Med Surg Certification Practice
Questions with correct answers
"Third-spacing" can cause which form of shock?
A. Anaphylactic
B. Hypovolemic
C. Septic
D. Cardiovascular - CORRECT ANSWER-B. Hypovolemic
Third-spacing = movement of fluid out of the vascular system into the interstitial areas, resulting in loss of fluid
leading to hypovolemic shock
A 18-year-old male is admitted after a motor-vehicle accident with air-bag release. He complains of chest
tightness and is restless and anxious. Heart sounds are barely audible on auscultation. The patient is most likely
experiencing what condition?
A. Cardiac tamponade
B. Acute myocardial infarction
C. Pulmonary edema
D. Aortic aneurysm - CORRECT ANSWER-A. Cardiac tamponade
We know that this patient sustained trauma to the chest. Cardiac tamponade occurs when there is fluid build up
around the heart that applies pressure to the heart and impairs its ability to pump adequately. This can happen
with trauma or uncontrolled bleeding from an open heart procedure. Signs and symptoms include chest pain and
pressure, muffled heart tones, shortness of breath, and jugular vein distention
A 24 year-old factory worker with a history of asthma presents to the emergency department with difficulty
breathing. During the respiratory assessment of the patient, the nurse would expect to auscultate:
A. diminished breath sounds and crackles in lung bases
B. moist crackles in lung bases
C. distant breath sounds and expiratory wheezes
D. bronchial breath sounds in lung bases - CORRECT ANSWER-C. distant breath sounds and expiratory
wheezes
A 30 year-old man with chronic traumatic brain injury was admitted for a surgical procedure and is to be
discharged. The nurse should modify his discharge instructions by:
1. Providing detailed oral instructions
2. Providing detailed written instructions
3. Having him repeat the instructions
4. Having sustained eye contact during the instruction - CORRECT ANSWER-3. Having him repeat the
instructions
A 30-year-old female has been diagnosed with Cushing's syndrome. The nurse knows the patient is most likely to
exhibit which symptoms?
A. Hypertension and hirsutism
,B. Hyperkalemia and obesity
C. Hypotension and anemia
D. Menstrual irregularities and hypoglycemia - CORRECT ANSWER-A. Hypertension and hirsutism
Hypertension may result from fluid retention due to mineralcorticoid excess, and they may also exhibit hirsutism
(abnormal hair growth).
For Answers (B, C, D) while they may also exhibit truncal or generalized obesity as well as menstrual
irregularities, it is patient's with Addison's Disease that would exhibit Hyperkalemia, Hypoglycemia and
Hypotension (it is the opposite in Cushing's Syndrome).
A 48 year-old patient with suspected gastrointestinal (GI) bleeding undergoes diagnostic endoscopy, which
determines the site of bleeding is a duodenal ulcer. The nurse explains to the patient that bleeding ulcers are
most commonly related to which of the following?
a. Intake of spicy foods
b. Use of salicylates
c. History of smoking
d. Severe retching and vomiting - CORRECT ANSWER-b. Use of salicylates
Most bleeding ulcers are related to the presence of Helicobacter pylori or drug use, especially aspirin and aspirin-
containing produces (salicylates) or nonsteroidal anti-inflammatory drugs. Severe retching and vomiting are
associated with esophageal bleeding. Spicy floods do not cause ulcers.
A 50-year-old woman weighs 85kg and has a history of cigarette smoking, high blood pressure, high sodium
intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that
the most important risk factors for peripheral artery disease that need to be modified are:
A. Weight and diet
B. Activity level and diet
C. Cigarette smoking and high blood pressure
D. Sedentary lifestyle and high blood pressure - CORRECT ANSWER-C. Cigarette smoking and high blood
pressure
These really all need to be addressed but smoking most of all, especially combined with high BP
A 60-year-old African American male who works as a soccer coach, is admitted with hypertension. On admission
his blood pressure was 210/108 mmHg. His last total cholesterol level was 156 mg/dl, and a random blood
glucose was 110 mg/dl. Which is unalterable risk factor for hypertension?
A. His blood glucose level
B. His cholesterol level
C. His occupation
D. His ethnicity - CORRECT ANSWER-D
Other risk factors: elevated serum lipids, DM, sedentary lifestyle
A 63 year old female patient contacts the clinic to report that she is has been extremely fatigued, is sleeping 12
hours a night, is always cold and her hair is falling out. Which of the following responses by the nurse is most
appropriate?
A. You will have more energy if you walk 30 min every day.
B. You don't need to worry. Sleeping a lot is good for you.
C. Come in and see your health care provider today.
D. You should eat more green leafy vegetables. - CORRECT ANSWER-C
Need more info
A 68 year old woman is admitted to the surgical unit after a gastric resection for gastric cancer. She states that
she doesn't want anyone to see her in this condition, even her husband. This nurse's best response is:
A."Patients' rights protect your privacy. I won't allow anyone in."
B."I've seen gastric cancer patients who look much worse. Don't worry."
C."Would you like to talk to a social worker?"
D."What about your condition worries you?" - CORRECT ANSWER-D
,The nurse should allow the patient to share her concerns and express her feelings in a nonjudgmental
environment.
If there is psych/behavioral component- AFFIRM AND VALIDATE, NO PROBING
A 75 year old patient complains to the clinical nurse that he is having difficulty sleeping. Which of the following
actions by the nurse is most appropriate?
