Medical-Surgical Nursing

1. The patient most at risk for metabolic alkalosis is: A. A 30-year-old postsurgical patient with undergoing nasogastric suction B. A 70-year-old patient in a nursing home unable to access water freely C. A 2-year-old infant receiving isotonic sodium chloride IV solution D. A 54-year-old patient who has just experienced a stroke

A. Removal of gastric acids may result in metabolic alkalosis. The patient unable to access water is at risk for fluid volume deficit and hypernatremia. The infant is at risk for fluid volume excess. The patient experiencing a stroke is not at risk for a specific fluid, electrolyte, or acid-base imbalance.

2. Increased capillary permeability: A. Resolves within 12 hours B. Causes fluid to shift from the interstitial space to the intravascular space C. Only occurs with chemical burns to the skin D. May cause hypovolemic shock in large total body surface area burns

D. Increased capillary permeability may cause hypovolemic shock in large total body surface area burns.

3. A superficial partial-thickness burn includes: A. Color pink, small thin-walled blisters B. Color pink, area moist, blisters large, pain sensation intact C. Color pink, area moist, will not blanch or refill, texture leathery D. Color pink, area moist, blanches with slow capillary refills no blisters

B. A superficial partial-thickness burn includes color pink, area moist, blisters large, and pain sensation intact.

4. Factors that may contribute to insensible fluid loss in the burned patient include: A. Loss of protective covering of the skin B. Increased temperature C. Increased respirations D. All of the above

D.Absence of skin leads to loss of protective barrier against fluid loss, hypermetabolic state increases insensible fluid loss, and increased respirations raise insensible fluid loss through moisture evaporation from the lungs.

5. Which of the following body functions is accomplished through osmosis? A.Urine production B. Menstruation C. Weight gain D. Respiration

6. Which of the following would be considered transcellular fluid? A.Digestive secretions B. Synovial fluid C. Nucleolus D.A and C

7. For which of the following might the nurse assess in a patient diagnosed with hypermagnesemia? A. Diminished deep tendon reflexes B. Tachycardia C. Cool clammy skin D. Increased serum magnesium

8. Which of the following would cause the release of an antidiuretic hormone (ADH)? A.Increased serum sodium B. Decreased serum sodium C. Decrease in serum osmolality D.Decrease in thirst

9. A patients lab results show a slight decrease in potassium. The physician has declined to treat with medication but has suggested increasing the potassium through diet. Which of the following would be a good source of potassium? A. Apples B. Potatoes C. Carrots D. Bananas

10. Which of the following patients would e at greatest risk of dehydration? A. An 18-year-old playing basketball B. An infant with diarrhea C. A 45-year-old with stomach flu D. An elderly patient living alone

11.Diabetes insipidus can occur when there is a decreased production of which of the following? A.ADH B. Estrogen C. Aldosterone D.Renin

12.Your patient is diaphoretic from a fever. The amount of sodium excreted in the urine will: A. Decrease B. Increase C. Remain unchanged D. Increase urine output

13.Your patient has the following gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would the nurse interpret the results? A. Respiratory acidosis with no compensation B. Metabolic alkalosis with a compensatory alkalosis C. Metabolic acidosis with no compensation D. Metabolic acidosis with a compensatory respiratory alkalosis

14. What would be the best initial nursing actions implemented by the nurse prior to inserting an IV? A. Have the patient wash the hands. B. Prepare the IV insertion site with povidone iodine. C. Verify order for IV therapy. D. Identify a suitable vein.

15.The patient asks the nurse if he or she will die if air bubbles get into the IV tubing. What is the nurses best response? A. The system is closed and that is impossible. B. Only relatively large volumes of air administered rapidly are dangerous. C. There is a risk of complication with IV administration. D. You watch too many movies.

