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Med Surg Practice Questions, Study Guides, Projects, Research of Nursing

Medical surgical nursing questions and answers that will help on quizzes and ATI.

Typology: Study Guides, Projects, Research

2022/2023

Uploaded on 04/13/2023

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I
1. A home care nurse is preparing to visit a client with a diagnosis of
Meniere’s disease. The nurse review’s the physician’s orders and
expects to note that which of the following dietary measures will be
prescribed?
A. low fiber diet with decreased fluids
B. low sodium diet and fluid restriction
C. low carbohydrate diet and elimination of red meats
D. low fat with restriction of citrus fruits
2. A nurse is assigned to care for a client who has just undergone eye
surgery. The nurse plans to instruct the client that which of the
following activities is permitted in the postoperative period?
A. reading
B. watching television
C. bending over
D. lifting objects
3. A nurse is instilling an otic solution into an adult client’s left
ear. The nurse avoids doing which of the following as part of this
procedure?
A. warming the solution to room temperature
B. placing the client in a side lying position with the ear facing up
C. pulling the auricle backward and upward
D. placing the tip of the dropper on the edge of the ear canal
4. A client has undergone surgery for glaucoma. The nurse provides
which discharge instructions to the clients?
A. wound healing usually takes 12 weeks
B. expected the vision will be permanently impaired
C. a shield or eye patch should be worn to protect the eye
D. the sutures are removed after 1 week
5. Which assessment findings provide the best evidence that a client
with acute angle-closure glaucoma is responding to drug therapy?
A. swelling of the eyelids decreases
B. redness of the sclera is reduced
C. eye pain is reduced or eliminated
D. peripheral vision is diminished
6. At the time of retinal detachment, a client most likely describes
which symptoms?
A. a seeing flashes of light
B. being unable to see light
C. feeling discomfort in light
D. seeing poorly in daylight
7. The most important health teaching the nurse can provide to the
client with conjunctivitis is to:
A. eat a well balanced, nutritious diet
B. wear sunglasses in bright light
C. cease sharing towels and washcloths
D. avoid products containing aspirin
8. When the nurse prepares the client or the myringotomy, the best
explanation as to the purpose for the procedures is that it will:
A. prevent permanent hearing loss
B. provide a pathway for drainage
C. aid in administering medications
D. maintain motion of the ear bones
9. A nurse is reviewing the record of the client with a disorder
involving the inner ear. Which of the following would the nurse
expect to see documented as an assessment finding in this client?
A. severe hearing loss
B. complaints of severe pain in the affected ear
C. complaints of burning in the ear
D. complaints of tinnitus
10. A client with a conduction hearing loss asks the nurse how a
hearing aid improves hearing. The nurse most accurately informs the
client that a hearing aid:
A. amplifies sound heard
B. makes sounds sharper and clearer
C. produces more distinct, crisp, speech
D. eliminates garbled background sounds
11. Which nursing action is best for controlling the client’s
nosebleed?
A. have the client lay down slowly and swallow frequently
B. have the client lay down and breathe through his mouth
C. have the client lean forward and apply direct pressure
D. have the client lean forward and clench his teeth
Situation: Benjie 59 years old male was admitted to the hospital
complaining of nausea, vomiting,
weight loss of 20 lbs, constipation and diarrhea. A diagnosis of
carcinoma of the colon was made.
12. A sigmoidoscopy was performed as a diagnostic measures. What
position Benjie should assume for hi examination?
A. knee-chest
B. Sim’s
C. Fowler’s
D. Trendelenburg
13. As part of the preparation of the client for sigmoidoscopy the
nurse should:
A. explain to Benjie that he will swallow a chalk-like substance
B. administer a cathartic the night before
C. withhold fluids and foods on the day of examination
D. administer cleansing enema in the morning of the
examination
14. The doctor performed a colostomy, post operative nursing care
include:
A. keeping the skin around the opening clean and dry
B. limiting visitors
C. withholding
D. limiting fluid intake
15. During the irrigation of the colostomy, Benjie complains of
abdominal cramps, the nurse should:
A. discontinue the irrigation
B. clamp the catheter for a few minutes
C. advance the catheter about one inch
D. add color water
16. If colostomy irrigation is done, the height of the irrigator can
must be how many inches above the stoma?
A. 14-18 inches
B. 18-20 inches
C. 20-24 inches
D. 10-14 inches
17. Which of the following gastrointestinal condition is known to
predispose to Cancer of the colon?
A. hemorrhoids
B. intussusception
C. islated colonic polyps
D. pyloric stenosis
Situation: Mr. J was brought to the ER complaining of pain located in
the upper abdomen
hematemesis and melena. Diagnosis is peptic ulcer.
18. A frequent discomfort experience by Mr. J due to his peptic ulcer
is:
A. diarrhea
B. vomiting
C. eructation
D. nausea
19. Which of this diagnostic measure is not indicated for Mr. J?
A. x-ray of the abdomen
B. patient’s history
C. gastrointestinal series
D. gastric analysis
20. The purpose of dietary treatment of Mr. J is to:
A. neutralize the free HCL in the stomach
B. delay gastric emptying
C. prevent constipation
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I

  1. A home care nurse is preparing to visit a client with a diagnosis of Meniere’s disease. The nurse review’s the physician’s orders and expects to note that which of the following dietary measures will be prescribed? A. low fiber diet with decreased fluids B. low sodium diet and fluid restriction C. low carbohydrate diet and elimination of red meats D. low fat with restriction of citrus fruits
  2. A nurse is assigned to care for a client who has just undergone eye surgery. The nurse plans to instruct the client that which of the following activities is permitted in the postoperative period? A. reading B. watching television C. bending over D. lifting objects
  3. A nurse is instilling an otic solution into an adult client’s left ear. The nurse avoids doing which of the following as part of this procedure? A. warming the solution to room temperature B. placing the client in a side lying position with the ear facing up C. pulling the auricle backward and upward D. placing the tip of the dropper on the edge of the ear canal
  4. A client has undergone surgery for glaucoma. The nurse provides which discharge instructions to the clients? A. wound healing usually takes 12 weeks B. expected the vision will be permanently impaired C. a shield or eye patch should be worn to protect the eye D. the sutures are removed after 1 week
  5. Which assessment findings provide the best evidence that a client with acute angle-closure glaucoma is responding to drug therapy? A. swelling of the eyelids decreases B. redness of the sclera is reduced C. eye pain is reduced or eliminated D. peripheral vision is diminished
  6. At the time of retinal detachment, a client most likely describes which symptoms? A. a seeing flashes of light B. being unable to see light C. feeling discomfort in light D. seeing poorly in daylight
  7. The most important health teaching the nurse can provide to the client with conjunctivitis is to: A. eat a well balanced, nutritious diet B. wear sunglasses in bright light C. cease sharing towels and washcloths D. avoid products containing aspirin
  8. When the nurse prepares the client or the myringotomy, the best explanation as to the purpose for the procedures is that it will: A. prevent permanent hearing loss B. provide a pathway for drainage C. aid in administering medications D. maintain motion of the ear bones
  9. A nurse is reviewing the record of the client with a disorder involving the inner ear. Which of the following would the nurse expect to see documented as an assessment finding in this client? A. severe hearing loss B. complaints of severe pain in the affected ear C. complaints of burning in the ear D. complaints of tinnitus
  10. A client with a conduction hearing loss asks the nurse how a hearing aid improves hearing. The nurse most accurately informs the client that a hearing aid: A. amplifies sound heard B. makes sounds sharper and clearer C. produces more distinct, crisp, speech D. eliminates garbled background sounds
  11. Which nursing action is best for controlling the client’s nosebleed? A. have the client lay down slowly and swallow frequently B. have the client lay down and breathe through his mouth C. have the client lean forward and apply direct pressure D. have the client lean forward and clench his teeth Situation: Benjie 59 years old male was admitted to the hospital complaining of nausea, vomiting, weight loss of 20 lbs, constipation and diarrhea. A diagnosis of carcinoma of the colon was made.
  12. A sigmoidoscopy was performed as a diagnostic measures. What position Benjie should assume for hi examination? A. knee-chest B. Sim’s C. Fowler’s D. Trendelenburg
  13. As part of the preparation of the client for sigmoidoscopy the nurse should: A. explain to Benjie that he will swallow a chalk-like substance B. administer a cathartic the night before C. withhold fluids and foods on the day of examination D. administer cleansing enema in the morning of the examination
  14. The doctor performed a colostomy, post operative nursing care include: A. keeping the skin around the opening clean and dry B. limiting visitors C. withholding D. limiting fluid intake
  15. During the irrigation of the colostomy, Benjie complains of abdominal cramps, the nurse should: A. discontinue the irrigation B. clamp the catheter for a few minutes C. advance the catheter about one inch D. add color water
  16. If colostomy irrigation is done, the height of the irrigator can must be how many inches above the stoma? A. 14-18 inches B. 18-20 inches C. 20-24 inches D. 10-14 inches
  17. Which of the following gastrointestinal condition is known to predispose to Cancer of the colon? A. hemorrhoids B. intussusception C. islated colonic polyps D. pyloric stenosis Situation: Mr. J was brought to the ER complaining of pain located in the upper abdomen hematemesis and melena. Diagnosis is peptic ulcer.
  18. A frequent discomfort experience by Mr. J due to his peptic ulcer is: A. diarrhea B. vomiting C. eructation D. nausea
  19. Which of this diagnostic measure is not indicated for Mr. J? A. x-ray of the abdomen B. patient’s history C. gastrointestinal series D. gastric analysis
  20. The purpose of dietary treatment of Mr. J is to: A. neutralize the free HCL in the stomach B. delay gastric emptying C. prevent constipation

