WorksheetsChapters 18-19
Total questions: 55
Worksheet time: 2hrs 50mins
1. Which physiological barriers protect the patient’s body against microorganisms?
1) A surgical incision
2) Occasional smoking
3) Alcoholic beverages
4) Adequate urinary output
2. A nurse working in the emergency department (ED) is providing care for a group of patients. Which patient demonstrates a decline in immune response that typically occurs with the aging process?
1) An 88-year-old with pneumonia who has a temperature of 99.5°F.
2) A 56-year-old who has 8 mm induration at the site of a PPD skin test 72 hours earlier.
3) A 58-year-old who reports redness and itching due to a rash from contact with poison ivy.
4) A 70-year-old who has swelling and redness at the incision from an open appendectomy.
3. The nurse is providing care to a patient who has an increased number of lymphocytes. Which explanation should the nurse provide to the patient regarding this abnormality?
1) “An elevated neutrophil count indicates your body is battling a parasitic infection.”
2) “An elevated neutrophil count indicates your body is battling a bacterial infection.
3) “An elevated neutrophil count indicates your body is experiencing an allergic reaction.”
4) “An elevated neutrophil count indicates your body is experiencing an adaptive immune response.”
4. Which scenario should the nurse provide as one in which active immunity is acquired when educating a group within the community?
1) Having measles as a child
2) Receiving an injection of gamma globulin
3) Becoming ill with tetanus and receiving tetanus toxoid
4) Receiving a rabies shot after being bitten by a rabid dog
5. The nurse is providing care to a patient with a compromised immune system. Which independent nursing intervention is appropriate for the nurse to include in the patient’s plan of care?
1) Recommending gene transfer therapy
2) Administering corticosteroids, per order
3) Prescribing prophylactic antibiotic therapy
4) Educating on the importance of a nutritious diet
6. A nurse is caring for a patient with who is experiencing leukocytosis. When providing care to this patient, which action by the nurse is the most appropriate?
1) Assess for source of infection
2) Assess for bleeding and bruising
3) Place the patient in reverse isolation precautions
4) Instruct the patient on the use of an electric razor and soft toothbrush
7. Which question should the nurse to ask during a health history with an adolescent patient, accompanied by a parent, to determine immune status?
1) “Is your child sexually active?”
2) “Is your child planning to go to college?”
3) “Does your child smoke tobacco products?”
4) “Are your child’s immunizations up-to-date?”
8. Which nursing action is appropriate when assessing a patient’s tonsils during a physical examination?
1) Asking the patient to cough several times
2) Asking the patient to open the mouth and say “ah”
3) Palpating the soft tissue of the face near the patient’s nose
4) Palpating the left upper quadrant of the patient’s abdomen
9. Which type of immunoglobulin (Ig) is produced during an allergic reaction?
1) IgA
2) IgD
3) IgE
4) IgM
10. Which nutritional deficiency often impacts a patient’s ability to mount an immune response?
1) Proteins
2) Calcium
3) Potassium
4) Carbohydrates
11. The nurse is providing care to a patient who experienced an allergic reaction. Which leukocyte does the nurse anticipate will be elevated?
1) Basophils
2) Monocytes
3) Eosinophils
4) Neutrophils
12. The nurse is teaching a new mother the immune benefits of breastfeeding her newborn. Which immunoglobulin (Ig) should the nurse include as one that is passed from mother to newborn by breast milk?
1) IgA
2) IgD
3) IgE
4) IgG
1/2 way done!!
13. The nurse is providing care to a patient who has a decreased neutrophil count and elevated hepatic enzymes. Which data in the patient’s health history supports this laboratory data indicating an increased risk for infection?
1) Anorexia nervosa
2) Acute renal failure
3) Pulmonary disease
4) Cirrhosis of the liver
14. The nurse is providing care to patient who is at an increased risk for infection due to poor dietary intake, a decreased white blood cell count, and diminished neutrophil activity. Which information in the patient’s health history supports the current data?
1) Anorexia nervosa
2) Acute renal failure
3) Pulmonary disease
4) Cirrhosis of the liver
15. The nurse is providing care to a patient who had the spleen removed after a car accident. Which type of infection is this patient at an increased risk for experiencing?
1) Viral
2) Fungal
3) Parasitic
4) Bacterial
16. Which laboratory test should the nurse anticipate for a patient who reports chronic inflammation?
1) Varicella titer
2) Type and crossmatch
3) Erythrocyte sedimentation rate (ESR)
4) Complete blood count (CBC), with differential
17. The nurse is teaching a group of patients about first-line defense against infection. Which patient statement indicates the need for further education?
1) “The skin is a first-line defense against infection.”
