Med-Surg Certification

A patient with end stage renal carcinoma is found by the nurse to be making her funeral preparations. Which stage of Kubler-Ross's five stages of grief would best describe this patient? A. Anger B. Acceptance C. Bargaining D. Depression

B. Acceptance

Rheumatoid arthritis may be treated with all of the following except: A. Methotrexate B. Hydroxychloroquine C. NSAIDs D. Steroids

B. Hydroxychloroquine hydroxy is used for lupus

Cushing's triad, which indicates the risk of cerebral herniation, consists of which of the following signs? A. Hypotension with narrowing pulse pressure, bradypnea and bradycardia B. Hypertension with widening pulse pressure, bradypnea, and bradycardia C. Hypotension, tachycardia and tachypnea D. Hypertension, tachycardia and bradypnea

B. Hypertension with widening pulse pressure, bradypnea, and bradycardia

Chronic kidney disease involves all of the following except: A. Hypermagnesemia B. Hypokalemia C. Hypocalcemia D. Hyperphosphatemia

B. Hypokalemia

Mr. Crafton's abdomen is firmly distended. He is pale and anxious. VS as follows: BP 100/50 (a drop from earlier reading of 130/84), HR 120, temp 38.0C and O2 sat of 92%. He rates his pain a 10/10. You suspect he may have suffered a perforation. What order would you expect the provider to give as a priority? A. 2L O2 via NC B. IVF C. morphine 2mg IV D. Abd xray

B. IVF the pt is becoming septic, you need to perfuse and protect body organs

Which statement from a patient with sickle cell disease is most concerning? A. "I am going on a mountain hiking trip in Colorado" B. "I am going to work at a local amusement park" C. "We're thinking of starting a family" D. "I accepted a position as a radiology tech"

A. "I am going on a mountain hiking trip in Colorado" high altitudes pose a risk for sickle cell disease bc there is less atmospheric oxygen

A 25-year old patient is being discharged after undergoing a repair of a cerebral aneurysm. Prior to admission the patient had had no pertinent medical problems or family history and has had a healthy lifestyle. Which of the following is the most important thing to tell the family members? A. "Immediate family members should be screened for aneurysms" B. "Cigarette smoking plays a large role in the development of aneurysms" C. "This was an isolated event and family members shouldn't be concerned" D. "aneurysms are more common in younger patients"

A. "Immediate family members should be screened for aneurysms" -cigarette smoking is one of the primary causes, is also genetic

The nurse caring for a patient with hypokalemia correctly identifies which of the following as a likely cause: A. Diarrhea B. Constipation C. Blood loss D. Fluid volume overload

A. Diarrhea

The nurse was informed that a patient with a positive Trousseau sign has a calcium level of 4 mg/dl. The nurse recognized that the patient has: A. Hypoparathyroidism B. Hyperparathyroidism C. Hyperthyroidism D. Hypothyroidism

A. Hypoparathyroidism

The most likely cause of acute kidney injury in the hospitalized patient is: A. Hypoperfusion B. Hyperlipidemia C. Hyperkalemia D. Hypernatremia

A. Hypoperfusion

It is hospital policy to assess and record a patient's pulse before administering digoxin (Lanoxin). By auditing the nursing records to determine the frequency of compliance with this policy, the quality assessment and improvement committee is conducting: A. a process analysis. B. a quality analysis. C. a system analysis. D. an outcome analysis.

A. a process analysis.

The most common, preventable complication of abdominal surgery is: A. atelectasis. B. fluid and electrolyte imbalance. C. thrombophlebitis. D. urinary retention.

A. atelectasis.

A 72-year old man underwent a total knee replacement. Prior to surgery he was alert, responsive, and oriented, but 24 hours after surgery he is having fluctuating periods of confusion with sudden changes in consciousness, inability to sustain attention, disorientation, and visual hallucinations. The most effective pharmaceutical intervention is: A. ativan B. Cogentin C. Librium D. Paxil

A. ativan

Which of the following is a symptom of Systemic Lupus Erythematosus? A. butterfly rash over the cheeks B. hypercoagulopathy C. nausea D. weight loss

A. butterfly rash over the cheeks

Mr. Crafton underwent an EGD to assess complaints of epigastric pain and belching. After the procedure which of the following assessments should the nurse perform? A. check for gag reflex B. auscultate bowel sounds C. monitor salivary ph D. measure abd girth

A. check for gag reflex posterior pharynx is anesthetized in order to pass the scope. Assess for return of gag reflex is important.

A 55-year old patient with a known history of tobacco abuse and hypertension has not seen a doctor in over 10 years. He states that he feels fine. Secondary prevention in the patient would include: A. colonoscopy B. education regarding tobacco abuse C. pneumococcal vaccine D. physical exam

A. colonoscopy

A patient with a tracheostomy is to receive the Passy-Muir valve to facilitate communication and improve swallowing. What change must be made when placing the valve on the tracheostomy tube? A. cuff deflated B. cuff inflation increased C. no changes necessary D. cuff inflation decreased by approx. 50%

A. cuff deflated

A patient whose intermittent claudication had progressed to rest pain and had not responded to conservative treatment has undergone a fem-pop bypass. The patient complains of numbness and tingling on the anterior and medial aspect of the leg. This suggests: A. damage to the femoral nerve B. occlusion of the femoral artery C. normal postoperative sensation D. bypass occlusion

A. damage to the femoral nerve

A patient who is 24-hour postoperative after a pulmonary lobectomy requests pain medication for severe pain, but when the nurse brings the opioid medication minutes later; the nurse finds the patient laughing and talking with family. The nurse should: A. give the patient the opioid medication B. ask the patient if she still needs the pain medication C. withhold the pain medication altogether D. exchange the opioid for acetaminophen

A. give the patient the opioid medication

Which of the following is not a symptom of Diabetes Insipidus? A. hyponatremia B. polydipsia C. polyphagia D. polyuria

A. hyponatremia DI would cause HYPERnatremia

While performing a hospital admission assessment, the nurse identifies which of the following factors that increases the patient's risk of TB? A. immunocompromised state B. presence of pneumonia and lupus C. refusal of the influenza vaccine during the current flu season D. African-American race

