MED SURG 201 Final Exam – Questions and Answers (West Coast University)

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MED SURG 201 FINAL EXAM – QUESTIONS AND ANSWERS
(WEST COAST UNIVERSITY)
FINAL EXAM QUESTIONS, ANSWERS (EXPLAINED)
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4. A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes
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mellitus is scheduled for discharge the second day after admission. When implementing patient
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teaching, what is the priority action forthe nurse?
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a. Instruct about the increased risk for cardiovascular disease. n n n n n n n


b. Provide detailed information about dietary control of glucose. n n n n n n n


c. Teach glucose self-monitoring and medication administration.
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d. Give information about the effects of exercise on glucose control.
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ANS: C
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When time is limited, the nurse should focus on the priorities of teaching. In this situation, the
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patient should know how to test blood glucose and administer medications to control glucose
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levels. The patient will need further teaching about the role of diet, exercise, various
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medications, and the many potential complications of diabetes, but these topics can be addressed
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through planning for appropriate referrals.
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14. A 75-year-old patient is admitted for pancreatitis. Which tool would be the most appropriate
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for the nurse to use during the admission assessment?
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a. Drug Abuse Screening Test (DAST-10) n n n n


b. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
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c. Screening Test-Geriatric Version (SMAST-G) n n n


d. Mini-Mental State Examination n n


ANS: C
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Because the abuse of alcohol is a common factor associated with the development of
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npancreatitis, the first assessment step is to screen for alcohol use using a validated screening
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questionnaire. The SMAST-G is a short-form alcoholism screening instrument tailored
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specifically to the needs of the older adult. If the patient scores positively on the SMAST-G, then
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the CIWA-Ar would be a useful tool for determining treatment. The DAST-10 provides more
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general information regarding substance use. The Mini-Mental State Examination is used to
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screen for cognitive impairment.
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1. The sister of a patient diagnosed with BRCA gene–related breast cancer asks the nurse, ―Do
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you think I should be tested for the gene?‖ Which response by the nurse is most appropriate?
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a. ―In most cases, breast cancer is not caused by the BRCA gene.‖
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b. ―It depends on how you will feel if the test is positive for the BRCA gene.‖
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c. ―There are many things to consider before deciding to have genetic testing.‖
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d. ―You should decide first whether you are willing to have a bilateral mastectomy.‖
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ANS: C
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Although presymptomatic testing for genetic disorders allows patients to take action (such as
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mastectomy) to prevent the development of some genetically caused disorders, patients also need
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to consider that test results in their medical record may affect insurance, employability, etc.
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Telling a patient that a decision about mastectomy should be made before testing implies that the
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nurse has made a judgment about what the patient should do if the test is positive. Although the
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patient may need to think about her reaction if the test is positive, other issues (e.g., insurance)
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also should be considered. Although most breast cancers are not related to BRCA gene mutations,
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the patient with a BRCA gene mutation has a markedly increased risk for breast cancer.
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7. The nurse in the outpatient clinic has obtained health histories for these new patients. Which
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patient may need referral for genetic testing?
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a. 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96 n n n n n n n n n n n n



b. 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy n n n n n n n n n n n n


c. 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease n n n n n n n n n n n



d. 50-year-old patient with a history of cigarette smoking who is complaining of dyspnea n n n n n n n n n n n n



ANS: C
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The adult form of polycystic kidney disease is an autosomal dominant disorder and frequently it is
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asymptomatic until the patient is older. Presymptomatic testing will give the patient information that
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will be useful in guiding lifestyle and childbearing choices. The other patients do not have any
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indication of genetic disorders or need for genetic testing.
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14. An adolescent patient seeks care in the emergency department after sharing needles forheroin
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injection with a friend who has hepatitis B. To provide immediate protection from infection, what
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medication will the nurse administer?
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a. Corticosteroids
b. Gamma globulin n


c. Hepatitis B vaccine n n


d. Fresh frozen plasma n n


ANS: B
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The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The
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hepatitis B vaccination series should be started to provide active immunity. Fresh frozen plasma
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and corticosteroids will not be effective in preventing hepatitis B in the patient.
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6. A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse
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what the letters and numbers mean. Which response by the nurse is most appropriate?
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a. ―The cancer involves only the cervix.‖
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b. ―The cancer cells look almost like normal cells.‖
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c. ―Further testing is needed to determine the spread of the cancer.‖
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d. ―It is difficult to determine the original site of the cervical cancer.‖
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ANS: A
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Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time.
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Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is
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the cervix. Further testing is not indicated given that the cancer has not spread.
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10. External-beam radiation is planned for a patient with cervical cancer. What instructions should the n n n n n n n n n n n n n


