Capstone Adult Medical Surg 1

Question 1: 1 of 50

Capstone Adult Medical Surg 1. A nurse is caring for a client who is postoperative and reports frequent leakage of small amounts of urine. The nurse notes that the client’s bladder is palpable upon examination. The nurse should identify these findings as which of the following forms of incontinence?

Stress
Urge
Functional
Overflow

Question 2: 2 of 50

A nurse in a rheumatologist’s office is caring for a client. For each body system below, click to specify the potential complication that may occur due to the client’s diagnosis. (Note: Client diagnosed with systemic lupus erythematosus (SLE), temperature 38.3°C, positive ANA, and Anti-DNA 15 units/mL).

Neurologic: Seizures
Cardiovascular: Pericarditis
Urinary/Renal: Glomerulonephritis
Musculoskeletal: Chronic joint pain

Question 3: 3 of 50

A nurse is caring for a client who has burn injuries covering their upper body and is concerned about their altered appearance. Which of the following statements should the nurse make?

“It is okay to not want to touch the burned areas of your body.”
“Cosmetic surgery should be performed within the next year to be effective.”
“Reconstructive surgery can completely restore your previous appearance.”
“It could be helpful for you to attend a support group for people who have burn injuries.”

Question 4: 4 of 50

A nurse is caring for a male client in the gastroenterologist’s office. Complete the following sentence by using the lists of options. (Note: Client has Crohn’s disease, recent small bowel resection, Hgb 8.1 g/dL, and transferrin saturation 10%).

The nurse should ask the client if they have noticed any dark, tarry stools and then prepare to administer IV iron dextran.

Question 6: 6 of 50

A nurse is caring for a client who has acute gastritis and is NPO. The client has a new prescription to resume oral intake. Which of the following items should the nurse offer the client?

Lemonade
Tomato soup
Gelatin
Black coffee

Question 8: 8 of 50

A triage nurse finds a school-age child lying in the road following a school bus crash with multiple casualties. The child has a respiratory rate of 8/min, is unresponsive to verbal commands, and groans to painful stimuli. The nurse should assign the client which of the following triage tags?

Red
Yellow
Green
Black

Question 9: 9 of 50

A nurse is caring for a client who has a cerebellar tumor. Which of the following actions is the nurse’s priority?

Provide assistance with ambulation.
Facilitate retention of facts by repeating instructions.
Place the client in a darkened room.
Speak slowly and clearly.

Question 10: 10 of 50

A nurse is caring for a client who has active tuberculosis. Which of the following actions should the nurse take?

Remain 1 m (3 feet) away from the client when providing care.
Apply a surgical mask before entering the client’s room.
Ensure the door to the client’s room is closed at all times.
Place a “no visitors” sign on the client’s door.

Question 11: 11 of 50

A nurse is preparing to administer epoetin alfa to a client who has chronic kidney disease. Which of the following actions should the nurse plan to take?

Review the client’s Hgb level prior to administration.
Shake the vial of medication before drawing up the dose.
Administer the medication using the Z-track method.
Instruct the client to stop taking iron supplements during therapy.

Question 12: 12 of 50

A nurse is monitoring a client who has a traumatic brain injury and a ventriculostomy. Which of the following findings should the nurse identify as a complication of the procedure? (Select all that apply.)

Infection
Vomiting
Widening pulse pressure
Equal and reactive pupils
Intracranial pressure 10 mm Hg

Question 13: 13 of 50

A nurse is providing teaching to a client who has a new prescription for paroxetine. Which of the following instructions should the nurse include in the teaching?

“You will experience the full effects of this medication immediately.”
“This medication can cause constipation.”
“You can stop taking this medication when you feel better.”
“You might experience a decreased desire for intimacy while taking this medication.”

Question 15

A nurse is preparing to administer potassium chloride 20 mEq IV to a client who has hypokalemia. Which of the following actions should the nurse take?

Verify that the client’s urine output is at least 30 mL/hr.
Administer the medication via IV bolus over 5 min.
Dilute the medication to a concentration of 40 mEq/L.
Apply a warm compress to the IV site during administration.

Question 16

A nurse is assessing a client who has a chest tube connected to a water-seal drainage system. Which of the following findings should the nurse report to the provider?

Continuous bubbling in the water-seal chamber.
Over 150 mL of serosanguineous drainage in the first hour.
Tidaling in the water-seal chamber with inspiration and expiration.
Constant bubbling in the suction control chamber.

Question 17

A nurse is providing teaching to a client who has a new prescription for sublingual nitroglycerin. Which of the following instructions should the nurse include?

“Discard the medication if it causes a tingling sensation under the tongue.”
“Place one tablet under the tongue every 5 minutes for up to three doses.”
“Store the medication in a clear plastic container in the refrigerator.”
“Take the medication with a full glass of water to increase absorption.”