2) “A sneeze is a mechanical first-line defense against infection.”
3) “My saliva is a biochemical first-line defense against infection.”
4) “A cut with pus is a mechanical first-line defense against infection.”
18. The nurse is conducting a health history for a patient who is at risk for infection. Which question is appropriate when collecting data related to the current problem?
1) “Do you smoke cigarettes?”
2) “Are your immunizations current and up-to-date?”
3) “What type of reaction do you have with an allergy flair?”
4) “Did you have your spleen removed after your car accident?”
20. The nurse is conducting a health history for a patient who is at risk for infection. Which question is appropriate when collecting data related to the patient’s past medical history?
1) “Do you smoke cigarettes?”
2) “Are your immunizations current and up-to-date?”
” 3) “What type of reaction do you have with an allergy flair?”
4) “Did you have your spleen removed after your car accident?”
21. A patient receives the yellow fever vaccine before traveling to the Amazon Basin and asks the nurse how the vaccine provides protection. Which responses by the nurse is the most appropriate? Select all that apply.
1) “The body's immune system eats away at the protective sheath that covers the nerves.”
2) “A response from yellow fever-specific T cells is activated. B cells secrete yellow fever antibodies.”
3) “In the lymph nodes, part of the lymphoid system, the macrophages present yellow fever antigens to T cells and B cells.”
4) “The initial weak infection is eliminated and the patient is left with a supply of memory T and B cells for future protection against yellow fever.”
5) “Human macrophages engulf the weakened vaccine virus as if it is dangerous and antigens stimulate the immune system to attack it.”
22. The nurse is conducting a physical assessment for a patient with a compromised immune system. Which actions by the nurse are appropriate? Select all that apply.
1) Assessing general appearance
2) Recommending increased fluid intake
3) Checking joint range of motion (ROM), including that of the spine
4) Inspecting the mucous membranes of the nose and mouth for color and condition
5) Palpating the cervical lymph nodes for evidence of lymphadenopathy or tenderness
23. Which locations should the nurse include when discussing the storage and production of lymphocytes during an education session for novice nurses? Select all that apply.
1) Liver
2) Spleen
3) Thymus
4) Lymph nodes
5) Bone marrow
24. The nurse is assessing a patient’s immune system. Which findings increase the patient’s risk for infection due to alterations in biochemical barriers? Select all that apply.
1) Dysphagia
2) Dry mouth
3) Nonintact skin
4) Urinary retention
5) Clogged tear duct
25. The nurse is assessing a patient’s immune system. Which findings increase the patient’s risk for infection due to alterations in mechanical barriers? Select all that apply.
1) Dysphagia
2) Dry mouth
3) Nonintact skin
4) Urinary retention
5) Clogged tear duct
PART 2
1. A patient recently diagnosed with rheumatoid arthritis (RA) asks the nurse if the disease is caused by ethnicity. Which response by the nurse is the most appropriate?
1) “RA affects all races at the same rate.”
2) “RA is most prevalent in Caucasian females.”
3) “RA affects those of German descent most often.”
4) “RA is most prevalent in men under the age of 20 years.”
2. The nurse is collecting a health history for a patient in an outpatient clinic who reports joint pain and swelling for the last two months. The patient is diagnosed with rheumatoid arthritis (RA). When planning care for this patient, which statement supports the nursing diagnosis of Activity Intolerance?
1) “I seem to get tired early in the day and require a nap.”
2) “My joints are stiffest at night before I go to sleep.”
3) “I find it difficult to move when I first get up in the morning.”
4) “I take ibuprofen for the pain as needed.”
___ 3. The nurse is completing a health screening for a school-age child with rheumatoid arthritis (RA). The parents ask the nurse to recommend activities that will promote exercise for their child. Which recommendation by the nurse is the most appropriate?
1) Running
2) Softball
3) Football
4) Swimming
4. A patient with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress check-up. The nurse is reviewing the patient’s plan of care and determines that the patient has met a goal of treatment when the patient makes which statement?
1) “I sleep for 10 hours at night.”
2) “I have increased pain in my joints all the time now.”
3) “I have delegated many household chores to my children and spouse.”
4) “I do not perform household chores at all anymore.”
5. The nurse is caring for a patient who was diagnosed with rheumatoid arthritis (RA) last year. The patient has recently been placed on prednisone for treatment. Which patient statement indicates that the medication teaching was successful?
1) “I will not have to limit my consumption of canned vegetables.”
2) “I will take this medication on a full stomach to enhance absorption.”
3) “I will not need to monitor my blood sugar more frequently while on this medication.”
4) “I will take the ordered dose at the same time every day.”
