Med Surg Exam4 (201-250)

A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? "I will take stool softeners for several weeks." "I will still take my PPI after this surgery." "After the operation I can eat anything I want." "I will have to eat smaller, more frequent meals."

"After the operation I can eat anything I want."

A patient tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? "Avoid getting salt water on the radiation site." "Do not expose the radiation area to direct sunlight." "Remember you should not drink alcohol for a year." "Have a wonderful time and enjoy your vacation!"

"Do not expose the radiation area to direct sunlight."

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? "Drink plenty of fluids to prevent dehydration." "Drink any flavor of Gatorade to supplement fluid loss." "Increase your protein intake by drinking more milk." "You should drink approximately 1 liter of fluids daily."

"Drink plenty of fluids to prevent dehydration."

A 52-yr-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I could choose nasal spray rather than injections of vitamin B12." "I need to start eating more red meat and liver." "I will need to take folic acid supplement." "I will stop having a glass of wine with dinner."

"I could choose nasal spray rather than injections of vitamin B12."

Which patient statement to the nurse indicates a need for addi- tional instruction about taking oral ferrous sulfate? "I will use a straw when I take my liquid iron." "I should increase my fluid and fiber intake while I am taking iron tablets." "I will call my health care provider if my stools turn black." "I should take the iron with orange juice about an hour before eating."

"I will call my health care provider if my stools turn black."

A nurse cares for a client with colon cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How should the nurse respond? A. "I have a good friend with a colostomy who would be willing to talk with you. B. "The enterostomal therapist will be able to answer all of your questions." C. "We will ask for a referral to talk to a specialist next time we see your doctor." D. "I will make a referral to the United Ostomy Associations of America."

"I will make a referral to the United Ostomy Associations of America."

A nurse has taught a patient about dietary changes that can reduce the chances of developing cancer. What statement by the patient indicates the nurse needs to provide additional teaching? "Vegetables, fruit, and high-fiber grains are important." "I'm so glad I don't have to give up my juicy steaks." "I'll have to cut down on the amount of bacon I eat." "Foods high in vitamin A and vitamin C are important."

"I'm so glad I don't have to give up my juicy steaks."

A patient in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? "It is normal to be fatigued even for years afterward." "Are you getting adequate rest and sleep each day?" "This is not normal and I'll let the provider know." "Try adding more vitamins B and C to your diet."

"It is normal to be fatigued even for years afterward."

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? "Benign tumors require their own blood supply to grow" "Malignant tumors may spread to other tissues or organs." "Benign tumors do not cause damage to other tissues." "Malignant cells reproduce more rapidly than normal cells."

"Malignant tumors may spread to other tissues or organs."

A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important? "Be sure you get enough sleep at night." "Notify your provider at once if you get a fever." "Weigh yourself every day on the same scale." "Get plenty of sunlight for maximum vitamin D synthesis."

"Notify your provider at once if you get a fever."

A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) -Changes in menstrual patterns -Indigestion or trouble swallowing -Near daily abdominal pain -A sore that does not heal -Obvious change in a mole

-Changes in menstrual patterns -Indigestion or trouble swallowing -A sore that does not heal -Obvious change in a mole

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) A. "I will use warm water and a soft washcloth to clean around the stoma." B. "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." C. "I might start bicycling and swimming again once my incision has healed." D. "I must change the ostomy appliance daily and as needed." E. "I must avoid dairy products to reduce gas and odor in the pouch."

A. "I will use warm water and a soft washcloth to clean around the stoma." B. "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." C. "I might start bicycling and swimming again once my incision has healed."

-A 57-year-old man with Escherichia coli food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question? -Infuse lactated Ringer's solution at 250 mL/hr. -Monitor electolytes. -Prepare patient for blood transfusion. -Administer loperamide (Imodium) after each stool.

Administer loperamide (Imodium) after each stool.

