310F

Which of the following is considered an early symptom of gastric cancer?

- Pain relieved by antacids

A patient diagnosed with IBS is advised to eat a diet that is:

High in fiber

You're assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?

A. Document your findings as normal.

6. Based on the clinical manifestations of Cushing syndrome, which nursing intervention would be appropriate for a client who is newly diagnosed with Cushing syndrome?

A. Monitor blood glucose levels daily.

The nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts to slowly advance the NG tube with each swallow. The client begins to cough, gag, and choke. Which actions should the nurse take that will result in proper tube insertion and promote client relaxation? Select all that apply.

A. Pull the tube back slightly. B. Instruct the client to breathe slowly. C. Assist the client to take sips of water. E. Check the back of the pharynx using a tongue blade and flashlight.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

A. Sweating and pallor

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply.

Clay colored stools Jaundice Dark urine

The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance.

Glucose

Which option would the nurse offer a client with acute glomerulonephritis who reports thirst?

Hard candy

1.) What medications would you expect to be ordered for a patient with liver cirrhosis. Select all

a.Albumin c.Vitamin K d.Lactulose:

What is a laboratory difference you would expect to find in DKA vs. HHS? Select All

c.Metabolic acidosis d.Potassium 6.0

A client presents to the emergency department with upper gastrointestinal (GI) bleeding and is in moderate distress. In planning care, which nursing action should be the priority for this client?

A. Assessment of vital signs

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?

Reposition the client every 2 hours

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess?

Client with crohn's disease

A client who has had abdominal surgery complains of feeling as though "something gave way" in the incisional site. The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing interventions should the nurse take? Select all that apply

Contact the surgeon Instruct the client to remain quiet Prepare the client for wound closure Document the findings and actions taken

A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause?

D) Coronary arteriosclerosis

A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result?

D.It is suggestive of rheumatoid arthritis.

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching?

D.The best position for me is to lie supine with my legs straight."

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis?

Decreased hemoglobin

An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

Diminished breath sounds

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

Fissure

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?

Fluid volume excess resulting from right sided heart failure

Your client with SIADH is experiencing shortness of breath, and when you auscultate his lungs you hear bilateral crackles, which medication would you expect to give?

Furosemide

5. A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply.

Hypothermia Hypotension Hypoventilation

What is the priority nursing intervention in helping a patient expectorate thick lung secretions?

Increase fluid intake to 3 L/day if tolerated.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome?

Limit the fluid taken with meals

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively?

Low fiber

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which S/S of duodenal ulcer?

Pain relieved by food intake

When a client with a history of heart failure on daily weights has a 4-pound (1.8-kilogram) weight gain since the previous day, which action would the nurse take next?

Perform a head-to-toe assessment.

The client is diagnosed with expressive aphasia. Which psychosocial client problem would the nurse include in the plan of care?

Powerlessness

The nurse is reviewing a prescription sheet for preoperative client that states that he client must be NPO after midnight. The nurse would telephone the physician to clarify that which medication should be given to the client and not withheld?

Prednisone

Sit the patient up in bed as tolerated and apply oxygen.

Assist the client into a sitting position at 90 degrees.

The client diagnosed with a mild concussion is being discharged from the emergency department. Which discharge instruction should the nurse teach the client's significant other?

Awaken the client every two (2) hours.

A female client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?

d. Ensuring the return of the gag reflex before offering food or fluids

What findings would concern you your patient may be experiencing a gastric ulcer?

melena

The nurse is teaching a patient with COPD how to self-administer ipratropium (Atrovent) via a metered dose inhaler (MDI). Which instruction given by the nurse is most appropriate to help the patient learn the proper inhalation technique?

"Breathe out slowly before positioning the inhaler."

Which statement made by the client diagnosed with chronic bronchitis indicates to the nurse more teaching is required?

"I need to return to the HCP to have my blood drawn with my annual physical."

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

"It will get better and then worse again."

The nurse is monitoring the patient who is 24 hours post-opt from surgery. Which finding requires intervention?

24 hour urine output of 300 mL

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction?

"I should increase the fiber in my diet"

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be:

1 to 2 L/day

You are completing the history on a patient who is scheduled to have surgery. What health history increases the risk for surgery for the patient?

