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WorksheetsMedsurg Final
Total questions: 80
Worksheet time: 40mins
Which is a key risk factor for peptic ulcer disease that nurses should assess during history taking?
Helicobacter pylori infection
Daily intake of high-fiber foods
Chronic use of proton pump inhibitors
Regular consumption of probiotics
A newly created stoma is assessed. Which finding most clearly indicates a normal stoma?
Pink-red and moist
Dusky and dry
Pale and retracting
Brown-black and cool
Which patient education point best reduces complications for peptic ulcer disease?
Use aspirin for mild pain
Limit fiber-rich vegetables
Increase spicy food intake
Avoid NSAIDs and smoking
A patient with suspected diverticulitis presents with abdominal pain. Which location of pain is most consistent with this diagnosis?
Periumbilical region
Right upper quadrant
Epigastric area
Left lower quadrant
Which clinical combination suggests peritonitis as a complication of diverticulitis?
Rigid board-like abdomen
Localized epigastric bruising
Soft non-tender abdomen
Hyperactive bowel sounds
Which statement accurately describes Crohn's disease pathophysiology?
Continuous superficial inflammation only
Transmural inflammation with skip lesions
Mucosal-layer disease without strictures
Involvement restricted to colon and rectum
Which symptom pattern is most characteristic of Crohn's disease?
Constipation with bright red bleeding
Watery diarrhea only at night
Ten bloody stools without pain
Five loose stools and skip lesions
Which complication is the patient with Crohn's disease at increased risk for over time?
Benign polyps exclusively
Bowel obstruction and fistulas
Acute pancreatitis only
Gallstone impaction solely
Which feature best distinguishes ulcerative colitis from Crohn disease in severe cases?
10–20 bloody stools per day pattern
Transmural inflammation with fistulas
Perianal abscesses and strictures common
Skip lesions throughout small intestine
A patient with suspected peritonitis presents with which classic abdominal finding?
Rigid board-like abdominal wall
Soft non-tender abdomen
Localized left lower quadrant mass
Hyperactive high-pitched bowel sounds
Which complication of peritonitis poses the greatest immediate threat to life?
Sepsis with septic shock
Acute respiratory distress syndrome
Localized abscess formation
Adhesive bowel obstruction
Which intervention is appropriate to prevent pyelonephritis in a female patient?
Wipe front to back after voiding
Use feminine douches weekly
Limit fluid intake during daytime
Delay urination to strengthen bladder
Which organism type most commonly causes pyelonephritis?
Gram-positive skin flora
Gram-negative enteric bacteria
Anaerobic oral bacteria
Fungal opportunistic yeasts
Which condition is a risk factor for pyelonephritis due to interrupted urine flow?
Hyperthyroidism with tachycardia
Asthma with nocturnal wheeze
Irritable bowel with diarrhea
Enlarged prostate with retention
Which lab pattern is expected in acute kidney injury?
Low creatinine with high sodium
Normal BUN with high calcium
Decreased BUN and creatinine
Increased BUN and creatinine
A patient with acute kidney injury develops hyponatremia primarily due to which mechanism?
Enhanced tubular secretion of sodium
Decreased GFR reducing sodium handling
Excess aldosterone increasing sodium loss
Increased renin causing vasoconstriction
Which potassium lab value falls within the normal reference range for adults?
6.5 mEq/L, dangerous hyperkalemia
5.8 mEq/L, marked hyperkalemia
3.8 mEq/L, normal potassium
2.9 mEq/L, severe hypokalemia
A patient’s urine specific gravity is 1.050. What interpretation is most accurate?
Random error, value is impossible
Diluted urine, likely overhydrated
Normal concentration, no concerns
Highly concentrated, probable dehydration
In chronic kidney disease, which expected trend in lab values is most likely?
Decreased BUN and creatinine
Increased potassium and phosphorous
Increased sodium and calcium
Decreased H&H and magnesium
Which dietary recommendation best aligns with chronic kidney disease management when not on dialysis?
High protein, high potassium diet
Low protein, low phosphorous diet
High sodium, high calcium diet
Low calories, high magnesium diet
A patient with CKD presents with hyperkalemia. What immediate risk should the nurse prioritize?
Air embolism during dialysis
Metabolic alkalosis from CO2 loss
Cardiac arrest due to dysrhythmias
Seizures from sodium depletion
Before hemodialysis, which nursing action is most appropriate regarding antihypertensive medications?
Give after weight measurement
Hold them before the session
Administer a double dose pre-dialysis
Switch to IV during dialysis
An AV fistula assessment reveals a palpable thrill and an audible bruit. What is the best interpretation?
