CERTIFIED MEDICAL-SURGICAL REGISTERED NURSE SAMPLE QUESTIONS AND CORRECT VERIFIED ANSWERS, Exams of Nursing

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A patient's wife is visibly upset and says to the nurse, "I thought my husband only broke his hip, but the doctor thinks he might have had a stroke." Which of the following would be an appropriate response by the nurse?

1. "It's really too early to be concerned about that. Let's wait until the test results come back."
2. "If it is a stroke, your husband is in the right hospital for treatment."
3. "Yes, he does have symptoms of a stroke. That's what the tests will help us find out."
4. "I'm going to get you some information to read about strokes and their treatment." - CORRECT ANSWERS 3) "Yes, he does have symptoms of a stroke. That's what the tests will help us find out." Rationale: Symptoms of stroke vary greatly and the initial diagnosis is made after a non- contrast CT scan is done to determine if the event was ischemic or hemorrhagic. Then, further tests are done to confirm the diagnosis and decide on treatment. In the event of a fire in a hospital's dialysis unit, which of these actions should the nurse take first?
5. Extinguish the fire if possible.
6. Activate the fire response system.
7. Confine the fire by closing all fire doors.
8. Remove patients or staff in danger. - CORRECT ANSWERS 4) Remove patients or staff in danger. Rationale: When a fire occurs in a patient area within the hospital, the nurses' first actions are to protect patients and staff. This usually involves removing the patients and staff from exposure to the fire. An 80-year-old male who has mild dementia is readmitted for the third time with multiple pressure ulcers. During the nursing assessment, multiple bruises are also observed on his body. He lives with his son and daughter-in-law. The nurse suspects elder abuse/neglect. Which of these actions should the nurse take?

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1. Have a staff member present during family visits.
2. Report the findings.
3. Discuss the situation with the family.
4. Ask the patient who is providing his care. - CORRECT ANSWERS 2) Report the findings. Rationale: Most states require that health care workers report suspected elder abuse to an official agency, such as Adult Protective Services. A patient who has active pulmonary tuberculosis (TB) states, "I'm not going to take these TB pills!" Which of these responses by the nurse would be appropriate?
5. "You have a legal right to refuse to take this medication."
6. "You need to sign a Refusal of Treatment Form."
7. "You need to ask your doctor about the possibility of discontinuing the medication."
8. "You should know that the health department can require you to take the medication." - CORRECT ANSWERS 4) "You should know that the health department can require you to take the medication." Rationale: Tuberculosis (TB) is a public health problem that requires reporting of the disease to the health department. It is essential that the patient understand the need to take prescribed TB medications as directed. Patients who are unwilling or unable to adhere to treatment may be required to do so by law or may be quarantined or isolated until noninfectious. State governments have legal responsibility for TB control activities, including treatment protocols for nonadherent patients. Health care workers should be familiar with the law in their particular states for these procedures. When a patient is having a chest tube removed, which of these instructions would be appropriate?
9. "Take short quick breaths with your mouth open."
10. "Take a deep breath and hold it."
11. "Breathe only through your mouth."
12. "Breathe as you normally do." - CORRECT ANSWERS 2) "Take a deep breath and hold it."

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A 30-year old patient has been diagnosed with advanced ovarian cancer. The patient says, "This is all my fault." Which of Kubler-Ross's five stages of grief is the patient probably experiencing? A.Denial B.Anger C.Depression D.Acceptance - CORRECT ANSWERS B. The patient is experiencing the stage of anger. People grieve individually and may not go through all stages, but most go through at least 2 stages. Kubler-Ross's 5 stages of grief include: Denial: Refusal to believe, confused, stunned, detached. Anger: Directed inward (self-blame) or outward. Bargaining: If - then thinking. ("If I go to church, then I will heal.") Depression: Sad, withdrawn. Acceptance: Resolution. A 68-year old man with mild COPD refuses to exercise because he tires easily. He spends most of every day sitting in a chair watching television. What is the most appropriate nursing diagnosis? A.Ineffective health maintenance B.Impaired physical mobility C.Risk for disuse syndrome D.Activity intolerance - CORRECT ANSWERS C. The most appropriate nursing diagnosis for a person who is able to exercise but remains sedentary is risk of disuse syndrome because the patient is putting himself at risk for the development of circulatory impairment and muscle atrophy. Failure to exercise may also exacerbate his condition. While his health maintenance may be ineffective, it is directly due to of his lack of activity. He does not have impaired physical mobility or activity intolerance that precludes exercise. Measuring the effectiveness of an intervention rather than the monetary savings is:

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A.A cost-benefit analysis. B.An efficacy study. C.A product evaluation. D.A cost-effective analysis. - CORRECT ANSWERS D. A cost-effective analysis measures the effectiveness of an intervention rather than the monetary savings. For example, annually 2 million nosocomial infections result in 90,000 deaths and an estimated $6.7 billion in additional health costs. From that perspective, decreasing infections should reduce costs, but there are human savings in suffering as well, and it can be difficult to place a dollar value on that. If each infection adds about 12 days to hospitalization, then a reduction of 5 infections (5 X 12 = 60) would result in a cost-effective savings of 60 fewer patient infection days. The main goal of treatment for acute glomerulonephritis is to:

1. Encourage activity.
2. Encourage high protein intake.
3. Maintain fluid balance.
4. Teach intermittent urinary catheterization. - CORRECT ANSWERS 3. Maintain fluid balance. Nursing diagnoses mostly differ from medical diagnoses in that they are:
5. Dependent upon medical diagnoses for the direction of appropriate interventions.
6. Primarily concerned with caring, while medical diagnoses are primarily concerned with curing.
7. Primarily concerned with human response, while medical diagnoses are primarily concerned with pathology.
8. Primarily concerned with psychosocial parameters, while medical diagnoses are primarily concerned with physiologic parameters. - CORRECT ANSWERS 3. Primarily concerned with human response, while medical diagnoses are primarily concerned with pathology. A patient who received spinal anesthesia four hours ago during surgery is transferred to the surgical unit and, after one and a half hours, now reports severe incisional pain. The patient's blood pressure is 170/90 mm Hg, pulse is 108 beats/min, temperature is 99oF

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2. Consult the spouse's healthcare provider about the spouse's ability to care for the patient.
3. Contact the children to ascertain their commitment to help.
4. Discuss community resources with the spouse and offer to make referrals. - CORRECT ANSWERS 4. Discuss community resources with the spouse and offer to make referrals. During an assessment of a patient who sustained a head injury 24 hours ago, the medical- surgical nurse notes the development of slurred speech and disorientation to time and place. The nurse's initial action is to:
5. Continue the hourly neurologic assessments.
6. Inform the neurosurgeon of the patient's status.
7. Prepare the patient for emergency surgery.
8. Recheck the patient's neurologic status in 15 minutes. - CORRECT ANSWERS 2. Inform the neurosurgeon of the patient's status. For the evaluation feedback process to be effective, a manager:
9. Conducts weekly meetings with staff members.
10. Considers staff members' interests and abilities when delegating tasks.
11. Informs staff members regularly of how well they are performing their jobs.
12. Provides goals for staff members to meet. - CORRECT ANSWERS 3. Informs staff members regularly of how well they are performing their jobs. An 80-year-old patient is placed in isolation when infected with methicillin-resistant Staphylococcus aureus. The patient was alert and oriented on admission, but is now having visual hallucinations and can follow only simple directions. The medical-surgical nurse recognizes that the changes in the patient's mental status are related to:
13. A fluid and electrolyte imbalance.
14. A stimulating environment.
15. Sensory deprivation.
16. Sundowning. - CORRECT ANSWERS 3. Sensory deprivation.

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To prepare a patient on the unit for a bronchoscopic procedure, a medical-surgical nurse administers the IV sedative. The medical-surgical nurse then instructs the licensed practical nurse to:

1. Educate the patient about the pending procedure.
2. Give the patient small sips of water only.
3. Measure the patient's blood pressure and pulse readings.
4. Take the patient to the bathroom one more time. - CORRECT ANSWERS 3. Measure the patient's blood pressure and pulse readings. Which physiological response is often associated with surgery-related stress?
   1. Bronchial constriction
   2. Decreased cortisol levels
   3. Peripheral vasodilation
   4. Sodium and water retention - CORRECT ANSWERS 4. Sodium and water retention A patient's family does not know the patient's end-of-life care preferences, but assumes that they know what is best for the patient under the circumstances. This assumption reflects:
5. Justice.
6. Paternalism.
7. Pragmatism.
8. Veracity. - CORRECT ANSWERS 2. Paternalism. Which statement by a patient with diabetes mellitus indicates an understanding of the medication insulin glargine (Lantus)?
9. "Lantus causes weight loss."
10. "Lantus is used only at night."

