Medical-Surgical Assignment Exam
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When making morning assessments, the practical nurse finds a client who is exhibiting
a new finding of right-sided facial drooping. Which assessment is most important for the
PN to implement first? - answers Test all four extremities for movement and strength
Rationale
Unilateral facial droop may be a symptom of an acute brain attack (stroke) or Bell's
Palsy. Unilateral motor deficits are the most obvious effects of a stroke (B) and should
be assessed for first. If ruled out, other assessments can be performed for the
possibility of Bell's Palsy (A, C and D).
An adult male presents in the Emergency Center with "tearing" chest pain that has
moved into his back. Which finding by the practical nurse in the client's history is
relevant to the client's chest pain? - answers Smokes three packs of cigarettes a day
Rationale
Cigarette smoking (A) is the common risk factor associated with hypertension that
contributes to dissecting aneurysms of the aortic arch, which is manifested by "tearing
chest" that radiates to the back. Alcohol consumption (B) does not have a direct
correlation with dissecting aneurysms. Although (C) increases the client's risk for
diabetes, the most relevant client behavior that contributes to arterial disease is
cigarette smoking. (D) is not related to these symptoms.
A client who is positive for human immunodeficiency virus (HIV) comes to the clinic for a
routine check up. During the initial interview, the client's partner tells the practical nurse
(PN) that the client has had several occasions of mental confusion. The PN should
focus questions to determine if the client is developing which opportunistic infection? -
answers Toxoplasmosis.
Rationale
,Clients with HIV who have toxoplasmosis (C) of the brain are most likely to manifest
mental confusion, so questions should focus on this protozoan infection that is hosted in
cats and excreted in cat feces. Although Kaposi's sarcoma has been associated as an
AIDS-defining opportunistic infection, it is a dermatological sarcoma associated with the
herpes virus, not a neurological complication. (B and D) are respiratory acquired
opportunistic infections in clients with acquired immunodeficiency syndrome (AIDS).
The practical nurse (PN) is monitoring a client with a comminuted fracture of the left
femur. Which finding should the PN report to the healthcare provider immediately? -
answers Leg pain of "10" unrelieved by opioids.
Rationale
Compartment syndrome, an emergency complication of circulatory impairment, is
manifested by severe pain unaffected by opioid analgesics (C), which should be
reported immediately. (A and B) are common findings consistent with trauma. Although
(D) should be reported, the presence of a pulse point provides some oxygenation to
distal tissues.
The practical nurse (PN) is caring for a group of clients on a telemetry unit. Which client
requires immediate follow-up by the PN? - answers A client with multiple premature
ventricular contractions (PVC)/minute after receiving atropine.
Rationale
A client who is experiencing multiple PVCs/minute (C) is at risk for ventricular fibrillation
(VF) and requires immediate follow-up and treatment. Digoxin slows the heart rate by
decreasing the rate impulse conduction through the AV node, which is contraindicated
in heart block (A), but the client who is at risk for impending VF is the priority. The PN
should continue monitoring (B and D) for other side effects of glucocorticosteroids and
epinephrine, such as trembling (D), which are not life threatening.
The practical nurse (PN) is transferring a client to the in-patient dialysis unit for
hemodialysis scheduled for today. Which information is essential for the PN to report to
the receiving nurse? - answers Today's hemoglobin result of 8.0 grams.
Rationale
The PN should report the client's recent hemoglobin level (D), which is low and is
essential information in planning the client's care for hemodialysis. (A and B) are
standards of care for a client who is receiving dialysis. Although routine antihypertensive
drugs (C) are withheld before hemodialysis, the priority is the client's need for possible
blood transfusion during the next hemodialysis session.
The practical nurse (PN) receives shift report about a client whose chest x-ray reveals
"free air under the right diaphragm." What action should the PN take? - answers
Maintain the client NPO.
, Rationale
"Free air under the diaphragm" on an upright chest x-ray is most often indicative of a
gastrointestinal perforation, and the client will probably need surgery, so the client
should be kept NPO (A) until that determination is made. Since the air is outside the
colon, hence the term "free air," it will not help to position (B) or ambulate (C) the client.
(D) is not indicated.
The practical nurse (PN) performs a Glasgow Coma Scale (GCS) assessment for a
client who experienced an acute brain attack (stroke) yesterday and obtains a score of
"12." What assessment should the PN do next? - answers Comparison of GCS score
with previous checks.
Rationale
A key element in neurological assessments is the client's trends, which can be subtle
changes, so the PN should compare the client's present score to previous scores to
determine if the client is better, worse, or the same (D). (A, B, and C) are components of
the GCS.
The practical nurse (PN) at an extended care facility is called to the unit's activity room
where a client has "fainted." Which finding indicates to the PN that the client
experienced a syncopal episode? - answers A sudden experience that everything went
black.
Rationale
In syncope or "fainting", the client experiences a sudden loss of consciousness (A).
Incontinence of urine or stool (B) is typical for a seizure disorder, not syncope. A sudden
fall in blood pressure (C) is common with syncope, which may rebound as the client
gains consciousness. (D) is typical of migraine headaches, not syncope.
The practical nurse (PN) is assessing breath sounds of a client who has spontaneous
respirations after an endotracheal tube (ET) insertion. The breath sounds are absent on
the left side. What action should the PN do? - answers Contact the nurse in charge
immediately.
