med surg clicker questions
Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says: "I should expect to have a low fever all the time with this disease." "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." "I should try to ignore my symptoms as much as possible and have a positive outlook." "I can expect a temporary improvement in my symptoms if I become pregnant."
"I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period
Initial imaging in patients with suspected appendicitis, RLQ pain, fever and leukocytosis should include? MRI of abdomen (this will take a long period of time, but will show the appendicitis) KUB x-ray (Will show an obstruction or a perforated bowel, will show free air) Barium Enema CT scan of abdomen with contrast (will show within 5 mins)
CT scan of abdomen with contrast (will show within 5 mins)
The cardiac care is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence?
SA - AV- BUNDLE- PURKINJE
In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. hematuria b. specific gravity fixed at 1.010 c. urine sodium of 12 mEq/l (12 mmol/L) d. osmolality of 1000 mOsm/kg (1000 mmol/kg)
b. specific gravity fixed at 1.010 shows inability of tubules to concentrate urine
A client is being treated for cancer and the nurse has identified the nursing diagnosis of risk for infection due to protein losses inhibit immune response in what way? Causing apoptosis of cytokines Increasing interferon production Causing CD4+ cells to mutate Depressing antibody response
depressing antibody response
The most common symptom of esophageal disease is? Nausea Vomiting Dysphagia Odynophagia
dysphagia
A nurse is educating the parent of a child on common food allergies that may cause hypersensitivity symptoms. Which foods should the parent be cautious of? Root vegetables and tomatoes Citrus fruit and rice Vegetable oils Eggs and wheat
eggs and wheat
EPS
electrophysiologic study: gives a roadmap of the circuitry of the heart. Diagnosis abnormality of the electrical short in the heart. Identify if a candidate for a cardiac ablation. (Cardiac ablation-go into the heart and cauterize (burn) that path they fry that part of the electrical current, gives scar tissue which can not conduct, curing the arrhythmia. Fist ablation is about 60% effective, second is about 70% and third is about 85%)
The nurse instructs the client with GERD regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes? Eliminating spicy foods Avoiding chocolate and coffee Eliminating cucumbers and other foods with seeds Avoiding steamed foods
eliminating spicy foods
EKG
evaluates the current rhythym
Post op, a client with a radical neck dissection should be placed in which position? Supine Fowler Prone Side lying
flowler
A client's natural immunity is enhanced by processes that are inherent in the physical and chemical barriers of the body. What is a chemical barrier that enhances natural immunity Cell Cytoplasm Interstitial fluid Gastric Secretions Cerebrospinal Fluid
gastric secretions
A clients exposure to which of the following multi organisms is most likely to trigger a cellular response? Herpes Simplex Staphylococcus aureus Pseudomonas aeruginosa Beta hemolytic Streptococcus
herpes simplex Herpes is a viral disease while the others are bacterial Herpes is a disease that is silently shedding
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? Diphenhydramine Montelukast Albuterol sulfate Epinephrine
montelukast
The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the clients signs and symptoms should the nurse report to the physician? Nausea Left lower quadrant pain Pain when pressure is applied to the right lower quadrant High Fever
nausea
A client undergoes total gastrectomy. Several hours after surgery you note that the NG tube has stopped draining. How should the nurse respond? Increase the suction level Reposition the tube Irrigate the tube Notify the health care provider
notify the health care provider
Each bone is composed of cells, protein matrix, and mineral deposits. Which type of bone cell works to repair fracture? Osteomytes Osteoblasts (bone formation) Osteoclasts Osteocytes (neural bone makeup)
osteoblasts osteoclasts (break down) Osteocytes (neural bone makeup) Osteoblasts (bone formation)
A 40-year-old woman was diagnosed with Raynaud phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The client also states that many of her skin surfaces are "stiff, like the skin is being stretched in all directions". The nurse should recognize the need for medical referral for what condition? Giant cell arteritis Fibromyalgia Rheumatoid arthritis Scleroderma
scleroderma
A nurse has included diagnosis of risk for latex allergy response in a client's plan of care. The presence of what chronic health problem would most likely prompt this diagnosis? Herpes simplex HIV Spina bifida Hypogammaglobulinemia
spina bifida
The nurse should recognize a client's risk for impaired function if the client has undergone surgical removal of which of the following? Thyroid gland Spleen Kidney Pancreas
spleen
5. During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient's energy level along with muscle strength and maintain joint health. Choose the correct statement. "It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics." "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike." "It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine." "Physical exercise should be limited to only range of motion exercises to prevent further joint damage."
"I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike." During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient's energy level along with muscle strength and maintain joint health.
Mr. Mc Princeton who is diagnosed with rheumatoid arthritis (RA) complains about joints that always hurt, saying, "I just feel like staying in bed all day." Which discharge instruction would be aimed at maintaining as such function as possible? "Refrain from exercise because it onlys aggravates the disease process." "Apply elastic bandages to all joints to increase the pain threshold." "Maintain a supine position for most of the day to prevent the stress of weight bearing." "Promote aquatic exercises to enhance joint mobility."
"Promote aquatic exercises to enhance joint mobility." Water exercises are excellent because water promotes buoyancy, which eases joint movement. Persons with RA should maintain an active exercise program to strengthen and preserve muscle movement. Heat or cold applications, which promote circulation and reduce swelling, may help relieve pain, but elastic bandage wraps most likely would not be helpful
7. A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? "You have an appointment with a physical therapist for tomorrow." "Leave the shoulder immobilizer on for the first few days to minimize pain." "The doctor will use the drop-arm test to determine the success of the procedure." "You should try to find a different position to play on the baseball team."
