RN VATI Adult Medical Surgical 2019, Exams of Surgical Pathology

Download RN VATI Adult Medical Surgical 2019 and more Exams Surgical Pathology in PDF only on Docsity! 1Question: 90 of 90Question: 90 of 90 RN VATI Adult Medical Surgical 2019 Que stion 90 loade d rationals provide d Question: 90 of 90 CORRECT FLAG A nurse is caring for a client who has atopic dermatitis and a prescription for triamcinolone ointment. The nurse should assess the client to monitor for which of the following adverse effects? Increased pigmentation Topical glucocorticoid therapy can cause the adverse effect of hypopigmentation. Localized hair loss Long-term glucocorticoid therapy can cause hypertrichosis, or excessive hair growth, especially on the facial area. MY ANSWER Thinning of the skin and delayed healing are adverse effects of topical glucocorticoid preparations. The client should only apply the ointment to dry patches of the skin because topical steroids can cause atrophy of the dermis and epidermis, which can result in thinning of the skin. Increased sensitivity to the sun The nurse should instruct the client to avoid excessive sun exposure when taking topical fluticasone; however, triamcinolone ointment does not cause photosensitivity.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 89 loade d rationals provide d Question: 89 of 90 CORRECT  Time Remaining: 00:37:45 joe 1 Thinning of the skin 2Question: 90 of 90Question: 90 of 90 FLAG  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse identify as a manifestation of left-sided heart failure? Dependent edema The nurse should identify that dependent edema is a manifestation of right-sided heart failure due to right ventricular failure and fluid retention from pressure building up in the venous system. Jugular distention The nurse should identify that jugular vein distention is a manifestation of right-sided heart failure due to right ventricular failure and fluid retention from pressure building up in the venous system. Weight gain The nurse should identify that weight gain is a manifestation of right-sided heart failure due to right ventricular failure and fluid retention from pressure building up in the venous system. MY ANSWER The nurse should identify that frothy sputum, dyspnea, and wheezing are manifestations of left-sided heart failure. Treatment includes fluid restriction and diuretics to decrease preload and reduce pulmonary congestion. Pink-tinged frothy sputum can be an early indication of pulmonary edema and can be life-threatening. Therefore, the nurse should notify the provider immediately.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 88 loade d rationals provide d Question: 88 of 90 CORRECT joe 2 Frothy sputum 5Question: 90 of 90Question: 90 of 90 A client who has melanoma has a lesion with irregular borders and variegated colors of red, white, and blue, most often on the upper back or lower legs. A firm, nodular, crusty, or ulcerated lesion A client who has squamous cell carcinoma has a firm, nodular, and crusty lesion with an ulcerated center, resulting from sun exposure, chronic irritation, burns, or irradiation to the skin. A weeping vesicle A client who has herpes zoster has weeping, blister-type lesions.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 85 loade d rationals provide d Question: 85 of 90 CORRECT FLAG  Time Remaining: 00:37:02  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who has hypocalcemia. In which of the following areas should the nurse tap on the client's face to detect the presence of Chvostek's sign? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.) joe 5 6Question: 90 of 90Question: 90 of 90 A is correct. The nurse should tap the client's cheek just in front of the ear and below the zygomatic arch. The client who has hypocalcemia will display a Chvostek's sign, which is a twitching of the facial muscle. B is incorrect. The nurse should apply upward pressure at the supraorbital ridge, below the eyebrow, to assess for tenderness and inflammation of the frontal sinuses. C is incorrect. The nurse should palpate the jaw and mastoid muscle of a client who has temporomandibular joint dysfunction. This can be caused by misaligned teeth, arthritis, or grinding of the teeth. With palpation, the nurse might feel a click, pop, or grating sensation when the client opens or closes the jaw. joe 6 7Question: 90 of 90Question: 90 of 90  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 84 loade d rationals provide d Question: 84 of 90 CORRECT FLAG  Time Remaining: 00:36:55  Pause Remaining: 00:05:00 PAUSE A nurse in an emergency department is assessing a client who is overusing prescribed diuretics and has a sodium level of 127 mEq/L. Which of the following laboratory findings should the nurse expect? High lipase A high lipase level is associated with pancreatic dysfunction or renal failure and is not an expected finding with hyponatremia or dehydration. MY ANSWER A client who has hyponatremia as a result of diuretic overuse has a low urine specific gravity. The increased excretion of water alters the ratio of particulate matter, which affects the specific gravity. Low hemoglobin A client who is dehydrated as a result of diuretic overuse can have an elevated hemoglobin level because of the difference in ratio between intravascular fluid and blood cells. High creatine kinase-MB (CK-MB) An elevated CK-MB level indicates a myocardial infarction and is not an expected finding with hyponatremia.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 83 loade d rationals provide d Question: 83 of 90 joe 7 Low urine specific gravity 10Question: 90 of 90Question: 90 of 90 FLAG  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has developed acute respiratory distress syndrome (ARDS). Which of the following findings should the nurse identify as a manifestation of this syndrome? An audible pleural friction rub A client who has a pulmonary embolism can have a pleural friction rub along with tachypnea, tachycardia, dyspnea, and sudden, sharp chest pain. However, a pleural friction rub is not a manifestation of ARDS. Tracheal deviation from the midline A client who has a tension pneumothorax can have tracheal deviation with dyspnea, tachycardia, and tachypnea. On auscultation, breath sounds over the area of the pneumothorax are decreased or absent. However, tracheal deviation is not a manifestation of ARDS. MY ANSWER ARDS is a systemic inflammatory response to trauma, sepsis, burns, pancreatitis, and blood transfusions, when excess lung fluid dilutes surfactant activity in the lungs. A client who has ARDS has refractory hypoxemia, which is hypoxemia that does not improve with oxygen therapy. Extensive pulmonary edema evident on a chest x-ray is a manifestation of ARDS. Bloody expectorant when coughing A client who has lung cancer or laryngeal trauma can have hemoptysis. However, bloody expectorant is not a manifestation of ARDS.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 81 loade d rationals provide d Question: 81 of 90 CORRECT joe 10 Refractory hypoxemia 11Question: 90 of 90Question: 90 of 90 FLAG  Time Remaining: 00:36:33  Pause Remaining: 00:05:00 PAUSE An emergency room nurse is assessing a client who has asthma and difficulty breathing. Which of the following findings should indicate to the nurse that the client is experiencing status asthmaticus? Coughing Status asthmaticus causes labored breathing and wheezing. Coughing indicates that the client is exchanging air and is a manifestation of pneumonia, not status asthmaticus. A client who has status asthmaticus has distended neck veins while trying to facilitate breathing due to increased pulmonary pressure. Use of accessory muscles MY ANSWER A client who has status asthmaticus uses accessory muscles to help facilitate breathing, which is a manifestation of a severe airflow obstruction. The situation is life-threatening and the nurse should intervene immediately with strong systemic bronchodilators, epinephrine, corticosteroids, and oxygen. Presence of coarse crackles The presence of coarse crackles indicates air movement through fluid-filled airways and is a manifestation of pneumonia, not status asthmaticus.