MEDICAL SURGICAL NURSE SIMPLE
PRACTICE QUESTIONS AND ANSWERS
- CORRECT ANSWER-
Christine Warren, 45 years old, has a long history of ulcerative colitis, and non-surgical
treatment no longer relieved her symptoms. She underwent a total proctocolectomy and
a permanent ileostomy 12 hours ago.
The nurse should contact the physician immediately if Mrs. Warren has which of these
findings?
1) The stoma appears pale and dry.
2) The stoma appears red and shiny.
3) There is 200 mL of dark green output from the stoma.
4) There is 50 mL of serosanguinous drainage from the stoma. - CORRECT ANSWER-
1) The stoma appears pale and dry.
Rationale: If there is an adequate blood supply to the stoma, the color is pink or red,
and the stoma is moist as a result of mucous production. A pale dry color suggests
ischemia of the stoma or bowel and must be reported immediately to the physician. With
an ‘ileostomy ‘initially ‘after ‘surgery, ‘the ‘output ‘is ‘a ‘loose, ‘dark ‘green ‘liquid ‘that ‘may
‘contain ‘some ‘blood. ‘The ‘ileostomy ‘usually ‘begins ‘to ‘drain ‘within ‘24 ‘of ‘surgery ‘at
‘more ‘than ‘one ‘liter ‘per ‘day.
When ‘changing ‘Mrs. ‘Warren's ‘ileostomy ‘bag, ‘the ‘nurse ‘notices ‘that ‘the ‘peristomal ‘skin
‘is ‘irritated.
Which ‘of ‘these ‘actions ‘by ‘the ‘nurse ‘would ‘be ‘appropriate ‘before ‘reapplying ‘the
‘appliance?
1) Wash ‘the ‘area ‘with ‘antiseptic ‘soap ‘and ‘water.
2) Clean ‘the ‘site ‘with ‘Dakin's ‘solution.
3) Use ‘a ‘solid ‘skin ‘barrier.
4) Obtain ‘an ‘order ‘for ‘a ‘topical ‘antibiotic. ‘- ‘CORRECT ‘ANSWER-3) ‘Use ‘a ‘solid
‘skin ‘barrier.
,Rationale: ‘The ‘drainage ‘from ‘the ‘stoma ‘can ‘quickly ‘irritate ‘the ‘surrounding ‘tissue.
‘Therefore, ‘a ‘solid ‘skin ‘barrier, ‘with ‘a ‘pectin ‘base ‘or ‘karaya ‘wafer ‘that ‘has ‘a ‘measurable
‘thickness ‘and ‘hydrocolloid ‘adhesive ‘properties, ‘should ‘be ‘applied.
Which ‘of ‘these ‘comments, ‘if ‘made ‘by ‘Mrs. ‘Warren ‘before ‘her ‘surgery, ‘would ‘indicate
‘that ‘she ‘had ‘concerns ‘about ‘her ‘body ‘image?
1) "I ‘will ‘have ‘to ‘stop ‘my ‘aerobics ‘classes."
2) "I'm ‘so ‘afraid ‘I ‘may ‘not ‘survive ‘the ‘surgery."
3) "I ‘need ‘to ‘go ‘shopping ‘for ‘some ‘loose, ‘baggy ‘clothes."
4) "I'm ‘concerned ‘that ‘this ‘may ‘be ‘only ‘the ‘first ‘of ‘many ‘surgeries." ‘-
‘CORRECT ‘ANSWER-3) ‘"I ‘need ‘to ‘go ‘shopping ‘for ‘some ‘loose, ‘baggy
‘clothes."
Rationale:Body ‘image ‘refers ‘to ‘a ‘person's ‘perception ‘of ‘self ‘and ‘determines ‘how ‘the
‘person ‘interacts ‘with ‘others. ‘One ‘does ‘not ‘need ‘to ‘purchase ‘special ‘clothing ‘after
‘ileostomy ‘surgery, ‘although ‘some ‘minor ‘adjustments ‘may ‘be ‘needed ‘for ‘comfort, ‘e.g.,
‘stretch ‘underwear ‘or ‘pantyhose ‘for ‘support.
