CERTIFIED MEDICAL-SURGICAL
REGISTERED NURSE SAMPLE
QUESTIONS WITH CORRECT ANSWERS
-aans--
ChristineaWarren,a45ayearsaold,ahasaaalongahistoryaofaulcerativeacolitis,aandanon-
surgicalatreatmentanoalongerarelievedaherasymptoms.aSheaunderwentaaatotalaproctocolect
omyaandaaapermanentaileostomya12ahoursaago.
TheanurseashouldacontactatheaphysicianaimmediatelyaifaMrs.aWarrenahasawhichaofatheseafi
ndings?
1)aTheastomaaappearsapaleaandadry.
2)aTheastomaaappearsaredaandashiny.
3)aThereaisa200amLaofadarkagreenaoutputafromatheastoma.
4)aThereaisa50amLaofaserosanguinousadrainageafromatheastoma.a-aans--
1)aTheastomaaappearsapaleaandadry.
Rationale:aIfathereaisaanaadequateabloodasupplyatoatheastoma,atheacoloraisapinkaorared,aan
datheastomaaisamoistaasaaaresultaofamucousaproduction.aAapaleadryacolorasuggestsaischem
iaaofatheastomaaorabowelaandamustabeareportedaimmediatelyatoatheaphysician.aWithaanaile
ostomyainitiallyaafterasurgery,atheaoutputaisaaaloose,adarkagreenaliquidathatamayacontainaso
meablood.aTheaileostomyausuallyabeginsatoadrainawithina24aofasurgeryaatamoreathanaonealit
eraperaday.
WhenachangingaMrs.aWarren'saileostomyabag,atheanurseanoticesathatatheaperistomalaskina
isairritated.a
Whichaofatheseaactionsabyatheanurseawouldabeaappropriateabeforeareapplyingatheaapplian
ce?
1)aWashatheaareaawithaantisepticasoapaandawater.
2)aCleanatheasiteawithaDakin'sasolution.
3)aUseaaasolidaskinabarrier.
4)aObtainaanaorderaforaaatopicalaantibiotic.a-aans--3)aUseaaasolidaskinabarrier.
Rationale:aTheadrainageafromatheastomaacanaquicklyairritateatheasurroundingatissue.aTher
efore,aaasolidaskinabarrier,awithaaapectinabaseaorakarayaawaferathatahasaaameasurableathic
knessaandahydrocolloidaadhesiveaproperties,ashouldabeaapplied.
,Whichaofatheseacomments,aifamadeabyaMrs.aWarrenabeforeaherasurgery,awouldaindicateath
atasheahadaconcernsaaboutaherabodyaimage?
1)a"Iawillahaveatoastopamyaaerobicsaclasses."
2)a"I'masoaafraidaIamayanotasurviveatheasurgery."
3)a"Ianeedatoagoashoppingaforasomealoose,abaggyaclothes."
4)a"I'maconcernedathatathisamayabeaonlyatheafirstaofamanyasurgeries."a-aans--
3)a"Ianeedatoagoashoppingaforasomealoose,abaggyaclothes."
Rationale:Bodyaimagearefersatoaaaperson'saperceptionaofaselfaandadeterminesahowatheape
rsonainteractsawithaothers.aOneadoesanotaneedatoapurchaseaspecialaclothingaafteraileosto
myasurgery,aalthoughasomeaminoraadjustmentsamayabeaneededaforacomfort,ae.g.,astretcha
underwearaorapantyhoseaforasupport.
LewisaPalmer,a45ayearsaold,ahasaaahistoryaofamultipleamyocardialainfarctionsaandaisaaahea
vyasmoker.aHeatakesawarfarinasodiuma(Coumadin)adaily.aTwoaweeksaago,aheahadaaarightaf
emoral-
poplitealabypass,awhichabecameaoccludeda24ahoursaago.aHeaisaadmittedafollowingaanaang
ioplastyaofatheafemoral-
poplitealabypassagraft.aMr.aPalmeraisareceivingacontinuousaIVaheparin.
BecauseaMr.aPalmeraisareceivingaheparin,aitaisaessentialaforatheanurseato
1)amonitorahisaprothrombinatime.
2)aobserveahimaforasignsaofapulmonaryaembolism.
