Deck 1: Medical Surgical

Question 1

Lisa, the nurse on duty, is preparing to discharge a client newly diagnosed with diabetes mellitus. The client states, " I should eat a candy bar or cup of ice cream every time I feel shaky, hungry, or nauseated." Which of the following is Lisa's best response?

A)"Yes. A candy bar or cup of ice cream is needed to treat the hypoglycemia."
B)"Yes. You should eat the snack and then have a meal as soon as possible."
C)"No. You should quickly eat a meal; the candy will cause hyperglycemia."
D)"No. These have too much sugar and fat, 5 Lifesavers candies or skim milk is better."

Answer 1

"No. These have too much sugar and fat, 5 Lifesavers candies or skim milk is better."

Question 2

Mr. Tuxen, a 66-year-old black American, was brought by his wife to the Emergency Department because he is increasingly confused and is coughing blood. His medical diagnosis is cirrhosis of the liver. While assessing Mr. Tuxen, the nurse understands that the correct technique when doing abdominal assessment is:

A)Palpate the most painful area progressing to the least painful parts
B)Begin with inspection and end with palpation
C)Follow the sequence of auscultation, inspection, percussion, and palpation
D)Auscultate the bowel sound first then perform palpation and percussion

Answer 2

Begin with inspection and end with palpation

Question 3

Thrombus formation is a danger for all postoperative clients. The nurse should act independently to prevent this complication by:

A)Encouraging adequate fluids
B)Applying elastic stockings
C)Gently massaging the legs with lotion
D)Performing active-assistive leg exercises

Answer 3

Performing active-assistive leg exercises

Question 4

The nurse is providing discharge teaching for a client's family member on the administration of enoxaparin (Lovenox). Which action by the family member would indicate an understanding of the administration procedure for the drug?

A)An 18-gauge, 1½-inch needle is selected for injection
B)The family member administers the medication subcutaneously
C)The family member aspirates for blood return after the needle is inserted in the muscle
D)The same administration site is used for every injection

Question 5

The nurse is developing a plan for Mrs. Ramos, a 38-year-old housewife, who is going home with a new diagnosis of heart failure. The nurse is teaching Mrs. Ramos to monitor fluid status. Which of the following is the best instruction?

A)Restrict fluid intake to 800ml per day
B)Increase the dose of diuretics if there is decreased urination
C)Record body weight every day before breakfast and report a weight gain of 3 or more pounds in a week
D)Keep track of daily output and call the doctor for if it is less than 1 liter on any day

Question 6

Which client is at greatest risk for developing hypertension?

A)Mr. Lincoln, a 52-year-old Caucasian with a family history of hypertension and heart disease
B)Mrs. Franklin, a 50-year-old African-American who is 24 pounds overweight
C)Mr. Bush, a 52-year-old African-American who smokes cigarettes
D)Mr. Carter, a 67-year-old Caucasian with diabetes

Question 7

Situation: Jenny, 43 years old, has consulted her family physician because she has been experiencing chest pains, intolerance to heat, nervousness, dizziness, frequent headaches, and palpitations during the past three months. The doctor diagnosed her with pheochromocytoma. The most important assessment that the nurse should carry out with regards to Jenny's condition is:

A)Urine output
B)Blood pressure
C)Respiratory rate
D)Temperature

Question 8

Arnold Swanson, who had a myocardial infarction 2 days ago, has been complaining to the nurse about issues related to his hospital stay. The best initial nursing response would be to:

A)Allow him to release his feelings and then leave him alone to allow him to regain his composure.
B)Refocus the conversation on his fears, frustrations, and anger about his condition.
C)Explain how his being upset dangerously disturbs his need for rest.
D)Attempt to explain the purpose of different hospital routines.

Question 9

The client is admitted with metabolic acidosis secondary to diabetic ketoacidosis (DKA). Understanding metabolic acidosis, the nurse should choose which of the following as the priority nursing diagnosis?

A)Decreased urinary elimination related to reduced output and muscle function.
B)Decreased cardiac output related to fluid and electrolyte imbalance.
C)Ineffective breathing pattern related to hyperventilation.
D)Anxiety related to fears of long-term outcomes and discomfort.

Question 10

A 45-year-old client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:

A)Decreased arterial blood flow secondary to vasoconstriction
B)Decreased arterial blood flow leading to hyperemia
C)Atherosclerotic obstruction of arteries
D)Trauma to the lower extremities

Question 11

A client who had a Billroth I procedure is beginning to eat solid foods. The nurse should assess the client for the development of dumping syndrome by determining the presence of which of the following?

A)Bradycardia
B)Diarrhea
C)Fever
D)Tumor formation

Question 12

The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following actions would the nurse include in the client's postoperative plan of care?

