N370 Med Surg Powerpoint Questions

What is a typical complication of inadequate chest tube dressing change? 1) Infection 2) Increased intra-abdominal pressure 3) Activation of clotting factors 4) Increased blood lactic acid

1) Infection Keep the dressing clean, dry and intact. Monitor vital signs for acute changes, as well as the site of chest tube placement for evidence of infection. If the dressing becomes soiled, change the dressing per hospital policy.

Regarding chest tubes, which finding in the suction system indicates a significant air leak? 1) Hypoxemia 2) Excessive bubbling 3) Chest pain 4) Shortness off breath (SOB)

2) Excessive bubbling

Which finding should prompt urgent re-evaluation of a patient with a chest tube? 1) Malar rash 2) Shortness of breath (SOB) 3) Dry mouth 4) Constipation

2) Shortness of breath (SOB)

Regarding chest tube management and care, what is the physical exam finding associated with subcutaneous emphysema? 1) Coughing 2) Respiratory depression 3) Crepitus 4) Dyspnea and respiratory distress

3) Crepitus Crepitus occurs when gas or air leaks into the subcutaneous emphysema. This can indicate an air leak or the need for a dressing change. Notify the doctor if crepitus is felt.

A client with chronic bronchitis is admitted to the health facility.Auscultation of the lungs reveal slow-pitched, rumbling sounds. What breath sound should the nurse document? A) Rhonchi B) Crackles C) Stridor D) Wheezes

A) Rhonchi

A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply. A. Decreased protein intake B. Decreased sodium intake C. Increased potassium intake D. Fluid restriction E. Vitamin D supplementation

A. Decreased protein intake B. Decreased sodium intake D. Fluid restriction

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A. Hematuria B. Precipitous decrease in serum creatinine levels C. Hypotension unresolved by fluid administration D. Glucosuria

A. Hematuria Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. A. Specific gravity of the client's urine B. Testing for the presence of glucose in the client's urine C. Microscopic examination of urine sediment for RBCs D. Microscopic examination of urine sediment for casts E. Testing for BUN and creatinine in the client's urine

A. Specific gravity of the patients urine B. Testing for the presence of glucose in the patients urine C. Microscopic examination of urine sediment for RBCs D. Microscopic examination of urine sediment for casts

A client exhibits a sudden and complete loss of voice and is coughing. The nurse states A) "The 'tickle' in your throat will improve with cold liquids." B) "Do not smoke and avoid being around others who are smoking." C) "Do not use a humidifier; it will make your problem worse." D) "It is fine to speak in a whisper. This does not strain your voice."

B) "Do not smoke and avoid being around others who are smoking."

The nurse is assessing a patient in respiratory failure. What finding is alate indicator of hypoxia? A) Crackles B) Cyanosis C) Clubbing of fingers D) Restlessness

B) Cyanosis

A nurse is caring for a client with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? A. A fasting serum potassium level and a random urine sample B. A 24-hour urine specimen and a serum creatinine level midway through the urine collection process C. A BUN and serum creatinine level on three consecutive mornings D. A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

B. A 24-hour urine specimen and a serum creatinine level midway through the urine collection process

A 52-year-old client is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A. Petechiae B. Pain C. Gastrointestinal symptoms D. Changes in voiding E. Jaundice

B. Pain C. Gastrointestinal symptoms D. Changes in voiding

A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient? A) 75% B) 90% C) 95% D) 100%

C) 95%

The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)? A. An inability to initiate voiding for 2 days. B. The urine is cloudy and has visible sediment with a foul odor. C. Average urine output has been 10 mL/hr for several hours. D. Client reports left-sided flank pain.

C. Average urine output has been 10 mL/hr for several hours.

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? A. Hemodialysis B. Peritoneal dialysis C. Continuous venovenous hemodialysis (CVVHD) D. Plasmapheresis

C. Continuous venovenous hemodialysis (CVVHD)

Results of a client's 24-hour urine sample indicate osmolality of 510mOsm/kg (510 mmol/kg), which is within reference range. What conclusion can the nurse draw from this assessment finding? A. The client's kidneys are capable of maintaining acid-base balance. B. The client's kidneys reabsorb most of the potassium that the client ingests. C. The client's kidneys can produce sufficiently concentrated urine. D. The client's kidneys are producing sufficient erythropoietin

C. The client's kidneys can produce sufficiently concentrated urine. Feedback: Osmolality is the most accurate measurement of the kidney's ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acid-base balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.

