ATI Med Surg Final Exam Study Guide with questions and answers

Test 1 A nursing manager is concerned about the number of infections on the hospital unit. What action by the manager would best help? Assess staff members' hand hygiene practices  This is the best possible answer- Power Point (PP) Slide 7 Igi-Pg 418. The nursing instructor explaining infection tells students that which factor is the best and most important barrier to infection? Intact skin and mucous membrane  Power Point Slide 5 Igi-p 415 Which type of transmission-based precautions must the nurse use to prevent the transmission of tuberculosis? Airborne Precautions pg 419 A nurse is assessing patients on a medical-surgical unit. Which adult patient does the nurse identify as being at greatest risk for insensible water loss? A patient who is febrile with diaphoresis A nurse is assessing a patient with hypokalemia and notes that the patient’s hand-grip strength has diminished since the previous assessment 1 hour ago. What action does the nurse take FIRST? Assess the patient's respiratory rate, rhythm, and depth  Fluid and Electrolyte table page 2 Which patient is at risk for hypokalemia? Patient with pancreatitis who has continuous nasogastric suction  Fluid and Electrolyte Table pg 2 1. What is the minimum amount of urine per day needed to excrete toxic products? 400 to 600 mL  Slide 6 pg 165 A patient with heart failure asks, “Why do I need to weigh myself every day?” How would the nurse respond? “Weight is the best indication that you are gaining or losing fluid." pg. 168 The patient who has undergone which surgical procedure is most at risk for hypocalcemia? Parathyroidectomy A nurse is caring for a patient who is experiencing excessive diarrhea. The patient’s arterial blood gas values are pH 7.18, PaO2 98 mm Hg, PaCO2 45 mm Hg and HCO3 16 mEq/L. Which provider order does the nurse expect to receive? Sodium Bicarbonate 100 mEq diluted in 1 Liter of D5W Power Point Slide 11 in notes Igi page 195 The nurse is caring for a patient who is hyperventilating. The patient’s arterial blood gas values are pH 7.52, PaO2 94mmHg, PaCO2 31 mmHg and HCO3 26mEq. Which question would the nurse ask when developing this patient’s plan of care? You appear anxious. What is causing your distress?  Open end question Asking for clarication  A patient who has Clostridioides difficile with severe diarrhea will likely have related alteration in which acid base balance? Metabolic Acidosis  Slide 11 p 192 Which nursing assessment nding indicates a worsening of respiratory acidosis? Respiratory Depression pg. 192 A patient has taken antacids for the past 3 weeks to relieve heart burn. What alteration in the acid base balance with the nurse likely nd? Metabolic Alkalosis pg. 196 The person is with respiratory acidosis is considered full compensated with which ABG? pH 7.35 PaCO2 is 75 and the HCO3 is 30  Slide 16 pg 190 An emergency department nurse obtains the health history of a patient. Which statement by the patient would alert the nurse to the occurrence of heart failure? I get short of breath when I climb stairs The nurse evaluates prescriptions for a patient with chronic heart failure. Which class of medications would the nurse expect to nd on the patient’s medication administration record to decrease cardiac workload? Ace Inhibitors Slides 17 and 23. JCHAO Core Measure A nurse prepares to discharge a patient with chronic heart failure home who is prescribed home healthcare services. Which priority information would be communicated to the home health nurse upon discharge? Medication reconciliation  Slides 23 24 and Igi table 35-4 A nurse assesses a patient in an outpatient clinic. Which statement alerts the nurse to the possibility of left- sided heart failure? I wake up at night short of breath.  Slide 12 and 14 Igi p. 695 A nurse assesses a patient admitted to the cardiac unit. Which statement by the patient alerts the nurse to the possibility of right-sided heart failure? My shoes t tight lately  Slide 15 and Igi p696 A nurse admits a patient who is experiencing an exacerbation of heart failure. What action would the nurse take rst? Assess the patient’s respiratory status  Slides 13 and 14 Igi pg 695 The nurse performing a physical assessment on a patient with known cardiovascular disease observes ascites and +3 pitting edema to lower extremities. The patient reports loss of appetite and nausea. How does the nurse interpret these ndings? Right Side Heart Failure A patient has been diagnosed with hypertension but does not take the prescribed antihypertensive medication because of the patient’s lack of symptoms. What is the best response by the nurse? Most people with hypertension do not have symptoms  Slides 13 and 14 pg 722 A student nurse asks what essential hypertension is. What response by the registered nurse is best? It is hypertension with no specific cause  Slide 6 and Igi p. 721 Upon assessment the nurse identies the following: stasis dermatitis along  ankles extending onto calves with +1 edema bilaterally. What condition is does the patient likely have? Venous Insufficiency  Slide 34 pg 747 What statement by a middle age male patient shows an understanding of self-care with essential hypertension? “ I better limit my sweets and salts.” A patient with peripheral arterial disease comes into the oce for a follow up  appointment. What tells you additional teaching is needed? Patient is seated with legs crossed and reading a book on healthy eating What is the normal measurement of the PR interval in an ECG? .12 to. 20 second  Jones pg. 22 What is the fourth step in analyzing an ECG rhythm strip ? Measure the PR interval  slide 23 Jones 26 What ECG rhythm is characterized by a saw-tooth waves instead of P-waves? Atrial Flutter  Slide 43 Jones 42 When looking at ECG monitor paper. What does the horizontal axis represent? Time  Slide 12 Jones pg 21 The nurse has just given a patient with a history of chronic angina his third dose of sublingual nitroglycerin. What statement warrants the nurse to notify