RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH VERIFIED SOLUTIONS/A+ GRADE

N VATI Adult Medical Surgical 2019
CLOSE Que s t ion 9 0 l o a d e d r a t io na ls p r o v i de d Question: 90 of 90
CORRECT
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A nurse is caring for a client who has atopic dermatitis and a prescription for triamcinolone
ointment. The nurse should assess the client to monitor for which of the following adverse
effects?
Increased pigmentation
Topical glucocorticoid therapy can cause the adverse effect of hypopigmentation.
Localized hair loss
Long-term glucocorticoid therapy can cause hypertrichosis, or excessive hair growth,
especially on the facial area.
Thinning of the skin
MY ANSWER
Thinning of the skin and delayed healing are adverse effects of topical glucocorticoid
preparations. The client should only apply the ointment to dry patches of the skin because
topical steroids can cause atrophy of the dermis and epidermis, which can result in
thinning of the skin.
Increased sensitivity to the sun
The nurse should instruct the client to avoid excessive sun exposure when taking topical
fluticasone; however, triamcinolone ointment does not cause photosensitivity.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 9 l o a d e d r a t io na ls p r o v i de d Question: 89 of 90
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RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Frothy sputum
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PAUSE
A nurse is assessing a client who hasleft-sided heart failure. Which of the following findings
should the nurse identify as a manifestation of left-sided heart failure?
Dependent edema
The nurse should identify that dependent edema is a manifestation of right-sided heart
failure due to right ventricular failure and fluid retention from pressure building up in the
venous system.
Jugular distention
The nurse should identify that jugular vein distention is a manifestation of right-sided heart
failure due to right ventricular failure and fluid retention from pressure building up in the
venous system.
Weight gain
The nurse should identify that weight gain is a manifestation of right-sided heart failure
due to right ventricular failure and fluid retention from pressure building up in the venous
system.
MY ANSWER
The nurse should identify that frothy sputum, dyspnea, and wheezing are manifestations of
left-sided heart failure. Treatment includes fluid restriction and diuretics to decrease
preload and reduce pulmonary congestion. Pink-tinged frothy sputum can be an early
indication of pulmonary edema and can be life-threatening. Therefore, the nurse should
notify the provider immediately.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 8 l o a d e d r a t io na ls p r o v i de d Question: 88 of 90
CORRECT
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Respiratory alkalosis
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A nurse is caring for a client who is experiencing anxiety as well as numbness and tingling of the
lips and fingers. The client's ABGs are: pH 7.48, PCO2 30 mm Hg, HCO3
- 24 mEq/L, PaO2 85 mm
Hg. Which of the following acid-base imbalances should the nurse identify that the client is
experiencing?
MY ANSWER
This pH is alkaline (increased) and the PCO2 is decreased, representing alveolar
hyperventilation and resultant respiratory alkalosis.
Respiratory acidosis
This pH is alkaline (increased) and the PCO2 is decreased. A decreased pH and an increased
PCO2 indicate respiratory acidosis.
Metabolic alkalosis
This HCO3
- 24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline
(increased). An increased pH and HCO3
- indicate metabolic alkalosis.
Metabolic acidosis
This HCO3
- 24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline
(increased). A decreased pH and HCO3
- indicate metabolic acidosis.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 7 l o a d e d r a t io na ls p r o v i de d Question: 87 of 90
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A nurse is assessing a client who has Cushing's syndrome. Which of the following findings
should the nurse expect?
Vitiligo
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Osteoporosis
Vitiligo is the loss of pigment from areas of a client's skin, causing irregular, white patches.
Vitiligo is a manifestation of adrenal-gland hypofunction.
MY ANSWER
Osteoporosis is a common finding with Cushing's syndrome. Bones become thinner as a
result of mineral loss and nitrogen depletion, and the risk for fractures increases.
Myxedema
A client who has hypothyroidism can develop myxedema that causes mucinous cellular
edema around the eyes, across the upper back, and in the hands and feet.
