Adults Final

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The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?

Gout

A home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?

Hypoxia

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches?

I-ICP

The nurse is administering an analgesic to a patient with major burns. What is the recommended route for administration for this patient?

IV

When describing the immunoglobulin most likely involved with allergic reactions, which of the following would the nurse address?

IgE

You enter your client's room and find him pulseless and unresponsive. What would be the treatment of choice for this client?

Immediate defibrillation

A child tips a pot of boiling water onto his bare legs. The mother should:

Immerse the child's legs in cool water

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 arm

The nurse reviews a patient's lab results and notes a serum calcium level of 7.9 mg/dL. The nurse knows that this reading can also be associated with which of the following?

Impaired myocardial contractility

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?

Implementing measures to clear pulmonary secretions

A type of therapeutic exercise performed by the patient where the muscle contracts and relaxes is which of the following?

Isometric

A client in the surgical intensive care unit has skeletal tongs in place to stabilize a cervical fracture. Protocol dictates that pin care should be performed each shift. When providing pin care for the client, which finding should the nurse report to the physician?

A small amount of yellow drainage at the left pin insertion site

For a client who has had a stroke, which nursing intervention can help prevent contractures in the lower legs?

Attaching braces or splints to each foot and leg

Which of the following is the most effective treatment for obstructive sleep apnea (OSA)?

CPAP

Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])?

Can control blood glucose through diet and exercise

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?

Cardiac tamponade

A patient presents to the emergency room with complaints of having an "exploding headache" for the last 2 hours. The patient is immediately seen by a triage nurse who suspects the patient is experiencing a stroke. Which of the following is a possible cause based on the characteristic symptom?

Cerebral aneurysm

The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD.

Chest pain, weight gain, fatigue

You are caring for a client with a damaged tricuspid valve. You know that the tricuspid valve is held in place by which of the following?

Chordae tendinae

Emphysema is described by which of the following statements?

A disease of the airways characterized by destruction of the walls of overdistended alveoli

Which of the following is true regarding gestational diabetes?

A glucose challenge test should be performed between 24-28 weeks

Which of the following is the primary function of the small intestine?

Absorption

An elderly female cient who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse:

Acknowledges the client's achievement when she walks to the bedside commode with her walker

Constant bubbling in the water seal of a chest drainage system indicates which of the following problems?

Air leak

Which of the following is the strongest predisposing factor for asthma?

Allergy

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

Anorexia, N/V

Which of the following is a potential complication of a low pressure in the ET cuff?

Aspiration pneumonia

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)?

Bone marrow transplant

What is true about both lung transplant and bullectomy?

Both are aimed at improving quality of life for COPD patients

A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?

Chelation therapy

Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness?

Comeback

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator?

Creatinine clearance level

A patient's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which of the following statements made by the nurse correctly explains the cause of DIC?

DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs

The nurse working in the ER receives a call from the x-ray department communicating that the patient the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the patient's fracture is which of the following?

Diaphysis

Which of the following would be considered a "free" item from the exchange list?

Diet soda

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by:

Edema and inflammation

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

Edrophonium (Tensilon)

A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema?

Encourage breathing exercises

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs

A patient is having an anaphylactic reaction. The patient is hypotensive and does not respond to vasopressors. Which of the following medications may be given for its acute inotropic and chronotropic effects?

Glucagon

Which disturbance results in loss of half of the visual field?

Homonymous hemianopsia

Which electrolyte disturbance most commonly follows thyroid surgery?

Hypocalcemia

Which of the following areas of the brain are responsible for temperature regulation?

Hypothalamus

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

Hypovolemic shock caused by hemorrhage

Which of the following is true regarding hormonal contraception?

Increases risk for VTE

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is

Malnutrition

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

NSAIDs

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

NSAIDs and exercise

A patient who is at risk for developing a chronic condition because of genetic factors is said to be in which phase of the Trajectory Model?

Pretrajectory

In the menstrual cycle, every month the female reproductive system generates an ovum. When the ovum is not fertilized, production of which of the following leads to menstruation?

