MEDICAL SURGICAL ASSESSMENT A EXAM QUESTIONS
WITH CORRECT VERIFIED ANSWERS
A nurse is reviewing the laboratory results of a client who is scheduled for a
CT scan with an IV contrast agent. Which of the following laboratory
findings should the nurse report to the provider prior to the procedure?
A) Sodium 136 mEq/L
B) Potassium 4.8 mEq/L
C) Creatinine 1.9 mg/dL
D) Calcium 10 mg/dL - ANS.... -C) Creatinine 1.9 mg/dL
Creatinine 1.9 mg/dL is not within the expected reference range. Therefore,
the nurse should report the finding to the provider before the client has a
CT scan with an IV contrast agent. This finding places the client at risk for
developing contrast-induced nephropathy.
A nurse is monitoring a client who is taking Acarbose. Which of the
following findings should the nurse identify as an adverse effect of the
medication?
A) Polyuria
B) Abdominal cramps
C) Renal insufficiency
D) Insomnia - ANS.... -B) Abdominal cramps
,Acarbose affects the gastrointestinal system. Therefore, the nurse should
monitor the client for abdominal cramping, rumbling bowel sounds, and
diarrhea as adverse effects of this medication.
A nurse is assisting with the care of a client who had a cardiac
catheterization via the right femoral artery. Which of the following actions
should the nurse take to prevent post procedure complications? (Select all)
A) Monitor the insertion site for bleeding
B) Position the affected extremity at a 45 degree angle
C) Restrict the client's fluid intake
D) Maintain the pressure dressing
E) Check the client's peripheral pulses - ANS.... -A) Monitor the insertion
site for bleeding
The nurse should monitor the client's insertion site for manifestations of
hemorrhaging.
D) Maintain the pressure dressing.
The nurse should maintain the client's pressure dressing to prevent
hemorrhaging and allow for the cannulation site to heal.
E) Check the client's peripheral pulses.
The nurse should assess the client's peripheral pulses to help identify signs
of arterial occlusion.
,A nurse is contributing to the plan of care for a client who has chronic
obstructive pulmonary disease (COPD) and is dyspneic. Which of the
following interventions should the nurse include in the plan?
A) Encourage abdominal breathing
B) Direct the client to inhale with pursed lips
C) Set the oxygen therapy at 5L/min
D) Instruct the client to lean back while coughing - ANS.... -A) Encourage
abdominal breathing
The nurse should encourage abdominal breathing, which reduces the
workload on the accessory muscles of respiration during dyspneic
episodes.
A nurse is preparing to administer phytonadione 7 mg subcutaneously to a
client who has an INR of 4. Available is phytonadione 10 mg/mL. How
many mL should the nurse administer? (Round the answer to the nearest
tenth. Use a leading zero is it applies. Do not use a trailing zero. - ANS.... -
7mg/10 mg *1mL= 0.7 mL
A nurse is examining a client's IV site and notes a red line up his arm. The
client reports a throbbing, burning pain at the IV site. The nurse should
identify that the client's manifestations indicate which of the following
complications of IV therapy?
A) Thrombophlebitis
B) Infiltration
C) Hematoma
D) Venous spasms - ANS.... -A) Thrombophlebitis
, The nurse should identify pain, warmth, and a red streak up the arm as
indications of thrombophlebitis.
A nurse is reinforcing teaching about management of constipation with a
client who has hypothyroidism. Which of the following should the nurse
include in the teaching?
A) Increase intake of fiber-rich foods
B) Take a laxative every morning
C) Maintain a fluid intake of 1200 mL per day
D) Limit activity to preserve energy - ANS.... -A) Increase intake of fiber-rich
foods
The nurse should instruct the client to increase the amount of fiber-rich
foods in his diet. Dried beans and brown rice are examples of fiber-rich
foods.
A nurse is caring for a client who has a compound fracture of the femur and
was placed in balanced suspension skeletal traction 4 days ago. Which of
the following actions should the nurse take?
