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MED SURG 201 Medical Surgical Final Exam- Questions and Answers; West Coast University

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med surg 201 medical surgical final exam

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Stuvia.com il- ilThe ilMarketplace ilto ilBuy iland ilSell ilyour ilStudy
FINAL EXAM QUESTIONS,
Material
ANSWERS (EXPLAINED)

4. A ilpatient ilwho ilwas iladmitted ilto ilthe ilhospital ilwith ilhyperglycemia iland ilnewly ildiagnosed
ildiabetes ilmellitus ilis ilscheduled ilfor ildischarge ilthe ilsecond ilday ilafter iladmission. ilWhen

ilimplementing ilpatient ilteaching, ilwhat ilis ilthe ilpriority ilaction ilforthe ilnurse?

a. Instruct ilabout ilthe ilincreased ilrisk ilfor ilcardiovascular ildisease.
b. Provide ildetailed ilinformation ilabout ildietary ilcontrol ilof ilglucose.
c. Teach ilglucose ilself-monitoring iland ilmedication iladministration.
d. Give ilinformation ilabout ilthe ileffects ilof ilexercise ilon ilglucose
ilcontrol. ilANS: ilC

When iltime ilis illimited, ilthe ilnurse ilshould ilfocus ilon ilthe ilpriorities ilof ilteaching. ilIn ilthis ilsituation,
ilthe ilpatient ilshould ilknow ilhow ilto iltest ilblood ilglucose iland iladminister ilmedications ilto ilcontrol

ilglucose illevels. ilThe ilpatient ilwill ilneed ilfurther ilteaching ilabout ilthe ilrole ilof ildiet, ilexercise, ilvarious

ilmedications, iland ilthe ilmany ilpotential ilcomplications ilof ildiabetes, ilbut ilthese iltopics ilcan ilbe

iladdressed ilthrough ilplanning ilfor ilappropriate ilreferrals.

14. A il75-year-old ilpatient ilis iladmitted ilfor ilpancreatitis. ilWhich iltool ilwould ilbe ilthe ilmost
ilappropriate ilfor ilthe ilnurse ilto iluse ilduring ilthe iladmission ilassessment?

a. Drug ilAbuse ilScreening ilTest il(DAST-10)
b. Clinical ilInstitute ilWithdrawal ilAssessment ilof ilAlcohol ilScale, ilRevised il(CIWA-Ar)
c. Screening ilTest-Geriatric ilVersion il(SMAST-G)
d. Mini-Mental ilState ilExamination
ilANS: ilC

Because ilthe ilabuse ilof ilalcohol ilis ila ilcommon ilfactor ilassociated ilwith ilthe ildevelopment ilof
i l pancreatitis, ilthe ilfirst ilassessment ilstep ilis ilto ilscreen ilfor ilalcohol iluse ilusing ila ilvalidated ilscreening

ilquestionnaire. ilThe ilSMAST-G ilis ila ilshort-form ilalcoholism ilscreening ilinstrument iltailored

ilspecifically ilto ilthe ilneeds ilof ilthe ilolder iladult. ilIf ilthe ilpatient ilscores ilpositively ilon ilthe ilSMAST-G,

ilthen ilthe ilCIWA-Ar ilwould ilbe ila iluseful iltool ilfor ildetermining iltreatment. ilThe ilDAST-10 ilprovides

ilmore ilgeneral ilinformation ilregarding ilsubstance iluse. ilThe ilMini-Mental ilState ilExamination ilis

ilused ilto ilscreen ilfor ilcognitive ilimpairment.

1. The ilsister ilof ila ilpatient ildiagnosed ilwith ilBRCA ilgene–related ilbreast ilcancer ilasks ilthe ilnurse,
il―Do il you ilthink il I ilshould ilbe iltested ilfor ilthe ilgene?‖ ilWhich ilresponse ilby ilthe ilnurse ilis ilmost

ilappropriate?

a. ―In ilmost ilcases, ilbreast ilcancer ilis ilnot ilcaused ilby ilthe ilBRCA ilgene.‖
b. ―It ildepends ilon ilhow ilyou ilwill ilfeel ilif ilthe iltest ilis ilpositive ilfor ilthe ilBRCA ilgene.‖
c. ―There ilare ilmany ilthings ilto ilconsider ilbefore ildeciding ilto ilhave ilgenetic iltesting.‖
d. ―You ilshould ildecide ilfirst ilwhether ilyou ilare ilwilling ilto ilhave ila ilbilateral
ilmastectomy.‖ ilANS: ilC