D. delay surgery

  1. Antacids are administered to Mr. J to: A. tranquilize the intestine B. decrease gastric motility C. lower the acidity of gastric secretion D. aid in digestion
  2. It is thought that emotional stress contribute to ulcer formation through: A. excessive stimulation of the parasympathetic nervous system B. increased activity of the sympathetic nervous system C. disturbance o cerebral cortex appetite control D. decrease of pituitary function
  3. The tissue change most characteristics of peptic ulcer is: A. a soft mass of the necrotic tissue with bleeding B. an erosion of the mucosa covered with thick exudates C. a sharp excavation of tissue membrane with a clean base D. an elevated fibrous tissue membrane with soft margins
  4. The stool Guiac test was ordered to detect the presence of: A. hydrochloric acid B. occult blood C. inflammatory cells D. undigested food
  5. In addition to its antacids effects, aluminum hydroxide gel is locally: A. analgesic B. astringent C. irritating D. depressant
  6. Intervention that would help control his bleeding: A. gastric lavage using iced cold normal saline solution B. gastric using warm normal saline solution C. application of tourniquet D. insertion of NGT
  7. Since she has NGT the appropriate nursing action is: A. render sponge bath B. provide laxative at bedtime C. administer enema once a day D. provide oral hygiene 3x a day
  8. He underwent total gastrectomy, dumping syndrome may occur and the least symptoms he may experience would be: A. feeling of soreness B. weakness C. feeling of fullness D. diaphoresis
  9. To prevent dumping syndrome the following includes your nursing care except: A. serve dry meals B. allow him to walk for a while after eating C. instruct him to lie down after eating D. giving of fluids after meals must be avoided
  10. Your operative nursing assessment after surgery: A. note and report excessive bleeding only B. assess for excessive secretions from the operative site C. ensure that the NG tube is detached from suction apparatus D. check the drainage from the NG tube everyday
  11. What is the involvement of her total gastrectomy? A. removal of the stomach only B. removal of the stomach with anastomosis of the esophagus to the jejunum C. removal of the ovary and fallopian tube D. removal of the stomach with anastomosis of the duodenal to jejunum
  12. A nurse is giving instructions to the client with peptic ulcer disease about symptom management. The nurse tells the client to: A. eat slowly and chew food thoroughly B. eat large meals to absorb gastric acid C. limit the intake of water D. use acetylsalicylic acid (aspirin) to relieve gastric pain
    1. A client has been given a prescription for Propantheline (Probanthine) as adjunctive treatment for peptic ulcer disease. The nurse tells the client to take this medication: A. with antacids B. 30 minutes before meals C. with meals D. just after meals Situation: Kim was known to be alcoholic for 15 yrs. He was admitted in the hospital after having vomited a large quantity of bright red blood with some coffee ground appearance.
    2. The most probable cause of Kim’s cirrhosis is: A. malnutrition B. bacterial inflammation of liver cells C. alcoholism D. obstruction of major bile ducts
    3. Which of the following vitamins are stored by the normal liver? A. vit. A, vit. B and vit. C B. vit. A, vit. B, vit. C, and vit. D C. vit A and vit B D. vit. A and vit. C
    4. The nurse should know how that pathophysiology predispose him to: A. varicose veins B. splenic rupture C. inguinal hernia D. umbilical hernia
    5. Kim’s portal hypertension is the result of: A. contraction of vascular muscles response to psychological stress B. compression of the liver substance due to emotional stress C. acceleration of portal blood flow secondary to severe anemia D. twisting and constriction of intralobular and interlobular blood vessels
    6. Kim is scheduled for a liver biopsy. What instructions regarding respiration is essential for the nurse to give him prior to the biopsy: A. exhale forcefully and to hold his breath for a few seconds B. hold his breath when the needle has reached the liver site C. take several deep breaths and to hold his breath while needle is being introduced D. flat with one pillow under his head
    7. Which position in bed would be best for Kim immediately after he has the needle biopsy of the liver? A. on his right side, with a small pillow under the costal margin B. anyway that he is comfortable C. semi-Fowler’s with his knees flexed D. flat with one pillow under his head
    8. A Blakemore-Sengstaken tube is inserted to prevent bleeding from esophageal varices. The nurse responsibility in this instance would be to: A. alternate inflate and deflate the esophageal balloon B. make certain that the desired degree of pressure is constantly maintained C. deflate both balloons periodically D. encourage Kim to swallow frequently while tube is I place
    9. A physician orders the deflation of the esophageal balloon of a Sengstaken-Balkemore tube in a client. The nurse prepares for the procedure knowing that the deflation of the esophageal balloon places. The client is at risk for: A. increased ascites B. esophageal necrosis C. recurrent hemorrhage from the esophageal varices D. gastritis
    10. Foods usually omitted from diet of Kim with cirrhosis of liver are: A. whole grain cereals B. milk products C. cereal products D. rich gravies and sauces
    11. Clay colored stool are caused by: A. improper utilization of vitamin K by the body
  1. A client’s nasogastric (NG) feeding tube has become clogged. The nurse’s first action is to: A. flush the tube with warm water B. aspirate the tube C. flush the carbonated liquids, such as cola D. Replace the tube
  2. When the client ask the nurse why he must take the neomycin sulfate (Mycifradin), the most accurate explanation in this case is that the drug is given to: A. treat any current infection he may have B. suppress the growth of intestinal bacteria C. prevent the onset of postoperative diarrhea D. reduce the number of bacteria near the incision
  3. If the client is typical of others with appendicitis the nurse can expect that when the client’s abdomen is palpated midway between the umbilicus and right iliac crest, the client will: A. experienced more pain when pressure is released B. lack any sensation of pain or pressure on palpation C. have extreme discomfort with the slightest pressure D. will feel referred pain in the opposite quadrant
  4. Which factor most probably contributed to the development of the client’s hemorrhoids? A. the client takes a daily stool softener B. the client has a history of ulcerative colitis C. the client is frequently constipated D. the client works as a computer programmer
  5. When the client describes her discomfort to the nurse she is most likely to indicate that the pain she experiences becomes worse: A. shortly after eating B. especially on an empty stomach C. following periods of activities D. before rising in the morning
  6. When the nurse empties the drainage in the Jackson Pratt bulb reservoir. Which nursing action is essential for reestablishing the negative pressure within this drainage device? A. the nurse compresses the bulb reservoir and closes the drainage valve B. the nurse opens the drainage valve, allowing the bulb to fill with air C. the nurse fill the bulb reservoir with sterile normal saline D. the nurse secures the bulb reservoir to the skin near the wound
  7. When the client asks the nurse how she acquired hepatitis A, the best answer is that a common route of hepatitis. A transmission is from: A. fecal contamination B. insect carries C. infected blood D. wound drainage
  8. It is essential that the nurse inform the client with hepatitis B that for the remainder of his lifetime he must avoid: A. sexual activity B. donating blood C. excessive caffeine D. foreign travel
  9. Which nursing action is appropriate prior to assisting with the paracentesis? A. the nurse asks the client to void B. the nurse withholds food and water C. the nurse cleanses the client’s abdomen with Betadine D. the nurse obtains a suction machine from storage room
  10. Which statements provides the best evidence that a client with colostomy is adjusting to the change in body image? A. the client wears loose-fitting garments B. the client takes a shower each day C. the client empties the appliance D. the client avoids foods that form gas
  11. A previously health client comes to the emergency department complaining of severe nausea and vomiting hours after eating in a restaurant. Which assessment question best determines if a food borne pathogen is the cause of the client’s syndrome? A. “what food did you eat?” B. “did you take something for you nausea?” C. “did your food look spoiled?” D. “have you ever had food poisoning?”
    1. A nurse is caring for a client with peptic ulcer. In assessing the client for gastrointestinal perforation (GI), the nurse monitors for: A. increase bowel sounds B. sudden, severe abdominal pain C. positive Guaiac test D. slow, strong pulse
    2. Which assessment is most important for the nurse to make before advancing a client from liquid to solid food? A. increase bowel sounds B. appetite C. presence of bowel sounds D. chewing ability
    3. What method would a nurse use to most accurately assess the effectiveness of a weight loss diet for an obese client? A. daily weights B. serum protein levels C. daily caloric counts D. daily intake and output
    4. A pregnant client has been diagnosed with a vaginal infection from the organism Candida albicans. Which findings would the nurse expect to note on assessment of the client? A. absence of any and symptoms B. pain, itching and vaginal discharge C. proteinuria, hematuria, edema and hypertension D. costovertebral angle pain
    5. A nurse is caring for a client who is hospitalized with acute systemic lupus erythematosus (SLE). The nurse monitors the client knowing that which of the following clinical manifestation is not associated with this disease? A. fever B. muscular aches and pains Associated with SLE s/sx C. butterfly rash on the face D. bradycardia
    6. A male being seen in the ambulatory care clinic has a history of being treated for syphilis infection. The nurse interprets that the client has been reinfected if which of the following characteristics is noted in a penile lesion? A. multiple vesicles, with some that have ruptured B. popular areas and erythema C. cauliflower-like appearance D. induration and absence of pain
    7. A nurse is preparing a poster for a booth at a health care to promote primary prevention of cervical cancer. The nurse includes which of the following recommendations on the poster? A. perform monthly breast self-examination (BSE) B. use oral contraceptives as a preferred method of birth control C. use a commercial douches on a daily basis D. seek treatment promptly for infections of the cervix
    8. A nurse is caring for a client who has just had a mastectomy. The nurse assists the client in doing which of the following exercises during the first 24 hours following surgery? A. elbow flexion and extension B. shoulder abduction and external rotation C. pendulum arm swing D. hand wall climbing
    9. Tretinoin (Retin-A) is prescribed for a client with acne. The client calls the clinic nurse and says that the skin has become very red and is beginning to pee. Which of the following nursing statements to the client would be most appropriate? A. “come to the clinic immediately” B. “discontinue the medication” C. “notify the physician”

