Med Surg Exam 4

A 50 year old woman with hypertension has a serum potassium level that has acutely risen to 6.2 milliequivalents per liter. Which order should be questioned? A) limit foods high in potassium B) calcium gluconate IV piggyback C) administer IV insulin and glucose D) spironolactone daily

A

A client develops moist crackles and dyspnea while receiving an IV infusion at 150 mL per hour. based on this information, which intervention should be the nurse's first priority? A) stop the infusion and notify the HCP B) administer oxygen stat via nasal cannula at 2 L per minute C) elevate the head of bed to 90° D) encourage the client to cough and deep breath

A

A client with fluid overload would have which of the following clinical signs? A) increased respirations, hypertension, peripheral edema B) fever, weak pulse, hypotension C) decreased respirations, urine specific gravity above 1.025, confusion D) afebrile, rhonchi, urine specific gravity less than 1.010

A

A patient with leukemia is considering whether to have hemopoietic stem cell transplantation. Which information should the nurse include in the patient's teaching plan? A) hospitalization is required for several weeks after the stem cell transplant B) transplant of the donated cells can be painful because of the nerves in the tissue lining the bone C) the transplant procedure takes place in a sterile operating room to decrease the risk for infection D) donor bone marrow is transplanted through external or hip incision

A

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making iContact. The patient asked the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which patient problem should the nurse identify? A) anxiety B) denial C) ineffective adherence to treatment D) acute confusion

A

Eight years after seroconversion, a patient with human immunodeficiency virus (HIV) infection has a CD4+ cell count of 800 and an undetectable viral load. What should be included in the plan of care at this time? A) encourage adequate nutrition, exercise, and sleep B) teach about the side effects of antiretroviral agents C) monitor symptoms of acquired immunodeficiency syndrome (AIDS) D) explain opportunistic infections and antibiotic prophylaxis

A

The nurse is caring for a patient who smokes two packs a day. Which action by the nurse could help reduce the patient's risk of lung cancer? A) discuss risks associated with cigarettes during each patient encounter B) plan to monitor the patient's carcinoma embryonic antigen (CEA) level C) teach the patient about annual chest x-rays for long cancer screening D) teach the patient about the seven warning signs of cancer

A

Which labs can help you to determine the hydration status on your patient? select all that apply A) H/H B) BUN/creatinine C) liver functions D) BNP

A, B

What vital sign changes do you anticipate to see when a patient is dehydrated? (select all that apply) A) tachycardia B) low-grade fever C) hypotension D) hypertension

A, b, c

Signs of fluid volume overload include: select all that apply A) tachycardia B) hypertension C) shortness of breath D) edema

A, b, c, d

List 3 clinical manifestations of upper G.I. problems

Anorexia, weight loss, prolonged fluid and electrolyte imbalances

A nurse assesses a client laboratory values. The nurse should associate a serum sodium level of 122 mEq per liter with which in balance? A) Hypokalemia B) hyponatremia C) hypokalemia D) hypernatremia

B

A nurse is admitting a client who is experiencing abdominal cramping, diarrhea, muscle spasms, and tingling around the mouth. Which electrolyte in balance for the nurse associate with the signs? A) Hypermagnesemia B) hypercalcemia C) hyperphosphatemia D) hypochloremia

B

A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should: A) initiate oxygen therapy at 2 L per minute to increase gas exchange B) Place a patient in Fowler's position to relieve pressure on the diaphragm C) notify the healthcare provider so that a paracentesis can be performed D) ask the patient to cough and breathe deeply to clear respiratory secretions

B

A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate? A) Have the patient eat large meals when nausea is not present B) administer prescribed anti-emetics one hour before the treatments C) give the patient a glass of citrus juice during treatments D) offer dry crackers and carbonated fluids during chemotherapy

B

An older adult patient who has colorectal cancer is receiving IV fluids at 170 mL per hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the healthcare provider? A) patient reports having severe fatigue B) patient has crackles up to the midline posterior chest C) patient voids every hour during the day D) patient takes only 50% of meals and refuses snacks

B

A nurse assesses a newly admitted client and find the client has hyperactive deep tendon reflexes. Which potential electrolyte in balance should the nurse suspect? A) hypernatremia B) hypercalcemia C) hypomagnesemia D) hypokalemia