nurse give to the patient to prevent complications from the effects of the radiation?
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a. Test all stools for the presence of blood.
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b. Maintain a high-residue, high-fiber diet. n n n n


c. Clean the perianal area carefully after every bowel movement.
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d. Inspect the mouth and throat daily for the appearance of thrush.
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ANS: C
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Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent
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diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection.
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Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing
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of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue
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diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.
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11. The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep
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respirations. Which action should the nurse take?
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a. Give the prescribed PRN lorazepam (Ativan).
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b. Start the prescribed PRN oxygen at 2 to 4 L/min.
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c. Administer the prescribed normal saline bolus and insulin. n n n n n n n


d. Encourage the patient to take deep, slow breaths with guided imagery. n n n n n n n n n n


ANS: C
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The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need for correction of the
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acidosis with a saline bolus to prevent hypovolemia followed by insulin administration to allow glucose to
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reenter the cells. Oxygen therapy is not indicated because there is no indication that the increased
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respiratory rate is related to hypoxemia. The respiratory pattern is compensatory, and the patient will not
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be able to slow the respiratory rate. Lorazepam administration will slow the respiratory rate and increase
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the level of acidosis.
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17. The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing
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action should the nurse include on the care plan?
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a. Maintain the patient on bed rest. n n n n n


b. Auscultate lung sounds every 4 hours. n n n n n


c. Monitor for Trousseau’s and Chvostek’s signs. n n n n n


d. Encourage fluid intake up to 4000 mL every day. n n n n n n n n


ANS: D
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To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mL daily.
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Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with
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hypercalcemia. Trousseau’s and Chvostek’s signs are monitored when there is a possibility of
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hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds, although
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these would be assessed every shift.
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26. A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction and
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is complaining of anxiety and incisional pain. The patient’s respiratory rate is 32 breaths/minute and the
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arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first?
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a. Discontinue the nasogastric suction. n n n


b. Give the patient the PRN IV morphine sulfate 4 mg.
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c. Notify the health care provider about the ABG results.
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d. Teach the patient how to take slow, deep breaths when anxious.
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ANS: B
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The patient’s respiratory alkalosis is caused by the increased respiratory rate associated with pain and
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anxiety. The nurse’s first action should be to medicate the patient for pain. Although the nasogastric
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suction may contribute to the alkalosis, it is not appropriate to discontinue the tube when the patient needs
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gastric suction. The health care provider may be notified about the ABGs but is likely to instruct the nurse
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to medicate for pain. The patient will not be able to take slow, deep breaths when experiencing pain.
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10. Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled
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for abdominal surgery for an open cholecystectomy?
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a. Care for the surgical incision n n n n


b. Medications used during surgery n n n


c. Deep breathing and coughing techniques
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d. Oral antibiotic therapy after discharge home
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ANS: C
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Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on
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patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of
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completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this
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information. The patient does not usually need information about medications that are used intraoperatively.
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15. The nurse is caring for a patient the first postoperative day following a laparotomy for a small bowel
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obstruction. The nurse notices new bright-red drainage about 5 cm in diameter on the dressing. Which
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action should the nurse take first?
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a. Reinforce the dressing. n n


b. Apply an abdominal binder. n n n


c. Take the patient’s vital signs. n n n n


d. Recheck the dressing in 1 hour for increased drainage. n n n n n n n n


ANS: C
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New bright-red drainage may indicate hemorrhage, and the nurse should initially assess the patient’s vital
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signs for tachycardia and hypotension. The surgeon should then be notified of the drainage and the vital
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signs. The dressing may be changed or reinforced, based on the surgeon’s orders or institutional policy.
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The nurse should not wait an hour to recheck the dressing.
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38. Which prescribed medication should the nurse give first to a patient who has just been admitted to
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a hospital with acute angle-closure glaucoma?
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a. Morphine sulfate 4 mg IV n n n n


b. Mannitol (Osmitrol) 100 mg IV n n n n


c. Betaxolol (Betoptic) 1 drop in each eye n n n n n n


d. Acetazolamide (Diamox) 250 mg orally n n n n


ANS: B
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The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly
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with IV administration of a hyperosmolar diuretic such as mannitol. The other medications are also
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appropriate for a patient with glaucoma but would not be the first medication administered.
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8. A patient’s capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral
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nutrition (PN) infusion. The most appropriate actionby the nurse is to
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a. obtain a venous blood glucose specimen. n n n n n


b. slow the infusion rate of the PN infusion.
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c. Recheck the capillary blood glucose in 4 to 6 hours. n n n n n n n n n


d. notify the health care provider of the glucose level.
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ANS: C
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