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NUR nursing1 kaplan med surg Quiz 1. Acute renal failure, common causes of renal failure? Hypotension 2. Fracture of the right femur goal of meticulous pin care in to prevent? Osteomyelitis ... 3. Laminectomy with a lumbar fusion, appropriate procedure to assist the client, teaching is effective if? The nursing assistant ask the client if he is lightheaded or dizzy 4. Shortness of breath secondary to cirrhosis. The physician order a paracentesis, teaching is necessary. This procedure will prevent fluids from accumulating in my abdomen. 5. Hypothyroidism further teaching is necessary if? I will keep the thermostat in my home at 66F (19.C) 6. Type 1 open wound to left great toe. (no entiendo) is 13% priority nursing diagnosis? Impaired skin integrity 7. Taking ibuprofen (advil) severe allergy to aspirin, question IV fluid orders? Lactaid ringers (isotonic) 8. Barium swallow, upper GI series, further teaching is needed if? I should expect my initial bowel material to be the usual dark brown color. 9. Cushing syndrome bases this nursing diagnosis? I wish the other patients on the unit would quit talking about me. 10. Ileostomy teaching plan. Take a warm shower or bath if a blockage is suspected 11. Teaching session about nutrition, hypothyroidism encourages? Fruit, vegetables and low sodium beverages. 12. Right knee replacement. The physician orders continuous passive motion device (CPM) client’s plan of care when implementing CPM? Initially set flexion at 50 13. Severe abdominal pain that is not relieved by vomiting, acute pancreatitis, action FIRST Administer morphine. 14. (?) reduction and internal fixation for a compound fracture of the left femur.nurse intervene if The student nurse covers the cast on the left leg with a blanket 15. Full-thickness burn of the right arm for the first dressing change. Determine what order is correct. Morphine 16 mg IV 16. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). serum blood glucose? 800 mg/dl 17. Extracorporeal shockwave lithotripsy, client’s discharge teaching/ Decrease intake of high-oxalate foods 18. Suffering head trauma 3 days ago, past 2 hours the client experience 6000 ml urinary output with a urine specific gravity of 1,002 to 1,1004 physician will order 0.9% NaCl 19. Positive water load test and diagnosis of syndrome of inappropriate antidiuretic hormone (SIAOH) secretion concerned if The client complains of nausea and vomiting 20. Out bowel obstruction nasogastric tube in place, understands the purpose of the tube. I will have to breath through my mouth while the tube is in place, so I should expect frequent mouth care. 21. Diabetic ketoacidosis (DKA) appropriate nursing diagnosis Fear 22. Cystoscopy, describe the procedure? A small tubular lighted scope will inspect the inside of your blader 23. Type 1 diabetes regular and NPH insulin, interested in incorporating a 20 minute brisk walk into daily routine. You should walk immediately before lunch 24. Clean- catch urine sample presence of both red and white blood cells, action FIRST Tell the client to take the antibiotic until the pain subsides 25. Chronic renal failure (CRF) undergoing hemodialysis. “I don’t know if I can take this” response by What do you mean when you say: “ I don’t know I can take this?” 26. Greatest risk to acquire HIV infection. A 28-year-old Hispanic homosexual male 27. Endoscopic cholecystectomy teaching is effective if The puncture wounds in my abdomen should appear red and swollen 28. Rheumatoid arthritis, client teaching plan Do low-impact aerobic exercise 20 min 3 times per week 29. (?) Intestinal obstruction vomiting for 4 days, an inability to tolerate any food or fluid, absent bowel movement for 3 days, abdominal distention and pain priority nursing diagnosis. Fluid volume deficit 30. Rheumatoid arthritis appears withdraw and its non-communicative responses by the nurse. What words best describe your emotions at this time? 31. Ulcerative colitis (????) Lean hamburger, apple sauce and ??? 32. ??? Quality of life Eating a balanced diet of fresh fruit, vegetables and whole grain will help you control the pain 33. Open cholecystectomy with a T-tube in place. The nurse notes the t-tube is below the level of the incision and has drained a total of 400 ml of blood tinged, green fluid on the first postoperative day. Action by the nurse. Notify the physician. 34. Peptic ulcer. Further teaching is necessary if. I can continue to take my daily aspirin 35. Chronic renal failure. Responses by I can help you select the appropriate proteins for CRF 36. Client is at risk for development an umbilical hernia? A 40-year-old female who weights 200 pounds. 37. Burns over 30% of the mid trunk and upper body, actions? Administer lactated ringers to maintain output at 30 ml per hour. 38. Addisonian crisis, question which order? O2 at 10L /min per nasal prongs 39. Addison’s disease, discharge teaching is effective? I must never suddenly stop taking my steroid medication 40. Painful, unilateral rash on the lower back beginning at the midline and extending out to the side, response by the nurse “Have you ever had chickenpox?” 