MED SURG II

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

"Keep your right leg elevated above heart level."

A patient with hypertension is presenting with allergic rhinitis and seeking symptom relief. What teaching will you include in his plan of care?

"You should avoid allergy drugs containing pseudoephedrine or phenylephrine."

Which assessment finding indicates an increased risk of skin cancer?

A deep sunburn

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and she observes petechiae on the client's chest. Which nursing action is indicated first?

Administer oxygen.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

While the nurse is obtaining an assessment and health history from a patient, which statement by the patient will alert the nurse to a possible immunodeficiency disorder?

"I had my spleen removed many years ago after a car accident."

You are have an order to give Augmentin 375 mg p.o. q 8 hr. Augmentin is supplied from the pharmacy in a 75 mL bottle with a concentration of 250 mg/5 mL. How many mL's will you administer to your patient per dose?

7.5 mL

There is an explosion at the local chemical factory. Several people are burned and are being rushed to the emergency department. Which of the following clients should be seen first?

A 65 year old man with burns on his hands and face

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. Which action is best for the nurse to take?

Administer prescribed analgesics to relieve the pain

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism

A post-operative patient who has been receiving nasogastric suction for 3 days has a serum sodium level of 125 mEq/L (125 mmol/L). Which of these prescribed therapies that the patient has been receiving should the nurse question?

Infuse 5% dextrose in water at 125 ml/hr

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Risk for falls

To help minimize calcium loss from a hospitalized client's bones, the nurse should:

encourage the client to walk in the hall.

A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. Which instruction best prevents skin damage?

"Apply sunscreen even on overcast days."

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

Because of Mr. White's recent blood clot, he was given an order for 30,000 units of heparin to be added to 500 mL of normal saline. The order is to infuse the heparin solution via IV at 50 mL/hr using macrodrip tubing (15 gtts/min). How many hours will the IV run?

10 hours

Your patient presents to the ER with burns to the highlighted areas of his body. Based on the Rules of Nine Chart, what percentage of his body is burned?

36%

What kind of fracture would this be categorized as?

Avulsion fracture of the elbow

A patient presents to the emergency department where it is determine he has a sprained wrist. What teaching areas will you include with the patient?

Elevate the wrist above the level of the heart and apply ice intermittently for 48 hours

A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do?

Immobilize the client's arm.

Mr. Smith is an 83 year old male diagnosed with rheumatoid arthritis. He is being cared for at home by his 57 year old daughter. The physician has ordered new medications to help manage his arthritis. Which of the following interventions would best ensure that Mr. Smith will take his medications correctly when at home?

Include the client's daughter when teaching the client about the medications.

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?

Renal calculi

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

You are caring for a client who sustained burns to 35% of his total body surface area. Of the burns, 20% are full-thickness. The burns are on the client's arms, face, neck and shoulders. The client's voice is becoming more hoarse and he develops a dry cough. What does this finding indicate?

The client may have a respiratory injury

Which of these four patients should the medical-surgical unit charge nurse assign to an licesned practical nurse (LPN) team member?

The patient who requires a sterile dressing change for a Stage III sacral ulcer.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

Use the large muscles of the leg when lifting items.

A nurse caring for patients diagnosed with HIV could best prevent becoming exposed to the virus by which of the following means?

Using standard precautions consistently with all patients at the facility.

Instructions for the client with low back pain include that, when lifting, the client should

avoid overreaching.

An elderly client, diagnosed with a wound infection, is not demonstrating the expected signs of inflammation. The nurse realizes this is because the:

client is experiencing age-related changes in immunological function.

What do you anticipate will be the treatment of choice for this condition?

radical excision with clean margins

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anywhere except here to the health clinic." An appropriate nursing diagnosis for the patient is:

social isolation related to embarrassment about the effects of SLE.

48 hours following the application of a cast to the left leg for a transerve fracture of the tibia, the patient begins complaining of numbness and tingling in his left foot and toes. What is suspected and what are anticipated interventions?

Compartment syndrome; elevate leg, apply ice, anticipate splitting cast

A 62 year old patient is complaining of pain in the knees and ankles with movement and weight-bearing activities. Which of the following is likely contributing to her symptoms?

Osteoarthritis

A client with an elevated cardiac output has received diuretic medication as prescribed. The nurse realizes that this medication will affect which cardiac parameter?

Preload

A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate?

Promoting weight-bearing exercises

When counseling an older patient about ways to prevent fractures, which information will the nurse include?

Buy shoes that provide good support and are comfortable to wear

When admitting a patient with stage III pressure ulcers on both heels, which information obtained by the nurse will have the most impact on wound healing?

The patient takes corticosteroids daily for rheumatoid arthritis (Corticosteriod use can increase blood sugar, cause weight gain, cause adrenal insufficiencies and impeded healing.)

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication?

Calcium level of 11.6 mg/dl

A client presents at an ambulatory clinic with complaints of pain and aching in the lower left leg. After examining the client, a physician determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?

After 24 hours, apply heat for periods of 15 to 30 minutes.

You are assessing a 68 year old retired football player. He reports a 40 pound weight gain since retiring from the game 35 years ago. He states he tries to walk daily but previous knee injuries make it difficult to do so. His HR = 102, BP = 168/94, RR = 12, T=39.6. He is a non-smoker but has occasional allergy related asthma. He has Type II Diabetes controlled with Metformin daily. Which of the above findings are likely contributing to a diagnosis of osteoarthritis?

Obesity and previous injuries

You are caring for a post-operative patient whose EKG is shown above. BP = 148/90, Oxygen = 88%, Respirations = 16. Pain score 7 out of 10. Based on these assessment findings, how would you interpret the EKG strip and what interventions would you anticipate?

Sinus tachycardia. Administer ordered pain medications and re-assess in 15 minutes.

A nurse is conducting a detailed skin assessment on an 80-year-old client. Which finding requires further investigation?

Small, waxy nodule with pearly borders