Med surge 2 questions

A client diagnosed with Parkinson disease will be starting ropinirole for symptom control. Which statement by the client indicates a need for further teaching?

"I know the drug will probably make help me prevent constipation."

Why are you testing my stool?"

11

You ask further questions about the clinical manifestations of PAD. Which of these would you expect S.P. to have, given the diagnosis of PAD? Select all that apply.

Paresthesia Elevation pallor Dependent rubor Rest pain at night

can LPN IV push

no

A client diagnosed with a brain tumor is receiving phenytoin. The client's partner questions the use of the drug, since there is no history of a seizure disorder. What response will the nurse provide to be best address the partner's concern?

"Increased pressure from the tumor can cause seizures."

The family of an unconscious dying client realizes that their mother will die soon. The client's children are having a difficult time letting go. How does the nurse respond to the needs of this family?

"This must be difficult for you."

Which statements would the nurse include when promoting the prevention of lower back pain? (Select all that apply.)

"Wear flat instead of high-heeled shoes to work each day." "Avoid prolonged standing or sitting, including driving." "Participate in an exercise program to strengthen back muscles."

Why can't this blood thinning medication be given orally?"

2

Client questions - "My doctor said I needed to stop smoking. How does smoking have anything to do with my swollen leg?"

5

What can I do to help decrease the swelling in my leg?

6

"I read on the internet that I should not move my leg because the clot will dislodge and go to my lungs. Is that true?

8

The home care nurse is doing a weekly visit to a client with Alzheimer's disease. What statement by the client would be of greatest concern? A."When I go to the grocery store to get a few things, it takes me a really long time to get home." getting lost on the way home B."My daughter organizes my medications and I have an alarm that goes off to let me know when to take them." C."Sometimes when the phone rings I am not sure how to answer it so I just let it ring until it stops." D."I thought you were going to come to see me last week but you didn't come until I called you today."

A."When I go to the grocery store to get a few things, it takes me a really long time to get home." getting lost on the way home

A client who has been experiencing chest pain takes aspirin when he has an attack of angina. Which of the following are contraindications to aspirin use? Select all that apply. A.An allergy to NSAIDs B.A client who has mitral valve prolapse C.The presence of inflammation D.Thrombocytopenic purpura- low platelet E.A child with chicken pox- reyes syndrome

A.An allergy to NSAIDs D.Thrombocytopenic purpura- low platelet E.A child with chicken pox- reyes syndrome

A client who has suffered a myocardial infarction requires percutaneous transluminal coronary angioplasty. The nurse is preparing the client for the procedure. Which information should be given as part of pre-operative teaching for the client? A.Explain that the client will have a sand bag or closure device placed on the site to provide pressure after the procedure B.Describe the procedure, its risks and benefits, and potential alternative treatments C.Discuss that the client will have some body hair shaved and he will feel a cold, tingling sensation during the procedure D.Tell the client that he will not be awake during the procedure and he won't feel a thing

A.Explain that the client will have a sand bag or closure device placed on the site to provide pressure after the procedure

Which of the following interventions will you implement for a patient with angina? Select all that apply. A.Give oxygen per nasal cannula B.Administer nitroglycerin sublingually C.Raise the head of bed to 30° D.Administer IV morphine- anxiety reduce slow RR E.Administer NSAID crushed

A.Give oxygen per nasal cannula B.Administer nitroglycerin sublingually D.Administer IV morphine- anxiety reduce slow RR

The home care nurse is doing an initial assessment for a client with a diagnosis of Alzheimer's disease and congestive heart failure. What assessment findings indicate a potential risk to the client's safety? Select all that apply. A.Lives with daughter who works outside the home all day. Will they wander and get hurt B.Struggles with telling time on the large wall clock. Disoriented to time and place, safety concern in the house or outside C.Able to ambulate without assistive devices. D.Often disoriented to place and time. E.Has meals delivered when daughter is at work.

A.Lives with daughter who works outside the home all day. Will they wander and get hurt B.Struggles with telling time on the large wall clock. D.Often disoriented to place and time.

