N3661 Care of the Adult SU25
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A nurse is assessing a client who has developed atelectasis postoperatively. Which of the following findings should the nurse expect
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Decreasing respiratory rate
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Facial flushing
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Increasing dyspnea
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Friction rub
Explanation
Correct Answer C: Increasing dyspnea
Explanation:
Atelectasis is the collapse of alveoli, often occurring postoperatively due to shallow breathing, pain, or immobility. A common clinical sign is increasing dyspnea (shortness of breath) as oxygenation becomes impaired. Other signs may include decreased breath sounds, crackles, and low oxygen saturation.
Why the Other Options Are Incorrect:
A. Decreasing respiratory rate
This is not expected. The respiratory rate typically increases in response to hypoxia caused by atelectasis.
B. Facial flushing
Facial flushing is not associated with atelectasis. Cyanosis or pallor may occur in severe cases due to oxygen deficiency.
D. Friction rub
A friction rub is associated with pleuritis or pericarditis, not atelectasis. Atelectasis causes reduced or absent breath sounds in the affected area.
The nurse is teaching a client recovering from a laparoscopic cholecystectomy and is being discharged. Which statement indicates that discharge teaching is effective
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I need to avoid lifting objects exceeding 5 lb after surgery, usually for 6 weeks.
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I can drive myself home
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I will call the surgeon if I have a fever of 37.2°C (100°F) or more for two consecutive days
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I need someone to stay with me at home for a week after the surgery
Explanation
Correct Answer A: I need to avoid lifting objects exceeding 5 lb after surgery, usually for 6 weeks.
Explanation:
After a laparoscopic cholecystectomy, patients are generally advised to avoid lifting more than 5 lb for several weeks to allow proper healing and avoid complications such as hernias or delayed wound healing. This response shows understanding of appropriate post-op care.
Why the Other Options Are Incorrect:
B. I can drive myself home.
This is incorrect. Clients should not drive immediately after surgery, especially if they received general anesthesia or are taking narcotics. They need a responsible adult to take them home.
C. I will call the surgeon if I have a fever of 37.2°C (100°F) or more for two consecutive days.
A temperature of 37.2°C (100°F) is not high enough to be concerning. Patients are typically instructed to call if fever exceeds 38°C (100.4°F).
D. I need someone to stay with me at home for a week after the surgery.
While it is ideal to have help for the first 24 hours, needing someone for an entire week is not typically necessary after a laparoscopic procedure unless complications arise.
Which assessment finding would the nurse expect from a client with chronic peripheral arterial disease (PAD
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Ulceration around the medial malleolus
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Pallor on elevation of limbs and rubor when limbs are dependent
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Scaling eczema of the lower legs with stasis dermatitis
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Significant edema around the ankles and feet
Explanation
Correct Answer B: Pallor on elevation of limbs and rubor when limbs are dependent
Explanation:
Clients with chronic peripheral arterial disease (PAD) often exhibit color changes due to impaired blood flow. Elevating the legs may cause pallor (paleness) because of reduced arterial perfusion, while lowering the legs (dependent position) may lead to rubor (a reddish-blue discoloration) as gravity helps bring blood back to the extremities. These findings are classic signs of arterial insufficiency.
Why the Other Options Are Incorrect:
A. Ulceration around the medial malleolus
This is more typical of venous ulcers, not arterial disease. Arterial ulcers tend to occur on bony prominences or pressure points like the toes or lateral malleolus.
C. Scaling eczema of the lower legs with stasis dermatitis
Stasis dermatitis and skin changes like eczema are associated with chronic venous insufficiency, not PAD.
D. Significant edema around the ankles and feet
Edema is more commonly associated with venous disorders, heart failure, or kidney disease. PAD usually involves minimal or no edema unless the condition is very advanced or mixed with venous insufficiency
A nurse is reviewing the diagnostic test results of an older adult female client preoperatively for a knee arthroplasty. Which of the following results should the nurse notify the surgeon Hematocrit reference range: 37–47%.
