RN Adult Medical Surgical Online Practice 2019 B with NGN Best Studyig Material, Exams of Nursing

Download RN Adult Medical Surgical Online Practice 2019 B with NGN Best Studyig Material and more Exams Nursing in PDF only on Docsity! RN Adult Medical Surgical Online Practice 2019 B with NGN Best Studyig Material Updated 2023- 2024 with All Questions and 100% Correct Answers and Rationale A nurse is caring for a client following extubation of an endotracheal tube 10 min ago. Which of the following findings should the nurse report to the provider immediately? ----- -- Correct Answer --------- Stridor Rationale: Using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is stridor. Stridor can indicate a narrowing airway or possible obstruction caused by edema or laryngeal spasms. The nurse should report the finding immediately and implement an intervention. A nurse is assessing a client who has advanced lung cancer and is receiving palliative care. The client has just undergone thoracentesis. The nurse should expect a reduction in which of the following common manifestations of advanced cancer? ------- Correct Answer --------- Dyspnea Rationale: Thoracentesis, the removal of pleural fluid, can temporarily relieve hypoxia and thus ease the client's breathing and improve comfort. A nurse is providing teaching to a client who takes ginkgo biloba as an herbal supplement. Which of the following statements should the nurse make? ------- Correct Answer --------- "Ginkgo biloba can cause an increased risk for bleeding." A nurse on a medical-surgical unit is reviewing the medical record of an older adult client who is receiving IV fluid therapy. Which of the following client information should indicate to the nurse that the client requires re-evaluation of the IV therapy prescription? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.) EXHIBIT ------- Correct Answer --------- BUN A nurse is receiving report on a client who is postoperative following an open repair of Zenker's diverticulum. The nurse should anticipate the surgical incision to be in which of the following locations? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.) ------- Correct Answer --------- A )Neck A nurse is reviewing the laboratory findings of a client who developed chest pain 6 hr ago. The nurse should identify which of the following findings as an indication of a myocardial infarction (MI)? ------- Correct Answer --------- Troponin I 8 ng/mL Rationale: Troponins are proteins present in skeletal and cardiac muscle that are involved with muscle contraction. The elevation of either troponin T or troponin I is an indication of cardiac injury. The client's laboratory value is above the expected reference range for troponin I, indicating an MI has occurred. A nurse is preparing to administer a blood transfusion to a client who has anemia. Which of the following actions should the nurse take first? ------- Correct Answer --------- Check for the type and number of units of blood to administer Rationale: According to evidence-based practice, the nurse should first confirm that the type and number of units of blood to administer matches what is indicated in the client's medication administration record. A nurse is reviewing the laboratory results of a client who has aplastic anemia. Which of the following findings indicates a potential complication? ------- Correct Answer --------- WBC count 2,000 Rationale: A WBC count of 2,000/mm3 is below the expected reference range and indicates a risk for severe immunosuppression. A nurse is providing discharge teaching to a client who is postoperative following a modified radical mastectomy. Which of the following instructions should the nurse include? ------- Correct Answer --------- Numbness can occur along the inside of the affected arm. Rationale: The nurse should instruct the client that numbness can occur near the incision and along the inside of the affected arm due to nerve injury. A nurse is preparing to present a program about prevention of atherosclerosis at a health fair. Which of the following recommendations should the nurse plan to include? (Select all that apply.) ------- Correct Answer --------- Follow a smoking cessation program is correct. Smoking cessation is an important lifestyle modification to prevent atherosclerosis. Maintain an appropriate weight is correct. Preventing obesity through diet and exercise can help to prevent atherosclerosis. Eat a low-fat diet is correct. Eating a low-fat diet decreases LDL cholesterol and can prevent atherosclerosis. Increase fluid intake is incorrect. Increasing intake of fruits, vegetables, and grains can prevent atherosclerosis. Decrease intake of complex carbohydrates is incorrect. Decreasing intake of simple sugars and sweetened foods and increasing complex carbohydrates, such as fiber, can reduce the risk of heart disease. understanding of the teaching? ------- Correct Answer --------- "I will avoid direct exposure to the sun." Rationale: The client should avoid exposure of irradiated skin areas to the sun for at least 1 year after completing radiation therapy. Skin in the radiation path is especially sensitive to sun damage. SN: Head and neck radiation can damage the salivary glands and cause dry mouth, which predisposes the client to mucositis. The client should rinse the mouth with plain water or 0.9% sodium chloride. A nurse is admitting a client who has active tuberculosis. Which of the following types of transmission precautions should the nurse initiate? ------- Correct Answer --------- Airborne. Rationale: Airborne precautions are required for clients who have infections due to micro-organisms that can remain suspended in air