6. A nurse is caring for a pregnant patient who has rheumatoid arthritis (RA). Based on this data, which does the nurse anticipate when providing care to this patient?
1) A higher risk for preterm delivery
2) An increased need for medication
3) An acute exacerbation of symptoms
4) A continued risk for anemia
7. A nurse is caring for a patient who is newly diagnosed with rheumatoid arthritis (RA). The patient asks the nurse what the difference is between RA and osteoarthritis (OA). Which response by the nurse is most appropriate?
1) “The onset of OA is gradual while the onset of RA may be rapid.”
2) “With OA, multiple joints are symmetrically affected; RA affects one joint at a time.”
3) “The affected joints in RA feel cold to the touch while the joints affected by OA are warm or hot to the touch.”
4) “The pain and stiffness with RA is with activity; OA pain and stiffness is predominant upon arising.”
8. The patient enters the outpatient clinic and states to the triage nurse, “I think I have the flu. I'm so tired, I have no appetite, and everything hurts.” The triage nurse assesses the patient and finds a butterfly rash over the bridge of nose and on the cheeks. Based on this data, which diagnosis does the nurse anticipate?
1) Gout
2) Lyme disease
3) Fibromyalgia
4) Systemic lupus erythematosus
9. A patient asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which response by the nurse is the most appropriate?
1) “Conditions causing hypotension can often exacerbate SLE.”
2) “GI upset is often associated with SLE exacerbation.
3) “Pregnancy is often associated with an SLE exacerbation.”
4) “Fever is a known trigger for an SLE exacerbation.”
10. The nurse is providing health education to a diverse group at a neighborhood community center. Why does the nurse plan to include signs and symptoms of systemic lupus erythematosus (SLE)?
1) The neighborhood is composed of many young female children.
2) The audience has asked the nurse to include the information.
. 3) The audience is mainly composed of Caucasian women.
4) The audience is mainly females of Asian-American descent.
11. The nurse is caring for a patient who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the patient’s lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which is a priority nursing diagnosis for this patient?
1) Risk for Infection
2) Ineffective Individual Coping
3) Risk for Impaired Skin Integrity
4) Ineffective Health Maintenance
12. A patient with systemic lupus erythematosus (SLE) is being treated with immunosuppressant drugs and corticosteroids. Which patient statement indicates the need for further education after teaching?
1) “I can go to events with large crowds.”
2) “I should avoid getting the flu shot.”
3) “I will use contraception to avoid pregnancy.”
4) “I will report any symptoms of infection immediately.”
13. A nurse is caring for a patient with systemic lupus erythematosus (SLE). The patient begins to cry stating, “I am afraid I will be disfigured because of all of these lesions.” Which intervention does the nurse plan to teach this patient to minimize skin infections associated with SLE?
1) Use sunscreen with an SPF of 15 or greater
2) Remain indoors on sunny days
3) Avoid swimming in a pool or the ocean
4) Decrease sun exposure between 3:00 p.m. and 5:00 p.m.
14. The nurse is caring for a patient diagnosed with discoid lupus erythematosus. The nurse is collaborating with the patient to set goals for the nursing plan of care. Which is an appropriate goal for this patient?
1) Work through the stages of death and dying
2) Compliance with a sun protection plan
3) Gain weight to within 10 pounds of normal for height
4) Report pain no higher than 4 on a scale of 1-10
15. The nurse is planning care for an adolescent patient who has systemic lupus erythematosus (SLE). Which action by the patient indicates the implemented plan of care is appropriate?
1) Refusing to attend school
2) Discussing skin changes with a good friend
3) Refraining from attending any social functions
4) Discussing skin changes with the health-care provider
16. The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which patient statement indicates an appropriate understanding of the plan of care?
1) “I will take birth control pills while I am taking cytotoxic medications.”
2) “I do not need to contact the doctor if I develop a fever or rash.”
3) “I plan to go to the movies this weekend so that I get out of the house.”
4) “I can take aspirin as indicated for pain.
17. A nurse is caring for a patient with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). When providing care for this patient, the nurse monitors for which adverse effect associated with the prescribed medication?
1) Renal toxicity
2) Retinal toxicity
3) Cushingoid effects
4) Pulmonary fibrosis
18. An Asian male accompanies his spouse to the clinic and states, “I want you to fix my wife and tell her that there is nothing wrong with her.” The patient reports pain, sleep disorders, and stiffness. Which would be most appropriate for the nurse to include in a plan of care for this family?
1) Medications used to treat fibromyalgia
2) An exercise program to increase energy
3) Information and literature on fibromyalgia
4) Suggested dietary changes to help with the pain
19. The nurse identifies the nursing diagnosis of chronic pain as being appropriate for a patient with fibromyalgia. Which manifestation did the patient most likely report that caused the nurse to select this diagnosis?
