Medical-Surgical Nursing Exam 5

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Text Mode – Text version of the exam

1. A 42-year-old client admitted with an acute myocardial infarction asks to see his chart. What should the nurse do first?

  1. Allow the client to view his chart
  2. Contact the supervisor and physician for approval
  3. Ask the client if he has concerns about his care
  4. Tell the client that he isn’t permitted to view his chart.

2. A registered nurse who works in the preoperative area of the operating room notices that a client is scheduled for a partial mastectomy and axillary lymph node removal the following week. The nurse should make sure, that the client is well educated about her surgery by:

  1. taking with the nursing staff at the physician’s office to find out what the client has been taught and her level of understanding
  2. making sure that the post-anesthesia recovery unit nurses know what to teach the patient before discharge
  3. providing all of the preoperative teaching before surgery
  4. having the post-operative nurses teach the patient because she’ll be too anxious before surgery

3. A male client brings a list of his prescribed medications to the clinic. During the initial assessment, he tells the nurse that
he has been experiencing delayed ejaculation. Which drug class is associated with this problem?

  1. Anticoagulants
  2. Antibiotics
  3. Antihypertens ive
  4. Steroids

Situation: Larry was admitted at Manila Doctor’s Hospital because of a second-degree burn wound.

4. Before debriding a second-degree burn wound in the left  lower leg, the nurse should do which of the following?

  1. Apply Lindane (Kwell) to the affected area
  2. Medicate the client with narcotic analgesic
  3. Administer acylovir (Zovirax) IV
  4. Apply a topical antimicrobial ointment

5. Larry’s anterior trunk, both front upper extremities, both lower extremities sustained second and third degree burn. Estimate the total percentage of body surface area burned using the Rule of Nines.

  1. 60%
  2. 63%
  3. 62%
  4. 61%

Situation . Hearing, impairment appears to be common among elderly patients. But also occurs among children.

6. To assess the degree of hearing impairment of a 70-year-old client. Which communication approach would you initiate?

  1. Use verbal communication and observe the response
  2. Give message to client in writing
  3. Asks a family member about the client’s
  4. Post a sign “Patient deaf”

7. While you are mating your routine rounds you were told that there is a client in the 1CU who is in respirator and who lip- reads. To establish relationship with him, communication is best accomplished by:

  1. Speaking slowly but aloud
  2. Writing messages
  3. Gesturing while speaking
  4. Using simple “charade” approach or strategy

8. One of your client’s has just undergone an ear surgery. Which of the following would be inappropriate in planning for his care?

  1. Administration of anti-emetics and analgesics as ordered
  2. Daily irrigation of the ear canal
  3. Walking with assistance at least 24 hours after operation
  4. Teaching the patient to avoid sneezing, coughing and nose blowing

9. Which of the following conditions would an irrigation of the  ear canal be appropriate intervention?

  1. Foreign body in the ear canal
  2. Serious otitis
  3. Impacted cerumen
  4. Tympanic membrane perforation

10. Children who have undetected hearing loss are likely to  exhibit which of the following:

  1. Indifference and lack of interest in the environment
  2. Hyperactivity
  3. An increased interest in reading
  4. Hand gestures while speaking

Situation . One of the main fools of the nursing profession is the use of therapeutic communication. The following situation would require you of your communication skills.

11. A patient who is diagnosed to have terminal illness tells  you. “I’m really scared. Am I dying?” What could be your most  appropriate response?

  1. “Tell me about what you think.”
  2. “I’m sure you are scared; other clients in your situation feel the same way.”
  3. “You should be careful not to let your family know you’re scared”
  4. “Why are you scared?”

12. The nurse assessing a male client who has been admitted  for treatment of alcoholism. Which question by the nurse is  least appropriate?

  1. “How much do you think?”
  2. “What other drugs do you use?” .
  3. “How is your general health?”
  4. “Why do you drink so much?”

13. A 58-year-old male client tells the office nurse that his wife does not let him change his colostomy bag himself. Which response by the nurse indicates as understanding of the situation?

  1. “Your wife’s need to help you is a reality you should accept”
  2. “Do you think your wife might benefit from counseling?”
  3. “You feel you need privacy when changing your colostomy?”
  4. “Have you discussed the situation with your doctor?”

