NURSING 101 Med Surg Medical-Surgical B-Completed A

NURSING 101 Med Surg Medical-Surgical B 1. 1.ID: Which method elicits the most accurate information during a physical assessment of an older client? o Ask the client to recount one's health history. o Obtain the client's information from a caregiver. o Review the past medical record for medications. o Use reliable assessment tools for older adults. Correct Specific assessment tools (D) for an older adult, such as Older Adult Resource Services Center Instrument (OARS), mini-mental assessment, fall risk, depression (Geriatric Depression Scale), or skin breakdown risk (Braden Scale), consider age-related physiologic and psychosocial changes related to aging and provide the most accurate and complete information. (A and B) are subjective and may vary in reliability based on the client's memory and caregiver's current involvement. Although (C) is a good resource to identify polypharmacy, a written record may not be available or currently accurate. Awarded 1.0 points out of 1.0 possible points. 2. 2.ID: A client who has just tested positive for human immunodeficiency virus (HIV) does not appear to hear what the nurse is saying during post-test counseling. Which information should the nurse offer to facilitate the client's adjustment to HIV infection? o Inform the client how to protect sexual and needle-sharing partners. o Teach the client about the medications that are available for treatment. o Identify the need to test others who have had risky contact with the client. o Discuss retesting to verify the results, which will ensure continuing contact. Correct Encouraging retesting (D) supports hope and gives the client time to cope with the diagnosis. Although post-test counseling should include education about (A, B, and C), retesting encourages the client to maintain medical follow-up and management. Awarded 1.0 points out of 1.0 possible points. 3.ID: The nurse hears short, high-pitched sounds just before the end of inspiration in the right and left lower lobes when auscultating a client's lungs. How should this finding be recorded? o Inspiratory wheezes in both lungs. Incorrect o Crackles in the right and left lower lobes. Correct o Abnormal lung sounds in the bases of both lungs. o Pleural friction rub in the right and left lower lobes. Fine crackles (B) are short, high-pitched sounds heard just before the end of inspiration that are the result of rapid equalization of pressure when collapsed alveoli or terminal bronchioles suddenly snap open. Wheezing (A) is a continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls that are first evident on expiration and may be audible. Although (C) describes an adventitious lung sound, this documentation is vague. (D) is a creaking or grating sound from roughened, inflamed surfaces of the pleura rubbing together heard during inspiration, expiration, and with no change during coughing. Awarded 0.0 points out of 1.0 possible points. 3. 4.ID: What assessment finding should the nurse identify that indicates a client with an acute asthma exacerbation is beginning to improve after treatment? o Wheezing becomes louder. Correct o Cough remains unproductive. o Vesicular breath sounds decrease. o Bronchodilators stimulate coughing. Incorrect In an acute asthma attack, air flow may be so significantly restricted that wheezing is diminished. If the client is successfully responding to bronchodilators and respiratory treatments, wheezing becomes louder (A) as air flow increases in the airways. As the airways open and mucous is mobilized in response to treatment, the cough becomes more productive, not (B). Vesicular sounds are soft, low-pitched, gentle, rustling sounds heard over lung fields (C) and is not an indicator of improvement during asthma treatment. Bronchodilators do not stimulate coughing (D). Awarded 0.0 points out of 1.0 possible points. 4. 5.ID: The nurse is caring for a client with non-Hodgkin's lymphoma who is receiving chemotherapy. Laboratory results reveal a platelet count of 10,000/ml. What action should the nurse implement? o Encourage fluids to 3000 ml/day. o Check stools for occult blood. Correct o Provide oral hygiene every 2 hours. o Check for fever every 4 hours. Platelet counts less than 100,000/mm3 are indicative of thrombocytopenia, a common side effect of chemotherapy. A client with thrombocytopenia should be assessed frequently for occult bleeding in the emesis, sputum, feces (B), urine, nasogastric secretions, or wounds. (A) does not minimize the risk for bleeding associated with thrombocytopenia. (C) may cause increased bleeding in a client with thromobcytopenia. (D) assesses for infection, not risk for bleeding. Awarded 1.0 points out of 1.0 possible points. 5. 6.ID: Three weeks after discharge for an acute myocardial infarction (MI), a client returns to the cardiac center for follow-up. When the nurse asks about sleep patterns, the client tells the nurse that he sleeps fine but that his wife moved into the spare bedroom to sleep when he returned home. He states, I guess we will never have sex again after this. Which response is best for the nurse to provide? o Sexual intercourse can be strenuous on your heart, but closeness and intimacy, such as holding and cuddling, can be maintained with your wife. o Sexual activity can be resumed whenever you and your wife feel like it because the sexual response is more emotional rather than physical. o You should discuss your questions about your sexual activity with your healthcare provider because sexual activity may be limited by your heart damage. o Sexual activity is similar in cardiac workload and energy expenditure as climbing two flights of stairs and may be resumed like other activities. Correct Sexual intercourse after an MI, or acute coronary syndrome, has been found to require no more energy expenditure or cardiac stress than walking briskly up two flights of stairs (D), as long as other guidelines, such as limiting food and alcohol intake before intercourse, are followed. (A, B, and C) do not provide the best factual information to reduce the client's anxiety and misconceptions. Awarded 1.0 points out of 1.0 possible points. 6. 7.ID: A male client with chronic atrial fibrillation and a slow ventricular response is scheduled for surgical placement of a permanent pacemaker. The client asks the nurse how this devise will help him. How should the nurse explain the action of a synchronous pacemaker? o Ventricular irritability is prevented by the constant rate setting of pacemaker. o Ectopic stimulus in the atria is suppressed by the device usurping depolarization. o An impulse is fired every second to maintain a heart rate of 60 beats per minute. o An electrical stimulus is discharged when no ventricular response is sensed. Correct The artificial cardiac pacemaker is an electronic device used to pace the heart when the normal conduction pathway is damaged or diseased, such as a symptomatic dysrhythmias like atrial fibrillation with a slow ventricular response. Pacing modes that are synchronous (impulse generated on demand or as needed according to the patient's intrinsic rhythm) send an electrical signal from the pacemaker to the wall of the myocardium stimulating it to contract when no ventricular depolarization is sensed (D). (A, B, and C) do not provide accurate information. Awarded 1.0 points out of 1.0 possible points. 7. 8.ID: The nurse completes visual inspection of a client's abdomen. What technique should the nurse perform next in the abdominal examination? o Percussion. o Auscultation. Correct o Deep palpation. o Light palpation. Auscultation (B) of the client's abdomen is performed next because manual manipulation (A, C, and D) can stimulate the bowel and create false sounds heard during auscultation. Awarded 1.0 points out of 1.0 possible points. 8. 