MED SURG QUIZ 1 PRACTICE QUESTIONS WITH 100% ANSWERS 2024 LATEST UPDATED GRADED A+ ACTUAL, Exams of General Surgery

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MED SURG QUIZ 1 PRACTICE

QUESTIONS WITH 100% ANSWERS 2024

LATEST UPDATED GRADED A+ ACTUAL

EXAM.

1. The nurse requests the client to sign a surgical informed consent form for an emergency appendectomy. Which statement by the client indicates further teaching is needed?
2. "I will be glad when this is over so I can go home today."
3. "I will not be able to eat or drink anything prior to my surgery."
4. "I can practice relaxing by listening to my favorite music."
5. "I will need to get up and walk as soon as possible." - Answer 1. "I will be glad when this is over so I can go home today."
6. The nurse in the holding area of the surgery department is interviewing a client who requests to keep his religious medal on during surgery. Which intervention should the nurse implement?
7. Notify the surgeon about the client's request to wear the medal
8. Tape the medal to the client and allow the client to wear the medal
9. Request the family member take the medal prior to surgery
10. Explain taking the medal to surgery is against the policy - Answer 2. Tape the medal to the client and allow the client to wear the medal
11. The nurse must obtain surgical consent forms for the scheduled surgery. Which client would not be able to consent legally to surgery?
12. The 65 year old client who cannot read or write
13. The 30 year old who does not understand English
14. The 16 year old who has a fractured ankle
15. The 8- year old who is not oriented to the day - Answer 3. The 16 year old who has a fractured ankle
16. The nurse is preparing a client for surgery. Which intervention should the nurse implement first?
17. Check the permit for the spouse's signature
18. Take and document intake and output

3. Administer the on-call sedative
4. Complete the preoperative checklist - Answer 4. Complete the preoperative checklist
5. The nurse is interviewing a surgical client in the holding area. Which information should the nurse report to the anesthesiologist? Select all that apply
6. The client has loose, decayed teeth
7. The client is experiencing anxiety
8. The client smokes two packs of cigarettes a day
9. The client has had a chest x ray which does not show infiltrates
10. The client reports using herbs - Answer 1. The client has loose, decayed teeth
11. The client smokes two packs of cigarettes a day
    5. The client reports using herbs
12. Which task would be most appropriate for the nurse to delegate to the UAP (unlicensed assistive personnel)?
    1. Complete the preop checklist
    2. Assess the client's preop vital signs
    3. Teach the client about coughing and deep breathing
    4. Assist the client to remove clothing and jewelry - Answer 4. Assist the client to remove clothing and jewelry
13. The nurse is assessing a client in the day surgery unit who states "I am really afraid of having this surgery. I'm afraid of what they will find." Which statement would be the best therapeutic response by the nurse?
    1. "Don't worry about your surgery. It is safe."
    2. "Tell me why you're worried about the surgery."
    3. "Tell me about your fears of having this surgery."
    4. "I understand how you feel, surgery is frightening." - Answer 3. "Tell me about your fears of having this surgery."
14. The 68 year old client is scheduled for intestinal surgery does not have clear fecal contents after 3 tap water enemas. Which intervention should the nurse implement first?
    1. Notify the surgeon of the client's status
    2. Continue giving enemas until clear
    3. Increase the client's fluid IV rate

4. Obtain STAT serum electrolytes - Answer 1. Notify the surgeon of the client's status
5. The nurse is caring for a male client scheduled for abdominal surgery. Which interventions should the nurse include in the plan of care? Select all that apply
6. Perform passive ROM exercises
7. Discuss how to cough and deep breathe effectively
8. Tell the client he can have a meal in the PACU
9. Teach ways to manage post op pain
10. Discuss events which occur in the post-anesthesia care unit - Answer
11. Discuss how to cough and deep breathe effectively
12. Teach ways to manage post op pain
13. Discuss events which occur in the post-anesthesia care unit
14. The nurse is caring for a client scheduled for total hip replacement. Which behavior indicates the need for further preoperative teaching?
15. The client uses the diaphragm and abdominal muscles to inhale through the nose and exhale through the mouth
16. The client demonstrates dorsiflexion of the feet, flexing of the toes, and moves the feet in a circular motion
17. The client uses the incentive spirometer and inhales slowly and deeply so the piston rises to the preset volume
18. The client gets out of bed by lifting straight upright from the waist and then swings both legs along the side of the bed - Answer 4. The client gets out of bed by lifting straight upright from the waist and then swings both legs along the side of the bed
19. The nurse is completing preoperative assessment on a male client who states, "I am allergic to codeine." Which intervention should the nurse implement first?
20. Apply an allergy bracelet on the client's wrist
21. Label the client's allergies on the front of the chair
22. Ask the client what happens when he takes codeine
23. Document the allergy on the medication administration record - Answer
24. Ask the client what happens when he takes codeine
25. Which lab result would require immediate intervention by the nurse for the client scheduled for surgery?
26. Calcium 9.

