RN Adult Medical Surgical 2023 B Flashcards

Questions and Answers

Which of the following statements by the client indicates an understanding of the preoperative teaching for right knee arthroplasty? (Select all that apply)

I will probably be going home with a walker (correct)

My physical therapy will start after I leave the hospital

I will be sure to ask for pain medication before my knee starts to hurt too bad (correct)

I will need to do the breathing exercises every 1 to 2 hours after the surgery (correct)

A client can refuse surgery at any time regardless of previous consent.

True

Which instructions should the nurse include for a client who is 2 weeks postoperative following a gastrectomy? (Select all that apply)

Consume high-protein snacks (correct)

Eat several small meals (correct)

Maintain a high carbohydrate intake

Avoid drinking fluids with meals (correct)

Avoid highly seasoned foods (correct)

Dumping syndrome requires a high carbohydrate diet.

False Signup and view all the answers

What should a client do regarding physical therapy after knee arthroplasty?

Physical therapy will begin the day of, or the day following, surgery. Signup and view all the answers

What does an elevated WBC count indicate?

Infection Signup and view all the answers

The client's heart rate is within the expected reference range.

True Signup and view all the answers

An elevated potassium level places a client at risk for cardiac dysrhythmias.

True Signup and view all the answers

What heart rate indicates improvement in a client's condition?

72/min Signup and view all the answers

What is a respiratory rate indicating improvement?

20/min Signup and view all the answers

What is the blood pressure reading indicating improvement?

128/56 mm Hg Signup and view all the answers

What oxygen saturation level indicates improvement?

95% on room air Signup and view all the answers

What should the nurse do as a priority after a parathyroidectomy?

Place a tracheostomy tray at the bedside Signup and view all the answers

Which food has the greatest amount of calcium to recommend after thyroidectomy?

12 almonds Signup and view all the answers

What statement indicates a client's understanding of telemetry monitoring?

"This identifies if the pacemaker cells of my heart are working properly." Signup and view all the answers

Which INR value is desired for a client taking warfarin?

2.5 Signup and view all the answers

What should the nurse do after noting a pacemaker artifact followed by a QRS complex?

Document that depolarization has occurred. Signup and view all the answers

What should the nurse instruct a client with mechanical ventilation who appears anxious?

Instruct the client to allow the machine to breathe for them. Signup and view all the answers

Stress ulcers are associated with long-term mechanical ventilation.

True Signup and view all the answers

What is the first action for a client unable to void post hip arthroplasty?

Scan the bladder with a portable ultrasound. Signup and view all the answers

What statement shows a client's understanding of preventing complications from Lyme disease?

"My joints ache because I have Lyme disease." Signup and view all the answers

What indicates a client is coping successfully with a diagnosis of type 1 diabetes?

"I inspect my feet every day with a mirror." Signup and view all the answers

What should be included in teaching clients with a history of UTIs?

Take daily cranberry supplements. Signup and view all the answers

What urine output can contribute to delayed wound healing?

25 mL/hr Signup and view all the answers

What clinical deficits should a nurse expect after a right-hemispheric stroke?

Visual spatial deficits Signup and view all the answers

Who should a nurse refer to physical therapy preoperatively?

A client receiving preoperative teaching for a right knee arthroplasty. Signup and view all the answers

What should the nurse do for a client with bacterial meningitis?

Wear a mask. Signup and view all the answers

What oxygen delivery system provides the highest concentration?

Nonrebreather mask. Signup and view all the answers

What should the nurse do for a client with MRSA?

Bathe the client using chlorhexidine solution. Signup and view all the answers

What finding indicates possible compartment syndrome?

Pain that increases with passive movement. Signup and view all the answers

What finding indicates lung re-expansion in a client with pneumothorax?

Bubbling in the water seal chamber has ceased. Signup and view all the answers

What medication should the nurse notify the provider about before cataract surgery?

Warfarin. Signup and view all the answers

When will the nurse remove the drain post-mastectomy?

When there is 25 mL of output or less over a 24-hr period. Signup and view all the answers

What finding is a priority for a client receiving chemotherapy?

Report of sore throat. Signup and view all the answers

Which conditions does the nurse assess for a client presenting with respiratory symptoms?

Pneumonia Signup and view all the answers

What actions should the nurse take for a client likely experiencing cholecystitis?

Administer Morphine IV - Ensure client is NPO. Signup and view all the answers

What condition is the client likely experiencing with increased respiratory rate?