Findings indicate patency of the fistula
Signs suggest thrombosis is developing
Results confirm severe hypotension
Evidence of immediate air embolism
An arterial blood gas shows pH 7.30 and PaCO2 55 mmHg. Which imbalance is indicated and what is the primary mechanism?
Respiratory acidosis from CO2 retention
Respiratory alkalosis from hyperventilation
Metabolic alkalosis from acid excretion
Metabolic acidosis from bicarbonate loss
Which finding best indicates metabolic acidosis rather than respiratory alkalosis?
pH increased with PaCO2 decreased
pH decreased with HCO3 decreased
pH increased with HCO3 increased
pH normal with PaCO2 increased
A patient with vomiting and nasogastric suctioning develops an acid–base disorder. Which cause most aligns with metabolic alkalosis?
Loss of bicarbonate in diarrhea
Excess lactic acid production
Loss of acids due to gastric drainage
Increased carbonic acid retention
Which patient education point is most appropriate for pneumonia to promote secretion clearance?
Avoid incentive spirometry use
Encourage coughing and deep breathing
Restrict fluids to reduce edema
Lie flat to improve oxygenation
Which combination of signs most strongly suggests pneumonia in an older adult?
Night sweats, weight gain, dry cough
Bradycardia, hypotension, clear sputum
Crackles, decreased breath sounds, pleuritic pain
Wheezing, chest tightness, morning cough
In asthma pathophysiology, chronic inflammation causes which airway change?
Remodeling with hypertrophy and hyperplasia
Alveolar necrosis and fibrosis
Permanent bronchodilator receptor loss
Loss of surfactant production
Which symptom pattern best differentiates asthma from pneumonia?
Elevated WBC with CRP positivity
Purulent sputum with pleuritic chest pain
Wheezing with chest tightness and dyspnea
Fever with productive cough and crackles
Which diagnostic test directly assesses airflow obstruction in asthma?
Serum CRP level
Arterial blood gas pH
Chest x‑ray imaging
Peak expiratory flow measurement
Which initial nursing intervention is most appropriate during an acute asthma exacerbation?
Discontinue oxygen to prevent dependence
Place flat and restrict fluids
Administer short‑acting bronchodilator
Start magnesium sulfate infusion
Which initial medication is recommended for status asthmaticus to rapidly relieve bronchospasm?
Montelukast, a leukotriene receptor blocker
Prednisone, an oral corticosteroid
Albuterol, a short-acting beta agonist
Ipratropium, an anticholinergic inhaler
Which statement best describes the pathophysiology of COPD?
Progressive, irreversible airflow limitation
Intermittent airway hyperresponsiveness only
Reversible bronchoconstriction with allergens
Acute alveolar collapse due to surfactant loss
Which clinical sign is most consistent with advanced COPD?
Barrel chest with diminished breath sounds
Sudden pleuritic chest pain on inspiration
Fine basilar crackles resolving with cough
Productive cough improving after antibiotics
A nurse encourages pursed‑lip breathing for a patient with COPD. What is the primary rationale?
Improves bronchodilator absorption via laminar flow
Increases inspiratory reserve to prevent atelectasis
Raises tidal volume through diaphragmatic lift
Prolongs exhalation to reduce air trapping
On ECG, which component represents ventricular depolarization?
QRS complex on the tracing
P wave on the baseline
T wave with upright shape
ST segment after the QRS
Which normal interval range is correctly matched?
PR interval: 0.12–0.20 seconds
QRS duration: 0.20–0.40 seconds
P wave: 0.40–0.60 seconds
QT interval: 0.02–0.04 seconds
On an ECG, pacemaker capture is best confirmed by which sequence?
Spike followed by ST segment depression
Spike followed by only a P wave
Spike followed by a prolonged PR interval
Spike followed by QRS and T wave
Post‑pacemaker insertion, which nursing action reduces the risk of lead displacement?
Encourage heavy lifting after forty‑eight hours
Discontinue cardiac rhythm monitoring early
Restrict arm movement on the insertion side
Increase active shoulder range of motion
Which ECG finding most characterizes atrial fibrillation?
Regular rhythm with occasional premature ventricular beats
Regular narrow QRS complexes with visible p-waves
Irregularly irregular rhythm without discernible p-waves
Wide QRS complexes with consistent atrial flutter waves
A patient in ventricular tachycardia without a pulse arrives. What is the immediate priority intervention?
Give beta-blocker and obtain a 12‑lead ECG
Perform synchronized cardioversion promptly
Administer adenosine and reassess rhythm
Begin CPR and defibrillate rapidly
Which complication is most closely associated with untreated ventricular tachycardia?
Progression to stable supraventricular tachycardia
Acute pericardial effusion and tamponade
Sudden cardiac arrest leading to death
Chronic left bundle branch block formation
What hallmark physical exam finding points to pericarditis?
