N491 Med-Surg HESI Practice Exam

A splint is prescribed for nighttime use by a client with rheumatoid arthritis. Which statement by the nurse provides the most accurate explanation for use of the splints? A. Relief of joint inflammation. B. Improvement in joint strength. C. Avoidance of joint trauma. D. Prevention of deformities.

D. Prevention of deformities.

A female client requests information about using the calendar method of contraception. Which assessment is most important for the nurse to obtain? A. An accurate menstrual cycle diary for the past 6 to 12 months. B. Previous birth-control methods and beliefs about the calendar method. C. Amount of weight gain or weight loss during the previous year. D. Skin pigmentation and hair texture for evidence of hormonal changes.

A. An accurate menstrual cycle diary for the past 6 to 12 months.

A client has been hospitalized with a femur fracture and is being treated with traction. Which action by the nurse is the priority when caring for this client? A. Assess neurovascular status. B. Change the client's position. C. Inspect the traction equipment. D. Review pain medication orders.

A. Assess neurovascular status.

The nurse is taking a history of a newly diagnosed Type 2 diabetic who is beginning treatment. Which subjective information is most important for the nurse to note? A. An allergy to sulfa drugs. B. Numbness in the soles of the feet. C. A history of obesity. D. Cessation of smoking three years ago.

A. An allergy to sulfa drugs. An allergy to sulfa drugs may make the client unable to use some of the most common antihyperglycemic agents (sulfonylureas). The nurse needs to highlight this allergy for the healthcare provider. (C) is common and warrants counseling, but does not have the importance of (A). (D) does increase the risk for vascular disease, but it is not as important to the treatment regimen as (A). Diabetic neuropathy, as indicated by (B), is common with diabetics, but when the serum glucose is decreased, new onset numbness can possibly improve.

A male client who smokes two packs of cigarettes a day states he understands that smoking cigarettes is contributing to the difficulty that he and his wife are having in getting pregnant and wants to know if other factors could be contributing to their difficulty. What information is best for the nurse to provide? (Select all that apply.) A. Alcohol consumption can cause erectile dysfunction. B. Cessation of smoking improves general health and fertility. C. Obesity has no effect on sperm production. D. Low testosterone levels affect sperm production. E. Marijuana cigarettes do not affect sperm count.

A. Alcohol consumption can cause erectile dysfunction. B. Cessation of smoking improves general health and fertility. D. Low testosterone levels affect sperm production.

The nurse is performing an ophthalmoscopic examination on a hypertensive client. When assessing the client, which finding indicates the severity of hypertension? A. Amount of retinal vessel damage that has occurred. B. Transparency of the cornea. C. Opague color of the sclera. D. Constriction and dilatation of the pupils.

A. Amount of retinal vessel damage that has occurred.

In assessing cancer risk, the nurse identifies which woman as being at greatest risk of developing breast cancer? A. A 50-year-old whose mother had unilateral breast cancer. B. A 55-year-old whose mother-in-law had bilateral breast cancer. C. A 20-year-old whose menarche occurred at age 9. D. A 35-year-old multipara who never breastfed.

A) A 50-year-old whose mother had unilateral breast cancer. The most predictive risk factors for development of breast cancer are over 40 years of age and a positive family history (occurrence in the immediate family, i.e., mother or sister). Other risk factors include nulliparity, no history of breastfeeding, early menarche and late menopause. Although all of the women described have one of the risk factors for developing breast cancer, (A) has the greater risk over (A, C, and D).

The nurse is assisting a client out of bed for the first time after surgery. Which action should the nurse do first? A. Allow the client to sit with the bed in a high Fowler's position. B. Place a chair at a right angle to the bedside. C. Encourage deep breathing prior to standing. D. Help the client to sit and dangle legs on the side of the bed.

A) Allow the client to sit with the bed in a high Fowler's position. The first step is to raise the head of the bed to a high Fowler's position (A), which allow venous return to compensate from lying flat and vasodilating effects of perioperative drugs. (B, C and D) are implemented after (A).

A 51-year-old truck driver who smokes two packs of cigarettes a day and is 30 pounds overweight is diagnosed with having a gastric ulcer. Which content is most important for the nurse to include in the discharge teaching for this client? A. Information about smoking cessation. B. Diet instructions for a low-residue diet. C. The importance of increasing milk in the diet. D. Instructions on a weight-loss program.

A) Information about smoking cessation. Smoking has been associated with ulcer formation, and stopping or decreasing the number of cigarettes smoked per day is an important aspect of ulcer management (A). Diet management includes a reduction in high-fiber/high-roughage foods as well as spicy foods. (B) would be indicated for inflammatory bowel disease. Sodium and caloric intake are not the key elements in an ulcer diet. Although this client does need (D), the management of his ulcer is the key factor at this point. (C) would actually increase gastric acid production.

Despite several eye surgeries, a 78-year-old client who lives alone has persistent vision problems. The visiting nurse is discussing home safety hazards with the client. The nurse suggests that the edges of the steps be painted which color? A. Medium yellow. B. Light green. C. White. D. Black.

A) Medium yellow. Yellow is the easiest for a person with failing vision to see (A). (D) will be almost impossible to see at night because the shadows of the steps will be too difficult to determine, and would pose a safety hazard. C) is very hard to see with a glare from the sun and it could hurt the eyes in the daytime to look at them. (B) is a pastel color and is difficult for elderly clients to see.

A 57-year-old male client is scheduled to have a stress-thallium test the following morning and is NPO after midnight. At 0130, he is agitated because he cannot eat and is demanding food. Which response is best for the nurse to provide to this client? A. "The test you are having tomorrow requires that you have nothing by mouth tonight." B. "I'm sorry sir, you have a prescription for nothing by mouth from midnight tonight." C. "I will let you have one cracker, but that is all you can have for the rest of tonight." D. "What did the healthcare provider tell you about the test you are having tomorrow?"

A. "The test you are having tomorrow requires that you have nothing by mouth tonight."

During suctioning, a client with an uncuffed tracheostomy tube begins to cough violently and dislodges the tracheostomy tube. Which action should the nurse implement first? A. Attempt to reinsert the tracheostomy tube. B. Ventilate client's tracheostomy stoma with a manual bag-mask. C. Position the client in a lateral position with the neck extended. D. Notify the healthcare provider for reinsertion.

A. Attempt to reinsert the tracheostomy tube.

A client presents with chronic venous insufficiency. Which assessment finding should the nurse anticipate? A. Bilateral lower leg stasis dermatitis. B. Intermittent claudication. C. Clubbing of fingers and toes. D. Peripheral cyanosis.

A. Bilateral lower leg stasis dermatitis Clients who suffer from chronic venous insufficiency often develop stasis dermatitis in the lower extremities. Stasis dermatitis appear as brownish-red discoloration on the lower extremities at the ankles which can develop into stasis ulcers due to the pooling of the venous blood flow back to the heart.

The nurse is caring for a client with a continuous feeding through a percutaneous endoscopic gastrostomy (PEG) tube. Which intervention should the nurse include in the plan of care? A. Check for tube placement and residual volume q4 hours. B. Obtain a daily x- ray to verify tube placement. C. Position on left side with head of bed elevated 45 degrees. D. Flush the tube with 50 ml of water q 8 hours.

A. Check for tube placement and residual volume q4 hours.

A client is newly diagnosed with diverticulosis. The registered nurse (RN) is assessing the client's basic knowledge about the disease process. Which statement by the client conveys an understanding of the etiology of diverticula? A. Chronic constipation causes weakening of colon wall which result in out-pouching sacs. B. Inflammation of the colon mucosa cause growths that protrude into the colon lumen. C. Over use of laxatives for bowel regularity result in loss of peristaltic tone. D. Diverticulosis is the result of high fiber diet and sedentary life style

A. Chronic constipation causes weakening of colon wall which result in out-pouching sacs.

An elderly client is admitted with a diagnosis of bacterial pneumonia. When observing the client for the first signs of decreasing oxygenation, the nurse should assess for which clinical cues? A. Confusion and tachycardia. B. Undue fatigue. C. Abominal distention. D. Cyanosis of the lips.

