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MEDICAL-SURGICAL NURSING
July 2011 Nurse Licensure Examination
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Instruction: Select the correct answer for each following questions. Mark only one answer for each item by
encircling the letter of your choice. STRICTLY NO ERASURES ALLOWED.
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a. Morphine
c.
Meperidine
b. NSAIDS
d. Codeine
Pain in acute pancreatitis is caused by irritation
and edema of the inflamed pancreas as well as
spasm due to obstruction of the pancreatic ducts.
Demerol is the drug of choice because it is less
likely to cause spasm of the Sphincter of Oddi
unlike Morphine which is spasmogenic.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 283
92. Immediately
after
cholecystectomy,
the
nursing action that should assume the highest
priority is:
a. encouraging the client to take adequate
deep breaths by mouth
b. encouraging the client to cough and
deep breathe
c. changing the dressing at least BID
d. irrigate the T-tube frequently
Cholecystectomy requires a subcostal incision. To
minimize pain, clients have a tendency to take
shallow breaths which can lead to respiratory
complications like pneumonia and atelectasis.
Deep breathing and coughing exercises can help
prevent such complications.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1354
93. A Sengstaken-Blakemore tube is inserted in the
effort to stop the bleeding esophageal varices
in a patient with complicated liver cirrhosis.
Upon insertion of the tube, the client
complains of difficulty of breathing. The first
action of the nurse is to:
a. Deflate the esophageal balloon
b. Monitor VS
c. Encourage him to take deep breaths
d. Notify the MD
When a client with a Sengstaken-Blakemore tube
develops difficulty of breathing, it means the tube
is displaced and the inflated balloon is in the
oropharynx causing airway obstruction.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1175
94. The client presents with severe rectal bleeding,
16 diarrheal stools a day, severe abdominal
pain, tenesmus and dehydration. Because of
these symptoms the nurse should be alert for
other problems associated with what disease?
a.Crohns disease
c.
Diverticulitis
b. Ulcerative colitis
d. Peritonitis
Ulcerative colitis is a chronic inflammatory
condition producing edema and ulceration
affecting the entire colon. Ulcerations lead to
sloughing that causes stools as many as 10-20
times a day that is filled with blood, pus and
mucus.
The
other
symptoms
mentioned
accompany the problem.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1274
95. A client is being evaluated for cancer of the
colon. In preparing the client for barium
enema, the nurse should:
a. Give laxative the night before and a
cleansing enema in the morning
before the test
b. Render an oil retention enema and give
laxative the night before
c. Instruct the client to swallow 6 radiopaque
tablets the evening before the study
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b. Alleviate pain
c. Maintain darkened room
d. Promote low-sodium diet
After surgery to correct a detached retina,
prevention of increased intraocular pressure is the
priority goal.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 2068-2069
202. When suctioning an unconscious client, which
nursing intervention should the nurse prioritize
in maintaining cerebral perfusion?
a. Administer diuretics
b. Administer analgesics
c. Provide hygiene
d. Hyperoxygenate before and after
suctioning
It is a priority to hyperoxygenate the client
before and after suctioning to prevent hypoxia and
to maintain cerebral perfusion.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 735
203. When discussing breathing exercises with a
postoperative client, Nurse Hazel should
include which of the following teaching?
a. Short frequent breaths
b. Exhale with mouth open
c. Exercise twice a day
d. Place hand on the abdomen and feel it
rise
Abdominal breathing improves lungs expansion
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 492-493
204. Nurse Judith obtains a specimen of clear
nasal drainage from a client with a head injury.
Which of the following tests differentiates
mucus from cerebrospinal fluid (CSF)?
a. Protein
c. Glucose
b. Specific gravity
d. Microorganism
The constituents of CSF are similar to those of
blood plasma. An examination for glucose content
is done to determine whether a body fluid is
mucus or CSF. A CSF normally contains glucose.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 2133-2134
205. What is the priority nursing assessment in
the first 24 hours after admission of the client
with thrombotic CVA?
a. Pupil size and papillary response
b. cholesterol level
c. Echocardiogram
d. Bowel sounds
It is crucial to monitor the pupil size and papillary
response to indicate changes around the cranial
nerves.
