med surg

a novice nurse provides aftercare instructions to a client who has just had sutures removed. Which statement by the novice nurses requires the nurse preceptor to clarify?

" if the wound edges are red or raised, you should call your doctor"

A nurse has just completed teaching with a client who has been prescribed a meter dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse further teaching and follow-up care is necessary?

"i do not need to rinse my mouth with this type of inhaler"

the nurse is planning the care for a client at risk for developing pulmonary embolism. what nursing interventions should be included in the care plan? select all that apply

1. Encourage a liberal fluid intake 2. instructing the client to move the legs in a " pumping" exercise 3. using elastic stockings, especially when decrease mobility would promote venous stasis. 4. Applying a sequential compression device.

The nurse recognizes that which of the following clients is at least risk for preoperative complications?

A 65 year old Caucasian man who has a history of arthritis

A nurse is caring for a client after a thoracentesis. Which sign, if noted in the client, should be reported to the physician immediately.

Client is becoming agitated and complains of pleuric pain

A nurse is assessing a client who comes to the clinic for care. Which finding in this client suggest bacterial pneumonia?

Dyspnea and wheezing

The nurse is physically preparing a client for surgery. What are does the nurse know needs to be addressed before the client is taken to the operating room?

Elimination

A client is recovering form a thoracic surgery needed to perform a right lower lobectomy. Which of the following is the most likely postoperative interventions?

Encourage coughing to mobilize secretions

A client who is post- thoracotomy is retaining secretions. What is the nurse's initial intervention?

Encourage the client to cough

A client is postoperative and prescribed an incentive spirometer. The nurse instructs the client to:

Expect coughing when using the spirometer properly.

A nurse is obtaining a health history form a client who reports hemoptysis for the past 2 months. the client reports occasional dyspnea. which imaging study, ordered by the physician, will view the thoracic cavity while in motion?

Fluoroscopy

A patient seen in the emergency room for a severe case of diabetes acidosis. The respiratory note indicates the presence of Kussmaul's respirations. The nurse knows that this diagnosis is associated with which of the following?

Hyperventilation

In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress. Which finding is the earliest sign of reduced oxygenation?

Increased restlessness

The nurse is caring for a postoperative client with an indwelling urinary catheter. The hourly urinary output is 80ml at 9am. At 10 am, the nurse assesses the hourly urinary output as 20ml. What is the priority action by the nurse?

Notify the primary care provider immediately

The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiatory wheeze. Respiration rate is 20, temperature is 99.8 (taken orally), heart rate us 87, and blood pressure is 124/70. what is the best action by the nurse?

Notify the surgeon to possibly delay surgery

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next?

Outline the drainage with a pen and record the date and time next to the drainage.

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurements best reflect the adequacy of alveolar ventilation?

PaCO2

The nurse is providing client teaching to a client diagnosed with acute rhinosinustis. For what possible complications should the nurse teach the client to seek immediate follow-up?

Periorbital edema

The nurse is caring for a client with an endotracheal tube. Which client data does the nurse interpret as a lfie threatening situation?

Sudden restlessness

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:

Uses the stenocleidomastoid muscles

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the clients care plan?

Using strict hand hygiene

The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated?

Wheezes

The nurse at an employee wellness clinic is meeting with a client who reports voice hoarseness for more than 2 weeks. To determine if the client has symptoms of early laryngeal cancer, the next question the nurse would ask is, "do you have...".

a persistent cough and sore throat

A first-line antibiotic used to treat rhinosinusits is

ampicillin

The nurse is caring for a client in the post anesthesia care unit (PACU). the client has the following vital signs: pulse 115, respirations 20, oral temp 97.2 and blood pressure 84/50. what should the nurse do first?

check for bleeding

which of the following is the key underlying feature of asthma?

inflammation

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. which of the following would the nurse correctly identify?

