Ati 24spns 126 med surg final exam 1
Total Questions : 74
Showing 25 questions, Sign in for moreA nurse is reinforcing teaching about rifampin with a female client who has active tuberculosis. Which of the following statements should the nurse include in the teaching?
Explanation
Choice A rationale
Rifampin does not cause amenorrhea when taken with oral contraceptives. However, it can reduce the effectiveness of hormonal contraceptives, including oral contraceptives, due to its enzyme-inducing properties. This means that women taking rifampin should use an alternative or additional non-hormonal method of contraception to prevent pregnancy.
Choice B rationale
Rifampin can cause discoloration of body fluids, including tears, which can stain contact lenses. This is why it is recommended to wear glasses instead of contact lenses while taking this medication.
Choice C rationale
A yellow tint to the skin is not an expected reaction to rifampin. However, rifampin can cause a harmless red-orange discoloration of body fluids such as urine, sweat, saliva, and tears.
Choice D rationale
Lifelong treatment with rifampin is not necessary. The duration of treatment for active tuberculosis typically ranges from 6 to 9 months, depending on the specific treatment regimen and the patient’s response to therapy.
A nurse in the emergency department is assisting with the care of a client who is comatose. The provider suspects ketoacidosis. Which of the following findings should the nurse expect?
Explanation
Choice A rationale
Cheyne-Stokes breathing is characterized by a pattern of periodic breathing with cycles of increasing and decreasing tidal volumes separated by periods of apnea. It is not typically associated with diabetic ketoacidosis (DKA) but rather with conditions such as heart failure, stroke, or brain injury.
Choice B rationale
Malignant hypertension is a severe form of high blood pressure that can lead to organ damage. It is not a typical finding in diabetic ketoacidosis. DKA is more commonly associated with dehydration, electrolyte imbalances, and metabolic acidosis.
Choice C rationale
An acetone odor to the breath is a classic sign of diabetic ketoacidosis. This occurs due to the accumulation of ketones in the blood, which are byproducts of fat metabolism when the body is unable to use glucose for energy.
Choice D rationale
Blood glucose levels below 40 mg/dL indicate hypoglycemia, not diabetic ketoacidosis. DKA is characterized by high blood glucose levels, typically above 250 mg/dL34.
A nurse is caring for a client who is scheduled for a blood sampling for a serum creatinine level. The client asks the nurse, “What is the purpose of this test?” Which of the following responses should the nurse give?
Explanation
Choice A rationale
A serum creatinine test does not inform the provider about anemia. Anemia is typically diagnosed through a complete blood count (CBC) test, which measures the levels of hemoglobin and hematocrit in the blood.
Choice B rationale
A serum creatinine test does not provide information about infections. Infections are usually diagnosed through clinical evaluation and specific tests such as blood cultures, urine cultures, or imaging studies.
Choice C rationale
A serum creatinine test measures the level of creatinine in the blood, which is an indicator of kidney function. Elevated creatinine levels can indicate impaired kidney function or kidney disease.
Choice D rationale
A serum creatinine test does not provide information about thyroid disorders. Thyroid function is typically assessed through tests that measure levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH) in the blood.
A nurse is reinforcing teaching about rifampin with a female client who has active tuberculosis. Which of the following statements should the nurse include in the teaching?
Explanation
Choice A rationale
Rifampin can cause discoloration of body fluids, including tears, which can stain contact lenses. Therefore, it is recommended to wear glasses instead of contacts while taking this medication.
Choice B rationale
A yellow tint to the skin is not an expected reaction to rifampin. This could indicate jaundice, a sign of liver dysfunction, which requires immediate medical attention.
Choice C rationale
Lifelong treatment with rifampin is not necessary. The typical duration of treatment for active tuberculosis is 6 to 9 months.
Choice D rationale
Rifampin does not cause amenorrhea when taken with oral contraceptives. However, it can reduce the effectiveness of oral contraceptives, so additional contraceptive methods should be used.
A nurse is assessing an older adult client who has a urinary tract infection (UTI). Which of the following findings should the nurse identify as unique for this age group?
Explanation
Choice A rationale
Confusion is a unique symptom of urinary tract infections (UTIs) in older adults. It is often the first and sometimes the only symptom, making it a critical indicator for this age group.
