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TI PN MEDICAL SURGICAL EXAM BANK 2024.
Typology: Exams
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A home health nurse is caring for a fluent who has COPD. The client tells the nurse that he becomes short of breath while eating despite the use of home oxygen. Which if the following instructions should the nurse include? - CORRECT ANSWER Drink beverages at the end of meals A home health nurse is reinforcing teaching with a clear f about preventing complications of peripheral vascular disease. Which of the following state meets indicates that the client is adhering today the nurses instructions? - CORRECT ANSWER I don't cross my legs anymore
A it's is reviewing the medical record of a client who has a cord pancreatitis. Which of the following findings should the myself anticipate? - CORRECT ANSWER Elevated serum amylase level A jade is reinforcing teaching with a client who postoperative following a cemented total hip arthroplasty. Which of the following instructions should the nurse include in the teaching? - CORRECT ANSWER Maintain hip flexion to 90° or less when sitting A nurse enters the room of a client whose transfusion of packed RBCs was initiated 15 min ago by the RN. The client reports dyspnea and urticaria. Which of the following actions should the nurse perform first? - CORRECT ANSWER Stop the infusion A nurse in a clinic is assisting with the development of a pamphlet about STIs. Which if the following f information should the nurse recommend to include in the pamphlet? - CORRECT ANSWER Women have a higher risk of contracting STI than men A nurse in a health clinic is reinforcing teaching with a client who has tuberculosis about transmission of the disease. Which of the following client statements indicates an understanding of the teaching? - CORRECT ANSWER I inhaled the infected droplets that were in the air A nurse in a long term care facility is collecting data from a client who reports fullness in the rectum and abdominal cramping. Which of the following findings should indicate to the nurse that the client might have a fecal impaction? - CORRECT ANSWER Small liquid stools A nurse in an oncology is reinforcing teaching about Mohs surgery with a client who has skin cancer. Which of the following information should the nurse include in the teaching? - CORRECT ANSWER Mohs surgery is a horizontal shaving of thin layers of the tumor
A nurse is assisting in the plan of care for a client who had a recent left hemispheric stroke, which of the following actions should the nurse include in the plan? - CORRECT ANSWER Use simple verbal cues when directing tasks A nurse is assisting in the plan of care regarding bowel restraining for a client who has a cervical spinal cord injury. Which of the following interventions should the nurse plan to implement first? - CORRECT ANSWER Determine the clients daily elimination habits A nurse is assisting the charge nurse with developing an in service about caring for clients who have internal sealed radiation implants. Which of the following information should the nurse include? - CORRECT ANSWER Dispose of radiation implants in a lead container. A nurse is assisting with an educational program for clients who have been newly diagnosed with diabetes mellitus. Which of the following instructions should the nurse include in the oral gram regarding insulin? - CORRECT ANSWER Opened can be stored in a cool countertop away from light A nurse is assisting with the care of a care who is reconciled 0.9 % sodium chloride by continuous IV infusion. The client report pain and swelling at the IV site. In which order should the nurse perform that following steps? - CORRECT ANSWER Check the IV site, stop the infusion, withdraw the IV catheter, elevate the affected arm, notify the charge nurse A nurse is assisting with the care of a client who had a stroke and is unable to speak. The nurse should identify that the clients injury occurs in which of the following lobe of the brain? - CORRECT ANSWER Frontal lobe A nurse is assisting with the care of a client who has a cardiac catheterization via the right femoral artery. Which of the following actions should the nurse take to prevent lost procedure complications? - CORRECT ANSWER Monitor the insertion site for bleeding is correct, maintain the pressure dressing, check the clients peripheral pulses
A nurse is assisting with the development of a plan of care to manage pain for a client who has herpes zoster with lesions on the lower extremities. Which of the following interventions should the nurse include in the plan of care? - CORRECT ANSWER Keep bed linens off of the affected areas A nurse is assisting with the discharge planning for a client who is postoperative following a total hip arthroplasty. Which of the following instructions should the nurse include in the discharge plan? - CORRECT ANSWER Obtain a raised toilet seat A nurse is care for for a client who has a compound fracture of the femur and was placed in balanced suspension skeletal traction 4 days ago. Which of the following actions should the nurse take? - CORRECT ANSWER Perform pin site care daily A nurse is care for for a client who is 2 hr postoperative following an amputation of the foot. Which if the following actions should the nurse take first? - CORRECT ANSWER Check the incisional dressing A nurse is caring for a client and administers penicillin IM. The client begins exhibiting hives and has severe difficulty breathing. After establishing a patent airway, which f the following actions should the nurse take next? - CORRECT ANSWER Administer epinephrine A nurse is caring for a client following a gastrectomy. Which of the following actions should the nurse take to decrease episodes of dumping syndrome? - CORRECT ANSWER Place the client in the supine position after meals. A nurse is caring for a client following a thyroidectomy. Which of the following findings should alert the nurse to the possibility of parathyroid gland injury? - CORRECT ANSWER muscle twitching
