Review Questions: Lewis Ch. 16 1. What is the function of monocytes in immunity? a. They stimulate the production of T and B lymphocytes. b. They produce antibodies on exposure to foreign substances. c. They bind antigens and stimulate natural killer cell activation. d. They capture antigens by phagocytosis and present them to lymphocytes. 2. Which of the following is a function of cell-mediated immunity? a. Formation of antibodies b. Activation of the complement system c. Surveillance for malignant cell changes d. Opsonization of antigens to allow phagocytosis by neutrophils 3. Which immunoglobulin from maternal transmission protects newborns in the first 3 to 6 months of life from bacterial infections? a. IgG b. IgA c. IgM d. IgE 4. Which primary immunological disorder typically occurs in a type I hypersensitivity reaction? a. Binding of IgG to an antigen on a cell surface b. Deposit of antigen–antibody complexes in small vessels c. Release of lymphokines to interact with specific antigens d. Release of chemical mediators from IgE-bound mast cells and basophils 5. Which response alerts the nurse that a possible anaphylactic shock reaction may be occurring immediately after a client has received an intramuscular penicillin injection? a. Edema and itching at the injection site b. Sneezing and itching of the nose and eyes c. A wheal-and-flare reaction at the injection site d. Chest tightness and production of thick sputum 6. Which is the most appropriate response when a person requests a friend who is a nurse to administer his allergy shot? a. It is illegal for nurses to administer injections outside of a medical setting. b. The nurse is qualified to do it if the friend has epinephrine in an injectable syringe provided with his extract. c. Avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective. d. Immunotherapy should be administered only in a setting where emergency equipment and medications are available. 1. d; 2. c; 3. a; 4. d; 5. a; 6. D Lilley’s Ch. 19 1. The nurse caring for a patient who is receiving beta1-agonist drug therapy should monitor for which of the following effects? a. Increased heart contractility b. Decreased heart rate c. Bronchoconstriction d. Increased GI tract motility 2. During a teaching session for a patient receiving inhaled salmeterol xinafoate, the nurse emphasizes that the drug is indicated for which condition? a. Rescue treatment of acute bronchospasm b. Prevention of bronchospasm c. Reduction of airway inflammation d. Long-term treatment of sinus congestion 3. For a patient receiving a vasoactive drug such as intravenous dopamine, which action by the nurse is most appropriate? a. Monitor the gravity drip infusion closely and adjust as needed. b. Assess the patient’s heart function by checking the radial pulse. c. Assess the intravenous site hourly for possible infiltration. d. Administer the drug by intravenous boluses, according to the patient’s blood pressure. 4. A patient is receiving dobutamine for shock and is reporting feeling more “skipping beats” than yesterday. What will the nurse do next? a. Monitor for other signs of a therapeutic response to the drug. b. Titrate the drug to a higher dose to reduce the palpitations. c. Discontinue the dobutamine immediately. d. Assess the patient’s vital signs and cardiac rhythm. 5. A patient is receiving a drug that is characterized as having a negative chronotropic effect. The nurse would expect to monitor for which physiological effect? a. Reduced blood pressure b. Decreased heart rate c. Decreased ectopic beats d. Increased force of heart contractions 6. The nurse is monitoring a patient who is receiving an infusion of a betaadrenergic agonist. Which adverse effects may occur with this infusion? (Select all that apply.) a. Mild tremors b. Bradycardia c. Tachycardia d. Palpitations e. Drowsiness f. Nervousness 1. a, 2. b, 3. c, 4. d, 5. b, 6. a, c, d, f, Lilley’s Ch. 37 1. When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? a. Glaucoma b. Fever c. Peptic ulcer disease d. Allergic rhinitis 2. When giving decongestants, the nurse must remember that these drugs have α-adrenergic- stimulating effects that may result in which effect? a. Fever b. Bradycardia c. Hypertension d. CNS depression 5. A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptom, which may indicate an adverse effect of this