Med Surg Final Exam
A
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? A. A1C 9% B. BP 126/80 C. FBG 130 D. LDL cholesterol 100
B, D
Dermatologic manifestations of addison's disease can include (select all that apply) A. urticaria B. loss of body hair C. increased sweating D. generalized hyperpigmentation E. hypopigmentation in the legs and trunk
B
During the assessment of a patient, you note an area of red, sharply defined plaques covered with silvery scales that are mildly itchy on the patient's knees and elbows. You recognize this finding as A. lentigo B. psoriasis C. actinic keratosis D. seborrheic keratosis
A
Important patient teaching after a chemical peel includes A. avoidance of sun exposure B. application of firm bandages C. limitation of vigorous exercise D. use of moist heat to relieve discomfort
B
In assessing the joints of a patient with osteoarthritis, the nurse understands that Heberden's nodes A. are often red, swollen and tender B. indicate osteophyte formation at the DIP joints C. are the result of pannus formation at the PIP joints D. occur from deterioration of cartilage by proteolytic enzymes
D
In teaching a client with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes? A. circulating immune complexes formed from IgG autoantibodies reacting with IgG. B. an autoimmune T-cell reaction that results in destruction of the deep dermal layer C. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles D. the production of a variety of autoantibodies directed against components of the cell nucleus
B, D
In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell that patient that (select all that apply) A. the cream form is the most efficient system of delivery B. short term use of topical corticosteroids usually does not cause systematic side effects C. creams and ointments should be applied with a glove in small amounts to prevent further infection D. abrupt discontinuation of the topical steroids may cause a reappearance of the dermatitis E. systematic side effects may occur from topical corticosteroids if the person is malnourished.
C
In teaching a patient with Sjögren's syndrome about drug therapy fro this disorder, the nurse includes instruction on the use of which drug? A. Pregabalin B. Etanercept C. Cyclosporine D. Cyclobenzaprine
A
In teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the patient's prognosis is most dependent on A. thickness of the lesion B. the degree of asymmetry in the lesion C. the amount of ulceration in the lesion D. how much the lesion had spread superficially
B
Polydipsia and polyuria related to diabetes mellitus are primarily due to? A. the release of ketones from cells during fat metabolism B. fluid shifts resulting from the osmotic effect of hyperglycemia C. damage to the kidneys from exposure to high levels of glucose D. changes in RBCs resulting from attachment of excessive glucose to hemoglobin
A, B, C
Teach a patient with fibromyalgia the importance of limiting intake of which foods? (select all that apply) A. sugar B. alcohol C. caffeine D. red meat E. Root vegetables
B
The nurse determines that a patient with the diagnosis of which disorder is most at risk for spreading the disease? A. tinea pedis B. impetigo of the face C. candidiasis of the nails D. psoriasis on the palms and soles
A
The nurse should teach the patient with ankylosing spondylitis the importance of? A. regularly exercising and maintaining proper posture B. avoiding extremes in environmental temperatures C. maintaining usual physical activity during flare ups D. applying hot and cold compresses for relief of local symptoms
C
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? A. Call the physician B. Administer insulin ordered C. Check the patient's blood glucose level D. Assess for other neurological symptoms
B
When administering medications to the patient with gout, the nurse would recognize that which drug is used as a treatment for the disease? A. colchicine B. febuxostat C. sulfasalazine D. cyclosporine
A, C, E
Which are appropriate therapies for patients with diabetes mellitus? (select all that apply) A. use of statins to treat dyslipidemia B. use of diuretics to treat nephropathy C. use of ACE inhibitors to treat nephropathy D. use of serotonin agonists to decrease appetite E. use of laser photocoagulation to treat retinopathy
A
Which statement by the patient with type 2 diabetes is accurate? A. "I am supposed to have a meal or snack when I drink alcohol" B. "I am not allowed to eat any sweets" C. "I do not need need to watch what I eat" D. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar"
D
Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. The patient must receive insulin therapy to prevent ketoacidosis B. The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin C. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome
A, B, D
Which sun safe practices would the nurse include in the teaching care plan for a patient who has photosensitivity? (select all that apply) A. wear protective clothing B. apply sunscreen liberally and often C. emphasize the short term use of a tanning booth D. avoid exposure to the sun, especially during the midday E. wear any sunscreen as long as it is purchased at a drug store
