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Medical-Surgical A

1.

2.

1.
The nurse is providing dietary instructions to a 68-year-old client who is at high
risk for development of coronary heart disease (CHD). Which information should
the nurse include?
A.

Limit dietary selection of cholesterol to 300 mg per day.

B.

Increase intake of soluble fiber to 10 to 25 grams per day.

C.

Decrease plant stanols and sterols to less than 2 grams/day.

D.
Ensure saturated fat is less than 30% of total caloric intake.
2.
Which reaction should the nurse identify in a client who is responding to
stimulation of the sympathetic nervous system?
A.

Pupil constriction.

B.

Increased heart rate.

C.

Bronchial constriction.

D.
Decreased blood pressure.
3.
3.
The nurse is taking a history of a newly diagnosed Type 2 diabetic who is
beginning treatment. Which subjective information is most important for the
nurse to note?
A.

A history of obesity.

B.

An allergy to sulfa drugs.

C.

Cessation of smoking three years ago.

D.
Numbness in the soles of the feet.
4.
4.
A female client is brought to the clinic by her daughter for a flu shot. She has lost
significant weight since the last visit. She has poor personal hygiene and
inadequate clothing for the weather. The client states that she lives alone and
denies problems or concerns. What action should the nurse implement?
A.
B.

Notify social services immediately of suspected elderly abuse.


Discuss the need for mental health counseling with the
daughter.

C.

Explain to the client that she needs to take better care of


herself.

D.
5.

Collect further data to determine whether self-neglect is


occurring.
5.

A client with a 16-year history of diabetes mellitus is having renal function tests
because of recent fatigue, weakness, elevated blood urea nitrogen, and serum
creatinine levels. Which finding should the nurse conclude as an early symptom
of renal insufficiency?
A.

Dyspnea.

B.

Nocturia.

C.

Confusion.

D.
Stomatitis.
6.
6.
A client has been taking oral corticosteroids for the past five days because of
seasonal allergies. Which assessment finding is of most concern to the nurse?
A.

White blood count of 10,000 mm3.

B.

Serum glucose of 115 mg/dl.

C.

Purulent sputum.

D.
Excessive hunger.
7.
7.
Which symptoms should the nurse expect a client to exhibit who is known to
have a pheochromocytoma?
A.

Numbness, tingling, and cramps in the extremities.

B.

Headache, diaphoresis, and palpitations.

C.

Cyanosis, fever, and classic signs of shock.

D.
Nausea, vomiting, and muscular weakness.
8.
8.
A client taking furosemide (Lasix), reports difficulty sleeping. What question is
important for the nurse to ask the client?

9.

A.

What dose of medication are you taking?

B.

Are you eating foods rich in potassium?

C.

Have you lost weight recently?

D.
At what time do you take your medication?
9.
The nurse knows that lab values sometimes vary for the older client. Which data
should the nurse expect to find when reviewing laboratory values of an 80-yearold male?
A.

Increased WBC, decreased RBC.

B.

Increased serum bilirubin, slightly increased liver enzymes.

C.

Increased protein in the urine, slightly increased serum glucose


levels.

D.

Decreased serum sodium, an increased urine specific gravity.

10.

10.
The nurse working in a postoperative surgical clinic is assessing a woman who
had a left radical mastectomy for breast cancer. Which factor puts this client at
greatest risk for developing lymphedema?
A.

She sustained an insect bite to her left arm yesterday.

B.

She has lost twenty pounds since the surgery.

C.

Her healthcare provider now prescribes a calcium channel


blocker for hypertension.

D.
Her hobby is playing classical music on the piano.
11.
11.
A client has taken steroids for 12 years to help manage chronic obstructive
pulmonary disease (COPD). When making a home visit, which nursing function is
of greatest importance to this client? Assess the client's

12.

A.

pulse rate, both apically and radially.

B.

blood pressure, both standing and sitting.

C.

temperature.

D.
skin color and turgor.
12.
A 58-year-old client, who has no health problems, asks the nurse about the
Pneumovax vaccine. The nurse's response to the client should be based on which
information?
A.

The vaccine is given annually before the flu season to those


over 50 years of age.

B.

The immunization is administered once to older adults or


persons with a history of chronic illness.

C.

The vaccine is for all ages and is given primarily to those


persons traveling overseas to areas of infection.

D.

The vaccine will prevent the occurrence of pneumococcal


pneumonia for up to five years.
13.
13.
The nurse working on a telemetry unit finds a client unconscious and in pulseless
ventricular tachycardia (VT). The client has an implanted automatic defibrillator.
What action should the nurse implement?

14.

A.

Prepare the client for transcutaneous pacemaker.

B.

Shock the client with 200 joules per hospital policy.

C.

Use a magnet to deactivate the implanted pacemaker.

D.
14.

Observe the monitor until the onset of ventricular fibrillation.