The nurse is preparing to administer a unit of platelets to an adult client. When administering this blood product, which of the following actions should the nurse perform? -Administer the platelets as rapidly as the client can tolerate -Establish IV access as soon as the platelets arrive from the blood bank -Ensure that the client has a patent central venous catheter -Aspirate 10 to 15 mL of blood from the client's IV immediately following the transfusion

Administer the platelets as rapidly as the client can tolerate

Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori? -Omeprazole (Priolosec), nystatin (Mycostatin), and bismuth (Pep- to-Bismol) -Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) -Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pan- toprazole (Protonix) -Metoclopramide (Reglan), levofloxacin (Levoquin), and promet- hazine (Phenergan)

Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

A client is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which procedure will be involved? -Angiography -Arthrocentesis -Paracentesis -Myelography

Arthrocentesis

The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding? -Auscultate the heart sounds. -Ask the patient about recent outdoor activities. -Check the patient's TDap immunization for recency. -Palpate the lesion for induration.

Ask the patient about recent outdoor activities.

A nurse is admitting a client with immune thrombocytopenic pur- pura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. -Aspirin-based drugs -Penicillins -NSAIDS -Antihypertensives -Sulfa-containing medications

Aspirin-based drugs NSAIDS Sulfa-containing medications

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? -Teach the patient about injections for the nodules. -Draw blood for rheumatoid factor analysis. -Demonstrate massage techniques -Assess the nodules for skin breakdown or infection.

Assess the nodules for skin breakdown or infection.

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse take? -Assess the rate and quality of the client's pulse. -Measure the specific gravity of the client's urine. -Administer intravenous pain medications. -Position the client to lay on the surgical incision.

Assess the rate and quality of the client's pulse.

A patient is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? -Monitoring the patient for nausea -Assessing the IV site every hour -Educating the patient on side effects -Providing warm packs for comfort

Assessing the IV site every hour

A nurse is preparing to administer pantoprazole (Protonix) intra- venously. What actions by the nurse are most appropriate? (Select all that apply.) A. Take vital signs frequently during infusion. B. Can be infused with Peripheral IV line/Use an in-line IV filter when infusing. C. Infuse pantoprazole using an IV pump. D. Administer drug via piggybag with dextrose. E. Administer the drug through a separate IV line.

B. Can be infused with Peripheral IV line/Use an in-line IV filter when infusing. C. Infuse pantoprazole using an IV pump. E. Administer the drug through a separate IV line.

The nurse caring for oncology patients knows that which form of metastasis is the most common? -Via bone marrow -Direct invasion -Bloodborne -Lymphatic spread

Bloodborne

A client has a platelet count of 9000/mm 3. The nurse finds the client confused and mumbling. What action takes priority? -Placing the client on bedrest -Delegating taking a set of vital signs -Calling the Rapid Response Team -Instituting bleeding precautions

Calling the Rapid Response Team

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood? -Insert a large-gauge IV catheter. -Inquire if the patient is taking anticoagulation medication at home. -Check blood pressure and heart rate. -Prepare to deliver emergent uncrossmatched PRBCs.

Check blood pressure and heart rate.

Which patient choice for a snack 2 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? -Peanut butter and jelly sandwich -Decaffeinated Peppermint Tea -Cherry gelatin with fruit -Glass of low-fat milk

Cherry gelatin with fruit

The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further? -Erythrocyte Sedimentation Rate: 22 mm/hr -Platelet count: 210,000/mm3 -Creatinine level: 3.2 mg/dL -White blood cell count: 4800/mm3

Creatinine level: 3.2 mg/dL

The nurse working with oncology patients understands that which age-related change increases the older patient's susceptibility to infection during chemotherapy? -Diminished nutritional stores -Decreased immune function -Poor physical reserves -Existing cognitive deficits

Decreased immune function

A client is receiving the first of two prescribed units of PRBCs. Shortly after the initiation of the transfusion, the client reports chills and experiences a sharp increase in temperature. What is the nurse's priority action? -Auscultate the client's lungs -Position the client in high Fowler's -Obtain a blood specimen from the client -Discontinue the transfusion

Discontinue the transfusion

Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about management of the condition?

Do daily deep-breathing exercises

A patient hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL (61 mmol/L). What medication does the nurse prepare to administer? -Epoetin alfa (Epogen) -Oprelvekin (Neumega) -Mesna (Mesnex) -Filgrastim (Neupogen)

Epoetin alfa (Epogen)

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a. Inspection of oral mucosa b. Recent dietary intake c. Heart rate and rhythm d. Percussion of abdomen

Heart rate and rhythm

The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? -Mucosal barrier fortifier -Proton pump inhibitor -Histamine receptor blocker -Gastric acid inhibitor

Mucosal barrier fortifier

A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that one arm feels like "pins and needles" and that the neck is very painful since returning from surgery. What action by the nurse is best?