drug? a. Increased cough b. Dry mouth c. Slower heart rate d. Heart palpitations 6. The nurse is giving an antihistamine and will observe the patient for which of the following adverse effects? (Select all that apply.) a. Hypertension b. Dizziness c. “Hangover” effect d. Drowsiness e. Tachycardia f. Dry mouth 1. a, 2. c, 5. d, 6. b, c, d, f, Lewis Ch. 30 + 48 1. What clinical manifestations should the nurse expect when assessing a client with pneumococcal pneumonia? a. Fever, chills, and a productive cough with purulent sputum b. Non-productive cough and night sweats that are usually self-limiting c. Gradual onset of nasal stuffiness, sore throat, and purulent productive cough d. Abrupt onset of fever, non-productive cough, and formation of lung abscesses 2. A client with pneumonia has the nursing diagnosis of inadequate airway clearance from an excessive amount of mucus and retained secretions. What would be an appropriate nursing intervention? a. Promote fluid hydration, as appropriate, to help liquefy secretions. b. Provide analgesics as ordered to promote client comfort. c. Administer oxygen as prescribed to maintain optimal oxygen levels. d. Teach the client how to cough effectively to bring secretions to the mouth. 4. A client has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment of serious trauma and infection. Which of the following infections is the client most susceptible to? a. Aspergillosis b. Candidiasis c. Coccidioidomycosis d. Histoplasmosis 1. Organisms that cause pyelonephritis most commonly reach the kidneys through which means? a. The bloodstream b. The lymphatic system c. A descending infection d. An ascending infection 2. What should the nurse teach the female client who has frequent urinary tract infections (UTIs)? a. Urinate after sexual intercourse. b. Take tub baths with bubble bath. c. Take prophylactic sulphonamides for the rest of her life. d. Restrict fluid intake to prevent the need for frequent voiding. 1. a; 2. a; 4. b; 1. d; 2. a Lilley’s Ch. 43 1. The nurse is caring for a patient who is scheduled for colorectal surgery the next day. The patient does not have sepsis, WBC count is normal, and the patient is afebrile and otherwise presents in good health. The health care provider orders the nurse to administer an antibiotic on call, prior to the patient going for surgery. Identify the rationale for why the nurse understands that the antibiotic is to be administered prior to surgery. a. To provide empiric therapy b. To provide prophylactic therapy c. To treat for a superinfection d. To reduce the number of resistant organisms 2. An adolescent patient is taking a tetracycline drug as part of treatment for severe acne. Which of the following statements should the nurse teach this patient about drug-related precautions when taking tetracycline? a. When the acne clears up, the medication may be discontinued. b. This medication needs to be taken with antacids to reduce GI upset. c. The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. d. The teeth should be observed closely for signs of mottling or other colour changes. 3. The nurse is caring for a newly admitted patient who reports a penicillin allergy. The health care provider has ordered a second-generation cephalosporin as part of therapy. Which of the following would be the most appropriate nursing action? a. Call the health care provider to clarify the order because of the patient’s allergy. b. Ask the pharmacy to change the order to a first-generation cephalosporin. c. Give the medication and monitor for adverse effects. d. Administer the drug with a nonsteroidal anti-inflammatory drug to reduce adverse effects. 4. The nurse is caring for a client who has been ordered an oral macrolide such as erythromycin. Which of the following would be the most important information by the nurse to provide to the patient during teaching? a. If GI upset occurs, the drug will have to be stopped. b. The drug needs to be taken with an antacid to avoid GI problems. c. The patient needs to take each dose with a sip of water. d. The patient may take the drug with a small snack to reduce GI irritation. 