N3661 Care of the Adult SU25
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Free N3661 Care of the Adult SU25 Questions
The nurse cares for a client receiving Enoxaparin subcutaneously to prevent deep vein thrombosis (DVT). Which assessment finding should be reported to the health care provider immediately
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The client's aPTT time is twice their baseline.
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The client's blood pressure is 88/46.
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The client's stool is a dark green liquid.
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The client has a few abdominal bruises.
Explanation
Correct Answer B: The client's blood pressure is 88/46.
Explanation:
A blood pressure of 88/46 indicates hypotension, which may be a sign of internal bleeding — a serious complication of anticoagulant therapy like enoxaparin (a low molecular weight heparin). This is especially concerning if accompanied by other signs like dizziness or a drop in hemoglobin. It requires immediate medical attention.
Why the Other Options Are Incorrect:
A. The client's aPTT time is twice their baseline.
aPTT is not routinely monitored for enoxaparin therapy. It is more relevant for unfractionated heparin. Therefore, a change in aPTT is not the most concerning or relevant here.
C. The client's stool is a dark green liquid.
Green stool can result from diet or rapid transit time and is not necessarily alarming. Black or tarry stool, indicating GI bleeding, would be a more urgent finding in someone on anticoagulants.
D. The client has a few abdominal bruises.
Mild bruising at the injection site is a common side effect of subcutaneous enoxaparin and usually not serious unless it becomes extensive or is accompanied by other bleeding signs.
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.
A nurse is preparing to administer a transfusion of red blood cells to a client who has a history of heart failure. Which of the following manifestations would indicate that the client has fluid overload
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Weight loss of 4 pounds
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A blood pressure of 120/80
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Dyspnea
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Gastrointestinal bloating
Explanation
Correct Answer C: Dyspnea
Explanation:
Dyspnea (shortness of breath) is a key indicator of fluid overload, especially in clients with heart failure. Transfusions can increase circulating volume, and clients with compromised cardiac function are at increased risk of pulmonary congestion and edema, which manifests as dyspnea.
Why the Other Options Are Incorrect:
A. Weight loss of 4 pounds
Weight gain, not loss, is typically associated with fluid overload.
B. A blood pressure of 120/80
This is a normal blood pressure and does not indicate fluid overload.
D. Gastrointestinal bloating
While discomfort may occur, bloating is not a primary sign of fluid overload related to blood transfusion or heart failure.
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.
A nurse is caring for a client who has type 2 diabetes mellitus, and their glucose levels are rising. Which of the following would indicate the client is in a hyperosmolar hyperglycemic state (HHS)
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Glucose level of 400 mg/dL
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Hypertension
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Serum osmolarity of 350 mOsm/L
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Ketosis
Explanation
Correct Answer C: Serum osmolarity of 350 mOsm/L
Explanation:
A serum osmolarity of 350 mOsm/L is a key diagnostic indicator of hyperosmolar hyperglycemic state (HHS), a serious complication of type 2 diabetes. HHS is characterized by extremely high blood glucose, severe dehydration, and elevated serum osmolarity, typically >320 mOsm/L, without significant ketosis. It often develops slowly and may be triggered by infection or illness.
Why the Other Options Are Incorrect:
A. Glucose level of 400 mg/dL
While elevated, this level alone is not high enough to confirm HHS, which often presents with glucose levels over 600 mg/dL.
B. Hypertension
Hypertension is not a defining feature of HHS. Clients are often hypotensive due to dehydration.
D. Ketosis
Ketosis is absent or minimal in HHS, which distinguishes it from diabetic ketoacidosis (DKA), where ketosis is a hallmark feature.
Which action most effectively prevents pneumonia and promotes healthy pulmonary function after surgery
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Ambulate the client as soon as possible and assist with incentive spirometry.
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Encourage bed rest
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Ask the client to turn, cough, and deep breathe every four hours
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Assess breath sounds at least every two hours and perform frequent oral hygiene.
Explanation
Correct Answer A: Ambulate the client as soon as possible and assist with incentive spirometry.
Explanation:
Early ambulation and use of an incentive spirometer are the most effective interventions to prevent postoperative pneumonia and maintain healthy lung function. Ambulation promotes deep breathing, improves circulation, and prevents atelectasis. Incentive spirometry encourages the client to take slow, deep breaths, expanding the lungs and helping to clear secretions.
Why the Other Options Are Incorrect:
B. Encourage bed rest
Prolonged bed rest leads to lung stasis, increasing the risk of atelectasis and pneumonia. It is not recommended postoperatively unless medically necessary.
