Medical Surgical Nurse Certification with complete solutions 2024, Exams of Nursing

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1.A nurse is reviewing the medical record of a client who is receiving heparin therapy for treatment of DVT. Which of the following interventions should the nurse anticipate taking if the client's aPTT is 96 seconds? a. Increase the heparin infusion flow rate by 2 mL/hr b. continue to monitor the heparin infusion as prescribed c. request a prothrombin time d. stop the heparin infusion: d 2.A nurse is providing teaching for a client who is 2 days post-op following a heart transplant. Which of the following statements should the nurse include in the teaching? a. "you may no longer be able to feel chest pain. "b. "your level of activity tolerance will not change. "c. "after 6 months, you will no longer need to restrict your sodium intake. "d. "you will be able to stop taking immunosuppressants after 12 months.": a 3.A nurse is assess a client in the emergency room who has a bradydysrhyth- mia. Which of the following findings should the nurse expect? A. confusion B. friction rub C. hypertension D. dry skin: a

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4.A nurse in the emergency department is caring for a client who had an anterior MI. The client's history reveals she is 1 week post-op open cholecys- tectomy. The nurse should recognize that which of the following interventions is contraindicated? A. administering IV morphine sulfate B. administering oxygen at 2 :/min via nasal cannula C. helping the client to the bedside commode D. assisting with thrombolytic therapy: d 5.A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? A. ventricular depolarization B. Guillain-Barre syndrom C. myelodysplastic syndrome D. Valvular disease: D 6.A nurse is caring for a client who presents to the ER with a BP of 254/ mmHg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? A. obtain blood samples for laboratory testing B. Tell the client to report vision changes C. Place the head of the bed at 45 degrees D. initiate an IV: C 7.a nurse is caring for a client who has HF and is experiencing AF. The nurse should plan to monitor for and report which of the following findings

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to the provider immediately? a. slurred speech b. irregular pulse c. dependent edema d. persistent fatigue: a 8.A nurse is assessing a client who has left-sided HF. Which of the following manifestations should the nurse expect to find? a. inc abdominal girth b. weak peripheral pulses c. jugular vein distention d. dependent edema: b 9.a nurse is caring for a client who is being treated for HF and has prescrip- tions for digoxin and furosemide. The nurse should plan to monitor for which of the following as an adverse effect of these medications? a. SOB b. lightheadedness c. dry cough d. metallic taste: b 10.a nurse is monitoring a client following coronary artery bypass graft surgery. Which of the following findings can indicate cardiac tamponade? a. sternal instability b. inc WBC count c. BP 140/82 mmHg on inspiration and 154/90 mmHg on expiration d. sinus rhythm with occasional premature atrial contraction and HR 88/min:

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c 11.A nurse is preparing a client for coroncary angiography. The nurse should report which of the following findings to the provider prior to the procedure? a. hemoglobin 14.4 g/dL b. history of peripheral arterial disease c. urine output 200 mL/4 hr d. previous allergic reaction to shellfish: d 12.A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? a. "I can't get rid of these hiccups. "b. "I feel dizzy when i stand. "c. "My incision site stings." d. "I have a headache.": a 13.A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching? a. apply the new patch to the same site as the previous patch b. place the patch on an area of skin away from skin folds and joints c. keep the patch on 24 hr per day d. replace the patch at the onset of angina: b 14.A nurse is caring for a client in the first hour following an aortic

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aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? a. serosanguinous drainage on dressing b. severe pain with coughing c. urine output of 20 mL/hr d. increase in temp from 36.C (98.2F)- 37.5C (99.5F): c 15.A nurse caring for a client following an abdominal aortic aneurysm resec- tion. Which of the following is the priority assessment for this client? a. neck vein distention b. bowel sounds c. peripheral edema d. urine output: d 16.A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachy- cardia. The client is conscious with a HR of 200-210 bpm and has a faint radial pulse. The nurse should anticipate assisting with which of the following interventions? a. delivery of precordial thump b. vagal stimulation c. administration of atropine IV d. defibrillation: b 17.A nurse is providing discharge teaching for a client who has HF. The nurse should instruct the client to report which of the following findings immediately to the provider? a. weight gain of 2 lb in 24 hr

