Med Surg Final Exam

A patient admitted to the emergency department 24 hours ago with reports of chest pain was diagnosed with a ST-segment-elevation myocardial infarction (STEMI). What complication of myocardial infarction should the nurse anticipate? A. Dysrhythmias B. Unstable angina C. Cardiac tamponade D. Sudden cardiac death

A

A patient has received a bolus dose and an infusion of alteplase (Activase) for an ST-segment elevation myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of the medication? A. Presence of chest pain B. Blood in the urine or stool C. Tachycardia with hypotension D. Decreased level of consciousness

A

A patient returns to the unit after a cardiac catheterization. Which nursing care would the registered nurse delegate to the unlicensed assistant personnel (UAP)? A. Take vital signs and report any abnormal values. B. Check for bleeding at the catheter insertion site. C. Prepare discharge teaching related to complications. D. Monitor the electrocardiogram for S-T segment changes.

A

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? A. Assess his adherence to therapy. B. Ask him to make an exercise plan. C. Teach him to follow the DASH diet. D. Request a prescription for a thiazide diuretic.

A

The nurse is admitting a preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) daily. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? A. Vitamin K B. Cobalamin C. Heparin sodium D. Protamine sulfate

A

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? A. BP 128/78 mm Hg B. Weight loss of 2 lb C. Absence of ankle edema D. Output of 600 mL per 8 hours

A

The nurse observes that phlebitis has developed at a patient's peripheral IV site over the past several hours. Which intervention should the nurse implement first? A. Remove the patient's IV catheter. B. Apply an ice pack to the affected area. C. Decrease the IV rate to 20 to 30 mL/hr. D. Administer prophylactic anticoagulants.

A

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of an obese patient admitted with heart failure. Which action by the UAP will require the nurse to intervene? A. Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec B. Waiting 2 minutes after position changes to take orthostatic pressures C. Taking the blood pressure with the patient's arm at the level of the heart D. Taking a forearm blood pressure if the largest cuff will not fit the patient's upper arm

A

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? A. Hypertension promotes atherosclerosis and damage to the walls of the arteries. B. Hypertension causes direct pressure on organs, resulting in necrosis and scar tissue. C. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. D. Hypertension increases blood viscosity, which causes intravascular coagulation and tissue necrosis distal to occlusions.

A

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administering? A. Oxygen, nitroglycerin, aspirin, and morphine B. Aspirin, nitroprusside, dopamine, and oxygen C. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)

A

When the patient is being examined for venous thromboembolism (VTE) in the calf, what diagnostic test should the nurse expect to teach the patient about first? A. Duplex ultrasound B. Contrast venography C. Magnetic resonance venography D. Computed tomography venography

A

Which assessment finding should be considered when caring for a woman with suspected coronary artery disease? A. Fatigue may be the first symptom. B. Classic signs and symptoms are expected. C. Increased risk is present before menopause. D. Women are more likely to develop collateral circulation.

A

Which patient is at greatest risk for sudden cardiac death (SCD)? A. A 52-yr-old black man with left ventricular failure B. A 62-yr-old obese man with diabetes and high cholesterol C. A 42-yr-old white woman with hypertension and dyslipidemia D. A 72-yr-old Native American woman with a family history of heart disease

A

Which person would the nurse identify as having the highest risk for abdominal aortic aneurysm? A. A 70-yr-old man with high cholesterol and hypertension B. A 40-yr-old woman with obesity and metabolic syndrome C. A 60-yr-old man with renal insufficiency who is physically inactive D. A 65-yr-old woman with high homocysteine levels and substance use

A

The patient has chronic venous insufficiency and a venous ulcer. The unlicensed assistive personnel (UAP) decides to apply compression stockings because that is what patients "always" have ordered. Which assessment finding would indicate the application of compression stockings could harm the patient? A. Leg pain at rest B. High blood pressure C. Dry, itchy, flaky skin D. Elevated blood glucose

A Rest pain occurs as peripheral artery disease (PAD) progresses and involves multiple arterial segments. Compression stockings should not be used on patients with PAD. Elevated blood glucose, possibly indicating uncontrolled diabetes, and hypertension may or may not indicate arterial problems. Dry, itchy, flaky skin indicates venous insufficiency. The RN should be the one to obtain the order and instruct the UAP to apply compression stockings if they are ordered.

The nurse is reviewing the laboratory test results for a patient whose warfarin (Coumadin) therapy was stopped before surgery. On postoperative day 2, the international normalized ratio (INR) result is 2.7. Which action by the nurse is most appropriate? A. Hold the daily dose of warfarin. B. Administer the daily dose of warfarin. C. Teach the patient signs and symptoms of bleeding. D. Call the health care provider to request an increased dose of warfarin.

A The therapeutic range for INR is 2.0 to 3.0 for many clinical diagnoses. To maintain therapeutic values, the nurse will administer the medication as ordered. Holding the medication would lower the INR, which would increase the risk of clot formation. Conversely, the higher the INR is, the more prolonged the clotting time. Calling the health care provider is not indicated. Although teaching is important, administering the medication is a higher priority at this time.

Which foods would the nurse encourage patients at risk for coronary artery disease (CAD) to include in their diets? (Select all that apply.) A. Tofu B. Walnuts C. Tuna fish D. Whole milk E. Orange juice

A,B,C

Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.) A. Systolic blood pressure increases with aging. B. White coat syndrome is prevalent in older patients. C. Volume depletion contributes to orthostatic hypotension. D. Blood pressures should be maintained near 120/80 mm Hg. E. Blood pressure drops 1 hour after eating in many older patients. F. Older patients require higher doses of antihypertensive medications.

A,B,C,D,E

What medications should the nurse expect to include in the teaching plan to decrease the risk of cardiovascular events and death for patients with PAD? (Select all that apply.) A. Ramipril (Altace) B. Cilostazol (Pletal) C. Simvastatin (Zocor) D. Clopidogrel (Plavix) E. Warfarin (Coumadin) F. Aspirin (acetylsalicylic acid)

A,C,D,E

Which antilipemic medications should the nurse question for a patient who has cirrhosis of the liver? (Select all that apply.) A. Niacin B. Cholestyramine C. Ezetimibe (Zetia) D. Gemfibrozil (Lopid) E. Atorvastatin (Lipitor)

A,C,D,E Ezetimibe (Zetia) should not be used by patients with liver impairment. Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy. Liver enzymes must be monitored frequently, and the medication stopped if these enzymes increase. Niacin's side effects subside with time, although decreased liver function may occur with high doses. Cholestyramine is safe for long-term use.

A 62-yr-old Hispanic male patient with diabetes has been diagnosed with peripheral artery disease (PAD). The patient smokes and has a history of gout. To prevent complications, which factor is priority in patient teaching? A. Gender B. Smoking C. Ethnicity D. Comorbidities

B

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which injection site should the nurse use to administer this medication safely? A. Buttock, upper outer quadrant B. Abdomen, anterior-lateral aspect C. Back of the arm, 2 in away from a mole D. Anterolateral thigh, with no scar tissue nearby

B

A patient with critical limb ischemia had peripheral artery bypass surgery to improve circulation. What nursing care should be provided on the first postoperative day? A. Keep patient on bed rest. B. Assist patient to walk several times. C. Have patient sit in the chair several times. D. Place patient on their side with knees flexed.

