Nursing textbooks medical-surgical practice questions, set 21
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 21
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
Clients are often in denial after a coronary event. The client who seems to be in denial but is compliant with treatment may be using a healthy form of cogent that allows time to process the event and start to use problemfocused coping. What action by the nurse is most appropriate?
A. Continue to educate the client on possible healthy changes.
B. Emphasize complications that can occur with noncompliance.
C. Tell the client that denial is normal and will soon go away.
D. You need to make sure the client understands this illness.
Show answer and rationale
Correct answer: A — Continue to educate the client on possible healthy changes.
Clients are often in denial after a coronary event. The client who seems to be in denial but is compliant with treatment may be using a healthy form of cogent that allows time to process the event and start to use problemfocused coping. The student should not disconcert this type of dental and coping, but rather continue providing education in a positive manner. Emphasizing complications may make the client defensive and more anxious. Telling the client that denial is normal is placing too much attention on the process. Forcing the client to understand the illness may not be effective.
Question 2
For a patient experiencing panic, which nursing intervention should be implemented first?
A. Teaching relaxation techniques
B. Administering an anxiolytic medication
C. Providing calm, brief, directive communication
D. Gathering a show of force in preparation for gaining physical control
Show answer and rationale
Correct answer: C — Providing calm, brief, directive communication
Calm, brief, directive verbal interaction can help the patient gain control of the overwhelming feelings and impulses related to anxiety. Patients experiencing panic-level anxiety are unable to focus on reality; thus, learning relaxation techniques is virtually impossible. Administering an anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the patient is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other, less-restrictive measures are proven ineffective.
Question 3
Which medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?
A. Narcotic analgesics for use as needed for acute pain
B. Antidepressant medications to treat underlying depression
C. Long-term use of benzodiazepines to support coping with anxiety
D. Conventional antipsychotic medications to correct cognitive distortions
Show answer and rationale
Correct answer: B — Antidepressant medications to treat underlying depression
Various types of antidepressants may be helpful in somatic disorders directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood, but also fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of anti-anxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated.
Question 4
Which of the following nurse statements is completed in the working phase of the nurse-client relationship?
A. Tell me about your religious beliefs during this season of the year.
B. I will put a chair in the bathroom so you can begin personal care. I will return to assist you as needed.
C. I understand that you are feeling anxious about going home. Let me assess you before we talk.
D. Let's talk about a way to assist you to a standing position so you can walk in the hall.
Show answer and rationale
Correct answer: B — I will put a chair in the bathroom so you can begin personal care. I will return to assist you as needed.
During the working phase of the nurse-client relationship, the nurse and the client puts the mutually developed plan into action. Each person shares in performing the task that leads to the desired outcome, which supports the client's independence. In the introductory phase, the nurse should be gathering information regarding religious beliefs. In the terminating phase, the client may feel apprehensive about assuming independent activity or self-care. Developing the plan with activities such as assisting to a standing position to walk in the hall is completed in the introductory phase.
Question 5
A nurse is instructing a client about his prescribed antihypertensive therapy with captopril. Which of the following instructions would the nurse include in the teaching plan? Select all that apply.
A. Taking the drug with meals to decrease GI upset
B. Informing the client about the possibility of a cough
C. Crushing the capsule before taking it
D. Taking measures to reduce injury from hypotension
E. Reporting any swelling of the face, throat, or extremities
Show answer and rationale
Correct answer: B — Informing the client about the possibility of a cough
The client needs to know that some clients experience a dry cough that does not subside until drug therapy is discontinued and this reaction may need to be tolerated. In addition, these drugs may cause a significant drop in blood pressure after the first dose, so the client needs to take measures to reduce the risk of injury from the drug's effects. The ACE inhibitors, captopril and moexipril, should be taken 1 hour before or 2 hours after meals to enhance absorption. The drugs are sustained-release capsules that should not be crushed, opened, or chewed. ACEIs do not cause angioedema.
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Question 6
The nurse and physician are viewing a brain scan, which indicates bleeding at the point of impact to the skull and edema on the opposite side. The client is sleeping but can be aroused. The client has no memory of the accident. The nurse provides all details to the next shift and is most accurate to report which type of injury?
A. Coup injury
B. Contusion
C. Head injury
D. Contrecoup injury
Correct answer:
The nurse most accurately reports a contrecoup injury because the client has this type of dual brain injury. The client has experienced not only a direct strike to the brain but the brain ricochets in the skull to the opposite side causing damage and inflammation at that location as well. The client experienced a head injury, which is a general term. The injury is a contusion because it is more serious than a concussion and leads to structural injury to the brain. It is inaccurate to report a coup injury because this reveals injury to the brain itself from a direct strike to the head.
A client is scheduled for magnetic resonance imaging (MRI) of the head and neck. Which action by the nurse would be most helpful in calming the anxious client?
A. Administer antianxiety medication.
B. Allow the client to express fears and concerns.
C. Discuss how others have survived the procedure.
D. Explain how the client can notify staff if anxiety increases.
Correct answer:
Building trust and restoring comfort can be accomplished when the nurse allows the client to verbalize anxiety. Identifying the problem and exploring possible solutions may be helpful in decreasing anxiety. The physician may prescribe an antianxiety medication to the client prior to testing. Antianxiety drugs work but conversation is more immediate and safer. Knowing the client can call for assistance during the testing may be helpful in decreasing anxiety. But calling for assistance does not help the client in the moment. Discussion of other clients is not helpful in this situation.