C. Ask the client to turn, cough, and deep breathe every four hours
While helpful, the frequency is insufficient. These exercises are more effective when done every 1 to 2 hours while awake.
D. Assess breath sounds at least every two hours and perform frequent oral hygiene
These are supportive measures, but they do not actively expand the lungs or mobilize secretions like ambulation and incentive spirometry do.
A nurse is caring for a client with type 1 diabetes. The client's medication administration record includes the administration of Humulin-R (regular insulin or Novolin-R) three times daily. Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the insulin
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11:45 AM
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10:45 AM
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11:50 AM
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11:30 AM
Explanation
Correct Answer D: 11:30 AM
Explanation:
Regular insulin (Humulin-R or Novolin-R) is a short-acting insulin with an onset of action of 30 to 60 minutes. To ensure that the insulin starts working as the food is absorbed, it should be administered approximately 30 minutes before meals. Therefore, if lunch arrives at 11:45 AM, the ideal time to administer the insulin is 11:30 AM.
Why the Other Options Are Incorrect:
A. 11:45 AM
This is too late. The insulin would not have started working by the time the food is absorbed, increasing the risk of post-meal hyperglycemia.
B. 10:45 AM
This is too early. The insulin may peak before the meal is consumed, increasing the risk of hypoglycemia.
C. 11:50 AM
This is after the meal has arrived. Like option A, it delays the insulin’s effect and may result in poor postprandial glucose control.
A nurse reviews the medication list for a client with a new warfarin prescription. The nurse should recognize which of the following medications is incompatible with warfarin
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Furosemide
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Vitamin K
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Vitamin A
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Alprazolam
Explanation
Correct Answer B: Vitamin K
Explanation:
Vitamin K directly antagonizes the effects of warfarin, which works by inhibiting the synthesis of vitamin K–dependent clotting factors. Taking vitamin K supplements can significantly reduce the anticoagulant effect of warfarin, increasing the risk for clot formation. Therefore, it is considered incompatible unless specifically prescribed to reverse warfarin effects (e.g., during bleeding or high INR).
Why the Other Options Are Incorrect:
A. Furosemide
Furosemide is a loop diuretic and does not directly interact with warfarin’s anticoagulant effects. However, close monitoring is still needed for electrolyte imbalances and kidney function.
C. Vitamin A
Vitamin A does not have a known significant interaction with warfarin. Unlike vitamin K, it does not affect clotting factors.
D. Alprazolam
Alprazolam, an anti-anxiety medication, is metabolized by the liver but does not have a direct interaction with warfarin. It may increase fall risk but doesn’t alter INR levels significantly.
A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia
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Vomiting
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Fruity odor on the client's breath
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Cool, clammy skin
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Bradycardia
Explanation
Correct Answer C: Cool, clammy skin
Explanation:
Cool, clammy skin is a classic sign of hypoglycemia. As blood glucose drops, the body activates the sympathetic nervous system, causing symptoms like sweating, shakiness, irritability, and pale, clammy skin. These signs indicate the need for immediate carbohydrate intake.
Why the Other Options Are Incorrect:
A. Vomiting
While vomiting can occur with many conditions, it is more commonly associated with hyperglycemia and diabetic ketoacidosis (DKA), not hypoglycemia.
B. Fruity odor on the client's breath
A fruity or acetone-like odor is a hallmark of DKA, a complication of severe hyperglycemia, not hypoglycemia.
D. Bradycardia
Bradycardia is not typically associated with hypoglycemia. Tachycardia is more common due to the stress response triggered by low blood sugar.
A nurse is providing care for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action postoperatively
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Offer the client ice cream postoperatively
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Instruct the client to lift over 4.5 kg (10 lb)
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Encourage ambulation once fully awake
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Place the client in a supine position postoperatively
Explanation
Correct Answer C: Encourage ambulation once fully awake
Explanation:
Early ambulation after a laparoscopic cholecystectomy promotes circulation, reduces the risk of venous thromboembolism, and helps relieve gas pain caused by carbon dioxide used during surgery. It is a standard and beneficial postoperative practice.
Why the Other Options Are Incorrect:
A. Offer the client ice cream postoperatively
High-fat foods like ice cream are not recommended immediately after gallbladder removal. The client should gradually progress to a low-fat diet.
B. Instruct the client to lift over 4.5 kg (10 lb)
Clients are typically instructed to avoid heavy lifting (>10 lb) for several weeks postoperatively to prevent complications like hernias.
D. Place the client in a supine position postoperatively
While supine is acceptable initially, clients are often more comfortable in semi-Fowler's position, which helps relieve shoulder pain from retained CO₂ and improves breathing.
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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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