med surg exam 3
A nurse is discharging a client who has COPD. Upon discharge the client is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse? A) there are portable oxygen delivery systems that you can take with you B) when you go out you can remove the oxygen and then reapply it when you get home C) you probably will not be able to go out as much as you used to D) home health services will come to you so you will not need to get out
A
The client has chronic atrial fibrillation. Which discharge teaching should the nurse discuss with the client? A) instruct the client to use a soft bristle toothbrush B) discuss the importance of getting a monthly partial thromboplastin time (PTT) C) teach the client about signs of pacemaker malfunction D) explain to the client the procedure for synchronized cardioversion
A
The nurse is caring for clients on a surgical floor. Which client should be assessed first? A) the client who is 4 days postoperative abdominal surgery and is complaining of left calf pain when ambulating B) the client who is one day postoperative hernia repair who has just been able to void 550 mL of clear amber urine C) the client who is 5 days postoperative open cholecystectomy whos has a t-tube and is being discharged D) the client who is 16 hours post abdominal hysterectomy and is complaining of abdominal pain an is expelling flatus
A
The nurse is caring of a patient with COPD. Which intervention could be delegated to the unlicensed assistive personnel A) assist the client to get out of bed B) auscultate breath sounds every 4 hours C) plan patient activities to minimize exertion D) teach the patient pursed lip breathing technique
A
The nurse teaches the patient with any venous disorder that the best way to prevent venous stasis and increase venous return is to... A) take short walks B) sit with the legs elevate C) frequently rotate the ankles D) continuously wear elastic compression stockings
A
The unlicensed assistive personnel is caring for the client diagnosed with chronic venous insufficiency. Which action would warrant immediate intervention from the nurse? A) removing compression stockings before assisting the client to bed B) taking the clients BP manually after using the machine C) assisting the client by opening the milk carton on the lunch tray D) calculating the clients shift intake and output with a pen and paper
A
What early manifestations is the patient with primary hypertension likely to report? A) no symptoms B) cardiac palpitations C) dyspnea on exertion D) dizziness and vertigo
A
When the patient is being examined for venous thromboembolism in the calf, what diagnostic test should the nurse expect to teach the patient about first? A) duplex ultrasound B) contrast venography C) magnetic resonance venography D) computed tomography venography
A
Which characteristics describe the anticoagulant warfarin? select all that apply A) vitamin K is the antidote B) protamine sulfate is the antidote C) may be administered orally D) dosage monitored using INR E) dosage monitored using PTT
A,C,D
What are nonmodifiable risk factors for primary hypertension? select all that apply A) age B) obesity C) gender D) ethnicity E) genetic link
A,C,D,E
A 62 yr old Hispanic male patient with diabetes has been diagnosed with peripheral artery disease. The patient is a smoker with a history of gout. To prevent complications which factor is priority in patient teaching? A) gender B) smoking C) ethnicity D) comorbidities
B
A 67 ye old man with peripheral artery disease is seen in the primary care clinic. Which symptom reported by the patient would indicate to the nurse that the patient is experiencing intermittent claudication? A) patient complains of chest pain with strenuous activity B) patient says muscle leg pain occurs with continued exercise C) patient has numbness and tingling of all toes and both feet D) patient states the feet become red if he puts them in a dependent position
B
A nurse is assessing a client who has a history of asthma. Which of the following should the nurse identify as a risk for asthma? A) gender B) environmental allergies C) alcohol use D) race
B
A nurse is reinforcing teaching with a client on the purpose of taking a bronchodilator. Which of the following client statements indicates an understanding of the teaching? A) this medication can decrease my immune response B) I take this medication to prevent asthma attacks C) I need to take this medication with food D) this medication has a slow onset to treat my symptoms
B
A patient is admitted to the ER with an acute asthma attack. Which patient assessment is of greatest concern to the nurse? A) the presence of a pulsus paradoxus B) markedly diminished breath sounds with no wheezing C) a respiratory rate of 34 and increased pulse and BP D) use of accessory muscles of respiration and a feeling of suffocation
B
The 66 year old male client has his blood pressure checked at a health fair. The BP is 168/98. Which action should the nurse implement first? A) recommend that the client have his BP checked in one month B) instruct the client to see his health care provider as soon as possible C) discuss the importance of eating a low salt, low fat, low cholesterol diet D) explain that this BP is within the normal range for an elderly person
B
The nurse is reviewing the lab test results for a 68 yr old patient whose warfarin therapy was initiated during the preoperative period. On postoperative day 2, the international normalized ratio (INR) result is 2.7. Which action by the nurse is most appropriate? A) hold the daily dose of warfarin B) administer the daily dose of warfarin C) teach the patient with signs and symptoms of bleeding D) call the physician to request an increased dose of warfarin
B
