lippincott exam 3 medsurg

Which finding should the nurse report to the client's health care provider for a client with unstable type 1 diabetes mellitus? Select all that apply. a. systolic blood pressure, 145 mm Hg b. diastolic blood pressure, 87 mm Hg c. high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) d. glycosylated hemoglobin (HbA1c), 10.2% (0.1) e. triglycerides, 425 mg/dL (23.6 mmol/L) f. urine ketones, negative

a,b,c,d,e

A client with diverticulitis has developed peritonitis following diverticular rupture. When assessing the client, the nurse should perform which action(s)? Select all that apply. a. Percuss the abdomen to note tympany. b. Percuss the liver to note lack of dullness. c. Monitor the vital signs for fever. d. Assess presence of excessive thirst. e. Auscultate bowel sounds to note frequency.

a,b,c,e

A nurse is assessing a client who has a potential diagnosis of pancreatitis. Which risk factors predispose the client to pancreatitis? Select all that apply. a. excessive alcohol use b. gallstones c. abdominal trauma d. hypertension e. hyperlipidemia with excessive triglycerides f. hypothyroidism

a,b,c,e

A client is admitted with a diagnosis of chronic hydronephrosis. Which assessment finding requires immediate action or will assist the nurse in planning care? a. Client's calcium level is 9.2 mg/dL (2.3 mmol/L). b. Client's blood urea nitrogen (BUN) is 32 mg/dL. c. Client's potassium level is 4.9 mEq/L. d. Client's urinary output is 40 mL/hour.

b

A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by the diagnosis and not sure about injecting insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because the space is needed for clients being admitted. How should the nurse handle the situation? Select all that apply. a. Suggest the client find a supportive friend or family member to assist in care. b. Ask the physician to delay the discharge because the client requires further teaching. c. Tell the charge nurse to provide further diabetic education for this client. d. Ask the physician for a referral for a diabetes nurse-educator to see the client before discharge. e. Give the client the phone number of the unit to call with questions about insulin administration.

b,d

The client presents to the emergency department with reports of dark urine and swelling in the face, bilateral hands, and feet. The client is subsequently admitted with the diagnosis of glomerulonephritis and is receiving trimethoprim-sulfa. Which data will the nurse examine to indicate the medication is effective? Select all that apply. a. urine specific gravity of 1.007 b. negative urine leukocyte esterase c. WBC count is 15,000/mcL d. negative urine culture after treatment e. urine pH of 7.5

b,d

The nurse is caring for a client who had an open cholecystectomy 24 hours ago. The client's vital signs have been stable for the past 24 hours, but the client now has a temperature of 101.1 degrees F (38.4 degrees C), a heart rate of 116 beats/min, and a respiratory rate of 26 breaths/min. Using SBAR communication, which of the following recommendations should the nurse make when calling the health care provider? Select all that apply. a. Continue to check vital signs every 4 hours. b. Draw stat blood cultures x 2. c. Assist with a CT scan of the abdomen. d. Start broad-spectrum I.V. antibiotics 4 hours after blood cultures are drawn. e. Draw CBC, CRP, ESR, and UA with culture and sensitivity if indicated. f. Ensure patent I.V. access for fluid bolus.

b,e,f

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? a. increased pH with decreased hydrogen ions b. increased serum levels of potassium, magnesium, and calcium c. blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl d. uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%

c

The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The nurse should notify the health care provider of a decrease in which serum lab value that is a potential precipitating factor for hepatic encephalopathy? a. aldosterone b. creatinine c. potassium d. protein

c

The nurse is completing a health history and physical assessment on a client admitted with esophageal varices and cirrhosis. What signs and symptoms alert the nurse to a potential internal hemorrhage? a. pulse 110 bpm, temperature 102.2°F (38.9°C), and flushed appearance b. pulse 80 bpm, temperature 99.1°F (37.3°C), pain in the right lower quadrant, and constipation c. pulse 108 bpm, temperature 97.7°F (36.5°C), respiratory rate 28, and nausea d. pulse 60 bpm, temperature 102.2°F (39°C), rebound tenderness in the right lower quadrant, and diarrhea

c

The nurse is instructing a client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? a. high-carbohydrate, high-protein b. high-calcium, high-potassium, high-protein c. low-protein, low-sodium, low-potassium d. low-protein, high-potassium

c

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take? a. Encourage activity as tolerated. b. Provide a high-protein, fluid-monitored diet. c. Monitor patient blood pressure. d. Place the client on a sheepskin, and monitor for increasing edema.