A. immunocompromised state

A patient who has developed cerebral edema is given Mannitol and Lasix. The nurse can expect which of the following changes in the patient's serum lab values? A. increased sodium B. increased platelet count C. increased glucose D. increased WBC count

A. increased sodium

Which of the following is NOT a treatment for a patient with ineffective airway clearance but patent airway? A. insert an LMA B. perform chest percussion C. administer medications that reduce secretions D. encourage use of incentive spirometer

A. insert an LMA would make an even smaller airway and pt's airway is patent

A patient who received spinal anesthesia four hours ago during surgery is transferred to the surgical unit and, after one and a half hours, now reports severe incisional pain. The patient's blood pressure is 170/90 mm Hg, pulse is 108 beats/min, temperature is 99oF (37.2oC), and respirations are 30 breaths/min. The patient's skin is pale, and the surgical dressing is dry and intact. The most appropriate nursing intervention is to: A. medicate the patient for pain. B. place the patient in a high Fowler position and administer oxygen. C. place the patient in a reverse Trendelenburg position and open the IV line. D. report the findings to the provider.

A. medicate the patient for pain.

A patient had a complete colectomy with an ileostomy. The nursing action that is most important for this patient is to: A. monitor the patient for fluid and electrolyte imbalances B. administer proteolytic enzymes to aid digestion of fats and proteins C. use warm tap water irrigations to prevent stool retention D. use mild antidiarrheal medications to prevent nutritional losses

A. monitor the patient for fluid and electrolyte imbalances

A patient diagnosed with a stroke received tPA five hours ago and now has urinary incontinence. The patient has moderate motor deficits, but she remains cognizant. Which of the following is the most appropriate nursing interventions for this patient? A. offer the bedpan often B. call a nephrology consult C. place a foley D. have the patient ambulate to the commode

A. offer the bedpan often

A patient with a subarachnoid hemorrhage is scheduled to receive Nimotop by mouth. The nurse in training accidentally gives the patient Nimotop IV and the patient's blood pressure drops to 50/20. The patient develops a small ischemic stroke following the event. How many sentinel events occurred during the patient's hospital stay? A. one B. two C. three D. four

A. one

ABG results that are characteristic of late-stage COPD include? A. pH 7.25, CO2 60, HCO3 30 B. pH 7.30, CO2 45, HCO3 18 C. pH 7.45, CO2 40, HCO3 26 D. pH 7.50, CO2 30, HCO3 35

A. pH 7.25, CO2 60, HCO3 30 late-stage COPD pts suffer from resp. acidosis. pH 7.25 is acidotic, retaining CO2 60, partially compensated with rising bicarb (HCO3 30) - kidneys are trying to buffer

According to Orlando's nursing process theory, observing the patient's behavior helps to determine the: A. patient's real needs B. patient's attitudes C. patient's response to the nurse D. patient's psychological status

A. patient's real needs

A nurse caring for a patient with a chest tube notices continuous bubbling in the water-seal chamber. The nurse has determined that the leak is inside of the chest. Which of the following is the most appropriate intervention? A. place the chest tube on suction until the air leak resolves B. clamp the tubing indefinitely C. no intervention D. pull out the chest tube

A. place the chest tube on suction until the air leak resolves

A patient with a history of heart failure and supraventricular dysrhythmias has been maintained on digoxin but has developed bradycardia (48bpm), headache, fatigue, nausea, diarrhea, and green halo vision. The physician has ordered serum digoxin, electrolyte levels, and continuous ECG monitoring. Which of the following electrolye values would be most concerning? A. potassium of 3.2 B. potassium of 5 C. sodium of 140 D. magnesium of 2

A. potassium of 3.2 hypokalemia increases the risk of digoxin toxicity -- immediately hold digoxin

Which of the following reflects a primary intervention? A. receiving a tetanus shot as a routine immunization B. undergoing a routine colonoscopy C. undergoing a mastectomy for breast cancer D. placing a chest tube for a pneumothorax

A. receiving a tetanus shot as a routine immunization

Which of the following medications used to treat Type 2 diabetes is least likely to cause hypoglycemia? A. Glimepiride (Amaryl) B. Metformin (Glucophage) C. Glipizide (Glucotrol) D. Micronized glyburide (Glynase)

B. Metformin (Glucophage)

Which of the following diagnoses could result in a C-reactive protein level of 562 mg/L? A. rheumotid arthritis B. spinal cord injury C. hypertension D. pulmonary embolism

A. rheumotid arthritis

A nurse receives a phone call from the lab stating that a patient's serum potassium is 6.5 but it is hemolyzed. Which of the following is the most appropriate step in intervention? A. send repeat serum potassium now B. send the patient for 2D echo C. send a troponin level and administer baby aspirin D. no intervention

A. send repeat serum potassium now

Which of the following is the most likely day for a fever to occur due to a UTI in a post-operative patient? A. POD 1 B. POD 3 C. POD 7 D. POD 10

B. POD 3 most likely POD 3-5

Which of the following is the most likely day for a fever to occur due to a wound infection in a post-operative patient? A. POD 1 B. POD 5 C. POD 10 D. POD 15

B. POD 5

A stroke patient in the ICU was supposed to receive a mechanical soft pureed diet due to her high risk of aspiration. The patient was accidentally ordered a regular diet by the medical team. When the patient ate her meal, she aspirated and went into respiratory distress requiring intubation. While on the ventilator she developed pneumonia. Azithromycin was ordered for this patient. The patient had a documented allergy to macrolides which was missed by the medical team. The patient developed anaphylaxis and died. How many sentinel events occured during the patient's hospital stay? A. one B. two C. three D. four

B. two 1st - doctor ordering wrong diet 2nd - giving her wrong antibiotic that she was allergic to

A patient's diagnosis is prerenal failure. The nursing intervention that is top priority for this patient is to: A. administer antibiotics, as prescribed B. administer IV fluid boluses, as prescribed C. reposition frequently D. provide frequent oral hygiene

B. administer IV fluid boluses, as prescribed

Which of the following changes in fluid intelligence are associated with age? A. decreased test anxiety B. altered time perception C. decreased long-term memory D. decreasing reaction time

B. altered time perception

The nursing diagnosis for a patient with a myocardial infarction is activity intolerance. The plan of care includes the patient outcome criterion of: A. agreeing to discontinue smoking. B. ambulating 50 feet without experiencing dyspnea. C. experiencing no dyspnea on exertion. D. tolerating activity well.

