Med Surg questions

Question 1

When assessing the client with COPD, which health promotion information would be most important for the nurse to obtain?

1. Number of years the client has smoked.
2. Risk factors for complications.
3. Ability to administer inhaled medication.
4. Possibility for lifestyle changes

Answer 1

4

Question 2

The client diagnosed with an exacerbation of COPD is in respiratory distress. Which
intervention should the nurse implement first?
1. Assist the client into a sitting position at 90 degrees.
2. Give oxygen at six (6) LPM via nasal cannula.
3. Monitor vital signs with the client sitting upright.
4. Notify the health-care provider about the client’s status

Answer 2

1 - O2 will be applied as soon as possible, but the least amount possible. Vitals need to be monitored but this is not the first priority. The hcp will be notified but the client needs to be treated first. AIRWAY!

Question 3

When assessing the client with the diagnosis of COPD, which data would require the
nurse to take immediate action?
1. Large amounts of thick white sputum.
2. Oxygen flow meter set on eight (8) liters.
3. Use of accessory muscles during inspiration.
4. Presence of a barrel chest and dyspnea

Answer 3

2 - the rest are common symptoms, 8L is too high.

Question 4

While the nurse is caring for the client diagnosed with COPD, which outcome would
require a revision in the plan of care?
1. The client has no signs of respiratory distress.
2. The client shows an improved respiratory pattern.
3. The client demonstrates intolerance to activity.
4. The client participates in establishing goals

Answer 4

3

Question 5

The nurse is caring for the client diagnosed with end-stage COPD. Which data would warrant immediate intervention by the nurse?

1. The client’s pulse oximeter reading is 92%.
2. The client’s arterial blood gas level is 74.
3. The client has SOB when walking to the bathroom.
4. The client’s sputum is rusty colored.

Answer 5

4

Question 6

What statement made by the client diagnosed with chronic bronchitis indicates to the
nurse that more teaching is needed?
1. “I should contact my health-care provider if my sputum changes color or amount.”
2. “I will take my bronchodilator regularly to prevent having bronchospasms.”
3. “This metered dose inhaler gives a precise amount of medication with each dose.”
4. “I need to return to the HCP to have my blood drawn with my annual physical.”

Answer 6

4

Question 7

Which nursing diagnoses would be appropriate for the nurse to include in the plan of
care for the client diagnosed with COPD? Select all that apply.
1. Impaired gas exchange.
2. Inability to tolerate temperature extremes.
3. Activity intolerance.
4. Inability to cope with changes in roles.
5. Alteration in nutrition.

Answer 7

1, 2, 3, 4, 5

Question 8

Which outcome would be appropriate for the client problem “ineffective gas
exchange” for the client recently diagnosed with COPD?
1. The client demonstrates the correct way to purse-lip breathe.
2. The client lists three (3) signs/symptoms to report to the HCP.
3. The client will drink at least 2500 mL of water daily.
4. The client will be able to ambulate 100 feet with dyspnea.

Answer 8

1

Question 9

When assessing the client recently diagnosed with COPD, which sign and symptom should the nurse expect?

1. Clubbing of the client’s fingers.
2. Infrequent respiratory infections.
3. Chronic sputum production.
4. Nonproductive hacking cough

Answer 9

3 - clubbing is a later sign, clients have frequent respiratory infection and productive coughs

Question 10

What statement made by the client would indicate that the nurse’s discharge teaching
was effective for the client diagnosed with COPD?
1. “I need to get an influenza vaccine each year, even when there is a shortage.”
2. “I need to get a vaccine for pneumonia each year with my flu shot.”
3. “If I reduce my cigarette smoking to six (6) a day, I won’t have difficulty breathing.”
4. “I need to restrict my drinking liquids to keep from having so much phlegm.”

