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medsurg practice test B Medical
Surgical Proctored Assessment B Latest
Updated 2024
A nurse is providing postoperative teaching for a client who had a total knee arthroplasty. Which of the following should the nurse include? A. Flex the foot q hr when awake. B. Place a pillow under the knee when lying in bed. C. Lower the leg when sitting in a chair.
D. Ensure the leg is abducted when resting in bed. - Correct Answer A. Flex the foot
q hr when awake. The nurse should instruct the client to flex the foot every hour to reduce the risk for thromboembolism and promote venous return. B. Avoid placing pillows under the knee to prevent flexion contractures. C. Elevate the leg when sitting in a chair to reduce edema and pain. D. Keep the operative leg in a neutral position when resting in the bed to prevent dislocation of the knee. A nurse is caring for a client who has a pneumothorax and a closed-chest drainage system. Which of the following findings is an indication of lung re-expansion? A. The chest tube is draining serosanguineous fluid at 65 mL/hr. B. The client tolerates gentle milking of the tubing. C. Bubbling in the water seal chamber has ceased.
D. There is tidaling in the water seal chamber. - Correct Answer C. Bubbling in the
water seal chamber has ceased. Bubbling in the water seal chamber ceases when the lung re-expands. D. The presence of tidaling in the water seal chamber results from the client's inhalation and exhalation and is NOT indicative of lung re-expansion. A nurse is assessing a client following the completion of hemodialysis. Which of the following findings is the nurse's priority to report to the provider? A. Temperature 37.2 C (99 F) B. BP 100/ C. Weight loss
D. Restlessness - Correct Answer D. Restlessness
Using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding to report to the provider is restlessness, which can be an indication the client is experiencing disequilibrium syndrome. Disequilibrium syndrome is caused by the rapid removal of electrolytes from the client's blood and can lead to dysrhythmias or seizures. Other manifestations include nausea, vomiting, fatigue, and headache. A. An increased temperature is an expected finding for a client who has just completed dialysis. The dialysis machine slightly warms the bloods. B. A decreased in BP is an expected finding for a client who has just completed dialysis. The decrease is a result of the removal of excess fluid from the client's blood. C. This is an expected finding after dialysis. A nurse is caring for a client who has DKA. Which of the following findings should indicate to the nurse that the client's condition is improving? A. K+ 3.5 mEq/L B. pH 7. C. BG 272 mg/dL
D. HCO3 14 mEq/L - Correct Answer C. BG 272 mg/dL
A glucose reading <300 mg/dL indicates improvement in the client's status. A. A K+ level of a client who has DKA might be below, at, or above the expected range. B. This is an expected finding and does not indicate improvement. D. This is an expected finding and does not indicate improvement. A nurse is caring for a client who had a nephrostomy tube inserted 12 hours ago. Which of the following findings should the nurse report to the provider? A. The client's urinary output has increased. B. The client reports back pain. C. The client's urine color is red tinged.
D. The client's BUN is 18 mg/dL. - Correct Answer B. The client reports back pain.
The nurse should notify the provider if the client reports back pain, which can indicate that the nephrostomy tube is dislodged or clogged. A. If there is a decreased UOP, it could indicate impaired renal function or dysfunction of the tube.
A nurse is planning care for a client who is having modified radical mastectomy of the right breast. Which of the following interventions should the nurse include in the plan of care? A. Instruct the client that the drain will be removed when there is 25 mL of output or less over a 24-hr period. B. Assist the client to start arm exercises 48 hr after surgery. C. Maintain the right arm in an extended position at the client's side when in bed.
