ATI Med-Surg Proctored Exam Review

A nurse is reviewing the medication administration record of a client who has osteoarthritis. What analgesic prescription should the the nurse expect to administer when the client reports pain?

Acetaminophen

A nurse is reinforcing teaching with a client who has coronary artery disease and is taking a statin medication to lower cholesterol levels. What instruction should the nurse include in the teaching?

Add oily fish to your diet

A nurse is planning to administer the first dose of iron dextran. What actions should the nurse plan to take?

Administer a small test dose before giving the full dose. Infuse the medication over 30 seconds Monitor the client closely for hypertension after the infusion. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. What action should the nurse take?

Administer oxygen via nasal cannula

High purine foods

Alcoholic beverages, some seafood/fish...some meats like turkey, bacon, liver

Iron deficiency symptoms

Anemia: weakness, fatigue, headaches; impaired work performance; impaired immunity; pale skin, nail beds, mucous membranes, and palm creases; concave nails; inability to regulate body temperature; pica

A nurse is reinforcing teaching about joint protection with a client who has an acute exacerbation of rheumatoid arthritis. What information should the nurse include in the teaching?

Apply cold packs to the joints

Hearing Loss Manifestations

Asking to speak up/repeat Answering questions inappropriately Not responding when looking away Straining to hear Cupping hand around ear

A nurse is contributing to the plan of care for a client who has just transferred to the medical-surgical unit from PACU following a right total knee arthroplasty. What interventions should the nurse include in the plan?

Assist the client to change position every 2hr

A nurse is contributing to the plan of care for an older adult client who is at risk for Osteoporosis. Which intervention should the nurse include to prevent bone loss?

Encourage weight bearing exercises (such as walking because it can help maintain bone mass by reducing bone demineralization, thus helping to prevent osteoporosis.)

Malabsorption S/S

FTT Bulk, foul stools (stetorrhea) Abdominal pain protrubent abdomen Pallor Fatigue

Glucosamine side effects

GI upset, nausea, diarrhea, constipation

A nurse is contributing to the plan of care for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infections and is on contract isolation precautions. What action should the nurse take?

Have a designated stethoscope in the client's room

A nurse is caring for a female client who is being treated for dehydration due to nausea & vomiting. What finding should the nurse report to the provider?

Heart rate 120/ min

A nurse is preparing to auscultate the bowel sounds of a client who has a mechanical bowel obstruction in the descending colon. When listening in the left upper quadrant, the nurse should identify this sound as what?

Hyperactive bowel sounds

A nurse is reinforcing teaching to a client about preventing osteoporosis. What statement indicates an understanding of the teaching?

I will limit my coffee intake

A nurse is reinforcing teaching with a client who has chronic kidney disease about management. What statement by the client indicates an understanding of the teaching?

I will limit my daily intake of protein

A nurse is assisting in the care of a client who has manifestations of sepsis. What provider prescriptions should the nurse implement first?

Initiate oxygen at 4 L/min via nasal cannula

A nurse is admitting a client who is suspected having active tuberculosis (TB). What action should should the nurse take first?

Institute airborne precautions

A nurse is caring for a client who is post operative following a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigation. The nurse notes decreased output from the urethral catheter. What prescription should the nurse expect the provider to order?

Irrigate the urethral catheter with 0.9% sodium chloride

A nurse is reviewing the medical record for an older adult client who is experiencing nausea & vomiting. Based on the client data, what action should the nurse take? (Na 142 mEq, K+ 4.2 mEq/L, BUN 36 mg/dL, Creatinine 1.4 mg/dL)

Notify the charge nurse of the client's BUN level

A nurse is reinforcing teaching with a client who has heart failure and a new prescription for hydrochlorothiazide. What should the client report to the provider?

Onset of nausea

A nurse is assisting with an educational program for clients who have newly diagnosed with diabetes mellitus. What instruction should the nurse include in the program regarding insulin?

Opened insulin can be stored on a cool countertop away from light

A nurse is caring for a client who is 24hr postoperative following an abdominal surgery. What finding requires immediate attention from the nurse?

Oxygen saturation of 88%

McBurney's point

Pain in RLQ with appendicitis

hypothermia symptoms

Pale, cold skin, dilated pupils, poor coordination, slurred speech, incoherent thinking, unconsciousness, muscle rigidity, weak pulse, labored breathing, irregular heart beat

A nurse is contributing to the plan of care for a client who has tuberculosis (TB). What intervention should the nurse include?

Place the client in a negative pressure airflow room

A nurse is caring for a client following a gastrectomy. What action should the nurse take to decrease episodes of dumping syndrome?

Place the client in the supine position after meals

A nurse is caring for a client who is 1 day post operative following a hip arthroplasty. The client is exhibiting hypotension, tachycardia, & tacky-nearly. The nurse should recognize these findings as what complication?

Pulmonary Embolism

A nurse is reinforcing discharge teaching with a client who has hearing loss. What action should the nurse take when communicating with the client?

Rephrase client instructions when not understood.