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b. inc of 10 mmHg in systolic BP c. dyspnea with exertion d. dizziness when rising quickly: a 18.A nurse is admitting a client who has a leg ulcer and a history of DM. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer? a. explore the clients family history of peripheral vascular disease b. note the presence or absence of pain at the ulcer site c. inquire about the presence or absence of claudication d. ask if the client has had a recent infection: c 19.A nurse is reviewing the laboratory results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which laboratory values? a. Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL b. Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL c. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL d. Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL: c 20.a nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? a. a client who has hypothyroidism b. a client who has DM c. a client whose daily caloric intake consists of 25% fat d. a client who consumes two bottles of beer a day: b

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21.a nurse is planning a presentation about hypertension for a community women's group. which of the following lifestyle modifications should the nurse include (select all that apply) a. limited alcohol intake b. regular exercise program c. dec Mg intake d. reduced K intake e. smoking cessation: a, b, e 22.A nurse is caring for a client in the first 8 hr following coronary artery bypass graft surgery. Which of the following client findings should the nurse report to the provider? a. mediastinal drainage 100 mL/hr b. BP 160/80 mmHg c. Temp 37.1 (98.8) d. K 3.8 mEq/L: b 23.A nurse is caring for a client who has a history of angina and is schedules for a stress test at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? a. "I'm still hungry after the bowl of cereal I ate at 7am. "b. "I didn't take my heart pills this morning because the doctor told me not to. "c. "I have had chest pain a couple of times since I saw my doctor in the office last week.

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"d. "I smoked a cigarette this morning to calm my nerves about having this procedure.": d 24.A nurse is caring for a client who has dilated cardiomyopathy. The client reports increasing difficulty completing her daily 1-mile walks. The nurse should recognize that this is a finding of which of the following? a. left ventricular failure b. peripheral vasodilation c. pericardial effusion d. dec vascular volume: a 25.A nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? a. "My arthritis is really bothering me because I haven't taken my aspiring in a week. "b. "My blood pressure shouldn't be high because I took my BP medication this morning." c. "I took my warfarin last night according to my usually schedule." d. "I will check my BP because I took a reduced dose of insulin this morning."- : c 26.A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in which of the following is diagnostic of a MI?a. myoglobinb. c-reactive protein c. creatine kinase- MB

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d. Homocysteine: c 27.a nurse is caring for a client who has a history of DVT and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy? a. hemoglobin 14 g/dL b. minimal bruising of extremities c. reduced circumference of affected extremity d. INR 2.5: d 28.A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following? a. tendon pain b. persistent cough c. frequent urination d. constipation: b 29.A client is being evaluated in the ED for a possible brain attack (stroke). Assessment findings consistent with a brain attack include which of the following? (select all that apply) a. facial droop b. slurred speech

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c. weakness of affected extremity d. crackles in lungs e. decreased urine output: a, b, c 30.A client is admitted with a diagnosis of acute stroke. The provider orders "diet as tolerated." Before feeding this client, which nursing action is priority? a. determine client's food preferences b. elevate the head of the bed 30 degrees c. assess client's swallowing reflex d. review serum albumin level to determine appropriate diet: c 31.Which of the following recommendations is best for the nurse to suggest to a client as a way to keep BP under control? a. follow a regular exercise program b. attend a stress-reduction support group c. avoid use of tobacco and limit alcohol intake d. increase intake of fruits and veggies: a 32.which of the following assessment findings indicate to the nurse the client is experiencing left-sided HF? a. fatigue and dyspnea b. Cheyne-Stokes breathing and orthostatic hypotension c. liver tenderness and peripheral edema d. anorexia and dependent edema: a 33.the nurse is teaching a group of adult clients about risk for coronary artery disease, especially MI. This nurse should instruct this group of clients about which of the following as ways to decrease incidence of CAD and MI?

