Med Surg EXAM 3 Clicker Questions
Indicate the level of acute spinal cord injury at which the following effects occur. 1.Loss of all respiratory muscle function 2.Diaphragmatic breathing solely 3.Ineffective coughing 4.Decreased response of the sympathetic nervous system 5.Paralytic ileus 6.Constipation/Bowel incontinence 7.Tetraplegia (Quadriplegia) 8.Paraplegia 9.Inability to use hands 10.Inability to stand independently; inability to ambulate independently
. Above C4 (Injury at C4 may or may not be able to breathe independently because the 4th cervical vertebra is the level where nerves run to the diaphragm, the main muscle that allows us to breathe) 2. Below C4 (e.g., C3-C5): When the injury is between C3 to C5 (the diaphragm is functional), respiratory insufficiency still occurs due to paralysis of the abdominal or intercostals muscles. So patients may have trouble taking a deep breath or strong cough, and develop lung congestion and respiratory infections. 3. Mainly T1-T6 chest muscles (some resources say T1-T5, some resources say T2-T6); may involve T6-T12 abdominal muscle 4. Above T6 5. Above T5 6. T12 or below 7. C8 and above 8. T1 and below 9. C5 and above 10. T1 and below; T6 and below
A client with syndrome of inappropriate antidiuretic hormone (SIADH) is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider should the nurse address first? A.Administer infusion of 150 mL of 3% NaCl over 3 hours. B.Draw blood for hemoglobin and hematocrit. C. Insert retention catheter and monitor urine output. D.Weigh the client on admission and daily.
A
Polyuria, Polydipsia, and Polyphagia are classic symptoms of A.Type I DM B.Type II DM
A
The nurse has been teaching the client to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the client that indicates a need for additional instruction is: A.I need to rotate injection sites among my arms, legs, buttock, and abdomen each day B.I will buy the 0.5 ml syringes because the line marking will be easier to see C.I should draw up the regular insulin first after injecting air into the NPH bottle D.I do not need to aspirate the plunger to check for blood before injecting insulin
A
The nurse is caring for a patient who has sustained a spinal cord injury. To prevent autonomic dysreflexia, the nurse instructs the patient to avoid which occurrence? A. Urine retention B. Emotional stress C. Respiratory infection D.High fowler's positions
A
Which information will the nurse include in teaching a female client who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? A.Choose flat-soled leather shoes. B.Set heating pads on a low temperature. C.Use callus remover for corns or calluses. D.Soak feet in warm water for an hour each day.
A
Which nursing action will be included in the postoperative plan of care for a patient who has had a transsphenoidal resection of a pituitary tumor? A.Monitor urine output every hour B.Palpate extremities for dependent edema C.Check hematocrit hourly for first 12 hours D.Obtain continuous pulse oximetry for 24 hours
A
Which of the following would be the most reliable diagnostic test for diabetes A.Hemoglobin A1C B.Fasting glucose test C.2-hour glucose tolerance test D.Random glucose test
A
Which precaution is most important for the nurse to teach a client who is prescribed oral corticosteroids for hormone replacement therapy after a unilateral adrenalectomy? A."Do not stop taking this drug without consulting your prescriber." B."Avoid crowds and people who are ill." C."Be sure to take this drug with food." D."Reduce your salt intake."
A
Which type of Diabetes is an autoimmune disease A.Type I B.Type II
A
Which of the following pairs of insulins can be physically mixed? A.Lispro (Humalog) and NPH (Humulin N) B.Regular (Novolin R) and NPH (Humulin N) C.Aspart (Novolog) and Glargine (Lantus) D.Detemir (Levemir) and NPH (Novolin N)
A B
Select the interventions that would be appropriate for a client with Addison's disease and corticosteroid therapy: A.A medical alert identification should be worn at all times. B.A normal life expectancy is anticipated for patients with Addison's disease who maintain hormone balance with consistent medication administration. C.Fluids should be limited to a daily intake of 1500 ml. D.Should contact health care provider if nausea and vomiting occur. E.Replacement therapy must be taken for the rest of the life. F.Must carry an emergency kit at all times that contains 100 mg of injectable hydrocortisone and syringes. G.Must learn to take blood pressure and monitor for hypertension. H.Symptoms of overdosage of corticosteroid include weight loss and moon face. I.Two thirds of the glucocorticoid dosage should be taken on awakening in the morning and the other third in the afternoon to mimic normal secretion patterns.
