Leadership Final

CHAPTER 19 22. After receiving the change-of-shift report, which patient should the nurse assess first? 1. An 18-month-old patient with coarctation of the aorta who has decreased pedal pulses 2. A 3-year-old patient with rheumatic fever who reports severe knee pain 3. A 5-year-old patient with endocarditis who has crackles audible throughout both lungs 4. An 8-year-old patient with Kawasaki disease who has a temperature of 102.2°F (38.9°C)

3. A 5-year-old patient with endocarditis who has crackles audible throughout both lungs

19. The nurse is preparing a care plan for a patient with Cushing disease. Which abnormal laboratory values would the nurse expect? Select all that apply. 1. Increased serum calcium level 2. Increased salivary cortisol level 3. Increased urinary cortisol level 4. Decreased serum glucose level 5. Decreased sodium level 6. Increased serum cortisol level

(All increased cortisol levels) 2. Increased salivary cortisol level 3. Increased urinary cortisol level 6. Increased serum cortisol level

12. A patient with adrenal insufficiency is to be discharged and will take prednisone 10 mg orally each day. Which instruction would the nurse be sure to teach the patient? 1. Excessive weight gain or swelling should be reported to the health care provider. 2. Changing positions rapidly may cause hypotension and dizziness. 3. A diet with foods low in sodium may be beneficial to prevent side effects. 4. Signs of hypoglycemia may occur while taking this drug.

1. Excessive weight gain or swelling should be reported to the health care provider.

CHAPTER 21 14. An experienced traveling nurse has been assigned to work in the emergency department (ED); however, this is the nurse's first week on the job. Which area of the ED is the most appropriate assignment for this nurse? 1. Trauma team 2. Triage 3. Ambulatory or fast-track clinic 4. Pediatric medicine team

3. Ambulatory or fast-track clinic

25. The nurse is caring for an 81-year-old adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the patient's risk for development of hyperglycemic-hyperosmolar syndrome (HHS)? Select all that apply. 1. Hydrochlorothiazide (HCTZ) prescribed to control her blood pressure 2. Weight gain of 6 lb (2.7 kg) over the past month 3. Avoids consuming liquids in the evening 4. Blood pressure of 168/94 mm Hg 5. Urine output of 50 to 75 mL/hr 6. Glucose greater than 600 mg/dL (33.3 mmol/L)

1. Hydrochlorothiazide (HCTZ) prescribed to control her blood pressure 3. Avoids consuming liquids in the evening 6. Glucose greater than 600 mg/dL (33.3 mmol/L)

8. A 58-year-old patient with type 2 diabetes was admitted to the acute care unit with a diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When the RN prepares a care plan for this patient, what would he or she be sure to include? Select all that apply. 1. Fingerstick blood glucose checks before meals and at bedtime 2. Sliding-scale insulin dosing as prescribed 3. Bed rest until the COPD exacerbation is resolved 4. Teaching about the Atkins diet for weight loss 5. Demonstration of the components of foot care 6. Discussing the relationship between illness and glucose levels

(Not bed rest or Atkins diet) 1. Fingerstick blood glucose checks before meals and at bedtime 2. Sliding-scale insulin dosing as prescribed 5. Demonstration of the components of foot care 6. Discussing the relationship between illness and glucose levels

CHAPTER 13 STARTS 5. A patient with newly diagnosed diabetes has peripheral neuropathy. Which key points should the nurse include in the teaching plan for this patient? Select all that apply. 1. "Clean and inspect your feet every day." 2. "Be sure that your shoes fit properly." 3. "Nylon socks are best to prevent friction on your toes from shoes." 4. "Only a podiatrist should trim your toenails." 5. "Report any nonhealing skin breaks to your health care provider (HCP)." 6. "Use a thermometer to check the temperature of water before taking a bath."

(Not nylon or podiatrist) 1. "Clean and inspect your feet every day." 2. "Be sure that your shoes fit properly." 5. "Report any nonhealing skin breaks to your health care provider (HCP)." 6. "Use a thermometer to check the temperature of water before taking a bath."