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(select all that apply) a. "if you smoke, quit" b. "be sure to consume at least 10% of your calories from saturates fats." c. "Engage in moderate exercise for 20-30 minutes 3-5 times a week." d. "jog at a mild pace for at least one hour a day." e. "check BP regularly.": a, c, e 34.Which client response requires a focused GI assessment? a. "I take ibuprofen 600 mg three times a day for arthritis pain." b. "I experienced occasional constipation." c. "I have had dentures for 3 years." d. "spicy foods upset my stomach.": a 35.After abdominal surgery, what is the most reliable assessment that sug- gests return of peristaltic movement? a. presence of normal bowel sounds b. client report of passing flatus c. client report of hunger d. absence of nausea: b 36.when administering a new medication to an older client, the nurse under- stands that: a. the dose may need to be increased to greater-than-normal levels b. close monitoring is needed because toxic levels may develop c. the dose may need to be decreased to lower-than-normal levels d. nausea and vomiting may develop rapidly and are common side effects

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in older adults: c 37.A 59 year old man was admitted to the hospital with dysphagia, stating that he has been having more difficulty swallowing food, even when he has chewed it throroughly and drinks plenty of water. A CT scan shows an area for a possible esophageal tumor. The client unergoes a biopsy and is awaiting results. The client asks, "what am I going to do if this is cancer?" What is the most appropriate nursing response? a. "You will have surgery to remove it." b. "I would choose to get radiation." c. "The doctor will go over the options with you." d. "You sound as if you are concerned about the biopsy results.": d 38.The client with a long history of osteoarthritis is at risk for developing GERD if he or she: a. weighs 220 pounds b. frequently takes NSAIDs for pain c. consumes food with calcium supplementation d. has limited physical mobility: b 39.A priority nursing intervention in the care of a client with a hiatal hernia is: a. providing nutrition education b. promoting regular exercise

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c. providing medication education d. instructing the client on signs and symptoms of intestinal strangulation: a 40.Which assessment variable requires immediate intervention post esophagectomy? a. BP 170/ b. respiratory rate 28 c. temp 38. d. pain 6/10: b 41.An older client diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea, and vomiting, and fatigue for the past 24 hours. The nurse should monitor the client for what priority assessment?a. dehydra- tion b. hypokalemia c. hypernatremia d. perineal skin breakdown: a 42.A client has recently been placed on corticosteroids as treatment for ulcerative colitis. the nurse should monitor the client's laboratory results for evidence of which condition? a. hypernatremia b. hypercalcemia c. hyperglycemia d. hyperkalemia: c 43.What priority laboratory analysis should the nurse review when caring

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for a client with Crohn's disease? a. c-reactive protein b. serum albumin c. hemoglobin d. potassium: c 44.A client is admitted to the acute medical client care unit. The nurse reviews her admission lab results. Which result supports a diagnosis of malnutrition? a. serum albumin 3.5 g/dL b. hematocrit 37% c. Hemoglobin 12g/dL d. Prealbumin 13 mg/dL: d 45.Upon assessment the client is noted to have conjunctival xerosis, dry skin, follicular hyperkeratosis and bright magenta (purple) tongue. Which vitamin deficiency does the nurse suspect? A. Vit A B. Vit C C. Vit D D. Vit K: a 46.what is a potential outcome when administering total parenteral nutrition (TPN)? a. infection b. hyperglycemia

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c. electrolyte imbalance d. dehydration: b 47.an older adult with anemia requests help with his menu choices. What type of food should the client be encouraged to eat? a. one-half cup of prunes b. skim milk c. wheat bread d. oranges: b 48.What percentage of adults in the US are obese (BMI>30)? a. 14% b. 21% c. 34% d. 47%: c 49.A client receiving chemotherapy for treatment of cancer is at greatest risk for developing: a. Stomatitis b. Xerostoma c. oral abscess d. candidiasis: a 50.A 26-year-old female client informs the nurse that she has had red, raised lesions at the base of the tongue and on the inside of her mouth for the past 2 weeks. What question should the nurse ask the client? a. "Have you seen a dentist recently?" b. "Do you smoke cigarettes?" c. "Do you have a history of HIV?"