Lewis ‘Palmer, ‘45 ‘years ‘old, ‘has ‘a ‘history ‘of ‘multiple ‘myocardial ‘infarctions ‘and ‘is ‘a
‘heavy ‘smoker. ‘He ‘takes ‘warfarin ‘sodium ‘(Coumadin) ‘daily. ‘Two ‘weeks ‘ago, ‘he ‘had ‘a
‘right ‘femoral-popliteal ‘bypass, ‘which ‘became ‘occluded ‘24 ‘hours ‘ago. ‘He ‘is ‘admitted
‘following ‘an ‘angioplasty ‘of ‘the ‘femoral-popliteal ‘bypass ‘graft. ‘Mr. ‘Palmer ‘is ‘receiving
‘continuous ‘IV ‘heparin.
Because ‘Mr. ‘Palmer ‘is ‘receiving ‘heparin, ‘it ‘is ‘essential ‘for ‘the ‘nurse ‘to
1) monitor ‘his ‘prothrombin ‘time.
2) observe ‘him ‘for ‘signs ‘of ‘pulmonary ‘embolism.
3) limit ‘his ‘intake ‘of ‘foods ‘high ‘in ‘vitamin ‘K.
4) check ‘the ‘femoral ‘puncture ‘site ‘at ‘frequent ‘intervals. ‘- ‘CORRECT ‘ANSWER-
4) ‘check ‘the ‘femoral ‘puncture ‘site ‘at ‘frequent ‘intervals.
Rationale: ‘Since ‘bleeding ‘is ‘a ‘common ‘side ‘effect ‘of ‘heparin, ‘it ‘is ‘vital ‘to ‘check ‘the
‘operative ‘site, ‘the ‘femoral ‘puncture ‘area, ‘for ‘signs ‘of ‘bleeding.
Attempts ‘to ‘revascularize ‘Mr. ‘Palmer's ‘leg ‘are ‘unsuccessful, ‘and ‘Mr. ‘Palmer ‘has ‘a
‘below-knee ‘amputation ‘(BKA) ‘of ‘his ‘right ‘extremity ‘and ‘is ‘returned ‘to ‘the ‘medical-
‘surgical ‘unit ‘with ‘an ‘intravenous ‘infusion ‘in ‘place. ‘His ‘orders ‘include: ‘heparin ‘drip,
‘morphine ‘sulfate ‘10 ‘mg ‘IV ‘push ‘q4h ‘prn ‘for ‘pain, ‘and ‘ampicillin ‘sodium ‘g ‘1 ‘IV ‘q6h.
‘Twelve ‘hours ‘postoperatively, ‘Mr. ‘Palmer ‘is ‘found ‘to ‘be ‘short ‘of ‘breath ‘and
‘diaphoretic. ‘He ‘says, ‘"My ‘chest ‘hurts." ‘His ‘pulse ‘is ‘140/min, ‘compared ‘to ‘a ‘baseline
‘of ‘80/min. ‘His ‘blood ‘pressure ‘is105/60 ‘mm ‘Hg, ‘compared ‘to ‘a ‘baseline ‘of ‘138/70
‘mm ‘Hg. ‘His ‘respirations ‘are ‘32/min, ‘compared ‘to ‘a ‘baseline ‘of ‘16/min. ‘His ‘O2
‘saturation ‘is ‘85%.
The ‘nurse ‘immediately ‘calls ‘for ‘help. ‘Which ‘of ‘the ‘following ‘questions ‘is ‘most
‘important ‘for ‘the ‘nurse ‘to ‘ask?
1) "Have ‘you ‘ever ‘had ‘this ‘type ‘of ‘chest ‘pain ‘before?"
2) "How ‘long ‘have ‘you ‘had ‘this ‘pain?"
,3) "What ‘pain ‘medication ‘do ‘you ‘usually ‘take?"
4) "What ‘- ‘CORRECT ‘ANSWER-1) ‘"Have ‘you ‘ever ‘had ‘this ‘type ‘of ‘chest ‘pain
‘before?" ‘Rationale: ‘Because ‘of ‘the ‘patient's ‘symptoms ‘and ‘his ‘history ‘of ‘myocardial
‘infarctions, ‘the ‘nurse ‘should ‘find ‘out ‘if ‘the ‘patient ‘has ‘had ‘this ‘time ‘of ‘pain
‘previously.
The ‘nurse ‘receives ‘all ‘of ‘the ‘following ‘stat ‘orders ‘for ‘Mr. ‘Palmer. ‘Which ‘one ‘should ‘the
‘nurse ‘question?
