CDC Medical Surgical Nursing (Part B)

BURNS
Situation: Because of the serious consequences of severe burns, management requires a multidisciplinary
approach. You have important responsibilities as a nurse.

While Sergio was lighting a barbecue grill with a lighter fluid, his shirt burns into flames. The most
effective way to extinguish the flames with as little further damage as possible is to:
A. log roll on the grass/ground

Once the flames are extinguished, it is most important to:

D. assess the Sergios breathing

Sergio is brought to Emergency Room after the barbecue grill accident. Based on the assessment of
the physician, Sergio sustained superficial partial thickness burns on his trunk, right upper
extremities and right lower extremities. His wife asks what that mean? Your most accurate response
would be:
D. Epidermis and dermis are both damaged

During the first 24 hours after the thermal injury, you should asses Sergio for:
C. Hyperkalemia and hyponatremia

Teddy, who sustained deep partial thickness and full thickness burns of the face, whole anterior
chest and both upper extremities two days ago begins to exhibit extreme restlessness. You
recognize that this most likely indicates that Teddy is developing:
C. Hypervolemia

Situation: Because severe burn can affect the persons totality it is important that-you apply interventions
focusing on the various dimensions of man. You also have to understand the rationale of the treatment.

What type of debridement involves proteolytic enzymes?

D. Chemical

Which topical antimicrobial is most frequently used in burn wound care?

B. Silver nitrate

Hypertrophic burn scars are caused by:

A. exaggerated contraction

The major disadvantage of whirlpool cleansing of burn wound is:

A. patient hypothermia

Oral analgesics are most frequently used to control burn injury pain:
C. after hospital discharge

DISASTER, TRIAGE AND, PRIORITIZATION

Situation: You are now working as a staff nurse in a general hospital. You have to be prepared to handle
situations with ethico-legal and moral implifications.

You are in night duty in surgical ward. One of your patients Martin is a prisoner who sustained an
abdominal gunshot wound. He is being guarded by policeman from the local police unit. During
your rounds you heard a commotion. You saw the policeman trying to hit Martin. You asked why he
was trying to hit Martin. He denied the matter. Which among the following activities will you do
first?
B. Call security officer and report the incident

You are on morning duty in the medical ward. You have 10 patients assigned to you. During your
endorsement rounds, you found out that one of your patients was not in bed. The patient next to
him informed you that he went home without notifying the nurses. Which among the following will
you do first?
B. Call security to report the incident

You are on duty in the medical ward. You were asked to check the narcotics cabinet. You found out
that what is on record does not tally with the drugs used. Which among the following will you do
first?
C. Report the matter to your supervisor

You are on duty in the medical ward. The mother of your patient, who is also a nurse, came running
to the nurse station and informed you that Fiolo went into cardiopulmonary arrest. As a nurse, what
is your priority action?
D. Go to see Fiolo and assess for airway patency and breathing problems

You are admitting Jorge to the ward and you found out that he is positive for HIV. Which among the
following will you do first?
D. Report the matter to your head nurse

Situation: In a disaster there must be a chain of command in place that defined the roles of each member
of the response team. Within the health care group there are pre-assigned roles based on education,
experience and training on disaster.

As a nurse to which of the following groups are you best prepared to join?
B. Triage group

There are important principles that should guide the triage team in disaster management that you
have to know if you were to volunteer as part of the triage team. The following principles should be
observed in disaster triage, EXCEPT:
C. training on the disaster is not important to the response in the event of a real
disaster because each disaster is unique in itself

Which of the following categories of conditions should be considered first priority in a disaster?
D. Trauma

A guideline that is utilized in determining priorities is to asses the status of the following, EXCEPT:
B. Locomotion

The most important component of neurologic assessment is:

D. level of consciousness/responsiveness

Situation: A disaster is a large-scale emergencyeven a small emergency left unmanaged may turn into
a disaster. Disaster preparedness is crucial and is everybodys business. There are agencies that are in
charge of ensuring prompt response. Comprehensive Emergency Management (CEM) is an integrated
approach to the management of emergency programs and activities for all four emergency phases
(mitigation, preparedness, response, and recovery), for all types of emergencies and disasters (natural,
man-made, and attack) and for all levels of government and the private sector.