Progesterone by the corpus luteum beginning to decrease

Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening?

Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles

Primary gout is often caused by an inherited disorder in which type of metabolism?

Purine

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

Quadriceps

The nurse practitioner is able to correlate a patient's neurologic deficits with the location in the brain affected by ischemia or hemorrhage. For a patient with a left hemispheric stroke, the nurse would expect to see:

R-sided paralysis

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

RR of 22 breaths/min.

Most cervical cancers if not detected and treated, spread to which area?

Regional pelvic lymph nodes

Which of the following is the most successful treatment for gastric cancer?

Removal of tumor

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

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

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from?

SA node

What is the term for a lateral curving of the spine?

Scoliosis

Which of the following dysrhythmias are common in older patients?

Sinus bradycardia

The nurse is caring for a patient who is to undergo a thoracentesis. In preparation for the procedure, the nurse will position the patient in which of the following positions?

Sitting on the edge of the bed

Which of the following principles apply to the patient in traction?

Skeletal traction is never interrupted

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?

Sprain

A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:

Stress incontinence

A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient?

Sx hypoglycemia

A client, who wishes to preserve childbearing, asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse?

Sx of endometriosis are increased during normal menstrual cycle

A patient diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse?

The joint above and below the fx must be immobilized

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer?

The lump is irregularly shaped

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern?

• Compromised gas exchange • Decreased airflow • Wheezes

A nursing student knows that there are three most common symptoms of asthma:

• Cough • Dyspnea • Wheezing

The nurse is developing a bowel training program for a patient. What education can the nurse provide for the patient that will increase the chance of success of the bowel program?

• Set a daily defecation time that is within 15 minutes of the same time every day • Have an adequate intake of fiber containing foods • Have a fluid intake between 2 and 4 L/day

A client who is elderly reports difficulty with reading and seeing faces. The nurse assesses the client for the following risk factors associated with age-related macular degeneration:

• Sunlight exposure • Family history • Cigarette smoking

Clinical manifestations of neurogenic shock include which of the following?

• Venous pooling in the extremities • Bradycardia • Warm skin

Which of the following medications are classified as leukotriene modifiers (inhibitors)?

• Zafirlukast (Accolate) • Montelukast (Singulair) • Zileuton (Zyflo)

The nurse is caring for an adult paraplegic with an ostomy. Which of the following would be an appropriate statement for the nurse to make?

"Do you need assistance managing your ostomy?"

What is the term for a rhythmic contraction of a muscle?

Clonus

The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Select the agent of first choice when an acute inflammatory attack begins.

Colchicine

Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

Cushing's

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

Decreased hematocrit

After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following?

Defibrillation

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following?

Dyskinesia

Menopause marks the end of a woman's reproductive capacity. Which of the following is a common complaint that may be due to a cystocele?

Dyspareunia

The most common symptom of esophageal disease is which of the following?

Dysphagia

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?

Elevated urine amylase levels

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?

Endocrine functioning

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds:

Enteric coated aspirin

After a plane crash, a client is brought to the emergency department with severe burns and respiratory difficulty. The nurse helps to secure a patent airway and attends to the client's immediate needs, then prepares to perform an initial neurologic assessment. The nurse should perform an:

Eval. corneal reflex response

A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when

Excess pericardial fluid compresses the heart and prevents adequate diastolic filling

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

GERD

The most common type of goiter is caused by lack of which of the following?

Iodine

Which of the following is the most common site of joint effusion?

Knee

Which topic is most important for the nurse to include in the teaching plan for a client newly diagnosed with Parkinson's disease?

Maintaining safe environment

A physician stated to the nurse that the patient has fluid noted in the pleural space and will need a thoracentesis. The nurse would expect that the physician will document this fluid as which of the following?

Pleural effusion

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?

Plt count 9000/mm3

Which of the following medications is an antidote to heparin?

Protamine sulfate

A client who has been severely beaten is admitted to the emergency department. The nurse suspects a basilar skull fracture after assessing:

Racoon's eyes and Battle sign

When assessing the older adult, the nurse anticipates an increase in which component of the respiratory status?

