medical surgical Flashcards
The client who has cervical cancer, is scheduled to receive internal radiation therapy using a vaginal implant for 72 hours. The nurse caring for the client should plan to:
Wear latex gloves at all times while in the room.
Spend no more than 30 minutes each shift performing bedside care.
Sit at the client’s bedside for 15-minute periods several times daily.
Wear a lead apron while providing physical care to the client.
Spend no more than 30 minutes each shift performing bedside care.
The nurse in a college setting is conducting a healthy living class for the freshman and teaching the young men about testicular examination. Which information should the nurse include in the discussion?
Self testicular examination should be performed once a month by all men.
The procedure is difficult to learn and should be practiced on a mannequin before doing it on one’s self.
The term self testicular exam is really a misnomer; the exam is best done by someone else, such as a nurse or provider.
Frequency of examination should be increased as a person ages
Self testicular examination should be performed once a month by all men.
The home care nurse is caring for a client who has cancer. The client has been hospitalized several times due to infections and the side effects of chemotherapy and radiation therapy. In developing a plan of care to improve the management of this client a goal should be to:
Prevent readmission and manage the client at home.
Teach the family to care for the client.
Have weekly family meetings to evaluate progress.
Perform personal care for the client.
Prevent readmission and manage the client at home.
The client is receiving chemotherapy for cancer and is in protective isolation. His wife comes to visit. She asks the nurse if she really has to put the mask on since she has a cold and it is hard for her to breathe with the mask. The nurse should recommend that the woman:
Must put the mask on before entering the room.
Speak to her husband from the doorway, but not enter the room even with a mask.
Does not need to put on a mask if it is uncomfortable for her.
Put on a mask and change it frequently while in the room.
Speak to her husband from the doorway, but not enter the room even with a mask.
The nurse is planning a community class on the prevention and early detection of breast cancer. Which one of the following instructions should the nurse include?
A breast self-examination should be done in order to determine normal from abnormal conditions.
Breasts should be examined every month, about five to seven days after the onset of the menstrual period.
Annual mammogram for all women of reproductive age is recommended.
With breast self-examination and periodic mammogram, yearly clinical breast exams are not needed
Breasts should be examined every month, about five to seven days after the onset of the menstrual period.
A woman who has breast cancer of the left breast has just undergone a mastectomy. In the immediate post-op period the nurse would encourage exercise for the affected arm by having the client:
Touch the right ear with the affected arm.
Raise her affected arm above her head repetitively.
Raise her affected arm above her head while holding a one pound weight.
Flex and extend the fingers and hand on the affected side.
Flex and extend the fingers and hand on the affected side.
Which symptom is a warning sign of colon cancer?
Hoarseness
Indigestion
Rectal bleeding
Sore that doesn’t heal
Rectal bleeding
The client asks the nurse what is the purpose of getting a glycosolated hemoglobin (HgbA1C) done? The nurse’s best response is “ the purpose of a glycosolated hemoglobin (Hgb A1C) is to:
Assess the client’s management of diabetes.
Monitor the ability of oxygen to attach to hemoglobin.
Accurately diagnose DM
Confirm fasting blood glucose levels.
Assess the client’s management of diabetes.
The nurse is caring for a client who is receiving growth hormone replacement therapy. The nurse monitors the client for which side effect of this therapy?
Hyperglycemia
Hyperthyroidism
Hypoglycemia
Hypocalcuria
Hyperglycemia
Somatropin (Humatrope), a growth hormone, is prescribed for a client. The nurse reviews the assessment data in the client’s health record, knowing that the medication is contraindicated in which of the following conditions?
A child with growth hormone deficiency
A child with pituitary dwarfism
A 20-year-old with growth failure
A child with growth failure
A 20-year-old with growth failure
A client with acromegaly will most likely experience which symptom?
Bone pain
Frequent infections
Fatigue
Weight loss
Frequent infections
A nurse is preparing to provide instructions to a client with Addison’s disease regarding diet therapy. The nurse knows that which of the following diets most likely would be prescribed for this client?
High-fat intake
Low-protein intake
Normal sodium intake
Low-carbohydrate intake
Normal sodium intake
The nurse caring for a client with Addison’s disease would expect to note which of the following on assessment of the client?
Obesity
Edema
Hypotension
Hirsutism
Hypotension
A nurse is caring for a client with a diagnosis of Addison’s disease. The nurse is monitoring the client for signs of addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis?
