Med SURG Practice Exam Questions with Answers Tested and Verified Solutions with Latest Up, Exams of Nursing

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Med SURG Practice Exam Questions with Answers

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Questions

□ The nurse is assessing a client's laboratory values following administration of chemotherapy. Which lab value leads the nurse to suspect that the client is experiencing tumor lysis syndrome (TLS)? A Serum PTT of 10 seconds. B Serum calcium of 5 mg/dl. Correct C Oxygen saturation of 90%. D Hemoglobin of 10 g/dl. □ TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatemia. A serum calcium level of 5 (B), which is low, is an indicator of possible tumor lysis syndrome. (A, C, and D) are not particularly related to TLS. Awarded 0.0 points out of 1.0 possible points. □ 2.ID: 6974889585 A client is admitted to the hospital with a diagnosis of severe acute diverticulitis. Which assessment finding should the nurse expect this client to exhibit? A Lower left quadrant pain and a low-grade fever. Correct B Severe pain at McBurney's point and nausea. C Abdominal pain and intermittent tenesmus. D Exacerbations of severe diarrhea. □ Left lower quadrant pain occurs with diverticulitis because the sigmoid colon is the most common area for diverticula, and the inflammation of diverticula causes a low- grade fever (A). (B) would be indicative of appendicitis. (C and D) are symptoms exhibited with ulcerative colitis. Awarded 0.0 points out of 1.0 possible points. □ 3.ID: 6974891763 During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not moving. What action should the nurse take first? A Use a laryngoscope to check for a foreign body lodged in the esophagus. B Reposition the head to validate that the head is in the proper position to open the airway. Correct

C Turn the client to the side and administer three back blows. D Perform a finger sweep of the mouth to remove any vomitus. □ The most frequent cause of inadequate aeration of the

client's lungs during CPR is improper positioning of the head resulting in occlusion of the airway (B). A foreign body can occlude the airway, but this is not common unless choking preceded the cardiac emergency, and (A, C and D) should not be the nurse's first action. Awarded 0.0 points out of 1. possible points. □ 4.ID: 6974891794 A client is admitted to the hospital with a medical diagnosis of pneumococcal pneumonia. The nurse knows that the prognosis for gram-negative pneumonias (such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor because A they occur in the lower lobe alveoli which are more sensitive to infection. B gram-negative organisms are more resistant to antibiotic therapy. Correct C they occur in healthy young adults who have recently been debilitated by an upper respiratory infection. D gram-negative pneumonias usually affect infants and small children. □ The gram-negative organisms are resistant to drug therapy (B) which makes recovery very difficult. Gram- negative pneumonias affect all lobes of the lung (A). The mean age for contracting this type of pneumonia is 50 years (C and D), and it usually strikes debilitated persons such as alcoholics, diabetics, and those with chronic lung diseases. Awarded 0.0 points out of 1.0 possible points. □ 5.ID: 6974891705 A client is placed on a mechanical ventilator following a cerebral hemorrhage, and vecuronium bromide (Norcuron) 0.04 mg/kg q12 hours IV is prescribed. What is the priority nursing diagnosis for this client? A Impaired communication related to paralysis of skeletal muscles. Correct B High risk for infection related to increased intracranial pressure. C Potential for injury related to impaired lung expansion. D Social isolation related to inability to communicate.

□ To increase the client's tolerance of endotracheal intubation and/or mechanical ventilation, a skeletal- muscle relaxant, such as vecuronium, is usually prescribed. Impaired

