Medsurg Module Questions
What is the most appropriate statement to Mr. Jarrett Makai 's wife?
"The occupational therapist will provide you with assistive devices so that Mr. Jarrett Makai can participate in his own care with your help."
Which of the following are assessment findings by the nurse that suggest a resolving bowel obstruction? (Select all that apply.)
*A. Decreased nasogastric output* B. Abdominal distention C. Pain managed with opiates *D. Passage of flatus* E. Decreased urine output F. Hypoactive bowel sounds
Mr. Jarrett Makai's condition stabilizes and he is undergoing a craniotomy to remove the hematoma. A supratentorial incision will be made. The nurse is providing preoperative education to the patient and his wife. The nurse teaches Mr. Jarrett Makai's wife to expect which findings after surgery? Select all that apply.
*A. Periorbital edema and ecchymosis* B. A complete resolution of deficits *C. Positioning on the nonoperative side* D. An incision at the nape of the neck *E. A large turban dressing on the head*
The nurse should closely monitor a patient for which of the following potential complications of hypovolemic shock? (Select all that apply.)
*A. Stress ulcer* *B. Decreased level of consciousness* *C. Acute kidney injury* D. Pneumothorax *E. Dysrhythmias*
Mr. Jarrett Makai is brought to the emergency department via ambulance after he was found by his wife on his front lawn, confused and unable to move his left side. During the history and physical assessment, his wife reports "He was complaining of a really bad headache this morning before he went to cut the grass and he vomited several times." Mr. Jarrett Makai is 78 years old and has a history of hypertension. He smoked when he was younger and has drunk three or fours beers per night for the last 50 years. Which of the following signs and symptoms of hemorrhagic stroke are exhibited by Mr. Jarrett Makai?
*A. Unilateral numbness or weakness of the face or extremities* *B. Confusion* C. Aphasia D. Visual disturbances E. Ataxia F. Dizziness *G. Severe headache* *H. Vomiting* I. Seizures
The nurse is caring for a patient who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should assess what parameters? Select all that apply
*A. Visible characteristics of the output* *B. Color of the output* C. pH of the output D. Odor of the output *E. Quantity of output*
The nurse is caring for a client who is being admitted for the removal of an intracranial mass. Which of the following diagnostic procedures might be included in this client's admission orders? Select all that apply.
A. Cranial radiography *B. MRI* C. Electromyelography (EMG) *D. Transcranial Doppler flow study* *E. Cerebral angiography*
The nurse receives a report from the Emergency Department regarding a new in patient admission. The new patient, Shirley Potter, age 65, is being admitted with complications from chronic kidney disease. What clinical manifestations can the nurse expect to see with chronic kidney disease? Select all that apply
A. Hypotension *B. Muscle weakness* *C. Constipation* *D. Fatigue*
Hemodialysis is used for which of the following options? Select all that apply
A. To cure renal disease *B. To remove toxins from the blood* *C. To prevent death due to complications* *D. To remove excess water from the blood*
The nurse reviews the patient's chart to evaluate what type of access device the patient is using for dialysis.The nurse discovers that Mrs. Potter has had surgery to join an artery and a vein. What is this type of permanent access called?
AV fistula
The nurse is aware that the most common cause of small bowel obstruction is which of the following?
Adhesions
The nurse is caring for a client who is recovering from intracranial surgery. The surgery was performed around 24 hours ago. The client is complaining of a headache 8 on a 10-point pain scale. What is the most appropriate nursing action?
Administer morphine sulfate as prescribed
The nurse is caring for a patient who is postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?
Assessment of the quantity of the pt's urine output
Which of the following initial symptom of abdominal pain described by Mr. Stan Checketts would lead the nurse to suspect a small bowel obstruction?
Colicky and crampy
The nurse anticipates that the initial treatment for small bowel obstruction will involve which of the following?
Decompression of stomach via NG tube
The nurse is caring for a post craniotomy patient. The assessment revealed that the patient hourly urine output from a catheter is1500 mL for two consecutive hours. This assessment finding should alert the nurse to which of the following condirions?
Diabetes incipudis
A client is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This client should be informed that he may experience which of the following adverse effects associated with this procedure?
Diarrhea and feeling of fullness
A client has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the client should adopt what dietary guidelines?
Eat small, frequent meals with high calorie and vitamin content
Dilute urine =
Expected finding
The nurse knows erythropoietin works to increase a patient's hematocrit rapidly. Is this statement true or false?