Diaphoresis
Agitation
Restlessness
Severe abdominal pain
Severe abdominal pain
A nurse is providing instructions to a client with a diagnosis of Addison’s disease regarding the administration of prescribed glucocorticoids. The nurse should instruct client:
To avoid taking the medication if nausea occurs
To stop the medication if side effects occur
That minimal side effects will occur with use of this medication
That an increased dose of medication may be needed during times of stress
That an increased dose of medication may be needed during times of stress
A nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which of the following signs and symptoms would indicate adrenal insufficiency in this client?
Subnormal temperature and hypotension
Hypotension and fever
Mental status changes and hypertension
Complaints of weakness and hypertension
Hypotension and fever
A nurse is developing a plan of care for a client with Addison’s disease. The nurse has identified a nursing diagnosis of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing intervention is an inappropriate component of the plan of care?
Encourage fluid intake of at least 3000mL per day.
Encourage an intake of low-sodium and low-protein foods.
Monitor for changes in mentation.
Monitor vital signs, skin turgor, and intake and output.
Encourage an intake of low-sodium and low-protein foods.
A nurse is providing home care instructions to a client with a diagnosis of Addison’s disease. Which statement by the client indicates a need for further instruction?
“I need to wear a Medic-Alert bracelet.”
“I will need to take daily medications until my symptoms decrease.”
“I need an increased dose of glucocorticoid medication during stressful minor illnesses.”
“I need to purchase a travel kit that contains
“I will need to take daily medications until my symptoms decrease.”
A hospitalized client is diagnosed with dysfunction of the adrenal medulla. The nurse monitors for changes in client status related to altered production and secretion of which of the following substances?
A. Cortisol
B. Epinephrine
C. Aldosterone
D. Androgens
B. Epinephrine
Epinephrine and norepinephrine are produced by the adrenal medulla. The other substances listed (cortisol,aldosterone, and the androgens) are produced by the adrenal cortex.
A nurse is providing discharge instructions to a client who has Cushing’s syndrome. Which client statement indicates that instructions related to dietary management are understood?
“I can eat foods that have a lot of potassium in them.”
“I will need to limit the amount of protein in my diet.”
“I am fortunate that I can eat all the salty foods I enjoy.”
“I am fortunate that I do not need to follow any special diet.”
“I can eat foods that have a lot of potassium in them.”
The client with Cushing’s syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement by the nurse is appropriate?
“This is permanent, but looks are deceiving and are not that important.”
“Don’t be concerned; this problem can be covered with clothing.”
“Try not to worry about it; there are other things to be concerned about.”
“Usually these physical changes slowly improve following treatment.”
“Usually these physical changes slowly improve following treatment.”
A nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing’s syndrome. Which of the following laboratory findings would the nurse expect to note in this client?
A blood glucose level of 110mg/dl
A potassium (K+) level of 5.5 mEq/L
A white blood cell (WBC) count of 6,000/uL
A platelet count of 200,000/uL
A potassium (K+) level of 5.5 mEq/L
A nurse is performing an assessment on a client with a diagnosis of Cushing’s syndrome. Which of the following would the nurse expect to note on assessment of the client?
Drooping on one side of the face
Skin atrophy
A rounded “moon-like” appearance to the face
The presence of sunken eyes
A rounded “moon-like” appearance to the face
A nurse is developing a plan of care for a client with Cushing’s syndrome. The client has a nursing diagnosis of excess fluid volume. Which of the following nursing actions is incorrect to include in the care for this client?
Monitor daily weight.
Monitor intake and output.
Maintain a low-potassium, high-sodium diet.
Monitor jugular venous pressure and assess extremities for edema.
Maintain a low-potassium, high-sodium diet.
A nurse has developed a nursing diagnosis of risk for disturbed body image for a client with a diagnosis of Cushing’s syndrome. The nurse identifies nursing interventions related to this nursing diagnosis and includes these interventions in the plan of care. Which of the following is a inappropriate nursing intervention?
Encourage client expression of feelings.
Assess the client’s understanding of the disease process.
Encourage family members to share their feelings about the disease process.
Encourage the client to recognized that the body changes need to be dealt with.
Encourage the client to recognized that the body changes need to be dealt with.
A nurse is providing home care instructions to the client with a diagnosis of Cushing’s syndrome and prepares a list of instructions for the client. Which of the following is inappropriate to include on the list?
