Adult Medical Surgical NGN B, Exams of Nursing

Download Adult Medical Surgical NGN B and more Exams Nursing in PDF only on Docsity! ATI - Adult Medical Surgical NGN B latest updated 2024 with right answered questions top ranked.  A nurse is providing teaching to a client who is perimenopausal and has a prescription for hormone replacement therapy. For which of the following adverse effects should the nurse instruct the client to notify the provider? - Correct answer Calf pain  Numbness in the arms  Intense headache  A nurse is planning care for a client who is postoperative following a laparotomy and has a closed-suction drain. Which of the following actions should the nurse take to manage the drain? - Correct answer Compress the drain reservoir after emptying.  A nurse is caring for a client who has DKA. Which of the following findings should indicate to the nurse that the client's condition is improving? - Correct answer Glucose 272 mg/dL  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  A nurse is planning a health promotional presentation for a group of African American clients at a community center. Which of the following disorders presents the greatest risk to this group of clients? - Correct answer hypertension  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 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.  A nurse is reviewing the ABG results of a client who has advanced COPD. Which of the following results should the nurse expect? - Correct answer PaCO2 56  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 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 a tracheostomy tray at the bedside.  A nurse is evaluating the plan of care for four clients after 2 days of hospitalization. The nurse should identify the need to revise the plan for which of the following clients? - Correct answer A client who is postoperative following abdominal surgery and reports feeling that something "popped" when they coughed  A nurse is checking the ECG rhythm strip for a client who has a temporary pacemaker. The nurse notes a pacemaker artifact followed by a QRS complex. Which of the following actions should the nurse take? - Correct answer Document that depolarization has occurred.  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 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  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 caring for a client who has homonymous hemianopsia as a result of a stroke. To reduce the risk of falls when ambulating, the nurse should provide which of the following instructions to the client? - Correct answer Scan the environment by turning your head from side to side.  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 (96.80 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 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 caring for a client who has increased intracranial pressure (ICP) and is receiving mannitol via continuous IV infusion. Which of the following findings should the nurse report to the provider as an adverse effect of this medication? - Correct answer Crackles heard on auscultation  A nurse is reviewing the laboratory results of a client who has AIDS and is taking amphotericin B for a fungal infection. The nurse should identify that which of the following values is an indication of an adverse effect of the medication? - Correct answer BUN 34 mg/dL  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 has received report on a client who is being admitted to the emergency department. - Correct answer Nurses' Notes  2330:  Report received from ambulance crew:  Client has a penetrating wound to the anterior upper right chest. Client is alert and oriented with a Glasgow Coma Scale (GCS) score of 15. Client's shirt covered with bright red blood.  Client reports pain as 6 on a scale of 0 to 10. Shortness of breath noted.  2345:  Client is alert and oriented with a GCS score of 15. Client has a penetrating wound to the anterior right upper chest measuring  2.5 cm (1 in). No other wounds or injuries found.  Bilateral radial and pedal pulses are +1. Left lung sounds are clear, right upper lung sounds diminished.  Client still reports pain as 6 on a scale of 0 to 10 over anterior chest.  Bowel sounds are present in all 4 quadrants.  Graphic Record  2330:  Current vital signs from ambulance crew:  Heart rate 125/min  Respiratory rate 28/min  Temperature 36° C (96.8° F)  Blood pressure 145/90 mm Hg  Sa0, 90% on oxygen 2 L/min via nasal cannula  2345:  Temperature 35.9° C (96.6° F) A  Heart rate 135/min  Respiratory rate 34/min  Blood pressure 96/45 mm Hg  Sa0, 92% on 40% face mask  Diagnostic Results  Hematocrit 26% (Male 42% to 52%)  Hemoglobin 8.7 g/dL (Male 14 to 18 g/dL)  WBC count 9,000/mm? (5,000 to 10,000/mm3)  Platelet count 148,000/mm (150,000 to 400,000/mm3)  Lactate (arterial) 5 mg/dL (3 to 7 mg/dL)  Provider Prescriptions  Transfuse 2 units of packed RBCs.  Prepare the client for chest tube insertion.  Initiate NPO status.  Select the 3 findings that require follow-up by the nurse. - Correct answer 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.  