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 Medical – Surgical Nursing
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INSTRUCTION: Select the correct answer for each of the following questions. Mark onlyone answer for each item by
shading 
the box corresponding to the letter of yourchoice on the answer sheet provided. STRICTLY NO ERASURES ALLOWED. Use pencil no. 2ONLY.SITUATION (1-5): Mrs. Geronimo is 25 years old, pale looking cafeteria owner whooften retires very late at night. She went to the clinic complaining of dizziness,fatigue, exertional dyspnea and body malaise..Mrs. Geronimo’s doctor suspects that she might be suffering anemia. The bloodexamination that would help diagnose her condition is:
a.
Hematocrit countc. WBC count
 b.
RBC countd.
Hemoglobin
.The blood examination revealed that she is suffering from anemia. All of theseare hematonic drugs, except:
a.
Jectofer
c. Clusivol
b.Imferond. Iberet 500
.
Your health teaching to improve Mrs. Geronimo’s condition includes foods thatare rich in iron. Which of the following is the best source of iron?
a.
Ampalaya
c. Eggyolk
b.Kangkongd. Lean meat.The intrinsic factor necessary for the manufacture of red blood cells is foundin the:
a.
Bone marrowc. Liver
 b.
Blood
d. Stomach
.The cause of pernicious anemia is:
a.
poor diet
c. absence of the intrinsic factor
 b.
overproduction of RBCd. absence of extrinsic factor6. A client who develops neutropenia following chemotherapy should be assessed by thenurse for which of these complications?A. BleedingC. Alopecia
B. Infection
D. Anorexia7. Nursing care for a patient who has multiple myeloma should focus on preventingwhich of the following complications?A. Pulmonary edemaC. Peripheral neuropathyB. Venous thrombophlebitisD.
Bone fractures
8. To which of the following nursing diagnoses would a nurse give priority in thecare of a patient whose blood test reveals a red blood cell count of 3.0 million/mm3?
 A. Risk for activity intoleranceC.
Risk for impaired skin integrityB. Risk for fluid volume deficitD. Risk for infection9. A woman is seen in the physician’s office because of nutritional anemia. During anursing history, the client makes all of the following comments. Which comment wouldbe indicative of nutritional anemia?A. “I get a headache about twice a week.”C. “I get pain in my lower back.”B. “I have trouble sleeping at night.”
D. “I always feel tired and weak.”
10. A child in sickle cell crisis has reduced ability to concentrate his urine. Whichof these instructions should the nurse give to his mother?
 
A. “Have your son apply gentle pressure over his bladder each time heurinates.”
B. “Have your son drink at least eight ounces of fruit juice a day.”
C. “Be sure that your son’s teacher knows that he will probably have to urinatemore frequently than his classmates.”D. “Give your son only sips of fluid after the evening meal.”11. One year following gastric resection, a client is diagnosed with perniciousanemia. The most appropriate treatment for this problem is:A. diet modification with iron-rich foods
B. monthly vitamin B12 injections
C. daily multivitamin supplementsD. oral replacement of intrinsic factor12. The nurse is preparing to teach a client with microcytic hypochromic anemia aboutthe diet to follow after discharge. Which of the following food should be included inthe diet?
a. eggs
c. citrus fruitsb. lettuced. cheese13. A client recently diagnosed with lung cancer says to the nurse, “I’m still goingto smoke”. The nurse’s best response to this client would beA. “I can’t believe you would still want to smoke.”B. “When did you start smoking?”
C. “Let’s talk more about this.”
D. “I’m sure your family will be upset.”14. The nurse is assigned to a client with a diagnosis of terminal cancer and anorder for comfort measures only. Which of the following nursing interventions wouldhave the highest priority for this client?A. Performing a body systems assessmentC. Assessing pain statusB. Measuring oxygen saturation level
D. Repositioning for comfort
15. A 48-year-old woman, who does not have a family history of breast cancer, asks anurse in the ambulatory care center whether she should have a mammogram. Which of thefollowing responses by the nurse would be accurate?
 A. “At your age, a mammogram is recommended every one to two years.”
B. “You do not need to begin to get mammograms until you are 50 years old.”C. “A mammogram is not indicated unless you have a family history of breastcancer.”D. “A mammogram would be necessary only if you feel a change in breast tissue.”16. Which of the following statements, if made by a 44-year-old female, would supporta nursing diagnosis of knowledge deficit: early detection of breast cancer?A. “I should not examine my breasts or have a mammogram during my menstrualperiod.”B. “I include the underarm area when I examine my breasts.”C. “Women who practice regular breast self-examination find breast lumpsearlier than women who do not.”