for lengthy periods of time, such as tuberculosis, measles, varicella, and disseminated varicella zoster. A nurse is reviewing the medical record of a client who has osteomyelitis and a prescription for gentamicin. Which of the following findings from the client's medical record should indicate to the nurse the need to withhold the medication and notify the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.) ------- Correct Answer --------- Serum creatinine. Rationale: A client who has an elevated serum creatinine level should not receive gentamicin because the medication is nephrotoxic. A nurse is assessing for compartment syndrome in a client who has a short leg cast. Which of the following findings should the nurse identify as a manifestation of this condition? ------- Correct Answer --------- Pain that increases with passive movement Rationale: The nurse should identify that a client who has compartment syndrome experiences pain that increases with passive movement. Compartment syndrome results from a decrease in blood flow in the extremity caused by a decrease in the muscle compartment size due to a cast that is too tight. A nurse is providing teaching to a client who has a severe form of stage II Lyme disease. Which of the following statements made by the client reflects an understanding of the teaching? ------- Correct Answer --------- My joints ache because I have Lyme disease Rationale: Lyme disease is a vector-borne illness transmitted by the deer tick. The disease course occurs in three stages beginning with joint and muscle pain in stage I. If left untreated, these symptoms continue throughout stage II and, by stage III, become chronic. Other chronic complications include memory problems and fatigue. A nurse is preparing to administer phenytoin 600 mg PO daily to a client. The amount available is oral solution 125 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) ------- Correct Answer --------- 24 A nurse is caring for a client who has an arterial line. Which of the following actions should the nurse take? ------- Correct Answer --------- place a pressure bag around the flush solution Rationale: The nurse should place a pressure bag around the flush solution of 0.9% sodium chloride because the pressure from an artery is greater than that of the line. An arterial line is not appropriate access for administering antibiotics. The nurse should use the arterial line to obtain arterial blood gas samples and monitor hemodynamic pressures. A nurse is updating the plan of care for a client who is receiving chemotherapy. Which of the following findings should the nurse identify as the priority? ------- Correct Answer - -------- Report of sore throat Rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a report of a sore throat, which could be a manifestation of an infection. The client is at risk for neutropenia due to myelosuppression; therefore, an infection could lead to sepsis. A nurse is reviewing the medical record of a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect? ------- Correct Answer --------- Facial butterfly rash Rationale: A butterfly rash is a manifestation of SLE. It appears as a dry, red rash on the client's cheeks and nose and can disappear during times of remission. A nurse is planning care for a client who is postoperative following a parathyroidectomy. Which of the following actions should the nurse identify as the priority? ------- Correct Answer --------- Place tracheostomy tray at the bedside Rationale: The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to place a tracheostomy tray at the client's bedside in case of airway obstruction. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? ------- Correct Answer --------- Low urine specific gravity Rationale: An expected finding for a client who has diabetes insipidus is a urine specific gravity between 1.001 and 1.005. Decreased water reabsorption by the renal tubules is caused by an alteration in antidiuretic hormone release or the kidneys' responsiveness to the hormone. A nurse is providing teaching to a client who has stage II cervical cancer and is scheduled for brachytherapy. Which of the following instructions should the nurse include? ------- Correct Answer --------- You will need to stay still in the bed during each treatment session." Rationale: The nurse should instruct the client that they will need to remain on bed rest with very limited movement because excessive movement can cause the radioactive source to become dislodged. The nurse should instruct the client that there is not excreted radiation between treatments. The nurse should instruct the client that there will likely be between two and five treatments, once or twice each week. The nurse should instruct the client that blood in the urine is an adverse effect of brachytherapy and is not an expected finding. A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following interventions should the nurse include in the plan? ------- Correct Answer ------- -- Encourage the client to take deep breaths after the procedure. Rationale: After a thoracentesis, the client should deep breathe to re-expand the lung. A nurse is caring for a client who is receiving a blood transfusion. The client becomes restless, dyspneic, and has crackles noted to the lung bases. Which of the following actions should the nurse anticipate taking? ------- Correct Answer --------- Slow the infusion rate Rationale: Dyspnea, restlessness, and the onset of crackles during a blood transfusion are manifestations of circulatory overload. The nurse should slow or stop the infusion to improve the client's ability to breathe, place the client in an upright position, and notify