1) Acute chest pain
2) Pain from eyestrain
3) Tender points in the knees
4) Pain from a severe skin rash
20. An adult patient is diagnosed with fibromyalgia. The patient asks the nurse whether a recent of infection with the Coxsackie B virus could have caused fibromyalgia. Which response by the nurse is the most appropriate?20. An adult patient is diagnosed with fibromyalgia. The patient asks the nurse whether a recent of infection with the Coxsackie B virus could have caused fibromyalgia. Which response by the nurse is the most appropriate?
1) “The Coxsackie B virus has nothing to do with fibromyalgia.”
2) “The Coxsackie B virus may have triggered the fibromyalgia.”
3) “The Coxsackie virus definitely caused the fibromyalgia.”
4) “Fibromyalgia is a psychiatric disorder.”
21. The nurse is counseling an adult patient with fibromyalgia. What are some elements of counseling that can help this patient develop effective coping skills?
1) Remind the patient that the patient has a progressive disease.
2) Suggest to the patient that some symptoms may be psychosomatic.
3) Inform the patient that the patient does not need to see a specialist.
4) Teach the patient strategies including distractions, relaxation techniques, or journaling.
22. The mother of three teenagers is diagnosed with fibromyalgia and asks the nurse how to keep up with all of the children's activities. Which suggestion by the nurse is the most appropriate?
1) Ask the children to limit their activities.
2) Attempt to attend the all the functions of the children.
3) Avoid attending any afterschool functions for the children.
4) Negotiate with the children to alternate attending their functions.
23. The nurse is discussing goals to relieve pain and fatigue with a patient newly diagnosed with fibromyalgia. Which goal statement would be realistic for this patient to achieve within 30 days?
1) Join an exercise group
2) Get a job outside the home
3) Walk her son to school daily
4) Cook dinner five nights a week
24. During a home visit, the family of a patient with fibromyalgia asks the nurse what they can do to help the patient with painful episodes. What should the nurse suggest to the patient and family?
1) Plan a family reunion
2) Keep the patient in bed
3) Protect the patient from injury
4) Divide household chores among each member of the family
25. The nurse is caring for a patient who has recently been diagnosed with fibromyalgia. Which medications does the nurse anticipate will be prescribed as part of the patient’s treatment plan? Select all that apply.
1) Ibuprofen
2) Aerobic exercise
3) Pregabalin (Lyrica)
4) Zolpidem (Ambien)
5) Tenormin (Atenolol)
26. The nurse is providing care to a patient who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis. When providing care to this patient, which actions by the nurse are appropriate? Select all that apply.
1) Assessing for an allergic reaction
2) Monitoring for signs of renal problems
3) Advising against abrupt discontinuation of drugs
4) Assuring the patient that there is no relationship between NSAIDs and heart disease
5) Encouraging the patient to take with water, milk, or small snack to help avoid stomach distress
27. A patient, recently diagnosed with rheumatoid arthritis (RA), asks the nurse whether RA will affect her in other ways. When responding to the patient, which systems will the nurse include as possibly being affected by the diagnosis? Select all that apply.
1) Exocrine
2) Respiratory
3) Hematologic
4) Reproductive
5) Cardiovascular
28. A patient recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. Which teaching topics will the nurse include as ways to decrease the likelihood of crippling deformities? Select all that apply.
1) Ignore pain as a warning signal
2) Use stronger joints for most activity
3) Avoid stress to any current area of deformity
4) Type instead of handwriting items if possible
5) Stop an activity if it is beyond your ability to perform
29. Which information should the nurse include when teaching a patient information regarding limited systemic scleroderma? Select all that apply.
1) A rapid onset is anticipated.
2) An insidious onset is anticipated.
3) Affects internal organs several years prior to onset
4) Can be preceded by a diagnosis of Raynaud’s phenomenon
5) Skin of extremities distal to the elbows and knees are affected
30. Which subjective findings should the nurse anticipate when assessing a patient diagnosed with gout? Select all that apply
1) Presence of tophi
2) Tenderness on palpation
3) Reports of severe pain in the great toe
4) Patient states, “I cannot move my joint.”
5) Soft tissue swelling accompanied by warmth
19. The nurse is conducting a health history for a patient who is at risk for infection. Which question is appropriate when collecting data related to the patient’s social history?
1) “Do you smoke cigarettes?”
2) “Are your immunizations current and up-to-date?”
3) “What type of reaction do you have with an allergy flair?”
4) “Did you have your spleen removed after your car accident?”
