Med Surg 1 Prep U

A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client

"Only you are to push the button for medication."

A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies

"What do you mean by the word sick?"

Which of the following is the appropriate response to the statement, "I'm so nervous about my surgery"?

"You seem nervous about your surgery."

Which of the following solutions is hypotonic?

0.45% NaCl

The nurse expects informed consent to be obtained for insertion of:

A gastrostomy tube

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?

Acidic

Which of the following would be considered an urgent surgical procedure?

Acute gallbladder infection

A client with appendicitis has an appendectomy. After surgery, what type of pain does the nurse anticipate the patient will have?

Acute pain

Patients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

Adrenal

A physically fit 86- year old is scheduled for right knee placement. What factor in this client makes them at increased risk for surgery?

Age

Which of the following is the most common cause of symptomatic hypomagnesemia?

Alcoholism

A 78 year old woman is undergoing right hip surgery to repair a hip fracture. What nursing action is appropriate during the intra-operative phase?

Appropriately position the patient using adequate padding and support

The nurse is completing a post op assessment for a patient who has received a depolarizing NMJ. The nursing assessment includes careful monitoring of which body system?

Cardiovascular because depolarizing muscle relaxants can cause cardiac dysrhythmias

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?

Chest pain

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:

Circulating nurse

The nurse is caring for a patient with a serum sodium level of 113 mEq/L. The nurse should monitor the patient for the development of which of the following?

Confusion

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?

Coordinating the surgical team

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration?

Dark, concentrated urine

A 70 year old patient who's to undergo surgery arrives at the operating room. The nurse when reviewing the patients medical record, understands that this patient will require a lower dose of anesthetic agent because of what?

Decreased lean tissue mass

A 73-year-old male client was admitted to your hospital unit after 2days of vomiting and diarrhea. His wife became alarmed when he demonstrated confusion and elevated temperature and reported "dry mouth."You suspect the client is experiencing which of the following conditions?

Dehydration

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults?

Dehydration

The nurse is monitoring the patient in shock. The patient begins bleeding from previous venipuncture sites, in the indwelling catheter, and rectum, and the nurse observes multiple areas of ecchymosis. What does the nurse suspect has developed in this patient?

Disseminated intravascular coagulation (DIC)

The community health nurse finds the client collapsed outdoors. The nurse assesses that the client is shallow breathing and has a weak pulse. The 911 is called by the neighbor. Which nursing action is helpful while waiting for the ambulance?

Elevate the legs higher than the heart.

A client who experienced shock is now nonresponsive and having cardiac dysrhythmias. The client is being mechanically ventilated, receiving medications to maintain renal perfusion, and is not responding to treatment. In this stage, it is most important for the nurse to

Encourage the family to touch and talk to the client.

What term refers to a protrusion of abdominal organs through the surgical incision?

Evisceration

Which type of healing occurs when granulation tissue is not visible and scar formation is minimal?

First intention

A patient with an abdominal surgical wound sneezes and states, "Something doesn't feel right with my wound." The nurse assess the upper half of the surgical wounds ages are no longer approximated and the lower half remains well approximated. What documentation by the nurse is the most appropriate?

Following a sneeze, the sound dehisced

Elevating the patient's legs slightly to improve cerebral circulation is contraindicated in which of the following disease processes?

Head injury

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?

Hypercalcemia

The nurse is educating a community group regarding types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true?

The excision of a tumor

0.45% sodium chloride is a ___________ solution.

Hypotonic

A client arrives in the orthopedic clinic with complaints of twisting the right ankle while playing softball. The nurse collects data including complaints of pain and swelling in the right ankle. What intervention will the nurse provide that will decrease vasodilation and reduce localized swelling?

Ice bag

An anxious preoperative surgical patient is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used?

Imagery

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which?

Insensible fluid loss

A patient is in the progressive stage of shock with lung decompensation. What treatment does the nurse anticipate assisting with?

Intubation and mechanical ventilation

Lactated Ringers solution is a ____________ solution

Isotonic

Whats the most important issue concerning safety for the preoperative team prior to proceeding to the operating room?

Its imperative that the entire preoperative team participates in the verifying the correct patient identity, surgical procedure and surgical site.

As a circulating nurse, what task are you sole responsible for?

Keeping records

With which condition should the nurse expect that a decrease in serum osmolality will occur?

Kidney failure

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

Light-headedness or paresthesia

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?

Limit sodium and water intake.

According to The Joint Commission's pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment?

