Nursing textbooks medical-surgical practice questions, set 2
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 2
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
An older-adult patient who is having difficulty breathing is admitted to the hospital. Which of the following approaches is the best for the nurse to use to obtain a complete health history?
A. Obtain subjective data about the patient from family members.
B. Omit subjective data collection and obtain the physical examination.
C. Use the health care provider's medical history to obtain subjective data.
D. Schedule several short sessions with the patient to gather subjective data.
Show answer and rationale
Correct answer: D — Schedule several short sessions with the patient to gather subjective data.
In the case of an older-adult patient with a low energy level, several short sessions may have to be scheduled. Allowing time for the patient to volunteer information about particular areas of concern enables the nurse to work with the patient to identify existing and potential health problems. In an emergency situation, the nurse may need to ask only the most pertinent questions for a specific problem and obtain more information later. A complete health history will include subjective information that is not available in the health care provider's medical history. Family members may be able to provide some subjective data, but only the patient will be able to give subjective information about the shortness of breath. Since the subjective data about the patient's respiratory status will be essential, obtaining the physical examination alone will not provide sufficient information.
Question 2
A chief nursing officer with a transformational leadership style is developing a plan for success to obtain Magnet status. What are the most appropriate strategies for the leader to use? Select all that apply.
A. Sharing their vision of excellence in patient care and high-level education
B. Encouraging nurses to incorporate evidence-based practice through hospital committees and to join nursing organizations
C. Promoting compliance by reminding subordinates that they have a good salary and working conditions
D. Ensuring employees are kept abreast of new developments in their department and the larger organization
E. Writing the Magnet application and supporting documentation with limited input from the nursing staff
Show answer and rationale
Correct answer: A — Sharing their vision of excellence in patient care and high-level education
Transformational leaders inspire, motivate, create intellectually stimulating practice environments, and challenge themselves and others to grow personally and professionally. They demonstrate caring and vulnerability, communicating honestly and openly. They are risk takers and pay attention to process as well as outcomes. Instituting a reward program and reminding workers that they have a good salary and working conditions are examples of transactional leadership, which is based on a task-and-reward orientation. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.
Question 3
What statement by the nurse shows an understanding of the vision of Healthy People 2030?
A. The vision is a society in which all people can achieve their full potential for health'
B. The vision is that they will find a cure for diabetes.'
C. The vision is that everyone be within a normal weight.'
D. The vision is that everyone will exercise once daily.'
Show answer and rationale
Correct answer: A — The vision is a society in which all people can achieve their full potential for health'
The Healthy People 2030 campaign provides an overall action plan to improve the health and quality of life for all people living the United States. The U.S. Department of Health and Human Services identified these overarching health goals: Attain healthy, thriving lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all. Healthy People 2030 is not focused on an individual disease process, a 'normal' weight, or exercise for the individual as the overall goal.
Question 4
The nurse is providing community instruction on the impact of aging and surgical incisional considerations. Which instructional area(s) would be included in the presentation? Select all that apply.
A. Increase protein in the diet.
B. Instruct on symptoms of wound/incision infection.
C. Cleanse wound/incision with products such as soap and water.
D. Avoid showering until healing has occurred.
E. Wash with half-strength peroxide to prevent infection.
Show answer and rationale
Correct answer: A — Increase protein in the diet.
The nurse realizes that there is a thinning of the skin and loss of subcutaneous tissue, which is normal in the aging process. Also, older adults may have a diminished immunological response, making them more susceptible to infection. For this reason, instructional areas would include areas which promote healing and diminish the risk of infection. Increasing protein in the diet promotes wound healing. Instructing on signs and symptoms of wound infection allows for early symptom recognition. Cleansing, as per physician instruction, but with products, such as soap and water, decreases bacteria on the skin. Showering may begin prior to healing with the stream of the water not directly on the incision. Peroxide is not recommended for wound/incisional care. Crusted areas should be allowed to heal and flake off. Removing the areas could open a wound allowing for bacteria to enter.
Question 5
The nurse, a member of the health care team in the ED, is caring for a patient who is determined to be in the irreversible stage of shock. What would be the most appropriate nursing intervention?
A. Provide opportunities for the family to spend time with the patient, and help them to understand the irreversible stage of shock.
B. Inform the patients family immediately that the patient will likely not survive to allow the family time to make plans and move forward.
C. Closely monitor fluid replacement therapy, and inform the family that the patient will probably survive and return to normal life.
D. Protect the patients airway, optimize intravascular volume, and initiate the early rehabilitation process.
Show answer and rationale
Correct answer: A — Provide opportunities for the family to spend time with the patient, and help them to understand the irreversible stage of shock.
