Sherpath Exam Review Med Surg 2

The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? 1. Monitor the patient for skin breakdown over the bony prominences. 2. Assist the patient to choose high-nutrition items from the menu. 3. Assess the patient's strength while ambulating the patient in the room. 4. Offer the patient the prescribed nutritional supplement between meals. - answer-Offer the patient the prescribed nutritional supplement between meals. After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood? 1. Cup of tossed salad and nonfat dressing topped with a chicken breast 2. Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery 3. 3 oz of roasted pork, a cup of corn, and a cup of carrot sticks 4. 3 oz of lean beef, 2 oz of low-fat cheese, and a sliced tomato - answer-3 oz of roasted pork, a cup of corn, and a cup of carrot sticks When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? 1. Cardiac enzyme test 2. Blood glucose test 3. Resting electrocardiogram 4. Postural blood pressures - answer-blood glucose test An older adult patient with a squamous cell carcinoma (SCC) on the lower arm has a Mohs procedure in the dermatology clinic. Which nursing action will be included in the postoperative plan of care? 1. Describe the use of topical fluorouracil on the incision. 2. Teach how to use sterile technique to clean the suture line. 3. Teach the use of cold packs to reduce bruising and swelling. 4. Schedule daily appointments for dressing changes. - answer-Teach the use of cold packs to reduce bruising and swelling. Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider? 1. The patient is experiencing a weight loss plateau. 2. The patient frequently has liquid stools. 3. The patient is pale and has many bruises. 4. The patient complains of bloating after meals. - answer-The patient is pale and has many bruises. Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet? 1. "You will decrease your risk for future health problems such as diabetes by losing weight now." 2. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat." 3. "You are likely to notice changes in how you feel after a few weeks of diet and exercise." 4. "It will be necessary to change lifestyle habits permanently to maintain weight loss." - answer-"You are likely to notice changes in how you feel after a few weeks of diet and exercise." Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? 1. Start oral fluids when the patient has active bowel sounds. 2. Notify the doctor for any bloody nasogastric (NG) drainage. 3. Reposition the NG tube if drainage stops. 4. Elevate the head of the bed to at least 30 degrees. - answer-Elevate the head of the bed to at least 30 degrees. Which patient should the nurse assess first? 1. A patient with full-thickness leg burns who is scheduled for a dressing change 2. A patient with partial thickness burns who is receiving IV fluids at 500 ml/hr 3. A patient with smoke inhalation who has wheezes and altered mental status 4. A patient with burns who is complaining of level 8 (0 to 10 scale) pain - answer-A patient with smoke inhalation who has wheezes and altered mental status Which assessment action will help the nurse determine if an obese patient has metabolic syndrome? 1. Ask the patient about dietary intake. 2. Dipstick the patient's urine for protein. 3. Check the patient's blood pressure. 4. Take the patient's apical pulse. - answer-Check the patient's blood pressure. A 40-yr-old obese woman reports that she wants to lose weight. Which question should the nurse ask first? 1. "How long have you been overweight?" 2. "What factors led to your obesity?" 3. "Which types of food do you like best?" 4. "What kind of activities do you enjoy?" - answer-"What factors led to your obesity?" A patient who has just been started on tube feedings of full-strength formula at 100 ml/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take? 1. Check gastric residual volumes more frequently. 2. Discontinue administration of water through the feeding tube. 3. Slow the infusion rate of the tube feeding. 4. Change the enteral feeding system and formula every 8 hours. - answer-Slow the infusion rate of the tube feeding. A patient with severe burns has crystalloid fluid replacement ordered using the Parkland formula. The initial volume of fluid to be administered in the first 24 hours is 30,000 ml. The initial rate of administration is 1875 ml/hr. After the first 8 hours, what rate should the nurse infuse the IV fluids? 1. 219 ml/hr 2. 938 ml/hr 3. 1875 ml/hr 4. 622 ml/hr - answer-938 ml/hr A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to 1. Determine the need for postoperative chemotherapy. 2. Monitor the tumor status after surgery. 3. Identify any metastasis of the cancer. 4. Confirm the diagnosis of a specific type of cancer. - answer-monitor the tumor status after surgery. The nurse notes the presence of white lesions that resemble milk curds in the back of a patient's throat. Which question by the nurse is appropriate at this time? 1. "How often do you brush your teeth?" 2. "Have you had an oral herpes infection?" 3. "Are you taking any medications?" 4. "Do you have a productive cough?" - answer-"Are you taking any medications?" A patient who has deep human bite wounds on the left hand is being treated in the urgent care center. Which action will the nurse plan to take? 1. Teach the patient the reason for the use of prophylactic antibiotics. 2. Assist the health care provider with suturing of the bite wounds. 3. Keep the wounds dry until the health care provider can assess them. 4. Prepare to administer rabies immune globulin (bayrab). - answer-Teach the patient the reason for the use of prophylactic antibiotics. A patient has just been admitted with a 40% total body surface area (TBSA) burn injury. To maintain adequate nutrition, the nurse should plan to take which action? 1. Infuse total parenteral nutrition via a central catheter. 2. Encourage an oral intake of at least 5000 kcal per day. 3. Administer vitamins and minerals intravenously. 4. Insert a feeding tube and initiate enteral feedings. - answer-Insert a feeding tube and initiate enteral feedings. The nurse working in the dermatology clinic assesses a young adult female patient who has. Severe cystic acne. Which assessment finding is of concern related to the patient's prescribed isotretinoin ? 1. The patient has a strong family history of rheumatoid arthritis. 2. The patient has also used topical antibiotics to treat the acne. 3. The patient already has some acne scarring on her forehead. 