Med-Surg-100 question & answers Review (test bank) latest Fall 2020
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NURSING MISC (NURSINGMISC)
Institution
Rasmussen College
1 Which of the following is an important component of a teaching plan for the client recently diagnosed with peptic ulcer disease? Incorrect: Antacids should not be taken concurrently with other ulcer drugs such as H2 blockers because they will decrease drug absorption by 10% to 20%.Correct: The GI...
med surg 100 question amp answers review test bank latest fall 2020
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NURSING MISC (NURSINGMISC)
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Med-Surg-100 question & answers Review
1
Which of the following is an important component of a teaching plan for the client
recently diagnosed with peptic ulcer disease?
Incorrect: Antacids should not be taken concurrently with other ulcer drugs such
as H2 blockers because they will decrease drug absorption by 10% to 20%.Correct: The
GI complications of NSAID use are strongly linked to mucosal injury and the
development of gastric ulcers.Incorrect: Although milk-based diets may provide symptom
relief, research has shown they do not influence healing and in fact actually act to
increase acid secretion. Diet plays no defined role in ulcer development and current
management of ulcers.Incorrect: The individual with an ulcer does not need to restrict
activity to enhance healing. Most clients are able to continue usual activities, although
adequate rest is encouraged.
Antacids and H2 receptor antagonists can be taken together.
Avoid the use of NSAIDs for pain control.
Increase milk products in the diet to enhance healing.
Limit physical activity to reduce stomach acid.
2
A nurse admits a 42-year-old female with the following characteristics: excessive
sleeping, fatigue, constipation, weight gain, and complaint of intolerance to cold. These
signs and symptoms are most consistent with:
Incorrect: Although some of the symptoms mentioned would be consistent with
acute renal failure (i.e. fatigue, weight gain), there is no mention of the classic symptoms
of acute renal failure. These would include signs and symptoms of fluid overload and
electrolyte imbalance such as hypertension, neck vein distention, low urine output,
confusion.Incorrect: Although fatigue is consistent with aplastic anemia, the remaining
symptoms are not. Aplastic anemia results from impaired erythrocyte production and is
manifested by pale skin color, fatigue, exertional dyspnea, palpations, low hemoglobin,
and signs of bleeding tendency such as petechiae and ecchymosis.Correct: This client
presents with some of the classic characteristics of hypothyroidism. Recall that a lack of
thyroid hormone results in a general depression of the basal metabolic rate. A typical
clinical picture includes fatigue, weakness, intolerance to cold, constipation, menstrual
irregularities, reduced appetite, dry skin, edema.Incorrect: The hallmark of diabetes is
insulin deficiency manifested by hyperglycemia, polyuria, polydipsia, polyphagia, visual
blurring, fatigue, and weight loss. This client does not present with this symptom
combination.
acute renal failure.
aplastic anemia.
hypothyroidism.
diabetes mellitus.
3
A client newly diagnosed with HIV says to the nurse, "I can't believe this is happening.
There must be some new treatments that can help." The most appropriate nursing
diagnosis for this client based on his comments would be:
, Incorrect: The defining characteristics of altered family processes include verbal
hostility between family members and a general lack of communication and respect
between family members. Although this may be a problem for the client with HIV, more
data is needed to formulate this nursing diagnosis in this situation.Incorrect: The client
has not expressed a feeling of aloneness or verbalized discomfort in social situations,
which are characteristics of social isolation. Although clients with a diagnosis of HIV or
AIDS may experience social isolation, there is insufficient data to validate this as a
problem for this individual.Correct: The client's statement is most consistent with
anticipatory grieving which is characterized by the normal grief response including anger,
denial, disbelief, and guilt.Incorrect: The defining characteristics of ineffective individual
coping include verbalization of the inability to cope, inability to problem-solve, altered
social participation, inability to meet basic needs and role expectations and inappropriate
use of defense mechanisms to mention a few. Although the client is expressing disbelief,
there is insufficient data to support a nursing diagnosis of ineffective individual coping.
altered family processes.
social isolation.
anticipatory grieving.
ineffective individual coping.
4
The nature of systemic lupus erythematosus (SLE) requires the nurse to teach the patient
and family:
Incorrect: Pregnancy is not necessarily contraindicated in clients with SLE.
Although pregnancy does not induce SLE exacerbations, pregnancy should be planned
with the client's primary care provider.Correct: Factors such as fatigue, sun exposure,
stress, and infection can exacerbate systemic lupus erythematosus. Nursing interventions
should include teaching the client and family measures to reduce stress and cope with the
chronic disease.Incorrect: Neither discoid nor systemic lupus erythematosus is a
contagious disease. Both are thought to be autoimmune disorders.Incorrect: The lesions
of SLE are well demarcated and are relatively benign in nature. The rash is generally
confined to the face, scalp, and neck. Although other parts of the body may be involved
(i.e. mucous membranes), the rash does not actually spread like an allergic dermatitis (i.e.
when an irritant or allergen is spread by the hands to another body part as in poison ivy).
birth control measures to prevent pregnancy.
strategies to prevent and cope with stress.
measures to prevent spread of the disease.
methods to diminish spread of skin lesions.
