Final Exam Practice Qs - Med Surg PDF

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Med Surg Final Exam Practice Questions: 6. A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first? a. Notify the patient's health care provider. b. Teach correct midstream urine collection. c. Ask the patient about current medications. d. Question the patient about urinary tract infection (UTI) risk factors. ANS: C A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium). The color would not be expected with urinary tract infection, is not a sign that poor technique was used in obtaining the specimen, and does not need to be communicated to the health care provider until further assessment is done. 7. a nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended adequate intake of which nutrients? SATA a. calcium b. potassium c. calcitonin d. vitamin D e. vitamin B12 Feedback: A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.

8. a nurse is educating a patient in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the patient and the family that this drainage system is used for? a. removing excess air and fluid b. monitoring pleural fluid osmolarity c. maintaining positive chest wall pressure d. providing positive intrathoracic pressure Feedback: Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess air, fluid, and blood.

9. a patients has a new diagnosis of crohn’s disease after having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months. The nurse will plan to teach about which of the following? a. medication use b. fluid restriction c. enteral nutrition d. activity restrictions feedback: Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.

10. the nurse is planning care of a patient who is scheduled for a laryngectomy. The nurse should assign the highest priority to which p ostoperative nursing diagnosis? A) Anxiety related to diagnosis of cancer B) Altered nutrition related to swallowing difficulties C) Ineffective airway clearance related to airway alterations D) Impaired verbal communication related to removal of the larynx (Feedback: Each of the listed diagnoses is valid, but ineffective airway clearance is the priority nursing diagnosis for all conditions.) 11. A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following statements related to osteoporosis is most accurate? a. Osteoporosis is categorized as a disease of the elderly. b. secondary osteoporosis occurs in women after menopause. c. A nonmodifiable risk factor for osteoporosis is a person's level of activity. d. Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis. Ans: Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis. Feedback: When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier in life, when bone mass peaks and then begins to decline. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause. 12. Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?"

c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain? Feedback: One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria. 13. A patient has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery?

A)Deficient fluid volume B)Delayed wound healing C)Hypocalcemia D)Pathologic fractures Feedback:Delayed wound healing is a complication of surgery due to tissue trauma from the surgery. Nutritional deficiency is usually due to the effects of chemotherapy and radiation therapy, which may cause weight loss. Pathologic fractures are not a complication of surgery 14. Which adult will the nurse plan to teach about risks associated with obesity? a. Man who has a BMI of 18 kg/m2 b. Man with a 42 in waist and 44 in hips c. Woman who has a body mass index (BMI) of 24 kg/m2 d. Woman with a waist circumference of 34 inches (86 cm) Feedback: The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of 100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome although they may be used to check for cardiovascular complications of the disorder. 17. A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning  the client, the nurse discovers blood underneath the client's lower back. The nurse should suspect A. retroperitoneal bleeding. B. cardiac tamponade. C. bleeding from the incisional site. D. heart failure. Feed back C. CORRECT: Bleeding is occurring from the incision site and then draining under the client. The nurse should check the incision for hematoma, apply pressure, monitor the client, and notify the provider. 18. the nurse is caring for a patient who has returned to the unit following a bronchoscopy. The patient is asking for something to drink. Which criterion will determine when the nurse should allow the patient to drink fluids? a. Presence of a cough and gag reflex b. Absence of nausea c. Ability to demonstrate deep inspiration d. Oxygen saturation of ³92% Feedback: After  the procedure, it is important that the patient takes nothing by mouth until the cough reflex returns because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing for several hours. Deep inspiration, adequate oxygen saturation levels, and absence of nausea do not indicate that oral intake is safe from the risk of aspiration. 19. A patient's x-ray reveals that there is no evidence of callus formation after the second week of treatment for a bone fracture. What does the nurse infer related to healing of the fracture?

a. It is failing to heal despite treatment. b. It is healing at a slower rate than expected. c. It is healing normally. d. It is healing in an abnormal position in relation to midline of structure. Feedback: During the second week of treatment after a bone fracture, an x-ray is performed to check for the presence of callus formation. Callus formation indicates that the healing process of the bone has started. Absence of callus formation indicates failure of the healing process in spite of treatment. When the fracture healing progress is slower than expected over time, it indicates a delayed union of the fractured bone. The fracture is not healing normally. When the fracture heals in an abnormal position in relation to the midline of the structure, it indicates angulation.