B

A patient with peripheral artery disease is seen in the primary care clinic. Which symptom reported by the patient would indicate to the nurse that the patient is experiencing intermittent claudication? A. Patient reports chest pain with strenuous activity. B. Patient says muscle leg pain occurs with continued exercise. C. Patient has numbness and tingling of all their toes and both feet. D. Patient states the feet become red when they are in a dependent position.

B

A patient with varicose veins has been prescribed compression stockings. Which nursing instruction would be appropriate? A. "Try to keep your stockings on 24 hours a day, as much as possible." B. "While you're still lying in bed in the morning, put on your stockings." C. "Dangle your feet at your bedside for 5 minutes before putting on your stockings." D. "Your stockings will be most effective if you can remove them several times a day."

B

An older adult with dementia has a venous ulcer related to chronic venous insufficiency. The nurse should provide teaching on which type of diet for this patient and his caregiver? A. Low-fat diet B. High-protein diet C. Calorie-restricted diet D. High-carbohydrate diet

B

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? A. Serum uric acid of 3.8 mg/dL B. Serum creatinine of 2.6 mg/dL C. Serum potassium of 3.5 mEq/L D. Blood urea nitrogen of 15 mg/dL

B

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT) who is scheduled for an emergency appendectomy. Vitamin K is ordered for immediate administration. The international normalized ratio (INR) value is 1.0. Which nursing action is most appropriate? A. Administer the medication as ordered. B. Hold the medication and record in the electronic medical record. C. Hold the medication until the lab result is repeated to verify results. D. Administer the medication and seek an increased dose from the health care provider.

B

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing provider for which vital sign taken just before administration? A. O2 saturation 93% B. Pulse 48 beats/min C. Respirations 24 breaths/min D. Blood pressure 118/74 mm Hg

B

The nurse is teaching a patient recovering from a myocardial infarction. How should resumption of sexual activity be discussed? A. Delegated to the primary care provider B. Discussed along with other physical activities C. Avoided because it is embarrassing to the patient D. Accomplished by providing the patient with written material

B

The nurse prepares a discharge teaching plan for a patient who has recently been diagnosed with coronary artery disease (CAD). Which priority risk factor should the nurse plan to focus on during the teaching session? A. Type A personality B. Elevated serum lipids C. Family cardiac history D. High homocysteine levels

B

The patient had aortic aneurysm repair 6 hours ago. What priority nursing action will maintain graft patency? A. Assess output for renal dysfunction. B. Use IV fluids to maintain adequate BP. C. Use oral antihypertensives to maintain cardiac output. D. Maintain a low BP to prevent pressure on surgical site.

B

When providing dietary teaching to a patient with hypertension, the nurse would teach the patient to restrict intake of which meat? A. Broiled fish B. Roasted duck C. Roasted turkey D. Baked chicken breast

B

When teaching a patient about dietary management of stage 1 hypertension, which instruction is appropriate? A. Increase water intake. B. Restrict sodium intake. C. Increase protein intake. D. Use calcium supplements.

B

Which assessment finding would alert the nurse that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox)? A. Crackles bilaterally in the lung bases B. Pain and swelling in a lower extremity C. Absence of arterial pulse in a lower extremity D. Abdominal pain with decreased bowel sounds

B

The nurse admits a 73-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? A. Clonidine (Catapres) B. Bumetanide (Bumex) C. Amiloride (Midamor) D. Spironolactone (Aldactone)

B Loop, bumex, lasix same same

The nurse in the recovery room assesses the right femoral artery puncture site after the patient had a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact? A. Palpate the insertion site for induration. B. Assess peripheral pulses in the right leg. C. Inspect the patient's right side and back. D. Compare the color of the left and right legs.

B The best method to determine that the right femoral artery is intact after inspection of the insertion site is to logroll the patient to inspect the right side and back for retroperitoneal bleeding. The artery can be leaking, and blood is drawn into the tissues by gravity. The peripheral pulses, color, and sensation of the right leg will be assessed per agency protocol.

The nurse is caring for a newly admitted patient with vascular insufficiency. The patient has a new order for enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to correctly administer this medication? A. Spread the skin before inserting the needle. B. Leave the air bubble in the prefilled syringe. C. Use the back of the arm as the preferred site. D. Sit the patient at a 30-degree angle before administration.

B The nurse should not expel the air bubble from the prefilled syringe because it should be injected to clear the needle of medication and avoid leaving medication in the needle track in the tissue.

The nurse is examining the electrocardiogram (ECG) of a patient just admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion? A. Sinus tachycardia B. Pathologic Q wave C. Fibrillatory P waves D. Prolonged PR interval

B The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? A. "I will replace my nitroglycerin supply every 6 months." B. "I can take up to 5 tablets every 3 minutes for relief of my chest pain." C. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." D. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

B The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or 1 metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every 5 minutes for a maximum of 3 doses and contact EMS if symptoms have not resolved completely.

In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) a. diffuse involvement of plaque formation in coronary veins. b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle.

B,C,D

Which assessment findings of the left lower extremity would the nurse identify as consistent with arterial occlusion? (Select all that apply.) A. Edematous B. Cold and mottled C. Reports of paresthesia D. Pulse not palpable with Doppler E. Warmer than right lower extremity F. Capillary refill less than 3 seconds

B,C,D Arterial occlusion may result in loss of limb if not timely revascularized. When an artery is occluded, perfusion to the extremity is impaired or absent. On assessment, the nurse would note a cold, mottled extremity with impaired sensation or numbness. The pulse would not be identified, even with a Doppler. In contrast, the nurse would find edema, erythema, and increased warmth in the presence of a venous occlusion (deep vein thrombosis). Capillary refill would be greater than 3 seconds in an arterial occlusion and less than 3 seconds with a venous occlusion.

The nurse would assess a patient with reports of chest pain for which clinical manifestations associated with a myocardial infarction (MI)? (Select all that apply.) A. Flushing B. Ashen skin C. Diaphoresis D. Nausea and vomiting E. S3 or S4 heart sounds

B,C,D,E During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) because of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.

The nurse is teaching a women's group about ways to prevent hypertension. What information should the nurse include? (Select all that apply.) A. Lose weight. B. Limit beef consumption. C. Limit sodium and fat intake. D. Increase fruits and vegetables. E. Exercise 30 minutes most days.

B,C,D,E Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Beef includes saturated fats, which should be limited. Weight loss may or may not be necessary, depending on the person.

A 74-yr-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which priority action will the nurse complete before administering sublingual nitroglycerin? A. Administer morphine sulfate IV. B. Auscultate heart and lung sounds. C. Obtain a 12-lead electrocardiogram (ECG). D. Assess for coronary artery disease risk factors.

