Health Care > NCLEX > MED SURG FINAL NCLEX PRACTICE QUESTIONS & ANSWERS/ Latest Solution (All)
Upon entering the room of a patient who has just returned from surgery for total laryngectomy and radical neck dissection, a nurse should recognize a need for intervention when finding A. a gastro... stomy tube that is clamped. B. the patient coughing blood-tinged secretions from the tracheostomy. C. the patient positioned in a lateral position with the head of the bed flat. D. 200 ml of serosanguineous drainage in the patient's portable drainage device. (ANS- C. the patient positioned in a lateral position with the head of the bed flat. After total laryngectomy and radical neck dissection, a patient should be placed in a semi-Fowler's position to decrease edema and limit tension on the suture line. A 78-year-old does not want to eat lunch and complains that the food that is serve does not taste good. Consistent with knowledge about age-related changes to taste, the nurse may find that the client is more willing to eat. A) Greasy foods B) Sour foods C) Sweet foods D) Salty foods. (ANS- C = the older adults' taste buds retain their sensitivity to carbohydrates. In addition, carbohydrates. Tend to be food items that are easy to chew. Older adults lose their sensitivity to sour and salty foods. Older adults may find greasy foods harder to digest and therefore may avoid them; however, preference for greasy foods is not related to changes in taste associated with age. The nurse is preparing a discharge plan to a female client with peptic ulcer for the dietary modification she will need to follow at home. Which of the following statements indicates that the client understands the instruction of the nurse? A) "I should not drink alcohol and caffeine." B) "I should eat a bland, soft diet." C) "It is important to eat six small meals a day." D) "I should drink several glasses of milk a day." (ANS- A = caffeinated beverages and alcohol should be avoided because they stimulate gastric acid production and irritate gastric mucosa. The client should avoid foods that cause discomfort; however, there is no need to follow a soft, bland diet. Eating six small meals daily is no longer a common treatment for peptic ulcer disease. Milk in large quantities is not recommended because it actually stimulates further production of gastric acids. A client has disabling attacks of vertigo. The nurse suspects that the client has Meniere's disease. The nurse is aware that the diet of the client must be modified. Which of the following is the best diet for the client? A) High protein B) Low Carbohydrates C) Low Sodium D) Low Fat (ANS- C = A low sodium diet is frequently an effective mechanism for reducing the frequency and severity of the disease episodes. About three-quarters of clients with Meniere's disease respond to treatment with a low salt diet. Which of the following is the most common surgical procedure for chronic otitis media? A) Myringotomy B) Ossiculoplasty C) Mastoidectomy D) Tympanoplasty (ANS- D Tympanoplasty involves surgical reconstruction as the tympanic membrane and is done to re-establish middle ear function, close perforation, prevent recurrent infections. - sew the tympanic membrane back up! A community health nurse is teaching smoking cessation program to a group of healthy adult smokers. What type of prevention activity is this? A) Primary B) Secondary C) Tertiary D) None of the above (ANS- A = primary cancer prevention targets healthy individuals and includes steps to avoid factors that might lead to the development of diseases. A female client with breast cancer is currently receiving radiation therapy for treatment. The client is complaining of apathy, hard to concentrate on something, and feeling tired despite of having time to rest and more sleep. These complains suggest symptoms of: A) Hypocalcemia B) radiation pneumonitis C) advanced breast cancer D) fatigue (ANS- D = Fatigue is a common complaint of individuals receiving medication therapy. The nurse is removing the client's staples from an abdominal when the client cough continuously and the incision splits open exposing the intestines. Which of the following is the immediate nursing action of the nurse? A) Call the surgeon to come to the client's room immediately B) Have all visitors and family member leave the room C) Press the emergency alarm to call the resuscitation team D) Cover the abdominal organs with sterile dressing moistened with sterile normal saline. (ANS- D = When a wound eviscerates, the nurse should cover the open area with sterile dressing moistened with sterile normal saline and then cover it with a dry dressing. The surgeon should then be notified to take the client back to the operating room to close the incision under general anesthesia. Which of the following signs and symptoms would indicate that a client has benign prostatic hypertrophy (BPH)? A) Hematuria B) Flank pain C) Impotence D) Difficulty starting the urinary stream (ANS- D = the symptoms of BPH are related to obstruction as a result of an enlarged prostate. Difficulty in starting the urinary stream is a common symptom, along with dribbling, hesitancy and urinary retention. [Show More]
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