Hypothyroidism S/S

Same as hypometabolism ie, tired, sluggish Cold intolerant obese decreased hr, p, rr

A nurse in an orthopedic clinic is reinforcing teaching with a client who has osteoarthritis. What instructions should the nurse include to promote comfort?

Sleep on a firm mattress

A nurse enters the room of a client whose transfusion of packed RBCs was initiated 15 min ago by the RN. The client reports dyspnea and urticaria. What action should the nurse perform first?

Stop the infusion

A nurse is reinforcing teaching with an older adult client who has osteoporosis. What instructions should the nurse include in the teaching?

Take the calcium supplements with meals

A nurse is reinforcing teaching with a client who is taking Levothyroxine. What statement by the client indicates an understanding of the teaching?

The medication should be taken before I eat breakfast every morning

A nurse is reinforcing teaching with a client who has a new diagnosis of genital herpes. What information should the nurse include in the teaching?

The virus can be transmitted without lesions present

Pregbalin (Lyrica)

This can be used to treat fibromyalgia, postherpetic neuropathy, and diabetic neuropathy:

Low calcium diet

This diet includes: Peas, carrots, fruit, meat, fish.

A nurse is reinforcing teaching with a client who is taking insulin Glargine. What information should the nurse include in the teaching?

This type of insulin should be given at the same time everyday. (It is released over a 24hr period)

A nurse is contributing to the plan of care for a client who has pericarditis. What position should the nurse plan to place the client to decrease plan?

Upright, leaning forward

A nurse is assisting in the plan of care for a client who has a recent left hemispheric stroke. What action should the nurse include in the plan?

Use simple verbal cues when directing tasks

A nurse is caring for a client who has a methicillin-resistant Staphlococcus aureus (MRSA) infections in a surgical wound. What information should the nurse plan to share with visitors?

Visitors must don a gown & gloves prior to entering the client's room.

A nurse is reviewing medical record of a client who is postoperative. What finding should the nurse identify as a complication of surgery?

WBC count of 15,000/ mmm3

A nurse is reinforcing teaching with a client who has diabetes mellitus and a new prescription for regular and NPH insulin. What instructions on preparing the insulin should the nurse include?

Withdraw the regular insulin before withdrawing the NPH insulin

A nurse is caring for a client who has a prescription for digoxin 0.25mg PO daily. While taking the client's apical pulse, the nurse notes a rate of 58/ min. What action should the nurse take?

Withhold the dose

functional hearing loss

a condition in which persons do not respond appropriately to speech or other sound and there does not appear to be an abnormality or lesion in their ears, auditory nerves, or CANS. also referred to as psychogenic hearing loss, pseudohypacusis, and idiopathic sudden deafness

A home health nurse is reinforcing teaching with a client about preventing complications of peripheral vascular disease. What statement by the client indicates that they are adhering to the nurse's instructions?

"I don't cross my legs anymore".

A nurse is caring for a client who has terminal pancreatic cancer. The client states, "I don't think I can go on any longer." What response should the nurse make?

"Tell me more about the way you are feeling."

peripheral neuropathy

damage to nerves in lower legs and hands as result of diabetes mellitus; symptoms include either extreme sensitivity or numbness and tingling

Hearing Loss: Sensorineural

damage to structures of inner ear

Hearing Loss: Conductive

deafness; occurs when sound waves are not conducted to the inner ear

Hypothermia treatment

remove wet clothing, wrap victim in blanket, protect from weather, provide food and drink to conscious victims if they aren't nauseas, do not massage to warm body, place unconscious victim in recovery position, place in warm bath if available

obstipation

severe constipation, which may be caused by an intestinal obstruction

Glucosamine contraindications

shellfish allergy, diabetes, bleeding disorders

vaso-occlusive crisis

visual disturbance, hematuria, painful swelling extremities, fever, tachy, PAIN

Foods high in potassium

• Avocado • Bananas • Cantaloupe • Carrots • Fish • Mushrooms • Oranges • Potatoes • Pork, Beef, Veal • Raisins • Spinach • Strawberries • Tomatoes

hyperlipidemia

excessive fat in the blood

Hyperthyroidism symptoms

heat intolerance, weight loss, sweating, anxiety, irritability, hyperactive reflexes, palpitations

metabolic alkalosis

high pH, high HCO3 causes: severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3

respiratory alkalosis

high pH, low CO2 lethargy lightheadedness confusion tachycardia dysrhythmias related to hypokalemia nausea vomiting epigastric pain numbness and tingling of the extremities hyperventilation (tachypnea)

Respiratory Alkalosis S/S

lethargy lightheadedness confusion tachycardia dysrhythmias related to hypokalemia nausea vomiting epigastric pain numbness and tingling of the extremities hyperventilation (tachypnea)

respiratory acidosis

low pH, high CO2 causes: (1) COPD (2) Pneumonia. (3) Atelectasis.

