MS test 3.

A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on which statement by the client?

"For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda."

After teaching a client with allergic rhinitis about loratadine, the nurse determines that the client needs additional instruction when the client makes which statement?

"I have to be careful because this drug will make me fairly sleepy."

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client?

"I will take this medication in the morning, with my first bite of breakfast."

A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply.

"Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue."

The side effect of bone marrow depression may occur with which medication used to treat gout?

Allopurinol

Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following?

Urgent

A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply.

Arteriography Open reduction of a fracture Cystoscopy Paracentesis

The nurse is admitting the older adult to the PACU. Which information about this client would be most important for the PACU nurse to obtain?

Does the client have a history of dementia-like symptoms?

A client with an allergic disorder is in treatment for their disorder. What might their treatment be?

Drug therapy

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which of the following individuals is most likely to have anemia?

An 81-year-old woman who has chronic heart failure

The client's surgery is nearly finished and the surgeon has opted to use tissue adhesives to close the surgical wound. This requires the nurse to prioritize assessments related to what complication?

Anaphylaxis

When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for?

Angina

The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient?

0.45 normal saline

The development of a positive HIV antibody test following initial infection generally occurs in which timeframe?

4 weeks

The nurse is preparing to administer intravenous immunoglobulin to a client with a primary immunodeficiency. This is the client's first dose. The nurse would anticipate administering another dose in approximately which time?

4 weeks

In an adult client, which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?

CDC stage 1: Acute HIV infection

Antithyroid medications are not generally recommended for elderly patients because of which side effect?

Granulocytopenia

The nurse is assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client?

small joint involvement

A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis?

Hyperthermia

A client is learning about his new diagnosis of asthma with the asthma nurse. What medication will best prevent the onset of acute asthma exacerbations?

Montelukast

A nurse is assessing a client with rheumatoid arthritis. The client expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurse's response to the client?

Most CAM therapies lack sufficient evidence to support them.

A client newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the clients at this class?

Most calories should be derived from carbohydrates.

The nurse recognizes that the client who takes hydrochlorothiazide to manage hypertension is predisposed for which interaction with anesthesia?

Respiratory depression

A client with rheumatic disease has developed a gastrointestinal bleed. The nurse caring for the client should further assess the client for the adverse effects of what medications?

Salicylate therapy

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?

Shorten the period of neutropenia

A nurse is aware that insulin secretion increases 3 to 5 minutes after a meal and then returns to baseline. If a patient ate breakfast at 7:30 AM, the nurse would expect a baseline level by:

10:30 AM

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?

70% NPH insulin and 30% regular insulin

A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station?

A 24-year-old client with unstable hyperthyroidism with sinus tachycardia

The nurse is assessing a diverse group of clients. What client is at a greater risk for the development of hypothyroidism?

A 75-year-old female client with osteoporosis

A nurse is working in a health clinic at a retirement community. What is the nurse's primary rationale for recommending HIV testing for older adults?

Age-related immune system changes increase the risks of infections for older adults.

Which of the following is the primary hormone for the long-term regulation of sodium balance?

Aldosterone

Which nursing diagnosis should the nurse plan to address first in the client upon arrival in the intraoperative setting?

Anxiety related to ineffective coping with surgical concerns

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurse's interview with the client, she admits that she drinks around 600 mL (20 oz) of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.

Breast cancer Esophageal cancer Liver cancer

A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?

Deficient fluid volume related to osmotic diuresis

A nurse is visiting the home of a client with AIDS who is experiencing HIV encephalopathy. When developing the plan of care for the client and his caregiver, the nurse identifies the nursing diagnosis of disturbed thought processes related to confusion and disorientation secondary to HIV encephalopathy. Which expected outcome would be most appropriate for the nurse to document on the client's plan of care?

The client can state that he is at his home.

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities?

The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times.

The nurse in the ED is caring for a client who has returned to the ED 4 days after receiving stitches for a knife wound on his hand. The wound is now infected, so the stitches were removed, and the wound is cleaned and packed with gauze. The ED doctor plans to have the man return tomorrow to remove the packing and resuture the wound. The nurse is aware that the wound will now heal by what means?

Third intention

A client with an acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities?

prone

A client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms?

dehydration

A nurse is caring for a bariatric client prior to a surgical procedure. What surgical complications would the nurse monitor the bariatric client for postoperatively? Select all that apply.

cardiovascular complications pulmonary complications

A client without symptoms receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.

client history risk factors tumor markers

The nurse recognizes that a traumatic wound with fecal contamination would be classified as

dirty.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order?

I.M

A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following?

Increased anxiety can increase the patient's postoperative pain level.

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply.

