Med Surg Final Exam

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/ minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? A. Sinus tachycardia B. Sinus bradycardia C. Sinus dysrhythmia D. Normal sinus rhythm

A. Sinus tachycardia

4. The client diagnosed with Addison's disease is admitted to the ER after having spent the day at a lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement? A. Start an IV with an 18-gage needle and infuse normal saline rapidly B. Leave the client in the waiting room until a bed is available C. Obtain a permit for the client to receive a blood transfusion D. Collect a urine and blood samples for a CBC and calcium levels

A. Start an IV with an 18-gage needle and infuse normal saline rapidly

A nurse is completing the admission assessment of a client who has a kidney stone. Select all that the nurse would expect to find. A. Tachycardia B. CVA tenderness/pain C. Bradypnea D. Hematuria E. Polyuria

A. Tachycardia B. CVA tenderness/pain D. Hematuria

5. Which of the following are functions of dialysis: SATA A. rids the body of excess fluid and electrolytes B. eliminates waste products C. achieves acid-base balance D. is a cure for chronic kidney failure E. replaced the hormonal function of the kidneys

A. rids the body of excess fluid and electrolytes B. eliminates waste products C. achieves acid-base balance

10. A nurse is a preceptor for an orientee (newly hired nurse). The orientee is providing postoperative care to a client who recently returned from a laryngoscopy. The orientee reminds the client not to eat or drink anything until instructed to do so. How does the preceptor evaluate the suitability of the instructions given to the client by the orientee? A. Appropriate; oral intake after the procedure may result in aspiration B. Appropriate; it is important to limit painful swallowing C. Inappropriate; the client is too groggy after general anesthesia to comprehend information D. Inappropriate; fluid replacement should begin immediately after the procedure

A. Appropriate; oral intake after the procedure may result in aspiration

A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Select all that apply. A. Atelectasis B. Status asthmaticus C. Respiratory failure D. Pertussis E. Pneumothorax

A. Atelectasis B. Status asthmaticus C. Respiratory failure

While a nurse is conducting an initial assessment on a client, which classic sign would alert the nurse that the client has chronic obstructive pulmonary disease (COPD)? A. Barrel chest B. Cyanosis C. Hyperventilation D. Lordosis

A. Barrel chest

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. A. Dietary substances B. Environmental factors C. Viruses D. Gender E. Age

A. Dietary substances B. Environmental factors C. Viruses Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions.

A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy? A. Dry oral muscles membranes and cracked lips B. Urine output of 400 ml in 8 hours C. Serum potassium level of 3.6 Eq/L D. Blood pressure of 120/64 to 130/72 mm Hg

A. Dry oral muscles membranes and cracked lips Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 30 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.

Which problem should the nurse identify as priority for a client who is one day postoperative? A. Potential for hemorrhaging B. Potential for injury C. Potential for fluid volume excess D. Potential for infection

A. Potential for hemorrhaging

The nurse is planning the care of a client diagnosed with SIADH. Which interventions should be implemented? Select all that apply. A. Restrict fluids per HCP order B. Assess level of consciousness every 2 hours C. Provide an atmosphere of stimulation D. Monitor urine and serum osmolality E. Weigh the client every three days

A. Restrict fluids per HCP order B. Assess level of consciousness every 2 hours D. Monitor urine and serum osmolality

The nurse is caring for a client diagnosed with myocardial infarction experiencing chest pain. Which interventions should the nurse implement. Select all that apply: A. Administer morphine intramuscularly B. Administer aspirin orally. C. Apply oxygen via nasal cannula D. Place client in supine position E. Administer nitroglycerin subcutaneously.