10. Which of the following should the nurse be sure to assess before and after giving amlodipine to treat high blood pressure? Select all that apply. 1. Swelling in ankles or feet 2. Heart rate 3. Oral temperature 4. Blood pressure 5. Lung sounds 6. Weight 7. Respiratory rate

(Not oral temp or resp rate) 1. Swelling in ankles or feet 2. Heart rate 4. Blood pressure 5. Lung sounds 6. Weight

CHAPTER 15 STARTS 1. Which actions will the nurse use when treating a client with a venous ulcer on the right lower leg? Select all that apply. 1. Position the right leg lower than the heart. 2. Use compression wraps consistently. 3. Administer analgesics before wound care. 4. Maintain a dry wound environment. 5. Encourage right ankle flexion exercises. 6. Clean wound with a nonirritating solution.

(Not position or dry wound) 2. Use compression wraps consistently. 3. Administer analgesics before wound care. 5. Encourage right ankle flexion exercises. 6. Clean wound with a nonirritating solution.

35. The RN supervising a senior nursing student is discussing methods for preventing acute kidney injury (AKI). Which points would the RN be sure to include in this discussion? Select all that apply. 1. Encourage patients to avoid dehydration by drinking adequate fluids. 2. Instruct patients to drink extra fluids during periods of strenuous exercise. 3. Immediately report a urine output of less than 2 mL/kg/hr. 4. Record intake and output and weigh patients daily. 5. Question any prescriptions for potentially nephrotoxic drugs. 6. Monitor laboratory values that reflect kidney function.

(Not report urine or question scripts) 1. Encourage patients to avoid dehydration by drinking adequate fluids. 2. Instruct patients to drink extra fluids during periods of strenuous exercise. 4. Record intake and output and weigh patients daily. 6. Monitor laboratory values that reflect kidney function.

4. A 19-year-old gravida 1, para 0 patient at 40 weeks' gestation who is in labor is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are priority assessments with this medication? Select all that apply. 1. Check deep tendon reflexes. 2. Observe for vaginal bleeding. 3. Check the respiratory rate. 4. Note the urine output. 5. Monitor for calf pain.

(Not vag bleeding or calf pain) 1. Check deep tendon reflexes. 3. Check the respiratory rate. 4. Note the urine output.

34. The RN is supervising a senior nursing student who is caring for a 78-year-old patient scheduled for an intravenous pyelography test. What information would the RN be sure to stress about this procedure to the nursing student? 1. "After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults." 2. "The purpose of this procedure is to measure kidney size." 3. "Because this procedure assesses kidney function, there is no need for a bowel prep." 4. "Keep the patient NPO after the procedure because during the procedure the patient will receive drugs that affect the gag reflex."

1. "After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults."

31. The nurse is caring for a client with multiple injuries sustained during a head-on car collision. Which assessment finding takes priority? 1. A deviated trachea 2. Unequal pupils 3. Ecchymosis in the flank area 4. Irregular apical pulse

1. A deviated trachea

29. A client underwent an exploratory laparotomy 2 days ago. The health care provider (HCP) should be called immediately for which physical assessment finding? 1. Abdominal distention and rigidity 2. Displacement of the nasogastric (NG) tube 3. Absent or hypoactive bowel sounds 4. Nausea and occasional vomiting

1. Abdominal distention and rigidity

21. The nurse is providing patient teaching for an older adult about spironolactone. Which key points would the nurse include? Select all that apply. 1. Avoid the use of salt substitutes. 2. Do not consume excessive amounts of foods that are high in potassium. 3. Be prepared for a decrease in your urine output. 4. This drug works by conserving sodium and excreting potassium. 5. Older adults may be more sensitive to the action of this drug. 6. As an older adult, you are more likely to experience side effects of this drug.

1. Avoid the use of salt substitutes. 2. Do not consume excessive amounts of foods that are high in potassium. 5. Older adults may be more sensitive to the action of this drug. 6. As an older adult, you are more likely to experience side effects of this drug.