B. ambulating 50 feet without experiencing dyspnea.

A patient's son becomes hysterical when he learns that his mother has suffered a massive stroke. He begins to yell obscenities at the nurse. Which of the following actions is the most appropriate for the nurse to take at this time? A. call the police to arrest the patient's son for inappropriate behavior B. call the social worker to speak with the patient's son C. explain to the patient's son about the pathophysiology of a stroke D. educate the patient's son about Kubler-Ross's stages of grief

B. call the social worker to speak with the patient's son

A patient undergoes gastrectomy for treatment of stomach cancer. The complication most likely to develop following gastrectomy is: A. folic acid deficiency anemia B. pernicious anemia C. pancytopenia D. thrombocytopenia

B. pernicious anemia

A patient is admitted for a stroke. The nurse noticed that the patient has developed contracture of the arm. Which of the following is NOT an appropriate intervention? A. daily massage B. placement of a sling C. dynamic splint D. keeping the arm extended using pillow rolls

B. placement of a sling

Which of the following measures will NOT help alleviate headache status post lumbar puncture? A. tylenol B. reverse trendelenburg C. epidural blood patch D. rest

B. reverse trendelenburg

Which of the following is a systemic autoimmune disorder? A. multiple sclerosis B. rheumatoid arthritis C. myasthenia gravis D. glomerulonephritis

B. rheumatoid arthritis

When teaching a patient about using an Advair Diskus, the nurse should include the following instructions: A. use advair at the first signs of an asthma attack B. rinse your mouth after using the inhaler C. keep advair in the refrigerator D. you can share this drug with others

B. rinse your mouth after using the inhaler long acting inhalers can cause thrush

"Giggle" incontinence is also known as: A. urge B. stress C. reflex D. functional

B. stress

A patient with a history of chronic renal failure is diagnosed with pericarditis after a viral infection. Which of the following nursing recommendations would help to support the patient's recovery? A. take aspirin every 4 hours as needed for pain management B. engage in activity and attempt to build exercise tolerance C. go to the ER if any chest pain is detected D. use colchicine therapy to decrease inflammation

A. take aspirin every 4 hours as needed for pain management aspirin can be taken by patients with chronic renal failure, pain management is essential for recovery from pericarditis, patient should rest, chest pain will be persistent

The nurse is assessing a patient who has undergone ileal conduit surgery. When preparing to change the appliance, the nurse understands that: A. the stoma size may change in the upcoming weeks B. the appliance should fit tightly around the stoma to prevent leakage C. the abdominal circumference should be measured prior to application D. the appliance should be changed on a daily basis

A. the stoma size may change in the upcoming weeks

A patient receiving maintenance lithium at 300mg three times daily for bipolar disorder has developed vomiting, diarrhea, tinnitus and tremors. The patient's blood level is 1.8. The initial response should be to: A. withhold lithium B. increase lithium dosage C. decrease lithium dosage D. maintain lithium dosage and provide an antipsychotic medication

A. withhold lithium for pt's on lithium, check monitors weekly initially and then monthly

Which of the following indicates portal HTN? A. Abdominal striae and malodorous urine B. increased WBC C. Ascites and tarry stools D. increased platelet count

C. Ascites and tarry stools the portal vein pumps against a stiff liver which causes fluid to leak into the abdomen causing ascites

Which of the following is a sign/symptom of hypocalcemia? A. nephrolithiasis B. abdominal pain C. Chvostek's sign D. bony pain

C. Chvostek's sign

A 50-year old bedridden patient has unilateral painful swelling of the lower extremity and a positive Homan's sign. This patient has no significant past medical history and no history of trauma. The leg is not erythematous or cyanotic. There are no palpable cords. Which of the following should be in the nurse's list of differential diagnoses? A. compartment syndrome B. Raynaud's phenomenon C. Deep vein thrombus D. phlebitis

C. Deep vein thrombus -Homan's sign = pain elicited with passive sudden dorsiflexion of foot

Which outcome is the focus of educating health professionals together as an interprofessional team? A. Decreased hospital costs B. Decreased patient length of stay C. Increased safety and quality D. Increased patient satisfaction

C. Increased safety and quality

A patient diagnosed with sickle cell disease is experiencing a vaso-occlusive crisis. Which medical treatment should the nurse anticipate the health care provider ordering for the patient? A. Administer meperidine (Demerol) intravenously B. Admit the patient to a private room with reverse precautions C. Infuse D5W or 0.9 NS at 150/hr via infusion pump D. Insert a 22 Fr foley catheter

C. Infuse D5W or 0.9 NS at 150/hr via infusion pump patients with sickle cell anemia and vaso-occlusive crisis benefit from hydration to reduce the sickling process

A nursing department in an acute care setting decides to redesign its nursing practice based on a theoretical framework. The feedback from patients, families, and staff reflects that caring is a key element. Which theorist best supports this concept? A. Erikson. B. Maslow. C. Rogers. D. Watson.

D. Watson.

A nurse is teaching a patient about self-insulin injection. The nurse knows which of the following is the site of fastest absorption? A. upper outer arm B. buttocks C. mid-lateral thigh D. abdomen

D. abdomen largest surface area of subcutaneous tissue

Which of the following is NOT a complication of diabetes mellitus? A. obesity B. renal insufficiency C. blindness D. anemia

D. anemia

Which of the following ABG results indicates metabolic alkalosis? A. pH 7.30, CO2 50, HCO3 19 B. pH 7.35, CO2 40, HCO3 24 C. pH 7.45, CO2 35, HCO3 26 D. pH 7.51, CO2 37, HCO3 32

D. pH 7.51, CO2 37, HCO3 32 ph is alkalotic and bicarb is high, CO2 is normal so it is uncompensated

A 68-year old man with a history of alcoholism has developed sudden onset of severe epigastric pain radiating to the back after eating. The pain is exacerbated when the patient lies flat or walks. He is pale and tachycardic and has nausea and vomiting and a temp of 39 C. Physical exam shows the upper abdomen is tender but not rigid and without guarding. The most likely cause of these symptoms is: A. hepatits B. acute cholecystitis C. small bowel obstruction D. pancreatitis