the provider. The provider might prescribe a diuretic to alleviate the fluid overload. A nurse is providing teaching to a client who has end-stage kidney disease and is waiting for a kidney transplant. Which of the following information should the nurse provide? ------- Correct Answer --------- Hemodialys is something required following surgery. Rationale: When a kidney comes from a deceased donor, it might not function immediately, requiring the recipient to continue hemodialysis postoperatively. A nurse is caring for a client who has hypothyroidism. Which of the following manifestations should the nurse expect? ------- Correct Answer --------- Constipation A nurse is assessing a client who has peripheral arterial disease. Which of the following findings should the nurse expect? ------- Correct Answer --------- Hair loss on the lower legs A home health nurse is providing teaching to a client who has a stage 1 pressure injury on the greater trochanter of his left hip. Which of the following instructions should the nurse include in the teaching? ------- Correct Answer --------- Change position every hour. A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following nonpharmacological interventions should the nurse suggest to the client to reduce pain? ------- Correct Answer --------- Alternate application of heat and cold to the affected joints. A nurse is assessing a client following the completion of hemodialysis. Which of the following findings is the nurse's priority to report to the provider? ------- Correct Answer -- ------- Restlessness A nurse is caring for a client who is 4 hr postoperative following an open reduction internal fixation of the right ankle. Which of the following assessment findings should the nurse report to the provider? ------- Correct Answer --------- Extremity cool upon palpation A nurse is assessing a client who is postoperative following a thyroidectomy. Which of the following findings is the nurse's priority? ------- Correct Answer --------- Temperature 38.9° C (102° F) A nurse is planning care for a client who is having a modified radical mastectomy of the right breast. Which of the following interventions should the nurse include in the plan of care? ------- Correct Answer --------- Instruct the client that the drain will be removed when there is 25 mL of output or less over a 24-hr period. A nurse is teaching a client about the use of transcutaneous electrical nerve stimulation (TENS) for the management of bone cancer pain. The nurse should explain that applying a TENS unit to the painful area has which of the following effects? ------- Correct Answer --------- A tingling sensation replacing the pain A nurse is providing teaching to a client who has a recent diagnosis of constipation- predominant irritable bowel syndrome. Which of the following instructions should the nurse include in the teaching? ------- Correct Answer --------- Consume at least 30 g of fiber daily. A nurse is providing teaching to a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? ------- Correct Answer --------- "I will take my temperature once a day." A nurse is reviewing the medical record of a client who is taking warfarin for chronic atrial fibrillation. Which of the following values should the nurse identify as a desired outcome for this therapy? ------- Correct Answer --------- INR 2.5 A nurse is caring for a newly admitted client who has a gastric hemorrhage and is going into shock. Identify the sequence of actions the nurse should take. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.) ------- Correct Answer --------- AdminiSTER o2 Initiate IV therapy Insert an NG tube Administer ranitidine A nurse is assessing heart sounds of a client who reports substernal precordial pain. Identify which of the following sounds the nurse should document in the client's medical record by listening to the audio clip. (Click on the audio button to listen to the clip.) ------- Correct Answer --------- Pericardial friction rub A nurse is teaching a client about osteoporosis prevention. The nurse should instruct the client that which of the following medications can increase their risk for developing osteoporosis? ------- Correct Answer --------- Prednisone A nurse is providing education to a client who is at risk for osteoporosis. Which of the following instructions should the nurse include? ------- Correct Answer --------- Walk for 30 min four times per week. A nurse is teaching a client who has a cardiac dysrhythmia about the purpose of undergoing continuous telemetry monitoring. Which of the following statements by the client reflects an understanding of the teaching? ------- Correct Answer --------- "This identifies if the pacemaker cells of my heart are working properly." A nurse is caring for a client who is 8 hr postoperative following a total hip arthroplasty. The client is unable to void on the bedpan. Which of the following actions should the nurse take first? ------- Correct Answer --------- Scan the bladder with a portable ultrasound. A nurse is assessing a client while suctioning the client's tracheostomy tube. Which of the following findings should indicate to the nurse the client is experiencing hypoxia? ---- --- Correct Answer --------- The client's heart rate increases. A nurse is providing discharge instructions to a client who has active tuberculosis (TB). Which of the following information should the nurse include in the instructions? ------- Correct Answer --------- Sputum specimens are necessary every 2 to 4 weeks until there are three negative cultures. A PACU nurse is assessing a client who is postoperative following a right nephrectomy. The client's initial vital signs