A nurse is caring for a client who has acute pancreatitis. While providing care, the nurse observes ecchymosis around the umbillicus. The nurse should identify that this is a manifestation of which of the following? - CORRECT ANSWER Intra abdominal bleeding A nurse is caring for a client who has an intestinal obstruction and reports a new onset of nausea. The client has an NG tube set at low intermittent suction and receiving continuous IV infusion of 0.9 % sodium chloride. Which of the following actions should the nurse take first? - CORRECT ANSWER Check for kinks in the NG tube A nurse is caring for a client who has bacterial meningitis. Upon monitoring the client, which of the following findings should the nurse expect? - CORRECT ANSWER Red macular rash A nurse is caring for a client who has been taking enalapril. The nurse should monitor the client for which of the following adverse effects? - CORRECT ANSWER cough A nurse is caring for a client who has Cushing's syndrome and expressed concern regarding body image changes. Which if the following should the nurse recognize as a physical change cause by this disease? - CORRECT ANSWER Truncal obesity A nurse is caring for a client who has dementia due to Alzheimer's disease. Which if the following actions should the nurse take to reduce the clients confusion? - CORRECT ANSWER Encourage reminiscence of past experiences A nurse is caring for a client who has difficult swallowing. Which of the following actions should the nurse implement to prevent aspiration? - CORRECT ANSWER Give the client liquids with increased viscosity A nurse is caring for a client who has endstage liver disease and just underwent an abdominal paracentesis. For which of the following manifestations should the nurse monitory as an adverse effect of the procedure? - CORRECT ANSWER Decreased blood pressure
A nurse is caring for a client who has just returned to the unit following a bronchoscopy. Which of the following findings should the nurse report to the provider? - CORRECT ANSWER Diminished breath sounds A nurse is caring for a client who has meningococcal pneumonia. Which of the following personal protective equipment should the nurse use? - CORRECT ANSWER Mask A nurse is caring for a client who has prostate cancer. The client asks the nurse why he is having difficulty with urination. Which of the the following responses should the nurse make? - CORRECT ANSWER The tumor causes obstruction of urine from the urethra A nurse is caring for a client who has restricted movement of the chest tube due to a burn injury. The nurse should anticipate preparing the client for which of the following procedures? - CORRECT ANSWER Escharotomy A nurse is caring for a client who has terminal pancreatic cancer. The client states, I don't think I can go on any longer. Which of the following responses should the nurse make? - CORRECT ANSWER Tell me more about the way you are feeling A nurse is caring for a client who is 1 day postoperative following a hip arthroplasty. The client is exhibiting hypotension,tachycardia, and tachypnea. The nurse should recognize these findings indicate which of the following complications? - CORRECT ANSWER Pulmonary embolism A nurse is caring for a client who is 24 hr postoperative following abdominal surgery and has an NG tube. Which of the following actions should the nurse plan to take to decrease the rain of postoperative complications? - CORRECT ANSWER Encourage the client to use an incentive spirometer every hour while awake
A nurse is caring for a client who is receiving a continuous tube feeding of 69 ml/hr at 1. cal/ml. How many calories will the client receive in 12hr? - CORRECT ANSWER 864 A nurse is caring for a client who is reveling chemotherapy. The client mentions that has a loss of appetite because she has sores in her mouth and that food no longer tastes good. Which of the following suggestions to the client should the nurse make? - CORRECT ANSWER Eat several small portioned meals daily A nurse is caring for a client who is scheduled for surgery and is experiencing anxiety. Which of the following interventions should the nurse identify as the priority? - CORRECT ANSWER Determine the client's understanding of the procedure. A nurse is caring for a client who is suspected of having a myocardial infarction. Which if the following actions should the nurse take to prepare the client for an ECG? - CORRECT ANSWER Cleanse the clients skin prior to electrode placement A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. Which of the following actions should the nurse take? - CORRECT ANSWER Administer oxygen via nasal cannula A nurse is caring for a female client who is being tested for dehydration due to nausea and vomiting. Which if the following findings should the nurse report to the provider? - CORRECT ANSWER Heart rate 120/ min A nurse is caring for a liner who is 24 hour postoperative following an abdominal surgery. Which of the following findings requires immediate attention from the nurse? - CORRECT ANSWER Oxygen saturation of 88%
A nurse is caring for an adult client who has age related macular degeneration. Which of the following findings should the nurse expect? - CORRECT ANSWER Distorted central vision of the eyes A nurse is caring for an older adult client who has a reddened area over the sacrum. Which of the following actions should the nurse take? - CORRECT ANSWER Minimize the time the head of the bed is elevated A nurse is caring for four clients. Which of the following conditions should the nurse identify as a risk for developing vascular disease? - CORRECT ANSWER diabetes mellitus A nurse is changing the dressing for a client who has abdominal incision and a hemovac drain. Which of the following actions should the nurse take? - CORRECT ANSWER Cleanse the drainage plug with alcohol swabs A nurse is collecting data from a 55 year old female client who reports vaginal dryness and hot flashes. The client is interested in trying hormone replacement HRT. Which of the following should the nurse recognize as a contraindication to HRT? - CORRECT ANSWER History of treatment for blood clots A nurse is collecting data from a client and noticed several skin lesions. Which of the following findings should the nurse report as possible melanoma? - CORRECT ANSWER Irregular borders A nurse is collecting data from a client who has 30% body surface area partial thickness and full thickness burns. Which of the following findings indicates that fluid resuscitation is adequate? - CORRECT ANSWER Urine output is 50 mL/hr.