C

A patient was just diagnosed with acute arterial ischemia in the left leg secondary to atrial fibrillation. Which early clinical manifestation must be reported to the provider to save the patient's limb? A. Paralysis B. Cramping C. Paresthesia D. Referred pain

C

A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority? A. Is the patient pregnant? B. Does the patient need to urinate? C. Does the patient have a headache or confusion? D. Is the patient taking antiseizure medications as prescribed?

C

A postoperative patient asks the nurse why the provider ordered daily administration of enoxaparin (Lovenox). Which reply by the nurse is accurate? A. "This medication will help prevent breathing problems after surgery, such as pneumonia." B. "This medication will help lower your blood pressure to a safer level, which is very important after surgery." C. "This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal." D. "This medication is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table."

C

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which common complication? A. Dehydration B. Paralytic ileus C. Atrial dysrhythmias D. Acute respiratory distress syndrome

C

The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action should the nurse instruct the UAP to take next? A. Repeat BP and HR in this position. B. Record the BP and HR measurements. C. Take BP and HR with patient standing. D. Return the patient to the supine position.

C

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history? A. Hypocapnia B. Tachycardia C. Bronchospasm D. Nausea and vomiting

C

The nurse is caring for a patient who has been receiving warfarin (Coumadin) and diltiazem (Cardizem) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed? A. Decreased cardiac output B. Increased blood pressure C. Cerebral or pulmonary emboli D. Excessive bleeding from incision or IV sites

C

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which laboratory study is abnormal before administering the dose? A. Hematocrit (Hct) B. Hemoglobin (Hgb) C. Prothrombin time (PT) D. Activated partial thromboplastin time (aPTT)

C

The nurse recognizes additional teaching is needed when the patient prescribed a low-sodium, low-fat cardiac diet selects which food? A. Baked flounder B. Angel food cake C. Canned chicken noodle soup D. Baked potato with margarine

C

The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? A. "I will avoid adding salt to my food during or after cooking." B. "If I lose weight, I might not need to continue taking medications." C. "I can lower my blood pressure by switching to smokeless tobacco." D. "Diet changes can be as effective as taking blood pressure medications."

C

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain? A. Blocks β-adrenergic effects. B. Relaxes arterial and venous smooth muscle. C. Inhibits conversion of angiotensin I to angiotensin II. D. Reduces sympathetic outflow from central nervous system.

C

n caring for the patient with angina, the patient said, "While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, then the pain went away." What further assessment data should the nurse obtain from the patient? A. "What precipitated the pain?" B. "Has the pain changed this time?" C. "In what areas did you feel this pain?" D. "What is your pain level on a 0 to 10 scale?"

C

Which person would the nurse identify as having the highest risk for coronary artery disease (CAD)? A. A 60-yr-old man with low homocysteine levels B. A 45-yr-old man with a high-stress job who is depressed C. A 54-yr-old woman vegetarian with increased high-density lipoprotein (HDL) levels D. A 62-yr-old woman who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m

C The 45-yr-old depressed man with a high-stress job is at the highest risk for CAD. Depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.

A 39-yr-old woman with a history of smoking and oral contraceptive use is admitted with a venous thromboembolism (VTE) and prescribed unfractionated heparin. What laboratory test should the nurse review to evaluate the expected effect of the heparin? A. Platelet count B. Activated clotting time (ACT) C. International normalized ratio (INR) D. Activated partial thromboplastin time (aPTT)

D

A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing teaching, which statement by the patient indicates correct understanding? A. "If I take this medication, I will not need to follow a special diet." B. "It is normal to have some swelling in my face while taking this medication." C. "I will need to eat foods such as bananas and potatoes that are high in potassium." D. "If I develop a dry cough while taking this medication, I should notify my doctor."

D

A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? A. Start an infusion of 0.9% normal saline at 100 mL/hr. B. Maintain the current administration rate of the nitroprusside. C. Request insertion of an arterial line for accurate blood pressure monitoring. D. Stop the nitroprusside infusion and assess the patient for potential complications.

D

A female patient with type 1 diabetes has chronic stable angina controlled with rest. She states that over the past few months, she has required increasing amounts of insulin. What goal should the nurse use in planning care to prevent cardiovascular disease progression? A. Exercise almost every day. B. Avoid saturated fat intake. C. Limit calories to daily limit. D. Keep Hgb A1C less than 7%.

D

A patient was admitted for possible ruptured aortic aneurysm. Ten minutes later, the nurse notes sinus tachycardia 138 beats/min, blood pressure is palpable at 65 mm Hg, increasing waist circumference, and no urine output. How should the nurse interpret the findings? A. Tamponade will soon occur. B. The renal arteries are involved. C. Perfusion to the legs is impaired. D. Bleeding into the abdomen is likely.

D

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to administer this medication correctly? A. Remove the air bubble in the prefilled syringe. B. Aspirate before injection to prevent IV administration. C. Rub the injection site after administration to enhance absorption. D. Pinch the skin between the thumb and forefinger before inserting the needle.

D

The nurse teaches a patient with high cholesterol about natural lipid-lowering therapies. The nurse determines further teaching is necessary when the patient makes which statement? A. "Omega-3 fatty acids are helpful in reducing triglyceride levels." B. "I should check with my physician before I start taking any herbal products." C. "Herbal products do not go through as extensive testing as prescription drugs do." D. "I will take garlic instead of my prescription medication to reduce my cholesterol."

D

The patient is being dismissed from the hospital after acute coronary syndrome (ACS) and will be attending rehabilitation. What information would be taught in the early recovery phase of rehabilitation? A. Therapeutic lifestyle changes should become lifelong habits. B. Physical activity is always started in the hospital and continued at home. C. Attention will focus on managing chest pain, anxiety, dysrhythmias, and other complications. D. Activity level is gradually increased under cardiac rehabilitation team supervision and monitoring.

D

What is a priority nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)? A. Applying topical antibiotics to venous ulcers B. Maintaining the patient's legs in a dependent position C. Administering oral and/or subcutaneous anticoagulants D. Teaching the patient the correct use of compression stockings

D

A male patient with coronary artery disease (CAD) has a low-density lipoprotein (LDL) cholesterol of 98 mg/dL and high-density lipoprotein (HDL) cholesterol of 47 mg/dL. What information should the nurse include in patient teaching? A. Consume a diet low in fats. B. Reduce total caloric intake. C. Increase intake of olive oil. D. The lipid levels are normal.

D For men, the recommended LDL is less than 100 mg/dL, and the recommended level for HDL is greater than 40mg/dL. His normal lipid levels should be included in the patient teaching and encourage him to continue taking care of himself. Assessing his need for teaching related to diet should also be done.

The patient reports tenderness when she touches her leg over a vein. The nurse assesses warmth and a palpable cord in the area. The nurse knows the patient needs treatment to prevent which consequence? A. Pulmonary embolism B. Pulmonary hypertension C. Postthrombotic syndrome D. Venous thromboembolism

D The manifestations are characteristic of a superficial vein thrombosis. If untreated, the clot may extend to deeper veins, and venous thromboembolism may occur. Pulmonary embolism, pulmonary hypertension, and postthrombotic syndrome are the sequelae of venous thromboembolism.

