Med Surg CMS
Study online at https://quizlet.com/_gl5tq9
1. 1. A nurse in the emergency department is B. Obtain an ECG.
managing the care of a client who has an elec-
trical shock injury. Which of the following ac-
tions should the nurse take first?
A. Change dressings over the entrance and exit
wounds.
B. Obtain an ECG.
C. Administer an opioid pain medication.
D. Titrate IV fluids to maintain urine output at
75 mL/hr.
2. 1. A nurse is assessing a client who is postoper- C. Use 0.9% sodium chloride to per-
ative following a transurethral resection of the form an intermittent bladder irriga-
prostate and is receiving continuous bladder tion.
irrigation. The client reports bladder spasms,
and the nurse notes a scant amount of fluid in
the urinary drainage bag. Which of the follow-
ing actions should the nurse take?
A. Apply a cold compress to the suprapubic
area.
B. Secure the urinary catheter to the upper left
quadrant of the client's abdomen.
C. Use 0.9% sodium chloride to perform an in-
termittent bladder irrigation.
D. Encourage the client to urinate every 2 hr.
3. 1. A nurse is assessing a client who has a uri- B. Infection
nary catheter. The nurse notes the client's IV
tubing is kinked and the urinary catheter bag is
lying next to the client in bed. The nurse should
identify that the client is at risk for which of the
following conditions?
, Med Surg CMS
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A. Skin breakdown
B. Infection
C. Neurogenic bladder
D. Phlebitis
4. 1. A nurse is caring for a client who is postop- D. Gag reflex
erative following an endoscopy with moderate
(conscious) sedation. Which of the following as-
sessment findings is the nurse's priority?
A. Level of pain
B. Temperature
C. Warmth of extremities
D. Gag reflex
5. 1. A nurse is providing instructions to a client C. "You will need three follow-up
who has primary syphilis. Which of the follow- blood tests within a 24-month peri-
ing instructions should the nurse include in the od."
discharge plan?
A. "You will need to take an antiviral medication
for 6 months."
B. "You will need cryotherapy for 1 to 2 weeks."
C. "You will need three follow-up blood tests
within a 24-month period."
D. "You will need to be monitored for 15 min-
utes after receiving each medication dose."
6. 1. A nurse is teaching the family of a client who C. Hang a monthly calendar in the
has Alzheimer's disease about caring for the client's bedroom.
client at home. Which of the following instruc-
tions should the nurse include?
A. Cover electrical outlets in the client's home
with tape.
, Med Surg CMS
Study online at https://quizlet.com/_gl5tq9
B. Keep the client's bedroom dark at night.
C. Hang a monthly calendar in the client's bed-
room.
D. Place a large-face clock in the client's bed-
room.
7. 1. A nurse is caring for a client who has an arte- A. Palpable thrill
riovenous graft. Which of the following findings
indicates adequate circulation of the graft?
A. Palpable thrill
B. Absence of a bruit
C. Normotensive blood pressure
D. Dilated appearance of the graft
8. 1. A nurse is caring for a client who is receiving a A. Slow infusion rate and contact the
0.9% sodium chloride via IV infusion. The client provider.
has become dyspneic with a blood pressure of
140/100 mm Hg. a fluid intake of 960 mL, and
an output of 300 mL in the past 12 hr. Which of
the following actions should the nurse take?
A. Slow infusion rate and contact the provider.
B. Lower the head of the bed to semi-Fowler's.
C. Administer prescribed corticosteroids.
D. Change infusion to Lactated Ringer's and
maintain rate.
9. 1. Client came to the emergency department A. Hypotension
this morning and reports not feeling well for D. Cardiac arrhythmias
the last 12 hr and increasing blood glucose. E. Renal failure
Client has a history of type 1 diabetes mellitus F. Cerebral edema
and hypertension. Client weight is 88 kg (194
lb). The client was recently treated for bronchi-
, Med Surg CMS
Study online at https://quizlet.com/_gl5tq9
tis and pneumonia. Client reports nausea and
decreased appetite. Client is alert and orientat-
ed x 4, heart and lung sounds are clear. Client
states that they have been frequently urinating
and are extremely thirsty. Bowel sounds are
hyperactive in all 4 quadrants. Bilateral pedal
pulses 1+. Slight tenting of skin. Peripheral IV
established and labs drawn.The nurse is caring
for the client in the ED. The nurse understands
that the client is at risk of developing which
of the following complications? (Select all that
apply.)
A. Hypotension
B. Respiratory alkalosis
C. Septic shock
D. Cardiac arrhythmias
E. Renal failure
F. Cerebral edema
10. 1. Client came to the emergency department D. Regular insulin continuous in-
this morning and reports not feeling well for travenous infusion, titrate per di-
the last 12 hr and increasing blood glucose. abetic ketoacidosis (DKA) protocol
Client has a history of type 1 diabetes mellitus once potassium is greater than 3.3
and hypertension. Client weight is 88 kg (194 mEq/L.
lb). The client was recently treated for bronchi- E. 0.9% sodium chloride at 15
tis and pneumonia. Client reports nausea and ml/kg/hr for 1 hr and then reduce
decreased appetite. Client is alert and orientat- to 10 ml/kg/hr.
ed x 4, heart and lung sounds are clear. Client H. Monitor urine outputs.
states that they have been frequently urinating
and are extremely thirsty. Bowel sounds are
hyperactive in all 4 quadrants. Bilateral pedal
pulses 1+. Slight tenting of skin. Peripheral IV
Study online at https://quizlet.com/_gl5tq9
1. 1. A nurse in the emergency department is B. Obtain an ECG.
managing the care of a client who has an elec-
trical shock injury. Which of the following ac-
tions should the nurse take first?
