Back of Book Questions for Med Surg Final

A patient with a T4 spinal cord injury has neurogenic shock due to sympathetic nervous system dysfunction. What would the nurse recognize as characteristic of this condition? A. Tachycardia B. Hypotension C. Increased cardiac output D. Peripheral vasoconstriction

B. Hypotension

The nurse suspects a neurovascular problem based on assessment of A. exaggerated strength with movement. B. increased redness and heat below the injury. C. decreased sensation distal to the fracture site. D. purulent drainage at the site of an open fracture.

C. decreased sensation distal to the fracture site.

A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects early compartment syndrome when the patient has A. increasing edema of the limb. B. muscle spasms of the lower arm. C. bounding pulse at the fracture site. D. pain when passively extending the fingers.

D. pain when passively extending the fingers.

What nutrition intervention may promote wound healing for a patient with a 10% burn injury? a. Eat a high-protein, high-carbohydrate diet b. Increase normal caloric intake by about 4 times c. Eat at least 1500 calories/day in small, frequent meals d. Eat a lactose-free diet to reduce the potential for diarrhea

a. Eat a high-protein, high-carbohydrate diet

A patient is hospitalized with burns to his head, neck, and anterior and posterior chest after an explosion in his garage. The respiratory therapist applied a non-rebreather mask. On assessment, the nurse auscultates wheezes throughout the lung fields. On reassessment, the wheezes are gone, and the breath sounds are greatly decreased. Respiratory rate is 6/min. Oxygen saturation decreases to 88%. The patient is unresponsive. What is the priority nursing intervention? a. Notify the HCP and get ready for intubation. b. Encourage the patient to cough and auscultate the lungs again. c. Obtain vital signs, oxygen saturation, and a STAT arterial blood gas. d. Document the findings and continue to monitor the patient's breathing

a. Notify the HCP and get ready for intubation.

What nursing interventions can be used to manage burn pain? (select all that apply) a. Suggest pain management options. b. Use a pain-rating tool to monitor the patient's level of pain. c. Delay painful dressing changes until the patient's pain is completely relieved. d. Use a multimodal approach (e.g., sustained-release and short-acting opioids, NSAIDs, adjuvant analgesics). e. Provide nonpharmacologic therapies (e.g., music therapy, distraction) to replace opioids in the acute phase of a burn injury.

a. Suggest pain management options. b. Use a pain-rating tool to monitor the patient's level of pain. d. Use a multimodal approach (e.g., sustained-release and short-acting opioids, NSAIDs, adjuvant analgesics).

A patient has 25% TBSA burn from a car fire. His wounds have been debrided and covered with a silver-impregnated dressing. What is the most important nursing intervention following surgery? a. Wash the wound with soap and water 3 times a day. b. Medicate for pain relief in between dressing changes. c. Reapply a new dressing without disturbing the wound bed. d. Assess the wound for signs of infection during dressing changes.

d. Assess the wound for signs of infection during dressing changes.

The nurse's first priority in managing the care of the patient with severe renal colic is to A. administer opioids as prescribed. B. obtain supplies for straining all urine. C. encourage fluid intake of 3 to 4 L/day. D. keep the patient NPO in preparation for surgery.

A. administer opioids as prescribed.

During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment of A. airway patency. B. presence of a neck injury. C. neurologic status with the Glasgow Coma Scale. D. cerebrospinal fluid leakage from the ears or nose.

A. airway patency.

The nurse would monitor a patient with a pelvic fracture for A. changes in urine output. B. petechiae on the abdomen. C. a palpable lump in the buttock. D. sudden increase in blood pressure.

A. changes in urine output.

Treatment for cardiogenic shock includes (select all that apply) A. dobutamine to increase myocardial contractility. B. vasopressors to increase systemic vascular resistance. C. circulatory assist devices such as an intraaortic balloon pump. D. corticosteroids to stabilize the cell wall in the infarcted myocardium. E. Trendelenburg positioning to facilitate venous return and increase preload.

A. dobutamine to increase myocardial contractility. C. circulatory assist devices such as an intraaortic balloon pump.

A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by A. formation of callus. B. complete bony union. C. hematoma at the fracture site. D. presence of granulation tissue.

A. formation of callus.

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes (select all that apply) A. teaching the patient to use Kegel exercises. B. clamping and releasing a catheter to increase bladder tone. C. teaching the patient biofeedback mechanisms to train pelvic floor muscles. D. counseling the patient concerning choice of incontinence containment device. E. developing a fluid modification plan, focusing on decreasing intake before bedtime.

A. teaching the patient to use Kegel exercises. C. teaching the patient biofeedback mechanisms to train pelvic floor muscles.

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) A. hypotension. B. ECG changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity.

B. ECG changes. D. pulmonary edema.

A patient with lung cancer develops SIADH. Which are anticipated findings? A. Hypernatremia and hyperkalemia B. Thirst, muscle cramping, and headache C. High urine output, weight gain, and vomiting D. Weight gain and decreased glomerular filtration rate

B. Thirst, muscle cramping, and headache

Which factor from the patient's history does the nurse identify as a risk factor for kidney and bladder cancer? A. Aspirin use B. Tobacco use C. Chronic alcohol use D. Use of artificial sweeteners

B. Tobacco use

Vasogenic cerebral edema increases intracranial pressure by A. shifting fluid in the gray matter. B. disrupting the blood-brain barrier. C. leaking molecules from the intracellular fluid to the capillaries. D. altering the osmotic gradient flow into the intravascular component.

