Detailed Answer Key For Medical Surgical Exam, A+ Solutions

Detailed Answer Key For Medical Surgical Exam, A+ gg gg gg gg gg gg gg




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1.A nurse is reviewing the cause of gout with a group of nurses. W hich of the following statements should the nurse make?
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A. "Uric acid levels drop and calcium forms precipitate."
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Rationale:Withgout, clients have hyperuricemia, rather than areduction in uric acid. gg gg gg gg gg gg gg gg gg




B. "Tophi form in the kidneys and theyimpair the excretion of uric acid."
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Rationale:Tophi, or deposits in tissues near a joint, develop in chronic, late-stage gout. They are not part of the
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primary disease process. gg gg gg




C. "The intra-articulardepositionof urate crystals causes inflammation."
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Rationale: Gout, or goutyarthritis, develops when urate crystals deposit in joints and tissues and cause
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inflammation and pain. gg gg gg




D. "Articular cartilage thins, leadingto splitting and fragmentation."
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Rationale:Goutdoes not thin and fragment cartilage. gg gg gg gg gg




2.A nurse is teaching a group of clients about osteoarthritis.Which of the following recommendations should the
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nurse include in the teaching?
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A. Use Echinacea to manage joint pain.
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Rationale:The nurse mayinclude the use of complementaryand alternative therapies in the teaching.
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However, Echinacea is used for the treatment of the common cold, not osteoarthritis. Alternative
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therapiesthat areusedfor osteoarthritis includeglucosamine, chondroitin, and topicalcapsaicin.
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B. Apply ice to the joint before exercising.
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Rationale:The nurse should recommend that the clients begin exercising immediately following
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the application of heat. This reduces pain and improves mobility, allowing for
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increased range-of-motion during exercises. Cold application may be applied
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following exercise to decrease discomfort and inflammation.
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C. Maintain arecommended body weight.
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Rationale:Obesityis arisk factor for the development of osteoarthritis. Maintenance of an ideal weight is
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one way a client can prevent added wear and tear on joints and promote overall joint
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health. gg



D. Reduce the amount of purine in the diet.
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Rationale: The nurse should recognize that limiting purine in the diet, which is often found in organ meats, is
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recommended for clients who have gout.
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,3.A nurse is caring for a client who has had a myocardial infarction. Upon his first visit to cardiac rehabilitation,
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gghe tells the nurse that he doesn't understand why he needs to be there because there is nothing more to do, as
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the
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, damage is done. W hich of the following is the correct nursing response?
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A. "Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back to your
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previous level of activity safely."
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Rationale:With this response, the nurse uses the therapeutic communication technique of presenting
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reality by indicating her perception of the situation for the client.
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B. "It’s not unusual to feel that way at first, but once you learn the routine, you’ll enjoy it."
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Rationale:Withthis response, the nurse illustrates the nontherapeutic communication technique of giving
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reassurance, thus discouraging the client from further communication.
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C. "Exercise is good for you and good for your heart."
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Rationale:Withthis response, the nurse illustrates the nontherapeutic communication techniques of
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disagreeing and giving advice. gg gg gg gg




D. "Your doctor is the expert here, and I’m sure he would only recommend what is best for you."
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Rationale:Withthis response, the nurse illustrates the nontherapeutic communication technique of defending.
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4.A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify
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which of the following medications as the cause of the client’s low potassium level?
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A. Furosemide

Rationale: Furosemide is aloop (high-ceiling) diuretic that inhibits the reabsorption of sodium and
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chloride and results in diuresis, which decreases potassium through excretion in the
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distal nephrons. Hypokalemia is an adverse effect of furosemide.
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B. Nitroglycerin

Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of nitroglycerin. Nitroglycerin is a vasodilator
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medication to treat angina. gg gg gg gg




C. Metoprolol
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of metoprolol. Metoprolol
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is a beta-blocker that slows the heart rate and improves contractility of the
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heart muscle. gg gg




D. Spironolactone
Rationale: Spironolactoneis a potassium-sparing diuretic medication; therefore, hyperkalemia is an
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adverse effect of this medication. gg gg gg gg gg




5.A nurse is caring for a client who is postoperative following an open reduction internal fixation (ORIF) of a
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femur fracture.Which of the following parameters should the nurse include in the evaluation of the neurovascular
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status of the client's affected extremity? (Select all that apply.)
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, A. Color
B. Temperature

C. Ecchymosis

D. Skin integrity
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E. Sensation
Rationale: Color is correct. Clients who have sustained trauma to an extremity, such as a fracture,
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are at increased risk for neurovascular compromise. The nurse should check the color of
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the client's affected extremity as part of this assessment. The nurse should identify pallor
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or cyanosis of the extremity as an indication of peripheral neurovascular dysfunction and
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should notify the provider.Temperature is correct. Clients who have sustained trauma to
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an extremity, such as a fracture, are at increased risk for neurovascular compromise.
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The nurse should monitor the temperature of the extremity as a part of this assessment
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and identify skin that is cool or cold to the touch as having decreased perfusion to the
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tissues of the extremity, which is an indication of peripheral neurovascular dysfunction. The
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nurse should report skin that is cool to the touch to the provider.Ecchymosis is incorrect.
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Ecchymosis, or bruising, is an expected finding with leg injuries and is not a component of
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a neurovascular check.Skin integrity is incorrect. While the nurse should assess the
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incision of a client who is postoperative following an open reduction
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fixation of the femur, it is not a component of a neurovascular check.Sensation is correct.
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Clients who have sustained trauma to an extremity, such as a fracture, are at increased
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risk for neurovascular compromise. The nurse should assess the client's extremity for
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numbness or tingling. The nurse should recognize diminished pain or paresthesia as an
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indication of damage to the nerves or peripheral neurovascular dysfunction and should
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report it to the provider.
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6.A nurse is monitoring a client following a thoracentesis. The nurse should identify which of the following
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manifestations as a complication and contact the provider immediately?
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A. Serosanguineous drainagefrom thepuncturesite
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Rationale: Asmall amount of serosanguineous drainage at the puncture site is expected after a thoracentesis.
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B. Discomfort at the puncture site
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Rationale:Milddiscomfort at the puncture site is expected after athoracentesis.
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C. Increasedheartrate
Rationale:Clients are at risk for developing pulmonary edema or cardiovascular distress due mediastinal
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content shift after the aspiration of a large amount of fluid from the client's pleural space.
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Therefore, the client may experience an increase in heart and respiratory rate, along
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with coughing with blood-tinged frothy sputum, and tightness in the chest. These findings
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require notification of the provider immediately.
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D. Decreasedtemperature
Rationale:Infection is possible after any invasive procedure; however, it takes time to develop and
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increases the body temperature.
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