Instructions to take the medications exactly as prescribed
A reminder to read the labels on over-the-counter medications before purchase
The signs and symptoms of hypoadrenalism
The signs and symptoms of hyperadrenalism
A reminder to read the labels on over-the-counter medications before purchase
A registered nurse (RN) is caring for a client with a diagnosis of Cushing’s syndrome. A student nurse (SN) is working with the RN for the day. The RN determines that the SN has an understanding of Cushing’s syndrome when the SN states that the condition is caused by:
Excessive amounts of cortisol
Decreased amounts of cortisol
Excessive amounts of antidiuretic hormone
Decreased amounts of antidiuretic hormone
Excessive amounts of cortisol
A client has overactivity of the thyroid gland. The nurse anticipates that the client will experience which of the following effects from this hormonal excess?
Low blood glucose level
Nutritional deficiencies
Weight gain
Increased body fat stores
Nutritional deficiencies
An antihypocalcemic medication has been prescribed for a client with hypoparathyroidism for the management of hypocalcemia. The client arrives at the clinic for follow up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation. The nurse determines that the client needs additional information if the client states to:
Increase his daily fluid intake
Add ½ ounce of mineral oil to the daily diet
Increase his daily intake of high fiber foods
Increase his activity level as tolerated
Add ½ ounce of mineral oil to the daily diet
Which item should be kept at bedside of a client who has just returned from having a thyroidectomy?
A ventilator
An endotracheal tube
An airway
A tracheostomy tray
A tracheostomy tray
When caring for a client who has had a thyroidectomy, the nurse’s initial assessment in the immediate postoperative period should be to evaluate the:
Ability to cough.
Urinary output.
Temperature and heart rate.
Ability to hyperextend head and neck.
Temperature and heart rate.
A hospitalized client is experiencing an episode of hypoglycemia. The nurse understands that the physiological mechanism that should take place to combat this decline in the blood glucose level is:
Decreased epinephrine release
Decreased cortisol release
Increased insulin secretion
Increased glucagon secretion
Increased glucagon secretion
A client with diabetes mellitus who refuses to take insulin as prescribed exhibits markedly increased blood glucose levels after meal. The nurse caring anticipates that which of the following initial body responses to elevated glucose levels will worsen the situation for the client?
Glycogenolysis
Gluconeogenesis
Binding of glucose onto cell membranes
Transport of glucose across cell membranes
Glycogenolysis
A client with diabetes mellitus is at risk for a serious metabolic disorder from breakdown of fats for conversion to glucose. The nurse caring for the client determines that pathological fat metabolism is occurring if the client has elevated levels of which of the following substances?
Glucose
Ketones
Glucagon
Lactate dehydorgenase
Ketones
A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto:
Muscle tissue
Adipose tissue
Red blood cells
Platelets
Red blood cells
A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse caring for the client anticipates that which of the following factors is an unlikely cause of the beta cell destruction that accompanies this disorder?
Genetic factors
Autoimmune factors
Primary failure of glucagon secretion
Viruses
Primary failure of glucagon secretion
A nurse is completing a health history for a female client with diabetes mellitus who has been taking insulin for many years. At present, the client states that she is experiencing periods of hypoglycemia followed by periods of hyperglycemia. The most likely cause for this pattern of diabetic control is:
Injecting insulin at a site of lipodystrophy
Adjusting insulin according to blood glucose levels
Eating snacks between meals
Initiating the use of insulin pump
Injecting insulin at a site of lipodystrophy
A client has been hospitalized for an endocrine system dysfunction of the pancreas. The nurse providingcare for the client anticipates that the client will exhibit impaired secretion of which of the followingsubstances?
a) Amylase
b) Lipase
c) Trypsin*
d) Insulin
d) Insulin
R: The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organsecretes insulin as a key endocrine hormone to regulate the blood glucose level. Other pancreatic endocrinehormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase,lipase, and trypsin.
A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse providingcare for the client anticipates that the client may exhibit altered secretion of which of the following hormones?*
a) Antidiuretic hormone (ADH)
b) Growth hormone (GH)
c) Follicle-stimulating hormone (FSH)
d) Luteinizing hormone (LH)
a) Antidiuretic hormone (ADH)
R: ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland isoxytocin. Both ADH and oxytocin are produced by the hypothalamus and stored in the posterior pituitary gland.These hormones are released as needed into the bloodstream for use. The anterior pituitary gland produces GH,FSH, and LH.
A client is experiencing delayed gastric emptying. The nurse determines that dysfunction of which of the following structures is responsible for the client’s symptoms?
Pyloric sphincter
Cardiac sphincter
Jejunum
Ileum
Pyloric sphincter
