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Medical-Surgical Nursing Midterm Exam Part 1

Total questions: 50

Worksheet time: 1hrs 26mins

Name
Class
Date
1.

The patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse recognize is the most common organism that causes community-acquired pneumonia?

a)

       Staphylococcus aureus

b)

       Mycobacterium tuberculosis

c)

       Pseudomonas aeruginosa

d)

     Streptococcus pneumoniae

2.

  The nurse notes that the patient who is retaining fluid had a 1-kg weight gain. Documentation should indicate that this is equivalent to about how many mL?

a)

       250 mL

b)

       500 mL

c)

       750 mL

d)

       1000 mL

3.

       The nurse is reviewing a patient’s laboratory results. All EXCEPT one are assessment findings consistent with acute glomerulonephritis.

a)

       Red blood cells in the urine

b)

       Polyuria

c)

       Proteinuria

d)

       White cell casts in the urine

4.

       A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse followed a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has?

a)

       Benign

b)

       Primary progressive

c)

       Relapsing-remitting (RR)

d)

Secondary Progressive

5.

The nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. The following interventions can be done to assist with relieving the spasms EXCEPT?

a)

       Have the patient take a hot tub bath to allow muscle relaxation

b)

       Demonstrate daily muscle stretching exercises

c)

      Apply warm compresses to the affected areas

d)

      Allow the patient adequate time to perform exercises

6.

       Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of diabetes?

a)

       6.5 – 7%

b)

       5.7 – 6.4%

c)

       5 – 5.6%

d)

       >5.6%

7.

      A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia?

a)

   Aspiration pneumonia

b)

  Ventilator acquired pneumonia

c)

Hospital-acquired pneumonia

d)

Community-acquired pneumonia

8.

Which of the following patients are MOST at risk for developing pneumonia?

a)

   53 year old female recovering from abdominal surgery.

b)

    A 69 year old patient who recently received the pneumococcal conjugate vaccine.

c)

    A 42 year old male with COPD and is on continuous oxygen via nasal cannula.

d)

    A 8 month old with RSV (respiratory syncytial virus) infection.

9.

      Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:

a)

Stridor

b)

Coarse crackles

c)

Oxygen saturation less than 90%

d)

   Non-productive, nagging cough

10.

   A 72 year-old male patient who is diagnosed with bilateral lower lobe pneumonia is admitted to your unit. The patient has a history of systolic heart failure and arthritis. On assessment, you note the patient has a respiratory rate of 21, oxygen saturation 93% on 2L nasal cannula, is alert & oriented, and has a productive cough with green/yellowish sputum. Which of the following nursing interventions will you provide to this patient based on your assessment findings and the patient's diagnosis? Select-all-that-apply:

a)

   Keep head-of-the-bed less than 30 degrees at all times.

b)

      Collect sputum cultures.

c)

      Encourage 3L of fluids a day to keep secretions thin.

d)

      Encourage incentive spirometer usage 

11.

1.       You’re providing discharge teaching to a patient who was admitted for pneumonia. You are discussing measures the patient can take to prevent pneumonia. Which of the following statements by the patient indicates they did NOT understand your education material?

a)

   "I’ll use hand sanitizer regularly while I'm out in public."

b)

"It is important I don’t receive the Pneumovax vaccine since I'm already immune to pneumonia."

c)

  "I will try to avoid large crowds of people during the peak of flu season."

d)

   "It is important I try to quit smoking."

12.

1.       Select ALL the TRUE statements about the pathophysiology of multiple sclerosis:

a)

     The dendrites on the neuron are overstimulated leading to the destruction of the axon

b)

      “The myelin sheath, which is made up of Schwann cells, is damaged along the axon.”

c)

      This disease affects the insulating structure found on the neuron in the central nervous system.”

d)

      The dopaminergic neurons in the part of the brain called substantia nigra have started to die.”

13.

1.       A patient Is suspected of having multiple sclerosis. The neurologist orders various test. The patient’s MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? Select all that apply

a)

     Blurry vision

b)

      Pain when moving eyes

c)

      Ptosis

d)

     Dark spots in vision

14.

TRUE OR FALSE: Multiple sclerosis tends to affect men more than women and occurs during the ages of 50-70 years.

(a)  

15.

TRUE OR FALSE: Patient with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system.

(a)  

16.

      Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis?

a)

The patient report dark spots in the visual fields during the confrontation visual field test.

b)

  When the patient closes the eyes and stands with his feet together they start to lose their balance and sway back and forth.

c)

  The patient's sign and symptoms increase when expose to hot temperatures.

d)

  The patient reports an electric shock feeling when the head and neck are moved downward.

17.

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present.

a)

      high amounts of IgM

b)

      oligoclonal bands 

c)

      low amounts of WBC

d)

     oblong red blood cells and glucose

18.

