Statement further stress?
A) Educating families about the moral implications of assisted suicide
B) Identifying patient and family concerns and fears
C) Identifying resources that meet the patient’s desire to die
D) Supporting effective means to honor the patient’s desire to die
B) Identifying patient and family concerns and fears
A hospice nurse is caring for a 22-year-old with a terminal diagnosis of leukemia.
When updating this patient’s plan of nursing care, what should the nurse prioritize?
A) Interventions aimed at maximizing quantity of life
B) Providing financial advice to pay for care
C) Providing realistic emotional preparation for death
D) Making suggestions to maximize family social interactions after the patient’s
death
C) Providing realistic emotional preparation for death
A pediatric nurse is emotionally distraught by the death of a 9-year-old girl who
received care on the unit over the course of many admissions spanning several years.
What action is the most appropriate response to the nurse’s own grief?
A) Take time off from work to mourn the death.
B) Post mementos of the patient on the unit.
C) Solicit emotional support from the patient’s family.
D) Attend the patient’s memorial service.
D) Attend the patient’s memorial service.
As a staff member in a local hospice, a nurse deals with death and dying on a frequent
basis. Where would be the safe venue for the nurse to express her feelings of frustration
and grief about a patient who has recently died?
A) In the cafeteria
B) At a staff meeting
C) At a social gathering
D) At a memorial service
B) At a staff meeting
A hospice nurse is well aware of how difficult it is to deal with others’ pain on a daily
basis. This nurse should put healthy practices into place to guard against what
outcome?
A) Inefficiency in the provision of care
B) Excessive weight gain
C) Emotional exhaustion
D) Social withdrawal
C) Emotional exhaustion
The hospice nurse is caring for a 45-year-old mother of three young children in the
patient’s home. During the most recent visit, the nurse has observed that the patient has
a new onset of altered mental status, likely resulting from recently diagnosed brain
metastases. What goal of nursing interventions should the nurse identify?
A) Helping the family to understand why the patient needs to be sedated
B) Making arrangements to promptly move the patient to an acute-care facility
C) Explaining to the family that death is near and the patient needs around-the-clock
nursing care
D) Teaching family members how to interact with, and ensure safety for, the patient
with impaired cognition
D) Teaching family members how to interact with, and ensure safety for, the patient
with impaired cognition
You are caring for a patient who has just been told that his illness is progressing and
nothing more can be done for him. After the physician leaves, the patient asks you to
stay with him for a while. The patient becomes tearful and tries several times to say
something, but cannot get the words out. What would be an appropriate response for
you to make at this time?
A) ìCan I give you some advice?î
B) ìDo you need more time to think about this?
C) ìIs there anything you want to say?î
D) ìI have cared for lots of patients in your position. It will get easier.î
B) ìDo you need more time to think about this?
A patient who is receiving care for osteosarcoma has been experiencing severe pain
since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patient’s level of
consciousness has declined and she is now unresponsive. How should the patient’s pain
control regimen be affected?
A) The patient’s pain control regimen should be continued.
B) The pain control regimen should be placed on hold until the patient’s level of
consciousness improves.
C) IV analgesics should be withheld and replaced with transdermal analgesics.
D) The patient’s analgesic dosages should be reduced by approximately one half.
A) The patient’s pain control regimen should be continued.
A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral
antibiotics. He then develops osteomyelitis of the right knee, prompting a detailed
diagnostic workup that reveals a phagocytic disorder. This patient faces an increased
risk of what complication?
A) Thrombocytopenia
B) HIV/AIDS
C) Neutropenia
D) Hemophilia
C) Neutropenia
A patient is admitted for the treatment of a primary immunodeficiency and intravenous
immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential
adverse effect of IVIG administration?
A) Anaphylaxis
B) Hypertension
C) Hypothermia
D) Joint pain
A) Anaphylaxis
A nurse is admitting a patient with an immunodeficiency to the medical unit. In
planning the care of this patient, the nurse should assess for what common sign of
immunodeficiency?
A) Chronic diarrhea
B) Hyperglycemia
C) Rhinorrhea
D) Contact dermatitis
A) Chronic diarrhea
A young couple visits the nurse practitioner stating that they want to start a family. The
husband states that his brother died of a severe infection at age 6 months. He says he
never knew what was wrong but his mother had him undergo ìblood testingî as a child.
Based on these statements, what health problem should the nurse practitioner suspect?
A) Severe neutropenia
B) X-linked agammaglobulinemia
C) Drug-induced thrombocytopenia
D) Aplastic anemia
B) X-linked agammaglobulinemia
The parents of a 1-month-old infant bring their child to the pediatrician with symptoms
of congestive heart failure. The infant is ultimately diagnosed with DiGeorge
syndrome. What will prolong this infant’s survival?
A) Stem cell transplantation
B) Long-term antibiotics
C) Chemotherapy
D) Thymus gland transplantation
D) Thymus gland transplantation
A patient who has received a heart transplant is taking cyclosporine, an
immunosuppressant. What should the nurse emphasize during health education about
infection prevention?
A) Eat a high-calorie, high-protein diet.
B) Limit physical activity in order to conserve energy.
C) Take prophylactic antibiotics as ordered.
D) Perform frequent handwashing.
D) Perform frequent handwashing.
The nurse is caring for a patient who has a diagnosis of paroxysmal nocturnal
hemoglobinuria. When planning this patient’s care, the nurse should recognize the
patient’s heightened risk of what complication?
A) Venous thromboembolism
B) Acute respiratory distress syndrome (ARDS)
C) Myocardial infarction
D) Hypertensive urgency
A) Venous thromboembolism
A patient diagnosed with common variable immune deficiency (CVID) has been
admitted to the acute medicine unit. When reviewing this patient’s laboratory findings,
the nurse should prioritize what values?
