RN exams medical-surgical practice questions, set 9
RN exams · medical-surgical
RN exams 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 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 with a history of cirrhosis is at risk for developing hepatic encephalopathy. Which nursing intervention is most effective in preventing and managing hepatic encephalopathy?
A. Administering lactulose as prescribed
B. Restricting dietary protein intake
C. Monitoring serum ammonia levels
D. Encouraging increased fluid intake
Show answer and rationale
Correct answer: A — Administering lactulose as prescribed
Lactulose is the most effective nursing intervention in preventing and managing hepatic encephalopathy in patients with cirrhosis. Lactulose works by promoting the elimination of ammonia in the colon through its laxative effect, thereby reducing ammonia levels in the blood. High ammonia levels are associated with the development of hepatic encephalopathy. By administering lactulose as prescribed, nurses can help reduce the risk of encephalopathy and manage symptoms effectively. Monitoring serum ammonia levels is important in assessing the effectiveness of lactulose therapy, but administering lactulose is the primary nursing intervention in this situation. Dietary protein restriction is also commonly recommended; however, lactulose administration is the most vital intervention in this scenario. Additionally, encouraging increased fluid intake is important for overall liver health but is not as specific to preventing and managing hepatic encephalopathy as administering lactulose.
Question 2
A woman in active labor has a prolonged second stage with inadequate expulsive efforts. What nursing intervention is appropriate to facilitate fetal descent?
A. Encourage the mother to push forcefully during contractions.
B. Apply fundal pressure to assist with fetal descent.
C. Prepare for immediate cesarean section.
D. Administer intravenous magnesium sulfate for uterine relaxation.
Show answer and rationale
Correct answer: B — Apply fundal pressure to assist with fetal descent.
In the scenario of a woman in active labor experiencing a prolonged second stage with inadequate expulsive efforts, the appropriate nursing intervention to facilitate fetal descent would be to apply fundal pressure. Fundal pressure, or applying pressure on the upper abdomen just above the uterine fundus, can help in directing the fetal head downwards and aiding in the descent through the birth canal. It is important to note that fundal pressure should be applied carefully and with proper technique to prevent excessive force that could potentially harm the mother or the baby. Encouraging the mother to push forcefully during contractions can be helpful, but the addition of fundal pressure can provide extra assistance in cases of inadequate progress. Immediate cesarean section may be considered if other interventions are unsuccessful or if there are concerns for fetal distress. Administering intravenous magnesium sulfate for uterine relaxation is not indicated in this situation.
Question 3
Nurse Carmi plans to gather 6 participants who are victims of domestic violence where she will base her questionnaires. What technique in qualitative research is applicable to this plan?
A. Data triangulation
B. Interview
C. Focus group discussion
D. Case study
Show answer and rationale
Correct answer: C — Focus group discussion
In qualitative research, a focus group discussion is a technique where a group of participants are brought together to discuss specific topics in depth. In this case, Nurse Carmi's plan to gather 6 participants who are victims of domestic violence aligns well with the focus group discussion technique. By involving multiple participants who have experienced domestic violence, she can facilitate a dynamic conversation to gather rich data and insights. This approach allows for the exploration of diverse perspectives, experiences, and opinions within the group setting, providing a deeper understanding of the issue at hand. Additionally, focus group discussions can be more cost-effective and efficient than conducting individual interviews when working with a small group of participants. Therefore, conducting a focus group discussion would be an appropriate qualitative research technique for Nurse Carmi's plan to gather data from victims of domestic violence for her questionnaires.
Question 4
The nurse has contributed to a staff education program on immunity. Which participant response indicates a correct understanding of the type of immunity that protects newborns for the first 3 months of life as a result of maternal transmission of IgG?
A. Active natural immunity occurs.
B. Passive natural immunity occurs.
C. Active artificial immunity occurs.
D. Passive artificial immunity occurs.
Show answer and rationale
Correct answer: B — Passive natural immunity occurs.
The correct answer is B: Passive natural immunity occurs. This type of immunity is achieved through the transfer of antibodies (IgG) from the mother to the fetus during pregnancy. The antibodies provide protection to the newborn for the first few months of life. It is considered passive because the newborn is not actively producing the antibodies themselves.
A: Active natural immunity occurs when the body produces its antibodies in response to exposure to an antigen. This is not the case for newborns receiving maternal IgG.
