MEG SURG MIDTERM 2
The nurse is teaching a client about ear protection. Which statement by the client indicates that teaching was effective?
"I always wear earplugs when I swim.
A client has received preoperative teaching from the nurse for a microdiskectomy. Which statement by the client indicates a correct understanding of the nurse's instruction?
"I can go home the day of the procedure.
The nurse is teaching a client and her husband about sexuality issues after a spinal cord injury. Which comment by the client indicates a correct understanding of the nurse's instruction?
"I may still be able to get pregnant."
The nurse is talking to a client about ear hygiene safety. Which statement by the client indicates a need for further teaching?
"I use a bobby pin to remove earwax.
A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure?
It will take me some time to get used to this."
The nurse is providing instructions to a client with a spinal cord injury about caring for the halo device. The nurse plans to include which instructions?
Keep straws available for drinking fluids."
An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client?
Keep the client's heels off the bed at all times.
An older adult client is discharged from the hospital for treatment of osteoporosis. What does the nurse include in client teaching related to the client's home safety?
Keep walkways free of clutter
The nurse is teaching a client newly diagnosed with multiple sclerosis (MS). Which statement by the client indicates a correct understanding of the pathophysiology of the disease?
Parts of my nervous system have plaques.
In the emergency department (ED), which is the nursing priority in assessing the client with a spinal cord injury?
Patent airway
The nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification?
Reviews all information with another registered nurse Correct
In assessing a client with back pain, the nurse uses a paper clip bilaterally on each limb. What is the nurse assessing?
Sensation
The nurse suspects that a client may have plantar fasciitis if the client has which assessment finding?
Severe pain in the arch of the foot, especially when getting out of bed
What is the most important environmental risk for developing leukemia
Smoking cigarettes Correct
An older adult client reports nausea during removal of impacted cerumen from the ear canal. What does the nurse do next?
Stop irrigation immediately
A client who is receiving a blood transfusion suddenly exclaims to the nurse, "I don't feel right!" What does the nurse do next?
Stop the transfusion
What is the primary role of the nurse when caring for an adult client with muscular dystrophy (MD
Supportive care
The nurse is instructing a client who has been prescribed calcium citrate (Citracal). Which instruction does the nurse include?
Take Citracal with food.
The nurse is teaching a client with vertigo about safety precautions for fall prevention. Which statement by the client indicates a need for further instruction?
Taking my medication will allow me to drive my car again.
Which intervention does the nurse suggest to a client with a leg amputation to help cope with loss of the limb?
Talking with an amputee close to the client's age who has had the same type of amputation
A client with amyotrophic lateral sclerosis is degenerating rapidly and will soon need respiratory support. What does the nurse plan to review with this client?
Advance directives
The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education?
After this therapy, I will not need to have any more." Correct
The nurse refers a client with an amputation and the client's family to which community resource?
Amputee Coalition of America (ACA)
he nurse assesses the client with which hematologic problem first?
An 81-year-old with thrombocytopenia and an increase in abdominal girth Correct
A client is considering treatments for a malignant brain tumor. Which statement by the client indicates a need for further instruction by the nurse?
Antibiotics will help minimize the size of the tumor.
An older adult client comes in for a routine visit. During the assessment, he irritably exclaims, "Speak up and quit mumbling!" How does the nurse respond?
Apologizes and speaks louder and clearer
A client returns to the neuromedicine floor after undergoing an anterior cervical diskectomy and fusion (ACDF). What is the nurse's first action?
Assess airway and breathing
A client's left arm is placed in a plaster cast. Which assessment does the nurse perform before the client is discharged?
Assess that the cast is dry.
A client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon?
Paresis of right lower extremity
A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client's problem?
Would you like to try some relaxation techniques?"
A client is having a stapedectomy. Which form of postoperative communication is most effective for the nurse to use?
Writing
A client hospitalized for hypertension presses the call light and reports "feeling funny." When the nurse gets to the room, the client is slurring words and has right-sided weakness. What does the nurse do first?
Assesses airway, breathing, and circulation
Which clients are at high risk for developing hearing problems? (Select all that apply.)