metabolic acidosis

low pH, low HCO3 causes: DKA, severe diarrhea, renal failure, shock

Gestational Diabetes risks

macrosomia, hypoglycemia, hypocalcemia, hyperbilirubinemia, and polycythemia

sepsis s/s

o Fever o Chills o Rapid breathing and heart rate o Rash o Confusion o Disorientation

Large bowel obstruction

-Differs in that manifestation may be constipation for months, slow progression -Pain less severe -Eventually, abdominal distention and fecal vomiting occurs -Diagnostics and treatment similar

celiac disease symptoms

-Malabsortive diarrhea -Flatulence -Steatorrhea (greasy, bulky stool) -Weight loss -Abd distention -Weakness and growth retardation -Iron deficiency -Bone pain or Bone weakness -Amenorrhea -Fertility problems -Dermatitis herpetiformis (blisters on extensor surface)

Teaching for a client who has a new dx of hyperlipidemia

1. focus on lifestyle modification for the first six months (management of identified CVD risk factors can be done in a primary care) 2. Offer nutrition support and lifestyle counseling. 3. If lifestyle modifications fail to reduce the lipids to the desired level in patients with extreme lipid disorders, pharmacotherapy is recommended

A nurse is planning care for a group of clients after receiving change-of-shift report. What client should the nurse see first?

A client who is dehydrated, has mental confusion, & was found getting out of bed several times during the night.

Small bowel obstruction is a condition characterized by which finding? A) Severe fluid and electrolyte imbalances. B) Metabolic acidosis. C) Ribbon-like stools. D) Intermittent lower abdominal cramping.

A) Severe fluid and electrolyte imbalances

A nurse is monitoring a client who has a wrist cast and reports intense itching underneath the cast. What action should the nurse take?

Blow cool air into the cast using a blow dryer on a cool setting

A nurse is collecting data from a client who has chronic kidney disease with hyperkalemia. What finding should the nurse expect related to hyperkalemia?

Bradycardia

A nurse is collecting data from a client who has hypothyroidism. What manifestation should the nurse expect?

Bradycardia

A nurse is caring for a client who has an intestinal obstruction & reports a new onset of nausea. The client has an NG tube set at low intermittent suction & is receiving continuous IV infusion of 0.9% sodium chloride. What action should the nurse take first?

Check for kinks in the NG tube

Foods high in calcium

Cheese *Collard greens* Milk and *soy milk* *Rhubarb* *Sardines* Spinach *Tofu* Yogurt

A nurse is caring for a client who has a new cast on her left forearm and report severe pain in the affected arm with numbness in the fingers. The nurse finds the skin is pale and cold with sluggish capillary refill. What fracture complication should the nurse suspect?

Compartment syndrome

A nurse is preparing to administer furosemide to a client who has heart failure. What should the nurse report before administering the medication?

Decreased potassium

A nurse is caring for four clients. What conditions should the nurse identify as a risk for developing vascular disease?

Diabetes mellitus

A home health nurse is caring for a client who has COPD. The client tells the nurse that he becomes short of breath while eating despite the use of home oxygen. What instructions should the nurse include?

Drink beverages at the end of meals

A nurse is collecting data from a client who has hypokalemia. What finding should the nurse identify as the priority?

Dysrhythmia

A nurse is reinforcing teaching with a client who has circulatory comprise in the lower extremities due to peripheral vascular disease. What action should the nurse take?

Educate the client about choosing low-fat, low cholesterol foods

A nurse is caring for a client who has dementia due to Alzheimer's disease. What action should the nurse take to reduce the client's confusion?

Encourage reminiscence of past experiences

A nurse is caring for a client who is 24hr postoperative following abdominal surgery & has an NG tube. What action should the nurse plan to take to decrease the risk of postoperative complications?

Encourage the client to use an incentive spirometer every hour while awake

A nurse is reviewing the plan of care for an older adult client who is 1 day post operative following a total hip arthroplasty. What interventions should the nurse contribute to the plan of care?

Keep an abduction pillow between the client's legs

A nurse is caring for a client who is in Buck's traction. What intervention should the nurse perform to reduce skin breakdown?

Keep the skin dry and free of perspiration

A nurse is monitoring a client who recently had a cast placed on the right lower extremity for a bone fracture. What finding should the nurse recognize as abnormal?

Lack of sensation between the first and second toes

A nurse reinforcing teaching with a client who has systemic lupus erythematosus (SLE) and is to begin taking methylprednisolone orally. What should the nurse include in the teaching?

Limit contact with large groups of people

A nurse is reinforcing teaching with a client who is postoperative following a cemented total hip arthroplasty. What instructions should the nurse include in the teaching?

Maintain hip flex ion to 90 or less when sitting

A nurse is caring for a client who has meningococal pneumonia. Which of the following personal protective equipment should the nurse use?

Mask (this disease requires droplet precautions)

Foods high in protein include

Meats, dairy, nuts and beans

Foods high in iron

Meats, eggs, legumes, whole grains, green leafy vegetables , and dried fruits

right hemisphere of brain

controls left side of the body and contains creativity and the arts

left hemisphere of brain

controls right side of the body and is logical, contains mathamatics, lauguage, & speech