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.
B.
C.
D.
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.
B.
C.
D.
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3.  When assessing the client with celiac disease, the nurse can expect to find which of the following?
A.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
12.  Ottorrhea and rhinorrhea are most commonly seen with which type of skull fracture?
A.
B.
C.
D.
13.  A male client should be taught about testicular examinations:
A.
B.
C.
D.
14.  Before weaning a client from a ventilator, which assessment parameter is most important for the nurse to review?
A.
B.
C.
D.
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.
B.
C.
D.
16.  When caring for a client with esophageal varices, the nurse knows that bleeding in this disorder usually stems from:
A.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
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.
B.
C.
D.
22.  Which assessment finding indicates dehydration?
A.
B.
C.
D.
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.
B.
C.
D.
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24.  For a client newly diagnosed with radiationinduced thrombocytopenia, the nurse should include which intervention in the plan of care?
A.
B.
C.
D.
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.
B.
C.
D.
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