My Reviewer Part2

8/8/2019 My Reviewer Part2

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SAMPLE REVIEW QUESTIONS ON MEDICAL AND

SURGICAL NURSING

PART 2



1. A client who is complaining of right lower quadrant pain, nausea, and

vomiting has a low-grade fever, rebound tenderness, and an elevated white

blood cell (WBC) count. Which intervention should the nurse perform first?

A. Administering antacids for gastroenteritis

B. Advising the client to assume a high Fowler·s position for

a peptic ulcerC. Calling the surgeon in anticipation of an appendectomy

D. Suggesting a course of antibiotics to treat peritonitis



CORRECT ANSWER: C

Rationale:The client is exhibiting classic findings associated

with appendicitis, which requires surgery as soon as possible;

notifying the surgeon should be the nurse·s first action.

Rebound tenderness is not associated with gastroenteritis,

which is characterized by generalized abdominal cramping,

diarrhea, fever, and malaise.

A high Fowler·s position would not alleviate pain produced by a

peptic ulcer, which includes burning, aching, and gnawing pain.

Nausea and vomiting are not generally associated with

peritonitis, which is indicated by diffuse abdominal pain,

rebound tenderness, fever, and an elevated WBC count.



2. Which assessment finding would be an appropriate indicator for

evaluating a client with heart failure and a nursing diagnosis of decreased

cardiac output?

A. Decreased intermittent claudication

B. Increased ability to walk to the bathroom without fatigue

C. Increased heart rate by 10 beats per minute

D. Weight gain of 3 pounds in one day



CORRECT ANSWER: B

Rationale: Fatigue may be associated with decreased cardiac

output; an increase in the client·s ability to ambulate to the

bathroom without fatigue indicates improvement in cardiac

output.

A decrease in intermittent claudication indicates improved

peripheral perfusion, but it does not demonstrate increased

cardiac output.

The body normally responds to a decrease in cardiac output by

increasing the heart rate.

Weight gain indicates fluid retention and a worsening of the

client·s heart failure.



3. A client who has frostbite is complaining of pain. In addition to giving

medication, which nursing intervention should the nurse implement?

A. Administration of sodium bicarbonate

B. Elevation of the body part

C. Gentle massage of the affected area

D. Administration of warmed, humidified oxygen



CORRECT ANSWER: B

Rationale: Elevation of the body part helps to reduce the

edema associated with frostbite.

Sodium bicarbonate is indicated for the treatment of

hypothermia. Massaging the affected area may result in further tissue damage.

Warm, humidified oxygen is used as treatment for

hypothermia.



4. A client scheduled for a biopsy of a mass asks the nurse to explain why

this surgery is necessary. Which statement would be the nurse·s best

response?

A. ´The physician removes the precancerous mass to prevent

cancer from occurring.µ

B. ´This is diagnostic surgery done to confirm or rule outmalignancy.µ

C. ´This will provide a more realistic look to the body part.µ

D. ´This will relieve your distress and help you to be more

comfortable.µ



CORRECT ANSWER: B

Rationale:A biopsy is performed to aid in diagnosing whether

a mass is benign or malignant.

Preventative surgery is done to remove tissue prior to its

becoming cancerous; whether or not the mass is precanceroushas yet to be determined.

Reconstructive surgery provides a more realistic look to a body

part.

P

alliative surgery is used to relieve the client·s distress and helpmake him more comfortable.



5. A client with deep venous thrombosis develops a sudden onset of severe

leg pain. The limb becomes pale, cold, numb, and pulseless. What medical

condition would the nurse suspect?

A. Acute arterial occlusion

B. Dissecting aneurysm

C. P

ostphlebitic syndromeD. Raynaud·s phenomenon



CORRECT ANSWER: A

Rationale:The change in color, temperature, sensation, andpulse accompanied by the sudden onset of pain (the classic ´P·sµof assessment) all suggest an acute arterial occlusion.

A dissecting aneurysm usually occurs in the chest, not the legs;

a tearing or ripping sensation of pain in the anterior chest, back, epigastric region, or abdomen is common.

Postphlebitic syndrome is characterized by a brownishdiscoloration of the skin, the hallmark sign.

R

aynaud·s phenomenon involves the episodic constriction of the small arteries or arterioles of the extremities, resulting inintermittent pallor and cyanosis of the skin, fingers, toes and,possibly, the ears or nose, followed by hyperemia, which mayproduce rubor.



6. When obtaining the history of a client admitted with endocarditis, which

information from the client interview would the nurse consider as mostsignificant?

A. Dental surgery in the recent past

B. History of coronary artery disease (CAD)

C. History of marijuana use

D. Prolonged use of steroid therapy



CORRECT ANSWER: A

Rationale:Dental surgery is one of the predisposing factors

for the development of endocarditis because it may create a

portal of entry for microorganisms.