C

A patient being admitted with acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care? A) administer IV metoclopramide B) teach the patient about total colectomy surgery C) discontinue the patient's oral food intake D) administer Cobalmin injections

C

A patient who has Gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed? A) I quit smoking years ago, but I chew gum B) I take antacids between meals and at bedtime each night C) I eat small meals and have a bedtime snack D) I sleep at the head of the bed elevated on 4 inch blocks

C

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with pneumocystis Jodeci pneumonia (PCP) and a CD4+ count of less than 200 cells per milliliter. Based on diagnostic criteria established by centers for disease control and prevention (CDC), which statement by the nurse is correct? A) The patient will be diagnosed with asymptomatic chronic HIV infection B) the patient will likely develop symptomatic HIV infection within one year C) the patient has developed acquired immunodeficiency syndrome (AIDS) D) the patient meets the criteria for a diagnosis of acute HIV infection

C

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate? A) benign tumors are likely to recurrent the same location B) benign tumors do not cause damage to other tissues C) malignant tumors my spread to other tissues and organs D) malignant cells reproduce more rapidly than a normal cells

C

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates the teaching has been effective? A) I should keep something in my stomach all the time to neutralize the excess acids B) I can have a glass of low-fat milk at bedtime C) I will have to use herbal teas instead of caffeinated drinks D) I will have to eliminate all spicy foods from my diet

C

The nurse obtained information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alert to the nurse to discuss a possible change in cancer therapy with the healthcare provider? A) Nausea and vomiting B) elevated white blood cell count C) increased carcinoembryonic antigen D) frequent loose stools

C

What are clinical manifestations of total obstruction? A) Clay colored stools, low-grade temp, restlessness B) lethargy, high fever, petechiae C) dark amber urine, clay colored stools, pain, jaundice D) severe pain, dark amber urine, tolerance to fatty foods

C

What are the signs and symptoms of hypocalcemia? A) contractions, arrhythmias, tachypnea, slurred pulse B) cataracts, apprehension, tachycardia, spontaneous fractures C) convulsions, arrhythmias, tetany, stridor, spasms D) confusion, agitation, thirst, skin flushing, sweat

C

A nurse is monitoring a patient who is receiving IVF. Which clinical findings indicate that the patient has fluid overload? A) Blood in the tube in close to the insertion site B) chills, fever, and generalized discomfort C) pallor, swelling, and pain at the insertion site D) dyspnea, headache, and increased blood pressure

D

Signs and symptoms of hypokalemia include which of the following: A) hypertension, pedal edema, urinary retention B) rapid speech, flatulence, hyperflexia C) bounding post, cramps, muscle tetany D) paresthesia, orthostatic hypotension, muscle weakness

D

Your patient believes they may have Crohn's disease. What are some manifestations you would expect to see?

Diarrhea, cramping, weight loss, abdominal pain, fever, fatigue, rectal bleeding

List three lifestyle modification/teaching you can do to help your patient with GERD

Elevate head of bed 4 to 6 inches with blocks, do not eat right before bedtime/do not lie down right after meals, eat smaller portions of meals throughout the day

List three ways you could teach her patient to help relieve constipation without the use of medication

Increase fluid intake, increase dietary fiber, exercise

List two differences between an ileostomy and colostomy

Stool consistency of an ileostomy is liquid to semiliquid, while stool consistency of colostomy is formed; increase fluid requirement with ileostomy

True or false: diarrhea is considered chronic if it has lasted more than 30 days

True

the nurse is caring for a patient who has a massive burn injury and possible hypovolemia. Which assessment data should be of most concern to the nurse? A) oral fluid intake is 100 mL for eight hours B) blood pressure is 90/40 C) skin tenting over the sternum is prolonged D) urine output is 30 mL per hour

b

a patient who has sever pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective? a) The patient agrees to take medications by the IV route to improve analgesic effectiveness B) the patient states that nonopioid analgesic's may be used if the maximal dose of the opioids reach without adequate pain relief C) The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs D) the patient uses the ordered opioid pain medication whenever the pain is greater than five

c

True or false: an ERCP is used to diagnose diseases of the gold platter, pancreas, and liver

true

The nurse palpates in large cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. What action would be appropriate for the nurse to take? A) explain to the patient that this is an expected finding B) request that an antibiotic be prescribed for the patient C) instruct the patient to apply ice to the neck D) tell the patient a secondary infection is present

