PN Adult Medical Surgical 2023

PN Adult Medical Surgical 2023 Related

Review PN Adult Medical Surgical 2023 related questions and content

Exhibit 1 Exhibit 2 Exhibit 3 Exhibit 4 Exhibit 5
Diagnostic Results
1000:
Hct 24% (37% to 47%)
Hgb 8 g/dL (12 to 16 g/dL)
RBC count 3 x 10⁶ µL (4.2 to 5.4 x 10⁶ µL)
Ferritin 8 ng/mL (10 to 150 ng/mL)
WBC count 9,000/mm³ (5,000 to 10,000/mm³)
Platelet count 180,000/mm³ (150,000 to 400,000/mm³)
Vitamin B₁₂ 159 pg/mL (160 to 950 pg/mL)
1030:
Stool for fecal occult blood negative

A nurse is assisting in the care of the client who has iron deficiency anemia. Which of the following instructions should the nurse include?

  • A. Take an antacid within 30 min after medication administration.
  • B. Increase sources of fiber in the diet.
  • C. Take the medication with a source of vitamin C.
  • D. Increase intake of milk and dairy products.
  • E. Take the medication on an empty stomach.
Correct Answer: C

Rationale: Iron deficiency anemia treatment hinges on maximizing iron absorption. Taking the medication with vitamin C enhances uptake ascorbic acid converts ferric to ferrous iron, boosting bioavailability in the acidic stomach environment, a cornerstone of anemia management. Antacids raise gastric pH, binding iron and reducing absorption, counterproductive to correcting deficiency. Increasing fiber mitigates constipation, a side effect of iron, but isn't the primary administration focus. Milk and dairy, high in calcium, inhibit iron absorption by competing for uptake sites, worsening anemia if paired with supplements. Vitamin C's synergistic effect backed by dietary guidelines optimizes therapy, especially critical with low ferritin (8 ng/mL, Exhibit 1), empowering the client to improve hemoglobin efficiently while minimizing common pitfalls, making it the essential instruction.

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A nurse is caring for a client who has returned to the unit following a cardiac catheterization using a femoral approach. Which of the following methods should the nurse use to monitor for complications?

  • A. Palpate the client's brachial pulses and compare bilaterally.
  • B. Check for jugular vein distention while the client is supine.
  • C. Check the client's blood pressure while the client lies supine, sits, and stands.
  • D. Palpate the client's pedal pulses and compare bilaterally.
  • E. Monitor respiratory rate.
  • F. Check for chest pain.
  • G. Assess skin temperature.
Correct Answer: D

Rationale: Pedal pulses assess for femoral artery complications like hematoma or occlusion.

History and Physical
1000:
Client reports generalized weakness and increased fatigue over the past few months.
Client states they become short of breath after climbing a flight of stairs and are having difficulty keeping up with their grandchildren.
History of rheumatoid arthritis. Reports taking naproxen 500 mg twice a day.
Client reports they follow a vegan diet.
Denies pain or discomfort.
Bilateral breath sounds clear and present throughout.
Mucous membranes pale.
Apical pulse rapid, regular.

Which of the following findings require follow-up? (Client with generalized weakness, vegan diet, pale mucous membranes)

  • A. Breath sounds
  • B. Activity level
  • C. Hematocrit
  • D. Blood pressure
  • E. Pain level
  • F. Temperature
  • G. Oxygen saturation
Correct Answer: B,C

Rationale: Decreased activity level and low hematocrit (24%) suggest anemia, requiring follow-up; breath sounds are clear, and other findings are less urgent.

A nurse is reviewing vital signs obtained by an assistive personnel on a group of clients. Which of the following changes should the nurse identify as the priority finding?

  • A. Heart rate change from 110/min to 68/min
  • B. Respiratory rate change from 12/min to 20/min
  • C. Blood pressure change from 118/78 mm Hg to 86/50 mm Hg
  • D. Temperature change from 36.6°C (97.9°F) to 38.8°C (101.9°F)
Correct Answer: C

Rationale: Blood pressure dropping to 86/50 mm Hg from 118/78 signals hypotension, risking organ perfusion a circulation priority per ABCs. Heart rate falling to 68 from 110 may normalize post-tachycardia, less urgent without distress. Respiratory rate rising to 20 from 12 suggests compensation, but hypotension trumps breathing acuity. Fever at 38.8°C indicates infection, but hemodynamic instability is more immediate shock or bleeding needs rapid action. This finding drives urgent assessment (e.g., fluids, vasopressors), aligning with triage protocols, making it the nurse's top concern.

A nurse is reinforcing teaching with a client who will undergo a colonoscopy the following week. Which of the following instructions should the nurse include?

  • A. Administer enemas 2 days before the procedure
  • B. Do not eat or drink anything except water for 12 hr. before the procedure.
  • C. Restrict the diet to clear liquids for 1 to 3 days before the procedure.
  • D. Expect the provider to schedule another procedure to remove any polyps
Correct Answer: B

Rationale: A 12-hour fast with only water prepares the colon adequately for a colonoscopy, reflecting standard protocol and client understanding.

A nurse is assisting with the care of a client who has a closed-chest tube drainage system. Which of the following actions should the nurse take?

  • A. Replace the unit when the drainage chamber is full.
  • B. Monitor for at least 150 mL of drainage every hour.
  • C. Clamp the tube for 30 min every 8 hr.
  • D. Pin the tubing to the client's bed sheets.
Correct Answer: A

Rationale: Chest tube systems remove pleural air or fluid, requiring functionality. Replacing the unit when full prevents backpressure or overflow, maintaining drainage and lung re-expansion, per manufacturer and infection control standards (e.g., CDC). Monitoring 150 mL/hr is excessive sudden high output signals hemorrhage, not routine care. Clamping risks tension pneumothorax by trapping air/fluid, only done briefly for specific checks (e.g., air leak). Pinning tubing prevents dislodgement, but full chamber replacement is the proactive maintenance action. This ensures system efficacy, prevents complications like atelectasis, and aligns with respiratory care priorities, making it the nurse's key responsibility.

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