Test 5 med-surg
A patient has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient?
"Abstain from vaginal intercourse for 2 weeks."
A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate?
"Are you using prescription hormone replacement therapy?"
A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective?
"Both my partner and I will need to be treated."
A patient is scheduled in the outpatient clinic for blood cortisol testing. Which instruction should the nurse provide?
"Come to the laboratory to have the blood drawn early in the morning."
A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?
"Do you have to wear larger shoes now?"
An 18-yr-old male patient with small stature is scheduled for a growth hormone stimulation test. What should the nurse obtain in preparation for the test?
50% dextrose solution
In preparation for which test should the nurse teach the patient to minimize physical and emotional stress?
A 24-hour urine test for free cortisol
Which patient in the women's health clinic will the nurse expect to teach about an endometrial biopsy?
A 25-yr-old patient who has a family history of hereditary nonpolyposis colorectal cancer
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
A 70-year-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134
The nurse has just received change-of-shift report about the following four patients. Which patient should be assessed first?
A patient with a possible ectopic pregnancy who is reporting shoulder pain
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next?
Administer IV calcium gluconate.
A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?
Administer prescribed subcutaneous DDAVP.
A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is important for the nurse to communicate to the health care provider before the test?
Allergies to iodine and shellfish
A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118 mEq/L. The nurse should anticipate the need for which diagnostic test?
Antidiuretic hormone level
Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?
Antithyroid medications may take several months for full effect.
Which nursing assessment of a 70-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
Apical pulse rate
A patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action should the nurse take first?
Ask the patient to keep track of her symptoms in a diary for 3 months.
A patient brought to the emergency department reports being sexually assaulted. The patient is confused about where she is and she has a laceration above the right eye. Which action should the nurse take first?
Assess the patient's neurologic status.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?
Assess the patient's respiratory effort.
The nurse is caring for a patient following an adrenalectomy. What is the highest priority in the immediate postoperative period?
Balancing fluids and electrolytes
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. What topic should the nurse plan to teach the patient?
Calcium supplements to normalize serum calcium levels
Which information will the nurse include when teaching a patient who has developed a small vesicovaginal fistula 2 weeks into the postpartum period?
Change the perineal pad frequently to prevent perineal skin breakdown.
Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?
Disturbed sleep pattern
During the physical examination, the nurse cannot feel the patient's thyroid gland. What action should the nurse take?
Document that the thyroid was nonpalpable.
The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care?
Elevate the head of the bed at least 30 degrees.
Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos?
Elevate the head of the patient's bed to reduce periorbital fluid.
A patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. What additional effect of the medication should the nurse monitor?
Elevated serum potassium
What topic should the nurse plan to teach a female patient who has genital warts?
Importance of regular Pap tests
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?
Increased thyroxine (T4) level
A young adult patient who is being seen in the clinic has excessive secretion of the anterior pituitary hormones. Which laboratory test result should the nurse expect?
Increased urinary cortisol
A patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon?
Increasing neck swelling.
Which finding indicates to the nurse that the current therapies are effective for a patient who has acute adrenal insufficiency?
Increasing serum sodium levels
Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)?
Inject the medication subcutaneously every day.
A patient is admitted with tetany. Which laboratory value should the nurse plan to monitor?
Ionized calcium
A patient with endometriosis asks why she is being treated with a contraceptive. What information should the nurse explain about this therapy?
It suppresses the menstrual cycle by mimicking pregnancy.
A patient in the emergency department reports that she has been sexually assaulted. Which action by the nurse will help to maintain the medicolegal chain of evidence?
Labeling all specimens and other materials obtained from the patient
Which nursing assessment finding in a patient who recently started taking hormone replacement therapy (HRT) requires discussion with the health care provider about a possible change in therapy?
Left calf swelling
A patient who has been sexually assaulted expresses that she wants to prevent pregnancy. What treatment option should the nurse in the emergency department plan to discuss with the patient?
Levonorgestrel (Plan-B One-Step)
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included?
Measure urine volume every hour.
What is most important for the nurse to teach a patient recently diagnosed with polycystic ovary syndrome?
Methods to maintain a healthy weight.
What action should the nurse take when providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism?
Monitor the blood pressure every 4 hours.
A 22-yr-old patient tells the nurse that she has not had a menstrual period for the past 3 months. Which action is most important for the nurse to take?
Obtain a urine specimen for a pregnancy test.
Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
Offer the patient hard candies to suck on.
What topic should the nurse teach a patient who had a pituitary adenoma after the hypophysectomy?
Oral corticosteroids to replace endogenous cortisol
A patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL. What should the nurse anticipate will be tested next?
Parathyroid hormone
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?
Patient stopped taking the medication 2 days ago.
The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?
Patient with tetany who has a new order for IV calcium chloride
A patient undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystoceleand rectocele. Which nursing action will be included in the postoperative care plan?
Perform urinary catheter care.
What topic should the nurse plan to teach a 26-yr-old patient who has been treated for pelvic inflammatory disease?
Potential complication of infertility
Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm?
Propranolol (Inderal)
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home?
Provide written reminders of information taught.
A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching?
Risk factors for cervical cancer
A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information should the nurse include in discharge teaching?
Symptoms of hypothyroidism will occur as the RAI therapy takes effect.
A patient has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient manage discomfort?
Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.
