exam 4 med surg bruh

Patient teaching on liquid oral iron supplement for someone with iron-deficiency anemia. 4 things!

drink with straw

take with vitamin C

avoid dairy/calcium, caffeine

may cause dark stools or constipation

What is the priority of a patient with Atrial fibrillation RVR?

stat EKG

Draw troponin

Nasal cannula

nasal cannula

pulmonary embolism priority

stat ct angio of chest

Notify provider

Put the pt in high fowlers position

Draw d-dimer

main symptom is SOB, so high fowler position

what is the nursing priority for a s/p chest tube insertion>

check incision site for signs of infection, monitor pain leverls, monitor for drainage. if no drainage, check line for kinks and leaks

risk factors for pt with peptic ulcer disease (9)

GERD, aspirin, NSAID use, alcohol, smoking, h pylori, scronic stress, high HCL acid secretions

finding in a ulcerative colitis pt

decreased H&H, consistent/bloody diarrhea

A client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which actions should the nurse plan to promote client safety? Select all that apply.

A. Monitor serum potassium levels.

B. Weigh client daily, and monitor trends.

C. Monitor for symptoms of fluid retention.

D. Provide the client with a soft toothbrush.

E. Instruct the client to use an electric razor.

F. Monitor all secretions for frank or occult blood.

D. Provide the client with a soft toothbrush.

E. Instruct the client to use an electric razor.

F. Monitor all secretions for frank or occult blood.

Nursing actions for a patient with AKI and elevated K levels.

insulin + D50 + bicarb + Ca gluconate

Normal findings when assessing a patient with an arteriovenous fistula.

bruit and thrill

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. What actions should the nurse take? Select all that apply:

a. check the level of the drainage bag

b. reposition the client to his or her side

c. place the client in good body alignment

d. check the peritoneal dialysis system for kinks

e. contact the primary health care provider

f. increase the flow rate of the peritoneal dialysis solution

a. check the level of the drainage bag

b. reposition the client to his or her side

c. place the client in good body alignment

d. check the peritoneal dialysis system for kinks

expected findings in a patient with glomerulonephritis.

HTN

Recent sore throat/strep

Should any diabetic medications be held if preparing Pt for cardiac angioplasty? Why?

Metformin

Insulin

Humulin

NPH

hold the metformin 48h before admin d/t can interact w/contrast dye and harm kidneys.

Effective nursing action to improve oral intake for a patient receiving chemotherapy

magic mouthwash

How many times do you flush the toilet after using it while on chemo medications to prevent exposure while on chemotherapy?

1

2

3

4

flush meds TWICE, and close the lid because the cytotoxic substances within chemotherapy meds can linger in bodily waste

Which pt should nurse see first:

A. Pt with acute pancreatitis requesting pain meds

B. Pt requesting to go to the bathroom

C. Pt who woke up screaming

D. pt having hemorrhage

D. pt having hemorrhage

For a chemo patient with decreased WBC's, what kind of isolation precaution are they placed on?

Neutropenic precautions aka protective environment

which of these is seen in chrons ONLY (SATA)

Diarrhea

bloody stools

dehydration

fatigue

weight loss

decreased appetite

affects large intestine

affects anywhere in GI tract

skip lesions

cobblestone appearance

malnutrition

fever

fistulas

abdominal pain

affects anywhere in GI tract

skip lesions

cobblestone appearance

which of these is seen in BOTH UC and Chron's

Diarrhea

bloody stools

dehydration

fatigue

weight loss

decreased appetite

affects large intestine

affects anywhere in GI tract

skip lesions

cobblestone appearance

malnutrition

fever

abdominal pain

diarrhea

dehydration

fatigue

malnutrition

weight loss

decreased appetite

fever

abdominal pain

which of these is seen in UC ONLY SATA

Diarrhea

bloody stools

dehydration

fatigue

weight loss

decreased appetite

affects large intestine

affects anywhere in GI tract

skip lesions

cobblestone appearance

malnutrition

fever

fistulas

abdominal pain

bloody stools

affects large intestine

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The nurse should anticipate which of the following complications in the client with a body cast:

infection

urinary retention

skin excoriation

intestinal obstruction

Intestinal Obstruction

The client for whom skeletal traction is planned asks for an explanation regarding the purpose of this type of traction. What is the best response?