Choice B rationale
Urinary retention can occur in any age group with a UTI and is not unique to older adults.
Choice C rationale
Incontinence is a common symptom of UTIs but is not unique to older adults.
Choice D rationale
Low back pain can be a symptom of UTIs but is not unique to older adults.
A nurse is caring for an older adult client who has left-sided heart failure. Which of the following findings should the nurse expect?
Explanation
Choice A rationale
Frothy sputum is a symptom of left-sided heart failure due to pulmonary congestion and edema.
Choice B rationale
Dependent edema is more commonly associated with right-sided heart failure.
Choice C rationale
Jugular distention is also more commonly associated with right-sided heart failure.
Choice D rationale
Nocturnal polyuria can occur in heart failure but is not specific to left-sided heart failure.
A nurse is reinforcing nutrition teaching for a client who has chronic kidney disease about limiting foods high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.)
Explanation
Choice A rationale
Orange juice is high in potassium and should be avoided by clients with chronic kidney disease.
Choice B rationale
White rice is low in potassium and is generally safe for clients with chronic kidney disease.
Choice C rationale
Corn flakes cereal is low in potassium and is generally safe for clients with chronic kidney disease.
Choice D rationale
Watermelon is high in potassium and should be avoided by clients with chronic kidney disease.
Choice E rationale
Bananas are high in potassium and should be avoided by clients with chronic kidney disease.
A nurse is reinforcing dietary instructions with a client who has episodes of biliary colic from chronic cholecystitis. Which of the following diets should the nurse reinforce in the teaching plan?
Explanation
Choice A rationale
A high protein diet is not recommended for clients with biliary colic from chronic cholecystitis as it can increase bile production and exacerbate symptoms.
Choice B rationale
A high fiber diet is beneficial for overall health but does not specifically address the needs of clients with biliary colic.
Choice C rationale
A low sodium diet is beneficial for overall health but does not specifically address the needs of clients with biliary colic.
Choice D rationale
A low fat diet is recommended for clients with biliary colic from chronic cholecystitis as it reduces the workload on the gallbladder and decreases the risk of gallstone formation.
A nurse is phoning a provider to report a client’s serum potassium of 6.2 mEq/L. Which of the following medications should the nurse expect the provider to prescribe?
Explanation
Choice A rationale
Potassium iodide is used to treat hyperthyroidism and protect the thyroid gland from radiation, but it does not help lower serum potassium levels.
Choice B rationale
Lactulose is a laxative used to treat constipation and hepatic encephalopathy, but it does not affect serum potassium levels.
Choice C rationale
Sodium polystyrene sulfonate is used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, thereby lowering serum potassium levels.
Choice D rationale
Acetylcysteine is used as a mucolytic agent and to treat acetaminophen overdose, but it does not have any effect on serum potassium levels.
A nurse is reviewing the laboratory results for a client who has chronic kidney disease. Which of the following laboratory findings should the nurse expect?
Explanation
Choice A rationale
Elevated creatinine is a common finding in clients with chronic kidney disease due to decreased renal function and impaired clearance of creatinine from the blood.
Choice B rationale
Decreased urine specific gravity is not typically associated with chronic kidney disease. Clients with chronic kidney disease may have an increased or normal urine specific gravity.
Choice C rationale
Hypokalemia is not a typical finding in chronic kidney disease. Clients with chronic kidney disease are more likely to have hyperkalemia due to impaired renal excretion of potassium.
Choice D rationale
Decreased BUN (blood urea nitrogen) is not expected in chronic kidney disease. Elevated BUN levels are more common due to reduced renal clearance of urea.
A nurse is reinforcing teaching with a client who has a new prescription for phenazopyridine. The nurse should reinforce to the client to expect which of the following while taking this medication?
Explanation
Choice A rationale
Lethargy is not a common side effect of phenazopyridine. This medication is primarily used to relieve urinary tract pain and discomfort.
Choice B rationale
Reddish-orange urine is a common and expected side effect of phenazopyridine. This discoloration is harmless but can stain clothing.
Choice C rationale
Burning during urination is a symptom that phenazopyridine is used to relieve, not a side effect of the medication.
