Nursing textbooks medical-surgical practice questions, set 20
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 20
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 reviewing a journal article about class IA antiarrhythmics. The article describes a drug that decreases depolarization and prolongs the refractory period. The nurse is most likely reading an article about which drug?
A. Quinidine
B. Lidocaine
C. Disopyramide
D. Flecainide
Show answer and rationale
Correct answer: C — Disopyramide
Disopyramide (Norpace) decreases depolarization of myocardial fibers, prolongs the refractory period, and increases the action potential duration of cardiac cells. Lidocaine (Xylocaine) decreases diastolic depolarization, decreases automaticity of ventricular cells, and raises the threshold of the ventricular myocardium. Quinidine depresses myocardial excitability or the ability of the myocardium to respond to an electrical stimulus. Flecainide (Tambocor) depresses fast sodium channels, decreases the height and rate of rise of action potentials, and slows conduction of all areas of the heart.
Question 2
A nurse is working with a teenage boy who was recently diagnosed with asthma. During the current session, the nurse has taught the boy how to administer his bronchodilator by metered-dose inhaler. How should the nurse evaluate the teaching-learning process?
A. Ask the boy specific questions about his medication.
B. Ask the boy whether he now understands how to use his inhaler.
C. Directly observe the boy using his inhaler to give himself a dose.
D. Assess the boys respiratory health at the next scheduled visit.
Show answer and rationale
Correct answer: C — Directly observe the boy using his inhaler to give himself a dose.
Demonstration and practice are essential ingredients of a teaching program, especially when teaching skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. By observing the patient using the inhaler, the nurse may identify what learning needs to be enhanced or reinforced. Asking questions is not as an accurate gauge of learning. Respiratory assessment is a relevant, but indirect, indicator of learning. Delaying the appraisal of the patients technique until a later clinic visit is inappropriate because health problems could occur in the interval.
Question 3
A client is having a procedure that will remove the entire colon and rectum and will bring the end of the ileum through a separate area on the right lower quadrant of the abdomen. What type of procedure does the nurse understand this client will be having?
A. Appendectomy
B. Total colectomy
C. Double-barrel colostomy
D. Abdominoperineal resection
Show answer and rationale
Correct answer: B — Total colectomy
In the usual surgical procedure for a conventional ileostomy, the entire colon and rectum are removed (total colectomy). The terminal end of the ileum is brought out through a separate area on the right lower quadrant of the abdomen slightly below the umbilicus, near the outer border of the rectus muscle. The end is averted and sutured to the skin, a process referred to as a matured stoma. An appendectomy is removal of the appendix. A double-barrel colostomy may be a temporary colostomy for rest of the bowel. Abdominoperineal resection removes the anus, rectum, and part of the sigmoid colon.
Question 4
A patient has experienced symptoms of dumping syndrome following bariatric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?
A. Irritation of the phrenic nerve due to diaphragmatic pressure
B. Chronic malabsorption of iron and vitamins A and C
C. Reflux of bile into the distal esophagus
D. A sudden release of peptides
Show answer and rationale
Correct answer: D — A sudden release of peptides
For many years, it had been theorized that the hypertonic gastric food boluses that quickly transit into the intestines drew extracellular fluid from the circulating blood volume into the small intestines to dilute the high concentration of electrolytes and sugars, resulting in symptoms. Now, it is thought that this rapid transit of the food bolus from the stomach into the small intestines instead causes a rapid and exuberant release of metabolic peptides that are responsible for the symptoms of dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux.
Question 5
A home health nurse is scheduled to visit a patient recently discharged from the hospital with a new colostomy. During the entry phase of the home visit, what actions will the nurse perform? Select all that apply.
A. Collect information about the patient's diagnosis, surgery, and treatments
B. Call the patient to make initial contact and schedule a visit
C. Develop rapport with the patient and their family
D. Assess the patient to identify their needs
E. Assess the physical environment of the home
Show answer and rationale
Correct answer: C — Develop rapport with the patient and their family
In the entry phase of the home visit, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. In the pre-entry phase of the home visit, the nurse collects information about the patient's diagnoses, surgical experience, socioeconomic status, and treatment orders. In the pre-entry phase, the nurse also gathers supplies needed, makes an initial phone contact with the patient to arrange for a visit, and assesses the patient's neighborhood for safety issues.
