MED SURG EXAM (MCA SAMUEL MERIT UNIVERSITY)
Which clinical problem would the nurse include in the care plan for a patient with
Parkinson disease (PD)?
Question 1:
A. Swallowing challenges.
B. Weight gain.
C. Obesity.
D. Cardiovascular problems.
Explanation
Correct Answer : A
Swallowing challenges (dysphagia) are common in Parkinson disease due to motor
dysfunction, increasing aspiration risk. This aligns with PD care planning, making it the
correct clinical problem for the nurse to include to ensure safe nutrition and prevent
complications like pneumonia.
Weight gain is not typical in PD; patients often lose weight due to dysphagia or
increased energy expenditure. Swallowing challenges are a priority, making this
incorrect, as it’s not a primary concern in the nurse’s care plan for Parkinson disease.
Obesity is uncommon in PD, as motor symptoms and dysphagia often lead to weight
loss. Swallowing challenges are more relevant, making this incorrect, as it’s not a
clinical problem the nurse would prioritize in the care plan for PD.
Cardiovascular problems may occur in PD but are less specific than swallowing
challenges, which directly impact daily function. This is incorrect, as it’s secondary to
the nurse’s focus on dysphagia as a key issue in Parkinson disease management.
Question 2:
When a patient with asthma who is on a budesonide hand-held inhaler reports
difficulty swallowing and has white patches on the tongue, which action will the
nurse take?
A. Teach the patient to gargle with water after using the budesonide.
B. Offer reassurance that the symptoms are common with budesonide use.
C. Suggest that the patient stop using the spray until the symptoms are resolved.
D. Anticipate obtaining a throat swab for rapid streptococcus testing.
Hide Correct Answer and Explanation
,Explanation
Correct Answer : A
White patches and difficulty swallowing suggest oral thrush, a side effect of budesonide.
Gargling with water post-inhalation prevents thrush, making this the correct action for
the nurse to take to address the patient’s symptoms and promote proper inhaler use.
Reassuring the patient that thrush is common doesn’t address the need for prevention
or treatment. Teaching to gargle is proactive, making this incorrect, as it fails to mitigate
the patient’s symptoms compared to the nurse’s priority intervention.
Stopping budesonide risks asthma exacerbation, and thrush can be managed with
gargling or antifungals. Teaching proper technique is better, making this incorrect, as it’s
unsafe compared to the nurse’s focus on maintaining asthma control while addressing
thrush.
Throat swabs for streptococcus are irrelevant, as white patches indicate thrush, not
bacterial infection. Gargling prevents further issues, making this incorrect, as it
misdiagnoses the cause compared to the nurse’s appropriate action for budesonide-
related oral symptoms.
A patient is being admitted with a diagnosis of Cushing syndrome. Which three
findings will the nurse expect during the assessment? (Select all that apply)
A. Bronzed appearance of the skin.
B. Purplish streaks on the abdomen.
C. Anorexia, nausea, and vomiting.
D. Hyperglycemia.
E. Truncal obesity, thin extremities, rounding of face (moon face).
Explanation
Correct Answer: B,D,E
Solution
Choice A reason: Bronzed skin is typical of Addison’s disease, not Cushing syndrome,
which causes striae and moon face. Hyperglycemia is expected, making this incorrect,
as it’s unrelated to the nurse’s anticipated findings in a patient with Cushing syndrome.
Choice B reason: Purplish streaks (striae) on the abdomen result from cortisol
excess in Cushing syndrome, weakening skin tissue. This aligns with endocrine
,assessment, making it a correct finding the nurse would expect during the
patient’s physical examination.
Choice C reason: Anorexia, nausea, and vomiting are more common in Addison’s
disease, not Cushing syndrome, which causes weight gain. Striae are typical, making
this incorrect, as it’s not a primary finding the nurse would expect in Cushing syndrome.
Choice D reason: Hyperglycemia occurs in Cushing syndrome due to cortisol-
induced insulin resistance, a common metabolic effect. This aligns with
laboratory assessment, making it a correct finding the nurse would anticipate in
the patient with Cushing syndrome.
Choice E reason: Truncal obesity, thin extremities, and moon face are classic
Cushing syndrome signs from fat redistribution due to hypercortisolism. This
aligns with physical assessment, making it a correct finding the nurse would
expect in the patient’s evaluation.
Question 4:
A patient admitted with acute renal failure asks for pain medication for a
headache described as five out of ten on the pain scale. The nurse checks the
MAR and sees that the only pain medication ordered is ibuprofen (an NSAID).
Which of the following actions should the nurse take first to ensure patient
safety?
A. Consult the healthcare provider about ordering a different pain medication.
B. Administer the ibuprofen as ordered since ibuprofen is used to treat headaches.
C. Monitor the patient closely after administering the ibuprofen for pain.
D. Inform the patient that the pain medication is contraindicated and offer to dim the
room lights.
