Herzing University NSG 223 Med Surg II Final Exam
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The nurse is reinforcing education prior to discharge for a client that has had a
kidney transplant. What statement made by the client indicates that education
about rejection is understood?
a. "I will take a laxative if I am unable to have a bowel movement."
b. "I will report fever, chills, and profuse sweating to the primary care provider."
c. "I will take my immunosuppressant drugs whenever I feel I am developing an
infection."
d. "I don't have to see my nephrologist any longer since I am cured of kidney
disease." - SOLUTION=Answer: b
Cognitive Level: Apply
Explanation: Signs of rejection, which can be similar to other antigen-antibody
responses, include fever, chills, diaphoresis, hypertension, hypotension, edema,
and signs of organ involvement. If the immunosuppressive drugs are not effective,
the organ will be rejected. Constipation is not a sign of rejection and may be
caused by decreased peristalsis after the surgical procedure. Clients must take the
immunosuppressants as prescribed to avoid rejection and not just when they feel
they are developing an infection. The client will continue to require the services of
the nephrologist to monitor the success of the transplant.
A client is taking methotrexate for the treatment of rheumatoid arthritis. What
expected finding does the nurse observe when reviewing laboratory results?
a. Low neutrophil count
b. Low hemoglobin
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c. Elevated leukocyte count
d. Elevated sedimentation rate - SOLUTION=Answer: a
Cognitive Level: Apply
Explanation: Methotrexate is a form of chemotherapy that is used in multiple
sclerosis, lupus, sarcoidosis, rheumatoid arthritis, and psoriasis. A common side
effect of chemotherapy is neutropenia, an abnormally low neutrophil count. In
contrast to treatments for cancer, treatment for autoimmune disorders can often
benefit from low neutrophil levels. Low hemoglobin is not commonly seen as a
result of methotrexate. A low leukocyte rather than a high leukocyte count may be
observed. A low sedimentation rate rather than a high one is seen as a result of the
administration of methotrexate due to the decrease of inflammation from its use.
A client suspects an allergy to latex. When gathering data from the client, what
questions would be appropriate for the nurse to ask? Select all that apply.
a. "Are you allergic to dairy products?"
b. "Are you allergic to bananas?"
c. "Are you allergic to kiwi?"
d. "Are you allergic to chestnuts?"
e. "Are you allergic to avocados?" - SOLUTION=Answer: b, c, d, e
Cognitive Level: Apply
Explanation: Latex allergies are noted in individuals who have hypersensitivities to
bananas, avocados, kiwis, and chestnuts. Dairy products are not associated with
latex allergies.
A sexually active 22-year-old female client arrives in the clinic for a wellness visit.
What procedure will the nurse prepare this client for?
a. A pap smear
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b. A chest x-ray
c. A CT scan of the abdomen
A barium enema - SOLUTION=Answer: a
Cognitive Level: Apply
Explanation: The Pap test is an important part of the physical examination of every
woman who is older than 20 years or who is sexually active. A chest x-ray, CT of
the abdomen, and a barium enema are not routine wellness screenings for a 22year-
old female.
The nurse is preparing a client with colon cancer for palliative surgery. What does
the nurse determine the expected outcome will be?
a. Complete recovery
b. Better quality of life
c. Damage to cancer cells
d. Remission - SOLUTION=Answer: b
Cognitive Level: Apply
Explanation: Palliative surgery may be performed to relieve some of the
complications of malignancies that cannot be totally excised. The goal of this type
of surgery is not to cure, but to promote comfort for the client. For example, with
metastatic lung cancer, a tumor putting pressure on the trachea may be removed to
facilitate breathing. Palliative surgery may also be done to promote quality of life
and to improve longevity. The outcome is also not to damage cancer cells or place
the client in remission.
A client is undergoing photodynamic therapy. What education should the nurse be
sure to reinforce to prevent complications?
a. Avoid direct sunlight and bright indoor lighting for 6 weeks.
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b. Maintain isolation for 6 weeks.
c. Apply antibiotic cream to the area after treatment.
d. Drink 10, 8-oz glasses of fluids per day. - SOLUTION=Answer: a