D. Place the client in a supine position for the first 24 hr after surgery. - Correct
Answer A. Instruct the client that the drain will be removed when there is 25 mL of
output or less over a 24-hr period. The nurse should instruct the client that the drain will remain in place for 1 to 3 weeks after surgery and will be removed when there is 25 mL of output or less in a 24-hr period. B. The nurse should instruct the client to start exercising the right arm 24 hr after surgery. C. The nurse should elevate the client's right arm on a pillow to promote lymphatic fluid return. D. The nurse should elevate the head of the client's bed to at least 30° to promote drainage from the surgical site and facilitate breathing. A nurse is caring for a client who is receiving mechanical ventilation via a tracheostomy tube. The nurse should recognize that which of the following complications is associated with long-term mechanical ventilation? A. Elevated blood pressure B. Dehydration C. Stress ulcers
D. Hypernatremia - Correct Answer C. Stress ulcers
Stress ulcers in clients who are receiving long-term mechanical ventilation are caused by elevated levels of hydrochloric acid in the stomach. Stress ulcers increase the risk for systemic infection and require pharmacological treatment. A. Positive pressure from mechanical ventilation inhibits blood return to the heart, leading to decreased cardiac output and hypotension. B. Decreased cardiac output associated with mechanical ventilation places the client at risk for fluid retention. D. Hyponatremia can occur secondary to fluid retention that results from long-term mechanical ventilation.
A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? A. Low urine specific gravity B. HTN C. Bounding peripheral pulses
D. Hyperglycemia - Correct Answer A. Low urine specific gravity
An expected finding for a client who has diabetes insipidus is a urine specific gravity between 1.001 and 1.005. Decreased water reabsorption by the renal tubules is caused by an alteration in antidiuretic hormone release or the kidneys' responsiveness to the hormone. B. hypotension d/t dehydration caused by excessive excretion of urine C. weak peripheral pulses d/t dehydration caused by excessive excretion of urine D. Hyperglycemia is a manifestation of DM. Manifestations of DI include polydipsia and polyuria. A nurse is assessing for compartment syndrome in a client who has a short leg cast. Which of the following findings should the nurse identify as a manifestation of this condition? A. Bounding pedal pulse B. Capillary refill less than 2 seconds C. Pain that increases with passive movement
D. Areas of warmth on the cast - Correct Answer C. Pain that increases with passive
movement The nurse should identify that a client who has compartment syndrome experiences pain that increases with passive movement. Compartment syndrome results from a decrease in blood flow in the extremity caused by a decrease in the muscle compartment size due to a cast that is too tight. A. Client would have diminished pulse or pulselessness in the affected extremity d/t lack of distal perfusion caused by a decrease in the muscle compartment size. B. Client would have a CRT >2 sec d/t lack of distal perfusion and venous congestion caused by a decrease in the muscle compartment size. D. This indicates an infection of the underlying tissue, not compartment syndrome. A nurse is providing d/c teaching to a client who is postoperative following a modified radical masectomy. Which of the following instructions should the nurse include?
A. Drink 240 mL (8 oz) of water after administration. B. Expect results in 4 to 6 hr. C. Take this medication before meals to increase appetite.
D. Reduce dietary fiber intake to improve medication absorption. - Correct Answer A.
Drink 240 mL (8 oz) of water after administration. The client should follow each dose of psyllium with an additional 240 mL (8 oz) of liquid. B. 12-24 hr C. Take the medication AFTER meals to prevent appetite suppression. D. Client should increase dietary fiber intake for management of chronic constipation. A nurse is planning care for a client who is postoperative following a parathyroidectomy. Which of the following actions should the nurse identify as the priority? A. Use pillows to support the client's head and neck. B. Offer opioid medication. C. Place a tracheostomy tray at the bedside.
D. Place the client in semi-Fowler's position. - Correct Answer C. Place a
tracheostomy tray at the bedside. The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to place a tracheostomy tray at the client's bedside in case of airway obstruction. A nurse is providing teach to a client who has stage II cervical cancer and is schedule for brachytherapy. Which of the following instructions should the nurse include? A. "You will have an implant placed twice each month for the duration of the treatment." B. "You should remain at least 6 feet away from others between treatments." C. "You should expect to have blood in your urine for a few days after treatment."
D. "You will need to stay still in the bed during each treatment session." - Correct
Answer D. "You will need to stay still in the bed during each treatment session."
