MedSurg Test 2

A client with diabetes who takes insulin has a blood glucose level of 40 mg/dL (2.22 mmol/L). What should the nurse offer the client to begin to raise the blood glucose level? Select all that apply. a) one tablespoon (15 mL) of peanut butter b) one slice of bread c) one-half cup (120 mL) of regular soda d) one cup (240 mL) of milk e) one-quarter cup (60 mL) of tuna f) one-half cup (120 mL) of orange juice

• one slice of bread • one cup (240 mL) of milk • one-half cup (120 mL) of regular soda • one-half cup (120 mL) of orange juice

A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for which signs and symptoms? Select all that apply. a) copious diarrhea b) rapid onset of dehydration c) increased bowel sounds d) significant abdominal distention e) projectile vomiting

• rapid onset of dehydration • increased bowel sounds • projectile vomiting

A client with insulin-dependent diabetes develops a seizure disorder and has been prescribed phenytoin. Which information should the nurse include in the teaching plan? The client should: (Select all that apply.) a) report changes in blood glucose levels to the health care provider. b) increase the daily calorie allotment by 200 calories. c) use a soft toothbrush and floss the teeth daily. d) substitute various brands of phenytoin as long as the dosage is the same. e) take potassium supplements to prevent hypokalemia.

• use a soft toothbrush and floss the teeth daily. • report changes in blood glucose levels to the health care provider.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse assess? Select all that apply. a) epigastric pain at night b) vomiting c) melena d) weight loss e) relief of epigastric pain after eating

• weight loss • melena • vomiting

During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which of the following actions should the nurse take? a) Administer IV glucagon bolus as needed b) Contact the healthcare provider c) Administer a saline bolus as needed d) Start oxygen at 2 L/min as needed

c) Administer a saline bolus as needed

What diet should be implemented for a client who is in the early stages of cirrhosis? a) high-carbohydrate, low-sodium b) high-protein, low-fat c) low-fat, low-protein d) high-calorie, high-carbohydrate

d) high-calorie, high-carbohydrate

A client's stools are light gray in color. For what finding should the nurse assess the client? Select all that apply. a) jaundice b) pain at McBurney's point c) respiratory distress d) intolerance to fatty foods e) fever f) peptic ulcer disease

• intolerance to fatty foods • fever • jaundice

The nurse is giving preoperative instructions to a client who will have a reversal of a colostomy. The nurse should prepare the client to expect which nursing actions during the immediate postoperative period? Select all that apply. a) daily measurement of abdominal girth b) nasogastric (NG) tube attached to low intermittent suction c) administration of IV fluids d) calculation of intake and output every 8 hours e) assessment of vital signs every 6 hours

• nasogastric (NG) tube attached to low intermittent suction • administration of IV fluids • calculation of intake and output every 8 hours

A client with peptic ulcer disease reports being nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. a) notifying the health care provider (HCP) of the client's symptoms b) initiating oxygen therapy c) monitoring the client's vital signs d) reassessing the client in an hour e) administering an antacid hourly until nausea subsides

• notifying the health care provider (HCP) of the client's symptoms • monitoring the client's vital signs

A 58-year-old homeless person is brought to the emergency department by the police after being found unconscious on the street. Following examination and evaluation of laboratory test results, a diagnosis of diabetic ketoacidosis is confirmed. Which information is most crucial to document on the client's medical record? Select all that apply. a) length of time the client has had diabetes b) blood pressure c) skin condition and presence of any rashes, lesions, or ulcers d) hourly urine output e) response to verbal and painful stimuli f) size of pupils and reaction of pupils to light

• size of pupils and reaction of pupils to light • response to verbal and painful stimuli • skin condition and presence of any rashes, lesions, or ulcers • blood pressure • hourly urine output

Cimetidine may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? a) Ulcer formation. b) Esophagitis. c) Dysphagia. d) Esophageal reflux.

b) Esophagitis.