"You have an appointment with a physical therapist for tomorrow." Rationale: Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of ROM. The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.
The nurse is providing care for a client whose PUD will be treated with a Billroth I procedure (gastroduodenostomy). The nurse should address which of the following topics when providing health education? Select all that apply. A. The procedure carries a risk for dumping syndrome B. The client is likely to require long-term total parenteral nutrition (TPN) C. The client's vagus nerve may be altered D. The client can resume a usual diet in 3 to 5 weeks E. Part of the client's stomach and colon will be removed
A. The procedure carries a risk for dumping syndrome C. The client's vagus nerve may be altered
Nurse is taking care of a client with lower motor neuron destruction. How would the nurse document on the electronic health record the muscle tone in the client's lower legs? Limp Flaccid Spastic Atonic
ATONIC Limp (osteoarthritis) Flaccid (stroke) Spastic (upper motor neuron, hyper-reflexive response) Atonic (muscle atrophy, lower motor neuron)
The nurse is reviewing the immune system before planning an immunocompromised client's care. How should the nurse characterize the humoral immune response? Specialized cells recognize and ingest cells that are recognized as foreign T Lymphocytes are assisted by cytokines to fight infection Lymphocytes are stimulated to become cells that attack microbes directly Antibodies are made by B lymphocytes in response to a specific antigen
Antibodies are made by B lymphocytes in response to a specific antigen
The patient is going to be removed from skeletal traction. What intervention is likely to follow? Application of a cast Passive range of motion exercises Application of a walking boot Education on how to use crutches
Application of a cast
A hospital client is immunocompromised because of his stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? Arrange for a portable x-ray machine to be used Have the client wear a mask to the x-ray department Ensure that the radiology department has been disinfected prior to the test Send the client to the x-ray department, and have the staff in the department wear masks
Arrange for a portable x-ray machine to be used
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury? Client reports inability to initiate voiding Clients urine is cloudy with foul odor Clients average urine output has been 10 ml/h for several hours Client complains of acute flank pain
Clients average urine output has been 10 ml/h for several hours -Urine output is the hallmark for any type of kidney injury -Make sure they are well hydrated and monitor urine output -Should be over 30 ml/h
A client sustained burns on the back. These areas appear dry, blotchy cherry red, blistering, doesn't blanch, no capillary refill and reduced or absent sensation. This type of burn depth is classified as? Superficial partial thickness Superficial dermal Deep partial thickness Full thickness
Deep partial thickness Deep partial-thickness burn: blistering, dry, blotchy cherry red, doesn't blanch, no capillary refill and reduced or absent sensation. Generally, heals in 3-6 weeks, but scar formation results and skin grafting may be required.Option A: Superficial partial-thickness: red, glistening, pain, absence of blisters and brisk capillary refill. Not life-threatening and normally heal within a week, without scarring. Option B: pale pink or mottled appearance with associated swelling and small blisters. With a wet, shiny, and weeping surface is also a characteristic. Brisk capillary refill. Option D: Full-thickness: dry, white or black, no blisters, absent capillary refill and absent sensation. Requires surgical repair and grafting
Which diagnostic study best evaluates different medication ability to restore normal heart rhythm? EKG EPS study
EPS
Which intervention would the nurse implement with the client in skeletal traction? Apply 8 pound weights to the rope Ensure pins or wires are covered with caps Remove the boot and inspect skin daily Position trapeze within clients reach
Ensure pins or wires are covered with caps Position trapeze within clients reach
An elderly client states " i don't understand why I have so many caries in my teeth". What assessment made by the nurse places the client at risk for dental caries? Exhibiting hemoglobin A1C 8.2 Drinking fluoridated water Eating fruits and cheese in diet Using a soft bristled toothbrush
Exhibiting hemoglobin A1C 8.2
A client with a fractured ankle is having a fiberglass cast apple. The client starts yelling "my leg is burning, take it off" what action by the nurse is most appropriate? Explain that the sensation being felt is normal and will not burn the client Remove the cast immediately, notifying the physician
Explain that the sensation being felt is normal and will not burn the client
Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? Administration of vasopressin and insertion of a balloon tamponade Preparation for a paracentesis and administration of diuretics Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day
Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit pancreatic stimulation and secretion of pancreatic enzymes. NG intubation with low intermittent suction is used to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid. Vasopressin would be appropriate for a client diagnosed with bleeding esophageal varices. Paracentesis and diuretics would be appropriate for a client diagnosed with portal hypertension and ascites. A low-fat diet and increased fluid intake would further aggravate the pancreatitis
Tube feedings are advised for a client who is recovering from oral surgery. The nurse manages the tube feedings to minimize the risk of aspiration. Which measures should the nurse include in the care plan to reduce the risk of aspiration? Select all that apply. Place the client in semi fowlers during and 30-60 minutes after an intermittent feeding Check tube placement and gastric residual prior to feeding Administer 15-30 mL of water before and after medications and feedings Change the tube feeding container and tubing
Place the client in semi fowlers during and 30-60 minutes after an intermittent feeding Check tube placement and gastric residual prior to feeding
A female patient is diagnosed with a right sided stroke. That patient is now experiencing hemianopsia. How might the nurse help the patient manage her potential sensory and perceptual difficulties? Keep lighting in the patient's room low Place patients clock on affected side Approach the patient on the side where vision is impaired Place the patient's extremities where she can see them
Place the patient's extremities where she can see them
A 43 year old male came into the emergency room department where you practice nursing and was diagnosed with afib. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order? Heparin Warfarin Pradaxa
Pradaxa -Pradaxa : has a quicker therapeutic effect -Within the first 48 hours they will be heparinized, but need to be on long term so if on warfarin remember the bridge effect -You would not want someone in a contact sport or a high fall risk to be on pradaxa, warfarin or heparin because of the chance of bleeding. They can exercise.
