Med Surg I HESI EAQ

Which finding is expected in a client diagnosed with early glomerulonephritis? a. anuria b. dysuria c. polyuria d. proteinuria

Proteinuria

The RN is teaching a nursing student about the process of medication reconciliation for a client who was admitted in a health care setting. Which statement made by the nursing student indicates the need for further teaching a. " i would check the new medication prescription against the current list of medicines" b. " I would avoid asking about the client's OTC meds" c. "I would obtain a comprehensive and current list of the client's meds" d> "I would avoid distractions and go slowly when reconciling the client's meds"

I would avoid asking about the client's OTC meds

Which intervention would the nurse implement when providing care for an older adult male client who is immobile and incontinent of urine? a. restrict the client's fluid intake b. regularly offer the client a urinal c. apply incontinence pants d. insert an indwelling urinary catheter

Regularly offer the client a urinal

Which manifestations are seen in an older adult with the diagnosis of dementia? Select all that apply a. resistance to change b. inability to recognize familiar objects c. preoccupation with personal appearance d. inability to concentrate on new activities e. tendency to dwell on the past

Resistance to change Inability to recognize familiar objects Inability to concentrate on new activities Tendency to dwell on the past

Which change in arterial blood gases does the nurse expect in a client with hyperventilation due to anxiety a. respiratory acidosis b. respiratory alkalosis c. respiratory compensation d. respiratory decompensation

Respiratory alkalosis

Which initial action would the nurse take for a nursing home resident with moderate Alzheimer disease who begins to engage in numerous acting-out behaviors a. assess the client's LOC b. ID the stressors that precipitate the client's behavior c. observe the client's performance of activities of daily living d. monitor the s/e associated with the client's meds

ID the stressors that precipitate the client's behavior

The nurse is reviewing a list of current meds with a client who has developed GI bleeding. Which prescription would the nurse discuss with the primary health care provider? a. digoxin b. ibuprofen c. famotidine d. atorvastatin

Ibuprofen

Which urinary diversion surgery involves the transplantation of the ureters to a section of the colon, with one end attached to the abdominal wall as an ileostomy? a. cystostomy b. ileal conduit c. ureterosigmoidostomy d. cutaneous ureterostomy

Ileal conduit

The nurse is caring for a client diagnosed with a gastric ulcer. The nurse expects that which type of diet will be prescribed? a. soft diet b. low-fat, high-protein liquid diet c. hourly feedings of dairy products d. regular diet with foods that are well tolerated

Regular diet with foods that are well tolerated

A client with an intestinal obstruction is prescribed intestinal suction via a nasoenteric decompression tube. When caring for the client, the nurse would consider the loss of which constituents associated with this type of suctioning? a. protein enzymes b. energy carbohydrates c. vitamins and minerals d. water and electrolytes

Water and eletrolytes

Which modifiable risk factor would the nurse include in a community presentation on cardiovascular risk factors? Select all that apply a. weight b. inactivity c. cholesterol d. tobacco use e. homocysteine

Weight Inactivity Cholesterol Tobacco use Homocysteine

Which action would the nurse take for a client with invasive bladder carcinoma who is receiving radiation to the lower abdomen? a. observe the feces for the presence of blood b. monitor the BP for HTN c. administer enemas to remove sloughing tissue d. provide a high-bulk diet to prevent constipation

Obserce the feces for the presence of blood

Which response would the nurse make to a 30 yr old client diagnosed with hyperlipidemia and hypertension who asks the nurse to explain why treatment is important, stating " I feel find, so i don't really see the need to make any changes" a. "both high BP and high cholesterol contribute to development of heart disease" b. "lifestyle adaptations alone will be adequate as long as you continue to be asymptomatic" c. "usually someone with these diagnoses will have symptoms of heart disease already" d. "you should discuss your questions about medical problems with the health care provider"

"both high BP and high cholesterol contribute to development of heart disease"

Which problems would the nurse plan to address when dealing with ethical issues specifically related to end-of-life care? Select all that apply a. clients may be unable to communicate effectively b. all interventions for helping the clients seem futile c. clients are often unfamiliar with the concept of autonomy d. multiple meds affect the cognitive ability of the clients e. predictions regarding health outcomes are not always accurate

Clients may be unable to communicate effectively All interventions for helping the clients seem futile Predications regarding health outcomes are not always accurate

When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. For what response should the nurse critically assess this client? a. edema b. belching c. fluid deficit d. excessive salivation

Fluid deficit

A client who is receiving radiation therapy for bone cancer lives alone and works full time. Which client action would the nurse encourage? a. begin to perform regularly scheduled aerobic activity daily b. take a leave of absence from work when receiving therapy c. include rest periods during the day while receiving radation d. continue the activities usually performed before becoming ill

Include rest periods during the day while receiving radiation

Which sign and symptom might the nurse identify when assessing a client with hyperthyroidism? Select all that apply a. menstrual irregularities b. hypotension c. facial edema d. flushed appearance e. short attention span

Menstrual irregularities Flushed appearance Short attention span

Which statement by a client is consistent with a diagnosis of heart failure a. "i see spots before my eyes" b. "I am tired at the end of the day" c. "i feel bloated when I eat a large meal" d. "i have trouble breathing when I climb a flight of stairs"

"i have trouble breathing when I climb a flight of stairs"

