1
Medical-Surgical Nursing
FULL Test Bank for Davis Advantage for
Understanding Medical-Surgical
Nursing, 7th Edition CHAPTER 1-57 by
Linda S. Williams (ORIGINAL PDF)
The nurse hears the presence of secretions in the lungs and determines the client, post
thoracotomy, needs to be suctioned. What steps will the nurse include in the suctioning
procedure? (Select all that apply.)
A.
Perform hand hygiene.
B.
Position in no less than a semi-Fowler's position.
C.
, 2
Medical-Surgical Nursing
Lubricate the suction catheter with a petroleum-based product.
D.
Insert the catheter with the suction on.
E.
Listen for breath sounds.
F.
Hyperoxygenate the client.
- Correct Answer :A, B, E, F
Rationale:
The suction catheter does need to be lubricated, but with a water-based product, not a
petroleum-based product. The suction catheter needs to be inserted with the suction off, not
on. Suction should be applied intermittently while withdrawing the catheter. The remainder
are steps in the suction process.
A client has newly diagnosed diabetes. To delay the onset of microvascular and
macrovascular complications in this client, the nurse stresses that the client take which
action?
A) Restrict fluid intake.
B) Prevent ketosis.
C) Control hyperglycemia.
D) Prevent hypoglycemia. –
Correct Answer :C
Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications.
Maintaining tight glycemic control will help delay the onset of complications. Preventing
hypoglycemia and ketosis, although important, is not as important as maintaining daily
, 3
Medical-Surgical Nursing
glycemic control. Restricting fluid intake is not part of the treatment plan for clients with
diabetes.
Which interventions are necessary to provide safe, quality care to a patient receiving enteral
tube feedings? SELECT ALL THAT APPLY!!
A) check the residual volume every 4-6 hours
B) use clean technique when changing the feeding system
C) keep the head of the beg elevated at least 30 degrees
D) change the feeding bag & tubing every 12 hours
E) allow closed system containers to hang for 24 hours –
Correct Answer :A,B,C,E
A client with a pressure ulcer has the following laboratory values: white blood count
8000/mm3, prealbumin 15.2 mg/dL, albumin 4.2 mg/dL, and lymphocyte count 2000/mm3.
Which action by the nurse is most appropriate?
A) Request a dietary consult.
B) Assess the client's vital signs.
C) Document the findings.
D) Place the client in isolation. –
Correct Answer :A
Albumin, prealbumin, and lymphocyte counts all give information related to nutritional status.
The albumin and lymphocyte counts given are normal. The white blood cell count is not
directly related to nutritional status. The prealbumin count is low and is a more specific
indicator of nutritional status than is the albumin count. This puts the client at risk for
impaired wound healing, so the nurse should request a dietary consult.
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Medical-Surgical Nursing
A nurse is explaining to a student nurse about perfusion. The nurse knows the student
understands the concept of perfusion when the student states, "Perfusion
A) is a normal function of the body, and I don't have to be concerned about it."
B) varies as a person ages, so I would expect changes in the body."
C) is monitored by the physician, and I just follow orders."
D) is monitored by vital signs and capillary refill." –
Correct Answer :D
The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows
the nurse to know if perfusion is adequate to maintain vital organs. The nurse does have to be
concerned about perfusion. Perfusion is not only monitored by the physician but the nurse
too. Perfusion does not always change as the person ages.
The nurse is a assessing a client with hypertension. Which client outcome is indicative of
effective hypertension management?
A) No complaints of sexual dysfunction occur.
B) Pedal edema is not present in the lower legs.
C) No indication of renal impairment is present.
D) The blood pressure reading is 148/94 mm Hg.