2. Bleeding time 2 minutes
3. Hemoglobin 15
4. Potassium 2.4 - Answer 4. Potassium 2.
5. Which activities are the circulating nurse's responsibilities in the OR?
6. Monitor the position of the client, prepare the surgical site, and ensure the client's safety
7. Give preop meds in the holding area and monitor the client's response to anesthesia
8. Prepare sutures; set up the sterile fild, and count all needles and sponges and instruments
9. Prepare the meds to be administered by the anesthesiologist and change the tubing for the anesthesia machine - Answer 1. Monitor the position of the client, prepare the surgical site, and ensure the client's safety
10. The circulating nurse observes the surgical scrub technician remove a sponge from the edge of the sterile field with a clamp and place the sponge and clamp in a designated area. Which action should the nurse implement?
11. Place the sponge back where it was
12. Tell the technician to not waste supplies
13. Do nothing because this is the correct procedure
14. Take the sponge out of the room immediately - Answer 3. Do nothing because this is the correct procedure
15. Which violation of surgical asepsis would require immediate intervention by the circulating nurse?
16. Surgical supplies were cleaned and sterilized prior to the case
17. The circulating nurse is wearing a long-sleeved sterile gown
18. Masks covering the mouth and nose are being worn by the surgical team
19. The scrub nurse setting up the sterile field is wearing artificial nails - Answer 4. The scrub nurse setting up the sterile field is wearing artificial nails
20. The nurse identifies the nursing diagnosis "risk for injury related to positioning" for the client in the operating room. Which nursing intervention should the nurse implement?
21. Avoid using the cautery unit, which does not have a biomedical tag on it
22. Carefully pad the client's elbows before covering the client with a blanket

3. Apply a warming pad on the OR table before placing the client on the table
4. Check the chart for any prescription or OTC medication use - Answer 2. Carefully pad the client's elbows before covering the client with a blanket
5. The circulating nurse is positioning clients for surgery. Which client has the greatest potential for nerve damage?
6. The 16 year old in dorsal recumbent position having an appendectomy
7. The 68 year old in the Trendlenburg position having a cholecystectomy
8. The 45 year old in the reverse trendlenburg position having a biopsy
9. The 22 year old client in the lateral postion having a nephrectomy - Answer 2. The 68 year old in the Trendlenburg position having a cholecystectomy
10. Which situation demonstrates the circulating nurse acting as the client's advocate?
11. Plays the client's favorite audio book during surgery
12. Keeps the family informed of the findings of the surgery
13. Keeps the operating room door closed at all times
14. Calls the client by the first name when the client is recovering - Answer
15. Keeps the operating room door closed at all times
16. The circulating nurse is planning the care for an intraoperative client. Which statement is the expected outcome?
17. The client has no injuries from the OR equipment
18. The client ahs no post op infection
19. The client has stable vital signs during surgery
20. The client recovers from anesthesia - Answer 1. The client has no injuries from the OR equipment
21. Which nursing intervention has the highest priority when preparing the client for a surgical procedure?
22. Pad the client's elbows and knees
23. Apply soft restraint straps to the extremities
24. Prepare the client's incision site
25. Document the temperature of the room - Answer 2. Apply soft restraint straps to the extremities
26. The nursing manager is making assignments for the OR. Which case should the manager assign to the inexperienced nurse?

1. The client having open-heart surgery
2. The client having a biopsy of the breast
3. The client having laser eye surgery
4. The client having a laparoscopic knee repair - Answer 2. The client having a biopsy of the breast
5. The circulating nurse assesses tachycardia and hypotension in the client. Which interventions should the nurse implement?
6. Prepare ice packs and mix dantrolene sodium
7. Request the defibrillator be brought into the OR
8. Draw a PTT and prepare a heparin drip
9. Obtain finger stick blood glucose immediately - Answer 1. Prepare ice packs and mix dantrolene sodium
10. The nurse is planning care of the surgical client having conscious sedation. Which intervention has highest priority?
11. Assess the client's respiratory status
12. Monitor the client's urinary output
13. Take a 12-lead ECG prior to injection
14. Attempt to keep the client focused - Answer 1. Assess the client's respiratory status
15. The PACU nurse is receiving the client from the OR. Which intervention should the nurse implement first?
16. Assess the client's breath sounds
17. Apply oxygen via nasal cannula
18. Take the client's BP
19. Monitor the pulse ox reading - Answer 1. Assess the client's breath sounds
20. Which assessment data indicate the post op client who had spinal anesthesia is suffering a complication of the anesthesia?
21. Loss of sensation at the lumbar (L5) dermatome
22. Absence of the client's posterior tibial pulse
23. The client has a respiratory rate of 8
24. The BP is within 20% of the client's baseline - Answer 3. The client has a respiratory rate of 8

