NUR 265 EXAM 4 STUDY GUIDE QUESTIONS AND ANSWERS GRADED A
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NUR 265
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NUR 265
Lupus: Hallmark sign -Answer- butterfly rash on face
Lupus: Indication of flare -Answer- Fever and fatigue
*also assess BUN function
*c reactive protein remains normal
Lupus: Interventions -Answer- -Falls precautions
-treat pain with tylenol and NSAIDS (monitor kidney function)
-AVOID ...
NUR 265 EXAM 4 STUDY GUIDE QUESTIONS
AND ANSWERS GRADED A 2024-2025
Lupus: Hallmark sign -Answer- ✔butterfly rash on face
Lupus: Indication of flare -Answer- ✔Fever and fatigue
*also assess BUN function
*c reactive protein remains normal
Lupus: Interventions -Answer- ✔-Falls precautions
-treat pain with tylenol and NSAIDS (monitor kidney function)
-AVOID SUNLIGHT
-REPORT FLARE IMMEDIATELY
-clean skin with mild soap and pat dry and apply lotion
Lupus: medical management -Answer- ✔-hydroxychloroquine(anti-malarial) decreases
absorption of UV light
Scleroderma: Interventions -Answer- ✔aspiration precautions (keep HOB at 60 degrees
during meals and after)
skin protection measures
small frequent meals--avoid caffeine and alcohol
-avoid spices, caffeine and pepper
Lyme Disease: Assess -Answer- ✔Skin
history of tick bites
Lyme Disease: Interventions -Answer- ✔prevention!
Insect repellant with DEET
early stage--doxycycline antibiotics ORAL
late stage--Iv antibiotics (ceftriaxone)
avoid tall grass
wear light colored clothing
have pets wear tick collars
Allergic Reaction Priority -Answer- ✔STOP THE INFUSION/ELIMINATE the trigger,
then STOP the immune response
Give Epi
maintain airway
Latex allergy: risks -Answer- ✔-frequent use of latex condoms
-healthcare workers
-allergy to avocados, bananas, and some nuts
Anaphylactic shock -Answer- ✔AIRWAY--give epi IV or IM STAT and intubate if needed
BREATHING--apply O2; mechanically ventilate
CIRCULATION--monitor for distributive shock; give fluids
Epinephrine Auto-injector teaching -Answer- ✔always carry 2 devices
inject by "stabbing" into top of thigh with pants on (AVOID pockets)
call 911 immediately--patient still needs to be monitored
keep epi in cool dark place.
NUR 265 Exam 4
, NUR 265 Exam 4
Immunocompromised Patient -Answer- ✔-Do not drink anything that has been sitting
out
-take temp at least once per day
-clean toothbrush once weekly in diswasher or bleach solution
-do not eat raw foods; salad, cottage cheese
-do not scoop litter boxes
-no plants or soil exposure
-antibacterial soap
-AVOID reptiles
HIV: Assess -Answer- ✔CD4 count
ELISA test once per year for at risk patients
HIV: Interventions -Answer- ✔PREVENTION:
-condoms
-PreP (truvada) must take 4 consecutive days in a row before protected; cant miss more
than one dose in a row
-needle safety
-post exposure prophylaxis-start cART within 24-36 hours of exposure
HIV: Nutrition -Answer- ✔high calorie
high protein
low fat
small frequent meals
thrush--treat with anitfungal
HIV tx: HAART/cART -Answer- ✔DOES NOT CURE
Does not prevent secondary/opportunistic infections
MUST TAKE 90% of the time --otherwise resistance will occur
HIV: complications --- AIDS -Answer- ✔CD4 count less than 200mmhg
most likely to experience opportunistic infections
--I.e Pneumocystic jiroveci pneumonia (ASSESS AIRWAY!!)
consult pallative care/hospice
candida albicans -Answer- ✔-Hallmark sign-- white patches in the mouth
-"food doesnt taste right"
-If patient wants a coke they can have it! They just have to rinse mouth out with water
(fungus loves sugar)
tuberculosis -Answer- ✔hallmark sign-- night sweats, high fever, cough
-airborne isolation
-do not trust TB skin test in client with HIV
Fungal pneumonia -Answer- ✔ABC's
NUR 265 Exam 4
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