Medical Surgical Challenge and Practice Test Multiple Choice Identify the choice that BEST completes the

statement or answers the question. ____ 1. SITUATION: Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup. His possible diagnosis is cancer of the lung. The MOST common lethal cancer in males between their fifth and seventh decades is: a. cancer of the prostate c. cancer of the pancreas b. cancer of the lung d. cancer of the bowel 2. WHICH of the following disease processes is caused by an absence of insulin or inadequate amount of insulin, resulting in hyperglycemia and leading to a series of biochemical disorders? a. Diabetes insipidus c. Diabetic ketoacidosis b. Hyperaldosteronism d. HHNK syndrome 3. WHICH of the following interventions would be MOST appropriate for the nurse to recommend to a client to decrease discomfort from hemorrhoids? a. Decrease fiber in the diet b. Take laxatives to promote bowel movements c. Use warm sitz baths d. Decrease physical activity ____ 4. A nurse notes that a client is an Orthodox Jew. Because of her religious beliefs, the client refuses to eat hospital food. Hospital policy discourages food from outside the hospital. WHAT step SHOULD the nurse take FIRST in this situation? a. Teach the client that it is IMPORTANT for her to eat WHAT she is served b. the situation and possible courses of action with the dietitian and the client c. Encourage the client's family to bring food for the client because of the special circumstances d. Explain to the client that if she does not eat, the physician will have to order intravenous therapy ____ 5. The nurse uses 30 mL of solution to irrigate a nasogastric tube and notes that 20 mL returns promptly into the drainage container. When the nurse records the results of the irrigation, how much solution SHOULD be recorded as intake? a. 10 mL c. 30 mL b. 20 mL d. 50 mL 6. The classic signs and symptoms of rheumatoid arthritis include WHICH of the following?

____

____

____

a. Pain on weight-bearing, rash, and low-grade fever b. Joint swelling, joint stiffness in the morning, and bilateral joint involvement c. development of Heberden's nodes, and anemia d. Fatigue, leukopenia, and joint pain ____ 7. A client is having problems controlling her seizures and is referred to have electroencephalography (EEG) performed. BEFORE the test, the nurse practitioner explains to the client that: a. This test will cause some discomfort c. The procedure is painless and she will and she will be given a sedative not be in any discomfort or experience BEFORE it begins electrical shock during the procedure b. It will be IMPORTANT for her to d. After the test, bed rest will be required take her regular dose of fluoxetine for 8 hours and she will be given full (Prozac) and phenytoin (Dilantin) liquids for 12 hours BEFORE the test 8. The MOST appropriate nursing diagnosis for a client with a somatoform disorder is: a. Altered role performance. c. High risk for violence, self-directed b. Knowledge deficit: medication ____ d. Stagnation

____

9. While meeting with a schizophrenic clients family, you are asked the question, WHAT causes schizophrenia? The BEST response to this question is: a. Research indicates that schizophrenia c. Poor parenting skills MOST likely is caused by a genetic predisposition. caused schizophrenia to occur. b. The exact cause of schizophrenia is d. An EARLY age trauma MOST unclear at this time. likely causes schizophrenia to occur.

____ 10. The client with Bells palsy asks the nurse WHAT caused this problem to occur. The nurses response is based on the understanding that the etiology is a. Unknown, but possibly includes c. Primarily genetic in origin triggered by ischemia, viral infection, or an exposure to neutroxins autoimmune problem b. Unknown, but possibly includes long d. Primarily genetic in origin but term tissue malnutrition and cellular triggered by exposure to meningitis hypoxia ____ 11. A nurse is supervising a group of elderly clients in a residential home setting. The nurse knows that the elderly are at greater risk of developing sensory deprivation for WHAT reason? a. Increased sensitivity to the side effects c. Isolation from their families and of the medications familiar surroundings b. Decreased visual, auditory, and d. Decreased Musculoskeletal function

gustatory abilities

and mobility

____ 12. You are caring for the patient with water sealed drainage. WHICH of the following is NOT a proper intervention or observation? a. Do not clamp the tubing during c. Keep the drainage equipment below transport or ambulation the level of the patients chest b. Observe the water fluctuate with d. Observe that continuous bubbling inspiration and expiration occurs in the fluid where the water seal is maintained ____ 13. A patient who has gout is given instructions about the importance of taking prescribed medications to prevent complications. The instructions were understood if the patient states that a complication of gout is a. Vasoconstriction c. Thrombophlebitis b. Ankylosing spondylitis d. Renal calculi

