MED-SURG Certification Practice Questions: Complete and Accurate Exam Preparation, Exams of Human Resource Management

Download MED-SURG Certification Practice Questions: Complete and Accurate Exam Preparation and more Exams Human Resource Management in PDF only on Docsity!

MED-SURG CERTIFICATION PRACTICE

QUESTIONS COMPLETE ACCURATE EXAM

QUESTIONS WITH DETAILED VERIFIED ANSWERS

(100% CORRECT ANSWERS) ALREADY GRADED A+

1. A newly diabetic patient will receive instructions from his nurse. Which of the following actions should the nurse take first? A. Provide the patient with brochures for making smart choices for cook- ing/baking. B. Ask the patient what they know about diabetes. C. Instruct the patient on exercise or activities that will increase their metab- olism. D. Teach them how to use the glucometer.: B. First ask the patient what they know about diabetes. *ACTION questions ask for intervention, NOT assessment
2. The post hysterectomy patient with calls the clinic stating that she has been having difficulty with incontinence. Which of the following statements if made by the patient, indicates that further teaching is needed? A. I drink 8 oz. of fluid on the even hours while awake. B. I will attempt to void 30 minutes after drinking 200 cc. of fluid C. I will only drink fluid when I eat my meals D. I will set the timer to remind me when to void: C. A patient saying that he or she will only drink fluids when eating meals indicates that they don't know what to do in case of incontinence. FURTHER TEACHING indicates that the patient needs more information

3. An RN assesses a patient in the Cancer Center with a diagnosis of terminal cancer. The patient states to the RN that he is short of breath, has no appetite and hurts everywhere. Which of the following statements by the nurse is best? A. Tell me how your family is coping B. Show me where it does not hurt C. I'll teach you relaxation techniques D. Your physician should increase your pain medication: C
4. A clinical nurse returns to the desk to find 4 phone messages. Which of the following messages should the nurse respond to first? A. A post cervical laminectomy patient complaining of sudden difficulty talk- ing. B. A patient with multiple sclerosis complaining of change in peripheral vision. C. A patient with a herniated disc complaining of consistent back pain. D. A patient with a cast due to a fracture of the right tibial bone complaining of tingling toes.: A B and C are expected symptoms of the patient's condition. A and D are unexpected. D is less critical than A. Best answer is A.
5. A 75 year old patient complains to the clinical nurse that he is having difficulty sleeping. Which of the following actions by the nurse is most appropriate? A. Determine the patient's usual sleeping and waking patterns. B. Suggest that the client abstain from alcohol and caffeine before bed time. C. Recommend that client establish a bedtime routine. D. Ask how much sleep the client required before retirement.: A B and C are recommendations that the RN can share after he/she determines the patient's sleeping and waking patterns. So remove B and C. D is an inquiry, but is concerned about the past (when the person retired). Remove D. A is the best answer. 6. The nurse cares for a patient several hours after a thyroidectomy. The RN observes that the patient is diaphoretic and confused. The vital signs

Common acute risks of tracheostomy include bleeding, airway loss, damage to adjacent structures, and failure of the chosen technique to achieve successful airway EVERYTHING 24 HR POST SURGERY, FIRST COMPLICATION IS BLEEDING. Infection comes 2-3 days later.

10. When a pulse oximetry monitor indicates that a patient has a drop in SpO2 from 96% to 85% over 4 hours, the nurse will first:
    1. Request an order for stat ABGs
    2. Start the patient on oxygen by NC at 2L/minute
    3. Notify the physician of the change
    4. Check the position of the probe on patient's finger or earlobe: 4 Pulse oximetry is inaccurate if the probe is loose, or in the presence of poor circulation, nail polish, or dark skin pigmentation.
11. To decrease a patient's shortness of breath and a sense of impending doom during an asthma attack, the nurse will: A. Place the patient on a cardiac monitor and observe from the nurses' station. B. Let the patient rest alone in a quiet, calm environment. C. Reassure the patient that the doctor will arrive soon D. Stay with the patient and encourage pursed-lip breathing.: D The patient experiencing an acute asthma exacerbation will be fearful and anxious. It is important for the nurse to stay with the patient for ongoing assessment and to provide a calm environment. Helping the patient breathe with pursed lips will facilitate the expiration of trapped air and help the patient regain control of his or her breathing.
12. A 68 year old woman is admitted to the surgical unit after a gastric resection for gastric cancer. She states that she doesn't want anyone to see her in this condition, even her husband. This nurse's best response is: A."Patients' rights protect your privacy. I won't allow anyone in." B."I've seen gastric cancer patients who look much worse. Don't worry."

