exam 3 review med surg

A client has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this client?

IV hydromorphone

A nurse is performing an admission assessment of a client with a diagnosis of cirrhosis. What technique should the nurse use to palpate the client's liver?

Place hand under right lower rib cage and press down lightly with the other hand.

The nurse is caring for a patient receiving IV aminoglycosides for an intractable infection in his or her leg. What would it be important for the nurse to monitor this patient for?

Renal dysfunction

A nurse is working with a patient who has a diagnosis of Cushing syndrome. When completing a physical assessment, the nurse should specifically observe for what integumentary manifestation?

Hirsutism

The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do?

Hold the dose and notify the physician immediately.

Following an addisonian crisis, a client's adrenal function has been gradually regained. The nurse should ensure that the client knows about the need for supplementary corticosteroid therapy in which circumstance?

A significant illness

A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patient's fluid volume excess? Select all that apply.

A) Administering diuretics C) Implementing fluid restrictions E) Enhancing patient positioning

The nurse admits a patient to the emergency department and recognizes the patient is in diabetic ketoacidosis (DKA) when what manifestations are assessed? (Select all that apply.)

A) Fruity breath C) Dehydration E) slow and deep respirations(Kussmaul's

A client's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment question(s) addresses likely etiologic factors? Select all that apply

A. "How many alcoholic drinks do you typically consume in a week?" B. "Have you ever been tested for diabetes?" C. "Have you ever been diagnosed with gallstones?" D. "Would you say that you eat a particularly high-fat diet?"

A client with Cushing syndrome has been hospitalized after a fall. The dietitian works with the client to improve the client's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply.

A. Foods high in vitamin D C. Foods high in protein D. Foods high in calcium

A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. What is the priority nursing diagnosis for a client with this condition?

Excess fluid volume

A client with esophageal varices is being cared for in the ICU. The varices have begun to bleed. The client has Ringer lactate at 150 cc/hr infusing. The nurse should also anticipate what intervention?

Administering volume expanders

The nurse caring for a client with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?

Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning

A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply.

B. Glycosuria C. Dehydration E. Hyperglycemia

The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply

B. Pallor C. Rapid respiratory rate E. Hypotension

A nurse is creating a care plan for a client with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?

Bed rest lowers the metabolic rate and reduces enzyme production.

A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?

Blood glucose

A student nurse is caring for a client who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments?

Blood glucose levels

The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem?

Burns

An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply.

C. Age-related physiologic changes D. Chronic systemic disease E. Nothing by mouth (NPO) status

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate?

Continuous venovenous hemodialysis (CVVHD)

A patient suspected of having Cushing's disease comes to the clinic. What drug might the nurse administer to test for adrenal function and responsiveness?

Corticotropin

The nurse is caring for a patient with neurogenic diabetes insipidus and administers what drug to treat the condition?

Desmopressin (DDAVP, Stimate)

The nurse's review of a client's most recent laboratory results indicates a bilirubin level of 3.0 mg/dL (51 mmol/L). The nurse assesses the client for:

jaundice

A client with diabetes is asking the nurse what causes diabetic ketoacidosis (DKA). Which of the following is a correct statement by the nurse?

"DKA can be caused by taking too little insulin."

A client with hyperthyroidism is being treated with radioactive iodine therapy. After receiving the dose of radioiodine, the nurse would assess the client for:

thyroid storm.

A client has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse explain the pathophysiology of this client's health problem?

"The enzymes that your pancreas produces have damaged the pancreas itself."

A diabetic patient calls the clinic complaining of having a "flu Bug" the nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient?

"try to eat small amounts of carbs, if possible".

A nurse is providing discharge education to a client who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?

. Low-fat foods high in proteins and carbohydrates

The nurse administers prednisone orally at 8 am. When would the nurse expect the drug to reach peak effect?

9 to 10 am

A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

A hemolytic anemia

A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?

Highly dilute urine

The nurse is caring for an 85 year old client diagnosed with a UTI. What assessment findings would indicate the client has early signs of sepsis. Select all that apply

A) Unexplained alteration in mental status C) Temperature less than 96.8 F D) Elevated lactic acid (lactate)

The nurse is teaching the patient about the newly prescribed external insulin pump. What are priority teaching points for the nurse to include? (Select all that apply.)