Increases lean muscle mass Increases resting metabolic rate as muscle size increase Decreases total cholesterol Increases glucose uptake by body muscles

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to:

Inhibit the production of glucose by the liver.

What are expected client outcomes the nurse would include in a plan of care for a client with allergic rhinitis? Select all that apply.

The client will wear a dampened mask if dust is a problem The client reports no symptoms of peripheral tingling The client controls outdoor precipitating factors

The nurse is providing care for an older adult client whose current medication regimen includes levothyroxine. As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication?

A benzodiazepine

A client has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the health care provider prescribe for this client?

A biguanide

An intraoperative nurse is applying interventions that will address surgical clients' risks for perioperative positioning injury. What factors contribute to this increased risk for injury in the intraoperative phase of the surgical experience? Select all that apply.

Absence of reflexes Diminished ability to communicate Loss of pain sensation

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.)

Acetaminophen Iodine Propylthiouracil

A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

Administer half of the client's typical morning insulin dose as ordered.

The nurse determines that a patient is at risk for the development of thrombophlebitis. What interventions can the nurse provide to prevent this? (Select all that apply.)

Assisting the patient with leg exercises Encouraging early ambulation Avoiding placement of pillows or blanket rolls under the patient's knees

During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for:

Cardiovascular collapse.

A client is to self-administer intravenous immunoglobulin (IVIG) in the home. What is the client's first action?

Check the IV device patency.

Why should the nurse be vigilant with assessment of perioperative risks on the older adult client? Select all that apply.

Ciliary action decreases, reducing the cough reflex. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics.

Which of the following is considered a late symptom of hypothyroidism?

Cold intolerance

A client is receiving a transfusion of packed red blood cells. Shortly after initiation of the transfusion, the client begins to exhibit signs and symptoms of a transfusion reaction. The client is suffering from which type of hypersensitivity?

Cytotoxic (type II)

A patient has a wound that has hemorrhaged. What does the nurse understand is the cause of the patient's increased risk of infection?

Dead space and dead cells provide a culture medium

A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.

Decrease in serum thyroid-stimulating hormone (TSH) Increased T3 Increased T4 Increase in radioactive iodine uptake

Allopurinol has been prescribed for a client receiving treatment for gout. The nurse caring for this client knows to assess the client for bone marrow suppression, which may be manifested by what diagnostic finding?

Decreased platelets

Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply.

Ensuring that the sponge, needle, and instrument counts are correct. Administering medications, fluid, and blood component therapy, if prescribed

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply.

Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions

The nurse's aide notifies the nurse that a client has decreased oxygen saturation levels. The nurse assesses the client and finds that he is tachypneic, has crackles on auscultation, and his sputum is frothy and pink. The nurse should suspect what complication?

Flash pulmonary edema

A patient comes to the clinic with complaints of severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the physician will order for diagnosis?

Fluid deprivation test

A nurse is reviewing with a client the use of a patient-controlled anesthesia device and is explaining the benefits. Which of the following would the nurse correctly emphasize? Select all that apply.

Fosters client participation in care Facilitates reduction of postoperative pulmonary complications

A client has just been told by his health care provider that he has scleroderma. The client is told that he is going to undergo tests to assess for systemic involvement. The nurse knows that priority systems to be assessed include what?

Gastrointestinal

A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for?

Hypokalemia

Which factor presents the most likely cause for weight gain in a diabetic client who is controlled with insulin?

Insulin is an anabolic hormone.

The nurse is caring for a client with cancer who is treating her cancer with deep-tissue massage in addition to radiation therapy. The nurse documents the use of which therapy on the client's chart?

Integrative medicine

The nurse is teaching a client how to self-administer epinephrine using an EpiPen autoinjector. What information should be included in the teaching? Select all that apply.

Jab the EpiPen autoinjector firmly into the outer thigh. After administering the injection, massage the area for 10 seconds. Hold the EpiPen autoinjector against the thigh for 10 seconds.

Which group of mediators initiates the inflammatory response?

Leukotrienes

The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to

Limit alcohol ingestion to one drink per day.

Which cells present the antigen to T cells and initiate the immune response?

Macrophages

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply.

May improve blood glucose levels Decrease the need for exogenous insulin Help reduce cholesterol levels

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor?

Miglitol

The nurse suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs?

Neovascularization into the vitreous humor

A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?

No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test

A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?

Papillary carcinoma

On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is:

Paresthesia

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?

Patient's eating and sleeping habits

A client is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)? Select all that apply.

Positive C-reactive protein (CRP) Positive antinuclear antibody (ANA) Red blood cell (RBC) count of <4.0 million/mcL

The nurse is caring for an 82-year-old female client in the PACU. The woman begins to awaken and responds to her name, but is confused, restless, and agitated. What principle should guide the nurse's subsequent assessment?

