RN VATI Adult Medical Surgical Practice Questions, Exams of Medical Sciences

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(2020/2021) Question 90 loaded rationals provided

Question:

A nurse is caring for a client who has atopic dermatitis and a prescription for triamcinolone ointment. The nurse should assess the client to monitor for which of the following adverse effects?

Increased pigmentation

Topical glucocorticoid therapy can cause the adverse effect of hypopigmentation.

Localized hair loss

Long-term glucocorticoid therapy can cause hypertrichosis, or excessive hair growth, especially on the facial area.

Thinning of the skin MY ANSWER

Thinning of the skin and delayed healing are adverse effects of topical glucocorticoid preparations. The client should only apply the ointment to dry patches of the skin because topical steroids can cause atrophy of the dermis and epidermis, which can result in thinning of the skin.

Increased sensitivity to the sun

The nurse should instruct the client to avoid excessive sun exposure when taking topical fluticasone; however, triamcinolone ointment does not cause photosensitivity.

 RN VATI Adult Medical Surgical 2019 Question^ CLOSE 89 loaded rationals provided

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Hg. Which of the following acid-base imbalances should the nurse identify that the client is experiencing?

Respiratory alkalosis MY ANSWER

This pH is alkaline (increased) and the PCO 2 is decreased, representing alveolar hyperventilation and resultant respiratory alkalosis. Respiratory acidosis This pH is alkaline (increased) and the PCO 2 is decreased. A decreased pH and an increased PCO 2 indicate respiratory acidosis. Metabolic alkalosis This HCO 3 -^ 24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline (increased). An increased pH and HCO 3 -^ indicate metabolic alkalosis. Metabolic acidosis This HCO 3 -^ 24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline (increased). A decreased pH and HCO 3 -^ indicate metabolic acidosis.

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A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect?

Vitiligo

Vitiligo is the loss of pigment from areas of a client's skin, causing irregular, white patches. Vitiligo is a manifestation of adrenal-gland hypofunction.

Osteoporosis MY ANSWER

Osteoporosis is a common finding with Cushing's syndrome. Bones become thinner as a result of mineral loss and nitrogen depletion, and the risk for fractures increases.

Myxedema

A client who has hypothyroidism can develop myxedema that causes mucinous cellular edema around the eyes, across the upper back, and in the hands and feet.

Heat intolerance

A client who has hyperthyroidism can develop heat intolerance, along with an increase in sweating.

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A nurse is inspecting the skin of a client who has basal cell carcinoma. The nurse should identify which of the following lesion characteristics on the client's skin?

A pearly, waxy nodule MY ANSWER

A client who has basal cell carcinoma has a nodular lesion with well-defined borders and a pearly or waxy appearance, resulting from overexposure to the sun, especially on the face, head, and neck.

An irregular border on a variegated-colored lesion

A client who has melanoma has a lesion with irregular borders and variegated colors of red, white, and blue, most often on the upper back or lower legs.

A firm, nodular, crusty, or ulcerated lesion

A is correct. The nurse should tap the client's cheek just in front of the ear and below the zygomatic arch. The client who has hypocalcemia will display a Chvostek's sign, which is a twitching of the facial muscle.

B is incorrect. The nurse should apply upward pressure at the supraorbital ridge, below the eyebrow, to assess for tenderness and inflammation of the frontal sinuses.

C is incorrect. The nurse should palpate the jaw and mastoid muscle of a client who has temporomandibular joint dysfunction. This can be caused by misaligned teeth, arthritis, or grinding of the teeth. With palpation, the nurse might feel a click, pop, or grating sensation when the client opens or closes the jaw.

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A nurse in an emergency department is assessing a client who is overusing prescribed diuretics and has a sodium level of 127 mEq/L. Which of the following laboratory findings should the nurse expect?

High lipase

A high lipase level is associated with pancreatic dysfunction or renal failure and is not an expected finding with hyponatremia or dehydration.

Low urine specific gravity MY ANSWER

A client who has hyponatremia as a result of diuretic overuse has a low urine specific gravity. The increased excretion of water alters the ratio of particulate matter, which affects the specific gravity.

Low hemoglobin

A client who is dehydrated as a result of diuretic overuse can have an elevated hemoglobin level because of the difference in ratio between intravascular fluid and blood cells.

High creatine kinase-MB (CK-MB)

An elevated CK-MB level indicates a myocardial infarction and is not an expected finding with hyponatremia.

