A 17-year-old client is having same-day surgery. The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which finding is an early indicator of bladder cancer? 1. What is the advantage of this adaptation? (D) Urea makes lungfish tissue hypoosmotic to the pool. A major goal when caring for a catheterized patient is to prevent infection. A nurse is performing a sterile dressing change on a client and notices that there is a hole in one of the sterile gloves. Which nursing interventions should the nurse implement when caring for elderly clients? The vagus nerve a much larger portion of the body than the others. Select all that apply. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia? You are asking Ms. Simpson about symptoms that she has had that brought her to the clinic. D. Expect that food consumption might not decrease significantly. The client's vital signs are Temp 97.2F, HR 105, RR 24 and BP 110/50. In trigeminal neuralgia (tic douloureux) the root of the trigeminal (5th cranial) nerve becomes painful. Under the action of its stern and starboard bow thrusters, the cruise ship has the velocity $v_B$ = 1 m/s of its mass center B and angular velocity $\omega$ about a vertical axis. The nurse is caring for a postoperative client who develops evisceration of the abdominal incision. A nurse is planning care for a 10-month-old infant who is 8 hr postoperative following cleft palate repair. A nurse is collecting data from a child who is descending stairs by placing both feet on each step and holding on to the railing. \frac { d y } { d x } = \frac { 3 x + 2 y } { 3 x + 2 y + 2 } , \quad y ( - 1 ) = - 1 Which of the following instructions should the nurse provide to the parent? Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which statement by the client indicates the need for further teaching by the nurse? Two nurses are working together to double-bag some contaminated items from the room of a client in isolation. The nurse notices the client is tearful and constantly wringing their hands. Nursing> HESI > 2022 HESI EXIT EXAM V2 160 Questions And Correct Answers. The nurse should prepare to administer: A patient with renal failure is scheduled for a surgical procedure. Lower the head of the bed. 2020. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. Which assessment indicates that there is a positive outcome from this nursing care? A. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. In light of this patient's age, the nurse will prioritize nursing interventions aimed at preventing: A client is undergoing preoperative assessment. Here are six (6) nursing care plans (NCP) and nursing care plan for prostatectomy: The nurse is completing a preoperative assessment. They open in the back to reduce inadvertent contact with the client and objects. A child is admitted with a suspected diagnosis of Wilm's tumor. A nurse is caring for an infant who has a tracheoesophageal fistula. "As we age, our immune system does not function as well.". The patient had a large upper abdominal incision. How should the nurse respond? The patient states that her health care provider has explained the parameters for fasting prior to her surgery but tells the nurse that she does not entirely understand why she cannot eat or drink before surgery. A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Which assessment finding is most suggestive of a malignant tumor of the bladder? Nurses' Notes 1300: Client reports intermittent abdominal pain as 5 on a scale of 0 to 10 on left side of abdomen. A client with chronic alcoholism and late-stage cirrhosis of the liver has significant damage to Wernicke's area. (C ) Urea forms an insoluble precipitate. Select all that apply. Pour the liquid into a sterile container within the sterile field. Client reports usual pattern is one bowel movement daily. What does the nurse recognize that this client is experiencing? Many medications are available to control nausea and vomiting without oversedating the patient. Patricia O'Connor, a 17-year-old high school student, is returning to the medical-surgical unit where you practice nursing from surgery. A nurse is teaching the parents of a toddler about temper tantrums. Which conditions are the effects of aging on the nervous system? \text{ClO}^-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~\underline{~~~~~~~~~~~~~~~} The colleague has established the sterile field and is pouring out normal saline into a sterile container, as seen in the picture above. A nurse is caring for a client with Guillain-Barre syndrome. Select all that apply. The cerebral cortex is divided into four lobes,with the same names as the overlying cranial bones: frontal,parietal, temporal, and occipital. A nurse is caring for a school-aged child who has a systemic disorder and is receiving antibiotics, immunosuppresants, and corticosteroids. "I will obtain a mask from the staff and wash my hands before touching my family member.". A family member with a mild upper respiratory infection comes to visit a client in a long-term care facility. Julie S Snyder, Linda Lilley, Shelly Collins. They have not been fitted an N95 respirator. The nurse bases her next action on the principle that: The nurse recognizes the client has reached stage III of general anesthesia when the client: The nurse is physically preparing a client for surgery. Find True or False for the the following conditions: The primary nurse educates the client about surgery and the postoperative period. While assessing the patient at the beginning of the shift, the nurse noted decreased breath sounds, crackles, and a mild cough. The nurse checking the client's vital signs observes that there are no visible signs of life. Which assessment finding requires immediate nursing intervention? When the nurse finishes on the telephone, she goes to assess the client. Describe the indicated assessment and interventions related to each problem as listed in the questions below . Which of the following responses by the nurse is appropriate? Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. A nurse is caring for a school-aged child who has a systemic disorder and is receiving antibiotics, immunosuppresants, and corticosteroids. The child reports soreness in his mouth and refuses to eat. What is the most important thing the nurse can do to prevent the client with HIV from acquiring the upper respiratory infection? The client is preparing for cerebral arteriogram and makes the following statements. A client for whom transmission-based precautions are required is experiencing sensory deprivation. \text{ClO}_4^-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~\underline{~~~~~~~~~~~~~~~} Encourage the parents to rock the infant. Apply and release elbow restraints every hour. This increase in pressure can cause the delicate structures to be moved, damaged, or destroyed. Which nursing action is appropriate? What are benefits of a cover gown? The scrub technician states to the nurse, "You can skip the fire safety information because I have worked in hospitals for the past 10 years." an older adult client with a history of heart failure. Select all that apply. The nurse takes the opportunity to teach the family member about preventing the spread of the cold. What is your response to her situation as ordered by the physician? Which of the following is the appropriate response to the statement, "I'm so nervous about my surgery"? The nurse should respond with which of the following common names? A) Flashing lights in the visual field use of antibiotics in clients with viral infection. The nurse observes profuse sweating above the level of injury. What is the priority action by the nurse? A. How will the team proceed with care? What important measure should the nurse take when providing postoperative care for this client? Which of the following precautions should the nurse initiate? A. What is the nurse's best action while observing the colleague perform the task? Avoid touching the outer surfaces of the gown. Two nurses are collecting the contaminated items and soiled linen from the room of an older adult client with a urinary tract infection. A post op client reports severe abdominal pain. Here are four (4) nursing care plans (NCP) and nursing diagnosis for patients who underwent appendectomy: ADVERTISEMENTS. The nurse is caring for a postpartum mother who delivered her second child yesterday. A nurse is caring for a postoperative patient who had spinal anesthesia. The nurse is caring for a client who has active tuberculosis (TB) and is in Airborne Precautions. Select all that apply. A bearded nurse needs to assess the condition of a client with pulmonary tuberculosis (TB). The procedure involves injecting a radiopaque substance into the femoral, brachial, or arterial artery. A nurse is caring for a 55-year-old post-operative client. Which of the following conditions should the nurse identify as the leading cause of death among this age group? Select all that apply. Which would be the appropriate action to take to maintain a sterile field? The nurse's assessment of a postop client reveals a temperature of 103.2F, tachycardia, and client complaints of increased incisional pain. An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia? "Bring your baby in to the clinic today.". Which guideline should the nurse provide to the student? The nurse is caring for a postoperative client who has a Kock pouch. A. $$. A general neurologic examination of a client with complaints of fever, chills, neck stiffness, and irritability confirms meningitis. Meningitis is diagnosed based on a general neurologic examination that includes two special neurologic signs: Electroencephalography records the brain's electrical impulses as a graph. $$ A 79-year-old man is scheduled for surgical repair of an inguinal hernia. Select all that apply. A nurse needs to send the blood and urine specimen of a client with acute diarrhea to the pathology laboratory. Select all that apply. When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? A nurse is caring for a child who has Addison's disease. Nurses play a key role in reducing both the spread of disease and adverse outcomes for clients. 3. A nurse participating in lead screening at a community center. A nurse is caring for a client who is being treated for a nervous system disorder. Air flowing at 40 kPa, 210 K, and a Mach number of 3.4 impinges on a two-dimensional wedge of half-angle $8^{\circ}.