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Medical-Surgical Nursing Questions and Answers, Exams of Advanced Education

Virginia Union University (VUU)Advanced Education

A collection of multiple-choice questions and answers focused on medical-surgical nursing principles. Designed as a study aid, it covers topics such as postoperative care, medication administration, and the management of various medical conditions. The material presents practical scenarios that require critical thinking for appropriate nursing interventions and assessments. This resource is useful for reinforcing knowledge and evaluating understanding of key concepts in medical-surgical nursing, providing a targeted review of essential subject matter.

Typology: Exams

2024/2025

Available from 06/05/2025

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ATI RN HESI Med-Surg II HESI Test Bank
2022/2023 Exam Questions and Answers
A. - A nurse is reinforcing teaching with a client who has HIV and is being discharged to
home. Which of the following instructions should the nurse include in the teaching?
A. Take temperature once a day.
B. Wash the armpits and genitals with a gentle cleanser daily.
C. Change the litter boxes while wearing gloves.
D. Wash dishes in warm water.
A. - A nurse is caring for a client who is postoperative following a tracheostomy, and has
copious and tenacious secretions. Which of the following is an acceptable method for
the nurse to use to thin this client's secretions?
A. Provide humidified oxygen.
B. Perform chest physiotherapy prior to suctioning.
C. Prelubricate the suction catheter tip with sterile saline when suctioning the airway.
D. Hyperventilate the client with 100% oxygen before suctioning the airway..
B. - Following admission, a client with a vascular occlusion of the right lower extremity
calls the nurse and reports difficulty sleeping because of cold feet. Which of the
following nursing actions should the nurse take to promote the client's comfort?
A. Rub the client's feet briskly for several minutes.
B. Obtain a pair of slipper socks for the client.
C. Increase the client's oral fluid intake.
D. Place a moist heating pad under the client's feet.
C. - A nurse is caring for a client is who is 4 hr postoperative following a transurethral
resection of the prostate (TURP). Which of the following is the priority finding for the
nurse report to the provider?
A. Emesis of 100 mL
B. Oral temperature of 37.5° C (99.5° F)
C. Thick, red-colored urine
D. Pain level of 4 on a 0 to 10 rating scale
A. - A nurse is caring for a client who has a temperature of 39.7° C (103.5° F) and has a
prescription for a hypothermia blanket. The nurse should monitor the client for which of
the following adverse effects of the hypothermia blanket?
A. Shivering
B. Infection
C. Burns
D. Hypervolemia
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Download Medical-Surgical Nursing Questions and Answers and more Exams Advanced Education in PDF only on Docsity!

ATI RN HESI Med-Surg II HESI Test Bank

2022/2023 Exam Questions and Answers

A. - A nurse is reinforcing teaching with a client who has HIV and is being discharged to home. Which of the following instructions should the nurse include in the teaching? A. Take temperature once a day. B. Wash the armpits and genitals with a gentle cleanser daily. C. Change the litter boxes while wearing gloves. D. Wash dishes in warm water. A. - A nurse is caring for a client who is postoperative following a tracheostomy, and has copious and tenacious secretions. Which of the following is an acceptable method for the nurse to use to thin this client's secretions? A. Provide humidified oxygen. B. Perform chest physiotherapy prior to suctioning. C. Prelubricate the suction catheter tip with sterile saline when suctioning the airway. D. Hyperventilate the client with 100% oxygen before suctioning the airway.. B. - Following admission, a client with a vascular occlusion of the right lower extremity calls the nurse and reports difficulty sleeping because of cold feet. Which of the following nursing actions should the nurse take to promote the client's comfort? A. Rub the client's feet briskly for several minutes. B. Obtain a pair of slipper socks for the client. C. Increase the client's oral fluid intake. D. Place a moist heating pad under the client's feet. C. - A nurse is caring for a client is who is 4 hr postoperative following a transurethral resection of the prostate (TURP). Which of the following is the priority finding for the nurse report to the provider? A. Emesis of 100 mL B. Oral temperature of 37.5° C (99.5° F) C. Thick, red-colored urine D. Pain level of 4 on a 0 to 10 rating scale A. - A nurse is caring for a client who has a temperature of 39.7° C (103.5° F) and has a prescription for a hypothermia blanket. The nurse should monitor the client for which of the following adverse effects of the hypothermia blanket? A. Shivering B. Infection C. Burns D. Hypervolemia

