Med-surge 3

49 Questions

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Medical Quizzes & Trivia

Surgery is the process of incursion into the body of a living organism with the intention to cure or treat a condition and prevent further damage. Med-surge 3 dwells more on the nurses' roles in matters surgery.


Questions and Answers
  • 1. 
    A client has very dry skin. Which is the best intervention for the nurse to teach the client?
    • A. 

      Use antimicrobial soap so scratching won't cause infection

    • B. 

      After you bathe, put lotion on before your skin dries completely

    • C. 

      Avoid wearing stockings or other constricting clothing

    • D. 

      Be sure to use lots of moisturizer several times a day

  • 2. 
    A client is going home with a surgical wound on the coccyx that is to heal by secondary intention. Which priority problem must the nurse address in the teaching plan?
    • A. 

      Pain

    • B. 

      Infection

    • C. 

      Dehydration

    • D. 

      Poor body image

  • 3. 
    • A. 

      Client who requires assistance with ambulation

    • B. 

      Incontinent client with limited mobility

    • C. 

      Client who has pneumonia

    • D. 

      Client with HTN on multiple medications

  • 4. 
    • A. 

      Turn the mattress overlay to the opposite side

    • B. 

      Do nothing because this is expected

    • C. 

      Apply a different pressure-relieving device

    • D. 

      Reinforce the overlay

  • 5. 
    A client has a wound on his left trochanter that is 4 inches in diameter, with black tissue at the periameter and the bone is exposed. Which is the nurse's best action?
    • A. 

      Document as a stage III pressure ulcer and start antibiotics

    • B. 

      Stage I pressure ulcer and apply a transparent dressing

    • C. 

      Stage II pressure ulcer and start wet-to-dry dressing

    • D. 

      Stage IV pressure ulcer and prep the client for debreidment

  • 6. 
    A client presents with a pressure ulcer on the ankle. Which is the first intervention that nurse implements?
    • A. 

      Place the client and the instruct him to elevate his foot

    • B. 

      Draw blood for albumin. prealbumin, and total protein

    • C. 

      Assess the affected leg for pulses, skin color, and temperature

    • D. 

      Option 4

  • 7. 
    • A. 

      Coexisting medical conditions

    • B. 

      Immune compromised status

    • C. 

      Presence of a deep wound

    • D. 

      Severely reddened skin

  • 8. 
    A client has a chronic wound that is being treated with a wound vac device. Which intervention by the nurse takes priorty?
    • A. 

      Assess the vac every 2 hours for bleeding

    • B. 

      Check the integrity of the dressing seal every 4 hours

    • C. 

      Document the wound size with each dressing change

    • D. 

      Provide pain meds as needed

  • 9. 
    • A. 

      He drinks nutritional supplement between meals to maintain his weight

    • B. 

      I apply lotion to his arms and legs every evening because they so dry

    • C. 

      I help him shift his position every hour hen he sits in the chair

    • D. 

      I massage his tailbone every morning when he gets up because it is red

  • 10. 
    A client has been identified as being at risk for formation of pressure ulcers. Which dietary choices by then client indicate a good understanding of teaching related to this condition?
    • A. 

      Low-fat, low cholesterol, high fiber, low carb

    • B. 

      Vegetarian diet with nutritional supplements

    • C. 

      High protein diet with vitamins and mineral supplements

    • D. 

      Low-fat diet with whole grains and cereal and vitamin supplements

  • 11. 
    The nurse sees a client with which condition first to evaluate for wound infection?
    • A. 

      Decrease in wound size

    • B. 

      This serous wound drainage

    • C. 

      Pending blood cultures

    • D. 

      WBC of 23,000

  • 12. 
    An African-American woman had a breast biopsy 1 year ago. The incision site is elevated, dark, and protruding. What information does the nurse provide to the client?
    • A. 

      A deep infection has probably become symptomatic

    • B. 

      Chronic inflammatory changes have occured

    • C. 

      The benign tumor has undergone malignant changes

    • D. 

      A keloid has formed over the biopsy scar

  • 13. 
    The RN has assigned a client who has an open burn to a LPN. Which instruction is most important to provide?
    • A. 

      Assess wounds for signs of infection

    • B. 