14. An 87 year old widow was hospitalized for treatment of chronic renal disease. She lives with her daughter and son-in- law and their family, who are very supportive. She is now ready for discharge. The doctor has ordered high carbohydrates, low-protein, low sodium diet for her and the family has asked for assistance in planning low-sodium diet meals. Which of the following choices best reflects the pre-discharge information the nurse should provide for the client’s family regarding low-sodium diet?

  1. Avoid canned and processed foods, do not use salt replacements substitute herbs and replaces for salt in cooking and when seasoning  foods, call a dietitian for help.
  2. Use potassium salts in place of table salt when coking and seasoning foods, read the labels on packaged foods to determine sodium content,
    and avoid snacks food
  3. Limit milk and dairy products, cook separate meals that are low in sodium and encourage increased fluid intake
  4. Avoid eating in a restaurant, soak vegetables well before cooking to remove sodium, omit all canned foods, and remove salt shakes from table.

15. You are encouraging your patient for major cancer operation to verbalize her fears. She remarked,” I am afraid to  do”. Your appropriate response is

  1. “I know how you feel about your condition”.
  2. “Don’t worry, you are in good hands.”
  3. “Let me call a chaplain to see you.”
  4. “Let us asks your doctor about your operation.”

16. The nurse is caring for a client whose arterial blood gases indicate metabolic acidosis. The nurse knows that of the  following, the least likely to cause metabolic acidosis is:

  1. cardiac arrest
  2. Diabetic ketoacidosis
  3. decreased serum potassium level
  4. renal failure

17. The nurse is caring for a client who is receiving IV fluids, Which observation the nurse makes best indicates that the IV  has infiltrated?

  1. Pain at the site
  2. A change in flow rate
  3. Coldness around the insertion site
  4. Redness around the insertion site

18 A 27 y.o adult is admitted for treatment of Crohn’s disease. Which information is most significant when the nurse assesses nurtritional health?

  1. Anthropometric measurements
  2. bleeding gums
  3. dry skin
  4. facial rubor

19. ASA (aspirin) is being administered to a client. The nurse understands that the most common mechanism of action for nonnarcotic analgesic is their ability to:

  1. Inhibit prostaglandin systhesis
  2. After pain perception in the cerebellum
  3. Directly affect the central nervous system
  4. Target the pain-producing effect of kinins

20. The nurse caring for an adult client who is receiving TPN will need to be monitored for which of the following metabolic complications?

  1. Hypoglycemia and Hypercalcemia
  2. Hyperglycemia and Hypokalemia
  3. Hyperglycemia and Kyperkalemia
  4. Hyperkalemia and Hypercalcemia

21. Total parenteral nutrition is ordered for an adult. Which nutrient is not likely to be in the solution?

  1. Dextrose 10%
  2. Trace minerals
  3. Amino acids
  4. Non of the above

22. A man has sprained his ankle. The physician would order cold applied to the injured area to.

  1. Reduce the body’s temperature
  2. Increase circulation to the area
  3. Aid in absorbing the edema
  4. Relieve pain and control bleeding.

23. An adult is to have a tepid sponge bath to lower his fever. What temperature should the nurse make the water?

  1. 65 F
  2. 90 F
  3. 110 F
  4. 105 F

24. An adult has chronic lower back pain and receives hot pack three times a week. The nurse knows that the treatment is given for which of the following reasons?

  1. To help remove debris from the wound
  2. To keep the client warm and raise his temperature
  3. To improve the client’s general circulation
  4. To relieve muscle spasm and promote muscle relaxation

25. A patient classification system where patients minimal therapy and less frequent observation

  1. minimal care (category 1)
  2. moderate care (category 2)
  3. maximum care (category 3)
  4. intensive care (category 4)

26. The nurse is to apply a dressing to a stage II pressure ulcer. Which of the following dressing is best?

  1. Dry gauze dressing
  2. wet gauze dressing
  3. wet to dry dressing
  4. moisture vapor permeable dressing

27. The client has been placed in the trendelenburg position. The nurse knows the effects of this position to the client include which of the following.

  1. increase blood flow to the feet
  2. decrease blood pressure
  3. increase pressure on the diaphragm
  4. decrease intracranial pressure

28. A man who has been in an MVA is going into shock. Before placing the client in a modified trendelenburg position, the nurse should assess the client for:

  1. long bone fracture
  2. air embolus
  3. head injury
  4. thrombophlebitis

29. The nurse enter a room and finds a fire. Which is the best initial action?

  1. Evacuate any people in the room, beginning with the most ambultory and ending with the least mobile
  2. activating the fire alarm or call the operator, depending on the institutions system
  3. get a fire extinguisher and put out the fire
  4. close all the windows and doors and turn off any oxygen or electricity appliance.

