Medical-Surgical Nursing Exam 1
Questions and Answers
The nurse is caring for a client who has as a son with a streptococcus throat
infection. Which nurse recommendation would be best to advise the client to
do in order to prevent acquiring the infection? - -Frequently wash her hands
and surfaces of the home.
- The nurse is caring for a client infected with Rocky Mountain spotted fever.
The nurse should ask if the client has experienced which of the following? - -
Was bitten by a tick
- The nurse is caring for a client with a protozoa infection. Which is the most
likely mode of transmission? - -Ingestion of contaminated food or water
- The nurse is caring for a client who is recovering from an allergic reaction.
Which leukocyte level would the nurse expect to be the most elevated? - -
Eosinophils
- The nurse is caring for a client who has an infected wound on the great toe
that is red with a purulent exudate. The nurse expects that this client has
which type of infection? - -Localized
- The client experienced a fall. Nursing assessment reveals that the client is
experiencing tachycardia, hypotension, confusion, tachypnea, and flat
jugular veins. What should be the nurse's first response? - -Administer
oxygen.
- The family wants to know why the nurse is putting a urinary catheter in a
client experiencing shock. What is the nurse's best response? - -"It will help
monitor how much urine the kidneys are able to produce."
- A client experiencing shock has had a urinary output of 250 mL in the last
10 hours. What is the nurse's most appropriate response? - -Notify the
physician.
- Which client is most likely to be experiencing hypovolemic shock? - -A
client who had surgery 24 hours ago and who also has a nasogastric tube
- The physician has ordered arterial blood gases for a client experiencing
shock. The nurse knows that which value indicates shock? - -pH 7.32
- A 63-year-old Arab American male states his left leg is "hot." What is the
nurse's best first response? - -Assess for pain
, - The client is complaining of excruciating pain in a foot that has been
amputated. The family tells the nurse that the client is just addicted to pain
medications. What is the nurse's best response? - -"He is experiencing
phantom limb pain."
- A client has had abdominal surgery and has orders to be ambulated three
times a day. Oral pain medication has been ordered for the client. What
should the nurse do to facilitate ambulation? - -Mediate 1 hour prior to
ambulating the client.
- The client reports frequent use of acetaminophen. How should the nurse
best respond? - -"Do you drink alcohol?"
- A client with chronic pain has been admitted with a fever. The nursing
assessment reveals that the client has a decreased level of consciousness.
What should the nurse ask the family about? - -What medications the client
has taken
- The practical nurse is reviewing the social history from a client diagnosed
with small cell carcinoma of the lung. Which information is significant for this
disease? - -The client has smoked two (2) packs of cigarettes a day for 20
years
- The practical nurse and an unlicensed assistive personnel (UAP) are caring
for a group of clients on a medical unit. Which information provided by the
UAP warrants immediate intervention by the practical nurse? - -The client
receiving Procrit (epoetin alfa) has a T 99.2˚F, P 68, R 24, and BP of 198/102
- The client diagnosed with lung cancer has been told the cancer has
metastasized to the brain. Which intervention should the practical nurse
expect to implement? - -Discuss implementing an advance directive
- The client diagnosed with lung cancer is being discharged. Which
statement made by the client indicates a reiteration of information is
required? - -"It doesn't matter if I smoke now. I already have cancer."
- The practical nurse is interviewing clients at the clinic. Which information
provided by a client warrants further investigation? - -The client has been
coughing up blood in the mornings
- The male client had abdominal surgery and the practical nurse suspects
the client has peritonitis. Which information support the diagnosis of
peritonitis? - -Hard, rigid abdomen and white blood cell count 22,000/mm3
, - The client who had abdominal surgery tells the practical nurse, "I felt
something give way in my stomach." Which intervention should the practical
nurse implement first? - -Inspect the abdominal wound incision
- The client is one (1) day postoperative major abdominal surgery. Which
client problem is a priority? - -Fluid and electrolyte imbalance
- The client has an eviscerated abdominal wound. Which intervention should
the practical nurse implement? - -Apply sterile normal saline dressing
- The client is diagnosed with peritonitis. Which information indicates to the
practical nurse the client's condition is improving? - -The client has a
decrease in temperature and a soft abdomen
- A patient is being released from the hospital with a prescription for
tetracycline. What should the nurse include in patient teaching?
Select all that apply. - -Advise limiting exposure to the sun.
Inform patient of the possibility of gastrointestinal upset.
Suggest eating crackers and some juice when taking this medicine.
- The nurse wants to determine if a patient not fully awake from anesthesia
for a surgical procedure is experiencing pain. What findings should the nurse
use to make this determination?
Select all that apply. - -Moaning
Restlessness
Pulling at a body area
Elevated blood pressure
- A patient is diagnosed with an infection that has spread to the blood
stream. Which term should the nurse use to document this patient's health
problem? - -Sepsis
- The nurse learns that a patient is being admitted with an infectious disease
that is transmited through the air. For which health problems should the
nurse prepare to provide care?
