MedSurg final prep u questions
The nurse is reporting the current nursing assessment to the physician. Vital signs: temperature, 97.2° F; pulse, 68 beats/minute, thready; respiration, 28 breaths/minute, blood pressure, 102/78 mm Hg; and pedal pulses, palpable. The physician asks for the pulse pressure. Which would the nurse report? A. 24 B. Within normal limits C. Palpable D. Thready
24
A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this client's care, which of the following nursing diagnoses should the nurse prioritize? A. Ineffective tissue perfusion related to bowel ischemia B. Imbalanced nutrition: Less than body requirements related to impaired absorption C. Anxiety related to bowel obstruction and subsequent hospitalization D. Impaired skin integrity related to bowel obstruction
A
A client is diagnosed with gastroesophageal reflux disease (GERD) and Barrett esophagus with minor cell changes. Which of the following principles should be integrated into the client's subsequent care? A. The client will require an upper endoscopy every 6 months to detect malignant changes. B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C. Small amounts of blood are likely to be present in the stools and are not cause for concern. D. Antacids may be discontinued when symptoms of heartburn subside.
A
A client is experiencing septic shock and infrequent bowel sounds. To ensure adequate nutrition, the nurse administers A. A continuous infusion of total parenteral nutrition B. A full liquid diet C. Isotonic enteral nutrition every 6 hours D. An infusion of crystalloids at an increased rate of flow
A
A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? A. Open reduction B. Buck's traction C. Skeletal traction D. Internal fixation
A
Which of the following is considered a late symptom of hypothyroidism? A. Cold intolerance B. Physical sluggishness C. Loss of libido D. Brittle nails
A
A client with a 20-year history of hypothyroidism who has not been compliant with taking thyroid replacement therapy is brought into the ED with a diagnosis of myxedema coma. What client symptoms are consistent with this life-threatening event? Select all that apply. A. Hypothermia B. Hypotension C. Hypoventilation D. Tachycardia E. Hyperactivity
A, B, C
Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. A. Lansoprazole (Prevacid) B. Rabeprazole (AcipHex) C. Esomeprazole (Nexium) D. Famotidine (Pepcid) E. Nizatidine (Axid)
A, B, C
What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.) A. Acetaminophen B. Iodine C. Propylthiouracil D. Synthetic levothyroxine E. Dexamethasone (Decadron)
A, B, C, E
A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate? Select all that apply. A. Anorexia B. Nausea and vomiting C. Diarrhea D Weight loss E. Epigastric fullness
A, B, E
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. A. Little or no endogenous insulin B. Obesity at diagnoses C. Younger than 30 years of age D. Ketosis-prone E. Older than 65 years of age
A, C, D
A client has a new order for metoclopramide. What potential side effects should the nurse educate the client about? A. Nausea B. Extrapyramidal C. Gastric slowing D. Peptic ulcer disease
B
A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: A. anorexia. B. polyphagia. C. polydipsia. D. polyuria.
B
The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis
B
Which nursing diagnosis takes highest priority for a client with a compound fracture? A. Activity intolerance related to weight-bearing limitations B. Infection related to effects of trauma C. Imbalanced nutrition: Less than body requirements related to immobility D. Impaired physical mobility related to trauma
B
Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia (BPH)? Select all that apply. A. Moderate use of alcohol is useful for bladder relaxation. B. Do not delay the urge to void. C. Low-dose Benadryl will promote restful sleep. D. Prolonged exposure to heat increases bladder spasms. E. Painless hematuria is a common symptom of BPH. F. Schedule digital rectal exams.
B, F
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? A. Inability to tolerate cold B. Complaints of sleepiness C. Reports of increased appetite D. Thick hard nails
C
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: A. "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." B. "It's easier to get foot infections if you have diabetes." C. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." D. "The circulation in your feet can help us determine how severe your diabetes is."
C
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis
D
A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement? A. Sit the client upright in a padded chair for meals. B. Withhold opioid pain medication to prevent ileus. C. Maintain NPO (nothing by mouth) status for surgical repair. D. Maintain bed rest with the head of the bed at 20 degrees.