A) Perform pin site care daily
B) Remove the overbed trapeze
C) Remove the boot every 2 hr
D) Keep the weights on a stable, flat surface - ANS.... -A) Perform pin site
care daily
WITH CORRECT VERIFIED ANSWERS
A nurse is reviewing the laboratory results of a client who is scheduled for a
CT scan with an IV contrast agent. Which of the following laboratory
findings should the nurse report to the provider prior to the procedure?
A) Sodium 136 mEq/L
B) Potassium 4.8 mEq/L
C) Creatinine 1.9 mg/dL
D) Calcium 10 mg/dL - ANS.... -C) Creatinine 1.9 mg/dL
Creatinine 1.9 mg/dL is not within the expected reference range. Therefore,
the nurse should report the finding to the provider before the client has a
CT scan with an IV contrast agent. This finding places the client at risk for
developing contrast-induced nephropathy.
A nurse is monitoring a client who is taking Acarbose. Which of the
following findings should the nurse identify as an adverse effect of the
medication?
A) Polyuria
B) Abdominal cramps
C) Renal insufficiency
D) Insomnia - ANS.... -B) Abdominal cramps
,Acarbose affects the gastrointestinal system. Therefore, the nurse should
monitor the client for abdominal cramping, rumbling bowel sounds, and
diarrhea as adverse effects of this medication.
A nurse is assisting with the care of a client who had a cardiac
catheterization via the right femoral artery. Which of the following actions
should the nurse take to prevent post procedure complications? (Select all)
A) Monitor the insertion site for bleeding
B) Position the affected extremity at a 45 degree angle
C) Restrict the client's fluid intake
D) Maintain the pressure dressing
E) Check the client's peripheral pulses - ANS.... -A) Monitor the insertion
site for bleeding
The nurse should monitor the client's insertion site for manifestations of
hemorrhaging.
D) Maintain the pressure dressing.
The nurse should maintain the client's pressure dressing to prevent
hemorrhaging and allow for the cannulation site to heal.
E) Check the client's peripheral pulses.
The nurse should assess the client's peripheral pulses to help identify signs
of arterial occlusion.
,A nurse is contributing to the plan of care for a client who has chronic
obstructive pulmonary disease (COPD) and is dyspneic. Which of the
following interventions should the nurse include in the plan?
A) Encourage abdominal breathing
B) Direct the client to inhale with pursed lips
C) Set the oxygen therapy at 5L/min
D) Instruct the client to lean back while coughing - ANS.... -A) Encourage
abdominal breathing
The nurse should encourage abdominal breathing, which reduces the
workload on the accessory muscles of respiration during dyspneic
episodes.
A nurse is preparing to administer phytonadione 7 mg subcutaneously to a
client who has an INR of 4. Available is phytonadione 10 mg/mL. How
many mL should the nurse administer? (Round the answer to the nearest
tenth. Use a leading zero is it applies. Do not use a trailing zero. - ANS.... -
7mg/10 mg *1mL= 0.7 mL
A nurse is examining a client's IV site and notes a red line up his arm. The
client reports a throbbing, burning pain at the IV site. The nurse should
identify that the client's manifestations indicate which of the following
complications of IV therapy?
A) Thrombophlebitis
B) Infiltration
C) Hematoma
D) Venous spasms - ANS.... -A) Thrombophlebitis
, The nurse should identify pain, warmth, and a red streak up the arm as
indications of thrombophlebitis.
A nurse is reinforcing teaching about management of constipation with a
client who has hypothyroidism. Which of the following should the nurse
include in the teaching?
A) Increase intake of fiber-rich foods
B) Take a laxative every morning
C) Maintain a fluid intake of 1200 mL per day
D) Limit activity to preserve energy - ANS.... -A) Increase intake of fiber-rich
foods
The nurse should instruct the client to increase the amount of fiber-rich
foods in his diet. Dried beans and brown rice are examples of fiber-rich
foods.
A nurse is caring for a client who has a compound fracture of the femur and
was placed in balanced suspension skeletal traction 4 days ago. Which of
the following actions should the nurse take?
A) Perform pin site care daily
B) Remove the overbed trapeze
C) Remove the boot every 2 hr
D) Keep the weights on a stable, flat surface - ANS.... -A) Perform pin site
care daily
