Nursing textbooks medical-surgical practice questions, set 3
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 3
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 client complains of having tender and painful breasts, often feeling multiple jumps within the breast tissue. The nurse would need to gather additional information about which of the following?
A. Alcohol and caffeine consumption
B. Client's workplace in relation to the surroundings
C. Timing of symptoms in relation to the menstrual cycle
D. Bathing frequency and living surroundings
Show answer and rationale
Correct answer: C — Timing of symptoms in relation to the menstrual cycle
Considering that the client has tender and painful breasts and often feels lumps within her breast tissue, it is most likely that she suffers from fibrocystic breast disease. To confirm these findings, the nurse should ask relevant questions about the characteristics and timing of symptoms in relation to the menstrual cycle. Symptoms of fibrocystic breast disease are noticeable before menstruation and usually state during menstruation. The size of one cyst becomes larger before menstruation and often changes with the menstrual cycle. The nurse should further ask the client about her habits of smoking and consuming coffee, chocolate, and caffeinated soft drinks, not alcohol, because they aggravate the condition. Workplace surroundings or cleanliness habits do not matter because fibrocystic breast disease is not infectious.
Question 2
The client is presently taking a multivitamin and is considering adding a supplement with extra vitamin A to promote eye health. Which is the best response by the nurse?
A. Why do you feel the need to take vitamins?
B. Let's review the vitamin containers together.
C. Some vitamins can have toxic effects.
D. Are you experiencing problems with your sight?
Show answer and rationale
Correct answer: B — Let's review the vitamin containers together.
Reviewing the vitamin containers will provide the nurse and client with information on the dosages and whether they fall within the RDA. This can also provide an opportunity for further teaching. Asking the client why they feel the need to take vitamins is not the best response because it can imply that the client has made a wrong decision to take vitamins. The Dietary Supplement Health and Education Act of 1994 was passed to 'preserve the consumer's right to choose dietary supplements.' Some vitamins do have toxic effects, including Vitamin A, which is why the best response is for the nurse to review the bottles with the client. Then the nurse can see if the dosage is appropriate or not. Although Vitamin A is associated with improved vision, asking if the client is experiencing vision problems is not the best response.
Question 3
The OR nurse acts in the circulating role during a patients scheduled cesarean section. For what task is this nurse solely responsible?
A. Performing documentation
B. Estimating the patients blood loss
C. Setting up the sterile tables
D. Keeping track of drains and sponges
Show answer and rationale
Correct answer: A — Performing documentation
Main responsibilities of the circulating nurse include verifying consent; coordinating the team; and ensuring cleanliness, proper temperature and humidity, lighting, safe function of equipment, and the availability of supplies and materials. The circulating nurse monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel as well as implementing fire safety precautions. The circulating nurse also monitors the patient and documents specific activities throughout the operation to ensure the patients safety and well-being. Estimating the patients blood loss is the surgeons responsibility; setting up the sterile tables is the responsibility of the first scrub; and keeping track of the drains and sponges is the joint responsibility of the circulating nurse and the scrub nurse.
Question 4
A patient diagnosed with somatic symptom disorder tells the nurse, "It's starting again. I feel as though my heart is beating out of my chest and I can't breathe." The nurse should provide what response to best address the patient's symptoms?
A. "I'll call your health care provider and see if I can give you a sedative."
B. "Do you think you will feel better with some oxygen?"
C. "We've talked about how being dramatic is helpful."
D. "Has something happened to make you anxious?"
Show answer and rationale
Correct answer: D — "Has something happened to make you anxious?"
Patients with somatic symptom disorders have difficulty communicating their emotional needs. As children, their family communication style may have neglected the appropriate expression of anger, depression, fear, and other emotions, and thus they do not recognize feelings nor understand how to relate to them. The feeling of anxiety may cause tightness in the stomach, nausea, rapid heartbeat, shortness of breath, dizziness, sweating, and tensing of muscles such as the hands or jaw. If a person is taught to consider the relationship of emotions to physical symptoms, the person will likely identify that he or she is anxious. Offering medical interventions are not addressing the likely trigger for the symptoms. Accusing the patient of being dramatic will likely serve to only increase the anxiety already being experienced.
