NSG 219 Final

A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what? A 30 mL/hr B. 50mL/hr C. 100mL/hr D. 125mL/hr

A 30 mL/hr

The nurse is assisting with teaching the client newly diagnosed with type 2 Diabetes Mellitus when the client asks, "What can I do to manage my diabetes in a way that will keep me healthy?" the nurse's response would include which of the following strategies? Select all that apply A Diet management is key to diabetic control. B. Exercise, coupled with maintaining a healthy weight, may help control blood sugar levels. C. Monitor blood sugar levels as your doctor recommends. D. Inject insulin before every meal. E. Inspect feet daily.

A Diet management is key to diabetic control. B. Exercise, coupled with maintaining a healthy weight, may help control blood sugar levels. C. Monitor blood sugar levels as your doctor recommends.

Which assessment finding would require the nurse to take immediate action in a client who is one hour post kidney biopsy? A Pink tinged urine B. Nausea and vomiting C. Increased bowel sounds D. Client is ambulating to the bathroom

A Pink tinged urine

Which medication below is used to treat acne? A Tretinoin (Avita, Retin-A) B. Nystatin (Mycostatin) C. Nifedepine (Procardia) D. Desenex

A Tretinoin (Avita, Retin-A)

A client with acute renal failure has a serum potassium level of 6.5 mEg/. The nurse should monitor the client for which complication? A cardiac arrest B. pulmonary edema C. circulatory collapse D. hemorrhage

A cardiac arrest

A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. "What should the nurse teach the client about hemodialysis? A. "Hemodialysis is a treatment option that is usually required three times a week." B. "Hemodialysis is a program that will require you to commit to daily treatment." C. "This will require you to have surgery and a catheter will need to be inserted into your abdomen." D. "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

A. "Hemodialysis is a treatment option that is usually required three times a week."

A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is pending an escharotomy. The client's spouse asks the nurse what the procedure entails. Which statement by the nurse is appropriate? A. "Incisions will be made in the eschar which is a scab to improve circulation." B. "I can call the doctor back here if you want me to." C. 'A piece of skin will be removed and grafted over the burn area." D. "Dead tissue will be surgically removed."

A. "Incisions will be made in the eschar which is a scab to improve circulation."

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? (Select all that apply): A. A major risk factor for complications in type 2 diabetes is obesity and central abdominal obesity. B. Supplemental insulin is mandatory for controlling the disease type 2 diabetes. C. Exercise increases insulin resistance in the type 2 diabetic. D. The only primary nutritional source requiring monitoring in the diet is carbohydrates. E. Annual eve and foot examinations are recommended by the American diabetes association (ADA).

A. A major risk factor for complications in type 2 diabetes is obesity and central abdominal obesity. E. Annual eve and foot examinations are recommended by the American diabetes association (ADA).

The nurse would anticipate that a client with cirrhosis of the liver would have increased levels of which laboratory values? (Select all that apply) A. Albumin B. Bilirubin C. Ammonia D. Prothrombin time E. Calcium

A. Albumin B. Bilirubin C. Ammonia D. Prothrombin time

A nurse is reviewing the health care record of a client with a lesion that has been diagnosed as malignant melanoma. The nurse would expect which characteristic of this type of lesion to be documented in the client's record? A. An Irregularty shaped lesion B. A small papule with a dry, rough scale C. A firm nodular lesion topped with a crust D. A pearly papule with a central crater and a waxy border

A. An Irregularty shaped lesion

Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula? A. Auscultate for a bruit at the fistula site. B. Assess the quality of the left radial pulse. C. Compare blood pressures in the left and right arms. D. Irrigate the fistula site with saline every 8 to 12 hours

A. Auscultate for a bruit at the fistula site.

A patient with chronic Kidney disease has a potassium level of 8 mEg/. The nurse notifles the health care provider after assessing for which sign/symptom? A. Cardiac dysrhythmias B. Respiratory depression c. Tremors or seizures D. Decreased urine output

A. Cardiac dysrhythmias

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate? A. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. B. Complications of type 2 diabetes are less serious than those of type 1 diabetes. C. Insulin is not used to control blood glucose in patients with type 2 diabetes. D. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic coma.

