Med Surg II: Final Exam (Questions on Spring 2024 Final Exam)

A nurse is preparing to administer atenolol 25 mg PO every 12 hr. The amount available is atenolol 50 mg/tab. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.5 tablets

A nurse is teaching a client who has chemotherapy-induced anemia and a prescription for epoetin alpha. The nurse should instruct the client to report which of the following findings as an adverse effect of epoetin alpha? (a) Hypertension (b) Leukocytosis (c) Bone pain (d) neutropenia

(a) Hypertension. The nurse should instruct the client to report hypertension, which is an adverse effect of epoetin alfa (growth factor that is used to stimulate production of red blood cells in the bone marrow). Other adverse effects can include headaches, seizures, heart failure, and thromboembolic events related to increased hemoglobin levels.

A nurse is reinforcing teaching with a client who has a child with neutropenia. Which of the following instructions should the nurse include in the teaching? A. "You can take your child to stores on weekends." B. "You should inspect your child's mouth weekly for ulcers." C. "You should avoid crowded places" D. "You can give your child fresh fruit for snacks."

Avoid crowded places Rationale: The nurse should inform the client to avoid crowds due to a suppressed immune system

A nurse is caring for a child who is experiencing an acute asthma attack. Which of the following medications should the nurse administer first? A. Methylprednisolone B. Albuterol C. Fluticasone D. Beclomethasone

B. Albuterol

A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless and apneic. Which of the following actions is the nurse's priority? a. Defibrillation b. Airway management c. Epinephrine administration d. Amiodarone administration

a. Defibrillation The greatest risk to the client is death from a lack of cardiac output. Ventricular fibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve ventricular fibrillation promptly and convert the rhythm to restore cardiac output. The nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation, if necessary, to convert the ventricular fibrillation into a sustainable rhythm.

A nurse is monitoring a client who reports having chills and back pain during a blood transfusion. Which of the following actions is nurse's priority? A. Stopping the transfusion B. Covering the client with a blanket C. Notifying the provider D. Assessing the client's skin for a rash

A. Stopping the transfusion

A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzymes studies? A. "These tests help determine the degree of damage to the heart tissues." B. "Cardiac enzymes will identify the location of the MI." C. "These tests will enable the provider to determine the heart structure and mobility of the heart valves." D. "Cardiac enzymes assist in diagnosing the presence of pulmonary congestion."

A. "These tests help determine the degree of damage to the heart tissues."

A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following room assignments should the nurse make for the client? A. A room with air exhaust directly to the outdoor environment B. A room with another nonsurgical client C. A room in the ICU D. A room that is within view of the nurses' station

A. A room with air exhaust directly to the outdoor environment

A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect? A. Fatigue B. Hypertension C. Bradycardia D. Diarrhea

A. Fatigue The nurse should anticipate that the client who has anemia due to blood loss following surgery will experience fatigue. This is due to the body is decreased ability to carry oxygen to vital tissues and organs.

A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect? A. Frothy sputum B. Dependent edema C. Nocturnal polyuria D. Jugular distention

A. Frothy sputum

A nurse is caring for a client 4 hr following a cardiac catheterization. Which of the following actions should the nurse take? A. Have the client lie flat in bed. B. Keep the affected leg slightly flexed. C. Elevate the head of the bed 45°. D. Keep the client NPO for 4 hr.

A. Have the client lie flat in bed.

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.) A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate D. Increase hematocrit E. Increased temperature

A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate

A nurse is caring for a client who reports an area of redness, warmth, tenderness and pain in the right calf. The nurse anticipates which of the following orders when notifying the provider of this finding? A. Obtain a venous duplex ultrasound. B. Obtain impedance plethysmography. C. Monitor Homan's sign. D. Apply cold therapy to the affected leg

A. Obtain a venous duplex ultrasound.

A nurse on a medical-surgical unit is caring for a client who reports pain in the jaw, back, and shoulder, and shortness of breath and nausea. Which of the following actions should the nurse take? A. Obtain an EKG. B. Administer enteric-coated acetaminophen. C. Administer ibuprofen. D. Maintain oxygen saturations greater than or equal to 92%

A. Obtain an EKG.

A nurse is assessing a client who is receiving one unit of packed RBCs to treat intraoperative blood loss. The client reports chills and back pain, and the client's blood pressure is 80/64 mm Hg. Which of the following actions should the nurse take first? A. Inform the provider B. Stop the infusion of blood C. Notify the laboratory D. Obtain a urine specimen

A. Stop the infusion of blood The client is experiencing an acute intravascular hemolytic transfusion reaction. The greatest risk to this client is injury from receiving additional blood; therefore, the first action the nurse should take it to stop the infusion of blood.