41. Fiancé just told her HIV positive, response by “I hear that you are upset. You will need to come in and have some blood drawn.” 42. Extensive burns to the legs actions FIRST? Soak the burned are with cool water. 43. Sick- day management with type-1 diabetes teaching plan. The client should check blood glucose levels a minimum of 4 times per day when ill. 44. Acute renal failure experiences the oliguria phase lab values. BUN16 mg/dl. 45. Polyuria, polydipsia, polyphagia, and glucosuria type 1diabetes, terms are associated. Hyperglycemia 46. Acute respiratory distress secondary to cirrhosis actions? Elevate head of the bed 47. Hepatitis B lab result Positive HBs 48. Urinary tract infection, drink plenty of fluid, including at least 1 glass of cranberry juice daily, and perform good perineal hygiene after voiding, decrease the probability of Pyelonephritis 49. Type 1 diabetes reports onset of tremors, appears pale and the pulse rate is 112, blood glucose level is 52 mg/dl action by Give the client 4 ounces glass of orange juice. 50. Cholecystitis, meal selection should teaching plan? Lean roast beef, green beans, fruit punch. 51. Right nephrectomy, nurse plan to position? Left lateral recumbent. 52. Deep partial thickness burn of the left leg statement by the nurse “It is a burn that is swollen and very painful and blisters occur.” 53. Hepatitis A complains of “flulike” symptoms and joint pains, what phase of acute hepatitis A? Preicteric 54. Cushion’s syndrome nurse to include? Encourage client to increase protein, calcium, and vitamin D in the diet. 55. Kidney transplant from a cadaver donor, signs and symptoms indicate rejection? Fever, weight gain, and decrease urinary output. 56. Post fracture of the left hip, and the client scores a 13 on the Braden scale lab values? Albumin 3.2g-dl 57. Prepares colonoscopy, client voices concern procedure by? “Tell me what you know about colonoscopy.” 58. Cirrhosis. The client states to the nurse responses? “I hear that you are concern that soberly will be a challenge for you.” 59. A right below the knee amputation nursing diagnosis of risk for impair skin integrity, laborable to the planed nursing intervention? Skin warm and dry well approximated suture line. 60. Peptic ulcer disease, drinks coffee, response by the nurse? “dietary modification can be difficult.” 61. Found pain and arthritis is confirmed no regular exercise routine nursing action? Review with the client strategies to increase exercises. 62. Addison’s disease lab values? Sodium 130mEq/l 63. Exophthalmos secondary to hyperthyroidism upset about how she looks? “Tell me how you feel about your condition.” 64. The nurse cares for a client in the emergency department with diagnosis of AIDS, the client complaints of a persistent cough and shortness of breath. The vitals are: T 101.2 F (38.4 C), BP 134/88, HR 120, RR 28. The nurse plans to explain which of the following diagnosis to the client? Pneumocystis project Pneumonia 65. The clinic nurse receives a call from a client diagnose with type 1 diabetes. The client is 24 years old, is in good diabetic control, and its interested in starting an exercise program. The client asks the nurse recommendation for diet management. Which of the following response by the nurse is BEST “You will need to increase your intake of carbohydrates by 15-30 grams, depending on the level of exercise.” 66. The nurse reviews charts in the outpatient clinic. The nurse determines which of the following clients is at GREATEST risk for developing a peptic ulcer. A 55-year-old client of low socio-economic status who smokes one pack of cigarettes/day. 67. The nurse cares for client in the emergency department. A client present with the following symptoms: T 103.2F (40.C), HR 142, diarrhea, abdominal pain, and confusion. The client’s blood work reveals a WBC of 8300/mm3 and serum thyroxin (T4) of 141 dg/dl. The nurse anticipates a medical diagnosis of which of the following disorders. Thyroid storm. 68. The nurse performs teaching with client diagnosed with Grave’s disease; the nurse determines teaching is effective if the client states which of the following? “I ill wear light cool clothing” 69. The nurse cares for a burn victim in the emergency department. The client suffered burns to 20% of the lower body and is hysterical and screaming out in pain. The screaming suddenly stops and the clients appear pale. Which of the following actions should the nurse takes FIRST. Start an IV using a #16 gauge needle. 