MED SURGE NUR 1200 Nursing Concept III Final Exam Latest Exam Guide with Rationale

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MED SURGE NUR 1200 Nursing Concept III Final Exam c. pH 7.32, pO2 80 mmHg, p CO2 60 mmHg, HCO3 24 mEq/L d. Increase the client's fluid intake. MED SURGE NUR 1200 Nursing Concept III Final Exam ... 1- What acid-base imbalance would a nurse expect to find in a patient with Myastenia Gravis crisis and decreased pulmonary forced vital capacity? Select one: a. pH 7.26, pO2 86 mmHg, p CO2 44 mmHg, HCO3 10 mEq/L b. pH 7.31, pO2 97 mmHg, p CO2 30 mmHg, HCO3 19 mEq/L d. pH 7.47, pO2 96 mmHg, p CO2 33 mmHg, HCO3 22 mEq/L Feedback Acute respiratory acidosis The correct answer is: pH 7.32, pO2 80 mmHg, p CO2 60 mmHg, HCO3 24 mEq/L 2- A previously healthy older client's morning urine is amber, with strong odor, and specific gravity 1.040. Which action by the nurse is best? Select one: a. Place the client on restricted dietary proteins. b. Review the client's creatinine level. c. Obtain an order for urine culture and sensitivity. Feedback Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often because of dehydration), and the presence of antidiuretic hormone (ADH). Increasing the client's fluid intake would be a beneficial intervention. The other interventions are not warranted. The correct answer is: Increase the client's fluid intake. 3- The nurse working in an endocrinology service has assigned four clients. Which client should the nurse see first?c. Type 1 diabetic client who has positive ++ ketones in urine a. Enforce standard precautions and updated vaccinations. Select one: a. Type 1diabetic client who is noncompliant with her diet and has proteinuria b. Type 2 diabetic client who presents with a hemoglobin A1c 12.8 % d. Type 2 diabetic client whose capillary glucose immediately after lunch is 65 mg/dL Feedback Presence of ketone bodies in urine in type 1 diabetes means the client is developing a diabetic ketoacidosis and is the absolute priority of these four clients. The correct answer is: Type 1 diabetic client who has positive ++ ketones in urine 4- Which of the following measures is most important for the nurse to institute for a client who has Cushing's disease? Select one: b. Assist the client to stand up changing positions slowly. c. Pad the siderails of the client's bed with pillows. d. Keep suctioning equipment at the client's bedside. Feedback Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to immune suppression, hyperglycemia, hypertension, fluid retention, and excessive bone demineralization and increases the risk for pathologic bone fracture. The client should not require suctioning, padding the siderails or assisting the client to change position because orthostatic hypotension. Risk for infection and its prevention is a priority. The correct answer is: Enforce standard precautions and updated vaccinations. 5- A male client with Parkinson's disease is newly diagnosed with benign prostatic hypertrophy. When reviewing the client's medication history, which medication is most likely to exacerbate his urologic symptoms? Select one: a. Bromocriptine, a dopamine receptor agonist.a. Increased urination at night b. Encourage 3000 to 4000 mL of oral fluids daily. c. Levodopa, an antiparkinsonian agent. d. Selegiline, a mono amino oxidase B inhibitor. Feedback ANS: A Cogentin (A) is an anticholinergic drug. One of its side effects is urinary retention which could be problematic for a client with benign prostatic hypertrophy. (B, C, and D) are all appropriate drugs for the treatment of Parkinson's disease. The correct answer is: Benztropine, an anticholinergic. 6- A client with a 16-year history of hypertension is having renal function tests because of recent fatigue, weakness, lightly elevated blood urea nitrogen and serum creatinine levels. Which finding should the nurse conclude as an early symptom of renal insufficiency? Select one: b. Uremic frost c. Confusion and disorientation d. Edema and lung crackles Feedback The capacity of concentration of urine is one of the first renal functions to be lost in the development of renal insufficiency. Normally the urine is concentrated during the sleep hours, being nocturia an early manifestation of the loss of this function. The correct answer is: Increased urination at night 7- A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dL and a phosphorus of 1.7 mg/dL. Which nursing action should be included in the plan of care? Select one: a. Monitor for positive Chvostek's sign. c. Have a tracheostomy kit available. d. Encourage the patient to remain on bed rest. b. Benztropine, an anticholinergic.b. Dizziness when rising from a sitting position. a. head of bed elevated 30 degrees; head and neck in midline position Feedback The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone. The correct answer is: Encourage 3000 to 4000 mL of oral fluids daily. 8- Which assessment finding has the highest priority when assessing and planning nursing care for a client recently admitted with a peptic ulcer disease (PUD) with risk of bleeding? Select one: a. Very dark color stools. c. Hemoglobin 10 g/dL, hematocrit 29%. d. Epigastric pain two hours after eating. Feedback Active bleeding and hypovolemia are priorities in patients with PUD. The presence of dizziness with changes of position suggests orthostatic hypotension and hypovolemia secondary to actual bleeding. Dark tarry stools mean the presence of digested blood in the stools, but not necessarily implies present active bleeding or hypovolemia. The correct answer is: Dizziness when rising from a sitting position. 