Heatintolerance
A client who has hyperthyroidism can develop heat intolerance, along with an increase in
sweating.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 6 l o a d e d r a t io na ls p r o v i de d Question: 86 of 90
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A nurse is inspecting the skin of a client who has basal cell carcinoma. The nurse should identify
which of the following lesion characteristics on the client's skin?
MY ANSWER
A client who has basal cell carcinoma has a nodular lesion with well-defined borders and a
pearly or waxy appearance, resulting from overexposure to the sun, especially on the face,
head, and neck.
An irregular border on a variegated-colored lesion
A pearly, waxy nodule
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
A client who has melanoma has a lesion with irregular borders and variegated colors of
red, white, and blue, most often on the upper back or lower legs.
A firm, nodular, crusty, or ulcerated lesion
A client who has squamous cell carcinoma has a firm, nodular, and crusty lesion with an
ulcerated center, resulting from sun exposure, chronic irritation, burns, or irradiation to
the skin.
A weeping vesicle
A client who has herpes zoster has weeping, blister-type lesions.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 5 l o a d e d r a t io na ls p r o v i de d Question: 85 of 90
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A nurse is assessing a client who has hypocalcemia. In which of the following areas should the
nurse tap on the client's face to detect the presence of Chvostek's sign? (You will find hot spots
to select in the artwork below. Select only the hot spot that corresponds to your answer.)
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
A is correct. The nurse should tap the client's cheek just in front of the ear and below the
zygomatic arch. The client who has hypocalcemia will display a Chvostek's sign, which is a
twitching of the facial muscle.
B is incorrect. The nurse should apply upward pressure at the supraorbital ridge, below
the eyebrow, to assess for tenderness and inflammation of the frontal sinuses.
C is incorrect. The nurse should palpate the jaw and mastoid muscle of a client who has
temporomandibular joint dysfunction. This can be caused by misaligned teeth, arthritis, or
grinding of the teeth. With palpation, the nurse might feel a click, pop, or grating sensation
when the client opens or closes the jaw.
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Low urine specific gravity
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 4 l o a d e d r a t io na ls p r o v i de d Question: 84 of 90
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A nurse in an emergency department is assessing a client who is overusing prescribed diuretics
and has a sodium level of 127 mEq/L. Which of the following laboratory findings should the
nurse expect?
High lipase
A high lipase level is associated with pancreatic dysfunction or renal failure and is not an
expected finding with hyponatremia or dehydration.
MY ANSWER
A client who has hyponatremia as a result of diuretic overuse has a low urine specific
gravity. The increased excretion of water alters the ratio of particulate matter, which
affects the specific gravity.
Low hemoglobin
A client who is dehydrated as a result of diuretic overuse can have an elevated hemoglobin
level because of the difference in ratio between intravascular fluid and blood cells.
High creatine kinase-MB (CK-MB)
An elevated CK-MB level indicates a myocardial infarction and is not an expected finding
with hyponatremia.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 3 l o a d e d r a t io na ls p r o v i de d Question: 83 of 90
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Review the daily schedule with the client every morning.
INCORRECT
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A home health nurse is assisting a client with planning care for a family member who has
Alzheimer's disease. Which of the following instructions should the nurse include?
Remove clutter from rooms and hallways.
The nurse should instruct the family member to remove clutter from rooms and hallways
so the client is able to walk without the risk of falling or tripping over objects. Later in the
disease, the client can experience seizures, so cluttered areas could be a risk to the client.
Place a monthly calendar in the client's room.
MY ANSWER
The nurse should instruct the family member to place a single-date calendar in the client's
room. A monthly calendar can be overwhelming and confusing to a client who has
Alzheimer's disease.
Use confrontation to manage the client's behavior.
The nurse should instruct the family member to redirect the client by starting another
activity when the client begins to act out or becomes overstimulated. Redirecting the client
might help them gain focus.
