Final Exam Practice Qs - Med Surg
Med Surg Final Exam Practice Questions:
6. A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the
nurse take first?
a. Notify the patient's health care provider.
b. Teach correct midstream urine collection.
c. Ask the patient about current medications.
d. Question the patient about urinary tract infection (UTI) risk factors.
ANS: C
A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as
phenazopyridine (Pyridium). The color would not be expected with urinary tract infection, is not a sign
that poor technique was used in obtaining the specimen, and does not need to be communicated to the
health care provider until further assessment is done.
7. a nurse is providing an educational class to a group of older adults at a community senior center. In an
effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the
recommended adequate intake of which nutrients? SATA
a. calcium
b. potassium
c. calcitonin
d. vitamin D
e. vitamin B12
Feedback:
A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12and
potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary
nutrient.
8. a nurse is educating a patient in anticipation of a procedure that will require a water-sealed chest
drainage system. What should the nurse tell the patient and the family that this drainage system is used
for?
a. removing excess air and fluid
b. monitoring pleural fluid osmolarity
c. maintaining positive chest wall pressure
d. providing positive intrathoracic pressure
Feedback:
Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess
air, fluid, and blood.
9. a patients has a new diagnosis of crohn’s disease after having frequent diarrhea and a weight loss of 10
lb (4.5 kg) over 2 months. The nurse will plan to teach about which of the following?
a. medication use
b. fluid restriction
c. enteral nutrition
d. activity restrictions
feedback: Medications are used to induce and maintain remission in patients with inflammatory bowel
disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness.
Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.
10. the nurse is planning care of a patient who is scheduled for a laryngectomy. The nurse should assign
the highest priority to which postoperative nursing diagnosis?
A) Anxiety related to diagnosis of cancer
B) Altered nutrition related to swallowing difficulties
C) Ineffective airway clearance related to airway alterations
D) Impaired verbal communication related to removal of the larynx
(Feedback:
Each of the listed diagnoses is valid, but ineffective airway clearance is the priority nursing diagnosis for
all conditions.)
11. A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following
statements related to osteoporosis is most accurate?
a. Osteoporosis is categorized as a disease of the elderly.
b. secondary osteoporosis occurs in women after menopause.
c. A nonmodifiable risk factor for osteoporosis is a person's level of activity.
d. Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
Ans: Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
Feedback:
When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of
lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier
in life, when bone mass peaks and then begins to decline. A person's level of physical activity is a
modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development
of osteoporosis. Primary osteoporosis occurs in women after menopause.
12. Which question from the nurse would help determine if a patient's abdominal pain might indicate
irritable bowel syndrome?
a. "Have you been passing a lot of gas?"
b. "What foods affect your bowel patterns?"
c. "Do you have any abdominal distention?"
d. "How long have you had abdominal pain?
Feedback: One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal
discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are
associated with IBS but are not diagnostic criteria.
13. A patient has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone
tumor. The nurse providing postoperative care in the days following surgery assesses for what
complication from surgery?
A)Deficient fluid volume
B)Delayed wound healing
C)Hypocalcemia
D)Pathologic fractures
Feedback:Delayed wound healing is a complication of surgery due to tissue trauma from the
surgery. Nutritional deficiency is usually due to the effects of chemotherapy and radiation
therapy, which may cause weight loss. Pathologic fractures are not a complication of surgery
14. Which adult will the nurse plan to teach about risks associated with obesity?
a. Man who has a BMI of 18 kg/m2
b. Man with a 42 in waist and 44 in hips
c. Woman who has a body mass index (BMI) of 24 kg/m2
d. Woman with a waist circumference of 34 inches (86 cm)
Feedback: The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level
of <0.80. A patient with a BMI of 18 kg/m2 is considered underweight. A BMI of 24 kg/m2 is
normal. Health risks associated with obesity increase in women with a waist circumference
larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm).