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A nurse is caring for a client who has developed acute respiratory distress syndrome (ARDS). Which of the following findings should the nurse identify as a manifestation of this syndrome?

An audible pleural friction rub

A client who has a pulmonary embolism can have a pleural friction rub along with tachypnea, tachycardia, dyspnea, and sudden, sharp chest pain. However, a pleural friction rub is not a manifestation of ARDS.

Tracheal deviation from the midline

A client who has a tension pneumothorax can have tracheal deviation with dyspnea, tachycardia, and tachypnea. On auscultation, breath sounds over the area of the pneumothorax are decreased or absent. However, tracheal deviation is not a manifestation of ARDS.

Refractory hypoxemia MY ANSWER

ARDS is a systemic inflammatory response to trauma, sepsis, burns, pancreatitis, and blood transfusions, when excess lung fluid dilutes surfactant activity in the lungs. A client who has ARDS has refractory hypoxemia, which is hypoxemia that does not improve with oxygen therapy. Extensive pulmonary edema evident on a chest x-ray is a manifestation of ARDS.

Bloody expectorant when coughing

A client who has lung cancer or laryngeal trauma can have hemoptysis. However, bloody expectorant is not a manifestation of ARDS.

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An emergency room nurse is assessing a client who has asthma and difficulty breathing. Which of the following findings should indicate to the nurse that the client is experiencing status asthmaticus?

Coughing

Status asthmaticus causes labored breathing and wheezing. Coughing indicates that the client is exchanging air and is a manifestation of pneumonia, not status asthmaticus.

Flat neck veins

A client who has status asthmaticus has distended neck veins while trying to facilitate breathing due to increased pulmonary pressure.

Use of accessory muscles MY ANSWER

A client who has status asthmaticus uses accessory muscles to help facilitate breathing, which is a manifestation of a severe airflow obstruction. The situation is life-threatening and the nurse should intervene immediately with strong systemic bronchodilators, epinephrine, corticosteroids, and oxygen.

Presence of coarse crackles

The presence of coarse crackles indicates air movement through fluid-filled airways and is a manifestation of pneumonia, not status asthmaticus.

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A nurse is teaching a client who has a new prescription for phenytoin to treat a seizure disorder. Which of the following adverse effects should the nurse instruct the client to report immediately to the provider?

Oral temperature of 37.2° C (99° F)

The nurse should expect a slight elevation of the client's temperature postoperatively. However, an increased temperature elevation or a spike can indicate an infection.

Clear drainage on the dressings

The nurse should identify clear drainage on or around the dressing as an indication of a cerebral spinal leak and should report this finding to the provider immediately.

Drain output 75 mL in 4 hr

The nurse should expect the client to have no more than 125 mL of drain output in 4 hr.

Decreased bowel sounds in all quadrants of the abdomen MY ANSWER

The nurse should expect decreased bowel sounds when caring for a client following a laminectomy due to anesthesia and pain medication. The nurse should continue to monitor the client to assess for a paralytic ileus.

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A nurse is assessing a client who has right-sided heart failure. Which of the following findings should the nurse identify as a manifestation of right-sided heart failure?

S 3 gallop An S 3 /S 4 summation gallop is an expected finding with left-sided heart failure due to pulmonary congestion and increased left ventricular pressure that causes a decrease in cardiac output and poor tissue perfusion.

Weak peripheral pulses Weak peripheral pulses are an expected finding with left-sided heart failure due to decreased cardiac output. Increased abdominal girthMY ANSWER Increased abdominal girth is an expected finding with right-sided heart failure due to systemic congestion and an enlarged liver and spleen. Systemic congestion can lead to fluid retention and increased pressure in the venous system, which can manifest with edema in the lower extremities. Wheezing Wheezing is an expected finding with left-sided heart failure due to pulmonary congestion and systolic dysfunction.

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A nurse is caring for a client who recently assumed the role of caregiver for their aging parents who have chronic illnesses. The nurse should identify that which of the following statements by the client indicates acceptance of the role change?

"I changed the floor plan of our home to accommodate my father's wheelchair."

The nurse should identify that the client has accepted the role change of caring for their aging parents by changing the floor plan of the home to accommodate their father's wheelchair.

"I'm so stressed out that it makes it difficult for me to manage everything."

This response indicates role overload because the client is feeling overwhelmed with having to care for their aging parents.

"At times, I get so frustrated with how to care for my parents."

This response indicates role strain, in which the client feels unsure and frustrated about caring for their aging parents. Feelings of inadequacy can also occur with role strain.