communication (A) is a serious outcome because the client cannot communicate his/her needs due to intubation and diaphragmatic paralysis caused by the drug. Although this client might also experience (D), it is not a priority when compared to (A). Infection is not related to increased intracranial pressure (B). The mechanical venilator provides consistent lung expansion (C). Awarded 0.0 points out of 1.0 possible points. □ 6.ID: 6974890435 When preparing a client who has had a total laryngectomy for discharge, what instruction is most important for the nurse to include in the discharge teaching? A Recommend that the client carry suction equipment at all times. B Instruct the client to have writing materials with him at all times. C Tell the client to carry a medic alert card stating that he is a total neck breather. Correct D Tell the client not to travel alone. □ It is imperative that total neck breathers carry a medic alert notice (C) so that if they have a cardiac arrest, mouth- to-neck breathing can be done. Mouth- to-mouth resuscitation will not help them. They do not need to carry (A) nor refrain from (D). There are many alternative means of communication for clients who have had a laryngectomy; depending on (B) is probably the least effective. How do you know he can read and write? Awarded 0.0 points out of 1.0 possible points. □ 7.ID: 6974891729 The nurse would be correct in withholding a dose of digoxin in a client with congestive heart failure without specific instruction from the healthcare provider if the client's A serum digoxin level is 1.5. B blood pressure is 104/68. C serum potassium level is 3. Correct D apical pulse is 68/min. □ Hypokalemia (C) can precipitate digitalis toxicity in persons receiving digoxin which will increase the chance of dangerous dysrhythmias (normal potassium level is 3.5 to

5.5 mEq/L). The therapeutic range for digoxin is 0.8 to 2 ng/ml (toxic levels=>2 ng/ml); (A) is within this range. (B) would not warrant the nurse withholding the digoxin. The nurse should withhold the digoxin if the apical pulse is less than 60/min (D). Awarded 0. points out of 1.0 possible points. □ 8.ID: 6974890473 After the fourth dose of gentamicin sulfate (Garamycin) IV, the nurse plans to draw blood samples to determine peak and trough levels. When are the best times to draw these samples? A 15 minutes before and 15 minutes after the next dose. B One hour before and one hour after the next dose. C 5 minutes before and 30 minutes after the next dose. Correct D 30 minutes before and 30 minutes after the next dose. □ Peak drug serum levels are achieved 30 minutes after IV administration of aminoglycosides. The best time to draw a trough is the closest time to the next administration (C). (A, B, and D) are not as good a time to draw the trough as (C). (B and D) are not the best times to draw the peak of an aminoglycoside that has been administered IV. Awarded 0.0 points out of 1.0 possible points. □ 9.ID: 6974891711 A client has undergone insertion of a permanent pacemaker. When developing a discharge teaching plan, the nurse writes a goal of, "The client will verbalize symptoms of pacemaker failure." Which symptoms are most important to teach the client? A Facial flushing. B Fever. C Pounding headache. D Feelings of dizziness. Correct □ Feelings of dizziness (D) may occur as the result of a decreased heart rate, leading to decreased cardiac output. (A and C) will not occur as the result of pacemaker failure. (B) may be an indication of infection postoperatively, but is not an indication of pacemaker failure. Awarded 0.0 points out of 1.0 possible points.

□ 10.ID: 6974890487 A client with heart disease is on a continuous telemetry monitor and has developed sinus bradycardia. In determining the possible cause of the

bradycardia, the nurse assesses the client's medication record. Which medication is most likely the cause of the bradycardia? A Propanolol (Inderal). Correct B Captopril (Capoten). C Furosemide (Lasix). D Dobutamine (Dobutrex). □ Inderal (A) is a beta adrenergic blocking agent, which causes decreased heart rate and decreased contractility. Neither (B), an ACE inhibitor, nor (C), a loop diuretic, causes bradycardia. (D) is a sympathomimetic, direct acting cardiac stimulant, which would increase the heart rate. Awarded 0.0 points out of 1.0 possible points. □ 11.ID: 6974890493 In preparing a discharge plan for a 22- year-old male client diagnosed with Buerger's disease (thromboangiitis obliterans), which referral is most important? A Genetic counseling. B Twelve-step recovery program. C Clinical nutritionist. D Smoking cessation program. Correct □ Buerger's disease is strongly related to smoking. The most effective means of controlling symptoms and disease progression is through smoking cessation (D). The cause of Buerger's disease is unknown; a genetic predisposition is possible, but (A) will not be of value. The client with Buerger's disease does not need referral to a 12-step program any more than the general population (B). Diet is not a significant factor in the disease, and general healthy diet guidelines can be provided by the nurse (C). Awarded 0.0 points out of 1.0 possible points. □ 12.ID: 6974894214Which symptoms should the nurse expect a client to exhibit who is diagnosed with a pheochromocytoma? A Numbness, tingling, and cramps in the extremities. B Headache, diaphoresis, and palpitations. Correct C Cyanosis, fever, and classic signs of shock. D Nausea, vomiting, and muscular

