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Exam 3
MedSurg Exam 3
| Question | Answer |
|---|---|
| A nurse is collecting a health history from a patient with a connective tissue disease. Which is the most important inquiry by the nurse? | History of a prior injury to a specific body part |
| A nurse is educating an osteoporotic patient taking alendronate (Fosamax). Which instruction should the nurse stress? | Sit or stand for 30 minutes after administration. |
| Which diagnostic test result should the nurse expect for a patient with polymyositis? | Muscle biopsy positive for muscle degeneration |
| A nurse is educating a patient with gout about the medication probenecid (Benemid). Which active effect should the nurse relay when explaining why this medication is prescribed? | Increases excretion of uric acid |
| The physician orders antinuclear antibodies for a patient with suspected rheumatoid arthritis. Which information will the nurse provide to the patient in preparation for this study? | Fast for 8 hours before test. |
| A patient is preparing for tomography as ordered to enhance visualization of tissue hidden by bone. Which assessment by the nurse should be immediately addressed? | Reports of claustrophobia |
| A nurse questions an older patient about the age-related changes she has experienced in her connective tissue, which have lessened her mobility. Which changes are most commonly included? (Select all that apply.) | Loss of bone, which may cause fragile bones Thickening of the tendons, causing loss of strength Bony deposits in the joints, causing pain and altered movement Hardening of cartilage, causing more friction in joints |
| A 51-year-old professional tennis instructor is newly diagnosed with osteoarthritis. Which is the nurse’s best explanation to the patient when asked what this diagnosis means? | Degeneration of articular cartilage |
| A nurse explains to a patient with rheumatoid arthritis that the drug leflunomide (Arava) is a disease-modifying antirheumatic drug (DMARD). Which action of this medication is correct? | Retards the progress of the disease |
| A nurse is caring for a patient with osteoarthritis. Which is the best recommendation by the nurse to this patient to control chronic pain? | Administer analgesics as prescribed on a routine basis. |
| An older patient with osteoarthritis complains of stomach discomfort and shortness of breath after years of taking aspirin for pain relief. Which change in pain control medication would be most appropriate for the home health care nurse to suggest? | Nonsteroidal anti-inflammatory drugs (NSAIDs) |
| A home health care nurse is visiting a patient after a total hip replacement. Which information should the nurse include when teaching the patient how to protect the new joint? | Put an extension on the toilet seat. |
| After a procedure, a patient rejects the use of the continuous passive motion machine, saying, “I did not march when I was a child, and I am not marching now.” Which benefits of CPM should the nurse point out to encourage the patient to use this machine? | Increase in flexibility for the new joint |
| Which body structures do connective tissue diseases affect? | Bones, ligaments, cartilage, and tendons |
| Which patient is most likely to develop a connective tissue disease? | A 30-year-old woman who plays tennis |
| Which statement is true regarding connective tissue function? | Provides protection to body parts |
| Which characteristic should a nurse recognize as diagnostic of rheumatoid arthritis? | Symmetric bilateral joint swelling |
| A patient asks why systemic glucocorticoid medications are used as the last choice for the treatment of rheumatoid arthritis. Which reply by the nurse is the most informative? | “They are used as a last choice or for short periods because they have many side effects.” |
| A nurse, in conjunction with a patient, establishes a plan to treat the pain associated with arthritis. Which strategy is the most effective? | Apply warm, moist compresses before doing activity. |
| Which is the best physiologic reason for a patient with osteoporosis to maintain a regular exercise regimen? | Promotes bone formation and improves strength |
| A nurse is organizing a teaching plan for a patient with gout. Which problem should the nurse caution this patient he is at an increased risk for? | Kidney stones |
| A nurse is educating a patient with gout about a low-purine diet. Which food choice by the patient would indicate the need for further teaching? | Seafood platter with scallops and mussels |
| A nurse is caring for a patient immediately after total knee replacement surgery. Which assessment requires priority? | Quality of pulses in the affected limb |
