Med Surg Final Exam Review
Chapter 42
1. The nurse is creating the care plan for a 70-year-old obese client who has been admitted
to the postsurgical unit following a colon resection. This client's age and increased body
mass index mean that the client is at increased risk for what complication in the
postoperative period?
a. Infection
Rationale: Like age, obesity increases the risk and severity of complications associated with
surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity
increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound
separation) and wound infections are more common. A postoperative client who is obese will not
likely be at greater risk for hyperglycemia, azotemia, or falls.\
2. A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going
to sleep at night, and snoring. The nurse should recognize the manifestations of what
health problem?
a. Obstructive sleep apnea
Rationale: Obstructive sleep apnea occurs in men, especially those who are older and
overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime
sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis.
This client's symptoms are not suggestive of laryngeal cancer.
3. A nurse is performing a health history on a client with obesity. Which condition is the
client most at risk for with a diagnosis of obesity?
a. Diabetes
Rationale: Clients are at a high risk for diabetes with a concurrent diagnosis of obesity.
4. The nurse is caring for a client that has undergone bariatric surgery. Which indication is a
complication from the surgery?
a. Dumping syndrome
Rationale: After surgery, the nurse assesses the client for complications from bariatric surgery,
such as changes in bowel habits, hemorrhage, venous thromboembolism (VTE), bile reflux,
dumping syndrome, dysphagia, and bowel or gastric outlet obstruction. Cushing syndrome,
malnutrition, and diverticulitis risk are not associated with bariatric surgery.
, 5. A client has recently been diagnosed with type 2 diabetes. The client is clinically obese
and has a sedentary lifestyle. How can the nurse best begin to help increase the client’s
activity level?
a. Identify barriers with the client that inhibit his lifestyle change.
Rationale: Nurses cannot expect sedentary clients to develop a sudden passion for exercise or
that they will rearrange their day to accommodate time-consuming exercise plans. The client
may not be ready or willing to accept this lifestyle change. This is why it is important that the
nurse and client identify barriers to change.
6. The nurse is caring for a client who had an intragastric balloon placed 5 months ago for
the treatment of obesity. The client's abdominal girth has increased over the past 48 hours
and the last bowel movement was 72 hours ago. What is the nurse's best action?
a. Report the possibility of balloon rupture to the primary provider.
Rationale: Balloon rupture can cause intestinal obstruction, which must be promptly addressed
by the primary provider. Waiting to perform further monitoring and assessment would be
inadequate, and the nurse should not place the onus for follow-up on the client.
Chapter 43
1. A nurse is caring for a client with liver failure and is performing an assessment of the
client's increased risk of bleeding. The nurse recognizes that this risk is related to the
client's inability to synthesize prothrombin in the liver. What factor most likely
contributes to this loss of function?
a. Inability of the liver to use vitamin K
Rationale: Decreased production of several clotting factors may be partially due to deficient
absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells
to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile
salts, or albumin.
2. A client with portal hypertension has been admitted to the medical floor. The nurse
should prioritize what assessments?
a. Daily weights and abdominal girth measurement
Rationale: Obstruction to blood flow through the damaged liver results in increased blood
pressure (portal hypertension) throughout the portal venous system. This can result in varices and
ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal
girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not
create a risk for unstable blood glucose or VTE.
, 3. A client who has undergone liver transplantation is ready to be discharged home. Which
outcome of health education should the nurse prioritize?
a. The client will take immunosuppressive agents as required.
Rationale: The client is given written and verbal instructions about immunosuppressive agent
doses and dosing schedules. The client is also instructed on steps to follow to ensure that an
adequate supply of medication is available so that there is no chance of running out of the
medication or skipping a dose. Failure to take medications as instructed may precipitate
rejection. The nurse would not teach the client to measure drainage from a T-tube as the client
wouldn't go home with a T-tube. The nurse may teach the client about the need to exercise or
what the signs of liver dysfunction are, but the nurse would not stress these topics over the
immunosuppressive drug regimen.
4. A nurse is participating in the emergency care of a client who has just developed variceal
bleeding. What intervention should the nurse anticipate?
a. IV administration of octreotide
Rationale: Octreotide—a synthetic analog of the hormone somatostatin—is effective in
decreasing bleeding from esophageal varices and lacks the vasoconstrictive effects of
vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred
treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin are not
given, and heparin would exacerbate, not alleviate, bleeding.
