PRE-TEST IN MEDICAL-SURGICAL NURSING 3

Prepared by: ROBERT C. REA, RN, MD

CLIENT WITH APPENDICITIS

CLIENT WITH CALCULOUS CHOLECYSTITIS

1.

Which of the following complications is thought to be the

most common cause of appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling

11. When assessing a client with obstructive cholelithiasis, the

nurse might expect to find:
A. Abdominal distention
B. Dark urine
C. Diminished bowel sounds
D. Loose stools

2.

LJ, 23/M, is being seen in the emergency room for

possible appendicitis. Which of the following would
indicate that LJ's appendix has ruptured?
A. Diaphoresis
B. Anorexia
C. Pain at Mc Burney's point
D. Relief from pain

12. A client is being taught by the nurse about his laboratory

and diagnostic test. The nurse explains that an accurate
and safe method of detecting gallstones is:
A. Biopsy
B. Oral cholecystogram
C. Radionuclide imaging
D. Ultrasound

3.

Which of the following is the scoring system used in the

diagnosis of appendicitis?
A. Aldrete
B. Alvarado
C. Ballard
D. Ranson

4.

An important nursing action to perform when preparing LJ

for an appendectomy is to:
A. administer saline enemas to cleanse the bowels
B. apply heat to reduce pain
C. measure abdominal girth
D. continuously monitor pain

13. A client is admitted to the hospital with a diagnosis of

cholecystitis from cholelithiasis. The client has severe
abdominal pain, nausea, and has vomited several times.
Based on these data, which nursing diagnosis would have
the highest priority for intervention at this time?
A. Anxiety related to severe abdominal discomfort
B. Deficient fluid volume related to vomiting
C. Pain related to gallbladder inflammation
D. Imbalanced nutrition: Less than body requirements
related to vomiting

5.

LJ has an appendectomy. Because the appendix had

perforated, he had localized peritonitis. Postoperatively the
nurse should position him in:
A. High Fowlers position
B. Semi Fowlers position
C. Trendelenburgs position
D. Prone position

CLIENT WITH CIRRHOSIS

6.

7.

A client with cirrhosis is receiving 100 mL of 25% serum

albumin solution IV. The nurse knows that this treatment is
effective if there is:
A. Decreased anorexia and itching
B. Easier breathing
C. Increased serum glucose
D. Increased urine output
Just prior to a paracentesis for tense ascites, the nurse will
prepare a client by:
A. Having him void
B. Measuring his abdominal girth
C. Placing him in a recumbent position
D. Taking his temperature

8.

About 30 minutes after a Blakemore-Sengstaken tube for

bleeding esophageal varices is inserted, an alert client
becomes short of breath. The nurse should first:
A. Check for airway obstruction
B. Deflate the esophageal part of the tube
C. Raise the head of the bed and increase the O2 flow
rate
D. Remove the tube

9.

When caring for a client with advanced cirrhosis, the nurse

is alert for changes in all of the following. Which change
suggests hepatic encephalopathy?
A. Level of consciousness
B. Respiratory status
C. Urine output
D. Vital signs

10. Oral neomycin and neomycin enemas are prescribed for a

client with cirrhosis. The nurse explains to the client that
the purpose of this order is to:
A. Help reduce the ammonia level
B. Increase bowel elimination
C. Prevent infection
D. Treat secondary infection