____ 14. A client is suspected of having systemic lupus erythematous (SLE). WHICH of the following is a characteristic sign of SLE? a. Rashes on the face across the bridge of the nose and on the cheeks b. Fatigue c. Fever d. Elevated red blood cell count ____ 15. Children with spina bifida are at high risk for developing intraoperative anaphylaxis linked to an allergic response to Latex. This allergic response occurs due to WHICH of the following factors? a. Weakened immune response b. Need for lifelong steroid therapy c. Need for numerous bladder catheterizations d. Use of large amounts of adhesive tape to attach sac dressings ____ 16. WHICH of the following is an EARLY sign of congestive heart failure that the nurse SHOULD recognize? a. Tachypnea c. Inability to sweat b. Bradycardia d. Increased urine output ____ 17. In the recovery room after a below knee amputation a female client begins carrying while feeling for her involved lower leg. The nurse SHOULD:

a. Administer medication to induce sleep b. Allow the client to ventilate feelings of loss c. Ignore the behavior until the client is more alert d. Leave the client alone to provide additional time for privacy ____ 18. Initially after cerebral vascular accident, a clients pupils are equal and reactive to light. Later the nurse assesses that the right pupil is reacting more slowly than the left and the systolic blood pressure is beginning to rise. The nurse RECOGNIZES that these adaptations are suggestive of: a. Spinal shock c. Transtentorial herniation b. Hypovolemic shock d. Increasing intracranial pressure ____ 19. A client is to have radiation therapy after a modified radical mastectomy. The client SHOULD be taught to care for the skin at the site of therapy by a. Washing the area with water c. Applying an ointment to the area b. Exposing the area to dry heat d. Using talcum powder on the area

____ 20. A client is admitted with possible liver cancer. WHICH of the tests below would be the MOST confirming of this diagnosis? a. Abdominal ultrasound c. Alpha-fetoprotein markers b. Abdominal flat plate X-ray d. Computed tomography (CT) scan

____ 21. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. Hes tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and Shoulders for breathing. This client has symptoms of WHICH of the following respiratory disorders? a. Adult respiratory distress syndrome c. Chronic obstructive bronchitis (ARDS) b. Asthma d. Emphysema ____ 22. A client who suffered a myocardial infarction (MI) 4 years ago is admitted for chest pain. WHICH ASSESSMENT finding SHOULD be of MOST concern? a. Heart rate of 96 beats/minute c. Blood pressure of 80/52 mm Hg b. Heart rate of 60 beats/minute d. Pulse oximetry of 93% on room air

____ 23. A 69-year-old woman has history of heart failure. She is admitted to the emergency department with heart failure complicated by pulmonary edema. On admission of this client, WHICH of the following SHOULD be assessed FIRST? a. Blood pressure c. Serum Potassium

b. Skin breakdown

d. Urine output

____ 24. The nurse is positioning the client with increased ICP. WHICH of the following positions does the nurse avoid? a. Head turned to side b. Head midline c. Neck in neutral position d. Head of the bed elevated to 30 to 45 degree ____ 25. The nurse is giving dietary instructions to the wife of patient with dysphagia. WHICH menu section indicates the wifes lack of understanding of the nurses instructions? a. Chopped meat in gravy c. Scrambled eggs b. Ground chicken and mashed potatoes d. Smooth peanut butter and jelly sandwich ____ 26. A 68-year old is admitted to the emergency department with medical diagnosis of closed angle glaucoma. He is placed on miotic therapy and receives 75% glycerin (Glycol). In planning care for the client WHICH of the following SHOULD be a teaching PRIORITY during the acute phase of his illness? a. Eyedrop administration c. Measuring intake and output b. Eye patch changes every hour d. Keeping bright lights on in the room

____ 27. An adult has undergone surgery to CORRECT a detached retina. The postoperative care plan includes WHICH of the following? a. Turn, cough, and deep breathe every 2 hours b. Position on the operative side to keep the retina next to the choroids. c. A patch over the operative eye to prevent further detachment d. Administer pilocarpine eye drops for pupil constriction ____ 28. The nurse is caring for a client who is hearing impaired. WHICH of the following approaches will facilitate communication? a. Speak frequently c. Speak directly into impaired ear b. Speak loudly d. Speak in a normal tone ____ 29. A patient who had a cholecystectomy is given dietary instruction prior to discharge. WHICH of these statements, if made by the patient, indicates that the instructions were understood? a. I will eliminate fatty foods from my c. I can have twenty grams of fat per diet.

b. I SHOULD eat only polyunsaturated d. I will gradually add fatty foods to my fats. diet. ____ 30. A patient has a liver biopsy. Following the procedure, WHICH of these measures SHOULD be included in the patients care plan? a. Assessing lung sounds. c. Monitoring the blood pressure. b. Listening for bowel sounds. d. Evaluating the pedal pulses.