Which of the four phases of emergency management is defined as sustained action that reduces
or eliminates long-term risk to people and property from natural hazards and their effects.?
D. Preparedness

You are a community health nurse collaborating with the Red Cross and working with disaster relief
following a typhoon which flooded and devastated the whole province. Finding safe housing for
survivors, organizing support for the family, organizing counseling debriefing sessions and securing
physical care are the services you are involved with. To which type of prevention are these activities
included:
C. Aggregate care prevention

During the disaster you see a victim with a green tag, you know that the person:
D. has injuries that are minor and treatment can be delayed from hours to days

The term given to a category of triage that refers to life threatening or potentially life threatening
injury or illness requiring immediate treatment:
D. Urgent

Which of the following terms refer to a process by which the individual receives education about
recognition of stress reaction and management strategies for handling stress which may be
instituted after a disaster?
A. Clinical incident stress management

Situation: NURSES are involved in maintaining a safe and healthy environment. This is part of quality care
management.

The first step in decontamination is:

C. to immediately apply personal protective equipment

For a patient experiencing pruritus, you recommend which type of bath.

C. colloidal (oatmeal)

Induction of vomiting is indicated for the accidental poisoning patient who has ingested.
D. aspirin

Which of the following term most precisely refer to an infection acquired in the hospital that was not
present or incubating at the same time of hospital admission?
B. Nosocomial infection

Which of the following guidelines is not appropriate to helping family members cope with sudden
death?
A. Obtain orders for sedation of family members

NURSING MANAGEMENT
Situation: As a member of the health and nursing team you have a crucial role to play in ensuring that all
the members participate actively is the various tasks agreed upon.

While eating his meal, Matthew accidentally dislodges his IV lines and bleeds. Blood oozes on the
surface of the over-bed table. It is most appropriate that you instruct the housekeeper to clean the
table with:
D. Bleach

You are a member of the infection control team of the hospital. Based on a feedback during the
meeting of the committee there is an increased incidence of pseudomonas infection in the Burn
Unit (3 out of 10 patients had positive
blood and wound culture). What is your priority activity?
A. Establish policies for surveillance and monitoring

Part of your responsibility as a member of the diabetes core group is to get referrals from the
various wards regarding diabetic patients needing diabetes education. Prior to discharge today, 4
patients are referred to you. How would you start prioritizing your activities?
C. Determine their learning needs then prioritize

You have been designated as a member of the task force to plan activities for the Cancer
Consciousness Week. Your committee has 4 months to plan and implement the plan. You are
assigned to contact the various cancer support groups in your hospital. What will be your priority
activity?
B. Clarify objectives of the activity with the task force before contacting the
support groups

You are invited to participate in the medical mission activity of your alumni association. In the
planning stage everybody is expected to identify what they can do during the medical mission and
what resources are needed. You thought it is also your chance to share what you can do for others.
What will be your most important role where you can demonstrate the impact of nursing in health?
A. Conduct health education on healthy life style

Situation: As a Nurse, you have specific responsibilities as professional. You have to demonstrate specific
competencies.

The essential components of professional nursing practice are all the following EXCEPT:
A. Culture

You are assigned to care for four (4) patients. Which of the following patients should you give first
priority?
B. Emy, who was previously lucid but is now unarousable.

Brenda, the Nursing Supervisor of the intensive care unit (ICU) is not on duty when a staff nurse
committed a serious medication error. Which statement accurately reflects the accountability of the
nursing supervisor?
A. Brenda should be informed when she goes back on duty

Which barrier should you avoid, to manage time wisely?

B. Procrastination

You are caring for Vincent who has just been transferred to the private room. He is anxious because
he fears he wont be monitored as closely as he was in the Coronary Care Unit. How can you allay
his fear?
B. Assign the same nurse to him when possible

COLORECTAL CANCER
Situation: Colorectal cancer can affect old and younger people. Surgical procedures and other modes of
treatment are done to ensure quality of life. You are assigned in the cancer institute to care of patients with
this type of cancer.

Larry, 55 years old, who is suspected of having colorectal cancer, is admitted to the CI. After taking
the history and vital signs the physician does which test as a screening test for colorectal cancer.
C. Annual digital rectal examination

To confirm his impression of colorectal cancer, Larry will require which diagnostic study?
A. Carcinoembryonic antigen

The following are risk factors for colorectal cancer, EXCEPT:

B. High fat, high fiber diet

Symptoms associated with cancer of the colon include:

C. blood in the stools, anemia, and pencil shaped stools

Several days prior to bowel surgery, Larry may be given sulfasuxidine and neomycin primarily to:
B. reduce the bacterial content of the colon

COLOSTOMY CARE
Situation: ENTEROSTOMAL THERAPY is now considered a specialty in nursing. You are participating in the
OSTOMY CARE CLASS.

