201 Nursezone Medical-surgical Nursing Final Coaching Part 2 (26 To 50)

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  • 1/25 Questions

    SITUATION: A 70 year old woman and her husband came to a clinic. The woman reveals a 10 year history of ear infection. She is experiencing sensorineural hearing loss. During her clinic appointment, she tells the nurse that her right ear is painful and is keeping her awake at night. She explains that she can hear most sounds, although sounds on the right side seem to be coming through a filter   Her husband is diagnosed with Meniere’s Disease and complains of vertigo. Which instruction would the nurse give to the client to assist him in controlling the vertigo?

    • Watch the television at a 12 feet distance
    • Decrease carbohydrates in diet
    • Increase sodium in diet
    • Avoid sudden head movements
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About This Quiz

This quiz assesses advanced nursing skills in medical-surgical contexts, focusing on patient scenarios involving tuberculosis management and emergency procedures. It is designed for nurses preparing for the NCLEX and tests practical knowledge and application in real-world medical situations.

Medical Surgical Nursing Quizzes & Trivia

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  • 2. 

    SITUATION: In preventing readmission in patients with heart failure, nurses make sure that clients know about each medication they will be taking and help clients create a schedule for them to follow at home   An older client comes to the community clinic. Furosemide (Lasix) is prescribed for the client. The nurse teaches the client about the medication. Which of the following statements, if made by the client, indicates need for further teaching?

    • “I need to drink lots of coffee and tea to keep myself healthy”

    • “If my ankles swell or my rings get tight I will call my doctor”

    • “I will sit up slowly before standing each morning”

    • “I will take my medication every morning with meals”

    Correct Answer
    A. “I need to drink lots of coffee and tea to keep myself healthy”
    Explanation
    The statement "I need to drink lots of coffee and tea to keep myself healthy" indicates a need for further teaching because caffeine found in coffee and tea can increase fluid loss and may worsen the symptoms of heart failure. Patients with heart failure are usually advised to limit their caffeine intake.

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  • 3. 

    SITUATION: In preventing readmission in patients with heart failure, nurses make sure that clients know about each medication they will be taking and help clients create a schedule for them to follow at home   Mr. Rivera arrives in the emergency room after complaining of unrelieved chest pain for 2 days. The pain has subsided slightly but never disappeared, when the nurse approaches the client with a 0.4 mg nitroglycerin sublingual tablet, the client states “I don’t need that, there is nothing wrong with my heart.” The nurse interprets that the client is exhibiting which type of reaction?

    • Anger

    • Phobia

    • Denial

    • Depression

    Correct Answer
    A. Denial
    Explanation
    The client's statement of "I don't need that, there is nothing wrong with my heart" indicates that they are in denial about their heart condition. Denial is a defense mechanism where individuals refuse to accept or acknowledge a reality that causes them distress or anxiety. In this case, the client is denying the possibility of having a heart problem despite experiencing chest pain for 2 days.

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  • 4. 

    SITUATION: An unconscious, 46 year old Muslim, is admitted to the emergency room. He is not breathing and no pulse is appreciated. Treatments were started and arterial blood gas measurements were made   Airway was established through an endotracheal tube to the unconscious client. During the suctioning procedure, the nurse notes on the monitor that the heart rate decreases. Which is the initial nursing intervention?

    • Notify the doctor immediately

    • Stop the procedure and re-oxygenate the client

    • Continue to suction

    • Make sure that the suction is limited to 10 seconds

    Correct Answer
    A. Stop the procedure and re-oxygenate the client
    Explanation
    The initial nursing intervention should be to stop the procedure and re-oxygenate the client. The nurse noticed that the heart rate decreased during the suctioning procedure, which could indicate a decrease in oxygenation to the client. Stopping the procedure and providing oxygen will help ensure that the client receives adequate oxygen and prevent further complications.

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  • 5. 

    SITUATION: In preventing readmission in patients with heart failure, nurses make sure that clients know about each medication they will be taking and help clients create a schedule for them to follow at home   A patient being discharged is taking warfarin sodium (Coumadin) and the nurse tells the client her discharge instructions. Which statement, if made by the client, reflects the need for further teaching?

