Medical-Surgical Blueprint Final Exam Questions and
Answers Study Guide
Parkinson’s
Iggy TB 10th The nurse plans care for a client with Parkinson disease. Which intervention would
the nurse include in this client’s plan of care?
d. Keep the head of the bed at 30 degrees or greater
Ans: D Elevation of the head of the bed will help prevent aspiration. The other options will
not prevent aspiration, which is the greatest respiratory complication of Parkinson disease,
nor do these interventions address any of the complications of Parkinson disease. Pursed-lip
breathing increases exhalation of carbon dioxide; incentive spirometry expands the lungs.
The client should not be restrained to prevent falls. Other less restrictive interventions should
PR
be used to maintain client safety.
Iggy TB 10th After teaching the wife of a client who has Parkinson disease, the nurse assesses the
wife’s understanding. Which statement by the client’s wife indicates that she correctly
understands changes associated with this disease?
O
d. “He may have trouble chewing, so I will offer bite-sized portions.”
Ans: D Because chewing and swallowing can be problematic, small frequent meals and a
supplement are better for meeting the client’s nutritional needs. A masklike face and drooling
FD
are common in clients with Parkinson disease. The client would be encouraged to continue to
socialize and communicate as normally as possible. The wife should understand that the
client’s masklike face can be misinterpreted and additional time may be needed for the client
to communicate with her or others. Excessive perspiration is also common in clients with
Parkinson disease and is associated with the autonomic nervous system’s response.
O
Iggy TB 10th A nurse teaches assistive personnel (AP) about how to care for a client with
Parkinson disease. Which statement would the nurse include as part of this teaching?
C
a. “Allow the client to be as independent as possible with activities.”
Ans: A Clients with Parkinson disease do not move as quickly and can have functional
problems. The client would be encouraged to be as independent as possible and provided
time to perform activities without rushing. Although oral care is important for all clients,
instructing the UAP to provide frequent and meticulous oral is not a priority for this client.
This statement would be a priority if the client was immune-compromised or NPO. The nurse
would assess the client’s ability to eat and swallow; this would not be delegated.
Appointments and activities would not be scheduled early in the morning because this may
cause the client to be rushed and discourage the client from wanting to participate in
activities of daily living.
GI System
A 42-yr-old patient is admitted to the outpatient testing area for an ultrasound of the gallbladder.
Which information obtained by the nurse indicates that the ultrasound may need to be
rescheduled?
D.The patient ate a low-fat bagel 4 hours ago for breakfast.
,ANS: D Food intake can cause the gallbladder to contract and result in a suboptimal study. The
patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening,
laxative use, or a gastrostomy tube will not affect the results of the study.
Iggy 10 textbook. A nurse is caring for a 34-year-old client newly diagnosed with GERD.
th
Which lifestyle change will the nurse suggest? Select all that apply.
A. Lose weight if needed.
B. Do not eat before bed.
C. Elevate the foot of your bed by 6 to 12 inches.
D. Avoid pants with a tight waistband or belt. E. Eat fay foods to minimize ongoing hunger.
Ans: B
Iggy 10 textbook. A client who had the Strea procedure to treat severe GERD is being
th
PR
discharged. Which client statement requires further nursing teaching? Select all that apply.
A. “Dysphagia after this procedure is normal.”
B. “It’s important to stop my proton pump inhibitor.”
D. “I might cough up some blood following this procedure.”
E. “Today I will drink clear liquids and tomorrow I can eat soft food.”
O
Ans: A,B,D,E
Iggy TB. The nurse assesses a client who has chronic pancreatitis. What assessment findings
would the nurse expect for this client? (Select all that apply.)
FD
a. Ascites
c. Steatorrhea
d. Jaundice
e. Polydipsia
f. Polyuria
O
ANS: A, C, D, E, F The client who has chronic pancreatitis has all of these signs and symptoms
except he or she loses weight. Ascites and jaundice result from biliary obstruction; ascites is
associated with portal hypertension. Steatorrhea is fatty stool that occurs because lipase is not
C
available in the duodenum; because it is released by the disease pancreas into the bloodstream.
