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CH.8 Med Surg

Terms in this set (44)

Pain is best described as?

A) a creation of a person's imagination
B) an unpleasant, subjective experience
C) a maladaptive response to stimulus
D) a neurologic event resulting from activation of nociceptors
B- An unpleasant, subjective experience
A patient is receiving a PCA infusion after surgery to repair a hip fracture. She is sleeping soundly but awakens when the nurse speaks to her in a normal tone of voice. Her respirations are 8 breaths/min. The most appropriate nursing action in this situation is to

A) stop the PCA infusion
B) Obtain an oxygen saturation level
C) Continue to closely monitor the patient
D) Administer naloxone and contact the provider
C-Continue to closely monitor the patient
Which words are most likely to be used to describe neuropathic pain (select all that apply)?

A) Dull
B) Mild
C) Burning
D) Shooting
E) Shock-like
B- mild
C- burning
D- Shooting
E- Shock-like
Unrelieved pain is

A) not expected after major surgery
B) expected in a person with cancer
C) dangerous and can lead to many physical and psychologic complications
D) an annoying sensation, but it is not as important as other physical care needs
C- dangerous and can lead to many physical and psychologic complications
A cancer patient who reports ongoing, constant moderate pain with short periods of severe pain during dressing changes is

A) probably exaggerating his pain
B) in need of a referral for surgical treatment of his pain
C) best treated by receiving a long-acting and a short-acting opioid
D) best treated by regularly scheduled short-acting opioids plus acetaminophen
C- best treated by receiving a long-acting and a short-acting opioid
An example of distraction to provide pain relief is

A) TENS.
B) music.
C) exercise.
D) biofeedback.
B- music
Appropriate nonopioid analgesics for mild pain include (select all that apply)

a. oxycodone.
b. ibuprofen (Advil).
c. lorazepam (Ativan).
d. acetaminophen (Tylenol).
e. codeine with acetaminophen (Tylenol #3).
b. ibuprofen
d. acetaminophen
An important nursing responsibility related to pain is to

a. leave the patient alone to rest.
b. help the patient appear to not be in pain.
c. believe what the patient says about the pain.
d. assume responsibility for eliminating the patient's pain.
c. believe what the patient says about the pain
Giving opioids to an actively dying patient who has moderate to severe pain

a. may cause addiction.
b. will likely be ineffective.
c. is an appropriate nursing action.
d. will likely hasten the person's death.
c. is an appropriate nursing action
A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects

a. a belief that will contribute to appropriate pain management
b. an accurate statement about pain mechanisms and expected goals of pain therapy
c. a belief that will not have any effort on the type of care provided to people in pain
d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management
d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management.
A patient who has been treated with morphine by patient-controlled analgesia (PCA) is discharged from the hospital with instructions that all of the following medications may be used for pain. Which medication will the nurse instruct the patient to use first?

a. Aspirin
b. Ibuprofen (Motrin, Advil)
c. Acetaminophen (Tylenol)
d. Oxycodone/acetaminophen (Percocet)
d. Oxycodone/acetaminophen (Percocet)

must transition from IV narcotic to oral narcotic first
The nurse is caring for a patient after abdominal surgery. Which action by the nurse is most appropriate for analgesic titration of the prescribed pain medication?

a. Limit use of pain medication to avoid dependence on opioid analgesics.
b. Determine with the patient the analgesic dosage required for pain relief.
c. Teach the patient to increase the time between doses of pain medication.
d. Assist patient to plan the distribution of a specific total dose of analgesic over a 24-hour period.
b. determine with the patient the analgesic dosage required for pain relief.

Titration is dose adjustment based on assessment of the adequacy of analgesic effect versus the side effects produced.
The percentage of daily calories for a healthy person consists of

a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids.
b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids.
c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids.
d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.
a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids.
Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component.