C: Active artificial immunity occurs when the body is intentionally exposed to an antigen, such as through vaccination, to stimulate an immune response. This is not relevant to the scenario described.
D: Passive artificial immunity occurs when pre-formed antibodies are transferred to an individual through a medical intervention, such as receiving immune globulin. This is not applicable to the situation of maternal transmission of IgG to newborns.
Question 5
The nurse has contributed to a staff education program on immunity. Which participant response indicates a correct understanding of the type of immunity that protects newborns for the first 3 months of life as a result of maternal transmission of IgG?
A. Active natural immunity occurs.
B. Passive natural immunity occurs.
C. Active artificial immunity occurs.
D. Passive artificial immunity occurs.
Show answer and rationale
Correct answer: B — Passive natural immunity occurs.
The correct answer is B: Passive natural immunity occurs. This type of immunity is achieved through the transfer of antibodies (IgG) from the mother to the fetus during pregnancy. The antibodies provide protection to the newborn for the first few months of life. It is considered passive because the newborn is not actively producing the antibodies themselves.
A: Active natural immunity occurs when the body produces its antibodies in response to exposure to an antigen. This is not the case for newborns receiving maternal IgG.
C: Active artificial immunity occurs when the body is intentionally exposed to an antigen, such as through vaccination, to stimulate an immune response. This is not relevant to the scenario described.
D: Passive artificial immunity occurs when pre-formed antibodies are transferred to an individual through a medical intervention, such as receiving immune globulin. This is not applicable to the situation of maternal transmission of IgG to newborns.
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Question 6
Which of the following is a safety mechanism of the complement system?
A. Binding C5a to plasma inhibitors
B. Activation of complement only in the absence of pathogens
C. Covalent binding of C3b and C4b to pathogen surfaces
D. Suppression of C1 activation by antibodies
Correct answer:
Rationale for Choice C: Covalent binding of C3b and C4b to pathogen surfaces is a safety mechanism of the complement system because it helps in targeting pathogens specifically, enhancing opsonization, and preventing damage to host cells by limiting complement activation to the pathogen surface. C3b and C4b form stable covalent bonds with the pathogens, marking them for destruction by phagocytes. This mechanism ensures that complement activation is directed towards the pathogen and not host cells, thus maintaining immune homeostasis.
Summary:
A: Binding C5a to plasma inhibitors is not a safety mechanism but a regulatory mechanism in the complement system.
B: Activation of complement only in the absence of pathogens is incorrect as the complement system can be activated in response to various stimuli, not just pathogens.
D: Suppression of C1 activation by antibodies is not a safety mechanism but a regulatory mechanism involving the classical pathway of complement activation.
The day after a 60-yr-old patient has open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the nurse identifies the priority nursing diagnosis as
A. activity intolerance related to deconditioning.
B. risk for constipation related to prolonged bed rest.
C. risk for impaired skin integrity related to immobility.
D. risk for infection related to disruption of skin integrity.
Correct answer:
Rationale for Correct Answer (D): The priority nursing diagnosis is "risk for infection related to disruption of skin integrity" because the patient underwent ORIF for an open tibial fracture, which increases the risk of infection due to the disruption of skin integrity. Post-surgery, there is a higher susceptibility to infection, which can lead to serious complications and delayed healing. Monitoring for signs of infection and implementing appropriate interventions is crucial to prevent further complications.
Summary of Incorrect Choices:
A: Activity intolerance is not the priority as the patient is not likely to be ambulating immediately after ORIF for a tibial fracture.
B: Risk for constipation is not the priority as it is not directly related to the surgical procedure and can be managed with appropriate interventions.
C: Risk for impaired skin integrity is not the priority as the main concern post-ORIF is infection due to the open fracture, which takes precedence.
Which of the following conditions is most likely to cause a patient to present with potentially reversible pulseless electrical activity on the monitor?
A. Traumatic asphyxia
B. Wolf Parkinson White syndrome
C. The R-on-T phenomenon
D. Tension pneumothorax
Correct answer:
The correct answer is D: Tension pneumothorax. This condition can lead to decreased venous return to the heart, causing decreased cardiac output and ultimately pulseless electrical activity. Tension pneumothorax is a life-threatening emergency that requires immediate intervention to relieve pressure on the heart and lungs.
