RN Adult Medical Surgical Online Practice 2019 B for NGN

1. A nurse is providing follow-up care for a client who sustained a compound fracture 3 weeks ago. The nurse should recognize that an UNEXPECTED finding for which of the following LABORATORY VALUES is a manifestation of OSTEOMYELITIS and should be reported to the provider? - An increased sedimentation rate occurs when a client has any type of inflammatory process, such as osteomyelitis 2. A nurse is reviewing the medical records of a client who is taking WARFARIN for chronic arterial fibrillation. Which of the following values should the nurse identify as a desired outcome for this therapy? - INR 2.5 3. Clients receive warfarin therapy to decrease the risk of stroke, myocardial infarction (MI), or pulmonary emboli (PE) from blood clots. Since warfarin is an anticoagulant, the medication must be monitored to ensure the anticoagulation is within the therapeutic range and prevent hemorrhage (levels of anticoagulation) or stroke, MI, PE (low levels of anticoagulation). An INR 2.5 is within the targeted therapeutic range of 2 to 3 for a client who has atrial fibrillation. 4. A nurse is planning a health promotional presentation for a group of African American clients at a community center. Which of the following disorders presents the greatest risk to this group of clients? - Hypertension 5. When using the safety/risk reduction approach to client care, the nurse should determine that the disorder with the greatest risk for this group of clients is hypertension. The prevalence of hypertension is highest among African American clients, followed by Caucasian clients, and then Hispanic clients. 6. A nurse is reviewing the laboratory results of a client who has aplastic anemia. Which of the following findings indicates a potential complication? - WBC count 2,000/mm3 A WBC count of 2,000/mm3 is below the expected reference range and indicates a risk for severe immunosuppression 7. A nurse is caring for an older adult client who has dementia and requires acute care for a respiratory infection. The client is agitated and is attempting to remove the IV catheter. Which of the following actions should nurse take to avoid restraining the client? - Keep the client occupied with a manual activity. The nurse should provide the client with a manual activity such as a puzzle or an art project. This can help to distract the client from the IV catheter. 8. A nurse is planning care for a client who has a sealed radiation implant for cervical cancer. Which of the following interventions should the nurse include in the plan of care? - Keep a lead-lined container in the client's room The nurse should keep a lead-lined container and forceps in the client's room in case of accidental dislodgement of the implant. 9. A nurse reviewing the ABG results of a client who has advanced COPD. Which of the following results should the nurse expect? - PaCO2 56 mm Hg A client who has COPD retains PaCO2 duet to the weakening and the collapse of the alveolar sacs, which is decreases the area in the lings for gas exchange and causes the PaCO2 to increase above the expected reference range. 10. A nurse is assessing a client who has peripheral arterial disease. Which of the following findings should the nurse expect? - Hair loss on the lower legs The nurse should expect a client who has a peripheral arterial disease to have hair loss on the lower legs as a result of impaired arterial circulation affecting follicular growth. 11. A nurse is caring for a client who has breast cancer and tells the nurse that they would like to have acupuncture because it provides greater relief than pain medication Which of the following statements should the nurse make? - " I can speak to the provider about incorporating acupuncture into your treatment plan." The nurse should serve as an advocate for the client by acting on behalf of the client and offering to speak with the provider. The client has the right to make choices and decisions about their treatment and the nurse should support these decisions and assist the client to carry them out. 12. A nurse is providing teaching to a client who has hypertension and a NEW prescription for verapamil. Which of the following information should the nurse include in the teaching? - " Increase fiber intake to avoid constipation." The nurse should instruct the client that constipation is an adverse effect of verapamil. The client should increase fiber intake to promote regular bowel function. 13. A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following interventions should the nurse include in the plan? - Encourage the client to take deep breaths after the procedure After a thoracentesis, the client should deep breathe to re-expand the lung. 14. A nurse is reviewing the medical record of a client who has osteomyelitis and a prescription for gentamicin. Which of the following findings from the client's medical record should indicate to the nurse the need to withhold the medication and notify the provider? - Serum Creatinine A client who has an elevated serum creatinine level should not receive gentamicin because the medication is nephrotoxic. 15. A nurse is providing postoperative teaching for a client who had a total knee arthroplasty. Which of the following instructions should the nurse include? - Flex the foot every hour when awake The nurse should instruct the client to flex the foot every hour to reduce the risk for thromboembolism and promote venous return. 16. A nurse is teaching a group of newly licensed nurses about pain management for older adult clients. Which of the following statements by a newly licensed nurse indicates an understanding of the teaching? - "Ibuprofen can cause gastrointestinal bleeding in older adult clients." 17. A nurse is teaching a client about osteoporosis prevention. The nurse should instruct the client that which of the following medications can increase their risk for developing osteoporosis? - Prednisone The nurse should instruct the client that prednisone can increase the risk of developing osteoporosis due to suppression of bone formation, and an increase in bone resorption by osteoclasts. Prednisone can also reduce intestinal absorption of calcium. 18. A nurse is caring for a client who has homonymous hemianopsia as a result of a stroke. To reduce the risk of falls when ambulation, the nurse should provide which of the following instructions to the client? - " Scan the environment by turning your head from side to side." Homonymous hemianopsia is the loss of the same visual field in both eyes. Turning their head from side to side helps enlarge a client's visual field. This technique is also useful for the client during mealtimes. 