Nursing textbooks medical-surgical practice questions, set 17
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 17
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
Nursing students enrolled in a leadership and management course attend clinical on a surgical unit. As they are planning their day, they note one student has a complex patient with multiple medications and the need for frequent turning, pressure injury wound care, and tube feedings. Which action by the group best reflects effective teamwork and coordination?
A. Asking patients to prioritize what they want to accomplish each day
B. Including a 'nice to do' for every 'need to do' task on the list
C. Front loading' their schedules with 'must do' priorities
D. Scheduling times to assist the student with the complex patient
Show answer and rationale
Correct answer: D — Scheduling times to assist the student with the complex patient
The students use teamwork and collaboration to appropriately coordinate patient care; this is the best response. By asking the patient to prioritize what they want to accomplish each day, the nurse is demonstrating an effective time management technique. To manage time, the nurse should establish goals and priorities for each day, differentiating 'need to do' from 'nice to do' tasks; the nurse should include the patient in this process. The nurse should also establish a time line, allocating priorities to hours in the workday in to keep track of falling behind and correct the problem before the day is lost.
Question 2
A nurse is caring for a client following a culdoscopy. Which assessment data would the licensed practical nurse report to the registered nurse?
A. Pain level of 7 on the 0-to-10 pain scale
B. Skin, cold, pulse, 110 beat/minute, blood pressure, 104/64 mm Hg
C. Dark drainage noted on surgical pad
D. Fleshy smell noted to perineal region
Show answer and rationale
Correct answer: B — Skin, cold, pulse, 110 beat/minute, blood pressure, 104/64 mm Hg
Culdoscopy is performed to visualize the uterus, broad ligaments, and fallopian tubes. An endoscope is inserted through a small incision made in the posterior vaginal wall. Afterward, the nurse must observe for signs of internal bleeding and shock. A client with cold and clammy skin, a rapid pulse, and low blood pressure indicates shock and the need to consult the registered nurse and even the physician. All of the other symptoms are able to be addressed by the licensed practical nurse. The client is to be medicated. Dark drainage and a fleshy smell to the perineal area are normal for old surgical drainage.
Question 3
Which of the following patients should the nurse recognize as being at the highest risk for the development of osteomyelitis?
A. A middle-age adult who takes ibuprofen daily for rheumatoid arthritis
B. An elderly patient with an infected pressure ulcer in the sacral area
C. A 17-year-old football player who had orthopedic surgery 6 weeks prior
D. An infant diagnosed with jaundice
Show answer and rationale
Correct answer: B — An elderly patient with an infected pressure ulcer in the sacral area
Patients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly patient with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this patient has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The patient with rheumatoid arthritis has one risk factor and the infant with jaundice has no identifiable risk factors. The patient 6 weeks postsurgery is beyond the usual window of time for the development of a postoperative surgical wound infection.
Question 4
The nurse is performing an assessment of a patient. Which assessment findings may indicate a higher risk for genetic disorders?
A. The patient's father was diagnosed with heart disease at 60 years of age.
B. The patient's mother was diagnosed with breast cancer at 33 years of age.
C. The patient's grandfather died of a cerebral vascular accident at 78 years of age.
D. The patient's sister has a history of both renal and lung cancer.
E. The patient has two uncles and a grandparent who have been diagnosed with Alzheimer's disease.
Show answer and rationale
Correct answer: B — The patient's mother was diagnosed with breast cancer at 33 years of age.
The nurse should assess for factors that may indicate a risk for genetic disorders. A few examples of factors that may indicate a risk for genetic disorders are a higher incidence of a particular disease or disorder in the patient's family than in the general population; diagnosis of a disease in family members at an unusually young age; or diagnosis of a family member with an unusual form of cancer or with more than one type of cancer. The options regarding heart disease at 60 years of age and cerebral vascular accident at 78 years of age are not factors that indicate a higher risk for genetic disorders.
Question 5
A client is in a driving accident creating a spinal cord injury. The nurse caring for a client realizes that the client is at risk for which type of shock?