1- Airline mechanic 2- Client with Down syndrome 3- Drummer in a rock band 4- Teenager listening to music using ear buds
The nurse is teaching a client with newly diagnosed anemia about conserving energy. What does the nurse tell the client? (Select all that apply
1- Allow others to perform your care during periods of extreme fatigue." 2- "Drink small quantities of protein shakes and nutritional supplements daily." 3- Provide yourself with four to six small, easy-to-eat meals daily." 4- "Stop activity when shortness of breath or palpitations are present.
A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks the nurse, "What should I say to her?" Which responses does the nurse suggest? (Select all that apply.)
1- Ask her how she is feeling." 2- "Ask her if she needs anything 3- Talk to her as you normally would when you haven't seen her for a long time.
he nurse is developing a teaching plan for a client with a history of low back pain. Which instructions does the nurse plan to include in teaching the client about preventing low back pain and injury? (Select all that apply.)
1- Begin a regular exercise program." 2- "When lifting something, the back should be straight and the knees bent." 3- "Do not wear high-heeled shoes."
What are the risk factors for the development of leukemia? (Select all that apply.)
1- Bone marrow hypoplasia Correct 2- Chemical exposure Correct 3- Down syndrome Correct 4- Ionizing radiation
What are the typical clinical manifestations of anemia? (Select all that apply.)
1- Dyspnea on exertion Correct 2- Elevated temperature 3- Fatigue Correct 4- Pallor Correct 5- Tachycardia
The nurse is assessing a client with recent changes in hearing. After taking a medication history, which drugs does the nurse identify as possible causes of the client's hearing change? (Select all that apply.)
1- Erythromycin 2- Ibuprofen (Advil) 3- Furosemide (Lasix) Correct
Which are risk factors for stroke? (Select all that apply.)
1- High blood pressure 2- Previous stroke or transient ischemic attack (TIA) 3- Smoking 4- Use of oral contraceptives
An 82-year-old client with anemia is requested to receive 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the client? (Select all that apply.)
1- Hypertension Correct 2- Hypotension Correct 3- Rapid, bounding pulse
The nurse is assessing a client with osteomalacia. Which findings does the nurse expect to observe? (Select all that apply.)
1- Hypophosphatemia 2- Looser's lines or zones 3- Unsteady gait
What are serious side effects of antiviral agents prescribed for a client with acute myelogenous leukemia? (Select all that apply.)
1- Nephrotoxicity Correct 2- Ototoxicity
A client with a spinal cord tumor and a poor prognosis has lost bladder control. The client asks the nurse whether the suggested surgery will be "worth it." What is the nurse's best response?
It should help return bladder control.
A hematology unit is staffed by RNs, LPN/LVNs, and unlicensed assistive personnel (UAP). When the nurse manager is reviewing documentation of staff members, which entry indicates that the staff member needs education about his or her appropriate level of responsibility and client care?
Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP"
The nurse has just received change-of-shift report about these clients. Which client needs to be assessed first?
Client with labyrinthitis who has a temperature of 102.4° F (39.1° C) and a headache
Which nursing intervention helps to reduce the incidence of osteomyelitis for a client receiving hemodialysis?
Instructing the client to brush teeth after every meal
A recently admitted client who is in sickle cell crisis requests "something for pain." What does the nurse administer?
Intravenous (IV) hydromorphone (Dilaudid)
The nurse is caring for a client with prostate cancer who has bone metastasis. The nurse anticipates that the health care provider will prescribe which medication?
Pamidronate (Aredia)
Which client does the nurse assign as a roommate for the client with aplastic anemia?
A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol
Which client is at greatest risk for having a hemolytic transfusion reaction?
A 34-year-old client with type O blood
An RN from pediatrics has "floated" to the medical-surgical unit. Which client is assigned to the float nurse?
A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells
Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?
A hematoma forms at the site of the fracture.
The nurse is evaluating the collaborative care of a client with traumatic brain injury (TBI). What is the most important goal for this client?
