RNSG 1343 Week 12 Medical surgical Assignment Exam. Questions With 100% Correct Answers.A client is admitted to the hospital with a traumatic braininjury
... [Show More] after his head violently struck a brick wall during a gang fight. Which finding
is most important for the nurse to assess further?
A. A scalp laceration oozing blood.
B. Headache rated "10" on a 0-10 scale.
C. • Serosanguineousnasal drainage. Correct
D. Dizziness, nausea and transient confusion.
ID: 20127808242
Any nasal discharge following a head injury should be evaluated to determine the presence of cerebral spinal fluid which would indicate a tear in the
dura making the client susceptible to meningitis.
Awarded 1.0 points out of 1.0 possible points.
2. A couple trying to cope with an infertility problem wants to know what can be done to preserve emotional equilibrium. What is the best
response for the nurse to provide?
A. "Start adoption proceedings immediately since obtaining an infant is very difficult."
B. "Tell your friends and family so that they can help you."
C. "Talkonly to other friends who are infertile since only they canhelp."
D. • "Get involved with a support group. I will give you some names." Correct
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A support group provides a safe haven for the couple to share their feelings and experience, gain insight from others dealing with the same
experience, and assure the couple that they are not alone in their situation.
Awarded 1.0 points out of 1.0 possible points.
3. When teaching a client with breast cancer about the prescribed radiation therapy for treatment, what information is important to include?
A. There is a possibility of long bone pain.
B. Permanent pigment changes to the breast may result.
C. • Dry, itchy skin changes may occur. Correct
D. A low-residue diet may be prescribed to reduce the likelihood ofdiarrhea.
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Side effects from radiation to the breast most often include temporary skin changes such as dryness, tenderness, redness, swelling, and pruritus.
Awarded 1.0 points out of 1.0 possible points.
4. A female client is recently diagnosed with Sarcoidosis. The client tells the registered nurse (RN) that she does not understand why she has ID: 20127809216
this. When teaching the client, the RN should include that sarcoidosis most commonly occurs with which ethnic group ofwomen?
A. Hispanic women.
B. Asian women.
C. Caucasian women.
D. • African American women. Correct
Sarcoidosis, an autoimmune inflammatory disease affecting multiple organs and has shown familial tendency due to multiple genes that together
increase the susceptibility of developing the disease. In research studies it occurs more commonly in African American women (10-80 out of
100,000); compare to Caucasian women of the United States (8 out of 100,000).
Awarded 1.0 points out of 1.0 possible points.
5. A male client with a prostatic stent is preparing for discharge. Which information is most important for the nurse to provide the client prior to ID: 20127806683
discharge?
A. The client should not undergo magnetic resonance imaging.
B. Increased frequency of assessment for prostatic cancer is needed.
C. • The client should not be catheterized through the stent for at least three months. Correct
D. Ongoing antibiotic therapy is needed for one year.
A prostatic stent is a cylinder shape tubethat isplaced in the urethra to relieve prostatic pressure from an enlarged prostate and improve urine flo,w
Toprevent complications,theclient should be cautioned against catheterizationthrough theprostatic stent forthree months after stent placement.
Awarded 1.0 points out of 1.0 possible points.
6. A 48-year-old client with endometrial cancer is being discharged after a total hysterectomy and bilateral salpingo-oophorectomy. Which
client statement indicates that further teaching is needed?
A. • "I know I will miss having sexual intercourse with my husband." Correct
B . "I have asked my daughter to stay with me next week after I am discharged."
C. "Well, I don't have to worry about getting pregnant anymore."
D. "I can't wait to go on the cruise that I have planned for this summer."
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Further teaching is needed in response to the client's misunderstanding of not being able to have sexual intercourse after a hysterectomy.
Awarded 1.0 points out of 1.0 possible points.
7. The nurse is caring for a client scheduled to undergo insertion of a percutaneous endoscopic gastrostomy (PEG) tube. The client asks the
nurse to explain how a PEG tube differs from a gastrostomy tube (GT). Which explanation best describes how they are different?