25. A patient visits the urgent care clinic with a bacterial respiratory infection. The nurse will anticipate the need for patient teaching about which medication? 1. Azithromycin 2. Amantadine 3. Fluconazole 4. Ethambutol

1. Azithromycin

15. The nurse is providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring by the nurse? 1. Calcium level 2. Sodium level 3. Potassium level 4. White blood cell count

1. Calcium level

23. The nurse is admitting a patient with nephrotic syndrome. Which assessment finding supports this diagnosis? 1. Edema formation 2. Hypotension 3. Increased urine output 4. Flank pain

1. Edema formation

29. A client who had an abdominal hysterectomy 3 days ago reports burning with urination. Her urine output during the previous shift was 210 mL, and her temperature is 101.3°F (38.5°C). Which of these actions prescribed by the health care provider will the nurse implement first? 1. Insert a straight catheter as needed (PRN) for output of less than 300 mL/8 hr. 2. Administer acetaminophen 650 mg now and every 6 hours PRN. 3. Send a urine specimen to the laboratory for culture and sensitivity testing. 4. Administer ceftizoxime 1 g IV now and every 12 hours.

1. Insert a straight catheter as needed (PRN) for output of less than 300 mL/8 hr.

29. A patient in the obstetric clinic is at 8 weeks' gestation. She tells the nurse of her plans to travel next month to visit family in a country that is affected by the Zika virus. What is the priority counseling by the nurse today? 1. It is recommended that a patient not travel to a country impacted by Zika. The Zika virus has been linked to a very serious birth defect called microcephaly. 2. It is recommended that long sleeved shirts and long pants be always worn while there and that mosquito repellent be applied because mosquitos carry the virus. 3. It is recommended that mosquito repellent containing DEET be avoided because it is hazardous in pregnancy. 4. It is recommended that family members from the Zika impacted country not travel to visit the patient because they may carry the Zika virus.

1. It is recommended that a patient not travel to a country impacted by Zika. The Zika virus has been linked to a very serious birth defect called microcephaly.

CHAPTER 14 STARTS 7. A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should the nurse delegate to unlicensed assistive personnel (UAP)? 1. Reminding the patient to change positions slowly 2. Assessing the patient for muscle weakness 3. Teaching the patient how to collect a 24-hour urine sample 4. Revising the patient's nursing plan of care

1. Reminding the patient to change positions slowly

Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is prescribed for Ms. G (older patient with dementia) to treat depression. What instruction related to the fluoxetine is the charge nurse most likely to give to the PNA? 1."Watch for and report mild nausea." 2."Assist patient to stand for orthostatic hypotension." 3."Offer fluids and oral hygiene for dry mouth." 4."Perform hygiene in the afternoon because of morning sedation."

1."Watch for and report mild nausea."

34. The nurse performs a pain assessment. Charlie rates his pain as 4 of 10 on the Wong-Baker FACES® Pain Rating Scale. Which intervention should the nurse implement? 1.Administer 200 mg of ibuprofen. 2.Administer 5 mg of hydrocodone. 3.Administer 100 mg of acetaminophen. 4.Administer 10 mg of codeine.

1.Administer 200 mg of ibuprofen.

18. What is the priority nursing concern for Terry, who is rubbing at his ears, acting fussy, refusing to suck, and has a temperature of 101.2°F (38.4°C)? 1.Pain 2.Poor nutrition 3.Recurrent ear infections 4.Elevated temperature

1.Pain

8. Which assessment finding for Billy is the most urgent and requires immediate intervention and notification of the pediatrician? 1.Sudden increase in respiratory rate and decreased breath sounds 2.Rattling cough productive of frothy, clear, gelatinous sputum 3.Crackles auscultated on inspiration in the lower lung fields 4.Restlessness and wheezing auscultated at the end of expiration

