Here is a practice Med-Surg Final Exam
with NO answers
This is for all you smarties out there, just curious on which ones I keep missing!:angryfire
Final Review online
1) Which condition or action identifies a modifiable risk factor for the prevention of osteoarthritis?
d) walking as an exercise
2) what precaution is important to teach the patient with rheumatoid arthritis who will be taking 20mg of prednisone daily?
a) take this drug at bedtime
b) avoid crowds and anyone who is ill
c) drink at least 3 L of fluid per day
d) wash your face at least 3 times per day with antibacterial soap
3) after an explanation of osteoporosis risk factors, which statement would indicate a need for further instruction?
a) I will begin walking
b) I will begin jogging
c) I will begin swimming
d) I will begin jumping rope
4) which of the following is a priority nursing diagnosis for a client with osteoporosis?
A) acute pain
B) risk for infection
C) improper gas exchange
D) imbalanced nutrition: < body requirements
5) which of the following is a nursing intervention that may be delegated when using the diagnosis impaired physical activity?
A) evaluate gait when ambulating
B) dress the client in nonrestrictive clothing
C) indicate pain control measures prior to ambulation
D) refer the client to a vocational counselor as necessary
6) treatment for fat embolism syndrome consists of which of the following?
c) fracture immobilization
d) surgical placement of vena cava umbrella
7) a client has just been diagnosed with chronic gout. Which drug does a nurse anticipate being prescribed for the patient?
a) Furosemide (Lasix)
b) Predisone (deltasone)
c) Allopurinol (Xyloprim)
d) Diphendramimine (Benedryl)
8) which statement made by a client with gout alerts you to the need for further teaching regarding the management of this disorder?
a) I will be drinking at least 3 L of water each day.
b) When the pain is very bad, I will drink my favorite wine.
c) Although my favorite food is shrimp, I will no longer have it on a regular basis.
d) My wife and I are substituting chicken and poultry for red meat these days.
9) the client with arthritis has the following allergies. The physician orders Celebrex (celecoxib) daily for the patient. Which allergy is most important for a nurse to report to the physician?
c) Sulfa drugs
10) the client is being diagnosed with a primary bone tumor. What information would lead you to believe this tumor is a chondrosarcoma?
a) dull pain and swelling of the affected area for a long period
b) pain and swelling of the affected area for a short period
c) local pain accompanied by muscle atrophy
d) local tenderness with a palpable mass
11) a client with an above the knee amputation is to use elastic bandages on the stump to prevent swelling and shape it for a prosthesis. Which of the following statements made by the client regarding this procedure indicate a need for further clarification?
a) I will apply the bandage once daily at the end of the leg and loosely wrap it around
b) I will wash the skin underneath the bandage every day
c) I will remove the bandage in preparation for bed
d) I will reapply the bandage when it loosens
12) the nursing expects which of the following problems as an early complication of fractures?
a) compartment syndrome
b) heterotrophic ossification
c) vascular necrosis of the bone
d) reflex sympathetic dystrophy
13) a client who has sustained a crush injury to the right lower leg in a farm tractor accident complains of numbness and tingling of the affected extremity. The skin of the right leg appears pale and the pedal pulse is weak. What should be the nurse's first response?
a) notify the physician
b) loosen the dressing
c) increase IV flow rate
d) document the finding as the only action
14) what is a possible serious side effect of biphosphonate therapy?
d) deep vein thrombosis
15) which is considered a common side effect of calcitonin therapy?
b) Vaginal bleeding
c) Nausea and vomiting
d) Deep vein thrombosis
16) nursing interventions for a client receiving estrogen replacement therapy would include which of the following?
a) observe for CNS side effects
b) assess for a history of urinary stones
c) rotate injection sites for Parenteral administration
d) teach them to follow up with gynecological exams every 6 months
17) a woman being treated for asthma with cromolyn asks how it helps with her attacks. Your best response is:
a) it helps to abort an ongoing attack.
b) It opens airways quickly when an attack begins
c) It helps prevent attacks by suppressing inflammation
d) It stabilizes inflammatory response and promotes histamine release
18) a client with a pulmonary embolism is receiving heparin continuous IV infusion. Heparin is administered for which of the following reasons?