Answer 10

1 - pneumococcal should be every 5-7 years, smoking needs to stop completely, and COPD patients should increase their fluid intake

Question 11

The nurse is completing the admission assessment on a 13-year-old client diagnosed
with asthma. Which signs and symptoms would the nurse expect to find?
1. Fever and crepitus.
2. Rales and hives.
3. Dyspnea and wheezing.
4. Normal chest shape and eupnea

Answer 11

3

Question 12

The nurse is planning the care of a client diagnosed with asthma and has written a
problem of “anxiety.” Which nursing intervention should be implemented?
1. Stay with the client.
2. Notify the health-care provider.
3. Administer an anxiolytic medication.
4. Encourage the client to drink fluids

Answer 12

1

Question 13

The client is diagnosed with mild intermittent asthma. Which medication should the
nurse discuss with the client?
1. Daily inhaled corticosteroids.
2. Use of a “rescue inhaler.”
3. Use of systemic steroids.
4. Leukotriene agonists

Answer 13

2

Question 14

The client diagnosed with asthma is admitted to the emergency department with difficulty
breathing and a blue color around the mouth. Which diagnostic test will be
ordered to determine the status of the client?
1. Complete blood count.
2. Pulmonary function test.
3. Allergy skin testing.
4. Drug cortisol level

Answer 14

2

Question 15

The client diagnosed with exercise-induced asthma (EIA) is being discharged. Which
information should the nurse include in the discharge teaching?
1. Take two (2) puffs on the rescue inhaler and wait five (5) minutes before exercise.
2. Warmup exercises will increase the potential for developing the asthma attacks.
3. Use the bronchodilator inhaler immediately prior to beginning to exercise.
4. Increase dietary intake of food high in monosodium glutamate (MSG).

Answer 15

3

Question 16

The nurse is discharging a client newly diagnosed with restrictive airway disease,

asthma. Which statement indicates the client understands the discharge instructions?
1. “I will call 911 if my medications don’t control an attack.”
2. “I should wash my bedding in warm water.”
3. “I can still eat at the Chinese restaurant when I want.”
4. “If I get a headache I should take a nonsteroidal anti-inflammatory drug.”

Answer 16

1

Question 17

The nurse writes a problem of “impaired gas exchange” for a client diagnosed with
cancer of the lung. Which interventions should be included in the plan of care? Select all that apply.
1. Apply O2 via nasal cannula.
2. Have the dietitian plan for six (6) small meals per day.
3. Place the client in respiratory isolation.
4. Assess vital signs for fever.
5. Listen to lung sounds every shift

Answer 17

1, 2, 4, 5

• Clients with lung cancer are at risk for developing an infection
• Lungs should be assessed on a routine and PRN basis

Question 18

The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment
data warrant immediate intervention by the nurse?
1. The client has an intake of 1500 mL IV and an output of 1000 mL.
2. The client has 450 mL of bright-red drainage in the chest tube.
3. The client is complaining of pain at a “10” on a 1–10 scale.
4. The client has absent lung sound on the side of the surgery.

Answer 18

2 - absent lung sound are expected at this point of the patient’s recovery

Question 19

The client diagnosed with oat cell carcinoma of the lung tells the nurse, “I am so tired
of all this. I might as well just end it all.” Which should be the nurse’s first response?
1. Respond by saying, “This must be hard for you. Would you like to talk?”
2. Tell the HCP of the client’s statement.
3. Refer the client to a social worker or spiritual advisor.
4. Find out if the client has a plan to carry out suicide.

Answer 19

4

Question 20

The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first?

1. Confirm that the ventilator settings are correct.
2. Verify that the ventilator alarms are functioning properly.
3. Assess the respiratory status and pulse oximeter reading.
4. Monitor the client’s arterial blood gas results.

Answer 20

3

Question 21

Which assessment data would indicate the client diagnosed with ARDS has experienced
a complication secondary to the ventilator?
1. The client’s urine output is 100 mL in two (2) hours.
2. The pulse oximeter reading is greater than 95%.
3. The client has asymmetrical chest expansion.
4. The telemetry reading shows sinus tachycardia.

Answer 21

3 - asymmetrical expansion indicates pneumothorax

Question 22

The client with ARDS is on a mechanical ventilator. Which intervention should be
included in the nursing care plan addressing the endotracheal tube care?
1. Do not move or touch the ET tube.
2. Obtain a chest x-ray daily.
3. Determine if the ET cuff is deflated.
4. Ensure that the ET tube is secure

Answer 22

4

Question 23

The client diagnosed with ARDS is in respiratory distress and the ventilator is

malfunctioning. Which intervention should the nurse implement first?
1. Notify the respiratory therapist immediately.
2. Ventilate with a manual resuscitation bag.
3. Request STAT arterial blood gases.
4. Auscultate the client’s lung sounds.

