The nurse suspects carpal tunnel syndrome

Med Surge Final Exam

1…. A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of following values?

Rational
Endometriosis is a condition in which the type of tissue that lines the uterus implants in locations outside the uterus. This typically causes pelvic pain around the time of the menstrual period but can cause pain at other times in the cycle. The discomfort is often unrelieved by the use of NSAIDs.

3…. A rehabilitation nurse is caring for a client who has had a spinal cord injury that resulted in paraplegia. After a week on the unit, the nurse notes that the client is withdrawn and increasingly resistant to rehabilitative efforts by the staff. Which of the following actions should the nurse take?

Rational
An escharotomy is a surgical incision made to release pressure and improve circulation in a part of the body that has a deep burn and is experiencing excessive swelling. Burn injuries that encircle a body part, such as an arm or the chest, can cause swelling and tightness in the affected area, resulting in reduced circulation. Making surgical incisions into the burned tissue allows the skin to expand, reduces tightness and pressure, and improves circulation.

5….A nurse is caring for a client who has suspected cholecystitis. The nurse should expect the client's urine to appear which of the following colors?

Rational
Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.

7….A nurse is providing dietary teaching to a client who has a history of recurring calcium oxalate kidney stones. Which of the following instructions should the nurse include in the teaching?

Rational
The nurse should expect excessive thrombosis and bleeding of mucous membranes because both DIC impairs both coagulation and anticoagulation pathways.

9….A nurse is caring for a middle adult client who has just received the diagnosis of endometrial cancer. In taking a nursing history, which of the following
manifestations is likely to be reported by this client?

A room with air exhaust directly to the outdoor environment

Rational
A room with air exhaust directly to the outside environment eliminates contamination of other client-care areas. This type of ventilation system is referred to as an airborne infection isolation room.

Obesity is incorrect. Women who are obese have a greater capacity for storing estrogen to help maintain acceptable levels of calcium.

Aging is correct. Women lose bone due to estrogen depletion after menopause.

Rational

Although the Mantoux (skin test) and the chest x-ray may be useful screening tools for TB, the presence of acid-fast bacillus noted in the client's sputum, secretions, or tissues is the only method that can actually confirm the diagnosis.

Barrel chest is correct. Clients with emphysema lose lung elasticity; the diaphragm becomes permanently flattened by hyperinflation of the lungs; the muscles of the rib cage become rigid; and the ribs flare outward. This produces the barrel chest typical of emphysema clients.

Clubbing of the fingers is correct. Clubbing results from chronic low arterial-oxygen levels. The tips of the fingers enlarge and the nails become extremely curved from front to back.

inhalation injury. The nurse should inspect the mouth and throat for soot and swelling. Using the airway, breathing, circulation (ABC) priority-setting framework, is the priority concern at this time

17…A nurse is planning care for a client who is being treated with chemotherapy and radiation for metastatic breast cancer, and who has neutropenia. The nurse should include which of the following restrictions in the client's plan of care?

19…A nurse is providing preoperative teaching for a client who is scheduled for a gastrectomy. Which of the following information regarding prevention of postoperative complications should the nurse include in in the teaching?

Instruct the client about the use of a sequential compression device.

21…During a routine physical examination, a nurse observes a 1-cm (0.4-in) lesion on a client's chest. The lesion is raised and flesh-colored with pearly white borders. The nurse should recognize that this finding is suggestive of which of the following types of skin cancer?

Basal cell carcinoma

23…A nurse is teaching a client who has hepatitis A about preventing transmission of the virus. Which of the following strategies should the nurse include in the teaching?

Practice effective hand hygiene.

Rational
Increased heart rate is correct. The nurse should expect the client who has fluid volume excess to have tachycardia and increased cardiac contractility in response to the excess fluid.

Increased blood pressure is correct. The nurse should expect the client who has fluid volume excess to have increased blood pressure and bounding pulse in response to the excess fluid.

It is caused by the lack of production of aldosterone by the adrenal gland.

Rational
Addison's disease is caused by a lack of production of the adrenocorticotropic hormones (cortisol and aldosterone) by the adrenal gland

27…A nurse is teaching a newly licensed nurse about the purpose of a CA 125 test.

Which of the following statements should the nurse include in the teaching? A CA 125 test is used to monitor a client's progress during treatment of ovarian cancer.