were heart rate 80/min, blood pressure 130/70 mm Hg, respiratory rate 16/min, and temperature 36° C (96.8° F). Which of the following vital sign changes should alert the nurse that the client might be hemorrhaging? ------- Correct Answer --------- Heart rate 110/min A nurse is caring for a client who has a positive culture for methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take? - ------ Correct Answer --------- Bathe the client using chlorhexidine solution. FLAG A nurse is assessing a client's hydration status. Which of the following findings indicates fluid volume overload? ------- Correct Answer --------- Distended neck veins A nurse is providing postoperative teaching for a client who had a total knee arthroplasty. Which of the following instructions should the nurse include? ------- Correct Answer --------- Flex the foot every hour when awake. A nurse at an urgent care clinic is caring for a client who is experiencing an anaphylactic reaction. After ensuring a patent airway, which of the following nursing interventions is the priority? ------- Correct Answer --------- Applying oxygen via face mask A nurse in an emergency department is assessing an older adult client who has a fractured wrist following a fall. During the assessment, the client states, "Last week I crashed my car because my vision suddenly became blurry." Which of the following actions is the nurse's priority? ------- Correct Answer --------- Check the client's neurologic status. A nurse is caring for an older adult client who has dementia and requires acute care for a respiratory infection. The client is agitated and is attempting to remove their IV catheter. Which of the following actions should nurse take to avoid restraining the client? ------- Correct Answer --------- Keep the client occupied with a manual activity. A nurse is caring for a client who has terminal cancer. The client tells the nurse, "I wish I could stop these treatments. I am ready to die." Which of the following statements should the nurse make? ------- Correct Answer --------- "Discontinuing with the treatments is your choice if it is your wish to do so." A nurse is planning care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan of care? ------- Correct Answer --------- Place personal items, such as pictures, at the client's bedside. A nurse is providing teaching to a client who has asthma about the use of a metered- dose inhaler. The nurse should identify that which of the following client actions indicates an understanding of the teaching? ------- Correct Answer --------- Holding breath for 10 seconds after inhaling A nurse has received report on a client who is being admitted to the emergency department.Select the 3 findings that require follow-up by the nurse ------- Correct Answer --------- GCS score is incorrect. The nurse should identify a GCS score of 15 indicates intact neurological functioning. Temperature is incorrect. The client's temperature is within the expected reference range. Oxygen saturation is correct. The client has an oxygen saturation that is less than the expected reference level, indicating hypoxia. The nurse should plan to increase the client's supplemental oxygen. Pain level is correct. The nurse should follow up on the client's pain level. Wound drainage is correct. The nurse should apply a pressure dressing to control bleeding. The nurse is caring for the client. Complete the following sentence by using the lists of options. ------- Correct Answer --------- The client is most likely experiencing a hemothorax as evidenced by the client's respiratory findings . Drag words from the choices below to fill in each blank in the following sentence. ------- Correct Answer --------- Oxygenation and blood pressure are correct. Using the airway, breathing, circulation priority framework, the nurse should first address the client's oxygenation, followed by the client's blood pressure. The client's oxygenation is below the expected reference range and is the priority. The nurse should then address the client's circulation because the client's blood pressure is below the expected reference range. Pedal pulses, temperature, and pain are incorrect. The nurse should address the client's pedal pulses because they are diminished. The nurse should address the client's temperature because it is below the expected reference range. The nurse should address the client's pain to promote comfort. However, using the airway, breathing, circulation priority framework, the nurse should address pedal pulses, temperature, and pain after oxygenation and blood pressure. For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client. ------- Correct Answer --------- Transfuse packed RBCs is anticipated. The client's increased heart rate and decreased blood pressure indicate decreased circulating blood volume due to trauma. Therefore, the nurse should anticipate transfusing packed RBCs. Place the client in Trendelenburg position is contraindicated. Due to clinical manifestations of hypovolemia, the nurse should position the client flat or place their head of bed no more than 30° to promote venous return to the heart. Prepare the client for chest tube insertion is anticipated. The client has manifestations of a hemothorax. Therefore, a chest tube is indicated. Cover the client with a cooling blanket is contraindicated. The client's temperature is below the expected reference range, which is a manifestation of hypothermia. Therefore, covering the client with a cooling blanket is contraindicated. Initiate NPO status is anticipated. The client might require a surgical procedure. Therefore, the nurse should anticipate initiating NPO status. The nurse is