Medical-Surgical Exam 2 Practice Questions

Magnesium levels

1.6-2.2

Phosphorus levels

2.2-4.5

A 48-year-old man is newly diagnosed with hypertension and Stage 1 chronic kidney disease (CKD). His primary health care provider has prescribed a thiazide diuretic. The client reports that he has increased his activity and changed his diet, which resulted in a 10-lb (4.5-kg) weight loss in the past 2 months. The client says he feels well and does not want to take any drugs. What is the nurse's best response? A. "Reducing your blood pressure may slow or prevent progression of your chronic kidney disease." B. "Your primary health care provider prescribed the diuretic because it will reverse the damage caused by kidney disease." C. "Taking medications is a personal decision, and you have the right to decline this prescription." D. "Because your lifestyle changes have resulted in weight loss, this intervention is all that is needed to reduce your risk for progression of kidney disease."

A. "Reducing your blood pressure may slow or prevent progression of your chronic kidney disease."

A woman who is 34 weeks pregnant is hospitalized for pyelonephritis. Which assessments should the nurse include in the plan of care? Select all that apply. 1. Homan sign 2. Urine output 3. Temperature 4. Dietary sodium 5. Blood pressure 6. Uterine contractions A. 2, 3, 5, 6 B. 1, 2, 3, 4 C. 2, 3, 4, 5 D. 3, 4, 5, 6

A. 2, 3, 5, 6

A nurse is caring for a client with complications associated with peritoneal dialysis. For which signs and symptoms should the nurse monitor the client? Select all that apply. 1. Pruritus 2. Oliguria 3. Tachycardia 4. Cloudy outflow 5. Abdominal pain A. 3, 4, 5 B. 1, 2, 3 C. 1, 2, 3, 4 D. 3, 5

A. 3, 4, 5

5. What condition does the nurse suspect? -Irregular heart rhythm -BP: 180/100 -Client reports: nausea, diarrhea, abd pain, muscle weakness -Lab results: K+ = 5.8, Na+ = 140, Ca = 9.0 A. Hyperkalemia B. Hyponatremia C. Hypouricemia D. Hypercalcemia

A. Hyperkalemia

What is your priority if the chest tube comes out of a patient?

Assess the patient and see if they are in distress

A patient is scheduled to have a hip replacement. Preoperatively, the patient is found to be mildly anemic and the surgeon states the patient may need a blood transfusion during or after the surgery. What action by the preoperative nurse is most important? A. Administer preoperative medications as prescribed. B. Ensure that a consent for transfusion is on the chart. C. Explain to the patient how anemia affects healing. D. Teach the patient about foods high in protein and iron.

B. Ensure that a consent for transfusion is on the chart.

Tommy is recovering from an ileostomy procedure in which a portion of the ileum is brought to the abdomen, and all portions of the large intestine are removed. Now that he is recovering, he is wondering which sports he can participate in. Which sport below can he NOT participate in? A. Swimming B. Cross country running C. Football D. Tennis

C. Football (contact sports)

The nurse is instructing Ms. Smith with chronic renal failure to maintain adequate nutritional intake. Which diet would be MOST appropriate? A. High carbohydrate, high protein B. High-calcium, high potassium, high protein C. Low-protein, low-sodium, low-potassium D. Low-protein, high potassium

C. Low-protein, low-sodium, low-potassium

A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the primary healthcare provider to explore with this client? A. Intensive psychotherapy B. Continued medical therapy C. Surgical therapy (colectomy) D. Diet therapy (low-residue, high-protein diet)

C. Surgical therapy (colectomy) If medical management fails, surgical therapy is the next logical choice because it removes the affected intestine. Psychotherapy might improve the client's ability to cope with the disease, but it will not solve the physical problems. Continued medical therapy and diet therapy are classic interventions that probably have been tried during prior exacerbations and have failed.

A nurse cares for a patient who has a chest tube. When would this patient be at highest risk for developing a pneumothorax? A. When the insertion site becomes red and warm to the touch B. When the tube drainage decreases and becomes sanguineous C. When the patient experiences pain at the insertion site D. When the tube becomes disconnected from the drainage system

D. When the tube becomes disconnected from the drainage system

What does a stoma site look like when it is not being perfused?

Turns purple or black

Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid? a) "I will take my stool softeners every day." b) "I will keep the drainage bag at the level of my abdomen." c) "Flushing the catheter is needed with each exchange." d) "Warmed dialysate infusion increases the speed of flow."

a) "I will take my stool softeners every day."

Ms. Smith with chronic kidney disease is restless, anxious, and short of breath. The nurse hears crackles that begin at the base of the lungs. The pulse rate is increased and the patient has frothy, blood-tinged sputum. What does the nurse do first? a. Facilitate transfer to intensive care for aggressive treatment. b. Place the patient in a high-Fowler's position. c. Continue to monitor vital signs and assess breath sounds. d. Administer a loop diuretic such as furosemide.

b. Place the patient in a high-Fowler's position.

A client hospitalized for worsening kidney injury suddenly becomes restless and agitated. Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs. Which is the nurse's first intervention? a) Begin ultrafiltration. b) Administer an antianxiety agent. c) Place the client on mechanical ventilation. d) Place the client in high Fowler's position.

d) Place the client in high Fowler's position.

Hgb

14-18

What does a collapsed lung sound like?

Absent lung sounds

Which of the following are correct for the nurse to teach her patient in regard to preventing a UTI? Select all that apply: A. Limit fluid intake B. Void frequently C. Wipe front to back D. Take baths instead of showers E. Urinate after sex F. Void completely

B, C, E, F

The nurse caring for a client undergoing a hemodialysis procedure places high priority on evaluating the client frequently for what common complication during the treatment? A. Hyperglycemia B. Infection and fever C. Dialysis dementia D. Hypotension

D. Hypotension

The nurse is reviewing laboratory values for a patient who has pneumonia. Which laboratory value does the nurse expect to see for this patient? A. Decreased hemoglobin B. Increased red blood cells (RBCs) C. Decreased neutrophils D. Increased white blood cells (WBCs)

D. Increased white blood cells (WBCs)

If there is no suctioning on the chest tube and there is bubbling then it means...

