Advanced Medical-Surgical Nursing Practice Questions
Course Introduction
Advanced Medical-Surgical Nursing is designed to deepen students understanding of complex health conditions and the advanced care required by adult patients in acute and chronic settings. This course emphasizes critical thinking, clinical decision-making, and evidence-based practice in the management of multisystem disorders, perioperative care, and emergency situations. Through a combination of theoretical frameworks and practical case analyses, students will enhance their proficiency in advanced assessment, interventions, and collaborative care, preparing them to lead and innovate in diverse medical-surgical nursing environments.
Recommended Textbook
Medical Surgical Nursing 10th Edition by Lewis
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68 Chapters
1998 Verified Questions
1998 Flashcards
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Page 2
Chapter 1: Professional Nursing Practice
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21 Verified Questions
21 Flashcards
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Sample Questions
Q1) A nurse is assigned as a case manager for a hospitalized patient with a spinal cord injury. The patient can expect the nurse functioning in this role to perform which activity?
A)Care for the patient during hospitalization for the injuries.
B)Assist the patient with home care activities during recovery.
C)Determine what medical care the patient needs for optimal rehabilitation.
D)Coordinate the services that the patient receives in the hospital and at home.
Answer: D
Q2) The nurse interviews a patient while completing the health history and physical examination. What is the purpose of the assessment phase of the nursing process?
A)To teach interventions that relieve health problems
B)To use patient data to evaluate patient care outcomes
C)To obtain data with which to diagnose patient problems
D)To help the patient identify realistic outcomes for health problems
Answer: C
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3
Chapter 2: Health Disparities and Culturally Competent Care
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Sample Questions
Q1) The nurse performs a cultural assessment with a patient from a different culture. Which action by the nurse should be taken first?
A)Request an interpreter before interviewing the patient.
B)Wait until a family member is available to help with the assessment.
C)Ask the patient about any affiliation with a particular cultural group.
D)Tell the patient what the nurse already knows about the patient's culture.
Answer: C
Q2) The nurse is caring for a Native American patient who has traditional beliefs about health and illness. Which action by nurse is most appropriate?
A)Avoid asking questions unless the patient initiates the conversation.
B)Ask the patient whether it is important that cultural healers are contacted.
C)Explain the usual hospital routines for meal times, care, and family visits.
D)Obtain further information about the patient's cultural beliefs from a family member.
Answer: B
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Chapter 3: Health History and Physical Examination
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Sample Questions
Q1) While the nurse is taking the health history,a patient states,"My mother and sister both had double mastectomies and were unable to be very active for weeks." Which functional health pattern is represented by this patient's statement?
A)Activity-exercise
B)Cognitive-perceptual
C)Coping-stress tolerance
D)Health perception-health management
Answer: D
Q2) The registered nurse (RN)cares for a patient who was admitted a few hours previously with back pain after falling. Which action can the RN delegate to unlicensed assistive personnel (UAP)?
A)Finish documenting the admission assessment.
B)Determine the patient's priority nursing diagnoses.
C)Obtain the health history from the patient's caregiver.
D)Take the patient's temperature, pulse, and blood pressure.
Answer: D
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Chapter 4: Patient and Caregiver Teaching
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Sample Questions
Q1) A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy,if implemented by the nurse,is most likely to be effective?
A)Assure the patient that the nurse is an expert on management of heart failure.
B)Teach the patient at each meal about the amounts of sodium in various foods.
C)Discuss the importance of medication control in maintenance of long-term health.
D)Refer the patient to a home health nurse for instructions on diet and fluid restrictions.
Q2) A family caregiver tells the home health nurse,"I feel like I can never get away to do anything for myself." Which action is best for the nurse to take?
A)Assist the caregiver in finding respite services.
B)Assure the caregiver that the work is appreciated.
C)Encourage the caregiver to discuss feelings openly with the nurse.
D)Tell the caregiver that family members provide excellent patient care.
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6
Chapter 5: Chronic Illness and Older Adults
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Sample Questions
Q1) The home health nurse cares for an older adult patient who lives alone and takes several different prescribed medications for chronic health problems. Which intervention,if implemented by the nurse,would best encourage medication compliance?
A)Use a marked pillbox to set up the patient's medications.
B)Discuss the option of moving to an assisted living facility.
C)Remind the patient about the importance of taking medications.
D)Visit the patient daily to administer the prescribed medications.
Q2) The family of an older patient with chronic health problems and increasing weakness is considering placement in a long-term care (LTC)facility. Which action by the nurse will be most helpful in assisting the patient to make this transition?
A)Have the family select a LTC facility that is relatively new.
B)Ask the patient's preference for the choice of a LTC facility.
C)Explain the reasons for the need to live in LTC to the patient.
D)Request that the patient be placed in a private room at the facility.
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Chapter 6: Stress and Stress Management
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Sample Questions
Q1) A female patient who initially came to the clinic with incontinence was recently diagnosed with endometrial cancer. She is usually well organized and calm,but the nurse who is giving her preoperative instructions observes that the patient is irritable,has difficulty concentrating,and yells at her husband. Which action should the nurse take?
A)Ask the health care provider for a psychiatric referral.
B)Focus teaching on preventing postoperative complications.
C)Try to calm the patient before repeating any information about the surgery.
D)Encourage the patient to combine the hysterectomy with surgery for bladder repair.
Q2) The nurse teaches a patient who is experiencing stress at work how to use imagery as a relaxation technique. Which statement by the nurse would be appropriate?
A)"Think of a place where you feel peaceful and comfortable."
B)"Place the stress in your life into an image that you can destroy."
C)"Repeatedly visualize yourself experiencing the distress in your workplace."
D)"Bring what you hear and sense in your work environment into your image."
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8
Chapter 7: Sleep and Sleep Disorders
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Sample Questions
Q1) Which patient statement indicates a need for further teaching about extended-release zolpidem (Ambien CR)?
A)"I should take the medication on an empty stomach."
B)"I will take the medication 1 to 2 hours before bedtime."
C)"I should not take this medication unless I can sleep for at least 6 hours."
D)"I will schedule activities that require mental alertness for later in the day."
Q2) Which information regarding a patient's sleep is most important for the nurse to communicate to the health care provider?
A)A 21-yr-old student who takes melatonin to assist in sleeping when traveling from the United States to Europe
B)A 64-yr-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning
C)A 41-yr-old librarian who has a body mass index (BMI) of 42 kg/m2 says that the spouse complains about snoring
D)A 32-yr-old accountant who is experiencing a stressful week uses diphenhydramine (Benadryl) for several nights
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Chapter 8: Pain
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Sample Questions
Q1) The nurse teaches a student nurse about the action of ibuprofen. Which statement,if made by the student,indicates that teaching was effective?
A)"The drug decreases pain impulses in the spinal cord."
B)"The drug decreases sensitivity of the brain to painful stimuli."
C)"The drug decreases production of pain-sensitizing chemicals."
D)"The drug decreases the modulating effect of descending nerves."
Q2) The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin)for chronic back pain but still has ongoing pain. Which medication should the nurse question?
A)Morphine
B)Dexamethasone
C)Pentazocine (Talwin)
D)Celecoxib (Celebrex)
Q3) A patient with chronic pain who has been receiving morphine sulfate 20 mg IV over 24 hours is to be discharged home on oral sustained-release morphine (MS Contin)administered twice a day. What dosage of MS Contin will be needed for each dose to obtain an equianalgesic dose for the patient? (Morphine sulfate 10 mg IV is equianalgesic to morphine sulfate 30 mg orally.)
