Understanding Medical-Surgical Nursing
6th Edition New Brand
_________________________________________________________________________________
A 45-year-old woman presents to the ambulatory clinic for a gynecological
examination. The health history reveals no significant personal or family medical history.
What information concerning health-promotion behaviors should be presented to the
client?
a. It is time to begin having mammograms every other year.
b. If the client is in a monogamous relationship, Pap smears will not be needed.
c. Bone density examinations are indicated every year.
d. Recommended calcium intake is at least 1,200 mg per day.
Answer: d
Rationale: The recommended calcium intake is at least 1,200 mg per day. This will be
beneficial in the prevention of osteoporosis. Women should begin having annual
mammograms by age 40. Pap smears are continued for women in monogamous
relationships. For women with no significant risk for the development of osteoporosis,
bone density examinations should be done every other year.
The admitting department alerts the nurse on a medical-surgical unit that a client with
active tuberculosis (TB) is being admitted to the unit. Which type of isolation is
appropriate based on the client's diagnosis?
1. Standard precautions
2. Airborne precautions
3. Droplet precautions
4. Contact precautions
Answer: 2
In addition to handwashing and standard precautions, the nature and spread of some
infectious diseases require that special techniques be used to protect uninfected clients
and workers. The client with pulmonary tuberculosis will be placed in airborne
precautions. The client should be placed in a private room with special ventilation that
does not allow air to circulate to general hospital ventilation; a mask or special filter
respirators will be used for everyone entering the room.
A 75-year-old client seeks care at an ambulatory clinic. The client reports having
experienced extreme drowsiness after recently taking dosages of an over-the-counter cold
medication. When collecting data, the nurse notes the client reports taking only the
prescribed amount of the preparation. What inferences can be made by the nurse
,concerning the events?
a. The client likely has taken more of the preparation than stated.
b. The client likely has experienced a reaction between the cold medication and other
routine medications.
c. The client's age has influenced his response to the medication.
d. The client is allergic to the cold medication.
Answer: c
Rationale: Older clients often experience altered responses to medications. These changes
are in response to age-related developments in the kidneys and liver. There is no evidence
the client has taken too much medication. There is no information provided to indicate
the client is taking other medications. Allergic reactions typically manifest with
integumentary- or respiratory-related symptoms.
The nurse is colleting data from a client regarding past alcohol use history. What
question will provide the greatest amount of information?
1. Are you a heavy drinker?
2. How often do you use alcohol?
3. Drinking doesn't cause any problems for you, does it?
4. Is alcohol use a concern for you?
Answer: 2
Rationale: Open-ended questions will elicit the greatest amount of information. Asking
closed questions will limit the information obtained.
A client is receiving IV vancomycin for the treatment of Clostridium difficile. The
nurse understands that the client who develops flushing, tachycardia, and hypotension
during the infusion of vancomycin indicates:
1. Ototoxicity effect.
2. Superinfection.
3. Red man syndrome.
4. Hives.
Answer: 3
Rationale: Vancomycin inhibits cell wall synthesis, and is used for serious infections. It is
only effective against gram-positive bacteria, especially Staphylococcus aureus and
Staphylococcus epidermidis. The nurse should infuse this medication slowly over 60
minutes or more to avoid "red man" syndrome. The syndrome is characterized by
erythematous rash, flushing, tachycardia, and hypotension. Clients can become dizzy and
agitated.
,The physician has ordered for the client to receive a trough blood level to evaluate the
therapeutic effect of an antibiotic. The nurse understands that the trough should be
ordered:
1. A few minutes before the next scheduled dose of medication.
2. 1-2 hours after the oral administration of the medication.
3. 30 minutes after the IV administration.
4. During the infusion of the antibiotic.
Answer: 1
Rationale: Antibiotic peak and trough levels monitor therapeutic blood levels of the
prescribed medication. The therapeutic range—the minimum and maximum blood levels
at which the drug is effective—is known for a given drug. By measuring blood levels at
the predicted peak (1-2 hours after oral administration, 1 hour after intramuscular
administration, and 30 minutes after IV administration) and trough (usually a few
minutes before the next scheduled dose), it is also possible to determine whether the drug
is reaching a toxic or harmful level during therapy, increasing the likelihood of adverse
effects.
A nursing student is reading about the concept of parish nursing. Which of the
following statements indicates understanding of the key concepts of parish nursing?
1. "You must practice a certain faith to be involved in parish nursing."
2. "Parish nurses are independent practitioners providing care to members of a selected
church."