36.A man has reported flulike symptoms to his physician over the past 2 months. A blood test shows hes positive for human immunodeficiency syndrome (AIDS). Which information is the most accurate? A. When seroconversion takes place B. When an opportunistic infection is diagnosed C. When the Western blot test results are abnormal D. When the enzyme-linked immunosorbent assay (ELISA) results are abnormal

B. A diagnosis of AIDS is appropriate when an opportunistic infection is present. ELISA is a screening test used to detect the presence of HIV antibodies. Because the ELISA can give false-positive results, the more expensive and specific Western blot test is used to confirm the presence of HIV antibodies. These tests together establish HIV positivity but not whether the person has AIDS. Seroconversion means that a person has gone from HIVnegative to HIV-positive.

37. Histamine plays an important role in the immune response. The effects of histamine include: A. Constriction of small venules B. Contraction of bronchial smooth muscle C. Dilation of large blood vessels D. Decrease secretion of gastric and mucosal cells

38. Which of the following is an example of a hypersensitivity reaction characterized by a delayed reaction that occurs 24 to 72 hours after exposure to an antigen? A. Myasthenia gravis B. Serum sickness C. Allergy to fresh water fish D. Contact dermatitis from tape adhesive

39.In the event of an anaphylactic reaction, selfadministration of epinephrine should be an injection in which of the following sites? A. Forearm B. Thigh C. Deltoid muscle D. Abdomen

40. Which of the following types of contact dermatitis requires light exposure in addition to allergen contact to produce immunologic reactivity? A. Allergic B. Irritant C. Phototoxic D. Photoallergic

41. Which of the following should be included when teaching the patient about a severe food allergy? A. The patient always has the food allergy for life. B. Eat minute amounts of the food to expose the body to antigens. C. The antigen may cause constipation during a reaction. D. Carry an Epi-pen at all times.

42. Which of the following is a clinical manifestation of combined B-cell and T-cell deficiencies? A. Alopecia B. Uncoordinated muscle movement C. Vascular lesions caused by dilated blood vessels D. A condition marked by development of urticaria.

43. Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines? A. Get regular exercise and rest. B. Refrain from using creams or emollients on skin. C. People who have been vaccinated recently may visit. D. Limit bathing.

44.Which of the following medical problems is a cardinal symptom of immunodeficiency? A. Poor response to treatment of infections B. Skin rashes C. Chronic constipation D. Joint pain

45.A patient diagnosed with immunodeficiency may experience symptoms such as: A.Chronic diarrhea B. Hyperglycemia C. Rhinitis D. Contact dermatitis

46.Mr. Lim is diagnosed with stage III colon cancer. He underwent external beam radiation prior to abdominal surgery. In considering Mr. Lims treatment approach, the nurse is aware that the patient is at increased risk for which of the following? A. Dehiscence B. Fatigue C. Body image disturbance D. Anemia

A. Skin cells are naturally rapidly dividing cells; as such the normal skin cells are at risk of damage in the area, which received external beam radiation therapy. When skin cells are damaged or weakened, dehiscence and evisceration are possible complications. The correct response to this item is specific to the external beam radiation and the abdominal surgery.

47. Mrs. Nolasco has a family history of stomach cancer. Which foods should her nurse instruct her to eat? A. Fresh fruits and vegetables B. Salted nuts C. Dried fish D. Smoked meats

A. Fresh fruits and vegetables are appropriate foods to eat when there is a family history of stomach cancer.

48. Which of the following is true concerning the risk factors for breast cancer? A. Other types of cancer history have no correlation with breast cancer. B. Environment is not a risk factor for breast cancer. C. Ethnicity is a risk factor for breast cancer. D. Hormones are not a risk factor for breast cancer.

C. Personal or first-degree family history of any cancer is correlated with increased risk for breast cancer; exposure to various environmental pollutants such as pesticides that have chemical similarities to estrogen may behave like estrogen, increasing risk of breast cancer; and hormones are thought to increase breast cancer by effecting cell proliferation, causing DNA damage and promoting cell growth.

49. After an adrenalectomy for an adrenal tumor, a client is prescribed cortisone (Cortone) and receives discharge instructions. Which statement indicates the client understands the instructions? A. Ill develop a full face and gain weight because of this surgery. B. Ill only need medication for 3 months and then Ill be back to normal. C. All my problems are over, and Ill be able to do whatever I want, when I want. D. Ill need to have close medical supervision for the first few months to adjust the medication to my needs.