c

A client is experiencing gastrointestinal bleeding from a duodenal ulcer. Which clinical assessments made by the nurse would determine that the client is in the compensatory stage of shock? Select all that apply. a. crackles b. jaundice c. cold, clammy skin d. blood pressure within normal range e. decreased urinary output

c,d,e

A client is in the oliguric phase of acute kidney injury. For which risk should the nurse assess the client? a. pulmonary edema b. metabolic alkalosis c. hypotension d. hypokalemia

a

A client with acute pancreatitis is put on nothing-by-mouth status, with the intent of not stimulating the pancreas. The client is prescribed an IV infusion of dextrose 5% in half-normal saline solution at 120 mL/hr. After 3 days of this regimen, the nurse should observe the client for which adverse metabolic condition? a. ketosis b. hyperglycemia c. metabolic syndrome d. lactic acidosis

a

Priority nursing care for a client in addisonian crisis should include which intervention? Select all that apply. a. Administer I.V. hydrocortisone sodium succinate as ordered. b. Administer I.V. dextrose and insulin as ordered to decrease serum potassium level. c. Encourage independence with activities of daily living (ADLs). d. Place the client in a private room. e. Administer I.V. glucose and glucagon as proscribed, and monitor blood glucose levels.

a,b,e

A client with diabetes who takes insulin has a blood glucose level of 40 mg/dL (2.27 mmol/L). What should the nurse offer the client to begin to raise the blood glucose level? Select all that apply. a. one-half cup (120 mL) of orange juice b. one cup (240 mL) of milk c. one-quarter cup (60 mL) of tuna d. one tablespoon (15 mL) of peanut butter e. one slice of bread f. one-half cup (120 mL) of regular soda

a,b,e,f

When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the nurse would expect which urine characteristics to be abnormal? Select all that apply. a. amount b. odor c. pH d. specific gravity e. glucose level f. ketone bodies

a,b,e,f

A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse would be alert for which signs and symptoms? Select all that apply. a. Trousseau's sign b. cardiac arrhythmias c. constipation d. decreased clotting time e. drowsiness and lethargy f. fractures

a,b,f

Which discharge instructions would the nurse give to the client with acute pancreatitis? Select all that apply. a. Report any twitching or muscle spasms. b. Keep hydrated by drinking beverages such as tea or coffee. c. Eat a high-carbohydrate, low-protein, low-fat diet. d. Take cough syrup such as guaifenesin as needed. e. Resume your normal activities right away.

a,c

A client with colon cancer has developed ascites. The nurse should conduct a focused assessment for which additional sign(s) or symptom(s)? Select all that apply. a. respiratory distress b. bleeding c. fluid and electrolyte imbalance d. weight gain e. infection

a,c,d

The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply. a. serum sodium level b. hemoglobin and hematocrit c. serum potassium level d. blood glucose level e. white blood cell count f. creatinine clearance total

a,c,d,e

A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for which sign(s) or symptom(s)? Select all that apply. a. projectile vomiting b. significant abdominal distention c. copious diarrhea d. rapid onset of dehydration e. increased bowel sounds

a,d,e

A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is present for their first day on the unit. An agency nurse and an experienced nurse are also present on the unit. The charge nurse should assign the new graduate to the care of a. a client who had an ileal conduit 3 days ago, an elderly client with a urinary tract infection (UTI), and an adolescent with kidney stones. b. an elderly client with bladder cancer awaiting surgery, an elderly client who had a prostatectomy and bladder irrigation 2 days ago, and an elderly client with renal insufficiency. c. a middle-age client who had a kidney transplant 3 days ago, an elderly client in acute renal failure, and an elderly client with urinary sepsis. d. an elderly client just admitted for acute stroke, a young adult client with suspected kidney stones, and a middle-age client with suspected pyelonephritis.

b

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. Based on the diagnosis of acute pancreatitis the nurse will provide which explanation for the prescribed interventions? a. "I can offer you ibuprofen for pain with a small sip of water." b. "You are not allowed anything by mouth so that your pancreas can rest." c. "I will be starting antibiotic therapy once the blood cultures are obtained." d. "Activity is important, so you will be scheduled for physical therapy."

b

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure.

b

After stabilization of Addison's disease, the nurse teaches the client about stress management. What should the nurse instruct the client to do? a. Remove all sources of stress from daily life. b. Use relaxation techniques such as music. c. Take antianxiety drugs daily. d. Avoid discussing stressful experiences.

b

In the early postoperative period after a bilateral adrenalectomy, the client has a temperature of 101°F (38.3°C). What should the nurse assess first to determine the cause of the elevated temperature? a. dehydration b. lung expansion c. wound infection d. urinary tract infection

b

The nurse is assessing a client who has cholecystitis caused by gallstones (cholelithiasis). Which finding should the nurse report to the health care provider? a. black stools b. nausea after ingestion of high-fat foods c. elevated temperature of 103°F (39.4°C) d. decreased white blood cell count

b

The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate? a. ascites b. anorexia c. jaundice d. peripheral edema

b

The nurse is assessing a client with suspected chronic cholecystitis. Which clinical manifestation is indicative of chronic cholecystitis? Select all that apply. a. pruritus b. heartburn c. dyspepsia d. restlessness e. muscle fatigue

b,c

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a. "Be sure to eat meat at every meal." b. "Eat plenty of bananas." c. "Increase your carbohydrate intake." d. "Drink plenty of fluids, and use a salt substitute."

