Medical – Surgical Nursing 2 (Complex Care) Final
exam full review. Comprehensive multiple-choice
revision questions covering the whole topic. The
correct answers are also provided. #2025#A+
A nurse has conducted teaching with a client in an arm cast about signs and symptoms of
compartment syndrome. The nurse determines that the client understands the information if
the client states that he/she should report which of the following early symptoms of
compartment syndrome?
A. Numbness and tingling in the fingers
B. Pain relieved by only oxycodone and aspirin (Percodan)
C. Pain that increases when the arm id dependent
D. Cold, bluish colored fingers - correct answers-A. Numbness and tingling in the fingers
The nurse is preparing to care for a burn client scheduled for an escharotomy procedure being
performed for a third-degree circumferential arm burn. The nurse understands that the
anticipated therapeutic outcome of the escharotomy is:
A. Return of distal pulses
B. Formulation of granulation tissue
C. Decreasing edema formation
D. Brisk bleeding from the site - correct answers-A. Return of distal pulses
,A client is undergoing fluid replacement after being burned on 20% of her body 12 hours ago.
The nursing assessment reveals a blood pressure of 90/50 mmHg, a pulse rate of 110 beats/min,
a urine output of 20 mL over the past hour. The nurse reports the findings to the physician and
anticipates which of the following orders to be prescribed?
A. Transfusing 1 unit of PRBCs
B. Changing IV LR solution to one that contains dextrose in water
C. Administering a diuretic to increase urine output
D. Increasing the amount of IV LR solution administered per hour - correct answers-D.
Increasing the amount of IV LR solution administered per hour
The adult client was burned as a result of an explosion. The burn initially affected the client's
entire face (anterior of the head) and the upper half of the anterior torso, and there were
circumferential burns to the lower half of both arms. The client's clothes caught on fire, and the
client ran, causing subsequent burn injuries to the posterior surface of the head and the upper
half of the posterior torso. - correct answers-45%
A client arrives at the emergency department who suffered multiple injuries from a head-on car
collision. Which of the following assessments should take the HIGHEST priority to perform?
A. A deviated trachea
B. Ecchymosis in the flank area
C. Unequal pupils
D. Irregular pulse - correct answers-A. A deviated trachea
,A client was brought to the emergency department after suffering a closed head injury and
lacerations around the face due to a hit-run accident. The client is unconscious and has a
minimal response to noxious stimuli. Which of the following assessment findings, if observed
after a few hours, should be reported to the physician IMMEDIATELY?
A. Drainage of a clear fluid from the client's nose
B. Bleeding around the lacerations
C. Bruises and minimal edema of the eyelids
D. Withdrawal of the client in response to painful stimuli - correct answers-A. Drainage of a clear
fluid from the client's nose
A trauma client with multiple open wounds is brought to the emergency department in cardiac
arrest. Which action should the nurse take prior to providing advanced cardiac life support?
A. Don personal protective equipment
B. Obtain a complete history from the paramedic
C. Contact the on-call orthopedic surgeon
D. Notify the Rapid Response Team - correct answers-A. Don personal protective equipment
A young male patient has been brought to the emergency department with a knife wound to
the abdomen. When the patient's hands are removed from the area of the wound to facilitate
assessment, the patient's intestine protrudes from the wound. How should the nurse respond
to this development?
A. Cover the protruding viscera with saline-soaked, sterile gauze
B. Apply a pressure dressing to the wound
C. Irrigate the protruding intestine with sterile water or normal saline
, D. Don sterile gloves and attempt to push the organ back inside the wound - correct answers-A.
Cover the protruding viscera with saline-soaked, sterile gauze
A 15-year-old boy has been brought the the emergency department by his friends after severing
his brachial artery while trying to scale a fence. In order to stop this patient's bleeding, the
nurse should:
A. Apply direct pressure to the wound
B. Administer platelets
C. Apply a tourniquet proximal to the site of the wound
D. Apply a tourniquet distal to the wound - correct answers-A. Apply direct pressure to the
wound
A trauma patient in the emergency department (ED) is showing signs of acute renal failure that
the care team suspects are due to myoglobinuria. The ED nurse should recognize that these
problems are most closely associated with what type of injury?