Which assessment in a female client suggests an abnormal endocrine finding? a. facial hair b. protruding eyes c. pulse of 90 beats per minute d. blood pressure of 120/80 mm Hg

Protruding eyes

Which assessment for findings would indicate a possible asthma exacerbation? Select all that apply a. fever b. stridor c. wheezing d. tachycardia e. hypotension

Wheezing Tachycardia

Which early sign of respiratory acidosis would the nurse expect the client with a restrictive airway disease to exhibit? Select all that apply a. headache b. irritability c. restlessness d. hypertension e. lightheadedness

Headache Irritability Restlessness

When a client is newly diagnosed with COPD, which action by the nurse has the highest priority? a. teach the client how to use the prescribed inhalers b. discuss the normal progression of the disease process c. ask whether the client is interested in quitting smoking d. explain the purpose of a pulmonary rehabilitation program

Ask whether the client is interested in quitting smoking

Which medication increaes the risk for upper GI bleeding? Select all that apply a. aspirin b. ibuprofen c. ciprofloxacin d. acetaminophen e. methylprednisolone

Aspirin Ibuprofen Methylprednisolone

Which statement indicates understanding after teaching a post-radiation therapy client about proper skin care to the treatment area? Select all that apply a. "i will wear loose-fitting clothing over the area" b. "i will avoid using adhesive bandages" c. "i will avoid exposing the area to cold temps" d. "i will avoid rinsing the area with a saline soluation" e. "i will use lotions to moisten the area when wearing makeup"

"i will wear loose-fitting clothing over the area" "i will avoid using adhesive bandages" "i will avoid exposing the area to cold temps"

The nurse is preparing an intraoperative care plan for a client. Which intervention would be excluded from the care plan? a. ensuring the client's skin integrity b. reviewing the preoperative instructions c. administering a general anesthetic to the client d. placing the client in the correct position on the operating table

Administering a general anesthetic to the client

How would the nurse describe heart failure to a client? a. a cardiac condition caused by inadequate circulating blood volume b. an acute state in which the pulmonary circulation pressure decreases c. an inability of the heart to pump blood in proportion to metabolic needs d. a chronic state in which the systolic BP drops below 90 mm Hg

An inability of the heart to pump blood in proportion to metabolic needs

Which action is the priority when the preoperative nurse learns that a client is taking several herbal supplements? a. provide the client with information about the usefulness of herbal therapies b. inform the client about taking supplemental vitamins rather than herbs c. teach the client about herbal supplements d. ask the client which herbs have been taken

Ask the client which herbs have been taken

Which manifestation would the nurse expect to find when assessing a client with hyperthyroidism? Select all that apply a. dry skin b. weight loss c. tachycardia d. restlessness e. constipation f. exophthalmos

Weight loss Tachycardia Restlessness Exophthalmos

Which condition would the nurse suspect in a client who complains of nocturia, bladder pain, urinary frequency, urgency, and dribbling at the end of urination with a digital rectal examination report indicating smooth, firm, and enlarged prostate tissue surrounding the urethra? a. prostatitis b. paraphimosis c. prostate cancer d. BPH

BPH (benign prostatic hyperplasia)

While obtaining a client's health hx, which factor would the nurse identify as predisposing the client to type 2 diabetes? a. having diabetes insipidus b. eating low-cholesterol foods c. being 20 lbs overweight d. drinking a daily alcoholic beverage

Being 20 lbs overweight

The nurse applies a cold pack to relieve musculoskeletal pain. What rationale explains the analgesic properties of cold therapy? a. promotes analgesia and circulation b. numbs the nerves and dilates the blood vessels c. promotes circulation and reduces muscle spasms d. causes local vasoconstriction, preventing edema and muscle spasms

Causes local vasoconstriction, preventing edema and muscle spasms

A client who had been receiving palliative care for cancer has deteriorated and now needs end of life care. The nurse identifies that which type of care will now be removed from the treatment plan? Select all that apply a. chemotherapy b. repositioning c. regular oral care d. blood transfusion e. radiation therapy

Chemotherapy Blood transfusion Radiation therapy

Which symptom requires the most rapid action by the nurse when caring for a client with known peripheral arterial disease who calls the clinic and tells the nurse about experiencing several symptoms? a. anxiety b. chest pain c. weak pulse quality d. cool and pale lower legs

Chest pain

The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early Alzheimer dementia and lives alone, with adult children living nearby. According to the prescribed medication regimen, the client is to take meds 6 times throughout the day. Which nursing intervention is correct to assist with client with taking the medication a. contact the client's children and ask them to hire a private-duty who will provide round-the-clock care b. develop a chart for the client, listening the times the medication should be taken c. Contact the primary health care provider and discuss the possibility of simplifying the medication regimen d. instruct the client and client's children to put meds in a weekly pill organizer

Contact the primary health care provider and discuss the possibility of simplifying the medication regimen

When receiving hemodialysis, the client may develop hyponatremia. Which clinical findings related to the potential development of hyponatremia would the nurse monitor? Select all that apply a. diarrhea b. seizures c. Chvostek sign d. cardiac dysrthythmias e. increased temperature

Diarrhea Seizures

A client is scheduled for a barium swallow. How would the nurse prepare the client for the test? Select all that apply a. ask about allergies to iodine before the test b. administer cleansing enemas before the test c. suggest a light breakfast on the day of the test d. ensure that a laxative is prescribed after the test e. instruct to withhold prescribed opiods for 1 day before the test

