Nursing textbooks medical-surgical practice questions, set 33
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 33
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
What is the nurses primary responsibility around the use of complementary therapies?
A. To become skilled in administering as many complementary therapies as possible
B. To liaise between practitioners of complementary therapies and the medical team
C. To examine the evidence base underlying each of the patients chosen complementary therapies
D. To assess the patients use of complementary therapies in order to promote safety
Show answer and rationale
Correct answer: D — To assess the patients use of complementary therapies in order to promote safety
Nurses must assess all patients for use of complementary therapies, be alert to the danger of herb-drug interactions or conflicting treatments, and be prepared to provide information to patients about treatments that may be harmful. However, nurses must be accepting of patients beliefs and right to autonomy (i.e., to control their own care). It is not the nurses role to be the intermediary between practitioners and the medical team or to evaluate the effectiveness of therapies. The nurse is also not responsible for becoming skilled in administering as many complementary therapies as possible.
Question 2
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this clients hypertension?
A. Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption
B. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion
C. Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient
D. Carefully assess for weight loss because of impaired kidney function resulting from normal aging
Show answer and rationale
Correct answer: B — Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion
Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.
Question 3
A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?
A. A hypoproliferative anemia
B. A leukemia
C. Thrombocytopenia
D. A hemolytic anemia
Show answer and rationale
Correct answer: D — A hemolytic anemia
In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is converted in large part to bilirubin, and therefore the bilirubin concentration rises. The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. This increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes. Hypoproliferative anemias, leukemia, and thrombocytopenia lack this pathology and presentation.
Question 4
The nurse is preparing a patient for cardiac surgery. During the procedure, the patients heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?
A. Orthotopic transplant
B. Xenograft
C. Heterotropic transplant
D. Homograft
Show answer and rationale
Correct answer: A — Orthotopic transplant
Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipients heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipients heart, leaving a portion of the recipients atria (with the vena cava and pulmonary veins) in place. Homografts, or allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not terms used to describe heart transplantation.
Question 5
A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?
A. AML
B. CML
C. MDS
D. ALL
Show answer and rationale
Correct answer: D — ALL
In acute lymphocytic leukemia (ALL), manifestations of leukemic cell infiltration into other organs are more common than with other forms of leukemia, and include pain from an enlarged liver or spleen, as well as bone pain. The central nervous system is frequently a site for leukemic cells; thus, patients may exhibit headache and vomiting because of meningeal involvement. Other extranodal sites include the testes and breasts. This particular presentation is not closely associated with acute myeloid leukemia (AML), chronic myeloid leukemia (CML), or myelodysplastic syndromes (MDS).
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Question 6
The nurse is assessing a patient who was admitted with heart failure and notes that the patient has jugular venous distension (JVD) when lying flat in bed. Which of the following actions should the nurse take next?
A. Use a ruler to measure the level of the JVD.
B. Document this finding in the patient's record.
C. Observe for JVD with the head at 45 degrees.
D. Have the patient perform the Valsalva manoeuvre.
Correct answer:
When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not clinically significant) finding. JVD that persists when the patient is sitting at a 45-degree angle or greater is significant. The nurse may use a ruler to determine the level of JVD above the heart if the JVD persists when the patient is at a 45-degree angle or more. JVD is an expected finding when a patient performs the Valsalva manoeuvre because right atrial pressure increases. The nurse will document the JVD in the record if it persists when the head is elevated.
The nurse working in the heart failure clinic will know that teaching for a patient with newly diagnosed heart failure has been effective when the patient does which of the following actions?
A. Uses an additional pillow to sleep when feeling short of breath at night.
B. Tells the home care nurse that furosemide is taken daily at bedtime.
C. Calls the clinic when the weight increases from 56 to 59 kg in 2 days.
D. Says that the nitroglycerin patch will be used for any chest pain that develops.
Correct answer:
Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of more than 2 kg in a 2 day period. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an 'as necessary' basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by elevating the head of the bed further.
The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems?