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Chapter 9: Palliative Care at End of Life
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Sample Questions
Q1) Which nursing actions for the care of a dying patient can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
A)Provide postmortem care to the patient.
B)Encourage the family members to talk with and reassure the patient.
C)Determine how frequently physical assessments are needed for the patient.
D)Teach family members about commonly occurring signs of approaching death.
E)Administer the prescribed morphine sulfate sublingual as necessary for pain control.
Q2) The nurse is caring for an adolescent patient who is dying. The patient's parents are interested in organ donation and ask the nurse how the health care providers determine brain death. Which response by the nurse accurately describes brain death determination?
A)"If CPR does not restore a heartbeat, the brain cannot function."
B)"Brain death has occurred if there is not any breathing or brainstem reflexes."
C)"Brain death has occurred if a person has flaccid muscles and does not awaken."
D)"If respiratory efforts cease and no apical pulse is audible, brain death is present."
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Chapter 10: Substance Use Disorders
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25 Flashcards
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Sample Questions
Q1) After receiving change-of-shift report on four patients who are undergoing substance use treatment,which patient will the nurse assess first?
A)A patient who has just arrived for alcohol use treatment and states that the last drink was 2 hours ago
B)A patient who is agitated and experiencing nausea, occasional vomiting, and diarrhea while withdrawing from heroin
C)A patient who has tremors secondary to benzodiazepine withdrawal and whose last benzodiazepine use was 4 days ago
D)A patient who is being treated for cocaine addiction and is irritable and disoriented, with a pulse rate of 112 beats/min
Q2) A patient with a history of heavy alcohol use is diagnosed with acute gastritis. Which statement by the patient indicates a willingness to stop alcohol use?
A)"I am older and wiser now, and I can change my drinking behavior."
B)"Alcohol has never bothered my stomach before.I think I have the flu."
C)"People say that I drink too much, but I feel pretty good most of the time."
D)"My drinking is affecting my stomach, but medication will help me feel better."
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Page 12
Chapter 11: Inflammation and Wound Healing
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22 Verified Questions
22 Flashcards
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Sample Questions
Q1) The nurse should plan to use a wet-to-dry dressing for which patient?
A)A patient who has a pressure ulcer with pink granulation tissue
B)A patient who has a surgical incision with pink, approximated edges
C)A patient who has a full-thickness burn filled with dry, black material
D)A patient who has a wound with purulent drainage and dry brown areas
Q2) A patient's 4 * 3-cm leg wound has a 0.4-cm black area in the center of the wound surrounded by yellow-green semiliquid material. Which dressing should the nurse apply to the wound?
A)Dry gauze dressing
B)Nonadherent dressing
C)Hydrocolloid dressing
D)Transparent film dressing
Q3) The nurse assesses a patient's surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is appropriate?
A)Obtain wound cultures.
B)Document the assessment.
C)Notify the health care provider.
D)Assess the wound every 2 hours.
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Page 13
Chapter 12: Genetics and Genomics
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7 Flashcards
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Sample Questions
Q1) A patient tells the nurse,"I would like to use a home genetic test to see if I will develop breast cancer." Which is the nurse's best initial response?
A)"Home genetic testing is very expensive."
B)"Are you prepared to cope with a positive result?"
C)"Are you concerned about developing breast cancer?"
D)"Genetic testing only determines if you are at higher risk for breast cancer."
Q2) The nurse in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing?
A)A 20-yr-old patient whose maternal grandparents died after strokes at ages 80 and 82
B)A 20-yr-old patient with a positive pregnancy test whose first child has cerebral palsy
C)A 30-yr-old patient who has a sibling with newly diagnosed polycystic kidney disease
D)A 30-yr-old patient with a history of cigarette smoking who is complaining of dyspnea
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Chapter 13: Altered Immune Responses and Transplantation
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26 Verified Questions
26 Flashcards
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Sample Questions
Q1) Which patient should the nurse assess first?
A)Patient with urticaria after receiving an IV antibiotic
B)Patient who is sneezing after subcutaneous immunotherapy
C)Patient who has graft-versus-host disease and severe diarrhea
D)Patient with multiple chemical sensitivities who has muscle stiffness
Q2) The health care provider asks the nurse whether a patient's angioedema has responded to prescribed therapies. Which assessment should the nurse perform?
A)Obtain the patient's blood pressure and heart rate.
B)Question the patient about any clear nasal discharge.
C)Observe for swelling of the patient's lips and tongue.
D)Assess the patient's extremities for wheal and flare lesions.
Q3) Which information about intradermal skin testing should the nurse teach to a patient with possible allergies?
A)"Do not eat anything for about 6 hours before the testing."
B)"Take an oral antihistamine about an hour before the testing."
C)"Plan to wait in the clinic for 20 to 30 minutes after the testing."
D)"Reaction to the testing will take about 48 to 72 hours to occur."
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Page 15
Chapter 14: Infection and Human Immunodeficiency Virus
Infection
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26 Verified Questions
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Sample Questions
Q1) To evaluate the effectiveness of antiretroviral therapy (ART),which laboratory test result will the nurse review?
A)Viral load testing
B)Enzyme immunoassay
C)Rapid HIV antibody testing
D)Immunofluorescence assay
Q2) Which of these patients who have arrived at the human immunodeficiency virus
(HIV)clinic should the nurse assess first?
A)Patient whose rapid HIV-antibody test is positive
B)Patient whose latest CD<sub>4</sub>+ count has dropped to 250/µL
C)Patient who has had 10 liquid stools in the last 24 hours
D)Patient who has nausea from prescribed antiretroviral drugs
Q3) A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS)tells the nurse,"I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate?
A)"Thinking about dying will not improve the course of AIDS."
B)"Do you think that taking an antidepressant might be helpful?"
C)"Can you tell me more about the thoughts that you are having?"
D)"It is important to focus on the good things about your life now."
Page 16
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Chapter 15: Cancer
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Sample Questions
Q1) A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action,if taken by the nurse,is appropriate?
A)Have the patient eat large meals when nausea is not present.
B)Offer dry crackers and carbonated fluids during chemotherapy.
C)Administer prescribed antiemetics 1 hour before the treatments.
D)Give the patient a glass of a citrus fruit beverage during treatments.
Q2) A patient who is diagnosed with cervical cancer classified as Tis,N0,M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate?
A)"The cancer involves only the cervix."
B)"The cancer cells look like normal cells."
C)"Further testing is needed to determine the spread of the cancer."
D)"It is difficult to determine the original site of the cervical cancer."
Q3) The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
A)Nausea
B)Alopecia
C)Hematuria
D)Xerostomia
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Chapter
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Sample Questions
Q1) A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?
A)Lung sounds
B)Urinary output
C)Peripheral pulses
D)Peripheral edema
Q2) A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse?
A)Arterial blood pH is 7.32.
B)Serum calcium is 18 mg/dL.
C)Serum potassium is 5.1 mEq/L.
D)Arterial oxygen saturation is 91%.
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18
Chapter 17: Preoperative Care
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Sample Questions
Q1) The outpatient surgery nurse reviews the complete blood cell (CBC)count results for a patient who is scheduled for surgery. The results are white blood cell (WBC)count 10.2 * 10³/µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 * 10³/µL. Which action should the nurse take?