D. A client who undergoes adrenalectomy (excision of one or both adrenal glands) must be carefully monitored so that the medication dosage can be adjusted as needed. The client needs lifelong glucocorticoid replacement medication such as cortisone. The surgery itself doesnt cause weight gain or a full face, but these could occur as an adverse reaction to the glucocorticoid. The client needs to manage his condition carefully, especially during times of stress.

50. When planning home care for a patient with terminal cancer, what is likely to be a first priority in goal setting for the patient? A. Morning care B. Pain control C. Clean living space D. Meal preparation

51. A home care nurse has been assigned a palliative patient with cancer of the liver. The nurse notes that over the last 3 weeks, the patients condition has deteriorated despite attempts to control the course through a proper treatment regimen. The nurse is aware of which of the following? A. Death will occur in the next week. B. The patient is in the trajectory phase of chronic illness. C. The patient is in the downward phase of chronic illness and should be reassessed. D. The patient should immediately be admitted into the hospital.

52. The patient arrives in clinic for a 2month follow-up appointment following chemotherapy. The nurse notes that the patients skin appears yellow. Which of the following blood tests should be done? A. Liver function test B. CBC C. Platelet count D. Electrolytes

53. A patient tells the nurse that he has heard that certain foods can increase the incidence of cancer. The nurse should instruct the patient to decrease his intake of: A. Tomatoes B. Carrots C. Broccoli D. Smoked meats

54. Which of the following tumor types have the greatest likelihood to metastasize? A.Hemangioma B. Benign C. Lymphosarcoma D. Papilloma

55.The patient is a 39-year-old woman with a family history of breast cancer. A breast tumor marking test is done, and the results are positive. The patient is requesting a bilateral mastectomy. This surgery is an example of which of the following? A. Salvage surgery B. Palliative surgery C. Prophylactic surgery D. Reconstructive surgery

56.The nurse should be aware of which of the following when assessing a right radical mastectomy patient postoperatively? A. The blood pressure should be taken on the left arm. B. The blood pressure should be taken on the right arm. C. Edema to the surgical area will be minimal. D. The room should be kept cool.

57. The patient is receiving external radiation for a malignant tumor of the head and neck. For which of the following side effects should the nurse assess from the radiation treatment? A. Impaired nutritional status B. Pink oral mucosa C. Diarrhea D. Alopecia

58. The patient is receiving carmustine a chemotherapy agent. A side effect of this medication is thrombocytopenia. Which of the following may occur if the patient has thrombocytopenia? A. Interrupted sleep pattern B. Hot flashes C. Nose bleed D. Increased weight

59. The patient is to receive a bone marrow transplant. Which of the following should be taught to the patients visitors? A. Bring plants to improve air quality B. Take the patient to the cafeteria for meals C. Wear hospital scrubs when entering the patients room D. Do not visit if theyve had a recent infection

60.The leading cause of death in an oncology patient is infection caused by which of the following? A. Malnutrition B. Impaired skin integrity C. Poor hygiene D. Broken oral mucosa

61. A nurse is caring for an adult patient who develops mild oral yeast infection following chemotherapy. The nurse should encourage the patient to: A. Limit intake of fluids B. Rinse the mouth with vinegar and water C. Avoid the use of dental floss until the stomatitis is resolved D. Rinse mouth as ordered with a nystatin suspension

62.A nurse is caring for a patient with cancer who is preparing for engraphment for a bone marrow transplant. A priority nursing diagnosis for this patient is: A. Fatigue and activity intolerance B. Altered nutrition: less than body requirements due to anorexia C. Risk for infection related to altered immunologic response D. Body image disturbance related to weight loss and anorexia

63. A nurse is caring for an oncology patient who develops erythema following radiation therapy. The nurse should instruct the patient to: A. Apply ice to the area. B. Keep the area cleanly shaven. C. Apply petroleum ointment to the affected area. D. Avoid using soap on the area of treatment.

