Nursing textbooks medical-surgical practice questions, set 10
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 10
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
A male client will be having an ileoanal anastomosis for the treatment of chronic ulcerative colitis. What is the benefit to this client of having this procedure rather than a total colectomy? Select all that apply.
A. Maintains bowel continence
B. Unlikely to experience bladder dysfunction
C. Unlikely to experience erectile dysfunction
D. Unlikely to experience infertility
E. Able to have the procedure as an outpatient
Show answer and rationale
Correct answer: A — Maintains bowel continence
The ileoanal reservoir, also called an ileoanal anastomosis, is a procedure that maintains bowel continence. It is performed on selected clients who have chronic ulcerative colitis or whose disease does not affect the anorectal sphincter. Besides allowing the client to control bowel elimination, this procedure, as opposed to a conventional ileostomy with total colectomy, preserves innervation to the male genitalia. Subsequently, the male client is unlikely to experience bladder dysfunction, erectile dysfunction, or infertility. The client will not be able to have this surgery done on an outpatient basis, they require postoperative care for a longer duration.
Question 2
A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?
A. The client has a decreased tolerance of pain related to the chronic nature of the illness.
B. Bone marrow decreases the erythrocyte production causing decrease in hypoxia.
C. Overhydration enlarges the red blood cells.
D. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
Show answer and rationale
Correct answer: D — Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.
Question 3
A nurse is caring for a patient admitted for an acute asthma exacerbation. The patient reports extreme dyspnea, stating, 'Turn up the oxygen, I'm not getting enough air.' Which actions would the nurse take first?
A. Suction the airway.
B. Assess the pulse oximetry reading.
C. Obtain a peak flow meter reading.
D. Assess for cyanosis of the lips.
Show answer and rationale
Correct answer: B — Assess the pulse oximetry reading.
Using the nursing process, the nurse first assesses the oxygen saturation via pulse oximetry before changing the oxygen flow rate. Suctioning is provided to remove respiratory secretions; the nurse would note adventitious breath sounds or phlegm with cough indicating a need for suction. A peak flow meter is used to assess the point of highest flow during forced expiration. It is routinely used for patients with moderate or severe asthma to measure the severity of the disease and degree of disease management. While cyanosis of the lips is a late sign of hypoxemia, the nurse can quickly begin to alleviate or lessen dyspnea by simply repositioning the patient.
Question 4
An elderly patient comes into the emergency department complaining of an earache. The patient has an oral temperature of 100.2 F and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next?
A. Palpate the patients parotid glands to detect swelling and tenderness.
B. Assess the temporomandibular joint for evidence of a malocclusion.
C. Test the integrity of cranial nerve XII by asking the patient to protrude the tongue.
D. Inspect the patients gums for bleeding and hyperpigmentation.
Show answer and rationale
Correct answer: A — Palpate the patients parotid glands to detect swelling and tenderness.
Older adults and debilitated patients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness, as well as swelling of the parotid glands. Pain radiates to the ear. Pain associated with malocclusion of the temporomandibular joint may also radiate to the ears; however, a temperature elevation would not be associated with malocclusion. The 12th cranial nerve is not associated with the auditory system. Bleeding and hyperpigmented gums may be caused by pyorrhea or gingivitis. These conditions do not cause earache; fever would not be present unless the teeth were abscessed.
Question 5
A patient with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the patient and her family to establish goals for care. What is likely to be a first priority in goal setting for the patient?
A. Maintenance of activities of daily living
B. Pain control
C. Social interaction
D. Promotion of spirituality
Show answer and rationale
Correct answer: B — Pain control
Once the phase of illness has been identified for a specific patient, along with the specific medical problems and related social and psychological problems, the nurse helps prioritize problems and establish the goals of care. Identification of goals must be a collaborative effort, with the patient, family, and nurse working together, and the goals must be consistent with the abilities, desires, motivations, and resources of those involved. Pain control is essential for patients who have a terminal illness. If pain control is not achieved, all activities of daily living are unattainable. This is thus a priority in planning care over the other listed goals.
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Question 6
A client receiving prescribed magnesium sulfate shows signs of dyspnea, tachycardia, and increased respiratory rate and rales. The nurse notices frothy sputum. Which of the following conditions should the nurse suspect?
