Student Item Analysis Report on Exam 1 Version A

Transcription

1 Student Item Analysis Report on Exam 1 Version A Course#: Course Title: Day/Time Instructor: Description: Term/Year: Total Possible Points: 150 Median Score: Highest Score: 144 Standard Deviation: 9.90 Mean Score Lowest Score: 105 Students in this group: 38 Reliability Coefficient (KR20): 0.48 No. Corr ect Group Responses Response Frequencies - * indicates correct Point Correct answer answer Total Upper 27% Lower 27% Biserial A B c D E % 60.00% 40.00% 0.11 A * % 80.00% 50.00% 0.26 D * % % 90.00% 0.11 c 2 0 * % % 90.00% 0.16 c 0 0 * % 80.00% 10 00% 0.50 D * % % 80.00% 0.22 B 3 * % 80 00% 10.00% 0.54 A * % 80.00% 20.00% 0.58 B 8 * % % % 0.52 D * % % 70.00% 0.37 D * % 70.00% 40.00% 0.32 c 3 12 * % % 90.00% 0.08 c 0 4 * % 60.00% 40.00% 0.13 B 14 * % % 90.00% 0.16 D * % 90.00% 90.00% 0.13 A * % % 70.00% 041 D * % 90.00% 70.00% 0.23 c 2 3 * % % % 0.09 B 2 * % 80.00% 50.00% 0.26 A * % 70.00% 80.00% c 2, 10 * % % 90.00% 0.16 D *37 0

2 % 60.00% 30.00% 0.10 C 2 10 * % % 60.00% 0.44 B 1 * % % % 0.00 A * % % % 0.00 A * % % 90.00% 0.16 C 0 0 * % % % 0.00 D * % % 70.00% 0.36 A * % % 80.00% 0.22 C D 1 4 *19 * % 70.00% 40.00% 0.27 A * % 20.00% 10.00% 0.01 A * % 90.00% 90.00% 0.00 C D 0 4 *22 * % % 60.00% 0.39 B 3 * % % 90.00% 0 23 A * % 90.00% 80.00% 0.11 c 1 0 * % 90.00% 80.00% 0.11 c 1 0 * % % 80.00% 0.29 c 1 0 * % % % 0.00 D * % 90.00% 80.00% 0.14 c % 50.00% 40.00% 0.09 A * % 90.00% 60.00% 0.23 A * % 90.00% 70 00% 0.16 B, C 0 * 15 * % 50.00% 70 00% % 50.00% 30.00% % 70.00% 60.00% % 80 00% 70.00% 0.11 B+C +D B+C +E A+B +D A+C +E 4 *38 *36 * *37 * * *29 0 *32 6 *

3 Multiple Choice Identify the choice that best completes the statement or answers the quest ion. 1. During genetic counseling, the nurse explains to a client that an autosomal dominant pattern of inheritance for a specific trait or characteristic means that? a. Unaffected family members do not transmit the trait to their children. b. Genotypes of individuals expressing the trait must be homozygous. c. The trait appears only among male offspring of female carriers. d. Carriers for the trait do not necessarily express the trait. 2. A client is seen in the outpatient clinic for an immune deficiency that involves the T-lymphocytes. The nurse should teach the client about the importance of frequent screening for a. allergies b. malignancies c. antibody deficiencies d. autoimmune disorders 3. The nurse educating a new mother about breast-feeding would include which of the following benefits of immunity? a. active immunity to many childhood diseases for several years b. passive immunity to all childhood diseases for many month s c. passive immunity to diseases in which the mother has immunity d. innate immunity to diseases in which the mother is immune 4. When administering an allergen injection to a client with unknown allergies, the nurse needs to educate the client on the importance of a. "not eating anything for about 6 hours before the injection." b. "taking an oral antihistamine about an hour before the injection." c. "plam1ing to wait in the clinic for 20 to 30 minutes after the injection." d. "reaction to the injection will take about 48 to 72 hours to occur." 5. A client who receives weekly immunotherapy at a clinic missed the previous appointment. When the client comes for the next injection, the nurse should a. schedule an additional dose that week b. administer the usual dosage of the allergen c. re-evaluate the client's sensitivity to the allergen with a repeat skin test d. consult with the health care provider about giving a lower allergen dose 6. While preparing a client diagnosed with systemic lupus erythematosus (SLE) for plasmapheresis, the nurse explains the rationale for this procedure is? a. eliminate eosinophils and basophils from blood. b. remove antibody-antigen complexes from circulation. c. prevent foreign antibodies from damaging various body tissues. d. decrease the damage to organs caused by attacking T-lymphocytes. 1

