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Med Surg Exam 4 NCLEX Exam Questions With 100% Correct And Verified Answers 2024 Which white blood cell types are involved in the development of antibody-mediated immunity? (Select all that apply.) a. Basophils b. B-lymphocytes c. Cytotoxic/cytolytic T-cells d. Helper/inducer T-cells e. Macrophages f. Natural killer cells g. Neutrophils - Correct Answer-ANS: B, D, E Basophils, cytotoxic/cytolytic T-cells, natural killer cells, and neutrophils have no role in antibody production, which is the basis of antibody-mediated immunity. Antibody production requires the interaction of macrophages, helper/inducer T-cells, and B-lymphocytes. The macrophages initially recognize and process the antigen. The helper/inducer T-cell presents to and assists the unsensitized B-lymphocyte to recognize the antigen as an invader. The B-lymphocyte then becomes sensitized to the antigen and begins producing antibodies against it.
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Which white blood cell types are involved in the development of antibody-mediated immunity? (Select all that apply.) a. Basophils b. B-lymphocytes c. Cytotoxic/cytolytic T-cells d. Helper/inducer T-cells e. Macrophages f. Natural killer cells g. Neutrophils - Correct Answer-ANS: B, D, E Basophils, cytotoxic/cytolytic T-cells, natural killer cells, and neutrophils have no role in antibody production, which is the basis of antibody-mediated immunity. Antibody production requires the interaction of macrophages, helper/inducer T-cells, and B- lymphocytes. The macrophages initially recognize and process the antigen. The helper/inducer T-cell presents to and assists the unsensitized B-lymphocyte to recognize the antigen as an invader. The B-lymphocyte then becomes sensitized to the antigen and begins producing antibodies against it. A client has a white blood cell change in which the number of suppressor T-cells is well below normal and asks the nurse what type of health problem(s) could be expected as a result of this deficiency. What is the nurse's best response? a. "You will need to receive booster vaccinations more often because your ability to make antibodies is reduced." b. "Try to avoid crowds and people who are ill because you are now more susceptible to bacterial and viral infections." c. "You will be more prone to allergic reactions when exposed to allergens or drugs." d. "Your risk for cancer development is increased." - Correct Answer-ANS: C Suppressor T-cells have the opposite action of helper/inducer T-cells. For optimal CMI, then, a balance between helper/inducer T-cell activity and suppressor T-cell activity must be maintained. This balance occurs when the helper/inducer T-cells outnumber the suppressor T-cells by a ratio of 2:1. When this ratio increases, indicating that helper/inducer T-cells vastly outnumber the suppressor cells, in this case because of way too few suppressor T-cells, overreactions can occur. These include allergies to almost anything, including drugs. Some of these overreactions are tissue damaging and dangerous, as well as unpleasant.
Which part of the HIV infection process is disrupted by the antiretroviral drug class of entry inhibitors? a. Activating the viral enzyme "integrase" within the infected host's cells b. Binding of the virus to the CD4+ receptor and either of the two co-receptors c. Clipping the newly generated viral proteins into smaller functional pieces d. Fusing of the newly created viral particle with the infected cell's membrane - Correct Answer-ANS: B Entry inhibitors work by binding to and blocking the CCR5 receptors on CD4+ T-cells, the main target of HIV. In order to successfully enter and infect a host cell, the virus must have its gp120 protein attached to the CD4 receptor and have its gp41 bound to the CD4+ T cell's CCR5 receptor. Viral binding to both receptors is required for infection. By blocking the HIV's attachment to the CCR5 receptor, infection is inhibited.