9- The nurse is caring for a patient who has returned from the operating room having undergone a supratentorial craniotomy. The nurse, knowing that brain surgery produces brain swelling, should position the patient in which of the following positions? Select one: b. supine with bed flat; head and neck in neutral midline position c. head of bed elevated 45 degrees; legs elevated to prevent DVT d. head of bed elevated 30 degrees; head turned toward non-operative sideb. Prolonged prothrombin time and INR d. Hyperammonemia e. Hypoglycemia f. Hyperbilirubinemia a. Corn flakes Feedback Head of bed elevated with neck in neutral position to facilitate venous drainage The correct answer is: head of bed elevated 30 degrees; head and neck in midline position 10- A client is diagnosed with liver cirrhosis. Which laboratory alterations does the nurse expect to find? Select all that apply Select one or more: a. Elevated blood urea nitrogen and creatinine c. Hyperalbuminemia Feedback Liver detoxificates ammonia and bilirubin, store glucose as glycogen, and synthetize prothrombin and albumin. Hyperammonemia, hypoalbuminemia, hyperbilirubinemia, hypoglycemia and prolonged coagulation times are expected findings in cirrhosis The correct answers are: Hyperammonemia, Hyperbilirubinemia, Prolonged prothrombin time and INR, Hypoglycemia 11- A nurse provides dietary instructions to the mother of a child with celiac disease. Which of the following foods does the nurse tell the mother to include in the child's breakfast? Select one: b. Oatmeal biscuits c. Rye crackers d. Wheat cereald. Twelve bloody liquid stools a day. d. Ensure that all enrolled children have been immunized for hepatitis A Feedback Dietary management is the mainstay of treatment in celiac disease. All wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn and rice. Vitamin supplements, especially fat-soluble vitamins and folate may be needed in the early period of treatment to correct deficiencies. Dietary restrictions are likely to be lifelong, although small amounts of grains may be tolerated after the ulcerations have healed. The correct answer is: Corn flakes 12- The client is diagnosed with ulcerative colitis. When assessing this client, which sign/symptom would the nurse expect to find? Select one: a. Hard, rigid abdomen. b. Oral temperature of 102 F. c. Urinary stress incontinence. Feedback The colon is ulcerated and unable to absorb water, resulting in bloody diarrhea. Ten (10) to twenty bloody diarrhea stools is the most common symptom of ulcerative colitis. The correct answer is: Twelve bloody liquid stools a day. 13- Which is the most important intervention should the school nurse implement to decrease the incidence of hepatitis A in a preschool setting? Select one: a. Teach children the correct handwashing technique to use after toileting b. Promote hygiene by ensuring that children's faces and hair are kept clean. c. Put a strip bandage on bleeding injuries to prevent contamination of othersd. Determine the capillary blood glucose level. c. Grapes and peaches Feedback The CDC recommended immunization schedule for children includes the hepatitis A vaccine (HAV), so follow-up of enrolled children's immunization status with HAV or human-immune gamma globulin should be implemented (B). Preschoolers should be taught the importance of hygiene practices, such as (A and D), but hepatitis A is transmitted via the fecal-oral route and immunization provides the best universal protection. Hepatitis A is not transmitted through blood contact (C). The correct answer is: Ensure that all enrolled children have been immunized for hepatitis A 14- The 56-year-old male client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the unlicensed nursing assistant tells the nurse the client has a headache, the skin is wet and cold, and is acting "funny." Which action should the nurse implement first? Select one: a. Practice a dipstick for ketones in urine. b. Administer a glass of orange juice and reevaluate in 15 minutes. c. Prepare to administer one amp 50% Dextrose intravenously. Feedback Regular insulin peaks in 2-4 hours. Therefore, the nurse should think about the possibility that the client is having a hypoglycemic reaction and should assess the client. The nurse should not delegate nursing tasks to an assistant if the client is unstable. The correct answer is: Determine the capillary blood glucose level. 15- A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet? Select one: a. Baked potatoes without salt b. Vegetable soup d. Organic sliced turkey cold cutd. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 99 mm Hg c. No symptoms exist Feedback Some fruits like apples and pears have low potassium content. Potatoes are high in potassium. Soups are high in sodium. Many salt substitutes contain potassium chloride and should not be used. The correct answer is: Grapes and peaches 16- A nurse assesses a client who has type 1 diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? Select one: a. pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 88 mm Hg b. pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 97 mm Hg c. pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 78 mm Hg Feedback When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels. The correct answer is: pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 99 mm Hg 17- Which of the following symptoms indicated diverticulosis? Select one: a. Anorexia with low-grade fever b. New onset change in bowel habits d. Episodic, dull, or steady midabdominal pain Feedback Uncomplicated diverticulosis is asymptomatic. The correct answer is: No symptoms exista. A 58-year-old indigenous Guatemalan female who is 5' 2" and weighs 190 lbs. a. "Pumps don't monitor blood glucose levels. You will still need to do that yourself." 18- A public health nurse teaching a class on diabetes plans to discuss risk factors for developing Type 2 diabetes. Which of the following individual has the greatest risk for developing Type 2 diabetes? Select one: b. A 24-year-old Caucasian male whose father is a Type 2 diabetic. c. A 32-year-old African American who has a history of hypertension. d. A 30-year-old Italian male whom caloric intake includes 60% from carbohydrates. Feedback Type 2 diabetes is prevalent in the Native Americans and Hispanic population with overweight. Having a history of Type 2 diabetes is a risk factor but age 24 or 32 are not the usual age to observe type 2 DM. 60% of daily calories should come from carbohydrates. The correct answer is: A 58-year-old indigenous Guatemalan female who is 5' 2" and weighs 190 lbs. 19- A client frustrated with self-monitoring his blood glucose level tells the nurse he wants an insulin pump to avoid the finger stick testing. Which would be the nurse's most helpful response? Select one: b. "The pump must be calibrated several times a day, but you will not need to monitor your blood glucose levels anymore." c. "Pumps are still experimental, and there are many problems associated with them." d. "If you are willing to make a commitment to good aseptic technique, you should like the pump." Feedback Insulin pumps often improve blood glucose control by means of continuous subcutaneous insulin infusion. However, pumps do not have a built-in feedback mechanism for monitoring blood glucose levels.b. Calcium gluconate c. Oxygen e. Suction f. Emergency tracheotomy kit b. Is at higher risk for development of diabetic vascular complications The correct answer is: "Pumps don't monitor blood glucose levels. You will still need to do that yourself." 