A) Watch for signs and symptoms of infection. B) Check blood glucose frequently. C) Change tubing frequently. D) Have pump calibrated weekly

A nurse is amending a client's plan of care in light of the fact that the client has recently developed ascites. What should the nurse include in this client's care plan?

Administration of diuretics as prescribed

A client's health care provider has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.

Alanine aminotransferase (ALT) Gamma-glutamyl transferase (GGT) Aspartate aminotransferase (AST)

A client has septicemia. The client's condition is noted to be deteriorating. The nurse begins to infuse the ordered intravenous albumin. Which change indicates the effectiveness of the treatment?

An increase of mean aterial pressure (MAP) from 54 to 67

A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's plan of care?

Assessment for variceal bleeding

A nurse is caring for a client with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the client has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?

Asterixis

The nurse develops a discharge teaching plan for a patient who was prescribed pancreatic enzyme replacement and includes what important teaching point?

Avoid spilling the powder on the skin because it may be irritating

What assessment findings would the nurse expect to see in a patient who overdosed on levothyroxine (Synthroid)?

Nervousness, tachycardia, tremors

A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined?

By objectively determining the client's medical need

What H2 antagonist would the nurse consider the drug of choice for a patient with advanced liver failure?

Nizatidine

A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk?

Central nervous system damage

The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurse's assessments most directly addresses a major complication of TPN?

Checking the client's capillary blood glucose levels regularly

. A client with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the client's treatment?

Death anxiety

Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings?

Decreased platelets

The nurse administers desmopressin (DDAVP) to the patient to treat diabetes insipidus. What assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect?

Decreased urine output

A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase?

Dehydration

A patient who is taking metoclopramide (Reglan) has come to the clinic for a follow-up visit. The nurse will be most concerned about a drug-drug interaction when learning the patient is taking what other medication?

Digoxin (Lanoxin

The patient with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine(T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication?

Elevated TSH, reduced T3 and T4levels

A client has been treated in the hospital for an episode of acute pancreatitis. The client has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes. What is the nurse's most appropriate response?

Encourage the client to connect with a community-based support group.

The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?

Establish fall-prevention measures.

A client is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

Fever, increased heart rate and decreased blood pressure

An older adult client with type 2 diabetes is brought to the emergency department by the client's daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?

Fluid and electrolyte replacement

You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patient's plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patient's health?

Fluid volume status

A patient is brought to the emergency department with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?

Glucagon (GlucaGen)

A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client reports falling when transferring to the commode. The client's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action?

Have the client assessed by the primary provider due to the risk of internal bleeding.

The health care provider has ordered a fluid deprivation test for a client suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments?

Heart rate and blood pressure

The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate?

Hyperkalemia

A patient presents at the clinic with complaints of weight loss despite an increased appetite. The nurse assesses this patient for what?

Hyperthyroidism

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?

IV administration of 50% dextrose in water

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

Inability of the liver to use vitamin K

A critical care nurse is caring for a client diagnosed with acute pancreatitis. The nurse knows this client should be started on parenteral nutrition (PN) after what indications?

Inability to take in adequate oral food or fluids within 7 days

The nurse is caring for a patient newly diagnosed with hypothyroidism. The patient also takes theophylline to control asthma symptoms. What changes will need to be made to the patient's theophylline dose?

Increase theophylline dosage immediately.

A client's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the client's laboratory studies, what finding is most closely associated with this diagnosis?

Increased bilirubin

A patient is at risk for thrombosis formation and is taking an oral anticoagulant. The patient has been newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What will the nurse monitor the patient for?

Increased bruising and bleeding

The nurse administers desmopressin to treat a patient with diabetes insipidus. Assessment of what laboratory studies would indicate the drug is working?

Increased serum sodium levels

The nurse is providing dietary teaching to the patient on long-term mineralocorticoid therapy and includes what teaching point?

Increasing potassium

A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?

Inform the health care provider and assess the client for signs of infection.

A 35-year-old client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize?

Insertion of a nasogastric tube

When conducting patient teaching about using antibiotic medications, what is it critical for the nurse to include to help stop the development of resistant strains of microorganisms?