A)Notify the surgeon and anesthesiologist immediately.
B)Ask the patient about any symptoms of a recent infection.
C)Continue to prepare the patient for the surgical procedure.
D)Discuss the possibility of blood transfusion with the patient.
Q2) A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse's preoperative intervention to maintain patient safety?
A)The patient has never had general anesthesia.
B)The patient is planning to drive home after surgery.
C)The patient had a sip of water 4 hours before arriving.
D)The patient's insurance does not cover outpatient surgery.
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19
Chapter 18: Intraoperative Care
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Sample Questions
Q1) Which action should the perioperative nurse take to best protect the patient from burn injury during surgery?
A)Ensure correct placement of the grounding pad.
B)Check emergency sprinklers in the operating room.
C)Verify that a fire extinguisher is available during surgery.
D)Confirm that all electrosurgical equipment is working properly.
Q2) Which action will the perioperative nurse take after surgery is completed for a patient who received ketamine as an anesthetic agent?
A)Question the order for giving a benzodiazepine.
B)Ensure that atropine is available in case of bradycardia.
C)Provide a quiet environment in the postanesthesia care unit.
D)Anticipate the need for higher than usual doses of analgesic agents.
Q3) The nurse facilitates student clinical experiences in the surgical suite. Which action,if performed by a student,would require the nurse to intervene?
A)The student wears a mask in the semirestricted area.
B)The student wears street clothes in the semirestricted area.
C)The student wears surgical scrubs in the semirestricted area.
D)The student covers head and facial hair in the semirestricted area.
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Chapter 19: Postoperative Care
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Sample Questions
Q1) The nurse assesses that the oxygen saturation is 89% in an unconscious patient who was transferred from surgery to the postanesthesia care unit (PACU)15 minutes ago. Which action should the nurse take first?
A)Suction the patient's mouth.
B)Increase the oxygen flow rate.
C)Perform the jaw-thrust maneuver.
D)Elevate the patient's head on two pillows.
Q2) The nurse assesses a patient on the second postoperative day after abdominal surgery to repair a perforated duodenal ulcer. Which finding is most important for the nurse to report to the surgeon?
A)Tympanic temperature 99.2° F (37.3° C)
B)Fine crackles audible at both lung bases
C)Redness and swelling along the suture line
D)200 mL sanguineous fluid in the wound drain
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Chapter 20: Assessment of Visual and Auditory Systems
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Sample Questions
Q1) A patient complains of dizziness when bending over and of nausea and dizziness associated with physical activities. The nurse will plan to teach the patient about A)tympanometry.
B)rotary chair testing.
C)pure-tone audiometry.
D)bone-conduction testing.
Q2) Which information will the nurse provide to the patient scheduled for refractometry?
A)"You should not take any of your eye medicines before the examination."
B)"You will need to wear sunglasses for a few hours after the examination."
C)"The doctor will shine a bright light into your eye during the examination."
D)"The surface of your eye will be numb while the doctor does the examination."
Q3) Which assessment finding alerts the nurse to provide patient teaching about cataract development?
A)History of hyperthyroidism
B)Unequal pupil size and shape
C)Blurred vision and light sensitivity
D)Loss of peripheral vision in both eyes
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Chapter 21: Visual and Auditory Problems
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Sample Questions
Q1) The nurse is assessing a patient who was recently treated with amoxicillin for acute otitis media of the right ear. Which finding is a priority to report to the health care provider?
A)The patient has a temperature of 100.6° F.
B)The patient complains of "popping" in the ear.
C)Clear fluid is visible through the tympanic membrane.
D)The patient frequently asks the nurse to repeat information.
Q2) Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation?
A)Use of oral opioids for pain control
B)Administration of corticosteroid drops
C)Importance of coughing and deep breathing exercises
D)Need for bed rest for the first 1 to 2 days after the surgery
Q3) Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma?
A)Morphine sulfate 4 mg IV
B)Mannitol (Osmitrol) 100 mg IV
C)Betaxolol (Betoptic) 1 drop in each eye
D)Acetazolamide (Diamox) 250 mg orally
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Page 23
Chapter 22: Assessment of Integumentary System
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Sample Questions
Q1) A patient reports chronic itching of the ankles and continuously scratches the area. Which assessment finding will the nurse expect?
A)Hypertrophied scars on both ankles
B)Thickening of the skin around the ankles
C)Yellowish-brown skin around both ankles
D)Complete absence of melanin in both ankles
Q2) Which abnormality on the skin of an older patient is the priority to discuss immediately with the health care provider?
A)Dry, scaly patches on the face
B)Numerous varicosities on both legs
C)Petechiae on the chest and abdomen
D)Small dilated blood vessels on the face
Q3) Which activities can the nurse working in the outpatient clinic delegate to a licensed practical/vocational nurse (LPN/LVN)?
A)Administer patch testing to a patient with allergic dermatitis.
B)Interview a new patient about chronic health problems and allergies.
C)Apply a sterile dressing after the health care provider excises a mole.
D)Explain potassium hydroxide testing to a patient with a skin infection.
E)Teach a patient about site care after a punch biopsy of an upper arm lesion.
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Page 24
Chapter 23: Integumentary Problems
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Sample Questions
Q1) A patient is undergoing psoralen plus ultraviolet A light (PUVA)therapy for treatment of psoriasis. What action should the nurse take to prevent adverse effects from this procedure?
A)Shield any unaffected areas with lead-lined drapes.
B)Apply petroleum jelly to the areas around the lesions.
C)Cleanse the skin carefully with antiseptic soap prior to PUVA.
D)Have the patient use protective eyewear while receiving PUVA.
Q2) The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions on the lower face. Which instructions should the nurse include in the teaching plan?
A)Clean the infected areas with soap and water.
B)Apply alcohol-based cleansers on the lesions.
C)Avoid use of antibiotic ointments on the lesions.
D)Use petroleum jelly (Vaseline) to soften crusty areas.
Q3) The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for patient teaching?
A)The patient applies corticosteroid cream to pruritic areas.
B)The patient adds oilated oatmeal to the bath water every day.
C)The patient uses bacitracin-neomycin-polymyxin on minor abrasions.
D)The patient takes diphenhydramine at night if persistent itching occurs.
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Chapter 24: Burns
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Sample Questions
Q1) A patient with severe burns has crystalloid fluid replacement ordered using the Parkland formula. The initial volume of fluid to be administered in the first 24 hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours,what rate should the nurse infuse the IV fluids?
A)219 mL/hr
B)625 mL/hr
C)938 mL/hr
D)1875 mL/hr
Q2) A patient with circumferential burns of both legs develops a decrease in dorsalis pedis pulse strength and numbness in the toes. Which action should the nurse take first?
A)Monitor the pulses every hour.
B)Notify the health care provider.
C)Elevate both legs above heart level with pillows.
D)Encourage the patient to flex and extend the toes.
Q3) Which patient should the nurse assess first?
A)A patient with burns who is complaining of level 8 (0 to 10 scale) pain
B)A patient with smoke inhalation who has wheezes and altered mental status
C)A patient with full-thickness leg burns who is scheduled for a dressing change
D)A patient with partial thickness burns who is receiving IV fluids at 500 mL/hr
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Page 26
Chapter 25: Assessment of Respiratory System
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Sample Questions
Q1) The laboratory has just called with the arterial blood gas (ABG)results on four patients. Which result is most important for the nurse to report immediately to the health care provider?
