RN Adult Medical Surgical Online Practice 2022
A nurse is caring for a client in the emergency department (ED).
Physical Examination
Client presents to the ED with upper abdominal pain that radiates to the right
shoulder. Client rates pain as 7 on a scale of 0 to 10. Client also reports nausea,
vomiting, and dyspepsia.
Client is awake, alert, and oriented x3. Lung sounds clear bilaterally, S1 and S2 heart
tones noted. All pulses palpable. Bowel sounds active in all 4 quadrants.
Complete the diagram by dragging from the choices below to specify what condition
the client is most likely experiencing, 2 actions the nurse should take to address that
condition, and 2 parameters the nurse should monitor to assess the client's progress.
- ANSWER: The nurse should plan to administer an opioid analgesic, such as
morphine, for acute pain. Since the client is experiencing nausea and vomiting, the
nurse should also ensure they are NPO. The client is likely experiencing cholecystitis,
which typically presents with nausea, vomiting, upper abdominal pain that radiates
to the right shoulder, fever, and dyspepsia. The client also has elevated liver
enzymes and a WBC count, which is consistent with cholecystitis. Surgical
management for cholecystitis might be indicated. The nurse should monitor the
client's stool and urine color because a biliary obstruction from gallstones may cause
clay-colored stools and dark urine.
A nurse is caring for a client who was just admitted from the emergency department
(ED).
Nurses' Notes
0945:
Client is experiencing a sickle cell crisis. Client states that they began experiencing
pain in the lower extremities 3 days ago and is now experiencing pain in the chest,
rating it as 4 on scale of 0 to 10.
Oxygen at 3 L/min via nasal cannula in place.
Oral mucosa pink, no cyanosis.
Pulses palpable in all four extremities, no peripheral edema noted.
Respirations even and slightly labored; lung sounds with slight wheezing in left upper
lobe.
Abdomen soft and nontender, bowel sounds active in all four quadrants.
0.45% sodium chloride IV at 200 mL/hr infusing to left hand with no reports of pain
or swelling at the site.
Drag words from the choices below to fill in each blank in the following sentence. -
ANSWER: Fluid volume overload is incorrect. While the client is experiencing an
increased respiratory rate and shortness of breath, fluid volume overload typically
includes moist crackles on auscultation, pitting edema in dependent areas, neck vein
distension, and hypertension.
Right-sided heart failure is incorrect. While clients who have sickle-cell disease are at
risk for developing heart failure, the client does not have manifestations of right-
sided heart failure. Right-sided heart failure typically presents with signs of fluid
,volume overload, which includes jugular vein distention, dependent edema, and
blood pressure alterations.
Acute chest syndrome is correct. The client is most likely experiencing acute chest
syndrome, which can be caused by respiratory infections and debris from sickled
cells. The client is displaying manifestations of acute chest syndrome, which include
cough, shortness of breath, wheezing, tachypnea, fever, and chest pain.
Pneumonia is correct. The client is most likely experiencing pneumonia as evidenced
by the manifestations of cough, shortness of breath, fever, tachypnea, blood-tinged
sputum, and chest pain.
Pneumothorax is incorrect. While the client is experiencing increased respiratory
distress, a pneumothorax typically presents with reduced or absent breath sounds
and unequal chest expansion.
A nurse is caring for a client.
Nurses' Notes
1200:
Client was admitted to the unit with shortness of breath, a nonproductive cough,
chest discomfort, and myalgia. Prefers orthopneic position. Client reports that
manifestations began about 2 days ago.
For each assessment finding, click to specify if the finding is consistent with
emphysema, asthma, or pneumonia. Each finding may support more than 1 disease
process. - ANSWER: Temperature is consistent with pneumonia. Fever is a
manifestation of pneumonia and is related to inflammation or infection.
Breath sounds are consistent with emphysema, asthma, and pneumonia. The client's
wheezing is a manifestation of emphysema, asthma, and pneumonia. It is the result
of narrowed airways and alveoli.
ABG results are consistent with emphysema and pneumonia. The client's ABG results
indicate respiratory acidosis, which is a manifestation of emphysema and
pneumonia.
Respiratory rate is consistent with emphysema, asthma, and pneumonia. The client's
respiratory rate is a manifestation of emphysema, asthma, and pneumonia.
Heart rate is consistent with emphysema and pneumonia. The client is experiencing
tachycardia, which is a manifestation of emphysema and pneumonia.
Cough is consistent with emphysema, asthma, and pneumonia. The client's cough is
a manifestation of emphysema, asthma, and pneumonia.
A nurse is caring for a client who is scheduled for a right knee arthroplasty.
Nurses' Notes
0600:
Client is admitted for surgery this a.m. Vital signs recorded. Consents reviewed.
Client reports understanding of surgery and has no further questions for provider.
The nurse provided preoperative teaching to the client. Which of the following
statements by the client indicates an understanding of the teaching?