A client who had a cholecystectomy with a biliary drainage tube in place. What color of the drainage is expected? a) pinkish red b) green c) clear d) dark yellow-orange

b) green

What information will the nurse include in the preoperative education for a client scheduled for thyroid lobectomy? a) Instructions for tracheostomy care b) Symptoms of hypercalcemia c) Daily neck exercises d) Medications for thyroid replacement

c) Daily neck exercises

A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. a) Nervousness. b) Tachycardia. c) Dry mouth. d) ECG changes. e) Low body temperature. f) Bradycardia.

• ECG changes. • Low body temperature. • Bradycardia.

A nurse is developing a care plan for a client with hepatic encephalopathy. Which are goals for the care for this client? Select all that apply. a) Prevent constipation. b) Check the pupil reaction. c) Administer lactulose to reduce blood ammonia levels. d) Encourage physical activity. e) Monitor coordination while walking. f) Provide food and fluids high in carbohydrate.

• Prevent constipation. • Administer lactulose to reduce blood ammonia levels. • Monitor coordination while walking. • Check the pupil reaction. • Provide food and fluids high in carbohydrate.

A client visiting the clinic is scheduled for an outpatient thyroid scan in 2 weeks. Which instructions should the nurse include to ensure that this client is prepared for the test? Select all that apply. a) Stop using iodized salt or iodized salt substitutes 1 week before the scan. b) Stop eating seafood 1 week before the scan. c) Do not consume any food or fluids after midnight on the night before the scan. d) Maintain bed rest for 24 hours after the scan. e) Do not take any prescribed thyroid medication on the day of the scan. f) Do not take prescribed thyroid medication until the results of the scan are known.

• Stop using iodized salt or iodized salt substitutes 1 week before the scan. • Stop eating seafood 1 week before the scan. • Do not take any prescribed thyroid medication on the day of the scan.

Which are the important considerations by the nurse before administering feedings to a client through a nasogastric tube? Select all that apply. a) Ensure that anchoring tape is intact. b) Determine placement of the tube by aspiration of gastric contents. c) Flush the tube with 50 mL of water before the feeding to prevent obstruction of the tube. d) Measure the pH of the aspirated fluid. e) Position the client in the supine position to prevent aspiration.

Determine placement of the tube by aspiration of gastric contents. • Measure the pH of the aspirated fluid.

A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? a) No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test b) Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay c) An increase in the TSH level after 30 minutes during the TSH stimulation test d) A decreased TSH level

a) No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test

The nurse is teaching the family and a client newly diagnosed with type 1 diabetes how diet and exercise affect insulin requirements. Which statement made by the client indicates understanding of the teaching? a) "I can remove my insulin pump when exercising." b) "Exercise will decrease my insulin need and decrease my food requirements." c) "An exercise regimen may cause me to eliminate my bedtime snack." d) "I will need more insulin and food when exercising."

a) "I can remove my insulin pump when exercising."

A client with a diagnosis of severe ulcerative colitis is admitted to the hospital. The nurse would assess for which of the following? a) Extreme muscle weakness and tachycardia b) Skin rash and diplopia c) Development of tetany with muscle spasms d) Nausea, vomiting, and leg and stomach cramps

a) Extreme muscle weakness and tachycardia

A nurse is teaching a client about insulin therapy. The nurse knows the client needs additional teaching when she states that insulin may interact with: a) metoprolol. b) hydrochlorothiazide (Hydro DIURIL). c) aspirin. d) hormonal contraceptives.

a) metoprolol.

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: a) rapid-acting insulin only. b) short- and long-acting insulins. c) intermediate- and long-acting insulins. d) short- and intermediate-acting insulins.

a) rapid-acting insulin only.

Which dietary instruction would be appropriate for the nurse to give a client who is recovering from acute pancreatitis? a) Restrict carbohydrate intake. b) Avoid crash dieting. c) Eat six small meals a day. d) Decrease sodium in the diet.

b) Avoid crash dieting.