5. A female client has been taking an antibiotic for a urinary tract infection (UTI) and calls the health care provider to report severe vaginal itching. The patient explains that she has also noticed a thick, whitish vaginal discharge. Which of the following would explain the patient’s clinical manifestations? a. This is an expected response to antibiotic therapy. b. The UTI has become worse instead of better. c. A superinfection has developed. d. The UTI is resistant to the antibiotic. 6. The nurse is reviewing orders for wound care, which include use of an antiseptic. Which statements best describe the use of antiseptics? (Select all that apply.) a. Antiseptics are appropriate for use on living tissue. b. Antiseptics work by sterilizing the surface of the wound. c. Antiseptics are applied to nonliving objects to kill microorganisms. d. The patient’s allergies must be assessed before using the antiseptic. e. Antiseptics are used to inhibit the growth of microorganisms on the wound surface. 8. The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The antibiotic orders include an order for doxycycline. However, when the patient is asked about his allergies, he lists “doxycycline” as one of his allergies. What is the nurse’s first action at this time? a. Call the prescriber to clarify the order because of the patient’s allergy. b. Ask the patient to explain what happened when he had the allergic reaction. c. Ask the pharmacy to order a different antibiotic. d. Administer the drug with an antihistamine to reduce adverse effects. 1. b, 2. c, 3. a, 4. d, 5. c, 6. a, d, e, Lilley’s Ch. 44 1. The nurse is assessing a woman who is receiving an antibiotic for communityacquired pneumonia. The patient complaints of perineal itching and a thick, white vaginal discharge Which of the following would the nurse suspect is the primary problem? a. Resistance to the antibiotic b. An adverse effect of the antibiotic c. A superinfection d. An allergic reaction 2. The nurse is reviewing a patient’s medication list. The patient has been admitted for treatment of an infected leg ulcer and will be started on IV linezolid. Which of the following medications, if listed in the medication list with linezolid, would be most concerning for the nurse? a. Beta-blocker b. Oral anticoagulant c. Selective serotonin reuptake inhibitor (SSRI) antidepressant d. Thyroid replacement hormone 3. The nurse is caring for a client who has been administered vancomycin. Which of the following would be a priority assessment for the nurse prior to administering the vancomycin? a. Kidney function b. WBC count c. Liver function d. Platelet count 4. During therapy with an IV aminoglycoside, the patient calls the nurse and says, “I am hearing some odd sounds, like ringing, in my ears.” Which is the following would be the nurse’s priority action at this time? a. Reassure the patient that these are expected adverse effects. b. Reduce the rate of the IV infusion. c. Increase the rate of the IV infusion. d. Stop the infusion immediately. 5. The nurse is caring for a client who has been ordered IV quinolones. Which of the following would the nurse be concerned about with a serious drug-to-drug interaction? a. Selective serotonin reuptake inhibitor (SSRI) antidepressants b. Nonsteroidal anti-inflammatory drugs (NSAIDs) c. Oral anticoagulants d. Antihypertensives 6. The nurse is administering an IV aminoglycoside to a patient who has had gastrointestinal surgery. Which of the following nursing measures would be most appropriate? (Select all that apply.) a. Report a trough drug level of 0.8 mcg/mL, and hold the drug. b. Enforce a strict fluid restriction. c. Monitor serum creatinine levels. d. Instruct the patient to report dizziness or a feeling of fullness in the ears. e. Warn the patient that the urine may turn a darker colour. 1. c, 2. c, 3. a, 4. d, 5. c, 6. c, d, Lewis Ch. 17 3. How is human immunodeficiency virus (HIV) transmitted? a. Most commonly as a result of sexual contact b. In all infants born to women with HIV infection c. Only when there is a large viral load in the blood d. Frequently in health care workers with needle-stick exposures 4. Which is the common physiological change after HIV infection? a. The virus replicates mainly in B lymphocytes before spreading to CD4+ T cells in lymph nodes. b. The immune system is impaired predominantly by infection and destruction of CD4+ T cells. c. Infection of monocytes may occur, but these cells are destroyed by antibodies produced by oligodendrocytes. d. A long period develops during which the virus is not found in the blood and there is little viral replication. 