Nursing textbooks medical-surgical practice questions, set 30
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 30
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
The nurse is caring for a client at the end of life. The client is prescribed a regularly scheduled dose of narcotics and a short-acting narcotic for breakthrough pain. Which action should the nurse take when administering narcotics to manage this client's pain?
A. Assess for signs of drug dependence.
B. Prepare to treat any drug side effects.
C. Recognize that dosages will be restricted.
D. Administer all analgesics on a PRN basis.
Show answer and rationale
Correct answer: B — Prepare to treat any drug side effects.
The nurse who is administering narcotics at the end of life still must realize that any side effects must be addressed. In end-of-life care there is no need to assess for signs of drug dependence. The nurse will also reassure the client that frequent use of opioid analgesia will not cause addiction when administered in a life-limiting illness. In this case, dosing will not be restricted and medications will be administered on a routine schedule not a PRN basis. Administering the narcotic on routine schedule around the clock avoids causing intense discomfort followed by a period of heavy sedation.
Question 2
A client is brought to the ED with burns exceeding 20% of total body surface area. Which is the primary nursing intervention in the care of this client?
A. Prevent infection
B. Fluid resuscitation
C. Endotracheal tube placement
D. Strict intake and output
Show answer and rationale
Correct answer: B — Fluid resuscitation
Fluid resuscitation requirements are paramount in the management of clients having burns that exceed 20% of TBSA. Fluid resuscitation with crystaloid and colloid solutions is calculated from the time the burn injury occurred to restore the intravascular volume and prevent hypovolemic shock and renal failure. Infection prevention is a care consideration with all burns. Endotracheal tube placement may be necessary if respiratory factors indicate the need. Intake and output records are maintained to determine the success of fluid resuscitation efforts.
Question 3
The nurse is caring for a patient who is taking an opioid for postoperative pain. Which of the following interventions should the nurse include in the patients plan of care to manage possible adverse effects of opioids?
A. Ensure the medication is given PRN only.
B. Administer the prescribed stool softener OD
C. Ensure the administration route maximizes drug concentration at the site of the adverse effect.
D. Request a prescription for a different classification of medication.
Show answer and rationale
Correct answer: B — Administer the prescribed stool softener OD
Examples of ways to manage anticipated adverse effects of opioids are to administer stool softeners to prevent constipation and an antiemetic to prevent nausea. The medication should have a scheduling dosage regimen to maintain blood levels rather than only PRN. Changing to a different medication in the same classification may be appropriate rather than changing the drug classification. Another way to manage an adverse effect is to use an administration route that minimizes rather than maximizes drug concentrations at the site of the adverse effect.
Question 4
A 28-year-old client is diagnosed with endometriosis and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.)
A. Reduce the pain by low-level heat.
B. Discuss in detail the side effects of laparoscopic surgery.
C. Reduce anxiety by relaxation techniques and education.
D. Suggest resources such as the Endometriosis Association.
E. Encourage the client to avoid all physical activity.
Show answer and rationale
Correct answer: A — Reduce the pain by low-level heat.
With endometriosis, pain is the predominant symptom, with anxiety occurring because of the diagnosis. Interventions should be directed to pain and anxiety relief, such as low-level heat, relaxation techniques, and education about the pathophysiology and possible treatment of endometriosis. The nurse could suggest resources like the Endometriosis Association. Discussing surgical side effects in detail is not appropriate without assessing the client's readiness, and avoiding all physical activity is not recommended as it may not help manage symptoms.
Question 5
The nurse is caring for a client in the immediate postoperative phase after having a colostomy created. What type of appliance should the nurse use at this time?
A. A reusable pouch appliance should be used.
B. A disposable or temporary appliance should be used.
C. A dry sterile dressing should be used over the stoma.
D. A wet to dry dressing should be used over the stoma to keep it moist.
Show answer and rationale
Correct answer: B — A disposable or temporary appliance should be used.
A disposable, or temporary, appliance is preferred in the immediate postoperative phase because the size of the stoma changes over time as a result of swelling from the procedure itself. The size of the stoma may change rapidly and differ from one appliance change to the next. After the stoma heals and reaches its final size and shape, a permanent appliance (reusable) may be used. A dry sterile dressing or wet to dry dressing should not be placed over the stoma due to the saturation of stool, which may cause maceration of the skin around the stoma.
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Question 6
The nurse is interviewing a patient who is to have outpatient surgery using a general anaesthetic. Which of the following information is most important to communicate to the surgeon and anaesthesiologist before surgery?
A. The patient drinks three or four cups of coffee every morning before going to work.
B. The patient takes a baby Aspirin daily but stopped taking Aspirin 2 weeks ago.
C. The patient drank 120 mL of apple juice 3 hours before coming to the hospital.
D. The patient's father died after receiving general anaesthesia for abdominal surgery.
Correct answer:
The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue Aspirin 1-2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.
A female patient, 47 years old, visits the clinic because she has been experiencing stress incontinence when she sneezes or exercises vigorously. What is the best instruction the nurse can give the patient?
