Nursing textbooks medical-surgical practice questions, set 14
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 14
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 bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which?
A. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
B. Use a combination of fentanyl and midazolam for conscious sedation.
C. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
D. Apply a transdermal fentanyl (Duragesic) patch immediately before the procedure.
Show answer and rationale
Correct answer: B — Use a combination of fentanyl and midazolam for conscious sedation.
A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.
Question 2
A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain?
A. This cannot be prevented.
B. Infants do not feel pain as adults do.
C. This is not a good reason for refusing immunizations.
D. A topical anesthetic can be applied before injections are given.
Show answer and rationale
Correct answer: D — A topical anesthetic can be applied before injections are given.
To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.
Question 3
The parent of an infant with colic tells the nurse, All this baby does is scream at me; it is a constant worry. What is the nurses best action?
A. Encourage the parent to verbalize feelings.
B. Encourage the parent not to worry so much.
C. Assess the parent for other signs of inadequate parenting.
D. Reassure the parent that colic rarely lasts past age 9 months.
Show answer and rationale
Correct answer: A — Encourage the parent to verbalize feelings.
Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parents anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.
Question 4
The nurse is evaluating an older adult client who, for the past year, has been constantly fretful and worries about finances, living alone, and being lonely. The nurse understands these are symptoms of which type of anxiety disorder?
A. Generalized anxiety disorder
B. Phobic disorder
C. Posttraumatic stress disorder
D. Obsessive-compulsive disorder
Show answer and rationale
Correct answer: A — Generalized anxiety disorder
Generalized anxiety disorder is characterized by chronic, daily worrying for 6 months or more. Phobic disorder is characterized by an exaggerated and irrational fear, such as the fear of insects, animals, or various life experiences such as riding on a roller coaster or flying on an airplane, some of which are potentially dangerous. Posttraumatic stress disorder is a condition that involves a delayed anxiety response 3 or more months after an emotionally traumatic experience. Obsessive-compulsive disorder is manifested by the performance of an anxiety-relieving ritual to terminate a disturbing, persistent, and recurring thought.
Question 5
A nurse is caring for a client who has exhibited repeated return of hordeolum (sty). Which assessment finding is most important in determining care for this client?
A. Dabbing the eyes multiple times with a washcloth
B. Presence of low blood sugar
C. Use of disposable wash cloths
D. Use of antibacterial facial wash
Show answer and rationale
Correct answer: A — Dabbing the eyes multiple times with a washcloth
Hordeolum is an infection usually caused by Staphylococcus aureus. To avoid transferring microorganisms, the client should not dab the eyes multiple times with a washcloth but should instead clean the unaffected eye first and change the washcloth, towel, and water after contact with the affected eye. The nurse should also instruct the client to use separate fresh tissues, cotton balls, or gauze for each wiping stroke when cleaning exudate from the eye. Clients with high blood sugar are more likely to develop hordeolum. Use of disposable wash cloths, antibacterial cleansers, and good hygiene practices are preventable techniques.
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Question 6
Based on the nurses knowledge of neurofibromatosis, the nurse understands that a single family member has which of the following?
A. A spontaneous mutation
B. A germline mutation
C. A nondisjunction
D. A monosomy
Correct answer:
Spontaneous mutations take place in individual oocytes or sperm at the time of conception. These mutations are not inherited in other family members. However, a person who carries the new spontaneous mutation may pass on the mutation to his or her children. Achondroplasia, Marfan syndrome, and neurofibromatosis type 1 are examples of genetic conditions that may occur in a single family member as a result of spontaneous mutation. Germline mutations are passed on to all daughter cells when body cells replicate. Nondisjunction and monosomy are related to chromosomal abnormalities, not single gene mutations like neurofibromatosis.
A client who is receiving respiratory support with a tracheostomy and mechanical ventilation after a stroke is being discharged from the acute care facility. Family members state that they will not be able to care for the client at home to provide the care that is required. What type of care may this client be a candidate for after discharge?