The nurse should instruct the client that they will need to remain on bed rest with very limited movement because excessive movement can cause the radioactive source to become dislodged. A. The nurse should instruct the client that there will likely be between two and five treatments, once or twice each week. B. The nurse should instruct the client that there is not excreted radiation between treatments. Therefore, there are no restrictions regarding contact with others.
C. The nurse should instruct the client that blood in the urine is an adverse effect of brachytherapy and is not an expected finding. Therefore, the client should report this finding to the provider immediately. A nurse is providing teaching to a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? A. "I should clean my toothbrush in the dishwasher once a month." B. "I should eat more fresh fruit and vegetables." C. "I will avoid drinking a glass of cold liquid that has been standing for 30 minutes."
D. "I will take my temperature once a day." - Correct Answer D. "I will take my
temperature once a day." A client who has AIDS is immunocompromised and is at risk for infection. The client should check their temperature daily to identify a temperature greater than 37.8° C (100° F), which is an early manifestation of an infection. A. the client should clean their toothbrush weekly in the dishwasher or in a bleach solution to destroy micro-organisms. B. the client should avoid eating raw fruits and vegetables that can contain bacteria and cause infection. The nurse should advise the client to eat a low-bacteria diet. C. the client should avoid drinking a glass of liquid that stands for 60 min or more to reduce the risk of drinking contaminated liquids. A nurse is assessing for compartment syndrome in a client who has a short leg cast. Which of the following findings should the nurse identify as a manifestation of this condition?
- bounding pedal pulse
- capillary refill less than 2 seconds
- pain that increases with passive movement
- areas of warmth on the cast - Correct Answer Pain that increases with passive movement The nurse should identify that a client who has compartment syndrome experiences pain that increases with passive movement. Compartment syndrome results from a decrease in blood flow in the extremity caused by a decrease in the muscle compartment size due to a cast that is too tight. A nurse is providing teaching to a client who has a severe form of stage II Lyme disease. Which of the following statements made by the client reflects an understanding of the teaching?
- "I will need to take antibiotics for 1 year"
- "my partner will need to take an antiviral medication"
- interstitial fibrosis - Correct Answer Facial butterfly rash A butterfly rash is a manifestation of SLE. It appears as a dry, red rash on the client's cheeks and nose and can disappear during times of remission. A nurse is planning care for a client who is postoperative following a parathyroidectomy. Which of the following actions should the nurse identify as the priority?
- use pillows to support the client's head and neck
- offer opioid medication
- place a tracheotomy tray at the bedside
- place the client in semi-fowler's position - Correct Answer Place a tracheostomy tray at the bedside in case of airway obstruction A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?
- low urine specific gravity
- hypertension
- bounding peripheral pulses
- hyperglycemia - Correct Answer Low urine specific gravity Decreased water reabsorption by the renal tubules is caused by an alteration in antidiuretic hormone release or the kidneys' responsiveness to the hormone. [1.005- 1.030 is normal] A nurse is providing teaching to a client who has stage II cervical cancer and is scheduled for brachytherapy. Which of the following instructions should the nurse include?
- "you will have an implant placed twice each month for the duration of the treatment"
- "you should remain at least 6 feet away from others between treatments"
- "you should expect to have blood in your urine for a few days after treatment"
- "you will need to stay still in the bed during each treatment session" - Correct
Answer You will need to stay still in the bed during each treatment session.
The nurse should instruct the client that they will need to remain on bed rest with very limited movement because excessive movement can cause the radioactive source to become dislodged. A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following interventions should the nurse include in the plan?
- encourage the client to take deep breaths after the procedure
- assist the client to hold their arms up during the procedure
- instruct the client to remain NPO after midnight prior to the procedure
- keep the client on bed rest for 8 hr following the procedure - Correct
Answer Encourage the client to take deep breaths after the procedure
After a thoracentesis, the client should deep breathe to re-expand the lung. A nurse is caring for a client who is receiving a blood transfusion. The client becomes restless, dyspneic, and has crackles noted to the lung bases. Which of the following actions should the nurse anticipate taking?