C."Would you like to talk to a social worker?" D."What about your condition worries you?": D The nurse should allow the patient to share her concerns and express her feelings in a nonjudgmental environment. If there is psych/behavioral component- AFFIRM AND VALIDATE, NO PROBING

13. A patient with a tricuspid valve disorder will have impaired blood flow between the: A. Vena cava and right atrium B. Left atrium and left ventricle C. Right atrium and right ventricle D. Right ventricle and pulmonary artery: C Tricuspid valve is located between right atrium and right ventricle MITRAL VALVE- left atrium and left ventricle
14. If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the: A. Atria B. AV node C. Ventricles D. Bundle of His: C Purkinje fibers provide a high-speed distribution of excitation throughout the ventricular myocardium; if the pattern of contraction is disrupted, the ventricles will not efficiently eject blood Order of impulse is SA node to AV node to Bundle of His to bundle branch to purkinje fibers
15. The P-wave on an EKG is representative of: A. Ventricular depolarization B. Atrial depolarization C. Atrial repolarization

When taking warfarin, caution with - garlic, ginseng, ginkgo, ibuprofen, pain drugs, vitamin E Garlic may increase bleeding, so supplemental garlic may cause a synergic effect when combined with coumadin

19. For the same patient - who is being discharged and is taking warfarin (Coumadin), the nurse should also emphasize that: A. Regular follow-up with healthcare provider is essential B. Aspirin would be recommended for headache therapy C. The medication can be taken any time of the day D. Diet should be high in iron content: A Discuss INR. High INR is a risk for bleeding (GI, hemorrhagic stroke, etc) Aspirin also being a blood thinner can be too much blood thinning action Timing of dose needs to be consistent Iron, mag, and zinc bind with coumadin and decrease absorption, it is not an absolute contraindication, but it recommended that these supplements be taken two hours apart from coumadin
20. Which of the following patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker and the caregiver (select all that apply)? A. Avoid or limit air travel B. Take and record a daily pulse rate C. Obtain and wear a Medic Alert ID or bracelet at all times D. Avoid lifting arm on the side of the pacemaker above shoulder E. Avoid microwave ovens because they interfere with pacemaker function: B, C, D Back in the day, persons with pacers needed to carry a medical device ID card as proof a pacer when they would go through security, as security heightened and body scans became normal this isn't really needed anymore Daily record keeping of HR is recommended as is wearing a med alert id bracelet, patients should NOT lift above the shoulder for a period of time so that the leads can stabilize in the body without being disrupted (about 2-4 weeks) Microwaves and most other household appliances pose no risk but extreme magnetic forces do

21. Causes of secondary hypertension would include: A. Alcohol abuse B. Diabetes C. Obesity D. Renal artery stenosis: D Renal stenosis ’ narrowing of arteries that carry blood to the kidneys ’ less blood to the kidneys ’ raises blood pressure
22. A 60-year-old African American male who works as a soccer coach, is admitted with hypertension. On admission his blood pressure was 210/ mmHg. His last total cholesterol level was 156 mg/dl, and a random blood glucose was 110 mg/dl. Which is unalterable risk factor for hypertension? A. His blood glucose level B. His cholesterol level C. His occupation D. His ethnicity: D Other risk factors: elevated serum lipids, DM, sedentary lifestyle
23. A patient who has type 2 diabetes is prescribed carvedilol (Coreg) for hypertension. The nurse monitors for A. Hypoglycemia B. Hyperglycemia C. Hypocalcemia D. Hypercalcemia: A. Hypoglycemia In patients with DM, Coreg may increase the effects of hypoglycemic drugs (prevent adrenalin from stimulating the liver to make glucose) and mask symptoms of hypoglycemia.
24. Which of the following is an AHA recommendation for patients with coronary artery disease for stroke prevention? A. Fibrate therapy B. Heparin therapy

