Adult Health Nursing II – Advanced Medical-
Surgical Nursing Exam Review
Question 1:
A client with systemic sclerosis reports increasing difficulty swallowing and
frequent episodes of heartburn. Which nursing intervention is most appropriate?
A. Encourage three large meals daily
B. Have the client lie flat after meals
C. Encourage small, frequent meals and upright positioning after eating
D. Restrict all fluids between meals
Correct Answer: C. Encourage small, frequent meals and upright positioning after
eating
Rationale: Systemic sclerosis can cause esophageal dysmotility and
gastroesophageal reflux because of smooth-muscle fibrosis. Small meals reduce
gastric distention, while remaining upright after eating reduces reflux and
aspiration risk. The client should also avoid eating shortly before bedtime and
follow prescribed acid-suppressive therapy.
Question 2:
A client with rheumatoid arthritis has been prescribed methotrexate. Which
laboratory value is most important for the nurse to monitor regularly?
A. Serum calcium
B. Liver enzymes
,C. Serum sodium
D. Amylase
Correct Answer: B. Liver enzymes
Rationale: Methotrexate can cause hepatotoxicity, particularly with prolonged
therapy. Regular monitoring of AST and ALT helps identify liver injury early. The
medication can also suppress bone marrow, so complete blood counts are
important. Clients should avoid excessive alcohol because it can increase hepatic
toxicity.
Question 3:
A client with gout is experiencing severe pain and swelling in the great toe. Which
instruction should the nurse provide during an acute attack?
A. Increase intake of organ meats
B. Apply vigorous massage to the joint
C. Rest the affected joint and use prescribed anti-inflammatory medication
D. Begin strenuous exercise immediately
Correct Answer: C. Rest the affected joint and use prescribed anti-inflammatory
medication
Rationale: Acute gout results from inflammatory deposition of monosodium urate
crystals within a joint. Rest, elevation, local cooling, and prescribed anti-
inflammatory therapy can reduce pain and inflammation. Vigorous massage may
worsen discomfort. Long-term urate-lowering therapy is generally managed
separately from acute symptom control.
,Question 4:
A client with systemic lupus erythematosus is prescribed hydroxychloroquine.
Which assessment should the nurse emphasize during long-term treatment?
A. Visual changes
B. Hearing loss
C. Urinary frequency
D. Increased appetite
Correct Answer: A. Visual changes
Rationale: Hydroxychloroquine can cause retinal toxicity, particularly with
prolonged use. Clients require regular ophthalmologic examinations and should
report visual disturbances promptly. Monitoring is important even when the client
has no symptoms because retinal injury may initially be subtle and can become
irreversible if not detected.
Question 5:
A client with osteoporosis asks why weight-bearing exercise has been
recommended. Which response is most accurate?
A. It eliminates the need for calcium
B. It stimulates bone remodeling and helps maintain bone strength
C. It prevents all future fractures
D. It increases cartilage production
Correct Answer: B. It stimulates bone remodeling and helps maintain bone
strength
, Rationale: Weight-bearing and resistance activities provide mechanical
stimulation that supports bone remodeling and helps preserve bone mineral density.
Exercise also improves muscle strength and balance, reducing fall risk. It does not
eliminate the need for adequate calcium and vitamin D or guarantee that fractures
will never occur.
Question 6:
A client develops severe pain in the lower leg after a tibial fracture. The pain is
disproportionate to the injury and worsens when the toes are passively extended.
What complication should the nurse suspect?
A. Osteoporosis
B. Compartment syndrome
C. Osteoarthritis
D. Venous insufficiency
Correct Answer: B. Compartment syndrome
Rationale: Severe pain disproportionate to the injury and pain with passive muscle
stretching are early indicators of compartment syndrome. Increasing tissue pressure
can compromise circulation and nerve function. This is an orthopedic emergency
requiring immediate provider notification and rapid intervention to prevent
permanent muscle and nerve damage.
Question 7:
A client with a newly applied long-leg cast reports increasing pressure and
numbness in the toes. Which finding requires immediate action?
