RN Targeted Medical Surgical Immune Online Practice 2019

A nurse is planning care for a client who has leukemia and a platelet count of
48,000/mm3. Which of the following interventions should the nurse include in the plan?
Provide the client with a diet that is low in vitamin K.
Place the client on contact precautions.
Administer subcutaneous epoetin alfa.
Test the client's urine and stool for occult blood.

Rationale: A client who is thrombocytopenic is at risk for occult bleeding. Therefore, the nurse
should test the client's urine and stool for occult blood.

A nurse is teaching the parent of a child about administration guidelines for the human
papilloma virus (HPV) vaccine. Which of the following information should the nurse
include?
One dose is administered at birth and another is administered at age 5.
The vaccine does not protect males.
The vaccine protects against chlamydia.
Three doses are administered to adolescents who start the series after age 15.

A nurse is providing teaching to a client who has systemic lupus erythematosus (SLE).
Which of the following statements by the client indicates an understanding of the
teaching?
"I should use a sunscreen with an SPF of at least 15."
"Long-term immunosuppressive therapy could cure this disease."
"I should wear gloves when it is cold outside."
"SLE should not affect my lungs or breathing."
A nurse is providing teaching to a client who takes an oral contraceptive and has a new
prescription for amoxicillin. Which of the following statements by the client indicates an
understanding of the teaching?
"I will use a backup method of birth control while I am taking this medication."
"I should take this medication on an empty stomach."
"I should expect to have constipation while taking this medication."
"I will keep taking this medication until I feel better."
A nurse is caring for four clients. Which of the following clients is at the greatest risk for
pneumonia?
A school-age child who has a history of asthma
A young adult client who is living in a college dormitory
A middle adult client who is using an incentive spirometer following surgery
An older adult client who has dysphagia
A nurse is reviewing the daily laboratory results for a female client who has acute
leukemia. Which of the following values is an expected finding?
WBC count 21,000/mm3
Hgb 14 g/dL
Hct 40%
Platelets 170,000/mm3
A nurse is reviewing the laboratory report for a client who has Hodgkin's lymphoma.
Which of the following findings should the nurse expect?
Overgrowth of B-lymphocyte plasma cells
Reed-Sternberg cells
Epstein-Barr virus
Overproduction of blast phase cells

A nurse is providing discharge teaching to a client who has HIV. Which of the following
statements by the client indicates an understanding of the teaching?
"I will clean the bathroom surfaces with full-strength bleach."
"I should discard open beverages that have been unrefrigerated for 1 hr."
"I should wash laundry that is soiled with a body fluid in cool water."
"I will work in the garden for exercise."
A nurse is providing teaching to a client who is scheduled for a Papanicolaou (Pap) test.
The nurse should inform the client that the Pap test is used to screen for which of the
following?
Uterine cancer
Cervical cancer
Ovarian cysts
Fibroids
A nurse is caring for a client who has viral pneumonia. Which of the following findings
should the nurse report to the provider immediately?
Negative blood culture
Left shift in WBC differential
Oxygen saturation 93%
Crackles heard on auscultation
A nurse is caring for a client who has an elevated prostate-specific antigen level. The
nurse should anticipate that the client will undergo which of the following diagnostic
tests?
Palpation of testes
Human chorionic gonadotropin level
Digital rectal examination
Pelvic ultrasound
A nurse is caring for a client who has non-Hodgkin's lymphoma and is receiving
chemotherapy. Which of the following is the priority assessment finding?
 Loss of body hair
Report of anorexia
Mucositis of the oral cavity
Erythema at the IV insertion site
A nurse is caring for a client who has HIV. Which of the following laboratory findings
should suggest to the nurse that medication therapy is effective?
WBC count 3,500/mm3
Lymphocyte 1,400/mm3
Decreased viral load
Low CD4/CD8 ratio
A nurse is caring for a client who has neutropenia. Which of the following findings
indicates a need for intervention?
The client's grandchild is visiting and telling the client about the first day of
kindergarten.
The client has a grilled ham and cheese sandwich, a banana, and yogurt on their lunch
tray.
The client's family brings in a silk flower arrangement.
The client's assistive personnel places paper cups and plastic utensils in the client's
room.
Rationale: The nurse should limit the client's visitors to healthy adults. A visit from a child who is
attending school can place the client at risk for infection due to the client's immunity.

A nurse is performing a breast examination on a female client who is pregnant. Which of

the following findings should the nurse report to the provider?
Slight asymmetrical breast size
Breast tissue with an orange-peel appearance
Nipple inversion of one breast since puberty
Elevated Montgomery's glands unocompromised status.