3)alimitahisaintakeaofafoodsahighainavitaminaK.
4)acheckatheafemoralapunctureasiteaatafrequentaintervals.a-aans--
4)acheckatheafemoralapunctureasiteaatafrequentaintervals.
Rationale:aSinceableedingaisaaacommonasideaeffectaofaheparin,aitaisavitalatoacheckatheaoper
ativeasite,atheafemoralapunctureaarea,aforasignsaofableeding.
AttemptsatoarevascularizeaMr.aPalmer'salegaareaunsuccessful,aandaMr.aPalmerahasaaabelo
w-kneeaamputationa(BKA)aofahisarightaextremityaandaisareturnedatoatheamedical-
surgicalaunitawithaanaintravenousainfusionainaplace.aHisaordersainclude:aheparinadrip,amorp
hineasulfatea10amgaIVapushaq4haprnaforapain,aandaampicillinasodiumaga1aIVaq6h.
Twelveahoursapostoperatively,aMr.aPalmeraisafoundatoabeashortaofabreathaandadiaphoretic.
aHeasays,a"Myachestahurts."aHisapulseaisa140/min,acomparedatoaaabaselineaofa80/min.aHisa
bloodapressureais105/60ammaHg,acomparedatoaaabaselineaofa138/70ammaHg.aHisarespirati
onsaarea32/min,acomparedatoaaabaselineaofa16/min.aHisaO2asaturationaisa85%.aTheanursea
immediatelyacallsaforahelp.aWhichaofatheafollowingaquestionsaisamostaimportantaforatheanur
seatoaask?
1)a"Haveayouaeverahadathisatypeaofachestapainabefore?"
2)a"Howalongahaveayouahadathisapain?"
3)a"Whatapainamedicationadoayouausuallyatake?"
4)a"Whata-aans--1)a"Haveayouaeverahadathisatypeaofachestapainabefore?"
Rationale:aBecauseaofatheapatient'sasymptomsaandahisahistoryaofamyocardialainfarctions,at
heanurseashouldafindaoutaifatheapatientahasahadathisatimeaofapainapreviously.
,TheanurseareceivesaallaofatheafollowingastataordersaforaMr.aPalmer.aWhichaoneashouldathea
nurseaquestion?
1)aOxygenaperanasalacannulaaata4aLaperaminute.
2)aEnoxaparina(Lovenox)a40amgasubcutaneously.
3)aTroponinalevel.
4)aComputedatomographya(CT)aangiogram.a-aans--
Rationale:aTheanurseashouldaquestionsatheaorderaforaLovenoxabecauseatheapatientaisarec
eivingaaaheparinadrip.
MaggieaClark,aaa42-year-
oldafemale,awasaadmittedawithanewlyadiagnosedatypea2adiabetesamellitus.aHerabloodagluc
oseahasabeenastabilized,aandatheanurseaisapreparingaheraforadischarge.aHeradischargeaord
ersawillaincludeametformina(Glucophage).aMrs.aClarkaisaalsoabeingatreatedaforahypertensio
n.
BecauseaMrs.aClarkaisatoatakeaGlucophageaonaaaregularabasisaitaisaimportantato
1)amonitoraheraglomerularafiltrationarate.
2)acheckaheraserumaamylasearoutinely.
3)aobtainaheraredabloodacellacountaperiodically.
4)aexamineaheraurineaforacasts.a-aans--1)amonitoraheraglomerularafiltrationarate.
Rationale:aTheaestimatedaglomerularafiltrationaratea(eGFR)aisaoneawayatoameasureatheaad
equacyaofakidneyafunction.aGlucophageaisaexcretedabyatheakidneyaandatheariskaofalacticaac
idosisaincreasesainapatientsawithaimpairedakidneyafunction.aTheadrugamayabeausedaifatheae
GFRaisabetweena45aanda60amL/min/1.73am2,ai.e.,ainamildachronicakidneyadisease.aGlucop
hageaisaabsolutelyacontraindicatedaifatheaeGFRaisabelowa30amL/min/1.73am2.
Mrs.aClarkaisaprescribedametoprololatartratea(Lopressor)aforahypertension.aWhichasympto
maofahypoglycemiaawouldabeamaskedabyaLopressor?
1)aDiaphoresis.
2)aTingling.
