Nursing textbooks medical-surgical practice questions, set 23
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 23
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
What statement should guide the nurses response?
A. She should not worry; it was stress related and her regular blood pressure is good.
B. The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems.
C. Blood pressure is only one measure of hypertension; she should review this with the doctor and plan to recheck it on a regular basis.
D. The respiratory infection is the probably the cause of the elevated blood pressure, and, with treatment, her blood pressure should remain normal.
Show answer and rationale
Correct answer: B — The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems.
A simple stress response will temporarily elevate a blood pressure and heart rate. Long-term blood pressure response is controlled by negative feedback systems. For a science teacher, this would be an appropriate level of teaching/learning and would serve to promote health. The nurse would be incorrect in assuming the patients blood pressure is good based on only two blood pressure readings. The stress of a respiratory infection could account for the elevated blood pressure, but assuring the patient that, with treatment, her blood pressure will return to normal may not be true.
Question 2
A nurse is assessing a patient who reports a throbbing, burning sensation in the right foot. The patient states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem?
A. Morton's neuroma
B. Pescavus
C. Hallux valgus
D. Onychocryptosis
Show answer and rationale
Correct answer: A — Morton's neuroma
Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve, which causes a throbbing, burning pain, usually relieved with rest. Pescavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Hallux valgus (bunion) is a deformity in which the great toe deviates laterally and there is a marked prominence of the medial aspect of the first metatarsal-phalangeal joint and exostosis. Onychocryptosis (ingrown toenail) occurs when the free edge of a nail plate penetrates the surrounding skin, laterally or anteriorly.
Question 3
During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess?
A. Acquired immunity
B. Natural immunity
C. Phagocytic immunity
D. Humoral immunity
Show answer and rationale
Correct answer: A — Acquired immunity
Acquired immunity usually develops as a result of prior exposure to an antigen, often through immunization. When the body is attacked by bacteria, viruses, or other pathogens, it has three means of defense. The first line of defense, the phagocytic immune response, involves the WBCs that have the ability to ingest foreign particles. A second protective response is the humoral immune response, which begins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. The natural immune response system is rapid, nonspecific immunity present at birth.
Question 4
The nurse is caring for a client who has experienced readmission to the behavioral health unit for an exacerbation of schizophrenia. Which assessment question asked by the nurse identifies a possible cause for the return?
A. Do you take a generic form of your medications?
B. When was your last dose of medication?
C. Are you having any side effects of the medication?
D. Can you afford to purchase your medication?
Show answer and rationale
Correct answer: B — When was your last dose of medication?
The nurse is correct to identify that noncompliance with drug therapy is the leading cause of the return of disease symptoms and the need for short-term hospitalization. Asking when the client's last dose of medication was opens communication for when the medication was last administered. If it was not at the prescribed time, the conversation allows the nurse to probe why. Taking a generic medication does not change the effectiveness. Asking if the client can afford the medication or if the medication causes side effects does not directly address the question of noncompliance.
Question 5
The nurse is aware of the various changes in the healthcare field. What important factor remains the same in this time of change?
A. Nurses must provide safe, high-quality, cost-effective care to individuals, families, and communities.
B. Nurses must inform clients that they will have to use facilities that are within their service area.
C. Clients must become actively involved in the process of standardizing care.
D. Nurses will have to work in unsafe conditions in order to provide care to clients.
Show answer and rationale
Correct answer: A — Nurses must provide safe, high-quality, cost-effective care to individuals, families, and communities.
In the midst of these dramatic changes and challenges, nurses must continue to provide safe, high-quality, cost-effective care to individuals, families, and communities. It is also imperative that nurses distinguish and communicate to clients the various choices that the clients may make about their healthcare. Clients have a choice as to location of care providers and are not limited to local facilities. Clients are not involved in standardizing care; this is a healthcare provider function. Nurses will not have to work in unsafe conditions in order to provide care to clients.
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Question 6
A client is diagnosed with stage II cancer of the prostate. The nurse interprets this as indicating which of the following?
A. Cancer is small with no symptoms.
B. Tumor is confined to the prostate gland.
C. Tumor has spread beyond the prostate.
D. Tumor has expanded to the bladder.
Correct answer:
Stage II cancer of the prostate involves a tumor that is larger than stage I but is still confined to the prostate gland, if left untreated, it is more likely to spread beyond the prostate and cause symptoms. Stage I cancer of the prostate involves a small, slow-growing cancer that may never cause symptoms or other health problems. Stage III involves a tumor that has spread beyond the prostate but has not reached the bladder, rectum, lymph nodes, or other organs. Stage IV involves a tumor that has spread to the bladder, rectum, lymph nodes, or distant organs such as the bones.
A nurse is preparing a plan of care for an older adult client who is receiving sulfonamide therapy. Which of the following would the nurse include in the plan of care to reduce the likelihood of causing renal damage? Select all that apply.
A. Administer sulfonamides once daily.
B. Increase fluid intake up to 2000 mL if tolerated.
C. Use sulfonamides cautiously in clients with renal impairment.
D. Administer the dose intravenously instead of orally.
E. Ask the prescriber to change the medication ordered
Correct answer:
Older adults experience a decline in renal function with aging. Therefore, sulfonamides must be used cautiously in older clients. In addition, increasing fluid intake up to 2000 mL daily can decrease the likelihood of causing renal damage in older clients. The drug is administered throughout the day, not as a once-daily dose. Sulfonamides can affect renal function regardless of the route administered. Asking the prescriber to change the medication ordered may be appropriate but is not necessary as long as the drug is administered cautiously and the client is monitored closely.