weakness. □ Pheochromocytoma is a catecholamine secreting tumor

of the adrenal medulla, and (B) is the typical triad of symptoms depending upon the relative proportions of epinephrine and norepinephrine secretion. (A) lists the signs of latent tetany, exhibited by clients diagnosed with hypoparathyroidism. (C) lists the signs of an Addisonian (adrenal) crisis. (D) lists the signs of hyperparathyroidism. Awarded 0.0 points out of 1.0 possible points. □ 13.ID: 6974890477 In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the laboratory test results to indicate a decreased serum level of which substance? A Sodium. B Antidiuretic hormone. C Potassium. Correct D Glucose. □ Clients with primary aldosteronism exhibit a profound decline in the serum levels of potassium (C) (hypokalemia)-- hypertension is the most prominent and universal sign. (A) is normal or elevated, depending on the amount of water reabsorbed with the sodium. (B) is decreased with diabetes insipidus. (D) is not affected by primary aldosteronism. Awarded 0.0 points out of 1.0 possible points. □ 14.ID: 6974891771 A middle-aged male client with diabetes continues to eat an abundance of foods that are high in sugar and fat. According to the Health Belief Model, which event is most likely to increase the client's willingness to become compliant with the prescribed diet? A He visits his diabetic brother who just had surgery to amputate an infected foot. Correct B He is provided with the most current information about the dangers of untreated diabetes. C He comments on the community service announcements about preventing complications associated with diabetes. D His wife expresses a sincere willingness to prepare meals that are within his prescribed diet. □ The loss of a limb by a family member (A) will be the strongest event or "cue to action" and is most likely to increase the perceived seriousness of the disease. (B, C, and D) may influence his behavior but

do not have the personal

impact of (A). Awarded 0.0 points out of 1.0 possible points. □ 15.ID: 6974891774 The nurse is taking a history of a newly diagnosed Type 2 diabetic who is beginning treatment. Which subjective information is most important for the nurse to note? A A history of obesity. B An allergy to sulfa drugs. Correct C Cessation of smoking three years ago. D Numbness in the soles of the feet. □ An allergy to sulfa drugs may make the client unable to use some of the most common antihyperglycemic agents (sulfonylureas). The nurse needs to highlight this allergy for the healthcare provider. (A) is common and warrants counseling, but does not have the importance of (B). (C) does increase the risk for vascular disease, but it is not as important to the treatment regimen as (B). Diabetic neuropathy, as indicated by (D), is common with diabetics, but when the serum glucose is decreased, new onset numbness can possibly improve. Awarded 0.0 points out of 1.0 possible points. □ 16.ID: 6974890475 A client with cirrhosis develops increasing pedal edema and ascites. What dietary modification is most important for the nurse to teach this client? A Avoid high carbohydrate foods. B Decrease intake of fat soluble vitamins. C Decrease caloric intake. D Restrict salt and fluid intake. Correct □ Salt and fluid restrictions are the first dietary modifications for a client who is retaining fluid as manifested by edema and ascites (D). (A, B, and C) will not impact fluid retention. Awarded 0.0 points out of 1.0 possible points. □ 17.ID: 6974894204 A female client receiving IV vasopressin (Pitressin) for esophageal varice rupture reports to the nurse that she feels substernal tightness and pressure across her chest. Which PRN protocol should the nurse initiate? A Start an IV nitroglycerin infusion. Correct

B Nasogastric lavage with cool saline.

