RN ADULT MEDICAL SURGICAL 2019
n n n n
1. Annurse nisnassessingnanclientnwhonhasnandiagnosisnonncolonncancernwhichnof nthe nfollowingnshouldnthe nnurs
e nexpect?
a. Steatorrhea
b. Elevatednhemoglobin
c. Hematochezian
d.nWeightngain
2. Annurse nisnassessingnanclientnadmittednwithnperipheralnvascularndisease.nWhichnofnthenfollowingnfindingsnindicates
n an venous n vascularn disorder?
a. Annulcernatnthe ntipnofnantoe
b. Hairnlossndistalntonthe nclient’sncalves
c. Legnpainnatnrest
d.n Edemanofnthe nankle n
3. Annurse nisnassessingnanclientnwhonhasnpericarditis.nInnwhichnof nthenfollowingnareasnof nthenclient’snchestnshouldnth
e nnurse nplace nthe nstethoscope ntonbestnhearnanpericardialnfrictionnrub?n (selectnHOTnspot)
Answer:nD
4. Annurse nisncaringnfornanclientnwhonhasnanchestntube.nThe nclientnasksnwhynthe nfluidninnthe nwater-
sealnchambernrisesnandnfalls.nWhichnofnthe nfollowingnstatementsnshouldnthe nnurse nmake?
a. “Thisnmeansnyournlungnisnfullynexpandedn“
b. “Thisnindicatesnanpossible nleak”
c. “Suctionnpressure nthatnisntoonhighncausesnthis”
d. “Yournbreathingnpatternncausesnthis”n– npage n111
5. Ancommunitynhealthnnursenisnreviewingnhome ncare ninstructionsnwithnannoldernadultnclientnwhonhasnannewndia
gnosisnof nheartnfailure.nWhichnofnthe nfollowingnisnthe npriorityntopicnfornthe nnurse ntonreviewnwithnthe nclient?
a. Dailynsodiumnrestriction
, b. Dailynexercise nroutine
c. Changesninnweightn
d. Fluidnintake nrecord
6. Annurse nisnteachingnanclientnaboutnthe nuse nofntranscutaneousnelectricalnnerve nstimulationn(TENS)nunit.
n Whichn of n the n followingn statements n should n the n nurse n include?
a. “Applynlotionntonthe nsite npriorntonattachingnthe nelectrodes”
b. “Thisndevice nrequiresnaccessntonan220-voltnoutlet”
c. “Thisndevice ndeliversnheatnvianelectrodesnthatnare nattachedntonthe naffectednarea”
d. “Adjustnthe ndialnuntilnyounfeelnan‘pinsnandnneedles’nsensation”n– npage n648
7. Annurse nisnprovidingnteachingntonanclientnwhonisnpostoperative nfollowingnantotalnhipnarthroplasty.nWhichnofnthe
n followingn statements n should n the n nurse n make?
a. “Use nraisedntoiletnseatntonmaintainnyournhipsnabove nthe nknees”n– npage n455
b. “Twistnatnthe nwaistnwhennstandingnfromnanseatednposition”
c. “Move nyournstrongernlegnfirstnwhennusingnanwalker”
d. “Applynanheatingnpadntonthe noperative nhipntondecrease npain”
8. Annurse nfindsnanclientninnbed,nunresponsive nandnbreathing.nWhichnofnthe nfollowingnactionnshouldnthe nnursentake
n first?
a. EstablishnIV naccess
b. Applynbloodnpressure ncuff
c. Palpate nfornthe nclient’sncarotidnpulse
d.n n Initiate ncardiacnmonitoringnfornthe nclient
9. Annurse nisncaringnwhonisnexperiencingnanhypertensive ncrisis.nWhichnof nthe nfollowingnactionsnshouldnthe nnurse ntake?
a. Initiate nIV ndopamine ninfusion
b.n n Performnneurologicalnassessments
c. Place nthe nclientnsupine
d. BeginnannIV nbolusnof nlactatednringer’s
10. Annurse nisnprovidingndischargenteachingnaboutnbloodnsugarnmonitoringnfornanclientnwhonhasnannewndiagnosisno
fntype n2ndiabetesnmellitus.nThe nnurse nshouldninstructnthe nclientntonobtainnwhichnof nthe nfollowingnsupplies?