5. Which of the following statements is false? a. “Infection with HIV results in a chronic disease with acute exacerbations and progression if left untreated.” b. “Untreated HIV infection can remain in the early chronic stage for a decade or more.” c. “Late-stage infection is often called acquired immune deficiency syndrome (AIDS).” d. “Opportunistic diseases occur more often when the CD4+ T-cell count is high and the viral load is low.” 6. When is AIDS diagnosed in an HIV-infected person? a. When an AIDS-defining illness develops b. When the amount of HIV in the blood increases c. When the CD4:CD8 ratio is reversed to less than 2:1 d. When the person has oral hairy leukoplakia, an infection caused by EpsteinBarr virus 7. What does screening for HIV infection generally involve? a. Laboratory analysis of blood to detect HIV antigen and antibody b. Electrophoretic analysis of HIV antigen in plasma c. Laboratory analysis of blood to detect increased T cells d. Analysis of lymph tissues for the presence of HIV RNA 8. What is the indication for use of antiretroviral medications? a. Cure acute HIV infection b. Treat opportunistic diseases c. Decrease viral RNA levels d. Supplement radiation therapy and surgery 9. Which statement about metabolic adverse effects of ART is true? (Select all that apply.) a. “These are annoying symptoms that are ultimately harmless.” b. “ART-related body changes include central fat accumulation and peripheral wasting.” c. “Lipid abnormalities include increases in triglycerides and decreases in highdensity cholesterol.” d. “Insulin resistance and hyperlipidemia can be treated with medications to control glucose and cholesterol.” e. “Insulin resistance and hyperlipidemia are more difficult to treat in HIVinfected clients than in uninfected people.” 10. Which of the following descriptions of opportunistic diseases in HIV infection is correct? a. Usually occur one at a time b. Generally slow to develop and progress c. Occur in the presence of immunosuppression d. Curable with appropriate pharmacological intervention 11. Of the following, which is the most appropriate nursing intervention to help an HIV-infected client adhere to the treatment regimen? a. Give the client a DVD and a brochure to view and read at home. b. Volunteer to “set up” a medication pillbox for a week at a time. c. Inform the client that the adverse effects of the medications are bad but that they go away after a while. d. Assess the client’s lifestyle and find adherence cues that fit into the client’s lifestyle. 12. Which strategy can the nurse teach the client to eliminate the risk of transmission of HIV? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking zidovudine (azidothymidine [AZT], ZDV, Retrovir) during pregnancy d. Using latex barriers to cover genitals during sexual contact 1. a, b, c, d, e; 2. a; 3. a; 4. b; 5. d; 6. a; 7. c; 8. c; 9. b, c, d; 10. c; 11. d; 12. a. Lilley’s Ch. 45 1. The nurse is caring for a client prescribed zidovudine. Which of the following adverse events would the nurse monitor? a. Retinitis b. Deep vein thrombosis c. Kaposi’s sarcoma d. Bone marrow suppression 2. After giving an injection to a patient with HIV infection, the nurse accidentally receives a needle stick from a needle disposal box that was too full. Which of the following drugs might be included in recommendations for treating an occupational HIV exposure? a. Didanosine and emtricitabine b. Lamivudine and enfuvirtide c. Tenofovir, lamivudine, and raltegravir d. Acyclovir 3. The nurse is teaching a patient who has been prescribed acyclovir for genital herpes. Which of the following statements by the nurse to the patient would be most accurate? a. “This drug will help the lesions dry and crust over.” b. “Acyclovir will eradicate the herpes virus.” c. “This drug will prevent the spread of this virus to others.” d. “Be sure to give this drug to your partner, too.” 4. A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education? a. “I will be monitored for adverse effects and improvements while I’m taking this medicine.” b. “These drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced.” c. “There is no cure for HIV.” d. “These drugs will eventually eliminate the virus in my body.” 6. The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (Select all that apply.) a. The combination of drugs has fewer associated toxicities. b. The use of multiple drugs is more effective against resistant strains of HIV. c. Effective treatment results in reduced T-cell counts. d. The goal of this treatment is to reduce the viral load. e. This type of therapy reduces the incidence of opportunistic infections. 