9.ID: During the assessment of a client who is 24 hours post-hemicolectomy with a temporary colostomy, the nurse determines that the client's stoma is dry and dark red in color. What action should the nurse implement? o Notify the surgeon. Correct o Document the assessment. o Secure a colostomy pouch over the stoma. o Place petrolatum gauze dressing over the stoma. The stoma should appear reddish pink and moist, which indicates circulatory perfusion to the surgical diversion of the intestine. If the stoma becomes dry, firm, flaccid, or is dark red or purple, the stoma is ischemic, and the surgeon should be notified immediately (A). Although (B, C, and D) may be implemented, the findings require immediate medical attention. Awarded 1.0 points out of 1.0 possible points. 9. 10.ID: The nurse is caring for a client with end stage liver disease who is being assessed for the presence of asterixis. To assess the client for asterixis, what position should the nurse ask the client to demonstrate? o Extend the left arm laterally with the left palm upward. o Extend the arm, dorsiflex the wrist, and extend the fingers. Correct o Extend the arms and hold this position for 30 seconds. o Extend arms with both legs adducted to shoulder width. Asterixis (flapping tremor, liver flap) is a hand-flapping tremor that is often seen frequently in hepatic encephalopathy. The tremor is induced by extending the arm and dorsiflexing the wrist causing rapid, non-rhythmic extension and flexion of the wrist while attempting to hold position (B). (A, C, and D) do not illicit axterixis. Awarded 1.0 points out of 1.0 possible points. 10. 11.ID: A client is admitted to the emergency department after being lost for four days while hiking in a national forest. Upon review of the laboratory results, the nurse determines the client's serum level for thyroid-stimulating hormone (TSH) is elevated. Which additional assessment should the nurse make? o Body mass index. o Skin elasticity and turgor. o Thought processes and speech. o Exposure to cold environmental temperatures. Correct TSH influences the amount of thyroxine secretion which increases the rate of metabolism to maintain body temperature near normal. Prolonged exposure to cold environmental temperatures (D) stimulates the hypothalamus to secrete thyrotropin-releasing hormone, which increases anterior pituitary serum release of TSH. (A) may reflect weight loss from lack of food. Tenting of the skin (B) is indicative of dehydration. Slow or confused thought processes (C) or speech patterns may be related to sleep deprivation. Awarded 1.0 points out of 1.0 possible points. 11. 12.ID: Which finding should the nurse report to the healthcare provider for a client with a circumferential extremity burn? o Full thickness burns rather than partial thickness. o Supinates extremity but unable to fully pronate the extremity. o Slow capillary refill in the digits with absent distal pulse points. Correct o Inability to distinguish sharp versus dull sensations in the extremity. A circumferential burn can form an eschar that results from burn exudate fluid that dries and acts as a tourniquet as fluid shifts occur in the interstitial tissue. As edema increases tissue pressure, blood flow to the distal extremity is compromised, which is manifested by slow capillary refill and absent distal pulses (C), so the healthcare provider should be notified about any compromised circulation that requires escharotomy. Although eschar formation occurs more readily over full thickness burns (A), the circumferential location of the burn is most likely to constrict underlying structures. Limited movement (B) is often due to pain. (D) may be related to the depth of the burn. Awarded 1.0 points out of 1.0 possible points. 12. 13.ID: The nurse is preparing a teaching plan for a client with newly diagnosed glacoma and a history of allergic rhinitis. Which information is most important for the nurse to provide the client about using over-the-counter (OTC) medications for allergies? o Notify your healthcare provider if there is an increase in heart rate. o Increase fluid intake while taking an antihistamine or decongestant. o Avoid allergy medications that contain pseudoephedrine or phenylephrine. Correct o Ophthalmic lubricating drops may be used for eye dryness due to allergy medications. OTC allergy medications may contain ephedrine, phenylephrine, or pseudoephedrine, which can cause adrenergic side effects, such as increased intraocular pressure, so a client with glaucoma should avoid using these OTC medications (C). A client with hypertension should avoid using OTC medications containing ingredients that can increase blood pressure and heart rate (A), but an increase in IOP is most important in a client with glaucoma. (B and D) may provide symptomatic relief for other side effects, such as dry mouth or eye dryness related to common agents used for allergic rhinits. Awarded 1.0 points out of 1.0 possible points. 13. 14.ID: The nurse obtains a client's history that includes right mastectomy and radiation therapy for cancer of the breast 10 years ago. Which current health problem should the nurse consider is a consequence of the radiation therapy? o Asthma. o Myocardial infarction. o Chronic esophagitis with gastroesophageal reflux. o Pathologic fracture of two ribs on the right chest. Correct The ribs lie in the radiation pathway and lose density over time, becoming thin and brittle, so the occurence of two right-sided ribs with pathological fractures resulting without evidence of trauma (D) is related to radiation damage. The heart (B), esophagus (C), and larger bronchi (A) are not usually in the radiation path. Awarded 1.0 points out of 1.0 possible points. 14. 15.ID: A client asks the nurse about the purpose of beginning chemotherapy (CT) because the tumor is still very small. Which information supports the explanation that the nurse should provide? o Side effects are less likely if therapy is started early. o Collateral circulation increases as the tumor grows. o Sensitivity of cancer cells to CT is based on cell cycle rate. o The cell count of the tumor reduces by half with each dose. Correct Initiating chemotherapy while the tumor is small provides a better chance of eradicating all cancer cells because 50% of cancer cells or tumor cells are killed with each dose. (A, B, and C) vary based on the type of cancer. Awarded 1.0 points out of 1.0 possible points. 15. 16.ID: The nurse is completing the health assessment of a 79-year-old male client who denies any significant health problems. Which finding requires the most immediate follow-up assessment? o Kyphosis with a reduction in height. o Dilated superficial veins on both legs. o External hemorrhoids with itching. o Yellowish discoloration of the sclerae. Correct Jaundice, a yellowish discoloration of the sclerae (D), may indicate liver damage and requires further assessment. Kyphosis and height reduction (A) due to bone loss, varicose veins (B), and external hemorrhoids with itching (C) are common findings in the elderly that do not require immediate intervention. Awarded 1.0 points out of 1.0 possible points. 16. 17.ID: An 85-year-old male client comes to the clinic for his annual physical exam and renewal of antihypertensive medication prescriptions. The client's radial pulse rate is 104 beats/minute. Which additional assessment should the nurse complete? o Palpate the pedal pulse volume. o Count the brachial pulse rate. o Measure the blood pressure. Correct o Assess for a carotid bruit. Elderly clients who take antihypertensive medications often experience side effects, such as hypotension, which causes tachycardia, a compensatory mechanism to maintain adequate cardiac output, so the client's blood pressure (C) should be determined. (A, B, and D) are less likely to provide data related to the client's tachycardia. Awarded 1.0 points out of 1.0 possible points. 17. 