Nursing textbooks medical-surgical practice questions, set 24
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 24
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 assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse?
A. Mid-sternal chest pain
B. Increased urine output
C. Mild orthostatic hypotension
D. P wave touching the T wave
Show answer and rationale
Correct answer: A — Mid-sternal chest pain
Chest pain, possibly angina, indicates that tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain. Increased urinary output and mild orthostatic hypotension are not life-threatening conditions and therefore do not require immediate intervention. The P wave touching the T wave indicates tachycardia and should be assessed to determine the underlying rhythm and cause, but this is not as critical as chest pain, which indicates cardiac cell death.
Question 2
A patient who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. Which of the following should be included in the patients immediate postoperative plan of care?
A. Teaching the patient to self-suction
B. Performing chest physiotherapy to promote oxygenation
C. Positioning the patient to prevent gastric reflux
D. Providing a regular diet as tolerated
Show answer and rationale
Correct answer: C — Positioning the patient to prevent gastric reflux
After recovering from the effects of anesthesia, the patient is placed in a low Fowlers position, and later in a Fowlers position, to help prevent reflux of gastric secretions. The patient is observed carefully for regurgitation and dyspnea because a common postoperative complication is aspiration pneumonia. In this period of recovery, self-suctioning is also not likely realistic or safe. Chest physiotherapy is contraindicated because of the risk of aspiration. Nutrition is prioritized, but a regular diet is contraindicated in the immediate recovery from esophageal surgery.
Question 3
After observing conflicts between nurses about scheduling, a nurse manager compliments the nurses for achieving the monthly goal of no patient falls. What strategy for conflict resolution did the manager display?
A. Collaborating
B. Competing
C. Compromising
D. Smoothing
Show answer and rationale
Correct answer: D — Smoothing
The manager who avoids conflict by complimenting the parties and avoids disagreements is using smoothing to reduce the emotion of the conflict. The original conflict is rarely resolved with this technique. Collaborating is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. Competing results is a win for one party at the expense of the other group. Compromising occurs when both parties relinquish something of equal value.
Question 4
Which of the following actions is an example of an approach magnification?
A. Using a telescopic lens
B. Sitting closer to a television while watching it
C. Using a black-tipped felt marker when writing
D. Reading books with large-type print
Show answer and rationale
Correct answer: B — Sitting closer to a television while watching it
Approach magnification is a simple but sometimes overlooked technique for enhancing the patient's residual vision. The nurse can recommend that the patient sit closer to the television or hold books closer to the eyes, which the patient may be reluctant to do unless encouraged. Using a telescopic lens is an optical device. Using a black-tipped marker to write is a contrast enhancement technique. Reading large-type print books may be helpful but is not an approach magnification action unless the book was brought close to the eyes, which is not indicated in the answer choice.
Question 5
A nurse assists a victim of intimate partner violence to create a plan for escape if it becomes necessary. The plan should include which components? (Select all that apply.)
A. Keep a cell phone fully charged.
B. Hide money with which to buy new clothes.
C. Have the telephone number for the nearest shelter.
D. Take enough toys to amuse the children for 2 days.
E. Secure a supply of current medications for self and children.
Show answer and rationale
Correct answer: A — Keep a cell phone fully charged.
The victim must prepare for a quick exit and so should assemble necessary items. Keeping a cell phone fully charged will help with access to support persons or agencies. The individual should be advised to hide a small suitcase containing a change of clothing for self and for each child. Taking a large supply of toys would be cumbersome and might compromise the plan. People are advised to take one favorite small toy or security object for each child, but most shelters have toys to further engage the children. Accumulating enough money to purchase clothing may be difficult.
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Question 6
To assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of the following nursing interventions will be most effective?
A. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary.
B. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes.
C. Assist the patient to modify favourite high-fat recipes by using polyunsaturated oils when possible.
D. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.
Correct answer:
Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences. The highest percentage of calories from fat should come from polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the patient with a list alone is not likely to be successful in making dietary changes. Removing saturated fat from the diet completely is not a realistic expectation. Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful.
A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection?
A. Limit interactions with people who are not HIV infected.
B. Limit interactions with people who are already HIV infected.
C. Follow the same sexual precautions as someone who has been diagnosed with AIDS.
D. Quit the healthcare job and get admitted to a hospital or a cancer treatment center.
Correct answer:
The healthcare worker will be tested for HIV at regular intervals and treated with antiretrovirals depending on the results of the tests or the potential for infection. While awaiting the results, the healthcare worker should follow the same sexual precautions as someone who has been diagnosed with AIDS. The healthcare worker should not limit interactions with either non-HIV-infected or HIV-infected people. In addition, the healthcare worker should not quit and be admitted to a hospital for treatment. Treatment, if required, can begin if the result of the test is positive.
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem?
A. Severe pancreatitis with possible peritonitis
B. Acute cholecystitis
C. Chronic pancreatitis
D. Acute appendicitis with possible perforation
Correct answer:
Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis.
