Medical-Surgical Practice Exam

B. Sitting upright in a tripod position leaning on an overbed table.

The practical nurse (PN) should place a client in which position for a thoracentesis?

C. Pinpoint rash on upper chest that does not blanch.

The practical nurse (PN) is performing a shift assessment of a client with a fractured left hip that occurred in a motor vehicle collision 36 hours ago. Which finding should the PN report to the charge nurse?

C. Elevated serum ammonia

The practical nurse (PN) is reviewing the admission laboratory results for a client with cirrhosis of the liver. Which finding should the practical nurse (PN) report to the healthcare provider?

D. Elevate the arm above the level of the heart.

The practical nurse (PN) is visiting a male client with diabetes who has a new cast on his arm. The client's fingers are pale, cool, slightly swollen, and the radial pulse is strong. What should the PN do first?

A. Check the pulse oximeter for a client with myasthenia gravis.

The practical nurse (PN) receives a report on a group of clients assigned for the day. Which priority assessment should the PN implement?

C. Continue to monitor client's blood pressure.

The practical nurse is caring for a client who is admitted with signs of possible acute brain attack (Stroke) three hours ago. The client's blood pressure is 170/96, regular radial pulse 76 beats/minute, respirations are nonlabored at 11 breaths/minute, and a Sp02 of 99%. What action is most important for the PN to implement?

B. Brain tumors increase cerebral mass, resulting in increased intracranial pressure.

The wife of a client with a large brain tumor asks the practical nurse (PN) to explain why the tumor should be surgically removed. What is the best response for the PN to provide?

A. Exercise the affected arm everyday.

A client who received graphs for a full-thickness burn of the right arm is admitted to the rehabilitation unit. Which action is important for the practical nurse to reinforce with the client to prevent long-term complications?

B. No vomiting with oral fluid intake.

A client who has vomiting, dysuria, and urinary tract infection (UTI) arrives in the clinic and receives an IV antiemetic and a liter of IV fluids. The healthcare provider prescribes oral antibiotics for the client's discharge. Which finding is essential for the practical nurse to determine before the client is discharged?

D. An indwelling catheter is sometimes prescribed to alleviate symptoms.

A 60-year-old client with benign prostatic hyperplasia (BPH) has been up to the bathroom six times during the night. The client asked the practical nurse (PN) if there is something the healthcare provider can do to help him with this problem before he has a transurethral resection of the prostate (TURP). What information should the PN offer?

A. 500/mm3.

A practical nurse (PN) is coordinating the care of four clients on an oncology unit. Which neutrophil count should the PN identify as a risk for a life-threatening infection in one of the clients?

C. Unilateral neglect.

After a stroke, a male client with left hemiplegia ignores his left leg and arm. He is unable to use his right arm to assist with moving his left arm or leg. Which descriptor should the practical nurse (PN) document to describe this behavior?

C. Surgery can restore vision with corrective lens implants or glasses.

An older client who has had a cataract in the right eye for several years tells the practical nurse (PN), "Now I have lost the sight in my right eye because I waited too long for treatment." What information should the PN provide?

C. Corrects vision for reading and close work.

An older client with presbyopia receives a prescription for corrective lenses. Which information should the practical nurse provide that explains the expected results of the corrective lenses?

D. Rales auscultated bilaterally.

During the daily assessment of a client with emphysema, the practical nurse (PN) identifies that the client's chest is barrel-shaped and he is demonstrating pursed-lip breathing. Which additional finding requires follow up by the PN?

A. Osteoporisis.

The practical nurse (PN) is implementing a focused assessment of a client's musculoskeletal system. Which family history finding should the PN identify as an increased risk factor for the client?

D. Hypoactive reflexes at the Achilles tendon

The practical nurse (PN) is obtaining deep tendon reflexes for a client with type 1 diabetes mellitus. Which finding indicates to the PN that the client has peripheral neuropathy?

D. Failing to follow medical recommendations.

Which behavior demonstrates hopelessness in an older client with a terminal disease?

