Med-Surg II HESI Exam - set one

Three days after mitral valve replacement surgery, the client tells the nurse there is a "clicking" noise coming from the chest incision and the incision seems to becoming larger. The nurse's response should reflect the understanding that the client may be experiencing which of the following? 1. Anxiety related to altered body image. 2. Anxiety related to altered health status. 3. Altered tissue perfusion. 4. Lack of knowledge regarding the postoperative course.

1. Anxiety related to altered body image.

A client is admitted with a 6.5-cm thoracic aneurysm. The nurse records findings from the initial assessment in the client's chart, as shown below. At 10:30 AM, the client has sharp mid-chest pain after having a bowel movement. What should the nurse do first? 1. Assess the client's vital signs. 2. Administer a bolus of lactated Ringer's solution. 3. Assess the client's neurologic status. 4. Contact the physician.

1. Assess the client's vital signs.

The nurse is teaching a client with hypertension about taking atenolol (Tenormin). The nurse should instruct the client to: 1. Avoid sudden discontinuation of the drug. 2. Monitor the blood pressure annually. 3. Follow a 2-g sodium diet. 4. Discontinue the medication if severe headaches develop.

1. Avoid sudden discontinuation of the drug.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: 1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. 2. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. 3. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. 4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include instructing the client to do which of the following? Select all that apply. 1. Brush the teeth at least twice a day. 2. Avoid use of an electric toothbrush. 3. Take an antibiotic prior to oral surgery. 4. Floss the teeth at least once a day. 5. Have regular dental checkups. 6. Rinse the mouth with an antibiotic mouthwash once a day.

1. Brush the teeth at least twice a day. 4. Floss the teeth at least once a day. 5. Have regular dental checkups.

Which instructions should the nurse include when developing a teaching plan for a client being discharged from the hospital on anticoagulant therapy after having deep vein thrombosis (DVT)? Select all that apply. 1. Checking urine for bright blood and a dark smoky color. 2. Walking daily as a good exercise. 3. Using garlic and ginger, which may decrease bleeding time. 4. Performing foot/leg exercises and walking around the airplane cabin when on long flights. 5. Preventing DVT because of risk of pulmonary emboli. 6. Avoiding surface bumps because the skin is prone to injury.

1. Checking urine for bright blood and a dark smoky color. 2. Walking daily as a good exercise. 4. Performing foot/leg exercises and walking around the airplane cabin when on long flights. 5. Preventing DVT because of risk of pulmonary emboli. 6. Avoiding surface bumps because the skin is prone to injury.

After a subtotal gastrectomy, the nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? 1. Dark brown. 2. Bile green. 3. Bright red. 4. Cloudy white.

1. Dark brown

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: 1. Decrease in heart rate. 2. Lessening of fatigue. 3. Improvement in blood sugar levels. 4. Increase in urine output.

1. Decrease in heart rate.

After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. It will be most important for the nurse to include information about which of the following in the client's teaching plan? 1. Nutritional intake. 2. Management of alopecia. 3. Exercise and activity levels. 4. Access to community resources.

1. Nutritional intake.

The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to: 1. Observe careful handwashing procedures. 2. Clean the incisional area with an antiseptic. 3. Use prepackaged sterile dressings to cover the incision. 4. Place soiled dressings in a waterproof bag before disposing of them.

1. Observe careful handwashing procedures.

When teaching the client older than age 50 who is receiving long-term prednisone therapy, the nurse should recommend which of the following? 1. Take the prednisone with food. 2. Take over-the-counter drugs as needed. 3. Exercise three to four times a week. 4. Eat foods that are low in potassium.

1. Take the prednisone with food.

A client who has diabetes is taking metoprolol (Lopressor) for hypertension. Which of the following information should the nurse include in the teaching plan? Select all that apply 1. These tablets should be taken with food at same time each day. 2. Do not crush or chew the tablets. 3. Notify the health care provider if pulse is 82 per minute. 4. Have a blood glucose level drawn every 6 to 12 months during therapy. 5. Use an appropriate decongestant if needed. 6. Report any fainting spells to the health care provider.

1. These tablets should be taken with food at same time each day. 2. Do not crush or chew the tablets. 4. Have a blood glucose level drawn every 6 to 12 months during therapy. 6. Report any fainting spells to the health care provider.

A client diagnosed with primary (essential) hypertension is taking chlorothiazide (Diuril). The nurse determines teaching about this medication is effective when the client makes the following statement. "I will (Select all that apply.) 1. take my weight daily at the same time each day." 2. not drink alcoholic beverages while on this medication." 3. reduce salt intake in my diet." 4. reduce my dosage if I have severe dizziness." 5. use sunscreen if I have prolonged exposure to sunlight." 6. take the drug late in the evening."