A. Confusion and tachycardia.

The nurse is interviewing a male client with hypertension. Which additional medical diagnosis in the client's history presents the greatest risk for developing a cerebral vascular accident (CVA)? A. Diabetes mellitus. B. Recurring pneumonia. C. Hypothyroidism. D. Parkinson's disease.

A. Diabetes mellitus A history of diabetes mellitus poses the greatest risk for developing a CVA (A). (B, C, and D) may place the client at some risk due to immobility, but do not present a risk as great as (A).

A client is admitted to the medical intensive care unit with a diagnosis of myocardial infarction. The client's history indicates the infarction occurred ten hours ago. Which laboratory test result would the nurse expect this client to exhibit? A. Elevated CK-MB. B. Elevated hematocrit. C. Elevated serum amylase. D. Elevated LDH.

A. Elevated CK-MB.

When providing discharge teaching for a client with osteoporosis, the nurse should reinforce which home care activity? A. Elimination of hazards to home safety. B. Skin inspection for bruising. C A diet low in phosphates. D. Exercise regimen, including swimming.

A. Elimination of hazards to home safety.

Which postmenopausal client's complaint should the nurse refer to the healthcare provider? A. Episodes of vaginal bleeding. B. Breasts feel lumpy when palpated. C. Excessive diaphoresis occurs at night. D. History of white nipple discharge.

A. Episodes of vaginal bleeding.

A male client receives a local anesthetic during surgery. During the post-operative assessment, the nurse notices the client is slurring his speech. Which action should the nurse take? A. Evaluate his blood pressure, pulse, and respiratory status. B. Determine the client is anxious and allow him to sleep. C. Continue to monitor the client for reactivity to anesthesia. D. Review the client's pre-operative history for alcohol abuse.

A. Evaluate his blood pressure, pulse, and respiratory status.

An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. When making a home visit, the nurse notices that his tongue is somewhat cracked and his eyeballs are sunken into his head. Which nursing intervention is indicated? A. Help the client to determine ways to increase his fluid intake. B. Schedule an appointment with an allergist to determine if the client is allergic to the cat. C. Obtain an appointment for the client to see an ear, nose, and throat specialist. D. Encourage the client to slightly increase his use of oxygen at night and to always use humidified oxygen.

A. Help the client to determine ways to increase his fluid intake.

The nurse is receiving report from surgery about a client with a penrose drain who is to be admitted to the postoperative unit. Before choosing a room for this client, which information is most important for the nurse to obtain? A. If the client's wound is infected. B. If the family would prefer a private or semi-private room. C. If suctioning will be needed for drainage of the wound. D. Prescription for removal of the drain.

A. If the client's wound is infected. Penrose drains provide a sinus tract or opening and are often used to provide drainage of an abscess. The fact that the client has a Penrose drain should alert the nurse to the possibility that the client is infected. To avoid contamination of another postoperative client, it is most important to place an infected client in a private room

A client is placed on a mechanical ventilator following a cerebral hemorrhage, and vecuronium bromide 0.04 mg/kg q12 hours IV is prescribed. Which is the priority nursing diagnosis for this client? A. Impaired communication related to paralysis of skeletal muscles. B. Social isolation related to inability to communicate. C. Potential for injury related to impaired lung expansion. D. High risk for infection related to increased intracranial pressure.

A. Impaired communication related to paralysis of skeletal muscles. To increase the client's tolerance of endotracheal intubation and/or mechanical ventilation, a skeletal-muscle relaxant, such as vecuronium, is usually prescribed. Impaired communication is a serious outcome because the client cannot communicate his/her needs due to intubation and diaphragmatic paralysis caused by the drug. Although this client might also experience social isolation (B), it is not a priority when compared to A. Infection is not related to increased intracranial pressure (D). The mechanical ventilator provides consistent lung expansion. (C)

A client who has heart failure is admitted with a serum potassium level of 2.9 mEq/L (2.9 mmol/L). Which action is most important for the nurse to implement? A. Initiate continuous cardiac monitoring. B. Arrange a consultation with the dietician. C. Teach about the side effects of diuretics. D. Give 20 mEq of potassium chloride.

A. Initiate continuous cardiac monitoring Hypokalemia (normal 3.5 to 5 mEq/L [3.5 to 5 mmol/L]) causes changes in myocardial irritability and ECG waveform, so it is most important for the nurse to initiate continuous cardiac monitoring to identify ventricular ectopy or other life-threatening dysrhythmias. After cardiac monitoring is initiated, then the potassium chloride should be given so that the effects of potassium replacement on the cardiac rhythm can be monitored.

A client's susceptibility to ulcerative colitis is most likely due to which aspect in the client's history? A. Jewish European ancestry. B. H. pylori bowel infection. C. Family history of irritable bowel syndrome. D. Age between 25 and 55 years.

A. Jewish European ancestry Ulcerative colitis is 4 to 5 times more common among individuals of Jewish European or Ashkenazi ancestry

Which description of pain is consistent with a diagnosis of rheumatoid arthritis? A. Joint pain is worse in the morning and involves symmetric joints. B. Joint pain is worse during the day and involves unilateral joints. C. Joint pain is better in the morning and worsens throughout the day. D. Joint pain is consistent throughout the day and is relieved by pain medication.

A. Joint pain is worse in the morning and involves symmetric joints.

A client is admitted for further testing to confirm sarcoidosis. Which diagnostic test provides definitive information that the nurse should report to the healthcare provider? A. Lung tissue biopsy. B. Computerized tomography (CT) of the thorax. C. Positive blood cultures. D. Magnetic resonance imaging (MRI).

A. Lung tissue biopsy. Sarcoidosis is an inflammatory condition that is characterized by the formation of widespread granulomatous lesions involving a pulmonary primary site. Although chest radiography identifies sarcoidosis, lung tissue biopsy obtained by bronchoscopy or bronchoalveolar lavage provides definitive confirmation.

During assessment of a client with amyotrophic lateral sclerosis (ALS), which finding should the nurse identify when planning care for this client? A. Muscle weakness. B. A decline in cognitive function. C. Abnormal involuntary movements. D. Urinary frequency.

A. Muscle weakness.

Which assessment finding by the nurse during a client's clinical breast examination requires follow-up? A. Newly retracted nipple. B. Whitish nipple discharge. C. A thickened area where the skin folds under the breast. D. Tender lumpiness noted bilaterally throughout the breasts.

A. Newly retracted nipple.

Which intervention should the nurse plan to implement when caring for a client who has just undergone a right above-the-knee amputation? A. Place a large tourniquet at the client's bedside. B. Maintain the residual limb on three pillows at all times. C. Apply constant, direct pressure to the residual limb. D. Do not allow the client to lie in the prone position.

A. Place a large tourniquet at the client's bedside. A large tourniquet should be placed in plain sight at the client's bedside (A). If severe bleeding occurs, the tourniquet should be readily available and applied to the residual limb to control hemorrhage. The residual limb should not be placed on a pillow (B) because a flexion contracture of the hip may result. (C) should be avoided because it may compromise wound healing. (D) should be encouraged to stretch the flexor muscles and to prevent flexion contracture of the hip.

When teaching diaphragmatic breathing to a client with chronic obstructive pulmonary disease (COPD), which information should the nurse provide? A. Place a small book or magazine on the abdomen and make it rise while inhaling deeply. B. Place one hand on the chest, one hand the abdomen and make both hands move outward. C. Wrap a towel around the abdomen and push against the towel while forcefully exhaling. D. Purse the lips while inhaling as deeply as possible and then exhale through the nose.

A. Place a small book or magazine on the abdomen and make it rise while inhaling deeply.

An adult client who is hospitalized after surgery reports sudden onset of chest pain and dyspnea. The client appears anxious, restless, and mildly cyanotic. The nurse should further assess the client for which condition? A. Pulmonary embolism. B. Tuberculosis. C. Heart failure. D. Bronchitis.

A. Pulmonary embolism.

A client has been taking oral corticosteroids for the past five days because of seasonal allergies. Which assessment finding is of most concern to the nurse? A. Purulent sputum. B. Excessive hunger. C. White blood count of 10,000 mm3. D. Serum glucose of 115 mg/dl.

A. Purulent sputum.

A client with gastroesophageal reflux disease (GERD) has been experiencing severe reflux during sleep. Which recommendation by the nurse is most effective to assist the client? A. Raising the head of the bed on blocks. B. Losing weight. C. Avoiding large meals. D. Decreasing caffeine intake.

A. Raising the head of the bed on blocks Raising the head of the bed on blocks (D) (reverse Trendelenburg position) to reduce reflux and subsequent aspiration is the most effective recommendation for a client experiencing severe gastroesophageal reflux during sleep.

The nurse is teaching a female client who uses a contraceptive diaphragm about reducing the risk for toxic shock syndrome (TSS). Which information should the nurse include? (Select all that apply.) A. Replace the old diaphragm every 3 months. B. Wash the diaphragm with an alcohol solution. C. Remove the diaphragm immediately after intercourse. D. Do not leave the diaphragm in place longer than 8 hours after intercourse. E. Use the diaphragm to prevent conception during the menstrual cycle.

A. Replace the old diaphragm every 3 months. D. Do not leave the diaphragm in place longer than 8 hours after intercourse.

A client with cirrhosis develops increasing pedal edema and ascites. Which dietary modification is most important for the nurse to teach this client? A. Restrict salt and fluid intake. B. Decrease intake of fat soluble vitamins. C Avoid high carbohydrate foods. D. Decrease caloric intake.

A. Restrict salt and fluid intake. Salt and fluid restrictions are the first dietary modifications for a client who is retaining fluid as manifested by edema and ascites (A). (B, C and D) will not impact fluid retention.

In preparing to administer intravenous albumin to a client following surgery, which are the priority nursing interventions? (Select all that apply.) A. Set the infusion pump to infuse the albumin within four hours. B. Monitor hemoglobin and hematocrit levels. C. Assign a UAP to monitor blood pressure q15 minutes. D. Compare the client's blood type with the label on the albumin. E. Assess for increased bleeding after administration. F. Administer through a large gauge catheter.

A. Set the infusion pump to infuse the albumin within four hours. B. Monitor hemoglobin and hematocrit levels. E. Assess for increased bleeding after administration. F. Administer through a large gauge catheter. (A, B, E, and F) are the correct selections. Albumin should be infused within four hours because it does not contain any preservatives. Any fluid remaining after four hours should be discarded (A). Albumin administration does not require blood typing (D). Vital signs should be monitored periodically to assess for fluid volume overload, but every 15 minutes is not necessary (C). This frequency is often used during the first hour of a blood transfusion. A large gauge catheter (F) allows for fast infusion rate, which may be necessary. Hemodilution may decrease hemoglobin and hematocrit levels (B), while increased blood volume and blood pressure may cause bleeding (E).

The nurse working in a postoperative surgical clinic is assessing a woman who had a left radical mastectomy for breast cancer. Which factor puts this client at greatest risk for developing lymphedema? A. She sustained an insect bite to her left arm yesterday. B. Her healthcare provider now prescribes a calcium channel blocker for hypertension. C. She has lost twenty pounds since the surgery. D. Her hobby is playing classical music on the piano.

A. She sustained an insect bite to her left arm yesterday.

The nurse is assessing a client who has a history of Parkinson's disease for the past 5 years. Which symptoms would this client most likely exhibit? A. Shuffling gait, masklike facial expression, and tremors of the head. B. Numbness of the extremities, loss of balance, and visual disturbances. C. Extreme muscular weakness, easy fatigability, and ptosis. D. Loss of short-term memory, facial tics and grimaces, and constant writhing movements.

A. Shuffling gait, masklike facial expression, and tremors of the head.

Which information should the nurse obtain when performing an initial assessment of a client who presents to the emergency department with a painful ankle injury? (Select all that apply.) A. Signs of inflammation. B. Muscle strength testing. C. Ankle range of motion. D. Quality of the pain. E. Visible deformities of the joint.

A. Signs of inflammation C. Ankle range of motion D. Quality of the pain E. Visible deformities of the joint

A 77-year-old female client is admitted to the hospital. She is confused, has no appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse rate is 43 beats per minute. It is most important for the nurse to assess for which finding? A. Takes digitalis. B. Use of aspirin prior to admit. C. Prescribed nitroglycerin for chest pain. D. Wearing dentures.

A. Takes digitalis.

A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide? A. The tumor's estrogen receptor guides treatment options. B. Lymph node involvement is not significant. C. Stage I indicates metastasis. D. Small tumors are aggressive and indicate poor prognosis.

A. The tumor's estrogen receptor guides treatment options.

The nurse is teaching a female client about the best time to plan sexual intercourse in order to conceive. Which information should the nurse provide? A. Two weeks before menstruation. B. Low basal temperature. C. First thing in the morning. D. Vaginal mucous discharge is thick.

A. Two weeks before menstruation.

The client is taking digoxin for congestive heart failure. The nurse would be correct in withholding a dose of digoxin based on which assessment? A. serum potassium level is 3. B. blood pressure is 104/68. C. apical pulse is 68/min. D. serum digoxin level is 1.5.

A. serum potassium level is 3.

The registered nurse (RN) is assessing a client who was discharged home after management of chronic hypertension. Which equipment should the RN instruct the client to use at home? A. Blood glucose monitor. B. Sphygmomanometer. C. Exercise bicycle. D. Weekly medication box.

B. Sphygmomanometer Self-awareness is the best way for a client to manage chronic hypertension, so the client should obtain a sphygmomanometer and learn how to monitor blood pressure daily and maintain a record.

Which nail color alteration should the nurse expect to observe in a client with chronic kidney disease? A. Thin, dark red vertical lines. B. Horizontal white banding. C. Diffuse blue discoloration. D. Diffuse brown discoloration.

B. Horizontal white banding.

A client has a staging procedure for cancer of the breast and ask the nurse which type of breast cancer has the poorest prognosis. Which information should the nurse offer the client? A. Stage II. B. Inflammatory with peau d'orange. C. T1N0M0. D. Invasive infiltrating ductal carcinoma.

B) Inflammatory with peau d'orange. Inflammatory breast cancer, which has a thickened appearance like an orange peel (peau d'orange), is the most aggressive form of breast malignancies (B). Staging classifies cancer by the extension or spread of the disease, and (A) indicates limited local spread. (D) indicates cancer cells have spread from the ducts into the surrounding breast tissue only. TNM classification is used to indicate the extent of the disease process according to tumor size, regional spread lymph nodes involvement, and metastasis, and (C) indicates early cancer with small in situ involvement, no lymph node involvement, and no distant metastases.

A client who is receiving chemotherapy asks the nurse, "Why is so much of my hair falling out each day?" Which response by the nurse best explains the reason for alopecia? A. "The chemotherapy causes permanent alterations in your hair follicles that lead to hair loss." B. "Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant." C. "Alopecia is a common side effect you will experience during long-term steroid therapy." D. "Your hair will grow back completely after your course of chemotherapy is completed."

