MEDICAL SURGICAL NURSIING

NCLEX CHAPTER QUESTIONS

Chapter 1
1. An example of a nursing activity that reflects the American Nurses Association’s definition of nursing is
♦ B. diagnosing that a patient with a feeding tube is at risk for aspiration
2. to obtain certification in a specialty area of nursing, a nurse must at least
♦ c. practice a specific period of time in the specialized area of nursing
3. in a responding to the Health People initiatives, the nursing profession is expected to
♦ c. teach people healthy self-care behaviors related to the major health problems of the country
4. when using evidence-based practice, the nurse,
♦ c. uses clinical decision making and judgment to determine what evidence is appropriate for a specific
clinical situation.
5. standardized nursing terminologies benefit patient care in that
♦ a. patient problems and nursing care are clearly defined
6. one advantage of the use of informatics in health care delivery is
♦ c. improved communication of the patient’s health status to the health care team.
7. when the nurse determines that the patient’s anxiety needs to be relieved before effective teaching can be
implemented, the phase of the nursing process being used is
♦ c. planning
8. an example of an independent nursing intervention is
♦ c. teaching a patient about the effects of prescribed drugs
9. the process of making a nursing diagnosis differs from a diagnostic process involves
♦ c. identifying factors related to the pathophysiology of a disease process
10. the nurse identifies the nursing diagnosis of risk for impaired skin integrity related to obesity and loss of
skin elasticity for a patient. The most appropriate expected patient outcome related to this nursing diagnosis
is that the
♦ b. patient achieves a normal weight for height
11. a patient has a nursing diagnosis of stress urinary incontinence related to overdistention between voidings.
An appropriate nursing intervention for this patient related to this nursing diagnosis is to
♦ a. provide privacy for toileting
12. linkages of NANDA nursing diagnoses, NOC patient outcomes, and NIC nursing interventions can be used
to
♦ b. provide guides for planning care
13. the primary purpose of the evaluation phase of the nursing process is to
♦ d. identify patient progress toward outcomes

Chapter 2

1. which of the following is the leading determinant of a patient’s health?

♦ A. behavior
2. in identifying patients at the greatest risk for health disparities, the nurse would note that
♦ b. cultural differences exist in the ability of patients to communicate with their health care provider
3. a 50 y/o Native American woman with type 2 diabetes mellitus living on a rural reservation has poor
glycemic control this situation may be related to all of the following factors except
♦ b. eating fresh foods rather than prepackaged foods
4. disparities in health are related to a number of factors including
♦ c. occupation: laborers are more vulnerable to job-related injuries than white collar workers
5. nurses play an important role in reducing health disparities. One important mechanism to do this is to
♦ d. engage in active listening and establish relationships with patients and families.
Chapter 3

1. forcing one’s own cultural beliefs and practices on another person is an example of
♦ cultural imposition
2. immigration may potentially affect an individual’s health in all of the following instances except
♦ d. immigrants are rarely affected by changes when they move to an area that has a different physical
environment
3. which of the following most accurately describes cultural factors that may affect health?
♦ A. diabetes and cancer rates differ by cultural/ethnic groups
4. when communicating with a patient who speaks a language that the nurse does not understand, it is
important to first attempt to
♦ b. use a trained medical interpreter
5. which of the following accurately reflects a physiologic aspect of culture/ethnicity to consider when
providing nursing care?
♦ D. Asians may require a lower dose of tricyclic antidepressants and antiphsychotics than whites
6. which of the following is the first step in developing cultural competence?
♦ B. examine one’s own cultural background, values, and beliefs about health and health care
7. as part of the nursing process, cultural assessment is best accomplished by
♦ b. using a cultural assessment guide as part of the nursing process

Chapter 4
1. the nursing history provides information to assist the nurse primarily in
♦ d. supporting identification of nursing diagnoses
2. the nurse would place information that the patient revealed about his concern that his illness is threatening
his job security in which of the following functional health patterns
♦ a. role-relationship
3. to examine the skin of a patient who has a full-thickness burn, the nurse primarily uses the technique of
♦ a. inspection
4. a focused examination is performed when
♦ c. a specific problem is identified during physical examination
5. after performing a screening history and physical, the first information the nurse records is the
♦ a. health history