Ensure that a laxative is prescribed after the test Instruct to withhold prescribed opioids for 1 day before the test

Which manifestations of surgically induced hypothyroidism might the client exhibit after a thyroidectomy? Select all that apply a. fatigue b. dry skin c. insomnia d. excitability e. weight loss d. intolerance to heat

Fatigue Dry skin

The registered nurse delegates the care of a client in the immediate postoperative period to the UAP. Which tasks are in the scope of practice of the UAP? Select all that apply a. feeding the client b. ambulating the client for the first time c. monitoring the VS d. assisting the client with bathing e. teaching leg exercises to the client

Feeding the client Assisting the client with bathing

To prevent an adverse outcome while providing care for a client experiencing diarrhea, which client data would the nurse closely monitor a. skin condition b. fluid and electrolyte balance c. food intake d. fluid intake and output

Fluid and electrolyte balance

A client suffering from cancer is near the end of life. Which action(s) would be performed by the nurse support the client's family members? Select all that apply a. helping the family set up hospice b. taking time to make sure that the family understands care options c. staying with the client in the absence of family members d. giving the family information about the dying process e. making sure that the family knowns what to do at the time of death

Helping the family set up hospice Taking time to make sure that the family understands care options Staying with the client in the absence of family members Giving the family information about the dying process Making sure that the family knowns what to do at the time of death

A client with COPD exacerbation is receiving O2 at 2L/min per nasal cannula and has an O2 sat of 88%. Which action would the nurse anticipate taking next? a. increasing O2 flow rate to 3 L/min b. preparing for intubation and assisted ventilation c. administration of an inhaled rapid-acting bronchodilator d. continuing to monitor the client with no therapy change

Increasing oxygen flow rate to 3L/min

Which guidance would the nurse to provide to a sexually active 16 year old client when she inquires as to how she can protect herself from contracting HIV a. ask her partner to withdraw before ejaculating b. make certain their relationship is monogamous c. insist that her partner use a condom when having sex d. seek counseling about various contraceptive methods

Insist that her partner use a condom when having sex

Which agent is indicated for tx of mild anemia that has developed in a client with upper GI bleeding? a. dextran b. iron salts c. vit B12 d. erythroproitein

Iran salts

Which assessment finding would the nurse consider abnormal? Select all that apply a. joint crepitation b. muscular atrophy c. muscle strength of 5 d. tenderness of the spine e. full range of joint motion

Joint crepitation Muscular atrophy Tenderness of the spine

After an acute episode of upper FO bleedings, a client vomits undigested meds and reports severe epigastric and abdominal pain. The client has absent bowel sounds, rigid abdomen, a pulse rate of 134, and shallow respirations of 32 per min. The primary health care provider has been contacted. Which action would the nurse take next? a. keep the client NPO b. teach the client about coughing and deep-breathing exercises c. inquire whether any red or black stools have been noted d. place the client in the supine position with the legs elevated

Keep the pt NPO

The nurse is teaching pursed-lip breathing to a client with COPD. The client asks about the benefit of the exercise. Which explanation would the nurse give? a. prevents complications that are associated with COPD b. relieves shortness of breath by increasing the breath rate c. increases the amount of air that the client can inhale with each breath d. keeps the airway open longer to decrease the work that goes into breathing

Keeps the airway open longer to decrease the work that goes into breathing

Which risk factor increases a client's risk for infection int he community? Select all that apply a. lifestyle b. occupation c. chronic diseases d. frequent traveling e. diagnostic procedures

Lifestyle Occupation Frequent traveling

Which clinic manifestation would the nurse expect to find in a client who has acute HIV infection? Select all that apply a. malaise b. confusion c. constipation d. swollen lymph glands e. oropharyngeal candidiasis

Malaise Swollen lymph glands

Which finding in a client with asthma exacerbation requires the most rapid action by the nurse? a. report of chest tightness b. HR of 112 beats per minute c. expiratory wheezes in both lungs d. markedly decreased breath sounds

Markedly decreased breath sounds

An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mmHg, and HCO3 is 20 mEq/l. Which disturbance would the nurse identify based on these results? a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis

Metabolic Acidosis

Which action would the nurse take to ID hyponatremia in an adolescent client with a perceived inability to ingest food? Select all that apply a. monitor VS b. monitor behavior c. monitor electrolyte status d. monitor for targeted daily calorie intake e. monitor activities for detrimental behaviors

Monitor VS Monitor electrolyte status

Which clinical manifestation would the nurse expect to ID when performing an admission hx and physical for a client with chronic peripheral arterial disease a. edema of the feet and ankles b. reddened and painful areas on the calves c. pain with exercising and thickening of the toenails d. ulcers around the ankles and reports of a dull ache in the legs

Pain when exercising and thickening of the toenails

The student nurse is describing palliative care to a client's family. Which statement made by the student nurse indicates a need for correction by the RN? a. "palliative care is the same as hospice care" b. "palliative care focuses on the care of the client" c. "palliative care includes symptom management in the client" d. "palliative care is an interprofessional approach to the delivery of care"

Palliative care is the same as hospice care

Which findings would the nurse expect when assessing a client with peripheral arterial disease? Select all that apply a. pallor of feet b. warm extremities c. ulcers on the toes d. thick, hardened skin e. delayed capillary refill

