RN Adult Medical Surgical Online Med-Surg Practice A 2021
1. A nurse is caring for a client who has pancreatitis. The nurse should expect which of the following
laboratory results to be below the expected reference range?
Calcium- A client who has pancreatitis is expected to have decreased calcium and magnesium levels due
to fat necrosis
2. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following
laboratory findings should the nurse expect?
BUN 32 mg/dL- DKA results in osmotic diuresis and subsequent dehydration. The nurse should expect a
client who has DKA to have elevated BUN, creatinine, and specific gravity levels resulting from the excess
glucose present in the urine
The nurse should expect a client who has DKA to have a pH level less than 7.35 due to the increased
production of ketones, which results in metabolic acidosis. The client might exhibit Kussmaul
respirations, which are deep and rapid respirations that compensate for the decreased pH. Sodium
bicarbonate is administered for severe acidosis when the client's pH level is less than 7
The nurse should expect a client who has DKA to have an HCO3- less than 15 mEq/L. This decreased
value is due to an increased production of ketones, resulting in metabolic acidosis.
3. A nurse is providing discharge instructions to a client who has a partial thickness burn of the hand.
Which of the following instructions should the nurse include?
Wrap fingers with individual dressings- The nurse should instruct the client to wrap the fingers
individually to allow for functional use of the hand while healing occurs. The nurse should also instructthe
client to perform range-of-motion exercises to each finger every hour while awake to promote function of
the injured hand.
The nurse should instruct the client to change the dressing every 12 to 24 hr to allow for wound
inspection. The client should observe the wound closely for manifestations of increased redness, warmth,
drainage, edema, or foul odor, which can indicate an infection.
A client who undergoes surgery to receive skin grafts for full-thickness burns should elevate and
immobilize the graft site with cotton pressure dressings for 3 to 5 days following the procedure. This
action prevents the graft from dislodging and allows for revascularization of the wound.
4. A nurse is planning care for a client who has extensive burn injuries and is immunocompromised.
Which of the following precautions should the nurse include in the plan of care to prevent Pseudomonas
aeruginosa infection?
Avoid placing plants or flowers in the client's room- Live plants can harbor P. aeruginosa, and this
bacterium can infect burn wounds and cause life-threatening complications. The nurse should ensure no
one brings live plants or flowers into the client's room.
The nurse does not need to limit visits to family members. However, the nurse should prohibit visits from
those at risk for P. aeruginosa infection, such as anyone who is ill, other hospitalized clients, and small
children.
,P. aeruginosa spreads by contact, either on health care workers' hands or contaminated equipment. It is not
airborne, so respirator masks are unnecessary
5. A nurse in an emergency department is caring for a client who reports vomiting and diarrhea for the
past 3 days. Which of the following findings should indicate to the nurse that the client is experiencing
fluid volume deficit?
Heart rate 110/min- A client who has a 3-day history of vomiting and diarrhea is likely to have fluid
volume deficit and an elevated heart rate.
A blood pressure of 138/90 mm Hg is within the expected reference range. A client who has a 3-day
history of vomiting and diarrhea is likely to have fluid volume deficit and hypotension.
A urine specific gravity of 1.020 is within the expected reference range. A client who has a 3-day history
of vomiting and diarrhea is likely to have fluid volume deficit, which is indicated by a urine specific
gravity greater than 1.030.
A BUN of 15 mg/dL is within the expected reference range. A client who has a 3-day history of vomiting
and diarrhea is likely to have fluid volume deficit and a BUN greater than 20 mg/dL.
6. A nurse in an emergency department is reviewing the provider's prescriptions for a client who
sustained a rattlesnake bite to the lower leg. Which of the following prescriptions should the nurse
expect?
Administer an opioid analgesic to the client.- The nurse should expect a prescription for an opioid
analgesic to promote comfort following a rattlesnake bit
The nurse should apply ice for a bite from a black widow spider to reduce the action of the neurotoxin from
the spider.
The nurse should expect a prescription for antihistamines and corticosteroids for stings from bees and wasps
The nurse should keep the affected extremity at heart level, not above or below it.
7. A nurse is providing teaching to a client who has kidney disease and a new prescription for
erythropoietin. Which of the following statements by the client indicates an understanding of the
teaching?
"I am taking this medication to increase my energy level."- The goal of erythropoietin therapy is to
increase the level of hematocrit in clients who have anemia. When the medication is effective, the client
should have a decrease in fatigue and an improvement in activity tolerance.
A client who has chronic kidney disease should have adequate iron stores for erythropoietin therapy to be
effective. Clients are encouraged to consume foods high in iron such as beef, liver, pork, and veal.
