Medical Surgery 2 (Final) PDF

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1. Which cardiac arrhythmia can be either acquired or congenital and can spontaneously disappear on its own or lead to ventricular fibrillation? A. Wenckebach B. Premature arterial contractions C. Torsades de pointes D. Premature ventricular contractions Answer:- C

2. The PN working on a cardiac unit will encounter various cardiac dysrhythmias. Which of the following is a dysrhythmia that is characterized Multiple rapid impulses from many foci depolarize in the atria in a totally disorganized manner and no P wave is observed. A. Atrial Fibrillation B. Ventricular tachycardia C. Ventricular fibrillation D. Sinus tachycardia Answer:- A

3. Which patient is at greatest risk for cholelithiasis and choledocholithiasis? A- A 70 year old male patient who has liver disease B- A 70 year old female patient who has liver disease C- A 50 year old male patient who is Asian D- A 50 year old female patient who is Asian Correct Response: B The 70 year old female patient who has liver disease is at the greatest risk because the female gender, advancing age and the liver disease are known risk factors for cholelithiasis and choledocholithiasis. Other risk factors include obesity, oral contraceptive use, diseases and disorders of the ileum, hypercholesterolemia and races like the Hispanic, Native American and Caucasian races.

4. Which nursing action is included when assessing a patient's visual field? A. Shine a light into one pupil and observe the response for both pupils B. Position the patient 20 feet from the Snellen Chart C. Instruct the patient to follow a moving object using only the eyes D. Have the patient cover one eye while facing the nurse. Anser:- D To perform confrontation visual field testing, the patient faces the examiner and covers one eye, then counts the number of fingers that the examiner brings into the visual field.

5. The nurse is caring for a client with a history of advanced chronic obstructive pulmonary disease (COPD). The client had conventional gallbladder surgery 2 days previously. Which intervention has priority for preventing respiratory complications? A. Incentive spirometry every 4 hours. B. Coughing and deep breathing four times daily. C. Getting the client out of bed 4 times daily as ordered by the physician. D. Giving oxygen at 4 L/minute according to the physician's order. Answer:- C. Getting the client out of bed 4 times daily as ordered by the physician. 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 (every 1 to 2 hours) instead of every 4 hours or 4 times daily. Giving oxygen at 4 L/minute could decrease the client's respiratory drive.

6. A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client’s safety? 1. His wife works from home in telecommunication. 2. The client has worked the nightshift his entire career. 3. His wife has minimal family support. 4. The client smokes one pack of cigarettes per day. Answer:- 4. The client smokes one pack of cigarettes per day. 7. A woman age 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. This is an example of what ethical principle? A) Nonmaleficence B) Veracity C) Autonomy D) Justice Ans:C Feedback:Autonomy essentially means independence and the ability to be self-directed.

8. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? a. Inspect the oral mucosa. b. Listen to the lung sounds. c. Auscultate the bowel tones. d. Check pupil reaction to light. ANS: A Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil reaction to light.

9. The nurse is caring for a patient with chronic otitis media. For which complication should the nurse observe in the patient? a. Tonsillitis b. Sore throat c. Hearing loss d. Cerebral edema Answer:- C Hearing Loss 10. An older adult patient reports "ringing" in the ears. What additional data should the nurse gather to help determine the cause of the patient's problem? A. Exercise and sleep patterns B. Use of prescription medications C. History of ear surgery D. Nutritional status, especially protein intake ANS: B Tinnitus can be a result of damage to inner structures caused by the toxic effect of certain drugs. The other assessment findings are not as important for this problem. 11. A hospitalized patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first? a.Put a moist hot pack on the patient’s neck. b.Start the prescribed PRN O2at 6 L/min. c.Give the ordered PRN acetaminophen (Tylenol). d.Notify the patient’s health care provider immediately Answer:-b.Start the prescribed PRN O2at 6 L/min.

