Deck 1: Medical Surgical Nursing Practice

Question 1

Mr) Mitchell, a 61-year-old retired banker, is diagnosed with cancer and has been immunocompromised and malnourished due to decreased intake because of nausea, anorexia, and a feeling of fullness. A Salem sump tube had been draining the stomach and has been discontinued. The initial nursing action to manage malnutrition would be:

A)Teach the client about total parenteral nutrition (TPN)
B)Assist with insertion of a PEG tube
C)Give an antiemetic before serving small, frequent meals
D)Give an aluminum hydroxide antacid with meals

Answer 1

Give an antiemetic before serving small, frequent meals

Question 2

After EGD, Edna was diagnosed to have gastroesophageal reflux disease (GERD). The nurse teaches Edna about ways to minimize symptoms. Which of the following statements made by Edna indicates that more teaching is needed?

A)"I will be sure to drink tea instead of coffee."
B)"I will take a walk after I eat."
C)"I will try to eat smaller meals more frequently."
D)"I will sleep with the head of the bed elevated about 12 inches."

Answer 2

"I will be sure to drink tea instead of coffee."

Question 3

Fluid intake for clients suffering from dumping syndrome should be:

A)Between meals
B)Only with meals
C)Anytime they want
D)Restricted to 1200 ml/day

Answer 3

Between meals

Question 4

A child admitted to rule out intussusception is scheduled for a barium enema. The nurse should teach the child's parents that the major purpose of this procedure is to:

A)Confirm the diagnosis
B)Reduce the telescoping
C)Ease the passage of stool
D)Provide symptomatic relief

Question 5

You are teaching Mr. Joseph dela Rosa, a 36-year-old taxi driver who was diagnosed with a new onset of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following statements by the client best indicates that he correctly understands how to manage this disease?

A)"I should limit my sodium intake to 2 grams daily."
B)"I should report constipation or fatigue to the doctor."
C)"I should drink at least 3,000 cc or 10 glasses of water daily."
D)"I should limit my fluid intake to approximately 800 cc or 4 glasses of water daily."

Question 6

The nurse has just received instructions for an oral glucose tolerance test (OGTT) with a client. Which of the following statements made by the client indicates a need for more teaching?

A)"I will eat a light breakfast the morning of the test."
B)"I will expect to take 100 mg of glucose at the start of the test."
C)"I can expect to have my blood drawn at 30 and 60 minute intervals during the test."
D)"I will report any symptoms of dizziness, sweating, and/or weakness if they occur during the test."

Question 7

A diabetic client with the flu asks why he should drink juices, check his finger stick glucose every 4 hours, and take insulin when he is not eating and is vomiting. Which of the following would be the best explanation by the nurse?

A)He needs to prevent dehydration, excessive breakdown of fats for glucose, and monitor for hyperglycemia.
B)He needs to check his blood glucose because vomiting could cause hypoglycemia and drinking fluids will prevent dehydration.
C)His body uses protein for energy when he is sick, causing increased ketones and hypoglycemia.
D)If he could substitute water for the juices to prevent dehydration, then he would not need to check his blood glucose levels so often

Question 8

Which of the following evaluation data would best lead the nurse to conclude that the client with hyperglycemic hyperosmolar nonketotic coma (HHNK) has demonstrated improvement during the first 24 hours?

A)Alert and oriented, balanced intake and output, and moist mucous membranes
B)Intake equals output, denies pain and shortness of breath
C)Alert and oriented, blood and urine without ketones, and no orthostatic BP
D)Respirations easy and even, eats 50 to 75 percent of meals, and vital signs stable

Question 9

A client underwent Billroth surgery for gastric ulcer. Post-operatively, the drainage from his NGT is thick and the volume of secretions has dramatically reduced in the last 2 hours and the client feels like vomiting. The most appropriate nursing action is to:

A)Reposition the NGT by advancing it gently NSS
B)Notify the MD of your findings
C)Irrigate the NGT with 50 cc of sterile
D)Discontinue the low-intermittent suction

Question 10

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)Crohn's disease
B)Ulcerative colitis
C)Diverticulitis
D)Peritonitis

Question 11

J) Chan, a 30-year-old bartender, receives a positive antinuclear antibody (ANA) test result with a titer level > 1:40. He does not understand what the test result means and asks the nurse for an explanation. Which of the following responses to the client would be most appropriate in this situation?

