Nur 215 Medical Surgical 1
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An elderly client was recently admitted with pneumonia. The nurse understands that the client is getting closer to going home when what goal has been met?
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Client can tolerate using the incentive spirometer once an hour.
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Lungs clear to auscultation by discharge
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Oxygen saturation of 90% on room air
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Client takes three shallow breaths before coughing to minimize pain.
Explanation
Clear lung sounds on auscultation indicate resolution of the infection and fluid/secretions, showing that the client's respiratory status has improved to a safe baseline appropriate for discharge.
Why the other options are incorrect:
A. Tolerating incentive spirometer use is a helpful intervention but not itself an indicator of resolved illness or readiness for discharge.
C. An oxygen saturation of 90% on room air is below the normal target range (typically ≥92-94%) and would not indicate readiness for discharge.
D. Taking shallow breaths before coughing is an ineffective coughing technique and does not promote adequate lung expansion or secretion clearance.
A client is prescribed a soft diet after a dental procedure. Which food is most appropriate for the client on a soft diet?
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Mashed potatoes
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Steak
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Raw vegetables
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Hard rolls
Explanation
Correct Answer:
A
Why the other options are incorrect:
B. Steak is tough and requires significant chewing, making it inappropriate for a soft diet after a dental procedure.
C. Raw vegetables are hard and crunchy, requiring substantial chewing that would be inappropriate for a soft diet.
D. Hard rolls have a tough, crusty texture requiring significant chewing, making them inappropriate for a soft diet.
The nurse is caring for a client who is in the final stages of life. The client's family expresses feelings of hopelessness and struggles to accept the diagnosis. What is the most therapeutic response for the nurse to give?
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"Please try to remain calm; everything will work out."
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"I understand how you feel; I just lost a loved one too."
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"It's okay to feel overwhelmed. Would you like to talk?"
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"It's going to be okay. Your loved one will be just fine."
Explanation
Correct Answer:
C
Why the other options are incorrect:
A. Telling the family to remain calm dismisses their genuine emotional response and offers false reassurance rather than validation.
B. Sharing the nurse's own personal loss shifts the focus away from the family and is not appropriate therapeutic communication.
D. Offering false reassurance that things will be "fine" is not honest or therapeutic, especially in end-of-life care, and can undermine trust.
A nurse is preparing a patient for magnetic resonance imaging (MRI) scan to confirm or rule out a spinal cord lesion. Which action would pose a threat to the patient during the procedure?
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The patient receives lorazepam 1 mg by mouth prior to the procedure
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The patient eats breakfast prior to the procedure
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The patient wears a watch and wedding band
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The patient is positioned supine
Explanation
Correct Answer:
The patient wears a watch and wedding band
Explanation:
MRI uses powerful magnets, and any metallic object can pose serious safety risks, including burns, dislodgement, or interference with imaging. Wearing metal items like a watch or wedding band is contraindicated because these objects can become projectiles or heat up during the scan. The patient must be screened and instructed to remove all metal before the procedure. Ensuring the patient is metal-free protects both the individual and the integrity of the imaging process.
Why Other Options Are Wrong:
The patient receives lorazepam 1 mg by mouth prior to the procedure
Lorazepam may be given to relieve anxiety, especially for patients who are claustrophobic. It does not interfere with the MRI procedure and can actually improve patient cooperation.
The patient eats breakfast prior to the procedure
MRI scans typically do not require fasting unless contrast agents or sedation are involved. Eating a light meal is generally acceptable and does not pose a threat.
The patient is positioned supine
Lying supine is the standard position for most MRI procedures. This positioning supports proper alignment and stillness during the scan and is not a safety concern.
What is the most effective nursing intervention to include in the patient’s plan of care to prevent urinary tract infections?
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Encourage patients to drink at least 8 ounces of water every hour
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Teach female patients to wipe from front to back after urinating
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Instruct patients to use bath powder to absorb perineal perspiration
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Advise patients to hold urine as long as possible
Explanation
Correct Answer:
Teach female patients to wipe from front to back after urinating
Explanation:
Wiping from front to back is a key hygienic practice to prevent bacterial contamination of the urinary tract, especially in females due to the proximity of the urethra to the anus. This method reduces the risk of transferring fecal bacteria such as E. coli into the urethra, which is a common cause of urinary tract infections. It is a simple and highly effective preventive measure that should be routinely taught during patient education. Promoting proper perineal hygiene can significantly decrease UTI incidence.
Why Other Options Are Wrong:
Encourage patients to drink at least 8 ounces of water every hour
While increasing fluid intake can help flush the urinary system, drinking 8 ounces every hour is excessive and unrealistic for most patients. Overhydration can lead to complications, especially in those with heart or kidney issues. Proper hydration should be tailored to individual needs.
Instruct patients to use bath powder to absorb perineal perspiration
Bath powder may help with moisture but does not address bacterial contamination or reduce UTI risk. In some cases, powders can even irritate the skin or promote yeast growth if not used appropriately.
Advise patients to hold urine as long as possible
Holding urine for extended periods increases the risk of urinary stasis and bacterial growth, leading to infection. Encouraging timely voiding is a more appropriate strategy to prevent UTIs.
The client on the hospice unit with metastatic lung cancer is experiencing severe pain and has been asking for more pain medication before the next dose is due. What action by the nurse is most appropriate?
