Med Surg Exam Test Bank A1 100 Questions & Answers Updated2023 Rated A+

MED SURG EXAM TEST BANK A1 100 QUESTIONS & ANSWERS UPDATED2023 RATED A+ • A nurse is preparing to administer thrombolytic therapy to a client who had an ischemic stroke. Which of the following is an appropriate nursing action? -Start the therapy within 8 hrs. (within 6 hrs.) -Insert an indwelling urinary catheter after therapy begins -Monitor blood pressure every 30 minutes during infusion. -Elevate the head of the bed between 25 and 30 degrees (to reduce ICP & promote venous drainage, ATI page 89) • A nurse is teaching a client about the use of an incentive spirometer. Which of the following instructions should the nurse include in the teaching? -Place hands on the upper abdomen during inhalation. -Exhale slowly through pursed lips. -Hold breath about 3 to 5 seconds before exhaling. (ATI page 138) -Position the mouthpiece 2.5 cm (1 in) from the mouth. • A nurse is assessing a client who is 12 hr. postoperative following a colon resection. Which of the following findings should the nurse report to the surgeon? -Heart rate 90/mm -Hgb 8.2 g/dL -Gastric ph of 3.0 -Absent bowel sounds Recall that bowel sounds are altered in patients with obstruction; absent bowel sounds imply total obstruction. QSEN: Safety (Book page 1143) • A nurse is caring for a client who has diabetes insipidus. Which of the following medications should the nurse plan to administer? -Regular Insulin -Furosemide -Desmopressin -Lithium Carbonate Teach patients with diabetes insipidus the proper way to self-administer desmopressin orally or by nasal spray. Management focuses on controlling symptoms with drug therapy. -The most preferred drug is desmopressin acetate (DDAVP), a synthetic form of vasopressin given orally, as a sublingual “melt,” or intranasally in a metered spray. The frequency of dosing varies with patient responses. Teach patients that each metered spray delivers 10 mcg and those with mild DI may need only one or two doses in 24 hours. -For more severe DI, one or two metered doses two or three times daily may be needed. • A nurse is admitting a client who has arthritic pain and reports taking ibuprofen several times daily for 3 years. Which of the following test should the nurse monitor? Stool occult blood -Urine for white blood cells -Fasting blood glucose -Serum calcium Assess for drug-related blood loss such as that caused by NSAIDs by checking the stool for gross or occult blood. Older white women are the most likely to experience GI bleeding as a result of taking these medications. (Book page 324) • A nurse in the emergency department is assessing a client. Which of the following actions should the nurse take first? (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.) -Obtain a sputum sample for culture. -Prepare the client for a chest x-ray. -Initiate airborne precautions (question sounds like a respiratory issue) -Administer ondansetron. • A nurse is contacting the provider of a client who has cancer and is experiencing breakthrough pain. Which of the following prescriptions should the nurse anticipate? -Intravenous dexamethasone -Transmucosal fentanyl -Oral acetaminophen- not strong enough -Intramuscular meperidine Fentanyl is a lipophilic (readily absorbed in fatty tissue) opioid and, as such, has a fast onset and short duration of action. It is recommended opioid for patients with end-organ failure because it has no clinically relevant metabolites. It also produces fewer hemodynamic adverse effects than other opioids; therefore, it is often preferred in patients who are hemodynamically unstable such as the critically ill. (Book page 59) • A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor. Which of the following should the nurse analyze to determine whether the client is experiencing a myocardial infarction? -QRS duration -ST segment -T-wave PR interval Examine the ST segment. The normal ST segment begins at the isoelectric line. ST elevation or depression is significant if displacement is 1 mm (one small box) or more above or below the line and is seen in two or more leads. ST elevation may indicate problems such as myocardial infarction, pericarditis, and hyperkalemia. ST depression is associated with hypokalemia, myocardial infarction, or ventricular hypertrophy. (Book page 670) • A nurse is teaching a client who has ovarian cancer about skin care following radiation treatment. Which of the following instructions should the nurse include? -Apply over the counter moisturizer to the radiation site -Cover the radiation site loosely with a gauze wrap before dressing -Use a soft