1.Sudden increase in respiratory rate and decreased breath sounds

23. A client with cellulitis is to receive linezolid 600 mg IV over 2 hours. Based on the medication label (refer to figure), the nurse will set the infusion pump for __________ mL/hr.View Figure mL/hr

150 mL (600/600=1 1x300=300 300/2=150)

7. An older adult patient with type 1 diabetes is legally blind and is prescribed daily morning doses of regular and NPH insulin. The patient's daughter provides in-home care and will be preparing insulin syringes on a weekly basis. What does the nurse teach the patient's daughter about storing the prefilled insulin syringes? 1. "Keep the syringes stored flat and do not attach the needles until you are ready to use a syringe." 2. "Keep the syringes in the upright position with the needle pointing toward the ceiling." 3. "Keep them in the upright position with the needle pointing toward the floor." 4. "Storage position is unimportant as long as the syringes are kept in the refrigerator."

2. "Keep the syringes in the upright position with the needle pointing toward the ceiling."

CHAPTER 18 3. Several patients have just come into the obstetric triage unit. Which patient should the nurse assess first? 1. A 17-year-old gravida 1, para 0 (G1P0) woman at 40 weeks' gestation with contractions every 6 minutes who is crying loudly and is surrounded by anxious family members 2. A 22-year-old G3P2 woman at 38 weeks' gestation with contractions every 3 minutes who is requesting to go to the bathroom to have a bowel movement 3. A 32-year-old G4P3 woman at 27 weeks' gestation who noted vaginal bleeding today after intercourse 4. A 27-year-old G2P1 woman at 37 weeks' gestation who experienced spontaneous rupture of membranes 30 minutes ago but feels no contractions

2. A 22-year-old G3P2 woman at 38 weeks' gestation with contractions every 3 minutes who is requesting to go to the bathroom to have a bowel movement

30. The nurse must rearrange the room assignments for clients. Which clients would be best to put in the same room? Select all that apply. 1. A 35-year-old woman with copious intractable nausea and vomiting 2. A 43-year-old woman who underwent cholecystectomy 2 days ago 3. A 53-year-old woman with pain related to alcohol-associated pancreatitis 4. A 62-year-old woman with colon cancer receiving chemotherapy and radiation 5. A 70-year-old woman with stool culture results that show Clostridium difficile 6. A 55-year-old woman who is having symptoms after an exposure to norovirus

2. A 43-year-old woman who underwent cholecystectomy 2 days ago 3. A 53-year-old woman with pain related to alcohol-associated pancreatitis

