Chapter 30: Medical-Surgical Disorders
MULTIPLE CHOICE
1. When caring for a pregnant woman with cardiac problems, the nurse must be alert for the
signs and symptoms of cardiac decompensation. Which critical findings would the nurse
find on assessment of the client experiencing this condition?
a. Regular heart rate and hypertension
b. Increased urinary output, tachycardia, and dry cough
c. Shortness of breath, bradycardia, and hypertension
d. Edema, crackles, and cyanosis of nails and lips
ANS: D
Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid
pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue;
and cyanosis of the lips and nailbeds. A regular heart rate and hypertension are not generally
associated with cardiac decompensation. Of the symptoms of increased urinary output,
tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation. Of the
symptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative
of cardiac decompensation.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. Which information should N eR
thU nuSrsIeN
taG
keTiB
nt.
oCcoOnM
sideration when planning care for a
postpartum client with cardiac disease?
a. The plan of care for a postpartum client is the same as the plan for any pregnant
woman.
b. The plan of care includes rest, stool softeners, and monitoring of the effect of
activity.
c. The plan of care includes frequent ambulating, alternating with active
range-of-motion exercises.
d. The plan of care includes limiting visits with the infant to once per day.
ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without
stress or strain for the woman are promoted with stool softeners, diet, and fluids. Care of the
woman with cardiac disease in the postpartum period is tailored to the woman’s functional
capacity. The woman will be on bed rest to conserve energy and to reduce the strain on the
heart. Although the woman may need help caring for the infant, breastfeeding and infant
visits are not contraindicated.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
3. A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be
avoided when treating postpartum bleeding to avoid exacerbating asthma?
a. Oxytocin (Pitocin)
, b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. 15-methyl PGF2
d. Fentanyl
ANS: C
Prostaglandin derivatives like 15-methyl PGF2 should not be used to treat women with
asthma, because they may exacerbate symptoms. Oxytocin is the drug of choice to treat this
woman’s bleeding; it will not exacerbate her asthma. NSAIDs are not used to treat bleeding.
Fentanyl is used to treat pain, not bleeding.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
4. Which important component of nutritional counseling should the nurse include in health
teaching for a pregnant woman who is experiencing cholecystitis?
a. Assess the woman’s dietary history for adequate calories and proteins.
b. Teach the woman that the bulk of calories should come from proteins.
c. Instruct the woman to eat a low-fat diet and to avoid fried foods.
d. Instruct the woman to eat a low-cholesterol, low-salt diet.
ANS: C
Eating a low-fat diet and avoiding fried foods is appropriate nutritional counseling for this
client. Caloric and protein intake do not predispose a woman to the development of
cholecystitis. The woman should be instructed to limit protein intake and choose foods that
are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats.
However, a low-salt diet is not indicated.
N R I G B.C M
PTS: 1 DIF: UCognitive
S N TLevel: Apply
O
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
5. Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis
includes which additional assessment?
a. Intake and output (I&O) and intravenous (IV) site
b. Signs and symptoms of infection
c. Vital signs and incision
d. Fetal heart rate (FHR) and uterine activity
ANS: D
Care of a pregnant woman undergoing surgery for appendicitis differs from that for a
nonpregnant woman in one significant aspect: the presence of the fetus. Continuous fetal
and uterine monitoring should take place. An assessment of I&O levels, along with an
assessment of the IV site, are normal postoperative care procedures. Evaluating the client for
signs and symptoms of infection is also part of routine postoperative care. Routine vital
signs and evaluation of the incision site are expected components of postoperative care.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
, 6. Since the gene for cystic fibrosis was identified in 1989, data can be collected for the
purposes of genetic counseling for couples regarding carrier status. According to the most
recent statistics, how often does cystic fibrosis occur in Caucasian live births?
a. 1 in 100
b. 1 in 1000
c. 1 in 2000
d. 1 in 3200
ANS: D
Cystic fibrosis occurs in approximately 1 in 3200 Caucasian live births. 1 in 100, 1 in 1000,
and 1 in 2000 occurrences of cystic fibrosis in live births are all too frequent rates.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
7. Which neurologic condition would require preconception counseling, if possible?
a. Eclampsia
b. Bell palsy
c. Epilepsy
d. Multiple sclerosis
ANS: C
Women with epilepsy should receive preconception counseling, if at all possible. Achieving
seizure control before becoming pregnant is a desirable state. Medication should also be
carefully reviewed. Eclampsia may sometimes be confused with epilepsy, and Bell palsy is
a form of facial paralysis; preconception counseling for either condition is not essential to
care. Multiple sclerosis is aN
pU RSyIdN
atch GTelinatio
emy B. On of the spinal cord that does not affect the
normal course of pregnancy or birth.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
8. The client makes an appointment for preconception counseling. The woman has a known
heart condition and is unsure if she should become pregnant. Which is the only cardiac
condition that would cause concern?
a. Marfan syndrome
b. Eisenmenger syndrome
c. Heart transplant
d. Ventricular septal defect (VSD)
ANS: B
Pregnancy is contraindicated in clients with Eisenmenger syndrome. Women who have had
heart transplants are successfully having babies. However, conception should be postponed
for at least 1 year after transplantation. Management of the client with Marfan syndrome
during pregnancy includes bed rest, beta-blockers, and surgery before conception. VSD is
usually corrected early in life and is therefore not a contraindication to pregnancy.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MULTIPLE CHOICE
1. When caring for a pregnant woman with cardiac problems, the nurse must be alert for the
signs and symptoms of cardiac decompensation. Which critical findings would the nurse
find on assessment of the client experiencing this condition?