1. d, 2. c, 3. a, 4. d, 5. c, 6. b, d, e Lilley’s Ch. 51 1. The nurse is assessing a patient who has been prescribed the measles vaccine. Which of the following conditions would the nurse indicate as a contraindication to the vaccine?? a. Anemia b. Pregnancy c. Ear infection d. Common cold 2. An infant is to receive a vaccination. Which of the following adverse events would the nurse teach the parent of the infant to monitor? a. Fever over 38.3°C b. Rash c. Soreness at the injection site d. Chills 3. A client presents with a suspected hepatitis B exposure. Which of the following would the nurse anticipate will be given to the client? a. Immune serum globulin b. Hepatitis B virus vaccine c. Hepatitis B immunoglobulin d. Rh0(D) immunoglobulin 4. During a routine checkup, a 72-year-old patient is advised to receive an influenza vaccine injection. The client questions this, saying, “I had one last year. Why do I need another one?” What of the following would be the most appropriate response by the nurse? a. “The effectiveness of the vaccine wears off after 6 months.” b. “Each year a new vaccine is developed on the basis of flu strains that are likely to be in circulation.” c. “When you reach 65 years of age, you need boosters on an annual basis.” d. “Taking the flu vaccine each year allows you to build your immunity to a higher level each time.” 5. A client presents to an urgent care centre after stepping on a rusty tent nail. The nurse evaluates the patient’s immunity status and notes that the patient last received the tetanus booster 10 years ago. Which of the following immunizations would be most appropriate for the client? a. Immunoglobulin intravenous b. DTaP (diphtheria, tetanus, and acellular pertussis) c. Tdap (tetanus, diphtheria, and acellular pertussis) d. No immunizations are necessary at this time. 6. The nurse is providing teaching after an adult receives a booster immunization. Which adverse reactions should the patient report immediately to the health care provider? (Select all that apply.) a. Swelling and redness at the injection site b. Fever of 37.8°C c. Joint pain d. Heat over the injection site e. Rash over the arms, back, and chest f. Shortness of breath 1. b, 2. c, 3. a, 4. b, 5. c, 6. c, e, f, Lewis Ch. 52 1. Polydipsia and polyuria related to diabetes mellitus are primarily caused by which of the following? a. The release of ketones from cells during fat metabolism b. Fluid shifts resulting from the osmotic effect of hyperglycemia c. Damage to the kidneys from exposure to high levels of glucose d. Changes in red blood cells resulting from attachment of excessive glucose to hemoglobin 2. Which statement would be correct for a client with type 2 diabetes mellitus who is admitted to the hospital with pneumonia? a. The client must receive insulin therapy to prevent the development of ketoacidosis. b. The client has islet-cell antibodies that have destroyed the ability of the pancreas to produce insulin. c. The client has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The client may have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic state. 3. Analyze the following diagnostic findings for a client with type 2 diabetes. Which of the following results will need further assessment? a. A1c 9.0% b. FBG 7.2 mmol/L c. BP 126/80 d. LDL cholesterol of 2.1 mmol/L 4. Which statement by the client with type 2 diabetes is accurate? a. “I am supposed to have a meal or snack if I drink alcohol.” b. “I am not allowed to eat any sweets because of my diabetes.” c. “I do not need to watch what I eat because my diabetes is not the bad kind.” d. “The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar.” 5. The nurse is caring for a client with newly diagnosed type 1 diabetes. What information is essential to include in the client teaching before discharge from the hospital? (Select all that apply.) a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment 6. What is the priority action for the nurse to take if the client with type 2 diabetes reports blurred vision and irritability? a. Call the health care provider. b. Administer insulin as ordered. c. Check the client’s blood glucose level. d. Assess for other neurological symptoms. 