D. “Breast self-examination is not necessary if I get regular mammograms.”
17. To which of the following nursing diagnoses should a nurse give priority in thecare of a patient who is receiving chemotherapy for treatment of breast cancer?
 A. Risk for infectionC.
Altered sexuality patternsB. Stress incontinenceD. Impaired physical mobility18. Which of these findings should a nurse expect to identify when assessing apatient who is receiving radiation therapy for cancer of the esophagus?A. Peripheral neuropathyC. AlopeciaB. Gingival hyperplasiaD
. Hypersalivation
19. Which of the following statements, if made by a patient who has had a basal cellcarcinoma removed, would indicate to the nurse the need for further instruction?A. “I will use sunscreen with at least a sun protection factor (SPF) of 15.”
B. “I will use tanning booths rather than sunbathing from now on.”
C. “I will stay out of the sun between 10:00 a.m. and 2:00 p.m.”D. “I will wear a broad-brimmed hat when I am in the sun.”20. Following a prostatectomy, the pathology report reveals that the client hascancer of the prostate. Which of these blood test results would support thisdiagnosis?
2
 
A. Decreased uric acidC. Elevated serum calciumB. Decreased serum CreatinineD.
Elevated prostate specific antigen
SITUATION (21-25): Krisca, a 56 years old executive consults her gynecologist due tovaginal bleeding. Diagnostic D&C reveals uterine cancer, stage II. She is scheduledfor Total Abdominal Hysterectomy with Bilateral Salphingoophorectomy (TAHBSO).21. Krisca expresses her fear about the surgery. Which of the following statements isthe best response of the nurse?a. “Let us focus on your pos-operative care.”b. “Your gynecologist is very competent. You are surely in safe hands.”
c. “Tell me about your fears. I am here to listen.”
d. “Do not be afraid because it may affect your recovery.”22. Which of the following is a priority nursing diagnosis immediately after surgery?a. Disturbance in body image related to loss of uterusb. Fluid volume deficit related to surgeryc. Abdominal pain related to surgical incision
d. Altered breathing pattern related to anesthesia
23. Three days post surgery, the nurse observed that Krisca understands her diseasecondition when she remarks that stage II uterine cancer:
a. involves corpus and cervix
b. involves bladder, rectum, and outside pelvisc. extends outside corpus but not outside the pelvisd. is confined in corpus only24. One week post surgery, Krisca develops bleeding and is re-admitted to thehospital. Which of the following should be done immediately upon admission at the ER?a. inspect sanitary padsc. take history of bleeding
 b. monitor VS
d. notify the gynecologist25. The nurse knows that Krisca can take care of herself at home when she enumeratesthe activities she can perform. Which 3 activities should she avoid?1. lift heavy weights2. climb stairs3. engage in coitus for about 3 weeks4. prolonged sitting and long car ridesa. 1, 3, 4c. 1, 2, 4
 b. 1, 2, 3
d. 2, 3, 426. The emergency department nurse has triaged 4 clients. Which client should begiven priority treatment?A. The 18-year-old with an impaled knife in the abdomen.B. The 40-year-old with sinus tachycardia and complaining of nausea, vomitingand diarrhea times 3 days.C. The 39-year-old with an obvious fracture of the right femur who iscomplaining of severe pain.
D. The 22-year-old stung by a wasp and exhibiting stridor.
27. The nurse is triaging clients in the emergency department. Which of the followingclients should be evaluated first?A. A 65 year old with abdominal painB. A 15 year old with a lacerated legC. A 2 year old with a 2-day history of diarrhea
D. A 30 year old with shortness of breath
28. The nurse is assigned to the following four clients. Which client should thenurse assess first?
 A. A 50 year old receiving chemotherapy with a temperature of 101°F
B. A 46 year old 2 days postoperative an open cholecystectomyC. A 52 year old newly diagnosed diabetic complaining of blurred visionD. A 40 year old ready for discharge to a rehabilitation center29. A client brought to the emergency department appears very anxious and tearful.The nurse’s best response would beA. “I’m sure you have been in the hospital before.”B. “There is really nothing to worry about.”
C. “I know this is frightening for you.”
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