Select all that apply. - ANSWER: "Well, I guess there's no changing my mind about
having surgery now" is incorrect. The nurse and the client reviewed the consents;
therefore, the nurse has instructed the client that they have the right to refuse
surgery at any time.
, "I will need to do the breathing exercises every 1 to 2 hours after the surgery" is
correct. The client should cough and deep breathe and use the incentive spirometer
every 1 to 2 hr to reduce the risk of postoperative complications, such as
pneumonia.
"I will be sure to ask for pain medication before my knee starts to hurt too bad" is
correct. For optimal control of postoperative pain, the client should request
analgesic medication before the pain becomes severe.
"My physical therapy will start after I leave the hospital" is incorrect. Early
ambulation leads to improved postoperative outcomes and reduces the risk of
complications of immobility, such as pneumonia and atelectasis. The client should be
informed that physical therapy will begin the day of, or the day following, surgery.
"I will probably be going home with a walker" is correct. It can take 6 weeks for
complete recovery from knee arthroplasty. Clients are often discharged with the use
of a walker and will advance to a cane or crutch 4 to 6 weeks following surgery.
A nurse is providing teaching to a client who has a severe form of stage II Lyme
disease. Which of the following statements made by the client reflects and
understanding of the teaching? - ANSWER: My joints ache because I have Lyme
disease."
Lyme disease is a vector-borne illness transmitted by the deer tick. The disease
course occurs in three stages beginning with joint and muscle pain in stage I. If left
untreated, these symptoms continue throughout stage II and, by stage III, become
chronic. Other chronic complications include memory problems and fatigue.
A nurse is caring for a client who is on bed rest and has a new prescription for
enoxaparin subcutaneous. Which of the following actions should the nurse take? -
ANSWER: Inject the medication into the anterolateral abdominal wall.
The nurse should inject the medication into the anterolateral or posterolateral
abdominal wall to enhance medication absorption and prevent hematoma
formation.
A nurse is caring for a client who is receiving mechanical ventilation via a
tracheostomy tube. The nurse should recognize that which of the following
complications is associated with long-term mechanical ventilation? - ANSWER: Stress
ulcers
Stress ulcers in clients who are receiving long-term mechanical ventilation are
caused by elevated levels of hydrochloric acid in the stomach. Stress ulcers increase
the risk for systemic infection and require pharmacological treatment.
A nurse is updating the plan of care for a client who is receiving chemotherapy.
Which of the following findings should the nurse identify as the priority? - ANSWER:
Report of sore throat
A nurse is caring for a client in the emergency department (ED).
Physical Examination
Client presents to the ED with upper abdominal pain that radiates to the right
shoulder. Client rates pain as 7 on a scale of 0 to 10. Client also reports nausea,
vomiting, and dyspepsia.
Client is awake, alert, and oriented x3. Lung sounds clear bilaterally, S1 and S2 heart
tones noted. All pulses palpable. Bowel sounds active in all 4 quadrants.
Complete the diagram by dragging from the choices below to specify what condition
the client is most likely experiencing, 2 actions the nurse should take to address that
condition, and 2 parameters the nurse should monitor to assess the client's progress.
- ANSWER: The nurse should plan to administer an opioid analgesic, such as
morphine, for acute pain. Since the client is experiencing nausea and vomiting, the
nurse should also ensure they are NPO. The client is likely experiencing cholecystitis,
which typically presents with nausea, vomiting, upper abdominal pain that radiates
to the right shoulder, fever, and dyspepsia. The client also has elevated liver
enzymes and a WBC count, which is consistent with cholecystitis. Surgical
management for cholecystitis might be indicated. The nurse should monitor the
client's stool and urine color because a biliary obstruction from gallstones may cause
clay-colored stools and dark urine.
A nurse is caring for a client who was just admitted from the emergency department
(ED).
Nurses' Notes
0945:
Client is experiencing a sickle cell crisis. Client states that they began experiencing
pain in the lower extremities 3 days ago and is now experiencing pain in the chest,
rating it as 4 on scale of 0 to 10.
Oxygen at 3 L/min via nasal cannula in place.
Oral mucosa pink, no cyanosis.
Pulses palpable in all four extremities, no peripheral edema noted.
Respirations even and slightly labored; lung sounds with slight wheezing in left upper
lobe.
Abdomen soft and nontender, bowel sounds active in all four quadrants.
0.45% sodium chloride IV at 200 mL/hr infusing to left hand with no reports of pain
or swelling at the site.
Drag words from the choices below to fill in each blank in the following sentence. -
ANSWER: Fluid volume overload is incorrect. While the client is experiencing an
increased respiratory rate and shortness of breath, fluid volume overload typically
includes moist crackles on auscultation, pitting edema in dependent areas, neck vein
distension, and hypertension.
Right-sided heart failure is incorrect. While clients who have sickle-cell disease are at
risk for developing heart failure, the client does not have manifestations of right-
sided heart failure. Right-sided heart failure typically presents with signs of fluid
,volume overload, which includes jugular vein distention, dependent edema, and
blood pressure alterations.
