RN exams medical-surgical practice questions set 31

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When a woman in active labor is receiving intravenous oxytocin for labor augmentation, it is essential to increase the oxytocin infusion rate gradually to prevent oxytocin-induced uterine hyperstimulation. Uterine hyperstimulation can lead to complications such as fetal distress, uterine rupture, and postpartum hemorrhage. By increasing the oxytocin infusion rate gradually, the uterus has more time to adapt to the medication and reduces the risk of hyperstimulation. It is crucial for the healthcare provider to carefully monitor the woman's response to oxytocin and adjust the infusion rate as needed to ensure safe and effective labor augmentation. Monitoring for signs of uterine hyperstimulation, such as persistent contractions close together or excessive uterine activity, is crucial in preventing complications and ensuring the well-being of both the mother and baby.

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The correct action for the nurse to take when observing signs of distress and discomfort in a patient during assessment is to offer emotional support and actively listen to the patient's concerns. Ignoring the patient's distress may lead to worsening of the patient's condition and can be detrimental to the patient's well-being. Documenting the findings and informing the healthcare provider later is important but should not be the immediate response when a patient is in distress. Administering pain medication without further assessment is also not appropriate as the nurse needs to understand the underlying cause of the distress before providing appropriate interventions. Offering emotional support and actively listening to the patient's concerns can help the nurse understand the patient's needs, provide comfort, and potentially address the root cause of the distress.

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The correct statements to include when teaching a client with stress incontinence about pelvic muscle exercises are that starting and stopping the urine stream involve using pelvic muscles and that tightening pelvic muscles for a slow count of 10 and then relaxing for a slow count of 10 can help strengthen them. It is essential to highlight that pelvic muscle exercises can be performed in various positions, including lying down, sitting up, and standing. This variety in positions helps engage the muscles effectively. Performing these exercises 15 times in each position can aid in strengthening the pelvic floor muscles. Consistent exercise over several weeks typically leads to improved control over urine leakage. Choice C is incorrect because pelvic muscle exercises can be performed in different positions and are not limited to sitting upright with feet on the floor.

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The correct answer is B: Do you have difficulty when you are putting on a shirt? This question is relevant because it specifically addresses the motion that triggers the patient's shoulder pain. It helps to assess the range of motion and identify any limitations or discomfort during activities involving arm movement behind the back. A: Are you able to feed yourself without difficulty? - While this question addresses arm movement, it does not specifically target the motion that triggers the pain. C: Are you able to sleep through the night without waking? - This question does not directly relate to the shoulder pain triggered by arm movement behind the back. D: Do you ever have trouble lowering yourself to the toilet? - This question does not address the specific movement causing the shoulder pain and is not as relevant for assessing the patient's condition.

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Rationale: A: Correct. The nurse should advise the patient to discuss her desire to start a family with her healthcare provider. By doing so, the provider can assess the risks, adjust the medication regimen if necessary, and provide guidance on how to proceed safely during pregnancy. B: Incorrect. Discontinuing immune modulating drugs abruptly can have negative consequences on the patient's health. It is important to have a healthcare provider manage any necessary adjustments to the medication. C: Incorrect. While some immune modulating drugs may have potential risks during pregnancy, not all are highly teratogenic. Each drug should be evaluated individually. D: Incorrect. While pregnancy may require adjustments to the medication regimen, it is not necessarily ruled out as an option. Adoption is a personal choice and should not be presented as the only alternative.

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The nurse's priority action when noticing a malfunctioning anesthesia machine in the operating room should be to inform the anesthesia provider immediately. Anesthesia providers are responsible for administering anesthesia safely during surgical procedures, and they need to be made aware of any equipment issues promptly to ensure patient safety. Continuing with the surgical procedure using a malfunctioning anesthesia machine can pose serious risks to the patient's well-being. Using an alternative anesthesia machine may be an option, but informing the anesthesia provider first ensures that the appropriate action is taken to address the issue effectively. Documenting the malfunction in the equipment log is important for record-keeping purposes, but it should not take precedence over informing the anesthesia provider and taking immediate action to address the problem.

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The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

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When a patient receiving gentamicin (Garamycin) reports experiencing ringing in the ears, it is crucial to consider the possibility of ototoxicity. Ototoxicity is a known adverse effect of aminoglycosides. The appropriate action for the nurse in this situation is to contact the provider to discuss obtaining a serum drug level. This is important to assess the drug concentration in the patient's blood, which can help determine if the ringing in the ears is related to the medication. Decreasing the dose or changing the dosing frequency without assessing the serum drug level may not address the underlying issue and could potentially lead to suboptimal treatment. Ordering a hearing test may be necessary at a later stage if the serum drug level indicates a concern. Therefore, option C, obtaining a serum drug level, is the most appropriate action to take in this scenario.

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Rationale for Correct Answer (C): The statement "I did not have this bone cancer until my leg broke a week ago" indicates a lack of understanding about osteosarcoma, a type of bone cancer. Osteosarcoma does not develop as a result of a broken bone; rather, it is a primary bone cancer that arises from bone cells. This statement suggests a misunderstanding of the nature of the disease, indicating a need for further patient education. Summary of Incorrect Choices: A: Choice A is correct as physical therapy is typically recommended after amputation to aid in rehabilitation and improve mobility. B: Choice B is not indicative of a need for additional teaching as chemotherapy is often part of the treatment plan for osteosarcoma. D: Choice D is also not a sign for additional teaching as PCA is commonly used for postoperative pain management after amputation surgery.

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The presence of ecchymosis (bruising) and significant swelling in the perineum despite analgesic medication suggests a potential complication such as a hematoma. A hematoma is a collection of blood that can occur due to trauma or during childbirth. It is important to notify the healthcare provider immediately so that further assessment and interventions, such as drainage of the hematoma, can be initiated promptly to prevent complications and alleviate the client's pain. Applying ice packs or encouraging the client to sit on a donut cushion may provide temporary relief but will not address the underlying issue of a potentially serious hematoma. Administering additional analgesic medication may not be effective in this case if the pain is primarily due to the hematoma. Prompt notification of the healthcare provider is crucial for proper management of this situation.