5. A nurse is caring for a client with hepatic encephalopathy. While making the initial shift
assessment, the nurse notes that the client has a flapping tremor of the hands. The nurse
should document the presence of what sign of liver disease?
a. Asterixis
Rationale: The nurse will document that a client exhibiting a flapping tremor of the hands is
demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to
reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not
associated with a motor disturbance. Skin changes associated with liver dysfunction may include
palmar erythema, which is a reddening of the palms, but is not a flapping tremor.
6. A client has been diagnosed with advanced stage breast cancer and will soon begin
aggressive treatment. What assessment findings would most strongly suggest that the
client may have developed liver metastases?
a. Abdominal pain and hepatomegaly
Rationale: The early manifestations of malignancy of the liver include pain—a continuous dull
ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia,
and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is
, present only if the larger bile ducts are occluded by the pressure of malignant nodules in the
hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.
7. A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals
that the client exhibits episodes of confusion, is difficult to arouse from sleep and has
rigid extremities. Based on these clinical findings, the nurse should document what stage
of hepatic encephalopathy?
a. Stage 3
Rationale: Clients in the third stage of hepatic encephalopathy exhibit the following symptoms:
stuporous, difficult to arouse, sleep most of the time, exhibits marked confusion, incoherent in
speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG
abnormalities. Clients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as
found in stage 3, and clients in stage 4 are comatose. In stage 4, there is an absence of asterixis,
absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.
8. A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free
bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk?
a. Central nervous system damage
Rationale: Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in
the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25
mg/dL) poses a risk for CNS damage. There are not specific risks of hepatomegaly or chronic
jaundice resulting from high bilirubin.
9. The nurse's review of a client's most recent laboratory results indicates a bilirubin level of
3.0 mg/dL (51 mmol/L). The nurse assesses the client for:
a. jaundice.
Rationale: Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.0
mg/dL (34 mmol/L). Elevated bilirubin levels are not associated with hypokalemia, malnutrition
or bleeding, though these complications may result from the underlying liver disorder.
Chapter 44
1. A nurse is assessing a client who has been diagnosed with cholecystitis and is
experiencing localized abdominal pain. When assessing the characteristics of the client's
pain, the nurse should anticipate that it may radiate to what region?
a. Right shoulder
Rationale: The client may have biliary colic with excruciating upper-right abdominal pain that
radiates to the back or right shoulder. Pain from cholecystitis does not typically radiate to the left
upper chest, inguinal area, neck, or jaw.
Chapter 42
1. The nurse is creating the care plan for a 70-year-old obese client who has been admitted
to the postsurgical unit following a colon resection. This client's age and increased body
mass index mean that the client is at increased risk for what complication in the
postoperative period?
a. Infection
Rationale: Like age, obesity increases the risk and severity of complications associated with
surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity
increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound
separation) and wound infections are more common. A postoperative client who is obese will not
likely be at greater risk for hyperglycemia, azotemia, or falls.\
2. A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going
to sleep at night, and snoring. The nurse should recognize the manifestations of what
health problem?
a. Obstructive sleep apnea
Rationale: Obstructive sleep apnea occurs in men, especially those who are older and
overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime
sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis.
This client's symptoms are not suggestive of laryngeal cancer.
3. A nurse is performing a health history on a client with obesity. Which condition is the
client most at risk for with a diagnosis of obesity?
a. Diabetes
Rationale: Clients are at a high risk for diabetes with a concurrent diagnosis of obesity.
4. The nurse is caring for a client that has undergone bariatric surgery. Which indication is a
complication from the surgery?
a. Dumping syndrome
Rationale: After surgery, the nurse assesses the client for complications from bariatric surgery,
such as changes in bowel habits, hemorrhage, venous thromboembolism (VTE), bile reflux,
dumping syndrome, dysphagia, and bowel or gastric outlet obstruction. Cushing syndrome,
malnutrition, and diverticulitis risk are not associated with bariatric surgery.
, 5. A client has recently been diagnosed with type 2 diabetes. The client is clinically obese
and has a sedentary lifestyle. How can the nurse best begin to help increase the client’s
activity level?
a. Identify barriers with the client that inhibit his lifestyle change.
Rationale: Nurses cannot expect sedentary clients to develop a sudden passion for exercise or
that they will rearrange their day to accommodate time-consuming exercise plans. The client
may not be ready or willing to accept this lifestyle change. This is why it is important that the
nurse and client identify barriers to change.
6. The nurse is caring for a client who had an intragastric balloon placed 5 months ago for
the treatment of obesity. The client's abdominal girth has increased over the past 48 hours
and the last bowel movement was 72 hours ago. What is the nurse's best action?
a. Report the possibility of balloon rupture to the primary provider.