During an initial assessment of a client with coronary artery disease, the nurse wants to assess the client's dietary intake to determine if diet is contributing to his health condition. Which question would most likely give the nurse an idea of the client's everyday diet? A.Please tell me what food and drinks you have had in the past 24 hours B.How much milk do you drink? C.I will say the name of a food, and you tell me if you like it or not D.Are you allergic to any medications?

A.Please tell me what food and drinks you have had in the past 24 hours

A nurse is caring for a client complaining of chest pain. A 12-lead EKG (ECG) shows normal sinus rhythm. After 30 minutes, the client's lab work results and shows elevated troponin. What are the priority interventions at this time? Select all that apply. A.Repeat the EKG (ECG) B.Administer the ordered morphine C.Re-evaluate the chest pain D.Re-draw the troponin E.Notify the provider

A.Repeat the EKG (ECG) C.Re-evaluate the chest pain E.Notify the provider

A client who has recovered from cardiac surgery is getting ready to go home from the hospital. The nurse is providing discharge care instructions to the client before he leaves. What information would the nurse include as part of discharge instructions? Select all that apply. A.Tests or blood work that need to be done B.A list of medications and when to take them C.Activities that are allowed and what to avoid D.Information about how to manage cardiac complications at home E.What signs or symptoms that require a call to the provider

A.Tests or blood work that need to be done B.A list of medications and when to take them C.Activities that are allowed and what to avoid E.What signs or symptoms that require a call to the provider

A 77-year-old client is seen in the ED for chest pain. The provider orders lab work to determine if damage has been done to the heart muscle. Which lab tests are cardiac enzymes (biomarkers) that would be ordered to check for heart damage? Select all that apply A.Troponin B.Creatinine C.BNP D.CK-MB E.Myoglobin

A.Troponin D.CK-MB E.Myoglobin

A dying client exhibits signs of agitation. The Foley catheter has drained 100 mL in the last 3 hours, and the client's last bowel movement was yesterday evening. What does the nurse do first?

Administer an analgesic.

A nurse teaches assistive personnel (AP) about how to care for a client with Parkinson disease. Which statement would the nurse include as part of this teaching?

Allow the client to be as independent as possible with activities."

A dying patient is having difficulty swallowing oral meds. Which intervention does the nurse implement?

Ask the provider if the meds can be discontinued or substituted

In addition to risk factor modification, what other measures to improve tissue perfusion or prevent skin damage should you recomment to S.P.? Select all that apply.

Avoid exposure to cold temperatures Avoid crossing the legs Take steps to prevent trauma or injury to the skin

The nurse just received reports on the following 4 clients. Which client should the nurse see first? A.91-year-old female with abdominal pain rating pain at 8/10 B.40-year-old male with chest pain C.29-year-old male with an anxiety attack D.10-year-old female with eye pain

B.40-year-old male with chest pain

A nurse is caring for a client who is 4 hours postop following CABG surgery. The client is able to inspire 200 mL with the incentive spirometer, then declines to try to cough because of fatigue and pain. Which of the following actions should the nurse take? A.Allow the client to rest, and return in 1 hour B.Administer IV bolus of analgesic, and return in 15 minutes C.Document the 200 mL as an appropriate inspired volume D.Tell the client coughing after incentive spirometry is required

B.Administer IV bolus of analgesic, and return in 15 minutes

A client with Alzheimer's disease has had difficulties eating and is not getting enough nutrients in his diet. The client's daughter asks the nurse if there is anything that can be done to improve his nutrition intake. Which recommendation should the nurse give? A.Limit calories to have better control of behavior B.Provide stand-by assistance when the client eats to offer support C.Help the client choose his own eating utensils D.Use more salt when cooking and serving food

B.Provide stand-by assistance when the client eats to offer support

S.P. has been on aspirin (ASA) therapy but now will be taking clopidrogrel (Plavix) instead. What is the most important aspect of patient teaching that you will emphasize with this drug?

