Medsurge Midterm III

Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?

"Ultra filtration methods take much longer than hemodialysis." 54

A client is recovering from a neck dissection. What volume of serosanguineous secretions would the nurse expect to drain over the first 24 hours?

80 to 120 mL 46

The nurse is caring for several older clients. Which client would the nurse be especially alert for signs and symptoms of pyelonephritis?

A client with urinary obstruction 54

Which of the following is one of the most common causes of death in patients diagnosed with fat emboli syndrome?

ARDS 43

What is the daily fluid goal of a client recovering from gastric surgery? Enter the correct number only.

After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals. 120 X 6 = 720 mL. 47

When reviewing the history of a female client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition?

Age below 50 years 43

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

Applying heat 43

A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. Which of the following would be the most accurate response from the nurse?

Approximately 75% 47

A patient has undergone a radical neck dissection. His skin graft site is pale. This indicates which of the following conditions?

Arterial thrombosis 46

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl 54

Which of the following is an accurate statement regarding cancer of the esophagus?

Chronic irritation of the esophagus is a known risk factor. 46

A client reports to the emergency department after experiencing pain in the left arm. The client reports that he extended his arms in an attempt to prevent a fall. Which fracture type does the nurse anticipate?

Colles' fracture 43

A patient who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold and feeling clammy shiny skin that is growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

Complex regional pain syndrome (CRPS) 43

A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client?

Deficient fluid volume 54

In the diuresis period of AKI, the nurse should observe the patient closely for what complication?

Dehydration 54

Which phase of acute renal failure signals that glomerular filtration has started to recover?

Diuretic 54

The nurse is caring for an older adult who complains of xerostomia. The nurse evaluates for use of which of the following medications?

Diuretics 46

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?

Dorsiflexion exacerbates signs and symptoms of a ganglion. 42

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client?

Epicondylitis 43

A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has what type of potential side effect?

Extrapyramidal 46

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse concludes that the most common cause of peptic ulcers is which of the following?

Gram-negative bacteria 47

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are?

Heberden's nodes 42

Which factor may contribute to compartment syndrome?

Hemorrhage 43

Which of the following is the most common complication associated with peptic ulcer?

Hemorrhage 47

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Hypertension 54

Following are complications the nurse should monitor for during dialysis except for which of the following?

Hypertension 54

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?

Inability to flex index and middle fingers 43

The nurse is counseling an adolescent who has a body mass index of 33%. Which of the following complications is of greatest concern?

Life long obesity 47

For a patient with salivary calculi, which of the following procedures uses shock waves to disintegrate the stone?

Lithotripsy 46

The client who has parotitis is being instructed by the nurse to

Maintain fluid intake of 3000 mL each day. 46

Which of the following is the most common symptom of gastrointestinal (GI) problems in general?

Nausea 46

A 17-year-old high school junior was involved in a motor vehicle collision and brought to the ED via squad. His left arm was severely traumatized in the accident and he was taken immediately to surgery. He is admitted to the ICU where you practice nursing, and the physician has ordered close monitoring for compartment syndrome. What musculoskeletal structure does compartment syndrome affect?

Nerve 43

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms?

No Symptoms 54

During hemodialysis, excess water is removed from the blood by which of the following?

Osmosis 54

A client is informed that he has a benign bone tumor but is the type of tumor that may become malignant. What type of tumor does the nurse know that this is characteristic of?

Osteoclastoma 42

Which assessment findings would the nurse expect in the client with osteomalacia?

Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels. 42

Bursitis is an inflammation of the bursa, a fluid-filled sac that cushions bone ends to enhance a gliding movement. What possible assessment findings would be present in a client with bursitis? Select all that apply.

Painful movement of a joint • A distinct lump 42

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?

Positive Anti-dsDNA antibody test 42

Which of the following diagnostics is used to identify malignant cells associated with esophageal cancer?

Positron emission tomography (PET) 46

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The doctor has ordered the "triple therapy" regimen. Which of the following is the correct representation of "triple therapy" refers?

Proton-pump inhibitor and two antibiotics 47

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

Raloxifene 42

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Risk for injury related to amputation. 43

Which of the following is the most sensitive indicator of renal function?

Serum creatinine 54

The nurse is caring for patient scheduled to undergo radical neck dissection. During preoperative teaching, the nurse includes that which of the following as associated complications?