    • “Starting today I’ll have to limit my alcohol intake”

    • “I will take my pills at the same time each day”

    • “I will always use my Medic-alert bracelet”

    • “I will take an enteric coated aspirin for my headache”

    Correct Answer
    A. “I will take an enteric coated aspirin for my headache”
    Explanation
    The need for further teaching is reflected in the statement "I will take an enteric coated aspirin for my headache." This statement indicates a lack of understanding because warfarin sodium (Coumadin) is an anticoagulant, and taking aspirin along with it can increase the risk of bleeding. Therefore, the client should be educated that it is not safe to take aspirin without consulting their healthcare provider while on warfarin.

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  • 6. 

    SITUATION: A 70 year old male client came into the outpatient department with complaints of fatigue, productive cough, and chest pains. Further assessment of this client was done in the department   Further assessment is done to this client and tuberculosis is suspected. The nurse reviews the results of which diagnostic test that will confirm this diagnosis?

    • Bronchoscopy

    • Chest x-ray film

    • Sputum culture

    • Tuberculin syringe test

    Correct Answer
    A. Sputum culture
    Explanation
    The nurse would review the results of a sputum culture to confirm the diagnosis of tuberculosis. A sputum culture involves collecting a sample of the client's sputum (phlegm) and testing it in a laboratory to determine if the tuberculosis bacteria is present. This test is considered the gold standard for diagnosing tuberculosis as it can provide a definitive confirmation of the infection. Bronchoscopy is a procedure that allows visualization of the airways and collection of samples, but it may not always detect tuberculosis. A chest x-ray can show abnormalities in the lungs, but it cannot confirm the presence of tuberculosis bacteria. The tuberculin syringe test, also known as the Mantoux test, is a screening tool for tuberculosis but it cannot confirm the diagnosis on its own.

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  • 7. 

    SITUATION: An unconscious, 46 year old Muslim, is admitted to the emergency room. He is not breathing and no pulse is appreciated. Treatments were started and arterial blood gas measurements were made   If the arterial blood gas measurements reveal a pH 7.25, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level, what does it denote?

    • Compensated Respiratory acidosis

    • Metabolic acidosis

    • Overcompensated respiratory acidosis

    • Metabolic alkalosis

    Correct Answer
    A. Metabolic acidosis
    Explanation
    The given arterial blood gas measurements indicate metabolic acidosis. A pH of 7.25 suggests acidosis, while a low bicarbonate level further supports the diagnosis of metabolic acidosis. The normal carbon dioxide level rules out respiratory acidosis as the primary cause. The normal oxygen level indicates that there is no respiratory compromise. The elevated potassium level may be a compensatory response to the acidosis. Overall, these findings are consistent with metabolic acidosis.

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  • 8. 

    SITUATION: An unconscious, 46 year old Muslim, is admitted to the emergency room. He is not breathing and no pulse is appreciated. Treatments were started and arterial blood gas measurements were made   The intubated, still unconscious client suddenly presents with a ventricular tachycardia. The medical team tried to return a normal heart rhythm but failed. Cardiac arrest then followed. Upon the death of the client, the nurse does which appropriate action?

    • Talk to the family about organ donation

    • Encourage the family to perform an autopsy

    • Give the family some time alone with their dead relative

    • Discuss with the family the death of their loved one

    Correct Answer
    A. Give the family some time alone with their dead relative
    Explanation
    Giving the family some time alone with their dead relative is the appropriate action for the nurse to take upon the death of the client. This allows the family to grieve and say their final goodbyes in privacy and according to their cultural or religious customs. It respects the family's need for emotional support and privacy during this difficult time.

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  • 9. 

    SITUATION: Mrs. Polka, a 62 year old housewife who cares for her two grandchildren, is admitted to the emergency department with complaints of chest pain. She is diaphoretic and pale and reports pain “under my left breast that pushes to my back.” She rates the pain an 8 on a scale of 1 to 10. She is placed on oxygen therapy and an IV line is inserted. Cardiac serum markers are drawn and sent to the laboratory. Her vital signs are temperature: 36.9°C, heart rate: 110 bpm, and BP: 108/68   Mrs. Polka has a 12-lead ECG taken during her stay in the ER. The nurse examines the tracing for which ECG change caused my myocardial ischemia:

    • Depressed ST segment

    • U wave

    • Prolonged PR interval

    • Widened QRS complex

    Correct Answer
    A. Depressed ST segment
    Explanation
    The correct answer is "Depressed ST segment." In myocardial ischemia, there is a lack of blood flow to the heart muscle, which can cause changes in the ECG. One of these changes is a depressed ST segment, which indicates that there is a disruption in the electrical activity of the heart. This can be a sign of an impending heart attack or myocardial infarction. It is important to recognize this ECG change in order to initiate appropriate interventions and prevent further damage to the heart.