1) Oxygen ‘per ‘nasal ‘cannula ‘at ‘4 ‘L ‘per ‘minute.
2) Enoxaparin ‘(Lovenox) ‘40 ‘mg ‘subcutaneously.
3) Troponin ‘level.
4) Computed ‘tomography ‘(CT) ‘angiogram. ‘- ‘CORRECT ‘ANSWER-Rationale: ‘The
‘nurse ‘should ‘questions ‘the ‘order ‘for ‘Lovenox ‘because ‘the ‘patient ‘is ‘receiving ‘a
‘heparin ‘drip.
Maggie ‘Clark, ‘a ‘42-year-old ‘female, ‘was ‘admitted ‘with ‘newly ‘diagnosed ‘type ‘2 ‘diabetes
‘mellitus. ‘Her ‘blood ‘glucose ‘has ‘been ‘stabilized, ‘and ‘the ‘nurse ‘is ‘preparing ‘her ‘for
‘discharge. ‘Her ‘discharge ‘orders ‘will ‘include ‘metformin ‘(Glucophage). ‘Mrs. ‘Clark ‘is ‘also
‘being ‘treated ‘for ‘hypertension.
Because ‘Mrs. ‘Clark ‘is ‘to ‘take ‘Glucophage ‘on ‘a ‘regular ‘basis ‘it ‘is ‘important ‘to
1) monitor ‘her ‘glomerular ‘filtration ‘rate.
2) check ‘her ‘serum ‘amylase ‘routinely.
3) obtain ‘her ‘red ‘blood ‘cell ‘count ‘periodically.
4) examine ‘her ‘urine ‘for ‘casts. ‘- ‘CORRECT ‘ANSWER-1) ‘monitor ‘her
‘glomerular ‘filtration ‘rate.
Rationale: ‘The ‘estimated ‘glomerular ‘filtration ‘rate ‘(eGFR) ‘is ‘one ‘way ‘to ‘measure ‘the
‘adequacy ‘of ‘kidney ‘function. ‘Glucophage ‘is ‘excreted ‘by ‘the ‘kidney ‘and ‘the ‘risk ‘of
‘lactic ‘acidosis ‘increases ‘in ‘patients ‘with ‘impaired ‘kidney ‘function. ‘The ‘drug ‘may ‘be
‘used ‘if ‘the ‘eGFR ‘is ‘between ‘45 ‘and ‘60 ‘mL/min/1.73 ‘m2, ‘i.e., ‘in ‘mild ‘chronic ‘kidney
‘disease.
Glucophage ‘is ‘absolutely ‘contraindicated ‘if ‘the ‘eGFR ‘is ‘below ‘30 ‘mL/min/1.73 ‘m2.
Mrs. ‘Clark ‘is ‘prescribed ‘metoprolol ‘tartrate ‘(Lopressor) ‘for ‘hypertension. ‘Which
‘symptom ‘of ‘hypoglycemia ‘would ‘be ‘masked ‘by ‘Lopressor?
1) Diaphoresis.
2) Tingling.
3) Diplopia.
4) Tachycardia. ‘- ‘CORRECT ‘ANSWER-4) ‘Tachycardia.
Rationale: ‘A ‘side ‘effect ‘of ‘Lopressor, ‘a ‘beta ‘blocker, ‘is ‘bradycardia. ‘The ‘Lopressor-
‘induced ‘bradycardia ‘can ‘mask ‘tachycardia, ‘a ‘symptom ‘of ‘hypoglycemia.
Charles ‘Haverford ‘is ‘diagnosed ‘with ‘prostate ‘cancer ‘and ‘is ‘to ‘have ‘a ‘radical
‘prostatectomy.
, Mr. ‘Haverford ‘has ‘been ‘researching ‘his ‘diagnosis ‘and ‘now ‘asks ‘the ‘nurse ‘to
‘recommend ‘a ‘reliable ‘web ‘source ‘for ‘accurate ‘prostate ‘cancer ‘information. ‘The ‘nurse
‘should ‘identify ‘which ‘of ‘these ‘websites ‘as ‘most ‘reliable?
1) www.wikipedia.org.
2) www.cancer.gov.
3) www.caringbridge.org.
4) www.google.com. ‘- ‘CORRECT ‘ANSWER-2) ‘www.cancer.gov.