A nurse is caring for a patient who is prescribed 1% hydrocortisone/4.71 mg neomycin (Coly-Mycin S Otifor bacterial infections of the external auditory canal. Which of the following instructions should be followed by the nurse administering the otic solution?
A. When the patient is upright, remove the solution running out of the ear with gauze.
B. After instilling the drops, insert a cotton piece deep into the ear to keep the drops in.
C. Keep the patient lying on the untreated side for 30 minutes after instilling the drops.
D. Insert the applicator or dropper tip sufficiently to reach into the external auditory canal.
Correct answer:
Once the patient is upright, the solution running out of the ear may be gently removed with gauze. A piece of cotton can be loosely inserted into the ear canal, but it should never be inserted deeply because if inserted too deeply it may cause increased pressure within the ear canal. The patient is kept lying on the untreated side after the medication is instilled for approximately 5 minutes to facilitate the penetration of the drops into the ear canal. The nurse should not insert the applicator of dropper tip anywhere into the ear or allow the tip to become contaminated.
An RN on a telemetry unit is falling behind while performing assessments and administering medications. Which task can the nurse safely delegate to the AP?
A. Assessing a patient who has just arrived on the unit
B. Teaching a patient with newly diagnosed diabetes about foot care
C. Documenting a patient's I & O in the electronic health record
D. Helping a postoperative patient out of bed for the first time
Correct answer:
Documenting a patient's I & O on a flow chart does not require professional judgment and can be delegated to AP. Professional nurses are responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, administering parenteral medications. What they can delegate are assistance with basic care activities (bathing, grooming, ambulation, feeding) and things like taking vital signs, measuring intake and output, weighing, simple dressing changes, transfers, and postmortem care.
A nurse is caring for an adult patient diagnosed with a back strain. What health education should the nurse provide to this patient?
A. Avoid lifting more than one-third of body weight without assistance.
B. Focus on using back muscles efficiently when lifting heavy objects.
C. Lift objects while holding the object a safe distance from the body.
D. Tighten the abdominal muscles and lock the knees when lifting of an object.
Correct answer:
The nurse will instruct the patient on the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of the weak back muscles. To prevent recurrence of acute low back pain, the nurse may instruct the patient to avoid lifting more than one-third of his weight without help. The patient should be informed to place the feet a hip-width apart to provide a wide base of support, the person should bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking.
The patient is lying in bed under a ceiling fan. Which technique is the nurse using when the fan produces heat loss?
A. Radiation
B. Conduction
C. Convection
D. Evaporation
Correct answer:
A ceiling fan moves air over the patient, causing heat loss via convection (C), where warm air around the body is replaced by cooler moving air. Radiation (A) involves heat emission without contact, not fan-driven. Conduction (B) requires direct contact (e.g., cold pack), not air movement. Evaporation (D) involves moisture loss, not primarily fan-related here. Choice C is correct because convection matches the mechanism of air circulation enhancing heat dissipation, a principle nurses apply in thermoregulation strategies to cool patients effectively in clinical settings.
A nurse is caring for a postoperative client on the surgical unit. The client's blood pressure was 142/76 mm Hg 30 minutes ago, and now is 89/50 mm Hg. What action by the nurse is best?
A. Call the Rapid Response Team
B. Document and continue to monitor
C. Notify the primary care provider
D. Repeat blood pressure measurement in 15 minutes
Correct answer:
The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating before they suffer respiratory or cardiac arrest. Since the client has experienced a significant change in blood pressure, the nurse should call the RRT. Changes in blood pressure, mental status, heart rate, and pain are particularly significant. Documentation is vital, but the nurse must do more than document. Notifying the primary care provider is important but does not address the immediate need for intervention. Repeating the blood pressure measurement delays necessary action.
A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia. The client scores a zero. What action by the nurse is best?
A. Assess pain physiological indicators and vital signs.
B. Do not give pain medication as no pain is indicated.
C. To present the findings and continue to monitor.
D. Try a human state of analgesic medication for pain.
Correct answer:
Assessing pain in a nonverbal client is difficult despite the use of a scale specifically designed for this population. The nurse should next look at physiologic indicators of pain and vital signs for clues to the presence of pain. Even a low score on this index does not mean the client does not have pain, he or she may be holding very still to prevent more pain. Documenting pain is important but not the most important action in this case. The nurse can try a small dose of analgesia, but without having indices to monitor, it will be difficult to assess for effectiveness.
A patient arrives at the ambulatory surgery centre for a scheduled outpatient surgery. Which of the following information is of most concern to the nurse?
A. The patient has not had outpatient surgery before.
B. The patient is planning to drive home after surgery.
C. The patient may not have paid sick leave from work.
D. The patient had a glass of water a few hours before arriving.
Correct answer:
After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patient's experience with outpatient surgery is assessed, but it does not have as much application to the patient's physiological safety. The patient's insurance coverage is important to establish, but this is not usually the nurse's role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration as the guideline indicates that clear fluids can be taken up to two hours before surgery.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 24 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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