Nursing textbooks medical-surgical practice questions
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questions
You practice adult health stems across systems, then name the action that changes the outcome. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the Nursing textbooks exam guide or more Nursing textbooks practice questions.
Five medical-surgical questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
The nurse is caring for a client who has had intracranial surgery and is being discharged home. What instructions would the nurse give the client besides instructions on the medication?
A. Understand that headaches are uncommon.
B. You can cover the incision with your hair.
C. You can expect swelling above the incision.
D. Expect sensory changes, such as hearing a clicking sound, around the bone flap.
Show answer and rationale
Correct answer: D — Expect sensory changes, such as hearing a clicking sound, around the bone flap.
In addition, the nurse must provide the following verbal and written instructions: Watch for signs of intracranial bleeding and infection (expect swelling around the eye and below the incision). Expect sensory changes such as hearing a 'clicking' sound around the bone flap, which will disappear as healing takes place. Understand that headaches also are common, but notify the surgeon if a mild analgesic such as acetaminophen fails to relieve them. Care for the surgical site as directed by the physician. Some recommendations include keeping the incision clean, avoiding scrubbing the incision, securing remaining hair away from the incision, resuming shampooing the hair when the staples or sutures are removed, and wearing a hat when outside to avoid sunburn until hair growth resumes. Maintain safety precautions at home, including ambulating only with assistance and ensuring well-lit and clutter-free rooms. Do not drive until the risk of seizures has been eliminated. Engage in exercises that promote strength and endurance. Use techniques to ensure bowel and bladder elimination. Follow feeding and/or nutritional suggestions. Keep follow-up appointments for measuring anticonvulsant blood levels, electroencephalograms, and continued medical care and evaluation. This information is usually given to the client on a take-home instruction sheet.
Question 2
The nurse is caring for a patient in the ICU whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. What would be the priority assessment and interventions specific to the administration of vasoactive medications?
A. Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration
B. Reviewing medications, performing a focused cardiovascular assessment, and providing patient education
C. Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema
D. Routine monitoring of vital signs, monitoring the peripheral IV site, and providing early discharge instructions
Show answer and rationale
Correct answer: A — Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration
When vasoactive medications are administered, vital signs must be monitored frequently (at least every 15 minutes until stable, or more often if indicated). Vasoactive medications should be administered through a central venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An IV pump should be used to ensure that the medications are delivered safely and accurately. Individual medication dosages are usually titrated by the nurse, who adjusts drip rates based on the prescribed dose and the patients response. Reviewing medications, performing a focused cardiovascular assessment, and providing patient education are important nursing tasks, but they are not specific to the administration of IV vasoactive drugs. Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema are not the priorities for administration of IV vasoactive drugs. Vital signs are taken on a frequent basis when monitoring administration of IV vasoactive drugs, vasoactive medications should be administered through a central venous line, and early discharge instructions would be inappropriate in this time of crisis.
Question 3
What is true about the use of silence in therapeutic communication?
A. Maintaining silence is an effective therapeutic communication technique.
B. Maintaining silence is generally overused in therapeutic communication.
C. The sender often becomes uncomfortable when using silence.
D. The ability to use silence effectively requires skill and timing.
E. Prolonged periods of misunderstood silence can cause tension.
Show answer and rationale
Correct answer: A — Maintaining silence is an effective therapeutic communication technique.
Maintaining silence is an extremely effective therapeutic communication technique, and yet tends to be quite underused. Because silence often feels awkward in American society, people tend to feel the need to 'fill' it. This impulse does not always allow the people involved in an interaction time to organize their thoughts sufficiently to communicate what they would like. It is common for a person to need several seconds after hearing a verbal message to interpret what has been stated and to formulate the most appropriate response. Unfortunately, the receiver often does not get this amount of time before a response is necessary. In many cases, the sender becomes uncomfortable with the silence and begins speaking again before the receiver has had an opportunity to formulate a response and is really ready to deliver it. The ability to use silence effectively requires skill and timing. It is easy for prolonged periods of misunderstood silence to cause uneasiness and tension. However, in many cases, purposeful use of silence conveys respect, understanding, caring, and support, and it is often used in conjunction with therapeutic touch.