18.ID: The nurse is assessing a client who is bedfast and refuses to turn or move from a supine position. How should the nurse assess the client for possible dependent edema? o Compress the flank and upper buttocks. Correct o Measure the client's abdominal girth. o Gently palpate the lower abdomen. o Apply light pressure over the shins. Dependent edema collects in dependent areas, such as the flank and upper buttocks (A) of the client who is persistently flat in bed. (B) provides data about ascites (fluid collection in the abdomen), rather than dependent edema, and (C) provides data about abdominal distention. (D) provides data about the collection of dependent edema for a client whose lower extremities are often in a dependent position, such as when sitting in a chair. Awarded 1.0 points out of 1.0 possible points. 18. 19.ID: The unlicensed assistive personnel (UAP) reports that an 87-year-old female client who is sitting in a chair at the bedside has an oral temperature of 97.2° F. Which intervention should the nurse implement? o Document the temperature reading on the vital sign graphic sheet. Correct o Report the temperature to the healthcare provider immediately. o Instruct the UAP to take the client's temperature again in 30 minutes. o Advise the UAP to assist the client in returning to her bed. A subnormal temperature of 97.2° F (orally) is a common finding in elderly clients, so the nurse should document the findings (A) and continue with the plan of care. (B, C, and D) are not indicated unless the temperature falls below 97° F or if other symptoms occur. Awarded 1.0 points out of 1.0 possible points. Medical-Surgical B 1. 1.ID: The nurse is caring for a client with human immunodeficiency virus (HIV) infection who develops Mycobacterium avium complex (MAC). What is the most significant desired outcome for this client? o Free from injury of drug side effects. o Return to pre-illness weight. Correct o Adequate oxygenation. o Maintenance of intact perineal skin. MAC is an opportunistic infection that presents as a tuberculosis-like pulmonary process. MAC is a major contributing factor to the development of wasting syndrome, so the most significant desired outcome is the client's return to a pre-illness weight (B) using oral, enteral, or parenteral supplementation as needed. Drug schedules and side effects (A) remain a life long management problem. Client outcomes for adequate oxygenation (C) are often dependent on management of anemia, maintenance of activities without fatigue, and supplemental oxygen to prevent hypoxia. Skin integrity (D) is dependent upon resolution of diarrhea, which is not as significant as optimal nutrition. Awarded 1.0 points out of 1.0 possible points. 2. 2.ID: A 26-year-old male client with Hodgkin's disease is scheduled to undergo radiation therapy. The client expresses concern about the effect of radiation on his ability to have children. What information should the nurse provide? o The radiation therapy causes the inability to have an erection. o Radiation therapy with chemotherapy causes temporary infertility. o Permanent sterility occurs in male clients who receive radiation. Correct o The client should restrict sexual activity during radiotherapy. Low sperm count and loss of motility are seen in males with Hodgkin's disease before any therapy. Radiotherapy often results in permanent aspermia, or sterility (C). (A, B, and D) are inaccurate. Awarded 1.0 points out of 1.0 possible points. 3. 3.ID: A client who had abdominal surgery two days ago has prescriptions for intravenous morphine sulfate 4 mg every 2 hours and a clear liquid diet. The client complains of feeling distended and has sharp, cramping gas pains. What nursing intervention should be implemented? o Obtain a prescription for a laxative. o Withhold all oral fluid and food. o Assist the client to ambulate in the hall. Correct o Administer the prescribed morphine sulfate. Postoperative abdominal distention is caused by decreased peristalsis as a result of handling the intestine during surgery, limited dietary intake before and after surgery, and anesthetic and analgesic agents. Peristalsis is stimulated and distention minimized by implementing early and frequent ambulation (C). Based on the client's status, laxatives (A) or withholding dietary progression (B) are not indicated at this time. Although pain management should be implemented (D), another analgesic prescription may be needed because morphine reduces intestinal motility and contributes to the client's gas pains. Awarded 1.0 points out of 1.0 possible points. 4. 4.ID: A client with Ménière's disease is incapacitated by vertigo and is lying in bed grasping the side rails and staring at the television. Which nursing intervention should the nurse implement? o Encourage fluids to 3000 ml per day. o Change the client's position every two hours. o Keep the head of the bed elevated 30 degrees. o Turn off the television and darken the room. Correct To decrease the client's vertigo during an acute attack of Ménière's disease, any visual stimuli or rotational movement, such as sudden head movements or position changes, should be minimized. Turning off the television and darkening the room (D) minimize fluorescent lights, flickering television lights, and distracting sound. (A, B, and C) are ineffective in managing the client's symptoms. Awarded 1.0 points out of 1.0 possible points. 5.ID: A client who has a chronic cough with blood-tinged sputum returns to the unit after a bronchoscopy. What nursing interventions should be implemented in the immediate post-procedural period? o Keep the client on bed rest for eight hours. o Check vital signs every 15 minutes for two hours. o Allow the client nothing by mouth until the gag reflex returns. Correct o Encourage fluid intake to promote elimination of the contrast media. The nasal pharynx and oral pharynx are anesthetized with local anesthetic spray prior to bronchoscopy, and the bronchoscope is coated with lidocaine (Xylocaine) gel to inhibit the gag reflex and prevent laryngeal spasm during insertion. The client should be NPO until the client's gag reflex returns (C) to prevent aspiration from any oral intake or secretions. (A, B, and D) are not indicated after bronchoscopy. Awarded 1.0 points out of 1.0 possible points. 5. 6.ID: The nurse is assessing a client with a cuffed tracheostomy tube in place who is breathing spontaneously. To evaluate if the client can tolerate cuff deflation to promote speaking and swallowing, what action should the nurse implement? o Ask the client to try to speak. o Assess for respiratory distress. o Auscultate for pulmonary crackles after the client drinks a small amount of clear water. o Observe the client for coughing colored sputum after drinking a small amount of colored water. Correct To evaluate the risk for aspiration after the cuff is deflated, the client should be instructed to swallow a small amount of colored water, then observed for coughing up colored sputum (D), or the tracheostomy should be suctioned for the presence of colored water. (A) does not determine if the client is at risk to aspirate oral intake. Large volumes of oral intake are more likely to cause respiratory distress (B) or crackles (C), and should not be used to evaluate the client's risk for aspiration. Awarded 1.0 points out of 1.0 possible points. 6. 7.ID: A client is admitted to the Emergency Department with a tension pneumothorax. Which assessment should the nurse expect to identify? o An absence of lung sounds on the affected side. Incorrect o An inability to auscultate tracheal breath sounds. o A deviation of the trachea toward the side opposite the pneumothorax. Correct o A shift of the point of maximal impulse to the left, with bounding pulses. Tension pneumothorax is caused by rapid accumulation of air in the pleural space, causing severely high intrapleural pressure. This results in collapse of the lung, and the mediastinum shifts toward the unaffected side, which is subsequently compressed (C). (A, B, and D) are not demonstrated with a tension pneumothorax. Awarded 0.0 points out of 1.0 possible points. 