Residual lung volume

Which of the following is one of the levels of hospice care covered under Medicare and Medicaid hospice benefits that includes a 5-day inpatient stay and is provided on an occasional basis to relive the family caregivers?

Respite care

A patient with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following is an important nursing action for this patient?

Restricting fluid intake and hydration

An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred?

Rh-hemolytic disease

The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this?

S3

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should:

Stay with the client and encourage him to eat

A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by:

Stimulation of the vagus nerve

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient?

The patient is hypoxic from suctioning

Which group of clients should not receive potassium iodide?

Those who are allergic to seafood

A client is on bed rest after sustaining injuries in a car accident. Which nursing action helps prevent complications of immobility?

Turning the client Q2H and providing a low-air-loss mattress

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse:

Turns off the television

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for?

Ulceration

A patient has been diagnosed with a concussion. He is to be released from the emergency department. The nurse teaches the family or friends who will be caring for the patient to contact the physician or return to the ED if the patient

Vomits

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of:

Vulvar pruritis

A nurse is teaching a client with a leg ulcer about tissue repair and wound healing. Which statement by the client indicates effective teaching?

"I'll eat plenty of fruits and vegetables"

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin (Glucophage) and exenatide (Byetta) and reports adhering to her diet. The glycohemoglobin is 5.9%. In the stable phase of the Trajectory Model of Chronic Illness, the nurse:

Acknowledges to the client she is performing satisfactorily

A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?

Acquired

Spinal cord injury is an example of which type of disability?

Acquired

A nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. The nurse should tell the client to transfer body weight to the unaffected leg, and then:

Advance both crutches

A nurse is working with a patient to establish a bowel training program. Based on the nurse's understanding of bowel function, the nurse would suggest planning for bowel evacuation at which time?

After breakfast

The antibiotic of choice utilized in the treatment of acute bacterial rhinosinusitis (ABRS) includes which of the following?

Amoxicillin (Augmentin)

A client is admitted to the emergency department with a stab wound and is now presenting dyspnea, tachypnea, and sucking noise heard on inspiration and expiration. The nurse should care for the wound in which manner?

Apply airtight dressing

The nurse is caring for a patient with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete which of the following?

Assess the patient for a cough reflex

For a client with an endotracheal (ET) tube, which nursing action is the most important?

Auscultating the lungs for BIL breath sounds

The nurse is helping a patient who experiences frequent constipation select his meal choices for the day. Which of the following should the nurse encourage the patient to order?

Bran cereal

A nurse is assigned to care for a client with a tracheostomy tube. How can the nurse communicate with this client?

By supplying a magic slate or similar device

The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective?

Classes at community centers to teach about smoking cessation strategies

A nurse is providing discharge teaching for a client who had a laryngectomy. Which instruction should the nurse include in her teaching?

Cover the stoma when you shower or bathe

The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia?

Cyanosis

Which is an age-related change in the respiratory system?

Decreased gas exchange

Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability?

Developmental

A nurse is caring for a patient who is documented to have orthostatic hypotension. The nurse anticipates finding which of the following symptoms upon assessment?

Dizziness

A nurse is preparing a client for bronchoscopy. Which instruction should the nurse give to the client?

Don't eat

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met?

Drainage is <30mL/day for 2 consecutive days

The nurse enters the room of a client who is being monitored with pulse oximetry. Which of the following factors may alter the oximetry results?

Dx peripheral vascular disease

Which of the following is a priority nursing intervention that the nurse should perform for a patient who has undergone surgery for a nasal obstruction?

Ensure mouth breathing

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to:

Ensure that the mother does not have access to car keys or drive an automobile

An older adult patient is experiencing presbycusis. When interviewing the patient, the nurse would be alert for problems associated with which consonants?

F, S, P

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family?

Family members should continue to talk to the client

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to

Ingest 5-6 small meals each day

The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique?

Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to:

Instruct the family to remove the toddler from the room for the protection of the client

A nurse practitioner diagnosed a patient with an infection in the maxillary sinuses. Select the area that the nurse palpated to make that diagnosis.

On the cheeks below the eyes

A client who is blind is hospitalized for hip surgery. The nurse notices that the containers on the client's lunch tray are unopened, the client is fumbling with items, and food is on the front of the client's gown. The nurse assists the client by:

Opening containers and orienting the client to placement of items on the tray

Which of the following terms will the nurse use to document the inability of a patient to breathe easily unless positioned upright?

Orthopnea

A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to:

Plan with the client how to incorporate the regimen into the client's activities of daily living

Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which of the following after a rib fracture?

Pneumonia

The nurse is conducting a community program about prevention of respiratory illness. What illness does the nurse know is the most common cause of death from infectious diseases in the United States?

Pneumonia

What is a nurse's role in providing home care for a patient with Alzheimer's disease?

Provide emotional and physical support

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding?

Respiratory acidosis

A nurse is caring for a client who requires a wheelchair. Which piece of equipment impedes circulation to the area it's meant to protect?

Ring or donut

A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to:

Seek medical help if he experiences inability to swallow

What position should be avoided when positioning a patient in bed in order to decrease the incidence of musculoskeletal complications?

Semi-Fowler's

Students are reviewing information about rehabilitation and brain and spinal cord injuries. They demonstrate understanding of the information when they identify which of the following as being responsible for approximately one-half of all traumatic brain injuries?

Substance abuse

A patient learning to ambulate with crutches advances both crutches and then lifts both feet, moving them forward and landing them in front of the crutches. The patient then repeats this motion. The nurse identifies this as which type of crutch gait?

Swing through

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for:

Symmetry of the client's chest expansion

The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction?

The survival of people with severe trauma, chronic disorders, and early-onset disabilites

Knowing respiratory physiology is important to understand how the disease process can work within that system. Which hollow tube transports air from the laryngeal pharynx to the bronchi?

Trachea

An older adult is is experiencing bowel changes. She used to have a bowel movement every day, but she is now having one every 3 to 4 days. She also states that the stools are hard. Which of the following assessments would the nurse make?

• Amount of dietary fiber • Use of laxatives • Activity level of the client • Quantity of daily fluid intake

What are clinical manifestations associated with obstructive sleep apnea (OSA)?

• Insomnia • Arrhythmias • Loud snoring • Excessive daytime sleepiness • Impotence

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. Which of the following is being tested?

Adrenal functioning

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for?

Atelectasis

The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle?

Atrial depolarization

A nurse is completing a shift assessment on a patient admitted to the telemetry unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The patient is also experiencing dizziness and shortness of breath. Which of the following medications will the nurse anticipate administering to the patient based on these clinical findings?

Atropine

Which drug should be available to counteract the effect of Tensilon?

Atropine

The nurse is caring for a client who is diagnosed with aortic stenosis, but is reluctant to have surgery for valve replacement. The nurse is present when the physician talks to the client about a treatment that is less invasive than surgery, but that will likely relieve some of the client's symptoms. Later, the client asks the nurse to review with her spouse the treatment offered. What does the nurse talk about with the spouse?

Balloon percutaneous valvuloplasty

A nurse is preparing a client for a lumbar puncture. The client has heard about post-lumbar puncture headaches and asks what causes them. The nurse tells the client that these headches are caused by which of the following?

CSF leakage at puncture site

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse?

CVP reading of 1mmHg (normal is 2-6)

Which of the following inhibits bone resorption and promotes bone formation?

Calcitonin

Which of the following is clinical manifestation of cholelithiasis?

Clay-colored stools

A client is admitted to an acute care facility after an episode of status epilepticus. After the client is stabilized, which factor is most beneficial in determining the potential cause of the episode?

Compliance w/prescribed med regimen

The ability of the cardiac muscle to shorten in response to an electrical impulse is termed

Contractility

You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis?

Encourage deep breathing Q2H

A client received burns to his entire back and left arm. Using the Rule of Nines, the nurse can calculate that he has sustained burns on what percentage of his body?