A, D, E
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge? (select all that apply) A. Insulin administration B. Elimination of sugar from diet C. Need to reduce physical activity D. Use of a portable blood glucose monitor E. Hypoglycemia prevention, symptoms and treatment
C
A common site for the lesions associated with atopic dermatitis is the A. butt B. temporal area C. antecubital space D. plantar surface of the feet
C
A diabetic patient has a serum glucose level of 824 and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of? A. polyuria B. severe dehydration C. rapid, deep respirations D. decreased serum potassium
A
A mother and her two children have been diagnosed with pediculosis corporis at a health care center. An appropriate measure in treating their condition is A. applying pyrethrins to the body B. topical application of griseofulvin C. moist compresses applied frequently D. administeration of systematic antibiotics
B, C, D, E
A nurse is admitting an older adult client who has suspected osteoporosis. Which of the following is an expected finding? (select all that apply) A. History of consuming one glass of wine daily B. Loss in height of 2 in C. Body mass index of 21 D. Kyphotic curve at upper thoracic spine E. History of lactose intolerance
B, C, D, E
A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (select all that apply) A. Weight gain B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis
A, D, E
A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (select all that apply) A. Heberden's nodes B. Swelling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking
B, D, E
A nurse is caring for a client who has RA. Which of the following laboratory tests are used to diagnose this disease? (select all that apply) A. Urinalysis B. Erythrocyte sedimentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count
C
A nurse is caring for a client who has blood glucose 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck blood glucose in 15 mins B. Provide a carbohydrate and protein food C. Provide 4 oz of grape fruit juice D. Report findings to the provider
B
A nurse is caring for a client who has contact dermatitis and has a new prescription for diphenhydramine. For which of the following adverse effects should the nurse monitor? A. Elevate blood glucose B. Urinary retention C. Hyperpigmentation of the skin D. Insomnia
B
A nurse is caring for a client who injured her lower back during a fall and describes sharp pain in her back and down her left leg. In which of the following positions should the nurse plan to place the client in to attempt to decrease pain? A. Prone without use of pillows B. Semi-Fowler's with a pillow under the knees C. High-Fowler's with a pillow under the knees D. Supine with the head flat
B, C, D, E
A nurse is educating a female client on the use of calcipotriene topical medication for the treatment of psoriasis. Which of the following information should the nurse include? (select all that apply) A. Recommend for facial lesions B. Expect a stinging sensation upon application C. Apply to the scalp D. Obtain a pregnancy test E. Limit application to the skin folds
A, C, D, E
A nurse is performing health screenings at a health fair. Which of the following clients are at risk for osteoporosis? (select all that apply) A. A 40 y/o client who takes prednisone for asthma B. A 30 y/o client who jogs 3 miles a day C. A 45 y/o client who takes phenytoin for seizures D. A 65 y/o client who has a sedentary lifestyle E. A 70 y/o client who has smoked for 50 years
A, B, C, E
A nurse is planning discharge teaching on home safety for an older adult who has osteoporosis. Which of the following information should the nurse include in the teaching? (select all that apply) A. Remove throw rugs in walkaways B. Use prescribed assistive devices C. Remove clutter from the environment D. Walk with caution on icy surfaces E. Maintain lighting of doorway areas
C
A nurse is preparing to administer IV fluids to a client who has diabetic ketoacidosis. Which of the following actions should the nurse take? A. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr B. Administer an IV infusion of 0.45% sodium chloride C. Rapidly administer an IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when serum glucose is 350
B
A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse implement? A. Check blood glucose immediately after breakfast B. Adminster insulin when breakfast arrives C. Hold breakfast for 1 hr after insulin administration D. Clarify the prescription because insulin should not be given at this time.
C
A nurse is preparing to administer a morning dose of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take? A. Draw up regular insulin and then the glargine insulin in the same syringe B. Draw up glargine insulin and then the regular insulin in the same syringe C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.
