medsurg e3

1. The nurse working in an outpatient center has instructed a client who is scheduled to have endoscopic retrograde cholangiopancreatography (ERCP). Which of the following client statements indicates a correct understanding?

"I will notify my primary health care provider (PHCP) if I experience abdominal pain 1 to 2 days following this procedure

3. The nurse is teaching a client about lifestyle modifications to manage gastroesophageal reflux disease (GERD). Which of the following statements should the nurse include?

"Avoid bent over or stooped positions"

38. The nurse is reviewing the electronic health record (HER) of a client who has empyema. Which of the following conditions in the client's history should the nurse recognize as most likely to have caused the empyema?

PNEUMONIA

25. The nurse is caring for a client who is obese and is being treated for a suspected hiatal hernia. Which of the following symptoms should the nurse associate with the possible presence of a hiatal hernia?

Wheezing

26. The nurse is assessing the breath sounds of a client over the trachea and larynx and notes sounds that are high pitched and have an expiratory phase that is greater than the inspiratory phase. The nurse should document these breath sounds as

Wheezing

45. The nurse is providing discharge to a client who has asthma and a new prescription for ipratropium. Which of the following should the nurse include as a potential side effect of this medication.

White coating in the mouth

46. The nurse is caring for a client who is having an asthma attack. It would be necessary to seek immediate help if the client has

A sudden absence of wheezing

22. The nurse working in a community health clinic is discussing health promotion with clients. The nurse should recommend that a client who is

50 years old should have a colonoscopy once every 10 years.

48. The nurse has become aware of the following client situation. Which of the following clients should the nurse assess FIRST?

56 year old who has pneumonia and has a recent white blood cell (WBC) count if 25,000

33. The nurse is preparing to perform tracheostomy care for a client with a cuffed tracheostomy. The nurse has gathered the necessary equipment, washed their hands, and donned clean gloves. Place the next steps of tracheostomy care in the correct order.

6. remove old dressings and excess secretions. 2. set up a sterile field 1. remove the disposable inner cannula and replace with new cannula 3. clean the stoma site and tracheostomy plate. 5. secure new tracheostomy ties in place. 7. remove soiled tracheostomy ties 4. remove gloves and wash hands.

17. The nurse is caring for a client who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the client's appendix is perforated?

Abdominal pain that worsens with coughing.

18. The nurse is observing a newly hired nurse care for a client who has an ileostomy. Which of the following observations would indicate correct technique by the newly hired nurse?

Applying an ostomy skin cream to fill in areas that may come in contact with ostomy contents.

42. The nurse is developing a plan of care for a client who has COPD. The nurse includes which of the following interventions n the plan?

Assist the client to develop a schedule of activities with rest periods

40. The nurse is assessing a client who has advances emphysema. Which of the following assessments findings is consistent with this diagnosis?

Asymmetric chest expansion with retractions

7. The nurse is caring for a group of clients. The nurse recognizes that the client who should be routinely evaluated for peptic ulcer disease (PUD) is the client who is

Being treated with high-dose prednisone.

12. The nurse is teaching a client with ulcerative colitis about the disease. The nurse states, " Ulcerative colitis is commonly associated with"

Bloody diarrhea

14. The nurse is teaching a client who has ulcerative colitis about the common link with Crohn's disease. Which of the following information should the nurse include?

Both have unknown etiology.

37. The nurse is caring for an older adult who is being admitted to the emergency department (ED) with respiratory symptoms and an oral temperature of 99? Which of the following symptoms requires the nurse to intervene immediately?

Crackles in the lungs base

39. The nurse is assessing a client with pneumonia and notes decreased lung sounds on the left side and decreased lung expansion, both of which are new findings. Which of the following is the nurses BEST action?

Check the clients oxygen saturation and notify the primary health care provider (PHCP)

6. The nurse is caring for a client who has peptic ulcer disease (PUD) and has a new prescription for omeprazole. The nurse understands that this medication may be used in the management of PUD to?

Decrease gastric acid secretions

30. The nurse is assessing a client who had a chest tube placed 12 hours ago for treatment of a hemothorax. The nurse should notify the primary health care provider (PHCP) of which of the following findings?

Drainage from the chest tube has stopped.

35. The nurse observers a staff member caring for a client with tuberculosis (TB) It would require immediate intervention if the nurse observes the staff member.

Entering the room wearing a surgical mask, gown, and gloves.

20. The nurse is admitting a client who is suspected of having acute cholelithiasis. The nurse should assess the client for

Episodic upper abdominal pain

13. The nurse is caring for a client who is experiencing an acute exacerbation of ulcerative colitis. The nurse recognizes which of the following actions as the priority?

Evaluate fluids and electrolyte levels.

15. The nurse planning care for a client who has active diverticulitis. Which of the following menu selections should the nurse include in the plan?

Grilled chicken breast with white rice.

24. The nurse has been made aware of the following client situations. The nurse should initially assess the client who

Has Crohn's disease and had a large emesis containing fecal matter

21. The nurse is preparing to give presentation about hepatitis virus. Which of the following information is correct for the nurse to include in the presentation?