Explanation
Correct Answer : A
Ibuprofen is contraindicated in acute renal failure, as NSAIDs worsen kidney function.
Consulting the provider for a safer alternative like acetaminophen ensures safety,
making this the correct first action for the nurse to take for the patient’s headache.
Administering ibuprofen risks further renal damage in acute renal failure, an unsafe
action. Consulting the provider is priority, making this incorrect, as it compromises
patient safety compared to the nurse’s need to avoid harmful medication administration.
Monitoring after giving ibuprofen doesn’t prevent renal injury, which is a risk in acute
renal failure. Consulting the provider avoids harm, making this incorrect, as it’s unsafe
compared to the nurse’s priority to ensure appropriate pain management.
, Informing the patient and dimming lights delays pain relief and doesn’t address the need
for safe medication. Consulting the provider is proactive, making this incorrect, as it’s
less effective than the nurse’s first action to secure a safe alternative.
Question 5:
The arterial blood gas (ABG) report of a patient with a spinal cord injury indicates
hypoxia. Select two interventions the nurse would perform to improve the
patient’s respiratory status.
A. Administer steroids.
B. Administer antibiotic drugs.
C. Perform assisted coughing.
D. Administer oxygen.
Explanation
Correct Answer: C,D
Solution
Choice A reason: Steroids reduce inflammation in spinal cord injury but don’t directly
address hypoxia, which requires oxygen delivery. Assisted coughing clears airways,
making this incorrect, as it’s not a primary intervention for the nurse to improve the
patient’s respiratory status.
Choice B reason: Antibiotics treat infection, not hypoxia, which results from impaired
ventilation in spinal cord injury. Oxygen administration is key, making this incorrect, as
it’s unrelated to the nurse’s focus on correcting the patient’s low oxygen levels
immediately.
Choice C reason: Assisted coughing clears secretions in spinal cord injury
patients with weak respiratory muscles, improving ventilation and hypoxia. This
aligns with respiratory care, making it a correct intervention the nurse would
perform to enhance the patient’s respiratory status.
Choice D reason: Administering oxygen directly corrects hypoxia by increasing
available oxygen for tissue perfusion. This is a standard intervention for spinal
cord injury patients, making it a correct action the nurse would take to improve
the patient’s respiratory status.
Question 6:
Which clinical problem would the nurse include in the care plan for a patient with
Parkinson disease (PD)?
Question 1:
A. Swallowing challenges.
B. Weight gain.
C. Obesity.
D. Cardiovascular problems.
Explanation
Correct Answer : A
Swallowing challenges (dysphagia) are common in Parkinson disease due to motor
dysfunction, increasing aspiration risk. This aligns with PD care planning, making it the
correct clinical problem for the nurse to include to ensure safe nutrition and prevent
complications like pneumonia.
Weight gain is not typical in PD; patients often lose weight due to dysphagia or
increased energy expenditure. Swallowing challenges are a priority, making this
incorrect, as it’s not a primary concern in the nurse’s care plan for Parkinson disease.
Obesity is uncommon in PD, as motor symptoms and dysphagia often lead to weight
loss. Swallowing challenges are more relevant, making this incorrect, as it’s not a
clinical problem the nurse would prioritize in the care plan for PD.
Cardiovascular problems may occur in PD but are less specific than swallowing
challenges, which directly impact daily function. This is incorrect, as it’s secondary to
the nurse’s focus on dysphagia as a key issue in Parkinson disease management.
Question 2:
When a patient with asthma who is on a budesonide hand-held inhaler reports
difficulty swallowing and has white patches on the tongue, which action will the
nurse take?
A. Teach the patient to gargle with water after using the budesonide.
B. Offer reassurance that the symptoms are common with budesonide use.
C. Suggest that the patient stop using the spray until the symptoms are resolved.
D. Anticipate obtaining a throat swab for rapid streptococcus testing.
Hide Correct Answer and Explanation
,Explanation
Correct Answer : A
White patches and difficulty swallowing suggest oral thrush, a side effect of budesonide.
Gargling with water post-inhalation prevents thrush, making this the correct action for
the nurse to take to address the patient’s symptoms and promote proper inhaler use.
Reassuring the patient that thrush is common doesn’t address the need for prevention
or treatment. Teaching to gargle is proactive, making this incorrect, as it fails to mitigate
the patient’s symptoms compared to the nurse’s priority intervention.
Stopping budesonide risks asthma exacerbation, and thrush can be managed with
gargling or antifungals. Teaching proper technique is better, making this incorrect, as it’s
unsafe compared to the nurse’s focus on maintaining asthma control while addressing
thrush.
