med surg

A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis?

Anticholinergic drugs block the neural impulses that stimulate pancreatic and gastric secretions; they inhibit the action of acetylcholine at postganglionic cholinergic nerve fibers.

On the second day after surgery, a client reports pain in the right calf. What should the nurse do first?

Calf pain may be a sign of thrombophlebitis, which can lead to pulmonary embolism. A postoperative client with pain in the calf should be confined to bed immediately and the health care provider notified.

What should the nurse expect when assessing a client with pleural effusion?

Compression of the lung by fluid that accumulates at its base reduces expansion and air exchange. Crackles or rhonchi at the posterior of the lungs are not associated with pleural effusion. If tracheal deviation occurs, it is away from the affected side. Dullness is produced on percussion of the affected area.

A thallium scan is scheduled for a client who had a myocardial infarction. The nurse explains that the reason the scan has been prescribed is to:

Establish the viability of myocardial muscle

A client has an open reduction and internal fixation (ORIF) of a fractured hip. The nurse monitors this client for signs and symptoms of a fat embolism. Which client assessment finding reflects this complication?

Tachycardia occurs because of an impaired gas exchange; petechiae are caused by occlusion of small vessels within the skin.

A client receiving combination chemotherapy for treatment of metastatic carcinoma asks the nurse in the clinic why more than one type of drug is necessary. Which concept is most important to teach the client in relation to why drug cocktails are more effective than a single drug in cancer therapy?

Different drugs destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one drug may be destroyed by another drug during a different stage of cell replication.

The nurse is caring for a client with acute renal failure. The most serious complication for this client is

Infection is responsible for one third of the traumatic or surgically induced deaths of clients with acute renal failure, as well as for medically induced acute renal failure. Resistance is reduced in clients with kidneys that fail because of decreased phagocytosis, which makes them susceptible to microorganisms. Anemia occurs often with acute renal failure, but it is not the most serious complication and should be treated in relation to the client's adaptations; erythropoietin and iron supplements usually are prescribed. Weight loss is not life threatening. Platelet dysfunction occurs because of decreased cell surface adhesiveness, but it is not as serious as an infection.

A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client?

Presence of infection

A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include

Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery.

A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed. The nurse concludes that the primary purpose of the IV insulin for this client is to:

The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.

The nurse is caring for a client with deep partial-thickness burns who is receiving a low dosage of an opioid for pain management. The preferred mode of medication administration for this client is:

The intravenous route provides for the quickest onset of action of the opioid

A client is on a cardiac monitor. The monitor begins to alarm showing ventricular tachycardia. What should the nurse do first?

The treatment of ventricular tachycardia depends on the presence of a pulse. Therefore, checking for a pulse is the first priority for the nurse.

A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's body should the nurse assess to identify osteoporotic changes?

Vertebral column. Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis.

Where should the nurse expect the first heart sound (S1) to be the loudest when auscultating a client's heart?

apex

A client is admitted to the hospital with a diagnosis of emphysema and dyspnea. The nurse should encourage the client to assume what position?

orthopneic

A nurse is caring for a client who just had a thyroidectomy. For which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?

tetany