Medical-Surgical Nursing Questions & Model Answers – Comprehensive Review for 4th Year Medical Students

Medical-Surgical Nursing Questions & Model
Answers – Comprehensive Review for 4th Year
Medical Students

CARDIOVASCULAR NURSING

Question 1: Post-MI Care

Q: A 58-year-old patient is admitted 6 hours post-STEMI following primary PCI. What are your
immediate nursing priorities for the first 24 hours?

A: Immediate priorities include:

 Cardiac monitoring: Continuous ECG monitoring for arrhythmias, particularly VT/VF in
the first 24-48 hours

 Pain assessment: Regular pain scoring using validated tools; ensure adequate analgesia
with GTN and morphine as prescribed

 Haemodynamic stability: Monitor BP, HR, oxygen saturations hourly initially, watching
for signs of cardiogenic shock

 Puncture site care: 4-hourly observations of femoral/radial access site for bleeding,
hematoma, or loss of distal pulses

 Medication compliance: Ensure dual antiplatelet therapy (aspirin +
clopidogrel/ticagrelor), ACE inhibitor, beta-blocker, and statin are commenced as per
NICE guidelines

 Early mobilization: Gradual mobilization from 4-6 hours post-procedure if no
complications

 Patient education: Begin discharge planning early, focusing on cardiac rehabilitation
referral and lifestyle modifications

Question 2: Heart Failure Management

Q: Explain the nursing management of a patient with acute exacerbation of chronic heart
failure (NYHA Class III).

A: Nursing management focuses on:

,  Fluid balance monitoring: Daily weights (same time, same scales, same clothing), strict
fluid balance charts, assess for peripheral oedema and JVP

 Respiratory assessment: Monitor for orthopnea, PND, respiratory rate and effort,
oxygen saturations

 Medication management: Ensure compliance with ACE inhibitors, beta-blockers, and
diuretics; monitor for side effects, including hypotension and electrolyte imbalance

 Activity tolerance: Assess functional capacity, encourage gradual activity as tolerated,
refer to cardiac rehabilitation

 Dietary advice: Low sodium diet (<2g/day), fluid restriction if severe (1.5-2L/day)

 Patient education: Recognition of deterioration signs, importance of medication
compliance, when to contact healthcare services

 Psychological support: Address anxiety and depression commonly associated with
chronic heart failure



RESPIRATORY NURSING

Question 3: COPD Exacerbation

Q: A 72-year-old patient with known COPD presents with increased dyspnea, purulent
sputum, and confusion. Outline your nursing assessment and management plan.

A: Assessment includes:

 ABCDE approach: Airway patency, breathing pattern and effort, circulation, disability
(confusion may indicate CO2 retention), exposure to cyanosis

 Arterial blood gas: Essential to determine type 1 vs type 2 respiratory failure and guide
oxygen therapy

 Sputum assessment: Color, consistency, volume - purulent suggests bacterial infection
requiring antibiotics

Management priorities:

 Controlled oxygen therapy: Target saturations 88-92% to avoid CO2 retention in type 2
respiratory failure

 Nebulized bronchodilators: Salbutamol and ipratropium bromide via air-driven
nebulizers

,  Oral corticosteroids: Prednisolone 30mg daily for 5 days as per NICE guidelines

 Antibiotics: If signs of bacterial infection (purulent sputum, raised inflammatory
markers)

 Physiotherapy: Chest physiotherapy to aid sputum clearance, encourage active cycle of
breathing techniques

 Nutritional support: COPD patients often malnourished; dietitian referral if BMI <20

 Smoking cessation: If applicable, refer to smoking cessation services

Question 4: Post-operative Pneumonia Prevention

Q: What evidence-based nursing interventions would you implement to prevent post-
operative pneumonia in a patient following major abdominal surgery?

A: Prevention strategies include:

 Early mobilization: Encourage sitting out of bed within 24 hours post-operatively,
progressive mobility as tolerated

 Respiratory physiotherapy: Deep breathing exercises, incentive spirometry, coughing,
and huffing techniques every 2 hours while awake

 Positioning: Semi-Fowler's position (30-45 degrees) to optimize lung expansion and
reduce aspiration risk

 Pain management: Adequate analgesia to enable effective breathing and coughing -
consider regional blocks or patient-controlled analgesia

 Oral hygiene: Regular mouth care to reduce bacterial colonization, particularly
important in intubated patients

 Nutritional support: Early enteral feeding when appropriate to maintain immune
function

 Smoking cessation: Pre-operative counselling and support for cessation at least 4 weeks
before surgery

 Infection control: Hand hygiene, appropriate use of PPE, equipment cleaning