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MedSurg 2
Exam 1
101
Nursing
Undergraduate 3
10/12/2019
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Term
The nurse is discussing actions that can be taken to best prevent osteoporosis with a patient. The nurse’s teaching should include:
 Definition
Exercising throughout life
Term
When the patient asks what the purpose of goniometry is, the nurse replies that goniometry measures:
 Definition
Range of motion
Term
The nurse is aware that positioning and range-of-motion (ROM) exercises most help the immobilized patient to prevent:
 Definition
Contractures
Term
The nurse adds interventions for range-of-motion (ROM) and isometric exercises for the new patient with a stroke because the nurse is aware that contracture formation begins as early as _____ day(s) of immobilization.
 Definition
3
Term
The nurse explains that, if muscles are not regularly stretched and contracted, the muscles will become:
 Definition
Shorter and less elastic
Term
The nurse uses a visual aid to show the pathologic muscle tone changes that result in footdrop. Those changes are:
 Definition
Flexor muscles are stretched
Term
The nurse informs the patient that the frequency of range-of-motion (ROM) exercises should be:
 Definition
3 to 4 times a day
Term
When the patient returns to the unit from having had an arthrogram, which intervention will the nurse perform first?
 Definition
Apply ice packs to the knee
Term
The nurse encourages the patient to use the four-point crutch gait technique. This technique is most likely indicated because it:
 Definition
is the most stable gait
Term
The nurse is assessing the patient’s cane for appropriate length. The nurse affirms that the appropriate cane has been selected when the:
 Definition
hand grip is at the level of the hip
Term
The nurse is instructing the patient on quadriceps and gluteal muscle exercises. The instructions will include:
 Definition
while lying down, straightening the leg and tensing leg muscles while raising heel.
Term
When a 90-year-old patient says, “My old bones are just about done in,” the nurse reminds him that his bones are being constantly renewed through the action of:
 Definition
Osteoblasts
Term
The patient’s plan of care includes using the continuous passive motion (CPM) machine. Which statement by the patient indicates the need for further teaching?
 Definition
I can make my new knee stronger if I reset this thing to go faster and flex my knee more.
Term
When preparing a patient for electromyography (EMG), the nurse will instruct the patient to:
 Definition
Refrain from caffiene drinks for at least 3 hours before the test
Term
When an 88-year-old patient enters the room for her health assessment, she walks with tiny steps, her shoulders are rounded and hunched, and her arms are crossed in front of her with her hands tucked in her armpits. Which response by the nurse is most appropriate?
 Definition
Are you cold?
Term
The nurse is changing the position of a person with flaccid paralysis. The priority action will be:
 Definition
To change joint position
Term
The nurse is caring for a patient who has had an arthrocentesis. The nurse has completed discharge instructions. Which statement by the patient indicates the need for further instruction?
 Definition
I will need to avoid moving my knee for at least 1 to 2 weeks
Term
A patient is learning to use crutches on the stairs. When evaluating this patient, which action indicates that the patient needs further instruction?
 Definition
The patient places the good leg on the step to be climbed first.
Term
The nurse is assessing the patient’s crutches. The nurse recognizes that correctly sized crutches are:
 Definition
approximately 16 inches shorter than the patient’s height
Term
A patient at risk for the development of osteoporosis has reported plans to increase calcium intake. When making menu choices, which selection demonstrates an understanding of calcium-rich foods?
 Definition
Grilled salmon, green beans, and milk
Term
A patient has come to the ambulatory care clinic with a sprain. The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of:
 Definition
Minor loss of function
Term
An older adult has fallen and sprained his ankle in a local park. The correct initial management of the injury will include which action?
 Definition
Elevating the foot to reduce swelling
Term
When the clinic nurse starts to take the “air cast” off the grade 2 sprain, the patient asks why it is being removed as he still has pain. The nurse explains that the cast is removed because:
 Definition
long-term immobilization can cause permanent disability
Term
The nurse recognizes a need for further instruction about application of ice to a sprain when the patient says:
 Definition
I will keep the ice on this knee for the rest of the day.