Choice D rationale
Visual disturbances are not commonly associated with phenazopyridine use.
A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease (GERD) about minimizing the effects of reflux during sleep. Which of the following client statements indicates an understanding of the teaching?
Explanation
Choice A rationale
Consuming alcohol before bed can worsen GERD symptoms by relaxing the lower esophageal sphincter and increasing acid reflux.
Choice B rationale
Eating a snack before bed can increase the likelihood of acid reflux during sleep, as lying down shortly after eating can promote reflux.
Choice C rationale
Elevating the head of the bed helps reduce acid reflux by keeping stomach acid from flowing back into the esophagus during sleep.
Choice D rationale
Sleeping on the stomach with the head flat can exacerbate GERD symptoms by increasing pressure on the stomach and promoting acid reflux.
A nurse is reinforcing discharge instructions to a client who is postoperative from a hip arthroplasty. Which of the following statements by the client indicates a correct understanding of the teaching?
Explanation
Choice A rationale
Wearing socks on the feet is not related to hip arthroplasty recovery and does not impact the healing process.
Choice B rationale
Performing leg exercises is important for preventing blood clots and maintaining mobility after hip arthroplasty.
Choice C rationale
Avoiding crossing the legs for the first 3 months after surgery helps prevent dislocation of the hip joint and promotes proper healing.
Choice D rationale
Lying on the side of the surgery may be uncomfortable, but it is not necessarily contraindicated. Proper positioning and support can help manage discomfort.
A nurse is assisting with the care of a client immediately following a lumbar puncture. Which of the following actions should the nurse take? (Select all that apply.)
Explanation
Choice A rationale
Monitoring the puncture site for hematoma is crucial because a hematoma can indicate bleeding at the puncture site, which can lead to complications such as infection or nerve damage. Hematomas can also cause increased intracranial pressure, which can be dangerous for the patient. Therefore, it is essential to monitor the site closely to ensure that any signs of bleeding are detected early and managed appropriately.
Choice B rationale
Elevating the client’s head of bed is incorrect because it can increase the risk of cerebrospinal fluid (CSF) leakage from the puncture site. After a lumbar puncture, it is recommended to keep the patient in a flat position for several hours to reduce the risk of post-lumbar puncture headache and to allow the puncture site to heal properly. Elevating the head of the bed too soon can disrupt this process and lead to complications.
Choice C rationale
Inserting a urinary catheter is incorrect because it is not a standard procedure following a lumbar puncture. The primary focus after a lumbar puncture is to monitor for complications related to the procedure itself, such as bleeding, infection, or CSF leakage. Inserting a urinary catheter is not necessary unless there is a specific indication for it, such as urinary retention or other urological issues.
Choice D rationale
Encouraging fluid intake is correct because it helps to replenish the CSF that was removed during the lumbar puncture. Increased fluid intake can also help to reduce the risk of post- lumbar puncture headache, which is a common complication. Hydration is important for overall recovery and helps to maintain normal bodily functions.
Choice E rationale
Applying a cervical collar to the client is incorrect because it is not related to the care of a lumbar puncture site. A cervical collar is typically used for patients with neck injuries or conditions affecting the cervical spine. It has no role in the management of a lumbar puncture site and would not provide any benefit in this context.
A nurse is contributing to the plan of care for a client who is postoperative following a total hip arthroplasty. Which of the following information should the nurse include?
Explanation
Choice A rationale
Positioning the lower extremities so that they are touching is incorrect because it can lead to adduction of the hip, which increases the risk of dislocation. After a total hip arthroplasty, it is important to maintain proper alignment of the hip joint to prevent dislocation. Keeping the legs apart with the use of an abduction pillow or wedge is recommended to maintain proper alignment and reduce the risk of complications.
Choice B rationale
Ensuring that the client’s heels are touching the bed is incorrect because it can lead to pressure ulcers. After a total hip arthroplasty, it is important to prevent pressure on the heels by using pillows or heel protectors to elevate the heels off the bed. This helps to reduce the risk of pressure ulcers and promotes better circulation to the lower extremities.
Choice C rationale
Instructing the client to avoid movement of the affected leg is incorrect because early mobilization is important for recovery. After a total hip arthroplasty, patients are encouraged to perform gentle exercises and mobilize as soon as possible to prevent complications such as deep vein thrombosis (DVT) and to promote healing. Immobilization can lead to stiffness, muscle atrophy, and other complications.