A. Changes in diet and exercise may control blood glucose levels in type 2 diabetes

A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 ml of bright red nasogastric (NG) drainage in the past hour. What is the highest priority action by the nurse? A. Contact the surgeon. B. Give prescribed morphine. C. Monitor drainage. D. Irrigate the NG tube.

A. Contact the surgeon.

The nurse, caring for a client with a diagnosis of Addison's disease, recognizes which of the following as a priority goal for this client? A. Identify potential stressors and ways you still deal with them. B. Demonstrate 100% adherence to the prescribed diet. C. Verbalize an understanding of the causes of Addison's disease. D. Exercise for 30 minutes three or more times each week.

A. Identify potential stressors and ways you still deal with them.

The nurse notes redness, warmth, and a purulent drainage at the insertion site of a central venous catheter in a client receiving total parenteral nutrition (TP). The nurse notifies the health care provider of this finding because: A. Infections of a central venous catheter site can lead to septicemia. B. The client is experiencing an allergy to the TPN solution. C. The TPN solution has infiltrated and must be stopped. D. The client is allergic to the dressing material covering the site.

A. Infections of a central venous catheter site can lead to septicemia.

What would the nurse teach the patient about using (RID) or (NIX) to treat a lice infestation in their child? (select all that apply) A. Leave shampoo in for ten minutes B. May only use once per month C. Comb nits out after use to prevent infestation D. May repeat or use as many times as Is needed

A. Leave shampoo in for ten minutes C. Comb nits out after use to prevent infestation D. May repeat or use as many times as Is needed

A client was burned on the forearm after tripping and falling against a wood-burning stove. There are currently several small blisters over the burn area. What does the nurse advise the client to do about the blisters? A. Leave the blisters Intact because they protect the wound from infection B. Use a sterile needle to open a tiny hole in each blister to drain the fluid C. Allow blisters to increase in size; then open them to prevent immunosuppression D. Leave the blisters intact unless the pain and pressure increase

A. Leave the blisters Intact because they protect the wound from infection

When planning nutritional interventions for a healthy, 83-year-old widowed man, the nurse recognizes what factor is most likely to affect his nutritional status? A. Living alone on a fixed income B. Changes in cardiovascular function C. An increase in Gl motility and absorption D. Snacking between meals, resulting in obesity

A. Living alone on a fixed income

A patient with circumferential burns of both legs develops a decrease in dorsalis pedis pulse strength and numbness in the toes. Which action should the nurse take first? A. Notify the health care provider. B. Elevate both legs above heart level with pillows. C. Monitor the pulses every hour. D. Encourage the patient to flex and extend the toes.

A. Notify the health care provider.

Which medication is used to treat head lice infestation? (Select all that apply) A. Permethrin (Nix) B. Epsom salts C. Mycostatin D. Pyrethrin (RID)

A. Permethrin (Nix) D. Pyrethrin (RID)

The nurse is making an initial client assessment. The client has a peripheral parenteral nutrition infusing and the bag is almost empty. A new bag is not yet available from the pharmacy. What is the best nursing action? A. Plan on hanging D5W until the new solution is available. B. Slow the rate of infusion until the new solution arrives. C. Flush the line with a heparin flush solution and hang new solution when it arrives. D. Slow the infusion and periodically check the client's blood glucose until the solution is available.

