Test bank for understanding medical surgical nursing 6th edition linda s williams paula d hopper

Test Bank for Understanding Medical-Surgical ns ns ns ns




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Chapter1 s
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1. The nurse iscaring forfour clients onamedical–surgicalunit. Whichclient shouldthe nurse
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see initially?
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1. Aclient admittedwithhepatitisAwho hashadseverediarrhea forthe last 24
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hours ns




2. Aclientadmittedwithpneumoniawho is hassmall amountsofyellow
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productive sputum ns ns




3. Aclient admittedwithfever ofunknownorigin(FUO) who hasbeen
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without fever for the last 48 hours
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4. Aclient admitted witha wound infectionwhose WBC is8,500 mm3
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Answer: 1 ns




Rationale:The nurse must decide whichclient should be seenonthe initialrounds ofthe day.
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The nurse must remember that the first client to be seenshould be the client who needs
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the attention of the nurse initially. A client with hepatitis A does experience diarrhea,
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but diarrhea for the last 24 hours could cause the client to have a problem with
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dehydration and experience a state of fluid volume deficit.
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Cognitive Level: Application ns ns




ClientNeeds:Safe,EffectiveCareEnvironment
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Nursing Process: Planning
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2. The nurse ispreparingto administer influenza vaccines to amassdrive-throughclinic.
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Which statement by a client would indicate further questioning prior to giving the client the
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influenza vaccine?
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1. “I amallergic to horsehair.”
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2. “I tryto get myvaccine everyyear.”
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3. “Iamnot allergic to anything except eggs.”
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4. “Myhusband had asevereallergicreactionafter hereceived his influenza
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vaccine.”
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Answer: 3 ns




Rationale: Influenza vaccines are recommended for person at high risk for serious sequelae of
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influenza. The nurseshould beaware that client witha sensitivityto eggs should not
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receive the vaccine. Vaccines prepared from chicken or duck embryos are
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contraindicated in clients who are allergic to eggs.
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Cognitive Level: Application ns ns




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, Test Bank for Understanding Medical-Surgical ns ns ns ns




Nursing6thEditionLindaS.WilliamsPaulaD.
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ClientNeeds:Safe,EffectiveCareEnvironment
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Nursing Process: Assessment
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3. The nurse is caring for four clients on a medical–surgical unit. The secretarygives the nurse
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the morning labs. Which of the following labs would require that the nurse call the physician
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and inform the healthcare provider about the client’s abnormalities?
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1. WBC 14,600 mm3 ns ns




2. Serumprotein 6.9 g/dL ns ns ns




3. I & D (incisionand drainage) showing no growth forthe last 24 hours
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4. Albumin 4.2 g/dL ns ns




Answer: 1 ns




Rationale: Whenthenurse iscaring forseveralclients, allofthe labs should bechecked frequently
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throughout the shift to assess for any abnormalities. The WBC in option 1 is abnormal. (Normal
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WBC 4,000–10,000 mm3.) All of the other lab results are within acceptable range; therefore, the
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results should not be called in to the physician.
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Cognitive Level: Application Client ns ns ns




Needs:PhysiologicIntegrity
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Nursing Process: Assessment
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4. The nurse is orienting a new graduate. The nurse is reinforcing the importance of
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standard precautions. Whichofthe following observations bythe nurse would require
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further education regarding standard precautions?
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1. The graduatenurseunderstands to washhandswhenentering andexiting the ns ns ns ns ns ns ns ns ns ns ns




client’s room. ns ns




2. The graduatenursewearsgloves whenserving breakfast traysto various ns ns ns ns ns ns ns ns ns ns




clients. ns




3. The graduate nurse wearsa gown, gloves, and goggleswhensuctioning a ns ns ns ns ns ns ns ns ns ns ns




client. ns




4. The graduatenurse leaves allsupplies inthe roomofaclient who is in ns ns ns ns ns ns ns ns ns ns ns ns ns ns




contact isolation. ns ns




Answer: 2 ns




Rationale: The nurse must have an understanding of standard precautions. Prevention is the
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most important measure to prevent nosocomial infections. Standard precautions were
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published in 1996 that provide guidelines for the handling of blood andotherbody
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fluids. Theseguidelines are used withallclients, regardless of whether they have a
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known infectious disease. Standard precautions are used
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, Test Bank for Understanding Medical-Surgical ns ns ns ns