Therapy with erythropoietin increases RBC production, which can result in hypertension, not hypotension
Erythropoietin does not affect the client's protein requirements, but the client should continue to restrict
protein as prescribed by the provider to manage kidney disease
, 8. A nurse is reviewing the laboratory results of a client who has cirrhosis. Which of the following
laboratory values should the nurse expect?
Elevated bilirubin level- Bilirubin levels reflect the liver's ability to conjugate and excrete bilirubin, a
byproduct of the hemolysis of red blood cells. Bilirubin levels rise with liver disease and clinically reflect
the client's degree of jaundice
Liver disease and severe liver cell damage causes the liver cells to produce less prothrombin, which
prolongs prothrombin time.
The liver converts ammonia to urea. When this process is interrupted, as it is with liver disease or liver
failure, ammonia levels rise.
Albumin forms in the liver. When liver function is impaired, as it is with cirrhosis, albumin levels decrease
9. A nurse in a community clinic is caring for a client who reports an increase in the frequency of
migraine headaches. To help reduce the risk for migraine headaches, which of the following foods should
the nurse recommend the client to avoid?
Aged cheese- Foods that contain tyramine, such as aged cheese and sausage, can trigger migraine headaches
Smoked fish, fermented/pickled, chocolate, yeast can trigger migraines
10. A nurse is planning to provide discharge teaching for the family of an older adult client who has
hemianopsia and is at risk for falls. Which of the following instructions should the nurse include?
Remind the client to scan their complete range of vision during ambulation- The nurse should instruct
the family to remind a client who has hemianopsia, or blindness in half of the visual field, to use visual
scanning to look over their complete range of vision during ambulation. This practice can accommodate
for the loss of vision and help to reduce the risk for falls
The nurse should instruct the client's family to keep the client's personal care items within the client's reach
to reduce the risk for falls.
The nurse should instruct the family to use nightlights in the client's bedroom and bathroom to reduce the
risk for falls. Keeping the overhead lights on while the client is sleeping can disrupt the client's circadian
rhythm.
The nurse should instruct the client's family that they should secure extension cords to the client's
baseboards using electrical tape, rather than placing them under carpeting. This practice can help to reduce
the risk for falls.
11. Inguinal hernia- palpate lower abdomen
12. A nurse is providing teaching to a client who has esophageal cancer and is to undergo radiation
therapy. Which of the following statements should the nurse identify as an indication that the client
understands the teaching?
1. A nurse is caring for a client who has pancreatitis. The nurse should expect which of the following
laboratory results to be below the expected reference range?
Calcium- A client who has pancreatitis is expected to have decreased calcium and magnesium levels due
to fat necrosis
2. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following
laboratory findings should the nurse expect?
BUN 32 mg/dL- DKA results in osmotic diuresis and subsequent dehydration. The nurse should expect a
client who has DKA to have elevated BUN, creatinine, and specific gravity levels resulting from the excess
glucose present in the urine
The nurse should expect a client who has DKA to have a pH level less than 7.35 due to the increased
production of ketones, which results in metabolic acidosis. The client might exhibit Kussmaul
respirations, which are deep and rapid respirations that compensate for the decreased pH. Sodium
bicarbonate is administered for severe acidosis when the client's pH level is less than 7
The nurse should expect a client who has DKA to have an HCO3- less than 15 mEq/L. This decreased
value is due to an increased production of ketones, resulting in metabolic acidosis.
3. A nurse is providing discharge instructions to a client who has a partial thickness burn of the hand.
Which of the following instructions should the nurse include?
Wrap fingers with individual dressings- The nurse should instruct the client to wrap the fingers
individually to allow for functional use of the hand while healing occurs. The nurse should also instructthe
client to perform range-of-motion exercises to each finger every hour while awake to promote function of
the injured hand.
The nurse should instruct the client to change the dressing every 12 to 24 hr to allow for wound
inspection. The client should observe the wound closely for manifestations of increased redness, warmth,
drainage, edema, or foul odor, which can indicate an infection.
A client who undergoes surgery to receive skin grafts for full-thickness burns should elevate and
immobilize the graft site with cotton pressure dressings for 3 to 5 days following the procedure. This
action prevents the graft from dislodging and allows for revascularization of the wound.
4. A nurse is planning care for a client who has extensive burn injuries and is immunocompromised.
Which of the following precautions should the nurse include in the plan of care to prevent Pseudomonas
aeruginosa infection?
Avoid placing plants or flowers in the client's room- Live plants can harbor P. aeruginosa, and this
bacterium can infect burn wounds and cause life-threatening complications. The nurse should ensure no
one brings live plants or flowers into the client's room.