Abuse of street drugs

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

Acute pain related to biliary spasms

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply.

Administer stool softeners as prescribed Encourage a high-fiber diet to promote bowel movements without straining Apply cold packs to the anal-rectal area over the dressing until the packing is removed

The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?

C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning

A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

D. Impaired gas exchange related to airflow obstruction

A female client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

Dyspnea

The physical examination of a client reveals moon face, buffalo hump, and truncal obesity. The laboratory report reveals salivary cortisol level of 3.0 ng/mL (9.54 nmol/L). Which other manifestations would be present in the client? Select all that apply. One, some, or all responses may be correct.

Edema Osteoporosis Muscle atrophy

2) A client has a history of gastroesophageal reflux disease (GERD). Why would the nurse also monitor the client for clinical manifestations of heart disease?

Esophageal pain may imitate the symptoms of a heart attack.

What is a potential postoperative concern regarding a patient who has already resumed a solid diet?

Failure to pass stool within 48 hours of eating solid foods

1) The registered nurse (RN) is caring for a client with peptic ulcer disease (PUD). What assessment should the RN identify and document that is consistent with PUD? (Select all that apply).

Gastric pain on an empty stomach Hematemesis Intolerance of spicy foods

A client who has undergone preadmission testing, has had blood drawn for serum lab studies, including a complete blood count, coagulation studies and electrolytes and creatine levels. Which lab result should be reported to the surgeon's office by the nurse, knowing that it could cause surgery to be postponed?

Hemoglobin, 8.0 g/dL

A client admitted with severe renal colic secondary to a ureteral calculus has less urinary output than intake over the past 8 hours. A bedside bladder scan indicates 40 mL of residual urine. Which potential complication would the nurse suspect?

Hydroureter

The nurse is caring for a client diagnosed with a subarachnoid hemorrhage resulting from a leaking aneurysm. The client is awaiting surgery. Which nursing interventions would be appropriate for the nurse to implement? Select all that apply.

Provide a dimly lit environment. Elevate the head of bed 30 degrees. Administer docusate per order.

Which finding is an indication of ulcer perforation in a client with peptic ulcer disease (PUD)? Select all that apply.

Tachycardia Hypotension Rigid abdomen N/V Back and shoulder pain

The nurse and an unlicensed assistive personnel (UAP) are caring for a client with right-sided paralysis. Which action by the UAP requires the nurse to intervene?

The assistant places a hand under the client's right axilla to move up in bed.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important?

The consistency of stool and comfort when passing stool

The nurse is assessing the client with COPD. Which health promotion information is most important for the nurse to obtain?

Willingness to modify lifestyle.

2. Following an addisonian crisis, a patient's adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances?

c. Episodes of high psychosocial stress

4. A nurse is caring for a client with hyperaldosteronism (Conn's Syndrome). Which assessment(s) should the nurse anticipate in this client? Select all that apply.

c. Polyuria d. Hypertension e. Hypokalemia

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

recent streptococcal infection.

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at this time?

"Tell me more about your concerns with your diet after going home"

Along with persistent, crushing chest pain, which clinical manifestations would make the nurse suspect that the client is experiencing an MI?

1. Diaphoresis and cool, clammy skin

The nurse is assessing a patient with acute coronary syndrome (ACS). The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. What signs and symptoms are suggestive of ACS? Select all that apply.

A) Dyspnea B) Unusual fatigue Syncope

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?

A) Fasting plasma glucose greater than or equal to 126 mg/dL

Your patient with ascites becomes hypotensive post-procedure, what medication would you expect to immediately give?

Albumin

After surgery your patient starts to shiver uncontrollably. What nursing intervention would you do FIRST?

Apply warm blankets and continue oxygen as prescribed

Which clinical indicator would the nurse monitor in a client with end-stage renal disease (ESRD)?

Azotemia

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about:

C. Occurrence of a weak urinary stream

A nurse is developing a care plan for a patient who is at risk for developing pneumonia after surgery. Which of the following is not an appropriate nursing intervention?

Repositioning every 3-4 hours

After surgery your patient is semicomatose with vital signs within normal limits. As the nurse, what position would be best for this patient?

Side positioning (preferably the left side)

The presence of mucus and pus in the stools suggests which condition?

Ulcerative colitis

The nurse is providing information about strokes to a community group. Which of the following would the nurse identify as the primary initial symptoms of an ischemic stroke?