- Correct Answer :C
One expected outcome for a client with hypertension is for the client to have no evidence of
target organ damage, such as renal or heart disease, that can occur with poorly managed
hypertension. Development of pedal edema is not directly related to the management of
hypertension. Side effects of some hypertensive agents may interfere with sexual function,
Medical-Surgical Nursing
FULL Test Bank for Davis Advantage for
Understanding Medical-Surgical
Nursing, 7th Edition CHAPTER 1-57 by
Linda S. Williams (ORIGINAL PDF)
The nurse hears the presence of secretions in the lungs and determines the client, post
thoracotomy, needs to be suctioned. What steps will the nurse include in the suctioning
procedure? (Select all that apply.)
A.
Perform hand hygiene.
B.
Position in no less than a semi-Fowler's position.
C.
, 2
Medical-Surgical Nursing
Lubricate the suction catheter with a petroleum-based product.
D.
Insert the catheter with the suction on.
E.
Listen for breath sounds.
F.
Hyperoxygenate the client.
- Correct Answer :A, B, E, F
Rationale:
The suction catheter does need to be lubricated, but with a water-based product, not a
petroleum-based product. The suction catheter needs to be inserted with the suction off, not
on. Suction should be applied intermittently while withdrawing the catheter. The remainder
are steps in the suction process.
A client has newly diagnosed diabetes. To delay the onset of microvascular and
macrovascular complications in this client, the nurse stresses that the client take which
action?
A) Restrict fluid intake.
B) Prevent ketosis.
C) Control hyperglycemia.
D) Prevent hypoglycemia. –
Correct Answer :C
Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications.
Maintaining tight glycemic control will help delay the onset of complications. Preventing
hypoglycemia and ketosis, although important, is not as important as maintaining daily
, 3
Medical-Surgical Nursing
glycemic control. Restricting fluid intake is not part of the treatment plan for clients with
diabetes.
Which interventions are necessary to provide safe, quality care to a patient receiving enteral
tube feedings? SELECT ALL THAT APPLY!!
A) check the residual volume every 4-6 hours
B) use clean technique when changing the feeding system
C) keep the head of the beg elevated at least 30 degrees
D) change the feeding bag & tubing every 12 hours
E) allow closed system containers to hang for 24 hours –
Correct Answer :A,B,C,E
A client with a pressure ulcer has the following laboratory values: white blood count
8000/mm3, prealbumin 15.2 mg/dL, albumin 4.2 mg/dL, and lymphocyte count 2000/mm3.
Which action by the nurse is most appropriate?
A) Request a dietary consult.
B) Assess the client's vital signs.
C) Document the findings.
D) Place the client in isolation. –
Correct Answer :A
Albumin, prealbumin, and lymphocyte counts all give information related to nutritional status.
The albumin and lymphocyte counts given are normal. The white blood cell count is not
directly related to nutritional status. The prealbumin count is low and is a more specific
indicator of nutritional status than is the albumin count. This puts the client at risk for
impaired wound healing, so the nurse should request a dietary consult.
, 4
Medical-Surgical Nursing
A nurse is explaining to a student nurse about perfusion. The nurse knows the student
understands the concept of perfusion when the student states, "Perfusion
A) is a normal function of the body, and I don't have to be concerned about it."
B) varies as a person ages, so I would expect changes in the body."
C) is monitored by the physician, and I just follow orders."
D) is monitored by vital signs and capillary refill." –
Correct Answer :D
The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows
the nurse to know if perfusion is adequate to maintain vital organs. The nurse does have to be
concerned about perfusion. Perfusion is not only monitored by the physician but the nurse
too. Perfusion does not always change as the person ages.
The nurse is a assessing a client with hypertension. Which client outcome is indicative of
effective hypertension management?
A) No complaints of sexual dysfunction occur.
B) Pedal edema is not present in the lower legs.
C) No indication of renal impairment is present.
D) The blood pressure reading is 148/94 mm Hg.
- Correct Answer :C
One expected outcome for a client with hypertension is for the client to have no evidence of
target organ damage, such as renal or heart disease, that can occur with poorly managed
hypertension. Development of pedal edema is not directly related to the management of
hypertension. Side effects of some hypertensive agents may interfere with sexual function,