64.A patient who has been diagnosed with lung cancer complains of dyspnea, dysphagia, and a headache. The nurse determines that these findings are indicative of superior vena cava syndrome. What can the nurse anticipate as a diagnostic test? A. Thoracic CT scan B. EEG C. EKG D. Abdominal CT scan

65. A nurse is caring for a patient with metastatic bone disease. The patient complains to the nurse of bowel incontinence and decreased sensation to the feet. The nurse determines that these findings are indicative of: A. Spinal cord compression B. Pericardial effusion C. SIADH D. Tumor lysis syndrome

66.Low-flow oxygen therapy is prescribed for your patient with COPD. What is the most essential action for the nurse to initiate? A. Anticipate the need for humidification B. Notify the practitioner that this order is contraindicated C. Placed the patient in high-Fowlers position D. Schedule nursing care to allow frequent observations of the patient

D. In a patient with COPD, the stimulus to breathe is low oxygen levels. Frequent nursing observations are necessary to see how the patient tolerates low-flow oxygen administration. Option A is incorrect, humidification is necessary, but this is not the most important nursing intervention. Option B is incorrect, because patients with COPD and hypoxemia need oxygen. Option C is incorrect, because the patient with COPD will probably need to be placed in highFowlers position, but this is not the most important nursing intervention.

67.Theophylline tablets are prescribed for a patient with COPD. A nurse instructs the patient about the medication. Which of the following nursing statements would not be a component of the teaching plan? A. Taking the medication in an empty stomach B. Take the medication with food C. Continue to take the medication even if you are feeling better D. Periodic blood levels need to be obtained

A The medication should be administered with food, such as milk and crackers to prevent gastrointestinal (GI) irritation. B, C, & D are appropriate instructions regarding the use of this medication.

68. You are caring for a patient who is admitted to the hospital in acute renal failure. The appearance of a U wave on the electrocardiogram (ECG) should alert you to check for which of the following laboratory values? A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hyponatremia

B. U waves on the electrocardiogram are associated with hypokalemia.

69. A patient is admitted to your care with ARF. Which of the following must you continually assess for? A. Hyponatremia and hyperkalemia B. decreased BUN and creatinine C. Alkalosis D. Hypercalcemia

A. The most common findings in acute renal failure include elevations in BUN and creatinine, metabolic acidosis, hyponatremia, hyperkalemia, hypocalcemia, and hypophosphatemia.

70. Youre caring for a client diagnosed with a myocardial infarction. You suspect he has developed pericarditis (inflammation of the pericardium). Which assessment finding leads you to this conclusion? A. Chest pain that worsens with expiration B. Friction rub C. Narrowed pulse pressure D. Pain relieved by lying flat

B. A pericardial friction rub is the hallmark sign or pericarditis, an inflammation of the pericardium. When the inflamed, roughened pericardial surfaces rub against each other, a grating sound results. The chest pain associated with pericarditis worsens with inspiration not expiration. Cardiac tamponade, a complication of pericarditis, produces a narrowed pulse pressure. The pain of pericarditis is aggravated not relieved by lying supine.

71. Youre caring for a client with a history of advanced chronic obstructive pulmonary disease who had conventional gallbladder surgery 2 days ago. Which intervention has priority for preventing respiratory complications? A. incentive spirometry every 4 hours B. coughing and deep breathing 4 times daily C. getting the client out of bed as ordered by the physician D. giving oxygen at 4L/minute according to the physicians order

C. Getting the client out of bed prevents pooling of secretions in the lungs and promotes better lung expansion. An incentive spirometer (a device that measures air movement into the lungs and encourages the client to breathe deeply), coughing, and deep breathing are important, but the client needs to perform these more frequently. Giving oxygen at 4L/minute could decrease the clients respiratory drive.