A)Position the client on the affected side
B)Irrigating the Penrose drain using sterile procedure
C)Changing dressings frequently around the Penrose drain
D)Weighing dressings and adding the amount to the output

Question 13

After her gastrectomy, actress Sandra Newton asks the nurse when the nasogastric tube will be removed. The nurse responds ______________.

A)"According to standard procedures only, it will be removed on the fourth postoperative day."
B)"When bowel sounds are established and you have passed flatus or stool."
C)"Thirty-six hours after the cessation of bloody drainage."
D)"After two days of alternate clamping and unclamping of the tube."

Question 14

Mr. Chandler has trouble remembering to rotate his sites for insulin injections. In the past week he has self-injected into the right abdomen, left abdomen, right upper arm, left thigh, and right thigh. Into which site should he self-inject his insulin next?

A)Left ankle
B)Right abdomen
C)Left midback
D)Left upper arm

Question 15

Julie Johnson is receiving total parenteral nutrition (TPN). The nurse reviews the following lab values:
Glucose = 72 mg/dL
Chloride = 98 mg/dL
Sodium = 138 mEq/L
Potassium = 3.0 mEq/L
Based on the nurse's review of the lab values, which nursing action is appropriate?

A)Discontinue the TPN administration
B)Notify the physician and discuss the need for potassium replacement
C)Administer 50% dextrose immediately
D)Assess the patient's vital signs and perform a physical assessment

Question 16

Marcus Pinel, 43-years-old, is brought back to the nursing unit following a thyroidectomy. Which of the following methods should the nurse use to assess for bleeding?

A)Inspect the dressing for signs of hemorrhage
B)Change the dressing applied in the operating room
C)Check the latest hemoglobin to determine if there has been a drop in value
D)Palpate the back of the neck and shoulders for evidence of bleeding

Question 17

Mr. HP recently undergone a colostomy. During his first day post-operative, the nurse does not find any measurable fecal drainage from the colostomy. What should the nurse do?

A)Continue the current plan of care
B)Call the doctor immediately
C)Irrigate the stoma
D)Encourage the patient to increase fluid intake

Question 18

Lanie, the new day-shift nurse, is developing a health promotion program for intestinal health. Which of the following pieces of information should the nurse include in the program?

A)The addition of dietary fiber can reduce the risk of diverticulosis
B)A diet high in fat increases the risk of developing Crohn's disease
C)Irritable bowel syndrome is caused by a deficiency in soluble fiber
D)Laxatives can improve motility and bowel health

Question 19

For which complication of thyroidectomy would the nurse monitor?

A)Hypercalcemia
B)Respiratory obstruction
C)Elevated serum T₄
D)Paralytic ileus

Question 20

A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the nurse include in the explanation to the client?

A)It dissolves existing thrombi.
B)It prevents the conversion of factors that are needed in the formation of clots.
C)It inactivates thrombin that forms and dissolves existing thrombi.
D)It interferes with vitamin K absorption.

Question 21

Following gastrectomy, the nurse must observe for signs of pernicious anemia because:

A)The extrinsic factor is produced in the stomach
B)The extrinsic factor is absorbed in the antral portion of the stomach
C)The intrinsic factor is produced in the stomach
D)Decreased hydrochloride acid production inhibits vitamin B₁₂ reabsorption

Question 22

Marcia, 68 years old, presents to the gynecology clinic with complaints of painless vaginal bleeding. The nurse should be certain the client is tested for which of the following health problems?

A)Ovarian cyst
B)Cervical or uterine cancer
C)Hormonal imbalances
D)Endometriosis

Question 23

The non-insulin-dependent diabetic who is obese is best controlled by weight loss because obesity:

A)Reduces the number of insulin receptors
B)Causes pancreatic islet cell exhaustion
C)Reduces insulin binding at receptor sites
D)Reduces pancreatic insulin production

Question 24

A client with multiple injuries following a vehicular accident is transferred to the critical care unit. He begins to complain of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the:

A)Complete safety of the procedure
B)Expectation of postoperative bleeding
C)Risk of the procedure with his other injuries
D)Presence of abdominal drains for several days after surgery

Question 25

Mikaela, 25 years old, is scheduled for a skin biopsy and asks the nurse how painful the procedure is. The appropriate response by the nurse is:

A)"There is no pain associated with this procedure."
B)"The local anesthetic may cause a burning or stinging sensation."
C)"A preoperative medication will be given so you will be sleeping and will not feel any pain."
D)"There is some pain, but the physician will prescribe an opioid analgesic following the procedure."

Question 26

Kevin, 23 years old, was admitted for closed head injury following a motor vehicle accident. Which of the following interventions should the nurse plan that would minimize increased intracranial pressure?