After teaching a client how to use an estradiol transdermal system, the nurse determines that the teaching was successful when the client states which of the following? Select all that apply.
A. I can put the patch on my breasts.
B. I should rotate the sites, staying away from the same site for about a week.
C. When I apply it, I should rub the patch vigorously for about 10 seconds.
D. I apply the patch immediately after I open the pouch.
E. If the area is oily or irritated, I need to avoid that area.
Correct answer:
When using a transdermal system, the client should apply the system immediately after opening the pouch with the adhesive side down, applying it to the clean dry skin of the buttocks, trunk, abdomen, upper inner thigh, or upper arm. The system should not be applied to the breasts, waistline, or a site exposed to sunlight. The area should not be oily or irritated. Once the patch is applied, the client should press on it firmly with the palm of the hand for about 10 seconds. The application site is rotated with at least 1-week intervals between applications to a particular site.
The charge nurse is making assignments for a group of clients on a medical unit. When reviewing the acuity of the clients, the charge nurse assigns the RN to the clients with higher acuity levels. Why would the charge nurse assign the RN to the clients with a higher acuity?
A. LPNs do not understand how to care for clients with complex disorders.
B. Assigning an LPN would allow them to provide care out of their scope of practice.
C. Higher acuity clients may request the services of an RN versus other care providers.
D. A higher acuity client requires a greater need for highly skilled care.
Correct answer:
Generally, higher acuity requires a greater need for highly skilled care. Clients with complicated or high-risk surgery, massive trauma, or critical illness will be cared for in an acute care hospital, where a high level of professional, skilled, and technological care is available. RNs are instrumental in caring for these clients. LPNs may understand how to care for clients with complex disorders, but RNs are instrumental in the client care. Clients generally do not request care by a specific provider; nurses with different levels of education perform various care activities.
A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?
A. The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.
B. The client is unable to bear weight on the left ankle and has a large ecchymotic area.
C. The client has ecchymosis, edema, and has no function of the left foot and ankle.
D. The client complains of pain when the joint is moved and has mild edema.
Correct answer:
A first-degree strain involves mild stretching of the muscle or tendon, causing some edema and muscle spasm, but no real loss of function. The second-degree strain is partial tearing of muscle or tendon, leading to inability to bear weight and causing edema, muscle tenderness, muscle spasm, and ecchymosis. The third-degree tear is severe muscle and/or tendon tearing, causing severe pain, muscle/spasm ecchymosis, edema, and loss of function. A first-degree sprain involves stretching of the ligament fibers characterized by mild edema, tenderness, and pain if the joint is moved.
A patient is responding to a microbial invasion and the patients differentiated lymphocytes have begun to function in either a humoral or a cellular capacity. During what stage of the immune response does this occur?
A. The recognition stage
B. The effector stage
C. The response stage
D. The proliferation stage
Correct answer:
In the response stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader. In the recognition stage, the recognition of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. During the proliferation stage the circulating lymphocytes containing the antigenic message return to the nearest lymph node.
The caregiver of a client with mental disabilities has recently passed away. The client is unable to perform self-care at home. What facility would best meet the needs of this client?
A. Acute care facility
B. Rehabilitation care
C. Intermediate care facility
D. Ambulatory care
Correct answer:
Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Clients must meet specific criteria related to an inability to meet their own activities of daily living (ADL). Rehabilitation centers provide physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Acute care facilities care for clients with a higher acuity level. Ambulatory care is also referred to as outpatient care and is a short stay.
The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which of the following information obtained by the nurse is most relevant?
A. The patient reports using cocaine once at age 16.
B. The patient has a history of a recent upper respiratory infection.
C. The patient's 29-year-old brother had a sudden cardiac arrest.
D. The patient has a family history of coronary artery disease.
Correct answer:
About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people, the information about the patient's brother will be helpful in planning care (such as an automatic implantable cardioverter-defibrillator [AICD]) for the patient and in counseling other family members. The patient should be counseled against use of stimulant drugs, but the one-time use indicates that the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy, but not for HC.
A child is placed in a foster home after being removed from parental contact because of both physical and verbal abuse. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help minimize the child's anxious behaviors. What should the nurse recommend?
A. Use a calm manner and low voice.
B. Maintain simplicity in the environment.
C. Avoid repetition in what is said to the child.
D. Minimize opportunities for exercise and play.
E. Explain and reinforce reality to avoid distortions.
Correct answer:
The child can be hypothesized to have moderate-to-severe anxiety. A calm manner calms the child. A simple, structured, predictable environment is less anxiety provoking and reduces overreaction to stimuli. Calm, simple explanations that reinforce reality validate the environment. Repetition is often needed when the child is unable to concentrate because of elevated levels of anxiety. Opportunities for play and exercise should be provided as avenues to reduce anxiety. Physical movement helps channel and lower anxiety. Play also helps by allowing the child to act out concerns.
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which ongoing assessment would the nurse complete?
A. Monitoring for appearance of adverse reactions
B. Monitoring patient's vital signs every 24 hours
C. Assessing patient's history of contacts
D. Use DOT to administer the drug to the patient
Correct answer:
The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every 4 hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the preadministration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 23 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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