MEDSURG Test Bank
Situation 1: Rica, a Pediatric Cardiovascular Nurse is assigned to take care of 3 children in her unit. She just admitted a
12-year-old female patient suffering from Rheumatic Fever (RF)
1. When doing an assessment, which ONE of the following conditions is NOT present based on the Jones Criteria?
A. Erythema marginatum
B. Subcutaneous nodules
C. Chorea
D. Bronchopneumonia
2. In Rheumatic fever, the factor contributory to the development of this disease process is brought about by:
A. auto-immune reaction to streptococcal infection
B. auto-immune reaction to collagen diseases
C. parents had rheumatic heart disease
D. exposure to colds and droplet infection
3. Leny, 6 years old, is receiving digitalis for having Patent Ductus Arteriosus with heart failure. Prior to the
administration of the medicines, which of the following nursing actions should be done by nurse Rica?
A. Take the carotid pulse rate for one full minute.
B. Take the heart rate for one full minute.
C. Take the respiratory rate.
D. Take the blood pressure.
4. While nurse Rica was doing her regular rounds, one of the mothers approached her saying that her child who has a
Tetralogy of Fallot preferred to squat on bed rather than assuming a supine position. The BEST action of the nurse is:
A. let the mother continue the position of her child if she feels comfortable with it
B. divert the child's attention by letting her join the nurses’ rounds
C. put her on bed and start to administer oxygen inhalation
D. discourage the child and let her lie on bed with 2 pillows instead
5. Another patient in the Unit is Letty, 8 years old, waiting to be scheduled for surgery because of a Coarctation of the
Aorta. With this disorder, Letty will manifest which one of the following symptoms?
A. Murmur and bruit of the lungs.
B. Central and peripheral edema.
C. Hypertension and diminished pulses in the extremities.
D. Hepatomegaly and shortness of breath.
Situation 2: Mr. Joe is 55-year-old, married, a car dealer has consulted the ER because of fever, indigestion, weight loss,
right abdominal pain, body malaise, and itchiness of the skin. Based on the health history the patient has been a chain
smoker and drinks alcoholic beverages almost every day especially when he has clients to entertain. His physical
examination showed he has a suspected liver cirrhosis. He was advised for admission for further work-up and treatment.
6. In your observational data, what additional EARLY SIGN of liver cirrhosis do you expect patient to manifest?
A. Gonadal atrophy
B. Hypotension
C. Splenomegaly
D. Ankle edema
7. You are the nurse on duty when Mr. Joe was admitted in the pay floor. In which of the following statements is TRUE of
liver cirrhosis?
1. Nutritional deficiency with decreased protein intake contributes to liver damage
2. cirrhosis can happen to people with alcohol intake.
3. Women are at greater risk for the development of alcohol-induced liver disease.
4. Most patients affected by liver cirrhosis are between 40 to 60 years of age.
A. 1, 2, 3 & 4
B. 1 & 2
C. 1, 2& 3
D. 2&3
8. During Mr. Joe's confinement he developed further itchiness of the skin and jaundice. Which of the following nursing
, 9. At early stage of Mr. Joe's disease process, the physician ordered this SPECIFIC diet for Mr. Joe. You emphasized to
the dietitian that he should be served foods that is
A. high carbohydrate and low sodium
B. high calorie and high carbohydrate
C. low protein and high fat
D. high protein and high fat
10. Mr. Joe started to develop ascites and complained of heaviness of the lower extremities to the physician. An order of
Spironolactone (Aldactone) 25 mg./day What adverse effect of the drug should you monitor?
A. Irregular pulse rate
B. Hypokalemia
C. Hyperkalemia
D. Palpitation
Situation 3 Mr. Perez is a surgical nurse in a medical center and he had been practicing for almost five years in this unit.
The staff go on shift rotation. For that shift, he had two patients for operation. One is for Lobectomy and another is for
Nephrectomy.
11. When is the BEST time for the operative consent be signed by his patients?
A. As soon as the surgical procedure is explained to the patient.
B. On admission when the relatives are around.
C. A day before the surgery
D. Before any pre-op medications are administered.
12. Which of the following nursing goals are achieved when early ambulation is done by post-surgery patients?
1. improved circulation
2. improved respiratory functions
3. prevent venous stasis
4. prevent emboli formation
A. 3 and 4
В. 1, 2, 3, 4
C. 1, 3, 4
D. 1 and 2
13. Which of the following patients is MOST at risk during the induction of anesthesia?
A. 6-year-old with history of allergy
B. 65 year old diabetic woman
C. 35 year old TB case
D. 25 year old Polio Case
14. As a circulating nurse, which of the following is your PRIORITY nursing action to promote safety of your patient?
A. Prevent peri-operative position injury
B. Provide adequate lighting during the procedure.
C. Optimize surgeon's access to surgical site
D. Maintain surgical aseptic technique during the procedure.
15. Being the nurse in the Post-Anesthesia Care Unit, which of the following is your PRIORITY Concern after surgery?
A. monitor vital signs
B. observe surgical site for bleeding
C. validate doctor's orders
D. check level of consciousness
Situation 4 - Lydia is a staff-nurse working in medical unit with several patients suffering from cardiovascular and
peripheral disorders
16. There are several factors contributory to the development of these conditions. which of the following are the
PRIORITY causative factors that should be emphasized by Nurse Lydia in her health teaching?