A)"The test result is normal."
B)"The test indicates that you may have an autoimmune disorder and this result should be discussed in more detail with your physician."
C)"You should have the test repeated to verify its specificity for autoimmune disorders."
D)"Your test result is specific for the detection of systemic lupus and this should be discussed further with your physician."

Question 12

Steven, 38 years old, was diagnosed with rheumatoid arthritis and was given acetylsalicylic acid (aspirin) as part of his medications. He asked the nurse why aspirin was ordered and even added "this is a child's medication." The nurse would explain that the main reason that aspirin is used in the treatment of rheumatoid arthritis is to:

A)Reduce fever
B)Reduce inflammation of the joints
C)Assist the client in range-of-motion activities without pain
D)Prevent extension of the disease process

Question 13

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching?

A)"It is normal to feel gassy or bloated after the procedure."
B)"The abdominal muscles may be tender from the procedure."
C)"It is alright to drive once I've been home for an hour or so."
D)"Intake should be light at first and the progress."

Question 14

The nurse is preparing a client with hiatal hernia for discharge. Which of the following statements made by the client would indicate that teaching has been effective?

A)"I will join the gym and get in shape by lifting weights."
B)"I know I need to eat a high-fat diet to slow down my digestion."
C)"I will join a support group."
D)"I will take a walk after dinner each night."

Question 15

After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take?

A)Call the physician immediately
B)Administer the prescribed antiemetic
C)Check the patency of the nasogastric tube for any obstruction
D)Change the patient's position

Question 16

The nurse is caring for a client following a Billroth II procedure. Which operative order should the nurse question and verify?

A)Leg exercises
B)Early ambulation
C)Irrigating the nasogastric tube
D)Coughing and deep-breathing exercises

Question 17

The nurse is caring for a client with new onset of atrial fibrillation. The nurse anticipates that which of the following is a possible treatment for this dysrhythmia when it first develops?

A)External pacemaker application
B)Insertion of automatic internal cardiac defibrillator (AICD)
C)Synchronized cardioversion
D)Defibrillation.

Question 18

Thirty minutes after left-heart catheterization, the client's blood pressure begins to drop. Which potential complication explains this?

A)Absent distal pulses
B)Increased pain at puncture site.
C)Nausea
D)Bleeding or hematoma at the puncture site

Question 19

In preparation for discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include:

A)Walking several times each day as part of an exercise routine
B)Keeping the heat up so that the environment is warm
C)Wearing TED hose during the day
D)Using hydrotherapy for increasing oxygenation

Question 20

A client tells the nurse that he has leg pains that begin when he walks, but cease when he stops walking. Which of the following conditions would the nurse assess for?

A)An acute obstruction in the vessels of the legs
B)Peripheral vascular problems in both legs
C)Diabetes
D)Calcium deficiency

Question 21

Michelle, a 24-year-old intern, was diagnosed with mitral stenosis. Aside from noticing a murmur during the physical examination, the nurse may also find:

A)Dyspnea upon exertion
B)Jugular vein distention
C)Syncope on exertion
D)Angina

Question 22

The nurse is caring for Mrs. Guzman, a 47-year-old Filipina broker, on the 3rd postoperative day after coronary artery bypass (CABG) surgery. Because an important nursing diagnosis for post-CABG clients is ineffective breathing pattern, what is the best plan by the nurse?

A)Ensure that Mrs. Guzman performs deep breathing and vigorous coughing every hour
B)Ensure that Mrs. Guzman uses the incentive spirometer every hour
C)Pre-medicate Mrs. Guzman before ambulation
D)Auscultate lungs once a shift

Question 23

The nurse is preparing to defibrillate a pulseless adult client. Which action demonstrates safe, appropriate use of defibrillator?

A)Apply the paddles to the right anterior and right posterior chest
B)Do not take the time to remove nitroglycerine ointment
C)Ensure that the device is placed on cardiovert
D)Notify all beside personnel to stand clear immediately prior to defibrillation

Question 24

Which of the following findings in a client awaiting abdominal aortic aneurysm repair would you report immediately to the physician?

A)Severe back pain
B)Swelling of the arms and face
C)Increased blue areas of the feet
D)Hoarseness or difficulty swallowing

Question 25

Which of the following disorders is characterized by a sudden drop in blood glucose, followed by rebound hyperglycemia caused by gradual and excessive administration of insulin?