Although ilpresymptomatic iltesting ilfor ilgenetic ildisorders ilallows ilpatients ilto iltake ilaction il(such ilas
ilmastectomy) ilto ilprevent ilthe ildevelopment ilof ilsome ilgenetically ilcaused ildisorders, ilpatients ilalso

ilneed ilto ilconsider ilthat iltest ilresults ilin iltheir ilmedical ilrecord ilmay ilaffect ilinsurance, ilemployability,

iletc.

Telling ila ilpatient ilthat ila ildecision ilabout ilmastectomy ilshould ilbe ilmade ilbefore iltesting ilimplies ilthat
ilthe ilnurse ilhas ilmade ila iljudgment ilabout ilwhat ilthe ilpatient ilshould ildo ilif ilthe iltest ilis ilpositive.

ilAlthough ilthe ilpatient ilmay ilneed ilto ilthink ilabout ilher ilreaction ilif ilthe iltest ilis ilpositive, ilother ilissues

il(e.g., ilinsurance) ilalso ilshould ilbe ilconsidered. ilAlthough ilmost ilbreast ilcancers ilare ilnot ilrelated ilto

ilBRCA ilgene ilmutations, ilthe ilpatient ilwith ila ilBRCA ilgene ilmutation ilhas ila ilmarkedly ilincreased ilrisk

ilfor ilbreast ilcancer.

, Stuvia.com il- ilThe ilMarketplace ilto ilBuy iland ilSell ilyour ilStudy
FINAL EXAM QUESTIONS,
Material
ANSWERS (EXPLAINED)

7. The ilnurse ilin ilthe iloutpatient ilclinic ilhas ilobtained ilhealth ilhistories ilfor ilthese ilnew ilpatients.
ilWhich ilpatient ilmay ilneed ilreferral ilfor ilgenetic iltesting?

a. 35-year-old ilpatient ilwhose ilmaternal ilgrandparents ildied ilafter ilstrokes ilat ilages il90 iland il96
b. 18-year-old ilpatient ilwith ila ilpositive ilpregnancy iltest ilwhose ilfirst ilchild ilhas ilcerebral ilpalsy
c. 34-year-old ilpatient ilwho ilhas ila ilsibling ilwith ilnewly ildiagnosed ilpolycystic ilkidney ildisease
d. 50-year-old ilpatient ilwith ila ilhistory ilof ilcigarette ilsmoking ilwho ilis ilcomplaining ilof
ildyspnea ilANS: ilC

The iladult ilform ilof ilpolycystic ilkidney ildisease ilis ilanautosomal ildominant and ilfrequently ilit ilis
asymptomatic iluntil ilthe ilpatient ilis ilolder. ilPresymptomaticdisorderiltesting ilwill ilgive ilthe ilpatient ilinformation ilthat

ilwill ilbe iluseful ilin ilguiding illifestyle iland ilchildbearing ilchoices. ilThe ilother ilpatients ildo ilnot ilhave ilany

ilindication ilof ilgenetic ildisorders ilor ilneed ilfor ilgenetic iltesting.

14. An iladolescent ilpatient ilseeks ilcare ilin ilthe ilemergency ildepartment ilafter ilsharing ilneedles
ilforheroin ilinjection ilwith ila ilfriend ilwho ilhas ilhepatitis ilB. ilTo ilprovide ilimmediate ilprotection ilfrom

ilinfection, ilwhat ilmedication ilwill ilthe ilnurse iladminister?

a. Corticosteroids
b. Gamma ilglobulin
c. Hepatitis ilB ilvaccine
d. Fresh ilfrozen ilplasma
ilANS: ilB

The ilpatient ilshould ilfirst ilreceive ilantibodies ilfor ilhepatitis ilB ilfrom ilinjection ilof ilgamma ilglobulin.
ilThe ilhepatitis ilB ilvaccination ilseries ilshould ilbe ilstarted ilto ilprovide ilactive ilimmunity. ilFresh ilfrozen

ilplasma iland ilcorticosteroids ilwill ilnot ilbe ileffective ilin ilpreventing ilhepatitis ilB ilin ilthe ilpatient.

