Nursing textbooks medical-surgical practice questions, set 9
Nursing textbooks · medical-surgical
Nursing textbooks medical-surgical practice questionsset 9
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 patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patients care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.
A. 1,2,5,4,3
B. 1,2,3,4,5
C. 2,3,1,4,5
D. 3,1,2,5,4
Show answer and rationale
Correct answer: B — 1,2,3,4,5
Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure unless he or she receives a liver transplant.
Question 2
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?
A. The patient will obtain measurement of drainage from the T-tube.
B. The patient will exercise three times a week.
C. The patient will take immunosuppressive agents as required.
D. The patient will monitor for signs of liver dysfunction.
Show answer and rationale
Correct answer: C — The patient will take immunosuppressive agents as required.
The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.
Question 3
A patient who has undergone a femoral to popliteal bypass graft surgery returns to the surgical unit. Which assessments should the nurse perform during the first postoperative day?
A. Assess pulse of affected extremity every 15 minutes at first.
B. Palpate the affected leg for pain during every assessment.
C. Assess the patient for signs and symptoms of compartment syndrome every 2 hours.
D. Perform Doppler evaluation once daily.
Show answer and rationale
Correct answer: A — Assess pulse of affected extremity every 15 minutes at first.
The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patients status remains stable. Doppler evaluations should be performed every 2 hours. Pain is regularly assessed, but palpation is not the preferred method of performing this assessment. Compartment syndrome results from the placement of a cast, not from vascular surgery.
Question 4
Following a radical vulvectomy, the nurse is preparing the client for discharge to home. Which care intervention would be considered the priority for this client?
A. Relieving edema to lower extremities
B. Alterations for sexual function
C. Prevention of wound complications
D. Care of colostomy site
Show answer and rationale
Correct answer: C — Prevention of wound complications
Prevention of complications and infection is paramount due to the location of the wound. The perineal area provides a warm, dark environment that supports the growth of microorganisms that can be introduced into the wound. With a radical vulvectomy, is is likely to find surgical drains and urinary catheter that can also interfere with the maintenance of the wound. Relieving edema to the lower extremities may be a necessary part of care if the lymph nodes and blood vessels are disturbed. The client may have a colostomy and care instructions should be provided. Alteration in sexual function needs to be addressed but is not a priority for the initial stage of healing.
Question 5
A nurse has been caring for a client and family for 6 months in a long-term care facility. Which nursing action(s) is appropriate during the terminating phase of the nurse-client relationship? Select all that apply.
A. Teach the client and family about care needs at home.
B. Attend to the client's preferences regarding diet.
C. Allow the client independence in decision-making.
D. Relay well wishes from the staff.
E. Arrange health-related services to support home care.
Show answer and rationale
Correct answer: A — Teach the client and family about care needs at home.
The terminating phase occurs when the client's health problems have improved and nursing services in the long-term care facility are no longer necessary. The nurse's role becomes one that transitions the client and family to home care. Teaching about needs, arranging health-related services, and coordinating medication regimen for home care are all appropriate. Also, relaying well wishes from the staff shows the caring nature of the staff and highlights the nurse-client relationship while in the facility. Attending to the client's dietary preferences and allowing client independence in decision-making are part of the working phase of the nurse-client relationship.
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Question 6
A client who has an intense fear of flying has elected to participate in a therapy that culminates in a short air flight. This is an example of which type of therapy?
A. Psychotherapy
B. Cognitive therapy
C. Behavioral therapy
D. Alternative therapy
Correct answer:
Desensitization is a form of behavioral therapy and attempts to extinguish undesirable responses by learning adaptive techniques. Emotional support is provided while the client is gradually coached through experiences that provoke anxiety. Eventually, the client will be able to tolerate the anxiety-provoking experience independently. Psychotherapy involves talking with a psychiatrist, psychologist, or other clinical specialist. Cognitive therapy is a form of psychotherapy in which the therapist assists the client in correcting faulty belief systems. Alternative therapy is the use of techniques to manage anxiety through relaxation techniques and physical exercise.
The nurse is providing discharge instructions to the client being prescribed antipsychotic medications. Which discharge instruction(s) should be included? Select all that apply.
A. Stop the medication for any side effects.
B. Double the next dose if you forget one dose.
C. Report any rhythmic, involuntary movements of the tongue, face, mouth, jaw, or extremities immediately.
D. Take all antipsychotic medications as directed.
E. Notify the health care provider if you have hypertension or severe muscle stiffness.
Correct answer:
When providing discharge instructions to a client prescribed antipsychotic medications, the nurse should instruct the client to take all medications as directed and notify the health care provider for any side effects including a high fever, increased confusion, dyspnea, tachycardia, hypertension, severe muscle weakness, or loss of bladder control, because these are signs of neuroleptic malignant syndrome. Similarly, the client should immediately report any rhythmic, involuntary movements of the tongue, face, mouth, jaw, or extremities, because these are signs of tardive dyskinesia. The client should not abruptly stop medications or double the dosage at any time.
A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?