A. Keep a record of when the incontinence occurs.
B. Perform clean intermittent self-catheterization.
C. Perform Kegel exercises four to six times per day.
D. Wear a protective undergarment to address this age-related change.
Correct answer:
For cognitively intact women who experience stress incontinence, the nurse should instruct the patient to perform Kegel exercises four to six times per day to strengthen the pubococcygeus muscle. Keeping a record of when the incontinence occurs or accepting incontinence as part of aging are incorrect answers because they are of no value in treating stress incontinence. Women with stress incontinence do not need clean intermittent catheterization. Protective undergarments hide the effects of urinary incontinence but they do not resolve the problem.
Which of the following levels are part of the patient response to health care recommendations based on a continuum of self-care?
A. Compliance
B. Adherence
C. Self-care
D. Denial
E. Acceptance
Correct answer:
Compliance, adherence, and self-care make up the three levels of patient response to health care recommendations on a continuum of self-care. Compliance reflects coercion of the patient to engage in particular recommendations, whereas adherence implies conformity of the patient with the recommendations. Self-care connotes a therapeutic alliance between the patient and the provider. Adherence is now the term most widely accepted because it incorporates the notion of the patient agreeing with the treatment plan presented by the health care provider.
The nurse is providing care for a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following?
A. High HDL values and high triglyceride values
B. Absence of detectable total cholesterol levels
C. Elevated blood lipids, fasting glucose less than 100
D. Low LDL values and high HDL values
Correct answer:
The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol.
The nurse is teaching a client about the management of benign prostatic hyperplasia (BPH). Which instruction(s) should be included in the teaching? Select all that apply.
A. Moderate use of alcohol is useful for bladder relaxation.
B. Do not delay the urge to void.
C. Low-dose Benadryl will promote restful sleep.
D. Prolonged exposure to heat increases bladder spasms.
E. Painless hematuria is a common symptom of BPH.
Correct answer:
The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and/or presence of prostatic nodules. Alcohol and antihistamines (e.g., Benadryl) should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.
The nurse is preparing a patient with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan?
A. Avoid eating or drinking for several hours before the testing.
B. Use rescue medications immediately before the tests are done.
C. Take oral corticosteroids at least 2 hours before the examination.
D. Withhold bronchodilators for 6-12 hours before the examination.
Correct answer:
Bronchodilators are held before pulmonary function testing so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids also should be held before the examination and corticosteroids given 2 hours before the examination would be at a high level. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.
A patient will be taking dabigatran as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true?
A. The dose of dabigatran is reduced in patients with decreased renal function.
B. Bleeding is the most common adverse effect.
C. Idarucizumab is given as an antidote in cases of uncontrolled bleeding.
D. Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results.
E. This drug is a prodrug and becomes activated in the liver.
Correct answer:
Dabigatran is excreted extensively in the kidneys, and the dose is dependent upon renal function. The normal dose is 150 mg twice daily, but it will be given at reduced dosage if renal impairment is present. The most common and serious side effect is bleeding. Dabigatran is a prodrug that becomes activated in the liver. Idarucizumab (Praxbind) is a specific dabigatran antidote that reverses the anticoagulant effects of dabigatran for emergency surgery or in life-threatening or uncontrolled bleeding. Dabigatran levels are not monitored by PT/INR.
The nurse is providing instruction on the use of compression garments for the client with lymphedema. What should be included in the instructions? Select all that apply.
A. Purchase two compression garments.
B. Change the garment in the morning and in the evening.
C. Limit the time the garment is not worn to 30 to 60 minutes.
D. Replace a compression garment every month.
E. Place the garment in the dryer after washing
Correct answer:
When instructing the client on use of the compression garment, purchase two compression garments so that one can be worn while the other is washed and dried. Change the garment in the morning and again in the evening because the garment becomes stretched after 12 hours of being worn. Limit the time that the garment is not worn to no more than 30 to 60 minutes to prevent re accumulation of tissue fluid and stretched skin. The garment should be replaced every 4 to 6 months, not every month. The garment should be air dried, not placed in the dryer.
A nurse is caring for a patient with hepatic encephalopathy. The nurses assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
A. Stage I
B. Stage 2
C. Stage 3
D. Stage 4
Correct answer:
Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.
A rehabilitation nurse is working with a patient who has had a below-the-knee amputation. The nurse knows the importance of the patients active participation in self-care. In order to determine the patients ability to be an active participant in self-care, the nurse should prioritize assessment of what variable?
A. The patients attitude
B. The patients learning style
C. The patients nutritional status
D. The patients presurgical level of function
Correct answer:
Amputation of an extremity affects the patients ability to provide adequate self-care. The patient is encouraged to be an active participant in self-care. The patient and the nurse need to maintain positive attitudes and to minimize fatigue and frustration during the learning process. Balanced nutrition and the patients learning style are important variables in the rehabilitation process but the patients attitude is among the most salient variables. The patients presurgical level of function may or may not affect participation in rehabilitation.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 30 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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