Medical-Surgical A1. 1.The nurse is providing dietary instructions to a 68-year-old client who is at high risk for development of coronary heart disease (CHD). Which information should the nurse include?A. Limit dietary selection of cholesterol to 300 mg per day.B. Increase intake of soluble fiber to 10 to 25 grams per day.C. Decrease plant stanols and sterols to less than 2 grams/day.D. Ensure saturated fat is less than 30% of total caloric intake.2. 2.Which reaction should the nurse identify in a client who is responding to stimulation of the sympathetic nervous system?A. Pupil constriction.B. Increased heart rate.C. Bronchial constriction.D. Decreased blood pressure.3. 3.The nurse is taking a history of a newly diagnosed Type 2 diabetic who is beginning treatment. Which subjective information is most important for the nurse to note?A. A history of obesity.B. An allergy to sulfa drugs.C. Cessation of smoking three years ago.D. Numbness in the soles of the feet.4. 4.A female client is brought to the clinic by her daughter for a flu shot. She has lost significant weight since the last visit. She has poor personal hygiene and inadequate clothing for the weather. The client states that she lives alone and denies problems or concerns. What action should the nurse implement?A. Notify social services immediately of suspected elderly abuse.B. Discuss the need for mental health counseling with the daughter.C. Explain to the client that she needs to take better care of herself.D. Collect further data to determine whether self-neglect is occurring.5. 5.A client with a 16-year history of diabetes mellitus is having renal function tests because of recent fatigue, weakness, elevated blood urea nitrogen, and serum creatinine levels. Which finding should the nurse conclude as an early symptom of renal insufficiency?A. Dyspnea.B. Nocturia.C. Confusion.D. Stomatitis.6. 6.A client has been taking oral corticosteroids for the past five days because of seasonal allergies. Which assessment finding is of most concern to the nurse?A. White blood count of 10,000 mm3.B. Serum glucose of 115 mg/dl.C. Purulent sputum.D. Excessive hunger.7. 7.Which symptoms should the nurse expect a client to exhibit who is known to have a pheochromocytoma?A. Numbness, tingling, and cramps in the extremities.B. Headache, diaphoresis, and palpitations.C. Cyanosis, fever, and classic signs of shock.D. Nausea, vomiting, and muscular weakness.8. 8.A client taking furosemide (Lasix), reports difficulty sleeping. What question is important for the nurse to ask the client?A. What dose of medication are you taking?B. Are you eating foods rich in potassium?C. Have you lost weight recently?D. At what time do you take your medication?9. 9.The nurse knows that lab values sometimes vary for the older client. Which data should the nurse expect to find when reviewing laboratory values of an 80-year-old male?A. Increased WBC, decreased RBC.B. Increased serum bilirubin, slightly increased liver enzymes.C. Increased protein in the urine, slightly increased serum glucose levels.D. Decreased serum sodium, an increased urine specific gravity.10. 10.The nurse working in a postoperative surgical clinic is assessing a woman who had a left radical mastectomy for breast cancer. Which factor puts this client at greatest risk for developing lymphedema?A. She sustained an insect bite to her left arm yesterday.B. She has lost twenty pounds since the surgery.C. Her healthcare provider now prescribes a calcium channel blocker for hypertension.D. Her hobby is playing classical music on the piano.11. 11.A client has taken steroids for 12 years to help manage chronic obstructive pulmonary disease (COPD). When making a home visit, which nursing function is of greatest importance to this client? Assess the client'sA. pulse rate, both apically and radially.B. blood pressure, both standing and sitting.C. temperature.D. skin color and turgor.12. 12.A 58-year-old client, who has no health problems, asks the nurse about the Pneumovax vaccine. The nurse's response to the client should be based on which information?A. The vaccine is given annually before the flu season to those over 50 years of age.B. The immunization is administered once to older adults or persons with a history of chronic illness.C. The vaccine is for all ages and is given primarily to those persons traveling overseas to areas of infection.D. The vaccine will prevent the occurrence of pneumococcal pneumonia for up to five years.13. 13.The nurse working on a telemetry unit finds a client unconscious and in pulseless ventricular tachycardia (VT). The client has an implanted automatic defibrillator. What action should the nurse implement?A. Prepare the client for transcutaneous pacemaker.B. Shock the client with 200 joules per hospital policy.C. Use a magnet to deactivate the implanted pacemaker.D. Observe the monitor until the onset of ventricular fibrillation.14. 