5
A Type I diabetic is prescribed to take Regular and NPH insulin before breakfast. The
client administers his insulin at 6:00 a.m. prior to breakfast. The nurse should teach the
client to:
Incorrect: The onset of NPH insulin is approximately 1-2 hours with peak effect
between 6-12 hours. Therefore a snack eaten between breakfast and lunch, when the NPH
insulin is beginning to reach it's peak action would be important to prevent hypoglycemia
before lunch. In addition, regular or quick acting insulin requires that a supplemental
,snack of 15 g of carbohydrate be given to match the peak action of the insulin. Since
regular insulin is peaking at 2-4 hours post administration, a 10:00 a.m. snack would be
recommended.Incorrect: Because the NPH insulin will still be peaking from
approximately 12:00 p.m. to 6:00 p.m., delaying the evening meal (dinner) until after 6:00
p.m. would put the client at risk for hypoglycemia.Incorrect: Carbohydrate intake must be
coordinated with the peak action of insulin. Therefore, the client should be taught to
consistently eat carbohydrates at meals, ranging from 45-60% of the total caloric
intake.Correct: The peak time of NPH insulin is 4-12 hours. If the client takes the NPH
insulin at 6:00 a.m., the insulin will be peaking between 12:00 p.m. and 6:00 p.m.
Therefore it is important that food be scheduled between this time period to prevent
hypoglycemia.
avoid any snacks between breakfast and lunch.
delay dinner until after 6:00 p.m..
eat a low carbohydrate lunch at noon.
schedule a snack at 3:00 p.m..
6
A client with a fractured femur was recently admitted to the orthopedic unit in traction. In
planning care to minimize the risk for fat embolism, the nurse should implement which
intervention?
Correct: Immobilization, surgery or trauma to the skeletal system, poor hydration
and low tidal volume in the lung are predisposing factors to fat embolism syndrome.
Nursing interventions to reduce the risk of fat embolism include good respiratory care,
adequate hydration, and stable traction. Other measures include: the use of intermittent
pneumatic compression, leg elevation, elastic stockings, and medications (anticoagulant,
anti-platelet agents).Incorrect: Fat embolism is not related to diet. The use of
supplementary oxygen may require an order, particularly to the client with chronic
obstructive pulmonary disease. Range of motion is not recommended for the affected
leg.Incorrect: A liquid diet is not necessary for the client in traction. Physical therapy is
essential in the rehabilitative phase.Incorrect: Sedation and analgesia are not related to the
prevention of fat emboli.
The client is encouraged to move the unaffected extremities to reduce the
risk of fat embolism syndrome, pressure-related skin injury, and muscle soreness.
Provide a low-fat, high-carbohydrate diet, give oxygen, and encourage
range of motion in the affected leg.
Keep the client on a liquid diet, and have physical therapy start the client
on an exercise program for upper body strengthening.
Maintain sedation and administer intravenous fluids and medications for
pain as needed.
7
The nurse is caring for a client who has just developed ventricular tachycardia following
a myocardial infarction. The nurse anticipates the client will immediately be given which
of the following medications?
Incorrect: Atropine sulfate is an anticholinergic drug used to increase the heart
rate in symptomatic bradycardia (defined as 40 beats per minute).Incorrect: Epinephrine
, is an adrenergic agent that increases the heart rate. This drug would be contraindicated in
fast-rate dysrhythmias. It is one of the first line drugs administered during CPR. By
constricting peripheral blood vessels, epinephrine shunts blood to the central circulation
and increases blood flow to the heart and brain. It is also given for asystole to stimulate
electrical and mechanical activity to produce myocardial contraction.Correct: The first
line drug for management of serious ventricular dysrhythmias is lidocaine, which
decreases myocardial irritability (automaticity) in the ventricles.Incorrect:
Nitroglycerin is used to dilate coronary arteries and improve blood flow. It has no
antidysrhythmic effect.
Atropine sulfate
Epinephrine
Lidocaine
Nitroglycerin
8
During a home visit the nurse determines that the client is experiencing dumping
syndrome following his recent total gastrectomy. Which dietary recommendation should
the nurse convey to the client?
Incorrect: Oral vitamins will have no effect on dumping syndrome. Further, they
are of no benefit to the client following total gastrectomy due to loss of intrinsic factor
normally secreted by the parietal cells of the stomach. Intrinsic factor is essential for the
absorption of vitamin B12. Monthly injection of vitamin B12 will prevent the
development of pernicious anemia.Incorrect: Malabsorption of fat may occur after
gastrectomy from reduced acid secretion and availability of pancreatic enzymes required
for fat absorption. Dumping syndrome occurs because of the rapid entry of hypertonic
food into the upper small intestine without undergoing the usual breakdown and dilution
in the stomach. This stimulates motility and diarrhea. Preventive measures include a
moderate-fat, high-protein diet with limited carbohydrates.Correct: Fluids with meals are
discouraged because they increase total volume and further promote diarrhea.Incorrect:
Rest on the left side for 20-30 minutes after eating is thought to delay gastric emptying
and may be helpful for some individuals.
Begin taking a vitamin B complex supplement.
Eat a high carbohydrate, low fat, low protein diet.
Decrease fluid intake with meals.
Go for a slow, short walk after eating.
9
A client with asthma goes into status asthmaticus. Which clinical signs, if present, would
indicate that intubation and mechanical ventilation are needed?
Incorrect: Both hyperresonance (air-trapping) and tachypnea are characteristic of
an acute asthma attack.Incorrect: Severe inspiratory and expiratory wheezing is consistent
with an acute asthma attack. Clients with status asthmaticus may be moving minimal
amounts of air into and out of the lungs therefore audible wheezing may NOT be
present.Correct: These blood gas values indicate respiratory acidosis and hypoxemia. This
occurs as a result of a prolonged attack where respiratory muscle exhaustion causes
hypoventilation. If respiratory acidosis and hypoxemia are present, intubation and
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