Pallor of feet Ulcers on the toes Delayed capullary refill

Which action by a clinet who requires an above-the-knee amputation for peripheral arterial disease best indicates readiness for the surgery? a. explains the goals of the procedure b. displays few signs of anticipatory greig c. participates in learning perioperative are d. verbalizes acceptance of permanent dependency needs

Participates in learning perioperative care

Which reason would an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium be prescribed for a client with a NG tube set to low intermittent suction? a. prevent constipation b. prevent dehydration c. prevent vomiting d. prevent electrolyte imbalance

Prevent electrolyte imbalance

Which intervention would the nurse include when developing a plan of care for an older client with dementia? a. explain to the client the details of the regimen b. demonstrate interest in the client's various likes and dislikes c. be firm when dealing with the client's attitudes and behaviors d. provide consistency in carrying out nursing activities for the client

Provide consistency in carrying out nursing activities for the client

How can the nurse best manage a common s/e of chemotherapy? a. restricting fluid intake b. instituting contact precautions c. keeping the hair closely cropped d. providing meticulous oral hygiene

Providing meticulous oral hygiene

Which factors are unique to delirium when distinguishing between dementia and delirium? Select all that apply a. slurred speech b. lability of mood c. long-term memory loss d. visual or tactile hallucinations e. insidious deterioration of cognition f. a fluctuating LOC

Slurred speech Visual or tactile hallucinations A fluctuating LOC

Which activities would the nurse include when teaching adults about activities that increase the risk of developing bladder cancer? Select all that apply a. jogging 3 miles a day b. drinking 3 cans of cola a day c. smoking 2 packs of cigarettes a day d. working with dyes used in rubber every day e. using a jackhammer and chainshaw every day

Smoking 2 packs of cigarettes a day Working with dyes used in rubber every day

Which stage of HIV disease is present in the client with 350 cells/mm3 of CD4+ T-cell count, according to the CDC a. stage 1 b. stage 2 c. stage 3 d. stage 4

Stage 2

Which priority intervention would the nurse expect to initiate for a postoperative care client with hypotension? a. start O2 therapy b. inspect the surgical incision c. administer IV fluid boluses d. administer vasoconstrictive agents

Start O2 therapy

Which instruction would the nurse include in a health practices teaching plan for a female client with a hx of recurrent UTIs? a. "wear cotton underwear or lingerie" b. "void at least every 6 hrs around the clock" c. "increase foods containing alkaline ash in the diet" d. "wipe the perineum from back to front after toileting"

Wear cotton underwear or lingerie

The primary health care provider instructs the nurse to manage fluid replacement therapy in a client with cancer. Which type of care is the client receiving? a. palliative care b. comfort care c. supportive care d. end of life care

Supportive care

Which description of symptoms is consistent with dementia of Alzheimer type? a. symptom onset is fairly rapid b. symptoms will subside periodically c. symptoms are triggered by personal crisis d. symptoms reflect progressive disintegration

Symptoms reflect progressive disintegration

Which clinical finding would the nurse expect when caring for a client with hyperthyroidism? Select all that apply a. lethargy b. tachycardia c. wt gain d. constipation e. exophthalmos

Tachycardia Exophthalmos

The RN is teaching a nursing about leadership skills for prioritizing the needs of the client. Which statement is an example of an intermediate-priority need? a. the teachings of home self-care b. a psychological episode of an anxiety attack c. a physiological episode of an obstructed airway d. the measures required to decrease postoperative complication

The measures required to decrease postoperative complications

Which statement would a nurse make when a client had sudden loss of muscle tone that lasted for a few seconds followed by confusion during a sz? Select all that apply a. these sz are associated with amnesia b. these sz increase the risk for injuries from a fall c. these sz are most resistant to medication therapy d. these sz are preceded by perception of an offensive smell e. these sz cause one-sided movement of extremities in the client

These sz increase the risk for injuries from a fall These sz are most resistant to medication therapy

Which response would the nurse provide a client asked the purpose for using Buck Traction before surgery? a. to reduce the fracture b. to immobilize the fracture c. to maintain abduction of the leg d. to eliminate rotation of the femur

To immobilize the fracture

The nurse provides moist heat for a client with cartilage degeneration. Which rational explains the use of this nursing intervention? a. to slow bone loss b. to prevent skin breakdown c. to increase muscle strength d. to increase blood flow to the area

To increase blood flow to the area

Which purpose of metoclopramide administered intravenously 30 min before initiating chemo for cancer of the colon would the nurse explains to a client? a. to stimulate production of GI secretions b. to stimulate peristalsis of the upper GI tract c. to prolong excretion of the chemotherapeutic medication d. to increase absorption of the chemotherapeutic medication

To stimulate peristalsis of the upper GI tract

Which instruction will the home health nurse when teaching a client with peripheral artery disease? Select all that apply a. "avoid crossing your legs" b. "inspect your feet daily" c. "change positions slowly' d. "do not use compression stockings" "avoid green leafy vegetables in your diet"

a. "avoid crossing your legs" b. "inspect your feet daily" "do not use compression stockings"

The nurse is educating the client newly diagnosed with type 2 DM on oral antidiabetic meds. Which instruction would the nurse include in the teaching plan a. obtain a finger stick BG reading before each meal b. does not need to follow a specific diet until insulin is required c. teaching plan should include sxs of hypoglycemia d. teaching plan should include how to admin regular insulin e. teaching plan should include sick day rules

obtain a finger stick BG reading before each meal teaching plan should include sxs of hypoglycemia teaching plan should include sick day rules