Answer 23

2

Question 24

The client diagnosed with ARDS is on a ventilator and the high alarm indicates that
there is an increase in the peak airway pressure. Which intervention should the nurse
implement first?
1. Check the tubing for any kinks.
2. Suction the airway for secretions.
3. Assess the lip line of the ET tube.
4. Sedate the client with a muscle relaxant

Answer 24

1

Question 25

Which diagnostic test should the nurse anticipate the health-care provider ordering to
rule out the diagnosis of asthma?
1. A bronchoscopy.
2. An immunoglobulin E.
3. An arterial blood gas.
4. A bronchodilator reversibility test.

Answer 25

2

Question 26

Which statement indicates the client diagnosed with asthma needs more teaching
concerning the medication regimen?
1. “I will take Singulair, a leukotriene, every day to prevent allergic asthma attacks.”
2. “I need to use my Intal, Cromolyn inhaler 15 minutes before I begin my exercise.”
3. “I need to take oral glucocorticoids every day to prevent my asthma attacks.”
4. “If I have an asthma attack, I need to use my Albuterol, a beta2 agonist, inhaler

Answer 26

4

Question 27

Which intervention should the emergency department nurse implement first for the
client admitted for an acute asthma attack?
1. Administer glucocorticoids intravenously.
2. Encourage the client to cough forcefully.
3. Establish and maintain a 20-gauge saline lock.
4. Assess breath sounds every 15 minutes.

Answer 27

3

Question 28

Which clinical manifestation would the nurse expect to find in the client newly diagnosed
with intrinsic lung cancer?
1. Dysphagia.
2. Foul-smelling breath.
3. Hoarseness.
4. Weight loss.

Answer 28

3

Question 29

Which statement indicates the need for further teaching for the client diagnosed with
sleep apnea?
1. “If I lose weight and stop smoking cigarettes I may not need treatment for sleep
apnea.”
2. “The continuous positive airway pressure (CPAP) holds my airway open with pressure.”
3. “The CPAP will help me stay awake during the day while I am at work.”
4. “It is all right to have a couple of beers at night because I have this CPAP machine

Answer 29

4

Question 30

The nurse is caring for a client on a mechanical ventilator and the alarm goes off. The
nurse is unable to determine what is wrong with the ventilator and the client is in respiratory distress. Which action should the nurse implement first?
1. Notify the respiratory therapist immediately.
2. Use the ambu bag to ventilate the client.
3. Elevate the head of the client’s bed.
4. Assess the client’s oxygen saturation

Answer 30

2

Question 31

The occupational health nurse is teaching a class on the risk factors for developing
osteoarthritisoa (OA). Which is a modifiable risk factor for developing OA?
1. Being overweight.
2. Increasing age.
3. Previous joint damage.
4. Genetic susceptibility

Answer 31

1 - Obesity is a well-recognized risk factor for the development of OA and it is modifiable n that the client can lose weight

Question 32

The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse
expect the client to exhibit?
1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan neck fingers.

Answer 32

2 - pain stiffness, and functional impairment are the primary clinical manifestations of OA

Question 33

The client diagnosed with OA is a resident in a long-term care facility. The resident is
refusing to bathe because she is hurting. Which instruction should the nurse give the unlicensed nursing assistant?
1. Allow the client to stay in bed until the pain becomes bearable.
2. Tell the assistant to give the client a bed bath this morning.
3. Try to encourage the client to get up and go to the shower.
4. Notify the family that the client is refusing to be bathed.

Answer 33

3 - not moving is the worse things the client can do - the warm water and movement will help decrease the pain

Question 34

The client has been diagnosed with OA for the last seven (7) years and has tried multiple medical treatments and alternative treatments but still has significant joint pain.
Which psychosocial client problem would the nurse identify?
1. Severe pain.
2. Body-image disturbance.
3. Knowledge deficit
4. Depression.