____ 31. A patient receiving peritoneal dialysis. The nurse instills 2,000 ml. of dialysate solution. The return is 1,000 ml. The nurse SHOULD take WHICH of these actions next? a. Irrigate the patients catheter. b. Instill the next prescribed amount of dialysate to the patient. c. Turn the patient from side to side. d. Replace the patients drainage tubing. ____ 32. A 68-year-old patient returns to his room following a transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). WHICH of the following would cause the nurse to suspect postoperative hemorrhage? a. Decreased BP, increased PR, increased RR b. Fluctuating BP, decreased PR, rapid respirations c. Increased BP, bounding pulse, irregular respirations d. Increased BP, irregular pulse, shallow respirations ____ 33. SITUATION: Mr. J was brought to the ER complaining of pain located in the upper abdomen hematemesis and melena. Diagnosis is peptic ulcer. The tissue change MOST characteristics of peptic ulcer is: a. a soft mass of the necrotic tissue with bleeding b. an erosion of the mucosa covered with thick exudates c. a sharp excavation of tissue membrane with a clean base d. an elevated fibrous tissue membrane with soft margins ____ 34. SITUATION: Mr. J was brought to the ER complaining of pain located in the upper abdomen hematemesis and melena. Diagnosis is peptic ulcer. To prevent dumping syndrome the following includes your nursing care except: a. serve dry meals c. instruct him to lie down after eating b. allow him to walk for a while after d. giving of fluids after meals MUST be

eating

avoided

____ 35. A client is scheduled for Papnicolaou smear at the next scheduled clinic visit. The nurse provides instructions to the client regarding preparation for this test. WHICH of the following is an ACCURATE instruction? a. The test can be performed during menstruation b. Fluids are restricted on the day of the test. c. The test is painless d. Vaginal douching is required 2 hours BEFORE the test ____ 36. The chief clinical manifestation that the nurse would EXPECT to note in the EARLY stages of cataract formation is a. Eye pain c. Blurred vision b. Floating spots d. Diplopia

____ 37. The nurse assesses a patient with a history of Addisons disease who has received steroid therapy for several years. The nurse could EXPECT the patient to exhibit WHICH of the following changes in appearance? a. Buffalo hump, girdle-obesity, gaunt c. Emaciation, nervousness, breast facial appearance engorgement, hirsutism b. Tanning of the skin, discoloration of d. Truncal obesity, purple striation on the the mucous membranes, Alopecia, skin, moon face weight loss ____ 38. An adult is admitted with a diagnosis of probable Graves disease with thyrotoxic crisis. WHICH of the following ASSESSMENTs will provide the nurse with the BEST measure of the severity of the clients disease? a. Blood glucose c. Urine output b. Heart rate d. Blood pressure

____ 39. An adult client is one-day post-subtotal thyroidectomy. The nurse is planning care for the day knows that it is MOST IMPORTANT to a. Carry out range of motion exercises to c. Ask the client questions every hour or the neck and Shoulders every shift two to assess for hoarseness b. Maintain bed rest with client in supine d. Provide tracheostomy care every shift position at all times and suction PRN to maintain patent airway

____ 40. A client has choledocholitiasis. ASSESSMENT findings include jaundice of skin and sclera, abdominal distension, and pain, WHICH he is MOST likely to describe as a. An intermittent, colicky pain in his left c. A vise-like pressure over his sternum flank b. Pain, WHICH awakens him during d. Right upper quadrant pain and often the night, and is relieved by eating radiates to his right Shoulder ____ 41. A client is receiving total parenteral nutrition (TPN). WHAT complications related to TPN and central venous catheter access MUST the nurse ANTICIPATES and monitor? a. Respiratory failure, hypoglycemia, and c. Water intoxication, rapid weight gain, hypovolemic shock and hemorrhage b. Hyperglycemia, pneumothorax, and d. Insulin shock, perforation, and iron infection deficiency anemia ____ 42. A client recovering from an exacerbation of left-sided heart failure has a nursing diagnosis of Activity Intolerance. The nurse evaluates that the client is BEST tolerating mild exercise if the client exhibits WHICH of the following changes in vital signs during activity? a. Pulse rate increased from 80 beats per minute to 104 b. Respiratory rate increased from 16 breaths per minute to 19 c. Oxygen saturation decreased from 96 % to 91% d. Blood pressure decreased from 140/86 mm Hg to 112/72 ____ 43. A client has ARDS. The lowest fraction of inspired oxygen possible for optimizing gas exchange is used. The nurse explains to the family that the reason for this precaution is to: a. avoid respiratory depression c. increase lung compliance b. prevent oxygen toxicity d. promote production of surfactant ____ 44. The client suspected of having an abdominal tumor is scheduled for a CT scan with dye injection. WHICH of the following is an ACCURATE description of the scan? a. the test maybe painful b. the dye injected may cause a warm, flushing, sensation c. fluids will be restricted following the test d. the test takes approximately 2 hours ____ 45. The nurse is monitoring a client for the EARLY signs and symptoms of dumping syndrome. WHICH of the following syndrome indicate this occurrence? a. abdominal cramping and pain c. sweating and pallor b. Bradycardia and indigestion d. double vision and chest pain