D. this is a normal occurrence with the use of medication” Situation: Luz 19 years old single is scheduled for mastectomy of the right breast

  1. Based on the health history and other assessment data, Luz’s nursing diagnosis includes the following except: A. potential sexual dysfunction B. body image disturbance C. pain related to anesthesia D. self-care deficit related to immobility of arm on the operative side
  2. The following are her possible post operative complication except: A. hematoma B. lymphedema C. neurovascular deficits D. infection
  3. Luz complains of pain 2 hours after receiving her medication of Meperidine HCL 50 mg IM ordered every 4 hours for the first 24 hours only. You should: A. tell Luz to wait for 2 hours more B. give the medicine STAT C. give fractional dose of Meperidine HCL D. use nursing measure to relieve pain
  4. You informed her that the most common breast tumor occurring in young women is: A. fibrocystic B. papilloma C. gynecomastia D. fibroadenoma
  5. Which of these work-up is not related to her surgery? A. CBC B. Urinalysis C. B.T. D. C.T.
  6. Rationale for moderately elevating post operative affected arm is to: A. prevent lymphedema B. reduce pain C. B.T. D. C.T.
  7. Which of these maybe used to her post operatively? A. pleural drainage B. hemovac C. prevent infection D. improve coping ability
  8. Which of the following is not a post operative complication A. bronchopneumonia B. pneumonia C. atelectasis D. decubitus ulcer
  9. Allowing her to do deep breathing exercise every 2 hours would prevent: A. bronchopneumonia B. atelectasis C. bronchitis D. pneumonia
  10. A client has a left mastectomy with axillary lymph node dissection. The nurse determines that client understands post operative restrictions and arm care if the client states to: A. use a straight razor to shave under the arms B. allow blood pressures to be taken only on the left arm C. carry a handbag and heavy objects on the left arm D. use gloves when working in the garden
  11. A nurse has provided instructions to a client who is receiving external radiation therapy. Which of the following if started by the client would indicate a need for further instructions regarding self- care related to the radiation therapy? A. “I need to avoid exposure to sunlight?” B. “I need to wash my skin with a mild soap and pat dry” C. “I need to apply pressure to the irritated area to prevent bleeding” D. “I need to eat a high-protein diet”
  12. A nurse is teaching a client about the modifiable risk factors that can reduce the risk for colorectal cancer. The nurse places highest priority on discussing which of the following risk factors with this client? A. personal history of ulcerative colitis or gastrointestinal (GI) polyps B. distant relative with colorectal cancer C. age over 30 years D. high-fat, low fiber diet Situation: Fe, a 21-year-old fourth year physical therapy student has been diagnosed with peptic ulcer. The personal and family history shows that she has difficulty coping with the demands of the course and her mother is being treated for peptic ulcer to:
  13. A relevant diagnosis the nurse identifies is one of the following: A. defensive coping B. self-esteem disturbance C. sensory-perceptual alteration D. ineffective individual coping
  14. Typical personality traits of a person with peptic ulcer: A. submissive and dependent B. competitive and aggressive C. self-sacrificing and dependent D. perfectionist and assertive
  15. One of the nursing intervention is to teach Fe: A. relaxation technique B. behavior modification C. stress management technique D. desensitization technique
  16. The following are psycho-physiological reactions except: A. migraine B. constipation C. bronchial asthma D. peptic ulcer
  17. The defense mechanism usually used by patient with peptic ulcer is: A. denial B. reaction formation C. projection D. sublimation

II

  1. The home health nurse is visiting the client who has had a prosthetic valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care for this surgery? A. “I threw away my straight razor and brought an electric razor.” B. “I have to go to the bathroom several times at night” C. “I count my pulse everyday” D. “I still do my deep breathing exercise”
  2. A client has been diagnosed with thromboangitis obliterans. The nurse is considering measures to help the client cope up with lifestyle changes needed to control the disease process. The nurse plans to refer the client to a: A. medical social worker B. dietician C. smoking cessation program D. pain management clinic
  3. The nurse is implementing a plan of care for a client with deep pain thrombosis of the right leg. Which of the following interventions does the nurse avoid when delivering care to this client? A. elevation of the right leg B. ambulation in the hall twice per shift

A. avoid respiratory depression B. prevent oxygen toxicity C. increase lung compliance D. promote production of surfactant

  1. A client who is recovering from a myocardial infarction demonstrates that touching has been effective with the statements: A. “if my chest pain lasts for more than 5 minutes, I should get myself to the emergency room” B. “I just need to avoid salty foods and not add salt to my food” C. “I need to avoid constipation and all activities that have caused me chest pain in the past” D. “I need to get to the drugstore to get some medicine for my cold”
  2. A client is admitted to the hospital complaining of nervousness, heat intolerance and muscle weakness. Her pulse rate is 118 and she has exopthalmos. An essential part of her assessment will be: A. palpation of the thyroid gland B. evaluation of fluid and electrolyte balance C. evaluation of deep tendon reflexes D. use of the Glasgow Coma Scale
  3. A client is scheduled for thyroidectomy. The nurse explains that PTU or an iodine preparation is given prior to surgery in order to: A. increase the size of the thyroid gland B. render the parathyroid glands visible C. induce a euthyroid state in the body D. Separate the thyroid from the laryngeal nerve
  4. A client is being evaluated for the possibility of Grave’s disease. The nurse teaches that the best laboratory test for evaluating whether a client has hypothyroidism or hyperthyroidism is the serum level of: A. thyroxine (T4) C. TSH B. triiodothyroinine (T3) D. epinephrine
  5. A client is taking Levothyroxine (synthroid) for hypothyroidism. The nurse teaches the client to: A. monitor the pulse regularly B. restrict sodium in the diet C. take the drug with meals D. measure urinary output
  6. A client with NIDDM is admitted to the hospital. The client is confused and has dry mucus membranes and poor skin turgor. The serum sodium is 149; the blood pressure 90/60 mmHg; the pulse is 118; and the serum glucose 465 mg/dl. The nurse anticipates that insulin and the following will be needed: A. a potassium drip C. intravenous fluids B. sodium bicarbonate D. calcium gluconate
  7. A nurse is teaching a diabetic client how to attain the optimal level of health. When assessing for other risk factors stroke and heart attack, this nurse looks for: A. hypervolemia C. proteinuria B. hypokalemia D. hypertension
  8. A nurse stops at the sight of a motor vehicle accident to find a young woman slumped over the wheel. She is breathing with a regular rhythm at a rate of 22; ventilation efforts normal. Her pulse rate is 110. The nurse’s next action would be: A. check the level of consciousness B. immobilize the spine C. call the rescue squad D. check for bleeding
  9. A 57-year-old client is being prepared for discharge following a myocardial infarction. The nurse knows that her teaching has been understood when she hears: A. “I guess my sex life is over” B. “depression is bad for me. I must stay happy and optimistic” C. “ the best way to know the amount of exercise I should take is to watch my pulse” D. “the injured area will be replaced with a new heart tissue”
  10. A client with IDDM has just been admitted to the ER after hitting a telephone pole with her car. Bystanders said she acted as if she has been drinking. Her temperature is 37.4 degrees Celsius, pulse 80, resp. 44 and deep. She complained of headache and acted confused. A fruity odor was noted on her breath. Her ABG report read= pH= 7.32, pCO2= 36, and bicarbonate= 18. The nurse prepared for the treatment of: A. metabolic acidosis C. respiratory acidosis B. metabolic alkalosis D. respiratory alkalosis
    1. A client with peptic ulcer is taking Maalox, Amoxicillin and Famotidine. The nurse teaches the client to take the Maalox: A. 1-2 hours before meals C. ½ hour before meals B. with meals D. 1-2 hours after meals
    2. A client with varicose veins tells the nurse, “I am afraid they will burst while I am walking.” Which response by the nurse would be the BEST? A. “the only way to prevent rupture is to have surgery” B. “you must find another job, one that requires less walking” C. “if that happens, you could bleed to death” D. “rupture of varicose veins rarely occur”
    3. A client asks why is it important to check the pupils. The nurse replies that changes in the pupils are a reflection of how well the following area of the nervous system is functioning: A. spinal cord C. midbrain B. brain stem D. cerebellum
    4. A 32-year-old client is being evaluated in the clinic today for possible Addison’s disease. The nurse knows that the most common cause of the disease is attributed to: A. autoimmune response C. disseminated tuberculosis B. blastomycosis D. diabetes mellitus
    5. The nurse knows that the recommended diet for a client with Addison’s disease includes: A. 1 mg. Na C. low fat, low cholesterol B. 3 gms. Na D. high potassium, high cholesterol
    6. A 36-year-old client with a history of Cushing’s disease is being seen in the ER for complaints of anorexia, vomiting, weakness and muscle cramps for the past 24 hours. The nurse recognizes that these clinical findings are a result of: A. hypernatremia C. hyperglycemia B. hypoglycemia D. hypokalemia
    7. When teaching a patient about home care related to outpatient corticosteroid therapy, the nurse emphasizes that side effects of corticosteroid therapy include: A. hyperglycemia and weight loss B. hyponatremia and hypotension C. hypoglycemia and gastric ulcers D. hyperglycemia and weight gain
    8. Additional teaming to a newly diagnosed diabetic client related to the effects of regular insulin is necessary when the client asks, “if I take my regular insulin at 8 A.M., when might I experience signs of low blood sugar reaction? A. 8:30 am B. 11 am C. 1:30 pm D. 4 pm
    9. The nurse recognizes which of the following as signs of early hypoxia? A. bradycardia, hypotension, facial flushing B. confusion, bradycardia, headache C. hypotension, tachypnea, lethargy D. restlessness, yawning, tachycardia
    10. A 68-year-old client has a new colostomy and is being treated today at the clinic for diarrhea. When discussing diet with the client, the nurse explains to him that the one food that caused this problem was: A. cabbage C. tapioca B. eggs D. fried chicken
    11. The nurse is caring for a client with folic acid deficiency. The nurse recalls that one of the most frequent causes of folic acid deficiency is: A. poor nutritional intake due to alcoholism B. lack of absorption of the intrinsic factor C. a diet that consists of vegetables only and no meat