Question 4
A nurse is preparing medications for patients in the ICU. The nurse is aware that patient variables may affect the absorption of these medications. Which statements accurately describe these variables the nurse will use as a basis for practice? Select all that apply.
A. Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed.
B. Some people experience the same response with a placebo as with the active drug used in studies.
C. People with liver disease metabolize drugs more quickly than people with normal liver functioning.
D. A patient who receives a pain medication in a noisy environment may not receive full benefit from the medication's effects.
E. Oral medications should not be given with food as the food may delay the absorption of the medications.
Show answer and rationale
Correct answer: A — Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed.
Nurses are responsible for applying pharmacologic knowledge during medication administration, including varied responses in patients from different ethnic groups (ethnopharmacology). The patient's expectations of the medication may affect the response to the medication; for example, when a placebo is given and a patient has a therapeutic effect. Environment may also influence the patient's response to medications; for example, sensory deprivation and overload may affect drug responses. Circadian rhythms and cycles may also influence drug action. The liver is the primary organ for drug breakdown, thus pathologic conditions that involve the liver may slow metabolism and alter the dosage of the drug needed to reach a therapeutic level. The presence of food in the stomach can delay the absorption of orally administered medications. Alternatively, some medications should be given with food to prevent gastric irritation, which the nurse should consider when establishing a patient's medication schedule. Other medications may have enhanced absorption if taken with certain foods.
Question 5
You are caring for a 67-year-old male who had a cerebrovascular accident 3 weeks ago. In addition, he has developed a pressure injury on his right hip. Which of the following data that you collected will be useful in developing a care plan that will address his pressure ulcer?
A. Last week he weighed 165.5 pounds, and today he weighs 161.8 pounds.
B. The pressure injury is a stage 3.
C. He has 250 mL of clear yellow urine in his Foley catheter.
D. He is not able to sit up in a chair for longer than 15 minutes at a time.
E. He dislikes cheese, beans, chicken, and fish, but loves steak, eggs, all kinds of nuts, and peanut butter.
Show answer and rationale
Correct answer: A — Last week he weighed 165.5 pounds, and today he weighs 161.8 pounds.
When developing a care plan for a 67-year-old male with a pressure injury, several pieces of collected data are particularly useful. His weight loss from 165.5 to 161.8 pounds over the past week suggests nutritional deficits, which can impair wound healing and should be addressed through dietary interventions. The identification of the pressure injury as stage 3 indicates full-thickness tissue damage and guides the level of wound care required, such as debridement and specialized dressings. His inability to sit in a chair for more than 15 minutes highlights limited mobility, a major risk factor for pressure ulcers, requiring repositioning schedules and pressure-relieving devices. Additionally, while he dislikes some high-protein foods like cheese, beans, chicken, and fish, his preference for steak, eggs, nuts, and peanut butter still offers adequate protein options, which are critical for tissue repair and wound healing. These preferences should be incorporated into his care plan to ensure compliance with nutritional recommendations.
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Question 6
When caring for a patient in shock, one of the major nursing goals is to reduce the risk that the patient will develop complications of shock. How can the nurse best achieve this goal?
A. Provide a detailed diagnosis and plan of care in order to promote the patients and familys coping.
B. Keep the physician updated with the most accurate information because in cases of shock the nurse often cannot provide relevant interventions.
C. Monitor for significant changes and evaluate patient outcomes on a scheduled basis focusing on blood pressure and skin temperature.
D. Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment.
Correct answer:
Shock is a life-threatening condition with a variety of underlying causes. It is critical that the nurse apply the nursing process as the guide for care. Shock is unpredictable and rapidly changing so the nurse must understand the underlying mechanisms of shock. The nurse must also be able to recognize the subtle as well as more obvious signs and then provide rapid assessment and response to provide the patient with the best chance for recovery. Coping skills are important, but not the ultimate priority. Keeping the physician updated with the most accurate information is important, but the nurse is in the best position to provide rapid assessment and response, which gives the patient the best chance for survival. Monitoring for significant changes is critical, and evaluating patient outcomes is always a part of the nursing process, but the subtle signs and symptoms of shock are as important as the more obvious signs, such as blood pressure and skin temperature. Assessment must lead to diagnosis and interventions.