27. The surgical clients V/S are T 98 degrees, P 106, R 24, BP 88/40. The client is awake and oriented times 3 and the skin is pale and damp. Which intervention should the nurse implement first?
28. Call the surgeon and report the V/S
29. Start an IV D5RL with 20 mEQ KCL at 125 ml/hr
30. Elevate the feet and lower the head of the bed
31. Monitor the vital signs every 15 minutes - Answer 3. Elevate the feet and lower the head of the bed
32. The PACU nurse administers Narcan, an opioid antagonist, to a post op client. Which client problem should the nurse include to the plan of care based on this medication?
33. Alteration in comfort
34. Risk for depressed respiratory pattern
35. Potential for infection
36. Fluid and electrolyte imbalance - Answer 2. Risk for depressed respiratory pattern
37. The 26 year old male client in the PACU has a HR of 110 and a rising temperature, and complains of muscle stiffness. Which interventions should the nurse implement? Select all
38. Give a backrub to the client to relieve stiffness
39. Apply ice packs to the axillary and groin areas
40. Prepare an ice slush for the client to drink
41. Prepare to administer dantrolene, a smooth-muscle relaxant
42. Reposition the client on a warming blanket - Answer 2. Apply ice packs to the axillary and groin areas
43. Which data indicate to the nurse the client who is one day post op right total hip replacement is progressing as expected?
44. Urine output was 160 ml in the past 8 hours
45. Paralysis and parasthesia of the Right leg
46. T 99, P 98, R 20, and BP 100/
47. Lungs are clear bilaterally in all lobes - Answer 4. Lungs are clear bilaterally in all lobes
48. The nurse and the UAP are working on a surgical unit. Which task can the nurse delegate to the UAP?
49. Take routine V/S on clients
50. Check the Jackson Pratt insertion site

3. Hang the client's next IV bag
4. Ensure the client obtains pain relief - Answer 1. Take routine V/S on clients
5. The charge nurse is making shift assignments. Which post op client should be assigned to the most experienced nurse?
6. The 4 year old who had a tonsillectomy and is able to swallow fluids
7. The 74 year old with a repair of the left hip who is unable to ambulate
8. The 24 year old who had an uncomplicated appendectomy the previous day
9. The 80 year old client with small bowel obstruction and CHF - Answer 4. The 80 year old client with small bowel obstruction and CHF
10. Which statement would be an expected outcome for the post op client who had general anesthesia?
11. The client will be able to sit in the chair for 30 minutes
12. The client will have a pulse ox reading of 97 on room air
13. The client will have urine output of 30 ml per hour
14. The client will be able to distinguish sharp from dull sensations - Answer
15. The client will have a pulse ox reading of 97 on room air
16. The post op client is transferred from the PACU to the surgical floor. Which action should the nurse implement first?
17. Apply antiembolism hose to the client
18. Attach the drain to 20 cm suction
19. Assess the clients V/S
20. Listen to the report from the anesthesiologist - Answer 3. Assess the clients V/S
21. Which problem should the nurse identify as priority for client who is one day post op?
22. Potential for hemorrahaging
23. Potential for injury
24. Potential for fluid volume excess
25. Potential for infection - Answer 1. Potential for hemorrahaging
26. The UAP reports the vital signs for first day post op client T 100.8, P 80, R 24, BP 148/80. Which intervention would be most appropriate for the nurse to implement?
27. Administer the antibiotic earlier than scheduled

2. Change the dressing over the wound
3. Have the client turn, cough, and deep breathe Q2 hrs.
4. Encourage the client to ambulate in the hall - Answer 3. Have the client turn, cough, and deep breathe Q2 hrs. A nurse working in an outpatient clinic is assessing a client who reports night sweats and fatigue. He states he has had a cough along with nausea and diarrhea. His temp is 100.6 orally. The client is afraid he has HIV. Which of the following actions should the nurse take? Select all
5. Perform a physical assessment
6. Determine when current symptoms began
7. Teach the client about HIV transmission
8. Draw blood for HIV testing
9. Obtain a sexual history - Answer 1. Perform a physical assessment
10. Determine when current symptoms began
11. Obtain a sexual history A nurse is caring for a client who is suspected of having HIV. Which of the following diagnostic tests and lab values are used to confirm HIV infection? Select all 1.Western blot
    2. Indirect immunofluorescence assay
    3. CD4 T lymphocyte count
    4. CD4 T lymph percentage of total lymphocytes
    5. CSF analysis - Answer 1.Western blot
    6. Indirect immunofluorescence assay A nurse is assessing a client for HIV. Which of the following are risk factors associated with this virus? Select all
12. Perinatal Exposure
13. Pregnancy
14. Monogamous sex partner
15. Older Adult woman
16. Occupational exposure - Answer 1. Perinatal Exposure
17. Older Adult woman
18. Occupational exposure A nurse is completing discharge instructions with a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching?