a) increase heart rate
b) dissolve blood clots
c) decrease BP
d) prevent further clot formation
19) the client with CHF has been admitted with bilateral pleural infusions and has been started on diuretic therapy. Thoracentesis is indicated if no results from this therapy are seen by which day?
a) day 1
b) day 2
c) day 3
d) day 4
20) the body's compensation for respiratory alkalosis includes:
a) increased excretion of hydrogen ions
b) decreased excretion of bicarbonate
c) increased excretion of bicarbonate
d) increased retention of bicarbonate
21) where would a shelled peanut aspirated by an adult most likely be dislodged?
a) anterior pharynx
b) posterior pharynx
c) left main stem bronchus
d) right main stem bronchus
22) as you are examining a client's anterior nose, you observe as you shine a light in the left nostril, the light appears in the right nostril?
a) deviated septum
b) perforated septum
c) left nostril is obstructed
d) right nostril is obstructed
23) After obtaining a client's respiratory status, which nonrespiratory data is essential for you to obtain?
A) height and weight
B) neck circumference
C) usual daily fluid intake
D) occupation and hobbies
24) which clinical manifestation in a client with paralysis of one of the vocal cords alerts the nurse to a possibility of aspiration?
a) client's oxygen saturation is 96%
b) client's voice is breathy and weak
c) the client coughs immediately after swallowing
d) the client has an audible wheeze on exhalation only
25) which statement made by a client prescribed voice rest therapy for vocal cord polyps indicates a need for further teaching?
a) I will stay out of rooms and places where people are smoking
b) When I speak at all, I will whisper rather than use a normal tone of voice
c) For the next several weeks, I will not lift anything weighing over 10 pounds
d) I will drink at least 3 quarts of water each day and use stool softeners to prevent constipation
26) a client is scheduled to have a hemilaryngectomy asks the nurse what changes to expect in voice quality after the surgery. What is the nurse's best response?
a) you will not be able to speak above a whisper
b) your permanent voice will be hoarse and breathy
c) the removal of your larynx represents a permanent loss of natural speech
d) speech will be absent immediately following the surgery but will return to normal when all swelling has resolved, usually within 6 months
27) which is a priority nursing diagnosis with unilateral vocal cord paralysis?
a) impaired verbal communication
b) self esteem disturbance
c) impaired gas exchange
d) risk for aspiration
28) a client observes shoulder drop postoperatively 24 hours after a radical neck dissection for cancer. What is the nurse's best action?
a) reposition the client on the nonoperative side
b) document the observation as the only action
c) assess the deep tendon reflexes
d) notify the physician
29) a client is admitted with the diagnosis of laryngeal cancer, and is scheduled for a total laryngectomy. The standardized laryngectomy plan of care includes all of the following interventions. Which intervention will be most important for the nurse to accomplish before the surgery?
a) establishing a means of communication during the immediate postoperative period, such as a magic slate or alphabet board
b) discuss appropriate clothing to wear to cover the largyngectomy stoma and decrease social isolation after surgery
c) teach the client and significant others about how to suction the stoma and do wound care around the stoma
d) educate the client about ways to avoid aspiration when swallowing after the surgery
30) which clinical manifestation in long standing COPD alerts you to the possibility of cor pulmonale?
a) pursed lip breathing
b) enlarged neck muscles
c) tall tented T-waves on EKG
d) JVD present when the client is in sitting position
31) client with the diagnosis of lung cancer is scheduled for a liver scan. The patient asks you why this procedure is being done. What is your best response?
a) cigarette smoking can cause liver cancer. The treatment is different if it is spread to the liver than if it is only confined to the lungs.
b) The treatment of lung cancer is different if it is spread to the liver, than if it is only confined to the lungs.
c) Some treatments are toxic to the liver, and it is best to check liver function before these treatments are started.
d) An enlarged liver can interfere with cancer therapy. So the Dr. wants to make sure of the liver size and condition before the cancer therapy is started.