Nursing6thEditionLindaS.WilliamsPaulaD.
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by all healthcare workers who have direct contact with clients or with their body
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fluids. It is not necessary for the nurse to wear gloves while delivering food trays to the
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client, because there is not contact with the client.
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Cognitive Level: Application ns ns




ClientNeeds:Safe,EffectiveCareEnvironment
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Nursing Process: Evaluation
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5. Theadmitting department alertsthe nurse onamedical–surgicalunit that aclient with active
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tuberculosis (TB) is being admitted to the unit. Which type of isolation is appropriate based
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on the client’s diagnosis?
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1. Standard precautions ns




2. Airborneprecautions ns




3. Droplet precautions ns




4. Contactprecautions ns




Answer: 2 ns




In addition to handwashing and standard precautions, the nature and spread of some
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infectiousdiseasesrequire that specialtechniquesbe used to protect uninfected clients and
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workers. The client with pulmonary tuberculosis will be placed in airborne precautions. The
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client should beplaced inaprivate roomwithspecial ventilation that does not allow air to
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circulate to general hospital ventilation; a mask or special filter respirators will be used for
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everyone entering the room.
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Cognitive Level:Application ns ns




ClientNeeds:Safe,EffectiveCareEnvironment
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Nursing Process: Assessment
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6. Aclient is receiving IV vancomycin for the treatment of Clostridium difficile. The nurse
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understandsthattheclient whodevelopsflushing,tachycardia, and hypotension during the
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infusion of vancomycin indicates:
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1. Ototoxicityeffect. ns




2. Superinfection.
3. Red mansyndrome. ns ns




4. Hives.

Answer: 3 ns




Rationale:Vancomycininhibitscellwallsynthesis, and isused forseriousinfections. Itis only
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effective against gram-positive bacteria, especially Staphylococcus aureus and
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downloadfull fileathttp://testbankinstant.com ns ns ns ns

, Test Bank for Understanding Medical-Surgical ns ns ns ns




Nursing6thEditionLindaS.WilliamsPaulaD.
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Staphylococcus epidermidis. The nurse should infuse this medication slowly over 60 minutes ns ns ns ns ns ns ns ns ns ns ns




or more to avoid “red man” syndrome. The syndrome is characterized by erythematousrash,
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flushing,tachycardia, and hypotension. Clients canbecome dizzyand agitated.
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Cognitive Level: Application ns ns




ClientNeeds:PhysiologicalIntegrity Nursing
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Process: Evaluation
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7. The physicianhas ordered forthe client to receive a troughblood levelto evaluatethe
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therapeutic effect of an antibiotic. The nurse understands that the trough should be ordered:
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1. Afew minutes beforethe next scheduled doseof medication.
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2. 1–2hours after the oraladministration ofthe medication.
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3. 30 minutes after the IVadministration.
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4. During the infusion ofthe antibiotic. ns ns ns ns ns




Answer: 1 ns




Rationale: Antibiotic peak and trough levels monitor therapeutic blood levels of the
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prescribed medication. The therapeutic range—the minimum and maximum blood levels at
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which the drug is effective—is known for a given drug. By measuring blood levels at the
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predicted peak (1–2 hours after oral administration, 1 hour after intramuscular administration,
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and 30minutes afterIVadministration) andtrough(usuallya few minutes before the next
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scheduled dose), it is also possible to determine whether the drug is reaching a toxic or harmful
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level during therapy, increasing the likelihood of adverse effects.
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Cognitive Level:Application ns ns




ClientNeeds:Safe,EffectiveCareEnvironment
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Nursing Process: Assessment
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8. The nurse needsto change adressingonthe client’s abdomen. Whichofthe following
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techniques should be implemented?
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1. Contact precautions ns




2. Standard precautions ns




3. Droplet precautions ns




4. Airborne precautions ns




Answer: 2 ns




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