12. The client asks the nurse why the nitrate patch needs to be off for 8 hours per day. What is the best response by the nurse? 1. "There is no reason to take the patch off each day." 2. "The patch can be addictive; leaving it off reduces the addiction." 3. "You should only leave the patch off for 15 minutes." 4. "Leaving the patch off for 8 hours per day helps to delay the development of tolerance." Answer:- 4. "Leaving the patch off for 8 hours per day helps to delay the development of tolerance."

13. Select the stage of viral hepatitis that is accurately paired with its characteristic(s). A- The prodromal stage: Jaundice begins B- The icteric stage: Flu like symptoms occur C- The preicteric stage: Elevated urine bilirubin levels D- The posticteric stage: Jaundice and dark urine occurs Correct Response: C During the preicteric stage of viral hepatitis, elevated urine bilirubin levels, nausea, chills, anorexia, fever and mild upper right quadrant pain occur.The icteric stage is marked with

pruritis, clay stools, darkened urine and jaundice.The posticteric stage occurs when the patient returns to near normal physical status.There is no prodromal stage of viral hepatitis. 14. The nurse notes that a patient has astigmatism. What should the nurse expect when collecting data from this patient? a. Blind spots b. Blurred vision c. Distorted near vision d. Distorted distance vision Answer:- B Astigmatism results from unequal curvatures in the shape of the cornea. The person with astigmatism has blurred vision with distortion. A. Central vision blind spots are associated with macular degeneration. C. Distorted near vision occurs with myopia. D. Distorted distance vision occurs with hyperopia.

15. The nurse is teaching staff in a long-term facility home the principles of caring for clients with essential hypertension. Which comment should the nurse include in the inservice presentation about the care of clients with hypertension? A. As long as clients receive daily antihypertensive medications, no further interventions are needed. B. Frequent blood pressure checks, including readings taken by automated machines, are recommended. C. Clients with elevated blood pressure often exhibit a stiff neck and are diaphoretic D. Caregivers should only conduct blood pressure checks under a registered nurse's direct supervision. Answer:- B

16. The nurse auscultates rhonchi in a patient with a tracheostomy tube and performs tracheostomy suctioning to clear the secretions. Which nursing interventions are most appropriate to limit the risks associated with suctioning? Select all that apply. A. Instill sterile normal saline to loosen secretions B. Apply suction only while withdrawing catheter C. Limit aspiration time to 10 seconds with each suction pass D. Maintain sterile technique throughout suction procedure E. Pre-oxygenate with 100% oxygen Answer:- B, C, D, E

17. Assessment of a patient's visual acuity reveals that the left eye can see at 20 feet what a person with normal vision can see at 40 feet and the right eye can see at 20 feet what a person with normal vision can see at 50 feet. The nurse records which finding? a. OS 20/40; OD 20/50 b. OU 20/40; OS 50/20 c. OD 20/40; OS 20/50

d. OU 40/20; OD 50/20 ANS: A When documenting visual acuity, the first number indicates the standard (for normal vision) of 20 feet and the second number indicates the line that the patient is able to read when standing 20 feet from the Snellen chart. OS is the abbreviation for left eye and OD is the abbreviation for right eye. The remaining three answers do not correctly describe the patient's visual acuity

18. Which action should the practical nurse implement from the plan of care specifically for the client in end-stage liver failure who is experiencing hepatic encephalopathy? 1. Auscultate for an abdominal fluid wave 2. Check the client’s stool for blood 3. Prepare to administer a loop diuretic 4. Determine the client’s neurological status Answer:- 4

19. Which statement about glaucoma is true and accurate? A- Acute angle-closure glaucoma is an ocular emergency. B- Acute angle-closure glaucoma leads to the loss of peripheral vision and tunnel vision. C- Primary open-angle glaucoma leads to eye pain, nausea and vomiting, blurry vision and halos. D- Bubbles are implanted to protect the retina from the glaucoma. Correct Response: A Acute angle-closure glaucoma is an ocular emergency and it is characterized with eye pain, nausea and vomiting, blurry vision and halos. The signs and symptoms of primary open-angle glaucoma are the loss of peripheral vision and tunnel vision. Bubbles are placed to treat retinal detachments, another ocular emergency and laser peripheral iridotomy to decrease intraocular pressure is used for the treatment of glaucoma.