Text Book of Medical Surgical Nursing by Brunner
and
Suddarth 11 ed. Page 2134
206. Nurse Linda is preparing a client with multiple
sclerosis for discharge from the hospital to
home. Which of the following instruction is
most appropriate?
a. Practice using the mechanical aids that you
will need when future disabilities arise.
b. Follow good health habits to change the
course of the disease.
c. Keep active, use stress reduction
strategies, and avoid fatigue.
d. You will need to accept the necessity for a
quiet and inactive lifestyle.
The nurse most positive approach is to
encourage the client with multiple sclerosis to stay
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a. Mushy
c. Formed
b. Fluid
d. Semi-mushy
A-For transverse colon colostomy B- For
ascending colon colostomy C- As sigmoid colon
is near the rectum, you expect the stools to be
formed and solid. D- For descending colon
colostomy
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1271
225. Upon assessment the nurse notes that the
client has a deep vein thrombosis (DVT). The
client asked what might have caused it. The
nurse enumerated the causes of the thrombus
formation by saying that a Virchows triad are
the following except:
a. Venous stasis
b. Homans sign
c. Vessel wall injury
d. Too much blood coagulating ability
Homans sign is a calf pain that is a
manifestation of DVT. Virchows triad is the one
that causes DVT and is seen in A, C and D.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page
226. A nurse is conducting a health teaching on
thrombophlebitis. The most effective action to
prevent thrombophlebitis after a vein surgery
is done is to do which of the following:
a. Elevating the leg when lying or sitting
b. Compression with elastic bandage
c. Applying pressure on the site
d. Early ambulation
All the option given are the interventions done
after a vein surgery is done. However, the most
effective way of thrombophlebitis prevention is
mobilization.
227. Mr. B is on chest tube. A three way bottle
system is used. The patient is asking what
should be observed on the bottle at the middle
(water seal). The nurses best response is:
a. The bottle at the middle should have
an intermittent bubbling.
b. The bottle at the middle should have a
continuous bubbling.
c. No bubbling should be seen on that bottle.
Please call me immediately if you observe
bubbling in it.
d. Just be sure all the bottles are not
bubbling.
A water seal bottle should have an intermittent
bubbling because it rises during inhalation and
falls on exhalation. B If continuous bubbling is
observed an air leak would be suspected. CBlockage or obstruction on the tubes can cause
the water seal chamber not to bubble. D - The
suction bottle should be bubbling continuously.
Thus, this is incorrect.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 758
228. As the nurse is administering medications to
Mr. B, he again inquired about his chest tube.
He was asking what possible reason would
cause no bubbling on the suction bottle. The
nurses best response is:
a. It is caused by an electrical fluctuation.
b. It is just a normal observation for a suction
bottle.
c. It is caused by too much water on the
suction bottle.
d. It is caused by the overexpansion of
the lungs.
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b. Second stage
d. Fourth stage
First stage: client is drowsy B- Second stage:
increased autonomic activity noted. C- Third stage
: client is unconcious D- Fourth stage : client not
be breathing (resuscitation needed)
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 508
234. The main goal after a surgery is:
a. Promotion of wound healing
b. Promotion of adequate respiratory
function
c. Promotion of adequate cardiac function
d. Promotion of adequate fluid and electrolyte
balance
Follow the principle of prioritization A-B-C! Airway
first, then breathing and circulation. Thus,
respiratory first then cardiac function (C) followed
by electrolyte balance (D)and wound healing (A).
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 670
235. Open
wound
healing
that
requires
regeneration of much more tissue that at times
may require grafting is healing by:
a. Primary intention
c.
Tertiary
intention
b. Dehiscence
d.
Secondary
intention
Primary intention fills wound with new tissue
leaving a thin and flat scar. B- Dehiscence
separation of wound edges. C- Tertiary intention
wounds that are closed later because of infection
due to contamination leaving a wide scar and
delayed closure D- Secondary intention healing
of open wounds that require regeneration of of
much more tissue and at times require grafting.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 104
236. The following are risk predictors of decubitus
ulcers except:
a. Friction
c. Moisture
b. Activity
d.