A)Diabetes insipidus
B)Diabetic ketoacidosis
C)Somogyi phenomenon
D)Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

Question 26

Following a thyroid scan with radioactive iodine for a thyroid nodule, the nurse should plan for:

A)No special radiation precautions
B)Full radiation precautions to be instituted, including segregating the client in a private room
C)Radiation precautions that are limited to urine and feces
D)Full radiation precautions to be instituted for 8 hours (the half-life of radioactive iodine)

Question 27

Because aldosterone is the major mineralocorticoid secreted by the adrenal cortex, which fluid and electrolyte imbalance should the nurse anticipate with decreased secretion of this hormone?

A)Hyperkalemia
B)Hypernatremia
C)Hypervolemia
D)Hypercalcemia

Question 28

The nurse would be correct in saying that the two common causes of primary hypothyroidism are:

A)Destruction of thyroid tissue by radioactive iodine during therapy for hyperthyroidism and spontaneous atrophy due to autoimmune response.
B)Spontaneous atrophy due to autoimmune response and surgical removal of the thyroid gland.
C)Surgical removal of the thyroid gland and tumors of the pituitary gland that decrease the amount of circulating thyroxine.
D)Tumors of the pituitary gland and/or large doses of antithyroid drugs.

Question 29

A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms except:

A)Hypertension
B)Oliguria
C)Tachycardia
D)Tachypnea

Question 30

The doctor orders for a glycosylated hemoglobin test for a client with diabetes. The client asked you what the purpose of this test is. You explained that glycosylated hemoglobin is used:

A)To check for anemia
B)To determine the average blood glucose level for up to 4 prior months
C)To compare hemoglobin to glucose levels
D)To calculate the amount of glucose in hemoglobin for the past 6 months

Question 31

A client was diagnosed with hyperparathyroidism. The nurse explains that because of his condition, he is at risk for having:

A)Hypothyroidism
B)Hypertension
C)Fractures
D)Gingivitis

Question 32

Contractures are among the most serious long-term complications of severe burns. If a burn is located on the upper torso, which nursing measure would be least effective to help prevent contractures?

A)Changing the location of the bed, the TV set, or both, daily
B)Encouraging the client to chew gum and blow up balloons
C)Avoiding the use of a pillow for sleep or placing the head in a position of hyperextension
D)Helping the client to rest in the position of maximal comfort

Question 33

The nurse explains to a client that bronchitis is characterized by:

A)Production of mucoid sputum, sometimes difficult to expectorate
B)Bronchoconstriction and edema of the wall of the bronchioles
C)Exudates in the alveoli
D)Increasing lung stiffness

Question 34

Which finding below would indicate the most effective response to asthma medications?

A)The ability to participate in active sports for longer periods
B)Cyanosis subsides
C)Peak expiratory flow rate (PEFR) within normal limits
D)Client can breathe on his own without oxygen

Question 35

Emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to:

A)Increase BP
B)Decrease mucosal swelling
C)Relax the bronchial smooth muscle
D)Decrease bronchial secretions

Question 36

Mr) KA is a client with tracheostomy in the neurology ward. As part of your routine care, you will perform suctioning because of the presence of secretions. It is important to follow which correct technique?

A)The suction pressure should be between 100 to 120 mmHg.
B)Hyperoxygenate the client before and after suctioning.
C)While advancing the suction catheter, occlude the Y-port of the catheter.
D)Use intermittent suction in the airway for up to 20 seconds.

Question 37

Auscultation of a client's lungs reveals rales (crackles) in the left posterior base. The nursing intervention is to:

A)Repeat auscultation after asking the client to take deep breaths and cough.
B)Instruct the client to limit fluid intake to less than 2000 mL/day.
C)Inspect the client's ankles and sacrum for the presence of edema.
D)Place the client on bed rest in a semi-Fowler's position.

Question 38

A client undergoes below the knee amputation following a vehicular accident. Three days postoperatively, the client is refusing to eat, talk, or perform any rehabilitative activities. The best initial nursing approach would be to:

A)Give him an explanation of why there is a need to quickly increase his activity
B)Emphasize repeatedly that with his prosthesis, he will be able to return to his normal lifestyle.
C)Appear cheerful and non-critical, regardless of his response to attempts at intervention.
D)Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieving.

Question 39

Rhoda Miller has returned to the clinic 72 hours following a tuberculin skin test with an induration of about 5 to 6 mm at the administration site. She is visibly upset and states, "I can't believe I have TB!" Which statement by the nurse is appropriate?

A)"You'll need to put on a mask and wear it whenever you are around other people."
B)"The doctor will prescribe Isoniazid for you to take for the next 3 months."
C)"This finding does not confirm TB; it may indicate a recent exposure to tuberculosis."
D)"We'll need to do a chest x-ray. This may be falsely positive because of your history of diabetes."