Acute chest syndrome and pneumonia. Signup and view all the answers

Match the following prescriptions with their classification for the client:

Obtain blood cultures = Anticipated Insert NG tube = Anticipated Obtain vitals = Anticipated Bolus fluids = Contraindicated Signup and view all the answers

Which of the following actions should the nurse take after reviewing the client's EMR? (Select 3 actions)

Administer gentamicin 100 mg IV Signup and view all the answers

Which of the following statements made by the client indicates an understanding of discharge teaching? (Select all that apply)

I should schedule several rest periods throughout the day. Signup and view all the answers

How often should a client with AIDS take their temperature?

Once a day. Signup and view all the answers

What prescription should the nurse expect for a client who sustained a rattlesnake bite?

Administer an opioid analgesic Signup and view all the answers

What is an important exercise recommendation for a client with heart failure?

Try to walk at least three times per week. Signup and view all the answers

What is the purpose of erythropoietin therapy in clients with chronic kidney disease?

To increase energy level. Signup and view all the answers

What finding is expected in a client with peripheral arterial disease?

Hair loss on the lower legs. Signup and view all the answers

What dietary recommendation should a client taking an oral iron supplement follow?

Eat more high-fiber foods. Signup and view all the answers

What should the nurse do for a client expressing concern about morphine addiction?

Instruct the client on alternative therapies for pain reduction Signup and view all the answers

The nurse should administer __ mL of phenytoin 600 mg PO daily to a client based on the available concentration.

24 mL. Signup and view all the answers

What laboratory finding indicates a myocardial infarction?

Troponin 18 ng/mL. Signup and view all the answers

Which medication is known to interact with feverfew?

Naproxen. Signup and view all the answers

What action should the nurse take when administering packed RBCs?

Remain with the client for the first 15 min of the infusion. Signup and view all the answers

What should a nurse instruct a client taking psyllium?

Drink 240 mL (8 oz) of water after administration. Signup and view all the answers

Which findings in a client with a gastric hemorrhage require follow-up?

All of the above Signup and view all the answers

Which findings should the nurse highlight to indicate a potential problem?

Client is diaphoretic Signup and view all the answers

What should the nurse first address when prioritizing client care?

Client's oxygen saturation. Signup and view all the answers

What are the anticipated actions for a client? (Select all that apply)

Obtain sputum Signup and view all the answers

Which findings in the client’s medical record require nursing intervention? (Select 3)

Potassium level Signup and view all the answers

Based on the client's heart rate, which finding should the nurse report to the provider?

Heart rate 55/min Signup and view all the answers

What sensation does a TENS unit produce when applied to the painful area?

A tingling sensation replacing the pain. Signup and view all the answers

Which findings should be identified as a component of Cushing's triad in a client with a traumatic brain injury?

All of the above Signup and view all the answers

What should a family do to help a client with Alzheimer's disease select outfits?

Create complete outfits and allow the client to select one each day. Signup and view all the answers

What precaution should be included in the plan of care for a client with burn injuries?

Avoid placing plants or flowers in the client's room. Signup and view all the answers

What is the recommended daily fiber intake for a client with irritable bowel syndrome?

At least 30 g per day. Signup and view all the answers

What urine specific gravity finding is expected in a client with diabetes insipidus?

Low urine specific gravity. Signup and view all the answers

The IV pump for TPN should be set at _____ mL/hr to provide 2,000 kcal per day.

167 Signup and view all the answers

What finding should a nurse report for a client who is 4 hours postoperative following a vaginal hysterectomy?

Perineal pad saturated with blood, large clots present Signup and view all the answers

What should a nurse ensure is available at the bedside for a client with dysphagia?

Suction machine. Signup and view all the answers

Changing a pet's litter box is safe for a client receiving chemotherapy.

False Signup and view all the answers

What should a nurse check to ensure a newly applied plaster cast is not too tight?

Check that one finger fits between the cast and the leg. Signup and view all the answers

An allergy to which food can indicate a latex allergy?

Avocados. Signup and view all the answers

What should be administered for a client with diabetic ketoacidosis?

Regular insulin 20 units IV bolus. Signup and view all the answers

What should a client with esophageal cancer use to clean the radiation area?

My hands rather than a washcloth. Signup and view all the answers

What should the nurse do for a client experiencing supraventricular tachycardia?

Perform synchronized cardioversion. Signup and view all the answers

What heart rate change should alert the nurse to possible hemorrhage in a postoperative client?

Heart rate 110/min. Signup and view all the answers

What is necessary for a client with active tuberculosis until there are three negative cultures?