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d. "What type of work do you do?": c 51.An older client with poor oral hygiene was admitted after a fall in which he sustained a fractured hip. What is the priority nursing intervention? a. initiate oral care every 6 hours b. implement aspiration precautions c. use lemon glycerin swabs to moisten the mouth as needed d. request a consult with a registered dietitian: a 52.A nurse is reviewing the prescriptions for a client who has Campylobacter enteritis. Which of the following prescriptions should the nurse clarify with the provider? a. 0.45% sodium chloride IV b. Milk of Magnesia c. Ciprofloxacin d. Potassium: b 53.A nurse is caring for a client who has GERD and a new prescription for metoclopramide. The nurse should plan to monitor for which of the following adverse effects? a. Thrombocytopenia b. hearing loss c. hypotension d. ataxia: d 54.A nurse is caring for a client who has colorectal cancer and is recieving chemotherapy. The client asks the nurse why blood is being drawn for a

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carcinoembryonic antigen (CEA) level. Which of the following responses by the nurse is appropriate? a. "The CEA determines the current stage of you colon cancer." b. "The CEA determines the efficacy of your chemotherapy." c. "The CEA determines if the neutrophil count is below the expected reference range." d. "The CEA determines if you are experiencing occult bleeding from the GI tract.": b 55.A nurse is providing discharge teaching for a client who has chronic cholecystitis. Which of the following food selections by the client indicated the teaching was effective? a. unsalted nuts b. bologna c. cheddar cheese d. bananas: d 56.A nurse is providing discharge for a client who has gastritis and a new prescription for famotidine. Which of the following client statements indicated the teaching was effective? a. "I should make sure the water I drink is filtered." b. "I should expect immediate pain relief after starting this therapy." c. "I will drink iced tea with my meals and snacks." d. "I will monitor by blood glucose level regularly while taking this medica- tion.": a

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57.What symptom does the nurse expect the client with intussusception to exhibit? a. decrease in pulse b. extremely elevated body temperature c. singultus (hiccups) d. frequent bloody stools: c 58.emotional stress is a risk factor for irritable bowel syndrom (IBS) true or false: false 59.which ethnic group has a higher incidence of colorectal cancer? a. hispanic b. asian c. caucasian d. african-american: d 60.A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? a. bloody diarrhea b. board-like abdomen c. periumbilical cyanosis d. increased bowel sounds: b 61.a nurse is assessing a client who has appendicitis. Which of the following findings should the nurse expect? a. oral temp 38. b. WBC 6,000/mm c. bloody diarrhea d. nausea and vomiting

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e. right lower quadrant pain: a, d, e 62.A nurse is assessing a client who is postoperative following a gastrectomy. The nurse should identify which of the following findings as an indication of acute gastric dilation? a. hiccups b. elevated BP c. bradycardia d. left lower quadrant pain: a 63.A nurse is caring for a client who has hepatic encephalopathy. The client asks the nurse if she can have a larger portion of beef for dinner. Which of the following responses by the nurse is appropriate? a. "Beef is too high in fat, but can i request chicken as a substitute." b. "You need to increase your fluid intake. Would you like beef and noodle soup?" c. "You should limit your animal protein intake. Can I get you a veggie burger instead?" d. "You need to limit calories. Would you like some sugar-free gelatin?": c 64.Immunity that is developed by vaccination or immunization is known as: a. natural active b. passive acquired c. innate/native d. artificial active: d 65.A patient with inflammation has a high eosinophil count. The nurse

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recog- nizes that this finding most likely indicated that: a. humoral and cell-mediated immunity is being stimulated b. the inflammatory response has been stimulated by infection c. tissue damage has been caused by an allergen-antibody reaction d. the inflammation has become chronic with persistent tissue damage: c 66.Which cell types associated with the inflammatory response participate in phagocytosis? a. neutrophils and eosinophils b. macrophages and neutrophils c. macrophages and eosinophils d. eosinophils and basophils: b 67.A nurse is providing discharge teaching for a client who has chronic hepatitis C. which of the following statements by the client indicates an understanding of the teaching? a. "I will avoid alcohol until I'm no longer contagious." b. "I will avoid medications containing acetaminophen." c. "I will decrease my intake of calories." d. "I will need treatment for 3 months.": b 68.A nurse is providing discharge teaching for an older adult client who has mild diverticulitis. which of the following client statements indicates an understanding of the teaching? a. "I may experience right lower quadrant pain." b. "I will remain active by working in my garden every day." c. "I should eat foods that are low in fiber." d. "I will use a mild laxative every day.": c