32) the temperature of your client 24 hrs. after a pleurodesis procedure is 100F. what is your best action?
a) obtain a specimen of chest fluid drainage for culture
b) document the findings as your only action
c) sponge bath the client with tepid water
d) notify the physician
33) which of the following clients would you NOT allow a nursing assistant to obtain an oral temperature from?
a) 67 year old with type II diabetes who has a suspected sinus infection
b) 43 year old smoker with a history of elevated cholesterol diagnosed with pneumonia
c) 37 year old client with stridor and complaint of fever and sore throat for the last two hours
d) 21 year old complains of fever and suspected viral pharyngitis
34) which intervention should the nurse teach the client after going home after a sinus surgery to prevent bleeding from the surgical site?
a) drink at least 8 glasses of water each day
b) sleep in a semi-sitting position for the first two weeks
c) use a stool softener as prescribed to prevent constipation
d) change the mustache dressing when it becomes wet or soiled
35) who is at the greatest risk for developing a community acquired pneumonia?
a) 40 year old first grade teacher
b) 60 year old smoker and alcoholic
c) 75 year old with exercise induced wheezing
d) 35 year old aerobics instructor who skips meals and only eats vegetables
36) two hours after a client with an ET tube has been extubated, the nurse hears stridor on inhalation. What is the nurse's best action after applying humidified oxygen?
a) document the findings as the only action
b) ask the client to cough and deep breathe
c) suction the client's mouth and pharynx
d) notify the emergency team
37) a client has undergone an open gastroplasty, and has an NG tube draining from the both proximal pouch and distal stomach. Which of the following nursing interventions takes priority to prevent disruption of the suture line?
a) never reposition the tube
b) closely monitor and check the tube placement
c) closely monitor the tube for patency
d) auscultate for bowel sounds frequently
38) the client has been receiving Parenteral nutrition for 4 days. The nurse observes that the blood glucose is 340mg/100mL, and the urine output is 3x the intake. the nurse knows that:
a) the client is absorbing dextrose well in the Parenteral nutrition
b) Parenteral nutrition should be stopped immediately
c) The client has developed a glucose intolerance
d) The client may go into cardiac arrest
39) Which of these clients receiving enteric feedings through an NG tube is most at risk for increased plasma osmolarity?
a) 50 year old client receiving an isotonic enteral feeding solution
b) 75 year old unconscious client receiving a hyperosmolar enteral feeding solution
c) 38 year old client receiving a hyperosmolar feeding solution who also eats and drinks PRN
d) 70 year old client with an IV of D5W infusing at 125ml/hr, who is also receiving a hyperosmolar enteral feeding solution
40) which medication will the nurse anticipate the physician will prescribe to improve the appetite of a client with anorexia?
41) which of the following clinical manifestations are late manifestations of dumping syndrome?
a) severe abdominal pain and a strong desire to defecate
b) epigastric distention and abdominal cramping
c) dizziness, diaphoresis, and palpitations
d) mouth dryness and partial seizures
42) the client has been prescribed an antacid for the treatment of a duodenal ulcer. What instructions should the client receive?
a) take antacid 2 hours before meals
b) take antacid 1 hour before meals
c) take antacid 2 hours after meals
d) take antacid only when you have pain
43) a client is admitted with biliary cirrhosis. The nurse would expect the client to report which of the following disorders?
a) heart disease
b) viral hepatitis
c) alcohol abuse
d) gallbladder disease
44) a client with cholelithiasis and obstructive jaundice is experiencing severe pruritis. The health care provider has prescribed Questran (cholecystyramine) for the client. The client asks how the drug works. What is the nurse's best response?
a) cholecystyramine blocks histamine reducing allergic response
b) inhibits the enzyme responsible for bile excretion
c) reduces the amount of bile stored in the gallbladder
d) binds with bile acid salts that are eventually excreted
45) for the client with cirrhosis, which of the following interventions would be the most appropriate to control ascites?
a) weighing the client daily
b) increasing PO fluid intake
c) providing a low sodium diet
d) monitoring I&O
46) a client is suspected of having pancreatic cancer. Which clinical manifestation of this client is often the presenting symptom that brings the client to seek health care?
d) abdominal discomfort
47) what statement made by a client receiving pancrelipase (Pancrease) indicates a need for further teaching?
