PN ADULT MEDICAL SURGICAL EXAM PROCTORED WITH VERIFIED NGN
QUESTION AND ANSWERS.
A nurse at a provider's office is assisting in the care of a client who is 2 weeks postoperative
following a gastrectomy.
Exhibit 1
Medical History
Since discharge, client reports several episodes of dizziness, "fast" heartbeat, and abdominal
cramping. Client states, "I am afraid to eat."
A nurse is reinforcing teaching with the client. Which of the following instructions should the
nurse include?
Select all that apply.
Avoid drinking fluids with meals is correct. The nurse should instruct the client to drink fluids
30 min before or after meals to decrease intestinal distension.
Eat several small meals per day is correct. The nurse should instruct the client to eat several
small, frequent meals instead of three large meals per day.
Consume high-protein snacks is correct. The client should eat snacks that are high in protein
and low in carbohydrates to prevent the gastric food boluses and reactive hypoglycemia in
dumping syndrome.
The nurse is reviewing the client's medical record.
Select the 3 findings that require nursing intervention.
ngn
Exhibit 1
Nurses' NotesDay 1 1000:
Client is short of breath and has a productive cough with yellow mucus. Client reports feeling
sick for the last few days. States, "I could barely breathe when I got up this morning, and I had a
throbbing headache." Client is alert and oriented to person, place, and time.Capillary refill is less
than 2 seconds. Client is diaphoretic. Crackles heard in posterior lungs. Pedal pulses are +2
bilaterally.Client reports a decreased appetite for the last 2 days.Day 3 0800:
Supplemental oxygen administered at 2 L/min via nasal cannula. Client reports difficulty with
coughing up mucus. Encouraged client to cough and deep breathe.
Potassium level is correct. The nurse should identify that the client's potassium level is
elevated, which places them at risk for cardiac dysrhythmias. Therefore, this finding requires
nursing intervention.
Temperature is correct. The nurse should identify that the client continues to have a fever as a
result of the body's immune system fighting the infection. Therefore, this finding requires
nursing intervention.
WBC count is correct. The nurse should identify that the client's WBC count remains elevated,
which indicates an infection. Therefore, this finding requires nursing intervention.
A nurse is collecting data from a client who has 30% body surface area deep partial-thickness
and full-thickness burns. Which of the following findings indicates that fluid resuscitation is
adequate?
Urine output is 50 mL/hr.
The nurse should closely monitor the client's urinary output as an indicator of effective fluid
,resuscitation. A urinary output greater than 30 to 50 mL/hr indicates that fluid resuscitation is
adequate.
A nurse is assisting with the development of a plan of care to manage pain for a client who
has herpes zoster with lesions on the lower extremities. Which of the following interventions
should the nurse include in the plan of care?
Keep bed linens off of the affected areas.
The nurse should keep bed linens off of the affected areas by using a bed cradle, which will
relieve pain caused by the linens rubbing against the lesions.
A nurse is reviewing the plan of care for a client who is 1 day postoperative following a total hip
arthroplasty. Which of the following interventions should the nurse contribute to the plan of
care?
Keep an abduction pillow between the client's legs.
The nurse should keep an abduction pillow or a splint between the client's legs to prevent hip
dislocation after surgery.
A nurse is contributing to the plan of care to promote a restful night's sleep for a client who
has Alzheimer's disease. Which of the following interventions should the nurse include in the
plan?
Offer a small snack at bedtime.
The nurse should offer the client a small snack of carbohydrates or a glass of milk as part of the
bedtime routine, which can help the client relax and prepare for sleep.
A nurse is reinforcing discharge teaching with a client who had a mechanical mitral valve
replacement. Which of the following statements by the client indicates an understanding of the
teaching?
"I will notify my dentist about this procedure."
The nurse should remind the client to notify their dentist about the mechanical mitral valve
replacement before any procedures so antibiotic therapy can be initiated to reduce the risk for
endocardial infection.
A nurse is assisting with the care for a client who is 1 day postoperative following a hip
arthroplasty. The client is exhibiting hypotension, tachycardia, and tachypnea. The nurse should
recognize that these findings indicate which of the following complications?
Pulmonary embolism
Manifestations of a pulmonary embolism include hypotension, tachycardia, and tachypnea.
A nurse is reviewing the medical record for a client who is experiencing nausea and vomiting.
Based on the client data, which of the following actions should the nurse take? (Click on the
exhibit tabs for additional information about the client. There are three tabs that contain separate
categories of data.)
Notify the charge nurse of the client's blood pressure.