A) Creatinine and blood urea nitrogen (BUN)
B) Hemoglobin and vitamin B12
C) Sodium, potassium and magnesium
D) D-dimer and c-reactive protein
B) Hemoglobin and vitamin B12
Patient teaching regarding infection prevention for the patient with an
immunodeficiency includes which of the following guidelines?
A) Cook all food thoroughly.
B) Refrain from using creams or emollients on skin.
C) Maintain contact only with individuals who have recently been vaccinated.
D) Take OTC vitamin supplements consistently.
A) Cook all food thoroughly.
A nurse has admitted a patient diagnosed with severe combined immunodeficiency
disease (SCID) to the unit. The patient’s orders include IVIG. How will the patient’s
dose of IVIG be determined?
A) The patient will receive 25 to 50 mg/kg of body weight.
B) The dose will be determined by the patient’s response.
C) The dose will be determined by body surface area.
D) The patient will receive a one-time bolus followed by 100- to 150-mg doses.
B) The dose will be determined by the patient’s response.
The nurse is preparing to administer IVIG to a patient who has an immunodeficiency.
What nursing guideline should the nurse apply?
A) Do not exceed an infusion rate of 300 mL/hr.
B) Slow the infusion rate if the patient exhibits signs of a transfusion reaction.
C) Weigh the patient immediately after the infusion is complete.
D) Administer pretreatment medications as ordered 30 minutes prior to infusion.
D) Administer pretreatment medications as ordered 30 minutes prior to infusion.
IVIG has been ordered for the treatment of a patient with an immunodeficiency. Which
of the following actions should the nurse perform before administering this blood
product?
A) Ensure that the patient has a patent central line.
B) Ensure that the IVIG is appropriately mixed with normal saline.
C) Administer furosemide before IVIG to prevent hypervolemia.
D) Weigh the patient before administration to verify the correct dose.
D) Weigh the patient before administration to verify the correct dose.
A patient with a diagnosis of common variable immunodeficiency begins to develop
thick, sticky, tenacious sputum. The patient has a history of episodes of pneumonia at
least one time per year for the last 10 years. What does the nurse suspect the patient is
developing?
A) Pulmonary edema
B) A pulmonary neoplasm
C) Bronchiectasis
D) Emphysema
C) Bronchiectasis
A nurse is admitting an adolescent patient with a diagnosis of ataxia-telangiectasis.
Which of the following nursing diagnoses should the nurse include in the patient’s plan
of care?
A) Fatigue Related to Pernicious Anemia
B) Risk for Constipation Related to Decreased Gastric Motility
C) Risk for Falls Due to Loss of Muscle Coordination
D) Disturbed Kinesthetic Sensory Perception Related to Vascular Changes
C) Risk for Falls Due to Loss of Muscle Coordination
A 20-year-old patient with an immunodeficiency is admitted to the unit with an acute
episode of upper airway edema. This is the fifth time in the past 3 months that the
patient has had such as episode. As the nurse caring for this patient, you know that the
patient may have a deficiency of what?
A) Interferons
B) C1esterase inhibitor
C) IgG
D) IgA
B) C1esterase inhibitor
A patient with Wiskott-Aldrich syndrome is admitted to the medical unit. The nurse
caring for the patient should prioritize which of the following?
A) Protective isolation
B) Fresh-frozen plasma administration
C) Chest physiotherapy
D) Nutritional supplementation
A) Protective isolation
The nurse is admitting a patient to the unit with a diagnosis of ataxia-telangiectasia. The
nurse’s assessment should reflect the patient’s increased risk for what complication?
A) Peripheral edema
B) Cancer
C) Anaphylaxis
D) Gastrointestinal bleeds
B) Cancer
The nurse is working with the interdisciplinary team to care for a patient who has
recently been diagnosed with severe combined immunodeficiency disease (SCID).
What treatment is likely of most benefit to this patient?
A) Combined radiotherapy and chemotherapy
B) Antibiotic therapy
C) Hematopoietic stem cell transplantation (HSCT)
D) Treatment with colony-stimulating factors (CSFs)
C) Hematopoietic stem cell transplantation (HSCT)
A patient has been admitted with a phagocytic cell disorder and the nurse is reviewing
the most common health problems that accompany these disorders. The nurse should
identify which of the following? Select all that apply.
A) Inflammatory bowel disease
B) Chronic otitis media
C) Cutaneous abscesses
D) Pneumonia
E) Cognitive deficits
B) Chronic otitis media
C) Cutaneous abscesses
D) Pneumonia
A nurse is caring for a patient with a phagocytic cell disorder. The patient states, ìMy
specialist says that I will likely be cured after I get my treatment tomorrow.î To what
treatment is the patient most likely referring?
A) Treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF)
B) Hematopoietic stem cell transplantation
C) Treatment with granulocyte colony-stimulating factor (G-CSF)
D) Brachytherapy
B) Hematopoietic stem cell transplantation
A patient’s primary immunodeficiency disease is characterized by the inability of white
blood cells to initiate an inflammatory response to infectious organisms. What is this
patient’s most likely diagnosis?
A) Chronic granulomatous disease
B) Wiskott-Aldrich syndrome
C) Hyperimmunoglobulinemia E syndrome
D) Common variable immunodeficiency
C) Hyperimmunoglobulinemia E syndrome
A nurse educator is explaining that patients with primary immunodeficiencies are living
longer than in past decades because of advances in medical treatment. This increased
longevity is associated with an increased risk of what?
A) Chronic obstructive pulmonary disease
B) Dementia
C) Pulmonary fibrosis
D) Cancer
D) Cancer
The nurse educator is differentiating primary immunodeficiency diseases from
secondary immunodeficiencies. What is the defining characteristic of primary
immunodeficiency diseases?
A) They require IVIG as treatment.
B) They are the result of intrauterine infection.
C) They have a genetic origin.
D) They are communicable.
C) They have a genetic origin.
A nurse has created a plan of care for an immunodeficient patient, specifying that care
providers take the patient’s pulse and respiratory rate for a full minute. What is the
rationale for this aspect of care?
