Galen medsurg exam #4 Questions With Complete Solutions
A 32-year-old female with a urinary tract infection (UTI) reports
urinary frequency, urgency, and some discomfort upon
urination. Her vital signs are stable except for a temperature of
100° F. Which drug does the health care provider prescribe?
Nitrofurantoin (Macrodantin) after intercourse
Estrogen (Premarin)
Trimethoprim/sulfamethoxazole (Bactrim)
Phenazopyridine (Pyridium) with intercourse
Guidelines indicate that a 3-day course of
trimethoprim/sulfamethoxazole is effective in treating
uncomplicated, community-acquired UTI in women. Correct
Answer Drugs from the same class as nitrofurantoin reduce
bacteria in the urinary tract by inhibiting bacterial reproduction
(bacteriostatic action). This client needs a drug that will kill
bacteria. Estrogen cream may help prevent recurrent UTIs in
postmenopausal women, which this client is not (at age 32). Use
of Premarin is related to problems with incontinence.
Phenazopyridine (Pyridium) is not used to treat infection, but
symptoms of a UTI.
A 65-year old client is seeing his primary care provider for an
annual examination. Which assessment finding alerts the nurse
to an increased risk for bladder cancer?
A. Smoking
B. Urine with a high specific gravity
C. Recurrent urinary tract infections
D. History of cancer in another organ or tissue Correct Answer
Answer: A
,Rationale: Many compounds in tobacco enter the bloodstream
and affect other organs, such as the bladder. Concentrated urine
is associated with kidney stones and UTIs. The urinary bladder
is not a common site for metastases.
A client admitted with severe diarrhea is experiencing skin
breakdown from frequent stools. What is an important comfort
measure for this client?
Applying hydrocortisone cream
Cleaning the area with soap and hot water
Using sitz baths three times daily
Wearing absorbent cotton underwear Correct Answer Clients
with skin breakdown may use sitz baths for comfort 2 or 3 times
daily. Barrier creams, not hydrocortisone creams, may be used.
The skin should be cleaned gently with soap and warm water.
Absorbent cotton underwear helps keep the skin dry, but is not a
comfort measure.
A client diagnosed with irritable bowel syndrome (IBS) is
discharged home with a variety of medications for IBS
symptoms. Upon returning to the clinic, the client states, "Most
of my symptoms have improved, except for the diarrhea." What
does the nurse anticipate will be prescribed for this client?
Antidiarrheal agent
Muscarinic receptor antagonist
Serotonin antagonist
Tricyclic antidepressant Correct Answer A muscarinic (M3)
receptor antagonist can also inhibit intestinal motility.
Antidiarrheal agents and serotonin antagonists are not the most
effective choices for this client. A tricyclic antidepressant is not
going to be effective for this client's diarrhea.
,A client diagnosed with stress incontinence is started on
propantheline (Pro-Banthine). What interventions does the nurse
suggest to alleviate the side effects of this anticholinergic drug?
(Select all that apply.)
Take the drug at bedtime.
Encourage increased fluids.
Increase fiber intake.
Limit the intake of dairy products.
Use hard candy for dry mouth. Correct Answer
Anticholinergics cause constipation; increasing fluids and fiber
intake will help with this problem. Anticholinergics also cause
extreme dry mouth, which can be alleviated with using hard
candy to moisten the mouth. Taking the drug at night and
limiting dairy products will not have an effect on the
complications encountered with propantheline.
A client diagnosed with ulcerative colitis is to be discharged on
loperamide (Imodium) for symptomatic management of
diarrhea. What does the nurse include in the teaching about this
medication?
"Be aware of the symptoms of toxic megacolon that we
discussed."
"If diarrhea increases, you should let your health care provider
know."
"Pregnancy should be avoided."
"You will need to decrease your dose of sulfasalazine
(Azulfidine)." Correct Answer Antidiarrheal drugs may
precipitate colonic dilation and toxic megacolon. Toxic
megacolon is characterized by an enlarged colon with fever,
leukocytosis, and tachycardia. Loperamide will decrease
, diarrhea rather than increase it. Constipation is sometimes a
problem. No contraindication for pregnancy is noted.
Sulfasalazine therapy typically continues on a long-term basis.
A client had a right total hip arthroplasty 2 days ago. Which
precautions will the nurse teach the client to prevent surgical
complications? Select all that apply.
A. "Stand on your right leg and pivot to the chair."
B. "Do not bend your hips more than 90 degrees."
C. "Cross your legs to be most comfortable."
D. "Avoid twisting your body when moving."
E. "Use a long-handled shoe horn to put on your shoes." Correct
Answer Answer: B, D, E
Rationale: After total hip arthroplasty, clients should not bend or
flex more than 90 degrees or adduct their legs (such as crossing
them). A long-handled shoe horn prevents having to bend
forward.
A client had a transurethral resection of the prostate (TURP)
with continuous bladder irrigation yesterday. The staff nurse
notes that the urinary drainage is bright red and thick. What is
the nurse's best action?
A. Notify the charge nurse as soon as possible.
B. Increase the rate of the bladder irrigation.
C. Document the assessment in the medical record.
D. Prepare the patient for a blood transfusion. Correct Answer
Answer: B
Rationale: After a TURP procedure, the flow of the irrigant
should be sufficient to keep the urine clear. Because the client's
A 32-year-old female with a urinary tract infection (UTI) reports
urinary frequency, urgency, and some discomfort upon
urination. Her vital signs are stable except for a temperature of
100° F. Which drug does the health care provider prescribe?
