MEDICAL SURGICAL NURSING

1. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and coughing exercises. The nurse’s
best response would be:

A. “Pain will become less each day.”

B. “This is a normal reaction after surgery.”

C. “With a pillow, apply pressure against the incision.”

D. “I will give you the pain medication the physician ordered.”

Answer: (C) “With a pillow, apply pressure against the incision.”

Applying pressure against the incision with a pillow will help lessen the intra-abdominal pressure created by coughing which causes
tension on the incision that leads to pain.
2. The nurse needs to carefully assess the complaint of pain of the elderly because older people

A. are expected to experience chronic pain

B. have a decreased pain threshold

C. experience reduced sensory perception

D. have altered mental function

Answer: (C) experience reduced sensory perception

Degenerative changes occur in the elderly. The response to pain in the elderly maybe lessened because of reduced acuity of touch,
alterations in neural pathways and diminished processing of sensory data.
3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than
before the medication was administered. The nurse’s best

A. The patient is having an allergic reaction to the drug.

B. The patient needs a higher dose of this drug

C. This is normal side-effect of AtSO4

D. The patient is anxious about upcoming surgery

Answer: (C) This is normal side-effect of AtSO4

Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate.
4. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock,
which of the following orders would the nurse question?

A. Put the client in modified Trendelenberg's position.

B. Administer oxygen at 100%.

C. Monitor urine output every hour.

D. Administer Demerol 50mg IM q4h

Answer: (D) Administer Demerol 50mg IM q4h

Administering Demerol, which is a narcotic analgesic, can depress respiratory and cardiac function and thus not given to a patient in
shock. What is needed is promotion for adequate oxygenation and perfusion. All the other interventions can be expected to be done
by the nurse.
5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He
is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach?

A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"

B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts.

C. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."

D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"

Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"
The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his
behavior and will allow for verbalization of feelings and concerns.
6. 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.

Answer: (C) Check the patency of the nasogastric tube for any obstruction.
Nausea is one of the common complaints of a patient after receiving general anesthesia. But this complaint could be aggravated by
gastric distention especially in a patient who has undergone abdominal surgery. Insertion of the NGT helps relieve the problem.
Checking on the patency of the NGT for any obstruction will help the nurse determine the cause of the problem and institute the
necessary intervention.
7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he
refuses to move. The nurse should plan to:

A. Reassure him that the nurses will not hurt him

B. Let him perform his own activities of daily living

C. Handle him gently when assisting with required care

D. Complete A.M. care quickly as possible when necessary

Answer: (C) Handle him gently when assisting with required care
Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the bone to
appoint at which normal activities and even position changes can lead to fracture. During nursing care, the patient needs to be
supported and handled gently.
8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood pressure is 120/80,
respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are stable. At noon, however, his pulse
rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action is most appropriate?

A. Notify his physician.

B. Take his vital signs again in 15 minutes.

C. Take his vital signs again in an hour.

D. Place the patient in shock position.