c

A client is receiving hemodialysis for chronic kidney failure. The nurse understands the client is at an increased risk for which condition? a. development of peritonitis during dialysis b. renal calculi due to the increased urine output c. bladder infections d. serum hepatitis

d

A client with acute kidney injury is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure? a. Assess the dialysis access for a bruit and thrill. b. Insert an indwelling urinary catheter and drain all urine from the bladder. c. Ask the client to turn toward the left side. d. Warm the dialysis solution in the warmer.

d

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? a. poor perfusion to the kidneys b. damage to cells in the adrenal cortex c. obstruction of the urinary collecting system d. nephrotoxic injury secondary to use of contrast media

d

The nurse working in an internal medicine clinic receives four phone calls from clients with chronic pancreatitis. Which client should the nurse contact first? a. The client reporting foul-smelling fatty stools. b. The client in need of pancreatic enzyme medication refill. c. The client reporting chronic abdominal tenderness. d. The client reporting increased thirst and hunger.

d

A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? a. no increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test b. a decreased TSH level c. an increase in the TSH level after 30 minutes during the TSH stimulation test d. below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay

a

A client has been admitted with acute kidney injury. What should the nurse do while admitting the client? Select all that apply. a. Elevate the head of the bed 30 to 45 degrees. b. Take vital signs. c. Establish an intravenous (IV) access site. d. Call the admitting health care provider (HCP) for prescriptions. e. Contact the hemodialysis unit.

a,b,c,d

A nurse is developing a care plan for a client with hepatic encephalopathy. Which would be the goal(s) for the care for this client? Select all that apply. a. Prevent constipation. b. Administer lactulose to reduce blood ammonia levels. c. Monitor coordination while walking. d. Check the pupil reaction. e. Provide food and fluids high in carbohydrates. f. Encourage physical activity.

a,b,c,d,e

The nurse is teaching a client to prevent dumping syndrome after bariatric surgery. Which suggestions will the nurse discuss? Select all that apply. a. Eat six small meals a day. b. Lie down for 15 minutes after a meal. c. Limit fluids with meals. d. Drink hot tea with each meal. e. Include a protein with each meal.

a,b,c,e

A nurse is managing the care of a client in a critical care unit. What medication may be used to reduce stress ulcers? Select all that apply. a.histamine receptor antagonists b.proton pump inhibitors c.aminosalicylates d.cytoprotective agents e.antacids

a,b,d

When the nurse is providing care for a client hospitalized with acute pancreatitis who has severe abdominal pain, which nursing intervention(s) would be most appropriate for this client? Select all that apply. a. Place the client in a side-lying position. b. Administer morphine sulfate for pain as needed. c. Maintain the client on a high-calorie, high-protein diet. d. Monitor the client's respiratory status. e. Obtain daily weights.

a,b,d,e

A client requests to perform continuous ambulatory peritoneal dialysis in the home. For which reason should the nurse identify that this procedure would be contraindicated for the client? Select all that apply. a. severe arthritis b. chronic backache from spinal stenosis c. chronically elevated blood glucose levels d. being treated for elevated blood lipid levels e. abdominal adhesions from previous hernia repair surgery

a,b,e

The nurse is working on a medical-surgical unit with a client who has received a kidney transplant and is now experiencing acute rejection. Which staff member is best to assign to care for this client? a. the graduate nurse who needs experience with IV medication administration b. the registered nurse (RN) who has worked on the medical-surgical unit for 4 years and is working a double shift today c. the registered nurse (RN) with 2 years experience in the operating room who is orienting to the medical-surgical unit d. the registered nurse (RN) floated to the medical unit from the coronary care unit for the day

b

A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effect(s) of corticosteroids? Select all that apply. a. hyperkalemia b. skeletal muscle weakness c. mood changes d. hypocalcemia e. increased susceptibility to infection f. hypotension

b,c,d,e

A young female client is diagnosed with hypothyroidism. What information should the nurse obtain when conducting a focused assessment? Select all that apply. a. rapid pulse b. decreased energy and fatigue c. weight gain of 10 lb (4.5 kg) d. fine, thin hair with hair loss e. constipation f. menorrhagia

b,c,e,f

The nurse is assessing a client who is being admitted to the hospital with upper gastrointestinal (GI) bleeding. Which finding(s) is significant? Select all that apply. a. dry, flushed skin b. decreased urine output c. tachycardia d. widening pulse pressure e. rapid respirations f. thirst

b,c,e,f