Medical-Surgical Nursing

Session 4
1. Following an extensive cardiac
bypass surgery, Carlo returns to the
intensive care unit with an order of
dobutamine (Dobutrex),
mcg!"g!minute #.$. %he nurse
understands that this drug is&
'. #ndirect(acting dual(active agent
). Direct(acting beta(active agent
C. #ndirect(acting beta(active agent
D. Direct(acting alpha(active agent
*. %he nurse would +,-% li"ely hear
which type of heart murmur in a client
with mitral stenosis.
'. /ansystolic, blowing, high(pitched
). -ystolic, harsh, crescendo(
decrescendo
C. Diastolic, blowing, decrescendo
D. Diastolic, rumbling, low pitched
0. 1urse 2ane is interviewing a female client
in the cardiovascular clinic. 3hen
investigating for childhood diseases and
disorders associated with structural heart
disease, the nurse should consider which
finding significant.
'. Croup
). 4heumatic fever.
C. -evere staphylococcal infection
D. +edullary sponge "idney
5. -unshine underwent a valve replacement
procedure * years ago. #n educating the
client about maintaining a healthy heart, the
nurse should include which point in her
teaching.
'. -mo"e in moderation.
). 6se alcohol in moderation
C. Consume a diet high in
saturated fats and low in
cholesterol.
D. 7xercise one or two times per
wee".
. 3hich of the following is the /4#,4#%8
diagnosis in a client with cardiomyopathy.
'. Decreased cardiac output
related to reduced myocardial
contractility.
). 7xcess fluid volume related
to fluid retention and altered
compensatory mechanisms.
C. #neffective coping related to
fear of debilitating illness.
D. 'nxiety related to actual
threat to health status.
9. ' male client has past medical history of
diabetes mellitus, hypertension, and
pernicious anemia: the client underwent an
appendectomy 1; years ago and an aortic
valve replacement 0 years ago. 3hich
history finding is a ma<or ris" factor for
infective endocarditis.
'. =ender
). 'ge
C. >istory of diabetes mellitus
D. >istory of aortic valve
replacement
?. )en had his tooth extracted 0 months
ago, now, he is admitted to the medical(
surgical unit for evaluation for infective
endocarditis. 3hich significant clinical
manifestation should the nurse watch out
for.
'. 4etrosternal pain that worsens
during supine positioning
). /ulsus paradoxus
C. ' sratchy pericardial friction rub.
D. ,sler@s nodes and splinter
hemorrhages
A. ' client who suffered from infectious
endocarditis underwent mitral valve
excision. Following the surgery, which of the
following actions ta"es /4#,4#%8.
1
'. +onitoring temperature
). Chec"ing for pain
C. 'ssessing heart sounds
D. Determining presence of
anxiety
B. 'n adolescent female client is diagnosed
with myocarditis. 3hich of the following
drugs is contraindicated in the acute stage
of the disease.
'. 1-'#D
). /enicillin
C. Cephalosporin
D. #ron
1;. %he nurse caring for a client with
pericarditis must be alert to the possibility of
cardiac tamponade. 3hich of the following
signs is 1,% consistent with cardiac
tamponade.
'. #ncreasing arterial pressure
). 4ising venous pressure
C. Distant heart sounds
D. Falling arterial pressure
11. +ila is receiving digoxin for the
treatment of congestive heart failure. 3hich
of the following food items needs
consultation to her physician before
including in her diet.
'. Dried apricots
). =rape fruit
C. %omato <uice
D. Dried plums
1*. +r. -antos, a 5A year(old client with
congestive heart failure, is restless, anxious
and feel overwhelmed by breathlessness.
3hich nursing intervention is +,-%
therapeutic for the client during this time.
'. 's" the family member to leave
the room
). %each the client about deep
breathing exercise
C. -pea" in a slow, calm, confident
manner and maintain eye
contact.
D. 'ssist the patient to identify
factors that contribute to
anxiety.
10. %he physician prescribed morphine
sulfate to a client with pulmonary edema.
