EVOLVE ELSEVIER HESI MED SURG
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,combination therapy can cause severe depression (B); therefore, it is most important for the nurse to
review the medication effects and report these to the health care provider. (A, C, and D) might be
implemented after the physiologic aspects of the situation have been assessed. The nurse is
interviewing a client who is taking interferon-alfa-2a (Roferon-A) and ribavirin (Virazole) combination
therapy for hepatitis C. The client reports experiencing overwhelming feelings of depression. Which
action should the nurse implement first?
A.Recommend mental health counseling.
B.Review the medication actions and interactions.
C.Assess for the client's daily activity level.
D.Provide information regarding a support group.
C
Placing the client in a supine position (C) reduces diaphragmatic pressure, thereby enhancing
oxygenation, and allows for visualization of the abdominal wound. (A) compromises diaphragmatic
expansion and inhibits pressoreceptor activity. (B) places the client at risk of evisceration of the
abdominal wound and increased bleeding. (D) will not stop internal bleeding in the liver and spleen
caused by the gunshot wound. A client in the emergency department is bleeding profusely from a
gunshot wound to the abdomen. In what position should the nurse immediately place the client to
promote maintenance of the client's blood pressure above a systolic pressure of 90 mm Hg?
A.Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow.
B.Turn the client prone to place pressure on the abdominal wound to help staunch the bleeding.
C.Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the wound.
D.Put the client on the right side to apply pressure to the liver and spleen to stop hemorrhaging.
D
A U wave (D) is a positive deflection following the T wave and is often present with hypokalemia (low
potassium level). (A, B, and C) are all signs of hyperkalemia. The nurse assesses a client who has
been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a
concern for a client taking a diuretic?
A.Tall, spiked T waves
B.A prolonged QT interval
C.A widening QRS complex
, D.Presence of a U wave
C
TPN solutions contain high concentrations of glucose, so the blood glucose level is often monitored as
often as q6h because of the risk for hyperglycemia (C). (A) is monitored periodically because an increase
in the albumin level, a serum protein, is generally a desired effect of TPN. (B) may be added to TPN
solutions, but calcium imbalances are not generally a risk during TPN administration. (D) may be
decreased in the client with malnutrition who receives TPN, but abnormal values, reflecting liver or bone
disorders, are not a common complication of TPN administration. When a nurse assesses a client
receiving total parenteral nutrition (TPN), which laboratory value is most important for the nurse to
monitor regularly?
A.Albumin
B.Calcium
C.Glucose
D.Alkaline phosphatase
C
The most common cause of a fractured hip in older women is osteoporosis, resulting from reduced
calcium in the bones as a result of hormonal changes in the perimenopausal years (C). (A) may or may
not have contributed to the accident, but eye changes were not involved in promoting the hip fracture.
(B) is not a common condition of older people but is associated with CKD. Although (D) may result in
transient ischemic attacks (TIAs) or stroke, it will not result in fragility of the bones, as does
osteoporosis. A 62-year-old woman who lives alone tripped on a rug in her home and fractured her
hip. Which predisposing factor most likely contributed to the fracture in the proximal end of her femur?
A.Failing eyesight resulting in an unsafe environment
B.Renal osteodystrophy resulting from chronic kidney disease (CKD)
C.Osteoporosis resulting from declining hormone levels
D.Cerebral vessel changes causing transient ischemic attacks
D
Only regular insulin is administered by the IV route, so the TPN solution containing NPH insulin should
be returned to the pharmacy (D). (A, B, and C) are not indicated because the solution should not be
administered. The nurse receives the client's next scheduled bag of TPN labeled with the additive NPH
insulin. Which action should the nurse implement?