Question 5
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician?
A. Decreased breath sounds
B. Drainage of bile-colored fluid onto the abdominal dressing
C. Rigidity of the abdomen
D. Acute pain with movement
Show answer and rationale
Correct answer: C — Rigidity of the abdomen
The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, which may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.
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Question 6
The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching?
A. With minimal sedation, the patients respiratory efforts are affected, and cognitive function is not impaired.
B. With general anesthesia, the patients airway cannot be maintained, but cardiovascular function is maintained.
C. During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation.
D. During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation.
Correct answer:
When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.
An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity?
A. Anaphylactic (type I)
B. Cytotoxic (type II)
C. Immune complex (type III)
D. Delayed-type (type IV)
Correct answer:
The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive in onset, anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Immune complex (type III) hypersensitivity involves immune complexes formed when antigens bind to antibodies. Type III is associated with systemic lupus erythematosus, rheumatoid arthritis, certain types of nephritis, and bacterial endocarditis. Delayed-type (type IV), also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen.
A client diagnosed with Huntington disease is on a disease-modifying drug regimen and has a urinary catheter in place. Which potential complication is the highest priority for the nurse while monitoring the client?
A. Severe depression
B. Choreiform movements
C. Urinary tract infection
D. Emotional apathy
Correct answer:
Because all disease-modifying drug regimens for Huntington disease can decrease immune cells and infection protection, it is most important for the nurse to assess for acquired infections such as urinary tract infections, especially if the client is catheterized. Severe depression is common and can lead to suicide. Symptoms of Huntington disease develop slowly and include mental apathy and emotional disturbances, choreiform movements (uncontrollable writhing and twisting of the body), grimacing, difficulty chewing and swallowing, speech difficulty, intellectual decline, and loss of bowel and bladder control. Assessing for these other conditions is appropriate but not as important as assessing for urinary tract infection in the client on a disease-modifying drug regimen with a urinary catheter in place.
The nurse is providing a program at the local YMCA about stress-reduction techniques combined with a 1-mile walk around the indoor track once a week. What does this type of program address for the community?
A. Health promotion
B. Health maintenance
C. Illness prevention
D. Early detection of illness
Correct answer:
Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques. Illness prevention involves identifying risk factors such as a family history of hypertension or diabetes and reducing the effects of risk factors on one's health. Early detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Health maintenance refers to protecting one's current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast and colon cancers, or practicing safe sex.
The nurse is collecting data at the clinic from a new client who is being seen for an employee physical. The client informs the nurse that both parents have a history of high blood pressure, with one of them having a stroke at the age of 52 years. The nurse discusses diet and exercise programs that may benefit the client. What is the nurse displaying with this information?
A. Early detection
B. Health maintenance
C. Health promotion
D. Illness prevention
Correct answer:
Illness prevention involves identifying risk factors such as family history of hypertension or diabetes and reducing the effects of risk factors on one's health. Early detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Health maintenance refers to protecting one's current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast and colon cancers, or practicing safe sex. Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques.
The nurse provides care to a menopausal client who states, 'I read a news article that says I am at risk for coronary vascular disease due to inflammation.' Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis?
A. Addressing obesity
B. Avoiding the use of caffeine
C. Taking a daily multivitamin
D. Drinking at least 2 liters of water a day
Correct answer:
The 2019 ACC/AHA Guideline on the Primary Prevention of Coronary Vascular Disease (CVD) indicates a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests that decreasing obesity and body fat stores via exercise, dietary modification, or developing drugs that target proinflammatory proteins may reduce risk factors for heart disease. The risk for CVD accelerates for clients after menopause due to withdrawal of endogenous estradiol levels, which can worsen many traditional CVD risk factors, including body fat distribution. Avoiding the use of caffeine, using a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to atherosclerosis.