There is a leak and not ready for chest tube removal

The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake? a) "Your protein needs will not change, but you may take more fluids." b) "You will need more protein now because some protein is lost by dialysis." c) "Your protein intake will be adjusted according to your predialysis weight." d) "You no longer need to be on protein restriction."

b) "You will need more protein now because some protein is lost by dialysis."

The nurse is monitoring for complications when caring Ms. Smith. Which ABG findings should indicate to the nurse that the client has metabolic acidosis? A. pH 7.54 PaCo2 25 mmHg HCO3 24 mEq/L B. pH 7.35 PaCo2 35 mmHg HCO3 22 mEq/L C. pH 7.50 PaCo2 40 mmHg HCO3 28 mEq/L D. pH 7.29 PaCo2 35 mmHG HCO3 18 mEq/L

D. pH 7.29 PaCo2 35 mmHG HCO3 18 mEq/L

A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing? a) Intrarenal b) Nonoliguric c) Oliguric d) Postrenal

c) Oliguric

Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status? a) Capillary refill b) Intake and output c) Muscle strength d) Weight and blood pressure

d) Weight and blood pressure

Creatinine levels

0.6-1.6

Sodium levels

135-145

Potassium levels

3.5-5.1

Which conditions may cause patients to be at risk for aspiration pneumonia? (Select all that apply.) A. Continuous tube feedings B. Bronchoscopy procedure C. Magnetic resonance imaging (MRI) procedure D. Decreased level of consciousness E. Stroke F. Chest tube

A, B, C, D, E,

A nurse knows that a patient may have pyelonephritis if they present with: A. Fever/chills B. Increased WBC in urine C. Diarrhea D. Unilateral pitting edema E. CVA Tenderness F. Blurry Vision G. Gynecomastia H. Cloudy, blood, foul smelling urine

A, B, E, H

Which of the following are signs of cholecystitis? [Select all that apply] A. Nausea B. Chest pain C. Right upper quadrant abdominal pain D. Indigestion E. Headache F. Steatorrhea

A, C, D, F

A patient is seen in the health care provider's office and is diagnosed with community-acquired pneumonia. What are the most common symptoms the patient will have? (Select all that apply.) A. Dyspnea B. Abdominal pain C. Back pain D. Hypoxemia E. Chest discomfort

A, D, E

Which of the following is not a component of aspiration precautions? A. HOB at 20 degrees B. Thickened Liquids C. Assistance with meals D. Gastric residual checks

A. HOB at 20 degrees (should be 30-45 degrees)

During the first 15 minutes of the blood administration the nurse stays with the patient obtaining baseline vital signs and vital signs after 15 minutes. The nurse notes that the patient's temperature has increased from 37.0C to 38.2C, the blood pressure has decreased from 120/80 to 90/40, and the patient complains of itching, and shortness of breath. What is the nurse's priority action? A. Stop the packed red blood cells and start Normal saline to keep vein open B. Call the blood bank C. Give Tylenol D. Find the charge nurse to double check the primary nurse's findings

A. Stop the packed red blood cells and start Normal saline to keep vein open

A client who was admitted to the hospital with a diagnosis of a renal calculus is successful in passing the stone. The nurse is preparing the client for discharge and should include what in the client's instructions? A. "Strain all urine." B. "Increase fluid intake." C. "Limit dietary potassium." D. "Maintain bed rest for 24 hours."

B. "Increase fluid intake."

Which statement best describes pneumonia? A. An infection of the windpipe because the lungs are clear of any problems B. A serious inflammation of the bronchioles from various causes C. Only an infection of the lungs with mild to severe effects on breathing D. An inflammation resulting from lung damage caused by long-term smoking

B. A serious inflammation of the bronchioles from various causes

Which of the following statements by the patient indicates the need for further teaching regarding a liver biopsy? A. "I should let you know if I have excess drainage from the site." B. "I will call my provider if I have a fever following the procedure." C. "I can continue to take my heparin before the procedure."

C. "I can continue to take my heparin before the procedure."

Ms. Smith asks the nurse why she is anemic. What response by the nurse is best? A. "The increased metabolic waste products in your body depress the bone marrow." B. "We will need to review your dietary intake of iron-rich foods." C. "There is a decreased production by the kidneys of the hormone erythropoietin." D. "It is most likely that you have hereditary traits for the development of anemia".

C. "There is a decreased production by the kidneys of the hormone erythropoietin."

A student nurse demonstrates effective learning when they state that the most common cause of pyelonephritis is: A. P. Hylori B. C. difficile C. E. coli D. Treponema Palladium

C. E. coli

A nurse cares for a patient who has developed esophagitis after undergoing radiation therapy for lung cancer. Which diet selection should the nurse provide for this patient? A. Spaghetti with meat sauce, ice cream B. Chicken soup, grilled cheese sandwich C. Omelet, soft whole wheat bread D. Pasta salad, custard, orange juice

C. Omelet, soft whole wheat bread

Which of the following is not a sign or symptom of GERD? A. dyspepsia B. epigastric pain C. constipation D. hyper-salivation E. nausea

C. constipation

A nurse cares for a patient who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. Which action should the nurse take? A. Ambulate the patient in the hallway to promote deep breathing. B. Auscultate the patient's anterior and posterior lung fields. C. Encourage the patient to take shallow breaths to help with the pain. D. Administer pain medication and encourage the patient to take deep breaths.

D.