CASE STUDY 20 STARTS 6. Note: In this case study, the term "psychiatric nursing assistant (PNA)" is used rather than the more familiar "unlicensed assistive personnel (UAP)." Different facilities and localities will use different titles for assistive personnel. The key point to remember in assigning tasks or making patient assignments is that UAPs who routinely work on a medical-surgical unit will have different skill sets compared with PNAs, who usually work on a psychiatric unit.The RN is the charge nurse caring for psychiatric patients on an acute admission unit. The team includes an experienced male RN, a female RN who has floated from a medical-surgical unit, an experienced female licensed practical nurse/licensed vocational nurse (LPN/LVN), and two experienced PNAs. There is also a male nursing student on the unit today. The morning hand-off report includes the following information about the patients. (Note to student: This case study includes seven patients and simulates some events that could occur over the course of one shift. Take notes as though you were listening to morning report. This will give you practice in identifying important information. Refer to your notes and use critical thinking to respond to the questions.)Ms. G, an 82-year-old woman, has a history of dementia and depression. She has been admitted because her daughter believes that "Mom is getting more depressed and confused." She is oriented to self and believes it is 1985. She is continuously trying to "find my coat so I can go to work." She is ambulatory with an unsteady gait and can perform self-care with step-by-step coaching. Her daughter would like her transferred to a long-term geropsychiatric unit.Ms. B, a 32-year-old woman, has borderline personality disorder and a history of frequent admissions to the psychiatric unit. Five days ago, she was admitted for suicidal gesture after self-infliction of cuts to the posterior forearm. She tries to manipulate others, and she is extremely flirtatious with males. She can independently perform activities of daily living (ADLs) but will dress in an excessively provocative manner.Mr. D, a 58-year-old man, has a long history of major depression. He appears lethargic and disinterested in the environment or in others. He responds appropriately when asked a direct question but does not initiate any social interaction. He requires verbal prompting for all ADLs, which he can perform himself; however, he says, "I would rather not."Mr. S, a 38-year-old homeless man, has disorganized schizophrenia and was found wandering naked on a busy street. He has been on the unit for 7 weeks with minimal improvement, but he has not been aggressive toward anyone. He frequently giggles to himself, and if allowed, he weaves bits of garbage into his hair. He demonstrates word salad (schizophasia) and looseness of associations. He requires repetitive coaching to perform all ADLs.Mr. V, a 62-year-old man, voluntarily committed himself 2 days previously for recurrent thoughts of suicide since the death of his wife several months ago. He reports frequently sitting at her graveside with a gun and a bottle of whiskey. He is alert and oriented × 3 (e.g., knows who he is, where he is, and what day and year it is) and answers questions appropriately, but he is preoccupied with thoughts of death. He is on one-to-one suicide precautions.Ms. M, a 40-year-old woman, is diagnosed with manic phase of bipolar disorder. She was admitted after a verbal altercation in an expensive department store when her credit cards were declined because she was over the $10,000 limit. She is talkative, grandiose, and emotionally labile. She can accomplish ADLs but will change her clothes repeatedly throughout the day.Mr. P, a 20-year-old man, has paranoid schizophrenia and was admitted yesterday through the emergency department after causing a disturbance on a public bus. He appears disheveled and acts suspicious. He has been refusing to eat or sleep because he believes that "those guys have been trying to kill me because I know who they are!" The charge nurse is receiving a report from a relatively new night shift nurse. She says that Ms. G (older patient with dementia) was confused during the evening and kept getting out of bed. Because of this, an as needed (PRN) sedative was administered, and a temporary chest restraint was placed to prevent falls. What is the charge nurse's priority action? 1.Report the night nurse to the supervisor for violating the patient's rights. 2.Assess the patient and obtain additional information about the incident. 3.Advise the night nurse to seek out the unit manager and discuss the incident. 4.Call the health care provider (HCP) to obtain prescriptions for medication and restraints.

2. Assess the patient and obtain additional information about the incident.

7. The nurse has just received a change-of-shift report for the burn unit. Which client should be assessed first? 1. Client with deep partial-thickness burns on both legs who reports severe and continuous leg pain 2. Client who has just arrived from the emergency department with facial burns sustained in a house fire 3. Client who has just been transferred from the postanesthesia care unit after having skin grafts applied to the anterior chest 4. Client admitted 3 weeks ago with full-thickness leg and buttock burns who has been waiting for 3 hours to receive discharge teaching

2. Client who has just arrived from the emergency department with facial burns sustained in a house fire

CHAPTER 17 1. A client who is being treated as an outpatient for pelvic inflammatory disease (PID) with oral antibiotics returns to the clinic after 3 days of treatment. Which finding by the nurse is of highest concern? 1. Client reports nausea after taking the antibiotics. 2. Client's abdominal rebound pain is unchanged. 3. Client says she feels ashamed to have the infection. 4. Client's cervical culture report shows gonorrhea.

2. Client's abdominal rebound pain is unchanged.

30. The nurse admits a patient whose assessment reveals prominent brow ridge, large hands and feet, and large lips and nose. Which pituitary hormone does the nurse suspect is elevated? 1. Thyroid-stimulating hormone 2. Growth hormone 3. Adrenocorticotropic hormone 4. Vasopressin antidiuretic hormone

2. Growth hormone

8. A female patient with type 2 diabetes who is breast-feeding her newborn infant has a prescription for glipizide. What is the nurse's best action? 1. Administer the drug as ordered with meals. 2. Hold the drug and clarify the order with the health care provider. 3. Assign the LVN/LPN to administer the drug before breakfast. 4. Instruct the unlicensed assistive personnel to check the patient's fingerstick glucose; then give the drug.