| Inadequate nutrition is the patient problem applicable to a patient with progressive systemic sclerosis. Which information is the most important point for the nurse to teach this patient? | Eat smaller, more frequent meals. |
| Which instruction should a nurse include in a teaching plan for a patient with carpal tunnel syndrome? | Splinting to prevent flexion and hyperextension |
| Two days after a total hip replacement, a patient is being discharged. Which statement indicates that the patient understands the discharge teaching? | “I will ask my husband to tie my shoes for me.” |
| Which action would best benefit the patient diagnosed with bursitis of the shoulder? | Walking the fingers of the affected arm up the wall |
| Which goals apply to therapy for patients with rheumatic arthritis? (Select all that apply.) | Decrease inflammation. Balance activity and rest. Promote adaptation to limitations. Supply patient education and support. |
| Which actions would be best for patients with osteoarthritis to seek the assistance of physical therapy? (Select all that apply.) | Moist heat application Instruction with a transcutaneous electrical nerve stimulation (TENS) unit Measures to increase range of motion Measures to increase strength |
| Which signs of progressive systemic sclerosis do the anonym CREST represent? (Select all that apply.) | Calcinosis Esophageal dysfunction Telangiectasis |
| A patient believed to have acromegaly asks the purpose of the diagnostic glucose tolerance test (GTT). Which response is the most accurate? | “It measures the growth hormone in the presence of oral glucose levels at specified times.” |
| A family member of a patient who is in adrenal crisis asks why the IV cortisone is continued after the initial IV push of Solu-Cortef, which seemed to stop the symptoms. Which reply is the best explanation by the nurse? | Solu-Cortef has a very brief therapeutic period and needs a maintenance IV infusion to keep up the level. |
| A patient is receiving the medication octreotide (Sandostatin) as a treatment for acromegaly. Which information should the nurse explain regarding this medication? | It suppresses the growth hormone. |
| Which instruction should a nurse provide when a patient starts taking a saturated solution of potassium iodide (SSKI)? | Sip medication through a straw to prevent tooth staining. |
| Which significant need should be included in instructions to a patient scheduled for a thyroid scan (123I)? | Wash their hands with soap and water after every voiding for the next 24 hours. |
| A patient asks about his laboratory test, which showed a high level of thyroid-stimulating hormone (TSH) and a low level of T4. Which reply offers the most accurate explanation? | “The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn’t producing enough hormone.” |
| A patient has been given an antithyroid drug called propylthiouracil. Which appropriate nursing implementations should be included? | Teaching her to watch for and report any signs and symptoms of hypothyroidism or infections |
| An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she has taken for 15 years, has been reduced. Which information provides the best rationale when explaining what the decreased dose is related to? | Age-related reduction in metabolic rate |
| A patient being treated for hyperparathyroidism is to receive calcitonin (Calcimar). Which patient assessment should occur before this medication is administered? | Test for sensitivity |
| Which statement explains why a nurse should recommend the use of salt that is iodized when providing dietary education to patients? | It prevents the development of goiter in adults and cretinism in infants. |
| A nurse makes a list of symptoms that a patient who is taking methimazole (Tapazole), a thionamide drug, should report. Which situation should this list include? (Select all that apply.) | Becoming pregnant Jaundice Blood in the stool Rash |
| Which statement explains why hypothyroidism is frequently overlooked in older adults? (Select all that apply.) | Signs and symptoms are subtle. Signs and symptoms are discounted as age-related changes. Weight changes in the older adult are not pronounced. Decrease in mental function is attributed to dementia. |
| Which information should preoperative teaching for a patient scheduled for a transsphenoidal hypophysectomy include that the patient should do postoperatively? | Avoid sneezing. |
| Which hormone causes the large, flattened features of a patient with acromegaly? | Growth hormone |
| Which classic symptoms pertain to diabetes insipidus (DI)? | Diuresis, tachycardia, and weakness |
| A patient with Addison disease asks why she must take hydrocortisone. Which information should the nurse relay regarding the action of hydrocortisone with Addison disease? | Regulates the excretion of potassium and sodium |
