Exam (elaborations) Medical-Surgical Nurse Exam Practice Test Questions

Exam (elaborations) Medical-Surgical Nurse Exam Practice Test Questions The client scheduled to have sx today cannot read or write. The surgeon obtaining the consent wants to have the client's spouse sign the consent instead. What is the nurse's best action? A. Nothing; a signed informed consent statement does not need to be obtained from this client. B. Locate the spouse because the informed consent statement must be signed by the client's closest relative C. Remind the surgeon that the client may sign the informed consent statement with an X in front of two witnesses D. Notify the administration because court must appoint a legal guardian 1 C.Remind the surgeon that the client may sign the informed consent statement with an X in front of two witnesses A female patient is having a biopsy of a nodule found in the right breast. Which classification identifies this surgery? A. Urgent B. Minor C. Cosmetic D. Diagnostic 2 D. Diagnostic Which statements best describes the preoperative period? (Select all that apply) A. It begins when the patient makes the appointment with the surgeon to discuss the need for surgery. B. It ends at the time of transfer to the surgical suite. C. It is a time during which the patients need for surgery is established. D. It begins when the patient is scheduled for surgery. E. It is a time during which the patient receives testing and education related to an impending surgery. 3 B. It ends at the time of transfer to the surgical suite. D. It begins when the patient is scheduled for surgery. Okay you can barely ambulate with a walker at home is having a left total knee replacement. What is the most appropriate category for the surgery? A. Urgent B. Restorative C. Simple D. Palliative 4 B. Restorative 5 Medical-Surgical Nurse Exam Practice Test Questions A colostomy is scheduled to be done on a patient who has severe Crohn's disease. What is the correct classification for this surgery? A. Palliative B. Minor C. Restorative D. Curative A. Palliative A male patient has a facial scar on his forehead from a third-degree burn. What is the correct classification for this surgery? A. Major B. Restorative C. Cosmetic D. Curative 6 C. Cosmetic An appendectomy is being performed on a patient with appendicitis. What is the correct classification for this surgery? A. Curative B. Diagnostic C. Urgent D. Radical 7 A. Curative A patient with an abdominal aortic aneurysm is having surgical repair. What is the correct classification of this surgery? A. Restorative B. Emergent C. Urgent D. Minor 8 B. Emergent A 76-year-old patient is having a bilateral cataract removal. What is the correct classification for this surgery? A. Major B. Cosmetic C. Elective D. Emergent 9 C. Elective 10 A 47-year-old patient is having surgery to remove kidney stones. What is the correct classification for this surgery? A. Restorative B. Emergent C. Palliative D. Urgent D. Urgent The nurse screens a preoperative patient for conditions that may increase the risk for complications during the perioperative period. Which conditions are possible risk factors? (Select all that apply) A. Emotionally stable B. 67 years old C. Obesity D. Marathon runner E. Pulmonary disease 11 B. 67 y.o. C. Obesity E. Pulmonary disease A 75-year-old patient is having an exploratory laparotomy tomorrow. The wife tells the nurse that at night the patient gets up and walks around his room. What does the nurse do next after hearing this information? A. Notifies the physician B. Develops a plan to keep the patient safe C. Obtains an order for sleep medication D. Tells the patient not to get out of bed at night 12 B. Develops a plan to keep the patient safe. Discharge planning is done for patients who have had which types of surgery? (Select all that apply) A. Minor B. Urgent C. Palliative D. Curative E. Emergent 13 A, B, C, D, E (all types of surgery) The nurse has received a patient in the holding area is scheduled for a left femoral-popliteal bypass. What are the priority safety measures for this patient before surgery? (Select all that apply) A. The operative limb is marked by the surgeon B. The patient is positively identified by checking the name and date of birth. C. The patient is asked to mark the operative limb. D. The patient is identified by checking the name and room number. E. The patient is instructed to verify any family members waiting. 