NUR 1211 Medical Surgical Final Exam- Questions and Answers; International College of Health Sciences 2023/2024

NUR 1211 Medical Surgical Final Exam- Questions and Answers; International College of Health Sciences 2023/2024 1. A client with diabetes mellitus is experiencing polyphagia. Which outcome statement is the priority for this client? a. Fluid and electrolyte balance. b. Prevention of water toxicity. c. Reduced glucose in the urine. d. Adequate cellular nourishment. - ANSWER-D Rationale Diabetes mellitus Type 1 is characterized by hyperglycemia that precipitates glucosuria and polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Polyphagia is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose into the cell for energy, so the outcome statement should include stabilization of adequate cellular nutrition which is done by providing the insulin supplement the client needs. 2. A client has taken steroids for 12 years to help manage chronic obstructive pulmonary disease (COPD). When making a home visit, which nursing function is of greatest importance to this client? Assess the client's a. pulse rate, both apically and radially. b. blood pressure, both standing and sitting. c. temperature. d. skin color and turgor. - ANSWER-C Rationale It is very important to check the client's temperature. Long term use of steroids use COPD clients is effective in suppressing inflammation in their airways making it easier for them to breath, but at the same time suppresses the immune system, placing the client at risk for infection. 3. Which intervention should the nurse plan to implement when caring for a client who has just undergone a right above-the-knee amputation? a. Maintain the residual limb on three pillows at all times. b. Place a large tourniquet at the client's bedside. c. Apply constant, direct pressure to the residual limb. d. Do not allow the client to lie in the prone position. - ANSWER-B Rationale A large tourniquet should be placed in plain sight at the client's bedside, in the event severe bleeding occurs. The purpose is to have the tourniquet available to applied to the residual limb to control bleeding if hemorrhaging was to occur. The residual limb should not be placed on a pillow because a flexion contracture of the hip may result and the client should be encouraged to lie in the prone position to prevent flexion contracture of the hip. 4. The nurse knows that lab values sometimes vary for the older client. Which data would the nurse expect to find when reviewing laboratory values of an 80-year-old male? a. Increased WBC, decreased RBC. b. Increased serum bilirubin, slightly increased liver enzymes. c. Increased protein in the urine, slightly increased serum glucose levels. d. Decreased serum sodium, an increased urine specific gravity. - ANSWER-C Rationale As older adults aged, the protein found in urine slightly rises as a result of kidney changes and the serum glucose increases slightly, also due to changes in the kidney. The specific gravity declines by age 80 from 1.032 to 1.024. 5. In preparing to administer intravenous albumin to a client following surgery, what is the priority nursing intervention? (Select all that apply.) a. Set the infusion pump to infuse the albumin within four hours. b. Compare the client's blood type with the label on the albumin. c. Assign a UAP to monitor blood pressure q15 minutes. d. Administer through a large gauge catheter. e. Monitor hemoglobin and hematocrit levels. f. Assess for increased bleeding after administration. - ANSWER-A, C, D, E, F Rationale Albumin should be infused within four hours because it does not contain any preservatives. Any fluid remaining after four hours should be discarded. Albumin administration does not require blood typing. Vital signs should be monitored periodically to assess for fluid volume overload. A large gauge catheter allows for fast infusion rate, which may be necessary. Hemodilution may decrease hemoglobin (HgB) and hematocrit (HCT) levels, so the HgB and HCT levels should be monitored. While monitoring for bleeding because of the increased blood volume and blood pressure. 6. The healthcare provider prescribes aluminum and magnesium hydroxide (Maalox), 1 tablet PO PRN, for a client with chronic kidney disease (CKD) who is complaining of indigestion. What intervention should the nurse implement? a. Administer 30 minutes before eating. b. Evaluate the effectiveness 1 hour after administration. c. Instruct the client to swallow the tablet whole. d. Question the healthcare provider's prescription. - ANSWER-D Rationale Magnesium agents are not usually used for clients with CKD due to the risk of hypermagnesemia, so this prescription should be questioned by the nurse. 7. Small bowel obstruction is a condition characterized by which finding? a. Severe fluid and electrolyte imbalances. b. Metabolic acidosis. c. Ribbon-like stools. d. Intermittent lower abdominal cramping. - ANSWER-A Rationale Among the findings characteristic of a small bowel obstruction is the presence of severe fluid and electrolyte imbalances. 8. The nurse is taking a history of a newly diagnosed Type 2 diabetic who is beginning treatment. Which subjective information is most important for the nurse to note? a. A history of obesity. b. An allergy to sulfa drugs. c. Cessation of smoking three years ago. d. Numbness in the soles of the feet. - ANSWER-B Rationale An allergy to sulfa drugs may make the client unable to use some of the most common antihyperglycemic agents (sulfonylureas). The nurse needs to highlight this allergy for the healthcare provider. 