B. Administer aspirin orally. C. Apply oxygen via nasal cannula

8. A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained secretions. To decrease the amount of secretions retained, what should the nurse do? A. Administer continuous oxygen B. Increase fluid intake to at least 2 L a day C. Place the client in a high-Fowler position D. Instruct the client to gargle deep in the throat using warmed normal saline

B. Increase fluid intake to at least 2 L a day Increased fluid intake helps to liquefy respiratory secretions

3. A patient is admitted to rule out Cushing's syndrome. What lab tests should the nurse anticipate being ordered? A. Plasma drug levels of quinidine, digoxin, and hydralazine B. Plasma levels of ACTH and cortisol C. A 24-hour urine for metanephrine and catecholamine D. Spot urine for creatinine and white blood cells

B. Plasma levels of ACTH and cortisol

5. A client is extubated in the postanesthesia care unit after surgery. For which common response should the nurse be alert when monitoring the client for acute respiratory distress? A. Bradycardia B. Restlessness C. Constricted pupils D. Clubbing of the fingers

B. Restlessness → not enough oxygen, typically sign of hypoxia

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. WHich signs and symptoms would suggest the aneurysm has ruptured? A. Sudden 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. Sudden, severe low back pain and bruising along his flank

The nurse is developing a discharge- teaching plan for the client diagnosed with congestive heart failure. Which intervention should be included in the plan? Select all the apply: A. Notify health-care provider of a weight gain of more than one (1) pound in s week. B. Teach client how to count the radial pulse when taking digoxin, a cardiac glycoside C. Instruct client to remove the salt shaker from the dinner table. D. Encourage client to monitor urine output for change in color to become dark E. Discuss the importance of taking a loop diuretic furosemide at bedtime- should be taken in the morning because of peeing

B. Teach client how to count the radial pulse when taking digoxin, a cardiac glycoside--> do not give if pulse is below 60 C. Instruct client to remove the salt shaker from the dinner table.

The nurse is caring for a postoperative patient who needs daily dressing changes. The patient is 3 days postoperative and is scheduled for discharge the next day. Until now, the patient has refused to learn how to change her dressing. What would indicate to the nurse the patient's possible readiness to learn how to change her dressing? Select all that apply. A. The patient wants you to teach a family member to do dressing changes. B. The patient expresses interest in the dressing change. C. The patient is willing to look at the incision during a dressing change. D. The patient expresses dislike of the surgical wound. E. The patient assists in opening the packages of dressing material for the nurse.

B. The patient expresses interest in the dressing change. C. The patient is willing to look at the incision during a dressing change. E. The patient assists in opening the packages of dressing material for the nurse.

5. The nurse is caring for a patient scheduled for a bilateral adrenalectomy for treatment of an adrenal tumor that is causing excessive aldosterone production (Conn's Syndrome). The nurse appropriately tells the client which of the following? A. "You will need to wear an abdominal bind after surgery." B. "You will most likely need to undergo chemotherapy after surgery." C. "You will need to take hormone replacements for the rest of your life." D. "You will not require any special long-term treatment after surgery."

C. "You will need to take hormone replacements for the rest of your life."

The nurse is providing community health screening. Which of the following clients should be referred to a health care provider for further evaluation? A. 30-year-old athlete with a heart rate of 50/min B. 45 -year-old client with a body mass index of 35 kg/m2 and fingerstick glucose of 150 mg/dL (8.3 mmol/L) C. 55-year-old client missing all the hair on the lower legs and failing the pinprick test D. 80-year-old client with a blood pressure of 150/90 mm Hg

C. 55-year-old client missing all the hair on the lower legs and failing the pinprick test

A 72 year old female patient reports to the ED with deep, circular and painful ulcers at the end of her toes. The most likely cause of the ulcers is: A. Diabetic Neuropathy B. Venous Insufficiency C. Arterial Insufficiency D. Inadequate Nutrition

C. Arterial Insufficiency→ painful ulcers, circular shape, usually toes/fingers

5. The nurse is assessing a patient's surgical dressing on the first postoperative day, the nurse notes new, bright-red drainage about 5 cm in diameter. What would be the nurse's first response to this finding? A.) Assess in 1 hour for increased drainage. B.) Notify the surgeon of a potential hemorrhage. C.) Assess the patient's blood pressure and heart rate. D.) Remove the dressing and assess the surgical incision.

C. Assess the patients blood pressure and heart rate. Always assess first

A nurse administers oxygen at 2 L/min via nasal cannula to a client with emphysema. Which clinical indicators should the nurse closely observe in the client? SELECT ALL THAT APPLY. A. Anxiety B. Cyanosis C. Drowsiness D. Mental confusion E. Increased respirations

C. Drowsiness D. Mental confusion

7. Surgery is performed on a client. The postoperative arterial blood gas values are pH 7.32, PCO2 53 mmHg, and HCO 3 25 mEq/L (25 mmol/L). Which action should the nurse take? → Respiratory acidosis A. Obtain a prescription for a diuretic. B. Have the client breathe into a rebreather bag. C. Encourage the client to take deep, cleansing breaths. D. Request a prescription for the administration of sodium bicarbonate.