14 A. The operative limb is marked by the surgeon. B. The patient is positively identified by checking the name and date of birth. D. The patient is identified by checking the name and room number In the preoperative setting, the nurse functions as a patient advocate when which factors are assessed in the discharge planning process? (Select all that apply) A. Support systems B. Any known allergies C. Self-care capabilities D. Preference for route of administration of analgesics E. Home environment 15 A. Support system C. Self-care capabilities E. Home environment The nurse is preparing the patient for surgery. Which common laboratory tests does the nurse anticipate to be ordered? (Select all that apply) A. Total cholesterol B. Electrolyte levels C. Uric acid D. Clotting studies E. Serum creatinine 16 B. Electrolyte levels D. Clotting studies E. Serum creatinine Which statement is true regarding the patient who has given consent for a surgical procedure? A. Information necessary to understand the nature of and reason for the surgery has been provided. B. The length of stay in the hospital has been preapproved by the managed care provider. C. Information about the surgeons experience has been provided. D. The nurse has provided detailed information about the surgical procedure. 17 A. Information necessary to understand the nature of and reason for the surgery has been provided. Which statement best describes the collaborative roles of the nurse and surgeon when obtaining the informed consent? A. The nurse is responsible for having the informed consent form on the chart for the physician to witness. B. The nurse my serve as a witness that the patient has been informed by the physician before surgery is performed. C. The nurse may serve as witness to the patients signature after the physician has the consent form signed before preoperative sedation is given and before surgery is performed. D. The nurse has no duties regarding the consent form if the patient has signed the informed consent form for the physician, even if the patient then asks additional questions about the surgery. 18 C. The nurse may serve as witness to the patients signature after the physician has the consent form signed before preoperative sedation is given and before surgery is performed. for which client preadmission testing laboratory result does the nurse take immediate action? A. International normalized ration 0.9 B. WBC count 8500/mm3 C. Serum Potassium level 2.8mEq/L D. Serum sodium level 132 mEq/L 19 C. Serum Potassium level 2.8mEq/L Which postoperative interventions will the nurse typically teach a patient to prevent complications following surgery? (Select all that apply) A. Range of motion exercises B. Massaging of lower extremities C. Taking pain medication only when experiencing severe pain. D. Incision splinting E. Deep-breathing exercises 20 A. Range of motion exercises D. Incision splinting E. Deep-breathing exercises The client scheduled for knee replacement sx today performed all of the following actions yesterday. Which action is most important for the nurse to report to the surgeon? A. Took 50 mg of diphenhydramine (Benadryl) at bedtime B. Smoked one pack of cigarettes instead of two C. Drank two 12-ounce glasses of beer D. Took two aspirins three times 21 D. took two aspirins three times A patient with diabetes is scheduled for surgery at 0700. What are the actions, in order of priority, that the nurse will perform preoperatively? (Select based on priority order) A. Modify the dose of insulin given based on the patient's blood glucose B. Completely preoperative checklist before 0700. C. Have non-licensed personnel obtain the patients Accucheck and vital signs. D. Check if the patient has any jewelry on and call security to secure valuables. 22 C. Have non-licensed personnel obtain the patients Accucheck and vital signs A. Modify the dose of insulin given based on the patient's blood glucose D. Check if the patient has any jewelry on an call security to secure valuables B. Complete the preoperative checklist before 0700 23 On admission to the preoperative area, the client scheduled for a hip replacement tells the nurse that three autologous blood donations for their sx have been made in the past 3 weeks. What is the nurse's best action? A. Check the client's international normalized ratio (INR) B. Call the lab to ensure that the blood is physically at the operating facility. C. Ensure that the client has given consent to receive blood if a transfusion is necessary. D. Inform the client that an autologous transfusion does not eliminate the risk for development of blood-borne diseases. B. Call the lab to ensure that the blood is physically at the operating facility. The client is NPO for surgery scheduled to occur in 4 hours. It is now 9 AM, and the client's regularly prescribed oral drugs (digoxin 0.125 mg, docusate [Colace] 300 mg, and ferrous fumarate [Feostat] 325 mg) are due to be administered. The physician will not be available until the time of surgery. What is the nurse's best action? A. Administer digoxin with minimal water and hold the other drugs. B. Administer all medications parenterally. C. Administer all medications orally. D. Hold all medications. 