6. A ilpatient ilwho ilis ildiagnosed ilwith ilcervical ilcancer ilthat ilis ilclassified ilas ilTis, ilN0, ilM0 ilasks ilthe
ilnurse ilwhat ilthe illetters iland ilnumbers ilmean. ilWhich ilresponse ilby ilthe ilnurse ilis ilmost ilappropriate?

a. ―The ilcancer ilinvolves ilonly ilthe ilcervix.‖
b. ―The ilcancer ilcells illook ilalmost illike ilnormal ilcells.‖
c. ―Further iltesting ilis ilneeded ilto ildetermine ilthe ilspread ilof ilthe ilcancer.‖
d. ―It ilis ildifficult ilto ildetermine ilthe iloriginal ilsite ilof ilthe ilcervical
ilcancer.‖ ilANS: ilA

Cancer ilin ilsitu ilindicates ilthat ilthe ilcancer ilis illocalized ilto ilthe ilcervix iland ilis ilnot ilinvasive ilat ilthis
iltime. ilCell ildifferentiation ilis ilnot ilindicated ilby ilclinical ilstaging. ilBecause ilthe ilcancer ilis ilin ilsitu, ilthe

ilorigin ilis ilthe ilcervix. ilFurther iltesting ilis ilnot ilindicated ilgiven ilthat ilthe ilcancer ilhas ilnot ilspread.

10. External-beam ilradiation ilis ilplanned ilfor ila ilpatient ilwith ilcervical ilcancer. ilWhat ilinstructions ilshould
ilthe ilnurse ilgive ilto ilthe ilpatient ilto ilprevent ilcomplications ilfrom ilthe ileffects ilof ilthe ilradiation?

a. Test ilall ilstools ilfor ilthe ilpresence ilof ilblood.
b. Maintain ila ilhigh-residue, ilhigh-fiber ildiet.
c. Clean ilthe ilperianal ilarea ilcarefully ilafter ilevery ilbowel ilmovement.
d. Inspect ilthe ilmouth iland ilthroat ildaily ilfor ilthe ilappearance ilof
ilthrush. ilANS: ilC

, Stuvia.com il- ilThe ilMarketplace ilto ilBuy iland ilSell ilyour ilStudy
FINAL EXAM QUESTIONS,
Material
ANSWERS (EXPLAINED)

Radiation ilto ilthe ilabdomen ilwill ilaffect ilorgans ilin ilthe ilradiation ilpath, ilsuch ilas ilthe ilbowel, iland ilcause ilfrequent
ildiarrhea. ilCareful ilcleaning ilof ilthis ilarea ilwill ilhelp ildecrease ilthe ilrisk ilfor ilskin ilbreakdown iland ilinfection.

Stools ilare illikely ilto ilhave iloccult ilblood ilfrom ilthe ilinflammation ilassociated ilwith ilradiation, ilso ilroutine
iltesting ilof ilstools ilfor ilblood ilis ilnot ilindicated. ilRadiation ilto ilthe ilabdomen ilwill ilnot ilcause ilstomatitis. ilA

illow-residue ildiet ilis ilrecommended ilto ilavoid ilirritation ilof ilthe ilbowel ilwhen ilpatients ilreceive ilabdominal

ilradiation.

11. The ilnurse ilnotes ilthat ila ilpatient ilwho ilwas iladmitted ilwith ildiabetic ilketoacidosis ilhas ilrapid,
ildeep ilrespirations. ilWhich ilaction ilshould ilthe ilnurse iltake?

a. Give ilthe ilprescribed ilPRN illorazepam il(Ativan).
b. Start ilthe ilprescribed ilPRN iloxygen ilat il2 ilto il4 ilL/min.
c. Administer ilthe ilprescribed ilnormal ilsaline ilbolus iland ilinsulin.
d. Encourage ilthe ilpatient ilto iltake ildeep, ilslow ilbreaths ilwith ilguided
ilimagery. ilANS: ilC

The ilrapid, ildeep il(Kussmaul) ilrespirations ilindicate ila ilmetabolic ilacidosis iland ilthe ilneed ilfor ilcorrection ilof
ilthe ilacidosis ilwith ila ilsaline ilbolus ilto ilprevent ilhypovolemia ilfollowed ilby ilinsulin iladministration ilto ilallow

ilglucose ilto ilreenter ilthe ilcells. ilOxygen iltherapy ilis ilnot ilindicated ilbecause ilthere ilis ilno ilindication ilthat ilthe

ilincreased ilrespiratory ilrate ilis ilrelated ilto ilhypoxemia. ilThe ilrespiratory ilpattern ilis ilcompensatory, iland ilthe

ilpatient ilwill ilnot ilbe ilable ilto ilslow ilthe ilrespiratory ilrate. ilLorazepam iladministration ilwill ilslow ilthe ilrespiratory

ilrate iland ilincrease ilthe illevel ilof ilacidosis.