Throat swabs for streptococcus are irrelevant, as white patches indicate thrush, not
bacterial infection. Gargling prevents further issues, making this incorrect, as it
misdiagnoses the cause compared to the nurse’s appropriate action for budesonide-
related oral symptoms.
A patient is being admitted with a diagnosis of Cushing syndrome. Which three
findings will the nurse expect during the assessment? (Select all that apply)
A. Bronzed appearance of the skin.
B. Purplish streaks on the abdomen.
C. Anorexia, nausea, and vomiting.
D. Hyperglycemia.
E. Truncal obesity, thin extremities, rounding of face (moon face).
Explanation
Correct Answer: B,D,E
Solution
Choice A reason: Bronzed skin is typical of Addison’s disease, not Cushing syndrome,
which causes striae and moon face. Hyperglycemia is expected, making this incorrect,
as it’s unrelated to the nurse’s anticipated findings in a patient with Cushing syndrome.
Choice B reason: Purplish streaks (striae) on the abdomen result from cortisol
excess in Cushing syndrome, weakening skin tissue. This aligns with endocrine
,assessment, making it a correct finding the nurse would expect during the
patient’s physical examination.
Choice C reason: Anorexia, nausea, and vomiting are more common in Addison’s
disease, not Cushing syndrome, which causes weight gain. Striae are typical, making
this incorrect, as it’s not a primary finding the nurse would expect in Cushing syndrome.
Choice D reason: Hyperglycemia occurs in Cushing syndrome due to cortisol-
induced insulin resistance, a common metabolic effect. This aligns with
laboratory assessment, making it a correct finding the nurse would anticipate in
the patient with Cushing syndrome.
Choice E reason: Truncal obesity, thin extremities, and moon face are classic
Cushing syndrome signs from fat redistribution due to hypercortisolism. This
aligns with physical assessment, making it a correct finding the nurse would
expect in the patient’s evaluation.
Question 4:
A patient admitted with acute renal failure asks for pain medication for a
headache described as five out of ten on the pain scale. The nurse checks the
MAR and sees that the only pain medication ordered is ibuprofen (an NSAID).
Which of the following actions should the nurse take first to ensure patient
safety?
A. Consult the healthcare provider about ordering a different pain medication.
B. Administer the ibuprofen as ordered since ibuprofen is used to treat headaches.
C. Monitor the patient closely after administering the ibuprofen for pain.
D. Inform the patient that the pain medication is contraindicated and offer to dim the
room lights.
Explanation
Correct Answer : A
Ibuprofen is contraindicated in acute renal failure, as NSAIDs worsen kidney function.
Consulting the provider for a safer alternative like acetaminophen ensures safety,
making this the correct first action for the nurse to take for the patient’s headache.
Administering ibuprofen risks further renal damage in acute renal failure, an unsafe
action. Consulting the provider is priority, making this incorrect, as it compromises
patient safety compared to the nurse’s need to avoid harmful medication administration.
Monitoring after giving ibuprofen doesn’t prevent renal injury, which is a risk in acute
renal failure. Consulting the provider avoids harm, making this incorrect, as it’s unsafe
compared to the nurse’s priority to ensure appropriate pain management.
, Informing the patient and dimming lights delays pain relief and doesn’t address the need
for safe medication. Consulting the provider is proactive, making this incorrect, as it’s
less effective than the nurse’s first action to secure a safe alternative.
Question 5:
The arterial blood gas (ABG) report of a patient with a spinal cord injury indicates
hypoxia. Select two interventions the nurse would perform to improve the
patient’s respiratory status.
A. Administer steroids.
B. Administer antibiotic drugs.
C. Perform assisted coughing.
D. Administer oxygen.
Explanation
Correct Answer: C,D
Solution
Choice A reason: Steroids reduce inflammation in spinal cord injury but don’t directly
address hypoxia, which requires oxygen delivery. Assisted coughing clears airways,
making this incorrect, as it’s not a primary intervention for the nurse to improve the
patient’s respiratory status.
Choice B reason: Antibiotics treat infection, not hypoxia, which results from impaired
ventilation in spinal cord injury. Oxygen administration is key, making this incorrect, as
it’s unrelated to the nurse’s focus on correcting the patient’s low oxygen levels
immediately.
Choice C reason: Assisted coughing clears secretions in spinal cord injury
patients with weak respiratory muscles, improving ventilation and hypoxia. This
aligns with respiratory care, making it a correct intervention the nurse would
perform to enhance the patient’s respiratory status.
Choice D reason: Administering oxygen directly corrects hypoxia by increasing
available oxygen for tissue perfusion. This is a standard intervention for spinal
cord injury patients, making it a correct action the nurse would take to improve
the patient’s respiratory status.
Question 6:
