Nursing textbooks medical-surgical practice questions, set 19
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 19
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 in a pediatric unit notes a school-aged child snores and appears to have labored breathing during sleep. Which assessment question could the nurse ask the patient or parents?
A. Do you have trouble sleeping?
B. Have you missed a lot of school due to not feeling well?
C. Have you been wetting the bed lately?
D. Do you have a history of high blood pressure?
Show answer and rationale
Correct answer: C — Have you been wetting the bed lately?
OSA (pediatric) is defined by the presence of snoring, labored/obstructed breathing, enuresis, or daytime consequences (hyperactivity or other neurobehavioral problems, sleepiness, fatigue). Adults, children, and adolescents with symptoms of OSA, including snoring, should have polysomnography to confirm the diagnosis. Although OSA may cause insomnia, this is not the primary diagnosis in this case. Narcolepsy is a condition characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. Hypertension is a consequence of OSA in adults.
Question 2
A nurse is caring for a client with hypertension who is prescribed epoetin alfa for anemia. Which of the following would the nurse include in the plan of care when administering this drug to the client?
A. Report 10 mm Hg rise in systolic blood pressure to primary health care provider.
B. Note the hematocrit value before each dose during therapy.
C. Shake the drug well before it is administered to the client.
D. Administer the drug once every 3 weeks through IV route.
Show answer and rationale
Correct answer: B — Note the hematocrit value before each dose during therapy.
When caring for a client who is prescribed epoetin alfa, the nurse should measure the hematocrit before each dose during the drug therapy. The nurse should monitor the blood pressure of a client with hypertension when he is receiving epoetin alfa and report any rise of 20 mm Hg or more in the systolic or diastolic pressure to the primary health care provider. The drug is given three times weekly IV or SC. If the client is receiving dialysis, the drug is administered into the venous access line. The drug is mixed gently during preparation for administration. Shaking may denature the glycoprotein.
Question 3
When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include what characteristics?
A. Preoccupation with minute details; perfectionist
B. Charming, dramatic, seductive; seeking admiration.
C. Difficulty being alone; indecisiveness, submissiveness.
D. Lack of empathy, exploitive, and arrogance.
Show answer and rationale
Correct answer: D — Lack of empathy, exploitive, and arrogance.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the characteristics of lacking empathy, exploitation of others, and arrogance are consistent with narcissistic personality disorder. Charm, drama, seductiveness, and admiration seeking are observed in patients diagnosed with histrionic personality disorder. Preoccupation with minute details and perfectionism are observed in individuals diagnosed with obsessive-compulsive personality disorder. Patients diagnosed with dependent personality disorder often express difficulty being alone and are indecisive and submissive.
Question 4
The nurse is caring for a patient with a T2 spinal cord injury who tells the nurse, 'I feel awful today. My head is throbbing, and I feel sick to my stomach.' Which of the following actions should the nurse take first?
A. Assess for a fecal impaction.
B. Give the prescribed antiemetic.
C. Check the blood pressure (BP).
D. Notify the health care provider.
Show answer and rationale
Correct answer: C — Check the blood pressure (BP).
The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is occurring. Notification of the patient's health care provider is appropriate after the BP is obtained. Administration of an antiemetic is indicated after autonomic dysreflexia is ruled out as the cause of the nausea. The nurse may assess for a fecal impaction, but this should be done after checking the BP and lidocaine jelly should be used when performing a digital rectal exam to prevent further symptoms such as increases in the BP.
Question 5
A client has end-stage chronic obstructive pulmonary disease (COPD) and is terminally ill. The family wants the client to spend their last days in a facility that will be able to keep the client comfortable and control their severe dyspnea. What facility will meet the needs of the client and family?
A. Rehabilitation care
B. Hospice care
C. Intermediate care facilities
D. Ambulatory care
Show answer and rationale
Correct answer: B — Hospice care
Hospice provides care for clients diagnosed with a terminal illness whose life expectancy is fewer than 6 months. Hospices allow terminally ill clients to live as fully as possible while managing pain, discomfort, and other symptoms. Rehabilitation centers provide physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Ambulatory care is also outpatient care.
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Question 6
A nurse counsels a patient diagnosed with serious and persistent mental illness. The patient lives at home with family. Which resource could the nurse suggest assisting the patient and family to cope with the stigma of mental illness as well as provide support and education?
A. American Psychiatric Association (APA)
B. National Alliance on Mental Illness (NAMI)
C. Community Mental Health Centers (CMHCs)
D. Programs of Assertive Community Treatment (PACT)
Correct answer:
Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. The organization also offers patient and family support and education about living with mental illness. Community Mental Health Centers (CMHCs) are government agencies that provide outpatient services to persons diagnosed with SPMI. The APA is the professional organization of psychiatrists. Programs of Assertive Community Treatment (PACT) use a treatment team approach to improve symptom management and quality of life for persons diagnosed with SPMI.
The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. What is the rationale for this statement by the nurse?
A. Trauma and microabrasions from a non-electric razor may contribute to anemia.
B. Strong tissues and intact clotting mechanisms may prevent hemorrhage.
C. The client is at risk for spontaneous and uncontrolled bleeding.
D. The client is not at risk for infection from microorganisms.
Correct answer:
In a client with leukemia who is at risk for hemorrhage, the nurse handles the client gently when assisting and encourages the client to use electric razors. Trauma and microabrasions from razors may contribute to anemia from bleeding. Fragile tissues and altered clotting mechanisms may result in hemorrhage even after minor trauma. Therefore, the nurse inspects the skin for signs of bruising and petechiae and reports melena, hematuria, or epistaxis (nosebleeds). The risks for spontaneous and uncontrolled bleeding or infection from microorganisms are not addressed by the use of electric razors.