1. take my weight daily at the same time each day." 2. not drink alcoholic beverages while on this medication." 3. reduce salt intake in my diet." 5. use sunscreen if I have prolonged exposure to sunlight."

The nurse is evaluating a client with hyperthyroidism who is taking Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which of the following statements from the client indicates the desired outcome of the drug? 1. "I have excess energy throughout the day." 2. "I am able to sleep and rest at night." 3. "I have lost weight since taking this medication." 4. "I do perspire throughout the entire day."

2. "I am able to sleep and rest at night." PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormones and peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be able to sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy throughout the day, loss of weight and perspiring through the day are symptoms of hyperthyroidism indicating the drug has not produced its outcome. CN: Pharmacological and parenteral therapies; CL: Evaluate.

The nurse is teaching a female client with a history of acquired thrombocytopenia about how to prevent and control hemorrhage. Which statement indicates that the client needs further instruction? 1. "I can apply direct pressure over small cuts for at least 5 to 10 minutes to stop a venous bleed." 2. "I can count the number of tissues saturated to detect blood loss during a nosebleed." 3. "I can take hormones to decrease blood loss during menses." 4. "I can count the number of sanitary napkins to detect excess blood loss during menses."

2. "I can count the number of tissues saturated to detect blood loss during a nosebleed."

A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily." Which of the following responses by the nurse would give the client the most accurate explanation of her behavior? 1. "Your behavior is caused by temporary confusion brought on by your illness." 2. "Your behavior is caused by the excess thyroid hormone in your system." 3. "Your behavior is caused by your worrying about the seriousness of your illness." 4. "Your behavior is caused by the stress of trying to manage a career and cope with illness."

2. "Your behavior is caused by the excess thyroid hormone in your system." A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid hormones in the body. This symptom decreases as the client responds to therapy. Thyrotoxicosis does not cause confusion. The client may be worried about her illness, and stress may influence her mood; however, irritability is a common symptom of thyrotoxicosis and the client should be informed of that fact rather than blamed. CN: Psychosocial integrity; CL: Synthesize

When a client with thrombocytopenia has a severe headache, the nurse interprets that this may indicate which of the following? 1. Stress of the disease. 2. Cerebral bleeding. 3. Migraine headache. 4. Sinus congestion.

2. Cerebral bleeding.

The client is admitted with left lower leg pain, a positive Homans' sign, and a temperature of 100.4°F (38°C). The nurse should assess the client further for signs of: 1. Aortic aneurysm. 2. Deep vein thrombosis (DVT) in the left leg. 3. IV drug abuse. 4. Intermittent claudication.

2. Deep vein thrombosis (DVT) in the left leg.

Before a client's discharge after mitral valve replacement surgery, the nurse should evaluate the client's understanding of post surgery activity restrictions. Which of the following should the client not engage in until after the 1-month post discharge appointment with the surgeon? 1. Showering. 2. Lifting anything heavier than 10 lb (4.5 kg). 3. A program of gradually progressive walking. 4. Light housework.

2. Lifting anything heavier than 10 lb (4.5 kg).

A client weighs 300 lbs (136 kg) and has a history of deep vein thrombosis and thrombophlebitis. When reviewing a teaching plan with this client, the nurse determines that the client has understood the nurse's instructions when the client states a willingness to: 1. Avoid exercise. 2. Lose weight. 3. Perform leg lifts every 4 hours. 4. Wear support hose, using rubber bands to hold the stockings up.

2. Lose weight.

One day following a subtotal thyroidectomy, a client begins to have tingling in the fingers and toes. The nurse should first: 1. Encourage the client to flex and extend the fingers and toes. 2. Notify the physician. 3. Assess the client for thrombophlebitis. 4. Ask the client to speak.

2. Notify the physician

Nursing assessment of a 54-year-old client in the emergency department reveals severe back pain, Grey Turner's sign, nausea, blood pressure of 90/40, heart rate 128 bpm, and respirations 28/min. The nurse should first: 1. Assess the urine output. 2. Place a large-bore IV 3. Position onto the left side. 4. Insert a nasogastric tube.

2. Place a large-bore IV

Which set of postural vital signs (BP and heart rate) indicate inadequate blood volume? 1. Supine 124/76, 88. Sitting 124/74, 92. Standing 122/74, 92. 2. Supine 120/70, 70. Sitting 102/64, 86. Standing 100/60, 92. 3. Supine 138/86, 74. Sitting 136/84, 80. Standing 134/82, 82. 4. Supine 100/70, 72. Sitting 100/68, 74. Standing 98/68, 80.

2. Supine 120/70, 70. Sitting 102/64, 86. Standing 100/60, 92. There was a significant change in both blood pressure and heart rate with position change. This indicates inadequate blood volume to sustain normal values. Normal postural changes allow for an increase in heart rate of 5 to 20 bpm, a possible slight decrease of less than 5 mm Hg in the systolic blood pressure, and a possible slight increase of less than 5 mm Hg in the diastolic blood pressure.