D
Lispro (Humalog) is an example of which type of insulin? A. Intermediate-acting B. Long-acting C. Short-acting D. Rapid-acting
D
What is the duration of regular insulin? A. 3 to 5 hours B. 24 hours C. 12 to 16 hours D. 4 to 6 hours
D
Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? A. Nizatidine (Axid) B. Famotidine (Pepcid) C. Esomeprazole (Nexium) D. Metoclopramide (Reglan)
D
Which type of insulin acts most quickly? A. Regular B. NPH C. Glargine D. Lispro
D
The nurse is preparing an educational session about foot care for clients with diabetes. Which information will the nurse include in the education? Select all that apply. A. Wear binding compression socks daily. B. Shave any calluses with a disposable razor. C. Apply lotion between the toes after bathing. D. Check the inside of shoes before putting them on. E. Check the bottom of the feet with a mirror every day.
D, E
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? A. Rapid, thready pulse B. Slow, shallow respirations C. Arm and leg trembling D. Cool, moist skin
A
Which of the following insulins are used for basal dosage? A. Glargine (Lantus) B. NPH (Humulin N) C. Lispro (Humalog) D. Aspart (Novolog)
A
Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. A. Hypertension B. Obesity C. Family history D. Age greater of 45 years or older E. History of gestational diabetes
A, B, C, D, E
Which medication may be ordered to relieve discomfort associated with a UTI? A. Nitrofurantoin B. Phenazopyridine C. Levofloxacin D. Ciprofloxacin
B
A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. A. Leukocytosis B. Glycosuria C. Dehydration D. Hypernatremia E. Hyperglycemia
B, C, E
A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? A. Due to a fistula (direct extension) B. The result of urethra abrasion (sexual intercourse) C. By ascending infection (transurethral) D. Through the bloodstream (hematogenous spread)
C
A client has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The client has a continuous bladder irrigation system in place. The client reports bladder spasms. What is the most appropriate nursing action to relieve the discomfort of the client? A. Apply a cold compress to the pubic area. B. Notify the urologist promptly. C. Irrigate the catheter with 30 to 50 mL of normal saline as ordered. D. Administer a smooth-muscle relaxant as ordered
D
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? A. Serum potassium level B. Serum sodium level C. Arterial blood gas (ABG) values D. Serum osmolarity
D
A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? A. Buck's traction B. Internal fixation C. Skeletal traction D. Open reduction
D
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? A. Opioid overdose B. Type 1 diabetes mellitus C. Myasthenia gravis D. Extreme anxiety
D
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? A. Contracture of the hip B. Avascular necrosis of the hip C. Re-fracture of the hip D. Dislocation of the hip
D
What assessment findings of the leg are consistent with a fracture of the femoral neck? A. Abducted and externally rotated B. Adducted and internally rotated C. Shortened, abducted, and internally rotated D. Shortened, adducted, and externally rotated
D
The nurse is assisting a client to drain his continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve? A. 2in B. 3in C. 4in D. 5in
A
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? A. NPH B. Glargine (Lantus) C. Lispro (Humalog) D. Iletin I
A
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: A. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. B. The process of gluconeogenesis will be inhibited. C. Glycogenesis will be decreased by the liver. D. Insulin will be released to facilitate the transport of sugar.
A
Vomiting results in which of the following acid-base imbalances? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Respiratory alkalosis
A
A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? A. Initiate physical therapy. B. Cut a cast window. C. Apply a fiberglass cast. D. Remove the cast.
B
A client with diabetes is attending a class on the prevention of associated diseases. What action should the nurse teach the client to reduce the risk of osteomyelitis? A. Increase calcium and vitamin intake. B. Monitor and control blood glucose levels. C. Exercise 3 to 4 times weekly for at least 30 minutes. D. Take corticosteroids as prescribed.
B
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? A. Hemorrhage B. Tetany C. Laryngeal nerve damage D. Thyroid storm
B
A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? A. Pancreatitis B. Diabetes mellitus C. Hyperparathyroidism D. Hyperuricemia
B
NPH is an example of which type of insulin? A. Short-acting B. Intermediate-acting C. Rapid-acting D. Long-acting
B
What is the most common cause of small-bowel obstruction? A. Neoplasms B. Adhesions C. Hernias D. Volvulus
B
A client seeks medical attention for new onset of weight loss and heat intolerance. Which additional statements indicate to the nurse that the client is experiencing hyperthyroidism? Select all that apply. A. "I always carry an extra sweater with me since I'm always cold no matter the temperature outside." B. "I use lotion on my skin 2 to 3 times a day since my skin is so dry and itchy." C. "I switched from knitting to glue projects since I have developed tremors in my hands." D. "Even sitting still, sometimes it feels like my heart is racing." E. "My children tell me that my eyes appear to be bigger, almost buldging, particularly when I tell them to do the dishes."