A nurse is caring for a client who reports a skin change. Which of the following findings
should the nurse report to the provider?
An asymmetrical papule that is pigmented-----> indication of malignant melanoma
A patch of silvery-white scales with a red epidermal base
A collection of irregular, dry papules that are black
An elevated red lesion that arises from a scar
A nurse is educating a client who is scheduled for a kidney transplant. Which of the
following information about hyperacute rejection should the nurse include in the
teaching?
Hyperacute rejection can occur during the first few weeks after the transplant.
If hyperacute rejection occurs, the kidney can become enlarged.
The organ will need to be removed if hyperacute rejection occurs.
Immunosuppressive therapy is given to reverse hyperacute rejection
A nurse is planning an education program about testicular cancer for a group of male
adolescents. Which of the following information should the nurse include?
Testicular cancer is more common in males who are older than 65.
With early treatment, the survival rate is 50%.
Examine the testicles immediately after showering.
Schedule an annual ultrasound to screen for testicular cancer.
A nurse is planning an education program for a group of high school teachers who will be
taking students on a hike. Which of the following information should the nurse include
regarding Lyme disease?
"If bitten by a tick, you should be tested immediately."
"If you have a tick embedded in your skin, apply a lit match to remove it."
"You should wear dark-colored clothing to deter ticks from biting."
"If you develop pain and stiffness in your joints, you should see your doctor."
A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the
following findings should the nurse expect? (Select all that apply.)
Subcutaneous nodules
Decreased urine output
Renal calculi
Butterfly rash
Joint inflammation
A nurse in an emergency department is assessing a newly admitted client. Which of the
following actions places the client at increased risk for contracting hepatitis B?
Residing in an institutional setting
Engaging in unprotected sexual intercourse
Working with hazardous chemical waste materials
Traveling to a foreign country
A nurse is assessing a client who has a new prescription for clindamycin to treat acute
pelvic inflammatory disease. The nurse should report which of the following findings to
the provider immediately?
Watery diarrhea
Vaginitis
Furry tongue
Nausea and vomiting
Rationale: The greatest risk to this client is pseudomembranous colitis, which is manifested by
watery diarrhea. Therefore, the priority finding is diarrhea. The nurse should report this finding
to the provider immediately and discontinue the medication.

A nurse is assessing a client who has HIV. Which of the following findings should cause
the nurse to suspect that the client's diagnosis has progressed to AIDS?
Small, purple-colored skin lesions
Fever and diarrhea lasting longer than 1 month
Persistent, generalized lymphadenopathy
 CD4-T-cells decreased to 750 cells/mm3
A nurse is providing teaching to a group of clients regarding skin cancer prevention.
Which of the following risk factors should the nurse include in the teaching?
Light skin pigmentation
Psoriasis
History of frostbite
Immunodeficiency disorder
A nurse is providing teaching to a client who has rheumatoid arthritis and a new
prescription for methotrexate. Which of the following client statements indicates an
understanding of the teaching?
"I will avoid being in large crowds while taking this medication."
"I should expect symptoms to subside in 1 to 2 weeks after starting this medication."
"I will increase my intake of vitamin D while taking this medication."
"I should expect to experience constipation while taking this medication."
A nurse is providing teaching to a client who has Hodgkin's lymphoma and is undergoing
external radiation treatment. Which of the following instructions should the nurse
include?
Use an antibacterial soap to cleanse the skin.
Wash the ink marking off when showering.
Rub the skin with a towel when drying.
Avoid direct sun exposure to the skin.
A nurse is providing teaching to a client who has an allergy to peanuts. Which of the
following instructions is the priority to include in the teaching?
Inform other health care professionals of the allergy.
Wear a medical identification tag.
Carry an emergency anaphylaxis kit.
Keep a food diary.
A nurse is providing teaching to a client who has rheumatoid arthritis and reports
persistent pain. Which of the following responses should the nurse make?
"Take a cool bath in the evening."
"Exercise every other day."
"Use pillows to support your joints while in bed."
"Ask a friend or a family member to help with household chores."-----> pt need to rest
A nurse is caring for a client who is admitted with enlarged lymph nodes and a fever. To
confirm a diagnosis of bacterial pharyngitis, the nurse should anticipate which of the
following diagnostic tests?
Indirect laryngoscopy
Chest x-ray
Throat culture
Monospot test
A nurse is planning discharge teaching for a client who is receiving chemotherapy and
has bone marrow suppression. Which of the following instructions should the nurse plan
to include in the teaching?
"Take aspirin for minor aches and pains."
"Clean your toothbrush with warm water weekly."
"Bathe with an antimicrobial soap twice per day."
"Wear clothing that will minimize sun exposure."