A nurse is contributing to the pan of care for a client who has TB. Which if the following interventions should the nurse include? - CORRECT ANSWER Place the client in a negative pressure airflow room A nurse is contributing to the plan of care for a clear who is postoperative following a total knee arthroplasty. The client is using a CPM machine. Which of the following interventions should the nurse recommend for the plan of care? - CORRECT ANSWER Keep a sheepskin pad between the clients extremetity and the CPM A nurse is contributing to the plan of care for a client who had a CVA.For which of the following interdisciplinary team members should the nurse recommend a referral prior to initiating oral intake for the client? - CORRECT ANSWER Speech language pathologist A nurse is contributing to the plan of care for a client who has a head injury and is at risk for increased ICP. Which if the following actions should the nurse include in the plan? - CORRECT ANSWER Use a turn sheet to reposition the client A nurse is contributing to the plan of care for a client who has a new prescription for nystatin suspension for oral candidiasis. Which of the following should the nurse include in the plan?
A nurse is contributing to the plan of care for a client who has methicillin resistant straphyloccus aureus MRSA infection and is in contact isolation precautions. Which of the following actions should the nurse take? - CORRECT ANSWER Have a designated stethoscope in the clients room A nurse is contributing to the plan of care for a client who has multiple sclerosis and is taking dantrolene to manage muscle spasms. Which of the following interventions should the nurse include? - CORRECT ANSWER Encourage the client to complete ADLs. A nurse is contributing to the plan of care for a client who has PAD of the lower extremities. Which of the following international should the nurse include? - CORRECT ANSWER Dangle the extremities off the side of the bed A nurse is contributing to the plan of care for a client who has pericarditis. In which if the following positions should the nurse plan to place the client to decrease pain? - CORRECT ANSWER Upright leaning forward A nurse is contributing to the plan of care for a client who is having difficulty eating following a stroke. Which if the following interventions should the nurse plan to implement first? - CORRECT ANSWER Recommend a referral for a speech language pathologist A nurse is contributing to the plan of care for a client who was admitted to the neurological unit following a stroke 3 hr ago. Which of the following interventions should the nurse identify as the priority? - CORRECT ANSWER Keep the client in a side lying position A nurse is contributing to the plan of care for an older adult client who is at risk for osteoporosis. Which of the following interventions should the nurse include to prevent bone loss? - CORRECT ANSWER Encourage weight bearing exercises
A nurse is monitoring a client who is taking a acarbose. Which of the following findings should the nurse identify as an adverse effect of this medication? - CORRECT ANSWER Abdominal cramps A nurse is monitoring a client who recently had a cast placed on the right lower extremity for a bone fracture. Which of the following findings should the should the nurse recognize as abnormal? - CORRECT ANSWER Lack of sensation between the first and second toes A nurse is monitoring an older adult client who has a history of an enlarge prostate and is experiencing Supra public discomfort. Which of the following actions should the nurse take first? - CORRECT ANSWER Palpate the abdomen A nurse is participating in a health fair for older adult clients. Which of the following immigrations should the nurse recommend for this age group? - CORRECT ANSWER Herpes zoster A nurse is performing an ECG on a client f who is scheduled for surgery the following morning. In which of the following locations should the nurse place the V1 electrode? - CORRECT ANSWER 4th intercostal space A nurse is planning care for a group of clients after receiving a change of shift report. Which of the following clients should the nurse plan to see first? - CORRECT ANSWER A client who is dehydrated, has mental confusion, and was found getting out of ed several times during the night A nurse is planning to implement droplet precautions for a client who has manifestation of pertussis. Which of the following interventions should the nurse include when contributing? - CORRECT ANSWER Apply a mask on the client of transport is needed
