RN ADULT MEDICAL SURGICAL 2019/RN ADULT MEDICAL SURGICAL 2019, Exams of Nursing

Download RN ADULT MEDICAL SURGICAL 2019/RN ADULT MEDICAL SURGICAL 2019 and more Exams Nursing in PDF only on Docsity! ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM 2019 • RN VATI Adult Medical Surgical 2019 CLOSE Que sti on90 loa de drati onal s provi de d Question: 90 of 90 CORRECT FLAG • Time Remaining: 00:38:42 • Pause Remaining: 00:05:00 PAUSE 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. Thinning of the skin 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 stion89 loa de drati onal s provi de d Question: 89 of 90 CORRECT Vitiligo is the loss of pigment from areas of a client's skin, causing irregular, white patches. Vitiligo is a manifestation of adrenal-gland hypofunction. MY ANSWER Osteoporosis is a common finding with Cushing's syndrome. Bones become thinner as a result of mineral loss and nitrogen depletion, and the risk for fractures increases. Myxedema A client who has hypothyroidism can develop myxedema that causes mucinous cellular edema around the eyes, across the upper back, and in the hands and feet. Heat intolerance A client who has hyperthyroidism can develop heat intolerance, along with an increase in sweating. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion86 loa de drati onal s provi de d Question: 86 of 90 CORRECT FLAG • Time Remaining: 00:37:13 • Pause Remaining: 00:05:00 PAUSE A nurse is inspecting the skin of a client who has basal cell carcinoma. The nurse should identify which of the following lesion characteristics on the client's skin? MY ANSWER A client who has basal cell carcinoma has a nodular lesion with well-defined borders and a pearly or waxy appearance, resulting from overexposure to the sun, especially on the face, head, and neck. An irregular border on a variegated-colored lesion Osteoporosis A pearly, waxy nodule 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 stion85 loa de drati onal s provi de 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.) 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. 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 stion81 loa de drati onal s provi de d Question: 81 of 90 CORRECT Refractory hypoxemia 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 stion80 loa de drati onal s provi de d Question: 80 of 90 CORRECT • Time Remaining: 00:36:27 • Pause Remaining: 00:05:00 PAUSE Flat neck veins 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 sti on79 loa de drati onal s provi de d Question: 79 of 90 INCORRECT • Time Remaining: 00:36:21 • Pause Remaining: 00:05:00 Skin rash 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 stion76 loa de drati onal s provi de 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 The client's blood pressure is elevated. BUN 24 mg/dL MY ANSWER 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 stion75 loa de drati onal s provi de 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. 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 stion74 loa de drati onal s provi de d Question: 74 of 90 CORRECT FLAG • Time Remaining: 00:35:49 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has dumping syndrome following a gastric resection. The nurse should monitor the client for which of the following complications of dumping syndrome? Weight gain Anorexia can result from dumping syndrome because the client can easily become reluctant to eat to avoid the unpleasant manifestations of this syndrome, resulting in weight loss. MY ANSWER The nurse should monitor the client for manifestations of anemia, such as pallor, tachycardia, and fatigue. Rapid emptying of the stomach contents into the intestine can lead to reduced absorption of iron in the duodenum, causing iron-deficiency anemia. Hypercalcemia Hypocalcemia, rather than hypercalcemia, is a manifestation of dumping syndrome due to rapid gastric emptying. Iron-deficiency anemia "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 stion71 loa de drati onal s provi de d Question: 71 of 90 CORRECT FLAG • Time Remaining: 00:35:31 • Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching to a client who has a new prescription for warfarin. Which of the following medications should the nurse instruct the client to avoid? (Select all that apply.) Ferrous sulfate Echinacea Dextromethorphan MY ANSWER Ferrous sulfate is incorrect. Ferrous sulfate is an iron supplement and has no known interaction with warfarin. Echinacea is incorrect. Echinacea is a supplement that a client might take to improve the immune system and has no known interaction with warfarin. Aspirin is correct. Aspirin is an antiplatelet medication. It can increase the risk of bleeding when taken with warfarin. Aspirin Naproxen Dextromethorphan is incorrect. Dextromethorphan is a cough suppressant and has no known interaction with warfarin. Naproxen is correct. Naproxen is an NSAID that relieves mild to moderate pain. It can increase the risk of bleeding if taken with warfarin. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion70 loa de drati onal s provi de d Question: 70 of 90 CORRECT FLAG • Time Remaining: 00:35:25 • Pause Remaining: 00:05:00 PAUSE 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. Place the client leaning forward over the bedside table for the procedure. 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 stion69 loa de drati onal s provi de d Question: 69 of 90 CORRECT FLAG • Time Remaining: 00:35:19 • Pause Remaining: 00:05:00 PAUSE 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. " MY ANSWER I will place my used tissues in a plastic bag." 