A client diagnosed with AIDS meets the criteria for Stage 3 category of HIV infection. Even when this client's CD4+ T-cell count increases as a result of therapy, the diagnosis of AIDS remains. The fact that the T-cell count has risen indicates that the combination of drugs used for therapy is effective; however, the dosages are not decreased. Which questions are most important for the nurse to first ask a client who comes to the emergency department with signs of severe angioedema? (Select all that apply.) a. "Are you able to swallow?" b. "When did you last eat or drink?" c. "Do you have an allergy to cortisone?" d. "What drugs do you take on a daily basis"? e. "Is there any possibility that you may be pregnant?" f. "Do any members of your family also have allergies?" - Correct Answer-ANS: A, D The client has severe angioedema that can progress rapidly to laryngeal edema and loss of the airway. The very first question should be to assess symptom severity. Asking whether the client can swallow provides an indication of severity. If the client can still swallow, an immediate intubation or tracheotomy is not needed. Asking what drugs he or she takes can help establish the diagnosis and the cause. It is not necessary to know when the last food or drink was taken. Also, regardless of whether the client is pregnant, interventions for angioedema must be started. It is not helpful during this emergency to know whether other family members also have allergies. This information can be obtained at a later time or from family members. Cortisone is used to treat allergies and does not cause them. Which statements by a nursing student indicate a need for further teaching by the nurse regarding infection control measures needed to care for a client with possible tuberculosis? (Select all that apply.) a. "I'll wear an isolation gown when providing direct care." b. "I'll wear gloves when emptying the bed pan." c. "I'll wear a mask each time I enter the client's room." d. "I'll use a hand sanitizer when I can't wash my hands." e. "I'll wear goggles to protect my eyes." - Correct Answer-ANS: A, E Tuberculosis is transmitted from an infected person to a susceptible person in airborne particles, called droplet nuclei. Therefore, a gown and goggles are not useful in preventing transmission. Wearing an N95 particulate respirator is most effective in preventing droplet transmission. Gloves and hand hygiene are a part of Standard Precautions that are used when caring for every patient. A client is diagnosed with a foot ulcer infected with methicillin-resistant Staphylococcus aureus (MRSA) infection. Which personal protective equipment is appropriate when providing direct client care? (Select all that apply.)
a. Mask b. Gloves c. Shoe covers d. Goggles e. Gown - Correct Answer-ANS: B, E A foot ulcer is an open wound that will drain when infected. Therefore, in addition to using gloves as part of Standard Precautions, the nurse needs to wear a gown because MRSA is transmitted via direct contact. When taking a history for a client with GI problems, which daily client behavior requires further nursing assessment? (Select all that apply.) a. Eats multiple servings of vegetables b. Takes 800 mg of ibuprofen for arthritic pain c. Walks 30 minutes d. Chews tobacco e. Takes senna to assist with bowel movements f. Listens to music to promote relaxation - Correct Answer-ANS: B, D, E Taking routine or larger amounts of NSAIDs places the client at risk for GI distress. Chewing tobacco places the client at risk for oral cancer. Senna is an over-the-counter herbal laxative. Taking certain herbal preparations can affect appetite, absorption, and elimination. Other behaviors are healthy and do not require further nursing assessment. Cognitive Level: Analysis The nurse is performing a physical assessment on a client's abdomen. The nurse inspects the abdomen and finds the abdomen asymmetrical, with a non-pulsating mass in the RUQ. What is the appropriate priority nursing intervention? a. Document the findings in the electronic health record. b. Auscultate for bowel sounds and bruits. c. Lightly palpate the mass. d. Notify the health care provider of the findings. - Correct Answer-ANS: B The nurse will eventually document the findings, palpate the mass, and notify the health care provider of the findings but should finish the physical assessment first. A nurse is preparing a health teaching session about early detection of colorectal cancer. Which test should the nurse include? (Select all that apply.) a. Colonoscopy every 10 years b. Single sample fecal immunochemical test (FIT). c. Flexible sigmoidoscopy every 5 years d. Stool DNA test (sDNA) every 3 years