7. 8.ID: A client with sickle cell anemia is admitted with severe abdominal pain and the diagnosis is sickle cell crisis. What is the most important nursing action to implement? o Limit the client's intake of oral fluids and food. o Evaluate the effectiveness of narcotic analgesics. Correct o Encourage the client to ambulate as tolerated. o Teach the client about prevention of crises. Pain management is the priority for a client during sickle cell crisis. Continuous narcotic analgesics are the mainstay of pain control, which should be evaluated (B) frequently to determine if the client's pain is adequately controlled. (A, C, and D) are not indicated at this time. Awarded 1.0 points out of 1.0 possible points. 8. 9.ID: A client who is receiving a whole blood transfusion develops chills, fever, and a headache 30 minutes after the transfusion is started. The nurse should recognize these symptoms as characteristic of what reaction? o A mild allergic reaction. o A febrile transfusion reaction. Correct o An anaphylactic transfusion reaction. o An acute hemolytic transfusion reaction. Symptoms of a febrile reaction (B) include sudden chills, fever, headache, flushing and muscle pain. An allergic reaction (A) is the response of histamine release which is characterized by flushing, itching, and urticaria. An anaphylactic reaction (C) exhibits an exaggerated allergic response that progresses to shock and possible cardiac arrest. An acute hemolytic reaction (D) presents with fever and chills, but is hallmarked by the onset of low back pain, tachycardia, tachypnea, vascular collapse, hemoglobinuria, dark urine, acute renal failure, shock, cardiac arrest, and even death. Awarded 1.0 points out of 1.0 possible points. 9. 10.ID: A client is admitted for complaints of chest pain and aching for the past 4 days. The results for serum creatine kinase-MB (CK-MB) and troponin levels are obtained. What rationale should the nurse use to evaluate the laboratory findings? o Serum myoglobin levels are needed to confirm myocardial damage. o The most reliable indicator of myocardial necrosis is serum CK-MB. Incorrect o Serum cardiac markers are inconclusive in determining myocardial injury after waiting several days. o Myocardial damage that occurred several days earlier is best validated by serum troponin levels. Correct Serum CK-MB and troponin are the two most important serum cardiac markers for confirming myocardial infarction. CK-MB begins to rise in the first 3 to 12 hours after the myocardial infarction, peaks in 24 hours, and returns to normal in 2 to 3 days. The troponin level rises as quickly but remains elevated for 2 weeks (D). (A, B, and C) do not provide the most significant data. Awarded 0.0 points out of 1.0 possible points. 10. 11.ID: Several hours after surgical repair of an abdominal aortic aneurysm (AAA), the client develops left flank pain. The nurse determines the client's urinary output is 20 ml/hr for the past 2 hours. The nurse should conclude that these findings support which complication? o Infection. o Hypovolemia. o Intestinal ischemia. o Renal artery embolization. Correct Postoperative complications of surgical repair of AAA are related to the location of resection, graft, or stent placement along the abdominal aorta. Embolization of a fragment of thrombus or plaque from the aorta into a renal artery (D) can compromise blood flow in one of the renal arteries, resulting in renal ischemia that precipitates unilateral flank pain. Intraoperative blood loss or rupture of the aorta anastomosis can cause acute renal failure related to hypovolemia (B), which involves both kidneys and causing bilateral flank pain. (A and C) are not associated with these symptoms. Awarded 1.0 points out of 1.0 possible points. 11. 12.ID: A man who smokes two packs of cigarettes a day wants to know if smoking is contributing to the difficulty that he and his wife are having getting pregnant. What information is best for the nurse to provide? (Select all that apply.) o Only marijuana cigarettes affect sperm count. o Smoking can decrease the quantity and quality of sperm. Correct o The first semen analysis should be repeated to confirm sperm counts. Correct o Cessation of smoking improves general health and fertility. Correct o Sperm specimens should be collected in 2 subsequent days. Correct selections are (B, C, and D). Use of tobacco, alcohol, and marijuana may affect sperm counts (B). Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity, so a single analysis may be inconclusive (C). A minimum of two analyses should be performed several weeks apart to assess male fertility, not (E). (A and D) contain inaccurate information. Awarded 1.0002 points out of 1.0002 possible points. 12. 13.ID: A couple trying to cope with an infertility problem wants to know what can be done to preserve emotional equilibrium. What is the best response for the nurse to provide? o Tell your friends and family so that they can help you. o Get involved with a support group. I will give you some names. Correct o Talk only to other friends who are infertile since only they can help. o Start adoption proceedings immediately since obtaining an infant is very difficult. A support group (B) provides a safe haven for the couple to share experiences and gain insight from others experiences. Although talking about feelings may unburden the couple of negative feelings, infertility is a major stressor that affects the couple's relationships, so discussion with family and friends (A) should be minimal. Limiting interaction to other infertile couples (C) may address some psychosocial needs, but depending on where the other couples are in the recovery process, it may not be helpful. Giving an opinion about adoption (D) is not therapeutic nor supportive of the psychosocial needs. Awarded 1.0 points out of 1.0 possible points. 13. 14.ID: The nurse is providing postoperative instructions for a female client after a mastectomy. Which information should the nurse include in the teaching plan? (Select all that apply.) o Empty surgical drains once a week using procedure gloves. o Report inflammation of the incision site or the affected arm. Correct o Wear clothing with snug sleeves over the arm on the operative side. o Avoid lifting more than 4.5 kg (10 lb) or reaching above her head. Correct Correct answers include (B and D). Part of the client's teaching plan should include reporting evidence of inflammation at the incision or of the affected arm (B), and to avoid lifting or reaching (D), which places the client at risk for injury to the extremity that may have compromised lymphatic drainage. The client should be instructed to empty surgical drains daily, not (A). Activity that decreases circulation (C) in the affected arm, such as carrying a handbag over the shoulder, wearing tight clothing, or tight jewelry, should be avoided. Awarded 1.0 points out of 1.0 possible points. 14. 15.ID: The nurse directs an unlicensed assistive personnel (IAP) to obtain the vital signs for a client who returns to the unit after having a mastectomy for cancer. What information should the nurse provide the UAP? o Elevate the arm with an IV infusing on the operative side with a pillow. o Apply the blood pressure cuff to the arm on the unoperative side. Correct o Position the arm on the operative side close to the body. o Collect a fingerstick blood specimen from the arm on the operative side. Blood pressure readings should be obtained from the arm on the unoperative side (B) to reduce the risk of injury of the extremity that may have compromised lymphatic drainage postoperatively. The arm on the operative side of the mastectomy should be elevated on a pillow above the level of the right atrium to facilitate lymphatic drainage, not (C). An IV infusion (A) or blood specimen collection (D) should not involve the use of the arm on the operative side. Awarded 1.0 points out of 1.0 possible points. 15. 