B. "Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant."

The nurse is completing an admission interview and assessment on a client with a history of Parkinson's disease. Which question provides information relevant to the client's plan of care? A. "Have you ever experienced any paralysis of your arms or legs?" B. "Have you ever been 'frozen' in one spot, unable to move?" C. "Have you ever sustained a severe head injury?" D. "Do you have headaches, especially ones with throbbing pain?"

B. "Have you ever been 'frozen' in one spot, unable to move?"

A client taking a thiazide diuretic for the past six months has a serum potassium level of 3. The nurse anticipates which change in prescription for the client? A. The diuretic will be discontinued. B. A potassium supplement will be prescribed. C. The dosage of the diuretic will be decreased. D. The dosage of the diuretic will be increased.

B. A potassium supplement will be prescribed.

A female client taking oral contraceptives reports to the nurse that she is experiencing calf pain. Which action should the nurse implement? A. Determine if the client has also experienced breast tenderness and weight gain. B. Advise the client to notify the healthcare provider for immediate medical attention. C. Encourage the client to begin a regular, daily program of walking and exercise. D. Tell the client to stop taking the medication for a week to see if symptoms subside.

B. Advise the client to notify the healthcare provider for immediate medical attention.

A client is admitted to the emergency department after falling from a high roof. Which finding should the nurse report immediately? A. Tenderness on palpation of the ear. B. Clear, watery drainage from the ear. C. Dried blood around the ear and neck. D. Pearly appearance of the tympanic membrane.

B. Clear, watery drainage from the ear.

The nurse is assessing a client with bacterial meningitis. Which assessment finding indicates the client may have developed septic emboli? A. Presence of S3 and S4 heart sounds. B. Cyanosis of the fingertips. C. 3+ pitting edema of the lower extremities. D. Bradycardia and bradypnea.

B. Cyanosis of the fingertips. Septic emboli secondary to meningitis commonly lodge in the small arterioles of the extremities, causing a decrease in circulation to the hands which may lead to gangrene.

A 49-year-old female client arrives at the clinic for an annual exam and asks the nurse why she becomes excessively diaphoretic and feels warm during nighttime. What is the nurse's best response? A. Ask if a fever above 101 F (38.3 C) has occurred in the last 24 hours. B. Discuss perimenopause and related comfort measures. C. Explain the effect of the follicle-stimulating and luteinizing hormones. D. Assess lung fields and for a cough productive of blood-tinged mucous.

B. Discuss perimenopause and related comfort measures.

While working in the emergency room, the nurse is exposed to a client with active tuberculosis. When should the nurse plan to obtain a tuberculin skin test? A. Immediately after the exposure. B. Four to six weeks after the exposure. C. Within one week of the exposure. D. Three months after the exposure.

B. Four to six weeks after the exposure.

The nurse is working with a 71-year-old obese client with bilateral osteoarthritis (OA) of the hips. Which recommendation should the nurse make that is most beneficial in protecting the client's joints? A. Use a walker for ambulation to lessen weight-bearing on the hips. B. Initiate a weight-reduction diet to achieve a healthy body weight. C. Increase the amount of calcium intake in the diet. D. Apply alternating heat and cold therapies.

B. Initiate a weight-reduction diet to achieve a healthy body weight.

The nurse is planning care to prevent complications for a client with multiple myeloma. Which intervention is most important for the nurse to include? A. Safety precautions during activity. B. Maintain a fluid intake of 3 to 4 L per day. C. Administer narcotic analgesic around the clock. D. Assess for changes in size of lymph nodes.

B. Maintain a fluid intake of 3 to 4 L per day. Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L to promote excretion of serum calcium.

A 67-year-old woman who lives alone tripped on a rug in her home and fractured her hip. Which predisposing factor probably led to the fracture in the proximal end of her femur? A. Failing eyesight resulting in an unsafe environment. B. Osteoporosis resulting from hormonal changes. C. Renal osteodystrophy resulting from chronic renal failure. D. Cardiovascular changes resulting in small strokes which impair mental acuity.

B. Osteoporosis resulting from hormonal changes.

The nurse is assessing a client with chronic kidney disease (CKD). Which finding is most important for the nurse to respond to first? A. Peripheral neuropathy. B. Potassium 6.0 mEq. C. Uremic fetor. D. Daily urine output of 400 ml.

B. Potassium 6.0 mEq.

A young adult male is diagnosed with Stage 4 Hodgkin's lymphoma in the abdominopelvic region and is scheduled for radiation therapy (RT). The client expresses concern about becoming infertile. How should the nurse respond? A. Tell the client that infertility is a non-reversible side effect of radiotherapy. B. Propose sperm banking before RT then artificial insemination is an option. C. Suggest adoption when the client is in remission or ready for parenting. D. Explain that sperm production will be suppressed after radiotherapy is over.

B. Propose sperm banking before RT then artificial insemination is an option.

During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not moving. Which action should the nurse take first? A. Use a laryngoscope to check for a foreign body lodged in the esophagus. B. Reposition the head to validate that the head is in the proper position to open the airway. C. Perform a finger sweep of the mouth to remove any vomitus. D. Turn the client to the side and administer three back blows.

B. Reposition the head to validate that the head is in the proper position to open the airway.

A client with multiple sclerosis has experienced an exacerbation of symptoms, including paresthesias, diplopia, and nystagmus. Which instruction should the nurse provide? A. Restrict intake of high protein foods. B. Schedule extra rest periods. C. Stay out of direct sunlight. D. Go to the emergency room immediately.

B. Schedule extra rest periods.

The nurse is assessing a client's laboratory values following administration of chemotherapy. Which lab value leads the nurse to suspect that the client is experiencing tumor lysis syndrome (TLS)? A. Oxygen saturation of 90%. B. Serum calcium of 5 mg/dL. C. Hemoglobin of 10 g/dL. D. Serum PTT of 10 seconds.

B. Serum calcium of 5 mg/dL TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatemia.

In preparing a discharge plan for a 22-year-old male client diagnosed with Buerger's disease (thromboangiitis obliterans), which referral is most important? A. Genetic counseling. B. Smoking cessation program. C. Twelve-step recovery program. D. Clinical nutritionist.

B. Smoking cessation program. Buerger's disease is strongly related to smoking. The most effective means of controlling symptoms and disease progression is through smoking cessation

A female client receiving IV vasopressin for esophageal varice rupture reports to the nurse that she feels substernal tightness and pressure across her chest. Which PRN protocol should the nurse initiate? A. Nasogastric lavage with cool saline. B. Start an IV nitroglycerin infusion. C. Prepare for endotracheal intubation. D. Increase the vasopressin infusion.

B. Start an IV nitroglycerin infusion Vasopressin is used to promote vasoconstriction, thereby reducing bleeding. Vasoconstriction of the coronary arteries can lead to angina and myocardial infarction, and should be counteracted by IV nitroglycerin per prescribed protocol

The nurse is preparing a teaching plan for a client who is newly diagnosed with Type 1 diabetes mellitus. Which clinical cues should the nurse describe when teaching the client about hypoglycemia? A. Fruity breath, tachypnea, chest pain. B. Sweating, trembling, tachycardia. C. Nausea, vomiting, anorexia. D. Polyuria, polydipsia, polyphagia.

B. Sweating, trembling, tachycardia.

A 58-year-old client, who has no health problems, asks the nurse about the Pneumovax vaccine. The nurse's response to the client should be based on which information? A. The vaccine is given annually before the flu season to those over 50 years of age. B. The immunization is administered once to older adults or persons with a history of chronic illness. C. The vaccine is for all ages and is given primarily to those persons traveling overseas to areas of infection. D. The vaccine will prevent the occurrence of pneumococcal pneumonia for up to five years.

