MED SURG HESI Quiz - Questions, Answers and Rationales A client with a recent history of blood in his stools is scheduled for a proctosigmoidoscopy. The nurse should implement which protocols to prepare the client for t
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MED SURG HESI Quiz - Questions, Answers and Rationales A client with a recent history of blood in his stools is scheduled for a proctosigmoidoscopy. The nurse should implement which protocols to prepare the client for this procedure? (Select all that apply.) Obtain consent for the procedure. Initiate preoperative sedation. Begin fast the morning of the procedure. Administer an enema before the procedure. Provide a clear-liquid diet 48 hours before the procedure. Correct selections are (A, C, D, and E). The usual preoperative preparation for proctosigmoidoscopy entails obtaining the client's consent to the procedure (A), a clear-liquid diet for 24 to 48 hours prior to the procedure (E), administration of an enema (D), and fasting (C) on the morning of the procedure. Preoperative sedation is not the norm for this procedure (B), although some healthcare providers administer a mild tranquilizer. A client who returns to the unit after having a percutaneous transluminal coronary angioplasty (PTCA) complains of acute chest pain. What action should the nurse implement next? Inform the healthcare provider. Obtain a 12-lead electrocardiogram. Give a sublingual nitroglycerin tablet. Administer prescribed analgesic. After a percutaneous transluminal coronary angioplasty (PTCA), a client who experiences acute chest pain may be experiencing cardiac ischemia related to restenosis, stent thrombosis, or acute coronary syndrome involving any coronary artery. The first action is to administer nitroglycerin (C) to dilate the coronary arteries and increase myocardial oxygenation. Then, (A, B, and D) are implemented. The nurse is caring for a client scheduled to undergo insertion of a percutaneous endoscopic gastrostomy (PEG) tube. The client asks the nurse to explain how a PEG tube differs from a gastrostomy tube (GT). Which explanation best describes how they are different? Method of insertion. Location of the tubes. Diameter of the tubes. Procedure for feedings. The best explanation of how a PEG tube differs from a GT is by the method of insertion (A). GT insertion involves making an incision in the wall of the abdomen and suturing the tube to the gastric wall. A PEG tube is inserted with endoscopic visualization through the esophagus into the stomach and then pulled through a stab wound in the abdominal wall. (B, C, and D) identify commonalities. The nurse obtains a client's history that includes right mastectomy and radiation therapy for cancer of the breast 10 years ago. Which current health problem should the nurse consider is a consequence of the radiation therapy? Asthma. Myocardial infarction. Chronic esophagitis with gastroesophageal reflux. Pathologic fracture of two ribs on the right chest. The ribs lie in the radiation pathway and lose density over time, becoming thin and brittle, so the occurence of two right-sided ribs with pathological fractures resulting without evidence of trauma (D) is related to radiation damage. The heart (B), esophagus (C), and larger bronchi (A) are not usually in the radiation path. A 48-year-old client with endometrial cancer is being discharged after a total hysterectomy and bilateral salpingo-oophorectomy. Which client statement indicates that further teaching is needed? Well, I don't have to worry about getting pregnant anymore. I can't wait to go on the cruise that I have planned for this summer. I know I will miss having sexual intercourse with my husband. I have asked my daughter to stay with me next week after I am discharged. Further teaching is needed in response to the client's misunderstanding of sexuality after a hysterectomy that is reflected in statement (C). The client's knowledge about reproduction (A), a positive outlook with plans for the future (B), and her anticipated need for assistance and support during recovery (D) indicate she understands the present status of her recovery. An older adult client begins wearing binaural hearing aids due to presbycusis. Which instruction should the nurse provide to assist the client in adapting to the new hearing aids? Begin wearing the aids in quiet environments to experiment with adjustments. Wear the hearing aids for an hour a day at first, gradually increasing the time. Keep the volume on low until the conditions with noises are audible. Use one hearing aid until comfortable, then add the second aid. Initially, the use of hearing aids should be restricted to quiet situations in the home (A). As adjustments occur, the client should gradually be exposed to conditions with background noise and the outdoors. Time restriction (B) is not necessary. (C and D) do not help the client adjust as well as gradually introducing various sound conditions. What instrument should the nurse use to determine the presence of deep tendon reflexes? Goniometer. Wood's lamp. Reflex hammer. Transilluminator Deep tendon reflexes are assessed using a reflex hammer (C). (A) is used to assess the degree of joint flexion and extension. (B) determines the presence of fungi. (D) is a light source that helps detect the presence of fluid in the sinus cavities. The nurse is teaching a client about precautions for a new prescription for lovastatin (Mevacor). Which symptom should the nurse instruct the client to report to the healthcare provider immediately? Terrible nightmares. Increased nocturia. Severe muscle pain. Visual disturbances. A potential, serious side effect of statin therapy that is used to lower both LDL-C and triglyceride levels is rhabdomyolysis, which is manifested by severe muscle pain and aching (C). (A) is a side effect, but not life threatening. (B) is not related to statin therapy. Blurred vision (D) is a transient side effect that does not need immediate medical treatment. A client with osteoarthritis receives a prescription for Naproxen (Naprosyn). Which potential side effect should the nurse provide to the client about this medication? Sensitivity to sunlight. Muscle fasciculations. Increased urinary frequency. Gastrointestinal disturbance. Prostaglandin synthesis inhibitors such as naproxen can have gastrointestinal side effects such as nausea and gastric burning (D). It is recommended that this drug be taken with food to avoid gastrointestinal upset. Naproxen (Naprosyn) does not cause sensitivity to sunlight (A), muscle fasciculations (B), or urinary frequency (C). The nurse is providing instructions about log rolling to a client who returns to the postoperative unit after a lumbar laminectomy. Which explanation should the nurse give the client about this technique?
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