20- The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? Select all that apply. Select one or more: a. Furosemide (Lasix) d. Hypertonic saline Feedback Calcium gluconate should be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage, or edema should occlude the airway. Respiratory distress can result from swelling or damage to the laryngeal nerve leading to spasm, so it is important that the nurse work with respiratory therapy to have oxygen ready at the bedside for the client on admission. Because of the potential for increased secretions, it is important that a working suction device is present at the bedside for admission of the client from the operating room. Furosemide might be useful in the postoperative client to assist with urine output; however, this is not of added importance for this client. Hypertonic saline would not be of benefit to this client as the client is not hyponatremic. The correct answers are: Calcium gluconate, Emergency tracheotomy kit, Oxygen, Suction 21- A woman with type 2 diabetes has a hemoglobin A1c level of 11. The nurse can conclude that the patient: Select one: a. Is noncompliant with the insulin c. Is at risk for development of diabetic ketoacidosis d. Is noncompliant with her dietc. "A mirror will be very helpful so I can look at all parts of my feet each day." c. "My hands seem to shake all the time." Feedback Three months glucose elevated The correct answer is: Is at higher risk for development of diabetic vascular complications 22- A client with diabetes has properly learned the principles of foot care. What would the client most likely say about foot care? Select one: a. "The best method of testing bath temperature is with the toes." b. "I prefer to use canvas shoes rather than leather because are more ventilated." d. "I should limit walking barefoot to my room and the bathroom only." Feedback The feet should be inspected daily for any trauma (a mirror may be needed). The diabetic client should wear properly fitting, nonrestrictive leather shoes; avoid walking barefoot; and test water temperature with the elbow or thermometer before bathing. The correct answer is: "A mirror will be very helpful so I can look at all parts of my feet each day." 23- A client diagnosed with hypothyroidism has been taking the thyroid hormone levothyroxine for three months. Which client statement could indicate the client is receiving too much dose of the medication? Select one: a. "I have a bowel movement every day." b. "I have a lot of energy and am less tired than before." d. "I have lost four pounds since I started this medication." Feedback Fine hand tremors are a symptom of hyperthyroidism, which indicates that the prescribed dose of levothyroxine (Synthroid) (C) is too high. The nurse should notify the healthcare provider so that the dosage can be adjusted. The client reported a regular bowel pattern (A) which does not indicate a need for intervention. Weight gain occurs with hypothyroidism, so aa. Activities that increase abdominal pressure b. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is ten-pound weight-loss over a three-month period would be expected as the client achieves an euthyroid state (B). (D) is an expected outcome. The correct answer is: "My hands seem to shake all the time." 24- When developing a plan of care for the client with stress incontinence, the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with: Select one: b. A strong urge to urinate c. Obstruction of the urethra d. Over distention of the bladder Feedback Stress incontinence happens when intra-abdominal pressure increases, and the pelvic muscles are weak The correct answer is: Activities that increase abdominal pressure 25- The nurse is caring for clients on a medical floor. Which client should be assessed first? Select one: a. The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night to urinate. having new onset of muscle twitching and lethargy. c. The client diagnosed with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 2500 mL and an output of 2600 mL in the last 8 hours. d. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday. Feedback Muscle twitching and confusion are signs of early sodium imbalance. If an immediate intervention is not made, the client could begin to seize.d. Infuse 0.9% NaCl solution intravenously. a. 4 PM The correct answer is: The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having new onset of muscle twitching and lethargy. 26- An elderly client was just admitted to the intensive care department diagnosed with severe hyperosmolar hyperglycemic non-ketonic (HHNK) diabetic coma. Which doctor's order should the nurse give priority? Select one: a. Infuse sodium bicarbonate solution intravenously. b. Administer rapid-acting insulin until blood glucose is 250 mg/dL. c. Perform blood glucometer checks hourly. Feedback The most important initial intervention is fluid replacement with 0.9% normal saline (an isotonic solution) intravenously. The rate depends on the client's fluid volume status and physical health, especially that of the heart. The correct answer is: Infuse 0.9% NaCl solution intravenously. 27- The nurse administers 6 units of regular insulin and 10 units NPH insulin at 7 AM. At what time does the nurse assess the client for possibility of hypoglycemia related to the NPH insulin received? Select one: b. 8 AM c. 8 PM d. 11 PM Feedback NPH is an intermediate-acting insulin with an onset of 1.5 hours, peak of 6 to 10 hours, and duration of action of 20 hours. Checking the client at 8:00 AM would be too soon; 8:00 PM and 11:00 PM would be too late. The correct answer is: 4 PMa. Client with post-streptococcus glomerulonephritis b. Urine output has decreased; specific gravity has increased. 