Shoulder drop 46

Which of the following medications used for the treatment of obesity prevents the reuptake of serotonin and norepinephrine?

Sibutramine hydrochloride (Meridia) 47

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?

Sicca syndrome 42

A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?

Sore throat 2 weeks ago 54

A 34-year-old client was playing a pick-up game of basketball when he became injured. He was brought to the urgent care facility where you practice nursing with an extremely painful elbow, which was very edematous. What type of injury would you suspect that the client experienced?

Sprain 43

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3 liters per day. 54

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?

The client has a history of diverticulitis. 54

A nurse is doing her initial assessment on a client who had gastric bypass surgery the previous day. Which of the following would she expect to see when observing the client's nasogastric tube drainage?

Yellow-green secretions 46

A patient has had a nasogastric tube decompression for 3 days and is scheduled for intestinal surgery in the morning. The nurse determines that this patient is at the greatest risk for

altered oral mucous membranes. 46

A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:

cardiac arrhythmia. 54

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

confusion, headache, seizure 54

Halitosis and a sour taste in the mouth are clinical manifestations associated most directly with

esophageal diverticula 46

Lifestyle risk factors for osteoporosis include

lack of exposure to sunshine. 42

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is

octreotide (Sandostatin) 47

A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions? Choose all that apply.

• "Continue to take antacids even if your symptoms subside." • "You may be prescribed H2-receptor antagonists for up to 1 year." 47

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply.

• "Immobilization of the fracture will promote healing by maximizing contact of bone fragments." • "Fractured bones require a good blood supply and adequate nutrition for healing." • "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized." 43

Select all of the following that are descriptors of the pathophysiologic process seen in osteomalacia.

• A deficiency of activated vitamin D (calcitriol) • Calcium and phosphate are not moved to the bones. • The bone mass is structurally weaker, and bone deformities occur. 42

A client has a family history of stomach cancer. Which of the following factors would further increase the client's risk for developing gastric cancer? Select all that apply.

• Age 55 years • Previous infection with H. pylori 47

A client experienced surgical resection of a tumor of the esophagus. After recovery from the anesthesia, the nurse plans postoperative care to include the following: (Select all that apply.)

• Assess lung sounds every 4 hours and prn. • Monitor drainage in the closed chest drainage system. • Verify rhythm on the cardiac monitoring system. 46

A client has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical resectability. Which two are the procedures? Choose the two that apply.

• Computed tomography (CT) • Endoscopic ultrasound 47

A client with acute gastritis asks the nurse what might have caused the problem. Which of the following are possible causes?

• Dietary indiscretion • Excessive alcohol intake • Radiation therapy 47

A client has recently been diagnosed with gastric cancer. He has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of this diagnosis because he has been asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On palpation, the nurse notes two signs that confirm metastasis to the liver. Which of the following are signs?

• Hepatomegaly • Ascites 47

Which of the following are routes of administration for Calcitonin?

• Nasal spray • Subcutaneous • Intramuscular injection 42

Sarah Butler, age 26 years, has been participating in a tennis tournament. She is being seen in the clinic for elbow discomfort. The physician has given her a diagnosis of tendinitis, epicondylitis, or tennis elbow. What symptoms and signs did she have? Choose all that are correct.

• Pain radiating down the dorsal surface of the forearm • Weak grasp 43

A nurse is caring for a construction worker who fell from the second story of a building site and fractured the femoral neck. Which nursing diagnosis is a priority for the client? Select all that apply.

• Risk for infection • Impaired physical mobility • Risk for injury 43

As glomerular filtration decreases, which of the following occurs? Select all that apply.

• Serum creatinine increases • Blood urea nitrogen (BUN) increases • Creatinine clearance decreases 54

The nurse is reviewing the chart of a client with swallowing problems. Which of the following factors would raise suspicion that the client has cancer of the esophagus? Choose all that apply.

• Smoking history of 20 years • Male gender • Previous treatment for gastroesophageal reflux disease 46

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

• The left leg is shorter than the right. • Limited range of motion of the left hip. • The skin of the lower left leg is pale. 43

Which of the following are associated with compartment syndrome? Select all that apply.

• Trauma from accidents • Surgery • Casts • Tight bandages • Crushing injuries 43