Nursing textbooks medical-surgical practice questions, set 31
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 31
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 development of clinical judgment requires intentional focus and a willingness to grow and change both personally and professionally. How can a nursing student best foster the development of clinical judgment?
A. Engaging in learning that only appeals to their preferred learning style
B. Focusing on knowledge acquisition that is straightforward and clear
C. Developing a model for learning that integrates feedback and reflection
D. Focusing inward to develop emotional intelligence and communication skills
Show answer and rationale
Correct answer: C — Developing a model for learning that integrates feedback and reflection
Each nursing student is in charge of their learning, including integrating feedback from exams, clinical experiences, simulations, and other assignments-reflecting on what has been learned and integrating new learning. Adaptability is key. Classroom and clinical learning presents information in myriad ways and in different settings. Students should learn what they can from each situation and adapt their studying style as needed. Nursing knowledge, like patient care, is rarely straightforward and clear. Picking up on cues, emphasizing the correct element, answering the question being asked, and maintaining a person-centered focus that is individualized and nuanced requires practice and time. Students must give themselves the space and grace needed to learn and apply information in various situations. There is a reciprocity in learning that requires and inward and outward combination. Engagement with others and the environment is essential for shaping thinking and development of clinical judgment.
Question 2
Nursing programs prepare students for safe clinical practice. As a student nurse, why is a basic understanding of NCSBN's Clinical Judgment Measurement Model (CJMM) important? Select all that apply.
A. Successful completion of the NCLEX is required for professional licensure in the United States.
B. Nurse educators use the CJMM model and NCLEX test plans to develop exam questions.
C. Students should be intimately familiar with theoretical models of education to answer questions.
D. Appreciation of the core principles assists students in understanding the structure and insent of nursing exams.
E. There is overlap in the core components of clinical judgment models, measurement models, and the nursing process.
Show answer and rationale
Correct answer: A — Successful completion of the NCLEX is required for professional licensure in the United States.
Nurses in the United States must pass NCLEX prior to being issued a license to practice as a professional nurse. To help students achieve this goal, nurse educators model course exams on the NCSBN's NCLEX test plan in terms of content and style. Understanding the why (rationale for actions) is often helpful when students are engaged in studying, working to apply the information they have learned, and developing test-taking strategies. There is overlap between the models and processes identified as foundational to nursing education, which demonstrates the importance of fundamental concepts. A deep understanding of theoretical and philosophical models is not necessary for student nurses.
Question 3
The mother of a cancer patient comes to the nurse concerned with her daughters safety. She states that her daughters morphine dose that she needs to control her pain is getting higher and higher. As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management?
A. The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction.
B. Frequently, female patients and younger patients need higher doses of opioids to be comfortable.
C. The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment.
D. There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.
Show answer and rationale
Correct answer: D — There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.
Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an inevitable risk.
Question 4
A patient has just died following urosepsis that progressed to septic shock. The patients spouse says, I knew this was coming, but I feel so numb and hollow inside. The nurse should know that these statements are characteristic of what?
A. Complicated grief and mourning
B. Uncomplicated grief and mourning
C. Depression stage of dying
D. Acceptance stage of dying
Show answer and rationale
Correct answer: B — Uncomplicated grief and mourning
Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations, such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity. Complicated grief and mourning occur at a prolonged time after the death. The spouses statement does not clearly suggest depression or acceptance.
Question 5
A male client has been in pain for 12 hours related to the presence of kidney stones and states, 'I can't take this pain any longer. It is getting worse by the minute.' What does the nurse understand about the client's ability to tolerate pain?
A. Fatigue diminishes the ability to cope with pain and heightens the perception of pain.
B. Men tend to report higher pain intensity and demonstrate lower pain tolerance.
C. Men tend to rate their pain at higher levels and report pain in more body regions than women.
D. Fatigue allows the client to feel less pain.
Show answer and rationale
Correct answer: A — Fatigue diminishes the ability to cope with pain and heightens the perception of pain.
Pain tolerance is the amount of pain a person endures once the threshold has been reached. The ability to endure a great deal of pain indicates a high pain tolerance; a low pain tolerance refers to very little ability to endure pain. Various factors can affect pain tolerance. For example, fatigue diminishes the ability to cope with pain and heightens the perception of pain. There are gender differences in pain tolerance. Men tend to report lower pain intensity and demonstrate higher pain tolerance; women tend to rate their pain at higher levels and report pain in more body regions than men.
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Question 6
The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching?
A. Self-care and safety
B. Autonomy and need
C. Health promotion and exercise
D. Dependence and health
Correct answer:
The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.
A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurses care?
A. To improve the patients and familys quality of life
B. To support aggressive and innovative treatments for cure
C. To provide physical support for the patient
D. To help the patient develop a separate plan with each discipline of the health care team
Correct answer:
The goal of palliative care is to improve the patients and the familys quality of life. The support should include the patients physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the patient and family. The goal of palliative care is not aggressive support for curing the patient. Providing physical support for the patient is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the patient with each discipline of the health care team.
A nursing program uses Tanner's Clinical Judgment Model, a research-based model that accounts for differences in the patient, environment, and individual student nurse. What makes Tanner's reflection step unique?
