Med Surg - Exam #2

The nurse is explaining side effects of chemotherapy to the new cancer patient. Which of the following are side effects of chemotherapy? Select all that apply

- N/V - Infection - Alopecia - Fatigue - Brain fog

The nurse instructs the patient who is receiving radiation therapy to do which of the following after treatment?

Avoid harsh skin cleaners

The nurse is teaching the client that the most definitive way to diagnose cancer is which of the following?

Biopsy

A nurse is triaging clients during a mass causality event. Which of the following labels should the nurse assign to a client who has a head injury with FIXED, DILATED pupils

Black Tag - EXPECTANT: Dying/Deceased

All the following are characteristics of malignant tumors, except? a) Fast growing b) Invades surrounding tissue c) Well differentiated d) Causes death

C - Well differentiated

The nurse understands that the most serious nutritional problem resulting from cancer is which of the following?

Cachexia

A client comes to the emergency department in severe respiratory distress following left-sided blunt chest trauma. The nurse notes absent breath sounds on the client's left side and a tracheal shift to the right. For which of the following procedures should the nurse prepare the client?

Chest tube insertion - Pneumothorax

A nurse is assessing a client who is unconscious. The client has a rhythmical breathing pattern of rapid, deep respirations followed by rapid shallow respirations, alternating with periods of apnea. The nurse should document that the client is experiencing which of the following types of respirations?

Cheyne-Stokes:

A client is admitted to the emergency department following a motorcycle crash. The nurse notes a crackling sensation upon palpation on the right side of the client's chest. After notifying the provider the nurse should document this finding as which of the following?

Crepitus

A nurse is caring for a client who smokes cigarettes and has a new diagnosis of emphysema. How should the nurse assist the client with smoking cessation?

Discuss ways the client can reduce the number of cigarettes smoked per day.

A nurse is caring for a client with pneumonia who is experiencing thick, oral secretions. Which of the following actions should the nurse take first?

Encourage deep breathing and coughing

A nurse is caring for a client who had a CVA. The client appears alert, and engaged during a visit, but does not respond verbally to questions. The nurse should document this as which of the following alterations?

Expressive Aphasia

The nurse is learning about complications of chemotherapy and understands that leaked chemotherapy on the skin causes which of the following?

Extravasation - Chemo med or other drug leaks outside the vein onto or into the skin

Cancer is the number one killer of people in the United States:

False - 2nd to Cardiovascular disease

A nurse is caring for a client who has a cerebral lesion and develops hyperthermia. Which of the following areas of the brain is affected?

Hypothalamus

The nurse is taking care of a patient with that has a drop in blood oxygenation, she charts this as which of the following?

Hypoxemia

A nurse is providing discharge teaching to a client who had a PE. Which of the following statements indicates that the client understands the information?

I'll call the doctor if I see any blood in my urine or stool - BLEEDING is a high risk!

A nurse is assessing a client who has increased ICP and has received IV mannitol. Which of the following findings indicates a therapeutic effect of this medication?

Increased urine output: Mannitol is a diuretic

A nurse is caring for a client who is scheduled to have his chest tube removed. Which of the following actions should the nurse take?

Instruct the client to perform the Valsalva maneuver during removal.

The nurse is teaching about primary prevention in helping to prevent cancer, she describes all the following as primary prevention practices, except: a) Smoking Cessation b) Mammogram c) Adding fruits and veggies to daily diet d) Reducing alcohol intake

Mammogram

The nurse is describing v/q mismatch to a nursing student, she explains ventilation as which of the following?

Oxygen that reaches the alveoli.

A nurse on a medical unit is caring for a client who aspirated gastric contents prior to admission. The nurse administers 100% oxygen by non rebreather mask after the client reports severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory distress syndrome (ARDS)?

PaO2 50 mmHg

A nurse is providing instructions about pursed-lip breathing for a client who has chronic obstructive pulmonary disease with emphysema. The nurse should explain that this breathing techniques accomplishes Which of the following?

Promotes CO2 elimination.

Which type of surgery is being done when lesions that are removed are likely to develop into cancer?

Prophylactic

The most deadly cancers among men and women are which of the following? Select all that apply a) Prostate b) Breast c) Colo/Rectal d) Lung e) Leukemia

Prostate, Breast, Colo/Rectal and Lung

The nurse is caring for a patient with a v/q mismatch, she understands that one of the common causes of a v/q mismatch is which of the following?

Pulmonary Embolism - Adequate ventilation rate, but O2 getting to the alveoli is ineffective.

The nurse is caring for a patient with a PaO2 of 55, the nurse knows this indicates which of the following?

Respiratory Failure

A nurse is caring for a client who has a brainstem injury. Which of the following physiological functions should the nurse monitor?

Respiratory effort

A nurse is preparing a client for a thoracentesis. In which of the following positions should the nurse place the client?

Sitting while leaning forward over the bedside table.

A nurse in a med-surg unit is assessing a client. The nurse should identify that which of the following findings is a manifestation of a PE?

Stabbing chest pain

Positive Romberg Test

Standing w/ feet together and closing eyes - losing balance - Cerebellar Dysfunction

A normal oxygen saturation is 95-100%:

TRUE

A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of the following findings indicates that the nurse should suction the client's airway secretions?

The nurse auscultates coarse crackles in the lung fields

A nurse is providing teaching to a client about pulmonary function testing. Which of the following measures the volume of air the lungs can hold at the end of maximum ventilation?

Total lung capacity

A nurse is providing discharge teaching to a client who has emphysema. Which of the following instructions should the nurse include?

Try to drink at least 2 - 3 L of fluid per day.

A nurse is teaching breathing techniques to a client who has emphysema. Which of the following statements indicates that the client understands the mechanics of pursed-lip breathing?

When I breathe out through pursed lips, my airways don't collapse between breaths.