LPN exams medical-surgical practice questions, set 20
LPN exams · medical-surgical
LPN exams medical-surgical practice questionsset 20
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 LPN exams exam guide or more LPN exams 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 papillary layer of the dermis is most closely associated with which layer of the epidermis?
A. stratum spinosum
B. stratum corneum
C. stratum granulosum
D. stratum basale
Show answer and rationale
Correct answer: D — stratum basale
The papillary layer of the dermis is the uppermost layer of the dermis, characterized by loose connective tissue and finger-like projections (papillae) that interlock with the deepest layer of the epidermis, the stratum basale. The stratum basale, also called the basal layer, is where new skin cells are produced and it rests directly on the papillary dermis, forming a strong connection via the basement membrane. The stratum spinosum lies above the basale and is thicker, with spiny cells, but it's not in direct contact with the papillary layer. The stratum granulosum is higher up, involved in keratinization, and the stratum corneum is the outermost dead layer, far from the dermis. The anatomical proximity and functional relationship between the papillary layer and stratum basale, including nutrient exchange and anchoring, make it the most closely associated layer.
Question 2
Which of the following influence resistance of skin integrity?
A. Age
B. Amount of underlying tissue
C. Illness
D. All of the above
Show answer and rationale
Correct answer: D — All of the above
All of the above,' as age, amount of underlying tissue, and illness all influence skin integrity resistance. Age (A) affects skin thickness and elasticity elderly skin thins, losing resilience, while youthful skin is more robust. Amount of underlying tissue (B), like subcutaneous fat, cushions and protects skin; less tissue increases vulnerability to breakdown, as in malnourishment. Illness (C) weakens skin through impaired immunity or circulation, as in diabetes or infection, reducing repair capacity. Each factor independently impacts durability, and together, they compound risk, making 'All of the above' correct. In nursing, this holistic view guides risk assessment e.g., an elderly, thin patient with chronic illness is prone to ulcers. No single factor suffices; their synergy is critical, distinguishing D as the comprehensive choice per wound care principles.
Question 3
A patient with 35% total body surface area burns is in the rehabilitative phase of care. Which approach should be used to reduce the risk of developing contractures?
A. Apply splints
B. Physical therapy two hours a day
C. Passive range of motion exercises
D. Occupational therapy one hour every other day
Show answer and rationale
Correct answer: A — Apply splints
The correct answer is A: Apply splints. Splints help maintain proper positioning of joints to prevent contractures in burn patients. Splints provide support and protect the joints during the healing process. They help to prevent shortening and tightening of muscles and tissues, reducing the risk of contractures.
B: Physical therapy two hours a day is not the most effective approach for preventing contractures in burn patients. While physical therapy is important for rehabilitation, excessive duration may not necessarily prevent contractures.
C: Passive range of motion exercises are beneficial for maintaining joint flexibility, but they may not provide enough support to prevent contractures in burn patients.
D: Occupational therapy one hour every other day focuses on activities of daily living and may not directly address the prevention of contractures.
Question 4
Which of the following influence resistance of skin integrity?
A. Age
B. Amount of underlying tissue
C. Illness
D. All of the above
Show answer and rationale
Correct answer: D — All of the above
All of the above,' as age, amount of underlying tissue, and illness all influence skin integrity resistance. Age (A) affects skin thickness and elasticity elderly skin thins, losing resilience, while youthful skin is more robust. Amount of underlying tissue (B), like subcutaneous fat, cushions and protects skin; less tissue increases vulnerability to breakdown, as in malnourishment. Illness (C) weakens skin through impaired immunity or circulation, as in diabetes or infection, reducing repair capacity. Each factor independently impacts durability, and together, they compound risk, making 'All of the above' correct. In nursing, this holistic view guides risk assessment e.g., an elderly, thin patient with chronic illness is prone to ulcers. No single factor suffices; their synergy is critical, distinguishing D as the comprehensive choice per wound care principles.
Question 5
The home health nurse observes several small, round bruises on the back side of an elderly client's arms. What action by the nurse is indicated first?
A. Question the client about the cause of the bruises.
B. Discuss the bruises with the client's spouse.
C. Document the bruises, with plans to review them for changes on the next visit.
D. Contact the home health supervisor to report the findings.
Show answer and rationale
Correct answer: A — Question the client about the cause of the bruises.
The correct answer is A: Question the client about the cause of the bruises. This is the first action indicated because it allows the nurse to gather more information directly from the client to understand the potential cause of the bruises. By communicating with the client, the nurse can assess if the bruises are due to accidental bumps, medication side effects, abuse, or other underlying health issues. This direct communication is crucial for determining the appropriate follow-up actions.
Summary of other choices:
B: Discussing with the client's spouse does not directly involve the client, who should be the primary source of information.
C: Documenting the bruises is important but does not address the immediate need to gather more information from the client.
D: Contacting the supervisor is premature without first gathering information from the client.
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Question 6
What are the two main outcomes of clonal selection?