An elderly woman diagnosed with osteoarthritis has been referred for care. The patient has difficulty ambulating because of chronic pain. When creating a nursing care plan, what intervention may the nurse use to best promote the patients mobility?
A. Motivate the patient to walk in the afternoon rather than the morning.
B. Encourage the patient to push through the pain in order to gain further mobility.
C. Administer an analgesic as ordered to facilitate the patients mobility.
D. Have another person with osteoarthritis visit the patient.
Correct answer:
At times, mobility is restricted because of pain, paralysis, loss of muscle strength, systemic disease, an immobilizing device (e.g., cast, brace), or prescribed limits to promote healing. If mobility is restricted because of pain, providing pain management through the administration of an analgesic will increase the patients level of comfort during ambulation and allow the patient to ambulate. Motivating the patent or having another person with the same diagnosis visit is not an intervention that will help with mobility. The patient should not be encouraged to push through the pain.
You are the nurse caring for an unconscious trauma victim who needs emergency surgery. The patient is a 55 -year-old man with an adult son. He is legally divorced and is planning to be remarried in a few weeks. His parents are at the hospital with the other family members. The physician has explained the need for surgery, the procedure to be done, and the risks to the children, the parents, and the fianc. Who should be asked to sign the surgery consent form?
A. The fianc
B. The son
C. The physician, acting as a surrogate
D. The patients father
Correct answer:
The patient personally signs the consent if of legal age and mentally capable. Permission is otherwise obtained from a surrogate, who most often is a responsible family member (preferably next of kin) or legal guardian. In this instance, the child would be the appropriate person to ask to sign the consent form as he is the closest relative at the hospital. The fianc is not legally related to him as the marriage has not yet taken place. The father would only be asked to sign the consent if no children were present to sign. The physician would not sign if family members were available.
The ED nurse is caring for a patient who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform?
A. Place gel pads over the apex and posterior chest for better conduction.
B. Ensure no one is touching the patient at the time shock is delivered.
C. Continue to ventilate the patient via endotracheal tube during the procedure.
D. Allow at least 3 minutes between shocks.
Correct answer:
In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patients skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.
A nurse is caring for a patient who has a pleural chest tube attached to a disposable chest drainage system. Which nursing actions are indicated for this patient?
A. Avoiding turning the patient to prevent disconnections in the tubing
B. Maintaining an occlusive dressing on the site
C. Assessing the patient for signs of respiratory distress
D. Keeping the chest drainage device at the level of the patient's thorax
E. Ensuring there are no dependent loops or kinks in the tubing
Correct answer:
The chest drainage collection device must be positioned below the tube's insertion site. Maintaining an occlusive dressing helps prevent air leak; assess for crepitus around the chest tube site indicating air leak. Avoid dependent loops or kinks in the tubing, which could impede drainage. Assess for bubbling in the water seal, maintaining the water level at the 2-cm mark. When a chest tube becomes separated from the drainage device, the nurse should submerge the tube's end in water, creating a temporary water seal and allowing air to escape until a new drainage unit can be attached.
A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what complication?
A. Avascular necrosis of bone
B. Compartment syndrome
C. Fat embolism syndrome
D. Complex regional pain syndrome
Correct answer:
Fat embolism syndrome occurs most frequently in young adults and elderly patients who experience fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.
A cancer patient requires supplemental oxygen at home through an oxygen cylinder. The nurse assigned to the patient teaches the patient's brother to administer oxygen from the cylinder at home. Which of the following is most effective for the nurse to use when evaluating the patient's brother's understanding?
A. Ask questions such as 'Do you understand?'
B. Ask the patient's brother to demonstrate the procedure.
C. Ask the patient's brother to document the technique.
D. Ask the patient's brother questions related to the procedure.
Correct answer:
To determine the effectiveness of teaching in this case, the nurse must evaluate the patient's brother's knowledge of the materials presented. This can be done by asking the patient's brother to demonstrate or explain the presented information. The nurse should not ask questions such as 'Do you understand?' as the patient may be uncomfortable admitting a lack of understanding. Asking questions related to the procedure may confuse the person. Asking the patient's brother to document the technique would not provide enough information about whether or not he does understand what to do.
A client falls to the floor in a generalized seizure with tonic-clonic movements. Which is the first action taken by the nurse?
A. Insert an airway or bite block.
B. Manually restrain the extremities.
C. Turn client to side-lying position.
D. Monitor vital signs.
Correct answer:
When a client begins to convulse, the highest priority is to maintain airway. This can best be accomplished by turning client to side-lying position, which allows saliva and emesis to drain from the mouth. Turning the client also allows the tongue to fall forward opening the airway. More damage can occur if a bite block is inserted after the seizure has begun. Manually restraining extremities is not recommended. Attempting to take blood pressure is not recommended and pulse rate and respirations during the event will not be beneficial. Monitor vital signs during the postictal phase.
The nurse is taking a health history of a new patient. The patient reports experiencing pain in his left lower leg and foot when walking. This pain is relieved with rest. The nurse notes that the left lower leg is slightly edematous and is hairless. When planning this patients subsequent care, the nurse should most likely address what health problem?
A. Coronary artery disease (CAD)
B. Intermittent claudication
C. Arterial embolus
D. Raynauds disease
Correct answer:
A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise. The nurse would not suspect the patient has CAD, arterial embolus, or Raynauds disease; none of these health problems produce this cluster of signs and symptoms.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 21 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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