washcloth to clean the area around the radiation site -Pat the skin on the radiation site to dry it. (Book page 390) Skin Protection During Radiation Therapy • Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team. • Use your hand rather than a washcloth when cleansing the therapy site to be gentler. • Rinse soap thoroughly from your skin. • If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. • Dry the irradiated area with patting rather than rubbing motions; use a clean, soft towel or cloth. • Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology department on your skin at the radiation site. • Wear soft clothing over the skin at the radiation site. • Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. • Avoid exposure of the irradiated area to the sun: • Protect this area by wearing clothing over it. • Try to go outdoors in the early morning or evening to avoid the more intense sun rays. • When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 AM to 7 PM). • Avoid heat exposure. • A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client has bounding peripheral pulses, hypertension, and distended jugular veins. The nurse should anticipate administering which of the following prescribed medications? Acetaminophen -Furosemide (this patient has fluid overload from the transfusion) Diphenhydramine Pantoprazole • A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of hypomagnesemia. Which of the following findings indicates effectiveness of the medication? -Lungs clear -Hypoactive bowel sounds- Reduced motility, anorexia, nausea, constipation, and abdominal distention are common. A paralytic ileus may occur when hypomagnesemia is severe. -Blood pressure 90/50 mm Hg-hypomagnesemia causes hypertension, but this is too low, abnormal -Apical pulse 82/min One aspect of the conduction problems is that, when serum magnesium levels are low, intracellular potassium levels are also low. This changes the resting membrane potential in cardiac muscle cells, slowing normal conduction and triggering ectopic beats. • A nurse is preparing a client for a lumbar puncture. Which of the following images indicates the position the nurse should assist the client into for this procedure? - “Cannonball position on the side” picture #4 (ATI page 20) • A nurse is reviewing a clients ABG results: pH 7.42, PaCO2 30 mm Hg, and HCO3 -21 mEq/L. The nurse should recognize these findings as an indication of which of the following conditions? -Compensated respiratory alkalosis -Uncompensated respiratory acidosis -Metabolic acidosis -Metabolic alkalosis • A nurse is preparing to administer daily medications to a client who is undergoing a procedure at 1000 that requires IV contrast dye. Which of the following routine medications to give at 0800 should the nurse withhold? -Metoprolol -Metformin -Fluticasone -Valproic Acid • A nurse is planning care for a client who is experiencing seizures secondary to meningitis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) -Assist the client to ambulate every 4 hr. -Place a tongue blade at the bedside. -Have suction equipment at the bedside. -Dim the overhead lights. -Apply a warming blanket. • A nurse is caring for a client who has a pressure ulcer with necrotic tissue and requires wet to damp dressing changes daily. Which of the following types of debridement should the nurse include in the plan of care? -Enzymatic -Surgical -Autolytic -Mechanical • A nurse is caring for a female who has toxic shock syndrome. Which of the following findings should the nurse expect? -Elevated platelet count -Decreased total bilirubin -Generalized rash -Hypertension • A nurse is preparing to administer a medication for a client though a non-tunneled percutaneous central catheter. Which of the following actions should the nurse take? -Close the inline clamp -Apply a local anesthetic to the skin -Don sterile gloves -Flush the catheter with 10 mL of 0.9% sodium chloride. • A nurse is caring for a client who was admitted with nausea, vomiting, and a possible bowel obstruction. An NG tube is placed and set to a low intermittent suction. Which of the following findings should the nurse report to the provider? -The client reports being extremely thirst with a sore throat -The drainage is bright green in color with brown fecal material -The amount of drainage is gradually decreasing -The client’s abdomen becomes distended and firm. • A nurse is reviewing the medical record of a client who has diabetes insipidus. Which of the following findings should the nurse expect? -Elevated blood pressure -Hypothermia -Urine specific gravity 1.001 -Bun 15 mg/d: • The