D. a complicated pregnancy during the second trimester

  1. When planning care for a patient who is pancytopenic, the major goal should be: A. prevent hemorrhage and infection B. administering an oral iron preparation C. preventing fatigue and fluid overload D. encouraging consumption of a neutropenic diet
  2. when explaining different effects of chemotherapy to students, the nurse correctly identifies which group of chemotherapy drugs that does not affect DNA synthesis to kill tumor cells? A. hormones C. antimetabolites B. vinca alkalosis D. alkylating agents
  3. The nurse evaluates the client’s ability to self-monitor blood glucose level at home. What information BEST indicates the average degree of diabetes control during the past 2 to 4 months? A. serum glycosylated hemoglobin B. postprandial blood glucose level C. a written record of daily blood glucose levels D. a written record of daily double voided urine glucose levels
  4. Which of the findings would the nurse most likely note during an Addisonian crisis? A. serum potassium of 3 mEq/L, BP=158/72 mmHg B. serum potassium of 5.8 mEq/L, BP=62/48 mmHg C. serum sodium of 150 mEq/L, BP= 158/ D. serum sodium of 135 mEq/L, BP=62/
  5. Propanolol (Inderal) is commonly prescribed for clients with hyperthyroidism to: A. block formation of the thyroid hormone B. decrease the vascularity of the thyroid gland C. inhibit peripheral conversion of T4 and T D. decrease CNS stimulation
  6. The client with cancer is receiving chemotherapy and develops thrombocytopenia. Which goal should be given the highest priority in the NCP? A. ambulation tree times a day B. monitoring temperature C. monitoring hemoglobin and hematocrit D. monitoring for pathologic fractures
  7. The nurse assesses the oral cavity of a client with cancer and notes white patches on the mucous membranes. The nurse determines that this occurrence: A. is common B. is characteristic of thrush infection C. indicates that oral hygiene need to be improved D. suggests that the client is anemic
  8. The nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The nurse determines that the WBC count is normal if which of the following results is present? A. 3,000 to 8,000/cu.mm. B. 4,000 to 9,000/cu.mm. C. 7,000 to 15,000/cu.mm. D. 2,000 to 5,000/cu. Mm.
  9. The client suspected of having an abdominal tumor is scheduled for a CT scan with dye injection. Which of the following is an accurate description of the scan? A. the test maybe painful B. the dye injected may cause a warm, flushing, sensation C. fluids will be restricted following the test D. the test takes approximately 2 hours
  10. The client is diagnosed as having a bowel tumor. Several diagnostic test are prescribed. Which of the following test will confirm the diagnosis of the malignancy? A. MRI C. abdominal ultrasound B. CT scan D. biopsy of the tumor
  11. The oncology nurse is preparing to administer chemotherapy to the client with Hodgkin’s disease. A multiagent medication regimen known as MOPP is prescribed. The medications included in the therapy are: A. belomycin, oncovin, vincristine, prednisone B. adrimycin, vincristine, oncovin, prednisone C. adriamycin, cytoxan, prednisone, oncovin D. procarbazine, mechlorethemine, oncovin, prednisone
  12. The nurse is analyzing the laboratory results of a client with leukemia who received a regimen of chemotherapy. Which of the following laboratory values does the nurse note specifically as a result of massive cell destruction that occurred from chemotherapy? A. anemia C. decrease platelets B. decreased WBC D. increased uric acid level
  13. The client is receiving external radiation to the neck for cancer of the larynx. The MOST likely side effect to be expected is: A. constipation C. sore throat B. dyspnea D. diarrhea
  14. The nurse is providing instructions to the client receiving external radiation therapy. Which of the following is NOT a component of the instructions? A. avoid exposure to sunlight B. wash the skin with a mild soap and pat dry C. apply pressure on the irritated area to prevent bleeding D. eat a high protein diet
  15. The nurse teaches skin care to the client receiving external radiation therapy. Which of the following statements, if made by the client indicates the need for further instruction? A. “I will handle the area gently” B. “I will avoid the use of deodorants” C. “I will limit sun exposure to 1 hour daily” D. “I will wear loose fitting clothing”
  16. The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000/cu.mm. Based on this laboratory value, the priority nursing assessment is which of the following? A. assess level of consciousness B. assess temperature C. assess bowel sounds D. assess skin turgor
  17. The client is admitted to the hospital with a diagnosis of suspected Hodgkin’s disease. Which of the following assessment signs would the nurse MOST likely to note in the client? A. weakness C. weight gain B. fatigue D. enlarged lymph nodes
  18. The client with leukemia is receiving Busulfan (myleran). Allopurinol (Zyloprim) is prescribed for the client. The purpose of Allopurinol (Zyloprim) is to: A. prevent gouty arthritis C. prevent hyperuricemia B. prevent stomatitis D. prevent diarrhea
  19. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the NGT. Which of the ff. is the MOST appropriate nursing intervention? A. notify the physician C. continue to monitor the drainage B. measure abdominal girth D. irrigate the NGT
  20. The nurse is reviewing the history of a client with bladder cancer. The MOST common symptom of this type of cancer is which of the following? A. frequency of urination C. hematuria B. urgency of urination D. dysuria
  1. The nurse is caring for a hospitalized patient with a diagnosis of ulcerative colitis (inflammation). When assessing the client, which finding, if noted, would the nurse report to the physician? A. bloody diarrhea C. hemoglobin level of 12 mg/dl B. hypotension D. rebound tenderness
  2. The nurse is providing discharge instruction to a client following gastrectomy, which of the following measures will the nurse instruct the client to the following assist in preventing dumping syndrome? A. eat high carbonated food B. limit the fluid taking with food C. ambulate following a meal D. sit in a high-fowler’s position during meals
  3. The nurse is caring for a client post-operatively following the creation of a colostomy. Which of the ff. nursing diagnosis does the nurse include in the plan of care? A. altered nutrition; more than body requirements B. body image disturbance C. fear related to poor diagnosis D. sexual dysnfunction
  4. The nurse is reviewing the record of the client with Crohn’s disease (inflammation). Which of the following stool characteristic does the nurse expect to note in this client? A. bloody stool B. diarrhea C. constipation alternating with diarrhea D. stool constantly oozing from the rectum
  5. The client with cirrhosis has ascites and a fluid volume excess. Which measure will the nurse include in the plan of care for this client? A. increase the amount of sodium in diet B. restrict the amount of fluids consumed C. encourage ambulation frequently D. administer magnesium antacids
  6. The client with ascites is schedule for a paracentesis. The nurse is assisting the physician in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure? A. supine C. right side lying B. left side lying D. upright
  7. An ultrasound of the gallbladder is schedule for the client with a suspect diagnosis of cholecystitis. The nurse explain to the client that this test: A. requires the client to lie still for short intervals B. requires that the client be NPO C. requires the administration of oral tables D. is uncomfortable
  8. The nurse is providing preoperative teaching to a client scheduled for a cholecystectomy. Which of the following interventions is of highest priority in the preoperative teaching plan? A. teaching coughing and deep breathing exercises B. teaching leg exercises C. instructions regarding fluid restrictions D. frequent need to work overtime on short notice
    1. A client with peptic ulcer states that stress frequently causes exacerbation (aggrevate;increase) of the disease. The nurse interprets that which of the following items mentioned by the client is most likely responsible for the exacerbations? A. sleeping 8 hours a night B. eating 5 to 6 small meals per day C. ability to work at home periodically D. frequent need to work overtime on short notice
    2. The client with peptic ulcer disease needs dietary modification to reduce episode of epigastric pain. The nurse plans to teach the client that which of the following items, which the client enjoys, does not need to be limited or eliminated with this disease? A. wine C. coffee B. baked chicken D. fresh fruit
    3. The medication history of a client with peptic ulcer disease reveals intermittent use of the following medications. The nurse teaches the client to avoid which of these medications altogether because of the irritating effects on the lining of the GI tract? A. (Prilosec) B. ibuprofen (Motrin) C. sucralfate (Carafate) D. Nizatidine (Axid)
    4. The nurse instructs the ileostomy client to do which of the following as part of essential care of the stoma? A. cleanse the peristomal skin meticulously B. take in high-fiber foods such as nuts C. massage the area below the stoma D. limit fluid intake to prevent diarrhea
    5. The client who has undergone creation of a colostomy has a nursing diagnosis of Body Image disturbance. The nurse evaluates that the client is making the most significant progress toward identified goals if the client: A. watches the nurse empty the ostomy bag B. looks at the ostomy site C. reads the ostomy product literature D. practices cutting the ostomy appliance
    6. The client with a new colostomy is concerned about odor from stool in the ostomy drainage bag. The nurse should teach the client to include which of the following foods in the diet to reduce odor? A. yogurt C. cucumbers B. broccoli D. eggs
    7. The nurse is giving dietary instruction for the client who has a new colostomy. The nurse encourages the client to eat foods representing which of the following diets for the first 4 to 6 weeks postoperatively? A. high protein C. low calorie B. high carbohydrates D. low residue
    8. The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse evaluates that the client did not fully understand the instructions if the client stated that eating which of the following foods makes the stool less watery? A. pasta C. bran B. boiled rice D. low-fat cheese
    9. The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperatively period for which of the following most frequent complications of this type of surgery? A. intestinal obstruction B. fluid and electrolyte imbalance C. malabsorption of fat D. folate deficiency
    10. The client with acute pancreatitis is experiencing severe pain from the disorder. The nurse teaches the client to avoid which of the following positions that could aggravate the pain? A. sitting up C. leaning forward B. lying flat D. flexing the left leg
    11. The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse evaluates that the client understands the instructions given if the client stated that which of the following food items is acceptable in the diet?