After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected? Tinnitus Drowsiness Reduced hearing Sensation of falling

Drowsiness

A 21-yr-old female patient received instructions on how to prevent recurrence of urinary tract infections. Which statement indicates that teaching was effective? "I will urinate before and after having intercourse." "I will use vinegar as a vaginal douche every week." "I should drink at least 3 8-oz glasses of water daily." "I can stop the antibiotics when symptoms disappear."

a

A kidney transplant recipient has had fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. Assess temperature and initiate workup to rule out infection. b. Reassure the patient that this is common after transplantation. c. Provide warm covers to the patient and give 1 gram oral acetaminophen. d. Notify the nephrologist that the patient has manifestations of acute rejection.

a

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? a. Fecal impaction b. Perineal hygiene c. Dietary fiber intake d. Antidiarrheal agent use

a

A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys. b. a rapid decrease in urine output with an elevated BUN. c. an increasing creatinine clearance with a decrease in urine output. d. prostration, somnolence, and confusion with coma and imminent death.

a

A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to a. administer opioids as prescribed. b. obtain supplies for straining all urine. c. encourage fluid intake of 3 to 4 L/day. d. keep the patient NPO in preparation for surgery.

a

A patient reporting nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? a. Tremors b. Constipation c. Double vision d. Numbness in fingers and toes

a

A patient with a history of peptic ulcer disease presents to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric (NG) tube b. Administering oral bicarbonate and testing the patient's gastric pH level c. Performing a fecal occult blood test and administering IV calcium gluconate d. Starting parenteral nutrition and placing the patient in a high Fowler's position

a

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. What should be the nurse's initial action? a. Notify the HCP of the change in perfusion. b. Start anticoagulant therapy with IV heparin. c. Elevate the leg to improve the venous return. d. Position the patient in reverse Trendelenburg.

a

A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Drug therapy will be needed because the BP is still not at goal. b. BP monitoring should continue for 3 months to confirm a diagnosis of hypertension. c. Lifestyle changes are less important since they were not effective, and drugs will be started. d. More changes in the patient's lifestyle are needed for a longer time before starting drug therapy.

a

A patient with oral cancer is not eating. A small-bore feeding tube was inserted, and the patient started on enteral feedings. Which patient goal would best indicate improvement? a. Weight gain of 1 kg in 1 week b. Tolerated the tube feeding without nausea c. Consumed 50% of clear liquid tray this shift d. The feeding tube remained in proper placement

a

A patient with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? a. Assess the patient's hydration status. b. Insert a urinary catheter for the expected diuresis. c. Evaluate the patient's lower extremities for edema. d. Check the patient's urine for the presence of ketones.

a

A patient with ulcerative colitis is scheduled for a colon resection with placement of an ostomy. The nurse should plan to include which prescribed measure in the preoperative preparation? a. Selecting the stoma site b. Where to purchase ostomy supplies c. Teaching about how to irrigate a colostomy d. Following a high-fiber diet the day before surgery

a

A with stage 3 CKD is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? a. Apple, green beans, and a roast beef sandwich b. Granola made with dried fruits, nuts, and seeds c. Watermelon and ice cream with chocolate sauce d. Bran cereal with ½ banana and milk and orange juice

a

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In helping the patient decide about treatment, the nurse informs the patient that a. successful transplantation usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection. d. the immunosuppressive therapy after transplantation makes the person ineligible to receive other treatments if the kidney fails.

a

Eight months after the delivery of her first child, a 31-yr-old woman is seeking care for occasional incontinence when sneezing or laughing. Which intervention should the nurse recommend first? a. Kegel exercises b. Use of adult incontinence pads c. Intermittent self-catheterization d. Dietary changes including fluid restriction

a

One of the nurse's most important roles in relation to acute poststreptococcal glomerulonephritis (APSGN) is to a. promote early diagnosis and treatment of sore throats and skin lesions. b. encourage patients to obtain antibiotic therapy for upper respiratory tract infections. c. teach patients with APSGN that long-term prophylactic antibiotic therapy is needed to prevent recurrence. d. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane.

a

The immunologic mechanisms involved in acute poststreptococcal glomerulonephritis include: a. deposition of immune complexes and complement along the GBM. b. tubular blocking by precipitates of bacteria and antibody reactions. c. thickening of the GBM from autoimmune microangiopathic changes. d. destruction of glomeruli by proteolytic enzymes contained in the GBM.

a

The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to a. increase fluid intake. b. administer an antibiotic. c. administer an antimotility drug. d. quarantine the patient to prevent spread of the virus.

a

The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stools." c. "I may not need to wear a drainage pouch if I irrigate it daily." d. "Limiting my fluid intake should decrease the amount of output."

a

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu a. scrambled eggs and sausage. b. buckwheat pancakes with syrup. c. oatmeal, skim milk, and orange juice. d. yogurt, strawberries, and rye toast with butter.

a

The nurse is caring for a patient who reports abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient's condition is declining? a. Pallor and diaphoresis b. Reddened peripheral IV site c. Guaiac-positive diarrhea stools d. Heart rate 90, respiratory rate 20, BP 110/60

a

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? a. Maintain a high intake of fluid and fiber in the diet. b. Discontinue intake of medications causing constipation. c. Eat several small meals per day to maintain bowel motility. d. Sit upright during meals to increase bowel motility by gravity.

a

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? a. "The tube will help to drain the stomach contents and prevent further vomiting." b. "The tube will push past the area that is blocked and help to stop the vomiting." c. "The tube is just a standard procedure before many types of surgery to the abdomen." d. "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

a

The nurse teaches older adults at a community center how to prevent food poisoning at social events. Which community member statement reflects accurate understanding? a. "Pasteurized juices and milk are safe to drink." b. "Raw cookie dough is safe to eat if it is cold." c. "Fresh fruits do not need washed before eating." d. "Ground beef is safe to eat if it is slightly pink."

a

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a. Monitor the patient's cardiac status. b. Teach the patient about hand washing. c. Obtain a serum specimen for electrolytes. d. Increase direct observation of the patient.

a

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? a. "It would be beneficial for you to stop drinking alcohol." b. "You'll need to drink at least 2 to 3 glasses of milk daily." c. "Many people find that a minced or pureed diet eases their symptoms of PUD." d. "You can keep your present diet and minimize symptoms by taking medication."

a

Two days after a bowel resection for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? a. Impaired peristalsis b. Irritation of the bowel c. Nasogastric suctioning d. Inflammation of the incision site

a

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? a. "I will be able to regulate when I have stools." b. "I will be able to wear a pouch until it leaks." c. "The drainage from my stoma can damage my skin." d. "Dried fruit and popcorn must be chewed very well."

a

Which instruction is a key aspect of teaching for the patient on anticoagulant therapy? a. Monitor for and report any signs of bleeding. b. Do not take acetaminophen (Tylenol) for a headache. c. Decrease your dietary intake of foods containing vitamin K. d. Arrange to have blood drawn twice a week to check drug effects.

a

Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."

a

Which problem is priority when caring for a patient with renal stones? a. Acute pain b. Constipation c. Powerlessness d. Fluid imbalance

a

The nurse counsels a patient on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? a. Venison, crab, and liver b. Spinach, cabbage, and tea c. Milk, yogurt, and dried fruit d. Asparagus, lentils, and chocolate

a Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation (see Table 45.12).