3)aDiplopia.
4)aTachycardia.a-aans--4)aTachycardia.
Rationale:aAasideaeffectaofaLopressor,aaabetaablocker,aisabradycardia.aTheaLopressor-
inducedabradycardiaacanamaskatachycardia,aaasymptomaofahypoglycemia.
CharlesaHaverfordaisadiagnosedawithaprostateacanceraandaisatoahaveaaaradicalaprostatect
omy.
Mr.aHaverfordahasabeenaresearchingahisadiagnosisaandanowaasksatheanurseatoarecomme
ndaaareliableawebasourceaforaaccurateaprostateacancerainformation.aTheanurseashouldaide
ntifyawhichaofatheseawebsitesaasamostareliable?
1)awww.wikipedia.org.
2)awww.cancer.gov.
3)awww.caringbridge.org.
, 4)awww.google.com.a-aans--2)awww.cancer.gov.
Rationale:aWhenaaapatientaasksaaboutaresearchingainformationaonatheainternet,atheapatien
tashouldabeainstructedatoalookaatareliableasites.aSitesathataareamostareliableaareathoseaspon
soredabyatheagovernmenta(.gov).
Mr.aHaverfordahasatheaplannedasurgeryaandaimmediatelyapostoperativelyaheahasaaaurinar
yacatheterainserted.aAfteratheaurinaryacatheteraisaremovedaMr.aHaverfordaisaurinatinganor
mally,ahoweveraheaisaexperiencingaoccasionalaincontinenceawithadribbling.aMr.aHaverforda
isatoabeadischarged.
Mr.aHaverfordasaysatoatheanurse,a"I'masoaembarrassed.aWhatawillamyawifeathinkaaboutathis
adribbling?"aInaadditionatoaacknowledgingahisafeelings,atheanurseashouldaencourageatheap
atientato
1)alimitaoralaintakeaofafluidsabeforeabedtime.
2)apalpateahisabladderatoacheckaforadistentionathreeatimesaaaday.
3)aperformapelvicaflooraexercisesaseveralatimesadaily.
4)aavoidainterruptingatheaurinaryastreamaduringavoiding.a-aans--
3)aperformapelvicaflooraexercisesaseveralatimesadaily.
Rationale:aItaisanotaunusualaforaaapatientawhoahasahadaaaprostatectomy,atoacomplainaofano
tahavingacompleteabladderacontrolaafteracatheteraremoval.aToahelpatheapatientaregainaurin
aryacontrol,apelvicafloorastrengtheningaexercisesaarearecommended.
Aapatient'sawifeaisavisiblyaupsetaandasaysatoatheanurse,a"Iathoughtamyahusbandaonlyabrokea
hisahip,abutatheadoctorathinksaheamightahaveahadaaastroke."aWhichaofatheafollowingawoulda
beaanaappropriatearesponseabyatheanurse?
1)a"It'sareallyatooaearlyatoabeaconcernedaaboutathat.aLet'sawaitauntilatheatestaresultsacomeab
ack."
2)a"Ifaitaisaaastroke,ayourahusbandaisainathearightahospitalaforatreatment."
3)a"Yes,aheadoesahaveasymptomsaofaaastroke.aThat'sawhatatheatestsawillahelpausafindaout."
4)a"I'magoingatoagetayouasomeainformationatoareadaaboutastrokesaandatheiratreatment."a-
aans--
3)a"Yes,aheadoesahaveasymptomsaofaaastroke.aThat'sawhatatheatestsawillahelpausafindaout."
Rationale:aSymptomsaofastrokeavaryagreatlyaandatheainitialadiagnosisaisamadeaafteraaanon-
contrastaCTascanaisadoneatoadetermineaifatheaeventawasaischemicaorahemorrhagic.aThen,af
urtheratestsaareadoneatoaconfirmatheadiagnosisaandadecideaonatreatment.
Inatheaeventaofaaafireainaaahospital'sadialysisaunit,awhichaofatheseaactionsashouldatheanursea
takeafirst?
1)aExtinguishatheafireaifapossible.
2)aActivateatheafirearesponseasystem.
3)aConfineatheafireabyaclosingaallafireadoors.
4)aRemoveapatientsaorastaffainadanger.a-aans--4)aRemoveapatientsaorastaffainadanger.