3. "Parish nursing is reserved for nurse practitioners."
4. "Parish nurses may be employed by a hospital."
Answer: 4
Rationale: Parish nursing seeks to provide health care to traditionally underserved
populations. Involvement in parish nursing is not limited to select faiths. The parish nurse
may work directly for the church involved or be contracted by the church to provide
nursing services and perform referrals. Parish nursing is not limited to nurse practitioners.
The nurse needs to change a dressing on the client's abdomen. Which of the following
techniques should be implemented?
1. Contact precautions
2. Standard precautions
3. Droplet precautions
4. Airborne precautions
Answer: 2
Rationale: Standard precautions are used on all clients, regardless of whether they have a
, know infectious disease. Standard precautions are used by all healthcare workers who
have direct contact with clients or with their body fluids. Since the client has an
abdominal dressing, the nurse will use standard precautions.
The physician has ordered for the nurse to obtain a sputum specimen. The nurse
understands that the sputum specimen should be collected:
1. Immediately after the first dose of antibiotic is administered.
2. 30 minutes after the first dose of antibiotics is administered.
3. During the first dose of antibiotics.
4. Before the first dose of antibiotics is administered.
Answer: 4
Rationale: When the physician orders a specimen to be collected, the nurse should collect
the specimen before the first dose of antibiotics is administered, to ensure adequate
organisms for culture.
A patient who had been in a house fire is experiencing a productive cough. What color should the
nurse expect the patient's sputum to exhibit? 1. Ye
1. Yellow
2. White
3. Black
4. Red
Answer:3
1. Yellow and yellowish-green sputum are associated with bacterial infections. 2. White sputum
most often is associated with viral infections. 3. Black sputum is associated with exposure to a
fire because of the inhalation of smoke. 4. Red sputum reflects blood in the sputum
(hemoptysis), which is associated with conditions such as pneumococcal pneumonia and
pulmonary edema.
Which of the following manifestations indicates a systemic reaction associated with
an inflammatory response?
1. Erythema
2. Pain
3. Tachypnea (RR 26)
4. Edema
Answer: 3
Rationale: If the nurse observes a systemic reaction, the client will exhibit manifestations
including temperature, increased pulse, tachypnea, and leukocytosis. Erythema, warmth,
pain, edema, and functional impairment indicate a local reaction.
6th Edition New Brand
_________________________________________________________________________________
A 45-year-old woman presents to the ambulatory clinic for a gynecological
examination. The health history reveals no significant personal or family medical history.
What information concerning health-promotion behaviors should be presented to the
client?
a. It is time to begin having mammograms every other year.
b. If the client is in a monogamous relationship, Pap smears will not be needed.
c. Bone density examinations are indicated every year.
d. Recommended calcium intake is at least 1,200 mg per day.
Answer: d
Rationale: The recommended calcium intake is at least 1,200 mg per day. This will be
beneficial in the prevention of osteoporosis. Women should begin having annual
mammograms by age 40. Pap smears are continued for women in monogamous
relationships. For women with no significant risk for the development of osteoporosis,
bone density examinations should be done every other year.
The admitting department alerts the nurse on a medical-surgical unit that a client with
active tuberculosis (TB) is being admitted to the unit. Which type of isolation is
appropriate based on the client's diagnosis?
1. Standard precautions
2. Airborne precautions
3. Droplet precautions
4. Contact precautions
Answer: 2
In addition to handwashing and standard precautions, the nature and spread of some
infectious diseases require that special techniques be used to protect uninfected clients
and workers. The client with pulmonary tuberculosis will be placed in airborne
precautions. The client should be placed in a private room with special ventilation that
does not allow air to circulate to general hospital ventilation; a mask or special filter
respirators will be used for everyone entering the room.
A 75-year-old client seeks care at an ambulatory clinic. The client reports having
experienced extreme drowsiness after recently taking dosages of an over-the-counter cold
medication. When collecting data, the nurse notes the client reports taking only the
prescribed amount of the preparation. What inferences can be made by the nurse
,concerning the events?
a. The client likely has taken more of the preparation than stated.
b. The client likely has experienced a reaction between the cold medication and other
routine medications.
c. The client's age has influenced his response to the medication.
d. The client is allergic to the cold medication.
Answer: c
Rationale: Older clients often experience altered responses to medications. These changes
are in response to age-related developments in the kidneys and liver. There is no evidence
the client has taken too much medication. There is no information provided to indicate
the client is taking other medications. Allergic reactions typically manifest with
integumentary- or respiratory-related symptoms.