The nurse is instructing the client with hypothyroidism who takes levothyroxine (Synthroid) 100 mcg, digoxin (Lanoxin) and simvastatin (Zocor). Teaching regarding medications is effective if the client will take: 1. The Synthroid with breakfast and the other medications after breakfast. 2. The Synthroid before breakfast and the other medications 4 hours later. 3. All medications together 1 hour after eating breakfast. 4. All medications before going to bed.

2. The Synthroid before breakfast and the other medications 4 hours later.

A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During preoperative teaching, the nurse is reinforcing information about the surgical procedure. Which of the following explanations is most accurate? 1. The procedure will result in enlargement of the pyloric sphincter. 2. The procedure will result in anastomosis of the gastric stump to the jejunum. 3. The procedure will result in removal of the duodenum. 4. The procedure will result in repositioning of the vagus nerve.

2. The procedure will result in anastomosis of the gastric stump to the jejunum.

A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? (Select all that apply.) 1. rapid pulse 2. decreased energy and fatigue 3. weight gain of 10 lbs (4.5 kg) 4. fine, thin hair with hair loss 5. constipation 6. menorrhagia.

2. decreased energy and fatigue, 3. weight gain of 10 lbs (4.5 kg), 5. constipation, 6. menorrhagia Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone. Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse hair, constipation, and menorrhagia are common signs and symptoms of hypothyroidism. CN: Physiological adaptation; CL: Analyze

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' Disease. The nurse should assess this client for: 1. anorexia 2. tachycardia 3. weight gain 4. cold skin

2. tachycardia Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism. CN: Physiological adaptation; CL: Analyze

A client with hypertensive emergency is being treated with sodium nitroprusside (Nipride). In a dilution of 50 mg/250 mL, how many micrograms of Nipride are in each milliliter? __________________ mcg.

200 mcg First, calculate the number of milligrams per milliliter: Next, calculate the number of micrograms in each milligram:

The nurse is teaching a diabetic client using an empowerment approach. The nurse should initiate teaching by asking which of the following? 1. "How much does your family need to be involved in learning about your condition?" 2. "What is required for your family to manage your symptoms?" 3. "What activities are most important for you to be able to maintain control of your diabetes?" 4. "What do you know about your medications and condition?"

3. "What activities are most important for you to be able to maintain control of your diabetes?"

The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? 1. Mixed green salad with blue cheese dressing, crackers, and cold cuts. 2. Ham sandwich on rye bread and an orange. 3. Baked chicken, an apple, and a slice of white bread. 4. Hot dogs, baked beans, and celery and carrot sticks.

3. Baked chicken, an apple, and a slice of white bread.

The client's family asks why the client who had a splenectomy has a nasogastric (NG) tube. An NG tube is used to: 1. Move the stomach away from where the spleen was removed. 2. Irrigate the operative site. 3. Decrease abdominal distention. 4. Assess for the gastric pH as peristalsis returns.

3. Decrease abdominal distention.

A client is admitted with an acute onset of shortness of breath. A diagnosis of pulmonary embolism is made. One common cause of pulmonary embolism is: 1. Arteriosclerosis. 2. Aneurysm formation. 3. Deep vein thrombosis (DVT). 4. Varicose veins.

3. Deep vein thrombosis (DVT).

The nurse is administering a saturated solution of potassium iodide (SSKI). The nurse should: 1. Pour the solution over ice chips. 2. Mix the solution with an antacid. 3. Dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. 4. Disguise the solution in a pureed fruit or vegetable.

3. Dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. SSKI should be diluted well in milk, water, juice, or a carbonated beverage before administration to help disguise the strong, bitter taste. Also, this drug is irritating to mucosa if taken undiluted. The client should sip the diluted preparation through a drinking straw to help prevent staining of the teeth. Pouring the solution over ice chips will not sufficiently dilute the SSKI or cover the taste. Antacids are not used to dilute or cover the taste of SSKI. Mixing in a puree would put the SSKI in contact with the teeth. CN: Pharmacological and parenteral therapies; CL: Apply

A client is receiving an IV infusion of 5% dextrose in water (D5W). The skin around the IV insertion site is red, warm to touch, and painful. The nurse should first: 1. Administer acetaminophen (Tylenol). 2. Change the D5W to normal saline. 3. Discontinue the IV. 4. Place a warm compress on the area.

3. Discontinue the IV.

A client with a cerebral embolus is receiving streptokinase. The nurse should evaluate the client for which of the following expected outcomes of this drug therapy? 1. Improved cerebral perfusion. 2. Decreased vascular permeability. 3. Dissolved emboli. 4. Prevention of cerebral hemorrhage.