Question 40

In developing the care plan for a client with pulmonary mycobacterium tuberculosis, what primary precaution should be included?

A)Contact skin precautions
B)Use of special mask to avoid inhaling infected airborne droplets
C)Avoidance of blood contamination
D)Containment of draining wounds

Question 41

When administering drugs during CPR, what would be a priority for the nurse?

A)Flush with saline between medications to prevent drug interactions.
B)Check the expiration dates of emergency drugs.
C)Identify potential adverse reactions of emergency drugs.
D)Audit the emergency drugs that will be replaced on the medication cart.

Question 42

Which initial nursing assessment finding would best indicate that a client has been successfully resuscitated after a cardio-respiratory arrest?

A)Skin warm and dry
B)Pupils equal and react to light
C)Palpable carotid pulse
D)Positive Babinski's reflex

Question 43

A 20-year-old client is being treated for pneumonia. He has a persistent cough and complains of severe pain on coughing. What type of instruction could be given to help the client reduce the discomfort he is having?

A)"Hold in your cough as much as possible."
B)"Place the head of your bed flat to help with coughing."
C)"Restrict fluids to help decrease the amount of sputum."
D)"Splint your chest wall with a pillow for comfort."

Question 44

What is the expected outcome for a client with a nursing diagnosis of ineffective airway clearance related to inflammation?

A)Closely monitor blood pH less than 7.25
B)Client will experience reduction of anxiety
C)Client will breathe easily and without dyspnea
D)Teach percussion, postural drainage, and encourage coughing

Question 45

Marcus, a 56-year-old miner, was diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed?

A)One entire lung
B)A lobe of the lung
C)A small, localized area near the surface of the lung
D)A segment of the lung, including a bronchiole and its alveoli

Question 46

The nurse is preparing her plan of care for a patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?

A)Fluid volume deficit
B)Decreased tissue perfusion
C)Impaired gas exchange
D)Risk for infection

Question 47

Which of the following physiologic effects of a pulmonary embolism would initially affect oxygenation?

A)A blood clot blocks ventilation; perfusion is unaffected.
B)A blood clot blocks ventilation, producing hypoxia despite normal perfusion.
C)A blood clot blocks perfusion and ventilation, producing profound hypoxia.
D)A blood clot blocks perfusion, producing hypoxia despite normal or supernormal ventilation.

Question 48

A 60-year-old client develops acute shortness of breath and progressive hypoxia, requiring mechanical ventilation after repair of a fractured right femur. The hypoxia was probably caused by which of the following conditions?

A)Asthma attack
B)Atelectasis
C)Bronchitis
D)Fat embolism

Question 49

The nurse inspects the skin of Jamie, 11 years old, suspected of having scabies. Which assessment finding would the nurse note if this disorder was present?

A)Patchy hair loss and round red macules with scales
B)The presence of white patches scattered about the trunk
C)Multiple straight or wavy, thread-like lines beneath the skin
D)The appearance of vesicles or pustules with a thick honey-colored crust

Question 50

The nurse prepares discharge instructions for Mayra, 27 years old, following cryosurgery for the treatment of a malignant skin lesion. Which of the following should the nurse include in the instructions?

A)Avoid showering for 7 to 10 days.
B)Apply ice to the site to prevent discomfort.
C)Apply alcohol-soaked dressings twice a day.
D)Clean the site with hydrogen peroxide to prevent infection.

Question 51

Shane, 12 years old, is an avid fan of skateboarding. She tried to learn the moves, but accidentally fell on her first try. Agonizing in pain, she was then brought to the Emergency Department. The X-ray film showed an incomplete fracture of the left tibia. The doctor ordered for a closed reduction and a cast was applied on her left leg. Which of the following is an incorrect intervention for Shane?

A)Elevate entire extremity higher than the client's heart for the first 24 to 48 hours
B)Exercise her toes
C)Support Shane's foot with the ankle in 90 degrees of flexion
D)Create a turning schedule for position changes every 3 hours

Question 52

The nurse should plan to include which of the following statements in client teaching for impetigo?

A)Poor hygiene is the only reason impetigo occurs.
B)Good hand washing with antibacterial soap helps reduce spreading the infection to others.
C)Impetigo is not contagious and cannot spread to other members of the family.
D)Antibacterial medication is not useful in impetigo.

