Final Exam Med Surg III

Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula?

Auscultate for a bruit at the fistula site.

A nurse is providing dietary teaching to a client who has frequently kidney stones. Which of the following instructions should the nurse include in the teaching?

Avoid eating tree nut, such as almonds.

Which instruction will the nurse plan to include in discharge teaching for a patient admitted with sickle cell crisis?

Avoid exposure to crowds when possible

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura?

Avoid intermuscular (IM) injections.

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

Avoid intramuscular injections

The complete blood count indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

Avoid intramuscular injections

A patient in the emergency department reports back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. What should the nurse's first action be?

Disconnect the transfusion and infuse normal saline

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5 (101.2). Which nursing action is most appropriate?

notify the health care provider

The nurse examines the lymph nodes of a patient during a physical assessment. Which finding would be of most concern to the nurse?

A 2 cm non-tender supraclavicular node

After receiving change of shift report for several patients with neutropenia, which patient should the nurse assess first?

A 33-year-old with a fever of 100.8 F (38.2 C)

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action?

notify the pcp

A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis is diagnosed with heparin-induced thrombocytopenia when the platelet level drops to 110,00/ul. Which action will the nurse include in the plan of care?

Discontinue the heparin infusion

Which question should the ask nurse ask to assess a patient's dysuria?

Do you have pain when you urinate?

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse as the patient?

Do you take medication containing salicylate? (Aspirin)

The nurse assessing a patient who has numerous petechiae on both arms. Which questions should the nurse ask the patient?

Do you take medication containing salicylates (aspirin)

A nurse is providing dietary teaching to a client who has a history of recurring calcium oxalate kidney stones. Which of the following instructions should the nurse include in the teaching?

Drink 3 L fluid every day.

The nurse is providing discharge instruction to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list?

Drink 8 to 10 glasses of water per day.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation for the disorder?

Dysuria and proteinuria

A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take?

Encourage intake of a least 3 L of fluid per day.

For the patient with anaphylaxis, which priority intervention does the nurse expect to implement?

Epinephrine Injection

It is important for the nurse providing care for a patient with sickle cell crisis to?

Evaluate the effectiveness of opioid analgesics

A nurse is caring for a client who has new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?

Family history

A patient who is receiving methotrexate for serve rheumatoid arthritis develops a megaloblastic anemia. Which nutrient supplements should the nurse plan to explain to the patient?

Folic acid

A patient with pancytopenia will have a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

Have the patient lie on the left side for 1 hour

A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

Have the patient lie on the left side for 1 hour.

An adult male with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. Which laboratory data wound the nurse identify as consistent with these symptoms?

Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)

A nurse is caring for a client who is postoperative following a transurethral resection of the prostate. Which of the following complications is the priority for the nurse to monitor for?

Hemorrhage

The nurse is reviewing lab results and notes a patients activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

Heparin

An 83-year-old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in this patient (select all that apply)?

Hypovolemia, Decreased cardiac output

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to provider?

I don't eat shellfish because it gives me hives.

A nurse is providing dietary teaching to a client who has calcium oxalate kidney stones. Which of the following statements indicates an understanding of the teaching?

I may eat a banana with my breakfast.

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast?

I need to avoid getting the cast wet.

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?

I will call my health care provider if my stools turn black

A patient received a kidney transplant last month. Because of the effect of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for to decrease the risk of mortality?

Infection

Which potential complication should the nurse identify as a high risk for a patient admitted to the hospital with idiopathic aplastic anemia?

Infection

What action should the nurse take first when a patient's urine dipstick test indicates a smell amount of protein?

Inquire about which medication the patient is currently taking.

A 78-year-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?

Leave a light on in the bathroom during the night.

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?

Lip swelling

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan care?

Schedule immunization with the pneumococcal vaccine (pneumovax)

A male patient in the client provides a urine sample that is red orange in color. Which action should the nurse take?

Ask the patient about current medications.

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thromboplastin time (HIT)?

Activated partial thromboplastin time (aPTT)

A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priorities nursing actions? SATA

Administer oxygen to the client, Notify the primary health care provider (PHCP) and Rapid Response Team, Stop dialysis, and turn the client on the client on the left side with head lower than feet.

A nurse is caring for a client who reports recurrent flank pain, nausea, and vomiting for 24 hrs. Which of the following actions is the nurse's priority?

Administer pain medication

A nurse is caring for a patient with sickle cell crisis. Which of the following is a priority intervention for the patient?

Administer pain medication

Which nursing action is essential for a patient immediately after a renal biopsy?

Apply a pressure dressing and position the patient of the affected side

The nurse observes sclera jaundice in a patient being admitted with hemolytic anemia. Which laboratory result the nurse should check?

Bilirubin

A young adult employed as a hair stylist who has a 15 pack-year history of cigarette smoking arrives for an annual physical examination. Which area of increased risk should the nurse plan to teach the patient?

Bladder cancer

A nurse is caring for a client who has an indwelling urinary catheter and notes blood-tinged urine in the catheter bag. The nurse recognizes this finding can be a manifestation of which of the following urinary alterations?