Which meal would be best for a patient who has received a cholecystectomy? A. Fried chicken strips, Cajun French fries, and a milkshake B. Cheeseburger, onion rings, Dr. Pepper C. Avocado and feta cheese wrap, salmon cooked sautéed in olive oil, dark chocolate D. Grilled chicken breast, spinach salad with lemon juice dressing, apple

D. Grilled chicken breast, spinach salad with lemon juice dressing, apple

Signs and symptoms of a moderate to severe systemic and inflammatory blood transfusion reaction includes all of the following except: A. Itching and hives B. Bronchospasm and dyspnea C. Hypotension D. Hypertension

D. Hypertension

A nurse evaluates the following arterial blood gas and vital sign results for a patient with COPD: Arterial Blood Gas Results: pH = 7.32 PaCO2 = 62 mm Hg PaO2 = 46 mm Hg HCO3- = 28 mEq/L Vital Signs: Heart rate = 110 beats/min Respiratory rate = 12 breaths/min Blood pressure = 145/65 mm Hg Oxygen saturation = 76% Which action should the nurse take first? A. Administer a short-acting beta2 agonist inhaler. B. Document the findings as normal for a patient with COPD. C. Teach the patient diaphragmatic breathing techniques. D. Initiate oxygenation therapy to increase saturation to 92%.

D. Initiate oxygenation therapy to increase saturation to 92%.

Ms. Smith now has a potassium level of 8 mEq/L. The nurse notifies the health care provider after assessing for which sign/symptom? a. Cardiac dysrhythmias b. Respiratory depression c. Tremors or seizures d. Decreased urine output

a. Cardiac dysrhythmias

A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day. Which is the nurse's best response? a) "This is based on the amount of damage to your kidneys." b) "You can drink an amount equal to your urine output, plus 700 mL." c) "It is based on your body weight and changes daily." d) "You can drink approximately 2 liters of fluid each day."

b) "You can drink an amount equal to your urine output, plus 700 mL."

The nurse is providing a client with a peritoneal dialysis exchange. The nurse notes the presence of cloudy peritoneal effluent. Which action by the nurse is most appropriate? a) Document the finding in the client's chart. b) Collect a sample to send to the laboratory. c) Reposition the client on the left side. d) Increase the free water content in the next bag.

b) Collect a sample to send to the laboratory

The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake? a) "Your protein needs will not change, but you may take more fluids." b) "You will need more protein now because some protein is lost by dialysis." c) "Your protein intake will be adjusted according to your predialysis weight." d) "You no longer need to be on protein restriction."

c) "Your protein intake will be adjusted according to your predialysis weight."

The nurse is caring for a client with chronic kidney disease who has developed uremia. Which assessment finding does the nurse correlate with this problem? a) Decreased breath sounds b) Foul-smelling urine c) Heart rate of 50 beats/min d) Respiratory rate of 40 breaths/min

d) Respiratory rate of 40 breaths/min

Hct

35-40%

WBC

5,000-10,000

A patient is taking an antacid and H2 receptor antagonist to treat their PUD. What statement indicates the patient needs further teaching? A. "I can take both medications at the same time." B. "My antacid neutralizes my stomach acid." C. "My H2 receptor antagonist inhibits stomach acid secretion." D. "I should take these medications an hour apart."

A. "I can take both medications at the same time." -They should be taken 1 hour apart

The nurse has completed a community presentation about lung cancer. Which statement from a participant demonstrates an understanding of the information presented? A. "The primary prevention for reducing the risk of lung cancer is to stop smoking and avoid second hand smoke." B. "The overall 5-year survival rate for all patients with lung cancer is 85%." C. "The death rate for lung cancer is less than prostate, breast, and colon cancer combined." D. "Cures are most likely for patients who undergo treatment for stage III disease."

A. "The primary prevention for reducing the risk of lung cancer is to stop smoking and avoid second hand smoke."

A client is hospitalized with a diagnosis of pneumonia. Which findings, based on the nurse's knowledge, are indicative of a deteriorating clinical state? Select all that apply. A. Increased respiratory rate B. Tachycardia C. Agitation D. Cyanosis E. Increased Urinary Output

A. Increased respiratory rate B. Tachycardia C. Agitation D. Cyanosis

A patient with COPD needs instruction in measures to prevent pneumonia. What information does the nurse include? (Select all that apply.) A. Avoid going outside B. Clean all respiratory equipment you have at home C. Avoid indoor pollutants such as dust and aerosols D. Get plenty of rest and sleep daily E. Limit alcoholic beverages to 4 to 5 per day

B, C, D

A nurse assesses a patient who has a chest tube. For which manifestations should the nurse immediately intervene? (Select all that apply.) A. Production of pink sputum B. Tracheal deviation C. Sudden onset of shortness of breath D. Pain at insertion site E. Drainage of 75 mL/hr

B, C, E

A nurse assesses a patient who has a mediastinal chest tube. Which symptoms require the nurse's immediate intervention? (Select all that apply.) A. Production of pink sputum B. Tracheal deviation C. Pain at insertion site D. Sudden onset of shortness of breath E. Drainage greater than 70 mL/hr F. Disconnection at Y site

B, D, E, F

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? Select all that apply. 1. Serum potassium of 2.8 mEq/L 2. Loss of 15 pounds without dieting 3. Abdominal pain in upper quadrants 4. Low-pitched bowel sounds 5. Serum sodium of 121 mEq/L A. 1, 2, 5 B. 1, 3, 5 C. 2, 3, 4 D. 3, 4, 5

B. 1, 3, 5

A client has a paracentesis, and the healthcare provider removes 1500 mL of fluid. To monitor for a serious post-procedure complication, what should the nurse assess for? A.Dry mouth B. Tachycardia C. Hypertensive crisis D. Increased abdominal distention

B. Tachycardia (compensatory due to hypovolemia)

The patient performs peritoneal dialysis. What should the nurse teach the patient about preventing peritonitis? Select all that apply 1. Sterile technique is important when performing peritoneal dialysis 2. Clean technique is permissible for prevention of peritonitis 3. Peritonitis is the most common and serious complication of peritoneal dialysis A. 1, 2, 3 B. 2, 3 C. 1, 3

C. 1, 3

Which foods should a patient with calcium stones avoid in their diet? 1. Yogurt 2. Chicken 3. Fruits 4. Spinach 5. Cheese A. 1, 2, 5 B. 1, 3, 5 C. 1, 4, 5 D. 1, 2, 4

C. 1, 4, 5

6. A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because: A. A person's body tends to retain fluid when a salt substitute is included in the diet. B. Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. C. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. D. A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.

C. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats

The post anesthesia recovery unit (PACU) nurse is giving hand off report to the 6 East nurse for an 82 year old patient who had a total hip replacement 2 hours ago. For which reported information about the patient or surgery does the receiving nurse ask the reporting team more details? A. Estimated blood loss 150ml B. The patient reported an allergy to codeine C. The total intraoperative urine output is 25 ml

C. The total intraoperative urine output is 25 ml

What is the priority of care to promote client safety directly after esophagogastroduodenoscopy? Select all that apply. 1. Preventing aspiration 2. Reminding the client not to drive 3. Monitoring for signs of perforation 4. Advising the client to use throat lozenges 5. Teaching the client about hoarseness of voice A. 2, 3 B. 3, 5 C. 4, 5 D. 1, 3

D. 1, 3

A nurse is caring for a client with acute renal failure. Which findings should the nurse anticipate when reviewing the laboratory report of the client's blood level of calcium, potassium, and creatinine? Select all that apply. 1. Calcium: 7.6 mg/dL 2. Calcium: 10.5 mg/dL 3. Potassium 6.0 mEq/L 4. Potassium 3.5 mEq/L 5. Creatinine: 3.2 mg/dL 6. Creatinine: 1.1 mg/dL A. 1, 2, 3 B. 1, 2, 4 C. 1, 5 D. 1, 3, 5

D. 1, 3, 5 If the kidney is not filtering wastes appropriately there will be a buildup of creatinine, electrolytes will be abnormal potassium will build up; since magnesium and phosphorus elevate build up and vitamin D receptors are lost calcium is low.

A client with acute kidney failure becomes confused and irritable. Which does the nurse determine is the most likely cause of this behavior? A. Hyperkalemia B. Hypernatremia C. A limited fluid intake D. An increased blood urea nitrogen level

D. An increased blood urea nitrogen level

A patient is admitted to the hospital to rule out pneumonia. Which infection control technique does the nurse maintain? A. Strict respiratory isolation and use of a specially designed facemask B. Respiratory isolation and contact isolation for sputum C. Respiratory isolation with a stock surgical mask D. Standard precautions and no respiratory isolation

D. Standard precautions and no respiratory isolation

Upon observation of a chest tube set-up, the nurse reports to the provider that there is a leak in the chest tube and system. How has the nurse identified this problem? A. Drainage in the collection chamber is decreased B. The bubbling in the suction chamber has suddenly increased C. Fluctuation in the water seal chamber has stopped D. There was onset of continuous bubbling in the water seal chamber

D. There was onset of continuous bubbling in the water seal chamber

A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client's cardiac monitor. Which action by the nurse is best? a) Check the serum potassium level. b) Document the finding in the client's chart. c) Prepare to give sodium bicarbonate. d) Call the health care provider to request an electrocardiogram (ECG).

a) Check the serum potassium level.

When providing care for a client receiving peritoneal dialysis, the nurse notices that the effluent is cloudy. Which intervention is most important for the nurse to carry out? a) Irrigate the peritoneal catheter with saline. b) Send a specimen for culture and sensitivity. c) Document the finding in the client's chart. d) Change the dialysate solution and catheter tubing.

b) Send a specimen for culture and sensitivity.

A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction. Which is the nurse's best response? a) "Rinse your mouth with an antiseptic solution after the procedure." b) "Kidney disease is probably what caused your dental decay." c) "You should receive prophylactic antibiotics before any dental procedure." d) "You may take any medication for pain that the dentist prescribes."

c) "You should receive prophylactic antibiotics before any dental procedure."

A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet? a) Bananas b) Ham c) Herbs and spices d) Salt substitutes

c) Herbs and spices

The nurse is caring for a client who is receiving peritoneal dialysis (PD). Which nursing intervention has the greatest priority when a dialysis exchange is performed? a) Adding potassium and antibiotic to the dialysate bags b) Positioning the client on either side c) Using sterile technique when hooking up dialysate bags d) Warming the dialysate fluid in a microwave oven

c) Using sterile technique when hooking up dialysate bags

The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN? a) "Avoid movement of the right extremity." b) "Place gentle pressure over the fistula site after blood draws." c) "Start any IV lines below the site of the fistula." d) "Take blood pressure in the left arm."

d) "Take blood pressure in the left arm."

Calcium levels

9.0-10.4

BUN

<20

What output with a chest tube is concerning?

> 70 mL an hour or change in color to brown, yellow, or blood

RBC

>4 million

GFR

>91

An active 45-year-old schoolteacher with COPD is taking prednisone asks if it is necessary to get a flu shot. What is the best response by the nurse? A. "Yes, flu shots are highly recommended for patients with chronic illness and/or patients who are receiving immunotherapy." B. "No, flu shots are only recommended for patients 50 years old and older." C. "Yes, it will help minimize the risk of triggering of exacerbation of COPD." D. "No, patients who are active, not living in a nursing home, and not health care providers do not need the flu shot."