____ 46. Joey is a 46 year-old radio technician who is admitted because of mild chest pain. He is 5 feet, 8 inches tall and weighs 190 pounds. He is diagnosed with a myocardial infarct. Morphine sulfate, Diazepam (Valium) and Lidocaine are prescribed. The physician orders 8 mg of Morphine Sulfate to be given IV. The vial on hand is labeled 1 ml/ 10 mg. The nurse SHOULD administer: a. 8 minims c. 12 minims b. 10 minims d. 15 minims

____ 47. Myra is ordered laboratory tests after she is admitted to the hospital for angina. The isoenzyme test that is the MOST reliable EARLY indicator of myocardial insult is: a. SGPT c. CK-MB b. LDH d. AST

____ 48. Routine postoperative IV fluids are designed to supply hydration and electrolyte and only limited energy. Because 1 L of a 5% dextrose solution contains 50 g of sugar, 3 L per day would apply approximately: a. 400 Kilocalories c. 800 Kilocalories b. 600 Kilocalories d. 1000 Kilocalories

____ 49. A client has been in a coma for 2 months. The nurse understands that to prevent the effects of shearing force on the skin, the head of the bed SHOULD be at an angle of: a. 30 degrees c. 60 degrees b. 45 degrees d. 90 degrees

____ 50. Situation 15 A client is brought to the hospital after vomiting bright red blood and is admitted with bleeding. WHICH of the following statements would indicate that the client understands how to adjust his response to work-related stress effectively? a. I will have to improve mutability to cope with stress. b. My job is too stressful; I will have to find a different career. c. Well, I guess this ulcer means I wont be able to work toward a promotion. d. I dont have any control over my stressors at work. My co-workers are difficult to work with.

Medical Surgical Nursing Answer Section MULTIPLE CHOICE 1. ANS: B The incidence of lung cancer is also rapidly rising in women. 2. ANS: C Diabetic ketoacidosis is caused by inadequate amounts of insulin or absence of insulin and leads to a series of biochemical disorders. Diabetes insipidus is caused by a deficiency of vasopressin. Hyperaldosteronism is an excess in aldosterone production, causing sodium and fluid excesses and hypertension. HHNS is a coma state in WHICH hyperglycemia and hyperosmolarity dominate. 3. ANS: C Use of warm sitz baths can help relieve the rectal discomfort of hemorrhoids. Fiber in the diet SHOULD be increased to promote regular bowel movements. Laxatives are irritating and SHOULD be avoided. Decreasing physical activity will not decrease discomfort 4. ANS: B The BEST course of action when a client refuses to eat food that is contrary to her religious beliefs is to discuss the situation with the client and the dietitian. Health team members may need to confer about this client's needs Telling the client that it is IMPORTANT for her to eat WHAT is served is unlikely to help because she has already refused the food and this approach does not address her concerns Encouraging her family to bring suitable food to the hospital for her may be acceptable. However, the family SHOULD not bear sole responsibility for meeting the client's nutritional needs. Health care team members need to seek ways the hospital can address the client's concerns Threatening a client by saying that if she does not eat, intravenous therapy will be necessary is not supportive and is unlikely to gain her cooperation 5. ANS: C The nurse records the total amount of solution used to irrigate a gastric tube as intake and the total amount of return in the drainage container as output. This answer is incorrect. The nurse records the total amount of solution used to irrigate a gastric tube as intake and the total amount of return in the drainage container as output. 6. ANS: B Classic signs and symptoms of rheumatoid arthritis include joint pain, swelling, and warmth. Symptoms are typically bilaterally symmetric. Joint stiffness in the morning lasting longer than 30 minutes is another classic symptom. Rheumatoid arthritis is a systemic disease. Other symptoms can include fatigue, low-grade fever, anemia, and weight loss. Pain on weight-bearing, rash, and low-grade fever are not signs and symptoms of rheumatoid arthritis. Heberden's nodes are present in osteoarthritis (degenerative joint disease). Fatigue and joint pain are signs and symptoms of rheumatoid arthritis, but leukopenia is not 7. ANS: C C. The procedure is painless and there is no danger of electrical shock. All anticonvulsants, antidepressants, stimulants (caffeine, tobacco), and alcohol SHOULD be stopped. There is no restriction on movement or diet after the procedure. 8. ANS: A Answer: A. Somatoform disorders result in altered role performance because the illness interferes with usual responsibilities in life. There is not enough data to support knowledge deficit or risk for selfdirected violence. Acute trauma reaction does not exist. 9. ANS: B