Rationale: Balloon rupture can cause intestinal obstruction, which must be promptly addressed
by the primary provider. Waiting to perform further monitoring and assessment would be
inadequate, and the nurse should not place the onus for follow-up on the client.
Chapter 43
1. A nurse is caring for a client with liver failure and is performing an assessment of the
client's increased risk of bleeding. The nurse recognizes that this risk is related to the
client's inability to synthesize prothrombin in the liver. What factor most likely
contributes to this loss of function?
a. Inability of the liver to use vitamin K
Rationale: Decreased production of several clotting factors may be partially due to deficient
absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells
to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile
salts, or albumin.
2. A client with portal hypertension has been admitted to the medical floor. The nurse
should prioritize what assessments?
a. Daily weights and abdominal girth measurement
Rationale: Obstruction to blood flow through the damaged liver results in increased blood
pressure (portal hypertension) throughout the portal venous system. This can result in varices and
ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal
girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not
create a risk for unstable blood glucose or VTE.
, 3. A client who has undergone liver transplantation is ready to be discharged home. Which
outcome of health education should the nurse prioritize?
a. The client will take immunosuppressive agents as required.
Rationale: The client is given written and verbal instructions about immunosuppressive agent
doses and dosing schedules. The client is also instructed on steps to follow to ensure that an
adequate supply of medication is available so that there is no chance of running out of the
medication or skipping a dose. Failure to take medications as instructed may precipitate
rejection. The nurse would not teach the client to measure drainage from a T-tube as the client
wouldn't go home with a T-tube. The nurse may teach the client about the need to exercise or
what the signs of liver dysfunction are, but the nurse would not stress these topics over the
immunosuppressive drug regimen.
4. A nurse is participating in the emergency care of a client who has just developed variceal
bleeding. What intervention should the nurse anticipate?
a. IV administration of octreotide
Rationale: Octreotide—a synthetic analog of the hormone somatostatin—is effective in
decreasing bleeding from esophageal varices and lacks the vasoconstrictive effects of
vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred
treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin are not
given, and heparin would exacerbate, not alleviate, bleeding.
5. A nurse is caring for a client with hepatic encephalopathy. While making the initial shift
assessment, the nurse notes that the client has a flapping tremor of the hands. The nurse
should document the presence of what sign of liver disease?
a. Asterixis
Rationale: The nurse will document that a client exhibiting a flapping tremor of the hands is
demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to
reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not
associated with a motor disturbance. Skin changes associated with liver dysfunction may include
palmar erythema, which is a reddening of the palms, but is not a flapping tremor.
6. A client has been diagnosed with advanced stage breast cancer and will soon begin
aggressive treatment. What assessment findings would most strongly suggest that the
client may have developed liver metastases?
a. Abdominal pain and hepatomegaly
Rationale: The early manifestations of malignancy of the liver include pain—a continuous dull
ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia,
and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is
, present only if the larger bile ducts are occluded by the pressure of malignant nodules in the
hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.
7. A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals
that the client exhibits episodes of confusion, is difficult to arouse from sleep and has
rigid extremities. Based on these clinical findings, the nurse should document what stage
of hepatic encephalopathy?
a. Stage 3
Rationale: Clients in the third stage of hepatic encephalopathy exhibit the following symptoms:
stuporous, difficult to arouse, sleep most of the time, exhibits marked confusion, incoherent in
speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG
abnormalities. Clients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as
found in stage 3, and clients in stage 4 are comatose. In stage 4, there is an absence of asterixis,
absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.
8. A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free
bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk?
a. Central nervous system damage
Rationale: Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in
the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25
mg/dL) poses a risk for CNS damage. There are not specific risks of hepatomegaly or chronic
jaundice resulting from high bilirubin.
9. The nurse's review of a client's most recent laboratory results indicates a bilirubin level of
3.0 mg/dL (51 mmol/L). The nurse assesses the client for:
a. jaundice.
Rationale: Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.0
mg/dL (34 mmol/L). Elevated bilirubin levels are not associated with hypokalemia, malnutrition
or bleeding, though these complications may result from the underlying liver disorder.
Chapter 44
1. A nurse is assessing a client who has been diagnosed with cholecystitis and is
experiencing localized abdominal pain. When assessing the characteristics of the client's
pain, the nurse should anticipate that it may radiate to what region?
a. Right shoulder
Rationale: The client may have biliary colic with excruciating upper-right abdominal pain that
radiates to the back or right shoulder. Pain from cholecystitis does not typically radiate to the left
upper chest, inguinal area, neck, or jaw.