A. "Yes, flu shots are highly recommended for patients with chronic illness and/or patients who are receiving immunotherapy."

A registered nurse is educating a client who has just undergone thoracentesis on the manifestations of pneumothorax. Which statements made by the client indicate effective learning? Select all that apply. 1. "I'll report any instance of blue skin right away." 2. "I'll report any feeling of air hunger immediately." 3. "I'll report any decrease in heart rate immediately." 4. "I'll call you right away if my nagging cough disappears." 5. "I'll call you right away if my shallow breathing goes away." A. 1, 2 B. 3, 4 C. 4, 5 D. 1, 5

A. 1, 2

The nurse is providing discharge instructions about pneumonia to a patient and family. Which discharge information must the nurse be sure to include? A. Complete antibiotics as prescribed, rest, drink fluids, and minimize contact with crowds. B. Take all antibiotics as ordered, resume diet and all activities as before hospitalization. C. No restrictions regarding activities, diet and rest because the patient is fully recovered when discharged. D. Continue antibiotics only until no further signs of pneumonia are present; avoid exposing immunosuppressed individuals.

A. Complete antibiotics as prescribed, rest, drink fluids, and minimize contact with crowds.

A nurse is performing a physical assessment of a client with ulcerative colitis. Which of the following symptoms is most often associated with a serious complication of this disorder? A. Decreased bowel sounds B. Loose, blood-tinged stools C. Distention of the abdomen D. Intense abdominal discomfort

A. Decreased bowel sounds Decreased intestinal motility is associated with serious problems, such as perforation or toxic megacolon. Loose, blood-tinged stools are an uncomfortable but less serious manifestation. Distention of the abdomen is an expected response that is not of primary concern at this time. Intense pain is a symptom of ulcerative colitis, not a complication.

After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated? A. Disequilibrium syndrome B. Respiratory distress C. Hypervolemia D. Peritonitis

A. Disequilibrium syndrome

A student nurse is learning about blood transfusion compatibilities. What information does this include? (Select all that apply.) A. Donor blood type A can donate to recipient blood type AB. B. Donor blood type B can donate to recipient blood type O. C. Donor blood type AB can donate to anyone. D. Donor blood type O can donate to anyone. E. Donor blood type A can donate to recipient blood type B.

A. Donor blood type A can donate to recipient blood type AB. D. Donor blood type O can donate to anyone.

A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease? A. Esophageal pain may imitate the symptoms of a heart attack. B. GERD may predispose to heart disease. C. Strenuous exercise may exacerbate reflux problems. D. Similar changes in laboratory studies may occur in both cardiac and reflux problems.

A. Esophageal pain may imitate the symptoms of a heart attack. Epigastric pain is common with GERD and may be present with unstable angina and myocardial infarction.

A student nurse is helping a registered nurse with a blood transfusion. Which actions by the student are most appropriate? (Select all that apply.) A. Hanging the blood product using normal saline and a filtered tubing set B. Taking a full set of vital signs prior to starting the blood transfusion C. Telling the patient someone will remain at the bedside for the first 5 minutes D. Using gloves to start the patient's IV if needed and to handle the blood product E. Verifying the patient's identity, and checking blood compatibility and expiration time

A. Hanging the blood product using normal saline and a filtered tubing set B. Taking a full set of vital signs prior to starting the blood transfusion D. Using gloves to start the patient's IV if needed and to handle the blood product

The patient is postoperative day 1 after an open thoracotomy and has two chest tubes in place on the right. The nurse notes that the trachea is deviated and pointing toward the left upper chest. What is the nurse's best action? A. Immediately notify the rapid response team and thoracic surgeon. B. Unplug the suction setting from the chest tube. C. Attempt to reposition the trachea midline. D. No action is needed because the trachea is deviated to the unaffected side.

A. Immediately notify the rapid response team and thoracic surgeon.

A patient is admitted to the hospital with pneumonia. What does the nurse expect the chest x-ray results to reveal? A. Patchy areas of increased density B. Tension pneumothorax C. Thick secretions causing airway obstruction D. Large hyperinflated airways

A. Patchy areas of increased density

The nurse is assessing another patient on the unit with chronic kidney disease. Assessment findings include the patient has chest pain when lying flat, recent fever, hypotension, muffled heart sounds, and jugular vein distension: The nurse's GREATEST concern would be for which of the following? A. Pericarditis with Beck's Triad B. Pericarditis with Virchow's Triad C. Pneumonia with Craig's Triad D. Pneumonia with the Ben and Jerry's Triad

A. Pericarditis with Beck's Triad (cardiac tamponade - JVD, muffled heart sounds, hypotension)

Which complication of pneumonia creates pain that increases on inspiration because of inflammation of the parietal pleura? A. Pleuritic chest pain B. Pulmonary emboli C. Pleural effusion D. Meningitis

A. Pleuritic chest pain

A client was diagnosed with ulcerative colitis. Two months after the diagnosis, the client is readmitted for an exacerbation of the illness. The client is weak, thin, and irritable. The client states, "I am now ready for surgery to create an ileostomy." Which nursing intervention will best meet the client's priority need? A. Replace the client's fluids and electrolytes B. Help the client gain weight C. Teach the client how to use the ileostomy appliance D. Encourage client interaction with other clients who have an ileostomy

A. Replace the client's fluids and electrolytes

The nurse is caring for a patient with a chest tube. What is the correct nursing intervention for this patient? A. The patient is encouraged to cough and do deep-breathing exercises frequently B. Stripping of the chest tube is done routinely to prevent obstruction by blood clots C. Water level in the suction chamber need not be monitored, just the collection chamber D. Drainage containers are positioned upright or on the bed next to the patient

A. The patient is encouraged to cough and do deep-breathing exercises frequently

Which of the following best describes a paracentesis? A. Transabdominal removal of fluid from the peritoneal cavity B. Removal of fluid from the pleural space C. An opening into the stomach from the abdominal wall, made surgically for the introduction of food