24 A. Administer digoxin with minimal water and hold the other drugs The nurse is educating a preoperative client about colostomy surgery. The colostomy surgery is categorized as what type of surgery? A. Cosmetic B. Curative C. Diagnostic D. Palliative 25 D. Palliative In going through the preoperative checklist, the nurse notices that the client's armband does not match the handwritten name on the informed consent, but it matches the stamped name. What does the nurse do first? A. Calls admissions B. Cancels the surgery C. Contacts the surgeon D. Talks to the operating team 26 D. Talks to the operating team As the nurse obtains the informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? A. Contacts the anesthesiologist B. Contacts the surgeon C. Explains the procedure D. Has the client sign the form 27 B. Contacts the surgeon The nurse is educating the client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? A. "I will wake up with a tube in my throat." B. "I will have a bandage on my chest." C. "My family will not be able to see me right away." D. "Pain medication will take away my pain." 28 D. "Pain medication will take away my pain." The older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? A. Calls the legal department to draft the paperwork B. Documents this in the chart C. Thanks the person and does nothing D. Talks to the client 29 D. Talks to the client The preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? A. Instructs the client to quit smoking B. Teaches about the dangers of tobacco C. Teaches the importance of incentive spirometry D. Tells the client where the smoking lounge is 30 C. Teaches the importance of incentive spirometry During a preoperative assessment, which statement by the client requires further investigation by the nurse to assess risk? A. "I am taking vitamins." B. "I drink a glass of wine a night." C. "I had a heart attack 4 months ago." D. "I don't like latex balloons." 31 C. "I had a heart attack 4 months ago." The nurse completes the preoperative checklist on the client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? A. Age of 59 years B. General anesthesia complications experienced by the client's brother C. Diet-controlled diabetes mellitus D. Ten pounds over the client's ideal body weight 32 C. Diet-controlled diabetes mellitus Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist? A. Creatinine, 1.9 mg/dL B. Fasting glucose, 80 mg/dL C. Potassium, 3.9 mEq/L D. Sodium, 140 mEq/L 33 A. Creatinine, 1.9 mg/dL The client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. Why is this preoperative procedure done? A. Decreases expected blood loss during surgery B. Eliminates any risk of infection C. Ensures that the bowel is sterile D. Reduces the number of intestinal bacteria 34 D. Reduces the number of intestinal bacteria What information about the postoperative client does the nurse include in the report to the postanesthesia care unit (PACU) nurse? A. Confirmation of informed consent B. Estimated blood loss C. Type of surgical instruments used D. Type of suture material used 35 B. Estimated blood loss The nurse is instructing the client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? A. "I will take off my stockings one to three times a day for 30 minutes." B. "My stockings are too loose." C. "These stockings will prevent blood clots." D. "These stockings help promote blood flow. 36 C. "These stockings will prevent blood clots." Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area? A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter. B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. C. Obtain the medical history from a client who is scheduled for a total hip replacement. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy. 37 B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer 38 At 8 AM, the registered nurse is admitting to the outpatient surgery department a client who is scheduled for sinus surgery. Which information given by the client would be of most immediate concern to the nurse? A. The client has an allergy to iodine and shellfish. B. The client was nauseated after a previous surgery. C. The client had a small glass of juice at 7 AM. D. The client expresses anxiety about the surgery. C. The client had a small glass of juice at 7 AM. A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which orders should the registered nurse accomplish first? A. Use electrical clippers to cut hair at the surgical site. B. Start an infusion of lactated Ringer's solution at 75 mL/hr. C. Administer one half of the client's usual lispro insulin dose. D. Draw blood for glucose, electrolyte, and complete blood count values. 39 D. Draw blood for glucose, electrolyte, and complete blood count values. The charge nurse is making client assignments for the med surg unit. Which client will be best to assign to an RN who has floated from pedi unit? 40 Client with Cushing's syndrome who has an elevated blood glucose and requires frequent administration of insulin. A client with iatrogenic Cushing's syndrome is a resident in a long term care facility. Which nursing action included in the clients care would be best to delegate to a nursing assistant? 41 Assist with personal hygiene and skin care. A client is referred to a home health agency after a tran-sphenoidal hypophysectomy. Which action will the RN case manager delegate to the home health aide who will see the client daily? 