Nursing textbooks medical-surgical practice questions, set 8
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 8
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 patient who had a C8 spinal cord injury 10 days ago and has a weak cough effort and loose-sounding secretions. Which of the following actions should the nurse implement initially?
A. Suction the patient's oral and pharyngeal airway.
B. Administer oxygen at 7-9 L/minute with a face mask.
C. Place the hands just below the xiphoid process and push upward when the patient coughs.
D. Encourage the patient to use an incentive spirometer every 2 hours during the day.
Show answer and rationale
Correct answer: C — Place the hands just below the xiphoid process and push upward when the patient coughs.
Since the cough effort is poor, the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions. The nurse places the heels of both hands just below the patient's xiphoid process and exerts firm upward pressure to the area, timed with the patient's efforts to cough. Administration of oxygen will improve oxygenation, but the data do not indicate hypoxemia. The use of the spirometer may improve respiratory status, but the patient's ability to take deep breaths is limited by the loss of intercostal muscle function. Suctioning may be needed if the patient is unable to expel secretions by coughing but should not be the nurse's first action.
Question 2
Nursing students attending a class on genomics are discussing its use in current nursing practice. Which statements by the students identify genetic principles that will challenge nurses to integrate genomics in their research, education, and practice? Select all that apply.
A. Genetic tests plus family history tools have the potential to identify people at risk for diseases.
B. Pharmacogenetic tests can determine if a patient is likely to positive therapeutic response to a drug or develop adverse reactions from the medication.
C. Evidence-based review panels are in place to evaluate the possible risks and benefits related to genetic testing.
D. Valid and reliable national data bases exist to establish baseline measures and track progress toward targets.
E. Genetic variation can either accelerate or slow the metabolism of many drugs.
Show answer and rationale
Correct answer: A — Genetic tests plus family history tools have the potential to identify people at risk for diseases.
Health care providers are challenged to integrate genomics into their research, education, and practice. Genetic tests plus family history tools have the potential to identify people at risk for diseases. Pharmacogenetics studies how genetic variation affects a person's response to drugs, helping to determine if a patient is likely to have a strong therapeutic response or develop adverse effects to a drug. Genetic variation can either accelerate or slow the metabolism of many drugs. Evidence-based review panels and national databases are emerging challenges, but they are not principles of genomics. It is within a nurse's scope to discuss genetic findings and their impact on health.
Question 3
Which of the following describes the role of the nurse as defined by Florence Nightingale?
A. Helping people to carry out activities that contribute to health and recovery
B. Putting clients in the best condition for nature to act upon them
C. Diagnosing and treating human responses to actual or potential health problems
D. Promoting a caring relationship that facilitates health and healing
Show answer and rationale
Correct answer: B — Putting clients in the best condition for nature to act upon them
Florence Nightingale (1859) described the role of the nurse as putting 'the patient in the best condition for nature to act upon him.' Virginia Henderson envisioned the nurse's role as helping people (sick or well) to carry out activities that contribute to health, recovery, or a peaceful death. The American Nurses Association (ANA) traditionally defined nursing as 'the diagnosis and treatment of human responses to actual or potential health problems.' In response to an increased emphasis on the science of care, the ANA now acknowledges 'promotion of a caring relationship that facilitates health and healing' as one of the four essential features of contemporary nursing practice.
Question 4
A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.)
A. Lipodystrophy
B. Liver damage
C. Kaposi's sarcoma
D. Osteoporosis
E. Type 2 diabetes
Show answer and rationale
Correct answer: A — Lipodystrophy
Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications"bone demineralization and possible osteoporosis. Kaposi's sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy.
Question 5
A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management to begin?
A. Before surgery
B. When the client is taken to the postanesthesia care unit
C. After the client returns to the room after surgery and receives pain medication
D. Twenty-four hours after the procedure
Show answer and rationale
Correct answer: A — Before surgery
Ideally, postoperative nursing management begins before surgery with demonstrations of deep-breathing and coughing exercises and descriptions and demonstrations of the incentive spirometer. Even if the client will have postoperative physical therapy, the nurse explains and helps the client practice active and isometric leg exercises. The nurse also describes other devices that may be used after surgery, such as intravenous infusions of fluid and blood, oxygen, a wound drain, elastic stockings, or roller bandages. It also is necessary to include a discussion of the possible use of traction or the CPM machine. The other options offered do not allow adequate time for instruction.
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Question 6
During the assessment of a client scheduled for orthopedic surgery, the nurse discovers that the client was previously treated for the disorder. In such a case, what additional data need to be collected?
A. Occurrence of complications or problems during treatment
B. Measures taken to minimize postoperative wound infection
C. Perception of the client about the previous treatment
D. Details of the medical team that handled the previous treatment
Correct answer:
If the same disorder has been treated earlier, the nurse needs to determine and document any complications or problems that occurred during treatment. The nurse can determine whether the client understands the treatment or not based on the measures taken by the client to minimize postoperative wound infection. However, this factor can be assessed later because the nurse needs to explain the new treatment to the client. Although the client's perceptions of the previous treatment may be helpful, this data would not be as important. In addition, the nurse does not need to get details about the medical team that handled the previous treatment, unless specifically asked to do so.
The nurse is caring for a patient with chronic atrial fibrillation who develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. Which of the following actions should the nurse implement first?
A. Elevate the left leg on a pillow.
B. Apply an elastic wrap to the leg.
C. Assist the patient in gently exercising the leg.
D. Notify the health care provider.
Correct answer:
The patient's history and clinical manifestations are consistent with acute arterial occlusion. Clinical manifestations of acute arterial ischemia include the 'six Ps': pain, pallor, paralysis, pulselessness, paresthesia, and poikilothermia (adaptation of the limb to the environmental temperature most often cool). Without immediate intervention, ischemia may progress quickly to tissue necrosis and gangrene within a few hours. If the nurse detects these signs, the nurse should immediately notify the health care provider. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.
