PN ADULT MEDICAL SURGICAL ACTUAL EXAM LATEST
2024/2025 DETAILED QUESTIONS AND VERIFIED CORRECT
ANSWERS/ ALREADY GRADED A++
Complete the diagram by dragging from the choices below to specify what
condition the client is most likely experiencing, 2 actions the nurse should
take to address that condition, and 2 parameters the nurse should monitor
to assess the client's progress. - ANSWER The nurse should reduce the
temperature in the client's room and limit visitors because the client has
manifestations of hyperthyroidism. Clients who have hyperthyroidism have
heat intolerance and require an environment with decreased stimuli. The
nurse should monitor the client for an increased temperature which can
indicate a thyroid storm, as well as the client's weight daily, to monitor for
weight loss.
A nurse is contributing to the plan of care for a client who has multiple
sclerosis and is taking dantrolene to manage muscle spasms. Which of the
following interventions should the nurse include? - ANSWER Encourage
the client to complete ADLs.
A nurse is assisting with the care for a client who has a new cast on their
left forearm and reports severe pain in the affected arm with numbness in
the fingers. The nurse finds the skin is pale and cold with sluggish capillary
refill. Which of the following fracture complications should the nurse
suspect? - ANSWER Compartment syndrome
A nurse is assisting with the care for a client who has Cushing's syndrome
and expresses concern regarding physical changes associated with the
syndrome. Which of the following should the nurse recognize as a physical
change caused by this disorder? - ANSWER Truncal obesity
A nurse is reinforcing teaching with a client who is taking levothyroxine.
Which of the following statements by the client indicates an understanding
of the teaching? - ANSWER "The medication should be taken before I eat
breakfast every morning."
A nurse is collecting data from a client who is being treated for hypovolemia
due to nausea and vomiting. Which of the following findings should the
nurse report to the provider? - ANSWER Heart rate 120/min
,FLAG
A nurse is assisting with the care for a client who reports stomatitis. Which
of the following dietary recommendations should the nurse make? -
ANSWER "Select foods that are low in protein."
A nurse is reviewing the medical record for a client who is experiencing
nausea and vomiting. Based on the client data, which of the following
actions should the nurse take? (Click on the exhibit tabs for additional
information about the client. There are three tabs that contain separate
categories of data.) - ANSWER Notify the charge nurse of the client's blood
pressure.
A nurse is reinforcing discharge teaching for the caregivers of a client who
has Parkinson's disease. Which of the following information should the
nurse include in the teaching? - ANSWER Remind the client to avoid
watching their feet when walking.
A nurse observes a client who is lying in bed and experiencing a tonic-
clonic seizure. Which of the following actions should the nurse take? -
ANSWER Loosen clothing around the client's neck.
A nurse is assisting with the care for a client who has acute pancreatitis.
While providing care, the nurse observes ecchymosis around the umbilicus.
The nurse should identify that this is a manifestation of which of the
following? - ANSWER Intra-abdominal bleeding
A home health nurse is assisting with the care for a client who has COPD.
The client reports shortness of breath while eating, despite the use of home
oxygen. Which of the following recommendations should the nurse make? -
ANSWER "Use a bronchodilator 30 minutes before your meal."
A nurse is changing the dressing for a client who has an abdominal incision
and a closed-suction drain. Which of the following actions should the nurse
take? - ANSWER Cleanse the drainage plug with alcohol swabs.
A nurse is contributing to planning care for a client who overdosed on
oxycodone. Which of the following medications should the nurse
recommend for the client? - ANSWER Naloxone
,A nurse is assisting with the care of a client who is at risk for developing
pressure injuries. Which of the following actions should the nurse take? -
ANSWER Position pillows between the bony prominences.
A nurse is reinforcing teaching with an adolescent client regarding testicular
self-examination. Which of the following statements by the client
demonstrates an understanding of the teaching? - ANSWER "I understand
that testicular cancer is typically painless."
A nurse is reinforcing discharge teaching with a client who has leukemia
and is receiving chemotherapy. Which of the following statements should
the nurse include in the teaching? - ANSWER "You should place your
toothbrush in hydrogen peroxide."
A nurse is assisting with the care of a client who has restricted movement
of the chest due to a burn injury. The nurse should anticipate preparing the
client for which of the following procedures? - ANSWER Escharotomy
A nurse is assisting in the plan of care regarding bowel retraining for a
client who has a cervical spinal cord injury. Which of the following
interventions should the nurse plan to implement first? - ANSWER
Determine the client's daily elimination habits.
