Nursing textbooks medical-surgical practice questions, set 15
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 15
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 nurse is assessing the postoperative client on the second postoperative day. What assessment finding requires the nurse to immediately notify the health care provider?
A. The client has an absence of bowel sounds.
B. The client's lungs reveal rales in the bases.
C. The client states a moderate amount of pain at the incisional site.
D. A moderate amount of serous drainage is noted on the operative dressing.
Show answer and rationale
Correct answer: A — The client has an absence of bowel sounds.
A nursing assessment finding of concern on the second postoperative day is the absence of bowel sounds, which may indicate a paralytic ileus. Other assessment findings may include abdominal pain and distention as fluids, solids, and gas do not move through the intestinal tract. Rales in the bases are a frequent finding postoperatively, especially if general anesthesia was administered. Encourage the client to cough and breathe deep. Pain is a common symptom following a surgical procedure. Serous drainage on the postoperative dressing needs to be monitored and brought to the physician's attention when assessing the client.
Question 2
A client comes to the orthopedic clinic and reports having pain that radiates down the forearm and being unable to grasp objects firmly. What does the nurse suspect is occurring with the client?
A. Carpal tunnel syndrome
B. Ganglion cyst
C. Epicondylitis
D. Shoulder dislocation
Show answer and rationale
Correct answer: C — Epicondylitis
Epicondylitis (tennis elbow) is a painful inflammation of the elbow that is caused by injury following excessive pronation and supination of the forearm, such as that which occurs when playing tennis, pitching a ball, or rowing. Client reports pain radiating down the dorsal surface of the forearm and a weak grasp. Carpal tunnel syndrome is compression of the median nerve and affects the hand with burning. Pain is more prominent in the early morning or at night. The pain of a ganglion cyst is more localized in the area of the cyst. The symptoms the client describes do not correlate with a diagnosis of shoulder dislocation.
Question 3
A nurse in the PACU is preparing to receive a patient from surgery who sustained a ruptured spleen in a motor vehicle accident. Which of these system assessments will take priority?
A. Neurologic system, ambulatory function
B. Cardiovascular system, vital signs
C. GI system, bowel function
D. Integumentary, skin breakdown
Show answer and rationale
Correct answer: B — Cardiovascular system, vital signs
The priority assessment focuses on the ruptured organ, blood loss, and monitoring for early signs of shock. Tachycardia, the first sign of shock, and decreasing blood pressure must be immediately reported to the health care provider. The neurologic system may be affected due to anesthesia, but ambulatory function is not the immediate priority. The nurse anticipates reduced or absent bowel sounds after surgery, but risk for blood loss is the priority. The nurse plans to promote wound healing and repositions the patient to prevent skin breakdown; however, hemorrhage and early detection of shock is the priority at this time.
Question 4
A nurse is caring for a client who is required to take NSAIDS on an outpatient basis. Which of the following would the nurse include in the teaching plan for the client and family?
A. Take aspirin if necessary strictly with a full glass of water.
B. Use the drug on a very regular basis during treatment.
C. Call your primary care provider if you have no relief after 2 weeks.
D. Take the drugs strictly with a glass of milk or juice.
Show answer and rationale
Correct answer: C — Call your primary care provider if you have no relief after 2 weeks.
The nurse should instruct the patient to consult the primary health care provider if the pain, swelling, inflammation, or tendemess is not relieved after 2 weeks. The drug takes several days to relieve the discomfort, so it is important for the patient to give the drug time to work. The nurse should instruct the patient to avoid the use of aspirin. The drug should be taken with a full glass of water or with food. It is not necessary to take NSAIDs strictly with a glass of juice or milk. These drugs are not to be used on a regular basis unless the patient is strictly instructed to do so by the primary health care provider.
Question 5
Which are examples of passive listening?
A. The nurse nods frequently while the patient speaks.
B. The nurse maintains eye contact while listening to the patient.
C. The nurse occasionally interjects "I see" when listening to the patient.
D. The nurse gives verbal feedback to the patient.
E. The nurse verbally interprets the meaning of what the patient has said.
Show answer and rationale
Correct answer: A — The nurse nods frequently while the patient speaks.
Listening is sometimes active and sometimes passive. Active listening requires full attention to what the patient is saying. The message is heard, its meaning is interpreted, and the patient is given feedback, indicating understanding of the message. Verbally interpreting the meaning of what the patient has said is an example of active listening. In passive listening, the nurse indicates that they are listening to what the patient is saying either nonverbally, through eye contact and nodding, or verbally through encouraging phrases such as 'Uh-huh' and 'I see.' All of the other options are examples of passive listening.
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Question 6
A client who is receiving a b blocker tells the nurse that he also takes ibuprofen for arthritis pain. The nurse would be alert for which of the following?
A. Decreased effect of the b blocker
B. Increased risk of bradycardia
C. Increased risk of paradoxical hypertensive effect
D. Increase risk of hypotension
Correct answer:
The nurse should monitor for the decreased effect of the b blocker in the client who is receiving a b blocker along with NSAIDs. The nurse need not monitor for increased risk of bradycardia and paradoxical hypertensive effect or decreased risk of hypotension. There is an increase in the risk of paradoxical hypertensive effect when a b-adrenergic blocking drug is administered with clonidine. There is an increase in the risk of bradycardia when a b-adrenergic blocking drug is administered with antidepressants. There is an increased risk of hypotension when a b-adrenergic blocking drug is administered with loop diuretics.
A 19-year-old patient with a diagnosis of Down syndrome is being admitted to your unit for the treatment of community-acquired pneumonia. When planning this patients care, the nurse recognizes that this patients disability is categorized as what?