Chapter 5
1. the nurse is teaching a middle-aged Hispanic woman in a clinic about various methods to relieve the
patient’s symptoms of menopause. The goal of this teaching would be to
♦ d. provide information for selection and use of treatment options
2. when planning teaching with consideration of adult learning principles, the nurse would
♦ c. provide opportunities for the patient to learn from other adults with similar experiences
3. a necessary skill of the nurse in the role of teacher is the ability to
♦ a. determine when patients are too distressed physically or psychologically to learn
4. when the nurse finds only a limited time available for patient teaching, a strategy that might be used is
♦ a. setting realistic goals that have high priority for the patient.
5. the nurse includes family members in patient teaching primarily because
♦ b. patients have been shown to have better outcomes when families are involved
6. when the nurse, the patient, and the patient’s family decide together what strategies would e best to meet the
learning objectives, the step of the teaching process that is involved is
♦ a. planning
7. a patient characteristic that enhances the teaching-learning process is
♦ b. high self-efficacy
8. which of the following is an example of a correctly written learning objective
♦ d. the patient’s spouse will demonstrate to the nurse how to correctly change a gastrostomy bag before
discharge
9. a patient tells the nurse that she enjoys talking with others and sharing experiences, but easily falls asleep
when reading. In planning teaching strategies with the patient, the nurse recognizes that the patient would
probably learn best with
♦ b. group teaching
10. short-term evaluation of teaching effectiveness includes
♦ a. observing the patient and asking direct questions

Chapter 6
1. ageism is characterized by
♦ c. negative attitudes toward the elderly based on age
2. autoimmune diseases increase with aging. This is consistent with which of the following theories of aging
♦ a. immune theory of aging
3. an ethnic older adult may experience a loss of self-worth when the nurse
♦ d. emphasizes that a therapeutic diet does not allow ethnic foods
4. an important nursing action helpful to a chronically ill older adult is to
♦ c. treat the patient as a competent manager of the disease
5. when older adults become ill they are more likely than younger adults to
♦ d. alter their daily living activities to accommodate new symptoms
6. an important fact for the nurse to know about caregivers is that they
♦ a. may need nurses to assist them in reducing caregiver strain
7. an appropriate care choice for an older adult living with an employed daughter but who requires assistance
with activities of daily living is
♦ a. adult day care
8. a natural death act is an advance directive that
♦ c. allows a person to direct his or her health care in the event of terminal illness
9. nursing interventions directed at health promotion in the older adult are primarily focused on
♦ c. teaching positive health behaviors

Chapter 9
1. determination of whether an event is a stressor is based on a person’s
♦ b. perception
2. the nurse recognizes that a patient with newly diagnosed cancer of the breast is using an emotion-focused
coping process when she
♦ a. joins a support group for women with breast cancer
3. the nurse would expect which of the following findings in a patient as a result of the physiologic effect of
stress on the reticular formation
♦ c. inability to sleep the night before beginning to self-administer insulin injections
4. the nurse utilizes knowledge of the effects of stress on the immune system by encouraging patients to
♦ b. avoid exposure to upper respiratory infections
5. the nurse recognizes that a person who is subjected to chronic stress could be at higher risk for
 ♦ b. colds and flu
6. during a stressful circumstance that is uncontrollable, which type of coping strategy is the most effective
♦ c. emotion-focused coping
7. an appropriate nursing intervention for a hospitalized patient who has a nursing diagnosis of ineffective
coping related t inadequate psychologic resources is
♦ d. asking the patient to describe previous stressful situations and how she managed to resolve them

Chapter 10
1. pain is best described as
♦ b. an unpleasant, subjective experience
2. a neurotransmitter known for its involvement in pain modulation is
♦ d. norepinephrine
3. which of the following words is most likely to be used to describe neuropathic pain
♦ d. burning
4. unrelieved pain is
♦ c. dangerous and can lead to many physical and psychologic complications
5. a cancer patient who reports ongoing, constant moderate pain with short periods of severe pain during
dressing changes
♦ c. should be receiving both a long-acting and a short-acting opioid
6. an example of distraction to provide pain relief is
♦ b. music
7. an appropriate nonopioid analgesic for mild pain is
♦ b. ibuprofen (Advil)
8. an important nursing responsibility related to pain is to
♦ c. believe what the patient shays about the pain
9. providing opioids to a dying patient who is experiencing moderate to severe pain
♦ c. is an appropriate nursing action
10. a nurse believes that patients with the same type of tissue injury should have the same amount of pain. This
statement reflects
♦ d. the nurse’s lack of knowledge about pain mechanisms, which is likely to contribute to poor pain
management