D. pancreatitis

Which of the following is TRUE regarding sickle cell disease? A. sickle cell disease is an autosomal dominant disorder B. patients with sickle cell disease are at increased risk of diabetes C. sickle cell disease is caused by a defective chromosome 18 D. patients who are heterozygous for the sickle cell trait are usually asymptomatic

D. patients who are heterozygous for the sickle cell trait are usually asymptomatic Sickle cell disease is autosomal recessive genetic disorder, caused by defect on chromosome 11

What is the treatment for syphilis in its early stages? A. no intervention B. diflucan C. miconazole cream D. penicillin

D. penicillin

A 56-year old female oncology patient arrives on the unit as a direct admit. As she is being assisted to her bed from the wheelchair, she is noted to have extreme SOB. She is found to be hypoxic, but her vitals are otherwise stable. Which of the following is the most appropriate action to be taken by the nurse initially? A. begin preparations for chest tube placement B. perform a history and physical C. perform an EKG D. place the patient on a non-rebreather mask

D. place the patient on a non-rebreather mask

To prevent a common, adverse effect of prolonged use of phenytoin sodium (Dilantin), patients taking the drug are instructed to: A. avoid crowds and obtain an annual influenza vaccination. B. drink at least 2 L of fluids daily, including 8 to 10 glasses of water. C. eat a potassium-rich, low sodium diet. D. practice good dental hygiene and report gum swelling or bleeding.

D. practice good dental hygiene and report gum swelling or bleeding.

The priority nursing care for a patient with suspected myocardial infarction is: A. auscultating for adventitious heart sounds B. monitoring fluid and electrolyte status C. preventing thrombi and emboli D. providing appropriate analgesia

D. providing appropriate analgesia

Two days following surgery, a patient is to have a ventilation/perfusion (VQ) scan. The nurse knows that this diagnostic study has most likely been ordered to confirm or exclude: A. asthma B. pulmonary fibrosis C. COPD D. pulmonary embolism

D. pulmonary embolism

A patient has just been diagnosed with glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency). The parents ask the nurse which stimuli can cause outbreak of symptoms. Which of the following answers are most appropriate? A. dairy products such as yogurt and ice cream B. seafood, red meat and alcohol C. gluten-based products D. sulfa drugs and aspirin

D. sulfa drugs and aspirin G6PD deficiency is a hereditary disease where red blood cells break down prematurely

Which of the following is the most common congenital cyanotic heart defect? A. ventricular septal defect B. tricuspid atresia C. aortic stenosis D. tetralogy of fallot

D. tetralogy of fallot

Which of the following medications is inappropriate for the treatment of Meniere's disease? A. Antivert B. Zofran C. Lasix D. Haloperidol

D. Haloperidol Meniere's disease is dysfunction of inner ear causing vertigo -- antivert and zofran relieve nausea, lasix helps normalize fluid in the inner ear

Which of the following is not a component of blood? A. Erythrocyte B. Leukocyte C. Thrombocyte D. Hemocyte

D. Hemocyte

Nursing interventions and orders for a patient following a Barium Swallow study should include? A. Decreased fluids and increase activity B. increased fluids and decreased activity C. decreased fluids and a laxative D. Increased fluids and a laxative

D. Increased fluids and a laxative Will allow the body to rid itself of barium

A patient being examined by the nurse experiences pain when then nurse palpates her RUQ with deep inspiration. What is this physical examination finding called? A. Psoas sign B. McBurney's sign C. Brudzinski sign D. Murphy's sign

D. Murphy's sign acute cholecystitis

Which of the following is the most likely day for a drug fever to occur in a post-operative patient? A. POD 1 B. POD 3 C. POD 5 D. POD 7

D. POD 7

Which action occurs primarily during the evaluation phase of the nursing process? A. Data collection. B. Decision-making and judgment. C. Priority-setting and expected outcomes. D. Reassessment and audit.

D. Reassessment and audit.

When using Maslow's hierarchy of human needs to develop a patient's plan of care, which of the following needs is the most difficult to assess? A. Safety/security B. Physiologic needs C. Self-esteem and self-respect D. Self-actualization

D. Self-actualization This is very subjective and cannot be measured externally

Which action best describes a sentinel event alert? A. Documenting the breakdown in communication during a shift report. B. Indicating that a community or institution is unsafe. C. Recording the harm done when a medication error occurs. D. Signaling the need for immediate investigation and response.

D. Signaling the need for immediate investigation and response.

Which physiological response is often associated with surgery-related stress? A. Bronchial constriction. B. Decreased cortisol levels. C. Peripheral vasodilation. D. Sodium and water retention.

D. Sodium and water retention.

Which is not part of Cushing's Triad? A. Hypertension B. Bradycardia C. Irregular breathing D. Tachycardia

D. Tachycardia Cushing's triad can indicate increased ICP, symptoms are hypertension, bradycardia and irregular breathing

When educating a patient about the triggers of asthma, the nurse instructs that: A. exercise-induced asthma only occurs in children B. asthma exacerbations are stress-oriented and can be controlled with a calm environment C. all pets should be removed from the house D. viral URIs are a common trigger

D. viral URIs are a common trigger

Which of the following is the most likely day for a fever to occur due to a DVT in a post-operative patient?

POD 5-7

The medical-surgical nurse needs to be knowledgeable of which organization that provides standards of patient care effectiveness and safety and fosters continuous process improvement? A. The Joint Commission B. The Beryl Institute C. The Carnegie Institute D. The Hospital Consumer Assessment of Healthcare Providers and Systems

A. The Joint Commission A not-for-profit organization that accredits and certifies healthcare organizations

Which of the following signs/symptoms are NOT caused by an atropine overdose? A. hallucinations B. blurred vision C. diaphoresis D. jaundice

D. jaundice atropine overdose = "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter"

Mr. Crafton is scheduled for a cardioversion to treat atrial fibrillation. Which statement should the nurse include when teaching him about the procedure? A. "You will be NPO for 4 hours before the procedure." B. "You will be awake and alert during the procedure." C. "The procedure will take approximately 1 hour" D. "I'll hold your hand during the procedure"

A. "You will be NPO for 4 hours before the procedure."

How is the absolute neutrophil count (ANC) calculated? A. (% neutrophils + % bands) x WBCs B. # platelets + # WBCs C. (% neutrophils - % bands) x WBCs D. (% neutrophils + % bands) / WBCs