False because EPO takes 2-6 weeks to increase a pt's hmct
A client with a diagnosis of colon cancer is 2 days postoperative following bowel resection and anastomosis. The nurse has planned the client's care in the knowledge of potential complications. What assessment should the nurse prioritize?
Frequent abdominal auscultation
The nurse is caring for a postcranial surgery client with increased intracranial pressure. How should the nurse best position the client?
HOB 30-45*
Which risk factor is the most serious to address to prevent a recurrent hemorrhage?
HTN
A client is scheduled for the creation of a continent ileostomy. What dietary guidelines should the nurse encourage during the weeks following surgery?
High intake of strained fruits and vegetables
Potassium chloride may be administered in the patient with small bowel obstruction and dehydration to correct hypokalemia. The nurse knows that a patient experiencing decreased potassium levels would exhibit which of the following signs and symptoms?
Hypotension and muscle weakness
The nurse is aware that untreated small bowel obstruction can progress to which type of shock?
Hypovolemic
In the patient experiencing small bowel obstruction, vomiting can result in severe dehydration. Laboratory values that would reflect this include which of the following?
Increased hematocrit
Observing which of the following characteristics would lead the nurse to suspect metabolic alkalosis?
Increased pH and increased HCO3
A client has experienced symptoms of dumping syndrome following gastric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?
Influx of extracellular fluid into the small intestine
What kind of medication is Venofer?
Iron supplement
The nurse is caring for a 66-year-old client with end-stage kidney disease. The client was informed by a physician that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?
Kidney transplants in pts your age are as successful as they are in younger pts
Mr. Jarrett Makai's intracranial pressure readings begin to rise above normal limits (20 mm Hg) and his blood pressure is elevated at 176/92 mm Hg. His confusion increases and he begins to vomit. The physician orders nicardipine (Cardene), mannitol (Osmitrol) and phenytoin (Dilantin).
Mannitol (Osmitrol): To decrease cerebral edema Phenytoin (Dilantin): To prevent seizures Nicardipine (Cardene): To decrease systemic hypertension
Mr. Stan Checketts has abdominal distention and reflux vomiting, which of the following acid-base disturbances could be caused by reflux vomiting?
Metabolic alkalosis
The nurse is caring for a post craniotomy client. The nurse identified a nursing diagnosis of "deficient fluid volume related to fluid restriction and osmotic diuretic use." Which of the following is the nurse's most appropriate intervention for this nursing diagnosis?
Monitor electrolytes
The nurse is caring for a client with a brain stem herniation. The client is exhibiting an altered LOC. Monitoring reveals that the client's MAP is 60 mm Hg with ICP reading of 5 mm Hg. What is the most appropriate nursing action?
Participate in interventions to increase cerebral perfusion pressure (CPP)
The nurse is caring for a postcranial surgery client. What medication would the nurse expect to administer prophylactically to prevent seizures in this client?
Phenytoin
The nurse is caring for a client who is recovering from intracranial surgery. A transsphenoidal approach was used. The nurse understands that this approach is used to perform surgeries on what neurologic structure?
Pituitary gland
The nurse is caring for a client who is postoperative day 1 following intracranial surgery. Assessment reveals that the client's LOC is slightly decreased compared with the day of surgery. What is the nurse's best action in response to this finding?
Recognize that this may represent the peak of postsurgical cerebral edema
A nurse caring for a client with a newly created ileostomy assesses the client and notes that the client has had not ostomy output for the past 12 hours. The client also reports worsening nausea. What is the nurse's priority action?
Report s/s of obstruction to HCP
GFR of 13mL/hr = what stage of CKD?
Stage 5 -- The normal GFR is 125 mL/min. Stage: 1 GFR: Greater than or equal to 90 mL/min, Interpretation: Kidney damage with normal or increased GFR Stage: 2 GFR: 60 to 89 mL/min, Interpretation: Mild decrease in GFR Stage: 3 GFR: 30 to 59 mL/min, Interpretation: Moderate decrease in GFR Stage: 4 GFR: 15 to 29 mL/min, Interpretation: Severe decrease in GFR Stage: 5 GFR: Less than 15 mL/min, Interpretation: Renal failure
The nurse is caring for a patient post kidney transplant surgery. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what?
Wash hands carefully and frequently
In addition to hypokalemia, Mr. Stan Checketts developed hypochloremia. The nurse recognizes that signs and symptoms of hypochloremia include which of the following?
muscle cramps
