Final Review Intermediate Medsurg
There is one opening in the schedule at the dermatology clinic, and 4 patients are seeking appointments today. Which patient will the nurse schedule for the available opening? a. 38-year old with a 7-mm nevus on the face that has recently become darker b. 62-year-old with multiple small, soft, pedunculated papules in both axillary areas c. 42-year-old with complaints of itching after using topical fluorouracil on the nose d. 50-year-old with concerns about skin redness after having a chemical peel 3 days ag
a. 38-year old with a 7-mm nevus on the face that has recently become darker
The nurse working in the vision and hearing clinic receives telephone calls from several patients who want appointments in the clinic as soon as possible. Which patient should be seen first? a. 71-year-old who has noticed increasing loss of peripheral vision b. 74-year-old who has difficulty seeing well enough to drive at night c. 60-year-old who has difficulty hearing clearly in a noisy environment d. 64-year-old who has decreased hearing and ear stuffiness without pai
a. 71-year-old who has noticed increasing loss of peripheral vision
The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care? a. Avoid intramuscular injections. b. Encourage increased oral fluids. c. Check temperature every 4 hours. d. Increase intake of iron-rich foods
a. Avoid intramuscular injections.
A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work done.
a. Cook food thoroughly before eating. c. Avoid public transportation such as buses. e. Talk to the oncologist before having any dental work done.
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b.Blood pressure 112/62 mm Hg c.Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level
a. Increased thyroxine (T4) level
A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first? a. Insert a urinary retention catheter. b. Schedule an intravenous pyelogram (IVP). c. Draw blood for a serum creatinine level. d. Administer lorazepam (Ativan) 0.5 mg PO
a. Insert a urinary retention catheter.
A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter. b. Obtain renal ultrasound. c.Draw a complete blood count. d. Infuse normal saline at 50 mL/hour.
a. Insert urethral catheter.
Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation
a. Monitor fluid intake and output.
The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall, and weighs 125 pounds (57 kg). The patient has not seen a healthcare provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening
a. Pap testing c. Sunscreen use d. Mammography e. Colorectal screening
When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patients saline oral rinses. c. The UAP puts fluoride toothpaste on the patients toothbrush. d. The UAP has the patient rinse after meals with a saline sol
a. The UAP assists the patient to use dental floss after eating.
A patient with a right retinal detachment had a pneumatic retinopexy procedure. Which information will be included in the discharge teaching plan? a. The purpose of maintaining the head in a prescribed position b. The use of eye patches to reduce movement of the operative eye c. The need to wear dark glasses to protect the eyes from bright light d. The procedure for dressing changes when the eye dressing is saturated
a. The purpose of maintaining the head in a prescribed position
The nurse should report which assessment finding immediately to the health care provider? a. The tympanum is blue-tinged. b. There is a cone of light visible. c. Cerumen is present in the auditory canal. d. The skin in the ear canal is dry and scaly
a. The tympanum is blue-tinged.
Which information will the nurse provide to the patient scheduled for refractometry? a. You will need to wear sunglasses for a few hours after the exam. b. The surface of your eye will be numb while the doctor does the exam. c. You should not take any of your eye medicines before the examination. d. The doctor will shine a bright light into your eye during the examination
a. You will need to wear sunglasses for a few hours after the exam.
The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a. a warm bath followed by a short rest. b. a short routine of isometric exercises. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.
a. a warm bath followed by a short rest.
The priority nursing diagnosis for a patient experiencing an acute attack with Meniere's disease is a. risk for falls related to dizziness. b. impaired verbal communication related to tinnitus. c. self-care deficit (bathing and dressing) related to vertigo. d. imbalanced nutrition: less than body requirements related to nausea.
a. risk for falls related to dizziness.
The nurse is testing the visual acuity of a patient in the outpatient clinic. The nurses instructions for this test include asking the patient to a. stand 20 feet from the wall chart. b. follow the examiners finger with the eyes only. c. look at an object far away and then near to the eyes. d. look straight ahead while a light is shone into the eyes.
a. stand 20 feet from the wall chart.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134 c. A 53-year-old male who has Addisons disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef). d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) whohas a serum sodium level of 130 mEq/L
b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patients airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.
b. Administer IV calcium gluconate.
Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of corticosteroid eye drops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 1 to 2 days after the surgery
b. Administration of corticosteroid eye drops
8. Which information will the nurse include when preparing teaching materials for patients with exacerbations of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present. b. Application of cold packs before exercise may decrease joint pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.
b. Application of cold packs before exercise may decrease joint pain.
Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a soft toothbrush for oral care. d. Restrict activity to passive and active range of motion.
b. Avoid intramuscular (IM) injections.
Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a No Visitors sign on the door.
b. Check temperature every 4 hours.
