RN Adult Medical Surgical Practice 2019

Questions and Answers

Oxygen saturation

Oxygen saturation levels indicate how well oxygen is being carried in the blood.

Temperature

Temperature can indicate the presence of infection or other health issues.

For each potential provider's prescription, what is the status of 'Cough and deep breathe every 2 hr'?

anticipated

For each potential provider's prescription, what is the status of 'Perform neurological checks every 2 hr'?

nonessential Signup and view all the answers

For each potential provider's prescription, what is the status of 'Limit the client's fluid intake to 1,500 mL per day'?

contraindicated Signup and view all the answers

In a medical record review, which findings require nursing intervention?

Temperature, WBC, Potassium Signup and view all the answers

Which findings indicate the client is improving?

Blood pressure is 128/56 Signup and view all the answers

What information should a nurse provide after an upper gastrointestinal series with barium contrast?

Increase fluid intake. Signup and view all the answers

Which image indicates that the client has exophthalmos?

Image D Signup and view all the answers

What should the nurse include in teaching for an older adult client prescribed an opioid analgesic for pain management?

You should void every 4 hours to decrease the risk of urinary retention. Signup and view all the answers

What instructions should a nurse provide to a client after a gastrectomy?

Eat several small meals per day Signup and view all the answers

After hospitalization for heart failure, which finding should the nurse report to the provider?

Heart rate 55/min Signup and view all the answers

Which statement by a client with stress incontinence indicates understanding of teaching?

I am dieting to lose weight. Signup and view all the answers

What should a nurse expect in a client who sustained a rattlesnake bite?

Administer an opioid analgesic to the client. Signup and view all the answers

When performing a dressing change for a client recovering from a hemicolectomy and noticing protruding bowel, what should the nurse do first?

Call for help. Signup and view all the answers

If a client with portal hypertension is vomiting blood mixed with food, what action should the nurse take first?

Obtain vital signs. Signup and view all the answers

To mitigate the risk of colorectal cancer, what dietary alteration should the client make?

Add cabbage to the diet. Signup and view all the answers

What should a client with type 2 diabetes mellitus and a new prescription for metformin understand?

I should take this medication with a meal. Signup and view all the answers

What actions should the nurse take for a postoperative client? Select all that apply.

Instruct the client to splint the abdomen with a pillow for coughing Signup and view all the answers

Which assessment finding should the nurse expect for a client with a potassium level of 3 mEq/L?

Hypoactive bowel sounds Signup and view all the answers

Where should a nurse palpate to verify a client has an inguinal hernia?

C Signup and view all the answers

What finding contributes to delayed wound healing in a client with a stage III pressure injury?

Urine output 25 mL/hr Signup and view all the answers

What action should the nurse take for a client experiencing a tonic-clonic seizure?

Loosen restrictive clothing. Signup and view all the answers

What should a client with chronic kidney disease understand about erythropoietin?

I am taking this medication to increase my energy level. Signup and view all the answers

What instruction should the nurse provide regarding a cutaneous diversion procedure for a client with bladder cancer?

You should cut the opening of the skin barrier one-eighth inch wider than the stoma. Signup and view all the answers

What intervention should the nurse include to decrease psychosocial health issues in a client starting dialysis treatments?

Tell the client that it is possible to return to similar previous levels of activity. Signup and view all the answers

In a client with hyperthyroidism, what is the priority assessment finding to report?

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

Which findings indicate increased intracranial pressure (ICP)? (Select all that apply.)

Widening pulse pressure Signup and view all the answers

What action should the nurse take when administering enoxaparin subcutaneously?

Inject the medication into the anterolateral abdominal wall. Signup and view all the answers

What should a nurse check for a client who has had a plaster cast applied to their left leg 2 hours ago?

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

What statement indicates a client with esophageal cancer understands the teaching about radiation therapy?