Sputum specimens are necessary every 2 to 4 weeks. Signup and view all the answers

What blood pressure finding indicates a risk for thyroid storm in a client with hyperthyroidism?

Blood pressure 170/80 mm Hg. Signup and view all the answers

How much wider should the skin barrier opening be cut in relation to the stoma?

One-eighth inch wider than the stoma. Signup and view all the answers

What item should be kept in the room of a client with a sealed radiation implant?

A lead-lined container. Signup and view all the answers

Which supplement can interfere with levothyroxine effectiveness?

Calcium. Signup and view all the answers

What should the nurse instruct for a client with a partial-thickness burn on the hand?

Wrap fingers with individual dressings. Signup and view all the answers

What history finding requires further assessment before a CT scan with IV contrast?

History of asthma. Signup and view all the answers

What urine specific gravity finding is indicative of hypertonic dehydration?

Urine specific gravity 1.045. Signup and view all the answers

After administering magnesium sulfate, what adverse effect should the nurse monitor for?

Respiratory paralysis. Signup and view all the answers

What should the nurse do for a client postoperative TURP with clots in the catheter?

Irrigate the indwelling urinary catheter. Signup and view all the answers

What indication shows a client understands self-care for venous insufficiency?

I will wear clean graduated compression stockings every day. Signup and view all the answers

Where should enoxaparin be injected for better absorption?

Anterolateral abdominal wall. Signup and view all the answers

What action can a nurse take to avoid restraining a client with dementia who is agitated?

Keep the client occupied with a manual activity. Signup and view all the answers

What laboratory value indicates an adverse effect of amphotericin B in a client with AIDS?

Increased BUN. Signup and view all the answers

What is the priority assessment finding in a client with acute cholecystitis?

Tachycardia. Signup and view all the answers

What findings should require follow-up for a nurse in an assessment?

12 % weight loss over 2 months, muscle guarding, abdominal firmness, abdominal pain rate of 8, hypoactive bowel sounds, report of anorexia, temperature of 38.5 C (101.4 F). Signup and view all the answers

Study Notes

Heart Failure and Digoxin Toxicity

Heart rate of 55/min indicates potential digoxin toxicity; report to provider.
Baseline heart rate was 74/min, showing a significant decrease.

TENS Unit for Pain Management

TENS unit application leads to a tingling sensation that may alleviate pain.
Small electric currents allow the client to adjust until pain is overridden.

Cushing's Triad and Brain Injury

Bradycardia is a sign of increased intracranial pressure, part of Cushing's triad.
Other components include severe hypertension and widened pulse pressure.

Alzheimer's Disease Care

Encourage family to create and present complete outfits for daily selection by the client.

Infection Precautions for Burn Victims

Avoid live plants or flowers in the room to prevent Pseudomonas aeruginosa infections.

Irritable Bowel Syndrome (IBS) Management

Increase dietary fiber intake to at least 30 g daily to promote regular bowel patterns.

Diabetes Insipidus Assessment

Expect low urine specific gravity (1.001 - 1.005) due to decreased water reabsorption.

Total Parenteral Nutrition (TPN) Calculation

IV pump setting: Approximately 167 mL/hr for 2000 kcal with a solution of 500 kcal/L.

Postoperative Care Following Hysterectomy

Report saturated perineal pad and large clots; indicate possible hemorrhage.

Dysphagia Precautions

Keep a suction machine at bedside for clients with dysphagia to ensure airway clearance.

Chemotherapy Infection Prevention

Client should avoid changing pet litter boxes to prevent exposure to toxoplasmosis.

Cast Care Protocol

Ensure one finger fits beneath the cast to prevent complications from tightness.

Allergies and Latex Sensitivity

Allergies to avocados may suggest a latex allergy; monitor for reactions.

Management of Diabetic Ketoacidosis (DKA)

Administer regular insulin IV bolus (20 units) for managing DKA complications.

Radiation Therapy for Esophageal Cancer

Clean the radiation area with hands rather than using a washcloth for skin protection.

Supraventricular Tachycardia Intervention

Synchronized cardioversion is indicated for heart rates >200/min with low blood pressure.

Postoperative Hemorrhage Indicators

Increased heart rate to 110/min may signify hemorrhaging after nephrectomy.

Tuberculosis Management

Obtain sputum specimens every 2-4 weeks until three negative cultures confirm no infectious status.

Hyperthyroidism Priority Assessment

Blood pressure of 170/80 mm Hg is critical; indicates a risk for thyroid storm.

