MEDICAL-SURGICAL NURSING
EXAM
MEDICAL-SURGICAL NURSING LEWIS
EXAM 1 VERIFIED QUESTIONS AND
CORRECT DETAILED ANSWERS
(RATIONALES) GUARANTEED PASS
GRADED A+
Which action by a new nurse who is caring for a patient who has just had an
implantable cardioverter-defibrillator (ICD) inserted indicates a need for more
education about care of patients with ICDs?
a. The nurse assists the patient to do active range of motion exercises for all
extremities.
b. The nurse assists the patient to fill out the application for obtaining a Medic
Alert ID and bracelet.
A+ TEST BANK 1
, MEDICAL-SURGICAL NURSING
EXAM
c. The nurse gives atenolol (Tenormin) to the patient without consulting first with
the health care provider.
d. The nurse teaches the patient that sexual activity usually can be resumed once
the surgical incision is healed.
A
The patient should avoid moving the arm on the ICD insertion site until healing
has occurred in order to prevent displacement of the ICD leads. The other actions
by the new nurse are appropriate for this patient.
DIF: Cognitive Level: Application REF: 833-835 TOP: Nursing Process: Evaluation
The nurse is seeing artifact on the telemetry monitor. Which factors could
contribute to this artifact?
a) Disabled automaticity
b) Electrodes in the wrong lead
c) Too much hair under the electrodes
d) Stimulation of the vagus nerve fibers
c) Too much hair under the electrodes
(Artifact is caused by muscle activity, electrical interference, or insecure leads and
electrodes that could be caused by excessive chest wall hair. Disabled
automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will
measure electricity in a different plane of the heart and may have a different
wave form than expected. Stimulation of the vagus nerve fibers causes a decrease
in heart rate, not artifact.)
Which action should the nurse perform when preparing a patient with
supraventricular tachycardia for cardioversion who is alert and has a blood
pressure of 110/66 mm Hg?
A+ TEST BANK 2
, MEDICAL-SURGICAL NURSING
EXAM
a. Turn the synchronizer switch to the "off" position.
b. Give a sedative before cardioversion is implemented.
c. Set the defibrillator/cardioverter energy to 360 joules.
d. Provide assisted ventilations with a bag-valve-mask device.
ANS: B
When a patient has a nonemergency cardioversion, sedation is used just before
the procedure. The synchronizer switch is turned "on" for cardioversion. The
initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are
not indicated for this patient
A patient reports dizziness and shortness of breath and is admitted with a
dysrhythmia. Which medication, if ordered, requires the nurse to carefully
monitor the patient for asystole?
Digoxin
Adenosine
Metoprolol
Atropine sulfate
Adenosine
IV adenosine is the first drug of choice to convert supraventricular tachycardia to
a normal sinus rhythm. Adenosine is administered IV rapidly (over 1 or 2 seconds)
followed by a rapid, normal saline flush. The nurse should monitor the patient's
electrocardiogram continuously because a brief period of asystole after adenosine
A+ TEST BANK 3
, MEDICAL-SURGICAL NURSING
EXAM
administration is common and expected. Atropine sulfate increases heart rate,
whereas lanoxin and metoprolol slow the heart rate.
The patient has hypokalemia, and the nurse obtains the following measurements
on the rhythm strip: Heart rate of 86 with a regular rhythm; the P wave is 0.06
seconds (sec) and normal shape; the PR interval is 0.24 sec; the QRS is 0.09 sec.
How should the nurse document this rhythm?
a) First-degree AV block
b) Second-degree AV block
c) Premature atrial contraction (PAC)
d) Premature ventricular contraction (PVC)
a) First-degree AV block
(In first-degree AV block there is prolonged duration of AV conduction that
lengthens the PR interval above 0.20 sec. In type I second-degree AV block the PR
interval continues to increase in duration until a QRS complex is blocked. In Type
II the PR interval may be normal or prolonged, the ventricular rhythm may be
irregular, and the QRS is usually greater than 0.12 sec. PACs cause an irregular
rhythm with a different-shaped P wave than the rest of the beats, and the PR
interval may be shorter or longer. PVCs cause an irregular rhythm, and the QRS
complex is wide and distorted in shape.)
A 20-year-old has a mandatory electrocardiogram (ECG) before participating on a
college soccer team and is found to have sinus bradycardia, rate 52. Blood
pressure (BP) is 114/54, and the student denies any health problems. What action
by the nurse is most appropriate?
a. Allow the student to participate on the soccer team.