20. A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal? a. Fever b. Nausea c. Diaphoresis d. Abdominal cramps Answer:- C Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.

21. When assessing a client with glaucoma, a nurse expects which finding? A. Complaints of double vision B. Complaints of halos around lights C. Intraocular pressure of 15mmHg D. Soft globe on palpation

ANS: B

22. The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer no steroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk from 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side lying position and take antacids before meals. 4. Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client. Answer:- 4. The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux.

23. The nurse admits a client with the medical diagnosis of pneumonia. which of the following will the LPN perform: a) The head-to-toe initial assessment of the client b) An admission assessment c) A focused assessment at the end of the shift d) A complete physical examination Answer:- c) A focused assessment at the end of the shift

24. A patient has Meniere disease. What statement by the patient indicates a good ability to manage the condition? 1. “Because it’s from dehydration, I can increase salt in my food.” 2. “If I get dizzy I should lie down immediately and hold my head still.” 3. “There are no medications, so I just have to learn to live with it.” 4. “Because I have asthma, I cannot take any medications for Meniere disease.” Answer:- 2

25. Which assessment technique or method is used to determine whether or not the patient has an irregular pulse? 1. Percussion 2. Auscultation 3. Inspection 4. Apical pulse Answer:- 4.

26. A client with obesity is diagnosed with pulmonary embolism.which findings does the nurse anticipate? Select all that apply 1. Chest pain 2. Chills and fever 3. Tracheal deviation 4. Hypoxemia

5. Tachypnea Answer:- 1,4,5

27. A patient is admitted to the surgical unit with a diagnosis of rule out intestinal obstruction. The nurse is preparing to insert a Salem sump NG tube as ordered. In which of the following positions would it beBEST for the nurse to place this patient during the procedure? 1. Head of bed elevated 30°–45°. 2. Head of bed elevated 60°–90°. 3. Side-lying with head elevated 15°. 4. Lying flat with the head turned to the left side. Answer:- 2

28. The nurse is caring for a blind patient. When the nurse enters the patient’s room, which action is most appropriate? a.Touch the patient before speaking to allow her to locate the nurse’s position. b.Speak to the patient by name when entering the room to avoid startling her. c.Speak to the patient only when at bedside to increase orientation. d.Walk about in the room, carrying on conversation. Answer:- b

29. A nurse is providing instructions for a patient who is to begin wearing a Holter monitor. Which of the following statements indicates further teaching is necessary? A) "I should press this button if I feel any chest pain or pressure." B) "I need to write down what I eat each day." C) "I should make notes about the activities I'm doing while I wear the monitor." D) "I'll wear this for 2 days so the doctor can be sure to capture anything that may be going on." Answer:- B) "I need to write down what I eat each day."

30. A client with liver disease is admitted with severe jaundice. Why is the client at risk for “impaired skin integrity”? 1. Because the pathology is associated with thinning of the skin 2. Because the blood supply to the skin is significantly decreased 3. Because the condition leads to impaired breakdown of bilirubin, which causes itching 4. Because the kidney produce high levels of uric acid which causes skin breakdown Answer:- 3

31. The nurse explains that, when the physician takes a tonometer reading, the reading reflects the amount of pressure applied by the: 1. Sclera 2. Cornea 3. Aqueous humor 4. Vitreous humor Answer:- 3

32. Drugs that would alert the nurse to the possibility cause ototoxicity? SELECT ALL THAT APPLY 1. ibuprofen 2. aspirin 3. furosemide 4. vancomycin 5. Amoxicillin Answer:1. Ibuprofen 2. aspirin 3. furosemide 4. vancomycin

