Prof. Exam in Medicine Part III

EXAM 3 1. The nurse is preparing discharge teaching for a client with a prescription of Eliquis. Which instruction should the nurse include in the teaching? ● Instruct the client to use a soft bristle toothbrush ○ Risk for bleeding 2. The nurse is assessing a client following a total thyroidectomy. Which finding indicates that the client has a positive Trousseau's sign? ● Carpopedal spasm 3. The nurse is caring for a client admitted in Addisonian crisis. Which prescribed medication should the nurse anticipate? ● Hydrocortisone 4. The nurse is assessing a client with the ECG reading below. Which of the medication(s) should anticipate the healthcare provider to hold? Select all that apply. ● ● ● ● Beta Blockers: -lol Sotalol Metoprolol Carvedilol 5. The nurse is caring for a client with Addisonian crisis. Which clinical change should indicate that therapy is effective ● An increase of 20 mm Hg in the client’s systolic BP 6. The nurse is teaching a client with hypoparathyroidism about foods to consume. Which food choice(s) indicate understanding? ● High calcium and low phosphorus diet 7. The nurse is caring for a client with left ventricular heart failure with air hunger, coughing frothy, and pink-tinged sputum. Which complication should the nurse suspect? ● Pulmonary Edema 8. The nurse is assessing a client who is being treated for heart failure. Which clinical manifestation should indicate that treatment has been effective? ● The client was able to perform ADL’s without dyspnea 9. The nurse is preparing a female client with an enlarged thyroid gland to receive radioactive iodine therapy. What precaution should be stressed to the client? ● Use contraceptives 10. Which client should the telemetry nurse assess first after receiving the morning shift report? ● The client was diagnosed with HF who has pink frothy sputum. 11. The nurse is assessing a patient with a pituitary tumor who is undergoing a postoperative transsphenoidal hypophysectomy. Which data warrant immediate intervention? ● The client has an output of 4,000 mL since surgery and an intake of 1500mL 12. The nurse is caring for a stable client with Addison's disease. Which skin appearance should be expected in the assessment? ● Bronze and suntanned hue 13. The nurse is monitoring a client with heart failure on a cardiac monitor and notes the ECG rhythm below. Which cardiac rhythm should the nurse suspect? ● Atrial fibrillation 14. The nurse is teaching a client newly diagnosed with hypothyroidism about the drug levothyroxine sodium. Which instruction(s) should be included? Select all that apply. ● Take 1 hour before meals or 2 hours after breakfast with a full glass of water ● Call the provider if the pulse is more than 100 bpm before taking the medication ● Take this drug as prescribed; it replaces thyroid hormone that is diminished or absent 15. The nurse is evaluating whether a client with heart failure has met outcomes for the nursing diagnosis "Activity intolerance related to decreased cardiac output?" Which outcome(s) best illustrate the client has met this goal? ● Maintains heart rate, blood pressure, respiratory rate, and pulse oximetry with the targeted range. 16. The nurse is caring for a hospitalized client diagnosed with Addison's disease. Which laboratory value should be reported immediately to the healthcare provider? ● Potassium 6.8 mEq/L 17. The nurse is administering medications on a cardiac unit. Which medication should the nurse question administering? ● Digoxin to a client with a potassium level of 3.3 mEq/L. 18. The nurse is administering medications in an endocrinology unit. Which medication should the nurse question administering? ● Propranolol (Inderal) to the client diagnosed with hypothyroidism. 19. The nurse is evaluating a client with hypothyroidism who is taking levothyroxine. Which assessment finding(s) indicate the prescribed dose is too low? Select all that apply. ● Decreased sweating ● Apathy and fatigue ● Paresthesias ● Slowed mental processes 20. The nurse is caring for a client diagnosed with heart failure. Which intervention should support the client to achieve an outcome goal of "demonstrating tolerance for increased activity?" ● Allow frequent rest periods 21. The nurse is preparing to defibrillate a client who is in ventricular fibrillation. Which action should the nurse implement next? ● Shout “All clear” prior to defibrillating the client 22. The nurse is administering 80 mg of furosemide to a client with heart failure. The prefilled syringe reads 100mg/ml. How many milliliters should the nurse administer to the client? ● 0.8 mL 23. The nurse is caring for a client with heart failure. Which intervention should the nurse implement when administering furosemide 40 mg IV push? ● Monitor serum potassium levels 24. The nurse and unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP? ● Help position the client who is having a portable X-ray done. 25. The LPN informs the clinic RN that the client diagnosed with atrial fibrillation has an INR of 4.5. Which intervention should the clinic RN implement? ● Tell the LPN to notify the clinic healthcare provider. 26. The nurse is teaching a client with Cushing's disease on measures to prevent bone resorption from corticosteroid therapy. Which statement demonstrates understanding? ● “I should participate in daily weight-bearing exercise” 27. The nurse is assessing a client diagnosed with Cushing's syndrome and notes a heart rate of 140bpm, 4+ pitting edema in the legs, and a blood glucose of 135 mg/dL. Which action should take priority? ● Notify the HCP 28. The nurse is caring for a 20-year-old male client diagnosed with hypertrophic cardiomyopathy on his college soccer team, what should be a teaching priority? ● Provide information about CPR to persons living with the client. 