MED DURG EXAM 4

A nurse is caring for a client who has hyperparathyroidism. Based on this diagnosis, the nurse is aware that the client is at risk for which of the following? 1.Impaired skin integrity 2.Fluid retention 3.Pathologic fractures 4.Dysphagia

Pathologic fractures Hyperparathyroidism results in the release of calcium and phosphate into the blood, thereby decreasing bone density. This places the client at risk for pathologic fractures. The client is not at risk for impaired skin integrity, fluid retention or dysphagia.

A family member is instructed by a nurse on the interventions for safe swallowing for a client who has residual effects from a stroke. Which of the following concepts are most important for the family members to understand? .Offer mouth care before meals 2.Place food in the unaffected side of the mouth. 3.Encourage the client to take small bites and chew food thoroughly. 4.Place the client in the upright position to facilitate swallowing.

Place the client in the upright position to facilitate swallowing. The greatest risk to this client is injury from aspiration; therefore, the most important concept for the family members to implement is to place the client in the upright position for meals to facilitate swallowing and prevent aspiration. All other options are correct instructions, but not the most important concept.

A newly licensed nurse is caring for a client who is at risk for developing diabetes insipidus. Which of the following should be included in the client's plan of care? 1.Measure blood glucose levels every 4 hr 2.Monitor for oliguria 3.Initiate fluid restrictions 4.Check urine specific gravity

Check urine specific gravity The urine will become dilute, resulting in a low specific gravity in a client with diabetes insipidus; therefore, the nurse should check the urine specific gravity.

A staff nurse is working on a medical-surgical floor for a client who has Addison's disease. The client asks the nurse what causes Addison's disease. Which of the following is an appropriate response by the nurse? 1.Overproduction of insulin by the pancreas. 2.Lack of production of cortisol by the adrenal gland. 3.Overproduction of growth hormone by the pituitary gland. 4.Lack of production of lymphocytes by the thymus gland.

Lack of production of cortisol by the adrenal gland. Addison's disease is caused by a lack of production of cortisol by the adrenal gland.

A client returns from the post anesthesia care unit after a subtotal thyroidectomy. The client's vital signs are stable and her dressing is dry. The nurse should assist the client in maintaining which of the following positions? 1.High Fowler's with her neck extended 2.High Fowler's with her neck in a neutral position. 3.Semi-Fowler's with her neck extended 4.Semi-Fowler's with her neck in a neutral position

Semi-Fowler's with her neck in a neutral position Semi-Fowler's is the most comfortable position for a client who has had thyroid surgery. Neck flexion could compromise the airway, and neck extension could place excessive tension on the operative area and the sutures. A neutral position is essential

A nurse is caring for a client who has peptic ulcer disease. The nurse knows to monitor the client for which of the following findings as an indication of the complication of gastrointestinal perforation? 1.Hyperactive bowel sounds 2.Sudden abdominal pain 3.Increased blood pressure 4.Bradycardia

Sudden abdominal pain Classic indications of gastrointestinal perforation include sudden sharp abdominal pain, with a rigid abdomen, declining peristalsis, and progression to septicemia and hypovolemic shock.

•A nurse is caring for a client who is receiving esomeprazole (Nexium) to manage GERD. Which of the following best indicates the desired therapeutic effect? 1."I don't pass gas as often." 2."My abdomen is no longer firm." 3."I don't have pain in my stomach. 4."I have regular bowel movements."

"I don't have pain in my stomach." Esomeprazole (Nexium) is a proton pump inhibitor (PPI) and works in the parietal cells of the stomach by inhibiting the proton pump enzyme that generates gastric acid secretion. It is used in the treatment of gastric ulcers, duodenal ulcers and GERD. An expected finding of the medication will be a decrease in the client's symptoms of an ulcer or GERD. Heartburn is a common sign of GERD, so absence of pain would be an indication that the medication is working. PPIs are generally well-tolerated.

A nurse is discharge teaching a client who has GERD. Which of the following client statements reveals an understanding of the teaching? 1."I can eat whatever I want." 2."I will sleep on my left side." 3."I will lie down following meals." 4."I will sleep with the head of my bed elevated."