30. The nurse is to open a sterile package from central supply.  Which is the correct direction to open the first lap?

  1. Toward the nurse
  2. Away from the nurse
  3. To the nurse’s left or right hand
  4. It does not matter as long as the nurse touches only the outside edge

31. The nurse knows which of the following is the proper  technique for medical asepsis?

  1. gloving for all the client contact
  2. changing hospital linens weekly
  3. using your hands to turn off the faucet after handwashing
  4. gowning to care for a 1 year old child w/ infections diarrhea

32. An adult ha a left, above the knee amputation two weeks ago. The nurse places him in a prone position tree times a day because:

  1. Prevents pressure ulcer on the sacrum
  2. helps the prosthesis to fit correctly
  3. prevents flexion constractures
  4. allow better blood flow to the heart

33. A woman is to have a pelvic exam. Which of the following should the nurse have the client do first?

  1. Remove all her clothes and her socks and shoes
  2. go to the bahtroom and void saving a sample
  3. assume a lithotomy position on the exam table
  4. assemble all the equipments needed for the examination

34. An adult is supine. Which of the ff. can the nurse to to prevent external rotation of the legs?

  1. put a pillow under the clients lower legs
  2. place a pillow directly under the client knee
  3. use a trochanter rool alongside the client’s upper thighs
  4. lower the client’s legs so that they ae below hips.

35. The nurse prepares to palpate a clients maxillary sinues. For this procedure, where should the nurse place the hands?

  1. On the bridge of the nose
  2. below the eyebrows
  3. below the cheekbones
  4. over the temporal area

36. A client who receives general anesthesia returns from  surgery. Postoperatively, which nursing diagnosis takes highest priority for this client?

  1. Pain related to the surgery
  2. Fluid volume deficit related to fluid and blood loss from surgery
  3. Impared physical mobility related to surgery
  4. Risk for aspiration related to anesthesia

37. After a client receives an IM injection, he complains of a burning pain in the injection site. Which nursing action whould be best to take at this time?

  1. apply a cold compress to decrease swelling
  2. apply a warm compress to dilate the blood vessels
  3. Massage the area to promote absorption of the drug
  4. Instruct the client to tighten his gluteal muscles to enhance absorption of the drug

38. A patient classification system where patients need close attention and complete care in most activities and requires frequent and complex treatments and medications:

  1. Minimal Care (category 1)
  2. Moderate Care (category 2)
  3. Maximum Care (category 3)
  4. Intensive Care (category 4)

39. An observation consistent with complete-airway obstruction is:

  1. Loud crowing when attempting to speak
  2. Inability to cough
  3. Wheezes on auscultation
  4. Gradual

40. The nurse assesses the client’s home environment for the safe use crutches. Which one of the following would pose the greatest hazard to the client’s safe use of crutches at home?

  1. A 4-year old cocker spaniel
  2. Scatter rugs
  3. Snack tables
  4. Diet high in fat

41. A patient who has kaposis sarcoma has all of the following nursing diagnoses. To which one should the nurse give priority?

  1. Altered thought processes related to lesions
  2. Altered with maintenance related to non compliance
  3. Defensive coping related to loss of boundaries
  4. Hopelessness, related to inability to control disease process

42. Which of the following statements, if made by a patient who has had a basal cell carcinoma removed, would indicate to  the nurse the need for further instruction?

  1. “I will use sunscreen with at least a sun protection factor (SPF) of 15.”
  2. “I will use tanning booths rather than sunbathing from now on.”
  3. “I will stay out of the sun between 10:00 AM and 2:00 PM”
  4. “I will wear a broad – brimmed heat when I am in the sun”

43. A patient who has a diagnosis is metastatic cancer of the kidney is told by the physician that the kidney needs to be removed. The patient asks the nurse. “What should I do?”Which of the following responses by the nurse would be most therapeutic?

  1. “Let’s talk about your options.”
  2. “You need to follow the doctor’s advice.”
  3. “What does your family want you to do.”
  4. “I wouldn’t have the surgery done without a second opinion.