When developing the plan of care for a client receiving sulfonamides for treatment of a urinary tract infection, the nurse identifies actions for encouraging fluid intake and monitoring intake and output based on which nursing diagnosis?
A. Risk for Fluid Imbalance
B. Impaired Urinary Elimination
C. Risk for Ineffective Renal Perfusion
D. Stress Incontinence
Correct answer:
A client with a urinary tract infection already is experiencing an alteration in urinary elimination. Because one adverse effect of the sulfonamide drugs is altered elimination patterns, it is important to help the client maintain adequate fluid intake and output. The nurse would encourage clients to increase fluid intake to 2000 mL or more per day to prevent crystalluria and stones (calculi) forming in the genitourinary tract, as well as to aid in removing microorganisms from the urinary tract. It is important to measure and record the client's intake and output every 8 hours and notify the primary health care provider if the urinary output decreases or the client fails to increase his or her oral intake. If the client is unable to maintain adequate intake, then he or she would be at risk for fluid imbalance. If renal injury would occur, then the client would be at risk for ineffective renal perfusion. Bladder training would be an appropriate intervention to address stress incontinence.
A client with diabetes insipidus has been prescribed vasopressin. The client's ambulatory status is limited. Which of the following would be most important for this client?
A. Measuring the amount of fluid loss every 24 hours
B. Refilling the water container at frequent intervals
C. Giving four glasses of water immediately after the client takes the drug
D. Examining the client's abdomen every 15 to 30 minutes
Correct answer:
Clients with diabetes insipidus are continually thirsty, and in this case, the client also has limited ambulatory activities. Therefore, the nurse should be careful to refill the water container at frequent intervals to ensure the availability of enough drinking water at hand for the client. The nurse need not be careful to measure the amount of fluid loss every 24 hours, give four glasses of water immediately after the client takes the drug, or examine the client's abdomen every 15 to 30 minutes. The nurse instructs the client to measure the amount of urine excreted at each voiding and then total the amount for each 24-hour period. The nurse should instruct the client to drink one or two glasses of water immediately before taking the drug. The nurse need not auscultate the abdomen every 15 to 30 minutes in a client with diabetes insipidus. The nurse auscultates the abdomen every 15 to 30 minutes in a client with abdominal distention.
A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?
A. Indicates acceptance of altered appearance and demonstrates positive self-image
B. Freely expresses needs and concerns related to postoperative pain management
C. Compensates effectively for alteration in ability to communicate related to dysarthria
D. Demonstrates effective stress management techniques to promote muscle relaxation
Correct answer:
Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the patients appearance is visibly altered. The face generally appears asymmetric, with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Patients who have had head and neck surgery generally report less pain as compared with other postoperative patients; however, the nurse must assess each individual patients level of pain and response to analgesics. Patients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.
A patient reporting stomach pain says, "I have seen 10 different health care providers but all of them tell me I don't have stomach cancer." Which term might be appropriate in describing this report?
A. Somatic symptom disorder
B. Factitious disorder
C. Illness anxiety
D. Malingering
Correct answer:
Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The patient is apprehensive of a particular illness despite continuous negative medical evaluations and assurances. Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Malingering is a behavior and not a psychiatric disorder. "Somatization," defined as a process by which psychological distress is expressed as physical symptoms without a known organic source, causes substantial distress and psychosocial impairment with or without a known general medical disease. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient. In addition, there are no obvious external benefits such as financial gain or avoiding work or criminal prosecution.
A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. The nurse understands that the client will be undergoing which test(s)?
A. Arthroscopy
B. Arthrocentesis
C. Arthrogram
D. Bone densit dissentery
E. Electromyography
Correct answer:
An arthrogram is a radiographic examination of a joint usually the knee or shoulder. The health care provider first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client involves local anesthesia just before this procedure. The health care provider inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques. Electromyography tests the electrical potential of the muscles and nerves leading to the muscles.