C, D, E
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor? A. Monitor the respiratory status. B. Administer prescribed corticosteroids carefully. C. Administer the prescribed medications at the same time each day. D. Handle body fluids carefully.
D
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? A. "This medication will relieve your pain." B. "This will kill the organism causing the infection." C. "This medication should be taken at bedtime." D. "This medication will prevent re-infection."
A
When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? A. Accuracy of the dosage B. Duration of the insulin C. Area for insulin injection D. Technique for injecting
A
The nurse is teaching a client with gastroesophageal reflux disease (GERD) about how to reduce reflux. What should the nurse include in the teaching? Select all that apply. A. Encourage the client to eat frequent, small, well-balanced meals. B. Inform the client to remain upright for at least 2 hours after meals. C. Encourage the client to eat later in the day before bedtime rather than early in the morning. D. Instruct the client to avoid alcohol or tobacco products. E. Instruct the client to eat slowly and chew the food thoroughly.
A, B, D, E
A nurse is reviewing a journal article about benign prostatic hyperplasia and possible risk factors associated with this condition. Which factor would the nurse most likely find as playing a role in increasing a client's risk for this condition? Select all that apply. A. Smoking B. Social alcohol use C. Hypertension D. Diabetes E. Atrial fibrillation
A, C, D
A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? A. Longer lasting B. Better molding to the client C. More breathable D. Quicker drying
B
A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? A. Cutting the faceplate opening no more than 2 inches larger than the stoma B. Gently washing the area surrounding the stoma using a facecloth and mild soap C. Scrubbing fecal material from the skin surrounding the stoma D. Maintaining wrinkles in the faceplate so it doesn't irritate the skin
B
A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture? A. Closed B. Incomplete C. Compression D. Stress
B
The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? A. Low blood pressure B. Urinary tract infections C. Lifelong obesity D. Elevated triglycerides
B
To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? A. "Lie down after meals to promote digestion." B. "Avoid coffee and alcoholic beverages." C. "Take antacids with meals." D. "Limit fluid intake with meals."
B
When a client's ventilation is impaired, the body retains which substance? A. Sodium bicarbonate B. Carbon dioxide C. Nitrous oxide D. Oxygen
B
Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? A. pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 B. pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 C. pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 D. pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15
B
A client with a fractured fibula has an external fixator device applied. Which interventions to care for this device will the nurse add to the client's plan of care? Select all that apply. A. Examine pin insertion sites daily B. Cover sharp fixator pins with caps C. Elevate the extremity to heart level D. Tighten loose pins on the device during pin care E. Monitor neurovascular status every 2 to 4 hours
B, C, E
A client has been scheduled to undergo a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). The nurse knows that the client understands preoperative teaching when he makes which statement? A. "I'm worried my wife will leave me after the TURP because of the side effect of erectile dysfunction." B. "I will have my wife come with me to drive me home after the outpatient procedure." C. "I understand I may develop urethral strictures as a result of having the TURP." D. "I understand there is no danger of retrograde ejaculation following the TURP."
C
A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? A. "Not all fractures require a cast." B. "You would have to stay here much longer because it takes a cast longer to dry." C. "A splint is applied when more swelling is expected at the site of injury." D. "It is best if an orthopedic doctor applies the cast."
C
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? A. Polyphagia and flushed, dry skin B. Polyuria, headache, and fatigue C. Nervousness, diaphoresis, and confusion D. Polydipsia, pallor, and irritability
C
Which term refers to the failure of fragments of a fractured bone to heal together? A. Dislocation B. Malunion C. Nonunion D. Subluxation
C
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect which of the following sets of assessment findings? A. Headache, blood pressure 90/54, dry skin B. Blood pressure 188/120, nausea, vomiting C. Confusion, respiratory rate 8 breaths/min, dry skin D. Clammy skin, blood pressure 86/46, headache
D
Which nursing intervention is essential in caring for a client with compartment syndrome? A. Wrapping the affected extremity with a compression dressing to help decrease the swelling B. Starting an I.V. line in the affected extremity in anticipation of venogram studies C. Keeping the affected extremity below the level of the heart D. Removing all external sources of pressure, such as clothing and jewelry
D
A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with: A. paralytic ileus. B. Crohn's disease. C. gastroenteritis. D. complete bowel obstruction.