- administer an antihistamine
- slow the infusion rate
- give the client a corticosteroid
- elevate the client's lower extremities - Correct Answer Slow the infusion rate circulatory overload. The nurse should slow or stop the infusion to improve the client's ability to breathe, place the client in an upright position, and notify the provider. The provider might prescribe a diuretic to alleviate the fluid overload. A nurse is providing teaching to a client who has end-stage kidney disease and is waiting for a kidney transplant. Which of the following information should the nurse provide?
- kidney donation must come from a living donor
- immunosuppressive therapy is necessary until the donated kidney begins producing urine
- hemodialysis is sometimes required following surgery
- kidney transplant recipients can resume their regular diet following surgery - Correct
Answer Hemodialys is something required following surgery
When a kidney comes from a deceased donor, it might not function immediately, requiring the recipient to continue hemodialysis postoperatively. A nurse is caring for a client who has hypothyroidism. Which of the following manifestations should the nurse expect?
- constipation
- insomnia
- tachycardia
- diaphoresis - Correct Answer Constipation A client who has hypothyroidism can experience constipation due to the decrease in the client's metabolism, resulting in slow motility of the gastrointestinal tract. The nurse
- "I can contact a family member or spiritual advisor for you to speak with" - Correct
Answer "I can speak to the provider about incorporating acupuncture into your
treatment plan." The nurse should serve as an advocate for the client by acting on behalf of the client and offering to speak with the provider. The client has the right to make choices and decisions about their treatment and the nurse should support these decisions and assist the client to carry them out. A nurse is caring for a client following extubation of an endotracheal tube 10 min ago. Which of the following findings should the nurse report to the provider immediately?
- stridor
- oral secretions
- hoarseness
- sore throat - Correct Answer Stridor Using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is stridor. Stridor can indicate a narrowing airway or possible obstruction caused by edema or laryngeal spasms. The nurse should report the finding immediately and implement an intervention. A nurse is reviewing the laboratory findings of a client who developed chest pain 6 hr ago. The nurse should identify which of the following findings as an indication of a myocardial infarction (MI)?
- creatine kinase (CK-MB) 85 units/L
- high-density lipoprotein (HDL) 65 mg/dL
- alanine aminotransferase (ALT) 28 units/L
- troponin I 8ng/mL - Correct Answer Troponin I 8 ng/mL Troponins are proteins present in skeletal and cardiac muscle that are involved with muscle contraction. The elevation of either troponin T or troponin I is an indication of cardiac injury. The client's laboratory value is above the expected reference range for troponin I, indicating an MI has occurred. A nurse is preparing to administer a blood transfusion to a client who has anemia. Which of the following actions should the nurse take first?
- obtain the client's vital signs
- describe the blood transfusion procedure to the client
- check for the type and number of units of blood to administer
- initiate a peripheral IV line - Correct Answer Check for the type and number of units of blood to administer
According to evidence-based practice, the nurse should first confirm that the type and number of units of blood to administer matches what is indicated in the client's medication administration record. A nurse is reviewing the laboratory results of a client who has aplastic anemia. Which of the following findings indicates a potential complication?
- RBC count 5.2 million/mm
- WBC count 2,000.mm
- platelets 380,000/mm
- potassium 4 mEq/L - Correct Answer WBC count 2, A WBC count of 2,000/mm3 is below the expected reference range and indicates a risk for severe immunosuppression. A nurse is providing discharge teaching to a client who is postoperative following a modified radical mastectomy. Which of the following instructions should the nurse include?
- flex the affected arm when ambulating
- numbness can occur along the inside of the affected arm
- begin active range-of-motion exercises 1 day after surgery
- dress in clothing that fits snugly - Correct Answer Numbness can occur along the inside of the affected arm The nurse should instruct the client that numbness can occur near the incision and along the inside of the affected arm due to nerve injury. A nurse is preparing to present a program about prevention of atherosclerosis at a health fair. Which of the following recommendations should the nurse plan to include? (Select all that apply.)