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 80 loade d rationals provide d Question: 80 of 90 CORRECT  Time Remaining: 00:36:27  Pause Remaining: 00:05:00 PAUSE joe 11 Flat neck veins 12Question: 90 of 90Question: 90 of 90 FLAG A nurse is teaching a client who has a new prescription for phenytoin to treat a seizure disorder. Which of the following adverse effects should the nurse instruct the client to report immediately to the provider? Tender, bleeding gums Gingival hyperplasia is an overgrowth of gum tissue that causes the gums to bleed, swell, and become tender. Gingival hyperplasia is nonurgent adverse effect when a client is taking phenytoin; therefore, there is another finding that is the priority. The nurse should advise the client to maintain good oral hygiene with a soft toothbrush and to follow up with an oral health professional. Increased facial hair Hirsutism, an increased growth of hair in unexpected places on the client's body, is nonurgent because it is an expected finding for a client who is taking phenytoin. Constipation Constipation is nonurgent because it is an expected finding for a client who is taking phenytoin. MY ANSWER When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a rash, which can have a measles-like appearance and progress to exfoliative dermatitis or Stevens-Johnson syndrome. The client should report this finding to the provider immediately.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 79 loade d rationals provide d Question: 79 of 90 INCORRECT  Time Remaining: 00:36:21  Pause Remaining: 00:05:00 joe 12 Skin rash 15Question: 90 of 90Question: 90 of 90 This response indicates role overload because the client is feeling overwhelmed with having to care for their aging parents. "At times, I get so frustrated with how to care for my parents." This response indicates role strain, in which the client feels unsure and frustrated about caring for their aging parents. Feelings of inadequacy can also occur with role strain. "I am learning to take care of my parents as I go." MY ANSWER This response indicates role ambiguity, in which the client feels unsure about how to care for their aging parents. This might create stress for the client.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 76 loade d rationals provide d Question: 76 of 90 CORRECT FLAG  Time Remaining: 00:36:00  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is receiving vancomycin intermittent IV bolus therapy for methicillin-resistant Staphylococcus aureus (MRSA). Which of the following findings is an indication to the nurse that the client is experiencing an adverse effect of the medication? The client can have an adverse effect called red man syndrome, which causes hypotension and tachycardia, due to infusing the vancomycin too rapidly. The nurse should infuse the medication over at least 60 min. The client is becoming flushed. MY ANSWER Flushing is a manifestation of an infusion reaction to vancomycin that also causes a rash on the face and upper body, called red man syndrome. Red man syndrome results from joe 15 The client's blood pressure is elevated. BUN 24 mg/dL MY ANSWER 16Question: 90 of 90Question: 90 of 90 infusing vancomycin too rapidly. The nurse should infuse the medication over at least 60 min. The client reports blurred vision. Blurred vision is not a manifestation of an infusion reaction to vancomycin. Vancomycin can have sensory implications, however. Although rare, it can cause ototoxicity, which is generally reversible. The client is experiencing polyuria. Polyuria is not a manifestation of an infusion reaction to vancomycin. However, vancomycin can cause renal failure.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 75 loade d rationals provide d Question: 75 of 90 CORRECT FLAG  Time Remaining: 00:35:54  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a male client who has a new prescription for cyclosporine following a kidney transplant. Which of the following findings should the nurse identify as an adverse effect of this therapy? WBC count 8,000/mm3 A WBC count of 8,000/mm<sup3< sup=""> is within the expected reference range of 5,000 to 10,000/mm3. If the client develops leukopenia, the nurse should notify the provider because the client is at risk for infection when taking an immunosuppressant such as cyclosporine.</sup3<> RBC count 6 million/mm3 An RBC count of 6 million/mm3 is within the expected reference range of 4.7 to 6.1 million/mm3 for men and 4.2 to 5.4 million/m3 for women. If the client's RBC count decreases, the nurse should notify the provider because the client is at risk for bleeding following an organ transplant. joe 16 17Question: 90 of 90Question: 90 of 90 A BUN of 24 mg/dL is above the expected reference range of 10 to 20 mg/dL, indicating renal impairment. An adverse effect of cyclosporine is nephrotoxicity. The nurse should monitor the client for increases in BUN and creatinine and report any elevation to the provider. A rise in BUN could indicate transplant rejection. Potassium 3.5 mEq/L A potassium level of 3.5 mEq/L is within the expected reference range of 3.5 to 5 mEq/L and does not indicate nephrotoxicity. However, the nurse should report a dramatic change in potassium level to the provider.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 74 loade d rationals provide d Question: 74 of 90 CORRECT FLAG  Time Remaining: 00:35:49  Pause Remaining: 00:05:00 PAUSE joe 17 20Question: 90 of 90Question: 90 of 90 A nurse is assessing a client who takes salmeterol to treat moderate asthma. Which of the following findings should indicate to the nurse that the medication has been effective? A client who has asthma should use a peak flow meter twice daily to monitor asthma control. A PEF in the green zone, or 80% or above personal best, indicates the effectiveness of medication therapy. The client's ABGs shows a pH level of 7.32. A pH level of 7.32 indicates the client is in an acidotic state. Acidosis occurs with bronchoconstriction and indicates the medication has not been effective. The client's forced expiratory volume is decreased after treatment with medication. MY ANSWER Forced expiratory volume measures the amount of air the client exhales during 1 second and is part of pulmonary function testing. Effective use of a bronchodilator should increase the client's forced expiratory volume. The client's wheezing is limited to expiratory. joe 20 The client's daily peak expiratory flow (PEF) measures 85% above personal best. 21Question: 90 of 90Question: 90 of 90 Salmeterol is a long-acting bronchodilator that helps prevent asthma attacks. Wheezing is a narrowing of the airways and indicates that the medication has not been effective.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 72 loade d rationals provide d Question: 72 of 90 CORRECT FLAG  Time Remaining: 00:35:38  Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching about health promotion activities for a client who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? "If I can keep my hemoglobin A1C less than 6.5%, I will be cured of diabetes." Tight control of blood glucose levels can minimize complications associated with diabetes mellitus such as cardiovascular disease, nephropathy, neuropathy, and retinopathy. The nurse should instruct the client that type 1 diabetes mellitus is a chronic condition that causes the body to fail to manufacture insulin and cannot currently be cured. MY ANSWER Clients who have diabetes mellitus should not exercise if their blood glucose level is less than 80 mg/dL or greater than 250 mg/dL. A client who has type 1 diabetes mellitus and is hyperglycemic can experience even higher blood glucose levels. Hypoglycemia can also occur during exercise and up to 24 hr following exercise. The nurse should instruct the client to monitor blood glucose levels before, during, and following exercise. "I should have my eyes checked every 2 years." Microvascular changes to the vessels in the eyes occurs with elevated blood glucose levels, which can lead to retinopathy. To monitor for changes to the eyes, the client should have eye examinations every year. joe 21 "I will check my blood sugar level before exercising." 22Question: 90 of 90Question: 90 of 90 "I should soak my feet daily in warm, soapy water." Health promotion activities for a client who has diabetes mellitus includes foot care. Clients should inspect their feet and wash them daily with warm water and soap. However, clients should not soak their feet because this can lead to maceration of the skin and skin breakdown.