Medical Surgical Nursing Test II (practice)- Www.rnpedia.com

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  • 1. 
    After a cerebrovascular accident, a 75 yr old client is admitted to the health care facility. The client has left-sided weakness and an absent gag reflex. He’s incontinent and has a tarry stool. His blood pressure is 90/50 mm Hg, and his hemoglobin is 10 g/dl. Which of the following is a priority for this client?
    • A. 

      Checking stools for occult blood

    • B. 

      Performing range-of-motion exercises to the left side

    • C. 

      Keeping skin clean and dry

    • D. 

      Elevating the head of the bed to 30 degrees


  • 2. 
    The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin holes in the drainage bag to help relieve gas. The nurse should teach him that this action:
    • A. 

      Destroys the odor-proof seal

    • B. 

      Wont affect the colostomy system

    • C. 

      Is appropriate for relieving the gas in a colostomy system

    • D. 

      Destroys the moisture barrier seal


  • 3. 
    When assessing the client with celiac disease, the nurse can expect to find which of the following?
    • A. 

      Steatorrhea

    • B. 

      Jaundiced sclerae

    • C. 

      Clay-colored stools

    • D. 

      Widened pulse pressure


  • 4. 
    A client is hospitalized with a diagnosis of chronic glomerulonephritis. The client mentions that she likes salty foods. The nurse should warn her to avoid foods containing sodium because:
    • A. 

      Reducing sodium promotes urea nitrogen excretion

    • B. 

      Reducing sodium improves her glomerular filtration rate

    • C. 

      Reducing sodium increases potassium absorption

    • D. 

      Reducing sodium decreases edema


  • 5. 
    The nurse is assessing a postcraniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour. The nurse should suspect:
    • A. 

      Cushing’s syndrome

    • B. 

      Diabetes mellitus

    • C. 

      Adrenal crisis

    • D. 

      Diabetes insipidus


  • 6. 
    The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
    • A. 

      Limit oral fluid intake for 1 to 2 weeks

    • B. 

      Report the presence of fine, sandlike particles through the nephrostomy tube.

    • C. 

      Notify the physician about cloudy or foul smelling urine

    • D. 

      Report bright pink urine within 24 hours after the procedure


  • 7. 
    A client with a serum glucose level of 618 mg/dl is admitted to the facility. He’s awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6º F (38.1º C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes the highest priority?
    • A. 

      Deficient fluid volume related to osmotic diuresis

    • B. 

      Decreased cardiac output related to elevated heart rate

    • C. 

      Imbalanced nutrition: Less than body requirements related to insulin deficiency

    • D. 

      Ineffective thermoregulation related to dehydration


  • 8. 
    Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Thenurse should expect the dose’s:
    • A. 

      Onset to be at 2 p.m. and its peak at 3 p.m.

    • B. 

      Onset to be at 2:15 p.m. and its peak at 3 p.m.

    • C. 

      Onset to be at 2:30 p.m. and its peak at 4 p.m.

    • D. 

      Onset to be at 4 p.m. and its peak at 6 p.m.


  • 9. 
    A client with a head injury is being monitored for increased intracranial pressure (ICP). His blood pressure is 90/60 mmHG and the ICP is 18 mmHg; therefore his cerebral perfusion pressure (CPP) is:
    • A. 

      52 mm Hg

    • B. 

      88 mm Hg

    • C. 

      48 mm Hg

    • D. 

      68 mm Hg


  • 10. 
    A 52 yr-old female tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client’s lump is cancerous?
    • A. 

      Eversion of the right nipple and a mobile mass

    • B. 

      Nonmobile mass with irregular edges

    • C. 

      Mobile mass that is oft and easily delineated

    • D. 

      Nonpalpable right axillary lymph nodes


  • 11. 
    A Client is scheduled to have a descending colostomy. He’s very anxious and has many questions regarding the surgical procedure, care of stoma, and lifestyle changes. It would be most appropriate for the nurse to make a referral to which member of the health care team?
    • A. 

      Social worker

    • B. 

      Registered dietician

    • C. 

      Occupational therapist

    • D. 

      Enterostomal nurse therapist


  • 12. 
    Ottorrhea and rhinorrhea are most commonly seen with which type of skull fracture?
    • A. 

      Basilar

    • B. 

      Temporal

    • C. 

      Occipital

    • D. 