Weakness on one side of the body and difficulty with speech

The client with a newly applied cast complains of severe unrelenting pain. Which of the following nursing actions should the nurse do next?

a) Make the client NPO and notify the physician.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse?

"I took my blood pressure medication with my morning coffee an hour ago."

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client?

Applesauce and a graham cracker

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders?

Chronic kidney disease

The client with a closed head injury has clear fluid draining from the nose. Which action should the nurse implement first?

Test the drainage for presence of glucose.

During an assessment of a patient's abdomen, a pulsating abdominal mass is noted by the healthcare provider. Which of the following should be the healthcare provider's next action?

a. Assess femoral pulses

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand.

A patient with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the patient about what potential adverse effects?

B) Throbbing headache or dizziness

3. A nurse is caring for a client who has Cushing syndrome due to an adrenal tumor. Which assessment finding(s) should the nurse anticipate in this client? Select all that apply.

Hirsutism D. Serum sodium is 154 mEq/L E. Truncal Obesity

1.) The client has had a liver biopsy. Which postprocedure intervention should the nurse implement?

c- Place the client on the right side (correct)

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

check the client's pedal pulses frequently.

A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client's history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client's respiratory status. Which complication may arise if the client receives a high oxygen concentration?

Apnea

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:

Atelectasis

Which clinical indicators would the nurse expect for a client who has end-stage renal disease (ESRD)? Select all that apply. One, some, or all responses may be correct.

Azotemia Hypertension

Which client is at most risk for cancer?

B. A 35- year old client who smokes ½ a pack of cigarettes a day

A client complains of nocturia, bladder pain, urinary frequency, urgency, and dribbling at the end of urination. The digital rectal examination report indicates smooth, firm, and enlarged prostate tissue surrounding the urethra. Which condition would the nurse suspect?

Benign prostatic hyperplasia (BPH)

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease?

C. Loose, watery stool

Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

Continue to monitor the client

Before discharge, the nurse discusses activity levels with a 61-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness?

Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

1. A client who sustained a fractured femur in a construction accident is admitted to the orthopedic unit directly from surgery. The client is in skeletal traction. Which nursing action is the priority?

a. Perform frequent neurovascular checks

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

c. 6 L/min

1.) A client who has been diagnosed with end stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication?

reduce protein intake to 60 to 80g a day RESTRICT PROTIEN

3) A client with Peptic Ulcer disease wants to know non-pharmacological ways that he can prevent reoccurrence. Which of the following measures would the nurse recommend? Select all that apply.

● Avoidance of alcohol. ● Smoking cessation ● Following a regular schedule for rest, relaxation and meals.

The nurse is caring for a patient with stable angina. Which assessment finding would be consistent with this medical diagnosis?

3. Correlation between activity level and pain

The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regimen, to maintain a healthy weight, and to adopt a reasonable exercise program. This advice is based on research data that shows the most important risk factor for stroke is

Hypertension

A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?

Intermittent bubbling may be noted in the water seal chamber.

A nurse is assigned to assist in caring for a client who recently returned from the operating room. On data collection, the nurse notes that the client's vital signs are as follows: blood pressure (BP) 102/62 mm Hg, pulse 91 beats per minute, respirations 16 breaths per minute. Preoperative vital signs were BP 124/78 mm Hg, pulse 74 beats per minute, respirations 20 breaths per minute. Which of the following actions should the nurse plan to take first?

Recheck the vital signs in 15 minutes.

A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient?

Semi-Fowler's with the head supported on two pillows

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient?

Semi-fowlers

The nurse is caring for a 73-year-old patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient complains of shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4° F, blood pressure 130/88, respirations 36/minute, and oxygen saturation 91% on room air. What action should the nurse take first?

Sit the patient up in bed as tolerated and apply oxygen.

