Question

While working in the outpatient clinic, the nurse notes that the client has a history of intermittent claudication. Which statement by the client would support this information?

Answer 1

Correct Answers:

"My legs cramp when I walk more than a block."

Rationale :

🔹 Intermittent claudication is characterized by muscle cramping due to ischemia during activity.

🔹 It is a classic symptom of peripheral arterial disease (PAD).

🔹 Rest usually relieves the pain, confirming its vascular origin.

🔹 It worsens with increased oxygen demand, especially walking or stair climbing.

🔹 Management includes exercise, antiplatelets, and vascular assessment.

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Answer 2

Correct Answers:

The client cannot move there left arm or leg when asked to do so.

Rationale :

⚠️ Sudden unilateral weakness may indicate an acute stroke or brain bleed.

⚠️ It is an emergency in a patient with hypertensive crisis.

⚠️ Requires immediate neuro evaluation and CT scan.

⚠️ High BP increases risk for cerebral hemorrhage or ischemia.

⚠️ Other symptoms like headache or tremor are less urgent than neurologic deficits.

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Answer 3

Correct Answers:

Bladder irrigation prevents obstruction of the catheter after surgery.

Rationale :

💧 Continuous bladder irrigation (CBI) is used to flush clots post-TURP.

💧 Prevents catheter occlusion, which could cause urine retention or bladder spasms.

💧 Does not directly reduce bleeding but prevents blockage from blood clots.

💧 Important part of post-op urologic care.

💧 Nurses must monitor input/output balance and urine color.

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Answer 4

Correct Answers:

Place the client in a private room.

Rationale :

🧪 WBC = 4000 + Neutrophils at 10% total = Absolute neutrophil count (ANC) = 400

🛡️ ANC < 500 = severe neutropenia; high risk of infection

🛡️ Requires protective isolation (private room, neutropenic precautions)

🛡️ The client is immunocompromised and must avoid exposure

🛡️ Early identification prevents sepsis or opportunistic infections

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Answer 5

Correct Answers:

"The client has developed Acquired Immunodeficiency Syndrome (AIDS)."

Rationale :

🦠 CDC defines AIDS as CD4+ count < 200 + presence of opportunistic infection

🦠 Pneumocystis jiroveci is an AIDS-defining illness

🦠 HIV with low CD4+ reflects advanced immune suppression

🦠 Requires HAART therapy and prophylaxis for further infections

🦠 The patient needs close monitoring and immune support

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Answer 6

Correct Answers:

Vitamin K

Rationale :

✴️ Vitamin K is the antidote to warfarin (Coumadin) overdose or excessive anticoagulation.

✴️ It promotes the synthesis of clotting factors II, VII, IX, and X in the liver.

✴️ Its use reverses the elevated INR, reducing the risk of active bleeding.

✴️ In clients with GI bleeding, urgent reversal prevents further blood loss.

✴️ Protamine sulfate is used for heparin—not warfarin—making vitamin K the correct therapy.

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Answer 7

Correct Answers:

An area on the breast is hot, pink, and tender to the touch.

Rationale :

✴️ These are signs of inflammation and possible mastitis or inflammatory breast cancer.

✴️ This presentation differs from benign fibrocystic changes, which are usually non-tender.

✴️ The reddened, warm area warrants urgent evaluation and possibly biopsy.

✴️ Early identification of malignant changes is critical in any new or altered breast symptoms.

✴️ Other symptoms listed are expected with fibrocystic disease, not alarming.

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Answer 8

Correct Answers:

undescended testicles

Rationale :

✴️ Cryptorchidism (undescended testicles) is a major risk factor for testicular cancer.

✴️ The risk remains even after surgical correction if done late in life.

✴️ Testicular cancer is more common in young men ages 15–35.

✴️ Routine self-exam is critical for early detection.

✴️ Other conditions (STIs, trauma, torsion) are not strongly associated with cancer development.

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Answer 9

Correct Answers:

Client with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes.

Rationale :

✴️ Hypomagnesemia (<1.3 mEq/L) may cause neuromuscular excitability, including tremors and hyperreflexia.

✴️ It increases risk for cardiac dysrhythmias like torsades de pointes.