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Question 6
A nurse is caring for a 25-year-old patient who is unresponsive following a head injury. The patient has several piercings in the ears and nose that appear crusted and slightly inflamed. What is the most appropriate action to care for this patient's piercings?
A. Avoiding removing or washing the piercings until the patient is responsive
B. Rinsing the sites with warm water and remove crusts with a cotton swab
C. Washing the sites with alcohol and apply an antibiotic ointment
D. Removing the jewelry and allow the sites to heal over
Correct answer:
When providing care for piercings, the nurse performs hand hygiene, applies gloves, then cleanses the site of all crusts and debris by rinsing the site with warm water and removing the crusts with a cotton swab. The nurse should then apply a dab of liquid-medicated cleanser, per policy, to the area, turn the jewelry back and forth to work the cleanser around the opening, rinse well, remove gloves, and perform hand hygiene. The nurse should not use alcohol, peroxide, or ointments at the site and should avoid removing piercings unless it is absolutely necessary (e.g., when an MRI is ordered.)
The nurse is caring for a patient who had abdominal surgery two days previously. Which of the following information about the patient is most important to communicate to the health care provider?
A. The right calf is swollen, warm, and painful.
B. The patient's temperature is 37.9??C (100.2??F).
C. The 24-hour oral intake is 600 mL greater than the total output.
D. The patient complains of abdominal pain at level 6 (0-10 scale).
Correct answer:
The calf pain, swelling, and warmth suggest that the patient has a deep vein thrombosis, which will require health care provider orders for diagnostic tests and anticoagulants. Because the stress response causes fluid retention for the first 2-5 days postoperatively, the difference between intake and output is expected. A temperature elevation to 37.9??C (100.2??F) on the second postoperative day suggests atelectasis, and the nurse should have the patient deep breathe and cough. Pain with ambulation is normal, and the nurse should administer the ordered analgesic before patient activities.
A nurse is preparing a teaching plan for a client who is receiving antiviral therapy. Which of the following would the nurse include? Select all that apply.
A. Only notify your physician if an allergic reaction to the antiviral drug occurs.
B. These drugs are not a cure for the viral infection, but they will shorten the course of disease.
C. Mark a calendar to designate the days the drug is to be taken so that you can keep to the ordered alternate-dosage schedule.
D. These drugs will help in preventing the spread of the infection to those around you.
E. Take precautions when you're outside because you might experience a sunburn reaction.
Correct answer:
The nurse's teaching plan for antiviral drugs should include educating the client and family that antiviral drugs are not a cure for viral infection but will shorten the course of disease; that antiviral drugs will not prevent the spread of disease to others; that some antiviral drugs cause photosensitivity, so precaution should be taken when going outdoors; that a calendar should be marked to designate the days the drug is to be taken for clients on an alternate-dosage schedule; and that the physician should be notified if burning, stinging, itching, or rash worsens or becomes pronounced.
Consider these comments made to three different nurses by a patient diagnosed with an antisocial personality disorder: 'You're a better nurse than the day shift nurse said you were'; 'Another nurse said you don't do your job right'; 'You think you're perfect, but I've seen you make three mistakes.' Collectively, these interactions can be appropriately assessed using what term?
A. Paranoia
B. Entitlement
C. Manipulation
D. Pathological lying
Correct answer:
Patients manipulate and control staff members in various ways. By keeping staff members off balance or fighting among themselves, the person with an antisocial personality disorder is left to operate as he or she pleases. Paranoia is the irrational and persistent feeling that people are 'out to get you.' Entitlement is a belief that one has the right to take what they want, treat others unfairly, destroy the property of others, and even hurt others if it is in their best interest. They do not adhere to traditional values or standards. Pathological liar seems to lie for no apparent reason.
The nurse is calling a report to the emergency department from a long-term care facility. The nurse states that the client abruptly experienced a change in mentation including disorientation and confusion. Vital signs are: temperature, 102.2???F; pulse rate, 88 beats/minute; respiratory rate, 24 breaths/minute, and blood pressure, 152/70 mm Hg. Lungs are clear. Which potential diagnosis would the emergency department physician place in the initial documentation?