20. The nurse is providing care for a patient who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? a. Numbness and tingling in the distal extremities b. Unequal peripheral pulses between extremities c. Visible clubbing of the fingers and toes d. Reddened extremities with muscle atrophy Feedback: PAD assessment may manifest as unequal pulses between extremities, with the affected leg cooler and paler than the unaffected leg.

21. A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where? a. Endocardium b. Pericardium c. Myocardium d. Visceral pericardium Feedback: The myocardium is the layer of the heart responsible for the pumping action. 22. The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems? a. To assess the patient's response to fluid and drug administration b. To obtain specimens for arterial blood gas measurements c. To dislodge pulmonary emboli

d. To diagnose the etiology of chronic obstructive pulmonary disease Feedback: Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patient's response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.

23. The nurse is creating the care plan for a 70-year-old obese patient who has been admitted to the postsurgical unit following a colon resection. This patient's age and increased body mass index mean that she is at increased risk for what complication in the postoperative period? a. Hyperglycemia b. Azotemia c. Falls d. Infection Feedback: (Like age, obesity increases the risk and severity of complications associated with surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and wound infections are more common.)

24. The ED nurse is assessing a patient complaining of dyspnea. The nurse auscultates the patient's chest and hears wheezing throughout the lung fields. What might this indicate? a. The patient has a narrowed airway. b. The patient has pneumonia. c. The patient needs physiotherapy. d. The patient has a hemothorax. Feedback: Wheezing is a high-pitched, musical sound that is often the major finding in a patient with bronchoconstriction or airway narrowing. Wheezing is not normally indicative of pneumonia or hemothorax. Wheezing does not indicate the need for physiotherapy. 25. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patient's insulin levels are inadequate.

D) The patient would benefit from a dose of metformin (Glucophage).

Feedback: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patient's ketonuria. Metformin will not cause short-term resolution of hyperglycemia. 26. a 23-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the patients pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? A) Type 1 diabetes B) Type 2 diabetes C) Non-insulin-dependent diabetes D) Prediabetes Feedback: Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

27. The nurse is preparing a patient for surgery. The patient states that she is very nervous and really does not understand what the surgical procedure is for or how it will be performed. What is the most appropriate nursing action for the nurse to take? a. Have the patient sign the informed consent and place it in the chart. b. Call the physician to review the procedure with the patient. c. Explain the procedure clearly to the patient and her family. d. Provide the patient with a pamphlet explaining the procedure. Feedback: While the nurse may ask the patient to sign the consent form and witness the signature, it is the surgeon's responsibility to provide a clear and simple explanation of what the surgery will entail prior to the patient giving consent. The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the patient requests additional information, the nurse notifies the physician. The consent form should not be signed until the patient understands the procedure that has been explained by the surgeon. The provision of a pamphlet will benefit teaching the patient about the surgical procedure, but will not substitute for the information provided by the physician.