The irreversible (or refractory) stage of shock represents the point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive. Providing opportunities for the family to spend time with the patient and helping them to understand the irreversible stage of shock is the best intervention. Informing the patients family early that the patient will likely not survive does allow the family to make plans and move forward, but informing the family too early will rob the family of hope and interrupt the grieving process. The chance of surviving the irreversible (or refractory) stage of shock is very small, and the nurse needs to help the family cope with the reality of the situation. With the chances of survival so small, the priorities shift from aggressive treatment and safety to addressing the end-of-life issues.
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Question 6
What is true about the use of touch in therapeutic communication?
A. Touch is a form of nonverbal communication.
B. Touch is a form of verbal communication.
C. Touch should be used with indiscretion.
D. Touch can convey warmth and caring.
E. Touch can convey support and understanding.
Correct answer:
Touch is a form of nonverbal communication that is inherent in the practice of nursing. Nearly every nursing intervention for the purpose of providing physical care calls for touch. Touch is frequently highly personal or of an intimate nature (e.g., giving a bed bath, assisting a patient on or off a bedpan, inserting a urinary catheter). Because of the intimate nature of touch in the nursing context, it is necessary to use it with great discretion to fit into sociocultural norms and guidelines. Some nurses are uncomfortable with touch because of a fear of it seeming inappropriate or being misinterpreted. When a nurse feels comfortable with physical contact with a patient, touch has great potential for conveying warmth, caring, support, and understanding. For the nurse to convey warmth, it is absolutely necessary for the nature of their touch to be sincere and genuine.
The nurse is preparing a patient for surgery. The patient states that she is very nervous and really does not understand what the surgical procedure is for or how it will be performed. What is the most appropriate nursing action for the nurse to take?
A. Have the patient sign the informed consent and place it in the chart
B. Call the physician to review the procedure with the patient
C. Explain the procedure clearly to the patient and her family
D. Provide the patient with a pamphlet explaining the procedure
Correct answer:
While the nurse may ask the patient to sign the consent form and witness the signature, it is the surgeons responsibility to provide a clear and simple explanation of what the surgery will entail prior to the patient giving consent. The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the patient requests additional information, the nurse notifies the physician. The consent form should not be signed until the patient understands the procedure that has been explained by the surgeon. The provision of a pamphlet will benefit teaching the patient about the surgical procedure, but will not substitute for the information provided by the physician.
An adult patient tells the case manager, 'I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends.' Which resources should the nurse suggest for the patient?
A. Psychoeducation classes
B. Vocational rehabilitation
C. Social skills training
D. Homeless shelter
E. Crisis intervention
Correct answer:
The patient does not understand the illness and the need for adhering to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. Work gives meaning and purpose to life; vocational rehabilitation can assist with this aspect of care. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with severe mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking down each skill into small verbal and nonverbal components. The patient presently has a home and does not require the services of a homeless shelter. The nurse case manager functions in the role of crisis stabilizer, so no related referral is needed.
A nurse is caring for a client who has been prescribed amaritadine for the treatment of the influenza A virus. After administration of the drug, the client complains of dry mouth. Which of the following instructions should the nurse offer the client to help relieve dry mouth?
A. Instruct the client to take ice chips frequently.
B. Encourage the client to take small, frequent meals.
C. Instruct the client to avoid protein-rich foods.
D. Stop the use of the antiparkinsonism drug by the client.
Correct answer:
The nurse should instruct the client to suck on ice chips or hard candy (if allowed). The nurse should also instruct the client to take frequent sips of water throughout the day and between meals. The nurse encourages the client to have small, frequent meals when the client experiences a GI disturbance and not when the client complains of dry mouth. The nurse also need not instruct the client to avoid protein-rich foods because this will not reduce the client's discomfort due to dry mouth. The nurse should stop the use of the antiparkinsonism drug when the client complains of severe nausea or vomiting and not when the client is experiencing dry mouth. If dry mouth is so severe that there is difficulty in swallowing or speaking, or if loss of appetite and weight loss occur, the dosage of the antiparkinsonism drug may be reduced but not stopped completely.
The nurse provides care for an older adult client who is diagnosed with valvular heart disease. On auscultation of the client's heart sounds, the nurse notes an erratic heart rhythm. Which age-related change is the most likely cause for this finding?
