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MEDICAL-SURGICAL EXAM 2025 | QUESTIONS
WITH 100% VERIFIED ANSWERS
- A postmenopausal client asks the nurse why she is experiencing discomfort during intercourse. What response is best for the nurse to provide?
a. Estrogen deficiency causes the vaginal tissues to become dry and thinner.
b. Infrequent intercourse results in the vaginal tissues losing their elasticity.
c. Dehydration from inadequate fluid intake causes vulva tissue dryness.
d. Lack of adequate stimulation is the most common reason for dyspareunia. - correct-answer- A
Rationale
Estrogen deprivation decreases the moisture-secreting capacity of vaginal cells, so vaginal tissues tend to become thinner, drier, and the rugae become smoother which reduces vaginal stretching that contributes to dyspareunia. The discomfort during intercourse, primary cause can be contributed to the decrease in estrogen hormone levels.
- A male client receives a local anesthetic during surgery. During the post- operative assessment, the nurse notices the client is slurring his speech. Which action should the nurse take?
a. Determine the client is anxious and allow him to sleep.
b. Evaluate his blood pressure, pulse, and respiratory status.
c. Review the client's pre-operative history for alcohol abuse.
d. Continue to monitor the client for reactivity to anesthesia. - correct-answer- B
Rationale
Slurred speech in the post-operative client who received a local anesthetic is an atypical finding and may indicate neurological deficits that require further assessment, so obtaining the client's vital signs will provide information about possible cardiovascular complications, such as stroke.
- 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.
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. - correct- answer- B
- In preparing to administer intravenous albumin to a client following surgery, what is the priority nursing intervention? (Select all that apply.)
a. Set the infusion pump to infuse the albumin within four hours.
b. Compare the client's blood type with the label on the albumin.
c. Assign a UAP to monitor blood pressure q15 minutes.
d. Administer through a large gauge catheter.
e. Monitor hemoglobin and hematocrit levels.
f. Assess for increased bleeding after administration. - correct-answer- A, C, D, E, F
Rationale
Albumin should be infused within four hours because it does not contain any preservatives. Any fluid remaining after four hours should be discarded. Albumin administration does not require blood typing. Vital signs should be monitored periodically to assess for fluid volume overload. A large gauge catheter allows for fast infusion rate, which may be necessary. Hemodilution may decrease hemoglobin (HgB) and hematocrit (HCT) levels, so the HgB and HCT levels should be monitored. While monitoring for bleeding because of the increased blood volume and blood pressure.
- The healthcare provider prescribes aluminum and magnesium hydroxide (Maalox), 1 tablet PO PRN, for a client with chronic kidney disease (CKD) who is complaining of indigestion. What intervention should the nurse implement?
a. Administer 30 minutes before eating.
b. Evaluate the effectiveness 1 hour after administration.
c. Instruct the client to swallow the tablet whole.
d. Question the healthcare provider's prescription. - correct-answer- D
Rationale
Magnesium agents are not usually used for clients with CKD due to the risk of hypermagnesemia, so this prescription should be questioned by the nurse.
- Small bowel obstruction is a condition characterized by which finding?
a. Severe fluid and electrolyte imbalances.
b. Metabolic acidosis.
c. Ribbon-like stools.
d. Intermittent lower abdominal cramping. - correct-answer- A
Rationale
Among the findings characteristic of a small bowel obstruction is the presence of severe fluid and electrolyte imbalances.
Rationale
Hypokalemia can precipitate digitalis toxicity in persons receiving digoxin which will increase the chance of dangerous dysrhythmias (normal potassium level is 3. to 5.5 mEq/L).
- 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.
c. Notify surgery that the ECG is over two years old.
d. Notify the client's surgeon immediately. - correct-answer- B
Rationale
According to the hospital policy, clients over the age of 50 and/or with a history of cardiovascular disease, should receive ECG evaluation prior to surgery, generally 24 hours to two weeks before. The nurse needs to first arrange for an ECG to be performed immediately prior to surgery.
- The nurse is planning care for a client with newly diagnosed diabetes mellitus that requires insulin. Which assessment should the nurse identify before beginning the teaching session?
a. Present knowledge related to the skill of injection.
b. Intelligence and developmental level of the client.
c. Willingness of the client to learn the injection sites.
d. Financial resources available for the equipment. - correct-answer- C
Rationale
If a client is incapable or does not want to learn, it is unlikely that learning will occur, so motivation is the first factor the nurse should assess before teaching.
- A 46-year-old female client is admitted for acute renal failure secondary to diabetes and hypertension. Which test is the best indicator of adequate glomerular filtration?
a. Serum creatinine.
b. Blood Urea Nitrogen (BUN).
c. Sedimentation rate.
d. Urine specific gravity. - correct-answer- A
Rationale
a. Hematuria.
b. 2 pounds weight gain.
c. 3+ bacteria in urine.
d. Steady, dull flank pain. - correct-answer- C
Rationale
Urinary tract infections (UTI) for a client with PKD require prompt antibiotic therapy to prevent renal damage and scarring which may cause further progression of the disease, so bacteria in the urine is the most significant finding at this time.