1. "I will wear gloves while changing the pet litter box."
2. "I will rinse raw fruits with water before eating them."
3. "I will wear a mask around family members who are ill."
4. "I will cook vegetables before eating them"(This will help with transmission of bacteria) - Answer 4. "I will cook vegetables before eating them"(This will help with transmission of bacteria) The school nurse is preparing to teach a health class to ninth graders regarding STD's. Which information regarding acquired immunodeficiency syndrome (AIDS) should be included?
5. Females taking birth control pills are protected from becoming infected with HIV
6. Protected sex is no longer an issue because there is a vaccine for the HIV virus
7. Adolescents with a normal immune system are not at risk for developing AIDS
8. Abstinence is the only guarantee of not becoming infected with sexually transmitted HIV. - Answer 4. Abstinence is the only guarantee of not becoming infected with sexually transmitted HIV. The nurse is admitting a client diagnosed with protein-calorie malnutrition secondary to AIDS. Which intervention should the nurse's first intervention?
9. Asses the client's body weight and ask what the client has been able to eat
10. Place in contact isolation and don a mask and gown before entering the room
11. Check the HCP's orders and determine what lab tests will be done.
12. Teach the client about TPN and monitor the subclavian IV site - Answer
13. Asses the client's body weight and ask what the client has been able to eat Which type of isolation technique is designed to decrease the risk of transmission of recognized and unrecognized sources of infections?
14. Contact
15. Airborne
16. Droplet
17. Standard - Answer 4. Standard

The nurse is describing the HIV virus infection to a client who has been told he is HIV positive. Which information regarding the virus is important to teach?

1. The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in
2. The HIV virus can be eradicated from the host body with the correct medical regimen
3. It is difficult for the HIV virus to replicate in humans because it is a monkey virus
4. The HIV virus uses the client's own red blood cells to reproduce the virus in the body - Answer 1. The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding?
5. The client is fortunate not to have contracted HIV from an infected needle
6. The client must be repeatedly exposed to HIV before becoming infected
7. The client may be in the primary infection phase of an HIB infection
8. The antibody test is negative because the client has a different flu virus - Answer 3. The client may be in the primary infection phase of an HIB infection The nurse on a medical floor is caring for clients diagnosed with AIDS. Which client should be seen first?
9. The client who has flushed, warm skin with tented turgor (Dehydration)
10. The client who states the staff ignores the call light
11. The client whose Vital signs are 99.9, pulse 101, R 26, and BP 110/
12. The client who is unable to provide a sputum specimen - Answer 1. The client who has flushed, warm skin with tented turgor (Dehydration)
13. The 26 year old female client is complaining of a low-grade fever, arthralgias, fatigue, and a facial rash. Which lab test should the nurse expect the HCP to order if SLE is suspected?
14. Complete metabolic panel and liver function tests
15. CBC and ANA tests
16. Cholesterol and lipid profile tests
17. BUN and GFR tests - Answer 2. CBC and ANA tests

38. The client diagnosed with SLE is being discharged from the medical unit. Which discharge instructions are most important for the nurse to include? Select all that apply
39. Use a sunscreen of SPF 30 or greater when in the sunlight
40. Notify the HCP immediately when developing a low-grade fever
41. Some dyspnea is expected and does not need immediate attention
42. The hands and feet may change color if exposed to cold or heat
43. Explain the client can be cure with continued therapy - Answer 1. Use a sunscreen of SPF 30 or greater when in the sunlight
44. Notify the HCP immediately when developing a low-grade fever
45. The hands and feet may change color if exposed to cold or heat
46. The nurse is developing a care plan for a client diagnosed with SLE. Which goal is priority for this client?
47. The client will maintain reproductive ability
48. The client will verbalize feelings of body-image changes
49. The client will have no deterioration of organ function
50. The client's skin will remain intact and have no irritation. - Answer 3. The client will have no deterioration of organ function
51. The nurse is admitting a client diagnosed with R/O SLE. Which assessment data observed by the nurse support the diagnosis of SLE?
52. Pericardial friction rub and crackles in the lungs
53. Muscle spasticity and bradykinesia
54. Hirsutism and clubbing of the fingers
55. Somnolence and weight gain - Answer 1. Pericardial friction rub and crackles in the lungs
56. The client diagnosed with an acute exacerbation of SLE is prescribed high-dose steroids. Which statement best explains the scientific rationale for using high-dose steroids in treating SLE?
57. The steroids will increase the body's ability to fight the infection
58. The steroids will decrease the chance of SLE spreading to other organs
59. The steroids will suppress tissue inflammation, which reduces damage to the organs
60. The steroids will prevent scarring of skin tissues associated with SLE - Answer 3. The steroids will suppress tissue inflammation, which reduces damage to the organs