16.ID: Which client is at highest risk for compromised psychological adjustment after a hysterectomy? o A 46-year-old woman with three children and a recent promotion at work. o A 55-year-old woman with abnormal bleeding and pain for 3 years. o A 62-year-old widow who has three friends who had uncomplicated hysterectomies. o A 29-year-old woman whose uterus ruptured after giving birth to her first child. Correct The client who is a primipara and is still in her childbearing years (D) is at highest risk for unresolved conflicts about the end of her childbearing opportunities. The client with a family and positive life events (A), the menopausal client with physical distress (B), the post-menopausal client with support of peers with similar positive outcomes (C) are less likely to be psychologically distressed. Awarded 1.0 points out of 1.0 possible points. 16. 17.ID: A 48-year-old client with endometrial cancer is being discharged after a total hysterectomy and bilateral salpingo-oophorectomy. Which client statement indicates that further teaching is needed? o Well, I don't have to worry about getting pregnant anymore. o I can't wait to go on the cruise that I have planned for this summer. o I know I will miss having sexual intercourse with my husband. Correct o I have asked my daughter to stay with me next week after I am discharged. Further teaching is needed in response to the client's misunderstanding of sexuality after a hysterectomy that is reflected in statement (C). The client's knowledge about reproduction (A), a positive outlook with plans for the future (B), and her anticipated need for assistance and support during recovery (D) indicate she understands the present status of her recovery. Awarded 1.0 points out of 1.0 possible points. 17. 18.ID: A client in the preoperative holding area receives a prescription for midazolam (Versed) IV. The nurse determines that the surgical consent form needs to be signed by the client. Which action should the nurse implement? o Give the drug and allow the client to read and sign the consent form. o Counter-sign the client's initials on the consent form after giving the drug. o Withhold the drug until the client validates understanding of the surgical procedure and signs the consent form. Correct o Call the healthcare provider to explain the surgical procedure before the client signs the consent. Midazolam, a benzodiazepine sedative, is commonly used for conscious-sedation intraoperatively and interferes with the client's cognition and level of consciousness, so the consent form should be signed before the drug is administered (C). The validity of legal documents will be in question if a client signs them while under the influence of any central nervous system-depressant drug (A and B). If indicated, (D) may need to be implemented but should be determined before the client arrives to the preoperative area. Awarded 1.0 points out of 1.0 possible points. 18. 19.ID: The nurse is assessing a middle-aged male client for risk factors related to chronic illness. Which finding should the nurse assess further? o Thinning hair and dry scalp. o Increase in appetite and taste-bud acuity. o Increase in muscle tone but decreased muscle strength. o Increase in abdominal fat deposits. Correct An increase in the abdominal girth (D) may be indicative of the onset of metabolic syndrome, which places the client at risk for cardiac disease and requires further assessment. During middle adulthood, common findings include thinning hair, dry skin and scalp (A), changes in taste bud acuity (B), and muscle size and strength (C), which are consistent with normal system functioning during aging. Awarded 1.0 points out of 1.0 possible points. 19. 20.ID: The nurse is caring for a male client who had an inguinal herniorrhaphy 3 hours ago. The nurse determines the client's lower abdomen is distended and assesses dullness to percussion. What is the priority nursing action? o Assessment of the client's vital signs. o Document the finding as the only action. o Determine the time the client last voided. Correct o Insert a rectal tube for the passage of flatus. Swelling at the surgical site in the immediate postoperative period can impact the bladder and prostate area causing the client to experience difficulty voiding due to pressure on the urethra. To provide additional data supporting bladder distention, the last time the client voided (C) should be determined next. Documentation (B) should be made, but the client's distended bladder requires additional intervention. (A and D) are not priority actions based on the client's abdominal findings. Awarded 1.0 points out of 1.0 possible points. 20. 21.ID: While the nurse obtains a male client's history, review of systems, and physical examination, the client tells the nurse that his breast drains fluid secretions from the nipple. The nurse should seek further evaluation of which endocrine gland function? o Posterior pituitary and testes. Incorrect o Adrenal medulla and adrenal cortex. o Hypothalamus and anterior pituitary. Correct o Parathyroid and islets of Langerhans. Breast fluid and milk production are induced by the presence of prolactin secreted from the anterior pituitary gland, which is regulated by the hypothalamus' secretion of prolactin-inhibiting hormone in both men and women. Further evaluation of the hypothalamus and the anterior pituitary gland (C) should provide additional information about the secretions or lactation. Evaluation of (A, B, or D) do not support a physiologic mechanism or pathology related to mammary discharge. Awarded 0.0 points out of 1.0 possible points. 21. 22.ID: The nurse is preparing discharge instructions for a client who is going home with a surgical wound on the coccyx that is healing by second intention. What is the priority nursing diagnosis that should guide the discharge instruction plan? o Acute pain. o Risk for infection. Correct o Disturbed body image. o Risk for deficient fluid volume. A wound healing by second intention is an open wound that is at risk for infection (B). Discomfort should be minimal 2 days after surgery, and acute pain (A) is not the priority. Risk for deficient fluid volume (D) requires a significant amount of wound draining, which is not evident. Although a wound may contribute to a disturbed body image (C), the client's distress may be minimal because the wound is not visible to others. Awarded 1.0 points out of 1.0 possible points. 22. 23.ID: The nurse assesses a long-term resident of a nursing home and finds the client has a fungal infection (candidiasis) beneath both breasts. To prevent nosocomial infection, which protocol should the nurse review with the rest of the staff? o Follow contact isolation procedures. o Wash hands after caring for the client. Correct o Wear gloves when providing personal care. o Restrict pregnant staff or visitors into the room. The organism Candida albicans, that causes this infection, is part of the normal flora on the skin of most adults. Good handwashing (B) is all that is needed to prevent nosocomial spread. (A) is not necessary. Standard precautions (C) should be used during moisture management and when applying a prescription for the active infection, but the client is not considered a risk to others (D). Awarded 1.0 points out of 1.0 possible points. 23. 24.ID: Which findings are within expected parameters of a normal urinalysis for an older adult? (Select all that apply.) o pH 6. Correct o Nitrate small. o Protein small. Incorrect o Sugar negative. Correct o Bilirubin negative. Correct o Specific gravity 1.015. Correct Correct selections are (A, D, E, and F). (A) is within the normal pH range for urine. Glucosuria and bilirubinuria are abnormal and should be negative upon urinalysis (D and E). Normal changes associated with aging include decreased creatinine clearance and decreased concentrating and diluting abilities which influence the normal range of urine specific gravity, 1.001 to 1.035. Although common health problems associated with aging include renal insufficiency, urinary incontinence, urinary tract infection (B and C), and enlarged prostate, these are indicative of pathology which should be treated. Awarded 0.0 points out of 1.0 possible points. 