| A patient states that he is confused because the physician told him that his diabetes insipidus (DI) is nephrogenic. Which response should the nurse state when describing the difference between nephrogenic DI and neurogenic DI? | Nephrogenic DI does not respond to ADH. |
| Which statement by a woman with Addison disease would indicate altered body image? | “Will I look like a zebra for the rest of my life?” |
| A 14-year-old adolescent male patient has been diagnosed with Addison disease. Which effect of Addison disease should this patient be aware of? | He will not develop pubic hair. |
| Which cardinal indication is related to pheochromocytoma? | Significant hypertension |
| A nurse is caring for a patient diagnosed with Addison disease. Which signs and symptoms should lead the nurse to suspect an adrenal crisis? | Confusion and tachycardia |
| A nurse includes in the discharge plan for a patient with Addison disease, “Potential for injury.” Which information should be provided regarding the measures to deal with this problem? | Rising slowly from a lying position |
| Which information should a nurse include when planning education to a patient with Addison disease? | Wear a medical alert tag and carry emergency dexamethasone. |
| A patient with long-term asthma develops Cushing syndrome. Which cause of this condition is most likely? | Taking corticosteroids for many years |
| Which findings are expected when assessing a patient with Cushing syndrome? | Excess adipose tissue in the trunk, slender extremities, and moon face |
| Which statement by a patient diagnosed with Cushing syndrome leads a nurse to conclude that teaching has been effective? | “I avoid being exposed to anyone with an infection.” |
| A nurse is assessing a patient with Simmonds cachexia. Which symptom should the nurse anticipate the patient will exhibit? | Muscle wasting |
| A nurse making a care plan for a 10-year-old boy with hyperpituitarism identifies an altered body image. To which attribute should the nurse relate this nursing diagnosis? | Excessive height |
| Which information should a nurse include when caring for a patient after a hypophysectomy, during which the entire pituitary was removed? | Maintaining strict intake and output fluids |
| Which situation can bring on an addisonian crisis? | Infection |
| On which information should discharge planning for a patient who underwent a hypophysectomy focus? | Education on self-care |
| A mother of a 6-foot, 2-inch, 16-year-old girl who is being treated for hyperpituitarism says, “I can’t stand it that my beautiful daughter is a freak.” Which reply is the nurse’s best response? | “What is it about her height that makes her a freak?” |
| A patient with hypopituitarism must take medications for the rest of his or her life. Which information should the patient teaching plan include? | “You must become familiar with the signs and symptoms of inadequate or excessive hormone replacement.” |
| Two days after a hypophysectomy a patient complains of a headache and nuchal rigidity. Which action should the nurse take based on these assessments? | Report suspected meningitis to the head nurse. |
| A nurse is caring for a patient with diabetes insipidus (DI). Which signs should the nurse report that indicate a change in condition? | Dropping blood pressure |
| Which symptoms should a nurse expect a patient with the diagnosis of SIADH to report during an intake interview? (Select all that apply.) | Headache Weight gain Muscle cramps Weakness |
| An 18-year-old girl is diagnosed with adenoma of the anterior pituitary gland. Which classic signs of this diagnosis should the nurse assess? (Select all that apply.) | Cessation of menses Milk production Changing facial features Weight gain |
| A physician ordered T3 and T4 tests for a young woman complaining of fatigue, weight gain, muscle aches and pains, and constipation. Which laboratory test results will help confirm the diagnosis of hypothyroidism? | Both tests show decreases. |
| A patient with a hyperthyroid complains of fatigue but still cannot get to sleep. Which is the best suggestion by the nurse? | Adhering to a bedtime ritual |
| A patient with exophthalmos is distressed about her appearance and asks when it will go away. Which is the best response by the nurse? | It usually subsides after medication for hyperthyroidism is started. |
| A nurse is explaining Graves disease to a newly diagnosed patient. Which statement by the nurse best clarifies the pathophysiologic changes of Graves disease? | “Your thyroid gland is overactive, but there are ways to treat it through medicine or surgery.” |