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 71 loade d rationals provide d Question: 71 of 90 CORRECT FLAG  Time Remaining: 00:35:31  Pause Remaining: 00:05:00 PAUSE joe 22 25Question: 90 of 90Question: 90 of 90 A nurse is assisting with the care of a client who is scheduled for a thoracentesis. Which of the following interventions should the nurse plan to take? Inform the client that they must empty their bladder before the procedure. A client who is undergoing a paracentesis should empty their bladder before the procedure to prevent injury to the bladder. This action is not necessary before a thoracentesis. Weigh the client before and after the procedure. The nurse should weigh a client who is scheduled for a paracentesis before and after the procedure to identify how much fluid the procedure removes from the client's abdomen. This action is not necessary before and after a thoracentesis. MY ANSWER The nurse should place the client leaning forward over the bedside table for a thoracentesis. This allows the provider complete access to the client's chest and back. This position also expands the spaces between the ribs where the pleural fluid accumulates. Keep the client on bed rest after the procedure. joe 25 Place the client leaning forward over the bedside table for the procedure. 26Question: 90 of 90Question: 90 of 90 A client who undergoes a paracentesis remains on bed rest following the procedure. The nurse should monitor the client for shortness of breath and listen to the client's lung sounds following the procedure. Bed rest is not necessary following a thoracentesis.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 69 loade d rationals provide d Question: 69 of 90 CORRECT FLAG  Time Remaining: 00:35:19  Pause Remaining: 00:05:00 PAUSE joe 26 27Question: 90 of 90Question: 90 of 90 A nurse is providing discharge teaching about infection control at home for a client who has tuberculosis. Which of the following statements by the client indicates an understanding of the teaching? "I will have to move out of my family's home until I am no longer contagious." Individuals living in the same household as the client have already been exposed to the tuberculosis bacteria, so it is not necessary for the client to be isolated from others in the household. Instead, the nurse should instruct the client that all members living in the household should be tested for tuberculosis. Clients who have tuberculosis are no longer considered contagious when three consecutive sputum samples test negative for Mycobacterium tuberculosis, which often occurs 2 to 3 weeks after starting the medication regimen. "I will place my used tissues in a plastic bag." MY ANSWER The sputum of a client who has tuberculosis is considered infectious until there are three consecutive sputum samples that test negative for Mycobacterium tuberculosis. Tissues that are soiled with the client's sputum should be placed in a plastic bag and sealed to avoid spreading the infection. The tuberculosis bacteria is easily spread through microscopic droplets, which can be spread when coughing, sneezing, talking, laughing, or singing. Placing hands over the mouth to cover the cough can result in the bacteria being present on the hands and transferred to another individual, spreading the infection. The nurse should instruct the joe 27 "I will cover my mouth with my hands when I have to cough." 30Question: 90 of 90Question: 90 of 90 disposable utensils, plates, and cups during this time period to decrease the risk for radiation exposure to other members of the household. Use an absorbent pad if incontinent. If a client experiences incontinence, specific steps should be taken because body fluids are radioactive for several weeks after therapy. Male clients should use a condom catheter and a drainage bag. Urine from the drainage bag can then be poured into the toilet and flushed. Women who are incontinent should be encouraged to use facial tissues placed within their clothing to absorb the urine. The tissues can be flushed as they become soiled with urine. The use of an absorbent pad keeps the radiation in close contact with the client, which should be avoided.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 67 loade d rationals provide d Question: 67 of 90 CORRECT FLAG  Time Remaining: 00:35:08  Pause Remaining: 00:05:00 PAUSE A nurse is providing preoperative teaching to a client who is scheduled for a radical prostatectomy. Which of the following information should the nurse include in the teaching? The client will be on bed rest while continuous bladder irrigation is in place. It is important to initiate ambulation soon after surgery to prevent complications, such as venous thromboembolism. A client who has had an open radical prostatectomy should dangle their legs over the side of the bed and then sit in a chair on the day of surgery. Ambulation should begin the next morning. Cold compresses will be used to manage bladder spasms. The nurse should use oxybutynin, sitz baths, or warm compresses to relieve bladder spasms. The client will have an NG tube in place for 48 hr postoperatively. joe 30 31Question: 90 of 90Question: 90 of 90 Clients who are undergoing gastrointestinal surgery require an NG tube. However, a client who is postoperative following an open radical prostatectomy does not require an NG tube. Bowel sounds and function should return postoperatively within the first 24 hr. MY ANSWER A PCA pump is a common method of pain management in the first 24 hr following an open radical prostatectomy. The nurse should teach the client how to manage pain during the preoperative period rather than waiting until after surgery when the client is feeling the sedative effects of the anesthesia and pain medication.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 66 loade d rationals provide d Question: 66 of 90 CORRECT FLAG  Time Remaining: 00:35:02  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client's ECG strip and notes an irregular heart rate of 98/min with no clear P waves. Which of the following cardiac dysrhythmias should the nurse document? First-degree heart block With a first-degree atrioventricular (AV) block, the atrial impulses reach the ventricles through the AV node at a slower-than-normal rate. The P waves have a regular shape and appear consistently in front of the QRS complex. MY ANSWER With atrial fibrillation, multiple rapid impulses from many different foci cause depolarization of the atria in a rapid, disorganized manner. This causes a chaotic rhythm on the ECG strip that has no clear P waves, no atrial contractions, and an irregular rhythm. Complete heart block joe 31 A PCA pump will be used for postoperative pain control. Atrial fibrillation 32Question: 90 of 90Question: 90 of 90 Complete heart block has regular rhythm with a low heart rate, and P waves are clear, but they outnumber the QRS complexes. There are two different impulses: one that stimulates the atria, thus generating the P wave, and another that stimulates the ventricles, creating the QRS complex. Ventricular tachycardia Ventricular tachycardia is a rapid, regular rhythm with a heart rate of 140/min or faster. P waves are rarely visible with sustained ventricular tachycardia.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 65 loade d rationals provide d Question: 65 of 90 CORRECT FLAG  Time Remaining: 00:34:57  Pause Remaining: 00:05:00 PAUSE joe 32 35Question: 90 of 90Question: 90 of 90 A nurse is assessing a client who has suspected appendicitis. Which of the following manifestations should the nurse expect? (Select all that apply.) Elevated amylase level Ascites MY ANSWER Elevated WBC count is correct. A client who has acute appendicitis will show a moderate elevation of the WBC count from 10,000 to 18,000/mm3. If the WBC count is greater than 20,000/mm3, it can indicate a perforated appendix. Elevated amylase level is incorrect. Amylase levels increase with pancreatitis but not with acute appendicitis. joe 35 Rebound tenderness Anorexia Elevated WBC count 36Question: 90 of 90Question: 90 of 90 Rebound tenderness is correct. A client who has appendicitis develops localized pain over the right lower quadrant of the abdomen. When the area is palpated, pain occurs during release of pressure on the client's abdomen. Ascites is incorrect. Ascites can be a manifestation of cirrhosis; however, it is not associated with appendicitis. Anorexia is correct. A client who has acute appendicitis experiences nausea, vomiting, and reduced appetite.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 63 loade d rationals provide d Question: 63 of 90 CORRECT FLAG  Time Remaining: 00:34:45  Pause Remaining: 00:05:00 PAUSE A nurse is planning preventative strategies for a client who is at risk for pressure injuries. Which of the following actions should the nurse include in the plan? Maintain the head of the bed greater than 45°. The nurse should keep the head of the client’s bed at 30° or lower to avoid shearing action on the skin. Place a donut-shaped cushion under the client's sacrum. A donut-shaped cushion or pillow damages capillary beds in the areas of pressure and can increase the risks of tissue breakdown and necrosis. Massage bony prominences three times daily. Massaging bony prominences damages capillary beds and can increase the risk of tissue breakdown and necrosis. joe 36 Apply moisturizer to damp skin after bathing. 