A. Transabdominal removal of fluid from the peritoneal cavity

3. A nurse is reviewing the arterial blood gas results of several clients. Which client's arterial blood gas result indicates metabolic acidosis? A. pH: 7.32 PaCO2: 32 HCO3: 16 B. pH: 7.34 PaCO2: 50 HCO3: 27 C. pH: 7.46 PaCO2: 33 HCO3: 18 D. pH: 7.48 PaCO2: 48 HCO3: 29

A. pH: 7.32 PaCO2: 32 HCO3: 16

An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough. The patient is afebrile. The health care provider orders a chest x-ray. The family member questions why this is needed since the manifestations seem so vague. What response by the nurse is best? A. "Chest x-rays are always ordered when we suspect pneumonia." B. "Older people often have vague symptoms, so an x-ray is essential." C. "The x-ray can be done and read before laboratory work is reported." D. "We are testing for any possible source of infection in the patient."

B. "Older people often have vague symptoms, so an x-ray is essential."

A client with acute renal failure moves into the diuretic phase after one week of therapy. For which signs during this phase should the nurse assess the client? Select all that apply. 1. Dehydration 2. Hypovolemia 3. Hyperkalemia 4. Metabolic acidosis 5. Skin rash A. 1, 2, 3, 4, 5 B. 1, 2 C. 1, 4, 5 D. 1, 2, 3

B. 1, 2

A client with gastroesophageal reflux disease (GERD) should make diet and lifestyle changes. Which instructions should the nurse include in the client's discharge teaching? Select all that apply. 1. Encourage to quit smoking 2. Elevate the foot of the bed 3. Avoid caffeine-containing products 4. Eat three large, evenly spaced meals daily 5. Avoid lying down for 2 to 3 hours after eating A. 1, 2, 3, 4, 5 B. 1, 3, 5 C. 2, 3, 5 D. 1, 4, 5

B. 1, 3, 5

How would the nurse know that the stoma site post ileostomy or colostomy is healthy and healing? Select all that apply 1. Red 2. Pale 3. Dry 4. Shiny 5. Swollen 6. Moist 7. Dusky A. 1, 3, 7 B. 1, 4, 6 C. 2, 3, 5 D. 3,4, 7

B. 1, 4, 6

A patient with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the patient to do? Select all that apply 1. Remind healthcare providers to draw blood from veins on the left side 2. Avoid sleeping on the left arm 3. Wear wristwatch on the right arm 4. Assess fingers on the left arm for warmth 5. Obtain BP from the left arm. A. 1, 2, 3, 4, 5 B. 2, 3, 4 C.1, 3, 5

B. 2, 3, 4

A patient presents with a suspected exacerbation of ulcerative colitis which of the following symptoms would you expect them to say? Select all that apply 1. "I can't catch my breath." 2. "I've noticed blood in my stool." 3. "All of this started after by 75th birthday party." 4. "I have the most pain right before I go to the bathroom" 5. "I feel like I'm going to the bathroom at least 10 times a day, almost every hour." A. 1, 2, 3 B. 2, 4, 5 C. 2, 3, 4 D. 3, 4, 5

B. 2, 4, 5

Mr. Wills reports that he has smoked 2 packs of cigarettes per day for the past 20 years. Calculate is pack-year history of cigarette use. A. 20 pack-years B. 40 pack-years C. 60 pack-years D. 80 pack-years

B. 40 pack-years

A pulmonary nurse cares for patients who have chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first? A. A 46-year-old with a 30-pack-year history of smoking B. A 52-year-old in a tripod position using accessory muscles to breathe C. A 68-year-old who has dependent edema and clubbed fingers D. A 74-year-old with a chronic cough and thick, tenacious secretions

B. A 52-year-old in a tripod position using accessory muscles to breathe

A client is admitted to the hospital from the emergency department with a diagnosis of urolithiasis. The nurse reviews the client's clinical record and performs an admission assessment. What is the priority nursing action? A. Strain the client's urine. B. Administer the prescribed morphine. C. Place in the high-Fowler position. D. Collect a urine specimen for culture and sensitivity.

B. Administer the prescribed morphine.

LM is a 75 year old female patient on your unit. The patient has an indwelling catheter. Upon your arrival to the unit today, she was confused, restless, and had a temperature of 100.4 degrees. What is your priority intervention? A. Obtain ordered urine specimen B. Call the HCP C. Place patient in bed with all 4 guardrails up D. Keep patient NPO

B. Call the HCP

A nurse concludes that the anemia that accompanies chronic kidney disease should be treated because it contributes to: A. Uremic frost B. Chronic fatigue C. Tubular necrosis D. Dependent edema

B. Chronic fatigue

While assessing a patient who is 12 hours postoperative after a thoracotomy for lung cancer, a nurse notices that the lower chest tube is dislodged. Which action should the nurse take first? A. Assess for drainage from the site. B. Cover the insertion site with sterile gauze. C. Contact the provider and obtain a suture kit. D. Reinsert the tube using sterile technique.