15. the nurse is assessing the patient who was admitted to your unit with hyperkalemia. which of
the following causes would the nurse expect to result in hyperkalemia?
a. excess potassium intake
b. lack of potassium intake
c. shift of potassium into cells
d. shift of potassium out of cells
e. failure to eliminate potassium
16. When teaching a patient about testing to diagnose metabolic syndrome, which topic would
the nurse include?
a. Blood glucose test
b. Cardiac enzyme tests
c. Postural blood pressures
d. Resting electrocardiogram
feedback: A fasting blood glucose test >100 mg/dL is one of the diagnostic criteria for metabolic
syndrome. The other tests are not used to diagnose metabolic syndrome although they may be
used to check for cardiovascular complications of the disorder.
17. A nurse is caring for a client following an angioplasty that was inserted through the femoral
artery. While turning the client, the nurse discovers blood underneath the client's lower bac k. The
nurse should suspect
A. retroperitoneal bleeding.
B. cardiac tamponade.
C. bleeding from the incisional site.
D. heart failure.
Feed back C. CORRECT: Bleeding is occurring from the incision site and then draining under
the client. The nurse
should check the incision for hematoma, apply pressure, monitor the client, and notify the
provider.
18. the nurse is caring for a patient who has returned to the unit following a bronchoscopy. The
patient is asking for something to drink. Which criterion will determine when the nurse should
allow the patient to drink fluids?
a. Presence of a cough and gag reflex
b. Absence of nausea
c. Ability to demonstrate deep inspiration
d. Oxygen saturation of ³92%
Feedback: After the procedure, it is important that the patient takes nothing by mouth until the
cough reflex returns because the preoperative sedation and local anesthesia impair the protective
laryngeal reflex and swallowing for several hours. Deep inspiration, adequate oxygen saturation
levels, and absence of nausea do not indicate that oral intake is safe from the risk of aspiration.
19. A patient's x-ray reveals that there is no evidence of callus formation after the second week
of treatment for a bone fracture. What does the nurse infer related to healing of the fracture?
a. It is failing to heal despite treatment.
b. It is healing at a slower rate than expected.
c. It is healing normally.
d. It is healing in an abnormal position in relation to midline of structure.
Feedback: During the second week of treatment after a bone fracture, an x-ray is performed to
check for the presence of callus formation. Callus formation indicates that the healing process of
the bone has started. Absence of callus formation indicates failure of the healing process in
spite of treatment. When the fracture healing progress is slower than expected over time, it
indicates a delayed union of the fractured bone. The fracture is not healing normally. When the
fracture heals in an abnormal position in relation to the midline of the structure, it indicates
angulation.
20. The nurse is providing care for a patient who has just been diagnosed with peripheral arterial
occlusive disease (PAD). What assessment finding is most consistent with this diagnosis?
a. Numbness and tingling in the distal extremities
b. Unequal peripheral pulses between extremities
c. Visible clubbing of the fingers and toes
d. Reddened extremities with muscle atrophy
Feedback: PAD assessment may manifest as unequal pulses between extremities, with the affected leg
cooler and paler than the unaffected leg.
21. A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the
heart responsible for the pumping action. You are aware that the damage occurred where?
a. Endocardium
b. Pericardium
c. Myocardium
d. Visceral pericardium
Feedback:
The myocardium is the layer of the heart responsible for the pumping action.
22. The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring
system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left
ventricular function. What is an additional function of pulmonary artery pressure monitoring
systems?
a. To assess the patient's response to fluid and drug administration
b. To obtain specimens for arterial blood gas measurements
c. To dislodge pulmonary emboli
d. To diagnose the etiology of chronic obstructive pulmonary disease
Feedback:
Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left
ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the
patient's response to medical interventions, such as fluid administration and vasoactive
medications. Pulmonary artery monitoring is preferred for the patient with heart failure over
central venous pressure monitoring. Arterial catheters are useful when arterial blood gas
measurements and blood samples need to be obtained frequently. Neither intervention is used
to clear pulmonary emboli.
23. The nurse is creating the care plan for a 70-year-old obese patient who has been admitted to
the postsurgical unit following a colon resection. This patient's age and increased body mass
index mean that she is at increased risk for what complication in the postoperative period?
a. Hyperglycemia
b. Azotemia
c. Falls
d. Infection
Feedback: (Like age, obesity increases the risk and severity of complications associated with surgery.
During surgery, fatty tissues are especially susceptible to infection. In addition, obesity increases
technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and
wound infections are more common.)