a. Sterile nlancetsn
b. Compressionnstockings
c. Handnmirror
d. Toenailnclippers
11. Annurse nisncompletingndischarge nteachingnwhonhasnanperipherallyninsertedncentralncathetern(PICC) nline ninnthenleft
n arm. n Whichn of n the n followingn instructions n should n the n nurse n include n inn the n teaching?
a. Donnotnelevate nthe narmnabove nthe nlevelnof nthe nheart
b. Change nthe ncatheterndressingndaily
c. Use n10-mLnsyringe ntonflushnline n– npage n176
d.n n Cleannthe ninsertionnsite nusingn20-nmLnofnhydrogennperoxide
12. Annurse nisnpreparingnnaloxone n10nmcg/kgnvianIVnbolusntonanclientnwhonweightsn220nlbs.nThenamountnavailable nisn0.
4nmg/mL.nHownmanynmLnshouldnthe nnurse nadminister?n(roundntonthe nnearestntenth) n2.5n mL
13. Annurse nisncaringnfornanclientnwhonhasnansealednradiationnimplant.nWhichnof nthe nfollowingnactionsnshouldnthe nnurs
e ntake?
a. Remove nsoilednlinensnfromnthe nroomnafterneachnchange
b. Give nthe ndosimeternbadge ntonthe noncomingnnurse natnthe nendnof nthe nshift
c. Applynansecondnpairnofnglovesnbefore ntouchingnthe nclient’snimplantnif nitndislodges
, d.n Limitnfamilynmembernvisitsnton30nminnperndaynPage n605
14. Annurse nisnprovidingnteachingntonanclientnandnhisnpartnernaboutnperformingnperitonealndialysisnatnhome.nWhenn
discussingnperitonitis,nwhichnofnthenfollowingnmanifestationsnshouldnthennursenidentifynasnthenearliestnindication
n of n thisn complication?
a. Generalizednabdominalnpain
b.n Cloudyneffluentn– npage n381
c. Increasednheartnrate
d. Fever
15. Annurse nisncaringnfornanclientnwhonisnreceivingnanbloodntransfusion.nThe nnursenobservesnthatnthenclientnhas
n boundingn peripheraln pulses, n hypertension, n andn distended n jugularn veins. nThe nnurse nshould n anticipate nad
ministeringnwhichnofnthe nfollowingnprescribednmedications?
a. Pantoprazole
b. Acetaminophen
c. Furosemide n
d. Diphenhydramine
16. Annurse nisnplanningncare nfornanclientnwhonhasnupperngastrointestinalnbleedingndue ntonanpepticnulcer.nWhichnofnthe
n followingn actions n should n the n nurse n plann ton take?
a. Provide nketorolacnfornabdominalnpain
b. Administernnitroprusside nIV nbasednonnthe nclient’snweight
c. Insertnanlarge nbore nnasogastricntube n– npage n330
d.n n Ensure nthatnthe nclientnhasnan22-gauge nIV nline ninnplace
17. Annurse nisncaringnfornanclientnwhonhasnbladderncancernandnanWBCncountnofn900/mm3.nWhichnofnthe nfollowin
gnactionsnshouldnthe nnurse ntake?
a. Instructnclientntonavoidneatingnrawnfruitn– npage n615
b. Move nthe nclientntonannegative npressure nroom
c. Use ncontactnisolationnwhile nprovidingncare
d. Applynpressure ntonvenipuncture nsitesnforn10nmin
18. Annurse nisncaringnfornanpatientnwhonhasnhypotension, ncoolnandnclammynskin,ntachycardianandntachypnea.nWhichnof
n the n followingn positions n should n the n nurse n place n the n client?
a. Reverse nTrendelenburgn– npage n397
b. Feetnelevated
c. Side nlying
d. High-fowler’s
19. Annurse nisncaringnfornanclientnwhonweightsn190nlbnandnisnreceivingnTotalnParenteralnNutrition.nIfnthe nRDAnProteinni
sn0.8g/kgnofnbodynweight,nhownmanyngramsnof nproteinnshouldnthenclientnreceivendailyn(Roundnthenanswerntonthen
nearestnwhole nnumber.nUse nanleadingnzeronif nitnapplies.nDonnotnuse nantrailingnzero) nAnswer:n69ngrams
20. Annurse nisnplanningncare nfornanclientnwhonhasnancentralnvenousnaccessndevice nfornintermittentninfusions.nWhichno
fnthe nfollowingnactionsnshouldnthe nnurse ninclude ninnthe nplannof ncare?