D. - A nurse is reinforcing teaching about exercise with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will carry a complex carbohydrate snack with me when I exercise." B. "I should exercise first thing in the morning before eating breakfast." C. "I should avoid injecting insulin into my thigh if I am going to go running." D. "I will not exercise if my urine is positive for ketones." A. - A nurse notes a small section of bowel protruding from the abdominal incision of a client who is postoperative. After calling for assistance, which of the following actions should the nurse take first? A. Cover the client's wound with a moist, sterile dressing. B. Have the client lie supine with knees flexed. C. Check the client's vital signs. D. Inform the client about the need to return to surgery. B. - A nurse is collecting data from a client who has alcohol use disorder and is experiencing metabolic acidosis. Which of the following manifestations should the nurse expect? A. Cool, clammy skin. B. Hyperventilation C. Increased blood pressure D. Bradycardia A. - A nurse is reinforcing discharge teaching with a client following a cataract extraction. Which of the following should the nurse include in the teaching? A. Avoid bending at the waist. B. Remove the eye shield at bedtime. C. Limit the use of laxatives if constipated. D. Seeing flashes of light is an expected finding following extraction. C - A nurse is caring for a client who has heart failure and has been taking digoxin 0. mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take first?

  1. Suggest that the client rests before eating the meal.
  2. Request a dietary consult.
  3. Check the client's vital signs.
  4. Request an order for an antiemetic. D. - A nurse is caring for a client who is 3 days postoperative following a cholecystectomy. The nurse suspects the client's wound is infected because the drainage from the dressing is yellow and thick. Which of the following findings should the nurse report as the type of drainage found?
  5. Sanguineous
  6. Serous
  1. Altered level of consciousness
  2. Oral temperature of 37.7° C (100° C)
  3. Muscle spasms
  4. Headache A. - A nurse is assisting in the care of a client who is 2 hours postoperative following a wedge resection of the left lung and has a chest tube to suction. Which of the following is the priority finding the nurse should report to the provider?
  5. Abdomen is distended
  6. Chest tube drainage of 70 mL in the last hour
  7. Subcutaneous emphysema is noted to the left chest wall
  8. Pain level of 6 on a 0 to 10 scale A. - A nurse is reinforcing discharge teaching with a client about how to care for a newly created ileal conduit. Which of the following instructions should the nurse include in the teaching?
  9. Change the ostomy pouch daily.
  10. Empty the ostomy pouch when it is 2/3 full.
  11. Trim the opening of the ostomy seal to be 1/2 in. wider than the stoma.
  12. Apply lotion to the peristomal skin when changing the ostomy pouch. B. - A nurse is assisting in the plan of care for a client who had a removal of the pituitary gland. Which of the following actions should the nurse include in the plan?
  13. Position the client supine while in bed.
  14. Change the nasal drip pad as needed.
  15. Encourage frequent brushing of teeth.
  16. Encourage the client to cough every 2 hr following surgery. C. - A nurse is caring for a client who asks why she is being prescribed aspirin 325 mg daily following a myocardial infarction. The nurse should instruct the client that aspirin is prescribed for clients who have coronary artery disease for which of the following effects?
  17. To provide analgesia
  18. To reduce inflammation
  19. To prevent blood clotting
  20. To prevent fever A. - A nurse is collecting data from a client who has open-angle glaucoma. Which of the following findings should the nurse expect?
  21. Loss of peripheral vision
  22. Headache
  23. Halos around lights
  24. Discomfort in the eyes C. - A nurse is collecting data from a client who has acute gastroenteritis. Which of the following data collection findings should the nurse identify as the priority?
  1. Weight loss of 3% of total body weight.
  2. Blood glucose 150 mg/dL.
  3. Potassium 2.5 mEq/L
  4. Urine specific gravity 1. D. - A nurse is reinforcing discharge teaching with a client who had a total abdominal hysterectomy and a vaginal repair. Which of the following statements by the client indicates a need for further teaching?
  5. "I should increase my intake of protein and vitamin C."
  6. "I will no longer have menstrual periods."
  7. "Once I am able to resume sexual activity, I can use a water-based lubricant if I experience discomfort."
  8. "I will take a tub bath instead of a shower." B. - A nurse is assisting with the care of a client who has a femur fracture and is in skeletal traction. Which of the following actions should the nurse take?
  9. Loosen the knots on the ropes if the client is experiencing pain. 2) Ensure the client's weights are hanging freely from the bed.
  10. Check the client's bony prominences every 12 hr.
  11. Cleanse the client's pin sites with povidone-iodine. A. - A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been taking ferrous gluconate for several weeks. Which of the following instructions should the nurse include?