2. Hold the drug and clarify the order with the health care provider.

CHAPTER 16 STARTS 1. The nurse is reviewing the lab values for a patient with risk for urinary problems. Which finding is of most concern to the nurse? 1. Blood urea nitrogen (BUN) of 10 mg/mL (3.6 mmol/L) 2. Presence of glucose and protein in urine 3. Serum creatinine of 0.6 mg/mL (53 mcmol/L) 4. Urinary pH of 8

2. Presence of glucose and protein in urine

12. In the emergency department, during initial assessment of a newly admitted patient with diabetes, the nurse discovers all of these findings. Which finding should be reported to the health care provider immediately? 1. Hammer toe of the left second metatarsophalangeal joint 2. Rapid respiratory rate with deep inspirations 3. Numbness and tingling bilaterally in the feet and hands 4. Decreased sensitivity and swelling of the abdomen

2. Rapid respiratory rate with deep inspirations

33. A patient with diarrhea has been prescribed loperamide 2 mg orally after each unformed stool. Which laboratory value will be most important for the nurse to monitor for this patient? 1. Serum sodium 2. Serum potassium 3. Urine protein 4. Urine nitrogen

2. Serum potassium

9. A patient is to receive metoprolol tartrate 5 mg IV to control high blood pressure. IV metoprolol tartrate is administered over 2 minutes. Based on the label for the medication (refer to figure), the nurse will administer __________ mL/min.

2.5 (5 mg in 5 mL = 5 mL / 2 min = 2.5 mL/min.)

42. The nurse is caring for a client who is on the cardiac monitor because of these symptoms: syncope, dizziness, and intermittent episodes of palpitations. The figure displays (refer to figure) what the nurse sees on the cardiac monitor. What should the nurse do first?View Figure 1. Call the Rapid Response Team. 2. Obtain the automated external defibrillator. 3. Assess the client and take vital signs. 4. Check the adherence of the gel pads on the chest.

3. Assess the client and take vital signs.

CASE STUDY 19 STARTS 1. The charge nurse is working in a large urban pediatric walk-in clinic that offers well-baby care, provides immunizations, and is an educational resource for child health topics. In addition, the clinic also accommodates walk-in clients and offers basic diagnostic testing and emergency care. The staff includes a pediatrician, a graduate student who is working toward an advanced practice nursing (APN) degree, an experienced RN, an experienced licensed practical nurse/licensed vocational nurse (LPN/LVN), a pediatric social worker, a new graduate nurse (GN), and an unlicensed assistive personnel (UAP). This morning, in addition to scheduled appointments, there is an immunization clinic. The charge nurse receives two phone calls, and there is one walk-in client.(Questions 24 through 28)Rebecca is a 6-year-old girl with cystic fibrosis. She arrives at the pediatric cystic fibrosis clinic for her routine 3-month appointment. The nurse obtains and calculates the following growth parameters: Weight, 33 lbs (15 kg) (< 5%); height, 42 in. (106 cm) (5%); and body mass index (BMI), 13 (< 5%). Her parents report specks of blood in her sputum after chest physiotherapy. Her forced expiratory volume in 1 second (FEV1) has decreased 25% from her last visit 3 months ago. Rebecca has clubbing of both her finger and toe nails.(Questions 29 through 31)Four-year-old Bobby is admitted to the pediatric unit with Kawasaki disease. Today is the 7th day of fever. Laboratory studies reveal C-reactive protein of 3.1 mg/dL (29.5 mmol/L) and a WBC count of 17,000 mm3 (17 × 109/L)(Questions 32 through 35)Eight-year-old Charlie had a laparoscopic appendectomy. During surgery, the appendix perforated. Charlie arrives on the pediatric unit from the operating room. His weight on admission was 46 lbs (21 kg). He has a peripheral IV line in the left basilic vein with D5W and 20 mEq/L (20 mmol/L) of KCl running at 70 mL/hr. A nasogastric tube (NG) is attached to low suction. To ensure efficient workflow of the clinic and maximize available expertise, which task should be assigned to the experienced LPN/LVN? 1.Perform triage for walk-in clients. 2.Perform physical assessment of walk-in clients. 3.Give routine immunizations. 4.Obtain weight and height measurements.