27%

A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as:

2:00pm (usually 4-10hrs)

The nurse is caring for a client who is to have a lumbar puncture. What are the lowest vertebrae that contain the spinal cord?

2nd lumbar vertebrae

A nurse is providing care to a client who was just admitted with a diagnosis of ectopic pregnancy. When reviewing the client's history, which of the following would the nurse identify as a major risk factor for this client?

Pelvic inflammatory disease (PID)

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

Peritonitis

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?

"I will avoid prolonged sitting or walking"

A nurse is preparing to obtain a sexual history from a client using the PLISSIT model. Which question would be most appropriate for the nurse to ask first?

"May I ask you some questions about your sexual health?"

A client from a low socioeonomic background was diagnosed with a chronic health problem. The client states, "Everyone has to die of something." The most appropriate response by this nurse is:

"There are things you can do to minimize the effects of this disease on your health."

A patient with Alzheimer's disease is prescribed donepezil (Aricept). When teaching the patient and family about this drug, which of the following would the nurse include?

"This drug helps control the symptoms of the disease"

When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods?

10-15 seconds

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of

2-12 days

The nurse is educating a patient about the best time to perform BSE. When does the nurse inform her is the best time after menses to perform BSE?

5-7 days

A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings?

84 mmHg

A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration?

A partial rebreathing mask

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true?

A positive rxn indicates that the client has been exposed to TB

A female client, aged 82, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine?

A possible AE of BP meds is dizziness when you stand

Which of the following is accurate regarding status asthmaticus?

A severe asthma episode that is refractory to initial therapy

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:

Albuterol (Proventil)

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)?

Allogenic stem cell transplant

The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?

Angina with nitrate use

The nurse is obtaining a history from a male client who states having difficulty achieving and sustaining an erection. When reviewing the medication history, which medication classification does the nurse anticipate?

Antihypertensives

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

Appendicitis

A patient with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which of the following is the priority action by the nurse?

Assess for complications

Which of the following terms refers to the inability to coordinate muscle movements, resulting in difficulty walking?

Ataxia

Which of the following ulcers is associated with extensive burn injury?

Curling's ulcer

What is the function of cerebrospinal fluid (CSF)?

Cushion the brain and spinal cord

A nurse taking care of a patient recently admitted to the ICU observes the patient coughing up large amounts of pink, frothy sputum. Auscultation of the lungs reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this patient is developing which of the following problems?

Decompensated HF with pulmonary edema

Which of the following is an age-related change of the hepatobiliary system?

Decreased blood flow

Which of the following diagnostic tests is used as a therapeutic measure for incomplete miscarriage?

Dilation and curettage (D&C)

The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics?

Diminished or absent pulses

A 6-month-old male client and his elder brother, a 3-year-old male, are being seen in the pediatric clinic for their third middle ear infection of the winter. The mother reports they develop an upper respiratory infection and an ear infection seems quick to follow. What contributes to this event?

Eustachian tubes

A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?

Exertional dyspnea, orthopnea, pulmonary edema

The nurse is caring for a client with mid-to-late stage of an inoperable brain tumor. What teaching is important for the nurse to do with this client?

Explaining hospice care and services

When describing the process of fertilization, the nurse would explain that it normally occurs in which structure?

Fallopian tube

A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display?

Fatty deposits in the lumen of arteries

A physician wants a study of diaphragmatic motion because of suspected pathology. What does the nurse anticipate that the physician will most likely order?

Fluoroscopy

The nurse is caring for a client with tuberculosis. Why should the nurse always encourage a client with tuberculosis to perform active range-of-motion (ROM) exercises three times a day?

For maintaining muscle strength

Which of the following is the leading cause of death in the elderly?

Heart disease

Which type of jaundice is the result of increased destruction of red blood cells?

Hemolytic

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed?

Hemorrhage

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Hep C increases risk for liver CA

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?

High CHO, low fat diet

The diagnosis of prostate cancer is confirmed by which of the following?