Term
The industrial nurse examines an employee who states that his right shoulder hurts when he abducts it and points with one finger to the spot at the point of his shoulder that is painful. He mentions that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering from:
 Definition
bursitis
Term
The nurse explains that carpal tunnel syndrome is caused when the carpal tunnel compresses the:
 Definition
median nerve
Term
The patient with mild discomfort from carpal tunnel syndrome delightedly reports amazing relief from taking a daily dose of vitamin:
 Definition
B6
Term
An 80-year-old man falls and suffers a compound fracture of the femur. The most appropriate immediate action is to:
 Definition
Splint the leg as it is
Term
The patient in a long arm cast (from below the shoulder to the wrist, with a 90-degree elbow flexion) complains of a burning sensation over the elbow. The nurse’s initial intervention should be:
 Definition
check to see if the cast is properly supported
Term
The nurse is performing an assessment on the patient who is in bilateral Buck’s traction. Which finding indicates the need to reposition the patient?
 Definition
Patient’s feet are against the footboard
Term
While the nurse is giving morning care to a patient who sustained a fractured pelvis and bilateral fractures of the femur in a motorcycle accident yesterday, the patient complains of shortness of breath and is audibly wheezing. An assessment of the oxygen saturation reveals 76%. The initial intervention by the nurse should be to:
 Definition
raise patient to high Fowler’s position
Term
A patient with osteoporosis calls the nurse in the doctor’s office to report that she has forgotten to take her weekly bisphosphonate (alendronate [Fosamax]) for 2 days past the weekly time. The nurse should advise the patient to:
 Definition
skip this week and pick up the schedule next week
Term
The nurse is aware that thyroid hormone production is dependent on the intake of:
 Definition
Protein and iodine
Term
The nurse explains that the hormone that acts on bone to release calcium into the blood is:
 Definition
Parathormone
Term
The gland that secretes epinephrine and norepinephrine is:
 Definition
Adrenal medulla
Term
Mineralocorticoids and glucocorticoids are the products of the:
 Definition
Adrenal Cortex
Term
The androgenic hormones are secreted by the:
 Definition
Adrenal Cortex
Term
The nurse explains that the function of aldosterone is to:
 Definition
Conserve water
Term
The corticoid that counteracts the inflammatory response is:
 Definition
Cortisol
Term
The nurse clarifies that endocrine glands, as opposed to exocrine glands:
 Definition
can put their secretions directly into the bloodstream
Term
Exocrine glands secrete into the blood stream via:
 Definition
ducts
Term
An 80-year-old diabetic is to be tested with the fructosamine assay instead of the glycosylated hemoglobin (HbA1c) test because the fructosamine assay:
 Definition
Is less influenced by age
Term
The patient who has a glucose tolerance test scheduled for next week is instructed not to take which medication because it will adversely affect the test result?
 Definition
Birth control pills
Term
When caring for a patient who is having a 17-ketosteroid (17-KS) test done, the nurse will need to provide:
 Definition
a method to keep the urine container chilled for 24 hours
Term
The long-term diabetic has had a glycosylated hemoglobin (HbA1c) test done to evaluate the effectiveness of his glucose control. The nurse evaluates the laboratory report of 5% to indicate that the effectiveness of the glucose control is:
 Definition
Excellent
Term
The nurse clarifies that the actual structural unit that secretes insulin is the:
 Definition
Beta cell
Term
The nurse instructs the patient that, before having a thyroid panel done, the patient should omit taking ______ for two days before the test
 Definition
Aspirin
Term
The nurse explains that, although thyroid hormone levels decrease with advancing age, the reduction in output of the gland is offset by the:
 Definition
decreased rate of thyroid hormone breakdown
Term
The nurse is aware that because of the reduced levels of cortisol, the older adult finds it difficult to deal with:
 Definition
Stress
Term
The nurse explains that when an endocrine gland begins to hypersecrete, the usual cause is:
 Definition
Hyperplasia
Term
The physician has ordered cortisol level testing for a patient. When planning the test, what information should be provided to the patient?
 Definition
Blood samples will be collected periodically during both the day and night
Term
The nurse is caring for a patient undergoing the fluid deprivation test. The nurse correctly recognizes that this test is used to assess for which condition?
 Definition
Diabetes Insipidus
Term
The nurse is aware that the patient has central diabetes insipidus because the disease was the result of the patient’s having:
 Definition
Brain surgery to remove a tumor
Term
The nurse is aware that the severe dehydration associated with diabetes insipidus can lead to the serious electrolyte imbalance of:
 Definition
Hypernatremia
Term
The nurse is reviewing the health history of a patient. Which finding is most linked to the probability of developing Graves’ disease?
 Definition
Smoking
Term
The patient with hyperthyroidism is undergoing ablation therapy with radioactive iodine. The precaution the nurse will employ is to:
 Definition
take radioactive precautions with syringes and bedpans
Term
The physician has prescribed methimazole (Tapazole). When providing education to the patient, which instruction should be included in the teaching?