A. baked scrod C. fried chicken B. sauces and gravies D. fresh whipped cream

  1. The nurse assesses the client experiencing an acute episode of cholecystitis for pain that is located in the right: A. upper quadrant and radiates to the left scapula and shoulder B. upper quadrant and radiates to the right scapula and shoulder C. lower quadrant and radiates to the umbilicus D. lower quadrant and radiates to the back
  2. The client is beginning to show signs of hepatic encephalopathy. The nurse plans a dietary consult to limit the amount of which of the following ingredients in the client’s diet? A. fat B. carbohydrates C. protein D. minerals
  3. The client with Crohn’s disease has an order to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken: A. 30 minutes before meals B. during meals C. 60 minutes after meals D. upon arising and at bedtime
  4. The client with ulcerative colitis is diagnosed with mild case of the disease. The nurse doing dietary teaching gives the client examples of foods to eat that represent which of the following therapeutic diets? A. high-fat with milk B. high-protein without milk C. low-roughage without milk D. low-roughage with milk
  5. It has been determined that the client with hepatitis has contracted the infection from contaminated food. What type of hepatitis is this client most likely experiencing? A. hepatitis A B. hepatitis B C. hepatitis C D. hepatitis D

III

Situation: The head nurse of an eye and ear clinic is ordering nursing students.

  1. Normal visual acuity as measured with a Snellen eye chart is 20/20. What does a visual acuity of 20/30 indicate? A at 20 feet, an individual can only read letters large enough to be read at 30 feet B. at 30 feet, an individual can read letters large enough to be read at 20 feet C. an individual can read 20 out of 30 total letters on the chart D. an individual can read 30 out of 50 total letters on the chart at 20 feet
  2. Damage to the visual area of the occipital lobe of cerebrum, on the left side, would produce what type of visual loss? A. left eye only B. right eye only C. medial half of the right eye and lateral half of the left eye D. medial half of the left eye and lateral half of the right eye
  3. An anterior chamber of the eye refers to all the space in what area? A. anterior to the retina B. between the iris and the cornea C. between the lens and the cornea D. between the lens and the iris
  4. What condition results when rays of light are focused in front of the retina? A. myopia (near sightedness) B. hyperopia (farsightedness) C. presbyopia (kind of farsightedness) D. emmetropia (normal) 5. As the person grows older, the lens losses its elasticity, causing which kind of farsightedness? A. emmetropia B. presbyopia C. diplopia (double vision) D. myopia 6. If a person has a foreign object of unknown material that is not readily seen in one eye, what would the first action be? A. irrigate the eye with a boric acid solution B. examine the lower eyelid and then the upper eyelid C. irrigate the eye with opious amounts of water D. shield the eye from pressure, and seek medical help 7. A sudden loss of an area of vision, as if a curtain were being drawn, is a principal symptom of? A. retinal detachment B. glaucoma C. cataracts D. keratitis (damage in cornea) 8. Postoperative care following stapedectomy would not include which of the following A. out of bed as desired B. no moisture in the affected ear C. avoid sneezing D. no bending over or lifting 9. Dimenhydrinate (Dramamine) is given after a stapedectomy A. to accelerate the auditory process B. to dull the pain experienced with the semicircular canal is disturbed C. to minimize the sensations of equilibrium disturbances and imbalance D. to prevent an increase tendency toward nausea 10. A client with Meniere’s syndrome (idiopathicendolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. ) is extremely uncomfortable because of which of these? A. severe earache B. many perceptual difficulties C. vertigo and resultant nausea D. facial paralysis 11. What is the cataract of the eyes? A. opacity of the cornea B. clouding of the aqueous humor C. opacity of the lens D. papilledema 12. Treating a cataract primarily involves which of the following? A. instillation of miotics B. installation of mydriatics C. removal of the lens D. enucleation 13. Preoperative instruction will not need to include A. type of surgery B. how to use the call bell C. how to prevent paralytic illeus D. how to prevent respiratory infetins 14. In preparing to teach patient about adjustment to cataract lenses, the nurse needs to know that the lenses will. A. magnify objects by one-third- with central vision B. magnify objects by one-third with peripheral vision C. reduce objects by one-third with central vision D. reduce objects by one-third with peripheral vision 15. In the immediate postoperative period the one action that is contraindicated for patient compared with clients after most other operations is which of the following? A. coughing B. turning on the unoperative side C. measures to control nausea and vomiting D. eating after nausea passes 16. Immediate nursing care following cataract extraction is directed primarily toward preventing