A. Plan on hanging D5W until the new solution is available.

For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)? A. Providing oral hygiene after a meal B. Teaching the patient the prescribed diet C. Palpating the abdomen for distention D. Assessing the patient for jaundice

A. Providing oral hygiene after a meal

The nurse is caring for a client that is 24 hours post-operative colostomy. The nurse assess the client and stoma site every 4 hours. Of the following descriptions, which indicates a normal stoma? A. Stoma is pink, mildly swollen, scant amount of blood noted. B. Stoma is red, swollen, and bleeding. C. Stoma is pink, with a large amount of edema, scant amount of blood noted. D. Stoma is dark red, no edema or bleeding noted.

A. Stoma is pink, mildly swollen, scant amount of blood noted.

After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care? A. Support the surgical Incision during patient coughing and turning in bed. B. Remind the patient that PCA use may slow the return of bowel function. C. Offer sips of fruit juices at frequent intervals. D. Irrigate the nasogastric (NG) tube frequently.

A. Support the surgical Incision during patient coughing and turning in bed.

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? A. The client is alert and oriented. B. The client denies nausea or anorexia. C. The client's bilirubin level decreases. D. The client has at least one stool daily.

A. The client is alert and oriented.

The client who has been hospitalized with pancreatitis does not drink alcohol because of her religious convictions. She becomes upset when the physician persists in asking her about alcohol intake. The nurse should explain that the reason for these questions is that: A. There is a strong link between alcohol use and acute pancreatitis B. alcohol intake can interfere with the tests used to diagnose pancreatitis C. alcoholism is a major health problem, and all clients are questioned about alcohol intake D. the physician must obtain the pertinent facts, regardless of religious beliefs

A. There is a strong link between alcohol use and acute pancreatitis

Which landmarks should the nurse use to correctly measure a client prior to nasogastric tube Insertion? (Select all that apply) A. Tip of nose B. Sternal notch C. Mandibular joint D. Tip of earlobe E. XIphold process

A. Tip of nose D. Tip of earlobe E. XIphold process

The nurse is caring for a patient who has hypovolemic shock secondary to trauma. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? A. Urinary output B. Presence of edema C. Urine color D. Presence of pain

A. Urinary output

Your patient has been diagnosed with a vaginal infection. What patient teaching would be most beneficial to your patient to prevent reinfection? A. Your partner may need to be treated also B. Drink lots of cranberry juice. C. You may stop the medication once you feel better D. Limit your water intake while you have this infection

A. Your partner may need to be treated also

A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which of the following factors is most likely of greatest significance in causing an exacerbation of uicerative colitis? A. demanding and stressful job B. Changing to a modified vegetarian diet C. Beginning a weight-training program D. Walking 2 miles every day

A. demanding and stressful job

Which prescribed drug is best for the nurse to give before scheduled wound debridement on a patient with partial-thickness burns? A. hydromorphone (Dilaudid) B. gabapentin (Neurontin) C. lorazepam (Ativan) D. ketorolac

A. hydromorphone (Dilaudid)

The client is about to undergo a computerized tomography (CT) with contrast. Which question by the nurse is most important to ask while preparing the client for the test? A. "Have you ever had a procedure like this before?" B. "Do you have an allergy to iodine or shellfish?" C. "Would you like something to drink before you go into the radiology department?" D. "Have you voided in the bathroom in the last few hours?"

B. "Do you have an allergy to iodine or shellfish?"

The nurse is performing an initial assessment on a 55 year old client with reports of abdominal pain and changes in bowel patterns. During the history portion of the assessment what is most important to the nurse to ask the client? A. "When was your last bowel movement?" B. "Have you had a colonoscopy in the last 10 years?' C. "Have you had a influenza vaccine this season?" D. "Have you had any problems voiding?"

B. "Have you had a colonoscopy in the last 10 years?'

The client who has ulcerative collis Is scheduled for an leostomy. When the clent asks the nurse what to expect related to bowel function and care after surgery, what response should the nurse make? A. "You will be able to have some control over your bowel movements." B. "The stoma will require that you wear a collection device all of the time." C. 'After the stoma heals, you can Irrigate your bowel so you will not have to wear a pouch." D. "The drainage will gradually become semisolid and formed."

