MEDICAL SURGICAL NURSING

1. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and
coughing exercises. The nurse’s best response would be:

A. “Pain will become less each day.”

B. “This is a normal reaction after surgery.”

C. “With a pillow, apply pressure against the incision.”

D. “I will give you the pain medication the physician ordered.”

2. The nurse needs to carefully assess the complaint of pain of the elderly because older people

A. are expected to experience chronic pain

B. have a decreased pain threshold

C. experience reduced sensory perception

D. have altered mental function

3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth
and her PR is higher, than before the medication was administered. The nurse’s best

A. The patient is having an allergic reaction to the drug.

B. The patient needs a higher dose of this drug

C. This is normal side-effect of AtSO4

D. The patient is anxious about upcoming surgery

4. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations
of 32. Suspecting shock, which of the following orders would the nurse question?

A. Put the client in modified Trendelenberg's position.

B. Administer oxygen at 100%.

C. Monitor urine output every hour.

D. Administer Demerol 50mg IM q4h

5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal
conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room.
What is the best approach?
A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"

B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts.

C. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."

D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"

6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric
tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would
the nurse take?

A. Call the physician immediately.

B. Administer the prescribed antiemetic.

C. Check the patency of the nasogastric tube for any obstruction.

D. Change the patient’s position

7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication
provides little relief and he refuses to move. The nurse should plan to:

A. Reassure him that the nurses will not hurt him

B. Let him perform his own activities of daily living

C. Handle him gently when assisting with required care

D. Complete A.M. care quickly as possible when necessary

8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82,
blood pressure is 120/80, respirations are 20, and all are within normal range. At 10 am and at 11 am,
his vital signs are stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and
respirations are 24. What nursing action is most appropriate?

A. Notify his physician.

B. Take his vital signs again in 15 minutes.

C. Take his vital signs again in an hour.

D. Place the patient in shock position.

9. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2-story
building. When assessing the client, the nurse would be most concerned if the assessment revealed:

A. Reactive pupils
B. A depressed fontanel

C. Bleeding from ears

D. An elevated temperature

10. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD?

A. “I exercise every other day.”

B. “My father died of Myasthenia Gravis.”

C. “My cholesterol is 180.”

D. “I smoke 1 1/2 packs of cigarettes per day.”

11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge regarding this drug?

A. It has positive inotropic and negative chronotropic effects

B. The positive inotropic effect will decrease urine output

C. Toxixity can occur more easily in the presence of hypokalemia, liver and renal problems

D. Do not give the drug if the apical rate is less than 60 beats per minute.

12. Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate
Valsalva's maneuver?

A. Use of stool softeners.

B. Enema administration

C. Gagging while toothbrushing.

D. Lifting heavy objects

13. The nurse is teaching the patient regarding his permanent artificial pacemaker. Which information
given by the nurse shows her knowledge deficit about the artificial cardiac pacemaker?

A. take the pulse rate once a day, in the morning upon awakening

B. may be allowed to use electrical appliances

C. have regular follow up care

D. may engage in contact sports

A. “When your chest pain begins, lie down, and place one tablet under your tongue. If the pain
continues, take another tablet in 5 minutes.”

B. “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”

C. “Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets
one every 5 minutes for 15 minutes, then go lie down.”

D. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the
hospital if the pain is unrelieved.

15. A client with chronic heart failure has been placed on a diet restricted to 2000mg. of sodium per day.
The client demonstrates adequate knowledge if behaviors are evident such as not salting food and
avoidance of which food?

A. Whole milk

B. Canned sardines

C. Plain nuts

D. Eggs

16. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this
team member is most appropriate?

A. Apply a heating pad to the involved site.

B. Elevate the client's legs 90 degrees.

C. Instruct the client about the need for bed rest.

D. Provide active range-of-motion exercises to both legs at least twice every shift.

17. A client receiving heparin sodium asks the nurse how the drug works. Which of the following points
would the nurse include in the explanation to the client?

A. It dissolves existing thrombi.

B. It prevents conversion of factors that are needed in the formation of clots.

C. It inactivates thrombin that forms and dissolves existing thrombi.

D. It interferes with vitamin K absorption.

A. Dyspnea on exertion

B. Foamy, blood-tinged sputum

C. Wheezing sound on inspiration

D. Cough or change in a chronic cough

19. Which is the most relevant knowledge about oxygen administration to a client with COPD?

A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.

B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath.

C. Oxygen is administered best using a non-rebreathing mask

D. Blood gases are monitored using a pulse oximeter.

20. When suctioning mucus from a client's lungs, which nursing action would be least appropriate?

A. Lubricate the catheter tip with sterile saline before insertion.

B. Use sterile technique with a two-gloved approach

C. Suction until the client indicates to stop or no longer than 20 second

D. Hyperoxygenate the client before and after suctioning

21. Dr. Santos prescribes oral rifampin (Rimactane) and isoniazid (INH) for a client with a positive
Tuberculin skin test. When informing the client of this decision, the nurse knows that the purpose of this
choice of treatment is to

A. Cause less irritation to the gastrointestinal tract

B. Destroy resistant organisms and promote proper blood levels of the drugs

C. Gain a more rapid systemic effect

D. Delay resistance and increase the tuberculostatic effect

22. Mario undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and
one-bottle water-seal drainage is instituted in the operating room. In the postanesthesia care unit Mario
is placed in Fowler's position on either his right side or on his back to

A. Reduce incisional pain.

C. Equalize pressure in the pleural space.

D. Increase venous return

23. A client with COPD is being prepared for discharge. The following are relevant instructions to the
client regarding the use of an oral inhaler EXCEPT:

A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth.

B. Inhale slowly through the mouth as the canister is pressed down

C. Hold his breath for about 10 seconds before exhaling

D. Slowly breathe out through the mouth with pursed lips after inhaling the drug.

24. A client is scheduled for a bronchoscopy. When teaching the client what to expect afterward, the
nurse's highest priority of information would be

A. Food and fluids will be withheld for at least 2 hours.

B. Warm saline gargles will be done q 2h.

C. Coughing and deep-breathing exercises will be done q2h.

D. Only ice chips and cold liquids will be allowed initially.

25. The nurse enters the room of a client with chronic obstructive pulmonary disease. The client's nasal
cannula oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9
per minute and shallow. What is the nurse’s best initial action?

A. Take heart rate and blood pressure.

B. Call the physician.

C. Lower the oxygen rate.

D. Position the client in a Fowler's position.

26. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most
appropriate nursing diagnosis for this patient?

A. Fluid volume deficit

B. Decreased tissue perfusion.

C. Impaired gas exchange.

27. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face.
Which additional assessment finding would lead the nurse to suspect that the client has Cushing’s
syndrome rather than obesity?

A. large thighs and upper arms

B. pendulous abdomen and large hips

C. abdominal striae and ankle enlargement

D. posterior neck fat pad and thin extremities

28. Which statement by the client indicates understanding of the possible side effects of Prednisone
therapy?

A. “I should limit my potassium intake because hyperkalemia is a side-effect of this drug.”

B. “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.”

C. “This medicine will protect me from getting any colds or infection.” D. “My incision will heal much
faster because of this drug.”

29. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and
headache. Which assessment is essential for the nurse to make first?

A. Pupil reaction

B. Hand grips

C. Blood pressure

D. Blood glucose

30. The nurse is attending a bridal shower for a friend when another guest, who happens to be a
diabetic, starts to tremble and complains of dizziness. The next best action for the nurse to take is to:

A. Encourage the guest to eat some baked macaroni

B. Call the guest’s personal physician

C. Offer the guest a cup of coffee

D. Give the guest a glass of orange juice