“this type of traction will aid in realigning the bone”

“this type of traction will prevent you from having low back pain”

“this type of traction will decrease muscle spasms”

“this type of traction will prevent injury to the skin”

This type of traction will aid in realigning the bone

When the client moves the extremity the nurse notes the presence of a grating sound. What conclusion can the nurse draw from this data?

an open fracture is evolving

air is trapped beneath the skin of the fracture

blood is collected @ the side of the fracture

bone fragments may be present at the fracture sire

Bone fragments may be present at the fracture site

Which of the following clients is most at risk of osteomyelitis after a fracture?

a client with a fracture clavicle

a client with an open fracture of the tibia

a client with a simpe fracture of the wrist

a client with a compression fracture of a vertebra

A client with an open fracture of the tibia

The most important consideration for a patient with a ORIF that nurse will remember is to monitor which of the following?

the # of times the client exercises the affected limb.

the pin site for unusual redness, swelling, and purulent foul odor drainage.

the distance between the client’s hip + the traction.

how the client is coping with immobilization instructions.

The pin site for unusual redness, swelling, and purulent foul odor drainage

A patient who has advanced cirrhosis is receiving lactulose. Which finding by the nurse indicates that the medication is effective?

the pt is alert and oeriented

the pt denies nausea or anorexia

the pt’s billirubin lvl decreases

the pt has @ least 1 stool daily

The patient is alert and oriented

Which statement by a patient who has had an above the knee amputation indicates that the nurse's discharge teaching has been effective?

“I should lay on my abdomen for 30 minutes 3 or 4 times a day”

“i should elevate my residual limb on a pillow 2 or 3 times a day”

“i should change the limb sock when it becomes soiled or stretched out”

“i should use lotion on the stump to prevent drying of the skin”

I should lay on my abdomen for 30 minutes 3 or 4 times a day

Which nursing action is focused on the consequence of low albumin levels

evaluating for asterixis

inspecting for petechiae

palpating for peripheral edema

evaluating for decreased lvl of consciousness

Palpating for peripheral edema

On assessment, the nurse finds the client's fingers to be pale, cool, and slightly swollen. What is the nurse's best first action?

apply heat to the affected hand

withold the next dose of insulin

elevate the arm aboce the lvl of the heart

petal the cast edges

Elevate the arm above the level of the heart

Which risk factor for colorectal cancer would the nurse include?

high fiber, low fat diet

age older than 30 yo

distant relative with colorectal cancer

personal hx of ulcerative colitis or GI polyps

Personal history of ulcerative colitis or gastrointestinal polyps

The nurse determines that the client demonstrates the greatest adjustment to the loss of the breast if which behavior is noted?

the client looks @ the surgical site

the client performs the prescribed arm exercises

the client takes the pain meds as Rx

the cloent has read all the post op materials as provided

The client looks at the surgical site

The nurse notes that the client's platelet count is 20,000. the nurse would prepare to implement which action?

remove the fresh flowers from the pt’s room

remove the rectal thermometer from the client's room

instruct family members to wear a mask wehn entering pt’s room

place pt on a low bacteria diet

Remove the rectal thermometer from the client's room

Nurse is caring for a client with leukemia. Nurse reviews lab results and notes that WBC count is 2000, platelet count is 150,000, clotting time is 10 min, and ammonia is 20. Which nursing action would be appropriate?

plact the client on bleeding precautions

place the client on neutropenic precautions

remove the rectal thermometer from the pt’s room

instruct the dietary dept to eliminate all protein from the diet

Place the client on neutropenic precautions

A nurse is caring for a patient with a serum K+ level of 2.8. Which ECG change should the nurse anticipate?

peaked t waves + widened QRS complex

Flattened or shallow T wave

Elevated ST segment and shortened QT interval

Inverted P waves + narrow QRS complex

Flattened or shallow T wave

Patient with hyperkalemia (6.8) is experiencing dangerous ventricular dysrhythmias. Which medication should the nurse prepare to administer first

IV insulin w/glucose

sodium polystyrene sulfonate (kayexalate)

IV calcium gluconate

loop diueretic

IV calcium gluconate

When obtaining assessment data from a client with a microcytic normochromic anemia, which would the nurse question the client about?

folic acid intake

iron

B12

Iron

The home care nurse is providing instructions to a client w/an arterial ischemic leg ulcer about home care management + self care management. Which statement, if made by the client, indicates a need for further instruction?

I need to be sure that I elevate my leg above the level of my heart

If I cut my toenails, I need to make sure the I cut them straight across

I need to be sure not to go barefoot around the house

It is alright to apply lanolin to my feet, but not in between my toes

I need to be sure that I elevate my leg above the level of my heart

A patient with a small AAA is not a good surgical candidate. What would the nurse teach the patient is the best way to prevent expansion of the lesion?

