Nursing textbooks medical-surgical practice questions, set 32
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 32
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
An LPN is a team leader for three nursing assistants covering a unit in a long-term care facility. At the beginning of each shift, the LPN instructs the nursing assistants to decide among themselves their client assignments. The LPN administers the clients' medications and some treatments but rarely checks in with the nursing assistants during the shift. The LPN's behavior reflects which managerial style?
A. Authoritarian
B. Laissez-faire
C. Democratic
D. Multicratic
Show answer and rationale
Correct answer: B — Laissez-faire
Laissez-faire leadership involves the least structure and control. In this scenario, the LPN allows the nursing assistants to make their own assignments and rarely checks in with them during the shift. This allows for minimal communication, which is one of the characteristics of the laissez-faire leadership style. Authoritarian leadership entails strong control by the manager over the work group, which is not demonstrated in this scenario. Democratic leadership involves more participation in decision-making by the work group. Although the nursing assistants decided among themselves about the client assignments, the LPN did not participate in the decision-making at all. There is also no communication between the nursing assistants and the LPN, which is not a characteristic of the democratic leadership style. Multicratic leadership allows a leader to determine which approach is best for a particular circumstance. This characteristic is not demonstrated in the scenario.
Question 2
An emergency department nurse is admitting a client brought in by the paramedics after falling from a tree stand. The client has fractured vertebrae at T3 and T4. The nurse knows the client is in the acute phase of neurologic deficit. What should the nurse know about the medical management of this client?
A. Goal is to keep the client stable and prevent or treat complications, such as pneumonia, and further neurologic impairment.
B. Goal is to plan a rehabilitation program in several domains according to the client's abilities and limitations.
C. Goal is to admit the client to a hospital for treatment of complications.
D. Goal is to stabilize the client and prevent further neurologic damage.
Show answer and rationale
Correct answer: D — Goal is to stabilize the client and prevent further neurologic damage.
The focus of management during the acute phase is to stabilize the client and prevent further neurologic damage. The client with a CVA may require management of hypertension or hypotension through drug therapy. The client with a head or spinal cord injury may require respiratory support through mechanical ventilation or surgical intervention to stabilize the injured area or remove bone fragments, blood clots, or foreign objects. Sometimes, surgery is postponed until the client is stabilized and the acute phase has passed. In other instances, surgery is performed during the acute phase as a lifesaving measure. Keeping the client stable and preventing or treating complications is the aim of medical management of the recovery phase. Planning a rehabilitation program according to the client abilities and limitations and admit the client for treatment of complications are nursing goals, not medical goals for different phases of neurologic deficit.
Question 3
An LPN, serving as team leader to a team consisting of LPNs and nursing assistants, is making client assignments. Which client situation should prompt the team leader to use acuity measures to reduce an LPN's assignment?
A. A client who demonstrates oxygen desaturation with minimal exertion
B. A client with dementia who is combative during medication administration
C. A client who requires the assistance of two for ambulation
D. A client who requires several intravenous antibiotics to treat a septic infection
Show answer and rationale
Correct answer: A — A client who demonstrates oxygen desaturation with minimal exertion
Acuity refers to the severity of the illness and the rapidity of change in the client, and thus the intensity of medical and nursing care and other therapies required. A client who desaturates with minimal exertion is at risk for respiratory compromise and respiratory arrest. This will require careful and frequent assessment that will limit the time the nurse will have for other client interactions. Dementia is a chronic condition making daily activities such as medication administration, but it does not require the frequent assessment that the client who demonstrates oxygen desaturation requires. The client who requires assistance with ambulation also is not at risk for severe complications like the client with oxygen desaturation. A client with multiple intravenous antibiotics should improve as treatment progresses and does not require the level of assessment and care that the client with oxygen desaturation will require.
Question 4
A nurse in the health care provider's office must provide care to the following clients. From first to last, in what order should the nurse provide needed care to the clients?