The nurse is preparing to change a patients abdominal dressing. The nurse recognizes the first step is to provide the patient with information regarding the procedure. Which of the following explanations should the nurse provide to the patient?
A. The dressing change is often painful, and we will be giving you pain medication prior to the procedure so you do not have to worry
B. During the dressing change, I will provide privacy at a time of your choosing, it should not be painful, and you can look at the incision and help with the procedure if you want to
C. The dressing change should not be painful, but you can never be sure, and infection is always a concern
D. The best time for doing a dressing change is during lunch so we are not interrupted. I will provide privacy, and it should not be painful
Correct answer:
When having dressings changed, the patient needs to be informed that the dressing change is a simple procedure with little discomfort; privacy will be provided; and the patient is free to look at the incision or even assist in the dressing change itself. If the patient decides to look at the incision, assurance is given that the incision will shrink as it heals and that the redness will likely fade. Dressing changes should not be painful, but giving pain medication prior to the procedure is always a good preventive measure. Telling the patient that the dressing change should not be painful, but you can never be sure, and infection is always a concern does not offer the patient any real information or options and serves only to create fear. The best time for dressing changes is when it is most convenient for the patient; nutrition is important so interrupting lunch is probably a poor choice.
A client who is diagnosed with aortic stenosis is scheduled for a percutaneous balloon valvuloplasty. Which statement does the nurse include when reinforcing education regarding this procedure?
A. The balloon is placed in your heart valve and inflated.
B. A chest incision is necessary for the scheduled procedure.
C. You will require hospitalization for several days after the procedure.
D. The opening from this procedure is likely to close in approximately 1 year.
Correct answer:
Percutaneous balloon valvuloplasty (i.e., valvotomy) is a nonsurgical alternative for the treatment of mitral stenosis. During this procedure, a catheter with an uninflated balloon is passed through the femoral vein and threaded into the right atrium. The septum is then punctured between the right and left atria. When the catheter is in the mitral valve, it is inflated; therefore, the statement the nurse includes when reinforcing education with this client regarding this procedure is 'The balloon is placed in your heart valve and inflated.' The other statements are not appropriate for the nurse to include when reinforcing education because this procedure is nonsurgical, thus will not require a chest incision; the client is likely to be discharged the same day as the procedure, and the opening that is caused as a result of this procedure is likely to close within 6 months, not 1 year.
The nurse identifies a nursing diagnosis of Diarrhea for a client being started on cholinergic drug therapy. Which of the following would the nurse most likely include in the client's plan of care?
A. Ensure that the client has readily available access to the bathroom.
B. Evaluate the number, frequency, and consistency of the stools.
C. Contact the primary health care provider for an order to switch to another cholinergic drug.
D. Limit the client's fluid intake to 1000 mL per day.
E. Maintain the client on strict bed rest.
Correct answer:
When a cholinergic drug is administered, the client may experience diarrhea. This reaction will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse needs to ensure that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist in the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse should document fluid intake and output and track the number, consistency, and frequency of stools if diarrhea is present. Since diarrhea occurs with any cholinergic drug, switching to another would be of no help. The client needs to replace fluids lost with diarrhea, so limiting fluid intake would be inappropriate. Ambulating to assist with the passage of flatus would be appropriate, while strict bed rest would not be necessary.
The nurse in a rural nursing outpost has just been notified that she will be receiving a patient in hypovolemic shock due to a massive postpartum hemorrhage after her home birth. You know that the best choice for fluid replacement for this patient is what?
A. 5% albumin because it is inexpensive and is always readily available
B. Dextran because it increases intravascular volume and counteracts coagulopathy
C. Whatever fluid is most readily available in the clinic, due to the nature of the emergency
D. Lactated Ringers solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure
Correct answer:
The best fluid to treat shock remains controversial. In emergencies, the best fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Albumin is very expensive and is a blood product so it is not always readily available for use. Dextran does increase intravascular volume, but it increases the risk for coagulopathy. Lactated Ringers is a good solution choice because it increases volume and buffers acidosis, but it should not be used in patients with liver failure because the liver is unable to covert lactate to bicarbonate.
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Nursing textbooks medical-surgical practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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