Med Surg Exam #2
What are the purposes for a client with a venous stasis ulcer to be prescribed the topical drug Accuzyme?
promote healing chemically debride the ulcer eliminate necrotic tissue
which question is the most appropriate for a nurse to ask to assess pain in a client who was just transferred to the unit from the PACU after abdominal surgery?
"can you tell me about any pain or discomfort you are having?"
What priority teaching would the nurse provide for a client who will be discharged with a prescription for atorvastatin?
"immediately report any muscle cramping to your primary health care provider"
which statement made by a nurse regarding a clients report of pain reflects personal bias?
"with all of her laughing and talking with friends, her pain cannot possibly be as bad as she reports it to be"
Which normal heart rates does the nurse expect to be initiated by the primary pacemaker of the heart (SA Node) in clients when the heart is regular? select all that apply
62, 74, 86, 98 bpm
What is recommended therapeutic range for the international normalized ration (INR) for a client receiving warfarin sodium to prevent DVT and decrease the risk of a stroke?
1.5-2.0
which factors with the nurse note as increasing the risk for atherosclerosis with an older African-American client?
20-year history of type 2 diabetes sedentary lifestyle 25 pounds overweight grandmother died after attack
with which client is the nurse most likely to question a prescription for PCA pump?
25-year-old with intermittent lucidity after a severe head injury
What does the nurse determine is the client's heart rate when assessing a 6-second telemtry ECG strip with five QRS complexes?
50 bpm
What does the nurse suspect when assessing a client on bedrest and finding that he or she has a left calf that is swollen, warm to touch, reddened, and moderately painful?
DVT
which pain scale with the nurse use to most accurately assess the pain level of an adult client who has either a language barrier or reading problem?
FACES (smile to frown)
Which drug would the nurse prepare to administer when a client enters the emergency department with chest pain described as a "tearing" sensation, diaphoresis, blood pressure of 200/130 mm Hg, weak pulses, and a sense of apprehension?
IV beta blocker (esmolol)
which analgesic type does the nurse expect to be prescribed to reduce the pain and discomfort from inflammation for a client who has a history of rheumatoid arthritis and is also being treated for acute pain from a wrist sprain?
NSAID
Which waveform does the nurse recognize as atrial depolarization when a client is placed on a cardiac monitor?
P wave
What would the nurse suspect when assessing a client's lower extremities and finding decreased pedal pulses, skin that is cool to touch, loss of hair, and thickened toenails?
PAD
Which relatively new therapy would be tried for clients with familial hypercholesterolemia or for those who are unable to reduce LDLs with existing therapies?
PCSK9 inhibitors
Which ECG waveforms and intervals are the normal measurements or positions? select all that apply
PR interval 0.12-0.20 sec ORS complex 0.06-0.10 sec PR segment isoelectric line QT interval less than half of the R to R interval U wave follows T wave if present TP segment one block above isoelectric line
Which assessment findings indicate to the nurse that a client has stage III peripheral arterial disease (PAD)? select all that apply
a c e f pain is described as numbness, burning, toothache-type pain pain is relieved by placing the extremity in a dependent position pain usually occurs in the distal part of the extremity pain while resting commonly awakens the client at night
with which client does the nurse expect to administer gabapentin?
a client who has persistent burning and tingling sensation in the lower extremities
which information will the nurse need ti understand when caring for a hospitalized client who has an intrathecal implanted pump for pain management?
assess for cerebral spinal fluid leak if the client reports headache morphine is the drug most often used an abdominal binder may be prescribed to keep the pump in the proper position
To determine if a client has a pulse deficit, what procedure would the nurse follow?
assess the apical and radial pulses for a full minute and calculate the difference
Which essential teaching would the nurse provide for a client being discharged with chronic venous innsufficiency?
abdf elevate your legs at least 20 minutes 4-5 times/day avoid crossing legs at all times avoid standing still for any length of time avoid tight restrictive pants, girdles or garters
Which statements are accurate about a client's true aneurysm? select all that apply
acef the aneurysm may be described as fusiform or saccular the aneurysm is creates a permanent dilation of an artery a congenitally weakened arterial wall may result in an aneurysm the aneurysm section of the arterial wall is enlarged to at least twice its normal diameter
What would the nurse expect to find in the history of a client admitted with acute arterial occlusion?