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69.A nurse is providing discharge teaching for a client who has GERD. Which of the following client statements indicates the teaching was effective? a. "I will decrease the amount of carbonated beverages I drink." b. "I will avoid drinking liquids for 30 minutes after taking a chew-able antacid tablet." c. "I will eat a snack before going to bed." d. "I will lie down for at least 30 minutes after eating each meal.": a 70.A nurse is reviewing the lab results of a client who has hepatic cirrhosis. Which of the following lab findings should the nurse report to the provider? a. Albumin 4.0 g/dL b. INR 1.5 c. Bilirubin 0.2 mg/dL d. Ammonia 180 mcg/dL: d 71.A nurse is providing discharge teaching for a client who has a new pre- scription for medications to treat peptic ulcer disease. The nurse should iden- tify that which of the following medications inhibits gastric acid secretion? a. calcium carbonate b. famotidine c. aluminum hydroxide d. sucralfate: b

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72.A nurse is providing teaching about dietary management to prevent dump- ing syndrome for a client who is post-op following a gastrectomy. The nurse should encourage the client to include which of the following foods in his diet? a. lactose-reduced milk b. eggs c. grape juice d. honey: b 73.A nurse is providing discharge teaching for a client following an ileostomy. The nurse should instruct the client to report which of the following findings to the provider? a. intolerance to high-fiber foods b. liquid ileostomy output c. dark purple stoma d. sensation of burning during bowel elimination: c 74.A nurse is reviewing the laboratory values of a client who has colorectal cancer. Which of the following findings should the nurse expect? a. negative fecal occult blood test b. decreased serum carcinoembryonic antigen (CEA) level c. hemocrit 43% d. hemoglobin 9.1 g/dL: d 75.A nurse is reviewing the laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect?

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a. blood glucose 110 mg/dL b. Increased serum amylase c. WBC 9,000/mm^3 d. Decreased bilirubin: b

76. A nurse is caring for a client who has duodenal ulcer. which of the following findings should the nurse expect? a. the client described the pain as spasms in the right lower quadrant of the stomach b. the client describes the pain as pressure felt in the epigastrium c. The client states the pain occurs as soon as food enters the stomach d. the client states the pain occurs 1.5-3 hrs after meals and during the night: d 77.A nurse is assessing a client who has acute hepatitis B. Which of the following findings should the nurse expect? a. joint pain b. obstipation c. abdominal distention d. periumbilical discoloration: a 78.A nurse is assessing a client who has Crohn's disease. Which of the following findings should the nurse expect? a. Fatty, diarrheal stools b. Hyperkalemia c. weight gain

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d. sharp epigastric pain: a 79.A nurse is providing teaching for a client who has cirrhosis and a new prescription for lactulose. The nurse should include which of the following instructions in the teaching? a. Notify the provider if bloating occurs b. expect to have two to three soft stools per day c. restrict carbs in the diet d. limit oral fluid intake to 1000 mL/day of clear liquids: b 80.A nurse is admitting a client who has acute pancreatitis. Which of the following actions should the nurse take first? a. insert an NG tube b. administer ceftazidime c. identify the clients current level of pain d. instruct the client to remain NPO: c 81.A nurse is teaching a client how to prepare for a colonoscopy. which of the following instructions should the nurse include in the teaching? a. begin drinking the oral liquid preparation for bowel cleansing on the morn- ing of the procedure b. drink full liquids for breakfast the day of the procedure, and then take

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nothing by mouth for 2 hr prior to the procedure c. drink clear liquids for 24 hr prior to the procedure, and then take NPO by mouth for 6 hr before the procedure d. Drink oral liquid preparation for bowel cleansing slowly: c 82.A nurse is developing a plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include? a. measure abdominal girth daily b. administer warfarin at the same time each day c. provide a daily intake of 4 g of sodium d. assess breath sounds every 12 hours: a 83.A nurse is assessing a client who has upper GI bleeding. Which of the following findings should the nurse expect? a. hypoactive bowel sounds b. epigastric pain c. hypotension d. pernicious anemia: c 84.A nurse is caring for a client who has ulcerative colitis. The client has had several exacerbation over the past 3 years. Which of the following instructions should the nurse include in the plan of care to minimize the risk of further exacerbation (select all that apply) a. use progressive relaxation techniques b. increase dietary fiber intake