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MEDSURG Final Exam questions and Answers _ 2020 (A GRADE) Chamberlain College of Nursing

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MEDSURG Final Exam questions and Answers _ 2020 (A GRADE) Chamberlain College of Nursing Med/ Surg I Final 1. When doing a pain assessment for a patient who has been admitted with me... tastatic breast cancer, which question asked by the nurse will give the most information about the patient’s pain? 2. A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective? . 3. A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? 4. A patient with second-degree burns has been receiving morphine through patient- controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. The most appropriate action by the nurse is to 5. The nurse is caring for a diabetic patient who has chronic burning leg pain even when taking oxycodone (OxyContin) twice daily. Which of these prescribed medications is the best choice for the nurse to administer as an adjuvant to decrease the patient’s pain? 6. The nurse assesses a postoperative patient who is receiving morphine through patient- controlled analgesia (PCA). Which information is most important to report to the health care provider? 7. When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication? 8. When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take? 9. Which of these prescribed therapies should the nurse use first when caring for a patient with cancer pain that the patient describes as at “level 8 (0 to 10 scale), deep, and aching.” patient who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take? patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first? . 12. A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer? 13. During recovery from anesthesia in the postanesthesia care unit (PACU), a patient’s vital signs are blood pressure 118/72, pulse 76, respirations 12, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take at this time? 14. After a new nurse has been oriented to the postanesthesia care unit (PACU), the charge nurse will evaluate that the orientation has been successful when the new nurse 15. A patient who has begun to awaken after 30 minutes in the postanesthesia care unit (PACU) is restless and shouting at the nurse. The patient’s oxygen saturation is 99%, and recent lab results are all normal. Which action by the nurse is most appropriate? 16. A patient who is just waking up after having a general anesthetic is agitated and confused. Which action should the nurse take first? 17. When caring for a patient during the second postoperative day after abdominal surgery, the nurse obtains an oral temperature of 100.8° F. Which action should the nurse take first? 18. While caring for a patient who had abdominal surgery on the second postoperative day, which information about the patient is most important to communicate to the health care provider? 19. After removal of the nasogastric (NG) tube on the second postoperative day, the patient is placed on a clear liquid diet. Four hours later, the patient complains of sharp, cramping gas pains. Which action should the nurse take? 20. A postoperative patient has not voided for 7 hours after return to the postsurgical unit. Which action should the nurse take first? 21. Which instruction will be included when teaching a patient with possible allergies about intradermal skin testing? 22. A patient seen at the clinic with atopic dermatitis has a history of multiple allergies and several previous anaphylactic reactions. Which type of testing for allergens will the nurse anticipate for this patient? 23. For early detection of an anaphylactic reaction in a patient who has received allergen testing using the cutaneous scratch method, which action should the nurse take first? 24. After being stung by a wasp, a patient is brought to the clinic by a co-worker. Upon arrival the patient is anxious and having difficulty breathing. The first action that the nurse should take is to 25. A patient who received a bone marrow transplant for treatment of leukemia develops a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication that the 26. Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider? 27. A patient is admitted to the hospital with acute rejection of a kidney transplant. The nurse will anticipate 28. A patient is receiving intravesical bladder chemotherapy. The nurse will monitor for 29. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to 30. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to 31. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient’s self-esteem, the nurse plans to 32. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? 33. When the nurse is assessing a new patient in the clinic, which information about the patient’s medications will be of most concern? 34. Which finding will the nurse expect when assessing a 60-year-old patient who has osteoarthritis (OA) of the left knee? 35. Which assessment finding about a patient who has been using naproxen (Naprosyn) for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider? 36. 36. 36. Which of these patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)? 37. A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient’s elbows. Which action will the nurse take? 38. When caring for a patient with a new diagnosis of rheumatoid arthritis, which action will the nurse include in the plan of care? 39. Which information will the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis? 40. When teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living, the nurse instructs the patient to 41. When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with 42. During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to 43. A patient with a history of hypertension treated with a diuretic and an angiotensin- converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? 44. Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? 45. history of 46. After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? 47. Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? 48. The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is 49. Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? 50. A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to 51. A patient who has chronic heart failure tells the nurse, “I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!” The nurse will document this assessment information as 52. During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of “feeling too tired to do anything.” Based on these data, the best nursing diagnosis for the patient is 53. The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include 54. A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? 55. The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? 56. When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for 57. During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding the 58. When caring for the patient with infective endocarditis of the tricuspid valve, the nurse will plan to monitor the patient for 59. The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for the patient who 60. A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? 