37Question: 90 of 90Question: 90 of 90 MY ANSWER Applying a moisturizer to damp skin after bathing helps prevent dry skin. The drier the skin is, the greater the risk is for skin breakdown.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 62 loade d rationals provide d Question: 62 of 90 CORRECT FLAG  Time Remaining: 00:34:39  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. Which of the following findings should the nurse identify as a manifestation of type 1 diabetes? Hypernatremia Clients who have type 1 diabetes mellitus have a decrease in serum sodium levels because of osmotic diuresis by the kidneys. Decreased serum osmolality Clients who have type 1 diabetes mellitus and have hyperglycemia can develop dehydration, which increases serum osmolality. High osmolality values can lead to stupor and grand mal seizures. MY ANSWER Clients who have type 1 diabetes mellitus can have ketones in the urine, which are a byproduct of the breakdown of fats for energy. Ketones in the urine are an indicator of inadequate amounts of insulin and high blood glucose levels. Hypoglycemia Clients who have type 1 diabetes mellitus have hyperglycemia when they produce too little insulin to metabolize glucose for energy. joe 37 Ketones in the urine 40Question: 90 of 90Question: 90 of 90  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 60 loade d rationals provide d Question: 60 of 90 CORRECT FLAG  Time Remaining: 00:34:27  Pause Remaining: 00:05:00 PAUSE A nurse is providing discharge teaching to a client following a loop electrosurgical excision procedure (LEEP) for the treatment of cervical cancer. Which of the following statements by the client indicates an understanding of the teaching? "I can resume sexual intercourse in 48 hours." During the healing period, the client is at an increased risk for infection. Therefore, the client should refrain from sexual intercourse for the time period the provider prescribes, which is usually 3 weeks or until healing is complete. "I can expect some heavy vaginal bleeding for 24 hours." The client should report heavy vaginal bleeding because this can be an indication of complications. The client can expect mild spotting after the LEEP procedure, which cuts away the affected cervical tissue using a painless electrical current. "I can use tampons when my period comes in a week." The client should not use tampons, because they can increase the risk for infection. Following the recovery period, which is usually 3 weeks, the client can resume the use of tampons. MY ANSWER The client should expect very little discomfort from the LEEP procedure, which is performed in ambulatory care using a painless electrical current.  RN VATI Adult Medical Surgical 2019 joe 40 "I may have mild cramping for several hours." 41Question: 90 of 90Question: 90 of 90 CLOSE Que stion 59 loade d rationals provide d Question: 59 of 90 CORRECT FLAG  Time Remaining: 00:34:21  Pause Remaining: 00:05:00 PAUSE joe 41 42Question: 90 of 90Question: 90 of 90 A nurse is assessing a group of clients. For which of the following clients should the nurse make a referral to palliative care? A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin Clients who have type 1 diabetes mellitus require insulin to maintain blood glucose levels within the expected reference range. The nurse should refer clients who cannot afford to purchase medications to a social worker who has expertise in identifying resources to assist with purchasing medications at a discounted rate. A client who has Meniere's disease and cannot safely ambulate due to vertigo Meniere's disease is a sensorineural disorder affecting the auditory system and causes tinnitus, hearing loss, and vertigo, or dizziness. Vertigo can increase the risk for falls. The nurse should refer this client to a physical or occupational therapist, who will determine the need for assistive devices and evaluate the client's home for safety. A client who had a stroke and cannot eat or drink without choking A stroke can impact cranial nerve function. Impairment of cranial nerves IX and X results in dysphagia. If this occurs, the nurse should make the client NPO and make a referral to a speech-language pathologist. MY ANSWER Parkinson's disease is a neurodegenerative disease marked by alterations in mobility, cognition, mood, and functioning of the sympathetic nervous system. The effectiveness of medications used to manage the symptoms can decrease over time. When this occurs, the nurse should make a referral to palliative care. Palliative care is designed to maintain the joe 42 A client whose medications to manage Parkinson's disease are no longer effective 45Question: 90 of 90Question: 90 of 90  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 56 loade d rationals provide d Question: 56 of 90 INCORRECT FLAG  Time Remaining: 00:34:00  Pause Remaining: 00:05:00 PAUSE joe 45 46Question: 90 of 90Question: 90 of 90 A nurse is caring for a client who had abdominal surgery. The client tells the nurse that "something gave way." The nurse removes the dressing and sees the wound has eviscerated. Identify the correct sequence of steps the nurse should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.) 3 2 1 4 Based on evidence-based practice, the nurse should immediately contact the surgeon and notify them of the wound evisceration. The nurse should then cover the client’s wound with a sterile saline soaked dressing to protect it from infection. The nurse should then place the client in a low Fowler's position with their knees bent and then prepare the client to be transferred to surgery.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 55 loade d rationals provide d Question: 55 of 90 CORRECT FLAG  Time Remaining: 00:33:54  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is hemorrhaging and hypotensive from esophageal variceal bleeding. Which of the following actions should the nurse take first? Administer vasopressin to the client. joe 46 Place the client in a low Fowler's position with the knees bent. Cover the client's wound with a sterile saline-soaked dressing.  Prepare the client for transfer to surgery. Notify the surgeon about the finding. 47Question: 90 of 90Question: 90 of 90 The nurse should administer a vasoactive medication, such as vasopressin. This medication increases blood pressure through vasoconstriction. However, there is another action the nurse should take first. Request blood from blood bank. The nurse should request blood from a blood bank in preparation for a blood transfusion. However, there is another action the nurse should take first. Blood should not be requested until the nurse has verified that the client has adequate IV access. MY ANSWER When using the airway, breathing, and circulation approach to client care, the nurse should first verify that the client has at least a 20-gauge IV for the administration of blood. Insert an indwelling urinary catheter. The nurse should insert an indwelling urinary catheter to monitor urinary output and the effectiveness of treatments. However, there is another action the nurse should take first.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 54 loade d rationals provide d Question: 54 of 90 CORRECT FLAG  Time Remaining: 00:33:47  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who has a new diagnosis of diabetes mellitus. The nurse should identify that which of the following findings is a manifestation of hyperglycemia? MY ANSWER The nurse should teach the client that increased thirst, or polydipsia, is a manifestation of hyperglycemia, which can lead to dehydration. Other manifestations of hyperglycemia joe 47 Verify that the client has adequate IV access. Increased thirst 50Question: 90 of 90Question: 90 of 90 A nurse is preparing to discharge a client who is postoperative following a total hip arthroplasty. Which of the following equipment should the nurse ensure that the client has available at home prior to discharge? Continuous passive motion device Continuous passive motion devices promote range of motion and the prevention of scar tissue of the knee following a total knee arthroplasty. However, they are not used for the client who is postoperative following a total hip arthroplasty. MY ANSWER A client who is postoperative following a total hip arthroplasty is at risk for dislocation of the hip prosthesis. Limitations on hip flexion and adduction decrease the risk. The client should avoid flexing the hip greater than 90° and should avoid using toilet seats that are low to the ground. An elevated toilet seat should be in place in the client's home prior to the client's discharge. joe 50 Elevated toilet seat 51Question: 90 of 90Question: 90 of 90 Trapeze bar A trapeze bar in unnecessary for a client who had a total knee arthroplasty because they receive physical therapy and occupational therapy during their inpatient stay regarding bed mobility and transfers. Compression garment Compression garments are specially designed elasticized clothing used in the treatment of burns. The compression garment places continuous pressure on the burn injury following grafting to promote healing and limit the development of scarring, which could inhibit mobility.