| A nurse assessing a patient after a subtotal thyroidectomy notes that the patient’s color is poor, the pulse and respirations are rapid, and the patient feels warm to the touch. Which action is the best initial implementation by the nurse? | Call the charge nurse; these are signs of a thyroid storm. |
| Which is the most appropriate nursing concern for the patient recently diagnosed with hyperthyroidism? | Disturbed sleep pattern |
| A patient, newly diagnosed with hypothyroidism, is anxious to begin her drug regimen. Which information should the nurse’s instructions relative to hormone replacement include? | “Know the signs and symptoms of hyperthyroidism.” |
| Which patient recommendation should a nurse include when preparing to present presurgical teaching of a patient scheduled for a subtotal thyroidectomy? | Demonstrate how to deep breathe and support her head during position changes. |
| On returning from surgery after undergoing a thyroidectomy, a patient is alarmed about the large tracheostomy tray on the bedside table. Which reply is the nurse’s most reassuring response when the patient asks why it is there? | “We have it there as a precautionary measure in the unlikely event that you have difficulty breathing.” |
| Which action is the most appropriate for the nurse to implement when assessing for hemorrhage in a post-thyroidectomy patient? | Examine behind patient’s neck and upper back to assess for hemorrhage. |
| Which statement correctly reflects how foods, such as soybeans, turnips, and rutabagas, affect people with thyroid disorders? | Suppress thyroid hormone. |
| A nurse taking the blood pressure of a patient who had a total thyroidectomy 2 days earlier notes that the patient’s hand goes into a carpopedal spasm. Which disorder should the nurse recognize this movement as an indication of? | Hypocalcemia, called the Trousseau sign |
| Which action should a nurse implement to address dry skin in the patient with hypothyroidism? | Apply lotions and creams to help maintain moisture. |
| Which t action should a nurse implement to initiate the Chvostek sign? | Tap the face over the facial nerve and watch for a spasm of the facial muscle. |
| Which symptoms should a nurse anticipate in the history of a patient with hyperparathyroidism? | Poor muscle tone, bone pain, urinary calculi, and fractures |
| Which problem is the priority nursing concern for a patient with hyperparathyroidism? | Which problem is the nurse aware is happening when the patient with hypoparathyroidism complains of fatigue and a lack of energy? |
| Which intervention is necessary to assist a patient with hypothyroidism to understand how he can live a full and normal life? | Encourage treatment with thyroid replacement therapy. |
| Which statement explains why anti-thyroid medications are provided pre-surgically to a patient with hyperthyroidism? (Select all that apply.) | To decrease the level of hormone in the blood before surgery To help reduce the risk of hemorrhage during surgery To decrease the threat of a thyroid storm To reduce exophthalmia |
| Which information should a nurse caring for a patient with hyperthyroidism include when developing a plan of care? (Select all that apply.) | Provision of a cool environment Eye care Nutritional support Prevention of diarrhea |
| A nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin. What statement provides the reason that blood glucose is elevated? | Destruction of the beta cells in the pancreas |
| A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill instead of insulin. The nurse explains that in type 2, the body still makes insulin. Which other information is pertinent for the nurse to relay? | The cells become resistant to the action of insulin. Pills are given to increase the sensitivity. |
| A patient tells a nurse that she eats “huge” amounts of food but stays hungry most of the time. Which explanation should the nurse provide as the cause of hunger experienced by persons with type 1 diabetes? | Fact that the cells cannot use the blood glucose |
| Which process does the lack of insulin in patients with type 1 diabetes cause that increases the risk for cardiovascular disorders? | Increased fatty acid levels |
| The self-care goal of a patient with diabetes is to keep the blood sugar within normal limits. Which factor causes hyperglycemia to occur? | The body responds to glucose -starved tissues by changing stored glycogen into glucose. |
| A young patient complains that diabetes is causing her to “have no life at all. It’s too hard.” Which is the most helpful response by the nurse? | “What’s hard about exercise, diet, and medicine?” |
| When a patient with type 2 diabetes says, “Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar.” Which information should the nurse explain about the level of hemoglobin A1c? | Shows what the glucose level has done during the past 3 months |