A+ TEST BANK 4
EXAM
MEDICAL-SURGICAL NURSING LEWIS
EXAM 1 VERIFIED QUESTIONS AND
CORRECT DETAILED ANSWERS
(RATIONALES) GUARANTEED PASS
GRADED A+
Which action by a new nurse who is caring for a patient who has just had an
implantable cardioverter-defibrillator (ICD) inserted indicates a need for more
education about care of patients with ICDs?
a. The nurse assists the patient to do active range of motion exercises for all
extremities.
b. The nurse assists the patient to fill out the application for obtaining a Medic
Alert ID and bracelet.
A+ TEST BANK 1
, MEDICAL-SURGICAL NURSING
EXAM
c. The nurse gives atenolol (Tenormin) to the patient without consulting first with
the health care provider.
d. The nurse teaches the patient that sexual activity usually can be resumed once
the surgical incision is healed.
A
The patient should avoid moving the arm on the ICD insertion site until healing
has occurred in order to prevent displacement of the ICD leads. The other actions
by the new nurse are appropriate for this patient.
DIF: Cognitive Level: Application REF: 833-835 TOP: Nursing Process: Evaluation
The nurse is seeing artifact on the telemetry monitor. Which factors could
contribute to this artifact?
a) Disabled automaticity
b) Electrodes in the wrong lead
c) Too much hair under the electrodes
d) Stimulation of the vagus nerve fibers
c) Too much hair under the electrodes
(Artifact is caused by muscle activity, electrical interference, or insecure leads and
electrodes that could be caused by excessive chest wall hair. Disabled
automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will
measure electricity in a different plane of the heart and may have a different
wave form than expected. Stimulation of the vagus nerve fibers causes a decrease
in heart rate, not artifact.)
Which action should the nurse perform when preparing a patient with
supraventricular tachycardia for cardioversion who is alert and has a blood
pressure of 110/66 mm Hg?
A+ TEST BANK 2
, MEDICAL-SURGICAL NURSING
EXAM
a. Turn the synchronizer switch to the "off" position.
b. Give a sedative before cardioversion is implemented.
c. Set the defibrillator/cardioverter energy to 360 joules.
d. Provide assisted ventilations with a bag-valve-mask device.
ANS: B
When a patient has a nonemergency cardioversion, sedation is used just before
the procedure. The synchronizer switch is turned "on" for cardioversion. The
initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are
not indicated for this patient
A patient reports dizziness and shortness of breath and is admitted with a
dysrhythmia. Which medication, if ordered, requires the nurse to carefully
monitor the patient for asystole?
Digoxin
Adenosine
Metoprolol
Atropine sulfate
Adenosine
IV adenosine is the first drug of choice to convert supraventricular tachycardia to
a normal sinus rhythm. Adenosine is administered IV rapidly (over 1 or 2 seconds)
followed by a rapid, normal saline flush. The nurse should monitor the patient's
electrocardiogram continuously because a brief period of asystole after adenosine
A+ TEST BANK 3
, MEDICAL-SURGICAL NURSING
EXAM
administration is common and expected. Atropine sulfate increases heart rate,
whereas lanoxin and metoprolol slow the heart rate.
The patient has hypokalemia, and the nurse obtains the following measurements
on the rhythm strip: Heart rate of 86 with a regular rhythm; the P wave is 0.06
seconds (sec) and normal shape; the PR interval is 0.24 sec; the QRS is 0.09 sec.
How should the nurse document this rhythm?
a) First-degree AV block
b) Second-degree AV block
c) Premature atrial contraction (PAC)
d) Premature ventricular contraction (PVC)
a) First-degree AV block
(In first-degree AV block there is prolonged duration of AV conduction that
lengthens the PR interval above 0.20 sec. In type I second-degree AV block the PR
interval continues to increase in duration until a QRS complex is blocked. In Type
II the PR interval may be normal or prolonged, the ventricular rhythm may be
irregular, and the QRS is usually greater than 0.12 sec. PACs cause an irregular
rhythm with a different-shaped P wave than the rest of the beats, and the PR
interval may be shorter or longer. PVCs cause an irregular rhythm, and the QRS
complex is wide and distorted in shape.)
A 20-year-old has a mandatory electrocardiogram (ECG) before participating on a
college soccer team and is found to have sinus bradycardia, rate 52. Blood
pressure (BP) is 114/54, and the student denies any health problems. What action
by the nurse is most appropriate?
a. Allow the student to participate on the soccer team.
A+ TEST BANK 4
