FINALS MEDICAL SURGICAL NURSING 2023 EXAM

FINALS MEDICAL SURGICAL NURSING 2023 EXAM The nurse would analyze an arterial pH of 7.46 as indicating: A. Acidosis B. alkalosis C. homeostasis D. neutrality - CORRECT ANSWERS B. Alkalosis Normal pH is 7.35-7.45. Alkalosis is indicated by a pH above 7.45 A rise in arterial pressure causes the baroreceptors and stretch receptors to signal an inhibition of the sympathetic nervous system, resulting in: A. decreased sodium reabsorption B. increased sodium reabsorption C. decreased urine output D. increased urine output - CORRECT ANSWERS D. increased urine output Arterial baroreceptors and stretch receptors help maintain fluid balance by increasing urine output in response to a rise in arterial pressure. Nurse John Joseph is totaling the intake and output for Elena Reyes, a client diagnosed with septicemia who is on a clear liquid diet. The client intakes 8 oz of apple juice, 850 ml of water, 2 cups of beef broth, and 900 ml of half-normal saline solution and outputs 1,500 ml of urine during the shift. How many milliliters should the nurse document as the client's intake. A. 2,230 B. 2,740 C. 2,470 D. 2,320 - CORRECT ANSWERS C. 2,470 The fluid intake includes 8 oz (240 ml) of apple juice, 850 ml of water, 2 cups (480 ml) of beef broth, and 900 ml of I.V. fluid for a total of 2,470 ml intake for the shift. Which of the following is the most important physical assessment parameter the nurse would consider when assessing fluid and electrolyte imbalance? A. skin turgor B. intake and output C. osmotic pressure D. cardiac rate and rhythm - CORRECT ANSWERS D. cardiac rate and rhythm Cardiac rate and rhythm are the most important physical assessment parameter to measure. Skin turgor, intake and output are physical assessment parameters a nurse would consider when assessing fluid and electrolyte imbalance, but choice d is the most important. Pierro was noted to be displaying facial grimaces after nurse Kara assessed his complaints of pain rated as 8 on a scale of 1 (no pain) 10 10 (worst pain). Which intervention should the nurse do? A. Administering the client's ordered pain medication immediately B. Using guided imagery instead of administering pain medication C. Using therapeutic conversation to try to discourage pain medication D. Attempting to rule out complications before administering pain medication - CORRECT ANSWERS D. Attempting to rule out complications before administering pain medication When intervening with a client complaining of pain, the nurse must always determine if the pain is expected pain or a complication that requires immediate nursing intervention. This must be done before administering the medication. Guided imagery should be used along with, not instead of, administration of pain medication. The nurse should medicate the client and not discourage medication. When monitoring the daily weight of a patient with fluid volume deficit (FVD), the nurse is aware that fluid loss may be considered when weight loss begins to exceed: A. 0.25 lb B. 0.50 lb C. 1 lb D. 1 kg - CORRECT ANSWERS B. 0.50 lb Weight loss of more than 0.50 lb. is considered to be fluid loss. Mr. Teban has a history of chronic obstructive pulmonary disease and has the following arterial blood gas results: partial pressure of oxygen (PO2), 55 mm Hg, and partial pressure of carbon dioxide (PCO2), 60 mm Hg. When attempting to improve the client's blood gas values through improved ventilation and oxygen therapy, which is the client's primary stimulus for breathing? A. High PCO2 B. Low PO2 C. Normal pH D. Normal bicarbonate (HCO3) - CORRECT ANSWERS B. Low PO2 A chronically elevated PCO2 level (above 50 mmHg) is associated with inadequate response of the respiratory center to plasma carbon dioxide. The major stimulus to breathing then becomes hypoxia (low PO2). High PCO2 and normal pH and HCO3 levels would not be the primary stimuli for breathing in this client. Which of the following conditions is associated with elevated serum chloride levels? A. cystitis B. diabetes C. eclampsia D. hypertension - CORRECT ANSWERS C. eclampsia Eclampsia is associated with increased levels of serum chloride. Nursing intervention for the patient with hyperphosphatemia include encouraging intake of: A. amphogel B. Fleets phospho-soda C. milk D. vitamin D - CORRECT ANSWERS A. amphogel Administration of phosphate binders (amphogel and basagel) will reduce the serum phosphate levels. A 36-year-old male client is about to be discharged from the the hospital after 5 days due to surgery. Which intervention should be included in the home health care nurse's instructions about measures to prevent constipation? A. Discouraging the client from eating large amounts of roughage-containing foods in the diet. B. Encouraging the client to use laxatives routinely to ensure adequate bowel elimination. C. Instructing the client to establish a bowel evacuation schedule that changes every day. D. Instructing the client to fill a 2-L bottle with water every night and drink it the next day - CORRECT ANSWERS D. Instructing the client to fill a 2-L bottle with water every night and drink it the next day Adequate fluids and fiber in the diet are key to preventing constipation. Having the client fill a 2-L bottle with water every night and drink it the next day is one method for ensuring the client receives at least 2,000 ml of water daily. The client also should be instructed to drink any other fluids throughout the day. High fiber or roughage foods are encouraged. Laxatives should not be used routinely for bowel elimination. They should be used only as a last resort, because clients may become dependent on them. A regular bowel evacuation schedule should be established. Marie Joy's lab test revealed that her serum calcium is 2.5 mEq/L. Which assessment data does the nurse document when a client diagnosed with hypocalcemia develops a carpopedal spasm after the blood-pressure cuff is inflated? A. Positive Trousseau's sign B. Positive Chvostek's sign C. Tetany D. Paresthesia - CORRECT ANSWERS A. Positive Trousseau's sign