72. The nurse is doing a physical health assessment on a patient with lung disease and chronic hyperinflation of the lungs. The patient will likely have which of the following? A. Dry flaky skin B. Large drooping eyes C. A barrel chest D. Long thin fingers

73. Which of the following statements best describes the rationale for giving only low levels of oxygen to a person with chronic lung disease? A. When oxygen levels are administered through nasal prong, the lungs receive 100% oxygenation. B. Low levels of oxygen prevent confusion. C. Raising the patients blood oxygen level may suppress his or her respiratory drive, causing increased retention of carbon dioxide. D. With high levels of oxygen, a rebound effect occurs, resulting in decreased levels of carbon dioxide in the blood.

74.The nurse is planning to assist a patient with ADLs. The patient has COPD and has limited energy. When is the best time for the nurse to schedule the patients activities? A. One hour before bed B. First thing in the morning C. One hour after the patient has been awake D. Late afternoon following visiting hours

75. What nursing intervention can help alleviate ineffective breathing patterns in a patient diagnosed with COPD? A. Inspiratory muscle training and breathing retraining B. Teaching the patient pursed-lip breathing C. Directed controlled coughing D. All of the above

76. A patient with CHF is displaying symptoms such as dry hacking cough, fatigue, and a slight increase in todays weight. The most appropriate position for the patient to be placed in is: A. Supine B. Low Fowlers C. High Fowlers with feet dangling D. Left lateral

77. What causes gastrointestinal distress during right-sided cardiac failure? A. Venous stasis and venous engorgement within the abdominal organs B. Anxiety and distress from the patient C. Pressure on the large intestine D. Urinary retention due to lack of renal perfusion

78. An adult patient with CHF is prescribed digoxin. The nurse should explain to the patient that when taking this medication, he or she should watch for the following adverse side effects: A. Fatigue and nausea B. Increased urine output C. Weight loss D. Decreased pulmonary crackles

79. When being discharged home, to assess fluid balance a patient with CHF should be instructed to: A. Monitor blood pressure B. Assess radial pulses C. Monitor weight daily D. Monitor bowel movements

80.A patient with cardiac disease has developed an intracardiac thrombus. The most common complication of this is: A. Pulmonary embolism B. Cerebral embolism C. Mesenteric embolism D. Peripheral embolism

81. A diabetic patient has been admitted with end-stage renal failure. What is the most lifethreatening effect of renal failure? A. Buildup of wastes B. Retention of potassium C. Depletion of potassium D. Uncontrolled blood pressure

82. The patient has a history of acute renal failure and is to undergo a renal biopsy. The patient asks the nurse why this test is required. What is the nurses best response? A. A biopsy is routinely ordered for most patients with renal disorders. B. A biopsy is generally ordered following abnormal X-ray findings of the renal pelvis. C. A biopsy is often ordered for patients with acute renal failure, polycystic disorders, and unexplained pain. D. A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.

83.The patient is unconscious and has an increased intracranial pressure (ICP) monitor. Of what should the nurse be aware while caring for the patient? A. Continue to stimulate the patient with loud speech and painful stimuli. B. Manage the system with medical aseptic technique. C. Level the transducer 1 inch above the patients ear. D. Keep the patients head away from the transducer.

84. Corticosteroids, such as dexamethasone, are given to the patient with increased ICP to: A. Control fever B. Dehydrate the brain and reduce cerebral edema C. Help reduce edema surrounding brain tumors D. Reduce cellular metabolic demands

85. Why is an extreme hip flexion position avoided in the patient with ICP? A. It increases the risk of skin breakdown. B. Hip flexion increases diastolic blood pressure C. The position causes an increase in intra-abdominal and intrathoracic pressures. D. It may cause misalignment of the patient and cause restlessness.

86.The nurse recognizes which of the following as a late sign of increased ICP? A.Disorientation B. Tachycardia C. Widening pulse pressure D. Headache that is constant

87. Which of the following is a correct statement regarding multiple sclerosis (MS)? A. It is a degenerative disease of the nervous system. B. It usually occurs more frequently in men. C. It has an acute onset. D. It is caused by a bacterial infection.