nurse is caring for a client who has hyperthyroidism and develops thyroid storm. Which of the following instructions should the nurse give to the client regarding management of thyroid storm? -You will need to begin taking an ACE inhibition medication -You will need a pacemaker to increase your heart rate -You will need a cooling blanket to lower your body temperature -You will need additional thyroid supplementation • The nurse is reviewing the medical record of a client who has acute gout. The nurse should expect an increase in which of the following laboratory results? -Uric acid -Intrinsic factor -Creatinine kinase -Chloride level • A nurse is preparing to administer peritoneal dialysis to a client. Which of the following actions should the nurse take? -Use clean technique to access the catheter -Chill the dialysate before administration -Hang the drainage bag below the client’s abdomen -Place the client in high-Fowler’s position. • A nurse in the emergency department is caring for a client who has deep partial thickness burns over 30% of his body, including his upper chest and abdomen. Which of the following actions is the nurse priority? -Insert an 18-gauge IV catheter -Administer tetanus toxoid -Check the clients mouth for black particles -Remove the clients burned clothing. • A nurse is teaching a client who is taking an ACE inhibitor for heart failure. Which of the following instructions should the nurse include for home management of heart failure? -Limit daily activity -Obtain daily weight -Monitor intake and output -Use a salt substitute • A nurse is presenting an in-service program about Parkinson’s disease (PD). Which of the following statements should the nurse include in teaching? -PD results form a decreased amount of dopamine in the client’s brain -PD causes clients to have an increased sympathetic nervous system response -PD results in the development of neurofibrillary tangles within the client’s brain -PD manifestations worsen due to the clients decreased production of acetylcholine • A nurse is caring for a client who has a serum sodium level of 150 mEq/L. Which of the following actions should the nurse take? -Increase sodium in the client’s diet -Administer hypotonic IV fluids to the client -Restrict the client’s oral fluid intake -Administer a beta blocker • A nurse is caring for a client who takes lisinopril for hypertension. Which of the following client statements indicates an adverse effect of the medication? -I seem to be bruising more easily -I have a nagging, dry cough -I have a heightened sense of taste -I have to urinate frequently • A nurse is providing discharge teaching to a client following a modified left mastectomy with breast expander. Which of the following statements by the client indicates an understanding of the teaching? -I will perform strength-building arm exercises using a 15-pound weight -I should expect less than 25 mL of secretions per day in the drainage devices -I will keep my left arm flexed at the elbow as much as possible -I will have to wait 2 months before additional saline can be added to my breast expander • A nurse is caring for a client who has diabetes mellitus and has been following a treatment plan for 3 months. Which of the following laboratory results should the nurse monitor to determine longterm glycemic control? -Oral glucose tolerance test results -Fasting blood glucose level -Glycosylated hemoglobin level -Postprandial blood glucose level • A nurse is providing discharge teaching to a client who has chronic urinary tract infections. The client has a prescription for ciprofloxacin 250 mg PO twice daily. Which of the following instructions should the nurse include in the teaching? -Take a laxative to prevent constipation -Drink 2 to 3 L of fluids daily -Take an antacid 30 min before taking the medication -Monitor heart rate once daily • A nurse is providing teaching to a client who has a deep-vein thrombosis (DVT). Which of the following findings should the nurse identify as a risk factor for the development of DVTs? NSAID use Cirrhosis Hypertension Oral contraceptive use • A nurse is caring for client who has Cushing’s disease. Which of the following actions should the nurse take first? (Click on the Exhibit button below for additional information about the client. There are three tabs that contain separate categories of data.) -Auscultate the client’s lung sounds -Check the client’s medication administration record for antihypertensive medications -Determine the need for further glucose monitoring -Verify the client’s understanding of sodium restriction • A nurse is assessing a