  12. Take this medication between meals.
  13. Limit intake of Vitamin C while taking this medication.
  14. Take this medication with milk.
  15. Limit intake of whole grains while taking this medication. A. - A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been taking ferrous gluconate for several weeks. Which of the following instructions should the nurse include?
  16. Take this medication between meals.
  17. Limit intake of Vitamin C while taking this medication. 3 ) Take this medication with milk.
  18. Limit intake of whole grains while taking this medication. C. - A nurse is reviewing the plan of care for a client who has cellulitis of the leg. Which of the following interventions should the nurse recommend?
  19. Apply topical antifungal agents.
  20. Apply fresh ice packs every 4 hr.
  21. Wash daily with an antibacterial soap.
  22. Keep draining lesions uncovered to air dry.
  1. Encourage the client to consume at least 2 L of fluid daily. C. - A nurse is reinforcing teaching about an esophagogastroduodenoscopy with a client who has upper gastric pain. Which of the following statements should the nurse include in the teaching?
  2. "A flexible tube is introduced through the nose during the procedure."
  3. "During the procedure you are in a sitting position."
  4. "You will remain NPO for 8 hours before the procedure."
  5. "You will be awake while the procedure is performed." C. - A nurse is caring for a client who is difficult to arouse and very sleepy for several hours following a generalized tonic-clonic seizure. Which of the following descriptions should the nurse use when documenting this finding in the medical record?
  6. Aura phase
  7. Presence of automatisms
  8. Postictal phase
  9. Presence of absence seizures C. - A nurse is reinforcing teaching with a client who reports right shoulder pain following a laparoscopic cholecystectomy. Which of the following statements should the nurse make?
  10. "The pain results from lying in one position too long during surgery."
  11. "The pain occurs as a residual pain from cholecystitis."
  12. "The pain will dissipate if you ambulate frequently."
  13. "The pain is caused from the nitrous dioxide injected into the abdomen." B. - A nurse is checking the suction control chamber of a client's chest tube and notes that there is no bubbling in the suction control chamber. Which of the following actions should the nurse take?
  14. Notify the provider.
  15. Verify that the suction regulator is on.
  16. Continue to monitor the client because this is an expected finding.
  17. Milk the chest tube to dislodge any clots in the tubing that may be occluding it. A, B - A nurse is assisting with the care of a client immediately following a lumbar puncture. Which of the following actions should the nurse take? (Select all that apply.)
  18. Encourage fluid intake.
  19. Monitor the puncture site for hematoma.
  20. Insert a urinary catheter.
  21. Elevate the client's head of bed.
  22. Apply a cervical collar to the client. D. - A nurse is assisting with the care of a client who is postoperative following surgical repair of a fractured mandible. The client's jaw is wired shut to repair and stabilize the fracture. The nurse should recognize which of the following is the priority action?
  1. Relieve the client's pain.
  2. Check the client's pressure points for redness.
  3. Provide oral hygiene.
  4. Prevent aspiration. D. - A nurse is collecting data from a client who has scleroderma. Which of the following findings should the nurse expect?
  5. A dry raised rash
  6. Excessive salivation
  7. Periorbital edema
  8. Hardened skin C. - A nurse is caring for an older adult client who has dysphagia and left-sided weakness following a stroke. Which of the following actions should the nurse take?
  9. Instruct the client to tilt her head back when she swallows.
  10. Place food on the left side of the client's mouth.
  11. Add thickener to fluids.
  12. Serve food at room temperature. A. - A nurse is caring for a client who has partial-thickness and full-thickness burns of his head, neck, and chest. The nurse should recognize which of the following is the priority risk to the client?
  13. Airway obstruction
  14. Infection
  15. Fluid imbalance
  16. Contractures A. - A nurse is reinforcing teaching with a client who is newly diagnosed with myasthenia gravis and is to start taking neostigmine. Which of the following instructions should the nurse include in the teaching?
  17. Take the medication 45 minutes before eating.
  18. Expect diaphoresis as a side effect of the neostigmine.
  19. If a medication dose is missed, wait until the next scheduled dose to take the medication.
  20. Treat nasal rhinitis with an over-the-counter antihistamine. A, D - A nurse is caring for a client who is 12 hours postoperative following a transurethral resection of the prostate (TURP) and has a 3-way urinary catheter with continuous irrigation. The nurse notes there has not been any urinary output in the last hour. Which of the following actions should the nurse perform first?
  21. Notify the provider.
  22. Administer a prescribed analgesic.
  23. Offer oral fluids.
  24. Determine the patency of the tubing.

