The nurse is caring for four clients on a medical-surgical unit. Which client should the
nurse see initially?
1. A client admitted with hepatitis A who has had severe diarrhea for the last
24 hours
2. A client admitted with pneumonia who is has small amounts of yellow
productive sputum
3...
MED-SURG PRACTICE QUESTIONS
The nurse is caring for four clients on a medical-surgical unit. Which client should the
nurse see initially?
1. A client admitted with hepatitis A who has had severe diarrhea for the last
24 hours
2. A client admitted with pneumonia who is has small amounts of yellow
productive sputum
3. A client admitted with fever of unknown origin (FUO) who has been
without fever for the last 48 hours
4. A client admitted with a wound infection whose WBC is 8,500 mm3 - answer-Answer: 1
Rationale: The nurse must decide which client should be seen on the initial rounds of the
day. The nurse must remember that the first client to be seen should be the client
who needs the attention of the nurse initially. A client with hepatitis A does
experience diarrhea, but diarrhea for the last 24 hours could cause the client to
have a problem with dehydration and experience a state of fluid volume deficit.
The nurse is preparing to administer influenza vaccines to a mass drive-through clinic.
Which statement by a client would indicate further questioning prior to giving the client
the influenza vaccine?
1. "I am allergic to horse hair."
2. "I try to get my vaccine every year."
3. "I am not allergic to anything except eggs."
4. "My husband had a severe allergic reaction after he received his influenza
vaccine." - answer-Answer: 3
Rationale: Influenza vaccines are recommended for person at high risk for serious
sequelae of influenza. The nurse should be aware that client with a sensitivity to
eggs should not receive the vaccine. Vaccines prepared from chicken or duck
embryos are contraindicated in clients who are allergic to eggs.
Each client's response to pain may be influenced by multiple factors. Select all that
apply:
a. Age
b. Past experience with pain
c. Cultural influences
d. Knowledge - answer-Correct Answers: a; b; c; d
Rationale: All factors listed can influence a client's response to pain.
The nurse is caring for four clients on a medical-surgical unit. The secretary gives the
nurse the morning labs. Which of the following labs would require that the nurse call the
[Type here] [Type here] [Type
here]
,physician and inform the healthcare provider about the client's abnormalities?
1. WBC 14,600 mm3
2. Serum protein 6.9 g/dL
3. I & D (incision and drainage) showing no growth for the last 24 hours
4. Albumin 4.2 g/dL - answer-Answer: 1
Rationale: When the nurse is caring for several clients, all of the labs should be checked
frequently throughout the shift to assess for any abnormalities. The WBC in option 1 is
abnormal. (Normal WBC 4,000-10,000 mm3
.) All of the other lab results are within
acceptable range; therefore, the results should not be called in to the physician.
The nurse is orienting a new graduate. The nurse is reinforcing the importance of
standard precautions. Which of the following observations by the nurse would require
further education regarding standard precautions?
1. The graduate nurse understands to wash hands when entering and exiting
the client's room.
2. The graduate nurse wears gloves when serving breakfast trays to various
clients.
3. The graduate nurse wears a gown, gloves, and goggles when suctioning a
client.
4. The graduate nurse leaves all supplies in the room of a client who is in
contact isolation. - answer-Answer: 2
Rationale: The nurse must have an understanding of standard precautions. Prevention is
the most important measure to prevent nosocomial infections. Standard
precautions were published in 1996 that provide guidelines for the handling of
blood and other body fluids. These guidelines are used with all clients, regardless
of whether they have a known infectious disease. Standard precautions are used by all healthcare workers who have
direct contact with clients or with their body
fluids. It is not necessary for the nurse to wear gloves while delivering food trays
to the client, because there is not contact with the client.
A 45-year-old woman presents to the ambulatory clinic for a gynecological
examination. The health history reveals no significant personal or family medical history.
What information concerning health-promotion behaviors should be presented to the
client?
a. It is time to begin having mammograms every other year.
b. If the client is in a monogamous relationship, Pap smears will not be needed.
c. Bone density examinations are indicated every year.
d. Recommended calcium intake is at least 1,200 mg per day. - answer-Answer: d
Rationale: The recommended calcium intake is at least 1,200 mg per day. This will be
beneficial in the prevention of osteoporosis. Women should begin having annual
mammograms by age 40. Pap smears are continued for women in monogamous
relationships. For women with no significant risk for the development of osteoporosis,
bone density examinations should be done every other year.