A. T cell activation and cytokine suppression
B. Differentiation into effector and memory cells
C. Pathogen destruction and tissue repair
D. Phagocytosis and complement activation
Correct answer:
The correct answer is B: Differentiation into effector and memory cells. During clonal selection, activated lymphocytes undergo differentiation into effector cells that combat the current infection and memory cells that provide long-lasting immunity. Effector cells directly eliminate pathogens, while memory cells remember the specific pathogen for future encounters. Choices A, C, and D are incorrect as they do not accurately represent the main outcomes of clonal selection. T cell activation and cytokine suppression (A) are processes involved in immune response regulation rather than the direct outcomes of clonal selection. Pathogen destruction and tissue repair (C) are broader immune responses that occur after clonal selection. Phagocytosis and complement activation (D) involve innate immune responses, not the adaptive immune responses seen in clonal selection.
An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report?
A. Look at last quarter's hemoglobin and hematocrit to assess for dehydration.
B. Look for an increase in today's LDH compared to the previous one to assess for possible liver damage.
C. Expect to find an increase in today's APTT compared to last quarter's due to bleeding.
D. Determine if there is a decrease in serum potassium due to renal compromise.
Correct answer:
The correct answer is B. The nurse should look for an increase in today's LDH compared to the previous one to assess for possible liver damage. Acetaminophen overdose can lead to liver toxicity, which can be indicated by elevated LDH levels. LDH is an enzyme released during liver damage. Checking for LDH levels can help assess the impact of increased acetaminophen doses on the liver.
Choices A, C, and D are incorrect:
A: Looking at hemoglobin and hematocrit is not directly related to acetaminophen use for joint pain. It does not provide information about liver damage.
C: APTT measures blood clotting time and is not directly affected by acetaminophen use for joint pain. It does not provide information about liver damage.
D: Serum potassium levels are not typically affected by acetaminophen use for joint pain. It does not provide information about liver damage.
The waterproof coating found in epidermal cells is called:
A. myelin
B. keratin
C. melanin
D. albumin
Correct answer:
The waterproof coating in epidermal cells is keratin, a fibrous protein forming the stratum corneum, the epidermis's outermost layer. Produced during keratinization, keratin fills dead keratinocytes, creating a tough, insoluble barrier that prevents water loss and entry. This hydrophobicity, due to keratin's sulfur-rich structure and tight packing, protects against dehydration and environmental damage, a key adaptation for terrestrial life. Myelin, a lipid sheath, insulates nerves, not skin cells. Melanin, a pigment from melanocytes, absorbs UV light but doesn't waterproof. Albumin, a blood protein, maintains osmotic pressure, unrelated to epidermal coating. Keratin's dominance in the corneum up to 85% of its dry weight ensures the skin's impermeability, a fact confirmed by studies of skin barrier function, setting it apart from pigments or unrelated proteins.
The nurse is caring for a client following debridement. The nurse is most concerned with which complication?
A. Bleeding
B. Pain control
C. Loss of fluids
D. Infection
Correct answer:
The correct answer is D: Infection. Following debridement, there is an increased risk of infection due to the open wound and potential exposure of underlying tissues. Infection can lead to serious complications such as delayed healing, sepsis, and tissue damage. The nurse must closely monitor for signs of infection like redness, swelling, warmth, and purulent drainage.
Incorrect choices:
A: Bleeding - While bleeding can occur post-debridement, it is a common and expected complication that can usually be managed with pressure and hemostatic agents.
B: Pain control - Pain is also a common post-debridement complication, but can be managed with analgesics and other pain management strategies.
C: Loss of fluids - Although fluid loss can occur during debridement, it is not typically a major concern post-procedure as long as the client is adequately hydrated.
A nurse is caring for a client who is in hypovolemic shock. While waiting for a unit of blood, the nurse should administer which of the following IV solutions?
A. 0.9% sodium chloride
B. 5% dextrose in water
C. Lactated Ringer’s
D. 0.45% sodium chloride
Correct answer:
The correct answer is A: 0.9% sodium chloride. In hypovolemic shock, there is a loss of blood volume, so isotonic solutions like 0.9% sodium chloride are ideal to expand intravascular volume and help improve perfusion. This solution closely resembles the electrolyte composition of plasma, making it effective for fluid resuscitation.
Explanation for other choices:
B: 5% dextrose in water - This solution is hypotonic and not ideal for fluid resuscitation in hypovolemic shock as it may worsen the condition by diluting the remaining blood volume.
C: Lactated Ringer’s - While this solution is isotonic and contains electrolytes, it may not be the best choice for hypovolemic shock as it contains potassium and lactate which may not be ideal in this situation.
D: 0.45% sodium chloride - This solution is hypotonic and may not provide adequate volume expansion needed
A client with a burn wound on the chest has a silver sulfadiazine (Silvadene) cream applied to the wound. Which adverse reaction should the nurse monitor for in this client?
