MED-SURG REVIEW

1. MED-SURG REVIEW Makeba Felton, RN, MSN, FNPC Spring, 2007

2. NCLEX FORMAT • Safe, Effective Care Environment • Management of Care • Safety and Infection Control • Health Promotion and Maintenance • Growth and Development Through the Life Span • Prevention and Early Detection of Disease • Psychosocial Integrity • Coping and Adaptation • Psychosocial Adaptation • Physiological Integrity • Basic Care and Comfort • Pharmacological and Parenteral Therapies • Reduction of Risk Potential • Physiological Adaptation

3. 1. During the acute phase of a cerebrovascular accident (CVA), the nurse should maintain the patient in which of the following positions? • Semi-prone with the head of the bed elevated 60-90 degrees. • Lateral, with the head of the bed flat. • Prone, with the head of the bed flat. • Supine, with the head of the bed elevated 30-45 degrees. Kaplan, 2005

4. 2. A client comes to the ER with c/o n/v and abdominal pain. He has IDDM. Four days earlier, he reduced his insulin dose when flu sxs prevented him from eating. The nurse performs an assessment of the pt which reveals poor skin turgor, dry mucous membranes, and fruity breath odor. The nurse should be alert for which of the following problems? 1. Hypoglycemia 2. Viral Illness 3. Ketoacidosis 4. Hyperglycemic Hyperosmolar Nonketotic Coma Kaplan, 2005

5. A pt hospitalized with a gastric ulcer is scheduled for discharge. The nurse teaches the pt about an anti-ulcer diet. Which of the following statements, if made by the pt, would indicate that dietary teaching was successful? • “I must eat bland foods to help my stomach heal.” • “I can eat most foods, as long as they don’t bother my stomach.” • “I cannot eat fruits and vegetables because they cause too much gas.” • “I should eat a low-fiber diet to delay gastric emptying.” Kaplan, 2005

6. 4. The nurse cares for a patient receiving full strength Ensure by tube feeding. The nurse knows that the MOST common complication of a tube feeding is: • Edema • Diarrhea • Hypokalemia • Vomiting Kaplan, 2005

7. 5. A man is diagnosed with cancer of the larynx and comes to the hospital for a total laryngectomy. When admitting this patient, how should the nurse assess laryngeal nerve function? • Assess the extent of neck edema. • Check his ability to swallow. • Observe for excessive drooling • Tap the side of his neck gently and observe for facial twitching. Kaplan, 2005

8. 6. The nurse cares for a pt with a possible bowel obstruction. An NG tube is to be inserted. Before inserting the tube, the nurse explains the purpose to the pt. Which of the following explanations, if made by the nurse, is MOST accurate? • “It empties the stomach of fluids and gas.” • “It prevents spasms of the sphincter of Oddi.” • “It prevents air from forming in the small and large intestine.” • “It removes bile from the gall bladder.” Kaplan, 2005

9. 7. The nurse evaluates the care provided to a pt hospitalized for tx of adrenal crisis. Which of the following changes would indicate to the nurse that the pt is responding favorably to medical and ng tx? • The pt’s urinary output has increased. • The pt’s blood pressure has increased. • The pt has lost weight. • The pt’s peripheral edema has decreased. Kaplan, 2005

10. 8. The physician orders heparin for a pt. In order to evaluate the effectiveness of the pt’s heparin therapy, the nurse should monitor which of the following lab values? • Platelet count • Clotting time • Bleeding time • Prothrombin time Kaplan, 2005

11. 9. A pt returns to his room following a cardiac catheterization. Which of the following assessments, if made by the nurse, would justify calling the physician? • Pain at the site of the catheter insertion. • Absence of a pulse distal to the catheter insertion site. • Drainage on the dressing covering the catheter insertion site. • Redness at the catheter insertion site. Kaplan, 2005

12. The nurse is caring for a pt with a cast on the left leg. The nurse would be MOST concerned if which of the following were observed? 1. Capillary refill time was less than 3 seconds • Pt complained of discomfort and itching. • Pt complained of tightness and pain. • Pt’s foot is elevated on a pillow. Kaplan, 2005