A. A client in an examination room who reports flulike symptoms
B. A client seated in the office reception area who reports chest heaviness
C. A client on the phone inquiring about doubling a dose of medication because of a missed dose the day before
D. A client requires a call back by the nurse for advice on a medication dosage change
E. A client who stopped into the office to pick up sample medications
Show answer and rationale
Correct answer: B — A client seated in the office reception area who reports chest heaviness
All nurses must manage multiple client needs in a timely manner. Nurses must prioritize to determine the proper order of response. Nurses should address issues critical to maintaining life first (airway, breathing, circulation). A client with chest heaviness potentially could be having a life-threatening condition requiring immediate attention. Next, the client in the exam room needs vital signs and a history of present illness before the health care provider enters. To maintain the flow of the office, this client is a priority. Next, the nurse would answer the question of the client on the phone who may otherwise incorrectly ingest a double dose of medication. Next, a client needs to be called with a medication dosage change. Last, the client in the office who has come to obtain sample medication needs medication instruction on dosage and side effects.
Question 5
A new client charting system is in the education phase at a healthcare facility. Much discussion has been prompted regarding the new system. With which statement does the nurse best exhibit the integrated leader/manager traits?
A. Let's look at the daily benefits of using the new technology on the clinical unit.'
B. I am not used to the new technology, but if it better serves the client and enables easy sharing of client authorized records, I see a benefit.'
C. New technology may be costly up front but will serve us well in the future.'
D. I do not believe that this technology will be helpful in caring for a client because it often is down during peak use times and is difficult to train for.'
Show answer and rationale
Correct answer: B — I am not used to the new technology, but if it better serves the client and enables easy sharing of client authorized records, I see a benefit.'
The traits of an integrated leader/manager combine understanding the daily operations on a clinical unit while seeing the big picture, thinking in the long term, and embracing change. Better serving the client and sharing records as needed demonstrates the willingness to think positively and take risks on improvement for the future. Focusing only on the daily benefits or only on the future impact of using the new technology each only look at one aspect of leadership and management. Stating that the new technology will not be helpful in client care is a negative statement and does not show that the manager is able to embrace change.
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Question 6
A nurse is caring for a client with stage IV colon cancer and multiple-stage two wounds on the coccyx area. The client confides feeling very weak and wanting to discontinue further aggressive treatment. Which nursing action best demonstrates the nurse in the role of the client advocate?
A. The nurse relays the message to the physician and requests an antidepressant.
B. The nurse asks the client how might their family feel with this decision.
C. The nurse sits with the client and suggests that the client reconsider.
D. The nurse offers to be present to support the client at a family meeting.
Correct answer:
Advocacy means promoting the cause of another person. The nurse functions as a client advocate by supporting the client and the client's decisions. Offering to support the client as the client expresses healthcare decisions is the best example of a client advocate. Relaying the message to the physician and asking for an antidepressant does not demonstrate supporting the client. Opening conversation related to family response is appropriate for discussion but is not the best choice to support the client. The nurse would not ask the client to reconsider because this is a block to communication.
When delegating tasks to unlicensed assistive personnel (UAP), a licensed practical nurse (LPN) should assess the situation. Which of the following is the first step involved in assessing the situation?
A. Communicate expectations clearly to UAP.
B. Identify the UAP who will best handle the delegated tasks.
C. Know the client's needs and priorities.
D. Trust the UAP to complete the task.
Correct answer:
To delegate tasks successfully, an LPN should first assess the situation. The steps taken to assess the situation involve understanding the client's needs, the skills of the UAP, and the priorities. The LPN should ensure that the UAP's skills map with the tasks to be completed. When planning the actions, the LPN should identify the UAP who will best handle the delegated tasks. When implementing the plan, the LPN should communicate expectations clearly to UAP, including what must be done, what to watch for, and potential problems. The LPN should trust the UAP to complete the task.
Goals and desired outcomes for an older adult patient experiencing delirium caused by fever and dehydration will focus on what?
A. Returning to premorbid levels of function
B. Identifying stressors negatively affecting self
C. Demonstrating motor responses to noxious stimuli
D. Exerting control over responses to perceptual distortions
Correct answer:
The desired overall goal is that the patient with delirium will return to the level of functioning held before the development of delirium since the condition is usually temporary in nature. Demonstrating motor responses to noxious stimuli is an appropriate indicator for a patient whose arousal is compromised. Identifying stressors that negatively affect the self is too nonspecific to be useful for a patient experiencing delirium. Exerting control over responses to perceptual distortions is an unrealistic indicator for the patient with sensorium problems related to delirium.
A patient experiencing fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, 'Someone get these bugs off me.' What is the nurse's best response?