      Parietal


  • 13. 
    A male client should be taught about testicular examinations:
    • A. 

      When sexual activity starts

    • B. 

      After age 60

    • C. 

      After age 40

    • D. 

      Before age 20


  • 14. 
    Before weaning a client from a ventilator, which assessment parameter is most important for the nurse to review?
    • A. 

      Fluid intake for the last 24 hours

    • B. 

      Baseline arterial blood gas (ABG) levels

    • C. 

      Prior outcomes of weaning

    • D. 

      Electrocardiogram (ECG) results


  • 15. 
    The nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (ACS) guidelines, the nurse should recommend that the women:
    • A. 

      Perform breast self-examination annually

    • B. 

      Have a mammogram annually

    • C. 

      Have a hormonal receptor assay annually

    • D. 

      Have a physician conduct a clinical evaluation every 2 years


  • 16. 
    When caring for a client with esophageal varices, the nurse knows that bleeding in this disorder usually stems from:
    • A. 

      Esophageal perforation

    • B. 

      Pulmonary hypertension

    • C. 

      Portal hypertension

    • D. 

      Peptic ulcers


  • 17. 
    A 49-yer-old client was admitted for surgical repair of a Colles’ fracture. An external fixator was placed during surgery. The surgeon explains that this method of repair:
    • A. 

      Has very low complication rate

    • B. 

      Maintains reduction and overall hand function

    • C. 

      Is less bothersome than a cast

    • D. 

      Is best for older people


  • 18. 
    A client is hospitalized with a diagnosis of chronic renal failure. An arteriovenous fistula was created in his left arm for hemodialysis. When preparing the client for discharge, the nurse should reinforce which dietary instruction?
    • A. 

      “Be sure to eat meat at every meal.”

    • B. 

      “Monitor your fruit intake and eat plenty of bananas.”

    • C. 

      “Restrict your salt intake.”

    • D. 

      “Drink plenty of fluids.”


  • 19. 
    The nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She’s in her 30s and has tow children. Although she’s worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to supporther coping?
    • A. 

      Tell the client’s spouse or partner to be supportive while she recovers.

    • B. 

      Encourage the client to proceed with the next phase of treatment.

    • C. 

      Recommend that the client remain cheerful for the sake of her children.

    • D. 

      Refer the client to the American Cancer Society’s Reach for Recovery program or another support program.


  • 20. 
    A 21 year-old male has been seen in the clinic for a thickening in his right testicle. The physician ordered a human chorionic gonadotropin (HCG) level. The nurse’s explanation to the client should include the fact that:
    • A. 

      The test will evaluate prostatic function.

    • B. 

      The test was ordered to identify the site of a possible infection.

    • C. 

      The test was ordered because clients who have testicular cancer has elevated levels of HCG.

    • D. 

      The test was ordered to evaluate the testosterone level.


  • 21. 
    A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals:
    • A. 

      A skin rash.

    • B. 

      Peripheral edema.

    • C. 

      A dry cough.

    • D. 

      Postural hypotension.


  • 22. 
    Which assessment finding indicates dehydration?
    • A. 

      Tenting of chest skin when pinched.

    • B. 

      Rapid filling of hand veins.

    • C. 

      A pulse that isn’t easily obliterated.

    • D. 

      Neck vein distention


  • 23. 
    The nurse is teaching a client with a history of atherosclerosis. To decrease the risk of atherosclerosis, the nurse should encourage the client to:
    • A. 

      Avoid focusing on his weight.

    • B. 

      Increase his activity level.

    • C. 

      Follow a regular diet.

    • D. 

      Continue leading a high-stress lifestyle.


  • 24. 
    For a client newly diagnosed with radiationinduced thrombocytopenia, the nurse should include which intervention in the plan of care?
    • A. 

      Administer aspirin if the temperature exceeds 38.8º C.

    • B. 

      Inspect the skin for petechiae once every shift.

    • C. 

      Provide for frequent periods of rest.

    • D. 

      Place the client in strict isolation.


  • 25. 
    A client is chronically short of breath and yet has normal lung ventilation, clear lungs, and an arterial oxygen saturation (SaO2) 96% or better. The client most likely has:
    • A. 

      Poor peripheral perfusion

    • B. 

      A possible Hematologic problem

    • C. 

      A psychosomatic disorder

    • D. 

      Left-sided heart failure


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