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WorksheetsMED SURG EXAM 1
Total questions: 45
Worksheet time: 2hrs 30mins
The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2am and hyperglycemia in the morning. What is this client likely experiencing?
dawn phenomenon
Somogyi effect
insulin spike
excessive corticosteroids
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
Insulin is not used to control blood glucose in patients with type 2 diabetes
Complications of type 2 diabetes are less serious than those of type 1 diabetes
Changes in diet and exercise may control blood glucose levels in type 2 diabetes
Type 2 diabetes is usually diagnosed when the patient is admitted with a
hyperglycemic coma
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7mmol/L). The nurse will plan to teach the patient about
self-monitoring of blood glucose
using low doses of regular insulin
lifestyle changes to lower blood glucose
effects of oral hypoglycemic medications
A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?
The patient always carries hard candies when engaging in exercise
The patient goes for a vigorous walk when his glucose is 200 mg/dL
The patient has a peanut butter sandwich before going for a bicycle ride
The patient increases daily exercise when ketones are present in the urine
The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response?
“Are you anorexic?”
“Is your urine dark colored?”
“Have you lost weight lately?”
“Do you crave sugary drinks?”
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?
fasting blood glucose
oral glucose tolerance
Glycosylated hemoglobin
Urine dipstick for glucose
The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient?
The patient will reach a glycosylated hemoglobin level of less than 7%
The patient will follow a diet and exercise plan that results in weight loss
The patient will choose a diet that distributes calories throughout the day
The patient will state the reasons for eliminating simple sugars in the diet
A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to
check glucose level before, during, and after swimming
delay eating the noon meal until after the swimming class
increase the morning dose of neutral protamine Hagedorn (NPH) insulin
time the morning insulin injection so that the peak occurs while swimming
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?
“I will need a bedtime snack because I take an evening dose of NPH insulin.”
“I can choose any foods, as long as I use enough insulin to cover the calories.”
“I can have an occasional beverage with alcohol if I include it in my meal plan.”
“I will eat something at meal times to prevent hypoglycemia, even if I am not
hungry.”
To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take?
Determine what types of activities the patient enjoys
Remind the patient that exercise improves self-esteem
Teach the patient about the effects of exercise on glucose level
Give the patient a list of activities that are moderate in intensity
The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
avoid snacking at bedtime
Increase the rapid-acting insulin dose
Check the blood glucose during the night
Administer a larger dose of long-acting insulin
Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse’s assessment of the patient?
Bedtime glucose of 140 mg/dL
Noon blood glucose of 52 mg/dL
Fasting blood glucose of 130 mg/dL
2-hr postprandial glucose of 220 mg/dL
A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse’s preoperative intervention to maintain patient safety?
The patient has never had general anesthesia
The patient is planning to drive home after surgery
The patient had a sip of water 4 hours before arriving
The patient’s insurance does not cover outpatient surgery
A 38-yr-old woman is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to communicate to the anesthesiologist and surgeon before surgery?
The patient’s lack of knowledge about postoperative pain control
The patient’s history of an infection following a cholecystectomy
The patient’s report that her last menstrual period was 8 weeks ago
The patient’s concern about being able to resume lifting heavy items
A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take?
Notify the dietitian about the specific food allergies
Alert the surgery center about a possible latex allergy
Reassure the patient that all allergies are noted on the health record
Ask whether the patient uses antihistamines to reduce allergic reactions
A patient undergoing an emergency appendectomy has been using St. John’s wort to prevent depression. Which complication would the nurse expect in the post-anesthesia care unit?
increased discomfort
increased blood pressure
Increased anesthesia recovery time
Increased postoperative wound bleeding
The surgical unit nurse has just received a patient with a history of smoking from the post-anesthesia care unit. Which action is most important at this time?
Auscultate for adventitious breath sounds
Obtain the blood pressure and temperature
Remind the patient about harmful effects of smoking
Ask the health care provider to prescribe a nicotine patch
The nurse is preparing to witness the patient signing the operative consent form when the patient says, “I don’t understand what the doctor said about the surgery.” Which action should the nurse take next?
Provide a thorough explanation of the planned surgical procedure
Notify the surgeon that the informed consent process is not complete
Give the prescribed preoperative antibiotics and withhold sedative medications
Notify the operating room nurse to give a more complete explanation of the
procedure
Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for an open cholecystectomy?
Care for the surgical incision
Deep breathing and coughing
Oral antibiotic therapy after discharge
Medications to be used during surgery
A patient who takes a diuretic and a b-blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery?
Hematocrit 36%
Blood pressure 144/82
Serum potassium 3.2 mEq/L
Pulse rate 54-58 beats/minute
Which statement, if made by a new circulating nurse, reflects understanding of the circulating nurse role?
“I will assist in preparing the operating room for the patient.”
“I will don sterile gloves to obtain items from the unsterile field.”
“I will remain gloved while performing activities in the sterile field.”
“I will assist with suturing of incisions and maintaining hemostasis as needed.”
The operating room nurse is providing orientation to a student nurse. Which action would the nurse list as a major responsibility of a scrub nurse?
Document all patient care accurately
Label all specimens to send to the laboratory
Keep both hands above the operating table level
Take the patient to the postanesthesia recovery area
Postoperatively, the nurse should monitor the patient who received inhalation anesthesia for which complication?