C. left ventricular dysfunction D. atherosclerotic heart disease: C. left ventricular dysfunction Those with LV dysfunction are at high risk for ventricular arrythmias. Typically, the LV dysfunction is secondary to MI, cardiomyopathy or advanced heart failure.

28. A patient with a history of myocardial infarction (MI) complains of chest pain while walking to the restroom. Which action should the nurse perform first? A. Assess patient's vital signs B. Instruct patient to sit down C. Obtain a STAT EKG D. Call the physician: B. Instruct patient to sit down Having the patient sit down reduces myocardial oxygen demand to help relieve pain and take stress off the heart. The other actions are important, but would come after having the patient sit down to ensure safety. 29. The key diagnostic test for heart failure is: A. Serum potassium B. B-type natriuretic peptide C. Troponin I D. Cardiac enzymes: B. B-type natriuretic peptide Hyperkalemia can be common in heart failure secondary to treatments like ACE inhibitors and betablockers can cause the kidneys to retain potassium, similarly diuretic can be used to treat fluid overload associated with heart failure, the desired effect achieving of high urine output to decrease preload can also lead to low potassium levels Troponin is the hallmark diagnostic test for acute coronary syndrome, has no value with HF, same goes for cardiac enzymes
29. A nurse is instructing a patient taking diuretics for heart failure about foods that are high in potassium to include in her daily diet. The nurse concludes that additional education is needed when the client states that the food highest in potassium is: A. Spinach

B. Apples C. Avocado D. Sweet potatoes: B. Apples From this list avocadoes have the most, followed by sweet potatoes, then spinach. Apples have the least

31. Mr. Jones is 72 years old and admitted with an exacerbation of left-sided heart failure. The nurse would expect to see which of these signs or symptoms? A.Hepatomegaly B. Enlarged spleen C. Oliguria D. Ascites: C. Oliguria Left-sided HF - sodium and water retention and peripheral edema. Decreased blood flow to the kidneys can lead to oliguria. Ascites, hepatomegaly, enlarged spleen are signs of right-sided heart failure. LEFT- Lungs and Kidneys
32. Mr. Jones develops acute pulmonary edema. In anticipation of the arrival of the Rapid Response Team, the nurse should take which of these measures? (select all that apply) A. Place Mr. Jones in high Fowler's position. B. Apply high-flow oxygen. C. Administer nitroglycerin sublingually. D. Insert an indwelling urinary catheter.: A, B This patient is going to feel like they're drowning in their lungs, and they are. Set the patient upright immediately and supplement O2. Nitroglycerine is a vasodilator and could be used to decrease afterload and strict urine output measuring will be ideal when diuretic treatment is initiated but these are not your initial steps at this time. 33. In preparing for discharge, Mr. Jones should receive education about which of these types of medication?

Loop diuretics and most diuretics will deplete potassium as they effectively reduce preload by increase urine output. Yes, you do want to measure I&Os, but the question asks about complications not verifying the effectiveness of the regimen. Some HF drugs can lead the kidneys to hold on to K, as we discussed on an earlier slide but there is no mention of those drugs in this regimen so we don't need to educate on reducing K, rather, since they are on diuretics we need to watch for low K. Dig is antiarrhythmic drug, its being used here for the AFIB, it makes no sense to hold it for an irregular HR. This is a distraction option since we learned early in pharmacology class to auscultate the apical pulse for one minute and hold if less than 60 when giving dig.

