Med Surg VATI Assessment Test Questions and Answers Graded A+
A nurse is preparing to discharge a client who is post- Elevated toilet seat
operative following a total hip arthroplasty. Which of the
following equipment should the nurse ensure that the A client who is postoperative following a total hip arthro-
client has available at home prior to discharge? plasty is at risk for dislocation of the hip prosthesis. Limita-
tions on hip flexion and adduction decrease the risk. The
Continuous passive motion device client should avoid flexing the hip greater than 90° and
Elevated toilet seat should avoid using toilet seats that are low to the ground.
Trapeze bar An elevated toilet seat should be in place in the client's
Compression garment home prior to the client's discharge.
Elevated WBC count
A client who has acute appendicitis will show a moderate
A nurse is assessing a client who has suspected appen- elevation of the WBC count from 10,000 to 18,000/mm3. If
dicitis. Which of the following manifestations should the the WBC count is greater than 20,000/mm3, it can indicate
nurse expect? (select all that apply) a perforated appendix.
Rebound tenderness
Elevated WBC count A client who has appendicitis develops localized pain over
Elevated amylase level the right lower quadrant of the abdomen. When the area
Rebound tenderness is palpated, pain occurs during release of pressure on the
Ascites client's abdomen.
Anorexia Anorexia
A client who has acute appendicitis experiences nausea,
vomiting, and reduced appetite.
A nurse is teaching a client who has a new diagnosis of
type 1 diabetes mellitus. Which of the following state-
"I am aware that my diabetes is caused by an autoimmune
ments by the client indicates an understanding of the
disorder."
teaching?
Type 1 diabetes mellitus is an autoimmune disorder that
"I am aware that my diabetes is caused by an autoimmune
destroys pancreatic beta cells. This autoimmune reaction
disorder."
is often triggered by a viral infection.
"I know that my diabetes developed slowly over several
years."
,Med Surg VATI Assessment Test Questions and Answers Graded A+
"If I lose weight, I may be able to stop taking insulin."
"I have developed a resistance to insulin."
A nurse is caring for a male client who has a new prescrip- BUN 24 mg/dL
tion for cyclosporine following a kidney transplant. Which
of the following findings should the nurse identify as an A BUN of 24 mg/dL is above the expected reference
adverse ettect of this therapy? range of 10 to 20 mg/dL, indicating renal impairment.
WBC count 8,000/mm3 An adverse ettect of cyclosporine is nephrotoxicity. The
RBC count 6 million/mm3 nurse should monitor the client for increases in BUN and
BUN 24 mg/dL creatinine and report any elevation to the provider. A rise
Potassium 3.5 mEq/L in BUN could indicate transplant rejection.
A nurse in a long-term care facility is caring for a client Provide finger food at mealtime.
who has dementia. Which of the following actions should
the nurse take? The nurse should provide the client who has dementia
Give detailed directions when addressing the client. with fingers foods. Clients who have dementia can have
Provide finger food at mealtime. diflculty sitting still and tend to wander, which makes
Use written signs to redirect the client. weight loss and malnutrition a concern. Therefore, foods
Seat the client at a large table for meals. that the client can hold while ambulating are ideal.
A nurse is caring for a client immediately following in-
tubation with an endotracheal (ET) tube. Which of the
Check for end-tidal carbon dioxide levels.
following methods should the nurse identify as the most
reliable for verifying placement of the ET tube? According to evidence-based practice, the most reliable
method for verifying ET tube placement is checking for
Feel for exhaled air emerging from the endotracheal
end-tidal carbon dioxide levels by using capnometry. A
tube.
chest x-ray is another reliable method for verifying place-
Assess for bilateral breath sounds.
ment.
Observe for symmetric chest movement.
Check for end-tidal carbon dioxide levels.
A nurse is providing teaching for a client who has neu- "I will avoid crowds."
tropenia and is receiving chemotherapy. Which of the The client who is immunocompromised should avoid
following client statements indicates an understanding of crowds while undergoing chemotherapy to reduce the risk
,Med Surg VATI Assessment Test Questions and Answers Graded A+
the teaching? (select all that apply)
of infection.
"I will avoid crowds." "I will take my temperature daily."
"I will wash my toothbrush weekly." The client who is immunocompromised should take daily
"I will change my cat's litter box twice weekly." temperature readings and report an elevated temperature
"I will take my temperature daily." to the provider.
"I will eat plenty of fresh fruits and vegetables."
A nurse is planning care for a. client who has a lump in
their right breast. Which of the following findings increas-
Menopausal obesity
es the client's risk of developing breast cancer?
During menopause, increased fat tissue can lead to higher
Menarche started at age 15
stores of estrogen. Higher levels of estrogen in the body
First born child was at 20 years of age
increase the risk for postmenopausal breast cancer.
History of a fibrocystic breasts
Menopausal obesity
A nurse is teaching a client who is scheduled to receive ra-
dioactive iodine therapy for treatment of hyperthyroidism. Use disposable utensils for meals.