Polyuria is not a manifestation of an infusion reaction to vancomycin. However, vancomycin can cause renal failure.

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A nurse is caring for a male client who has a new prescription for cyclosporine following a kidney transplant. Which of the following findings should the nurse identify as an adverse effect of this therapy?

WBC count 8,000/mm^3 A WBC count of 8,000/mm<sup3< sup=""> is within the expected reference range of 5,000 to 10,000/mm^3. If the client develops leukopenia, the nurse should notify the provider because the client is at risk for infection when taking an immunosuppressant such as cyclosporine.</sup3<> RBC count 6 million/mm^3 An RBC count of 6 million/mm^3 is within the expected reference range of 4.7 to 6.1 million/mm^3 for men and 4.2 to 5.4 million/m^3 for women. If the client's RBC count decreases, the nurse should notify the provider because the client is at risk for bleeding following an organ transplant. BUN 24 mg/dLMY ANSWER A BUN of 24 mg/dL is above the expected reference range of 10 to 20 mg/dL, indicating renal impairment. An adverse effect of cyclosporine is nephrotoxicity. The nurse should monitor the client for increases in BUN and creatinine and report any elevation to the provider. A rise in BUN could indicate transplant rejection. Potassium 3.5 mEq/L A potassium level of 3.5 mEq/L is within the expected reference range of 3.5 to 5 mEq/L and does not indicate nephrotoxicity. However, the nurse should report a dramatic change in potassium level to the provider.

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A nurse is caring for a client who has dumping syndrome following a gastric resection. The nurse should monitor the client for which of the following complications of dumping syndrome?

Weight gain

Anorexia can result from dumping syndrome because the client can easily become reluctant to eat to avoid the unpleasant manifestations of this syndrome, resulting in weight loss.

Iron-deficiency anemia MY ANSWER

The nurse should monitor the client for manifestations of anemia, such as pallor, tachycardia, and fatigue. Rapid emptying of the stomach contents into the intestine can lead to reduced absorption of iron in the duodenum, causing iron-deficiency anemia.

Hypercalcemia

Hypocalcemia, rather than hypercalcemia, is a manifestation of dumping syndrome due to rapid gastric emptying.

Reduced heart rate

Nausea, abdominal cramping, and tachycardia are manifestations of dumping syndrome due to rapid gastric emptying.

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"If I can keep my hemoglobin A1C less than 6.5%, I will be cured of diabetes."

Tight control of blood glucose levels can minimize complications associated with diabetes mellitus such as cardiovascular disease, nephropathy, neuropathy, and retinopathy. The nurse should instruct the client that type 1 diabetes mellitus is a chronic condition that causes the body to fail to manufacture insulin and cannot currently be cured.

"I will check my blood sugar level before exercising." MY ANSWER

Clients who have diabetes mellitus should not exercise if their blood glucose level is less than 80 mg/dL or greater than 250 mg/dL. A client who has type 1 diabetes mellitus and is hyperglycemic can experience even higher blood glucose levels. Hypoglycemia can also occur during exercise and up to 24 hr following exercise. The nurse should instruct the client to monitor blood glucose levels before, during, and following exercise.

"I should have my eyes checked every 2 years."

Microvascular changes to the vessels in the eyes occurs with elevated blood glucose levels, which can lead to retinopathy. To monitor for changes to the eyes, the client should have eye examinations every year.

"I should soak my feet daily in warm, soapy water."

Health promotion activities for a client who has diabetes mellitus includes foot care. Clients should inspect their feet and wash them daily with warm water and soap. However, clients should not soak their feet because this can lead to maceration of the skin and skin breakdown.

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A nurse is providing teaching to a client who has a new prescription for warfarin. Which of the following medications should the nurse instruct the client to avoid? (Select all that apply.)

Ferrous sulfate

Echinacea

Aspirin

Dextromethorphan

Naproxen MY ANSWER

Ferrous sulfate is incorrect. Ferrous sulfate is an iron supplement and has no known interaction with warfarin.

Echinacea is incorrect. Echinacea is a supplement that a client might take to improve the immune system and has no known interaction with warfarin.

Aspirin is correct. Aspirin is an antiplatelet medication. It can increase the risk of bleeding when taken with warfarin.

Dextromethorphan is incorrect. Dextromethorphan is a cough suppressant and has no known interaction with warfarin.

Naproxen is correct. Naproxen is an NSAID that relieves mild to moderate pain. It can increase the risk of bleeding if taken with warfarin.

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