42. The nurse enters the room of a female client diagnosed with SLE and finds the client crying. Which statement is the most therapeutic response?
43. "I know you are upset, but stress makes the SLE worse."
44. "Please explain to me why you are crying."
45. "I recommend going to an SLE support group."
46. " I see you are crying. We can talk if you would like." - Answer 4. " I see you are crying. We can talk if you would like."
47. The nurse is assessing a client with cutaneous lupus erythematosus. Which intervention should be implemented?
48. Use astringent lotion on the face and skin
49. Inspect the skin weekly for open areas or rashes
50. Dry the skin thoroughly by patting
51. Apply anti-itch medication between the toes - Answer 3. Dry the skin thoroughly by patting
52. The nurse and a female UAP are caring for a group of clients on a medical floor. Which action by the UAP warrants immediate intervention by the nurse?
53. The UAP washes her hands before and after performing vital signs on a client
54. The UAP dons sterile gloves prior to removing an indwelling catheter from a client
55. The UAP raises the head of the bed to a high Fowlers position for a client about to eat
56. The UAP uses a fresh plastic bag ot get ice for a clients water pitcher - Answer 2. The UAP dons sterile gloves prior to removing an indwelling catheter from a client
57. The client recently diagnosed with SLE asks the nurse, "What is SLE and how did I get it?" Which statement best explains the scientific rationale for the nurse's response?
58. SLE occurs because the kidneys do not filter antibodies from the blood
59. SLE occurs after a viral illness as a result of damage to the endocrine system
60. There is no known identifiable reason for a client to develop SLE
61. This is an autoimmune disease that may have a genetic or hormonal component - Answer 4. This is an autoimmune disease that may have a genetic or hormonal component

47. The client diagnosed with an acute exacerbation of SLE is being discharged with a prescription for an oral steroid which will be discontinued gradually. Which statement is the scientific rationale for this type of medication dosing?
48. Tapering the medication prevents the client from having withdrawal symptoms
49. So thyroid gland starts working, because this medication stops it from working
50. Tapering the dose allows the adrenal glands to begin to produce cortisol again
51. This is the HCP personal choice in prescribing medications - Answer 3. Tapering the dose allows the adrenal glands to begin to produce cortisol again
52. The nurse is discussing autoimmune disease with a class of nursing students. Which s/s are shared by RA and SLE?
53. Nodules in the subq layer and bone deformity
54. Renal involvement and pleural effusions
55. Joint stiffness and pain
56. Raynauds phenomenon and skin rash - Answer 3. Joint stiffness and pain
57. The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented?
58. Hold all venipuncture sites for at least 5 minutes
59. Limit fresh fruits and flowers
60. Place all clients in reverse isolation
61. Have the clients use a soft-bristle toothbrush - Answer 2. Limit fresh fruits and flowers
62. The nurse is assessing a client diagnosed with acute leukemia. Which assessment data support this diagnosis?
63. Fever and infections
64. N+V
65. Excessive energy and high platelet counts
66. Cervical lymph node enlargement and positive acid-fast bacillus - Answer 1. Fever and infections
67. The client diagnosed with leukemia has CNS involvement. Which instruction should the nurse teach?

1. Sleep with the HOB elevated to prevent increased intracranial pressure
2. Take an analgesic medication for pain only when the pain becomes severe
3. Explain radiation therapy to the head may result in permanent hair loss
4. Discuss end of life decisions prior to cognitive deterioration - Answer 3. Explain radiation therapy to the head may result in permanent hair loss 4.The client diagnosed with leukemia is scheduled for bone marrow transplantation. Which interventions should be implemented to prepare the client for this procedure? Select all
5. Administer high-dose chemo
6. Teach the client about autologous transfusions
7. Have the family members HLA typed
8. Monitor the CBC daily
9. Provide central line care per protocol - Answer 1. Administer high-dose chemo
10. Have the family members HLA typed
11. Monitor the CBC daily
12. Provide central line care per protocol
13. The nurse writes a nursing problem of "altered nutrition" for a client diagnosed with leukemia who has received a treatment regimen of chemo and radiation. Which nursing intervention should be implemented?
14. Administer and antidiarrheal medication prior to meals
15. Monitor the client's serum albumin levels
16. Asses for signs and symptoms of infection
17. Provide skin care to irradiated areas - Answer 2. Monitor the client's serum albumin levels
18. The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed?
19. Infection
20. Anemia
21. Nutrition
22. Grieving - Answer 4. Grieving
23. The nurse is caring for a client diagnosed with acute leukemia. Which assessment data warrant immediate intervention?
24. T 99, P 102, R 22, and BP 132/
25. Hyperplasia of the gums

