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Medical Surgical Nursing 3rd Edition White Duncan Baumle Test Bank

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Medical Surgical Nursing 3rd Edition White Duncan Baumle Test Bank

ISBN-13: 978-1435488021

ISBN-10: 1435488024

 

 

Description

Medical Surgical Nursing 3rd Edition White Duncan Baumle Test Bank

ISBN-13: 978-1435488021

ISBN-10: 1435488024

 

 

 

 

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Free Nursing Test Questions:

Chapter 54—Caring for Clients with Hypersensitive Immune Response

 

MULTIPLE CHOICE

 

  1. After petting a neighbor’s cat, a client called the nurse’s advice line to report an itchy, raised red rash on her skin. This is called:
a. angioedema c. tissue necrosis
b. urticaria d. vasodilation

 

 

ANS:  B

Urticaria (hives) are raised pruritic, red, nontender wheals on the skin. They are usually on the trunk and on the areas of the extremities closest to the trunk.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

  1. A client has been cleaning window screens for the past 2 days and has now developed sneezing, thin, watery nasal discharge, and redness and itching of the eyes. Which type of allergic reaction should the nurse suspect?
a. allergic rhinitis c. animal dander hypersensitivity
b. anaphylaxis d. contact dermatitis

 

 

ANS:  A

Allergic rhinitis (hay fever) causes nasal congestion, sneezing, itching, and headache.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

  1. The nurse is caring for a client who is having an anaphylactic reaction. Which of these medications does the nurse know is usually administered FIRST to a client who has an anaphylactic reaction?
a. aminophylline c. dopamine hydrochloride
b. ampicillin d. epinephrine

 

 

ANS:  D

Medical management of clients who have anaphylactic reactions involves life-supporting treatment measures (e.g., maintaining airway and administering intravenous fluids and medications such as epinephrine, antihistamines, vasopressors, and bronchodilators).

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. The nurse is caring for a client who just had an intravenous pyelogram (IVP). The client suddenly develops severe urticaria, angioedema, dyspnea, and cyanosis. Which of these actions should the nurse take first?
a. Administer epinephrine subcutaneously.
b. Maintain the airway and administer oxygen via mask.
c. Notify the health care provider for medication orders.
d. Start an IV line of D5W.

 

 

ANS:  A

Anaphylaxis is a potentially life-threatening type I systemic reaction to allergens. Clients who are extremely sensitive to a particular allergen (e.g., shellfish, chocolate, antibiotics) suddenly develop symptoms such as flushing, nasal and throat congestion, and severe dyspnea, which can lead to respiratory failure, severe hypotension, and death. Medical management of clients who have anaphylactic reactions involves life-supporting treatment measures. Administering epinephrine subcutaneously will decrease the client’s response and open the airway.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. A client who has previously required blood transfusions is admitted for another transfusion. Four hours after a unit of blood infuses, the client develops fever, chills, nausea, and headache. The nurse should suspect the client is experiencing which type of transfusion reaction?
a. acute hemolytic c. delayed hemolytic
b. allergic urticarial d. febrile nonhemolytic

 

 

ANS:  D

Reactions can be classified as febrile nonhemolytic, allergic urticarial, delayed hemolytic, acute hemolytic, or anaphylactic. The most common is the febrile nonhemolytic reaction, which occurs in people who have had previous blood transfusions; symptoms include fever, chills, nausea, headache, hypotension, and respiratory problems.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. The client who is suspected of having an acute hemolytic transfusion reaction would receive all of the following emergency treatments. Which one should the nurse initiated FIRST?
a. Start an IV of normal saline.
b. Administer emergency drugs intravenously as ordered.
c. Maintain an airway.
d. Stop the transfusion.