3. Dissolved emboli.

The client realizes the importance of quitting smoking, and the nurse develops a plan to help the client achieve this goal. Which of the following nursing interventions should be the initial step in this plan? 1. Review the negative effects of smoking on the body. 2. Discuss the effects of passive smoking on environmental pollution. 3. Establish the client's daily smoking pattern. 4. Explain how smoking worsens high blood pressure.

3. Establish the client's daily smoking pattern.

The nurse should teach the client with Graves' disease to prevent corneal irritation from mild exophthalmos by: 1. Massaging the eyes at regular intervals. 2. Instilling an ophthalmic anesthetic as prescribed. 3. Wearing dark-colored glasses. 4. Covering both eyes with moistened gauze pads.

3. Wearing dark-colored glasses. Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures such as wearing sunglasses to protect the eyes from corneal irritation. Treatment of ophthalmopathy should be performed in consultation with an ophthalmologist. Massaging the eyes will not help to protect the cornea. An ophthalmic anesthetic is used to examine and possibly treat a painful eye, not protect the cornea. Covering the eyes with moist gauze pads is not a satisfactory nursing measure to protect the eyes of a client with exophthalmos because treatment is not focused on moisture to the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the retrobulbar connective tissues and extraocular muscle volume are expanded because of fluid retention. The pressure is also increased. CN: Reduction of risk potential; CL: Synthesize

When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about which of the following changes in the menstrual cycle? 1. dysmenorrhea 2. metrorrhagia 3. oligomenorrhea 4. menorrhagia

3. oligomenorrhea A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the absence of menstruation (amenorrhea) may result from the hormonal imbalances of thyrotoxicosis. Oligomenorrhea in women and decreased libido and impotence in men are common features of thyrotoxicosis. Dysmenorrhea is painful menstruation. Metrorrhagia, blood loss between menstrual periods, is a symptom of hypothyroidism. Menorrhagia, excessive bleeding during menstrual periods, is a symptom of hypothyroidism. CN: Physiological adaptation; CL: Analyze

The nurse should assess a client with hypothyroidism for which of the following? 1. Corneal abrasion due to inability to close the eyelids. 2. Weight loss due to hypermetabolism. 3. Fluid loss due to diarrhea. 4. Decreased activity due to fatigue.

4. Decreased activity due to fatigue

A client has an emergency embolectomy for an embolus in the femoral artery. After the client returns from the recovery room, in what order, from first to last, should the nurse provide care? 1. Administer pain medication. 2. Draw blood for laboratory studies. 3. Regulate the IV infusion. 4. Monitor the pulses. 5. Inspect the dressing.

4. Monitor the pulses. 5. Inspect the dressing. 3. Regulate the IV infusion. 1. Administer pain medication. 2. Draw blood for laboratory studies. The nurse should first monitor the popliteal and the pedal pulses in the affected extremity after arterial embolectomy. Monitoring peripheral pulses below the site of occlusion checks the arterial circulation in the involved extremity. The nurse should next inspect the dressing to be sure that the client is not bleeding at the surgical site. The nurse should next regulate the IV infusion to prevent fluid overload. Then the nurse should assess pain and administer pain medications as prescribed. Last, the nurse can obtain blood for laboratory studies.

When discussing recent onset of feelings of sadness and depression in a client with hypothyroidism, the nurse should inform the client that these feelings are: 1. The effects of thyroid hormone replacement therapy and will diminish over time. 2. Related to thyroid hormone replacement therapy and will not diminish over time. 3. A normal part of having a chronic illness. 4. Most likely related to low thyroid hormone levels and will improve with treatment.

4. Most likely related to low thyroid hormone levels and will improve with treatment.

The client with idiopathic thrombocytopenic purpura (ITP) asks the nurse why it is necessary to take steroids. Which is the nurse's best response? 1. Steroids destroy the antibodies and prolong the life of platelets. 2. Steroids neutralize the antigens and prolong the life of platelets. 3. Steroids increase phagocytosis and increase the life of platelets. 4. Steroids alter the spleen's recognition of platelets and increase the life of platelets.

4. Steroids alter the spleen's recognition of platelets and increase the life of platelets.

Which intervention would be most likely to assist the client with hypertension in maintaining an exercise program? 1. Giving the client a written exercise program. 2. Explaining the exercise program to the client's spouse. 3. Reassuring the client that he or she can do the exercise program. 4. Tailoring a program to the client's needs and abilities.

4. Tailoring a program to the client's needs and abilities.

A client has been on long-term prednisone therapy. The nurse should instruct the client to consume a diet high in which of the following? Select all that apply. 1. Carbohydrate. 2. Protein. 3. Trans fat. 4. Potassium. 5. Calcium. 6. Vitamin D.