A)pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97%
B)pH 7.35, PaO2 85 mm Hg, PaCO2 50 mm Hg, and O2 sat 95%
C)pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98%
D)pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%
Q2) After the nurse has received change-of-shift report,which patient should the nurse assess first?
A)A patient with pneumonia who has crackles in the right lung base
B)A patient with chronic bronchitis who has a low forced vital capacity
C)A patient with possible lung cancer who has just returned after bronchoscopy
D)A patient with hemoptysis and a 16-mm induration after tuberculin skin testing
Q3) On auscultation of a patient's lungs,the nurse hears low-pitched,bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?
A)Inspiratory crackles at the bases
B)Expiratory wheezes in both lungs
C)Abnormal lung sounds in the apices of both lungs
D)Pleural friction rub in the right and left lower lobes
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Chapter 26: Upper Respiratory Problems
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25 Verified Questions
25 Flashcards
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Sample Questions
Q1) The nurse is caring for a patient who has acute pharyngitis caused by Candida albicans. Which action is appropriate for the nurse to include in the plan of care?
A)Assess patient for allergies to penicillin antibiotics.
B)Teach the patient to sleep in a warm, dry environment.
C)Avoid giving the patient warm food or warm liquids to drink.
D)Teach patient to "swish and swallow" prescribed oral nystatin
Q2) The nurse is caring for a hospitalized older patient who has nasal packing in place after a nosebleed. Which assessment finding will require the most immediate action by the nurse?
A)The oxygen saturation is 89%.
B)The nose appears red and swollen.
C)The patient reports level 8 (0 to 10 scale) pain.
D)The patient's temperature is 100.1° F (37.8° C).
Q3) Which action should the nurse take first when a patient develops epistaxis?
A)Pack the affected nare tightly with an epistaxis balloon.
B)Apply squeezing pressure to the nostrils for 10 minutes.
C)Obtain silver nitrate that may be needed for cauterization.
D)Instill a vasoconstrictor medication into the affected nare.
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28
Chapter 27: Lower Respiratory Problems
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51 Verified Questions
51 Flashcards
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Sample Questions
Q1) Employee health test results reveal a tuberculosis (TB)skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse?
A)Use and side effects of isoniazid
B)Standard four-drug therapy for TB
C)Need for annual repeat TB skin testing
D)Bacille Calmette-Guérin (BCG) vaccine
Q2) Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting?
A)Providing supportive care to patients diagnosed with pertussis
B)Teaching family members about the need for careful hand washing
C)Teaching patients about the need for adult pertussis immunizations
D)Encouraging patients to complete the prescribed course of antibiotics
Q3) Which action should the nurse plan to prevent aspiration in a high-risk patient?
A)Turn and reposition an immobile patient at least every 2 hours.
B)Place a patient with altered consciousness in a side-lying position.
C)Insert a nasogastric tube for feeding a patient with high calorie needs.
D)Monitor respiratory symptoms in a patient who is immunosuppressed.
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Page 29
Chapter 28: Obstructive Pulmonary Diseases
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44 Flashcards
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Sample Questions
Q1) The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first?
A)A patient with loud expiratory wheezes
B)A patient with a respiratory rate of 38 breaths/min
C)A patient who has a cough productive of thick, green mucus
D)A patient with jugular venous distention and peripheral edema
Q2) Which information will the nurse include in the asthma teaching plan for a patient being discharged?
A)Use the inhaled corticosteroid when shortness of breath occurs.
B)Inhale slowly and deeply when using the dry powder inhaler (DPI).
C)Hold your breath for 5 seconds after using the bronchodilator inhaler.
D)Tremors are an expected side effect of rapidly acting bronchodilators.
Q3) The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?
A)Chest pain
B)Finger clubbing
C)Peripheral edema
D)Elevated temperature
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Chapter 29: Assessment of Hematologic System
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16 Flashcards
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Sample Questions
Q1) The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?
A)Platelet count
B)Neutrophil count
C)Hemoglobin level
D)White blood cell count
Q2) A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test?
A)Bone marrow biopsy
B)Abdominal ultrasound
C)Complete blood count (CBC)
D)Activated partial thromboplastin time (aPTT)
Q3) The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?
A)Check for any iodine allergy.
B)Insert a large-bore IV catheter.
C)Administer prescribed sedatives.
D)Assist the patient to a flat position.
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Chapter 30: Hematologic Problems
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48 Verified Questions
48 Flashcards
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Sample Questions
Q1) Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?
A)Prothrombin time
B)Erythrocyte count
C)Fibrinogen degradation products
D)Activated partial thromboplastin time
Q2) A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
A)iron.
B)folic acid.
C)cobalamin (vitamin B12).
D)ascorbic acid (vitamin C).
Q3) An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to
A)provide a diet high in vitamin K.
B)alternate periods of rest and activity.
C)teach the patient how to avoid injury.
D)place the patient on protective isolation.
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Page 32
Chapter 31: Assessment of Cardiovascular System
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Sample Questions
Q1) The nurse is reviewing the laboratory results for newly admitted patients on the cardiovascular unit. Which laboratory result is most important to communicate as soon as possible to the health care provider?
A)High troponin I level
B)Increased triglyceride level
C)Very low homocysteine level
D)Elevated high-sensitivity C-reactive protein level
Q2) A 74-yr-old patient has just arrived in the emergency department. After assessment reveals a pulse deficit of 46 beats,the nurse will anticipate that the patient may require
A)emergent cardioversion.
B)a cardiac catheterization.
C)hourly blood pressure (BP) checks.
D)electrocardiographic (ECG) monitoring.
Q3) The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to
A)connect the recorder to a computer once daily.
B)exercise more than usual while the monitor is in place.
C)remove the electrodes when taking a shower or tub bath.
D)keep a diary of daily activities while the monitor is worn.
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Page 33
Chapter 32: Hypertension
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Sample Questions
Q1) Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP)for a new patient?
A)Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
B)Have the patient sit in a chair with the feet flat on the floor.
C)Assist the patient to the supine position for BP measurements.
D)Obtain two BP readings in the dominant arm and average the results.
Q2) The nurse is caring for a 70-yr-old patient who uses hydrochlorothiazide and enalapril (Norvasc)but whose self-monitored blood pressure (BP)continues to be elevated. Which patient information may indicate a need for a change?
A)Patient takes a daily multivitamin tablet.
B)Patient checks BP daily just after getting up.
C)Patient drinks wine three to four times a week.
D)Patient uses ibuprofen (Motrin) treat osteoarthritis.
Q3) The nurse obtains a blood pressure of 176/82 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?
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34
Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome
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Sample Questions
Q1) Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina?
A)"The pain wakes me up at night."
B)"The pain is level 3 to 5 (0 to 10 scale)."
C)"The pain has gotten worse over the last week."
D)"The pain goes away after a nitroglycerin tablet."
Q2) Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin?
A)Heparin enhances platelet aggregation at the plaque site.
B)Heparin decreases the size of the coronary artery plaque.
C)Heparin prevents the development of new clots in the coronary arteries.
D)Heparin dissolves clots that are blocking blood flow in the coronary arteries.
Q3) During the administration of the thrombolytic agent to a patient with an acute myocardial infarction,the nurse should stop the drug infusion if the patient experiences A)bleeding from the gums.