 

 

ANS:  D

Delayed hemolytic reactions are usually undetected and untreated. Emergency treatment is initiated for acute hemolytic and anaphylactic reactions. Nursing care includes carefully assessing baseline information, such as vital signs prior to transfusion, and checking the client’s type and crossmatch information and that of the scheduled transfusion product with another nurse. The nurse also monitors the client for any signs of transfusion reaction and stops the transfusion if a reaction occurs.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. In addition to careful observation for signs of rejection, which of these nursing interventions is appropriate for clients who have undergone a heart transplant?
a. weighing the client weekly
b. supporting frequent visits from family members
c. encouraging intake of fresh fruits and vegetables
d. placing the client in reverse isolation

 

 

ANS:  D

Nursing care of clients who undergo organ transplant focuses on assisting the client and family to deal with concerns about the procedure and monitoring client status (e.g., vital signs, nutritional status, mental status, and fluid balance) following the transplant. Clients must also be instructed about symptoms of rejection and the importance of preventing infection, including the use of reverse isolation techniques.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. The nurse is caring for a client who is taking immunosuppressive medications. The nurse recognized that this client is especially prone to which of the following adverse reactions?
a. developing infection c. hypotension
b. elevated glucose levels d. muscle wasting

 

 

ANS:  A

The immunosuppressive medications’ mechanism of action results in the suppression of the body’s immune response. This action places the client at greater risk for the development of infections.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. The nurse is teaching a client who had a liver transplant to observe for signs of rejection. The client’s understanding is verified when what sign is listed?
a. nausea and vomiting c. fever
b. altered mental status d. weight loss

 

 

ANS:  C

Manifestations of rejection include fever, weight gain, and edema or tenderness at the transplant site and symptoms of liver failure.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. A coworker who has just completed an aseptic client procedure is now flushed and wheezing and complains of chest tightness and shortness of breath. Vital signs are heart rate 76, respiratory rate 24, and blood pressure 86/67. The nurse should suspect the coworker is experiencing which of the following?
a. anaphylactic shock
b. hypersensitivity to the antiseptic used in the procedure
c. hypoglycemic shock
d. latex allergy

 

 

ANS:  D

The coworker is experiencing a potentially life-threatening type I systemic reaction to latex allergens. Clients who are extremely sensitive to a particular allergen suddenly develop symptoms such as flushing, nasal and throat congestion, and severe dyspnea, which can lead to respiratory failure, severe hypotension, and death.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

  1. A client was prescribed Penicillin for a respiratory infection.  After taking the second dose, the client developed a bright, red itchy rash on his trunk.  A drug reaction is which type of hypersensitivity?
a. Type I c. Type III
b. Type II d. Type IV

 

 

ANS:  A

Drug and food allergies are also Type I hypersensitivity. Any drug potentially may cause a drug reaction, but common ones include penicillin, cephalosporins, codeine, pain medications, vaccines, and local anesthetics. Reactions vary from mild to severe. Usually, symptoms do not occur until the client has taken several doses of the medication, although they can occur at first exposure. The most common reaction is the sudden development of a bright red, itchy rash, often appearing initially on the trunk or arms. Occasionally, a client may develop an anaphylactic reaction.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

  1. The symptoms of anaphylaxis most often occur in which time timeframe?
a. generally within 72 hours
b. > 72 hours after exposure
c. suddenly, quickly progressing to severe
d. delayed, up to one week

 

 

ANS:  C

Anaphylaxis is a type I systemic reaction to allergens and is the most serious type of allergic reaction. It occurs in individuals who are extremely sensitive to an allergen. Symptoms develop suddenly and can progress to severe levels within minutes. Usually, the faster the reaction, the worse it is. Foods, drugs, hormones, insect bites, blood, and vaccines all are associated with anaphylactic reactions. Shellfish, eggs, nuts, berries, and chocolates are the most common foods involved.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

  1. What area the leading causes of anaphylaxis in the United States?
a. insect bites c. eggs
b. shellfish d. peanuts and tree nuts

 

 

ANS:  D

Peanut and tree nut allergies are the leading causes of anaphylaxis in the United States.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

  1. The physician has asked the nurse to educate a client with a severe allergy to beestings. Which of the following should the nurse be sure to include in the teaching plan?
a. take Benadryl prior to going out c. carry an Epi-pen at all times
b. wear long sleeves and pants d. know the distance to the local ER

 

 

ANS:  C

In conducting client teaching about severe allergies, the nurse should advise clients with severe allergies to wear a Medic Alert tag and to encourage clients who are allergic to insect stings to carry an emergency anaphylactic kit containing epinephrine at all times.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. The reason Epinephrine is administered subcutaneously to a client experiencing an anaphylactic reaction is to:
a. increase the histamine response c. decrease heart contractions
b. dilate the bronchioles d. relax the blood vessels