A nurse is preparing a client for a cardiac catheterization. Which of the following actions should the nurse take first? - CORRECT ANSWER Verify the client has given informed consent. A nurse is preparing to administer an influenza vaccine to a client. Which of the following statements by the client should cause the nurse to postpone administration of the vaccine? - CORRECT ANSWER " I had a low fever this morning" A nurse is preparing to administer furosemide to a client who has heart failure. Which of the following findings should the nurse report before administering the medication? - CORRECT ANSWER Decreased potassium A nurse is preparing to administer phytonadione 7 mg subcutaneously to a client who has an INR of 4. Available is phytonadione 10 mg/ml. How many ml should the nurse administer? - CORRECT ANSWER 0. A nurse is preparing to administer scheduled medications to a client. Which of the following precautions should the nurse verify with the provider? - CORRECT ANSWER Cefrriaxone A nurse is preparing to assist a client out of bed 4 hr following a laparoscopic cholecystectomy. Which of the following actions should the nurse take first? - CORRECT ANSWER Obtain the client's blood pressure. A nurse is preparing to auscultate the bowel sounds of a client who has a mechanical bowel obstruction in the descending colon. When listening in the upper left upper quadrant, the nurse should identify this sound as which of the following? - CORRECT ANSWER Hyperactive bowel sounds A nurse is preparing to insert a double lumen gastric Salem sump tube for a glider who has peptic ulcer disease and has developed gastrointestinal bleeding. Which of the following
A nurse is reinforcing discharge teaching for a client who has a mechanical mitral valve replacement. Which of the following statements by the client indicates an understanding of the teaching? - CORRECT ANSWER I will notify my dentist about this procedure A nurse is reinforcing discharge teaching to prevent dumping syndrome for a client following a partial gastrectomy for ulcers. Which of the following information should the nurse include in the teaching? - CORRECT ANSWER Avoid liquids at mealtimes. A nurse is reinforcing discharge teaching with a client who has cirrhosis. Which of the following instructions should the nurse include? - CORRECT ANSWER Consume foods low in sodium A nurse is reinforcing discharge teaching with a client who has Crohn's disease. Which of the following statements should the nurse include in the teaching? - CORRECT ANSWER Maintain a low residue diet A nurse is reinforcing discharge teaching with a client who has hearing loss. Which of the following actions should the nurse take when communication with the client? - CORRECT ANSWER Rephrase client instructions when not understood A nurse is reinforcing discharge teaching with a client who has leukemia and is recovering chemotherapy. Which of the following statements should the nurse include in the teaching? - CORRECT ANSWER You should place your toothbrush in hydrogen peroxide overnight A nurse is reinforcing g discharge instructions with a glue f who is postoperative following a right hip arthroplasty. Which of the following statements should the nurse make? - CORRECT ANSWER Avoid bending your hips more than 90 degrees
A nurse is reinforcing g teaching with a client who is taking insulin flatline. Which of the following information should the nurse include in the teaching? - CORRECT ANSWER This type of insulin should be given at the same time every day A nurse is reinforcing teaching about dietary changes with a client who has cardiovascular disease. Which of the following images indicates the type of cooking fat the nurse recommend the client use when preparing meals? - CORRECT ANSWER Olive oil A nurse is reinforcing teaching about GERd with a client. Which of the following statements by the client indicates an understanding of the teaching? - CORRECT ANSWER I should wait at least 2 hours after eating before going to bed A nurse is reinforcing teaching about glucose lates hemoglobin HbA1c testing with a client who has diabetes mellitus. Which of the following statements indicates that the client understands the teaching? - CORRECT ANSWER I will have my HbA1c checked twice per year A nurse is reinforcing teaching about insulin with an adult client who weighs 45.4 kg ( Ib). Which of the following statements by the client indicates an understanding of the teaching? - CORRECT ANSWER I should give my shot in my belly tissue A nurse is reinforcing teaching about joint protection with a client who has an acute exacerbation of rheumatoid arthritis. Which of the following information should the nurse include in the teaching? - CORRECT ANSWER Apply cold packs to the inflamed joints A nurse is reinforcing teaching about nutrition choices with a client who has leukemia and is receiving chemotherapy. The nurse should identify that which of ten following statements by the client indicators an understanding of the teaching? - CORRECT ANSWER I drink bottled water