9. A patient received a total hip replacement the day before. How can the nurse prevent dislocation of the new prothesis? Have the client reposition himself independently Protect the affected leg from internal rotation Keep the affected leg in a position of adduction Keep the hip flexed by placing a pillow under the client's knee
Protect the affected leg from internal rotation
After completion of testing, a child's allergies have been attributed to her family's cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action? Removing the cat from the family's home Administer OTC antihistamines to the child regularly Keeping the cat restricted from the child's bedroom Maximizing airflow in the house
Removing the cat from the family's home
A client with rheumatoid arthritis comes to the clinic reporting pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this client, what management technique should the nurse emphasize? Take OTC calcium supplements consistently Restrict foods high in purines Ensure fluid intake of at least 4L per day Restrict weight bearing on right foot
Restrict foods high in purines
A clients decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with what health problem? Rheumatoid Arthritis (RA) SLE Osteoporosis Polymyositis
Rheumatoid Arthritis (RA)
The nurse is caring for a client who returned from the tropics a few weeks ago and who sought care with signs and symptoms of lymphedema. The nurses plan of care should prioritize what nursing diagnosis? Risk for infection rt lymphedema Disturbed body image rt lymphedema Ineffective health maintenance rt lymphedema Risk for deficient fluid volume rt lymphedema
Risk for infection rt lymphedema
The nurse is providing care for a client whose peptic ulcer disease will be treated with a Billroth1 procedure (gastroduodenostomy). The nurse should address which of the following topics when providing health education? Select all that apply. The procedure carries a risk for dumping syndrome The client is likely to require long-term total parenteral nutrition (TPN) The clients vagus nerve may be altered The client can resume a usual diet in 3-5 weeks Part of the clients stomach and colon will be removed
The procedure carries a risk for dumping syndrome The clients vagus nerve may be altered The client can resume a usual diet in 3-5 weeks
In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes: Circulating immune complexes formed from IgG autoantibodies reacting with IgG An autoimmune T-cell reaction that results in destruction of the deep dermal skin layer Immunologic dysfunction leading to chronic inflammation in the cartilage and muscles The production of a variety of autoantibodies directed against components of the cell nucleus
The production of a variety of autoantibodies directed against components of the cell nucleus Rationale: Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response
Family members bring a client to the ED with pale skin, sudden mid sternal chest pain relieved with rest and history of CAD. how should the nurse best interpret these initial data? The symptoms indicate angina and should be treated as such The symptoms indicate a pulmonary etiology rather than a cardiac etiology The symptoms indicate an acute coronary episode and should be treated as such Treatment should be determined pending the results of an exercise stress test
The symptoms indicate an acute coronary episode and should be treated as such Angina would be relieved with rest
A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. Where do you self admin epi? Forearm Thigh Deltoid muscle Abdomen
Thigh
Which statement correctly identifies a difference between duodenal and gastric ulcers? Malignancy is associated with duodenal ulcer Weight gain may occur with gastric ulcer A gastric ulcer is caused by hypersecretion of stomach acid Vomiting is uncommon in clients with duodenal ulcers
Vomiting is uncommon in clients with duodenal ulcers
A 5 year old boy has been diagnosed with severe food allergies. What should the nurse include when educating the parents of this child about his allergy and care? Wear a medical identification bracelet Know how to use the antihistamine pen Know how to give injection Avoid live attenuated vaccinations
Wear a medical identification bracelet
A patient had a lumbar puncture performed at the outpatient clinic and the nurse has phones the patient and family that evening. What does this phone call enable the nurse to determine? What are the patients and families expectations of the test Whether the family had any questions about why the test was necessary Whether the patient has had any complications of the test Whether the patient understood accurately why the test was done
Whether the patient has had any complications of the test
A client has undergone treatment for urosepsis and received high doses of numerous antibiotics during the course of treatment. When planning the clients subsequent care, the nurse should be aware of what potential effect on the clients immune function? Bone marrow suppression Uncontrolled apoptosis Thymus atrophy Lymphoma
bone marrow suppression
A nurse is performing the initial assessment of a client who has a recent diagnosis of systemic lupus erythematosus (SLE). what skin manifestation should the nurse expect to observe on inspection? Petechiae Butterfly rash Jaundice Skin sloughing
butterfly rash
a client with a diagnosis of diabetic ketoacidosis is being treated in the ER. which finding would the nurse expect to note as confirming this diagnosis? elevated blood glucose and low plasma bicarbonate decrease urine output increased respirations and an increase in pH comatose state
elevated blood glucose and low plasma bicarbonate In diabetic acidosis, the arterial pH is less than 7.35. plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis
An OR nurse is preparing to assist in a coronary artery bypass graft. The OR nurse knows that the vessel most commonly used as a source for a CABG is what? Brachial artery Brachial vein Femoral artery Greater saphenous vein
greater saphenous vein -The greater saphenous vein is harvested very often for CABG surgery as well as internal mammary (usually non dominant) and radial artery (not as common, need to do alans test before) -Arteries don't have valves so they are less likely to clot off
Which of the following is the most common complication associated with a peptic ulcer? Hemorrhage Vomiting Elevated temperature Abdominal pain
hemorrhage
Murphy's sign
it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the midclavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a "catch" in breath, the test is considered positive. In order for the test to be considered positive, the same maneuver must not elicit pain when performed on the left side.