B. The immunization is administered once to older adults or persons with a history of chronic illness.

Which discharge instruction is most important for a client after a kidney transplant? A. Report symptoms of secondary Candidiasis. B. Use daily reminders to take immunosuppressants. C. Stop cigarette smoking. D. Weigh weekly.

B. Use daily reminders to take immunosuppressants.

Healthcare workers must protect themselves against becoming infected with HIV. The Center for Disease Control has issued guidelines for healthcare workers in relation to protection from HIV. These guidelines include which recommendation? A. Freeze HIV blood specimens at -70 F to kill the virus. B. Wear gloves when coming in contact with the blood or body fluids of any client. C. Conduct mandatory HIV testing of those who work with AIDS clients. D. Place HIV positive clients in strict isolation and limit visitors.

B. Wear gloves when coming in contact with the blood or body fluids of any client The CDC guidelines recommend that healthcare workers use gloves when coming in contact with blood or body fluids from ANY client (B) since HIV is infectious before the client becomes aware of symptoms. (A) is not recommended, nor is it necessary. (C) is very controversial, difficult to enforce, and is not recommended by CDC. (D) does not guarantee to kill the virus. Additionally, the purpose of the blood specimen will determine how it is stored and handled

The nurse is planning care for a client with newly diagnosed diabetes mellitus that requires insulin. Which assessment should the nurse identify before beginning the teaching session? A. Financial resources available for the equipment. B. Willingness of the client to learn the injection sites. C. Intelligence and developmental level of the client. D. Present knowledge related to the skill of injection.

B. Willingness of the client to learn the injection sites.

Which information about mammograms is most important to provide a post-menopausal female client? A. Radiation exposure is minimized by shielding the abdomen with a lead-lined apron. B. Yearly mammograms should be done regardless of previous normal x-rays. C. Breast self-examinations are not needed if annual mammograms are obtained. D. Women at high risk should have annual routine and ultrasound mammograms.

B. Yearly mammograms should be done regardless of previous normal x-rays.

Small bowel obstruction is a condition characterized by which finding? A. Metabolic acidosis. B. Intermittent lower abdominal cramping. C. Severe fluid and electrolyte imbalances. D. Ribbon-like stools.

C. Severe fluid and electrolyte imbalances Among the findings characteristic of a small bowel obstruction is the presence of severe fluid and electrolyte imbalances (C). (A, B, and D) are findings associated with large bowel obstruction.

A client has taken steroids for 12 years to help manage chronic obstructive pulmonary disease (COPD). When making a home visit, which nursing assessment is of greatest importance to this client? A. pulse rate, both apically and radially. B. skin color and turgor. C. temperature. D. blood pressure, both standing and sitting.

C) temperature. It is very important to check the client's temperature. Infection is the most common factor precipitating respiratory distress. Clients with COPD who are on maintenance doses of corticosteroids are particularly predisposed to infection.

A client who is HIV positive asks the nurse, "How will I know when I have AIDS?" Which response is best for the nurse to provide? A. "Diagnosis is made when both the ELISA and the Western Blot tests are positive." B. "Diagnosis of AIDS is made when you have 2 positive ELISA test results." C. "AIDS is diagnosed when a specific opportunistic infection is found in an otherwise healthy individual." D. "I can tell that you are afraid of being diagnosed with AIDS. Would you like for me to call your minister?"

C. "AIDS is diagnosed when a specific opportunistic infection is found in an otherwise healthy individual."

A client taking furosemide, reports difficulty sleeping. Which question is important for the nurse to ask the client? A. "Are you eating foods rich in potassium?" B. "Have you lost weight recently?" C. "At what time do you take your medication?" D. "What dose of medication are you taking?"

C. "At what time do you take your medication?"

A 20-year-old female client calls the nurse to report a lump she found in her breast. Which response is the best for the nurse to provide? A. "If you are in your menstrual period it is not a good time to check for lumps." B. "Check it again in one month, and if it is still there schedule an appointment." C. "Most lumps are benign, but it is always best to come in for an examination." D. "Try not to worry too much about it, because usually, most lumps are benign."

C. "Most lumps are benign, but it is always best to come in for an examination."

A client with diabetes mellitus is experiencing polyphagia. Which outcome statement is the priority for this client? A. Fluid and electrolyte balance. B. Reduced glucose in the urine. C. Adequate cellular nourishment. D. Prevention of water toxicity.

C. Adequate cellular nourishment. Diabetes mellitus Type 1 is characterized by hyperglycemia that precipitates glucosuria and polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Polyphagia is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose into the cell for energy, so the outcome statement should include stabilization of adequate cellular nutrition which is done by providing the insulin supplement the client needs.

During an interview with a client planning elective surgery, the client asks the nurse, "What is the advantage of having a preferred provider organization insurance plan?" Which response is best for the nurse to provide? A. Neither plan allows selections of healthcare providers or hospitals. B. An individual can become a member of a PPO without belonging to a group. C. An individual may select healthcare providers from outside of the PPO network. D. There are fewer healthcare providers to choose from than in an HMO plan.

C. An individual may select healthcare providers from outside of the PPO network.

What types of medications should the nurse expect to administer to a client during an acute respiratory distress episode? A. Anticoagulants and expectorants. B. Vasodilators and hormones. C. Bronchodilators and steroids. D. Analgesics and sedatives.

C. Bronchodilators and steroids.

An older adult female client is brought to the clinic by her daughter for a flu shot. She has lost significant weight since the last visit. She has poor personal hygiene and inadequate clothing for the weather. The client states that she lives alone and denies problems or concerns. Which action should the nurse implement? A. Notify social services immediately of suspected elderly abuse. B. Explain to the client that she needs to take better care of herself. C. Collect further data to determine whether self-neglect is occurring. D. Discuss the need for mental health counseling with the daughter.

C. Collect further data to determine whether self-neglect is occurring.

A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit. Which initial medication should the nurse anticipate administering to the client? A. Procainamide. B. Phenytoin. C. Digoxin. D. Xylocaine.

C. Digoxin.

Which intervention should the nurse implement for a female client diagnosed with pelvic relaxation disorder? A. Discuss the importance of keeping a diary of daily temperature and menstrual cycle events. B. Describe proper administration of vaginal suppositories and cream. C. Encourage the client to perform Kegel exercises 10 times daily. D. Explain the importance of using condoms when having sexual intercourse.

C. Encourage the client to perform Kegel exercises 10 times daily. Pelvic relaxation disorders are structural disorders resulting from weakening support tissues of the pelvis. Kegel exercises help strengthen the surrounding muscles.

An adult client is admitted to the hospital burn unit with partial-thickness and full-thickness burns over 40% of the body surface area. In assessing the potential for skin regeneration, which should the nurse remember about full-thickness burns? A. Tissue regeneration will begin several days following return of normal circulation. B. Debridement of eschar will delay the body's ability to regenerate normal tissue. C. Regenerative function of the skin is absent because the dermal layer has been destroyed. D. Normal tissue formation will be preceded by scar formation for the first year.

C. Regenerative function of the skin is absent because the dermal layer has been destroyed.

A client is admitted to the hospital with a medical diagnosis of pneumococcal pneumonia. The nurse knows that the prognosis for gram-negative pneumonias (such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor. Which information relates most directly to the prognosis for gram-negative pneumonias? A. Usually occur in healthy young adults who have recently been debilitated by an upper respiratory infection. B. Gram-negative pneumonias usually affect infants and small children. C. Gram-negative organisms are more resistant to antibiotic therapy. D. The gram-negative infections occur in the lower lobe alveoli which are more sensitive to infection.