88. Which of the following nursing interventions would be included when caring for a patient diagnosed with MS? A. Have patient void 1 hour after drinking. B. Encourage a low-residue diet. C. Total assistance is needed with all activities of daily living. D. Encourage daily muscle stretching.

89. A 37-year-old woman has been diagnosed with multiple sclerosis. She is married and has three children. What is the nurses most important role with this patient? A. Ensure the patient is compliant with all treatments. B. Provide the patient with advice on treatment options. C. Provide a detailed plan of activities of daily living for the patient. D. Help the patient develop strategies to implement treatment regimens.

90. The patient has suffered a myocardial infarction the patients heart is pumping an inadequate supply of oxygen to the tissue. For what should the nurse assess? A. Dysrhythmias B. Increase in blood pressure C. Decrease in heart rate D. Decrease in oxygen demands

91. A patient with chronic obstructive pulmonary disease has been receiving oxygen therapy for an extended time. The nurse suspects that the patient is experiencing oxygen toxicity as evidenced by the following symptoms: A. Bradycardia and frontal headache B. Dyspnea and substernal pain C. Anger and restlessness D. Poor personal hygiene

92.A patient who has had a myocardial infarction (MI) states that he or she is prone to constipation. The nurse advises the patient to establish a regular bowel regimen because straining to have a bowel movement may: A. Lead to disease progression B. Cause shortness of breath C. Trigger a vagal response D. Worsen edema

93.A 57-year-old patient is admitted with an acute MI. The nurse obtaining a health history must remember initially: A. To obtain an extensive history B. To focus on onset and severity of chest pain, later obtaining patients vital signs C. To focus on patients vital signs and later obtain information of onset and severity of chest pain D. To focus on patients vital signs at the same time as obtaining on onset and severity of chest pain

94. A patient who has experienced an MI and his wife identify to the nurse that they are nervous about resuming sexual activity after discharge, even though the doctor has stated that they may. The most appropriate advice to give the patient is: A. If impotence occurs, stop taking your cardiac medications. B. Avoid sexual activity for at least 1 year after discharge. C. The physiologic demands of sexual intercourse are equivalent to walking up two flights of stairs. D. There is no risk at all involved with resuming sexual activity on discharge and no reason to modify sexual activity.

95. The most appropriate hemodynamic monitoring procedure to assess the left ventricular function of a patient who has suffered an MI would be: A. CVP monitoring B. Pulmonary artery pressure monitoring (PAPM) C. Systemic arterial pressure monitoring (SAPM) D. Arterial blood gases (ABG)

96. A patient is suspected of experiencing an MI at approximately 6:00 AM, at which time laboratory results show an increase in troponin I. The nurse can expect troponin I to peak at what time? A. 6:00 PM B. 1:00 PM C. 6:00 PM the next day D. 10:00 AM

97.Forty minutes after arrival to the emergency room, a patient suffering an MI is to have emergent percutaneous transluminal coronary angioplasty (PTCA) to: A. Decrease cardiac workload B. Cure elevated cholesterol C. Reperfuse the area of myocardium derived of oxygen D. Remove the area of ischemia from the myocardium

98. The most appropriate expected patient outcome for the nursing diagnosis of Deficient knowledge about post-MI self-care would be: A. Experiences relief of angina B. Is less anxious C. Maintains adequate tissue perfusion D. Adheres to self-care program

99.A 45-year-old man with diabetic nephropathy is in end-stage renal failure and is considering starting dialysis. He asks for details about hemodialysis. The nurse includes which of the following in the teaching? A. Hemodialysis is done three times a week. B. Hemodialysis is done daily. C. A catheter will need to be inserted into the abdomen. D. Hemodialysis is a continuous renal replacement therapy.

100. A patient is scheduled for a fistula creation. The patient has end-stage renal disease. The nurse would include which of the following in teaching the patient about the fistula? A. A vein and artery will be attached surgically. B. The arm should be immobilized for 4 to 6 weeks. C. One needle will be inserted for each dialysis treatment. D. The fistula can be used immediately after the surgery for dialysis treatment.