a. Flushnancatheternusingnan10nmLnsyringe
b. Use ncleanntechnique nwhennchangingnthe ndressing
c. Cleanse nthe nsite nwithnProvondine niodine
d. Change nthe ndressingneveryn24nhours
21. Annurse nisnreviewingnthenmedicalnrecordnof nanclientnwhonisntonundergonopennheartnsurgery.nWhichnofnthe nfollowin
gnfindingsnshouldnthe nnurse nreportntonthe nprovidernasnancontradictionntonreceivingnheparin?na.nThalassemia
b. Rheumatoidnarthritis
, c. COPD
d.n Thrombocytopenian
22. Annurse nisncaringnfornannoldernadultnclientnwhonhasndementia.nWhichnofnthenfollowingnquestionnshouldnthe nnurse
n askn ton assess n the n client's n abstractn thinking?
a.n Whatnisnmeantnbynsayingn“don'tnbeatnaroundnthe nbush?”
b. Whatndonyoununderstandnaboutnyourncondition?
c. Cannyouncountnbackwardsnfromn100ninnintervalsnof n7?
d. Cannyounstate nwhere nyounwere nborn?
23. Annurse nisncompletingnannassessmentnofnannoldernadultnclientnandnnotesnreddenednareasnovernthenbonynpromine
nces,nbutnthenclient'snskinnisnintact.nWhichnofnthenfollowingninterventionsnshouldnthe nnurse nincludeninnthenplannof n
care?
a. Applynannocclusive ndressing
b. Turnnandnrepositionnthe nclientneveryn4nhours
c. Supportnbonynprominencesnwithnpillows
d.nMassage nTourette ninnareasnthree ntimesndaily
24. Annurse nisnreviewingnancardiacnrhythmnstripnof nanclientnwhonhasnatrialnflutter.nWhichnofnthenfollowingnfindings
n should n the n nurse n expect?
a. ProgressivelynlongernPRndurations
b. Undetectable npnwaves
c. AbsentnPRnintervalsnwithnventricularnrate nofn40nton60n/nminutesnd)
d.n Sawtoothnpatternnwithnatrialnrate nofn252nton400n/nminutes
25. Annurse nisncaringnfornanclientnwhonisnschedulednfornannabdominalnparacentesis.nThennursenshouldnplanntontak
e nwhichnof nthe nfollowingnactions?
a. Administernanstoolnsoftenernfollowingnthe nprocedure
b. Asknthe nclientntonemptynhisnbladdernpriorntonthe nprocedure n– nPage n311
c. Instructnthe nclientntontake ndeepnbreathsnandnholdnthemnduringnthe nprocedure
d. Assistnthe nclientnintonthe nleftnlateralnpositionnduringnthe nprocedure
26. Annurse nisnassessingnanclientnfollowingntheninsertionnofnancentralnvenousncatheter.nWhichnofnthenfollowingnfinding
snindicatesnanpneumothorax?
a. Diminishednbreathnsounds
b. Itchingnovernthe nincision
c. Distendednnecknveins
d. Irregularnheartnrate
27. Annurse nisnprovidingnteachingntonanclientnwhonisnreceivingnopioidsnfornpainnmanagement.nWhichnof nthe nfollowin
gninformationnshouldnthe nnurse ninclude ninnthe nteaching?
a. Monitornurinarynoutputnfornretention
b. avoidntakingnantinemeticsnwithnthe nmedication
c. restrictnfluidnintake nIfnyounexperience nconstipation
d. itchingnIndicatesnyounare nhavingnannallergicnreactionntonthe nmedication
28. Annurse nisnprovidingndischargenteachingnfornanclientnwhonhasnasthmanandnannewnprescriptionnfornanmeteredndose
n inhaler. n Whichn of n the n followingn clientn statements n indicates n ann understandingn of n the n teaching?
a. Inshouldncleannthe ncapnof nthe ninhalernonce npernweek
b. Inshouldnshake nthe ninhalernbefore nInuse nit
c. InShouldnwaitn15nsecondsnbetweennpuffs
d. Inshouldninhale nthe nmedicationnquickly
n n n n
1. Annurse nisnassessingnanclientnwhonhasnandiagnosisnonncolonncancernwhichnof nthe nfollowingnshouldnthe nnurs
e nexpect?