caring for the client following the placement of a chest tube for a hemothorax. Which of the following actions should the nurse take? Select all that apply. ------- Correct Answer --------- Place the client in high-Fowler's position is correct. The nurse should place the client in high-Fowler's position to promote drainage of the hemothorax. Ensure there is continuous bubbling in the water seal chamber is incorrect. The nurse should monitor the water seal chamber for continuous bubbling because this is an indication of a leak in the chest tube system. Monitor drainage every 30 min for the first hour is incorrect. The nurse should monitor the drainage from the chest tube every 15 min for the first 2 hr to identify excessive drainage. Strip the drainage tubing to ensure it is patent is incorrect. The nurse should not strip the chest tube because this can cause increased intrathoracic pressure. Place two rubber-tipped hemostats in the client's room is correct. The nurse should place two rubber-tipped hemostats in the client's room to use in case of an emergency, such as chest tube dislodgment. Palpate the chest tube insertion site for subcutaneous emphysema is correct. The nurse should palpate the chest tube insertion site for subcutaneous emphysema because this is a manifestation of an air leak. Ensure that all chest tube connections are securely attached is correct. The nurse should ensure that all connections between the chest tube and drainage system are secure and intact to reduce the risk of a tension pneumothorax. The nurse is caring for the client 1 hr following chest tube insertion. Click to highlight the findings in the nurses' note that indicate the client's condition is improving. To deselect a finding, click on the finding again. ------- Correct Answer --------- Client reports pain as 3 on a scale of 0 to 10 is correct. The nurse should identify that the client's pain has decreased, indicating their condition is improving. Client reports shortness of breath has decreased is correct. The nurse should identify that the client's shortness of breath has decreased, indicating their condition is improving. Client reports nausea, awaiting prescription for nausea is incorrect. The nurse should identify that nausea is an indication that the client's condition is not improving. Transfused 1 unit of packed RBCs, awaiting second unit is incorrect. The transfusion of 1 unit of packed RBCs is not an indication that the client's condition is improving. Wound dressing is dry and intact is correct. The nurse should identify that a dry and intact wound dressing indicates the client's wound is no longer bleeding. Respiratory rate 24/min, blood pressure 108/74 mm Hg, and oxygen saturation 95% on 2 L/min via nasal cannula are correct. The nurse should identify that the client's vital signs have improved, indicating improved hemodynamic function. A nurse is caring for a client who is scheduled for a right knee arthroplasty. The nurse provided preoperative teaching to the client. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply. ------- Correct Answer --------- "Well, I guess there's no changing my mind about having surgery now" is incorrect. The nurse and the client reviewed the consents; therefore, the nurse has instructed the client that they have the right to refuse surgery at any time. "I will need to do the breathing exercises every 1 to 2 hours after the surgery" is correct. The client should cough and deep breathe and use the incentive spirometer every 1 to 2 hr to reduce the risk of postoperative complications, such as pneumonia. "I will be sure to ask for pain medication before my knee starts to hurt too bad" is correct. For optimal control of postoperative pain, the client should request analgesic medication before the pain becomes severe. "My physical therapy will start after I leave the hospital" is incorrect. Early ambulation leads to improved postoperative outcomes and reduces the risk of complications of immobility, such as pneumonia and atelectasis. The client should be informed that physical therapy will begin the day of, or the day following, surgery. "I will probably be going home with a walker" is correct. It can take 6 weeks for complete recovery from knee arthroplasty. Clients are often discharged with the use of a walker and will advance to a cane or crutch 4 to 6 weeks following surgery. A nurse is caring for a client who is 4 hr postoperative following a total vaginal hysterectomy. Click to highlight the findings the nurse should report to the provider immediately. ------- Correct Answer --------- Perineal pad saturated with blood, large clots present, blood pressure trend, and heart rate of 102/min are correct. The client has manifestations of vaginal hemorrhage, including vaginal bleeding, blood clots, reduced blood pressure, and tachycardia. The nurse should report these findings to the provider. Client sleeping, arouses to verbal stimuli, respiratory rate 14/min, oxygen saturation 95% on room air, breath sounds clear, and reports pain as 2 on scale of 0 to 10 are incorrect. These are expected findings. Therefore, the nurse does not need to report these findings to the provider. A nurse is caring for a client. Complete the following sentence by using the lists of options. ------- Correct Answer --------- After reviewing the findings in the client's medical record, the nurse should first address the client's abdominal distention followed by the client's acute pain . The nurse is performing an assessment on the client. For each assessment finding, click to specify if the finding is consistent with appendicitis, diverticular disease, or Crohn's disease. Each finding may support more