Chapter 13
1. the role of the complement system in opsonization affects which response of the inflammatory process
♦ b. cellular
2. fever that accompanies inflammation is most likely caused by
♦ b. release of IL-1, IL-6, and TNF from monocytes
3. a patient has an open, infected surgical wound that is treated with irrigations and moist gauze dressings. The
nurse expects that this wound
♦ d. heals by the same processes as an uninfected deep wound
4. contractures frequently occur after burn healing because of
♦ d. excess fibrous tissue formation
5. rest and immobilization are important measures of acute care for wound healing because they
♦ a. decrease the inflammatory response
6. which one of the following orders should a nurse question as part of the plan of care for a patient with a
stage III pressure ulcer
♦ c. clean the ulcer every shift with Dakin’s solution
7. an 85 y/o patient is assessed to have a score of 15 on the Braden scale. This means that the patient
 ♦ b. is at risk for developing a pressure ulcer
8. a 65 y/o stroke patient who is confined to bed is assessed to be at risk for the development of a pressure
ulcer. Based on this information, the nurse should
♦ a. implement a 12hr turning schedule
9. an 82 y/o man is being cared for at home by his family. A pressure ulcer on his right buttock measures 1 cm
X 2 cm X 0.8 cm in depth, and pink tissue is completely visible on the wound bed. This pressure ulcer
should be documented as
♦ c. stage III

Chapter 14
1. if a person is heterozygous for a given gene, it means that the person
♦ d. has two different alleles for the gene
2. a father who has a sex-linked recessive disorder and a wife with a normal genotype will
♦ c. pass the carrier state to his female children
3. the function of monocytes in immunity is related to their ability to
♦ d. capture antigens by phagocytosis and present them to lymphocytes
4. one function of cell-mediated immunity is
♦ c. surveillance for malignant cell changes
5. the reason newborns are protected for the first 6 months of life from bacterial infections is because of the
maternal transmission of
♦ a. IgG
6. in a type I hypersensitivity reaction, the primary immunologic disorder appears to be
♦ d. release of chemical mediators of IgE-bound mast cells and basophils
7. the nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular
penicillin by the development of
♦ a. edema and itching at the injection site
8. the nurse advises a friend who asks him to administer his allergy shots that
♦ d. immunotherapy should only be administered in a setting where emergency equipment and drugs are
available
9. association between HLA antigens and disease is most commonly found in what disease conditions
♦ d. autoimmune disorders
10. a patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains
that plasmapheresis is used in her treatment to
♦ c. exchange her plasma that contains antinuclear antibodies with a substitute fluid
11. the most common cause of secondary immunodeficiencies is
♦ a. drugs
12. which of the following accurately describes rejection following transplantation
♦ d. hyperacute reaction can usually be avoided if crossmatching is done prior to the transplantation
13. if a person is having an acute rejection of a transplanted organ, which of the following drugs would most
likely be used
♦ b. daclizumab

Chapter 15
1. sources of emerging infections include all of the following except
♦ a. plants
2. which of the following antibiotic-resistant organisms cannot be killed by normal hand soap
♦ a. vancomycin-resistant enterococci
3. transmission of HIV from an infected individual to another occurs
 ♦ a. most commonly as a result of sexual contact
4. following infection with HIV
♦ c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T
cells
5. which of the following statements is false
♦ d. opportunistic diseases occur more often
6. a diagnosis of AIDS is made when an HIV-infected patient has
♦ a. a CD4+ T cell count below 200 μl
7. screening for HIV infection generally involves
♦ b. electrophoretic analysis for HIV antigen in plasma
8. antiretroviral drugs are used to
♦ c. treat opportunistic diseases
9. opportunistic diseases in HIV infection
♦ c. occur in the presence of immunosupporesion
10. which of the following statements about metabolic side effects of ART is false
♦ a. theses are an annoying set of symptoms that are ultimately harmless
11. which of the following eliminates the risk of transmission of HIV
♦ a. using sterile equipment to inject drugs
12. of the following, which is the most appropriate nursing intervention to help an HIV-infected patient adhere
to a treatment regiment
♦ d. assess the patient’s routines and find adherence cues that fit into the patient’s life circumstances