A, B, D, E, F, G, I
The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? A.Calcium gluconate B.Emergency tracheotomy kit C.Furosemide (Lasix) D. Hypertonic saline E.Suction F.Oxygen
A, B, E, F
Select the interventions that would be appropriate for a client with Cushing's Syndrome: A.Monitor capillary blood glucose and control blood glucose with sliding-scale insulin. B.Encourage increased salt intake. C.Reassure the patient that the physical changes will resolve when hormone levels return to normal. D.Encourage low-calorie, high-protein snacks. E.Weigh daily to evaluate fluid retention. F.Protect the patient from noise, light, and environmental temperature extremes because of decreased response to stress. G.Administer potassium supplements.
A, C, D, E, G
A client has been admitted to the hospital with a T3 level complete spinal cord injury. The nurse has to plan the home-based rehabilitation for this client. When creating the care plan, the nurse considers which of the following activities that the client is able to do independently. Select all that apply. A.Independent wheelchair mobility is possible. B.Client may be able to drive with hand controls. C.Patient will be able to have effective coughing ability. Patient will be able to climb stairs independently
A,B
A client has been admitted with a T5 level spinal cord injury and has gastric distension. Which nursing interventions if prescribed would be appropriate for this client? Select all that apply. A.Place a nasogastric tube B.Administer laxatives. C.Administer ranitidine (Zantac). D.Administer metoclopramide (Reglan).
A,C,D
What manifestation should the nurse expect to find from a client diagnosed with syndrome of inappropriate anti-diuretic hormone? A. Increased body weight B. Increased urinary output C. increased plasma osmolality D. Increased serum sodium levels
A.
What manifestation should the nurse expect to find from a client diagnosed with syndrome of inappropriate antidiuretic hormone? A. Increased body weight B. Increased urinary output C. Increased plasma osmolality D.Increased serum sodium levels
A.
A nurse is observing a client with a T2 level spinal cord injury. The nurse notices that the blood pressure is 220/100 mm Hg. What nursing interventions would be appropriate for this client if the nurse suspects autonomic Dysreflexia? Select all that apply. A. Monitor blood pressure closely. B. Make the client lie flat on the bed C. Notify the primary health care provider. D. Check for the presence of bowel impaction. E. Place the client in the Trendelenburg position. F. Check for the kink in the urinary catheter and distended bladder.
ACDF
A nurse is observing a client with a T2 level spinal cord injury. The nurse notices that the blood pressure is 220/100mm Hg. What nursing interventions would be appropriate for this client, if the nurse suspects autonomic dysreflexia? A. Monitor blood pressure closely. B. Make the client lie flat on the bed. C. Notify the primary health care provider. D. Check for the presence of bowel impaction. E. Place the client in the Trendelenburg position F. Check for a kink in the urinary catheter and distended bladder
ACDF
Which assessment finding for a client who takes levothyroxine (Synthroid) to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication? A.Elevated free thyroxine (T4) level B.Blood pressure 102/62 mmHg C.Distant heart sounds D.Elevated thyroid-stimulating hormone (TSH) level
A`
A client with Alzheimer's disease is wandering the halls very agitated, asking for her "mommy" and crying. What is the best response by the nurse? A.Ask the client, "Why are you behaving this way?" B.Tell the client, "Let's go get a snack in the kitchen." C.Ask the client, "Wouldn't you like to lie down now?" D.Tell the client, "Just take some deep breaths and calm down."
B
An appropriate treatment for diabetic ketoacidosis may include: A. Treatment for hyperkalemia B. Regular insulin therapy C. 50% dextrose IV push D. Fluid restriction
B
An unresponsive client with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to: A.50% dextrose B.Normal saline C.Aglargine (Lantus) insulin D.Potassium
B
The client states, "I have become so forgetful. I am worried that Iam developing Alzheimer's disease." Which assessment question will help to determine if the client has memory loss related to AD? A. " Do you sometimes misplace your keys?" B. "Have you ever forgotten what an everyday item is used for?" C. "Do you momentarily forget a friends name?" D. "When driving, do you occasionally forget where to turn?"
B
The rationale for instructing a patient with Addison's Disease to avoid fruit and vegetable juices is that these drinks may contribute to: A.Muscle weakness. B.Cardiac dysrhythmias. C.Postural hypotension. D.Drowsiness and confusion.