Notify the provider immediately

Which menu choice indicates that the patient understands the nurse's teaching about recommended dietary choices for iron-deficiency anemia? -Omelet and whole wheat toast -Croissant with strawberry cream cheese -Cornmeal muffin and orange juice -Fruit plate with Greek yogurt

Omelet and whole wheat toast

A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best? -Prepare to administer folic acid. -Prepare to administer cobalamin (vitamin B12). -Perform a Hemoccult test on the client's stools. -Encourage high-protein foods

Perform a Hemoccult test on the client's stools.

A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? -Notify the surgeon immediately. -Assess the drainage for clots. -Document the findings in the chart. -Take a full set of vital signs.

Take a full set of vital signs.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? a. Measuring the quantity of emesis b. Palpating the abdomen for distention c. Auscultating the chest for breath sounds d. Taking the blood pressure (BP) and pulse

Taking the blood pressure (BP) and pulse

A nurse works with patients who have alopecia from chemotherapy. What action by the nurse takes priority? -Referring patients to a reputable wig shop -Reassuring patients that this change is temporary -Teaching measures to prevent scalp injury -Helping patients adjust to their appearance

Teaching measures to prevent scalp injury

Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? -Testicular self-examination should be done at least weekly. -Testicular self-examination should be done in a warm room. -Schedule annual screening PET scan. -The only structure normally felt in the scrotal sac is the testis.

Testicular self-examination should be done in a warm room.

The home health nurse is assessing a client who is immunosup- pressed. What is the most essential teaching for this client and the family? -How to promote immune function through nutrition -How to choose antibiotics based on the client's symptoms -The importance of maintaining the client's vaccination status -The need to report any slight changes in the client's health status

The need to report any slight changes in the client's health status

Which information about a patient who is scheduled for an oral glucose tolerance test should the nurse consider in interpreting the test results? a. The patient reports having occasional orthostatic dizziness. b. The patient takes oral corticosteroids for rheumatoid arthritis. c. The patient has had a 10 pound weight gain in the last month. d. The patient drank several glasses of water an hour previously.

The patient takes oral corticosteroids for rheumatoid arthritis.

Which statement about carcinogenesis is accurate? -Normal hormones and proteins do not promote cancer growth. -Tumor cells need to develop their own blood supply. -An initiated cell will always become clinical cancer. -Cancer becomes a health problem once it is 1 cm in size

Tumor cells need to develop their own blood supply.

The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjögren's syndrome? -Abdominal assessment -Renal function studies -Oxygen saturation -Visual acuity

Visual acuity

A patient with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the patient's oral chemotherapy medications. What action by the nurse is most appropriate? -Crush the medications if the patient cannot swallow them. -Wear personal protective equipment when handling the medications. -No special precautions are needed for these medications. -Give one medication at a time with a full glass of water

Wear personal protective equipment when handling the medications.

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? -Family history of H. pylori infection -Willingness to adhere to drug therapy -Use of nicotine patches -Alcohol intake of 1 to 2 drinks per week

Willingness to adhere to drug therapy

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory test findings to include -an RBC count of 4,500,000/mL. -a hemoglobin (Hgb) of 8.6 g/dL (86 g/L). -Serum potassium level 3.4 mEq/L. -a hematocrit (Hct) value of 38%.

a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease con- trol. What information does the nurse include? (Select all that apply.) a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. c. Pregnancy and breast-feeding are not affected by MTX. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects.

a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects.

When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will teach about -maintaining oral care during the treatments. -emptying the bladder before the medication. -obtaining wigs and scarves to wear. -premedicating to prevent nausea.

emptying the bladder before the medication.

The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication -reduces gastroesophageal reflux by increasing the rate of gastric emptying. -treats gastroesophageal reflux disease by decreasing stomach acid production. -neutralizes stomach acid and provides relief of symptoms in a few minutes. -protects the lining of the stomach.

treats gastroesophageal reflux disease by decreasing stomach acid production.