C Increase the vasopressin infusion. D Prepare for endotracheal intubation. □ Vasopressin is used to promote vasoconstriction, thereby reducing bleeding. Vasoconstriction of the coronary arteries can lead to angina and myocardial infarction, and should be counteracted by IV nitroglycerin per prescribed protocol (A). (B) will not resolve the cardiac problem. (C) will worsen the problem. Endotracheal intubation may be needed if respiratory distress occurs (D). Awarded 0.0 points out of 1.0 possible points. □ 18.ID: 6974890412A client who is HIV positive asks the nurse, "How will I know when I have AIDS?" Which response is best for the nurse to provide? A "Diagnosis of AIDS is made when you have 2 positive ELISA test results." B "Diagnosis is made when both the ELISA and the Western Blot tests are positive." C "I can tell that you are afraid of being diagnosed with AIDS. Would you like for me to call your minister?" D "AIDS is diagnosed when a specific opportunistic infection is found in an otherwise healthy individual." Correct □ AIDS is diagnosed when one of several processes defined by the CDC is present in an individual who is not otherwise immunosuppressed (D) (PCP, candidacies, cryptococcus, cryptosporidiosis, Kaposi’s sarcoma, CNS lymphomas). (A and B) identify the presence of HIV, indicating a high probability that in time the individual will develop AIDS, but do not necessarily denote the presence of AIDS. (C) is telling the client how he/she feels (afraid) and is dismissing the situation to the minister. This client is asking a question and specific medical information needs to be provided. Awarded 0.0 points out of 1.0 possible points. □ 19.ID: 6974891751 Which description of symptoms is characteristic of a client diagnosed with trigeminal neuralgia (tic douloureux)? A Tinnitus, vertigo, and hearing difficulties. B Sudden, stabbing, severe pain over the lip and chin.

Correct C Facial weakness and paralysis. D Difficulty in chewing, talking, and swallowing.

□ Trigeminal neuralgia is characterized by paroxysms of pain, similar to an electric shock, in the area innervated by one or more branches of the trigeminal nerve (5th cranial) (B). (A) would be characteristic of M ni re's disease (8th cranial nerve). (C) would be characteristic of Bell's palsy (7th cranial nerve). (D) would be characteristic of disorders of the hypoglossal cranial nerve (12th). Awarded 0.0 points out of 1.0 possible points. □ 20.ID: 6974890459 Which intervention should the nurse plan to implement when caring for a client who has just undergone a right above-the-knee amputation? A Maintain the residual limb on three pillows at all times. B Place a large tourniquet at the client's bedside. Correct C Apply constant, direct pressure to the residual limb. D Do not allow the client to lie in the prone position. □ A large tourniquet should be placed in plain sight at the client's bedside (B). If severe bleeding occurs, the tourniquet should be readily available and applied to the residual limb to control hemorrhage. The residual limb should not be placed on a pillow (A) because a flexion contracture of the hip may result. (C) should be avoided because it may compromise wound healing. (D) should be encouraged to stretch the flexor muscles and to prevent flexion contracture of the hip. Awarded 0.0 points out of 1.0 possible points. □ 21.ID: 6974891796 The nurse is assessing a client who has a history of Parkinson's disease for the past 5 years. What symptoms would this client most likely exhibit? A Loss of short-term memory, facial tics and grimaces, and constant writhing movements. B Shuffling gait, masklike facial expression, and tremors of the head. Correct C Extreme muscular weakness, easy fatigability, and ptosis. D Numbness of the extremities, loss of balance, and visual disturbances. □ (B) are common clinical features of Parkinsonism.