Rationale: ‘When ‘a ‘patient ‘asks ‘about ‘researching ‘information ‘on ‘the ‘internet, ‘the
‘patient ‘should ‘be ‘instructed ‘to ‘look ‘at ‘reliable ‘sites. ‘Sites ‘that ‘are ‘most ‘reliable ‘are
‘those ‘sponsored ‘by ‘the ‘government ‘(.gov).
Mr. ‘Haverford ‘has ‘the ‘planned ‘surgery ‘and ‘immediately ‘postoperatively ‘he ‘has ‘a
‘urinary ‘catheter ‘inserted. ‘After ‘the ‘urinary ‘catheter ‘is ‘removed ‘Mr. ‘Haverford ‘is
‘urinating ‘normally, ‘however ‘he ‘is ‘experiencing ‘occasional ‘incontinence ‘with ‘dribbling.
‘Mr. ‘Haverford ‘is ‘to ‘be ‘discharged.
Mr. ‘Haverford ‘says ‘to ‘the ‘nurse, ‘"I'm ‘so ‘embarrassed. ‘What ‘will ‘my ‘wife ‘think ‘about ‘this
‘dribbling?" ‘In ‘addition ‘to ‘acknowledging ‘his ‘feelings, ‘the ‘nurse ‘should ‘encourage ‘the
‘patient ‘to
1) limit ‘oral ‘intake ‘of ‘fluids ‘before ‘bedtime.
2) palpate ‘his ‘bladder ‘to ‘check ‘for ‘distention ‘three ‘times ‘a ‘day.
3) perform ‘pelvic ‘floor ‘exercises ‘several ‘times ‘daily.
4) avoid ‘interrupting ‘the ‘urinary ‘stream ‘during ‘voiding. ‘- ‘CORRECT ‘ANSWER-
3) ‘perform ‘pelvic ‘floor ‘exercises ‘several ‘times ‘daily.
Rationale: ‘It ‘is ‘not ‘unusual ‘for ‘a ‘patient ‘who ‘has ‘had ‘a ‘prostatectomy, ‘to ‘complain
‘of ‘not ‘having ‘complete ‘bladder ‘control ‘after ‘catheter ‘removal. ‘To ‘help ‘the ‘patient
‘regain ‘urinary ‘control, ‘pelvic ‘floor ‘strengthening ‘exercises ‘are ‘recommended.
A ‘patient's ‘wife ‘is ‘visibly ‘upset ‘and ‘says ‘to ‘the ‘nurse, ‘"I ‘thought ‘my ‘husband ‘only
‘broke ‘his ‘hip, ‘but ‘the ‘doctor ‘thinks ‘he ‘might ‘have ‘had ‘a ‘stroke." ‘Which ‘of ‘the
‘following ‘would ‘be ‘an ‘appropriate ‘response ‘by ‘the ‘nurse?
1) "It's ‘really ‘too ‘early ‘to ‘be ‘concerned ‘about ‘that. ‘Let's ‘wait ‘until ‘the ‘test ‘results
‘come ‘back."
2) "If ‘it ‘is ‘a ‘stroke, ‘your ‘husband ‘is ‘in ‘the ‘right ‘hospital ‘for ‘treatment."
3) "Yes, ‘he ‘does ‘have ‘symptoms ‘of ‘a ‘stroke. ‘That's ‘what ‘the ‘tests ‘will ‘help ‘us ‘find ‘out."
4) "I'm ‘going ‘to ‘get ‘you ‘some ‘information ‘to ‘read ‘about ‘strokes ‘and ‘their ‘treatment."
‘- ‘CORRECT ‘ANSWER-3) ‘"Yes, ‘he ‘does ‘have ‘symptoms ‘of ‘a ‘stroke. ‘That's ‘what
‘the ‘tests ‘will ‘help ‘us ‘find ‘out."
Rationale: ‘Symptoms ‘of ‘stroke ‘vary ‘greatly ‘and ‘the ‘initial ‘diagnosis ‘is ‘made ‘after ‘a
‘non- ‘contrast ‘CT ‘scan ‘is ‘done ‘to ‘determine ‘if ‘the ‘event ‘was ‘ischemic ‘or ‘hemorrhagic.
‘Then, ‘further ‘tests ‘are ‘done ‘to ‘confirm ‘the ‘diagnosis ‘and ‘decide ‘on ‘treatment.