D. - A nurse is preparing to provide morning hygiene care for a client who has Alzheimer's disease. The client becomes agitated and combative when the nurse approaches him. Which of the following actions should the nurse plan to take?

  1. Turn the water on and ask the client to test the temperature.
  2. Obtain assistance to place mitten restraints on the client.
  3. Firmly tell the client that good hygiene is important.
  4. Calmly ask the client if he would like to listen to some music. C. - A nurse is collecting data on a client's wound. The nurse observes that the wound surface is covered with soft, red tissue that bleeds easily. The nurse should recognize this is a manifestation of which of the following?
  5. Decreased perfusion
  6. Infection
  7. Granulation tissue
  8. An inflammatory response D. - A nurse is caring for a client who has multiple myeloma and has a WBC count of 2,200/mm3. Which of the following food items brought by the family should the nurse prohibit from being given to the client?
  9. Baked chicken
  10. Bagels
  11. A factory-sealed box of chocolates
  12. Fresh fruit basket D. - A nurse is contributing to the plan of care for an older adult client who is postoperative following a right hip arthroplasty. Which of the following interventions should the nurse include in the plan?
  13. Perform the client's personal care activities for her.
  14. Limit the client's fluid intake.
  15. Monitor the Homan's sign.
  16. Maintain abduction of the right hip. B. - A nurse is caring for a client who has heart failure and respiratory arrest. Which of the following actions should the nurse take first?
  17. Establish IV access.
  18. Feel for a carotid pulse.
  19. Establish an open airway.
  20. Auscultate for breath sounds. B. - A nurse is caring for a client scheduled for coronary artery bypass grafting who reports he is no longer certain he wants to have the procedure. Which of the following responses should the nurse make?
  21. "Why have you changed your mind about the surgery?"
  22. "Bypass surgery must be very frightening for you."
  23. "Your provider would not have scheduled the surgery unless you needed it."
  24. "I will call your doctor and have him discuss your surgery with you."

B. - A nurse is caring for a client who is postoperative following foot surgery and is not to bear weight on the operative foot. The nurse enters the room to discover the client hopped on one foot to the bathroom, using an IV pole for support. Which of the following actions should the nurse take?