B. a deviated septum C. acute sinusitis D. hypotension

  1. Which of the following medications would be used with in order to promote vasoconstriction and control bleeding? A. epinephrine B. lidocaine C. pilovarpine D. cylospentolate
  2. Which of the following positions would be most desirable for Gary? A. trendelenburg’s to control shock B. a sitting position, unless he is hypotensive C. side-lying, to prevent aspiration D. prone, to prevent aspiration
  3. The physician decides to insert nasal packing. Of the following nursing actions, which would have the highest priority? A. encourage Gary to breath through his mouth, because he may feel panicky after the insertion. B. advice Gary to expectorate the blood in the nasopharynx gently and not to swallow it C. periodically check the position of the nasal packing, because airway obstruction can occur if the packing accidentally slip out of place D. take rectal temperature, because he must rely on mouth breathing and would be unable to keep his mouth closed on the thermometer.
  4. After bleeding has been controlled, Gary taken to surgery to correct a deviated nasal septum. Which of the following is likely complication of this surgery? A. loss of the ability to smell B. inability to breath through the nose C. infection D. hemorrhage
  5. Upon his discharge, the nurse instructs Gary on the use of vasoconstrictive nose drops and cautions him to avoid too frequent, and excessive use to these drugs, which of the following provides the best rationale for this caution A. A rebound effect occurs in which stuffness worsens after each successive dose B. cocaine, a frequent ingredient in nose drops, may lead to psychological addiction C. these medications may be absorbed systematically, causing severe hypotension D. persistent vasoconstriction of the nasal mucosa can lead to alterations in the olfactory nerve Situation: Brix had redial and neck surgery for cancer of the larynx.
  6. Brix has tracheostomy. When suctioning through laryngectomy tube. When doing these two procedures at the same time, the nurse would not do which of the ff: A. Use sterile technique B. turn head to right to suction left bronchus C. suction for no longer then 10 to 15 seconds D. observe for tachycardia
    1. Brix requires both nasopharyngeal suctioning and suctioning through laryngectomy tube. When doing these two procedures at the same time, the nurse would not do which of the ff: A. use a sterile suction setup B. suction the nose first, then the laryngectomy tube C. suction the laryngectomy tube first, then the nose D. lubricate the catheter with saline
    2. A nasogastric tube is used to provide Brix with fluids and nutrient for approximately 10 days, for which of the following reasons? A. to prevent pain while swallowing B. to prevent contamination of the suture line C. to decrease need for swallowing D. to prevent need for holding head up to ear
    3. Brix’s children are concerned about their own risk of developing cancer. All but one of the following are facts that describe malignant neoplasia and must be considered by the nurse in her responses. Which one is correct? A. family factors may influence an individual’s susceptibility to neoplasia B. long-term use of corticosteroids enhances the body’s defense C. Sexual differences influence an individuals susceptibility to specific neoplasm D. living in industrialized areas increase an individual’s susceptibility to a malignant neoplasm
    4. When would Brix best begin speech rehabilitation? A. when he leaves the hospital B. when the esophageal suture line is healed C. three months after surgery D. when he regains all his strength
    5. The nurse is complaining the initial morning assessment on the client. Which physical examination technique would be used first when assessing the abdomen? A. inspection B. light palpation C. auscultation D. percussion
    6. The client has orders for a nasogastric (NG) tube insertion. During the procedure, instruction that will assist in insertion would be: A. instruct the client to tilt his head back for insertion into the nostril, then flex his neck for final insertion B. after insertion into the nostril, instruct the client to extend his neck C. introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion D. instruct the client to hold his chin down, then back for insertion of the tube
    7. The most important pathophysiologic factor contributing to the formation of esophageal varices is: A. decreased prothrombin formation B. decreased albumin formation by the liver C. portal hypertension D. increased central venous pressure
    8. The nurse analyzes the results of the blood chemistry tests done on a client with acute pancreatitis. Which of the following results would the nurse expect to find? A. low glucose B. low alkaline phosphatase C. elevated amylase D. elevated creatinine
    9. A client being treated for esophageal varices has a Sengstaken- Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: A. check that a hemostat is at the bedside B. monitor IV fluids for the shift C. regularly assess respiratory status D. check that the balloon is deflated on a regular basis
  1. A female client complains of gnawing (bite/chew) midepigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A. cancer of the stomach B. peptic ulcer disease C. chronic gastritis D. pylorospasm
  2. When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A. assisting in inserting a Miller-Abbott tube B. assisting in inserting an atrial pressure line C. inserting a nasogastric tube D. inserting an IV
  3. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonists (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: A. reduce gastric acid output B. protect the ulcer surface C. inhibit the production of hydrochloric acid (HCl) D. inhibit vagal nerve stimulation
  4. The nurse is admitting a client with Crohn’s disease who is scheduled for intestinal surgery. Which surgical procedure would the nurse anticipate for the treatment of this condition: A. ileostomy with total colectomy B. sigmoid colostomy with mucous fistula C. intestinal resection with end-to-end anastomosis D. colonoscopy with biopsy and polypectomy
  5. A client who has just returned home following ileostomy surgery will need a diet that is supplemented: A. potassium B. vitamin B C. sodium D. fiber
  6. A client scheduled for colostomy surgery. An appropriate preoperative diet will include: A. broiled chicken, baked potato, and wheat bread B. ground hamburger, rice, and salad C. broiled fish, rice, squash, and tea (deodorant) D. steak, mashed potatoes, raw carrots, and celery
  7. As the nurse is completing evening care for a client, he observes that the client is upset, quiet, and withdrawn. The nurse knows that the client is scheduled for diagnostic tests the following day. An important assessment question to ask the client is: A. “would you like to go to the dayroom to watch TV?” B. “are you prepared for the test tomorrow?” C. “have you talked with anyone about the test tomorrow?” D. “have you asked your physician to give you a sleeping pill tonight?”
  8. Following abdominal surgery, a client complaining of “gas pains” will have a rectal tube inserted. The client should be positioned on his: A. left side, recumbent B. left side, sims C. right side, semi-fowler’s D. left side, semi-Fowler’s
  9. Which of the following statements is most correct regarding colostomy irrigations? A. the solution temperature should be 100 deg. F B. 1000 ml/1L is the usual amount of solution for the irrigation C. the solution container should be placed 10 inches above the stoma D. the irrigation cone is inserted in an upward direction in relation to the stoma
  10. The nurse is teaching a client with a new colostomy how to apply an appliance to a colostomy. How much skin should remain exposed between the stoma and the ring of the appliance? A. 1/8 inch B. ½ inch C. ¾ inch D. 1 inch
  11. Following a liver biopsy, the highest priority assessment of the client’s condition is to check for: A. pulmonary edema B. uneven respiratory pattern C. hemorrhage D. pain
  12. A client has a bile duct obstruction and is jaundiced. Which intervention will be most effective in controlling the itching associated with his jaundice? A. keep the client’s nails clean and short B. maintain the client’s room temperature at 72 to 75 deg. F C. provide tepid water for bathing D. use alcohol for back rubs
  13. When a client is in liver failure, which of the following behavioral changes is the most important assessment to report? A. shortness of breath B. lethargy C. fatigue D. nausea
  14. A client with a history of cholecystitis is now being admitted to the hospital for possible surgical intervention. The orders include NPO, IV therapy, and bed rest. In addition to assessing for nausea, vomiting and anorexia, the nurse should observe for pain: A. in the right lower quadrant B. after ingesting food C. radiating to the left shoulder D. in the upper quadrant
  15. The nurse taking a nursing history from a newly admitted client learns that he has a Denver shunt. This suggest that he has a history of: A. hydrocephalus B. renal failure C. peripheral occlusive disease D. cirrhosis
  16. A female client had a laparoscopic cholecystectomy this morning. She is now complaining of right shoulder pain. The nurse would explain to the client this symptom is: A. common following this operation B. expected after general anesthesia C. unusual and will be reported to the surgeon D. indicative of a need to use the incentive spirometer
  17. For a client with the diagnosis of acute pancreatitis, the nurse would plan for which critical component of his care? A. testing for Homan’s sign B. measuring the abdominal girth C. performing a glucometer test D. straining the urine
  18. After removing a fecal impaction, the client complains of feeling lightheaded and the pulse rate is 44. The priority intervention is: A. monitoring vital signs B. place in shock position C. call the physician D. begin CPR
  19. Peritoneal reaction to acute pancreatitis results in a shift of fluid from the vascular space into the peritoneal cavity. If this occurs, the nurse would evaluate for: A. decreased serum albumin B. abdominal pain C. oliguria D. peritonitis
  20. The assessment finding should be reported immediately if it develop in the client with acute pancreatitis which is: A. nausea and vomiting B. abdominal pain C. decreased bowel sounds D. shortness of breath
  21. Following brain surgery, the client suddenly exhibits polyuria and begins voiding 15 to 20 L/day. Specific gravity of the urine is

A. secrete hydrogen ions and sodium B. secrete ammonia C. exchange hydrogen and sodium in the kidney tubules D. decrease sodium ions, hold on to the hydrogen ions, and then secrete sodium bicarbonate

  1. Conditions known to predispose to renal calculi formation include: A. Polyuria B. dehydration, immobility C. glycosuria D. presence of an indwelling Foley catheter
  2. the most appropriate nursing intervention, based on physician’s orders, for treating metabolic acidosis is to: A. replace potassium ions immediately to prevent hypokalemia B. administer oral sodium bicarbonate to act as a buffer C. administer IV cathecholamines (Levophed) to prevent hypertension D. administer fluids to prevent dehydration
  3. IV is attached to a controller to maintain the flow rate. If the alarm sounds on the controller: A. ensure that drip chamber is full B. assess that height of IV container is at least 30 inches above venipuncture site C. ensure that the drop sensor is properly placed on the drip chamber D. evaluate the needle and IV tubing to determine if they are patent and positioned appropriately
  4. A 76-year-old woman who has been in good health develops urinary incontinence over a period of several days and is admitted to the hospital for a diagnostic workup. The nurse would assess the client for other indicators of: A. renal failure B. urinary tract infection C. fluid volume excess D. dementia
  5. A 60-year-old male client’s physician schedules a prostatectomy and orders a straight urinary drainage system to be inserted preoperatively. For the system to be effective, the nurse would: A. coil the tubing above the level of the bladder B. position the collection bag above the level of the bladder C. check that the collection bag is vented and distensible D. determine that the tubing is less that 3 feet in length
  6. During a retention catheter insertion or bladder irrigation, the nurse must use: A. sterile equipment and wear sterile gloves B. clean equipment and maintain surgical asepsis C. sterile equipment and maintain medical asepsis D. clean equipment and technique
  7. The physician has ordered a 24 hours urine specimen. After explaining the procedure to the client, the nurse collects the first specimen. This specimen. This specimen is the: A. discarded, then collection begins B. saved as part of the 24 hours collection C. tested, then discarded D. placed in a separate container and later added to collection
  8. The most common cause of bladder infection in the client with a retention catheter is contamination: A. due to insertion technique B. at the time of the catheter removal C. of the urethral/ catheter interface D. of the internal lumen of the catheter
  9. A client in acute renal failure receive an IV infusion of 10 percent dextrose in water with 20 units of regular insulin. The nurse understands that the rational for this therapy is to: A. correct the hyperglycemia that occurs with acute renal failure B. facilitate the intracellular movement of potassium C. provide calories to prevent tissue catabolism and azotemia D. force potassium into cells to prevent arrhythmias
    1. A client with chronic renal failure is on continuous ambulatory peritoneal dialysis (CAPD). Which nursing diagnosis should have the highest priority? A. powerlessness B. high risk for infection C. altered nutrition: less than body requirements D. high risk for fluid volume deficit\

IV

AM-CARE Review Academy for Nurses Room 301 3 rd^ Floor P & J Lim Bldg. Tiano Brothers Kalambaguhan Sts., Cagayan de Oro City Tel. No. (08822) 721- NLE DECEMBER 2005 MEDICAL SURGICAL NURSING IV Situation: John Lee is an 18-year old high school student who suffered an injury to his cervical spine in a football game.

