MEDICAL SURGICAL NURSING CONCEPTS

MULTIPLE CHOICE 1. The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse monitor? a. Hypertension b. Bradycardia c. Dehydration d. Pulmonary embolus ANS: C The client who has DI has fluid loss through excessive urination. Decreased fluid volume, or dehydration, is manifested by tachycardia, hypotension, and possibly elevated temperature. Pulmonary embolism (PE) could possible as a clot in the lower extremity (...

MULTIPLE CHOICE 1. The nurse is caring for a client scheduled to have a transjugular intrahepatic portal-systemic shunt (TIPS) procedure. What client assessment would the nurse perform prior to this procedure? a. Musculoskeletal assessment b. Neurologic assessment c. Mental health assessment d. Cardiovascular assessment ANS: D A postprocedure complication of a TIPS procedure is right-sided heart failure. Therefore, the nurse would perform a cardiovascular assessment before the p...

MULTIPLE CHOICE 1. The nurse is caring for a client who is prescribed sulfasalazine. Which question would the nurse ask the client before starting this drug? a. “Are you taking Vitamin C or B? b. “Do you have any allergy to sulfa drugs?” c. “Can you swallow pills pretty easily?” d. “Do you have insurance to cover this drug?” ANS: B Sulfasalazine is a sulfa drug given for clients who have ulcerative colitis. However, it should not be given to those who have an aller...

MULTIPLE CHOICE 1. A nurse participates in a community screening event for oral cancer. What client is the highest priority for referral to a primary health care provider? a. Client who has poor oral hygiene practices. b. Client who smokes and drinks daily. c. Client who tans for an upcoming vacation. d. Client who occasionally uses illicit drugs. ANS: B Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not related to the etiology of cancer bu...

MULTIPLE CHOICE 1. An older adult has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best? a. “Changes in your liver cause drugs to be metabolized differently.” b. “Perhaps you don’t need as high a dose of the drug as before.” c. “Stomach muscles atrophy with age and you digest more slowly.” d. “Your body probably can’t tolerate as much medication anymo...

MULTIPLE CHOICE 1. During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect? a. Hematemesis b. Pain when eating c. Melena d. Weight loss ANS: C All of the other assessment findings are more commonly seen in clients who have gastric ulcers rather than duodenal ulcers. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Peptic ulcer disease, Assessment MSC: Client Needs Catego...

MULTIPLE CHOICE 1. An older client with diabetes is admitted with a heavily draining leg wound. The client’s white blood cell count is 38,000/mm3 (38  109/L) but the client is afebrile. Which nursing action is most appropriate at this time? a. Administer acetaminophen as needed. b. Educate the client on amputation. c. Place the client on Contact Precautions. d. Refer the client to the wound care nurse. ANS: C In the presence of a heavily draining wound, the nurse would pla...

MULTIPLE CHOICE 1. A nurse cares for a client with a recently fractured tibia. Which assessment would alert the nurse to take immediate action? a. Pain of 4 on a scale of 0-10 b. Numbness in the extremity c. Swollen extremity at the injury site d. Feeling cold while lying in bed ANS: B The client with numbness and/or tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of ...

MULTIPLE CHOICE 1. A client asks the nurse about having a total knee arthroplasty to relieve joint pain. Which factor would place the client at the highest risk for impaired postoperative healing? a. Controlled hypertension b. Obesity c. Osteoarthritis d. Mild osteopenia ANS: B Obesity places a client at high risk for many postoperative complications including slower wound and bone healing. The other factors usually do not affect healing after surgery. DIF: Understanding TOP:...

MULTIPLE CHOICE 1. The nurse is caring for a client who had a hemorrhagic stroke. Which assessment finding is the earliest sign of increasing intracranial pressure (ICP) for this client? a. Projectile vomiting b. Dilated and nonreactive pupils c. Severe hypertension d. Decreased level of consciousness ANS: D The earliest sign of increasing ICP is decreased level of consciousness. The other signs occur later. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessmen...