Surgical Nursing Exam Review
Question 1:
A client with systemic sclerosis reports increasing difficulty swallowing and
frequent episodes of heartburn. Which nursing intervention is most appropriate?
A. Encourage three large meals daily
B. Have the client lie flat after meals
C. Encourage small, frequent meals and upright positioning after eating
D. Restrict all fluids between meals
Correct Answer: C. Encourage small, frequent meals and upright positioning after
eating
Rationale: Systemic sclerosis can cause esophageal dysmotility and
gastroesophageal reflux because of smooth-muscle fibrosis. Small meals reduce
gastric distention, while remaining upright after eating reduces reflux and
aspiration risk. The client should also avoid eating shortly before bedtime and
follow prescribed acid-suppressive therapy.
Question 2:
A client with rheumatoid arthritis has been prescribed methotrexate. Which
laboratory value is most important for the nurse to monitor regularly?
A. Serum calcium
B. Liver enzymes
,C. Serum sodium
D. Amylase
Correct Answer: B. Liver enzymes
Rationale: Methotrexate can cause hepatotoxicity, particularly with prolonged
therapy. Regular monitoring of AST and ALT helps identify liver injury early. The
medication can also suppress bone marrow, so complete blood counts are
important. Clients should avoid excessive alcohol because it can increase hepatic
toxicity.
Question 3:
A client with gout is experiencing severe pain and swelling in the great toe. Which
instruction should the nurse provide during an acute attack?
A. Increase intake of organ meats
B. Apply vigorous massage to the joint
C. Rest the affected joint and use prescribed anti-inflammatory medication
D. Begin strenuous exercise immediately
Correct Answer: C. Rest the affected joint and use prescribed anti-inflammatory
medication
Rationale: Acute gout results from inflammatory deposition of monosodium urate
crystals within a joint. Rest, elevation, local cooling, and prescribed anti-
inflammatory therapy can reduce pain and inflammation. Vigorous massage may
worsen discomfort. Long-term urate-lowering therapy is generally managed
separately from acute symptom control.
,Question 4:
A client with systemic lupus erythematosus is prescribed hydroxychloroquine.
Which assessment should the nurse emphasize during long-term treatment?
A. Visual changes
B. Hearing loss
C. Urinary frequency
D. Increased appetite
Correct Answer: A. Visual changes
Rationale: Hydroxychloroquine can cause retinal toxicity, particularly with
prolonged use. Clients require regular ophthalmologic examinations and should
report visual disturbances promptly. Monitoring is important even when the client
has no symptoms because retinal injury may initially be subtle and can become
irreversible if not detected.
Question 5:
A client with osteoporosis asks why weight-bearing exercise has been
recommended. Which response is most accurate?
A. It eliminates the need for calcium
B. It stimulates bone remodeling and helps maintain bone strength
C. It prevents all future fractures
D. It increases cartilage production
Correct Answer: B. It stimulates bone remodeling and helps maintain bone
strength
, Rationale: Weight-bearing and resistance activities provide mechanical
stimulation that supports bone remodeling and helps preserve bone mineral density.
Exercise also improves muscle strength and balance, reducing fall risk. It does not
eliminate the need for adequate calcium and vitamin D or guarantee that fractures
will never occur.
Question 6:
A client develops severe pain in the lower leg after a tibial fracture. The pain is
disproportionate to the injury and worsens when the toes are passively extended.
What complication should the nurse suspect?
A. Osteoporosis
B. Compartment syndrome
C. Osteoarthritis
D. Venous insufficiency
Correct Answer: B. Compartment syndrome
Rationale: Severe pain disproportionate to the injury and pain with passive muscle
stretching are early indicators of compartment syndrome. Increasing tissue pressure
can compromise circulation and nerve function. This is an orthopedic emergency
requiring immediate provider notification and rapid intervention to prevent
permanent muscle and nerve damage.
Question 7:
A client with a newly applied long-leg cast reports increasing pressure and
numbness in the toes. Which finding requires immediate action?