A, B, C, E
A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? (select all that apply) A. Eat less meat and processed foods B. Decrease intake of saturated fats C. Increase daily fiber intake D. Limit saturated fat intake to 15% of daily caloric intake. E. Include omega-3 fatty acids in the diet
B
A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following is an appropriate action by the nurse? A. Apply heat to the puncture site B. Place the client in a supine position C. Turn the client every 1 hr D. Ambulate the client within the first hour post procedure
B
A nurse is providing dietary teaching about calcium-rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions? A. white bread B. white beans C. white meat D. white rice
A, B, C, E
A nurse is providing discharge teaching to a client who has experienced diabetic ketoacidosis. Which of the following information should the nurse include in the teaching? (select all that apply) A. Drink 2 L fluids daily B. Monitor blood glucose every 4 hrs when ill C. Administer insulin as prescribed when ill D. Notify the provider when blood glucose is 200 E. Report ketones in the urine after 24 hrs of illness
A, C, D
A nurse is providing information about a new prescription for corticosteroid cream to a client who had mild psoriasis. Which of the following instructions should the nurse include? (select all that apply) A. Apply an occlusive dressing after application B. Apply three or four times per day C. Wear gloves after application to lesions on the hands D. Avoid applying to skin folds E. Use medication continuously over a period of several months
B
A nurse is providing information about capsaicin cream to a client who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include? A. Continuous pain relief is provided B. Inspect for skin infection irritation and cuts prior to application C. Cover the area with tight bandages after application D. Apply the medication every 2hr during the day
A, B, C, E
A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include? (select all that apply) A. Apply heat to joints to alleviate pain B. Ice inflamed joints following activity C. Install an elevated toilet seat D. Take tub baths E. Complete high-energy activities in the morning
A, D, E
A nurse is providing teaching for a client who has a history of low back injury. Which of the following instructions should the nurse give the client to prevent future problems with low back pain? (select all that apply) A. Engage in regular exercise including walking B. Sit for up to 10 hrs each day C. Maintain weight within 25% of ideal body weight D. Create a smoking cessation plan E. Wear low heeled shoes
C
A nurse is providing teaching to the parent of a child who has contact dermatitis. Which of the following information should the nurse include? A. Use fabric softener dryer sheets when drying the child's clothing B. Apply a warm, dry compress to the rash area C. Place the child in a bath with colloidal oatmeal. D. Leave the child's hands uncovered during the night
B
A nurse is reviewing laboratory reports of a client who has hyperglycemic-hyperosmolar state (HHS). The nurse should expect which of the following findings? A. Serum pH 7.2 B. Serum osmolarity of 350 C. Serum potassium of 3.8 D. Serum creatinine of 0.8
A, B, C, D
A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). The nurse should identify that which of the following data confirm this diagnosis? (select all that apply) A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 E. No insulin production
B
A nurse is teaching a client who has a history of psoriasis about photochemotherapy and ultraviolet light (PUVA) treatments. Which of the following instructions should the nurse include in the teaching? A. Apply vitamin A cream before each treatment B. Administer a psoralen medication before the treatment C. Use this treatment every evening D. Remove the scales gently following treatment
A
A nurse is teaching a client who has a new diagnosis of RA. Which of the following statements should the nurse include in the teaching? A. "You can experience morning stiffness when you get out out bed" B. "You can experience abdominal pain" C. "You can experience weight gain" D. "You can experience low blood sugar"
C, D, E
A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (select all that apply) A. Remove calluses using over the counter remedies B. Apply lotion between the toes C. Perform nail care after bathing D. Trim toenails straight across E. Wear closed-toe shoes
A, B, E
A nurse is working in an outpatient clinic assessing a client who has rheumatoid arthritis. The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (select all that apply) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Increased blood pressure E. Pain at rest
D
A patient with acne vulgaris tells the nurse that she has quit her job as a receptionist because she believes her facial appearance is unattractive to the customers. The nursing diagnosis that best describes this patient response is A. ineffective coping related to lack of social support B. impaired skin integrity related to presence of lesions C. anxiety related to lack of knowledge of the disease process D. social isolation related to decreased activities secondary to fear of rejection
B, E
A patient with rheumatoid arthritis is experiencing articular involvement of the joints. The nurse recognizes that these characteristic changes include? (select all that apply) A. bamboo shaped fingers B. metatarsal head dislocation in feet C. noninflammatory pain in the large joints D. asymmetric involvement of small joints E. morning stiffness lasting 60 minutes or more