B. "The stoma will require that you wear a collection device all of the time."

A nurse is caring for clients on the pediatric unit. An 8-year-old client with second - and - third degree burns on the right thigh is being admitted. The nurse should assign the new client to which of the following roommates? A. A 2-year-old with chickenpox B. A 4-year-old with asthma C. A 9-year-old with acute diarrhea D. A 10-year-old with methicillin-resistant Staphylococcus aureus (MRSA)

B. A 4-year-old with asthma

Which patient should the nurse assess first after receiving change-of-shift report? A. A patient who is crying after receiving a diagnosis of esophageal cancer B. A patient with esophageal varices who has a rapid heart rate C. A patient with a history of gastrointestinal bleeding who has melena D. A patient with nausea who has a dose of metoclopramide (Regian) due

B. A patient with esophageal varices who has a rapid heart rate

The nurse is caring for a client receiving peritoneal dialysis. The nurse is completing the exchange by draining the dialysate and notices the dialysate is cloudy. What is the nurse's interpretation of this finding? A. The normal appearance of draining dialysate. B. A sign of infection. C. An indication of an impeding lower back problem. D. A sign of a vascular access occlusion.

B. A sign of infection.

A 32, year old female has started on Amoxicillin (Amoxil, Trimaox) for a severe UTI. Before sending her home with this prescription the nurse will provide which instruction? A. Teach her to wear a sunscreen B. Ask her about oral contraceptive use and recommend an alternative method while on an antibiotic and for several weeks after. C. Assess her for hearing loss D. Recommend taking this antibiotic with an antacid to decrease Gl upset.

B. Ask her about oral contraceptive use and recommend an alternative method while on an antibiotic and for several weeks after.

Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program? A. Having the adults write down the caloric intake of each meal B. Asking the adults about situations that tend to increase appetite C. Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals D. Encouraging the adults to eat small amounts frequently rather than having scheduled meals

B. Asking the adults about situations that tend to increase appetite

Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)? A. Nausea and vomiting B. Buming on urination C. Bilateral flank pain D. Low urine output

B. Buming on urination

During routine hemodialysis, a patient reports nausea and dizziness. Which action should the nurse take first? A. Slow down the rate of dialysis. B. Check the blood pressure (BP). C. Review the hematocrit (Hct) level. D. Give prescribed PRN antiemetic drugs.

B. Check the blood pressure (BP).

When assessing a client who has diabetes what symptoms would most cause the nurse to suspect that the client is having a 100. hypoglycemic reaction? A. Nausea, deep rapid respirations, and fruity breath. B. Cold sweats, clammy skin, and shakiness. C. Skin hot and dry to the touch and abdominal cramps. D. Slow onset of pallor of the skin and fainting.

B. Cold sweats, clammy skin, and shakiness.

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? A. Left flank bruising B. Decreased urine output C. Left flank discomfort D. Blood in urine

B. Decreased urine output

The nurse is completing a physical assessment for a newly admitted female client. The nurse is unable to feel either kidney on palpation. Which action should the nurse take next? A. Obtain a urine specimen to check for hematuria. B. Document the information on the assessment form. C. Ask the patient about any history of recent sore throat. D. Ask the health care provider about scheduling a renal ultrasound.

B. Document the information on the assessment form.

Which of the responsibllities related to the care of a cllent with a Foley catheter are appropriate for the nurse to delegate to the UAP? Select all that apply A Flush the catheter as needed to ensure patency. B. Empty drainage bag, and record output. C. Apply catheter-securing device to the client's leg. D. Perform bladder irrigation as ordered. E. Provide Foley catheter care and perineal care each shift. F. Ensure the drainage bag is below the level of the bladder at all times.

B. Empty drainage bag, and record output. C. Apply catheter-securing device to the client's leg. E. Provide Foley catheter care and perineal care each shift. F. Ensure the drainage bag is below the level of the bladder at all times.

