Nursing textbooks medical-surgical practice questions, set 5
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 5
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 requires a blood transfusion for anemia and tells the nurse, 'I don't want a transfusion because I don't want to get AIDS.' Which is the best response from the nurse to the client?
A. It's always a possibility.'
B. You don't want to die, do you?'
C. The blood is screened, and your risk is one in two million.'
D. If you don't have the transfusion, you are taking a greater risk.'
Show answer and rationale
Correct answer: C — The blood is screened, and your risk is one in two million.'
Before 1984, blood and blood products were a major source of HIV transmission. Since then, an HIV screening test known as nucleic acid testing (NAT) is performed on all blood and plasma donations. Although screening donated blood for HIV antibodies reduces the risk of transfusion-related infection with HIV, it is not flawless. The Verywell Health's website states that the risk for HIV infection in the United States from a blood transfusion is approximately one in two million units of blood. Informing the client that transmission is always a possibility does not provide any information that will be relevant to the decision. The other responses are nontherapeutic and, therefore, should not be used as a response to the client's statement.
Question 2
The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action?
A. Evaluate the client's dietary intake.
B. Observe the client's stools for blood.
C. Monitor the client's body temperature.
D. Monitor the client's blood pressure (BP).
Show answer and rationale
Correct answer: B — Observe the client's stools for blood.
If an older adult is anemic, blood loss from the gastrointestinal (GI) or genitourinary (GU) tracts is suspected. Observing the stool for blood will determine if the source of the client's bleeding is in the GI tract. Iron-deficiency anemia is unusual in older adults because the body does not eliminate excessive iron, thus increasing total body iron stores and necessitating maintenance of hydration. If evaluation of the GI and GU tracts does not reveal a source of bleeding, evaluating the client's diet may be appropriate; however, this is not the priority nursing action. Monitoring the client's body temperature and BP will assist the nurse in determining the source of the client's blood loss, but these are not priority nursing actions.
Question 3
A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a patio door, suffering a laceration. The nurse caring for this patient knows that the site of the injury will have an invasion of what?
A. Interferons
B. Phagocytic cells
C. Apoptosis
D. Cytokines
Show answer and rationale
Correct answer: B — Phagocytic cells
Monocytes migrate to injury sites and function as phagocytic cells, engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes. This occurs in response to the foreign bodies that have invaded the laceration from the dirt on the broken glass. Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Apoptosis, or programmed cell death, is the bodys way of destroying worn out cells such as blood or skin cells or cells that need to be renewed. Cytokines are the various proteins that mediate the immune response. These do not migrate to injury sites.
Question 4
A patient whose mother has diagnosed with BRCA gene-related breast cancer asks the nurse, 'Do you think I should be tested for the gene?' Which of the following responses by the nurse is most appropriate?
A. In most cases, breast cancer is not caused by the BRCA gene.
B. It depends on how you will feel if the test is positive for the BRCA gene.
C. There are many things to consider before deciding to have genetic testing.
D. You should decide first whether you are willing to have a double mastectomy.
Show answer and rationale
Correct answer: C — There are many things to consider before deciding to have genetic testing.
Although presymptomatic testing for genetic disorders allows patients to take action (such as mastectomy) to prevent the development of some genetically caused disorders, patients also need to consider that test results in their medical file may impact other areas of their life. Telling a patient that a decision about mastectomy should be made before testing implies that the nurse has made a judgment about what the patient should do if the test is positive. Although the patient may need to think about her reaction if the test is positive, other issues also should be considered. Although most breast cancers are not related to BRCA gene alterations, the patient with the gene alteration has a markedly increased risk for breast cancer.
Question 5
The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient?
A. Avoid applying suction on or near the suture line.
B. Position patient on the non operative side with the head of the bed down.
C. Assess the patients ability to perform self-suctioning.
D. Evaluate the patients ability to swallow saliva and clear fluids.
Show answer and rationale
Correct answer: A — Avoid applying suction on or near the suture line.
The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Self-suctioning may be unsafe because the patient may damage the suture line. Following a modified radical neck dissection with graft, the patient is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the patients ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the patients need for suctioning.
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Question 6
Which is a complication that can occur after abdominal surgery if pain is not managed?
A. Atelectasis
B. Hypoglycemia
C. Decrease in heart rate
D. Increase in cardiac output
Correct answer:
Pain associated with surgery in the abdominal region (e.g., appendectomy, cholecystectomy, splenectomy) may result in pulmonary complications. Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume, vital capacity, functional residual capacity, and alveolar ventilation. The patient is unable to cough and clear secretions, and the risk for complications such as pneumonia and atelectasis is high. Severe postoperative pain also results in sympathetic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure, and cardiac output. Hypoglycemia, decreases in heart rate, and increases in cardiac output are not complications of poor pain management.