Which of the following instructions should the nurse in-
clude in the teaching? The client who receives radioactive iodine has radioactivity
in the body fluids, including saliva, for several weeks fol-
Remain 0.3 m (1 ft) away from children. lowing treatment. The nurse should instruct the client to
Limit the time spent around women who are pregnant to use disposable utensils, plates, and cups during this time
10 min daily. period to decrease the risk for radiation exposure to other
Use disposable utensils for meals. members of the household.
Use an absorbent pad if incontinent.
A nurse is providing discharge teaching to a client follow-
ing a loop electrosurgical excision procedure (LEEP) for
the treatment of cervical cancer. Which of the following "I may have mild cramping for several hours."
statements by the client indicates an understanding of the The client should expect very little discomfort from the
teaching?
, Med Surg VATI Assessment Test Questions and Answers Graded A+
"I can resume sexual intercourse in 48 hours."
"I can expect some heavy vaginal bleeding for 24 hours." LEEP procedure, which is performed in ambulatory care
"I can use tampons when my period comes in a week." using a painless electrical current.
"I may have mild cramping for several hours."
A nurse is providing teaching to a client who has a new
prescription for cephalexin oral suspension. Which of the
following statements by the client indicates an under-
standing of the teaching?
"I will keep the medication refrigerated."
"I will increase my consumption of foods high in potassi-
um."
"I will apply lotion to my skin if I feel any itching."
"I will avoid sun exposure while taking this medication."
"I will keep the medication refrigerated."
A nurse is assessing a client who has a history of type
2 diabetes mellitus. The nurse should identify which of
Retinopathy
the following findings as an indication of a microvascular
complication? Diabetic retinopathy is a microvascular complication of di-
abetes mellitus resulting from pathologic changes in small
Coronary artery disease
blood vessels, which eventually cause tissue damage, cell
Retinopathy
death in the retina, and blindness.
Cerebrovascular accident
Hypertension
A nurse in an emergency department is caring for a client
Administer oxygen using a high-concentration mask.
who is confused, has a temperature of 104 F, a BP of 74/52
The first action the nurse should take when using the
mm Hg, and a diagnosis of exertional heat stroke. Which
airway, breathing, and circulation approach to client care
of the following actions should the nurse take first?
is to ensure that the client has a patent airway and admin-
ister oxygen using a high-concentration mask to promote
Measure the client's urine specific gravity.
oxygen perfusion to vital organs.
Administer oxygen using a high-concentration mask.
A nurse is preparing to discharge a client who is post- Elevated toilet seat
operative following a total hip arthroplasty. Which of the
following equipment should the nurse ensure that the A client who is postoperative following a total hip arthro-
client has available at home prior to discharge? plasty is at risk for dislocation of the hip prosthesis. Limita-
tions on hip flexion and adduction decrease the risk. The
Continuous passive motion device client should avoid flexing the hip greater than 90° and
Elevated toilet seat should avoid using toilet seats that are low to the ground.
Trapeze bar An elevated toilet seat should be in place in the client's
Compression garment home prior to the client's discharge.
Elevated WBC count
A client who has acute appendicitis will show a moderate
A nurse is assessing a client who has suspected appen- elevation of the WBC count from 10,000 to 18,000/mm3. If
dicitis. Which of the following manifestations should the the WBC count is greater than 20,000/mm3, it can indicate
nurse expect? (select all that apply) a perforated appendix.
Rebound tenderness
Elevated WBC count A client who has appendicitis develops localized pain over
Elevated amylase level the right lower quadrant of the abdomen. When the area
Rebound tenderness is palpated, pain occurs during release of pressure on the
Ascites client's abdomen.
Anorexia Anorexia
A client who has acute appendicitis experiences nausea,
vomiting, and reduced appetite.
A nurse is teaching a client who has a new diagnosis of
type 1 diabetes mellitus. Which of the following state-
"I am aware that my diabetes is caused by an autoimmune
ments by the client indicates an understanding of the
disorder."
teaching?
Type 1 diabetes mellitus is an autoimmune disorder that
"I am aware that my diabetes is caused by an autoimmune
destroys pancreatic beta cells. This autoimmune reaction
disorder."
is often triggered by a viral infection.
"I know that my diabetes developed slowly over several
years."
,Med Surg VATI Assessment Test Questions and Answers Graded A+
"If I lose weight, I may be able to stop taking insulin."
"I have developed a resistance to insulin."
A nurse is caring for a male client who has a new prescrip- BUN 24 mg/dL
tion for cyclosporine following a kidney transplant. Which
of the following findings should the nurse identify as an A BUN of 24 mg/dL is above the expected reference
adverse ettect of this therapy? range of 10 to 20 mg/dL, indicating renal impairment.
WBC count 8,000/mm3 An adverse ettect of cyclosporine is nephrotoxicity. The
RBC count 6 million/mm3 nurse should monitor the client for increases in BUN and
BUN 24 mg/dL creatinine and report any elevation to the provider. A rise
Potassium 3.5 mEq/L in BUN could indicate transplant rejection.
