RETAKE 2 RN MEDSURG EXAM

1. A nurse is caring for a client who has a closed head injury and has an intraventricular catheter placed. Which of the following findings indicates that the client is experiencing increased ICP?SATA. a. Flat jugular v ...

1. A nurse is caring for a client who has a closed head injury and has an intraventricular catheter placed. Which of the following findings indicates that the client is experiencing increased ICP?SATA. a. Flat jugular veins b. GCS score of 15 c. Sleepiness exhibited by the client d. Widening pulse pressure e. Decerebrate posturing 2. A nurse is preparing a client who has supraventricular tachycardia for elective cardioversion. Which of the following prescribed medications should the nurse instruct the clients to withhold for 48hr prior to cardioversion? a. Enoxaparin b. Metformin c. Diazepam d. Digoxin 3. A nurse is assessing a client who has acute cholecystitis. which of the following findings is the nurse’s priority? a. Anorexia b. Abdominal pain radiating to the right shoulder c. Tachycardia d. Rebound abdominal tenderness 4. A nurse is preparing to admit a client who has dysphagia. The nurse should plan to place which of the following items at the client’s bedside? a. Suction machine b. Wire cutters c. Padded clamp d. Communication board 5. A nurse is caring for a client who is having a seizure. Which of the following intervention is the nurse’s priority? a. Loosen the clothing around the client’s neck b. Check the client’s pupillary response c. Turn the client to the side. d. Move furniture away from the client 6. A nurse is providing teaching to a client who has hypothyroidism and is receiving levothyroxine. The nurse should instruct the client that which of the following supplements can interfere with the effectiveness of the medication? a. Ginkgo biloba b. Glucosamine c. Calcium d. Vitamin C 7. A nurse is planning to irrigate and dress a clean, granulation wound for a client who has a pressure injury. Which of the following actions should the nurse take? a. Apply a wet-to-dry gauze dressing b. Irrigate with hydrogen peroxide solution c. Use a 30-ml syringe d. Attach a 24-gauge angiocatheter to the syringe. the nurse is providing teaching to a female client who has a history of UTI’s. which of the following information should the nurse include in the teaching? a. Avoid foods that are high in ascorbic acid b. Add oatmeal to the water when taking a tub bath c. Urinate every 6 hours d. Take daily cranberry supplements? 10. A nurse is providing teaching to a client who has esophageal cancer and is to undergo radiation therapy. Which off the following statements should the nurse identify as an indication that the client understands the teaching? A.“ I will wash the ink markings off the radiation area after each treatment.” B.“I will use my hands rather than a washcloth to clean the radiation area.” C.“I will be able to be out in the sun 1 month after my radiation treatments are over.” D.“I will use a heating pad on my neck it if becomes sore during the radiation therapy.” A nurse is caring for a client 1 hr following a cardiac catheterization. The nurse notes the formation of a hematoma at the insertion site and a decreased pulse rate in the affected extremity. Which of the following interventions is the nurse’s priority? A.Initiate oxygen at 2 L via nasal cannula B.Apply firm pressure to the insertion site C.Take the client’s vital signs D.Obtain a stat order for an aPTT 12. A nurse is caring for a client who has emphysema and is receiving mechanical ventilation. The client appears anxious and restless, and the high-pressure alarm is sounding. Which of the following actions should the nurse take first? a. Obtain ABGs b. Administer propofol to the client c. Instruct the client to allow the machine to breathe for them d. Disconnect the machine and manually ventilate the client. 13. A nurse is reviewing the lab results of a client who has cirrhosis. Which of the following laboratory values should the nurse expect? a. Decreased prothrombin time b. Elevated bilirubin level c. Decreased ammonia level d. Elevated albumin level 14. A nurse is teaching a client who has venous insufficiency about self-care. Which of the following statements should the nurse identify as an indication that the client understands the teaching? a. “ I should avoid walking as much as possible.” b. “I should sit down and read for several hours a day” c. “I will wear clean graduatied compression stockings every day.” d. “I will keep my legs level with my body when I sleep at night.” 15. A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the following laboratory values should the nurse report to the provider? a. Potassium 4 mEq/L b. WBC count 10,000/mm3 c. Hct 45% d. Hgb 8 g/dL 16. A nurse is caring for a client who has a stage III pressure injury. Which of the following findings contributes to delayed would healing? a. WBC count 6K b. BMI 24 c. Urine output 25ml/hr d. Albumin 4 a nurse is planning care for a client who is undergoing brachytherapy via a sealed vaginal implant to treat endometrial cancer. Which of the following actions should the nurse include in the client’s plan of care? a. Collect and place the client’s urine or feces in a biohazard bag b. Limit the client’s ambulation to their own room c. Wear a lead apron while providing care to the client d. Limit each visitor to 1 hr per day. .nurse is caring for a client who has a potassium level of 3 mEq/L/ Whichh of the following assessment findings should the nurse expect? a. Positive trousseaus sign b. 4+ deep tendon reflexes c. Deep respirations d. Hypoactive bowel sounds A nurse in a community clinic is caring for a client who reports an increase in the frequency of migraine headaches. To reduce the risk for migraine headaches, which of the following foods should the nurse recommend the client avoid? a. Shellfish b. Aged cheese: Aged cheese A nurse in an emergency department is caring for a client who reports vomiting and diarrhea for the past 3 days. Which of the following findings should indicate to the nurse that the client is experiencing FVD? a. HR 110/min b. BP 138/90 c. Urine Specific Gravity 1.020 d. BUN 15 mg/dL nurse is providing instructions to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following statements by the client indicates and understanding of the teaching? a. “I will monitor my blood sugar carefully because the medication increases the secretion of insulin.” b. I should take the medication with a meal c. I can expect to gain weight while taking this medication d. While taking this medication, I will experience flushing of my skin.” A nurse is caring for a client who as ALS and is being admitted to the hospital with pneumonia. Which of the following assessment findings is the nurse’s priority? a. Temp 38.4 C b. Increased respiratory secretion c. Fluid intake of 200ml in the prior 8 hr d. Limited range of motion CONTINUED.....DOWNLOAD FOR MORE REVISION TO BEST SCORES