A 58-year-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which nursing diagnosis is a priority for the patient? a. Activity intolerance related to rapidly increased weight b. Excess fluid volume related to low serum protein levels c. Disturbed body image related to peripheral edema and ascites d. Altered nutrition: less than required related to protein restriction
b. Excess fluid volume related to low serum protein levels
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
b. Mannitol (Osmitrol) 100 mg IV
When the patient turns his head quickly during the admission assessment, the nurse observes nystagmus. What is the indicated nursing action? a. Assess the patient with a Rinne test. b. Place a fall-risk bracelet on the patient. c. Ask the patient to watch the mouths of staff when they are speaking. d. Remind unlicensed assistive personnel to speak loudly to the patient.
b. Place a fall-risk bracelet on the patient.
A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).
b. Place the patient on a cardiac monitor.
The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene? a. The nurse leaves the eye shield in place. b. The nurse encourages the patient to cough. c. The nurse elevates the patients head to 45 degrees. d. The nurse applies corticosteroid drops to the right eye
b. The nurse encourages the patient to cough.
34. A 31-year-old woman is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which information from the patients health history is important for the nurse to report to the health care provider about the methotrexate? a. The patient had a history of infectious mononucleosis as a teenage b. The patient is trying to get pregnant before her disease becomes more severe. c. The patient has a family history of age-related macular degeneration of the retina. d. The patient has been using large doses of vitamins and health foods to treat the RA.
b. The patient is trying to get pregnant before her disease becomes more severe.
The nurse is performing an eye examination on a 76-year-old patient. The nurse should refer the patient for a more extensive assessment based on which finding? a. The patients sclerae are light yellow. b. The patient reports persistent photophobia. c. The pupil recovers slowly after responding to a bright light. d. There is a whitish gray ring encircling the periphery of the iris
b. The patient reports persistent photophobia.
Which assessment information obtained by the nurse indicates that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone (Deltasone)? a. The patient has joint pain and stiffness. b. The patients blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patients erythrocyte sedimentation rate (ESR) has increased
b. The patients blood glucose is 165 mg/dL.
Which equipment will the nurse obtain to perform a Rinne test? a. Otoscope b. Tuning fork c. Audiometer d. Ticking watch
b. Tuning fork
When a 74-year-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rollingtype tremor, the nurse will anticipate teaching the patient about a. oral corticosteroids. b. antiparkinsonian drugs. c. magnetic resonance imaging (MRI). d. electroencephalogram (EEG) testing
b. antiparkinsonian drugs.
The nurse evaluates that wearing bifocals improved the patients myopia and presbyopia by assessing for a. strength of the eye muscles. b. both near and distant vision. c. cloudiness in the eye lenses. d. intraocular pressure changes
b. both near and distant vision.
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a. bisphosphonates to reduce bone demineralization. b. calcium supplements to normalize serum calcium levels. c. increasing fluid intake to decrease risk for nephrolithiasis. d. including whole grains in the diet to prevent constipation
b. calcium supplements to normalize serum calcium levels.
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a. iron b. folic acid. c. cobalamin (vitamin B) d. ascorbic acid (vitamin C).
b. folic acid
A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c Purplish streaks on the abdomen d. Decreased axillary and pubic hair
c Purplish streaks on the abdomen
Which assessment finding alerts the nurse to provide patient teaching about cataract development? a. History of hyperthyroidism b. Unequal pupil size and shape c. Blurred vision and light sensitivity d. Loss of peripheral vision in both eye
c. Blurred vision and light sensitivity
To decrease the risk for future hearing loss, which action should the nurse who is working with college students at the on-campus health clinic implement? a. Arrange to include otoscopic examinations for all patients. b. Administer influenza immunizations to all students at the clinic. c. Discuss the importance of limiting exposure to amplified music. d. Perform tympanometry on all patients between the ages of 18 to 2
c. Discuss the importance of limiting exposure to amplified music.
A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patients treatment? a. I use aspirin when I have a sinus headache. b. I have had frequent episodes of conjunctivitis. c. I take metoprolol (Lopressor) daily for angina. d. I have not had an eye examination for 10 years.
c. I take metoprolol (Lopressor) daily for angina.
The nurse recording health histories in the outpatient clinic would plan a focused hearing assessment for adult patients taking which medication? a. Atenolol (Tenormin) taken to prevent angina b. Acetaminophen (Tylenol) taken frequently for headaches c. Ibuprofen (Advil) taken for 20 years to treat osteoarthritis d. Albuterol (Proventil) taken since childhood to treat asthma
c. Ibuprofen (Advil) taken for 20 years to treat osteoarthritis
A patient in the dermatology clinic is scheduled for removal of a 15-mm multicolored and irregular mole from the upper back. The nurse should prepare the patient for which type of biopsy? a. Shave biopsy b. Punch biopsy c. Incisional biopsy d. Excisional biopsy
c. Incisional biopsy
After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/L after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5 F (38.1 C) d. Patient who is worried about getting the prescribed long-acting opioid on time
c. Patient who is neutropenic and has a temperature of 100.5 F (38.1 C)
Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness
c. Respiratory effort
Which assessment finding for a 33-year-old female patient admitted with Graves disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8 F (40.4 C) d. Blood pressure 166/100 mm H
c. Temperature 103.8 F (40.4 C)
The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? a. The patient has had blurred vision for 3 years. b. The patient has not eaten anything for 8 hours. c. The patient takes 2 antihypertensive medications. d. The patient gets nauseated with general anesthesia
c. The patient takes 2 antihypertensive medications.