- follow a smoking cessation program
- maintain an appropriate weight
- eat a low-fat diet
- increase fluid intake
- decrease intake of complex carbohydrates - Correct Answer - Follow a smoking cessation program
- Maintain an appropriate weight
- Eat a low-fat diet A nurse is caring for a client who has homonymous hemianopsia as a result of a stroke. To reduce the risk of falls when ambulating, the nurse should provide which of the following instructions to the client?
- "wear an eyepatch over one eye"
A nurse is performing a preoperative assessment for a client. The nurse should identify that an allergy to which of the following foods can indicate a latex allergy?
- shellfish
- peanuts
- avocados
- eggs - Correct Answer Avocados Clients who have an avocado allergy might have an allergic reaction or a sensitivity to latex. Allergies to certain fruits, such as strawberries and bananas, can also indicate latex allergy or sensitivity. A nurse is caring for a client who has DKA. Which of the following findings should indicate to the nurse that the client's condition is improving?
- potassium 3.5 mEq/L
- pH 7.
- glucose 272 mg/dL
- HCO3 14 mEq/L - Correct Answer Glucose 272 less than 300 mg/dL indicates improvement in the client's status. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following should the nurse plan to administer?
- 240 mL (8oz) of orange juice
- 1 ampule of 50% dextrose IV bolus
- NPH insulin 60 units subcutaneous
- regular insulin 20 units IV bolus - Correct Answer Regular insulin 20 units IV DKA is a complication of diabetes mellitus that results in dehydration, ketosis, metabolic acidosis, and elevated blood glucose levels. Management of DKA involves providing hydration, correcting acid-base imbalances, and decreasing blood glucose levels. Regular insulin is a fast-acting insulin that can be effective within 10 min when administered intravenously. A nurse is evaluating the plan of care for four clients after 2 days of hospitalization. The nurse should identify the need to revise the plan for which of the following clients?
- a client who is taking potassium supplements, has a potassium level of 3.2 mEq/L, and reports constipation
- a client who has Alzheimer's Disease (AD), has a room near the nurse's station, and is agitated
- a client who is postoperative following abdominal surgery and reports feeling that something "popped" when they coughed
- a client who has a conductive hearing loss, speaks softly, and is scheduled for a
cerumen removal - Correct Answer A client who is postoperative following
abdominal surgery and reports feeling that something "popped" when they coughed A feeling of something popping or loosening with coughing might indicate a wound dehiscence. This client will need to have revisions to the plan of care, which can include management of the dehiscence, prevention of evisceration, or possible surgical repair of an evisceration if one occurs. A nurse is providing teaching to a client who has a new prescription for psyllium. Which of the following information should the nurse include in the teaching?
- drink 240 mL (8 oz) of water after administration
- expect results in 4 to 6 hrs
- take this medication before meals to increase appetite
- reduce dietary fiber intake to improve medication absorption - Correct
Answer Drink 240 mL (8 oz) of water after administration.
The client should follow each dose of psyllium with an additional 240 mL (8 oz) of liquid. A nurse is assessing a client who is at risk for the development of pernicious anemia resulting from peptic ulcer disease. Which of the following images depicts a condition
caused by pernicious anemia? - Correct Answer This image depicts glossitis, which
can indicate pernicious anemia. Glossitis, a smooth red tongue, is also a manifestation of deficiencies in vitamin B6, zinc, niacin, or folic acid. A nurse is providing discharge instructions to a client who has laryngeal cancer and is receiving radiation therapy. Which of the following statements by the client indicates an understanding of the teaching?