Choice D rationale
Preventing hip flexion of the affected extremity is correct because excessive hip flexion can increase the risk of dislocation. After a total hip arthroplasty, it is important to avoid positions that involve hip flexion greater than 90 degrees, such as sitting in low chairs or bending forward excessively. Maintaining proper hip precautions helps to reduce the risk of dislocation and promotes a safe recovery.
A nurse is contributing to the plan of care for a client who has urolithiasis. Which of the following interventions should the nurse include in the plan?
Explanation
Choice A rationale
Telling the client to expect a decrease in urine output is incorrect because it may indicate dehydration, obstruction, or infection. Clients with urolithiasis should be encouraged to maintain adequate urine output to help flush out stones and prevent new stone formation. Decreased urine output can lead to complications and should be addressed promptly.
Choice B rationale
Providing the client with a high protein diet is incorrect because it may increase uric acid and calcium excretion, which can promote stone formation. Clients with urolithiasis should follow a balanced diet that is low in substances that can contribute to stone formation, such as oxalates, purines, and excessive calcium.
Choice C rationale
Maintaining the client on bed rest is incorrect because it may decrease renal perfusion and increase urinary stasis. Clients with urolithiasis should be encouraged to stay active and mobile to promote better circulation and prevent complications. Bed rest is not typically recommended unless there are specific medical indications for it.
Choice D rationale
Encouraging the client to drink 3 L of fluids per day is correct because it helps to flush out stones, prevent new stone formation, and reduce urinary concentration. Adequate hydration is essential for clients with urolithiasis to maintain proper kidney function and reduce the risk of
complications. Drinking plenty of fluids helps to dilute the urine and promote the passage of stones.
A nurse is collecting data from a client who has diabetes mellitus. The client is confused, flushed, and has an acetone odor on his breath. The nurse should anticipate a prescription for which of the following types of insulin to treat the client?
Explanation
Choice A rationale
Regular insulin is correct because it is a short-acting insulin that can be used to treat diabetic ketoacidosis (DKA). The client’s symptoms of confusion, flushed appearance, and acetone odor on the breath suggest DKA, which requires prompt treatment with insulin to lower blood glucose levels and correct metabolic acidosis. Regular insulin has a rapid onset of action and can be administered intravenously to achieve quick results.
Choice B rationale
NPH insulin is incorrect because it is an intermediate-acting insulin that is not suitable for the immediate treatment of DKA. NPH insulin has a slower onset of action and is typically used for basal insulin coverage rather than for acute management of hyperglycemia. In cases of DKA, rapid-acting or short-acting insulin is preferred to achieve quick glucose control.
Choice C rationale
Glargine insulin is incorrect because it is a long-acting insulin that provides basal insulin coverage over 24 hours. It is not suitable for the immediate treatment of DKA, as it does not have a rapid onset of action. Glargine insulin is typically used for maintaining stable blood glucose levels over a prolonged period rather than for acute management of hyperglycemia.
Choice D rationale
Detemir insulin is incorrect because it is a long-acting insulin similar to glargine. It provides basal insulin coverage and is not suitable for the immediate treatment of DKA. Detemir insulin has a slower onset of action and is used for maintaining stable blood glucose levels rather than for rapid correction of hyperglycemia in acute situations.
A nurse is reinforcing discharge instructions with a client who has a new prescription for phenazopyridine hydrochloride. Which of the following statements should the nurse include in the instructions?
Explanation
Choice A rationale
Phenazopyridine hydrochloride does not turn the urine purple. Instead, it typically causes the urine to turn a reddish-orange color. This discoloration is harmless and is due to the dye properties of the medication. The purple urine bag syndrome is a rare condition associated with urinary tract infections and not with phenazopyridine hydrochloride use.
Choice B rationale
Phenazopyridine hydrochloride should be taken after meals to minimize stomach upset. Taking it before meals can increase the risk of gastrointestinal discomfort. The medication works as a urinary tract analgesic and does not require administration before meals for effectiveness.