Polydipsia, polyuria, and polyphagia result from diabetes mellitus, a common problem seen in
clientswhose pancreas is unable to release adequate amounts of insulin.
Pernicious Anemia (ch 37, Q 25 for the picture)
Iggy TB 10th The nurse assesses a oral cavity as seen in the photo below:
What action by the nurse is most appropriate?
, d. Teach the client about cobalamin therapy.
ANS: D This condition is known as glossitis, and is characteristic of B12 anemia. If the anemia
is a pernicious anemia, it is treated with cobalamin. Genetic testing is not a priority for this
condition. The client does not need high-fiber foods or protective precautions.
PR
Lewis TB.The nurse assesses a patient with pernicious anemia. Which assessment finding would
the nurse expect?
c. Numbness of the extremities
O
ANS: C Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious
anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged
sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and
FD
tenderness occur with thrombocytopenia or neutropenia.
Seizure Precaution (DILANTIN therapy levels 10-20)
Lewis TB. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the
nurse take when evaluating for adverse effects of the medication?
O
a. Inspect the oral mucosa.
C
ANS: A Phenytoin can cause gingival hyperplasia, but does not affect bowel sounds, lung sounds,
or pupil reaction to light.
Lewis TB. Which information about a patient who has a new prescription for phenytoin
(Dilantin) indicates that the nurse should consult with the health care provider before
administration of the medication?
c. Patient has minor elevations in the liver function tests.
ANS: C Many older patients (especially with compromised liver function) may not be able to
metabolize phenytoin. The health care provider may need to choose another antiseizure
medication. Phenytoin is an appropriate medication for patients with tonic-clonic seizures, with
or without an aura. Hypertension is not a contraindication for phenytoin therapy.
Iggy TB 10th A client experiences a seizure that is observed by the nurse. What will the nurse
document in the client’s medical record? Select all that apply.
, a. Time that seizure began and ended
b. Whether the seizure was preceded by an aura
c. What the client does after the seizure
d. How long it takes for the client to return to preseizure status
ANS: A, B C, D
Multiple Sclerosis (assess for weakness in the leg)
Lewis TB.After change-of-shift report, which patient should the nurse assess first?
a. Patient with myasthenia gravis who is reporting increased muscle weakness
ANS: A Because increased muscle weakness may indicate the onset of a myasthenic crisis, the
nurse should assess this patient first. The other patients should also be assessed but do not appear
to need immediate nursing assessments or actions to prevent life-threatening complications.
Lewis TB.Which action will the nurse plan to take for a patient with multiple sclerosis who has
PR
urinary retention caused by a flaccid bladder?
b. Teach the patient how to use the Credé method.
ANS: B The Credé method can be used to improve bladder emptying. Decreasing fluid intake
will not improve bladder emptying and may increase risk for urinary tract infection and
O
dehydration. The use of incontinence briefs and frequent toileting will not improve bladder
emptying.
Iggy 10 textbook. A nurse is assessing a client with a suspected diagnosis of multiple sclerosis.
th
FD
Which assessment findings will the nurse expect? Select all the apply.
b. Memory loss
c. Muscle spasticity
d. Fatigue
e. Diplopia
O
f. Dysarthria
Ans: B,C,D,E,F
C
Iggy 10 textbook. The primary health care provider started a client with multiple sclerosis on
th
mitoxantrone therapy. Which statement will the nurse include in teaching the client about this
drug?
d. “Avoid crowded places such as malls and large public gatherings.”
Ans: D
Myasthenia Gravis
Iggy Textbook The primary health care provider started a client with multiple sclerosis on
mitoxantrone therapy. Which statement will the nurse include in teaching the client about this
drug?
d. “Avoid crowded places such as malls and large public gatherings.”
