MED SURG 201 Medical Surgical Final Exam- Questions and Answers; West Coast University

MED SURG 201 Medical Surgical Final Exam- Questions and Answers; West Coast University/MED SURG 201 Medical Surgical Final Exam- Questions and Answers; West Coast University/MED SURG 201 Medical Surgical Final Exam- Questions and Answers; West Coast University

FINAL EXAM PASADO

4. A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes

mellitus is scheduled for discharge the second day after admission. When implementing patient

teaching, what is the priority action forthe nurse?

a. Instruct about the increased risk for cardiovascular disease.

b. Provide detailed information about dietary control of glucose.

c. Teach glucose self-monitoring and medication administration.

d. Give information about the effects of exercise on glucose control.

ANS: C

When time is limited, the nurse should focus on the priorities of teaching. In this situation, the

patient should know how to test blood glucose and administer medications to control glucose

levels. The patient will need further teaching about the role of diet, exercise, various

medications, and the many potential complications of diabetes, but these topics can be addressed

through planning for appropriate referrals.

14. A 75-year-old patient is admitted for pancreatitis. Which tool would be the most appropriate

for the nurse to use during the admission assessment?

a. Drug Abuse Screening Test (DAST-10)

b. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

c. Screening Test-Geriatric Version (SMAST-G)

d. Mini-Mental State Examination

ANS: C

Because the abuse of alcohol is a common factor associated with the development of

pancreatitis, the first assessment step is to screen for alcohol use using a validated screening

questionnaire. The SMAST-G is a short-form alcoholism screening instrument tailored

specifically to the needs of the older adult. If the patient scores positively on the SMAST-G, then

the CIWA-Ar would be a useful tool for determining treatment. The DAST-10 provides more

general information regarding substance use. The Mini-Mental State Examination is used to

screen for cognitive impairment.

1. The sister of a patient diagnosed with BRCA gene–related breast cancer asks the nurse, “Do

you think I should be tested for the gene?” Which response by the nurse is most appropriate?

a. “In most cases, breast cancer is not caused by the BRCA gene.”

b. “It depends on how you will feel if the test is positive for the BRCA gene.”

c. “There are many things to consider before deciding to have genetic testing.”

d. “You should decide first whether you are willing to have a bilateral mastectomy.”

ANS: C

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Although presymptomatic testing for genetic disorders allows patients to take action (such as

mastectomy) to prevent the development of some genetically caused disorders, patients also need

to consider that test results in their medical record may affect insurance, employability, etc.

Telling a patient that a decision about mastectomy should be made before testing implies that the

nurse has made a judgment about what the patient should do if the test is positive. Although the

patient may need to think about her reaction if the test is positive, other issues (e.g., insurance)

also should be considered. Although most breast cancers are not related to BRCA gene mutations,

the patient with a BRCA gene mutation has a markedly increased risk for breast cancer.

7. The nurse in the outpatient clinic has obtained health histories for these new patients. Which

patient may need referral for genetic testing?

a. 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96

b. 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy

c. 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease

d. 50-year-old patient with a history of cigarette smoking who is complaining of dyspnea

ANS: C

The adult form of polycystic kidney disease is an autosomal dominant disorder and frequently it is

asymptomatic until the patient is older. Presymptomatic testing will give the patient information that

will be useful in guiding lifestyle and childbearing choices. The other patients do not have any

indication of genetic disorders or need for genetic testing.

14. An adolescent patient seeks care in the emergency department after sharing needles forheroin

injection with a friend who has hepatitis B. To provide immediate protection from infection, what

medication will the nurse administer?

a. Corticosteroids

b. Gamma globulin

c. Hepatitis B vaccine

d. Fresh frozen plasma

ANS: B

The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The

hepatitis B vaccination series should be started to provide active immunity. Fresh frozen plasma

and corticosteroids will not be effective in preventing hepatitis B in the patient.

6. A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse

what the letters and numbers mean. Which response by the nurse is most appropriate?

a. “The cancer involves only the cervix.”

b. “The cancer cells look almost like normal cells.”

c. “Further testing is needed to determine the spread of the cancer.”

d. “It is difficult to determine the original site of the cervical cancer.”

ANS: A

Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time.

Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is

the cervix. Further testing is not indicated given that the cancer has not spread.

10. External-beam radiation is planned for a patient with cervical cancer. What instructions should the

nurse give to the patient to prevent complications from the effects of the radiation?

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a. Test all stools for the presence of blood.

b. Maintain a high-residue, high-fiber diet.

c. Clean the perianal area carefully after every bowel movement.

d. Inspect the mouth and throat daily for the appearance of thrush.

ANS: C

Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent

diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection.

Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing

of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue

diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

11. The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep

respirations. Which action should the nurse take?

a. Give the prescribed PRN lorazepam (Ativan).

b. Start the prescribed PRN oxygen at 2 to 4 L/min.

c. Administer the prescribed normal saline bolus and insulin.

d. Encourage the patient to take deep, slow breaths with guided imagery.

ANS: C

The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need for correction of the

acidosis with a saline bolus to prevent hypovolemia followed by insulin administration to allow glucose to

reenter the cells. Oxygen therapy is not indicated because there is no indication that the increased

respiratory rate is related to hypoxemia. The respiratory pattern is compensatory, and the patient will not

be able to slow the respiratory rate. Lorazepam administration will slow the respiratory rate and increase

the level of acidosis.

17. The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing

action should the nurse include on the care plan?

a. Maintain the patient on bed rest.

b. Auscultate lung sounds every 4 hours.

c. Monitor for Trousseau’s and Chvostek’s signs.

d. Encourage fluid intake up to 4000 mL every day.

ANS: D

To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mL daily.

Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with

hypercalcemia. Trousseau’s and Chvostek’s signs are monitored when there is a possibility of

hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds, although

these would be assessed every shift.

26. A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction and

is complaining of anxiety and incisional pain. The patient’s respiratory rate is 32 breaths/minute and the

arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first?

a. Discontinue the nasogastric suction.

b. Give the patient the PRN IV morphine sulfate 4 mg.

c. Notify the health care provider about the ABG results.

d. Teach the patient how to take slow, deep breaths when anxious.

ANS: B

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The patient’s respiratory alkalosis is caused by the increased respiratory rate associated with pain and

anxiety. The nurse’s first action should be to medicate the patient for pain. Although the nasogastric

suction may contribute to the alkalosis, it is not appropriate to discontinue the tube when the patient needs

gastric suction. The health care provider may be notified about the ABGs but is likely to instruct the nurse

to medicate for pain. The patient will not be able to take slow, deep breaths when experiencing pain.

10. Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled

for abdominal surgery for an open cholecystectomy?

a. Care for the surgical incision

b. Medications used during surgery

c. Deep breathing and coughing techniques

d. Oral antibiotic therapy after discharge home

ANS: C

Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on

patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of

completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this

information. The patient does not usually need information about medications that are used intraoperatively.

15. The nurse is caring for a patient the first postoperative day following a laparotomy for a small bowel

obstruction. The nurse notices new bright-red drainage about 5 cm in diameter on the dressing. Which

action should the nurse take first?

a. Reinforce the dressing.

b. Apply an abdominal binder.

c. Take the patient’s vital signs.

d. Recheck the dressing in 1 hour for increased drainage.

ANS: C

New bright-red drainage may indicate hemorrhage, and the nurse should initially assess the patient’s vital

signs for tachycardia and hypotension. The surgeon should then be notified of the drainage and the vital

signs. The dressing may be changed or reinforced, based on the surgeon’s orders or institutional policy.

The nurse should not wait an hour to recheck the dressing.

38. Which prescribed medication should the nurse give first to a patient who has just been admitted to

a hospital with acute angle-closure glaucoma?

a. Morphine sulfate 4 mg IV

b. Mannitol (Osmitrol) 100 mg IV

c. Betaxolol (Betoptic) 1 drop in each eye

d. Acetazolamide (Diamox) 250 mg orally

ANS: B

The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly

with IV administration of a hyperosmolar diuretic such as mannitol. The other medications are also

appropriate for a patient with glaucoma but would not be the first medication administered.

8. A patient’s capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral

nutrition (PN) infusion. The most appropriate actionby the nurse is to

a. obtain a venous blood glucose specimen.

b. slow the infusion rate of the PN infusion.

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