24. 25.ID: An older female client is admitted with atrophic vaginitis and perineal cutaneous candidiasis. What is the priority nursing diagnosis for this client? o Risk for injury. o Impaired comfort. Correct o Disturbed body image. o Ineffective health maintenance. In menopausal women, the vaginal mucous membrane responds to low estrogen levels causing the vaginal walls to become thinner, drier, and susceptible to infection which leads to atrophic vaginitis. Perineal cutaneous candidiasis contributes to other manifestations of vaginal infections, such as vaginal irritation, burning, pruritus, increased leukorrhea, bleeding, and dyspareunia, and support the primary nursing diagnosis, Impaired comfort (B). Risk for injury (A), body image (C), and ineffective health maintenance (D) are secondary and linked to impaired comfort. Awarded 1.0 points out of 1.0 possible points. 25. 26.ID: The nurse is giving discharge instructions to a client with chronic prostatitis. What instruction should the nurse provide the client to reduce the risk of spreading the infection to other areas of the client's urinary tract? o Wear a condom when having sexual intercourse. o Avoid consuming alcohol and caffeinated beverages. o Empty the bladder completely with each voiding. o Have intercourse or masturbate at least twice a week. Correct The prostate is not easily penetrated by antibiotics and can serve as a reservoir for microorganisms, which can infect other areas of the genitourinary tract. Draining the prostate regularly through intercourse or masturbation (D) decreases the number of microorganisms present and reduces the risk for further infection from stored contaminated fluids. (A, B, and C) do not reduce the risk of spreading the infection internally. Awarded 1.0 points out of 1.0 possible points. 26. 27.ID: A middle-aged male client asks the nurse what findings from his digital rectal examination (DRE) prompted the healthcare provider to prescribe a repeat serum prostatic surface antigen (PSA) level. What information should the nurse provide? o A uniformly enlarged prostate is benign prostatic hypertrophy that occurs with aging. o The spongy or elastic texture of the prostate is normal and requires no further testing. o An infection is usually present when the prostate indents when a finger is pressed on it. o Stony, irregular nodules palpated on the prostate should be further evaluated. Correct PSA levels are prescribed to screen for prostatic cancer which is often detected by DRE and manifested as small, hard, or stony, irregularly-shaped nodules on the surface of the prostate (D). Although PSA levels are prescribed for routine screening, the findings suggestive of BPH (A), normal texture (B) or infection (C) do not suggest cancer of the prostate, which requires further evaluation. Awarded 1.0 points out of 1.0 possible points. 27. 28.ID: The nurse is providing discharge instructions to a client who has undergone a left orchiectomy for testicular cancer. Which statement indicates that the client understands his post-operative care and prognosis? o I should continue to perform testicular self-examination (TSE) monthly on my remaining testicle. Correct o I should wear an athletic supporter and cup to prevent testicular cancer in my remaining testicle. o I should always use a condom because I am at increased risk for acquiring a sexually transmitted disease. o I should make sure my sons know how to perform TSE because they are at increased risk for this type of cancer. Although testicular cancer protocols, such as surgery, radiation, or chemotherapy, focus on the primary site of testicular cancer, these treatments do not reduce the risk of testicular cancer in the remaining testicle, so early recognition is the best prevention. The client's understanding is reflected in the statement to perform monthly TSE for changes in size, shape, or consistency of the testis that may indicate early cancer (A). Although an athletic support (B) protects the testicle from trauma, it does not address the client's understanding of self-care. The client's risk of STD is not related to a history of testicular cancer, but to direct exposure (C). Although the client's sons should learn TSE (D), the client should continue TSE himself. Awarded 1.0 points out of 1.0 possible points. 28. 29.ID: A male client with sickle cell anemia, who has been hospitalized for another health problem, tells the nurse he has had an erection for over 4 hours. What action should the nurse implement first? o Notify the client's healthcare provider. Correct o Document the finding in the client record. o Prepare a warm enema solution for rectal instillation. o Obtain a large bore needle for aspiration of the corpora cavernosa. Priapism, a urologic emergency, is common during sickle cell crisis due to sickle cells clogging the microcirculation in the penis, causing a reduction of blood flow and oxygenation to the penis, so the healthcare provider should be notified immediately (A). Documentation (B) is not the first action that should be taken. Treatment may consist of noninvasive measures such as applying ice to the penis, instilling a warm solution enema to increase outflow in the corpora cavernosa (C) and giving pain medications, but (A) has priority. If noninvasive measures do not work, (D) is implemented by the healthcare provider. Awarded 1.0 points out of 1.0 possible points. 29. 30.ID: Which sexually transmitted infection (STI) should the nurse include in a client's teaching plan about the risk for cervical cancer? o Neisseria gonorrhoea. o Chlamydia trachomatis. o Herpes simplex virus. o Human papillomavirus. Correct Human papillomavirus (D) is known to alter cervical epithelium cytology, which is consistent with early changes of cervical cancer. Although STIs (A, B, and C) place the client at risk for exposure to HPV, these are likely to place the client at risk for pelvic inflammatory disease, infertility sequela, and painful reoccurrence. Awarded 1.0 points out of 1.0 possible points. 30. 31.ID: What is the primary nursing diagnosis for a client with asymptomatic primary syphilis? o Acute pain. o Risk for injury. o Sexual dysfunction. o Deficient knowledge. Correct An asymptomatic client with primary syphilis is most likely unaware of this disease, so to prevent transmission to others and recurrence in the client, the priority nursing diagnosis is deficient knowledge (D). Asymptomatic primary syphilis is not painful, so (A) is not applicable at this time. Although the client is at risk for injury (B) and sexual dysfunction (C) related to complications, teaching the client about transmission and treatment is instrumental in preventing the progression to systemic secondary or tertiary syphilis. Awarded 1.0 points out of 1.0 possible points. 31. 32.ID: The nurse is caring for a client with multiple trauma after a motor vehicle collision. The nurse learns that the client has secondary syphilis. What precaution should the nurse implement? o A mask should be worn by anyone entering the client's room. o Handwashing is required before and after contact with the client. o Gloves should be worn during direct contact with the client's skin. Correct o No precautions in addition to standard precautions are necessary. The secondary stage of syphilis is a systemic blood-borne disease that presents with skin lesions and rashes that may drain the highly contagious spirochete, so gloves should be worn during direct contact with the client's skin (C). Although contact with the client's blood or lesions should be avoided, masks (A) are not indicated. (B and D) are implemented for all clients. Awarded 1.0 points out of 1.0 possible points. 