Achieving the highest level of functioning
The nurse is assessing a client with a traumatic brain injury after a skateboarding accident. Which symptom is the nurse most concerned about?
Asymmetric pupils
Which test best determines hearing acuity?
Audioscopy
A 56-year-old client admitted with a diagnosis of acute myelogenous leukemia is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy?
Bone marrow suppression
A client is admitted with a brain abscess. Which diagnostic assessment intervention does the nurse question as nonspecific to the diagnosis?
Bone scan
In addition to frequent re-positioning, the nurse anticipates a consultation request for which special pressure relief device to help prevent pressure ulcers in the client with a spinal cord injury?
Chair pad
A client with a traumatic brain injury from a motor vehicle crash is monitored for signs of increased intracranial pressure (ICP). Which sign does the nurse monitor for?
Changes in breathing pattern
Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)?
Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago.
A 56-year-old client admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. An infection develops. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this client?
Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection
A client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?
Compound fracture involves a break in the bone, with damage to the skin.
An older adult client reports ear pain. Otoscopic examination by the nurse practitioner (NP) reveals a dull and retracted membrane. What does the NP do next?
Continues further assessment
A client recovering from a stroke reports double vision that is preventing the client from effectively completing activities of daily living. How does the nurse help the client compensate?
Covers the affected eye
he nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat?
Dairy products
The nurse is monitoring a client after supratentorial surgery. Which sign does the nurse report immediately to the provider?
Decorticate positioning
The nurse is performing an otoscopic examination of a client's ear and sees a greenish-white drainage. What does the nurse do next?
Disposes of the otoscope tip and washes the hands before examining the other ear
Which type of drug therapy does the nurse anticipate giving to a client with Ménière's disease to decrease endolymph volume?
Diuretics
The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information?
Do you feel more tired after you get up and go to the bathroom?" Correct
When preparing to examine an ear with drainage, what does the nurse do first?
Dons clean gloves
A client with severe muscle spasticity has been prescribed tizanidine (Zanaflex, Sirdalud). The nurse instructs the client about which adverse effect of tizanidine?
Drowsiness
Which intervention most effectively protects a client with thrombocytopenia?
Encouraging the use of an electric shaver Correct
The nurse admits a client diagnosed with Paget's disease. The nurse anticipates that the client will have which condition?
Enlarged, thick skull
The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the health care provider will request which medication?
Ergocalciferol (Calciferol)
The nurse is caring for a client with sickle cell disease. Which action is most effective in reducing the potential for sepsis in this client?
Frequent and thorough handwashing Correct
The nurse is educating a group of young women who have sickle cell disease (SCD). Which comment from a class member requires correction?
Getting an annual 'flu shot' would be dangerous for me
The daughter of a client who has had a stroke asks the nurse for additional resources. What is the nurse's best response?
Go to the National Stroke Association website."
A client with a T6 spinal cord injury who is on the rehabilitation unit suddenly develops facial flushing and reports a severe headache. Blood pressure is elevated, and the heart rate is slow. Which action does the nurse take first?
Help the client sit up
Which risk factor is shared by clients who have osteoporosis or osteomalacia?
High alcohol intake
A 32-year-old client is recovering from a sickle cell crisis. His discomfort is controlled with pain medications and he is to be discharged. What medication does the nurse expect to be prescribed for him before his discharge?
Hydroxyurea (Droxia) Correct
The nurse is transfusing 2 units of packed red blood cells to a postoperative client. What post-transfusion electrolyte imbalance does the nurse want to rule out?
Hyperkalemia
The nurse is preparing a client for electronystagmography. Which statement by the client indicates that teaching was effective?
I can't drink caffeine 24 to 48 hours before the test."
The nurse is teaching a client and family about home care after a stroke. Which statement made by the client's spouse indicates a need for further teaching?
I should spend all my time with my husband in case I'm needed.
Which client statement indicates that stem cell transplantation that is scheduled to take place in his home is not a viable option?
I was a nurse, so I can take care of myself.
The nurse is reviewing postoperative instructions with a client undergoing stapedectomy. Which statement by the client indicates a need for further teaching?