Question 18

A nurse is planning care for a client who is postoperative following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan?

Maintain the client’s legs in an adducted position.
Place an abductor pillow between the client’s legs when turning.
Encourage the client to lean forward when sitting in a chair.
Instruct the client to cross their legs at the ankles when in bed.

Question 19

A nurse is caring for a client who has a pulmonary embolism and is receiving heparin via continuous IV infusion. Which of the following laboratory values should the nurse monitor?

Prothrombin time (PT)
International normalized ratio (INR)
Activated partial thromboplastin time (aPTT)
Platelet count

Question 20

A nurse is assessing a client who has Cushing’s syndrome. Which of the following findings should the nurse expect?

Moon face and buffalo hump.
Weight loss and muscle tremors.
Hyperpigmentation of the skin.
Hypotension and dizziness.

Question 21

A nurse is providing discharge teaching to a client who has a new permanent pacemaker. Which of the following instructions should the nurse include?

“Avoid using a microwave oven for cooking.”
“Check your pulse daily at the same time.”
“You can resume lifting heavy objects in 48 hours.”
“Keep your cell phone in your shirt pocket on the side of the pacemaker.”

Question 22

A nurse is reviewing the laboratory results for a client who is taking warfarin. Which of the following results should the nurse report to the provider?

aPTT 35 seconds
INR 5.2
PT 12 seconds
Platelets $200,000/mm^3$

Question 23

A nurse is planning care for a client who is 12 hours postoperative following a thyroidectomy. Which of the following is the priority assessment?

Check the client for laryngeal stridor.
Monitor the client’s calcium levels.
Assess the client’s surgical dressing for drainage.
Evaluate the client’s voice quality.

Question 24

A nurse is caring for a client who has hyperthyroidism. Which of the following findings should the nurse expect?

Bradycardia
Exophthalmos
Cold intolerance
Weight gain

Question 25

A nurse is teaching a client who has a new diagnosis of Type 1 diabetes mellitus about self-administration of insulin. Which of the following instructions should the nurse include?

“Shake the vial of NPH insulin vigorously before drawing it up.”
“Rotate injection sites within one anatomic area.”
“Inject the insulin at a 15-degree angle into the skin.”
“Store opened vials of insulin in the freezer.”

Question 26

A nurse is assessing a client who is receiving a blood transfusion. Which of the following findings indicates a hemolytic transfusion reaction?

Low back pain
Hypertension
Bradycardia
Dry, flushed skin

Question 27

A nurse is caring for a client who has a prescription for a magnesium sulfate IV infusion. Which of the following findings should the nurse report to the provider?

Respiratory rate 10/min
Deep tendon reflexes 2+
Urine output 40 mL/hr
Blood pressure 128/82 mm Hg

Question 28

A nurse is providing teaching to a client who has a new prescription for iron supplements. Which of the following instructions should the nurse include?

“Take the medication with an antacid to prevent stomach upset.”
“Expect your stools to be dark green or black in color.”
“Take the supplement with a glass of milk.”
“Report any constipation to your provider immediately.”

Question 29

A nurse is assessing a client who has heart failure and is taking digoxin. Which of the following findings indicates digoxin toxicity?

Yellow-tinged vision
Increased appetite
Constipation
Heart rate 90/min

Question 30

A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should the nurse include?

Change the TPN IV tubing every 24 hours.
Check the client’s blood glucose levels once daily.
Speed up the infusion rate if the schedule falls behind.
Administer TPN through a peripheral IV line.

Question 31

A nurse is assessing a client who is 4 hours postoperative following a transurethral resection of the prostate (TURP). Which of the following findings should the nurse report to the provider?

Pink-tinged urine in the drainage bag.
Reports of feeling the urge to urinate.
Brick-red urine with large clots.
Small amounts of tissue in the drainage tubing.

Question 32

A nurse is assessing a client who has Guillain-Barré syndrome. Which of the following findings should the nurse report to the provider immediately?

Decreased knee-jerk reflexes
Decreasing voice volume
Weakness of the lower extremities
Numbness and tingling of the hands

Question 33

A nurse is assessing a client who has appendicitis. Which of the following findings should the nurse report to the provider as a manifestation of peritonitis?

Distended, board-like abdomen
WBC count 15,000/mm³
Tenderness at McBurney’s point
Right lower quadrant pain

Question 35

A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.50, $PaCO_{2}$ 29 mm Hg, and $HCO_{3}$ 25 mEq/L. The nurse should interpret these findings as which of the following acid-base imbalances?

Metabolic alkalosis
Respiratory acidosis
Metabolic acidosis
Respiratory alkalosis

Question 36

A nurse is caring for a client who is receiving mechanical ventilation and the low-pressure alarm sounds. Which of the following actions should the nurse take?

Suction the client’s airway.
Check the ventilator tubing connections.
Administer a sedative.
Empty water from the ventilator tubing.