e. Double contrast barium enema every 5 years f. Take home yearly guaiac fecal occult blood test (gFOBT) - Correct Answer-ANS: A, C, D, E, F The nurse should teach about all methods of early detection except the FIT test, which should use a multi-sample approach. Adequate nutrition is required for healing after treatment for recurrent aphthous ulcers (RAU). Which client response indicates that nursing teaching has been effective? a. "I have ordered a snack of milk and pretzels." b. "I will try to drink orange juice twice per day." c. "I ordered my sandwich on a crusty roll." d. "I would like scrambled eggs and a banana for breakfast." - Correct Answer-ANS: D To promote healing, clients should consume foods high in protein and vitamin C. To minimize pain, salty, spicy, hard, and acidic foods should be avoided. Scrambled eggs and bananas are soft and do not contain irritating agents. The nurse is caring for four clients. Which is at the highest risk for development of oral cancer? a. 32-year-old client with ankle fracture b. 41-year-old with human papilloma virus (HPV) infection c. 60-year old who quit smoking twenty years ago d. 83-year old that lives in a warm climate during the winter - Correct Answer-ANS: B Research indicates a correlation between specific strains of the human papilloma virus (HPV) and oral cancer. Oral cancer associated with HPV appears in the tonsillar area or along the base of the tongue in younger people. Because HPV-positive oral cancers account for a large number of oral cancer diagnoses, routine oral assessment is essential. Which client statement requires immediate nursing intervention? a. "I used to chew tobacco but quit 5 years ago." b. "I use sunscreen to cover my face and body when I'm at the beach." c. "I do not have dental insurance, so I cannot get dental check-ups." d. "I only drink alcohol on special occasions like my birthday and anniversary." - Correct Answer-ANS: C The primary risk factors for oral cavity cancer and/or lesions include smoking, use of tobacco products, alcohol use, and poor dental care. The risk for basal cell carcinoma is increased by excessive sun exposure. The client without dental insurance, who cannot get dental check-ups, is more likely to have poor oral health, which increases the risk for oral cancer. This requires nursing intervention to teach the client about oral health.
A client completing radiation treatment has developed dysphagia and stomatitis. What teaching will the nurse provide? (Select all that apply.) a. Brush teeth twice daily with chemobrush. b. Thin liquids will make it easier to swallow. c. Limit alcohol consumption to three drinks per day. d. Rinse mouth with mild saline and water mix before and after eating. e. Refrain from using liquid dietary supplements, as these will irritate mucous membranes. f. Plan to eat soft foods like cheese, well-cooked legumes, peanut butter, and pudding. - Correct Answer-ANS: A, D, F A chemobrush is softer than a regular toothbrush. Teeth should be brushed gently twice daily. Thicker liquids are easier to swallow. Alcohol use should be discontinued. Rinsing the mouth can relieve xerostomia, which can affect the client's ability to eat. Liquid dietary supplements can help increase caloric intake. Soft foods should be eaten, since these pose the least risk to tissue integrity of mucous membranes. Which facial assessment finding in a client with a salivary gland tumor prompts the nurse to notify the health care provider? a. Loss of sensation in tongue b. Alternates smiling and grimacing c. Wrinkles brows on command d. Holds eyes shut as the nurse pulls gently upon the eyebrows - Correct Answer-ANS: A Impaired tongue movement and loss of sensation in the tongue can indicate tumor invasion of the hypoglossal nerve. Other findings are normal. Upon assessment of a client with GERD, which statement requires nursing intervention? a. "I quit smoking several years ago." b. "Sometimes I wake up gasping for air in the middle of the night." c. "My family likes to eat small meals every 3 to 4 hours throughout the day." d. "When I buy meat, I ask for the leanest cut that is available." - Correct Answer-ANS: B Gasping for air upon waking in the middle of the night can be a sign of sleep apnea. Often patients who have one condition (sleep apnea or GERD) also experience the other.
