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Exam (elaborations)

VATI Med Surg – Questions with Verified Solutions

VATI Med Surg – Questions with Verified Solutions

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  • November 24, 2023
  • 23
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers
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VATI Med Surg – Questions with Verified
Solutions
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? ✔️Ans - Thinning of the skin.

Only apply the ointment to dry patches of the skin to avoid atrophy.

A nurse is assessing a client who has left-sided heart failure. Which of the
following findings should the nurse identify as a manifestation of left-sided
heart failure? ✔️Ans - Frothy sputum

Pink-tinged frothy sputum can be an early indication of pulmonary edema and
can be life-threatening. Therefore, the nurse should notify the provider
immediately.

A nurse is caring for a client who is experiencing anxiety as well as numbness
and tingling of the lips and fingers. The client's ABGs are: pH 7.48, PCO2 30
mm Hg, HCO3- 24 mEq/L, PaO2 85 mm Hg. Which of thefollowing acid-base
imbalances should the nurse identify that the client is experiencing? ✔️Ans -
Respiratory alkalosis

- The pH is alkaline (increased)
- PCO2 is decreased representing alveolar hyperventilation & resultant
respiratory alkalosis

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

Bone become thinner as a result of mineral loss & nitrogen depletion.

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? ✔️Ans - A pearly, waxy nodule.

,- Basal cell carcinoma has a nodular lesion with well defined borders & pearly
or waxy appearance resulting from overexposure to the sun. especially on the
face, head, and neck.
-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 client who has squamous cell carcinoma has a firm, nodular, and crusty
lesion with a ulcerated center, resulting from sun exposure, chronic irritation,
burns, or irradiation to the skin.

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? ✔️Ans - LOW URINE
SPECFIC GRAVITY.
-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.

A home health nurse is assisting a client with planning care for a family
member who has Alzheimer's disease. Which of the following instructions
should the nurse include? ✔️Ans - Remove clutter from rooms and
hallways

- This allows the client is able to walk without the risk of falling or tripping
over objects. Later in the disease, the client can experience seizures, so
cluttered areas could be a risk to the client

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? ✔️Ans - REFRACTORY HYPOXEMIA

- 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.

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? ✔️Ans - USE OF ASSCESSORY
MUSCLES.

, - 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.

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? ✔️Ans -
SKIN RASH.

- the nurse should determine that the priority finding is a rash, which can have
a measles-like appearance and progress to exfoliative dermatitis or Stevens-
Johnson syndrome. The client should report this finding to the provider
immediately.

A nurse is monitoring a client following a LUMBAR LAMINECTOMY. The client
has a drain and indwelling urinary catheter. The nurse should identify which
of the following findings as an indication of a COMPLICATION of the surgery?
✔️Ans - CLEAR DRAINAGE OF DRESSINGS

- This is an indication of a cerebral spinal leak

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? ✔️Ans - INCREASED ABDOMINAL GIRTH

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? ✔️Ans - " I changed the floor plan of our homes to
accommodate my father's wheelchair. "

A nurse is caring for a client who is receiving VANCOMYCIN intermittent IV
bolus therapy for METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS.
Which of the following findings is an indication to the nurse that the client is
experiencing an ADVERSE EFFECT of the medication? ✔️Ans - THE CLIENT
IS BECOMING FLUSHED.

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