Nitrofurantoin (Macrodantin) after intercourse
Estrogen (Premarin)
Trimethoprim/sulfamethoxazole (Bactrim)
Phenazopyridine (Pyridium) with intercourse
Guidelines indicate that a 3-day course of
trimethoprim/sulfamethoxazole is effective in treating
uncomplicated, community-acquired UTI in women. Correct
Answer Drugs from the same class as nitrofurantoin reduce
bacteria in the urinary tract by inhibiting bacterial reproduction
(bacteriostatic action). This client needs a drug that will kill
bacteria. Estrogen cream may help prevent recurrent UTIs in
postmenopausal women, which this client is not (at age 32). Use
of Premarin is related to problems with incontinence.
Phenazopyridine (Pyridium) is not used to treat infection, but
symptoms of a UTI.
A 65-year old client is seeing his primary care provider for an
annual examination. Which assessment finding alerts the nurse
to an increased risk for bladder cancer?
A. Smoking
B. Urine with a high specific gravity
C. Recurrent urinary tract infections
D. History of cancer in another organ or tissue Correct Answer
Answer: A
,Rationale: Many compounds in tobacco enter the bloodstream
and affect other organs, such as the bladder. Concentrated urine
is associated with kidney stones and UTIs. The urinary bladder
is not a common site for metastases.
A client admitted with severe diarrhea is experiencing skin
breakdown from frequent stools. What is an important comfort
measure for this client?
Applying hydrocortisone cream
Cleaning the area with soap and hot water
Using sitz baths three times daily
Wearing absorbent cotton underwear Correct Answer Clients
with skin breakdown may use sitz baths for comfort 2 or 3 times
daily. Barrier creams, not hydrocortisone creams, may be used.
The skin should be cleaned gently with soap and warm water.
Absorbent cotton underwear helps keep the skin dry, but is not a
comfort measure.
A client diagnosed with irritable bowel syndrome (IBS) is
discharged home with a variety of medications for IBS
symptoms. Upon returning to the clinic, the client states, "Most
of my symptoms have improved, except for the diarrhea." What
does the nurse anticipate will be prescribed for this client?
Antidiarrheal agent
Muscarinic receptor antagonist
Serotonin antagonist
Tricyclic antidepressant Correct Answer A muscarinic (M3)
receptor antagonist can also inhibit intestinal motility.
Antidiarrheal agents and serotonin antagonists are not the most
effective choices for this client. A tricyclic antidepressant is not
going to be effective for this client's diarrhea.
,A client diagnosed with stress incontinence is started on
propantheline (Pro-Banthine). What interventions does the nurse
suggest to alleviate the side effects of this anticholinergic drug?
(Select all that apply.)
Take the drug at bedtime.
Encourage increased fluids.
Increase fiber intake.
Limit the intake of dairy products.
Use hard candy for dry mouth. Correct Answer
Anticholinergics cause constipation; increasing fluids and fiber
intake will help with this problem. Anticholinergics also cause
extreme dry mouth, which can be alleviated with using hard
candy to moisten the mouth. Taking the drug at night and
limiting dairy products will not have an effect on the
complications encountered with propantheline.
A client diagnosed with ulcerative colitis is to be discharged on
loperamide (Imodium) for symptomatic management of
diarrhea. What does the nurse include in the teaching about this
medication?
"Be aware of the symptoms of toxic megacolon that we
discussed."
"If diarrhea increases, you should let your health care provider
know."
"Pregnancy should be avoided."
"You will need to decrease your dose of sulfasalazine
(Azulfidine)." Correct Answer Antidiarrheal drugs may
precipitate colonic dilation and toxic megacolon. Toxic
megacolon is characterized by an enlarged colon with fever,
leukocytosis, and tachycardia. Loperamide will decrease
, diarrhea rather than increase it. Constipation is sometimes a
problem. No contraindication for pregnancy is noted.
Sulfasalazine therapy typically continues on a long-term basis.
A client had a right total hip arthroplasty 2 days ago. Which
precautions will the nurse teach the client to prevent surgical
complications? Select all that apply.
A. "Stand on your right leg and pivot to the chair."
B. "Do not bend your hips more than 90 degrees."
C. "Cross your legs to be most comfortable."
D. "Avoid twisting your body when moving."
E. "Use a long-handled shoe horn to put on your shoes." Correct
Answer Answer: B, D, E
Rationale: After total hip arthroplasty, clients should not bend or
flex more than 90 degrees or adduct their legs (such as crossing
them). A long-handled shoe horn prevents having to bend
forward.
A client had a transurethral resection of the prostate (TURP)
with continuous bladder irrigation yesterday. The staff nurse
notes that the urinary drainage is bright red and thick. What is
the nurse's best action?
A. Notify the charge nurse as soon as possible.
B. Increase the rate of the bladder irrigation.
C. Document the assessment in the medical record.
D. Prepare the patient for a blood transfusion. Correct Answer
Answer: B
Rationale: After a TURP procedure, the flow of the irrigant
should be sufficient to keep the urine clear. Because the client's