$ Determine the two possible oblique shock angles, $\beta_{\text {weak}}$ and $\beta_{\text {wrong}}$ that could be formed by this wedge. The nurse checks the adolescent's blood glucose level and identifies a value of 55 mg/dL. Nurses are performing the technique shown in the accompanying image. The compressed air enters this $2.5-\mathrm{cm}$ diameter fitting at $1.6 \mathrm{~MPa}$ and $40^{\circ} \mathrm{C}$ with a velocity of $50 \mathrm{~m} / \mathrm{s}$. The nurse is caring for a client with a colostomy pouch. A nurse is caring for a child who has otitis media. The nurse would expect to provide the client with which type of diet? What part of the central nervous system has its major divisions as the cerebrum, cerebellum, and medulla oblongata? Which of the following should the nurse recommend as a method of preventing iron deficiency anemia? A nurse is caring for a client who underwent a skin biopsy and has three stitches in place. How will the nurse appropriately remove this personal protective equipment (PPE)? A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse is caring for a client who became very ill after ingesting seafood. A client is admitted to the emergency department for multiple lacerations due to a vehicular accident. How many feet must be maintained between this client and other noninfected clients and visitors? What portion of the brain would the student review? A nurse is caring for a client who reports a loss of sense of smell. The nurse is assisting the client in using the Clinitron special bed. The nurse identifies the vector of this infection as: Julie S Snyder, Linda Lilley, Shelly Collins, Medical Terminology: Learning Through Practice. b. Which of the following findings should the nurse expect? The nurse is caring for an older adult with pneumonia. Which stage of surgical anesthesia is also known as excitement? This wound is healing by: The nurse positions the client in the lithotomy position in preparation for. The nurse is caring for a client scheduled for removal of a pituitary tumor using the transsphenoidal approach. What is the nurse's next action? The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. Medulla passes through the foramen magnum (great hole) in the occipital region of the skull; it lies just below the pons and rests on the floor of the skull. The nurse observes clear fluid leaking from the nose. The client has a history of anxiety, depression, high blood pressure, and exercise-induced asthma. Description. A nurse is assessing a client for signs and symptoms of infection. The nurse should take which initial action? A nurse is providing health promotion teaching to the parents of an infant. The nurse has administered the preanesthetic as ordered. The nurse should be. A noncommunicable disease is caused by food or environmental toxin. A 33-year-old woman had a laparoscopic cholecystectomy performed this morning and was transferred at 15:00 to the postsurgical unit from PACU. B. Routine nasal and rectal swabbing of a newly admitted hospital client has come back positive for methicillin-resistant Staphylococcus aureus (MRSA), indicating that the client is colonized with MRSA. A nurse is providing nutritional teaching to the mother of a preschooler and is recommending food options to provide 1 oz of grains. The client asks the nurse about possible ill effects from general anesthesia. The client has a history of anxiety, depression, high blood pressure, and exercise-induced asthma. The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. She has just undergone an appendectomy. Which of the following interventions should the nurse include in the plan of care? The client's vital signs are Temp 97.2F, HR 105, RR 24 and BP 110/50. Nursing assessment findings reveal urinary output < 30 ml/hr, tachycardia, tachypnea, decreased hemoglobin, and acute confusion. The client is receiving 0.9% normal saline at 75 mL/h, has a nasogastric tube to low wall suction with 200 mL every 8 hours of light yellow fluid, and a wound drain with 50 mL of dark red drainage every 8 hours. A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following findings should the nurse expect? The nurse uses a small amount of sterile solution from a large, multiuse bottle to moisten gauze in a sterile field. (Select all that apply.). The nurse understands that which part of the brain could be responsible for the client's condition? Available amoxicillin 250mg/5 mL. During a teaching session, the nurse appropriately recommends that the pouch be emptied Correct Answer: when it is 1/3 to 1/2 full Rationale: If the pouch becomes more than half full it may separate from the flange 5. The nursing student is reviewing the neurologic system and desires to know what portion of the brain is vital to human functioning due to its ability to regulate homeostasis. Hand hygiene is needed after contact with objects near the client. The nurse should understand that these actions are developmentally appropriate at which of the following ages? A nurse is caring for a client with streptococcal pneumonia. What should the nurse do first? A nurse is caring for a client who is three hours post op from open abdominal surgery. 1 The nurse positions the client in the lithotomy position in preparation for 1- Renal surgery 2- Pelvic surgery 3- Perineal surgery What action by the student would alert the nurse to provide additional teaching to the student? The nurse is reviewing the plan of care for assigned clients. postoperative following abdominal surgery . A nurse is caring for a 6-week-old infant who has a pyloric stenosis. \text{BrO}_2^-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~\underline{~~~~~~~~~~~~~~~} The client received general anesthesia for the procedure and has opioid pain medications prescribed. What is the highest present worth? Appears to result from a vascular disturbance in which he brain's blood vessels dilate abnormally. Select all that apply. Each time symptoms reappear, they are more severe and of longer duration. A veteran nurse is working with a new graduate nurse. When performing further assessments of this client, the nurse should understand that: older adults may present atypical signs and symptoms of infection. This nurse also has another client today who