14. A client with cholecystectomy and exploration of the

common bile duct has a T-tube and a Jackson-Pratt drain.
Because of the location of the incision, an important
nursing action is to encourage the client to:
A. Lie on the unoperative side
B. Remain in a semi-Fowler position
C. Splint the incision when moving
D. Turn, cough, and breathe deeply
15. Twenty-four hours after cholecystectomy, a clients T- tube
has drained 500 mL. The nurse will:
A. Clamp the T-tube
B. Empty the bag and discard the drainage
C. Lower the head of the bed
D. Take no action after documenting the observation
CLIENT WITH PANCREATITIS
16. The initial diagnosis of pancreatitis is confirmed if the
clients blood work shows a significant elevation in which
of the following serum values?
A. Amylase
B. Glucose
C. Potassium
D. Trypsin
17. The nurse notes that a client with acute pancreatitis
occasionally experiences muscle twitching and jerking.
How should the nurse interpret the significance of these
symptoms?
A. The client may be developing hypocalcemia.
B. The client is experiencing a reaction to meperidine
(Demerol).
C. The client has a nutritional imbalance.
D. The client needs muscle relaxant to help him rest.
18. When providing care for a client with acute pancreatitis,
the nurse should anticipate which of the following orders?
A. Increase oral intake to 3,000 mL every 24 hours
B. Insert a nasogastric tube and connect it to low suction
C. Place the client in the reverse trendelenburg position
D. Place the client on enteric precautions
19. The nurse should teach the client with chronic pancreatitis
to monitor the effectiveness of pancreatic enzyme
replacement therapy by doing which of the following?
A. Monitoring fluid intake.
B. Observing regular glucose fingerstick tests.
C. Observing stools for steatorrhea.
D. Testing urine for ketones.

20. The client with chronic pancreatitis should be monitored

closely for the development of which of the following
disorders?
A. Cholelithiasis
B. Hepatitis
C. Irritable bowel syndrome
D. Diabetes mellitus

29. A severe inflammatory response triggered the patients

asthma attack. Which of the following drugs would the
nurse expect to give to combat the inflammatory
response?
A. Theophylline (Aminophylline)
B. Prednisone (Sterapred)
C. Metoprolol (Lopressor)
D. Albuterol (Proventil)

CLIENT WITH INFLAMMATORY BOWEL DISORDERS

21. A client who has had ulcerative colitis for the past 5 years
is admitted to the hospital with an exacerbation of the
disease. Which of the following factors was most likely of
greatest significance in causing an exacerbation of
ulcerative colitis?
A. A demanding and stressful job.
B. Changing to a modified vegetarian diet.
C. Beginning a weight-training program.
D. Walking 2 miles every day.
22. Which goal for the clients care should take priority during
the first days of hospitalization for an exacerbation of
ulcerative colitis?
A. Promoting self-care and independence.
B. Managing diarrhea.
C. Maintaining adequate nutrition.
D. Promoting rest and comfort
23. Which of the following diets would be most appropriate for
the client with ulcerative colitis?
A. High-calorie, low-protein.
B. High-protein, low-residue.
C. Low-fat, high-fiber.
D. Low-sodium, high-carbohydrate.
24. The client with ulcerative colitis is following orders for bed
rest with bathroom privileges. When evaluating the
effectiveness of this level of activity, the nurse should
determine if the client has:
A. Conserved energy.
B. Reduced intestinal peristalsis.
C. Obtained needed rest.
D. Minimized stress.
25. The physician prescribes sulfasalazine (Azulfidine) for the
client with ulcerative colitis to continue taking at home.
Which instruction should the nurse give the client about
taking this medication?
A. Avoid taking it with food.
B. Take the total dose at bedtime.
C. Take it with a full glass (240 mL) of water.
D. Stop taking it if urine turns orange-yellow.
CLIENT WITH BRONCHIAL ASTHMA
26. The client with asthma should be taught that which of the
following is one of the most common precipitating factors
of an acute asthma attack?
A. Occupational exposure to toxins
B. Viral respiratory infections
C. Exposure to cigarette smoke
D. Exercising in cold temperature
27. When assessing a patient with asthma, the nurse would
expect to auscultate:
A. Diminished breath sounds and fine crackles in lung
bases
B. Absent tactile fremitus
C. Distant breath sounds and expiratory wheezes
D. Bronchial breath sounds in lung bases
28. The nurse should anticipate which of the following arterial
blood gas results in a client experiencing a prolonged,
severe asthma attack?
A. Decreased PaCo2, increased PaO2, and decreased
pH
B. Increased PaCo2, decreased PaO2, and decreased
pH
C. Increased PaCo2, increased PaO2, and increased pH
D. Decreased PaCo2, decreased PaO2, and increased
pH