I will be able to hear as soon as my dressing is removed."
The nurse is providing medication instructions to a client diagnosed with amyotrophic lateral sclerosis who has been prescribed riluzole (Rilutek). Which statement indicates to the nurse that the client understands the instructions?
I will need frequent checks of my liver enzymes.
The nurse is teaching a client with impaired hearing about audiometric testing. Which statement by the nurse effectively communicates information about the procedure to the client?
I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond.
A client with bone cancer is scheduled for a right upper extremity amputation. Which statement by the client's husband indicates an effective coping strategy?
I'll have to find ways to help my wife focus on positive aspects of her body."
A client has been admitted with a diagnosis of stroke (brain attack). The nurse suspects that the client has had a right hemisphere stroke because the client exhibits which symptoms?
Impulsiveness and smiling
A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan?
Infection
The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow?
Infuse the transfusion over a 15- to 30-minute period
A client is in skeletal traction. Which nursing intervention ensures proper care of this client?
Inspect the skin at least every 8 hours. Correct
A client is eating a soft diet while recovering from a stroke. The client reports food accumulating in the cheek of the affected side. What is the nurse's best response?
Let's see if the speech-language pathologist can help." Correct
The nurse is assessing a client with Ewing's sarcoma. Which finding does the nurse expect to observe?
Leukocytosis
The nurse is teaching a client who will soon be fitted for a hearing aid about proper care and use. Which statement by the client indicates that teaching was effective?
Listening to the radio and television will help me get used to new sounds."
A client who has just undergone spinal surgery must be moved. How does the nurse plan to move this client?
Log rolling the client
A client has had a traumatic brain injury and is mechanically ventilated. Which technique does the nurse use to prevent increasing intracranial pressure (ICP)?
Maintaining PaCO2 levels at 35 mm Hg
The nurse is monitoring a postoperative craniotomy client with increased intracranial pressure (ICP). Which pharmacologic agent does the nurse expect to be requested to maintain the ICP within a specified range?
Mannitol (Osmitrol
A client is admitted with a stroke (brain attack). Which tool does the nurse use to facilitate a focused neurologic assessment of the client?
National Institutes of Health Stroke Scale (NIHSS)
The nurse plans to refer a client diagnosed with osteoporosis to which community resource?
National Osteoporosis Foundation
A client is being discharged with paraplegia secondary to a motor vehicle crash and expresses concern over the ability to cope in the home setting after the injury. Which is the best resource for the nurse to provide for the client?
National Spinal Cord Injury Association
The nurse is caring for a client with a spinal cord injury resulting from a diving accident, who has a halo fixator and an indwelling urinary catheter in place. The nurse notes that the blood pressure is elevated and that the client is reporting a severe headache. The nurse anticipates that the health care provider will prescribe which medication?
Nifedipine (Procardia)
The nurse is assessing a newly admitted client with thrombocytopenia. Which factor needs immediate intervention?
Nosebleed
The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first?
Obtain requested cultures
Which would be an appropriate task to delegate to unlicensed assistive personnel (UAP) working on a medical-surgical unit?
Obtaining vital signs on a client receiving a blood transfusion
A 32-year-old client recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request?
Penicillin V (Pen-V K)
The nurse is caring for a client with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which client statement indicates effective coping after the procedure?
Physical therapy and counseling will help me adjust to my prosthesis.
Which technique is the correct way to instill eardrops?
Place the medication bottle in a bowl of warm water before instillation
A family member of a client with a recent spinal cord injury asks the nurse, "Can you please tell me what the real prognosis for recovery is? I don't feel like I'm getting a straight answer." What is the nurse's best response?
Please request a meeting with the health care provider.
A client is admitted with a spinal cord injury at the seventh cervical vertebra secondary to a gunshot wound. Which nursing intervention is the priority for this client's care?
Positioning the client to maximize ventilation potential
Which is a priority problem for the older adult client diagnosed with bone cancer?