B. Cover the insertion site with sterile gauze.

While caring for an obese client who underwent a cholecystectomy, the nurse notices a separation in the surgical incision. Which complication does the nurse identify? A. Adhesions B. Dehiscence C. Evisceration D. Contractions

B. Dehiscence

You are teaching a patient about post-EGD considerations. Which of the following indicates a need for further teaching? Select all that apply A. A sore throat and belching is normal after this procedure B. I can eat my favorite foods such as carbonated beverages, tomatoes, and dairy as often as I want C. I will need someone to drive me home after the procedure D. I should contact my doctor immediately if I have a fever E. I can continue taking Advil up until the day of my procedure

B. I can eat my favorite foods such as carbonated beverages, tomatoes, and dairy as often as I want E. I can continue taking Advil up until the day of my procedure

Mr. Higgins returns from surgery. His vital signs are WNL except hypotension and tachycardia. Which order from the HCP would the RN expect to implement? A. Administer 450 mg of Lasix B. Initiate IV fluids C. Administer 2L O2 via nasal cannula D. Turn the patient

B. Initiate IV fluids

A client who performs home continuous ambulatory peritoneal dialysis reports that the drainage (effluent) has become cloudy in the past 24 hours. What is the nurse's best first action? A. Remove the peritoneal catheter. B. Notify the nephrology health care provider immediately. C. Teach the patient about peritonitis prevention D. Explain to the client the need to keep the dialysate in the refrigerator to prevent bacterial overgrowth.

B. Notify the nephrology health care provider immediately.

Which of the following would be the most correct way to manage an accidental removal of a chest tube? A. Do nothing; it was probably ready to be removed. B. Quickly apply petroleum gauze dressing with occlusive tape, call the physician. C. Attempt to put the tube back into the incision site. D. Monitor the patient closely until the thoracic surgeon rounds in 4 hours.

B. Quickly apply petroleum gauze dressing with occlusive tape, call the physician.

A patient is receiving ipratropium (Atrovent) and reports nausea, blurred vision, headache, and inability to sleep. What action does the nurse take? A. Administer a PRN medication for nausea and PRN sedative. B. Report these symptoms to the provider as signs of overdose. C. Obtain a provider's request for an ipratropium level. D. Tell the patient that these side effects are normal and not to worry.

B. Report these symptoms to the provider as signs of overdose.

Which information would the nurse include regarding appliance care and maintenance, when teaching a client with a new colostomy? Select all that apply. 1. Change the ostomy pouch on a routine basis. 2. Replace the ostomy wafer weekly or sooner as needed. 3. Remove the ostomy pouch when showering. 4. Empty the ostomy pouch when three-quarters full of stool or gas. 5. Empty the ostomy pouch before exercise and at bedtime. A. 1, 3, 5 B. 2, 3, 5 C. 1, 2, 5 D. 3, 4, 5

C. 1, 2, 5 (Waiting until pouch is more than half full increases the likelihood of the leakage)

Ms. Smith with ESRD is to be admitted to the hospital because of fluid volume overload and electrolyte imbalance. The serum potassium level is now 7. What appropriate hospital unit should this client be admitted to? A. A semiprivate room in a medical-surgical unit B. A private room in a medical-surgical unit C. A nursing unit with continuous cardiac monitoring D. A nursing unit for ventilator-assisted clients

C. A nursing unit with continuous cardiac monitoring

A patient is having pain resulting from bone metastases caused by lung cancer. What is the most effective intervention for relieving the patient's pain? A. Support the patient through chemotherapy B. Handle and move the patient gently C. Administer analgesics around the clock D. Reposition the patient, use distraction.

C. Administer analgesics around the clock

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? A. Administer intravenous opioid medications. B. Insert a nasogastric tube for decompression. C. Assess the client's bowel sounds.

C. Assess the client's bowel sounds. Assess first-assess for changes from patient's baseline first.

Ms. Smith's roommate has stage 2 CKD, the nurse would consider questioning the order for which diagnostic test? A. Kidney biopsy B. Ultrasonography C. Computed tomography with contrast dye D. Kidney, ureter, bladder x-ray

C. Computed tomography with contrast dye (contrast dye is nephrotoxic)

Mr. Higgins, a 52-year-old male, came to the ED this morning with nausea, and pain localized to the RLQ of the abdomen. The nurse palpates and discovers the patient is experiencing positive rebound tenderness. What should the nurse prepare the patient for? A. Dinner. He's hungry! B. Colonoscopy C. Emergent appendectomy D. Inducing emesis

C. Emergent appendectomy

A patient has a chest tube in place. What does the water in the water seal chamber do when the system is functioning correctly? A. Bubbles vigorously and continuously B. Bubbles gently and continuously C. Fluctuates with the patient's respirations D. Stops fluctuation, and bubbling is not observed

C. Fluctuates with the patient's respirations

Which nursing diagnosis, for the patient with pneumonia, is the highest priority? A. Alteration in Comfort r/t Fever B. Activity Intolerance C. Impaired Gas Exchange D. Deficient Fluid Volume

C. Impaired Gas Exchange

A patient comes into the ED with a chief complaint of "not being able to pee lately." What is a primary nursing diagnosis? A. Acute Pain B. Risk for Fluid Deficit C. Impaired Urinary Elimination D. Incomplete Voiding

C. Impaired Urinary Elimination

During lung assessment, the nurse places a stethoscope on a patient's chest and instructs him/her to say "99" each time the chest is touched with the stethoscope. What should be the correct interpretation if the nurse hears the spoken words "99" very clearly through the stethoscope? A. This is a normal auscultatory finding B. May indicate pneumothorax C. May indicate pneumonia D. May indicate severe emphysema

C. May indicate pneumonia

A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess? A. Increased weight B. Distended neck veins C. Orthostatic hypotension D. Abnormal breath sounds

C. Orthostatic hypotension

Which intervention would be most beneficial in preventing a catheter-associated urinary tract infection in a postoperative client? A. Pouring warm water over the perineum B. Ensuring the patency of the catheter C. Removing the catheter within 24 hours D. Cleaning the catheter insertion site

C. Removing the catheter within 24 hours

What nursing intervention may help to prevent the complication of pneumonia in a surgical patient? A. Monitoring chest x-rays and WBC counts for early signs of infection B. Monitoring lung sounds every shift and encouraging fluids C. Teaching coughing, deep-breathing exercises, and use of incentive spirometry D. Encouraging hand hygiene among all caregivers, patients, and visitors

C. Teaching coughing, deep-breathing exercises, and use of incentive spirometry

A nurse is caring for a client with acute kidney failure who is receiving a protein restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the client's questions? A. A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses. B. Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis. C. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. D. Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

C. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.