Answer 34

4

Question 35

The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug
(NSAID). Which instruction should the nurse teach the client?
1. Take the medication on an empty stomach.
2. Make sure the client tapers the medication when discontinuing.
3. Apply the medication topically over the affected joints.
4. Notify the health-care provider if vomiting blood

Answer 35

4

Question 36

The nurse is discussing osteoporosis with a group of women. Which factor will the
nurse identify as a nonmodifiable risk factor?
1. Calcium deficiency.
2. Tobacco use.
3. Female gender.
4. High alcohol intake.

Answer 36

3

Question 37

The client diagnosed with osteoporosis asks the nurse, “Why does smoking cigarettes
cause my bones to be brittle?” Which response by the nurse would be most appropriate?
1. “Smoking causes nutritional deficiencies that contribute to osteoporosis.”
2. “Tobacco causes an increase in blood supply to the bones, causing osteoporosis.”
3. “Smoking low-tar cigarettes will not cause your bones to become brittle.”
4. “Nicotine impairs the absorption of calcium, causing decreased bone strength.”

Answer 37

4

Question 38

Which signs/symptoms would make the nurse suspect that the client has developed
osteoporosis?
1. The client has lost one (1) inch in height.
2. The client has lost 12 pounds in the last year.
3. The client’s hands are painful to the touch.
4. The client’s serum uric acid level is elevated.

Answer 38

1

Question 39

Which foods should the nurse recommend to a client when discussing sources of
dietary calcium?
1. Yogurt and dark-green, leafy vegetables.
2. Oranges and citrus fruits.
3. Bananas and dried apricots.
4. Wheat bread and bran.

Answer 39

1

Question 40

Which intervention is an example of a secondary nursing intervention when discussing
osteoporosis?
1. Obtain a bone density evaluation test.
2. Perform non–weight-bearing exercises regularly.
3. Increase the intake of dietary calcium.
4. Refer clients to a smoking cessation program

Answer 40

1 - secondary nursing interventions include screenings

Question 41

The nurse is teaching a class to pregnant teenagers. Which information is most important
when discussing ways to prevent osteoporosis?
1. Take at least 1200 mg of calcium supplements a day.
2. Eat foods low in calcium and high in phosphorus.
3. Osteoporosis does not occur until around age 50 years.
4. Remain as active as possible until the baby is born.

Answer 41

1

Question 42

The 84-year-old client is a resident in a long-term care facility. Which intervention
should be implemented to help prevent complications secondary to osteoporosis?
1. Keep the bed in the high position.
2. Perform passive range-of-motion exercises.
3. Turn the client every two (2) hours.
4. Provide nighttime lights in the room

Answer 42

4 - nighttime lights will help prevent the client from falling - fractures are the #1 complication of osteoporosis

Question 43

The client admitted with a diagnosis of a fractured hip is complaining of severe pain.
Which pain management technique would be best for the nurse to implement for this
client?
1. Adjust the patient-controlled analgesia (PCA) machine for a lower dose.
2. Ensure that the weights of the Buck’s traction are off the floor and hang freely.
3. Raise the head of the bed to 45 degrees and the foot to 15 degrees.
4. Turn the client to the affected leg using pillows to support the other leg

Answer 43

2

Question 44

The nurse is preparing the preoperative client for a total hip replacement (THR).
Which information should the nurse include concerning postoperative care?
1. Keep abduction pillow in place between legs at all times.
2. Cough and deep breathe at least every four (4) to five (5) hours.
3. Turn to both sides every two (2) hours to prevent pressure ulcers.
4. Sit in a high-seated chair for a flexion of less than 90 degrees.

Answer 44

4 - pillow is only for when in bed

Question 45

The client that is one (1) day postoperative total hip replacement complains of hearing
a “popping sound” when turning. What assessment data should the nurse report
immediately to the surgeon?
1. Dark red–purple discoloration.
2. Equal length of lower extremities.
3. Groin pain in the affected leg.
4. Edema at the incision site.

Answer 45

3 - this and the sound can indicate dislocation

Question 46

The nurse is preparing the client who received a total hip replacement for discharge.
Which statement would indicate that further teaching is needed?
1. “I should not cross my legs because my hip may come out of the socket.”
2. “I will call my HCP if I have a sudden increase in pain.”
3. “I will sit on a chair with arms and a firm seat.”
4. “After three (3) weeks, I don’t have to worry about infection.”