A home care nurse provides care to a client three times a week. The client's family member lives in the home and is employed full time. The family member believes that the client would benefit greatly from care 24 hours a day but wants the client to remain at home. Which is the best action for the nurse to take to meet the family member's goal and to ensure the client receives the care required?
A. Advocate for the client and the family member to receive additional services as needed.
B. Encourage the family member to consider placement in a skilled nursing facility.
C. Teach the family member to provide care to the client during the times the nurse is not in the home.
D. Recommend enrolling the client in an adult day care center.
Correct answer:
The best action for the nurse to take to ensure the client receives needed care and to meet the family member's goals for the client is to advocate for the family to receive whatever additional services are required. A skilled nursing facility will provide 24-hour care for the client and will assist in ADLs but will not allow the client to remain at home as the family member wants. An adult day care center allows the client to remain at home but does not provide 24-hour care and can only assist with ADLs during the time frame the client is at the center. Teaching the family member to perform procedures, administer medications, and provide other care would not be the best options because the family member is employed full-time.
A student with a history of asthma visits the school nurse reporting difficulty breathing and wheezing. Which tool would the nurse use to assess the severity of airway resistance?
A. Peak flow meter
B. End-tidal CO2 monitor
C. Chest tube
D. Arterial blood gas
Correct answer:
A peak flow meter is used to assess the point of highest flow during forced expiration. It is routinely used by and for patients with moderate or severe asthma to measure the severity of the disease and degree of disease management. Capnography or end-tidal CO2 monitoring is used for assessing and monitoring ventilation and placement of artificial airways, predicting patients who are at risk for respiratory compromise, are experiencing partial or complete airway obstruction, or are experiencing hypoventilation. A chest tube is used to remove air or fluid from the pleural space. The arterial blood gas (ABG) is used to assess oxygenation, ventilation, and acid-base status; it is invasive and not performed in the school setting.
A pregnant patient with a family history of cystic fibrosis (CF) asks the emergency department nurse for information about genetic testing. Which of the following actions is most appropriate for the nurse to take?
A. Refer the patient to a qualified genetic counsellor.
B. Ask the patient why genetic testing is important to her.
C. Remind the patient that genetic testing has many social implications.
D. Tell the patient that cystic fibrosis is an autosomal-recessive disorder.
Correct answer:
Although the nurse should understand basic genetics, the emergency department is often not the ideal environment for genetic counselling. A genetic nurse or counsellor is best qualified to address the multiple issues involved in genetic testing for a patient who is considering having children. Although genetic testing does have social implications, a pregnant patient will be better served by a genetic counsellor who will have more expertise in this area. CF is an autosomal-recessive disorder, but the patient might not understand the implications of this statement. Asking why the patient feels genetic testing is important may imply to the patient that the nurse is questioning her value system regarding issues such as abortion.
The nursing instructor is discussing postoperative care with a group of nursing students. A student nurse asks, Why does the patient go to the PACU instead of just going straight up to the postsurgical unit? What is the nursing instructors best response?
A. The PACU allows the patient to recover from anesthesia in a stimulating environment to facilitate awakening and reorientation
B. The PACU allows the patient to recover from the effects of anesthesia, and the patient stays in the PACU until he or she is oriented, has stable vital signs, and is without complications
C. Frequently, patients are placed in the medicalsurgical unit to recover, but hospitals are usually short of beds, and the PACU is an excellent place to triage patients
D. Patients remain in the PACU for a predetermined time because the surgeon will often need to reinforce or alter the patients incision in the hours following surgery
Correct answer:
The PACU provides care for the patient while he or she recovers from the effects of anesthesia. The patient must be oriented, have stable vital signs, and show no evidence of hemorrhage or other complications. Patients will sometimes recover in the ICU, but this is considered an extension of the PACU. The PACU does allow the patient to recover from anesthesia, but the environment is calm and quiet as patients are initially disoriented and confused as they begin to awaken and reorient. Patients are not usually placed in the medicalsurgical unit for recovery and, although hospitals are occasionally short of beds, the PACU is not used for patient triage. Incisions are very rarely modified in the immediate postoperative period.
A client receiving levofloxacin comes to the clinic for a follow-up visit. The client tells the nurse, 'I used sunscreen but it didn't help.' Which response by the nurse would be most helpful?