Select all that apply. - -Measles
Tuberculosis
Chickenpox
Questions and Answers
The nurse is caring for a client who has as a son with a streptococcus throat
infection. Which nurse recommendation would be best to advise the client to
do in order to prevent acquiring the infection? - -Frequently wash her hands
and surfaces of the home.
- The nurse is caring for a client infected with Rocky Mountain spotted fever.
The nurse should ask if the client has experienced which of the following? - -
Was bitten by a tick
- The nurse is caring for a client with a protozoa infection. Which is the most
likely mode of transmission? - -Ingestion of contaminated food or water
- The nurse is caring for a client who is recovering from an allergic reaction.
Which leukocyte level would the nurse expect to be the most elevated? - -
Eosinophils
- The nurse is caring for a client who has an infected wound on the great toe
that is red with a purulent exudate. The nurse expects that this client has
which type of infection? - -Localized
- The client experienced a fall. Nursing assessment reveals that the client is
experiencing tachycardia, hypotension, confusion, tachypnea, and flat
jugular veins. What should be the nurse's first response? - -Administer
oxygen.
- The family wants to know why the nurse is putting a urinary catheter in a
client experiencing shock. What is the nurse's best response? - -"It will help
monitor how much urine the kidneys are able to produce."
- A client experiencing shock has had a urinary output of 250 mL in the last
10 hours. What is the nurse's most appropriate response? - -Notify the
physician.
- Which client is most likely to be experiencing hypovolemic shock? - -A
client who had surgery 24 hours ago and who also has a nasogastric tube
- The physician has ordered arterial blood gases for a client experiencing
shock. The nurse knows that which value indicates shock? - -pH 7.32
- A 63-year-old Arab American male states his left leg is "hot." What is the
nurse's best first response? - -Assess for pain
, - The client is complaining of excruciating pain in a foot that has been
amputated. The family tells the nurse that the client is just addicted to pain
medications. What is the nurse's best response? - -"He is experiencing
phantom limb pain."
- A client has had abdominal surgery and has orders to be ambulated three
times a day. Oral pain medication has been ordered for the client. What
should the nurse do to facilitate ambulation? - -Mediate 1 hour prior to
ambulating the client.
- The client reports frequent use of acetaminophen. How should the nurse
best respond? - -"Do you drink alcohol?"
- A client with chronic pain has been admitted with a fever. The nursing
assessment reveals that the client has a decreased level of consciousness.
What should the nurse ask the family about? - -What medications the client
has taken
- The practical nurse is reviewing the social history from a client diagnosed
with small cell carcinoma of the lung. Which information is significant for this
disease? - -The client has smoked two (2) packs of cigarettes a day for 20
years
- The practical nurse and an unlicensed assistive personnel (UAP) are caring
for a group of clients on a medical unit. Which information provided by the
UAP warrants immediate intervention by the practical nurse? - -The client
receiving Procrit (epoetin alfa) has a T 99.2˚F, P 68, R 24, and BP of 198/102
- The client diagnosed with lung cancer has been told the cancer has
metastasized to the brain. Which intervention should the practical nurse
expect to implement? - -Discuss implementing an advance directive
- The client diagnosed with lung cancer is being discharged. Which
statement made by the client indicates a reiteration of information is
required? - -"It doesn't matter if I smoke now. I already have cancer."
- The practical nurse is interviewing clients at the clinic. Which information
provided by a client warrants further investigation? - -The client has been
coughing up blood in the mornings
- The male client had abdominal surgery and the practical nurse suspects
the client has peritonitis. Which information support the diagnosis of
peritonitis? - -Hard, rigid abdomen and white blood cell count 22,000/mm3
, - The client who had abdominal surgery tells the practical nurse, "I felt
something give way in my stomach." Which intervention should the practical
nurse implement first? - -Inspect the abdominal wound incision
- The client is one (1) day postoperative major abdominal surgery. Which
client problem is a priority? - -Fluid and electrolyte imbalance
- The client has an eviscerated abdominal wound. Which intervention should
the practical nurse implement? - -Apply sterile normal saline dressing
- The client is diagnosed with peritonitis. Which information indicates to the
practical nurse the client's condition is improving? - -The client has a
decrease in temperature and a soft abdomen
- A patient is being released from the hospital with a prescription for
tetracycline. What should the nurse include in patient teaching?
Select all that apply. - -Advise limiting exposure to the sun.
Inform patient of the possibility of gastrointestinal upset.
Suggest eating crackers and some juice when taking this medicine.
- The nurse wants to determine if a patient not fully awake from anesthesia
for a surgical procedure is experiencing pain. What findings should the nurse
use to make this determination?
Select all that apply. - -Moaning
Restlessness
Pulling at a body area
Elevated blood pressure
- A patient is diagnosed with an infection that has spread to the blood
stream. Which term should the nurse use to document this patient's health
problem? - -Sepsis
- The nurse learns that a patient is being admitted with an infectious disease
that is transmited through the air. For which health problems should the
nurse prepare to provide care?
Select all that apply. - -Measles
Tuberculosis
Chickenpox