3. Weaknesses and Fatigue
4. Pain in LUQ - Answer 4. Pain in LUQ
5. The client asks the nurse, "they say I have cancer. How can they tell if I have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale?
6. Biopsies are nuclear medication scans that can detect cancer
7. A biopsy is a laboratory test that detects cancer cells
8. It determines which kind of cancer the client has
9. The HCP takes a small piece out of the tumor and looks at the cells - Answer 3. It determines which kind of cancer the client has
10. Which client is at the highest risk for developing a lymphoma?
11. The client is diagnosed with chronic lung disease who is taking a steroid
12. The client diagnosed with breast cancer who has extensive lymph involvement
13. The client who received a kidney transplant several years ago
14. The client ho has had ureteral stent placements for a neurogenic bladder

• Answer 3. The client who received a kidney transplant several years ago In each of the following situations, identify which option has the highest risk for HIV transmission? a. Transmission to women OR to men during sexual intercourse b. hollow-bore needle used for vascular access OR used for IM injections c. first 2 to 6 months of infection OR 1 year after infection d. perinatal transmission from HIV-infected mothers taking antiretroviral therapy OR HIV infected mothers using no therapy e. a splash exposure of HIV infected blood on skin with an open lesion OR a needle-stick exposure to HIV infected blood - Answer a. a women b. vascular access c. first 2 to 6 months of infection d. HIV-infected mothers using no therapy e. needle-stick exposure of HIV-infected blood place the following events of HIV infection of a cell in sequence from first to last

1. viral RNA is converted to sing-stranded viral DNA with assistance of reverse transcriptase
2. viral DNA is sliced into cell genome using the enzyme integrase

3. gp 120 proteins on viral envelope combine with CD4 receptors of body cells
4. cell replicates infected daughter cells and makes more HIV
5. viral RNA and reverse transcriptase enzyme enter host CD4+ T cell
6. long strands of viral RNA are cut in the presence of protease
7. single-stranded viral DNA replicates into double-stranded DNA - Answer 3 5 1 6 2 7 4 What is a primary reason that the normal immune response fails to contain the HIV infection a. CD4+ T cells become infected with HIV and are destroyed b. the virus inactivates B cells, preventing the production of HIV antibodies c. natural killer cells are destroyed by the virus before the immune system can be activated d. monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues - Answer a. CD4+ T cells become infected with HIV and are destroyed which characteristic corresponds with the acute stage of HIV infection a. burkitts lymphoma b. temporary fall of CD4+ T cells c. persistent fevers and night sweats d. pneumocystis jiroveci pneumonia - Answer b. temporary fall of CD4+ T cells what findings support the diagnosis of AIDS in the individual with HIV? a. flu like symptoms b. oral hairy leukoplakia c. CD4+ cells 200- d. cytomegalovirus retinitis - Answer d. cytomegalovirus retinitis why do opportunistic disease develop in an individual with AIDS a. they are side effects of drug treatment of AIDS b. they are sexually transmitted to individuals during exposure to HIV

c. they are characteristics in individuals with stimulated B and T lymphocytes d. these infections or tumors occur in a person with an incompetent immune system - Answer d. these infections or tumors occur in a person with an incompetent immune system which characteristics describe pneumocystis jiroveci infection. an opportunistic disease that can be assocaited with HIV? a. may cause fungal meningitis b. diagnosed by lymph node biopsy c. pneumonia with dry, nonproductive cough d. viral retinitis, stomatitis, esophagitis, gastritis, or colitis - Answer c. pneumonia with dry, nonproductive cough which opportunistic disease assocaited with AIDS is characterized by hyperpigmented lesions of skin, lyngs, and GI tract? a. kaposi sarcoma b. candida albicans c. herpes simplex type 1 infection d. varicella zoster virus infection - Answer a. kaposi sarcoma A patient comes to the clinic and requests testing for HIV infection. Before administering testing, what is the most important for the nurse to do? a. ask the patient to identify all sexual partners b. determine when the patient thinks exposure to HIV occurred c. explain that all test results must be repeated at least twice to be valid d. discuss the prevention practices to prevent transmission of HIV to others