WBC count reference range: 5,000 to 10,000/mm³
Creatinine reference range: 0.5 to 1.2 mg/dL
Potassium reference range: 3.5 to 5.0 mEq/L
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Creatinine 0.9 mg/dL
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WBC count 20,000/mm³
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Potassium 3.8 mEq/L
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Hematocrit 40%
Explanation
Correct Answer B: WBC count 20,000/mm³
Explanation:
A WBC count of 20,000/mm³ is well above the normal range (5,000–10,000/mm³) and may indicate the presence of an active infection or significant inflammation. This is a critical preoperative finding that could increase the risk of surgical complications, including delayed healing or sepsis. The surgeon must be notified immediately to evaluate the client and determine if the surgery should be postponed.
Why the Other Options Are Incorrect:
A. Creatinine 0.9 mg/dL
This value is within the normal reference range (0.5–1.2 mg/dL) and does not suggest renal impairment. No action is needed.
C. Potassium 3.8 mEq/L
This is within the normal range (3.5–5.0 mEq/L) and is safe for surgery.
D. Hematocrit 40%
Also within the normal female range (37–47%), indicating adequate red blood cell levels. No need to notify the provider.
In preparation for ambulation, the nurse plans to assist a postoperative client in transitioning from a lying to a sitting position. Which nursing action is most appropriate to maintain the client's safety
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Assist the client to move quickly from the lying position to the sitting position
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Allow the client to rise from the bed to a standing position unassisted
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Elevate the head of the bed quickly to assist the client to a sitting position
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Assess the client for signs of dizziness and hypotension
Explanation
Correct Answer D: Assess the client for signs of dizziness and hypotension
Explanation:
Postoperative clients are at risk for orthostatic hypotension due to anesthesia, immobility, and fluid shifts. The nurse should always assess for dizziness, lightheadedness, and changes in blood pressure before assisting the client to sit or stand. This helps prevent falls and ensure safety during early ambulation.
Why the Other Options Are Incorrect:
A. Assist the client to move quickly from the lying position to the sitting position
This can lead to sudden drops in blood pressure and increase the risk of fainting or falling.
B. Allow the client to rise from the bed to a standing position unassisted
This is unsafe, especially in the immediate postoperative period when the client may be weak or unstable.
C. Elevate the head of the bed quickly to assist the client to a sitting position
Changes in position should be done slowly to allow the body time to adjust and prevent orthostatic hypotension.
A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take
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Assess for hypoglycemia four hours after the lispro insulin injection.
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The client should eat no more than 5–15 minutes after the injection.
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Administer lispro insulin and long-acting insulin in the same syringe.
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Monitor for polyuria.
Explanation
Correct Answer B: The client should eat no more than 5–15 minutes after the injection.
Explanation:
Lispro insulin is a rapid-acting insulin with an onset of action in about 15 minutes. To prevent hypoglycemia, the client should eat within 5 to 15 minutes after the injection. This timing ensures that glucose is available in the bloodstream when the insulin starts to work.
Why the Other Options Are Incorrect:
A. Assess for hypoglycemia four hours after the lispro insulin injection
This is too late. Hypoglycemia from lispro typically occurs 1 to 2 hours after administration when its action peaks.
C. Administer lispro insulin and long-acting insulin in the same syringe
Lispro insulin should not be mixed with long-acting insulin like glargine (Lantus) in the same syringe. They must be administered separately.
D. Monitor for polyuria
Polyuria is a sign of hyperglycemia, not a typical immediate concern after insulin administration. The focus after giving insulin should be on monitoring for hypoglycemia.
The nurse is caring for a client who receives an intermediate-acting insulin, Humulin N (Novolin N, Neutral Protamine Hagedorn insulin, isophane, NPH), 25 units daily at 7 a.m. When is hypoglycemia most likely to occur
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5 a.m.
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10 a.m.
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2 p.m.
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10 p.m.
Explanation
Correct Answer C: 2 p.m.
Explanation:
Humulin N (NPH insulin) is an intermediate-acting insulin with an onset of 1 to 2 hours, a peak effect between 4 to 12 hours, and a duration of up to 24 hours. When administered at 7 a.m., the insulin typically peaks between 11 a.m. and 3 p.m., placing the client at greatest risk for hypoglycemia around 2 p.m., during the peak action time.
Why the Other Options Are Incorrect:
A. 5 a.m.
This is much earlier than the expected peak time and would not be associated with a morning dose of NPH insulin.
B. 10 a.m.
Although this is closer to the beginning of the peak window, significant hypoglycemia is more likely slightly later, during the actual peak.
D. 10 p.m.
This is too late in the day to be affected by a 7 a.m. dose. The insulin's peak action would have passed by this time.