Heart rate

Rational
When a client's circulating fluid volume is low, the heart rate increases to maintain adequate blood pressure. Therefore, the nurse should identify a decrease in heart rate as in indication of adequate fluid replacement

31…A nurse is providing discharge teaching to a client who has a new
arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

Cold and numb numbness distal to the fistula site
Pallor and numbness distal to the fistula site are possible indicators of venous insufficiency and should be immediately reported to the provider.

As soon as the nurse can prepare the client and the administration set

Rational
The nurse should infuse the blood as soon as possible and complete the procedure within 4 hr.

36…A nurse is instructing a client how to decrease the nausea associated with chemotherapy and radiation. Which of the following statements indicates an understanding of the teaching?

I will eat foods that are served at room temperature.

Musculoskeletal pain

Rational
The client who is experiencing musculoskeletal pain should notify the provider. Musculoskeletal pain is a common adverse effect that affects 50% of clients that is possibly caused from estrogen deprivation

Poor

Rational
At this advanced stage, the prognosis for ovarian cancer is poor. Ovarian cancer is the leading cause of death from female reproductive cancers. Survival rates are low because it is not often discovered until its late stages.

Establish the ability to communicate effectively.

Rational

44…A nurse is teaching a newly licensed nurse about gynecological examination. Which of the following information should the nurse include in the teaching? The urethral orifice is assessed by separating the labia minora.

Rational
The urethral orifice, clitoris, and vaginal orifice are examined for lesions, inflammation, and discharge by separating the labia minora.

the time while at work. The nurse suspects carpal tunnel syndrome. Which of the following tests should the nurse request that the client perform?
Hold the wrist at a 90-degree flexion.

Rational
Carpal tunnel syndrome is the compression of the median nerve at the wrist. The condition is common in people who perform repetitive motions of the hand and wrist, such as typing. Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand, and bending the wrist at a 90-degree flexion will usually result in numbness, tingling, or weakness

Feces can be present in the vagina.

Rational
The presence of feces in the vagina is a manifestation of a genital fistula. This statement indicates a need for further teaching.

50…A nurse is assessing a client's wound dressing, and observes a watery red drainage. The nurse should document this drainage as which of the following?

Serosanguineous

52…A nurse is teaching a client about preventing osteoporosis. Which of the following statements by the client indicates a need for further teaching? I will reduce my intake of vitamin K-rich foods.

Rational
Vitamin K is necessary for bone health. The nurse should instruct the client to increase her intake of vitamin K-rich foods—such as green, leafy vegetables—to promote bone health

An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner.

Rational
The nurse should instruct the client that many clients report being disconcerted by the loud thumping and humming noises produced by the scanner, and for that reason, earplugs are offered to reduce the discomfort

Cheyne-Stokes respirations

Rational
Cheyne-Stokes respirations (CSR) are characterized by a rhythmic increase (to the point of hyperventilation) and decrease (to the point of apnea) in the rate and depth of respiration. CSR are common respiratory alterations seen in clients who are unconscious, comatose, or moribund (approaching death).

Rational
A lack of bubbling may indicate that either the suction regulator is turned off or that there is a leak in the tubing.

59…A nurse is caring for a client who has a severe gangrenous infection of the right lower extremity. The nurse should plan preoperative teaching based on the possibility of which of the following amputation procedures?

Rational
The BRCA1 gene is used to determine the probability of a client developing breast cancer. BRCA1 genetic testing is used for women who have a strong family history of breast cancer

61…A nurse is planning a teaching session about hysterosalpingography for a client who has a diagnosis of infertility. The nurse should include which of the following information in the teaching plan?

Rational
Women with a history of breast cancer should be counseled against using HT.

63…A nurse is planning care for a client who has immunosuppression following chemotherapy. Which of the following interventions should the nurse include in the plan of care?

Rational
The client should follow standard precautions and use a 1:10 solution of bleach to disinfect areas that come into contact with blood and body fluids.

65…A nurse is caring for four hospitalized clients. Which of the following clients should the nurse identify as being at risk for fluid volume deficit?
The client who has gastroenteritis and is febrile.

67…A nurse is caring for a client who is receiving cisplatin to treat bladder cancer. After several treatments, the client reports fatigue. Which of the following actions should the nurse take?

Check the results of the client's most recent CBC

69…A nurse is caring for a client who is HIV positive and is one day postoperative following an appendectomy. The nurse should wear a gown as personal protective equipment when taking which of the following actions?

Completing a dressing change

71…A nurse is planning a presentation about HIV for a church-based group. Which of the following information about HIV transmission should the nurse include?

It is primarily transmitted through direct contact with infected body fluids.