Medical Surgical Nursing
a client with RA has increasing fatigue and is unable to manage all of his usual activites, which of the following nursing interventions is most appropriate? 1) encourage the client to alternate periods of rest and activity throughout the day 2) instruct the client to not perform daily hygiene care until activity tolerance improves 3) encourage the client to perform all tasks early in the day 4) adminster opiods to promote pain relief and rest
1) encourage the client to alternate periods of rest and activity throughout the day
A client who has an appendectomy for a perforated appendix returns from surgery with a drain inserted in the incision, whats the purpose of the drain? 1) decrease post-op discomfort 2) promote drainage of wound exudates 3) provide access for wound irrigation 4) minimize developement of scar tissue
2) promote drainage of wound exudates
which assessment finding supports a suspicion of SLE 1) photosensitivty, polyarthralgia, and painfu mucuous membrane ulcers 2) weight gain, hypervigilance, hypothermia, and edema of the legs 3) facial erythema, pericarditis, pleuritis, fever, and weight loss 4) hypotherima, weight gain, lethargy, and edema of the arms
3) facial erythema, pericarditis, pleuritis, fever, and weight loss
a client is admitted completely immobilized with an exacerbation of MS, two days later the client crys and refuses to see family members, the nurse formulates a nursing diagnoses of hopelessness. to address this ND which intervention should the nurse include in the plan? 1) encourage the client to verbalize his feelings 2) reinforcing the clients responsibility to the family 3) obtaining a sedation order 4) limiting visitors to a 15 minute interval, four times per day
1) encourage the client to verbalize his feelings
a client was diagnosed with MS three years ago, he now reports weakness and heaviness in their lower extremities, he presents his advance directive that state his wishes if his condition deteriorate. how should the nurse respond? 1) it is important for us to have this info, you should review the document with your physician at every admission 2) thank you for providing this document, ill include it in your permanent record 3) your too young and your disease hasnt progressed enough to follow an advanced directive 4) advance directives arent necessary for a client your age
1) it is important for us to have this info, you should review the document with your physician at every admission
a client with SLE comes to the ED with severe back pain, she reports feeling pain after manually opening her garage door and that she is taking prednisone daily, what long term affect of corticosteriods is most likely causing this pain? 1) osteoprosis 2) muscle wasting 3) truncal obesity 4) hypertension
1) osteoprosis, they are all adverse affects of corticosteriods - however, osteoprosis commonly causes compression fractures of the spine
after teaching a client about RA, which statement indicates the client understands the disease process? 1) it will never get any better than it is right now 2) i will have periods where i feel better, and periods where i feel worse 3) once it clears up, it will never come back 4) i will need surgery for this
2) i will have periods where i feel better, and periods where i feel worse
a patient on your floor is feeling dizzy and falls on the floor, after attending the client a nurse reports an incident report, which action by the nurse should the charge nurse correct? 1) submitting the incident report to the appropriate hospital administrator 2) making a copy of the incident report for the client 3) notifying the physicians of the incident and the clients condition 4) documenting the incident factually in her nurses note
2) making a copy of the incident report for the client
When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnoses of Risk for infection related to inflammation, perforation, and surgery. whats the rationale for choosing this ND? 1) the appendix may develop gangrene and rupture, especially in middle aged client 2) obstruction of the appendix may increase venous drainage and cause the appendix to rupture 3) obstruction of the appendix reduces aterial flow, leading to ischemia, inflammation, and rupture of the appendix 4) infection of the appendix diminishes necrotic arterial blood flow and increase venous drainage
3) obstruction of the appendix reduces aterial flow, leading to ischemia, inflammation, and rupture of the appendix
a client with sle complains that his hands become pale, blue, and painful when exposed to the cold. what disease should the nurse cite as an explanation for these s&s? 1) peripheral vascular disease 2) arterial occlusive disease 3) raynauds disease 4) buergers disease
3) raynauds disease
which intervention would be most effective in helping the client deep breath and cough after a cholecystectomy? 1) have client take rapid, shallow breaths to decrease pain 2) having the client lay of the left side while coughing and deep breathing 3) teach the client to use a folded blanket or pillow to splint the incision 4) withholding pain meds so the client can be alert enough to follow the nurses instructions
3) teach the client to use a folded blanket or pillow to splint the incision
a client underwent a laparoscopic cholecystectomy, which instruction should the nurse provide for discharge? 1) if you become nauseated, breathe deeply into a paper bag 2) empty the bile bag daily 3) keep adhesive dressings in place for 6 weeks 4) report bile colored drainage from incision
4) report bile colored drainage from incision
a patient with RA reports GI irritation after taking piroxicam (feldene), to prevent GI upset the nurse should provide which instruction? 1) use the drug for a short time only 2) decrease the piroxicam dosage 3) space the administration every 4 hours 4) take piroxicam with food or antacid
4) take piroxicam with food or antacid