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 "I will cover my mouth with my hands when I have to cough." 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 stion66 loa de drati onal s provi de 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 A PCA pump will be used for postoperative pain control. Atrial fibrillation 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 stion65 loa de drati onal s provi de d Question: 65 of 90 CORRECT FLAG • Time Remaining: 00:34:57 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is receiving peritoneal dialysis. Which of the following actions should the nurse take? Use an infusion pump to deliver the dialysate at a safe rate. The nurse should infuse the dialysate by gravity into the peritoneal cavity, without an infusion pump. MY ANSWER The most serious complication of peritoneal dialysis is peritonitis, an inflammation of the peritoneum. Assessment findings include cloudy dialysate drainage, rebound abdominal tenderness, and diffuse abdominal pain. The nurse should report these findings immediately to the provider, who can then prescribe a fluid culture, quick exchanges to wash out mediators of infection, and antibiotics. Warm the dialysate solution using a low power level on a microwave oven. Report cloudy dialysate drainage to the provider. The nurse should not use a microwave oven to warm dialysate solution. This can result in uneven heating of the solution, which can increase the risk for burns to peritoneal tissues. The nurse should warm the solution using a heating pad or place it in the warming section of the automated cycling machine. Allow the dialysate to drain over 1 to 4 hr. The dwell time for each exchange takes 4 to 8 hr; drainage usually takes 10 to 20 min. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion64 loa de drati onal s provi de d Question: 64 of 90 INCORRECT FLAG • Time Remaining: 00:34:52 • Pause Remaining: 00:05:00 PAUSE 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. Elevated WBC count Rebound tenderness Anorexia • RN VATI Adult Medical Surgical 2019 CLOSE Que stion61 loa de drati onal s provi de d Question: 61 of 90 CORRECT FLAG • Time Remaining: 00:34:33 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who had a surgical repair of an abdominal aortic aneurysm 3 days ago. The client's vital signs are: temperature 38.3° C (100.9° F), heart rate 80/min, respirations 16/min, and blood pressure 128/76 mm Hg. Which of the following actions is the nurse's priority? Notify the surgeon of the temperature elevation. The nurse should notify the surgeon of the client's temperature elevation for further assessment and intervention for possible complications; however, another action is the priority. Encourage the client to drink more fluids. The nurse should encourage the client to drink more fluids to replace fluid loss from fever; however, another action is the priority. MY ANSWER A surgical wound infection typically appears 3 to 6 days following the surgery. Fever from the third postoperative day onward indicates that this client's greatest risk is either a wound infection or a pulmonary infection; therefore, this is the priority action the nurse should take. Monitor vital signs every 4 hr. The nurse should continue to monitor vital signs every 4 hr to assess improvement or deterioration of the client's condition; however, another action is the priority. Assess the surgical incision for signs of infection. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion60 loa de drati onal s provi de 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 "I may have mild cramping for several hours." CLOSE Que stion59 loa de drati onal s provi de d Question: 59 of 90 CORRECT FLAG • Time Remaining: 00:34:21 • Pause Remaining: 00:05:00 PAUSE 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 A client whose medications to manage Parkinson's disease are no longer effective • RN VATI Adult Medical Surgical 2019 CLOSE Que stion56 loa de drati onal s provi de d Question: 56 of 90 INCORRECT FLAG • Time Remaining: 00:34:00 • Pause Remaining: 00:05:00 PAUSE 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 stion55 loa de drati onal s provi de 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. Place the client in a low Fowler's position with the knees bent. Cover the client's wound with a sterile saline-soaked dressing. Notify the surgeon about the finding. Prepare the client for transfer to surgery. 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 stion54 loa de drati onal s provi de 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 Increased thirst Verify that the client has adequate IV access. include an increase in appetite, or polyphagia, an increase in urine production, or polyuria, and fatigue. Decreased urine output The nurse should teach the client that polyuria is a manifestation of hyperglycemia. Dry skin The nurse should teach the client that warm, moist skin is a manifestation of hyperglycemia. Tremors The nurse should teach the client that tremors and anxiety are manifestations of hypoglycemia. • RN VATI Adult Medical Surgical 2019 CLOSE Que sti on53 loa de drati onal s provi de d Question: 53 of 90 CORRECT FLAG • Time Remaining: 00:33:41 • Pause Remaining: 00:05:00 PAUSE A nurse is reviewing the health histories of a group of clients. Which of the following findings should the nurse identify as an indication that a client is at an