A) Respirations affect heart rate in immunodeficient patients.
B) These patients’ blunted inflammatory responses can cause subtle changes in
status.
C) Hemodynamic instability is one of the main complications of immunodeficiency.
D) Immunodeficient patients are prone to ventricular tachycardia and atrial
fibrillation.
B) These patients’ blunted inflammatory responses can cause subtle changes in
status.
A nurse is providing health education regarding self-care to a patient with an
immunodeficiency. What teaching point should the nurse emphasize?
A) The importance of aggressive treatment of acne
B) The importance of avoiding alcohol-based cleansers
C) The need to keep fingernails and toenails closely trimmed
D) The need for thorough oral hygiene
D) The need for thorough oral hygiene
The nurse is applying standard precautions in the care of a patient who has an
immunodeficiency. What are key elements of standard precautions? Select all that
apply.
A) Using appropriate personal protective equipment
B) Placing patients in negative-pressure isolation rooms
C) Placing patients in positive-pressure isolation rooms
D) Using safe injection practices
E) Performing hand hygiene
A) Using appropriate personal protective equipment
D) Using safe injection practices
E) Performing hand hygiene
The nurse is caring for a patient with an immunodeficiency who has experienced
sudden malaise. The nurse’s colleague states, ìI’m pretty sure that it’s not an infection,
because the most recent blood work looks fine.î What principle should guide the nurse’s
response to the colleague?
A) Immunodeficient patients will usually exhibit subtle and atypical signs of
infection.
B) Infections in immunodeficient patients have a slower onset but a more severe
course.
C) Laboratory blood work is often inaccurate in immunodeficient patients.
D) Immunodeficient patients do not develop symptoms of infection.
A) Immunodeficient patients will usually exhibit subtle and atypical signs of
infection.
A nurse is caring for a patient who has an immunodeficiency. What assessment finding
should prompt the nurse to consider the possibility that the patient is developing an
infection?
A) Uncharacteristic aggression
B) Persistent diarrhea
C) Pruritis (itching)
D) Constipation
B) Persistent diarrhea
A patient with a diagnosis of primary immunodeficiency informs the nurse that he has
been experiencing a new onset of a dry cough and occasional shortness of breath. After
determining that the patient’s vital signs are within reference ranges, what action should
the nurse take?
A) Administer a nebulized bronchodilator.
B) Perform oral suctioning.
C) Assess the patient for signs and symptoms of infection.
D) Teach the patient deep breathing and coughing exercises.
C) Assess the patient for signs and symptoms of infection.
A home health nurse is reinforcing health education with a patient who is
immunosuppressed and his family. What statement best suggests that the patient has
understood the nurse’s teaching?
A) ìMy family needs to understand when I can go get the seasonal flu shot.î
B) ìI need to know how to treat my infections in a home setting.î
C) ìI need to understand how to give my platelet transfusions.î
D) ìMy family needs to understand that I’ll probably need lifelong treatment.
D) ìMy family needs to understand that I’ll probably need lifelong treatment.
A nurse is preparing to administer a scheduled dose of IVIG to a patient who has a
diagnosis of severe combined immunodeficiency disease (SCID). What medication
should the nurse administer prior to initiating the infusion?
A) Diphenhydramine
B) Ibuprofen
C) Hydromorphone
D) Fentanyl
A) Diphenhydramine
An immunocompromised patient is being treated in the hospital. The nurse’s assessment
reveals that the patient’s submandibular lymph nodes are swollen, a finding that
represents a change from the previous day. What is the nurse’s most appropriate action?
A) Administer a PRN dose of acetaminophen as ordered.
B) Monitor the patient’s vital signs q2h for the next 24 hours.
C) Inform the patient’s primary care provider of this finding.
D) Implement standard precautions in the patient’s care.
C) Inform the patient’s primary care provider of this finding.
A nurse caring for a patient who has an immunosuppressive disorder knows that
continual monitoring of the patient is critical. What is the primary rationale behind the
need for continual monitoring?
A) So that the patient’s functional needs can be met immediately
B) So that medications can be given as ordered and signs of adverse reactions noted
C) So that early signs of impending infection can be detected and treated
D) So that the nurse’s documentation can be thorough and accurate
C) So that early signs of impending infection can be detected and treated
A nurse is planning the care of a patient who requires immunosuppression to ensure
engraftment of depleted bone marrow during a transplantation procedure. What is the
most important component of infection control in the care of this patient?
A) Administration of IVIG
B) Antibiotic administration
C) Appropriate use of gloves and goggles
D) Thorough and consistent hand hygiene
D) Thorough and consistent hand hygiene
A home health nurse is caring for a patient who has an immunodeficiency. What is the
nurse’s priority action to help ensure successful outcomes and a favorable prognosis?
A) Encourage the patient and family to be active partners in the management of the
immunodeficiency.
B) Encourage the patient and family to manage the patient’s activity level and
activities of daily living effectively.
C) Make sure that the patient and family understand the importance of monitoring
fluid balance.
D) Make sure that the patient and family know how to adjust dosages of the
medications used in treatment.
A) Encourage the patient and family to be active partners in the management of the
immunodeficiency.
A nurse is preparing to discharge a patient with an immunodeficiency. When preparing
the patient for self-infusion of IVIG in the home setting, what education should the
nurse prioritize?
A) Sterile technique for establishing a new IV site
B) Signs and symptoms of adverse reactions
C) Formulas for calculating daily doses
D) Technique for adding medications to the IVIG
B) Signs and symptoms of adverse reactions
A home health nurse will soon begin administering IVIG to a new patient on a regular
basis. What teaching should the nurse provide to the patient?
A) The need for a sterile home environment
B) Complementary alternatives to IVIG
C) Expected benefits and outcomes of the treatment
D) Technique for managing and monitoring daily fluid intake
C) Expected benefits and outcomes of the treatment
The home health nurse is assessing a patient who is immunosuppressed following a
liver transplant. What is the most essential teaching for this patient and the family?