A. (% neutrophils + % bands) x WBCs

Which of the following is the most appropriate fluids to use for a patient in DKA? A. 0.9% NS B. 0.45% NS C. D5LR D. 0.33% NS

A. 0.9% NS DKA should be treated with isotonic solution

Kidney failure is defined as a GFR less than: A. 15% B. 30% C. 45% D. 60%

A. 15%

Which one of the following patients had the greatest risk for CAD? A. African-american female B. Hispanic male C. Caucasian female D. Asian male

A. African-american female

Which of the following is the most likely day for a fever to occur due to atelectasis in a post-operative patient? A. POD 1 B. POD 3 C. POD 5 D. POD 7

A. POD 1

A patient with a new dx of erosive esophagitis is prescribed Nexium. The nurse should teach the patient to: A. Take 1 hour before meals B. Crush and mix with applesauce if unable to swallow C. Store in refrigerator D. Avoid taking antacids

A. Take 1 hour before meals PPIs should be taken 1 hour before meals

A nurse trying to obtain consent from an elderly patient who is hearing impaired. Which of the following actions is most inappropriate? A. facing the patient while speaking B. acting out the surgical procedure C. speaking in a loud clear voice D. having the patient read the consent themselves

B. acting out the surgical procedure

A non-responsive patient is administered Narcan for a heroin overdose. At what point should the patient be administered a second dose if there is no response? A. 1-2 minutes B. 2-5 minutes C. 5-7 minutes D. 7-10 minutes

B. 2-5 minutes

The nurse is reviewing pre-operative lab values. The nurse should alert the physician to which of the following values? A. glucose of 98 B. BUN of 26 C. Creatinine of 0.79 D. calcium level of 9.2

B. BUN of 26

The nurse evaluating fluid and electrolytes in a medical surgical patient knows that which of the following components are necessary in determining serum osmolality? A. BUN, creatinine, calcium B. BUN, glucose and sodium C. Glucose, sodium and potassium D. Magnesium, sodium and potassium

B. BUN, glucose and sodium

Your patient underwent a gastric resection r/t gastric cancer and is preparing for discharge home. Which point about Dumping Syndrome should the nurse include in discharge teaching? A. drink 8 oz of water with each meal B. Eat 6 small meals per day C. eat a low-fat diet D. Eat only 2 meals a day

B. Eat 6 small meals a day Avoids over distending the stomach

Which is primarily a developmental task of middle age? A. Learning and acquiring new skills and information. B. Rediscovering or developing satisfaction in one's relationship with a significant other. C. Relying strongly upon spiritual beliefs. D. Risk taking and its perceived consequences

B. Rediscovering or developing satisfaction in one's relationship with a significant other.

A patient is diagnosed with lateral wall ST segment elevation myocardial infarction (STEMI). What can the EKG be expected to show? A. ST elevation in leads V1-V6 B. ST elevation in leads I, aVL, V5, V6 C. ST elevation in leads II, III, aVF D. St elevation in leads V7, V8, V9

B. ST elevation in leads I, aVL, V5, V6

A patient admitted to the hospital is currently on a regimen of penicillin, which was started yesterday. Toda the nurse notices diffuse rash and facial swelling. The patient states the he's never had this rash before. He has no drug allergies. He has no significant past medical history. On physical exam the nurse notices diffuse dark reddish purple papular rash on his trunk, face and extremities with extensive blister formation. His temp is 99.9, otherwise his vitals are normal. Based on his history and physical exam, what is the most likely diagnosis? A. Turner syndrome B. Steven-Johnson syndrome C. Cushing syndrome D. Guillain-Barre syndrome

B. Steven-Johnson syndrome

Which of the following would be a treatment of choice in an acute asthma exacerbation? A. Mucinex B. Xopenex C. Singulair D. Augmentin

B. Xopenex Xopenex, proventil, and ventolin are short acting beta-2 bronchodilator used in asthma exac as first line of defense

The nurse understands that the most effective treatment for ventricular fibrillation is: A. lidocaine B. defibrillation C. cardiac catheterization D. atenolol

B. defibrillation

A nurse is caring for a patient receiving peritoneal dialysis, who continually remains in positive fluid balance. What substance would be added to this patient's peritoneal dialysate to remove more fluid? A. potassium B. dextrose C. urea D. heparin

B. dextrose

One hour after hemodialysis, the patient develops headache and confusion. The suspected complication would be: A. hemorrhagic shock B. dialysis disequilibrium syndrome C. intracranial hemorrhage D. hyperkalemia

B. dialysis disequilibrium syndrome

A nurse if caring for a patient who received radiographic contrast medium for a procedure and the patient shows signs of dyspnea, flushing and pruritus. The top priority intervention is to: A. check vitals B. ensure the airway is patent C. apply a cold pack to IV site D. call the physician

B. ensure the airway is patent

After tests are conducted to determine the causes of chronic weight loss, anemia, diarrhea, rash, bone pain, and irregular menses, a patient is diagnosed with celiac disease. When discussing dietary interventions, the nurse tells the patient that celiac disease may result in malabsorption of: A. vitamin B12 B. folate and iron C. vitamin C D. vitamin D

B. folate and iron

A key nursing intervention related to hyponatremia is: A. rapid replacement B. gradual replacement C. replacing with dextrose D. replacing without dextrose

B. gradual replacement rapid correction can lead to CPM (brain damage)

To assess long term maintenance of serum glucose, the nurse will monitor results of which ordered lab test? A. glucose tolerance testing B. hemoglobin A1C C. serum insulin D. pancreatic enzymes

B. hemoglobin A1C

A patient who is taking metformin for diabetes mellitus, type 2, is also taking metoprolol for junctional tachycardia and has been prescribed hydrochlorothiazide for persistent elevated blood pressure. What is the primary concern with this drug combination? A. increased tachycardia B. hyperglycemia C. renal failure D. muscle cramps

B. hyperglycemia hydrochlorothiazide can interfere with anti-diabetic drugs, decreasing their effects causing hyperglycemia

What is the #1 cause of hemorrhagic stroke? A. alcohol abuse B. hypertension C. liver dysfunction D. bleeding disorders

B. hypertension

Which of the following is not a risk factor for osteoporosis? A. smoking B. hypothyroidism C. post menopausal D. caucasian

B. hypothyroidism HYPERthyroidism is a risk factor

A 40-year old female with no significant past medical history asks her nurse at what age should she undergo her first colonoscopy. She notes that her uncle died of colon cancer when he was 82. Which of the following is the most appropriate response? A. this year B. in 5 years C. in 10 years D. in 15 years

B. in 5 years if no first-degree relative was diagnosed, obtain colonoscopy at 45 years old

During an assessment of a patient who sustained a head injury 24 hours ago, the medical-surgical nurse notes the development of slurred speech and disorientation to time and place. The nurse's initial action is to: A. continue the hourly neurologic assessments. B. inform the neurosurgeon of the patient's status. C. prepare the patient for emergency surgery. D. recheck the patient's neurologic status in 15 minutes.