Hepatitis virus B (HVB) can be spread through sexual contact.

32. The nurse preceptor is observing a newly hired nurse suction an adult client who has a tracheostomy. Which of the following actions by the newly hired nurse indicates appropriate nursing care?

Hyper oxygenating prior to insertion of the suction catheter

36. The nurse has provided medication teaching to a client recently diagnosed with pulmonary tuberculosis (TB) who has been prescribed isoniazid (INH). Which of the following client statements indicates the need for additional teaching?

I should expect this medication to cause my secretions to be a reddish orange.

43. The nurse has instructed a client who has emphysema about pursed-lip breathing. Which of the following client statement would indicate the need for additional teaching?

I will breathe out slowly through my mouth while puffing out my chest.

19. The home health nurse is reviewing self-care instructions with a client who has an ileostomy. Which of the following client statements requires additional teaching by the nurse?

I will give myself an enema if I have not passed any stool in 6 to 12 hours.

50. A nurse has attended a continuing education conference about seasonal influenza. Which of the following statements would indicate a correct understanding of the conference?

Individuals who are immunocompromised should receive a kill virus vaccine, such as fluvirion, every year

5. The nurse is assessing a client who has peptic ulcer disease (PUD). Which of the following findings should the nurse identify as the priority?

Melena

8. The nurse is reviewing the plan of care for a client who has gastroenteritis. Which of the following interventions should the nurse include?

Monitor for development of cardiac dysrhythmias.

27. The nurse is performing a health history and admission assessment on a client who is suspected of having sleep apnea. Which of the following statements by the client supports the nurse's suspicion?

My wife says I am more irritable than I used to be

10. The nurse is caring for a client who is 3 hours postoperative from bowel surgery. The nurse auscultates all abdominal quadrants and hears no sounds. The nurse understands this finding likely indicates

Nonmechanical obstruction.

29. The nurse preceptor and student nurse are caring for a client who has a chest tube in place to a closed-chest drainage system. Which of the following actions by the student nurse requires intervention by the nurse preceptor?

Obtaining a pleural fluid culture from the client's chest tube using a 20-guage needle and syringe.

9. The nurse is assessing a client who has a duodenal ulcer. The nurse would expect that the client will report having pain that

Occurs 30 to 60 minutes after eating a meal.

44. The nurse is caring for a client who has had emphysema for the past 15 years and uses prescribed oxygen at 2L/minute per nasal cannula. It is a priority for following up by the nurse if the client has a

PaCO2 that has been 52 mm Hg for the past 4 hours

16. The nurse is caring for a client with anorexia nervosa who is severely malnourished. A nasogastric feeding tube is inserted, and tube feedings are started. Which of the following laboratory findings is the best indication that the clients nutritional status is improving?

Prealbumin level has risen from 9 to 17 mg/dL.

4. The nurse is caring for a client with a peptic ulcer perforation. Which of the following actions is a Priority for the nurse to take?

Prepare the client for surgery

28. The nurse is teaching a client who has inadequate gas exchange and has been prescribed continuous positive airway pressure (CPAP). It would be appropriate for the nurse to explain to the client that CPAP is prescribed in order to

Prevent the alveoli from collapsing

2. The nurse is caring for a client who is 4 hours postoperative for a Roux-en-Y bariatric surgery. Which of the following nursing interventions should the nurse include in the clients plan of care? Select all that apply

Provide the client with clear liquids 1 ounce at a time Place a sign above the clients bed that stated, " do not manipulate nasogastric (NG) tube" Administer prescribed anticoagulant therapy Apply an abdominal binder over dressing 1,3,5,6

23. The nurse is caring for a client who has Crohn's disease and is taking the prescribed monoclonal antibody drug, adalimumab, via subcutaneous injection. Which of the following findings is a priority for the nurse to report to the primary health care provider (PHCP)?

Redness and swelling at the injection site.

31. The nurse is assessing a client who had a left thoracentesis 1 hour ago. Which of the following findings requires the nurse to report to the primary health care provider (PHCP) immediately?

Respirations of 32 with shallow breathing

11. The nurse is admitting a client who has a large bowel obstruction. Which of the following assessment findings should the nurse anticipate the client will have?

Ribbon-like stools.

49. The nurse is caring for a client who is postoperative following a pneumonectomy. Which of the following should the nurse recognize as abnormal following this procedure?

Serious fluid replaces the space where the client's lung was removed

34. The nurse is teaching a client about how to use an incentive spirometer. Which of the following instructions should the nurse provide to the client? "After sealing you mouth over the mouth piece

Take in a slow, deep breath to elevate the cylinder in the chamber.

47. The nurse is teaching a client who has asthma on the use of albuterol metered-dose inhaler (MDI). Which of the following actions by the client indicates a correct understanding of the teaching?

The client waits at least 1 minute between inhalations ???

41. The nurse is reviewing recent arterial blood gas (ABG) results for a client who has chronic obstructive pulmonary disease (COPD) and had developed respiratory distress. Which of the following ABG results is consistent for this client?

pH = 7.50; Pao2 = 79; PaCO2 = 35 HCO3 = 30 Meq SaO2 ==88%