Question 53

Forty-eight hours after a burn injury, the physician orders for the client 2 liters of IV fluid to be administered q12 h. The drop factor of the tubing is 10 gtt/ml. The nurse should set the flow to provide:

A)18 gtt/min
B)28 gtt/min
C)32 gtt/min
D)36 gtt/min

Question 54

To promote the safety environment of a client with Von Willebrand's disease, which actions would the nurse take?

A)Administer ibuprofen if the client has a temperature of 101.5°F or experiences pain.
B)Advise the client to wear gloves while doing household chores.
C)Provide oral care and recommend daily flossing.
D)Administer vitamins C and K on a daily basis.

Question 55

A school-age child has leukemia. Considering the diagnosis and health teaching needs, the nurse would be most correct in advising this child to:

A)Skip brushing the teeth at this time.
B)Brush the teeth with a soft toothbrush only.
C)Brush the teeth with a firm toothbrush only.
D)Rinse the mouth with an antiseptic solution instead of brushing the teeth.

Question 56

Ana, 55 years old, is admitted to the hospital to rule out pernicious anemia. A Schilling test is ordered for Ana. The nurse recognizes that the primary purpose of the Schilling test is to determine the client's ability to:

A)Store vitamin B12
B)Digest vitamin B12
C)Absorb vitamin B12
D)Produce vitamin B12

Question 57

Roxanne, a 32-year-old waitress, underwent a cerebral angiogram through the right femoral site. Which procedural nursing assessment(s) would justify calling the physician? Select all that apply.

A)Intact dressing that needs reinforcement due to bloody drainage
B)Right pedal pulse weaker than left pedal pulse
C)Equal, bilateral pedal pulses
D)Bilateral pink, warm toes
E)Blood pressure 88/52 mmHg

Question 58

The nurse reads in an admission note that the physical examination of a client revealed an impairment of cranial nerve II. The nurse instructs ancillary caregivers to do which of the following when caring for this client?

A)Whisper to the client
B)Serve food at room temperature
C)Clear the client's path of obstacles
D)Test the temperature of any running water

Question 59

The nurse includes the important measures for stump care in the teaching plan for a client with an amputation. Which measure would be excluded from the teaching plan?

A)Wash, dry, and inspect the stump daily
B)Treat superficial abrasions and blisters promptly
C)Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb
D)Toughen the stump by pushing it against a progressively harder substance (e.g., pillow on a foot-stool)

Question 60

Which nursing action is the first priority during a generalized tonic-clonic seizure episode?

A)Observe and record all events that occur before, during, and after the seizure
B)Maintain a patent airway by turning the head to the side
C)Protect the client from injury
D)Monitor vital signs, with special attention directed to respiratory status

Question 61

Levin, age 27, was driving home when his car collided with another moving vehicle. He obtained multiple injuries and a concussion. The paramedics placed a hard neck brace to immobilize the spine. Upon arriving at the hospital, X-rays are inconclusive because of swelling. To assess and care for the skin under the collar, the nurse should:

A)Place the client flat and supine; remove the anterior section of the collar, turning the head to the right or left to remove the back section.
B)Have the client sit up in a chair to remove the front and back sections without turning the head from side to side.
C)Have at least one nurse stabilize the head in line with the torso, while the other nurse removes the collar sections.
D)Wait until the X-rays are conclusive for any trauma before assessing the skin or providing skin care under the collar.

Question 62

Troy, 27 years old, suffered from multiple injuries after his car crashed into a moving vehicle. He was then rushed to a nearby hospital where his left leg was amputated below the knee. After surgery, the physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under Troy's amputated limb. The nursing action is to:

A)Leave the pillow, as his stump is elevated
B)Remove the pillow and elevate the foot of the bed
C)Leave the pillow and elevate the foot of the bed
D)Check with the physician and clarify the orders

Question 63

A client is scheduled for an electroencephalogram (EEG) early in the morning. The nurse working the night shift prior to the procedure would write a note to do which of the following per protocol order in the early morning on the day of the test?

A)Instruct the client to refrain from washing the hair
B)Hold the daily dose of anticonvulsant
C)Place the client on NPO status
D)Reinforce client teaching that the test is only mildly uncomfortable

Question 64

S) McCormick, R.N., is one of several persons who witness a vehicle hit a pedestrian at fairly low speed on a street. The person is dazed and tries to get up. The leg appears fractured. Ms. McCormick would plan to:

A)Try to reduce the fracture manually
B)Assist the person to get up and walk to the sidewalk
C)Leave the person for a few moments to call an ambulance
D)Stay with the person and encourage the person to remain still