A) How to promote immune function through nutrition
B) The importance of maintaining the patient’s vaccination status
C) How to choose antibiotics based on the patient’s symptoms
D) The need to report any slight changes in the patient’s health status
D) The need to report any slight changes in the patient’s health status
Family members of an immunocompromised patient have asked the nurse why
antibiotics are not being given to the patient in order to prevent infection. How should
the nurse best respond?
A) ìUsing antibiotics to prevent infections can cause the growth of drug-resistant
bacteria.
B) ìIf an antibiotic is given to prevent a bacterial infection, the patient is at risk of a
viral infection.î
C) ìAntibiotics can never prevent an infection; they can only cure an infection that is
fully developed.î
D) ìAntibiotics cannot resolve infections in people who are immunocompromised.î
A) ìUsing antibiotics to prevent infections can cause the growth of drug-resistant
bacteria.
A 6-month-old infant has been diagnosed with X-linked agammaglobulinemia and the
parents do not understand why their baby did not develop an infection during the first
months of life. The nurse should describe what phenomenon?
A) Cell-mediated immunity in infants
B) Passive acquired immunity
C) Phagocytosis
D) Opsonization
B) Passive acquired immunity
Since the emergence of HIV/AIDS, there have been significant changes in
epidemiologic trends. Members of what group currently have the greatest risk of
contracting HIV?
A) Gay, bisexual, and other men who have sex with men
B) Recreational drug users
C) Blood transfusion recipients
D) Health care providers
A) Gay, bisexual, and other men who have sex with men
A clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that
the patient is experiencing a progressive decline in cognitive, behavioral, and motor
functions. The nurse recognizes that these symptoms are most likely related to the onset
of what complication?
A) HIV encephalopathy
B) B-cell lymphoma
C) Kaposi’s sarcoma
D) Wasting syndrome
A) HIV encephalopathy
A nurse is assessing a 28-year-old man with HIV who has been admitted with
pneumonia. In assessing the patient, which of the following observations takes
immediate priority?
A) Oral temperature of 100∞F
B) Tachypnea and restlessness
C) Frequent loose stools
D) Weight loss of 1 pound since yesterday
B) Tachypnea and restlessness
A patient has come into the free clinic asking to be tested for HIV infection. The patient
asks the nurse how the test works. The nurse responds that if the testing shows that
antibodies to the AIDS virus are present in the blood, this indicates what?
A) The patient is immune to HIV.
B) The patient’s immune system is intact.
C) The patient has AIDS-related complications.
D) The patient has been infected with HIV.
D) The patient has been infected with HIV.
A hospital patient is immunocompromised because of stage 3 HIV infection and the
physician has ordered a chest radiograph. How should the nurse most safely facilitate
the test?
A) Arrange for a portable x-ray machine to be used.
B) Have the patient wear a mask to the x-ray department.
C) Ensure that the radiology department has been disinfected prior to the test.
D) Send the patient to the x-ray department, and have the staff in the department
wear masks.
A) Arrange for a portable x-ray machine to be used.
The mother of two young children has been diagnosed with HIV and expresses fear of
dying. How should the nurse best respond to the patient?
A) ìWould you like me to have the chaplain come speak with you?î
B) ìYou’ll learn much about the promise of a cure for HIV.î
C) ìCan you tell me what concerns you most about dying?
D) ìYou need to maintain hope because you may live for several years.î
C) ìCan you tell me what concerns you most about dying?
The nurse is addressing condom use in the context of a health promotion workshop.
When discussing the correct use of condoms, what should the nurse tell the attendees?
A) Attach the condom prior to erection.
B) A condom may be reused with the same partner if ejaculation has not occurred.
C) Use skin lotion as a lubricant if alternatives are unavailable.
D) Hold the condom by the cuff upon withdrawal.
D) Hold the condom by the cuff upon withdrawal.
A nurse is planning the care of a patient with AIDS who is admitted to the unit with
Pneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for
this patient?
A) Ineffective Airway Clearance
B) Impaired Oral Mucous Membranes
C) Imbalanced Nutrition: Less than Body Requirements
D) Activity Intolerance
A) Ineffective Airway Clearance
A public health nurse is preparing an educational campaign to address a recent local
increase in the incidence of HIV infection. The nurse should prioritize which of the
following interventions?
A) Lifestyle actions that improve immune function
B) Educational programs that focus on control and prevention
C) Appropriate use of standard precautions
D) Screening programs for youth and young adults
B) Educational programs that focus on control and prevention
A nurse is working with a patient who was diagnosed with HIV several months earlier.
The nurse should recognize that a patient with HIV is considered to have AIDS at the
point when the CD4+ T-lymphocyte cell count drops below what threshold?
A) 75 cells/mm3 of blood
B) 200 cells/mm3 of blood
C) 325 cells/mm3 of blood
D) 450 cells/mm3 of blood
B) 200 cells/mm3 of blood
During the admission assessment of an HIV-positive patient whose CD4+ count has
recently fallen, the nurse carefully assesses for signs and symptoms related to
opportunistic infections. What is the most common life-threatening infection?
A) Salmonella infection
B) Mycobacterium tuberculosis
C) Clostridium difficile
D) Pneumocystis pneumonia
D) Pneumocystis pneumonia
A patient’s current antiretroviral regimen includes nucleoside reverse transcriptase
inhibitors (NRTIs). What dietary counseling will the nurse provide based on the
patient’s medication regimen?
A) Avoid high-fat meals while taking this medication.
B) Limit fluid intake to 2 liters a day.
C) Limit sodium intake to 2 grams per day.
D) Take this medication without regard to meals.
D) Take this medication without regard to meals.