28. The nurse is caring for a 72-year-old patient who is in cardiac rehabilitation following heart surgery. The patient has been walking on a regular basis for about a week and walks for 15 minutes 3 times a day. The patient states that he is having a cramp-like pain in the legs every time he walks and that the pain gets better when I rest. The patients care plan should address what problem? a. Decreased mobility related to VTE b. Acute pain related to intermittent claudication c. Decreased mobility related to venous insufficiency d. Acute pain related to vasculitis Feedback: Intermittent claudication presents as a muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest. Patients with peripheral arterial insufficiency often complain of intermittent claudication due to a lack of oxygen to muscle tissue. Venous insufficiency presents as a disorder of venous blood reflux and does not present with cramp-type pain with exercise. Vasculitis is an inflammation of the blood vessels and presents with weakness, fever, and fatigue, but does not present with cramp-type pain with exercise. The pain associated with VTE does not have this clinical presentation. 29. The triage nurse in the ED is assessing a patient who has presented with complaint of pain and swelling in her right lower leg. The patient's pain became much worse last night and appeared along with fever, chills, and sweating. The patient states, "I hit my leg on the car door 4 or 5 days ago and it has been sore ever since." The patient has a history of chronic venous insufficiency. What intervention should the nurse anticipate for this patient? a. Platelet transfusion to treat thrombocytopenia b. Warfarin to treat arterial insufficiency c. Antibiotics to treat cellulitis d. Heparin IV to treat VTE Feedback: Cellulitis is the most common infectious cause of limb swelling. The signs and symptoms include acute onset of swelling, localized redness, and pain; it is frequently associated with systemic signs of fever, chills, and sweating. The patient may be able to identify a trauma that accounts for the source of infection. Thrombocytopenia is a loss or decrease in platelets and increases a patient's risk of bleeding; this problem would not cause these symptoms. Arterial insufficiency would present with ongoing pain related to activity. This patient does not have signs and symptoms of VTE. 30. During routine hemodialysis, patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check patient's blood pressure (BP). c. Review the hematocrit (Hct) level.

d. Give prescribed PRN antiemetic drugs. Feedback: The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate based on the blood pressure obtained. 31. The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic? a. Assess the patient's level of consciousness (LOC). b. Assess the patient's extremities for signs of cyanosis. c. Assess the patient's oxygen saturation level. d. Review the patient's hemoglobin, hematocrit, and red blood cell levels. Feedback: The effectiveness of the patient's oxygen therapy is assessed by the ABG analysis or pulse oximetry. ABG results may not be readily available. Presence or absence of cyanosis is not an accurate indicator of oxygen effectiveness. The patient's LOC may be affected by hypoxia, but not every change in LOC is related to oxygenation. Hemoglobin, hematocrit, and red blood cell levels do not directly reflect current oxygenation status. 32. the provider prescribes docusate sodium (Colace) 200 mg po daily. Available is docusate sodium (Colace) 150 mg/ 15 ml. how many ml should the nurse administer? a. 10ml b. 15ml C. 20 ml d. 25 ml E. another amount

34. A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. which of the following actions should the nurse take? a. b. c. d.

Obtain

a 12-lead ECG Suggest that the patient use a salt substitute Obtain a blood sample for a serum sodium level Advise the patient to add citrus juices and bananas to her diet

Feedback: Clients potassium level is above expected reference rage of 3.5-5.0 mEq/L and is at risk for dysrhythmias as well as cardiac arrest. Therefore, the nurse should obtain a 12-lead ECG to monitor cardiac changes 35. I n teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply)

a. diffuse involvement of plaque formation in coronary veins b. abnormal levels of cholesterol, especially low-density lipoproteins c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to a decreased blood supply to the heart muscle e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm

Rationale: Atherosclerosis is the major cause of coronary artery disease (CAD) and is characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the artery. The endothelial lining of the coronary arteries becomes inflamed from the presence of unstable plaques and the oxidation of low-density lipoprotein (LDL) cholesterol. Fibrous plaque causes progressive changes in the endothelium of the arterial wall. The result is a narrowing of the vessel lumen and a reduction in blood flow to the myocardial tissue. 36. a home health nurse is making a home visit to a client who takes a daily diuretics for heart failure. Which of the following should the nurse identify as indicating the patient is hypokalemic? a. pitting edema b. fatigue c. dyspnea d. oliguria Rational: d/t muscle weakness with hypokalemia 37. A nurse is reviewing the serum lab findings for a pt who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report? a. Sodium 136 mEq/L b. Potassium 2.3...