Question 37

A nurse is planning care for a client who has Ménière’s disease. Which of the following interventions should the nurse include in the plan of care?

Administer aspirin for pain.
Encourage the client to increase fluid intake.
Provide a low-sodium diet.
Maintain the client on strict bed rest.

Question 38

A nurse is providing discharge teaching to a client who is postoperative following a liver biopsy. Which of the following instructions should the nurse include?

“Lie on your right side.”
“Resume your usual activities tomorrow.”
“Drink 1 liter of fluid to flush out the dye.”
“You may have a fever for the next 48 hours.”

Question 39

A nurse is providing teaching to a client who is scheduled for a bone marrow biopsy taken from the iliac crest. Which of the following information should the nurse include?

“Avoid strenuous activities for 1 week following the procedure.”
“You will lie on your back during the procedure.”
“You will receive general anesthesia for the procedure.”
“Take acetaminophen as prescribed for pain relief after the procedure.”

Question 41

A nurse is teaching a client who has glaucoma and is to start taking timolol. Which of the following information should the nurse include?

“Notify the provider if you experience a stinging sensation following administration.”
“Watch for a decreased heart rate while using this medication.”
“You can expect to develop a harmless darkening of the iris.”
“This medication can cause the lashes of the affected eye to lengthen.”

Question 42

A nurse is planning care for a client who has acute pancreatitis. Which of the following interventions should the nurse include in the client’s plan? (Select all that apply.)

Initiate insulin drip.
Monitor blood glucose levels.
Continue regular diet as tolerated.
Maintain NPO status until pain-free.
Manage acute pain.

Question 43

A nurse is receiving report on a group of clients. Which of the following clients should the nurse assess first?

A client who has a chest tube and reports a pain level of 6 on a scale of 0 to 10.
A client who received parenteral cephalosporin and reports urticaria and edema.
A client who is being admitted with bilateral stage 3 pressure injuries on both heels.
A client who has a systemic infection and an oral temperature of 39.1° C (102.4° F).

Question 44

A nurse is teaching a client about fecal occult blood testing (FOBT) for the screening of colorectal cancer. Which of the following statements should the nurse include in the teaching?

“Your provider will use stool from your digital rectal examination to perform the test.”
“Your provider will prescribe a stimulant laxative prior to the procedure to evacuate the bowel.”
“You should begin annual fecal occult blood testing for colorectal cancer screening at 40 years old.”
“You should avoid taking corticosteroids prior to testing.”

Question 45

A nurse is providing instructions to a newly licensed nurse about NG intubation for a client who is postoperative following a colectomy. Which of the following statements should the nurse include?

“Tube drainage should be rust-colored.”
“Nutrition will be provided through the tube.”
“The tube decreases pressure within the stomach.”
“The tube should be irrigated with sterile water.”

Question 46

A nurse is assessing a client who has a herniated lumbar disc. Which of the following findings should the nurse expect?

The client reports relief from pain when lying in the prone position.
The client reports that their low-back pain radiates upward toward one scapula.
The client reports tingling and a burning sensation in one foot.
The client reports decreased pain when the affected leg is raised and straightened.

Question 47

A nurse is caring for a client who had surgery 2 days ago and reports incisional pain. Which of the following actions should the nurse take first?

Determine the time the last dose of pain medication was administered.
Reposition the client to assist with reduction of pain.
Ask the client to describe the pain and rate it on a scale of 0 to 10.
Check the client’s medical record for type of PRN pain medication.

Question 48

A nurse is initiating a plan of care for a client who has COPD. Which of the following interventions should the nurse include?

Request a prescription for an antibiotic.
Educate the client on pursed-lip breathing.
Place the client on airborne precautions.
Initiate oxygen therapy for $SpO_{2}$ of 92%.

Question 49

A nurse is preparing to discharge a client who has a new diagnosis of chronic kidney disease (CKD). Which of the following referrals should the nurse plan to initiate?

Respiratory therapy
Hospice care
Occupational therapy
Dietary services

Question 50

A nurse is reviewing laboratory reports for a client who is taking NSAIDs for rheumatoid arthritis. Which of the following results should the nurse recognize as a possible adverse effect of NSAID therapy?

Increased erythrocyte sedimentation rate
Elevated creatinine clearance
Increased serum potassium
Positive fecal occult blood test

Question: Final Case Study

For a client with a history of active Hepatitis B infection and current symptoms of jaundice and enlarged liver, identify the expected change for each assessment finding.

Hemoglobin: Decreased / Increased
Risk of liver cancer: Increased / Decreased
Aspartate aminotransferase (AST): Increased / Decreased
Prothrombin time: Increased / Decreased
Serum albumin: Increased / Decreased
Alanine aminotransferase (ALT): Increased / Decreased

Adult Medical Surgical, Capstone Adult Medical Surg 1

Isaura K

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