MedSurg Quizzes

Neurological

.

A patient in the coronary care unt develops ventricular fibrillation. The first action the nurse should take is to a) perform defibrillation b) initiate CPR c) prepare for synchronized cardioversion d) administer IV antidysrhythmic drug per protocol

B

A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit a. Palpitations. b. Hypertension. c. Warm, flushed skin. d. Shortness of breath.

D

Cardiovascular

.

Musculoskeletal

.

Respiratory

.

A nurse observes a nursing student working with a patient with advanced Alzheimer's disease. The nurse would intervene if they observe the nursing student do which of the following:

C

A patient arrives at an urgent care center after experiencing unrelenting substernal and epigastric pain and pressure for about 12 hours. The nurse reviews laboratory results with the understanding that at this point in time, a myocardial infarction would be indicated by peak levels of a. Troponin T. b. Homocysteine. c. Creatine kinase-MB. d. Type b natriuretic peptide.

A

The nurse notices that a patient has a disturbed gait. To further assess this problem, which action should the nurse take? Measure the length of both legs. Perform deep palpation of the hip joints. Test range of motion of the lower extremities. Perform muscle-strength testing of the legs.

A

Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are A. Hypertension and cigarette smoking. B. Obesity and smokeless tobacco use. C. Elevated serum lipids and diabetes mellitus. D. Physical inactivity and elevated homocysteine levels

A

While performing blood pressure screening at a health fair, the nurse counsels which person as having the greatest risk for developing hypertension? a.A 56-year-old man whose father died at age 62 from a stroke b.A 30-year-old female advertising agent who is unmarried and lives alone c.A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland d.A 43-year-old man who travels extensively with his job and exercises only on weekends

A

A patient with peripheral artery disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is 1. risk for injury related to decreased sensation. 2. impaired skin integrity related to decreased peripheral circulation. 3. ineffective peripheral tissue perfusion related to decreased arterial blood flow. 4. activity intolerance related to imbalance between oxygen supply and demand.

A (Rationale: Peripheral neuropathy is caused by diminished perfusion to neurons and results in loss of both pressure and deep pain sensations. The patient may not notice lower extremity injuries. Neuropathy increases susceptibility to traumatic injury and results in delay in seeking treatment.)

A patient is admitted to the emergency department with a severe exacerbation of asthma. Which finding is of most concern to the nurse? a. Unable to speak and sweating profusely b. PaO2 of 80 mm Hg and PaCO2 of 50 mm Hg c. Presences of inspiratory and expiratory wheezing d. Peak expiratory flow rate at 60% of personal best

A During a severe exacerbation of asthma the patient may not be able to speak (or may speak in words, not sentences) because of difficulty breathing; the patient may also be perspiring profusely. Other indicators of severe asthma include absence of wheezing because of limited airflow; arterial blood gas results with decreased PaO2 (< 80 mm Hg) and increased PaCO2 (> 48 mm Hg); and peak expiratory flow rate at or below 40% of personal best.

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus b. dry, nonproductive cough c. Hyperresonance to percussion d. a grating sound on auscultation

A Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A grating sound is more representative of a pleural friction rub rather than pneumonia

Which of these definitions is accurate in describing pneumonia? a. Inflammation of the bronchi b. Acute infection of the lung parenchyma. c. inflammation of the upper airway d. inflammation of the nasopharynx and lyrynx

A Pneumonia is an abnormal inflammatory condition of the lung, characterized by inflammation of the brochioles and alveoli, and abnormal alveolar filling with fluid.

After assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak cough effort b. Profuse green sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%

A The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs?

B "The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow."

A plaster splint is applied with an elastic bandage to the leg of a patient with a fractured tibia in preparation for open reduction and internal fixation. The patient complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. the most appropriate action by the nurse is to 1. Elevate the leg on two pillows. 2. Perform neurovascular assessment of the foot. 3. Notify the health care provider. 4. Apply ice over the fracture site.

B

The home care nurse visits a patient with chronic heart failure who is taking digoxin (Lanoxin) and furosemide (Lasix). The patient complains of nausea and vomiting. which action is most appropriate for the nurse to take? a) Perform a dipstick urine test for protein. b) Notify the health care provider immediately. c) Have the patient eat foods high in potassium. d) Ask the patient to record a weight every morning

B Furosemide increases excretion of K & may cause hypokalemia. Risk for digitalis toxicity increases if potassium levels are below normal and digoxin is administered

The most significant factor in long-term survival of a patient with sudden cardiac death is A. Absence of underlying heart disease. B. Rapid institution of emergency services and procedures. C. Performance of perfect technique in resuscitation procedures. D. Maintenance of 50% of normal cardiac output during resuscitation efforts.