A nurse in a long-term care facility is caring for a client Provide finger food at mealtime.
who has dementia. Which of the following actions should
the nurse take? The nurse should provide the client who has dementia
Give detailed directions when addressing the client. with fingers foods. Clients who have dementia can have
Provide finger food at mealtime. diflculty sitting still and tend to wander, which makes
Use written signs to redirect the client. weight loss and malnutrition a concern. Therefore, foods
Seat the client at a large table for meals. that the client can hold while ambulating are ideal.
A nurse is caring for a client immediately following in-
tubation with an endotracheal (ET) tube. Which of the
Check for end-tidal carbon dioxide levels.
following methods should the nurse identify as the most
reliable for verifying placement of the ET tube? According to evidence-based practice, the most reliable
method for verifying ET tube placement is checking for
Feel for exhaled air emerging from the endotracheal
end-tidal carbon dioxide levels by using capnometry. A
tube.
chest x-ray is another reliable method for verifying place-
Assess for bilateral breath sounds.
ment.
Observe for symmetric chest movement.
Check for end-tidal carbon dioxide levels.
A nurse is providing teaching for a client who has neu- "I will avoid crowds."
tropenia and is receiving chemotherapy. Which of the The client who is immunocompromised should avoid
following client statements indicates an understanding of crowds while undergoing chemotherapy to reduce the risk
,Med Surg VATI Assessment Test Questions and Answers Graded A+
the teaching? (select all that apply)
of infection.
"I will avoid crowds." "I will take my temperature daily."
"I will wash my toothbrush weekly." The client who is immunocompromised should take daily
"I will change my cat's litter box twice weekly." temperature readings and report an elevated temperature
"I will take my temperature daily." to the provider.
"I will eat plenty of fresh fruits and vegetables."
A nurse is planning care for a. client who has a lump in
their right breast. Which of the following findings increas-
Menopausal obesity
es the client's risk of developing breast cancer?
During menopause, increased fat tissue can lead to higher
Menarche started at age 15
stores of estrogen. Higher levels of estrogen in the body
First born child was at 20 years of age
increase the risk for postmenopausal breast cancer.
History of a fibrocystic breasts
Menopausal obesity
A nurse is teaching a client who is scheduled to receive ra-
dioactive iodine therapy for treatment of hyperthyroidism. Use disposable utensils for meals.
Which of the following instructions should the nurse in-
clude in the teaching? The client who receives radioactive iodine has radioactivity
in the body fluids, including saliva, for several weeks fol-
Remain 0.3 m (1 ft) away from children. lowing treatment. The nurse should instruct the client to
Limit the time spent around women who are pregnant to use disposable utensils, plates, and cups during this time
10 min daily. period to decrease the risk for radiation exposure to other
Use disposable utensils for meals. members of the household.
Use an absorbent pad if incontinent.
A nurse is providing discharge teaching to a client follow-
ing a loop electrosurgical excision procedure (LEEP) for
the treatment of cervical cancer. Which of the following "I may have mild cramping for several hours."
statements by the client indicates an understanding of the The client should expect very little discomfort from the
teaching?
, Med Surg VATI Assessment Test Questions and Answers Graded A+
"I can resume sexual intercourse in 48 hours."
"I can expect some heavy vaginal bleeding for 24 hours." LEEP procedure, which is performed in ambulatory care
"I can use tampons when my period comes in a week." using a painless electrical current.
"I may have mild cramping for several hours."
A nurse is providing teaching to a client who has a new
prescription for cephalexin oral suspension. Which of the
following statements by the client indicates an under-
standing of the teaching?
"I will keep the medication refrigerated."
"I will increase my consumption of foods high in potassi-
um."
"I will apply lotion to my skin if I feel any itching."
"I will avoid sun exposure while taking this medication."
"I will keep the medication refrigerated."
A nurse is assessing a client who has a history of type
2 diabetes mellitus. The nurse should identify which of
Retinopathy
the following findings as an indication of a microvascular
complication? Diabetic retinopathy is a microvascular complication of di-
abetes mellitus resulting from pathologic changes in small
Coronary artery disease
blood vessels, which eventually cause tissue damage, cell
Retinopathy
death in the retina, and blindness.
Cerebrovascular accident
Hypertension
A nurse in an emergency department is caring for a client
Administer oxygen using a high-concentration mask.
who is confused, has a temperature of 104 F, a BP of 74/52
The first action the nurse should take when using the
mm Hg, and a diagnosis of exertional heat stroke. Which
airway, breathing, and circulation approach to client care
of the following actions should the nurse take first?
is to ensure that the client has a patent airway and admin-
ister oxygen using a high-concentration mask to promote
Measure the client's urine specific gravity.
oxygen perfusion to vital organs.
Administer oxygen using a high-concentration mask.