%he nurse understands that the primary
reason for this is to&
'. /romote excretion of sodium
and water
). 4educe peripheral resistance
and venous return to the lungs
C. 4elieve hypoxemia and
dyspnea
D. Decrease chest discomfort
15. %he nurse is assessing a client with
massive pulmonary embolism for danger
signs. %he nurse would assess the following
as the +,-% reliable sign of cardiac arrest.
'. %emperature
). >eart beat
C. )lood pressure
D. /ulse
1. ' client with cardiogenic shoc" is closely
supervised in the intensive care unit (#C6).
3hat intervention by the nurse has the
highest priority.
'. 4ecording of fluid inta"e and
urinary output
). ,bservation of the cardiac
rhythm
C. /roviding emotional support
D. Documenting hemodynamic
findings
2
(-ituation 19(1B)& Cuis, a 5; year old fish
vendor, visits the clinic for assessment of
vascular functions. >e has been
complaining of persistent pain in his
extremities that often interferes with his
sleep.
19. Cuis reports to the nurse persistent pain
in the forefoot when at rest and is often
worst at night. %he nurse would interpret this
finding as&
'. #ntermittent claudication
). 4est pain
C. Dependent rubot
D. Ceg edema
1?. %he nurse would instruct Cuis which of
the following positions to improve perfusion
pressure on the distal tissues.
'. Cower extremity to dependent
position
). Cower extremity to independent
position
C. 7levate extremity to dependent
position
D. 7levate extremity to
independent position
1A. 3hich of the following additional
findings would suggest to the nurse that
Cuis is suffering from arterial insufficiency.
'. /resence of pulse but difficult to
palpate
). -evere edema
C. 'ching and cramping pain
D. 'bsent pulse
1B. #n assessing a client with severe
peripheral arterial damage, the nurse would
+,-% li"ely observe which of the following
after placing the client@s extremity to a
dependent position for * minutes.
'. Cyanosis
). 4ubor
C. 7dema
D. =angrene
*;. #n assessing a client with )uerger@s
disease, the nurse would inspect the
inflammation commonly in which of the
following sites.
'. Fingertips
). +outh
C. Cower extremities
D. Dnees and elbows
*1. #n creating a care plan for a 5 year(old
client with arterial occlusive disease, what
nursing diagnosis should be considered the
priority.
'. Dnowledge deficit
). Decreased cardiac output
C. 'ltered tissue perfusion
D. )ody image disturbance
**. 3hich of the following interventions
employed by the nurse does 1,% need
further instruction from the head nurse in
the care of a client with peripheral arterial
insufficiency.
'. 'pplication of heating pads on
the extremities
). 6se hot water bottles on the
abdomen
C. %elling the client to buy shoes
with laces
D. #nstructing the client to wal" to
the point of pain
*0. #n assessing a client with )uerger@s
disease, the nurse would inspect the
inflammation commonly in which of the
following sites.
'. Fingertips
). +outh
C. Cower extremities
D. Dnees and elbows
3
*5. 1urse 'na is teaching a client with
4aynaud@s disease about self(management
of the condition. %he nurse would evaluate
that the client needs further reinforcement if
the client states that&
'. -mo"ing cessation is very important
). -ources of caffeine should be eliminated
from the diet
C. %a"ing nifedipine (/rocardia) as
prescribed will decrease vessel spasm
D. +oving to a warmer climate is needed
*. +arlon, a client with venous stasis leg
ulcer visits the outpatient department for
follow(up chec" up. %he nurse assesses the
client@s ulcer and would expect to note the
following&
'. /ale(colored base
). Cesion is deep, with even edges
C. Contain little granulation tissue
D. >as brown pigmentation surrounding it
*9. 4ichard, a client diagnosed with
thrombophlebitis suddenly complains of
chest pain and shortness of breath and is
visibly anxious. %he nurse should
immediately assess the client for
manifestations of&
'. +yocardial infarction
). /neumonia
C. /ulmonary embolism
D. /ulmonary edema
*?. 3hich of the following measures
implemented by the nurse in ta"ing the
client@s blood pressure indicates lac" of
understanding about the procedure.
'. -eating the client with arm bared,
supported, and at heart level.