Histologic exam of tissue

A nurse takes the initial history of a patient who is being examined for cancer of the larynx. Select the sign that is considered an early clinical indicator.

Hoarseness of more than 2 weeks duration

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?

Homans'

A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient's ECG reveals peaked T waves. The nurse reviews the patient's serum electrolytes anticipating which of the following abnormalities?

Hyperkalemia

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component?

It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

The nurse is preparing a client for a pelvic examination. The client asks the nurse, "Why do I need to urinate and empty my bladder?" Which response by the nurse would be most appropriate?

It helps make you more comfortable and the exam easier

The nurse is conducting a community education program on colorectal cancer. Which of the following statements should the nurse include in the program?

It is the 3rd most common CA in the US

Which of the following is a true statement regarding severe acute respiratory syndrome (SARS)?

It is the most contagious during the 2nd week of illness

A new client has been admitted with right-sided heart failure. The nurse knows to look for which of the following assessment findings when assessing this client?

JVD

A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following?

Kayexalate

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine?

Ketones

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

Kinking of the ventilator tubing

A client has just undergone bronchoscopy. Which nursing assessment is most important at this time?

LOC

The diagnosis of multiple sclerosis is based on which of the following tests?

MRI

The nurse is caring for a patient diagnosed with a hemorrhagic stroke. The nurse recognizes that which of the following interventions is most important?

Maintaining a patent airway

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by

Mast cells

Vitamin B and folic acid deficiencies are characterised by production of abnormally large erythrocytes called

Megaloblasts

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?

Metabolism of meds

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

Metformin

Which of the following is the most effective treatment for trichomoniasis?

Metronidazole (Flagyl)

The classification of Stage I of COPD is defined as:

Mild COPD

Which of the following is the primary vector of arthropod-borne virus encephalitis in North America?

Mosquitos

A nurse is completing a neurological assessment and determines that the client has significant visual deficits. A brain tumor is considered. Considering the functions of the lobes of the brain, which area will most likely contain the neurologic deficit?

Occipital

Which of the following cranial nerves is responsible for muscles that move the eye and lid?

Oculomotor

A group of students is reviewing the medications that may be used to treat esophageal reflux. The students demonstrate understanding of the information when they identify which of the following as an example of a proton-pump inhibitor?

Omeprazole (Prilosec)

What is the most common cause of anaphylaxis?

PCN

Which of the following is the most common symptom of bladder cancer?

Painless gross hematuria

When preparing a woman for a gynecologic examination, which of the following would the nurse explain as being done at the end of the examination?

Palpation of the posterior uterus via the rectum

Cardiac effects of hyperthyroidism include which of the following?

Palpitations

A patient admitted to the hospital following a motor vehicle crash has suffered a flail chest. A nurse assesses the patient for what most common clinical manifestation of flail chest?

Paradoxical chest movement

A patient is admitted to the hospital for management of an extrapyramidal disorder. Included in the physician's admitting orders are the medications levodopa, Cogentin, and Eldepryl. The nurse knows that most likely, the client has a diagnosis of ________.

Parkinson's

A patient with brain tumor recently stopped radiation and chemotherapy for treatment of his cancer. Of late, he is complaining of dry mouth. Which of the following interventions by the hospice nurse demonstrates the nurse understands treatment measures for dry mouth?

Provide gentle mouth care after each meal

When the nurse places the patient in the stirrups for a pelvic exam she observes a bulge caused by rectal cavity protrusion. What does the nurse know this protrusion is called?

Rectocele

The nurse teaches the patient that corticosteroids will be used to treat his brain tumor for which reason?

Reduce cerebral edema

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?

Reduce fluid accumulation and venous pressure

A client informs the nurse that he is taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about the taking a stimulant laxative?

They can be habit forming and will require increasing doses to be effective

A patient with herpes simplex virus (HSV) encephalitis is receiving acyclovir (Zovirax). To ensure early intervention, the nurse monitors laboratory values and urine output for which of the following adverse reactions?