10. 11. 12. 13. 14. 15. 16. 17. 18.

Answer: B. The precise cause of schizophrenia is unknown. The general consensus is that schizophrenia results from the interaction between factors that have been correlated with schizophrenia. Research has correlated genetic factors with schizophrenia, but more research is needed. Poor parenting skill or EARLY-age trauma have not been documented in causing schizophrenia ANS: A PTS: 1 ANS: B PTS: 1 ANS: D PTS: 1 ANS: D PTS: 1 ANS: A PTS: 1 ANS: C PTS: 1 ANS: A PTS: 1 ANS: B PTS: 1 ANS: D PTS: 1

19. ANS: A A. A client receiving radiation therapy SHOULD avoid lotions, ointments, and anything that may cause irritation to the skin, such as exposure to sunlight, heat, or talcum powder. The area may safely be washed with water if it is done gently and if care is taken not to injure the skin. 20. ANS: C C. Although an abdominal ultrasound, x-ray, and CT scan are useful in the diagnosis of cancer of the liver, the alpha-fetoprotein serum markers are specific to detecting primary hepatocellular carcinoma. 21. ANS: D D. These are classic signs and symptoms of a client with emphysema. Clients with ARDS are acutely short of breath and require emergency care; those with asthma are also acutely short of breath during an attack and appear very frightened. Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance. 22. ANS: C C. A decreased blood pressure reflects a decreased cardiac output and SHOULD be the MOST concerning finding in this client. A heart rate of 96 beats/minute is at the high end of the acceptable range. A heart rate of 60 beats/minute in this patient would be in the desirable range, because a slower heart rate decreases the afterload and the myocardial workload, WHICH can prevent further tissue damage. A pulse oximetry of 93% on room air isnt necessarily diagnostic of hypoxia (level < 90% on room air are diagnostic of hypoxia). In addition, oxygen SHOULD be administered to a patient experiencing an MI despite pulse oximetry readings in order to meet myocardial oxygen demands. 23. ANS: A A. It is a PRIORITY to assess the blood pressure FIRST, because people with pulmonary edema typically experience severe hypertension that requires EARLY intervention. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: A D C B D D C C A C B C C D B C D B B PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

 Vitals signs that remain near baseline indicate good cardiac reserve with exercise. Options 1 and 3 are incorrect because they represent changes from normal values to abnormal ones. Blood pressure drops by more than 10 mm Hg is not a sign that indicates tolerance of activity. Only the respiratory rate remains in the normal range and it reflects a minimal increase. 43. 44. 45. 46. ANS: B PTS: 1 ANS: B PTS: 1 ANS: B PTS: 1 ANS: C - 12 minims. Using ratio and proportion 8 mg/10 mg = X minims/15 minims 10 X= 120 X = 12 minims. The nurse will administer 12 minims intravenously equivalent to 8mg Morphine Sulfate

47. ANS: C CK-MB. The cardiac marker, Creatinine phosphokinase (CPK) isoenzyme levels, especially the MB sub-unit WHICH is cardio-specific, begins to rise in 3-6 hours, peak in 12-18 hours and is elevated 48 hours after the occurrence of the infarct. They are therefore MOST reliable in assisting with EARLY diagnosis. The cardiac markers elevate as a result of myocardial tissue damage. 48. ANS: B - 600 Kilocalories. Carbohydrates provide 4 kcal/ gram; therefore 3L x 50 g/L x 4 kcal/g = 600 kcal; only about a third of the basal energy need. 49. ANS: A 30 degrees. Shearing force occurs when 2 surfaces move against each other; when the bed is at an angle greater than 30 degrees, the torso tends to slide and causes this phenomenon. Shearing forces are good contributory factors of pressure sores. 50. ANS: A PTS: 1