Nursing Care and Diagnosis for Gastrointestinal and Endocrine Disorders, Exams of Nursing

Download Nursing Care and Diagnosis for Gastrointestinal and Endocrine Disorders and more Exams Nursing in PDF only on Docsity! MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 MEDSURG A 78 year old client is admitted to the emergency department with numbness and weakness of the left arm and slurred speech. Which nursing intervention is priority? * 1/1 Prepare to administer recombinant tissue plasminogen activator (rt- PA). Discuss the precipitating factors that caused the symptoms. Schedule for A STAT computer tomography (CT) scan of the head. Notify the speech pathologist for an emergency consult. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? * 1/1 A. There is no skin breakdown. B. Her appetite improves. C. She loses more than 10 lbs. D. Stools are less fatty and decreased in frequency. During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement? * 1/1 A. “The head of your bed must remain flat for 24 hours after surgery.” B. “You should avoid deep breathing and coughing after surgery.” C. “You won’t be able to swallow for the first day or two.” D. “You must avoid hyperextending your neck after surgery.” A nurse in the emergency department is observing a 4- year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern? * 1/1 Bulging anterior fontanel. Repeated vomiting. Signs of sleepiness at 10 PM. Inability to read short words from a distance of 18 inches. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? * 1/1 They contain exudate and provide a moist wound environment. They protect the wound from mechanical trauma and promote healing. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 They debride the wound and promote healing by secondary intention. They prevent the entrance of microorganisms and minimize wound discomfort. A 22 year old client suffered from his first tonic-clonic seizure. Upon awakening the client asks the nurse, “What caused me to have a seizure? Which of the following would the nurse include in the primary cause of tonic clonic seizures in adults more the 20 years? * 1/1 Electrolyte imbalance Head trauma Epilepsy Congenital defect A 38 year old woman returns from a subtotal thryroidectomy for the treatment of hyperthyroidism. Upon assessment, the immediate priority that the nurse would include is: * 1/1 Assess for pain Assess for neurological status Assess fluid volume status Assess for respiratory distress Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? * 1/1 A. Tetany B. Hemorrhage C. Thyroid storm D. Laryngeal nerve damage A female client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). The client is intubated and placed on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug endotracheally before suctioning? * 1/1 Phenytoin (Dilantin) Mannitol (Osmitrol) Lidocaine (Xylocaine) Furosemide (Lasix) MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to: * 1/1 A. Begin total parenteral nutrition B. Start a cutdown infusion C. Administer tube feedings D. Perform a tracheostomy You assess a patient with Cushing’s disease. For which finding will you notify the physician immediately? * 1/1 Purple striae present on abdomen and thighs Weight gain of 1 pound since the previous day +1 dependent edema in ankles and calves Crackles bilaterally in lower lobes of lungs Initial treatment for a CSF leak after transphenoidal hypophysectomy would most likely involve: * 1/1 A. Repacking the nose. B. Returning the client to surgery. C. Enforcing bed rest with the head of the bed elevated. D. Administering high-dose corticosteroid therapy. A client who is regaining consciousness after a craniotomy becomes restless and attempts to pull out her IV line. Which nursing intervention protects the client without increasing her ICP? * 1/1 Place her in a jacket restraint Wrap her hands in soft “mitten” restraints Tuck her arms and hands under the draw sheet Apply a wrist restraint to each arm A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: * 1/1 A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised. The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the ICP is rising? * 1/1 MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure. In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Angelo would expect a decline in: * 1/1 Serum glucose level. Hair loss. Bone mineralization. Menstrual flow. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? * 1/1 A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C. Body image disturbance related to weight gain and edema D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective? * 1/1 Urine output increases Pupils are 8 mm and nonreactive Systolic blood pressure remains at 150 mm Hg BUN and creatinine levels return to normal A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar),20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? * 1/1 A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs. B. It interacts with plasma membrane receptors to inhibit enzymatic actions. C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate D. It regulates the threshold for water resorption in the kidneys. When a client is first admitted with hyperglycemic MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide: * 1/1 A. Oxygen B. Carbohydrates C. Fluid replacement D. Dietary instruction * 0/1 Give regular insulin by IV Give NPH by IV Give 10-15 g CHO or Orange juice Give 1 mg glucagon Correct answer Give 1 mg glucagon At a senior citizens meeting a nurse talks with a client who has diabetes mellitus Type 1. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity? * 1/1 “I give my insulin to myself in my thighs.” “Sometimes when I put my shoes on I don’t know where my toes are.” “Here are my up and down glucose readings that I wrote on my calendar.” “If I bathe more than once a week my skin feels too dry.” Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? * 1/1 A. Tetanic contractions B. Neck vein distention C. Weight loss D. Polyuria Hyperphosphatemia and hypocalcemia are indicative of which of the following disorders? * 1/1 A. Grave’s Disease B. Hyperparathyroidism C. Cushing’s Syndrome D. Hypoparathyroidism When a client is in diabetic ketoacidosis, the insulin that would be administered is: * 1/1 A. Human NPH insulin B. Human regular insulin C. Insulin lispro injection D. Insulin glargine injection A patient is admitted to the medical unit with possible Graves’ disease (hyperthyroidism). Which MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 10 U of fast-acting insulin. The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: * 1/1 Measure the urinary output Check the vital signs Encourage increased fluid intake Weigh the client Paolo with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client’s urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse’s suspicion of diabetes insipidus? * 0/1 Above-normal urine and serum osmolality levels Below-normal urine and serum osmolality levels Above-normal urine osmolality level, below-normal serum osmolality level Below-normal urine osmolality level, above- normal serum osmolality level Correct answer Below-normal urine osmolality level, above-normal serum osmolality level The nurse is positioning the female client with increased intracranial pressure. Which of the following positions would the nurse avoid? * 1/1 Head mildline Head turned to the side Neck in neutral position Head of bed elevated 30 to 45 degrees A client who recently had a cerebrovascular accident/stroke requires a cane to ambulate. When teaching about cane use, the rationale for holding a cane on the uninvolved side is to: * 1/1 prevent leaning distribute weight away from the involved side maintain stride length prevent edema While working in the ICU, you are assigned to care for a patient with a seizure disorder. Which of these nursing actions will you implement first if the patient has a seizure? * 1/1 Place the patient on a non- rebreather mask will the oxygen at 15 L/minute. Administer lorazepam (Ativan) 1 mg IV. Turn the patient to the side and protect airway. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 Assess level of consciousness during and immediately after the seizure. Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? * 1/1 A. Administration of vasopressin and insertion of a balloon tamponade B. Preparation for a paracentesis and administration of diuretics C. Maintenance of nothing-by- mouth status and insertion of nasogastric (NG) tube with low intermittent suction D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day Questions 51 to 100 36 of 50 points A client is admitted to the hospital with weakness in the right extremities and a slight speech problem. Vital signs are normal. During the first 24 hours, the nurse should give priority to: * 1/1 Evaluating the client's motor status Checking the client's temperature Obtaining a urine specimen from the client. Monitoring the client's blood pressure. A female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has a history of: * 1/1 Seizures or trauma to the brain Respiratory or gastrointestinal infection during the previous month. Meningitis during the last five (5 years Back injury or trauma to the spinal cord Osteomyelitis most commonly results from which of the following mechanisms? * 0/1 IV drug use Surgery Trauma .Immune suppression Correct answer Trauma During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as: * 1/1 A normal finding A conductive hearing loss in the right ear A sensorineural or conductive loss The presence of nystagmus MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 A nurse would question an order to irrigate the ear canal in which of the following circumstances? * 1/1 Otitis externa Perforated tympanic membrane Hearing loss . Ear pain When assisting the family to help an aphasic member regain as much speech function as possible, the nurse should instruct them to: * 0/1 Give positive reinforcement for correct communication Speak louder than usual during visits. Encourage the client to speak while being patient with all attempts. Tell the client to use the correct words when speaking Correct answer Encourage the client to speak while being patient with all attempts. On the evening before discharge from the hospital, a client has a hypertensive crisis and a brain attack (CVA). Initially the nurse should place the client in a: * 1/1 High