The zollinger ellison syndrome 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? Ranitidine (zantac) Omeprazole (Prilosec) Vasopressin (Pitressin) Octreotide (Sandostatin)
octreotide (sandostatin) Used in pt w/severe GI bleeding, pancreatitis, esophageal varices
A client is admitted with cellulitis and experiences a consequent increase in WBC. during what process will pathogens be engulfed by white blood cells that ingest foreign particles? Apoptosis Phagocytosis Antibody Response Cellular immune response
phagocytosis If you have developed immunity and blood is drawn you will have a positive titer, which means you have a successful IgG A titer is a ratio used to explain the amount of something in a solution. When talking about vaccines or immunity to disease, titers identify the amount of antibodies in a person's blood. The first response is an IgM response IgE is primary allergic response The most prevalent immunoglobulin in the mucus membrane and upper airway is IgA
A client with rheumatic disease has developed a GI bleed. The nurse caring for the client should further assess the client for the adverse effects of what medications? Corticosteroids Immunomodulators Antimalarials Salicylate therapy
salicytate therapy
A pt is scheduled for a bone marrow biopsy, which bone is most likely used for the sample Humerus Scapula Sternum Femur
sternum
How much does a liter of fluid weigh?
1 L of water = I kilo 1 L of water = 2.2 lbs
rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: third day week 2-3 weeks 2-4 weeks
2-3 weeks to prevent lipodystrophy
4. During a routine health check-up visit a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply: "Does the pain and stiffness tend to be the worst before bedtime?" "Are you experiencing fatigue and fever as well?" "Is your pain and stiffness symmetrical on the body?" Is your pain and stiffness aggravated by extreme temperature changes?"
"Are you experiencing fatigue and fever as well?" "Is your pain and stiffness symmetrical on the body?" Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued...remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.
While auscultating a client's heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected an expected finding in what client? Valve replacement Old adult 20 year old
20 year old -S3 sounds like KENTUCKY, life's about to get sucky. Usually heard in fluid overload. Heard in pregnant women, athletes and young people. S4 sounds like TENNESSEE. Usually heard in newborns until about 6 months of age from stiffness. -valve replacement: mechanical valve you would hear a click -If you have a PIG valve there will be no click -Hear pericardial rubs sometimes after surgery -Hear bruit over aneurysm, fistula, JVD
Clients weight has increased by 5 lbs (2.27 kilos) in 24 hours. Nurse estimates the client retained how much fluid?
2300 mL
A nurse is caring for a client with impaired renal function. A Cr clearance measurement has been ordered. The nurse should facilitate collection of what samples? 24 hour urine specimen and a serum cr level midway though the urine collection process A BUN and Cr level for three consecutive days
24 hour urine specimen and a serum cr level midway though the urine collection process
A client is brought to the emergency unit with third-degree burns on the posterior trunk, right arm, and left posterior leg. Using the Rule of Nines, what is the total body surface area that has been burned? 36% 45% 27% 54%
36% Based on the rule of nines, posterior trunk equals 18%, right arm equals 9%, and left posterior leg equals 9%. Therefore, a total of 36%
What is the percentage meds will get someone out of afib?
50%
The health care provider has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A B C D
A https://www.who.int/hepatitis/topics/en/
Which of the following is not a typical sign and symptom of Cushing's Syndrome? A. Hyperpigmentation of the skin B. Hirsutism C. Purplish striae D. Moon face
A. Hyperpigmentation of the skin
In Cushing's Disease and Syndrome there are: A. Increased cortisol production B. Low potassium and glucose levels C. Increased production of aldosterone and cortisol D. Decreased production of aldosterone and cortisol
A. Increased cortisol production
Which statement reflects the process of bone healing? All fracture healing takes place at the same rate no matter the type of bone fractured The age of the client influences the rate of fracture healing Serial x-rays are used to monitor the progress of bone healing Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification
Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification -With bone fractures that break through the skin first Immobilize the joint, then cover the fracture and perforation site, assess vitals, elevate the limb, CIRC checks (pain, pulse, pallor, paresthesia, paralysis) -With any fracture there is an increased risk of compartment syndrome (A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues)
Acute appendicitis is best treated by which of the following Antibiotics Drainage of abscess Appendectomy All of the above are correct
All of the above are correct *if they have not ruptured they can be treated with antibiotics and drainage *an appendectomy is not necessary, usually only if it have ruptured If there is a rupture the typically treatment is the removal of the appendix but it depends on the pt and the length of the rupture
A nurse is providing care for a client whose pattern of laboratory testing reveals long standing hypocalcemia. What other lab result is most consistent with this finding? An elevated parathyroid hormone level An elevated calcitonin level An elevated potassium level A decreased vitamin D level
An elevated calcitonin level
An office worker takes a cookie that contains peanut butter. The worker begins wheezing, with an inspiratory stridor and air hunger, and the occupational health nurse is called to the office. The nurse should recognize Anaphylactic (type 1) Cytotoxic (type II) Immune complex (type III) Delayed type (type IV)
Anaphylactic (type 1) treatment is epi into the thigh