Answers Study Guide
Parkinson’s
Iggy TB 10th The nurse plans care for a client with Parkinson disease. Which intervention would
the nurse include in this client’s plan of care?
d. Keep the head of the bed at 30 degrees or greater
Ans: D Elevation of the head of the bed will help prevent aspiration. The other options will
not prevent aspiration, which is the greatest respiratory complication of Parkinson disease,
nor do these interventions address any of the complications of Parkinson disease. Pursed-lip
breathing increases exhalation of carbon dioxide; incentive spirometry expands the lungs.
The client should not be restrained to prevent falls. Other less restrictive interventions should
PR
be used to maintain client safety.
Iggy TB 10th After teaching the wife of a client who has Parkinson disease, the nurse assesses the
wife’s understanding. Which statement by the client’s wife indicates that she correctly
understands changes associated with this disease?
O
d. “He may have trouble chewing, so I will offer bite-sized portions.”
Ans: D Because chewing and swallowing can be problematic, small frequent meals and a
supplement are better for meeting the client’s nutritional needs. A masklike face and drooling
FD
are common in clients with Parkinson disease. The client would be encouraged to continue to
socialize and communicate as normally as possible. The wife should understand that the
client’s masklike face can be misinterpreted and additional time may be needed for the client
to communicate with her or others. Excessive perspiration is also common in clients with
Parkinson disease and is associated with the autonomic nervous system’s response.
O
Iggy TB 10th A nurse teaches assistive personnel (AP) about how to care for a client with
Parkinson disease. Which statement would the nurse include as part of this teaching?
C
a. “Allow the client to be as independent as possible with activities.”
Ans: A Clients with Parkinson disease do not move as quickly and can have functional
problems. The client would be encouraged to be as independent as possible and provided
time to perform activities without rushing. Although oral care is important for all clients,
instructing the UAP to provide frequent and meticulous oral is not a priority for this client.
This statement would be a priority if the client was immune-compromised or NPO. The nurse
would assess the client’s ability to eat and swallow; this would not be delegated.
Appointments and activities would not be scheduled early in the morning because this may
cause the client to be rushed and discourage the client from wanting to participate in
activities of daily living.
GI System
A 42-yr-old patient is admitted to the outpatient testing area for an ultrasound of the gallbladder.
Which information obtained by the nurse indicates that the ultrasound may need to be
rescheduled?
D.The patient ate a low-fat bagel 4 hours ago for breakfast.
,ANS: D Food intake can cause the gallbladder to contract and result in a suboptimal study. The
patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening,
laxative use, or a gastrostomy tube will not affect the results of the study.
Iggy 10 textbook. A nurse is caring for a 34-year-old client newly diagnosed with GERD.
th
Which lifestyle change will the nurse suggest? Select all that apply.
A. Lose weight if needed.
B. Do not eat before bed.
C. Elevate the foot of your bed by 6 to 12 inches.
D. Avoid pants with a tight waistband or belt. E. Eat fay foods to minimize ongoing hunger.
Ans: B
Iggy 10 textbook. A client who had the Strea procedure to treat severe GERD is being
th
PR
discharged. Which client statement requires further nursing teaching? Select all that apply.
A. “Dysphagia after this procedure is normal.”
B. “It’s important to stop my proton pump inhibitor.”
D. “I might cough up some blood following this procedure.”
E. “Today I will drink clear liquids and tomorrow I can eat soft food.”
O
Ans: A,B,D,E
Iggy TB. The nurse assesses a client who has chronic pancreatitis. What assessment findings
would the nurse expect for this client? (Select all that apply.)
FD
a. Ascites
c. Steatorrhea
d. Jaundice
e. Polydipsia
f. Polyuria
O
ANS: A, C, D, E, F The client who has chronic pancreatitis has all of these signs and symptoms
except he or she loses weight. Ascites and jaundice result from biliary obstruction; ascites is
associated with portal hypertension. Steatorrhea is fatty stool that occurs because lipase is not
C
available in the duodenum; because it is released by the disease pancreas into the bloodstream.