Fowler's position Slight Trendelenburg position Side-lying position Supine position After cataract surgery, a client is taught how to self- administer eyedrops before discharge. The nurse approves the technique when the client : * 1/1 Places the drops on the cornea of the eye. Holds the dropper tip above the eye. Raises the upper eyelid with gentle traction Squeezes the eye shut after instilling the eyedrops The husband of a client with aphasia as a result of a brain attack (CVA) asks whether his wife's speech will ever return. The nurse should respond: * 1/1 "This will probably be the extent of her speech from now on." "You will have to ask your physician". "It should return to normal in two or three months." "It is hard to say how much improvement will occur." The nurse is aware that the teaching about myasthenic and cholinergic crises is understood when a client who has been diagnosed with myasthenia gravis states that a symptom common to both is: * MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 During the neurological assessment of a client with a tentative diagnosis of Guillain- Barre syndrome, the nurse should expect that the client will manifest: * 1/1 Increased muscular weakness Pronounced muscular atrophy Impairment in cognitive reasoning Diminished visual acuity The nurse identifies that a client exhibits the characteristic gait associated with Parkinson's disease. When recording on the client's chart, the nurse should describe this gait as: * 1/1 Ataxic Shufflin g Scissorin g Spastic A client who has had a retinal detachment has a scleral buckling procedure to attempt to reattach the retina. Before the client is discharged home, the nurse should: * 0/1 Instruct the client to wear dark glasses after the patch is removed. Tell the client that usual activities can be resumed within two weks. Reassure the client that the glasses worn before surgery can still be worn. Explain to the client that reading will help strengthen the eye muscles. Correct answer Instruct the client to wear dark glasses after the patch is removed. During the immediate post- trauma period after injury to the frontal lobe of the brain, the nurse should pace a client in the: * 0/1 Trendelenburg position Low- fowler's position Side-lying position Supine position Correct answer Low-fowler's position During the first week after a spinal cord injury at the T3 level, a male client and the nurse identify a short term goal. An appropriate short-term goal for this client would be, "The client will: * 0/1 Perform independent ambulation." Consider lifestyle changes." Carry out personal hygiene activities." Understand his limitations". Correct answer Carry out personal hygiene activities." MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 The nurse might expect a client with multiple sclerosis to complain about the most common initial symptom, which is: * 1/1 Visual disturbances Headaches Skin infections Diarrhea The nurse in the neurologic clinic assesses for damage to the glossopharyngeal (ninth cranial) and vagus (tenth cranial) nerve by testing the client's ability to: * 1/1 swallo w shru g smil e smel l A female client is admitted to the facility for investigation of balance and coordination problems, including possible Ménière’s disease. When assessing this client, the nurse expects to note: * 0/1 Vertigo, pain, and hearing impairment. Vertigo, tinnitus, and hearing loss. Vertigo, vomiting, and nystagmus Vertigo, blurred vision, and fever. Correct answer Vertigo, tinnitus, and hearing loss. While assessing a client with Parkinson's disease , the nurse identifies bradykinesia when the client exhibits: * 1/1 Paralysis of the limbs Muscle flaccidity An intention tremor A lack of spontaneous movement A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines that which of the following results would verify the diagnosis? * 1/1 Clear CSF, elevated protein, and decreased glucose Clear CSF, decreased pressure, and elevated protein Cloudy CSF, decreased protein, and decreased glucose Cloudy CSF, elevated protein, and decreased glucose A client who has Guillain-Barre syndrome asks, "Will I ever got MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 better?" The most appropriate answer by the nurse would be: * 0/1 "You'll notice your strength will improve each day." "We are doing everything we can to provide the best care." "Your chances for recovery are very good but recovery is slow". "You seem concerned about getting better. What do you think?" Correct answer "Your chances for recovery are very good but recovery is slow". Which of the following clinical manifestations suggest Amyotrophic Lateral Sclerosis (ALS)? * 1/1 Fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and incoordination Paralysis of the facial muscles, increased lacrimation (tearing), and painful sensations in the face, behind the ear, and in the eye Tremor, rigidity, bradykinesia (abnormally slow movements), and postural instability Involuntary contraction of the facial muscles causing sudden closing of the eye or twitching of the mouth The nurse has notes that the physician has a diagnosis of presbycusis on the client’s chart. The nurse plans care knowing the condition is: * 1/1 Nystagmus that occurs with aging A sensorineural hearing loss that occurs with aging Tinnitus that occurs with aging A conductive hearing loss that occurs with aging. While performing the history and physical examination of a client with Parkinson's disease , the nurse should assess the client for: * 0/1 Frequent bouts of diarrhea A low-pitched , monotonous voice Hyperextension of the neck A recent increase in appetite and weight gain Correct answer A low-pitched , monotonous voice A client asks for an explanation about glaucoma. The nurse explains that with glaucoma there is: * 1/1 An opacity of the crystalline lens or its capsule An increase in the pressure within the eyeball. A separation of the neural retina from the pigmented retina A curvature of the cornea that becomes unequal A client with Meniere’s disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo? * MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 an increase in intracranial pressure would be a slowly: * 1/1 Decreasing level of consciousness Rising respiratory rate Narrowing pulse pressure Increasing diastolic blood pressure Pathophysiologic changes seen with osteoarthritis includes: * 0/1 Narrowing of the joint space. All of the above. The formation of bony spurs at the edges of the joint surfaces. Joint cartilage degeneration. Correct answer Narrowing of the joint space. A female client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test? * 0/1 Determine whether the client is allergic to iodine, contrast dyes, or shellfish. Immobilize the neck before the client is moved onto a stretcher. Place a cap on the client’s head. Administer a sedative as ordered. Correct answer Determine whether the client is allergic to iodine, contrast dyes, or shellfish. A client whose vertebral column at the level of T6 and T7 was completely crushed and whose left leg was traumatically amputated above the knee is admitted to the ICU . When performing an assessment, the nurse would expect to find that the client was experiencing: * 1/1 Spastic paralysis of the arms and legs. Pain in the residual limb Pain at the level of compression Difficulty breathing Alvin has a history of peptic ulcer disease and vomits coffee- ground emesis. What does this indicate? * 1/1 A. He has fresh, active upper GI bleeding. B. He needs immediate saline gastric lavage. C. His gastric bleeding occurred 2 hours earlier. D. He needs a transfusion of packed RBC’s. Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects? * 1/1 A. Dry oral mucosa B. Hypertension C. Urinary urgency MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 D. Constipation The client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test? * 1/1 A. Fast for 8 hours before the test B. Eat a regular supper and breakfast C. Continue to take all oral medications as scheduled. D. Monitor own bowel movement pattern for constipation Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next? * 1/1 A. Discontinue the procedure B. Lower the height of the enema container C. Complete the procedure as quickly as possible D. Continue administering the enema without making any adjustments A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? * 1/1 A. Lying on the right side with legs straight B. Lying on the left side with knees bent C. Prone with the torso elevated D. Bent over with hands touching the floor Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes: * 1/1 A. Giving pain medication Q6H. B. Flushing the NG tube with sterile water. C. Positioning her in high Fowler’s position. D. Keeping her NPO until the return of peristalsis. A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? * 1/1 A. Lean beef MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 B. Air popped popcorn C. Raw vegetables D. Hot chocolate Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? * 1/1 A. Limit caffeine intake to two cups of coffee per day. B. Do not lie down for 2 hours after eating. C. Follow a low-protein diet. D. Take medications with milk to decrease irritation. Nurse Gemma is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: * 1/1 A. a sedentary lifestyle and smoking. B. a history of hemorrhoids and smoking. C. alcohol abuse and a history of acute renal failure. D. alcohol abuse and smoking. The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: * 1/1 A. administer an enema B. take a laxative C. take an antiemetic D. follow a clear liquid diet The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? * 1/1 A. Ambulate following a meal B. Eat high carbohydrate foods C. Limit the fluid taken with meal D. Sit in a high-Fowler’s position during meals Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred method of feeding for your patient? * 1/1 A. Total Parenteral Nutrition B. Partial Parenteral Nutrition C. Nasogastric Feeding D. Oral Liquid Supplementation Which specific data should the nurse obtain from the client MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been “bored” with the clear liquid diet. The nurse would offer which full liquid item to the client? * 1/1 A. Tea B. Gelatin C. Custard D. Popsicle The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? * 1/1 A. Sexual Dysfunction B. Disturbed Body Image C. Fear related to Poor Prognosis D. Imbalanced Nutrition: more than body requirements Questions 26 to 50 20 of 25 points A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention? * 1/1 A. Administer Dilaudid B. Notify the physician C. Call and ask the operating room team to perform the surgery as soon as possible D. Reposition the client and apply a heating pad on a warm setting to the client’s abdomen. After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should include which of the following nursing interventions? * 0/1 A. Irrigate the tube with 30 ml of sterile water every hour, if needed. B. Reposition the tube if it is not draining well C. Monitor the client for nausea and vomiting, and abdominal distention D. Turn the machine to high suction of the drainage is sluggish on low suction. Correct answer MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 C. Monitor the client for nausea and vomiting, and abdominal distention The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? * 1/1 A. Development of laryngeal cancer B. Irritation of the esophagus C. Esophageal scar tissue formation D. Aspiration of gastric contents Nursing suggestions to help a person break the constipation habit include all of the following except: * 0/1 A. A low-residue, bland diet. B. A fluid intake of at least 2 L/day. C. Establishing a regular schedule of exercise. D. Establishing a regular time for daily elimination. Correct answer A. A low-residue, bland diet. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? * 1/1 A. Notify the physician B. Stop the irrigation temporarily C. Increase the height of the irrigation D. Medicate for pain and resume the irrigation A 70-year-old client visits the clinic and complains of minor soiling with occasional urgency and loss of control. Further assessment reveals that the client has poor control of flatus. Based on the presenting symptoms, you suspect that the client may have: * 1/1 A. Peptic ulcer disease B. Constipation C. Irritable bowel syndrome D. Fecal incontinence A patient with IBS asks, “How can I manage abdominal discomfort?” Your best response would be: * 1/1 A. “It is best managed by eating dry crackers.” B. “Some patients maintain an antidepressant drugs.” C. “You will be the one to choose what is best for you.” D. “Abdominal pain can be reduced by avoiding carbonated beverages.” A client with irritable bowel syndrome is being prepared for MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 discharge. Which of the following meal plans should the nurse give the client? * 1/1 A. Low fiber, low-fat B. High fiber, low-fat C. Low fiber, high-fat D. High-fiber, high-fat A 20 year old college student was rushed to the ER of VSMMC after he fainted during their ROTC drill. He complained of severe right iliac pain. Upon palpation of his abdomen, the student jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to : * 0/1 A. Allay anxiety and apprehension B. Reduce pain C. Prevent vomiting D. Relax abdominal muscle Correct answer A. Allay anxiety and apprehension When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? * 1/1 A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. C. The appendix may develop gangrene and rupture, especially in a middle-aged client. D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which of the following most frequent symptom(s) of duodenal ulcer? * 1/1 A. Pain that is relieved by food intake B. Pain that radiated down the right arm C. Nausea and vomiting D. Weight loss Trent has been diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease? * 1/1 A. Neutralize gastric acid B. Reduce gastric acid secretions C. Stimulate gastrin release D. Protect the mucosal barrier In a client with diarrhea, which outcome indicates that fluid resuscitation is successful? * 1/1 A. The client passes formed stools at regular intervals B. The client reports a decrease in stool frequency and liquidity C. The client exhibits firm skin turgor D. The client no longer experiences perianal burning. Angelo is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 38 C. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Angelo should assume which position? * 1/1 A. Prone B. Supine, stretched out C. Sitting D. Lying with legs drawn up The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is: * 1/1 A. Severe and unrelenting, located in the epigastric area and radiating to the back. B. Severe and unrelenting, located in the left lower quadrant and radiating to the groin. C. Burning and aching, located in the epigastric area and radiating to the umbilicus. D. Burning and aching, located in the left lower quadrant and radiating to the hip. Questions 51 to 75 25 of 25 points A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response? * 1/1 “You may have eaten contaminated restaurant food.” “You could have gotten it by using I.V. drugs.” “You must have received an infected blood transfusion.” “You probably got it by engaging in unprotected sex.” MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 . The physician orders intestinal decompression. The primary purpose of a nasoenteric tube is to: * 1/1 . Break up the obstruction Remove fluid and gas from the intestine Prevent fluid accumulation in the stomach Provide an alternative route for drug administration You’re assessing the stoma of a patient with a healthy, well- healed colostomy. You expect the stoma to appear: * 1/1 Pale, pink and moist Red and moist Dark or purple colored Dry and black A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for: * 1/1 . Malaise Stomatitis Hand tremors Weight loss The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? * 1/1 Dyspnea and fatigue Ascites and orthopnea Purpura and petechiae Gynecomastia and testicular atrophy . For which of the following positions would be appropriate for a client with severe ascites? * 1/1 Fowler’s Side-lying Reverse Trendelenburg Sims’ Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: * 1/1 Pork Milk Chicke n Broccol i MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 Which of the following measures should the nurse focus on for the client with esophageal varices? * 1/1 Recognizing hemorrhage Controlling blood pressure Encouraging nutritional intake Teaching the client about varices You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? * 1/1 . “Now I can never get hepatitis again.” “I can safely give blood after 3 months.” “I’ll never have a problem with my liver again, even if I drink alcohol.” “My family knows that if I get tired and start vomiting, I may be getting sick again.” Immediately after a liver biopsy, which of the following complications should the client be closely monitored for? * 1/1 . Abdominal cramping Hemorrhage Nausea and vomiting Potential infection Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be included in the care plan for the client? * 1/1 Administering vitamin K subcutaneously Applying pressure when giving I.M. injections Decreasing the client’s dietary protein intake Keeping the client’s fingernails short and smooth . Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include? * 1/1 . “You’ll need to lie on your stomach during the test.” “You’ll need to lie on your right side after the test.” “During the biopsy you’ll be asked to exhale deeply and hold it.” “The biopsy is performed under general anesthesia.” The most important pathophysiologic factor contributing to the formation of esophageal varices is: * 1/1 Decreased prothrombin formation Decreased albumin formation by the liver Portal hypertension MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 When a client is diagnosed with ulcerative colitis. What complication would the nurse be on alert for? * 1/1 Intestinal obstruction Toxic megacolon Malnutrition from malabsorption Fistula formation An adult has a sigmoid colostomy. The nurse is performing peristomal skin care and changing the stoma pouch. What is the most appropriate nursing action? * 0/1 Empty the ostomy pouch when it is full Pull flange and pouch off together to prevent spillage of stomach pouch contents. Leave 1/4 inch of skin exposed around stoma when determining size to cut new sin barrier Apply liquid deodorant to mucous membrane of protruding stoma Correct answer Leave 1/4 inch of skin exposed around stoma when determining size to cut new sin barrier Which of the following considerations has highest priority when preparing to administer a medication to a client with liver cancer? * 1/1 Frequency of the medication Purpose of the medication Necessity of the medication Metabolism of the medication Immediately before an abdominal paracentesis, the nurse should ask the client to void because a full bladder: * 1/1 Decreases the intraabdominal pressure Decreases the amount of fluid in the abdominal cavity Increases the danger of puncture during the procedure Increases the presence of urea in the intraabdominal fluid What is the major dietary treatment for ascites> * 0/1 High protein Increased potassium Restricted sodium Restricted fluids Correct answer Restricted sodium An adult who has 7 year history of hepatic cirrhosis was brought to the emergency room because he began vomiting large amounts of dark red blood. A Sengstaken-Blakemore tube was inserted to tamponade the bleeding esophageal varices. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 While the balloon tamponade is in place ,what is given the highest priority? * 0/1 Assessing his stools for occult blood Evaluating capillary refill in extremities Performing frequent mouth care Auscultating breath sounds. Correct answer Auscultating breath sounds. Early manifestation of a patient with liver cancer includes: * 1/1 Ascites Hepatomega ly Continuous dull abdominal pain at RUQ Jaundice A client has choledocholithiasis . During the nursing admission , the nurse notes that the client's sclera and skin are jaundiced . Ehen complaining of abdominal distention and pain, how is the client most likely to described this condition? * 1/1 An intermittent, colicky pain in his left flank. Pain which awakens him during the night, and is relieved by eating. A vise-like pressure over his sternum. Right upper quadrant pain that often radiates to his right shoulder. Which of the following not considered as appropriate management for a patient diagnosed with liver abscess? * 0/1 Monitor white blood cell count Administer IV antibiotic Meticulous skin care Open surgical drainage is the treatment of choice Correct answer Open surgical drainage is the treatment of choice What is the primary nursing diagnosis for a 4th to 10th day postoperative liver transplant patient? * 1/1 . Excess Fluid Volume Risk for Rejection Impaired Skin Integrity Decreased Cardiac Output The client with hepatitis may be anicteric and symptomless. What sign/symptom is most likely present in the early presentation f hepatic inflammatory disorder? * 0/1 Dark urine Ascites Occult blood in stools Anorexia Correct answer Anorexia MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 When preparing a client for liver biopsy, the nurse should instruct the client to: * 0/1 Turn on the left side after the procedure. Breathe normally throughout the procedure. Hold the breath at the moment of the actual biopsy Bear down (Valsalva maneuver) during the insertion of the biopsy needle. Correct answer Bear down (Valsalva maneuver) during the insertion of the biopsy needle. A client with ascites is to receive IV albumin to replace each liter of fluid removed via paracentesis. The albumin replacement is expected to decrease: * 0/1 Capillary perfusion and BP Ascites and the blood ammonia level Venous stasis and the Blood urea Nitrogen level. Tissue fluid accumulation and the hematocrit level Correct answer Tissue fluid accumulation and the hematocrit level A client is experiencing advanced hepatic cirrhosis complicated by hepatic encephalopathy. He is confused, restless, and demonstrate asterixis. In developing a two part nursing diagnosis for this condition, what would be the second part following Disturbed Thought Processes? * 1/1 Massive ascites formation Increased serum ammonia level Fluid volume excess Altered clotting mechanism Which of the following tests is the most accurate for diagnosing liver cancer? * 1/1 Abdominal ultrasound Abdominal flat plate X- ray Cholangiogram Computed tomography (CT) scan A client is admitted to the hospital for acute cholecystitis. She is now 6 hours post-op abdominal cholecystectomy with a choledochostomy and has a T-tube in place. What is the proper management of the T-tube? * 0/1 Hanging the T-tube drainage below the bed Notifying the physician if T-tube drainage is 75 ml for the first 24 hours after surgery. Irrigating the T- tube with sterile normal saline q 2 hours to prevent obstruction. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 expect to find which of the following structures? A. Sigmoid colon B. Appendix C. Splee n D. Liver 3. A female client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? A. Fast for 8 hours before the test B. Eat a regular supper and breakfast C. Continue to take all oral medications as scheduled D. Monitor own bowel movement pattern for constipation 4. Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Endoscopy B. Upper GI series C. Hemoglobin (Hb) levels and hematocrit (HCT) D. Arteriography 5. A patient complains about an inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland/s? A. Buccal B. C. Parotid D. E. Sublingual F. G. Submandibular H. 6. Parotitis caused by bacteria is treated with which of the following drug classifications? A. Analgesics B. C. Corticosteroids D. E. Antipyretics F. G. Antibiotics H. 7. Which of the following are the possible causes of sialadenitis? Select all that apply. A. Dehydration B. C. Stress D. E. Dental extraction F. G. Improper oral hygiene H. I. Frequent ingestion of cold beverages J. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 8. A patient asks, “Is surgery always the treatment of choice for inflamed salivary glands?” Your best response would be: A. Yes, surgery is always the answer. B. Surgery is only recommended for children. C. Elderly is not a candidate for parotidectomy. D. The procedure is advised for chronic sialadenitis and uncontrolled pain. 9. Which of the following conditions described as presence of calculi in the salivary glands? A. Parotitis B. Sialolithiasis C. Sialadenitis D. Mumps 10. Which of the following medical management is recommended for salivary calculus? A. Lithotripsy B. Antibiotic therapy C. Nephrectomy D. Endoscopy SAS 3 1.Acute gastritis is often caused by: A. Ingestion of strong acids B. Irritating foods C. Overuse of Aspirin D. All of the above 2. Which of the following definitions best describes gastritis? A. Erosion of the gastric mucosa B. Inflammation of a diverticulum C. Inflammation of the gastric mucosa D. Reflux of stomach acid into the esophagus 3. Which of the following substances is most likely to cause gastritis? A. Milk B. Bicarbonate of soda, or baking soda C. Enteric coated aspirin D. Nonsteriodal anti-imflammatory drugs 4. The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies? A.Vitamin A B. Vitamin B12 C. Vitamin C MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 D. Vitamin E 5. The nurse is reviewing the medication record of a client with gastritis. Which medication, if noted on the client’s record, would the nurse question? A. Amoxicillin (Amoxil) B. Indomethacin (Indocin) C. Lansoprazole (Prevacid) D. Clarithromycin (Biazin) 6. Which of the following treatments should be included in the immediate management of acute gastritis? A. Reducing work stress B. Completing gastric resection C. Treating the underlying cause D. Administering enteral tube feedings 7. Which of the following risk factors can lead to chronic gastritis? A. Young age B. Antibiotic usage C. Gallbladder disease D. Helicobacter pylori infection 8. Which of the following factors associates chronic gastritis with pernicious anemia? A. Chronic blood loss B. Inability to absorb vitamin B12 C. Overproduction of stomach acid D. Overproduction of vitamin B12 9. Which of the following measures helps relieve pain to a client with gastritis? A. Avoid foods and beverages that may be irritating to the gastric mucosa. B. Monitor fluid intake and output daily to detect early signs of dehydration. C. Administer Amoxicillin (Amoxil) twice a day. D. Start intravenous fluid therapy. 10 A patient with gastritis is nauseated and vomited 10 times at home, which of the following nursing diagnoses is appropriate for this patient? Select all that apply. A. Acute pain related to irritated stomach mucosa B. Anxiety related to treatment C. Imbalanced nutrition, less than body requirements related to inadequate intake of nutrients D. Risk for imbalanced fluid volume related to insufficient fluid intake and excessive fluid loss 11.Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 B. The client reports a decrease in stool frequency and liquidity C. The client exhibits firm skin turgor D. The client no longer experiences perianal burning. 7. The mechanism of action of diphenoxylate (Lotomil) is: A. An increase in intestinal excretion of water B. C. An increase in intestinal motility D. E. A decrease in peristalsis in the intestinal wall F. G. A decrease in the reabsorption of water in the bowel H. 8. Hypokalemia can occur rapidly in an elderly person who experiences diarrhea. The nurse should immediately report to the physician a critical potassium level of: A. 3.0 mEq/L B. 4.0 mEq/L C. 4.5 mEq/L D. 5.0 mEq/L 9. Which of the following drugs may be administered to patient with diarrhea? A. Loperamide (Imodium) B. Bisacodyl (Dulcolax) C. Senna Concentrate (Senokot) D. Docusate (Colace) 10. Which of the following is the priority nursing diagnosis to a patient with diarrhea? A. Fluid volume excess related to fluid retention B. Fluid volume deficit related to excessive fluid loss C. Activity intolerance related to imbalanced oxygen supply and demand D. Risk for infection related to underlying inflammatory process SAS 6 1. A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give the client? A. Low fiber, low- fat B. High fiber, low-fat C. Low fiber, high-fat D. High-fiber, high-fat 2. Which of the following disorders characterized by spasm, distention, and accumulation of mucus in the intestines. A. Malabsorption syndrome B. Gastritis C. Constipation D. Irritable bowel syndrome 3. A patient with IBS asks, “How can I manage abdominal discomfort?” Your best response would be: A. “It is best managed by eating dry crackers.” B. “Some patients maintain an antidepressant drugs.” C. “You will be the one to choose what is best for you.” D. “Abdominal pain can be reduced by avoiding carbonated beverages.” 4. Which of the following are considered as the risk factors of irritable bowel syndrome? Select all that apply. A. Gastric resection B. Stress C. Spicy foods D. Celiac disease E. Enteritis F. Smoking MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 5. How exercise helps manage IBS? A. It increases peristalsis. B. It decreases peristalsis. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 C. It decreases intestinal motility. D. It relieves abdominal pain. 6. Which of the following statements best describes fecal incontinence? A. It is a common disorder that affects the large intestine characterized by cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. B. It is the involuntary passage of stool from the rectum. C. It is an infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. D. It is condition with loose and watery stools during a bowel movement. 7. Fecal incontinence is most frequently seen in which of the following conditions? A. Trauma B. Inflammation C. Fecal impaction D. Laxative abuse 8. A 70-year-old client visits the clinic and complains of minor soiling with occasional urgency and loss of control. Further assessment reveals that the client has poor control of flatus. Based on the presenting symptoms, you suspect that the client may have: A. Peptic ulcer disease B. Constipation C. Irritable bowel syndrome D. Fecal incontinence 9. Which of the following measures helps control fecal incontinence? A. Increase fiber in the diet during episodes of diarrhea. B. Initiate a bowel-training program. C. Encourage use of laxatives 3 times a day. D. Use incontinence brief/adult diaper. 10.Which of the following interventions is necessary for fecal incontinence? A. Encourage use of incontinence brief. B. Weigh patient daily, with accurate intake and output. C. Advise to delay the urge to defecate to control incontinence .D. Avoid carbonated beverages to control abdominal cramping. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 palpation at Mcburney’s point, which is located in the: A. Right lower quadrant B. Right upper quadrant C. Left lower quadrant D. Left upper quadrant 3. Which of the following complications is thought to be the most common cause of appendicitis? A. A fecalith B. Bowel kinking C. Internal bowel occlusion D. Abdominal bowel swelling 4. An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take? A. Prepare 750 ml of irrigating solution warmed to 100*F B. Question the physician about the order C. Provide privacy and explain the procedure to the client D. Assist the client to left lateral Sim’s position 5. A client with acute appendicitis develops fever, tachycardia, and hypotension. Based on these assessment findings, the nurse suspects which of the following complications? A. Peritonitis B. Bowel ischemia C. Intestinal obstruction D. Deficient fluid volume 6. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care? A. Low-fiber diet and fluid restrictions. B. Total parenteral nutrition and bed rest. C. High-fiber diet and administration of psyllium. D. Administration of analgesics and antacids. 7. Which of the following types of diets is implicated in the development of diverticulosis? A. Low-fiber diet B. High-fiber diet C. High-protein diet D. Low-carbohydrate diet 8. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by: A. Periodic rectal hemorrhage. B. Hypertension and tachycardia. C. Vomiting and elevated temperature. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 D. Crampy and lower left quadrant pain and low-grade fever. 9. Medical management of the client with diverticulitis should include which of the following treatments? A. Reduced fluid intake B. Increased fiber in diet C. Administration of antibiotics D. Exercises to increase intra- abdominal pressure 10. Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis? A. Treating constipation with chronic laxative use, leading to dependence on laxatives B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents C. Herniation of the intestinal mucosa, rupturing the wall of the intestine D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion. SAS 10 1. You’re assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear: A. Pale, pink and moist B. Red and moist C. Dark or purple colored D. Dry and black 2. You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is? A. Formed B. Semisolid C. Semiliquid D. Watery 3. You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend? A. Peas B. Cabbage C. Brocco li D. Yogurt 4. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her? MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 A. Obtain daily weights. B. Measure abdominal girth. C. Keep strict intake and output. D. Encourage her to increase fluids. 5. Annabelle is being discharged with a colostomy, and you’re teaching her about colostomy care. Which statement correctly describes a healthy stoma? A. “At first, the stoma may bleed slightly when touched.” B. “The stoma should appear dark and have a bluish hue.” C. “A burning sensation under the stoma faceplate is normal.” D. “The stoma should remain swollen away from the abdomen.” 6. Five days after undergoing surgery, a client develops a small- bowel obstruction. A Miller-Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority? A. Imbalanced nutrition: Less than body requirements B. Acute pain C. Deficient fluid volume D. Excess fluid volume 7. The nurse caring for a client with small- bowel obstruction would plan to implement which nursing intervention first? A. Administering pain medication B. Obtaining a blood sample for laboratory studies C. Preparing to insert a nasogastric (NG) tube D. Administering I.V. fluids 8. A client is admitted to the hospital complaining of nausea, vomiting, and abdominal pain. Bowel obstruction is suspected. During the initial assessment, the nurse hears high-pitched tinkling bowel sounds on auscultationand flat sounds on percussion. The flat sounds are caused by: A. Hyperactive peristalsis B. Fluid trapped in the intestine C. Excessive gas trapped in the intestine D. The presence of a mass or tumor in the bowel 9. The physician orders intestinal decompression. The primary purpose of a nasoenteric tube is to: A. Break up the obstruction B. Remove fluid and gas from the intestine C. Prevent fluid accumulation in the stomach MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 SAS 12 1. For a client in hepatic coma, which outcome would be the most appropriate? A. The client is oriented to time, place, and person. B. The client exhibits no ecchymotic areas. C. The client increases oral intake to 2,000 calories/day. D. The client exhibits increased serum albumin level. 2. Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy? A. Passage of two or three soft stools daily B. Evidence of watery diarrhea C. Daily deterioration in the client’s handwriting D. Appearance of frothy, foul-smelling stools 3. A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for: A. Malaise B. Stomatitis C. Hand tremors D. Weight loss 4. A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? Select all that apply. A. Range of motion every 4 hours B. Turn and reposition every 2 hours C. Abdominal and foot massages every 2 hours D. Alternating air pressure mattress E. Sit in chair for 30 minutes each shift 5. Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? Select all that apply. A. Assessing the client’s neurologic status every 2 hours B. Monitoring the client’s hemoglobin and hematocrit levels C. Evaluating the client’s serum ammonia level D. Monitoring the client’s handwriting daily E. Preparing to insert an esophageal tamponade tube MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 F. Making sure the client’s fingernails are short 6. Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be included in the care plan for the client? A. Administering vitamin K subcutaneously B. Applying pressure when giving I.M. injections C. Decreasing the client’s dietary protein intake D. Keeping the client’s fingernails short and smooth 7. Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client? A. “Jaundice is associated with pressure ulcer formation.” B. “Jaundice impairs urea production, which produces pruritus.” C. “Jaundice produces pruritus due to impaired bile acid excretion.” D. “Jaundice leads to decreased tissue perfusion and subsequent breakdown.” 8. Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is hemorrhaging? A. Allowing the client to help insert the tube B. Beginning teaching for home care C. Maintaining the client’s level of anxiety and alertness D. Obtaining cooperation and reducing fear 9. Which of the following measures should the nurse focus on for the client with esophageal varices? A. Recognizing hemorrhage B. Controlling blood pressure C. Encouraging nutritional intake D. Teaching the client about varices 10. The most important pathophysiologic factor contributing to the formation of esophageal varices is: A. Decreased prothrombin formation B. Decreased albumin formation by the liver C. Portal hypertension D. Increased central venous pressure SAS 13 1. When planning home care for a client with hepatitis A, which preventive measure MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 should be emphasized to protect the client’s family? A. Keeping the client in complete isolation B. Using good sanitation with dishes and shared bathrooms C. Avoiding contact with blood- soiled clothing or dressing D. Forbidding the sharing of needles or syringes 2. Which of the following will the nurse include in the care plan for a client hospitalized with viral hepatitis? A. Increase fluid intake to 3000 ml per day B. Adequate bed rest C. Bland diet D. Administer antibiotics as ordered 3. Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort? A. Give tepid baths. B. Avoid lotions and creams. C. Use hot water to increase vasodilation. D. Use cold water to decrease the itching. 4. You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? A. “Now I can never get hepatitis again.” B. “I can safely give blood after 3 months.” C. “I’ll never have a problem with my liver again, even if I drink alcohol.” D. “My family knows that if I get tired and start vomiting, I may be getting sick again.” 5. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? A. Elevated hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreased erythrocyte sedimentation rate 6. A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response? A. “You may have eaten contaminated restaurant food.” B. “You could have gotten it by using I.V. drugs.” C. “You must have received an infected blood transfusion.” D. “You probably got it by engaging in unprotected sex.” 7. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 intravascular fluid volume. 8. Which one of the following statements regarding pyogenic liver abscess is false? A. Biliary sepsis is the commonest source MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 B. Blood culture identifies the organism in 50% of cases C. Surgery is needed for drainage in loculated abscess D. Usually single abscess is seen 9. Which of the following assessment findings is expected to a patient with liver abscess? A. weight gain B. Liver atrophy C. Erythrocytosis D. Abdominal tenderness at RUQ 10.Which of the following not considered as appropriate management for a patient diagnosed with liver abscess? A. Monitor white blood cell count B. Administer IV antibiotic C. Meticulous skin care D. Open surgical drainage is the treatment of choice C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day 4. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? A. Serum creatinine and BUN B. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) C. Serum amylase and lipase D. Cardiac enzymes 5. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation? A. “It empties the stomach of fluids and gas.” B. “It prevents spasms at the sphincter of Oddi.” C. “It prevents air from forming in the small intestine and large intestine.” D. “It removes bile from the gallbladder.” 6. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? A. Calcium B. Glucose C. Magnesium D. Potassium 7. For Rico who has chronic pancreatitis, which nursing intervention would be most helpful? A. Allowing liberalized fluid intake SAS 16 1. When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? A. Transports fatty acids into the brush border B. Breaks down fat into fatty acids and glycerol C. Triggers cholecystokinin to contract the gallbladder D. Breaks down protein into dipeptides and amino acids 2. What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated blood urea nitrogen (BUN) B. Elevated serum lipase C. Elevated aspartate aminotransferase (AST) D. Increased lactate dehydrogenase (LD) 3. Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 SAS 17 1. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration 2. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respirations and an increase in pH D. Comatose state 3. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised. 4. A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor. 5. A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? A. Pulse B. BP C. Respiration D. Temperature 6. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. “The best time for me to exercise is every afternoon.” B. “The best time for me to exercise is right after I eat.” C. “The best time for me to exercise is after breakfast.” D. “The best time for me to exercise is after my morning snack.” 7. Glucose is an important molecule in a cell because this molecule is primarily used for: A. Extraction of energy B. Synthesis of protein C. Building of genetic material D. Formation of cell membranes. 8. When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide: A. Oxygen B. Carbohydrates C. Fluid replacement D. Dietary instruction 9. The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. B. Her appetite improves. C. She loses more than 10 lbs. D. Stools are less fatty and decreased in frequency. 9. To inhibit pancreatic secretions, which pharmacologic agent would you anticipate administering to a patient with chronic pancreatitis? A. Nitroglycerin B. Somatostatin C. Pancrelipase D. Pepcid 10. A clinical manifestation of chronic pancreatitis is epigastric pain. Your nursing intervention to facilitate relief of pain would place the patient in a: A. Knee-chest position B. Semi-Fowler’s position C. Recumbent position MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 C. Risk for injury related to decreased blood pressure D. Impaired skin integrity related to dehydration MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 11.A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs. B. It interacts with plasma membrane receptors to inhibit enzymatic actions. C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. D. It regulates the threshold for water resorption in the kidneys. 12.A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? A. “You must lie flat for 24 hours after surgery.” B. “You must avoid coughing, sneezing, and blowing your nose.” C. “You must restrict your fluid intake.” D. “You must report ringing in your ears immediately.” 13.A somatotropin-secreting tumor of which of the following glands would lead to the development of acromegaly, Cushing’s syndrome, and hypopituitarism? A. Adrenal gland B. Hypothalam us C. Pituitary gland D. Thyroid gland 14.Surgical management for large, invasive pituitary tumors is a transphenoidal hypophysectomy. The nurse would explain that the surgery will be performed through an incision in the: A. Nose B. Back of the mouth C. Sinus channel below the right eye D. Upper gingival mucosa in the space between the upper gums and lip MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 15.Initial treatment for a CSF leak after transphenoidal hypophysectomy would most likely involve: A. Repacking the nose. B. Returning the client to surgery. C. Enforcing bed rest with the head of the bed elevated. D. Administering high-dose corticosteroid therapy SAS 19 1. Nurse Oliver should expect a client with hypothyroidism to report which health concerns? A. Increased appetite and weight loss B. Puffiness of the face and hands C. Nervousness and tremors D. Thyroid gland swelling 2. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect? A. Dysuria B. Leg cramps C. Tachycard ia D. Blurred vision 3. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: A. Thyroid storm B. Cretinism C. Myxedema coma D. Hashimoto’s thyroiditis 4. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 SAS 20 1. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase should the nurse add? A. Related to bone demineralization resulting in pathologic fractures B. Related to exhaustion secondary to an accelerated metabolic rate C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces D. Related to tetany secondary to a decreased serum calcium level 2. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? A. Diabetes mellitus B. Diabetes insipidus C. Hypoparathyroidis m D. Hyperparathyroidis m 3. When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? A. Restricting fluids B. Restricting sodium C. Forcing fluids D. Restricting potassium 4. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C. Body image disturbance related to weight gain and edema D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 5. Which of the following laboratory results supports a diagnosis of primary hyperparathyroidism? A. High parathyroid hormone and high calcium levels B. High magnesium and high thyroid hormone levels C. Low parathyroid hormone and low potassium levels D. Low thyroid-stimulating hormone and high phosphorous levels 6. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? A. Muscle weakness B. Tremors C. Diaphoresis D. Constipation 7. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: A. Trousseau’s sign. B. Homans’ sign. C. Hegar’s sign. D. Goodell’s sign. 8. Nurse Wayne is aware that a positive Chvostek’s sign indicate? A. Hypocalcemia B. Hyponatremia C. Hypokalemia D. Hypermagnesemia 9. Hyperphosphatemia and hypocalcemia are indicative of which of the following disorders? A. Grave’s Disease B. Hypothyroidism C. Cushing’s Syndrome D. Hypoparathyroidi sm 10.Which of the following symptoms is the chief sign of hypoparathyroidism? A. Chest pain B. Exophthalmos C. Shortness of breath D. Tetany 11.Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 with Cushing’s syndrome, the nurse would expect to find: A. Hypotension. B. Thick, coarse skin. C. Deposits of adipose tissue in the trunk and dorsocervical area. D. Weight gain in arms and legs. 12.In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in: A. Serum glucose level. B. Hair loss. C. Bone mineralization. D. Menstrual flow. 13.A female client with Cushing’s syndrome is admitted to the medical- surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? A. Depression B. Neuropathy C. Hypoglycemia D. Hyperthyroidism 14.Which of the following nursing diagnoses is appropriate for a client with Cushing’s syndrome? A. Risk for infection B. Deficient fluid volume C. Acute pain with movement D. Functional urinary incontinence 15.A client has thin extremities but an obese truncal area and a “buffalo hump” at the shoulder area. The client also complains of weakness and disturbed sleep. Which of the following disorders is the most likely diagnosis? A. Addison’s disease B. Cushing’s syndrome C. Grave’s disease D. Hyperparathyroidism 16.Adrenal insufficiency develops secondary to inadequate secretion of which of the following pituitary hormones? A. Corticotropin B. Antidiuretic hormone (ADH) C. Follicle-stimulating hormone (FSH) D. Thyroid-stimulating hormone (TSH) 17.Laboratory findings indicating decreased levels of glucose and sodium and increased levels of potassium and white blood cells (WBC) would correlate with which diagnosis? A. Addison’s disease B. Cushing’s syndrome C. Diabetes mellitus D. Hypothyroidism 18.An appropriate nursing diagnosis for a client with Addison’s disease would include which of the following assessments? A. Risk for injury B. Excess fluid volume C. Impaired gas exchange D. Ineffective thermoregulation 19.Nursing care for a client with Addison’s disease may include which of the following goals? A. Limiting fluid intake to 100 mL/day. B. Participating in relaxation techniques. C. Ambulating in the hall five to six times per day. D. Knowing which high-sodium foods to avoid. 20.Which of the following outcomes are expected for a client being treated for Addison’s disease? A. Avoiding alcohol to decrease abdominal girth. B. Avoiding hot and uncomfortable environments.\ C. Reporting absence of postural hypotension symptoms. D. Selecting and eating foods high in protein, calcium, and vitamin D SAS 21 1. The nurse is assessing the motor function of an unconscious male client. The nurse would plan to use which plan to use which of the following to test the client’s peripheral response to pain? A. Sternal rub B. Nail bed pressure MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 PO daily. C. Teach patient about the need for good oral hygiene. D. Develop a discharge plan, including physician visits and referral to the Epilepsy Foundation. 8. Shortly after admission to an acute care facility, a male client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can the nurse administer the second dose of diazepam, if needed and prescribed? A. In 30 to 45 seconds B. In 10 to 15 minutes C. In 30 to 45 minutes D. In 1 to 2 hours 9. A male client is having tonic- clonic seizures. What should the nurse do first? A. Elevate the head of the bed. B. Restrain the client’s arms and legs. C. Place a tongue blade in the client’s mouth. D. Take measures to prevent injury. 10.The nurse is caring for the male client who begins to experience seizure activity while in bed. Which of the following actions by the nurse would be contraindicated? A. Loosening restrictive clothing B. Restraining the client’s limbs C. Removing the pillow and raising padded side rails D. Positioning the client to side, if possible, with the head flexed forward SAS 22 1. Regular oral hygiene is an essential intervention for the client who has had a stroke. Which of the following nursing measures is inappropriate when providing oral hygiene? A. Placing the client on the back with a small pillow under the head. B. Keeping portable suctioning equipment at the bedside. C. Opening the client’s mouth with a padded tongue blade. D. Cleaning the client’s mouth and teeth with a toothbrush. 2.A 78-year-old client is admitted to the emergency department with numbness and weakness of the left arm and slurred speech. Which nursing intervention is a priority? A. Prepare to administer recombinant tissue plasminogen activator (rt-PA). MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 B. Discuss the precipitating factors that caused the symptoms. C. Schedule for A STAT computer tomography (CT) scan of the head. D. Notify the speech pathologist for an emergency consult. 