A. Determine the patient's usual sleeping and waking patterns.
B. Suggest that the client abstain from alcohol and caffeine before bed time.
C. Recommend that client establish a bedtime routine.
D. Ask how much sleep the client required before retirement. - CORRECT ANSWER-A
B and C are recommendations that the RN can share after he/she determines the patient's sleeping and waking
patterns. So remove B and C. D is an inquiry, but is concerned about the past (when the person retired). Remove
D. A is the best answer.
A classic finding in the patient with acute respiratory distress syndrome (ARDS) is:
A. Sudden hypocalcemia with tetany
B. Severe hyperkalemia
C. Hypoxia resistant to oxygen therapy
D. Hypercapnia - CORRECT ANSWER-C. Hypoxia resistant to oxygen therapy
A client admitted to the hospital with a sickle cell crisis complains of severe abdominal, hip, and knee pain. You
observe an LVN accomplishing these client care tasks. Which one requires that you, as charge nurse, intervene
immediately?
A. The LVN encourages the client to use the ordered PCA.
B. The LVN positions cold packs on the client's knees.
C. The LVN places a "No Visitors" sign on the client's door.
D. The LVN checks the client's temperature every 2 hours. - CORRECT ANSWER-B. The LVN positions cold
packs on the client's knees.
The joint pain that occurs in sickle cell crisis is caused by obstruction of blood flow by the sickled red blood cells.
The appropriate therapy for this client would be application of moist heat to the joints to cause vasodilation and
improve circulation.
(A) Because control of pain is a priority during sickle cell crisis, encouraging the client to use the PCA is an
appropriate therapy.
(C, D) While infection control is important in preventing and treating sickle cell crisis, there is no need to restrict
all visitors or to check the temperature every 2 hours.
A client complains of crushing chest pain that radiates to his left arm. Which of the following treatments should
you anticipate:
A. Aspirin, oxygen, nitroglycerin, and morphine
B. Aspirin, oxygen, nitroglycerin, and codeine
C. Oxygen, nitroglycerin, meperidine, and thrombolytics
D. Aspirin, oxygen, nitroprusside, and morphine - CORRECT ANSWER-A. Aspirin, oxygen, nitroglycerin, and
morphine
MONA
A client with a past history of angina has had a total knee replacement. What will the nurse teach the client prior
to rehabilitation activities?
A. "Use analgesics even if you are not in pain."
B. "Take nitroglycerine prophylactically prior to activity."
C. "Take anti-inflammatory medications before you get out of bed."
D. "Do not exercise if you have knee pain." - CORRECT ANSWER-B. "Take nitroglycerine prophylactically prior
to activity."
Participation in exercise may increase myocardial oxygen demand beyond the ability of the coronary circulation
to deliver enough oxygen to meet the increased need. Nitroglycerin dilates coronary arteries within 5 minutes of
use, ensuring that they will be ready to meet the demand during exercise.
, A client with acute myelogenous leukemia is receiving induction phase chemotherapy. Which assessment
information is of most concern?
A. Serum potassium level of 7.8 mEq/L
B. Urine output less than intake by 400 mL
C. Inflammation and redness of oral mucosa
D. Ecchymoses present on anterior trunk - CORRECT ANSWER-
A clinical nurse returns to the desk to find 4 phone messages. Which of the following messages should the nurse
respond to first?
A. A post cervical laminectomy patient complaining of sudden difficulty talking.
B. A patient with multiple sclerosis complaining of change in peripheral vision.
C. A patient with a herniated disc complaining of consistent back pain.
D. A patient with a cast due to a fracture of the right tibial bone complaining of tingling toes. - CORRECT
ANSWER-A
B and C are expected symptoms of the patient's condition. A and D are unexpected. D is less critical than A. Best
answer is A.
A diabetic patient presents with hot and dry skin, rapid and deep respirations, and a fruity odor to his breath. As
charge nurse, you observe the new graduate RN accomplishing all these patient tasks. Which one requires that
you intervene immediately?
A. The RN checks the patient's fingerstick glucose.
B. The RN encourages the patient to drink orange juice.
C. The RN checks the patient's order for sliding scale insulin.
D. The RN assesses the patient's vital signs every 15 minutes. - CORRECT ANSWER-B. The RN encourages
the patient to drink orange juice.
The signs and symptoms the patient is exhibiting are consistent with Hyperglycemia. The RN should not give the
patient additional glucose.
Answers (A, C, D) are all appropriate interventions for this patient. The RN should also notify the physician at this
time.
A home care nurse is visiting a diabetic client with a new cast on the arm. On assessment, the nurse finds the
client's fingers to be pale, cool, and slightly swollen. Which is the nurse's first intervention?
a. Elevating the arm above the level of the heart
b. Encouraging active and passive range of motion
c. Applying heat to the affected hand
d. Applying a bivalve the cast - CORRECT ANSWER-a. Elevating the arm above the level of the heart
Arm casts can impinge on circulation when the arm is in the dependent position. The nurse should elevate the
arm above the level of the heart, ensuring that the hand is above the elbow, and reassess the extremity in 15
minutes. If the fingers are warmer and less swollen, the cast is not too tight and adjustments do not need to be
made. Heat would cause more edema. Encouraging range of motion would not assist the client as much as
elevating the arm.
A long-term-care client with chronic lymphocytic leukemia has a nursing diagnosis of Activity Intolerance related
to weakness and anemia. Which of these nursing activities is most appropriate for you, as the charge nurse, to
delegate to a nursing assistant?
A. Evaluate the client's response to normal activities of daily living.
B. Check the client's blood pressure and pulse rate after ambulation.
C. Determine which self-care activities the client can do independently.
D. Assist the client in choosing a diet that will improve strength. - CORRECT ANSWER-B. Check the client's
blood pressure and pulse rate after ambulation.
Nursing assistant education includes routine nursing skills such as assessment of vital signs.
(A, C, D) Evaluation, baseline assessment of client abilities, and nutrition planning are roles appropriate to RN
practice.
A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by
blood loss after surgery. Which action by the new RN requires that you, as charge RN, intervene immediately?
A. The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion.