A: Traumatic asphyxia can cause compression of the chest and airway obstruction, leading to respiratory distress but not necessarily pulseless electrical activity.
B: Wolf Parkinson White syndrome is a cardiac condition characterized by an accessory pathway for electrical conduction in the heart, which can cause arrhythmias but not typically pulseless electrical activity.
C: The R-on-T phenomenon refers to a specific ECG finding where a premature ventricular contraction occurs on the T wave of the preceding beat, which can lead to ventricular fibrillation but is less likely to result in pulseless electrical activity compared to tension pneumothorax.
Which information should the nurse discuss with the client diagnosed with seborrheic dermatitis of the scalp?
A. Use a fine-toothed comb to comb out the hair after shampooing.'
B. Apply hydrocortisone 1% to the scalp area twice a day.'
C. Rotate two or three different types of shampoos daily.'
D. Dry the hair using the high heat setting for at least 5 minutes.
Correct answer:
Correct Answer: C
Rationale: The nurse should discuss rotating two or three different types of shampoos daily with the client diagnosed with seborrheic dermatitis of the scalp. This is because using different shampoos can help prevent the scalp from becoming resistant to one specific shampoo and can also help target different aspects of the condition. Using the same shampoo repeatedly may lead to decreased effectiveness over time. Additionally, rotating shampoos can help prevent the buildup of product residue on the scalp, which can exacerbate seborrheic dermatitis symptoms. This approach promotes scalp health and reduces the risk of irritation and flare-ups.
Incorrect Choices:
A: Using a fine-toothed comb after shampooing may exacerbate irritation and inflammation in seborrheic dermatitis.
B: Applying hydrocortisone 1% twice a day may provide temporary relief but is not a long-term solution for managing seborrheic dermatitis and can have side effects with prolonged
The BEST reason why Nurse Nilda opted to review Erikson's psychosocial theory is, which of the following statements?
A. Completion of task results in a sense of competence and a healthy personality.
B. Failure to master these tasks leads to feelings of inadequacy
C. . Helps children grow into successful, contributing members of society.
D. We are motivated by the need to achieve competence in certain areas of our 1ives.
Correct answer:
Nurse Nilda likely opted to review Erikson's psychosocial theory because completion of each developmental task in the theory results in a sense of competence and contributes to the development of a healthy personality. Erikson's theory outlines different stages of psychosocial development that individuals go through, with each stage presenting a specific conflict or challenge to be resolved. Successfully navigating and resolving these challenges at each stage leads to the development of essential strengths and virtues. For example, in Erikson's stage of industry versus inferiority (ages 6 to 11 years), successfully completing tasks related to school, sports, and social interactions can lead to a sense of competence and accomplishment. Conversely, failure to master these tasks can lead to feelings of inadequacy and inferiority. By understanding and applying Erikson's theory, Nurse Nilda can better support individuals in their development and help promote positive outcomes.
A 72-year-old male patient has arrived at the outpatient unit to receive an infusion of alemtuzumab (Compath). The patient tells the nurse this is the second time his chronic lymphocytic leukemia has relapsed and the second time he will receive this drug because he failed alemtuzumab therapy after being treated with an alkylating agent. What is the nurse's priority action?
A. Calling the physician and questioning the order
B. Washing your hands
C. Beginning an intravenous infusion
D. Canceling the infusion
Correct answer:
The correct answer is A: Calling the physician and questioning the order. This is the priority action because the patient's history of relapse and prior failure of alemtuzumab therapy after receiving an alkylating agent raises concerns about potential drug interactions, contraindications, or other issues that need to be clarified with the physician before proceeding with the infusion. It is crucial to ensure patient safety and the effectiveness of the treatment by confirming the appropriateness of the order.
Summary of other choices:
B: Washing your hands - While hand hygiene is important, it is not the priority in this situation.
C: Beginning an intravenous infusion - Starting the infusion without clarifying the order and potential issues first could be harmful to the patient.
D: Canceling the infusion - While canceling the infusion may be necessary depending on the physician's response, it is not the initial action to take without consulting the physician first.
When preparing a client for transfer to the ICU for placement of a pulmonary artery catheter, the nurse should explain that this catheter is used to monitor which of the following conditions?