19. A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following nonpharmacological interventions should the nurse suggest to the client to reduce pain? - The nurse should instruct the client to alternate heat and cold applications to decrease join inflammation and pain. Then application of cold can relieve joint swelling and the application of heat can decrease joint stiffness and pain. 20. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? - Low urine specific gravity An expected finding for a client who has diabetes insipidus is a urine specific gravity between 1.001 and 1.005. Decreased water reabsorption by the renal tubules is caused by an alteration in antidiuretic hormone release or the kidneys responsiveness to the hormone. 21. A nurse is providing preoperative teaching for a client who is scheduled for a mastectomy. which of the following statements should the nurse make? - "I will refer you to community resources that can provide support." The nurse should provide the client with support resources, including community programs, to assist the client with acceptance of body image changes. 22. A nurse is providing teaching to a client who has a new perscription for psyllium. Which of the following information should the nurse include in the teaching? - Drink 240 mL (8 oz) of water after administration 23. A nurse is preparing to present a program about prevention of atherosclerosis at a health fair. Which of the following recommendations should the nurse plan to include? (Select all that apply.) - Follow a smoking cessation program Maintain an appropriate weight Eat a low-fat diet 24. A nurse is providing education to a client who is at risk for osteoporosis. Which of the following instructions should the nurse include. - Walk for 30 min four times per week Weight-bearing exercises promote bone mass. Therefore, walking can help the client prevent osteoporosis. 25. Client presents with abdominal pain in the upper left quadrant for the past 2 days. States pain became worse this morning and is radiating to the back. Rates pain as 8 on a scale of 0 to 10. – Drop down 1: Pancreatitis Drop down 2: Amylase and lipase The client's laboratory results, and physical assessment indicate the client is experiencing manifestations of pancreatitis. Clients who have pancreatitis experience and increase in pancreatic enzymes, amylase and lipase. 26. A nurse is caring for a client following extubation of an endotracheal tube 10 min ago. Which of the following findings should the nurse report to the provider immediately? - Stridor Urgent vs. nonurgent, stridor can indicate a narrowing airway or possible obstruction caused by edema or laryngeal spasms. 27. A nurse is assessing a client who has advanced lung cancer and is receiving palliative care. the client has just undergone thoracentesis. The nurse should expect a reduction in which of the following common manifestations of advanced cancer? - Dyspnea Thoracentesis, the removal of pleural fluid, can temporarily relieve hypoxia and thus ease the clients breathing and improve comfort. 28. A nurse is planning care for a client who is postoperative following a parathyroidectomy. Which of the following actions should the nurse identify as the priority? - Place a tracheostomy tray at bedside The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to place a tracheostomy tray at the client's bedside in case of airway obstruction. 29. A nurse is planning care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan of care? - Place personal items, such as pictures, at the client's bedside The nurse should plan to have the family bring personal items such as pictures to place at the client's bedside for cognitive support 30. A nurse is providing teaching to a client who takes ginkgo biloba as an herbal supplement. Which of the following statement should the nurse make? - "Ginkgo biloba can cause increased risk for bleeding." Ginkgo biloba increases blood flow and is effective in decreasing the pain associated with peripheral artery disease. 31. A nurse is updating the plan of care for a client who is receiving chemotherapy. Which of the following should the nurse identify as the priority? - Report of sore throat Sore throat, which could be a manifestation of an infection. 32. A nurse is evaluating the plan of care for four clients after 2 days of hospitalization. The nurse should identify the need to revise the plan for which of the following clients? - A client who is postoperative following abdominal surgery and reports feeling that something "popped" when they coughed 33. A nurse is reviewing the laboratory results of a client who has AIDS and is taking amphotericin B for fungal infection. The nurse should identify that which of the following values is an indication of an adverse effect of the medication? - BUN 34 mg/dL 34. A nurse is providing discharge instructions to a client who has active tuberculosis (TB). Which of the following information should the nurse include in the instructions? - Sputum specimens are necessary every 2 to 4 weeks until there are three negative cultures. After 3 negative sputum cultures, the client is no longer considered infectious. 35. A nurse is caring for a client who is 4 hr postoperative following a total vaginal hysterectomy - Perineal pad saturated with blood, large clots present Change of blood pressure, heart rate of 102/min 36. A nurse is caring for a client who has a positive culture for methicillin resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take? - Bathe the client using chlorhexidine solution. The nurse should bathe the client using Chlorhexidine solution because it reduces the risk of transmission of MRSA to other areas of the body. 37. A nurse is assessing a client following the completion of hemodialysis. Which of the following findings is the nurse's priority to report to the provider? - Restlessness Restlessness, which can be an indication the client is experiencing disequilibrium syndrome. Disequilibrium syndrome is caused by the rapid removal of electrolytes from the client's blood and can lead to dysrhythmias or seizures. Other manifestations include nausea, vomiting, fatigue, and headache. 38. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) and is NPO. When reviewing the chart, the nurse notes the following prescription: capillary blood glucose AC and HS. Which of the following actions should the nurse take? - Contact the provider to clarify the prescription. Mealtimes do not pertain to this client due to the NPO status. 39. A nurse is providing teaching to a client who is perimenopausal and has a prescription for hormone replacement therapy. For which of the following adverse effects should the nurse instruct the client to notify the provider? (Select all that apply) - Calf pain Numbness in the arms Intense headache 40. During the emergent phase of burn care, the client is at risk for developing - Hypovolemia and Respiratory failure