70. The nurse prepares a client for esophagogastroduodenoscopy (EDO). The nurse determines that the client understands the procedure if the client states which of the following? “ A flexible tube with a camera it’s passed down the throat to look at the stomach” 71. The clinic nurse care for a client 8 weeks after the placement of an ileostomy secondary to Crohn’s disease. The client had lost 15 pound since surgery. When the nurse asks the client about the weight lost, The client states “if I don’t eat much, then I don’t have much output because I don’t like the way I look with an ostomy.” The nurse determines that which of the following it’s the client primary nursing diagnosis. Body image disturbance 72. A nurse instructs a staff member diagnosed with a latex allergy. The nurse plans to include which of the following teaching points in the clients teaching plans? Vinyl gloves are an acceptable replacement to latex gloves. 73. The nurse cares for a client after an ostomy placement. The client states that she is concer that her husband will not find her sexually disireable. Which of the following responses by the nurse is BEST? “Tell me more about how you are feeling.” 74. A client presents to the emergency department with a sudden onset severe left sided flank pain, nausea, and vomiting, chills, clammy skin, and dysuria. The physician diagnosis urolithiasis. The nurse should question which of the following orders? Folic catheter to gravity drainage. 75. The nurse provides care for a client admitted with shortness of breath and diagnosis with chronic renal failure (CRF), the client is scheduled for a dialysis treatment. The nurse determines that treatment is effective if which of the following serum lab values is noted? Potassium 3.8mEq/l 76. The nurse conducts an in-home assessment of an elderly client and instructs the client about how to prevent falls. Which of the following client statements should the nurse correct? “ I will secure the turned-up corner of my through rug with a nail.” 77. The nurse cares for a client immediately after the placement of a hip prosthesis. The client has a cell- saving device in place. The nurse understands the purpose of a cell-saving device includes which of the following? Returns collected blood to the client as a transfusion. 78. Another recreation employee asks the public health nurse how to best avoid a thick bite, which could lead to lime disease. The nurse knows that the employee understands the teaching when which of the following statement are made? “ I need to wear a long sleeve shirt and long pants when I am outside.” 79. The nurse cares for a client after a left above the knee amputation with a closed ridged cast dressing in place. 2 days after the procedure, the nurse enters the room and notes the cast has come off. Which of the following actions should the nurse takes first? Wrap the residual limb with an elastic compression bandage. 80. The nurse performs discharge teaching for a client recovering from a reaction to peanuts. The nurse determines that teaching is successful when the client makes which of the following statements? “ I will carry an Epi-Pen with me at all times.” 81. The nurse in the operating room is at increased risk for exposure to which type of hepatitis? Hepatitis B 82. The nurse performs preoperative teaching for a client prior to abdominal surgery. The nurse determines that further teaching is necessary if the client states which of the following? “ I will use the incentive spirometer only when instructed to do so.” 83. The nurse procedure cares for a patient diagnosed with Crohn’s disease (regional enteritis) treated with total peripheral nutrition. The nurse evaluates the patient nutritional responses to TPN. The nurse determines that the client is responding favorable to the treatment if which of the following is observed? The nurse notes that the client gains weight. 84. The nurse cares for a client in the outpatient clinic. A client complains of morning stiffness for the past 4 months. The client states the pain and swelling developed in the right wrist 2 months ago and the left wrist has been painful and swelling for the past 6 weeks. The nurse anticipates the physician will order which of the following test? Rheumatoid factor. 85. The nurse performs teaching for an older client diagnosed with osteoarthritis complaining of increased joint pain. The client admits of gaining 75 pounds in the previous 6 months due to stress and a lack of physical activity. The nurse determines that further teaching is necessary if the client states which of the following? “ I am so glad that I don’t have to go on a weight-reduction diet.” 86. The nurse performs port operative teaching for a client after an inguinal hernia repair. Which instruction should the nurse include regarding lifting? Do not lift object heaver than a quart of milk for 4-6 weeks. 87. The cares for a client 48 hours post thyroidectomy. The nurse is MOST concerned if which of the following is observed? The client states there is tingling of the finger and toes. 88. The client diagnosed with chronic renal failure has an AV fistula in place. When assessing the fistula, the nurse palpates pulsation that is synchronous with the client heart rate. Which of the following actions should the nurse takes NEXT? Document the presents of a palpable AV fistula pulsation in the chart. [Show More]

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