A nurse is performing an admission assessment on a patient with stage 3 HIV. After
assessing the patient’s gastrointestinal system and analyzing the data, what is most
likely to be the priority nursing diagnosis?
A) Acute Abdominal Pain
B) Diarrhea
C) Bowel Incontinence
D) Constipation
B) Diarrhea
A patient with a recent diagnosis of HIV infection expresses an interest in exploring
alternative and complementary therapies. How should the nurse best respond?
A) ìComplementary therapies generally have not been approved, so patients are
usually discouraged from using them.î
B) ìResearchers have not looked at the benefits of alternative therapy for patients
with HIV, so we suggest that you stay away from these therapies until there is
solid research data available.î
C) ìMany patients with HIV use some type of alternative therapy and, as with most
health treatments, there are benefits and risks.
D) ìYou’ll need to meet with your doctor to choose between an alternative approach
to treatment and a medical approach.î
C) ìMany patients with HIV use some type of alternative therapy and, as with most
health treatments, there are benefits and risks.
A patient was tested for HIV using enzyme immunoassay (EIA) and results were
positive. The nurse should expect the primary care provider to order what test to
confirm the EIA test results?
A) Another EIA test
B) Viral load test
C) Western blot test
D) CD4/CD8 ratio
C) Western blot test
The nurse’s plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk
for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best
addresses this risk?
A) Providing thorough oral care before and after meals
B) Administering prophylactic antibiotics
C) Promoting nutrition and adequate fluid intake
D) Applying skin emollients as needed
A) Providing thorough oral care before and after meals
A patient with HIV infection has begun experiencing severe diarrhea. What is the most
appropriate nursing intervention to help alleviate the diarrhea?
A) Administer antidiarrheal medications on a scheduled basis, as ordered.
B) Encourage the patient to eat three balanced meals and a snack at bedtime.
C) Increase the patient’s oral fluid intake.
D) Encourage the patient to increase his or her activity level.
A) Administer antidiarrheal medications on a scheduled basis, as ordered.
A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the
patient and privately asks the nurse about the risk of contracting HIV when visiting the
patient. What is the nurse’s best response?
A) ìDo you think that you might already have HIV?î
B) ìDon’t worry. Your immune system is likely very healthy.î
C) ìAIDS isn’t transmitted by casual contact.
D) ìYou can’t contract AIDS in a hospital setting.î
C) ìAIDS isn’t transmitted by casual contact.
A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What
nursing intervention best addresses this risk?
A) Utilize a pressure-reducing mattress.
B) Limit the patient’s physical activity.
C) Apply antibiotic ointment to dependent skin surfaces.
D) Avoid contact with synthetic fabrics.
A) Utilize a pressure-reducing mattress.
A nurse would identify that a colleague needs additional instruction on standard
precautions when the colleague exhibits which of the following behaviors?
A) The nurse wears face protection, gloves, and a gown when irrigating a wound.
B) The nurse washes the hands with a waterless antiseptic agent after removing a
pair of soiled gloves.
C) The nurse puts on a second pair of gloves over soiled gloves while performing a
bloody procedure.
D) The nurse places a used needle and syringe in the puncture-resistant container
without capping the needle.
C) The nurse puts on a second pair of gloves over soiled gloves while performing a
bloody procedure.
An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her
baby is going to be born with HIV. What is the nurse’s best response?
A) ìThere is no way to know that for certain, but we do know that your baby has a
one in four chance of being born with HIV.î
B) ìYour physician is likely the best one to ask that question.î
C) ìIf the baby is HIV positive there is nothing that can be done until it is born, so
try your best not to worry about it now.î
D) ìIt’s possible that your baby could contract HIV, either before, during, or after
delivery.
D) ìIt’s possible that your baby could contract HIV, either before, during, or after
delivery.
A nurse is addressing the incidence and prevalence of HIV infection among older
adults. What principle should guide the nurse’s choice of educational interventions?
A) Many older adults do not see themselves as being at risk for HIV infection.
B) Many older adults are not aware of the difference between HIV and AIDS.
C) Older adults tend to have more sex partners than younger adults.
D) Older adults have the highest incidence of intravenous drug use.
A) Many older adults do not see themselves as being at risk for HIV infection.
A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen
what she needs and the teen responds that she has become sexually active and is
concerned about getting HIV. The teen asks the nurse what she can do keep from
getting HIV. What would be the nurse’s best response?
A) ìThere’s no way to be sure you won’t get HIV except to use condoms correctly.î
B) ìOnly the correct use of a female condom protects against the transmission of
HIV.î
C) ìThere are new ways of protecting yourself from HIV that are being discovered
every day.î
D) ìOther than abstinence, only the consistent and correct use of condoms is
effective in preventing HIV.
D) ìOther than abstinence, only the consistent and correct use of condoms is
effective in preventing HIV.
A patient is in the primary infection stage of HIV. What is true of this patient’s current
health status?
A) The patient’s HIV antibodies are successfully, but temporarily, killing the virus.
B) The patient is infected with HIV but lacks HIV-specific antibodies.
C) The patient’s risk for opportunistic infections is at its peak.
D) The patient may or may not develop long-standing HIV infection.
B) The patient is infected with HIV but lacks HIV-specific antibodies.
A patient’s primary infection with HIV has subsided and an equilibrium now exists
between HIV levels and the patient’s immune response. This physiologic state is known
as which of the following?
A) Static stage
B) Latent stage
C) Viral set point
D) Window period
C) Viral set point
A patient with HIV will be receiving care in the home setting. What aspect of self-care
should the nurse emphasize during discharge education?
A) Appropriate use of prophylactic antibiotics
B) Importance of personal hygiene
C) Signs and symptoms of wasting syndrome
D) Strategies for adjusting antiretroviral dosages
B) Importance of personal hygiene
A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with
HIV. What nursing action is most likely to increase the likelihood of successful
therapy?