Renal

A nurse is aware that after a burn injury and respiratory difficulties have been managed, the next most urgent need is to:

Replace lost F/E

The nurse is providing discharge instructions to a patient with pulmonary sarcoidosis. The nurse concludes that the patient understands the information if the patient correctly states which of the following early signs of exacerbation?

SOB

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do?

See her gynecologist ASAP

Which of the following neurotransmitters is implicated in depression?

Serotonin

A nurse is providing instructions for the client with chronic rhinosinusitis. The nurse accurately tells the client:

Sleep with HOB elevated

A community nurse is working to decrease the incidence of cardiac disease in Nicaragua. The nurse should plan educational health promotion activities around which of the following?

Smoking cessation

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

Sputum and productive cough

During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring?

Stable

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained abd pain

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient?

Suggest fluid intake of at least 2L/day

The nurse advises a patient that the best position to ease low back pain is:

Supine w/knees slightly flexed and HOB at 30 degrees

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

Tall, peaked T waves

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3L per day

A patient had a carotid endarterectomy yesterday and when the nurse arrived in the room to perform an assessment, the patient states, "All of a sudden, I am having trouble moving my right side." What concern should the nurse have about this complaint?

Thrombus formation at the site of the endarterectomy

The patient is describing to the nurse a test that he underwent to detect a small bowel obstruction prior to admission to the hospital. The patient states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse documents the name of the test as which of the following?

Upper GI enteroclysis

The most frequent reason for admission to skilled care facilities includes which of the following?

Urinary incontinence

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan?

Use a topical skin moisturizer daily

The nurse caring for a patient with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy?

Vitamin B6

A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. The nurse tells the client to:

Wear sunglasses with UV protection when outside

A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:

Within 12-48h

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways.

• Increase oxygen distribution • Alter smooth muscle tone • Reduce airway obstruction

A patient has undergone a cervical discectomy. What interventions are essential to teach the patient?

• Keep staples or sutures clean and dry • Cover incision with dry dressing • Call health care provider if the area is red or irritated • Avoid twisting or flexing your neck • Do not remove dressing until your next visit

A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy?

• Poor wound healing • Hypertension • Alterations in glucose metabolism

During assessment of cognitive impairment, post stroke, the nurse documents that the patient was experiencing memory loss and impaired learning capacity. The nurse knows that brain damage has most likely occurred in which lobe?

Frontal

Which of the following cerebral lobes is the largest and controls abstract thought?

Frontal

A patient has a burn injury that has destroyed all of the dermis and extends into the subcutaneous tissue, involving the muscle. This type of burn injury would be documented as which of the following?

Full thickness

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?

Low purine

A nurse and a nursing student are caring for a client with pericarditis and perform the physical assessment together. The client has a pericardial friction rub audible on auscultation. When the nurse and student leave the room, the student asks how to distinguish a pericardial from a pleural friction rub. The nurse's best response is which of the following?

"Ask the client to hold the breath while you auscultate; the pericardial friction rub will continue, while the pleural friction rub will stop."

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following?

"Do you experience any claustrophobia?"

A family will be providing care at home to an immobilized patient at risk for impaired skin integrity. After teaching the family about reducing the patient's risk for skin breakdown, the nurse determines that the teaching was successful when the family states which of the following?

"We need to make sure that the patient drinks enough fluids"

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:

"What precipitates the outbursts?"

A 15-year-old high student reports to the school nurse with complaints of cramping, nausea, diarrhea, and backache. Which of the following assessment questions by the nurse is most appropriate in this situation?

"When was your last period?"

A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication?

0-4mm

Patient teaching about mild allergic responses should include information about the onset of symptoms. The nurse tells the patient that if exposure to an allergen occurs around 8:00 AM, he should expect a mild or moderate reaction by what time?

10:00am

A patient comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"?

3mo.

A nurse is assisting a client with range-of-motion exercises. The nurse moves the client's leg out and away from the midline of the body. What movement does the nurse document?

Abduction

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about?

Absent distal pulses

Which cranial nerve is tested by listening to a ticking watch?

Acoustic

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?

Acute glomerulonephritis

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?

