RN exams medical-surgical practice questions, set 28
RN exams · medical-surgical
RN exams medical-surgical practice questionsset 28
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 RN exams exam guide or more RN 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
A patient presents with gradual-onset weakness, spasticity, hyperreflexia, and positive Babinski sign. Imaging reveals demyelinating plaques in the white matter of the brain and spinal cord. Which of the following neurological conditions is most likely responsible for these symptoms?
A patient undergoing mechanical ventilation in the ICU develops ventilator-associated pneumonia (VAP). What intervention should the healthcare team prioritize to manage the patient's respiratory infection?
A. Administer broad-spectrum antibiotics targeting common pathogens.
B. Perform endotracheal suctioning to clear airway secretions.
C. Implement oral hygiene measures to reduce bacterial colonization.
D. Recommend early mobilization to prevent complications of immobility.
Show answer and rationale
Correct answer: A — Administer broad-spectrum antibiotics targeting common pathogens.
Ventilator-associated pneumonia (VAP) is a serious complication in patients receiving mechanical ventilation in the ICU. The priority intervention to manage respiratory infection in a patient with VAP is the administration of appropriate antibiotics to target and eliminate the causative pathogens. Broad-spectrum antibiotics are usually initiated empirically to cover a wide range of potential pathogens commonly associated with VAP, such as Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter species. Timely initiation of antibiotic therapy is crucial in improving outcomes and reducing morbidity and mortality associated with VAP. Other interventions like endotracheal suctioning, oral hygiene measures, and early mobilization are also important in preventing complications and promoting recovery, but the primary focus should be on treating the infection with antibiotics.
Question 3
Which of the following conditions does the nurse explain to the patient the contributory factor that slows uterine involution?
A. Full bladder during labor
B. Difficult birth
C. Prolonged labor
D. Infection during pregnancy
Show answer and rationale
Correct answer: C — Prolonged labor
Prolonged labor is a condition in which labor lasts for an extended period, typically more than 20 hours for first-time mothers and more than 14 hours for experienced mothers. Prolonged labor can contribute to slowing down uterine involution because the prolonged pressure and strain on the uterus can affect its ability to return to its pre-pregnancy size and position. The prolonged contractions and stretching of the uterine muscles can hinder the normal process of uterine involution, leading to a delay in the uterus shrinking back to its non-pregnant state. Additionally, prolonged labor can increase the risk of postpartum complications such as excessive bleeding and infection, which can further impact uterine involution. Therefore, it is crucial for healthcare providers to monitor labor progress closely to prevent prolonged labor and its potential effects on uterine involution.
Question 4
As an epidemiology nurse, Nurse Rona's PRIMARY function and responsibility is to _____.
A. Assist the epidemiologist in making reports
B. Implement public health surveillance
C. Render nursing care to sick residents
D. Follow up cases and contacts Situation.
Show answer and rationale
Correct answer: B — Implement public health surveillance
As an epidemiology nurse, Nurse Rona's primary function and responsibility is to implement public health surveillance. Epidemiology nurses play a crucial role in monitoring and controlling the spread of diseases within communities. This involves conducting surveillance activities to identify patterns of disease occurrence, investigating outbreaks, collecting and analyzing data, and collaborating with various stakeholders to develop strategies for disease prevention and control. While providing nursing care to sick residents is important, the primary focus of an epidemiology nurse is on population-based health issues rather than individual patient care. Additionally, while Nurse Rona may assist epidemiologists in making reports and follow up cases and contacts, her main role is to implement public health surveillance to protect and promote the health of the community as a whole.
Question 5
While caring for a client with extensive partial and full-thickness burns of the head, neck, and chest, which risk should the nurse prioritize for assessment and intervention?
A. Airway obstruction
B. Infection
C. Fluid imbalance
D. Paralytic ileus
Show answer and rationale
Correct answer: A — Airway obstruction
The correct answer is A: Airway obstruction. This should be prioritized because burns to the head, neck, and chest can lead to swelling and inflammation, potentially compromising the airway. Maintaining a clear airway is crucial for oxygenation and ventilation. If the airway becomes obstructed, it can quickly lead to respiratory distress or failure. Assessing for signs of airway compromise and intervening promptly is essential to prevent serious complications.
Choices B, C, and D are incorrect because while infection, fluid imbalance, and paralytic ileus are also important considerations in burn care, they are not as immediately life-threatening as airway obstruction in this case. Infection can be managed with appropriate wound care, fluid imbalance can be addressed with fluid resuscitation, and paralytic ileus can be treated with medications and bowel management strategies.
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Question 6
During a surgical procedure, the nurse notices a sudden decrease in the patient's oxygen saturation on the monitor. What immediate action should the nurse take?