A. Be sure to wear long sleeves and a wide-brimmed hat in addition to using sunscreen.
B. I guess you didn't apply enough sunscreen to be effective.
C. Maybe we need to change your medication because this is unusual.
D. The sunscreen should have worked. Are you sure you actually did use it?
Correct answer:
The fluoroquinolone drugs cause severe photosensitivity reactions. Clients may experience 'sunburn' reactions even when they use sunscreen or sunblock products. Caution clients to wear cover-up clothing with long sleeves and wide-brimmed hats when outside in addition to sunblock preparations. Remind them that sunscreen needs to be applied repeatedly throughout the day or when going into water. Clients should be aware that glare during hazy or cloudy days can cause skin reactions as readily as direct sunlight on a clear day. Telling the client that he didn't apply enough or questioning the client's actual use of sunscreen is inappropriate. There is no need to change the medication because the client's report is not unusual.
A client receiving levofloxacin comes to the clinic for a follow-up visit. The client tells the nurse, 'I used sunscreen but it didn't help.' Which response by the nurse would be most helpful?
A. Be sure to wear long sleeves and a wide-brimmed hat in addition to using sunscreen.
B. I guess you didn't apply enough sunscreen to be effective.
C. Maybe we need to change your medication because this is unusual.
D. The sunscreen should have worked. Are you sure you actually did use it?
Correct answer:
The fluoroquinolone drugs cause severe photosensitivity reactions. Clients may experience 'sunburn' reactions even when they use sunscreen or sunblock products. Caution clients to wear cover-up clothing with long sleeves and wide-brimmed hats when outside in addition to sunblock preparations. Remind them that sunscreen needs to be applied repeatedly throughout the day or when going into water. Clients should be aware that glare during hazy or cloudy days can cause skin reactions as readily as direct sunlight on a clear day. Telling the client that he didn't apply enough or questioning the client's actual use of sunscreen is inappropriate. There is no need to change the medication because the client's report is not unusual.
A client is preparing to have colorectal surgery and will have a colostomy created temporarily in hopes that he may be able to have it reversed in 6 months. The client is very concerned about the care of the colostomy. What preoperative interaction would the client benefit from?
A. Discussing other options with the surgeon
B. Meeting with an enterostomal therapist
C. Going to a support group with other clients that have colostomies
D. Watching a video about colostomies
Correct answer:
Clients benefit from preoperative interactions with a specially certified nurse, referred to as an enterostomal therapy nurse, enterostomal therapist, or wound, ostomy, and continence nurse. This nurse assists with marking placement of the stoma and collaborates with the surgeon regarding placement and the client's educational needs. Other options may not be available for this client, especially if there is a tumor present. Going to a support group would be a good option in the postoperative management because the client should be given information from the professional prior to going to surgery. Watching the video with the therapist and having the option to answer questions would be a better choice than watching it alone.
When administering an opioid antagonist to reverse opioid-induced respiratory depression, which of the following would be most important for the nurse to keep in mind?
A. Monitoring is less frequent if respiratory depression occurs in the immediate postoperative setting.
B. The nurse should notify the primary health care provider if any adverse drug reactions occur.
C. After the client has shown a response to the drug, the nurse monitors vital signs every 30 to 60 minutes.
D. Monitoring of the client's respiratory status includes rate, rhythm, and depth.
E. The nurse monitors the client's blood pressure, pulse, and respiratory rate at frequent intervals, usually every 3 minutes, until the client responds.
Correct answer:
As part of the ongoing assessment during the administration of the antagonist, continue to monitor the blood pressure, pulse, and respiratory rate at frequent intervals, usually every 5 minutes, until the client responds. This monitoring should be more frequent if respiratory depression occurs in the immediate postoperative setting. After the client has shown a response to the drug, monitor vital signs every 5 to 15 minutes. Notify the anesthesiologist or primary health care provider if any adverse drug reactions occur because additional medical treatment may be needed. Continue to monitor the respiratory rate, rhythm, and depth; pulse; blood pressure; and level of consciousness until the effects of the opioid wear off.
The nurse conducts an educational in-service training on infection protection and control for staff members who will provide care to clients who are positive for human immunodeficiency virus (HIV). Which subtype of HIV does the nurse inform staff members is the most prevalent in the United States?
A. HIV-1, Group M, subtype A
B. HIV-1, Group M, subtype B
C. HIV-1, Group M, subtype C
D. HIV-1, Group M, subtype D
Correct answer:
Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 is composed of four groups identified as M, N, O, and P. Group M mutates easily and frequently, producing multiple substrains that are identified by letters from A through K, and circulating recombinant form (CRF), a hybrid virus formed by genetic material from various combined subtypes. HIV-2 is the primary type of infection in Western Africa. It is less transmittable, and the interval between initial infection with HIV-2 and the development of AIDS is longer. HIV-1, Group M, subtype B is more prevalent in the United States and in the rest of the world, but the distribution of subtypes changes from time to time because of the diverse merging of populations.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 5 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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