✴️ Magnesium replacement is needed to stabilize neuromuscular and cardiac systems.

✴️ Symptoms are more dangerous than mild electrolyte disturbances like Na 145 or K 5.0.

✴️ Immediate evaluation and IV magnesium may be required.

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Answer 10

Correct Answers:

A 19-yr-old client with menorrhagia who has been using superabsorbent tampons and has fever with weakness.

Rationale :

✴️ This client is at high risk for toxic shock syndrome (TSS), especially with tampon use and systemic symptoms.

✴️ Fever, weakness, and tampon use are classic symptoms that require immediate evaluation.

✴️ TSS is caused by toxin-producing strains of Staphylococcus aureus.

✴️ Early recognition prevents progression to septic shock and multiorgan failure.

✴️ This client meets multiple red flags requiring priority evaluation.

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Med sur 2 Exam-ICHS

No.

1 :
While working in the outpatient clinic, the nurse notes that the client has a history of intermittent claudication. Which statement by the client would support this information?

2 :
The nurse is assessing a client who has been admitted to the intensive care unit (ICU) with hypertensive emergency. Which of the following is most important to report to the healthcare provider?

3 :
Which information about continuous bladder irrigation will the nurse teach to a client who is being admitted for a transurethral resection of the prostate (TURP)?

4 :
A client admitted to a medical - surgical unit has a CBC with differential drawn. Lab results show a WBC count of 4000, with neutrophil segments at 5% and neutrophil bands at 5%. Based on these values what would the nurse do? Calculate the absolute neutrophil count

6 :
A client who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the client may have been taken too much warfarin. The nurse anticipates that client will receive which antidote?

7 :
A 36-yr-old client who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan?

8 :
The nurse taking a focused health history for a client with possible testicular cancer will ask the client about a history of

9 :
After receiving change-of-shift report, which client should the nurse assess first?

10 :
The nurse in the women's health clinic has four clients who are waiting to be seen. Which client should the nurse see first?

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Med sur 2 Exam-ICHS

No.

1 : While working in the outpatient clinic, the nurse notes that the client has a history of intermittent claudication. Which statement by the client would support this information?

2 : The nurse is assessing a client who has been admitted to the intensive care unit (ICU) with hypertensive emergency. Which of the following is most important to report to the healthcare provider?

3 : Which information about continuous bladder irrigation will the nurse teach to a client who is being admitted for a transurethral resection of the prostate (TURP)?

4 : A client admitted to a medical - surgical unit has a CBC with differential drawn. Lab results show a WBC count of 4000, with neutrophil segments at 5% and neutrophil bands at 5%. Based on these values what would the nurse do? Calculate the absolute neutrophil count

6 : A client who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the client may have been taken too much warfarin. The nurse anticipates that client will receive which antidote?

7 : A 36-yr-old client who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan?

8 : The nurse taking a focused health history for a client with possible testicular cancer will ask the client about a history of

9 : After receiving change-of-shift report, which client should the nurse assess first?

10 : The nurse in the women's health clinic has four clients who are waiting to be seen. Which client should the nurse see first?

1 :
While working in the outpatient clinic, the nurse notes that the client has a history of intermittent claudication. Which statement by the client would support this information?

2 :
The nurse is assessing a client who has been admitted to the intensive care unit (ICU) with hypertensive emergency. Which of the following is most important to report to the healthcare provider?

3 :
Which information about continuous bladder irrigation will the nurse teach to a client who is being admitted for a transurethral resection of the prostate (TURP)?

4 :
A client admitted to a medical - surgical unit has a CBC with differential drawn. Lab results show a WBC count of 4000, with neutrophil segments at 5% and neutrophil bands at 5%. Based on these values what would the nurse do? Calculate the absolute neutrophil count

6 :
A client who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the client may have been taken too much warfarin. The nurse anticipates that client will receive which antidote?

7 :
A 36-yr-old client who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan?

8 :
The nurse taking a focused health history for a client with possible testicular cancer will ask the client about a history of

9 :
After receiving change-of-shift report, which client should the nurse assess first?

10 :
The nurse in the women's health clinic has four clients who are waiting to be seen. Which client should the nurse see first?