24. The ED nurse is assessing a patient complaining of dyspnea. The nurse auscultates the
patient's chest and hears wheezing throughout the lung fields. What might this indicate?
a. The patient has a narrowed airway.
b. The patient has pneumonia.
c. The patient needs physiotherapy.
d. The patient has a hemothorax.
Feedback: Wheezing is a high-pitched, musical sound that is often the major finding in a patient with
bronchoconstriction or airway narrowing. Wheezing is not normally indicative of pneumonia or
hemothorax. Wheezing does not indicate the need for physiotherapy.
25. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was
positive. What is the nurse's most plausible conclusion based on this assessment finding?
A) The patient should withhold his next scheduled dose of insulin.
B) The patient should promptly eat some protein and carbohydrates.
C) The patient's insulin levels are inadequate.
D) The patient would benefit from a dose of metformin (Glucophage).
Feedback:
Ketones in the urine signal that there is a deficiency of insulin and that control
of type 1 diabetes is deteriorating. Withholding insulin or eating food would
exacerbate the patient's ketonuria. Metformin will not cause short-term
resolution of hyperglycemia.
26. a 23-year-old child is brought to the emergency department with symptoms of hyperglycemia
and is subsequently diagnosed with diabetes. Based on the fact that the patients pancreatic
beta cells are being destroyed, the patient would be diagnosed with what type of diabetes?
A) Type 1 diabetes
B) Type 2 diabetes
C) Non-insulin-dependent diabetes
D) Prediabetes
Feedback: Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent
diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired
insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose
metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.
27. The nurse is preparing a patient for surgery. The patient states that she is very nervous and
really does not understand what the surgical procedure is for or how it will be performed. What
is the most appropriate nursing action for the nurse to take?
a. Have the patient sign the informed consent and place it in the chart.
b. Call the physician to review the procedure with the patient.
c. Explain the procedure clearly to the patient and her family.
d. Provide the patient with a pamphlet explaining the procedure.
Feedback: While the nurse may ask the patient to sign the consent form and witness the
signature, it is the surgeon's responsibility to provide a clear and simple explanation of what the
surgery will entail prior to the patient giving consent. The surgeon must also inform the patient of
the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of
body parts as well as what to expect in the early and late postoperative periods. The nurse
clarifies the information provided, and, if the patient requests additional information, the nurse
notifies the physician. The consent form should not be signed until the patient understands the
procedure that has been explained by the surgeon. The provision of a pamphlet will benefit
teaching the patient about the surgical procedure, but will not substitute for the information
provided by the physician.
28. The nurse is caring for a 72-year-old patient who is in cardiac rehabilitation following heart
surgery. The patient has been walking on a regular basis for about a week and walks for 15
minutes 3 times a day. The patient states that he is having a cramp-like pain in the legs every
time he walks and that the pain gets better when I rest. The patients care plan should address
what problem?
a. Decreased mobility related to VTE
b. Acute pain related to intermittent claudication
c. Decreased mobility related to venous insufficiency
d. Acute pain related to vasculitis
Feedback: Intermittent claudication presents as a muscular, cramp-type pain in the extremities
consistently reproduced with the same degree of exercise or activity and relieved by rest.
Patients with peripheral arterial insufficiency often complain of intermittent claudication due to a
lack of oxygen to muscle tissue. Venous insufficiency presents as a disorder of venous blood
reflux and does not present with cramp-type pain with exercise. Vasculitis is an inflammation of
the blood vessels and presents with weakness, fever, and fatigue, but does not present with
cramp-type pain with exercise. The pain associated with VTE does not have this clinical
presentation.
29. The triage nurse in the ED is assessing a patient who has presented with complaint of pain
and swelling in her right lower leg. The patient's pain became much worse last night and
appeared along with fever, chills, and sweating. The patient states, "I hit my leg on the car door
4 or 5 days ago and it has been sore ever since." The patient has a history of chronic venous
insufficiency. What intervention should the nurse anticipate for this patient?
a. Platelet transfusion to treat thrombocytopenia
b. Warfarin to treat arterial insufficiency
c. Antibiotics to treat cellulitis
d. Heparin IV to treat VTE
Feedback:
Cellulitis is the most common infectious cause of limb swelling. The signs and symptoms include
acute onset of swelling, localized redness, and pain; it is frequently associated with systemic
signs of fever, chills, and sweating. The patient may be able to identify a trauma that accounts
for the source of infection. Thrombocytopenia is a loss or decrease in platelets and increases a
patient's risk of bleeding; this problem would not cause these symptoms. Arterial insufficiency
would present with ongoing pain related to activity. This patient does not have signs and
symptoms of VTE.
