RN exams medical-surgical practice questions set 2

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The correct answer is A: A few minutes before the next scheduled dose of medication. This timing ensures that the trough level represents the lowest concentration of the antibiotic in the client's bloodstream, allowing for an accurate assessment of how well the medication is being metabolized and eliminated. Explanation: 1. Trough level is usually measured just before the next dose to ensure that the drug has reached its lowest concentration. 2. This timing helps determine if the drug concentration remains within the therapeutic range and if adjustments to the dosing regimen are needed. 3. Option B is incorrect because waiting 1-2 hours after oral administration would not reflect the trough level. 4. Option C is incorrect as measuring 30 minutes after IV administration would not capture the trough level accurately. 5. Option D is incorrect because measuring during infusion would not provide an accurate trough level. In summary, the trough level should be ordered just before the next dose to accurately assess the drug's concentration at its lowest point.

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The nurse's best approach to address the patient's confusion about their medication regimen is to use a teach-back method to assess understanding and clarify any misconceptions. This method involves the nurse asking the patient to explain in their own words how they will take their medications, what each medication is for, and any potential side effects they should watch for. By using the teach-back method, the nurse can confirm the patient's comprehension and correct any misunderstandings in a supportive and non-judgmental manner. This approach promotes patient education, empowerment, and adherence to the medication regimen. Providing written instructions alone (Choice A) may not be sufficient if the patient has difficulty reading or understanding written information. Explaining the medication regimen using complex medical terminology (Choice B) can further confuse the patient, making it harder for them to grasp the information. Dismissing the patient's concerns and reassuring them that the medication is safe (Choice D) does not address the root of the issue and

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The correct answer is B: Acute pain related to central nervous system (CNS), gastrointestinal (GI), and flu-like effects. This nursing diagnosis is appropriate for a patient receiving immune suppressants for leukemia as these medications can cause adverse effects such as CNS, GI, and flu-like symptoms leading to acute pain. The nurse should assess the patient for these symptoms and provide interventions to manage pain effectively. Incorrect Choices: A: Anxiety related to diagnosis and drug therapy - While anxiety can be common in patients with leukemia and receiving immune suppressants, acute pain is a more specific and immediate concern that should be addressed first. C: Risk for infection related to immune stimulation - This is not the most immediate concern for a patient receiving immune suppressants, as the main focus should be on managing side effects such as pain. D: Imbalanced nutrition: More than body requirements - This nursing diagnosis is not directly related to the side effects of immune suppressants and would not be the priority for this patient.

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The correct nursing intervention to prioritize in this situation is providing education on techniques to improve latch and milk transfer. Cesarean section deliveries can sometimes pose challenges for breastfeeding initiation, but with proper education and support, many women can successfully breastfeed following a C-section. By teaching the client techniques to improve latch and milk transfer, the nurse can help address the client's concerns about breastfeeding difficulties and worries about insufficient milk supply. This proactive approach empowers the client to overcome breastfeeding challenges and increase their confidence in their ability to breastfeed successfully. Referring the client to a lactation consultant for specialized support may also be beneficial, but providing initial education on latch and milk transfer is crucial in this early postpartum period. Recommending formula feedings or discouraging breastfeeding may not be appropriate interventions, as they can affect the establishment of breastfeeding and undermine the client's breastfeeding goals.

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Teaching the patient diaphragmatic breathing exercises for respiratory support would be the most appropriate intervention to address the symptoms of dyspnea and anxiety in this scenario. Diaphragmatic breathing, also known as belly breathing, focuses on engaging the diaphragm for deep, slow breaths, which can help improve lung expansion and ventilation. This technique can help the patient manage their breathing difficulty and reduce anxiety by promoting relaxation and improving oxygen exchange in the lungs. It empowers the patient with a coping strategy they can use independently to alleviate distressing symptoms at any time. Administering oxygen therapy may be beneficial, but the priority is to teach the patient a technique they can use proactively and routinely. Prescribing benzodiazepines should be considered as an adjunct if non-pharmacological interventions are ineffective in managing anxiety. Referring to a pulmonologist may be necessary for comprehensive evaluation and treatment but may not directly address the immediate symptoms of dyspnea and anxiety.