a. Steatorrhea
b. Elevatednhemoglobin
c. Hematochezian
d.nWeightngain
2. Annurse nisnassessingnanclientnadmittednwithnperipheralnvascularndisease.nWhichnofnthenfollowingnfindingsnindicates
n an venous n vascularn disorder?
a. Annulcernatnthe ntipnofnantoe
b. Hairnlossndistalntonthe nclient’sncalves
c. Legnpainnatnrest
d.n Edemanofnthe nankle n
3. Annurse nisnassessingnanclientnwhonhasnpericarditis.nInnwhichnof nthenfollowingnareasnof nthenclient’snchestnshouldnth
e nnurse nplace nthe nstethoscope ntonbestnhearnanpericardialnfrictionnrub?n (selectnHOTnspot)
Answer:nD
4. Annurse nisncaringnfornanclientnwhonhasnanchestntube.nThe nclientnasksnwhynthe nfluidninnthe nwater-
sealnchambernrisesnandnfalls.nWhichnofnthe nfollowingnstatementsnshouldnthe nnurse nmake?
a. “Thisnmeansnyournlungnisnfullynexpandedn“
b. “Thisnindicatesnanpossible nleak”
c. “Suctionnpressure nthatnisntoonhighncausesnthis”
d. “Yournbreathingnpatternncausesnthis”n– npage n111
5. Ancommunitynhealthnnursenisnreviewingnhome ncare ninstructionsnwithnannoldernadultnclientnwhonhasnannewndia
gnosisnof nheartnfailure.nWhichnofnthe nfollowingnisnthe npriorityntopicnfornthe nnurse ntonreviewnwithnthe nclient?
a. Dailynsodiumnrestriction
, b. Dailynexercise nroutine
c. Changesninnweightn
d. Fluidnintake nrecord
6. Annurse nisnteachingnanclientnaboutnthe nuse nofntranscutaneousnelectricalnnerve nstimulationn(TENS)nunit.
n Whichn of n the n followingn statements n should n the n nurse n include?
a. “Applynlotionntonthe nsite npriorntonattachingnthe nelectrodes”
b. “Thisndevice nrequiresnaccessntonan220-voltnoutlet”
c. “Thisndevice ndeliversnheatnvianelectrodesnthatnare nattachedntonthe naffectednarea”
d. “Adjustnthe ndialnuntilnyounfeelnan‘pinsnandnneedles’nsensation”n– npage n648
7. Annurse nisnprovidingnteachingntonanclientnwhonisnpostoperative nfollowingnantotalnhipnarthroplasty.nWhichnofnthe
n followingn statements n should n the n nurse n make?
a. “Use nraisedntoiletnseatntonmaintainnyournhipsnabove nthe nknees”n– npage n455
b. “Twistnatnthe nwaistnwhennstandingnfromnanseatednposition”
c. “Move nyournstrongernlegnfirstnwhennusingnanwalker”
d. “Applynanheatingnpadntonthe noperative nhipntondecrease npain”
8. Annurse nfindsnanclientninnbed,nunresponsive nandnbreathing.nWhichnofnthe nfollowingnactionnshouldnthe nnursentake
n first?
a. EstablishnIV naccess
b. Applynbloodnpressure ncuff
c. Palpate nfornthe nclient’sncarotidnpulse
d.n n Initiate ncardiacnmonitoringnfornthe nclient
9. Annurse nisncaringnwhonisnexperiencingnanhypertensive ncrisis.nWhichnof nthe nfollowingnactionsnshouldnthe nnurse ntake?
a. Initiate nIV ndopamine ninfusion
b.n n Performnneurologicalnassessments
c. Place nthe nclientnsupine
d. BeginnannIV nbolusnof nlactatednringer’s
10. Annurse nisnprovidingndischargenteachingnaboutnbloodnsugarnmonitoringnfornanclientnwhonhasnannewndiagnosisno
fntype n2ndiabetesnmellitus.nThe nnurse nshouldninstructnthe nclientntonobtainnwhichnof nthe nfollowingnsupplies?