A

Which patient would benefit from education about HIV pre-exposure prophylaxis (PrEP)? A) A 52-year-old recently single woman just diagnosed with chlamydia B) a 33-year-old hospice worker who received a needlestick injury three hours ago C) a 60-year-old male in a monogamous relationship with an HIV uninfected partner D) a 23-year-old woman living with HIV infection

A

Your patient must undergo surgical intervention. Which comment indicates that additional instruction about the care of his new ileostomy is needed? A) I should change the appliance daily to prevent odors B) I should clean around the stoma with mild soap and water and pat dry C) I need to alter the appliance opening when the stoma will become smaller as the area heals D) when I change the appliance I should check the skin for irritation

A

The nurse explains to a patient with an episode of acute pancreatitis at the most effective means of relieving pain by suppressing pancreatic secretions is the use of A) Antibiotics B) antispasmodics C) NPO status D) proton pump inhibitors

C

List the four hallmark manifestations of an intestinal obstruction

Abdominal pain, nausea and vomiting, constipation, abdominal distention

A nurse suspects that an older adult may have a fluid and electrolyte imbalance. Which assessment best reflects fluid and electrolyte balance for an older adult? A) presence of tenting B) Serum laboratory values C) intake and output results D) condition of the skin

B

The nurse is caring for a patient diagnosed with stage one colon cancer. When assessing the need for a psychological support, which question by the nurse will provide the most information? A) are you familiar with the stages of emotional adjustment to cancer of the colon? B) Can you tell me what has been helpful when coping with past stressful events? C) Do you have any concerns about body image changes? D) How long ago were you diagnosed with this cancer?

B

what is the gold standard diagnostic study for detecting colon cancer? A) CT scan B) endoscopy C) colonoscopy D) heme occult test

C

The nurse administers an IV vesicant chemotherapeutic agents to a patient. Which action is most important for the nurse to take? A) hold the medication unless a central venous line is available B) administer the chemotherapy through a small bore catheter C) infuse the medication a very short period of time D) stop the infusion if swelling is observed at the site

D

Which focus data should the nurse assess after identifying 4+ pitting Edema on a patient who has cirrhosis? A) Hemoglobin B) temperature C) activity level D) albumin level

D

True or false: the criteria used to determine if a G.I. bleed is massive is: greater than 1000 mL blood loss

False (greater than 1500 mL)

List two late manifestations of cirrhosis

Jaundice, peripheral edema

The nurse reviewed the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the healthcare provider? A) white blood cells 2700 B) hemoglobin 10 g/L C) hematocrit 30% D) platelets 95,000

A

The nurse teaches a patient with a history of upper G.I. bleeding how to check for bloody stools. Which statement by the nurse is appropriate? A) stools that are black and Tarry occur with slow bleeding from the stomach B) blood is never obvious in stores and must be detected by a lab test C) if vomiting a bright red blood occurs doors will not be black and sticky D) acute bleeding in your stomach will cause bright red blood in your stool's

A

During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? A) schedule a sigmoidoscopy to provide baseline data B) obtain more information about the patient's relatives C) teach the patient about the need for a colonoscopy at age 50 D) teach the patient how to do home testing for a fecal occult blood

B

Is 74-year-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first? A) encourage the patient to increase oral fluid intake B) question the patient about risk factors for constipation C) suggest that the patient increase intake of high fiber foods D) teach the patient that a daily bowel movement is unnecessary

B

When evaluating a client being treated for fluid volume excess, a nurse determines that the fluid volume excess has not been resolved based on which of the following findings? A) decrease in urine specific gravity and increase in urine output B) crackles increased bilaterally in anterior and posterior lung fields C) level of consciousness improved to alert and oriented D) bilateral lower extremity's edema decreased to trace Edema

B

Patient was diagnosed with acquired immunnodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with morbid thoughts about dying". Which response by the nurse is appropriate? A) do you think they're taking an antidepressant might be helpful B) thinking about dying will not improve the course of AIDS C) can you tell me more about the thoughts that you were having D) it is important to focus on the good things about your life now

C

The most characteristic manifestations of hypocalcemia and hypomagnesemia is A) Anorexia and nausea B) lack of coordination C) tetany D) constipation