A history of valvular heart disease (not CAD), I.V. drug use(not marijuana use), and prolonged I.V. antibiotic therapy (not

steroid therapy) are predisposing factors for endocarditis.



7. When assessing a client diagnosed with an abdominal aortic aneurysm,the nurse monitors the client for which signs and symptoms?

A. Intermittent episodes of high fever with chills

B. Paresthesias and loss of position sense

C. Positive Homans· sign and calf pain

D. Pulsatile mass and systolic bruit



CORRECT ANSWER: D

Rationale:A pulsatile mass and systolic bruit are classic signs

of an abdominal aortic aneurysm.

Intermittent episodes of high fever with chills are associated

with secondary lymphedema or other infections. Paresthesias and loss of position sense are associated with

peripheral arterial occlusive disease as well as neurovascular

and neurologic conditions.

A positive Homans· sign and calf pain are symptoms of deep

vein thrombosis.



8. Which scientific rationale must the nurse keep in mind when

administering oxygen to a client with chronic obstructive pulmonarydisease (COPD)?

A. A facemask is necessary for delivery of adequate

B. Oxygen is reserved for use when the client is short of breath.

C. The client is encouraged to remove the oxygen as often as

possible.

D. The oxygen must be administered at a low rate.



CORRECT ANSWER: D

Rationale:The primary stimulus to breathe for the client with

COPD is hypoxia.

If oxygen were administered at too high a rate, the client·s

respiratory drive would be depressed. The increased effectiveness of using a facemask as opposed to a

nasal cannula has not been proven.

Due to loss of supporting structures and narrowing of airways,

the condition is irreversible; intermittent oxygen is not

effective.



9. Which client would require the nurse to be on highest alert for thedevelopment of a pulmonary embolism (PE)?

A. A woman who has taken hormonal contraceptives for the past 2

years

B. A client who has had laparoscopic gallbladder surgery

C. A client with arterial vascular disease and difficulty walking

D. A client who has experienced multiple trauma and fractures



CORRECT ANSWER: D

Rationale:A client with massive trauma and multiple orthopedic injuries is

at increased risk for developing a PE.The injury may predispose the client to

fat emboli and bony fragments that can become emboli, and the prolonged

period of immobility that results from the injuries and their treatment further

compounds the client·s risk. Women on hormonal contraceptives have aslightly higher risk for PE, but this risk is not as great as that for the client

experiencing multiple trauma and fractures.The risk for cardiovascular

complications increases after age 35 in women who smoke and after age 40 in

women who do not smoke.

Laparoscopic cholecystectomy is now considered a relatively minor procedure

requiring a short hospitalization, usually in an outclient department.

A client with arterial vascular disease may be at increased risk for pulmonary

emboli but PE usually develops in the venous system.



10. Which assessment finding would be the most appropriate indicator for

evaluating the adequacy of gas exchange for the postoperative client with athoracotomy?

A. Effective coughing and deep-breathing

B. Oxygen saturation level of 98%

C. Report of breathing without difficulty

D. Report of pain relief



CORRECT ANSWER: B

Rationale: Following a thoracotomy, the goal is to promote

adequate gas exchange, evidenced by objective parameters

including oxygen saturation, normal blood gases, and breath

sounds.

Effective coughing and deep breathing help to maintain a patent

airway and promote lung expansion, but they do not ensure

adequate gas exchange.

Although client reports of breathing without difficulty are an

important assessment, adequacy of gas exchange is bestevaluated by objective findings.

Assessment and pain relief is important, but pain relief is not a

reliable indicator of adequate gas exchange.



1. When auscultating the breath sounds of a client with bacterialpneumonia, the nurse would expect to find which assessment data?

A. Adventitious breath sounds with crackles and wheezes

B. Bronchial breath sounds over consolidated lung fields

C. Decreased breath sounds with crackles and a pleural

friction rub

D. Wheezing with expiration more prolonged than inspiration



CORRECT ANSWER: B

Rationale: In normal, clear lungs, bronchial breath sounds would be

heard over the large airways and vesicular breath sounds would be heard

over the clear lungs.

With pneumonia, exudate fills the air spaces producing consolidationand bronchial breath sounds over these areas.

Adventitious breath sounds, including crackles and wheezes, would be

indicative of acute respiratory failure.

Decreased breath sounds with crackles and a pleural friction rub would

suggest a pulmonary embolism. Wheezing with expiration that is more

prolonged than inspiration is indicative of chronic obstructive

pulmonary disease.



2. When documenting the assessment finding of a client with emphysema

who has an increase in the anteroposterior diameter of the chest, whichterm would the nurse use?

A. Barrel chest

B. Flail chest

C. Funnel chest

D. Pigeon chest



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My Reviewer Part2