The nurse is receiving report on a client who has a Sengstaken-Blakemore tube in place. The nurse expects that the client has which health problem as the primary reason for tube placement? A. Cirrhosis of the liver B. Esophageal varices C. Portal hypertension D. Abdominal ascites

B. Esophageal varices

Which should be included in the client's plan of care during dialysis therapy? A. Limit the client's visitors. B. Monitor the client's blood pressure. C. Pad the side rails of the bed. D. Keep the client NPO.

B. Monitor the client's blood pressure.

Of the below medications, which one is best for treatment of vaginal infection caused by candida albicans.? A. Penicillin B. Nystatin (Mycostatin) C. Desenex D. Tetracycline

B. Nystatin (Mycostatin)

Which action should the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? A. Administer antidiarrheal medication. B. Obtain a stool specimen for culture. C. Teach the adverse effects of acetaminophen (Tylenol). D. Provide teaching about antibiotic therapy.

B. Obtain a stool specimen for culture.

What should the nurse anticipate teaching a patient with a new report of heartburn? A. Radionuclide tests B. Proton pump inhibitors C. Endoscopy procedures D. A barium swallow

B. Proton pump inhibitors

The nurse is caring for a client brought to the emergency department after bending over the engine of his car when it exploded in his face. What is the priority for this client? A. Initiate fluid resuscitation B. Secure the airway C. Manage pain and discomfort D. Prevent infection

B. Secure the airway

A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis?" Which initial response by the nurse is best? A. "It depends on which type of dialysis you are considering." B. Tell me more about what you are thinking regarding dialysis." C. "You are the only one who can make the decision about dialysis." D. "Many people your age use dialysis and have a good quality of life."

B. Tell me more about what you are thinking regarding dialysis."

A female client with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? A. The client has an outflow volume of 1800 mL. B. The client's peritoneal effluent appears cloudy. C. The client's abdomen appears bloated after the inflow. D. The client has abdominal pain during the inflow phase.

B. The client's peritoneal effluent appears cloudy.

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? A. The patient is experiencing intermittent waves of nausea. B. The patient has no breath sounds in the left anterior chest. C. The patient reports 7/10 (0 to 10 scale) abdominal pain. D. The patent has hypoactive bowel sounds in all four quadrants

B. The patient has no breath sounds in the left anterior chest.

A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching? A. The patient has multiple dysplastic nevi. B. The patient uses a tanning booth weekly. C. The patient's mother died of malignant melanoma. D. The patient is fair-skinned with blue eyes.

B. The patient uses a tanning booth weekly.

An older patient reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation A. in the mid-afternoon. B. after eating breakfast. C. right after getting up in the morning. D. immediately before the first daily meal.

B. after eating breakfast.

The nurse will teach a client with chronic pancreatitis to take the prescribed pancrelipase (Viokase): A. at bedtime. B. with meals C. in the morning. D. for abdominal pain.

B. with meals

The nurse is talking to a group of healthy young athletes about maintaining good kidney health and preventing acute kidney injury. Which health promotion point is the nurse most likely to emphasize with this group? A. "Have your blood pressure checked regularly." B. "Find out if you have a family history of diabetes." C. "Avoid dehydration by drinking at least 2 to 3 L of water daily D. "Have annual testing for protein and glucose in urine."

C. "Avoid dehydration by drinking at least 2 to 3 L of water daily

A few months after bariatric surgery, a 56-year-old man tells the nurse, "My skin is hanging in folds. I think I need cosmetic surgery." Which response by the nurse is most appropriate? A. "The important thing is that you are improving your health." B. "The skinfolds will disappear once most of the weight is lost." C. "Cosmetic surgery is a possibility once your weight has stabilized. D. "Perhaps you would like to talk to a counselor about your body image."