PRACTICE QUESTIONS AND ANSWERS
- CORRECT ANSWER-
Christine Warren, 45 years old, has a long history of ulcerative colitis, and non-surgical
treatment no longer relieved her symptoms. She underwent a total proctocolectomy and
a permanent ileostomy 12 hours ago.
The nurse should contact the physician immediately if Mrs. Warren has which of these
findings?
1) The stoma appears pale and dry.
2) The stoma appears red and shiny.
3) There is 200 mL of dark green output from the stoma.
4) There is 50 mL of serosanguinous drainage from the stoma. - CORRECT ANSWER-
1) The stoma appears pale and dry.
Rationale: If there is an adequate blood supply to the stoma, the color is pink or red,
and the stoma is moist as a result of mucous production. A pale dry color suggests
ischemia of the stoma or bowel and must be reported immediately to the physician. With
an ‘ileostomy ‘initially ‘after ‘surgery, ‘the ‘output ‘is ‘a ‘loose, ‘dark ‘green ‘liquid ‘that ‘may
‘contain ‘some ‘blood. ‘The ‘ileostomy ‘usually ‘begins ‘to ‘drain ‘within ‘24 ‘of ‘surgery ‘at
‘more ‘than ‘one ‘liter ‘per ‘day.
When ‘changing ‘Mrs. ‘Warren's ‘ileostomy ‘bag, ‘the ‘nurse ‘notices ‘that ‘the ‘peristomal ‘skin
‘is ‘irritated.
Which ‘of ‘these ‘actions ‘by ‘the ‘nurse ‘would ‘be ‘appropriate ‘before ‘reapplying ‘the
‘appliance?
1) Wash ‘the ‘area ‘with ‘antiseptic ‘soap ‘and ‘water.
2) Clean ‘the ‘site ‘with ‘Dakin's ‘solution.
3) Use ‘a ‘solid ‘skin ‘barrier.
4) Obtain ‘an ‘order ‘for ‘a ‘topical ‘antibiotic. ‘- ‘CORRECT ‘ANSWER-3) ‘Use ‘a ‘solid
‘skin ‘barrier.
,Rationale: ‘The ‘drainage ‘from ‘the ‘stoma ‘can ‘quickly ‘irritate ‘the ‘surrounding ‘tissue.
‘Therefore, ‘a ‘solid ‘skin ‘barrier, ‘with ‘a ‘pectin ‘base ‘or ‘karaya ‘wafer ‘that ‘has ‘a ‘measurable
‘thickness ‘and ‘hydrocolloid ‘adhesive ‘properties, ‘should ‘be ‘applied.
Which ‘of ‘these ‘comments, ‘if ‘made ‘by ‘Mrs. ‘Warren ‘before ‘her ‘surgery, ‘would ‘indicate
‘that ‘she ‘had ‘concerns ‘about ‘her ‘body ‘image?
1) "I ‘will ‘have ‘to ‘stop ‘my ‘aerobics ‘classes."
2) "I'm ‘so ‘afraid ‘I ‘may ‘not ‘survive ‘the ‘surgery."
3) "I ‘need ‘to ‘go ‘shopping ‘for ‘some ‘loose, ‘baggy ‘clothes."
4) "I'm ‘concerned ‘that ‘this ‘may ‘be ‘only ‘the ‘first ‘of ‘many ‘surgeries." ‘-
‘CORRECT ‘ANSWER-3) ‘"I ‘need ‘to ‘go ‘shopping ‘for ‘some ‘loose, ‘baggy
‘clothes."
Rationale:Body ‘image ‘refers ‘to ‘a ‘person's ‘perception ‘of ‘self ‘and ‘determines ‘how ‘the
‘person ‘interacts ‘with ‘others. ‘One ‘does ‘not ‘need ‘to ‘purchase ‘special ‘clothing ‘after
‘ileostomy ‘surgery, ‘although ‘some ‘minor ‘adjustments ‘may ‘be ‘needed ‘for ‘comfort, ‘e.g.,
‘stretch ‘underwear ‘or ‘pantyhose ‘for ‘support.
