CJE Med-Surg 1 Exam Review – Questions And Answers |
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1. A patient admitted with acute exacerbation of chronic obstructive pulmonary disease
(COPD) is receiving oxygen via nasal cannula at 3 L/min. The patient's arterial blood gases
reveal pH 7.31, PaCO2 58 mmHg, PaO2 62 mmHg, and HCO3 29 mmol/L. Which nursing
action is the most appropriate initial priority?
A. Increase the oxygen flow rate to 5 L/min to improve the PaO2 level.
B. Encourage the patient to perform pursed-lip breathing and monitor respiratory status.
C. Prepare the patient for immediate endotracheal intubation and mechanical ventilation.
D. Administer a rapid-acting intravenous diuretic to reduce fluid overload.
The patient is experiencing compensated respiratory acidosis with moderate hypoxemia,
which is expected in chronic COPD exacerbations. Increasing oxygen aggressively can
abolish the hypoxic drive, worsening hypercapnia. Pursed-lip breathing promotes exhalation
and air trapping reduction without increasing oxygen levels abruptly. Intubation is premature
without clinical deterioration, and diuretics are unindicated without signs of heart failure.
2. A postoperative patient on the surgical unit complains of sudden, sharp chest pain and
severe shortness of breath on the second day following a total hip arthroplasty. Vital signs:
BP 90/60 mmHg, heart rate 125 beats/min, respiratory rate 32 breaths/min, and SpO2 84%
on room air. What is the nurse's immediate priority intervention?
A. Administer sublingual nitroglycerin as prescribed for chest pain.
B. Initiate high-flow oxygen via non-rebreather mask and notify the rapid response team.
C. Position the patient in a flat supine position to maximize cerebral perfusion.
D. Encourage effective coughing and deep breathing exercises.
The patient exhibits classic clinical indicators of a massive pulmonary embolism (tachycardia,
hypotension, severe hypoxemia, and acute dyspnea following orthopedic surgery). Immediate
oxygenation and activation of emergency response teams are critical. Nitroglycerin is
inappropriate for suspected embolic shock, and a flat position worsens respiratory distress.
3. A nurse is caring for a client newly diagnosed with type 1 diabetes mellitus who is
learning self-injection techniques. The client expresses intense fear of needles and states, "I
just cannot give myself this shot." Which therapeutic nursing response is most effective?
A. "You must learn to do this, or you will not be able to leave the hospital."
B. "Don't worry, many people feel this way, but it becomes routine quickly."
C. "Tell me more about what specifically frightens you regarding the injections."
D. "Let's skip the practice session today and try again tomorrow when you are calmer."
,Options A and D are untherapeutic and dismissive or coercive. Option B offers false
reassurance. Option C utilizes open-ended communication to explore the client's underlying
fears, fostering trust and enabling targeted education and support.
4. A client with severe heart failure is prescribed furosemide 40 mg IV push. Before
administering the medication, which laboratory result should the nurse review first?
A. Serum potassium level
B. Fasting blood glucose
C. White blood cell count
D. Partial thromboplastin time
Furosemide is a loop diuretic that causes renal excretion of potassium, placing the client at
high risk for hypokalemia, which can trigger lethal cardiac arrhythmias. Monitoring
potassium before administration is essential. The other labs are not directly impacted by loop
diuretic administration.
5. A nurse assesses a client who is 4 hours post-thyroidectomy. The client reports a tingling
sensation around the mouth and muscle twitching in the fingers. Which piece of equipment
is most critical to keep immediately available at the bedside?
A. Suction canister and tubing
B. Intravenous calcium gluconate
C. Emergency mechanical ventilator
D. Continuous cardiac telemetry box
Perioral tingling and muscle twitching (positive Chvostek's sign) indicate hypocalcemia
resulting from inadvertent damage or removal of the parathyroid glands during thyroid
surgery. IV calcium gluconate must be immediately available to prevent tetany and
laryngospasm. While suction and telemetry are important post-thyroidectomy, calcium is
specific to these neuromuscular symptoms.
6. An adult client is admitted with a diagnosis of syndrome of inappropriate antidiuretic
hormone secretion (SIADH) secondary to bronchogenic carcinoma. Which clinical
manifestation should the nurse expect to find during the assessment?
A. Polyuria and extreme thirst
B. Serum sodium of 122 mEq/L and weight gain
C. Blood pressure of 180/100 mmHg and warm, flushed skin
D. Serum osmolality of 310 mOsm/kg and poor skin turgor
SIADH causes excessive release of antidiuretic hormone, leading to water reabsorption,
dilutional hyponatremia (serum sodium 122 mEq/L), fluid retention manifested by weight
gain, and concentrated urine with low serum osmolality. Polyuria, dehydration, and high
serum osmolality occur in diabetes insipidus, the opposite condition.