17. The ilnurse ilis ilcaring ilfor ila ilpatient ilwho ilhas ila ilcalcium illevel ilof il12.1 ilmg/dL. ilWhich
ilnursing ilaction ilshould ilthe ilnurse ilinclude ilon ilthe ilcare ilplan?

a. Maintain ilthe ilpatient ilon ilbed ilrest.
b. Auscultate illung ilsounds ilevery il4 ilhours.
c. Monitor ilfor ilTrousseau’s iland ilChvostek’s ilsigns.
d. Encourage ilfluid ilintake ilup ilto il4000 ilmL ilevery
ilday. ilANS: ilD

To ildecrease ilthe ilrisk ilfor ilrenal ilcalculi, ilthe ilpatient ilshould ilhave ila ilfluid i l intake ilof il3000 ilto il4000 ilmL ildaily.
Ambulation ilhelps ildecrease ilthe illoss ilof ilcalcium ilfrom ilbone iland ilis ilencouraged ilin ilpatients ilwith
ilhypercalcemia. ilTrousseau’s iland ilChvostek’s ilsigns ilare ilmonitored ilwhen ilthere ilis ila ilpossibility ilof

hypocalcemia. ilThere ilis ilno ilindication ilthat ilthe ilpatient ilneeds ilfrequent ilassessment ilof illung ilsounds, ilalthough
ilthese ilwould ilbe ilassessed ilevery ilshift.

26. A ilpatient ilwho ilhad ila iltransverse ilcolectomy ilfor ildiverticulosis il18 ilhours ilago ilhas ilnasogastric ilsuction
iland ilis ilcomplaining ilof ilanxiety iland ilincisional ilpain. ilThe ilpatient’s ilrespiratory ilrate ilis il32 ilbreaths/minute

iland ilthe ilarterial ilblood ilgases il(ABGs) ilindicate ilrespiratory ilalkalosis. ilWhich ilaction ilshould ilthe ilnurse

iltake ilfirst?

a. Discontinue ilthe ilnasogastric ilsuction.
b. Give ilthe ilpatient ilthe ilPRN ilIV ilmorphine ilsulfate il4 ilmg.
c. Notify ilthe ilhealth ilcare ilprovider ilabout ilthe ilABG ilresults.
d. Teach ilthe ilpatient ilhow ilto iltake ilslow, ildeep ilbreaths ilwhen
ilanxious. ilANS: ilB

The ilpatient’s ilrespiratory ilalkalosis ilis ilcaused ilby ilthe ilincreased ilrespiratory ilrate ilassociated ilwith ilpain
iland ilanxiety. ilThe ilnurse’s ilfirst ilaction ilshould ilbe ilto ilmedicate ilthe ilpatient ilfor ilpain. ilAlthough ilthe

ilnasogastric

suction ilmay ilcontribute ilto ilthe ilalkalosis, ilit ilis ilnot ilappropriate ilto ildiscontinue ilthe iltube ilwhen ilthe ilpatient
ilneeds ilgastric ilsuction. ilThe ilhealth ilcare ilprovider ilmay ilbe ilnotified ilabout ilthe ilABGs ilbut ilis illikely ilto ilinstruct

ilthe ilnurse ilto ilmedicate ilfor ilpain. ilThe ilpatient ilwill ilnot ilbe ilable ilto iltake ilslow, ildeep ilbreaths ilwhen

ilexperiencing ilpain.