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 51 loade d rationals provide d Question: 51 of 90 CORRECT FLAG  Time Remaining: 00:33:30  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who has a history of type 2 diabetes mellitus. The nurse should identify which of the following findings as an indication of a microvascular complication? Coronary artery disease Coronary artery disease is a macrovascular complication of diabetes mellitus. Macrovascular complications result from pathologic changes in large or generalized vessels as a result of hyperglycemia, hyperlipidemia, and an inflammatory process reflected in elevated C-reactive protein levels. The alterations in lipid metabolism that characterize diabetes accelerate the development of atherosclerotic plaque, which is a characteristic of coronary artery disease. MY ANSWER joe 51 Retinopathy 52Question: 90 of 90Question: 90 of 90 Diabetic retinopathy is a microvascular complication of diabetes mellitus resulting from pathologic changes in small blood vessels, which eventually cause tissue damage, cell death in the retina, and blindness. Cerebrovascular accident A cerebrovascular accident, or stroke, is a macrovascular complication of diabetes mellitus. Macrovascular complications result from pathologic changes in medium or large vessels as a result of hyperglycemia, hyperlipidemia, and an inflammatory process reflected in elevated C-reactive protein levels. It is essential for a client who has diabetes mellitus to reduce risk factors that can precipitate stroke, such as cigarette smoking. Hypertension Hypertension is a macrovascular complication of diabetes mellitus. Macrovascular complications result from pathologic changes in large or generalized vessels as a result of hyperglycemia, hyperlipidemia, and an inflammatory process reflected in elevated C- reactive protein levels. These factors eventually lead to hypertension, other cardiovascular disorders, or cerebrovascular diseases.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 50 loade d rationals provide d Question: 50 of 90 CORRECT FLAG  Time Remaining: 00:33:24  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is receiving a transfusion of packed RBCs. The nurse notes that the client's blood type is AB positive and the blood infusing is labeled type B negative. Which of the following actions should the nurse take? Stop the blood transfusion immediately. Clients who have type AB blood are universal recipients and can receive any ABO blood type. Clients who have Rh-positive blood can receive a transfusion from a Rh-negative donor. joe 52 55Question: 90 of 90Question: 90 of 90 A client should not take vitamin C supplements for 3 days before collecting the specimen because this supplement can cause a false-positive result in a fecal occult blood test. MY ANSWER A client should not eat red meat for 3 days before collecting the specimen because red meat contains hemoglobin, myoglobin, and some enzymes that can cause a false-positive result in a fecal occult blood test.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 47 loade d rationals provide d Question: 47 of 90 INCORRECT FLAG  Time Remaining: 00:33:06  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client immediately following intubation with an endotracheal (ET) tube. Which of the following methods should the nurse identify as the most reliable for verifying placement of the ET tube? Feel for exhaled air emerging from the endotracheal tube. The nurse should feel with the palm of the hand for exhaled air to determine if there is air exchange in both lungs. However, evidence-based practice indicates that there is a more reliable method for verifying placement of the ET tube. Assess for bilateral breath sounds. MY ANSWER The nurse should assess for bilateral breath sounds to determine if there is air exchange in both lungs. However, evidence-based practice indicates that there is a more reliable method for verifying placement of the ET tube. Observe for symmetric chest movement. joe 55 Avoid eating red meat. 56Question: 90 of 90Question: 90 of 90 The nurse should observe for symmetric chest movement to determine if there is air exchange in both lungs. However, evidence-based practice indicates that there is a more reliable method for verifying placement of the ET tube. According to evidence-based practice, the most reliable method for verifying ET tube placement is checking for end-tidal carbon dioxide levels by using capnometry. A chest x- ray is another reliable method for verifying placement.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 46 loade d rationals provide d Question: 46 of 90 CORRECT FLAG  Time Remaining: 00:33:01  Pause Remaining: 00:05:00 PAUSE A nurse notes that a client's eyes are protruding slightly from their orbits. Which of the following laboratory findings should the nurse expect? Decreased calcium levels Low serum calcium levels reflect hypoparathyroidism and cause tetany, not exophthalmos. Decreased somatotropin levels A decrease in somatotropin levels related to growth hormones is helpful in confirming hypopituitarism and adrenocortical hypofunction, but exophthalmos is not a manifestation of these conditions. Increased glucose levels Diabetes mellitus is the most common cause of increased serum glucose levels. Hyperglycemia, however, does not cause exophthalmos. MY ANSWER joe 56 Increased T4 levels Check for end-tidal carbon dioxide levels. 57Question: 90 of 90Question: 90 of 90 Exophthalmos, an abnormal protrusion of the eyeballs, is a classic sign of hyperthyroidism. Elevated thyroid hormone levels (T3 and T4) and a decreased thyroid stimulating hormone level reflect primary hyperthyroidism.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 45 loade d rationals provide d Question: 45 of 90 CORRECT FLAG  Time Remaining: 00:32:54  Pause Remaining: 00:05:00 PAUSE A nurse is preparing a teaching plan for a client who is starting to receive hemodialysis for chronic kidney disease. Which of the following instructions should the nurse include in the teaching? "Use salt substitutes to reduce your sodium intake." Salt substitutes can contain high amounts of potassium. The client should use herbs and spices instead of salt or salt substitutes to decrease the risk for retention of sodium, potassium, and fluids due to reduced kidney function. "Increase your fluid intake to 1,000 mL a day." Fluid restriction is common for clients who have chronic kidney disease. Most clients are allowed 500 mL to 700 mL of fluid intake per day plus a volume equal to the amount of urine excreted each day. "Include phosphorus-rich foods in your diet." A client who is starting hemodialysis needs an increased protein intake, which will also increase phosphorus intake. Phosphorus restriction is necessary to prevent renal osteodystrophy. MY ANSWER joe 57 "Increase your intake of protein to 1 to 1.5 grams per kilogram per day." 60Question: 90 of 90Question: 90 of 90  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 43 loade d rationals provide d Question: 43 of 90 CORRECT FLAG  Time Remaining: 00:32:42  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is intubated and receiving mechanical ventilation for heroin toxicity. Which of the following assessments is the nurse's priority? WBC count The nurse should monitor the client's WBC count to check for infection. However, there is another assessment that is the nurse's priority. Intake and output The nurse should monitor the client's intake and output to evaluate hydration status. However, there is another assessment that is the nurse's priority. MY ANSWER When using the airway, breathing, and circulation (ABC) approach to client care, the nurse's priority assessment is to monitor the client's ABGs, including respiratory status. Blood glucose level The nurse should monitor the client's blood glucose level to check for hypoglycemia or hyperglycemia. However, there is another assessment that is the nurse's priority.