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MEDICINE AND SURGERY EXAM (2024) WITH COMPLETE SOLUTIONS
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1. The nurse empties the nasogastric suction collection canister of a client who had a bowel resection the previous day and notes that 1000 ml of gastric secretions were collected in the last 4 hours. The nurse should assess the client for symptoms of which related problem? a. Metabolic alkalosis ...

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  • September 1, 2024
  • 26
  • 2024/2025
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  • medicine and surgery exam 2024

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MEDICINE AND SURGERY EXAM (2024)
WITH COMPLETE SOLUTIONS




1. The nurse empties the nasogastric suction collection canister of a client who
had a bowel resection the previous day and notes that 1000 ml of gastric
secretions were collected in the last 4 hours. The nurse should assess the client
for symptoms of which related problem?
a. Metabolic alkalosis
b. Hyperkalemia
c. Metabolic acidosis
d. Hypoglycemia
a. Metabolic alkalosis

The nasogastric suctioning can lead to a loss of gastric acid, which is rich in
hydrochloric acid. When this acid is lost, the body's balance of bases and acids
can be disrupted, leading to metabolic alkalosis. Metabolic alkalosis is a
condition marked by a decrease in the body's acidity, or an increase in its
alkalinity. Symptoms can include confusion, hand tremors, light-headedness,
nausea, and vomiting. Therefore, the nurse should assess the client for
symptoms of metabolic alkalosis.
2. A young client who is being taught to use an inhaler for symptoms of asthma
tells the nurse the intention to use the inhaler but, plans to continue smoking
cigarettes in evaluating the client's response, what is the best initial action by the
nurse?
a. Inform the healthcare provider of this statement made by the client.
b. Explain that denial of illness can interfere with the treatment regimen.
c. Revise the plan of care based on the client's plans to continue smoking.
d. Review factors surrounding the client's beliefs about smoking cessation.
d. Review factors surrounding the client's beliefs about smoking cessation.

This response aligns with the motivational interviewing approach, which involves
exploring the client's beliefs and motivations regarding behavior change. The

,nurse should engage the client in a non-judgmental conversation to understand
their perspective on smoking and its relationship to their asthma. This approach
allows the nurse to assess the client's readiness to quit smoking and identify
potential barriers to smoking cessation. By understanding the client's beliefs and
motivations, the nurse can tailor the education and support provided to the client,
ultimately increasing the likelihood of successful behavior change.
3. A client with sudden onset of big toe joint pain and swelling is diagnosed with
gout. Which pathophysiologic process is producing the symptoms of gout?
a. An immune complex and autoantibody deposition in connective tissue results
in inflammation.
b. Chondrocyte injury destroys joint cartilage, producing osteophytes and joint
inflammation.
c. An autoimmune inflammation involving IgG response to an antigen causes
joint destruction.
d. Deposition of crystals in the synovial space of the joint produces inflammation
and irritation.
d. Deposition of crystals in the synovial space of the joint produces inflammation
and irritation.

Gout is a disease that occurs in response to the presence of monosodium urate
(MSU) crystals in joints, bones, and soft tissues, leading to acute inflammatory
responses mediated by the innate immune system activation. The deposition of
these crystals in the synovial space of the joint results in inflammation and
irritation, leading to the characteristic symptoms of gout, such as joint pain and
swelling
4. An older female client has normal saline infusing at 45ml/hour. She complains
of pain at the insertion site of the IV catheter. There is no redness or edema
around the IV site. Which action should the nurse take?
a. Determine what IV medications have recently been administered.
b. Explain that without redness or edema, there is no need to restart the IV.
c. Consult with the healthcare provider about the best localization to start a new
IV.
d. Convert the IV to a saline lock and continue to monitor the site.
c. Consult with the healthcare provider about the best localization to start a new
IV.
IV fluid and drug administration should not hurt, if the drugs are diluted and
administered correctly, blood flow around the catheter is adequate to dilute them
further and if the catheter is properly immobilized, an infusion should not cause
pain. If the client complains of pain during an infusion it indicates vein damage
that may lead to infiltration. Therefore the best action the nurse should take is to

, consult with the healthcare provider about localization of the IV and whether to
start a new IV.
5. While assessing a female client who is chronically fatigued and was recently
diagnosed with adrenal insufficiency, the client tells the nurse that she is very
nervous that her hospitalization will cause her to lose her job. Which intervention
should the nurse implement first?
a. Teach the client about the risk of infection.
b. Offer support and care measure to reduce anxiety and stress.
c. Encourage the client to rest quietly to reduce fatigue.
d. Place a referral to social services to discuss financing options.
b. Offer support and care measure to reduce anxiety and stress.

Adrenal insufficiency shows some psychiatric presentations such as anxiety,
depression and mania among the patients. Offering support and care measure to
reduce anxiety and stress should be the first intervention the nurse should carry
out to help the patient.
6. The nurse is collecting information from a client with chronic pancreatitis who
reports persistent gnawing abdominal pain. To help the client manage the pain.
Which assessment data is most important for the nurse to obtain?
a. Color and consistency of feces.
b. Eating patterns and dietary intake.
c. Presence and activity of bowel sounds.
d. Level and amount of physical activity.
b. Eating patterns and dietary intake.

Both the fat and fat cells and the inflammation from them will reduce what you eat
and drink. This ensures that the amount of pain you have will be reduced. Eating
foods that prevent inflammation can also minimize obesity as a side effect, so the
body becomes healthier over time.
7. A young adult client, admitted to the Emergency Department following a motor
vehicle collision, is transfused with 4 units of PRBCs (packed red blood cells).
The client's pretransfusion hematocrit is 17%. Which hematocrit value should the
nurse expect the client to have after all the PRBCs have been transfused?
a. 19%
b. 9%
c. 39%
d. 29%
d. 29%

Each unit of PRBCs (packed red blood cells) raises the hematocrit by
approximately 3%. The client's pretransfusion hematocrit is 17%. After receiving 4

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