I will use my hands rather than a washcloth to clean the radiation area. Signup and view all the answers

What instruction should a nurse include in discharge teaching for a client with hemianopsia at risk for falls?

Remind the client to scan their complete range of vision during ambulation. Signup and view all the answers

Which client should a nurse assess first after receiving a change-of-shift report?

A client who had a myocardial infarction (MI) 4 days ago and is asking for a PRN sublingual nitroglycerin tablet. Signup and view all the answers

What laboratory value should a nurse report for a postoperative client following total hip arthroplasty?

Hgb 8 g/dL. Signup and view all the answers

Which client medication interacts with feverfew?

Naproxen. Signup and view all the answers

What assessment finding should a nurse suspect indicates hypertonic dehydration in an older adult client?

Urine specific gravity 1.045. Signup and view all the answers

What should a nurse place at the bedside of a client with dysphagia?

Suction machine. Signup and view all the answers

What finding indicates an adverse reaction to propranolol in a client with hypertension?

Report of a night cough. Signup and view all the answers

If a client is to receive 2,000 kcal per day via TPN with 500 kcal/L, what should the IV pump be set at in mL/hr?

167 mL/hr. Signup and view all the answers

What is the priority intervention for a nurse caring for a client having a seizure?

Turn the client to the side. Signup and view all the answers

What intervention should be included in the plan of care for a client with neutropenia from chemotherapy?

Monitor the client's temperature every 4 hr. Signup and view all the answers

What action should a nurse include in the plan of care for a client undergoing brachytherapy?

Wear a lead apron while providing care to the client. Signup and view all the answers

What is the appropriate action for a nurse preparing to administer packed RBCs?

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

Which medication should a client with supraventricular tachycardia withhold prior to elective cardioversion?

Digoxin. Signup and view all the answers

What is the first action for a nurse caring for a client with anorexia, fever, night sweats, and a productive cough?

Initiate airborne precautions. Signup and view all the answers

What food should a nurse recommend a client avoid to reduce the risk of migraine headaches?

Aged cheese. Signup and view all the answers

What adverse effect should a nurse monitor for a client taking lactulose for hepatic encephalopathy?

Hypokalemia. Signup and view all the answers

What feeling should a nurse expect to find in a client who had extracorporeal shock wave lithotripsy?

Stone fragments in the urine. Signup and view all the answers

What should a nurse tell a client who requests sildenafil for erectile dysfunction?

You will not be able to use sildenafil if you are taking nitroglycerin. Signup and view all the answers

What should a nurse demonstrate during preoperative teaching for a client scheduled for an open cholecystectomy?

Demonstrate ways to deep breathe and cough. Signup and view all the answers

What should a nurse administer for a client with cholecystitis?

Administer morphine. Signup and view all the answers

What statement explains how omeprazole relieves symptoms of a gastric ulcer?

Suppressing gastric acid production. Signup and view all the answers

What laboratory result is expected in a client with pancreatitis?

Calcium. Signup and view all the answers

What precaution should a nurse implement for a client at risk for seizures?

Ensure the client has IV access. Signup and view all the answers

What instruction should a nurse include in discharge teaching for a client with a partial-thickness burn on the hand?

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

What finding should a nurse prioritize when assessing a client suspected of having a stroke?

Dysphagia. Signup and view all the answers

What medication should a nurse plan to administer for a client experiencing muscle cramps and tingling during hemodialysis?

Calcium carbonate. Signup and view all the answers

What vital sign finding in an ICU client with a traumatic brain injury indicates Cushing's triad?

Bradycardia. Signup and view all the answers

What conditions should a nurse be aware of regarding a client just admitted from the emergency department?

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

What instruction should be included for a female client at risk for urinary tract infections?

Take daily cranberry supplements. Signup and view all the answers

What finding in a client undergoing a CT scan with IV contrast requires further assessment?

History of asthma. Signup and view all the answers

What heart rate finding indicates fluid volume deficit in a client with vomiting and diarrhea?