The nurse is obtaining a health history from a client with diabetes mellitus who has been taking insulin for 20 years. Currently the client reports having periods of hypoglycemia followed by periods of hyperglycemia. The nurse should specifically ask if the client is: a) eating snacks between meals. b) injecting insulin at a site of lipodystrophy. c) adjusting insulin according to blood glucose levels. d) initiating the use of the insulin pump.

b) injecting insulin at a site of lipodystrophy.

A client with acute pancreatitis is put on nothing-by-mouth status, with the intent of not stimulating the pancreas. The client is prescribed an IV infusion of dextrose 5% in half-normal saline solution at 120 mL/h. After 3 days of this regimen, the nurse should observe the client for which adverse metabolic condition? a) lactic acidosis b) ketosis c) metabolic syndrome d) hyperglycemia

b) ketosis

Which statement indicates that the client with hepatitis B has understood the nurse's discharge teaching? a) "I must avoid sexual intercourse." b) "I should be able to resume normal activity in a week or two." c) "I will not drink alcohol for at least 1 year." d) "Because hepatitis B is a chronic disease, I know I will always be jaundiced."

c) "I will not drink alcohol for at least 1 year."

A 34-year-old female is diagnosed with hypothyroidism. What should the nurse assess the client for? Select all that apply. a) decreased energy and fatigue b) constipation c) rapid pulse d) weight gain of 10 lb (4.5 kg) e) menorrhagia f) fine, thin hair with hair loss

• decreased energy and fatigue • weight gain of 10 lb (4.5 kg) • constipation • menorrhagia

A client is admitted from the emergency department after falling down a flight of stairs at home. The client's vital signs are stable, and the history states that the client had a gastric stapling 2 years ago. The client jokes about being clumsy lately and tripping over things. The nurse should gather additional information by asking the client which questions? Select all that apply. a) "Do you feel safe at home?" b) "Are you getting sufficient iron in your diet?" c) "Are you feeling depressed?" d) "How much vitamin B12 are you getting?" e) "Are you experiencing numbness in your extremities?"

• "Are you experiencing numbness in your extremities?" • "How much vitamin B12 are you getting?" • "Are you feeling depressed?" • "Do you feel safe at home?"

A client is scheduled to undergo an upper gastrointestinal (GI) series. The nurse should give the client which instructions in preparation for the test? Select all that apply. a) "You can expect white stools for about 48 hours after the test." b) "Do not eat or drink for 8 hours before the test." c) "You will experience mild stomach pain during the test." d) "It is okay for you to smoke before the test." e) "You will need to take a stool softener before the test to promote evacuation of the barium."

• "Do not eat or drink for 8 hours before the test." • "You can expect white stools for about 48 hours after the test."

After teaching a client about collecting a stool sample for occult testing, which client statement indicates effective teaching? Select all that apply. a) "I will take the sample from different areas of the stool that I have passed." b) "I will avoid eating meat for 1 to 3 days before getting a stool sample." c) "I can continue to take all of my regular medications at home." d) "I need to eat foods low in fiber a few days before collecting the sample." e) "I need to send the stool sample to the lab in a covered container right away."

• "I will take the sample from different areas of the stool that I have passed." • "I will avoid eating meat for 1 to 3 days before getting a stool sample."

A client with diverticulitis has developed peritonitis following diverticular rupture. When assessing the client, what should the nurse do? Select all that apply. a) Assess presence of excessive thirst. b) Percuss the abdomen to note tympany. c) Percuss the liver to note lack of dullness. d) Auscultate bowel sounds to note frequency. e) Monitor the vital signs for fever.

• Percuss the abdomen to note tympany. • Percuss the liver to note lack of dullness. • Monitor the vital signs for fever. • Auscultate bowel sounds to note frequency.

The nurse is evaluating how a client with hepatitis A understands the discharge teaching given. Which client statements indicate that further teaching is needed? Select all that apply. a) "My bath towels shouldn't be used by any other family members." b) "I should wear a mask when visitors come." c) "I can have an occasional glass of wine with my meal as I recover." d) "My family members should receive the hepatitis A vaccine to prevent them from getting the disease." e) "My spouse and I can have intercourse and kiss." f) "My family and I do not need to take any special precautions as long as I take my medication."