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  • 10. 

    SITUATION: A 70 year old woman and her husband came to a clinic. The woman reveals a 10 year history of ear infection. She is experiencing sensorineural hearing loss. During her clinic appointment, she tells the nurse that her right ear is painful and is keeping her awake at night. She explains that she can hear most sounds, although sounds on the right side seem to be coming through a filter   The nurse plans care for this patient and formulates a diagnosis. Which diagnosis will be the priority?

    • Impaired verbal communication related to decreased hearing

    • Impaired social interaction related to perceive inability to interact with others

    • Ineffective individual coping related to loss of hearing

    • Pain related to inflammation in the middle ear

    Correct Answer
    A. Pain related to inflammation in the middle ear
    Explanation
    The priority diagnosis for this patient would be "Pain related to inflammation in the middle ear." This is because the patient is experiencing pain in her right ear that is keeping her awake at night. Addressing the pain and inflammation in the middle ear would be the first step in providing relief and improving the patient's quality of life.

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  • 11. 

    SITUATION: Mrs. Polka, a 62 year old housewife who cares for her two grandchildren, is admitted to the emergency department with complaints of chest pain. She is diaphoretic and pale and reports pain “under my left breast that pushes to my back.” She rates the pain an 8 on a scale of 1 to 10. She is placed on oxygen therapy and an IV line is inserted. Cardiac serum markers are drawn and sent to the laboratory. Her vital signs are temperature: 36.9°C, heart rate: 110 bpm, and BP: 108/68   Two days has passed after the admission and the client with MI developed a bilateral 2+ edema in her lower extremities. The nurse would plan to do which of the following next?

    • The diuretic medication administration should be changed from morning to evening

    • Monitor daily weights starting on the following morning

    • Request a sodium restriction of 3 grams/day from the doctor

    • Review the intake and output records for the last two days

    Correct Answer
    A. Review the intake and output records for the last two days
    Explanation
    The development of bilateral 2+ edema in the client's lower extremities suggests fluid retention, which could be a sign of worsening heart failure. Reviewing the intake and output records for the last two days would help the nurse assess the client's fluid balance and determine if there has been an increase in fluid intake or a decrease in urine output. This information would be important in guiding further interventions and determining the appropriate course of action.

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  • 12. 

    SITUATION: Mrs. Polka, a 62 year old housewife who cares for her two grandchildren, is admitted to the emergency department with complaints of chest pain. She is diaphoretic and pale and reports pain “under my left breast that pushes to my back.” She rates the pain an 8 on a scale of 1 to 10. She is placed on oxygen therapy and an IV line is inserted. Cardiac serum markers are drawn and sent to the laboratory. Her vital signs are temperature: 36.9°C, heart rate: 110 bpm, and BP: 108/68   Mrs. Polka has been transferred from a coronary care unit to a general medical unit with cardiac monitoring. A nurse plans to allow for which of the following client activities?

    • Complete bed rest for 24 hours

    • Bathroom privileges and self-care activities

    • Unsupervised hallway ambulation with distances under 200 feet

    • Any activity because the client is supervised

    Correct Answer
    A. Bathroom privileges and self-care activities
    Explanation
    The correct answer is "Bathroom privileges and self-care activities." This is because Mrs. Polka has been transferred from a coronary care unit to a general medical unit with cardiac monitoring, indicating that her condition has stabilized. Allowing her to have bathroom privileges and engage in self-care activities is important for promoting her independence and maintaining her overall well-being. It is also a sign that she is not required to be on complete bed rest and can safely perform these activities without compromising her health.

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  • 13. 