Ureterostomy Teaching

Skin barrier opening should be cut 1/8 inch wider than the stoma to minimize irritation.

Radiation Implant Safety

Keep a lead-lined container in the room for potential dislodgement of a sealed radiation implant.

Levothyroxine Administration Guidance

Advise clients to avoid calcium supplements within 4 hours of taking levothyroxine to prevent interference.

Burn Care Instructions

Wrap fingers with individual dressings to promote healing and functional mobility.

CT Scan Precautions

History of asthma requires further assessment due to potential contrast dye reactions.

Hypertonic Dehydration Indicator

Urine specific gravity of 1.045 suggests hypertonic dehydration.

Magnesium Sulfate Adverse Effects

Monitor for respiratory paralysis, a life-threatening effect of magnesium sulfate administration.

Indwelling Catheter Management Post TURP

Irrigate the urinary catheter to remove clots and restore urine flow.

Venous Insufficiency Self-Care

Daily usage of clean graduated compression stockings is vital for management.

Enoxaparin Administration

Inject medication into the anterolateral abdominal wall to enhance absorption and reduce hematoma risk.

Dementia Care Strategies

Engage clients with manual activities to prevent agitation and distraction from IV catheters.

Amphotericin B Monitoring

Elevated BUN indicates possible nephrotoxicity associated with amphotericin B treatment.

Acute Cholecystitis Priority Findings

Tachycardia is a priority assessment finding; may indicate impending shock.

Assessment Follow-Up Findings

Significant findings include weight loss, abdominal pain, guarding, and elevated temperature, necessitating further evaluation.

Diagnosing Appendicitis vs. Crohn's Disease

Pain location, temperature, and GI concerns support both appendicitis and Crohn's Disease.

Care Prioritization Framework

Address abdominal findings first, focusing on inflammatory markers to prevent complications.

Anticipated vs. Contraindicated Actions

Anticipate obtaining blood cultures and vital signs; contraindications include bolus IV fluids when stable.

Postoperative Preparations

Ensure informed consent, administer gentamicin, and prepare for an exploratory laparotomy if necessary.### Patient Care Guidelines
Schedule multiple rest periods daily for recovery post-exploratory laparotomy.
Monitor and report temperature exceeding 101°F as a potential infection indicator post-surgery.

HIV Client Education

Daily temperature checks are essential for clients with AIDS, with a fever threshold of 37.8°C (100°F) indicating possible infection.

Emergency Management

For rattlesnake bites, expect prescriptions for opioid analgesics to alleviate pain.

Heart Failure Management

Encourage clients with heart failure to maintain a regular walking routine, ideally at least three times weekly.

Chronic Kidney Disease Treatment

Erythropoietin is administered to enhance energy levels and increase hematocrit in patients with anemia.

Peripheral Arterial Disease Signs

Expect hair loss on lower legs as a characteristic finding due to inadequate arterial circulation.

Iron Supplement Teaching

Advise an increase in high-fiber foods to mitigate constipation, a common side effect of oral iron supplements.

Pain Management Alternatives

For clients hesitant about morphine due to addiction fears, suggest nonpharmacologic therapies like relaxation and distraction techniques.

Medication Dosage Calculation

Administer 24 mL of phenytoin oral solution for a daily dose of 600 mg, based on available strength.

Myocardial Infarction Indicators

An elevated troponin level (18 ng/mL) is a significant marker of myocardial infarction.

Drug Interactions

Beware of potential bleeding risks when using feverfew alongside naproxen due to both impairing platelet aggregation.

Blood Transfusion Safety

Remain with the client for the first 15-30 minutes of packed RBC transfusion to monitor for hemolytic reactions.

Psyllium Administration

Recommend drinking 240 mL (8 oz) of water after taking psyllium to enhance effectiveness.

Emergency Response Sequence

Prioritize oxygen administration via nonrebreather mask, followed by IV therapy, NG tube insertion, and famotidine administration for shock management in gastric hemorrhage.

Allergy Testing Considerations

Postpone allergy skin testing if the client is on specific medications (e.g., ACE inhibitors or glucocorticoids) that can affect test results.

Fall Prevention Strategies

Educate families of hemianopsia clients to encourage visual scanning during ambulation to reduce fall risk.

External Fixation Device Safety

Instruct clients with external fixation devices to use crutches equipped with rubber tips to prevent falls.

HIV Treatment Monitoring

A decreased viral load indicates effective response to HIV treatment.

Symptoms of Pernicious Anemia

Glossitis (smooth red tongue) can signal pernicious anemia, often resulting from vitamin deficiencies.