The client's blood pressure is decreasing indicating the presence of hypotension, which is a
,manifestation of hypovolemia. The nurse should anticipate interventions to restore the client's
fluid volume.
A nurse is reviewing the medication record of a client who is taking digoxin. Which of the
following medications should the nurse identify as increasing the risk for the client to develop
digoxin toxicity?
Furosemide
The nurse should identify that loop diuretics, such as furosemide, increase the urinary excretion
of potassium, which can lead to hypokalemia. Hypokalemia increases the risk for the
development of digoxin toxicity.
A nurse is reviewing the laboratory results of a female client who has chronic kidney failure and
is receiving epoetin alfa. The nurse should identify that which of the following laboratory values
indicates the treatment is effective?
Hgb 11 g/dL (12 to 16 g/dL)
Epoetin alfa stimulates the production of erythropoietin and red blood cells, resulting in
increased hemoglobin levels. Therefore, a hemoglobin level of 11 g/dL indicates the epoetin alfa
treatment is effective.
A nurse is reinforcing teaching with a client who has systemic lupus erythematosus (SLE) and is
to begin taking methylprednisolone orally. Which of the following statements should the nurse
include in the teaching?
"Limit contact with large groups of people."
Glucocorticoids cause immunosuppression and can mask infection. The client should limit
contact with sources of possible infections, such as large groups of people.
A nurse is monitoring a client who has a cast and reports intense itching underneath the cast.
Which of the following actions should the nurse take?
Blow cool air into the cast using a blow dryer on a cool setting.
Using a blow dryer on a cool setting to blow cold air into the cast is an effective way to relieve
the client's itching without damaging the skin.
A nurse in a telemetry unit is collecting data from a client who has a newly inserted permanent
pacemaker. Which of the following findings should the nurse report to the provider?
The client experiences hiccups when sitting.
The nurse should monitor clients who have a newly-inserted permanent pacemaker for hiccups
because this finding can indicate that the pacemaker wires are displaced or that the pacemaker is
not firing properly. Therefore, the nurse should report this finding to the provider.
A nurse is reinforcing discharge instructions with a client who is postoperative following a right
hip arthroplasty. Which of the following statements should the nurse make?
"Avoid bending your hips more than 90 degrees."
The nurse should remind the client to avoid bending their hips more than 90° to prevent
dislocation of the replacement hip.
, A nurse is reinforcing teaching about nutrition choices with a client who has leukemia and is
receiving chemotherapy. The nurse should identify that which of the following statements by the
client indicates an understanding of the teaching?
"I drink bottled water."
To avoid exposure to bacteria, clients who have cancer and are receiving chemotherapy should
be sure that drinking water is safe. Drinking fresh, bottled water limits exposure to bacteria.
A nurse is assisting in the care of a client who is scheduled for a CT scan with an IV contrast
agent. Which of the following laboratory test does the nurse anticipate that the provider will
prescribe?
Creatinine
The nurse should anticipate a prescription for a creatinine level prior to the administration of IV
contrast. Contrast dye is contraindicated in clients with elevated creatinine because contrast is
nephrotoxic.
A nurse is participating in a health fair for older adult clients. Which of the
following vaccines should the nurse recommend for this age group?
Herpes zoster
The nurse should recommend the herpes zoster vaccine for adults who are 60 years of age and
older.
A nurse is assisting in the care of a client who has manifestations of sepsis. Which of the
following provider prescriptions should the nurse implement first?
Initiate oxygen at 4 L/min via nasal cannula.
.
When using the airway, breathing, circulation approach to client care, the first action the nurse
should take is to initiate oxygen. Clients who have manifestations of sepsis are often hypoxic,
tachypneic, or have a PaCO2 level less than 32 mm Hg. The nurse should provide supplemental
oxygen to keep the client's oxygen saturation levels at 95% or greater, which will maximize the
ability of the hemoglobin to support the oxygen needs of the body.
A nurse is reinforcing teaching with a client who is postoperative following a cemented total hip
arthroplasty. Which of the following instructions should the nurse include in the teaching?
Maintain hip flexion at 90° or less when sitting.
A client who had a cemented total hip arthroplasty should maintain hip flexion at 90° or less
when sitting to prevent hip dislocation.
A nurse is preparing to perform intermittent urinary catheterization for a female client who has
been unable to void following surgery 6 hr ago. Which of the following catheters should the
nurse use to perform this procedure?
This is an intermittent straight catheter and is the correct catheter for the nurse to use.
A nurse is collecting data from a client who is receiving sumatriptan. Which of the following is
an expected outcome?