When caring for patients using evidence-informed practice, which of the following does the nurse use?
A. Clinical judgment based on experience
B. Evidence from a clinical research study
C. The best available evidence to guide clinical expertise
D. Evaluation of data showing that the patient outcomes are met
Correct answer:
Evidence-informed nursing practice is a continuous interactive process involving the explicit, conscientious, and judicious consideration of the best available evidence to provide care. Four primary elements are: (a) clinical state, setting, and circumstances; (b) patient preferences and actions; (c) best research evidence, and (d) health care resources. Clinical judgment based on the nurse's clinical experience is part of EIP, but clinical decision making also should incorporate current research and research-based guidelines. Evidence from one clinical research study does not provide an adequate substantiation for interventions. Evaluation of patient outcomes is important, but interventions should be based on research from randomized control studies with a large number of subjects.
The nurse in the ICU is admitting a 57-year-old man with a diagnosis of possible septic shock. The nurses assessment reveals that the patient has a normal blood pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurses analysis of these data should lead to what preliminary conclusion?
A. The patient is in the compensatory stage of shock.
B. The patient is in the progressive stage of shock.
C. The patient will stabilize and be released by tomorrow.
D. The patient is in the irreversible stage of shock.
Correct answer:
In the compensatory stage of shock, the blood pressure remains within normal limits. Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to maintaining adequate cardiac output. Patients display the often-described fight or flight response. The body shunts blood from organs such as the skin, kidneys, and GI tract to the brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin is cool and clammy, and bowel sounds are hypoactive. In progressive shock, the blood pressure drops. In septic shock, the patients chance of survival is low and he will certainly not be released within 24 hours. If the patient were in the irreversible stage of shock, his blood pressure would be very low and his organs would be failing.
Which assessments and interventions should the nurse consider when performing tracheal suctioning?
A. Closely assessing the patient before, during, and after the procedure
B. Hyperoxygenating the patient before and after suctioning
C. Limiting the application of suction to 20 to 30 seconds
D. Monitoring the pulse to detect effects of hypoxia and stimulation of the vagus nerve
E. Using an appropriate suction pressure (80 to 150 mm Hg)
Correct answer:
Close assessment of the patient before, during, and after the procedure is necessary to identify complications such as hypoxia, infection, tracheal tissue damage, dysrhythmias, and atelectasis. The nurse should hyperoxygenate the patient before and after suctioning and limit the application of suction to 10 to 20 seconds. In addition, monitor the patient's pulse frequently to detect potential effects of hypoxia and stimulation of the vagus nerve. Using an appropriate suction pressure (80 to 150 mm Hg) will help prevent atelectasis caused by excessive negative pressure. Research suggests that insertion of the suction catheter should be limited to a predetermined length (no further than 1 cm past the length of the tracheal or endotracheal tube) to avoid tracheal mucosal damage.
Which experiences are most likely to precipitate posttraumatic stress disorder (PTSD)? (Select all that apply.)
A. An 8-year-old child watches an R-rated movie with both parents.
B. A young adult jumps from a bridge with a bungee cord with a best friend.
C. An adolescent is kidnapped and held for 2 years in the home of a sexual predator.
D. A passenger is in a bus that overturns on a sharp curve in the road, tumbling down an embankment.
E. An adult is trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.
Correct answer:
PTSD usually follows a traumatic event that is outside the range of usual experience. Examples are childhood physical abuse, torture or kidnapping, military combat, sexual assault, and natural disasters such as floods, tornados, earthquakes, and tsunamis; human disasters such as a bus or elevator accident or crime-related events such being taken hostage are additional examples. The common element in these experiences is the individual's extraordinary helplessness or powerlessness in the face of such stressors. Bungee jumping by adolescents is part of the developmental task and might be frightening but in an exhilarating way rather than a harmful way. A child may be disturbed by an R-rated movie, but the presence of the parents would modify the experience in a positive way.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 3 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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