Thrombophlebitis
Thrombophlebitis is an inflammation of the vein
that occurs 7-14 days post operatively if the
patient will not promote early ambulation. A, B
and C are risk factors of D.Ulcer.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 208-209
a. Diuretics
c. Vasodilator
b. Beta blockers
d. Calcium channel
blocker
Verapamil (Calan) is a Calcium channel blocker
that blocks entry of calcium into the smooth
muscle thus, lowering BP.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 3123
247. A 33 year old male client enters the clinic
with complaints of pain at the calf muscle. He
said that pain aggravates when he ambulates
or walks. You expect this disorder to be an:
a. Arterial disorder
b. Hypertension
c. Venous disorder
d. Raynauds disease
In arterial disorder the pain is aggravated by
walking and exercise thus, A is the best choice. (C)
Venous D/O is caused by prolonged standing and
management involves elevating the legs.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 992-995
248. Buergers
disease
or
thromboangitis
Obliterans commonly affects:
a. Medical professionals c. Adolescents
b. Smokers
d. A and B
Buergers disease causes thrombotic and
inflammatory occlusions of the small arterioles
among smokers.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 995-996
249. A client was admitted in the ER with profuse
bleeding due to a vehicular accident. You
expect what type of shock will occur in this
client if prompt treatment is not implemented?
a. Cardiogenic
c. Anaphylactic
b. Neurogenic
d. Hypovolemic
Hypovolemic shock is caused by a decrease in
circulating volume such as bleeding or plasma loss
in burns. A cardiogenic shock is caused by a loss
of cardiac pumping action (M.I.). Anaphylactic
shock is caused by an allergy. Neurogenic shock is
most likely caused by a spinal injury or shock
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 356
250. Pancreatitis would most likely cause:
a. Increased insulin secretion
b. Vasoconstriction
c. Bronchodilation
d. Tachycardia
Increased insulin secretion Pancreatitis is
inflammation of the pancreas. The pancreas is a
gland located behind the stomach. It releases the
hormones insulin and glucagon, as well as
digestive enzymes that help you digest and
absorb food.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1358
251. Which symptom is associated with peritoneal
irritation?
a. Cullens sign
c.
Rebound
tenderness
b. Ascites
d. Grey Turners sign
Rebound tenderness is a clinical sign that a
doctor may detect in physical examination of a
patient's abdomen. Cullen's sign is superficial
edema and bruising in the subcutaneous fatty
tissue around the umbilicus. Ascites is a
gastroenterological term for an accumulation of
fluid in the peritoneal cavity. Grey Turner's sign
refers to bruising of the flanks.
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a. Alcohol
c. Cirrhosis
b. Aspirin
d. NSAIDS
Cirrhosis is most commonly caused by
alcoholism, hepatitis B and C, and fatty liver
disease, but has many other possible causes.
Some cases are idiopathic, i.e., of unknown cause.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1209
257. As a post-procedure nursing care after
endoscopic therapy of upper GI bleeding,
observe the following EXCEPT:
a. Fever
c. Heartburn
b. Pain
d. Increased bowel
sounds
Monitor the patient for possible complications
such as adverse effects from sedation, cardiac
arrhythmias, respiratory depression and bleeding.
It is impossible for the patient to have increased
bowel sounds since the patient lies supine for
hours.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1211
258. Among the tests being done to evaluate a
case of acute pancreatitis, which of the
following is the imaging gold standard for it?
a. CT scan
c. Ultrasound
b. Plain radiograph
d. Arteriogram
A reasonable indication for a CT scan at
admission (but not necessarily a CT with IV
contrast) is to distinguish acute pancreatitis from
another serious intra-abdominal condition, such as
a perforated ulcer.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1358
259. In acute pancreatitis, an early nutrition is
ordered. This is via:
a. Mouth
c. Jejunostomy tube
b. Nasogastric tube
d.
Intravenous line
Intravenous line - The patient is inhibited to eat
or under NPO in order to prevent undue damage
to
the
gastrointestinal
disorders.
Likewise
intravenous line makes it easier for medications to
be absorbed.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1359
260. The results of the blood examination was
handed in to the station. For a patient with
pancreatitis which of the values is mostly
under monitoring?
a. Iron
c. Potassium
b. Cholesterol
d. Glucose
Glucose Glucose is the primary source of energy
for the body's cells, and blood lipids (in the form of
fats and oils) are primarily a compact energy
store. Glucose is transported from the intestines or
liver to body cells via the bloodstream, and is
made available for cell absorption via the hormone
insulin, produced by the body primarily in the
pancreas.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1360
261. Which of the following interventions will be
most effective in improving Transcultural
communications with oncology clients and
their families?
a. Use touch to show concern and caring for
the client
b. Focus attention on verbal communication
skills only
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9-year-old
girl
post
appendectomy has a non-infectious case, however
the gender of the child is not appropriate. C A
10-year-old boy with CHF is appropriate to be his
roommate since they are of the same age and
gender. This lowers the anxiety as well as it
promotes a familiarity for both kids. D- An 8-yearold-boy with salmonellosis is not also appropriate
to be place with the child since it is an infectious
type of case.