3. A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. Which is the priority nursing assessment? A. Current medications. B. Complete physical and history. C. Time of onset of current stroke. D. Upcoming surgical procedures. 4. During the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to control the client’s: A. Pulse B. Respirations C. Bloo d pressure D. Temperature 5. What is a priority nursing assessment in the first 24 hours after admission of the client with a thrombotic stroke? A. Cholestero l level B. Pupi l size and pupillary response C. Bowel sounds D. Echocardiogram 6. Which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke? A. A blood glucose level of 480 mg/dl. B. A right-sided carotid bruit. C. A blood pressur e of 220/120 mmHg. D. The presence of bronchogenic carcinoma. 7. A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances? A. Vomiting continues B. Intracranial pressure (ICP) is increased C. The client needs mechanical ventilation D. Blood is anticipated in the cerebrospinal fluid (CSF) 8.A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 A. To reduce intraocular pressure B. To prevent acute tubular necrosis C. To promote osmotic diuresis to decrease ICP D. To draw water into the vascular system to increase blood pressure 9. A female client who’s paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety. Which behavior indicates that the client accurately understands safety measures related to paralysis? A. The client leaves the side rails down. B. The client uses a mirror to inspect the skin. C. The client repositions only after being reminded to do so. D. The client hangs the left arm over the side of the wheelchair. 10. During recovery from a cerebrovascular accident (CVA), a female client is given nothing by mouth, to help prevent aspiration. To determine when the client is ready for a liquid diet, the nurse assesses the client’s swallowing ability once each shift. This assessment evaluates: A. Cranial nerves I and II. B. Cranial nerves III and V. C. Cranial nerves VI and VIII. D. Cranial nerves IX and X. SAS 23 1.A male client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure client to ensure client safety? A. Speak loudly to the client B. Test the temperature of the shower water C. Check the temperature of the food on the delivery tray. D. Provide a clear path for ambulation without obstacles 2. An 18-year-old client is admitted with a closed head injury sustained in a MVA. His intracranial pressure (ICP) shows an upward trend. Which intervention should the nurse perform first? A. Reposition the client to avoid neck flexion B. Administer 1 g Mannitol IV as ordered C. Increase the ventilator’s respiratory rate to 20 breaths/minute MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 C. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics D. Maintain neutropenic precautions 3. Which of the following assessment data indicated nuchal rigidity? A. Positive Kernig’s sign B. Negative Brudzinski’s sign C. Positive homan’s sign D. Negative Kernig’s sign 4. Which of the following are considered as the initial symptoms of HSV-1 encephalitis? Select all that apply. A.Confusion B.Seizure C.Headache D.Behavioral changes E.Fever 5. All of the following are considered as preventive measures against arboviral encephalitis, EXCEPT: A.Encourage clothing that provides coverage. B.Apply insect repellents on exposed skin. C.Use of screens at home D.Advise flower vase with water at home to get rid of mosquitos. 6. Which of the following is the treatment of choice for fungal encephalitis? A.Amphotericin B B.Interferon C.Ribavirin D.Acyclovir 7.The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find? A. Vision changes B. Absent deep tendon reflexes C. Tremors at rest D. Flaccid muscles 8. The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to: A. Take a hot bath. B. Rest in an air-conditioned room. C. Increase the dose of muscle relaxants. D. Avoid naps during the day. 9.Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)? A.Double vision B.Sudden burst of energy C.Weakness in the extremitie D.Muscle tremors 10. A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine? A. Ulcerative colitis B. Blood dyscrasia C. Intestinal obstruction D. Spinal cord injury 11. A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: A. Getting too little exercise B. Taking excess medication C. Omitting doses of medication D. Increasing intake of fatty foods 12. The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: A. Eating large, well-balanced meals B. Doing muscle-strengthening exercises C. Doing all chores early in the day while less fatigued D. Taking medications on time to maintain therapeutic bloo d levels 13. A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation . When the MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 client asks the nurse about the paralysis, how should the nurse respond? A. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.” B. “You’ll have to accept the fact that you’re permanently paralyzed. However, you won’t have any sensory loss.” C. “It must be hard to accept the permanency of your paralysis.” D. “You’ll first regain use of your legs and then your arms.” 14. A female client is admitted to the hospital with a diagnosis of Guillain- Barre syndrome. The nurse inquires during the nursing admission interview if the client has a history of: A. Seizures or trauma to the brain B. Meningitis during the last five (5 years C. Back injury or trauma to the spinal cord D. Respiratory or gastrointestinal infection during the previous month. 15. A female client with Guillain-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness? A. Giving client full control over care decisions and restricting visitors. B. Providing positive feedback and encouraging active range of motion. C. Providing information, giving positive feedback and encouraging relaxation . D. Providing intravenously administered sedatives, reducing distractions and limiting visitors. SAS 25 1. Tic douloureux is characterized by paroxysms of pain and burning sensations. It is a disorder of which cranial nerve? A.Third B.Fifth C.Sevent h D.Eighth 2. Which of the following drugs is used for trigeminal neuralgia? Riluzole (Rilutek) A.Levodopa (Larodopa) B.Carbamazepine (Tegretol) C.Ceftriaxone D. sodium (Rocephin) 3. A male client with Bell’s Palsy asks the nurse what has caused this problem. The nurse’s response is based on an understanding that the cause is: A. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem B. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia C. Primary genetic in origin, triggered by exposure to meningitis D. Primarily genetic in origin, triggered by exposure to neurotoxins 4. The nurse has given the male client with Bell’s palsy instructions on preserving muscle tone in the face and preventing denervation. The nurse determines that the client needs additional information if the client states that he or she will: A. Exposure to cold and drafts B. Massage the face with a gentle upward motion C. Perform facial exercises D. Wrinkle the forehead, blow out the cheeks, and whistle 5.The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? Select all that apply. A. Head tilt B. Vomiting C. Polydipsia D. Lethargy E. Increased appetite F. Increased pulse 6. A female client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test? A. Immobilize the neck before the client is moved onto a stretcher. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 B. Determine whether the client is allergic to iodine, contrast dyes, or shellfish. C. Place a cap on the client’s head. D. Administer a sedative as ordered. MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 A. Instilling one drop of pilocarpine 0.25% into both eyes daily. B. Instilling one drop of pilocarpine 0.25% into both eyes four times daily. C. Instilling one drop of pilocarpine 0.25% into the right eye daily. D. Instilling one drop of pilocarpine 0.25% into the left eye four times daily. 6.The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is: A. “Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. B. “Your vision will return as soon as the medications begin to work.” C. “Your vision will never return to normal.” D. “Your vision loss is temporary and will return in about 3-4 weeks.” 7.The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? A. Decrease fluid intake to control the intraocular pressure B. Avoid overuse of the eyes C. Decrease the amount of salt in the diet D. Eye medications will need to be administered lifelong. 8.The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: A. Eye pain B. Floating spots C. Blurred vision D. Diplopia 9.The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions? A. “I will take Aspirin if I have any discomfort.” B. “I will sleep on the side that I was operated on.” C. “I will wear my eye shield at night and my glasses during the day.” D. “I will not lift anything if it weighs more that 10 pounds.” 10. A male client has just had a cataract operation without a lens implant. In MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 discharge teaching, the nurse will instruct the client’s wife to: A. Feed him soft foods for several days to prevent facial movement B. Keep the eye dressing on for one week C. Have her husband remain in bed for 3 days D. Allow him to walk upstairs only with assistance. 11. When obtaining the health history from a male client with retinal detachment, the nurse expects the client to report: A. Light flashes and floaters in front of the eye. B. A recent driving accident while changing lanes. C. Headaches, nausea, and redness of the eyes. D. Frequent episodes of double vision. 