A. Hypersensitivity or allergic reaction
B. Leukopenia or decreased white blood cell count
C. Hyperglycemia or increased blood glucose level
D. A and B
Correct answer:
as the nurse should monitor for both hypersensitivity or allergic reaction and leukopenia or decreased white blood cell count when using silver sulfadiazine (Silvadene) on a burn wound. This topical antimicrobial can cause allergic reactions like rash, itching, or swelling, which may escalate to severe symptoms like difficulty breathing, requiring immediate attention. It can also lead to leukopenia, a drop in white blood cells, increasing infection risk, necessitating regular blood count monitoring. Hyperglycemia isn't a typical adverse reaction to Silvadene; it may occur in burn patients due to stress or infection, not the cream itself. Since both A and B are valid concerns supported by the need for baseline and periodic complete blood counts choice D encompasses the full scope of critical monitoring, ensuring comprehensive care for potential complications.
A client with a burn wound on the chest has a silver sulfadiazine (Silvadene) cream applied to the wound. Which adverse reaction should the nurse monitor for in this client?
A. Hypersensitivity or allergic reaction
B. Leukopenia or decreased white blood cell count
C. Hyperglycemia or increased blood glucose level
D. A and B
Correct answer:
as the nurse should monitor for both hypersensitivity or allergic reaction and leukopenia or decreased white blood cell count when using silver sulfadiazine (Silvadene) on a burn wound. This topical antimicrobial can cause allergic reactions like rash, itching, or swelling, which may escalate to severe symptoms like difficulty breathing, requiring immediate attention. It can also lead to leukopenia, a drop in white blood cells, increasing infection risk, necessitating regular blood count monitoring. Hyperglycemia isn't a typical adverse reaction to Silvadene; it may occur in burn patients due to stress or infection, not the cream itself. Since both A and B are valid concerns supported by the need for baseline and periodic complete blood counts choice D encompasses the full scope of critical monitoring, ensuring comprehensive care for potential complications.
A client is in the hospital and has received two doses of an angiotensin-converting enzyme for hypertension. When the nurse answers the client's call light, the client presents an appearance as shown below: What action by the nurse takes is most appropriate?
A. Administer epinephrine 1:1000, 0.3 mg IV push immediately.
B. Apply oxygen by facemask at 100% and a pulse oximeter.
C. Ensure a patent airway while calling the Rapid Response Team.
D. Reassure the client that these symptoms will go away.
Correct answer:
The correct action by the nurse is to ensure a patent airway while calling the Rapid Response Team (Choice C). This is because the client is showing signs of angioedema, a potential adverse reaction to angiotensin-converting enzyme (ACE) inhibitors. Angioedema can lead to airway compromise and respiratory distress, hence ensuring a patent airway is crucial. Additionally, calling the Rapid Response Team will allow for immediate medical intervention and monitoring of the client's condition.
Choice A (Administer epinephrine) is incorrect as epinephrine is not the first-line treatment for angioedema associated with ACE inhibitors. Choice B (Apply oxygen) is not sufficient to address the potential airway compromise. Choice D (Reassure the client) is inappropriate as the client's condition requires immediate action to address the potential airway obstruction.
A patient with 35% total body surface area burns is in the rehabilitative phase of care. Which approach should be used to reduce the risk of developing contractures?
A. Apply splints
B. Physical therapy two hours a day
C. Passive range of motion exercises
D. Occupational therapy one hour every other day
Correct answer:
The correct answer is A: Apply splints. Splints help maintain proper positioning of joints to prevent contractures in burn patients. Splints provide support and protect the joints during the healing process. They help to prevent shortening and tightening of muscles and tissues, reducing the risk of contractures.
B: Physical therapy two hours a day is not the most effective approach for preventing contractures in burn patients. While physical therapy is important for rehabilitation, excessive duration may not necessarily prevent contractures.
C: Passive range of motion exercises are beneficial for maintaining joint flexibility, but they may not provide enough support to prevent contractures in burn patients.
D: Occupational therapy one hour every other day focuses on activities of daily living and may not directly address the prevention of contractures.
A 60-year-old man with abdominal fullness, fatigue, leukocytes 40,000/µL, platelets 500,000/µL, Philadelphia chromosome. Most likely diagnosis?
A. Acute myeloid leukemia
B. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Acute lymphocytic leukemia
Correct answer:
The correct answer is B: Chronic Myelogenous Leukemia (CML). The presentation of a 60-year-old man with abdominal fullness, fatigue, leukocytosis, thrombocytosis, and the presence of the Philadelphia chromosome strongly suggests CML. The Philadelphia chromosome results from a reciprocal translocation between chromosomes 9 and 22, leading to the formation of the BCR-ABL fusion gene characteristic of CML. This gene encodes a constitutively active tyrosine kinase, driving uncontrolled proliferation of myeloid cells. Acute myeloid leukemia (A) typically presents with bone marrow failure, not leukocytosis and thrombocytosis. Chronic lymphocytic leukemia (C) is more common in older adults, but it is characterized by lymphocytosis, not leukocytosis. Acute lymphocytic leukemia (D) usually presents with pancytopenia and blast cells in the peripheral blood, not leuk
LPN exams medical-surgical practice questions, set 20 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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