Med Surg 2 HESI Final NGN Exam with All 130 Questions and 1 00% Correct Answers New Latest Version Updated 2023 -2024 A postmenopausal client asks the nurse why she is experiencing discomfort during intercourse. What response is best for the nurse to provide? A) Estrogen deficiency causes the vaginal tissues to become dry and thinner. B) Infrequent intercourse results in the vaginal tissues losing their elasticity. C) Dehydration from inadequate fluid intake causes vulva tissue dryness. D) Lack of adequate stimulation is the most common reason for dyspareunia. ---------- Correct Answer --------- A) Estrogen deficiency causes the vaginal tissues to become dry and thinner. Estrogen deprivation decreases the moisture -secreting capacity of vaginal cells, so vaginal tissues tend to become thinner, drier (A), and the rugae become smoother which reduces vaginal stretching that contributes to dyspareunia. Dyspareunia is not relate d to (B or C). While (D) can contribute to discomfort during intercourse, the primary cause is hormone -related. After attending a class on reducing cancer risk factors, a client selects bran flakes with 2% milk and orange slices from a breakfast menu. In evaluating the client's learning, the nurse affirms that the client has made good choices, and makes what additio nal recommendation? --------- Correct Answer --------- Switch to skim milk. An older female client with dementia is transferred from a long -term care unit to an acute care unit. The client's children express concern that their mother's confusion is worsening. How should the nurse respond? --------- Correct Answer --------- "Confusion in an older person often follows relocation to new surroundings." The nurse is completing an admission interview for a client with Parkinson disease. Which question will provide additional information about manifestations the client is likely to experience? --------- Correct Answer --------- "Have you ever been 'frozen' in one spot, unable to move? A female client who received a nephrotoxic drug is admitted with acute renal failure and asks the nurse if she will need dialysis for the rest of her life. The nurse should explain which pathophysiologic consequence that supports the need for temporary dia lysis until acute tubular necrosis subsides? --------- Correct Answer --------- Oliguria The nurse is teaching a female client who uses a contraceptive diaphragm about reducing the risk for toxic shock syndrome (TSS). Which information should the nurse include? (Select all that apply.) A) Remove the diaphragm immediately after intercourse. B) Wash the diaphragm with an alcohol solution. C) Use the diaphragm to prevent conception during the menstrual cycle. D) Do not leave the diaphragm in place longer than 8 hours after intercourse. E) Contact a healthcare provider a sudden onset of fever grater than 101º F appears. F) Replace the old diaphragm every 3 months. ---------- Correct Answer --------- D) Do not leave the diaphragm in place longer than 8 hours after intercourse. E) Contact a healthcare provider a sudden onset of fever grater than 101º F appears. Correct selections are (D and E). The diaphragm needs to remain against the cervix for 6 to 8 hours to prevent pregnancy but should not remain for longer than 8 hours (D) to avoid the risk of TSS. If a sudden fever occurs, the client should notify the heal thcare provider (E). (A) increases the risk of pregnancy, and (B) can reduce the integrity of the barrier contraceptive but neither prevents the risk of TSS. The diaphragm should not be used during menses (C) because it obstructs the menstrual flow and is not indicated because conception does not occur during this time. (F) is not necessary. The nurse is assessing a client who has a history of Parkinson's disease for the past 5 years. What symptoms should this client most likely exhibit? A) Loss of short -term memory, facial tics and grimaces, and constant writhing movements. B) Shuffling gait, masklike facial expression, and tremors of the head. C) Extreme muscular weakness, easy fatigability, and ptosis. D) Numbness of the extremities, loss of balance, and visual disturbances. ---------- Correct Answer --------- B) Shuffling gait, masklike facial expression, and tremors of the head. (B) are common clinical features of Parkinsonism. (A) are symptoms of chorea, (C) of myasthenia gravis, and (D) of multiple sclerosis. During suctioning, a client with an uncuffed tracheostomy tube begins to cough violently and dislodges the tracheostomy tube. Which action should the nurse implement first? A) Notify the healthcare provider for reinsertion. B) Attempt to reinsert the tracheostomy tube. C) Position the client in a lateral position with the neck extended. D) Ventilate client's tracheostomy stoma with a manual bag -mask. ---------- Correct Answer --------- B) Attempt to reinsert the tracheostomy tube. The nurse should attempt to reinsert the tracheostomy tube (B) by using a hemostat to open the tracheostomy or by grasping the retention sutures (if present) to spread the opening in insert a replacement tube (with its obturator) into the stoma. Once in pl ace, the obturator should immediately be removed. (A, C, and D) place the client at risk of airway obstruction. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which finding should the nurse consider an indication of progressive hepatic encephalopathy? A) An increase in abdominal girth. B) Hypertension and a bounding pulse. C) Decreased bowel sounds. D) Difficulty in handwriting. ---------- Correct Answer --------- D) Difficulty in handwriting. A daily record in handwriting may provide evidence of progression or reversal of hepatic encephalopathy leading to coma (D). (A) is a sign of ascites. (B) are not seen with hepatic encephalopathy. (C) does not indicate an increase in serum ammonia level which is the primary cause of hepatic encephalopathy. A client who has heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which action is most important for the nurse to implement? A) Give 20 mEq of potassium chloride. B) Initiate continuous cardiac monitoring. C) Arrange a consultation with the dietician. D) Teach about the side effects of diuretics. ---------- Correct Answer --------- B) Initiate continuous cardiac monitoring. Hypokalemia (normal 3.5 to 5 mEq/L) causes changes in myocardial irritability and ECG waveform, so it is most important for the nurse to initiate continuous cardiac monitoring (B) to identify ventricular ectopy or other life -threatening dysrhythmias. Potas sium chloride (A) should be given after cardiac monitoring is initiated so that the effects of potassium replacement on the cardiac rhythm can be monitored. (C and D) should be implemented when the client is stable. The nurse is planning care to prevent complication for a client with multiple myeloma. Which intervention is most important for the nurse to include? A) Safety precautions during activity. B) Assess for changes in size of lymph nodes. C) Maintain a fluid intake of 3 to 4 L per day. D) Administer narcotic analgesic around the clock. ---------- Correct Answer --------- C) Maintain a fluid intake of 3 to 4 L per day. Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (C) to promote excretion of serum calcium. Although the c lient is at risk for pathologic fractures due to diffuse osteoporosis, mobilization and weight bearing (A) should be encouraged to promote bone reabsorption of circulating calcium, which can cause renal complications. (B) is a component of ongoing assessme nt. Chronic pain management (D) should be included in the plan of care, but prevention of complications related to hypercalcemia is most important. A client has a staging procedure for cancer of the breast and ask the nurse which type of breast cancer has the poorest prognosis. Which information should the nurse offer the client? A) Stage II.
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