the provider? My pain is a bit better, but it feels different than usual  Chart 38-2 pg 773 #1. The home health nurse has been caring for a patient with a chronic respiratory disorder. Today the patient seems confused when she is normally alert and oriented to time, place and person. What is the FIRST nursing action? . Check oxygen saturation with a pulse oximeter #2. The nurse has just taken report on a patient with COPD, who is experiencing severe dyspnea. The following have just resulted: ABG's =pH 7.32 PaCO2=62 PaO2=46 HCO3= 28. The patient has the following vital signs: T 99.8F, P 110, R 28 BP 150/80. What should the nurse do FIRST? Do a focused pulmonary assessment and titrate oxygen therapy #3. The nurse is instructing a patient regarding complications of COPD. Which statement by the patient indicates the need for additional teaching? "My COPD is a serious illness, but it will be cured if I quit smoking." #4. A patient has been diagnosed with tuberculosis. What action by the discharge nurse takes HIGHEST priority? . Educating the patient on the adherence to the treatment regimen. #5. A nurse is teaching a patient how to perform pursed lip breathing. Which instructions would the nurse include in this teaching? Close your mouth and breathe in through your nose #6. Which statement is true about the relationship between smoking cessation and the pathophysiology of COPD? . c. Smoking cessation slows the rate of disease progression of COPD #7. A patient with chronic asthma ask the nurse, "I am really enjoying going for walks, but I always have an asthma attack with exercise. Do you have any ideas?" Encourage the patient to use his short acting bronchodilator 30 minutes before he goes for walks #8 A family member of a patient with COPD asks the nurse, "What is the purpose of making him cough on a routine basis?" What' is the nurse's best response? "It improves air exchange by increasing airow in the large airways. #9 . A patient is 12 hour post op from a left lower lobectomy. The patient asks; " Why do I have 2 chest tubes?" What is the BEST answer by the nurse? The upper chest tube is removing air from the pleural cavity and the lower chest tube is removing the bloody drainage." #10. The nurse is caring for a patient who is 12 hours post tracheostomy. While assessing the patient, which observation made by the nurse warrants immediate notication of the provider? Skin is puffy around the neck with a crackling sensation upon palpation #11. The nurse is caring for a patient with a chest tube. What is the correct nursing intervention for this patient? d. The patient is encouraged to cough and do deep-breathing exercises often and use incentive spirometry . #12. A patient has COPD with chronic diculty breathing. In planning this patient's care, what dietary requirements are needed for this patient? Patients with COPD have increased metabolic needs so encourage high calorie and high protein foods. #13. The nurse has just received an elderly patient from the recovery room who is drowsy but is capable of following instructions. Pulse oximetry has dropped from 95% to 90% on room air. What is the PRIORITY nursing intervention? . Have the patient use the incentive spirometer to help with pulmonary hygiene #14. The nurse is developing a teaching plan for a patient with COPD using the priority patient problem of insucient knowledge related to energy conservation. What does the nurse recommend the patient AVOID? . Eating three large meals per day #15. The nurse has completed a community presentation about Lung Cancer. Which statement from a participant demonstrates an understanding of the information presented? The primary prevention for reducing the risk of lung cancer is to stop smoking and avoid secondhand smoke #16. A patient with a tracheostomy is unable to speak. He is not in acute distress but is gesturing and trying to communicate with the nurse. Which nursing intervention is the best approach in this situation? Ask questions that can be answered with a "yes" or "no" response #17. The discharge nurse is planning treatment for a patient with a relapse of tuberculosis. Which action will be most effective in ensuring that the patient completes treatment? . Enroll the patient in direct observation therapy #18. A patient who smokes is being discharged home on oxygen therapy. The patient tells the nurse, "I can't wait to get to the car and get a cigarette." What is the nurse's best response? "Let's discuss why smoking around oxygen is dangerous #19. A patient with chronic bronchitis ask the nurse, "What can I do to get these secretions up?" Drink at least 2 liters a day #20. A patient with chronic bronchitis is showing signs of hypoxia. Which clinical manifestation is the priority to look out for in this patient? Large amounts of thick mucus #21. The clinic nurse has taught a patient with COPD about seasonal inuenza prevention. Which statement indicates the need for further teaching? " I need to start antibiotics as soon as I have the first symptoms of the flu. #22. A hospitalized patient with active tuberculosis needs to go for a chest x-ray. The transport has arrived and states, "This patient is on isolation. I cannot take this patient to radiology?" What is the nurse's best response? "I will get the patient a surgical mask before you take him #23. When treating a patient with hypoxia, the amount of oxygen administered is based on which factors? SELECT ALL THAT APPLY Pulse oximetry reading, arterial blood gas results #24. During an assessment of an elderly patient who is in the initial postoperative period, The nurse hears ne crackles and diminished lung sounds bilaterally in the bases. Which nursing intervention helps relieve this respiratory problem? d. Encourage coughing and deep breathing During an assessment of an elderly patient who is in the initial postoperative period, The nurse hears ne crackles and diminished lung sounds bilaterally in the bases. Which nursing intervention helps relieve this respiratory problem? d. Encourage coughing and deep breathing