2. Protein. 4. Potassium. 5. Calcium. 6. Vitamin D.

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The expected outcome of using this drug is that it helps: 1. Slow progression of exophthalmos. 2. Reduce the vascularity of the thyroid gland. 3. Decrease the body's ability to store thyroxine. 4. Increase the body's ability to excrete thyroxine.

2. Reduce the vascularity of the thyroid gland. SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of exophthalmos, and it does not decrease the body's ability to store thyroxine or increase the body's ability to excrete thyroxine. CN: Pharmacological and parenteral therapies; CL: Apply

A client is on complete bed rest. The nurse should assess the client for risk for developing which of the following complications? 1. Air embolus. 2. Fat embolus. 3. Stress fractures. 4. Thrombophlebitis.

4. Thrombophlebitis.

The nurse interviews a 22-year-old female client who is scheduled for abdominal surgery the following week. The client is obese and uses estrogen-based oral contraceptives. This client is at high risk for development of: 1. Atherosclerosis. 2. Diabetes. 3. Vasospastic disorder (Raynaud's disease). 4. Thrombophlebitis.

4. Thrombophlebitis.

The nurse is developing a discharge teaching plan for a client who underwent a repair of abdominal aortic aneurysm 4 days ago. The nurse reviews the client's chart for information about the client's history. Key findings are noted in the chart below. Based on the data and expected outcomes, which should the nurse emphasize in the teaching plan? 1. Food intake. 2. Fluid volume. 3. Skin integrity. 4. Tissue perfusion.

4. Tissue perfusion.

In order to prevent deep vein thrombosis (DVT) following abdominal surgery, the nurse should: 1. Restrict fluids. 2. Encourage deep breathing. 3. Assist the client to remain sedentary. 4. Use pneumatic compression stockings.

4. Use pneumatic compression stockings.

The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client? 1. Floor exercises. 2. Stretching. 3. Running. 4. Walking.

4. Walking

The nurse is preparing to administer platelets. The nurse should: 1. Check the ABO compatibility. 2. Administer the platelets slowly. 3. Gently rotate the bag. 4. Use a whole blood tubing set.

3. Gently rotate the bag.

In teaching the client with hypertension to avoid orthostatic hypotension, the nurse should emphasize which of the following instructions? Select all that apply. 1. Plan regular times for taking medications. 2. Arise slowly from bed. 3. Avoid standing still for long periods. 4. Avoid excessive alcohol intake. 5. Avoid hot baths.

2. Arise slowly from bed. 3. Avoid standing still for long periods.

A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? 1. Tachycardia. 2. Weight gain. 3. Diarrhea. 4. Nausea.

Weight gain

A client who weighs 187 lb (85 kg) has a prescription to receive enoxaparin (Lovenox) 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? _________________ mL.

0.85 mL The physician's prescription is for the client to receive enoxaparin (Lovenox) 1 mg/kg. Therefore, the client is to receive 85 mg. The desired dose in milliliters then can be calculated by using the formula of desired dose (D) divided by dose or strength of dose on hand (H) times volume (V).

The nurse is discussing medications with a client with hypertension who has a prescription for furosemide (Lasix) daily. The client needs further education when the client states which of the following? 1. "I know I should not drive after taking my Lasix." 2. "I should be careful not to stand up too quickly when taking Lasix." 3. "I should take the Lasix in the morning instead of before bed." 4. "I need to be sure to also take the potassium supplement that the doctor prescribed along with my Lasix."

1. "I know I should not drive after taking my Lasix."

A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? Select all that apply. 1. Dry mouth. 2. Hyperkalemia. 3. Impotence. 4. Pancreatitis. 5. Sleep disturbance.

1. Dry mouth. 3. Impotence. 5. Sleep disturbance. Clonidine (Catapres) is a central-acting adrenergic antagonist. It reduces sympathetic outflow from the central nervous system. Dry mouth, impotence, and sleep disturbances are possible adverse effects. Hyperkalemia and pancreatitis are not anticipated with use of this drug.

For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery, which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion? 1. Ensure a liberal fluid intake. 2. Provide an alkaline-ash diet. 3. Prevent constipation. 4. Enrich the client's diet with dairy products.

1. Ensure a liberal fluid intake.

Which of the following clients is at risk for varicose veins? 1. A client who has had a cerebrovascular accident. 2. A client who has had anemia. 3. A client who has had thrombophlebitis. 4. A client who has had transient ischemic attacks.

3. A client who has had thrombophlebitis.

The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client makes which of the following statements? 1. "Petechiae are large, red skin bruises." 2. "Ecchymoses are large, purple skin bruises." 3. "Purpura is an open cut on the skin." 4. "Abrasions are small pinpoint red dots on the skin."

2. "Ecchymoses are large, purple skin bruises."