C. "Cosmetic surgery is a possibility once your weight has stabilized.

The nurse is conducting a client intervew, which question will provide the nurse with focused information about a possible thyroid disorder? A "Do you get up during the night to empty your bladder?" B. "Have you experienced any pain?" C. "Have you had any recent unplanned weight gain or loss?" D. "What methods do you use to cope with stress?"

C. "Have you had any recent unplanned weight gain or loss?"

Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-calorie diet? A. "It will be necessary to change lifestyle habits permanently to maintain weight loss." B. "You will decrease your risk for future health problems such as diabetes by losing weight now." C. "You are likely to notice changes in how you feel with just a few weeks of diet and exercise." D. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat"

C. "You are likely to notice changes in how you feel with just a few weeks of diet and exercise."

charge nurse must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates? (Please select 2 patients.) A. A 58-year-old patient with urothelial cancer receiving multi-agent chemotherapy. B. A 63-year-old patient with kidney stones who has just undergone open ureterolithotomy. C. A 24-year-oldpatient with acute pyelonephritis and severe flank pain. D. A 76-year-old patient with urge incontinence and a urinary tract infection (UTI).

C. A 24-year-oldpatient with acute pyelonephritis and severe flank pain. D. A 76-year-old patient with urge incontinence and a urinary tract infection (UTI).

The intensive care nurse is caring for a client who underwent a kidney transplant and was just transferred from the recovery unit. Which finding is the most serious within the first 12 hours after surgery warranting immediate notification of the transplant surgeon? A. Diuresis with increased output. B. Pink and bloody urine. C. Abrupt decrease in urine output. D. Low-grade fever.

C. Abrupt decrease in urine output.

A male client in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take? A. Notify the client's health care provider. B. Teach correct midstream urine collection. C. Ask the client about current medications. D. Question the client about urinary tract infection (UTI) risk factors.

C. Ask the client about current medications.

Which statement by a nurse to a client newly diagnosed with type 2 diabetes is correct? A. Insulin is not used to control blood glucose in clients with type 2 diabetes. B. Complications of type 2 diabetes are less serlous than those of type 1 diabetes. C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. D. Type 2 diabetes is usually diagnosed when the client is admitted with a hyperglycemic coma.

C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.

A client who has scabies has been admitted to the medical/surgical unit. The nurse knows he/she should use which of the following precautions when caring for this client? A. Droplet precautions B. Airborne precautions C. Contact precautions D. Precautions are not necessary with this client

C. Contact precautions

A client with chronic kidney disease has an internal venous access site for hemodialysis in the left forearm. What action will the nurse take to protect this access site? A. Irrigate with heparin and normal saline solution every 8 hours. B. Apply warm moist packs to the area after hemodialysis. C. Do not use the left arm to take blood pressure readings. D. Keep the arm elevated above the level of the heart.

C. Do not use the left arm to take blood pressure readings.

The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include? A. Choose foods high in fiber to promote bowel function. B. Developing flabby skin can be prevented by exercise. C. Drink fluids between meals but not with meals. D. Choose high-fat foods for at least 30% of intake.

C. Drink fluids between meals but not with meals.

The nurse is assessing the laboratory findings for a client and determines the test for Helicobacter pylori bacteria is positive. The nurse would identify this finding as associated with what condition? A. Gastrosophageal reflux disease B. Irritable bowel syndrome C. Duodenal ulcer D. Infectious esophagitis

C. Duodenal ulcer

The nurse is caring for a patent with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling urinary catheter? A. Vigorously clean the meatus area daily. B. Apply powder to the perineal area twice a day. C. Empty the drainage bag at least every 8 hours. D. Irrigate the catheter every 8 hours with normal saline.