An older client asks, " How do I know that the meds that I take are safe?" Which response by the nurse is correct? Select all that apply a. "ask your health care provider how and when you should be taking your meds" b. "stop taking a prescribed medication if you are not feeling better in a few days" c. "discard meds into the toilet that have exceeded the expiration date on the bottle" d. "check the name, dose, and instructions about administration of meds each time before leaving the pharmacy" e. "inform your health care provider of the OTC meds, recreational drugs, and amount of alcohol you ingest"

"ask your health care provider how and when you should be taking your meds" "check the name, dose, and instructions about administration of meds each time before leaving the pharmacy" "inform your health care provider of the OTC meds, recreational drugs, and amount of alcohol you ingest"

Which type of treatment is the Buck extension? a. skeletal traction b. cutaneous traction c. halter transfixation d. balanced suspension

Cutaneous traction

The nurse is caring for a client who had surgery for the formation of a continent urostomy. The nurse engages the client in early postoperative ambulation to prevent which complication? a. wound infection b. urinary retention c. abdominal distention d. incisional evisceration

Abdominal distention

Which clinical manifestations would the nurse expect a client with hypothyroidism to exhibit? Select all that apply a. cool skin b. photophobia c. constipation d. periorbital edema e. decreased appetite

Cool skin Constipation Periorbital edema Decreased appetite

When a client with COPD reports a 5;b wt gain in 1 wk, the nurse will assess for other signs and symptoms of which complications? a. polycythemia b. cor pulomonale c. compensated acidosis d. left ventricular failure

Cor pulmonale

Which type of lung sounds would the nurse expect to hear when caring for a client with heart failure a. stridor b. crackles c. wheezes d. rhonchi

Crackles

Which medication prescribed for a client with an acute episode of heart failure would the nurse question? a. diuretic b. beta blockers c. long-acting nitrate d. angiotensin receptor blocker

Beta Blocker

Which clinical manifestation would the nurse report immediately to the primary health care provider when providing care for a client with HIV infection a. blood in the urine b. new or productive cough c. vomiting accompanied by fever d. burning, itching, and discharge from the eyes

Blood in urine

Which nursing interventions require the nurse to wear gloves? Select all that apply a. giving a back rub b. cleaning a newborn immediately after delivery c. emptying a portable wound drainage system d. interviewing a client in the ED e. obtaining the BP of a client who is positive for HIV

Cleaning a newborn immediately after delivery Emptying a portable wound drainage system

Which clinical indicator would the nurse expect a client with hyperkalemia to exhibit? Select all that apply a. tetany b. seizures c. confusion d. weakness e. dysrhythmias

Confusion Weakness Dysrhythmias

Which event indicates a need to suggest testing of a client for HIV? Select all that apply a. diagnosed with TB in 1985 b. travelled to italy and greece in the late 1990s c. received blood transfusions in 1980 during total hip replacement surgery d. engaged in sexual relations with someone of the same sex for several years e. spent several nights in jail for a DUI charge

Diagnosed with TB in 1985 Received blood transfusions in 1980 during total hip replacement surgery Engaged in sexual relations with someone of the same sex for several years

A client with a disturbed state of mind is under observation . Which manifestation indicates that the client is suffering from dementia? Select all that apply a. displaying signs of depression b. difficulty making decisions c. continuously mentioning past failures d. inability to complete purposeful work e. disturbed sleep/wake cycle

Difficulty making decisions Inability to complete purposeful work

Which assessment finding is consistent with a client diagnosis of right-sided heart failure? Select all that apply a. collapsed neck veins b. distended abdomen c. dependent edema d. decreased appetite e. cool extremities

Distended abdomen Dependent edema Decreased appetite

Which condition would the nurse document to describe a client presenting with the loss of the ability to taste after cancer treatment has affected the client's ability to eat food? a. mucositis b. dysgeusia c. dysphagia d. xerostomia

Dysgeusia

A client with T1 DM for 25 yrs states, " I have been really bad for the past 15 yrs. I have not paid attention to my diet and have done little to control my DM." Which common complications of DM might the nurse expect to ID when assessing this client? Select all that apply a. leg ulcers b. loss of visual acuity c. thick, yellow toenails d. increased growth of body hair e. decrease sensation in the feet

Leg ulcers Loss of visual acuity Thick, yellow toenails Decreased sensation in the feet

Which finding would be of most concern when the nurse assesses a client with emphysema? a. barrel chest b. oral cyanosis c. pursed-lip expiration d. respirations 26 breaths per min

Oral cyanosis

While caring for a client in traction, which action would the nurse delegates to a LPN? Select all that apply a. padding traction connections b. determining correct body alignment c. assessing complication associated with immobility d. teaching the client about ROM exercises e. assisting the client with passive and active ROM exercises

Padding traction connections Assisting the client with passive and active ROM exercises

After an acute episode of upper GI bleeding, a client vomits undigested antacids and reports having severe epigastric pain. The nursing assessment reveals an absence of bowel sounds, a pulse rate of 134, and shallow respirations of 32 per min. In addition to calling the health care provider, what action should the nurse take? a. prepare the client for surgery b. request a state chest XR (radiograph) c. place the client in the supine position, with legs elevated d. ask the client if there have any black stools