30. During routine hemodialysis, patient complains of nausea and dizziness. Which action should the
nurse take first?
a. Slow down the rate of dialysis.
b. Check patient's blood pressure (BP).
c. Review the hematocrit (Hct) level.
d. Give prescribed PRN antiemetic drugs.
Feedback: The patient's complaints of nausea and dizziness suggest hypotension, so the initial action
should be to check the BP. The other actions may also be appropriate based on the blood pressure
obtained.
31. The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should
the nurse best assess whether the patient is hypoxemic?
a. Assess the patient's level of consciousness (LOC).
b. Assess the patient's extremities for signs of cyanosis.
c. Assess the patient's oxygen saturation level.
d. Review the patient's hemoglobin, hematocrit, and red blood cell levels.
Feedback:
The effectiveness of the patient's oxygen therapy is assessed by the ABG analysis or pulse
oximetry. ABG results may not be readily available. Presence or absence of cyanosis is not an
accurate indicator of oxygen effectiveness. The patient's LOC may be affected by hypoxia, but
not every change in LOC is related to oxygenation. Hemoglobin, hematocrit, and red blood cell
levels do not directly reflect current oxygenation status.
32. the provider prescribes docusate sodium (Colace) 200 mg po daily. Available is docusate sodium
(Colace) 150 mg/ 15 ml. how many ml should the nurse administer?
a. 10ml
b. 15ml
C. 20 ml
d. 25 ml
E. another amount
34. A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L.
which of the following actions should the nurse take?
a. Obtain a 12-lead ECG
b. Suggest that the patient use a salt substitute
c. Obtain a blood sample for a serum sodium level
d. Advise the patient to add citrus juices and bananas to her diet
Feedback: Clients potassium level is above expected reference rage of 3.5-5.0 mEq/L and is at
risk for dysrhythmias as well as cardiac arrest. Therefore, the nurse should obtain a 12-lead ECG
to monitor cardiac changes
35. In teaching a patient about coronary artery disease, the nurse explains that the changes that
occur in this disorder include (select all that apply)
a. diffuse involvement of plaque formation in coronary veins
b. abnormal levels of cholesterol, especially low-density lipoproteins
c. accumulation of lipid and fibrous tissue within the coronary arteries
d. development of angina due to a decreased blood supply to the heart muscle
e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm
Rationale: Atherosclerosis is the major cause of coronary artery disease (CAD) and is
characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the
artery. The endothelial lining of the coronary arteries becomes inflamed from the presence of
unstable plaques and the oxidation of low-density lipoprotein (LDL) cholesterol. Fibrous plaque
causes progressive changes in the endothelium of the arterial wall. The result is a narrowing of
the vessel lumen and a reduction in blood flow to the myocardial tissue.
36. a home health nurse is making a home visit to a client who takes a daily diuretics for heart
failure. Which of the following should the nurse identify as indicating the patient is
hypokalemic?
a. pitting edema
b. fatigue
c. dyspnea
d. oliguria
Rational: d/t muscle weakness with hypokalemia
37. A nurse is reviewing the serum lab findings for a pt who has hypertension and is prescribed
hydrochlorothiazide. Which of the following findings should the nurse report?
a. Sodium 136 mEq/L
b. Potassium 2.3 mEq/L on exam is 3.3 and still correct
c. Chloride 99 mEq/L
d. Calcium 10 mg/dL
-Potassium 2.3 mEq/L (should report hypokalemia and monitor the pt for dysrhythmias.)
38. A nurse is performing an admission on a patient. Which of the following findings should the
nurse identify as an indication that the patient is dehydrated?
a. Low body temperature
b. Jugular vein distention
c. Skin tenting present answer can also be increased respiration
d. Blood pressure 178/90 mm Hg
Feedback- Dehydration = elevated temp, low BP, and flat neck veins
38. Math question
39. A nurse is caring for a client who has hypernatremia and requires IV fluid therapy due to his
NPO status. Which of the following solutions should the nurse prepare to infuse for this client?