      Chronic inflammatory changes have occurred in the skin

    • C. 

      Wash hands on entering the clients room

    • D. 

      Have the client cough and deep breathing

  • 14. 
    The nurse is teaching burn prevention to a community group.  Which information shared by a member of the group causes the nurse greatest concern?
    • A. 

      My hot water heater is set at about 120 degrees

    • B. 

      I use a space heater when it gets below zero

    • C. 

      I get chimney swept every other year

    • D. 

      Sometimes I wake up and smoke at night

  • 15. 
    • A. 

      My goal is to achieve the highest level of functioning that I can

    • B. 

      I will eventually be able to perform all my former activities

    • C. 

      I am fully recovered when all the wounds are closed

    • D. 

      Full recovery from a major burn injury never recurs

  • 16. 
    A client is in the ED after being rescued from a house fire. After the initial assessment, the client develops a loud brassy cough. What is the priority intervention?
    • A. 

      Allow the client to suck on small quantities of ice chips

    • B. 

      Apply oxygen and continuous pulse ox

    • C. 

      Request an antitussive med from the physician

    • D. 

      Have the RT provide humidified room air

  • 17. 
    A client has burns on both legs. They are white and leather like. No blister or bleeding is present and the client describes a small amount of pain. How is this injury categorized?
    • A. 

      Full thickness

    • B. 

      Partial thickness deep

    • C. 

      Superficial

    • D. 

      Partial thickness superficial

  • 18. 
    A client who is burned is drooling and is having difficulty swallowing. Which action does the nurse take first?
    • A. 

      Measure abdominal girth and auscultate bowel sounds

    • B. 

      Auscultate breath sounds over the trachea and main stem bronchi

    • C. 

      Assess level of consciousness and pupillary reactions

    • D. 

      Ascertain the time food or liquid was last consumed

  • 19. 
    On assessment, the nurse notes that a client has burns inside the mouth and is wheezing. Several hours later, then wheezing is no longer heard. What is the nurse's next action?
    • A. 

      Gather appropriate equipment and prepare for intubation

    • B. 

      Administer a laxative

    • C. 

      Raise head of the bed to a semi-fowelrs

    • D. 

      Document the findings and reassess in 1 hour

  • 20. 
    A client suffered a% total body surface area burn and was intubated. 12 hours later, bowel sounds were absent in all four quadrants. Which is the best action? 
    • A. 

      Re-position the client on the right side

    • B. 

      Admin. a laxative

    • C. 

      Prepare to insert NG tube

    • D. 

      Document the finding

  • 21. 
    A client has experienced an electrical burn of the lower extremities. What is the priority assessment of this client?
    • A. 

      Orientation to time, place and person

    • B. 

      Heart rate, rhythm, and ECG

    • C. 

      ROM of all extremities

    • D. 

      Respiratory rate and pulse ox

  • 22. 
    A client who has had a full-thickness burn is being discharged. Which information is most important for the nurse to provide?
    • A. 

      Learning to perform dressing changes

    • B. 

      Joining a community reintegration program

    • C. 

      Options available for scar removal

    • D. 

      How to maintain home smoke detectors

  • 23. 
    A client with aphasia presents to the ED with a suspected brain attack. Which clinical manifestation leads the nurse to suspect  that this client has had a thrombotic stroke?
    • A. 

      Chest pain and nuchal

    • B. 

      Sudden loss of motor coordination

    • C. 

      Two episodes of speech difficulty in the last month

    • D. 

      A grand mal seizure 2 months ago

  • 24. 
    The nurse is caring for an 80 y.o.  who presented to the ED in coma. Which question does the nurse as the client's family to determine if the coma is related to a stroke. 
    • A. 

      Is any history of seizures among your mother's immediate family?

    • B. 

      Did you mother complain of any weakness in her lower extremities

    • C. 

      Does your mother drink any alcohol or take any meds?

    • D. 

      How many hours does your mother usually sleep at night?

  • 25. 
    The nurse is assessing a client who had a stroke in the right cerebral hemisphere. Which neurologic deficit does the nurse assess for?
    • A. 

      Agrphia

    • B. 

      Aphasia

    • C. 