A. Inform the surgeon and anesthesiologist
B. Increase the flow rate of oxygen
C. Check the endotracheal tube placement
D. Assess the patient's respiratory status
Correct answer:
The correct immediate action is to inform the surgeon and anesthesiologist (Choice A) because a sudden decrease in oxygen saturation during surgery is a critical situation that requires prompt attention from the entire surgical team. The surgeon and anesthesiologist need to be made aware of the situation so that they can assess the patient's condition and make any necessary adjustments to the surgical procedure or anesthesia delivery. Increasing the flow rate of oxygen (Choice B) may help temporarily but does not address the underlying cause of the oxygen desaturation. Checking the endotracheal tube placement (Choice C) is important but may not be the immediate priority in this critical situation. Assessing the patient's respiratory status (Choice D) is important but should be done after informing the surgeon and anesthesiologist to ensure coordinated and timely interventions.
The physician inserted a chest tube drainage to Mr. Alda in order to help re-expand the lungs. Which of the following should you prepare FIRST as a nurse in case of emergency when the tube is accidentally disconnected?
A. sterile clamps
B. Sterile dressing.
C. Another chest tube
D. A bottle of sterile water.
Correct answer:
Correct Answer: A - sterile clamps
Rationale:
1. **Immediate action**: Sterile clamps are essential to clamp the chest tube to prevent air from entering the pleural space.
2. **Prevent lung collapse**: Clamping the tube will prevent lung collapse and maintain positive pressure in the pleural space.
3. **Buy time**: By clamping the tube, you buy time to properly reattach the tube or secure it with a new connection.
4. **Safety**: Sterile clamps are a quick and effective solution to prevent a potentially life-threatening situation.
Summary of other choices:
B: Sterile dressing - Not the first priority as the immediate concern is preventing air from entering the pleural space.
C: Another chest tube - Not necessary initially as clamping can buy time to reattach the disconnected tube.
D: A bottle of sterile water - Not needed for emergency management of a disconnected chest tube.
A patient with cystic fibrosis (CF) presents with recurrent pulmonary exacerbations characterized by increased sputum production, cough, and fever. Which of the following treatments is most effective for addressing the underlying pathophysiology of CF and preventing disease progression?
A. Inhaled corticosteroids
B. Mucolytic agents (e.g., dornase alfa)
C. Antibiotic therapy for respiratory infections
D. Lung transplantation
Correct answer:
The most effective treatment for addressing the underlying pathophysiology of cystic fibrosis (CF) and preventing disease progression is the use of mucolytic agents, such as dornase alfa. CF is a genetic disorder that leads to the production of thick, sticky mucus in the respiratory tract. This mucus buildup can obstruct airways, lead to recurrent infections, and contribute to pulmonary exacerbations. Mucolytic agents work by reducing the viscosity of the mucus, making it easier to clear from the airways. This helps to improve lung function, reduce the frequency of exacerbations, and slow down disease progression in CF patients. Inhaled corticosteroids may be used for managing airway inflammation, but they do not target the underlying mucus production in CF. Antibiotic therapy is important for treating respiratory infections in CF patients, but it does not address the primary
A patient with acute respiratory distress syndrome (ARDS) develops refractory hypoxemia despite maximal ventilatory support and prone positioning. Which of the following adjunctive therapies is most likely to improve oxygenation and reduce mortality in this patient?
A. High-frequency oscillatory ventilation (HFOV)
B. Continuous renal replacement therapy (CRRT)
C. Extracorporeal membrane oxygenation (ECMO)
D. Inhaled nitric oxide (iNO)
Correct answer:
In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.
Which information obtained during the nurse’s assessment of a patient’s nutritional-metabolic pattern may indicate increased risk for musculoskeletal problems?
A. The patient takes a multivitamin daily.
B. The patient dislikes fruits and vegetables.
C. The patient is 5 ft, 2 in tall and weighs 180 lb.
D. The patient prefers whole milk to nonfat milk.
Correct answer:
The correct answer is C because the patient being 5 ft, 2 in tall and weighing 180 lb indicates potential obesity, which can increase the risk for musculoskeletal problems. Excess weight puts strain on the bones and joints, leading to conditions like osteoarthritis.
A: Taking a multivitamin daily is generally positive for overall health but does not directly indicate an increased risk for musculoskeletal problems.
B: Disliking fruits and vegetables may point to potential nutritional deficiencies but does not directly indicate musculoskeletal issues.
D: Preferring whole milk over nonfat milk may impact overall nutritional intake but is not directly linked to musculoskeletal problems.
In summary, choice C is correct because obesity is a significant risk factor for musculoskeletal problems, while choices A, B, and D do not directly indicate an increased risk in this context.
One of the patients is manifesting signs and symptoms of alcohol withdrawal such as: tremors, diaphoresis, and hyperactivity. Blood pressure is 190/92 mm.Hg and pulse rate of 92 beats/min. Which of the following medications should you expect to be ordered for these patients?