Prepare the client for surgery

Which action would the nurse take while a client is seizing on the hallway floor? a. hold the client's extremities firmly b. protect the client's head from injury c. insert an airway between the client's teeth d. have staff members move the client to a soft surface

Protect the client's head from injury

A client with COPD is breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. Which action would the nurse take? a. encourage the client to take slow, deep breaths and administer 5L/min oxygen per nasal cannula b. place the client in a side-lying position and perform chest physiotherapy using clapping and vibration c. raise the HOB to a high-fowler position and administer 2L/min oxygen per nasal cannula d. assist the client in assuming a position of comfort and perform postural drainage

Raise the HOB to a high-Fowler position and administer 2L/min oxygen per nasal cannula

The nurse is providing preoperative teaching to a client who is scheduled for abdominal surgery. The client is fidgeting, slightly diaphorectic, and asking simple questions about information that was already provided during the education session. Which initial step would the nurse take? a. repeat the information, speaking slowly and distinctly b. reduce the client's level of anxiety c. teach the client about measures to lessen preoperative anxiety d. ask the client to verbalize concerns and questions

Reduce the client's level of anxiety

Which physiological change of the musculoskeletal system would the nurse associate with aging? Select all that apply a. slowed movement b. cartilage degeneration c. increased bone density d. increased ROM e. increased bone prominence

Slowed movement Cartilage degeneration Increased bone prominence

Which topic will the nurse include in teaching for a client with Raynaud disease a. tobacco avoidance b. dietary salt reduction c. need for increased exercise d. low-fat, low-cholesterol diet

Tobacoo avoidance

Which client statements indicates the need for further teaching about the traction device after a major fracture? a. "traction must be applied continuously to be effective" b. "weights of 5-45 lbs are used to apply the counterweight" c. "the risks of skeletal traction include infection at the pin insertion site" d. "traction pushes the fractured ends together to prevent them from pulling apart"

Traction pushes the fractured ends together to prevent them from pulling apart

Which instruction would the nurse provide to the client who has been diagnosed with a urinary tract infection? a. void every 2 hrs b. record fluid intake and urinary output c. pour warm water over the vulva after voiding d. urinate after intercourse

Urinate after intercourse

Which topic would the nurse in teaching for a client with a new diagnosis of HTN? Select all that apply a. reason for daily low-dose aspirin use b. use of a home BP monitor c. adverse effects of tobacco on BP d. avoidance of any alcohol consumption e. benefits of moderate daily exercise

Use of a home BP monitor Adverse effects of tobacco on BP Benefits of moderate daily exercise

Which intervention would the public-health nurse prioritize to support secondary prevention efforts for cardiovascular disease a. offer routine BP screening at various community sites including worksites, schools, and faith institutions b. advocate for policy changes to support healthy environments that include opportunities for safe physical activity c. provide educational opportunities regarding prevention of CV disease through a variety of venues d. support access to healthy food options in the local community for all residents

offer routine BP screening at various community sites including worksites, schools, and faith institutions

Which blood gas report most likely reflects the acid-base balance of an infant with severe dehydration? a. pH of 7.50 and PCO2 of 34 mm Hg b. pH of 7.23 and PCO2 of 70 mm Hg c. pH of 7.20 and HCO3 of 20 mEq/L d. pH of 7.56 and HCO3 of 30 mEq/L

pH of 7.20 and HCO3 of 20 mEq/L

The nurse advises a client recovering from a musculoskeletal injury to increase intake of which nutrient? a. fat b. protein c. sodium d. Vit A

Protein

Which statement from a client who has received prescriptions for digoxin, furosemide, and a 2g sodium indicates that further teaching is needed a. "i must check my pulse every day" b. "i can gradually increased my exercise as long as I take rest periods" c. " i should call my health care provider if I have difficulty breathing when I am lying flat" d. "i can use a little table salt on my food as long as i do not use it when cooking food"

"i can use a little table salt on my food as long as i do not use it when cooking food"

A client's fasting plasma glucose are being evaluated. The nurse identifies that the client is considered to be diabetic if the results are within which range? a. 40-60 mg/dL (2.2-3.3 mmol/L) b. 80-99 mg/dL (4.5-5.5 mmol/L) c. 100-125 mg/dL (5.6-6.9 mmol/L) d. 126-140 mg/dL (7.0-7.8 mmol/L)

126-140 mg/dL (7.0-7.8 mmol/L)

For an older adult client with dementia who developed dehydration as a result of vomiting and diarrhea, which assessment information best reflects the client's fluid balance a. skin turgor b. intake and output results c. client's report about fluid intake d. blood lab results

Blood lab results

Which radiographic test would be used to view the entire skeleton? a. bone scan b. gallium and thallium scan c. CT d. MRI

Bone scan

Which response would the nurse provide to a client who develops a sz d/o as a result of a traumatic fall and states " I have not had a sz in 2 yrs. When can I stop taking my anti-sz meds?" a. " a gradual reduction in sz medication may be considered" b. " you will require medication for the rest of your life" c. " the medication probably will be d/c at this visit" d. "a minimum of 10 yrs w/o sz is necessary before d/c of meds is considered"

A gradual reduction in sz medication may be considered

Which factor is unique to vascular dementia when comparing assessment findings in clients with vascular dementia and dementia of the Alzheimer type a. memory impairment b. abrupt onset of symptoms c. difficulty making decisions d. inability to use words to communicate