D. Breath sounds are clear bilaterally

The practical nurse (PN) is performing a focused assessment for a postoperative client who returns to the unit after receiving general anesthesia. Which finding should the PN identify as an indicator that the client is free of respiratory complication?

D. Pain medication should be taken every day.

The practical nurse (PN) is reviewing discharge instructions with a client after out-patient surgery. Which client response indicates to the PN the need for teaching reinforcement?

B. Peritonitis

Which client medical diagnosis is a contraindication for peritoneal dialysis in a client with chronic renal failure?

B. Infection

What complication is most important for the practical nurse to monitor for in a client who has a total hip replacement?

A. Tracheostomy tray.

What equipment should the practical nurse (PN) ensure is in the room for a client after a thyroidectomy?

C. Diabetes increases the risk for cardiovascular disease.

What information should the practical nurse (PN) reinforce with a client who is recently diagonsed with diabetes mellitus (DM)?

B. Prescribed exercises should be performed daily.

What information should the practical nurse reinforce while reviewing discharge instructions with a client who has a joint dislocation?

B. An older female who does not use estrogen replacement.

Which client should the practical nurse consider at greatest risk for bacterial cystitis?

D. Review laboratory results for serum calcium and magnesium levels.

A client who received several units of blood for a hemorrhagic event is reporting muscle cramps and tingling sensation. Which action should the practical nurse implement?

D. Reports the hospital room is an office.

A client who was hit in the head with a baseball is admitted to the hospital for observation. Which finding requires the practical nurse (PN) to follow-up with further assessment?

A. The client has vomited.

Which finding prompts the practical nurse (PN) to check the nasogastric tube (NGT) placement?

C. Vomiting

A male client who is unconscious after blunt trauma to the head during a baseball game is admitted for observation for possible epidural hematoma. The client is awake and oriented at each hourly check and becomes more difficult to arouse. Which additional finding should the practical nurse report?

B. Check the respiratory effort and pulse oximeter reading.

A client is admitted with a C4 spinal cord injury (SCI) after falling from a roof at a construction site. After returning to the unit for a CT scan to confirm the vertebral fracture, which assessment by the practical nurse has the highest priority?

1. Maintain the client's airway 2. Apply pads to the bedside rails. 3. Avoid stimulation during post-ictal phase. 4. Observe the client for incontinence.

A client with epilepsy is having bilateral rhythmic jerking movements of all extremities. After calling for help, which action should the practical nurse (PN) do next?

D. Sleeps with two additional pillows.

A client with heart failure (HF) takes a daily tablet of furosemide (Lasix) and lisinopril (Zestril). Which finding during the clinic visit should indicate to the practical nurse that the client's condition is worsening?

D. Absense of blood in the stool.

A client with major burns is receiving cimetidine (Tagamet). Which finding should the practical nurse (PN) obtain to best evaluate the effectiveness of the medication?

A. Role play a situation the client identifies as stressful.

A client with newly diagnosed essential hypertension is learning to cope with stressful situations in his life. Which activity should the practical nurse (PN) implement to help the client learn constructive coping?

D. Fingerstick glucose level

A client with type 2 diabetes mellitus (DM) presents in the clinic with a leg laceration that has not healed in two weeks. Which client data is most important for the practical nurse to collect?

B. Institute bleeding precautions

A client's results for this morning's platelet count is 30,000/mm3. What action should the practical nurse (PN) implement first?

D. Keep the client NPO for possible surgery.

A male client is admitted with lower right abdominal pain for the past two days. During the focused assessment, the practical nurse (PN) observes that the client's abdomen is rigid with tense positioning. Which action should the PN implement?

B. A topical anesthetic will be used on the eye surface.

A male client is having an intraocular pressure (IOP) measurement using a tonometer for the first time. The client is fearful that the test hurts and may damage his vision. Which explanation should the practical nurse provide?

B. Offer the client the commode or urinal every two hours.

A male client who had a stroke is incontinent of urine. Which action should the practical nurse (PN) implement in providing bladder training?