  1. Walk the client back to bed immediately and get the client a bedpan.
  2. Tell the client to remain in the bathroom after toileting and obtain a wheelchair.
  3. Warn the client she might have to be restrained if she gets up without assistance.
  4. Keep the bathroom door open to ensure the client is okay. A. - A nurse is assisting with the care of a client who is postoperative and has a closed- wound drainage system in place. Which of the following actions should the nurse take?
  5. Fully recollapse the reservoir after emptying it.
  6. Empty the reservoir once per day.
  7. Replace the drainage plug after releasing hand pressure on the device.
  8. Irrigate the tubing with sterile normal saline solution at least once every 8 hr. B. - A nurse is reinforcing discharge instructions with a client who has hepatitis A. Which of the following statements by the client indicates an understanding of the teaching?
  9. "I will not eat fried foods."
  10. "I will abstain from sexual intercourse."
  11. "I will refrain from international travel."
  12. "I will not order a salad in a restaurant." C. - A nurse is reinforcing discharge teaching on actions that improve gas exchange to a client diagnosed with emphysema. Which of the following instructions should be included in the teaching?
  13. Rest in a supine position.
  14. Consume a low-protein diet.
  15. Breathe in through her nose and out through pursed lips.
  16. Limit fluid intake throughout the day. B. - A nurse is caring for a client who is postoperative and has a history Addison's disease. For which of the following manifestations should the nurse monitor?
  17. Hypernatremia 2) Hypotension
  18. Bradycardia
  19. Hypokalemia A, B, E - A nurse is reinforcing pre-operative teaching for a client who is scheduled for surgery and is to take hydroxyzine preoperatively. Which of the following effects of the medication should the nurse include in the teaching? (Select all that apply.)
  20. Decreasing anxiety 2) Controlling emesis
  21. Relaxing skeletal muscles
  22. Preventing surgical site infections
  23. Reducing the amount of narcotics needed for pain relief

D. - A nurse is assisting with caring for a client who has a new concussion following a motor-vehicle crash. The nurse should monitor the client for which of the following manifestations of increased intracranial pressure?

  1. Polyuria
  2. Battle's sign
  3. Nuchal rigidity
  4. Lethargy D. - A nurse is reinforcing teaching about a tonometry examination with a client who has manifestations of glaucoma. Which of the following statements should the nurse include in the teaching?
  5. "Tonometry is performed to evaluate peripheral vision."
  6. "This test will diagnose the type of your glaucoma."
  7. "Tonometry will allow inspection of the optic disc for signs of degeneration."
  8. "This test will measure the intraocular pressure of the eye." B. - A nurse is reviewing the laboratory results of a client who is taking cyclosporine following a kidney transplant. Which of the following laboratory findings should the nurse identify as the most important to report to the provider?
  9. Increase in serum glucose
  10. Increase in serum creatinine
  11. Decrease in white blood cell count
  12. Decrease in platelets D. - A nurse is checking for paradoxical blood pressure on a client who has constrictive pericarditis. Which of the following findings should the nurse expect?
  13. Apical pulse rate different than the radial pulse rate
  14. Increase in heart rate by 20% when standing
  15. Drop in systolic BP by 20 mm Hg when moving from a lying to a sitting position
  16. Drop in systolic BP more than 10 mm Hg on inspiration A. - A nurse is caring for a client who has Alzheimer's disease. The nurse discovers the client entering the room of another client, who becomes upset and frightened. Which of the following actions should the nurse take?
  17. Attempt to determine what the client was looking for.
  18. Explain the client's Alzheimer's diagnosis to the frightened client.
  19. Reprimand the client for invading the other client's privacy.
  20. Ask the client to apologize for his behavior. A. - A nurse is caring for a client immediately following a cardiac catheterization with a femoral artery approach. Which of the following actions should the nurse take?
  21. Check pedal pulses every 15 min.
  22. Perform passive range-of-motion for the affected extremity.
  23. Remind the client not to turn from side to side.
  24. Keep the client in high-Fowler's position for 6 hr.

C. - A nurse is assisting with planning an immunization clinic for older adult clients. Which of the following information should the nurse plan to include about influenza?