A. Cigarette smoking and hyperlipidemia.
B. Aging process and alcohol intake
C. Stress and over-acidity
D. Sedentary life and obesity
Situation 1: Rica, a Pediatric Cardiovascular Nurse is assigned to take care of 3 children in her unit. She just admitted a
12-year-old female patient suffering from Rheumatic Fever (RF)
1. When doing an assessment, which ONE of the following conditions is NOT present based on the Jones Criteria?
A. Erythema marginatum
B. Subcutaneous nodules
C. Chorea
D. Bronchopneumonia
2. In Rheumatic fever, the factor contributory to the development of this disease process is brought about by:
A. auto-immune reaction to streptococcal infection
B. auto-immune reaction to collagen diseases
C. parents had rheumatic heart disease
D. exposure to colds and droplet infection
3. Leny, 6 years old, is receiving digitalis for having Patent Ductus Arteriosus with heart failure. Prior to the
administration of the medicines, which of the following nursing actions should be done by nurse Rica?
A. Take the carotid pulse rate for one full minute.
B. Take the heart rate for one full minute.
C. Take the respiratory rate.
D. Take the blood pressure.
4. While nurse Rica was doing her regular rounds, one of the mothers approached her saying that her child who has a
Tetralogy of Fallot preferred to squat on bed rather than assuming a supine position. The BEST action of the nurse is:
A. let the mother continue the position of her child if she feels comfortable with it
B. divert the child's attention by letting her join the nurses’ rounds
C. put her on bed and start to administer oxygen inhalation
D. discourage the child and let her lie on bed with 2 pillows instead
5. Another patient in the Unit is Letty, 8 years old, waiting to be scheduled for surgery because of a Coarctation of the
Aorta. With this disorder, Letty will manifest which one of the following symptoms?
A. Murmur and bruit of the lungs.
B. Central and peripheral edema.
C. Hypertension and diminished pulses in the extremities.
D. Hepatomegaly and shortness of breath.
Situation 2: Mr. Joe is 55-year-old, married, a car dealer has consulted the ER because of fever, indigestion, weight loss,
right abdominal pain, body malaise, and itchiness of the skin. Based on the health history the patient has been a chain
smoker and drinks alcoholic beverages almost every day especially when he has clients to entertain. His physical
examination showed he has a suspected liver cirrhosis. He was advised for admission for further work-up and treatment.
6. In your observational data, what additional EARLY SIGN of liver cirrhosis do you expect patient to manifest?
A. Gonadal atrophy
B. Hypotension
C. Splenomegaly
D. Ankle edema
7. You are the nurse on duty when Mr. Joe was admitted in the pay floor. In which of the following statements is TRUE of
liver cirrhosis?
1. Nutritional deficiency with decreased protein intake contributes to liver damage
2. cirrhosis can happen to people with alcohol intake.
3. Women are at greater risk for the development of alcohol-induced liver disease.
4. Most patients affected by liver cirrhosis are between 40 to 60 years of age.
A. 1, 2, 3 & 4
B. 1 & 2
C. 1, 2& 3
D. 2&3
8. During Mr. Joe's confinement he developed further itchiness of the skin and jaundice. Which of the following nursing
, 9. At early stage of Mr. Joe's disease process, the physician ordered this SPECIFIC diet for Mr. Joe. You emphasized to
the dietitian that he should be served foods that is
A. high carbohydrate and low sodium
B. high calorie and high carbohydrate
C. low protein and high fat
D. high protein and high fat
10. Mr. Joe started to develop ascites and complained of heaviness of the lower extremities to the physician. An order of
Spironolactone (Aldactone) 25 mg./day What adverse effect of the drug should you monitor?
A. Irregular pulse rate
B. Hypokalemia
C. Hyperkalemia
D. Palpitation
Situation 3 Mr. Perez is a surgical nurse in a medical center and he had been practicing for almost five years in this unit.
The staff go on shift rotation. For that shift, he had two patients for operation. One is for Lobectomy and another is for
Nephrectomy.
11. When is the BEST time for the operative consent be signed by his patients?
A. As soon as the surgical procedure is explained to the patient.
B. On admission when the relatives are around.
C. A day before the surgery
D. Before any pre-op medications are administered.
12. Which of the following nursing goals are achieved when early ambulation is done by post-surgery patients?
1. improved circulation
2. improved respiratory functions
3. prevent venous stasis
4. prevent emboli formation
A. 3 and 4
В. 1, 2, 3, 4
C. 1, 3, 4
D. 1 and 2
13. Which of the following patients is MOST at risk during the induction of anesthesia?
A. 6-year-old with history of allergy
B. 65 year old diabetic woman
C. 35 year old TB case
D. 25 year old Polio Case
14. As a circulating nurse, which of the following is your PRIORITY nursing action to promote safety of your patient?
A. Prevent peri-operative position injury
B. Provide adequate lighting during the procedure.
C. Optimize surgeon's access to surgical site
D. Maintain surgical aseptic technique during the procedure.
15. Being the nurse in the Post-Anesthesia Care Unit, which of the following is your PRIORITY Concern after surgery?
A. monitor vital signs
B. observe surgical site for bleeding
C. validate doctor's orders
D. check level of consciousness
Situation 4 - Lydia is a staff-nurse working in medical unit with several patients suffering from cardiovascular and
peripheral disorders
16. There are several factors contributory to the development of these conditions. which of the following are the
PRIORITY causative factors that should be emphasized by Nurse Lydia in her health teaching?
A. Cigarette smoking and hyperlipidemia.
B. Aging process and alcohol intake
C. Stress and over-acidity
D. Sedentary life and obesity
