ADVANCED MEDSURG | EXAM 6 PRACTICE QUESTIONS

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority? a. Administer oxygen. b. Apply an oximetry probe. c. Give pain medication. d. Start an IV line.

a. Administer oxygen.

A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? a. Asterixis b. Constructional apraxia c. Fetor hepaticus d. Palmar erythema

a. Asterixis

A nurse in a clinic is caring for a client who has a history of alcohol abuse and reports bruising and frequent nosebleeds. For which of the following is the client at risk? a. Cirrhosis b. Diabetes c. Hepatitis A d. Malnutrition

a. Cirrhosis

A nurse working with clients with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factors should clients be taught to avoid? Select all that apply. a. Dehydration b. Exercise c. Extreme stress d. High altitudes e. Pregnancy

a. Dehydration c. Extreme stress d. High altitudes e. Pregnancy

55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? a. Destruction of the patients liver tumor b. Restoration of portal vein patency c. Destruction of a liver abscess d. Reversal of metastasis

a. Destruction of the patients liver tumor

A nurse is providing dietary teaching to a client who has a history of recurring calcium oxalate kidney stones. Which of the following instructions should the nurse include in the teaching a. Drink 3 L of fluid every day b. Eat 12 oz animal protein daily c. Take 3000 mg of vit C daily d. Restrict calcium intake to one serving daily

a. Drink 3 L of fluid every day

A nurse is assessing a client who has obstruction of the common bile duct resulting from chronic cholecystitis which of the following findings should the nurse expect? a. Fatty stools b. Straw-colored urine c. Tenderness in the left upper abdomen d. Ecchymosis of the extremities

a. Fatty stools

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history? a. Gallstones b. Hypolipidemia c. COPD d. Diabetes mellitus

a. Gallstones

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best? a. Give the client pain medication if it is time for another dose. b. Instruct the client not to request pain medication too early. c. Request the provider leave a prescription for a placebo. d. Tell the client it is too early to have

a. Give the client pain medication if it is time for another dose.

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is ess

a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. a. How many alcoholic drinks do you typically consume in a week? b. Have you ever been tested for diabetes? c. Have you ever been diagnosed with gallstones? d. Would you say that you eat a particularly high-fat diet? e. Does anyone in your family have cystic fibrosis?

a. How many alcoholic drinks do you typically consume in a week? c. Have you ever been diagnosed with gallstones?

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? a. Inform the physician and assess the patient for signs of infection. b. Flush the peritoneal catheter with normal saline. c. Remove the catheter promptly and have the catheter tip cultured. d. Administer a bolus of IV normal saline as ordered.

a. Inform the physician and assess the patient for signs of infection.

A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment? a. The client has lost 11 pounds in the past 10 days. b. The clients urine specific gravity is 1.048. c. No blood is observed in the clients urine. d. The clients blood pressure is 152/88 mm Hg.

a. The client has lost 11 pounds in the past 10 days.

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram a. They are going to examine my gallbladder and ducts b. I will have a camera put down my throat and I can see my gallbladder c. Soon the shockwaves will get rid of my gallstone d.. They will put medication into my gallbladder to dissolve the stones

a. They are going to examine my gallbladder and ducts

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? Select all that apply. a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

a. Urine output of 100 mL in 4 hours c. Large amount of sediment in the urine e. Blood pressure of 90/60 mm Hg

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patients treatment, the nurse should anticipate what intervention? a. Administration of immune globulins b. A regimen of antiviral medications c. Rest and watchful waiting d. Administration of fresh-frozen plasma (FFP)

b. A regimen of antiviral medications

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following lab values? a. Calcium b. Amylase c. Red blood cell count d. Magnesium

b. Amylase

The family of a neutropenic client reports the client is not acting right. What action by the nurse is the priority? a. Ask the client about pain. b. Assess the client for infection. c. Delegate taking a set of vital signs. d. Look at todays laboratory results

b. Assess the client for infection.