Potential for injury related to weakness and drug therapy
A client with a history of atrial fibrillation is receiving sodium heparin 24 hours after receiving thrombolytic therapy for a stroke. Which emergency drug does the nurse ensure is on the floor?
Protamine sulfate
The nurse is caring for a client who is in sickle cell crisis. What action does the nurse perform first?
Provide pain medications as needed.
What is the proper technique for assessing an adult client's ear with an otoscope?
Pull the pinna up and back with the nondominant hand.
A client recently diagnosed with Ménière's disease is struggling with tinnitus. How does the nurse provide support to this client?
Refer the client to the American Tinnitus Association.
An older adult client with a new diagnosis of hearing loss is deeply concerned about not being able to hear at the neighborhood council meetings. Which nursing intervention best addresses the client's concern?
Refer the client to the Hearing Loss Association of America
Which nursing intervention is best for preventing complications of immobility when caring for a client with spinal cord problems?
Regular turning and re-positioning
A client is brought to the emergency department via ambulance after a motor vehicle crash. What condition does the nurse assess for first?
Respiratory distress
The nurse assesses multiple clients who are receiving transfusions of blood components. Which assessment indicates the need for the nurse's immediate action?
Respiratory rate of 36 breaths/min in a client receiving red blood cells
To prevent the leading cause of death for clients with spinal cord injury, collaboration with which component of the health care team is a nursing priority?
Respiratory therapy
The nurse is caring for a client postoperatively after an anterior cervical diskectomy and fusion. Which assessment finding is of greatest concern to the nurse?
The client is reporting difficulty swallowing secretions
The nurse is caring for a client who is admitted with mastoiditis. Which assessment data obtained by the nurse requires the most immediate action?
The client reports a headache and a stiff neck. Correct
The nurse is caring for a client in the emergency department whose spinal cord was injured at the level of C7 1 hour ago. Which assessment finding requires the most rapid action?
The client's chest moves very little with each respiration
A client with leukemia is being discharged from the hospital. After hearing the nurse's instructions to keep regularly scheduled follow-up provider appointments, the client says, "I don't have transportation." How does the nurse respond?
The local American Cancer Society may be able to help." Correct
The nurse is teaching the spouse and client who has had a brain attack about rehabilitation. Which statement by the spouse demonstrates understanding of the nurse's instruction?
The rehabilitation therapist will help identify changes needed at home
The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information does the nurse include?
The sickle cell trait will be inherited by your children.
A mother who is a carrier of muscular dystrophy (MD) has a daughter. The client asks the nurse what the daughter's genetic risk is for having MD. What is the nurse's best response?
There is a 50% chance that your daughter may carry the gene.
A client in the emergency department (ED) has slurred speech, confusion, and visual problems, and has been having intermittent episodes of worsening symptoms. The symptoms have a gradual onset. The client also has a history of hypertension and atherosclerosis. What does the nurse suspect that the client is probably experiencing?
Thrombotic stroke
Which finding does the nurse expect to observe in a client with suspected common chronic osteomyelitis?
Ulceration of the skin
A client with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client?
Use a soft-bristled toothbrush." Correct
A client has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement?
Use strict aseptic technique when cleaning the site.
The nurse is mentoring a recent graduate RN about administering blood and blood products. What does the nurse include in the data?
Verify with another RN all of the data on blood products.
An older adult client reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media?
Vertigo
The nurse is transfusing a unit of whole blood to a client when the health care provider requests the following: "Furosemide (Lasix) 20 mg IV push." What does the nurse do?
Wait until the transfusion has been completed to administer furosemide
Which is the best way to decrease the risk for osteoporosis in a client who has just been determined to be at high risk for the disease?
Walk for 30 minutes three times a week.
A client is being discharged home after surgery for brain cancer. Which statement by the client's spouse indicates a correct understanding of the nurse's discharge teaching?
We can find a support group through the local American Cancer Society.
The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?
Wear helmets when riding a motorcycle."
The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out?
Wheezes or crackles
A client is in the immediate postoperative period after tympanoplasty. How does the nurse position the client?
With the affected ear facing up
The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis?
Working at a desk and playing the piano for a hobby Correct