, Stuvia.com il- ilThe ilMarketplace ilto ilBuy iland ilSell ilyour ilStudy
FINAL EXAM QUESTIONS,
Material
ANSWERS (EXPLAINED)

10. Which iltopic ilis ilmost ilimportant ilfor ilthe ilnurse ilto ildiscuss ilpreoperatively ilwith ila ilpatient ilwho ilis
ilscheduled ilfor ilabdominal ilsurgery ilfor ilan ilopen ilcholecystectomy?

a. Care ilfor ilthe ilsurgical ilincision
b. Medications ilused ilduring ilsurgery
c. Deep ilbreathing iland ilcoughing iltechniques
d. Oral ilantibiotic iltherapyilafter ildischarge ilhome
ilANS: ilC

Preoperative ilteaching, ildemonstration, iland ilredemonstration ilof ildeep ilbreathing iland ilcoughing ilare ilneeded ilon
ilpatients ilhaving ilabdominal ilsurgery ilto ilprevent ilpostoperative ilatelectasis. ilIncisional ilcare iland ilthe ilimportance

ilof ilcompleting ilantibiotics ilare ilbetter ildiscussed ilafter ilsurgery, ilwhen ilthe ilpatient ilwill ilbe ilmore illikely ilto ilretain

ilthis ilinformation. ilThe ilpatient ildoes ilnot ilusually ilneed ilinformation ilabout ilmedications ilthat ilare ilused

ilintraoperatively.

15. The ilnurse ilis ilcaring ilfor ila ilpatient ilthe ilfirst ilpostoperative ilday ilfollowing ila illaparotomy ilfor ila ilsmall
ilbowel ilobstruction. ilThe ilnurse ilnotices ilnew ilbright-red ildrainage ilabout il5 ilcm ilin ildiameter ilon ilthe

ildressing. ilWhich ilaction ilshould ilthe ilnurse iltake ilfirst?

a. Reinforce ilthe ildressing.
b. Apply ilan ilabdominal ilbinder.
c. Take ilthe ilpatient’s ilvital ilsigns.
d. Recheck ilthe ildressing ilin il1 ilhour ilfor ilincreased
ildrainage. ilANS: ilC

New ilbright-red ildrainage ilmay ilindicate ilhemorrhage, iland ilthe ilnurse ilshould ilinitially ilassess ilthe ilpatient’s ilvital
ilsigns ilfor iltachycardia iland ilhypotension. ilThe ilsurgeon ilshould ilthen ilbe ilnotified ilof ilthe ildrainage iland ilthe ilvital

ilsigns. ilThe ildressing ilmay ilbe ilchanged ilor ilreinforced, ilbased ilon ilthe ilsurgeon’s ilorders ilor ilinstitutional ilpolicy.

The ilnurse ilshould ilnot ilwait ilan ilhour ilto ilrecheck ilthe ildressing.

38. Which ilprescribed ilmedication ilshould ilthe ilnurse ilgive ilfirst ilto ila ilpatient ilwho ilhas iljust ilbeen iladmitted
ilto ila ilhospital ilwith ilacute ilangle-closure ilglaucoma?

a. Morphine ilsulfate il4 ilmg ilIV
b. Mannitol il(Osmitrol) il100 ilmg ilIV
c. Betaxolol il(Betoptic) il1 ildrop ilin ileach ileye
d. Acetazolamide il(Diamox) il250 ilmg ilorally
ilANS: ilB

The ilmost ilimmediate ilconcern ilfor ilthe ilpatient ilis ilto illower ilintraocular ilpressure, ilwhich ilwill iloccur ilmost ilrapidly
ilwith ilIV iladministration ilof ila ilhyperosmolar ildiuretic ilsuch ilas ilmannitol. ilThe ilother ilmedications ilare ilalso

ilappropriate ilfor ila ilpatient ilwith ilglaucoma ilbut ilwould ilnot ilbe ilthe ilfirst ilmedication iladministered.

8. A ilpatient’s ilcapillary ilblood ilglucose illevel ilis il120 ilmg/dL il6 ilhours ilafter ilthe ilnurse ilinitiated ila
ilparenteral ilnutrition il(PN) ilinfusion. ilThe ilmost ilappropriate ilactionby ilthe ilnurse ilis ilto

a. obtain ila ilvenous ilblood ilglucose ilspecimen.
b. slow ilthe il infusion ilrate ilof ilthe ilPN ilinfusion.
c. Recheck ilthe ilcapillary ilblood ilglucose ilin il4 ilto il6 ilhours.
d. notify ilthe ilhealth ilcare ilprovider ilof ilthe ilglucose
illevel. ilANS: ilC

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