A client who is sexually active with several partners requests an intrauterine


device (IUD) as a contraceptive method. Which information should the nurse
provide?
A.

Using an IUD offers no protection against sexually transmitted


diseases (STD), which increase the risk for pelvic inflammatory disease
(PID).

B.

Getting pregnant while using an IUD is common and is not the


best contraceptive choice.

C.

Relying on an IUD may be a safer choice for monogamous


partners, but a barrier method provides a better option in preventing
STD transmission.

D.

Selecting a contraceptive device should consider choosing a


successful method used in the past.
15.
15.
While working in the emergency room, the nurse is exposed to a client with
active tuberculosis. When should the nurse plan to obtain a tuberculin skin test?
A.

Immediately after the exposure.

B.

Within one week of the exposure.

C.

Four to six weeks after the exposure.

D.
Three months after the exposure.
16.
16.
A female client taking oral contraceptives reports to the nurse that she is
experiencing calf pain. What action should the nurse implement?
A.

Determine if the client has also experienced breast tenderness


and weight gain.

B.

Encourage the client to begin a regular, daily program of


walking and exercise.

C.

Advise the client to notify the healthcare provider for


immediate medical attention.

D.

Tell the client to stop taking the medication for a week to see if
symptoms subside.
17.
17.
A 58-year-old client who has been post-menopausal for five years is concerned
about the risk for osteoporosis because her mother has the condition. Which
information should the nurse offer?
A.

Osteoporosis is a progressive genetic disease with no effective


treatment.

B.

Calcium loss from bones can be slowed by increasing calcium


intake and exercise.

C.

Estrogen replacement therapy should be started to prevent the


progression osteoporosis.

D.

Low-dose corticosteroid treatment effectively halts the course


of osteoporosis.
18.
18.
A 51-year-old truck driver who smokes two packs of cigarettes a day and is 30
pounds overweight is diagnosed with having a gastric ulcer. What content is most
important for the nurse to include in the discharge teaching for this client?
A.

Information about smoking cessation.

B.

Diet instructions for a low-residue diet.

C.

Instructions on a weight-loss program.

D.
The importance of increasing milk in the diet.
19.
19.
A client is admitted to the hospital with a medical diagnosis of pneumococcal
pneumonia. The nurse knows that the prognosis for gram-negative pneumonias
(such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor because
A.

they occur in the lower lobe alveoli which are more sensitive to
infection.

B.

gram-negative organisms are more resistant to antibiotic


therapy.

20.

C.

they occur in healthy young adults who have recently been


debilitated by an upper respiratory infection.

D.

gram-negative pneumonias usually affect infants and small

children.
20.
During assessment of a client with amyotrophic lateral sclerosis (ALS), which
finding should the nurse identify when planning care for this client?
A.

Muscle weakness.

B.

Urinary frequency.

C.

Abnormal involuntary movements.

D.
A decline in cognitive function.
21.
21.
An 81-year-old male client has emphysema. He lives at home with his cat and
manages self-care with no difficulty. When making a home visit, the nurse notices
that his tongue is somewhat cracked and his eyeballs are sunken into his head.
What nursing intervention is indicated?
A.

Help the client to determine ways to increase his fluid intake.

B.

Obtain an appointment for the client to see an ear, nose, and


throat specialist.

C.

Schedule an appointment with an allergist to determine if the


client is allergic to the cat.

D.

Encourage the client to slightly increase his use of oxygen at


night and to always use humidified oxygen.
22.
22.
The nurse is planning care for a client who has a right hemispheric stroke. Which
nursing diagnosis should the nurse include in the plan of care?
A.

Impaired physical mobility related to right-sided hemiplegia.

B.

Risk for injury related to denial of deficits and impulsiveness.

C.

Impaired verbal communication related to speech-language


deficits.

D.

Ineffective coping related to depression and distress about


disability.
23.
23.
A 67-year-old woman who lives alone is admitted after tripping on a rug in her
home and fractures her hip. Which predisposing factor probably led to the
fracture in the proximal end of her femur?
A.

Failing eyesight resulting in an unsafe environment.

B.

Renal osteodystrophy resulting from chronic renal failure.

C.

Osteoporosis resulting from hormonal changes.

D.

Cardiovascular changes resulting in small strokes which impair


mental acuity.
24.
24.
A client with heart disease is on a continuous telemetry monitor and has
developed sinus bradycardia. In determining the possible cause of the
bradycardia, the nurse assesses the client's medication record. Which medication
is most likely the cause of the bradycardia?
A.

Propanolol (Inderal).

B.

Captopril (Capoten).

C.

Furosemide (Lasix).

D.
Dobutamine (Dobutrex).
25.
25.
Which healthcare practice is most important for the nurse to teach a
postmenopausal client?
A.

Wear layers of clothes if experiencing hot flashes.

B.

Use a water-soluble lubricant for vaginal dryness.

C.

Consume adequate foods rich in calcium.

D.

Participate in stimulating mental exercises.