COMPREHENSIVE EXAMINATION 1-B Medical Surgical Nursing May 14, 2009

07:42 Middle East Time 12:42 Philippine Time

Question 1. Discharge teaching for a client following a laparoscopic cholecystectomy must include explaining: 1. The importance of taking bile salts indefinitely 2. The need for regular exercise to increase abdominal muscle strength 3. Techniques for abdominal wound irrigation 4. Dietary restrictions to prevent GI distress Question 2. Which assessment would most likely precede wound dehiscence? 1. A sharp pain and pressure sensation at the incision site 2. An increase in serosanguineous drainage from the wound 3. A fever and increased white cell count 4. Excessive purulent drainage and redness of the incision Question 3. If a wet-to-dry dressing has been done correctly, what should occur when the dressing is removed? 1. Necrotic tissue and exudate are present on the damp dressing 2. Slight bleeding occurs when the dressing is removed 3. The dressing has dried completely and adheres to the wound 4. No new granulation tissue is removed with the dressing Question 4. Which circumstance threatens the legality of an informed consent signed by a client before surgery? 1. The physician explained the benefits and risks of surgery 2. The client was competent to make the decision for surgery 3. Preoperative drugs were given before the client signed 4. The client was anxious when voluntary consent was given Question 5. Following a cholecystectomy and placement of a T-tube, the client complains of severe pain. What is the first nursing action prior to giving pain medication? 1. Document the complaint of pain in the nursing notes 2. Check pulse, respiratory rate, and blood pressure 3. Measure drainage from the T-tube 4. Check for bladder distention and time of last voiding

Question 6. A straight catheterization has been ordered for a client with suspected urinary retention. The correct nursing action includes: 1. Clamping the catheter for 1 hour after the first 1000 mL are withdrawn 2. Connecting the catheter to continuous irrigation solution 3. Permitting the catheter to drain until the bladder is empty 4. Attaching the catheter to either a bedside or a leg drainage bag Question 7. The priority of care for a client experiencing renal colic is: 1. Pain relief 2. Relief of nausea 3. Fluid balance 4. Ambulation Question 8. Which nursing diagnosis would be a priority for a client following an ureterolithotomy? 1. Altered urinary elimination 2. Impaired gas exchange 3. Urge incontinence 4. Impaired skin integrity Question 9. As the T-tube of a client post-cholecystectomy begins to drain smaller amounts, which would be the most important nursing action? 1. Observe the color of the stool 2. Test the urine level for bilirubin 3. Weigh the client daily 4. Irrigate the tube more often Question 10. Which laboratory finding would indicate a side effect of TPN? 1. Serum glucose: 200 mg 2. Serum K+: 3.2 mEg/L 3. Serum Na+: 150 mEg/L 4. Serum total protein: 7 g/dl Question 11. Following abdominal surgery, which early indication of a paralytic ileus would the nurse recognize? 1. Fever 2. Abdominal pain 3. Absent bowel sounds 4. Increased wound drainage Question 12. Preoperative teaching will have no effect on which perioperative outcome? 1. The amount of anesthesia needed 2. The need for pain medication

3. The postoperative recovery time 4. The risk of developing shock Question 13. Which family member should the nurse restrict from visiting a client who has TB because of susceptibility to disease transmission? 1. A 17-year-old nephew with a cold 2. A 50-year-old sister recovering from a recent hysterectomy 3. A 2-year-old granddaughter on antibiotics for an ear infection 4. A 24-year-old son on ibuprofen for tendonitis Question 14. The client with iron deficiency anemia asks why she feels so tired. What is the basis for the clients complaint? 1. Bone marrow production of RBCs is inhibited 2. The amount of oxygen delivered to the tissues is decreased 3. Lack of Hgb causes lactic acid build-up in muscles 4. Insomnia is a common problem with anemia Question 15. Which outcome would indicate that the TPN is achieving its desired effect? 1. Urinary output has increased to 1000 mL/day 2. Blood pressure is stable at 100/60 mm Hg 3. Blood urea nitrogen level is 30 gm/dL 4. Total serum protein is 8 gm/dL Question 16. During a blood transfusion, which client complaint would indicate a reaction necessitating an immediate nursing action? 1. A tingling sensation in the extremities 2. Bradycardia 3. Weakness of the face on one side 4. Flank pain Question 17. After taking report from the night shift, the arriving nurse finds an elderly client soaked in urine that has a very strong ammonia smell. Which would be the most appropriate nursing response? 1. Use incontinent pads with this client 2. Discuss with the client the importance of calling a nurse 3. Talk to the night nurse about the incident 4. Fill out an incident report and tell the nurse manager Question 18. Which nursing assessment finding would suggest that a client has developed fecal impaction? 1. Fatigue 2. Flatulence 3. Diaphoresis 4. Liquid stools