REGISTERED NURSE SAMPLE
QUESTIONS WITH CORRECT ANSWERS
-aans--
ChristineaWarren,a45ayearsaold,ahasaaalongahistoryaofaulcerativeacolitis,aandanon-
surgicalatreatmentanoalongerarelievedaherasymptoms.aSheaunderwentaaatotalaproctocolect
omyaandaaapermanentaileostomya12ahoursaago.
TheanurseashouldacontactatheaphysicianaimmediatelyaifaMrs.aWarrenahasawhichaofatheseafi
ndings?
1)aTheastomaaappearsapaleaandadry.
2)aTheastomaaappearsaredaandashiny.
3)aThereaisa200amLaofadarkagreenaoutputafromatheastoma.
4)aThereaisa50amLaofaserosanguinousadrainageafromatheastoma.a-aans--
1)aTheastomaaappearsapaleaandadry.
Rationale:aIfathereaisaanaadequateabloodasupplyatoatheastoma,atheacoloraisapinkaorared,aan
datheastomaaisamoistaasaaaresultaofamucousaproduction.aAapaleadryacolorasuggestsaischem
iaaofatheastomaaorabowelaandamustabeareportedaimmediatelyatoatheaphysician.aWithaanaile
ostomyainitiallyaafterasurgery,atheaoutputaisaaaloose,adarkagreenaliquidathatamayacontainaso
meablood.aTheaileostomyausuallyabeginsatoadrainawithina24aofasurgeryaatamoreathanaonealit
eraperaday.
WhenachangingaMrs.aWarren'saileostomyabag,atheanurseanoticesathatatheaperistomalaskina
isairritated.a
Whichaofatheseaactionsabyatheanurseawouldabeaappropriateabeforeareapplyingatheaapplian
ce?
1)aWashatheaareaawithaantisepticasoapaandawater.
2)aCleanatheasiteawithaDakin'sasolution.
3)aUseaaasolidaskinabarrier.
4)aObtainaanaorderaforaaatopicalaantibiotic.a-aans--3)aUseaaasolidaskinabarrier.
Rationale:aTheadrainageafromatheastomaacanaquicklyairritateatheasurroundingatissue.aTher
efore,aaasolidaskinabarrier,awithaaapectinabaseaorakarayaawaferathatahasaaameasurableathic
knessaandahydrocolloidaadhesiveaproperties,ashouldabeaapplied.
,Whichaofatheseacomments,aifamadeabyaMrs.aWarrenabeforeaherasurgery,awouldaindicateath
atasheahadaconcernsaaboutaherabodyaimage?
1)a"Iawillahaveatoastopamyaaerobicsaclasses."
2)a"I'masoaafraidaIamayanotasurviveatheasurgery."
3)a"Ianeedatoagoashoppingaforasomealoose,abaggyaclothes."
4)a"I'maconcernedathatathisamayabeaonlyatheafirstaofamanyasurgeries."a-aans--
3)a"Ianeedatoagoashoppingaforasomealoose,abaggyaclothes."
Rationale:Bodyaimagearefersatoaaaperson'saperceptionaofaselfaandadeterminesahowatheape
rsonainteractsawithaothers.aOneadoesanotaneedatoapurchaseaspecialaclothingaafteraileosto
myasurgery,aalthoughasomeaminoraadjustmentsamayabeaneededaforacomfort,ae.g.,astretcha
underwearaorapantyhoseaforasupport.
LewisaPalmer,a45ayearsaold,ahasaaahistoryaofamultipleamyocardialainfarctionsaandaisaaahea
vyasmoker.aHeatakesawarfarinasodiuma(Coumadin)adaily.aTwoaweeksaago,aheahadaaarightaf
emoral-
poplitealabypass,awhichabecameaoccludeda24ahoursaago.aHeaisaadmittedafollowingaanaang
ioplastyaofatheafemoral-
poplitealabypassagraft.aMr.aPalmeraisareceivingacontinuousaIVaheparin.
BecauseaMr.aPalmeraisareceivingaheparin,aitaisaessentialaforatheanurseato
1)amonitorahisaprothrombinatime.
2)aobserveahimaforasignsaofapulmonaryaembolism.
3)alimitahisaintakeaofafoodsahighainavitaminaK.