(A) are symptoms of chorea, (C) of myasthenia gravis, and (D) of multiple sclerosis. Awarded 0.0 points out of 1.0 possible points. □ 22.ID: 6974891790 The nurse is completing an admission

interview and assessment on a client with a history of Parkinson's disease. Which question provides information relevant to the client's plan of care? A "Have you ever experienced any paralysis of your arms or legs?" B "Have you ever sustained a severe head injury?" C "Have you ever been 'frozen' in one spot, unable to move?" Correct D "Do you have headaches, especially ones with throbbing pain?" □ Clients with Parkinson's disease frequently experience difficulty in initiating, maintaining, and performing motor activities. They may even experience being rooted to the spot and unable to move (C). Parkinson's disease does not cause (A). Parkinson's disease is not usually associated with (B), nor does it typically cause (D). Awarded 0.0 points out of 1.0 possible points. □ 23.ID: 6974890479 The nurse is interviewing a male client with hypertension. Which additional medical diagnosis in the client's history presents the greatest risk for developing a cerebral vascular accident (CVA)? A Diabetes mellitus. Correct B Hypothyroidism. C Parkinson's disease. D Recurring pneumonia. □ A history of diabetes mellitus poses the greatest risk for developing a CVA (A). (B, C, and D) may place the client at some risk due to immobility, but do not present a risk as great as (A). Awarded 0.0 points out of 1.0 possible points. □ 24.ID: 6974890485 The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two hours is dated two years ago. The client reports that he has a history of "heart trouble," but has no problems at present. Hospital protocol requires that those over 50 years of age have a recent ECG prior to surgery. What nursing action is best for the nurse to implement? A Ask the client what he means by "heart trouble." B Call for an ECG to be performed immediately. Correct

C Notify surgery that the ECG is over two years old.

D Notify the client's surgeon immediately. □ Clients over the age of 40 and/or with a history of cardiovascular disease, should receive ECG evaluation prior to surgery, generally 24 hours to two weeks before. (B) should be implemented to ensure that the client's current cardiovascular status is stable. Additional data might be valuable (A), but since time is limited, the priority is to obtain the needed ECG. Documentation of vital signs is important, but does not replace the need for the ECG (C). The surgeon only needs to be notified if the ECG cannot be completed, or if there is a significant problem (D). Awarded 0. points out of 1.0 possible points. □ 25.ID: 6974889581 The nurse is receiving report from surgery about a client with a penrose drain who is to be admitted to the postoperative unit. Before choosing a room for this client, which information is most important for the nurse to obtain? A If suctioning will be needed for drainage of the wound. B If the family would prefer a private or semi-private room. C null D If the client's wound is infected. Correct □ Penrose drains provide a sinus tract or opening and are often used to provide drainage of an abscess. The fact that the client has a penrose drain should alert the nurse to the possibility that the client is infected. To avoid contamination of another postoperative client, it is most important to place an infected client in a private room (D). A penrose drain does not require (A). Although (B) is information that should be considered, it does not have the priority of (D). (C) is used to drain fluid from a dead space and is not important in choosing a room. Awarded 0.0 points out of 1.0 possible points. □ 26.ID: 6974890481 What is the correct procedure for performing an ophthalmoscopic examination on a client's right retina? A Instruct the client to look at examiner's nose and not move his/her eyes during the exam. B Set ophthalmoscope on the plus 2 to 3 lens and hold it in front of the examiner's right eye.

C From a distance of 8 to 12 inches and slightly to the side, shine the light into the client's pupil. Correct D For optimum visualization, keep the ophthalmoscope at least 3 inches from the client's eye. □ The client should focus on a distant object in order to promote pupil dilation. The ophthalmoscope should be set on the 0 lens to begin (creates no correction at the beginning of the exam), and should be held in front of the examiner's left eye when examining the client's right eye. For optimum visualization, the ophthalmoscope should be kept within one to three inch of the client's eye (D). (A and B) describe incorrect methods for conducting an ophthalmoscopic examination. (C) should illicit a red reflex as the light travels through the crystalline lens to the retina. Awarded 0.0 points out of 1.0 possible points. □ 27.ID: 6974891731During lung assessment, the nurse places a stethoscope on a client's chest and instructs him/her to say "99" each time the chest is touched with the stethoscope. What would be the correct interpretation if the nurse hears the spoken words "99" very clearly through the stethoscope? A This is a normal auscultatory finding. B May indicate pneumothorax. C May indicate pneumonia. Correct D May indicate severe emphysema. □ This test (whispered pectoriloquy) demonstrates hyperresonance and helps determine the clarity with which spoken words are heard upon auscultation. Normally, the spoken word is not well transmitted through lung tissue, and is heard as a muffled or unclear transmission of the spoken word. Increased clarity of a spoken word is indicative of some sort of consolidation process (e. g., tumor, pneumonia) (C), and is not a normal finding (A). When lung tissue is filled with more air than normal, the voice sounds are absent or very diminished (e. g., pneumothorax, severe emphysema) (B and D). Awarded 0.0 points out of 1.0 possible points. □ 28.ID: 6974890425 A client has taken steroids for 12 years to help manage chronic obstructive pulmonary disease (COPD). When making a home