A)Maintain head of the bead at less than 10 degrees
B)Group all nursing activities and leave the client undisturbed for 2 hours
C)Maintain alignment of the head and neck
D)Elevate the client's legs

Question 27

Ms. Margaret Shawn, a 45-year-old librarian, was ordered by her physician to undergo an oral cholecystography. Which nursing action is inappropriate in preparing Ms. Shawn for this procedure?

A)Administering a fat-free diet the evening before the test
B)Administering Telepaque (iopanoic acid) tablets in 5-minute intervals 1 hour after supper
C)Administering at least 6 oz. of water with each Telepaque (iopanoic acid) tablet
D)Allowing the client, after ingesting the tablets, to drink water until midnight, then NPO

Question 28

The physician has ordered a 24-hour urine specimen collection. After explaining the procedure to the client, the nurse collects the first specimen. She is doing the right thing if she ________.

A)Discards the first specimen, and then starts the collection
B)Saves this specimen as part of the 24-hour collection
C)Tests the specimen, and then discards it
D)Places this specimen in a separate container and later adds to the collection

Question 29

Forty-eight hours after a nephrectomy, a client complains of increasing nausea and abdominal pressure. The nurse's first nursing action is to:

A)Change the client's position to relieve abdominal pressure
B)Auscultate bowel sounds
C)Insert a rectal tube to relieve flatus
D)Administer morphine SO4, 6 mg, as ordered for the relief of discomfort

Question 30

Mr. Gregory, a 55-year-old tailor, is admitted to the hospital complaining of difficulty holding objects. He states that his condition progressively worsened. Based on the initial examination, the physician suspects Amyotrophic Lateral Sclerosis (ALS). The nurse is aware that characteristics of ALS are the following except:

A)Loss of bowel and urine control
B)Uncontrolled outburst of crying
C)Aphagia and dysartria
D)Fasciculation of the involved muscles

Question 31

Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching?

A)TURP is the most common operation for BPH.
B)Explain the purpose and function of a two-way irrigation system
C)Expect bloody urine, which will clear as healing takes place
D)He will be pain free.

Question 32

Mr. Rodriguez is to undergo a vasectomy the next day. The nurse discussed with him important points after the operation is done. Which of the following instructions should the nurse include in her health teaching?

A)No sexual activity for 2 weeks
B)Application of ice for pain or swelling
C)Bed rest for several days
D)Returning for suture removal in 1 week

Question 33

Luis, 32 years old, obtained a third-degree circumferential arm burn after a pot of boiling oil was accidentally turned over. Escharotomy procedure was ordered for Luis. The nurse understands that the anticipated therapeutic outcome of the escharotomy is:

A)Return of distal pulses
B)Brisk bleeding from the site
C)Decreasing edema formation
D)Formation of granulation tissue

Question 34

While installing Christmas lights on his rooftop, Matt fell from the staircase and sustained a fractured femur. He was placed in a balance skeletal traction with a Thomas splint. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

A)Protect the skin with lotion
B)Keep the client pulled up in bed
C)Pad the top of the splint with washcloths
D)Provide a footplate in the bed

Question 35

Which of the following individuals is least likely to be at risk of developing psoriasis?

A)Kaleya, a 32-year-old African American
B)Mrs. Johnson, who is experiencing menopause
C)Mr. Sanchez, who has a family history of the disorder
D)Peter, who is experiencing a significant amount of emotional distress

Question 36

Which of the following clients would indicate that he/she is manifesting chronic renal failure?

A)A client with a total urinary output of 876 ml over 24 hours
B)A client with serum potassium level of 4.2 mEq/L
C)A client with serum creatinine level of 1.1 mg/dL
D)A client with serum blood urea nitrogen of 25 mg/dL

Question 37

A client newly diagnosed with trigeminal neuralgia asks the nurse to explain why it hurts so much when an episode occurs. The nurse would explain that the pain of trigeminal neuralgia is the result of which of the following?

A)Stimulation of the nerve by temperature or pressure
B)Irritation due to cellular effects of hypoglycemia
C)Release of epinephrine during the fight-or-flight response
D)An immune system reaction to cold and influenza

Question 38

Kaitlyn, who was diagnosed with juvenile rheumatoid arthritis, must take long-term steroids. Through health teaching on the nurse's part, which adverse effect of the medications can be prevented?

A)Infection
B)Hyperglycemia
C)Hirsutism
D)Delayed growth

Question 39

Faye, a nurse in a urology clinic, conducts a community education program about benign prostatic hypertrophy. When asked to explain the condition, Faye should respond that BPH is:

A)Associated with multiple factors, including frequent UTIs
B)Thought to occur because of declining testosterone levels
C)Rare until the seventh decade of life
D)Responsible for the symptoms such as weak urinary stream and that the size of the prostate gland directly correlates to the severity of the symptoms.