A nurse is contributing to the plan of care for a client who was admitted to
the neurological unit following a stroke 3 hr ago. Which of the following
interventions should the nurse identify as the priority? - ANSWER Keep the
client in a side-lying position.
A nurse is reinforcing teaching with a client who is scheduled for a guaiac
fecal occult blood test. Which of the following instructions should the nurse
include in the teaching? - ANSWER Avoid eating red meat for 3 days prior
to the test.
A nurse in a clinic is collecting data from a client who has hyperthyroidism
and has been taking methimazole for 4 weeks. Which of the following
statements by the client indicates a therapeutic response to the
medication? - ANSWER "I have gained 3 pounds since my last
appointment."
, A nurse is reinforcing teaching with a client who has gonorrhea. Which of
the following information should the nurse include? - ANSWER "You are at
risk for infertility with this infection, regardless of treatment."
A nurse is assisting with the care of a client who has hearing loss. Which of
the following actions should the nurse take? - ANSWER Lower voice pitch
when speaking
A nurse in a long-term care facility is collecting data from a client who
reports fullness in the rectum and abdominal cramping. Which of the
following findings should indicate to the nurse that the client might have a
fecal impaction? - ANSWER Small liquid stools
A nurse is reviewing the medication record of a client who is taking digoxin.
Which of the following medications should the nurse identify as increasing
the risk for the client to develop digoxin toxicity? - ANSWER Furosemide
A nurse is contributing to the plan of care for a client who has peripheral
arterial disease of the lower extremities. Which of the following
interventions should the nurse include? - ANSWER Dangle the extremities
off the side of the bed.
A nurse is preparing to administer phytonadione 7 mg subcutaneously to a
client who has an INR of 4. Available is phytonadione 10 mg/mL. How
many mL should the nurse administer? (Round the answer to the nearest
tenth. Use a leading zero if it applies. Do not use a trailing zero.) -
ANSWER 0.7 mL
A nurse is reinforcing teaching with a client about increasing dietary fiber.
The nurse should recommend which of the following foods as the best
source of fiber? - ANSWER 1/2 cup cooked kidney beans
A nurse in a telemetry unit is collecting data from a client who has a newly
inserted permanent pacemaker. Which of the following findings should the
nurse report to the provider? - ANSWER The client experiences hiccups
when sitting.
2024/2025 DETAILED QUESTIONS AND VERIFIED CORRECT
ANSWERS/ ALREADY GRADED A++
Complete the diagram by dragging from the choices below to specify what
condition the client is most likely experiencing, 2 actions the nurse should
take to address that condition, and 2 parameters the nurse should monitor
to assess the client's progress. - ANSWER The nurse should reduce the
temperature in the client's room and limit visitors because the client has
manifestations of hyperthyroidism. Clients who have hyperthyroidism have
heat intolerance and require an environment with decreased stimuli. The
nurse should monitor the client for an increased temperature which can
indicate a thyroid storm, as well as the client's weight daily, to monitor for
weight loss.
A nurse is contributing to the plan of care for a client who has multiple
sclerosis and is taking dantrolene to manage muscle spasms. Which of the
following interventions should the nurse include? - ANSWER Encourage
the client to complete ADLs.
A nurse is assisting with the care for a client who has a new cast on their
left forearm and reports severe pain in the affected arm with numbness in
the fingers. The nurse finds the skin is pale and cold with sluggish capillary
refill. Which of the following fracture complications should the nurse
suspect? - ANSWER Compartment syndrome
A nurse is assisting with the care for a client who has Cushing's syndrome
and expresses concern regarding physical changes associated with the
syndrome. Which of the following should the nurse recognize as a physical
change caused by this disorder? - ANSWER Truncal obesity
A nurse is reinforcing teaching with a client who is taking levothyroxine.
Which of the following statements by the client indicates an understanding
of the teaching? - ANSWER "The medication should be taken before I eat
breakfast every morning."
A nurse is collecting data from a client who is being treated for hypovolemia
due to nausea and vomiting. Which of the following findings should the
nurse report to the provider? - ANSWER Heart rate 120/min
,FLAG
A nurse is assisting with the care for a client who reports stomatitis. Which
of the following dietary recommendations should the nurse make? -
ANSWER "Select foods that are low in protein."
A nurse is reviewing the medical record for a client who is experiencing
nausea and vomiting. Based on the client data, which of the following
actions should the nurse take? (Click on the exhibit tabs for additional
information about the client. There are three tabs that contain separate
categories of data.) - ANSWER Notify the charge nurse of the client's blood
pressure.