___ a. skeletal protein.
___ b. glycogen.
___ c. visceral protein.
___ d. fat stores.
b. glycogen.
a. skeletal protein.
d. fat stores.
c. visceral protein.
A complete nutritional assessment including anthropometric measurements is important for the patient who

a. has a BMI of 25.5 kg/m2.
b. complains of frequent nocturia.
c. reports a 5-year history of constipation.
d. reports an unintentional weight loss of 10 lb in 2 months.
d. reports an unintentional weight loss of 10 lb in 2 months.
Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube?

a. X-ray
b. Air insertion
c. Observing patient for coughing
d. pH measurement of gastric aspirate
a. X-ray
A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives

a. 20% intralipids
b. 5% dextrose solution
c. 0.45% normal saline solution
d. 5% lactated Ringer's solution
b. 5% dextrose solution
A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply)

a. hypokalemia
b. hypoglycemia
c. hypercalcemia
d. hypomagnesemia
e. hypophosphatemia
a. hypokalemia
d. hypomagnesemia
e. hypophosphatemia
Which statement best describes the etiology of obesity?

a. Obesity primarily results from a genetic predisposition
b. Psychosocial factors can override the effects of genetics in causing obesity
c. Obesity is the result of complex interactions between genetic and environmental factors
d. Genetic factors are more important than environmental factors int he etiology of obesity
c. Obesity is the result of complex interactions between genetic and environmental factors
Health risks associated with obesity include (select all that apply)

a. colorectal cancer.
b. rheumatoid arthritis.
c. polycystic ovary syndrome.
d. nonalcoholic steatohepatitis.
e. systemic lupus erythematosus.
a. colorectal cancer.
c. polycystic ovary syndrome.
d. nonalcoholic steatohepatitis.
The obesity classification that is most often associated with cardiovascular health problems is

a. primary obesity.
b. secondary obesity.
c. gynoid fat distribution.
d. android fat distribution.
d. android fat distribution.
The best nutritional therapy plan for a person who is obese is

a. is high in animal protein
b. is fat-free and low in carbohydrates
c. restricts intake to under 800 calories per day
d. lowers calories with foods from all the basic groups
d. lowers calories with foods from all the basic groups
This bariatric surgical procedure involves creating a gastric pouch that is reversible, and no malabsorption occurs. What surgical procedure is this?

a. Vertical gastric banding
b. Biliopancreatic diversion
c. Roux-en-Y gastric bypass
d. Adjustable gastric banding
d. Adjustable gastric banding
A patient with extreme obesity has undergone Roux-en-Y gastric bypass surgery. In planning post-operative care, the nurse anticipates that the patient

a. may have severe diarrhea early in the postoperative period
b. will not be allowed to ambulate for 1 to 2 days postoperatively
c. will require nasogastric suction until the drainage is pale yellow
d. may have limited amounts of oral liquids during the early postoperative period.
d. may have limited amounts of oral liquids during the early postoperative period.
Which criteria must be met for a diagnosis of metabolic syndrome? (select all that apply)
a. hypertension
b. high triglycerides
c. elevated plasma glucose
d. increased waist circumference
e. decreased low density lipoproteins
a. hypertension
b. high triglycerides
c. elevated plasma glucose
d. increased waist circumference
"Polydipsia and polyuria related to diabetes mellitus are primarily due to:
"a. The release of ketones from cells during fat metabolism
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
c. Damage to the kidneys from exposure to high levels of glucose
d. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin"
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
Which statement would be correct for a patient with type-2 diabetes who was admitted to the hospital with pneumonia?

a. the patient must receive insulin therapy to prevent ketoacidosis
b. the patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin
c. the patient has minimal or absent endogenous insulin secretions and requires daily insulin injections
d. the patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.
d. the patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment?

a. A1C 9%
b. BP 126/80
c. FBG 130mg/dL
d. LDL cholesterol 100mg/dL
a. A1C 9%
Which statement by the patient with type 2 diabetes is accurate?

a. "I will limit my alcohol intake to 1 drink each day."
b. "I am not allowed to eat sweets because of my diabetes."
c. "I cannot exercise because I take a blood glucose-lowering medication."
d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."
a. "I will limit my alcohol intake to 1 drink each day."
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply)

a. Insulin Administration
b. Elimination of sugar from diet
c. Need to reduce physical activity
d. use of a portable blood glucose monitor
e. Hypoglycemia prevention, symptoms, and treatment.
a. Insulin Administration
d. use of a portable blood glucose monitor
e. Hypoglycemia prevention, symptoms, and treatment.
What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability?

a. call the provider
b. give insulin as ordered
c. assess for other neurologic symptoms
d. check the patient's blood glucose level
d. check the patient's blood glucose level
A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of

a. polyuria
b. severe dehydration
c. rapid, deep respirations
d. decreased serum potassium
c. rapid, deep respirations
Which are appropriate therapies for patients with diabetes mellitus (select all that apply)?

a. use of statins to reduce CVD risk
b. use of diuretics to treat nephropathy
c. use of ACE inhibitors to treat nephropathy
d. use of serotonin agonists to decrease appetite
e. use of laser photocoagulation to treat retinopathy
a. use of statins to reduce CVD risk
c. use of ACE inhibitors to treat nephropathy
e. use of laser photocoagulation to treat retinopathy
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). Which statement by the nurse is best?

a. "The laboratory test result is positive for type 2 diabetes."
b. "You will develop type 2 diabetes within 5 years."
c. "The test result is normal, and diabetes is not a problem."
d. "You are at increased risk for developing diabetes."
d. "You are at increased risk for developing diabetes."
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to

a. Withhold the regular dose of insulin.
b. Drink cool fluids with high glucose content.
c. Check the blood glucose level every 2 to 4 hours.
d. Use a less strenuous form of exercise than usual until the illness resolves.
c. Check the blood glucose level every 2 to 4 hours.
Rationale: If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2- to 4-hour intervals to determine the effects of this stressor on the blood glucose level.
The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goals is most appropriate?

a. Make all patients responsible for the management of their disease.
b. Involve the family and significant others in the care of these patients.
c. Enable the patients to become active participants in the management of their disease.
d. Provide the patients with as much information as soon as possible to prevent complications.
c. Enable the patients to become active participants in the management of their disease.
Rationale: The goal of diabetes education is to enable the patient to become the most active participant in his or her own care.
The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result?

a. Hypokalemia
b. Fluid overload
c. Hypoglycemia
d. Hyperphosphatemia
a. Hypokalemia
Rationale: Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate levels. A patient with diabetic ketoacidosis will be dehydrated (fluid volume deficit), and blood glucose levels would be elevated (hyperglycemia).
After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on
a. frequent monitoring of serum and urine osmolarity.
b. parenteral administration of a GH-receptor antagonist.
c. keeping the patient in a recumbent position at all times.
d. patient teaching regarding the need for lifelong hormone therapy.
a. frequent monitoring of serum and urine osmolarity.
A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include

a. hypernatremia and edema
b. muscle spasticity and hypertension
c. low urine output and hyponatremia
d. weight gain and decreased glomerular filtration rate
c. low urine output and hyponatremia
The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching about this drug, the nurse determines that further instruction is needed when the patient says

a. "I can expect the medication dose may need to be adjusted."
b. "I only need to take this drug until my symptoms are improved."
c. "I can expect to return to normal function with the use of this drug."
d. "I will report any chest pain or difficulty breathing to the doctor right away."
b. "I only need to take this drug until my symptoms are improved."
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops

a. muscle weakness and weight loss.
b. hyperthermia and severe tachycardia.
c. hypertension and difficulty swallowing.
d. laryngospasms and tingling in the hands and feet.
d. laryngospasms and tingling in the hands and feet.
Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply)

a. restricting protein intake.
b. monitoring blood glucose levels.
c. observing for signs of hypotension.
d. administering medication in equal doses.
e. protecting patient from exposure to infection.
b. monitoring blood glucose levels.
e. protecting patient from exposure to infection.
An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to

a. monitor blood glucose levels
b. restrict fluid and sodium intake
c. administer potassium-sparing diuretics
d. advise the patient to make postural changes slowly
a. monitor blood glucose levels
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