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 42 loade d rationals provide d Question: 42 of 90 INCORRECT  Time Remaining: 00:32:33 joe 60 ABGs 61Question: 90 of 90Question: 90 of 90 FLAG  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who has a new diagnosis of pericarditis. Which of the following findings should the nurse identify as a manifestation of cardiac tamponade? Fever Fever and an elevated WBC count are manifestations of bacterial pericarditis, not cardiac tamponade. Atrial fibrillation MY ANSWER Atrial fibrillation is a manifestation of acute pericarditis, not cardiac tamponade. Cardiac tamponade results from an excess of fluid in the pericardial cavity and causes a sudden drop in cardiac output. Paradoxical pulse is a systolic blood pressure of 10 mm Hg or more on expiration and is a manifestation of cardiac tamponade. The nurse should report manifestations of cardiac tamponade to the provider immediately. Pericardial friction rub A pericardial friction rub is a scratchy, high-pitched sound resulting from inflamed pericardial tissue and is a manifestation of acute pericarditis, not cardiac tamponade.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 41 loade d rationals provide d Question: 41 of 90 CORRECT FLAG  Time Remaining: 00:32:26  Pause Remaining: 00:05:00 PAUSE joe 61 Paradoxical pulse 62Question: 90 of 90Question: 90 of 90 A nurse is assessing a client who is undergoing radiation therapy for breast cancer. Which of the following findings is an indication to the nurse that the client is experiencing an adverse effect of the therapy? Stomatitis Stomatitis is an adverse effect of chemotherapy. Stomatitis can occur with radiation of the head and neck, but not radiation of the breast. A client who is receiving radiation therapy can have an adverse effect of taste changes due to dead cell metabolism. Vomiting Vomiting is an adverse effect of chemotherapy and generally develops after radiation to the abdomen and pelvis. Radiation therapy to the abdomen can also cause vomiting. MY ANSWER A client who is receiving radiation therapy to the breast will have localized adverse effects of the treatment, such as skin changes, esophagitis, and lymphedema. Hematuria Hematuria is an adverse effect of chemotherapy and generally develops after radiation to the abdomen and pelvis, causing cystitis that can lead to bleeding.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 40 loade d rationals provide d Question: 40 of 90 CORRECT FLAG  Time Remaining: 00:32:20  Pause Remaining: 00:05:00 PAUSE A nurse is preparing to administer enoxaparin 0.75 mg/kg subcutaneously to a client who weighs 154 lb. The amount available is enoxaparin 60 mg/0.6 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) joe 62 Skin changes 0.5 mL. 65Question: 90 of 90Question: 90 of 90 X mL = × × × 60 mg 1 kg 2.2 lb 1 dose Step 4: Solve for X. X mL = 0.525 mL Step 5: Round if necessary. 0.525 mL = 0.5 mL Step 6: Determine whether the amount to administer makes sense. If there are 60 mg/0.6 mL and the prescription reads 0.75 mg/kg subcutaneously, it makes sense to administer The nurse should administer enoxaparin 0.5 mL subcutaneously.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 39 loade d rationals provide d Question: 39 of 90 CORRECT FLAG  Time Remaining: 00:32:14  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a group of clients. In which of the following scenarios is the nurse acting as a client advocate? MY ANSWER Palliative care is an interdisciplinary approach to client care that works toward optimizing the quality of life for a client who has a chronic illness. Nurses advocate for their clients when they promote the health, safety, and rights of the client, such as providing a referral for needed services to relieve suffering and promote a client's quality of life. The nurse provides wound care to a client at the time promised to the client. Fidelity is the act of keeping promises. Nurses demonstrate fidelity by following the nursing code of ethics, caring for clients whose personal and political views differ from that of the nurse, and by keeping promises, such as delivering care at a specified time. The nurse declines to inform a client's neighbor about the client's prognosis. joe 65 The nurse refers a client who has chronic obstructive pulmonary disease for palliative care services. 66Question: 90 of 90Question: 90 of 90 Federal regulations mandate that health care personnel cannot share a client's personal health information with individuals whom the client has not designated as being able to receive the information. The Health Insurance Portability and Accountability Act (HIPAA) has established fines for breaching confidentiality of personal health information. The nurse files an incident report regarding a medication error. Nurses demonstrate responsibility by following the policies and procedures of health care facilities, such as filing an incident report following an unusual or unexpected occurrence. Nurses have an obligation to follow through with the expectations of the facility and the profession of nursing as identified in the nursing code of ethics.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 38 loade d rationals provide d Question: 38 of 90 INCORRECT FLAG  Time Remaining: 00:32:06  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who recently had a myocardial infarction. Which of the following findings indicates that the client might be developing pulmonary edema? (Select all that apply.) Epistaxis Urinary frequency MY ANSWER Excessive somnolence is correct. Manifestations of pulmonary edema can include a change in orientation or mental status. A client who has excessive somnolence might be experiencing pulmonary edema. joe 66 Excessive somnolence Pink, frothy sputum Tachypnea 67Question: 90 of 90Question: 90 of 90 Epistaxis is incorrect. Epistaxis, or a nosebleed, can be an indication of a low platelet count; however, it is not a manifestation associated with pulmonary edema. Pink, frothy sputum is correct. A client who has pulmonary edema can develop pink, frothy sputum, wheezing, and tachypnea. Tachypnea is correct. A client who has pulmonary edema can develop pink, frothy sputum, wheezing, and tachypnea. Urinary frequency is incorrect. The client who is developing pulmonary edema is retaining fluid. Once treated with diuretics, the kidneys will begin excreting sodium and water.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 37 loade d rationals provide d Question: 37 of 90 INCORRECT FLAG  Time Remaining: 00:32:00  Pause Remaining: 00:05:00 PAUSE A nurse is teaching a client about preventing the transmission of HIV. Which of the following information should the nurse include? Use a natural material condom during oral, genital, and anal intercourse. MY ANSWER The consistent use of latex condoms can reduce the risk for transmission of HIV. However, natural material condoms, such as lambskin condoms, do not provide protection. Tenofovir/emtricitabine is an oral medication that can be used prophylactically by a client who does not have an HIV infection to reduce the risk for HIV transmission. Pre-exposure prophylaxis is recommended for men who have sexual relationships with men, clients who joe 67 Medication is available that will reduce the risk for HIV transmission. 70Question: 90 of 90Question: 90 of 90 The nurse should use symbols instead of written signs to redirect the client who has dementia. Written signs can confuse the client by requiring the ability to read, which can be affected by the dementia. Therefore, using symbols makes it easier to redirect the client and for them to remember. Seat the client at a large table for meals. The nurse should seat the client who has dementia at a small table with three or five other clients during mealtime. A larger table with multiple clients can be overwhelming and confusing to a client who has dementia.