PN ADULT MEDICAL SURGICAL ONLINE PRACTICE FORM
A AND B 2020 EXAM ALL 90 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
A home health nurse is assisting with the care for a client who has COPD. The client reports
shortness of breath while eating, despite the use of home oxygen. Which of the following
recommendations should the nurse make? - ANSWER = "Use a bronchodilator 30 minutes before
your meal."
RATIONALE -The dient should use a bronchodilator 30 min before meals to prevent shortness of
breath while eating.
A nurse in a clinic is collecting data from a client who has hyperthyroidism and has been taking
methimazole for 4 weeks. Which of the following statements by the client indicates a therapeutic
response to the medication? - ANSWER = "I have gained 3 lbs since my last appointment"
RATIONALE -Hyperthyroidism can cause weight loss. Therefore, the nurse should identify weight
gain as an indication that the methimazole therapy has been effective
A nurse in a long-term care facility is collecting data from a client who reports ful
1088
in the rectum andabdominal cramping. Which of the following findings should indicate to the
nurse that the client might have a fecal impaction? - ANSWER = Small liquid stools
RATIONALE -Small liquid stools can be the result of fecal material being expelled around an
impaction.
A nurse in a telemetry unit is collecting data from a client who has a newly inserted permanent
pacemaker. Which of the following findings should the nurse report to the provider? - ANSWER =
The client experiences hiccups when sitting.
A nurse is assisting in the care of a client who has manifestations of sepsis. Which of the following
provider prescriptions should the nurse implement first? - ANSWER = Initiate oxygen at 4L/min via
nasal cannula.
Rationale:
The nurse should remind the client to have a pneumococcal immunization at age 65 and every
10 years thereafter to protect them from acquiring pneumonia.
,PN ADULT MEDICAL SURGICAL ONLINE PRACTICE FORM
A AND B 2020 EXAM ALL 90 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
CONTACT TUTOR, WHATSAPP @ +254713480490
The nurse should collect a sputum culture to identify the organism causing the client's infection.
Antimicrobial sensitivities are obtained from the sputum culture to guide the provider in
prescribing antibiotics. However, there is another prescription the nurse should implement first.
The nurse should administer antibiotics to treat the infection. A broad spectrum antibiotic, such
as ceftriaxone, is administered when sepsis is suspected because it treats both gram-positive
and gram-negative bacteria. After the results of the blood and sputum cultures are obtained,
the provider will often change to a more specific antibiotic. However, there is another
prescription the nurse should implement first.
The nurse should obtain blood cultures to identify the organism causing the client's infection.
Antimicrobial sensitivities obtained from the blood cultures will guide the provider in prescribing
treatment. However, there is another prescription the nurse should implement first.
A nurse is assisting in the plan of care regarding bowel retraining for a client who has a cervical
spinal cord injury. Which of the following interventions should the nurse plan to implement first? -
ANSWER = Determine the client's daily elimination habits.
RATIONALE -The first action the nurse should take when using the nursing process is to collect
data on the client's daily bowel elimination habits to establish a routine defecation time.
A nurse is assisting the charge nurse with developing an in-service about caring for clients who
have internal sealed radiation implants. Which of the following information should the nurse
include? - ANSWER = Dispose of radiation implants in a lead container:
Rationale:
Lead impairs the emission of radiation. Therefore, the nurse should dispose of radiation implants
in a lead container in accordance with facility protocol.
------------------------------
Pregnant women and children should not be allowed to visit a client who is receiving internal
radiation therapy because of the risk for exposure to radiation emissions.
The nurse should use forceps to pick up a radiation implant if it becomes dislodged.
The nurse should limit time spent in the client's room to 30 min during an 8 hr shift.
, PN ADULT MEDICAL SURGICAL ONLINE PRACTICE FORM
A AND B 2020 EXAM ALL 90 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
A nurse is assisting with an educational program for clients who have been newly diagnosed
with diabetes mellitus. Which of the following instructions should the nurse include in the program
regarding insulin? - ANSWER = Opened insulin can be stored on a cool countertop away from
light
RATIONALE -The nurse should reinforce teaching with the clients that opened insulin vials do not
require refrigeration, but can be placed in a cool location for up to 4 weeks, out of direct
sunlight.
A nurse is assisting with the care for a client following a thyroidectomy. Which of the following
findings should alert the nurse to the possibility of parathyroid gland injury? - ANSWER = Muscle
twitching
RATIONALE -A common complication of a thyroidectomy is parathyroid gland injury, leading to
hypocalcemia. Clients experiencing hypocalcemia can have twitching, numbness, and tingling
of fingers, toes, and around the mouth.
A nurse is assisting with the care for a client who has a compound fracture of the femur and was
placed in balanced suspension skeletal traction 4 days ago. Which of the following actions
should the nurse take? - ANSWER = Perform pin site care daily.
RATIONALE -The nurse should perform pin site care daily with chlorhexidine solution or use a
solution according to facility protocol. The nurse should also monitor the pin sites for
manifestations of infection.
A nurse is assisting with the care for a client who has a methicillin-resistant Staphylococcus
aureus (MRSA) nfection in a surgical wound. Which of the following information should the nurse
plan to share with visitors? - ANSWER = Visitors must don a gown and gloves prior to entering the
client's room
.
RATIONALE -The nurse should provide teaching to the visitors regarding the infection control
measures for a client who is on contact isolation precautions. Contact precautions require
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