Asterixis

A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs?

Auscultation

Which of the following describes a valve used in replacement surgery that is made from the patient's own heart valve?

Autograft

The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

Autonomy

A patient is being treated for prostatitis and the nurse is providing education about the treatment. What should the nurse include in the education of this patient?

Avoid foods and liquids with diuretic action or that increase prostatic secretions

Which of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis?

Avoid potential allergens

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise?

Avoid residue, lactose, fat, caffeine

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack?

Avoid situations that contribute to ischemic episodes

Which of the following is a key diagnostic laboratory test for heart failure?

B-type natriuretic peptide

Which of the following is a deformity of the chest that occurs as a result of over inflation of the lungs?

Barrel chest

A female client is being treated for increased intracranial pressure (ICP). Why should the nurse ensure that the client does not develop hypothermia?

Bc shivering in hypothermia can increase ICP

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis?

Because I had a previous rxn to the test, this time I need to get a CXR

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?

Begin fluid replacement

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which of the following characteristics would the nurse be most likely to find?

Black and tarry in appearance

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?

Bleeding

The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first:

Collaborates with the client to establish an agreed-upon goal

A patient has been diagnosed with fused mitral leaflets, causing a backward flow of blood. What type of procedure does the nurse know is commonly performed for this type of problem?

Commissurotomy

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

A 13-year-old client is brought to the emergency department. The client's mother reports that the client was struck with a baseball bat on his upper arm while diving for a pitched ball. After diagnostic tests are completed, the physician reassures the mother that her son's humerus is not broken but he has suffered another type of injury. What type of injury would you expect the physician to diagnose?

Contusion

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?

Early detection and treatment of diseases

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency?

Elevate the legs periodically for at least 15-20 min.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

Encourage high fluid intake

A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend?

Encouraging clients to avoid cigarette smoking

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy?

Increased diameter of the calf

A 34-year-old man is diagnosed with chronic hepatitis C. Testing reveals that he is a candidate for treatment. The nurse anticipates that which of the following could be used to treat his condition?

Interferon

The nurse is working with a patient with a chronic condition. The nurse includes which of the following in the plan of care?

Interventions to prevent complications and manage symptoms, assessment for identity changes

A 62-year-old male client with a history of chronic laryngitis arrives at the clinic complaining of a hoarseness "he can't shake." The nurse is aware that this client may be at risk for which of the following conditions?

Laryngeal cancer

An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to:

Limit ingestion of caffeinated beverages

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

Log rolling client from side to side

The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?

Loss of arterial elasticity

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is:

Loud and may be associated with a thrill sound similar to a purring cat

A nurse reading a chart notes that the patient had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result?

Negative

Students are preparing a class presentation on elder abuse. Which of the following would they include as the most common type of elder abuse?

Neglect

The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized?

The client will change positions frequently throughout the procedure

A nurse is required to monitor the effectiveness of fluid resuscitation in a client who is being treated for burns. Which of the following assessments would indicate the success of the fluid resuscitation?

The client's urinary output is 0.5 mL/kg/hour.

A patient is receiving theophylline (Theo-Dur) for long-term control and prevention of asthma symptoms. Patient teaching related to this medication will include which of the following?

The importance of blood tests to monitor serum concentrations

A nurse is preparing to discharge an adolescent with sickle cell anemia. What client need should the nurse emphasize in her discharge assessment?

The need for an adequate support structure

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?

The pt. has eating and not taken insulin

The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located?

The thin fibrous sac encasing the heart

Decades ago, a typical childhood surgery, after repeated bouts with tonsillitis, was to have a tonsillectomy and adenoidectomy. That was before the role of the tonsils and adenoids were better understood. As it is understood today, what are the roles of the tonsils and adenoids?

They are lymphoid tissues that filter bacteria from tissue fluid

Which of the following statements best describes the function of stem cells in the bone marrow?

They produce all blood cells

A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient?

You should switch to wearing your glasses while taking this med

Osteoarthritis is known as a disease that

is the most common and frequently disabling of joint disorders


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