D. The four-drug protocol should be taken concurrently.

A male client who has been taking a four-drug regiment for tuberculosis (TB) tells the practical nurse (PN) that he has finished the first drug, isoniazid, and will start taking rifampin next. How should the PN respond?

D. The pain is immediately relieved when he sits down.

A male client with diabetes mellitus calls the clinic to report left calf pain after walking around the block. Which additional information should the PN report to the healthcare provider?

B. Raise the head 30 degrees and lower the feet.

A male client with increased intracranial pressure (ICP) due to a skull fracture is in the supine position with his legs elevated. What should the practical nurse (PN) do first?

B. Verify that the client is able to swallow.

Before implementing oral feedings for a client who has had a stroke, which action should the practical nurse (PN) implement?

D. Distended neck veins while upright.

Which finding for a client with heart failure (HF) should the practical nurse (PN) report to the charge nurse?

A. Right calf is 24 cm and left calf is 21 cm.

Which finding is most important for the practical nurse (PN) to explore further for a client who had a total abdominal hysterectomy and bilateral oophorectomy yesterday?

A. Pain relief after ear drainage begins.

An adult client with otitis media has thick, yellow drainage from the right ear canal. What additional findings should the practical nurse (PN) expect to identify?

D. Apply oxygen and inspect the chest wall.

An adult male who is covered with "road rash" after falling off his bicycle arrives at the clinic. He holds his hand to his chest and tells the practical nurse (PN) that he hurts when he breathes. The PN hears an audible "slurping" sound each time the client takes a breath. Which intervention should the PN implement first?

C. Joint damage can occur from years of weight-bearing stress.

An older male client with osteoarthritis complains of stiffness and pain in his hips, knees and feet each morning and asks the practical nurse (PN) why just these joints bother him. Which explanation should the PN provide?

B. Apply oxygen per nasal cannula at 2 L/minute.

An older male with a history of emphysema arrives to the emergent care center with complaints of increasing dyspnea on exertion. The client's chest has an increased anteroposterior diameter, a dry, hacking cough, and pulse oximetry of 89%. What action should the practical nurse take?

B. Add sterile water to the suction control chamber to the 20 cm mark.

The practical nurse (PN) is caring for a client with a chest tube connected to a closed chest drainage system to suction at 20 cm of water pressure. The sterile water in the suction chamber is gently bubbling at the water level of 15 cm. What action should the PN take?

A. Use pursed-lip and abdominal breathing.

The practical nurse (PN) is caring for a client with chronic obstructive pulmonary disease (COPD). To reduce carbon dioxide (CO2) retention in the lungs, which information should the PN reinforce?

D. Check the client's groin.

What is the immediate assessment the practical nurse (PN) should implement for a client who returns to the unit after a cardiac catheterization?

D. Respiratory pattern and airway.

What is the priority data that the practical nurse (PN) should obtain for a client with a cervical spinal cord injury?

C. Change the transparent dressing every 72 hours.

Which action should the practical nurse (PN) implement to reduce the risk of infection for a client who is receiving total parenteral nutrition (TPN)?

C. 50-year-old with Prinzmetal's angina.

Which client should the practical nurse question a PRN prescription for sumatriptan (Imitrex) for migraine headaches?

D. Bleeding precautions.

A client who experienced a thrombolic stroke has received recombinant tissue plasminogen activator (TPA)(Alteplase) two hours ago in the emergency center. Which priority precaution should the practical nurse implement for this client on admission to the medical unit?

B. Metabolic alkalosis

A client who is 2-days postoperative for abdominal surgery has a nasogastric tube (NGT) to low continuous suction. The client tells the practical nurse (PN) his mouth is so dry that he has been drinking water to quench his thirst. Which potential imbalance should the PN monitor for development in the client?

C. Hard, rigid abdomen.

A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the practical nurse to report to the healthcare provider?

D. Assist the client into a Fowler's position.

A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/minute. During the bed bath, the client complains of shortness of breath. Which action should the practical nurse (PN) implement?

C. What do you know about the surgery you are having?

The practical nurse (PN) is reviewing preoperative instructions with a male client who is having surgery today. What question should the PN ask the client to best evaluate his understanding of the surgery?