A. Lorazepam ( Ativan )
B. Haloperidol ( Haldol )
C. Naloxone ( Narcan )
D. Benztropin ( Cogentin )
Correct answer:
The patient is exhibiting signs and symptoms of alcohol withdrawal, such as tremors, diaphoresis, hyperactivity, elevated blood pressure, and tachycardia. Lorazepam, which is a benzodiazepine, is commonly used to manage alcohol withdrawal symptoms. It helps alleviate symptoms such as anxiety, agitation, tremors, and seizures by acting on the same brain receptors affected by alcohol. It has sedative, anxiolytic, and anticonvulsant properties which can help stabilize the patient and prevent potential complications of alcohol withdrawal, such as seizures. Haloperidol is an antipsychotic medication used for conditions like schizophrenia and acute psychosis; therefore, it would not be appropriate for alcohol withdrawal. Naloxone is used to reverse opioid overdose, and Benztropin is used to treat Parkinson's disease and extrapyramidal symptoms, so they are not indicated for alcohol
T-cell antigen receptors are distinguished from antibodies by which of the following
A. T-Cell receptors are glycosylated
B. T-cell receptors must interact with antigen uniquely presented by other cells but not with free antigen
C. T-Cell receptors bind various cytokines
D. T-Cell receptors bind complement to lyse cells
Correct answer:
The correct answer is B. T-cell receptors must interact with antigens uniquely presented by other cells but not with free antigen. This is because T-cell receptors recognize antigens that are processed and presented on the surface of other cells via major histocompatibility complex (MHC) molecules. T-cell receptors specifically bind to the antigen-MHC complex, allowing T-cells to respond to specific foreign antigens.
A: T-cell receptors are not distinguished from antibodies by glycosylation. Both T-cell receptors and antibodies can be glycosylated, so this does not differentiate them.
C: T-cell receptors do not bind various cytokines. Cytokine receptors are separate entities that mediate cellular responses to cytokines.
D: T-cell receptors do not bind complement to lyse cells. Complement activation is a separate immune response mechanism not involving T-cell receptors.
The BEST rationale for the conduct of the program is which of the following?
A. Ensure safe practice in the hospital
B. Improve nursing practice in general
C. Provide knowledge and skills to all nursing staff in IV Therapy
D. De1iver safe and quality nursing care to patients on intravenous therapy
Correct answer:
The BEST rationale for the conduct of the program is to deliver safe and quality nursing care to patients on intravenous therapy (IV). This directly ties the purpose of the program to the real-world outcome it seeks to achieve - providing optimal care for patients requiring intravenous therapy. Ensuring safe practice in the hospital (Option A) is important but it is not specific to the focus of the IV therapy program. Improving nursing practice in general (Option B) is a noble goal but the program should have a specific and targeted objective. Providing knowledge and skills to all nursing staff in IV Therapy (Option C) is essential, but the primary aim should be centered on improving patient care outcomes. Therefore, delivering safe and quality nursing care to patients on IV therapy aligns most closely with the core purpose of the program and should be the primary rationale.
A client had a stroke involving the right cerebral hemisphere. The nurse should monitor for which of the following findings?
A. Poor impulse control
B. Inability to discriminate words and letters
C. Deficits in the right visual field
D. Motor retardation
Correct answer:
The correct answer is A: Poor impulse control. When a client has a stroke involving the right cerebral hemisphere, it can affect their ability to regulate emotions and impulses. The right hemisphere is responsible for inhibiting impulsive behavior, so damage to this area can lead to poor impulse control. This can manifest as impulsivity, lack of judgement, and difficulty controlling emotions.
Summary of Incorrect Choices:
B: Inability to discriminate words and letters - This is typically associated with left cerebral hemisphere damage, not right hemisphere.
C: Deficits in the right visual field - This is associated with damage to the left occipital lobe, not the right hemisphere.
D: Motor retardation - Motor functions are controlled by the opposite side of the brain, so right hemisphere damage would typically affect the left side of the body, not motor function in general.
T-cell antigen receptors are distinguished from antibodies by which of the following
A. T-Cell receptors are glycosylated
B. T-cell receptors must interact with antigen uniquely presented by other cells but not with free antigen
C. T-Cell receptors bind various cytokines
D. T-Cell receptors bind complement to lyse cells
Correct answer:
The correct answer is B. T-cell receptors must interact with antigens uniquely presented by other cells but not with free antigen. This is because T-cell receptors recognize antigens that are processed and presented on the surface of other cells via major histocompatibility complex (MHC) molecules. T-cell receptors specifically bind to the antigen-MHC complex, allowing T-cells to respond to specific foreign antigens.
A: T-cell receptors are not distinguished from antibodies by glycosylation. Both T-cell receptors and antibodies can be glycosylated, so this does not differentiate them.
C: T-cell receptors do not bind various cytokines. Cytokine receptors are separate entities that mediate cellular responses to cytokines.
D: T-cell receptors do not bind complement to lyse cells. Complement activation is a separate immune response mechanism not involving T-cell receptors.
RN exams medical-surgical practice questions, set 28 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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