A client reports ongoing episodes of heartburn. The nurse educates the client on prevention and control of reflux by recommending dietary elimination of which food item? a. Lean steak b. Carrot sticks c. Chocolate candy d. Air-popped popcorn - Correct Answer-ANS: C Foods that decrease esophageal sphincter pressure, such as fatty food, caffeine, and chocolate, should be avoided. The community clinic nurse is discussing risk factors for esophageal cancer with a group of clients. Which client behavior requires further teaching? a. Smokes 1 pack of cigarettes daily b. Walks at the shopping mall three times weekly c. Elevates pillows at night d. Eats a small snack each night before bedtime - Correct Answer-ANS: A Tobacco use is one of the primary risk factors for esophageal cancer (along with obesity). This client behavior requires teaching about lifestyle risks that could increase the risk for esophageal cancer. Other reported client behaviors are acceptable and do not increase risk for esophageal cancer. The nurse is caring for a client who has been diagnosed with esophageal cancer. The client appears anxious and asks the nurse, "Does this mean I am going to die?." Which nursing responses are appropriate? (Select all that apply.) a. "No, surgery can cure you." b. "It sounds like death frightens you." c. "Let me call the hospital chaplain to talk with you." d. "You can beat this disease if you just put your mind to it." e. "Let me sit with you for awhile and we can discuss how you are feeling about this." - Correct Answer-ANS: B, E "B" and "E" are therapeutic responses that allow the client to express feelings and fears. "A" is nontherapeutic because it gives false hope. Although the nurse may take the action listed in "C" later in the interaction, the immediate need is to explore the client's feelings and then determine how to best meet those needs. The nurse should not assume that the client immediately wishes to see a chaplain. "D" is a nontherapeutic response that does not address the client's feelings and fears. The nurse is performing medication reconciliation for a newly admitted client. The nurse recognizes that which drugs contribute to signs and symptoms of gastritis? (Select all that apply.)
a. Aspirin, taken once daily to prevent cardiac concerns b. Naproxen, taken once daily for joint pain associated with arthritis c. Amoxicillin, taken over a 10-day period for an acute sinus infection d. Bacitracin ointment (over the counter), applied to minor scrapes on arms and legs e. Prednisone, tapered over a 14-day period to decrease inflammation associated with an acute sinus infection - Correct Answer-ANS: A, B, E Corticosteroids, erythromycin (E-Mycin, Erythromid), ASA (aspirin), and NSAIDs such as naproxen (Naprosyn) and ibuprofen (Motrin, Advil, Amersol, Novo-Profen)—as well as OTC products that contain aspirin or ibuprofen—are associated with contributing to symptoms associated with gastritis. Amoxicillin and bacitracin ointment are not. When caring for a patient who has just had an upper GI endoscopy, the nurse assesses that the client has developed a temperature of 101.8F (38.8C). What is the appropriate nursing intervention? a. Promptly assess the patient for potential perforation. b. Ask the nursing assistant to bathe the client with tepid water. c. Administer acetaminophen (Tylenol) to lower the temperature. d. Delegate to an unlicensed assistive personnel (UAP) to retake the temperature. - Correct Answer-ANS: A A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, being aware of other signs and symptoms of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, board-like abdomen; and developing signs of shock. The nurse is caring for a client with a bleeding duodenal ulcer who was admitted to the hospital after vomiting bright, red blood. Which condition does the nurse anticipate when the client develops a sudden, sharp pain in the midepigastric region and a rigid, board- like abdomen? a. Pancreatitis b. Ulcer perforation c. Small bowel obstruction d. Development of additional ulcers - Correct Answer-ANS: B The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in board-like abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. A small bowel obstruction would not cause midepigastric pain. The development of additional ulcers or pancreatitis would not cause a rigid, board-like abdomen.
Which client statement regarding treatment for gastric cancer requires the nurse to immediately intervene? a. "I understand my treatment regimen." b. "My prognosis is frightening to me and my partner." c. "Life just does not seem to be worth living anymore." d. "There is a list of community resources stored in my computer for when I need them."
a. "Genes are responsible for obesity." b. "Tell me about your family history." c. "Let's talk about your nutrition intake." d. "How do you feel about exercise?" e. "You should get bariatric surgery." - Correct Answer-ANS: B, C, D Learning about the client's family history can be helpful, as there are studies that indicate that mutations in many genes may be associated with the development of obesity (although they are not solely responsible for such). Talking about the client's nutrition intake and feelings about exercise opens lines of communication to also explore other factors that may contribute to the client's nutrition status. Recommending bariatric surgery at this point in the conversation is inappropriate.