Diminished headache
QUESTION AND ANSWERS.
A nurse at a provider's office is assisting in the care of a client who is 2 weeks postoperative
following a gastrectomy.
Exhibit 1
Medical History
Since discharge, client reports several episodes of dizziness, "fast" heartbeat, and abdominal
cramping. Client states, "I am afraid to eat."
A nurse is reinforcing teaching with the client. Which of the following instructions should the
nurse include?
Select all that apply.
Avoid drinking fluids with meals is correct. The nurse should instruct the client to drink fluids
30 min before or after meals to decrease intestinal distension.
Eat several small meals per day is correct. The nurse should instruct the client to eat several
small, frequent meals instead of three large meals per day.
Consume high-protein snacks is correct. The client should eat snacks that are high in protein
and low in carbohydrates to prevent the gastric food boluses and reactive hypoglycemia in
dumping syndrome.
The nurse is reviewing the client's medical record.
Select the 3 findings that require nursing intervention.
ngn
Exhibit 1
Nurses' NotesDay 1 1000:
Client is short of breath and has a productive cough with yellow mucus. Client reports feeling
sick for the last few days. States, "I could barely breathe when I got up this morning, and I had a
throbbing headache." Client is alert and oriented to person, place, and time.Capillary refill is less
than 2 seconds. Client is diaphoretic. Crackles heard in posterior lungs. Pedal pulses are +2
bilaterally.Client reports a decreased appetite for the last 2 days.Day 3 0800:
Supplemental oxygen administered at 2 L/min via nasal cannula. Client reports difficulty with
coughing up mucus. Encouraged client to cough and deep breathe.
Potassium level is correct. The nurse should identify that the client's potassium level is
elevated, which places them at risk for cardiac dysrhythmias. Therefore, this finding requires
nursing intervention.
Temperature is correct. The nurse should identify that the client continues to have a fever as a
result of the body's immune system fighting the infection. Therefore, this finding requires
nursing intervention.
WBC count is correct. The nurse should identify that the client's WBC count remains elevated,
which indicates an infection. Therefore, this finding requires nursing intervention.
A nurse is collecting data from a client who has 30% body surface area deep partial-thickness
and full-thickness burns. Which of the following findings indicates that fluid resuscitation is
adequate?
Urine output is 50 mL/hr.
The nurse should closely monitor the client's urinary output as an indicator of effective fluid
,resuscitation. A urinary output greater than 30 to 50 mL/hr indicates that fluid resuscitation is
adequate.
A nurse is assisting with the development of a plan of care to manage pain for a client who
has herpes zoster with lesions on the lower extremities. Which of the following interventions
should the nurse include in the plan of care?
Keep bed linens off of the affected areas.
The nurse should keep bed linens off of the affected areas by using a bed cradle, which will
relieve pain caused by the linens rubbing against the lesions.
A nurse is reviewing the plan of care for a client who is 1 day postoperative following a total hip
arthroplasty. Which of the following interventions should the nurse contribute to the plan of
care?
Keep an abduction pillow between the client's legs.
The nurse should keep an abduction pillow or a splint between the client's legs to prevent hip
dislocation after surgery.
A nurse is contributing to the plan of care to promote a restful night's sleep for a client who
has Alzheimer's disease. Which of the following interventions should the nurse include in the
plan?
Offer a small snack at bedtime.
The nurse should offer the client a small snack of carbohydrates or a glass of milk as part of the
bedtime routine, which can help the client relax and prepare for sleep.
A nurse is reinforcing discharge teaching with a client who had a mechanical mitral valve
replacement. Which of the following statements by the client indicates an understanding of the
teaching?
"I will notify my dentist about this procedure."
The nurse should remind the client to notify their dentist about the mechanical mitral valve
replacement before any procedures so antibiotic therapy can be initiated to reduce the risk for
endocardial infection.
A nurse is assisting with the care for a client who is 1 day postoperative following a hip
arthroplasty. The client is exhibiting hypotension, tachycardia, and tachypnea. The nurse should
recognize that these findings indicate which of the following complications?
Pulmonary embolism
Manifestations of a pulmonary embolism include hypotension, tachycardia, and tachypnea.
A nurse is reviewing the medical record for a client who is experiencing nausea and vomiting.
Based on the client data, which of the following actions should the nurse take? (Click on the
exhibit tabs for additional information about the client. There are three tabs that contain separate
categories of data.)
Notify the charge nurse of the client's blood pressure.
