Med Surg Practice

A nurse is caring for a client 1 hr following a subtotal thyroidectomy. In which of the following positions should the nurse place the client? Semi-Fowler's Dorsal recumbent Supine Sims'

Semi Fowler's

A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching? "I will use both medications immediately after exercising." "If my breathing begins to feel tight, I will use the cromolyn immediately." "I will be sure to take the albuterol before taking the cromolyn." "I will administer the medications 10 minutes apart."

"I will be sure to take the albuterol before taking the cromolyn." (bronchodilator first to open airway up)

A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to? Arterial blood gases Urinary output Chest tube drainage Pain level

Arterial blood gases (to see if they need supplemental oxygen)

A nurse is caring for a client who had an evacuation of a subdural hematoma. Which of the following actions should the nurse take first? Observe for cerebrospinal fluid (CSF) leaks from the evacuation site. Assess for an increase in temperature. Check the oximeter. Monitor for manifestations for increased intracranial pressure.

Check the oximeter. (poor oxygenation can cause cerebral edema)

A nurse is caring for a client 8 hr postoperative following a total knee replacement. Which of the following actions should the nurse take? Place a pillow under the affected limb Apply cool compresses to the affected limb every 6 hr Promote bed rest for 5-7 days Encourage increased fluid intake

Encourage increased fluid intake

A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions? Encourage the client to ambulate frequently Encourage coughing and deep breathing Encourage the client to increase fluid intake Encourage regular use of the incentive spirometer.

Encourage the client to increase fluid intake

A nurse is providing preoperative teaching by demonstrating diaphragmatic breathing to a client who is scheduled for surgery in the morning. Which of the following actions should the nurse include in the demonstration? Place her hands on the sides of her rib cage Inhale slowly and evenly through her nose Hold her breath for at least 10 seconds Exhale forcefully through the nose

Inhale slowly and evenly through her nose

A nurse is caring for a client who has a hemothorax following a motor-vehicle crash. The client has a chest tube connected to a closed drainage system. When assisting the client out of bed to a chair, which of the following actions should the nurse take? Clamp the tube when the client is ambulating. Keep the collection device below the level of the client's chest. Coil the tubes carefully to prevent kinking. Lay the client flat to avoid leaks in the tubing.

Keep the collection device below the level of the client's chest.

A nurse is caring for a child who ingested kerosene. Which of the following assessments is the nurse's priority? Respiratory rate Burns of the mouth Bowel sounds Visual Acuity

Respiratory rate (kerosene can damage the lungs leading to pneumonia that antibiotics cannot treat)

A nurse is providing discharge teaching to a client who has an implantable cardioverter/defibrillator (ICD). Which of the following info should the nurse include? The client cannot travel by air due to security screenings. The client should hold their cell phone on the side opposite the ICD. The client should avoid the use of small electric devices The client can carry their ICD in a small pocket

The client should hold their cell phone on the side opposite the ICD.

A nurse receives a unit of packed RBC's from a blood bank and notes that the time is 1130. The nurse should begin the infusion at which of the following times?

As soon as the nurse can prepare the client and the administration set

A nurse is teaching a middle-age client about hypertension. Which of the following information should the nurse include in the teaching? A "Reaching your goal blood pressure will occur within 2 months." B "Diuretics are the first type of medication to control hypertension." C "Limit your alcohol consumption to three drinks a day. D "Plan to lower saturated fats to 10 percent of your daily calorie intake."

B "Diuretics are the first type of medication to control hypertension."

A nurse in a clinic is caring for a client who has recently begun taking warfarin. The nurse should instruct the client to avoid which of the following? Cabbage Cantaloupe Green beans White beans

Cabbage (high in Vitamin K)

A nurse is assessing for cyanosis in a client who has dark skin. Which of the following sites should the nurse examine to identify cyanosis in the client? Pinnae of the ears Dorsal surface of the hand Conjunctivae Dorsal surface of the foot

Conjunctivae (this area has minimal pigmentation)

A nurse is caring for a client who is 12hr postoperative and has a chest tube to a disposable water-seal drainage system with suction. The nurse should intervene for which of the following observations? Constant bubbling in the suction-control chamber Continuous bubbling in the water-seal chamber Bloody drainage in the collection chamber Fluid-level fluctuations in the water-seal chamber

Continuous bubbling in the water-seal chamber (indicates an air leak)

A nurse is creating a dietary plan for an adult female who has a hemoglobin level of 9.8 g/dL. Which of the following foods will help to improve this result? Carrots Raisins Maple Syrup Orange Juice

Raisins (high in iron)

When giving a unit of blood the nurse should verify the information on the blood label with the client's information by checking what?

identification wristband

A nurse is teaching a client who has acute kidney injury about dietary sources of potassium. Which of the following statements by the client indicates a need for clarification? "I will enjoy eating cantaloupe for my morning snack." "I can easily add baked potatoes to my diet." "Eating yogurt will be a new experience." "Adding pecans will be a change I can readily make."