A. Anaphylactic
B. Neurogenic
C. Septic
D. Obstructive
Show answer and rationale
Correct answer: B — Neurogenic
Neurogenic shock results from an insult to the vasomotor center of the medulla or to the peripheral nerves that extend from the spinal cord to the blood vessels. The tone of the sympathetic nervous system is impaired, resulting in deceased arterial vascular resistance, vasodilation, and hypotension. Anaphylactic shock has vasodilation also as a key characteristic, along with increased capillary permeability, swelling of the airway, hives, and itching. Septic shock is associated with overwhelming bacterial infections. Obstructive shock is when there is an interference of blood flow in and out of the heart.
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Question 6
A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?
A. Vaso-occlusive crisis
B. Pneumocystis pneumonia
C. Acute chest syndrome
D. Acute muscular strain
Correct answer:
One of the unique manifestations of sickle cell disease is 'acute chest syndrome,' a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion and predisposes the client to pneumonia but is not the present problem with this client. Pneumocystis pneumonia is present in the client with HIV/AIDS or other immunocompromised clients. The client's symptoms do not correlate with a diagnosis of acute muscular strain.
The nurse is collecting objective data from the client with lymphedema of the left leg. The nurse observes that the affected leg is 10 cm greater in measurement than the unaffected leg. The affected leg is hot to the touch and red. What classification of lymphedema does the nurse recognize this client has?
A. Grade I (Mild)
B. Grade II (Moderate)
C. Grade III (Severe)
D. Grade IV (Extreme)
Correct answer:
In severe, the circumference of the affected limb is 8 cm greater than the unaffected limb, involves the entire limb, or is accompanied by infection or cellulitis (inflammation of connective tissue in or close to the skin). Mild is the circumference of the limb is 2 cm, but not more than 4 cm larger than the unaffected limb; client is asymptomatic. Moderate lymphedema is the circumference of the affected limb is 4 cm, but not more than 8 cm larger than the unaffected limb; client experiences symptoms such as heaviness in the limb, pain, and limited movement. There is no classification considered extreme.
A client is prescribed preanesthetic drugs prior to surgery. Which of the following nursing interventions should the nurse perform when caring for this client before the administration of preanesthetic drugs?
A. Explain postoperative client activities.
B. Check the client every 5 to 15 minutes.
C. Assess the respiratory status of the client.
D. Admit the client to an appropriate unit.
Correct answer:
When caring for a client prescribed preanesthetic drugs, the nurse should demonstrate, describe, and explain postoperative client activities, such as deep breathing, coughing, and leg exercises. The nurse should check the client every 5 to 15 minutes for emergence from anesthesia, but this is done after the administration of anesthesia, not before. Assessing the respiratory status of the client and admitting the client to an appropriate unit are both postoperative interventions that a nurse should perform. Therefore, these are not performed before the administration of preanesthetic drugs and anesthesia.
A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses anger and irritation when her call bell isnt answered immediately. What would be the most appropriate response?
A. You seem like youre feeling angry. Is that something that we could talk about?
B. Try to remember that stress can make your symptoms worse.
C. Would you like to talk about the problem with the nursing supervisor?
D. I can see youre angry. Ill come back when youve calmed down.
Correct answer:
The changes and the unpredictable course of SLE necessitate expert assessment skills and nursing care, as well as sensitivity to the psychological reactions of the patient. Offering to listen to the patient express anger can help the nurse and the patient understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the patient to calm down doesn't acknowledge her feelings. Ignoring the patients feelings suggests that the nurse has no interest in what the patient has said. Offering to get the nursing supervisor also does not acknowledge the patients feelings.
A staff nurse tells a new graduate nurse not to bother studying too hard, since most clinical reasoning becomes second nature and intuitive once they begin practicing. Which response by the student is appropriate?
A. Intuitive problem solving comes with years of practice and observation based on nursing knowledge and science.
B. For nursing to remain a science, nurses must continue to be vigilant about avoiding intuitive reasoning.
C. The emphasis on logical, scientific, evidence-based reasoning has held nursing back; we need intuitive, creative thinkers.