Choice C rationale
Yellowing of the sclera is not an expected effect of phenazopyridine hydrochloride. Yellowing of the sclera, or jaundice, is typically associated with liver dysfunction or hemolysis.
Phenazopyridine hydrochloride does not cause jaundice and any yellowing of the sclera should be promptly evaluated by a healthcare provider.
Choice D rationale
Phenazopyridine hydrochloride works as a urinary tract analgesic. It provides relief from pain, burning, and discomfort caused by irritation of the urinary tract. It is not an antibiotic and does not treat the underlying infection but helps alleviate the symptoms.
A nurse is assisting with the care of a client who has hypertension and chronic kidney disease. The client is scheduled for hemodialysis. Which of the following actions should the nurse plan to take while caring for this client? (Select all that apply.)
Explanation
Choice A rationale
Obtaining the client’s weight is essential before hemodialysis to assess fluid status and determine the amount of fluid to be removed during the procedure. Accurate weight measurement helps in preventing complications such as hypotension or fluid overload.
Choice B rationale
Verifying the glomerular filtration rate (GFR) is important in assessing the kidney function of the client. GFR helps in determining the stage of chronic kidney disease and the appropriate dialysis regimen. It also aids in monitoring the effectiveness of the treatment.
Choice C rationale
Checking the graft site for a palpable thrill is crucial in assessing the patency of the vascular access used for hemodialysis. A palpable thrill indicates that the graft is functioning properly and allows for adequate blood flow during dialysis. Absence of a thrill may indicate a blockage or malfunction of the graft.
Choice D rationale
Documenting vital signs is a standard nursing practice before, during, and after hemodialysis. Monitoring vital signs helps in detecting any changes in the client’s condition, such as hypotension, hypertension, or arrhythmias, which may occur during the procedure. It ensures timely intervention and promotes client safety.
Choice E rationale
Administering a sedative to the client is not a standard practice for hemodialysis. Sedatives are generally not required for the procedure and may pose risks such as respiratory depression or altered mental status. The focus should be on providing comfort and reassurance to the client without the use of sedatives.
A nurse is reinforcing teaching with a client who is scheduled for lithotripsy about conditions that can contribute to the formation of renal calculi. Which of the following conditions should the nurse include?
Explanation
Choice A rationale
Obesity is not a direct cause of renal calculi. However, it can be a risk factor due to associated conditions such as metabolic syndrome, diabetes, and hypertension, which can contribute to stone formation. Weight management and a healthy lifestyle can help reduce the risk of kidney stones.
Choice B rationale
Dehydration is a significant risk factor for the formation of renal calculi. When the body is dehydrated, the urine becomes concentrated, leading to the crystallization of minerals and the formation of stones. Adequate hydration is essential in preventing kidney stones by diluting the urine and reducing the concentration of stone-forming substances.
Choice C rationale
Iron deficiency is not associated with the formation of renal calculi. Iron deficiency primarily affects red blood cell production and can lead to anemia. It does not contribute to the crystallization of minerals in the urine or the formation of kidney stones.
Choice D rationale
Protein in the urine, or proteinuria, is not a direct cause of renal calculi. Proteinuria is often a sign of kidney damage or disease but does not lead to stone formation. The presence of protein in the urine should be evaluated to determine the underlying cause and appropriate treatment.
A nurse is emptying a client’s urinal when she notices the urine is dark amber, cloudy, and has an unpleasant odor. The nurse should identify that these findings are likely to be the result of which of the following?
Explanation
Choice A rationale
A urinary tract infection (UTI) is a common cause of dark amber, cloudy urine with an unpleasant odor. UTIs are caused by bacteria that infect the urinary tract, leading to inflammation and the presence of pus or white blood cells in the urine. This can result in cloudyurine with a strong odor. Prompt treatment with antibiotics is necessary to resolve the infection and prevent complications.
Choice B rationale
Dehydration can cause dark amber urine, but it does not typically cause cloudiness or an unpleasant odor. Dehydration leads to concentrated urine, which appears darker in color. However, the presence of cloudiness and odor suggests an infection rather than dehydration.
Choice C rationale
Kidney stones can cause dark urine if there is bleeding, but they do not typically cause cloudiness or an unpleasant odor. The passage of a kidney stone can lead to hematuria (blood in the urine), which may darken the urine. However, the symptoms described are more indicative of a urinary tract infection.