The triage nurse in the ED is assessing a client who reports pain and swelling in her right lower leg. The client's pain became a much worse last night and appeared along with fever, chills and sweating. The client states "i hit my leg on my car door 4 to 5 days ago and it has been sore ever since then" the client has a history of chronic venous insufficiency. What intervention should the nurse anticipate for the client? Antibiotics to treat cellulitis Heparin IV to treat VTE
Antibiotics to treat cellulitis -With a VTE their d dimer level will be elevated
The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the clients diverticulitis? Anti Anxiety Antispasmodic Antiemetic Anti-inflammatory
Antispasmodic
The triage nurse in the ED is performing a rapid assessment of a man with reports of severe chest pain and SOB. the client is diaphoretic, pale and weak. When the client collapses, what should the nurse do first? Give 2 full breaths Ask if they are ok, see if they are responsive Check for carotid pulse
Ask if they are ok, see if they are responsive
A pt with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce complications? Select all that apply Assess the fingers for color and temp Administer prescribed medications Assess for a pressure sore Determine the exact site of pain
Assess for a pressure sore Assess the fingers for color and temp
A client with a diagnosis of primary immunodeficiency disease informs the nurse that he has been experiencing a new onset of a dry cough and occasional SOB. after determining that the client's vital signs are within reference ranges, what action should the nurse take? Administer a nebulized bronchodilator Perform oral suctioning Assess the client for signs and symptoms of infection Teach the client deep breathing and coughing exercises
Assess the client for signs and symptoms of infection
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed Keeping the ropes over the center of the pulley
Assessing the extremity for neurovascular integrity
A nurse is providing care for a client with a recent diagnosis of giant cell arteritis (GCA). what aspect of physical assessment should the nurse prioritize? Assessment for subtle signs of bleeding disorders Assessment of metatarsal joints Assessment for thoracic pain that is exacerbated by activity Assessment for headaches and jaw pain
Assessment for headaches and jaw pain
Nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end stage kidney disease. Client has elevated phosphorus level and had been prescribed calcium acetate to bind phosphorus. When should it be given?
At the end of every meal
The nurse teaches client with GERD which to manage the disease? Minimize intake of caffeine, beer, milk, and foods containing peppermint or spearmint Avoid eating or drinking 2 hours before bedtime Elevate the foot of the bed on 6 - 8 inch blocks Eat a low carb diet
Avoid eating or drinking 2 hours before bedtime
Your client has 50 ml in the bladder after voiding? What do you do? Perform a straight cath Avoid further interventions as this is normal
Avoid further interventions as this is normal
Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Lets see if the coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "this new approach worked for you, keep it up." D. "I notice that you seem to be responding to voices that I do not here"
B. "Please tell me in your own words what brought you to the hospital."
A nurse is performing an assessment on her patient diagnosed with systemic lupus erythematosus (SLE). What skin manifestation will likely be documented? Skin sloughing Jaundice Butterfly Rash Pettechiae
Butterfly Rash
6. When counseling an older patient about ways to prevent fractures, which information will the nurse include? Tacking down scatter rugs in the home is recommended. Occasional weight-bearing exercise will improve muscle and bone strength. Most falls happen outside the home. Buying shoes that provide good support and are comfortable to wear is recommended.
Buying shoes that provide good support and are comfortable to wear is recommended. Comfortable shoes with good support will help to decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Regular weight-bearing exercise will improve strength, but occasional exercise is not helpful in improving strength. Falls inside the home are responsible for many injuries
A nurse is caring for a client who is suspected of having giant cell arteritis. WHat lab tests are most useful in diagnosing rheumatic disorder? Select all that apply? Erythrocyte count Erythrocyte sedimentation rate Creatinine clearance C-reactive protein D-dimer
C-reactive protein Erythrocyte sedimentation rate Both of these labs indicate an inflammatory response has occurred
3. The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? Presence of HIV antibodie CD4+ T cell count below 200/µL Presence of oral hairy leukoplakia White blood cell count below 5000/µl
CD4+ T cell count below 200/µL Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS
A client presents to the clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client the angina is most often attributed to what cause? MI Coronary arterosclerosis
Coronary arterosclerosis -Angina is associated with ischemia and is caused by CAD, plaque formation -An MI is ongoing ischemia to damage of the heart -Angina left untreated leads to an MI
The nurse is caring for a client who sustained rib fractures in an auto accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? BP of 140/90 Crackles in lung bases Heart rate of 94
Crackles in lung bases
A nurse states to a client "things will look better tomorrow after a good nights sleep" this is an example of which technique? A. Giving advice B. Defending C. Presenting reality D. Giving false reassurance
D. Giving false reassurance
A client reports diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea? Decrease the fat content in the diet Increase the fiber content in the diet Decrease the amount of fluid the patient is drinking Increase the protein content in the diet
Decrease the fat content in the diet Increase the fiber content in the diet
Often you are unaware i exist. Often i present as a stomach upset, ache, most with my condition gain weight. Peptic ulcer Duodenal ulcer Lymphoma Ulcerative colitis
Duodenal ulcer - Symptoms go away when they eat
The nurse is caring for a client with cirrhosis of the liver. The client has developed ascites and requires a paracentesis. Which of the following symptoms is associated with ascites and should be relieved by the paracentesis? Pruritus Dyspnea Jaundice Peripheral neuropathy