  1. Individuals at high risk should receive the live influenza vaccine.
  2. Immunization for influenza should be repeated every 10 years.
  3. The composition of the influenza vaccine changes yearly.
  4. The influenza vaccine is necessary only for clients who have never had influenza. C. - A nurse is caring for an older adult client who has colon cancer. The client asks the nurse several questions about his treatment plan. Which of the following actions should the nurse take?
  5. Tell the client to have a family member call the provider to ask what options he plans to recommend.
  6. Assure the client that the provider will tell him what is planned.
  7. Help the client write down questions to ask his provider.
  8. Provide the client with a pamphlet of information about cancer. C. - A nurse is caring for a client who has hemiplegia following a stroke. The client's adult son is distressed over his mother's crying and condition. Which of the following responses should the nurse make?
  9. "If you just sit quietly with your mother, I'm sure she will calm down."
  10. "I'll talk with your mother and see if I can comfort her."
  11. "It must be hard to see your mother so ill and upset."
  12. "Your mother's crying seems to bother you more than it does her." B. - A nurse is reinforcing teaching with the family of a client who has primary dementia. Which of the following manifestations of dementia should the nurse include in the teaching?
  13. Temporary, reversible loss of brain function
  14. Forgetfulness gradually progressing to disorientation
  15. Sleeping more during the day than nighttime
  16. Hyper vigilant behaviors B. - A nurse is contributing to the plan of care for a client who has labyrinthitis. Which of the following interventions should the nurse include in the plan?
  17. Limit fluid intake..
  18. Monitor client's cardinal fields of vision.
  19. Encourage ambulation.
  20. Ensure the room is brightly lit. B. - A nurse is contributing to the plan of care for a client who is admitted with a deep vein thrombosis (DVT) of the left leg. Which of the following interventions should the nurse include in the plan?
  21. Apply ice to the extremity
  22. Monitor platelet levels
  23. Restrict oral fluids
  24. Administer vasodilating medications

A. - A nurse is caring for a client newly diagnosed with ovarian cancer. Which of the following reactions from the client should the nurse initially expect?