A. Lactated Ringer's
B. Dextrose 5% in 0.9% sodium chloride
C. 0.45% sodium chloride
D. Dextrose 10% in water
Feedback: (Lactated Ringer's is an isotonic IV solution, which will not help correct the client's
sodium elevation. Dextrose 5% in 0.9% sodium chloride is a hypertonic IV solution, which will
not help correct the client's sodium elevation. Dextrose 10% in water is a hypertonic IV solution,
which will not help correct the client's sodium elevation.
Rationale for C - A client who has an elevated sodium level and is NPO requires a hypotonic IV
solution, such as 0.45% sodium chloride or 0.225% sodium chloride.)
46. a postoperative patient with a nasogastric tube that is attached to low suction has a change in
condition. An arterial blood reveals the following. PH 7.50 PCO 39 HCO 30. how would the
nurse interpret these values?
a.Metabolic acidosis
b.Respiratory alkalosis
c.Metabolic alkalosis
d.Respiratory acidosis
47. a nurse is monitoring a patient who is receiving a unit of packed RBCs following surgery.
Which of the following assessment is an indication that the patient might be experiencing
circulatory overload?
a. flushing
b. dyspnea
c. vomiting
d. bradycardia
Feedback: Circulatory overload - can occur when a blood product is infused too quickly.
Manifestations of circulatory overload can include dyspnea, hypotension, hypertension, crackles,
distended neck veins, and confusion.
48. when taking the blood pressure of a patient after a parathyroidectomy, the nurse notes that
the patient’s hands has gone into flexion contractions. Which laboratory results does the nurse
correlate with this condition?
a. Serum potassium: 2.9 mEq/L
b. Serum magnesium: 1.7 mEq/L exams says serum potassium: 5.8 for this choice
c. Serum sodium: 122 mEq/L
d. Serum calcium: 6.9 mg/dL
feedback: Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches,
spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia.
The flexion contractions (Trousseau's sign) that occur during blood pressure measurement are
indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia,
hyponatremia, and hypomagnesemia.
49. A patient with angina has been prescribed nitroglycerin. Before administering the drug, the
nurse should inform the patient about what potential adverse effects?
a. tinnitus or diplopia
b. nervousness or paresthesia
c. drowsiness or blurred vision
d. Throbbing headache or dizziness
Headache and dizziness commonly occur when nitroglycerin is taken at the beginning of therapy.
However, the client usually develops a tolerance
50. A patient with osteoarthritis is scheduled for a total hip arthroplasty. The nurse explains that
the purpose of this procedure is to (select all that apply)
a. fuse the joint.
b. replace the joint.
c. prevent further damage.
d. improve or maintain ROM.
e. decrease the amount of destruction in the joint.
Rationale: Arthroplasty is the reconstruction or replacement of a joint. This surgical procedure is
performed to relieve pain, improve or maintain range of motion, and correct deformity. Total hip
arthroplasty (THA) provides significant relief of pain and improvement of function for a patient
with osteoarthritis (OA).
51. in a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because
vomiting results in
a. Fluid movement from the cells into the interstitial space and the blood vessels
b. Excretion of large amounts of interstitial fluid with depletion of extracellular fluids
c. An overload of extracellular fluid with a significant increase in intracellular fluid volume
d. Fluid movement from the vascular system into the cells, causing cellular swelling and rupture
Rationale: Fluid volume deficit occurs when there is loss of both sodium and water. Intracellular
fluid moves into the interstitial spaces and blood vessels.
52. An unresponsive patient with type 2 diabetes is brought to the emergency department and
diagnosed with hyperosmolar hyperglycemic syndrome (HHS). the nurse will anticipate which of
the following a laboratory finding?
a. excess of carbon dioxide
b. minimal ketones in urine and blood
c. marked decreased in serum osmolality
d. blood glucose greater than 500 mg/dl
53. The nurse is conducting patient teaching about cholesterol levels. When discussing the
patient's elevated LDL and lowered HDL levels, the patient shows an understanding of the
significance of these levels by stating what?