A client's bone marrow report reveals normal stem cells and precursors of platelets (megakaryocytes) in the presence of decreased circulating platelets. The nurse recognizes a knowledge deficit when the client makes which of the following statements? 1. "I need to stop flossing and throw away my hard toothbrush." 2. "I am glad that my report turned out normal." 3. "Now I know why I have all these bruises." 4. "I shouldn't jump off that last step anymore."

2. "I am glad that my report turned out normal."

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the client should eat which of the following? 1. Bland foods. 2. High-protein foods. 3. Any foods that are tolerated. 4. A glass of milk with each meal.

3. Any foods that are tolerated.

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from a briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1. Involvement with the job will keep the client from becoming bored. 2. A relaxed environment will promote ulcer healing. 3. Not keeping up with the job will increase the client's stress level. 4. Setting limits on the client's behavior is an important nursing responsibility.

2. A relaxed environment will promote ulcer healing.

Which of the following medications should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? 1. Sodium phosphate. 2. Calcium gluconate. 3. Echothiophate iodide. 4. Sodium bicarbonate.

2. Calcium gluconate

A client who is recovering from gastric surgery is receiving IV fluids to be infused at 100 mL/h. The IV tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/h? ____________ gtt/min.

25 gtt/min To administer IV fluids at 100 mL/h using tubing that has a drip factor of 15 gtt/mL, the nurse should use the following formula: 100 mL/60 minutes × 15 gtts/1 mL = 25 gtt/min.

A client is to take one daily dose of ranitidine (Zantac) at home to treat a peptic ulcer. The client understands proper drug administration of ranitidine when the client will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.

3. At bedtime.

A client is to be discharged on prednisone. Which of the following statements indicates that the client understands important concepts about the medication therapy? 1. "I need to take the medicine in divided doses at morning and bedtime." 2. "I am to take 40 mg of prednisone for 2 months and then stop." 3. "I need to wear or carry identification that I am taking prednisone." 4. "Prednisone will give me extra protection from colds and flu."

3. "I need to wear or carry identification that I am taking prednisone."

After treatment with radioactive iodine (RAI) in the form of sodium iodide 131I, the nurse teaches the client to: 1. Monitor for signs and symptoms of hyperthyroidism. 2. Rest for 1 week to prevent complications of the medication. 3. Take thyroxine replacement for the remainder of the client's life. 4. Assess for hypertension and tachycardia resulting from altered thyroid activity.

3. Take thyroxine replacement for the remainder of the client's life. The client needs to be educated about the need for lifelong thyroid hormone replacement. Permanent hypothyroidism is the major complication of RAI 131I treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client needs to monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1 week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not hypothyroidism. CN: Pharmacological and parenteral therapies; CL: Synthesize

A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication? 1. The client has a sore throat. 2. The client displays signs of sedation. 3. The client experiences a sudden increase in temperature. 4. The client demonstrates a lack of appetite.

3. The client experiences a sudden increase in temperature.

A client has been taking aluminum hydroxide 30 mL six times per day at home to treat a peptic ulcer. The client has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1. The client has not been including enough fiber in the diet. 2. The client needs to increase the daily exercise. 3. The client is experiencing an adverse effect of the aluminum hydroxide. 4. The client has developed a gastrointestinal obstruction.

3. The client is experiencing an adverse effect of the aluminum hydroxide.

A client is scheduled for an elective splenectomy. Immediately before the client goes to surgery, the nurse should determine that the client has: 1. Voided completely. 2. Signed the consent. 3. Vital signs recorded. 4. Name band on wrist

3. Vital signs recorded.

A client diagnosed with a deep vein thrombosis has heparin sodium infusing at 1,500 units/h. The concentration of heparin is 25,000 units/500 mL. If the infusion remains at the same rate for a full 12-hour shift, how many milliliters of fluid will infuse? __________________________-mL.

360 mL

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. "I should take my antacid before I take my other medications." 2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3. "My antacid will be most effective if I take it whenever I experience stomach pains." 4. "It is best for me to take my antacid 1 to 3 hours after meals."

4. "It is best for me to take my antacid 1 to 3 hours after meals."

A client who is recovering from a subtotal gastrectomy experiences dumping syndrome. The client asks the nurse, "When will I be able to eat three meals a day again like I used to?" Which of the following responses by the nurse is most appropriate? 1. "Eating six meals a day is time-consuming, isn't it?" 2. "You will have to eat six small meals a day for the rest of your life." 3. "You will be able to tolerate three meals a day before you are discharged." 4. "Most clients can resume their normal meal patterns in about 6 to 12 months."

4. "Most clients can resume their normal meal patterns in about 6 to 12 months."