Question 40

Kyle, a 28-year-old teacher, is admitted to the hospital with a diagnosis of renal calculi. The result of Kyle's blood studies shows a BUN of 20 mg/dL, serum calcium level of 4.5 mEq/L, serum phosphorus of 1.8 mEq/L, serum sodium of 138 mEq/L, and urine pH of 5.1. Calcium phosphate stone is suspected. What nursing intervention would be most effective in altering Kyle's urine pH?

A)Increasing activity
B)Forcing fluids
C)Administering allopurinol zyloprim as ordered
D)Excluding high calcium fluids from his diet

Question 41

A client has been diagnosed with emphysema and has dyspnea with minimal exertion. The nurse understands that this client is at risk for developing which of the following?

A)Respiratory acidosis
B)Respiratory alkalosis
C)Metabolic acidosis
D)Metabolic alkalosis

Question 42

An HIV-positive client presents with a CD4 count of <200/μl and invasive cervical cancer. How would the nurse evaluate these findings in terms of current CDC guidelines?

A)The client has seroconverted.
B)The client is HIV-positive.
C)The client in the latent period of the disease process.
D)The client has AIDS.

Question 43

One potential complication of an abdominal hysterectomy is abdominal distention. Postoperative nursing measures designed to avoid abdominal distention are:

A)Auscultation of the abdomen for bowel sounds
B)Abdominal massage and bed rest
C)Insertion of nasogastric and rectal tubes and ambulation, as ordered
D)Progression of postoperative diet

Question 44

In a client with new rib fractures, which assessment finding would best alert the nurse to the possible development of a pneumothorax?

A)Pink, frothy sputum
B)Hoarseness
C)Decreased breath sounds on affected side
D)Dullness to percussion on the affected side

Question 45

Eddie, a plane crash victim, undergoes endotracheal intubation and positive pressure ventilation. The most immediate nursing intervention for him at this time would be to:

A)Facilitate his verbal communication
B)Maintain sterility of the ventilation system
C)Assess his response to the equipment
D)Prepare him for emergency surgery

Question 46

A client with myasthenia gravis is given a Tensilon test. Forty minutes after the test, the client develops severe weakness and ptosis. The nurse should be prepared to:

A)Administer atropine
B)Administer pyridostigmine
C)Check for constricted pupils
D)Intubate the client

Question 47

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse's response is based on the understanding that this could result in:

A)A fall and further injury
B)Injury to the brachia plexus nerves
C)Skin breakdown in the area of the axilla
D)Impaired range of motion while the client ambulates

Question 48

A client with fat embolism is receiving 100% FiO₂ on a mechanical ventilator and continues to be hypoxic. Which of the following measures can improve his oxygenation?

A)Add positive end-expiratory pressure (PEEP)
B)Give beta blockers
C)Give diuretics
D)Increase the FiO₂ on the ventilator

Question 49

Two hours ago the client had a left thoracotomy with a lobe resection. The sanguineous drainage in the chest tube collection chamber is 325 mL. The nurse recognizes that this is:

A)Normal chest tube drainage
B)Indicative of a pneumothorax
C)Chyle drainage
D)A sign of hemorrhage

Question 50

In a client with right lung pneumonia, the nurse should encourage which position to facilitate optimal oxygenation?

A)Prone position
B)Supine position with head elevated at 30 degrees
C)Positioned with the right side dependent
D)Positioned with the left side dependent

Question 51

What is a normal tidal volume for a client on a ventilator?

A)5-7 ml/kg
B)7-9 ml/kg
C)9-11 ml/kg
D)11-13 ml/kg

Question 52

A client with a left leg fracture is to be taught the three-point gait before discharge. Which instruction should the nurse give to this client?

A)"your right crutch, swing the left foot forward, advance the left crutch, and then bring the right foot forward."
B)"Move your right crutch and left foot forward together, and then swing the right foot and left crutch in one movement."
C)"While partially bearing weight on your left leg, advance both crutches and then bring your right leg forward."
D)"Using one movement, advance your left foot and both crutches and then bring right leg forward."

Question 53

Which assessment finding by the nurse has the most serious implication for a 70-year-old client with emphysema?

A)Increased anterior-posterior diameter of the chest
B)Bilateral crackles throughout the lung fields
C)Pursed-lip breathing
D)Circumoral cyanosis

Question 54

The nurse is encouraging a client who has undergone an amputation to immediately fit a prosthesis. The advantage for this immediate action is:

A)Ability to ambulate sooner
B)Less chance of phantom limb sensation
C)Dressing changes are not necessary
D)Better fit of the prosthesis