The nurse is colleting data from a client regarding past alcohol use history. What
question will provide the greatest amount of information?
1. Are you a heavy drinker?
2. How often do you use alcohol?
3. Drinking doesn't cause any problems for you, does it?
4. Is alcohol use a concern for you?
Answer: 2
Rationale: Open-ended questions will elicit the greatest amount of information. Asking
closed questions will limit the information obtained.
A client is receiving IV vancomycin for the treatment of Clostridium difficile. The
nurse understands that the client who develops flushing, tachycardia, and hypotension
during the infusion of vancomycin indicates:
1. Ototoxicity effect.
2. Superinfection.
3. Red man syndrome.
4. Hives.
Answer: 3
Rationale: Vancomycin inhibits cell wall synthesis, and is used for serious infections. It is
only effective against gram-positive bacteria, especially Staphylococcus aureus and
Staphylococcus epidermidis. The nurse should infuse this medication slowly over 60
minutes or more to avoid "red man" syndrome. The syndrome is characterized by
erythematous rash, flushing, tachycardia, and hypotension. Clients can become dizzy and
agitated.
,The physician has ordered for the client to receive a trough blood level to evaluate the
therapeutic effect of an antibiotic. The nurse understands that the trough should be
ordered:
1. A few minutes before the next scheduled dose of medication.
2. 1-2 hours after the oral administration of the medication.
3. 30 minutes after the IV administration.
4. During the infusion of the antibiotic.
Answer: 1
Rationale: Antibiotic peak and trough levels monitor therapeutic blood levels of the
prescribed medication. The therapeutic range—the minimum and maximum blood levels
at which the drug is effective—is known for a given drug. By measuring blood levels at
the predicted peak (1-2 hours after oral administration, 1 hour after intramuscular
administration, and 30 minutes after IV administration) and trough (usually a few
minutes before the next scheduled dose), it is also possible to determine whether the drug
is reaching a toxic or harmful level during therapy, increasing the likelihood of adverse
effects.
A nursing student is reading about the concept of parish nursing. Which of the
following statements indicates understanding of the key concepts of parish nursing?
1. "You must practice a certain faith to be involved in parish nursing."
2. "Parish nurses are independent practitioners providing care to members of a selected
church."
3. "Parish nursing is reserved for nurse practitioners."
4. "Parish nurses may be employed by a hospital."
Answer: 4
Rationale: Parish nursing seeks to provide health care to traditionally underserved
populations. Involvement in parish nursing is not limited to select faiths. The parish nurse
may work directly for the church involved or be contracted by the church to provide
nursing services and perform referrals. Parish nursing is not limited to nurse practitioners.
The nurse needs to change a dressing on the client's abdomen. Which of the following
techniques should be implemented?
1. Contact precautions
2. Standard precautions
3. Droplet precautions
4. Airborne precautions
Answer: 2
Rationale: Standard precautions are used on all clients, regardless of whether they have a
, know infectious disease. Standard precautions are used by all healthcare workers who
have direct contact with clients or with their body fluids. Since the client has an
abdominal dressing, the nurse will use standard precautions.
The physician has ordered for the nurse to obtain a sputum specimen. The nurse
understands that the sputum specimen should be collected:
1. Immediately after the first dose of antibiotic is administered.
2. 30 minutes after the first dose of antibiotics is administered.
3. During the first dose of antibiotics.
4. Before the first dose of antibiotics is administered.
Answer: 4
Rationale: When the physician orders a specimen to be collected, the nurse should collect
the specimen before the first dose of antibiotics is administered, to ensure adequate
organisms for culture.
A patient who had been in a house fire is experiencing a productive cough. What color should the
nurse expect the patient's sputum to exhibit? 1. Ye
1. Yellow
2. White
3. Black
4. Red
Answer:3
1. Yellow and yellowish-green sputum are associated with bacterial infections. 2. White sputum
most often is associated with viral infections. 3. Black sputum is associated with exposure to a
fire because of the inhalation of smoke. 4. Red sputum reflects blood in the sputum
(hemoptysis), which is associated with conditions such as pneumococcal pneumonia and
pulmonary edema.
Which of the following manifestations indicates a systemic reaction associated with
an inflammatory response?
1. Erythema
2. Pain
3. Tachypnea (RR 26)
4. Edema
Answer: 3
Rationale: If the nurse observes a systemic reaction, the client will exhibit manifestations
including temperature, increased pulse, tachypnea, and leukocytosis. Erythema, warmth,
pain, edema, and functional impairment indicate a local reaction.
