Med-Surg Certification Practice Questions and Answers with complete solutions

Med-Surg Certification Practice Questions and Answers with complete solutions "Third-spacing" can cause which form of shock? A. Anaphylactic B. Hypovolemic C. Septic D. Cardiovascular - ANS -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 - ANS -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 - ANS -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 - ANS -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 - ANS -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 - ANS -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 - ANS -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 - ANS -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. - ANS -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?" - ANS -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. - ANS -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 - ANS -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. - ANS -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 - ANS -A. Aspirin, oxygen, nitroglycerin, and morphine MONA