C. Gram-negative organisms are more resistant to antibiotic therapy. The gram-negative organisms are resistant to drug therapy (C) which makes recovery very difficult. Gram-negative pneumonias affect all lobes of the lung (D). The mean age for contracting this type of pneumonia is 50 years (A and B), and it usually strikes debilitated persons such as alcoholics, diabetics, and those with chronic lung diseases.

Which statement made by a client with chronic pancreatitis indicates that further education is needed? A. I will eat a bland, low-fat, high-protein diet. B. I will avoid drinking caffeinated beverages. C. I will cut back on smoking cigarettes daily. D. I will rest frequently and avoid vigorous exercise.

C. I will cut back on smoking cigarettes daily. To prevent exacerbations of chronic pancreatitis, clients should be instructed to avoid nicotine entirely. Additional teaching includes avoiding caffeinated beverages, resting frequently as needed, and eating a bland diet low fat and high in protein.

A 32-year-old female client complains of severe abdominal pain each month before her menstrual period, painful intercourse, and painful defecation. Which additional history should the nurse obtain that is consistent with the client's complaints? A. Frequent urinary tract infections. B. Premenstrual syndrome. C. Inability to get pregnant. D. Chronic use of laxatives.

C. Inability to get pregnant. Dysmenorrhea, dyspareunia, and difficulty or painful defecation are common symptoms of endometriosis, which is the abnormal displacement of endometrial tissue in the dependent areas of the pelvic peritoneum. A history of infertility is another common finding associated with endometriosis.

A client receiving cholestyramine for hyperlipidemia should be evaluated for which vitamin deficiency? A. B6. B. C. C. K. D. B12.

C. K Clients should be monitored for an increased prothrombin time and prolonged bleeding times which would alert the nurse to a vitamin K deficiency. These drugs reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K.

Twenty four hours after a client returns from surgical gastric bypass, the registered nurse (RN) observes large amounts of blood in the nasogastric tube (NGT) cannister. Which assessment finding should the RN report as early signs of hypovolemic shock? A. Slow breathing. B. Faint pedal pulses. C. Lethargy. D. Decrease in blood pressure.

C. Lethargy One of the early signs of hypovolemic shock is changes in the client's level of consciousness due to the decrease perfusion to the brain which can manifests as lethargy or confusion.

A client is admitted to the hospital with a diagnosis of severe acute diverticulitis. Which assessment finding should the nurse expect this client to exhibit? A. Abdominal pain and intermittent tenesmus. B. Exacerbations of severe diarrhea. C. Lower left quadrant pain and a low-grade fever. D. Severe pain at McBurney's point and nausea.

C. Lower left quadrant pain and a low-grade fever.

During lung assessment, the nurse places a stethoscope on a client's chest and instructs him/her to say "99" each time the chest is touched with the stethoscope. Which would be the correct interpretation if the nurse hears the spoken words "99" very clearly through the stethoscope? A. May indicate pneumothorax. B. This is a normal auscultatory finding. C. May indicate pneumonia. D. May indicate severe emphysema.

C. May indicate pneumonia.

The nurse is assessing a client who smokes cigarettes and has been diagnosed with emphysema. Which finding would the nurse expect this client to exhibit? A. Normal arterial blood gases. B. A decreased total lung capacity. C. Normal skin coloring. D. An absence of sputum.

C. Normal skin coloring.

An older adult male client comes to the geriatric screening clinic complaining of pain in his left calf. The nurse notices a reddened area on the calf of his right leg which is warm to the touch and suspects it might be thrombophlebitis. Which type of pain would further confirm this suspicion? A. Calf pain on exertion which stops when standing in one place. B. Pain upon arising in the morning which is relieved after some stretching and exercise. C. Pain in the calf upon exertion which is relieved by rest and elevating the extremity. D. Pain in the calf awakening him from a sound sleep.

C. Pain in the calf upon exertion which is relieved by rest and elevating the extremity.

In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the laboratory test results to indicate a DECREASED serum level of which substance? A. Antidiuretic hormone. B. Sodium. C. Potassium. D. Glucose.

C. Potassium.

A client who was in a motor vehicle collision was admitted to the hospital and the right knee was placed in skeletal traction. The nurse has documented this nursing diagnosis in the client's medical record: "Potential for impairment of skin integrity related to immobility from traction." Which nursing intervention is indicated based on this diagnosis statement? A. Release the traction q4h to provide skin care. B. Give back care after the client is released from traction. C. Provide back and skin care while maintaining the traction. D. Turn the client for back care while suspending traction.

C. Provide back and skin care while maintaining the traction.

The nurse working on a telemetry unit finds a client unconscious and in pulseless ventricular tachycardia (VT). The client has an implanted automatic defibrillator. Which action should the nurse implement? A. Observe the monitor until the onset of ventricular fibrillation. B. Use a magnet to deactivate the implanted pacemaker. C. Shock the client with 200 joules per hospital policy. D. Prepare the client for transcutaneous pacemaker.

C. Shock the client with 200 joules per hospital policy.

Which description of symptoms is characteristic of a client diagnosed with trigeminal neuralgia (tic douloureux)? A. Difficulty in chewing, talking, and swallowing. B. Tinnitus, vertigo, and hearing difficulties. C. Sudden, stabbing, severe pain over the lip and chin. D. Facial weakness and paralysis.

C. Sudden, stabbing, severe pain over the lip and chin.

When preparing a client who has had a total laryngectomy for discharge, which instruction is most important for the nurse to include in the discharge teaching? A. Tell the client not to travel alone. B. Recommend that the client carry suction equipment at all times. C. Tell the client to carry a medic alert card stating that he is a total neck breather. D. Instruct the client to have writing materials with him at all times.

C. Tell the client to carry a medic alert card stating that he is a total neck breather. It is imperative that total neck breathers carry a medic alert notice so that if they have a cardiac arrest, mouth-to-neck breathing can be done. Mouth-to-mouth resuscitation will not help them. They do not need to carry nor refrain from A. There are many alternative means of communication for clients who have had a laryngectomy; depending on D is probably the least effective.

The nurse is planning to initiate a socialization group for older residents of a long-term facility. Which information would be most useful to the nurse when planning activities for the group? A. The length of time each group member has resided at the nursing home. B. The age of each group member. C. The usual activity patterns of each member of the group. D. A brief description of each resident's family life.

C. The usual activity patterns of each member of the group.

A client who is sexually active with several partners requests an intrauterine device (IUD) as a contraceptive method. Which information should the nurse provide? A. Selecting a contraceptive device should consider choosing a successful method used in the past. B. Relying on an IUD may be a safer choice for monogamous partners, but a barrier method provides a better option in preventing STD transmission. C. Using an IUD offers no protection against sexually transmitted diseases (STD), which increase the risk for pelvic inflammatory disease (PID). D. Getting pregnant while using an IUD is common and is not the best contraceptive choice.

C. Using an IUD offers no protection against sexually transmitted diseases (STD), which increase the risk for pelvic inflammatory disease (PID).

The registered nurse (RN) assesses arterial blood gas results of a client that has emphysema. Which finding is consistent with respiratory acidosis? A. pH 7.34, pCO 2 36 mmHg, HCO 3 21 mEq/L. B. pH 7.46, pCO 2 35 mmHg, HCO 3 28 mEq/L. C. pH 7.32, pCO 2 46 mmHg, HCO 3 24 MEq/L. D. pH 7.45 , pCO 2 37 mmHg, HCO 3 24 mEq/L.

C. pH 7.32, pCO 2 46 mmHg, HCO 3 24 MEq/L.

Which condition should the nurse suspect when a client reports vaginal dryness during intercourse? A. Hyperactive sebaceous glands. B. Infected bulbourethral glands. C. Strangulated prostate gland. D. Obstructed Bartholin's glands.