A. Pulmonary edema
B. Water intoxication
C. Renal failure
D. Cardiac arrest
Correct answer:
The client is most likely experiencing pulmonary edema. If there is an increase in respiratory rate of more than 20 respirations/min with the administration of magnesium sulfate, the nurse should assess the respiratory status for symptoms of pulmonary edema such as dyspnea, tachycardia, rales, and frothy sputum. In such cases, the primary health care provider is notified immediately because use of the drug may be discontinued or the dosage may be decreased. The danger of water intoxication is associated with oxytocin as it has an antidiuretic effect, and not with magnesium sulfate. Renal failure and cardiac arrest are not associated with magnesium sulfate.
A nurse is teaching a nursing student how to perform perineal care for patients. What actions are appropriate when performing this procedure? Select all that apply.
A. For male and female patients, wash the groin area with a small amount of soap and water and rinse.
B. For a female patient, spread the labia and move the washcloth from the anal area toward the pubic area.
C. For male and female patients, always proceed from the most contaminated area to the least contaminated area.
D. For male and female patients, use a clean portion of the washcloth for each stroke.
E. For a male patient, clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward.
Correct answer:
Wash and rinse the groin area (both male and female patients) with a small amount of soap and water, and rinse. For male and female patients, always proceed from the least contaminated area to the most contaminated area and use a clean portion of the washcloth for each stroke. For a male patient, clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. For a female patient, spread the labia and move the washcloth from the pubic area toward the anal area. In an uncircumcised male patient (teenage or older), retract the foreskin (prepuce) while washing the penis and return it to its original position when finished.
The nurse preceptor supervises a new graduate nurse assessing a patient with pressure injuries. The graduate documents biofilm presence in the wound site. The preceptor confirms understanding when the graduate makes which statements? Select all that apply.
A. Enhanced healing due to sugars or proteins present.
B. Delayed healing due to dead tissues in tissue present in the wound.
C. Antibiotics are less effective against bacteria.
D. Loss of skin integrity due to excessive hydration of wound cells.
E. Delayed healing due to dehydration of cells dehydrating or dying.
Correct answer:
Wound films are the result of bacterial growth in wounds forming clumps, embedded within a thick, self-made, protective, or slimy barrier of sugars or proteins. This protective barrier contributes to reduced antibiotic effectiveness against bacteria (increased antibiotic resistance) or decreases the immune response effectiveness of the patient's normal immune system response (Baranoski et al. & Ayello, 2020). Dead tissue delays healing or necrosis in the wound delays healing. Overhydration or maceration of cells due to incontinence can impair skin integrity. Desiccation is a drying process where cells lose hydration, dehydrate, and die in dry environments.
When taking a client's history, the client reports to the nurse inappropriate use of diuretics and laxatives, secreteating of high-calorie and high-carbohydrate foods, and alternately bingeing and fasting. Based on this information, which eating disorder should the nurse suspect?
A. Bulimia nervosa
B. Anorexia nervosa
C. Binge eating
D. Compulsive overeating
Correct answer:
Behavioral signs and symptoms of bulimia nervosa include excessive exercise; use of diuretics, and laxatives, secret eating of high-calorie, high-carbohydrate foods, and alternately bingeing and fasting. Anorexia nervosa is characterized by behavioral signs and symptoms including restriction of food choices and intake, ritualistic handling of food (e.g., cutting into tiny pieces, arranging food in a certain way), weighing oneself frequently, and denial of hunger. Binge eating and compulsive overeating are characterized by frequent dieting, restricting activities because of embarrassment about weight, eating when not hungry, rapid eating, and eating alone.
A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient responsibilities of the scrub nurse? Select all that apply.
A. Maintaining sterile technique
B. Draping and handling instruments and supplies
C. Identifying and assessing the patient on admission
D. Integrating case management
E. Preparing the skin at the surgical site
Correct answer:
The scrub nurse is a member of the sterile team who maintains sterile technique while draping and handling instruments and supplies. Two duties of the circulating nurse are to identify and assess the patient on admission to the OR and prepare the skin at the surgical site. The perioperative registered nurse actively assists the surgeon by providing exposure of the operative area. The advanced practice registered nurse coordinated nurse and integrates care activities, collaborates with physicians and nurses in all phases of perioperative and postanesthesia care, and integrates care management, critical paths, and research into care of the surgical patient.