• "My family and I do not need to take any special precautions as long as I take my medication." • "My spouse and I can have intercourse and kiss." • "I can have an occasional glass of wine with my meal as I recover." • "I should wear a mask when visitors come."

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply. a) A major risk factor for complications is obesity and central abdominal obesity. b) Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations. c) The primary nutritional source requiring monitoring in the diet is carbohydrates. d) Supplemental insulin is mandatory for controlling the disease. e) Exercise increases insulin resistance.

• A major risk factor for complications is obesity and central abdominal obesity. • Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations.

A client with ulcerative colitis is to take sulfasalazine. Which instruction should the nurse provide for the client about taking this medication at home? Select all that apply. a) Discontinue therapy if symptoms of acute intolerance develop, and notify the health care provider (HCP). b) Drink enough fluids to maintain a urine output of at least 1,200 to 1,500 mL/day. c) If a dose is missed, skip and continue with the next dose. d) Stop taking the medication if the urine turns orange-yellow. e) Avoid activities that require alertness.

• Avoid activities that require alertness. • Discontinue therapy if symptoms of acute intolerance develop, and notify the health care provider (HCP). • Drink enough fluids to maintain a urine output of at least 1,200 to 1,500 mL/day.

A client is receiving a tube feeding and has developed diarrhea, cramps, and abdominal distention. What should the nurse do? Select all that apply. a) Use a diluted formula, gradually increasing the volume and concentration. b) Slow the administration rate. c) Use a higher volume of formula because the formula may be too hypotonic. d) Change the feeding apparatus every 24 hours. e) Anticipate changing to a lactose-free formula.

• Change the feeding apparatus every 24 hours. • Slow the administration rate. • Use a diluted formula, gradually increasing the volume and concentration. • Anticipate changing to a lactose-free formula.

A client is diagnosed with diabetes mellitus. Which assessment findings best support a nursing diagnosis of ineffective coping related to diabetes mellitus? Select all that apply. a) Failure to purchase diabetic test strips for glucose monitor b) Changes the subject whenever diabetes is mentioned c) Refuses to attend diabetic support meetings d) Skipping insulin doses during illness e) Recent weight gain of 20 lb. (9.1 kg)

• Changes the subject whenever diabetes is mentioned • Refuses to attend diabetic support meetings

The nurse is caring for a client who had an open cholecystectomy 24 hours ago. The client's vital signs have been stable for the last 24 hours, but the client now has a temperature of 101.1 F (38.4 C), a heart rate of 116 beats/min, and a respiratory rate of 26 breaths/min. Using SBAR communication, which of the following recommendations should the nurse make when calling the physician? Select all that apply. a) Continue to check vital signs every 4 hours. b) Start broad-spectrum IV antibiotics 4 hours after blood cultures are drawn. c) Draw CBC, CRP, ESR, UA with culture and sensitivity if indicated. d) Assist with a CT scan of the abdomen. e) Ensure patent IV access for fluid bolus. f) Draw stat blood cultures x 2.

• Draw stat blood cultures x 2. • Draw CBC, CRP, ESR, UA with culture and sensitivity if indicated. • Ensure patent IV access for fluid bolus.

A client diagnosed with hypothyroidism (myxedema) is receiving levothyroxine. Which assessment findings would require a nursing intervention? Select all that apply. a) Heart rate of 132 beats/min b) Dysrhythmias c) Mild chest pain d) Adventitious breath sounds e) Dysuria

• Mild chest pain • Dysrhythmias • Heart rate of 132 beats/min

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply. a) Eat small, frequent meals throughout the day. b) Obtain adequate rest to reduce stimulation. c) Sit up for 1 hour when awakened at night. d) Stay away from crowded areas. e) Take all medications on time as ordered.

• Obtain adequate rest to reduce stimulation. • Eat small, frequent meals throughout the day. • Take all medications on time as ordered. • Sit up for 1 hour when awakened at night.