13. 11. The home care nurse is visiting a client with a dx of hepatitis of unknown etiology. The nurse knows that teaching has been successful if the pt makes which one of the following statements? • “I am so sad that I am not able to hold my baby.” • “I will eat after my family eats.” • “I will make sure that my children don’t eat or drink after me.” • “I’m glad that I don’t have to get help taking care of my children.” Kaplan, 2005

14. 12. The nurse is caring for a pt four hours after intracranial surgery. Which of the following actions should the nurse take immediately? • Turn, cough and deep breathe the pt. • Place the pt with the neck flexed and head turned to the side. • Perform passive range of motion exercises. • Move client to the head of the be using a turning sheet. Kaplan, 2005

15. 13. The nurse is caring for a pt with an acute myocardial infarction. Which of the following laboratory findings would MOST concern the nurse? • Erythrocyte sedimentation rate (ESR): 10mm/h • Hematocrit (Hct): 42% • Creatine Kinase (CK): 150U/mL • Serum Glucose: 100mg/ dL Kaplan, 2005

16. 14. The nurse is supervising care of a pt receiving TPN through a single-lumen percutaneous central catheter. The nurse would be MOST concerned if which of the following was observed? • The pt receives insulin through the single-lumen • A mask is worn when changing the pt’s dressing. • The pt’s dressing is changed daily using sterile technique. • The pt is weighed two or three times per week. Kaplan, 2005

17. 15. The nurse assists the physician with the removal of a chest tube. Before the physician removes the chest tube, which instruction should the nurse give to the pt? • “Exhale and bear down.” • “Hold your breath for five seconds.” • “Inhale and exhale rapidly.” • “Cough as hard as you can.” Kaplan, 2005

18. A man is admitted to the Telemetry Unit for evaluation of c/o chest pain. Eight hours after admission, the pt goes into ventricular fibrillation. The physician defibrillates the pt. The nurse understands that the purpose of defibrillation is to: • Increase cardiac contractility and cardiac output. • Cause asystole so the normal pacemaker can recapture. • Reduce cardiac ischemia and acidosis. • Provide energy for depleted myocardial cells. Kaplan, 2005

19. 17. A pt newly diagnosed with Alzheimer’s disease is admitted to the unit. Which action, if taken by the nurse, is BEST? • Place the pt in a private room away from the nurses’ station. • Ask the family to wait in the waiting room while the nurse admits the pt. • Assign a different nurse daily to care for the pt. • Ask the pt to state today’s date. Kaplan, 2005

20. 18. The client is instructed regarding foods that are low in fat and cholesterol. Which diet selection is lowest in saturated fats? • Macaroni and cheese • Shrimp with rice • Turkey breast • Spaghetti http://www.examcram2.com/articles/article.asp?p=402459&rl=1

21. 19. The client with Alzheimer's disease is being assisted with activities of daily living when the nurse notes that the client uses her toothbrush to brush her hair. The nurse is aware that the client is exhibiting: • Agnosia • Apraxia • Anomia • Aphasia http://www.examcram2.com/articles/article.asp?p=402459&rl=1

22. The nurse knows that a positive diagnosis for HIV infection is made based on: • Positive ELISA and Western blot tests. • A history of high-risk sexual behaviors • Evidence of extreme wt loss and high fever. • Identification of an associated opportunistic infection. Mosby, 2004

23. 21. A client with a family hx of atherosclerosis is advised to follow a diet based on the US Dept of Ag. Food Guide Pyramid. The nurse should teach the client to eat: • 4-6 servings of fruit daily • 5-7 servings of vegetables daily • 3-5 servings of meat, poultry, or fish daily • 6-11 servings of bread, rice or pasta daily. Mosby, 2004

24. The (NEW) Food Pyramid

25. 22. The teaching plan for a client receiving digoxin for left ventricular failure should include having the client: • Sleep flat in bed • Rest during the day • Follow a low potassium diet • Take the pulse three times daily Mosby, 2004

26. 23. During a routine physical exam, an abdominal aortic aneurysm is diagnosed. The client is immediately admitted to the hospital, and surgery is scheduled for the next morning. When performing the admission assessment, the nurse should expect: • Severe radiating abdominal pain • Cyanosis and symptoms of shock • A pattern of visible peristaltic waves • A palpable pulsating abdominal mass Mosby, 2004