D. Atrial fibrillation.

The practical nurse (PN) is reviewing the health history of a client with coronary artery disease (CAD). Which finding should the PN identify that places the client at risk for stroke?

C. Disturbed body image.

The practical nurse (PN) is reviewing the plan of care for a client scheduled for a surgical amputation of the left lower leg. Which nursing diagnosis should the PN use as the highest priority for this client after the surgery?

A. Use sugarless gum and candy to increase salivary secretions.

The practical nurse (PN) is caring for a client who is receiving radiotherapy for cancer of the larynx. Which information should the PN provide the client to reduce the undesirable effects of radiation?

C. A client with asthma who is coughing and has distant auscultated breath sounds.

The practical nurse (PN) is completing focused assessments for four clients. Which client finding should be the PN's first priority?

B. The salt water solution is dated 3 days ago.

The practical nurse (PN) is evaluating the self-care of a client who is recovering at home after a laryngectomy. Which finding indicates to the PN that the client needs additional information?

D. A low-dose aspirin given daily.

The practical nurse (PN) is reinforcing information to a older male client with a history of coronary artery disease about his prescribed daily medication regimen. Which medication is most likely to reduce the client's risk factors?

B. Implement droplet precautions

The practical nurse (PN) is reviewing laboratory results for a client admitted with possible meningitis and identifies that the cerebrospinal fluid (CSF) findings are positive for bacteria. Which action is most important for the PN implement?

B. Pre-menopausal breast cancer in her mother.

Which factor should the practical nurse (PN) identify that indicates a client needs to be screened for an aggressive breast cancer?

A. High pitched expiratory sound.

Which finding for a client who is 1-day postoperative for a partial thyroidectomy requires immediate follow-up by the practical nurse (PN)?

B. Hemoglobin of 10 grams/dl

Which finding should the practical nurse (PN) identify as typical for a client who is hypoxic?

B. Smooth, beefy-red oral cavity. D. Paresthesia of hands and feet.

Which findings should the practical nurse identify in a client with anemia due to a vitamin B12 deficiency? (Select all)

B. Avoid wearing tight-fitting jeans. C. Limit caffeine and alcohol. D. Void before and after intercourse E. Wipe the perineum from front to back.

Which information should the practical nurse (PN) offer a female client who is at risk for recurrent urinary tract infection (UTI)? Select all

C. Tilt the chin forward toward the chest when swallowing.

Which information should the practical nurse (PN) reinforce with a client with a tracheostomy who is learning self-feeding?

D. Check digitally for a bowel impaction.

The practical nurse (PN) auscultates the abdomen of a client who had a barium swallow 24 hours ago and determines the client has decreased bowel sounds. The client reports having no bowel movements for 2 days. Which nursing intervention should the PN implement?

C. Assess the placement of the NGT.

The practical nurse (PN) determines that a client's nasogastric tube (NGT), which is attached to low intermittent suction, has a decreased amount of drainage in the collection unit. Gastric secretions have pooled in the tubing and do not move with the onset of intermittent suction. Which action should the PN implement?

C. Minimize exposure to sunlight during therapy.

The practical nurse (PN) is reviewing the side effects associated with chlopromazine (Thorazine) rectal suppository for a client with nausea and vomiting. Which information should the PN review with the client?

C. Avoid using ice packs on the exposed area.

Which instruction should the practical nurse (PN) reinforce with a female client about skin care after her first radiotherapy treatment?

A. Request the use of special hand scanning at airports. C. Do not lean against the car while the engine is running. D. Keep the regularly scheduled follow-up appointments.

Which instructions should the practical nurse (PN) reinforce with a client who is preparing for discharge after placement of a permanent pacemaker implant? Select all

D. Impaired gas exchange related to altered blood flow to alveoli

A male client is one day postoperative for surgical repair of a fractured femur when he suddenly experiences dyspnea, coughing, chest pain, and hemoptysis. Based on this data, what nursing diagnoses should the practical nurse address for this client?