Dyspnea
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Upper GI series Endoscopy Hemoglobin and hematocrit Arteriography
Hemoglobin and hematocrit
A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? I'll eat 3 large meals everyday without any restrictions I'll lie down immediately after a meal I'll eat frequent small bland meals high in fiber I'll gradually increase the amount of heavy lifting I do
I'll eat frequent small bland meals high in fiber
Client has been admitted to the ER with signs of anaphylaxis following a bee sting. The nurse knows that if it is a true allergic reaction the client will present with what alteration in the laboratory values? Increased eosinophils Increased neutrophils Increased serum albumin Decreased blood glucose
Increased eosinophils
A clinic nurse is caring for a client with suspected gout. While explaining the pathophysiology of gout to the client, what should the nurse explain? Autoimmune processes in the joints Chronic metabolic acidosis Increased uric acid levels Unstable serum calcium levels
Increased uric acid levels
A client with hypertrophic cardiomyopathy has been admitted to the medical unit. During the nurses admission interview, the client states that she takes over the counter "water pills" on a regular basis. How should the nurse best respond to the fact that the client has been on diuretics? Encourage client to drink at least 2 L of water a day Increase clients oral sodium intake Inform the provider because diuretics are contraindicated Ensure the client's fluid balance is monitored vigilantly
Inform the provider because diuretics are contraindicated -Diuretics will adversely effect SV which will lower the CO -Diuretics can exacerbate symptoms of hypertrophic cardiomyopathy
The client has been taking famotidine (pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily which of the following? Inhibit gastric acid secretions Neutralize acid in the stomach Shorten the time required for digestion in the stomach Improve the mixing of foods and gastric secretions
Inhibit gastric acid secretions
Which intervention should the nurse implement with the client who has undergone a hip replacement? Instruct the client to avoid internal rotation of the leg Place client in high fowlers for meals Have the client bend forward to rise from the chair Adduct the legs by placing a pillow between the legs
Instruct the client to avoid internal rotation of the leg
A nurse is performing the health history and physical assessment of a client who has a diagnosis of RA. what assessment finding is most consistent with the clinical presentation of RA? Cool joints with decreased ROM Signs and symptoms infection Joint stiffness, especially in the morning Visible atrophy of the knee and shoulder joints
Joint stiffness, especially in the morning
Which mouth condition is associated with HIV infection? Kaposi sarcoma Stomatitis Krythoplakia Candidiasis
Kaposi sarcoma
A positive rovsing's sign is indicative of appendicitis. A nurse knows to assess for this indicator by palpating the: A Right lower quadrant B Left lower quadrant C Right upper quadrant D Left upper quadrant
LLQ -Mcburney's point is associated with rebound pain in appendicitis -Cullen's sign is associated with ectopic pregnancy and bleeding
The nurse is caring for a client who has developed scar tissue in many of the areas that normally produce blood cells. What organs can become active in blood cell production by the process of extramedullary hematopoiesis? Spleen and kidney Liver and spleen
Liver and spleen
A patient with a documented history of a seizure disorder experiences a generalized seizure. Which action is most appropriate? Restrain the patient to prevent injury Open the patients jaws to insert an oral airway Place the patient in high fowler's position Loosen the patients restrictive clothing
Loosen the patients restrictive clothing
Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful? 4-6 small meals of low-carbohydrate foods daily High-fat, high-carbohydrate meals Low-fat, high-carbohydrate meals High-fat, low protein meals
Low-fat, high-carbohydrate meals For the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis
A client comes to a walk in clinic reports pain in his foot following stepping on a rusty nail 4 days ago. The client has visible red streaks running up his foot and ankle. Which health problem should the nurse suspect? Cellulitis Lymphangitis
Lymphangitis -Lymphangitis will run up veins/arteries -Both are treated similar -When you see the red streak you need to be worried more -Cellulitis is localized but can go systemically
The neuro ICU nurse is admitting a patient following a craniotomy using the supratentorial approach. How should the nurse best position the patient? Position patient in supine Maintain head of bed elevated 30-45 degrees Position the patient in prone position Maintain bed in trendelenburg position
Maintain head of bed elevated 30-45 degrees
The nurse provides health teaching to inform the client with oral cancer that? Most oral cancers are painful at the onset Blood testing is used to diagnose oral cancer A typical lesion is soft and craterlike Many oral cancers produce no symptoms in the early stages
Many oral cancers produce no symptoms in the early stages
A client is undergoing testing to determine the etiology of recent joint pain. The client asks the nurse about the different between osteoarthritis and rheumatoid arthritis. What is the best response by the nurse? OA is considered a non-inflammatory joint disease. RA is characterized by inflamed, swollen joints OA and RA are very similar. OA affects the smaller joints such as fingers, and RA affects the larger, weight bearing joints like knees OA originates with an infection, RA results in your body's cells attacking one another OA is associated with impaired immune function RA is a consequence of physical damage
OA is considered a non-inflammatory joint disease. RA is characterized by inflamed, swollen joints
An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate? Occulant blood testing Bone marrow biopsy lumbar puncture urinalysis
Occulant blood testing -Monitor for signs of bleeding, most common would be a GI bleed, leading to an occulant blood test to test for blood in the stool, losing iron.