Fixed split S2 in all breathing phases
Continuous machinery-like murmur systolic-diastolic
Pericardial friction rub on auscultation
S3 gallop that worsens with inspiration
Which symptom set best indicates left-sided heart failure?
Bradycardia, hypotension, syncope, cool extremities
Warm flushed skin, bounding pulses, fever
Dyspnea, rales, orthopnea, nocturnal dyspnea
Peripheral edema, JVD, hepatomegaly, weight gain
A patient with pericarditis reports increased chest pain when lying supine and during coughing. Which nursing action is most appropriate to reduce inflammation?
Apply continuous cold packs to chest
Administer NSAIDs as prescribed
Start prophylactic anticoagulation
Encourage high-impact exercise daily
You suspect cardiac tamponade in a patient with muffled heart sounds. What is the emergent procedure most indicated?
Elective valve replacement surgery
Percutaneous coronary intervention
Transesophageal echocardiography only
Pericardiocentesis for fluid removal
Which patient description suggests uncontrolled atrial fibrillation requiring rate control?
Heart rate fluctuating between 50 and 70 at rest
Heart rate persistently under 60 with dizziness
Heart rate over 100 with palpitations and chest pain
Heart rate consistently under 100 and asymptomatic
Which finding most specifically indicates right-sided heart failure rather than left-sided failure?
Bibasilar crackles on lung auscultation
Orthopnea with nocturnal dyspnea
Peripheral edema with jugular venous distention
Pink frothy sputum during coughing
Which nursing intervention is appropriate in standard heart failure pharmacologic management?
Encourage high sodium intake for volume support
Administer ACE inhibitors and beta-blockers
Prefer NSAIDs to reduce inflammation
Avoid diuretics to prevent electrolyte loss
A patient develops acute pulmonary edema. Which sign most strongly supports this diagnosis?
Polyuria with clear yellow urine
Productive cough without sputum color change
Cough with frothy, pink-tinged sputum
Bradycardia with warm extremities
Infective endocarditis primarily involves which pathophysiologic process?
Allergic inflammation of bronchioles
Infection of endocardium and valves
Autoimmune attack on myelin sheaths
Ischemic necrosis of ventricular septum
Which complication of endocarditis requires close neurologic assessment due to increased risk?
Hypoglycemic seizures from insulin overdose
Embolic stroke from vegetation
Renal colic from ureteral stone
Pulmonary contusion after trauma
Which patient is at highest risk for developing delirium during hospitalization?
Middle-aged runner with muscle strain
Young adult after routine vaccination
Elderly ICU patient with dehydration
Adolescent with seasonal allergies
Which measure is part of endocarditis treatment and prevention?
Prophylactic antibiotics for pre-dental procedures
Daily anticoagulation for all patients
Routine NSAIDs before dental care
High-protein diet for valve regrowth
Which correctly lists the stages of Alzheimer’s disease in order?
Early, moderate, late
Prodrome, crisis, resolution
Initial, terminal, recovery
Acute, chronic, remission
Which feature best characterizes the first stage of Alzheimer’s disease?
Impairment of all cognitive functions with agitation
Agnosia with loss of verbal skills and mobility
Independent in ADLs with short-term memory loss
Completely bedridden with total ADL dependence
Which set lists the four cardinal motor symptoms of Parkinson’s disease?
Hand trembling, arm weakness, unilateral limb involvement
Freezing in place, difficulty with coordination, balance loss
Masklike face, shuffling gait, stooped posture, stiffness
Tremor, muscle rigidity, bradykinesia, postural instability
Match each Parkinson’s stage description to the correct stage number.
Stage 3: postural instability, increased gait disturbances
Stage 2: bilateral limb involvement, slow shuffling gait
Stage 4: akinesia, rigidity stage
Stage 5: complete ADL dependence
Stage 1: unilateral limb involvement, minimal weakness
A patient with Parkinson’s is at increased risk for aspiration. Which complication can aspiration directly lead to?
Deep vein thrombosis
Hypothyroidism
Renal failure
Pneumonia
Which home safety recommendation is most appropriate for a client with mild Parkinson’s to reduce fall risk?
Place locks at bottom of doors to limit wandering
Encourage prolonged bed rest and daytime napping
Install handrails and remove loose rugs and cords
Use dim lighting to promote a relaxed environment
Which medication combination is standard pharmacologic therapy for Parkinson’s disease?
Carbidopa/levodopa (Sinemet)
Phenytoin/levetiracetam
Haloperidol/benztropine
Warfarin/aspirin
During an active seizure, which immediate nursing action takes priority to prevent aspiration and maintain airway patency?