A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG strip should the nurse recognize as normal sinus rhythm? A. The P wave falls before the QRS complex. B. The T wave is in the inverted position. C. The P-R interval measures 0.22 seconds. D. The QRS duration is 0.20 seconds.

A. The P wave falls before the QRS complex.

A nurse in the emergency department is caring for a client who reports chest pressure and shortness of breath. Which of the following laboratory tests should the nurse anticipate them provider to prescribe? A. Troponin I B. Lipase C. B-type natriuretic peptide (BNP) D. Aspartate aminotransferase (AST)

A. Troponin I

A nurse in a clinic is assessing a client who has AIDS and a significantly decreased CD4-T-cell count. The nurse should recognize that the client is at risk for developing which of the following infectious oral conditions? A) Halitosis B) Gingivitis C) Xerostomia D) Candidiasis

ANS: D Although oral candidiasis can affect anyone, it occurs most often in infants, toddlers, older adults, and clients whose immune systems have been compromised by illness, such as AIDS, or medications.

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A. The erythrocyte sedimentation rate (ESR) B. The hematocrit (Hct) C. The leukocyte count D. The platelet count

B. The hematocrit (Hct)

A nurse is caring for a client who is 5 hr postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first? A. Notify the provider. B. Check the tubing for kinks. C. Adjust the rate of the bladder irrigant. D. Irrigate the catheter.

B. Check the tubing for kinks. Rationale: When providing client care, the nurse should first use the least restrictive intervention; therefore, the nurse should check the catheter tubing for kinks. The nurse must ensure constant flow of the bladder irrigant into the catheter and outward drainage from the catheter to prevent clotting, which could occlude the catheter lumen.

A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi? A. Protein in the urine B. Dehydration C. Iron deficiency D. Obesity

B. Dehydration Rationale: Dehydration can cause hypercalcemia which increases the risk for renal stone formation. Inadequate fluid intake can result in urinary stasis and promote the formation of calculi.

Same questions twice on Final Exam! A nurse is assisting with obtaining an electrocardiogram (ECG) for a client who has atrial fibrillation. Which of the following actions should the nurse take? (Select all that apply.) A. Keep the client NPO after midnight. B. Inspect the electrode pads. C. Wash the skin with plain water before placing the electrodes. D. Instruct the client not talk during the test. E. Administer an analgesic prior to the procedure

B. Inspect the electrode pads. C. Wash the skin with plain water before placing the electrodes. D. Instruct the client not talk during the test.

A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions? A. Elevating her feet B. Massaging her legs C. Flexing her ankles D. Ambulating soon after surgery

B. Massaging her legs

A nurse is caring for a client with a ventricular pacemaker who is on ECG monitoring. The nurse understands that the pacemaker is functioning properly when which of the following appears on the monitor strip? A. Pacemaker spikes after each QRS complex B. Pacemaker spikes before each P wave C. Pacemaker spikes before each QRS complex D. Pacemaker spikes with each T wave

B. Pacemaker spikes before each P wave

A nurse is interpreting a client's ECG strip. Which of the following components of the ECG should the nurse examine to determine the time it takes for ventricular depolarization and repolarization? A. PR interval B. QT interval C. ST segment D. QRS complex

B. QT interval

A nurse is caring for a client who has an indwelling urinary catheter and notes blood-tinged urine in the catheter bag. The nurse recognizes this finding can be a manifestation of which of the following urinary alterations? a. Pernicious anemia b. Dehydration c. Prostate enlargement d. Bladder infection

Bladder infection The nurse should recognize that hematuria, or blood-tinged urine, can be a manifestation of a bladder or kidney infection. pernicious anemia- decrease in red blood cells when the body can't absorb enough vitamin B-12

A nurse is planning a presentation about HIV for a church-based group. Which of the following information about HIV transmission should the nurse include? A It is primarily transmitted through casual contact. B It is primarily transmitted through mosquitoes. C It is primarily transmitted through direct contact with infected body fluids. D It is primarily transmitted through accidental puncture wounds.

C It is primarily transmitted through direct contact with infected body fluids.

