MSN 5410 Advanced Medical Surgical Nursing Final Exam Fall 2020 Practice Questions

MSN 5410 Advanced Medical Surgical Nursing Final Exam Fall 2020 Practice Questions 1. The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? 1. Urinary output of 20 mL/hour 2. Temperature of 37.6°C (99.6°F) 3. Blood pressure of 100/70 mm Hg 4. Serous drainage on the surgical dressing 2. Which client is at risk for the development of a sodium level at 130 mEq/L (130 mmol/L)? 1. The client who is taking diuretics 2. The client with hyperaldosteronism 3. The client with Cushing's syndrome 4. The client who is taking corticosteroids 3. A health care provider prescribes genetic testing for a client who has a family history of colorectal cancer. Which action should the nurse take before scheduling the client for the procedure? a. Confirm that informed consent was obtained and placed on the client’s chart. b. Provide genetic counseling to the client and the client’s family members. c. Assess if the client is prepared for the risk of psychological side effects. d. Respect the client’s right not to share the results of the genetic test. 4. A nurse cares for a pregnant client who has a family history of sickle cell disease. The client is unsure if she wants to participate in genetic testing. What action should the nurse take? a. Provide information about the risks and benefits of genetic testing. b. Empathize with the client and share a personal story about a hereditary disorder. c. Teach the client that early detection can minimize transmission to the fetus. d. Advocate for the client and her baby by encouraging genetic testing. 5. The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? 1. Weight loss and dry skin 2. Flat neck and hand veins and decreased urinary output 3. An increase in blood pressure and increased respirations 4. Weakness and decreased central venous pressure (CVP) 6. The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client’s record and determines that the client is at risk for developing the potassium deficit because of which situation? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison’s disease 4. Uric acid level of 9.4 mg/dL (559 μmol/L) 7. The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse’s findings? 1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) 2. pH 7.35, Paco2 40 mm Hg (40 mm Hg) 3. pH 7.50, Paco2 52 mm Hg (52 mm Hg) 4. pH 7.52, Paco2 28 mm Hg (28 mm Hg) 8. The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing base products. 9. A client had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 1500. The nurse making rounds at 1545 finds that the client is complaining of a pounding headache and is dyspneic, experiencing chills, and apprehensive, with an increased pulse rate. The intravenous (IV) bag has 400 mL remaining. The nurse should take which action first? 1. Slow the IV infusion. 2. Sit the client up in bed. 3. Remove the IV catheter. 4. Call the health care provider (HCP). 10. The nurse provides a list of instructions to a client being discharged to home with a peripherally inserted central catheter (PICC). The nurse determines that the client needs further instructions if the client made which statement? 1. “I need to wear a MedicAlert tag or bracelet.” 2. “I need to restrict my activity while this catheter is in place.” 3. “I need to keep the insertion site protected when in the shower or bath.” 4. “I need to check the markings on the catheter each time the dressing is changed.” 11. The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? 1. Urinary output of 20 mL/hour 2. Temperature of 37.6 °C (99.6 °F) 3. Blood pressure of 100/70 mm Hg 4. Serous drainage on the surgical dressing 12. The nurse is teaching a client about coughing and deep-breathing techniques to prevent postoperative complications. Which statement is most appropriate for the nurse to make to the client at this time as it relates to these techniques? 1. “Use of an incentive spirometer will help prevent pneumonia.” 2. “Close monitoring of your oxygen saturation will detect hypoxemia.” 3. “Administration of intravenous fluids will prevent or treat fluid imbalance.” 4. “Early ambulation and administration of blood thinners will prevent pulmonary embolism.” 13. A patient has scleroderma manifested by CREST (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action will the nurse include in the plan of care? a. Avoid use of capsaicin cream on hands. b. Keep the environment warm and draft free. c. Obtain capillary blood glucose before meals. d. Assist to bathroom every 2 hours while awake. 14. Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep 15. A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/μL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. CD4+ cell count trajectory b. HIV genotype and phenotype c. Patient’s tolerance for potential medication side effects d. Patient’s ability to follow a complex medication regimen 16. The nurse is advising a clinic patient who was exposed a week ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient’s antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient? b. “You do not need to fear infecting others.” c. “Since you don’t have symptoms and you have had a negative test, you do not have HIV).” d. “We won’t know for years if you will develop acquired immunodeficiency syndrome (AIDS).” 