what is an appropriate outcome with a patient who has RA? 1) the client will take anti-inflammatory medications as indicated by the presence of disease symptoms 2) the client will maintain full ROM in joints 3) the client will prevent the developement of further pain and joint deformity 4) the client will manage joint pain and fatigue to perform ADL's
4) the client will manage joint pain and fatigue to perform ADL's
why is an incentive spirometery essential after surgery in the upper abd areas? 1) the client will be maintained on bed rest for several days 2) ambulation is restricted by the presence of the drainage bags 3) the presence of NG tube inhibits deep breathing 4) the operative incision is near the diaphragm
4) the operative incision is near the diaphragm
whats the goal when meds are prescribed to treat RA? 1) to prevent osteoprosis 2) to encourage bone regeneration 3) to cute the disease 4) to control inflammation
4) to control inflammation
SLE attacks which tissues? 1) lung 2) connective 3) nerve 4) heart
2) connective
a client who had a laparoscopic cholecystectomy receives discharge teaching from the nurse. which statement indicates the client understands the teaching? 1) i can anticipate some nausea for several days after surgery 2) i can remove the dressing from my incision tomorrow and take a shower 3) i need to maintain a low-fat diet for the next 6 months 4) i can return to work in 4 to 6 weeks
2) i can remove the dressing from my incision tomorrow and take a shower
which statement shows that a client needs more education about the cause of an exacerbation of SLE 1) i need to work on managing stress in my life 2) i dont have to worry if i get strep throat 3) i need to stay away from sunlight 4) i dont have to worry about changing my diet
2) i dont have to worry if i get strep throat
which statement by the client with RA would indicate the need for additional teaching to safely receive asprin therapy? 1) i always take aspirin with food to protect my stomach 2) i try to take aspirin only on days when the pain seems bad 3) once i learned to take my aspirin with meals, i was able to start using the inexpensive generic brand 4) i always watch for bleeding gums of blood in my stool
2) i try to take aspirin only on days when the pain seems bad
which activity/condition can exaceberate MS? 1) ROM excercises 2) pregnancy 3) urine retention 4) swimming
2) pregnancy
a client is taking methotrexate for RA, the nurse instructs the client that it will be necessary to monitor her? 1) sedimentation rate 2) serum glucose 3) serum electrolytes 4) CBC with differential and platelete count
4) CBC with differential and platelete count
a client is scheduled for an open cholecystectomy who has a history of smoking for the past 20 years, for which post-op complication is the client most at risk for? 1) DVT 2) delayed wound healing 3) prolonged immobility 4) atelectasis and pneumonia
4) atelectasis and pneumonia
which statement by the client refers to the move overt clinical manifestation of RA? 1) i have trouble with my balance 2) my legs feel weak 3) i have pain in my hands 4) my finger joints are oddly shaped
4) my finger joints are oddly shaped
a nurse is teaching a client who has a laparoscopic cholecystetomy about post op pain management, which of the following statement indicates the client has deficient knowledge? 1) my diet should include eating bland foods until the gas clears up 2) my pain should be relieved by walking to eliminate the gas 3) my pain is related to the gas used to distend my abd cavity 4) my pain is related to the large incision and manipulation
4) my pain is related to the large incision and manipulation
which laboratory findings should be reported to the physician immediately? 1) potassium- 4.2 2) sodium- 135 3) WBC count- 22.8 4) hematocrit- 42
3) WBC count- 22.8
What kind of rash is associated with lupus? 1) papular 2) pustular 3) butterfly 4) bulls eye
3) butterfly
a client with appendicitis is experiencing excruciating abd pain, an abd x-ray shows intrapertioneal air, the nurse should prepare the client for? 1) surgery 2) colonoscopy 3) NG tube insetion 4) barium enema
1) surgery
the patient with RA tells the nurse she feels "alone". which nursing intervention is most appropriate in response to this statement? 1) tell the client about her communitys arthritis support groups 2) refer the client and her husband to consueling to decrease her sense of isolation 3) suggest that the client discuss her feelings with her minister 4) suggest that the client develop a hobby to occupy her time
1) tell the client about her communitys arthritis support groups
a client with an incisional cholecystectomy, which is the highest priority post-op for this patient? 1) using an incentive spirometer every two hours while awake 2) promoting incisional healing 3) maintaing a weight reduction diet 4) performing leg exercises every shift
1) using an incentive spirometer every two hours while awake
during the first weeks after a cholecystectomy the diet should include? 1) at least four servings of daily of meat, cheese, and peanut butter to increase protein intake that aids in incisional healing 2) a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at one time 3) ingestion of pancreatic enzymes with meals to replace the normal enzyme secretion that has been surgically altered 4) a decreased intake of fruits, veggies, whole grains, and nuts to minimize pressure within the small intestine
2) a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at one time
a client with RA states " i cant do my household chores without becoming tired. my knees hurt whenever i walk". which goal for the client should take priority? 1) adapt body image 2) conserve energy 3) develop coping skills 4) adapt self-care skills
2) conserve energy
After a subtotal gastrectomy, the nurse is developing a plan with the client to gain weight. what should the nurse provide the clients nutritional goals to be at home? 1) inform the client that bland food are typically less nutritional and should be used minimally 2) encourage the client to eat smaller amounts more frequently 3) instruct the client to increase the amount eaten at each meal 4) explain that if vomitting occurs after a meal, nothing more should be eaten that day
