MED SURG HESI BSN 266 FINAL EXAM QUESTION BANK
(A NEW UPDATED VERSION) NEWEST 2024 COMPLETE
REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS (APPROVED SOLUTIONS)
A 77 yr old female is admitted to the hospital. She is confused, has no appetite, is
nauseated and vomiting, and is complaining of a headache. Her pulse rate is 43 bpm.
Which question is priority for the nurse to ask this pt or her family on admission? -
ANSWER: Does the pt take digitails?
It is important to ontain a complete medication history, the symptoms described are
classic for digutails toxicity and assessment of this problem should be made
promptly.
The nurse is working with a 71 yr old obese pt with bilateral osteoarthritis of the
hips. What recommendation should the nurse make that is most beneficial in
protecting the pt joints? - ANSWER: Initiate a weight-reduction diet to achieve a
healthy body weight.
Achieving a healthy weight is critical to protect the joints of pt with OA. Weight loss
will take off the excess pressure that joints are exposed to
An elderly male pt comes to the geriatric screening clinic complaining of pain in his
left calf. The nurse notices a reddened area on the calf of his right leg which is warm
to the touch and suspects it might be thrombophlebitis. Which type of pain would
further confirm this suspicion? - ANSWER: Pain in the calf upon exertion which is
relieved by rest and elevating the extremity.
In preparing to administer intravenous albumin to a client following surgery, what is
the priority nursing intervention? (Select all that apply.)
A) Set the infusion pump to infuse the albumin within four hours.
B) Compare the client's blood type with the label on the albumin.
C) Assign a UAP to monitor blood pressure q15 minutes.
D) Administer through a large gauge catheter.
E) Monitor hemoglobin and hematocrit levels.
F) Assess for increased bleeding after administration. - ANSWER: A,d, e, f
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. - ANSWER: Evaluate his
BP, pulse, and respiratory status
,Slurred speech in the post operative client who received a local anesthesia is an
atypical finding and may indicate neurological deficits that require further
assessment.
Which symptoms should the nurse expect a client to exhibit who is diagnosed with a
pheochromocytoma? - ANSWER: Headache, diaphoresis, and palpitations
A client with diabetes mellitus is experiencing polyphagia. Which outcome statement
is the priority for this client?
A) Fluid and electrolyte balance.
B) Prevention of water toxicity.
C) Reduced glucose in the urine.
D) Adequate cellular nourishment. - ANSWER: Adequate cellular nourishment
The nurse is teaching a female client about the best time to plan intercourse in order
to conceive. Which information should the nurse provide? - ANSWER: Two weeks
before menstruation
Which intervention should the nurse plan to implement when caring for a client who
has just undergone a right above-the-knee amputation?
A) Maintain the residual limb on three pillows at all times.
B) Place a large tourniquet at the client's bedside.
C) Apply constant, direct pressure to the residual limb.
D) Do not allow the client to lie in the prone position. - ANSWER: B) Place a large
tourniquet at the client's bedside.
A large tourniquet should be placed in plain sight at the client's bedside (B). If severe
bleeding occurs, the tourniquet should be readily available and applied to the
residual limb to control hemorrhage.
The nurse is preparing a client for orthopedic surgery on the left leg and completing
a safety checklist before transport to the operating room. Which items should the
nurse remove from the client? - ANSWER: Nail polish - provides more accurate pulse
oximetry
Hearing aids, contact lenses, partial dentures - removed to prevent damage, loss or
misplacement, or injury during surgery
What instruction should the nurse include in the discharge teaching for a client who
needs to preform self-catherization technique at home? - ANSWER: Catheterize
every 3-4 hours
The nurse assesses a long-term resident of a nursing home and finds the client has a
fungal infection beneath both breasts. To prevent nosocomial infection, which
protocol should the nurse review with the rest of the staff? - ANSWER: Wash hands
after caring for the client
, What assessment finding should the nurse identify that indicates a client with an
acute asthma exacerbation is beginning to improve after treatment? - ANSWER:
Wheezing becomes louder.
-
In an acute asthma attack, air flow may be so significantly restricted that breath
sounds and wheezing is diminished. If the client is successfully responding to
bronchodilators and respiratory treatments, wheezing should become louder as the
air flow increases in the airways. As the airways open and mucous is mobilized in
response to treatment, the cough should become more productive.
When caring for a client with a per cutaneous endoscopic gastrostomy (PEG) tube,
what protocols should the e nurse implement for Intermittent feedings? - ANSWER:
Keeping the head of the bed elevated
Changing the enteral-feeding bag every 24 hrs
Checking placement of the tube by means of gastric aspiration
Flushing the tube with 50 ml of normal solution after each feeding
The home health nurse is assessing a client with terminal lung cancer who is
receiving hospice care. Which activity should be assigned to the hospice practical
nurse? - ANSWER: Administer medications for pain relief, SOB, and nausea
A man who smokes two packs of cigarettes a day wants to know if smoking is
contributing to the difficulty that he and his wife are having getting pregnant. What
information is best for the nurse to provide? (Select all that apply.)
A) Only marijuana cigarettes affect sperm count.
B) Smoking can decrease the quantity and quality of sperm.
C) The first semen analysis should be repeated to confirm sperm counts.
D) Cessation of smoking improves general health and fertility.
E) Sperm specimens should be collected in 2 subsequent days. - ANSWER: Smoking
can decrease the quantity and quality of sperm (cause low testosterone levels)
Cessation of smoking improves general health and fertility
alcohol consumption can cause erectile dysfunction
When teaching a client with breast cancer about the prescribed radiation therapy for
treatment, what information is important to include? - ANSWER: Dry, itchy skin
changes may occur.
-
Side effects from radiation to the breast most often include temporary skin changes
such as: dryness, tenderness, redness, swelling, and pruritis.