Abrupt onset of symptoms

Which nursing intervention would be contraindicated for a client who has a fracture and has compartment syndrome? Select all that apply a. splitting the cast in half b. applying cold compresses c. reducing the traction weight d. loosening the client's bandage e. elevating the extremity above heart level

Applying cold compresses Elevating the extremity above the heart level

Which type of immunity will clients acquire through immunizations with live or killed vaccines? a. natural active immunity b. artificial active immunity c. natural passive immunity d. artificial passive immunity

Artifical active immunity

When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes which clinical presentation about type 1? a. onset of disease is slow b. excessive weight is contributing factor c. complications are not present at the time of diagnosis d. treatment involves diet, exercise, and oral medications

Complications are not present at the time diagnosis

The nurse is providing preoperative education to a client scheduled for orthopedic surgery at 0800 the next day. Which instruction would the nurse include? a. "have your dinner completed by 6:00pm tonight and then no food or fluids after that" b. "drink whatever liquids you want tonight and then only clear liquids tomorrow morning" c. "consume a light evening meal tonight and then no food or liquids after midnight d. "eat lunch today and then don't drink or eat anything until after your surgery"

Consume a light evening meal tonight and then no food or fluids after midnight

A client arrives at a health clinic reporting a recent onset of hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse observe in the client's medical record? a. chronic glomerulonephritis b. nephrotic syndrome c. pyelonephritis d. cystitis

Cystitis

Which factor contributes to a client's slow rate of healing? Select all that apply a. diabetes b. cataract c. smoking d. dermatitis e. alcohol abuse

Diabetes Smoking Alcohol abuse

Which intervention would the nurse recommend to decrease TB in the community? a. improving financial resources b. eliminating overcrowded housing c. initiating needle-sharing programs d. improving access for food pantries e. providing barrier contraceptive device

Improving financial resources Eliminating overcrowded housing Initiating needle-sharing programs Improving access for food pantries Providing barrier contraceptive device

After treatment for a bladder infection, a client ask whether there is anything she can do to prevent cystitis in the future. Which response would the nurse give? a. "avoid regular use of tampons" b. "decrease your intake of prune juice" c. "increase your daily fluid consumption" d. "cleanse the perineum from back to front"

Increase your daily fluid consumption

Which action would the nurse take after finding a child having a tonic-clonic sz a. applying restraints b. administering oxygen c. protecting the child from self-injury d. inserting a plastic airway in the child's mouth

Protecting the child from self-injury

The nurse notes a client's BP of 200/110 mm Hg and swelling of the operative leg after a femoropopliteal bypass graft. Which action would the nurse take next? a. evaluate the client's orientation b. check pedal pulses distal to the graft c. notify the client's health care provider d. monitor BP every 15 minutes

Notify the client's health care provider

Which food would the nurse mention is bladder irritant when educating a client with interstitial cystitis? Select all that apply a. milk b. nuts c. citrus fruit d. aged cheeses e. soy-containing foods f. green, leafy vegetables

Nuts Citrus fruit Aged cheeses

Which statement indicates a client understands transmission of the HIV? Select all that apply a. "i can contract HIV by participating in oral sex" b. "i can contract HIV by eating from used utensils" c. "i can contract HIV by using the bathroom of a person who is HIV +" d. "HIV is contracted by using contaminated needles" e. "babies can contract HIV because of contact with maternal blood during birth"

"i can contract HIV by participating in oral sex" "HIV is contracted by using contaminated needles" "babies can contract HIV because of contact with maternal blood during birth"

Which statement by a client with type 2 diabetes indicates to the nurse that additional dietary teaching in needed? a. "i can eat as much dietetic fruit as i want" b. "i can have a lettuce salad whenever i want it" c. "i know that half of my diet should be carbohydrates" d. "i need to reduce the amounts of saturated fats in my diet"

"i can eat as much dietetic fruit as i want"

Which statement by the client would the nurse expect when assessing a client with a diagnosis of left ventricular failure? a. "my ankles are swollen" b. "my appetite is not very good" c. "when i eat a large meal, i feel bloated" d. "i have trouble breathing when i walk rapidly"

"i have trouble breathing when i walk rapidly"

Which statement indicates that the teaching has been effective after the nurse has finished teaching a 50 yr old female client symptoms of coronary artery disease in women a. "i don't need to worry about symptoms like chest pain or pressure" b. "i will call my health care provider about any unusual fatigue" c. "women have less risk of death from heart disease than men" d. "bad cholesterol levels are usually higher in women than in men"

"i will call my health care provider about any unusual fatigue"

Which activity would the nurse expect to cause the most distress when assessing a client with heart failure for activity tolerance? a. getting up from bed in the morning b. walking to visit the next-door neighbor c. climbing a flight of stairs to the bedroom d. leaving the table immediately after a meal

Climbing a flight of stairs to the bedroom

A client presenting with an acute asthma attack is being assessed in the emergency department. Th client's spouse that the client currently is undergoing treatment for an upper respiratory infection. The nurse understand that the client most lilkey has which type of asthma? a. allergic b. emotional c. extrinsic d. intrinsic

Intrinsic

Which action would the nurse take if the weights attached to a 7 year old child in traction are touching the floor? a. raising the foot of the bed b. lengthening the traction rope c. notifying the health care provider d. moving the child toward the head of the bed