increased risk for urinary tract infections (UTIs)? Asthma A history of asthma does not increase the risk for UTI development. However, clients who use corticosteroids to manage their asthma have an increased risk for infections because these medications can reduce the immune response. MY ANSWER Diabetes mellitus 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 stion50 loa de drati onal s provi de 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. Prepare to administer antipyretics. Leukocyte incompatibilities are a common cause of febrile transfusion reactions. Unless a client has a history of febrile reactions to prior transfusions or develops chills or fever, there is no reason to administer antipyretics. MY ANSWER Although the client is a universal recipient and can receive any ABO blood type, the nurse should continue to monitor for any adverse reactions, which is standard procedure for any blood transfusion. Transfuse the blood over 6 hr. The nurse should transfuse the packed RBCs within 4 hr after removing it from refrigeration to reduce the risk of bacterial contamination of the blood. • RN VATI Adult Medical Surgical 2019 CLOSE Que sti on49 loa de drati onal s provi de d Question: 49 of 90 CORRECT FLAG • Time Remaining: 00:33:19 • Pause Remaining: 00:05:00 PAUSE A nurse is planning care for a client who had a lumbar laminectomy. Which of the following interventions should the nurse include in the plan of care? Instruct the client to lift no more than 6.8 kg (15 lb) when at home. The nurse should instruct the client to lift objects no heavier than 2.3 kg (5 lb) for several weeks following surgery to prevent reinjuring the lower back. MY ANSWER Monitor the client for any adverse reactions. Turn the client by log rolling with a turning sheet. The nurse should turn the client by log rolling with a turning sheet to keep the client's back straight and to prevent back spasms from occurring. Inform the client to shower on the second postoperative day. The nurse should instruct the client to shower on the third or fourth postoperative day to ensure the healing of the incision. Remove sterile adhesive strips before discharge. The nurse should leave the sterile adhesive strips on until the provider removes them or until the strips fall off. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion48 loa de drati onal s provi de d Question: 48 of 90 CORRECT FLAG • Time Remaining: 00:33:12 • Pause Remaining: 00:05:00 PAUSE A nurse is teaching a client how to obtain a specimen at home for a fecal occult blood test. Which of the following actions should the nurse instruct the client to take for 3 days prior to collecting the specimen? Take a low-dose aspirin tablet twice daily. A client should not take any type of NSAIDs for 7 days before collecting the specimen because aspirin and NSAIDs can cause a false-positive result in a fecal occult blood test. Avoid eating cooked vegetables. A client can eat cooked vegetables because these foods do not cause a false-positive result in a fecal occult blood test. However, a client should not ingest raw vegetables, red meat, or citrus fruits for 3 days before collecting the specimen because these foods can cause a false- positive result in a fecal occult blood test. Take vitamin C supplements. 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 stion45 loade drati onal sprovi de 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 "Increase your intake of protein to 1 to 1.5 grams per kilogram per day." A client who receives hemodialysis for chronic kidney disease needs protein to prevent a negative nitrogen balance and muscle wasting. A client who is receiving hemodialysis is allowed 1 g to 1.5 g of protein/kg/day. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion44 loa de drati onal s provi de d Question: 44 of 90 CORRECT FLAG • Time Remaining: 00:32:48 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has deep-vein thrombosis and is receiving heparin via continuous IV infusion. The client's weight is 80 kg (176.4 lb). Using the client information provided, which of the following actions should the nurse take? (Click on the "Exhibit" button below for additional information about the client. There are three tabs that contain separate categories of data.) According to the titration table, when the aPTT is greater than 95, the nurse should stop the infusion for 1 hr, then restart the infusion with a decrease of 3 units/kg/hr, which is a decrease of 240 units/hr for a client who weighs 80 kg (176.4 lb). Increase the rate of the infusion by 160 units/hr. An aPTT greater than 95 seconds is outside the expected reference range of 60 to 70 seconds. Therefore, increasing the rate of the heparin infusion places the client at risk for hemorrhage. The nurse should monitor for manifestations of bleeding. Administer heparin 2,400 unit IV bolus. An aPTT greater than 95 seconds is outside the expected reference range. Therefore, administering heparin 2,400 unit IV bolus places the client at risk for hemorrhage. The nurse should monitor for manifestations of bleeding. Continue the infusion without change. An aPTT greater than 95 seconds is outside the expected reference range. Therefore, continuing the infusion at the current rate places the client at risk for hemorrhage. The nurse should monitor for manifestations of bleeding. EXHIBIT St o p the heparin infusion for 1 hr. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion43 loa de drati onal s provi de 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 stion42 loa de drati onal s provi de d Question: 42 of 90 INCORRECT • Time Remaining: 00:32:33 ABGs MY ANSWER Follow these steps for the Ratio and Proportion method of calculation: Step 1: What is the unit of measurement the nurse should calculate? kg Step 2: Set up an equation and solve for X. 2.2 lb Client's weight in lb = 21.2kglb 154Xlbkg = 1 kg X kg X kg = 70 kg Step 3: What is the unit of measurement the nurse should calculate? mg Step 4: Set up an equation and solve for X. X = Dose per kg × Client's weight in kg X mg = 0.75 mg/kg × 70 kg X mg = 52.5 mg Step 5: What is the unit of measurement the nurse should calculate? mL Step 6: What is the dose the nurse should administer? Dose to administer = Desired 52.5 mg Step 7: What is the dose available? Dose available = Have 60 mg Step 8: Should the nurse convert the units of measurement? No Step 9: What is the quantity of the dose available? 0.6 mL Step 10: Set up an equation and solve for X. Have Desired = Q6u0anmtigty 52.5Xmg = 0.6 mL X mL X mL = 0.525 mL Step 11: Round if necessary. 0.525 mL = 0.5 mL Step 12: 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 0.5 mL. The nurse should administer enoxaparin 0.5 mL subcutaneously. Follow these steps for the Desired Over Have method of calculation: Step 1: What is the unit of measurement the nurse should calculate? kg Step 2: Set up an equation and solve for X. Client's weight in lb × 1 kg X kg = 154 lb × 12k.2g lb mL X kg = 2.2 lb X kg = 70 kg Step 3: What is the unit of measurement the nurse should calculate? mg Step 4: Set up an equation and solve for X. X = Dose per kg × Client's weight in kg X mg = 0.75 mg/kg × 70 kg X mg = 52.5 mg Step 5: What is the unit of measurement the nurse should calculate? mL Step 6: What is the dose the nurse should administer? Dose to administer = Desired 52.5 mg Step 7: What is the dose available? Dose available = Have 60 mg Step 8: Should the nurse convert the units of measurement? No Step 9: What is the quantity of the dose available? 0.6 mL Step 10: Set up an equation and solve for X. Desired × Quantity X = 52.5Hmavge× 0.6 mL X mL = 60 mg X mL = 0.525 mL Step 11: Round if necessary. 0.525 mL = 0.5 mL Step 12: 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 mL. The nurse should administer enoxaparin 0.5 mL subcutaneously. Follow these steps for the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X mL = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) mL X mL = 60 mg Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 0.6 mL 0.75 mg 1 kg 154 lb 0.5 mL. 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 stion39 loa de drati onal s provi de 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. The nurse refers a client who has chronic obstructive pulmonary disease for palliative care services. are heterosexual and sexually active, noninfected partners who have a sexual relationship with a partner who has HIV, and clients who use intravenous drugs. Use skin lotion as a lubricant when using a condom. Lubrication products that are water-based are safe to use as a lubricant when using a condom. Other products such as skin lotion, petroleum jelly, or cold cream can cause the latex condom to break down, resulting in ineffective protection. A diaphragm will provide protection against HIV transmission. A diaphragm is a dome-shaped device that covers the cervix and, when used with a spermicide, prevents pregnancy. It does not, however, prevent the transmission of HIV. The use of a condom is recommended for all clients to decrease the risk of HIV transmission. • RN VATI Adult Medical Surgical 2019 CLOSE Que sti on36 loa de drati onal s provi de d Question: 36 of 90 INCORRECT FLAG • Time Remaining: 00:31:54 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has multiple leg fractures and is 24 hr postoperative following placement of skeletal traction. Which of the following actions should the nurse take? Apply petroleum jelly to the pin sites. The nurse should not routinely apply any ointments to the pin sites. During the first 24 to 48 hr after insertion of the pins, the nurse should administer a prophylactic broad- spectrum IV antibiotic. Apply a sterile hydrocolloid dressing every 24 hr. Initially, a sterile, absorbent, nonadherent dressing covers the pin sites. Hydrocolloid dressings are for necrotic or granulating wounds. Cleanse the pin sites with isopropyl alcohol. MY ANSWER Although pin protocols vary, the nurse should cleanse the pin sites with chlorhexidine solution to prevent infection and subsequent development of osteomyelitis. The nurse should inspect the pin sites at least every 8 hr, noting any inflammation or evidence of infection. Expected findings after the insertion of pins include redness, warmth, and serosanguineous drainage, which should subside after 72 hr. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion35 loa de drati onal s provi de d Question: 35 of 90 CORRECT FLAG • Time Remaining: 00:31:49 • Pause Remaining: 00:05:00 PAUSE A nurse in a long-term care facility is caring for a client who has dementia. Which of the following actions should the nurse take? Give detailed directions when addressing the client. The nurse should provide simple directions and focus on one task at a time for a client who has dementia. The nurse should speak in a respectful tone of voice while providing direction to the client. MY ANSWER The nurse should provide the client who has dementia with fingers foods. Clients who have dementia can have difficulty sitting still and tend to wander, which makes weight loss and malnutrition a concern. Therefore, foods that the client can hold while ambulating are ideal. Use written signs to redirect the client. Inspect the pin sites at least every 8 hr. Provide finger food at mealtime. 