). +easuring the blood pressure after the
client has been seated Euietly for minutes.
C. 6sing a cuff with a rubber bladder that
encircles at least A;F of the limb.
D. %a"ing the blood pressure within 0;
minutes after nicotine or caffeine ingestion.
*A. +ario is diagnosed with pulmonary
embolism and is prescribed to ta"e
strepto"inase (-treptase). ' nurse would
report which of the following assessments to
the physician before administering the
drug.
'. 'dventitous breath sounds
). 4espiratory rate of *A breaths per minute
C. %emperature of BB.5G F orally
D. )lood pressure ()/) of 1BA!11; mm >g
*B. ' nurse is performing an assessment on
a client with pregnancy(induced
hypertension (/#>) who is in labor. %he
nurse most li"ely expects to note&
'. Decelerations and increased variability of
the fetal heart rate
). #ncreased blood pressure
C. Decreased brachial reflexes
D. Decreased blood pressure
0;. ' male client complaints of oliguria,
hypertension. and peripheral edema. %he
laboratory test reveals the following& )61(
*, D(.;. 3hat nutrient should be restricted
in this client@s diet.
'. /rotein.
). Fats.
C. Carbohydrates.
D. +agnesium.
01. Caboratory studies are performed for a
child suspected of having iron deficiency
anemia. %he nurse reviews the laboratory
results, "nowing that which of the following
results would indicate this type of anemia.
'. 'n elevated hemoglobin level
). ' decreased reticulocyte count
C. 'n elevated red blood cell count
D. 4ed blood cells that are microcytic and
hypochromic
4
0*. ' nurse analyHes the laboratory results
of a child with hemophilia. %he nurse
understands that which of the following
would most li"ely be abnormal in this child.
'. /latelet count
). >ematocrit level
C. >emoglobin level
D. /artial thromboplastin time
00. ' home care nurse is instructing the
parents of a child with iron deficiency
anemia regarding the administration of a
liEuid oral iron supplement. %he nurse tells
the mother to&
'. 'dminister the iron at mealtimes.
). 'dminister the iron through a straw.
C. +ix the iron with cereal to administer.
D. 'dd the iron to formula for easy
administration.
05. ' pediatric nursing instructor as"s a
nursing student to describe the cause of the
clinical manifestations that occur in sic"le
cell anemia. %he student responds correctly
by telling the instructor that&
'. )one marrow depression occurs because
of the development of
sic"led cells
). -ic"led cells increase blood flow through
the body and cause a
great deal of pain
C. -ic"led cells mix with the unsic"led cells
and cause the immune
system to become depressed
D. -ic"led cells are unable to flow easily
through the microvasculature and their
clumping obstructs blood flow
0. 'n adult client with a history of
gastrointestinal bleeding has a platelet
count of 0;;,;;; cells!mm0. 3hich action
by the nurse is most appropriate after
seeing the laboratory results.
'. 4eport the abnormally low count.
). 4eport the abnormally high count.
C. /lace the client on bleeding precautions.
D. /lace the normal report in the clientIs
medical record.
09. 'n adult female client has a hemoglobin
level of 1;.A g!dC. %he nurse interprets that
this result is most li"ely caused by which of
the following conditions noted in the clientIs
history.
'. Dehydration
). >eart failure
C. #ron deficiency anemia
D. Chronic obstructive pulmonary disease
0?. %he nurse is caring for a client with a
diagnosis of cancer who is
immunosuppressed. %he nurse would
consider implementing neutropenic
precautions if the clientIs white blood cell
count was which of the following.
'.*,;;; cells!mm0
). ,A;; cells!mm0
C. A,5;; cells!mm0
D. 11,;; cells!mm0
0A. %he nurse who is about to begin a blood
transfusion "nows that blood cells start to
deteriorate after a certain period of time.
3hich of the following items is important to
chec" regarding the age of blood cells
before the transfusion is begun.
'. 7xpiration date
). /resence of clots
C. )lood group and type
D. )lood identification number
0B. %he nurse is told by a physician that a
client in hypovolemic shoc" will reEuire
plasma expansion. %he nurse anticipates
receiving an order to transfuse which
product.