A
In a client with benign prostatic hyperplasia (BPH), which assessment finding provides the best indication of urinary retention? A. Frequency B. Urgency C. Hesitancy D. Dribbling
A
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? A. Hypokalemia and hypoglycemia B. Hypocalcemia and hyperkalemia C. Hyperkalemia and hyperglycemia D. Hypernatremia and hypercalcemia
A
The nurse is caring for a client with an ileostomy because of inflammatory bowel disease. Which assessment findings indicate to the nurse that the ileostomy is functioning as expected? Select all that apply. A. Stoma is pink and shiny B. Stoma is edematous and bleeding C. Formed stool in collection pouch D. Continuous liquid flows from the stoma E. Slight skin excoriation around the stoma
A, D
A medical-surgical nurse is teaching a client about the health implications of the client's recently diagnosed type 2 diabetes. The nurse should teach the client to be proactive with glycemic control to reduce the risk of what health problem? A. Urinary tract infections B. Renal failure C. Pneumonia D. Inflammatory bowel disease
B
A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to A. Apply water-based lubricant to the nares daily. B. Auscultate lung sounds every 4 hours. C. Inspect the nose daily for skin irritation. D. Change the nasal tape every 2 to 3 days.
B
A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? A. Clear mucus mixed with yellow urine drained from the appliance bag B. Red, sensitive skin around the stoma site C. Stoma site not sensitive to touch D. Beefy red stoma site
B
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? A. Respiratory acidosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory alkalosis
B
Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. A. Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. B. Avoid beer, especially in the evening. C. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. D. Elevate the head of the bed on 6- to 8-inch blocks. E. Elevate the upper body on pillows.
B, D, E
The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet? A. Autonomic neuropathy B. Nephropathy C. Sensory neuropathy D. Retinopathy
C
Which set of arterial blood gas (ABG) results requires further investigation? A. pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L B. pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L C. pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L D. pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L
C
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? A. Transurethral laser incision of the prostate B. Suprapubic prostatectomy C. Retropubic prostatectomy D. Transurethral resection of the prostate (TURP)
D
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? A. They have no effect. B. They cause wide fluctuations in the need for insulin. C. They decrease the need for insulin. D. They increase the need for insulin.
D
A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? A. Administering pain medication B. Obtaining a blood sample for laboratory studies C. Preparing to insert a nasogastric (NG) tube D. Administering I.V. fluids
D
A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take? A. Administer a unit of packed red blood cells. B. Prepare the patient for an ECG. C. Increase the rate of the IV fluids. D. Discontinue the irrigations.
D
A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? A. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland." B. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." C. "The surgeon is going to remove the entire prostate gland." D. "I'll have a small incision on my lower abdomen after the procedure."
A
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? A. Suggest fluid intake of at least 2 L/day B. Instruct the client to avoid prune or apple juice C. Assist the client regarding the correct diet or to minimize food intake D. Instruct the client to keep a record of food intake
A
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: A. Deficient knowledge (treatment regimen). B. Health-seeking behaviors (diabetes control). C. Defensive coping. D. Impaired adjustment.
A
A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: A. 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). B. 10 units regular insulin and 20 units NPH. C. 20 units regular insulin and 10 units NPH. D. 21 units regular insulin and 9 units NPH.
A
A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: A. suggest referral to a sex counselor or other appropriate professional. B. encourage the client to ask questions about personal sexuality. C. provide time for privacy. D. provide support for the spouse or significant other.