Lewis ‘Palmer, ‘45 ‘years ‘old, ‘has ‘a ‘history ‘of ‘multiple ‘myocardial ‘infarctions ‘and ‘is ‘a
‘heavy ‘smoker. ‘He ‘takes ‘warfarin ‘sodium ‘(Coumadin) ‘daily. ‘Two ‘weeks ‘ago, ‘he ‘had ‘a
‘right ‘femoral-popliteal ‘bypass, ‘which ‘became ‘occluded ‘24 ‘hours ‘ago. ‘He ‘is ‘admitted
‘following ‘an ‘angioplasty ‘of ‘the ‘femoral-popliteal ‘bypass ‘graft. ‘Mr. ‘Palmer ‘is ‘receiving
‘continuous ‘IV ‘heparin.
Because ‘Mr. ‘Palmer ‘is ‘receiving ‘heparin, ‘it ‘is ‘essential ‘for ‘the ‘nurse ‘to
1) monitor ‘his ‘prothrombin ‘time.
2) observe ‘him ‘for ‘signs ‘of ‘pulmonary ‘embolism.
3) limit ‘his ‘intake ‘of ‘foods ‘high ‘in ‘vitamin ‘K.
4) check ‘the ‘femoral ‘puncture ‘site ‘at ‘frequent ‘intervals. ‘- ‘CORRECT ‘ANSWER-
4) ‘check ‘the ‘femoral ‘puncture ‘site ‘at ‘frequent ‘intervals.
Rationale: ‘Since ‘bleeding ‘is ‘a ‘common ‘side ‘effect ‘of ‘heparin, ‘it ‘is ‘vital ‘to ‘check ‘the
‘operative ‘site, ‘the ‘femoral ‘puncture ‘area, ‘for ‘signs ‘of ‘bleeding.
Attempts ‘to ‘revascularize ‘Mr. ‘Palmer's ‘leg ‘are ‘unsuccessful, ‘and ‘Mr. ‘Palmer ‘has ‘a
‘below-knee ‘amputation ‘(BKA) ‘of ‘his ‘right ‘extremity ‘and ‘is ‘returned ‘to ‘the ‘medical-
‘surgical ‘unit ‘with ‘an ‘intravenous ‘infusion ‘in ‘place. ‘His ‘orders ‘include: ‘heparin ‘drip,
‘morphine ‘sulfate ‘10 ‘mg ‘IV ‘push ‘q4h ‘prn ‘for ‘pain, ‘and ‘ampicillin ‘sodium ‘g ‘1 ‘IV ‘q6h.
‘Twelve ‘hours ‘postoperatively, ‘Mr. ‘Palmer ‘is ‘found ‘to ‘be ‘short ‘of ‘breath ‘and
‘diaphoretic. ‘He ‘says, ‘"My ‘chest ‘hurts." ‘His ‘pulse ‘is ‘140/min, ‘compared ‘to ‘a ‘baseline
‘of ‘80/min. ‘His ‘blood ‘pressure ‘is105/60 ‘mm ‘Hg, ‘compared ‘to ‘a ‘baseline ‘of ‘138/70
‘mm ‘Hg. ‘His ‘respirations ‘are ‘32/min, ‘compared ‘to ‘a ‘baseline ‘of ‘16/min. ‘His ‘O2
‘saturation ‘is ‘85%.
The ‘nurse ‘immediately ‘calls ‘for ‘help. ‘Which ‘of ‘the ‘following ‘questions ‘is ‘most
‘important ‘for ‘the ‘nurse ‘to ‘ask?
1) "Have ‘you ‘ever ‘had ‘this ‘type ‘of ‘chest ‘pain ‘before?"
2) "How ‘long ‘have ‘you ‘had ‘this ‘pain?"
,3) "What ‘pain ‘medication ‘do ‘you ‘usually ‘take?"
4) "What ‘- ‘CORRECT ‘ANSWER-1) ‘"Have ‘you ‘ever ‘had ‘this ‘type ‘of ‘chest ‘pain
‘before?" ‘Rationale: ‘Because ‘of ‘the ‘patient's ‘symptoms ‘and ‘his ‘history ‘of ‘myocardial
‘infarctions, ‘the ‘nurse ‘should ‘find ‘out ‘if ‘the ‘patient ‘has ‘had ‘this ‘time ‘of ‘pain
‘previously.
The ‘nurse ‘receives ‘all ‘of ‘the ‘following ‘stat ‘orders ‘for ‘Mr. ‘Palmer. ‘Which ‘one ‘should ‘the
‘nurse ‘question?