D. The nurse's preference dictates whether they are logical, scientific thinkers or intuitive, creative thinkers.
Correct answer:
When intuition is used alone, increased risks and fewer benefits may occur. Beginning nurses must use nursing knowledge and scientific problem solving as the basis of care; intuitive problem solving comes with years of practice and observation. If the beginning nurse has an intuition about a patient, that information should be discussed with the faculty member, preceptor, or supervisor. There is a place for intuitive reasoning in nursing, but it will augment, not replace logical, scientific reasoning. Critical thinking is contextual and changes depending on the circumstances, not on personal preference.
When changing the position of a patient with a spinal cord injury at T4, the nurse should recognize that what symptom is an indication of an episode of autonomic dysreflexia?
A. Nausea
B. Pallor
C. Goose bumps
D. Dizziness
Correct answer:
Patients with spinal cord lesions above T5 may experience sudden and extreme elevations in blood pressure caused by a reflex action of the autonomic nervous system. It is produced by stimulation of the body below the level of the injury, usually by a distended bladder from a blocked catheter. Any stimulation can produce the syndrome, including constipation, diarrhea, sexual activity, pressure injuries, position changes (from lying to sitting), and even wrinkles in clothing or bed sheets. Other symptoms may include diaphoresis, shivering, goose bumps, flushing of the skin, and a severe pounding headache.
The client arrives at the emergency department reporting symptoms of heart palpitations, tightness in the chest, and epigastric pain after a stressful event. What system will the nurse correlate with the client symptoms?
A. Respiratory system
B. Autonomic nervous system
C. Cardiopulmonary system
D. Central nervous system
Correct answer:
The nurse is correct to correlate stress and the symptoms, which stem from organs affected by the autonomic nervous system. Clients may present with heart palpitations, pounding headache, breathlessness, tightness in the chest, chest pain, chronic pain, irritability, epigastric pain, abdominal discomfort and bloating, or constipation and diarrhea. The respiratory system is affected by stress, but the client's symptoms do not correlate to the respiratory system. The symptoms extend beyond cardiopulmonary system effects. The central nervous system is involved in only the brain and the spinal cord effects.
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
A. Low oxalate
B. Low purine
C. High protein
D. High sodium
Correct answer:
A low-purine diet is used for uric acid stones, the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalcium?ó??approximately half of the clients?ó??need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.
A nurse in the emergency department is caring for a patient who was brought in by fire rescue due to a heroin overdose. The nurse notes the patient is not breathing. What action will the nurse take immediately?
A. Tilt the patient's head forward.
B. Begin ventilation using a manual resuscitation bag (Ambu bag).
C. Place the mask tightly over the patient's nose and mouth.
D. Pull the patient's jaw backward.
E. Compress the bag twice the normal respiratory rate for the patient.
Correct answer:
The priority is to establish ventilation using the manual resuscitation bag to provide emergency or rescue breathing. The nurse tilts the head back, pulls the jaw forward, and positions the mask tightly over the patient's nose and mouth. The bag is compressed at a rate that approximates normal respiratory rate (e.g., 12 to 20 breaths/min in adults). Sputum for cytology is done primarily to detect cells that may be malignant, determine organisms causing infection, and identify blood or pus in the sputum. Note that the bag, with the mask removed, also fits easily over tracheostomy and endotracheal tubes.
The nurse is obtaining medication history information from a client with Crohn's disease. What medication would the nurse include when asking what medications the client has taken for suppression of the inflammatory and immune response?
A. Nonsteroidal anti-inflammatory
B. Angiotensin-converting enzyme inhibitors (ACE-I)
C. Diuretics
D. Corticosteroids
Correct answer:
The nurse obtains a history of immunizations, recent and past infectious diseases, and recent exposure to infectious diseases. The nurse reviews the client's drug history because certain drugs, such as corticosteroids, suppress the inflammatory and immune responses. Nonsteroidal anti-inflammatory medication does not suppress the inflammatory and immune responses of Crohn's disease. An ACE-I prevents the conversion of angiotensin I to angiotensin II and does not suppress the inflammatory or immune response. Diuretics also do not suppress the immune response but help reduce excess fluid from the kidneys.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 17 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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