• Answer b. determine when the patient thinks exposure to HIV occurred the "rapid" HIV antibody testing is performed on a patient of high risk for HIV infection. What should the nurse explain about this test? a. the test measures the activity of the HIV reports viral loads as real numbers b. the test is highly reliable, and in five minutes the patient will know if HIV infection is present c. if the results are positive, another blood test and a return appointment for results will be necessary d. the test detects drug resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral drugs - Answer c. if the

results are positive, another blood test and a return appointment for results will be necessary Treatment with two NRTIs and PI is prescribed for patient with HIV infection who has a CD4+ T cell count less than 400. the patient asks why so many drugs are necessary for treatment. What should the nurse explain as the primary rationale for combination therapy? a. cross-resistance between specific antiretroviral drugs is reduced when drugs are given in combination b. combination of antiretroviral drugs decrease the potential for development of antiretroviral-resistant HIV variants c. side effects of the drugs are reduced when smaller doses of three different drugs are used rather than large doses of one drug d. when CD4+ T cell counts are less than 500, a combination of drugs that have different actions is more effective in slowing HIV growth - Answer b. combination of antiretroviral drugs decrease the potential for development of antiretroviral-resistant HIV variants what is one of the most significant factors in determining when to start antiretroviral therapy in a patient with HIV infection? a. when the patient has high levels of HIV antibodies b. confirmation that the patient has contracted HIV infection c. the patients readiness to commit to a complex, lifelong, uncomfortable, drug regimen d. whether the patient has a support system to help manage the costs and side effects of the drug - Answer c. the patients readiness to commit to a complex, lifelong, uncomfortable, drug regimen after teach a patient with HIV infection about using antiretroviral drugs, the nurse recognizes that further teaching is needed when the patient says: a. i should never skip doses of my medication, even if i develop side effects b. if my viral load becomes undetectable, i will no longer be able to transmit HIV to others c. i should not use OTC drugs without checking with my HCP d. if i develop a constant headache that is not relieved with aspiring or acetaminophen, I should report it within 24 hours - Answer b. if my viral load becomes undetectable, i will no longer be able to transmit HIV to others

Prophylactic measures that are routinely used as early as possible in HIV infection to prevent opportunistic and debilitating secondary problems include administration of a. INH to prevent TB b. TMP/TMX for toxoplasmosis c. vaccines for pneumococcal pneumonia, influenza, and hep A and B d. VZIG to prevent chicken pox or shingles - Answer c. vaccines for pneumococcal pneumonia, influenza, and hep A and B a patient identified as HIV antibody - positive one year ago manifests acute HIV infection but does not want to start antiretroviral therapy at this time. what is an appropraite nursing intervention for the patient at this stage of illness? a. assess with end of life issues b. provide care during acute exacerbations c. provide physical care for chronic disease d. teach the patient about immune enhancements - Answer d. teach the patient about immune enhancements how can you eliminate the risk of HIV/AIDs through sexual intercourse - Answer abstain from sex noncontact sexual activities condoms how can you eliminate the risk of HIV/AIDs through drug use - Answer abstain from drug use do not share equipment use alternative routes to injecting do not have sexual intercourse while under the influence of drugs how can you eliminate the risk of HIV/AIDs through perinatal transmission - Answer use family planning to avoid pregnancy use antiretroviral therapy to reduce the risk of transmission the nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventative action for both women and men? a. smoking cessation b. routine colonscopies c. protection from UV light

d. regular examination of reproductive organs - Answer a. smoking cessation What defect in cellular proliferation is involved in the development of cancer? a. a rate of cell proliferation that is more rapid than that of normal body cells b. shorted phases of cell life cycles with occasional skipping of GI or S phases c. rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. indiscriminate and continuous proliferation of cells with loss of contact inhibition - Answer d. indiscriminate and continuous proliferation of cells with loss of contact inhibition what does the presence of carcinoembryonic antigens (CEAs) and AFP on cell membranes indicate has happened to the cells a. they have shifted to more immature metabolic pathways and functions b.they have spread from areas of original development to different body tissues c. they produced abnormal toxins or chemicals that indicate abnormal cellular function d. they have become more differentiated as a result of repression of embryonic functions - Answer a. they have shifted to more immature metabolic pathways and functions what factor differentiates a malignant tumor form benign tumor a. it causes death b. it grows at a faster rate c. it is often encapsulated d. it invades and metastasizes - Answer d. it invades and metastasizes a patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse likely to find in the patients history? a. work as a radiation chemist b. epstein-barr virus diagnosed in vitro c. intense tanning throughout the lifetime d. alkylating agents for treating the Hodgkins lymphoma - Answer d. alkylating agents for treating the Hodgkins lymphoma