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 stion34 loa de drati onal s provi de d Question: 34 of 90 CORRECT FLAG • Time Remaining: 00:31:43 • Pause Remaining: 00:05:00 PAUSE 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. The nurse should place the client in left lateral Trendelenburg position when an air embolism is suspected to prevent air from traveling to the pulmonary arteries. However, the nurse should take another action first. Check the tubing for placement of a locking adaptor. The nurse should verify that locking adaptors are on all tubing ports to reduce the risk of air embolism from a break in the system. However, the nurse should take another action first. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion31 loa de drati onal s provi de d Question: 31 of 90 CORRECT FLAG • Time Remaining: 00:31:24 • Pause Remaining: 00:05:00 PAUSE 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. Place monitoring cords and tubes in a stockinette. 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 stion30 loa de drati onal s provi de d Question: 30 of 90 CORRECT FLAG • Time Remaining: 00:31:19 • Pause Remaining: 00:05:00 PAUSE 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. The stool will have a high volume of liquid. The nurse should identify that the first drainage from an ileostomy can appear red in color but should not contain frank blood or clots and should quickly change to a greenish-yellow color. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion29 loa de drati onal s provi de d Question: 29 of 90 CORRECT FLAG • Time Remaining: 00:31:13 • Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching to a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following statements by the client indicates an understanding of the teaching? MY ANSWER Levothyroxine increases metabolism, which can increase oxygen consumption and heart rate. If the client's heart is racing, the dosage might be too high, causing thyrotoxicosis with manifestations of tachycardia, insomnia, tremors and nervousness, hyperthermia, heat intolerance, and sweating. The provider should retest the client's thyroid hormone levels and adjust the dosage accordingly. "I will keep a journal of my daily food intake to show the provider." Levothyroxine is a synthetic thyroid hormone for replacement therapy. Providers do not prescribe it for weight loss, so a food journal is unnecessary. However, a therapeutic response of weight loss can occur once hormone levels stabilize. "Once my weight is back to normal, I can gradually reduce and then stop the medication." Levothyroxine provides lifelong thyroid hormone replacement therapy. Providers do not prescribe it for weight loss. The provider might need to make periodic dosage adjustments based on thyroid hormone levels, but the client will have to continue taking it for life. "If my heart starts racing, my provider might need to adjust my dosage." FLAG • Time Remaining: 00:30:53 • Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching for a client who has constipation-predominant irritable bowel syndrome (IBS-C). Which of the following statements should the nurse include in the teaching? "Take a dose of loperamide each morning." A client who has diarrhea-predominant IBS should take loperamide, which is an antidiarrheal agent that decreases peristalsis and the volume of the stool. "Increase your fluid intake to 1,000 milliliters per day." MY ANSWER A client who has IBS-C should consume 2,000 to 2,500 mL of fluid each day to soften the stool in the colon and promote regular bowel movements. A client who has IBS-C should take a bulk-forming laxative, such as psyllium, to increase the bulk of the stool, reduce constipation, and promote regular bowel movements. "Consume a diet that is low in protein." A client who has IBS-C should consume a high-calorie, high-protein diet. Smaller, more frequent meals are better tolerated than larger meals. • RN VATI Adult Medical Surgical 2019 CLOSE Que sti on25 loa de drati onal s provi de d Question: 25 of 90 CORRECT FLAG • Time Remaining: 00:30:46 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is receiving mechanical ventilation. Which of the following actions should the nurse implement to decrease the client's risk for ventilator-associated pneumonia (VAP)? (Select all that apply.) "Take psyllium in the evening." CORRECT • Time Remaining: 00:30:39 • Pause Remaining: 00:05:00 Wear a protective gown when suctioning the client's airway. Maintain the client in a supine position. MY ANSWER Wear a protective gown when suctioning the client's airway is incorrect. The nurse should use standard precautions when exposure to bodily secretions is possible. However, a protective gown will not prevent VAP in the client. Monitor for oral secretions every 2 hr is correct. The nurse should monitor for oral secretions at least every 2 hr to decrease the likelihood of micro-organisms moving from the mouth into the respiratory tract. Provide oral care every 2 hr is correct. The nurse should provide oral care every 2 hr using chlorhexidine rinse or sodium chloride solution with swabbing or tooth brushing. Maintain the client in a supine position is incorrect. The nurse should position the client with the head of the bed elevated at least 30° to prevent aspiration of bacteria into the airway. Assess the client daily for readiness of extubation is correct. To lower the risk of the client acquiring VAP, the nurse should assess the client daily for neurological readiness for discontinuing mechanical ventilation. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion24 loa de drati onal s provi de d Question: 24 of 90 Monitor for oral secretions every 2 hr. Provide oral care every 2 hr. Assess the client daily for readiness of extubation. 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 stion23 loa de drati onal s provi de d Question: 23 of 90 CORRECT • Time Remaining: 00:30:34 • Pause Remaining: 00:05:00 Assess the PICC infusion system systematically. The client's bed has a three-prong plug attached to the electrical cord. The nurse should use appliances that have grounded plugs to reduce the risk for injury. The third prong on the cord acts as a grounding device while the other two prongs transmit the electricity. A protective cover is inserted into an unused outlet. The nurse should cover unused outlets with a protective cover to prevent small children who are visiting the client from being electrocuted. MY ANSWER The nurse should plug all electrical appliances into outlets away from wet areas. Water conducts electricity and places the client at risk for electrocution. An electrical cord is coiled and secured to the floor. The nurse should coil and secure electrical cords to the floor and away from heavy traffic areas to reduce the risk of injury to the client. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion20 loa de drati onal s provi de d Question: 20 of 90 CORRECT FLAG • Time Remaining: 00:30:15 • Pause Remaining: 00:05:00 PAUSE A nurse is teaching a client about self-management of their halo fixator device. Which of the following information should the nurse include in the teaching? Give each screw a quarter turn daily using the wrench provided. An IV pump is plugged into an outlet near a sink. The halo fixator device is used to provide immobilization of the cervical spine following injury. It is attached with four screws into the skull. A special wrench is necessary to adjust the device and should be kept with the client at all times. However, the screws should not be adjusted by the client or the nurse. The client should be instructed to inspect the screw sites daily and report any loosening, redness, or drainage to the provider. Apply powder liberally under the chest portion of the halo fixator device. Powder can contribute to skin breakdown. The nurse should instruct the client to avoid powder or to use it sparingly. Avoid the use of straws when drinking liquids. The nurse should instruct the client to use a straw when drinking liquids. The use of a cup requires hyperextension of the neck, which should be avoided while the halo fixator device is in place. MY ANSWER The halo fixator device is worn for a period of 8 to 12 weeks and immobilizes the cervical spine, preventing flexion and hyperextension of the neck. The use of a small pillow under the head provides support to the head and neck, preventing additional discomfort and pressure from the device. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion19 loa de drati onal s provi de d Question: 19 of 90 CORRECT FLAG • Time Remaining: 00:30:11 • Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching to a client about strategies to manage menopausal symptoms. Which of the following instructions should the nurse include in the teaching? "Drink green tea to relieve menopausal hot flashes." Place a small pillow under the head while lying supine. 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 stion18 loa de drati onal s provi de 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.) "Use water-based lubricant during intercourse to reduce discomfort." • RN VATI Adult Medical Surgical 2019 CLOSE Que sti on16 loa de drati onal s provi de d Question: 16 of 90 CORRECT FLAG • Time Remaining: 00:29:54 • 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. Urine specific gravity 1.020 • RN VATI Adult Medical Surgical 2019 CLOSE Que stion16 loa de drati onal s provi de 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 Urine specific gravity 1.020 CLOSE Que stion15 loa de drati onal s provi de d Question: 15 of 90 CORRECT FLAG • Time Remaining: 00:29:39 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is 3 hr postoperative and exhibiting signs of hypovolemia. Which of the following findings should the nurse identify as a manifestation of hypovolemia? Distended neck veins A client who has hypovolemia has flat neck veins due to lack of circulating fluid volume. The veins on the hands might appear flat as well. Distended neck veins can be a sign of hypervolemia. MY ANSWER A client who has hypovolemia has a rapid, weak pulse rate to compensate for the decrease in blood volume in an attempt to increase blood pressure. Urine output 45 mL/hr A client who has hypovolemia has a urine output less than 30 mL/hr and a specific gravity higher than 1.030 due to the lack of circulating fluid volume and kidney perfusion. Decreased respiratory rate A client who has hypervolemia has an increase in respiratory rate to compensate for the decrease in circulating fluid volume. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion14 loa de drati onal s provi de d Question: 14 of 90 CORRECT • Time Remaining: 00:29:32 • Pause Remaining: 00:05:00 Rapid pulse rate node and reducing the force of ventricular contraction. This can lead to a decrease in oxygen demand, a slower heart rate, and an increase in myocardial oxygen supply. A client who has a heart rate of 98/min Beta-adrenergic blockers have a chronotropic action that decreases the heart rate by suppressing conduction through the AV node and reducing the force of ventricular contraction. The nurse should clarify the prescription with the provider if the client's heart rate is slower than 60/min. A client who has hypertension Hypertension is an indication for taking propranolol. Propranolol is a beta-adrenergic blocker that slows the heart rate and decreases blood pressure and cardiac output by suppressing conduction through the AV node and reducing the force of ventricular contraction. MY ANSWER Propranolol is a nonselective beta-adrenergic blocker. Contraindications include asthma, COPD, and heart failure because the blockade of beta2 receptors in the lungs can cause bronchoconstriction. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion11 loa de drati onal s provi de d Question: 11 of 90 CORRECT FLAG • Time Remaining: 00:29:12 • Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching for a client who has neutropenia and is receiving chemotherapy. Which of the following client statements indicates an understanding of the teaching? (Select all that apply.) A client who has a history of asthma "I will avoid crowds." "I will wash my toothbrush weekly." "I will change my cat's litter box twice weekly." "I will eat plenty of fresh fruits and vegetables." MY ANSWER "I will avoid crowds" is correct. The client who is immunocompromised should avoid crowds while undergoing chemotherapy to reduce the risk of infection. "I will wash my toothbrush weekly" is incorrect. The client who is immunocompromised should wash their toothbrush daily in the dishwasher or rinse it in a bleach solution to prevent bacterial growth. "I will change my cat's litter box twice weekly" is incorrect. The client who is immunocompromised should have someone else change the litter box to avoid infections. "I will take my temperature daily" is correct. The client who is immunocompromised should take daily temperature readings and report an elevated temperature to the provider. "I will eat plenty of fresh fruits and vegetables" is incorrect. The client who is immunocompromised should avoid food sources that contain bacteria, such as fresh fruits and vegetables, undercooked meat, fish, and eggs. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion10 loa de drati onal s provi de d Question: 10 of 90 INCORRECT FLAG • Time Remaining: 00:29:05 • Pause Remaining: 00:05:00 PAUSE A nurse is assessing a client who has a chest tube connected to a closed water-seal drainage system. Which of the following findings should the nurse report to the provider? "I will take my temperature daily." Fluctuation of the water level in the chamber as the client breathes MY ANSWER Fluctuation in the water seal chamber with the client's respirations is an expected finding and indicates a patent drainage system. Constant bubbling in the water seal chamber can be an indication of an air leak, which is caused by a disruption in the system such as a loose connection. Pulmonary air leaks create intermittent bubbling that is synchronous with respiration. This finding should be reported to the provider immediately. Numerous small blood clots in the drainage tubing Numerous small blood clots in the drainage tubing are an expected finding that indicates a patent drainage system that is removing blood from the pleural space. Water seal chamber contains 1 cm (0.39 in) of water The water seal chamber requires at least 2 cm (0.79 in) of water to function properly. The nurse should add water to the chamber; however, this does require the nurse to notify the provider. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion9 l oa de d rati onal s provi de d Question: 9 of 90 CORRECT FLAG • Time Remaining: 00:28:57 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who has a small bowel obstruction and an NG tube in place. Which of the following actions should the nurse take? Constant bubbling in the water seal chamber Maintain low intermittent suction. A change in blood pressure from 130/80 mm Hg to 180/100 mm Hg indicates a widened pulse pressure and hypertension, which are components of Cushing's triad, a sign of increased intracranial pressure. Increase in urine output from 30 mL/hr to 100 mL/hr Following a traumatic brain injury, an increase in urinary output indicates that the client is at risk for diabetes insipidus; however, this is not a manifestation of Cushing's triad. Increase in heart rate from 70/min to 90/min Bradycardia is a component of Cushing's triad, which is a classic sign of increased intracranial pressure. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion6 loa de d rati onal s provi de d Question: 6 of 90 CORRECT FLAG • Time Remaining: 00:28:37 • Pause Remaining: 00:05:00 PAUSE A nurse is preparing to administer potassium chloride 10 mEq IV over 1 hr to a client. Available is potassium chloride 10 mEq in 100 mL of 0.9% sodium chloride. The nurse should set the infusion pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) M Y ANS WE R mL/hr Follow these steps to calculate the infusion rate using the Ratio and Proportion or Desired Over Have method of calculation: Step 1: What is the unit of measurement the nurse should calculate? mL/hr Step 2: What is the volume the nurse should infuse? 