Elsevier adaptive quizzing MED SURG 1 QUIZ #3 2023/24 update

Exit Performance Elsevier adaptive quizzing MED SURG 1 QUIZ #3 2023/24 update A parent receives a note from the school reporting that a student in the class has head lice. The parent calls the school nurse to ask how to check for head lice. What instruction should the nurse provide? "Ask the child where it itches." "Check to see whether your dog has ear mites." "Look at your child's head along the scalp line for white dots." "Inspect your child's hands and look between the fingers for red lines." Rationale The white dots are nits, the eggs of head lice ( Pediculosis capitis); they can be seen on the shaft of hair along the scalp line, behind the ears, and at the nape of the neck. Asking the child where it itches is too vague; objective visualization will confirm the presence of nits. Canine ear mites are not transferable to humans. Red lines between the fingers are a sign of scabies, infestation with the Sarcoptes scabiei mite. Which part of the respiratory system is referred to as Angle of Louis? Hilum Carina Alveoli Epiglottis Rationale Located at the level of the manubriosternal junction, the carina is also referred to as the Angle of Louis. The mainstream bronchi, pulmonary vessels, and nerves enter the lungs through a slit called the hilum. Alveoli are small sacs that are the primary site of gas exchange in the lungs. The epiglottis is a small flap located behind the tongue that closes over the larynx during swallowing. A primigravida has just given birth. The nurse is aware that the client has type AB Rh- negative blood. Her newborn’s blood type is B positive. What should the plan of care include? Determining the father’s blood type Preparing for a maternal blood transfusion Observing the newborn for signs of ABO incompatibility Obtaining a prescription to administer Rho(D) immune globulin to the mother Rationale Rho(D) immune globulin will prevent sensitization resulting from Rh incompatibility that may arise between an Rh-negative mother and an Rh-positive newborn. Determining the father’s blood type is unnecessary because only the mother’s and infant’s Rh factors are relevant. Preparing for a maternal blood transfusion is unnecessary; if a transfusion were needed, it would be for the newborn, not the mother. There is no ABO incompatibility; incompatibility might occur if the mother were O positive and the newborn had type A, B, or AB blood. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. A client has symptoms associated with salmonellosis. Which data are most relevant for the nurse to obtain from the client’s history? Any rectal cancer in the family All foods eaten in the past 24 hours Any recent extreme emotional stress An upper respiratory infection in the past 10 days Rationale The salmonella organism thrives in warm, moist environments; all foods eaten within the last 24 hours are the most relevant data. Washing, cooking, and refrigerating food limit the growth of or eliminate the organism. Salmonellosis is unrelated to cancer. The salmonella organism, not stress, causes salmonellosis. The salmonella organism is ingested; it is not an airborne or blood-borne infection. A 3-year-old child is to receive a liquid iron preparation. What will the nurse teach the mother regarding this medication? Monitor the stools for diarrhea. Administer with meals to improve absorption. Avoid giving the child orange juice with the iron preparation. Have the child drink the diluted iron preparation through a straw. Rationale A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. Iron absorption is improved when taken on an empty stomach. The exception is acidic foods, such as citrus juices, which improve absorption. The nurse is providing discharge instructions to the parents of a child who has undergone surgical correction of hypospadias. What is the priority information for the nurse to include? Ensuring that the child's privacy is maintained Increasing the time that the catheter is clamped Maintaining the surgically implanted tension device Teaching parents how to care for the catheterization system Rationale Parents should know how to empty the urine bag and how to prevent kinking of the tubing. Although the child's privacy is important, the priority is maintaining the flow of urine through the indwelling catheter. The indwelling catheter is never clamped because backup pressure could disturb the suture line. There is no tension device. When teaching an adolescent with type 1 diabetes about dietary management, what instruction should the nurse include? Meals should be eaten at home. Foods should be weighed on a gram scale. A ready source of glucose should be available. Specific foods should be cooked for the adolescent. An adolescent with type 1 diabetes must carry a source of simple sugar (e.g., glucose tablets, Insta-Glucose, sugar-containing candy such as LifeSavers) to rapidly counteract the effects of hypoglycemia. This should be followed by a complex carbohydrate and a protein. Stating that meals should be eaten at home is an unrealistic and unnatural instruction for an adolescent. Stating that foods should be weighed on a gram scale is an unnecessary and time-consuming procedure. The adolescent should be made to feel a part of the family; the recommended diet is nutritious and no different from that of the rest of the