A. There are no bugs on your legs. Your imagination is playing tricks on you.'
B. Try to relax. The crawling sensation will go away sooner if you can relax.'
C. Don't worry. I will have someone stay here and brush off the bugs for you.'
D. I don't see any bugs, but I know you are frightened so I will stay with you.'
Correct answer:
When hallucinations are present, the nurse should acknowledge the patient's feelings and state the nurse's perception of reality, but not argue. Staying with the patient increases feelings of security, reduces anxiety, offers the opportunity for reinforcing reality, and provides a measure of physical safety. Denying the patient's perception without offering help does not emotionally support the patient. Telling the patient to relax makes the patient responsible for self-soothing. Telling the patient that someone will brush the bugs away supports the perceptual distortions.
The nurse is caring for a patient with sudden-onset right-sided weakness who has a CT scan and is diagnosed with an intracerebral hemorrhage. Which of the following information about the patient is most important to communicate to the health care provider?
A. The patient's speech is difficult to understand.
B. The patient's blood pressure is 144/90 mm Hg.
C. The patient takes a diuretic because of a history of hypertension.
D. The patient has atrial fibrillation and takes warfarin.
Correct answer:
The use of warfarin will have contributed to the intracerebral bleeding and remains a risk factor for further bleeding. Administration of vitamin K is needed to reverse the effects of the warfarin, especially if the patient is to have surgery to correct the bleeding. The history of hypertension is a risk factor for the patient but has no immediate effect on the patient's care. The BP of 144/90 indicates the need for ongoing monitoring but not for any immediate change in therapy. Slurred speech is consistent with a left-sided stroke, and no change in therapy is indicated.
In which of the following disease processes is the nurse most likely to care for a client in the chronic phase of a neurologic disease?
A. Transient ischemic attack (TIA)
B. Malignant brain tumor
C. Alzheimer disease
D. Pneumonia
Correct answer:
Clients with Alzheimer disease are often admitted to the hospital for treatment of complications. Sometimes, when their disease process progresses, they are also admitted to a skilled nursing facility. A transient ischemic attack causes transient symptoms or minor neurologic deficits. A malignant brain tumor typically causes debilitating symptoms and spreads due to the malignant nature causing death. Pneumonia is a complication of neurologic deficits, but itself is not a neurologic deficit. Pneumonia can be resolved with antibiotics depending on the status of the client.
Which statement best demonstrates a combination of leadership and management skills when teaching a client with uncontrolled diabetes?
A. Although you have learned to check your blood sugar every morning, it is also important to recognize its overall effect on your health.'
B. Once you have the lancet in the device, hold it against the finger and press the button.'
C. Because Thanksgiving is next week, evaluate the amount of simple sugars in the desserts and eat those in moderation.'
D. I will notify your health care provider of your blood glucose reading and request a referral for a dietitian to improve your knowledge of calorie-controlled diets.'
Correct answer:
It is important for the nurse to acknowledge that the client has learned to check their blood sugar but also to stress the importance of recognizing the blood sugar level's overall effect on the client's health. Teaching the client how to obtain a glucose level and providing feedback uses management but not leadership. Providing teaching about simple sugars, notifying the client's health care provider, and requesting a referral for a dietitian are all examples of managing the client's care but do not address seeing the big picture, which is characteristic of leadership.
A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight. Which drug should the nurse advocate?
A. Clozapine
B. Ziprasidone
C. Olanzapine
D. Aripiprazole
Correct answer:
Aripiprazole is an atypical antipsychotic medication that is effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol levels, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.
A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance. Which statement best explains the rationale for a low-protein diet?
A. A low-protein diet will help the liver rest and restore function.
B. Less protein in the diet will help prevent confusion associated with liver failure.
C. Increasing dietary protein will help the client gain weight and muscle.
D. Low dietary protein is needed to prevent fluid overload.
Correct answer:
A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein may help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.
A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, 'I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone!' Which action should the nurse take?
A. Ensure the client is in as upright a position as possible.
B. Add humidity to the oxygen and encourage the client to wear it.
C. Document the client's refusal, and call the health care provider.
D. Contact the provider to request an extra dose of the client's diuretic.
Correct answer:
The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and using a face mask to deliver the oxygen. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 32 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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