client who has nephrotic syndrome. Which of the following findings should the nurse expect? -Proteinuria -Hyperalbuminemia -Flank pain -Hypotension • A nurse is preparing to administer a 250 mL IV bolus of dextrose 5% in water to infuse over 2 hr. for a client. The drop factor is 10 gtt./mL. The nurse should set the pump to administer how many gtt./min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) gtt./min (change 2 hours to minutes = 120 minutes) 250 mL x 10 gtts/mL = 21 gtts/mL. 120 mins. • A nurse is caring for an older adult who has not been eating. Which of the following findings indicate dehydration? -Capillary refill of 2 seconds -Engorged neck veins -Crackles auscultated bilaterally -Diminished peripheral pulses (thready pulse) A nurse is assessing a client who has right-sided heart failure. Which of the following assessment findings should the nurse expect to find? -Poor skin turgor -Pitting edema -Oliguria -S3/S4 galloping heart sounds • A nurse is caring for a client who has a newly inserted chest tube. The nurse should clarify which of the following prescriptions with the provider? -Administer morphine 2 mg IV bolus every 3 hr. PRN for pain -Vigorously strip the chest tube twice daily -Notify the provider when tidaling creases -Assist the client out of bed 3 times daily • A nurse is providing discharge teaching to a client who has a permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching? -I need to check my pulse rate every day for a full minute -When a microwave oven I in use, I need to stay out of the room -I need to maintain pressure over the pacemaker site with an elastic bandage -The pacemaker will deliver a shock if I develop a dysrhythmia • A nurse in a clinic is providing preventive teaching to an older adult client during a well visit. The nurse should instruct the client that which of the following immunizations are recommended for healthy adults after age 60? (Select all that apply.) -Influenza -Human Papillomavirus -Meningococcal -Herpes Zoster -Pneumococcal polysaccharide • A nurse is assessing a client who is 4 hr. postoperative following arterial revascularization of the left femoral artery. Which of the following findings should the nurse repot to the provider immediately? -Urine output 150 mL over 4 hr. -Pallor in the affected extremity -Bruising around the incisional site -Temperature of 37.9 C (100.2 F) • A nurse is preparing to discharge a client who has a halo device and is reviewing prescriptions from the provider. The nurse should clarify which of the following prescriptions with the provider? -May place a small pillow under the head when sleeping -Take tub baths instead of showers -Increase intake of fiber-rich foods. -May operate a motor vehicle when no longer taking analgesics • A nurse is assessing for early signs of compartment syndrome for a client who has a short- leg fiberglass cast. Which of the following findings should the nurse expect? -Bounding distal pulses -Intense pain with movement -Capillary refill less than 2 seconds -Erythema of the toes • A nurse is caring for a client who is postoperative following coronary artery bypass surgery and reports shortness of breath. The nurse administers oxygen at 3 L/min and obtains arterial blood gases 60 min later. Which of the following laboratory findings indicates a positive response to the oxygen therapy? -pH 7.32 -PaCO2 34 mm Hg -Pa02 90 mm Hg -Bicarbonate 20 mEq/L • A nurse is preforming a cranial nerve assessment on a client following a head injury. Which of the following findings should the nurse expect if the client has impaired function of the vestibulocochlear nerve (cranial nerve VIII)? -Loss of peripheral vision -Deviation of the tongue from midline -Disequilibrium with movement -Inability to smell • A nurse is caring for a client admitted with a skull fracture. Which of the following assessment findings should be of greatest concern to the nurse? -Bilateral pupil diameter changes from 4 to 2 mm -Glasgow Coma Scale score changes from 14 to 9 -Pulse pressure changes from 30 to 20 mm/hg -WBC count changes from 9,000 to 16,000/mm3 • A nurse is caring for a client who presents to the emergency department after experiencing a heat stroke. Which of the following actions should the nurse take? -Administer an antipyretic -Apply a cooling blanket -Assess axillary temperature every 15 min. -Administer lactated Ringer’s • A nurse is caring for a client who is taking furosemide. The client has a potassium level of 3.1 mEq/L. Which of the following should the nurse assess first? -Muscle weakness -Urine output -Level of orientation -Cardiovascular status