COMPREHENSIVE EXAMINATION 1 Medical Surgical Nursing May 14, 2009

07:00 Middle East Time 12:00 Philippine Time

Instructions: Read and understand the questions. Highlight your answer and email it back to me not later than 12 hours Question 1. Which nursing diagnosis is applicable to all types of shock? 1. Decreased cardiac output 2. Fluid volume deficit 3. Peripheral neurovascular dysfunction 4. Altered tissue perfusion Question 2. What is the most important nursing diagnosis for a client with a newly diagnosed myocardial infarction? 1. Ineffective breathing pattern 2. Activity intolerance 3. Altered tissue perfusion 4. Fluid volume excess Question 3. The nurse should tell the client who is elderly that an important advantage of outpatient surgery, especially given the clients age, would be: 1. Greater satisfaction with the surgical experience 2. Earlier return to full-time work responsibilities 3. Decreased exposure to hospital infections 4. Less psychological stress than hospitalization Question 4. The nurse can expect that a client admitted for a myocardial infarction will most likely develop which type of shock? 1. Neurogenic 2. Vasogenic 3. Hypovolemic 4. Cardiogenic Question 5. The nurse arrives at the site of an airplane crash and finds the following clients. Which client should be checked first? The client with: 1. Closed fracture of the humerus 2. Full thickness (3rd and 4th degree) burns over the torso 3. Partial-thickness (1st degree) on the face and neck 4. Laceration to the forehead, who is wandering among the wreckage asking for help

Question 6. What is the priority in caring for an older adult? 1. To provide a pain-free state 2. To allow dependence if needed 3. To maintain functional independence 4. To provide home rehabilitation Question 7. After surgical repair of an abdominal aortic aneurysm, what is the most important reason for the client to avoid sharp flexion of the hips? 1. The peripheral pulses will be diminished 2. Venous return will be impaired 3. Intra-abdominal pressure will be increased 4. Thrombus formation in the leg may occur Question 8. What is the primary nursing diagnosis for the client in shock? 1. Fluid volume deficit 2. Altered tissue perfusion 3. High risk for injury 4. Impaired gas exchange Question 9. Following a fall at home, what information would alert the nurse that the 78year-old client might be at risk for future falls? 1. A client lives alone in a single-story retirement apartment 2. The client gets up during the night to go to the bathroom 3. The client wears glasses following successful cataract surgery 4. The client occasionally takes a Tylenol PM to help sleep Question 10. The nurse would know that the modified shock position is generally not used with which type of shock? 1. Hypovolemic 2. Cardiogenic 3. Neurogenic 4. Anaphylactic Question 11. When caring for a client in shock, which position should the nurse implement? 1. Head lowered, legs elevated, keeping body straight 2. Legs elevated 45 degrees, trunk horizontal 3. Head and trunk elevated 30 degrees, foot of bed lowered 4. Bed flat, foot of bed raised on shock blocks

Question 12. What is the greatest risk factor for developing a transient ischemic attack (TIA)? 1. Sedentary life-style 2. Family history of pulmonary embolism 3. History of high blood pressure 4. Obesity Question 13. What is the desired outcome for complete bedrest for a client with heart failure? 1. Temperature will be within normal limits 2. Heart rate will be within normal limits 3. Blood pressure will be within normal range 4. Respiratory rate will increase Question 14. An elderly client has been placed in isolation because of tuberculosis. Which action by the nurse would be helpful in preventing disorientation related to sensory deprivation? 1. Keep the room lights on to provide visual stimulation. 2. Put a clock on the bedside table for orientation. 3. Tell the client about any procedures to be done. 4. Provide a Walkman and headset for listening to music. Question 15. If cancer of the larynx is suspected, for which early sign or symptoms should the nurse assess? 1. Hoarseness 2. Dyspnea 3. Dysphagia 4. Oral lesions Question 16. A woman in the second trimester of pregnancy has a history of rheumatic fever as a child. For which potential problem should the nurse assess? 1. Increased blood pressure and urinary frequency 2. Proteinuria and increased serum creatinine 3. Ankle edema and weight gain 4. A murmur and complaint of increasing cough and sputum Question 17. The nurse reviews the history of a client with breast cancer. Which factor should the nurse recognize as having placed the client at greater risk? 1. A family history of colon cancer 2. Taking birth control pills 3. Having breastfed her baby 4. A high fat diet