"I will sleep with the head of my bed elevated." The client should sleep with the head of the bed elevated 6 to 12 inches for sleep to prevent reflux at night. The client should avoid spicy and acidic foods, caffeine, and carbonated beverages. The client should lie on the right side position to decrease symptoms of night time reflux. The client should sit up in a chair following meals to decrease reflux.

A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia, dysmetria, and sensory change. Which of the following nursing statements are appropriate? 1."Wear an eye patch on the right eye at all times." 2."Plan to relax in a hot tub spa each day." 3."Engage in a vigorous exercise program." 4."Implement a schedule to include periods of rest."

"Implement a schedule to include periods of rest." The nurse should implement a schedule with periods of exercise followed by periods of rest to maintain muscle strength and coordination. The nurse should instruct the client to alternate every two hours an eye patch to improve diplopia, not leave on the right eye continually, to avoid extreme temperature changes which may exacerbate the MS symptoms and to develop a tolerable exercise program, not a vigorous exercise program, which may exacerbate the MS symptoms.

A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take the medication... 1.with an antacid. 2.1 hr before meals. 3.with food or milk. 4.immediately after meals.

1 hr before meals. Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness. The client should not take antacids within 30 min of taking sucralfate. And taking sucralfate with food or milk and on a full stomach reduces its effectiveness.

A nurse is creating a plan of care for a client who has a tonic-clonic seizures disorder. Which of the following seizure precautions should the nurse implement? (Select all that apply.) 1.Provide a suction setup at the bedside. 2.Elevate the side rails when in bed. 3.Place the bed in the lowest position 4.Keep an oxygen setup at the bedside. 5.Furnish restraints at the bedside.

1, 2, 3 & 4. Provide a suction setup at the bedside, Elevate the side rails when in bed, Place the bed in the lowest position and Keep an oxygen setup at the bedside. •The nurse should provide a suction setup at the bedside to do oral suctioning following the seizure to prevent aspiration. The nurse should also implement elevation the rails of the bed to prevent a fall during a seizure. The bed should be placed in the lowest position to prevent injury if a fall should occur during a seizure. And the nurse should keep an oxygen setup at the bedside to administer oxygen during a seizure. Furnish restraints at the bedside is incorrect. The client should not be restrained during a seizure.

A nurse is caring for a client following the surgical placement of a colostomy. Which of the following statements indicates the client understands the dietary teaching? 1. "Eating yogurt can help decrease the amount of gas that I have. 2."I should eliminate pasta from my diet so that I don't have as many loose stools." 3."My largest meal of the day should be in the evening." 4."Carbonated beverages can help control odor."

1."Eating yogurt can help decrease the amount of gas that I have." The client who has a colostomy can include yogurt into his diet to help reduce odors and intestinal gas. The client should also include pasta and other sources of fiber into his diet to help control loose stools. The client should have his largest meal in the middle of the day to help decrease the amount of stool produced during the hours of sleep. And the client should avoid carbonated beverages due to the increased production of intestinal gas.

A nurse is caring for a client admitted with a diagnosis of hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months despite increased appetite. Additional symptoms reported include increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following measures should the nurse include in the client's plan of care to prevent a thyroid crisis? 1.Provide a quiet, low-stimulus environment. 2.Administer aspirin as prescribed for any sign of hyperthermia. 3.Maintain the client's NPO status. 4.Observe the client carefully for signs of hypocalcemia.

1.Provide a quiet, low-stimulus environment. Thyroid crisis can occur in response to a stressor, so the client should not be exposed to other clients who have active infections or an environment that is noisy and stimulating. In clients who have hyperthyroidism, aspirin displaces the thyroid hormone from plasma proteins and results in active thyroid hormone in the blood, which may exacerbate a thyrotoxic crisis. The client should be encouraged to eat a high-protein, high-calorie diet to maintain weight and prevent negative nitrogen balance. Hypocalcemia is a clinical finding in hypoparathyroidism, and calcium levels do not play a role in preventing thyrotoxic crisis.

The nurse is conducting a class on Parkinson's disease for a group of family members. Which of the following information should the nurse include in the teaching? 1.Provide client supervision. 2.Limit client physical activity. 3.Speak loudly to the client. 4.Leave the television on continuously.