The nurse is caring for a patient with polycystic kidney disease. Which assessment finding requires immediate nursing intervention? a. Temperature of 99° F b. Blood pressure of 170/90 c. Heart rate of 100 beats/min d. Urine output less than 30 cc/hr

b. Blood pressure of 170/90

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? Select all that apply. a. Clear drainage b. Bloody drainage at site c. Client reports headache d. Foul-smelling drainage e. Urine draining from site

b. Bloody drainage at site d. Foul-smelling drainage e. Urine draining from site

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first? a. Client with a blood pressure of 180/98 mm Hg b. Client who reports shortness of breath c. Client who reports calf tenderness and swelling d. Client with a swollen and painful left great toe

b. Client who reports shortness of breath

A nurse is providing care for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action? a. Place the client in a supine position postoperatively. b. Encourage ambulation once fully awake. C. Offer the client ice cream postoperatively. D. Instruct the client not to lift over 4.5 kg (10 lb)

b. Encourage ambulation once fully awake.

A 23-year-old African-American male with a history of sickle cell disease had an emergent open reduction and internal fixation of his right femur after a car crash. What is the initial postoperative nursing priority? a. Treating the patient's pain b. Ensuring adequate IV hydration c. Titrating oxygen to an Spo2 >95% d. Examining the surgical incision for signs and symptoms of infection

b. Ensuring adequate IV hydration

A nurse is preparing to administer blood transfusion to an older adult. Understanding age-related changes what alteration in the usual protocol are necessary for the nurse to implement a. Transfuse each unit over 8 hours b. Hold other IV fluids running c. Transfuse smaller bag of blood d. Pre-medicate to prevent reaction e. Access vital signs more often

b. Hold other IV fluids running e. Access vital signs more often

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowlers position with the head of bed elevated.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids.

A nurse is teaching self management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching a. Consume a high protein diet b. Rest frequently throughout the day c. You may donate blood in in 6 months d. After completing the medication regiment take acetaminophen every 4 hrs. as needed for discomfort

b. Rest frequently throughout the day

A nurse is assessing a client who has cirrhosis which of the following is an expected finding for this client? a. Moist skin b. Spider angiomas c. Blood in the urine d. Black stool

b. Spider angiomas

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

c. Administering intravenous fluids through the AV fistula

A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate action? a. Administer a PRN dose of pancreatic enzymes as ordered. b. Teach the patient about the importance of abstaining from alcohol. c. Arrange for the patient to be transported to the hospital. d.

c. Arrange for the patient to be transported to the hospital.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? a. Include foods high in starch and proteins. b. Include foods high in fiber. c. Avoid foods high in fat. d. Avoid foods high in sodium

c. Avoid foods high in fat.

A nurse dis assessing a client who has chronic kidney disease a. Intake and output b. Skin turgor c. Daily weight d. Serum sodium level

c. Daily weight

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? a. Assessment of blood pressure and assessment for headaches and visual changes b. Assessments for signs and symptoms of venous thromboembolism c. Daily weights and abdominal girth measurement d. Blood glucose monitoring q4h

c. Daily weights and abdominal girth measurement

A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the clients bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care providers notes about the prognosis for the client.

c. Determine whether the client feels like talking about his or her feelings.

A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, What can I do to help prevent these infections? How should the nurse respond? a. Test your urine daily for the presence of ketone bodies and proteins. b. Use tampons rather than sanitary napkins during your menstrual period. c. Drink more water and empty your bladder more frequently during the day. d. Keep your hemoglobin A1c

c. Drink more water and empty your bladder more frequently during the day.