B
When caring for a client who has Guillain-Barré syndrome, which assessment data obtained by the nurse will require the most immediate action? A.The client is incontinent. B.The client has continuous drooling saliva. C.The client's blood pressure is 152/82 mm Hg. D.The client complains of severe pain in the feet.
B
Which clinical manifestation does the nurse expect to assess in a client diagnosed with hyperthyroidism? A. weight gain B. exophthalmos C. Thick, cold, and dry skin D. Purplish red marks on abdomen
B
Which information will the nurse include when teaching a 50-year-old client who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)? A.Glyburide decreases glucagon secretion from the pancreas. B.Glyburide stimulates insulin production and release from the pancreas. C.Glyburide should be taken even if the morning blood glucose level is low. D.Glyburide should not be used for 48 hours after receiving IV contrast media
B
Which intervention will the nurse include in the plan of care for a client who has late stage Alzheimer's disease? A.Encourage the client to discuss events from the past B.Maintain a consistent daily routine for the client's care C.Reorient the client to the date and time every 2 to 3 hours D.Provide the client with current newspapers and magazines
B
Which of the following statements describes the pathophysiology in Type 1 diabetes? A. Insulin resistance in which body tissues do not respond to insulin B. An autoimmune destruction of beta cells C. Compensatory overproduction of insulin D. Genetic predisposition
B
Which type of diabetes runs in families? A.Type I B.Type II
B
Who of the following is at the highest risk for developing type 2 diabetes? A.A 44-year-old Native American Indian who has a body mass index (BMI) of 32. B.A 55-year-old Asian American who has hypertension and two siblings with type 2 diabetes. C.A child whose father has type I diabetes. D.An 62-year-old obese white man.
B
To monitor for complications in a client with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? A.Chest x-ray B.Blood pressure C.Serum creatinine D.Urine for microalbuminuria E.Complete blood count F.Monofilament testing of the foot
B, C, D, F
Which clinical manifestation does the nurse expect to assess in a client diagnosed with hyperthyroidism? A. Weight Gain B. Exophthalmos C. Thick, cold and dry skin D. Purplish red marks on abdomen
B.
Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness? A.Assess the patient for symptoms of hyperglycemia. B.Give the patient a snack of peanut butter and crackers. C.Have the patient drink a glass of orange juice or nonfat milk. D.Administer a continuous infusion of 5% dextrose for 24 hours.
B; Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.
A 62-year-old client is brought to the clinic by a family member who is concerned about the client's inability to solve common problems. To identify whether the client's current mental status indicates an early stage in dementia, which question should the nurse ask the client? A."Where were you were born?" B."How positive is your self-image?" C."What did you have for breakfast?" D."Do you have any feelings of sadness?"
C
A client screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL. The nurse will plan to teach the client about: A.Self-monitoring of blood glucose B.Use of low doses of regular insulin C.Lifestyle change to lower blood glucose D.Effect of oral hypoglycemic medications
C
A client with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. The nurse should advise the client to: A.Hold the regular dose of insulin B.Drink cool fluids with high glucose content C.Check the blood glucose level every 2 to 4 hours D.Use a less strenuous form of exercise than usual until the illness resolves
C
A patient has an incomplete left spinal cord lesion at the level of T7, resulting in Brown-Séquard syndrome. Which nursing action should be included in the plan of care? A.Assessment of the patient for right arm weakness B.Assessment of the patient for increased right leg pain C.Positioning the patient's left leg when turning the patient D.Teaching the patient to look at the right leg to verify its position
C
Kussmaul respirations is one of the symptoms indicating: A. Hypoglycemia B. Somogyi effect C. Diabetic Ketoacidosis D. Hyperosmolar hyperglycemic syndrome
C
Type II Diabetes is related to: A.Abnormal insulin production B.Impaired insulin utilization C.Both
C
Which priority assessments would be most appropriate for managing DKA/HHS? A.Pain scale B.Pedal pulses C.Lung sounds D.Skin integrity E.Bowel sounds F.Pupillary reaction G.Serum electrolytes H.Level of consciousness I.Hourly intake and output J.Hourly capillary blood glucose monitoring
C G H I J
A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching? A."I cannot share my toothpaste with anyone." B."I must flush the toilet three times after I use it." C. "I need to wash my clothes separately from everyone else's clothes." D. "I'm ready to hold my newborn grandson now."