a. Regular heart rate and hypertension
b. Increased urinary output, tachycardia, and dry cough
c. Shortness of breath, bradycardia, and hypertension
d. Edema, crackles, and cyanosis of nails and lips
ANS: D
Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid
pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue;
and cyanosis of the lips and nailbeds. A regular heart rate and hypertension are not generally
associated with cardiac decompensation. Of the symptoms of increased urinary output,
tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation. Of the
symptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative
of cardiac decompensation.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. Which information should N eR
thU nuSrsIeN
taG
keTiB
nt.
oCcoOnM
sideration when planning care for a
postpartum client with cardiac disease?
a. The plan of care for a postpartum client is the same as the plan for any pregnant
woman.
b. The plan of care includes rest, stool softeners, and monitoring of the effect of
activity.
c. The plan of care includes frequent ambulating, alternating with active
range-of-motion exercises.
d. The plan of care includes limiting visits with the infant to once per day.
ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without
stress or strain for the woman are promoted with stool softeners, diet, and fluids. Care of the
woman with cardiac disease in the postpartum period is tailored to the woman’s functional
capacity. The woman will be on bed rest to conserve energy and to reduce the strain on the
heart. Although the woman may need help caring for the infant, breastfeeding and infant
visits are not contraindicated.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
3. A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be
avoided when treating postpartum bleeding to avoid exacerbating asthma?
a. Oxytocin (Pitocin)
, b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. 15-methyl PGF2
d. Fentanyl
ANS: C
Prostaglandin derivatives like 15-methyl PGF2 should not be used to treat women with
asthma, because they may exacerbate symptoms. Oxytocin is the drug of choice to treat this
woman’s bleeding; it will not exacerbate her asthma. NSAIDs are not used to treat bleeding.
Fentanyl is used to treat pain, not bleeding.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
4. Which important component of nutritional counseling should the nurse include in health
teaching for a pregnant woman who is experiencing cholecystitis?
a. Assess the woman’s dietary history for adequate calories and proteins.
b. Teach the woman that the bulk of calories should come from proteins.
c. Instruct the woman to eat a low-fat diet and to avoid fried foods.
d. Instruct the woman to eat a low-cholesterol, low-salt diet.
ANS: C
Eating a low-fat diet and avoiding fried foods is appropriate nutritional counseling for this
client. Caloric and protein intake do not predispose a woman to the development of
cholecystitis. The woman should be instructed to limit protein intake and choose foods that
are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats.
However, a low-salt diet is not indicated.
N R I G B.C M
PTS: 1 DIF: UCognitive
S N TLevel: Apply
O
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
5. Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis
includes which additional assessment?
a. Intake and output (I&O) and intravenous (IV) site
b. Signs and symptoms of infection
c. Vital signs and incision
d. Fetal heart rate (FHR) and uterine activity
ANS: D
Care of a pregnant woman undergoing surgery for appendicitis differs from that for a
nonpregnant woman in one significant aspect: the presence of the fetus. Continuous fetal
and uterine monitoring should take place. An assessment of I&O levels, along with an
assessment of the IV site, are normal postoperative care procedures. Evaluating the client for
signs and symptoms of infection is also part of routine postoperative care. Routine vital
signs and evaluation of the incision site are expected components of postoperative care.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
, 6. Since the gene for cystic fibrosis was identified in 1989, data can be collected for the
purposes of genetic counseling for couples regarding carrier status. According to the most
recent statistics, how often does cystic fibrosis occur in Caucasian live births?
a. 1 in 100
b. 1 in 1000
c. 1 in 2000
d. 1 in 3200
ANS: D
Cystic fibrosis occurs in approximately 1 in 3200 Caucasian live births. 1 in 100, 1 in 1000,
and 1 in 2000 occurrences of cystic fibrosis in live births are all too frequent rates.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
7. Which neurologic condition would require preconception counseling, if possible?
a. Eclampsia
b. Bell palsy
c. Epilepsy
d. Multiple sclerosis
ANS: C
Women with epilepsy should receive preconception counseling, if at all possible. Achieving
seizure control before becoming pregnant is a desirable state. Medication should also be
carefully reviewed. Eclampsia may sometimes be confused with epilepsy, and Bell palsy is
a form of facial paralysis; preconception counseling for either condition is not essential to
care. Multiple sclerosis is aN
pU RSyIdN
atch GTelinatio
emy B. On of the spinal cord that does not affect the
normal course of pregnancy or birth.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
8. The client makes an appointment for preconception counseling. The woman has a known
heart condition and is unsure if she should become pregnant. Which is the only cardiac
condition that would cause concern?
a. Marfan syndrome
b. Eisenmenger syndrome
c. Heart transplant
d. Ventricular septal defect (VSD)
ANS: B
Pregnancy is contraindicated in clients with Eisenmenger syndrome. Women who have had
heart transplants are successfully having babies. However, conception should be postponed
for at least 1 year after transplantation. Management of the client with Marfan syndrome
during pregnancy includes bed rest, beta-blockers, and surgery before conception. VSD is
usually corrected early in life and is therefore not a contraindication to pregnancy.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