- "I will wear a badge to measure how much radiation I am receiving"
- "I will remove the markings on my skin after each radiation treatment"
- "I will avoid direct exposure to the sun"
- "I will rinse my mouth with a commercial mouthwash" - Correct Answer "I will avoid direct exposure to the sun." The client should avoid exposure of irradiated skin areas to the sun for at least 1 year after completing radiation therapy. Skin in the radiation path is especially sensitive to sun damage. A nurse is admitting a client who has active tuberculosis. Which of the following types of transmission precautions should the nurse initiate?
- airborne
- droplet
- contact
- adjust the screws to maintain alignment - Correct Answer Use crutches with rubber tips. Using crutches with rubber tips prevents the client from slipping and decreases the risk of falls. A nurse is teaching a group of newly licensed nurses about pain management for older adult clients. Which of the following statements by a newly licensed nurse indicates an understanding of the teaching?
- "Older adult clients might require up to 6 grams of acetaminophen over 24 hours for effective pain control."
- "Ibuprofen can cause gastrointestinal bleeding in older adult clients."
- "Meperidine is the medication of choice for older adult clients experiencing severe pain."
- "Older adult clients taking oxycodone are at risk for diarrhea." - Correct
Answer Ibuprofen can cause gastrointestinal bleeding in older adult clients.
A common adverse effect of ibuprofen is gastrointestinal bleeding, and older adult clients have an increased risk for gastrointestinal toxicity and bleeding. A nurse is caring for a client who has a cervical spinal cord injury sustained 1 month ago. Which of the following manifestations indicates that the client is experiencing autonomic dysreflexia (AD)?
- temperature 102 F
- systolic blood pressure 70 mmHg
- heart rate 52/min
- respiratory rate 8/min - Correct Answer Heart rate 52/min will exhibit multiple manifestations, including bradycardia, severe headache, and flushing. A nurse is assessing a client who has advanced lung cancer and is receiving palliative care. The client has just undergone thoracentesis. The nurse should expect a reduction in which of the following common manifestations of advanced cancer?
- dyspnea
- hemoptysis
- mucus production
- dysphagia - Correct Answer Dyspnea Thoracentesis, the removal of pleural fluid, can temporarily relieve hypoxia and thus ease the client's breathing and improve comfort.
A nurse is providing teaching to a client who takes ginkgo biloba as an herbal supplement. Which of the following statements should the nurse make?
- "Ginkgo biloba relieves nausea for people who have vertigo."
- "Taking ginkgo biloba will help relieve your joint pain."
- "Ginkgo biloba can cause an increased risk for bleeding."
- "Taking ginkgo biloba decreases the risk of migraine headache." - Correct
Answer "Ginkgo biloba can cause an increased risk for bleeding."
Ginkgo biloba increases blood flow and is effective in decreasing the pain associated with peripheral artery disease. The supplement also decreases platelet aggregation, which in turn increases the risk for bleeding. Clients who have been prescribed antiplatelet medications, such as aspirin, should avoid taking ginkgo biloba without first speaking with their provider. A nurse on a medical-surgical unit is reviewing the medical record of an older adult client who is receiving IV fluid therapy. Which of the following client information should indicate to the nurse that the client requires re-evaluation of the IV therapy prescription? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.) EXHIBIT
- blood pressure
- prescribed medications
- oxygen saturation
- BUN - Correct Answer BUN The client's Hct and BUN levels indicate dehydration and require an increase in the IV fluid infusion rate. A nurse is receiving report on a client who is postoperative following an open repair of Zenker's diverticulum. The nurse should anticipate the surgical incision to be in which of the following locations? (You will find hot spots to select in the artwork below. Select
only the hot spot that corresponds to your answer.) - Correct Answer Neck
Zenker's diverticulum, or pharyngeal pouch, is a herniation of the esophagus occurring through the cricopharyngeal muscle in the midline of the neck. Repair of the diverticulum is accomplished through an open incision in the client's neck. A nurse is obtaining a medication history from a client who is scheduled to undergo cataract surgery. The nurse should recognize that which of the following client medications is a contraindication for the surgery and notify the provider?
- hydrocodone
- bupropion
- lactulose