 Definition
The medication should be taken on a strict schedule
Term
The husband of a patient with Graves’ disease confides that he is frustrated with his wife’s emotional outbursts and wide mood swings. The nurse’s most helpful response would be:
 Definition
Her antithyroid drugs will smooth the behavior out in a few weeks
Term
During the preoperative thyroidectomy instruction to a patient with Graves’ disease, the patient bursts into tears and says, “I am so nervous and can’t listen to you. Just get out!” The nurse’s best action is to:
 Definition
inform the charge nurse or surgeon of this stressful behavior
Term
When a patient who is 8 hours postoperative from a total thyroidectomy shows a positive Chvostek’s sign and complains of muscle cramps, the nurse interprets these assessments as indicative of:
 Definition
hypoparathyroidism
Term
The patient in addisonian crisis is receiving IV fluids for rehydration. The nursing care is focused on:
 Definition
early assessment of hypotension
Term
The nurse is preparing a patient to undergo a dexamethasone suppression test. Which action is most appropriate?
 Definition
Instruct the patient that a blood specimen will be collected in the morning
Term
The nurse is caring for a patient scheduled for a thyroidectomy. Which instruction should be included in the preoperative care?
 Definition
Medications will be administered in the 2 weeks before surgery to reduce the vascularity of the gland
Term
The nurse explains to a newly diagnosed type 1 diabetic that the beta cells can no longer produce adequate insulin because:
 Definition
the body’s immune system has destroyed them
Term
The nurse uses a visual aid to demonstrate that among diabetics, type 2 diabetics comprise up to _____% of all known cases.
 Definition
95
Term
The nurse recognizes a need for further information when a young woman with gestational diabetes says:
 Definition
I’ll be free of diabetes when this baby is born
Term
A patient asks the nurse if stress can be a potential cause of type 2 diabetes. What should be included in the response provided by the nurse?
 Definition
Periods of stress cause increases in glycogen production by the adrenal cortex
Term
The nurse counsels the 30-year-old woman with type 2 diabetes who is overweight and noncompliant that control of diabetes would most improve if she were to:
 Definition
Lose weight
Term
The patient inquires about the significance of islet cell antibodies. The nurse’s most informative response is that islet cell antibodies:
 Definition
will cause beta cells to quit producing insulin, resulting in diabetes mellitus
Term
A patient recently diagnosed with type 1 diabetes mellitus questions the nurse about her increased thirst level. What should be included in the response by the nurse?
 Definition
Elevated levels of blood glucose pull cellular water into circulating volume
Term
The nurse is caring for a patient who was hospitalized with ketosis. The nurse recognizes that the patient correctly understands the phenomenon when she reports what about the condition?
 Definition
The condition resulted when my body tried to break down and use my stores of fats
Term
At 2:00 AM, the CNA reports that a patient with type 1 diabetes is extremely wet with perspiration, is cool to the touch, and is complaining of hunger. The nurse should:
 Definition
Give 6oz of orange juice
Term
The nurse would anticipate laboratory values from a patient in ketoacidosis to reveal:
 Definition
increased blood urea nitrogen
Term
The patient comes to the emergency room with dry hot skin, fruity breath, and deep respirations and is complaining of abdominal pain. The nurse interprets these signs and symptoms as:
 Definition
ketoacidosis
Term
The nurse is aware that diabetics are prone to infection, which can be attributed to:
 Definition
atherosclerotic vascular changes
Term
The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What inference can best be made about this patient?
 Definition
The patient is demonstrating improved control of hyperglycemia over the last several months
Term
The nurse cautions that the technique of “tight control” of hyperglycemia is not recommended for the older adult because the older adult:
 Definition
is prone to cardiovascular problems resultant from hypoglycemia
Term
The patient takes his NovoLog 70-30 at 7:00 AM. The nurse suggests the best time to schedule exercise would be at:
 Definition
1:00 PM after peak action of insulin
Term
A long-term diabetic patient reports that the physician has told him he has the early symptoms of cardiovascular disease. The nurse correctly understands that diabetes predisposes the patient to cardiovascular complications for which reason?
 Definition
The periods of hyperglycemia that result in diabetes damage the basement membrane causing atherosclerosis
Term
A patient with type 1 diabetes mellitus is preparing for a moderate 30-minute exercise period. Which action best indicates understanding of condition management?