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  The nurse should first address the client's blood pressure followed by the client's oxygenation - 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.  For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client. - Correct answer Transfuse packed RBs 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 NO 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? - 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 fire 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. - 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.  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 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  A nurse is caring for a client who is 4 hr postoperative following a total vaginal hysterectomy. - Correct answer Nurses' Notes  2000:  Client reports pain as 3 on a scale of 0 to 10. Breath sounds clear and present throughout. Three abdominal bandages to abdomen, dry and intact with no drainage noted. Client voided 90 mL of clear-yellow urine into bedpan. Perineal pad with small amount of blood, no clots; perineal pad changed at this time.  2400:  Client sleeping, arouses to verbal stimuli. Reports pain as 2 on a scale of 0 to 10 with repositioning. Client voided 125 mL of blood-tinged urine into bedpan. Perineal pad saturated with blood, large clots present.  Vital Signs  2000:  Blood pressure 128/78 mm Hg  Respiratory rate 16/min  Temperature 37° C (98.6° F)  Heart rate 88/min  Oxygen saturation 97% on room air  2400:  Blood pressure 106/56 mm Hg  Respiratory rate 14/min  Temperature 37° C (98.6° F)  Heart rate 102/min  Oxygen saturation 95% on room air  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 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 education to a client who has tuberculosis (TB) and their family. Which of the following information should the nurse include in the teaching? - Correct answer Family members in the household should undergo TB testing  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 2,000/mm3  A nurse is providing preoperative teaching for a client who is scheduled for a mastectomy. Which of the following statements should the nurse make? - Correct answer I will refer you to community resources that can provide support  A nurse is teaching a group of newly licensed nurses about pain management for older adult clients. Which of the following statements by a newly licensed nurse indicates an understanding of the teaching? - Correct answer Ibuprofen can cause gastrointestinal bleeding in older adult clients.  A nurse is planning discharge teaching for a client who has an external fixation device for a fracture of the lower extremity. Which of the following instructions should the nurse include in the plan of care? - Correct answer Use crutches with rubber tips.  A nurse is caring for a client. - Correct answer History and Physical  Client admitted to the medical-surgical unit with severe, acute abdominal pain, abdominal distention, diarrhea, mucus and small amount of blood in the stool, and a 12% weight loss over the past 2 months.  Client's weight 2 months ago was 100.3 kg (221.1 lb). Client has a history of Crohn's disease and a seizure disorder that is managed with diet and medication.  Respirations are equal and unlabored. S,S, heart tones auscultated. Abdominal assessment performed with muscle guarding and tenderness in the right lower quadrant noted on palpation. Abdomen is firm and rigid upon examination.  Abdominal pain rated as an 8 on a scale of 0 to 10. Client states that pain is constant and localized in the lower right abdominal quadrant. Reports anorexia. Hypoactive bowel sounds noted upon auscultation.  Graphic Record  Day 1  0700:  Temperature 38.3° C (101 ° F)  Heart rate 102/min  Respiratory rate 18/min  Blood pressure 142/88 mm Hg  Oxygen saturation 97% on room air  1300:  Temperature 38.9° C (102° F)  Heart rate 112/min  Respiratory rate 22/min  Blood pressure 104/68 mm Hg  Oxygen saturation 96% on room air  Diagnostic Results  Day 1:  Hgb 12 g/dL (12 to 18 g/dL)  Hct 34% (37% to 52%)  0800:  WBC count 19,000/mm (5,000 to 10,000/mm3)  Neutrophils 75% (55% to 70%)  Erythrocyte sedimentation rate (ESR) 18 mm/hr (less than 15 mm/hr)  PREVIOUS  Medication Administration Record  Day 1:  Phenytoin 200 mg PO daily  Day 4:  Hydrocodone/acetaminophen 10 mg/325 mg PO every 4 hr PRN  pain  Provider Prescriptions  Day 1  1300:  Prepare client for exploratory laparotomy.  After reviewing the findings in the client's medical record, the nurse should first address the client's abdominal distention followed by the clients acute pain. - Correct answer Abdominal distention is correct. When using the greatest risk framework, the nurse should identify that abdominal distention is a manifestation of an inflammatory intestinal disorder. The nurse should address this finding first to reduce the risk of life-threatening complications, such as obstruction or infection.  