A. Procedure for feedings.
B. Diameter of the tubes.
C. • Method of insertion. Correct
D. Location of the tubes.
ID: 20127806665
The best explanation of how a percutaneous endoscopic gastrostomy (PEG) tube differs from a gastrostomy tube (GT) is by the method of insertion.
GT insertion involves making an incision in the wall of the abdomen and suturing the tube to the gastric wall. A PEG tube is more commonly used as
it does not require general anesthesia and is less invasive. Insertion is performed with endoscopic visualization through the esophagus into the
stomach and then pulled through a small incision in the abdominal wall. It is held in place by a tiny plastic device called a "bumper" that holds the gtube in place with a small water-filled balloon securing it against the abdominal wall.
Awarded 1.0 points out of 1.0 possible points.
8. A client who is admitted to the coronary care unit with a myocardial infarction (Ml) begins to develop increased pulmonary congestion, an
increase in heart rate from 80 to 102 beats per minute, and cold, clammy skin. What action should the nurseimplement?
A. Prepare the client for an emergency echocardiography.
B. • Notify the healthcare provider. Correct
C . Increase the IV flowrate.
D. Place the client in the supine position.
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Increased pulmonary congestion, increased heart rate, and cold, clammy skin in a client with a myocardial infarction indicate impending cardiogenic
shock related to heart failure, a common complication of Ml. The healthcare provider should be notified immediately for emergency interventions of
this life-threatening complication.
Awarded 1.0 points out of 1.0 possible points.
9. What is the primary nursing problem for a client with asymptomatic primary syphilis? ID: 20127807185
A. • Deficient knowledge. Correct
B. Acute pain.
C. Risk for injury.
D. Sexual dysfunction.
An asymptomatic client with primary syphilis is most likely unaware of this disease, so to prevent transmission to others and recurrence in the client,
the priority nursing diagnosis is deficient knowledge of the disease pathophysiology.
Awarded 0.0 points out of 1.0 possible points.
10. Which client is at highest risk for compromised psychological adjustment after a hysterectomy?
A. A 46-year-old woman with three children and a recent promotion at work.
B. A 55-year-old woman with abnormal bleeding and painfor 3 years.
C. A 29-year-old woman whose uterus ruptured after giving birth to her first child. Correct
D. • A 62-year-old widow who has three friends who had uncomplicated hysterectomies.
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The client who is a primipara and is still in her childbearing years and is at highest risk for unresolved conflicts about the end of her childbearing
opportunities.
Awarded 1.0 points out of 1.0 possible points.
11. The nurse is caring for a client receiving tamoxifen for the treatment of breast cancer. Which action should the nurse include in the client's
plan of care?
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A. Encourage milk products to increase calcium intake.
B. Increase fluid intake.
C. Monitor sodium chloride intake.
D. • Assist the client in coping with hot flashes. Correct
Tamoxifen, an estrogen receptor blocking agent, can cause hot flashes, so client education regarding menopausal-like symptoms should be
included in the plan of care.
Awarded 1.0 points out of 1.0 possible points.
12. A client withheart failure is prescribed digoxin 0.125 mgPO. The client's apical heart rate is70 beats per minute, blood pressure is 125/75 ID: 20127807113
mmHg, and respirations are 18 breaths per minute. Which action should the nurse implement next?
A. Inform the healthcare provider.
B. • Administer the medication. Correct
C . Review the vital sign flowsheet.
D. Reassess the apical heart rate.
Obtaining the apical heart rate is a common parameter prior to administering digoxin, which may indicate early digoxin toxicity if the heart rate is less
than 60 beats per minute, so the dose should be administered since the client is not demonstrating any signs of toxicity.
Awarded 1.0 points out of 1.0 possible points.
13. Which assessment is most important for the nurse to perform on a client who is hospitalized for Guillain-Barre syndrome that is rapidly
progressing?
A. Intensity of pain.
8 . Ability to eat.
C. Unsteady gait.
D. • Respiratory effort. Correct [Show Less]