A. The emphasis is on noticing, interpreting, and responding; reflection is less important.
B. Reflection occurs both in-action (in the moment) and on-action (after the situation).
C. Reflection occurs first in the model that is focused on rapid decision making and patient outcomes.
D. Reflection is the last step in a linear model and is designed to minimize bias in the student nurse.
Correct answer:
Reflection drives the clinical judgment cycle and allows for the integration of new knowledge that will inform future situations. Reflection is as important in Tanner's model as the other elements of noticing, interpreting, and responding. The focus of the model is the development of clinical judgment, rather than rapid decision making; as clinical judgment is developed, decision making improves and may lead to better patient outcomes. Tanner's model is cyclic, not linear; although bias may be addressed as part of the development of clinical judgment, it is not the focus.
Patients who are enrolled in hospice care through Medicare are often felt to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?
A. Unwillingness to overmedicate the dying patient
B. Rules concerning completion of all cure-focused medical treatment
C. Unwillingness of patients and families to acknowledge the patient is terminal
D. Lack of knowledge of patients and families regarding availability of care
Correct answer:
Because of Medicare rules concerning completion of all cure-focused medical treatment before the Medicare hospice benefit may be accessed, many patients delay enrollment in hospice programs until very close to the end of life. Hospice care does not include an unwillingness to medicate the patient to keep him or her from suffering. Patients must accept that they are terminal before being admitted to hospice care. Lack of knowledge is common; however, this is not why some Medicare patients do not receive adequate attention for the symptoms of their underlying illness.
The nurse is caring for a client who has diminished lung function due to emphysema. The terminally ill client is short of breath on exertion and reports difficulty sleeping in bed. The client states, 'I am so afraid of getting any worse.' Which statement, by the nurse, assists the client in sustaining hope?
A. Do not worry, I will be here for you to help you with your needs.'
B. I will talk with the health care provider to determine the next step in your care.'
C. Your grandchild is almost here, and you will enjoy seeing him.'
D. I hear you say that you are not sleeping well.'
Correct answer:
The client is assisted in hopefulness by believing that the healthcare team will make his remaining days meaningful. By conveying a sense that the nurse will discuss the client's condition with the health care provider, the client recognizes that the healthcare team will use whatever treatment and comfort measures are available. Telling a client not to worry is not therapeutic and is condescending. Waiting for a grandchild does not address the client's thought. Reflecting what the client said for clarification opens communication but does not instill hopefulness.
As the nurse admits a patient with severe heart failure to the hospital, the patient tells the nurse, 'If my heart or breathing stop, I do not want to be resuscitated.' Which of the following actions should the nurse take?
A. Ask if these wishes have been discussed with the health care provider.
B. Place a 'Do-Not-Resuscitate' (DNR) notation in the patient's care plan.
C. Inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed.
D. Advise the patient to designate a person to make health care decisions when the patient is not able to make them independently.
Correct answer:
A health care provider's order should be written describing the actions that the nurses should take if the patient requires CPR, but the primary right to decide belongs to the patient or family. The nurse should document the patient's request but does not have the authority to place the DNR order in the care plan. A notarized advance directive is not needed to establish the patient's wishes. The patient may need a durable power of attorney for health care (or the equivalent), but this does not address the patient's current concern with possible resuscitation.
The organization of a patients care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice?
A. It is based on the participation of clinicians without a team leader.
B. It is based on clinicians of varied backgrounds integrating their separate plans of care.
C. It is based on communication and cooperation between disciplines.
D. It is based on medical expertise and patient preference with the support of nursing.
Correct answer:
Interdisciplinary collaboration, which is different from multidisciplinary practice, is based on communication and cooperation among the various disciplines, each member of the team contributing to a single integrated care plan that addresses the needs of the patient and family. Multidisciplinary care refers to participation of clinicians with varied backgrounds and skill sets, but without coordination and integration. Interdisciplinary collaboration is not based on patient preference and should not prioritize medical expertise over other disciplines.
A physician has prescribed bisacodyl to a client with constipation. The client complains of epigastric pain and a burning sensation after taking the drug. Which of the following instructions should the nurse provide to the client?
A. Immediately stop taking the drug.
B. Take antacids between meals.
C. Take the drug in powdered form.
D. Avoid milk before taking the drug.
Correct answer:
The nurse should instruct the client to avoid milk, antacids, H2 antagonists, and proton pump inhibitors 1 to 2 hours before taking the bisacodyl tablets because the enteric coating may dissolve early before reaching the intestinal tract, resulting in gastric lining irritation or dyspepsia and decreasing the laxative effect of the drug. The nurse need not instruct the client to immediately stop taking the drug, take the drug in powdered form, or take antacids between meals as these interventions will not help in preventing gastric lining irritation.
The nurse is teaching a patient who has persistent constipation, about the use of psyllium. Which of the following information should the nurse include?
A. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
B. Dietary sources of fibre should be eliminated to prevent excessive gas formation.
C. Use of this type of laxative to prevent constipation does not cause adverse effects.
D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
Correct answer:
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fibre, the patient should gradually increase dietary fibre and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
You are called to your patient's room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patient's signs and symptoms?
A. Hypocalcemia
B. Hyponatremia
C. Hyperchloremia
D. Hypophosphatemia
Correct answer:
The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma. A high chloride level is accompanied by a high sodium level and fluid retention. With hypocalcemia, you would expect tetany. There would not be edema with hyponatremia. Signs or symptoms of hypophosphatemia are mainly neurologic.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 31 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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