  1. In directing emergency care until the ambulance arrives, it is most important that the school nurse A. place a small makeshift pillow under his head B. check to see if he can move all of his extremities C. keep him flat and immobilized in a natural position D. cover him with a blanket
  2. A primary goal of nursing care when John is brought into the emergency room will be A. prevention of spinal shock B. maintenance of respiration C. maintenance of orientation D provision for pain relief Situation: Crutchfield tongs are used to apply traction to realign the spinal cord.
  3. A nursing measure for john while he is in cervical traction should be to A. massage the back of his head B. position him from side to side C. remove the weights at least once a shift D. encourage involvement in his own care Situation: John is found to have a temperature of 36ºC (96.8ºF).
  4. The most appropriate initial nursing measure for John in response to his hypothermia would be to A. cover him with additional blankets B. place a hot-water bottle at his feet C. check for signs of shock D. notify his physician Situation: John has a tracheostomy performed and is on assisted ventilation.
  5. The alarm on the ventilator sounds. The initial response by the nurse should be to quickly A. notify the respiratory therapist B. check all connections from the respirator C. notify the respiratory therapist to come immediately D. use a self-inflating bag to ventilate John
  6. When suctioning John, the nurse should A. ensure that he is able to take a breath between insertions of the catheter B. suction him for at least 30 seconds with each catheter insertion C. apply suction and gently rotate the catheter while inserting it into the bronchial bifurcation D. use clean technique during the suction procedure
  7. John suddenly becomes diaphoretic, his blood pressure rises to 190/110, and he complains of a headache. The nurse should assess the patient for signs of A. increased intracranial pressure

B. spinal meningitis C. pulmonary congestion D. fecal impaction

  1. Upon admission John had a complete loss of motor ability. Within 48 hours he is noted to be having muscle spasms. His family becomes very excited when they notice these movements. Which of the following choices would be the most appropriate response by the nurse? A. at this stage, muscle spasms are expected, but it is too soon to evaluate the extent of the injury or its permanent effects B. I can understand your excitement. These movements are a good sign that he is making progress C. these movements are an indication that he is trying to move and that his will is very strong D. these movements are reflex activities that indicate that his spinal cord is intact Situation: Mark Richards has a compound fracture of the temporal bone.
  2. The nurse notices bleeding from the orifice of the ear. Which of the following actions by the nurse can be safely used to determine if the drainage contains cerebrospinal fluid (CSF)? The nurse should A. swab the orifice of the ear with sterile applicator and send the specimen to the laboratory B. blot the drainage with a sterile gauze pad and look for a clear halo or ring around the spot of blood C. gently suction the ear an send the specimen to the laboratory D. test the CSF with a Tes-Tape and get a negative reading for sugar
  3. The nursing care plans states “Observe for early signs of increased intracranial pressure (IIP).” Early symptoms of IIP include A. widening pulse pressure and dilated pupils B. rising blood pressure and bradycardia C. elevated temperature and decerebrate posturing D. nausea, vomiting, and restlessness
  4. During the initial period after a head injury, nursing intervention for Mr. Richards should include A. packing the ear with cotton balls to stop bleeding B. awakening the patient every 2 hours to determine his level of consciousness C. placing the patient in Trendelenburg’s position D. forcing fluids to restore hydration
  5. Before discharge, a computerized axial tomogram will be performed to rule out any intracranial or extracranial bleeding. Mr. Richards should be told that A. the procedure is noninvasive and he will not feel any pain B. he will experience a burning sensation as the dye is being injected C. the procedure is done in the operating room under anesthesia D. local anesthetic is used before injecting air into the ventricles of the brain via the spinal canal Situation: Tonnie Miccio is a 43-year old divorced man who has been rushed to the emergency room with an acute gouty arthritis.
  6. While admitting Mr. Miccio to the hospital, the nurse should recognize those factors that can precipitate an acute attack. They include A. excessive smoking B. large alcohol intake C. emotional stress D. improper rest
  7. A serum uric acid level is performed by the hospital laboratory. In acute gout, the uric acid level is approximately A. 1.0 mg/100 ml B. 2.1 mg/100 ml C. 6.5 mg/100 ml D. 10 mg/100 ml
  8. Colchicine is the standard drug used to treat acute gout: The physician orders colchicines, 1.0 mg every 2 hours. After receiving the third dose, the patient complains of nausea, vomiting, and diarrhea. The nurse should recognize that this is A. a transient side effect and give the next dose B. a sign of toxicity and withhold the medication C. an allergic response to the drug and notify the physician D. a psychogenic response to the severe pain
  9. The expected outcome for colchicine is to A. reduce uric acid levels B. relieve joint pain and inflammation C. increase blood flow to the kidney D. detoxify purines in the liver
  10. During the night, Mr. Miccio complains of severe pain in his toe and asks the nurse for 2 aspirin tablets. The nurse should A. give the patient the 2 aspirin tablets B. elevate the foot on a pillow C. notify the physician D. offer the patient a cup of tea
  11. Some physicians prescribe an alkali-ash diet to enhance the effect of the medications. Which of the following foods are allowed? A. liver, shellfish, and fats B. cranberries, cheese, and whole grain cereals C. milk, vegetables, and most fruits D. eggs, milk, prunes, and plums
  12. After the acute attack subsides, the physician orders allopurinol (Zyloprim), 300 mg/day. The expected outcome for this drug is to A. lower the plasma and urinary uric acid level B. reduce inflammation of the affected joints C. produce diuresis D. relieve pain
  13. A teaching program for Mr. Miccio should include A. emphasizing that aspirin is contraindicated in patient’s taking allopurinol B. restricting fluid intake to 1,000 ml/day C. explaining that acute gouty attacks often occur during initiation of allopurinol therapy D. stating that a low-purine diet should be followed while taking allopurinol
  14. About 2 months after taking the allopurinol, Mr. Miccio develops a skin rash. The nurse should A. recognize this as a minor side effect that will subside B. ask the patient if he has been taking any aspirin while taking the allopurinol C. recognize this is an indication to discontinue the drug D. be aware that concomitant use of colchicines with allopurinol causes this reaction
  15. One day, Jennifer asks her roommate, Erin, how her scoliosis was first recognized. Erin replies, “The school health nurse told me that there may be a problem after all the girls in my class were asked to stand erect while she examined our backs.” The nurse suspected scoliosis when she observed that Erin’s shoulder on one side was elevated and her A. head appeared aligned to the opposite side B. leg on the same side appeared shorter C. hip on the opposite side appeared prominent D. arm on the same side appeared longer
  16. When Erin’s scoliosis was diagnosed after x-ray examination of her spine, she was fitted with a Milwaukee brace. Erin asks the nurse when it could be removed each day. Which of the following would be the best response? A. only when you are lying flat, either resting or sleeping B. for 1 hour a day when you bathe, shower, or go swimming C. only for special occasions, such as a party D. for 3 hours a day: one in the morning, one in the afternoon, and one in the evening Situation: Erin’s admission to the hospital for spinal fusion was necessary because hr scoliosis did not respond to the Milwaukee brace.
  17. Preoperative preparation for Erin includes explaining that for 2 weeks after surgery she will be positioned A. on either side or prone B. sitting upright

D. there is an increase in the knee-jerk reflex Situation: After a week of bed rest at home, Ms. C’s condition remains about the same. She is admitted to the hospital for further treatment and diagnostic tests.