33. The nurse is caring for a client following an appendectomy. The client reports nausea and complains of surgical site pain at a 6 on a 0-10 scale. The client's employer is present in the room and states he is paying for the insurance and wants to know what pain meds have been prescribed by the physician. Which of the following is the appropriate nurse response? A. Explain to the employer that you cannot release private information and ask the employer to step out while you conduct your assessment of the client B. Answer any questions the employer may have as he pays for the insurance C. Tell the employer his question is inappropriate and that the information is none of his business D. Ask the employer to leave and wait until the client returns home to visit Answer:- A 34. Which assessment information obtained by the nurse when performing an eye examination for a 78-year-old patient indicates that more extensive examination of the eyes is needed? a. The patient's sclerae are light yellow in color. b. The patient complains of persistent photophobia. c. The pupil recovers slowly after being stimulated by a penlight. d. There is a whitish gray ring encircling the periphery of the iris. Answer:- b. Photophobia is not a normally occurring change with aging and would require further assessment. The other assessment data are common gerontologic differences and would not be unusual in a 78-year-old patient.

35. The nurse is reinforcing teaching about constipation prevention to a client. Which statement the client indicates a need for additional instruction? Select all that apply 1. “I will go to the restroom when I have the urge to have a bowel movement.” 2. “ I will use a laxative every other day if needed.” 3. “I will increase my tea or coffee consumption to stimulate the bowel.” 4. “I will increase my intake of fruits and vegetables.” 5. “I will increase my exercise to at least 3 times a week.” Answer:- 2,3

36. The practical nurse is caring for the client in end-stage liver failure who is diagnosed with portal hypertension. Which intervention should the nurse implement from the established plan of care? 1. Monitor the client’s BP 2. Percuss the liver for size and location 3. Weigh the client twice each week 4. Inspect the abdomen for ascites Answer:- 4 37. The nurse is caring for a patient scheduled for an electroencephalography. Which of the following actions taken by the nurse is BEST? 1. Identify what medications the patient is currently taking. 2. Instruct the patient to wash her hair 3. Assess vital signs 4. Determine if the patient has an allergy to shellfish. Answer:-2

38. As a community health care nurse, you met with several elders to address their concerns regarding the onset of alzheimer disease. What are the onset signs of Alzheimer? 1. The first signal would be an awful headache 2. The first signal would be aggressive behavior 3. The first signal would be progressive memory loss 4. The first signal would be depression Answer:- 3

39. A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following his therapeutic regimen? a. Total cholesterol level increases from 250 mg/dl to 275 mg/dl (6.48 mmol/L to 7.12 mmol/L). b. Low density lipoproteins (LDL) increase from 180 mg/dl (4.66 mmol/L to 190 mg/dl (4.92 mmol/L). c. High density lipoproteins (HDL) increase from 25 mg/dl (0.65 mmol/L) to 40 mg/dl (1.03 mmol/L). d. Triglycerides increase from 225 mg/dl (5.83 mmol/L) to 250 mg/dl (6.47 mmol/L). Answer:- C

40. Select all of the risk factors that are associated with deep vein thrombosis. 1. Rh negative blood 2. Nulliparity 3. The use of oral contraceptives 4. Type B and O blood 5. Obesity 6. Leukemia Answer:- 3, 5 41. A nurse is assessing a client with aortic stenosis. The nurse expects to hear a murmur that is: 1. high-pitched and blowing.

2. loud and rough during systole. 3. low-pitched, rumbling during diastole. 4. low-pitched and blowing. Answer:- 2 loud and rough during systole. Explanation: An aortic murmur is loud and rough and is heard over the aortic area. The murmur in aortic insufficiency is high-pitched and blowing and is heard at the third or fourth intercostal space at the left sternal border. Mitral stenosis has a low-pitched rumbling murmur heard at the apex. Mitral insufficiency has a high-pitched, blowing murmur at the apex. There is no condition that has a low-pitched, blowing murmur.

42. For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? 1. Teaching the client how to perform controlled coughing 2. Administering ordered sedatives regularly and in large amounts 3. Restricting fluid intake to 1,000 ml/day 4. Enforcing absolute bed rest Answer:- 1 Teaching the client how to perform controlled coughing

43. Your 88-year-old client is hospitalized for a retinal detachment. He is on bed rest, and both eyes are covered with patches. Which nursing diagnosis takes priority at this time? a. Self-esteem disturbance related to decreased independence b. High risk for altered thought processes related to visual impairment c. High risk for injury related to altered sensory p...