14.A client who is sexually active with several partners requests an intrauterine device (IUD) as a contraceptive method. Which information should the nurse provide?A. Using an IUD offers no protection against sexually transmitted diseases (STD), which increase the risk for pelvic inflammatory disease (PID).B. Getting pregnant while using an IUD is common and is not the best contraceptive choice.C. Relying on an IUD may be a safer choice for monogamous partners, but a barrier method provides a better option in preventing STD transmission.D. Selecting a contraceptive device should consider choosing a successful method used in the past.15. 15.While working in the emergency room, the nurse is exposed to a client with active tuberculosis. When should the nurse plan to obtain a tuberculin skin test?A. Immediately after the exposure.B. Within one week of the exposure.C. Four to six weeks after the exposure.D. Three months after the exposure.16. 16.A female client taking oral contraceptives reports to the nurse that she is experiencing calf pain. What action should the nurse implement?A. Determine if the client has also experienced breast tenderness and weight gain.B. Encourage the client to begin a regular, daily program of walking and exercise.C. Advise the client to notify the healthcare provider for immediate medical attention.D. Tell the client to stop taking the medication for a week to see if symptoms subside.17. 17.A 58-year-old client who has been post-menopausal for five years is concerned about the risk for osteoporosis because her mother has the condition. Which information should the nurse offer?A. Osteoporosis is a progressive genetic disease with no effective treatment.B. Calcium loss from bones can be slowed by increasing calcium intake and exercise.C. Estrogen replacement therapy should be started to prevent the progression osteoporosis.D. Low-dose corticosteroid treatment effectively halts the course of osteoporosis.18. 18.A 51-year-old truck driver who smokes two packs of cigarettes a day and is 30 pounds overweight is diagnosed with having a gastric ulcer. What content is most important for the nurse to include in the discharge teaching for this client?A. Information about smoking cessation.B. Diet instructions for a low-residue diet.C. Instructions on a weight-loss program.D. The importance of increasing milk in the diet.19. 19.A client is admitted to the hospital with a medical diagnosis of pneumococcal pneumonia. The nurse knows that the prognosis for gram-negative pneumonias (such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor becauseA. they occur in the lower lobe alveoli which are more sensitive to infection.B. gram-negative organisms are more resistant to antibiotic therapy.C. they occur in healthy young adults who have recently been debilitated by an upper respiratory infection.D. gram-negative pneumonias usually affect infants and small children.20. 20.During assessment of a client with amyotrophic lateral sclerosis (ALS), which finding should the nurse identify when planning care for this client?A. Muscle weakness.B. Urinary frequency.C. Abnormal involuntary movements.D. A decline in cognitive function.21. 21.An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. When making a home visit, the nurse notices that his tongue is somewhat cracked and his eyeballs are sunken into his head. What nursing intervention is indicated?A. Help the client to determine ways to increase his fluid intake.B. Obtain an appointment for the client to see an ear, nose, and throat specialist.C. Schedule an appointment with an allergist to determine if the client is allergic to the cat.D. Encourage the client to slightly increase his use of oxygen at night and to always use humidified oxygen.22. 22.The nurse is planning care for a client who has a right hemispheric stroke. Which nursing diagnosis should the nurse include in the plan of care?A. Impaired physical mobility related to right-sided hemiplegia.B. Risk for injury related to denial of deficits and impulsiveness.C. Impaired verbal communication related to speech-language deficits.D. Ineffective coping related to depression and distress about disability.23. 23.A 67-year-old woman who lives alone is admitted after tripping on a rug in her home and fractures her hip. Which predisposing factor probably led to the fracture in the proximal end of her femur?A. Failing eyesight resulting in an unsafe environment.B. Renal osteodystrophy resulting from chronic renal failure.C. Osteoporosis resulting from hormonal changes.D. Cardiovascular changes resulting in small strokes which impair mental acuity.24. 24.A client with heart disease is on a continuous telemetry monitor and has developed sinus bradycardia. In determining the possible cause of the bradycardia, the nurse assesses the client's medication record. Which medication is most likely the cause of the bradycardia?A. Propanolol (Inderal).B. Captopril (Capoten).C. Furosemide (Lasix).D. Dobutamine (Dobutrex).25. 25.Which healthcare practice is most important for the nurse to teach a postmenopausal client?A. Wear layers of clothes if experiencing hot flashes.B. Use a water-soluble lubricant for vaginal dryness.C. Consume adequate foods rich in calcium.D. Participate in stimulating mental exercises.