B Rationale: Rapid cardiopulmonary resuscitation and prompt defibrillation (with an automated external defibrillator) and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest.

Which measure should the nurse use to help liquefy and facilitate expectoration of chest secretions in the patient with pneumonia? a. Administer oxygen as ordered. b. Encourage a fluid intake of at least 2500 to 3000 a day. c. Place the client in supine position. d. Administer frequent oral feedings.

B Encouraging a fluid intake of at least 2500 to 3000 a day is the best option to help liquefy and facilitate expectoration of chest secretions.

A patient with a head injury has an arterial BP of 92/50 mm/Hg and ICP of 18 mm Hg. The nurse uses the assessments to calculate the cerebral perfusion pressure (CPP). How should the nurse interpret the results? The CPP is so low that brain death is imminent. The CPP is low, and the BP should be increased. The CPP is high, and the ICP should be reduced. The CPP is adequate for normal cerebral blood flow.

B Rationale: The cerebral perfusion pressure (CPP) is the pressure needed to ensure blood flow to the brain. CPP is equal to the MAP minus the ICP (CPP = MAP - ICP). MAP = DBP + 1/3 (SBP-DBP) = 50 + 1/3 (92-50) = 64 mm Hg CPP = MAP - ICP = 46 mm Hg Normal CPP is 60 to 100 mm Hg. CPP <50 mm Hg is associated with ischemia and neuronal death. A CPP <30 mm Hg results in ischemia and is incompatible with life. It is critical to maintain MAP when ICP is elevated. A patient with a head injury may require a higher blood pressure, increasing MAP and CPP, to increase perfusion to the brain and prevent further tissue damage.

The nurse plans to teach a patient how to manage allergic rhinitis. Which information should the nurse include in the teaching plan? a. Using oral antihistamines for 2 weeks before the allergy season may prevent reactions. b. Identifying and avoiding environmental triggers are the best way to prevent symptoms. c. Frequent hand washing is the primary way to prevent spreading the condition to others. d. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.

B The most important intervention is to assist the patient in identifying and avoiding potential allergens. Intranasal corticosteroids (not oral antihistamines) should be started several weeks before the allergy season. Corticosteroid nasal sprays have minimal systemic absorption. Acute viral rhinitis (the common cold) can be prevented by washing hands.

A patient is receiving a drug that decreases afterload. To evaluate the patient's response to this drug, what is most important for the nurse to assess? A. Progressive target organ damage. B. The possibility of drug interactions. C. The patient not adhering to therapy. D. The patient's possible use of recreational drugs.

C

The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says, A. "I should not eat any red meat such as beef, pork, or lamb." B. "I should have some type of fish at least 3 times a week." C. "Most of my fat intake should be from olive oil or the oils in nuts." D. "If I reduce the fat in my diet to about 5% of my calories, I will be much healthier."

C

You administer the Confusion Assessment Method (CAM) tool to differentiate among various cognitive disorders, primarily because a) delirium can be reversed by treating the underlying causes. b) depression is a common cause of dementia in older adults. c) nursing care should be based on the cause of the cognitive impairment. d) drug therapy with antipsychotic agents is indicated in the treatment of dementia.

C

The nurse teaches a patient with peripheral arterial disease.. The nurse determines that further teaching is needed if the patient makes which statement? 1. "I should not use heating pads to warm my feet." 2. "I will examine my feet every day for any sores or red areas." 3. "I should cut back on my walks if they cause pain in my legs." 4. "I think I can quit smoking with the use of short-term nicotine replacement and support groups."

C (Rationale: Patients should be taught to exercise to the point of discomfort, stop and rest, and then resume walking until the discomfort recurs. Smoking cessation and proper foot care are also important interventions for patients with peripheral arterial disease.)