Answer 46

4

Question 47

Which topics should the nurse include in the discharge teaching plan for a client after
having a total hip replacement? Select all that apply.
1. Weight-bearing limits.
2. Use of assistive devices.
3. Gradual increase in activity.
4. Medication therapy.
5. Periods of rest.

Answer 47

1, 2, 3, 4, 5 (all)

Question 48

The nurse is preparing a plan of care for the client who has had a total hip replacement.
Which outcome would be most appropriate for this client?
1. The client has limited amount of pain relief.
2. The client will have limited ability to ambulate.
3. The client will have hip instability for several months.
4. The client will have adequate hip joint motion.

Answer 48

4

Question 49

When assessing the client six (6) hours after having a right total knee replacement,
which data should the nurse report to the surgeon?
1. A total of 100 mL of red drainage in the autotransfusion drainage system.
2. Pain relief after using the patient-controlled analgesia (PCA) pump.
3. Cool toes, distal pulses palpable, and pale nail beds bilaterally.
4. Urinary output of 60 mL of clear yellow urine in three (3) hours

Answer 49

4 - minimum urine output is 30 mL/hr

Question 50

When preparing the client for the transition to home rehabilitation after having a total
knee replacement, which information regarding discharge teaching would the nurse
include?
1. Deep breathe and cough every two (2) hours.
2. Procedure for emptying Jackson-Pratt drainage.
3. Burning or frequency of urination is expected.
4. Modify the home for altered mobility.

Answer 50

4

Question 51

When developing the plan of care for the client having a total knee repair, which of the
expected outcomes would the nurse include? Select all that apply.
1. The client has effective pain management.
2. The client does not smoke or use tobacco products.
3. The client ambulates within the weight-bearing limits.
4. The client participates in activities of daily living.
5. The client is able to return to his or her previous lifestyle

Answer 51

1, 2, 3, 4, 5 (all)

Question 52

The nurse is caring for the client who had a total knee replacement (TKR). Which data
would the nurse observe to determine if the nursing interventions are effective?
1. The client’s lungs have bilateral crackles.
2. The client’s knee has flexion of 45 degrees.
3. The client participates in self-care activities.
4. The client has reduced pain using a single approach.

Answer 52

3

Question 53

The nurse is assessing the client who is immediately postoperative from a total knee replacement. Which assessment data would warrant immediate intervention?

1. T 99!F, HR 80, RR 20, and BP 128/76.
2. Pain in the unaffected leg during dorsiflexion of the ankle.
3. Bowel sounds heard intermittently in four quadrants.
4. Diffuse, crampy abdominal pain.

Answer 53

2

Question 54

The 50-year-old client came to the health-care provider’s office for an annual physical

examination. Which information should the nurse assess to rule out osteoporosis? Select all that apply.
1. Family history of osteoporosis.
2. Estrogen or androgen deficit.
3. Use of tobacco products.
4. Level and amount of exercise.
5. Alcohol intake.

Answer 54

All

Question 55

While working in the day surgery department, the nurse is caring for the client two (2)
hours after having a right knee arthroscopy. Which intervention should the nurse implement?
1. Encourage the client to perform range-of-motion exercises.
2. Monitor the amount and color of the urinary output hourly.
3. Check the client’s pulses distally and assess the toes.
4. Monitor the client’s vital signs every eight (8) hours.

Answer 55

3

Question 56

The nurse is responsible for teaching the client to take Fosamax, a bisphosphonate.
Which information should the nurse include?
1. Take this medication with a full glass of water.
2. Take with breakfast to prevent gastrointestinal upset.
3. Use sunscreen to prevent sensitivity to sunlight.
4. This medication increases calcium reabsorption.

Answer 56

1

Question 57

When caring for the client with a fractured right hip who has Buck’s traction, which
intervention should the nurse include in the plan of care?
1. Assess the insertion sites for signs and symptoms of infection.
2. Monitor for drainage or odor from under the plaster covering the pins.
3. Monitor the condition of the skin beneath the Velcro™ boot every eight (8) hours.
4. Take weights off for one (1) hour every eight (8) hours and as needed.

Answer 57

3