Kaplan NCLEX Review Series 2008 page 451
290. A patient was diagnosed to be suffering from
phenylketonuria. Interventions by the nurse
should be aimed in monitoring the patients
growth and development due to which of the
following complications:
a. Hydrocephalus
c. Malnutrition
b. Paralysis
d.
Mental
retardation
Mental retardation is the complication of
phenylketonuria since the baby has an inborn
abnormality of lacking the ability to break down
phenylalanine. A - Hydrocephalus is a complication
for meningitis. B - Paralysis is a complication for
cases like tetanus or nerve damage. C Malnutrition is a case when a vitamin or mineral is
depleted in the body.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 141
291. Gary Jordan suffered a cerebrovascular
accident that left her unable to comprehend
speech and unable to speak. This type of
aphasia is known as:
a. Receptive aphasia
c.
Global
aphasia
b. Expressive aphasia
Conduction
aphasia
Global aphasia occurs when all language
functions are affected. Receptive aphasia, also
known as Wernickes aphasia, affects the ability to
comprehend written or spoken words. Expressive
aphasia, also known as Brocas aphasia, affected
the patients ability to form language and express
thoughts.
Conduction
aphasia
refers
to
abnormalities in speech repetition.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 2146
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b. Hand grips
d. Blood glucose
Pheochromocytoma is a tumor of the adrenal
medulla that causes an increase secretion of
catecholamines that can elevate the blood
pressure.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1475-1477
338. The nurse is attending a bridal shower for a
friend when another guest, who happens to be
a diabetic, starts to tremble and complains of
dizziness. The next best action for the nurse to
take is to:
a. Encourage the guest to eat some baked
macaroni
b. Call the guests personal physician
c. Offer the guest a cup of coffee
d. Give the guest a glass of orange juice
In diabetic patients, the nurse should watch out
for signs of hypoglycemia manifested by dizziness,
tremors, weakness, pallor diaphoresis and
tachycardia. When this occurs in a conscious
client,
he
should
be
given
immediately
carbohydrates in the form of fruit juice, hard
candy, honey or, if unconscious, glucagons or
dextrose per IV.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1387
339. An
adult,
who
is
newly
diagnosed
with Graves disease, asks the nurse, Why do I
need to take Propanolol (Inderal)? Based on
the nurses understanding of the medication
and Graves disease, the best response would
be:
a. The medication will limit thyroid hormone
secretion.
b. The medication limit synthesis of the
thyroid hormones.
c. The medication will block the
cardiovascular symptoms of Graves
disease.
d. The medication will increase the synthesis
of thyroid hormones.
Propranolol (Inderal) is a beta-adrenergic blocker
that controls the cardiovascular manifestations
brought about by increased secretion of the
thyroid hormone in Graves disease.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1459-1465
340. During the first 24 hours after thyroid
surgery, the nurse should include in her care:
a. Checking the back and sides of the
operative
dressing
b. Supporting the head during mild range
of
motion
exercise
c. Encouraging the client to ventilate her
feelings
about
the
surgery
d. Advising the client that she can resume
her normal activities immediately
Following surgery of the thyroid gland, bleeding
is a potential complication. This can best be
assessed by checking the back and the sides of
the operative dressing as the blood may flow
towards the side and back leaving the front dry
and clear of drainage.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1464
341. On discharge, the nurse teaches the patient
to observe for signs of surgically induced
hypothyroidism. The nurse would know that
the patient understands the teaching when she
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b. A fractured femur
c. Ventricular fibrillation
d. A penetrating abdominal wound
VF could alter the circulation since the heart is
the main pumping organ of the body, an
emergency
situation,
emboli
formed
from
fibrillation might lead to infarction on the major
organs of the body.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 836-837
378. Which of the following statements, if made
by a patient who is suspected of having
congested heart disease, would support the
diagnosis?
a. I sleep using two pillows.
b. My ears have a ringing sensation.
c. My weight has gone down.
d. I am not able to tolerate it.