What is the nurse's priority when changing the appliance for a patient with an ileal conduit? a. keep the skin free of urine b. inspect the peristomal area c. cleanse and dry the area gently d. affic the appliance to the faceplate

a The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.

a,b

Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements are true related to nutritional therapy? (select all that apply) a. Sodium and salt may be restricted in someone with advanced CKD. b. Fluid is not usually restricted for patients receiving peritoneal dialysis. c. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving hemodialysis. d. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving peritoneal dialysis. e. Decreased fluid intake and a diet in protein-rich foods are part of a diet for a patient receiving hemodialysis.

a,b,c

Patients with chronic kidney disease have an increased incidence of cardiovascular disease related to (select all that apply) a. hypertension. b. vascular calcifications. c. a genetic predisposition. d. hyperinsulinemia causing dyslipidemia. e. increased high-density lipoprotein levels.

a,b,d

Nurses can screen patients at risk for developing chronic kidney disease. Those considered to be at increased risk include (select all that apply) a. older black patients. b. patients more than 60 years old. c. those with a history of pancreatitis. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

a,b,d,e

A patient is admitted to the ICU with a diagnosis of NSTEMI. Which drugs(s) would the nurse expect the patient to receive? (select all that apply) a. Oral statin therapy b. Antiplatelet therapy c Thrombolytic therapy d. Prophylactic antibiotics e. Intravenous nitroglycerin

a,b,e

A patient is admitted to the hospital in a hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategies would be most appropriate for this patient? (select all that apply) a. Measuring hourly urine output b. Continuous BP monitoring with an arterial line c. Decreasing the MAP by 50% within the first hour d. Maintaining bed rest and giving tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

a,b,e

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI)? (Select all that apply.) a. Dehydration b. Hypokalemia c. Hypernatremia d. BUN increases e. Urine output increases f. Serum creatinine increases

a,b,e

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes (select all that apply) a. teaching the patient to use Kegel exercises. b. clamping and releasing a catheter to increase bladder tone. c. teaching the patient biofeedback mechanisms to train pelvic floor muscles. d. counseling the patient concerning choice of incontinence containment device. e. developing a fluid modification plan, focusing on decreasing intake before bedtime.

a,c

A hospitalized patient has just been diagnosed with diarrhea due to C. difficile. Which nursing interventions should be included in the patient's plan of care? (Select all that apply.) a. Initiate contact isolation precautions. b. Place the patient on a clear liquid diet. c. Teach any visitors to wear gloves and gowns. d. Disinfect the room with 10% bleach solution as needed. e. Use hand sanitizer before and after any bodily fluid contact.

a,c,d

Which BP-regulating mechanism(s) can result in the development of hypertension if defective? (select all that apply) a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

a,c,e

Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? (Select all that apply.) a. Anemia b. Dehydration c. Hypertension d. Hypercalcemia e. Increased fracture risk f. Elevated white blood cells

a,c,e

A patient admitted to the emergency department after a motor vehicle accident. Which urinalysis findings would the nurse expect if kidney trauma occurred? (Select all that apply.) a. Casts b. Glucose c. Bilirubin d. Myoglobinuria e. Red blood cells f. White blood cells

a,d,e After kidney trauma, the nurse will expect urinalysis results to be positive for myoglobin and red blood cells. Casts in urine indicate blood destruction intravascularly. Glucose in urine could indicate diabetes. Bilirubin in urine is suggestive liver dysfunction. White blood cells in urine indicate infection.

The urinalysis of a patient reveals a high microorganism count. What data should the nurse use to determine which part of the urinary tract is infected? (Select all that apply.) a. Pain location b. Fever and chills c. Mental confusion d. Urinary hesitancy e. Urethral discharge f. Postvoid dribbling

a,d,e Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis. Flank pain is characteristic of pyelonephritis. Dysuria occurs with cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.

Assessment findings suggestive of peritonitis include (select all that apply) a. rebound tenderness. b. a soft, distended abdomen. c. dull, intermittent abdominal pain. d. shallow respirations with bradypnea. e. observing that the patient is lying still.

a,e

A 35-yr-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain? (select all that apply) a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

all

A 22-yr-old patient's blood pressure during a pre-employment physical examination was 110/68 mm Hg. During a health fair 2 months later, the blood pressure is 154/96 mm Hg. What renal problem could contribute to this rise in blood pressure? a. Renal trauma b. Renal artery stenosis c. Renal vein thrombosis d. Benign nephrosclerosis

b

A 50-year-old woman who weighs 95 kg has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. Which is the most important risk factor for peripheral artery disease (PAD) to address in the nursing plan of care? a. Salt intake b. Tobacco use c. Excess weight d. Sedentary lifestyle

b

A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia a. will always progress to myocardial infarction. b. can be relieved by rest, nitroglycerin, or both. c. is often associated with vomiting and extreme fatigue. d. indicates that irreversible myocardial damage is occurring.

b

A nurse is admitting a patient with advanced renal cancer. Which clinical manifestations represent the "classic triad" observed in patients with renal cancer? a. Fever, chills, and flank pain b. Hematuria, flank pain, and palpable mass c. Hematuria, proteinuria, and palpable mass d. Flank pain, palpable abdominal mass, and proteinuria

b

A patient donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is having significant pain and refuses to get up to walk. How should the nurse respond? a. Allow the patient to rest and try again tomorrow. b. Encourage a short walk around the patient's room. c. Have the transplant psychologist convince her to walk. d. Tell the patient she is lucky she did not have an open nephrectomy.

b

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which signs and symptoms would suggest that the aneurysm has ruptured? a. Rapid onset of shortness of breath and hemoptysis b. Sudden, severe low back pain and bruising along his flank c. Gradually increasing substernal chest pain and diaphoresis d. Sudden, patchy blue mottling on feet and toes and rest pain

b

A patient is given a bisacodyl suppository and asks the nurse how long it will take to work. What is the best response by the nurse? a. 2 to 5 minutes b. 15 to 60 minutes c. 2 to 4 hours d. 6 to 8 hours

b

A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes a. clamping the tube for 10 minutes every hour to decrease spasms. b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided. c. notifying the provider if nephrostomy tube drainage is more than 30 mL/hr. d. irrigating the nephrostomy tube with 10 mL of normal saline solution as needed.