A) Promoting appropriate use of complementary therapies
B) Addressing possible barriers to adherence
C) Educating the patient about the pathophysiology of HIV
D) Teaching the patient about the need for follow-up blood work
B) Addressing possible barriers to adherence
The nurse is caring for a patient who has been admitted for the treatment of AIDS. In
the morning, the patient tells the nurse that he experienced night sweats and recently
ìcoughed up some blood.î What is the nurse’s most appropriate action?
A) Assess the patient for additional signs and symptoms of Kaposi’s sarcoma.
B) Review the patient’s most recent viral load and CD4+ count.
C) Place the patient on respiratory isolation and inform the physician.
D) Perform oral suctioning to reduce the patient’s risk for aspiration.
C) Place the patient on respiratory isolation and inform the physician.
A patient has come into contact with HIV. As a result, HIV glycoproteins have fused
with the patient’s CD4+ T-cell membranes. This process characterizes what phase in the
HIV life cycle?
A) Integration
B) Attachment
C) Cleavage
D) Budding
B) Attachment
An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results
of the test are 45 cells/μL, and the nurse recognizes the patient’s increased risk for
Mycobacterium avium complex (MAC disease). The nurse should anticipate the
administration of what drug?
A) Azithromycin
B) Vancomycin
C) Levofloxacin
D) Fluconazole
A) Azithromycin
A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The
nurse caring for this patient should expect the physician to order what drug for the
management of the patient’s diarrhea?
A) Zithromax
B) Sandostatin
C) Levaquin
D) Biaxin
B) Sandostatin
A patient with AIDS is admitted to the hospital with AIDS-related wasting syndrome
and AIDS-related anorexia. What drug has been found to promote significant weight
gain in AIDS patients by increasing body fat stores?
A) Advera
B) Momordicacharantia
C) Megestrol
D) Ranitidine
C) Megestrol
A nurse is completing a nutritional status of a patient who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. A) Serum albumin level B) Weight history C) White blood cell count D) Body mass index E) Blood urea nitrogen (BUN) level
A) Serum albumin level
B) Weight history
D) Body mass index
E) Blood urea nitrogen (BUN) level
A nurse is assessing the skin integrity of a patient who has AIDS. When performing
this inspection, the nurse should prioritize assessment of what skin surfaces?
A) Perianal region and oral mucosa
B) Sacral region and lower abdomen
C) Scalp and skin over the scapulae
D) Axillae and upper thorax
A) Perianal region and oral mucosa
A hospital nurse has experienced percutaneous exposure to an HIV-positive patient’s
blood as a result of a needlestick injury. The nurse has informed the supervisor and
identified the patient. What action should the nurse take next?
A) Flush the wound site with chlorhexidine.
B) Report to the emergency department or employee health department.
C) Apply a hydrocolloid dressing to the wound site.
D) Follow up with the nurse’s primary care provider.
B) Report to the emergency department or employee health department.
The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired
Skin Integrity. What nursing intervention should be included in the plan of care?
A) Maximize the patient’s fluid intake.
B) Provide total parenteral nutrition (TPN).
C) Keep the patient’s bed linens free of wrinkles.
D) Provide the patient with snug clothing at all times.
C) Keep the patient’s bed linens free of wrinkles.
A patient has been diagnosed with AIDS complicated by chronic diarrhea. What
nursing intervention would be appropriate for this patient?
A) Position the patient in the high Fowler’s position whenever possible.
B) Temporarily eliminate animal protein from the patient’s diet.
C) Make sure the patient eats at least two servings of raw fruit each day.
D) Obtain a stool culture to identify possible pathogens.
D) Obtain a stool culture to identify possible pathogens.
A patient who has AIDS is being treated in the hospital and admits to having periods of
extreme anxiety. What would be the most appropriate nursing intervention?
A) Teach the patient guided imagery.
B) Give the patient more control of her antiretroviral regimen.
C) Increase the patient’s activity level.
D) Collaborate with the patient’s physician to obtain an order for hydromorphone.
A) Teach the patient guided imagery.
A patient who has AIDS has been admitted for the treatment of Kaposi’s sarcoma. What
nursing diagnosis should the nurse associate with this complication of AIDS?
A) Risk for Disuse Syndrome Related to Kaposi’s Sarcoma
B) Impaired Skin Integrity Related to Kaposi’s Sarcoma
C) Diarrhea Related to Kaposi’s Sarcoma
D) Impaired Swallowing Related to Kaposi’s Sarcoma
B) Impaired Skin Integrity Related to Kaposi’s Sarcoma
A nurse is performing the admission assessment of a patient who has AIDS. What
components should the nurse include in this comprehensive assessment? Select all that
apply.
A) Current medication regimen
B) Identification of patient’s support system
C) Immune system function
D) Genetic risk factors for HIV
E) History of sexual practices
A) Current medication regimen
B) Identification of patient’s support system
C) Immune system function
E) History of sexual practices
A patient with a family history of allergies has suffered an allergic response based on a
genetic predisposition. This atopic response is usually mediated by what
immunoglobulin?
A) Immunoglobulin A
B) Immunoglobulin M
C) Immunoglobulin G
D) Immunoglobulin E
D) Immunoglobulin E
An office worker takes a cupcake that contains peanut butter. He begins wheezing, with
an inspiratory stridor and air hunger and the occupational health nurse is called to the
office. The nurse should recognize that the worker is likely suffering from which type
of hypersensitivity?
A) Anaphylactic (type 1)
B) Cytotoxic (type II)
C) Immune complex (type III)
D) Delayed-type (type IV)
A) Anaphylactic (type 1)
A patient is learning about his new diagnosis of asthma with the asthma nurse. What
medication has the ability to prevent the onset of acute asthma exacerbations?
A) Diphenhydramine (Benadryl)
B) Montelukast (Singulair)
C) Albuterol sulfate (Ventolin)
D) Epinephrine
B) Montelukast (Singulair)
A nurse is preparing a patient for allergy skin testing. Which of the following
precautionary steps is most important for the nurse to follow?