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 34 loade d rationals provide d Question: 34 of 90 CORRECT FLAG  Time Remaining: 00:31:43  Pause Remaining: 00:05:00 PAUSE joe 70 71Question: 90 of 90Question: 90 of 90 A nurse is completing an admission assessment for a client who has bacterial meningitis. Which of the following personal protective equipment should the nurse use while caring for the client? N95 respirator An N95 respirator is required for specific diseases that have airborne transmission, such as measles, tuberculosis, and chickenpox, but it is not required with bacterial meningitis. Goggles Goggles are not necessary when obtaining a client's vital signs because the nurse is not at risk for any splashing of secretions. Disposable gown A gown is not necessary, because transmission of the micro-organisms that cause bacterial meningitis does not occur through direct contact. joe 71 72Question: 90 of 90Question: 90 of 90 MY ANSWER The nurse should adhere to droplet precautions in addition to standard precautions for clients who have bacterial meningitis, provided the causative pathogen spreads via droplets. Examples of pathogens that spread via droplets include Haemophilus influenzae and Neisseria meningitidis. The nurse should place these clients in a private room and wear a mask when within 0.9 m (3 feet) of the client to prevent acquiring the infection. Clients should wear a mask whenever they are outside their room. These precautions are essential until 24 hr after the initiation of antibiotic therapy.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 33 loade d rationals provide d Question: 33 of 90 CORRECT FLAG  Time Remaining: 00:31:36  Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client for fluid volume deficit following lumbar spinal surgery. The nurse should identify which of the following findings as an indication the client is at risk for fluid volume deficit? BUN 16 mg/dL A BUN level of 16 mg/dL is within the expected reference range of 10 to 20 mg/dL. An elevated BUN level can indicate a risk for fluid volume deficit. Urine output 40 mL every hour for 3 hr Urine output of 40 mL every hour for 3 hr is within the expected reference range. A minimum of 400 mL to 600 mL of urine in 24 hr is necessary to excrete toxic waste. Hct 42% An Hct of 42% is within the expected reference range of 37% to 52%. An Hct above the expected reference range can indicate fluid volume deficit. joe 72 Surgical mask 75Question: 90 of 90Question: 90 of 90 A nurse is planning care for a client who is scheduled for surgery and has a latex allergy. Which of the following actions should the nurse plan to take? Schedule the client for the last surgery of the day. The nurse should schedule the client for the first procedure of the day to minimize the client's exposure to latex, including latex dust. MY ANSWER The nurse should place monitoring devices in a stockinette to prevent direct contact with the client's skin. Choose rubber injection ports for fluid administration. Rubber injection ports contain latex, which places the client at risk for an allergic reaction. The nurse should ensure that latex-free products are available for this client and use stopcocks to inject medications. joe 75 Place monitoring cords and tubes in a stockinette. 76Question: 90 of 90Question: 90 of 90 Have phenytoin IV readily available. The nurse should ensure that epinephrine is readily available in the surgical suite in case of an anaphylactic reaction.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 30 loade d rationals provide d Question: 30 of 90 CORRECT FLAG  Time Remaining: 00:31:19  Pause Remaining: 00:05:00 PAUSE joe 76 77Question: 90 of 90Question: 90 of 90 A nurse is providing preoperative teaching about stool consistency to a client who will undergo a colectomy with the placement of an ileostomy. Which of the following information about stool consistency should the nurse include in the teaching? The stool will have a tarry color. The nurse should identify that a tarry color can indicate a GI bleed. MY ANSWER The nurse should include in the teaching that when peristalsis returns, the client can have an initial period of high-volume liquid stool output, more than 1,000 mL/day. Later, as the proximal small bowel adapts, stool volume should decrease. The stool will be solid and well-formed. The nurse identify that a descending colostomy excretes solid stool similar to what the rectum would eliminate. Drainage from an ileostomy is not solid because it is not passing through the colon, where a great deal of fluid is absorbed to form stool that is more solid in consistency. The stool will appear bloody with clots. joe 77 The stool will have a high volume of liquid. 80Question: 90 of 90Question: 90 of 90 "I'm not forgetful, so I do not need a pill reminder system." The client should take levothyroxine every morning 30 min before eating to maintain a therapeutic thyroid hormone level. Using a pill reminder system provides visual confirmation of whether or not the client took the medication each day.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 28 loade d rationals provide d Question: 28 of 90 INCORRECT FLAG  Time Remaining: 00:31:07  Pause Remaining: 00:05:00 PAUSE joe 80 81Question: 90 of 90Question: 90 of 90 A nurse is assessing a client who has an exacerbation of diverticular disease. In which of the following quadrants should the nurse anticipate the client to be experiencing abdominal pain? Diverticula commonly develop in the sigmoid colon because of the high pressure it takes to move stool into the rectum. Therefore, the pain with this disorder is often in the left lower quadrant. Left upper quadrant MY ANSWER Left upper quadrant pain is a manifestation of pancreatitis, not diverticular disease. Right lower quadrant Right lower quadrant pain is a manifestation of appendicitis, not diverticular disease. Right upper quadrant Right upper quadrant pain is a manifestation of cholecystitis, not diverticular disease. joe 81 Left lower quadrant 82Question: 90 of 90Question: 90 of 90  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 27 loade d rationals provide d Question: 27 of 90 INCORRECT FLAG  Time Remaining: 00:31:01  Pause Remaining: 00:05:00 PAUSE A nurse is planning care for a client who has a lump in their right breast. Which of the following findings increases the client's risk of developing breast cancer? Menarche started at age 15 MY ANSWER Early menarche, or menstruation, is considered a risk factor for developing breast cancer because the longer the interval is between the start of menarche and menopause, the greater the risk is for developing breast cancer. First born child was at 20 years of age Delivering a first child after the age of 30 increases the risk of breast cancer, as does nulliparity. History of a fibrocystic breasts A history of fibrocystic breasts is not a risk factor for breast cancer. Dense breast tissue increases the risk for breast cancer. Clients who take hormones, such as estrogen therapy, fertility drugs, and oral contraceptives, have an increased risk of developing breast cancer.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 26 loade d rationals provide d Question: 26 of 90 INCORRECT joe 82 Oral contraceptives were taken for the last 6 years 85Question: 90 of 90Question: 90 of 90 PAUSE FLAG A nurse is planning care for a client who is receiving intermittent IV fluids via a peripherally inserted central catheter (PICC). Which of the following information should the nurse include in the client's plan of care? MY ANSWER The nurse should assess the infusion system in a systematic fashion beginning with the insertion site, observing for signs of infection, and working upward and following the tubing to ensure that all connections are secure. Use a 3-mL syringe to flush the PICC following infusions. The nurse should use a 10-mL or larger syringe to flush the PICC because using a smaller syringe could place undue pressure on the catheter and increase the risk of rupture. Change the needleless connector device on the IV tubing after each infusion. The nurse should change the needleless connector device on the PICC at least once per week or in accordance with the facility's policy. Frequently changing the needleless connector device increases the risk of introducing micro-organisms into the client's bloodstream. Provide daily dressing changes to the PICC insertion site. Most facilities require PICC dressing changes every 5 to 7 days for transparent membrane dressings and when indicated, such as when wet, loose, or soiled. Changing the dressing daily can expose the client to the risk of bloodstream infection.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 23 loade d rationals provide d Question: 23 of 90 CORRECT  Time Remaining: 00:30:34  Pause Remaining: 00:05:00 joe 85 Assess the PICC infusion system systematically. 