A nurse is caring for a client with hepatitis A the client as the nurse how might I have contracted the virus. Which of the following is a question the nurse might ask the client? a. Did you receive a blood transfusion lately b. Do you take any recreational drugs c. Have you eaten any fresh fish lately d. Have you been to a third world country lately

c. Have you eaten any fresh fish lately

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? a. Precipitous b. Decrease in creatinine level c. Hematuria d. Hypotension unresolved by fluid administration

c. Hematuria

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? a. Maintaining oxygen saturation of 89% b. Minimal crackles and wheezes in lung sounds c. Maintaining a balanced intake and output d. Limited shortness of breath upon exertion

c. Maintaining a balanced intake and output

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver? a. Place hand under the right lower abdominal quadrant and press down lightly with the other hand. b. Place the left hand over the abdomen and behind the left side at the 11th rib. c. Place hand under right lower rib cage and press down lightly with the other hand. d. Hold hand 90 degrees to right side of the abdomen and push down firmly.

c. Place hand under right lower rib cage and press down lightly with the other hand.

A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics? a. Management of fluid balance in the home setting b. The need for blood glucose monitoring for the next week c. Signs and symptoms of intra-abdominal complications d. Appropriate use of prescribed pancreatic enzymes

c. Signs and symptoms of intra-abdominal complications

A nurse is assessing a client receiving one unit of packed RBCs to treat intraoperative blood loss. The client reports chills and back pain, and the client BP is 80/64. Which of the following action should nurse take first? a. Inform the provider b. Notify the lab c. Stop the infusion of blood d. Obtain a urine sample

c. Stop the infusion of blood

A nurse is amending a patients plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patients care plan? a. Mobilization with assistance at least 4 times daily b. Administration of beta-adrenergic blockers as ordered c. Vitamin B12 injections as ordered d. Administration of diuretics as ordered

d. Administration of diuretics as ordered

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram which of the following statements by the client should the nurse report to the provider a. The last time I voided it was painful and red tinged b. My period ended 2 days ago c. I drink at least 2 quarts of fluids every day d. I don't eat shellfish because it gives me hives

d. I don't eat shellfish because it gives me hives

The nurse is caring for a client with liver failure and is performing assessment and the knowledge of the clients increase risk of bleeding. The nurse recognizes that this risk is related to the client inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? a. Alterations in glucose metabolism b. Retention of bile salts c. Inadequate production of albumin by hepatocytes d. Inability of the liver to use vitamin K

d. Inability of the liver to use vitamin K

In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention? a. Heart rate of 105 beats/min b. Serum glucose of 136 mg/dL c. Blood pressure of 102/76 mm Hg d. Respiratory rate of 28 breaths/min

d. Respiratory rate of 28 breaths/min

Which assessment finding requires immediate nursing intervention in a patient with severe ascites? a. Confusion b. Temperature 38.2º C c. Tachycardia, rate 110 beats/min d. Shallow respirations, rate 32 breaths/min

d. Shallow respirations, rate 32 breaths/min

A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may include what? a. Fever and pain b. Chills and jaundice c. Nausea and vomiting d. Signs and symptoms of septic shock

d. Signs and symptoms of septic shock

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurses priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the clients pulse. d. Slow down the normal saline infusion

d. Slow down the normal saline infusion

A client with chronic kidney disease states, I feel chained to the hemodialysis machine. What is the nurses best response to the clients statement? a. That feeling will gradually go away as you get used to the treatment. b. You probably need to see a psychiatrist to see if you are depressed. c. Do you need help from social services to discuss financial aid? d. Tell me more about your feelings regarding hemodialysis treatment.

d. Tell me more about your feelings regarding hemodialysis treatment.

A client newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patient health problem a. Toxins have accumulated and inflamed your pancreas b. Bacterial likely migrated from your intestines and became lodged in your pancreas c. A virus that was likely already present in your body has begun to attack your pancreatic cells d. The enzymes that your pancreas produces have damaged the pancreas itself.

d. The enzymes that your pancreas produces have damaged the pancreas itself.

A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for nfection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best? a. If the WBCs are high, there already is an infection present. b. The client is in a blast crisis and has too many WBCs. c. There must be a mistake; the WBCs should be very low. d. Those WBCs are abnormal and dont provide protection.

d. Those WBCs are abnormal and dont provide protection.