A) The patient must not have received an immunization within 7 days.
B) The nurse should administer albuterol 30 to 45 minutes prior to the test.
C) Prophylactic epinephrine should be administered before the test.
D) Emergency equipment should be readily available.
D) Emergency equipment should be readily available.
A patient who is scheduled for a skin test informs the nurse that he has been taking
corticosteroids to help control his allergy symptoms. What nursing intervention should
the nurse implement?
A) The patient should take his corticosteroids regularly prior to testing.
B) The patient should only be tested for grass, mold, and dust initially.
C) The nurse should have an emergency cart available in case of anaphylaxis during
the test.
D) The patient’s test should be cancelled until he is off his corticosteroids.
D) The patient’s test should be cancelled until he is off his corticosteroids.
A patient has developed severe contact dermatitis with burning, itching, cracking, and
peeling of the skin on her hands. What should the nurse teach the patient to do?
A) Wear powdered latex gloves when in public.
B) Wash her hands with antibacterial soap every few hours.
C) Maintain room temperature at 75°F to 80°F whenever possible.
D) Keep her hands well-moisturized at all times.
D) Keep her hands well-moisturized at all times.
A patient with severe environmental allergies is scheduled for an immunotherapy
injection. What should be included in teaching the patient about this treatment?
A) The patient will be given a low dose of epinephrine before the treatment.
B) The patient will remain in the clinic to be monitored for 30 minutes following the
injection.
C) Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3
months.
D) The allergen will be administered by the peripheral intravenous route.
B) The patient will remain in the clinic to be monitored for 30 minutes following the
injection.
The nurse in an allergy clinic is educating a new patient about the pathology of the
patient’s health problem. What response should the nurse describe as a possible
consequence of histamine release?
A) Constriction of small venules
B) Contraction of bronchial smooth muscle
C) Dilation of large blood vessels
D) Decreased secretions from gastric and mucosal cells
B) Contraction of bronchial smooth muscle
The nurse is providing care for a patient who has experienced a type I hypersensitivity
reaction. What condition is an example of such a reaction?
A) Anaphylactic reaction after a bee sting
B) Skin reaction resulting from adhesive tape
C) Myasthenia gravis
D) Rheumatoid arthritis
A) Anaphylactic reaction after a bee sting
A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee
sting. The nurse is providing patient teaching prior to the patient’s discharge. In the
event of an anaphylactic reaction, the nurse informs the patient that she should selfadminister
epinephrine in what site?
A) Forearm
B) Thigh
C) Deltoid muscle
D) Abdomen
B) Thigh
A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a
patient’s plan of care. The presence of what chronic health problem would most likely
prompt this diagnosis?
A) Herpes simplex
B) HIV
C) Spina bifida
D) Hypogammaglobulinemia
C) Spina bifida
A patient has a documented history of allergies presents to the clinic. She states that she
is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability
to concentrate. The nurse should identify which of the following nursing diagnoses?
A) Deficient Knowledge of Self-Care Practices Related to Allergies
B) Ineffective Individual Coping with Chronicity of Condition and Need for
Environmental Modification
C) Acute Confusion Related to Cognitive Effects of Allergic Rhinitis
D) Disturbed Body Image Related to Sequelae of Allergic Rhinitis
B) Ineffective Individual Coping with Chronicity of Condition and Need for
Environmental Modification
A patient’s decline in respiratory and renal function has been attributed to Goodpasture
syndrome, which is a type II hypersensitivity reaction. What pathologic process
underlies the patient’s health problem?
A) Antigens have bound to antibodies and formed inappropriate immune complexes.
B) The patient’s body has mistakenly identified a normal constituent of the body as
foreign.
C) Sensitized T cells have caused cell and tissue damage.
D) Mast cells have released histamines that directly cause cell lysis.
B) The patient’s body has mistakenly identified a normal constituent of the body as
foreign.
A child is undergoing testing for food allergies after experiencing unexplained signs
and symptoms of hypersensitivity. What food items would the nurse inform the parents
are common allergens?
A) Citrus fruits and rice
B) Root vegetables and tomatoes
C) Eggs and wheat
D) Hard cheeses and vegetable oils
C) Eggs and wheat
A patient has been admitted to the emergency department with signs of anaphylaxis
following a bee sting. The nurse knows that if this is a true allergic reaction the patient
will present with what alteration in laboratory values?
A) Increased eosinophils
B) Increased neutrophils
C) Increased serum albumin
D) Decreased blood glucose
A) Increased eosinophils
A nurse is aware of the need to assess patients’ risks for anaphylaxis. What health care
procedure constitutes the highest risk for anaphylaxis?
A) Administration of the measles-mumps-rubella (MMR) vaccine
B) Rapid administration of intravenous fluids
C) Computed tomography with contrast solution
D) Administration of nebulized bronchodilators
C) Computed tomography with contrast solution
After the completion of testing, a child’s allergies have been attributed to her family’s
cat. When introducing the family to the principles of avoidance therapy, the nurse
should promote what action?
A) Removing the cat from the family’s home
B) Administering OTC antihistamines to the child regularly
C) Keeping the cat restricted from the child’s bedroom
D) Maximizing airflow in the house
A) Removing the cat from the family’s home
The nurse is providing health education to the parents of a toddler who has been
diagnosed with food allergies. What should the nurse teach this family about the child’s
health problem?
A) ìFood allergies are a life-long condition, but most families adjust quite well to the
necessary lifestyle changes.î
B) ìConsistent use of over-the-counter antihistamines can often help a child
overcome food allergies.î
C) ìMake sure that you carry a steroid inhaler with you at all times, especially when
you eat in restaurants.î
D) ìMany children outgrow their food allergies in a few years if they avoid the
offending foods.
D) ìMany children outgrow their food allergies in a few years if they avoid the
offending foods.
A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic
reaction. What is a priority for health education?