A female client hospitalized for an unrelated problem has a large partly-white lesion on her lip, to which she is the nurse or health care provider. What action by the nurse is best?
A. Ask the client why her appearance is so important
B. Ignore the lesion since the client and not discuss it
C. Inform the client that early-stage cancer is curable
D. Know with the client to establish a trusting relationship
Correct answer:
Clients with oral cancers often have body image difficulties due to the location of the tumor or the results of surgical treatment. This client appears to be using denial to cope with this problem. The nurse should work to establish a helping-trusting relationship in hopes that the client will be amenable to future discussions about the lesion. Asking why questions often puts people on the defensive and should be avoided. Ignoring the lesion is not being an advocate for the client. Education is important, but right now the client is in denial, so this information will not seem relevant to her.
The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurses response should be based on which characteristic about preterm infants pain?
A. They may react to painful stimuli but are unable to remember the pain experience.
B. They perceive and react to pain in much the same manner as children and adults.
C. They do not have the cortical and subcortical centers that are needed for pain perception.
D. They lack neurochemical systems associated with pain transmission and modulation.
Correct answer:
Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.
A client adopted at birth recently discovers that Huntington disease is prevalent in the biological family history. The nurse is providing education to the client about the condition. Which statement(s) should the nurse include in the teaching? Select all that apply.
A. In the early stages, people with the disease can participate in most physical activities.
B. The disease eventually leads to hallucinations, delusions, impaired judgment, and increased intensity of abnormal movements.
C. Disease-modifying medications for Huntington disease can decrease immune cells and infection protection.
D. There are specific tests that can be arranged to diagnose whether or not you have the disorder.
E. Huntington disease is familial; it is not transmitted genetically.
Correct answer:
In teaching the client about Huntington disease, the nurse will explain to the client that people with the disease can participate in most physical activities in the early stages, but that the disease eventually causes hallucinations, delusions, impaired judgment, and increased intensity of abnormal movements. The nurse will go on to inform the client that medications for Huntington disease can decrease immune cells and immune protection. There are no specific diagnostic tests for this disorder, and it is transmitted genetically; thus, the nurse will leave out these statements in the teaching.
A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, "My heart misses beats. I'm frequently absent from work. I don't go out much because I need to rest." Which health problem is most likely?
A. Depersonalization disorder
B. Antisocial personality disorder
C. Illness anxiety disorder
D. Persistent depressive disorder
Correct answer:
Illness anxiety disorder (hypochondriasis) involves a preoccupation with fears of having a serious disease, even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Depersonalization disorder involves recurrent periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception. Persistent depressive disorder (dysthymia) is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others.
A nurse is caring for a 70-year-old client undergoing antiparkinsonism drug therapy. The client is prescribed pramipexole by the physician. The nurse should monitor the client's condition for the development of which of the following adverse reactions associated with the use of this drug?
A. Blurred vision
B. Memory loss
C. Visual hallucinations
D. Muscular rigidity
Correct answer:
The nurse should monitor the elderly client who is administered a dopamine receptor antagonist for signs of visual, auditory, or tactile hallucinations. Hallucinations occur more often in older adults than in younger adults receiving the antiparkinsonism drugs, especially when taking the dopamine receptor agonists. The incidence of hallucinations appears to increase with age. The nurse need not monitor the clients condition for signs of blurred vision, memory loss, and muscular rigidity as these conditions are not known to occur in elderly clients due to the use of dopamine receptor agonists.
The client is referred from the physician to a cardiologist for a cardiac catheterization to determine if the client has coronary artery disease. What type of care does the nurse understand that this is?
A. Primary care
B. Secondary care
C. Tertiary care
D. Acute care
Correct answer:
Secondary care includes referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis as well as emergency and acute care interventions. This client falls into this category due to the referral to the cardiologist for the cardiac catheterization. The client does not fall into the acute care category. Primary care would include being seen by the client's primary physician. Tertiary care focuses more on complex medical and surgical interventions, cancer care, rehabilitative services, long-term care such as burn care, and palliative and hospice care.
A patient being treated with paroxetine 50 mg/day orally for major depressive disorder reports to the clinic nurse, 'I took a few extra tablets earlier in the day and now I feel bad.' Which aspects of the nursing assessment are most critical?
A. Vital signs
B. Urinary frequency
C. Increased suicidal ideation
D. Presence of abdominal pain and diarrhea
E. Hyperactivity or feelings of restlessness
Correct answer:
The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. Although assessing for suicidal ideation is never inappropriate, in this situation physiological symptoms should be the initial focus. The patient may have urinary retention, but frequency would not be expected.
A patient is receiving chloroquine. The nurse would instruct the client to do which of the following?
A. Avoid foods that acidify the urine.
B. Take the drug on an empty stomach.
C. Increase dosage if dosage missed once.
D. Discontinue drug if color of urine changes.
Correct answer:
The nurse should educate the patient to avoid foods that acidify the urine (cranberries, plums, prunes, meats, cheeses, eggs, fish, and grains), as they may interact with the antimalarial drug and increase excretion and thereby decrease the effectiveness of chloroquine while taking the drug. Taking the drug on an empty stomach is not advisable for antimalarial drugs. The nurse should instruct the patient to adhere to the dosage regimen unless instructed otherwise. Yellow or brownish discoloration of the urine during chloroquine treatment is normal; there is no need to discontinue the therapy.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 19 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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