B. inform the neurosurgeon of the patient's status.

A patient is experiencing delirium tremens. Which of the following is NOT an appropriate intervention? A. administer ativan B. keep the patient NPO C. administer a banana bag D. administer reglan

B. keep the patient NPO unless there is compromised neurological status that impairs swallowing

A patient is being evaluated for potential meningitis. Which of the following is NOT a typical sign/symptom associated with meningitis? A. Brudzinski sign B. nystagmus C. confusion D. fever

B. nystagmus

After completing a thorough neurological and physical assessment of a patient who is admitted for a suspected stroke, the medical-surgical nurse anticipates the next step in the immediate care of this patient to include: A. administering tissue plasminogen activator. B. obtaining a computed tomography scan of the head without contrast. C. obtaining a neurosurgical consultation. D. preparing for carotid Doppler ultrasonography.

B. obtaining a computed tomography scan of the head without contrast.

A patient's family does not know the patient's end-of-life care preferences, but assumes that they know what is best for the patient under the circumstances. This assumption reflects: A. justice. B. paternalism. C. pragmatism. D. veracity.

B. paternalism.

An important component on interprofessional collaboration is the inclusion of the __________________ in care and transition planning. A. attending physician B. patient and family C. respiratory therapist D. home health nurse

B. patient and family

A patient with a subarachnoid hemorrhage is in moderate vasospasm. The family sees the nurse administering nimodipine to their family member and asks the nurse why she is doing so. Which of the following is the most appropriate response? A. "It is a beta blocker which causes the vessels to vasoconstrict" B. "It is a potassium channel blocker which causes the vessels to vasodilate" C. "It is a calcium channel blocker which causes the vessels to vasodilate" D. "It is a sodium channel blocker which causes the vessels to vasoconstrict"

C. "It is a calcium channel blocker which causes the vessels to vasodilate"

A patient recently diagnosed with psoriasis asks the nurse about potential triggers for this condition. How should the nurse respond? A. "There are no known triggers for psoriasis symptoms" B. "Psoriasis is linked to vitamin b12 deficiency" C. "Psoriasis may be triggered by a recent bacterial or viral infection" D. "Psoriasis is commonly triggered by weight loss"

C. "Psoriasis may be triggered by a recent bacterial or viral infection"

Neutropenia is defined as: A. ANC < 1500 B. ANC < 1000 C. ANC < 500 D. ANC < 250

C. ANC < 500

A patient being examined by the nurse has McBurney's point tenderness and a positive jar sign. Which of the following is the most likely diagnosis? A. Pyelonephritis B. Cholecystitis C. Appendicitis D. Meningitis

C. Appendicitis

John Crafton is post-op day one thyroidectomy. While completing his assessment, John complains of numbness in his lips. The nurse should: A. Give John a mouth moisturizer B. Review sodium level C. Review calcium level D. Check for Tapazole orders

C. Review calcium level thyroid is close to parathyroid gland that is at risk for damage during thyroidectomy, parathyroid stores and maintain calcium

An assessment of a pressure injury reveals full-thickness tissue loss surrounded by pink healing tissue with no bone, tendon, or muscle exposed. How would this wound be classified? A. Stage I B. Stage II C. Stage III D. Stage IV

C. Stage III

The nurse notes her patient's serum Na is 127. Which of the following is the likely source of this finding? A. Diabetes insipidus B. Dehydration C. Syndrome of Inappropriate Antidiuretic hormone (SIADH) D. Hypertension

C. Syndrome of Inappropriate Antidiuretic hormone (SIADH)

A woman in the hospital has heavy menses, prolonged bleeding time, and chronic anemia. This patient should be screened for which of the following diseases? A. Turner syndrome B. Down syndrome C. Von Willebrand disease D. Parkinson's disease

C. Von Willebrand disease - hereditary bleeding disorder

Lovenox was just ordered for a patient. Which of the following medications should be questioned immediately during medication reconciliation? A. vancomycin B. phenergan C. aspirin D. ativan

C. aspirin

Mr. Rossi is being discharged home. He underwent surgery to create an ileostomy for colon cancer. Which of the following statments is correct? A. Your stool will be solid B. you will need to decrease fluid intake to reduce the amount of output C. avoid all medications with an enteric coating D. increase amount of fiber rich foods

C. avoid all medications with an enteric coating They do not break down until they reach the large intestine

When a pulse oximeter monitor indicates a patient has a drop from 96% to 84%, what should the nurse do first? A. request order for stat ABG B. administer oxygen 2L/min C. check position of probe D. notify physician immediately

C. check position of probe first step is assessment

A patient who is restless pulls out his chest tube when trying to get out of bed independently. Which of the following actions by the nurse is most immediately indicated? A. call for assistance and dressing supplies B. hold a folded washcloth against the insertion site C. cover the insertion site with a clean, gloved hand D. ask the patient to place his hand over insertion site and go for dressings

C. cover the insertion site with a clean, gloved hand

As a nurse, one must have an understanding of individual cultures and personal values with the ability to detach from personal views. This is known as: A. cultural awareness B. cultural sensitivity C. cultural self-awareness D. ethnocentrism

C. cultural self-awareness

The medical-surgical nurse, who is caring for a patient with a new diagnosis of cancer, observes the patient becoming angry with the physicians and nursing staff. The best approach to diffuse the emotionally charged discussion is to: A. allow the patient and family members time to be alone. B. arrange time for the patient to speak with another patient with cancer. C. direct the discussion and validation of emotion, without false reassurance. D. request a consultation from a social worker on the oncology unit.

