ATI FINAL MEDSURG B3 EXAM

A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding? a.Serum hematocrit of 42% b.Serum sodium level of 120 mg/dL c.Reported weight gain of 2.2 lb (1 kg) d.Urinary output of 280 mL during past 8 hours b.Serum sodium level of 120 mg/dL Hyponatremia is the most important finding to report. SIADH causes water retention and a decrease in serum sodium level. Hyponatremia can cause confusion and other central nervous system effects. A critically low value likely needs to be treated. At least 30 mL/hr of urine output indicates adequate kidney function. The hematocrit level is normal. Weight gain is expected with SIADH because of water retention. A patient with new-onset confusion and hyponatremia is being admitted. When making room assignments, the charge nurse should take which action? a.Assign the patient to a semi-private room. b.Assign the patient to a room near the nurse's station. c.Place the patient in a room nearest to the water fountain. d.Place the patient on telemetry to monitor for peaked T waves.. b.Assign the patient to a room near the nurse's station. The patient should be placed near the nurse's station if confused for the staff to closely monitor the patient. To help improve serum sodium levels, water intake is restricted. Therefore a confused patient should not be placed near a water fountain. Peaked T waves are a sign of hyperkalemia, not hyponatremia. A confused patient could be distracting and disruptive for another patient in a semiprivate room. A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L? a. Metabolic acidosis c.Respiratory acidosis b.Metabolic alkalosis d.Respiratory alkalosis d.Respiratory alkalosis 11. The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take? a. Give the prescribed PRN lorazepam (Ativan). b. Encourage the patient to take deep slow breaths. c. Start the prescribed PRN oxygen at 2 to 4 L/min. d. Administer the prescribed normal saline bolus and insulin. d. Administer the prescribed normal saline bolus and insulin. The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need for correction of the acidosis with a saline bolus to prevent hypovolemia followed by insulin administration to allow glucose to reenter the cells. Oxygen therapy is not indicated because there is no indication that the increased respiratory rate is related to hypoxemia. The respiratory pattern is compensatory, and the patient will not be able to slow the respiratory rate. Lorazepam administration will slow the respiratory rate and increase the level of acidosis. The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? a. Maintain the patient on bed rest. b. Auscultate lung sounds every 4 hours. c. Monitor for Trousseau's and Chvostek's signs. d. Encourage fluid intake up to 4000 mL every day. d. Encourage fluid intake up to 4000 mL every day. HYPERCALCEMIA: dilute! A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most important for the nurse to report to the health care provider? a.The patient is experiencing laryngeal stridor. b.The patient complains of generalized fatigue. c.The patient’s bowels have not moved for 4 days. d.The patient has numbness and tingling of the lips. a.The patient is experiencing laryngeal stridor. Hypocalcemia can cause laryngeal stridor, which may lead to respiratory arrest. Rapid action is required to correct the patient's calcium level. The other data are also consistent with hypocalcemia, but do not indicate a need for as immediate action as laryngospasm. Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete? a. Presence of the Chvostek's sign b. Abnormal serum potassium level c. Decreased thyroid hormone level d. Bleeding on the patient's dressing a. Presence of the Chvostek's sign The patient's symptoms indicate possible hypocalcemia, which can occur secondary to parathyroid injury or removal during thyroidectomy. There is no indication of a need to check the potassium level, the thyroid hormone level, or for bleeding. 6. To determine possible causes, the nurse will ask a patient admitted with acute glomerulonephritis about a. recent bladder infection. c. recent sore throat and fever. b. history of kidney stones. d. history of high blood pressure. c. recent sore throat and fever. Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection. Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The patient denies pain with voiding. b. The urine dipstick is negative for nitrites. c. The antistreptolysin-O (ASO) titer has decreased. d. The periorbital and peripheral edema are resolved. d. The periorbital and peripheral edema are resolved. Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection. A 56-yr-old female patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect? a. Poor skin turgor c. Elevated urine ketones b. Recent weight gain d. Decreased blood pressure b. Recent weight gain The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high. Ketones are not related to nephrotic syndrome. To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. c. spinach and chocolate. b. sardines and liver. d. legumes and dried fruit. b. sardines and liver. Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones. The nurse teaches an adult patient to prevent the recurrence of renal calculi by a. using a filter to strain all urine. b. avoiding dietary sources of calcium. c. drinking 2000 to 3000 mL of fluid each day. d. choosing diuretic fluids such as coffee and tea. c. drinking 2000 to 3000 mL of fluid each day. A 68-yr-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching? a. Application of ostomy appliances b. Barrier products for skin protection c. Catheterization technique and schedule d. Analgesic use before emptying the pouch c. Catheterization technique and schedule Continent urostomy requires self-cath Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)? a. Low urine output c. Nausea and vomiting b. Bilateral flank pain d. Burning on urination d. Burning on urination Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI. A 76-yr-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first? a. Insert a urinary retention catheter. b. Draw blood for a serum creatinine level. c. Schedule an intravenous pyelogram (IVP). d. Administer lorazepam (Ativan) 0.5 mg PO. a. Insert a urinary retention catheter. Bypass the obstruction! A 48-yr-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma from a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon? a. Blood pressure is 102/58. b. Urine output is 20 mL/hr for 2 hours. c. Incisional pain level is reported as 9/10. d. Crackles are heard at bilateral lung bases. b. Urine output is 20 mL/hr for 2 hours. Because the urine output should be at least 0.5 mL/kg/hr, a 40-mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain. A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (select all that apply)? a. Milk b. Liver c. Spinach d. Chicken e. Cabbage f. Chocolate b. Liver d. Chicken Meats have purines which are metabolized into uric acid. Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum b. A 35-yr-old patient who is concerned that his scrotum “feels like a bag of worms” c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum Suggests testicular cancer A patient was recently diagnosed with polycystic ovary syndrome. It is most important for the nurse to teach the patient a. reasons for a total hysterectomy. b. how to decrease facial hair growth. c. ways to reduce the occurrence of acne. d. methods to maintain appropriate weight. d. methods to maintain appropriate weight. Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse should also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, it is usually performed only after other therapies have been unsuccessful. A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching? a. Use of water-soluble lubricants b. Risk factors for cervical cancer c. Antifungal cream administration d. Possible difficulties with conception b. Risk factors for cervical cancer The nurse will plan to teach the female patient with genital warts about the a. importance of regular Pap tests. b. increased risk for endometrial cancer. c. appropriate use of oral contraceptives. d. symptoms of pelvic inflammatory disease (PID). a. importance of regular Pap tests. A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse’s teaching has been effective? a. “I can purchase an over-the-counter medication to treat this infection.” b. “The symptoms are due to the overgrowth of normal vaginal bacteria.” c. “The medication will need to be inserted once daily with an applicator.” d. “Both my partner and I will need to take the medication for a full week.” d. "Both my partner and I will need to take the medication for a full week." After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Teach the patient about normal AVG function. b. Remind the patient to take a daily low-dose aspirin tablet. c. Report the patient's symptoms to the health care provider. d. Elevate the patient's arm on pillows to above the heart level. c. Report the patient's symptoms to the health care provider. Steal Syndrome! When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of a. persistent skin tenting c. hot, flushed face and neck. b. rapid, deep respirations. d. bounding peripheral pulses. b. rapid, deep respirations. Metabolic Acidosis - Kussmaul's Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection." c. "I will measure my urinary output each day to help calculate the amount I can drink." A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can accommodate larger needles. d. A fistula can be used sooner after surgery a. A fistula is much less likely to clot. A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes. A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider? a. Serum creatinine level of 2.1 mg/dL b. Serum potassium level of 6.5 mEq/L c. White blood cell count of 11,500/μL d. Blood urea nitrogen (BUN) of 56 mg/dL b. Serum potassium level of 6.5 mEq/L A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate). b. Place the patient on a cardiac monitor. A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient's abdomen appears bloated after the inflow. d. The patient has abdominal pain during the inflow phase. b. The patient's peritoneal effluent appears cloudy. Suggests Peritonitis A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for the next 24 hours? Output plus 500mL = 850mL The initial neurologic symptom of Guillain-Barré syndrome is: a. absent tendon reflexes. c. paresthesia of the legs. b. dysrhythmias. d. transient hypertension. c. paresthesia of the legs. The nurse is aware that multiple sclerosis is a progressive disease of the central nervous system characterized by: a. axon degeneration. c. sclerosed patches of neural tissue. b. demyelination of the brain and the spinal cord. d. all of the above. b. demyelination of the brain and the spinal cord The clinical manifestations of Parkinson's disease (bradykinesia, rigidity, and tremors) are directly related to a decreased level of: a. acetylcholine. c. serotonin. b. dopamine. d. phenylalanine. b. dopamine. Clinical manifestations of Huntington's disease include: a. abnormal involuntary movements (chorea). b. emotional disturbances. c. intellectual decline. d. all of the above. d. all of the above. When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should s for the presence of chest pain. re about urinary tract problems. ct the skin for rashes or discoloration. the patient about any increase in libido. re about urinary tract problems. MS - fatigued muscles --> incontinence The nurse advises a patient with myasthenia gravis (MG) to a. perform physically demanding activities early in the day. b. anticipate the need for weekly plasmapheresis treatments. c. do frequent weight-bearing exercise to prevent muscle atrophy. d. protect the extremities from injury due to poor sensory perception. a. perform physically demanding activities early in the day. After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a.Auscultate the patient’s bowel sounds. b.Notify the patient’s health care provider. c.Administer the prescribed PRN antiemetic drug. d.Give the scheduled dose of prednisone (Deltasone). b.Notify the patient's health care provider. Symptoms may indicate cholinergic crisis.