Chapter 16
1. trends in the incidence and death rates of cancer include the fact that
♦ d. African Americans have a higher death rate from cancer than whites
2. cancer is a name for a large group of diseases, all of which are characterized by
♦ d. cell growth that escapes normal control
3. a characteristic of the stage of progression in the development of cancer is
♦ d. proliferation of cancer cells in spite of host control mechanisms
4. the primary protective role of the immune system related to malignant cells is
♦ a. surveillance for cells with tumor-associated antigens
5. the primary difference between benign and malignant neoplasms is the
♦ d. characteristic of tissue invasiveness
6. important nursing roles related to prevention and detection of cancer include
♦ b. instructing persons on ways to increase capacity to cope with stress
7. the goals of cancer treatment are based on the principle that
♦ c. a combination of treatment modalities is effective or controlling many cancers
8. the most effective method of administering a chemotherapeutic agent that is a vesicant is to
♦ d. use a central venous access device
9. the nurse explains to a patient undergoing brachytherapy of the cervix that she
♦ b. requires the use of radioactive precautions during nursing care
10. stomatitis, a common side effect of chemotherapeutic agents, occurs because the
♦ d. rapidly dividing cells of the mucous membranes of the mouth are being destroyed
11. the nurse teaches the patient receiving IL-2 about the drug based on the knowledge that this agent is
administered primarily for the purpose of
♦ a. stimulating the immune system
12. the nurse counsels the patient receiving radiation therapy or chemotherapy that
♦ c. following successful treatment, a return to the person’s previous functional level can be expected
13. an inappropriate nursing intervention to promote nutrition in the patient with cancer is
 ♦ a. providing bland, pureed food because the person’s taste sensation is altered
14. syndrome of inappropriate ADH secretion (SIADH) that occurs in certain types of cancer is primarily due to
♦ ectopic hormonal production
15. a patient has recently been diagnosed with early stages of breast cancer. Which of the following is most
appropriate for the nurse to focus on
♦ a. maintaining patient’s hope

Chapter 17
1. during the postoperative care of a 76 y/o patient, the nurse monitors the patient’s intake and output
carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because
♦ d. small losses of fluid are more significant because body fluids account for only about 50% of body
weight in older adults
2. if the blood plasma has a higher osmolality than the fluid within a red blood cell, the mechanism involved in
equalizing the fluid concentration is
♦ a. osmosis
3. an elderly woman was admitted to the medical unit with dehydration. A clinical indication of this problem
is
♦ a. weight loss
4. implementation of nursing care for the patient with hyponatremia includes
♦ a. fluid restriction
5. a patient is receiving a loop diuretic. The nurse should be alert for which symptoms
♦ c. weak, irregular pulse, and poor muscle tone
6. which patient would be at greatest risk for the potential development of hypermagnesemia
♦ c. 42 y/o woman with systemic lupus erythematosus and renal failure
7. it is especially important for the nurse to assess for which clinical manifestation(s) in a patient who has just
undergone a total thyroidectomy
♦ c. positive chvostek sign
8. the nurse anticipates that the patient with hyperphosphatemia secondary to renal failure will require
♦ a. calcium supplements
9. the lungs act as an acid-base buffer by
♦ a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
10. a patient has the following arterial blood gas results: pH 7.52; PaCO2 30mm hG; hco3- 24 mEq/L. the nurse
determines that the results indicate
♦ d. respiratory alkalosis
11. the typical fluid replacement for the patient with an ICF fluid volume deficit is
♦ b. hypotonic

