medsurg study guide

Intravenous therapy with a hypotonic fluid is ordered for the patient. The nurse would plan to start which solution?

0.45 % NaCl

a 23 year old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. his respiratory rate is 34/min with deep breaths and a fruity smell to his breath. he is unresponsive but difficult to arouse 1.What does the nurse suspect is happening with this patient? 2.What serum glucose level would the nurse expect to see with this patient?

1. Diabetic Ketoacidosis 2. most likely great than 300 mg/dL

What symptoms may be suggestive of an intestinal obstruction in a patient with an ileostomy?

D. nausea and abdominal distention

in the ED, the patient is diagnosed with diabetic ketoacidosis (DKA) what is the nurse's first priority for managing this condition

a. airway assessment the first priority is airway management, rapidly followed by administration of insulin, fluids, and correction of any electrolyte imbalances

two days, later the patient is recovered and is preparing for discharge. his wife asks about what they can do to prevent this from happening again what should the nurse teach the patient and his wife?

a. monitor glucose whenever the patient is ill c. watch for and report any illness lasting more than 1 to 2 days d. check blood glucose levels every 4 to 6 hours if anorexia, nausea or vomiting is experience e. check urine ketones when blood glucose is greater than 300 mg/dL It is important to teach the patient to reduce the risk of dehydration by maintaining fluid and food intake. Small amounts of fluid may be tolerated even when vomiting is present. The patient should drink at least 3 L of fluid daily and increase this amount when infection is present.

the student nurse asks why the patient is breathing so rapidly and deeply. what is the nurse's best response?

b. his serum pH is low and this is a compensatory mechanism reasoning: as keto levels rise, the buffering capacity of the body is exceeded and the pH of the body decreases, leading to metabolic acidosis. kussmaul respiration (very deep and rapid) cause respiratory alkalosis in an attempt to correct in the acidosis by exhaling carbon dioxide

a patient returns to his room following a diagnostic colonoscopy after radiologic evidence of diverticulosis. he reports an increase in abdominal pain, fever, chills. which clinical condition is most concerning to the nurse?

bowel perforation

the provider orders laboratory work that includes thyroid function tests what results does the nurse expect to see?

decreased T3 and T4 levels

which instruction should the nurse include in the teaching plan for a client who is GERD

do not lie down for 2 hours after eating

which question is most important for the nurse to ask the client who has a serum potassium level of 2.9 mEq/L?

do you use diuretics or laxatives

which medication should the nurse question before administering it to a patient with peptic ulcer disease?

erythromycin, antibiotic

The nurse is assessing a patient notes a bounding pulse quality, neck vein distention when supine, presence of crackles in the lungs, and increasing peripheral edema. What fluid disorder do these findings reflect?

fluid overload

a nurse encourage a client to increase fluid intake, based on which lab results?

increase BUN level increased serum creatinine

a patient is complaining of right lower quadrant pain, fever, and decreased appetite. what does the nurse suspect which condition

intestinal perforation

which intervention is most important for the nurse to teach the client who is at continuing risk for hypercalcemia and has normal kidney function

keep track of the number of bowel movements you have each day

the client with a peptic ulcer is admitted to the hospital's intensive care unit with obvious gastric bleeding. what is the priority intervention for the nurse

monitor vital signs and observe for signs of hypovolemia

the patient is preparing to go home. what important teaching points should the nurse include in discharge teaching

note how many hours you sleep in a 24 hr period report any difficulty with orientation to time, place, or person be sure to that you take your medication every day at the same time call the provider if you develop an unsteady gait or tremors in your hands

the nurse is reviewing the standing order for a patient who has admitted for evaluation of chest pain. the patient has a history of COPD and his lab results and assessment reveal that he has mild respiratory acidosis. the nurse who question which order?

oxygen therapy at 4 L/min as needed

what assessment finding supports a client's diagnosis of gastric ulcer

period of pain shortly after eating any food

which precaution or intervention does the nurse teach a patient a continued risk for hypernatremia?

read labels on canned or package food to determine sodium content

A patient complains of abdominal pain unrelieved by defecation, that typically occurs after meals along with diarrhea. what doses the nurse recognize as the most likely diagnosis

regional enteritis

A client with hypokalemia is to receive intravenous (IV) potassium replacement. Which action should the nurse take when administering potassium intravenously?

report an increased urinary output to the health care provider

the nurse assess a client diverticulitis and suspects peritonitis when which of the following symptoms is noted?

rigid abdominal wall

A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?

rule hypothyroidism: most cases of hypothyroidism in the U.S. occur as a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism

a patient has a bowel perforation from a recent surgery and now has been diagnosed with peritonitis. the patient has hypoactive bowel sounds, a temperature of 100.5 degrees Fahrenheit and an elevated WBC count. what is the most serious potential complication of peritonitis for which the nurse should monitor?

sepsis

the nurse is evaluating the laboratory work of a patient who has uncontrolled metabolic acidosis. which outcome would result from the condition

serum potassium 5.7 mEq/L

which condition or manifestation in the client with serum sodium level of 149 mEq/L indicates the nurse that this electrolyte imbalance may be caused by excessive fluid loss ?

the client has twitching muscle contractions in the lower extremities

the nurse is planning for the discharge of a client with peptic ulcer disease. which outcome must be included in the plan of care?

the client understands and maintains lifestyle modifications

a 47 year old man with epigastric pain is being admitted to the hospital. during the admission assessment and interview, what specific information should the nurse obtain from the patient,. who is suspected of having peptic ulcer disease?

use of nonsteroidal anti-inflammatory drugs

A patient has just been diagnosed with gastric cancer and the nurse is taking a history on this patient. What would be a priority question to ask?

what is your smoking and alcohol history?

which patient statement it indicates that further nursing teaching is needed about hypothyroidism

when I am feeling better in a few months, I will no longer need to take the Synthroid pills