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

What adverse effect should a nurse monitor for a client taking enalapril?

Orthostatic hypotension. Signup and view all the answers

What adverse effect should a nurse observe after administering magnesium sulfate IV?

Respiratory paralysis. Signup and view all the answers

What syringe size should a nurse use to irrigate and dress a clean, granulating wound?

Use a 30-mL syringe. Signup and view all the answers

Select the four findings that require follow-up by the nurse.

Visual disturbances, Tingling of the lips, Hand grasps, Expressive aphasia. Signup and view all the answers

Identify the abnormal findings that can indicate a problem.

Crackles heard in posterior lungs Signup and view all the answers

What is the nurse's first priority when addressing a client's urgent issue?

Address the client's pain followed by the client's anxiety. Signup and view all the answers

What laboratory value should a nurse expect in a client with cirrhosis?

Elevated bilirubin level. Signup and view all the answers

What method should a nurse teach a young adult client for testicular self-examination?

Roll each testicle between the thumb and fingers. Signup and view all the answers

What client statement indicates understanding of the effects of epoetin alfa?

I will monitor my blood pressure while taking this medication. Signup and view all the answers

Which client is at risk for experiencing a role change?

A client who has multiple sclerosis and is experiencing progressive difficulty ambulating. Signup and view all the answers

What finding indicates chronic glomerulonephritis with oliguria?

Hyperkalemia. Signup and view all the answers

What vital sign finding should a nurse prioritize for a client with acute cholecystitis?

Tachycardia. Signup and view all the answers

What finding can indicate peritonitis in a client?

X-ray results. Signup and view all the answers

What BUN level should a nurse expect in a client with diabetic ketoacidosis (DKA)?

BUN 32 mg/dL. Signup and view all the answers

What is the priority intervention for a nurse caring for a client after cardiac catheterization with a hematoma?

Apply firm pressure to the insertion site. Signup and view all the answers

What supplement can interfere with levothyroxine effectiveness?

Calcium. Signup and view all the answers

For which client should a nurse refer to physical therapy?

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

Which of the following findings requires follow-up?

PCO2 Signup and view all the answers

Study Notes

Nursing Assessment and Care

Assess limb casts for tightness by checking if one finger can fit underneath; normal for molds to loosen with swelling.
Identify client awareness in radiation therapy by their willingness to use hands, not cloths, for cleansing treated skin areas.
Instruct clients with hemianopsia to perform visual scanning during ambulation to minimize fall risks.

Priority Client Assessment

Prioritize the assessment of clients who are experiencing chest pain or have had myocardial infarctions.
Report significant laboratory findings promptly, such as hemoglobin levels at 8 g/dL after hip arthroplasty.

Medication Interactions and Adverse Effects

Be aware of medication interactions, such as feverfew with naproxen.
Recognize symptoms of hypertension drugs like propranolol, particularly night cough.
Monitor for adverse effects of magnesium sulfate, including respiratory paralysis, and follow-up on complications following drug administration.

Patient Education and Discharge Instructions

Teach clients about safe practices, such as inspecting feet daily for diabetic patients and avoiding aged cheese to reduce migraine triggers.
Instruct clients to monitor blood pressure when taking epoetin alfa, and ensure understanding of condition and treatment for hypothyroidism.

Emergency and Postoperative Care

Implement immediate interventions for postoperative clients, including the establishment of IV access in seizure-prone patients.
During emergencies, the priority action could include managing vital signs like tachycardia and changes in mental status in clients with neurological conditions.

Infection Control and Precautions

Follow airborne precautions for clients with respiratory symptoms, especially in cases of suspected infectious processes.
Prevent cross-contamination in immunocompromised clients by prohibiting plants or flowers in their rooms.