3. Give routine immunizations.

29. The patient is experiencing nausea due to Ménière disease. For which drug is the nurse most likely to plan patient teaching? 1. Promethazine 2. Prochlorperazine 3. Meclizine 4. Granisetron

3. Meclizine

CHAPTER 20 A patient is prescribed meloxicam for rheumatoid arthritis. This drug has a long half-life of 51 hours. Which prescription would the nurse be sure to clarify with the health care provider before giving the medication? 1. Meloxicam 7.5 to 15 mg/day 2. Meloxicam 15 mg/day before breakfast 3. Meloxicam 7.5 mg every 4 hours as needed for pain 4. Meloxicam 7.5 mg/day as needed

3. Meloxicam 7.5 mg every 4 hours as needed for pain

28. A 4-year-old patient with acute lymphocytic leukemia has these medications ordered. Which one is most important to double-check with another licensed nurse? 1. Prednisone 1 mg PO 2. Amoxicillin 250 mg PO 3. Methotrexate 10 mg PO 4. Filgrastim 5 mcg subcutaneously

3. Methotrexate 10 mg PO

19. A patient with hypertension is prescribed atenolol 25 mg orally once a day. Which change would be most important for the nurse report to the health care provider (HCP) after the patient begins taking this drug? 1. Heart rate of 58 beats/min 2. Cold hands and feet 3. Patient report of depression 4. Patient report of tiredness

3. Patient report of depression

42. The client has a medical diagnosis of acute appendicitis. On the figure, which area of the abdomen is the client most likely to report abdominal pain and tenderness.View Figure 1. Right upper quadrant (RUQ) 2. Left upper quadrant (LUQ) 3. Right lower quadrant (RLQ) 4. Left lower quadrant (LLQ)

3. Right lower quadrant (RLQ)

14. For clients with peptic ulcer disease (PUD), what is the most important lifestyle modification? 1. Avoiding caffeine 2. Decreasing alcohol intake 3. Smoking cessation 4. Controlling stress

3. Smoking cessation

4. The nurse is assessing a long-term-care client with a history of benign prostatic hyperplasia. Which information will require the most immediate action? 1. The client states that he always has trouble starting his urinary stream. 2. The chart shows an elevated level of prostate-specific antigen. 3. The bladder is palpable above the symphysis pubis, and the client is restless. 4. The client says he has not voided since having a glass of juice 4 hours ago.

3. The bladder is palpable above the symphysis pubis, and the client is restless.

28. When the nurse is evaluating a client who has been taking prednisone 30 mg/day to treat contact dermatitis, which finding is most important to report to the health care provider? 1. The glucose level is 136 mg/dL (7.6 mmol/L). 2. The client states, "I am eating all the time." 3. The client reports frequent epigastric pain. 4. The blood pressure is 148/84 mm Hg.

3. The client reports frequent epigastric pain.

24. The nurse is providing postoperative care for a client who underwent laparoscopic cholecystectomy. What should be reported immediately to the health care provider? 1. The client cannot void 5 hours postoperatively. 2. The client reports shoulder pain. 3. The client reports right upper quadrant pain. 4. Output does not equal input for the first few hours.

3. The client reports right upper quadrant pain.

33. Charlie's parents ask the nurse if the NG tube can be removed because it is irritating Charlie's nose. What is the nurse's best response? 1."The NG tube is necessary to prevent aspiration of the stomach contents into the lungs." 2."The NG tube is necessary because Charlie will need to have feedings through it." 3."The NG tube is necessary to keep Charlie's stomach empty, allowing the intestines to rest." 4."The NG tube is necessary to prevent swallowed air from building up in the stomach."