family. What is a manifestation of tertiary syphilis? Chancre Alopecia Gummas Condylomata lata Rationale Gummas which are chronic, destructive lesions affecting the skin, bone, liver, and mucous membranes occur during tertiary syphilis. A chancre appears during primary syphilis. Alopecia and condylomata lata occur during secondary syphilis. An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How should the nurse respond when the client complains of pain and requests medication? By withholding the medication to help prevent addiction By stating that the limb has been removed and that the pain is psychological By acknowledging that the pain is real and administering medication to relieve it By explaining that the phantom limb sensation will subside within a few more days Rationale Pain medication is required, along with intensive supportive nursing care. To the client the pain is real, requiring pain medication; addiction is not a concern at this time. Explaining that the pain is psychological in origin does not help relieve the pain; medication and emotional support are required. The pain may not recede within a few days; pain medication should be administered. Which autoantigens are responsible for the development of Crohn’s disease? Crypt epithelial cells Thyroid cell surface Basement membranes of the lungs Basement membranes of the glomeruli Crypt epithelial cells are considered to be the autoantigens responsible for Crohn’s disease. Thyroid cell surfaces are autoantigens responsible for Hashimoto’s thyroiditis. The pulmonary and glomerular basement membranes act as autoantigens responsible for Goodpasture syndrome. A nurse encourages parents to have their toddler's eyes tested especially for monocular strabismus. What should the nurse explain may occur if the condition is not corrected early? Dyslexia will develop. Peripheral vision will disappear. Vision in both eyes will be diminished. Amblyopia will progress in the weak eye. Rationale Amblyopia is reduced visual acuity that may occur when an eye weakened by strabismus is not forced to function. The lack of binocularity may result in impaired depth and spatial perception, not dyslexia. Depth and spatial perceptions are impaired when vision in one eye is severely impaired, not peripheral vision. Only vision in the affected eye will be diminished. A client who is receiving chemotherapy for lung cancer has nausea and vomiting because of the therapy. The client wants to know if it is true that smoking marijuana will help. What is the nurse's best response? "Smoking marijuana is not legal in any state." "Marijuana is effective for nausea and vomiting if it is injected." "Marijuana is not proven to be effective in preventing chemotherapy-induced nausea and vomiting." "There are some tetrahydrocannabinol (THC)-based medications that contain marijuana that control chemotherapy-induced nausea and vomiting in some people." Rationale THC, an ingredient in marijuana, acts as an antiemetic in some people and can be absorbed through the gastrointestinal tract or inhaled. THC-based medications, dronabinol (Marinol) and nabilone (Cesamet), are available by prescription to control nausea and vomiting resulting from cancer chemotherapy. The statement, "Smoking marijuana is not legal in any state," does not answer the client's question and is inaccurate. Marijuana is not injected. THC is an effective antiemetic for some clients. STUDY TIP: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment. A client in a psychiatric hospital requests an unaccompanied pass, but it is denied, and the client vocalizes anger toward the staff. The nurse concludes that this anger results from feelings of what? Hopelessness Indecisiveness Powerlessness Worthlessness Rationale Anger is a common feeling when people do not have control over decisions that affect them. There is no information to indicate that the client is feeling hopeless, indecisive, or worthless. Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as "When assessing for pain, you should not," the false option is the correct choice. Which ethical principle is violated when the nurse forgets to give a painkiller to a client as promised? Justice Fidelity Veracity Nonmaleficence Rationale Fidelity involves being loyal by keeping promises, doing what is expected, performing duties, and being trustworthy. Justice refers to fair treatment and fair distribution of resources. Veracity involves being truthful to the client. Nonmaleficence refers to acting in ways that prevent harm or risk of it. A registered nurse teaches a nursing student about the effects of aspirin in pregnant women. Which statement made by the nursing student indicates a need for further teaching? "Aspirin may reduce a fever." "Aspirin may cause Reye syndrome." "Aspirin may increase the risk of bleeding." "Aspirin may suppress labor contractions." Rationale Aspirin does not cause Reye syndrome in pregnant clients. Aspirin may reduce fever, increase the risk of bleeding, and suppress labor contractions. A preschool child is found to have atopic dermatitis. The nurse emphasizes that the child should be discouraged from scratching. The child's mother asks why scratching should be prevented. What is the nurse’s response? "Scratching causes lesions to become more contagious." "Scratching spreads dermatitis to other areas of the body." "Scratching