A. Cutting of a bivalve cast
B. Cutting a cast window
C. Removal of the cast
D. Insertion of an external fixator
Correct answer:
After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
A. Rotate injection sites for frequent parenteral injections.
B. Monitor patient's vital signs each morning.
C. Monitor signs of liver dysfunction weekly.
D. Administer streptomycin to promote nutrition.
Correct answer:
The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor the patient's vital signs every 4 hours and not once every morning.
A charge nurse on the step-down unit will likely use which leadership style during resuscitation efforts for a cardiac arrest?
A. Democratic
B. Laissez-faire
C. Servant
D. Autocratic
Correct answer:
Autocratic leadership assumes control over the decisions and activities of the group, such as taking charge of emergencies, dictating schedules and work responsibilities, and scheduling mandatory in-service training. Polling other nurses is an example of democratic leadership, which is characterized by a sense of equality among the leader and other participants, with decisions and activities being shared. In laissez-faire leadership, the leader relinquishes power to the group and encourages independent activity by group members. Examples of laissez-faire leadership style are allowing the nurses to divide up the tasks and encouraging them to work independently.
A nurse educator is teaching students the types of shock and associated causes. Which combination(s) of shock type and causative factors is correct? Select all that apply.
A. Hypovolemic shock; blood loss
B. Obstructive shock; kidney stone
C. Cardiogenic shock; myocardial infarction
D. Anaphylactic shock; nut allergy
E. Septic shock; infection
Correct answer:
Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Hypovolemic shock occurs when the volume of extracellular fluid is significantly diminished due to the loss of or reduced blood or plasma. Obstructive shock occurs when there is interference in blood flow through the heart. Cardiogenic shock occurs when the heart is ineffective in pumping possibly due to a myocardial infarction. Anaphylactic shock occurs from an allergen such as nuts. Septic shock occurs from a bacterial infection. Neurogenic shock results from an insult to the vasomotor center in the medulla or peripheral nerves.
The client develops acne. What should the nurse instruct the client with acne?
A. Use water-based cosmetics or creams.
B. Do not receive live virus vaccines.
C. Avoid the use of alcohol while taking the drug.
D. Avoid exposure to infections.
Correct answer:
The nurse should instruct the client with acne to keep the affected areas clean and use over-the-counter acne drugs and water-based cosmetics or creams. The nurse need not instruct the client to stop receiving live virus vaccines, avoid using alcohol, or avoid exposure to infections. When the client is undergoing long-term or high-dose glucocorticoid therapy, the nurse should inform the client to avoid receiving live virus vaccines and avoid exposure to infections if possible in the teaching plan for the client and family. If the client is undergoing vasopressin therapy, the nurse needs to instruct the client to avoid the use of alcohol while taking the drug.
A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included?
A. If the client experiences nausea, omit the dose.
B. The client should be alert for joint aches.
C. This medication is commonly used for many inflammatory reactions and is relatively safe.
D. Be alert for signs and symptoms of infection and report them immediately to the physician.
Correct answer:
Instruct the client about signs and symptoms of and the increased risk for infection. Instruct the client to report signs and symptoms of infection immediately to the physician. Early treatment promotes a shorter duration of illness and reduced complication. Tell the client to avoid high-risk activities, such as being in crowds, during periods of immunosuppression. The client should not omit a dose if nausea is experienced but instead may take the medication with food. There are many side effects and required laboratory work to detect the side effects from immunosuppressive therapy. Joint aches are vague symptoms and are not a priority for reporting purposes.
The nurse is instructing a community class when a student asks, 'How does someone get super strength in an emergency?' The nurse should respond by describing the action of the:
A. musculoskeletal system.
B. sympathetic nervous system.
C. parasympathetic nervous system.
D. endocrine system.
Correct answer:
The division of the autonomic nervous system called the sympathetic nervous system regulates the expenditure of energy. The neurotransmitters of the sympathetic nervous system are called catecholamines. During an emergency situation or an intensely stressful event, the body adjusts to deliver blood flow and oxygen to the brain, muscles, and lungs that need to react in the situation. The musculoskeletal system benefits from the sympathetic nervous system as the fight-or-flight effects pump blood to the muscles. The parasympathetic nervous system works to conserve body energy not expend it during an emergency. The endocrine system regulates metabolic processes.
You are caring for a patient with a history of chronic angina. The patient tells you that after breakfast he usually takes a shower and shaves. It is at this time, the patient says, that he tends to experience chest pain. What might you counsel the patient to do to decrease the likelihood of angina in the morning?
A. Shower in the evening and shave before breakfast.
B. Skip breakfast and eat an early lunch.
C. Take a nitro tab prior to breakfast.
D. Shower once a week and shave before breakfast.
Correct answer:
If the nurse determines that one of the situations most likely to precipitate angina is to shower and shave after breakfast, the nurse might counsel the patient to break these activities into different times during the day. Skipping breakfast and eating an early lunch would not decrease the likelihood of angina in the morning. Taking a nitro tablet before breakfast is inappropriate because the event requiring the medication has not yet occurred. Also, suggesting that the patient shower once a week and shave prior to breakfast is an incorrect suggestion because showering and shaving can both be done every day if they are spread out over the course of the day.
About these Nursing textbooks medical-surgical questions
Nursing textbooks medical-surgical practice questions, set 9 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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