A
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? A. Assessing the extremity for neurovascular integrity B. Keeping the client from sliding to the foot of the bed C. Keeping the ropes over the center of the pulley D. Ensuring that the weights hang free at all times
A
A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? A. leukocytosis; elevated hematocrit; low sodium, potassium, and chloride B. leukopenia; metabolic acidosis; elevated sodium, potassium, and chloride C. leukopenia, decreased hematocrit; low sodium, potassium, and chloride D. leukocytosis; metabolic alkalosis; elevated sodium, potassium, and chloride
A
A nurse is writing a care plan for a client admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a client with an open fracture of the radius? A. Risk for infection B. Risk for ineffective role performance C. Risk for perioperative positioning injury D. Risk for powerlessness
A
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? A. Levothyroxine (Synthroid) B. Thyroid USP desiccated (Thyroid USP Enseals) C. Liothyronine (Cytomel) D. Methimazole (Tapazole)
A
The most common cause of hypothyroidism is which of the following? A. Autoimmune thyroiditis B. Radioiodine therapy C. Antithyroid medications D. Thyroidectomy
A
Upon shift report, the nurse states the following laboratory values: pH, 7.44; PCO2, 30 mm Hg; and HCO3, 21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state? A. Compensated respiratory alkalosis B. Uncompensated respiratory alkalosis C. Compensated metabolic acidosis D. Compensated metabolic alkalosis
A
What is the primary nursing diagnosis for a client with a bowel obstruction? A. Deficient fluid volume B. Deficient knowledge C. Acute pain D. Ineffective tissue perfusion
A
Which nursing intervention is essential in caring for a client with compartment syndrome? A. Removing all external sources of pressure, such as clothing and jewelry B. Keeping the affected extremity below the level of the heart C. Wrapping the affected extremity with a compression dressing to help decrease the swelling D. Starting an I.V. line in the affected extremity in anticipation of venogram studies
A
A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply. A. "Insulin permits entry of glucose into the cells of the body." B. "Insulin promotes synthesis of proteins in various body tissues." C. "Insulin promotes the storage of fat in adipose tissue." D. "Insulin interferes with glucagon from the pancreas." E. "Insulin interferes with the release of growth hormone from the pituitary."
A, B, C
A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply. A. Decrease in serum thyroid-stimulating hormone (TSH) B. Increased T3 C. Increased T4 D. Increase in radioactive iodine uptake E. Increases in serum TSH
A, B, C, D
During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply. A. "I cannot seem to quench my thirst." B. "At times my vision is blurry." C. "I have to void nearly every hour." D. "I have lost 10 pounds without even trying." E. "I sleep at least 8 hours each night."
A, B, C, D
The nurse recognizes what conditions cause elevated prostate-specific antigen (PSA) levels in the absence of prostate cancer. Select all that apply. A. acute urinary retention B. acute prostatitis C. benign prostatic hyperplasia (BPH) D. transurethral resection of the prostate (TURP) E. erectile dysfunction
A, B, C, D
The nurse is teaching a client with gastroesophageal reflux disease (GERD) about how to reduce reflux. What should the nurse include in the teaching? Select all that apply. A. Inform the client to remain upright for at least 2 hours after meals. B. Instruct the client to avoid alcohol or tobacco products. C. Instruct the client to eat slowly and chew the food thoroughly. D. Encourage the client to eat later in the day before bedtime rather than early in the morning. E. Encourage the client to eat frequent, small, well-balanced meals.
A, B, C, E
The nurse reviews data collected during a client assessment. Which lifestyle modifications will the nurse discuss with the client to prevent the development of gastroesophageal reflux disease (GERD)? Select all that apply. A. Smoking cessation B. Limit the intake of alcohol C. Avoid eating before bedtime D. Engage in intermittent fasting E. Achieve a BMI of 22
A, B, C, E
An older client with foul-smelling urine has a temperature of 100.4°F (38°C). Which assessment findings will the nurse use to determine if the client has a urinary tract infection? Select all that apply. A. Confusion B. Warm, flushed skin C. Hyperactive bowel sounds D. Heart rate of 102 beats/minute E. Respiratory rate of 26 breaths/minute
A, B, D, E
The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply. A. "I will test my blood sugar level every 3 to 4 hours." B. "I will call the doctor if I have vomiting or diarrhea." C. "I will skip my diabetes medication for the day." D. "I will increase my intake of fluids." E. "I will eat soft foods if I cannot tolerate regular food."
A, B, D, E
The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply. A. Assist the patients with frequent toileting. B. Provide careful perineal care. C. For those patients who are incontinent, insert indwelling catheters. D. Encourage patients to wear briefs. E. Perform hand hygiene prior to patient care.
A, B, E
The nurse has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply. A. Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. B. Drink caffeinated beverages twice a day to increase urination. C. Drink liberal amounts of fluid to flush out bacteria. D. Void every 2-3 hours to prevent overdistention of the bladder. E. Bathe in warm water to soak the affected area.