A) Increased LDL and decreased HDL increase my risk of coronary artery disease.
B) Increased LDL has the potential to decrease my risk of heart disease.
C) The decreased HDL level will increase the amount of cholesterol moved away from the artery
walls.
D) The increased LDL will decrease the amount of cholesterol deposited on the artery walls.î
Feedback:
Elevated LDL levels and decreased HDL levels are associated with a greater incidence of
coronary artery disease.
54. A patient who is receiving magnesium sulfate has a urine output of 20 mL/hr. Which of the
following medications should the nurse expect to administer?
a. Lasix
b. Protamine
c. Flumazenil
d. Calcium gluconate
A. INCORRECT:Nifedipine is an antihypertensive medication that may be administered to
women who have gestational hypertension.
B. INCORRECT: Pyridoxine (vitamin B6) is a vitamin supplement prescribed for clients who
have hyperemesis gravidarum.
C. INCORRECT:Ferrous sulfate is a medication used in the treatment of iron deficiency anemia.
D. CORRECT: Calcium gluconate is the antidote for magnesium sulfate.
55. Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient. Which
statement by the patient indicates that the medication teaching has been effective?
a. “I will try to drink at least 8 glasses of water every day.”
b. B “I will use salt substitute to decrease my sodium intake”
c. “I Will increase my intake of potassium-containing foods.”
d. “I will drink apple juice instead of orange juice for breakfast.”
Feedback: Spironolactone is a potassium-sparing diuretic. Patients should be taught to choose
low-potassium foods such as apple juice rather than foods that have higher levels of potassium,
such as citrus fruits. Cheese is high in sodium; the fat content of the cheese is not relevant.
Because the patient is using spironolactone as a diuretic, the nurse would not encourage the
patient to increase fluid intake. Patients are taught to avoid salt substitutes, which are high in
potassium.
56. A nurse is teaching a patient who has a new prescription for hydrochlorothiazide for
management of HTN. Which of the following instructions should the nurse include?
A. “Avoid grapefruit juice.”
b. “Monitor for leg cramps.”
c. “Take medication before bedtime.”
d. “Reduce intake of potassium-rich foods”
57. A nurse is providing instructions for a 52-year-old client who is scheduled for a colonoscopy.
The client reports that he has not had the procedure before and is very anxious about feeling pain
during the procedure. Which of the following responses by the nurse is appropriate?
a. After you have signed the consent form, we can talk more about this
b. Don't worry, most patients dislike the prep more than the procedure itself
c. I know you’re anxious, but this procedure is recommended for people your age
d. Before the examination, your provider will give you a sedative that will make you sleepy
58. Which prescribed drug is best for the nurse to give before scheduled open reduction internal
fixation on a patient with a fracture?
a. Ketorolac
b. lorazepam (Ativan)
c. Gabapentin (Neurontin)
d. hydromorphone(Dilaudid)
59. The nurse is reviewing laboratory results on a patient who experienced a large amount of
fluid loss. Which result requires priority action by the nurse?
A. Hematocrit of 53%
b. Serum sodium of 147 mEq/L
c. Serum potassium of 5.9 mEq/L
d. Bun of 37 mg/dL
60. For the patient with fluid loss, which assessment will be the most useful in determining
whether the patient is receiving adequate fluid infusion?
a. Check skin turgor.
b. Monitor daily weight.
c. Assess mucous membrane
d. measure hourly urine output.
61. a young adult patient who is in the rehabilitation phase after having surgical incisions to the
face and neck has a nursing diagnosis of disturbed body image. Which statement by the patient
best indicates that the probation is resolving?
a. “I’m glad the scars are only temporary.”
b. “I will avoid using pillows, so my neck will be Ok.”
c. “Do you think dark beige makeup will cover this scar?”
d. “I don’t think my boyfriend will want to look at me now.”
62. The nurse caring for the patient during the wound healing phase should be aware of which of
the following cause of hypernatremia? (SATA)
a. Vomiting or diarrhea
b. Prolonged GI suction
c. Improper tube feedings
d. Successful fluid replacement
e. inappropriate fluid administration
63. The nurse is caring for a patient with possible hypovolemia. Which assessment data will be
of most concern to the nurse?
a. urine output is 30 mL/hr.
b. Blood pressure is 90/40 mm Hg.
c. Oral fluid intake is 100 mL for the past 8 hours.
d. There is prolonged skin tenting over sternum.
