with hyperglycemia and newly diagnosed diabetes me
teach glucose self monitoring and medication adm
screening test geriatric version smast g
smast g is a short form alcoholis
Written for
MED SURG 201
All documents for this subject (54)
Seller
Follow
Hosmerit
Reviews received
Content preview
MED SURG 201 Medical Surgical Final
Exam- Questions and Answers; West Coast
UniversityFINAL EXAM PASADO (A+
GUIDE)
• A patient who was admitted to the hospital with hyperglycemia and
newly diagnosed diabetes mellitus is scheduled for discharge the second
day after admission. When implementing patient teaching, what is the
priority action forthe nurse?
• Instruct about the increased risk for cardiovascular disease.
• Provide detailed information about dietary control of glucose.
• Teach glucose self-monitoring and medication administration.
• Give information about the effects of
exercise on glucose control. ANS: C
When time is limited, the nurse should focus on the priorities of teaching.
In this situation, the patient should know how to test blood glucose and
administer medications to control glucose levels. The patient will need
further teaching about the role of diet, exercise, various medications, and
the many potential complications of diabetes, but these topics can be
addressed through planning for appropriate referrals.
• A 75-year-old patient is admitted for pancreatitis. Which tool would
be the most appropriate for the nurse to use during the admission
assessment?
• Drug Abuse Screening Test (DAST-10)
• Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
• Screening Test-Geriatric Version (SMAST-G)
• Mini-Mental State
Examination ANS: C
Because the abuse of alcohol is a common factor associated with the
development of pancreatitis, the first assessment step is to screen for
alcohol use using a validated screening questionnaire. The SMAST-G is a
short-form alcoholism screening instrument tailored specifically to the
needs of the older adult. If the patient scores positively on the SMAST-G,
then the CIWA-Ar would be a useful tool for determining treatment. The
DAST-10 provides more general information regarding substance use.
The Mini-Mental State Examination is used to screen for cognitive
impairment.
• The sister of a patient diagnosed with BRCA gene–related breast
cancer asks the nurse, “Do you think I should be tested for the gene?”
Which response by the nurse is most appropriate?
• “In most cases, breast cancer is not caused by the BRCA gene.”
,• “It depends on how you will feel if the test is positive for the BRCA gene.”
• “There are many things to consider before deciding to have genetic testing.”
• “You should decide first whether you are willing to have a
bilateral mastectomy.” ANS: C
Although presymptomatic testing for genetic disorders allows patients to
take action (such as mastectomy) to prevent the development of some
genetically caused disorders, patients also need to consider that test results
in their medical record may affect insurance, employability, etc.
Telling a patient that a decision about mastectomy should be made before
testing implies that the nurse has made a judgment about what the patient
should do if the test is positive. Although the patient may need to think
about her reaction if the test is positive, other issues (e.g., insurance) also
should be considered. Although most breast cancers are not related to
BRCA gene mutations, the patient with a BRCA gene mutation has a
markedly increased risk for breast cancer.
• The nurse in the outpatient clinic has obtained health histories for
these new patients. Which patient may need referral for genetic testing?
• 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96
• 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy
• 34-year-old patient who has a sibling with newly diagnosed polycystic kidney
disease
• 50-year-old patient with a history of cigarette smoking who is
complaining of dyspnea ANS: C
The adult form of polycystic kidney disease is an autosomal dominant disorder and
frequently it is
asymptomatic until the patient is older. Presymptomatic testing will give the
patient information that will be useful in guiding lifestyle and childbearing
choices. The other patients do not have any indication of genetic disorders or
need for genetic testing.
• An adolescent patient seeks care in the emergency department after
sharing needles forheroin injection with a friend who has hepatitis B. To
provide immediate protection from infection, what medication will the
nurse administer?
• Corticosteroids
• Gamma globulin
• Hepatitis B vaccine
• Fresh frozen plasma ANS: B
The patient should first receive antibodies for hepatitis B from injection of
gamma globulin. The hepatitis B vaccination series should be started to
provide active immunity. Fresh frozen plasma and corticosteroids will not
be effective in preventing hepatitis B in the patient.
,• A patient who is diagnosed with cervical cancer that is classified as Tis,
N0, M0 asks the nurse what the letters and numbers mean. Which
response by the nurse is most appropriate?
• “The cancer involves only the cervix.”