Which of the following indicates that a client has achieved the goal of correctly demonstrating deep breathing for an upcoming splenectomy? The client: 1. Breathes in through the nose and out through the mouth. 2. Breathes in through the mouth and out through the nose. 3. Uses diaphragmatic breathing in the lying, sitting, and standing positions. 4. Takes a deep breath in through the nose, holds it for 5 seconds, and blows out through pursed lips.

4. Takes a deep breath in through the nose, holds it for 5 seconds, and blows out through pursed lips.

A client who is taking acetylsalicylic acid (ASA) caplets develops prolonged bleeding from a superficial skin injury on the forearm. The nurse should tell the client to do which of the following first? 1. Place the forearm under a running stream of lukewarm water. 2. Pat the injury with a dry washcloth. 3. Wrap the entire forearm from the wrist to the elbow. 4. Apply an ice pack for 20 minutes

4. Apply an ice pack for 20 minutes

To reduce the risk of dumping syndrome, the nurse should teach the client to do which of the following? 1. Sit upright for 30 minutes after meals. 2. Drink liquids with meals, avoiding caffeine. 3. Avoid milk and other dairy products. 4. Decrease the carbohydrate content of meals.

4. Decrease the carbohydrate content of meals.

The nurse should instruct the client with a platelet count of 31,000/μL (31 × 109/L) to: 1. Pad sharp surfaces to avoid minor trauma when walking. 2. Assess for spontaneous petechiae in the extremities. 3. Keep the room darkened. 4. Check for blood in the urine.

1. Pad sharp surfaces to avoid minor trauma when walking.

The nurse should assess a client with thrombocytopenia who has developed a hemorrhage for which of the following? 1. Tachycardia. 2. Bradycardia. 3. Decreased PaCO2. 4. Narrowed pulse pressure.

1. Tachycardia

Platelets should not be administered under which of the following conditions? 1. The platelet bag is cold. 2. The platelets are 2 days old. 3. The platelet bag is at room temperature. 4. The platelets are 12 hours old.

1. The platelet bag is cold.

An older adult with a history of hypertension is admitted with diagnosis of dehydration. The client is becoming increasingly confused and weak. The client reports taking one tablet of hydrochlorothiazide (HydroDIURIL) daily, and the prescription is written for 1/2 tablet. The nurse should obtain additional information about: 1. Decreased drug half-life of the HydroDIURIL. 2. Decreased hepatic blood flow. 3. Increased GI activity. 4. Increased urinary elimination.

2. Decreased hepatic blood flow.

The nurse should instruct the client with a platelet count of less than 150,000/μL (150 × 109/L) to avoid which of the following activities? 1. Ambulation. 2. Valsalva's maneuver. 3. Visiting with children. 4. Semi-Fowler's position.

2. Valsalva's maneuver.

The nurse should teach the client who is receiving warfarin sodium that: 1. Partial thromboplastin time values determine the dosage of warfarin sodium. 2. Protamine sulfate is used to reverse the effects of warfarin sodium. 3. International Normalized Ratio (INR) is used to assess effectiveness. 4. Warfarin sodium will facilitate clotting of the blood.

3. International Normalized Ratio (INR) is used to assess effectiveness.

A client is admitted with a diagnosis of thrombophlebitis and deep vein thrombosis of the right leg. A loading dose of heparin has been given in the emergency room, and IV heparin will be continued for the next several days. The nurse should develop a plan of care for this client that will involve: 1. Administering aspirin as prescribed. 2. Encouraging green leafy vegetables in the diet. 3. Monitoring the client's prothrombin time (PT). 4. Monitoring the client's activated partial thromboplastin time (aPTT) and International Normalized Ratio (INR).

4. Monitoring the client's activated partial thromboplastin time (aPTT) and International Normalized Ratio (INR).

Since the diagnosis of stomach cancer, the client has been having trouble sleeping and is frequently preoccupied with thoughts about how life will change. The client says, "I wish my life could stay the same." Based on this information, the nurse should understand that the client: 1. Is having difficulty coping. 2. Has a sleep disorder. 3. Is grieving. 4. Is anxious.

3. Is grieving

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate engaging in contact sports.

2. Explain the rationale for eliminating alcohol from the diet.

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately report which of the following? 1. sore throat 2. painful, excessive menstruation 3. constipation 4. increased urine output

1. sore throat The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and increased urine output are not associated with PTU therapy. CN: Pharmacological and parenteral therapies; CL: Synthesize

After a subtotal gastrectomy, the nurse is developing a plan with the client to assist the client to gain weight. To help the client meet nutritional goals at home, the nurse should: 1. Instruct the client to increase the amount eaten at each meal. 2. Encourage the client to eat smaller amounts more frequently. 3. Explain that if vomiting occurs after a meal, nothing more should be eaten that day. 4. Inform the client that bland foods are typically less nutritional and should be used minimally.

2. Encourage the client to eat smaller amounts more frequently.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate engaging in contact sports.