BLEEDING stop before surgery GI Upset 1-2 hr before meals

The nurse is admitting a client who states, "When I was pregnant I would get heartburn so bad, I was eating antacids like crazy. I now feel the same way, except I am not pregnant. The antacids aren't helping me and now I have this pain between my shoulder blades." Which part of this statement is most concerning and must be investigated further? A."When I was pregnant I would get heartburn so bad" B."I was eating antacids like crazy" C."I have this pain between my shoulder blades" D."The antacids aren't helping me"

C."I have this pain between my shoulder blades"

The nurse visits an older adult home care client who is bedridden and being cared for by her family. The nurse is discussing with the client and family about the importance of changing position in bed. The nurse's teaching is direct toward preventing complications in which area when a client is immobile? A.Nausea B.Jaundice C.Atelectasis D.Mental confusion

C.Atelectasis

A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse suspect? A.Retroperitoneal bleeding B.Cardiac tamponade C.Bleeding from the incisional site D.Heart failure

C.Bleeding from the incisional site

An adult client presents to the emergency department with a chief complaint of heartburn. What is the nurse's immediate priority? A.Find out the last time the client had oral intake B.Start an IV C.Call for an EKG D.Inspect the client's mouth

C.Call for an EKG

A 44-year-old client is recovering in the hospital following a myocardial infarction. The client asks the nurse about participation in cardiac rehabilitation. Which of the following is an accurate explanation of cardiac rehabilitation? A.Cardiac rehabilitation is designed to teach a person what to do if they have a heart attack again B.Cardiac rehabilitation is designed for people over the age of 60 for additional physical therapy after a heart attack C.Cardiac rehabilitation can help you to improve activity levels and exercise tolerance after a heart attack D.Cardiac rehabilitation is designed only for people who were born with congenital heart disease and have experienced a heart attack

C.Cardiac rehabilitation can help you to improve activity levels and exercise tolerance after a heart attack

A rapid, jerky, involuntary, and purposeless movement of the extremities or facial muscles is:

Chorea

Which client would the RN assess first? Client with hyperthyroidism who is exhibiting exophthalmos Client with type 1 diabetes who has an inflamed foot ulcer Client with Cushing's disease exhibiting moon face Client with Addison's disease showing tremors and diaphoresis

Client with Addison's disease showing tremors and diaphoresis

A nurse in the emergency room has clients that are all complaining of pain. The nurse knows that the client having pain in which of the following areas is the priority? A.Bilateral flank B.Lower back C.Lower abdomen D.Jaw and neck

D.Jaw and neck

Four clients in the emergency room have complaints of chest pain. The nurse should assess which client first? A.Constant chest pain 2/10; HR 110 B.Chest pain 0/10 after sublingual nitroglycerin C.Chest pain 6/10 after motor vehicle accident D.New chest pain 8/10; diaphoretic

D.New chest pain 8/10; diaphoretic

The nurse is assessing a client who is coughing so hard that his chest hurts. The client is holding his chest and asking for pain medications. What is the priority for this client? A.Get the client cough syrup B.Give the client water C.Give the client pain medications D.Obtain orders for an EKG (ECG)

D.Obtain orders for an EKG (ECG)

When debriefing the nursing staff after a confused client has fallen, the nurse stresses the need for client safety. The nurse knows the staff understands safety when they make which statement? A.The client should eat a balanced diet. B.The client should not receive pain medicine. C.The client should have all four side rails up at all times. D.The client should wear non-skid footwear when ambulating. Prevent falls

D.The client should wear non-skid footwear when ambulating. Prevent falls

Upon further assessment, Ms. Collins' lungs are clear, pulses are 2+ bilaterally in radial and pedal pulses, S1 and S2 are present with a loud systolic murmur over the mitral and tricuspid valves. She has small bruises on her hands and arms and says her fingers are always cold. She admits to the use of IV heroin and cries that she wants to stop using. Per the provider, you insert a 20g peripheral IV in her left forearm and send a CBC and BMP. Her vital signs are as follows: BP 98/62 mmHg Ht 170 cm HR 92 bpm and regular Wt 55 kg RR 32 bpm SpO2 92% on Room Air Temp 37.9°C Pain 4/10, "comes and goes". What other orders do you anticipate the provider ordering for Ms. Collins?