    SITUATION: Mrs. Polka, a 62 year old housewife who cares for her two grandchildren, is admitted to the emergency department with complaints of chest pain. She is diaphoretic and pale and reports pain “under my left breast that pushes to my back.” She rates the pain an 8 on a scale of 1 to 10. She is placed on oxygen therapy and an IV line is inserted. Cardiac serum markers are drawn and sent to the laboratory. Her vital signs are temperature: 36.9°C, heart rate: 110 bpm, and BP: 108/68   The RN in the coronary unit is planning assignments for the clients on the nursing unit. The RN needs to assign four clients and has a licensed practical nurse (LPN) and three nursing assistants on a nursing team. Which of the following clients would the nurse most appropriately assign to one of nursing assistants?

    • Range-of-motion exercises in the morning

    • Dressing change in a post-op client

    • Instructing a client how to walk using a crutch

    • Doing urinary catheterization on a client

    Correct Answer
    A. Range-of-motion exercises in the morning
    Explanation
    The nurse would most appropriately assign the task of range-of-motion exercises in the morning to one of the nursing assistants. This task does not require advanced nursing skills and can be safely performed by a nursing assistant under the supervision of the RN. The LPN and the RN can be assigned to tasks that require higher levels of nursing knowledge and expertise, such as the dressing change in a post-op client or instructing a client how to walk using a crutch. Doing urinary catheterization on a client is a task that should be performed by a nurse, not a nursing assistant.

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  • 14. 

    SITUATION: A 70 year old male client came into the outpatient department with complaints of fatigue, productive cough, and chest pains. Further assessment of this client was done in the department   Nurse Dina is preparing to obtain a sputum specimen from the client. Which of the following interventions will aid in obtaining the specimen?

    • Restricting fluids

    • Having the client take three deep breaths

    • Asking the client to spit directly into the specimen container

    • Asking the client to obtain the specimen after eating

    Correct Answer
    A. Having the client take three deep breaths
    Explanation
    Taking three deep breaths can aid in obtaining a sputum specimen because it helps to mobilize secretions in the lungs and promote coughing. This can make it easier for the client to produce a sputum sample for testing. Restricting fluids is not necessary for obtaining a sputum specimen. Asking the client to spit directly into the specimen container is not recommended as it can lead to contamination. Asking the client to obtain the specimen after eating is also not recommended as it can interfere with the quality of the sample.

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  • 15. 

    SITUATION: In preventing readmission in patients with heart failure, nurses make sure that clients know about each medication they will be taking and help clients create a schedule for them to follow at home   Propanolol hydrochloride (inderal) has been prescribed to a client being discharged. In developing a medication teaching plan, a nurse would include which of the following instructions?

    • Medication should be withheld if the pulse rate drops below 60 bpm

    • Sauna is preferable for this client

    • Exercise will prevent orthostatic hypotension

    • Medication should be taken before meals to enhance absorption

    Correct Answer
    A. Medication should be withheld if the pulse rate drops below 60 bpm
    Explanation
    The nurse would include the instruction to withhold the medication if the pulse rate drops below 60 bpm because propanolol hydrochloride (inderal) is a beta blocker medication that can lower heart rate. If the pulse rate drops below 60 bpm, it may indicate that the medication is causing bradycardia, which can be a potential side effect. Therefore, it is important to monitor the client's pulse rate and withhold the medication if it drops below 60 bpm to prevent further complications.

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  • 16. 

    SITUATION: An unconscious, 46 year old Muslim, is admitted to the emergency room. He is not breathing and no pulse is appreciated. Treatments were started and arterial blood gas measurements were made   The nurse in the emergency room is performing cardiopulmonary resuscitation (CPR) on the client. When the nurse performs chest compressions, the nurse understands that correct hand placement is located over the:

    • Lower half of the sternum

    • Upper third of the sternum

    • Upper half of the sternum

    • Lower third of the sternum

    Correct Answer
    A. Lower half of the sternum
    Explanation
    The correct hand placement during chest compressions in CPR is located over the lower half of the sternum. This is because compressions need to be performed on the lower part of the sternum in order to effectively pump blood and circulate oxygen to the vital organs. Placing the hands too high or too low on the sternum may not provide enough pressure or may cause damage to the ribs or other structures. Therefore, the nurse must ensure that the hands are positioned correctly to maximize the effectiveness of the chest compressions.

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  • 17. 