acute myocardial infarction or atrial fibrillation within the previous weeks
what is the appropriate action for the nurse to take when a client is prescribed both around-the-clock opioid and a daily NSAID dose after ortho surgery?
administer both drugs as prescribed and assess the clients level of pain relief
the nurse expects which physiologic responses with a client who is taking a mu opioid agonist IV?
an increase in dosage yields an increase in pain relief gastrointestinal peristalsis slows
Which drugs are useful in promoting circulation for clients with chronic peripheral arterial disease? select all that apply
aspirin pentoxifylline clopidogrel cilostazol
what is the best way for a nurse to determine when to administer a PRN analgesic with a prescription of q 4-6 h PRN for a client who is also receiving around-the-clock analgesic medication?
assess the client for breakthrough pain and also administer it in advance of painful procedures
which action does the nurse take or perform first when caring for a client on the first post-op day after major abdominal surgery who states he or she has no pain, but blood pressure and pulse are elevated and the client is diaphoretic and appears anxious?
assess the client for post-op complications or barriers to reporting pain
which is the priority action for the nurse to take after assessing a client with severe dementia at a score of 9 using the PAINAD scale?
assess the client for the source of the pain and immediately inform the primary health care provider
What is the priority action for the nurse when the monitor technician states that a client's telemetry monitor shows a rhythm that appears as a wandering or fuzzy baseline?
assess the client to differentiate artifact from actual lethal rhythm
Which would be the best method for the nurse to confirm a report from the monitor technician about a change in a monitored client's heart rate?
assess the client's heart rate directly by checking the apical pulse
how much time does the nurse expect to pass between the first dosage level and a change of dosage level with transdermal fentanyl administration when starting the titration of this medication until the client experiences adequate pain control?
at least 24 hours
what is the nurse's best response when a client asks about the difference between arteriosclerosis and atherosclerosis?
atherosclerosis is forming plaques in arteries but arteriosclerosis is thickening of arterial walls associated with aging
Which criteria support the nurse's assessment that a client's ECG rhythm strip shows a normal sinus rhythm (NSR)?
atrial and ventricular rates are regular P waves are present before every QRS QRS duration is consistent at 0.08 atrial and ventricular rates are 82 bpm
on reassessing a client for pain relief 1 hour after administering 15 mg of morphine intramuscularly, the nurse finds the client sleeping and has a respiratory rate of 10. what is the nurse's best first action to prevent harm?
attempt to arouse the patient by calling his or her name and lightly shaking their arm
What would the nurse teach a client with peripheral arerial disease about positioning and position changes?
avoid crossing legs at all times
What would the nurse assess for when a client is suspected of having an abdominal arotic aneurysm? select all that apply
bcde abdominal, flank, or back pain gnawing pain unaffected by movement pulsation in the upper abdomen auscultation of a bruit in the upper abdomen
Which statements pertaining to the use of an Unna boot for a client are accurate?
bcef it is constructed from gauze and zinc oxide promotes venous return and prevents stasis it forms a sterile environment for the ulcer the client is instructed to report any increase in pain
which common side effects will the nurse assess for in a client receiving (NSAIDs) therapy for pain management?
bleeding gastrointestinal ulcers hypertension
Which piece of equipment would the nurse recommend for a client to manage hypertension at home?
blood pressure monitoring device
What is the most important teaching point for the nurse to emphasize with a client who has Beurger's disease?
cease cigarette smoking and all exposure to tobacco to arrest the disease process
Which observation after administering prescribed pain medication to a client who reported persistent (chronic) leg pain level of 7/10 scale indicates to the nurse that the functional goal of therapy is being met?
client is able to ambulate independently to the bathroom without distress
which outcome indicates to the nurse assessing that a client's pain control medication is effective 45 minutes after receiving pain medications for pain intensity rated as the "worst possible?"
client reports the pain level is 4/10
Which clients are at increases risk for peripheral arterial disease (PAD)?
client with HTN, diabetes, smokes and African American
when the nurse performs blood pressure screenings, which clients would be referred for further evaluation?
client with heart disease and blood pressure 148/90 client with renal failure and blood pressure 180/90 client with muscle cramping taking a statin drug with blood pressure 124/82 COPD client with blood pressure 158/88
which side effect does the nurse assess for in a client who has been using an opioid analgesic for the past 5 days?
constipation
Which instructions would the nurse give a client for following dietary recommendations of the American College of Cardiology (ACC) and the American Heart Association (AHA)?