Laboratory Monitoring and Evaluation

Evaluate laboratory results for clients with liver dysfunction (elevated bilirubin in cirrhosis) and monitor electrolyte levels in conditions like pancreatitis (low calcium).
Assess for dehydration in clients with fluid loss, such as elevated heart rate or concentrating urine.

Specific Interventions for Compromised Conditions

Manage complications like acute chest syndrome in sickle cell crisis effectively by monitoring oxygen saturation and vital signs.
Anticipate the need for specific interventions concerning managing chronic conditions, such as implementing a physical therapy referral for clients needing mobility assistance.

Cancer Care Considerations

Provide teaching on managing symptoms and side effects from cancer treatments, including the proper methods for self-examination and understanding chemotherapy's effects on the body.
Monitor pain management in clients receiving opioids, considering alternatives, and educating on addiction fears.

Treatment and Symptom Management

Instruct clients undergoing TPN about caloric intake calculations, and manage nutrient solutions accordingly.
Promote appropriate dietary changes and lifestyle modifications to help manage chronic conditions and prevent exacerbations.

Communication and Understanding Client Needs

Encourage effective communication about patient rights and informed consent, especially during clinical trials involving placebo treatment.
Ensure clients understand their health conditions and the importance of following treatment regimens and appointment schedules.### Postoperative Care
Encourage clients to void every 4 hours to reduce the risk of urinary retention.
For clients two weeks postoperative from a gastrectomy, advise avoiding drinking fluids with meals, eating several small meals daily, consuming high-protein snacks, and avoiding highly seasoned foods.

Heart Failure Management

Report significant findings such as a heart rate of 55/min for clients on a follow-up after hospitalization for heart failure.

Managing Incontinence

An indication of understanding for a client with stress incontinence and a BMI of 32 is the statement, "I am dieting to lose weight."

Emergency Response

Administer opioid analgesics for clients who suffer a rattlesnake bite.

Wound Care Protocol

On discovering bowel protrusion during a dressing change post-hemicolectomy, the first action should be to call for help.

Managing Portal Hypertension

If a client with portal hypertension is vomiting blood mixed with food, the first step is to obtain vital signs.

Cancer Risk Reduction

For clients with family histories of colorectal cancer, recommend incorporating cabbage into their diet.

Diabetes Medication Instruction

Clients prescribed metformin should understand to take the medication with a meal.

Postoperative Procedures

In postoperative care, instruct clients to splint the abdomen with a pillow when coughing, plan for early ambulation, report urinary output, and assess pain on a 0 to 10 scale.

Potassium Level Implications

A potassium level of 3 mEq/L can lead to hypoactive bowel sounds.

Inguinal Hernia Assessment

To assess for an inguinal hernia, palpate the inguinal area.

Pressure Injury Healing

A urine output of 25 mL/hr in clients with a stage III pressure injury can contribute to delayed wound healing.

Seizure Management

During a tonic-clonic seizure, the nurse should loosen restrictive clothing.

Chronic Kidney Disease Treatment

Clients on erythropoietin should recognize it aims to increase energy levels.

Ureterostomy Teaching

For clients undergoing a ureterostomy, advise they should keep the skin barrier opening one-eighth inch wider than the stoma.

Psychosocial Care in Dialysis

Stress the possibility of a return to previous activity levels can help mitigate psychosocial health issues in clients starting dialysis.

Hyperthyroidism Concerns

The priority finding for a client with a new diagnosis of hyperthyroidism to report is a blood pressure of 170/80 mm Hg.

Increased Intracranial Pressure Indicators

In closed head injury clients with intraventricular catheters, report signs of increased intracranial pressure (ICP) like sleepiness, widening pulse pressure, and decerebrate posturing.

Enoxaparin Administration

For clients on bed rest receiving enoxaparin, inject into the anterolateral abdominal wall.

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Description

Test your knowledge on nursing assessments with this quiz focused on adult medical-surgical nursing. It includes scenarios such as monitoring casts and recognizing complications. Perfect for preparation for the NGN exam format.