• “The cancer cells look almost like normal cells.”
• “Further testing is needed to determine the spread of the cancer.”
• “It is difficult to determine the original site
of the cervical cancer.” ANS: A
Cancer in situ indicates that the cancer is localized to the cervix and is not
invasive at this time. Cell differentiation is not indicated by clinical
staging. Because the cancer is in situ, the origin is the cervix. Further
testing is not indicated given that the cancer has not spread.
• External-beam radiation is planned for a patient with cervical cancer. What
instructions should the nurse give to the patient to prevent complications from
the effects of the radiation?
• Test all stools for the presence of blood.
• Maintain a high-residue, high-fiber diet.
• Clean the perianal area carefully after every bowel movement.
• Inspect the mouth and throat daily for the
appearance of thrush. ANS: C
Radiation to the abdomen will affect organs in the radiation path, such as the
bowel, and cause frequent diarrhea. Careful cleaning of this area will help
decrease the risk for skin breakdown and infection.
Stools are likely to have occult blood from the inflammation associated with
radiation, so routine testing of stools for blood is not indicated. Radiation to the
abdomen will not cause stomatitis. A low-residue diet is recommended to avoid
irritation of the bowel when patients receive abdominal radiation.
• The nurse notes that a patient who was admitted with diabetic
ketoacidosis has rapid, deep respirations. Which action should the nurse
take?
• Give the prescribed PRN lorazepam (Ativan).
• Start the prescribed PRN oxygen at 2 to 4 L/min.
• Administer the prescribed normal saline bolus and insulin.
• Encourage the patient to take deep, slow breaths
with guided imagery. ANS: C
The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need
for correction of the acidosis with a saline bolus to prevent hypovolemia followed
by insulin administration to allow glucose to reenter the cells. Oxygen therapy is not
indicated because there is no indication that the increased respiratory rate is related
to hypoxemia. The respiratory pattern is compensatory, and the patient will not be
able to slow the respiratory rate. Lorazepam administration will slow the respiratory
rate and increase the level of acidosis.
, • The nurse is caring for a patient who has a calcium level of 12.1
mg/dL. Which nursing action should the nurse include on the care
plan?
• Maintain the patient on bed rest.
• Auscultate lung sounds every 4 hours.
• Monitor for Trousseau’s and Chvostek’s signs.
• Encourage fluid intake up
to 4000 mL every day. ANS:
D
To decrease the risk for renal calculi, the patient should have a fluid intake of
3000 to 4000 mL daily. Ambulation helps decrease the loss of calcium from bone
and is encouraged in patients with hypercalcemia. Trousseau’s and Chvostek’s
signs are monitored when there is a possibility of hypocalcemia. There is no
indication that the patient needs frequent assessment of lung sounds, although
these would be assessed every shift.
• A patient who had a transverse colectomy for diverticulosis 18 hours ago has
nasogastric suction and is complaining of anxiety and incisional pain. The
patient’s respiratory rate is 32 breaths/minute and the arterial blood gases (ABGs)
indicate respiratory alkalosis. Which action should the nurse take first?
• Discontinue the nasogastric suction.
• Give the patient the PRN IV morphine sulfate 4 mg.
• Notify the health care provider about the ABG results.
• Teach the patient how to take slow, deep
breaths when anxious. ANS: B
The patient’s respiratory alkalosis is caused by the increased respiratory rate
associated with pain and anxiety. The nurse’s first action should be to medicate the
patient for pain. Although the nasogastric suction may contribute to the alkalosis, it
is not appropriate to discontinue the tube when the patient needs gastric suction. The
health care provider may be notified about the ABGs but is likely to instruct the
nurse to medicate for pain. The patient will not be able to take slow, deep breaths
when experiencing pain.
• Which topic is most important for the nurse to discuss preoperatively with a
patient who is scheduled for abdominal surgery for an open cholecystectomy?
• Care for the surgical incision
• Medications used during surgery
• Deep breathing and coughing techniques
• Oral antibiotic
therapy after discharge
home ANS: C
Preoperative teaching, demonstration, and redemonstration of deep breathing and
coughing are needed on patients having abdominal surgery to prevent postoperative
atelectasis. Incisional care and the importance of completing antibiotics are better
discussed after surgery, when the patient will be more likely to retain this information.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Hosmerit. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