Rationale
A complication of endotracheal intubation is advancement of the tube into the right main
stem bronchus, which does not aerate the left lobes. The PN should contact the nurse
(C) so the ET can be repositioned. (B) is ineffective in aerating the left lung fields if the
ET has been advanced into the right stem bronchus. (A and D) can be implemented
after the ET is repositioned.
complete latest update
When making morning assessments, the practical nurse finds a client who is exhibiting
a new finding of right-sided facial drooping. Which assessment is most important for the
PN to implement first? - answers Test all four extremities for movement and strength
Rationale
Unilateral facial droop may be a symptom of an acute brain attack (stroke) or Bell's
Palsy. Unilateral motor deficits are the most obvious effects of a stroke (B) and should
be assessed for first. If ruled out, other assessments can be performed for the
possibility of Bell's Palsy (A, C and D).
An adult male presents in the Emergency Center with "tearing" chest pain that has
moved into his back. Which finding by the practical nurse in the client's history is
relevant to the client's chest pain? - answers Smokes three packs of cigarettes a day
Rationale
Cigarette smoking (A) is the common risk factor associated with hypertension that
contributes to dissecting aneurysms of the aortic arch, which is manifested by "tearing
chest" that radiates to the back. Alcohol consumption (B) does not have a direct
correlation with dissecting aneurysms. Although (C) increases the client's risk for
diabetes, the most relevant client behavior that contributes to arterial disease is
cigarette smoking. (D) is not related to these symptoms.
A client who is positive for human immunodeficiency virus (HIV) comes to the clinic for a
routine check up. During the initial interview, the client's partner tells the practical nurse
(PN) that the client has had several occasions of mental confusion. The PN should
focus questions to determine if the client is developing which opportunistic infection? -
answers Toxoplasmosis.
Rationale
,Clients with HIV who have toxoplasmosis (C) of the brain are most likely to manifest
mental confusion, so questions should focus on this protozoan infection that is hosted in
cats and excreted in cat feces. Although Kaposi's sarcoma has been associated as an
AIDS-defining opportunistic infection, it is a dermatological sarcoma associated with the
herpes virus, not a neurological complication. (B and D) are respiratory acquired
opportunistic infections in clients with acquired immunodeficiency syndrome (AIDS).
The practical nurse (PN) is monitoring a client with a comminuted fracture of the left
femur. Which finding should the PN report to the healthcare provider immediately? -
answers Leg pain of "10" unrelieved by opioids.
Rationale
Compartment syndrome, an emergency complication of circulatory impairment, is
manifested by severe pain unaffected by opioid analgesics (C), which should be
reported immediately. (A and B) are common findings consistent with trauma. Although
(D) should be reported, the presence of a pulse point provides some oxygenation to
distal tissues.
The practical nurse (PN) is caring for a group of clients on a telemetry unit. Which client
requires immediate follow-up by the PN? - answers A client with multiple premature
ventricular contractions (PVC)/minute after receiving atropine.
Rationale
A client who is experiencing multiple PVCs/minute (C) is at risk for ventricular fibrillation
(VF) and requires immediate follow-up and treatment. Digoxin slows the heart rate by
decreasing the rate impulse conduction through the AV node, which is contraindicated
in heart block (A), but the client who is at risk for impending VF is the priority. The PN
should continue monitoring (B and D) for other side effects of glucocorticosteroids and
epinephrine, such as trembling (D), which are not life threatening.
The practical nurse (PN) is transferring a client to the in-patient dialysis unit for
hemodialysis scheduled for today. Which information is essential for the PN to report to
the receiving nurse? - answers Today's hemoglobin result of 8.0 grams.
Rationale
The PN should report the client's recent hemoglobin level (D), which is low and is
essential information in planning the client's care for hemodialysis. (A and B) are
standards of care for a client who is receiving dialysis. Although routine antihypertensive
drugs (C) are withheld before hemodialysis, the priority is the client's need for possible
blood transfusion during the next hemodialysis session.
The practical nurse (PN) receives shift report about a client whose chest x-ray reveals
"free air under the right diaphragm." What action should the PN take? - answers
Maintain the client NPO.
, Rationale
"Free air under the diaphragm" on an upright chest x-ray is most often indicative of a
gastrointestinal perforation, and the client will probably need surgery, so the client
should be kept NPO (A) until that determination is made. Since the air is outside the
colon, hence the term "free air," it will not help to position (B) or ambulate (C) the client.
(D) is not indicated.
The practical nurse (PN) performs a Glasgow Coma Scale (GCS) assessment for a
client who experienced an acute brain attack (stroke) yesterday and obtains a score of
"12." What assessment should the PN do next? - answers Comparison of GCS score
with previous checks.
Rationale
A key element in neurological assessments is the client's trends, which can be subtle
changes, so the PN should compare the client's present score to previous scores to
determine if the client is better, worse, or the same (D). (A, B, and C) are components of
the GCS.
The practical nurse (PN) at an extended care facility is called to the unit's activity room
where a client has "fainted." Which finding indicates to the PN that the client
experienced a syncopal episode? - answers A sudden experience that everything went
black.
Rationale
In syncope or "fainting", the client experiences a sudden loss of consciousness (A).
Incontinence of urine or stool (B) is typical for a seizure disorder, not syncope. A sudden
fall in blood pressure (C) is common with syncope, which may rebound as the client
gains consciousness. (D) is typical of migraine headaches, not syncope.
The practical nurse (PN) is assessing breath sounds of a client who has spontaneous
respirations after an endotracheal tube (ET) insertion. The breath sounds are absent on
the left side. What action should the PN do? - answers Contact the nurse in charge
immediately.
Rationale
A complication of endotracheal intubation is advancement of the tube into the right main
stem bronchus, which does not aerate the left lobes. The PN should contact the nurse
(C) so the ET can be repositioned. (B) is ineffective in aerating the left lung fields if the
ET has been advanced into the right stem bronchus. (A and D) can be implemented
after the ET is repositioned.