, 7. A nurse is caring for a client receiving a transfusion of packed red blood cells (PRBCs).
Twenty minutes into the transfusion, the client develops chills, lower back pain, and
anxiety. What is the nurse's first immediate action?
A. Slow the rate of the blood transfusion and notify the physician.
B. Stop the transfusion immediately and disconnect the blood tubing from the IV access.
C. Administer an oral antipyretic medication prescribed for chills.
D. Flush the intravenous line with 5% dextrose in water.
Lower back pain, chills, and anxiety during a blood transfusion are classic signs of an acute
hemolytic transfusion reaction. The immediate priority is stopping the transfusion and
disconnecting the tubing while maintaining IV access with normal saline using new tubing to
infuse fluids and support blood pressure.
8. A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L.
Which electrocardiographic (ECG) change is the nurse most alert for in this client?
A. U waves
B. Prolonged QT intervals
C. Tall, peaked T waves
D. Flattened ST segments
Hyperkalemia (potassium > 5.0 mEq/L) characteristically manifests on an ECG as tall,
peaked T waves, widened QRS complexes, and prolonged PR intervals, which can progress to
ventricular fibrillation. U waves are associated with hypokalemia, and prolonged QT intervals
are linked to hypocalcemia or hypomagnesemia.
9. A nurse is developing a care plan for an immobile client at high risk for pressure
injuries. Which intervention should be included in the plan of care?
A. Massage bony prominences vigorously every two hours to stimulate blood flow.
B. Position the client at a 90-degree lateral angle when side-lying.
C. Use a draw sheet to lift rather than slide the client when repositioning.
D. Keep the head of the bed elevated to 45 degrees at all times to prevent aspiration.
Lifting clients with a draw sheet prevents friction and shear forces that damage skin integrity.
Massaging bony prominences is contraindicated because it damages deep tissues. A 30-degree
lateral position is recommended rather than 90 degrees to avoid pressure over the greater
trochanter, and continuous 45-degree elevation increases shear risk.
10. A client is admitted to the emergency department with suspected acute appendicitis.
Which assessment finding should the nurse anticipate during abdominal palpation?
A. Pain localized in the right upper quadrant with deep inspiration
B. Rebound tenderness and pain elicited at McBurney's point
C. Hyperactive bowel sounds throughout all four quadrants
D. Pain radiating from the left lower quadrant to the umbilicus
Verified And Well Detailed Answers Plus Rationales |
Guaranteed Pass | Latest Exam Update | Exam Prep | Study
Guide | Practice Test| Download Instant Pdf
1. A patient admitted with acute exacerbation of chronic obstructive pulmonary disease
(COPD) is receiving oxygen via nasal cannula at 3 L/min. The patient's arterial blood gases
reveal pH 7.31, PaCO2 58 mmHg, PaO2 62 mmHg, and HCO3 29 mmol/L. Which nursing
action is the most appropriate initial priority?
A. Increase the oxygen flow rate to 5 L/min to improve the PaO2 level.
B. Encourage the patient to perform pursed-lip breathing and monitor respiratory status.
C. Prepare the patient for immediate endotracheal intubation and mechanical ventilation.
D. Administer a rapid-acting intravenous diuretic to reduce fluid overload.
The patient is experiencing compensated respiratory acidosis with moderate hypoxemia,
which is expected in chronic COPD exacerbations. Increasing oxygen aggressively can
abolish the hypoxic drive, worsening hypercapnia. Pursed-lip breathing promotes exhalation
and air trapping reduction without increasing oxygen levels abruptly. Intubation is premature
without clinical deterioration, and diuretics are unindicated without signs of heart failure.
2. A postoperative patient on the surgical unit complains of sudden, sharp chest pain and
severe shortness of breath on the second day following a total hip arthroplasty. Vital signs:
BP 90/60 mmHg, heart rate 125 beats/min, respiratory rate 32 breaths/min, and SpO2 84%
on room air. What is the nurse's immediate priority intervention?
A. Administer sublingual nitroglycerin as prescribed for chest pain.
B. Initiate high-flow oxygen via non-rebreather mask and notify the rapid response team.
C. Position the patient in a flat supine position to maximize cerebral perfusion.
D. Encourage effective coughing and deep breathing exercises.
The patient exhibits classic clinical indicators of a massive pulmonary embolism (tachycardia,
hypotension, severe hypoxemia, and acute dyspnea following orthopedic surgery). Immediate
oxygenation and activation of emergency response teams are critical. Nitroglycerin is
inappropriate for suspected embolic shock, and a flat position worsens respiratory distress.
3. A nurse is caring for a client newly diagnosed with type 1 diabetes mellitus who is
learning self-injection techniques. The client expresses intense fear of needles and states, "I
just cannot give myself this shot." Which therapeutic nursing response is most effective?