36. Patients with a heart transplantation are at risk for which of the following complications in the first year after transplantation (select all that apply)? A. Cancer B. Infection C. Rejection D. Vasculopathy E. Sudden cardiac death: B, C, E Cancer is not a complication of transplant. Infection risk is significant because these patients are on medications to help keep their body from rejecting the organ, this reduces their defenses to infection and can also mask early signs of infection. Rejection comes in different types and can happen early or late post transplant Vasculopathy is a complication of transplant but is not seen in the first year, this is seen later. Sudden cardiac death can occur in the event of graft failure, which tends to happen earlier post transplant
37. Which assessment finding would the nurse expect to auscultate in a patient with mitral valve insufficiency? A. Harsh systolic murmur heard best at the right upper sternal border B. Rumbling diastolic murmur heard best at the left lower sternal border C. Holosystolic murmur heard best at the cardiac apex D. Mid-systolic click and soft diastolic murmur at the right lower sternal border: C

Mitral insufficiency or regurgitation is characterized by a holosystolic murmur at the apex. Think back to your pneumatic devices from the previous slide

38. Which of the following is a risk factor for a deep vein thrombosis (DVT)? A. Decreased thyroid stimulating hormone level B. Elevated liver function tests C. Hypocoagulability D. Dehydration: D. Dehydration A has minimal relevance, some studies have shown a potential link to two elevated liver enzyme values increasing a risk for VTE but it is not directly linked, hypocoagulapthy is a distractor to trick you into selecting it thinking it is hypercoagulability In a dehydrated state blood vessels narrow and blood becomes more concentrated, therefore creating an ideal situation for blood to pool and clot Virchow's Triad - stasis of blood flow, endothelial injury, hypercoagulability Dehydration can promote hypercoagulability
39. Which are probably clinical findings in a patient with an acute VTE? SATA. A. Pallor and coolness of foot and calf B. Mild to moderate calf pain and tenderness C. Crossly diminished or absent pedal pulses D. Unilateral edema and induration of the thigh E. Palpable cord along a superficial varicose vein: B, D VTE will generally present as a warm, reddened, unilaterally swollen extremity with mild to moderate pain.
40. A 50-year-old woman weighs 85kg and has a history of cigarette smoking, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease that need to be modified are: A. Weight and diet B. Activity level and diet

D. Cardiovascular: B. Hypovolemic Third-spacing = movement of fluid out of the vascular system into the interstitial areas, resulting in loss of fluid leading to hypovolemic shock

44. A patient is prescribed simvastatin (Zocor). Which of the following is an adverse effect of Zocor that should be reported immediately? A. Muscle pain B. Blurred vision C. Urinary retention D. Gastrointestinal reflux: A. Muscle pain Muscle pain is an adverse effect of Zocor that should be reported immediately, since muscle pain can be an indication of rhabdomyolysis and ultimately kidney failure.
    45. In a patient with thrombocytopenia, which of the following assessment findings should be immediately reported to the physician? A. Blood pressure of 210/ B. Heart rate of 90 C. Oxygen saturation of 95% D. Specks of blood in nasal discharge after vigorous blowing: A. Blood pressure of 210/ I think this question could be applicable to really any disease. A is a medical emergency regardless of the background where as the other choices are normal ranges and findings. These patients are at risk for hemorrhagic complications so elevated BP will only increase that risk.
45. A 18-year-old male is admitted after a motor-vehicle accident with air-bag release. He complains of chest tightness and is restless and anxious. Heart sounds are barely audible on auscultation. The patient is most likely experiencing what condition? A. Cardiac tamponade B. Acute myocardial infarction C. Pulmonary edema D. Aortic aneurysm: A. Cardiac tamponade

We know that this patient sustained trauma to the chest. Cardiac tamponade occurs when there is fluid build up around the heart that applies pressure to the heart and impairs its ability to pump adequately. This can happen with trauma or uncontrolled bleeding from an open heart procedure. Signs and symptoms include chest pain and pressure, muffled heart tones, shortness of breath, and jugular vein distention