32. 33.ID: During the initial outbreak of genital herpes simplex for a female client, what should be the nurse's primary focus in planning care? o Promotion of comfort. Correct o Prevention of pregnancy. o Instruction in condom use. o Information about transmission. Incorrect The initial outbreak of genital herpes simplex in a woman causes severe discomfort. Promotion of comfort is the first priority (A). Prevention of pregnancy (B), instruction in condom use (C), and information about transmission (D) are all important to teach the client, but the client's ability to learn is hindered until the pain is controlled. Awarded 0.0 points out of 1.0 possible points. 33. 34.ID: A 24-year-old female client diagnosed with a human papillomavirus infection (HPV) is angry at her ex-boyfriend and says she is not going to tell him that he is infected. What response is best for the nurse to provide? o You do not have to tell him because this is not a reportable disease. o Because there is no cure for this disease, telling him is of no benefit to him or to you. o Even though you are angry, he should be told, so he can take precautions to prevent the spread of infection. Correct o You should tell him, so he can feel as guilty and miserable as you do now, knowing that you have this disease. Anger is a common emotional reaction when confronted with the diagnosis of a STI, and often lay blame and project this anger at the sexual partner. Although HPV is not a reportable disease in many states, all contacts should be informed of the infection, treatment, transmission, and precautions to minimize infecting others (C). (A and B) provide false information and increase the risk of complications and transmission. (D) is not therapeutic. Awarded 1.0 points out of 1.0 possible points. 34. 35.ID: A client who is admitted to the coronary care unit with a myocardial infarction (MI) begins to develop increased pulmonary congestion, an increase in heart rate from 80 to 102 beats per minute, and cold, clammy skin. What action should the nurse implement? o Notify the healthcare provider. Correct o Increase the IV flow rate. o Place the client in the supine position. o Prepare the client for an emergency echocardiography. Increased pulmonary congestion, increased heart rate, and cold, clammy skin in a client with a myocardial infarction indicate impending cardiogenic shock related to heart failure, a common complication of MI. The healthcare provider should be notified immediately (A) for emergency interventions of this life-threatening complication. Increasing the IV rate (B) increases the cardiac workload and contributes to cardiac decompensation. The client should be elevated to a Fowler's to semi-Fowler's position, not (C). Although an emergency echocardiography (D) should be performed, the healthcare provider should be notified for differentiating diagnosis. Awarded 1.0 points out of 1.0 possible points. 35. 36.ID: A client who returns to the unit after having a percutaneous transluminal coronary angioplasty (PTCA) complains of acute chest pain. What action should the nurse implement next? o Inform the healthcare provider. o Obtain a 12-lead electrocardiogram. o Give a sublingual nitroglycerin tablet. Correct o Administer prescribed analgesic. After a percutaneous transluminal coronary angioplasty (PTCA), a client who experiences acute chest pain may be experiencing cardiac ischemia related to restenosis, stent thrombosis, or acute coronary syndrome involving any coronary artery. The first action is to administer nitroglycerin (C) to dilate the coronary arteries and increase myocardial oxygenation. Then, (A, B, and D) are implemented. Awarded 1.0 points out of 1.0 possible points. 36. 37.ID: A client with a history of hypertension, myocardial infarction, and heart failure is admitted to the surgical intensive care unit after coronary artery bypass surgery graft (CABG). The nurse determines the client's serum potassium level is 4.5 mEq/L. What action should the nurse implement? o Notify the healthcare provider. o Decrease the IV solution flow rate. o Document the finding as the only action. Correct o Administer potassium replacement as prescribed. Coronary artery bypass surgery graft (CABG) places a client at risk for hypokalemia from hemodilution, nasogastric suction, or diuretic therapy, so the serum potassium level is maintained between 4 and 5 mEq/L to avoid dysrhythmias. Documentation of the normal finding (C) is indicated at this time. Continued monitoring of the client should anticipate the onset of complications that may require (A, B, and C). Awarded 1.0 points out of 1.0 possible points. 37. 38.ID: Which condition is associated with an oversecretion of renin? o Hypertension. Correct o Diabetes mellitus. o Diabetes insipidus. o Alzheimer's disease. Renin is an enzyme synthesized and secreted by the juxtaglomerular cells of the kidney in response to renal artery blood volume and pressure changes. Low renal perfusion stimulates the release of renin, which is converted by angiotensinogen into angiotensin I, which causes the secretion of aldosterone, resulting in renal reabsorption of sodium, water, and subsequently increases blood pressure (A). (B, C, and D) are not directly related to renin oversecretion. Awarded 1.0 points out of 1.0 possible points. 38. 39.ID: What information should the nurse include in a teaching plan about the onset of menopause? (Select all that apply). o Smoking. Correct o Oophorectomy with hysterectomy. Correct o Early menarche. Correct o Cardiac disease. o Genetic influence. Correct o Chemotherapy exposure. Correct Correct responses are (A, B, C, E, and F). Menopausal symptoms are related to the cessation of ovarian function. Factors influencing the onset of menopause include smoking (A), genetic influences (E), early menarche (C), surgical removal (B), and exposure to chemotherapy agents and radiation (F). Cardiovascular disease (D) is unrelated. Awarded 1.0 points out of 1.0 possible points. 39. 40.ID: A Korean-American client, who speaks very little English, is being discharged following surgery. Which nurse should the nurse manager assign to provide the discharge instructions for the client? o A graduate registered nurse (RN) with three weeks of experience. o The registered nurse (RN) case manager for the unit with 1 year's experience. Correct o A floating registered nurse (RN) with five years of nursing experience. o A Korean-American practical nurse (PN) with six years of nursing experience. The RN case manager (B) is the best qualified nurse to assess and provide discharge educational needs, obtain resources for the client, enhance coordination of care, and prevent fragmentation of care. The RN graduate (A) lacks the experience to provide individualized and complete discharge instructions. The float nurse (C) lacks case management expertise to advocate adequately for the client, coordinate care, and provide community resources. It is not in the scope of practice for the PN (D) to give discharge instructions. Awarded 1.0 points out of 1.0 possible points. 40. 41.ID: A female client with hyperesthesia on the oncology unit is using a transcutaneous electrical nerve stimulation (TENS) unit for chronic pain. Which nursing activity should the nurse implement instead of delegating to a practical nurse (PN)? o Determine the client's level of discomfort using a pain rating scale. o Ask the client about her past experience with chronic pain. o Observe the client's facial expressions for pain and discomfort. o Evaluate the client's ability to adjust the voltage to control pain. Correct The oncology nurse has the knowledge and experience with the use of a transcutaneous electrical nerve stimulation (TENS) unit for chronic pain relief, so the nurse should evaluate the client's skill in effectively controlling the pain by adjusting the voltage (D). The PN can collect data about the client's pain (A, B, and C). Awarded 1.0 points out of 1.0 possible points. 