A. "You must learn to do this, or you will not be able to leave the hospital."
B. "Don't worry, many people feel this way, but it becomes routine quickly."
C. "Tell me more about what specifically frightens you regarding the injections."
D. "Let's skip the practice session today and try again tomorrow when you are calmer."
,Options A and D are untherapeutic and dismissive or coercive. Option B offers false
reassurance. Option C utilizes open-ended communication to explore the client's underlying
fears, fostering trust and enabling targeted education and support.
4. A client with severe heart failure is prescribed furosemide 40 mg IV push. Before
administering the medication, which laboratory result should the nurse review first?
A. Serum potassium level
B. Fasting blood glucose
C. White blood cell count
D. Partial thromboplastin time
Furosemide is a loop diuretic that causes renal excretion of potassium, placing the client at
high risk for hypokalemia, which can trigger lethal cardiac arrhythmias. Monitoring
potassium before administration is essential. The other labs are not directly impacted by loop
diuretic administration.
5. A nurse assesses a client who is 4 hours post-thyroidectomy. The client reports a tingling
sensation around the mouth and muscle twitching in the fingers. Which piece of equipment
is most critical to keep immediately available at the bedside?
A. Suction canister and tubing
B. Intravenous calcium gluconate
C. Emergency mechanical ventilator
D. Continuous cardiac telemetry box
Perioral tingling and muscle twitching (positive Chvostek's sign) indicate hypocalcemia
resulting from inadvertent damage or removal of the parathyroid glands during thyroid
surgery. IV calcium gluconate must be immediately available to prevent tetany and
laryngospasm. While suction and telemetry are important post-thyroidectomy, calcium is
specific to these neuromuscular symptoms.
6. An adult client is admitted with a diagnosis of syndrome of inappropriate antidiuretic
hormone secretion (SIADH) secondary to bronchogenic carcinoma. Which clinical
manifestation should the nurse expect to find during the assessment?
A. Polyuria and extreme thirst
B. Serum sodium of 122 mEq/L and weight gain
C. Blood pressure of 180/100 mmHg and warm, flushed skin
D. Serum osmolality of 310 mOsm/kg and poor skin turgor
SIADH causes excessive release of antidiuretic hormone, leading to water reabsorption,
dilutional hyponatremia (serum sodium 122 mEq/L), fluid retention manifested by weight
gain, and concentrated urine with low serum osmolality. Polyuria, dehydration, and high
serum osmolality occur in diabetes insipidus, the opposite condition.
, 7. A nurse is caring for a client receiving a transfusion of packed red blood cells (PRBCs).
Twenty minutes into the transfusion, the client develops chills, lower back pain, and
anxiety. What is the nurse's first immediate action?
A. Slow the rate of the blood transfusion and notify the physician.
B. Stop the transfusion immediately and disconnect the blood tubing from the IV access.
C. Administer an oral antipyretic medication prescribed for chills.
D. Flush the intravenous line with 5% dextrose in water.
Lower back pain, chills, and anxiety during a blood transfusion are classic signs of an acute
hemolytic transfusion reaction. The immediate priority is stopping the transfusion and
disconnecting the tubing while maintaining IV access with normal saline using new tubing to
infuse fluids and support blood pressure.
8. A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L.
Which electrocardiographic (ECG) change is the nurse most alert for in this client?
A. U waves
B. Prolonged QT intervals
C. Tall, peaked T waves
D. Flattened ST segments
Hyperkalemia (potassium > 5.0 mEq/L) characteristically manifests on an ECG as tall,
peaked T waves, widened QRS complexes, and prolonged PR intervals, which can progress to
ventricular fibrillation. U waves are associated with hypokalemia, and prolonged QT intervals
are linked to hypocalcemia or hypomagnesemia.
9. A nurse is developing a care plan for an immobile client at high risk for pressure
injuries. Which intervention should be included in the plan of care?
A. Massage bony prominences vigorously every two hours to stimulate blood flow.
B. Position the client at a 90-degree lateral angle when side-lying.
C. Use a draw sheet to lift rather than slide the client when repositioning.
D. Keep the head of the bed elevated to 45 degrees at all times to prevent aspiration.
Lifting clients with a draw sheet prevents friction and shear forces that damage skin integrity.
Massaging bony prominences is contraindicated because it damages deep tissues. A 30-degree
lateral position is recommended rather than 90 degrees to avoid pressure over the greater
trochanter, and continuous 45-degree elevation increases shear risk.
10. A client is admitted to the emergency department with suspected acute appendicitis.
Which assessment finding should the nurse anticipate during abdominal palpation?
A. Pain localized in the right upper quadrant with deep inspiration
B. Rebound tenderness and pain elicited at McBurney's point
C. Hyperactive bowel sounds throughout all four quadrants
D. Pain radiating from the left lower quadrant to the umbilicus