4. The patient recently had an intrauterine device removed. - answer-The patient recently had an intrauterine device removed. A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? 1. Headache 2. Nausea 3. Fever 4. Joint pain - answer-fever A 26-yr-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid 1. Foods that cause distention or bloating 2. Emotionally stressful situations. 3. Chronic use of H2 blocking medications. 4. Smoked foods such as ham and bacon. - answer-smoked foods such as ham and bacon. When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes dry, pale, and hard skin. The patient states that the burn is not painful. What term would the nurse use to document the burn depth? 1. First-degree skin destruction 2. Superficial partial-thickness skin destruction 3. Full-thickness skin destruction 4. Deep partial-thickness skin destruction - answer-Full-thickness skin destruction After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition? 1. Blood glucose is less than 110 mg/dl. 2. Serum albumin level is 3.5 mg/dl. 3. Surgical incision is healing normally. 4. Fluid intake and output are balanced. - answer-Surgical incision is healing normally. A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago complains of increasing abdominal pain. The patient has no bowel sounds and 200 ml of bright red nasogastric (NG) drainage in the past hour. The highest priority action by the nurse is to 1. Contact the surgeon. 2. Administer the prescribed morphine. 3. Irrigate the NG tube. 4. Monitor the NG drainage. - answer-contact the surgeon. A patient is admitted to the burn unit with burns to the head, face, and hands. Initially, wheezes are heard, but an hour later, the lung sounds are decreased and no wheezes are audible. What is the best action for the nurse to take? 1. Reposition the patient in high-Fowler's position and reassess breath sounds. 2. Document the results and continue to monitor the patient's respiratory rate. 3. Encourage the patient to cough and auscultate the lungs again. 4. Notify the health care provider and prepare for endotracheal intubation. - answer-Notify the health care provider and prepare for endotracheal intubation. What is the best method to prevent the spread of infection to others when the nurse is changing the dressing over a wound infected with Staphylococcus aureus? 1. Apply antibiotic ointment over the wound. 2. Soak the dressing in sterile normal saline before removal. 3. Change the dressing using sterile gloves. 4. Wash hands and properly dispose of soiled dressings. - answer-Wash hands and properly dispose of soiled dressings. The following interventions are part of the emergency department (ED) protocol for a patient who has been admitted with multiple bee stings to the hands. Which action should the nurse take first? 1. Apply ice packs 2. Remove pt's rings 3. Give diphenhydramine (Benadryl) 50 mg PO. 4. Apply calamine lotion to itching areas. - answer-remove pt's rings A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about 1. The amount of saturated fat in the diet. 2. A history of a large recent weight gain or loss. 3. A family history of gastric or colon cancer. 4. Use of nonsteroidal antiinflammatory drugs (nsaids). - answer-use of nonsteroidal antiinflammatory drugs (nsaids). A 71-yr-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? 1. Monitor output from the stoma 2. Assess the perineal drainage and incision. 3. Teach about a low-residue diet. 4. Encourage acceptance of the colostomy stoma. - answer-Assess the perineal drainage and incision. A patient who has burns on the arms, legs, and chest from a house fire has become agitated and restless 8 hours after being admitted to the hospital. Which action should the nurse take first? 1. Use pulse oximetry to check oxygen saturation. 2. Assess orientation and level of consciousness. 3. Administer the ordered morphine sulfate IV. 4. Stay at the bedside and reassure the patient. - answer-Use pulse oximetry to check oxygen saturation. The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss? 1. Playing soccer for an hour on the weekend 2. Running for 10 to 15 minutes 3 times/week 3. Lifting weights with friends 3 times/week 4. Walking for 40 minutes 6 or 7 days/week - answer-Walking for 40 minutes 6 or 7 days/week A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. What action should the nurse take to prevent adverse effects from this procedure? 1. Cleanse the skin carefully with antiseptic soap prior to PUVA. 2. Have the patient use protective eyewear while receiving PUVA. 3. Apply petroleum jelly to the areas around the lesions. 4. Shield any unaffected areas with lead-lined drapes. - answer-Have the patient use protective eyewear while receiving PUVA. Which information should the nurse include in the teaching plan for a patient diagnosed with basal cell carcinoma (BCC)? 1. Minimizing sun exposure reduces risk for future BCC. 2. Treatment plans include watchful waiting. 3. Low dose systemic chemotherapy is used to treat BCC. 4. Screening for metastasis will be important. - answer-Minimizing sun exposure reduces risk for future BCC. To evaluate an obese patient for adverse effects of lorcaserin (Belviq), which action will the nurse take? 1. Assess for agitation or restlessness. 2. Check sclera for jaundice. 3. Take the apical pulse rate. 4. Ask about bowel movements. - answer-Ask about bowel movements. A teenaged male patient who is on a wrestling team is examined by the nurse in the clinic. Which assessment finding would prompt the nurse to teach the patient about the importance of not sharing headgear to prevent the spread of pediculosis? 1. Red, hivelike papules and plaques with sharply circumscribed borders 2. Patchy areas of alopecia with small vesicles and excoriated areas 3. Papular, wheal-like lesions with white deposits on the hair shaft 4. Ringlike rashes with red, scaly borders over the entire scalp - answer-Papular, wheal-like lesions with white deposits on the hair shaft The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions on the lower face. Which instructions should the nurse include in the teaching plan? 1. Apply alcohol-based cleansers on the lesions. 2. Clean the infected areas with soap and water. 3. Avoid use of antibiotic ointments on the lesions. 4. Use petroleum jelly (Vaseline) to soften crusty areas. - answer-Clean the infected areas with soap and water. Which information should the nurse include when teaching a patient who has just received a prescription for ciprofloxacin