A nurse is preparing to administer medications to four clients. The nurse should administer medications to which of the following clients first? A. A client who has pneumonia, a WBC count of 11,500/mm3, and is prescribed piperacillin (10,000 normal) B. A client who has anemia, hemoglobin of 11g/dL, and is prescribed epoetin alfa C. A client who has renal failure, a serum potassium of 5.8/mEq/L, and is prescribed sodium polystyrene sulfonate D. A client who is post coronary artery bypass graft (CABG), has total cholesterol of 318mg/dL, and is prescribed atorvastatin

C. A client who has renal failure, a serum potassium of 5.8/mEq/L, and is prescribed sodium polystyrene sulfonate

A nurse is interpreting the ECG strip of a client who has bradycardia. Which of the following cardiac components should the nurse identify as the role of the P wave? A. Ventricular depolarization B. Slow repolarization of ventricular Purkinje fibers C. Atrial depolarization D. Early ventricular repolarization

C. Atrial depolarization

A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor? A. Hypocalcemia B. BMI less than 25 C. Family history D. Diuretic use

C. Family history Rationale: Family history is strongly correlated with the formation of urolithiasis. A nurse should assess a client who has kidney stones for familial tendencies toward stone formation.

A nurse in the emergency room is caring for a client who presents with manifestations that indicate a myocardial infarction. Which of the following prescriptions should the nurse take first? A. Attach the leads for a 12-lead ECG. B. Obtain a blood sample. C. Initiate oxygen therapy. D. Insert the IV catheter.

C. Initiate oxygen therapy.

A nurse in an emergency department is caring for a client who is bleeding from a deep laceration on his left lower forearm. After observing standard precautions, which of the following actions should the nurse perform first? A. Apply a tourniquet just below the elbow B. Clean the wound C. direct pressure over the wound D. Elevate the limb and apply ice

C. direct pressure over the wound

A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority? A WBC 5,000/mm3 B Platelets 150,000/mm3 C Positive Western blot test D CD4-T-cell count 180 cells/mm3

D CD4-T-cell count 180 cells/mm3

A nurse is collecting data from a client who has left sided heart failure. For which of the following findings should the nurse notify the provider? A. Weight loss of 1 kg (2.2 lb) in the past 24 hr B. Pale, clammy skin C. Fatigue when ambulating 152 m (500 ft) D. Productive cough with pink, frothy sputum

D. Productive cough with pink, frothy sputum

A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication? A. anti-inflammatory. B. antipyretic. C. analgesic. D. antiplatelet aggregate.

D. antiplatelet aggregate.

A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take? A. Apply cold compress to the client's flank area. B. Restrict protein intake to 2 servings per day. C. Discourage ambulation. D. Encourage intake of at least 3 L of fluids per day.

D. Encourage intake of at least 3 L of fluids per day. Rationale: The nurse should encourage the client to consume at least 3,000 mL of fluids per day to dilute the urine, increase hydrostatic pressure behind the stone, and move the calculi down the urinary tract.

A nurse is evaluating the central venous pressure (CVP) of a client who has sustained multiple traumas. Which of the following interpretations of a low CVP pressure should the nurse make? A. Fluid overload B. Left ventricular failure C. Intracardiac shunt D. Hypovolemia

D. Hypovolemia

A nurse is planning care for a female client who has a T4 spinal cord injury and is at risk for acquiring urinary tract infections, Which of the following actions shouid the nurse include in the client's plan of care? a. Cleanse the perineum from back to front. b. Obtain a prescription for an indwelling urinary catheter. c. Encourage fluid intake at and between meals. d. Offer the client the bedpan every 2 hr.

Encourage fluid intake at and between meals. Increased fluid intake dilutes the urine, reduces stasis, and greatly reduces the urinary bacterial count. Consequently, the risk of nosocomial (hospital- acquired) UTI is reduced, even for a client who has a spinal cord injury.

A nurse is caring for a client who has sickle cell disease. Nurses' Notes 0800: Client reports fatigue, muscle weakness, joint pain, and dyspnea. Sclerae is jaundiced. 2.5 cm (1 in) by 2.5 cm (1 in) open ulcer noted on inner left ankle. Vital Signs 0800: Temperature 37.5° C (99.5° F) Blood pressure 122/68 mm Hg Heart rate 95/min Respiratory rate 28/min Oxygen saturation 95% on room air 1000: Temperature 37.5° C (99.5° F) Blood pressure 88/56 mm Hg Heart rate 112/min Respiratory rate 26/min, labored Oxygen saturation 90% on room air Diagnostic Results 1000: Hct 26% (37% to 47%) Hgb 8 g/dL (12 to 16 g/dL) For each client finding, click to specify if the finding is consistent with sickle cell disease, iron deficiency anemia, or leukemia. Each finding may support more than 1 disease process. -Respiratory status -Joint pain -Heart rate at 1000 -Jaundice -Ankle ulcer