Acute chest syndrome is correct. The client is most likely experiencing acute chest
syndrome, which can be caused by respiratory infections and debris from sickled
cells. The client is displaying manifestations of acute chest syndrome, which include
cough, shortness of breath, wheezing, tachypnea, fever, and chest pain.
Pneumonia is correct. The client is most likely experiencing pneumonia as evidenced
by the manifestations of cough, shortness of breath, fever, tachypnea, blood-tinged
sputum, and chest pain.
Pneumothorax is incorrect. While the client is experiencing increased respiratory
distress, a pneumothorax typically presents with reduced or absent breath sounds
and unequal chest expansion.
A nurse is caring for a client.
Nurses' Notes
1200:
Client was admitted to the unit with shortness of breath, a nonproductive cough,
chest discomfort, and myalgia. Prefers orthopneic position. Client reports that
manifestations began about 2 days ago.
For each assessment finding, click to specify if the finding is consistent with
emphysema, asthma, or pneumonia. Each finding may support more than 1 disease
process. - ANSWER: Temperature is consistent with pneumonia. Fever is a
manifestation of pneumonia and is related to inflammation or infection.
Breath sounds are consistent with emphysema, asthma, and pneumonia. The client's
wheezing is a manifestation of emphysema, asthma, and pneumonia. It is the result
of narrowed airways and alveoli.
ABG results are consistent with emphysema and pneumonia. The client's ABG results
indicate respiratory acidosis, which is a manifestation of emphysema and
pneumonia.
Respiratory rate is consistent with emphysema, asthma, and pneumonia. The client's
respiratory rate is a manifestation of emphysema, asthma, and pneumonia.
Heart rate is consistent with emphysema and pneumonia. The client is experiencing
tachycardia, which is a manifestation of emphysema and pneumonia.
Cough is consistent with emphysema, asthma, and pneumonia. The client's cough is
a manifestation of emphysema, asthma, and pneumonia.
A nurse is caring for a client who is scheduled for a right knee arthroplasty.
Nurses' Notes
0600:
Client is admitted for surgery this a.m. Vital signs recorded. Consents reviewed.
Client reports understanding of surgery and has no further questions for provider.
The nurse provided preoperative teaching to the client. Which of the following
statements by the client indicates an understanding of the teaching?
Select all that apply. - ANSWER: "Well, I guess there's no changing my mind about
having surgery now" is incorrect. The nurse and the client reviewed the consents;
therefore, the nurse has instructed the client that they have the right to refuse
surgery at any time.
, "I will need to do the breathing exercises every 1 to 2 hours after the surgery" is
correct. The client should cough and deep breathe and use the incentive spirometer
every 1 to 2 hr to reduce the risk of postoperative complications, such as
pneumonia.
"I will be sure to ask for pain medication before my knee starts to hurt too bad" is
correct. For optimal control of postoperative pain, the client should request
analgesic medication before the pain becomes severe.
"My physical therapy will start after I leave the hospital" is incorrect. Early
ambulation leads to improved postoperative outcomes and reduces the risk of
complications of immobility, such as pneumonia and atelectasis. The client should be
informed that physical therapy will begin the day of, or the day following, surgery.
"I will probably be going home with a walker" is correct. It can take 6 weeks for
complete recovery from knee arthroplasty. Clients are often discharged with the use
of a walker and will advance to a cane or crutch 4 to 6 weeks following surgery.
A nurse is providing teaching to a client who has a severe form of stage II Lyme
disease. Which of the following statements made by the client reflects and
understanding of the teaching? - ANSWER: My joints ache because I have Lyme
disease."
Lyme disease is a vector-borne illness transmitted by the deer tick. The disease
course occurs in three stages beginning with joint and muscle pain in stage I. If left
untreated, these symptoms continue throughout stage II and, by stage III, become
chronic. Other chronic complications include memory problems and fatigue.
A nurse is caring for a client who is on bed rest and has a new prescription for
enoxaparin subcutaneous. Which of the following actions should the nurse take? -
ANSWER: Inject the medication into the anterolateral abdominal wall.
The nurse should inject the medication into the anterolateral or posterolateral
abdominal wall to enhance medication absorption and prevent hematoma
formation.
A nurse is caring for a client who is receiving mechanical ventilation via a
tracheostomy tube. The nurse should recognize that which of the following
complications is associated with long-term mechanical ventilation? - ANSWER: Stress
ulcers
Stress ulcers in clients who are receiving long-term mechanical ventilation are
caused by elevated levels of hydrochloric acid in the stomach. Stress ulcers increase
the risk for systemic infection and require pharmacological treatment.
A nurse is updating the plan of care for a client who is receiving chemotherapy.
Which of the following findings should the nurse identify as the priority? - ANSWER:
Report of sore throat