4 7. A client who received a bone marrow transplant for treatment of leukemia develops a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication that the a. donor T cells are attacking the patient 's skin cells. b. patient 's antibodies are rejecting the donor bone marrow. c. patient is experiencing a delayed hypersensitivity reaction. d. patient will need treatment to prevent hyperacute rejection. 8. A client comes to the ED after having injected heroine with a needle borrowed from a friend with Hep B. To provide immediate protection from infection, the nurse expects to administer a. corticosteroids. b. gamma globulin. c. hepatitis B vaccine. d. fresh frozen plasma. 9. Which of the following allergy tests would be most appropriate for the client with a history of multiple allergies and anaphylactic reactions? a. Serum IgE-level test b. Cutaneous scratch test c. Intracutaneous skin test d..radioallergosorbent test (RAST) 10. To identify anaphylaxis after a client has received allergy testing, the nurse should initially monitor the client 's a. blood pressure and pulse rate. b. lung sounds bilaterally. c. pupil size and reaction to light. d. the arm at the site of the skin testing A client is admitted to the hospital with Pneumocystis carnii pneumonia (PCP). The client would be considered to be in which of the following clinical categories a. asymptomatic b. symptomatic c. AIDS d. acute HIV 12. A client who seeks health care for HIV testing is found to have a positive enzyme immunoassay (EIA) for HIV antibodies. In discussing the test results with the client, the nurse informs the client that a. it will probably be 10 or more years before the client develops AIDS b. the client should immediately notify all past sexual partners c. the enzyme immunoassay test will need to be repeated to verify results d. a viral culture will be done to determine the progress of the disease I3. A pregnant woman with a history of early chronic HIV infection is seen at the clinic. Which information will the nurse need to include in the client 's education? a. The antiretroviral medications used to treat HIV infection are teratogenic b. Most infants born to HIV-positive mothers are not infected with the virus c. Since she is at an early stage of HIV infection the infant will not contract HIV d. The infant will need started on ART therapy when born 2

5 14. Antiretroviral therapy (ART) is being considered for an HIV-infected client who has a CD4+ cell count of 400/µL. Which of the following factors is most important to consider when determining whether ART should be started for the client? a. Client social support system b. HIV genotype and phenotype c. Potential medication side effects d. Patient willingness to comply with ART schedule 15. A client who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse would educate the client on which of the following to reduce the risk of infection? a. participate in a needle-exchange program. b. clean drug injection equipment before use. c. ask those who share equipment to be tested for HIV. d. avoid sexual intercourse when using injectable drugs. 16. A patient who has been treated for HIV infection for 7 years has developed metabolic syndrome. The nurse will anticipate teaching the patient about a. the benefits of daily exercise. b. foods that are higher in protein. c. treatment with antifungal agents. d. a change in antiretroviral therapy. 17. Ten years after seroconversion, an HIV -infected client has a CD4+ cell count of 800/ µi and an undetectable viral load. What is the priority nursing intervention at this time? a. Monitor for symptoms of AIDS. b. Teach about the effects of antiretroviral agents. c. Encourage adequate nutrition, exercise, and sleep. d. Discuss likelihood of increased opportunistic infections. 18. When designing a program to decrease the incidence of HIV infection in the community, the nurse will prioritize teaching about a. methods to prevent perinatal HIV transmission. b. how to prevent transmission between sexual partners. c. ways to sterilize needles used by injectable drug users. d. means to prevent transmission through blood transfusions. 19. The client has lost the ability to synthesize T-suppressor lymphocytes. What type of immune system problem should the nurse expect this client to demonstrate? a. Increased severity of allergy and other hypersensitivity reactions b. Decreased ability to recognize self from non-self c. Decreased immunoglobulin production d. Increased rate of cancer development 20. Which specific cells are responsible for causing acute rejection episodes after a solid organ transplant? a. Activated monocytes and macrophages b. Sensitized B lymphocytes c. Cytotoxic/cytolytic T cells d. Eosinophils 3