64. The nurse interviews a patient scheduled to undergo anesthesia for bilateral hernia repair.
Which information is most important to communicate to the surgeon and anesthesiologist before
surgery?
a. The patient drinks 3 cups of coffee every morning before going to work.
b. the patient’s father died after general anesthesia for abdominal surgery.
c. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago.
d. the patient drank 4 ounces of apple juice 3 hours before coming to the hospital.
65. which statement by a patient schedule for surgery is most important to report to the health
care provider?
a. “I have a strong family history of cancer.”
b. “I had a heart valve replacement last year.”
c. “I had bacterial pneumonia 3 months ago.”
d. “I have knee pain whenever I walk or jog.”
66. Which topic is most important for the nurse to discuss preoperatively with a patient who is
scheduled for an open cholecystectomy?
a. care for the surgical incision
b. Deep breathing and coughing
c. oral antibiotic therapy after discharge
d. medications to be used during surgery
67. A Patient who takes a diuretic B-blocker to control blood pressure is scheduled for breast
reconstruction surgery. Which patient information is most important to communicate to the
health care provider before surgery?
a. Hematocrit 36%
b. Blood pressure 144/ 82
c. Serum potassium 3.3 mEq/L
d. Pulse rate 54-58 beats/minute
68. A patient who has diabetes and uses insulin to control blood glucose has been NPO since
midnight before having a knee replacement surgery. Which action should the nurse take?
a. Withhold the usual scheduled insulin dose because the patient is NPO.
b. Obtain a blood glucose measurement before any insulin administration.
c. Give the patient the usual insulin does because stress will increase the blood glucose.
d. Give half the usual dose of insulin because there will be no oral intake before surgery.
69. A 40-year-old male patient has been newly diagnosed with type 2 diabetes mellitus.
Which information about the patient will be most useful to the nurse who is helping the
patient develop strategies for successful adaptation to this disease?
A. Ideal weight
B. Value system
C. Activity level
D. Visual changes
Feedback: When dealing with a patient with a chronic condition such as diabetes,
identification of the patient's values and beliefs can assist the health care team in
choosing strategies for successful lifestyle change. The other information also will be
useful, but is not as important in developing an individualized plan for the necessary
lifestyle changes.
70. A patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone
on the kidney for hypertension. The nurse will monitor for:
a. increased serum sodium.
b. decreased urinary output.
c. elevated serum potassium.
d. evidence of fluid overload.
71. Which finding indicates a need to contact the health care provider before the nurse administer
metformin (Glucophage)? (SATA)
a. The patient’s blood glucose is 174mg/dL.
b. The is currently taking Lisinopril (Zestril)
c. The patient is scheduled for a chest x-ray in an hour.
d. The patient has gained 2 Ib (0.9 kg) in the past 24 hours.
e. The patient’s blood urea nitrogen (BUN) levels is 52 mg/dL.
72. A patient is admitted with tetany. Which laboratory value should the nurse plan to monitor?
a. potassium
b. total protein
c. Blood Glucose
d. Ionized calcium
73. the nurse is caring for a 63-yr-old with a possible pituitary tumor who is scheduled for
computed tomography scan with contrast. Which information about the patient is important to
discuss with the health care provider before the test?
a. History of renal insufficiency
b. complains of chronic headache
c. Recent bilateral visual field loss
d. Blood glucose level of 174 mg/dL
74. The nurse reviews a patient's glycosylated hemoglobin (A1C) results to evaluate
a. fasting preprandial glucose levels.
b. glucose levels 2 hours after a meal.
c. glucose control over the past 90 days.
d. hypoglycemic episodes in the past 3 months.
Feedback: Glycosylated hemoglobin testing measures glucose control over the last 3
months. Glucose testing before/after a meal or random testing may reveal impaired
glucose tolerance and indicate prediabetes, but it is not done on patients who already
have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in
the past.
75. what glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with
a creatinine clearance result of 60 mL/min?
a .60 mL/min
b. 90 mL/min
c. 120 mL/min
d. 180 mL/min