B. A negative result for occult blood does not rule out lesions in the colon.

A male client receives the negative results for his recent fecal occult blood test and calls the clinic to cancel his colonoscopy scheduled for the next day. Which information should the practical nurse provide?

C. Assess the client's respiratory status.

A male client returns to the surgical nursing unit after having a thyroidectomy. Which action is most important for the practical nurse to implement?

D. Suggest a referral for the client to have hospice care provided in their home.

A male client with metastatic gastric cancer is being discharged home, but the client and family members are fearful of managing the client's symptoms at home. What action should the practical nurse provide?

D. Notify the healthcare provider

A male client with peptic ulcer disease complains of feeling weak and dizzy. The practical nurse (PN) observes that the client is diaphoretic, has a firm abdomen, thready pulse at 104 beats/minute, and blood pressure of 90/50. Which action should the PN implement?

D. It is a combination of wear and tear and calcium loss that causes the change.

An older female client with osteoporosis asks the practical nurse (PN) to explain why she is now 2 inches shorter than when she was younger. What information is best for the practical nurse (PN) to provide?

C. Ice application and elevation.

Which actions should the practical nurse implement for a client whose fractured tibia is causing swelling of the lower leg?

C. Palpation of both pedal pulses.

Which assessment is most important for the practical nurse (PN) to implement for a client who returns from surgery for an arthroscopic repair of the right knee?

B. Place an isolation mask on the client.

A client arrives at the oncology clinic for the next treatment in the prescribed course of chemotherapy (CT). The practical nurse (PN) reviews the client's laboratory results: white blood cells 700/mmd, red blood cells 2.8 million/mm3, hemoglobin 7.9 grams/dl, hematocrit 25.5%, and platelet count 14,000/mm3. Which action should the PN take first?

C. My incision will probably be painful.

A client is scheduled for transurethral resction of the prostate (TURP). What statement by the client reveals to the practical nurse that the client needs additional information?

B. Notify the healthcare provider.

A male client with a crushing injury of the right lower leg from a tractor accident complains of numbness and tingling in his right leg and foot. The practical nurse (PN) determines the right leg is pale and he has a weak pedal pulse. What action should the PN take?

D. Urticaria on the neck and chest.

A client is receiving a unit of packed red blood cells (RBC's). Which finding should the practical nurse (PN) report to the healthcare provider?

A. Implement standard precautions with the CSF specimen.

Which action should the practical nurse take when handling a sample of cerebrospinal fluid (CSF) collected for diagnostic testing from a client?

C. Decrease oxygen flow rate to 2 liter/minute and attach pulse oximeter.

After receiving report, the practical nurse (PN) begins assessment for a client with chronic obstructive pulmonary disease (COPD) who has just completed a respiratory treatment. The PN finds the client sitting upright in bed with oxygen at 6 liters/minute per nasal cannula. Which intervention is most important for the PN to implement?

A. Have the client remain on-site for 30 minutes after the injections.

Which intervention is most important for the practical nurse to implement after giving a client an initial injection for the screening for allergies?

B. Asks questions regarding the surgical experience

While completing preoperative preparation for a client admitted for same-day surgery, what evaluation statement should the practical nurse identify as an important outcome?

A. Notify the healthcare provider of the changes

A male client who is 6 hours post radical nephrectomy has a urine output of 20 ml/hour and his blood pressure has changed from 134/90 to 100/56 in the past hour. Which action should the PN implement?

D. Report the change in condition to the healthcare provider.

A client who is 3 days postoperative after a laminectomy is coughing up thick green sputum and wheezing. What action is most important for the practical nurse (PN) to implement?

C. Degeneration of the basal ganglia leads to a decrease in dopamine levels.

A client with Parkinson's disease asks the practical nurse (PN) to explain how this disease causes his muscles to malfunction. Which underlying pathophysiology should the PN use as a basis for the explanation

C. International normalized ratio (INR) of 0.9

A client's prescription for warfarin (Coumadin) therapy was discontinued three weeks ago and returns to the clinic for follow-up laboratory tests. Which results should indicate to the practical nurse that the medication has been eliminated from the body?