30. A client is prescribed metaproterenol (Alupent) via a

metered-dose inhaler, two puffs every four hours. The
nurse instructs the client to report adverse effects of
metaproterenol?
A. Irregular heartbeat
B. Constipation
C. Pedal edema
D. Decreased pulse rate
CLIENT WITH CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
31. A nurse is caring for a client hospitalized with acute
exacerbation of chronic obstructive pulmonary disease.
Which of the following would the nurse expect to note on
assessment of this client?
A. Hypocapnia
B. A hyperinflated chest noted on the chest x-ray
C. Increased oxygen saturation with exercise
D. A widened diaphragm noted on the chest x-ray
32. A nurse is assessing a client with chronic airflow limitation
and notes that the client has a barrel chest. The nurse
interprets that this client has which of the following forms
of chronic airflow limitation?
A. Emphysema
B. Bronchial asthma
C. Chronic obstructive bronchitis
D. Bronchial asthma and bronchitis
33. An oxygen delivery system is prescribed for a client with
chronic obstructive pulmonary disease to deliver a precise
oxygen concentration. Which of the following types of
oxygen delivery systems would the nurse anticipate to be
prescribed?
A. Face tent
B. Venturi mask
C. Aerosol mask
D. Tracheostomy collar
34. The nurse teaches a client with chronic obstructive
pulmonary disease to assess for signs and symptoms of
right-sided heart failure. Which of the following signs and
symptoms should be included in the teaching plan?
A. Clubbing of nail beds
B. Barrel chest
C. Peripheral edema
D. Paroxysmal nocturnal dyspnea
35. Which of the following diets would be most appropriate for
a client with chronic obstructive pulmonary disease
(COPD)?
A. Low-fat, low-cholesterol diet
B. Bland, soft diet
C. Low-sodium diet
D. High-calorie, high-protein diet
CLIENT WITH ACUTE RESPIRATORY DISTRESS
SYNDROME
36. Which of the following factors places a patient at risk for
developing acute respiratory distress syndrome (ARDS)?
A. Traumatic injury
B. History of diabetes
C. History of breast cancer
D. Use of birth control pills
37. What pathologic change is responsible for the
development of pulmonary edema in the patient with acute
respiratory distress syndrome (ARDS)?
A. Right-sided heart failure
B. Alveolocapillary membrane damage
C. Extravascular fluid volume excess
D. Pulmonary artery infarct

38. A classic finding in the patient with acute respiratory

distress syndrome (ARDS) is:
A. Sudden hypocalcemia with tetany
B. Severe hyperkalemia
C. Hypoxia resistant to oxygen therapy
D. Hypercapnia
39. When a patient with ARDS continues to show signs of
hypoxemia, the nurse knows that the patients treatment
plan is appropriate when the doctor:
A. Prescribes mechanical ventilation
B. Prescribes chest physiotherapy
C. Prescribes low FiO2 concentrations
D. Inserts a chest tube
40. A client with acute respiratory distress syndrome (ARDS)
is intubated and placed on mechanical ventilation. His
partial pressure of arterial oxygen (PaO2) is 60 mm Hg on
100% fraction of inspired oxygen (FIO2). To increase his
PaO2 without raising the FIO2, the client will most likely be
placed on:
A. time-cycled ventilation.
B. volume-cycled ventilation.

C.
D.

positive end-expiratory pressure (PEEP.

pressure support.

POST-TEST IN MEDICAL SURGICAL NURSING 3

41. The patient has peritonitis, which is a major
complication of appendicitis. What treatment will the
nurse plan to include?
a. Peritoneal lavage
b. IV fluid replacement
c. Peritoneal dialysis
d. Increased oral fluid intake
42. A clients serum ammonia level is elevated and the
physician orders 30 mL of lactulose (Duphalac). Which
of the following adverse effects of this drug should
the nurse expect to see?
A. Increased urine output
B. Improved level of consciousness
C. Increased bowel movement
D. Nausea and vomiting