B)increase in blood pressure.
C)a decrease in level of consciousness.
D)a nonsustained episode of ventricular tachycardia.
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Chapter 34: Heart Failure
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Sample Questions
Q1) Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF)requires the most immediate action by the nurse?
A)O2 saturation of 88%
B)Weight gain of 1 kg (2.2 lb)
C)Heart rate of 106 beats/min
D)Urine output of 50 mL over 2 hours
Q2) IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. During the first hours of administration,the nurse will need to titrate the nitroprusside rate down if the patient develops
A)ventricular ectopy.
B)a dry, hacking cough.
C)a systolic BP below 90 mm Hg.
D)a heart rate below 50 beats/min.
Q3) Which topic will the nurse plan to include in discharge teaching for a patient with heart failure with reduced ejection fraction (HFrEF)?
A)Need to begin an aerobic exercise program several times weekly
B)Use of salt substitutes to replace table salt when cooking and at the table
C)Importance of making an annual appointment with the health care provider
D)Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
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Page 36
Chapter 35: Dysrhythmias
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31 Flashcards
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Sample Questions
Q1) A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED),the nurse obtains the following electrocardiographic (ECG)tracing. The nurse interprets this heart rhythm as
A)junctional escape rhythm.
B)accelerated idioventricular rhythm.
C)third-degree atrioventricular (AV) block.
D)sinus rhythm with premature atrial contractions (PACs).
Q2) The nurse knows that discharge teaching about the management of a new permanent pacemaker has been most effective when the patient states
A)"It will be several weeks before I can return to my usual activities."
B)"I will avoid cooking with a microwave oven or being near one in use."
C)"I will notify the airlines when I make a reservation that I have a pacemaker."
D)"I won't lift the arm on the pacemaker side until I see the health care provider."
Q3) When analyzing an electrocardiographic (ECG)rhythm strip of a patient with a regular heart rhythm,the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ____.
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Chapter 36: Inflammatory and Structural Heart Disorders
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) Which admission order written by the health care provider for a patient admitted with infective endocarditis (IE)and a fever would be a priority for the nurse to implement?
A)Administer ceftriaxone 1 g IV.
B)Order blood cultures drawn from two sites.
C)Give acetaminophen (Tylenol) PRN for fever.
D)Arrange for a transesophageal echocardiogram.
Q2) While caring for a 23-yr-old patient with mitral valve prolapse (MVP)without valvular regurgitation,the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to
A)take antibiotics before any dental appointments.
B)limit physical activity to avoid stressing the heart.
C)avoid over-the-counter (OTC) drugs that contain stimulants.
D)take an aspirin a day to prevent clots from forming on the valve.
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Chapter 37: Vascular Disorders
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36 Verified Questions
36 Flashcards
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Sample Questions
Q1) Which actions could the nurse delegate to unlicensed assistive personnel (UAP)who are providing care for a patient who is at risk for venous thromboembolism?
A)Monitor for any bleeding after anticoagulation therapy is started.
B)Apply sequential compression device whenever the patient is in bed.
C)Ask the patient about use of herbal medicines or dietary supplements.
D)Instruct the patient to call immediately if any shortness of breath occurs.
Q2) When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD),the nurse determines a need for further instruction when the patient says,"I will
A)use a heating pad on my feet at night to increase the circulation."
B)buy some loose clothes that do not bind across my legs or waist."
C)walk to the point of pain, rest, and walk again for at least 30 minutes 3 times a week."
D)change my position every hour and avoid long periods of sitting with my legs crossed."
Q3) When assessing a patient with possible peripheral artery disease (PAD),the nurse obtains a brachial blood pressure (BP)of 147/82 mm Hg and an ankle pressure of 112/74 mm Hg. The nurse calculates the patient's ankle-brachial index (ABI)as ________ (round up to the nearest hundredth).
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Page 39
Chapter 38: Assessment of Gastrointestinal System
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17 Flashcards
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Sample Questions
Q1) Which statement to the nurse from a patient with jaundice indicates a need for teaching?
A)"I used cough syrup several times a day last week."
B)"I take a baby aspirin every day to prevent strokes."
C)"I use acetaminophen (Tylenol) every 4 hours for back pain."
D)"I need to take an antacid for indigestion several times a week"
Q2) A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP)requires that the registered nurse (RN)intervene?
A)Offering the patient a pitcher of water
B)Positioning the patient on the right side
C)Checking the vital signs every 30 minutes
D)Swabbing the patient's mouth with a wet cloth
Q3) The nurse is assessing an alert and independent 78-yr-old patient for malnutrition risk. Which is the most appropriate initial question?
A)"How do you get to the store to buy your food?"
B)"Can you tell me the food that you ate yesterday?"
C)"Do you have any difficulty in preparing or eating food?"
D)"Are you taking any medications that alter your taste for food?"
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Page 40
Chapter 39: Nutritional Problems
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Sample Questions
Q1) Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG)may be delegated to a licensed practical/vocational nurse (LPN/LVN)?
A)Assessing the patient's nutritional status weekly
B)Providing skin care to the area around the tube site
C)Teaching the patient how to administer tube feedings
D)Determining the need for adding water to the feedings
Q2) A 20-yr-old woman is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?
A)The patient uses laxatives daily.
B)The patient's knuckles are macerated.
C)The patient has a history of extreme fluctuations.
D)The patient's serum potassium level is 2.9 mEq/L.
Q3) Which menu choice best indicates that the patient is implementing the nurse's suggestion to choose high-calorie,high-protein foods?
A)Baked fish with applesauce
B)Beef noodle soup and canned corn
C)Fresh fruit salad with yogurt topping
D)Fried chicken with potatoes and gravy
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Page 41
Chapter 40: Obesity
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Sample Questions
Q1) After successfully losing 1 lb weekly for several months,a patient at the clinic has not lost any weight for the past month. The nurse should first
A)review the diet and exercise guidelines with the patient.
B)instruct the patient to weigh and record weights weekly.
C)ask the patient whether there have been any changes in exercise or diet patterns.
D)discuss the possibility that the patient has reached a temporary weight loss plateau.
Q2) What information will the nurse include for an overweight 35-yr-old woman who is starting a weight-loss plan?
A)Weigh yourself at the same time every morning and evening.
B)Stick to a 600- to 800-calorie diet for the most rapid weight loss.
C)Low carbohydrate diets lead to rapid weight loss but are difficult to maintain.
D)Weighing all foods on a scale is necessary to choose appropriate portion sizes.
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Chapter 41: Upper Gastrointestinal Problems
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Sample Questions
Q1) The health care provider prescribes antacids and sucralfate (Carafate)for treatment of a patient's peptic ulcer. The nurse will teach the patient to take
A)sucralfate at bedtime and antacids before each meal.
B)sucralfate and antacids together 30 minutes before meals.
C)antacids 30 minutes before each dose of sucralfate is taken.
D)antacids after meals and sucralfate 30 minutes before meals.
Q2) A 26-yr-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid
A)emotionally stressful situations.
B)smoked foods such as ham and bacon.
C)foods that cause distention or bloating.
D)chronic use of H2 blocking medications.
Q3) After change-of-shift report,which patient should the nurse assess first?