consume low-fat dairy products, poultry, and fish lower sodium intake to no more than 2400 mg/day limit intake of sweets and red meats eat legumes, tropical vegetable oils, and nuts
What is the first step when the nurse analyzes a client's ECG rhythm strip?
determine the heart rate
Which common causes of persistent (chronic) pain are most associated with long-term disability?
diabetic neuropathy osteoarthritis rheumatoid arthritis
which physiologic responses indicate to the nurse that the client is experiencing acute pain?
diaphoresis tachycardia dilated pupils
What symptom would the nurse expect on assessment of a client with inflow peripheral arterial disease?
discomfort in the lower back, buttocks or thighs after walking
What is the priority action for the nurse when a client is to have unfractionated heparin (UFH) discontinued and to start receiving subcutaneous low-molecular-weight heparin (LMWH)
discontinue the UFH at least 30 minutes before giving the first LMWH injection
Which questions would the nurse use to assess a client's P wave on an ECG rhythm strip? select all that apply
do all P waves look similar are P waves present are P waves occurring regularly are P waves smooth, rounded, and upright
What is the nurse's best advice for a client, who is an avid golfer, but has been recently diagnosed with thoracic outlet syndrome?
don't elevate your arms above your head
an older client tells the home health nurse that he took two tablets of arthritis-strength extended-release acetaminophen at 6 am and two tablets of hydrocodone at 2 pm and plans to take one dose of an OTC product that contains acetaminophen, doxylamine succinate, and dextromethorphan to sleep tonight. which action would the nurse take first to prevent harm?
educate the client about the acetaminophen in each product and maximum dosage/day
What is the nurse's best response when a client with peripheral arterial disease asks why he or she should exercise when walking causes pain?
exercise is a nonsurgical, noninvasive technique used to increased arterial blood flow to your affected leg
During which timeframe is it most important for the nurse to monitor a client for graft occlusion after receiving revascularization with graft placement?
first 24 hours
which strategy will the nurse use to help an older adult client who reports having "pain all over" to accurately identify which areas of the body are painful?
focus on the hand and fingers of one extremity
which client actions during the use of fentanyl patches for pain control will the nurse correct to prevent harm, especially respiratory depression?
folding the patch in half placing a heating pad over the patch placing a new patch and retaining the old ones in their current position
Which are conservative managment measures for a client's varicose veins?
graduate compression stockings (GCSs) exercise to increased venous return elevating the extremities
which behavior(s) by a client with cognitive impairment indicate(s) to the nurse the possibility that the client is experiencing pain?
has no interest in attending a musical entertainment that he or she always has enjoyed in the past attempting to slap assistive personnel who are providing care restlessness and pulling at the bed clothes grimacing when being turned refusal to eat or drink inability to sleep
which assessment question does the home health nurse as an older adult client who is taking naproxen twice daily for pain to assess for adverse effects?
have you had any gastric discomfort, vomiting, bleeding or bruising?
What findings would the nurse expect to assess when a client presents with a thoracic aortic aneurysm?
hoarseness SOA difficultly swallowing visible mass above the suprasternal notch
For which client would the nurse question the prescription of hydrochlorothiazide?
hypokalemia
Which symptoms would indicate to the nurse that a client's aneurysm had ruptured? select all that apply
hypotension diaphoresis decrease LOC loss of pulses distal to rupture scant urine output
which side effects does the nurse assess for in a client who is using cannabis to help manage persistent pain?
increased heart rate impaired attention increased appetite dry mouth
Which symptom causes most clients to seek medical attention for peripheral arterial disease (PAD)?
intermittent claudication
What is the nurse's best explanation to a client for use of low-dose niacin to decrease LDL-C and very-low-density lipoprotein (VLDL) cholesterol levels?
it helps reduce side effects of flushing and feeling too warm
which behavior exemplifies the nurse's primary role in assessing and managing the client's pain?
listens to and accepts the self-report of pain and assesses client's preferences and values
Which information would the nurse be sure to include when teaching a client with peripheral arterial disease about methods to promote vasodilation?
maintain a warm environment at home wear socks or insulated shoes at all times prevent cold exposure to the affected limb completely abstain from smoking or chewing tobacco avoid emotional stress and excessive caffeine
What is the best nonsurgical intervention for a client with a 3-cm abdominal aortic aneurysm to decrease the risk of rupture?