28- Which client is most at risk for developing intra-renal acute kidney failure? Select one: b. Client with dissecting abdominal aortic aneurysm c. Client with congestive left heart failure d. Client diagnosed with bilateral renal calculi Feedback Causes of postrenal kidney failure include disorders that obstruct the flow of urine, such as renal calculi. Heart failure can lead to prerenal failure, which is due to decreased blood flow to the kidneys. NSAIDs and glomerulonephritis can damage the kidney, leading to intrarenal failure. The correct answer is: Client with post-streptococcus glomerulonephritis 29- A client has received vasopressin for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy? Select one: a. Urine output has increased; specific gravity has increased. c. Urine output has increased; specific gravity has decreased. d. Urine output has decreased; specific gravity has decreased. Feedback Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity. The correct answer is: Urine output has decreased; specific gravity has increased.c. IV propranolol d. Type 1 diabetic client who has positive ++ ketones in urine a. Respiratory pattern and O2 saturation. 30- A patient with Graves' disease is admitted to the emergency department with thyroid storm. Which of these prescribed medications should the nurse administer first? Select one: a. IV levothyroxine b. IV propylthiouracil (PTU) d. Oral triiodothyronine Feedback β-adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function. The correct answer is: IV propranolol 31- The nurse working in an endocrinology service has assigned four clients. Which client should the nurse see first? Select one: a. Type 1diabetic client who is noncompliant with her diet b. Type 2 diabetic client who presents with a hemoglobin A1c 12.8 % c. Type 2 diabetic client whose capillary glucose before of lunch was 65 mg/dL Feedback Presence of ketone bodies in urine in type 1 diabetes means the client is developing a diabetic ketoacidosis and is the absolute priority of these four clients. The correct answer is: Type 1 diabetic client who has positive ++ ketones in urine 32- A polytrauma client with a cervical spinal cord injury is brought to the emergency center. What should be the nurse's priority assessment? Select one:c. Risk for injury related to denial of deficits and impulsiveness. c. Ulcerative colitis b. Heart rate and blood pressure. c. Glasgow comma scale and pupil reactions. d. Ability to move extremities and sensitivity level. Feedback ABC. Respiratory pattern has priority in cervical spinal cord injury. The correct answer is: Respiratory pattern and O2 saturation. 33- The nurse is planning care for a client who has a right hemispheric (non-dominant) stroke and left homonymous hemianopsia. Which nursing diagnosis should the nurse include in the plan of care? Select one: a. Risk for injury related to right-sided hemiplegia. b. Ineffective coping related to depression and distress about disability. d. Impaired verbal communication related to aphasia, agraphia and/or alexia Feedback If the client presents with a lesion in the right hemisphere of the brain, the most probable it will be the non-dominant hemisphere. Lesions of the non-dominant hemisphere generate a neglect syndrome which could be associated to absence of vision in the left visual fields of both eyes (left homonymous hemianopsia). The denial of neurologic and visual deficits goes associated with impulsive behavior and predisposition for injuries. The hemiplegia should be left-sided, and the communications capacities would not directly affected. The correct answer is: Risk for injury related to denial of deficits and impulsiveness. 34- Colorectal cancer is most closely associated with which of the following conditions? Select one: a. Hemorrhoids b. Diverticulosisc. Potassium 3.4 mEq/L d. Smoked fish intake Feedback Ulcerative colitis and Chron's disease The correct answer is: Ulcerative colitis 35- A nurse is studying the results of periodic serum laboratory studies in a client with diabetic ketoacidosis (DKA) who is receiving an intravenous insulin infusion and hydration with normal saline. Which finding should prompt the nurse to contact immediately the physician? Select one: a. Blood glucose 350 mg/dL b. Serum pH 7.25 d. Sodium 131 mEq/L Feedback The client with DKA initially becomes hyperkalemic as potassium leaves the cells in response to a lowered pH. Once fluid replacement and insulin therapy are started, the potassium level drops quickly because potassium is carried into the cells along with glucose and insulin and because potassium is excreted in the urine once rehydration has occurred. Therefore, the nurse must carefully monitor the client's serum potassium results and report hypokalemia immediately. A blood glucose reading of 290 mg/dL is high and is the reason that the client is receiving the insulin infusion. Normally the blood glucose level is higher than 300 mg/dL in DKA, so a value of. A serum pH of 7.30 is low, reflecting the metabolic acidosis that accompanies DKA. A sodium value of 133 mEq/L is not in a critical range; serum sodium values in DKA fluctuate and may be low, normal, or high. The correct answer is: Potassium 3.4 mEq/L 36- In caring for a client with a fracture of the femur, the nurse should be alert for compartment syndrome. What symptom is characteristic of this complication? Select one: a. Tachycardia and petechiae over the chest wall and buccal membranes. b. Acute anxiety, diaphoresis, and elevated blood pressure.d. hydrocele. d. Positive Homan's sign with calf tenderness and warmth. Feedback Ischemic necrosis of distal tissues produces the severe pain characteristic of compartment syndrome The correct answer is: Deep, throbbing, unrelenting pain which is not controlled with opioids. 37- When conducting an initial assessment on a 10-year-old male patient, the nurse assesses a mass in the left testicle that on transillumination glows red. The nurse notes the presence of: Select one: a. orchitis. b. hematocele. c. varicocele. Feedback A hydrocele will glow red on transillumination, but a hematocele will not. Phimosis is a foreskin that will not retract over the glans and varicocele are dilated veins in the spermatic cord. The correct answer is: hydrocele. 38- Which is a major side effect of radioactive iodine treatment for hyperthyroidism? Select one: c. Deep, throbbing, unrelenting pain which is not controlled with opioids.d. Hypothyroidism d. Draw up and inject the insulin glargine first, then draw up and inject the regular insulin a. Hyperparathyroidism b. Hypocalcemia c. Airway obstruction Feedback Hypothyroidism The correct answer is: Hypothyroidism 39- A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: • Insulin glargine: 12 units daily at 1800 • Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the client's medication administration record, which action should the nurse take? Select one: a. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe and inject the two insulins together. b. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe and inject the two insulins together. c. Draw up and inject a pharmacy pre-mixed form insulin glargine with regular insulin. separately. Feedback Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and inject first the glargine and then the regular insulin right afterward. The correct answer is: Draw up and inject the insulin glargine first, then draw up and inject the regular insulin separately.a. Pulse pressure changes from 50 to 90 mmHg. d. Systolic blood pressure changes from 120 to 160 mmHg. e. Heart rate changes from 92 to 60 bpm. d. increases the amount of dopamine, needed for muscles to function correctly. 40- A male client has a traumatic brain injury and is admitted with a Glasgow comma scale of 12. After thirty minutes the nurse reevaluates the client and determines he has a Glasgow scale of 7. Which changes from the initial findings make the nurse suspect the client has increased intracranial pressure and is developing a Cushing's triad? Select all that apply Select one or more: b. Urinary output changes from 50 to 35 mL/h. c. Diastolic blood pressure changes from 70 to 100 mmHg. f. Respiratory rate changes from 18 to 20 rpm. Feedback These manifestations of Cushing's triad, a potentially life-threatening increase in intracranial pressure (ICP), are increasing systolic blood pressure whithout parallel increment of diastolyc, increased pulse pressure and tendency to bradycardia. It is an emergency. Immediate medical attention is necessary, so the nurse notifies the provider or the Rapid Response Team. The correct answers are: Systolic blood pressure changes from 120 to 160 mmHg., Heart rate changes from 92 to 60 bpm., Pulse pressure changes from 50 to 90 mmHg. 41- In teaching a client with Parkinson's disease, the nurse describes what rationale for the prescription of levodopa-carbidopa? This drug Select one: a. acts as an antiseizure medication, reducing the tremors caused by the disease. b. reduces the inflammatory process, improving nerve transmission and function. c. slows the scarring in the myelin sheath, improving muscle tone and strength. Feedback The symptoms of Parkinson's disease are caused by insufficient dopamine to maintain normal muscle function (B). Hand tremors, while typical of the disease, are not the result of (A or D). (C) describes the pathology of multiple sclerosisb. Terminal ileum d. Who had a total knee replacement 24 hours ago, is restless and has a petechial rash on the chest. Feedback The correct answer is: increases the amount of dopamine, needed for muscles to function correctly. 42- Which area of the alimentary canal is the most common location for Crohn's disease? Select one: a. Ascending colon c. Descending colon d. Sigmoid colon Feedback Terminal ileum The correct answer is: Terminal ileum 43- The nurse has become aware of the following client situations in several hospitalized clients. The nurse should first assess the client: Select one: a. With bacterial pneumonia who has bronchial breath sounds auscultated between the scapulae and a temperature of 101.6 oF. b. With hepatic cirrhosis who has an elevated aspartate aminotransferase (AST) level and respirations of 23. c. Who had a total abdominal hysterectomy 1 day ago and is unable to void 6 hours after the indwelling catheter was removed. The client with the petechial rash is presenting and unexpected complication of orthopedic surgery: fat embolism, condition requiring immediate attention because high mortality. The other clients present expected finding in their respective conditions. The correct answer is: Who had a total knee replacement 24 hours ago, is restless and has a petechial rash on the chest.a. The stoma is dark red to purple c. Reducing heart rate 44- The nurse evaluates the client's stoma during the initial post-op period of a colostomy. Which of the following observations should be reported immediately to the physician? Select one: b. The stoma does not expel stool c. The stoma is slightly edematous d. The stoma oozes a small amount of blood Feedback Dark red to purple The correct answer is: The stoma is dark red to purple 45- When a patient is hospitalized with acute adrenal insufficiency and adrenal shock, which assessment finding by the nurse indicates that the prescribed replacement therapies are effective? Select one: a. Decreasing blood glucose levels b. Decreasing serum sodium levels d. Increasing serum potassium levels Feedback Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium, chloride, water and blood pressure indicates improvement. When blood pressure improves, heart rate is expected to decrease. Potassium should decrease and blood glucose should increase as signs of improvement. The correct answer is: Reducing heart rate 46- The healthcare provider prescribes Mylanta (aluminum and magnesium hydroxide), 2 tablets PO PRN, to chew and swallow, for a client with chronic renal failure who is complaining of heartburn after taking his blood pressure (BP) tablet. Knowing the pharmacology of this drugs and the pathophysiology of chronic renal failure, what important intervention should thea. Withhold the antacid and clarify the order with the healthcare provider. a. Provider prescription for reduction of intake of saturated fats b. Decreased plasma albumin c. Edema on face and eyelids mainly in the mornings d. Proteinuria f. Recent history of impetigo or scarlet fever streptococcal infections nurse implement? Select one: b. Administer 30 minutes before eating but at least one hour apart of BP drug. c. Keep the client upright for at least 30 minutes after each dose. d. Instruct the client to drink at least 2 ounces of water which each dose. Feedback Decreased urine output or renal failure are predisposing factors for decreased renal excretion of magnesium and development of hypermagnesemia. Drugs containing magnesium like antacids and laxatives are avoided in patients with renal failure. The nurse should clarify the prescription with the provider. The correct answer is: Withhold the antacid and clarify the order with the healthcare provider. 47- A client has a minimal change nephrotic syndrome and a normal glomerular filtration. Which findings does the nurse expect to observe in association with this condition? Select all that apply Select one or more: e. Macroscopic hematuria Feedback In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near-normal, increased protein loss should be matched by increased intake of protein. The correct answers are: Edema on face and eyelids mainly in the mornings, Decreased plasma albumin, Provider prescription for reduction of intake of saturated fats, Recent history of impetigo or scarlet fever streptococcal infections, Proteinuriac. Sodium d. Alendronate, to a client diagnosed with osteoporosis. 