 

 

ANS:  B

Epinephrine is administered subcutaneously as soon as symptoms develop to dilate bronchioles, increase heart contractions, and constrict blood vessels.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. What is contraindicated in a client experiencing an allergic urticarial transfusion reaction?
a. feeding the client c. bedrest
b. IV fluids d. Benadryl

 

 

ANS:  A

If a febrile nonhemolytic or allergic urticarial reaction occurs, diphenhydramine hydrochloride (Benadryl) and a corticosteroid (hydrocortisone or prednisone) are administered to counteract the immunological response. Antipyretics are ordered to control fever. For life-threatening conditions, emergency medications are employed. Clients should not be fed if a reaction is occurring, especially if respiratory symptoms have developed, because aspiration could occur.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. Post transplant a client is required to take immunosupressive medications. These medications make the client prone to the development of infections and what other condition?
a. arthritis c. cancers
b. autoimmune disorders d. neuromuscular disorders

 

 

ANS:  C

Immunosuppressive medications make the client prone to the development of infections and cancers. Clients must have a regular medical checkup, including cancer screening tests.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. A client has just received a new liver. What type of precautions are taken with this client?
a. standard precautions c. reverse isolation
b. negative pressure room d. complete isolation

 

 

ANS:  C

Clients who receive a major organ, such as a heart, lung, pancreas, or liver, are placed in reverse isolation in the hospital setting for at least 2 weeks. They are carefully observed for signs of rejection. Exposure to others is limited. Before discharge, they are taught to avoid contact with anyone who may have an infection and to wear a mask whenever out in public.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. Which is the client most at risk for developing a latex allergy?
a. elderly female with frequent hospitalizations
b. child with spina bifida
c. client undergoing first operative procedure
d. client allergic to environmental allergens

 

 

ANS:  B

Up to 68 % of children with spina bifida, or clients who need multiple surgeries, have a risk of developing allergies to latex (American Latex Allergy Association, 2010). These clients need to avoid exposure to latex products such as gloves, band-aids, rubber bands, condoms, and latex birthday balloons.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. Which nursing diagnosis applies to the client post heart transplant and the need to learn about the signs and symptom of organ rejection?
a. Fear c. Risk for Infection
b. Deficient Knowledge d. Ineffective Breathing

 

 

ANS:  B

Deficient Knowledge related to home care following transplantation is the appropriate diagnosis. The client will discuss signs and symptoms of rejection. The client will demonstrate an understanding of the side effects of immunosuppressive drugs and lifestyle changes to adapt to their effects. Teach client and family about signs of rejection and infection as well as the ramifications of taking immunosuppressive medications. Teach client to watch for side effects and report them to physician.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

MULTIPLE RESPONSE

 

  1. Which interventions would apply when caring for a client at high risk for an allergic response to a latex allergy? (Select all that apply.)
a. Use nonlatex gloves.
b. Keep a latex-free supply cart available for the client’s use.
c. Only use a blood pressure cuff from an electronic device to measure the blood pressure.
d. Use medications from glass ampoules.
e. Do not puncture rubber stoppers with needles.

 

 

ANS:  A, B, D, E

All equipment and items that enter the client’s room should be latex-free. Blood pressure cuffs, unless specifically latex free, use a bladder made of latex despite the type of device.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

  1. Symptoms of which body systems can be involved with an anaphylactic reaction? (Select all that apply.)
a. gastrointestinal d. male and female reproductive
b. cardiovascular e. respiratory
c. integumentary f. neurological

 

 

ANS:  A, B, C, E

Symptoms involve the skin, GI tract, and cardiovascular and respiratory systems. Clients experience peripheral tingling, flushing, fullness in the mouth, throat/nasal congestion, tearing and swelling around the eyes, itching, cough, laryngeal edema, bronchospasms, severe dyspnea, vasodilation, and cyanosis. If untreated, these catastrophic effects lead to respiratory failure, severe hypotension, anaphylactic shock, and death.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

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