C. Empty the drainage bag at least every 8 hours.

The nurse is assessing a client with a diagnosis of peptic ulcer disease (PUD). What pain characteristics would the nurse expect the client to describe? A. Pain in the right shoulder preceded by nausea B. Sudden, sharp abdominal pain, increasing in intensity C. Gnawing epigastric pain or boring pain in the back D. Heartburn and substernal discomfort when lying down

C. Gnawing epigastric pain or boring pain in the back

Of the insulins listed below, which one can be administered via the intravenous route? A. Insulin Lispro (Humalog) B. Insulin Isophane (Humulin N) C. Humulin R D. Insluin Gargline (Lantus)

C. Humulin R

A client In the intensive care unit develops prerenal failure following surgery. Which of the following cause should the nurse suspect? A. Vascular disease B. Urethral obstruction C. Hypovolemia D. Glomerulonephritis

C. Hypovolemia

A client who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The client reports feeling lightheaded and sweaty. Which action should the nurse take first? Infuse dextrose 50% by slow IV push. B. Administer 1 mg glucagon subcutaneously. C. Obtain a glucose reading using a finger stick. D. Have the client drink 4 ounces of orange juice.

C. Obtain a glucose reading using a finger stick.

Isotretinoin (Claravis, Accutane) is a medication used to treat acne. Before women can take this medication what test has to be done? A Cardlac stress test B. Cancer screening test C. Pregnancy test D. Colonoscopy

C. Pregnancy test

A 55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which Intervention Is appropriate to include in the care plan? A Assist the patient to the bathroom q3hr. B. Place a commode at the patient's bedside. C. Teach the patient how to perform Kegel exercises. D. Demonstrate how to perform the Credé maneuver.

C. Teach the patient how to perform Kegel exercises.

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What Information is most important to report to the health care provider? A Absent bowel sounds in all quadrants B. Scant nasogastric (NG) tube drainage C. Temperature 102.1° F (38.9° C) D. Hemoglobin (Hgb) 10.8 g/dL

C. Temperature 102.1° F (38.9° C)

When assigned to care for a cllent who has just arrived from the recovery room after thyroid surgery, the nurse would consider which of the following essential to keep at bedside? A. Nasal axygen setup B. Suture removal kit. C. Tracheostomy tray. D. Oropharyngeal airway

C. Tracheostomy tray.

To prepare a client with ascites for paracentesis, immediately before the procedure the nurse A. places the client on NO status. B. assists the client to lie flat in bed. C. asks the client to empty the bladder. D. positions the client on the right side.

C. asks the client to empty the bladder.

A client has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting longer than 1 week. The nurse should assess the client for which of the following complications? A heart failure B. deep vein thrombosis C. hypokalemia D. hypocalcemia

C. hypokalemia

A patient has been admitted to the hospital with burns to his upper chest. The nurse notes singed nasal hairs. It would be important for the nurse to assess this patient frequently for. A. decreased activity. B. bradycardia. C. respiratory complications. D. hypertension.

C. respiratory complications.

Which statement by a 50-yr-old female patient Indicates to the nurse that further assessment of thyrold function may be necessary? A. "I notice my breasts are tender lately." B. "I am so thirsty that I drink all day long." C. "I get up several times at night to urinate." D. " feel a lump In my throat when I swallow.

D. " feel a lump In my throat when I swallow.

A renal biopsy has been scheduled for a client with a history of acute renal failure. The client asked the nurse why this test has been scheduled. What is the nurse's best response? A. "A biopsy is routinely ordered for all clients with renal disorders." B. "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." C. "A biopsy is often ordered for clients before they have a kidney transplant." D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

A client refuses to look at or care for her colostomy. Which of the following statements by the nurse would be most appropriate? A. "It has been 4 days since your surgery, and you will soon be discharged. You have to want to care for your colostomy before you leave the hospital." B. "I think we will need to teach your husband to care for your colostomy if you are not going to be able to do it." C. "I understand how you are feeling. It is important for you to feel attractive and you think having a colostomy changes your attractiveness." D. "I can see that you are upset. Would you like to share your concerns with me?"

D. "I can see that you are upset. Would you like to share your concerns with me?"

Which statement by a client who had a cystoscopy the previous day should be reported immediately to the health care provider? A."My urine looks pink." B. "My IV site is bruised." C. "My sleep was restless." D. "My temperature is 101."