results in skin breaks that can lead to infection." "Scratching produces changes that are precursors to skin cancer." Rationale Scratching can break the integrity of the skin, leaving it vulnerable to infection. Dermatitis is a response to an allergen; it is not contagious. Scratching will not cause the dermatitis to spread. There are no data to indicate that scratching or dermatitis is a precursor to skin cancer. What is the first activity of daily living (ADL) that the nurse should help teach a developmentally disabled 8-year-old child? Dressing Toileting Self-feeding Combing hair Rationale Self-feeding is an early step in the progression of growth and developmental skills. All the steps for acquiring the skills needed to fulfill ADLs should progress in the same order as they do for a child who is not mentally challenged. The difference is the age when the skill is acquired and the difficulty in learning to acquire the skill. Dressing is a more advanced skill than self-feeding; it requires mastery of gross and fine motor skills and hand-eye coordination. Toileting is a more advanced skill than self-feeding; it requires control of the anal and urethral sphincters, readiness of psychophysiological factors, and motivation. Combing the hair is a more advanced skill than self-feeding. It requires control of gross and fine motor skills and muscle coordination. Which diagnostic test may be used to distinguish vascular from nonvascular structures? Chest X-ray Pulmonary angiogram Computed tomography Magnetic resonance imaging Rationale Magnetic resonance imaging is used for distinguishing vascular from nonvascular structures. An X-ray is useful to screen, diagnose, and evaluate changes in the respiratory system. A pulmonary angiogram is used to visualize pulmonary vasculature and locate obstruction of pathologic conditions. Computed tomography is performed for diagnosis of lesions difficult to assess by conventional X-ray studies. At which stage of Kohlberg’s theory does an individual want to fulfill the expectations of one’s immediate group? Good boy-nice girl orientation Society-maintaining orientation Instrumental relativist orientation Universal ethical principle orientation Rationale The good boy-good girl orientation stage involves an individual who wants to win the approval and maintain the expectations of one’s immediate group. During the society-maintaining orientation stage, an individual expands focus from a relationship with others to societal concerns. The instrumental relativist orientation stage involves a child who wants to follow his or her parent’s rules. The universal ethical principle orientation stage defines "right" by the decision of conscience according to self-chosen ethical principles. The nurse is caring for a client with Alzheimer disease who exhibits behaviors associated with hyperorality. To meet the client’s need for a safe milieu, what instructions will the nurse give the staff to monitor the client? At meals to help prevent choking For the presence of mouth ulcers To prevent injury caused by hot foods For attempts at eating inedible objects Rationale Hyperorality is the compulsive need to taste and chew inedible objects. Hyperorality is not related to choking, a tendency to mouth ulcers, or the inability to perceive temperature properly. What feeding instruction should a nurse give the parent of a 2-month-old infant with the diagnosis of heart failure? Use double-strength formula. Avoid using a preemie nipple. Refrain from feeding until crying from hunger begins. Feed slowly while allowing time for adequate periods of rest. Rationale Because of limited exercise tolerance and fatigue, infants with heart failure become too tired to feed; allowing rest and feeding slowly limit the fatigue associated with feeding. Although the infant may be given a formula with a higher caloric value (30kcal/oz (30 kcal/30 mL) rather than 20 kcal/oz (20 kcal/30 mL)), double-strength formula is too high an osmotic load for the infant. A soft nipple used for preterm infants or a regular nipple with an enlarged opening is preferred to conserve the energy required for sucking. Crying consumes energy and is exhausting. The infant should be fed when exhibiting signs of hunger, such as sucking on a fist. A 10-year-old child is admitted to the pediatric unit in vaso-occlusive sickle cell crisis. The nurse manager is planning to assign a room. Which child is the best roommate option for this client? Child with thalassemia Child with osteomyelitis Child with viral pneumonia Child with acute pharyngitis Rationale Thalassemia is a hemolytic anemia that is not communicable; roommates with infectious diseases should be avoided because a child with sickle cell anemia is susceptible to infection. Osteomyelitis is an infection of the bone, pneumonia is an infection of the lung, and pharyngitis is an upper respiratory infection; therefore none of these children is a suitable roommate. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. An adolescent visits the allergy clinic because of seasonal environmental allergies, and blood is drawn for testing. Which laboratory finding indicates to the nurse that an allergic response is in progress? Decreased platelet count Increased eosinophil level Increased lymphocyte count Decreased immunoglobulin level Rationale Eosinophils increase to inhibit the inflammatory response to histamine, which is released in allergic reactions. Platelets and lymphocytes are unrelated to allergic reactions. Immunoglobulins increase, not decrease, in response to an allergic reaction. A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response? Hypothyroidism is a gradual slowing of the body's function. A decrease in pituitary thyroid-stimulating hormone (TSH) will occur. Less thyroid tissue is available to supply thyroid hormone after surgery. Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones. Rationale After a thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate. Hypothyroidism is decreased thyroid functioning, not a slowing of functions of the entire body. With hypothyroidism, the level of TSH from the pituitary usually is increased. Thyroid tissue remaining after surgery does not atrophy. What is the causative organism for syphilis? Treponema pallidum Campylobacter jejuni Trichomonas vaginalis Chlamydia trachomatis Rationale The causative organism for syphilis is Treponema pallidum. Campylobacter jejuni is the causative organism for proctitis. Trichomonas vaginalis is the causative organism for vulvovaginitis. Chlamydia trachomatis is the causative organism for salpingitis. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. A nurse is caring for a client with quadriplegia. Which nursing intervention will decrease the occurrence of pressure ulcers? Avoiding leg massages Frequent repositioning of client Increasing fiber content in food Encouraging weight-bearing exercises Rationale Frequent repositioning of the client in bed or wheelchair will relieve pressure points, thereby decreasing pressure ulcers. Avoiding leg massages will decrease the risk of embolism but does not relieve pressure ulcers. Increased intake of dietary fiber will relieve the immobilized client of constipation. Weight-bearing exercises will prevent the immobilized client from developing muscular atrophy or loss of calcium from the bone. Before effectively responding to a sexually abused victim on the phone, it is essential that the nurse in the rape crisis center do what? Get the client's full name and address. Call for assistance from the psychiatrist. Know some myths and facts about sexual assault. Be aware of any personal bias about sexual assault. Rationale If nurses are unaware of their biases about sexual assault, they will be unprepared to evaluate objectively and meet the client's needs. Getting the client's full name and address may interrupt communication; information can be solicited later. The nurse should be able to help this client without assistance. Although knowing some myths and facts about sexual assault may be important, it is not the priority. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so. Intestinal infestation with Enterobius vermicularis (pinworm) is suspected in a 6-year-old child. The nurse asks the parents to assist in confirming the child's diagnosis. What does the nurse instruct the parents to do? Collect stools for three consecutive days for culture. Perform an anal cellophane tape test early in the morning. Schedule hypersensitivity tests of the child's blood serum. Send a sample of the child's stools to the laboratory for testing. Rationale Pinworms emerge nocturnally to lay eggs in the perianal area; eggs are caught on cellophane tape in the morning before toileting. Laboratory tests of the stool will not reveal an infestation of pinworms. Hypersensitivity tests are not used to diagnose pinworms. A stool culture will not reveal the presence of parasites. The nurse can best handle personal questions asked by the client in any phase of the nurse– client relationship by doing what? Reviewing the positive and negative aspects of the subject Providing brief, truthful answers and redirecting the focus of conversation Offering an honest, brief expression of personal views on the topic in question Reminding the client gently that the nurse's feelings are not the client's concern Rationale Unless the nurse answers the question, the client will continue to focus on the nurse rather than on the self; the nurse can best redirect after a brief answer. Reviewing the positive and negative aspects of the subject moves the focus to the nurse's opinions rather than the client's feelings. Offering an honest, brief expression of personal views on the subject raised moves the focus to the nurse's opinions rather than the client's feelings. Reminding the client gently that the nurse's feelings are not the client's concern is not therapeutic; the client is being asked to share, and the nurse should also be willing to share. After the client gives birth, her vital signs are temperature 99.3° F (37.4° C); pulse 80 beats/min, regular and strong; respirations 16/min, slow and even; and blood pressure 148/92 mm Hg. Which vital sign should the nurse check more frequently? Pulse Respirations Temperature Blood pressure Rationale This blood pressure is higher than anticipated; therefore intervention may be necessary. A pulse of 80 beats/min is within expected limits. A respiratory rate of 16/min is within expected limits. The temperature of 99.3° F (37.4° C) is slightly high but consistent with the physiology of the birthing process. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. Item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." 19 topics covered