Medical-Surgical Nursing RN-BC
Medical-Surgical Nursing Review RN-BC
According to Maslow's hierarchy of needs, which of the following actions has the lowest priority for a newly diagnosed quadriplegic client?
A. Administering a daily stool softener
B. Arranging for transportation to a support group
C. Adapting the home with accessibility devices
D. Obtaining a wheelchair with motorized controls
Answer: D. Obtaining a wheelchair with motorized controls
Maslow's hierarchy of needs prioritizes survival needs above more sophisticated self-actualization needs. Meeting needs at each of the five levels of the pyramid provides the motivation to engage in behaviors that help meet needs at the next level. The 5 steps are: physiological (e.g. food, water, etc.), safety (e.g. security, property, etc.), love/belonging (e.g. family, friendship), self-esteem (e.g. confidence, respect), and self-actualization (e.g. creativity, morality). The stool softener is necessary for physiologic stability (e.g. to prevent impaction). Accessibility devices will make the home safer. The support group will provide a sense of belonging and bonding with like individuals. The motorized wheelchair provides increased independence and confidence, a less crucial need than the other options.
A nurse has difficulty understanding a stroke patient whose speech is slurred. This finding suggests the client has
A. global aphasia.
B. expressive aphasia.
D. receptive aphasia
Answer: C. dysarthria.
Dysarthria describes any disturbance related to muscular control of speech. Because of motor deficits, the dysarthric patient's speech is slurred. Rehabilitation with speech therapy can help the client strengthen specific muscles used for speech. Speech deficits after a stroke typically occur when the pathology is in the dominant hemisphere. The left hemisphere is dominant in approximately 95% of right-handed individuals and in 70% of left-handed individuals. The person with expressive aphasia cannot initiate speech appropriately or may even be mute. Receptive aphasia results in an inability to understand words, although hearing remains intact. Clients may experience both expressive and receptive aphasia. This condition is referred to as global or mixed aphasia.
A medical-surgical nurse is informed that a client's complete blood count has a "shift to the left." The nurse understands that this refers to an increased
A. eosinophil percentage.
B. neutrophil percentage.
C. basophil percentage.
D. total white cell count.
Answer: B. neutrophil percentage.
White blood cells (WBCs) are the body's chief defense against bacterial infection. The normal WBC count is 5,000 -10,000/mm3. There are two general WBC classifications: granulocytes (a.k.a. granular leukocytes, polymorphonuclear leukocytes; PMLs) and non-granulocytes. The granulocyte group consists of neutrophils, eosinophils, and basophils. The non-granulocytes are monocytes and lymphocytes. In response to inflammation or an acute infectious process, there is a rapid increase in the number of neutrophils released from the bone marrow, including a number of immature neutrophils, known as stabs or bands. Normally, 50-62% of WBCs are neutrophils; 3-6% are bands. A "shift to the left" (an old-fashioned term) represents increases in both of these percentages and signals an acute pathologic processes.
When changing a peripherally inserted central catheter dressing, which of the following actions by a client's home caregiver would indicate to the nurse that further instruction is necessary?
A. The patient and the caregiver are masked for the procedure.
B. Sterile gloves are applied prior to removing the old dressing.
C. The insertion site is cleansed with a chlorhexidine swab.
D. The used supplies are thrown away with the regular trash.
Answer: B. Sterile gloves are applied prior to removing the old dressing.
A peripherally inserted central catheter (PICC) dressing change is a sterile procedure. The patient's caregiver should be observed to ensure understanding of the principles and steps involved. Sterile gloves do not need to be worn to remove the old dressing. However, sterile gloves are required to handle supplies in the sterile dressing kit. During a PICC dressing change, both the caregiver and the patient should be masked for the procedure. After the old dressing is removed, the insertion site is cleansed with a chlorhexidine swab (e.g., ChloraPrep® stick), using a circular motion, starting at the catheter insertion site and moving outward. Used supplies may be thrown away in the regular trash.
An advantage of hemodialysis over peritoneal dialysis in the patient with end-stage kidney disease is that hemodialysis
A. does not require anticoagulation.
B. allows the client to be ambulatory.
C. can readily be performed in a home setting.
D. removes fluid and toxins more rapidly.
Answer: D. removes fluid and toxins more rapidly.
Both hemodialysis (HD) and peritoneal dialysis (PD) use diffusion and osmosis to remove excess fluid, electrolytes, and metabolic wastes in end-stage kidney disease. However, the HD process is much faster than is PD. This can be both an advantage and a disadvantage of HD. When a client's metabolic condition is severely disordered, rapid normalization is required. When used routinely, PD provides a much gentler dialysis experience. Typically, HD is performed in a health care facility. The client will not be able to get up and move about because the access route (external A-V shunt, AV fistula, graft, or a femoral, subclavian, or jugular cannula) is attached to the HD machine. An anticoagulant must be added to the HD dialysate to prevent clotting.
Medical-Surgical Nursing Review RN-BC
Medical-Surgical Nursing Review RN-BC®
Pocket Study Guide Volume 1
S. Kay Sedlak MS RN RN-BC CEN FAEN
Laura M. Criddle PhD RN ACNS-BC RN-BC FAEN