Med surg final

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?

"After a couple of years I will be able to stop taking the cyclosporine."

After change-of-shift report on the Alzheimer's disease/dementia unit, which patient will the nurse assess first?

Patient who developed a new cough after eating breakfast

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department. The patient reports a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings?

"Have you consistently taken your medications?"

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.)

Bulk-forming laxatives are an excellent source of fiber Walking or cycling frequently will help bowel motility A good time for a bowel movement may be after breakfast Some over-the-counter (OTC) medications cause constipation

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate?

"Enoxaparin will work right away, but warfarin takes several days to begin preventing clots."

Which patient statement indicates a need for further teaching about extended-release zolpidem (Ambien CR)?

"I will take the medication 1 to 2 hours before bedtime."

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate?

"Malignant tumors may spread to other tissues or organs."

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ count of less than 200 cells/μL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?

"The patient has developed acquired immunodeficiency syndrome (AIDS)."

A patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room? (Select all that apply.)

1) Oxygen mask 2) Suction tubing 3) Side rail pads

Which actions could the nurse delegate to a licensed practical/vocational nurse (LPN/VN) who is part of the team caring for a patient with Alzheimer's disease? (Select all that apply.)

1) Remove potential safety hazards from the patient's environment 2) Administer the prescribed memantine (Namenda)

A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?

Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. What medication topic should the nurse anticipate including in discharge teaching?

Angiotensin-converting enzyme (ACE) inhibitors

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. What should the nurse teach the patient to take?

Antacids after meals and sucralfate 30 minutes before meals

Which action should the nurse take first when a patient develops epistaxis?

Apply squeezing pressure to the nostrils for 10 minutes

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure?

B-type natriuretic peptide

What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia?

Cobalamin (B12) supplements

What should the nurse will teach about when preparing a patient with bladder cancer for intravesical chemotherapy?

Emptying the bladder before instillation

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient's ventilation?

Encourage the patient to sit in a chair and lean forward

A patient has received atropine before surgery and reports a dry mouth. Which action by the nurse is appropriate?

Explain that dry mouth is an expected side effect.

The nurse obtains a health history from an older adult with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse helps identify a risk factor for IE?

Have you had dental work done recently?

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient?

Patient's ability to follow a complex medication regimen

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care?

Position the patient with knees flexed

What should the nurse anticipate teaching a patient with a new report of heartburn?

Proton pump inhibitors

A patient with gonorrhea is treated with a single IM dose of ceftriaxone and is given a prescription for azithromycin (Zithromax) 1000 mg × 1 dose. What rationale should the nurse provide to the patient for this combination?

Provides coverage for possible chlamydia infection.

The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first?

Question the patient about current medications

A college athlete is seen in the clinic 6 weeks after a concussion. Which assessment information will the nurse collect to determine whether the patient is developing postconcussion syndrome?

Short-term memory

Which assessment finding(s) indicate to the nurse that a patient with infective endocarditis has decreased cardiac output?

Urine production of 25 ml/hr

A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L?

respiratory alkalosis

Which topics will the nurse include when preparing to teach a patient with recurrent genital herpes simplex? (Select all that apply.)

1) Sitz baths may be used to relieve discomfort caused by the lesions. 2) Recurrent genital herpes episodes usually are shorter than the first episode. 3) The virus can infect sexual partners even when you do not have symptoms.

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?

"I should apply sunscreen before going outdoors."

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis? (Select all that apply.)

1) Take phosphate binders with each meal 2) Choose high-protein foods for most meals 3) Avoid commercial salt substitutes

Which preventive actions by the nurse will help limit the development of systemic inflammatory response syndrome (SIRS) in patients admitted to the hospital? (Select all that apply.)

1) Administer prescribed antibiotics within 1 hour for patients with possible sepsis. 2) Remove indwelling urinary catheters as soon as possible after surgery. 3) Ambulate postoperative patients as soon as possible after surgery. 4) Use aseptic technique when manipulating invasive lines or devices.

Which information regarding a patient's sleep is most important for the nurse to communicate to the health care provider?

A 41-yr-old librarian who has a body mass index (BMI) of 42 kg/m2 says that the spouse complains about snoring

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first

A patient with a respiratory rate of 38 breaths/min

The charge nurse is assigning semiprivate rooms for new admissions. Which patient could safely be assigned as a roommate for a patient who has acute rejection of an organ transplant?

A patient with an anaphylactic reaction

The nurse supervises a student nurse who is assigned to take care of a patient with active tuberculosis (TB). Which action, if performed by the student nurse, would require an intervention by the nurse?

A surgical face mask is applied before visiting the patient

Which prescribed intervention should the emergency department nurse implement first for a patient who is experiencing continuous tonic-clonic seizures?

Administer lorazepam (Ativan) 4 mg IV

A patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take?

Administer the prescribed fluid bolus and insulin.

A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take?

Alert the surgery center about a possible latex allergy.

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-lb weight gain in the past 3 days. What is the nurse's priority action?