48- Which electrolyte is closely monitored in patients with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and water intoxication? Select one: a. Magnesium b. Potassium d. Calcium Feedback Hyponatremia and brain edema are the main complications of SIADH The correct answer is: Sodium 49- The nurse is preparing to administer early morning medications to clients on a medical unit, one hour before breakfasts are coming. Which medication should the nurse administer first? Select one: a. Lispro insulin, to a client with diabetes mellitus. b. Indomethacin to a client with acute crisis of gout. c. Enoxaparin SQ to a client after abdominal surgery. Feedback Alendronate must be given with empty stomach, at least half an hour before breakfast. For this reason, should be the first to be given. The correct answer is: Alendronate, to a client diagnosed with osteoporosis. 50- A male client tells the nurse that he has experienced gastro esophageal acid reflux (GERD) for several years. The nurse recognizes that this client has an increased risk for what problem? Select one: a. Metabolic alkalosis and hyperkalemia.c. Barret's esophagus. a. Obtain a sieve to strain urine. c. Lower the client to a safe position and stay with him. b. Esophageal varices and bleeding. d. Duodenal cancer. Feedback Chronic gastro esophageal acid reflux produces dysplasia of the local mucosa (Barret's esophagus) and eventually esophageal cancer. The other referred conditions are not related to acid reflux disease. The correct answer is: Barret's esophagus. 51- The nurse is admitting a patient with recurrent kidney stones and pain. The nurse knows that in this case it is important to determine the chemical composition of the urolithiasis, to plan diet and prophylactic treatment. For this specific purpose, what nursing action is the most appropriated? Select one: b. Request a glass container to collect 24-hour urine. c. Obtain an order for blood level of oxalates. d. Prepare the client for cystoscopy. Feedback When a patient is suspected of having urolithiasis (a urinary stone), the urine is strained through a fine sieve. The correct answer is: obtain a sieve to strain urine. 52- A male client with a history of generalized tonic-clonic seizures tells the nurse that he feels like he is about to have a seizure. What should the nurse do first? Select one: a. Perform a neurological assessment. b. Give a STAT dose of phenytoin IV. d. Keep open airway extending the client's neck.b. Decrease the intermediate-acting insulin (NPH) dose with dinner (PM). a. "I will place blocks under my bed keeping the head of it elevated." Feedback The nurse should remain with the client to protect his safety in case the seizure occurs. The nurse should also obtain additional assistance from other staff (C). Anticonvulsant medications are administered based on therapeutic levels and are not administered PRN (A). (B and D) are not a priority because safety takes priority over assessment. The correct answer is: Lower the client to a safe position and stay with him. 53- A male client with Type 1 diabetes takes an AM (breakfast) and a PM (dinner) doses of intermediate-acting (NPH) insulin. The client's AM blood glucose average for the past week has been above 250 mg/dl. The nurse tested the client's glucose at 3 am resulting in 60 mg/dl, and concluded that the client was experiencing Somogyi phenomenon. Which dose change is most likely to relieve this alteration? Select one: a. Increase the intermediate-acting insulin (NPH) dose with breakfast (AM). c. Increase the intermediate-acting insulin (NPH) dose with evening meal. d. Delay the morning doses of intermediate-acting insulin (NPH) until after breakfast. Feedback The client presents morning rebound hyperglycemia as consequence of nocturnal hypoglycemia. A reduction of the evening dose of NPH should eliminate the cause of this rebound. The correct answer is: Decrease the intermediate-acting insulin (NPH) dose with dinner (PM). 54- What statement, made by a client diagnosed with gastroesophageal reflux disease (GERD), indicates successful learning about management of the symptoms of GERD? Select one: b. "I will rest on bed after meals to accelerate gastric emptying." c. "I will increase alkaline fluids like milk with my meals." d. "I need to limit my carbonated beverages to two colas a day."b. Decorticate posturing Feedback The head of the bed should be elevated on 6-inch blocks (D) because the client should avoid situations that decrease lower esophageal sphincter pressure, such as lying flat. (A) is not necessary. (B) should be eliminated, not limited, because they cause esophageal irritation, thereby exacerbating GERD. GERD is not the result of weakened muscles, and abdominal pressure should be avoided (C). The correct answer is: "I will place blocks under my bed keeping the head of it elevated." 55- A nurse assesses a client and notes the client's position as indicated in the illustration below: How should the nurse document this finding? Select one: a. Atypical hyperreflexia c. Spinal cord degeneration d. Decerebrate posturingc. Standard Precautions. a. Aging b. Sedentarism c. Estrogen insufficiency d. Smoking Feedback The client is demonstrating decorticate posturing, which is seen with interruption in the corticospinal pathway. This finding is abnormal and is a sign that the client's condition has deteriorated. The physician, the charge nurse, and other health care team members should be notified immediately of this change in status. Decerebrate posturing consists of external rotation and extension of the extremities. Hyperreflexes present as increased reflex responses. Spinal cord degeneration presents frequently with pain and discomfort. The correct answer is: Decorticate posturing 56- While administering oral antiviral drugs for a patient with hepatitis B and jaundice, the nurse would follow: Select one: a. Droplets Precautions. b. Strict isolation. d. Contact Precautions. Feedback Standard Precautions are needed to care for a patient with hepatitis B. Isolation and Contact or Droplets Precautions are not indicated for this diagnosis. The correct answer is: Standard Precautions. 