Question 19. For what purpose is a referral to hospice care appropriate for a terminal cancer client? 1. Pain relief 2. Hope for recovery 3. Alternative cures 4. Supportive care Question 20. Which nursing measure may contribute to the development of pressure sores? 1. Massaging bony prominences 2. Avoiding hot water during bathing 3. Applying cornstarch to the skin 4. Repositioning at least every 2 hours Question 21. What is an appropriate non-pharmacologic intervention for a client with essential hypertension? 1. Restricting potassium intake 2. Using stress management techniques 3. Taking up golf lessons 4. Increasing dietary potassium Question 22. In which order should the nurse schedule the series of diagnostic tests for a client with abdominal pain of unknown origin? 1. Upper GI, lower GI, ultrasound of the gallbladder 2. Ultrasound of the gallbladder, lower GI, upper GI 3. Upper GI, ultrasound of the gallbladder, lower GI 4. Lower GI, upper GI, ultrasound of the gallbladder Question 23. What manifestations of wound dehiscence could the nurse observe in a client who is obese? 1. Separation of the wound edges 2. Protrusion of the bowel through the wound 3. Prolapse of the bladder 4. Wound healing by secondary intention Question 24. On assessment, which finding would the nurse consider consistent with a diagnosis of Pneumocystis carinii pneumonia? 1. Green purulent sputum 2. Absent breath sounds over the affected lobe 3. Persistent dry hacking cough 4. Nasal flaring and circumoral cyanosis Question 25. Prior to administering antibiotic therapy for a post-surgical wound infection, which laboratory test should the nurse ensure is completed first?

1. Complete blood count 2. Chest x-ray 3. Wound culture 4. Urinalysis Question 26. Which laboratory finding would be consistent with a diagnosis of liver cancer? 1. Increased total protein 2. Decreased alkaline phosphatase 3. Decreased alpha-fetoprotein 4. lncreased aspartate aminotransferase Question 27. During a blood transfusion, which sign/symptom would the nurse recognize as an allergic reaction? 1. Abdominal cramping 2. Numbness in the hands 3. Calf tenderness 4. Hives on the chest Question 28. What assessment finding will the client with cholelithiasis most likely experience? 1. Black stools 2. Constipation 3. Umbilical pain 4. Indigestion Question 29. Which clinical state would alert the nurse to a systemic sign of inflammation? 1. Thrombocytopenia 2. Leukocytosis 3. Leukoplakia 4. Hypothermia Question 30. Which intervention for the treatment of tuberculosis has the most beneficial effect on recovery? 1. Adequate ventilation 2. Well-balanced diet 3. Optimal rest 4. Consistent drug therapy

Question 31. Following an above-the-knee amputation, what is a primary client care goal during the convalescent period? 1. Build the clients reliance on community resources 2. Promote the clients self-care abilities before discharge 3. Orient the client to the use of therapeutic equipment 4. Help the client accept dependence on family members Question 32. When the fire signal in the hospital is sounded, what should be the nurses first action? 1. Evacuate all the clients immediately 2. Close all client room doors and windows 3. Pull clients out on a blanket 4. Grab the fire extinguisher if the fire is near Question 33. Which nursing diagnosis is most important for a client with acute pancreatitis? 1. Pain 2. Fluid volume excess 3. Activity intolerance 4. Ineffective individual coping Question 34. Which symptom would the nurse expect in a client with a diagnosis of acute lymphoblastic leukemia? 1. Skin pallor 2. Ankle edema 3. Expiratory wheezing 4. Dysphagia Question 35. Which would be an appropriate nursing diagnosis for a client with acute lymphocytic leukemia? 1. Risk for infection 2. Risk for impaired skin integrity 3. Fluid volume excess 4. Acute confusion Question 36. Which assessment finding would alert the nurse to an increased risk for immune incompetence in the client? 1. Leukopenia 2. Malnourishment 3. Surgery 4. Aging