6 21. A client who is HIV positive is classified in CDC clinical category A 1. Which of the following is the most appropriate for the nurse to include when educating the client about this disease? a. "At this stage, you can only transmit the virus through donation of blood or blood products. " b. ''If your CD4+ T-cells drop below 200/µL you would be considered infectious." c. "You cannot transmit the virus as long as you take your prescribed drugs.'' d. "The virus can be transmitted at all stages and categories of HIV+." 22.. Which of the following nursing interventions is most appropriate for a client with AIDS who has a meningial opportunistic infection? a. Changing the diet from a regular to a soft or liquid diet b. Administering pentamidine (Pentam) by mask on time c. Initiating seizure precautions with padded siderails d. Providing meticulous skin care after each stool 23. Which characteristic is common to all types of hypersensitivity reactions? a. Decreased inflammatory responses b.. The presence of tissue-damaging reactions c. Enhanced natural killer cell activity d. Loss of the ability to recognize non-self 24. While preparing a client for intradermal testing for allergies, the nurse would place priority on which of the following interventions? a. Ensure that emergency equipment is in the room. b. Pretreat the skin area to be tested with a c01iisone-based cream. c. Apply oxygen by mask or nasal cannula before injecting the test agent. d. Cover the examination table with plastic or an ultrafine mesh A client that suffered an anaphylactic reaction from a bee sting is preparing to be discharged home. Which of the following would be of most importance to include in the discharge instructions? a. the assembly and use of an EpiPen b. obtaining and wearing a medical alert bracelet c. avoid direct contact with the offending allergen d. keep diphenhydramine(benadryl) with him or her at all times 26. Four months following a kidney transplant, a client presents to the ED with complaints of decreased urine output and weight gain. The most likely cause of the client's symptoms is a. urinary tract infection b. hyperacute rejection c. chronic rejection d. acute rejection 27. The nurse is discharging a client post-organ transplant. The intial educational priority for the client is a. need for medical alert identification b. information about follow-up appointments c. information about laboratory screenings d. medication teaching regarding immunosuppressants 4

7 ID: A 28. Nursing interventions to support the client's health post transplant include? a. using strict aseptic technique b. wearing a mask at all times c. using only sterile technique d. cleaning all equipment with 10% bleach solution 29. The nurse is providing education to a client that has decreased level of natural killer cells. Which statement by the nurse is most appropriate to include in the education? a. "you will no longer develop a fever when you have an infection" b. "you will be at an increased risk for developing allergies" c. "you will need to avoid people with viral infections" d. "your risk for cancer development is greater now, and you will need frequent follow-ups" 30. A client who received a heart transplant three years ago has arrived in the ER. The nurse would assess which clinical manifestations as signs of potential rejection? a. fluid retention b. elevated temperature > 101F c. elevated WBC count d. hypertension 31. External beam radiation is planned for a client with endometrial cancer. The nurse educates the client that an important intervention to prevent complication s from the radiation is to a. test all stools for the presence of occult blood b. perform perianal care with warm sitz baths and meticulous cleaning c. maintain a high residue, high fat diet d..inspect the mouth and throat daily for signs of thrush 32. An appropriate intervention for the nurse to teach the client who is receiving chemotherapy and has stomatitis is to a. remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. gargle and rinse the mouth several times a day with an antiseptic mouthwash. d..rinse the mouth before and after each meal and at bedtime with a saline solution. 33. A hospitalized client who has received chemotherapy for leukemia develops neutropenia. In which of the following situations should the nurse intervene? a. The client ambulates several times a day in the room b..t The client's visitors bring in potted flowers from home c. The client cleans with a warm washcloth after having a stool d. The client uses soap and shampoo to shower every other day 5