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1. Allow the patient and family members time to be alone.
2. Arrange time for the patient to speak with another patient with cancer.
3. Direct the discussion and validation of emotion, without false reassurance.
4. Request a consultation from a social worker on the oncology unit. - CORRECT ANSWERS
5. Direct the discussion and validation of emotion, without false reassurance. It is hospital policy to assess and record a patient's pulse before administering digoxin (Lanoxin). By auditing the nursing records to determine the frequency of compliance with this policy, the quality assessment and improvement committee is conducting:
6. A process analysis.
7. A quality analysis.
8. A system analysis.
9. An outcome analysis. - CORRECT ANSWERS 1. A process analysis. The nursing diagnosis for a patient with a myocardial infarction is activity intolerance. The plan of care includes the patient outcome criterion of:
10. Agreeing to discontinue smoking.
11. Ambulating 50 feet without experiencing dyspnea.
12. Experiencing no dyspnea on exertion.
13. Tolerating activity well. - CORRECT ANSWERS 2. Ambulating 50 feet without experiencing dyspnea. A nursing department in an acute care setting decides to redesign its nursing practice based on a theoretical framework. The feedback from patients, families, and staff reflects that caring is a key element. Which theorist best supports this concept?
14. Erikson
15. Maslow
16. Rogers

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4. Watson - CORRECT ANSWERS 4. Watson Which statement by a patient demonstrates an accurate understanding about herbal supplements?
5. "Herbs may interact with prescribed medications but not other herbs."
6. "Most herbs have been tested and found to be safe and therapeutic."
7. "The Food and Drug Administration regulates herbs and allows advertising."
8. "There is no standardization among the manufacturers of herbs in this country." - CORRECT ANSWERS 4. "There is no standardization among the manufacturers of herbs in this country." For a patient with Crohn's disease, the medical-surgical nurse recommends a diet that is:
9. High in fiber, and low in protein and calories.
10. High in potassium.
11. Low in fiber, and high in protein and calories.
12. Low in potassium. - CORRECT ANSWERS 3. Low in fiber, and high in protein and calories. When examining a patient who is paralyzed below the T4 level, the medical-surgical nurse expects to find:
13. Flaccidity of the upper extremities.
14. Hyperreflexia and spasticity of the upper extremities.
15. Impaired diaphragmatic function requiring ventilator support.
16. Independent use of upper extremities and efficient cough. - CORRECT ANSWERS 4. Independent use of upper extremities and efficient cough. After completing a thorough neurological and physical assessment of a patient who is admitted for a suspected stroke, a medical-surgical nurse anticipates the next step in the immediate care of this patient to include:

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When performing an assessment, the nurse identifi es the following signs and symptoms: impaired coordination, decreased muscle strength, limited range of motion, and reluctance to move. These signs and symptoms indicate which nursing diagnosis? A. Health-seeking behaviors B. Impaired physical mobility C. Disturbed sensory perception D. Deficient knowledge - CORRECT ANSWERS B. Impaired physical mobility Rationale:Impaired physical mobility is a limitation of physical movement and is defined by the patient's signs and symptoms. Options A, C, and D are nursing diagnoses with different defining signs and symptoms. When prioritizing a patient's care plan based on Maslow's hierarchy of needs, the nurse's fi rst priority would be: A. allowing the family to see a newly admitted patient. B. ambulating the patient in the hallway. C. administering pain medication. D. using two nurses to transfer the patient. - CORRECT ANSWERS C. administering pain medication. Rationale: In Maslow's hierarchy of needs, pain relief is on the first layer. Activity (Option B) is on the second layer. Safety (Option D) is on the third layer. Love and belonging (Option A) are on the fourth layer

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When a nurse asks another nurse for advice on handling a particular patient problem, she's seeking what type of consultation? A. Patient-centered case consultation B. Consultee-centered case consultation C. Program-centered administrative consultation D. Consultee-centered administrative consultation - CORRECT ANSWERS A. Patient- centered case consultation Rationale: Patient-centered case consultation (Option A) provides expert advice on handling a particular patient or group of patients. Consultee-centered case consultation (Option B) focuses on work difficulties with patients, which are used as a learning opportunity. Program-centered administrative consultation (Option C) provides expert advice on developing new programs or improving existing ones. Consultee-centered administrative consultation (Option D) considers work problems in the areas of program development and organization. When implementing an evidence-based nursing program to decrease the incidence of pressure ulcers on a medical-surgical unit, which of the following is the most important to ensure its success? A. Obtaining support from management, administration, and physicians B. Determining and documenting patient outcomes C. Identifying a significant problem that needs to be addressed D. Evaluating research based on its validity and reliability - CORRECT ANSWERS A. Obtaining support from management, administration, and physicians Rationale: To successfully implement an evidence-based nursing program, it's important to obtain the support of management, administration, and physicians. Option B is part of evaluating evidence-based nursing program implementation. Option C is part of the first step of the evidence-based nursing program process. Option D is part of the critical evaluation of resources.