A nurse is reinforcing discharge teaching for the caregivers of a client who
has Parkinson's disease. Which of the following information should the
nurse include in the teaching? - ANSWER Remind the client to avoid
watching their feet when walking.
A nurse observes a client who is lying in bed and experiencing a tonic-
clonic seizure. Which of the following actions should the nurse take? -
ANSWER Loosen clothing around the client's neck.
A nurse is assisting with the care for a client who has acute pancreatitis.
While providing care, the nurse observes ecchymosis around the umbilicus.
The nurse should identify that this is a manifestation of which of the
following? - ANSWER Intra-abdominal bleeding
A home health nurse is assisting with the care for a client who has COPD.
The client reports shortness of breath while eating, despite the use of home
oxygen. Which of the following recommendations should the nurse make? -
ANSWER "Use a bronchodilator 30 minutes before your meal."
A nurse is changing the dressing for a client who has an abdominal incision
and a closed-suction drain. Which of the following actions should the nurse
take? - ANSWER Cleanse the drainage plug with alcohol swabs.
A nurse is contributing to planning care for a client who overdosed on
oxycodone. Which of the following medications should the nurse
recommend for the client? - ANSWER Naloxone
,A nurse is assisting with the care of a client who is at risk for developing
pressure injuries. Which of the following actions should the nurse take? -
ANSWER Position pillows between the bony prominences.
A nurse is reinforcing teaching with an adolescent client regarding testicular
self-examination. Which of the following statements by the client
demonstrates an understanding of the teaching? - ANSWER "I understand
that testicular cancer is typically painless."
A nurse is reinforcing discharge teaching with a client who has leukemia
and is receiving chemotherapy. Which of the following statements should
the nurse include in the teaching? - ANSWER "You should place your
toothbrush in hydrogen peroxide."
A nurse is assisting with the care of a client who has restricted movement
of the chest due to a burn injury. The nurse should anticipate preparing the
client for which of the following procedures? - ANSWER Escharotomy
A nurse is assisting in the plan of care regarding bowel retraining for a
client who has a cervical spinal cord injury. Which of the following
interventions should the nurse plan to implement first? - ANSWER
Determine the client's daily elimination habits.
A nurse is contributing to the plan of care for a client who was admitted to
the neurological unit following a stroke 3 hr ago. Which of the following
interventions should the nurse identify as the priority? - ANSWER Keep the
client in a side-lying position.
A nurse is reinforcing teaching with a client who is scheduled for a guaiac
fecal occult blood test. Which of the following instructions should the nurse
include in the teaching? - ANSWER Avoid eating red meat for 3 days prior
to the test.
A nurse in a clinic is collecting data from a client who has hyperthyroidism
and has been taking methimazole for 4 weeks. Which of the following
statements by the client indicates a therapeutic response to the
medication? - ANSWER "I have gained 3 pounds since my last
appointment."
, A nurse is reinforcing teaching with a client who has gonorrhea. Which of
the following information should the nurse include? - ANSWER "You are at
risk for infertility with this infection, regardless of treatment."
A nurse is assisting with the care of a client who has hearing loss. Which of
the following actions should the nurse take? - ANSWER Lower voice pitch
when speaking
A nurse in a long-term care facility is collecting data from a client who
reports fullness in the rectum and abdominal cramping. Which of the
following findings should indicate to the nurse that the client might have a
fecal impaction? - ANSWER Small liquid stools
A nurse is reviewing the medication record of a client who is taking digoxin.
Which of the following medications should the nurse identify as increasing
the risk for the client to develop digoxin toxicity? - ANSWER Furosemide
A nurse is contributing to the plan of care for a client who has peripheral
arterial disease of the lower extremities. Which of the following
interventions should the nurse include? - ANSWER Dangle the extremities
off the side of the bed.
A nurse is preparing to administer phytonadione 7 mg subcutaneously to a
client who has an INR of 4. Available is phytonadione 10 mg/mL. How
many mL should the nurse administer? (Round the answer to the nearest
tenth. Use a leading zero if it applies. Do not use a trailing zero.) -
ANSWER 0.7 mL
A nurse is reinforcing teaching with a client about increasing dietary fiber.
The nurse should recommend which of the following foods as the best
source of fiber? - ANSWER 1/2 cup cooked kidney beans
A nurse in a telemetry unit is collecting data from a client who has a newly
inserted permanent pacemaker. Which of the following findings should the
nurse report to the provider? - ANSWER The client experiences hiccups
when sitting.