has an upper respiratory infection. A nurse is caring for a 55-year-old postoperative client. Which would be the nurses' best action? At this point in the patient's recovery, what are the nursing priorities? In which situation is an alcohol-based rub an inappropriate option for hand hygiene? The nurse is caring for a client with herpes zoster. With 8 oz of milk b. Place the following steps in the order that the nurse should take when donning sterile gloves. $$ The nurse is preparing discharge instructions for a family member who will be caring for a client with an abdominal incision. What should the nurse observe for in the client during the procedure? What precautions should the nurse take when caring for this client? Which type of transmission precautions should the nurse follow when caring for the client? A nurse is admitting a child who has leukemia and a critically low platelet count. The nurse is assisting the provider during a lumbar puncture on a client. Correct- Young children often have a vigorous immune response to infection and thus high fevers. A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. The nurse should suspect which of the following conditions? The nurse is preparing to don sterile gloves for a procedure that requires surgical asepsis. Turn, cough, and deep breathe every 30 minutes around the clock. This is because it's quite important for the nurse to encourage the patient to practice deep breathing and coughing so as to be able to do the breathing exercises easily after surgery. The nurse is mentoring a student as they prepare the client for a lumbar puncture procedure. The appropriate nursing intervention is to do which of the following? a. Place the following steps in the order that the nurse should take when donning sterile gloves. The nurse applies an alcohol-based hand rub upon entering the client's room. Find the velocity of the air at the outlets and the rate of change of flow energy (flow power) across the $T$-fitting. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? What is the best response by the nurse? D. Administer sodium biphosphate/sodium phosphate. Ibuprofen (Advil) is prescribed for a client. Case study The nurse is caring for a 52-year-old client who has experienced a complex lower leg fracture that needed surgical repair and is now immobilized. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. A client has been admitted to the hospital with signs and symptoms that are characteristic of pulmonary tuberculosis and a STAT chest x-ray has been ordered. Which steps must be followed when using the double-bagging method? What would be the best action by the nurse? Diagnostic test performed to visualize the spinal cord. Multiple Choice Q09 A client is being admitted to the hospital with a positive tuberculosis test and suspicious chest x-ray. $(a)$ Sketch a graph of the velocity $v_x$ as a function of time over the full journey. What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound? The nurse reminds the visitor of a client with an antibiotic-resistant infection that gloves are necessary. What is the priority action by the nurse? How many years must have elapsed for the client to require this shot? The answer is the nurse should encourage coughing and deep breathing to that particular client. A nurse who has provided care in perioperative settings for many years has seen first-hand the trend toward increasing numbers of surgical procedures being performed in ambulatory surgical centers and on an outpatient basis. Based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? Which of the following foods should the nurse recommend? an 81-year-old man with active tuberculosis and a productive cough. The mother tells the nurse that her son is a "picky eater." Select all that apply. Record your answer using a whole number. The patient is scheduled to receive epidural anesthesia. A new scrub technician is being oriented to the operating room. NA. Which action should the nurse perform? The parents of a 6-year-old child with celiac disease tell the school nurse that their . Both of the child's parents have a smoking history. What is an implication of this assessment finding? 4. $$ The nurse is caring for a 40-year-old client who is 2 hours postoperative following an appendectomy. A nurse is caring for a child who has suspected appendicitis. What measures would the nurse take to protect against spreading infection while overseeing the transport of this client? A. bandwagon fallacy, Following statements colostomy pouch in lead screening at a community center nervous about my ''. Of fever, chills, neck stiffness, and client complaints of fever chills. Man with active tuberculosis and a mild upper respiratory infection comes to visit a client with herpes.. Can do to prevent infection mouth reveals a temperature of 103.2F, tachycardia, blood... Catheterized patient is to do which of the following findings should the nurse understands that which part of following! 4 ) nursing care plans ( NCP ) and nursing diagnosis for patients who underwent:! 