      Imparied olfaction

    • D. 

      Impaired proprioception

  • 26. 
    A client who had a stroke combs her hair only on the right side of her hand and washes only the right side of her face. How does the nurse interpret these actions?
    • A. 

      Poor left-sided motor control

    • B. 

      Unawareness of the existence of her left side

    • C. 

      Limited visual perception of the left fields

    • D. 

      Paralysis or contractures on the right side

  • 27. 
    The nurse is caring for a client who has experience a stroke.  Which nursing intervention for nutrition is implemented to prevent complications from cranial nerve IX impairment?
    • A. 

      Turn the client's plate around halfway through the meal

    • B. 

      Place the client in high fowlers position

    • C. 

      Verbalize the placement of food on the client's plate

    • D. 

      Order a clear liquid diet for the client

  • 28. 
    The nurse is caring for a client who had a stroke. What intervention does the nurse implement in the first 72 hours to prevent complications?
    • A. 

      Monitor neurologic and VS closely to ID early changes

    • B. 

      Position head of bed flat to enhance cerebral perfusion

    • C. 

      Administer prescribed analgesics to promote pain relief

    • D. 

      Cluster nursing ares to avoid fatigue

  • 29. 
    The nurse is caring for a client who is immobile from a recent stroke. Which intervention does the nurse implement to prevent complications in this client?
    • A. 

      Teach the client to touch and use both sides of the body

    • B. 

      Instruct the client to turn the head from side to side

    • C. 

      Apply sequential compression stockings

    • D. 

      Position the client with the unaffected side down

  • 30. 
    A client who has had a stroke with left-sided hemiparesis is referred to rehab center. The client asks "Why do I need rehab?" How does the nurse respond?
    • A. 

      Rehab will reverse any physical deficits caused by the stroke

    • B. 

      Rehab will help you function at the highest level possible

    • C. 

      Your doctor knows best and has ordered this treatment for you

    • D. 

      If you do not have rehab you may never walk again

  • 31. 
    The nurse is teaching bladder training to a client who is incontinent after a stroke. Which instruction does the nurse include on the teaching?
    • A. 

      Decrease oral intake of fluids to 1 liter per day

    • B. 

      Use a Foley catheter at night to prevent accidents

    • C. 

      Plan to use the commode every 2 hours during the day

    • D. 

      How your bladder as long as possible to restore bladder tone

  • 32. 
    The nurse is caring for a client admitted to the ICU after incurring a basilar skull fracture. Which complication of this injury does the nurse monitor for?
    • A. 

      Pulmonary embolus

    • B. 

      Myocardial infarction

    • C. 

      Hemorrage

    • D. 

      Aspiration

  • 33. 
    A client who has a head injury is transported to the ED. Which assessment does the ED nurse perform immediately?
    • A. 

      Short-term memory

    • B. 

      Motor function

    • C. 

      Resp. Status

    • D. 

      Pupil response

  • 34. 
    A client who has severe head injury is placed in a drug-induced coma. The husband states "I do not understand. Why are you putting her into a coma?" What is the best response?
    • A. 

      This med will decrease the activity of her brain so that additional damage doesn't occur

    • B. 

      This med will prevent from seizure and need for ICP monitoring

    • C. 

      This med will help her remain cooperative and calm

    • D. 

      These meds will prevent her from pain when positioning or suctioning

  • 35. 
    An older adult client who has a mature cataract in the right eye states, "Now I have lost sight in my right eye because I waited too long for treatment" How does the nurse best respond?
    • A. 

      Nothing you could have done would have made any difference

    • B. 

      Surgery can still save the sight with removal of cataract

    • C. 

      Is it fortunate your came for treatment in time to save the sight in the other eye

    • D. 

      Yes this type of blindness could have been prevented by earlier treatment

  • 36. 
    • A. 

      It may increase IOP after cataract surgery

    • B. 

      It reduces inflammation and might mask any symptoms of infections

    • C. 

      It changes the ability of the blood to clot and increases the risk of bleeding

    • D. 

      It can cause nausea and vomiting and may increase IOP

  • 37. 
    • A. 

      Blurred vision and reduced color perception

    • B. 

      Dull aching in the eye and brow area

    • C. 