Control hypertension with prescribed therapy

Avoid strenuous physical exertion

comply w/prescribed anticoagulant therapy

maintain a low calcium diet to prevent calcification of the vessel

Control hypertension with prescribed therapy

A patient receives aspart(Novalog) insulin(rapid acting) at 8:00 am. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?

0900

1230

1600

2000

0900

While caring for the patient in the oliguric phase of AKI, when would the nurse notify the hcp?

Urine output is 300mL/day

Edema occurs in the feet, legs, and sacral area

Cardiac monitor reveals a depressed T wave + a deepend Q wave

The patient develops increasing muscle weakness and abdominal cramping

The patient develops increasing muscle weakness and abdominal cramping

A dehydrated patient is in the injury stage of the RIFLE staging of AKI. What would the nurse anticipate as the first treatment for this patient?

Assessment of daily weight

IV administration of fluid and furosemide(lasix)

IV admin of insulin + sodium bicarbonate

Urinalysis to check for sediment, osmolality, Na+, and specific gravity

IV administration of fluid and furosemide(lasix)

A patient with newly diagnosed heart failure with reduced ejection fraction has been prescribed lisinopril, carvedilol, and furosemide. The hcp has discussed the importance of sodium restriction and regular exercise. Which patient statement indicates the need for further education about heart failure management?

i should report a weight gain of 3lbs in 2 days

i should avoid adding additional salt to my meals

i should take furosemide in the morning

i need to gradually increase my walking from 5 min to 30 min

I should report a weight gain of 3 pounds in 2 days

A client has a possible dx of dvt. which diagnostic studies does the nurse anticipate will be prescribed to assist in the diagnosis of this disorder? Select all that apply.

platelet count

d-dimer blood test

electrocardiography

venous duplex ultrasound

MRi

INR

D-dimer/Venous duplex ultrasound

The nurse is doing an admission assessment on a client with a hx of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which s/s of duodenal ulcer?

weight loss

nausea and vomiting

pain relieved by food intake

pain radiating down the R arm

Pain relieved by food intake

The nurse is reviewing the record of a client with a dx of cirrhosis and notes that there is documentation of the presence of asterixis. How would the nurse assess its presence?

dorsiflex the client’s foot measure the ABD girth

ask the client to extend their arms

instruct the client to lean foreward

Ask the client to extend their arms

When caring for a patient with SIADH, what action would the nurse include in the plan of care?

Monitor neurologic status at least every 2 hours

Teach the pt recieving diuretic therapy to restrict sodiu intake

Keep the head of the bed elevated

Notify the HCP if the pt’s BP decreased

Monitor neurologic status at least every 2 hours

The nurse should teach the pt to avoid which of the following groups of activities to prevent dislocation of the hip?

taking leisurely walks, and use of low chair seats.

crossing legs and setting on low toilet seats.

using an assistive devide for applying shoes and socks.

all exercises, bed rest + using raised toilet seats.

crossing legs and setting on low toilet seats

Who is the priority?
A.  Pt with pancreatitis

B. Pt woke up screaming

C. Pt that is having a hemorrhage

Pt that is having a hemorrhage

what is a good indicator of renal perfusion for a patient with AKI?

Adequate bp, no s/s of htn or sob, good monitor creatinine/bun

A patient has a K+ level of 6.2. Which intervention is the priority?

A. Administer sodium polystyrene sulfonate
B. Administer IV calcium gluconate
C. Place patient on a cardiac diet
D. Give oral diuretics

B

A patient with heart failure presents with crackles and pink frothy sputum. This indicates:A. Right-sided HF
B. Pulmonary embolism
C. Left-sided HF with pulmonary edema
D. COPD exacerbation

C

A patient taking oral liquid iron reports black stools. The nurse should:

A. Notify the provider
B. Stop the supplement
C. Reassure this is expected
D. Give with milk

C

Which EKG change is expected in hypokalemia?

A. Peaked T waves
B. ST elevation
C. Flattened or inverted T waves
D. Widened QRS

C

A patient with critically low ejection fraction (<40%) will MOST likely exhibit:

A. Bradycardia
B. Fatigue and dyspnea
C. Hypertension
D. Bounding pulses

B

Which finding indicates nitroglycerin is being stored correctly?

A. Tablets transferred to a weekly pill organizer
B. Kept in original dark glass bottle
C. Placed in sunlight to reduce moisture
D. Stored in bathroom cabinet

B

A patient with an AAA. Which assessment is expected?

A. Absent bowel sounds
B. Pulsatile abdominal mass
C. Chest pain
D. Hematemesis

B

Priority for A-fib with RVR?

A. Decrease HR <100 bpm
B. Increase fluid intake
C. Give aspirin
D. Start statin therapy

A

What diagnostic test confirms a DVT?