The nurse is providing preoperative teaching to a patient who is scheduled for surgery in 3 days. Which of the following information should the nurse include when addressing preoperative sensory information?
A. Warming blankets are available as the operating room is often cold
B. Lighting in the operating room is low that may cause the patient to have blurred vision.
C. The operating room bed is narrow and a safety strap is used to secure the patient to the bed.
D. Not to be alarmed by the quiet environment as there is no conversation in the operating room.
E. Machines may be making 'ticking and pinging noises' that can be heard.
Correct answer:
When providing preoperative teaching related to sensory information the nurse should include that warming blankets will be available as the operating room is often cold, a safety strap will be applied over the patients knees as the operating room bed is narrow, and the operating room machines make noises that the patient may hear when they are awake. Lighting in the OR is very bright, not dull although the patient may have blurred vision related to the preoperative medication it would not be related to the OR. Talking may be heard in the OR but is often distorted because of the masks and patients should be directed to ask any questions that they may have.
Selye developed a theory of adaptation to biologic stress that he named the general adaptation syndrome (GAS), which has three phases: alarm, resistance, and exhaustion. During the alarm phase, the sympathetic fight-or-flight response is activated with release of catecholamines and the onset of the adrenocorticotropic hormone (ACTH) adrenal cortical response. The alarm reaction is defensive and anti-inflammatory but self-limited. Because living in a continuous state of alarm would result in death, people move into the second stage, resistance. During the resistance stage, adaptation to the noxious stressor occurs, and cortisol activity is still increased.
A nurse is teaching an adult patient how to care for their new ostomy appliance. Which evaluation method is most appropriate to confirm that the patient has learned the information?
A. Ask Me 3
B. Newest Vital Sign (NVS)
C. Teach-Back Method
D. TEACH acronym
Correct answer:
The Teach-Back Method tool is a method of assessing literacy and confirming that the learner understands health information received from a health professional. The Ask Me 3 is a brief tool intended to promote understanding and improve communication between patients and their providers. The NVS is a reliable screening tool to assess low health literacy, developed to improve communications between patients and providers. The TEACH acronym is used to maximize the effectiveness of patient teaching by tuning into the patient, editing patient information, acting on every teaching moment, clarifying often, and honoring the patient as a partner in the process.
A client with bipolar disorder is having a disturbed thought process. What nursing intervention can help the client to be oriented and accurately perceive circumstances surrounding admission?
A. Provide ample information.
B. Support the client when in delusion.
C. Reduce distracting stimuli.
D. Offer a large-music activity.
Correct answer:
The nurse should reduce distracting stimuli such as noise and stimulation. External stimuli potentiate client's internal activity. The nurse should not provide ample information at once, but rather should provide information in small amounts, using brief sentences. Brief discussion accommodates short attention span. The nurse should also present reality when the client is delusional and should not support the delusion of the client. Failing to present reality reinforces that the client's delusions are real. Exercise releases energy and reduces the potential for an angry outburst. It will not help a client with disturbed thought processes to be oriented.
A nurse is assigned to care for a 40-year-old client with a hepatic injury that has occurred due to the administration of tolcapone. Which of the following interventions should the nurse perform when caring for this client?
A. Monitor the client for signs of tactile hallucinations.
B. Monitor the client for signs of dystonic movements.
C. Perform regular blood tests of the client.
D. Perform serum transaminase level testing every day.
Correct answer:
A serious and potentially fatal adverse reaction to tolcapone is hepatic injury. The nurse should, therefore, perform regular blood testing to monitor liver function of the client as prescribed. The testing of serum transaminase levels may be ordered at frequent intervals such as every 2 weeks for the first year and every 8 weeks thereafter. The nurse need not perform serum transaminase level testing every day. The nurse should monitor for signs of dystonic movements when caring for a client receiving carbidopa and levodopa, not tolcapone. The nurse should monitor for signs of tactile hallucinations when caring for an elderly client receiving tolcapone.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 10 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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