maintenance of normal blood pressure and avoidance of HTN
Which condition would the nurse suspect when a client has these findings (BP 200/130 mm Hg; sudden headache, blurred vision, and dyspnea)?
malignant hypertension
Why are older residents in homes at high risk for inadequate pain management?
many nursing home residents lack the verbal ability to describe or report pain
which drug prescription for an older adult client in acute pain does the nurse question of the possibility of severe adverse effects?
meperidine
Which condition is indicated when the nurse notes ST segment elevation or one to two small blocks on a client's ECG?
myocardial injury or ischemia
Which drug would the nurse expect to administer to a client with Raynaud's or Buerger's disease?
nifedipine
Which features would the nurse recognize as indication that a client had a venous ulcer? select all that apply
no claudication or rest pain ulcer located in the ankle area brown pigmentation ulcer bed is pink pulses are present
What would be the nurse's best action when a client reports dizziness when changing position from sitting to standing and a sudden dry cough after starting a prescription of captopril?
notify health care provider immediately about side effects
Which are characteristics a nurse would expect in clients with Raynaud's disease? Select all that would apply?
occurs more often in young women clients experience cold intolerance causes red-white-blue skin color changes
What frequency of drug dosage therapy would the nurse advocate for an older client with hypertension who lives alone and is able to manage his or her self-care?
once a day
Which statements about percutaneous vascular interventions are accurate? select all that apply
one or more arteries are dilated with a balloon catheter to open the vessels stents are often placed to ensure adequate blood flow some clients are occlusion free for 3-5 years clients who are candidates must have occlusions or stenoses that are accessible to the catheter
Which techniques would the nurse use when performing an initial cardiovascular assessment on a middle-aged client?
palpate all of the major pulse sites auscultate bruits in the radial and brachial arteries palpate and compare temperature differences in lower extremities check the client for orthostatic hypotension perform bilateral but separate palpation on the carotid arteries
Which priority concept does the nurse focus on when a client is diagnosed with a dysrhythmia?
perfusion
Which conditions would the nurse suspect when a client's telemetry ECG rhythm strip shows ST elevation of 1.5 mm (1.5 small blocks)? select all that apply
pericarditis myocardial infarction hyperkalemia
the nurse considers the pain reported by a client with which health problem more likely to likely reflect acute pain rather than persistent (chronic) pain?
peripheral vascular disease with a foot that is suddenly cold and blue
Which serum electrolyte would the nurse check after noting tall and peaked T waves on a client's ECG?
potassium
which observation indicates to the nurse that a client with rheumatoid arthritis who has had persistent (chronic) pain for years and now has an exacerbation that started this morning has a physiologic adaptation to pain?
pulse rate is 70 bpm
What is the nurse's best interpretation when reviewing a client's abdominal CT scan and noting that there is an out pouched segment coming off the abdominal aorta?
saccular aneurysm
For prevention of DVT, which drug would the nurse expect the health care provider to prescribe?
subq LMWH (heparin)
which statement is the best response for a nurse to use when interviewing a client who frequently comes to the clinic to obtain medication for chronic back pain says, "I know you guys think I am faking, but I hurt and I am really sick of your attitude" ?
tell me about your pain and how it is affecting your life
Which action increases the effectiveness of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) in controlling hypertension for African-American clients?
the ARB or ACE-I is given with a diuretic, beta blocker, or a calcium, channel blocker
Which definition best describes the electrophysiologic property called automaticity of myocardial pacemaker cells?
the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively
which control systems play an important role in maintaining a client's blood pressure?
the arterial baroreceptor system regulation of body fluid volume vascular autoregulation the renin-angiotension-aldosterone system
How would the nurse best interpret the electrocardiogram (ECG) of a younger athletic client which shows sinus bradycardia with a rate of 54 beats/min?
the sinus bradycardia provides an adequate stroke volume that is associated with cardiac conditioning
What drug would the nurse expect to be prescribed for a client with hypertension and for whom lifestyle modifications have failed to control blood pressure?
thiazide diuretic
Which diagnostic tests would the health care provider prescribe to confirm a diagnosis of abdominal aortic aneurysm (AAA) suspected in a client? select all that apply
ultrasound computed tomography
which lifestyle changes would the nurse teach a client to help control hypertension?
weight reduction if overweight or obese implement a healthy diet such as the DASH diet use relaxation techniques to decrease stress increase activity by use of a structured exercise program