A. Chest X-ray
B. Venous duplex ultrasound
C. Echocardiogram
D. ABG

B

A chest tube with continuous bubbling in the water seal suggests:

A. Lung re-expansion
B. Normal function
C. Air leak
D. Blockage

C

A patient with pneumonia should FIRST receive:

A. Incentive spirometer
B. Oral hydration
C. IV antibiotics
D. Nebulized saline

C

Crohn’s disease teaching includes:

A. High-fiber diet at all times
B. Avoid fluids during meals
C. High-calorie, high-protein diet
D. Zero B12 supplementation

C

uodenal ulcer pain typically occurs:

A. Immediately after eating
B. 2–5 hours after eating
C. Before bed
D. On an empty stomach only

B

Which medication must be held before cardiac angioplasty?

A. Regular insulin
B. Glargine
C. Metformin
D. Lispro

C

A patient in DKA is improving when:

A. Blood glucose drops from 500 to 120 in 1 hour
B. Anion gap begins closing
C. Ketones remain elevated
D. Kussmaul respirations persist

B

Hallmark finding in glomerulonephritis:

A. Polyuria
B. Hematuria and proteinuria
C. Hypercalcemia
D. Alkalosis

B

Normal finding in an AV fistula:

A. Absent pulses
B. Bruit and thrill present
C. Cool pale extremity
D. Pain at site

B

Highest risk for osteomyelitis:

A. Closed fractures
B. Open tibia fracture
C. Stress fracture
D. Greenstick fracture

B

Major complication of body cast:

A. GI bleeding
B. Cast syndrome (bowel obstruction)
C. Increased appetite
D. Hypotension

B

A patient with expressive aphasia needs:

A. Loud speaking
B. Long explanations
C. Yes/no questions
D. Minimizing wait time

C

Signs of hypernatremia (Select all that apply)A. Lethargy
B. Seizures
C. JVD
D. Hypotensio

A, B, D

Management of hyperkalemia (SATA)

A. Stop potassium intake
B. Administer IV calcium gluconate
C. Give insulin + D50
D. Restrict fluids
E. Encourage potassium-rich foods

A, B, C

 Symptoms of left-sided HF (SATA)

A. Pulmonary crackles
B. JVD
C. S3 sound
D. Pink frothy sputum
E. Peripheral edema

A, C, D

Oral iron teaching (SATA)

A. Use straw
B. Take with milk
C. Take with vitamin C
D. Avoid tea/coffee
E. Take on full stomach

A, C, D

Ulcerative colitis symptoms (SATA)

A. Bloody diarrhea
B. Weight gain
C. Fever
D. Dehydration
E. Continuous colon involvement

A, C, D, E

Signs of acute pancreatitis (SATA)

A. LUQ pain radiating to back
B. Kussmaul respirations
C. Cullen sign
D. Grey Turner’s sign
E. Hypocalcemia

A, C, D, E

Cholelithiasis symptoms (SATA)

A. RUQ pain to right shoulder
B. Jaundice
C. Biliary colic
D. Hypotension
E. Fever

A, B, C, E

Peritonitis (PD) signs (SATA)

A. Cloudy effluent
B. Fever
C. Clear yellow drainage
D. Abdominal pain
E. Weight gain

A, B, D

Stroke risk factors (SATA)

A. Hypertension
B. Diabetes
C. Smoking
D. Low cholesterol
E. Obesity

A, B, C, E

Stroke warning signs — BE FAST (SATA)

A. Balance problems
B. Eye vision changes
C. Arm weakness
D. Speech difficulty
E. Tremors

A, B, C, D

Hip fracture precautions (SATA)

A. No crossing legs
B. No low chairs
C. Pillow between knees
D. Squatting encouraged
E. High-fiber diet

A, B, C

Leukemia with platelets 20,000 — nursing actions (SATA)

A. Avoid IM injections
B. Avoid rectal temps
C. Start aspirin
D. Monitor for bruising
E. Use soft toothbrush

A, B, D, E

Signs DKA is resolving (SATA)

A. Closing anion gap
B. Kussmaul persists
C. Improved mental status
D. Ketones decreasing
E. Glucose drops rapidly to normal

Answers: A, C, D

A, C, D

Expressive aphasia communication strategies (SATA)

A. Yes/no questions
B. Write or gesture
C. Speak loudly
D. One idea at a time
E. Allow extra time

A, B, D, E

Prevention of complications after ORIF (SATA)A. Monitor for infection
B. Frequent neurovascular checks
C. Avoid elevating limb
D. Pillow between knees
E. Avoid turning to affected side

A, B, D, E