1. The client will leave the hospital sooner 2. Need for teaching is increased 3. The client must be prepared to take on more self-care than he or she have done before

a nursing school student is taking pathophysiology exam. which of the following would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease? All that apply

1. inflamed airway that obstructs airflow 2. mucus secreationsthat block airways 3. over-inflated alveoli that impair gas exchange

Why would a client with COPD report feeling fatigued? select all that apply

1. lung function gradually decreases over time in clients with COPD 2. The client is using all expendable energy just to breath.

Following a thoracic surgery. what would be included in the care plan for a client at risk for impaired gas exchange? select all that apply

1. monitor vital signs frequently 2. Reinforce preoperative breathing exercises. 3. Elevate head of bed 30 to 40 degrees as tolerated

a nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? choose all that apply

1. respiratory distress 2. status asthmaticus 3. atelectasis

The nurse is providing discharge teaching for a client who develops a pulmonary embolism after total knee surgery. The client has been converted from heparin to sodium warfarin anti coagulation therapy. What should the nurse teach the client?

Anticoagulant therapy usually last between 3-6 months

When the nurse observes that postoperative client demonstrates a constant low level of oxygen saturation via the O₂ saturation monitor despite the clients breathing appearing normal, what action should the nurse take first?

Assess the clients heart rhythm and nail beds

Which of the following interventions would be most appropriate for a client who has undergone surgery for a liver disorder and has started shivering?

Cover the client with a light blanket

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

A safe environment

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand as the main goal of treatment?

Providing sufficient oxygen to improve oxygenation

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. which of the following is the most likely drug to be prescribed?

Albuterol

A PACU nurse is caring for a postoperative client who received general anesthesia and has a hard, plastic oral airway in place. The patient has clear lung sounds, even and unlabored respiration of 16, and 98% oxygen saturation. The client in minimally responsive to painful stimuli. What action should the nurse take?

Continue to monitor client assessment frequently

Which client would the nurse recognize as having the greatest risk for complications during the inter operative or postoperative period?

The 35 year old client with non-insulin dependent diabetes

A client is administered succinlcholine and propofol for induction of anesthesia. one hour after administration, the client demonstrates rigidity with a heart rate of 180. What should the nurse do first?

Notify the surgical team

Arterial blood gas analysis would reveal which value related to acute respiratory failure?

Ph 7.28

During the surgical procedure, the client's temperature falls to 96.6. Which of the following nursing actions is inappropriate?

Place a cooling blanket under the client

The nurse, caring for a patient with emphysema, understand that airflow limitations are not reversible. the end result of deterioration is:

Respiratory acidosis

The nurse in the ICU is caring for a client with a nasotracheal tube. Because of the tube placement, the nurse understands that the client is at risk for developing?

Sinus infection

The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment?

Tachypnea

A client is prescribed postural drainage because secreations are accumulating in the upper lobes of the lung. The nurse instructs the client to:

Take prescribed albuterol (ventolin) before performing postural drainage

A client is visiting the emergency department because of massive bleeding form the nose that will not stop. Blood is on the client's shirt, and bleeding form the nose continues. The nurse intervenes by

Telling the client to sit upright with the head tilted forward

Which of the following is a symptom diagnosis of emphysema?

dyspnea

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The client has been receiving high flow- oxygen therapy for an extended time. What symptoms would suggest that the client is experiencing oxygen toxicity?

dyspnea and substernal pain

The nurse is caring for a client who is receiving oxygen therapy for pneumonia. The nurse should best assess whether the client is hypoxemic by monitoring the clients?

oxygen saturation level.

An older adult client has been diagnosed with COPD. What characteristic of the clients current health status would rule out the safe and effective use of metered-dose inhaler

the client has sever arthritis in her hands

The nurse initiates the following interventions upon reeving a client back to the clinical unit after a throat-related procedures. "elevate the head of the bed 45 degrees:. This assists in meeting which nursing goal?

the client will have decreased edema

The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurses priority?

Place the side rails up in the up position and make sure the call button is in reach

A client abruptly sits up in bed, reports difficulty breathing and has an arterial oxygen saturation of 88%. Which oxygen delivery method would give the greatest level of inspired oxygen?

nonrebreather mask