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Tell the client that the medication can only be given when it is due
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Encourage the client to use relaxation techniques
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Remind the client that lung cancer comes with significant pain
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Notify the health care provider of the client's request
Explanation
Correct Answer:
D
Why the other options are incorrect:
A. Simply telling the client the medication can only be given when due dismisses the client's pain without addressing the underlying inadequate pain control.
B. Relaxation techniques alone are insufficient for managing severe pain from metastatic cancer and do not address the need for medication adjustment.
C. This statement dismisses the client's pain and fails to take action to address their unmet need for adequate pain relief.
A nurse is teaching a patient with Parkinson’s disease about dietary practices. What signs and symptoms are potential complications related to this disease? Select all that apply.
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Dysphagia
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Choking
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Diarrhea
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Aspiration
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Fluid overload
Explanation
Correct Answer:
Dysphagia
Choking
Aspiration
Explanation:
Parkinson’s disease commonly affects muscle control, including those used in swallowing. This can lead to dysphagia (difficulty swallowing), increasing the risk for choking and aspiration. These complications are particularly serious during eating and drinking and may result in aspiration pneumonia, a leading cause of hospitalization and death in Parkinson’s patients. Nurses must educate patients and caregivers on safe swallowing techniques and appropriate food textures to prevent such risks.
Why Other Options Are Wrong:
Diarrhea
Constipation, not diarrhea, is a more common gastrointestinal symptom in Parkinson’s disease due to slowed motility and medication side effects. Diarrhea is not typically associated with the condition.
Fluid overload
This is not a usual complication of Parkinson’s disease and is more commonly seen in patients with cardiac or renal issues. Parkinson’s does not inherently affect fluid balance in this way.
The nurse is aware that which patients are at risk for a skin alteration? (Drag the correct answers.)
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The patient who had numbness in the right arm that resolved several hours ago
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A patient who has been newly diagnosed with diabetes
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A patient who has had vomiting and diarrhea for several days and lost 12 pounds
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The patient who has paralysis and unable to move in the bed
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A roofer who spends a lot of time outdoors
Explanation
Correct Answer:
A patient who has been newly diagnosed with diabetes
A patient who has had vomiting and diarrhea for several days and lost 12 pounds
The patient who has paralysis and unable to move in the bed
A roofer who spends a lot of time outdoors
Explanation:
Patients at risk for skin alteration often have underlying conditions or exposures that compromise skin integrity. Diabetic patients are at increased risk due to impaired circulation and sensation. Dehydration from vomiting and diarrhea affects skin turgor and resilience. Immobility, as seen in paralyzed patients, leads to pressure injuries due to sustained pressure and poor circulation. Roofers experience prolonged sun exposure and sweat buildup, both of which can weaken skin and increase the risk of breakdown.
Why Other Option Is Wrong:
The patient who had numbness in the right arm that resolved several hours ago
Transient numbness without lasting sensory impairment or immobility does not significantly raise the risk of skin breakdown. Once sensation returns, normal skin protection mechanisms are restored.
A nurse is assisting during a lumbar puncture. How should the nurse position the patient for this procedure?
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Prone with the head turned to the right
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Supine with the knees raised toward the chest
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Lateral recumbent with chin resting on flexed knees
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Prone with right leg flexed
Explanation
Correct Answer:
Lateral recumbent with chin resting on flexed knees
Explanation:
The lateral recumbent position with the patient’s back arched and chin resting on flexed knees allows maximum separation of the vertebrae. This positioning facilitates access to the subarachnoid space for the lumbar puncture. It also helps the patient remain still during the procedure, reducing the risk of needle misplacement. Correct positioning is essential to ensure safety and obtain accurate cerebrospinal fluid (CSF) samples.
Why Other Options Are Wrong:
Prone with the head turned to the right
The prone position does not adequately separate the vertebrae and is not standard for lumbar puncture. It also makes needle placement more difficult and less controlled.
Supine with the knees raised toward the chest
This position does not offer the same degree of spinal flexion as the lateral recumbent position. It is not ideal for accessing the lumbar subarachnoid space.
Prone with right leg flexed
Again, the prone position is incorrect for this procedure, and flexing just one leg does not aid spinal access. This posture may actually increase patient discomfort without benefit.
What lower urinary tract symptoms would the nurse expect to find if a patient has a urinary tract infection? Select all that apply.
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Fever
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Hesitancy
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Nocturia
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Dysuria
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Incomplete emptying
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Hematuria
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Chills
Explanation
Correct Answer:
Hesitancy
Nocturia
Dysuria
Incomplete emptying
Hematuria
Explanation:
Lower urinary tract infection (UTI) typically presents with localized symptoms related to bladder irritation and incomplete bladder emptying. These include dysuria (painful urination), hesitancy (difficulty starting urination), nocturia (frequent urination at night), incomplete emptying, and sometimes hematuria (blood in the urine). These symptoms result from inflammation of the bladder and urethra due to bacterial invasion, most commonly by E. coli.
Why Other Options Are Wrong:
Fever
Fever is more common in upper UTIs (such as pyelonephritis). Lower UTIs may not cause systemic signs like fever unless they progress.
Chills
Chills are also typically associated with systemic infection or upper urinary tract involvement. They are not hallmark signs of lower UTI alone.
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