A. A sensory disability
B. A developmental disability
C. An acquired disability
D. An age-associated disability
Correct answer:
Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy. Acquired disabilities may occur as a result of an acute and sudden injury, acute nontraumatic disorders, or progression of a chronic disorder. Age-related disabilities are those that occur in the elderly population and are thought to be due to the aging process. A sensory disability is a type of a disability and not a category.
A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client reports not being able to feel or move the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?
A. Compartment syndrome
B. Dislocation
C. Muscle spasms
D. Subluxation
Correct answer:
Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.
A nurse is caring for a patient who is receiving penicillin. The nurse would assess for which of the following as a common adverse reaction?
A. Inflammation of the tongue and mouth
B. Impaired oral mucous membranes
C. Severe hypotension
D. Sudden loss of consciousness
Correct answer:
Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless the adverse effects are severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.
To what do you attribute this elevation in blood sugars?
A. It is a temporary result of increased secretion of antidiuretic hormone.
B. She must have had diabetes prior to surgery that was undiagnosed.
C. She has suffered pancreatic trauma during her abdominal surgery.
D. The blood sugars are probably a result of the fight-or-flight reaction.
Correct answer:
During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress-induced hyperglycemia. No evidence presented in the question other than elevated blood sugars would support a diagnosis of diabetes.
The patient asks the nurse about taking large doses of vitamin C to improve her immunity to colds. 'It's just a vitamin, right? What can happen?' Which responses by the nurse are correct? (Select all that apply.)
A. Vitamin C is harmless because it is a water-soluble vitamin.
B. Large doses of vitamin C can cause nausea, vomiting, headache, and abdominal cramps.
C. Keep in mind that if you suddenly stop taking these large doses, you might experience symptoms similar to scurvy.
D. Studies have shown that vitamin C has little value in preventing the common cold.
E. Vitamin C acidifies the urine, which can lead to the formation of kidney stones.
Correct answer:
Vitamin C is usually nontoxic unless excessive dosages are consumed. Large doses (megadoses) can produce nausea, vomiting, headache, and abdominal cramps, and they acidify the urine, which can result in the formation of kidney stones. Furthermore, individuals who discontinue taking excessive daily doses of ascorbic acid can experience scurvy-like symptoms. Studies have shown that megadoses of vitamin C have little or no value as prophylaxis against the common cold. Vitamin C is required for several important metabolic activities, including collagen synthesis and the maintenance of connective tissue and tissue repair.
A patient experiencing chest pain asks the nurse why a nitroglycerin tablet must be placed under their tongue instead of swallowed. Which answer by the nurse is appropriate?
A. We could put the tablet between the cheek and gum, instead.'
B. The area is rich in superficial blood vessels, and helps with absorption.'
C. Swallowing interferes with quick systemic effects.'
D. This is an enteric-coated tablet, designed for absorption outside the stomach.'
Correct answer:
Drugs with extensive or variable first-pass effects, such as nitroglycerin, are not given orally because most of the drug would be destroyed by the liver, with little or no drug left to work in the body. Sublingual medications should not be swallowed, but rather held in place so that complete absorption can occur. Before administering a sublingual or buccal drug, offer the patient water (if permitted) or oral care (if NPO). Placing a tablet between the cheek and gum is consistent with the buccal route of administration, not sublingual. Enteric-coated tablets are designed to dissolve after passing through the stomach.
The nurse is admitting an older-adult patient who is hospitalized with an acute illness. Which of the following interventions should the nurse do first?
A. Orientate the patient to their room.
B. Administer the prescribed PRN sedative medication.
C. Ask the health care provider to order a vest restraint.
D. Place the patient in a 'geri chair' near the nurse's station for observation.
Correct answer:
The older adult who moves to a different location needs a thorough orientation to the environment. The nurse should repeatedly reassure the patient that he or she is safe and attempt to answer all questions. The unit should foster patient orientation by displaying large-print clocks, avoiding complex or visually confusing wall designs, clearly designating doors, and using simple bed and nurse-call systems. Physical or chemical restraints may be necessary, but the nurse's first action should be to provide an ongoing and clear physical orientation. There is no indication that the patient needs observation at this time.
The nurse is caring for a patient admitted to hospital with chest pain who is a pack-a-day smoker and tells the nurse, 'I am just not ready to quit smoking yet.' Which of the following responses is the most appropriate?
A. This would be a really good time to quit.
B. Your smoking is the cause of your chest pain.
C. Do you think that smoking has caused any health problems?
D. Are you familiar with the various nicotine replacement options?
Correct answer:
The patient is in the precontemplation stage of change, and the nurse's role is to assist the patient in identifying motivators to quitting. The current Clinical Practice Guidelines indicate that the nurse should ask the patient to identify any negative consequences from smoking. The responses 'This would be a really good time to quit.' and 'Your smoking is the cause of your chest pain.' express judgmental feelings by the nurse and are not likely to motivate the patient. Providing information about the various nicotine replacement options would be appropriate for a patient who has expressed a desire to quit smoking.
Which of the following complementary and alternative therapies uses 7,000 nerve endings to improve the body's ability to facilitate natural healing?
A. Reflexology
B. Magnetism
C. Acupuncture
D. Chiropractic
Correct answer:
Practitioners of reflexology claim that reflex centers in the extremities have more than 7,000 nerve endings connected to the body organs and tissues. When pressure is applied to one reflex center, the impulse travels to the spinal cord and brain. This reconditioning of the neural reflex facilitates natural healing. Magnetism seeks to cure by influencing the natural magnetic field of body cells. Acupuncture is a procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes. Chiropractors manipulate the spine to correct its misalignment.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 15 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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