A. Crush injury
B. Blunt force trauma
C. Hemorrhage
D. Severe lacerations - correct answers-A. Crush injury
You respond to a call for help from the ED waiting room. There is an elderly patient lying on the
floor. List the order for the actions that you must perform. - correct answers-1. Establish
unresponsiveness
2. Call for help and activate the code team
exam full review. Comprehensive multiple-choice
revision questions covering the whole topic. The
correct answers are also provided. #2025#A+
A nurse has conducted teaching with a client in an arm cast about signs and symptoms of
compartment syndrome. The nurse determines that the client understands the information if
the client states that he/she should report which of the following early symptoms of
compartment syndrome?
A. Numbness and tingling in the fingers
B. Pain relieved by only oxycodone and aspirin (Percodan)
C. Pain that increases when the arm id dependent
D. Cold, bluish colored fingers - correct answers-A. Numbness and tingling in the fingers
The nurse is preparing to care for a burn client scheduled for an escharotomy procedure being
performed for a third-degree circumferential arm burn. The nurse understands that the
anticipated therapeutic outcome of the escharotomy is:
A. Return of distal pulses
B. Formulation of granulation tissue
C. Decreasing edema formation
D. Brisk bleeding from the site - correct answers-A. Return of distal pulses
,A client is undergoing fluid replacement after being burned on 20% of her body 12 hours ago.
The nursing assessment reveals a blood pressure of 90/50 mmHg, a pulse rate of 110 beats/min,
a urine output of 20 mL over the past hour. The nurse reports the findings to the physician and
anticipates which of the following orders to be prescribed?
A. Transfusing 1 unit of PRBCs
B. Changing IV LR solution to one that contains dextrose in water
C. Administering a diuretic to increase urine output
D. Increasing the amount of IV LR solution administered per hour - correct answers-D.
Increasing the amount of IV LR solution administered per hour
The adult client was burned as a result of an explosion. The burn initially affected the client's
entire face (anterior of the head) and the upper half of the anterior torso, and there were
circumferential burns to the lower half of both arms. The client's clothes caught on fire, and the
client ran, causing subsequent burn injuries to the posterior surface of the head and the upper
half of the posterior torso. - correct answers-45%
A client arrives at the emergency department who suffered multiple injuries from a head-on car
collision. Which of the following assessments should take the HIGHEST priority to perform?
A. A deviated trachea
B. Ecchymosis in the flank area
C. Unequal pupils
D. Irregular pulse - correct answers-A. A deviated trachea
,A client was brought to the emergency department after suffering a closed head injury and
lacerations around the face due to a hit-run accident. The client is unconscious and has a
minimal response to noxious stimuli. Which of the following assessment findings, if observed
after a few hours, should be reported to the physician IMMEDIATELY?
A. Drainage of a clear fluid from the client's nose
B. Bleeding around the lacerations
C. Bruises and minimal edema of the eyelids
D. Withdrawal of the client in response to painful stimuli - correct answers-A. Drainage of a clear
fluid from the client's nose
A trauma client with multiple open wounds is brought to the emergency department in cardiac
arrest. Which action should the nurse take prior to providing advanced cardiac life support?
A. Don personal protective equipment
B. Obtain a complete history from the paramedic
C. Contact the on-call orthopedic surgeon
D. Notify the Rapid Response Team - correct answers-A. Don personal protective equipment
A young male patient has been brought to the emergency department with a knife wound to
the abdomen. When the patient's hands are removed from the area of the wound to facilitate
assessment, the patient's intestine protrudes from the wound. How should the nurse respond
to this development?
A. Cover the protruding viscera with saline-soaked, sterile gauze
B. Apply a pressure dressing to the wound
C. Irrigate the protruding intestine with sterile water or normal saline
, D. Don sterile gloves and attempt to push the organ back inside the wound - correct answers-A.
Cover the protruding viscera with saline-soaked, sterile gauze
A 15-year-old boy has been brought the the emergency department by his friends after severing
his brachial artery while trying to scale a fence. In order to stop this patient's bleeding, the
nurse should:
A. Apply direct pressure to the wound
B. Administer platelets
C. Apply a tourniquet proximal to the site of the wound
D. Apply a tourniquet distal to the wound - correct answers-A. Apply direct pressure to the
wound
A trauma patient in the emergency department (ED) is showing signs of acute renal failure that
the care team suspects are due to myoglobinuria. The ED nurse should recognize that these
problems are most closely associated with what type of injury?
A. Crush injury
B. Blunt force trauma
C. Hemorrhage
D. Severe lacerations - correct answers-A. Crush injury
You respond to a call for help from the ED waiting room. There is an elderly patient lying on the
floor. List the order for the actions that you must perform. - correct answers-1. Establish
unresponsiveness
2. Call for help and activate the code team