A. Long-term acute care
B. Subacute care
C. Intermediate care facility
D. Rehabilitation care
Correct answer:
Clients who require ventilator support or who have other conditions that are potentially unstable but do not have rapid changes may receive care in a long-term acute care facility. Subacute care refers to care that is more intense than traditional long-term care but less intense than acute inpatient care. Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Rehabilitation centers provide physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible.
A nurse directs the intervention team who must take an aggressive patient to seclusion. Other patients were removed from the area. Before approaching the patient, the nurse should ensure that which actions are taken by staff? (Select all that apply.)
A. Remove jewelry, glasses, and harmful items from the patient and staff members.
B. Appoint a person to clear a path and open, close, or lock doors.
C. Quickly approach the patient and grab the closest extremity.
D. Select the person who will communicate with the patient.
E. Move behind the patient to use the element of surprise.
Correct answer:
Injury to staff members and to the patient should be prevented. Only one person should explain what will happen and direct the patient; this person might be the nurse or staff member who has a good relationship with the patient. A clear pathway is essential; those restraining a limb cannot use keys, move furniture, or open doors. The nurse is usually responsible for administering the medication once the patient is restrained. Each staff member should have an assigned limb rather than just grabbing the closest limb. This system could leave one or two limbs unrestrained. Approaching in full view of the patient reduces suspicion.
The PACU nurse is caring for a patient who has arrived from the OR. During the initial assessment, the nurse observes that the patients skin has become blue and dusky. The nurse looks, listens, and feels for breathing, and determines the patient is not breathing. What is the priority intervention?
A. Check the patients oxygen saturation level, continue to monitor for apnea, and perform a focused assessment
B. Treat the possible airway obstruction by tilting the head back and pushing forward on the angle of the lower jaw
C. Assess the arterial pulses, and place the patient in the Trendelenburg position
D. Reintubate the patient
Correct answer:
When a nurse finds a patient who is not breathing, the priority intervention is to open the airway and treat a possible hypopharyngeal obstruction. To treat the possible airway obstruction, the nurse tilts the head back and then pushes forward on the angle of the lower jaw or performs the jaw thrust method to open the airway. This is an emergency and requires the basic life support intervention of airway, breathing, and circulation assessment. Arterial pulses should be checked only after airway and breathing have been established. Reintubation and resuscitation would begin after rapidly ruling out a hypopharyngeal obstruction.
A client with a history of atrial fibrillation has experienced a TIA. What does the nurse expect will be the priority preventative medical treatment(s) to reduce the risk of a cerebrovascular accident (CVA)? Select all that apply.
A. Cholesterol-lowering drugs
B. Anticoagulant therapy
C. Monthly prothrombin levels
D. Carotid endarterectomy
E. Percutaneous transluminal angioplasty
Correct answer:
To manage atherosclerosis and the consequences of cardiac arrhythmias, especially atrial fibrillation, cholesterol-lowering drugs and prophylactic anticoagulant or antiplatelet therapy are prescribed. Prothrombin and international normalized ratio (INR) levels may be prescribed to monitor therapeutic effects of anticoagulant therapy. Carotid endarterectomy would be anticipated only when the carotids have narrowing from plaque. Similarly, a percutaneous transluminal angioplasty (also called a balloon angioplasty) accompanied by placement of a stent is performed to dilate the carotid artery and increase blood flow to the brain.
The nurse is teaching a client who underwent a skin graft for a burn injury about the use of pressure garments. What instruction(s) should the nurse include in the teaching? Select all that apply.
A. Wear the garment at least 12 hours each day.
B. Contact the primary provider if the garment does not seem to fit properly.
C. Machine wash the pressure garment daily with a mild detergent.
D. Roll the garment and wring tightly to ensure garment is as dry as possible after washing.
E. Massage any moisturizers, lotions, creams, and petroleum-based ointments completely into the skin before donning the garment.