A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?
A. Knowledge of the causes of obesity and its associated risks
B. Adequate understanding of required lifestyle changes
C. Positive body image and high self-esteem
D. Insight into why past weight loss efforts failed
Correct answer:
Patients seeking bariatric surgery should be free of serious mental disorders and motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. While assessment of knowledge about causes of obesity and its associated risks as well as insight into the reasons why previous diets have been ineffective are included in the clients plan of care, these do not predict positive client outcomes following bariatric surgery. Most obese patients have an impaired body image and alteration in self-esteem. An obese patient with a positive body image would be unlikely to seek this surgery unless he or she was experiencing significant comorbidities.
A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal?
A. Taking a proton-pump inhibitor
B. Nasal congestion
C. Hypothyroidism
D. Taking an antihypertensive drug
E. Sinus infections
Correct answer:
Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton-pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acid-promoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies.
The nurse is caring for a patient who is admitted to the ER with the diagnosis of acute appendicitis. The nurse notes during the assessment that the patients ribs and xiphoid process are prominent. The patient states she exercises two to three times daily and her mother indicates that she is being treated for anorexia nervosa. How should the nurse best follow up these assessment data?
A. Inform the postoperative team about the patients risk for wound dehiscence
B. Evaluate the patients ability to manage her pain level
C. Facilitate a detailed analysis of the patients electrolyte levels
D. Instruct the patient on the need for a high-sodium diet to promote healing
Correct answer:
The surgical team should be informed about the patients medical history regarding anorexia nervosa. Any nutritional deficiency, such as malnutrition, should be corrected before surgery to provide adequate protein for tissue repair. The electrolyte levels should be evaluated and corrected to prevent metabolic abnormalities in the operative and postoperative phase. The risk of wound dehiscence is more likely associated with obesity. Instruction on proper nutrition should take place in the postoperative period, and a consultation should be made with her psychiatric specialist. Evaluation of pain management is always important, but not particularly significant in this scenario.
The nurse is caring for a client who has undergone cervical laminectomy surgery. Which nursing intervention(s) is included in the postoperative plan of care? Select all that apply.
A. Monitor vital signs.
B. Report an inability to void or an output of less than 8 oz (240 mL) in 8 hours.
C. Instruct on coughing and deep breathing exercises.
D. Perform side-to-side range-of-motion exercises of the head and neck.
E. Perform a neurovascular assessment below the area of the surgery.
Correct answer:
When planning care for a client who has undergone surgery for cervical nerve root decompression, the nurse should include monitoring vital signs, reporting on fluid intake and output, instruction on deep breathing exercises, performing neurovascular assessment below the area of the surgery, and examining the dressing for CSF leakage or bleeding. The nurse should not have the client perform coughing exercises, because these increase pressure within the spinal canal. The nurse should instruct the client to avoid side-to-side rotation of the head for the client with cervical nerve compression and should not perform side-to-side range of motion exercises of the head and neck.
A 48-year-old man presents to the ED complaining of severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU?
A. Begin ECG monitoring
B. Obtain information about family history of heart disease
C. Auscultate lung fields
D. Determine if the patient smokes
Correct answer:
The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored; life-threatening arrhythmias are the leading cause of death in the first hours after an MI. Obtaining information about family history of heart disease and whether the patient smokes are not immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation and pain control needs are met.
A nurse is reviewing the discharge plan with a patient who had major abdominal surgery. Which statement by the nurse is most appropriate?
A. I'll bet you will be so glad to be home and sleep in your own bed.
B. Tell me about your understanding of your recovery needs after discharge.
C. Be sure to take your pain medications and change your dressing.
D. You will just be fine! Please stop worrying.
Correct answer:
The purpose of discharge planning is to ensure for continuity of care for the patient and family needs. The nurse uses open-ended assessment questions to begin a planning session. Essential components of discharge planning include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the care plan; considering individual, family, and community resources; and evaluating the effectiveness of care. Answers a and c are examples of communication or interventions, which may be included after an assessment. The statement 'You will just be fine! Please stop worrying,' is a clich??® and is avoided.
A nurse is creating a plan of care and has identified several problems for the client including a collaborative problem. Which statement distinguishes a collaborative problem from a problem-focused nursing diagnosis?
A. A collaborative problem addresses the problem's related risk factors and defining characteristics.
B. A collaborative problem denotes a complication that has a physiologic origin which can be addressed by independent and/or health care provider prescribed nursing interventions.
C. A collaborative problem denotes a client's response to a physiologic condition that can be addressed solely by nursing interventions.
D. A collaborative problem is a secondary risk factor that provides a more in-depth explanation of the problem.
Correct answer:
Collaborative problems denote complications with a physiologic origin and differ from nursing diagnoses, which address client responses to various circumstances and are managed by nursing interventions. Related risk factors and defining characteristics are parts of a nursing diagnosis, not a collaborative problem. A nursing diagnosis describes a client's response to a physiologic condition or the environment and can be addressed by nursing interventions (independent or health care provider prescribed). Secondary risk factors can provide a more in-depth explanation of the cause of a problem in a nursing diagnosis. Collaborative problems do not have secondary risk factors.
The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included?
A. Dress infant warmly to prevent chilling.
B. Keep the infants fingernails and toenails cut short and clean.
C. Give bubble baths instead of washing lesions with soap.
D. Launder clothes in mild detergent; use fabric softener in the rinse.
Correct answer:
The infants nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the childs hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the childs clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 8 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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