3."The NG tube is necessary to keep Charlie's stomach empty, allowing the intestines to rest."

16. A 24-year-old patient with diabetes insipidus makes all of these statements when the nurse is preparing the patient for discharge from the hospital. Which statement indicates to the nurse that the patient needs additional teaching? 1. "I will drink fluids equal to the amount of my urine output." 2. "I will weigh myself every day using the same scale." 3. "I will wear my medical alert bracelet at all times." 4. "I will gradually wean myself off the vasopressin."

4. "I will gradually wean myself off the vasopressin."

40. A male nurse tells an older male client that he needs to perform a digital examination of the rectum to check for possible fecal impaction. The client responds, "I'm not letting any homosexual get near me." What should the nurse do first? 1. Explain that the procedure is a nursing action, not a sexual advance. 2. Ask the charge nurse to reassign that client to a different nurse. 3. Document that the client refused to allow the examination. 4. Ask the client if the presence of a female staff member would be acceptable.

4. Ask the client if the presence of a female staff member would be acceptable.

8. Assessment findings for a patient with Cushing disease include all of the following. For which finding would the nurse notify the health care provider (HCP) immediately? 1. Purple striae present on the abdomen and thighs 2. Weight gain of 1 lb (0.5 kg) since the previous day 3. Dependent edema rated as + 1 in the ankles and calves 4. Crackles bilaterally in the lower lobes of the lungs

4. Crackles bilaterally in the lower lobes of the lungs

9. An unlicensed assistive personnel (UAP) tells the nurse that while assisting with the morning care of a postoperative patient with type 2 diabetes who has been given insulin, the patient asked if she will always need to take insulin now. What is the RN's priority for teaching the patient? 1. Explain to the patient that she is now considered to have type 1 diabetes. 2. Tell the patient to monitor fingerstick glucose level every 4 hours after discharge. 3. Teach the patient that a person with type 2 diabetes does not always need insulin. 4. Discuss the relationship between illness and increased glucose levels.

4. Discuss the relationship between illness and increased glucose levels.

CHAPTER 12 STARTS 4. The nurse would be most concerned about a prescription for a total parenteral nutrition (TPN) fat emulsion for a client with which condition? 1. Gastrointestinal (GI) obstruction 2. Severe anorexia nervosa 3. Chronic diarrhea and vomiting 4. Fractured femur

4. Fractured femur

14. A patient with familial hypercholesterolemia is prescribed atorvastatin 10 mg once a day. Which finding will the nurse immediately report to the health care provider? 1. Stomach upset 2. Constipation 3. Bloating 4. Muscle soreness

4. Muscle soreness

A psychiatric social worker is conducting a community meeting. The charge nurse is the co-leader. All patients are attending because there has been theft of personal items. Ms. M (manic phase bipolar disorder) continuously interrupts and loudly announces, "Ms. B (borderline personality) stole my lipstick. Look at her lips!" What is the nurse's best response to this situation? 1.Walk over to Ms. M and quietly escort her out of the meeting. 2.Allow the psychiatric social worker to control the meeting and the patients' behaviors. 3.Instruct Ms. B to give an honest response to Ms. M's accusations. 4.Tell Ms. M that the thefts are being investigated and to please not interrupt.

4. Tell Ms. M that the thefts are being investigated and to please not interrupt.

12. The nurse obtains this information about a 60-year-old client who has a shingles infection. Which finding is of most concern? 1. The client has had symptoms for about 2 days. 2. The client has severe burning-type discomfort. 3. The client has not had the herpes zoster vaccination. 4. The client's spouse is currently receiving cancer chemotherapy.

4. The client's spouse is currently receiving cancer chemotherapy.

29. Which nursing assessment is a priority? 1.Obtain a rectal temperature. 2.Auscultate the lungs. 3.Obtain a blood pressure. 4.Auscultate the heart.

4.Auscultate the heart.