You plan to teach Fermin how to irrigate the colostomy when:

C. The abdominal incision is closed and contamination is no longer a danger

When preparing to teach Fermin how to irrigate colostomy, you should plan to do the procedure:
C. Prior to breakfast and morning care

When observing a return demonstration of colostomy irrigation, you know that more teaching is
required if Fermin:
C. Discontinues the insertion of fluid after only 500 ml of fluid has been instilled

You are aware that teaching about colostomy care is understood when Fermin states, I will contact
my physician and report:
B. If I noticed a loss of sensation of touch in the stoma tissue

You would know after teaching Fermin that dietary instruction for him is effective when he states, It
is important that I eat:
B. Bland food so that my intestines do not become irritated.

PREVENTING COMPLICATIONS
Situation: Ensuring safety is one of your most important responsibilities. You will need to provide
instructions and information to your clients to prevent complications.

Randy has chest tubes attached to a pleural drainage system. When caring for him you should:
C. palpate the surrounding areas for crepitus

Fanny, came in from PACU after pelvic surgery. As Fannys nurse you know that the sign that would
be indicative of a developing thrombophlebitis would be:
A. a tender, painful area on the leg

To prevent recurrent attacks on Terry who has acute glumerulonephritis, you should instruct her to:
C. Continue to take the same restriction on fluid intake

Herbert had a laryngectomy and he is now for discharge. He verbalized his concern regarding his
laryngectomy tube being dislodged. What should you teach him first?
D. Notify the physician at once

When caring for Larry after an exploratory chest surgery and pneumonectomy, your priority would
be to maintain:
A. supplementary oxygen

INFECTION

Situation: Infection can cause debilitating consequences when host resistance is compromised and
virulence of microorganisms and environmental factors are favorable. Infection control is one important
responsibility of the nurse to ensure quality of care.

Honrad, who has been complaining of anorexia and feeling tired, develops jaundice, after a workup
he is diagnosed of having Hepatitis A. his wife asks you about gamma globulin for herself and her
household help. Your most appropriate response would be:
D. A vaccine has been developed for this type of hepatitis

Voltaire develops a nosocomial respiratory tract infection. He ask you what that means? Your best
response would be:
A. You acquired the infection after you have been admitted to the hospital.

As a nurse you know that one of the complications that you have to watch out for when caring for
Omar who is receiving total parenteral nutrition is:
D. infection

A solution used to treat Pseudomonas wound infection is:

A. Dakins solution

Which of the following is the most reliable in diagnosing a wound infection?

D. Gram stain testing

STROKE AND INCREASED ICP

Situation: As a nurse you need to anticipate the occurrence of complications of stroke so that life
threatening situations can be prevented.

Wendy is admitted to the hospital with signs and symptoms of stroke. Her Glasgow Coma Scale is 6
on admission. A central venous catheter was inserted an I.V. infusion was started. As a nurse
assigned to Wendy what will be your priority goal?
D. Maintain a patent airway

Knowing that for a comatose patient hearing is the last sense to be lost, as Judys nurse, what
should you do?
D. Speak softly then hold her hands gently

Which among the following interventions should you consider as the highest priority when caring
for June who has hemiparesis secondary to stroke?
B. Perform range of motion exercises

Ivy, age 40, was admitted to the hospital with a severe headache, stiff neck and photophobia. She
was diagnosed with a subarachnoid hemorrhage secondary to ruptured aneurysm. While waiting for
surgery, you can provide a therapeutic environment by doing which of the following?
C. dimming the light in her room

When performing a neurologic assessment on Walter, you find that his pupils are fixed and dilated.
This indicated that he:
D. has received a significant brain injury

Situation: Brain tumor, whether malignant or benign, has serious management implications. As a nurse,
you should be able to understand the consequences of the disease and the treatment.

You are caring for Conrad who has a brained tumor and increased Intracranial Pressure (ICP). Which
intervention should you include in your plan to reduce ICP?
A. Administer bowel softener

Keeping Conrads head and neck alignment results in:

B. increased venous outflow

Which of the following activities may increase intracranial pressure (ICP)?

D. Valsalvas maneuver

After you asses Conrad, you suspected increased ICP. Your most appropriate respiratory goal is to:
D. promote CO2 elimination

Conrad underwent craniotomy. As his nurse, you know that drainage on a craniotomy dressing must
be measured and marked. Which findings should you report immediately to the surgeon?

A. Foul-smelling drainage

CARE OF THE ELDERLY

Situation: With the improvement in life expectancies and the emphasis in the quality of life it is important
to provide quality care to our older patients. There are frequently encountered situations and issues
relevant to the older patients.