    SITUATION: Mrs. Polka, a 62 year old housewife who cares for her two grandchildren, is admitted to the emergency department with complaints of chest pain. She is diaphoretic and pale and reports pain “under my left breast that pushes to my back.” She rates the pain an 8 on a scale of 1 to 10. She is placed on oxygen therapy and an IV line is inserted. Cardiac serum markers are drawn and sent to the laboratory. Her vital signs are temperature: 36.9°C, heart rate: 110 bpm, and BP: 108/68   Dysrhythmias are a common complication of myocardial infarction (MI). The client has developed atrial fibrillation with a ventricular rate of 150 bpm. The nurse assesses the client for:

    • Nausea and vomiting

    • Flat neck veins

    • Hypotension and dizziness

    • Hypertension and headache

    Correct Answer
    A. Hypotension and dizziness
    Explanation
    The correct answer is hypotension and dizziness because atrial fibrillation can lead to a decrease in cardiac output, resulting in decreased blood pressure and symptoms of dizziness.

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  • 18. 

    SITUATION: An unconscious, 46 year old Muslim, is admitted to the emergency room. He is not breathing and no pulse is appreciated. Treatments were started and arterial blood gas measurements were made   Nurse Freddie reviews the arterial blood gas values of the client. The results indicate respiratory acidosis. Which of the following values would indicate that this acid-base imbalance exists?

    • HCO3 of 22 mEq/L

    • PCO2 of 30 mmHg

    • PH of 7.50

    • PH of 7.25

    Correct Answer
    A. pH of 7.25
    Explanation
    A pH of 7.25 would indicate respiratory acidosis. Respiratory acidosis occurs when there is an excess of carbon dioxide in the blood, leading to a decrease in pH. A pH of 7.25 is lower than the normal range of 7.35-7.45, indicating acidosis. The other values listed (HCO3 of 22 mEq/L and PCO2 of 30 mmHg) are within the normal range and do not indicate an acid-base imbalance.

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  • 19. 

    SITUATION: A 70 year old male client came into the outpatient department with complaints of fatigue, productive cough, and chest pains. Further assessment of this client was done in the department   Isoniazid (INH) and Rifampicin (Rifadin) have been prescribed for this client. Which of the following, if noted by the nurse in the client’s history would require doctor’s notification?

    • Hepatitis B

    • Meningitis

    • Allergy to penicillin

    • Diabetes mellitus

    Correct Answer
    A. Hepatitis B
    Explanation
    If the nurse notes that the client has a history of Hepatitis B, it would require the doctor's notification because Isoniazid (INH) and Rifampicin (Rifadin) can potentially cause hepatotoxicity and worsen the condition of the client's liver. Therefore, it is important for the doctor to be aware of the client's Hepatitis B status and monitor liver function closely during the course of treatment.

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  • 20. 

    SITUATION: A 70 year old male client came into the outpatient department with complaints of fatigue, productive cough, and chest pains. Further assessment of this client was done in the department   Nurse Diana is teaching a client with tuberculosis about dietary elements that should be increased in the diet. The nurse suggest that the client increase intake of:

    • Potatoes and fish

    • Eggs and spinach

    • Grains and broccoli

    • Meats and citrus fruits

    Correct Answer
    A. Meats and citrus fruits
    Explanation
    The correct answer is "Meats and citrus fruits" because tuberculosis is a bacterial infection that can weaken the immune system and cause weight loss. Meats are a good source of protein which is important for muscle strength and repair. Citrus fruits are rich in vitamin C which helps boost the immune system. Increasing intake of these foods can help the client regain strength and support their immune system during the treatment of tuberculosis.

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  • 21. 

    SITUATION: A 70 year old woman and her husband came to a clinic. The woman reveals a 10 year history of ear infection. She is experiencing sensorineural hearing loss. During her clinic appointment, she tells the nurse that her right ear is painful and is keeping her awake at night. She explains that she can hear most sounds, although sounds on the right side seem to be coming through a filter   Which of the following approaches by the nurse will facilitate communication?

    • Speak closer and louder

    • Speak directly into the impaired ear

    • Repeat statements for the client

    • Speak in a normal tone

    Correct Answer
    A. Speak in a normal tone
    Explanation
    Speaking in a normal tone would facilitate communication for the 70-year-old woman with sensorineural hearing loss. This approach ensures that the nurse's speech is clear and easily understandable without the need for the client to strain or struggle to hear. Speaking closer and louder may distort the sound and make it difficult for the client to understand, while speaking directly into the impaired ear may not be effective if the client is experiencing pain in that ear. Repeating statements for the client may be helpful, but speaking in a normal tone would be the most appropriate approach to facilitate communication.