A. A stiffening of the aorta
B. A decrease in metabolism
C. An increase in thirst sensation
D. A thinning of the mitral valve
Correct answer:
Age-related effects, such as stiffening of the aorta, calcification, and fibrotic thickening (not thinning) of the mitral and aortic valves, contribute to development of symptoms (e.g., increased systolic blood pressure [BP], dangerous arrhythmias [erratic heart rhythms or rates that are too fast or slow] sometimes referred to as dysrhythmias) and complications (e.g., increased myocardial oxygen demand, heart failure, and alterations in cardiac output) in the older adult with valvular heart disease. A decrease in metabolism is an age-related effect for clients with valvular heart disease; however, this affects the dosage of prescribed medication and is not the cause of the client's dysrhythmia. A decrease, not increase, in thirst sensation is an age-related change that could lead to dehydration, and, thus, changes in the client's heart rhythm.
The LPN states to an RN, 'I don't know why we have to follow a care plan. No one even uses it, and it just means more paperwork. What's the purpose?' What is the best response by the RN?
A. I agree with you, and we should talk to the manager about eliminating them from our required paperwork.'
B. I think it is something we have always done, and we have to continue to use them.'
C. It helps to provide a systematic method for us to plan and implement care so that we achieve positive outcomes.'
D. Health care providers use our care plans in order to see what we are doing for the clients.'
Correct answer:
The purpose of the nursing process is to provide a systematic method for nurses to plan and implement client care to achieve desired outcomes. The nursing process cannot be eliminated from the paperwork because nurses use the process to evaluate and update a client's care. It is an integral part of nursing practice. Stating that the nursing process is something nurses have always done and must continue to do so is a vague and incomplete answer. It does not give a rationale for using the nursing process. Although health care providers may review a nurse's care plan to see what is being done for the client, that is not the reason nurses use the nursing process or create care plans. The client's plan of care guides nursing care and provides a vehicle for assessment, planning, implementation, evaluation, and, if needed, the revision of care.
The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.)
A. Take the medications until the symptoms disappear.
B. Take the medications at the same time every day.
C. Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control.
D. Stop taking the medications if you have severe adverse effects.
E. Avoid alcoholic beverages while on this therapy.
Correct answer:
Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy; the medication must not be stopped.
A patient who is alert and oriented is threatening to leave the hospital against medical advice (AMA). What action should the nurse take?
A. Forcibly detain and restrain the patient.
B. Administer a sedative hypnotic medication.
C. Prevent patient from leaving until an AMA form is signed.
D. Notify the health care provider that the patient is threatening to leave AMA.
Correct answer:
When a patient threatens to leave AMA, the health care provider should be notified immediately. If the health care provider fails to convince the patient to remain in the facility, the health care provider will ask the patient to sign an AMA form releasing the facility from legal responsibility for any medical problems the patient may experience after discharge. If the health care provider is not available, the nurse should discuss the discharge form with the patient and obtain the patient's signature. If the patient refuses to sign the AMA form, the patient should not be detained. This violates the patient's legal rights. After the patient leaves, the nurse should document the incident thoroughly in the nurse's notes and notify the health care provider. A rational adult patient who will not sign the AMA form cannot be forcibly detained.
The nursing instructor is discussing hypersensitivity responses with a clinical group. What allergic reaction(s) would the nursing instructor talk about? Select all that apply.
A. Typical
B. Unmediated
C. Cytotoxic
D. Atopic
E. Immune complex
Correct answer:
Once sensitization occurs, one of four types of hypersensitivity responses can occur. These may be immediate or delayed depending on the time it takes for the immune system to mount a response. An immediate hypersensitivity response is due to antibodies interacting with allergens and occurs rapidly. There are three types of immediate hypersensitivity responses: type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies; type II, cytotoxic, which is mediated by immunoglobulin M or G (IgM or IgG) antibodies; and type III, immune complex, which is mediated by IgG antibodies. The first two types of responses occur within minutes; type III responses reach a peak within 6 hours after exposure to an allergen. The nurse would not discuss atypical and unmediated hypersensitivity responses in this scenario.
A nurse is teaching patients of all ages in a hospital setting. Which teaching examples are appropriate for the patient's developmental level? Select all that apply.
A. The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes.
B. The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions.
C. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers.
D. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis.
E. The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching.
Correct answer:
Successful teaching plans for older adults incorporate extra time, short teaching sessions, accommodation for sensory deficits, and reduction of environmental distractions. Older adults also benefit from instruction that relates new information to familiar activities or information. School-aged children are capable of logical reasoning and should be included in the teaching-learning process whenever possible; they are also open to new learning experiences but need learning to be reinforced by either a parent or health care provider as they become more involved with their friends and school activities. Teaching strategies designed for an adolescent patient should recognize the adolescent's need for independence, as well as the need to establish a trusting relationship that demonstrates respect for the adolescent's opinions.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 2 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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