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The best action the nurse should prioritize to enhance patient comfort during a colposcopy procedure is to explain the procedure steps and provide emotional support to the patient. Colposcopy is a procedure that involves examining the cervix, vagina, and vulva closely. Patients may feel anxious or uncomfortable during the procedure due to the sensitive nature of the area being examined and the potential concerns related to abnormal cervical cytology results. By explaining the procedure steps in detail before starting and providing emotional support, the nurse can help alleviate the patient's fears and anxieties, thereby enhancing their comfort and promoting a more positive experience overall. Additionally, establishing good communication and trust with the patient can also improve their cooperation during the procedure. Administering sedation, applying a topical anesthetic cream, and allowing a support person to be present are all important factors in providing holistic care as well, but the initial priority should be on communication and emotional support.

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Preoperative nursing intervention that is essential for preparing a patient with a history of coronary artery disease for coronary artery bypass graft (CABG) surgery is assisting the patient with deep breathing and coughing exercises. These exercises are crucial to prevent postoperative complications such as atelectasis and pneumonia, which are common risks after surgery. Deep breathing exercises help to expand the lungs and improve ventilation, while coughing exercises help to clear secretions and prevent respiratory complications. By assisting the patient with these exercises preoperatively, the nurse can help optimize the patient's respiratory function and decrease the risk of complications during and after surgery. Administering aspirin, providing education about pain management, and obtaining informed consent are also important aspects of preoperative care, but assisting with deep breathing and coughing exercises is particularly essential for patients undergoing CABG surgery due to the increased risk of respiratory complications in this population.

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It is important for the nurse to provide the PACU nurse with the patient's intraoperative vital signs and hemodynamic parameters as this information gives insight into the patient's stability during the surgical procedure. The PACU nurse needs this data to monitor the patient's postoperative recovery, assess for any potential complications, and establish appropriate care interventions. Understanding the patient's intraoperative status allows the PACU nurse to provide a seamless continuation of care from the operating room to the post-anesthesia care unit. The details of the surgical procedure and anesthesia administration are also important but are typically conveyed through the surgical and anesthesia records. The plan for postoperative pain management and analgesic medications is essential but can be discussed and adjusted based on the patient's current status in the PACU. Documentation of the surgical count and instrument inventory is crucial for ensuring patient safety but is typically managed by the operating room team and may not be the immediate

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The correct answer is C because the patient lost consciousness immediately following the injury, then quickly regained consciousness, but lost consciousness again just before calling 911. This pattern of lucid intervals followed by a deteriorating level of consciousness is indicative of an epidural hematoma. The initial loss of consciousness is due to the initial trauma causing bleeding between the skull and the dura mater, leading to increased intracranial pressure. The temporary regaining of consciousness occurs when the hematoma temporarily stops expanding before resuming bleeding, causing a decline in consciousness again. Summary: A: A 'goose egg' noted on the patient's head is more indicative of a scalp hematoma or soft tissue injury, not necessarily an epidural hematoma. B: The patient being unconscious throughout transport could indicate a severe brain injury, but the specific pattern described in option C is more characteristic of an epidural hematoma. D: A sudden, severe headache may be a symptom of various head injuries, but it is

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The correct answer is A: Effects of oral contraceptives may be altered by liver changes or changes in immune response. Rationale: 1. Immune modulating drugs can affect liver function, potentially altering the metabolism of oral contraceptives. 2. Liver changes can impact the effectiveness of oral contraceptives by either increasing or decreasing their levels in the body. 3. Changes in immune response can also interfere with the hormonal balance maintained by oral contraceptives, leading to decreased efficacy. 4. Barrier contraceptives are recommended to prevent unintended pregnancies due to the potential interactions between immune modulating drugs and oral contraceptives. Summary of other choices: B: Incorrect. Oral contraceptives do not increase the action of immune modulating drugs; they may interact with them due to changes in metabolism. C: Incorrect. Immune modulators can affect oral contraceptives through liver metabolism rather than hormonal impact. D: Incorrect. High-estrogen pills are not the only option if barrier contrace