12. After pneumatic retinopexy, the patient must be placed in: A.Side-lying position B.Prone position C.Trendelenburg position D.Recumbent position 13. The most common cause of visual loss in people older than 60 years of age is: A.Macular degeneration B.Ocular trauma C.Retinal detachment D.Conjunctivitis 14. The most common manifestation in dry eye syndrome is: A. Excessive mucus secretions B. Difficulty moving the lids C. Burning sensation D. Scratchy or foreign body sensation MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 15.Acute bacterial conjunctivitis is characterized by: A.Painless blurry vision B.Elevated intraocular pressure C.A mucopurulent ocular discharge SAS 27 1. The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test? A. Stand 4 feet away from the client to ensure that the client can hear at this distance. B. Whisper a statement and ask the client to repeat it. C. Whisper a statement with the examiners back facing the client D. Whisper a statement while the client blocks both ears. 2. During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as: A. A normal finding B. A conductive hearing loss in the right ear C. A sensorineural or conductive loss D. The presence of nystagmus 3. The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate communication? A. Speak frequently B. Speak loudly C. Speak directly into the impaired ear D. Speak in a normal tone 4. The nurse has notes that the physician has a diagnosis of presbycusis on the client’s chart. The nurse plans care knowing the condition is: A. A sensorineural hearing loss that occurs with aging B. A conductive hearing loss that occurs with aging. C. Tinnitus that occurs with aging D. Nystagmus that occurs with aging MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 possible Ménière’s disease. When assessing this client, the nurse expects to note: A. Vertigo, tinnitus, and hearing loss. B. Vertigo, vomiting, and nystagmus C. Vertigo, pain, and hearing impairment. D. Vertigo, blurred vision, and fever. 15.A client with Meniere’s disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo? A. Increase fluid intake to 3000 ml a day B. Avoid sudden head movements C. Lie still and watch the television D. Increase sodium in the diet 16.The nurse is reviewing the physician’s orders for a client with Meniere’s disease. Which diet will most likely be prescribed? A. Low-cholesterol diet B. Low-sodiu m diet C. Low-carbohydrate diet D. Low-fat diet 17.Canalith repositioning is performed to patients with benign paroxysmal positional vertigo to: A.Relieve nausea and vomiting B.Treat vertigo C.Enhance disequilibrium D.Suppress vestibular function 18.A client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear? A. Hearing loss B. Prurit us C. Tinnitus D. Burning of the ear 19.A client who is complaining of tinnitus is describing a symptom that is: A. Objective B. Subjective C. Functional D. Prodromal MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 20.An acoustic neuroma is a benign tumor of which cranial nerve? D.Fluids provide a cushion for weakened bones. SAS 28 A.Fifth B.Sixth C.Sevent h D.Eighth 5. Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? A. Take the medication in the morning with meals. B. Take the medication 2 hours before bedtime. C. Take the medication with a glass of water after rising in the morning. D. Take the medication during lunch. 1. A client with osteoarthritis has a prescription for Celebrex (celecoxib). Which instruction should be included in the discharge teaching? A. Take the medication with milk. B. Report chest pain . C. Remain upright after taking for 30 minutes. D. Allow 6 weeks for optimal effects. 2. Pathophysiologic changes seen with osteoarthritis include: A. Joint cartilage degeneration. B. The formation of bony spurs at the edges of the joint surfaces. C. Narrowing of the joint space. D. All of the above. 3.Aclient has been prescribed a diet that limits purine-rich foods. Which of the following foods would the nurse teach him to avoid eating? A.Bananas and dried fruits B.Milk, ice cream, and yogurt C.Wine, cheese, preserved fruits, meats, and vegetables D.Anchovies, sardines, kidneys, sweetbreads, and lentils 4.Aclient with gout is encouraged to increase fluid intake. Which of the following statements best explains why increased fluids are encouraged for gout? A.Fluids decrease inflammation. B.Fluids increase calcium absorption. C.Fluids promote the excretion of uric acid. 6.The nurse knows that a 60-year-old female client’s susceptibility to osteoporosis is most likely related to: A. Lack of exercise B. Hormonal disturbances C. Lack of calcium D. Genetic predisposition 7. The most common symptoms of osteomalacia are: A.Bone fractures and kyphosis B.Bone pain and tenderness C.Muscle weakness and spasm D.Softened and compressed vertebrae 8. Which of the following dietary management is recommended to patient with osteomalacia associated with diet? A.Adequate calcium and low protein intake B.Adequate protein and moderate vitamin intake C.Restrict calcium and vitamin D intake D.Increase calcium and vitamin D intake MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 9. Which of the following medications used in Paget’s disease which facilitates remodeling of abnormal bone? A.Plicamycin B.Calcitonin C.Dexamethaso ne D.Atropine sulfate 10.Which of the following diagnostic tests confirms Paget’s disease? D.Arthroscopy 4.Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as: A. sarcoma. B. lymphoma. C. carcinoma. D. melanoma. 5. For a client diagnosed with Ewing’s sarcoma, which test is most useful in determining the extent of metastasis? SAS 29 A.X-ray B.Bone scan C. Bone biopsy D. Serum alkaline phosphate A.Bone scan B.Computerized tomography (CT) scan C.Magnetic resonance imaging (MRI) D.Positron emission tomography (PET) 1.A 20-year-old client developed osteomyelitis 2 weeks after a fishhook was removed from his foot. Which of the following rationales best explains the expected long-term antibiotic therapy needed? A.Bone has poor circulation. B.Tissue trauma requires antibiotics. C.Feet are normally more difficult to treat. D.Fishhook injuries are highly contaminated. 2. Osteomyelitis most commonly results from which of the following mechanisms? A.Immune suppression B.IV drug use C.Surgery D.Trauma 3. Which of the following is the primary treatment of septic arthritis? A.Aspiration of joint fluid B.Arhtrotomy C.Antibiotics 6. Nursing interventions to treat a musculoskeletal injury may include cold or heat therapy. Cold therapy decreases pain by which of the following actions? A.Promotes analgesia and circulation B.Numbs the nerves and dilates the vessels C.Promotes circulation and reduces muscle spasms D.Causes local vasoconstriction and prevents edema or muscle spasm 7. Management for a patient with sprain includes RICE? Which of the following is the correct meaning of RICE? A.Rise, Ice, Compression, and Elevation MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 Vitamin D is important in the healing of fractures for which of the following reasons? It reduces the excretion of calcium and phosphorus. It increases the excretion of calcium and phosphorus. It reduces the absorption and use of calcium and phosphorus. It increases the absorption and use of calcium and phosphorus. At the scene of an accident, which of the following interventions applies to a client with a suspected fracture? Don’t move the client. Move the client to safety immediately. Sit the client up to facilitate his airway. Immobilize the extremity, and move the client to safety. Which of the following symptoms is an early sign of compartment syndrome? Heat Treatment of compartment syndrome includes which of the following measures? Amputati on Casting Fasciotom y Observation, no treatment is necessary Which of the following areas would be included in a neurovascular assessment? Orientation, movement, pulses, warmth Capillary refill, movement, pulses, warmth Orientation, pupillary response, temperature, pulses Respiratory pattern, orientation, pulses, temperature Paresthesi a Skin pallor Swelling MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 EXTRA DAILY QUIZ 16 & 17 For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? * They contain exudate and provide a moist wound environment. They protect the wound from mechanical trauma and promote healing. They debride the wound and promote healing by secondary intention. They prevent the entrance of microorganisms and minimize wound discomfort. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? * A. There is no skin breakdown. B. Her appetite improves. C. She loses more than 10 lbs. D. Stools are less fatty and decreased in frequency. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, respirations 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation? * A. “It empties the stomach of fluids and gas.” B. “It prevents spasms at the sphincter of Oddi.” C. “It prevents air from forming in the small intestine and large intestine.” D. “It removes bile from the gallbladder.” Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? * A. Administration of vasopressin and insertion of a balloon tamponade B. Preparation for a paracentesis and administration of diuretics C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day The nurse enters a diabetic patient’s room at 11:30 and notices that the patient is diaphoretic, tachycardic, anxious, states she is hungry, and doesn’t remember where she MED_SURG_P1_P2_THIRD_YR_LAST_YEAR_PART_1 COMPLETE QUESTIONS & ANSWERS UPDATED 2024 is. This patient is most likely showing signs of what? * hyperglycemic hypoglycemic diabetic ketoacidosis hyperosmolar hyperglycemic noketotic coma At a senior citizens meeting a nurse talks with a client who has diabetes mellitus Type 1. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity? * “I give my insulin to myself in my thighs.” “Sometimes when I put my shoes on I don’t know where my toes are.” “Here are my up and down glucose readings that I wrote on my calendar.” “If I bathe more than once a week my skin feels too dry.” A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? * “You’ll need more insulin when you exercise or increase your food intake.” “You’ll need less insulin when you exercise or reduce your food intake.” “You’ll need less insulin when you increase your food intake.” “You’ll need more insulin when you exercise or decrease your food intake.” Nurse Alvin is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light- headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: * I.M. or subcutaneous glucagon. I.V. bolus of dextrose 50%. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 10 U of fast-acting insulin. A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: * A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor. The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. * A. Thirst B. Palpitation s C. Diaphoresis D. Slurred speech E. Hyperventilation A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia