Detailed Answer Key For Medical Surgical Exam, A+ Solutions
1. A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements should the nurse make?
A. "Uric acid levels drop and calcium forms precipitate."
Rationale: With gout, clients have hyperuricemia, rathe...
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Detailed Answer Key
Medical Surgical, A+
1.A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements
should the nurse make?
A. "Uric acid levels drop and calcium forms precipitate."
Rationale: With gout, clients have hyperuricemia, rather than a reduction in uric acid.
B. "Tophi form in the kidneys and they impair the excretion of uric acid."
Rationale: Tophi, or deposits in tissues near a joint, develop in chronic, late-stage gout. They are
not part of the primary disease process.
C. "The intra-articular deposition of urate crystals causes inflammation."
Rationale: Gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues
and cause inflammation and pain.
D. "Articular cartilage thins, leading to splitting and fragmentation."
Rationale: Gout does not thin and fragment cartilage.
2.A nurse is teaching a group of clients about osteoarthritis. Which of the following
recommendations should the nurse include in the teaching?
A. Use Echinacea to manage joint pain.
Rationale: The nurse may include the use of complementary and alternative therapies in the
teaching.
However, Echinacea is used for the treatment of the common cold, not
osteoarthritis. Alternative therapies that are used for osteoarthritis include
glucosamine, chondroitin, and topical capsaicin.
B. Apply ice to the joint before exercising.
Rationale: The nurse should recommend that the clients begin exercising immediately
following the application of heat. This reduces pain and improves mobility,
allowing for increased range-of-motion during exercises. Cold application
may be applied following exercise to decrease discomfort and inflammation.
C. Maintain a recommended body weight.
Rationale: Obesity is a risk factor for the development of osteoarthritis. Maintenance of an
ideal weight is one way a client can prevent added wear and tear on joints and
promote overall joint health.
D. Reduce the amount of purine in the diet.
Rationale: The nurse should recognize that limiting purine in the diet, which is often found in
organ meats, is recommended for clients who have gout.
3.A nurse is caring for a client who has had a myocardial infarction. Upon his first visit to cardiac
rehabilitation, he tells the nurse that he doesn't understand why he needs to be there because
there is nothing more to do, as the
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,Detailed Answer Key
Medical Surgical, A+
damage is done. Which of the following is the correct nursing response?
A. "Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back
to your previous level of activity safely."
Rationale: With this response, the nurse uses the therapeutic communication technique of
presenting reality by indicating her perception of the situation for the client.
B. "It’s not unusual to feel that way at first, but once you learn the routine, you’ll enjoy it."
Rationale: With this response, the nurse illustrates the nontherapeutic communication technique
of giving reassurance, thus discouraging the client from further communication.
C. "Exercise is good for you and good for your heart."
Rationale: With this response, the nurse illustrates the nontherapeutic communication techniques
of disagreeing and giving advice.
D. "Your doctor is the expert here, and I’m sure he would only recommend what is best for you."
Rationale: With this response, the nurse illustrates the nontherapeutic communication technique
of defending.
4.A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse
should identify which of the following medications as the cause of the client’s low potassium
level?
A. Furosemide
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium
and chloride and results in diuresis, which decreases potassium through excretion in
the distal nephrons.
Hypokalemia is an adverse effect of furosemide.
B. Nitroglycerin
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of nitroglycerin. Nitroglycerin
is a vasodilator medication to treat angina.
C. Metoprolol
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of metoprolol.
Metoprolol is a beta-blocker that slows the heart rate and improves
contractility of the heart muscle.
D. Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic medication; therefore,
hyperkalemia is an adverse effect of this medication.
5.A nurse is caring for a client who is postoperative following an open reduction internal fixation (ORIF)
of a femur fracture. Which of the following parameters should the nurse include in the evaluation of
the neurovascular status of the client's affected extremity? (Select all that apply.)
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,Detailed Answer Key
Medical Surgical, A+
A. Color
B. Temperature
C. Ecchymosis
D. Skin integrity
E. Sensation
Rationale: Color is correct. Clients who have sustained trauma to an extremity, such as a
fracture, are at increased risk for neurovascular compromise. The nurse should
check the color of the client's affected extremity as part of this assessment. The
nurse should identify pallor or cyanosis of the extremity as an indication of
peripheral neurovascular dysfunction and should notify the provider.Temperature is
correct. Clients who have sustained trauma to an extremity, such as a fracture, are
at increased risk for neurovascular compromise. The nurse should monitor the
temperature of the extremity as a part of this assessment and identify skin that is
cool or cold to the touch as having decreased perfusion to the tissues of the
extremity, which is an indication of peripheral neurovascular dysfunction. The nurse
should report skin that is cool to the touch to the provider.Ecchymosis is incorrect.
Ecchymosis, or bruising, is an expected finding with leg injuries and is not a
component of a neurovascular check.Skin integrity is incorrect. While the nurse
should assess the incision of a client who is postoperative following an open
reduction and internal fixation of the femur, it is not a component of a
neurovascular check.Sensation is correct. Clients who have sustained trauma to an
extremity, such as a fracture, are at increased risk for neurovascular compromise.
The nurse should assess the client's extremity for numbness or tingling. The nurse
should recognize diminished pain or paresthesia as an indication of damage to the
nerves or peripheral neurovascular dysfunction and should report it to the provider.
6.A nurse is monitoring a client following a thoracentesis. The nurse should identify which of
the following manifestations as a complication and contact the provider immediately?
A. Serosanguineous drainage from the puncture site
Rationale: A small amount of serosanguineous drainage at the puncture site is expected after a
thoracentesis.
B. Discomfort at the puncture site
Rationale: Mild discomfort at the puncture site is expected after a thoracentesis.
C. Increased heart rate
Rationale: Clients are at risk for developing pulmonary edema or cardiovascular distress due
mediastinal content shift after the aspiration of a large amount of fluid from the
client's pleural space.
Therefore, the client may experience an increase in heart and respiratory rate,
along with coughing with blood-tinged frothy sputum, and tightness in the chest.
These findings require notification of the provider immediately.
D. Decreased temperature
Rationale: Infection is possible after any invasive procedure; however, it takes time to
develop and increases the body temperature.
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, Detailed Answer Key
Medical Surgical, A+
7.A nurse is caring for a client who has a history of exposure to TB and symptoms of night sweats
and hemoptysis. Which of the following tests should the nurse realize is the most reliable to
confirm the diagnosis of active pulmonary TB?
A. Chest x-ray
Rationale: A chest x-ray may be helpful for detecting old or new lesions that are large
enough to be visualized. However, the client who has an HIV infection may
have a normal x-ray or show infiltrates which would be expected in the client
who has pneumonia.
B. Sputum culture for acid-fast bacillus
Rationale: Although the Mantoux (skin test) and the chest x-ray may be useful screening tools
for TB, the presence of acid-fast bacillus noted in the client's sputum, secretions, or
tissues is the only method that can actually confirm the diagnosis.
C. Sputum smear
Rationale: A sputum smear is able to detect the presence of mycobacterium, but it does not
distinguish between mycobacterium tuberculosis and other strains of mycobacterium.
D. Mantoux test
Rationale: The Mantoux skin test is an effective screening tool, but it is unable to distinguish
between an active case of TB and a client who has been, at some time in the
past, exposed to TB. The results are also variable, depending upon the skill of the
nurse administrating and reading the test.
8.A nurse in a medical clinic is providing teaching to an older adult client who has osteoarthritis that
is affecting her knees. Which of the following client statements indicates an understanding of the
teaching?
A. "I can use either heat or ice to help relieve the discomfort."
Rationale: The nurse should reinforce that different treatment modalities, such as heat or cold
therapy, can be tried to determine which one is more effective for the client. Heat
application can help with muscle relaxation in the area around the affected joint.
The application of cold numbs nerve endings and decreases joint inflammation.
B. "Ibuprofen is the first step in medication therapy for osteoarthritis."
Rationale: The nurse should instruct the client that the primary medication of choice for the
treatment of osteoarthritis is acetaminophen. NSAIDS, such as celecoxib and
ibuprofen, might be tried if acetaminophen does not control discomfort.
C. "I should limit physical activity to prevent further injury."
Rationale: The nurse should encourage the client to include aerobic exercise and lower extremity
strength training into her daily regimen. These activities have been shown to slow the
progression of osteoarthritis and relieve the manifestations of the disorder.
D. "I will elevate my legs by placing two pillows under my knees when I go to bed."
Rationale:
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