Offer water to help swallow oral secretions
Restrain the patient’s arms to prevent injury
Insert a tongue depressor to protect the teeth
Turn the patient to the side and keep airway clear
Which Alzheimer’s stage is best described by disorientation to time, place, and event with psychotic behaviors and wandering episodes?
First stage
Moderate stage
Late stage
Prodromal stage
During seizure safety teaching, which activity should a patient avoid to reduce injury risk when seizures are unpredictable?
Keeping a seizure diary for triggers
Wearing loose clothing at home
Practicing relaxation breathing daily
Using power tools without supervision
Which set best represents classic signs of increased intracranial pressure in meningitis?
Arthralgia with pruritus and normal pupils
Polyuria with orthostatic hypotension only
Bradycardia with warm flushed skin only
Cushing’s triad with decreased LOC and vomiting
A patient with suspected meningitis develops nuchal rigidity and myalgia. What additional change most strongly suggests worsening ICP?
Resolution of neck stiffness quickly
Stable blood pressure and heart rate
Improved oral intake overnight
Altered pupillary reactivity to light
For multiple sclerosis self-management, which recommendation helps prevent exacerbations related to temperature sensitivity?
Avoid extreme temperatures during activities
Increase caffeine intake for fatigue
Skip bowel routine to save energy
Limit hydration to reduce urgency
Which immediate nursing action is prioritized when autonomic dysreflexia occurs in a T4 spinal cord injury patient with sudden severe hypertension?
Sit the patient upright to reduce BP and ICP
Lay the patient flat to improve perfusion
Apply warming blankets to lower tone
Restrict fluids until blood pressure falls
Which common trigger should be assessed first when evaluating autonomic dysreflexia in a patient with a high thoracic injury?
Mild dehydration from exertion
Ear infection causing fever alone
Hypoglycemia after missed meal
Bladder distention from blocked catheter
Autonomic dysreflexia, if untreated, most directly risks which serious complication?
Cerebral hemorrhage and cardiac dysrhythmias
Chronic anemia and peripheral neuropathy
Renal failure from prolonged oliguria
Peptic ulcer disease from stress alone
Early postoperative nursing priorities after total hip arthroplasty include which intervention to reduce complications?
Avoid neurovascular checks to reduce anxiety
Monitor for bleeding and infection with hip precautions
Aggressive passive ROM beyond pain thresholds
Limit ambulation for several days post-op
After total hip arthroplasty, which positioning precaution best reduces the risk of dislocation in the first weeks?
Allow legs to touch to prevent external rotation
Use an abduction pillow to maintain proper alignment
Cross legs at knees to stabilize the joint
Keep hips flexed beyond ninety degrees when sitting
A patient on multi-agent chemotherapy develops fatigue, frequent infections, and easy bruising. Which adverse effect is most likely causing these findings?
Bone marrow suppression with low WBC and platelets
Autoimmune thyroiditis with low T3 and T4
Hepatic enzyme induction with cholestasis
Electrolyte wasting due to renal tubular injury
Which feature best characterizes fibrocystic breast changes in reproductive-age women?
Firm stony-hard nodules concerning for cancer
Rubbery, ill-defined tender lumps in upper outer breast
Painless mobile masses that appear after menopause
Non-tender uniform enlargement without elasticity
Patient education for fibrocystic breasts should include which statement?
This condition markedly increases breast cancer risk
Supportive bras and ice or heat can reduce swelling
Expect symptoms to worsen significantly after menopause
Avoid oral contraceptives because they raise estrogen
A man reports weak stream, hesitancy, and postvoid dribbling. On exam, the prostate feels uniform, elastic, and nontender. What is the most likely condition?
Benign prostatic hyperplasia causing outlet obstruction
Prostate cancer invading the seminal vesicles
Neurogenic bladder from diabetic autonomic neuropathy
Acute bacterial prostatitis with febrile sepsis
Which late sign commonly appears when prostate cancer has progressed?
Nocturia without other urinary symptoms
Hematuria and pain in pelvis, hips, or spine
Low PSA with normal digital rectal exam
Uniform elastic enlargement of the prostate
Following TURP, the urinary return suddenly looks like ketchup and the patient complains of pelvic pain. What is the priority nursing action?
Decrease bladder irrigation to prevent overdistention
Encourage ambulation to relieve bladder spasm
Notify the surgeon immediately due to arterial bleeding
Clamp the catheter to promote clot formation
Continuous bladder irrigation is running after TURP. The effluent becomes dark red. Which adjustment is appropriate to maintain light pink return?
Lower the bag height to reduce pressure
Increase the irrigation rate to flush out clots
Switch to hypotonic fluid to reduce bleeding
Stop irrigation and remove the catheter promptly