     A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of?

a)

     Physical exercise to improve fatigue

b)

     Low fat diet

c)

     Hand hygiene and avoiding infection 

d)

    Reporting ideation of suicide

19.

      Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply:

a)

     Propranolol

b)

     Isoniazid

c)

    Baclofen

d)

     Modafinil

20.

A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing intervention will you include in this patient's plan of care?

a)

  Initiate and maintain a high sodium diet daily.

b)

Monitor intake and output hourly. 

c)

   Encourage patient to ambulate every 2 hours while awake. 

d)

   Encourage the patient to consume 4 L of fluid per day.

21.

  A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be most prominent during the?

a)

    Evening

b)

Afternoon

c)

     Morning

d)

     Bedtime

22.

   Which patient below is at MOST RISK for developing acute glomerulonephritis?

a)

     A 3 year old male who has a positive antistreptolysin titer. 

b)

    A 5 year old male who is recovering from an appendectomy.

c)

     An 18 year old male who is diagnosed with HIV.

d)

     A 6 year old female newly diagnosed with measles.

23.

    Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? SELECT-ALL-THAT-APPLY:

a)

   Hypotension 

b)

     Increased Glomerular filtration rate 

c)

     Cola-colored urine

d)

     Massive proteinuria 

24.

TRUE OR FALSE: Poststreptococcal glomerulonephritis is a condition leading to the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate.

(a)  

25.

     Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition?

a)

   This condition tends to present after a strep infection of the throat or skin

b)

   It is important the patient consumes a diet rich in potassium-based foods due to risk of hypokalemia.

c)

    "Patients are less likely to experience hematuria with this condition."

d)

   "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system’s response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus."

26.

A client is noted to have a type I (IgE-mediated) hypersensitivity reaction with a systemic response. Which clinical manifestation is NOT anticipated?

a)

   Allergic rhinitis

b)

   Wheezing

c)

  Urticaria

d)

   Hypotension

27.

       Which is the nurse's PRIORITY action when managing a client experiencing a type I hypersensitivity?

a)

Management of arthralgia

b)

Airway management

c)

Stopping the blood transfusion

d)

Decreasing a fever

28.

The nurse is providing teaching for a client on dietary intake and anaphylaxis. Which food should the nurse identify that trigger anaphylaxis in a sensitized individual?

a)

  Coconut oil

b)

   Milk

c)

   Chocolate

d)

Carrots

29.

   The nurse is providing discharge teaching for a teenager who has experienced anaphylaxis related to a food allergy. Which statement by the nurse addresses the most common risk factor for an allergic reaction in a teenager?

a)

  "Eat nutritional meals and drink plenty of fluids."

b)

   "Monitor what you are eating outside the home."

c)

  Seek emergency medical help if you feel you have experiencing anaphylaxis."

d)

"limit your exposure to the food that caused the reaction."

30.

    Your patient is having a sudden and severe anaphylactic reaction to a medication. You immediately stop the medication and call a rapid response. The patient's blood pressure is 80/52, heart rate 120, and oxygen saturation 87%. Audible wheezing is noted along with facial redness and swelling. As the nurse you know that the first initial treatment for this patient's condition is?

a)

    IV Diphenhydramine

b)

      IV Normal Saline Bolus

c)

     IM Epinephrine 

d)

     Nebulized Albuterol

31.

      A 25-year-old female is admitted to the ER in anaphylactic shock due to a bee sting. According to the patient's mother, the patient is severely allergic to bees and was recently stung by one. This type of anaphylactic reaction is known as a?

a)

    Type I Hypersensivity Reaction 

b)

    Type II Hypersensivity Reaction 

c)

    Type III Hypersensivity Reaction 

d)

    Type IV Hypersensivity Reaction 

32.

During anaphylactic shock the mast cells and basophils release large amounts of histamine. The following are effects of histamine except?

a)

   Decreases capillary permeability

b)

    Shifts intravascular fluid to interstitial space 

c)

  Inhibits the production of gastric secretions

d)

     Decreases heart rate 

33.

    You're providing education to a patient, who has a severe peanut allergy, on how to recognize the signs and symptoms of anaphylactic shock. Select all the signs and symptoms associated with anaphylactic shock:

a)

    Hyperglycemia

b)

   Difficulty speaking 

c)

Feeling dizzy 

d)

  Fever

34.

Your patient is started on an IV antibiotic to treat a severe infection. During infusion, the patient uses the call light to notify you that she feels a tight sensation in her throat and it's making it hard to breathe. You immediately arrive to the room and assess the patient. While auscultating the lungs you note wheezing. You also notice that the patient is starting to scratch the face and arms, and on closer inspection of the face you note redness and swelling that extends down to the neck and torso. The patient's vital signs are the following: blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. You suspect anaphylactic shock. Which of the following should not be included in the nursing interventions?

a)

    Slow down the antibiotic infusion 

b)

    Call a rapid response 

c)

    Place the patient on oxygen 

d)

Prepare for the administration of Epinephrine 

35.

