RN exams medical-surgical practice questions set 15

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The correct answer is B: Fighting cancer by targeting abnormal cells. The immune system plays a crucial role in cancer by identifying and eliminating abnormal cells that can develop into tumors. This process is known as immunosurveillance. Through mechanisms like T cells and natural killer cells, the immune system can detect and destroy cancerous cells before they can grow and spread. This function is essential in preventing the development and progression of cancer. Choices A, C, and D are incorrect: A: Promoting cell growth - The immune system does not promote cell growth in cancer; rather, it regulates and suppresses the growth of abnormal cells. C: Enhancing pathogen resistance - While the immune system does enhance resistance against pathogens, this is not its critical function in cancer. D: Stimulating autoimmune responses - Autoimmune responses involve the immune system attacking healthy cells, not targeting cancerous cells.

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The correct answer is A because a patient with periorbital cellulitis requires close monitoring and immediate intervention due to the risk of complications such as vision loss or intracranial involvement. This assignment will provide the new graduate with an opportunity to develop critical thinking skills and prioritize care for a potentially unstable patient. Choice B is incorrect because a patient needing discharge instructions after skin grafts is usually stable and may not require acute interventions, making it less suitable for a new graduate. Choice C is incorrect because a dressing change for a stage 3 pressure ulcer post-hydrotherapy is a routine procedure that may not challenge the new graduate's critical thinking skills or require immediate interventions. Choice D is incorrect as teaching before a punch biopsy is important but not as time-sensitive or critical compared to managing a patient with periorbital cellulitis.

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Administering a stool softener as ordered is the most appropriate nursing intervention for a postpartum client experiencing severe perineal pain and difficulty passing stools following a vaginal delivery. Stool softeners help to soften the stool, making it easier for the client to pass without straining, which can exacerbate perineal pain. It is important to follow the healthcare provider's orders when administering medications to ensure proper dosing and effectiveness. Encouraging the client to refrain from defecation may lead to constipation and worsen the situation. Applying ice packs to the perineum can provide temporary pain relief, but addressing the underlying issue of constipation with a stool softener is more effective in the long term. Providing education on proper perineal hygiene is important for overall postpartum care, but addressing the immediate issue of constipation with a stool softener takes precedence in this scenario.

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The sudden onset of severe vertigo, nausea, vomiting, and nystagmus in a patient with a recent upper respiratory tract infection is highly suggestive of vestibular neuritis. Vestibular neuritis is typically caused by inflammation of the vestibular nerve, often following a viral infection such as an upper respiratory tract infection. This condition presents with acute, severe, continuous vertigo without associated hearing loss. The presence of nystagmus, along with the absence of hearing loss, helps differentiate vestibular neuritis from Meniere's disease (which typically presents with episodic vertigo, hearing loss, and tinnitus) and acoustic neuroma (which presents with gradual onset of symptoms including unilateral hearing loss, tinnitus, and imbalance). Benign paroxysmal positional vertigo (BPPV) typically presents with brief episodes of vertigo triggered by specific head movements, rather than the continuous vertigo seen in this case.

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The palliative nurse should prioritize performing thoracentesis to drain the pleural fluid and relieve dyspnea in a patient with terminal cancer experiencing pleural effusion. Pleural effusion is a common complication in patients with advanced cancer and can cause significant respiratory distress. Drainage of the pleural fluid through thoracentesis can provide immediate relief by easing the pressure on the lungs and improving the patient's ability to breathe. This intervention is essential in managing dyspnea for comfort and quality of life in palliative care settings. Administering bronchodilator medications (option A) or recommending non-invasive positive pressure ventilation (option C) may not directly address the underlying cause of dyspnea in this case. While relaxation techniques (option D) can help with anxiety and overall well-being, they may not be sufficient in managing the physical symptom of dyspnea caused by pleural effusion.

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Consulting with the provider about surgical debridement is the correct action for a diabetic foot ulcer with black, dry, hard eschar. Eschar indicates significant necrotic tissue, which delays healing and heightens infection risk in diabetic patients, who are prone to complications due to poor vascularity and immune response. Surgical debridement swiftly removes this barrier, exposing viable tissue for healing, and is the most efficient method for extensive necrosis. Wet-to-dry dressings are outdated and inappropriate for dry eschar, as they're better for moist slough and can harm healthy tissue. Transparent film traps moisture but doesn't address necrosis, risking infection beneath the eschar. Leaving it open to air invites contamination and drying, slowing recovery. Given the wound's severity and diabetes context, consulting for surgical intervention ensures timely, effective management, reducing risks like osteomyelitis or amputation.

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The correct answer is A because it encourages open communication between the patient, nurse, and provider to ensure the best possible outcome for both the patient's health and desire to start a family. By discussing the desire to start a family with the provider, the risks associated with immune modulating medications can be assessed, and appropriate steps can be taken to minimize these risks. This approach allows for personalized care and decision-making based on the individual's specific situation. Choice B is incorrect because discontinuing immune modulating drugs without proper guidance can have negative consequences for the patient's health. Choice C is incorrect because while some immune modulating drugs may have teratogenic effects, not all drugs in this class are equally harmful. Choice D is incorrect as it presents a limited view that pregnancy is not an option without considering individual circumstances and medical advice.

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The correct answer is B: It is a dynamic field, continually evolving through research. Immunology is constantly evolving due to new discoveries and advancements in technology. Research in immunology leads to a deeper understanding of the immune system and its interactions with pathogens, cancer, and other diseases. This ongoing evolution is essential for the development of new treatments and vaccines. Explanation of why other choices are incorrect: A: It is largely static, with few modern discoveries - This is incorrect as immunology is a rapidly advancing field with numerous breakthroughs and discoveries. C: It exclusively studies pathogen biology - This is incorrect as immunology also encompasses the study of the immune system's responses to various stimuli, not just pathogens. D: It focuses solely on innate immunity - This is incorrect as immunology covers both innate and adaptive immunity, as well as the interactions between them.

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The correct answer is B because mature naïve T cells that leave the thymus can include self-reactive T cells that have not been tolerized against a specific antigen. This is because the process of negative selection in the thymus eliminates most self-reactive T cells but does not catch all of them. Some self-reactive T cells may escape negative selection and circulate as mature naïve T cells. Therefore, it is possible for mature naïve T cells leaving the thymus to include self-reactive T cells that have not been tolerized against a specific antigen. Choices: A: This is incorrect because although negative selection in the thymus eliminates most self-reactive T cells, it does not catch all of them, so some self-reactive T cells may still be present in the mature naïve T cell population. C: This is incorrect because mature naïve T cells already have the ability to recognize antigens presented by MHC, which is developed in the th

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In end-stage liver disease, pruritus (itching) can be a distressing symptom caused by the accumulation of bile salts in the skin due to impaired liver function. Cholestyramine and other bile acid sequestrants are the primary treatment for managing pruritus in these patients. These medications bind to the bile salts in the intestine, preventing their reabsorption and reducing the itching symptoms. Antihistamines may not be as effective for this type of pruritus since it is not histamine-mediated. Topical corticosteroids are generally not recommended for long-term use in liver disease due to the risk of systemic absorption and adverse effects. Avoiding hot showers or baths may provide some temporary relief but is not a definitive treatment. Therefore, prioritizing the prescription of cholestyramine or bile acid sequestrants would be the most appropriate intervention to address the severe pruritus in a patient with end-stage liver disease