7. A client with diabetes has a serum glucose level of 36 mmol/L and is unresponsive. Following assessment of the client, the nurse suspects diabetic ketoacidosis (DKA) rather than hyperosmolar hyperglycemic state (HHS), based on which finding? a. Polyuria b. Severe dehydration c. Rapid, deep respirations d. Decreased serum potassium 8. Which of the following are appropriate therapies for clients with diabetes mellitus? (Select all that apply.) a. Use of diuretics to treat nephropathy b. Use of angiotensin-converting enzyme inhibitors to treat nephropathy c. Use of serotonin agonists to decrease appetite d. Use of laser photocoagulation to treat retinopathy e. Use of statins to treat dyslipidemia 1. b; 2. d; 3. a; 4. a; 5. a, d, e; 6. c; 7. c; 8. b, d, e Lilley’s Ch. 33 1. The nurse is to administer rapid-acting insulin to a hospitalized patient. Which would be the most appropriate timing for the patient to receive the dose? a. Give it 15 minutes before the patient begins a meal. b. Give it ½ hour before a meal. c. Give it 1 hour after a meal. d. The timing of the insulin injection does not matter with a rapid-acting insulin. 2. The nurse is teaching a patient about type 2 diabetes. Which of the following statements would be most appropriate for the nurse? a. “Insulin injections are never used with type 2 diabetes.” b. “You don’t need to measure your blood glucose levels because you are not taking insulin injections.” c. “A person with type 2 diabetes still has functioning β-cells in the pancreas.” d. “Patients with type 2 diabetes usually have better control over their diabetes than those with type 1 diabetes.” 3. The nurse monitoring a patient for a therapeutic response to oral antihyperglycemic drugs. What of the following adverse events will the nurse monitor? a. Fewer episodes of diabetic ketoacidosis (DKA) b. Weight loss of 2.3 kg c. Hemoglobin A1C levels of less than 7% d. Glucose levels of 9.5 mmol/L 4. A patient with type 2 diabetes is scheduled for magnetic resonance imaging (MRI) with contrast dye. The nurse is reviewing the orders and notices that the patient is receiving metformin (Glucophage). Which action by the nurse would be most appropriate? a. Proceed with the MRI as scheduled. b. Notify the radiology department that the patient is receiving metformin. c. Expect to hold the metformin the day of the test and for 48 hours after the test is performed. d. Call the health care provider regarding holding the metformin for 2 days before the MRI is performed. 5. A patient with type 2 diabetes has a new prescription for repaglinide (GlucoNorm). After 1 week, the patient contacts the office to ask what to do if there are missed meals. “I work right through lunch sometimes, and I’m not sure whether I need to take it. What do I need to do?” Which of the following would be the nurse’s best response? a. “You need to try not to skip meals, but if that happens, you will need to skip that dose of repaglinide.” b. “We will probably need to change your prescription to insulin injections because you can’t eat meals on a regular basis.” c. “Go ahead and take the pill when you first remember that you missed it.” d. “Take both pills with the next meal, and try to eat a little extra to make up for what you missed at lunchtime.” 6. When checking a patient’s blood glucose level, the nurse obtains a reading of 2.3 mmol/L. The patient is awake but states feeling a bit “cloudy-headed.” After double-checking the patient’s glucose level and getting the same reading, which of the following nursing actions would be most appropriate? a. Administer two packets of table sugar. b. Administer oral glucose in the form of a semisolid gel. c. Administer 50% dextrose IV push. d. Administer the morning dose of insulin lispro. 7. A patient is taking metformin for new-onset type 2 diabetes. When teaching the patient about potential adverse effects, which of the following information would the nurse include? (Select all that apply.) a. Abdominal bloating b. Nausea c. Diarrhea d. Headache e. Weight gain f. Metallic taste 1. a, 2. c, 3. c, 4. c, 5. a, 6. b, 7. a, b, c, f