Medical-Surgical Exam - Version A
Your response has been submitted successfully.
Points
26
Awarded
Points
85
Missed
Percentage 23%
1. The nurse is assessing a client with bacterial meningitis. Which
assessment finding indicates the client may have developed septic
emboli?
A. Cyanosis of the fingertips.
B. Bradycardia and bradypnea.
C. Presence of S3 and S4 heart sounds.
D. 3+ pitting edema of the lower
extremities.
Septic emboli secondary to meningitis commonly lodge in the small
arterioles of the extremities, causing a decrease in circulation to the
hands (A) which may lead to gangrene. (B, C, and D) are abnormal
findings, but do not indicate the development of septic emboli.
Points Earned: 0/1
Correct Answer: A
Your Response: C
2. A client experiencing uncontrolled atrial fibrillation is admitted to
the telemetry unit. What initial medication should the nurse
anticipate administering to the client?
A. Xylocaine (Lidocaine).
B. Procainamide
(Pronestyl).
C. Phenytoin (Dilantin).
D. Digoxin (Lanoxin).
Digoxin (Lanoxin) (D) is administered for uncontrolled, symptomatic
atrial fibrillation resulting in a decreased cardiac output. Digoxin slows
the rate of conduction by prolonging the refractory period of the AV
node, thus slowing the ventricular response, decreasing the heart rate,
,and effecting cardiac output. (A, B, and C) are not indicated in the
initial treatment of uncontrolled atrial fibrillation.
Points Earned: 0/1
Correct Answer: D
Your Response: A
3. How should the nurse position the electrodes for modified chest
lead one (MCL I) telemetry monitoring?
A. Positive polarity right shoulder, negative polarity left shoulder,
ground left chest nipple line.
B. Positive polarity left shoulder, negative polarity right chest nipple
line, ground left chest nipple line.
C. Positive polarity right chest nipple line, negative polarity left
chest nipple line, ground left shoulder.
D. Negative polarity left shoulder, positive polarity right chest nipple
line, ground left chest nipple line.
In MCL I monitoring, the positive electrode is placed on the client's
mid-chest to the right of the sternum, and the negative electrode is
placed on the upper left part of the chest (D). The ground may be
placed anywhere, but is usually placed on the lower left portion of the
chest. (A, B, and C) describe incorrect placement of electrodes for
telemetry monitoring.
Points Earned: 0/1
Correct Answer: D
Your Response: A
4. 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-year-old 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.
In older adults, the protein found in urine slightly rises probably as a
result of kidney changes or subclinical urinary tract infections. The
serum glucose increases slightly due to changes in the kidney. The
specific gravity declines by age 80 from 1.032 to 1.024.
Points Earned: 0/1
Correct Answer: C
Your Response: A
,5. A client is brought to the Emergency Center after a snow-skiing
accident. Which intervention is most important for the nurse to
implement?
A. Review the electrocardiogram
tracing.
B. Obtain blood for coagulation
studies.
C. Apply a warming blanket.
D. Provide heated PO fluids.
Airway, breathing, and circulation are priorities in client assessment
and treatment. Continuous cardiac monitoring is indicated (A) because
hypothermic clients have an increased risk for dysrhythmias.
Coagulations studies (A) and re-warming procedures (C and D) can be
initiated after a review of the ECG tracing (A).
Points Earned: 1/1
Correct Answer: A
Your Response: A
6. A 20-year-old female client calls the nurse to report a lump she
found in her breast. Which response is the best for the nurse to
provide?
A. Check it again in one month, and if it is still there schedule an
appointment.
B. Most lumps are benign, but it is always best to come in for an
examination.
C. Try not to worry too much about it, because usually, most lumps
are benign.
D. If you are in your menstrual period it is not a good time to check
for lumps.
(B) provides the best response because it addresses the client's
anxiety most effectively and encourages prompt and immediate action
for a potential problem. (A) postpones treatment if the lump is
malignant, and does not relieve the client's anxiety. (C and D) provide
false reassurance and do not help relieve anxiety.
Points Earned: 0/1
Correct Answer: B
Your Response: C
7. A male client receives a local anesthetic during surgery. During the
post-operative assessment, the nurse notices the client is slurring
, his speech. Which action should the nurse take?
A. Determine the client is anxious and allow him to sleep.
B. Evaluate his blood pressure, pulse, and respiratory
status.
C. Review the client's pre-operative history for alcohol
abuse.
D. Continue to monitor the client for reactivity to
anesthesia.
Slurred speech in the post-operative client who received a local
anesthetic is an atypical finding and may indicate neurological deficits
that require further assessment, so obtaining the client's vital signs (B)
will provide information about possible cardiovascular complications,
such as stroke. The client's anxiety (A), a history of alcohol abuse (D),
or local anesthesia (D) are unrelated to the client's sudden onset of
slurred speech.
Points Earned: 1/1
Correct Answer: B
Your Response: B
8. A client is admitted to the hospital with a diagnosis of severe acute
diverticulitis. Which assessment finding should the nurse expect this
client to exhibit?
A. Lower left quadrant pain and a low-grade
fever.
B. Severe pain at McBurney's point and
nausea.
C. Abdominal pain and intermittent tenesmus.
D. Exacerbations of severe diarrhea.
Left lower quadrant pain occurs with diverticulitis because the sigmoid
colon is the most common area for diverticula, and the inflammation of
diverticula causes a low-grade fever (A). (B) would be indicative of
appendicitis. (C and D) are symptoms exhibited with ulcerative colitis.
Points Earned: 1/1
Correct Answer: A
Your Response: A
9. 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
Your response has been submitted successfully.