9. The nurse would be correct in withholding a dose of digoxin in a client with congestive heart failure without specific instruction from the healthcare provider if the client's a. serum digoxin level is 1.5. b. blood pressure is 104/68. c. serum potassium level is 3. d. apical pulse is 68/min. - ANSWER-C Rationale Hypokalemia can precipitate digitalis toxicity in persons receiving digoxin which will increase the chance of dangerous dysrhythmias (normal potassium level is 3.5 to 5.5 mEq/L). 10. The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two hours is dated two years ago. The client reports that he has a history of "heart trouble," but has no problems at present. Hospital protocol requires that those over 50 years of age have a recent ECG prior to surgery. What nursing action is best for the nurse to implement? a. Ask the client what he means by "heart trouble." b. Call for an ECG to be performed immediately. c. Notify surgery that the ECG is over two years old. d. Notify the client's surgeon immediately. - ANSWER-B Rationale According to the hospital policy, clients over the age of 50 and/or with a history of cardiovascular disease, should receive ECG evaluation prior to surgery, generally 24 hours to two weeks before. The nurse needs to first arrange for an ECG to be performed immediately prior to surgery. 11. The nurse is planning care for a client with newly diagnosed diabetes mellitus that requires insulin. Which assessment should the nurse identify before beginning the teaching session? a. Present knowledge related to the skill of injection. b. Intelligence and developmental level of the client. c. Willingness of the client to learn the injection sites. d. Financial resources available for the equipment. - ANSWER-C Rationale If a client is incapable or does not want to learn, it is unlikely that learning will occur, so motivation is the first factor the nurse should assess before teaching. 12. A 46-year-old female client is admitted for acute renal failure secondary to diabetes and hypertension. Which test is the best indicator of adequate glomerular filtration? a. Serum creatinine. b. Blood Urea Nitrogen (BUN). c. Sedimentation rate. d. Urine specific gravity. - ANSWER-A Rationale Creatinine is a product of muscle metabolism that is filtered by the glomerulus, and blood levels of this substance are not affected by dietary or fluid intake. An elevated creatinine strongly indicates nephron loss, reducing filtration. 13. A 32-year-old female client complains of severe abdominal pain each month before her menstrual period, painful intercourse, and painful defecation. Which additional history should the nurse obtain that is consistent with the client's complaints? a. Frequent urinary tract infections. b. Inability to get pregnant. c. Premenstrual syndrome. d. Chronic use of laxatives. - ANSWER-B Rationale Dysmenorrhea, dyspareunia, and difficulty or painful defecation are common symptoms of endometriosis, which is the abnormal displacement of endometrial tissue in the dependent areas of the pelvic peritoneum. A history of infertility is another common finding associated with endometriosis. 14. Which finding should the nurse identify as most significant for a client diagnosed with polycystic kidney disease (PKD)? a. Hematuria. b. 2 pounds weight gain. c. 3+ bacteria in urine. d. Steady, dull flank pain. - ANSWER-C Rationale Urinary tract infections (UTI) for a client with PKD require prompt antibiotic therapy to prevent renal damage and scarring which may cause further progression of the disease, so bacteria in the urine is the most significant finding at this time. 15. A client with multiple sclerosis has experienced an exacerbation of symptoms, including paresthesias, diplopia, and nystagmus. Which instruction should the nurse provide? a. Stay out of direct sunlight. b. Restrict intake of high protein foods. c. Schedule extra rest periods. d. Go to the emergency room immediately. - ANSWER-C Rationale Exacerbations of the symptoms of MS occur most commonly as the result of fatigue and stress. The client should be encouraged to schedule extra rest periods to help reduce the symptoms. 16. The nurse is planning care to prevent complication for a client with multiple myeloma. Which intervention is most important for the nurse to include? a. Safety precautions during activity. b. Assess for changes in size of lymph nodes. c. Maintain a fluid intake of 3 to 4 L per day. d. Administer narcotic analgesic around the clock. - ANSWER-C Rationale Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (C) to promote excretion of serum calcium. Although the client is at risk for pathologic fractures due to diffuse osteoporosis, mobilization and weight bearing should be encouraged to promote bone reabsorption of circulating calcium, which can cause renal complications. 17. A middle-aged male client with diabetes continues to eat an abundance of foods that are high in sugar and fat. According to the Health Belief Model, which event is most likely to increase the client's willingness to become compliant with the prescribed diet? a. He visits his diabetic brother who just had surgery to amputate an infected foot. b. He is provided with the most current information about the dangers of untreated diabetes. c. He comments on the community service announcements about preventing complications associated with diabetes. d. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet. - ANSWER-A Rationale The loss of a limb due to diabetes by a family member should be the strongest event or "cue to action" and is most likely to increase the client's perceived seriousness of the disease. 18. An elderly client is admitted with a diagnosis of bacterial pneumonia. The nurse's assessment of the client will most likely reveal which sign/symptom? a. Leukocytosis and febrile. b. Polycythemia and crackles. c. Pharyngitis and sputum production. d. Confusion and tachycardia. - ANSWER-D Rationale