A) The need to begin immunotherapy as soon as possible
B) The need for the parents to carry an epinephrine pen
C) The need to vigilantly maintain the child’s immunization status
D) The need for the child to avoid all foods that have a high potential for allergies
B) The need for the parents to carry an epinephrine pen
An adolescent patient’s history of skin hyperreactivity and inflammation has been
attributed to atopic dermatitis. The nurse should recognize that this patient
consequently faces an increased risk of what health problem?
A) Bronchitis
B) Systemic lupus erythematosus (SLE)
C) Rheumatoid arthritis
D) Asthma
D) Asthma
The nurse is planning the care of a patient who has a diagnosis of atopic dermatitis,
which commonly affects both of her hands and forearms. What risk nursing diagnosis
should the nurse include in the patient’s care plan?
A) Risk for Disturbed Body Image Related to Skin Lesions
B) Risk for Disuse Syndrome Related to Dermatitis
C) Risk for Ineffective Role Performance Related to Dermatitis
D) Risk for Self-Care Deficit Related to Skin Lesions
A) Risk for Disturbed Body Image Related to Skin Lesions
A patient has been brought to the emergency department by EMS after being found
unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patient’s
condition. The care team should attempt to assess for what potential causes of
anaphylaxis? Select all that apply.
A) Foods
B) Medications
C) Insect stings
D) Autoimmunity
E) Environmental pollutants
A) Foods
B) Medications
C) Insect stings
A school nurse is caring for a child who appears to be having an allergic response.
What should be the initial action of the school nurse?
A) Assess for signs and symptoms of anaphylaxis.
B) Assess for erythema and urticaria.
C) Administer an OTC antihistamine.
D) Administer epinephrine.
A) Assess for signs and symptoms of anaphylaxis.
A patient is receiving a transfusion of packed red blood cells. Shortly after initiation of
the transfusion, the patient begins to exhibit signs and symptoms of a transfusion
reaction. The patient is suffering from which type of hypersensitivity?
A) Anaphylactic (type 1)
B) Cytotoxic (type II)
C) Immunecomplex (type III)
D) Delayed type (type IV)
B) Cytotoxic (type II)
Which of the following individuals would be the most appropriate candidate for
immunotherapy?
A) A patient who had an anaphylactic reaction to an insect sting
B) A child with allergies to eggs and dairy
C) A patient who has had a positive tuberculin skin test
D) A patient with severe allergies to grass and tree pollen
D) A patient with severe allergies to grass and tree pollen
A nurse has asked the nurse educator if there is any way to predict the severity of a
patient’s anaphylactic reaction. What would be the nurse’s best response?
A) ìThe faster the onset of symptoms, the more severe the reaction.
B) ìThe reaction will be about one-third more severe than the patient’s last reaction
to the same antigen.î
C) ìThere is no way to gauge the severity of a patient’s anaphylaxis, even if it has
occurred repeatedly in the past.î
D) ìThe reaction will generally be slightly less severe than the last reaction to the
same antigen.î
A) ìThe faster the onset of symptoms, the more severe the reaction.
A nurse knows of several patients who have achieved adequate control of their allergy
symptoms using over-the-counter antihistamines. Antihistamines would be
contraindicated in the care of which patient?
A) A patient who has previously been treated for tuberculosis
B) A pregnant woman at 30 weeks’ gestation
C) A patient who is on estrogen-replacement therapy
D) A patient with a severe allergy to eggs
B) A pregnant woman at 30 weeks’ gestation
A patient has been living with seasonal allergies for many years, but does not take
antihistamines, stating, ìWhen I was young I used to take antihistamines, but they
always put me to sleep.î How should the nurse best respond?
A) ìNewer antihistamines are combined with a stimulant that offsets drowsiness.î
B) ìMost people find that they develop a tolerance to sedation after a few months.î
C) ìThe newer antihistamines are different than in years past, and cause less
sedation.
D) ìHave you considered taking them at bedtime instead of in the morning?î
C) ìThe newer antihistamines are different than in years past, and cause less
sedation.
A child has been transported to the emergency department (ED) after a severe allergic
reaction. The ED nurse is evaluating the patient’s respiratory status. How should the
nurse evaluate the patient’s respiratory status? Select all that apply.
A) Facilitate lung function testing.
B) Assess breath sounds.
C) Measure the child’s oxygen saturation by oximeter.
D) Monitor the child’s respiratory pattern.
E) Assess the child’s respiratory rate.
B) Assess breath sounds.
C) Measure the child’s oxygen saturation by oximeter.
D) Monitor the child’s respiratory pattern.
E) Assess the child’s respiratory rate.
A patient with multiple food and environmental allergies tells the nurse that he is
frustrated and angry about having to be so watchful all the time and wonders if it is
really worth it. What would be the nurse’s best response?
A) ìI can only imagine how you feel. Would you like to talk about it?
B) ìLet’s find a quiet spot and I’ll teach you a few coping strategies.î
C) ìThat’s the same way that most patients who have a chronic illness feel.î
D) ìDo you think that maybe you could be managing things more efficiently?î
A) ìI can only imagine how you feel. Would you like to talk about it?
A nurse at an allergy clinic is providing education for a patient starting immunotherapy
for the treatment of allergies. What education should the nurse prioritize?
A) The importance of scheduling appointments for the same time each month
B) The importance of keeping appointments for desensitization procedures
C) The importance of avoiding antihistamines for the duration of treatment
D) The importance of keeping a diary of reactions to the immunotherapy
B) The importance of keeping appointments for desensitization procedures
A patient has presented with signs and symptoms that are consistent with contact
dermatitis. What aspect of care should the nurse prioritize when working with this
patient?
A) Promoting adequate perfusion in affected regions
B) Promoting safe use of topical antihistamines
C) Identifying the offending agent, if possible
D) Teaching the patient to safely use an EpiPen
C) Identifying the offending agent, if possible