86Question: 90 of 90Question: 90 of 90 PAUSE FLAG A nurse is performing a risk assessment for a client. Which of the following factors should the nurse identify as increasing the client's risk for falls? The client has gastroesophageal reflux disease A client who has gastroesophageal reflux disease is not at an increased risk for falls. The client is 62 years old. Clients who are older than 80 years of age are at increased risk for injury from falls. However, this client's age does not increase their risk for injury. MY ANSWER A client who had recent eye surgery is at increased risk for falls. The nurse should ensure the client is wearing prescription glasses when ambulating and that environmental hazards, such as loose rugs, are removed because the client's vision might be blurred. The client takes colesevelam. Colesevelam is a lipid-lowering agent used to lower cholesterol levels in clients who have hyperlipidemia. Adverse effects of this medication include constipation and dyspepsia. This medication does not put the client at an increased risk of falls. The nurse should review the client's prescribed and over-the-counter medications, as well as any nutritional and herbal supplements the client takes, to determine whether any of the medications can cause confusion, limited mobility, or orthostatic hypotension.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 22 loade d rationals provide d Question: 22 of 90 CORRECT  Time Remaining: 00:30:30  Pause Remaining: 00:05:00 PAUSE joe 86 The client had cataract surgery 1 day ago. 87Question: 90 of 90Question: 90 of 90 FLAG A nurse is providing teaching to a group of clients about the prevention of coronary artery disease. Which of the following information should the nurse include in the teaching? MY ANSWER The clients should walk 30 min daily at a comfortable pace to prevent weight gain and decrease the risk of coronary artery disease. Limit saturated fat intake to 10% of total daily calories. Limiting saturated fat intake to 5% to 6% of total daily calories can decrease the risk of coronary artery disease. Maintain a BMI of 30. A BMI of 30 indicates that a client is obese, and, therefore, has a greater risk of developing coronary artery disease and hypertension. Clients should strive to maintain a BMI within the range for healthy weight, which is 18.5 to 24.9. Consume at least 2,000 mg of sodium per day. Consuming no more than 1,500 mg sodium per day can decrease the risk of hypertension and coronary artery disease.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 21 loade d rationals provide d Question: 21 of 90 CORRECT FLAG  Time Remaining: 00:30:23  Pause Remaining: 00:05:00 PAUSE A home health nurse is inspecting a client's residence for electrical hazards as part of the agency's quality improvement plan. Which of the following findings should the nurse identify as a safety hazard? joe 87 Walk 30 min daily at a comfortable pace. 90Question: 90 of 90Question: 90 of 90 Drinking green tea can potentially improve mental clarity due to the caffeine it contains. However, green tea will not relieve menopausal hot flashes. "Take vitamin D supplements to relieve menopausal hot flashes." Taking vitamin D supplements with calcium can prevent fractures following menopause. However, vitamin D will not relieve menopausal hot flashes. MY ANSWER The nurse should instruct the client to use water-based lubricants to help relieve vaginal dryness and irritation during sexual intercourse. Atrophic vaginitis is a common manifestation of menopause. "Apply estrogen cream during intercourse to reduce discomfort." The nurse should instruct the client to apply topical vaginal estrogen once daily and not use it as a lubricant during intercourse. The client can use topical estrogen to prevent and treat vaginal atrophy and dryness without producing systemic effects of oral estrogen therapy.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 18 loade d rationals provide d Question: 18 of 90 CORRECT FLAG  Time Remaining: 00:30:05  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has chronic venous insufficiency. Which of following areas should the nurse assess for the presence of a venous ulcer? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.) joe 90 "Use water-based lubricant during intercourse to reduce discomfort." 91Question: 90 of 90Question: 90 of 90 A is correct. The nurse should assess the medial malleolus (ankle) of a client who has chronic venous insufficiency for the presence of a venous ulcer. The ankle is the most common area for a venous ulcer. A client who has venous insufficiency can exhibit skin discoloration and edema as well as a large or superficial ulcer with irregular borders at the site of the medial or lateral malleolus that weeps exudate. A pulse is palpable in this area and the client typically experiences a moderate level of pain at the site. B is incorrect. The nurse should assess the tip of the toe and between the toes of a client who has arterial insufficiency for the presence of an arterial ulcer. A client who has an arterial ulcer can exhibit cyanosis in the extremity, cool temperature to the touch, and weak or absent pulses. joe 91 92Question: 90 of 90Question: 90 of 90 C is incorrect. The nurse should assess the ball of the foot of a client who has diabetes mellitus. A client who has a diabetic ulcer can exhibit wounds or ulcers on the plantar or other pressure areas of the feet. These wounds are deep with pale, even edges, and little granulation in the wound bed.  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 17 loade d rationals provide d Question: 17 of 90 CORRECT FLAG  Time Remaining: 00:29:59  Pause Remaining: 00:05:00 PAUSE joe 92 95Question: 90 of 90Question: 90 of 90 A nurse is caring for a client who has a prescription for lactated Ringer's by continuous IV infusion to replace output from an NG tube. Which of the following findings should indicate to the nurse that this therapy is effective? Decreased NG tube drainage Administering IV fluids replaces volume lost to gastric drainage, but a slowing of the gastric drainage does not indicate a balance in the client's fluid status. Serum osmolality 350 mOsm/L A serum osmolality above 300 mOsm/L can indicate dehydration due to a decrease in circulating fluid volume and an increase of blood particles per unit volume of serum. Therefore, this finding indicates that fluid replacement therapy is not effective for the client. MY ANSWER The concentration of the urine regulated by hydration is measured by the weight of the particles in the urine. A urine specific gravity within the expected reference range of 1.005 to 1.030 indicates that fluid replacement is keeping up with fluid loss from gastric drainage. Increased hematocrit An increase in hematocrit can indicate hemoconcentration and hypovolemia and is an indication that fluid replacement therapy is not effective for the client. joe 95 Urine specific gravity 1.020 96Question: 90 of 90Question: 90 of 90  RN VATI Adult Medical Surgical 2019 CLOSE Que stion 16 loade d rationals provide d Question: 16 of 90 CORRECT FLAG  Time Remaining: 00:29:48  Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has a prescription for lactated Ringer's by continuous IV infusion to replace output from an NG tube. Which of the following findings should indicate to the nurse that this therapy is effective? Decreased NG tube drainage Administering IV fluids replaces volume lost to gastric drainage, but a slowing of the gastric drainage does not indicate a balance in the client's fluid status. Serum osmolality 350 mOsm/L A serum osmolality above 300 mOsm/L can indicate dehydration due to a decrease in circulating fluid volume and an increase of blood particles per unit volume of serum. Therefore, this finding indicates that fluid replacement therapy is not effective for the client. MY ANSWER The concentration of the urine regulated by hydration is measured by the weight of the particles in the urine. A urine specific gravity within the expected reference range of 1.005 to 1.030 indicates that fluid replacement is keeping up with fluid loss from gastric drainage. Increased hematocrit An increase in hematocrit can indicate hemoconcentration and hypovolemia and is an indication that fluid replacement therapy is not effective for the client.  RN VATI Adult Medical Surgical 2019 joe 96 Urine specific gravity 1.020 97Question: 90 of 90Question: 90 of 90 CLOSE Que stion 15 loade d rationals provide d Question: 15 of 90 CORRECT FLAG  Time Remaining: 00:29:39  Pause Remaining: 00:05:00 PAUSE joe 97