    A patient is in anaphylactic shock. The patient has a severe allergy to peanuts and mistakenly consumed an eggroll containing peanut ingredients during his lunch break. The patient is given Epinephrine intramuscularly. As the nurse, you know this medication will have what effect on the body?

a)

   It will prevent a recurrent attack. 

b)

    It will cause vasoconstriction and decrease the blood pressure.

c)

   It will help dilate the airways.

d)

  It will help block the effects of histamine in the body.

36.

You're providing care to a patient in anaphylactic shock. What is NOT a typical medical treatment for this condition, and if ordered the nurse should ask for an order clarification?

a)

  IV Diphenhydramine 

b)

   Epinephrine

c)

    IV Furosemide

d)

    Isotonic intravenous fluids

37.

What is the MOST important step a nurse can take to prevent anaphylactic shock in a patient?

a)

  Assessing, documenting, and avoiding all the patient allergies 

b)

  Administering Epinephrine

c)

   Administering Corticosteroids

d)

Establishing IV access

38.

   Nurse Ivan is assigned to a telephone triage. A client called who was stung by a honeybee and is asking for help. The client reports of pain and localized swelling but has no respiratory distress or other symptoms of anaphylactic shock. What is the appropriate initial action that the nurse should direct the client to perform?

a)

 Removing the stinger by scraping it.

b)

   Applying a cold compress.

c)

Taking an oral antihistamine

d)

None of the above

39.

   Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first?

a)

Administering oxygen

b)

  Inserting an I.V. catheter

c)

Obtaining a complete blood count

d)

Taking vital signs

40.

Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next?

a)

   Administer beta-adrenergic blockers.

b)

    Obtain serum electrolyte levels.

c)

Administer bronchodilators.

d)

Have the client lie flat in the bed.

41.

  The nurse is teaching a young adult client about risk factors likely to cause allergic skin reactions. Of the​ possibilities, which ones would the nurse identify as possible risk​ factors? (Select all that​ apply.)

a)

  Dry environment

b)

  Exposure to plants

c)

  Infrequent hand washing

d)

   Exposure to soap

42.

A client is diagnosed with a severe case of allergic contact​ dermatitis, which covers​ 20% of the​ client's body. Which treatment can the nurse anticipate will be prescribed for this client that is specific to severe allergic contact​ dermatitis?

a)

Wet dressings

b)

Oral corticosteroids

c)

Topical antibiotics

d)

Antipruritic medications

43.

   A client with allergic contact dermatitis is scheduled for a skin test in which small amounts of an allergen will be injected into the skin on the arm. Which test will the nurse educate this client about prior to​ performing?

a)

  IgE antibody test

b)

  Scratch test

c)

Patch test

d)

Intradermal test

44.

The nurse carefully inspects a skin lesion that the nurse believes is due to contact dermatitis. Besides​ inspection, what other technique is important for the nurse to use during the nursing assessment of this​ client?

a)

   Percussion

b)

Palpation

c)

  Biopsy

d)

Auscultation

45.

The nurse is completing discharge teaching for a client with a skin infection related to contact dermatitis. Which information should NOT be included in managing this skin infection at​ home?

a)

  Keep nails trimmed short

b)

Stop antibiotics when redness disappears

c)

Seek medical attention if lesion becomes painful

d)

  Use mild soap to clean skin

46.

Which pathological finding characterizes irritant contact dermatitis but not allergic contact​ dermatitis?

a)

Rash confined to area of contact with allergen or irritant

b)

Not a hypersensitivity response

c)

Pruritus

d)

Damage to the dermis and epidermis

47.

The nurse is assisting in planning care for a client with undergoing immunosuppressant therapy. What nursing intervention should be incorporated as a priority in the plan?

a)

Protecting the client from infection

b)

Providing emotional support to decrease fear

c)

Encouraging discussion about lifestyle changes

d)

Identifying factors that decreased the immune function

48.

The community health nurse is conducting a research study and is identifying clients in the community at risk for latex allergy. Which client population is at most risk for developing this type of allergy?

a)

Hairdressers

b)

The homeless

c)

Children in day care centers

d)

Individuals living in a group home

49.

All of the following except one are interventions applied in the care of a client at high risk for an allergic response to a latex allergy.

a)

Use nonlatex gloves.

b)

Place the client in a private room only.

c)

Keep a latex-safe supply cart available in the client's area.

d)

Avoid the use of medication vials that have rubber stoppers.

50.

1.       When educating the client about activity level, the nurse bases the information on the knowledge that exercise affects the body’s physiologic functioning relative to glucose usage in which of the following ways?

a)

Exercise helps evade hypoglycemia.

b)

Exercise stimulates insulin overproduction.

c)

Exercise decreases the renal threshold for glucose.

d)

Exercise enhances the use of glucose by muscles.