7. List clinical manifestations of anemia and evidence of anemia on the complete blood count results.

Clinical manifestations of anemia a. Skin: Pale, cool, cold intolerance, brittle nails. b. Cardiovascular :Tachycardia, activity intolerance c. Respiratory: DOE, activity intolerance, Decreased oxygen saturation (with severe anemia) d. Neurologic: Increased fatigue, headache, increased somnolence Chronic anemia common clinical manifestations include pallor, hypotension, weakness, depressed mood, impaired cognitive function, fatigue.

Which statement made by Ms. Smith, with CKD and who is on hemodialysis, indicates the need for further teaching? A. "I will report any increase in my weight of 5 lbs in a 2 day period." B. "I take my prescribed antihypertensive drugs daily." C. "I am careful to take precautions in the arm with the AV fistula". D. "I comply with salt restrictions in my diet by using salt substitutes."

D. "I comply with salt restrictions in my diet by using salt substitutes."

A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, what does the nurse reinforce? A. Antacids should be taken 1 hour before meals. B. These should be scheduled at 4-hour intervals. C. Antacid tablets are just as fast and effective as the liquid form. D. Antacids commonly interfere with the absorption of other drugs.

D. Antacids commonly interfere with the absorption of other drugs. Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.

A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease? A. Inclusion of transmural involvement of the small bowel wall B. Higher occurrence of fistulas and abscesses from changes in the bowel wall C. Pathology beginning proximally with intermittent plaques found along the colon D. Involvement starting distally with rectal bleeding that spreads continuously up the colon

D. Involvement starting distally with rectal bleeding that spreads continuously up the colon Ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. Intermittent areas of pathology occur in Crohn. In ulcerative colitis, the pathology is in the inner layer and does not extend throughout the entire bowel wall; therefore, abscesses and fistulas are rare. Abscesses and fistulas occur more frequently in Crohn disease.

A nurse cares for a patient who has a pleural chest tube. Which action should the nurse take to ensure safe use of this equipment? A. Strip the tubing to minimize clot formation and ensure patency. B. Secure tubing junctions with clamps to prevent accidental disconnections. C. Connect the chest tube to wall suction at the level prescribed by the provider. D. Keep padded clamps at the bedside for use if the drainage system is interrupted.

D. Keep padded clamps at the bedside for use if the drainage system is interrupted.

When the nurse caring for Ms. Smith, with severe chronic kidney disease, asks what dietary modifications she has made for the disease, she reports the following actions. Which action indicates to the nurse that additional client education is needed? A. Using a scale to measure protein weight B. Taking calcium and vitamin D supplements daily C. Eliminating bananas, citrus fruits, and avocados D. Using a salt-substitute instead of ordinary table salt

D. Using a salt-substitute instead of ordinary table salt (Salt substitutes contain high levels of potassium)

A client asks the nurse, "What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate? (Select all that apply.) a) "It will give you greater freedom in your scheduling." b) "You have less chance of getting an infection." c) "You need to do it only three times a week." d) "You do not need a machine to do it." e) "You will have fewer dietary restrictions."

a) "It will give you greater freedom in your scheduling." d) "You do not need a machine to do it." e) "You will have fewer dietary restrictions."

A client with acute kidney injury is placed on a fluid restriction. To determine whether outcomes related to fluid balance are being met, the nurse assesses for which finding? a) Absence of lung crackles b) Decreased serum creatinine level c) Decreased serum potassium level d) Increased muscle strength

a) Absence of lung crackles

A client with acute kidney injury had normal assessments 1 hour ago. Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless. Which assessment does the nurse perform? a) Obtain an oxygen saturation level. b) Send blood for a creatinine level. c) Assess the client for dehydration. d) Perform a bedside blood glucose.

a) Obtain an oxygen saturation level.

A client with a decreased glomerular filtration rate (GFR) asks how to prevent further damage to the kidneys. Which is the nurse's best response? a. Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs). b. Kidney damage is inevitable as you age. c. The diuretics you are taking will prevent further damage. d. You will need to follow a high-protein diet

a. Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs).

The nurse is reviewing the Ms. Smith's medication list and appropriate dose adjustments made for chronic kidney disease. The nurse would question the use and/or dosage adjustment of which type of medication? a. Antibiotics b. Magnesium antacids c. Oral antidiabetics d. Opioids

b. Magnesium antacids (patients with CKD are at risk for hypermagnesemia)

A patient has been diagnosed with end-stage renal disease. In addition to patient's complaints of fatigue, anorexia, dyspnea, and nocturia, the nurse's assessment findings include: +1 pedal edema, basilar crackles in both lungs, and clear, pale urine. VS are: T 98.8° F, P 86, R 28, and BP 178/92. Lab values: Hct (hematocrit) 30%; Hgb 9.5 g/dL K+ (Potassium) 6.0 meq/L, Phosphorus 7.0 mg/dL. Which of the lab values are outside of normal range for adults? a. Potassium only b. Hct/Hgb and Phosphorous c. Hct/Hgb, K, and Phosphorus d. All are in the normal range.

c. Hct/Hgb, K, and Phosphorus

A nurse noted that a patient with chronic kidney disease (CKD) had a glomerular filtration rate (GFR) of 25 ml/min (stage 4 CKD). Given the lab result, how might the plan of care be changed for this patient? a. Increased drug dosages or a shorter interval between doses of some medications. b. No change in drug dosages or frequency of medications. c. No interpretation can be made from this data. d. Reduced drug dosages or a longer interval between doses of some medications.

d. Reduced drug dosages or a longer interval between doses of some medications.