PN Adult Medical Surgical 2023

Extract:

Question 1 of 5

A nurse is caring for a client who is 3 days postoperative following an ileostomy placement. Which of the following findings should the nurse report to the provider?

A. Stoma retracts into the abdominal wall. B. Stoma is a cherry red color. C. Stool contains scant red blood. D. Stool is a dark green color. E. Stoma is pale and dry. F. Stool is watery and excessive. G. Stoma is swollen and painful.

Correct Answer: A

Rationale: A retracted stoma is a complication requiring intervention; cherry red is normal, scant blood and dark green stool are expected early post-op.

Question 2 of 5

A nurse is reinforcing teaching with a client who is starting to take metformin extended release. Which of the following instructions should the nurse include in the instructions?

A. Monitor blood glucose while taking this medication B. Expect muscle pain while taking this medication. C. Take the medication with breakfast. D. Chew the medication before swallowing. E. Take it on an empty stomach. F. Expect weight gain as a side effect. G. Avoid all carbohydrates while on this.

Correct Answer: A

Rationale: Metformin requires glucose monitoring to assess efficacy and prevent hypoglycemia; muscle pain isn't typical, it's taken with food to reduce GI upset, and it's not chewed.

Question 3 of 5

A nurse is assisting with the care of a postoperative client who is receiving a unit of packed RBCs. Which of the following manifestations should the nurse recognize as an indication of a septic reaction to the blood transfusion?

A. Distended neck veins B. Polyuria C. Vomiting D. Hypertension E. Fever and chills F. Tachycardia G. Hypotension

Correct Answer: C

Rationale: Vomiting is a sign of a septic reaction due to contaminated blood; distended veins suggest fluid overload, polyuria isn't typical, and hypertension isn't specific.

Question 4 of 5

A nurse is reinforcing teaching with the family of a client who has methicillin-resistant Staphylococcus aureus (MRSA) of a leg wound and is on contact precautions. Which of the following statements by a family member indicates an understanding of the teaching?

A. We should remove gloves before leaving the hospital room. B. There is no cure for MRSA. C. MRSA only occurs in health care facilities. D. We will need to wear masks when we are in the hospital room. E. We can touch the client without precautions. F. MRSA will resolve without treatment. G. We should wash hands after glove removal.

Correct Answer: A

Rationale: Gloves should be removed before leaving to prevent contamination spread; MRSA is treatable, can occur outside facilities, and masks aren't required for contact precautions.

Question 5 of 5

A home health nurse is assisting in the care of a client following a modified radical mastectomy. Which of the following statements by the client indicates effective coping?

A. I would like to see what this looks like today. B. I would just like to spend my day staring at the TV. C. I'm going to close my eyes until you are done dressing my incision. D. I'm planning to stay at home until my breast reconstructive surgery. E. I don't care about my appearance anymore. F. I'll never leave the house again. G. I feel fine and don't need help.

Correct Answer: A

Rationale: Wanting to see the incision shows acceptance and engagement in recovery; other options suggest avoidance or denial.

PN Adult Medical Surgical 2023 | Nurselytic

Nurselytic

ATI LPN

ATI LPN