A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The clients diagnostic test results were positive for h pylori. The health care provider has ordered triple therapy regimen. Which medications will the nurse educate the client on? H2 receptor antagonist and two antibiotics H2 receptor antagonist, PPI, and an antibiotic PPI, an antibiotic and bismuth salts PPI and two antibiotics
PPI and two antibiotics
Following a traumatic brain injury, a patient has been in a coma for several days. Which of the following statements of this patient's current LOC? Patient occasionally makes incomprehensible sounds Patients current LOC will likely become a permanent state Patient may occasionally make non purposeful movements Patient is incapable of spontaneous respirations
Patient may occasionally make non purposeful movements
A nurse on the neurologic unit is providing care for a patient who has spinal cord injury at the level of C4. When planning the patients care, what aspect of the patients neuro care and functional status should the nurse consider? Patient will be unable to use a wheelchair Patient will be unable to swallow food Patient will be continent of urine but incontinent of bowel Patient will require full assistance for all aspects of elimination
Patient will require full assistance for all aspects of elimination
A nurse on the orthopedic unit is assessing a client's peroneal nerve. The nurse should perform which action?
Prick the skin between the great toe and second toe
The nurse is caring for a client with a large venous ulcer. What intervention should the nurse implement to promote healing? Irrigate the wound with hydrogen peroxide once daily Apply antibiotic ointment on surrounding skin with each dressing change Apply clean occlusive dressing once daily and whenever soiled Provide a high calorie, high protein diet
Provide a high calorie, high protein diet -Call the dr. who will call wound care -You need order for wound care -The nurse can encourage someone to eat more protein to promote healing -If you don't fix the nutrition, no matter how much wound care they receive, it won't heal without adequate nutrition -An occlusive dressing in a venous ulcer could make it worse
A client with oral cancer reports dryness of the mouth. What is the nurse's best response? State "this is a normal consequence of oral cancer" Provide a humidifier for the client to use while sleeping Ensure the client maintains a fluid intake of 2000 mL per day Allow the client to continue with their usual diet
Provide a humidifier for the client to use while sleeping
The nurse is preparing to care for a client who has scleroderma. The nurse refers to resources that describe crest syndrome. Which of the following is a component of CREST syndrome? Raynaud phenomenon Thyroid dysfunction Esophageal varices Osteopenia
Raynaud phenomenon Scleroderma is often seen in hands, sometimes in the face
What is the most common presentation and physical exam findings of appendicitis? Diarrhea or constipation Rebound tenderness, pain on percussion, rigidity, and guarding Vomiting that precedes pain Pain in LLQ is usually 48-72 hours
Rebound tenderness, pain on percussion, rigidity, and guarding -Other signs that you should look for in the assessment: Lay on back, lift up leg and they should have pain
A nurse is caring for a client with HF who has developed an intracardiac thrombus. The nurse should assess for signs and symptoms of what sequela? Stroke MI Hemorrhage Peripheral edema
Stroke -Odds are the clot will be moving towards the head, potentially causing a stroke -What causes an MI? Clots in the coronary arteries. -When you have a thrombus it is likely to get pushed up to the carotid and then up to the brain -Clots in the veins get pushed to the lungs=pulmonary embolism
You've been unsuccessful in catheterizing a client with a full bladder and a prostate obstruction. What approach does the nurse anticipate the health care provider to use to drain the clients bladder? Re attempt using a coude cath Surgeon to place a suprapubic catheter
Surgeon to place a suprapubic catheter
A nurse is assessing a client with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? Oral Temperature of 99 degrees F Tachypnea and restlessness Frequent loose stools Weight loss of 0.45 kg (1 pound) since yesterday
Tachypnea and restlessness
The nurse is preparing health education for a patient who is being discharged after hospitalization for a hemorrhagic stroke. What content should the nurse include in this education? Mild intermittent seizures can be expected Take ibuprofen for complaints of serious headache Take antihypertensive medication as ordered Drowsiness is normal for the first week after discharge
Take antihypertensive medication as ordered
The client has a chancre on the lips. What instruction should the nurse provide? Apply warm soaks to the lip Gargle with an antiseptic solution Avoid foods that could irritate the lesion Take measures to prevent spreading the lesion to other people
Take measures to prevent spreading the lesion to other people
TRACTION
Temperature (extremity, infection) Ropes hang freely Alignment Circulation check (5 P's) Type and location of fracture Increase fluid intake Overhead trapeze No weights on bed or floor
A client with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the client about this treatment? The client will be given a low dose of epi before the treatment The client will remain in the clinic to be monitored for 30 min following the injection Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months The allergen will be given by the peripheral IV rate
The client will remain in the clinic to be monitored for 30 min following the injection
A nurse has asked the nurse educator if there is any way to predict the severity of a client's anaphylactic reaction. What would be the nurse's best response? The faster the onset of symptoms, the more severe the reaction The reaction will be about one third more severe than the clients last reaction to the same antigen There is no way to gauge the severity of a clients anaphylaxis, even if it has occurred repeatedly in the past The reaction will generally be slightly less severe that the last reaction to the same antigen
The faster the onset of symptoms, the more severe the reaction Each time a person has an anaphylactic reaction the response will become more severe with each event
A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? The left leg is internally rotated Adduct and place a pillow between the knees
The left leg is internally rotated
A client has been living with seasonal allergies for many years, but does not take antihistamines, stating, "when i was young, i used to take antihistamines, but they always put me to sleep." how should the nurse best respond? Newer antihistamines are combined with a stimulant that offsets drowsiness Most people find that they develop a tolerance to sedation after a few months The newer antihistamines are different than in years past, and cause less sedation have you considered taking them at bedtime instead of in the morning