Location, onset, alleviating factors, and aggravating factors

What is the highest priority nursing intervention for a patient in the immediate post op phase?

Maintaining a patient airway

The PACU nurse is caring for an older adult who presents with clinical manifestations of delirium. Which short-term outcomes would be most important for this client?

Maintains adequate oxygenation status

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?

Metabolic acidosis

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing?

Metabolic alkalosis

Which positioning strategy should be utilized for the patient diagnosed with hypovolemic shock?

Modified Trendelenburg

A priority nursing intervention for a client with hypervolemia involves which of the following?

Monitoring respiratory status for signs and symptoms of pulmonary complications.

An 82-year-old client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. He is without breakthrough pain at this point in time. How would his pain be classified?

Neuropathic and chronic

A 64-year-old client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and is lethargic. Serum sodium level is above 145 mEq/l. Should the nurse start salt tablets when caring for this client?

No, sodium intake should be restricted.

A high school football player hurts his foot while playing a game. He complains of intense pain with muscle spasms and swelling of the toe. Which of the following pain assessment tools will the nurse most likely use to assess the patient's pain level?

Numeric Rating Scale (NRS)

The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully?

Older adults are more sensitive to drugs

The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?

Older adults experience reduced sensory perception

Which of the following is a correct route of administration for potassium?

Oral

Which phase of pain transmission occurs when the brain experiences pain at a conscious level?

Perception

The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain?

Place the client in a modified Trendelenburg position.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?

Prepare to assist with ventilation.

The scrub nurse is responsible for

Preparing the sterile instruments for the surgical procedure

Opioid analgesics are effective pain management tools for many clients. A significant demographic within your practice are older adults who suffer from chronic pain. What impact does their age have on their initial dosing?

Reduce dose

When caring for a postsurgical patient, the nurse observes that the client has hemorrhaged and is in hypovolemic shock. Which of the following nursing interventions will manage and minimize hemorrhage and shock?

Reinforcing dressing or applying pressure if bleeding is frank

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects:

Respiratory alkalosis

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?

Respiratory alkalosis

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate?

Respiratory alkalosis

The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to:

Respond verbally during the procedure

Once the operating team has assembled in the room, the circulating nurse calls for a "time out". What action should the nurse take during the time out?

Review the scheduled procedure, site, and client

Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis?

Sodium bicarbonate

When a patient is in the compensatory stage of shock, which of the following symptoms occurs?

Tachycardia

A physician calls the nurse for an update on his client who underwent abdominal surgery 5 hours ago. The physician asks the nurse for the total amount of drainage collected in the Hemovac since surgery. The nurse reports that according to documentation, no drainage has been recorded. When the nurse finishes on the telephone, she goes to assess the client. Which assessment finding explains the absence of drainage?

The Hemovac drain isn't compressed; instead it's fully expanded

The nurse is caring for the client in the pre op period and documenting rationale for a palliative surgical procedure. Which rationale is most appropriate?

The client and physician are focusing on symptom relief not a cure

When does the nurse understand the patient is knowledgeable about the impending surgical procedure?

The patient participates willingly in the preoperative preparation.

A client is placed on the operating table for the surgical procedure. Which surgical team member is responsible for handling sterile instruments to the surgeon and assistants

The scrub nurse

The nurse is teaching the client about patient-controlled analgesia. Which of the following would be appropriate for the nurse to include in the teaching plan?

Therapeutic drug levels can be maintained more evenly with patient-controlled analgesia.

When a person who has been taking opioids becomes less sensitive to the drug's analgesic properties, that person is said to have developed a

Tolerance

T or F: The most common colloid solution used to treat hypovolemic shock is 5% albumin

True

When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that patient may show signs of alcohol withdrawal delirium during which time period?

Up to 72 hours after alcohol with drawal

Your caring for a client 6 hours post surgery. You observe that the client voids urine frequently and in small amounts. You know that this most probably indicates what?

Urine retention

What priority intervention can the nurse provide to decrease the incidence of septic shock for patients who are at risk?

Use strict hand hygiene techniques.

At what point does the preoperative period end?

When the client is transferred onto the operating table

When assessing a postoperative client, the nurse is correct to relate which surgical risk factor that would decrease if the surgical client maintained a blood glucose level under 150 mg/dL?

Wound healing

Nursing assessment findings reveal a temp of 103.2 F, tachycardia, and client complaints of increased incisional pain. the nurse recognizes the clients experiencing

Wound infection