[Type here] [Type here] [Type
here]
,The admitting department alerts the nurse on a medical-surgical unit that a client with
active tuberculosis (TB) is being admitted to the unit. Which type of isolation is
appropriate based on the client's diagnosis?
In addition to handwashing and standard precautions, the nature and spread of some
infectious diseases require that special techniques be used to protect uninfected clients
and workers. The client with pulmonary tuberculosis will be placed in airborne
precautions. The client should be placed in a private room with special ventilation that
does not allow air to circulate to general hospital ventilation; a mask or special filter
respirators will be used for everyone entering the room.
A 75-year-old client seeks care at an ambulatory clinic. The client reports having
experienced extreme drowsiness after recently taking dosages of an over-the-counter cold
medication. When collecting data, the nurse notes the client reports taking only the
prescribed amount of the preparation. What inferences can be made by the nurse
concerning the events?
a. The client likely has taken more of the preparation than stated.
b. The client likely has experienced a reaction between the cold medication and other
routine medications.
c. The client's age has influenced his response to the medication.
d. The client is allergic to the cold medication. - answer-Answer: c
Rationale: Older clients often experience altered responses to medications. These changes
are in response to age-related developments in the kidneys and liver. There is no evidence
the client has taken too much medication. There is no information provided to indicate
the client is taking other medications. Allergic reactions typically manifest with
integumentary- or respiratory-related symptoms.
The nurse is colleting data from a client regarding past alcohol use history. What
question will provide the greatest amount of information?
1. Are you a heavy drinker?
2. How often do you use alcohol?
3. Drinking doesn't cause any problems for you, does it?
4. Is alcohol use a concern for you? - answer-Answer: 2
Rationale: Open-ended questions will elicit the greatest amount of information. Asking
closed questions will limit the information obtained.
A client is receiving IV vancomycin for the treatment of Clostridium difficile. The
nurse understands that the client who develops flushing, tachycardia, and hypotension
during the infusion of vancomycin indicates:
[Type here] [Type here] [Type
here]
, 1. Ototoxicity effect.
2. Superinfection.
3. Red man syndrome.
4. Hives. - answer-Answer: 3
Rationale: Vancomycin inhibits cell wall synthesis, and is used for serious infections. It is
only effective against gram-positive bacteria, especially Staphylococcus aureus and Staphylococcus epidermidis. The
nurse should infuse this medication slowly over 60
minutes or more to avoid "red man" syndrome. The syndrome is characterized by
erythematous rash, flushing, tachycardia, and hypotension. Clients can become dizzy and
agitated.
The physician has ordered for the client to receive a trough blood level to evaluate the
therapeutic effect of an antibiotic. The nurse understands that the trough should be
ordered:
1. A few minutes before the next scheduled dose of medication.
2. 1-2 hours after the oral administration of the medication.
3. 30 minutes after the IV administration.
4. During the infusion of the antibiotic. - answer-Answer: 1
Rationale: Antibiotic peak and trough levels monitor therapeutic blood levels of the
prescribed medication. The therapeutic range—the minimum and maximum blood levels
at which the drug is effective—is known for a given drug. By measuring blood levels at
the predicted peak (1-2 hours after oral administration, 1 hour after intramuscular
administration, and 30 minutes after IV administration) and trough (usually a few
minutes before the next scheduled dose), it is also possible to determine whether the drug
is reaching a toxic or harmful level during therapy, increasing the likelihood of adverse
effects.
A nursing student is reading about the concept of parish nursing. Which of the
following statements indicates understanding of the key concepts of parish nursing?
1. "You must practice a certain faith to be involved in parish nursing."
2. "Parish nurses are independent practitioners providing care to members of a selected
church."
3. "Parish nursing is reserved for nurse practitioners."
4. "Parish nurses may be employed by a hospital." - answer-Answer: 4
Rationale: Parish nursing seeks to provide health care to traditionally underserved
populations. Involvement in parish nursing is not limited to select faiths. The parish nurse
may work directly for the church involved or be contracted by the church to provide
nursing services and perform referrals. Parish nursing is not limited to nurse practitioners.
The nurse needs to change a dressing on the client's abdomen. Which of the following
techniques should be implemented?
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