The client's blood pressure is decreasing indicating the presence of hypotension, which is a
,manifestation of hypovolemia. The nurse should anticipate interventions to restore the client's
fluid volume.
A nurse is reviewing the medication record of a client who is taking digoxin. Which of the
following medications should the nurse identify as increasing the risk for the client to develop
digoxin toxicity?
Furosemide
The nurse should identify that loop diuretics, such as furosemide, increase the urinary excretion
of potassium, which can lead to hypokalemia. Hypokalemia increases the risk for the
development of digoxin toxicity.
A nurse is reviewing the laboratory results of a female client who has chronic kidney failure and
is receiving epoetin alfa. The nurse should identify that which of the following laboratory values
indicates the treatment is effective?
Hgb 11 g/dL (12 to 16 g/dL)
Epoetin alfa stimulates the production of erythropoietin and red blood cells, resulting in
increased hemoglobin levels. Therefore, a hemoglobin level of 11 g/dL indicates the epoetin alfa
treatment is effective.
A nurse is reinforcing teaching with a client who has systemic lupus erythematosus (SLE) and is
to begin taking methylprednisolone orally. Which of the following statements should the nurse
include in the teaching?
"Limit contact with large groups of people."
Glucocorticoids cause immunosuppression and can mask infection. The client should limit
contact with sources of possible infections, such as large groups of people.
A nurse is monitoring a client who has a cast and reports intense itching underneath the cast.
Which of the following actions should the nurse take?
Blow cool air into the cast using a blow dryer on a cool setting.
Using a blow dryer on a cool setting to blow cold air into the cast is an effective way to relieve
the client's itching without damaging the skin.
A nurse in a telemetry unit is collecting data from a client who has a newly inserted permanent
pacemaker. Which of the following findings should the nurse report to the provider?
The client experiences hiccups when sitting.
The nurse should monitor clients who have a newly-inserted permanent pacemaker for hiccups
because this finding can indicate that the pacemaker wires are displaced or that the pacemaker is
not firing properly. Therefore, the nurse should report this finding to the provider.
A nurse is reinforcing discharge instructions with a client who is postoperative following a right
hip arthroplasty. Which of the following statements should the nurse make?
"Avoid bending your hips more than 90 degrees."
The nurse should remind the client to avoid bending their hips more than 90° to prevent
dislocation of the replacement hip.
, A nurse is reinforcing teaching about nutrition choices with a client who has leukemia and is
receiving chemotherapy. The nurse should identify that which of the following statements by the
client indicates an understanding of the teaching?
"I drink bottled water."
To avoid exposure to bacteria, clients who have cancer and are receiving chemotherapy should
be sure that drinking water is safe. Drinking fresh, bottled water limits exposure to bacteria.
A nurse is assisting in the care of a client who is scheduled for a CT scan with an IV contrast
agent. Which of the following laboratory test does the nurse anticipate that the provider will
prescribe?
Creatinine
The nurse should anticipate a prescription for a creatinine level prior to the administration of IV
contrast. Contrast dye is contraindicated in clients with elevated creatinine because contrast is
nephrotoxic.
A nurse is participating in a health fair for older adult clients. Which of the
following vaccines should the nurse recommend for this age group?
Herpes zoster
The nurse should recommend the herpes zoster vaccine for adults who are 60 years of age and
older.
A nurse is assisting in the care of a client who has manifestations of sepsis. Which of the
following provider prescriptions should the nurse implement first?
Initiate oxygen at 4 L/min via nasal cannula.
.
When using the airway, breathing, circulation approach to client care, the first action the nurse
should take is to initiate oxygen. Clients who have manifestations of sepsis are often hypoxic,
tachypneic, or have a PaCO2 level less than 32 mm Hg. The nurse should provide supplemental
oxygen to keep the client's oxygen saturation levels at 95% or greater, which will maximize the
ability of the hemoglobin to support the oxygen needs of the body.
A nurse is reinforcing teaching with a client who is postoperative following a cemented total hip
arthroplasty. Which of the following instructions should the nurse include in the teaching?
Maintain hip flexion at 90° or less when sitting.
A client who had a cemented total hip arthroplasty should maintain hip flexion at 90° or less
when sitting to prevent hip dislocation.
A nurse is preparing to perform intermittent urinary catheterization for a female client who has
been unable to void following surgery 6 hr ago. Which of the following catheters should the
nurse use to perform this procedure?
This is an intermittent straight catheter and is the correct catheter for the nurse to use.
A nurse is collecting data from a client who is receiving sumatriptan. Which of the following is
an expected outcome?
Diminished headache