Polydipsia, polyuria, and polyphagia result from diabetes mellitus, a common problem seen in
clientswhose pancreas is unable to release adequate amounts of insulin.
Pernicious Anemia (ch 37, Q 25 for the picture)
Iggy TB 10th The nurse assesses a oral cavity as seen in the photo below:
What action by the nurse is most appropriate?
, d. Teach the client about cobalamin therapy.
ANS: D This condition is known as glossitis, and is characteristic of B12 anemia. If the anemia
is a pernicious anemia, it is treated with cobalamin. Genetic testing is not a priority for this
condition. The client does not need high-fiber foods or protective precautions.
PR
Lewis TB.The nurse assesses a patient with pernicious anemia. Which assessment finding would
the nurse expect?
c. Numbness of the extremities
O
ANS: C Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious
anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged
sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and
FD
tenderness occur with thrombocytopenia or neutropenia.
Seizure Precaution (DILANTIN therapy levels 10-20)
Lewis TB. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the
nurse take when evaluating for adverse effects of the medication?
O
a. Inspect the oral mucosa.
C
ANS: A Phenytoin can cause gingival hyperplasia, but does not affect bowel sounds, lung sounds,
or pupil reaction to light.
Lewis TB. Which information about a patient who has a new prescription for phenytoin
(Dilantin) indicates that the nurse should consult with the health care provider before
administration of the medication?
c. Patient has minor elevations in the liver function tests.
ANS: C Many older patients (especially with compromised liver function) may not be able to
metabolize phenytoin. The health care provider may need to choose another antiseizure
medication. Phenytoin is an appropriate medication for patients with tonic-clonic seizures, with
or without an aura. Hypertension is not a contraindication for phenytoin therapy.
Iggy TB 10th A client experiences a seizure that is observed by the nurse. What will the nurse
document in the client’s medical record? Select all that apply.
, a. Time that seizure began and ended
b. Whether the seizure was preceded by an aura
c. What the client does after the seizure
d. How long it takes for the client to return to preseizure status
ANS: A, B C, D
Multiple Sclerosis (assess for weakness in the leg)
Lewis TB.After change-of-shift report, which patient should the nurse assess first?
a. Patient with myasthenia gravis who is reporting increased muscle weakness
ANS: A Because increased muscle weakness may indicate the onset of a myasthenic crisis, the
nurse should assess this patient first. The other patients should also be assessed but do not appear
to need immediate nursing assessments or actions to prevent life-threatening complications.
Lewis TB.Which action will the nurse plan to take for a patient with multiple sclerosis who has
PR
urinary retention caused by a flaccid bladder?
b. Teach the patient how to use the Credé method.
ANS: B The Credé method can be used to improve bladder emptying. Decreasing fluid intake
will not improve bladder emptying and may increase risk for urinary tract infection and
O
dehydration. The use of incontinence briefs and frequent toileting will not improve bladder
emptying.
Iggy 10 textbook. A nurse is assessing a client with a suspected diagnosis of multiple sclerosis.
th
FD
Which assessment findings will the nurse expect? Select all the apply.
b. Memory loss
c. Muscle spasticity
d. Fatigue
e. Diplopia
O
f. Dysarthria
Ans: B,C,D,E,F
C
Iggy 10 textbook. The primary health care provider started a client with multiple sclerosis on
th
mitoxantrone therapy. Which statement will the nurse include in teaching the client about this
drug?
d. “Avoid crowded places such as malls and large public gatherings.”
Ans: D
Myasthenia Gravis
Iggy Textbook The primary health care provider started a client with multiple sclerosis on
mitoxantrone therapy. Which statement will the nurse include in teaching the client about this
drug?
d. “Avoid crowded places such as malls and large public gatherings.”