100 mL Step 3: What is the total infusion time? 1 hr Step 4: Should the nurse convert the units of measurement? No Step 5: Set up an equation and solve for X. Volume (mL) X mL/hr = 100 mL/hr. Time (hr) 100 mL X mL/hr = 1 hr X mL/hr = 100 mL/hr Step 6: Round if necessary. Step 7: Determine if the amount to administer makes sense. If the prescription reads potassium chloride 10 mEq in 100 mL 0.9% sodium chloride IV to infuse over 1 hr, it makes sense to administer 100 mL/hr. The nurse should set the IV pump to deliver potassium chloride 10 mEq in 100 mL 0.9% sodium chloride IV at 100 mL/hr. Follow these steps to calculate the infusion rate using the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X mL/hr = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) 100 mL X mL/hr = 1 hr Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 100 mL X mL/hr = X mL/hr = 100 mL/hr 1 hr Step 4: Solve for X. Step 5: Round if necessary. Step 6: Determine if the amount to administer makes sense. If the prescription reads potassium chloride 10 mEq in 100 mL 0.9% sodium chloride IV to infuse over 1 hr, it makes sense to administer 100 mL/hr. The nurse should set the IV pump to deliver potassium chloride 10 mEq in 100 mL 0.9% sodium chloride IV at • RN VATI Adult Medical Surgical 2019 CLOSE Que stion5 loa de d rati onal s provi de d Question: 5 of 90 INCORRECT FLAG • Time Remaining: 00:28:31 • Pause Remaining: 00:05:00 PAUSE A nurse is providing teaching about dietary options for a client who has cholelithiasis. Which of the following statements should the nurse include in the teaching? "Cauliflower is a good dietary choice." MY ANSWER The nurse should instruct the client to avoid foods that are gas forming, such as cauliflower and cabbage. These foods can increase the client's abdominal discomfort. "Increase the amount of egg yolks in your diet." Clients who have acute cholelithiasis should consume a low-fat diet. Foods such as egg yolks are high in fat and trigger the release of bile from the gall bladder, which can increase the client's abdominal discomfort. Clients who have acute cholelithiasis will be prescribed a low-fat diet. Desserts such as sherbet, gelatin, and angel food cake are dessert choices that are low in fat. "Eat choice or prime cuts of meat." The nurse should inform the client that select cuts of meat are lower in fat than prime or choice cuts. Select cuts are recommended for clients who have cholelithiasis and are on a low-fat diet. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion4 l oa de drati onal s provi de d Question: 4 of 90 CORRECT FLAG • Time Remaining: 00:28:24 • Pause Remaining: 00:05:00 PAUSE "Select desserts such as angel-food cake." FLAG A nurse is providing teaching to a client who is scheduled for a bronchoscopy. Which of the following statements should the nurse include in the teaching? MY ANSWER A client who had a bronchoscopy received a local anesthetic that can suppress the cough reflex. The cough reflex protects the client from aspirating fluids or food. Therefore, the client should not eat or drink until the cough reflex returns. "You will drink a contrast solution 30 minutes prior to the procedure." A bronchoscopy allows for direct visualization of bronchial structures and does not require the use of a contrast solution. The client should be NPO for 4 to 8 hr prior to the test. "The purpose of this procedure is to remove excess fluid from your lungs." A bronchoscopy allows for direct visualization of bronchial structures to identify disorders, collect specimens, remove foreign bodies or secretions, stop bleeding, remove lesions, or provide brachytherapy or radiation to the endobronchial area. A thoracoscopy removes excess fluid from the pleural cavity. "You will need to lie on your back for 4 to 6 hours following the procedure." Following a bronchoscopy, the client is at risk for hypoxia and dyspnea. Therefore, the nurse should elevate the head of the client's bed. • RN VATI Adult Medical Surgical 2019 CLOSE Que stion1 loa de d rati onal s provi de d Question: 1 of 90 CORRECT FLAG • Time Remaining: 00:28:06 • Pause Remaining: 00:05:00 PAUSE A nurse is caring for a client who is 24 hr postoperative following a total hip arthroplasty. Which of the following actions should the nurse take? "You will not be able to eat or drink after the procedure until you are able to cough." Place the affected leg in external rotation. The nurse should keep the affected extremity in a neutral position to prevent dislocation. Manifestations of a dislocation of the hip include inward rotation of the affected leg, sudden severe pain, and shortening of the surgical extremity. Encourage the client to use the incentive spirometer every shift. The nurse should encourage the client to cough, breathe deeply, and use the incentive spirometer every 2 hr to prevent pneumonia and atelectasis, which is the collapse of alveoli. Atelectasis can lead to poor oxygen exchange and pneumonia. Instruct the client to lean forward when rising from a chair. To prevent dislocation of the hip, the client should not flex the hip more than 90º at any time. Leaning forward when rising from a chair flexes the hip more than 90º. MY ANSWER The nurse should ensure that the affected extremity is in a position of abduction to prevent hip dislocation. The nurse should place an abductor pillow or several pillows between the client's legs to keep the affected extremity in abduction while the client is in bed. Maintain abduction of the affected extremity.