 Definition
The patient consumes a simple carbohydrate snack after 30 minutes of activity
Term
The nurse is reviewing the patient’s prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication will best meet this criteria?
 Definition
Lantus
Term
The functions of the musculoskeletal system are: (Select all that apply.)
 Definition
motion, support, protection of organs, body shape
Term
The nurse points out the age-related changes that occur in the musculoskeletal system, which are: (Select all that apply.)
 Definition
bones are brittle and break easily, bones heal slowly, decrease in muscle mass, tendon sclerosis
Term
When the nurse plans for the progressive mobilization of a hemiplegic, the nurse will consider the patient’s ability to: (Select all that apply.)
 Definition
move limbs, walk, change positions in bed independently, transfer self from bed to chair
Term
The nurse understands that all soft tissue injuries require the nurse to assist with or instruct about: (Select all that apply.)
 Definition
pain control, immobilization, activity restriction, prevention of recurrence
Term
The nurse lists the advantages of fiberglass casts, which include that this type of cast: (Select all that apply.)
 Definition
Is lighter, dries quickly, allows weight bearing in 30 minutes
Term
The patient is returning to the unit with a wet long leg cast. To prevent damage to the wet cast, the nurse should: (Select all that apply.)
 Definition
Determine the cast material, support the cast with the palms of the hands rather than holding it with the fingers, assess heat generated from the drying cast
Term
The nurse instructs a patient going home with a short arm synthetic cast to: (Select all that apply.)
 Definition
cover the cast with a plastic bag when taking a shower, observe skin at the edge of the cast for irritation or injury, check circulation and sensation in the fingers frequently, move and flex the fingers to stimulate circulation
Term
The nurse lists the age-related changes to the endocrine function as: (Select all that apply.)
 Definition
metabolism declining, blood glucose levels rising, decreasing level of epinephrine, decreasing level of thyroxine
Term
The nurse is aware that endocrine disorders are caused by: (Select all that apply.)
 Definition
over production of hormone, underproduction of hormone, effects of certain drugs
Term
The nurse uses a visual aid to demonstrate the effects of a benign pituitary adenoma, which include: (Select all that apply.)
 Definition
gigantism in children, acromegaly in adults, muscle weakness, joint pain
Term
The nurse planning the hypophysectomy postoperative instructions that will be given to the patient before surgery will include: (Select all that apply.)
 Definition
presence of drip pad under nose, postponing brushing teeth, presence of nasal packing for several days, avoiding bending over
Term
The nurse planning care for a patient with diabetes insipidus will include: (Select all that apply.)
 Definition
maintaining fluid therapy, conserving energy, assessing for bradycardia
Term
A tumor of the pituitary has caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse plans interventions for: (Select all that apply.)
 Definition
assisting with activities of daily living because of weakness, recording accurate urine output because of oliguria, weighing daily to assess edema, assessing for changes in level of conscious because of confusion and seizures
Term
The immediate postoperative care of a person who had a total thyroidectomy will include: (Select all that apply.)
 Definition
supporting the head with sandbags, assessing ability to swallow, assessing for bleeding
Term
On the first postoperative day following a total thyroidectomy, the nurse assesses signs that indicate a developing “thyroid storm,” which are: (Select all that apply.)
 Definition
rising temperature, brief attention span, apprehension and restlessness
Term
The nurse is aware that among the microbiologic factor(s) that may cause diabetes mellitus are: (Select all that apply.)
 Definition
coxsackievirus, influenza virus, mumps
Term
The nurse is aware that the weight loss experienced by type 1 diabetics is attributed to: (Select all that apply.)
 Definition
loss of body fluid, metabolization of body fats
Term
The nurse outlines the criteria for “tight control” of hyperglycemia as: (Select all that apply.)
 Definition
insulin injections three times a day based on glucometer readings, fasting glucose remaining within normal limits, maintaining normal weight for height and age, maintaining cholesterol within normal limits
Term
When discussing exercise programs with the diabetic, the nurse should stress that the patient should: (Select all that apply.)
 Definition
delay the exercise program until glucose is under control, have a quick source of glucose available while exercising, begin slowly and build up to 30 to 45 minutes, use abdomen only for injection site for insulin
Term
The nurse is observing a patient administer insulin. Which observation indicates the need for further instruction? (Select all that apply.)
 Definition
The patient rubs the injection site after administration of the insulin injection, The patient draws up the cloudy insulin and then the clear insulin, The patient shakes the insulin bottle before administration
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