Assess the patient for manifestations of acute heart failure

On the second postoperative day, the patient's nasogastric (NG) tube is removed and the patient begins drinking clear liquids. Four hours later, the patient reports frequent, cramping gas pains. What action by the nurse is the most appropriate?

Assist the patient to ambulate.

Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula?

Auscultate for a bruit at the fistula site

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

Avoid intramuscular injections

A patient who has been hospitalized for 2 days has a nasogastric tube to low suction and is receiving normal saline IV at 100 mL/hr. Which assessment finding would be a priority for the nurse to report to the health care provider?

Decreased alertness since admission

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?

Drain and measure the output from the ostomy

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which response by the nurse reflects accurate knowledge about the medication and the patient's illness?

Explain that orange discolored urine and tears are normal while taking this medication

Which instructions should the nurse include in a teaching plan for an older adult patient newly diagnosed with peripheral artery disease (PAD)?

It is very important that you stop smoking cigarettes.

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care?

Maintain a consistent daily routine for the patient's care

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)?

Measure O2 saturation using pulse oximetry

Which menu choice indicates that the patient understands the nurse's recommendations about dietary choices for iron-deficiency anemia?

Omelet and whole wheat toast

The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3.

Respiratory alkalosis

A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching?

Risk factors for cervical cancer

A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse that prescribed airborne precautions are likely to be discontinued?

Sputum smears for acid-fast bacilli are negative

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?

Stop the infusion if swelling is observed at the site.

When caring for an older patient with hypertension who has been hospitalized after a transient ischemic (TIA), which topic is the most important for the nurse to include in the discharge teaching?

Symptoms indicating that the patient should contact the health care provider

A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes is scheduled for discharge the second day after admission. When implementing patient teaching, what is the priority action for the nurse?

Teach glucose self-monitoring and medication administration.

The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a patient who has an impaired breathing pattern due to anxiety?

Teach the patient how to use the pursed-lip technique

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

Use care when eating high-fiber foods to avoid obstruction of the ileum

Which assessment finding for a patient with a history of asthma indicates that the nurse should take immediate action?

Use of accessory muscles in breathing

Which discharge instruction should the emergency department nurse include for a patient with a sprained ankle?

Use pillows to elevate the ankle above the heart.

The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) after hospitalization for venous thromboembolism (VTE). Which patient statement indicates a need for additional teaching?

"I should reduce the amount of green, leafy vegetables that I eat."

A female patient is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says which of the following?

"My partner will need to take antibiotics at the same time I do."

According to the Center for Disease Control and Prevention (CDC) guidelines, which personal protective equipment will the nurse put on before assessing a patient who is on contact precautions for Clostridium difficile diarrhea? (Select all that apply.)

1) Gloves 2) Gown

The nurse plans to provide instructions about diabetes to a patient who has a low literacy level. Which teaching strategies should the nurse use? (Select all that apply.)

1) Obtain CDs and DVDs that illustrate how to perform blood glucose testing. 2) Schedule one-to-one teaching sessions to practice insulin administration. 3) Provide illustrations and photographs showing various types of insulin.

During assessment of the patient with fibromyalgia, the nurse should expect the patient to report which of the following? (Select all that apply.)

1) Sleep disturbances 2) Multiple tender points 3) Widespread bilateral, burning musculoskeletal pain

A patient diagnosed with hypertension has been prescribed captopril. Which information is most important to teach the patient about this drug?

Change position slowly to help prevent dizziness and falls

A patient diagnosed with hypertension has been prescribed captopril. Which information is most important to teach the patient about this drug?

Change position slowly to help prevent dizziness and falls.

The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action could be delegated to unlicensed assistive personnel (UAP)?

Change the ostomy appliance

A 20-yr-old male patient is admitted with a head injury after a collision while playing football. After noting that the patient has developed clear nasal drainage, which action should the nurse take?

Check the drainage for glucose content

The nurse and the patient who is diagnosed with hypertension develop this goal: "The patient will select a 2-g sodium diet from the hospital menu for 3 days." Which evaluation method will the nurse use to determine whether teaching was effective?

Check the sodium content of the patient's menu choices over the next 3 days.

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take?

Document stoma assessment findings

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test?

Determine the need for postoperative findings

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?

Lip swelling

After a patient who has septic shock receives 2 L of normal saline intravenously, the central venous pressure is 10 mm Hg and the blood pressure is 82/40 mm Hg. What medication should the nurse anticipate?

Norepinephrine

A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take?

Obtain a blood glucose measurement before any insulin administration.

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?

Red patches on the buccal mucosa

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care?

Tadalafil (Cialis)

The nurse is assessing a patient with osteoarthritis who uses naproxen (Naproxyn) for pain management. Which assessment finding should the nurse recognize as likely to require a change in medication?

The patient has dark-colored stools.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information would prompt the nurse to consult with the health care provider before administering the prescribed theophylline?

The patient takes cimetidine (Tagamet HB) daily