RN Adult Medical Surgical 2023 B Flashcards
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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.

    <p>False</p> Signup and view all the answers

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

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

    What does an elevated WBC count indicate?

    <p>Infection</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>72/min</p> Signup and view all the answers

    What is a respiratory rate indicating improvement?

    <p>20/min</p> Signup and view all the answers

    What is the blood pressure reading indicating improvement?

    <p>128/56 mm Hg</p> Signup and view all the answers

    What oxygen saturation level indicates improvement?

    <p>95% on room air</p> Signup and view all the answers

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

    <p>Place a tracheostomy tray at the bedside</p> Signup and view all the answers

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

    <p>12 almonds</p> Signup and view all the answers

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

    <p>&quot;This identifies if the pacemaker cells of my heart are working properly.&quot;</p> Signup and view all the answers

    Which INR value is desired for a client taking warfarin?

    <p>2.5</p> Signup and view all the answers

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

    <p>Document that depolarization has occurred.</p> Signup and view all the answers

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

    <p>Instruct the client to allow the machine to breathe for them.</p> Signup and view all the answers

    Stress ulcers are associated with long-term mechanical ventilation.

    <p>True</p> Signup and view all the answers

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

    <p>Scan the bladder with a portable ultrasound.</p> Signup and view all the answers

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

    <p>&quot;My joints ache because I have Lyme disease.&quot;</p> Signup and view all the answers

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

    <p>&quot;I inspect my feet every day with a mirror.&quot;</p> Signup and view all the answers

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

    <p>Take daily cranberry supplements.</p> Signup and view all the answers

    What urine output can contribute to delayed wound healing?

    <p>25 mL/hr</p> Signup and view all the answers

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

    <p>Visual spatial deficits</p> Signup and view all the answers

    Who should a nurse refer to physical therapy preoperatively?

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

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

    <p>Wear a mask.</p> Signup and view all the answers

    What oxygen delivery system provides the highest concentration?

    <p>Nonrebreather mask.</p> Signup and view all the answers

    What should the nurse do for a client with MRSA?

    <p>Bathe the client using chlorhexidine solution.</p> Signup and view all the answers

    What finding indicates possible compartment syndrome?

    <p>Pain that increases with passive movement.</p> Signup and view all the answers

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

    <p>Bubbling in the water seal chamber has ceased.</p> Signup and view all the answers

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

    <p>Warfarin.</p> Signup and view all the answers

    When will the nurse remove the drain post-mastectomy?

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

    What finding is a priority for a client receiving chemotherapy?

    <p>Report of sore throat.</p> Signup and view all the answers

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

    <p>Pneumonia</p> Signup and view all the answers

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

    <p>Administer Morphine IV - Ensure client is NPO.</p> Signup and view all the answers

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

    <p>Acute chest syndrome and pneumonia.</p> Signup and view all the answers

    Match the following prescriptions with their classification for the client:

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

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

    <p>Administer gentamicin 100 mg IV</p> 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)

    <p>I should schedule several rest periods throughout the day.</p> Signup and view all the answers

    How often should a client with AIDS take their temperature?

    <p>Once a day.</p> Signup and view all the answers

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

    <p>Administer an opioid analgesic</p> Signup and view all the answers

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

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

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

    <p>To increase energy level.</p> Signup and view all the answers

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

    <p>Hair loss on the lower legs.</p> Signup and view all the answers

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

    <p>Eat more high-fiber foods.</p> Signup and view all the answers

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

    <p>Instruct the client on alternative therapies for pain reduction</p> 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.

    <p>24 mL.</p> Signup and view all the answers

    What laboratory finding indicates a myocardial infarction?

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

    Which medication is known to interact with feverfew?

    <p>Naproxen.</p> Signup and view all the answers

    What action should the nurse take when administering packed RBCs?

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

    What should a nurse instruct a client taking psyllium?

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

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>Client is diaphoretic</p> Signup and view all the answers

    What should the nurse first address when prioritizing client care?

    <p>Client's oxygen saturation.</p> Signup and view all the answers

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

    <p>Obtain sputum</p> Signup and view all the answers

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

    <p>Potassium level</p> Signup and view all the answers

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

    <p>Heart rate 55/min</p> Signup and view all the answers

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

    <p>A tingling sensation replacing the pain.</p> 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?

    <p>All of the above</p> Signup and view all the answers

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

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

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

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

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

    <p>At least 30 g per day.</p> Signup and view all the answers

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

    <p>Low urine specific gravity.</p> Signup and view all the answers

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

    <p>167</p> Signup and view all the answers

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

    <p>Perineal pad saturated with blood, large clots present</p> Signup and view all the answers

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

    <p>Suction machine.</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>Check that one finger fits between the cast and the leg.</p> Signup and view all the answers

    An allergy to which food can indicate a latex allergy?

    <p>Avocados.</p> Signup and view all the answers

    What should be administered for a client with diabetic ketoacidosis?

    <p>Regular insulin 20 units IV bolus.</p> Signup and view all the answers

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

    <p>My hands rather than a washcloth.</p> Signup and view all the answers

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

    <p>Perform synchronized cardioversion.</p> Signup and view all the answers

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

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

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

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

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

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

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

    <p>One-eighth inch wider than the stoma.</p> Signup and view all the answers

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

    <p>A lead-lined container.</p> Signup and view all the answers

    Which supplement can interfere with levothyroxine effectiveness?

    <p>Calcium.</p> Signup and view all the answers

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

    <p>Wrap fingers with individual dressings.</p> Signup and view all the answers

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

    <p>History of asthma.</p> Signup and view all the answers

    What urine specific gravity finding is indicative of hypertonic dehydration?

    <p>Urine specific gravity 1.045.</p> Signup and view all the answers

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

    <p>Respiratory paralysis.</p> Signup and view all the answers

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

    <p>Irrigate the indwelling urinary catheter.</p> Signup and view all the answers

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

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

    Where should enoxaparin be injected for better absorption?

    <p>Anterolateral abdominal wall.</p> Signup and view all the answers

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

    <p>Keep the client occupied with a manual activity.</p> Signup and view all the answers

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

    <p>Increased BUN.</p> Signup and view all the answers

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

    <p>Tachycardia.</p> Signup and view all the answers

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

    <p>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).</p> 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.

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