Med SURG Practice EXAM Questions from evolve hesi

Questions
The nurse is assessing a client's laboratory values following administration of chemotherapy. Which lab value leads the nurse to suspect that the client is experiencing tumor lysis syndrome (TLS)? A Serum PTT of 10 seconds. B Serum calcium of 5 mg/dl. Correct C Oxygen saturation of 90%. D Hemoglobin of 10 g/dl.
TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatemia. A serum calcium level of 5 (B), which is low, is an indicator of possible tumor lysis syndrome. (A, C, and D) are not particularly related to TLS. Awarded 0.0 points out of 1.0 possible points.
2.ID: 5A client is admitted to the hospital with a diagnosis of severe acute diverticulitis. Which assessment finding should the nurse expect this client to exhibit? A Lower left quadrant pain and a low-grade fever. Correct B Severe pain at McBurney's point and nausea. C Abdominal pain and intermittent tenesmus. D Exacerbations of severe diarrhea.
Left lower quadrant pain occurs with diverticulitis because the sigmoid colon is the most common area for diverticula, and the inflammation of diverticula causes a lowgrade fever (A). (B) would be indicative of appendicitis. (C and D) are symptoms exhibited with ulcerative colitis. Awarded 0.0 points out of 1.0 possible points.
3.ID: 3During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not moving. What action should the nurse take first? A Use a laryngoscope to check for a foreign body lodged in the esophagus. B Reposition the head to validate that the head is in the proper position to open the airway. Correct C Turn the client to the side and administer three back blows. D Perform a finger sweep of the mouth to remove any vomitus.
The most frequent cause of inadequate aeration of the client's lungs during CPR is improper positioning of the head resulting in occlusion of the airway (B). A foreign body can occlude the airway, but this is not common unless choking preceded the cardiac emergency, and (A, C and D) should not be the nurse's first action. Awarded 0.0 points out of 1.0 possible points.
4.ID: 4A client is admitted to the hospital with a medical diagnosis of pneumococcal pneumonia. The nurse knows that the prognosis for gram-negative pneumonias (such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor because A they occur in the lower lobe alveoli which are more sensitive to infection. B gram-negative organisms are more resistant to antibiotic therapy. Correct C they occur in healthy young adults who have recently been debilitated by an upper respiratory infection. D gram-negative pneumonias usually affect infants and small children.
The gram-negative organisms are resistant to drug therapy (B) which makes recovery very difficult. Gramnegative pneumonias affect all lobes of the lung (A). The mean age for contracting this type of pneumonia is 50 years (C and D), and it usually strikes debilitated persons such as alcoholics, diabetics, and those with chronic lung diseases. Awarded 0.0 points out of 1.0 possible points.
5.ID: 5A client is placed on a mechanical ventilator following a cerebral hemorrhage, and vecuronium bromide (Norcuron) 0.04 mg/kg q12 hours IV is prescribed. What is the priority nursing diagnosis for this client? A Impaired communication related to paralysis of skeletal muscles. Correct B High risk for infection related to increased intracranial pressure. C Potential for injury related to impaired lung expansion. D Social isolation related to inability to communicate.
To increase the client's tolerance of endotracheal intubation and/or mechanical ventilation, a skeletal-muscle relaxant, such as vecuronium, is usually prescribed. Impaired communication (A) is a serious outcome because the client cannot communicate his/her needs due to intubation and diaphragmatic paralysis caused by the drug. Although this client might also experience (D), it is not a priority when compared to (A). Infection is not related to increased intracranial pressure (B). The mechanical venilator provides consistent lung expansion (C). Awarded 0.0 points out of 1.0 possible points.
6.ID: 5When preparing a client who has had a total laryngectomy for discharge, what instruction is most important for the nurse to include in the discharge teaching? A Recommend that the client carry suction equipment at all times. B Instruct the client to have writing materials with him at all times. C Tell the client to carry a medic alert card stating that he is a total neck breather. Correct D Tell the client not to travel alone.
It is imperative that total neck breathers carry a medic alert notice (C) so that if they have a cardiac arrest, mouthto-neck breathing can be done. Mouth-to-mouth resuscitation will not help them. They do not need to carry (A) nor refrain from (D). There are many alternative means of communication for clients who have had a laryngectomy; depending on (B) is probably the least effective. How do you know he can read and write? Awarded 0.0 points out of 1.0 possible points.
7.ID: 9The nurse would be correct in withholding a dose of digoxin in a client with congestive heart failure without specific instruction from the healthcare provider if the client's A serum digoxin level is 1.5. B blood pressure is 104/68. C serum potassium level is 3. Correct D apical pulse is 68/min.
Hypokalemia (C) can precipitate digitalis toxicity in persons receiving digoxin which will increase the chance of dangerous dysrhythmias (normal potassium level is 3.5 to 5.5 mEq/L). The therapeutic range for digoxin is 0.8 to 2 ng/ml (toxic levels=>2 ng/ml); (A) is within this range. (B) would not warrant the nurse withholding the digoxin. The nurse should withhold the digoxin if the apical pulse is less than 60/min (D). Awarded 0.0 points out of 1.0 possible points.
8.ID: 3After the fourth dose of gentamicin sulfate (Garamycin) IV, the nurse plans to draw blood samples to determine peak and trough levels. When are the best times to draw these samples? A 15 minutes before and 15 minutes after the next dose. B One hour before and one hour after the next dose. C 5 minutes before and 30 minutes after the next dose. Correct D 30 minutes before and 30 minutes after the next dose.
Peak drug serum levels are achieved 30 minutes after IV administration of aminoglycosides. The best time to draw a trough is the closest time to the next administration (C). (A, B, and D) are not as good a time to draw the trough as (C). (B and D) are not the best times to draw the peak of an aminoglycoside that has been administered IV. Awarded 0.0 points out of 1.0 possible points.
9.ID: 1A client has undergone insertion of a permanent pacemaker. When developing a discharge teaching plan, the nurse writes a goal of, "The client will verbalize symptoms of pacemaker failure." Which symptoms are most important to teach the client? A Facial flushing. B Fever. C Pounding headache. D Feelings of dizziness. Correct
Feelings of dizziness (D) may occur as the result of a decreased heart rate, leading to decreased cardiac output. (A and C) will not occur as the result of pacemaker failure. (B) may be an indication of infection postoperatively, but is not an indication of pacemaker failure. Awarded 0.0 points out of 1.0 possible points.
10.ID: 7A client with heart disease is on a continuous telemetry monitor and has developed sinus bradycardia. In determining the possible cause of the bradycardia, the nurse assesses the client's medication record. Which medication is most likely the cause of the bradycardia? A Propanolol (Inderal). Correct B Captopril (Capoten). C Furosemide (Lasix). D Dobutamine (Dobutrex).
Inderal (A) is a beta adrenergic blocking agent, which causes decreased heart rate and decreased contractility. Neither (B), an ACE inhibitor, nor (C), a loop diuretic, causes bradycardia. (D) is a sympathomimetic, direct acting cardiac stimulant, which would increase the heart rate. Awarded 0.0 points out of 1.0 possible points.