Correct answer:
When using a pressure garment, the nurse should instruct the client to wear the garment for at least 23 hours a day, not 12 hours a day. The client should contact the primary provider if the garment does not seem to fit. The nurse should instruct the client to hand wash, not machine wash, the pressure garment daily with a mild detergent. The garment should not be wring dry. Instead, the client should squeeze and roll the garment in a towel to remove as much moisture as possible. The client should also massage any moisturizers, lotions, creams, and petroleum-based ointments completely into the skin before donning the garment.
A patient diagnosed with borderline personality disorder and a history of self-mutilation has now begun dialectical behavior therapy (DBT) on an outpatient basis. Today the patient telephones to say, 'I'm feeling empty and want to cut myself.' The nurse should implement what intervention?
A. Arrange for emergency inpatient hospitalization.
B. Send the patient to the crisis intervention unit for 8 to 12 hours.
C. Assist the patient to identify the trigger situation and choose a coping strategy.
D. Advise the patient to take an antianxiety medication to decrease the anxiety level.
Correct answer:
The patient has responded appropriately to the urge for self-harm by calling a helping individual. A component of dialectical behavior therapy is telephone access to the therapist for 'coaching' during crises. The nurse can assist the patient to choose an alternative to self-mutilation. The need for a protective environment may not be necessary if the patient is able to use cognitive strategies to determine a coping strategy that reduces the urge to mutilate. Taking a sedative and going to sleep should not be the first-line intervention; sedation may reduce the patient's ability to weigh alternatives to mutilating behavior.
The nurse is assessing a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which of the following assessment data is a priority?
A. The patient complains of incisional pain.
B. The patient 's heart rate is 110 beats/minute.
C. The patient is unable to detect when the eyelids are touched
D. The skin around the incision is pale and cold when palpated.
Correct answer:
Pale, cool skin indicates a possible decrease in circulation, so the surgeon should be notified immediately. Warm, pink skin that blanches with pressure indicates that adequate circulation is present in the surgical area. The other assessment data indicate a need for ongoing assessment or nursing action. A heart rate of 110 may be related to the stress associated with surgery, assessment of other vital signs and continued monitoring are appropriate. Because local anaesthesia would be used for the procedure, numbness of the incisional area is expected immediately after surgery. The nurse should monitor for return of feeling.
The school reviewed the pediculosis capitis (head lice) policy and removed the no nit requirement. The nurse explains that now, when a child is found to have nits, the parents must do which before the child can return to school?
A. No treatment is necessary with the policy change.
B. Shampoo and then trim the childs hair to prevent reinfestation.
C. The child can remain in school with treatment done at home.
D. Treat the child with a shampoo to treat lice and comb with a fine-tooth comb every day until nits are eliminated.
Correct answer:
Many children have missed significant amounts of school time with no nit policies. The child should be appropriately treated with a pediculicide and a fine-tooth comb. The environment needs to be treated to prevent reinfestation. The treatment with the pediculicide will kill the lice and leave nit casings. Cutting the childs hair is not recommended; lice infest short hair as well as long. With a no nit policy, treating the child with a shampoo to treat lice and combing the hair with a fine-tooth comb every day until nits are eliminated is the correct treatment. The policy change recognizes that most nits do not become lice.
Following cataract removal, the client receives discharge instructions from the nurse. Which of the following instructions is most important?
A. Apply a protective patch to the affected eye at bedtime.
B. For the first 48 hours, avoid any activity that could cause particles to lodge in the eye.
C. Avoid washing face and eyes for the first 24 hours.
D. Avoid heavy lifting for 1 week.
Correct answer:
For at least 1 week, the client should avoid strenuous activity and heavy lifting; bending, stooping, or other exercises that potentially increase intraocular pressure; immersing the eyes in water (clients may use a clean damp cloth to remove any eye discharge); and any activity that could cause dust or other particles to lodge in the eye. Clients may sleep on the back or unaffected side. The client should wear a protective eye shield for 24 hours after the procedure and then at night and during naps for about a week. Therefore, it is insufficient for the nurse to instruct the client to wear a protective shield at bedtime.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 14 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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