b

A patient with end-stage renal disease (ESRD) secondary to diabetes has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? a. Level of consciousness b. Blood pressure and fluid balance c. Temperature, heart rate, and blood pressure d. Assessment for signs and symptoms of infection

b

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? a. 7:00 AM, 10:00 AM, and 1:00 PM b. 8:00 AM, 12:00 PM, and 4:00 PM c. 9:00 AM and 3:00 PM d. 9:00 AM, 12:00 PM, and 3:00 PM

b

A patient with type 2 diabetes and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? a. Fatigue b. Dysrhythmias c. Hypoglycemia d. Elevated triglycerides

b

A patient with type 2 diabetes is reporting a second urinary tract infections (UTI) within the past month. Which medication should the nurse expect to be ordered for the recurrent infection? a. fosfomycin b. ciprofloxacin c. nitrofurantoin d. trimethroprim-sulfamethoxazole

b

A patient with ulcerative colitis is scheduled for a total proctocolectomy with permanent ileostomy. The wound, ostomy, and continence nurse is selecting the site where the ostomy will be placed. What should be included in site consideration? a. Protruding areas make the best sites. b. The patient must be able to see the site. c. The site should be outside the rectus muscle area. d. The appliance will need to be placed at the waist line.

b

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that further instruction is needed when the patient says a. "I can keep my blood pressure normal with medication." b. "I would like to add weight lifting to my exercise program." c. "I can change my diet to decrease my intake of saturated fats." d. "I will change my lifestyle to reduce activities that increase my stress."

b

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? a. Increasing the pressure gradient b. Increasing osmolality of the dialysate c. Decreasing the glucose in the dialysate d. Decreasing the concentration of the dialysate

b

In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. usually develops peritonitis. d. has localized cramping pain.

b

M.J. calls the clinic and tells the nurse that her 85-yr-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to a. administer antiemetic drugs and assess her mother's skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother large quantities of Gatorade to decrease the risk for sodium depletion. d. give her mother a high-protein liquid supplement to drink to maintain her nutritional needs.

b

Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing a. beef. b. meat and milk. c. poultry and eggs. d. home-preserved vegetables.

b

The home care nurse visits a patient receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? a. "Drain time is faster if I rub my abdomen." b. "The fluid draining from the catheter is cloudy." c. "The drainage is bloody when I have my period." d. "I wash around the catheter with soap and water."

b

The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of a. aspirin use. b. tobacco use. c. chronic alcohol use. d. use of artificial sweeteners.

b

The nurse identifies that which patient is at highest risk for developing colon cancer? a. A 28-yr-old man who has a body mass index of 27 kg/m2 b. A 32-yr-old woman with a 12-year history of ulcerative colitis c. A 52-yr-old man who has followed a vegetarian diet for 24 years d. A 58-yr-old woman taking prescribed estrogen replacement therapy

b

The nurse is caring for a patient being treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate? a. Iced tea b. Dry toast c. Hot coffee d. Plain yogurt

b

The nurse is caring for a patient who is 2 days post MI. The patient reports that she is experiencing chest pain when she takes a deep breath. Which action would be a priority? a. Notify the provider STAT and obtain a 12-lead ECG. b. Obtain vital signs and auscultate for a pericardial friction rub. c. Apply high-flow O2 by face mask and auscultate breath sounds. d. Medicate the patient with as-needed analgesic and reevaluate in 30 minutes.

b

The nurse is caring for a patient who is in the oliguric phase of acute kidney disease. Which action would be appropriate to include in the plan of care? a. Provide foods high in potassium. b. Restrict fluids based on urine output. c. Monitor output from peritoneal dialysis. d. Offer high-protein snacks between meals.

b

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. What orders does the nurse anticipate? a. Keep the patient on bed rest. b. Use 5 mL of sterile saline to irrigate. c. Use 30 mL of water to gently irrigate. d. Have the patient turn from side to side.

b

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? a. Osteoarthritis b. History of colorectal polyps c. History of lactose intolerance d. Use of herbs as dietary supplements

b

The nurse is preparing to administer famotidine to a patient after a laparotomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? a. "It will prevent air from accumulating in the stomach, causing gas pains." b. "It will reduce the amount of acid in the stomach while you are not eating." c. "It will prevent the heartburn that occurs as a side effect of general anesthesia." d. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

b

The nurse should administer an as-needed dose of magnesium citrate after noting what information when reviewing a patient's medical record? a. Abdominal pain and bloating b. No bowel movement for 3 days c. A decrease in appetite by 50% over 24 hours d. Muscle tremors and other signs of hypomagnesemia

b

The nurse teaches the female patient who has frequent UTIs that she should a. take tub baths with bubble bath. b. void before and after sexual intercourse. c. take prophylactic sulfonamides for the rest of her life. d. restrict fluid intake to prevent the need for frequent voiding.

b

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? a. Zolpidem b. Ondansetron c. Dexamethasone d. Morphine sulfate

b

The patient with a history of irritable bowel disease and gastroesophageal reflux disease (GERD) is admitted with a diagnosis of diverticulitis and has received a dose of Mylanta 30 mL PO. The nurse will determine the medication was effective when which symptom has been resolved? a. Diarrhea b. Heartburn c. Constipation d. Lower abdominal pain

b

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for an exploratory laparotomy? a. How to care for the wound b. How to deep breathe and cough c. The location and care of drains after surgery d. Which medications will be used during surgery

b

When teaching a patient about rest pain with PAD, what should the nurse explain as the cause of the pain? a. Vasospasm of cutaneous arteries in the feet. b. Decrease in blood flow to the nerves of the feet. c. Increase in retrograde venous perfusion to the lower legs. d. Constriction in blood flow to leg muscles during exercise.

b

Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? a. Help the patient cope with the rapid progression of the disease. b. Suggest genetic counseling resources for the children of the patient. c. Implement appropriate measures for the patient's deafness and blindness. d. Expect the patient to have polyuria and poor concentration ability of the kidneys.

b

Which patient has the most significant risk factors for CKD? a. A 50-yr-old white woman with hypertension b. A 61-yr-old Native American man with diabetes c. A 28-yr-old black woman with a urinary tract infection d. A 40-yr-old Hispanic woman with cardiovascular disease

b

Which patient is at highest risk for venous thromboembolism (VTE)? a. A 62-yr-old man with spider veins who is having arthroscopic knee surgery b. A 32-yr-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe c. A 26-yr-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor d. An active 72-yr-old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia

b

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. A low-calcium diet. b. Excess alcohol intake. c. A family history of hypertension. d. Consumption of a high-protein diet.

b

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcohol use, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? a. Barium swallow b. Endoscopic biopsy c. Capsule endoscopy d. Endoscopic ultrasonography

b Because of this patient's history of alcohol use, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of cancer, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show esophageal problems but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer.

The nurse provides nutritional counseling for a patient with nephrotic syndrome. The nurse determines teaching has been successful if the patient selects which breakfast menu? a. Scrambled eggs, milk, yogurt, and sliced ham b. Oatmeal, nondairy creamer, banana, and orange juice c. Cottage cheese, peanut butter, white bread, and coffee d. Waffle, bacon strips, tomato juice, and canned peaches

b Patients with nephrotic syndrome should follow a low-sodium (2 to 3 g/day), low- to moderate-protein (0.5 to 0.6 g/kg/day) diet. Ham, milk products, peanut butter, and bacon are high in sodium. Eggs, milk products, and peanut butter are high in protein.

Which statement about continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? a. "Maintain a daily written record of blood pressure and weight." b. "It is essential that you maintain aseptic technique to prevent peritonitis." c. "You will be allowed a more liberal protein diet once you complete CAPD." d. "Continue regular medical and nursing follow-up visits while performing CAPD."

b Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of prevention. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality that peritonitis does.