Question 18. Which finding would alert the nurse to a complication of the high osmolarity of TPN (hyperalimentation) solution? 1. Development of ascites or third spacing of fluid 2. Increased blood pressure and pulse; increased urine output 3. Decreased blood pressure and increased pulse; decreased urine output 4. Hyperglycemia and hyperlipidemia Question 19. Following an open repair of a compound fracture, the client suddenly complains of dyspnea, and is in obvious respiratory distress. The nurse should assess the client for which of the following? 1. Fat emboli 2. Spontaneous pneumothorax 3. Pneumonia 4. Atelectasis Question 20. An 84-year-old client is admitted, diaphoretic and shivering, with a fever of 102.8F of unknown origin. The nurse knows the client is at highest risk for which electrolyte imbalance? 1. Hyponatremia 2. Hypercalcemia 3. Hypokalemia 4. Hypermagnesemia Question 21. What is the most appropriate nursing action for a client experiencing nausea, vomiting and diarrhea associated with radiation therapy? 1. Record the intake and output accurately 2. Give an antiemetic before the treatment 3. Offer a carbonated beverage before the treatment 4. Offer soda crackers or dry toast before the treatment Question 22. What initial nursing diagnosis is most important for the client in heart failure? 1. Activity intolerance 2. Fatigue 3. Self-care deficit 4. Altered tissue perfusion Question 23. A correct explanation given by the RN to the nursing student of the difference between primary (essential) and secondary hypertension would include the fact that: 1. The cause of primary hypertension is unknown 2. The majority of clients have secondary hypertension

3. Systolic pressure is higher with secondary hypertension 4. Primary hypertension is due to pathological causes Question 24. In assessing a client with right-side involvement from a transient ischemic attack (TIA), which symptom in the right arm should the nurse anticipate that this client would most likely experience? 1. Muscle spasm 2. Weakness 3. Swelling 4. Tremors Question 25. The nurse is completing a preoperative history on the client. The client is allergic to latex. What other allergies might this client have? 1. Industrial solvents and perfume 2. Avocados and bananas 3. Eczema 4. Cats and dogs Question 26. Which nursing diagnosis is a priority on admission of a client with a CVA? 1. Impaired physical mobility 2. Self-care deficit 3. Altered nutrition 4. Altered tissue perfusion Question 27. Which response by the client would indicate a possible problem with altered self-concept following a mastectomy? 1. Refusing her tray at dinner 2. Requesting pain medication frequently 3. Asking for a robe when walking in the hall 4. Concern about what to wear home Question 28. A client is admitted because of dysrhythmia, and a pacemaker is being considered. The client is found unresponsive, and the heart rate is 40 beats per minute. Which nursing action would be appropriate? 1. Call a code, and start CPR immediately 2. Assess the client for the cause of unresponsiveness 3. Give atropine IV per order 4. Prepare the client for pacemaker insertion Question 29. The nurse should assess for indications of impaired wound healing in the older adult because of which normal aging process? 1. Decreased inflammatory response 2. Decreased skin turgor

3. Change in skin pH 4. Loss of subcutaneous fat Question 30. The client is to receive 200 mL of IV fluids hourly because of pancreatitis. What is the best explanation for the high IV fluid volume? 1. Dehydration has occurred from persistent vomiting 2. Hyperglycemia has caused an osmotic diuresis 3. Fluid has shifted into the retroperitoneal space 4. Pleural effusion of the left lung has reduced volume Question 31. The client tells the nurse she is upset about the alopecia which is going to occur from chemotherapy. What is the best response by the nurse? 1. Suggest a permanent, to give the hair body and prevent loss 2. Tell her to brush her hair vigorously to prevent loss 3. Suggest she start wearing a wig before the hair is gone 4. Use a medicated shampoo on the client, to prevent scalp irritation Question 32. A client has a positive Chvosteks. What electrolyte imbalance does this demonstrate? 1. Hypoglycemia 2. Hyponatremia 3. Hypocalcemia 4. Hypokalemia Question 33. Which response by the client indicates a lack of understanding about the warning signs of cancer? 1. I have had this mole for years, so a change is really nothing to worry about. 2. If this sore isnt gone in a few weeks, Ill call my doctor. 3. Ive been having bloody vaginal drainage which I need to have checked. 4. Ive made an appointment to have this lump in my breast checked. Question 34. Assessment findings of a client with mitral valve regurgitation would most likely include which manifestation? 1. Dependent edema 2. Hepatomegaly 3. Hacking cough 4. Nail bed cyanosis Question 35. Which assessment finding should the nurse determine to be consistent with dehydration? 1. Tachycardia 2. Jugular vein distention 3. Warm, moist skin 4. Low urine specific gravity