Bladder infection

A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the?

Bleeding time

A routine complete blood count for an older man indicates possible myelodysplastic syndrome. What should the nurse plan to explain to the patient?

Bone marrow transplant

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health provider?

Calf swelling and pain

A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate?

Cardiac rhythm

An appropriate nursing intervention for a patient with non-Hodgkin lymphoma whose platelet count drops to 18,000/L during chemotherapy is to?

Check all stool for occult blood.

Which action will the admitting nurse include in the care plan for a patient who has neutropenia?

Check temperature every 4 hours

A nurse is caring for a client who is 5 hr post op following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first?

Check the tubing for kinks

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus?

Clear mentation

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response?

Continue taking the medication; the brown urine occurs and is not harmful.

A nurse is reviewing the medical record of a client who has a urinary tract infection (UTI). Which of the following findings should the nurse recognize as a risk factor?

Diabetes mellitus

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination?

Diarrhea, groin pain, testicular torsion and scrotal edema

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of the which medication?

Decongestants

A child was B-thalassemia is receiving long-term transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate?

Deferoxamine (Desferal)

A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain which of the following conditions can increase the risk of renal calculi?

Dehydration

What are intrarenal causes of acute kidney injury (AKI)? SATA

Nephrotoxic drugs, Acute glomerulonephritis, Tubular obstruction by myoglobin

A client is admitted to the ED following a fall from a horse, and the PCP prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action?

Notify the PCP before performing the catheterization

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

Numbness of the extremities

The nurse assesses a patient with pernicious anemia. Which finding would the nurse expect?

Numbness of the extremities

Which menu choice indicates that the patient understands the nurse teaching about best dietary choices for iron-deficiency anemia?

Omelet and whole wheat toast.

Which of the following is the most common manifestation in sickle cell crisis?

Pain

A client with acute kidney injury has serum potassium level 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? SATA.

Place the client on a cardiac monitor, Notify the primary health care provider (PHCP), Review the client's medications to determine whether any contain or retain potassium.

A client with a hip fracture asks the nurse about Bucks (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client?

Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

A nurse is planning care for a client who is 2 hr post op followed a transurethral resection of the prostate. The client is receiving continuous bladder irrigation. Which of the following interventions should the nurse include?

Remind the client he might feel a constant urge to void.

Which statement by a patient indicates good understanding of the nurse's teaching about preventing sickle cell crisis?

Risk for a crisis is decreased by having a n annual influenza vaccination

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?

The patient is difficult to arouse

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider?

The patient is difficult to arouse.

A patient gives the admitting nurse health information before a scheduled intravenous pyelogram (IVP). Which item requires the nurse to intervene before the procedure?

The patient lists allergies to shellfish and penicillin.

Which patient requires the most rapid assessment and care by the emergency department nurse?

The patient with neutropenia who has a temperature of 101.8 F

The nurse has reviewed activity restrictions with a client who is being discharged after insertion of a femoral head prosthesis. What statement by the client will help the nurse determine that the client understands the material presented?

Use a raised toilet seat

A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

Wash hand and avoid persons who are ill

A nurse reviews the lab data for an older adult. The nurse would be most concerned about which finding?

White blood cell count of 2800

A nurse is teaching a client who is scheduled for a cystoscopy. Which of the following information should the nurse include in the teaching?

You may have pink-tinged urine after this procedure.

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome?

numbness and tingling in the fingers

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the pcp?

blood pressure 100/50, pulse bpm

The nurse is examining an adult patient. For what purpose would the nurse use palpation?

check for bladder distention

The nurse is monitoring a client receiving Peritoneal dialysis notes that the clients outflow is less than the inflow. what actions should the nurse take?

check the level of the drainage bag. reposition the client to her or his side, place client in good body alignment, check the peritoneal dialysis system for kinks

A 78 year old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?

leave a light on in the bathroom during the night

Which question should the nurse ask to assess a patient's dysuria?

do you have pain when you urinate?

The nurse completing a physical assessment for a newly admitted patient is unable to feel either kidney on palpation. Which action should the nurse take?

document the information on the assessment form

Allopurinal is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide?

drink 3000ml of fluid a day

a client is being discharged to home after application of a plaster leg cast/ which statement indicates that the client understands proper care of the cast?

i need to avoid getting the cast wet

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement?

injury to the brachial plexus nerves

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the clients record knowing that this medication would be used with caution in which disorder?

kidney disease

The nurse is caring for an older adult who has been placed in Buck's extension traction after a hip fracture. On assessment of the client, the nurse notes that the client is disoriented. What is the best nursing action based on this information?

plan a clock and calendar in the clients room

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?

presence of a "hot spot" on the cast

The nurse is caring for a client who has an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take?

rewrap the residual limb with an elastic compression bandage

A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which should the nurse specifically observe in the postoperative period?

separation of the wound edges

The nurse preparing a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client?

signs of skin breakdown

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy?

sore throat

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide?

take the medication with a full glass of water after rising in the morning

The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding?

temp of 101.6

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?

uric acid level of 8.6mg/dl