The nurse is caring for a 62-yr-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. Which instruction should be included in the discharge plan? a. stop smoking for 2-3 weeks beofre starting this medication b. suck on sugarless candy or chew sugarless gum if you develop a dry mouth c. have your vision checked every 6 months because this drug can cause cataracts d. ask your provider to prescribe an extended-release form if you have loose stools

b anticholinergic

Which clinical manifestations can the nurse expect to see in both patients with Buerger's disease and patients with Raynaud's phenomenon? (select all that apply) a. Intermittent low-grade fevers b. Sensitivity to cold temperatures c. Gangrenous ulcers on fingertips d. Color changes of fingers and toes e. Episodes of superficial vein thrombosis

b,c,d

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension. b. ECG changes. c. hypernatremia. d. pulmonary edema. e. urine with high specific gravity.

b,d

Which clinical findings should the nurse expect in a person with an acute lower extremity VTE? (select all that apply) a. Pallor and coolness of foot and calf b. Mild to moderate calf pain and tenderness c. Grossly decreased or absent pedal pulses d. Unilateral edema and induration of the thigh e. Palpable cord along a superficial varicose vein

b,d

A patient has a sliding hiatal hernia. What priority nursing intervention will reduce the symptoms of heartburn and dyspepsia? a. Keeping the patient NPO b. Putting the bed in the Trendelenburg position c. Having the patient eat 4 to 6 smaller meals each day d. Giving various antacids to determine which one works for the patient

c

A patient has scleroderma and hypertension. The nurse knows this could be related to which renal diagnoses? a. Obstructive uropathy b. Goodpasture syndrome c. Chronic glomerulonephritis d. Calcium oxalate urinary calculi

c

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? a. Nausea and vomiting b. Hyperactive bowel sounds c. Firmly distended abdomen d. Abrasions on all extremities

c

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? a. An UAP on the unit who has hospice experience b. An LPN that has worked on the unit for 10 years c. An RN with 6 months of experience on the surgical unit d. An RN who has floated to the surgical unit from pediatrics

c

A patient is prescribed diltiazem (Cardizem) for Raynaud's phenomenon. Which assessment finding would indicate to the nurse that the medication is effective? a. Improved skin turgor b. Decreased cardiac rate c. Improved finger perfusion d. Decreased mean arterial pressure

c

A patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan? a. Refrain from sexual activity for a minimum of 3 weeks. b. Plan a diet program that aims for a 1- to 2-lb weight loss per week. c. Begin an exercise program that aims for at least 5 30-minute sessions per week. d. Consider the use of erectile agents and prophylactic NTG before engaging in sexual activity.

c

A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? a. Hypokalemia b. Hyponatremia c. Large urine output d. Leukocytosis with cloudy urine output

c

A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? a. Malnutrition b. Bile reflux gastritis c. Dumping syndrome d. Postprandial hypoglycemia

c

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full-liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings. b. extension of the tumor into the aorta. c. leakage of fluids into the mediastinum. d. esophageal perforation with fistula formation into the lung.

c

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but reports of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? a. Notify the provider. b. Auscultate for bowel sounds. c. Reposition the tube and check for placement. d. Remove the tube and replace it with a new one.

c

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify the site for the ostomy.

c

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? a. Return the patient to NPO status. b. Place cool compresses on the abdomen. c. Encourage the patient to ambulate as ordered. d. Administer an as-needed dose of IV morphine sulfate.

c

After receiving a dose of metoclopramide, which patient assessment finding would indicate the medication was effective? a. Decreased blood pressure b. Absence of muscle tremors c. Relief of nausea and vomiting d. No further episodes of diarrhea

c

An older male patient visits his primary care provider because of burning with urination and foul-smelling urine. What contributing factor should the health care provider consider? a. High-purine diet b. Sedentary lifestyle c. Benign prostatic hyperplasia (BPH) d. Recent use of broad-spectrum antibiotics

c

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a. Give hypertonic saline. b. Initiate a blood transfusion. c. Decrease the rate of fluid removal. d. Administer antiemetic medications.

c

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia

c

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. often results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, while ulcerative colitis is curable with a colectomy. d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.

c

The most common finding in people at risk for sudden cardiac death is a. aortic valve disease. b. mitral valve disease. c. left ventricular dysfunction. d. atherosclerotic heart disease.

c

The nurse determines a patient has experienced the beneficial effects of famotidine when which symptom is relieved? a. Nausea b. Belching c. Epigastric pain d. Difficulty swallowing

c

The nurse is caring for a postoperative patient who has just vomited yellow-green liquid. Which action would be an appropriate nursing intervention? a. Offer the patient an herbal supplement such as ginseng. b. Discontinue medications that may cause nausea or vomiting. c. Apply a cool washcloth to the forehead and provide mouth care. d. Take the patient for a walk in the hallway to promote peristalsis.

c

The nurse teaching young adults about behaviors that put them at risk for oral cancer includes a. discouraging use of chewing gum. b. avoiding use of perfumed lip gloss. c. avoiding use of smokeless tobacco. d. discouraging drinking of carbonated beverages.

c

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? a. Deep breathe, cough, and use spirometer every 4 hours. b. Maintain an upright position for at least 2 hours after eating. c. NG will have bloody drainage and it should not be repositioned. d. Keep in a supine position to prevent movement of the anastomosis.

c

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? a. Antibiotic(s), antacid, and corticosteroid b. Antibiotic(s), aspirin, and antiulcer/protectant c. Antibiotic(s), proton pump inhibitor, and bismuth d. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

c

The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs.

c

The provider has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? a. Hemodialysis (HD) three times per week b. Automated peritoneal dialysis (APD) c. Continuous venovenous hemofiltration (CVVH) d. Continuous ambulatory peritoneal dialysis (CAPD)

c

What are the priority nursing interventions 8 hours after an abdominal aortic aneurysm repair? a. Assessing nutritional status and dietary preferences b. Initiating IV heparin and monitoring anticoagulation c. Administering IV fluids and watching kidney function d. Elevating the legs and applying compression stockings

c

What is the first priority of interprofessional care for a patient with a suspected acute aortic dissection? a. Reduce anxiety. b. Monitor chest pain. c. Control blood pressure. d. Increase myocardial contractility.

c

When caring for a patient with nephrotic syndrome, which food selection indicates the patient understands the dietary teaching provided? a. peanut butter and crackers b. one small grilled pork chop c. salad made of fresh vegatables d. spaghetti with canned spaghetti sauce

c

Which instruction should the nurse provide when teaching a patient how to exercise the pelvic floor? a. tighten both buttocks together b. squeeze thighs together tightly c. contract muscles around rectum d. lie on back and lift the legs together

c

A 74-year-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? a. Sucralfate b. Cimetidine c. Omeprazole d. Metoclopramide

c There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine.