Acute pain is correct. When using the greatest risk frankawork, the nurse should identify that acute abdominal pain is a manifestation of an inflammatory intestinal disorder. The nurse should address this finding next to reduce the risk of life- threatening complications, such as obstruction or  infection. findings should the nurse report to the provider? - Correct answer Extremity cool upon palpation  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 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.  A nurse is caring for a client who is receiving mechanical ventilation via a tracheostomy tube. The nurse should recognize that which of the following complications is associated with long-term mechanical ventilation? - Correct answer stress ulcers  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  A nurse is caring for a client. - Correct answer Nurses' Notes  1200:  Client was admitted to the unit with shortness of breath, a nonproductive cough, chest discomfort, and myalgia. Prefers orthopneic position. Client reports that manifestations began about 2 days ago.  1215:  Oxygen applied at 2 L/min via nasal cannula. Wheezes noted bilaterally. Use of accessory muscles noted. Client speaks in short phrases, with report of increased shortness of breath when speaking. Oral mucosa is pink; capillary refill is 4 seconds.  Vital Signs  1200:  Temperature 38.7° C (101.6° F)  Blood pressure 104/64 mm Hg  Heart rate 100/min *  Respiratory rate 24/min  Oxygen saturation 90% on room air  1215:  Temperature 38.7° C (101.6° F)  Blood pressure 106/64 mm Hg  Heart rate 104/min  Respiratory rate 24/min  Oxygen saturation 93% on oxygen 2 L/min via nasal cannula  Diagnostic Results  ABGs:  pH 7.30 (7.35 to 7.45)  Pa0, 70 mm Hg (80 to 100 mm Hg)  PaCO, 47 mm Hg (35 to 45 mm Hg)  HCO; 24 mEq/L (21 to 28 mE/L)  Sa0, 90% on room air (95% to 100%)  Sputum culture collected:  Results pending  Medical History.  Client reports having a sinus infection for about 2 weeks.  Reports smoking approximately two packs of cigarettes a week.  Client states that sleep during the night is interrupted by coughing and shortness of breath most nights of the week.  Client reports not having received the influenza vaccination.  For each assessment finding, click to specify if the finding is consistent with emphysema, asthma, or pneumonia. Each finding may support more than 1 disease process. - Correct answer Temperature is consistent with pneumonia. Fever is a manifestation of pneumonia and is related to inflammation or infection  Breath sounds are consistent with emphysema, asthma, and pneumonia  The client's wheezing is a manifestation of emphysema, asthma, and pneumonia. It is the result of narrowed airways and alveoli.  ABG results are consistent with emphysema and pneumonia. The client's  ABG results indicate respiratory acidosis, which is a manifestation of emphysema and pneumonia.  Respiratory rate is consistent with emphysema, asthma, and pneumonia.  The client's respiratory rate is a manifestation of emphysema, asthma, and pneumonia.  Heart rate is consistent with emphysema and pneumonia. The client is experiencing tachycardia, which is a manifestation of emphysema and pneumonia.  Cough is consistent with emphysema, asthma, and pneumonia. The client's cough is a manifestation of emphysema, asthma, and pneumonia.  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 nurse is planning care for a client who has a sealed radiation implant for cervical cancer. Which of the following interventions should the nurse include in the plan of care? - Correct answer Keep a lead-lined container in the client's room  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? - Correct answer 24 mL  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 providing discharge teaching about infection prevention to a client who has AIDS. Which of the following statements by the client indicates understanding of the teaching? - Correct answer "I will no longer floss my teeth after brushing my teeth."  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 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 providing discharge teaching to a client who is to self-administer heparin subcutaneously. Which of the following statements by the client indicates an understanding of the teaching? - Correct answer I will use an electric razor to shave  Nurses' Notes  1800:  Emergency medical team removed client's shirt at the scene and initiated 18- gauge IV therapy in the right antecubital space.  Client has full-thickness burns over the upper half of the chest and both forearms; partial-thickness burns are present on the client's face and neck.  Sinus tachycardia, pulses to brachial extremities palpable. 1+ edema to upper extremities.  h  Respirations even, labored with scattered rhonchi. Soot noted to the client's mouth and nose. Oxygen 40% via face tent applied.  Hypoactive bowel sounds.  16 French indwelling urinary catheter inserted with return of  250 mL of yellow urine.  Lactated Ringer's infusing to right antecubital. Provider preparing to insert right femoral central line catheter.  hyp  hyp  hypt