ANCC Med-Surg Certification exam questions and answers (verified for accuracy)

d A nurse is reviewing the medical record of a client who is receiving heparin therapy for treatment of DVT. Which of the following interventions should the nurse anticipate taking if the client's aPTT is 96 seconds?a. Increase the heparin infusion flow rate by 2 mL/hrb. continue to monitor the heparin infusion as prescribedc. request a prothrombin timed. stop the heparin infusion a A nurse is providing teaching for a client who is 2 days post-op following a heart transplant. Which of the following statements should the nurse include in the teaching?a. "you may no longer be able to feel chest pain."b. "your level of activity tolerance will not change."c. "after 6 months, you will no longer need to restrict your sodium intake."d. "you will be able to stop taking immunosuppressants after 12 months." a A nurse is assess a client in the emergency room who has a bradydysrhythmia. Which of the following findings should the nurse expect?A. confusionB. friction rubC. hypertensionD. dry skin d A nurse in the emergency department is caring for a client who had an anterior MI. The client's history reveals she is 1 week post-op open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated?A. administering IV morphine sulfateB. administering oxygen at 2 :/min via nasal cannulaC. helping the client to the bedside commodeD. assisting with thrombolytic therapy D A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication?A. ventricular depolarizationB. Guillain-Barre syndromC. myelodysplastic syndromeD. Valvular disease C A nurse is caring for a client who presents to the ER with a BP of 254/138 mmHg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first?A. obtain blood samples for laboratory testingB. Tell the client to report vision changesC. Place the head of the bed at 45 degreesD. initiate an IV a a nurse is caring for a client who has HF and is experiencing AF. The nurse should plan to monitor for and report which of the following findings to the provider immediately?a. slurred speechb. irregular pulsec. dependent edemad. persistent fatigue b A nurse is assessing a client who has left-sided HF. Which of the following manifestations should the nurse expect to find?a. inc abdominal girthb. weak peripheral pulsesc. jugular vein distentiond. dependent edema b a nurse is caring for a client who is being treated for HF and has prescriptions for digoxin and furosemide. The nurse should plan to monitor for which of the following as an adverse effect of these medications?a. SOBb. lightheadednessc. dry coughd. metallic taste c a nurse is monitoring a client following coronary artery bypass graft surgery. Which of the following findings can indicate cardiac tamponade?a. sternal instabilityb. inc WBC countc. BP 140/82 mmHg on inspiration and 154/90 mmHg on expirationd. sinus rhythm with occasional premature atrial contraction and HR 88/min d A nurse is preparing a client for coroncary angiography. The nurse should report which of the following findings to the provider prior to the procedure?a. hemoglobin 14.4 g/dLb. history of peripheral arterial diseasec. urine output 200 mL/4 hrd. previous allergic reaction to shellfish a A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure?a. "I can't get rid of these hiccups."b. "I feel dizzy when i stand."c. "My incision site stings."d. "I have a headache." b A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching?a. apply the new patch to the same site as the previous patchb. place the patch on an area of skin away from skin folds and jointsc. keep the patch on 24 hr per dayd. replace the patch at the onset of angina c A nurse is caring for a client in the first hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider?a. serosanguinous drainage on dressingb. severe pain with coughingc. urine output of 20 mL/hrd. increase in temp from 36.C (98.2F)- 37.5C (99.5F) d A nurse caring for a client following an abdominal aortic aneurysm resection. Which of the following is the priority assessment for this client?a. neck vein distentionb. bowel soundsc. peripheral edemad. urine output b A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The client is conscious with a HR of 200-210 bpm and has a faint radial pulse. The nurse should anticipate assisting with which of the following interventions?a. delivery of precordial thumpb. vagal stimulationc. administration of atropine IVd. defibrillation a A nurse is providing discharge teaching for a client who has HF. The nurse should instruct the client to report which of the following findings immediately to the provider?a. weight gain of 2 lb in 24 hrb. inc of 10 mmHg in systolic BPc. dyspnea with exertiond. dizziness when rising quickly c A nurse is admitting a client who has a leg ulcer and a history of DM. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer?a. explore the clients family history of peripheral vascular diseaseb. note the presence or absence of pain at the ulcer sitec. inquire about the presence or absence of claudicationd. ask if the client has had a recent infection c A nurse is reviewing the laboratory results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which laboratory values?a. Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dLb. Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dLc. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dLd. Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL b a nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease?a. a client who has hypothyroidismb. a client who has DMc. a client whose daily caloric intake consists of 25% fatd. a client who consumes two bottles of beer a day a, b, e a nurse is planning a presentation about hypertension for a community women's group. which of the following lifestyle modifications should the nurse include (select all that apply)a. limited alcohol intakeb. regular exercise programc. dec Mg intaked. reduced K intakee. smoking cessation b A nurse is caring for a client in the first 8 hr following coronary artery bypass graft surgery. Which of the following client findings should the nurse report to the provider?a. mediastinal drainage 100 mL/hrb. BP 160/80 mmHgc. Temp 37.1 (98.8)d. K 3.8 mEq/L d A nurse is caring for a client who has a history of angina and is schedules for a stress test at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling?a. "I'm still hungry after the bowl of cereal I ate at 7am."b. "I didn't take my heart pills this morning because the doctor told me not to."c. "I have had chest pain a couple of times since I saw my doctor in the office last week."d. "I smoked a cigarette this morning to calm my nerves about having this procedure." a A nurse is caring for a client who has dilated cardiomyopathy. The client reports increasing difficulty completing her daily 1-mile walks. The nurse should recognize that this is a finding of which of the following?a. left ventricular failureb. peripheral vasodilationc. pericardial effusiond. dec vascular volume c A nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse?a. "My arthritis is really bothering me because I haven't taken my aspiring in a week."b. "My blood pressure shouldn't be high because I took my BP medication this morning."c. "I took my warfarin last night according to my usually schedule."d. "I will check my BP because I took a reduced dose of insulin this morning." c A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in which of the following is diagnostic of a MI?a. myoglobinb. c-reactive proteinc. creatine kinase- MBd. Homocysteine d a nurse is caring for a client who has a history of DVT and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy?a. hemoglobin 14 g/dLb. minimal bruising of extremitiesc. reduced circumference of affected extremityd. INR 2.5 b A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following?a. tendon painb. persistent coughc. frequent urinationd. constipation a, b, c A client is being evaluated in the ED for a possible brain attack (stroke). Assessment findings consistent with a brain attack include which of the following? (select all that apply)a. facial droopb. slurred speechc. weakness of affected extremityd. crackles in lungse. decreased urine output c A client is admitted with a diagnosis of acute stroke. The provider orders "diet as tolerated." Before feeding this client, which nursing action is priority?a. determine client's food preferencesb. elevate the head of the bed 30 degreesc. assess client's swallowing reflexd. review serum albumin level to determine appropriate diet a Which of the following recommendations is best for the nurse to suggest to a client as a way to keep BP under control?a. follow a regular exercise programb. attend a stress-reduction support groupc. avoid use of tobacco and limit alcohol intaked. increase intake of fruits and veggies a which of the following assessment findings indicate to the nurse the client is experiencing left-sided HF?a. fatigue and dyspneab. Cheyne-Stokes breathing and orthostatic hypotensionc. liver tenderness and peripheral edemad. anorexia and dependent edema a, c, e the nurse is teaching a group of adult clients about risk for coronary artery disease, especially MI. This nurse should instruct this group of clients about which of the following as ways to decrease incidence of CAD and MI? (select all that apply)a. "if you smoke, quit"b. "be sure to consume at least 10% of your calories from saturates fats."c. "Engage in moderate exercise for 20-30 minutes 3-5 times a week."d. "jog at a mild pace for at least one hour a day."e. "check BP regularly." a Which client response requires a focused GI assessment?a. "I take ibuprofen 600 mg three times a day for arthritis pain."b. "I experienced occasional constipation."c. "I have had dentures for 3 years."d. "spicy foods upset my stomach." b After abdominal surgery, what is the most reliable assessment that suggests return of peristaltic movement?a. presence of normal bowel soundsb. client report of passing flatusc. client report of hungerd. absence of nausea c when administering a new medication to an older client, the nurse understands that:a. the dose may need to be increased to greater-than-normal levelsb. close monitoring is needed because toxic levels may developc. the dose may need to be decreased to lower-than-normal levelsd. nausea and vomiting may develop rapidly and are common side effects in older adults d A 59 year old man was admitted to the hospital with dysphagia, stating that he has been having more difficulty swallowing food, even when he has chewed it throroughly and drinks plenty of water. A CT scan shows an area for a possible esophageal tumor. The client unergoes a biopsy and is awaiting results. The client asks, "what am I going to do if this is cancer?" What is the most appropriate nursing response?a. "You will have surgery to remove it."b. "I would choose to get radiation."c. "The doctor will go over the options with you."d. "You sound as if you are concerned about the biopsy results." b The client with a long history of osteoarthritis is at risk for developing GERD if he or she:a. weighs 220 poundsb. frequently takes NSAIDs for painc. consumes food with calcium supplementationd. has limited physical mobility