A patient with bacterial pneumonia has course crackles and thick sputum. Which action should the nurse plan to promote airway clearance? a. Restrict oral fluids during the day b. Teach pursed-lip breathing technique c. Assist the patient to splint the chest when coughing d. encourage the patient to wear the nasal O2 cannula

C Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with COPD, but will not improve airway clearance

How should the nurse assess cranial nerves III, IV, and VI? a. Check the patient's gag reflex b. Have the patient stick out his tongue. c. Test the patient's eye movements. d. Ask the patient to smile and frown

C Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) help move the eye. These nerves can be tested by instructing the patient to follow the nurse's finger as it is moved both horizontally and vertically. If the eyes move together (conjugate gaze), cranial nerves III, IV, and VI are intact. Option A is testing cranial nerve VII (facial nerve); option C is testing cranial nerve XII (hypoglossal); and option D is testing cranial nerves IX (glossopharyngeal) and X (vagus)

An older patient is admitted to the hospital with a urinary infection and possible bacterial sepsis. The family is concerned because the patient is confused and not able to carry on a conversation. Which statement by the nurse is most appropriate? A.) "Depression is a common cause of confusion in older adults in the hospital." B.) "It is normal for an older person to have cognitive problems while in the hospital." C.) "The mental changes are most likely caused by the infection and most often reversible." D.) "Drug therapy with antipsychotic agents is indicated to slow the progression of dementia."

C Rationale: Delirium, a state of temporary but acute mental confusion, is a common, life-threatening, and possibly preventable syndrome in older adults. Clinically, delirium is rarely caused by a single factor. It is often the result of the interaction of the patient's underlying condition with a precipitating event.

Interferon B-1b (Betaseron) has been prescribed for a patient who has been diagnosed with relapsing-remitting multiple sclerosis. Which statement, if made by the patient, indicates that additional teaching is needed? a. "I must rotate injection sites with each dose." b. "I should report depression or suicidal thoughts." c. "I will reduce my sodium intake to prevent edema." d. "It is important to avoid direct sunlight and use sunscreen."

C Rationale: Interferon β-1b (Betaseron) is an immunomodulator drug (and not a corticosteroid). The drug is given subcutaneously every other day. Patient teaching should include rotate injection sites with each dose; assess for depression, suicidal ideation; wear sunscreen and protective clothing while exposed to sun; know that flu-like symptoms are common following initiation of therapy.

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? a. Complete the admission database to check for allergies before treatment. b. Delay the physical assessment to first complete pulmonary function tests. c. Briefly ask specific questions about this episode of respiratory distress. d. Ask the patient to lie down to complete a full physical assessment.

C When a patient has severe respiratory distress, only information pertinent to the current episode is obtained, and a more thorough assessment is deferred until later. Obtaining a comprehensive health history or full physical examination is unnecessary until the acute distress has resolved. Brief questioning and a focused physical assessment should be done rapidly to help determine the cause of the distress and suggest treatment. Checking for allergies is important, but it is not appropriate to complete the entire admission database at this time. The initial respiratory assessment must be completed before any diagnostic tests or interventions can be ordered.

As one of your clinical assignments, you are assisting an RN with health screening at a health fair. Which individual is at greatest risk for experiencing a stroke? A.A 46-year-old white female with hypertension and oral contraceptive use for 10 years. B.A 58-year-old white male salesman who has a total cholesterol level of 285 mg/dL. C.A 42-year-old African American female with diabetes mellitus who has smoked for 30 years. D.A 62-year-old African American male with hypertension who is 35 pounds overweight.

D

The daughter of a patient with early familial Alzheimer's disease (AD) asks how AD is different from forgetfulness. You describe early warning signs of AD, including a. Forgetting a colleague's name at a party b. Repeatedly misplacing car keys or a wallet c. Leaving a pot on the stove that boils dry and burns d. Having no memory of preparing a meal and forgetting to serve or eat it

D

The nurse determines that the patient has stage 2 hypertension when the patient's average blood pressure is: a)150/96 mm Hg. b)155/88 mm Hg. c)172/92 mm Hg. d)160/110 mm Hg. e)182/106 mm Hg

D

The nurse is caring for a patient with pneumonia. If a pleural effusion is developing, the nurse would expect which finding? a. Barrel-shaped chest b. Paradoxical respirations c. Hyperresonance on percussion d. Localized decreased breath sounds

D

The nurse would interpret an induration of 5mm resulting from tuberculin skin testing as a positive finding in which patient? a. A patient with a history of illegal IV drug use b. A patient with diabetes and end-stage kidney disease c. A patient who immigrated from India 3 months ago d. A patient who is human immunodeficiency virus-infected

D

Three years ago Mr. King was diagnosed with Parkinson's disease. He presents at your outpatient clinic with a cough and fever. It is obvious that his Parkinson's disease has advanced. During your assessment, you would expect to find A. slurred speech, visual disturbances, and ataxia. B. muscle atrophy, spasticity, and speech difficulties. C. muscle weakness, double vision, and reports of fatigue. D. drooling, stooped posture, tremors, and a propulsive gait.