A)A 42-yr-old patient who has acute gastritis and ongoing epigastric pain
B)A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn
C)A 60-yr-old patient with nausea and vomiting who has dry mucosa and lethargy
D)53-yr-old patient who has dumping syndrome after a recent partial gastrectomy
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43
Chapter 42: Lower Gastrointestinal Problems
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Sample Questions
Q1) A patient with diverticulosis has a large bowel obstruction. The nurse will monitor for
A)referred back pain.
B)metabolic alkalosis.
C)projectile vomiting.
D)abdominal distention.
Q2) Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)?
A)"Have you been passing a lot of gas?"
B)"What foods affect your bowel patterns?"
C)"Do you have any abdominal distention?"
D)"How long have you had abdominal pain?"
Q3) A 58-yr-old patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage,which action will the nurse plan to take next?
A)Auscultate the bowel sounds.
B)Prepare the patient for surgery.
C)Check the patient's oral temperature.
D)Obtain information about the accident.
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44
Chapter 43: Liver, pancreas, and Biliary Tract Problems
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Sample Questions
Q1) Which information given by a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?
A)The patient had a blood transfusion in 2005.
B)The patient used IV drugs about 20 years ago.
C)The patient frequently eats in fast-food restaurants.
D)The patient traveled to a country with poor sanitation.
Q2) Which focused data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis?
A)Hemoglobin
B)Temperature
C)Activity level
D)Albumin level
Q3) A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?
A)The patient reports no chest pain.
B)Blood pressure is 140/90 mm Hg.
C)Stools test negative for occult blood.
D)The apical pulse rate is 68 beats/minute.
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Page 45
Chapter 44: Assessment of Urinary System
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Sample Questions
Q1) What glomerular filtration rate (GFR)would the nurse estimate for a 30-yr-old patient with a creatinine clearance result of 60 mL/min?
A)60 mL/min
B)90 mL/min
C)120 mL/min
D)180 mL/min
Q2) The nurse assessing the urinary system of a 45-yr-old patient would use palpation to
A)determine kidney function.
B)identify renal artery bruits.
C)check for ureteral peristalsis.
D)assess for bladder distention.
Q3) A 79-yr-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?
A)Limit fluid intake to no more than 1000 mL/day.
B)Leave a light on in the bathroom during the night.
C)Ask the patient to use a urinal so that urine can be measured.
D)Pad the patient's bed to accommodate overflow incontinence.
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Chapter 45: Renal and Urologic Problems
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Sample Questions
Q1) Which information will the nurse include when teaching the patient with a urinary tract infection (UTI)about the use of phenazopyridine?
A)Take phenazopyridine for at least 7 days.
B)Phenazopyridine may cause photosensitivity
C)Phenazopyridine may change the urine color
D)Take phenazopyridine before sexual intercourse.
Q2) The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs)has been effective for a 22-yr-old female patient with cystitis when the patient states which of the following?
A)"I can use vaginal antiseptic sprays to reduce bacteria."
B)"I will drink a quart of water or other fluids every day."
C)"I will wash with soap and water before sexual intercourse."
D)"I will empty my bladder every 3 to 4 hours during the day."
Q3) To determine possible causes,the nurse will ask a patient admitted with acute glomerulonephritis about
A)recent bladder infection.
B)history of kidney stones.
C)recent sore throat and fever.
D)history of high blood pressure.
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Page 47
Chapter 46: Acute Kidney Injury and Chronic Kidney Disease
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Sample Questions
Q1) A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for the next 24 hours?
Q2) When caring for a patient with a left arm arteriovenous fistula,which action will the nurse include in the plan of care to maintain the patency of the fistula?
A)Auscultate for a bruit at the fistula site.
B)Assess the quality of the left radial pulse.
C)Compare blood pressures in the left and right arms.
D)Irrigate the fistula site with saline every 8 to 12 hours.
Q3) A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury (AKI)caused by dehydration. Which information will be most important for the nurse to report to the health care provider?
A)The creatinine level is 3.0 mg/dL.
B)Urine output over an 8-hour period is 2500 mL.
C)The blood urea nitrogen (BUN) level is 67 mg/dL.
D)The glomerular filtration rate is less than 30 mL/min/1.73 m2.
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Chapter 47: Assessment of Endocrine System
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22 Flashcards
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Sample Questions
Q1) Which question from a nurse during a patient interview will provide focused information about a possible thyroid disorder?
A)"What methods do you use to help cope with stress?"
B)"Have you experienced any blurring or double vision?"
C)"Have you had a recent unplanned weight gain or loss?"
D)"Do you have to get up at night to empty your bladder?"
Q2) A registered nurse (RN)is caring for a patient with a goiter and possible hyperthyroidism. Which action by the RN indicates that the charge nurse needs to provide the RN with additional teaching?
A)The RN checks the blood pressure in both arms.
B)The RN palpates the neck to assess thyroid size.
C)The RN orders saline eye drops to lubricate the patient's bulging eyes.
D)The RN lowers the thermostat to decrease the temperature in the room.
Q3) During the nurse's physical examination of a young adult,the patient's thyroid gland cannot be felt. The most appropriate action by the nurse is to
A)palpate the patient's neck more deeply.
B)document that the thyroid was nonpalpable.
C)notify the health care provider immediately.
D)teach the patient about thyroid hormone testing.
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Page 49
Chapter 48: Diabetes Mellitus
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49 Flashcards
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Sample Questions
Q1) Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP)who are working in the diabetic clinic?
A)Measure the ankle-brachial index.
B)Check for changes in skin pigmentation.
C)Assess for unilateral or bilateral foot drop.
D)Ask the patient about symptoms of depression.
Q2) A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
A)Infuse dextrose 50% by slow IV push.
B)Administer 1 mg glucagon subcutaneously.
C)Obtain a glucose reading using a finger stick.
D)Have the patient drink 4 ounces of orange juice.
Q3) The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose
A)washes the puncture site using warm water and soap.
B)chooses a puncture site in the center of the finger pad.
C)hangs the arm down for a minute before puncturing the site.
D)says the result of 120 mg indicates good blood sugar control.
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Page 50
Chapter 49: Endocrine Problems
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Sample Questions
Q1) Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider?
A)Changes in visual field
B)Milk leaking from breasts
C)Blood glucose 150 mg/dL
D)Nausea and projectile vomiting
Q2) The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for A)flushing.
B)headache.
C)bradycardia.
D)hypoglycemia.
Q3) A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment?
A)Chronically low blood pressure
B)Bronzed appearance of the skin
C)Purplish streaks on the abdomen
D)Decreased axillary and pubic hair
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Chapter 50: Assessment of Reproductive System
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Q1) A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated three tampons in the past 2 hours. The nurse estimates that the amount of blood loss over the past 2 hours is _____ mL.
A)20 to 30
B)30 to 40
C)40 to 60
D)60 to 90
Q2) The following patients call the outpatient clinic. Which phone call should the nurse return first?
A)A 44-yr-old patient who has bloody discharge after a hysteroscopy earlier today
B)A 64-yr-old patient who is experiencing shoulder pain after a laparoscopy yesterday
C)A 34-yr-old patient who is short of breath after having a pelvic CT with contrast dye
D)A 54-yr-old patient who has severe breast tenderness following a needle aspiration breast biopsy
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Chapter 51: Breast Disorders
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Q1) The nurse provides discharge teaching for a 61-yr-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful?
A)"I will need to use my right arm and to rest the left one."
B)"I will avoid reaching over the stove with my left hand."
C)"I will keep my left arm in a sling until the incision is healed."