A 32-yr-old patient has oral contraceptives prescribed for endometriosis. What instruction should the nurse give this patient?
Take the medication every day for the next 9 months.
A patient requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which action should the nurse take first?
Take the patient's personal and family health history.
Which action should the nurse take when a 35-yr-old patient whose repeat cervical Pap test was abnormal?
Teach the patient about colposcopy.
Which assessment finding for an adult admitted with Graves' disease requires the most rapid intervention by the nurse?
Temperature 103.8° F (40.4° C)
The nurse is caring for a patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider?
The patient has a 5-lb (2.3-kg) weight loss.
Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)?
The patient has a serum sodium level of 118 mEq/L.
The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider?
The patient is confused and lethargic.
Which information about a patient who is scheduled for an oral glucose tolerance test should the nurse consider in interpreting the test results?
The patient takes oral corticosteroids for rheumatoid arthritis.
Which additional information should the nurse consider when reviewing the laboratory results for a patient's total calcium level?
The serum albumin
A 50-yr-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan?
The symptoms may decrease after the patient undergoes menopause.
Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland?
Thyroid-stimulating hormone (TSH) level
What should the nurse teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids?
To keep the specimen refrigerated or on ice
Which finding indicates to the nurse that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
Urinary output is increased.
A patient is on the surgical unit after a total abdominal hysterectomy. Which finding requires contacting the health care provider?
Urine output of 125 mL in the first 8 hours after surgery
A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void, which action should the nurse take first?
Use an ultrasound scanner to check for urinary retention.
A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. What is the greatest risk to the patient at this time?
Wound infection
Which question from the nurse during a patient interview will provide focused information about a possible thyroid disorder?
"Have you had a recent unplanned weight gain or loss?"
A 19-yr-old patient visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed?
"Have you had sexual intercourse?"
Which statement made by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be needed?
"I feel a lump in my throat when I swallow."
The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching?
"I had the flu earlier this week, so I couldn't take the hydrocortisone."
Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)?
"I need to shop for foods low in sodium and avoid adding salt to food."
Which statement by the patient indicates that the nurse's teaching about treating vaginal candidiasis was effective?
"I should clean carefully after each urination and bowel movement."
A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include?
"The prednisone dose should be decreased gradually."
Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter?
"What medications are you taking?"
A 47-yr-old patient asks whether she is going into menopause if she has not had a menstrual period for 3 months. Which response by the nurse is appropriate?
"What was your menstrual pattern before your periods stopped?"
A 34-yr-old patient who is discussing contraceptive options with the nurse says, "I want to have children but not for a few years." Which response by the nurse is accurate?
"Women often have more difficulty becoming pregnant after about age 35."
What topic should the nurse plan to discuss with a patient who has been diagnosed with stage 0 cervical cancer?
Conization
When caring for a 58-yr-old patient with persistent menorrhagia, what should the nurse plan to monitor?
Complete blood count (CBC)
An 82-year-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed
Diazepam (Valium)
The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband's salary. The man replies that if his wife worked outside the home, they would have enough money. Which patient problem should the nurse identify?
Difficulty coping
A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care?
Encourage 4000 mL of fluids daily.
What action will the nurse take when caring for a patient who has a radium implant for treatment of cervical cancer?
Encourage the patient to discuss any concerns by telephone.
A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. What topic should the nurse plan to discuss with this patient?
Endometrial biopsy
A patient who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next?
Explain the reason for taking vital signs every 15 to 30 minutes
A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion?
HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid temporary relief from the symptoms?
Have the patient rebreathe from a paper bag.
What finding should the nurse plan to assess for in a patient diagnosed with a pheochromocytoma?
Headache
A patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMDD) symptoms. Which patient information that contraindicates oral contraceptives should be communicated to the health care provider?
History of migraine headaches
The nurse is caring for a patient with a possible pituitary tumor who is scheduled for a computed tomography scan with contrast. Which information about the patient is important to discuss with the health care provider before the test?
History of renal insufficiency
Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider?
Nausea and projectile vomiting
A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will the nurse expect during the assessment?
Purplish streaks on the abdomen
Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy?
Purpose of ambulation and leg exercises
A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be helpful for the patient problem of disturbed body image related to changes in appearance?
Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.
A patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching?
Return for a follow-up appointment in 2 to 3 days.
A registered nurse (RN) is caring for a patient with a goiter and possible hyperthyroidism. Which action by the RN indicates that the charge nurse needs to provide the RN with additional teaching?
The RN palpates the neck to assess thyroid size.
Which assessment finding inNa pRatienIt wGho hBa.dCa biMlateral adrenalectomy requires the most rapid action by the nurse?
The blood pressure (BP) is 88/50 mm Hg.
A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss with the patient before the procedure?
The expulsion of the fetus may take 1 to 2 days.
A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. What should the nurse include in preoperative teaching?
Avoid brushing teeth for at least 10 days after the surgery.
The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Which assessment finding is consistent with panhypopituitarism?
Decreased facial hair
A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result should the nurse expect?
Decreased serum sodium
What information will a review of a patient's glycosylated hemoglobin (A1C) results provide to the nurse?
Glucose control over the past 90 days
Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action?
New-onset changes in the patient's voice
A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. What information should the nurse provide?
Ovulation prediction kits can provide accurate information about ovulation.
A patient has been newly diagnosed with type 2 diabetes. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease?
Value system