D

Following an aortic aneurysm repair, the patient suddenly develops severe pain in the right lower extremity. The right pedal pulse is decreased, and the right foot is cool and pale. Which complication should the nurse suspect? 1. hypothermia. 2. a wound infection. 3. bleeding from the graft site. 4. an embolization or graft occlusion.

D (Rationale: A decreased or absent pulse together with a cool, pale, mottled, or painful extremity may indicate embolization or graft occlusion.)

To reduce the recurrence of bronchitis, the nurse should emphasize the importance of which of these long-term measures? a. taking a cough suppressant to facilitate rest b. taking Tylenol (acetaminophen) c. increasing oral fluid intake to reduce fever d. smoking cessation

D For a long-term measure, quitting smoking is the best option to reduce the recurrence of bronchitis. Smoking impairs the airways and puts the client at a greater risk for inflammation and infection.

The nurse teaches a patient about discharge instructions after a rhinoplasty. Which statement, if made by the patient, indicates that the teaching was successful? a. "My nose will look normal after 24 to 48 hours." b. "I can take 800 mg ibuprofen every 6 hours for pain." c. "I will remove and reapply the nasal packing every day." d. " I will elevate my head for 48 hours to minimize swelling."

D Maintaining the head in an elevated position will decrease the amount of nasal swelling. NSAIDs, such as ibuprofen, increase the risk for postoperative bleeding and should not be used postoperatively. The patient would not be taught to remove or reapply nasal packing, which is usually removed by the surgeon on the day after surgery. Although return to a preinjury appearance is the goal of the surgery, it is not always possible to achieve this result, especially in the first few weeks after surgery.

A patient with increased ICP is positioned in a lateral position with the head of the bed elevated 30 degrees. The nurse evaluates a need for lowering the head of the bed when the patient experiences ptosis of the eyelid. unexpected vomiting. a decrease in motor functions. decreasing level of consciousness.

D Rationale: Decreasing level of consciousness indicates increased intracranial pressure. Maintain the patient with increased ICP in the head-up position and prevent extreme neck flexion, which can cause venous obstruction and contribute to elevated ICP. Adjust the body position to decrease the ICP maximally and to improve the CPP. Elevation of the head of the bed reduces sagittal sinus pressure, promotes drainage from the head via the valveless venous system through the jugular veins, and decreases the vascular congestion that can produce cerebral edema. However, raising the head of the bed above 30 degrees may decrease the CPP by lowering systemic BP. Careful evaluation of the effects of elevation of the head of the bed on both the ICP and the CPP is required. Position the bed so that it lowers the ICP while optimizing the CPP and other indices of cerebral oxygenation.

The nurse is providing discharge teaching to a patient who had a myelogram. What would the nurse include in the teaching plan? A Take Tylenol to prevent a fever B Remain flat in bed for 24-48 hours to prevent pain C Decrease fluid intake for 4-8 hours to prevent nausea D Report a headache that is worse when sitting or standing

D Rationale: The main risk after a myelogram is a spinal headache. Patients should be taught to report a headache to the health care provider. The headache usually resolves in 1 to 2 days with rest and fluids. Fluid intake should be increased to hasten absorption or residual contrast, to replace cerebrospinal fluid, and to reduce the risk of headache. Bed rest is usually indicated for a few hours after testing. A fever should be reported; it may indicate an infection and is not expected after a myelogram.

The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient? a. High-Fowler's position with the left arm extended. b. Supine with the head of the bed elevated 30 degrees. c. On the Right side with the left arm extended above the head. d. Sitting upright with the arms supported on an over bed table.

D The upright position with the arms supported increases lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space so that access to the pleural space is easier. The other positions would increase the work of breathing for the patient and make it more difficult for the health care provider performing the thoracentesis.

The nurse is caring for a 74-year old woman. What would be a normal age-related finding? 1. loss of height. 2. back pain. 3. kyphosis. 4. spinal crepitation.

Loss of height, thinning of the vertebral column

A client recovering from a limb amputation complains of pain the ankle of the amputated limb. This type of pain is

phantom limb pain