C. direct the discussion and validation of emotion, without false reassurance.

a 25-year old female is admitted to the hospital for fever of unknown origin. She has a temp of 102.3 and is complaining of fever, chills and diaphoresis. She has a known history of IV drug abuse. A nursing student notes that the patient has Janeway lesions. Based on her history and physical exam, the most likely diagnosis is: A. pneumonia B. meningitis C. endocarditis D. C diff

C. endocarditis

During which stage of the nurse-client relationship does the nurse assume different roles to help the patient cope? A. fixation B. orientation C. exploration D. termination

C. exploration 3 stages of nurse-client therapeutic relationship (orientation, exploration and termination)

A patient has been hospitalized with nausea and vomiting but minimal abdominal distension. The patient has not passed flatus in 14 hours, and abdominal x-ray shows dilated small bowel loops and no colonic or rectal gas. The patient's CBC and electrolytes are within normal limits. Based on these findings, the nurse should suspect that the primary initial intervention will be: A. contrast studies B. NG suction C. exploratory surgery D. observation

C. exploratory surgery need to rule out complete small bowel obstruction, risk of ischemia is high

A patient is being discharged with Lopressor. Which of the following is a common side effect that the nurse should educate the patient about? A. angioedema B. bruising C. fatigue D. flushing

C. fatigue

Which of the following is not true concerning fistula sites for dialysis? A. place distally and move proximally, arms then legs B. no BP in that arm C. feel "bruit" and hear "thrill" D. IV and lab sticks below the site only

C. feel "bruit" and hear "thrill" you should feel "thrill" and hear "bruit"

A patient has stepped on a rusty nail. Her last tetanus shot was five years ago. When should she receive another tetanus shot? A. now B. one year C. five years D. ten years

C. five years tetanus shots are good for 10 years

A patient is being discharged on niacin. Which of the following is a common side effect that the nurse should educate the patient about? A. orange urine B. cough C. flushing D. weight gain

C. flushing Niacin raises a person's HDL (good cholesterol)

The discharging nurse is providing verbal discharge instructions to your patient, a 69-year old male. When the nurse asks him if he understands the instructions, he looks at her and nods. The nurse questions his understanding and should take which action? A. ask him to repeat the instructions B. give him written instructions to ensure his understanding C. have him demonstrate the instructions D. give the instructions to a family member

C. have him demonstrate the instructions repeating instructions does not ensure understanding of the instructions

A nurse is caring for a patient who has just returned from the operating room for an open cholecystectomy. The patient is vomiting and crying that she is in pain. The nurse notices a stage I decubitus ulcer on the patient's hip. The nurse also notices that one-third of the incision has opened up and is actively bleeding. Which one of the following issues should be addressed first? A. pain B. nausea C. incision D. decubitus ulcer

C. incision

A patient who often gets kidney stones asks his nurse what he can do to prevent future recurrences. All of the following are appropriate responses EXCEPT: A. decrease protein intake B. decrease sodium intake C. increase calcium intake D. increase fluid intake

C. increase calcium intake

For the evaluation feedback process to be effective, the medical-surgical nurse who is a manager: A. conducts weekly meetings with staff members. B. considers staff members' interests and abilities when delegating tasks. C. informs staff members regularly of how well they are performing their jobs. D. provides goals for staff members to meet.

C. informs staff members regularly of how well they are performing their jobs.

A male patient confides in his nurse about his sadness and anxiety after being diagnosed with a brain tumor. He denies hallucinations or SI. Which of the following medications may help this patient? A. haldol B. keppra C. lexapro D. levoxyl

C. lexapro

For a patient with Crohn's disease, the medical-surgical nurse recommends a diet that is: A. high in fiber, and low in protein and calories. B. high in potassium. C. low in fiber, and high in protein and calories. D. low in potassium.

C. low in fiber, and high in protein and calories.

The main goal of treatment for acute glomerulonephritis is to: A. encourage activity. B. encourage high protein intake. C. maintain fluid balance. D. teach intermittent urinary catheterization.

C. maintain fluid balance

To prepare a patient on the unit for a bronchoscopic procedure, the medical-surgical nurse administers the IV sedative. The nurse then instructs the licensed practical/vocational nurse to: A. educate the patient about the pending procedure. B. give the patient small sips of water only. C. measure the patient's blood pressure and pulse readings. D. take the patient to the bathroom one more time.

C. measure the patient's blood pressure and pulse readings.

Nursing diagnoses mostly differ from medical diagnoses, in that they are: A. dependent upon medical diagnoses for the direction of appropriate interventions. B. primarily concerned with caring, while medical diagnoses are primarily concerned with curing. C. primarily concerned with human response, while medical diagnoses are primarily concerned with pathology. D. primarily concerned with psychosocial parameters, while medical diagnoses are primarily concerned with physiologic parameters.

C. primarily concerned with human response, while medical diagnoses are primarily concerned with pathology.

A patient suffers from a significant left middle cerebral artery stroke. The patient is right-handed. Which of the following deficits could the family expect to see in this patient? A. left-sided weakness, visual deficits B. right-sided weakness, visual deficits C. right-sided weakness, speech deficits D. left-sided weakness, speech deficits

C. right-sided weakness, speech deficits middle cerebral territory is where language center of brain is located

The first step in applying the quality improvement process to an activity in a clinical setting is to: A. assemble a team to review and revise the activity. B. collect data to measure the status of the activity. C. select an activity for improvement. D. set a measurable standard for the activity.

C. select an activity for improvement.

An 80-year-old patient is placed in isolation when infected with methicillin-resistant Staphylococcus aureus. The patient was alert and oriented on admission, but is now having visual hallucinations and can follow only simple directions. The medical-surgical nurse recognizes that the changes in the patient's mental status are related to: A. a fluid and electrolyte imbalance. B. a stimulating environment. C. sensory deprivation. D. sundowning.