Hypoxia may occur in the older patients because of which of the following physiologic changes
associated with aging.
B. Decreased alveolar surfaced area

The older patient is at higher risk for incontinence because of:

D. decreased bladder capacity

Merle, age 86, is complaining of dizziness when she stands up. This may indicate:
B. a visual problem

DEATH AND DYING

Situation: One of the realities that we are confronted with is our mortality. It is important for us nurses to
be aware of how we view suffering, pain, illness, and even our death as well as its meaning. That way we
can help our patients cope with death and dying.

Irma is terminally ill, she speaks to you in confidence. You now feel that Irmas family could be
helpful if they knew what Irma has told to you. What should you do first?
C. Tell Irma that she has to tell her family what she told you

Ruby who has been told that she has terminal cancer, turns away and refuses to respond to you.
You can best help her by:
A. Coming back periodically and indicating your availability if she would like you
to sit with her

Leo, who is terminally ill and recognizes that he is in the process of losing everything and
everybody he loves, is depressed. Which of the following would best help him during his
depression?
D. Sit silently with him

Which of the following statements would best indicate that Ruffy, who is dying, has accepted his
impending death?
A. Im ready to go.

Marla, 90 years old has planned ahead for her death-philosophically, socially, financially and
emotionally. This is recognized as:
D. Awareness that death will soon occur

Cardiac ischemia in an older patient usually produces:

C. Chest pain radiating to the left arm

The most dependable sign of infection in the older patient is:

C. pain

RADIATION THERAPY
Situation: As a nurse in the Oncology Unit, you have to be prepared to provide safe, efficient and effective
care to your patients.

Which one of the following nursing interventions would be most helpful in preparing the patient for
radiation therapy?
C. Emphasis on the therapeutic value of the treatment

What side effects are most likely to occur to the patient during radiation therapy to the pelvis?
A. Urinary retention

Which of the following can be used on the irradiated skin during a course of radiation therapy?
D. Zinc oxide ointment

Earliest sign of skin reaction to radiation therapy is:

B. erythema

What is the purpose of wearing a film badge while caring for the patient who is radioactive?
D. Measure the amount of exposure to radiation

CERVICAL CANCER
Situation: You are going to participate in a Cancer Consciousness Week. You are assigned to take charge of
the women to make them aware of cervical cancer. You reviewed its manifestations and management,

The following are risk factors for cervical cancer EXCEPT:

A. immunosuppressive therapy

Late signs and symptoms of cervical cancer include the following EXCEPT:
D. Lymph Edema of lower extremities

When a panhysterectomy is performed due to cancer of the cervix, which of the following organs
are removed?
D. the uterus and cervix

The primary modalities of treatment for Stage 1 and IIA cervical cancer include the following:
D. surgery and radiation therapy

HYSTERECTOMY

A common complication of hysterectomy is

A. thrombophelbitis of the pelvic and thigh vessels

THYROIDECTOMY
Situation: The body has regulatory mechanism to maintain the needed electrolytes. However there are
conditions/surgical interventions that could compromise life. You have to understand how management of
these conditions are done.

You are caring for Leda who is scheduled to undergo total thyroidectomy because of a diagnosis of
thyroid cancer. Prior to total thyroidectomy, you should instruct Leda to:
C. Cough and deep breath every 2 hours

As Ledas nurse, you plan to set up an emergency equipment at her beside following thyroidectomy.
You should include:
B. A tracheostomy set and oxygen

Which of the following nursing interventions is appropriate after a total thyroidectomy?

C. Keep you patient in a high-fowlers position.

If there is an accidental injury to the parathyroid gland during a thyroidectomy which of the
following might Leda develop postoperatively?
D. Tetany

After surgery Leda develops peripheral numbness, tingling and muscle twitching and spasm. What
would you anticipate to administer?
B. Calcium gluconate

NURSING RESEARCH
Situation: As a nurse you are expected to participate in initiating or participating in the conduct of research
studies to improve nursing practice. You have to be updated on the latest trends and issues affecting
profession and the best practices arrived at by the profession.

You are interested to study the effects of meditation and relaxation on the pain experienced by
cancer patients. What type of variable is pain?
A. Dependent

You would like to compare the support system of patients with chronic illness to those with acute
illness. How will you best state your problem?
C. A Comparative Analysis Of The Support System Of Patients With Chronic Illness
And Those With Acute Illness.

You would like to compare the support system of patients with chronic illness to those with acute
illness. What type of research it this?

A. Correlational

You are shown a Likert Scale that will be used in evaluating your performance in the clinical area.
Which of the following questions will you not use in critiquing the Likert Scale?
A. Are the techniques to complete and score the scale provided?

In any research study where individual persons are involved, it is important that an informed
consent for the study is obtained. The following are essential information about the consent that
you should disclose to the prospective subjects EXCEPT:
A. Consent to incomplete disclosure