The nurse is preparing discharge instructions for a client with Raynaud's Disease. Which teaching point would the nurse include in the teaching plan
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Use nail polish to protect nail beds from injury
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Stop smoking because it causes cutaneous vasospasm
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Always wear warm clothing even in warm climates to prevent vasoconstriction
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Wear gloves for all activities involving use of both hands
Explanation
Correct Answer B: Stop smoking because it causes cutaneous vasospasm
Explanation:
Smoking is a major risk factor in Raynaud's disease because nicotine causes vasoconstriction, which can worsen the frequency and severity of vasospastic episodes. Therefore, smoking cessation is a critical component of discharge teaching. Educating the client on avoiding tobacco can significantly improve blood flow and reduce symptoms.
Why the Other Options Are Incorrect:
A. Use nail polish to protect nail beds from injury
Using nail polish does not protect the nail beds from injury or improve circulation. In fact, it can hide signs of poor perfusion or cyanosis in the nail bed, which are important clinical indicators in Raynaud’s.
C. Always wear warm clothing even in warm climates to prevent vasoconstriction
While it's important to stay warm, wearing warm clothing in warm climates is unnecessary and could lead to overheating. The key is to keep extremities warm, especially in cold environments, rather than overdressing inappropriately.
D. Wear gloves for all activities involving use of both hands
Gloves are helpful in cold weather to prevent attacks, but wearing gloves for all hand-related activities is impractical and unnecessary. Gloves should be used when exposed to cold or during activities that could provoke symptoms.
A nurse provides preoperative teaching by demonstrating diaphragmatic breathing to a client scheduled for surgery in the morning. Which of the following actions should the nurse include in the demonstration
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Exhale forcefully through the nose.
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Inhale slowly and evenly through her nose.
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Hold her breath for at least 10 seconds.
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Place her hands on the sides of her rib cage.
Explanation
Correct Answer B: Inhale slowly and evenly through her nose.
Explanation:
When performing diaphragmatic breathing, the client should be instructed to inhale slowly and evenly through the nose, allowing the diaphragm to expand the lungs effectively. This helps increase lung capacity, improves oxygenation, and is commonly used in preoperative and postoperative respiratory care.
Why the Other Options Are Incorrect:
A. Exhale forcefully through the nose
Exhalation should be slow and controlled, typically through the mouth, not forceful or through the nose.
C. Hold her breath for at least 10 seconds
A brief pause (2–3 seconds) may be included, but holding for 10 seconds is excessive and may cause discomfort or dizziness.
D. Place her hands on the sides of her rib cage
Hands should be placed on the abdomen, not the rib cage, to feel the rise and fall of the diaphragm during breathing.
While hospitalized and recovering from an episode of diabetic ketoacidosis, the client calls the nurse and reports feeling anxious, nervous, and sweaty. What is the nurse's priority action based on the client's report
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Administer a glucose tablet.
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Administer 1 mg of glucagon subcutaneously.
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Obtain a glucose reading using a finger stick.
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Have the client drink 8 ounces of Coca-Cola.
Explanation
Correct Answer C: Obtain a glucose reading using a finger stick.
Explanation:
The client is showing early symptoms of hypoglycemia (anxious, nervous, sweaty), which can occur during DKA recovery due to insulin administration. The nurse’s priority is to confirm the blood glucose level with a finger stick reading before taking further action. This ensures the symptoms are due to hypoglycemia and guides the next appropriate intervention.
Why the Other Options Are Incorrect:
A. Administer a glucose tablet.
While appropriate if hypoglycemia is confirmed, the nurse must first check the glucose level to ensure this is the correct action.
B. Administer 1 mg of glucagon subcutaneously.
Glucagon is used for severe hypoglycemia, especially when the client is unconscious or unable to swallow — not appropriate for mild symptoms.
D. Have the client drink 8 ounces of Coca-Cola.
This can be effective treatment for hypoglycemia, but again, it should only be given after confirming low blood glucose. Administering sugar without confirmation may cause unnecessary hyperglycemia.
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The package offers over 150 practice questions tailored specifically for the N3661 Care of the Adult SU25 Exam 4. These questions cover key nursing topics such as peripheral vascular conditions, anticoagulant therapy, peripheral artery disease (PAD), venous ulcers, and patient education. Each question comes with clear, step-by-step explanations to help deepen your understanding.
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