'. 'lbumin
5
). /latelets
C. Cryoprecipitate
D. /ac"ed red blood cells
5;. >' client with severe blood loss
resulting from multiple trauma reEuires rapid
transfusion of several units of blood. %he
nurse as"s another health team member to
obtain which device for use during the
transfusion procedure to help reduce the
ris" of cardiac dysrhythmias.
'. /ulse oximetry
). Cardiac monitor
C. #nfusion controller
D. )lood(warming device
51. ' client is brought to the emergency
room having experienced blood loss related
to an arterial laceration. Fresh froHen
plasma (FF/) is ordered and transfused to
replace fluid and blood loss. %he nurse
understands that the rationale for
transfusing FF/ in this client is&
'. %o treat the loss of platelets
). %o promote rapid volume expansion
C. %hat the transfusion must be done slowly
D. %hat it will increase the hemoglobin and
hematocrit levels
5*. ' female client is suspected of having
iron deficiency anemia (#D'). 3hich of the
following would the nurse expect to note
regarding the client@s status.
'. ' low hemoglobin and
hematocrit level
). ' high hemoglobin and
hematocrit level
C. Fluid volume excess
D. Fluid volume deficit
50. 'n adolescent client has been
diagnosed with acute poststreptococcal
glomerulonephritis, and renal insufficiency is
suspected. 3hich of the following
laboratory results will a nurse expect to note
in the child.
'. 'n elevated white blood cell
(3)C) count
). 1egative red blood cells in
the urinalysis
C. 1egative protein in the
urinalysis
D. 7levated blood urea nitrogen
()61) and creatinine
55. ' client in labor has a concurrent
diagnosis of sic"le cell anemia. )ecause
the client is at high ris" for sic"ling crisis,
which nursing action is the priority to assist
in preventing a crisis from occurring during
labor.
'. 4eassure the client
). 'dminister oxygen as
ordered throughout labor
C. +aintain strict asepsis
D. /revent bearing down
5. ' nurse is conducting a clinic visit with a
prenatal client with heart disease. %he
nurse carefully assesses the client@s vital
signs, weight, and fluid and nutritional status
to detect complications caused by&
'. >ypertrophy and increased
contractility of the heart
). %he increase in circulating
blood volume
C. Fetal cardiomegaly
D. 4h incompatibility
59. ' nurse is monitoring the results of
serial arterial blood gases for a client in
whom carbon monoxide poisoning has been
diagnosed. %he client does not want to
"eep the oxygen in place. %he nurse
evaluates that the oxygen may be safely
removed once the carboxyhemoglobin level
deceases to less than&
'. F
). 1;F
C. 1F
D. *F
5?. %he nurse determines that a client is
having a transfusion reaction. 'fter the
nurse stops the transfusion, which action
should immediately be ta"en next.
'. 4emove the #$ line.
). 4un normal saline at a "eep vein open
rate.
6
C. 4un a solution of F dextrose in water.
D. ,btain a culture of the tip of the catheter
device removed from the client.
5A. %he nurse has <ust obtained a unit of
blood from the blood ban" to transfuse into
a client as ordered. )efore preparing the
blood for transfusion, the nurse next loo"s
for which of the following members of the
health care team to assist in chec"ing the
unit of
blood.
'. /hlebotomist
). +edical student
C. 4egistered nurse
D. )lood ban" technician
5B. %he nurse has obtained a unit of blood
from the blood ban" and has chec"ed the
blood bag properly with another nurse. 2ust
before beginning the transfusion, the nurse
assesses which of the following items.
'. $ital signs
). -"in color
C. 6rine output
D. Catest hematocrit level
;. ' client has an order to receive a unit of
pac"ed red blood cells. %he nurse should
obtain which of the following intravenous
(#$) solutions from the #$ storage area to
hang with the blood product at the clientIs
bedside.
'. Cactated 4ingerIs
). ;.BF sodium chloride
C. F dextrose in ;.BF sodium chloride
D. F dextrose in ;.5F sodium chloride
7