  1. Denial
  2. Bargaining
  3. Acceptance
  4. Anger D. - A nurse is contributing to the plan of care for a client who is postoperative following peritoneal lavage for peritonitis. The client has a nasogastric tube to low-intermittent suction and closed-suction drains in place. Which of the following interventions should the nurse include in the plan?
  5. Irrigate the nasogastric tube with tap water.
  6. Mark abdominal girth once daily.
  7. Ambulate the client twice daily.
  8. Place the client in a high Fowler's position. C. - A nurse is caring for a client who is receiving hemodialysis. Which of the following client measurements should the nurse compare before and after dialysis treatment to determine fluid losses?
  9. Neck vein distention
  10. Blood pressure
  11. Body weight
  12. Abdominal girth C. - A nurse is caring for a client who is receiving a unit of packed RBCs. About 15 min following the start of the transfusion, the nurse notes that the client is flushed and febrile, and reports chills. To help confirm that the client is having an acute hemolytic transfusion reaction, the nurse should observe for which of the following manifestations?
  13. Urticaria
  14. Muscle pain
  15. Hypotension
  16. Distended neck veins B. - A nurse is caring for a client who has a seizure disorder and reports experiencing an aura. The nurse should recognize the client is experiencing which of the following conditions?
  17. A continuous seizure state in which seizures occur in rapid succession
  18. A sensory warning that a seizure is imminent
  19. A period of sleepiness following the seizure during which arousal is difficult
  20. A brief loss of consciousness accompanied by staring D. - A nurse is caring for a client who just had cataract surgery. Which of the following comments from the client should the nurse report to the provider?
  21. "The bright light in this room is really bothering me."
  1. "My eye really itches, but I'm trying not to rub it."
  2. "It's really hard to see with a patch on one eye."
  3. "I need something for the horrible pain in my eye." C. - A nurse is caring for a client who is scheduled for a colonoscopy. The client asks the nurse if there will be a lot of pain during the procedure. Which of the following responses should the nurse make?
  4. "You shouldn't feel any pain since the local area is anesthetized."
  5. "Most clients report more discomfort from the preparation than from the procedure itself."
  6. "You may feel some cramping during the procedure."
  7. "Don't worry; you won't remember anything about the procedure due to the effects of the medication." B. - A nurse caring for a client at risk for increased intracranial pressure is monitoring the client for manifestations that indicate that the pressure is increasing. To do this, the nurse should check the function of the third cranial nerve by performing which of the following data-collection activities?
  8. Observing for facial asymmetry
  9. Checking pupillary responses to light
  10. Eliciting the gag reflex
  11. Testing visual acuity A. - A nurse is caring for a client during the immediate postoperative period following thoracic surgery. When administering an opioid analgesic for pain, the nurse should explain that the medication should have which of the following effects?
  12. Reducing anxiety
  13. Increasing blood pressure
  14. Increasing coughing
  15. Increasing the client's respiratory rate A. - A nurse is collecting data on a client who has hyperthyroidism. Which of the following manifestations should the nurse expect the client to report?
  16. Frequent mood changes
  17. Constipation
  18. Sensitivity to cold
  19. Weight gain D. - A nurse is collecting data from a client who has skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites?
  20. Serosanguineous drainage
  21. Mild erythema
  22. Warmth
  23. Fever
  1. "This medication will boost my immune system." C. - A nurse is caring for a client who has Parkinson's disease and is taking selegiline 5 mg by mouth twice daily. Which of the following therapeutic outcomes should the nurse monitor for with a client who is taking this medication?
  2. Improved speech patterns
  3. Increased bladder function.
  4. Decreased tremors
  5. Diminished drooling B. - A nurse is assisting in the care of a client who is receiving a transfusion of packed red blood cells. The client develops itching and hives. Which of the following actions should the nurse take first?
  6. Obtain vital signs.
  7. Stop the transfusion.
  8. Notify the registered nurse.
  9. Administer diphenhydramine. A. - A nurse is reinforcing teaching with a client about how to prevent the onset of manifestations of Raynaud's phenomenon. Which of the following statements should the nurse identify as an indication that the client needs further teaching?
  10. "I will keep my house at a cool temperature."
  11. "I will try to anticipate and avoid stressful situations."
  12. "I will complete the smoking cessation program I started."
  13. "I will wear gloves when removing food from the freezer." A. - A nurse is reinforcing teaching with a client who has iron deficiency anemia and is to start taking ferrous sulfate twice a day. Which of the following statements by the client indicate an understanding of the teaching?
  14. "I will take the medication with orange juice."
  15. "I should expect to have loose stools while taking this medication."
  16. "I will have clay colored stools while taking this medication."
  17. "I should take the medication with milk." A. - A nurse is reinforcing teaching about pernicious anemia with a client following a total gastrectomy. Which of the following dietary supplements should the nurse include in the teaching as the treatment for pernicious anemia?
  18. Vitamin B
  19. Vitamin C
  20. Iron
  21. Folate B. - A nurse is caring for a client who is scheduled for surgical repair of a femur fracture and has a prescription for lorazepam preoperatively. Which of the following statements by the client should indicate to the nurse that the medication has been effective?
  22. "My mouth is very dry."
  1. "I feel very sleepy."
  2. "I am not hungry any longer."
  3. "My leg feels numb." C. - A nurse is collecting data from a client who has AIDS. When checking the client's mouth, the nurse notes a white, creamy covering on the tongue and buccal membranes. The nurse should recognize this is a manifestation of which of the following conditions?
  4. Xerostomia
  5. Gingivitis
  6. Candidiasis
  7. Halitosis A. - A nurse is caring for a client who is postoperative open reduction and internal fixation with placement of a wound drain to repair a hip fracture. Which of the following actions should the nurse take?
  8. Empty the suction device every 4 hr.
  9. Monitor circulation on the affected extremity every 2 hr for the first 12 hr.
  10. Position the client's hip so that it is internally rotated.
  11. Encourage foot exercises every 4 hr. B. - A nurse is assisting with teaching a client who has a history of smoking about recognizing early manifestations of laryngeal cancer. The nurse should instruct the client to monitor and report which of the following manifestations of laryngeal cancer?
  12. Aphagia
  13. Hoarseness
  14. Tinnitus
  15. Epistaxis D. - A nurse is collecting data from a client who has systemic lupus erythematosus (SLE). Which of the following laboratory values should the nurse review to determine the client's renal function?
  16. Antinuclear antibody
  17. C-reactive protein
  18. Erythrocyte sedimentation rate
  19. Serum creatinine A. - A nurse is collecting data from a client who has Cushing's syndrome. Which of the following manifestations should the nurse expect?
  20. Bruising
  21. Weight loss
  22. Hyperpigmentation
  23. Double vision C. - A nurse is caring for a client who is postoperative and requesting something to drink. The nurse reads the client's postoperative prescriptions, which include, "Clear