27. A client has recently been diagnosed with Type I diabetes. A glucose tolerance test is ordered. The order reads, “Administer glucose 1.0 g/kg.” The client weighs 240 pounds. The nurse should administer:( ___ pounds= 1 kg) Answer: ________________ Mosby, 2004

28. 25. A female client has a tentative diagnosis of Cushing’s syndrome. The nurse’s physical assessment of this client will probably include the findings of: • Fever and tachycardia • Lethargy and constipation • Hypertension and moon-face • Hyperactivity and exopthalmos Mosby, 2004

29. 26. The lab findings of a 40 yo man with burns are: BUN, 30mg/dL; serum potassium, 6.3mEq/L; pH, 7.1; PO2, 90mm Hg; and Hgb, 7.4 g/dL. The nurse is aware that these findings indicate: • Azotemia • Hypokalemia • Metabolic Alkalosis • Respiratory Alkalosis Mosby, 2004

30. Normal Lab Values • BUN = 5-20 • K+= 3.5-5.5 • Hgb= 12-15 • Na+= 135-145 • pH = 7.35-7.45 • PO2= 80-100

31. 27. When teaching a client how to avoid dumping syndrome following a gastrectomy, the nurse should emphasize: • Increasing activity after eating • Avoiding excess fluids with meals • Eating heavy meals to delay emptying • Providing carbohydrates with each meal Mosby, 2004

32. 28. The nurse is preparing to change a client’s dressing. The statement that best explains the basis of surgical asepsis that the nurse will perform in this procedure is: • Keep the area free of microorganisms • Protect self from microorganisms to the surgical site • Confine the microorganisms to the surgical site • Keep the number of opportunistic microorganisms to a minimum Mosby, 2004

33. 29. A 30 yo female dancer notices a mole on her ankle has turned dark brown and seeks medical attention. A diagnosis of malignant melanoma is made. This client has increased her chance of survival by early tx, b/c melanoma spreads quickly. The nurse recognizes that melanoma spreads: • By seeding across membranes of body tissues • By runner-like chains of cells to satellite tumors • Through invasion of the lymphatic system and bloodstream • Through direct extension into subcutaneous tissue to bone Mosby, 2004

34. Melanoma Normal Nevi

35. 30. A client with burns develops a wound infection. The nurse knows that local wound infections are primarily treated with: • Oral antibiotics • Topical antibiotics • IV antibiotics • IM antibiotics Mosby, 2004

36. A client is admitted to the hospital after sustaining a head injury. The most reliable sign that this is client is experiencing an increase in intracranial pressure would be a slowly: • Rising RR • Narrowing pulse pressure • Decrease in level of conscious • Increasing diastolic blood pressure Mosby, 2004

37. 32. A client has been admitted to the emergency department with multiple injuries including fractured ribs. Because of the client’s fractured ribs, the nurse should assess for signs of: • Pneumonitis • Hematemesis • Pulmonary Edema • Respiratory acidosis Mosby, 2004

38. 33. A client is placed on a ventilator. Because hyperventilation can occur when mechanical ventilation is used, the nurse should monitor the client for signs of: • Hypoxia • Hypercapnia • Metabolic Acidosis • Respiratory Alkalosis Mosby, 2004

39. 34. A 21yo client comes to the ED with chief complaint of left sided chest pain following racquetball game. A chest x-ray reveals a left pneumothorax. When assessing the left side of the client’s chest, the nurse would expect to find: • A dull sound on percussion • Vocal fremitus on palpation • Rales and rhonchi on auscultation • An absence of breath sounds on auscultation Mosby, 2004

40. 35. A client with end-stage renal dz is receiving continous ambulatory peritoneal dialysis. The nurse is preparing to teach the client to monitor for signs of complications associated with peritoneal dialysis. Check all the complications that should be included in this teaching plan. ____Pruritus ____Oliguria __x__Tachycardia __x__Cloudy Outflow __x_Abdominal Pain Mosby, 2004

41. 36. A client with a distal femoral fracture is placed in skeletal traction. The nurse is aware that the weights would only be removed if: • There is a life-threatening situation • The client complains of intense pain • There is evidence of external rotation • The cords have become twisted during turning Mosby, 2004