41. 42.ID: Which client should the nurse assess first? o A 27-year-old complaining of severe back pain. o A 63-year-old complaining of foot and ankle pain. o A 49-year-old with pancreatitis complaining of unrelenting abdominal pain. o A 55-year-old newly admitted client complaining of jaw pain and indigestion. Correct The 55-year-old client (D) should be assessed first to rule out cardiac involvement because jaw pain and indigestion are common descriptors of myocardial injury. While severe back pain (A) may indicate a dissecting abdominal aortic aneurysm, a 27-year-old client is less likely to be experiencing cardiac syndrome. The client with foot and ankle pain (B) is not experiencing a life-threatening condition. The client with pancreatitis (C) requires pain management but this is not as high a priority as (D). Awarded 1.0 points out of 1.0 possible points. 42. 43.ID: The home health nurse is assessing a client with terminal lung cancer who is receiving hospice care. Which activity should be assigned to the hospice practical nurse (PN)? o Administer medications for pain relief, shortness of breath, and nausea. Correct o Clarify family members' feelings about the meaning of client behaviors and symptoms. o Develop a plan of care after assessing the needs of the client and family. o Teach the family to recognize restlessness and grimacing as signs of client discomfort. Hospice care provides symptom management and pain control during the dying process and enhances the quality of life for a client who is terminally ill. Administering medication and monitoring for therapeutic and adverse effects (A) is within the scope of practice for the PN. Nursing actions that require the skills of the RN include assessing and clarifying the feelings of family members (B), planning care (C), and teaching symptom recognition (D). Awarded 1.0 points out of 1.0 possible points. 43. 44.ID: A client who is receiving the sixth unit of packed red blood cell transfusion is demonstrating signs and symptoms of a febrile, nonhemolytic reaction. What assessment finding is most important for the nurse to identify? o Increased anxiety since the transfusion began. o Drowsiness after receiving diphenhydramine (Benadryl). o Complaints of feeling cold. o Flushed skin and headache. Correct The most common type of reaction is a febrile, nonhemolytic blood transfusion reaction related to leukocyte incompatibility, which causes chills, fever, headache, and flushing (D). Some clients are anxious (A) about the risk of blood-borne infections, but the client's response to the release of inflammatory and immunologic mediators can potentially lead to bronchospasm and circulatory collapse. Drowsiness (B) is an expected symptom after diphenhydramine administration. (C) is often a sensory response to environmental temperatures or the administration of cold blood. Awarded 1.0 points out of 1.0 possible points. 44. 45.ID: A client with acute osteomyelitis has undergone surgical debridement of the diseased bone and asks the nurse how long will antibiotics have to be administered. Which information should the nurse communicate? o Oral antibiotics for 2 to 4 months, then for dental procedure prophylaxis. o Parenteral antibiotics for 4 to 6 weeks, then oral antibiotics for up to 1 year. o Parenteral antibiotics for 4 to 8 weeks, then oral antibiotics for 4 to 8 weeks. Correct o Parenteral antibiotics for 2 to 3 weeks, then oral antibiotics for 4 weeks. Treatment of acute osteomyelitis requires administration of high doses of parenteral antibiotics for 4 to 8 weeks, followed by oral antibiotics for another 4 to 8 weeks (C). (A, B, and D) are incorrect antibiotic schedules for osteomyelitis. Awarded 1.0 points out of 1.0 possible points. 45. 46.ID: A client with osteoarthritis requests information from the nurse about what type of exercise regimen would be most beneficial for him. The nurse should communicate which information? o Low impact exercise, walking, swimming and water aerobics. Correct o Repetitive strength-building exercises with weights or resistance bands. o Circuit training alternating with frequent rest periods. o High-impact aerobic exercise. Low impact exercises such as walking or swimming (A), that do not cause further harm to damaged joints, are most beneficial to clients with osteoarthritis. Strength-building exercises, circuit training, and high-impact aerobics (B, C and D) may cause too much stress on the joint areas and subsequently increase inflammation and damage. Awarded 1.0 points out of 1.0 possible points. 46. 47.ID: The nurse is preparing an adult client for an upper gastrointestinal (UGI) series. Which information should the nurse include in the teaching plan? o The xray procedure may last for several hours. o A nasogastric tube (NGT) is inserted to instill the barium. o Enemas are given to empty the bowel after the procedure. o Nothing by mouth is allowed for 6 to 8 hours before the study. Correct The client should be NPO for at least 6 hours before the UGI (D). (A) is not typical for this procedure. A NGT is not needed to instill the barium (B) unless the client is unable to swallow. A laxative, not enemas (C), is given after the procedure to help expel the barium. Awarded 1.0 points out of 1.0 possible points. 47. 48.ID: The nurse is caring for a client scheduled to undergo insertion of a percutaneous endoscopic gastrostomy (PEG) tube. The client asks the nurse to explain how a PEG tube differs from a gastrostomy tube (GT). Which explanation best describes how they are different? o Method of insertion. Correct o Location of the tubes. o Diameter of the tubes. o Procedure for feedings. The best explanation of how a PEG tube differs from a GT is by the method of insertion (A). GT insertion involves making an incision in the wall of the abdomen and suturing the tube to the gastric wall. A PEG tube is inserted with endoscopic visualization through the esophagus into the stomach and then pulled through a stab wound in the abdominal wall. (B, C, and D) identify commonalities. Awarded 1.0 points out of 1.0 possible points. 48. 49.ID: The healthcare provider prescribes high-protein, high-fat, low-carbohydrate diet with limited fluids during meals for a client recovering from gastric surgery. The client asks the nurse what the purpose is for this type of diet. Which rationale should be included in the nurse's explanation to this client? o It is quickly digested. o It does not cause diarrhea. o It does not dilate the stomach. o It is slow to leave the stomach. Correct This type of diet is slowly digested and is slow to leave the stomach (D). Because of its density from proteins and fats, and the reduction of fluids with the meal, the possibility of dumping syndrome is reduced. (A, B, and C) are incorrect rationales. Awarded 1.0 points out of 1.0 possible points. 49. 50.ID: The nurse is caring for a client with a small bowel obstruction. The client is vomiting foul smelling fecal-like material. What action should the nurse implement? o Administer antiemetics every 2 to 3 hours. o Position on the left side with knees drawn up. o Encourage ice chips sparingly. o Give IV fluids with electrolytes. Correct When the bowel is obstructed, electrolytes and fluids are not absorbed, so parenteral fluids with sodium chloride, bicarbonate, and potassium should be administered (D). (A and C) are contraindicated. (B) may or may not be a position of comfort for the client. The nurse should implement (D). Awarded 1.0 points out of 1.0 possible points. 50. 51.ID: What instruction should the nurse include in the discharge teaching for a client who needs to perform self-catheterization technique at home? o Catheterize every 3 to 4 hours. Correct o Maintain sterile technique. o Use the Credé maneuver before catheterization. o Drink 500 ml of fluid within 2 hours of catheterization. The average interval between catheterizations for adults is every 3 to 4 hours (A). Although