1) Oxygen ‘per ‘nasal ‘cannula ‘at ‘4 ‘L ‘per ‘minute.
2) Enoxaparin ‘(Lovenox) ‘40 ‘mg ‘subcutaneously.
3) Troponin ‘level.
4) Computed ‘tomography ‘(CT) ‘angiogram. ‘- ‘CORRECT ‘ANSWER-Rationale: ‘The
‘nurse ‘should ‘questions ‘the ‘order ‘for ‘Lovenox ‘because ‘the ‘patient ‘is ‘receiving ‘a
‘heparin ‘drip.
Maggie ‘Clark, ‘a ‘42-year-old ‘female, ‘was ‘admitted ‘with ‘newly ‘diagnosed ‘type ‘2 ‘diabetes
‘mellitus. ‘Her ‘blood ‘glucose ‘has ‘been ‘stabilized, ‘and ‘the ‘nurse ‘is ‘preparing ‘her ‘for
‘discharge. ‘Her ‘discharge ‘orders ‘will ‘include ‘metformin ‘(Glucophage). ‘Mrs. ‘Clark ‘is ‘also
‘being ‘treated ‘for ‘hypertension.
Because ‘Mrs. ‘Clark ‘is ‘to ‘take ‘Glucophage ‘on ‘a ‘regular ‘basis ‘it ‘is ‘important ‘to
1) monitor ‘her ‘glomerular ‘filtration ‘rate.
2) check ‘her ‘serum ‘amylase ‘routinely.
3) obtain ‘her ‘red ‘blood ‘cell ‘count ‘periodically.
4) examine ‘her ‘urine ‘for ‘casts. ‘- ‘CORRECT ‘ANSWER-1) ‘monitor ‘her
‘glomerular ‘filtration ‘rate.
Rationale: ‘The ‘estimated ‘glomerular ‘filtration ‘rate ‘(eGFR) ‘is ‘one ‘way ‘to ‘measure ‘the
‘adequacy ‘of ‘kidney ‘function. ‘Glucophage ‘is ‘excreted ‘by ‘the ‘kidney ‘and ‘the ‘risk ‘of
‘lactic ‘acidosis ‘increases ‘in ‘patients ‘with ‘impaired ‘kidney ‘function. ‘The ‘drug ‘may ‘be
‘used ‘if ‘the ‘eGFR ‘is ‘between ‘45 ‘and ‘60 ‘mL/min/1.73 ‘m2, ‘i.e., ‘in ‘mild ‘chronic ‘kidney
‘disease.
Glucophage ‘is ‘absolutely ‘contraindicated ‘if ‘the ‘eGFR ‘is ‘below ‘30 ‘mL/min/1.73 ‘m2.
Mrs. ‘Clark ‘is ‘prescribed ‘metoprolol ‘tartrate ‘(Lopressor) ‘for ‘hypertension. ‘Which
‘symptom ‘of ‘hypoglycemia ‘would ‘be ‘masked ‘by ‘Lopressor?
1) Diaphoresis.
2) Tingling.
3) Diplopia.
4) Tachycardia. ‘- ‘CORRECT ‘ANSWER-4) ‘Tachycardia.
Rationale: ‘A ‘side ‘effect ‘of ‘Lopressor, ‘a ‘beta ‘blocker, ‘is ‘bradycardia. ‘The ‘Lopressor-
‘induced ‘bradycardia ‘can ‘mask ‘tachycardia, ‘a ‘symptom ‘of ‘hypoglycemia.
Charles ‘Haverford ‘is ‘diagnosed ‘with ‘prostate ‘cancer ‘and ‘is ‘to ‘have ‘a ‘radical
‘prostatectomy.
, Mr. ‘Haverford ‘has ‘been ‘researching ‘his ‘diagnosis ‘and ‘now ‘asks ‘the ‘nurse ‘to
‘recommend ‘a ‘reliable ‘web ‘source ‘for ‘accurate ‘prostate ‘cancer ‘information. ‘The ‘nurse
‘should ‘identify ‘which ‘of ‘these ‘websites ‘as ‘most ‘reliable?
1) www.wikipedia.org.
2) www.cancer.gov.
3) www.caringbridge.org.
4) www.google.com. ‘- ‘CORRECT ‘ANSWER-2) ‘www.cancer.gov.