42 Test any nasal drainage for the presence of glucose. These data are obtained by a RN who is assessing a client who had a trans-sphenoidal hypophysectomy yesterday. What information has the most immediate implications for the clients care? 43 Client report of a stuff neck and a headache. A client with SIADH is admitted with a serum sodium level of 105. Which request by the health care provider should the nurse address first? 44 Administer infusion of 150 mL of 3% NaCl over 3 hours. After receiving change of shift report about the following four clients, which should the nurse address first? 45 Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL The client has been diagnosed with hyperpituitarism resulting from a prolactin secreting tumor, and bromocriptine mesylate (parlodel) has been prescribed. As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain? 46 Inhibits the release of some pituitary hormones. A client has been admitted to the medical ICU with a dx of diabetes insipidus secondary to lithium overdose. Which medication is used to treat the DI? 47 Desmopressin (DDAVP) A client has been admitted to the med surg unit with a dx of diabetes insipidus. The physician has requested desmopressin DDAVP. How does DDAVP decrease urine output? 48 Works as an anti diuretic hormone in the kidneys. A client presents to the ED with a history of adrenal insufficiency. The following lab values are obtained: Na 130 K 5.6 & glucose 72. Which of the following is the first request that the nurse should anticipate? 49 Administer insulin & dextrose in normal saline to shift potassium into cells The client with diabetes insipidus has dry lips & mucous membranes and poor skin turgor. Which intervention does the nurse provide first? 50 Forces fluids * dry lips & mucous membranes are indications of dehydration, which can occur with diabetes insipidus. The client with Cushing's disease says that she has lost 1 lb. what does the nurse do next? 51 Weighs the client The nurse is caring for the client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in her shift. What does the nurse do? 52 Wears a face mask when caring for the client A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? 53 Avoids palpating the abdomen *the abdomen must not be palpated bc this action could cause a sudden release of catecholamines & severe hypertension in the client. The client has undergone a trans-sphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing ICP in the client? 54 Instructs the client not to strain during a bowel movement The client is taking fludrocortisone (Florinef) for adrenal hypo function. The nurse instructs the client to report which symptom while taking this drug? 55 Headache The nurse is teaching the client about how to monitor therapy effectiveness for SIADH. What will the nurse tell the client to look for? 56 Daily weight gain of less than 2 lbs. The client with Cushing's begins to laugh loudly & inappropriately , causing the family in the room to be uncomfortable. What is the nurses best response? 57 The disease can sometimes affect emotional responses. The nurse is providing discharge to the client on spironolactone therapy. Which comment by the client indicates a need for further teaching? 58 "I should eat a banana everyday" *spironolactone increases potassium levels, so potassium supplements & foods rich in potassium should be avoided. Which lab result indicates that fluid restrictions have been effective in treating SIADH? 59 Increased serum sodium Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use? 60 Client with SOB and chest tightness, nasal flaring, audible wheezing, & O2 sat of 85% for the second time this week. A client presents to the ED with acute adrenal insufficiency & the following vitals: HR 118 BP 84/44 pulse ox 98% & temp 98.8 oral. Which intervention does the nurse prioritize for this client? 61 Providing isotonic fluids Which nursing intervention can reduce a preoperative patients anxiety? A. Provide a climate of privacy, comfort, and confidentiality when caring for the patient. B. Instruct the patient that after the preoperative medication has taken effect, the anxiety will go away. C. Avoid discussing the activities taking place around the patient while in the holding area. D. Assist members of the surgical team readying the operating room suite. 62 A. Provide a climate of privacy, comfort, and confidentiality when caring for the patient. A patient is hospitalized for acute cholelithiasis. On the intake admission, which information does the nurse include? (Select all that apply) A. Any spiritual or cultural considerations of the patient. B. History of the patient or family. C. When the patient plans to return to work D. What food preferences the patient has post surgery E. The patient's medical history 63 A. Any spiritual or cultural considerations of the patient B. History of the patient or family