| A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM. Which action should the nurse implement based on the reading of 72 mg/dL? | Give him 8 oz of skim milk. |
| A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-threatening condition. Which result is attributed to DKA? | Disorder of carbohydrates, fats, and proteins metabolism |
| A patient has been admitted to the hospital with the diagnosis of DKA. Which vital signs should a nurse anticipate that the patient will exhibit? | Temperature, 97.4 F; pulse, 110 beats/min; respirations, 26 breaths/min and deep |
| A home health care nurse is assessing a patient with type 1 diabetes who has been controlled for 6 months. The nurse is concerned about a blood glucose reading of 52 mg/dL. Which action by this patient most likely caused this episode of hypoglycemia? | A 2-hour long exercise class at the spa this morning |
| Which guideline should be included as part of a teaching plan in preparation for discharge of a patient with type 1 diabetes needing guidelines for exercise? | Exercise should be performed daily at the same time of day and at the same intensity. |
| A nurse preparing to administer insulin to a patient who has type 1 diabetes. The physician has prescribed two types of insulin, Which procedure is appropriate for the nurse to follow when preparing these medications? | Inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin. |
| A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very strangely and seems confused. The friend states that the patient has diabetes and takes insulin. | Irritability, anxiety, confusion, and dizziness |
| A patient has come to the physician’s office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her physician. She asks the nurse if she has diabetes. | “That test indicates that we need to perform more tests that are specific for diabetes.” |
| A nurse is formulating a teaching plan for a 22-year-old woman taking rosiglitazone (Avandia). Which information should the nurse include in this plan to caution the patient? | Decreased effectiveness of her birth control pills |
| A patient with type 1 diabetes has an insulin order for NPH insulin, 35 U, to be given at 0700. The patient has also been instructed not to take anything by mouth (NPO) Which action should the nurse implement? | Hold the insulin until after the blood draw. |
| A patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet exchange program that she was given. Which is the best response by the nurse? | “Okay. Let’s talk about what you eat and drink and how you manage your diabetes.” |
| A patient with type 1 diabetes asks why his 0700 insulin has been changed from NPH insulin to 70/30 premixed insulin. Which reply is the best explanation by the nurse that explains about 70/30 insulin mixture? | It makes insulin administration easier and safer. |
| Which intervention should a nurse include when drawing up a patient’s diabetes teaching plan? | Develop an exercise plan because regular exercise helps control blood glucose levels. |
| Which situation has most likely occurred in a patient who has been diagnosed with endogenous hypoglycemia? | Excessive secretion of insulin or an increase in glucose metabolism |
| Which time correctly identifies how long it takes for Humulin R 20 units to peak? | 2 hours |
| A nurse suspects that a patient with type 1 diabetes may be experiencing the Somogyi phenomenon. Which symptom supports this suspicion? | Headache on awakening and enuresis |
| A patient has been admitted with (HHNS). The blood glucose level is very high (880 mg/dL) on admission. The physician believes that the condition is the result of large amounts of glucose solutions administered intravenously (IV) during renal dialysis. | Severe dehydration and hypernatremia caused by the hyperglycemia |
| Which functional causes relate to hypoglycemia? (Select all that apply.) | Dumping syndrome Addison disease Prolonged muscular exercise |
| Which information should a teaching plan about foot care include for a patient with diabetes? (Select all that apply.) | Wash and carefully dry the feet every day. Protect the feet from extreme temperatures. Buy shoes that are comfortable and supportive. |
| A teaching plan for a patient with diabetes is focused on smoking cessation and the control of hypertension for the avoidance of microvascular complications. Which disease processes are examples of microvascular complications? (Select all that apply.) | Macular degeneration End-stage renal disease (ESRD) |
| Which statement(s) describe the Whipple triad? (Select all that apply.) | Symptoms of hypoglycemia are present. Low blood glucose levels are documented when symptoms are present. Symptoms improved when the blood glucose level rises. |
Created by:
DrFeelgood
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