C. Encourage the client to take deep, cleansing breaths.

A client with a chest tube is to be transported via a stretcher. When transporting the client, what should the nurse do? A. Keep collection device attached to mechanical suction B. Keep chest tube clamped distal to the water-seal chamber C. Keep collection device below the level of the client's D. Keep chest tube end covered with sterile gauze pads taped to the client

C. Keep collection device below the level of the client's

A client arrives in the emergency department with multiple crushing wounds of the chest, abdomen, and legs. Which are the priority nursing assessments? A. Level of consciousness and pupil size B. Characteristics of pain and blood pressure C. Quality of respirations and presence of pulses D. Observation of abdominal contusions and other wounds

C. Quality of respirations and presence of pulses ABC

The nurse is caring for a patient on the medical-surgical unit postoperative day five. During each patient assessment, the nurse evaluates the patient for infection. Which of the following would be most indicative of infection? A. Presence of an indwelling urinary catheter B. Rectal temperature of 99.5ºF (37.5ºC) C. Red, warm, tender incision D. White blood cell (WBC) count of 8,000/mL

C. Red, warm, tender incision

A nurse is educating a 65 year old female patient with elevated LDL levels about the modifiable risk factors for atherosclerosis. She refers to the following as modifiable to reduce the risk of atherosclerosis: (select all that apply) A. Increasing Age B. Use of NSAIDs C. Sedentary lifestyle D. Family history E. Diabetes

C. Sedentary lifestyle E. Diabetes

Which assessment data indicate the postoperative client who had anesthesia is suffering a complication of the anesthesia? A. Loss of sensation of the lumbar (L5) dermatome B. Absence of the clients posterior tibial pulse C. The client has a respiratory rate of eight D. The blood pressure is within 20% of the client's baseline

C. The client has a respiratory rate of eight

A 50-year-old woman weighs 95kg and has a history of tobacco use, high blood pressure, high sodium intake and a sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease (PAD) that need to be modified are: A.Weight and diet B.Activity level and diet C.Tobacco use and high blood pressure D. Sedentary lifestyle and high blood pressure

C. Tobacco use and high blood pressure

The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse, wavy lines of varying amplitude. How should the nurse correctly interpret this rhythm? A. Asystole B. Atrial fibrillation C. Ventricular fibrillation D. Ventricular tachycardia

C. Ventricular fibrillation

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of BPH. A. Nocturia B. Scrotal edema C. Occasional constipation D. Decreased force in the stream of urine

D. Decreased force in the stream of urine

A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? A. chronic ache or pain B. Persistent nausea C. Rash D. Indigestion

D. Indigestions The other six are: a change in bowel or bladder habits, a sore that does not heal unusual bleeding or discharge a thickening or lump in the breast or elsewhere an obvious change in a wart or mole and a nagging cough or hoarseness.

For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care? A. Providing for frequent rest periods B. Administering aspirin if the temperature exceeds 102° F C. Placing the patient in strict isolation D. Inspecting the skin for petechiae once every shift

D. Inspecting the skin for petechiae once every shift Since thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums.

6. A nurse is teaching a client with a diagnosis of pulmonary tuberculosis about recovery after discharge. What is the most important intervention for the nurse to include in this plan? A. Ensuring sufficient rest B. Changing lifestyle routines C. Breathing clean outdoor air D. Taking medications as prescribed

D. Taking medications as prescribed

A client comes to the emergency department with severe dyspnea and a cough. Vital signs are temperature 99.2 F, blood pressure 108/70 mmHg, heart rate 88/min, and respirations 24/min. the client has a history of COPD and CHF. Which diagnostic test will be most useful to the nurse in determining if this is an exacerbation of heart failure? a. Arterial blood gases (ABGs) b. B-type natriuretic peptide (BNP) c. Cardiac enzymes (CK-MB) d. Chest x-ray

b. B-type natriuretic peptide (BNP)