A. Intracranial pressure
B. Spinal cord perfusion
C. Renal function
D. Hemodynamic status
Correct answer:
The correct answer is D: Hemodynamic status. A pulmonary artery catheter is used to monitor hemodynamic parameters such as cardiac output, pulmonary artery pressure, and central venous pressure. This helps assess the patient's circulatory status and guide interventions in critically ill patients.
Explanation:
1. Pulmonary artery catheter measures cardiac output and helps in assessing the heart's ability to pump blood effectively.
2. It provides information on pulmonary artery pressure which reflects the pressure in the right side of the heart and pulmonary circulation.
3. Central venous pressure is also monitored, indicating the fluid status and right heart function.
Summary:
A: Intracranial pressure - Incorrect. Pulmonary artery catheter does not monitor intracranial pressure.
B: Spinal cord perfusion - Incorrect. Pulmonary artery catheter does not monitor spinal cord perfusion.
C: Renal function - Incorrect. Pulmonary artery catheter does not monitor renal function.
The nurse has contributed to a staff education program on immunity. Which participant response indicates a correct understanding of the type of immunity that protects newborns for the first 3 months of life as a result of maternal transmission of IgG?
A. Active natural immunity occurs.
B. Passive natural immunity occurs.
C. Active artificial immunity occurs.
D. Passive artificial immunity occurs.
Correct answer:
The correct answer is B: Passive natural immunity occurs. This type of immunity is achieved through the transfer of antibodies (IgG) from the mother to the fetus during pregnancy. The antibodies provide protection to the newborn for the first few months of life. It is considered passive because the newborn is not actively producing the antibodies themselves.
A: Active natural immunity occurs when the body produces its antibodies in response to exposure to an antigen. This is not the case for newborns receiving maternal IgG.
C: Active artificial immunity occurs when the body is intentionally exposed to an antigen, such as through vaccination, to stimulate an immune response. This is not relevant to the scenario described.
D: Passive artificial immunity occurs when pre-formed antibodies are transferred to an individual through a medical intervention, such as receiving immune globulin. This is not applicable to the situation of maternal transmission of IgG to newborns.
Which of the following conditions is most likely to cause a patient to present with potentially reversible pulseless electrical activity on the monitor?
A. Traumatic asphyxia
B. Wolf Parkinson White syndrome
C. The R-on-T phenomenon
D. Tension pneumothorax
Correct answer:
The correct answer is D: Tension pneumothorax. This condition can lead to decreased venous return to the heart, causing decreased cardiac output and ultimately pulseless electrical activity. Tension pneumothorax is a life-threatening emergency that requires immediate intervention to relieve pressure on the heart and lungs.
A: Traumatic asphyxia can cause compression of the chest and airway obstruction, leading to respiratory distress but not necessarily pulseless electrical activity.
B: Wolf Parkinson White syndrome is a cardiac condition characterized by an accessory pathway for electrical conduction in the heart, which can cause arrhythmias but not typically pulseless electrical activity.
C: The R-on-T phenomenon refers to a specific ECG finding where a premature ventricular contraction occurs on the T wave of the preceding beat, which can lead to ventricular fibrillation but is less likely to result in pulseless electrical activity compared to tension pneumothorax.
The day after a 60-yr-old patient has open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the nurse identifies the priority nursing diagnosis as
A. activity intolerance related to deconditioning.
B. risk for constipation related to prolonged bed rest.
C. risk for impaired skin integrity related to immobility.
D. risk for infection related to disruption of skin integrity.
Correct answer:
Rationale for Correct Answer (D): The priority nursing diagnosis is "risk for infection related to disruption of skin integrity" because the patient underwent ORIF for an open tibial fracture, which increases the risk of infection due to the disruption of skin integrity. Post-surgery, there is a higher susceptibility to infection, which can lead to serious complications and delayed healing. Monitoring for signs of infection and implementing appropriate interventions is crucial to prevent further complications.
Summary of Incorrect Choices:
A: Activity intolerance is not the priority as the patient is not likely to be ambulating immediately after ORIF for a tibial fracture.
B: Risk for constipation is not the priority as it is not directly related to the surgical procedure and can be managed with appropriate interventions.
C: Risk for impaired skin integrity is not the priority as the main concern post-ORIF is infection due to the open fracture, which takes precedence.
RN exams 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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