17. A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value? a. IgE c. Basophils b. IgA d. Neutrophils 18. A patient is anxious and reports difficulty breathing after being stung by a wasp. What is the nurse’s priority action? a. Provide high-flow oxygen. c. Assess the patient’s airway. b. Administer antihistamines. d. Remove the stinger from the site. 19. A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. “Benign tumors do not cause damage to other tissues.” b. “Benign tumors are likely to recur in the same location.” d. “Malignant cells reproduce more rapidly than normal cells.” 20 When admitting a patient with stage III pressure ulcers on both heels, which information obtained by the nurse will have the most impact on wound healing? a. The patient has had the heel ulcers for 6 months. b. The patient takes oral hypoglycemic agents daily. c. The patient states that the ulcers are very painful. d. The patient has several incisions that formed keloids. 21. The nurse caring for a patient admitted with burns over 30% of the body surface assesses that urine output has dramatically increased. Which action by the nurse would best support maintaining kidney function? A. Monitor white blood cells (WBCs). B. Continue to measure the urine output. C. Assess that blisters and edema have subsided. D. Encourage the patient to eat an adequate number of calories. 22. The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client? 1. A low respiratory rate 2. Diminished breath sounds 3. The presence of a barrel chest 4. A sucking sound at the site of injury 23. An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse prepare for the client? 1. Face tent 2. Venturi mask 3. Aerosol mask 4. Tracheostomy collar 24. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? 1. Call a code. 2. Call the health care provider. 3. Check the client’s status and lead placement. 4. Press the recorder button on the electrocardiogram console. 25. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. 26. The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats/minute. The nurse determines that the client is experiencing which dysrhythmia? a. atrial flutter b. ventricular fibrillation c. atrial fibrillation d. ventricular tachycardia 27. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment could be used to evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Monitor for elevated white blood cell count. 28. The nurse is caring for a client immediately after removal of the endotracheal tube. The nurse should report which sign immediately if experienced by the client? A. Stridor B. Occasional, pink-tinged sputum C. Respiratory rate of 24 breaths/minute D. A few basilar lung crackles on the right 29. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis 30. Which vital sign is most important for the nurse to monitor in a patient receiving general anesthesia in the post anesthesia care unit? a) Pulse b) Blood pressure d) Body temperature 31. The nurse is evaluating a patient’s cardiogram (ECG) rhythm strip. The nurse notes the presence of a U wave. What action by the nurse is priority? a) Check the patient’s lead placement b) Prepare to administer magnesium sulfate c) Document the findings in the patient’s chart d) Request that a stat potassium level is obtained. 32. A nurse working in a burn unit is caring for a patient with extensive burns that affect more than 40% of the total body surface (TBS). The patient is now in day #6 post burn. The patient has been complaining of nausea, vomiting, moderate abdominal bloating, and diffuse discomfort in his belly. During the assessment the nurse finds a urinary output of about 4L in 24 hours (polyuria), and absent of the bowel sounds in all 4 quadrants. The nurse suspects which of the following: a) Hypovolemic shock. b) Mechanical obstruction of the small intestine. c) Mesenteric thrombosis. d) Paralytic ileus. 33. Intravenous heparin therapy is prescribed for a client with A. Fib. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? A- Vitamin K B- Protamine Sulfate C- Potassium Chloride D- Aminocaproic acid. 34. The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? a. Cyanosis b. Arm edema c. Periorbital edema d. Mental status change 35. The nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse interpret the client’s rhythm? a. Atrial fibrillation b. Sinus tachycardia c. Ventricular fibrillation d. Ventricular tachycardia 36. The nurse is caring for a client who has just been prescribed a glucocorticoid to treat an exacerbation of ulcerative colitis. What teaching will the nurse provide? a. Decrease the drug dose during the next exacerbation. b. Report fever to health care provider immediately. c. Determine if the client's insurance covers payment for this medication. d. This drug will act as an antidiarrheal. 37. Which teaching will the nurse provide when discharging a client with chronic pancreatitis? a. Weight reduction and daily exercise regimen b. Constipation precautions, including daily laxative use c. Dietary adjustments to include avoiding high-fat food, caffeine, and alcohol d. Relaxation techniques and stress management 38. The nurse is caring for a patient who is admitted with a serum sodium level of 120 mEq/L. Which is the most important intervention for the nurse to perform? A) Perform regular neurologic checks and institute seizure precautions B) Assess for signs and symptoms of digoxin (Lanoxin) toxicity. C) Administer hypotonic IV solutions as ordered by the physician D) Encourage the patient to eat foods that are high in sodium. 39. The nurse is caring for a patient with advanced colon cancer. The patient is to have surgery to relieve a bowel obstruction that has been causing unrelenting vomiting and abdominal pain. What type of surgery will this patient undergo? A) Reconstructive B) Diagnostic C) Ablative D) Palliative 40. The nurse works with clients who have hearing problems. Which action by a client best indicates goals for an important diagnosis have been met? a. Babysitting the grandchildren several times a week b. Having an adaptive hearing device for the television c. Being active in community events and volunteer work d. Responding agreeably to suggestions for adaptive devices 41. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCK in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued? a. Narrowed QRS complex b. Shortened PR interval c. Tall peaked T waves d. Prominent U wave 42. An older patient with osteoarthritis is preparing for discharge. Which of the following information is correct? a. Increased physical activity and daily exercise will help decrease discomfort associated with the condition. b. Joint pain will diminish after a full night of rest. c. Nonsteroidal anti-inflammatory medications should be taken on an empty stomach. d. Acetaminophen (Tylenol) is more effective anti-inflammatory than ibuprofen (Motrin). 43. Which assessment information is most important for the nurse to obtain when evaluating whether treatment of a patient with anaphylactic shock has been effective? a. Heart rate c. Blood pressure b. Orientation d. Oxygen saturation 44. Which information from a patient helps the nurse confirm a diagnosis of chronic stable angina? a. “The pain wakes me up at night.” b. “The pain is level 3 to 5 (0 to 10 scale).” c. “The pain has gotten worse over the last week.” d. “The pain goes away after a nitroglycerin tablet.” 45. After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? a. A 39-yr-old patient with pericarditis who is complaining of sharp, stabbing chest pain b. A 56-yr-old patient with variant angina who is scheduled to receive nifedipine (Procardia) c. A 65-yr-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today’s planned discharge d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI) 46. A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium (Coumadin) has a prothrombin time (PT) of 35 seconds. Based on the prothrombin time, the nurse anticipates which of the following prescriptions? A. Adding a dose of heparin sodium B. Holding the next dose of warfarin C. Increasing the next dose of warfarin D. Administering the next dose of warfarin 47. Which client is at risk for the development of a sodium level at 130mEq/L(130mmol/L)? A. The client who is taking diuretics B. The client with hyperaldosteronism C. The client with Cushing’s syndrome D. The client who is taking corticosteroids 48. The nurse is caring for a patient with an acute pancreatitis. Which subjective and objective assessments would the nurse report immediately? a. Client is lying with knees drawn up to the abdomen and trunk flexed. b. Client states,” my lips are tingling and numb” c. Foul-smelling, fatty stool. d. Temperature of 102 F (39 C) and increasing abdominal pain. 49. The nurse is educating a patient recently diagnosed with anaphylactic allergy to latex. Which statement made by the client indicates that the clients understood the condition correctly? a. I do not need to worry about my allergy when I am outside of a health care environment b. I just need to check labels to ensure products do not contain latex and I will be fine c. I should always carry my Epi-pen in case I have difficulty breathing d. I should take better care of myself and eat healthy food like bananas and chestnuts 50. A client is scheduled for insertion of an inferior vena cava (IVC) filter. Nurse Patricia consults the physician about withholding which regularly scheduled medication on the day before the surgery? A. Potassium Chloride B. Warfarin Sodium C. Furosemide D. Docusate Sodium 51. During the initial postoperative period of the client’s stoma. The nurse evaluates which of the following observations should be reported immediately to the physician? A. Stoma is dark red to purple B. Stoma oozes a small amount of blood C. Stoma is slightly edematous D. Stoma does not expel stool 52. The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should be taken next? A. Remove the intravenous (IV) line. B. Run a solution of 5% dextrose in water. C. Run normal saline at a keep-vein-open rate. D. Obtain a culture of the tip of the catheter device removed from the client. 53. A patient has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? a. Hot, flushed feeling b. Sudden chills and fever c. Chest pain that occurs suddenly d. Dyspnea when deep breaths are taken 54. The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? a. Chest x-ray b. Bronchoscopy c. Sputum culture d. Tuberculin skin test 55. The nurse is evaluation a client’s response to cardioversion. Which assessment would be the priority? a. Blood pressure b. Airway patency c. Oxygen flow rate d. Level of consciousness 56. Which assessment finding is consistent with fluid overload? a. Heart murmurs b. Decreased pulse rate c. Decreased respiratory rate d. Moist crackles in the lungs upon auscultation 57. Which cardiac rhythm typically deteriorates into ventricular fibrillation? a. Atrial flutter b. Atrial fibrillation c. Ventricular tachycardia d. Third-degree heart block 58. A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect? A. Diverticulosis B. Hypercalcemia C. Hypocalcemia D. Irritable bowel syndrome ANSWERS 1. 1 2. 1 3. A 4. A 5. 3 6. 2 7. 1 8. 1 9. 1 10. 2 11. 1 12. 1 13. B 14. B 15. D 16. A 17. A 18. C 19. C 20. B 21. B 22. B 23. 2 24. 3 25. 1 26. C 27. A 28. A 29. B 30. C 31. D 32. D 33. B 34. C 35. A 36. B 37. C 38. A 39. D 40. C 41. C 42. A 43. D 44. D 45. D 46. B 47. A 48. D 49. C 50. B 51. A 52. C 53. C 54. C 55. B 56. D 57. C 58. B