D. Obstructed Bartholin's glands. Bartholin's glands are located posteriorly on each side of the vaginal opening; they secrete lubrication fluid during sexual excitement. The nurse should suspect obstructed Bartholin's glands when a client reports vaginal dryness during intercourse.

What instruction should the nurse give a client who is diagnosed with fibrocystic changes of the breast? A. Notify the healthcare provider if whitish nipple discharge occurs. B. Observe cyst size fluctuations as a sign of malignancy. C. Use estrogen supplements to reduce breast discomfort. D. Perform a breast self-exam (BSE) procedure monthly.

D. Perform a breast self-exam (BSE) procedure monthly.

Two days postoperative, a male client reports aching pain in his left leg. The nurse assesses redness and warmth on the lower left calf. Which intervention would be most helpful to this client? A. Apply sequential compression devices (SCDs) bilaterally. B. Pad all bony prominences on the affected leg. C. Assess for a positive Homan's sign in each leg. D. Advise the client to remain in bed with the leg elevated.

D) Advise the client to remain in bed with the leg elevated. The client is exhibiting symptoms of deep vein thrombosis (DVT), a complication of immobility. The initial care includes bedrest and elevation of the extremity (D). SCDs are used to prevent thrombophlebitis, not for treatment, when a clot might be dislodged (A). Once a client has thrombophlebitis, (C) is contraindicated because of the possibility of dislodging a clot. (B) is indicated to prevent pressure ulcers, but is not a therapeutic action for thrombophlebitis.

The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two hours is dated two years ago. The client reports that he has a history of "heart trouble," but has no problems at present. Hospital protocol requires that those over 50 years of age have a recent ECG prior to surgery. Which nursing action is best for the nurse to implement? A. Ask the client what he means by "heart trouble." B. Notify the client's surgeon immediately. C. Notify surgery that the ECG is over two years old. D. Call for an ECG to be performed immediately.

D) Call for an ECG to be performed immediately. Clients over the age of 40 and/or with a history of cardiovascular disease, should receive ECG evaluation prior to surgery, generally 24 hours to two weeks before. (D) should be implemented to ensure that the client's current cardiovascular status is stable. Additional data might be valuable (A), but since time is limited, the priority is to obtain the needed ECG. Documentation of vital signs is important, but does not replace the need for the ECG (C). The surgeon only needs to be notified if the ECG cannot be completed, or if there is a significant problem (B).

The nurse is providing dietary instructions to a 68-year-old client who is at high risk for development of coronary heart disease (CHD). Which information should the nurse include? A. Decrease plant stanols and sterols to less than 2 grams/day. B. Ensure saturated fat is less than 30% of total caloric intake. C. Limit dietary selection of cholesterol to 300 mg per day. D. Increase intake of soluble fiber to 10 to 25 grams per day.

D) Increase intake of soluble fiber to 10 to 25 grams per day. To reduce risk factors associated with coronary heart disease, the daily intake of soluble fiber (D) should be increased to between 10 and 25 gm. Cholesterol intake (C) should be limited to 180 mg/day or less. Intake of plant stanols and sterols is recommended at 2 g/day (A). Saturated fat (B) intake should be limited to 7% of total daily calories.

During a health fair, a 72-year-old male client tells the nurse that he is experiencing shortness of breath. Auscultation reveals crackles and wheezing in both lungs. Suspecting that the client might have chronic bronchitis, which classic symptom would the nurse expect this client to have? A. An increased chest diameter. B. Clubbing of the fingers. C. Racing pulse with exertion. D. Productive cough with grayish-white sputum.

D) Productive cough with grayish-white sputum. Chronic bronchitis, one of the diseases comprising the diagnosis of COPD, is characterized by a productive cough with grayish-white sputum (D), which usually occurs in the morning and is often ignored by smokers. (C) is not related to chronic bronchitis; however, it is indicative of other problems such as ventricular tachycardia and should be explored. (A and B) are symptoms of emphysema and are not consistent with the other symptoms. (A) is usually referred to as a "barrel chest."

A client with heart disease is on a continuous telemetry monitor and has developed sinus bradycardia. In determining the possible cause of the bradycardia, the nurse assesses the client's medication record. Which medication is most likely the cause of the bradycardia? A. Furosemide. B. Captopril. C. Dobutamine. D. Propanolol.

D) Propanolol. Propanolol (D) is a beta adrenergic blocking agent, which causes decreased heart rate and decreased contractility. Neither (B), an ACE inhibitor, nor (A), a loop diuretic, causes bradycardia. (C) is a sympathomimetic, direct acting cardiac stimulant, which would increase the heart rate.

Which finding should the nurse identify as most significant for a client diagnosed with polycystic kidney disease (PKD)? A. Hematuria. B. 2 pounds weight gain. C. Steady, dull flank pain. D. 3+ bacteria in urine.

D. 3+ bacteria in urine.

A 58-year-old client who has been post-menopausal for five years is concerned about the risk for osteoporosis because her mother has the condition. Which information should the nurse offer? A. Osteoporosis is a progressive genetic disease with no effective treatment. B. Low-dose corticosteroid treatment effectively halts the course of osteoporosis. C. Estrogen replacement therapy should be started to prevent the progression osteoporosis. D. Calcium loss from bones can be slowed by increasing calcium intake and exercise.

D. Calcium loss from bones can be slowed by increasing calcium intake and exercise.

A client who is fully awake after a gastroscopy asks the nurse for something to drink. After confirming that liquids are allowed, which assessment action should the nurse consider a priority? A. Listen to bilateral lung and bowel sounds. B. Assist the client to the bathroom to void. C. Obtain the client's pulse and blood pressure. D. Check the client's gag and swallow reflexes.

D. Check the client's gag and swallow reflexes.

Which milestone indicates to the nurse successful achievement of young adulthood? A. Develops a strong need for parental support and approval. B. Demonstrates a conceptualization of death and dying. C. Creates a new definition of self and roles with others. D. Completes education and becomes self-supporting.

D. Completes education and becomes self-supporting.

The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which finding would the nurse consider an indication of progressive hepatic encephalopathy? A. Hypertension and a bounding pulse. B. An increase in abdominal girth. C. Decreased bowel sounds. D. Difficulty in handwriting.

D. Difficulty in handwriting.

The nurse is caring for a client with a stroke resulting in right-sided paresis and aphasia. The client attempts to use the left hand for feeding and other self-care activities. The spouse becomes frustrated and insists on doing everything for the client. Based on this data, which nursing problem should the nurse document for this client? A. Situational low self-esteem related to functional impairment and change in role function. B. Interrupted family processes related to shift in health status of family member. C. Risk for ineffective therapeutic regimen management related to complexity of care. D. Disabled family coping related to dissonant coping style of significant person.

D. Disabled family coping related to dissonant coping style of significant person.

The nurse is initiating the client's fourth dose of gentamycin sulfate IV. The health care provider (HCP) has prescribed peak and trough levels. Which is the most important action for the nurse to implement next? A. Draw the peak 15 minutes before and the trough 15 minutes after the next dose. B. Draw the peak one hour before and one hour after the next dose. C. Draw the trough 30 minutes before and 30 minutes after the next dose. D. Draw the trough 5 minutes before and the peak 30 minutes after the next dose

D. Draw the trough 5 minutes before and the peak 30 minutes after the next dose

A postmenopausal client asks the nurse why she is experiencing discomfort during intercourse. Which response is best for the nurse to provide? A. Lack of adequate stimulation is the most common reason for dyspareunia. B. Infrequent intercourse results in the vaginal tissues losing their elasticity. C. Dehydration from inadequate fluid intake causes vulva tissue dryness. D. Estrogen deficiency causes the vaginal tissues to become dry and thinner.