A. Change dressings over the entrance and exit
wounds.
B. Obtain an ECG.
C. Administer an opioid pain medication.
D. Titrate IV fluids to maintain urine output at
75 mL/hr.
2. 1. A nurse is assessing a client who is postoper- C. Use 0.9% sodium chloride to per-
ative following a transurethral resection of the form an intermittent bladder irriga-
prostate and is receiving continuous bladder tion.
irrigation. The client reports bladder spasms,
and the nurse notes a scant amount of fluid in
the urinary drainage bag. Which of the follow-
ing actions should the nurse take?
A. Apply a cold compress to the suprapubic
area.
B. Secure the urinary catheter to the upper left
quadrant of the client's abdomen.
C. Use 0.9% sodium chloride to perform an in-
termittent bladder irrigation.
D. Encourage the client to urinate every 2 hr.
3. 1. A nurse is assessing a client who has a uri- B. Infection
nary catheter. The nurse notes the client's IV
tubing is kinked and the urinary catheter bag is
lying next to the client in bed. The nurse should
identify that the client is at risk for which of the
following conditions?
, Med Surg CMS
Study online at https://quizlet.com/_gl5tq9
A. Skin breakdown
B. Infection
C. Neurogenic bladder
D. Phlebitis
4. 1. A nurse is caring for a client who is postop- D. Gag reflex
erative following an endoscopy with moderate
(conscious) sedation. Which of the following as-
sessment findings is the nurse's priority?
A. Level of pain
B. Temperature
C. Warmth of extremities
D. Gag reflex
5. 1. A nurse is providing instructions to a client C. "You will need three follow-up
who has primary syphilis. Which of the follow- blood tests within a 24-month peri-
ing instructions should the nurse include in the od."
discharge plan?
A. "You will need to take an antiviral medication
for 6 months."
B. "You will need cryotherapy for 1 to 2 weeks."
C. "You will need three follow-up blood tests
within a 24-month period."
D. "You will need to be monitored for 15 min-
utes after receiving each medication dose."
6. 1. A nurse is teaching the family of a client who C. Hang a monthly calendar in the
has Alzheimer's disease about caring for the client's bedroom.
client at home. Which of the following instruc-
tions should the nurse include?
A. Cover electrical outlets in the client's home
with tape.
, Med Surg CMS
Study online at https://quizlet.com/_gl5tq9
B. Keep the client's bedroom dark at night.
C. Hang a monthly calendar in the client's bed-
room.
D. Place a large-face clock in the client's bed-
room.
7. 1. A nurse is caring for a client who has an arte- A. Palpable thrill
riovenous graft. Which of the following findings
indicates adequate circulation of the graft?
A. Palpable thrill
B. Absence of a bruit
C. Normotensive blood pressure
D. Dilated appearance of the graft
8. 1. A nurse is caring for a client who is receiving a A. Slow infusion rate and contact the
0.9% sodium chloride via IV infusion. The client provider.
has become dyspneic with a blood pressure of
140/100 mm Hg. a fluid intake of 960 mL, and
an output of 300 mL in the past 12 hr. Which of
the following actions should the nurse take?
A. Slow infusion rate and contact the provider.
B. Lower the head of the bed to semi-Fowler's.
C. Administer prescribed corticosteroids.
D. Change infusion to Lactated Ringer's and
maintain rate.
9. 1. Client came to the emergency department A. Hypotension
this morning and reports not feeling well for D. Cardiac arrhythmias
the last 12 hr and increasing blood glucose. E. Renal failure
Client has a history of type 1 diabetes mellitus F. Cerebral edema
and hypertension. Client weight is 88 kg (194
lb). The client was recently treated for bronchi-
, Med Surg CMS
Study online at https://quizlet.com/_gl5tq9
tis and pneumonia. Client reports nausea and
decreased appetite. Client is alert and orientat-
ed x 4, heart and lung sounds are clear. Client
states that they have been frequently urinating
and are extremely thirsty. Bowel sounds are
hyperactive in all 4 quadrants. Bilateral pedal
pulses 1+. Slight tenting of skin. Peripheral IV
established and labs drawn.The nurse is caring
for the client in the ED. The nurse understands
that the client is at risk of developing which
of the following complications? (Select all that
apply.)
A. Hypotension
B. Respiratory alkalosis
C. Septic shock
D. Cardiac arrhythmias
E. Renal failure
F. Cerebral edema
10. 1. Client came to the emergency department D. Regular insulin continuous in-
this morning and reports not feeling well for travenous infusion, titrate per di-
the last 12 hr and increasing blood glucose. abetic ketoacidosis (DKA) protocol
Client has a history of type 1 diabetes mellitus once potassium is greater than 3.3
and hypertension. Client weight is 88 kg (194 mEq/L.
lb). The client was recently treated for bronchi- E. 0.9% sodium chloride at 15
tis and pneumonia. Client reports nausea and ml/kg/hr for 1 hr and then reduce
decreased appetite. Client is alert and orientat- to 10 ml/kg/hr.
ed x 4, heart and lung sounds are clear. Client H. Monitor urine outputs.
states that they have been frequently urinating
and are extremely thirsty. Bowel sounds are
hyperactive in all 4 quadrants. Bilateral pedal
pulses 1+. Slight tenting of skin. Peripheral IV