Choice D rationale
Liver disease can cause dark urine due to the presence of bilirubin, but it does not typically cause cloudiness or an unpleasant odor. Dark urine in liver disease is usually accompanied by other symptoms such as jaundice, pale stools, and fatigue. The combination of dark, cloudy urine with an unpleasant odor is more suggestive of a urinary tract infection.
A nurse is providing care for an older adult client who has hyperglycemia, polydipsia, and polyuria. Which of the following manifestations supports the clinical presentation of hyperosmolar hyperglycemic syndrome (HHS)? (Select All that Apply.)
Explanation
Choice A rationale
Acetone breath is a characteristic symptom of diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). In DKA, the body produces ketones, leading to a fruity or acetone-like breath odor. HHS, on the other hand, does not typically involve significant ketone production.
Choice B rationale
Fever can be a manifestation of HHS, often due to an underlying infection or illness that precipitates the hyperglycemic state. Infections are common triggers for HHS, leading to elevated body temperature.
Choice C rationale
Serum glucose levels of 800 mg/dL are indicative of HHS. HHS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL, without significant ketoacidosis.
Choice D rationale
Serum bicarbonate levels of 15 mEq/L are more indicative of DKA rather than HHS. In HHS, bicarbonate levels are usually within the normal range because there is no significant ketoacidosis.
Choice E rationale
Insidious onset is a hallmark of HHS. The condition develops gradually over days to weeks, unlike DKA, which has a more rapid onset.
A nurse is reinforcing teaching with a client who takes furosemide and has a serum potassium level of 3.1 mEq/L. Which of the following foods should the nurse instruct the client to include in his daily diet?
Explanation
Choice A rationale
Cabbage is not a significant source of potassium. While it is a healthy vegetable, it does not provide the necessary potassium to help raise serum potassium levels.
Choice B rationale
Cheddar cheese is also not a high-potassium food. It is rich in calcium and protein but does not significantly contribute to potassium intake.
Choice C rationale
Bananas are well-known for their high potassium content. Including bananas in the diet can help increase serum potassium levels, which is beneficial for a client taking furosemide, a diuretic that can cause potassium loss.
Choice D rationale
Potatoes are another excellent source of potassium. However, the question specifies choosing one food, and bananas are a more commonly recommended option for increasing potassium intake.
A nurse is reinforcing teaching with a middle-aged client about hypertension. Which of the following information should the nurse include in the teaching?
Explanation
Choice A rationale
Monitoring potassium levels is essential when taking thiazide diuretics because these medications can cause hypokalemia (low potassium levels). Regular blood tests help ensure that potassium levels remain within a safe range.
Choice B rationale
Limiting alcohol consumption to 3 drinks a day is not recommended for individuals with hypertension. Excessive alcohol intake can raise blood pressure and negate the benefits of other lifestyle modifications.
Choice C rationale
Setting a goal body weight within 25% of ideal body weight is not an appropriate recommendation. The goal should be to achieve and maintain a healthy weight, which is typically defined as a BMI within the normal range.
Choice D rationale
Lowering sodium intake to 3,000 mg each day is still above the recommended limit. The American Heart Association recommends reducing sodium intake to less than 2,300 mg per day, with an ideal limit of 1,500 mg per day for most adults.
An adult client newly diagnosed with type 2 diabetes mellitus asks a nurse to explain how he developed the condition. Which of the following responses should the nurse make?
Explanation
Choice A rationale
Type 2 diabetes is characterized by insulin resistance, not the overproduction of insulin. Over time, the pancreas may produce less insulin, but the primary issue is the body’s inability to use insulin effectively.
Choice B rationale
Type 2 diabetes involves the body’s inability to process glucose properly due to insulin resistance. This leads to elevated blood glucose levels and various complications if not managed effectively.
Choice C rationale
Hemoglobin binding to sugar is related to the measurement of HbA1c, which reflects average blood glucose levels over time. It is not a cause of type 2 diabetes.
Choice D rationale
The destruction of pancreatic cells is a characteristic of type 1 diabetes, an autoimmune condition. Type 2 diabetes is primarily due to insulin resistance and is not caused by an autoimmune response.
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