D)"I will stop the left arm exercises if moving the arm is painful."
Q2) A 33-yr-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching?
A)Take aspirin every 4 hours to reduce inflammation.
B)Check wound drains for excessive blood or a foul odor.
C)Wear a loose-fitting bra to decrease irritation of the sutures.
D)Resume normal activities 2 to 3 days after the mammoplasty.
Q3) The nurse teaching a young women's community service group about breast self-examination (BSE)will include that
A)BSE will reduce the risk of dying from breast cancer.
B)BSE should be done daily while taking a bath or shower.
C)annual mammograms should be scheduled in addition to BSE.
D)performing BSE after the menstrual period is more comfortable.
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Page 53
Chapter 52: Sexually Transmitted Infections
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Q1) Which patient will the nurse plan on teaching about the Gardasil vaccine?
A)A 24-yr-old female patient who has not been sexually active
B)A 34-yr-old female patient who has multiple sexual partners
C)A 24-yr-old female patient who is pregnant for the first time
D)A 34-yr-old female patient who is in a monogamous relationship
Q2) A 46-yr-old patient who has had blood drawn for an insurance screening has a positive Venereal Disease Research Laboratory (VDRL)test. Which action should the nurse take next?
A)Ask the patient about past treatment for syphilis.
B)Explain the need for blood and spinal fluid cultures.
C)Schedule fluorescent treponemal antibody absorption (FAT-Abs) testing.
D)Assess for the presence of chancres, flulike symptoms, or a rash on the trunk.
Q3) A 19-yr-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not sought treatment until now because "the warts are so disgusting." Which nursing diagnosis is consistent with these data?
A)Disturbed body image related to feelings about the genital warts
B)Ineffective coping related to denial of increased risk for infection
C)Risk for infection related to lack of knowledge about transmission
D)Anxiety related to impact of condition on interpersonal relationships
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Page 54
Chapter 53: Female Reproductive and Genital Problems
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Q1) A 34-yr-old patient who is discussing contraceptive options with the nurse says,"I want to have children but not for a few years." Which response by the nurse is accurate?
A)"If you do not become pregnant within the next few years, you never will."
B)"Women often have more difficulty becoming pregnant after about age 35."
C)"Stop taking oral contraceptives several years before you want to have a child."
D)"You have many more years of fertility left, so there is no rush to have children."
Q2) A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective?
A)"I can purchase an over-the-counter medication to treat this infection."
B)"The symptoms are due to the overgrowth of normal vaginal bacteria."
C)"The medication will need to be inserted once daily with an applicator."
D)"Both my partner and I will need to take the medication for a full week."
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Chapter 54: Male Reproductive and Genital Problems
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Q1) The nurse in the clinic notes elevated prostate specific antigen (PSA)levels in the laboratory results of these patients. Which patient's PSA result is not expected to be elevated?
A)A 38-yr-old patient who is being treated for acute prostatitis
B)A 48-yr-old patient whose father died of metastatic prostate cancer
C)A 52-yr-old patient who goes on long bicycle rides every weekend
D)A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia (BPH)
Q2) A patient tells the nurse that he decided to seek treatment for erectile dysfunction (ED)because his wife "is losing patience with the situation." The nurse's follow-up questions should focus on the man's identified concern with A)low self-esteem.
B)role performance.
C)increased anxiety.
D)infrequent intercourse.
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Chapter 55: Assessment of Nervous System
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Q1) The nurse will anticipate teaching a patient with a possible seizure disorder about which test?
A)Cerebral angiography
B)Evoked potential studies
C)Electromyography (EMG)
D)Electroencephalography (EEG)
Q2) Which problem can the nurse expect for a patient who has a positive Romberg test result?
A)Pain
B)Falls
C)Aphasia
D)Confusion
Q3) The nurse performing a focused assessment of left posterior temporal lobe functions will assess the patient for
A)sensation on the left side of the body.
B)reasoning and problem-solving ability.
C)ability to understand written and oral language.
D)voluntary movements on the right side of the body.
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Chapter 56: Acute Intracranial Problems
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Q1) When a brain-injured patient responds to nail bed pressure with internal rotation,adduction,and flexion of the arms,the nurse reports the response as A)flexion withdrawal.
B)localization of pain.
C)decorticate posturing.
D)decerebrate posturing.
Q2) A patient admitted with a diffuse axonal injury has a systemic blood pressure (BP)of 106/52 mm Hg and an intracranial pressure (ICP)of 14 mm Hg. Which action should the nurse take first?
A)Document the BP and ICP in the patient's record.
B)Report the BP and ICP to the health care provider.
C)Elevate the head of the patient's bed to 60 degrees.
D)Continue to monitor the patient's vital signs and ICP.
Q3) Which question will the nurse ask a patient who has been admitted with a benign occipital lobe tumor to assess for functional deficits?
A)"Do you have difficulty in hearing?"
B)"Are you experiencing visual problems?"
C)"Are you having any trouble with your balance?"
D)"Have you developed any weakness on one side?"
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Page 58
Chapter 57: Stroke
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Q1) A patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously,and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for A)surgical endarterectomy.
B)transluminal angioplasty.
C)intravenous heparin drip administration.
D)tissue plasminogen activator (tPA) infusion.
Q2) A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which response by the nurse is accurate?
A)"The obstructing plaque is surgically removed from inside an artery in the neck."
B)"The diseased portion of the artery in the brain is replaced with a synthetic graft."
C)"A wire is threaded through an artery in the leg to the clots in the carotid artery, and the clots are removed."
D)"A catheter with a deflated balloon is positioned at the narrow area, and the balloon is inflated to flatten the plaque."
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Chapter 58: Chronic Neurologic Problems
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Q1) A hospitalized patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first?
A)Put a moist hot pack on the patient's neck.
B)Start the prescribed PRN O2 at 6 L/min.
C)Give the ordered PRN acetaminophen (Tylenol).
D)Notify the patient's health care provider immediately.
Q2) After change-of-shift report,which patient should the nurse assess first?
A)Patient with myasthenia gravis who is reporting increased muscle weakness
B)Patient with a bilateral headache described as "like a band around my head"
C)Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin)
D)Patient with Parkinson's disease who has developed cogwheel rigidity of the arms
Q3) A patient has been taking phenytoin (Dilantin)for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication?
A)Inspect the oral mucosa.
B)Listen to the lung sounds.
C)Auscultate the bowel sounds.
D)Check pupil reaction to light.
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Chapter 59: Dementia and Delirium
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Q1) The spouse of a 67-yr-old male patient with early stage Alzheimer's disease (AD)tells the nurse,"I am exhausted from worrying all the time. I don't know what to do." Which actions are best for the nurse to take next ?
A)Suggest that a long-term care facility be considered.
B)Offer ideas for ways to distract or redirect the patient.
C)Teach the spouse about adult day care as a possible respite.
D)Suggest that the spouse consult with the physician for antianxiety drugs.
E)Ask the spouse what she knows and has considered about dementia care options.
Q2) The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate action by the nurse is to
A)secure the patient in bed using a soft chest restraint.
B)ask the health care provider to order an antipsychotic drug.
C)instruct family members to remain at the patient's bedside and prevent injury.
D)assign unlicensed assistive personnel (UAP) to stay with and reorient the patient.