Follow-Up Diagnostic Findings

Elevated BUN, WBC count, PCO2, and decreased oxygen saturation levels necessitate nursing follow-up for intervention.

Identifying Client Improvement

Monitor heart rate (72 bpm), respiratory rate (20/min), blood pressure (128/56 mm Hg), and oxygen saturation (95%) to assess client health status improvement.

Postoperative Priority Actions

After parathyroidectomy, ensure a tracheostomy tray is readily available to address potential airway obstructions.

Dietary Recommendations Post-Thyroidectomy

Advise inclusion of foods high in calcium, such as 12 almonds, to prevent hypocalcemia following removal of parathyroid glands.

Continuous Telemetry Monitoring

Educate clients with cardiac dysrhythmias on the importance of continuous telemetry monitoring for real-time heart rhythm assessment.### Pacemaker Management
Telemetry assesses the functionality of heart pacemaker cells by detecting cardiac impulses.

Warfarin Therapy

Desired INR for clients on warfarin for chronic atrial fibrillation is 2.5, within a therapeutic range of 2 to 3.
Warfarin reduces risks of stroke, MI, and PE by preventing blood clot formation.

Pacemaker Artifact

A pacemaker artifact appears as a spike on an ECG, followed by a QRS complex indicating successful depolarization.

Mechanical Ventilation

Clients on mechanical ventilation may exhibit anxiety; instructing them to relax and let the machine breathe for them is essential.
High-pressure alarms indicate resistance that may be alleviated through calming interventions.

Complications of Mechanical Ventilation

Long-term mechanical ventilation can lead to stress ulcers due to increased hydrochloric acid secretion.

Postoperative Urinary Retention

If a postoperative client cannot void, the first action is to assess bladder volume using a portable ultrasound.

Lyme Disease

Joint pain in Lyme disease indicates progression from stage I to II if untreated, leading to chronic issues in later stages.

Diabetes Management

Regular foot inspections reflect adaptive coping strategies in newly diagnosed type 1 diabetes clients.

Preventing Urinary Tract Infections

Daily cranberry supplements or low-fructose cranberry juice can help reduce UTI risk by preventing bacterial adherence.

Pressure Injury Wound Healing

Low urine output (25 mL/hr) can signal dehydration, hindering wound healing in pressure injuries.

Stroke Recovery Expectations

Clients post right-hemispheric stroke may show visual-spatial deficits, left hemianopsia, and one-sided neglect.

Physical Therapy Referrals

Clients undergoing preoperative teaching for knee arthroplasty should be referred to physical therapy for education on postoperative care.

Dementia Care

Personal items like photographs at the bedside can provide cognitive support for clients with dementia.

Infection Control

For clients with bacterial meningitis, droplet precautions require masks for nursing staff.

Oxygen Delivery for Pneumonia

A nonrebreather mask is recommended for clients with fluctuating low oxygen levels to provide high-concentration oxygen.

MRSA Infection Control

Bathing with chlorhexidine solution decreases the risk of MRSA transmission during care.

Compartment Syndrome Symptoms

Pain increasing with passive movement indicates potential compartment syndrome, requiring immediate attention.

Closed-Chest Drainage Monitoring

The absence of bubbling in the water seal chamber signifies lung re-expansion after pneumothorax treatment.

Preoperative Medication Review

Warfarin is contraindicated for clients scheduled for cataract surgery due to increased bleeding risk.

Post-Surgery Drain Management

A drainage system post-mastectomy will be removed when output is 25 mL or less over 24 hours.

Monitoring for Chemotherapy Complications

A sore throat in chemotherapy patients may indicate infection risk and requires prompt assessment.

Assessment of Respiratory Conditions

Key manifestations of emphysema, asthma, and pneumonia are similar, including respiratory rates, cough, and corresponding vital signs.

Cholecystitis Management in the ED

Administer opioid analgesics like morphine for pain in clients suspected of cholecystitis; maintain them NPO.

Postoperative Norms for Knee Arthroplasty

Clients should practice breathing exercises and request pain medication proactively after knee surgery.

Post-Gastrectomy Dietary Teaching

Post-gastrectomy clients should avoid drinking fluids with meals, consume small meals, choose high-protein snacks, and limit seasoned foods.

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Test your knowledge on adult medical-surgical nursing practices with these flashcards. Covering essential topics related to heart failure and patient follow-up care, this quiz helps reinforce critical concepts. Perfect for nurses preparing for exams or enhancing their clinical skills.