A. Delirium
B. Dementia
C. Disorientation
D. Alzheimer disease
Correct answer:
There is evidence in the stated report that the client is experiencing delirium. Delirium is a sudden, transient state of confusion. Clients with delirium have difficulty processing information. They may be disoriented, confused, and have impaired judgment. Many times, delirium is associated with a high fever, head trauma, brain tumor, drug intoxication or withdrawal, or inflammatory/metabolic disorders of the central nervous system. Alzheimer disease, with dementia being its most common symptom, is a progressive, deteriorating brain disorder. Disorientation is a symptom, not a diagnosis.
Which of the following information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?
A. No change in the patient's chest pain
B. A large bruise at the patient's IV insertion site
C. A decrease in ST segment elevation on the electrocardiogram (ECG)
D. An increase in cardiac enzyme levels since admission
Correct answer:
Continued chest pain suggests that the fibrinolytic therapy is not effective and that other interventions such as percutaneous coronary intervention (PCI) may be needed. Bruising is a possible adverse effect of fibrinolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST segment elevation indicates that fibrinolysis is occurring and perfusion is returning to the injured myocardium. An increase in cardiac enzyme levels is expected with reperfusion and is related to the washout of enzymes into the circulation as the blocked vessel is opened.
A patient with seasonal allergies has been prescribed a nasal spray, which will be administered at home. The patient wants to know about the addictive nature of the nasal spray, the adverse reactions, and the harmful effects involved. Which of the following nursing diagnoses should the nurse address while educating the patient?
A. Ineffective Self Health Management
B. Anxiety
C. Deficient Knowledge
D. Effective Self Health Management
Correct answer:
Effective Self Health Management indicates a desire by the client to manage his or her own treatment regimen. It includes teaching about adverse drug reactions, harmful drug effects, and management of harmful effects. Ineffective Self Health Management helps in teaching patients who have complicated postdischarge medical regimens. Anxiety is appropriate for the client who has uncertainty and fear related to the regimen, for example, a person who is apprehensive about self-injections. Deficient Knowledge is used for patients who are deficient in cognitive knowledge and psychomotor skills.
A patient is being discharged from a health care facility but is required to continue antiviral therapy at home. Which of the following points should the nurse include in the teaching plan to educate the patient?
A. A slight elevation in temperature is normal and needn't be reported.
B. Double the dosage of the drug if you miss a dose.
C. Stop taking the drug as soon as the symptoms of the infection disappear.
D. Make sure to notify your primary health care provider if you develop any adverse reactions.
E. Take the drug with food to reduce stomach upset
Correct answer:
The nurse should instruct the patient to report adverse reactions to the primary health care provider. The nurse should also tell the patient to report any increase in temperature, even if it is a slight increase. If the patient misses a dose, the next dose should be taken as soon as remembered, but it should not be doubled. The nurse should also instruct the patient to take the drug exactly as directed for the full course of therapy, even if the symptoms of the infection disappear. Taking the drug with food is not a general requirement for all antivirals but may apply to specific drugs.
A college student reports that, "My vision is too blurry to read effectively, especially when it's time to be studying for a test." Which health problem should be considered initially?
A. Malingering
B. Illness anxiety
C. Factitious disorder
D. Functional neurological disorder
Correct answer:
Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Functional neurological disorder (FND) involves chronic or brief symptoms of altered voluntary motor or sensory function that cause substantial distress or psychosocial impairment. Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient.
The nurse is caring for a client who is receiving valproic acid. What clinical manifestation should the nurse periodically monitor for?
A. Hepatotoxicity
B. Hypertensive crisis
C. Orthostatic hypotension
D. Hyper alertness
Correct answer:
The nurse should closely monitor a client on valproic acid, Depakote or Depakene, for hepatotoxicity. Frequent liver function tests and serum ammonia concentrations may be ordered. When a monoamine oxidase inhibitor is mixed with foods containing tyramine, clients are likely to develop a potentially fatal hypertensive crisis, not when taking valproic acid. Risk for orthostatic hypotension from psychotropic drugs is increased in older adults because of decreased functioning of the blood pressure-regulating mechanism. Some clients administered valproic acid experience sedation and ataxia.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 20 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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