The nurse is teaching a class on arterial essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation? A) include information on retinopathy and nephropathy B) discuss sedentary lifestyle and smoking cessation C) include discussions on family history and gender D) provide information on a low fiber and high salt diet
B
The nurse observes no P waves on the patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec, but they occur irregularly with a rate of 120 beats/min. What does the nurse determine the rhythm to be? A) sinus tachy B) a fib with RVR C) a fib with CVR D) ventricular tachy
B
The patient with VTE is receiving therapy with heparin and asks the nurse whether the drug will dissolve the clot in her leg. What is the best response by the nurse? A) this drug will break up and dissolve the clot so that circulation in the vein can be restored B) the purpose of the heparin is to prevent growth of the clot or formation of the new clots where the circulation is slowed C) heparin won't dissolve the clot but it will inhibit the inflammation around the clot and delay the development of new clots D) the heparin will dilate the vein, preventing turbulence of blood flow around the clot that may cause it to break off and travel to the lungs
B
When teaching a patient about dietary management of stage 1 hypertension which instruction is most appropriate? A) increase water intake B) restrict sodium intake C) increase protein intake D) use calcium supplements
B
When teaching the patient with PAD about modifying risk factors associated with the condition what should the nurse emphasize? A) amputation is the ultimate outcome if the patient does not alter lifestyle behaviors B) modifications will reduce the risk of other atherosclerotic conditions such as stroke C) risk reducing behaviors initiated after angioplasty can stop the progression of the disease D) maintenance of normal body weight is the most important factor in controlling arterial disease
B
Which dietary modification helps to meet the nutritional needs of patients with COPD? A) eating a high carb, low fat diet B) avoiding foods that require a lot of chewing C) preparing most foods of the diet to be eaten hot D) drinking fluids with meals to promote digestion
B
the nurse recognizes that additional teaching is needed when the patient with asthma says A) I should exercise every day if my symptom are controlled B) I may use over the counter bronchodilator drugs occasionally if I develop chest tightness C) I should inform my spouse about my medications and how to get help if I have a severe asthma attack D) a diary to record my medication use, symptoms, peak expiratory flow rates and activity levels will help in adjusting my therapy
B
to decrease the patients sense of panic during an acute asthma attack what is the best action for the nurse to do? A) leave the patient alone to rest in a quiet calm environment B) stay with the patient and encourage slow pursed lip breathing C) reassure the patient that the attack can be controlled with treatment D) let the patient know that frequent monitoring is being done using measurement of vital signs and SpO2
B
A patient with peripheral artery disease has a nursing diagnosis of ineffective peripheral tissue perfusion. What should be included in the teaching plan for this patient? select all that apply A) apply cold compresses when the legs become swollen B) wear protective footwear and avoid hot or cold extremities C) walk at least 30 minutes per day at least 3 times per week D) use nicotine replacement therapy as a substitute for smoking E) inspect lower extremities for pulses, temperature and any injury
B,C,E
What are the characteristics of peripheral artery disease? select all that apply A) pruritus B) thickened brittle nails C) dull ache in calf or thigh D) decreased peripheral pulses E) pallor on elevation of the legs F) ulcers over bony prominences on toes and feet
B,D,E,F
A nurse is planning to instruct a client on how to perform pursed- lip breathing. Which of the following should be nurse include in the plan of care? A) take a quick breaths upon inhalation B) place your hand over your stomach C) take a deep breath in through your nose D) puff your cheeks upon exhalation
C
A nurse is providing discharge teaching to a client who has COPD and anew prescription for albuterol. Which of the following statements by the client indicates an understanding of the teaching? A) this medication can increase my blood sugar levels B) this medication can decrease my immune response C) I can have an increase in my heart rate while taking this medication D) I can have mouth sores while taking this medication
C
A nurse is providing discharge teaching to a client who has a new prescription for prednisone for asthma. Which of the following statements indicates an understanding of the teaching? A) I will decrease my fluid intake while taking this medication B) I will expect to have black tarry stools C) I will take my medication with meals D) I will monitor for weight loss while on this medication
C
During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider if the patient experiences.. A) fever and redness at the incision site B) 2+ edema of the extremity and pain at the incision site C) a loss of palpable pulses and numbness and tingling of the feet D) increasing ankle brachial indices and serous drainage from the incision
C
The client is being admitted with Coumadin toxicity. Which lab data should the nurse monitor? A) BUN levels B) bilirubin levels C) international normalized ratio (INR) D) partial thromboplastin time (PTT)
C
The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? A) allow time to calm the patient B) observe for signs of diaphoresis C) evaluate the use of intercostal muscles D) monitor the patient for bilateral chest expansion
C