Question 36. The nurse expects edema formation with malnutrition, burns, and liver disease because in these conditions there is: 1. Increased aldosterone production 2. Decreased capillary osmotic pressure 3. Increased capillary osmotic pressure 4. Decreased systemic blood pressure Question 37. A clients vital signs are as follows: BP92/50; P112; R-20; CVP-3. How do these assessment findings influence nursing intervention? 1. Give digoxin, as vital signs indicate heart failure 2. Anticipate the need for fluids, as hypovolemia may be present 3. Place the client in modified Trendelenburg immediately 4. Continue to monitor vital signs, as no other action is needed Question 38. What urine assessment finding would be present in a client with diabetes insipidus? 1. Presence of white blood cells 2. Increased protein 3. Decreased urine pH 4. Decreased specific gravity Question 39. The nurse directs the nursing assistant to provide mouth care to a client with stomatitis who is receiving chemotherapy. What direction should the nurse give the nursing assistant? 1. Rinse the clients mouth with normal saline 2. Rinse the clients mouth with hydrogen peroxide 3. Vigorously brush and floss the clients teeth 4. Follow brushing with an alcohol-based mouthwash Question 40. The nurses assessment of a client with complete heart block will most likely reveal a history of: 1. Syncope 2. Ataxia 3. Insomnia 4. Tachycardia Question 41. The nurse knows that the primary goal of treatment in all types of shock is to increase: 1. Tissue perfusion 2. Sympathetic innervation 3. Circulating volume 4. Cardiac contractility

Question 42. Following a mastectomy, which client response would indicate appropriate adaptation to a body image disturbance? 1. Does her dressing change 2. Holds her children on her lap 3. Denies any pain 4. Plans to keep her follow-up appointment Question 43. A client receiving radiation therapy for treatment of multiple myeloma has developed moderate leukopenia. What is the priority for nursing care? 1. Observe for bleeding 2. Prevent infection 3. Promote acceptance of death 4. Conserve energy Question 44. Which physical assessment finding would be characteristic of breast cancer? 1. Palpable, movable lump 2. Dull ache in affected breast 3. Dark, cyanotic areola 4. Dimpling over lump Question 45. Which nursing action is most important for the client experiencing hyperthyroidism? 1. Increase oral fluid intake 2. Maintain physical activity 3. Maintain a cool environment 4. Orient the client to surroundings Question 46. Following a mastectomy for breast cancer, what is the best indication of the clients adjustment to her altered body image? 1. Wanting to look at the incision 2. Putting on make-up and lipstick 3. Talking to friends about the surgery 4. Walking with her husband in the hall Question 47. Following a femoral-popliteal bypass graft, which assessment finding in the client should the nurse report immediately? 1. Warm toes with some mottling 2. Hourly urine output of 70 mL 3. Absent pedal pulse 4. Blood pressure: 108/58

Question 48. During health teaching, the nurse should counsel a client who is post-MI that the position requiring the least amount of exertion when resuming sexual activity is: 1. Cardiac-client prone 2. Side-lying for both partners 3. Whatever position the client chooses 4. Sitting or standing with back supported Question 49. The nurse would conclude the client is experiencing left-sided heart failure when which of the following is observed? 1. Abdominal distention 2. Jugular venous distention 3. Swollen ankles bilaterally 4. Crackles on auscultation Question 50. Upon discharge, a client with heart failure should be instructed to notify the MD if which change occurs? 1. Weight increased by 3 lbs in one week 2. Pulse rate slows to 6070 beats/min 3. Body temperature drops to 97.8F 4. Urinary output exceeds 1000 mL daily