(A NEW UPDATED VERSION) NEWEST 2024 COMPLETE
REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS (APPROVED SOLUTIONS)
A 77 yr old female is admitted to the hospital. She is confused, has no appetite, is
nauseated and vomiting, and is complaining of a headache. Her pulse rate is 43 bpm.
Which question is priority for the nurse to ask this pt or her family on admission? -
ANSWER: Does the pt take digitails?
It is important to ontain a complete medication history, the symptoms described are
classic for digutails toxicity and assessment of this problem should be made
promptly.
The nurse is working with a 71 yr old obese pt with bilateral osteoarthritis of the
hips. What recommendation should the nurse make that is most beneficial in
protecting the pt joints? - ANSWER: Initiate a weight-reduction diet to achieve a
healthy body weight.
Achieving a healthy weight is critical to protect the joints of pt with OA. Weight loss
will take off the excess pressure that joints are exposed to
An elderly male pt comes to the geriatric screening clinic complaining of pain in his
left calf. The nurse notices a reddened area on the calf of his right leg which is warm
to the touch and suspects it might be thrombophlebitis. Which type of pain would
further confirm this suspicion? - ANSWER: Pain in the calf upon exertion which is
relieved by rest and elevating the extremity.
In preparing to administer intravenous albumin to a client following surgery, what is
the priority nursing intervention? (Select all that apply.)
A) Set the infusion pump to infuse the albumin within four hours.
B) Compare the client's blood type with the label on the albumin.
C) Assign a UAP to monitor blood pressure q15 minutes.
D) Administer through a large gauge catheter.
E) Monitor hemoglobin and hematocrit levels.
F) Assess for increased bleeding after administration. - ANSWER: A,d, e, f
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. - ANSWER: Evaluate his
BP, pulse, and respiratory status
,Slurred speech in the post operative client who received a local anesthesia is an
atypical finding and may indicate neurological deficits that require further
assessment.
Which symptoms should the nurse expect a client to exhibit who is diagnosed with a
pheochromocytoma? - ANSWER: Headache, diaphoresis, and palpitations
A client with diabetes mellitus is experiencing polyphagia. Which outcome statement
is the priority for this client?
A) Fluid and electrolyte balance.
B) Prevention of water toxicity.
C) Reduced glucose in the urine.
D) Adequate cellular nourishment. - ANSWER: Adequate cellular nourishment
The nurse is teaching a female client about the best time to plan intercourse in order
to conceive. Which information should the nurse provide? - ANSWER: Two weeks
before menstruation
Which intervention should the nurse plan to implement when caring for a client who
has just undergone a right above-the-knee amputation?
A) Maintain the residual limb on three pillows at all times.
B) Place a large tourniquet at the client's bedside.
C) Apply constant, direct pressure to the residual limb.
D) Do not allow the client to lie in the prone position. - ANSWER: B) Place a large
tourniquet at the client's bedside.
A large tourniquet should be placed in plain sight at the client's bedside (B). If severe
bleeding occurs, the tourniquet should be readily available and applied to the
residual limb to control hemorrhage.
The nurse is preparing a client for orthopedic surgery on the left leg and completing
a safety checklist before transport to the operating room. Which items should the
nurse remove from the client? - ANSWER: Nail polish - provides more accurate pulse
oximetry
Hearing aids, contact lenses, partial dentures - removed to prevent damage, loss or
misplacement, or injury during surgery
What instruction should the nurse include in the discharge teaching for a client who
needs to preform self-catherization technique at home? - ANSWER: Catheterize
every 3-4 hours
The nurse assesses a long-term resident of a nursing home and finds the client has a
fungal infection beneath both breasts. To prevent nosocomial infection, which
protocol should the nurse review with the rest of the staff? - ANSWER: Wash hands
after caring for the client
, What assessment finding should the nurse identify that indicates a client with an
acute asthma exacerbation is beginning to improve after treatment? - ANSWER:
Wheezing becomes louder.
-
In an acute asthma attack, air flow may be so significantly restricted that breath
sounds and wheezing is diminished. If the client is successfully responding to
bronchodilators and respiratory treatments, wheezing should become louder as the
air flow increases in the airways. As the airways open and mucous is mobilized in
response to treatment, the cough should become more productive.
When caring for a client with a per cutaneous endoscopic gastrostomy (PEG) tube,
what protocols should the e nurse implement for Intermittent feedings? - ANSWER:
Keeping the head of the bed elevated
Changing the enteral-feeding bag every 24 hrs
Checking placement of the tube by means of gastric aspiration
Flushing the tube with 50 ml of normal solution after each feeding
The home health nurse is assessing a client with terminal lung cancer who is
receiving hospice care. Which activity should be assigned to the hospice practical
nurse? - ANSWER: Administer medications for pain relief, SOB, and nausea
A man who smokes two packs of cigarettes a day wants to know if smoking is
contributing to the difficulty that he and his wife are having getting pregnant. What
information is best for the nurse to provide? (Select all that apply.)
A) Only marijuana cigarettes affect sperm count.
B) Smoking can decrease the quantity and quality of sperm.
C) The first semen analysis should be repeated to confirm sperm counts.
D) Cessation of smoking improves general health and fertility.
E) Sperm specimens should be collected in 2 subsequent days. - ANSWER: Smoking
can decrease the quantity and quality of sperm (cause low testosterone levels)
Cessation of smoking improves general health and fertility
alcohol consumption can cause erectile dysfunction
When teaching a client with breast cancer about the prescribed radiation therapy for
treatment, what information is important to include? - ANSWER: Dry, itchy skin
changes may occur.
-
Side effects from radiation to the breast most often include temporary skin changes
such as: dryness, tenderness, redness, swelling, and pruritis.