C

The nurse plans a presentation for community members about how to decrease the risk for antibiotic resistant infections. Which information will the nurse include in the teaching plan? Select all that apply A) antibiotics are effective in treating influenza associated with high fevers B) unused antibiotics that are more than a year old should be discarded C) continue taking antibiotics until all of the prescription is gone D) hand washing is effective in preventing many viral and bacterial infections E) antibiotics may sometimes be prescribed to prevent infection

C, d, e

The nurse is caring for a patient who is living with HIV and taking ART. Which information is most important for the nurse to address one planning care? A) The patient reports having no side effects from the medications B) the patient is unable to explain the effects of Lipitor C) the patient reports feeling constantly tired D) the patient reports missing doses of tenofovir AF/ entricitabine

D

The nurse should suggest which food choice for a patient scheduled to receive external beam radiation for abdominal cancer? A) Creamed broccoli B) fruit salad C) toasted wheat bread D) baked chicken

D

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." d. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured."

D

What are the signs and symptoms of hyperkalemia? A) monotone speech, urine diluted, rapid pulse, decreased tendon reflexes, elastic skin, respiratory distress B) muscle contraction, unequal pulses, rapid respirations, decreased sensations, erratic breathing, reduced mental status C) muscle spasms, uneven breath sounds, rapid pulse, decreased reflexes, EEG changes, and restlessness D) muscle cramps, urine abnormalities, respiratory distress, decreased cardiac contractility, EKG changes, reflexes

D

A forty-year-old woman, was previously admitted to the hospital for exacerbation of Crohn's disease. After beginning high-dose IV corticosteroid treatment for Crohn's disease, she developed in massive upper G.I. bleeding with bright red hematemesis and melena. The origin of her bleeding is likely at her...? What is the probable cause of her bleeding?

Likely in stomach or duodenum caused by high dose corticosteroids

Which drugs may be used for upper G.I. problems? A) anti-cholinergic, anti-histamines, corticosteroids B) 5HT3, anti-histamines, stool softeners C) corticosteroids, laxatives, substance P D) anticholinergic, pro kinetics, colaces

A

Which exposure by the nurse is most likely to require postexposure prophylaxis when the patient's HIV status is unknown? A) needle stick with a needle and syringe used for venipuncture B) contamination of open skin lesions with patient vaginal secretions C) splash into the eyes while emptying a bedpan containing stool D) bite to the arm that does not result in open skin

A

Which manifestation should nurse identify as the most serious complication associated with hyponatremia? A) lethargy, acute confusion, and decreased level of consciousness B) anorexia, nausea, and vomiting C) tachycardia, weak thready pulses, and decreased blood pressure D) generalized weakness, muscle cramps, and twitching

A

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement by the patient indicates a teaching was effective? A) The biopsy will determine how much longer I have to live B) the biopsy will help decide the treatment for my enlarged prostate C) the biopsy will indicate what are the cancer has spread to other organs D) the biopsy will remove the cancer in my prostate gland

B

When assessing a patient admitted with nausea and vomiting, which finding but supports the nursing diagnosis of deficient fluid volume? A) Difficulty breathing B) bradycardia C) tachycardia D) polyuria

B

Which nursing action will be most useful in assisting a young adult to adhere to a newly prescribed anti-retroviral therapy (ART) regimen? A) encourage the patient to join a support group for adults who are HIV positive B) help the patient develop a schedule to decide when the drug should be taken C) give the patient detailed information about possible medication side effects D) remind the patient of the importance of taking the medication as scheduled

B

Diagnostic testing is plan for a patient with a suspected peptic ulcer. The nurse explained to the patient of the most reliable test to determine the presence and location of an ulcer is A) CAT scan B) colonoscopy C) endoscopy D) ultrasound

C

Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile? A) teach the patient about why antibiotics will not be used B) order a diet without dairy products for the patient C) place a patient in a private room on contact isolation D) teach the patient about proper food storage

C

following a thyroidectomy, patient reports a tingling feeling around their mouth. Which assessment should the nurse complete first? A) verify the serum potassium level B) test for presence of Chvostek's sign C) observe for blood on the neck dressing D) confirm a prescription for thyroid replacement

B

which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? A) request that the patient stand on 1 foot B) ask the patient to extend both arms forward C) request that the patient walk with eyes closed D) ask the patient to perform the Valsalva maneuver

B