D. "My temperature Is 101."

When caring for a client with cirrhosis the nurse notices flapping tremors of the wrist and fingers. How should the nurse chart this finding? A. Trousseau's sign noted. B. Caput medusa noted. C. Fector hepaticus noted. D. Asterixis noted.

D. Asterixis noted.

The nurse verifies an order for sodium polystyrene sulfonate for a client diagnosed with Acute Kidney Injury (AI), prior to administering the medication which assessment will the nurse perform? A. Level of consciousness B. Blood urea nitrogen (BUN) C. Fasting blood glucose D. Bowel sounds

D. Bowel sounds

The nurse is caring for a patient who has had an ilea conduit for several years. Which nursing action could be delegated to unlicensed assistive personnel (UAP)? A. Monitor the appearance of the stoma. B. Assess for possible urinary tract infection (UTI). C. Choose the appropriate ostomy bag. D. Change the ostomy appliance.

D. Change the ostomy appliance.

A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what topic? A. Typical diet B. Allergy status C. Psychosocial stressors D. Current medication use

D. Current medication use

The nurse is performing a nutritional assessment on a newly admitted client with a diagnosis of recent weight loss and malnutrition. Which finding is consistent with a diagnosis of malnutrition? A. Moist skin B. Muscle growth C. Increase in subcutaneous fat D. Decreased pigmentation of the hair

D. Decreased pigmentation of the hair

When taking Tretinoin (Avita, Retin-A) you should ask the patient are they allergic to: A. Peanuts B. Fluoride C. Fruit D. Fish

D. Fish

During the early phase of a burn injury, there is a drastic increase in capillary permeability. What does this physiologic change place the client as risk for? A Acute kidney injury B. Fluid overload C. Increased cardiac output D. Hypovolemic shock

D. Hypovolemic shock

The nurse is assessing a client who is being admitted from the emergency room with a history of vomiting bright red blood for the past 24 hours. What would be a priority nursing assessment? A. Inquire as to how much emesis the client has had in the past 6 hours. B. Evaluate bowel sounds and palpate the abdomen for areas of tenderness. C. Determine the quality of bilateral breath sounds. D. Monitor the blood pressure and pulse.

D. Monitor the blood pressure and pulse.

The nurse has delegated collection of a urinalysis specimen to an experienced unlicensed assistive personnel (UAP). For which action must the nurse intervene? A. The UP provides the patient with a specimen cup. B. The UAP reminds the patient of the need for the specimen. C. The UAP assists the patient to the bathroom. D. The UAP allows the specimen to sit for more than an hour.

D. The UAP allows the specimen to sit for more than an hour.

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? A. Serum Glucose B. Blood Pressure C. Respiratory rate D. Urine specific gravity

D. Urine specific gravity

The nurse is inserting an Intravenous (M line into a client's vein. After the initial stick, the nurse would continue to advance the catheter in which situation? A the catheter advances easily B. the vein is distended under the needle C. the client does not complain of discomfort D. blood return shows in the backflash chamber of the catheter

D. blood return shows in the backflash chamber of the catheter

A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these findings, the nurse should further assess the client for which of the following complications? A. deficient fluid volume B. Intestinal obstruction C. bowel ischemia D. peritonitis

D. peritonitis

A health care provider has written a prescription to discontinue an intravenous (IV) line. The nurse should obtain which item from the unit supply area for applying pressure to the site after removing the IV catheter? A. elastic wrap B. povidone lodine swab C. adhesive bandage D. sterile 2 x 2 gauze

D. sterile 2 x 2 gauze

A client with hypertension has been told to maintain a diet low in sodium. The nurse who is teaching this client about foods that are allowed should include which food item in a list provided to the client? A. canned tomato soup B. boiled saltwater shrimp C. canned meats D. summer squash

D. summer squash