The nurse is caring for a 48 yr old male patient admitted for exacerbation of COPD. The patients develops severe dyspnea at rest with a change in respiratory rate from 26 breaths/min to 44 breaths/min. Which action by the nurse would be the most appropriate? A) have the patient perform huff coughing B) perform chest physiotherapy for 5 minutes C) teach the patient to use pursed lip breathing D) instruct the patient in diaphragmatic breathing
C
What should the nurse include when teaching the patient with COPD about the need for physical exercise? A) all patients with COPD should be able to increases walking gradually up to 20 minutes per day B) a bronchodilator inhaler should be used to relieve exercise induced dyspnea immediately after exercise C) shortness of breath is expected during exercise but should return to baseline within minutes after the exercise D) monitoring the HR before and after exercise is the best way to determine how much exercise can be tolerated
C
Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation? A) huff coughing B) thoracic breathing C) pursed lip breathing D) diaphragmatic breathing
C
Which care could the RN delegate to the UAP for a patient with VTE? A) assess the patients use of herbs B) measure the patient for elastic compression stockings C) remind the patient to flex and extend the legs and feet every 2 hours D) teach the patient to call emergency response system with signs of pulmonary embolus
C
Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? A) supine B) lithotomy C) high fowlers D) reverse Trendelenburg
C
when teaching the patient with mild asthma about the use of the peak flow mater, what should the nurse instruct the patient to do? A) carry the flowmeter with the patient at all times in case an asthma attack occurs B) use the flowmeter to check the status of the patients asthma every time the patient takes quick relief medication C) follow the written asthma action plan if the expiratory flow rate is in the yellow zone D) use the flowmeter by emptying the lungs, closing the mouth around the mouthpiece and inhaling through the meter as quickly as possible
C
A nurse is preparing to administer a dose of new prescriptions of prednisone to a client who has COPD. The nurse should monitor for which of the following adverse effects of this medication? select all that apply A) hypokalemia B) tachycardia C) fluid retention D) nausea E) black tarry stools
C,E
A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements by the client indicate an understanding of the teaching? A) I will place the adaptor on my finger t read my blood oxygen saturation level B) I will lie on my back with my knees bent C) I will rest my hand over my abdomen to create resistance D) I will take a deep breath and hold it before exhaling
D
A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? A) long term home oxygen therapy should be used to prevent respiratory failure B) oxygen will not be needed until or unless you are in the terminal stages of this disease C) long term home oxygen therapy should be used to prevent heath problems related to COPD D) you will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia
D
A patient with VTE is to be discharged on long term warfarin therapy and is taught about prevention and continuing treatment of VTE. The nurse determines that discharge teaching for the patient has been effective when the patient makes which statement? A) I should expect that coumadin will cause my stools to be somewhat black B) I should avoid all dark greens and leafy vegetables while im taking coumadin C) massaging my legs several times a day will help increase my venous circulation D) swimming is a good activity in my exercise program to increase my circulation
D
In addition to smoking cessation what treatments is included for COPD to slow the progression of the disease? A) use of bronchodilation B) use of inhaled corticosteroids C) lung volume reduction surgery D) prevention of respiratory tract infections
D
When teaching the patient about going from a metered dose inhaler to a dry powder inhaler, which statement by the patient shows the nurse that that patient needs more teaching? A) I do not need to use the spacer like I used to B) I will hold my breath for 10 seconds or longer if I can C) I will not shake this inhaler like I did with my old inhaler D) I will store it in the bathroom so I will be able to clean it when I need to
D
Which indirect thrombin inhibitor is only administered subcutaneously and does not need routine coagulation tests? A) warfarin B) unfractionated heparin C) hirudin derivatives (angiomax) D) low molecular weight heparin (lovenox)
D
Which medication should the nurse anticipate being used first in the ER for relief of severe respiratory distress related to asthma? A) prednisone orally B) tiotropium inhaler C) fluticasone inhaler D) albuterol nebulizer
D
While assisting a patient with intermittent asthma to identify specific triggers of asthma, what should the nurse explain? A) food and drug allergies do not manifest in respiratory symptoms B) exercise induced asthma is seen only in individuals with sensitivity to cold air C) asthma attacks are psychogenic in origin and can be controlled with relaxation techniques D) Viral upper respiratory infections are a common precipitating factor in acute asthma attacks
D
tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking? A) bronchospasm and hoarseness B) decreased mucus secretions and cough C) increased function of alveolar macrophages D) increased risk of infection and hyperplasia of mucous glands
D
A patient has atrial fibrillation and develops an acute arterial occlusion in an artery. What are the 6 P's of acute arterial occlusion the nurse may assess in this patient that would require immediate notification of the health care provider?
pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (inability to regulate body temp)