B. disrupting the blood-brain barrier.

Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing A. beef. B. meat and milk. C. poultry and eggs. D. home-preserved vegetables.

B. meat and milk.

A 78-year-old man with a history of diabetes has confusion and temperature of 104°F (40°C). There is a wound on his right heel with purulent drainage. After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow; CO 8 L/min; and PAWP 4 mm Hg. This patient's symptoms are most likely indicative of A. sepsis. B. septic shock. C. multiple organ dysfunction syndrome. D. systemic inflammatory response syndrome.

B. septic shock.

The nurse teaches the female patient who has frequent UTIs to A. take tub baths with bubble bath. B. void before and after sexual intercourse. C. take prophylactic sulfonamides for the rest of her life. D. restrict fluid intake to prevent the need for frequent voiding.

B. void before and after sexual intercourse.

A patient with spinal cord injury has severe neurologic deficits. What is the most likely mechanism of injury for this patient? A. Compression B. Hyperextension C. Flexion-rotation D. Extension-rotation

C. Flexion-rotation

When a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia

C. Hypokalemia and hyponatremia

The nurse on the clinical unit is assigned to 4 patients. Which patient should she assess first? A. Patient with a skull fracture whose nose is bleeding B. A patient with an acute stroke who is confused and whose daughter is present C. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0 to 10 scale D. Patient 2 days postoperative after a craniotomy for a brain tumor who has had continued vomiting

C. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0 to 10 scale

After thyroid surgery, the nurse suspects damage of the parathyroid glands when the patient develops A. hyperthermia and severe tachycardia. B. hypercalcemia and shortness of breath. C. laryngospasms and tingling in the hands and feet D. hypophosphatemia, hypertension, vomiting, and chest pain.

C. laryngospasms and tingling in the hands and feet

A patient undergoing rehabilitation for a C7 spinal cord injury tells the nurse he must have the flu because he has a bad headache and nausea. The nurse's first priority is to A. call the health care provider. B. check the patient's temperature. C. measure the patient's blood pressure. D. elevate the head of the bed to 90 degrees.

C. measure the patient's blood pressure.

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when A. the patient cannot tolerate prolonged immobilization. B. the patient cannot tolerate the surgery for a closed reduction. C. other nonsurgical methods cannot achieve adequate alignment. D. a temporary cast would be too unstable to provide normal mobility.

C. other nonsurgical methods cannot achieve adequate alignment.

A patient who ran his first marathon had heel pain that would not resolve and was diagnosed with calcaneus stress fracture. The nurse will teach the patient to (select all that apply) A. resume running in 1 week. B. rest and refrain from running. C. wear a shoe heel pad when ambulating. D. walk barefoot to decrease pressure on the heel. E. apply ice to the heel and take NSAIDs as directed by HCP.

C. wear a shoe heel pad when ambulating.

A patient with extreme obesity has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse expects that the patient A. may have severe diarrhea early in the postoperative period. B. will not be allowed to ambulate for 1 to 2 days postoperatively. C. will have small amounts of oral liquids within the first 24 hours. D. will require nasogastric suction until the drainage is pale yellow.

C. will have small amounts of oral liquids within the first 24 hours.

This bariatric surgical procedure involves creating a gastric pouch that is reversible, and no malabsorption occurs.Which procedure is this? A. Vertical gastric banding B. Biliopancreatic diversion C. Roux-en-Y gastric bypass D. adjustable gastric banding

D. adjustable gastric banding

The nurse recommends genetic counseling for the children of a patient with A. nephrotic syndrome. B. chronic pyelonephritis. C. malignant nephrosclerosis. D. adult-onset polycystic kidney disease.

D. adult-onset polycystic kidney disease.

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are A. blood pressure, pulse, and respirations. B. breath sounds, blood pressure, and body temperature. C. pulse pressure, level of consciousness, and pupillary response. D. level of consciousness, urine output, and skin color and temperature.

D. level of consciousness, urine output, and skin color and temperature.

A patient has a spinal cord injury at T4. Vital signs include falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing A. a relative hypervolemia. B. an absolute hypovolemia. C. neurogenic shock from low blood flow. D. neurogenic shock from massive vasodilation.

D. neurogenic shock from massive vasodilation.

The nurse is teaching the patient and family that peptic ulcers are A. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori. B. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. C. promoted by factors that cause oversecretion of acid, such as excess diet fats, smoking, and alcohol use. D. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.

D. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.

The nurse using RIFLE to determine the early stage of AKI evaluates the patient's A. blood pressure and urine osmolality. B. fractional excretion of urinary sodium. C. estimation of GFR with the MDRD equation. D. serum creatinine or urine output from baseline.

D. serum creatinine or urine output from baseline.

The nurse in urgent care suspects an ankle sprain when a patient describes A. being hit by another soccer player during a game. B. having ankle pain after sprinting around the track. C. dropping a 10-lb weight on his lower leg at the health club. D. twisting his ankle while running bases during a baseball game.

D. twisting his ankle while running bases during a baseball game.

Which lab result supports the need for additional IV fluid to treat burn shock? a. Hematocrit 52% b. Sodium 137 mEq/L c. WBC 12.5 × 109/L d. Potassium 3.4 mmol/L

a. Hematocrit 52%