In which position should the client be placed for a thoracentesis? A) Lateral recumbent B) Supine C) Prone D) Sitting at edge of the bed

D) Sitting at edge of the bed

A geriatric nurse is performing an assessment of body systems on an older adult client. The nurse should be aware of what age-related change affecting the renal and urinary systems? A. Increased ability to concentrate urine B. Increased bladder capacity C. Urinary incontinence D. Decreased glomerular filtration rate

D. Decreased glomerular filtration rate

The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate? A. Decrease in blood urea nitrogen (BUN) B. Less antidiuretic hormone (ADH) released C. Decreased urine osmolality D. Increased urine specific gravity

D. Increased urine specific gravity

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A. The kidneys will excrete increased quantities of acid. B. Bicarbonate will be released from the adrenal medulla. C. Alveoli in the lungs will synthesize new bicarbonate. D. Renal tubular cells will generate new bicarbonate.

D. Renal tubular cells will generate new bicarbonate. Feedback: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body.

A nurse is assessing a new client who is diagnosed with peripheral artery disease. The nurse cannot feel the pulse in the client's left foot. How should the nurse proceed with assessment? A. Have the primary care provider prescribe a computed tomography (CT) scan. B. Apply a tourniquet for 3 to 5 minutes and then reassess. C. Elevate the extremity and attempt to palpate the pulses. D. Use Doppler ultrasound to identify the pulses.

D. Use Doppler ultrasound to identify the pulses.

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? A. Only when needed B. Daily at bedtime C. First thing in the morning D. With each meal

D. With each meal

Why aren't full thickness burns generally pain-free? ➢ They aren't. All burns have the same level of pain ➢ Full-thickness burn involve the epidermis, dermis, and the subcutaneous tissue destroying nerve ending ➢ Modern medical procedures relieve much of the pain of full-thickness burns

Full-thickness burn involve the epidermis, dermis, and the subcutaneous tissue destroying nerve ending

The body response to burn injury has been classified as ➢ Hyperdynamic response, hypermetabolic response, and hypercatabolic response ➢ Hyperdynamic response, hypometabolic response, and hypercatabolic response ➢ Hypodynamic response, hypermetabolic response, and hypercatabolic response ➢ Hypodynamic response, hypometabolic response, and hypocatabolic response

Hyperdynamic response, hypermetabolic response, and hypercatabolic response

Prevention of shock and respiratory distress are two immediate priorities of care during the emergent/resuscitation phase burn injury ➢ True ➢ False

True

The nurse assess a patient with a known history of asthma and finds wheezing through the lung fields, suprasternal retractions on inhalation, and decreased oxygen saturation. What is the nurse's best action at this time? a) Administer the prescribed PRN oxygen and beta agonist medication by nebulizer b) Assess for signs of upper respiratory infection c) Call code blue d) Perform peak expiratory flow reading and calculate minute ventilation

a) Administer the prescribed PRN oxygen and beta agonist medication by nebulizer

The nurse is providing care for a client who has recently been diagnosed with chronic obstructive pulmonary disease. When educating the client about exacerbations, the nurse should prioritize which topic? a) Identifying specific causes of exacerbations b) Prompt administration of corticosteroids during exacerbations c) The importance of prone positioning during exacerbations d) The relationship between activity level and exacerbations

a) Identifying specific causes of exacerbations

The patient being ventilated with a bag valve mask for acute respiratory failure has the following arterial blood gas values. What is the nurse's interpretation of the cause of these values? pH: 7.30 pCO2: 58 mmHg pO2: 98 mmHg HCO3: 22 mEd/L a) The patient is being hyper ventilation b) The patient is being under ventilation c) The patient is being normal ventilation d) The patient is being hypovolemic

b) The patient is being under ventilation

You are monitoring care for a patient diagnosed with active pulmonary tuberculosis who has been taking the prescribed doses of isoniazid, rifampin, pyrazinamide, and ethambutol. Which finding best indicates the antibiotic therapy is effective a) Patient can breathe better b) No more fever c) Sputum cultures converts to negative d) Non- productive cough only

c) Sputum cultures converts to negative