When the client lies supine, the feeling of
congestion is felt and cannot tolerate it longer
than the normal person.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 946
379. Which of this statement, if made by a
patient who has a prescription for sublingual
nitroglycerine tablets, would indicate a correct
understanding of the medication instruction?
a. I should take the pills with a full glass of
water.
b. I should protect these pills from
sunlight.
c. I should wait 30 minutes before taking the
second pill.
d. I should chew the pill for faster effect.
These drugs are photosensitive and are placed in
an amber colored bottle
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 869
380. A
client
has
undergone
a
left
hemicolectomy for bowel cancer. Which of
these activities should the nurse include post
operatively
to
prevent
pulmonary
complications such as pneumonia?
a. Administering oxygen, coughing, breathing
deeply, and maintaining bed rest
b. Coughing, breathing deeply, maintaining
bed rest, and using an incentive spirometer
c. Coughing, breathing deeply, frequent
repositioning, and using an incentive
spirometer
d. Administering pain medications, frequent
repositioning, and limiting fluid intake
Activities that help to prevent the occurrence of
postoperative pneumonia are: coughing, breathing
deeply, frequent repositioning, medicating the
client for pain, and using an incentive spirometer.
Limiting fluids and lying still will increase the risk
of pneumonia.
381. What should Mang Gibo, 49 years old, do to
ensure early identification of prostate cancer?.
a. Have a digital rectal examination and
prostate-specific antigen (PSA) test
done yearly.
b. Have a transrectal ultrasound every 5 years.
c. Have a complete blood count (CBC) yearly
(including blood urea nitrogen [BUN] and
creatinine assessment).
d. Perform
monthly
testicular
selfexaminations, especially after age 50.
The incidence of prostate cancer increases after
age 50. The digital rectal examination, which
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a. Barbiturates
c. Cocaine
b. Opioids
d. Benzodiazepines
Because of the clients age and negative medical
history, the nurse should question her about
cocaine use. Cocaine increases myocardial oxygen
consumption and can cause coronary artery
spasm, leading to tachycardia, ventricular
fibrillation, myocardial ischemia, and myocardial
infarction. Barbiturate overdose may trigger
respiratory depression and slow pulse. Opioids can
cause marked respiratory depression, while
benzodiazepines can cause drowsiness and
confusion.
Kaplan NURSING REVIEW series 2008, 345
472. A 51-year-old female client tells the nurse
in-charge that she has found a painless lump in
her right breast during her monthly selfexamination. Which assessment finding would
strongly suggest that this client's lump is
cancerous?
a. Eversion of the right nipple and mobile mass
b. Nonmobile mass with irregular edges
c. Mobile mass that is soft and easily
delineated
d. Nonpalpable right axillary lymph nodes
Breast cancer tumors are fixed, hard, and poorly
delineated with irregular edges. A mobile mass
that is soft and easily delineated is most often a
fluid-filled benign cyst. Axillary lymph nodes may
or may not be palpable on initial detection of a
cancerous mass. Nipple retraction not eversion
may be a sign of cancer
Kaplan NURSING REVIEW series 2008, 356
473. Which
complication
of
cardiac
catheterization should the nurse monitor for in
the initial 24 hours after the procedure?
a. Angina at rest
b. Thrombus formation
c. Dizziness
d. Falling blood pressure
Thrombus formation in the coronary arteries is a
potential problem in the initial 24 hours after a
cardiac catheterization. A falling BP occurs along
with hemorrhage of the insertion site which is
within the first 12 hours after the procedure.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 1037
474. During an assessment of a client with
cardiomyopathy, the nurse finds that the
systolic blood pressure has decreased from
145 to 110 mm Hg and the heart rate has risen
from 72 to 96 beats per minute and the client
complains of periodic dizzy spells. The nurse
instructs the client to:
a. increase fluids that are high in protein
b. restrict fluids
c. force
fluids
and
reassess
blood
pressure
d. limit fluids to non-caffeine beverages
Postural hypotension, a decrease in systolic
blood pressure of more than 15 mm Hg and an
increase in heart rate of more than 15 percent
usually accompanied by dizziness indicates
volume depletion, inadequate vasoconstrictor
mechanisms, and autonomic insufficiency.
Text Book of Medical Surgical Nursing by Brunner
and Suddarth 11 ed. Page 843
475. A nurse is evaluating the quality of home
care for a client with Alzheimer's disease. It
would be a priority to reinforce which
statement by a family member?
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c.
"Nurses are not servants. They are professionals that should be treated with respect."
- Christina Hawthorne
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