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) a. limiting alcohol intake to 1 serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.

c,d

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply) a. Restricted to rectum b. Strictures are common c. Bloody, diarrhea stools d. Cramping abdominal pain e. Lesions penetrate intestine

c,d

To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should (select all that apply) a. monitor the BP in the affected arm. b. irrigate the graft daily with low-dose heparin. c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. assess the pulses and neurovascular status distal to the graft.

c,d,e

A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is to a. apply a truss to the hernia site. b. allow the patient to stand to void. c. support the incision during coughing. d. apply a scrotal support with an ice bag.

d

A patient has had a cystectomy and ileal conduit diversion. Four days after surgery, you note mucous shreds in the drainage bag. The nurse should a. notify the provider. b. notify the charge nurse. c. irrigate the drainage tube. d. document it as a normal observation.

d

A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a. Back pain 3 or 4 hours after eating a meal b. Chest pain relieved with eating or drinking water c. Burning epigastric pain 90 minutes after breakfast d. Rigid abdomen and vomiting following indigestion

d

A patient with a 25-year history of type 1 diabetes is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood glucose levels. Which diagnostic study is most indicative of chronic kidney disease (CKD)? a. Serum creatinine b. Serum potassium c. Microalbuminuria d. Calculated glomerular filtration rate (GFR)

d

A priority consideration in the management of the older adult with hypertension is to a. Prevent primary hypertension from converting to secondary hypertension. b. Recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult. c. Ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. d. Use precise technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

d

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources.

d

In teaching a patient with hypertension about controlling the illness, the nurse recognizes that a. All patients with elevated BP need drug therapy. b. Obese persons must achieve a normal weight to lower BP. c. It is not necessary to limit salt in the diet if taking a diuretic. d. Lifestyle modifications are needed for all persons with elevated BP.

d

In teaching a patient with pyelonephritis about the disorder, the nurse tells the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through: a. the bloodstream. b. the lymphatic system. c. a descending infection. d. an ascending infection.

d

RIFLE defines the first 3 stages of AKI based on changes in a. blood pressure and urine osmolality. b. fractional excretion of urinary sodium. c. estimation of GFR with the MDRD equation. d. serum creatinine or urine output from baseline.

d

The edema that occurs in nephrotic syndrome is due to a. increased hydrostatic pressure caused by sodium retention. b. decreased aldosterone secretion from adrenal insufficiency. c. increased fluid retention caused by decreased glomerular filtration. d. decreased colloidal osmotic pressure caused by loss of serum albumin.

d

The nurse asks a patient scheduled for colectomy to sign the operative permit as directed in the provider's preoperative orders. The patient states that the provider has not explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? a. Ask family members whether they have discussed the surgical procedure with the provider. b. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. c. Have the patient sign the form and state the provider will visit to explain the procedure before surgery. d. Delay the patient's signature on the consent and notify the provider about the conversation with the patient.

d

The nurse explains to the patient with Vincent's infection that treatment will include a. tetanus vaccinations. b. viscous lidocaine rinses. c. amphotericin B suspension. d. topical application of antibiotics.

d

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? a. Bisacodyl b. Lubiprostone c. Cascara sagrada d. Magnesium hydroxide

d

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? a. Wear a mask to prevent transmission of infection. b. Have visitors use the alcohol-based hand sanitizer. c. Wipe down equipment with ammonia-based disinfectant. d. Don gloves and gown before entering the patient's room.

d

The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia who has symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? a. White blood cell count is 7500 cells/µL. b. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. c. Glucose, protein, and ketones are present in the urine. d. Nitrites and leukocyte esterase are present in the urine.

d

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? a. Low-pitched and rumbling above the area of obstruction b. High-pitched and hypoactive below the area of obstruction c. Low-pitched and hyperactive below the area of obstruction d. High-pitched and hyperactive above the area of obstruction

d

The nurse is planning care and teaching for a patient with venous leg ulcers. What is the most important patient action in healing and control of this condition? a. Following activity guidelines. b. Using moist environment dressings. c. Taking horse chestnut seed extract daily. d. Applying graduated compression stockings.

d

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? a. Write an incident report about this untoward event. b. Attempt to have the family convince the patient to take the ordered dose. c. Withhold the medication at this time and try to administer it later in the day. d. Chart the dose as not given on the medical record and explain in the nursing progress notes.

d

The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? a. assessment of pain and LOC b. assessment of serum calcium and phosphorus levels c. blood pressure and assessment for orthostatic hypotension d. daily weights and measurement of the patient's abdominal girth

d

The nurse is teaching a group of college students how to prevent food poisoning. Which comment shows an understanding of foodborne illness protection? a. "To save refrigerator space, leftover food can be kept on the counter if it is in a sealed container." b. "Eating raw cookie dough from the package is a great snack when you do not have time to bake." c. "Since we only have one cutting board, we can cut up chicken and salad vegetables at the same time." d. "When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."

d

The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that cause oversecretion of acid, such as excess dietary fats, smoking, and alcohol use. d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.

d

The nurse preparing to give a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? a. Sodium b. Potassium c. Magnesium d. Phosphorus

d

The nurse recommends genetic counseling for the children of a patient with a. nephrotic syndrome. b. chronic pyelonephritis. c. malignant nephrosclerosis. d. adult-onset polycystic kidney disease.

d

What should a patient be taught after a hemorrhoidectomy? a. Take mineral oil before bedtime. b. Eat a low-fiber diet to rest the colon. c. Use oil-retention enemas to empty the colon. d. Take prescribed pain medications before a bowel movement.

d

When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? a. Weigh patient three times weekly. b. Increase dietary sodium and potassium. c. Provide a low-protein, high-carbohydrate diet. d. Restrict fluids according to previous daily loss.

d

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? a. White bread, cheese, and green beans b. Fresh tomatoes, pears, and corn flakes c. Oranges, baked potatoes, and raw carrots d. Dried beans, All Bran (100%) cereal, and raspberries

d

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? a. IV tobramycin b. Incompatible blood transfusion c. Poststreptococcal glomerulonephritis d. Dissecting abdominal aortic aneurysm

d

Which patient is at highest risk for developing oral candidiasis? a. A 74-yr-old patient who has vitamin B and C deficiencies b. A 22-yr-old patient who smokes 2 packs of cigarettes per day c. A 58-yr-old patient who is receiving amphotericin B for 2 days. d. A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks.

d

Which treatment should the nurse anticipate for an otherwise healthy person with an initial VTE? a. IV argatroban as an inpatient b. IV unfractionated heparin as an inpatient c. Subcutaneous unfractionated heparin as an outpatient d. Subcutaneous low-molecular-weight heparin as an outpatient

d

A frail 86-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? a. Aspirin b. Acetaminophen c. Diphenhydramine d. Aluminum hydroxide

d Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? a. "It will increase bulk in the stool." b. "It will lubricate the intestinal tract to soften feces." c. "It will increase fluid retention in the intestinal tract." d. "It will increase peristalsis by stimulating nerves in the colon wall."

d Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk-forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? a. Take a dose of mineral oil at the same time. b. Add extra salt to food on at least one meal tray. c. Ensure a dietary intake of 10 g of fiber each day. d. Take each dose with a full glass of water or other liquid.

d Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.