Tachypnea
Myoclonus
Hypertension
Laryngospasm
A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. While in the postanesthesia care unit (PACU), what assessment finding is most important for the nurse to report?
lethargy
complaint of nausea
disorientation to time
weak chest movement
On admission of a patient to the postanesthesia care unit (PACU), the blood pressure (BP) is 122/72 mm Hg. Thirty minutes after admission, the BP is 114/62, with a pulse of 74 and warm, dry skin. Which action by the nurse is most appropriate?
Increase the IV fluid rate
Notify the anesthesia care provider (ACP)
Continue to take vital signs every 15 minutes
Administer oxygen therapy at 100% per mask
An older patient is being discharged from the ambulatory surgical unit following left eye surgery. The patient tells the nurse, “I don’t know if I can take care of myself once I’m home.” Which action by the nurse is most appropriate?
Provide written instructions for the care
Assess the patient’s home support system
Discuss specific concerns regarding self-care
Refer the patient for home health care services
Which action by the nurse will be most helpful to a patient who is expected to ambulate, deep breathe, and cough on the first postoperative day?
Schedule the activity to begin after the patient has taken a nap
Administer prescribed analgesic medications before the activities
Ask the patient to state two possible complications of immobility
Encourage the patient to state the purpose of splinting the incision
A postoperative patient has a nursing diagnosis of ineffective airway clearance. The nurse determines that interventions for this nursing diagnosis have been successful if which is observed?
Patient drinks 2 to 3 L of fluid in 24 hours
Patient uses the spirometer 10 times every hour
Patient’s breath sounds are clear to auscultation
Patient’s temperature is less than 100.2°F orally
A patient is transferred from the postanesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed first?
assess their pain
orient the patient to the unit
take vital signs
read post op orders
An older patient who had knee replacement surgery 2 days ago can only tolerate being out of bed with physical therapy twice a day. Which collaborative problem should the nurse identify as a priority for this patient?
Potential complication: hypovolemic shock
Potential complication: venous thromboembolism
Potential complication: fluid and electrolyte imbalance
Potential complication: impaired surgical wound healing
A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action should the nurse take first?
Administer the prescribed opioid
Check the oxygen (O2) saturation
Take the blood pressure and pulse
Apply wrist restraints to secure IV lines
When caring for a patient the second postoperative day after abdominal surgery for removal of a large pancreatic cyst, the nurse obtains an oral temperature of 100.8° F (38.2° C). Which action should the nurse take next?
Place ice packs in the patient’s axillae
Have the patient use the incentive spirometer
Request an order for acetaminophen (Tylenol)
Ask the health care provider to prescribe a different antibiotic
The nurse working in the postanesthesia care unit (PACU) notes that a patient who has just been transported from the operating room is shivering and has a temperature of 96.5° F. Which action should the nurse take next?
Notify the anesthesia care provider
Cover the patient with a warm blanket
Avoid giving opioid analgesics until the patient is warmer
Give acetaminophen (Tylenol) 650 mg suppository rectally
Which finding would indicate to the nurse that a postoperative patient is at increased risk for poor wound healing?
Potassium 3.5 mEq/L
Albumin level 2.2 g/dL
Hemoglobin 10.2 g/dL
White blood cells 11,900/µL
In which situation might surgery be delayed?
The patient has taken Dilantin today
An illegible signature is on the consent form
The patient is still taking anticoagulants
The admission office is unable to confirm insurance coverage
The nurse anticipates that the patient will be given ______________anesthesia because of the
extensive tissue manipulation involved in a hysterectomy.
general
regional
specific
preoperative
Why might the older adult patient not respond to surgical treatment as well as a younger adult patient?
poor skin turgor
fear of the unknown
Response to physiologic changes
Decreased peristalsis related to anesthesia
The nurse acting as a circulating nurse has a responsibility for:
observing breaks in sterile technique
identifying and handling surgical specimens correctly
assisting with surgical draping of the patient
maintaining count of sponges, needles, and instruments during surgery
Frequent assessment of a postoperative patient is essential. What is one of the first signs and symptoms of hemorrhage?
increasing blood pressure
decreasing pulse
restlessness
weakness, apathy
In which location are guidelines for ensuring that all nursing interventions on the day of surgery completed and documented?
nurse's notes
anesthesia record
pre-op checklist
progress notes
After change-of-shift report, which patient should the nurse assess first?
A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%
A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL
A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202
mg/dL
A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute
abdominal pain
A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?
Infuse 1 L of normal saline per hour
Give sodium bicarbonate 50 mEq IV push
Administer regular insulin 10 U by IV push
Start a regular insulin infusion at 0.1 units/kg/hr
The nurse is developing a plan of care for a client scheduled for surgery. The nurse should include which activity in the nursing care plan for the client on the day of surgery?
Avoid oral hygiene and rinsing with mouthwash
Verify that the client has not eaten for the last 24 hours
Have the client void immediately before going into surgery
Report immediately any slight increase in BP or pulse
The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid. The nurse determines that the client needs additional teaching if the client makes which statement?
"Aspirin can cause bleeding after surgery."
"Aspirin can cause my ability to clot blood to be abnormal."
"I need to continue to take the aspirin until the day of surgery."
"I need to check with my HCP about the need to stop the aspirin before the scheduled surgery."
The nurse assess a client's surgical incision for signs of infection. Which finding by the nurse would be interpreted as a normal finding at the surgical site?
red, hard skin
serous drainage
purulent drainage
warm, tender skin