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Chapter 60: Spinal Cord and Peripheral Nerve Problems
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Q1) When evaluating outcomes of a glycerol rhizotomy for a patient with trigeminal neuralgia,the nurse will
A)assess if the patient is doing daily facial exercises.
B)question if the patient is using an eye shield at night.
C)ask the patient about social activities with family and friends.
D)remind the patient to chew on the unaffected side of the mouth.
Q2) A 20-yr-old patient who sustained a T2 spinal cord injury 10 days ago tells the nurse,"I want to be transferred to a hospital where the nurses know what they are doing." Which action by the nurse is appropriate?
A)Respond that abusive language will not be tolerated.
B)Request that the patient provide input for the plan of care.
C)Perform care without responding to the patient's comments.
D)Reassure the patient about the competence of the nursing staff.
Q3) A patient is hospitalized with new onset of Guillain-Barré syndrome. The most essential assessment for the nurse to complete is
A)determining level of consciousness.
B)checking strength of the extremities.
C)observing respiratory rate and effort.
D)monitoring the cardiac rate and rhythm.
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Page 62
Chapter 61: Assessment of Musculoskeletal System
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Q1) Which medication information will the nurse identify as a potential risk to a patient's musculoskeletal system?
A)The patient takes a daily multivitamin and calcium supplement.
B)The patient takes hormone replacement therapy (HRT) to prevent "hot flashes."
C)The patient has severe asthma requiring frequent therapy with oral corticosteroids.
D)The patient has headaches treated with nonsteroidal antiinflammatory drugs (NSAIDs).
Q2) The nurse notes crackling sounds and a grating sensation with palpation of an older patient's elbow. How will this finding be documented?
A)Torticollis
B)Crepitation
C)Subluxation
D)Epicondylitis
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Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery
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Q1) After a motorcycle accident,a patient arrives in the emergency department with severe swelling of the left lower leg. Which action will the nurse take first?
A)Elevate the leg on 2 pillows.
B)Apply a compression bandage.
C)Assess leg pulses and sensation.
D)Place ice packs on the lower leg.
Q2) After change-of-shift report,which patient should the nurse assess first?
A)Patient with a repaired mandibular fracture who is complaining of facial pain
B)Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated
C)Patient with an unrepaired Colles' fracture who has right wrist swelling and deformity
D)Patient with repaired right femoral shaft fracture who is complaining of tightness in the calf
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Chapter 63: Musculoskeletal Problems
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Q1) Which actions will the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur ?
A)Monitor serum calcium.
B)Teach about the need for strict bed rest.
C)Discontinue use of sustained-release opioids.
D)Support the left leg when repositioning the patient.
E)Support family and patient as they discuss the prognosis.
Q2) Which assessment finding for a patient who has had surgical reduction of an open fracture of the right radius requires notification of the health care provider?
A)Serous wound drainage
B)Right arm muscle spasms
C)Right arm pain with movement
D)Temperature 101.4° F (38.6° C)
Q3) Which action will the nurse take when caring for a patient with osteomalacia?
A)Teach about the use of vitamin D supplements.
B)Educate about the need for weight-bearing exercise.
C)Discuss the use of medications such as bisphosphonates.
D)Emphasize the importance of sunscreen use when outside.
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Chapter 64: Arthritis and Connective Tissue Diseases
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Q1) A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA)and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate?
A)"You need to see a family therapist for some help with stress."
B)"Tell me more about the situations that are causing you stress."
C)"Your family should understand the impact of your rheumatoid arthritis."
D)"Perhaps it would be helpful for your family to be involved in a support group."
Q2) Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis?
A)Affected joints should not be exercised when pain is present.
B)Applying cold packs before exercise may decrease joint pain.
C)Exercises should be performed passively by someone other than the patient.
D)Walking may substitute for range-of-motion (ROM) exercises on some days.
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Chapter 65: Critical Care
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Q1) The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action should be included in the plan of care?
A)Avoid the use of anticoagulant medications.
B)Measure the patient's urinary output every hour.
C)Provide passive range of motion for all extremities.
D)Position the patient supine with head flat at all times.
Q2) Which action should the nurse take when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery?
A)Fast flush the arterial line.
B)Check the left hand for pallor.
C)Assess for cardiac dysrhythmias.
D)Re-zero the monitoring equipment.
Q3) While waiting for heart transplantation,a patient with severe cardiomyopathy has a ventricular assist device (VAD)implanted. When planning care for this patient,the nurse should anticipate
A)preparing the patient for a permanent VAD.
B)administering immunosuppressive medications.
C)teaching the patient the reason for complete bed rest.
D)monitoring the surgical incision for signs of infection.
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Page 67
Chapter 66: Shock, sepsis, and Multiple Organ Dysfunction Syndrome
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Q1) A patient is admitted to the emergency department (ED)for shock of unknown etiology. The first action by the nurse should be to
A)obtain the blood pressure.
B)check the level of orientation.
C)administer supplemental oxygen.
D)obtain a 12-lead electrocardiogram.
Q2) After receiving 2 L of normal saline,the central venous pressure for a patient who has septic shock is 10 mm Hg,but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an order for A)furosemide .
B)nitroglycerin .
C)norepinephrine .
D)sodium nitroprusside .
Q3) The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider?
A)Skin cool and clammy
B)Heart rate of 118 beats/min
C)Blood pressure of 92/56 mm Hg
D)O2 saturation of 93% on room air
Page 68
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Chapter 67: Acute Respiratory Failure and Acute
Respiratory Distress Syndrome
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Q1) After receiving change-of-shift report on a medical unit,which patient should the nurse assess first?
A)A patient with cystic fibrosis who has thick, green-colored sputum
B)A patient with pneumonia who has crackles bilaterally in the lung bases
C)A patient with emphysema who has an oxygen saturation of 90% to 92%
D)A patient with septicemia who has intercostal and suprasternal retractions
Q2) A patient with acute respiratory distress syndrome (ARDS)who is intubated and receiving mechanical ventilation develops a right pneumothorax. Which collaborative action will the nurse anticipate next?
A)Increase the tidal volume and respiratory rate.
B)Decrease the fraction of inspired oxygen (FIO<sub>2</sub>).
C)Perform endotracheal suctioning more frequently.
D)Lower the positive end-expiratory pressure (PEEP).
Q3) Which actions should the nurse start to reduce the risk for ventilator-associated pneumonia (VAP)?
A)Obtain arterial blood gases daily.
B)Provide a "sedation holiday" daily.
C)Give prescribed pantoprazole (Protonix).
D)Elevate the head of the bed to at least 30°.
E)Provide oral care with chlorhexidine (0.12%) solution daily.
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Chapter 68: Emergency and Disaster Nursing
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Q1) A 22-yr-old patient who experienced a drowning accident in a local pool,but now is awake and breathing spontaneously,is admitted for observation. Which assessment will be most important for the nurse to take during the observation period?
A)Auscultate heart sounds.
B)Palpate peripheral pulses.
C)Auscultate breath sounds.
D)Check mental orientation.
Q2) Family members are in the patient's room when the patient has a cardiac arrest and the staff start resuscitation measures. Which action should the nurse take next?
A)Keep the family in the room and assign a staff member to explain the care given and answer questions.
B)Ask the family to wait outside the patient's room with a designated staff member to provide emotional support.
C)Ask the family members whether they would prefer to remain in the patient's room or wait outside the room.
D)Tell the family members that patients are comforted by having family members present during resuscitation efforts.
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