Question 37. Following a cholecystectomy, greenish-yellow drainage is seeping around the clients T-tube, and there is no drainage in the collection system. What is the appropriate action by the nurse? 1. Reinforce the dressing around the T-tube 2. Secure the T-tube with tape to the skin 3. Assess the tubing for any kinks 4. Irrigate the T-tube with normal saline Question 38. Which breathing pattern would alert the nurse that a client was experiencing respiratory distress following a thyroidectomy? 1. Deep, sighing breaths on inspiration 2. Low pitched sounds on auscultation 3. Harsh and shrill sounding respirations 4. Prolonged expiratory phase of respiration Question 39. During shock, hypoxia results from the slow movement of blood in the capillaries. For which signs of complication of this poor perfusion state should the client be assessed? 1. Disseminated intravascular coagulation (DIC) 2. Adult respiratory distress syndrome (ARDS) 3. Autonomic dysreflexia 4. Compensatory vasoconstriction Question 40Which symptom would the nurse note is consistent with a suspected diagnosis of tuberculosis? 1. Increased weight gain 2. Persistent sore throat 3. Inspiratory wheezing 4. Night sweats Question 41. For which symptom should the client with prostatic enlargement be taught to observe? 1. Bladder spasms 2. Rectal bleeding 3. Urinary retention 4. Scrotal enlargement Question 42. The client is diagnosed with vancomycin-resistant enterococci (VRE). The nurse knows that appropriate infection control procedures will include: 1. A fit-tested mask 2. A gown for any client contact 3. A positive-pressure room 4. No visitors

Question 43. When the nurse goes in to give insulin to a client, the clients ID band is missing. What should the nurse do? 1. Ask the clients roommate to identify the client 2. Check the clients name on the bed 3. Compare the client to the picture in the chart 4. Ask another nurse to confirm the clients name Question 44. Following removal of a Foley catheter, what is the appropriate nursing intervention to assess residual urine volume? 1. Palpate for distention after measuring output 2. Measure each voiding, and total the 24-hour amount 3. Catheterize the client after voiding 4. Send a specimen to the lab for analysis Question 45. The clinical manifestations of the types of shock differ. With which type of shock would the nurse most likely find warm, dry, flushed skin? 1. Hypovolemic 2. Cardiogenic 3. Septic 4. Neurogenic Question 46. While caring for a client with pruritus secondary to liver disease, the most important nursing intervention would be: 1. Finding a topical agent to relieve the itching 2. Limiting bath frequency to avoid drying of skin 3. Nail care to prevent further skin injury 4. Reviewing the clients diet for foods that increase itching Question 47. As the client care leader, which activity would the nurse delegate to the LVN/LPN? 1. Administration of pain medication to a client who is two days post-op 2. Assessment of chest pain in a client who is post-MI 3. Teaching discharge instruction to a client who is newly diagnosed with diabetes 4. Admission of a client returning to the floor from the recovery room Question 48. What is the best nursing intervention to manage severe bladder spasms experienced by the client following a TURP? 1. Give prescribed pain medication 2. Check urinary catheter patency 3. Prepare a warm sitz bath 4. Palpate for bladder distention

D is INCORRECT because, while bladder overdistention can cause spasms, the drainage system is checked first, looking for clots, which may be plugging the system and causing the distention. Question 49. What is the most characteristic symptom of peptic ulcer disease for which the nurse should monitor? 1. Weakness and diaphoresis after eating 2. Nausea after eating 3. Bloating after eating dairy products 4. Gnawing pain 12 hours after eating Question 50. Following a transurethral resection of the prostate (TURP), the nurse tells the client that the urge to void, even with a catheter in place is most likely due to: 1. Trauma to the bladder 2. Bladder spasm following the surgery 3. The return of sensation following the spinal 4. The stimulation from the irrigant solution