"Adding pecans will be a change I can readily make." (pecans are low in potassium)

A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify? Serum cardiac enzyme levels MRI of the chest Physical therapy low-sodium diet

MRI of the chest (magnets would cause the pacemaker to malfunction)

A nurse is teaching a client about taking diphenhydramine. The nurse should explain to the client that which of the following in an adverse effect of this medication? Sedation Constipation Hypertension Bradycardia.

Sedation (also diarrhea, low BP, and palpitations)

A nurse is teaching a client who will undergo a bronchoscopy procedure. the provider will use a rigid scope and general anesthesia. nurse should explain the client's neck will be in which position? A flexed position An extended position A neutral position A hyperextended position

A hyperextended position

A nurse is monitoring a client following thoracentesis. The nurse should identify which of the following manifestations as a complication and contact the provider immediately? Serosanguineous drainage from the puncture site Discomfort at the puncture site Increased heart rate Decreased temperature

Increased heart rate

What reverses warfarin toxicity?

Vitamin K (produced in intestines)

A nurse is caring for a male client who has peripheral vascular disease and is taking dietary supplements and has a new prescription for warfarin (coumadin). The nurse should instruct the client to stop which of the following supplements prior to starting the warfarin? (select all that apply) A. Saw palmetto ​B. Echinacea​ C. Glucosamine ​D. Black cohosh ​E. Gingko biloba

A. Saw Palmetto C. Glucosamine E. Gingko bilboa

A nurse is providing teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide? Consume a high-protein diet. Administer the medication with food. Avoid caffeine while taking this medication. Increase fluids to 1L/per day.

Avoid caffeine while taking this medication. (high protein decreases duration of action, 8oz of water but no food, 2L/day)

A nurse is teaching a client who is postoperative following the insertion of a permanent pacemaker. Which of the following instructions should the nurse include? Count your pulse for 1 min each morning. Resume activities that can cause jolting, such as horseback riding, after 4 weeks. Do not wear tight clothing over the insertion area. Request to be scanned with a handheld metal detector when in the airport. Do not have a microwave oven in the home.

Count your pulse for 1 min each morning. Do not wear tight clothing over the insertion area.

A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions? Reduces inflammation Suppresses the urge to cough Dries mucous membranes Stimulates secretions

Stimulates secretions (Glucocorticoids reduce inflammation Antitussives suppress the cough Anticholinergics reduce secretions)

A nurse is administering platelets to a client who reports feeling chilled and is itching. Which of the following is a priority nursing action? Notify the provider Stop the infusion Collect a urine sample from the client Return the platelet bag and tubing to the blood bank

Stop the infusion (transfusion reaction)

A nurse is reinforcing discharge instructions for a client who has asthma and is about to start taking theophylline. The nurse should instruct the client to monitor for which of the following findings as an adverse effects? Drowsiness Constipation Oliguria Tachycardia

Tachycardia (can increase cardiac stimulation)

A nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching? "I'll rinse my mouth after taking this medication." "I'll take this medication when I get an asthma attack." "I'll take this medication once a day in the evening." "I'll use a spacer device when I inhale this medication."

"I'll take this medication once a day in the evening." (this is not a rescue medication, it is in a tablet form so no need to use a spacer or rinse)

A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider required clarification? Morphine sulfate 2mg IV bolus every 2hr PRN pain Laboratory testing of serum potassium upon admission 0.9% Normal saline IV at 50ml/hr continuous Bumetanide 1mg IV bolus every 12 hr (loop diuretic)

0.9% Normal saline IV at 50ml/hr continuous (NS is isotonic so wont cause the fluid shift needed to reduce circulatory overload)

A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 100/min, respiratory rate 40/min, and blood pressure 140/80 mmHg, HCO₃ mEq/L, and SaO₂ 86%. Which of the following is the priority nursing intervention? Prepare for mechanical ventilation Administer oxygen via face mask Prepare to administer a sedatived Assess for indications of pulmonary embolism

Administer oxygen via face mask (in respiratory alkalosis so low on O2)

A nurse is caring for a child who has asthma and a prescription for montelukast granules. Which of the following instructions should the nurse provide the client's parent on administering the medication. Give the medication in the morning daily. Administer the medication 2 hr before exercise. Give the medication at the onset of wheezing. Administer the granules mixed with 20 oz of water.

