MED SURG EXAM 4 TESTED AND
PASSED 100%
,MED SURG EXAM 4 TESTED AND
PASSED 100%
A nurse is working with many stroke clients. Which clients would the nurse consider referring to a
mental health provider on discharge (Select all that apply.)
A Client who exhibits extreme emotional lability
B Client with an initial National Institutes of Health (NIH) Stroke Scale score of 38
C Client with mild forgetfulness and a slight limp
D Client who has a past hospitalization for a suicide attempt
E Client who is unable to walk or eat 3 weeks post-stroke - CORRECT ANSWERSA B D E
A client has a small-bore feeding tube (Dobhoff tube) inserted for continuous enteral feedings while
recovering from a traumatic brain injury. What actions should the nurse include in the client's care
(Select all that apply.)
A Assess tube placement per agency policy.
B Keep the head of the bed elevated at least 30 degrees.
C Listen to lung sounds at least every 4 hours.
D Run continuous feedings on a feeding pump.
E Use blue dye to determine proper placement - CORRECT ANSWERSA B C D
A nurse assesses clients on a medical-surgical unit. Which client should the nurse identify as having the
greatest risk for cardiovascular disease
A An 86-year-old man with a history of asthma
B A 32-year-old Asian-American man with colorectal cancer
C A 45-year-old American Indian woman with diabetes mellitus
D A 53-year-old postmenopausal woman who is on hormone therapy - CORRECT ANSWERSC
, A nurse assesses an older adult client who is experiencing a myocardial infarction. Which clinical
manifestation should the nurse expect
A Excruciating pain on inspiration
B Left lateral chest wall pain
C Disorientation and confusion
D Numbness and tingling of the arm - CORRECT ANSWERSC
A nurse assesses a client who is scheduled for a cardiac catheterization. Which assessment should the
nurse complete prior to this procedure
A Client's level of anxiety
B Ability to turn self in bed
C Cardiac rhythm and heart rate
D Allergies to iodine-based agents - CORRECT ANSWERSD
A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA) and is scheduled
for bypass surgery. Which intervention should the nurse be prepared to implement while this client
waits for surgery
A Administration of IV furosemide (Lasix)
B Initiation of an external pacemaker
C Assistance with endotracheal intubation
D Placement of central venous access - CORRECT ANSWERSC
A nurse teaches a client with diabetes mellitus and a body mass index of 42 who is at high risk for
coronary artery disease. Which statement related to nutrition should the nurse include in this client's
teaching
A "The best way to lose weight is a high-protein, low-carbohydrate diet."
B "You should balance weight loss with consuming necessary nutrients."
PASSED 100%
,MED SURG EXAM 4 TESTED AND
PASSED 100%
A nurse is working with many stroke clients. Which clients would the nurse consider referring to a
mental health provider on discharge (Select all that apply.)
A Client who exhibits extreme emotional lability
B Client with an initial National Institutes of Health (NIH) Stroke Scale score of 38
C Client with mild forgetfulness and a slight limp
D Client who has a past hospitalization for a suicide attempt
E Client who is unable to walk or eat 3 weeks post-stroke - CORRECT ANSWERSA B D E
A client has a small-bore feeding tube (Dobhoff tube) inserted for continuous enteral feedings while
recovering from a traumatic brain injury. What actions should the nurse include in the client's care
(Select all that apply.)
A Assess tube placement per agency policy.
B Keep the head of the bed elevated at least 30 degrees.
C Listen to lung sounds at least every 4 hours.
D Run continuous feedings on a feeding pump.
E Use blue dye to determine proper placement - CORRECT ANSWERSA B C D
A nurse assesses clients on a medical-surgical unit. Which client should the nurse identify as having the
greatest risk for cardiovascular disease
A An 86-year-old man with a history of asthma
B A 32-year-old Asian-American man with colorectal cancer
C A 45-year-old American Indian woman with diabetes mellitus
D A 53-year-old postmenopausal woman who is on hormone therapy - CORRECT ANSWERSC
, A nurse assesses an older adult client who is experiencing a myocardial infarction. Which clinical
manifestation should the nurse expect
A Excruciating pain on inspiration
B Left lateral chest wall pain
C Disorientation and confusion
D Numbness and tingling of the arm - CORRECT ANSWERSC
A nurse assesses a client who is scheduled for a cardiac catheterization. Which assessment should the
nurse complete prior to this procedure
A Client's level of anxiety
B Ability to turn self in bed
C Cardiac rhythm and heart rate
D Allergies to iodine-based agents - CORRECT ANSWERSD
A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA) and is scheduled
for bypass surgery. Which intervention should the nurse be prepared to implement while this client
waits for surgery
A Administration of IV furosemide (Lasix)
B Initiation of an external pacemaker
C Assistance with endotracheal intubation
D Placement of central venous access - CORRECT ANSWERSC
A nurse teaches a client with diabetes mellitus and a body mass index of 42 who is at high risk for
coronary artery disease. Which statement related to nutrition should the nurse include in this client's
teaching
A "The best way to lose weight is a high-protein, low-carbohydrate diet."
B "You should balance weight loss with consuming necessary nutrients."