What mutated tumor suppressor gene is most likely to contribute to many types of cancer, including bladder, breast, colorectal, and lung? a. p53 b. APC c. BRCA1 d. BRCA2 - Answer a. p53 cancer cells go through stages of development. What accurately describe the stage of promotion? (select all) a. obesity is an example of a promoting factor b. the stage is characterized by increased growth rate and metastasis c. withdrawal of promoting factors will reduce the risk of cancer development d. tobacco smoke is a complete carcinogen that is capable of both initiation and promotion e. promotion is the stage of cancer development in which there is an irreversible alteration in the cells DNA - Answer a. obesity is an example of a promoting factor c. withdrawal of promoting factors will reduce the risk of cancer development d. tobacco smoke is a complete carcinogen that is capable of both initiation and promotion The patient was told she has carcinoma in situ, and the student nurse wonders what that is. How should the nurse explain this to the student nurse? a. evasion of the immune system by cancer cells b. lesion with histologic features of cancer except invasion c. capable of causing cellular alterations assocaited with cancer d. tumor cell surface antigens that stimulate an immune response - Answer b. lesion with histologic features of cancer except invasion which word identifies a mutation of protooncogenes? a. oncogenes b. retrogenes c. oncofetal antigens d. tumor angiogensis factor - Answer a. oncogenes what is the name of a tumor from the embryonal mesoderm tissue of origin located in the anatomic site of meninges that has malignant behavior?

a. menengitis b. meningioma c. meningocele d. meningeal sarcoma - Answer d. meningeal sarcoma A patients breast tumor originates from embryonal ectoderm. It has moderate dysplasia and moderately differentiated cells. It is a small tumor with minimal lymph node involvement and no metastasis. What is the best description of this tumor? a. sarcoma, grade II T3, N4, M0 b. leukemia, grade I T1, N2, M1 c. carcinoma, grade II T1, N1, M0 d. lymphoma, grade III T1, N0, M - Answer c. carcinoma, grade II T1, N1, M0 The nurse is counseling a group of individuals over the age of 50 with average risk for cancer about screening tests for cancer. Which screening recommendation should be performed to screen for colorectal cancer? a. barium enema every eyar b. colonoscopy every ten years c. fecal occult blood every five years d. PSA and digital rectal exam annually - Answer b. colonoscopy every ten years a small lesion is discovered in a patients lung when an xray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. lung scan b. tissue biopsy c. oncofetal antigens in the blood d. CT or PET scan - Answer b. tissue biopsy A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. prevent breast cancer b. diagnose breast cancer c. cure or control breast cancer d. provide palliative care for untreated breast cancer? - Answer a. prevent breast cancer

what patient would be most likely to be cured with chemotherapy as a treatment measure? a. small cell lung cancer b. new neuroblastoma c. small tumor of the bone d. large hepatocelular carcinoma - Answer b. new neuroblastoma The nurse uses many precautions during IV administration of vesicant chemotherapeutic agents, primarily to prevent a. septicemia b. extravasation c. catheter occlusion d. anaphylactic shock - Answer b. extravasation which delivery system would be used to deliver regional chemotherapy for metastasis from a primary colorectal cancer? a. intrathecal b. intraarterial c. IV d. intraperitoneal - Answer d. intraperitoneal when teaching a patient with cancer about chemotherapy, which approach should the nurse take? a. avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety b. explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects c. assure the patient that the side effects from chemotherapy are uncomfortable but never life threatening d. inform the patient that chemotherapy related alopecia is usually permanent but can be managed with lifelong use of wigs - Answer b. explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects which normal tissues manifest early, acute responses to radiation therapy? a. spleen and liver b. kidney and nervous tissues c. bone marrow and GI mucosa

d. hollow organs such as the stomach and bladder - Answer c. bone marrow and GI mucosa The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse include in the teaching? a. moisturize skin with lotion b. keep the area covered if it is sore c. dry the skin thoroughly after cleansing it d. avoid extreme temps to the area - Answer d. avoid extreme temps to the area to prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. implement a walking program b. ignore the fatigue as much as possible c. do the most stressful activities when fatigue is tolerable d. schedule rest periods throughout the day whether fatigue is present or not - Answer a. implement a walking program when the patient asks about the late effects of chemotherapy and high dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. third space syndrome b. secondary malignancies c. chronic nausea and vomiting d. persistent myelosuppression - Answer b. secondary malignancies what describes a primary use of biological therapy in cancer treatment? a. protect normal, rapidly reproducing cells of the GI system from damage during chemotherapy b. prevent the fatigue associated with chemotherapy and high dose radiation as seen with bone marrow depression c. enhance or supplement the effects of the hosts immune responses to tumor cells that produce flu like symptoms d. depress the immune system and circulation lymphocytes as well as increase the sense of well being by replacing CNS deficits - Answer c. enhance or supplement the effects of the hosts immune responses to tumor cells that produce flu like symptoms