57- The nurse is delivering a conference about osteoporosis and risk for fractures at a senior community group. Which risk factors for osteoporosis should the nurse highlight? Select all that apply. Select one or more: e. African American raceb. 3, 1, 2, 8, 7, 4, 6, 5 f. Obesity Feedback The correct answers are: Estrogen insufficiency, Smoking, Sedentarism, Aging 58- A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications. 1. Inspect bottles for expiration dates. 2. Gently roll the bottle of NPH between the hands. 3. Wash your hands. 4. Inject air into the regular insulin. 5. Withdraw the NPH insulin. 6. Withdraw the regular insulin. 7. Inject air into the NPH bottle. 8. Clean rubber stoppers with an alcohol swab. Select one: a. 3, 1, 8, 2, 4, 6, 7, 5 c. 1, 3, 8, 2, 4, 6, 7, 5 d. 2, 3, 1, 8, 7, 5, 4, 6 Feedback After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first. The correct answer is: 3, 1, 2, 8, 7, 4, 6, 5 59- Which essential information should the nurse give to a client with chronic kidney disease (CKD)? Select one: a. Restrict calcium-rich foods. b. Increase daily liquids intake.c. Creatinine clearance. c. Low refined carbohydrate, low sodium d. Increase consume of chicken and turkey, instead of red meat. Feedback A client with chronic kidney disease (CKD) should restrict sodium and potassium dietary intake, and salt substitutes usually contain potassium, so avoiding salt substitutes should be taught. The correct answer is: Avoid salt substitutes. 60- A 46-year-old female client is admitted for acute renal failure secondary to diabetes and hypertension. The nurse evaluates the laboratory results and finds an elevated creatinine and blood urea nitrogen (BUN) and decreased specific gravity and clearance of creatinine. Which of these tests is the most precise and best indicator of the glomerular filtration rate? Select one: a. Serum creatinine. b. Specific gravity. d. Blood Urea Nitrogen (BUN). Feedback Creatinine clearance is the test that better correlates with glomerular filtration rate. BUN and urine specific gravity are modified by the patient's hydration status, independently of renal damage. The correct answer is: Creatinine clearance. 61- Which dietary alterations does the nurse make for a client with Cushing's disease? Select one: a. Low refined carbohydrate, low potassium b. High refined carbohydrate, low potassium d. Low protein, high sodium c. Avoid salt substitutes.c. "I will schedule meals and snacks at a time when the insulin has its peak effect." c. Increase the client's oral fluids. Feedback The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. The correct answer is: Low refined carbohydrate, low sodium 62- The nurse is teaching a client with diabetes about the relationship between different types of insulin administration and diet, and the discipline of regular meals. Which client statement indicates an understanding of the instructions? Select one: a. "The insulin will lower my blood sugar, so I can eat whenever after injecting insulin." b. "I need to check my blood sugar level only before deciding when to eat." d. "I will need to eat a meal or snack shortly after any type of insulin injection." Feedback The goal of insulin and dietary management of diabetes is to eat meals and snacks on a regular schedule to maintain a consistent blood glucose level within the normal range (A). (B) should not be needed on a routine basis if a schedule of insulin and meals/snacks is maintained. (C) may cause hyperglycemia. (D) may cause hypoglycemia. The correct answer is: "I will schedule meals and snacks at a time when the insulin has its peak effect." 63- The nurse is reviewing a client's laboratory test results and notes a blood urea nitrogen (BUN) of 41 mg/dL and a creatinine of 1.2 mg/dL. After communicating the results to the provider, what new order does the nurse anticipate? Select one: a. Prepare the client for dialysis. b. Place the client on a fluid restriction.d. Metformin a. Elevate the head with two pillows at night. d. Restrict dietary protein. Feedback Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than is BUN because BUN can be affected by several factors (dehydration, high-protein diet, and others). This client's creatinine is normal, which suggests a non-renal cause of the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids. The correct answer is: Increase the client's oral fluids. 64- A nurse reviews the medication list of a client going for a computed tomography (CT) scan with IV iodine contrast to rule out a liver cyst. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? Select one: a. Pioglitazone b. Glimepiride c. Glipizide Feedback Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure and lactic acidosis. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast. The correct answer is: Metformin 65- To increase the comfort of a client with exophthalmos, which intervention would the nurse recommend? Select one: b. Restrict fluids and administer pilocarpine eye drops. c. Provide relief with warm compresses.a. First degree family history of breast cancer b. Previous personal history of breast cancer c. Late menopause e. Hormonal replacement therapy f. Early menarche c. Albumin in the urine during a random urinalysis d. Rest the client in prone position with only one pillow. Feedback General nursing interventions also help to reduce eye discomfort and prevent corneal ulceration and infection in the client with exophthalmos. The client should elevate the head of the bed at night and should restrict salt intake to relieve edema. The correct answer is: elevate the head with two pillows at night. 66- The nurse is teaching a group of clients in the woman clinic about risk factors and screening for breast cancer. Which of the following should be included as risk factors for this type of cancer during the conference? Select all that apply Select one or more: d. Pregnancy at early age Feedback Family and personal history of breast cancer, early menarche, late menopause, HRT and nulliparity or first pregnancy after 30 are risk factors for breast concern requiring intensification of the screening. The correct answers are: First degree family history of breast cancer, Early menarche, Late menopause, Hormonal replacement therapy, Previous personal history of breast cancer 67- A client with type 2 diabetes has a serum creatinine of 2.9 mg/dL. The nurse correlates which urinalysis finding with the diagnosis of diabetic nephropathy in this client? Select one: a. White blood cells in the urine during a random urinalysis b. Increased leukocytes and presence of bacteriab. "I should increase my intake of proteins and eliminate carbohydrates from my diet." b. Difficulty in handwriting. d. Ketone bodies in the urine during ketoacidosis Feedback Urine should not contain protein. The presence of proteinuria in a diabetic client marks the beginning of kidney problems known as diabetic nephropathy, which progresses eventually to end-stage kidney disease. Decline in kidney function is assessed with serum creatinine. This client's creatinine level is high. The other findings would not be correlated with declining kidney function. The correct answer is: Albumin in the urine during a random urinalysis 68- After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? Select one: a. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should increase my intake of vegetables with higher amounts of dietary fiber." d. "My intake of water is not restricted by my treatment plan or medication regimen." Feedback The client should not completely eliminate carbohydrates from the diet and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present. The correct answer is: "I should increase my intake of proteins and eliminate carbohydrates from my diet." 69- The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which finding should the nurse consider an indication of progressive hepatic encephalopathy? Select one: a. Increased level of blood urea nitrogen (BUN).b. Administer a tissue plasmin activator ( r-TPA) drug, like alteplase. c. An increase in abdominal girth. d. Hypertension and a bounding pulse. Feedback In advanced cirrhosis the liver is unable to metabolize the blood ammonia into urea (BUN). The elevation of the ammonia is associated with hepatic encephalopathy. An early sign of this condition is a characteristic tremor called asterixis or flapping tremor. This alteration of the fine movement translates in difficulty in handwriting, easy to demonstrate comparing the patient's writing before and after the development of the hepatic encephalopathy. The increase in abdominal girth is related to portal hypertension. Systemic hypertension is not a direct consequence of hepatic cirrhosis. The correct answer is: Difficulty in handwriting. 70- While assessing a client with an arteriovenous (AV) shunt who is scheduled for dialysis today, the nurse notes the absence of a thrill and bruit at the shunt site, suspecting thrombosis of the fistula. What action should the nurse anticipate the provider would take to reestablish the fistula patency? Select one: a. Advise the client that the pressure of the dialysis will reopen the fistula. c. Flush the fistula with a heparinized saline solution. d. Order a daily dose of warfarin until bruit and thrill reappear. Feedback Absence of a thrill or bruit indicates that the shunt may be obstructed. The nurse should notify the health care provider so that intervention can be initiated to restore function of the shunt. An AV shunt is internal and cannot be flushed and heparin doesn't dissolve already formed clots. The thrombolytic therapy can reestablish patency of the obstructed fistula. The correct answer is: Administer a tissue plasmin activator ( r-TPA) drug, like alteplase. 71- The client has been diagnosed with Cushing's syndrome. The nurse would monitor this client for which of the following expected signs of this disorder? Select all that apply. Select one or more: a. Anorexiad. Truncal obesity f. Moon face c. Leave the room and re-approach the client in about 30 minutes. c. Weight loss e. Hyperkalemia Feedback Rationale: The client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon facies, truncal obesity, and a "buffalo hump" fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder. The correct answers are: Hypertension, Moon face, Truncal obesity 72- A male client with moderate Alzheimer's disease had abdominal surgery yesterday. Today, when the nurse begins to perform a dressing change, the client states, "I don't want you to change my dressing." What is the best initial action for the nurse to take? Select one: a. Do not change the dressing and note "refused" in the client's medical record. b. Explain the importance of dressing change and proceed with the procedure. d. Ask another nurse, who had the client before, to do the dressing change. Feedback The nurse shouldn't pass the assignment to another nurse. It is probable that the client forgets the initial refusal and allows the care after a while The correct answer is: Leave the room and re-approach the client in about 30 minutes. 73- A nurse assesses a male client with a spinal cord injury at level T5 because the client is not feeling well while he was transferred in wheelchair for a chest x-ray. The client's blood pressure is 194/95 mm Hg, heart rate 59 beats/min, and the client presents with a headache, nasal congestion, flushed face and blurred vision. Which action should the nurse take first? Select one: b. Hypertensiond. Palpate the bladder for distention. a. Apical pulse regular at 70 beats/minute. c. Vitamin B12, intramuscular a. Administer a dose of atropine IV. b. Initiate oxygen via a nasal cannula. c. Place the client in left lateral and Trendelenburg position. Feedback The client is manifesting symptoms of autonomic dysreflexia. Common causes include bladder distention, tight clothing, increased room temperature, and fecal impaction. If persistent, the client could experience neurologic injury. Precipitating conditions should be eliminated, and the physician notified. The other actions would not be appropriate. The correct answer is: Palpate the bladder for distention. 74- A client is receiving the medication propylthiouracil (PTU). Which assessment finding indicates to the nurse that the medication is effective? Select one: b. The blood level of TSH has decreased c. Client improves cold tolerance. d. White blood cell count is 4,500 cells/mm3. Feedback The medication is effective when an euthyroid state is achieved, which includes a return of vital signs to within normal parameters. The correct answer is: Apical pulse regular at 70 beats/minute. 75- A male client with gastric cancer is 1 week postoperative for a total gastrectomy and has normal hematologic parameters. Which supplement should the nurse explain to the client is indicated for lifetime to prevent complications? Select one: a. Vitamin B6, intramuscular b. Intrinsic factor, oral with each meald. Vitamin B12, oral [Show More]

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