61. On auscultation of a patient’s lungs, the nurse hears short, high-pitched sounds during exhalation in the lower 1/3 of both lungs. The nurse records this finding as 62. When auscultating a patient’s chest while the patient takes a deep breath, the nurse hears loud, high-pitched, “blowing” sounds at both lung bases. The nurse will document these as 63. The nurse is observing a student who is listening to a patient’s lungs. Which action by the student indicates a need to review respiratory assessment skills? 64. The nurse obtains this information when assessing a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the last 3 days. Which finding is most important to report to the health care provider? 65. A patient seen in the asthma clinic has recorded daily peak flows that are 85% of the baseline. Which action will the nurse plan to take? 66. Which action by a patient who has asthma indicates a good understanding of the nurse’s teaching about peak flow meter use? 67. When teaching the patient with chronic obstructive pulmonary disease (COPD) about exercise, which information should the nurse include? 68. A patient with chronic bronchitis who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that 69. Which information will the nurse include when teaching the patient with asthma about the prescribed medications? 70. The nurse obtains all of the following information about a 65-year-old patient in the clinic. When developing a plan to decrease stroke risk, which risk factor is most important for the nurse to address? 71. A patient with a stroke experiences right-sided arm and leg paralysis and facial drooping on the right side. When admitting the patient, which clinical manifestation will the nurse expect to find? 72. The nurse identifies the nursing diagnosis of imbalanced nutrition: less than body requirements related to impaired self-feeding ability for a patient with right-sided hemiplegia. Which intervention should be included in the plan of care? 73. A patient with right-sided weakness that started 90 minutes earlier is admitted to the emergency department and all these diagnostic tests are ordered. Which test should be done first? 74. A patient has a tonic-clonic seizure while the nurse is in the patient’s room. Which action should the nurse take? 75. Which of these prescribed interventions will the nurse implement first for a hospitalized patient who is experiencing continuous tonic-clonic seizures? 76. A patient who is hospitalized with pneumonia is disoriented and confused 2 days after admission. Which information obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia? 77. To determine whether a new patient’s confusion is caused by dementia or delirium, which action should the nurse take? 78. A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which equipment will the nurse need to obtain? 79. A patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim) for 3 days. Which action will the nurse plan to take? 80. The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) for a patient with cystitis has been effective when the patient states, 81. Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine (Pyridium)? 82. A 72-year-old who has benign prostatic hyperplasia is admitted to the hospital with chills, fever, and vomiting. Which finding by the nurse will be most helpful in determining whether the patient has an upper urinary tract infection (UTI)? 83. When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about 84. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what “type 2” means in relation to diabetes. Which statement by the nurse about type 2 diabetes is correct? 85. When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question is most appropriate for the nurse to ask? 86. A patient with type 2 diabetes that is well-controlled with metformin (Glucophage) develops an allergic rash to an antibiotic and the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may 87. The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which finding indicates a need to contact the health care provider before giving the metformin? 88. A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which information obtained by the nurse is most important to report to the health care provider before the procedure? 89. A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? 90. A diabetic patient is admitted with ketoacidosis and the health care provider writes these orders. Which order should the nurse implement first? 91. When the nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take first? A hospitalized diabetic patient who received 34 U of NPH insulin at 7:00 AM is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. To prevent hypoglycemia, the best action by the nurse is to 93. Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? 94. Which information collected by the nurse when caring for a patient who has just arrived in the recovery area after an upper endoscopy is most important to communicate to the health care provider? 95. The health care provider sees a patient at 10 AM and writes an order for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of these actions that are included in the agency policy for ERCP should the nurse take first? 96. A patient with a peptic ulcer who has a nasogastric (NG) tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next? 97. A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse perform first? 98. The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed? 99. When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient’s family that the patient has a history of gastroesophageal reflux disease (GERD). The nurse will plan to do frequent assessments 100. A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about 101. Which information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)? 102. A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking? 103. A 22-year-old patient with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. All of the following orders are received. Which order will the nurse question? 104. When interviewing a patient with abdominal pain and possible irritable bowel syndrome, which question will be most important for the nurse to ask? 105. A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to 106. Which nursing action will the nurse include in the plan of care when admitting a patient with an exacerbation of inflammatory bowel disease (IBD)? 107. Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern? 108. A patient with cirrhosis who has been vomiting blood is admitted to the emergency department. Which action should the nurse take first? 109. Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider? 110. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of 111. When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patient’s hand. Which action should the nurse take next? 112. A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? 113. When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern? [Show More]

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