C. sensory deprivation.

Which of the following is a treatment for active tuberculosis? A. clindamycin B. gentamicin C. streptomycin D. penicillin

C. streptomycin

When giving Haldol, a nurse should educate the patient and family about which common side effect? A. polyphagia B. facial swelling C. tardive dyskinesia D. bradycardia

C. tardive dyskinesia

Which of the following reflects a tertiary intervention? A. ordering a mammogram for a patient with a family history of breast cancer B. educating a patient about the importance of physical activity C. undergoing a diverting colostomy for a stage III decubitus ulcer of the buttock D. administering a vaccine to adolescent females to prevent cervical cancer

C. undergoing a diverting colostomy for a stage III decubitus ulcer of the buttock

If a patient is newly diagnosed with epileptic seizure disorder, at which point should a steady-state trough level of the prescribed drug be determined? A. after the first 48 hours of drug administration B. after one week of drug administration C. when the seizures appear to be controlled D. with every change in dosage

C. when the seizures appear to be controlled

Which of the following drugs puts the patient with diabetes mellitus, type 2, most at risk for episodes of acute hypoglycemia? A. Metformin (glucophage) B. Rosiglitazone (Avandia) C. Exenatide (Byetta) D. Glipizide (Glucotrol

D. Glipizide (Glucotrol

A patient has been diagnosed with Addison's disease. The patient's family member asks the patient's nurse what causes Addison's disease. Which of the following is the most appropriate response? A. "It is due to a lack of testosterone" B. "It is due to an excess of human growth hormone" C. "It is due to an excess of estrogen" D. "It is due to a lack of cortisol"

D. "It is due to a lack of cortisol"

Which statement by a patient with diabetes mellitus indicates an understanding of the medication insulin glargine (Lantus)? A. "Lantus causes weight loss." B. "Lantus is used only at night." C. "The duration of Lantus is six hours." D. "There is no peak time for Lantus."

D. "There is no peak time for Lantus."

Which statement by a patient demonstrates an accurate understanding about herbal supplements? A. "Herbs may interact with prescribed medications but not other herbs." B. "Most herbs have been tested and found to be safe and therapeutic." C. "The Food and Drug Administration regulates herbs and allows advertising." D. "There is no standardization among the manufacturers of herbs in this country."

D. "There is no standardization among the manufacturers of herbs in this country."

Compartment syndrome may be suspected with a pressure of: A. 5 mmHg B. 10 mmHg C. 15 mmHg D. 20 mmHg

D. 20 mmHg

Which of the following is not true concerning Disseminated Intravascular Coagulation (DIC)? A. risk factors included bleeding and sepsis B. hypercoagulation is present causing widespread clotting C. depleted clotting factors lead to increased bleeding D. DIC is a common occurrence and easily treated with IVF

D. DIC is a common occurrence and easily treated with IVF

Which of the following is a complication of paraphimosis? A. Mastitis B. Palpitations C. Cardiac arrhythmias D. Gangrene

D. Gangrene paraphimosis is when foreskin of penis cannot be reduced back to its original position - gangrene occurs if left untreated

A physical exam finding a nurse would expect to find on a patient with left-sided heart failure is: A. pedal edema B. ascites C. pericardial friction rub D. bibasilar crackles

D. bibasilar crackles left side of heart is weak so fluid backs up into the lungs causing crackles, dyspnea, fatigue and orthopnea

When preparing your patient for his operating room time out, the nurse asks him to verify his date of birth. His identification band does not match the stated date of birth. What is the next step? A. cross out the identification band date of birth and write the correct on in it place and initial it. B. Ask a family member to validate his date of birth. C. Call the surgeon's office to verify the date of birth D. call the admission's office to verify the correct date of birth.

D. call the admission's office to verify the correct date of birth.

A 78-year-old patient is scheduled for transition to home after treatment for heart disease. The patient's spouse, who has chronic obstructive pulmonary disease, plans to care for the patient at home. The spouse says that their grown children, who live nearby, will help. The best approach to discharge planning is to: A. arrange nursing home placement for the couple. B. consult the spouse's healthcare provider about the spouse's ability to care for the patient. C. contact the children to ascertain their commitment to help. D. discuss community resources with the spouse and offer to make referrals.

D. discuss community resources with the spouse and offer to make referrals.

According to Erikson's psychosocial model of development, which stage is typical of those who are elderly? A. initiative vs. guilt B. identity vs. role confusion C. intimacy vs. isolation D. ego integrity vs. despair

D. ego integrity vs. despair

If a patient is hospitalized in a skilled nursing facility, according to OBRA provisions, how frequently must the patient be seen by a physician, PA, or NP? A. weekly for 1 month and then every 30 days B. weekly for 3 months and then every 90 days C. every 30 days throughout the stay D. every 30 days for 3 months and then every 90 days

D. every 30 days for 3 months and then every 90 days

A patient is scheduled to receive hemodialysis at 10am and has several medications ordered at 9am. The most appropriate action is to: A. give the medications at 9am B. call the physician for further instructions C. hold all medications until dialysis is complete D. give the medications that will be retained, and hold those that would be dialyzed out

D. give the medications that will be retained, and hold those that would be dialyzed out

A patient develops diabetes insipidus after surgery to remove a pituitary tumor. The critical complication of DI is: A. bradycardia B. hyponatremia C. dehydration D. hypokalemia

D. hypokalemia low potassium can lead to cardiac arrhythmias

A patient's diagnosis is adrenal crisis. The electrolyte imbalance that is common with adrenal crisis is: A. hyperglycemia B. hypernatremia C. hypokalemia D. hyponatremia

D. hyponatremia adrenal crisis is deficient in aldosterone which regulates reabsorption of sodium, decreased aldosterone would resolve in decreased reabsorption of sodium so it would be excreted in urine

When examining a patient who is paralyzed below the T4 level, the medical-surgical nurse expects to find: A. flaccidity of the upper extremities. B. hyperreflexia and spasticity of the upper extremities. C. impaired diaphragmatic function requiring ventilator support. D. independent use of upper extremities and efficient cough.

D. independent use of upper extremities and efficient cough.

A patient is in the oliguric phase of acute renal failure. Which physician order should the nurse question? A. administer sodium polystyrene sulfonate (Kayexalate) B. limit oral fluids to 500 ml/24 hrs C. maintain a low-sodium, low-potassium, high-calorie diet D. infuse IV fluids at 500 ml/hr

D. infuse IV fluids at 500 ml/hr can cause fluid overload, fluid restriction is critical to prevent hypervolemia