2. Explain the rationale for eliminating alcohol from the diet.

Knee-high sequential compression devices have been prescribed for a newly admitted client. The client reports new pain localized in the right calf area that is noted to be slightly reddened and warm to touch upon initial assessment. The nurse should first: 1. Offer analgesics as prescribed and apply the compression devices. 2. Leave the compression devices off and contact the physician to report the assessment findings. 3. Massage the area of discomfort before applying the compression devices. 4. Leave the compression devices off and report assessment findings to the oncoming shift.

2. Leave the compression devices off and contact the physician to report the assessment findings.

When receiving a client from the post anesthesia care unit after a splenectomy, which should the nurse assess next after obtaining vital signs? 1. Nasogastric drainage. 2. Urinary catheter. 3. Dressing. 4. Need for pain medication.

3. Dressing.

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The nurse does this to monitor for signs of which of the following? 1. Internal hemorrhage. 2. Decreasing level of consciousness. 3. Laryngeal nerve damage. 4. Upper airway obstruction.

3. Laryngeal nerve damage. Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the physician immediately. Internal hemorrhage is detected by changes in vital signs. The client's level of consciousness can be partially assessed by asking her to speak, but that is not the primary reason for doing so in this situation. Upper airway obstruction is detected by color and respiratory rate and pattern. CN: Reduction of risk potential; CL: Analyze

Following a gastrectomy, the nurse should position the client in which of the following positions? 1. Prone. 2. Supine. 3. Low Fowler's. 4. Right or left Sims.

3. Low Fowler's

A client has a nasogastric (NG) tube following a subtotal gastrectomy. The nurse should: 1. Irrigate the tube with 30 mL of sterile water every hour, if needed. 2. Reposition the tube if it is not draining well. 3. Monitor the client for nausea, vomiting, and abdominal distention. 4. Turn the machine to high suction if the drainage is sluggish on low suction.

3. Monitor the client for nausea, vomiting, and abdominal distention.

What should the nurse teach a client about how to avoid the dumping syndrome? Select all that apply. 1. Consume three regularly spaced meals per day. 2. Eat a diet with high-carbohydrate foods with each meal. 3. Reduce fluids with meals, but take them between meals. 4. Obtain adequate amounts of protein and fat in each meal. 5. Eat in a relaxing environment.

3. Reduce fluids with meals, but take them between meals. 4. Obtain adequate amounts of protein and fat in each meal. 5. Eat in a relaxing environment.

A client with Graves' disease is treated with radioactive iodine (RAI) in the form of sodium iodide 131I. Which of the following statements by the nurse will explain to the client how the drug works? 1. "The RAI stabilizes the thyroid hormone levels before a thyroidectomy." 2. "The RAI reduces uptake of thyroxine and thereby improves your condition." 3. "The RAI lowers the levels of thyroid hormones by slowing your body's production of them." 4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer produced."

4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer produced." Sodium iodide 131I destroys the thyroid follicular cells, and thyroid hormones are no longer produced. RAI is commonly recommended for clients with Graves' disease, especially the elderly. The treatment results in a "medical thyroidectomy." RAI is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine. The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible to slow the production of thyroid hormones with RAI. CN: Pharmacological and parenteral therapies; CL: Synthesize

The nurse observes that an older female has small-to-moderate, distended, and tortuous veins running along the inner aspect of her lower legs. The nurse should: 1. Apply a half-leg pneumatic compression device. 2. Suggest the client contact her physician. 3. Assess the client for foot ulcers. 4. Encourage the client to avoid standing in one position for long periods of time.

4. Encourage the client to avoid standing in one position for long periods of time.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? 1. Conduct physical activity in the morning in order to be able to rest in the afternoon. 2. Have the family agree to perform the necessary yard work at home. 3. Give up jogging and substitute a less demanding hobby. 4. Incorporate periods of physical and mental rest in the daily schedule.

4. Incorporate periods of physical and mental rest in the daily schedule.

A client with a history of systemic lupus erythematosus was admitted with a severe viral respiratory tract infection and diffuse petechiae. Based on these data, it is most important that the nurse further evaluate the client's recent: 1. Quality and quantity of food intake. 2. Type and amount of fluid intake. 3. Weakness, fatigue, and ability to get around. 4. Length and amount of menstrual flow.

4. Length and amount of menstrual flow.

The nurse is planning care for a client on complete bed rest. The plan of care should include all except which of the following: 1. Turning every 2 hours. 2. Passive and active range-of-motion exercises. 3. Use of thromboembolic disease (TED) support hose. 4. Maintaining the client in the supine position.

4. Maintaining the client in the supine position.

A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to: 1. Begin total parenteral nutrition. 2. Start a cutdown infusion. 3. Administer tube feedings. 4. Perform a tracheotomy.

4. Perform a tracheotomy