1.Provide client supervision. The nurse's information should include providing client supervision to create a safe and respectful environment. It should also include providing exercise program to improve mobility, alternated with periods of rest, not limiting activity, speaking clearly and in a normal tone to the client, not loudly and should include decreasing excess environmental noise to increase the client's ability to concentrate on listening so, the television should be off.

A nurse is caring for a client after a craniotomy for pituitary tumor who has developed diabetes insipidus. The client is receiving vasopressin (Pitressin). The desired response to the medication is evident when the nurse observes which of the following findings? 1.A decrease in blood sugar. 2.A decrease in blood pressure. 3.A decrease in urine output. 4.A decrease in specific gravity.

A decrease in urine output. The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Pitressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is caring for a client who has a long history of peptic ulcers and is admitted for treatment of pyloric obstruction. The nurse is preparing to insert a nasogastric tube. Which of the following options is the rationale for the use of the nasogastric tube? 1.Determine the pH of the gastric secretions 2.Supply nutrients via tube feedings 3.Decompress the stomach Administer medications

Decompress the stomach Due to a pyloric obstruction, removal of gastric secretions and gas from the stomach is needed. This is the purpose of the nasogastric tube.

A nurse is caring for a client who is diagnosed with a cerebrovascular accident (CVA, stroke). Which of the following actions should be implemented to prevent deep-vein thrombosis (DVT)? 1.Massage lower extremities daily. 2.Check for positive Homans' sign. 3.Monitor the client's level of consciousness. 4.Place sequential compression devices bilaterally.

Place sequential compression devices bilaterally. DVT is the most common type of thrombophlebitis. DVT usually is treated using a combination of rest, anticoagulant therapy, and sequential compression devices (SCDs). The use of SCDs helps prevent blood stasis by promoting circulation. The SCDs should be measured from the middle of the foot to just below the knee or thigh and are worn while in bed. The nurse should refrain from massaging lower extremities in the event that the client has an existing DVT. Massage can promote the dislodging of the Pain in the calf upon dorsiflexion of the foot (positive Homans' sign) appears in only a small percentage of clients who have DVT, and false positive findings are common. Therefore, checking for Homans' sign is not advised.

A nurse in the post anesthesia care unit is assessing a client who has a colostomy after a colectomy. Which of the following conditions should the nurse report to the provider? 1.Stoma oozing red drainage 2.Shiny moist stoma 3.Purplish colored stoma 4.Rosebud appearing stoma orifice

Purplish colored stoma The client whose stoma is purplish in color indicates ischemia and the provider should be notified immediately.

A nurse is planning care for several clients and the nurse is considering the client's risk for ischemic embolic stroke. Which of the following clients are at risk? 1.The client who has uncontrolled hypertension. 2.The client who has chronic atrial fibrillation. 3.The client who has thrombocytopenia 4.The client who has an arteriovenous malformation.

The client who has chronic atrial fibrillation. Chronic atrial fibrillation places the client at risk for embolic stroke because a small thrombus may dislodge and migrate to the brain. Uncontrolled hypertension places the client at risk for hemorrhagic stroke. Thrombocytopenia places the client at risk for bleeding-induced stroke. Arteriovenous malformation places the client at risk for hemorrhagic stroke.

A client who is 1 day postoperative following a thyroidectomy reports severe muscle spasms of the lower extremities. Which action should the nurse implement? 1.Check the pedal pulses. 2.Verify the most recent calcium level. 3.Request medical order for relaxant. Administer an oral potassium supplement

Verify the most recent calcium level. A client who has had a thyroidectomy is at risk of hypocalcemia due to possible disruption of the parathyroid gland during surgery. The parathyroid glands are four small glands located inside the thyroid gland. They are responsible for calcium regulation; if they are damaged during a thyroidectomy, there is a risk of hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive reflexes. If a client develops any of these symptoms following a thyroidectomy, it would be important to see what the latest calcium level is. The expected reference range for calcium is 8.5-10.5 mg/dL. If a calcium level is not available, one should be ordered. If the calcium is low, the provider should be notified, and oral or intravenous calcium replacement should be administered.