8 ID: A 34. When reviewing the chart for a client with lung cancer, the nurse notes that the cancer is staged as T4N3M4. The nurse explains to the client that this means? a. large tumor, lymph node involvement, and distant metastasis. b. No evidence of primary tumor, lymph node involvement, or distant metastasis. c. carcinoma in situ, regional lymph node involvement, and meta stasis to one site. d. medium-sized tumor, no lymph node involvement, and distant metastasis. 35. The nurse educating a client who smokes about the warning signs of cancer would include which of the following? a. gallbladder disease b. hematopoietic changes c. nagging cough or hoarseness d. a sore that heals slowly 36. While providing education for a client that is scheduled to have a radioactive implant, the nurse would include which of the following instructions? a. "Nurses will always be available, but they will spend only short periods of time at your bedside." b. "Personal cleanliness is essential, so you will be given a complete bed bath each day." c. "Pain or discomfort is a common side effect of this type of radiation." d.. Your bed linens will be completely changed every third day to minimize radioactive contamination. 37. The nurse educating a client with a benign brain tumor would include which of the following as the reason for needing to remove the tumor? a. Because benign tumor s can migrate, they should be removed before they spread." b. "Because benign tumors are composed of completely normal cells, removal is only done for cosmetic purposes. " c. "Because benign tumors can easily become malignant, they should be removed before cancer develops." d. "Because benign tumors continue to get larger, when they are in a place that could damage normal tissue, they need to be removed." 38. When performing an assessment on a client that has been receiving radiation therapy, the nurse notes that the client has distant heart tones, increased heart rate, and dyspnea. The nurse is concerned about which of the following complications? a. hypercalcemia b. tumor lysis syndrome c. cardiac tamponade d. coronary artery rupture 39. The nurse providing education to a client with a family history of cancer includes which of the following as the single greatest risk factor? a. advancing age b. cigarette smoking c. genetic disposition d. normal immune function 6

9 ID: A e. 40. An appropriate nursing intervention for the client with radiation related fatigue is for the nurse to plan for the client to a. plan frequent rest periods between activities b. exercise vigorously when fatigue is not as noticeable c. maintain bedrest until the radiation treatment is completed d. complete all activities in the morning while the client has the most energy 41. The nurse is caring for a bedridden client with metastasis to the bone. Which intervention is most imp01tant for the nurse to implement to prevent injury for this client? a. Ensuring that the client's heels are touching the mattress b. Providing small, frequent meals that are rich in calcium and phosphorus c. Using a lift sheet when repositioning the client d. Applying pressure for a full 5 minutes after any intramuscular injections Multiple Response Identify one or more choices that best complete the statement or answer the question A client with HIV is started on highly active antiretroviral therapy (HAART). The goal of the therapy for this client include : (Select all that apply) a. increased B cell count b. decreased viral load c. increased CD4 count d. increase the client 's immune function e. decrease white blood cell count 43. The nurse is educating a client receiving chemotherapy about interventions to assist with fatigue. Which of the following would be most appropriate to include in the education? (Select all that apply) a. completing all chores in the morning b. encouraging rest periods during the day c. adequate protein and calorie intake d. encourage frequent visitation from friends and family e. use of relaxation techniques such as guided imagery 44. Which organs are responsible for assisting in the immune response? (Select all that apply) a. Lymph glands b. Thymus gland c. Parathyroid gland d. Bone Marrow 45. A client who is receiving chemotherapy develops mylesuppression. Which of the following instructions should the nurse include in the client's teaching plan? (Select all that apply) a. avoid activities that may cause bleeding b. increase intake of fruits and vegetables c. wash hands frequently d. treat sore throat with over-the-counter medication e. avoid crowded places such as the mall 7