A, C, D
A client is diagnosed with several fractured ribs after a motor vehicle crash. Which actions will the nurse take when caring for this client? Select all that apply. A. Provide analgesics as prescribed. B. Apply a chest binder as prescribed. C. Instruct on the use of an incentive spirometer. D. Demonstrate the use of a pillow to splint the area. E. Remind to take deep breaths and cough every hour.
A, C, D, E
A nurse should expect a client with hypothyroidism to report: A. increased appetite and weight loss. B. puffiness of the face and hands. C. nervousness and tremors. D. thyroid gland swelling.
B
A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency department (ED). The triage nurse notes upon assessment that the patient has been experiencing rapid, deep respirations since before arriving at the ED 20 minutes ago. This observation suggests that the patient is at risk for developing which form of acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
B
After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? A. Compartment syndrome B. Fat embolism C. Infection D. Volkmann's ischemic contracture
B
Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? A. 1 month B. 3 months C. 6 months D. 9 months
B
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: A. Bradypnea B. Paresthesia C. Hypotension D. Hypothermia
B
The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? A. Do not flex the hip more than 120 degrees. B. Do not flex the hip more than 90 degrees. C. Do not flex the hip more than 30 degrees. D. Do not flex the hip more than 60 degrees.
B
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? A. Kidney and liver B. Lungs and kidney C. Pancreas and stomach D. Heart and lungs
B
The nurse is taking a nursing history on a client who has come to the clinic with complaints of fatigue, weight gain, and constipation. The client states, "I'm just depressed." The nurse knows that before the health care provider institutes therapy, the client will receive a full physical assessment for what reason? A. Medications for depression are dosed according to weight. B. Physical conditions such as hypothyroidism can mimic the symptoms of depression. C. A full evaluation offers to opportunity to better determine what is causing the client's depression. D. Performing a physical examination provides the client the feeling of caring by another individual.
B
A 65-year-old client with possible pyloric stenosis has been on a Salem Sump tube and low continuous suction ever since being admitted 72 hours ago. Upon reviewing the latest blood work, the nurse notices that the client's potassium is below reference range, placing the client at risk for what imbalance? A. Hypercalcemia B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis
C
A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)? A. "I've had a fever and noticed I've been running to the bathroom more often." B. "I'm waking up at night to urinate and I've noticed some burning, too." C. "I've had trouble getting started when I urinate, often straining to do so." D. "I've had some pain in my lower abdomen lately and felt a bit sick to my stomach."
C
A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? A. Be unable to perform in response to low levels of thyroid hormone. B. Produce a new hormone to try and regulate the thyroid function C. Stimulate more hormones using the negative feedback system D. Stimulate more hormones using the positive feedback system
C
A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? A. Start an infusion of regular insulin at 50 U/hr. B. Administer sodium bicarbonate 50 mEq IV push. C. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. D. Administer regular insulin 30 U IV push.
C
A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation? A. Ensure that the client knows that he or she will be responsible for care after discharge. B. Reassure the client that many people are fearful after the creation of an ostomy. C. Acknowledge the client's reluctance and initiate discussion of the factors underlying it. D. Arrange for the client to be seen by a social worker or spiritual advisor.
C
A newly graduated nurse is admitting a client with a long history of emphysema. The nurse learns that the client's PaCO2 has been between 56 and 64 mm Hg for several months. Why should the nurse be cautious administering oxygen? A. Oxygen will increase the client's intracranial pressure and create confusion. B. The client's calcium will rise dramatically due to pituitary stimulation. C. Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. D. Oxygen may cause the client to hyperventilate and become acidotic.
C
A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? A. Type 1 diabetes always develops before the age of 20. B. New cases of diabetes will be split roughly evenly between type 1 and type 2. C. The participants are unlikely to develop a new onset of type 1 diabetes. D. New cases of diabetes are highly uncommon in older adults.
C
A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? A. Beefy red stoma site B. Stoma site not sensitive to touch C. Red, sensitive skin around the stoma site D. Clear mucus mixed with yellow urine drained from the appliance bag
C
A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? A. Tell the client she'll feel better if she consistently takes the thyroid replacement medication. B. Tell the client that she looks fine and offer to help her with makeup. C. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. D. Tell the client she needs to learn to accept herself as she is and be compliant during treatment.