Chapter 21
1. in a patient who has a hemorrhage in the vitreous cavity of the eye, the nurse knows that blood is
accumulating
♦ b. between the lense and the retina
2. increased intraocular pressure may occur as a result of
♦ d. increased production of aqueous humor by the ciliary process
3. the nurse should specifically question patients using eyedrops to treat glaucoma about
♦ c. a history of heart or lung disease
4. the nurse should always assess the patient with an ophthalmic problem for
♦ a. visual acuity
5. during assessment of hearing, the nurse would expect to find
 ♦ b. pearl-gray tympanic membrane
6. arcus senilis is due to
♦ d. cholesterol deposits in the cornea
7. before injection fluorescein for angiography, it is important to
♦ a. obtain an emisis basin

Chapter 22
1. presbyopia occurs in older individuals because
♦ b. the lens becomes inflexible
2. the most important nursing intervention in patients with epidemic keratoconjunctivitis is
♦ d. teaching patient and family members good hygiene techniques
3. patients with eye inflammation or an eye infection should be taught
♦ c. to apply a cold washcloth with pressure to the inflamed area frequently
4. rubella can cause hearing problems if
♦ b. exposure is before 16 weeks of gestation
5. in preparing patients for retinal detachment surgery, the nurse should
♦ d. assess the patient’s level of knowledge about retinal detachment and provide information appropriate
to the situation
6. the nurse is teaching an adult patient how to administer antibiotic eardrops. Instruction should include
which of the following
♦ b. be careful to avoid touching the tip of the dropper bottle to the ear
7. the nurse would suspect otosclerosis from assessment findings of hearing loss in
♦ a. a 26 y/o woman who has three biologic children under 5 years of age
8. the patient who has a sensorineural hearing loss
♦ a. has difficulty understanding speech
9. the nurse teaches the patient with extended-wear contact lenses that
♦ b. the lenses may be worn for up to 1 week without removal
10. the nurse is teaching a patient with a moderate hearing impairment in preparation for hospital discharge. To
facilitate communication, the nurse should
♦ a. use simple sentences
11. patients with permanent visual impairment
♦ d. may experience the same grieving process that is associated with other losses

Chapter 23
1. the primary function of the skin is
♦ b. protection
2. age-related changes in the skin include
♦ b. a loss of collagen
3. when assessing the sleep-rest pattern in relation to the skin, the nurse questions the patient regarding
♦ d. the presence of dark circles under the eyes
4. during the physical examination of a patient’s skin, the nurse would
♦ c. pinch up a fold of skin to assess for turgor
5. skin lesions found by the nurse and described as circumscribed, superficial, elevated, solid, and greater than
1 cm in diameter are called
♦ a. plaques
6. to assess the skin for temperature and moisture, the most appropriate technique is
♦ a. palpation
7. individuals with dark skin are more likely to develop
 ♦ a. keloids
8. on inspection of the patient’s skin, the nurse notes the complete absence of melanin pigment in patchy areas
on the patient’s hands. This condition is called
♦ a. vitiligo
9. diagnostic testing is recommended for skin lesions when
♦ b. a more definitive diagnosis is needed

Chapter 24
1. the nurse advises a patient with photosensitivity to use a sunscreen that contains
♦ c. benzophenones
2. in teaching a patient who is using topical corticosteroids to treat an acute dermatitis, the nurse should tell the
patient that
♦ b. topical corticosteroids usually do not cause systemic side effects
3. a patient with psoriasis tells the nurse that she has quit her job as a receptionist because she feels her
appearance is disgusting to customers. The nursing diagnosis that best describes this patient response is
♦ d. social isolation related to decreased activities secondary to fear of rejection
4. in teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the prognosis
of the patient is most dependent on
♦ a. the thickness of the lesion
5. the nurse identifies that a patient with a diagnosis of which of the following disorders is most at risk for
spreading the disease
♦ b. impetigo on the face
6. a mother and her two children have been diagnosed with pediculosis corporis at a health center. An
appropriate measure in treating this condition is
♦ a. applying pyrethrins to the body
7. a common site for the lesions associated with childhood atopic dermatitis is the
♦ c. antecubital space
8. during assessment of a patient the nurse notes an area of red, sharply defined plaques covered with silvery
scales that are mildly itchy on the patient’s knees and elbows. The nurse recognizes this finding as
♦ b. psoriasis
9. a dermatologic manifestation of Cushing syndrome would include
♦ a. telangiectasia
10. important patient teaching after a chemical peel includes
♦ a. avoidance of sun exposure

Chapter 25
1. which of the following is the leading determinant of a patient’s health?