  1. Phenylbutazone (Butazolidin) is ordered for Ms. C. Planning for the administration of this medication should include directions to A. administer it immediately before or after eating B. avoid administering it with dairy products C. administer it at least 2 hours after eating D. administer it at specific time intervals, without regard to meals
  2. In addition to the order for phenylbutazone, Ms. C is placed on bed rest and in pelvic traction. To diminish adverse responses to this treatment, the nurse should request an order for A. acetylsalicylic acid (aspirin) B. diphenoxylate hydrochloride (Lomotil) C. prochlorpeazine (Compazine) D. dioctyl sodium sulosuccinate (Colace)
  3. A myelogram is performed on Mrs. C with a water-soluble contrast medium. Care after this procedure should include A. limiting fluid intake and elevating the head of the bed to 15 to 30 degrees B. not allowing anything by mouth and keeping the bed flat C. encouraging fluid intake and keeping the bed flat D. encouraging fluid intake and raising the head of the bed to 15 to 30 degrees
  4. Ms. C has a laminectomy. Postoperatively, she complains that the pain is no different now than it was before surgery. The nurse should A. administer analgesics as ordered, and explain that the pain is to be expected because of the edema that results from the surgery B. administer the analgesics as ordered, but request that the physician check the patient immediately C. withhold the analgesic and notify the physician D. administer the analgesics as ordered, and tell Ms. C it will give her relief shortly
  5. Rehabilitation will be facilitated if Ms. C is encouraged to do which of the following? A. sleep in prone position B. sit up for at least part of he day C. perform abdominal-strengthening exercise D. perform full trunk range-of-motion exercises Situation: Martha S is a 27-year old patient who has experienced increasing generalized stiffness, especially in the morning, fatigue, general malaise, and swelling and pain in the finger joints. She has a tentative diagnosis of rheumatoid arthritis.
  6. Upon admission, Mrs. S is noted to have a rectal temperature of 37.7ºC (100ºF). A white blood count is ordered, and the report comes back at 8,500/mm³. The nurse should recognize this as being consistent with rheumatoid arthritis because it is A. within normal limits B. evidence of leukopenia C. only slightly elevated D. indicative of a generalized infectious process
  7. Which of the following blood-analysis tests would be consistent with diagnosis of rheumatoid arthritis? A. an elevated erythrocyte sedimentation rate and negative C- reactive protein B. an elevated erythrocyte sedimentation rate and positive C- reactive protein C. a low erythrocyte sedimentation rate and negative C-reactive protein D. a low erythrocyte sedimentation rate and positive C-reactive protein
  8. The primary goal of nursing care for Mrs. S during this initial acute phase of rheumatoid arthritis should be to A. prevent deformity and reduce inflammation B. prevent the spread of the inflammation to other joints C. provide for comfort and relief of pain D. assist her to accept the fact that rheumatoid arthritis is a log- term illness
  9. During hospitalization, the nurse should explain to Mrs. Samuel that analgesics of choice would be A. codeine B. acetylsalicylic acid (aspirin) C. acetaminophen (Tylenol) D. proppoxyphene hydrochloride (Darvon)
  10. During the acute phase of Mrs. S’s illness, which of the following measures would be the most appropriate? A. frequent periods of active exercises B. frequent periods of bed rest C. rest for he affected joints only D. encouragement to perform activities of daily living independently
  11. The nurse understands that the main nursing goal in helping Mrs. S adapt to her chronic illness and plan is to A. provide the care she is unable to give herself B. provide guidance so that she will not repress her illness C. plan for social contacts so that she will not feel alone D. arrange for her after-care with the home health aide
  12. Mrs. S is given instructions for using paraffin for her hands. The nurse should include the fact that the dips will be most effective if they are performed A. before exercising her hands B. after exercising her hands C. instead of exercising her fingers D. while exercising her fingers
  13. Whenever Mrs. S feels pain from her arthritis, she tells the nurse she feels not only the pain but that her “whole body feels threatened.” Which response by the nurse is the most therapeutic? A. I will have someone stay with you so you won’t harm yourself B. I will teach you some relaxing exercises so you won’t be so tense C. you must have some medication to help you gain control D. arthritic pain will lessen if you try to grin and bear it
  14. When Mrs. S is discharged, she is instructed to take aspirin at home. It is important that she be told to take the drug A. on a regular basis throughout the day B. only when other measures are not effective C. upon arising and again at bedtime D. between meals to promote its absorption
  15. When Mrs. S is discharged, the nursing staff refers her to a nurse therapist who will assist her in dealing with the anxiety over her arthritis and the changes it has made in her life. The nursing team recognizes that the role of the nurse therapist is to A. work in conjunction with a psychiatrist B. provide individual nursing psychotherapy C. lead groups in therapy for those with similar problems D. give family nursing psychotherapy Situation: Twenty years after Mrs. S was first diagnosed with rheumatoid arthritis, she is admitted for a right total hip replacement. She has experienced severe right hip pain that has not responded to treatment for several years, and has had increasing difficulty moving about because of damage to the right hip joint.
  16. Preoperative teaching for Mrs. S should include A. isometric exercises of the quadriceps and gluteal muscles B. instructions on the necessity for keeping the right leg perfectly straight after surgery C. the need to flex the involved hip postoperatively to maintain mobility D. the avoidance of aspirin for 4 days prior to surgery
  17. Which of the following should the nurse consider to be most significant if noted when checking Mrs. S 3 days postoperatively? A. pain in the operative site B. swelling of the operative sites C. pain and tenderness in the calf D. orthostatic hypotension
  1. The physical therapist orders exercises of Mrs. S’s right hip, knee, and foot to gradually increase range of motion to the right hip. The nurse can best assist Mrs. S by A. administering an analgesic before the exercises B. stopping the exercises if Mrs. S experiences pain C. performing the exercises for Mrs. S D. observing Mrs. S’s ability to perform the exercises
  2. Mrs. S should be instructed to avoid A. adduction of her right leg B. abduction of hr right leg C. bearing any weight on her right leg D. the prone position in bed
  3. The nurse and Mrs. S plan for her rehabilitation. Mrs. S asks the nurse, “What do I have to do in therapy?” Which reply by the nurse most accurately describes the task of the patient in rehabilitation? To A. follow the instructions of the rehabilitation team B. regain some function that was lost C. prevent further loss of your ability to function D. learn to deal realistically with your disability
  4. When the rehabilitation therapist tells Mrs. S that the outcome of her therapy depends on “the ability of the nursing staff” as well as on her motivation, Mrs. S questions the nurse on the meaning of this phrase. The nurse should reply that “the nurse’s role in rehabilitation is to A. make the patient as comfortable as possible B. follow the directions of the rehabilitation therapist C. supervise the patient’s therapy appointments and exercise program D. assist the patient in establishing therapy priorities and goals
  5. Mrs. S asks the nurse if her new joint will function normally. The nurse can best answer this by saying that A. the new joint will be stronger than the old one B. the new joint won’t function as well as a normal joint, but it will be better than the arthritic joint C. the new joint will function almost as well as a normal joint, particularly if you perform your exercise faithfully D. the doctor will be able to assess your limitations in 6 weeks and then explain them to you Situation: Mr. Lee is a 20-year-old patient who sustains a compound fracture of the right shaft of the femur and a simple fracture of the ulna in a motorcycle accident.
  6. While serving as a member of a first aid squad, Mary V, RN, reaches the scene of the motorcycle accident and administers emergency treatment, which includes the application of a splint. It is important that the splint A. be applied while the limb is in good alignment B. be applied to the limb in the position in which it is found C. extend from the fracture site downward D. extend from the fracture site upward
  7. While Mr. Lee is being transported in the ambulance to the hospital, he should be positioned with the affected limbs A. elevated B. in a flat position C. lower than his heart D. slightly abducted
  8. While taking a history from the patient, the nurse determines that his last booster injection for tetanus immunization was 5 years ago. The nurse should recognize that this information is important because it means that he should receive A. a full tetanus immunization program B. nothing, because he is sufficiently immunized against tetanus C. an additional booster injection D. human tetanus immune globulin Situation: Mr. Lee is taken to the operating room and the wound caused by the fracture of the femur is cleansed and debrided. The fracture is then reduced, and a Steinmann pin for skeletal traction is inserted. A closed reduction of the ulna is performed, and a cast is applied.
    1. The most important nursing measure in the immediate postoperative period will be A. encouragement of isometric exercises B. cleansing of the area around the Steinmann pin C. careful observation of vital signs D. massage of pressure areas
    2. After Mr. Lee returns to his room, he complains of pain in his right arm. The initial action of the nurse should be to A. administer analgesics as ordered B. check his fingers C. notify his physician immediately D. pad the edges of the cast
    3. To maintain proper alignment and immobilization of the femur, the physician has ordered skeletal traction with a Thomas splint. While caring for Mr. Lee, the nurse should explain to him that he A. cannot turn or sit up B. cannot turn but can sit up C. can turn but cannot sit up D. can turn and can sit up
    4. In dealing with the weights that are applying the traction, the nurse should A. allow them to hang freely in place B. hold them up if the patient is shifting position in bed C. remove them if the patient is being moved up in bed D. lighten them for short periods if the patient complains of pain
    5. Mr. Lee has a Thomas knee splint in place. In addition to the usual measures for a patient in traction, it will be important that the nurse observe A. the groin area for pressure B. for constipation C. his skin for sings of decubiti D. for signs of hypostatic pneumonia
    6. If Mr. Lee should show an increase in blood pressure and signs of confusion and increased restlessness, the nurse should suspect A. a concussion B. impending shock C. fat emboli D. anxiety
    7. Because of the nature of Mr. Lee’s wound and the insertion of a Steinmann pin, it is especially important that the nurse observe for A. a foul odor B. foot drop C. pulmonary congestion D. fecal impaction
    8. Mr. Lee develops an acute localized osteomyelitis. He is placed on intravenous antibiotic therapy. The wound is incised and drained, and neomycin irrigations are ordered four times a day. It is important that these irrigations be performed A. with strict aseptic techniques B. with a warm solution C. for at least 5 minutes D. at equal time intervals Situation: Maria Alfredo is a 30-year old married woman who has systemic lupus erythematosus (SLE).
    9. While doing as nursing history on Mrs. Alfredo, the nurse should recognize that the most common initial symptoms of SLE are A. petechiae in the skin, nosebleeds, and pallor B. hematuria, increased blood pressure, and edema C. tachycardia, tremors, and loss of weight D. painful muscles and joints, stiffness, and inflammation of joints
    10. Mrs. Afredo is instituted on long-term prednisone therapy. Her daily maintenance dose is 5 mg/day. In the instructions to Mrs. Alfredo, the nurse should emphasize that A. once the symptoms of SLE subside, the medication will be discontinued gradually