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  • 22. 

    SITUATION: A 70 year old woman and her husband came to a clinic. The woman reveals a 10 year history of ear infection. She is experiencing sensorineural hearing loss. During her clinic appointment, she tells the nurse that her right ear is painful and is keeping her awake at night. She explains that she can hear most sounds, although sounds on the right side seem to be coming through a filter   The nurse caring for this client knows that the client’s age and history of ear infection is an important data for diagnosis. The gradual sensorineural loss caused by degeneration in the inner ear or auditory nerve is called:

    • Presbystasis

    • Presbycusis

    • Labyrinthisis

    • Mastoiditis

    Correct Answer
    A. Presbycusis
    Explanation
    Presbycusis is the correct answer because it is a gradual sensorineural hearing loss that is commonly associated with aging. The fact that the woman is 70 years old and has a 10-year history of ear infections suggests that her hearing loss is likely due to age-related degeneration in the inner ear or auditory nerve. This condition can cause a decrease in the ability to hear high-frequency sounds and can make sounds on one side of the head seem muffled or filtered.

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  • 23. 

    SITUATION: A 70 year old woman and her husband came to a clinic. The woman reveals a 10 year history of ear infection. She is experiencing sensorineural hearing loss. During her clinic appointment, she tells the nurse that her right ear is painful and is keeping her awake at night. She explains that she can hear most sounds, although sounds on the right side seem to be coming through a filter   During a hearing assessment, the nurse notes that the sounds lateralizes to the client’s left ear with the Weber test. The nurse analyzes these results as:

    • A sensorineural or conductive loss

    • A normal finding

    • A conductive hearing loss in the right ear

    • The presence of tympanosclerosis

    Correct Answer
    A. A sensorineural or conductive loss
    Explanation
    The nurse analyzes the results as a sensorineural or conductive loss because the Weber test shows that the sounds lateralize to the client's left ear. This indicates that there is an issue with the client's right ear, which is consistent with her complaint of pain and difficulty hearing on the right side. A sensorineural loss refers to damage or dysfunction in the inner ear or auditory nerve, while a conductive loss refers to a problem in the outer or middle ear that prevents sound from reaching the inner ear. The combination of symptoms suggests that the client may be experiencing both types of hearing loss.

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  • 24. 

    SITUATION: A 70 year old male client came into the outpatient department with complaints of fatigue, productive cough, and chest pains. Further assessment of this client was done in the department   The client is now being treated with INH and Rifadin. Instructions regarding these medications are given by the nurse to the client. Which of the following statements are included in the plan?

    • “You must discontinue the medication if gastrointestinal irritation occurs”

    • “You must take the medication with meals”

    • “The entire year-long course of the medication needs to be completed”

    • “Fluids must be increased while taking this medication to prevent renal failure”

    Correct Answer
    A. “You must take the medication with meals”
    Explanation
    The correct answer is "You must take the medication with meals." This statement is included in the plan because taking the medication with meals helps to minimize gastrointestinal irritation, which can be a common side effect of INH and Rifadin. Taking the medication with food also helps with absorption and can improve the effectiveness of the treatment.

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  • 25. 

    SITUATION: In preventing readmission in patients with heart failure, nurses make sure that clients know about each medication they will be taking and help clients create a schedule for them to follow at home   Nurse Klang is caring for a client receiving Dopamine (Inotropine). Which of the following potential nursing diagnoses is appropriate for this client?

    • Disturbed sensory perception

    • Impaired tissue perfusion

    • Excess fluid volume

    • Increased cardiac output

    Correct Answer
    A. Impaired tissue perfusion
    Explanation
    Dopamine is a medication that is commonly used to improve tissue perfusion in patients with heart failure. It works by increasing cardiac output and improving blood flow to the tissues. Therefore, it is appropriate to diagnose impaired tissue perfusion in a client receiving Dopamine, as the medication is specifically being used to address this issue.

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  • Current Version
  • Mar 19, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 02, 2012
    Quiz Created by
    Nsgzonemedsurg
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