EKG, chest x-ray, supplemental O2, pain control, anticoagulants (prevent clots), echo, ABG, UA (tox screen), blood cultures, antibiotics, lactic acid labs,

The ED provider orders the following: Blood - Blood Cultures x 2, Lactate level Diagnostics - CXR, Cardiac Echo. Interventions - 12-Lead ECG. Nasal Cannula to keep SpO2> 92%. Meds - Vancomycin 1,000mg IVPB one time, now. Morphine 2 mg PRN q4h for pain. Which order would you implement first?

EKG-chest pain!! infection vs MI blood cultures vancomycin Technically pt is stable so ABC don't apply

Which health teaching will the nurse include as part of the discharge planning related to the cllient's DVT management and prevention of a new DVT? Select all that apply.

Elevate your legs on a couple of pillows when in bed Wear knee-high graduated compression stockings Apply prolonged pressure over cuts and nosebleeds Increase your activity slowly and rest when needed Keep your scheduled appontment at the Coumadin (warfarin) clinic Contact your primary health care provider if your stool is black and tarry Monitor your heart rate and blood pressure daily Avoid eating foods that are high in fat and cholesterol

The client with a brain tumor may be at increased risk for aspiration. What does the nurse determine is the most important nursing intervention?

Evaluation of gag reflex and ability to swallow

A client diagnosed with lung cancer 6 months ago is now ventilator dependent and unresponsive. The family wants to remove the ventilator and stop antibiotics and IV fluids. What is the best nursing action?

Facilitates a meeting between the family and the healthcare team

The nurse is coordinating interdisciplinary palliative care interventions for the dying client. Which goal is the nurse seeking to meet?

Facilitating a peaceful death for the client

Which assessment findings would alert the nursing to a complication specific to an open traditional anterior cervical fusion? (Select all that apply.)

Hoarse voice Difficulty swallowing

Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia?

Huntington disease

You provide teaching on proper care of his feet and lower extremities, then use "teach-back" to assess S.P.'s learning. Which statements by S.P. indicate a need for further education? Select all that apply.

I can go barefoot in the house, but not outside.- more sus to injury/tramua I will soak my feet in water once a day to make sure they are clean.- cant feel temp, avoid masuration

The RN provides teaching to a client who is prescribed prednisone 10mg orally daily. Which statements by the client indicate that teaching was effective? Select all that apply I can take aspirin if I need it for pain I need to take the medication at the same time daily I need to check for bruising on my skin If I gain more than 5 lbs a week, I will call my provider

I need to take the medication at the same time daily I need to check for bruising on my skin If I gain more than 5 lbs a week, I will call my provider

A nurse assesses a client who is recovering from an open traditional lumbar laminectomy with fusion. Which complications would the nurse report to the primary health care provider? (Select all that apply.)

Incisional bulging Sudden and severe headache Clear drainage on the dressing

A nurse is completing an assessment of a client who has increased intercranial pressure (ICP). Which of the following are expected findings? (Select all that apply).

Increasing disorientation to time and place Restlessness and irritability Headache

The RN suspects a postoperative client who had a thyroidectomy may have had an inadvertent removal of the parathyroid when the client began to experience which symptoms Select all that apply. Hematoma formation Laryngeal stridor Tingling of lips, hands, and toes Positive Chvostek's sign Sensation of fullness at the incision site

Laryngeal stridor Tingling of lips, hands, and toes Positive Chvostek's sign

Which medication is the most effective agent in the treatment of Parkinson disease?

Levodopa

Which adaptation of the environment is most important for the RN to include in the plan of care for a client diagnosed with myxedema? Reduce environmental stimuli Prevent direct sunlight from entering the room Maintain a warm room temperature Minimize exposure to visitors

Maintain a warm room temperature

A nurse is caring for a client who has just undergone a craniotomy for a brain tumor and has a respiratory rate of 12 breaths per minute. Which of the following postoperative prescriptions should the nurse clarify with the provider?

Morphine 2mg IV Push q2 hours PRN Pain

1. What are the likely sources of his calf pain and hip pain?

Occlusion-calf Osteoarthritis-hip pain

A dying client becomes increasingly withdrawn and begins to refuse to eat and drink. What intervention does the nurse implement?

Offers ice chips

The nurse cares for a client with Huntington disease. What intervention is a priority for safe care?