Which laboratory data is important to communicate to the health care provider for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis? a. The blood glucose is 90 mg/dL. b. The rheumatoid factor is positive. c. The white blood cell (WBC) count is 1500/L. d. The erythrocyte sedimentation rate is elevated.
c. The white blood cell (WBC) count is 1500/L.
While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. increased right atrial pressure. d. incompetent jugular vein valves.
c. increased right atrial pressure.
A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy
c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count
d. Absolute neutrophil count
A patient who is taking a potassium-wasting diuretic for treatment of hypertension complains of generalized weakness. It is most appropriate for the nurse to take which action? a. Assess for facial muscle spasms. b. Ask the patient about loose stools. c. Suggest that the patient avoid orange juice with meals d. Ask the health care provider to order a basic metabolic panel
d. Ask the health care provider to order a basic metabolic panel
A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask? a. Are you claustrophobic? b. Are you allergic to shellfish? c. Do you have any metal implants or prostheses? d. Have you taken any bronchodilators in the past 6 hours
d. Have you taken any bronchodilators in the past 6 hours?
When obtaining a health history from a 49-year-old patient, which patient statement is most important to communicate to the primary health care provider? a. My eyes are dry now. b. It is hard for me to see at night. c. My vision is blurry when I read. d. I cant see as far over to the side
d. I cant see as far over to the side
Which statement by the patient to the home health nurse indicates a need for more teaching about self-administering eardrops? a. I will leave the ear wick in place while administering the drops. b. I should lie down before and for 5 minutes after administering the drops. c. I will hold the tip of the dropper above the ear while administering the drops. d. I should keep the medication refrigerated until I am ready to administer the drops
d. I should keep the medication refrigerated until I am ready to administer the drops
A 72-year-old patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective? a. I will need to use bright lights to read for at least the next week. b. I will use drops to keep my pupils dilated until my appointment. c. I will not use facial lotions near my eyes during the recovery period. d. I will cover up with long-sleeved shirts and pants for the next 5 days
d. I will cover up with long-sleeved shirts and pants for the next 5 days
A nurse develops a teaching plan for a patient diagnosed with basal cell carcinoma (BCC). Which information should the nurse include in the teaching plan? a. Treatment plans include watchful waiting. b. Screening for metastasis will be important. c. Low dose systemic chemotherapy is used to treat BCC. d. Minimizing sun exposure will reduce risk for future BCC
d. Minimizing sun exposure will reduce risk for future BCC
The nurse is completing the admission database for a patient admitted with abdominal pain and notes a history of hypertension and glaucoma. Which prescribed medications should the nurse question? a. Morphine sulfate 4 mg IV b. Diazepam (Valium) 5 mg IV c. Betaxolol (Betoptic) 0.25% eyedrops d. Scopolamine patch (Transderm Scop) 1.5 mg
d. Scopolamine patch (Transderm Scop) 1.5 mg
A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? a. Titrate oxygen to keep saturation at least 90%. b. Discuss a high-protein, high-calorie diet with the patient. c. Suggest the use of over-the-counter sedative medications. d. Teach the patient how to effectively use pursed lip breathing
d. Teach the patient how to effectively use pursed lip breathing
A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching? a. The patient has multiple dysplastic nevi. b. The patient is fair-skinned and has blue eyes. c. The patients mother died of a malignant melanoma. d. The patient uses a tanning booth throughout the winter
d. The patient uses a tanning booth throughout the winter
A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse? a. The patients radial pulse is 105 beats/minute. b. There is sediment and blood in the patients urine c. The blood pressure increases from 120/80 to 142/94. d. There are crackles audible throughout both lung fields
d. There are crackles audible throughout both lung fields
A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinsons disease. Which information is most important for the nurse to report to the health care provider? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of limbs d. Uncontrolled head movement
d. Uncontrolled head movement
The nurse in the eye clinic is examining a 67-year-old patient who says I see small spots that move around in front of my eyes. Which action will the nurse take first? a. Immediately have the ophthalmologist evaluate the patient. b. Explain that spots and floaters are a normal part of aging. c. Inform the patient that these spots may indicate retinal damage. d. Use an ophthalmoscope to examine the posterior eye chambers
d. Use an ophthalmoscope to examine the posterior eye chambers
10. The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests that they a. stand rather than sit when performing household and yard chores. b. strengthen small hand muscles by wringing sponges or washcloths. c. protect the knee joints by sleeping with a small pillow under the knees. d. avoid activities that require repetitive use of the same muscles and joints
d. avoid activities that require repetitive use of the same muscles and joints
When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a. family history of coronary artery disease. b. increased risk associated with the patients gender. c. increased risk of cardiovascular disease as people age. d. elevation of the patients low-density lipoprotein (LDL) level
d. elevation of the patients low-density lipoprotein (LDL) level
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a.Hematocrit of 30% b.Platelets of 95,000/L c.Hemoglobin of 10 g/L d.White blood cell (WBC) count of 2700/L
d.White blood cell (WBC) count of 2700/L