47. Immediately following soft tissue injury, the doctor prescribes treatment that follows the acronym "RICE," which stands for: A. Rest, immobilization, compression, exercise B. Relax, ice, conserve energy, elevation C. Rest, ice, compression, elevation D. Rigid fixator, immobilization, compression, exercise: C. Rest, ice, compression, elevation Added M to rice- early MOBILIZATION
48. The nurse is preparing the plan of care for the client with an open fracture of the right arm. Which problem has the highest priority? A. Anger related to the inability to perform ADLs B. Sleep disturbances related to loss of work C. Infection related to exposed tissue D. Altered body image related to scarring: C. Infection related to exposed tissue 49. When preparing the discharge teaching for the 12 year old with a fractured humerus, which information should the nurse include regarding cast care? A. Keep the arm at heart level B. Handle the cast with the tips of the fingers C. Apply an ice pack to any area that itches D. Foul smells are expected occurrences: A. Keep the arm at heart level
49. The patient suffered a fractured femur. Which of the following would you tell the nursing assistant to report immediately? A. The patient complains of pain. B. The patient appears confused. C. The patient's blood pressure is 136/88. D. The patient voided using the bedpan.: B. The patient appears confused.

D. Keeping the hip flexed by placing pillows under the patient's knee: C. Placing the leg in abduction

55. As a nurse develops a postoperative nursing care plan, she knows that the patient status post total hip replacement surgery is at risk for developing complications associated with immobility. Which of the following is the most common postoperative complication for this patient? A. Pneumonia B. Thromboembolism C. Hemorrhage D. Wound infection: B. Thromboembolism
56. A patient sustains a fracture of her right hip in a fall at a nursing home. Her surgery is delayed until she can be medically stabilized. Buck's traction is applied to the patient's right leg. Which of the following is true about Buck's traction? A. The head of the bed should be elevated. B. Her heel should be resting on the bed. C. The use of an overhead trapeze should be discouraged. D. The leg in traction must not be elevated on a pillow.: D. The leg in traction must not be elevated on a pillow.
57. The client is diagnosed with osteoarthritis. Which sign and symptom would the nurse expect the client to exhibit? A. Severe bone deformity B. Joint stiffness C. Waddling gait D. Swan neck fingers: B. Joint stiffness
58. Which foods should the nurse recommend to a client when discussing sources of dietary calcium? A. Yogurt and dark-green, leafy vegetables B. Oranges and citrus fruits C. Bananas and dried apricots D. Wheat bread and bran: A. Yogurt and dark-green, leafy vegetables

59. The client is taking calcium carbonate (Tums) to help prevent further development of osteoporosis. Which teaching should the nurse implement? A. Encourage the client to take Tums with at least 8 ounces of water B. Teach the client to take Tums with the breakfast meal only C. Instruct the client to take Tums 30 to 60 minutes before meal D. Discuss the need to get a monthly serum level: C. Instruct the client to take Tums 30 to 60 minutes before meal
60. You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing interventions apply to the nursing diagnosis Risk for Falls. Which intervention should you delegate to the nursing assistant? A. Identify environmental factors that increase risk for falls. B. Monitor gait, balance, and fatigue level with ambulation. C. Collaborate with physical therapy to provide patient with walker. D. Assist the patient with ambulation to bathroom and in halls.: D. Assist the patient with ambulation to bathroom and in halls.
61. To prevent or treat osteoporosis, adequate calcium intake: A. is essential throughout the life span B. is only necessary after menopause C. can only be obtained by supplements D. is important only until bone density peaks: A. is essential throughout the life span
62. You delegate taking vital signs to an experienced nursing assistant. The patient has been diagnosed with osteomyelitis. Which vital sign do you want the nursing assistant to report immediately? A. Temperature 99.9ÚF B. Blood pressure 136/ C. Heart rate 96/minute D. Respiratory rate 24/minute: A. Temperature 99.9ÚF
63. An older adult client is getting out of bed for the first time. The nurse is alert for the development of which potential problem?