a. Sterile nlancetsn
b. Compressionnstockings
c. Handnmirror
d. Toenailnclippers
11. Annurse nisncompletingndischarge nteachingnwhonhasnanperipherallyninsertedncentralncathetern(PICC) nline ninnthenleft
n arm. n Whichn of n the n followingn instructions n should n the n nurse n include n inn the n teaching?
a. Donnotnelevate nthe narmnabove nthe nlevelnof nthe nheart
b. Change nthe ncatheterndressingndaily
c. Use n10-mLnsyringe ntonflushnline n– npage n176
d.n n Cleannthe ninsertionnsite nusingn20-nmLnofnhydrogennperoxide
12. Annurse nisnpreparingnnaloxone n10nmcg/kgnvianIVnbolusntonanclientnwhonweightsn220nlbs.nThenamountnavailable nisn0.
4nmg/mL.nHownmanynmLnshouldnthe nnurse nadminister?n(roundntonthe nnearestntenth) n2.5n mL
13. Annurse nisncaringnfornanclientnwhonhasnansealednradiationnimplant.nWhichnof nthe nfollowingnactionsnshouldnthe nnurs
e ntake?
a. Remove nsoilednlinensnfromnthe nroomnafterneachnchange
b. Give nthe ndosimeternbadge ntonthe noncomingnnurse natnthe nendnof nthe nshift
c. Applynansecondnpairnofnglovesnbefore ntouchingnthe nclient’snimplantnif nitndislodges
, d.n Limitnfamilynmembernvisitsnton30nminnperndaynPage n605
14. Annurse nisnprovidingnteachingntonanclientnandnhisnpartnernaboutnperformingnperitonealndialysisnatnhome.nWhenn
discussingnperitonitis,nwhichnofnthenfollowingnmanifestationsnshouldnthennursenidentifynasnthenearliestnindication
n of n thisn complication?
a. Generalizednabdominalnpain
b.n Cloudyneffluentn– npage n381
c. Increasednheartnrate
d. Fever
15. Annurse nisncaringnfornanclientnwhonisnreceivingnanbloodntransfusion.nThe nnursenobservesnthatnthenclientnhas
n boundingn peripheraln pulses, n hypertension, n andn distended n jugularn veins. nThe nnurse nshould n anticipate nad
ministeringnwhichnofnthe nfollowingnprescribednmedications?
a. Pantoprazole
b. Acetaminophen
c. Furosemide n
d. Diphenhydramine
16. Annurse nisnplanningncare nfornanclientnwhonhasnupperngastrointestinalnbleedingndue ntonanpepticnulcer.nWhichnofnthe
n followingn actions n should n the n nurse n plann ton take?
a. Provide nketorolacnfornabdominalnpain
b. Administernnitroprusside nIV nbasednonnthe nclient’snweight
c. Insertnanlarge nbore nnasogastricntube n– npage n330
d.n n Ensure nthatnthe nclientnhasnan22-gauge nIV nline ninnplace
17. Annurse nisncaringnfornanclientnwhonhasnbladderncancernandnanWBCncountnofn900/mm3.nWhichnofnthe nfollowin
gnactionsnshouldnthe nnurse ntake?
a. Instructnclientntonavoidneatingnrawnfruitn– npage n615
b. Move nthe nclientntonannegative npressure nroom
c. Use ncontactnisolationnwhile nprovidingncare
d. Applynpressure ntonvenipuncture nsitesnforn10nmin
18. Annurse nisncaringnfornanpatientnwhonhasnhypotension, ncoolnandnclammynskin,ntachycardianandntachypnea.nWhichnof
n the n followingn positions n should n the n nurse n place n the n client?
a. Reverse nTrendelenburgn– npage n397
b. Feetnelevated
c. Side nlying
d. High-fowler’s
19. Annurse nisncaringnfornanclientnwhonweightsn190nlbnandnisnreceivingnTotalnParenteralnNutrition.nIfnthe nRDAnProteinni
sn0.8g/kgnofnbodynweight,nhownmanyngramsnof nproteinnshouldnthenclientnreceivendailyn(Roundnthenanswerntonthen
nearestnwhole nnumber.nUse nanleadingnzeronif nitnapplies.nDonnotnuse nantrailingnzero) nAnswer:n69ngrams
20. Annurse nisnplanningncare nfornanclientnwhonhasnancentralnvenousnaccessndevice nfornintermittentninfusions.nWhichno
fnthe nfollowingnactionsnshouldnthe nnurse ninclude ninnthe nplannof ncare?
