NUR 425 MED SURG EXAM 1
QUESTIONS & COMPLETE
SOLUTIONS ALL PASSED
A nurse is caring for a pt who has visual impairment/loss. What do you think the nurse should
implement? - correct answer ✔✔Count steps to the bathroom with the pt
A nurse is teaching a pt who asks about taking a glucosamine supplement for osteoarthritis.
What information should the nurse include in the teaching? - correct answer ✔✔Avoid taking
glucosamine if you have a shellfish allergy
A nurse is discussing activity modification with a pt who had a right total hip arthroplasty. What
statement should the nurse include in the information? - correct answer ✔✔Place a pillow
between your legs when lying in bed
A nurse is planning wound management for a pt who has a stage 3 pressure injury. What
intervention should the nurse include in the plan? - correct answer ✔✔Measure the depth of
the wound with a cotton-tipped applicator
A nurse is teaching a newly licensed nurse about preventing a catheter-associated urinary tract
infection for a pt who has an indwelling urinary catheter. What instruction should the nurse
include? - correct answer ✔✔Ensure the urinary catheter tubing is not kinked
A nurse is planning care for four clients following a change-of-shift report. Which of the
following clients is the nurse's priority? - correct answer ✔✔A pt who has peptic ulcer disease
and a rigid abdomen
, A nurse is planning care for four pts following the change-of-shift report. Which of the following
clients should the nurse see first? - correct answer ✔✔A client who has a pacemaker and has
persistent hiccuping
A nurse is caring for a pt who is postoperative and has a history of heart failure. The pt reports
slight dyspnea when ambulating. What finding should the nurse expect when performing a skin
assessment? - correct answer ✔✔Shiny areas on the client's ankles and feet
A hospice nurse is planning end-of-life comfort care for a pt. What intervention should the nurse
include in the plan? - correct answer ✔✔Position the client on their side to improve breathing
A nurse is teaching a pt who has a prescription for continuous ambulatory peritoneal dialysis.
What instruction should the nurse include? - correct answer ✔✔Allow the dialysate to dwell for
4 hr during each exchange
A nurse is providing hydrotherapy for a pt who has full-thickness turns on the lower leg. What
action should the nurse take? - correct answer ✔✔Wash the pt's burns with mild soap and
water
A nurse is assessing a pt who is receiving head and neck radiation therapy to treat esophageal
cancer. The nurse should identify what finding as an adverse effect of this treatment? - correct
answer ✔✔The client reports a dry mouth, tooth decay and dysphagia (difficulty swallowing)
A nurse is assessing a pt who has an endotracheal tube and is receiving mechanical ventilation.
The pt is agitated and appears to be in respiratory distress. What action should the nurse take
first? - correct answer ✔✔Manually ventilate the client using a bag-valve device
A nurse is assisting with a paracentesis for a client who has ascites. What action should the
nurse take? - correct answer ✔✔Weigh the client before the procedure
QUESTIONS & COMPLETE
SOLUTIONS ALL PASSED
A nurse is caring for a pt who has visual impairment/loss. What do you think the nurse should
implement? - correct answer ✔✔Count steps to the bathroom with the pt
A nurse is teaching a pt who asks about taking a glucosamine supplement for osteoarthritis.
What information should the nurse include in the teaching? - correct answer ✔✔Avoid taking
glucosamine if you have a shellfish allergy
A nurse is discussing activity modification with a pt who had a right total hip arthroplasty. What
statement should the nurse include in the information? - correct answer ✔✔Place a pillow
between your legs when lying in bed
A nurse is planning wound management for a pt who has a stage 3 pressure injury. What
intervention should the nurse include in the plan? - correct answer ✔✔Measure the depth of
the wound with a cotton-tipped applicator
A nurse is teaching a newly licensed nurse about preventing a catheter-associated urinary tract
infection for a pt who has an indwelling urinary catheter. What instruction should the nurse
include? - correct answer ✔✔Ensure the urinary catheter tubing is not kinked
A nurse is planning care for four clients following a change-of-shift report. Which of the
following clients is the nurse's priority? - correct answer ✔✔A pt who has peptic ulcer disease
and a rigid abdomen
, A nurse is planning care for four pts following the change-of-shift report. Which of the following
clients should the nurse see first? - correct answer ✔✔A client who has a pacemaker and has
persistent hiccuping
A nurse is caring for a pt who is postoperative and has a history of heart failure. The pt reports
slight dyspnea when ambulating. What finding should the nurse expect when performing a skin
assessment? - correct answer ✔✔Shiny areas on the client's ankles and feet
A hospice nurse is planning end-of-life comfort care for a pt. What intervention should the nurse
include in the plan? - correct answer ✔✔Position the client on their side to improve breathing
A nurse is teaching a pt who has a prescription for continuous ambulatory peritoneal dialysis.
What instruction should the nurse include? - correct answer ✔✔Allow the dialysate to dwell for
4 hr during each exchange
A nurse is providing hydrotherapy for a pt who has full-thickness turns on the lower leg. What
action should the nurse take? - correct answer ✔✔Wash the pt's burns with mild soap and
water
A nurse is assessing a pt who is receiving head and neck radiation therapy to treat esophageal
cancer. The nurse should identify what finding as an adverse effect of this treatment? - correct
answer ✔✔The client reports a dry mouth, tooth decay and dysphagia (difficulty swallowing)
A nurse is assessing a pt who has an endotracheal tube and is receiving mechanical ventilation.
The pt is agitated and appears to be in respiratory distress. What action should the nurse take
first? - correct answer ✔✔Manually ventilate the client using a bag-valve device
A nurse is assisting with a paracentesis for a client who has ascites. What action should the
nurse take? - correct answer ✔✔Weigh the client before the procedure