C
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? A. "I should take a tub bath at least 3 times per week." B. "I should wipe from back to front." C. "I should take at least 1,000 mg of vitamin C each day." D. "I should limit my fluid intake to limit my trips to the bathroom."
C
The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? A. Calcitonin B. Thyrotropin C. Iodine D. Thyroxine
C
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? A. Pelvic x-ray B. Stool specimen C. Nasogastric tube insertion D. Oral contrast
C
The nurse in the medical intensive care unit is caring for a client who is in respiratory acidosis due to inadequate ventilation. Which diagnosis could the client have that could cause inadequate ventilation? A. Endocarditis B. Multiple myeloma C. Guillain-Barré syndrome D. Overdose of amphetamines
C
The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client? A. Milk at lunch B. Ginger ale at dinner time C. Coffee in the morning D. Fruit juice midmorning
C
The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? A. Increase the rate of administration. B. Discontinue the irrigation immediately. C. Clamp the tubing and allow client to rest. D. Change irrigation fluid to normal saline.
C
The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? A. Dark amber with copious mucous B. Light pink with few red streaks C. Light yellow and clear D. Reddish-pink with numerous clots
C
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? A. Blood sugar 170 mg/dL B. Cloudy urine C. Fruity breath D. Respirations of 12 breaths/minute
C
Which client requires immediate nursing intervention? The client who: A. complains of epigastric pain after eating. B. complains of anorexia and periumbilical pain. C. presents with a rigid, board-like abdomen. D. presents with ribbonlike stools.
C
A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate? A. Reassure the client that the procedure is relatively low risk and that clients are usually successful in adjusting to an ostomy. B. Provide the client with educational materials that match the client's learning style. C. Encourage the client to write down these concerns and questions to bring forward to the surgeon. D. Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.
D
An emergency department nurse is caring for a trauma patient with arterial blood gas (ABG) results of pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would the nurse interpret these results? A. Respiratory acidosis with no compensation B. Metabolic alkalosis with compensatory alkalosis C. Metabolic acidosis with no compensation D. Metabolic acidosis with compensatory respiratory alkalosis
D
During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? A. Glucose via a urine dipstick test B. Glucose via an oral glucose tolerance test C. Fasting blood glucose level D. Glycosylated hemoglobin level
D
In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client? A. Disseminated intravascular coagulation B. Carpal tunnel syndrome C. Fat embolism syndrome D. Compartment syndrome
D
The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? A. Decreases need for pancreas to produce more cells B. Decreases risk of developing insulin resistance and hyperglycemia C. Creates an overall feeling of well-being and lowers risk of depression D. Increases ability for glucose to get into the cell and lowers blood sugar
D
The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). The nurse notes in the client's record that the client is taking carbidopa/levodopa. Which order for the client by the health care provider should the nurse question? A. a low-fat diet B. pantoprazole C. elevation of upper body on pillows D. metoclopramide
D
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? A. Client is prone to ketosis B. Client is usually thin at diagnosis C. Clients demonstrate islet cell antibodies D. Blood glucose can be controlled through diet and exercise
D
Which instruction about insulin administration should a nurse give to a client? A. "Store unopened vials of insulin in the freezer at temperatures well below freezing." B. "Discard the intermediate-acting insulin if it appears cloudy." C. "Shake the vials before withdrawing the insulin." D. "Always follow the same order when drawing the different insulins into the syringe."
D
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? A. "Follow your regular meal plan, even if you're nauseous." B. "It's okay for your blood glucose to go above 300 mg/dl while you're sick." C. "Don't take your insulin or oral antidiabetic agent if you don't eat." D. "Test your blood glucose every 4 hours."
D
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? A. The client continues medication therapy despite adequate food intake. B. The client has not consumed sufficient calories. C. The client has been exercising more than usual. D. The client has eaten and has not taken or received insulin.
D
Which of the following is the most plausible nursing diagnosis for a client whose treatment for colon cancer has necessitated a colostomy? A. Risk for unstable blood glucose due to changes in digestion and absorption B. Unilateral neglect related to decreased physical mobility C. Risk for excess fluid volume related to dietary changes and changes in absorption D. Ineffective sexuality patterns related to changes in self-concept
D