Points
26
Awarded
Points
85
Missed
Percentage 23%
1. The nurse is assessing a client with bacterial meningitis. Which
assessment finding indicates the client may have developed septic
emboli?
A. Cyanosis of the fingertips.
B. Bradycardia and bradypnea.
C. Presence of S3 and S4 heart sounds.
D. 3+ pitting edema of the lower
extremities.
Septic emboli secondary to meningitis commonly lodge in the small
arterioles of the extremities, causing a decrease in circulation to the
hands (A) which may lead to gangrene. (B, C, and D) are abnormal
findings, but do not indicate the development of septic emboli.
Points Earned: 0/1
Correct Answer: A
Your Response: C
2. A client experiencing uncontrolled atrial fibrillation is admitted to
the telemetry unit. What initial medication should the nurse
anticipate administering to the client?
A. Xylocaine (Lidocaine).
B. Procainamide
(Pronestyl).
C. Phenytoin (Dilantin).
D. Digoxin (Lanoxin).
Digoxin (Lanoxin) (D) is administered for uncontrolled, symptomatic
atrial fibrillation resulting in a decreased cardiac output. Digoxin slows
the rate of conduction by prolonging the refractory period of the AV
node, thus slowing the ventricular response, decreasing the heart rate,
,and effecting cardiac output. (A, B, and C) are not indicated in the
initial treatment of uncontrolled atrial fibrillation.
Points Earned: 0/1
Correct Answer: D
Your Response: A
3. How should the nurse position the electrodes for modified chest
lead one (MCL I) telemetry monitoring?
A. Positive polarity right shoulder, negative polarity left shoulder,
ground left chest nipple line.
B. Positive polarity left shoulder, negative polarity right chest nipple
line, ground left chest nipple line.
C. Positive polarity right chest nipple line, negative polarity left
chest nipple line, ground left shoulder.
D. Negative polarity left shoulder, positive polarity right chest nipple
line, ground left chest nipple line.
In MCL I monitoring, the positive electrode is placed on the client's
mid-chest to the right of the sternum, and the negative electrode is
placed on the upper left part of the chest (D). The ground may be
placed anywhere, but is usually placed on the lower left portion of the
chest. (A, B, and C) describe incorrect placement of electrodes for
telemetry monitoring.
Points Earned: 0/1
Correct Answer: D
Your Response: A
4. 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-year-old 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.
In older adults, the protein found in urine slightly rises probably as a
result of kidney changes or subclinical urinary tract infections. The
serum glucose increases slightly due to changes in the kidney. The
specific gravity declines by age 80 from 1.032 to 1.024.
Points Earned: 0/1
Correct Answer: C
Your Response: A
,5. A client is brought to the Emergency Center after a snow-skiing
accident. Which intervention is most important for the nurse to
implement?
A. Review the electrocardiogram
tracing.
B. Obtain blood for coagulation
studies.
C. Apply a warming blanket.
D. Provide heated PO fluids.
Airway, breathing, and circulation are priorities in client assessment
and treatment. Continuous cardiac monitoring is indicated (A) because
hypothermic clients have an increased risk for dysrhythmias.
Coagulations studies (A) and re-warming procedures (C and D) can be
initiated after a review of the ECG tracing (A).
Points Earned: 1/1
Correct Answer: A
Your Response: A
6. A 20-year-old female client calls the nurse to report a lump she
found in her breast. Which response is the best for the nurse to
provide?
A. Check it again in one month, and if it is still there schedule an
appointment.
B. Most lumps are benign, but it is always best to come in for an
examination.
C. Try not to worry too much about it, because usually, most lumps
are benign.
D. If you are in your menstrual period it is not a good time to check
for lumps.
(B) provides the best response because it addresses the client's
anxiety most effectively and encourages prompt and immediate action
for a potential problem. (A) postpones treatment if the lump is
malignant, and does not relieve the client's anxiety. (C and D) provide
false reassurance and do not help relieve anxiety.
Points Earned: 0/1
Correct Answer: B
Your Response: C
7. A male client receives a local anesthetic during surgery. During the
post-operative assessment, the nurse notices the client is slurring
, his speech. Which action should the nurse take?
A. Determine the client is anxious and allow him to sleep.
B. Evaluate his blood pressure, pulse, and respiratory
status.
C. Review the client's pre-operative history for alcohol
abuse.
D. Continue to monitor the client for reactivity to
anesthesia.
Slurred speech in the post-operative client who received a local
anesthetic is an atypical finding and may indicate neurological deficits
that require further assessment, so obtaining the client's vital signs (B)
will provide information about possible cardiovascular complications,
such as stroke. The client's anxiety (A), a history of alcohol abuse (D),
or local anesthesia (D) are unrelated to the client's sudden onset of
slurred speech.
Points Earned: 1/1
Correct Answer: B
Your Response: B
8. A client is admitted to the hospital with a diagnosis of severe acute
diverticulitis. Which assessment finding should the nurse expect this
client to exhibit?
A. Lower left quadrant pain and a low-grade
fever.
B. Severe pain at McBurney's point and
nausea.
C. Abdominal pain and intermittent tenesmus.
D. Exacerbations of severe diarrhea.
Left lower quadrant pain occurs with diverticulitis because the sigmoid
colon is the most common area for diverticula, and the inflammation of
diverticula causes a low-grade fever (A). (B) would be indicative of
appendicitis. (C and D) are symptoms exhibited with ulcerative colitis.
Points Earned: 1/1
Correct Answer: A
Your Response: A
9. 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