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C. Write down the order and then read back the complete order to the physician. D. Immediately carry out the order. - CORRECT ANSWERS C. Write down the order and then read back the complete order to the physician. Rationale: When receiving a telephone or other verbal order, the nurse should write down the order and then read back the complete order to the physician to verify its accuracy. Options A, B, and D aren't appropriate actions for the nurse to take when receiving a telephone order from a physician. A secondary latency phase that occurs in some diseases that is commonly followed by another acute phase is referred to as: A. remission. B. convalescence. C. the acute phase. D. the subclinical acute phase. - CORRECT ANSWERS A. remission. Rationale: A secondary latency phase that occurs in some diseases that is commonly followed by another acute phase is referred to as remission. Convalescence (Option B) is progression toward recovery. The acute phase (Option C) refers to the disease at its full intensity, possibly with complications. The subclinical acute phase (Option D) occurs when the patient is in the acute phase but still functions as if the disease weren't present. Qualitative research emphasizes developing new insights, theories, and knowledge. Which term in qualitative research describes the researcher laying aside what is known about the experience being studied? A. Bracketing

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B. Saturation C. Intuiting D. Theoretical sampling - CORRECT ANSWERS A. Bracketing Rationale: Bracketing requires the researcher to lay aside what's known about the experience being studied and be open to new insights. Saturation (Option B) describes the point at which data collection is ended because continuing would result in acquiring more of the same information or data. Intuiting (Option C) refers to the focused awareness on the phenomena being studied. Theoretical sampling (Option D) is the selecting of subjects on the basis of concepts that have theoretical relevance to an evolving theory. The nurse leaves a patient who is elderly and confused to fi nd someone to assist with transferring the patient to bed. While the nurse is gone, the patient falls and hurts herself. The nurse is at fault because she hasn't: A. properly educated the patient about safety measures. B. restrained the patient. C. documented that she left the patient. D. arranged for continual care of the patient. - CORRECT ANSWERS D. arranged for continual care of the patient. Rationale: By leaving the patient, the nurse is at fault for abandonment. The better courses of action are to turn on the call bell or elicit help on the way to the patient's room. Options A and C are incorrect because neither excuses the nurse from her responsibility for ensuring the patient's safety. Option B is incorrect because restraints are only to be used as a last resort, when all other alternatives for ensuring patient safety have been tried and have failed; moreover, restraints won't ensure the patient's safety.

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the failure to exercise the degree of care that a person of ordinary prudence would exercise under the same circumstances, is an unintentional tort. Option D is incorrect because although abandonment is a liability for nurses, the act isn't an intentional tort. OSHA is responsible for: A. compensating workers injured in the workplace. B. providing rehabilitation for workers injured in the workplace. C. inspecting high-hazard workplaces for compliance with protective standards. D. disciplining workers injured in the workplace. - CORRECT ANSWERS C. inspecting high- hazard workplaces for compliance with protective standards. Rationale: OSHA is responsible for preventing work-related injuries, illnesses, and deaths. Options A and B are incorrect because it's the responsibility of workers' compensation to compensate workers for injuries occurring in the workplace and to provide rehabilitative services. Option D is incorrect because it's the employer's responsibility to improve the safety and health of employees. Employers who violate OSHA standards are subject to fines and penalties A patient became seriously ill after a nurse gave him the wrong medication. After his recovery, he fi led a lawsuit. Who is most likely to be held liable? A. No one because it was an accident B. The hospital C. The nurse D. The nurse and the hospital - CORRECT ANSWERS D. The nurse and the hospital Rationale: Nurses are always responsible for their actions. The hospital is liable for negligent conduct of its employees within the scope of employment. Consequently, the nurse and the hospital are liable. Therefore, Options B and C are incorrect. Option A is incorrect because although the mistake wasn't intentional, standard procedure wasn't followed.

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Which of the following is incorrect about informed consent? A. It can be revoked by the state, especially when the benefits outweigh the risks. B. A person has to be mentally competent to sign an informed consent. C. Physicians can waive informed consents in emergency situations. D. The name of the procedure, its risks and benefits, and other alternative procedures make up all the essential elements of informed consent - CORRECT ANSWERS D. The name of the procedure, its risks and benefits, and other alternative procedures make up all the essential elements of informed consent Rationale: An informed consent should also contain the name of the health care professional who will be performing the procedure. The other options are correct statements about informed consent. Which of the following is considered identifi able health information? A. A photograph of a patient's leg showing a unique tattoo B. A patient's chart listing his history of a stroke last year C. A blank menu for a regular diet on the patient's over-bed table D. A laboratory report with the patient's name, address, Social Security number, date of birth, and room number deleted - CORRECT ANSWERS A. A photograph of a patient's leg showing a unique tattoo Rationale: Any information that can identify the person or that relates to a past, present, or future physical or mental condition is considered identifiable health information. Options B, C, and D don't contain information that can identify the patient. In a negligence suit against a nurse, what must the plaintiff prove? A. The nurse intended to cause harm. B. The nurse's actions caused harm. C. The nurse knew she caused harm.