A. To assess the patients response to fluid and drug administration
B. To obtain specimens for arterial blood gas measurements
C. To dislodge pulmonary emboli
D. To diagnose the etiology of chronic obstructive pulmonary disease
Correct answer:
Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patients response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.
During change-of-shift report, the nurse obtains this information about a patient who is hypertensive and received the first dose of propranolol during the previous shift. Which of the following information indicates that the patient needs immediate intervention?
A. The patient's most recent BP reading is 156/94 mm Hg.
B. The patient's pulse has dropped from 64 to 58 beats/minute.
C. The patient has developed wheezes throughout the lung fields.
D. The patient complains that the fingers and toes feel quite cold.
Correct answer:
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective ??-adrenergic blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.
A nurse is caring for a patient with severe anemia. The patient is tachycardic and complains of dizziness and exertional dyspnea. The nurse knows that in an effort to deliver more blood to hypoxic tissue, the workload on the heart is increased. What signs and symptoms might develop if this patient goes into heart failure?
A. Peripheral edema
B. Nausea and vomiting
C. Migraine
D. Fever
Correct answer:
Cardiac status must be carefully assessed in patients with anemia. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly), and by peripheral edema. Nausea, migraine, and fever are not associated with heart failure.
A client diagnosed with heart failure has been admitted to the ICU prior to invasive treatment. What treatment could be considered curative for this client?
A. Cardiomyoplasty
B. External pacemaker placement
C. Surgical ventricular restoration
D. Ventricular assist device
Correct answer:
A procedure known as surgical ventricular restoration (SVR) decreases the size of the heart to a near normal size and shape by removing dysfunctional heart muscle that does not contract properly. Once the adynamic (nonfunctioning) area is removed, the ventricle is repaired with a patch. In the cases that were studied, 91% were free of congestive heart failure after surgery with an ejection fraction that increased from 30% to 40%. A cardiomyoplasty, placement of an external pacemaker, or a ventricular assist device are not considered curative for heart failure.
The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS) who is hospitalized with pneumonia. Which of the following actions should the nurse take?
A. Assist with active range of motion
B. Observe for agitation and paranoia
C. Give muscle relaxants as needed to reduce spasticity
D. Use simple words and phrases to explain procedures.
Correct answer:
ALS causes progressive muscle weakness. Patients should be guided to use moderate-intensity, endurance-type exercises for the trunk and limbs, since this may help reduce ALS spasticity. When hospitalized with other health concerns, it is important to complete ROM to maintain strength. Psychotic symptoms such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.
The nurse is caring for a patient who has just diagnosed with hypertension and has a new prescription for captopril. Which of the following information is important to include when teaching the patient?
A. Check BP daily before taking the medication.
B. Increase fluid intake if dryness of the mouth is a problem.
C. Include high-potassium foods such as bananas in the diet.
D. Change position slowly to help prevent dizziness and falls.
Correct answer:
The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.
A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses?
A. Activity Intolerance
B. Risk for Infection
C. Acute Confusion
D. Risk for Spiritual Distress
Correct answer:
Induction therapy places the patient at risk for infection, thus this is the priority nursing diagnosis. During the time of induction therapy, the patient is very ill, with bacterial, fungal, and occasional viral infections; bleeding and severe mucositis, which causes diarrhea; and marked decline in the ability to maintain adequate nutrition. Supportive care consists of administering blood products and promptly treating infections. Immobility, confusion, and spiritual distress are possible, but infection is the patients most acute physiologic threat.
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the arrhythmia?
A. Defibrillation
B. Maze procedure
C. Pacemaker implantation
D. Elective cardioversion
Correct answer:
Atrial fibrillation is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. Maze procedures are used for clients who are not candidates for cardio diversion; these procedures use scar-forming techniques to eliminate rapid firing of ectopic pacemaker sites, thus restoring the normal conduction pathways in the atria. A Maze procedure might be considered for this client only after determining ineligibility for cardiodiversion. Pacemakers are implanted for bradycardia.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 33 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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