Rationale: ‘When ‘a ‘patient ‘asks ‘about ‘researching ‘information ‘on ‘the ‘internet, ‘the
‘patient ‘should ‘be ‘instructed ‘to ‘look ‘at ‘reliable ‘sites. ‘Sites ‘that ‘are ‘most ‘reliable ‘are
‘those ‘sponsored ‘by ‘the ‘government ‘(.gov).
Mr. ‘Haverford ‘has ‘the ‘planned ‘surgery ‘and ‘immediately ‘postoperatively ‘he ‘has ‘a
‘urinary ‘catheter ‘inserted. ‘After ‘the ‘urinary ‘catheter ‘is ‘removed ‘Mr. ‘Haverford ‘is
‘urinating ‘normally, ‘however ‘he ‘is ‘experiencing ‘occasional ‘incontinence ‘with ‘dribbling.
‘Mr. ‘Haverford ‘is ‘to ‘be ‘discharged.
Mr. ‘Haverford ‘says ‘to ‘the ‘nurse, ‘"I'm ‘so ‘embarrassed. ‘What ‘will ‘my ‘wife ‘think ‘about ‘this
‘dribbling?" ‘In ‘addition ‘to ‘acknowledging ‘his ‘feelings, ‘the ‘nurse ‘should ‘encourage ‘the
‘patient ‘to
1) limit ‘oral ‘intake ‘of ‘fluids ‘before ‘bedtime.
2) palpate ‘his ‘bladder ‘to ‘check ‘for ‘distention ‘three ‘times ‘a ‘day.
3) perform ‘pelvic ‘floor ‘exercises ‘several ‘times ‘daily.
4) avoid ‘interrupting ‘the ‘urinary ‘stream ‘during ‘voiding. ‘- ‘CORRECT ‘ANSWER-
3) ‘perform ‘pelvic ‘floor ‘exercises ‘several ‘times ‘daily.
Rationale: ‘It ‘is ‘not ‘unusual ‘for ‘a ‘patient ‘who ‘has ‘had ‘a ‘prostatectomy, ‘to ‘complain
‘of ‘not ‘having ‘complete ‘bladder ‘control ‘after ‘catheter ‘removal. ‘To ‘help ‘the ‘patient
‘regain ‘urinary ‘control, ‘pelvic ‘floor ‘strengthening ‘exercises ‘are ‘recommended.
A ‘patient's ‘wife ‘is ‘visibly ‘upset ‘and ‘says ‘to ‘the ‘nurse, ‘"I ‘thought ‘my ‘husband ‘only
‘broke ‘his ‘hip, ‘but ‘the ‘doctor ‘thinks ‘he ‘might ‘have ‘had ‘a ‘stroke." ‘Which ‘of ‘the
‘following ‘would ‘be ‘an ‘appropriate ‘response ‘by ‘the ‘nurse?
1) "It's ‘really ‘too ‘early ‘to ‘be ‘concerned ‘about ‘that. ‘Let's ‘wait ‘until ‘the ‘test ‘results
‘come ‘back."
2) "If ‘it ‘is ‘a ‘stroke, ‘your ‘husband ‘is ‘in ‘the ‘right ‘hospital ‘for ‘treatment."
3) "Yes, ‘he ‘does ‘have ‘symptoms ‘of ‘a ‘stroke. ‘That's ‘what ‘the ‘tests ‘will ‘help ‘us ‘find ‘out."
4) "I'm ‘going ‘to ‘get ‘you ‘some ‘information ‘to ‘read ‘about ‘strokes ‘and ‘their ‘treatment."
‘- ‘CORRECT ‘ANSWER-3) ‘"Yes, ‘he ‘does ‘have ‘symptoms ‘of ‘a ‘stroke. ‘That's ‘what
‘the ‘tests ‘will ‘help ‘us ‘find ‘out."
Rationale: ‘Symptoms ‘of ‘stroke ‘vary ‘greatly ‘and ‘the ‘initial ‘diagnosis ‘is ‘made ‘after ‘a
‘non- ‘contrast ‘CT ‘scan ‘is ‘done ‘to ‘determine ‘if ‘the ‘event ‘was ‘ischemic ‘or ‘hemorrhagic.
‘Then, ‘further ‘tests ‘are ‘done ‘to ‘confirm ‘the ‘diagnosis ‘and ‘decide ‘on ‘treatment.