44. Which of the following conditions, reported to a nurse by a 20 year old male patient, would indicate a risk for development  of testicular cancer?

  1. Genital Herpes
  2. Undescended testicle
  3. Measles
  4. Hydrocele

45. A client has been diagnosed as having bladder cancer, and a cystectomy and an ileal conduit are scheduled. Preoperatively, the nurse plans to:

  1. Limit fluid intake for 24 hours
  2. Teach muscle tightening exercises
  3. Teach the procedure for irrigation of the stoma
  4. Provide cleansing enemas and laxatives as ordered

46. To gain access to a vein and an artery, an external shunt may be used for clients who require hemodialysis. The most serious problem with an external shunt is.

  1. Septicemia
  2. Clot-formation
  3. Exsanguination
  4. Sclerosis of vessels

47. A client has been diagnosed as having bladder cancer, and a cystectomy and an ileal conduit are scheduled. Preoperatively, the nurse plans to:

  1. Limit fluid intake for 24 hours
  2. Teach the procedure for irrigation of the stoma
  3. Teach muscle-tightening exercises
  4. Provide cleansing enemas and laxatives as ordered

48. Intramedullary nailing is used in the treatment of:

  1. Slipped epiphysis of the femur
  2. Fracture of shaft of the femur
  3. Fracture of the neck of the femur
  4. Intertrochanteric fracture of the femur

49. The nurse should know that, following a fracture of the neck of the femur, the desirable position for the

  1. Internal rotation with extension of the knee
  2. Internal rotation with flexion of the knee and hip
  3. External rotation with flexion of the knee and hip
  4. External rotation with extension of the knee and hip

50. A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:

  1. Stimulating the cerebral cortex
  2. Blocking the action of cholinesterase
  3. Replacing deficient neurotransmitters
  4. Accelerating transmission along neural swaths
Answers and Rationales
  1. C. Ask the client if he has concerns about his care
  2. A. taking with the nursing staff at the physician’s office to find out what the client has been taught and her level of understanding
  3. C. Antihypertensive
  4. B. Medicate the client with narcotic analgesic
  5. B. 63%
  6. A. Use verbal communication and observe the response
  7. A. Speaking slowly but aloud
  8. D. Teaching the patient to avoid sneezing, coughing and nose blowing
  9. C. Impacted cerumen
  10. A. Indifference and lack of interest in the environment
  11. A. “Tell me about what you think.”
  12. D. “Why do you drink so much?”
  13. C. “You feel you need privacy when changing your colostomy?”
  14. A. Avoid canned and processed foods, do not use salt replacements substitute herbs and replaces for salt in cooking and when seasoning foods, call a dietitian for help.
  15. A. “I know how you feel about your condition”.
  16. C. decreased serum potassium level
  17. C. Coldness around the insertion site
  18. A. Anthropometric measurements
  19. A. Inhibit prostaglandin systhesis
  20. B. Hyperglycemia and Hypokalemia
  21. D. Non of the above
  22. D. Relieve pain and control bleeding.
  23. B. 90 F
  24. D. To relieve muscle spasm and promote muscle relaxation
  25. A. minimal care (category 1)
  26. D. moisture vapor permeable dressing
  27. C. increase pressure on the diaphragm
  28. C. head injury
  29. A. Evacuate any people in the room, beginning with the most ambultory and ending with the least mobile
  30. B. Away from the nurse
  31. D. gowning to care for a 1 year old child w/ infections diarrhea
  32. C. prevents flexion constractures
  33. B. go to the bahtroom and void saving a sample
  34. C. use a trochanter rool alongside the client’s upper thighs
  35. C. below the cheekbones
  36. D. Risk for aspiration related to anesthesia
  37. B. apply a warm compress to dilate the blood vessels
  38. D. Intensive Care (category 4)
  39. B. Inability to cough
  40. B. Scatter rugs
  41. D. Hopelessness, related to inability to control disease process
  42. B. “I will use tanning booths rather than sunbathing from now on.”
  43. A. “Let’s talk about your options.”
  44. B. Undescended testicle
  45. D. Provide cleansing enemas and laxatives as ordered
  46. C. Exsanguination
  47. D. Provide cleansing enemas and laxatives as ordered
  48. B. Fracture of shaft of the femur
  49. A. Internal rotation with extension of the knee
  50. B. Blocking the action of cholinesterase

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