D
Following a parathyroidectomy, a client develops tingling of the lips and extremities stiffness. Which action should the nurse take first? A.Administer the ordered muscle relaxant B.Give the ordered oral calcium supplement C.Start the PRN oxygen at 2L/min per cannula D.Have the client rebreathe using a paper bag
D
The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? A.Client in Addisonian crisis who is receiving IV hydrocortisone. B.Client admitted with syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to lung cancer. C.Client being discharged after a unilateral adrenalectomy to remove an adrenal tumor D.Client with Cushing's syndrome who has an elevated blood glucose and requires frequent administration of insulin
D
The client with type I diabetes mellitus is taught to take NPH (Humulin N) at 5 pm. each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time? A.11 a.m., shortly before lunch. B.1 p.m., shortly after lunch. C.6 p.m. shortly after dinner. D.1 a.m., while sleeping.
D
The nurse has been teaching the client with the new onset of syndrome of inappropriate antidiuretic hormone (SIADH) about the disorder. Which statement by the client indicates the correct understanding of how to manage this disease? A.I should limit my sodium intake. B.I should limit my potassium intake. C.I should drink at least 3,000 ml of water daily. D.I should limit fluid intake to 800-1000 ml daily.
D
What instruction should the nurse give the patient with diabetes and numbness in the feet when teaching about diabetic foot care? A. "You may go barefoot." B. "Clean the wounds with Iodine." C. "Apply oil and cream between the toes." D. "Protect the feet from extreme heat and cold."W
D
When providing postoperative care for a client who has had bilateral adrenalectomy. Which assessment information obtained by the nurse is most important to communicate to the health care provider? A.The blood glucose is 176 mg/dl B.The lungs have bibasilar crackers C.The client has 5/10 incisional pain D.The client's blood pressure is 90/50 mmHg
D
When taking care of a client with a spinal cord injury, the nurse would avoid which of the following measures to minimize the risk of autonomic dysreflexia. A.Strict adherence to a bowel retraining program B.Keeping the linen wrinkle-free under the client C.Preventing unnecessary pressure on the lower limbs D.Limiting bladder catheterization to once every 12 hours
D
Which of the following should the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury? A.Homan's sign. B.Pain C.Tenderness D.Leg girth
D
what instruction should the nurse give the patient with diabetes and numbness in the feet when teaching about diabetic foot care? A. "You may go barefoot." B. "Clean the wounds with iodine." C. "Apply oil and cream between the toes." D. "Protect the feet from extreme heat and cold."
D
Neurogenic shock is characterized by decreased reflexes, loss of sensation, and flaccid paralysis below the level of the injury. T/F
False
Which of the following actions will the nurse perform first when caring for a patient with possible C5 spinal cord trauma who is admitted to the emergency department A.Infuse normal saline at 150 mL/hr. B.Monitor cardiac rhythm and blood pressure. C.Administer O2 using a non-rebreather mask. D.Immobilize the patient's head, neck, and spine. E.Transfer the patient to radiology for spinal computed tomography (CT).
Ranking: D, C, B,A,E
An appropriate treatment for diabetic ketoacidosis may include: A.Treatment for hyperkalemia B. regular insulin therapy C. 50% dextrose IV push D. Fluid restriction
Regular insulin therapy
Counterregulatory hormones oppose the effects of insulin. T/F?
True
Type I Diabetes is insulin dependent and oral antiglycemic agents will not work for it. T/F
True
When mixing insulins, always withdraw Regular insulin first then NPH. T/F
True
The nurse has been teaching the client to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the client that indicates a need for additional instruction is: A.I need to inject the insulin on my thigh before I swim every morning. B.I will buy the 0.5 ml syringes because the line marking will be easier to see C.I should draw up the regular insulin first after injecting air into the NPH bottle D.I do not need to aspirate the plunger to check for blood before injecting insulin
a
After a traumatic spinal cord severance, a young client is having difficulty accepting the paralysis. One day the client has severe leg spasms and says, "My strength is coming back, and I know I will walk again." The nurse's response should be based upon what understanding. A.The nerves are regenerating and motor function is returning. B.Motor function may be returning now that the edema is subsiding. C.Spinal shock has subsided and the client's reflexes are hyperactive. D.The client has developed thrombophlebitis and is experiencing pain.
c