29. The nurse is caring for a client with symptoms associated with pheochromocytoma. Which intervention should be included in the plan of care? ● Administer nicardipine for hypertension ○ Nicardipine is a calcium channel blocker ○ BP goes 250/140 ○ Sit the patient up ○ Limit stimulation ○ Avoid ambulation 30. The nurse is preparing to administer metoprolol 25 mg orally to a client diagnosed with coronary artery disease. Which data would cause the nurse to hold the medication? ● The client has an apical pulse of 50 31. The nurse is assigned to care for four clients with endocrine disorders. In what order should the nurse plan to attend to the clients? 1. The client following a thyroidectomy who has hoarseness and SaO2 of 80% 2. The client with hyperthyroidism who has a temperature of 101.8 F and tachycardia 3. The client with diabetes insipidus drinking frequently and asking for more cold water 4. The client with hyperparathyroidism with a serum calcium level of 9.1 mg/dL 32. The nurse is preparing to administer digoxin to a client with heart failure. Which laboratory data could place the client at risk for digoxin toxicity? ● Low serum potassium level 33. The nurse is administering morning medications to clients on a telemetry unit. Which medication should the nurse question? ● Lisinopril/Enalapril orally to a client whose BP is 86/64 and apical pulse is 65. 34. The nurse is caring for a client with hyperthyroidism. The client reports dyspnea and palpitations. Assessment data reveals BP: 180/110 mm Hg. HR 140 bpm. thinning hair and recent 10-lb weight loss. Which intervention should be given priority? ● Administer propranolol 2 mg IV q15 min or until symptoms are controlled 35. The cardiac nurse is teaching the client diagnosed with heart failure. Which teaching interventions should the nurse discuss with the client? Select all that apply. ● Notify the HCP if the client gains more than 2 lb in 1 day ● Keep the HOB elevated when sleeping ● Teach the client which foods are high in sodium and should be avoided ● Perform isometric exercises at least once a day 36. The nurse is caring for a client with ventricular tachycardia. Which intervention should the nurse implement first? ● Assess the client’s apical pulse and blood pressure ○ To establish if the patient is stable or unstable ○ Is there a pulse? Or not? That will determine the Tx ○ Pulseless V-tach: you start the code, do CPR, and then move onto defibrillation 37. Which priority intervention should the nurse implement for the client diagnosed with syndrome of inappropriate antidiuretic hormone? ● Maintain the prescribed daily fluid restriction. 38. The nurse is caring for a client with coronary artery disease on the telemetry floor. Based on the client's ECG reading below, which action should the nurse implement? Document this as a normal sinus rhythm. 39. The nurse is caring for a newly admitted client with Addison's disease. Which prescriptions should the nurse question with the Healthcare Provider? Select all that apply ● Potassium 40 mEq oral now ● Sodium restricted diet of 2 gm ○ Because they already have hyponatremia 40. The nurse is monitoring a client after a permanent pacemaker placement via the right subclavian vein approach. Which intervention can best prevent pacemaker lead dislodgement? ● Prevent the right arm from going above shoulder level 41. The nurse is caring for a client experiencing a thyroid storm. The client's temperature is 101.3°F (38.5°C). Which additional assessment finding(s) should be anticipated? Select all that apply ● HR 140 bpm ● Diarrhea lasting 4 days ● Recent tooth extraction 42. The nurse is caring for a client with the ECG reading below. The client reports chest discomfort, dyspnea and has a BP of 70/50. Which intervention should the nurse anticipate? ● Prepare for insertion of a pacemaker 43. The nurse is caring for a client diagnosed with heart failure. Which diagnostic value is indicative of heart failure? ● An ejection fraction of 35% ○ Positive D-dimer in pulmonary embolism. 44. The nurse is assessing a client with coronary artery disease. Suddenly, the bedside monitor shows the ECG rhythm below. Which action should the nurse implement first? V-fibrillation ● Call a code ○ Sequence: call a code, start CPR, defibrillate 45. The nurse is caring for the client who had a thyroidectomy 2 days ago. Based on the client's laboratory results: BUN 24 mg/dL, Creatinine 1.2 mg/dL, Na 138 mEg/L, K 3.4 mEq/L, Calcium 6 mg/dL, Hgb 14.0 g/dL, and HCT 42.0%, which medication should be administered first? ● Calcium gluconate 2 gm IV once 46. The nurse is caring for a client with heart failure on a telemetry unit. Based on this 6-seconds ECG reading, what should the nurse implement? Normal Sinus Rhythm ● Continue to monitor the client 47. The nurse is caring for a hospitalized client with possible Cushing's syndrome. Which laboratory results would confirm the diagnosis? Select all that apply. ● Hyperglycemia ● Hypokalemia ● Elevated serum cortisol ○ Addisons will have hypoglycemia, hyperkalemia, and low serum cortisol 48. The nurse is preparing a client with the ECG reading below for cardioversion. The nurse understands that the client is cleared to have the procedure done if which criteria have been met? ● The client has been on an heparin drip infusion for the past 48 hrs ● The clients echocardiogram is negative for thrombus 49. The nurse is performing a 12-lead ECG on a male client with abundant chest hair. What is the most appropriate nursing intervention to improve adhesion of the ECG leads? ● Clip the chest hair with the patient's permission before applying the leads. 50. The nurse is caring for a client with heart failure and notes this ECG rhythm on the monitor below. Which intervention should the nurse implement first? Sinus Bradycardia ● Administer atropine, an antidysrhythmic (THIS IS THE 1ST THING YOU DO) ○ Prepare to insert a pacemaker (only if you 100% positive that the patient needs this, but the question doesn’t give you any info for this) ○ Transcutaneous pacing only if the patient is unstable