Protecting the client from falls

What actions would the nurse take after discovering cerebrospinal fluid leaking onto a client's surgical dressing? (Select all that apply.)

Report the leak to the surgeon immediately. Place the client in a flat position.

A client dying of cancer is receiving high doses of opioids. In addition, which intervention is the most effective for this client?

Short, light massage

2. S.P. has several risk factors for PAD. From his history, list 2 risk factors, and explain the reason they are risk factors.

Smoking Diet Obesity Hypertension Hyperlipidemia

The nurse assesses a client who has Parkinson disease. Which signs and symptoms would the nurse recognize as a key feature of this disease? (Select all that apply.)

Stooped posture Uncontrolled drooling Slow movements

A dying client says to the nurse "I am afraid to die. I did a lot of things wrong in my life " how does the nurse respond

Tell me more about that

You decide to look at S.P.'s lower extremities. What signs do you expect to find with PAD? Select all that apply.

Thick, brittle nails Cool or cold extremity Thin, shiny, and taut skin Decreased or absent pedal pulses

what labs are concerning? and why?

UA-blood and protein ABNORMAL BUN& Creatine are HIGH Sodium is LOW

The father of a dying client says, " I don't want my dad to be uncomfortable " how does the nurse respond?

Your father will be closely monitored and cared for

What is plasmapheresis?

a method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the RBC back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions.

Upon further assessment, Ms. Collins' lungs are clear, pulses are 2+ bilaterally in radial and pedal pulses, S1 and S2 are present with a loud systolic murmur over the mitral and tricuspid valves. She has small bruises on her hands and arms and says her fingers are always cold. She admits to the use of IV heroin and cries that she wants to stop using. Per the provider, you insert a 20g peripheral IV in her left forearm and send a CBC and BMP. Her vital signs are as follows: BP 98/62 mmHg Ht 170 cm HR 92 bpm and regular Wt 55 kg RR 32 bpm SpO2 92% on Room Air Temp 37.9°C Pain 4/10, "comes and goes". What are your top concerns? Why are they concerning?

concerns- low BP, RR high, poor perfusions, why- low cardiac output, increased RR pt will tire out and eventually go into failure,

The 12-lead ECG shows normal sinus rhythm at 96 bpm with no ST abnormalities. After drawing blood cultures, you initiate the Vancomycin IVPB. The echocardiogram is completed which shows vegetation on valves and moderate to severe endocarditis with an EF of 50%. She is still complaining of chest pain so you also administer 2 mg Morphine IV push and place her on a bedside monitor. Ms. Collins's lab results have resulted, the following abnormal values were reported: WBC 23,000/mcL BUN 38 mg/dL Creatinine 2.4 mg/dL Lactate 2.7 mmol/L You return 30 minutes later to take another set of vital signs and find Ms. Collins' left eye and mouth drooping, she reports a new headache. You notify the provider who orders a STAT Head CT. The scan shows multiple small embolic strokes. What, physiologically, is going on with Ms. Collins at this time?

endocarditis kidney is first to go

Ms. Collins, a 25-year old female, presents to the Emergency Department (ED) complaining of chest pain and tooth pain. You notice her eyes are bloodshot and she has what appear to be recent track marks from IV drug use on her arms. She is breathing rapidly and seems very uncomfortable. She has very poor dentition and appears to have multiple cavities and broken teeth. She denies any medical history. What initial nursing assessments need to be performed for Ms. Collins?

heart sounds, BP, HR, lung sounds, pain, s/s of HF, pulse, skin temp, cap refil, dizziness,

S.P. tells you his neighbor told him to keep his legs elevated higher than his heart and asks for compression stockings to keep swelling down in his legs. How should you respond?

legs should be kept in a dependent position to allow for blood flow

Which condition when assessed in a dying client, requires that the nurse take action?

moaning

can LPN give blood products

no

What is the purpose of the daily aspirin (ASA) listed in S.P.'s current medications?

prevent platelet aggregation prevent occulsion in the graft Anti platelet prevent platelets clotting together

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to:

reduce cerebral edema

You counsel S.P. on risk factor modification. What would you address and why?

smoking, diet, exercise, adhering to medication regimen