MULTIPLE CHOICE 1. The client’s electronic health record indicates genu varum. What does the nurse understand this term to mean? a. Bow-legged b. Fluid accumulation c. Knock-kneed d. Spinal curvature ANS: A Genu varum is a bow-legged deformity. A fluid accumulation is an effusion. Genu valgum is knock-kneed. A spinal curvature could be kyphosis or lordosis. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Musculoskeletal assessment, Musculoskeleta...

MULTIPLE CHOICE 1. The nurse is teaching a client about factors that can cause external otitis. Which of these factors would the nurse emphasize as the highest risk? a. Excess cerumen b. Swimming c. Sinus congestion d. Meniere disease ANS: B External otitis is often called “swimmer’s ear” because it is most often caused by swimming in lakes, ponds, and untreated pools. DIF: Remembering TOP: Integrated Process: Assessment KEY: Ear and hearing problems, Assessment MSC: ...

MULTIPLE CHOICE 1. A client who is nearly blind is admitted to the hospital. What action by the nurse is most important? a. Allow the client to feel his or her way around. b. Let the client arrange objects on the bedside table. c. Orient the client to the room using a focal point. d. Speak loudly and slowing when talking to the client. ANS: C Using a focal point, orient the client to the room by giving descriptions of items as they relate to the focal point. Letting the client a...

MULTIPLE CHOICE 1. After teaching a patient who is scheduled for magnetic resonance imaging (MRI), the nurse assesses the client’s understanding. Which statement indicates client understanding of the teaching? a. “I must increase my fluids because of the dye used for the MRI.” b. “My urine will be radioactive so I should not share a bathroom.” c. “My gag reflex will be tested before I can eat or drink anything.” d. “I can return to my usual activities immediately after...

MULTIPLE CHOICE 1. A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition? a. Bence-Jones protein in urine b. Epstein-Barr virus: positive c. Hemoglobin: 18 mg/dL (180 mmol/L) d. Red blood cell count: 8.2 million/mcL (8.2 1012/L) ANS: A This client has possible multiple myeloma. A positive Bence-Jones protein finding would correlate with this condition. The Ep...

MULTIPLE CHOICE 1. A nurse cares for a client with a spinal cord injury. With which interprofessional health team member would the nurse collaborate to assist the client with activities of daily living? a. Social worker b. Physical therapist c. Occupational therapist d. Case manager ANS: C The occupational therapist instructs the patient in the correct use of all adaptive equipment. In collaboration with the therapist, the nurse instructs family members or the caregiver about tr...

MULTIPLE CHOICE 1. The nurse assesses a client who has a history of migraines. Which symptom would the nurse identify as an early sign of a migraine with aura? a. Vertigo b. Lethargy c. Visual disturbances d. Numbness of the tongue ANS: C Early warning of impending migraine with aura usually consists of visual changes, flashing lights, or diplopia. The other symptoms are not associated with an impending migraine with aura. DIF: Remembering TOP: Integrated Process: Nursing P...

MULTIPLE CHOICE 1. A client is receiving norepinephrine for shock. What assessment finding best indicates a therapeutic effect from this drug? a. Alert and oriented, answering questions b. Client denies chest pain or chest pressure c. IV site without redness or swelling d. Urine output of 30 mL/hr for 2 hours ANS: A Normal cognitive function is a good indicator that the client is receiving the benefits of norepinephrine. The brain is very sensitive to changes in oxygenation and ...

MULTIPLE CHOICE 1. What is the nurse’s priority when caring for a client who just completed a bone marrow aspiration and biopsy? a. Teach the client to avoid activity for 24 to 48 hours to prevent infection. b. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort. c. Check the pressure dressing frequently for signs of excessive or active bleeding. d. Report the laboratory results to the primary health care provider. ANS: C The client having a bone marrow...

MULTIPLE CHOICE 1. A client with coronary artery disease (CAD) asks the nurse about taking fish oil supplements. What response by the nurse is best? a. “Fish oil is contraindicated with most drugs for CAD.” b. “The best source is fish, but pills have benefits too.” c. “There is no evidence to support fish oil use with CAD.” d. “You can reverse CAD totally with diet and supplements.” ANS: B Omega-3 fatty acids have shown benefit in reducing lipid levels, in reduci...