D. Estrogen deficiency causes the vaginal tissues to become dry and thinner. Estrogen deprivation decreases the moisture-secreting capacity of vaginal cells, so vaginal tissues tend to become thinner, drier (D), and the rugae become smoother which reduces vaginal stretching that contributes to dyspareunia. Dyspareunia is not related to (B or C). While (A) can contribute to discomfort during intercourse, the primary cause is hormone-related.

A client has undergone insertion of a permanent pacemaker. When developing a discharge teaching plan, the nurse writes a goal of, "The client will verbalize symptoms of pacemaker failure." Which symptoms are most important to teach the client? A. Fever. B. Pounding headache. C. Facial flushing. D. Feelings of dizziness.

D. Feelings of dizziness.

A middle-aged male client with diabetes continues to eat an abundance of foods that are high in sugar and fat. According to the Health Belief Model, which event is most likely to increase the client's willingness to become compliant with the prescribed diet? A. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet. B. He comments on the community service announcements about preventing complications associated with diabetes. C. He is provided with the most current information about the dangers of untreated diabetes. D. He visits his diabetic brother who just had surgery to amputate an infected foot.

D. He visits his diabetic brother who just had surgery to amputate an infected foot.

Which symptoms should the nurse expect a client to exhibit who is diagnosed with a pheochromocytoma? A. Numbness, tingling, and cramps in the extremities. B. Nausea, vomiting, and muscular weakness. C. Cyanosis, fever, and classic signs of shock. D. Headache, diaphoresis, and palpitations.

D. Headache, diaphoresis, and palpitations. Pheochromocytoma is a catecholamine secreting tumor of the adrenal medulla, and D is the typical triad of symptoms depending upon the relative proportions of epinephrine and norepinephrine secretion. A lists the signs of latent tetany, exhibited by clients diagnosed with hypoparathyroidism. C lists the signs of an Addisonian (adrenal) crisis. B lists the signs of hyperparathyroidism

Which physical assessment finding should the nurse anticipate in a client with long-term gastroesophagealreflux disease (GERD)? A. Weight loss. B. Mouth ulcers. C. Dry mouth. D. Hoarseness.

D. Hoarseness

The nurse knows that lab values sometimes vary for the older client. Which data would the nurse expect to find when reviewing laboratory values of an 80-year-old male? A. Increased WBC, decreased RBC. B. Increased serum bilirubin, slightly increased liver enzymes. C. Decreased serum sodium, an increased urine specific gravity. D. Increased protein in the urine, slightly increased serum glucose levels.

D. Increased protein in the urine, slightly increased serum glucose levels. In older adults, the protein found in urine slightly rises probably as a result of kidney changes or subclinical urinary tract infections. The serum glucose increases slightly due to changes in the kidney. The specific gravity declines by age 80 from 1.032 to 1.024

How should the nurse position the electrodes for modified chest lead one (MCL I) telemetry monitoring? A. Positive polarity right shoulder, negative polarity left shoulder, ground left chest nipple line B. Positive polarity left shoulder, negative polarity right chest nipple line, ground left chest nipple line C. Positive polarity right chest nipple line, negative polarity left chest nipple line, ground left shoulder D. Negative polarity left shoulder, positive polarity right chest nipple line, ground left chest nipple line

D. Negative polarity left shoulder, positive polarity right chest nipple line, ground left chest nipple line In MCL I monitoring, the positive electrode is placed above the client's mid-chest to the right of the sternum, and the negative electrode is placed on the upper part of the chest. The ground may be placed anywhere, but is usually placed on the lower left portion of the chest.

A client with a 16-year history of diabetes mellitus is having renal function tests because of recent fatigue, weakness, elevated blood urea nitrogen, and serum creatinine levels. Which finding should the nurse conclude as an early symptom of renal insufficiency? A. Stomatitis. B. Dyspnea. C. Confusion. D. Nocturia.

D. Nocturia. As the glomerular filtration rate decreases in early renal insufficiency, metabolic waste products, including urea, creatinine, and other substances, such phenols, hormones, electrolytes, accumulate in the blood. In the early stage of renal insufficiency, polyuria results from the inability of the kidneys to concentrate urine and contribute to nocturia (D). (A, B, and C) are more common in the later stages of renal failure.

Which client should the nurse recognize as most likely to experience sleep apnea? A. Adolescent female with a history of tonsillectomy. B. School-aged male with a history of hyperactivity disorder. C. Middle-aged female who takes a diuretic nightly. D. Obese older male client with a short, thick neck.

D. Obese older male client with a short, thick neck.

The healthcare provider prescribes aluminum and magnesium hydroxide, 1 tablet PO PRN, for a client with chronic kidney disease (CKD) who is complaining of indigestion. Which intervention should the nurse implement? A. Administer 30 minutes before eating. B. Instruct the client to swallow the tablet whole. C. Evaluate the effectiveness 1 hour after administration. D. Question the healthcare provider's prescription.

D. Question the healthcare provider's prescription. Magnesium agents are not usually used for clients with CKD due to the risk of hypermagnesemia, so this prescription should be questioned by the nurse

After checking the urinary drainage system for kinks in the tubing, the nurse determines that a client who has returned from the post-anesthesia care has a dark, concentrated urinary output of 54 mL for the last 2 hours. Which priority nursing action should be implemented? A. Irrigate the indwelling urinary catheter. B. Apply manual pressure to the bladder. C. Increase the IV flow rate for 15 minutes. D. Report the findings to the surgeon.

D. Report the findings to the surgeon.

A 46-year-old female client is admitted for acute renal failure secondary to diabetes and hypertension. Which test is the best indicator of adequate glomerular filtration? A. Sedimentation rate. B. Urine specific gravity. C. Blood Urea Nitrogen (BUN). D. Serum creatinine.

D. Serum creatinine. BUN is also an indicator of renal activity, but it can be affected by non-renal factors such as hypovolemia and increased protein intake.

The nurse is caring for a client who has been diagnosed with primary hyperaldosteronism. Which laboratory test result should the nurse expect an INCREASE in the serum level? A. Glucose. B. Antidiuretic hormone. C. Potassium. D. Sodium.

D. Sodium.

The nurse formulates the nursing problem of urinary retention related to sensorimotor deficit for a client with multiple sclerosis. Which nursing intervention should the nurse implement? A. Explain that anticholinergic drugs will decrease muscle spasticity. B. Decrease fluid intake to prevent over distention of the bladder. C. Use incontinence briefs to maintain hygiene with urinary dribbling. D. Teach the client techniques of intermittent self-catheterization.

D. Teach the client techniques of intermittent self-catheterization.

The registered nurse (RN) is assessing a male client who arrives at the clinic with severe abdominal cramping, pain, tenesmus, and dehydration. The RN discovers that the client has had 14 to 20 loose stools with rectal bleeding. When taking the client's medical history, which information is most for the nurse to obtain? A. Diverticulitis. B. Irritable bowel syndrome. C. Crohn's disease. D. Ulcerative colitis.

D. Ulcerative colitis.

A client with a completed ischemic stroke has a blood pressure of 180/90 mmHg. Which action should the nurse implement? A.Administer a bolus of IV fluids. B. Withhold intravenous fluids. C. Give an antihypertensive medication. D. Position the head of the bed (HOB) flat.

Give an antihypertensive medication. Most ischemic strokes occur during sleep when baseline blood pressure declines or blood viscosity increases due to minimal fluid intake. Completed strokes usually produce neurologic deficits within an hour, the client's current elevated blood pressure requires antihypertensive medication (C). Positioning the HOB flat (D) decreases venous drainage and contributes to cerebral edema post stroke. Increased blood viscosity during sleep may be related to reduced fluids, so (B) is not indicated. Increasing the vascular fluid volume increases the blood pressure, so (A) is not indicated.