      Loss of peripheral vision

    • D. 

      Loss of central vision

  • 38. 
    • A. 

      If a complication arises in that eye, i will still have some vision in the better eye

    • B. 

      Insurance reimbursement dictates the timing of surgeries

    • C. 

      The eye with poorer vision is at greater risk for permanent damage

    • D. 

      The pressure in the poorer eye could increase causing permanent damamge

  • 39. 
    The nurse is teaching a client about home care after cataract surgery. Which statement indicates that the client requires further teaching?
    • A. 

      I will try a cool compress to decrease the swelling around the eye

    • B. 

      I am glad that I don't need an eye patch after surgery

    • C. 

      Dark sunglasses will be necessary when I am in the sun

    • D. 

      Pain, nausea, and vomiting are normal after surgery is normal

  • 40. 
    The nurse has been educated about activities that can increase IOP. Which statement indicates that the client requires further teaching?
    • A. 

      I will not put my arms above my head

    • B. 

      I will try not to sneeze cough or blow my nose

    • C. 

      I will take stool softeners daily to prevent straining

    • D. 

      I will avoid wearing tight shirt collars and ties

  • 41. 
    The nurse assess several clients. Which is most likely to have secondary open-angle glaucoma?
    • A. 

      Client who sees halos around lights

    • B. 

      Client with reactive pupils and clear sclera

    • C. 

      Client who recently had eye surgery

    • D. 

      Client with gradual onset of blurred vision

  • 42. 
    • A. 

      Red haze or floaters in the line of vision

    • B. 

      Presence of a red reflex

    • C. 

      Swelling of the upper and lower eyelids

    • D. 

      Reddened whites of the eyes

  • 43. 
    The nurse is teaching a client to apply eye medication. Which is the correct technique for applying ointment into the eye?
    • A. 

      Against the inner aspect of the eye

    • B. 

      From the inner canthus to the other canthus

    • C. 

      From the middle out

    • D. 

      From the other canthus to the inner canthus

  • 44. 
    The nurse is caring for a client with otitis media and notes purulent drainage in the ear canal during the physical assessment. Which is the priority intervention?
    • A. 

      Gently examine the clients ear with an otoscope

    • B. 

      Obtain a specimen of drainage for culture

    • C. 

      Place a cotton ball in the middle ear

    • D. 

      Irrigate the ear canal with NS

  • 45. 
    A client with a ruptured tympanic membrane asks the nurse whether hearing will be affected permanently. Which is the nurse's best response?
    • A. 

      Yes. It will be important to be fitted with a hearing aid

    • B. 

      Yes any time the eardrum is ruptured it will form a scar, causing permanent loss

    • C. 

      No. Antibiotics will help resolve the infection and cure impairment

    • D. 

      Possibly. Te eardrum usually heals in 1-2 weeks. Any persistent problems should be evaluated

  • 46. 
    The nurse is caring for a client with Meniere's disease. What does the nurse recommend to reduce symptoms of vertigo?
    • A. 

      When dizziness begins lie down, keep head still

    • B. 

      Drink at least 8 glasses of water a day

    • C. 

      Blow your nose hard when it first begins

    • D. 

      Take salt and potassium supplements daily

  • 47. 
    The nurse teaches a client's wife how to administer eardrops to the client. Which statement by the client's wide indicates that additional teaching is needed?
    • A. 

      I will make sure that the eardrops are at the room temp before using them

    • B. 

      I will wash my hands before and after giving my husband the eardrops

    • C. 

      After I put the drops in I will gently tug on the outer ear to make sure that they go into the ear canal

    • D. 

      I will have my husband lay on his back with his chin up when I give him the ear drops

  • 48. 
    • A. 

      Write out the question for the client to answer

    • B. 

      Check with the client's primary health care provider

    • C. 

      Question the client's family

    • D. 

      Obtain the information from the client's old chart

  • 49. 
    The client requires a hearing aid but tells the nurse that he cannot afford to pay for it right now. What is the best response?
    • A. 

      You can check around for the lowest price

    • B. 

      I'll ask the social worker about organizations that help pay

    • C. 

      Your insurance company should pay some of the cost

    • D. 

      Option 4