It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.

A child is diagnosed with hypothyroidism. The nurse anticipates an order for the drug of choice when treating children, which is what?

Levothyroxine (Synthroid)

The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk?

Maintain aseptic technique when administering dialysate.

A client with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the client's initial phase of treatment?

Maintaining and monitoring the client's fluid balance

A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes?

Maintaining fluid and electrolyte balance

An adult client has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this client's plan of care?

Measure the client's abdominal girth daily

The nurse is caring for a patient receiving cyclophosphamide (Cytoxan). What is the priority nursing action for this patient?

Monitor urinalysis results.

The nurse is caring for a client with a diagnosis of Addison disease. What sign or symptom is most closely associated with this health problem?

Muscle weakness

What glucocorticoids could the nurse only administer orally?

Prednisone (Deltasone)

The nurse admits an elderly patient in thyroid crisis for whom surgery is not an option. What antithyroid drug would the nurse expect will be ordered?

Radioactive iodine (Generic)

After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect?

Rash

A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response?

Report this finding to the primary provider due to the possibility of hepatic encephalopathy.

The nurse is caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient?

Respiratory function

The nurse is caring for a patient requiring digestive enzyme replacement therapy and establishes what appropriate nursing diagnosis for this patient?

Risk for imbalanced nutrition

A 16-year-old presents at the emergency department reporting right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this client's nursing care, the nurse should prioritize what nursing diagnosis?

Risk for infection related to possible rupture of appendix

The nurse is developing a care plan for a client with Cushing syndrome. What nursing diagnosis should the nurse prioritize?

Risk for injury related to weakness

A nurse is caring for a patient with HIV. What lab tests would the nurse monitor when a protease inhibitor has been ordered for this patient?

Serum alanine aminotransferase and bilirubin

A 37-year-old client presents at the emergency department (ED) reporting nausea and vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's spouse states that the client was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the client for what health problem?

Severe pancreatitis with possible peritonitis

A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action?

Slowly taper down the dose of prednisone, as prescribed

The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan?

Small, frequent meals, high in protein and calories

A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals that the client exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?

Stage 3

A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what factor most likely caused this short-term change in treatment?

Stress has likely caused an increase in the client's blood sugar levels.

The patient is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the patient would indicate the need to consult the health care provider before administering the ordered medication?

Takes furosemide (Lasix), a potent diuretic, daily

The nurse is caring for a 57-year-old woman who is complaining about gaining so much weight after menopause and suggests that thyroid hormone replacement would help her lose weight and speed up her metabolism. What is the nurse's best response?

The body compensates for the extra hormone by reducing the amount secreted.

A client with type 1 diabetes has told the nurse that the client's most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding?

The client's insulin levels are inadequate.

A patient's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patient's drug regimen. What principle will guide this aspect of the patient's treatment?

The drug should be used for as short a time as possible.

The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic?

The need for lifelong steroid replacement

The nurse, working in the emergency department, receives a patient following a motor vehicle accident whose medical history is unknown with a blood glucose level of 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?

The stress reaction caused an increase in blood sugar

The nurse is providing discharge teaching for a patient prescribed prednisone to be taken on alternate days. The patient asks why he cannot take half a pill every day. What is the nurse's best response?

To decrease adrenal suppression

After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the patient's body?

To inhibit production of thyroid hormone in the thyroid gland

A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

Two to three soft bowel movements daily

A client is admitted to the ICU with acute pancreatitis. The client's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of clients with acute pancreatitis have what health issue?

Undiagnosed chronic pancreatitis

Family members of an immunocompromised patient have asked the nurse why antibiotics are not being given to the patient in order to prevent infection. How should the nurse best respond?

Using antibiotics to prevent infections can cause the growth of drug-resistant bacteria

A patient with diabetes insipidus is taking desmopressin (DDAVP). He or she is complaining of drowsiness, lightheadedness, and headache. What does the nurse suspect that he is experiencing?

Water intoxication

A client is receiving pharmacologic therapy for treatment of hyperthyroidism and is prescribed propylthiouracil (PTU). When developing this client's plan of care, the nurse integrates understanding that this drug:

blocks synthesis of T3 to T4.

A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what priority topic?

Current medication use