Postoperative confusion is common in the older adult client, but it could also indicate a significant blood loss.

An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client?

Prevention of respiratory complications

A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping?

Refer client for professional counseling.

The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is:

Soft with poorly defined borders.

The nurse is caring for a 78-year-old man who has had an outpatient cholecystectomy. The nurse is getting him up for his first walk postoperatively. To decrease the potential for orthostatic hypotension and consequent falls, what should the nurse have the client do?

Stand upright for 2 to 3 minutes prior to ambulating.

A patient with sickle cell disease comes to the emergency department and reports severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide?

Start an intravenous line with dextrose 5% in 0.25 normal saline

A nurse is reviewing a laboratory order for a client who is scheduled to be tested for a suspected endocrine disorder. The client was recently seen in the office for bronchitis, and you note that he is still taking cough medication. The nurse explains to the client that he will not be able to get his lab testing done today. Why has the testing been postponed?

The client is being tested for a thyroid disorder

A client with human immunodeficiency virus undergoes intradermal anergy testing using Candida and mumps antigen. During the 3 days following the tests, there is no induration or evidence of reaction at the intradermal injection sites. What accurate conclusion can the nurse make?

The client is immunodeficient and won't have a skin response.

In anticipation of a client's scheduled surgery, the nurse is teaching her to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the client?

The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs.

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.

The client will leave the hospital sooner than in the past. Need for teaching is increased. The client must be prepared to take on more self-care than he or she may have done in the past

Which position should the patient undergoing pelvis surgery be positioned?

Trendelenburg

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns?

Tricyclic antidepressants

A client has sought care, stating that she developed hives overnight. The nurse's inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the client developed?

Type I

A client on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks' duration can suppress the adrenal cortex for how long?

Up to 1 year

The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure?

Up to 2 hours before surgery

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications?

Urinary tract infections

The most common cause of iron deficiency anemia in men and postmenopausal women is

bleeding.

In a client infected with human immunodeficiency virus (HIV), CD4+ levels are measured to determine the:

extent of immune system damage.

A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply.

instructs the client to discontinue calcium asks about nausea and vomiting teaches the client to report abdominal or bone pain

A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with?

normal cellular processes during the S phase of the cell cycle

A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits

Urine output greater than or equal to 30 mL/hour

The nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. What actions should the nurse encourage the client to perform? Select all that apply.

Use a lip lubricant. Use dental floss every 24 hours. Rinse the mouth with normal saline.

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching?

Use all available injection sites within one area.

Which newer pharmacological therapy, used to treat osteoarthritis, is thought to prevent the loss of cartilage and repair chondral defects, as well as have some anti-inflammatory effects?

Viscosupplementation

A patient is scheduled for surgery with spinal anesthesia. When explaining this type of anesthesia to the patient, which body area would the nurse describe as being affected first?

Perineum

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.

Diarrhea Intestinal cramping Nausea and vomiting

The health care provider has explained to a client that the client has developed diabetic neuropathy in his right foot. Later that day, the client asks the nurse what causes diabetic neuropathy. What would be the nurse's best response?

"The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years."

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen?

Administering a dose of intermediate-acting insulin before the evening meal

A diabetes nurse is assessing a client's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the client's knowledge of nutritional therapy in diabetes?

Ask the client to keep a food diary and review it with the nurse.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

Disease-modifying antirheumatic drugs (DMARDs)

When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?

High blood sugar decreases blood circulation to nerves.

A client diagnosed with cancer has his tumor staged and graded based on what factors?

How they tend to grow and the cell type

Which type of phagocytic disorder occurs when white blood cells cannot initiate an inflammatory response to infectious organisms?

Hyperimmunoglobulinemia

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.

Hyperkalemia Hyperuricemia Hyperphosphatemia

Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience?

Perioperative

A 76-year-old client had surgery for an abdominal hernia. The PACU nurse observes that the client is confused and is trying to climb out of the bed and pull at the cardiac monitor lines. At this time, what interventions by the nurse are appropriate? Select all that apply.

Reorient the client. Assess for hypoxia. Assess urine output.

The physician requests lidocaine 2% with epinephrine for use in local infiltration anesthesia. What does the nurse understand is the purpose of adding epinephrine to the lidocaine? (Select all that apply.)

The epinephrine causes vasoconstriction. The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine prolongs the local action of the anesthetic agent.

Which intervention should the nurse implement during the intraoperative period to protect the client from injury? Select all that apply.

Verify scheduled procedure with client. Assess the client for allergies. Confirm the consent form is signed.