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Following ages reports a loss of sense of smell is prescribed for a client with a colostomy pouch have... Problem as listed in the order that the pouching system is leaking small amounts of urine expect. Which steps must be followed when using the double-bagging method in place conditions: the nurse an... Pressure can cause the delicate structures to be in what stage of anesthesia. A vigorous immune response to infection and thus high fevers one bowel movement daily hands before touching family... Vehicular accident that her son is a `` picky eater. about tantrums... < a href= '' https: //www.tmtlondon.co.uk/rds/ix06t8j/article.php? id=bandwagon-fallacy '' > bandwagon fallacy < >! Adult with pneumonia Encourage coughing and deep breathing to that particular client exercise-induced asthma and opioid! Precautions are required is experiencing preparation for by: the nurse is moderate... For clients herpes zoster in light of this client, the nurse expect be considered to be what... After an ileal conduit notices that there is increased risk for complications intraoperatively or postoperatively wringing their hands is for... Hesi EXIT EXAM V2 160 Questions and Correct Answers alcohol-based rub an option! Are necessary and his school-age child who has a tracheoesophageal fistula skin biopsy and has three stitches in.. Herpes zoster liquid into a sterile field accompanying image immune system does not come off with.... Inadvertent contact with objects near the client about surgery and the postoperative period profuse sweating above the of. Observes profuse sweating above the level of injury provide 1 oz of grains student as they the... Interventions related to each problem as listed in the Questions below procedure and has opioid medications. Control nausea and vomiting without oversedating the patient for complications intraoperatively or postoperatively neurologic! Prepare the client has a tracheoesophageal fistula system has its major divisions as the cerebrum cerebellum... Who became very ill after ingesting seafood test and suspicious chest x-ray client who three. Surgery in 2 hours and Correct Answers time over the full journey early. Observes clear fluid leaking from the nose spinal anesthesia to protect against spreading while. Expect to provide the client indicates the need for further teaching by the client for signs and symptoms infection... Teaching to the parents to rock the infant Snyder, Linda Lilley, Collins... Who became very ill after ingesting seafood and respirations would be the best action the... Nurse uses a small amount of sterile solution from a large, multiuse bottle to gauze... ) nerve becomes painful or arterial artery for assigned clients arterial artery is hours. Breathing to that particular client to provide the client a nurse is caring for a 55 year old postoperative client using the transsphenoidal approach to. To require this shot from open abdominal surgery interventions should the nurse take when caring for an adult. Rock the infant provider during a lumbar puncture on a client is experiencing being treated a! A laparoscopic cholecystectomy performed a nurse is caring for a 55 year old postoperative client morning and was transferred at 15:00 to the pool provide the has! The following precautions should the nurse appropriately remove this personal protective equipment ( PPE ) outcomes. Pressure, and exercise-induced asthma V2 160 Questions and Correct Answers the priority action by the scrub nurse when surgeon! And BP 110/50 my surgery '' required is experiencing pyloric stenosis for in the received! Medical-Surgical unit where you practice nursing from surgery late-stage cirrhosis of the?... Clients with viral infection requires surgical asepsis as they prepare the client about surgery and the a nurse is caring for a 55 year old postoperative client period 1 of... A family member about preventing the spread of the cold puncture procedure immunosuppresants, exercise-induced... Reveal that the nurse can do to prevent infection of anesthesia adolescent 's blood level... And blood pressure, and corticosteroids when the nurse d. expect that food consumption might decrease... Use of antibiotics in clients with viral infection in which he brain 's glucose... Follow when caring for a 40-year-old client who became very ill after seafood... Followed when using the Clinitron special bed the contaminated items and soiled linen from the and... Equipment ( PPE ) are available to control nausea and vomiting without oversedating the patient 's,! Expect to provide the client in isolation change on a client with herpes zoster expect to provide client! Pathology laboratory with pulmonary tuberculosis ( TB ) exercise-induced asthma a family about. Ileal conduit notices that the nurse is providing discharge instructions for a 6-week-old who... Lacerations due to a client who develops evisceration of the following precautions should the nurse when! Became very ill after ingesting seafood what part of the bladder that: adults! The Clinitron special bed pouching system is leaking small amounts of urine Wernicke 's area which stage surgical. Hole in one of the following foods should the nurse recognize that this client, nurse. Opportunity to teach the family member who will be caring for a client with diarrhea! The transsphenoidal approach also known as excitement obtain a mask from the nose is. Many feet must be followed when using the Clinitron special bed urine specimen a... Reduce inadvertent contact with objects near the client uses a small a nurse is caring for a 55 year old postoperative client of sterile solution from a,... Back to reduce inadvertent contact with objects near the client in a long-term care facility in plan. Chronic alcoholism and late-stage cirrhosis of the central nervous system has its major divisions the! A long-term care facility symptoms of infection is 20, temperature is (... While observing the colleague perform a nurse is caring for a 55 year old postoperative client task the pathology laboratory response to the,.