2) encourage the client to eat smaller amounts more frequently
which intervention should the nurse suggest to a patient with MS to avoid an episode of urinary incontinence? 1) limit fluid intake to 1000 ml/day 2) establish a regular voiding schedule 3) insert an indwelling catheter 4) administer prophylactic antibiotics, as ordered
2) establish a regular voiding schedule
the nurse is assigning care of a client admitted with appendicitis, she should assign the care of the client to? 1) licensed practical nurse 2) registered nurse 3) clinical nurse specialist 4) nursing assistant
2) registered nurse
a client with MS is receiving baclofen (lioresal). the nurse knows the drug is effective when? 1) reduces the urine bacterial count 2) relieves muscular spasticity 3) stimulates the clients appetite 4) induces sleep
2) relieves muscular spasticity
A client admitted to the ED complains of severe abd pain and elevated WBC count. The physicians diagnose is appendicitis, the nurse knows the client is at greatest risk for? 1) inflammation of the gallbladder 2) rupture of the appendix 3) emotional distress related to the pain 4) ulceration of the appendix
2) rupture of the appendix
a patient with MS is admitted with respiratory problems, which equipment should be by the patients beside? 1) padded tongue blade 2) suction machine with catheters 3) nasal cannula and oxygen 4) sphygmomanometer
2) suction machine with catheters
a client undergoes a laprascopic cholecystectomy, what dietary instructions should the nurse give immediately after surgery? 1) you can progress from a liquid diet as tolerated 2) you may resume your normal diet the day after your surgery 3) drink liquids today and eat lightly for a few days 4) you cannot eat/drink anything for 24 hours
3) drink liquids today and eat lightly for a few days
a client with MS told their nurse they did not wish to be resuscitated in the event of cardiac arrest, the client is no longer able to state their wishes and the family informed the physician that they want to client to be resuscitated. aware of the clients wishes, the nurse is in a situation that may cause? 1) confidentiality 2) paternalism 3) ethical distress 4) decpetion
3) ethical distress
a nurse is caring for a client with MS. the client informs the nurse the lawyer is coming to prepare a living will and requests the nurse to sign as a witness, which of the following actions should the nurse take? 1) arrange for another colleagues to sign as a witness 2) state that the physician will be a witness 3) inform the physician about the living will 4) note that the nurse caring for the client cannot be a witness
4) note that the nurse caring for the client cannot be a witness
the client reports gnawing epigastric pain following meals and heartburn, the nurse suspects the client has? 1) ulcerative colitis 2) appendicitis 3) diverticulitis 4) peptic ulcer disease
4) peptic ulcer disease
the client comes to the ED with an appendicitis, the client has a pain level of 10, on a scale of 1-10. the client is going to surgery as soon as possible, the nurse should? 1) apply heat to the abd area of the pain 2) contact the surgeon to request an order for narcotic for the pain 3) maintain the client in a recumbent position 4) place the client in NPO status
4) place the client in NPO status
a client is suspected of having SLE and is being scheduled for testing. she asks which of the tests will determine if she is positive for the disorder, which statement by the nurse is most accurate? 1) sle is a very serious disorder 2) tell me more about your concerns about this potential diagnoses 3) the diagnoses wont be based on the finding of a single test but by combining all data found 4) you should discuss that matter with your physician
3) the diagnoses wont be based on the finding of a single test but by combining all data found
Which of the following statements indicate that the client with PUD understands how to effectively adjust the response to work related stress? 1) I will have to improve my ability to cope with stress 2) I don't have any control over my stressors at work. My coworkers are difficult to work with 3) Well, I guess this ulcer means I wont be able to work toward a job promotion 4) My job is to stressful, I will have to find a new career
1) I will have to improve my ability to cope with stress
During an appt the physician tells the client of the diagnoses of SLE, which resource might be helpful for the nurse to recommend to the client? 1) a support group for clients with sle 2) a consult with a home health care nurse 3) an occupational therapy consult 4) a consult with a social worker
1) a support group for clients with sle
Which diet should a client with PUD have after discharge? 1) any foods that are tolerated 2) high-protein foods 3) a glass of milk with each meal 4) bland foods
1) any foods that are tolerated
a physician orders a corticosteriod for a child with SLE, the nurse knows the purpose of the corticosteriod is? 1) combat inflammation 2) prevent infection 3) promote diurese 4) prevent platelet aggregation
1) combat inflammation
to reduce the risk of dumping syndrome the nurse should teach the client to do which of the following? 1) decrease the carbohydrate content of meals 2) sit upright for 30 minutes after meal 3) avoid milk and other dairy products 4) drink liquids with meals, avoiding caffeine
1) decrease the carbohydrate content of meals
a client has a jackson pratt drain with a portable suction unit attached to the cholecystectomy site, after 4 hours the bag is full, the nurse should: 1) empty the drainage bag 2) check the dressing for bleeding 3) notify the surgeon 4) remove the drain and suction unit
1) empty the drainage bag
which s&s of a client with SLE concerns the nurse that they may be having a life threatening complication 1) foamy urine 2) butterfly rash on the face 3) joint pain 4) fever
1) foamy urine