1. A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate?

a. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

1. The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia care unit (PACU). What should the nurse's initial action be upon the patient's arrival?

a. Assess the patient's vital signs

5. The nurse assesses a female client with a diagnosis of primary adrenal insufficiency (Addison's disease). The nurse recognizes which finding associated with the disease?

a. Bronze pigmentation of skin

What are the usual signs and symptoms a male would present with for prostate cancer? (Select all)

a. Increased prostate size c. Increased urination d Sexual dysfunction

A nurse teaches a male client about the use of a respiratory inhaler. Which action by the client indicates a need for further teaching?

a. Inhales the mist and quickly exhales

A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of:

a. Right pneumothorax

1. The nurse writes a problem of "altered body image" for a 34-year-old client with Cushing's disease. Which intervention should be implemented?

c. Use therapeutic communication to allow the client to discuss feelings.

You are caring for a patient post-op after resection of a pituitary tumor, which would indicate your patient might be experiencing a complication?

c.Serum sodium of 155

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications?

d) Hypovolemic shock

A patient has a history of multiple urinary tract infections. The nurse catheterized the patient and confirmed the presence of residual urine. Select the urine volume that is significantly associated with the risk of infection.

150 mL

After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

C. Encourage coughing and deep breathing

The nurse is providing dietary teaching to a client with a history of gallstones. Which diet should the nurse​ recommend? (Select all that​ apply.)

A. High protein C. Low fat

Your client takes NPH at 1200pm, when are they at the greater risk for hypoglycemia?

A.6pm

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription is documented in the client's medical record?

Administer 30 mL of milk magnesia (MOM)

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parenteral nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis?

Administering oral analgesics around the clock

A black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the:

B. Mucous membranes.

A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

B. Sputum culture

Which clinical manifestations would the nurse expect the client to report when experiencing renal calculi? Select all that apply. One, some, or all responses may be correct.

Blood in the urine Frequency and urgency of urination

The nurse is participating in the care conference for a patient with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments?

C) Balancing myocardial oxygen supply with demand

3. A 78-year-old client is admitted to the emergency department with numbness and weakness of the left arm and slurred speech. Which nursing intervention is a priority?

C) Schedule for A STAT computer tomography (CT) scan of the head.

5. Following a traumatic brain injury, a patient has been in a coma for several days. Which of the following statements is true of this patient's current LOC?

C) The patient may occasionally make nonpurposeful movements.

Family members bring a patient to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data?

C) The symptoms indicate an acute coronary episode and should be treated as such.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider (HCP)?

C. Rebound tenderness

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

C. Restricting fluids

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result?

C. The client has eliminated any irritating foods from the diet.

Your patient who has just had a thyroidectomy, what electrolyte would you plan to administer for potential complications?

Calcium

During the assessment in the ED, the nurse is palpating the patient's chest. Which finding is a medical emergency?

Trachea moved to the left

A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize which of the following assessments?

D) Reviewing the patient's creatinine and BUN levels

A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications?

Do you feel any muscle twitches or spasms?

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

Hypokalemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? Select All.

Hypokalemia Hypoglycemia

Which statement indicates the need for further teaching for a patient with newly diagnosed diabetes?

I will take only half of my insulin when I am sick, if i am nauseas

A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply.

Immobility Sickle-cell anemia Hypotension

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Low residue

An adult patient is admitted to the ED with chest pain. The patient states that he had developed unrelieved chest pain that was present for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions?

Morphine sulphate, oxygen, and bed rest

The nurse would be alerted to the occurrence of malignant hyperthermia when the patient demonstrates what manifestation?

Muscle rigidity

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication?

Pernicious anemia

A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

Polyps

The client is diagnosed with a closed head injury and is in a coma. The nurse writes the client problem as "high risk for immobility complications." Which intervention would be included in the plan of care?

Position the client with the head of the bed elevated at intervals.

Which client requires immediate nursing intervention? The client who:

Presents with rigid, board like abdomen

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the health care provider?

Purple discoloration of the stoma

A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

Stridor

4. The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency?

Temperature of 102ºF

A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy?

The patient is at an increased risk for developing infection.

Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate?

The system is functioning normally

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm?

Ventricular fibrillation

what would be an expected lab findings in a patient with Addisons disease

a. K 6.0 C. glucose 50

what would be an expected lab finding of cushings (select all that applies)?

a. sodium 154 b. potassium 3.0 c. glucose 250 d. WBC's 14

Which of the following are signs of a rupturing AAA? Select all that apply:

b. Decreased Hct c. Low Back Pain d. Decreased BP

A community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

d. A cough with the expectoration of mucoid sputum

Which of the following is not a s/s of DKA

oliguria