4)acheckatheafemoralapunctureasiteaatafrequentaintervals.a-aans--
4)acheckatheafemoralapunctureasiteaatafrequentaintervals.
Rationale:aSinceableedingaisaaacommonasideaeffectaofaheparin,aitaisavitalatoacheckatheaoper
ativeasite,atheafemoralapunctureaarea,aforasignsaofableeding.
AttemptsatoarevascularizeaMr.aPalmer'salegaareaunsuccessful,aandaMr.aPalmerahasaaabelo
w-kneeaamputationa(BKA)aofahisarightaextremityaandaisareturnedatoatheamedical-
surgicalaunitawithaanaintravenousainfusionainaplace.aHisaordersainclude:aheparinadrip,amorp
hineasulfatea10amgaIVapushaq4haprnaforapain,aandaampicillinasodiumaga1aIVaq6h.
Twelveahoursapostoperatively,aMr.aPalmeraisafoundatoabeashortaofabreathaandadiaphoretic.
aHeasays,a"Myachestahurts."aHisapulseaisa140/min,acomparedatoaaabaselineaofa80/min.aHisa
bloodapressureais105/60ammaHg,acomparedatoaaabaselineaofa138/70ammaHg.aHisarespirati
onsaarea32/min,acomparedatoaaabaselineaofa16/min.aHisaO2asaturationaisa85%.aTheanursea
immediatelyacallsaforahelp.aWhichaofatheafollowingaquestionsaisamostaimportantaforatheanur
seatoaask?
1)a"Haveayouaeverahadathisatypeaofachestapainabefore?"
2)a"Howalongahaveayouahadathisapain?"
3)a"Whatapainamedicationadoayouausuallyatake?"
4)a"Whata-aans--1)a"Haveayouaeverahadathisatypeaofachestapainabefore?"
Rationale:aBecauseaofatheapatient'sasymptomsaandahisahistoryaofamyocardialainfarctions,at
heanurseashouldafindaoutaifatheapatientahasahadathisatimeaofapainapreviously.
,TheanurseareceivesaallaofatheafollowingastataordersaforaMr.aPalmer.aWhichaoneashouldathea
nurseaquestion?
1)aOxygenaperanasalacannulaaata4aLaperaminute.
2)aEnoxaparina(Lovenox)a40amgasubcutaneously.
3)aTroponinalevel.
4)aComputedatomographya(CT)aangiogram.a-aans--
Rationale:aTheanurseashouldaquestionsatheaorderaforaLovenoxabecauseatheapatientaisarec
eivingaaaheparinadrip.
MaggieaClark,aaa42-year-
oldafemale,awasaadmittedawithanewlyadiagnosedatypea2adiabetesamellitus.aHerabloodagluc
oseahasabeenastabilized,aandatheanurseaisapreparingaheraforadischarge.aHeradischargeaord
ersawillaincludeametformina(Glucophage).aMrs.aClarkaisaalsoabeingatreatedaforahypertensio
n.
BecauseaMrs.aClarkaisatoatakeaGlucophageaonaaaregularabasisaitaisaimportantato
1)amonitoraheraglomerularafiltrationarate.
2)acheckaheraserumaamylasearoutinely.
3)aobtainaheraredabloodacellacountaperiodically.
4)aexamineaheraurineaforacasts.a-aans--1)amonitoraheraglomerularafiltrationarate.
Rationale:aTheaestimatedaglomerularafiltrationaratea(eGFR)aisaoneawayatoameasureatheaad
equacyaofakidneyafunction.aGlucophageaisaexcretedabyatheakidneyaandatheariskaofalacticaac
idosisaincreasesainapatientsawithaimpairedakidneyafunction.aTheadrugamayabeausedaifatheae
GFRaisabetweena45aanda60amL/min/1.73am2,ai.e.,ainamildachronicakidneyadisease.aGlucop
hageaisaabsolutelyacontraindicatedaifatheaeGFRaisabelowa30amL/min/1.73am2.
Mrs.aClarkaisaprescribedametoprololatartratea(Lopressor)aforahypertension.aWhichasympto
maofahypoglycemiaawouldabeamaskedabyaLopressor?
1)aDiaphoresis.
2)aTingling.
3)aDiplopia.
4)aTachycardia.a-aans--4)aTachycardia.
Rationale:aAasideaeffectaofaLopressor,aaabetaablocker,aisabradycardia.aTheaLopressor-
inducedabradycardiaacanamaskatachycardia,aaasymptomaofahypoglycemia.
CharlesaHaverfordaisadiagnosedawithaprostateacanceraandaisatoahaveaaaradicalaprostatect
omy.
Mr.aHaverfordahasabeenaresearchingahisadiagnosisaandanowaasksatheanurseatoarecomme
ndaaareliableawebasourceaforaaccurateaprostateacancerainformation.aTheanurseashouldaide
ntifyawhichaofatheseawebsitesaasamostareliable?
1)awww.wikipedia.org.
2)awww.cancer.gov.
3)awww.caringbridge.org.
, 4)awww.google.com.a-aans--2)awww.cancer.gov.
Rationale:aWhenaaapatientaasksaaboutaresearchingainformationaonatheainternet,atheapatien
tashouldabeainstructedatoalookaatareliableasites.aSitesathataareamostareliableaareathoseaspon
soredabyatheagovernmenta(.gov).
Mr.aHaverfordahasatheaplannedasurgeryaandaimmediatelyapostoperativelyaheahasaaaurinar
yacatheterainserted.aAfteratheaurinaryacatheteraisaremovedaMr.aHaverfordaisaurinatinganor
mally,ahoweveraheaisaexperiencingaoccasionalaincontinenceawithadribbling.aMr.aHaverforda
isatoabeadischarged.
Mr.aHaverfordasaysatoatheanurse,a"I'masoaembarrassed.aWhatawillamyawifeathinkaaboutathis
adribbling?"aInaadditionatoaacknowledgingahisafeelings,atheanurseashouldaencourageatheap
atientato
1)alimitaoralaintakeaofafluidsabeforeabedtime.
2)apalpateahisabladderatoacheckaforadistentionathreeatimesaaaday.
3)aperformapelvicaflooraexercisesaseveralatimesadaily.
4)aavoidainterruptingatheaurinaryastreamaduringavoiding.a-aans--
3)aperformapelvicaflooraexercisesaseveralatimesadaily.
Rationale:aItaisanotaunusualaforaaapatientawhoahasahadaaaprostatectomy,atoacomplainaofano
tahavingacompleteabladderacontrolaafteracatheteraremoval.aToahelpatheapatientaregainaurin
aryacontrol,apelvicafloorastrengtheningaexercisesaarearecommended.
Aapatient'sawifeaisavisiblyaupsetaandasaysatoatheanurse,a"Iathoughtamyahusbandaonlyabrokea
hisahip,abutatheadoctorathinksaheamightahaveahadaaastroke."aWhichaofatheafollowingawoulda
beaanaappropriatearesponseabyatheanurse?
1)a"It'sareallyatooaearlyatoabeaconcernedaaboutathat.aLet'sawaitauntilatheatestaresultsacomeab
ack."
2)a"Ifaitaisaaastroke,ayourahusbandaisainathearightahospitalaforatreatment."
3)a"Yes,aheadoesahaveasymptomsaofaaastroke.aThat'sawhatatheatestsawillahelpausafindaout."
4)a"I'magoingatoagetayouasomeainformationatoareadaaboutastrokesaandatheiratreatment."a-
aans--
3)a"Yes,aheadoesahaveasymptomsaofaaastroke.aThat'sawhatatheatestsawillahelpausafindaout."
Rationale:aSymptomsaofastrokeavaryagreatlyaandatheainitialadiagnosisaisamadeaafteraaanon-
contrastaCTascanaisadoneatoadetermineaifatheaeventawasaischemicaorahemorrhagic.aThen,af
urtheratestsaareadoneatoaconfirmatheadiagnosisaandadecideaonatreatment.
Inatheaeventaofaaafireainaaahospital'sadialysisaunit,awhichaofatheseaactionsashouldatheanursea
takeafirst?
1)aExtinguishatheafireaifapossible.
2)aActivateatheafirearesponseasystem.
3)aConfineatheafireabyaclosingaallafireadoors.
4)aRemoveapatientsaorastaffainadanger.a-aans--4)aRemoveapatientsaorastaffainadanger.