The newer antihistamines are different than in years past, and cause less sedation
The nurse is caring for a client with a diagnosis of afib. The onset was approx 2-3 days ago. A TEE is scheduled this morning. The client's spouse asked what this test id for. The best response by the nurse is which of the following? This test will show a specific area causing the afib and what can be done to stop it This test will show any blood clots in the heart and if it is safe to do a cardioversion
This test will show any blood clots in the heart and if it is safe to do a cardioversion
An elderly women found with a head injury on the floor of their home is subsequently admitted to the neuro ICU. what is the best rationale for the following physician orders: elevate the HOB, keep head in neural alignment with no neck flexion of head rotation, avoid sharp hip flexion? To decrease cerebral arterial pressure To avoid impeding venous outflow To prevent flexion contractures To prevent aspiration of stomach contents
To avoid impeding venous outflow
Which condition is a type II hypersensitivity reaction? Allergic rhinitis Positive purified protein derivative (PPD) test for tuberculosis Transfusion reaction to improper blood type Serum sickness after receiving immune globulin
Transfusion reaction to improper blood type
Nurse Amber is caring for a client who underwent a lumbar laminectomy two days ago. Which of the following findings should the nurse consider abnormal? More back pain than the first postoperative day Paresthesia in the dermatomes near the wound Urinary retention or incontinence Temperature of 99.3 degrees Fahrenheit
Urinary retention or incontinence Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in pain on the second postoperative day is common because the long-acting local anesthetic, which may have been injected during surgery, will wear off. While paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if it reaches 101° F (38.3° C)
Family members of an immunocompromised client have asked the nurse why antibiotics are not being given to the client in order to prevent infection. How should the nurse best respond? Using antibiotics to prevent infections can cause drug resistant bacteria If an antibiotic is given to prevent a bacterial infection, the client is at risk for a viral infection Antibiotics can never prevent an infection; they can only cure an infection that is fully developed Antibiotics cannot resolve infections in people who are immunocompromised
Using antibiotics to prevent infections can cause drug resistant bacteria
During a mumps outbreak at a local school a teacher has been exposed. The client has previously been immunized for mumps, and consequently possesses: Acquired Immunity Natural Immunity Phagocytic immunity Humoral immunity
acquired immunity
A nurse has given a child's scheduled vaccination for rubella. The vaccination will cause the child to develop which of the following: Natural Immunity Active Acquired Immunity Cellular Immunity Mild Hypersensitivity
active acquired immunity vaccines should be administered 4 weeks apart
A client with pericarditis has just been admitted to the telemetry unit. The nurse planning the clients care should prioritize what nursing diagnosis? Acute pain Ineffective tissue perfusion Ineffective Breathing Anxiety
acute pain Pericarditis is inflammation of the pericardium Treated pain is managed by pain meds
Verapamil
antiarrhythmic affecting the AV node and the HR. This would slow more the HR more than procainamide.
Procainamide
antiarrhythmic that prolongs QT, putting yourself at risk for vtach, a life threatening rhythm. After .5 you have a risk of a sudden death
A client has undergone a radical neck dissection. His skin graft is pale. This indicates which condition? Possible necrosis Venous congestion Arterial thrombosis infection
arterial thrombosis
A client is scheduled to have an x-ray exam of the shoulder in which the synovial fluid will be aspirated and sent to the lab for analysis. This will be followed by admin of contrast medium and xray. What procedure will the nurse prepare the client for? Arthroscopy Arthrocentesis Arthrogram bone densitometry
arthrogram
To prevent gastroesophageal reflux in a client with a hiatal hernia, the nurse should provide which discharge instruction? Avoid alcoholic and coffee beverages Take antacids with meals Limit fluid intake with meals Lie down after meals to promote digestion
avoid alcoholic and coffee beverages
Which post implantation instruction must a nurse provide to a client with a permanent pacemaker? Avoid activity for 3 weeks Avoid electrical interference
avoid electrical interference -You would want to avoid activity for almost 6 weeks, not 3, to avoid dislodgement or fracture of the leads -Avoid strong magnetic fields because it can make it stop working. Be careful in airports for example, the strong magnetic fields
A patient is having a flight or fight response after receiving bad news about his prognosis. What effect will this have on the patients sympathetic nervous system? Constriction of blood vessels in the heart muscle Constriction of bronchioles Increase in the secretion of sweat
increase the secretion of sweat
A 58-year-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma due to a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon? a. Blood pressure is 102/58. b. Urine output is 20 mL/hr for 2 hours. c. Incisional pain level is reported as 9/10. d. Crackles are heard at bilateral lung bases.
b. Urine output is 20 mL/hr for 2 hours. A urine output of 40ml/2hrs is a very small amount of output, and needs to be noted and reported
Which is a circulatory indicator of peripheral neurovascular dysfunction? Weakness Paresthesia Cool skin Paralysis
cool skin
Which of the following causes the majority of UTI's in hospitalized patients? Lack of fluid intake Inadequate perineal care Invasive procedures Immunosuppression
invasive procedures Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection
8. A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone: is strong enough to stand mild stress. union is complete on the x-ray. fragments are fully fused. healing has started.
is strong enough to stand mild stress. The cast may be removed when callus ossification has occurred. It is not necessary to wait until radiologic union or complete bone fusion occurs. Bone healing starts immediately after the injury, but the cast will need to be worn at least 3 weeks
I present as gnawing burning pain in mid epigastric region? Peptic ulcer Duodenal ulcer C diff
peptic ulcer
TEE
transesophageal echocardiogram: people go through TEE before cardioversion because if they are cardioverted with a clot in the heart, they will stroke out. TEE looks at heart muscle. After 24 hours of being in afib a TEE will always be needed.
Nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating the client about self catheterization the nurse should include? Use clean technique Catheterize every 2 hours
use clean technique