The nurse does not need to limit visits to family members. However, the nurse should prohibit visits from
those at risk for P. aeruginosa infection, such as anyone who is ill, other hospitalized clients, and small
children.
,P. aeruginosa spreads by contact, either on health care workers' hands or contaminated equipment. It is not
airborne, so respirator masks are unnecessary
5. A nurse in an emergency department is caring for a client who reports vomiting and diarrhea for the
past 3 days. Which of the following findings should indicate to the nurse that the client is experiencing
fluid volume deficit?
Heart rate 110/min- A client who has a 3-day history of vomiting and diarrhea is likely to have fluid
volume deficit and an elevated heart rate.
A blood pressure of 138/90 mm Hg is within the expected reference range. A client who has a 3-day
history of vomiting and diarrhea is likely to have fluid volume deficit and hypotension.
A urine specific gravity of 1.020 is within the expected reference range. A client who has a 3-day history
of vomiting and diarrhea is likely to have fluid volume deficit, which is indicated by a urine specific
gravity greater than 1.030.
A BUN of 15 mg/dL is within the expected reference range. A client who has a 3-day history of vomiting
and diarrhea is likely to have fluid volume deficit and a BUN greater than 20 mg/dL.
6. A nurse in an emergency department is reviewing the provider's prescriptions for a client who
sustained a rattlesnake bite to the lower leg. Which of the following prescriptions should the nurse
expect?
Administer an opioid analgesic to the client.- The nurse should expect a prescription for an opioid
analgesic to promote comfort following a rattlesnake bit
The nurse should apply ice for a bite from a black widow spider to reduce the action of the neurotoxin from
the spider.
The nurse should expect a prescription for antihistamines and corticosteroids for stings from bees and wasps
The nurse should keep the affected extremity at heart level, not above or below it.
7. A nurse is providing teaching to a client who has kidney disease and a new prescription for
erythropoietin. Which of the following statements by the client indicates an understanding of the
teaching?
"I am taking this medication to increase my energy level."- The goal of erythropoietin therapy is to
increase the level of hematocrit in clients who have anemia. When the medication is effective, the client
should have a decrease in fatigue and an improvement in activity tolerance.
A client who has chronic kidney disease should have adequate iron stores for erythropoietin therapy to be
effective. Clients are encouraged to consume foods high in iron such as beef, liver, pork, and veal.
Therapy with erythropoietin increases RBC production, which can result in hypertension, not hypotension
Erythropoietin does not affect the client's protein requirements, but the client should continue to restrict
protein as prescribed by the provider to manage kidney disease
, 8. A nurse is reviewing the laboratory results of a client who has cirrhosis. Which of the following
laboratory values should the nurse expect?
Elevated bilirubin level- Bilirubin levels reflect the liver's ability to conjugate and excrete bilirubin, a
byproduct of the hemolysis of red blood cells. Bilirubin levels rise with liver disease and clinically reflect
the client's degree of jaundice
Liver disease and severe liver cell damage causes the liver cells to produce less prothrombin, which
prolongs prothrombin time.
The liver converts ammonia to urea. When this process is interrupted, as it is with liver disease or liver
failure, ammonia levels rise.
Albumin forms in the liver. When liver function is impaired, as it is with cirrhosis, albumin levels decrease
9. A nurse in a community clinic is caring for a client who reports an increase in the frequency of
migraine headaches. To help reduce the risk for migraine headaches, which of the following foods should
the nurse recommend the client to avoid?
Aged cheese- Foods that contain tyramine, such as aged cheese and sausage, can trigger migraine headaches
Smoked fish, fermented/pickled, chocolate, yeast can trigger migraines
10. A nurse is planning to provide discharge teaching for the family of an older adult client who has
hemianopsia and is at risk for falls. Which of the following instructions should the nurse include?
Remind the client to scan their complete range of vision during ambulation- The nurse should instruct
the family to remind a client who has hemianopsia, or blindness in half of the visual field, to use visual
scanning to look over their complete range of vision during ambulation. This practice can accommodate
for the loss of vision and help to reduce the risk for falls
The nurse should instruct the client's family to keep the client's personal care items within the client's reach
to reduce the risk for falls.
The nurse should instruct the family to use nightlights in the client's bedroom and bathroom to reduce the
risk for falls. Keeping the overhead lights on while the client is sleeping can disrupt the client's circadian
rhythm.
The nurse should instruct the client's family that they should secure extension cords to the client's
baseboards using electrical tape, rather than placing them under carpeting. This practice can help to reduce
the risk for falls.
11. Inguinal hernia- palpate lower abdomen
12. A nurse is providing teaching to a client who has esophageal cancer and is to undergo radiation
therapy. Which of the following statements should the nurse identify as an indication that the client
understands the teaching?