A 22-year-old female client has lactose intolerance. After teaching her about foods that will help her maintain adequate calcium intake, which client responses identifying foods to eat or drink indicates to the nurse that the client understands the teaching plan? Select all that apply. a) broccoli b) almonds c) ice cream d) soy milk e) canned sardines

• broccoli • canned sardines • soy milk • almonds

When providing care for a client hospitalized with acute pancreatitis who has acute abdominal pain, which nursing interventions would be most appropriate for this client? Select all that apply. a) Obtain daily weights. b) Maintain the client on a high-calorie, high-protein diet. c) Administer morphine sulfate for pain as needed. d) Place the client in a side-lying position. e) Monitor the client's respiratory status.

• Place the client in a side-lying position. • Monitor the client's respiratory status. • Obtain daily weights.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris and a hemoglobin A1C of 10%. After evaluating the client's diabetic management regimen the nurse should do what? Select all that apply. a) Expect to give large doses of oral sulfonylureas. b) Obtain a blood sample for a troponin level. c) Connect to continuous cardiac monitoring and prepare to cardiovert. d) Consult the diabetic educator. e) Prepare to schedule a trans-esophageal echo (TEE).

• Prepare to schedule a trans-esophageal echo (TEE). • Consult the diabetic educator. • Obtain a blood sample for a troponin level.

A client comes to the emergency department with suspected cholecystitis. Which data collection findings are characteristic of this diagnosis? Select all that apply. a) Flatulence b) Urticaria c) Nausea d) Transient epigastric pain radiating to the back and right shoulder e) Burning in the chest after eating fried foods

• Transient epigastric pain radiating to the back and right shoulder • Burning in the chest after eating fried foods • Flatulence • Nausea

A nurse is caring for a client with symptoms of epigastric pain. When teaching the action of gastric contents related to functioning of the body, which actions occur in the stomach? Select all that apply. a) Emulsifying fats b) Killing microorganisms c) Vitamin B12 absorption d) Activating the enzyme pepsin e) Vitamin B6 absorption f) Breaking down food fibers

• Vitamin B12 absorption • Breaking down food fibers • Killing microorganisms • Activating the enzyme pepsin

A 56-year-old female client is being discharged after having a thyroidectomy. Which discharge instructions are appropriate for this client? Select all that apply. a) Avoid over-the-counter medications. b) Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician. c) Take thyroid replacement medication, as ordered. d) Report any signs and symptoms of hypoglycemia. e) Carry injectable dexamethasone at all times. f) Recognize the signs of dehydration.

• Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician. • Take thyroid replacement medication, as ordered.

The nurse should review the glucose level of which clients who are going to surgery today? Select all that apply. a) a client receiving corticosteroids for the past 3 months b) a client who consumes a high carbohydrate diet c) a client with a high stress response to surgery d) a client with a family history of diabetes receiving dextrose 5% in lactated Ringer's solution (DLR) IV fluids e) a client with diabetes mellitus controlled by diet

• a client with diabetes mellitus controlled by diet • a client with a high stress response to surgery • a client receiving corticosteroids for the past 3 months

Which finding should the nurse report to the client's health care provider (HCP) for a client with unstable type 1 diabetes mellitus? Select all that apply. a) high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) b) glycosylated hemoglobin (HbA1c), 10.2% (0.1) c) systolic blood pressure, 145 mm Hg d) triglycerides, 425 mg/dL (23.6 mmol/L) e) urine ketones, negative f) diastolic blood pressure, 87 mm Hg

• systolic blood pressure, 145 mm Hg • diastolic blood pressure, 87 mm Hg • high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) • glycosylated hemoglobin (HbA1c), 10.2% (0.1) • triglycerides, 425 mg/dL (23.6 mmol/L)

The nurse should assess the client who is being admitted to the hospital with upper GI bleeding for which finding? Select all that apply. a) dry, flushed skin b) decreased urine output c) rapid respirations d) tachycardia e) thirst f) widening pulse pressure

• thirst • rapid respirations • tachycardia • decreased urine output