Respiratory Status: -Sickle Cell Disease -Iron Deficiency Anemia -Leukemia Respiratory status is consistent with sickle cell disease, iron deficiency anemia, and leukemia. In sickle cell disease, iron deficiency anemia, and leukemia, dyspnea occurs to compensate for decreased hematocrit and hemoglobin. Joint Pain: -Sickle Cell Disease -Leukemia Joint pain is consistent with sickle cell disease and leukemia. In sickle cell disease and leukemia, impaired function of the bone marrow can result in joint pain and swelling. Heart rate at 1000: -Sickle Cell Disease -Iron Deficiency Anemia -Leukemia Heart rate at 1000 (112 bpm) is consistent with sickle cell disease, iron deficiency anemia, and leukemia. In sickle cell disease, iron deficiency anemia, and leukemia, heart rate increases to increase perfusion to the tissues and to compensate for a decreased hematocrit and hemoglobin. Jaundice: -Sickle Cell Disease Jaundice is consistent with sickle cell disease. In sickle cell disease, jaundice can occur due to destruction of red blood cells and the release of bilirubin. Ankle Ulcer: -Sickle Cell Disease Ankle ulcer is consistent with sickle cell disease. In sickle cell disease, decreased perfusion can result in ulcers of the lower extremities.

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? A. pH 7.25, HCO3- 19 mEq / L PaCO2 30 mmHg B. pH 7.30, HCO3-26 26 mEq / L PaCO2 50 mmHg C. pH 7.50 0. HCO * 3 - 20mE /L, PaCO2 32 mm Hg D. pH 7.55, HCO3- 30 mEq / L PaCO2 31 mm Hg

The Correct Answer is A In a client with chronic kidney disease (CKD), metabolic acidosis is a common acid-base disorder due to impaired excretion of acid and decreased bicarbonate reabsorption in the kidneys. The arterial blood gas values associated with metabolic acidosis in CKD are a low pH (acidemia), low bicarbonate (HCO3-), and normal or low partial pressure of carbon dioxide (PaCO2). Option A fits this pattern, with a pH of 7.25 (acidic), HCO3- of 19 mEq/L (low), and a PaCO2 of 30 mm Hg (within the normal to low range).

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? A. Activated partial thromboplastin time (APTT) B. Bleeding time C. Prothrombin time (PT) D. Hemoglobin (Hgb)

The Correct Answer is C warfarin inhibits vitamin K epoxide reductase interfering with the synthesis of vitamin K dependent clotting factors (II, VII, IX, and X). This prolongs the prothrombin time, expressed in the form of INR international normalized ratio. Monitoring of INR helps to ensure that the prescribed dosages are within the therapeutic levels without increasing the risk of bleeding. The target INR range is between 2.5 and 3.5.A. Used to monitor heparin therapy B, D- not used for monitoring

A nurse in an emergency department is assessing a client who is having a suspected acute myocardial infarction (MI). Which of the following manifestations should the nurse expect to find for a client experiencing a acute MI? (SATA) a. Orthopnea b. Headache c. Nausea d. Tachycardia e. Diaphoresis

b. Headache c. Nausea d. Tachycardia e. Diaphoresis Headache: Chest pain and sometimes jaw, back, and shoulder pain are manifestations of an acute MI. Nausea and vomiting are manifestations of an acute MI. Tachycardia and dysrhythmias are manifestations of an acute MI. Tachycardia can also occur as a result of the client's anxiety.Diaphoresis: Profuse sweating and anxiety are manifestations of an acute MI.

A nurse in a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect the provider will prescribe which of the following diagnostic tests first? a. Sputum culture for acid-fast bacillus (AFB) b. Nucleic acid amplification test (NAAT) c. CT scan d. Chest x-ray

b. Nucleic acid amplification test (NAAT) The CDC recommends that the NAAT test replace other diagnostic screening tests for tuberculosis. The test is performed on a client's sputum.

A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals. Which of the following responses should the nurse make? a. "Taking the medication between meals will help you avoid becoming constipated." b. "Taking the medication with food increases the risk of esophagitis." c. "Taking the medication between meals will help you absorb the medication more efficiently." d. "The medication can cause nausea if taken with food."

c. "Taking the medication between meals will help you absorb the medication more efficiently."

A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up". Which of the following actions should the nurse take to help this client with tenacious bronchial secretions? a. Maintaining a semi-Fowler's position as often as possible b. Administering oxygen via nasal cannula at 2 L/min c. Helping the client select a low-salt diet d. Encouraging the client to drink 2 to 3 L of water daily

d. Encouraging the client to drink 2 to 3 L of water daily COPD is a term for two diseases of the respiratory system: chronic bronchitis and emphysema. Maintaining hydration through the consumption of adequate fluids will help liquefy thick secretions and facilitate their expectoration.