visit, which nursing function is

of greatest importance to this client? Assess the client's A pulse rate, both apically and radially. B blood pressure, both standing and sitting. C temperature. Correct D skin color and turgor. □ It is very important to check the client's temperature (C). Infection is the most common factor precipitating respiratory distress. Clients with COPD who are on maintenance doses of corticosteroids are particularly predisposed to infection. (A and B) are important data for baseline and ongoing assessment, but they are not as important as temperature measurement for this client who is taking steroids. Assessment of skin color and turgor is less important (D). Awarded 0.0 points out of 1.0 possible points. □ 29.ID: 6974890429 While working in the emergency room, the nurse is exposed to a client with active tuberculosis. When should the nurse plan to obtain a tuberculin skin test? A Immediately after the exposure. B Within one week of the exposure. C Four to six weeks after the exposure. Correct D Three months after the exposure. □ A tuberculin skin test is effective 4 to 6 weeks after an exposure (C), so the individual with a known exposure should wait 4 to 6 weeks before having a tuberculin skin test. Awarded 0.0 points out of 1.0 possible points. □ 30.ID: 6974889587 The nurse is planning to initiate a socialization group for older residents of a long-term facility. Which information would be most useful to the nurse when planning activities for the group? A The length of time each group member has resided at the nursing home. B A brief description of each resident's family life. C The age of each group member. D The usual activity patterns of each member of the group. Correct □ An older person's level of activity (D) is a determining factor in adjustment to aging as described by the Activity Theory of Aging. All information

described in the options might be useful to the nurse, but the most useful information

initially would be an assessment of each individual's adjustment to the aging process. Awarded 0.0 points out of 1.0 possible points. □ 31.ID: 6974890443 The nurse knows that lab values sometimes vary for the older client. Which data would the nurse expect to find when reviewing laboratory values of an 80-year-old male? A Increased WBC, decreased RBC. B Increased serum bilirubin, slightly increased liver enzymes. C Increased protein in the urine, slightly increased serum glucose levels. Correct D Decreased serum sodium, an increased urine specific gravity. □ In older adults, the protein found in urine slightly rises probably as a result of kidney changes or subclinical urinary tract infections. The serum glucose increases slightly due to changes in the kidney. The specific gravity declines by age 80 from 1.032 to 1.024. Awarded 0.0 points out of 1.0 possible points. □ 32.ID: 6974894202 A 77-year-old female client is admitted to the hospital. She is confused, has no appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse rate is 43 beats per minute. Which question is a priority for the nurse to ask this client or her family on admission? "Does the client A have her own teeth or dentures?" B take aspirin and if so, how much?" C take nitroglycerin?" D take digitalis?" Correct □ Elderly persons are particularly susceptible to digitalis intoxication (D) which manifests itself in such symptoms as anorexia, nausea, vomiting, diarrhea, headache, and fatigue. Although it is important to obtain a complete medication history (B and C), the symptoms described are classic for digitalis toxicity, and assessment of this problem should be made promptly. (A) is irrelevant. Awarded 0.0 points out of 1.0 possible points. □ 33.ID: 6974889589 A 67-year-old woman who lives alone tripped on a rug in her home and