a. Flushnancatheternusingnan10nmLnsyringe
b. Use ncleanntechnique nwhennchangingnthe ndressing
c. Cleanse nthe nsite nwithnProvondine niodine
d. Change nthe ndressingneveryn24nhours
21. Annurse nisnreviewingnthenmedicalnrecordnof nanclientnwhonisntonundergonopennheartnsurgery.nWhichnofnthe nfollowin
gnfindingsnshouldnthe nnurse nreportntonthe nprovidernasnancontradictionntonreceivingnheparin?na.nThalassemia
b. Rheumatoidnarthritis
, c. COPD
d.n Thrombocytopenian
22. Annurse nisncaringnfornannoldernadultnclientnwhonhasndementia.nWhichnofnthenfollowingnquestionnshouldnthe nnurse
n askn ton assess n the n client's n abstractn thinking?
a.n Whatnisnmeantnbynsayingn“don'tnbeatnaroundnthe nbush?”
b. Whatndonyoununderstandnaboutnyourncondition?
c. Cannyouncountnbackwardsnfromn100ninnintervalsnof n7?
d. Cannyounstate nwhere nyounwere nborn?
23. Annurse nisncompletingnannassessmentnofnannoldernadultnclientnandnnotesnreddenednareasnovernthenbonynpromine
nces,nbutnthenclient'snskinnisnintact.nWhichnofnthenfollowingninterventionsnshouldnthe nnurse nincludeninnthenplannof n
care?
a. Applynannocclusive ndressing
b. Turnnandnrepositionnthe nclientneveryn4nhours
c. Supportnbonynprominencesnwithnpillows
d.nMassage nTourette ninnareasnthree ntimesndaily
24. Annurse nisnreviewingnancardiacnrhythmnstripnof nanclientnwhonhasnatrialnflutter.nWhichnofnthenfollowingnfindings
n should n the n nurse n expect?
a. ProgressivelynlongernPRndurations
b. Undetectable npnwaves
c. AbsentnPRnintervalsnwithnventricularnrate nofn40nton60n/nminutesnd)
d.n Sawtoothnpatternnwithnatrialnrate nofn252nton400n/nminutes
25. Annurse nisncaringnfornanclientnwhonisnschedulednfornannabdominalnparacentesis.nThennursenshouldnplanntontak
e nwhichnof nthe nfollowingnactions?
a. Administernanstoolnsoftenernfollowingnthe nprocedure
b. Asknthe nclientntonemptynhisnbladdernpriorntonthe nprocedure n– nPage n311
c. Instructnthe nclientntontake ndeepnbreathsnandnholdnthemnduringnthe nprocedure
d. Assistnthe nclientnintonthe nleftnlateralnpositionnduringnthe nprocedure
26. Annurse nisnassessingnanclientnfollowingntheninsertionnofnancentralnvenousncatheter.nWhichnofnthenfollowingnfinding
snindicatesnanpneumothorax?
a. Diminishednbreathnsounds
b. Itchingnovernthe nincision
c. Distendednnecknveins
d. Irregularnheartnrate
27. Annurse nisnprovidingnteachingntonanclientnwhonisnreceivingnopioidsnfornpainnmanagement.nWhichnof nthe nfollowin
gninformationnshouldnthe nnurse ninclude ninnthe nteaching?
a. Monitornurinarynoutputnfornretention
b. avoidntakingnantinemeticsnwithnthe nmedication
c. restrictnfluidnintake nIfnyounexperience nconstipation
d. itchingnIndicatesnyounare nhavingnannallergicnreactionntonthe nmedication
28. Annurse nisnprovidingndischargenteachingnfornanclientnwhonhasnasthmanandnannewnprescriptionnfornanmeteredndose
n inhaler. n Whichn of n the n followingn clientn statements n indicates n ann understandingn of n the n teaching?
a. Inshouldncleannthe ncapnof nthe ninhalernonce npernweek
b. Inshouldnshake nthe ninhalernbefore nInuse nit
c. InShouldnwaitn15nsecondsnbetweennpuffs
d. Inshouldninhale nthe nmedicationnquickly