a) I can mix the enzyme powder in fruit juice
b) I may wipe my lips after taking the enzyme preparation
c) I will crush or chew all of the medication to enhance digestion
d) I will not mix the enzyme powder in any foods containing protein
48) the diagnosis of folic acid deficiency anemia related to chronic alcohol abuse has which description of the RBCs?
a) normocytic, normochromic
b) microcytic, normochromic
c) macrocytic, normochromic
d) macrocytic, hypochromic
49) which clinical manifestation is common in all types of anemia regardless of the cause or pathological mechanism?
a) jaundice sclera and roof of mouth
b) hypertension and peripheral edema
c) tachycardia at rest
d) increased partial pressure of carbon dioxide (PaCo2)
50) which action when administering blood is most important to prevent transfusion reaction?
a) administer the blood at a rate of no more than 2ml/min
b) stay with the client during the first 15 min
c) keep blood chilled during administration
d) properly identify the patient
51) the nurse practitioner is assessing for clinical manifestations of hypertension. The nurse would expect to:
a) note edema of the lower extremities
b) examine the skin for telangiectasis
c) assess for male pattern baldness
d) visualize retinal changes
52) a client presents to an outpatient clinic with a venous ulcer on the left ankle. What additional assessment findings would the nurse expect to be present in this client?
a) dependant rubor present, accompanied by hair loss on the extremity
b) brownish discoloration of the lower extremity
c) decreased or absent pulses
d) presence of pain at rest
53) what intervention does the nurse suggest to promote vasodilation in a client with peripheral arterial disease?
a) walking increasingly longer and longer distances
b) use a heating pad to the affected limb
c) take an aspirin on a daily basis
d) quit smoking
54) to prevent a potential complication of pulmonary embolism, clients with deep vein thrombosis should receive treatment with:
a) low molecular weight heparin
b) Trental (pentoxifylline)
c) Low dose aspirin
55) the nurse understands that the drug hydroxyurea benefits the client with sickle cell disease by:
a) preventing crises by decreasing blood viscosity and reducing blood vessel obstruction
b) prevent crises by stimulating the RBCs to synthesize more hemoglobin F
c) prevent anemia by stabilizing RBC plasma membranes
d) prevent anemia by increasing cellular iron storage
56) the nurse is preparing to give the first dose of captopril (Capoten), an ACE inhibitor. What specific assessment should the nurse make?
a) pulse rate before and 30 minutes after the dose
b) urine output within 6 hours of the first oral dose
c) blood pressure before and within 2 hours after the first dose
d) lung status to assess for the development of pulmonary edema
57) a patient with heart disease calls the nurse to report the onset of muscle pain and weakness. He is taking Zocor (simvastin), an HNG Co-A drug, a statin. The nurse should be concerned about the development of:
b) muscle tenderness
c) peripheral neuropathy
d) coronary artery disease
58) the client just diagnosed with hyperpituitarism and acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for further teaching?
a) I will drink whenever I feel thirsty after the surgery
b) I am glad there will be no visible incision after the surgery
c) I hope I can go back to wearing a size 8 shoe instead of a size 12
d) I will wear slip on shoes after surgery so I don't have to bend over
59) the male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. what is the nurse's best answer?
a) when your blood levels of testosterone are normal, the therapy will no longer be needed.
b) When your beard thickens and your voice deepens, the dose is decreased, but must continue forever
c) When your sperm count is high enough to demonstrate fertility, you will no longer need the therapy
d) When you start to have undesirable side effects, the dose is decreased to the lowest possible level and continued until you are 50 years old
60) the administration of corticosteroids to control the symptoms of one disease can cause infection. The rationale that does not support the concept is that corticosteroids:
a) prevent the production of leukocytes
b) stop antibody production in the lymphatic tissue
c) promote the growth and spread of enteric viruses
d) interfere with the inflammatory response of the body
61) which would the nurse assess as an indicator in a diabetic client with ketoacidosis?
a) weight loss
c) peripheral edema
d) increased abdominal girth
62) the nurse administers Lispro insulin sub-q at 0730. At what time would be the onset of action?
63) Which clinical manifestation of the diabetic client would the nurse assess as a neurogenic symptom of hypoglycemia?