Moving the child toward the head of the bed

Diagnosed with COPD, a 50 year old client's clinical data after treatment is: HR of 100 beats/min, BP of 138/82 mm Hg, RR of 32 breaths/min, Temp of 98.2%, and an O2 sat of 80%. Which VS obtained by the nurse indicates a positive outcome? Select all that apply a. radial pulse: 70 beaths/min b. temp: 98.6 c. rr: 14 breaths/min d. bp: 110/70 mm Hg e. O2 sat: 92%

RR: 14 breaths/min BP: 110/70 mm Hg O2 sat: 92%

Which action would the nurse correct after observing the student nurse caring for the skin of a client who recently underwent radiation therapy? Select all that apply a. using a washcloth for cleaning the radiated site b. rinsing soap thoroughly from the skin of the client c. drying the irradiated area with rubbing motions d. telling the client to wear loose clothing over the skin at the radian site e. removing the ink marks that ID the location of the focused beam of radiation

Using a washcloth for cleaning the radiated site Drying the irradiated area with rubbing motions Removing the ink marks that ID the location of the focused beam of radiation

Which prescribed diagnostic test would the nurse expect to confirm a tentative urinary tract infection diagnosis in a client recovering from deep, partial-thickness burns who develops chills, fever, flank pain, and malaise? a. cystoscopy and bilirubin level b. specific gravity and pH of the urine c. urinalysis and urine culture and sensitivity d. creatinine clearance and albumin/globulin (A/G) ratio

urinalysis and urine culture and sensitivity

Which basic strategy would the nurse teach a health class to reduce the incidence of HIV transmission? Select all that apply a. using condoms b. using separate toilets c. practicing sexual abstinence d. preventing direct causal contacts e. sterilizing the household utensils

using condoms practicing sexual abstinence

Which steps listen by the nursing student are accurate regarding discharge planning? Select all that apply? a. "plan the client's discharge at the time of leaving the hospital" b. "teach the client the safe and effective use of medications and medical equipment" c. "remember that discharge planning is a centralized, coordination, interdisciplinary process" d. "coordinate with just the primary health care provider when preparing discharge planning" e. "develop a care plan that moves the client from the hospital to another level of care"

Teach the client the safe and effective use of medications and medical equipment Remember that discharge planning is a centralized, coordinated, interdisciplinary process Develop a care plan that moves the client from the hospital to another level of health care

Once a client admitted with shock secondary to severe GO bleeding is stabilized, which action would the nurse take? a. monitor the peripheral pulses b. check the level of consciousness c. take a blood sample for laboratory tests d. control the bleeding with a pressure dressing

Take a blood sample for laboratory tests

Which topic would be the most important to include in teaching when a obese client receives a diagnosis of high BP a. causes of HTN b. symptoms of HTN c. effect of weight loss in HTN d. effect of lowering alcohol intake in HTN

Effect of weight loss in HTN

Which perioperative actions would the nurse plan when caring for a client scheduled for a septoplasty? Select all that apply? a. teach the client how to use hot compresses b. encourage the client to quit smoking before surgery c. observe the surgical site for edema d. teach the client about postsurgery activities that are restricted e. assess the client's respiratory status f. encourage the client to take aspirin before the surgery

Encourage the client to quit smoking before surgery Observe the surgical site for edema Teach the client about postsurgery activities that are restricted Assess the client's respiratory status

Which condition would the nurse consider as the most likely cause of pain for a client who tells the nurse, "My legs begin to hurt after walking for several blocks. The pain goes away when I stop walking, but it comes again when I resume walking" a. spinal stenosis b. beurger disease c. rheumatoid arthritis d. intermittent claudication

Intermittent Claudication

Which metabolic manifestation are likely to be observed in a client with hypothyroidism? Select all that apply a. impaired memory b. intolerance to cold c. difficulty breathing d. decreased BP e. decreased body temperature

Intolerance to cold Decreased body temperature

Which finding in a client seen at the outpatient clinic supports a diagnosis of an arterial ulcer? Select all that apply a. lack of hair b. thickened toenails c. copious ulcer drainage d. diminished pedal pulses e. brown skin discoloration

Lack of hair Thickened toenails Diminished pedal pulses

In which scenario is the nurse providing tertiary prevention? a. educating a community about the proper use of environmental sanitation b. educating a family about how to protect themselves from carcinogens c. providing education to a family regarding the need to pay attention to personality development d. providing education to a community about the need to integrate individual's limb amputations into the professional sphere

Providing education to a community about the need to integrate individual's limb amputations into the professional sphere

Which eye problem is the leading cause of blindness in clients with diabetes a. cataracts b. glaucoma c. retinopathy d. astigmatism

Retinopathy

Which action by a client with peripheral arterial disease indicates that more teaching about how to manage the disease is needed a. applying a hot water bottle to the abdomen b. using a heating pad to warm the extremities c. drinking a warm cup of tea when feeling chilly d. turning the room thermostat above 72F

Using a heating pad to warm the extremities

Which nursing intervention helps prevent complications associated with a shortened urethra revealed by a recent intravenous pyelogram? a. providing thorough perineal care after each voiding b. encouraging the client to use the toilet or bedpan every 2 hrs c. responding quickly to the client's indication of the need to void d. applying voiding stimulants to the perineum

providing thorough perineal care after each voiding