- A client with multiple sclerosis has experienced an exacerbation of symptoms, including paresthesias, diplopia, and nystagmus. Which instruction should the nurse provide?
a. Stay out of direct sunlight.
b. Restrict intake of high protein foods.
c. Schedule extra rest periods.
d. Go to the emergency room immediately. - correct-answer- C
Rationale
Exacerbations of the symptoms of MS occur most commonly as the result of fatigue and stress. The client should be encouraged to schedule extra rest periods to help reduce the symptoms.
- The nurse is planning care to prevent complication for a client with multiple myeloma. Which intervention is most important for the nurse to include?
a. Safety precautions during activity.
b. Assess for changes in size of lymph nodes.
c. Maintain a fluid intake of 3 to 4 L per day.
d. Administer narcotic analgesic around the clock. - correct-answer- C
Rationale
Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (C) to promote excretion of serum calcium. Although the client is at risk for pathologic fractures due to diffuse osteoporosis, mobilization and weight bearing should be encouraged to promote bone reabsorption of circulating calcium, which can cause renal complications.
- 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
Rationale
The onset of pneumonia in the elderly may be signaled by general deterioration, confusion, increased heart rate or increased respiratory rate due to the decreased oxygen- carbon dioxide exchange at the alveoli, known as the V-Q mismatch.
- A client has a staging procedure for cancer of the breast and ask the nurse which type of breast cancer has the poorest prognosis. Which information should the nurse offer the client?
a. Stage II.
b. Invasive infiltrating ductal carcinoma.
c. T1N0M0.
d. Inflammatory with peau d'orange. - correct-answer- D
Rationale
Inflammatory breast cancer onset is very rapid and a very rare form of breast cancer and is considered the most aggressive form of breast malignancies. It is often mistaken for a breast infection because it has a thickened appearance like an orange peel (peau d'orange), causing the breast to become swollen and tender.
- A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for what vitamin deficiency?
a. K.
b. B12.
c. B6.
d. C. - correct-answer- A
Rationale
This drug is administered to help lower the triglycerides levels. One of the side effects clients should be monitored for an increased prothrombin time and prolonged bleeding times which would alert the nurse to a vitamin K deficiency. These drugs reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K.
- A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide?
a. Lymph node involvement is not significant.
b. Small tumors are aggressive and indicate poor prognosis.
c. The tumor's estrogen receptor guides treatment options.
d. Stage I indicates metastasis. - correct-answer- C
- A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit. What initial medication should the nurse anticipate administering to the client?
a. Xylocaine (Lidocaine).
b. Procainamide (Pronestyl).
c. Phenytoin (Dilantin).
d. Digoxin (Lanoxin). - correct-answer- D
Rationale
Digoxin (Lanoxin) is administered for uncontrolled, symptomatic atrial fibrillation resulting in a decreased cardiac output. Digoxin slows the rate of conduction by prolonging the refractory period of the AV node, thus slowing the ventricular response, decreasing the heart rate, and effecting cardiac output.
- 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.
c. Oxygen saturation of 90%.
d. Hemoglobin of 10 g/dl. - correct-answer- B
Rationale
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.
A 49-year-old female client arrives at the clinic for an annual exam and asks the nurse why she becomes excessively diaphoretic and feels warm during nighttime. What is the nurse's best response?
a. Explain the effect of the follicle-stimulating and luteinizing hormones.
b. Discuss perimenopause and related comfort measures.
c. Assess lung fields and for a cough productive of blood-tinged mucous.
d. Ask if a fever above 101 F (38.3 C) has occurred in the last 24 hours. - correct- answer- B
Rationale
The perimenopausal period begins about 10 years before menopause with the cessation of menstruation at the average ages of 52 to 54. Lower estrogen levels causes FSH and LH secretion in bursts (surges), which triggers vasomotor instability, night sweats, and hot flashes, so discussions about the perimenopausal body's changes, comfort measures, and treatment options should be provided.
e. Replace the old diaphragm every 3 months. - correct-answer- D, E
Rationale
The diaphragm needs to remain against the cervix for 6 to 8 hours to prevent pregnancy but should not remain for longer than 8 hours to avoid the risk of TSS. The diaphragm should be replaced every 3 months to maintain integrity.
- The nurse is assisting a client out of bed for the first time after surgery. What action should the nurse do first?
a. Place a chair at a right angle to the bedside.
b. Encourage deep breathing prior to standing.
c. Help the client to sit and dangle legs on the side of the bed.
d. Allow the client to sit with the bed in a high Fowler's position. - correct-answer- D
Rationale
The first step is to raise the head of the bed to a high Fowler's position, which allow venous return to compensate from lying flat and the vasodilation effects of perioperative drugs. This helps prevent the client from becoming light-headed and decreases the chance of a client fall.
- Which assessment finding by the nurse during a client's clinical breast examination requires follow-up?
a. Newly retracted nipple.
b. A thickened area where the skin folds under the breast.
c. Whitish nipple discharge.
d. Tender lumpiness noted bilaterally throughout the breasts. - correct-answer- A
Rationale
A newly retracted nipple, compared to a life-long finding, may be an indication of breast cancer and requires additional follow-up.
- Which postmenopausal client's complaint should the nurse refer to the healthcare provider?
a. Breasts feel lumpy when palpated.
b. History of white nipple discharge.
c. Episodes of vaginal bleeding.
d. Excessive diaphoresis occurs at night. - correct-answer- C
Rationale