The nurse should instruct the family member to use short, simple sentences when
explaining an activity to the client. The explanation should be done immediately before the
activity to aid the client's memory and ability to follow directions.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 2 l o a d e d r a t io na ls p r o v i de d Question: 82 of 90
CORRECT
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RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Refractory hypoxemia
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A nurse is caring for a client who has developed acute respiratory distress syndrome (ARDS).
Which of the following findings should the nurse identify as a manifestation of this syndrome?
An audible pleural friction rub
A client who has a pulmonary embolism can have a pleural friction rub along with
tachypnea, tachycardia, dyspnea, and sudden, sharp chest pain. However, a pleural friction
rub is not a manifestation of ARDS.
Tracheal deviation from the midline
A client who has a tension pneumothorax can have tracheal deviation with dyspnea,
tachycardia, and tachypnea. On auscultation, breath sounds over the area of the
pneumothorax are decreased or absent. However, tracheal deviation is not a manifestation
of ARDS.
MY ANSWER
ARDS is a systemic inflammatory response to trauma, sepsis, burns, pancreatitis, and blood
transfusions, when excess lung fluid dilutes surfactant activity in the lungs. A client who
has ARDS has refractory hypoxemia, which is hypoxemia that does not improve with
oxygen therapy. Extensive pulmonary edema evident on a chest x-ray is a manifestation of
ARDS.
Bloody expectorant when coughing
A client who has lung cancer or laryngeal trauma can have hemoptysis. However, bloody
expectorant is not a manifestation of ARDS.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 1 l o a d e d r a t io na ls p r o v i de d Question: 81 of 90
CORRECT
RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Flat neck veins
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An emergency room nurse is assessing a client who has asthma and difficulty breathing. Which
of the following findings should indicate to the nurse that the client is experiencing status
asthmaticus?
Coughing
Status asthmaticus causes labored breathing and wheezing. Coughing indicates that the
client is exchanging air and is a manifestation of pneumonia, not status asthmaticus.
A client who has status asthmaticus has distended neck veins while trying to facilitate
breathing due to increased pulmonary pressure.
Use of accessory muscles
MY ANSWER
A client who has status asthmaticus uses accessory muscles to help facilitate breathing,
which is a manifestation of a severe airflow obstruction. The situation is life-threatening
and the nurse should intervene immediately with strong systemic bronchodilators,
epinephrine, corticosteroids, and oxygen.
Presence of coarse crackles
The presence of coarse crackles indicates air movement through fluid-filled airways and is
a manifestation of pneumonia, not status asthmaticus.
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RN VATI Adult Medical Surgical 2019
CLOSE Que s t ion 8 0 l o a d e d r a t io na ls p r o v i de d Question: 80 of 90
CORRECT
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RN VATI ADULT MEDICAL SURGICAL 2019 REAL QUESTIONS WITH
VERIFIED SOLUTIONS/A+ GRADE
Skin rash
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A nurse is teaching a client who has a new prescription for phenytoin to treat a seizure
disorder. Which of the following adverse effects should the nurse instruct the client to report
immediately to the provider?
Tender, bleeding gums
Gingival hyperplasia is an overgrowth of gum tissue that causes the gums to bleed, swell,
and become tender. Gingival hyperplasia is nonurgent adverse effect when a client is taking
phenytoin; therefore, there is another finding that is the priority. The nurse should advise
the client to maintain good oral hygiene with a soft toothbrush and to follow up with an
oral health professional.
Increased facial hair
Hirsutism, an increased growth of hair in unexpected places on the client's body, is
nonurgent because it is an expected finding for a client who is taking phenytoin.
Constipation
Constipation is nonurgent because it is an expected finding for a client who is taking
phenytoin.
MY ANSWER
When using the urgent vs. nonurgent approach to client care, the nurse should determine
that the priority finding is a rash, which can have a measles-like appearance and progress
to exfoliative dermatitis or Stevens-Johnson syndrome. The client should report this finding
to the provider immediately.