Administer the medication 2 hr before exercise. (montelukast is given at night, not a rescue, and should not be diluted)

A nurse is teaching a Group of postmenopausal women about activities to reduce the risk of developing CAD. Which of the following statements by a client requires further teaching? A. ​"A weight loss program can increase the LDL cholesterol levels." B.​"Exercising regularly will lower HDL cholesterol levels." C. ​"Adding foods containing omega-3 fatty acids to my diet can lower my risk." D. ​"Increasing the intake of foods containing trans-fatty acids in my diet can lower my risk."

D. ​"Increasing the intake of foods containing trans-fatty acids in my diet can lower my risk."

A nurse is providing discharge instructions to a client who has asthma and a new prescription for montelukast. The nurse should instruct the client to report which of the following adverse effects to the provider? Blurred vision Palpitations Constipation Depression

Depression

A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of breath. Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation? Different blood pressures in the upper limbs. Different apical and radial pulses. Differences between oral and axillary temperatures. Differences in upper and lower lung sounds.

Different apical and radial pulses.

A nurse is providing discharge instructions to a client who developed deep-vein thrombosis (DVT) postoperatively and is prescribed anticoagulant therapy. Which of the following instructions should the nurse include? Applying cool compresses to her legs Wearing loose, non-constricting stockings Flexing her knees and feet frequently Taking an NSAID tablet daily

Flexing her knees and feet frequently (warm compresses would be used not cold, and compression stockings would be beneficial to move blood back to the heart)

A nurse is caring for a client in the critical care unit following a knife wound to the chest. The nurse suspects the client is developing cardiac tamponade. Which of the following findings supports this suspicion? Sudden lethargy Muffled heart sounds Flattened neck veins Bradycardia

Muffled heart sounds (caused by excess fluid around the heart) (Cardiac Tamponade would manifest as restlessness, JVD, and tachycardia)

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 monitoring strip? Pacemaker spikes after each QRS complex Pacemaker spikes before each P wave Pacemaker spikes before each QRS complex Pacemaker spikes with each T wave

Pacemaker spikes before each QRS complex

As part of an annual physical examination a nurse is preparing a client to undergo a chest x-ray. Which of the following instructions should the nurse give to the client prior to the procedure? Remove all metal necklaces Take several shallow breaths during the procedure Do not eat or drink anything the morning of the test Expect minor discomfort after the procedure

Remove all metal necklaces

A nurse is caring for an adolescent client in the emergency department who sustained a head injury. Thenurse notes the client's IV fluids are infusing at 125 mL/hour. Which of the following is an appropriate action bythe nurse? Slow the rate to 20 mL/hr. Continue the rate at 125 mL/hr. Slow the rate to 50 mL/hr. Increase the rate to 250 mL/hr.

Slow the rate to 50 mL/hr. (to prevent increased intracranial pressure)

A nurse is preparing to administer blood to a client. Which of the following actions should the nurse take to identify the client? (Select all that apply) Verify the provider's prescription with another RN Confirm that the room number matches the medical record Scan the barcode on the client's identification band Ask the client to verbalize if blood type is Rh-negative or positive Compare client identification number to the blood component tag number

Verify the provider's prescription with another RN Scan the barcode on the client's identification band Compare client identification number to the blood component tag number

A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol. For which of the following adverse effect should the nurse instruct the client to report to the provider. Sedation Increased appetite White coating in the mouth Dry oral mucous membranes

White coating in the mouth (glucocorticoids)

A nurse is caring for a client who just had a flexible bronchoscopy. Which of the following nursing action is appropriate? Withhold food and liquids until the clients gag reflex returns Irrigate the client's throat every 4 hr. Have the client refrain from talking for 24 hr. Suction the client's oropharynx frequently.

Withhold food and liquids until the clients gag reflex returns (choking risk, irrigation and suctioning are not necessary)

A nurse in a cardiac unit is caring for a client with acute right-sided heart failure. which of the following findings should the nurse expect? decreased brain natriuretic peptide (BNP) elevated central venous pressure (CVP) increased pulmonary artery wedge pressure (PAWP) decreased specific gravity

elevated CVP (BNP would be elevated, increased PAWP is w/ L-HF, urine specific gravity is increased)

a nurse is performing tracheostomy care for a client and suctioning to remove copious secretions. what following action should the nurse perform?

Suction two to three times with a 60-second pause between passes.

A nurse is assessing a client before administering a unit of packed RBCs. The nurse should identify which of the following data as most important to obtain prior to the infusion? Skin color Fluid intake Temperature Hemoglobin level

Temperature (a baseline temp is needed to be able to identify an infusion reaction)

A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching? The client holds his breath for 10 seconds after inhaling the medication. The client takes a quick inhalation while releasing the medication from the inhaler. The client exhales as the medication is released from the inhaler. The client waits 10 min between inhalations.

The client holds his breath for 10 seconds after inhaling the medication.