Review Med Surg Exam(MCA Samuel Merit University)

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Med Surg Exam(MCA Samuel Merit University)

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Total Questions : 47

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Question 1:

Which clinical problem would the nurse include in the care plan for a patient with Parkinson disease (PD)?

A. Swallowing challenges. B. Weight gain. C. Obesity. D. Cardiovascular problems.

Answer and Explanation

Choice A:

Swallowing challenges (dysphagia) are common in Parkinson disease due to motor dysfunction, increasing aspiration risk. This aligns with PD care planning, making it the correct clinical problem for the nurse to include to ensure safe nutrition and prevent complications like pneumonia.

Choice B:

Weight gain is not typical in PD; patients often lose weight due to dysphagia or increased energy expenditure. Swallowing challenges are a priority, making this incorrect, as it’s not a primary concern in the nurse’s care plan for Parkinson disease.

Choice C:

Obesity is uncommon in PD, as motor symptoms and dysphagia often lead to weight loss. Swallowing challenges are more relevant, making this incorrect, as it’s not a clinical problem the nurse would prioritize in the care plan for PD.

Choice D:

Cardiovascular problems may occur in PD but are less specific than swallowing challenges, which directly impact daily function. This is incorrect, as it’s secondary to the nurse’s focus on dysphagia as a key issue in Parkinson disease management.

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Question 2:

When a patient with asthma who is on a budesonide hand-held inhaler reports difficulty swallowing and has white patches on the tongue, which action will the nurse take?

A. Teach the patient to gargle with water after using the budesonide. B. Offer reassurance that the symptoms are common with budesonide use. C. Suggest that the patient stop using the spray until the symptoms are resolved. D. Anticipate obtaining a throat swab for rapid streptococcus testing.

Answer and Explanation

Choice A:

White patches and difficulty swallowing suggest oral thrush, a side effect of budesonide. Gargling with water post-inhalation prevents thrush, making this the correct action for the nurse to take to address the patient’s symptoms and promote proper inhaler use.

Choice B:

Reassuring the patient that thrush is common doesn’t address the need for prevention or treatment. Teaching to gargle is proactive, making this incorrect, as it fails to mitigate the patient’s symptoms compared to the nurse’s priority intervention.

Choice C:

Stopping budesonide risks asthma exacerbation, and thrush can be managed with gargling or antifungals. Teaching proper technique is better, making this incorrect, as it’s unsafe compared to the nurse’s focus on maintaining asthma control while addressing thrush.

Choice D:

Throat swabs for streptococcus are irrelevant, as white patches indicate thrush, not bacterial infection. Gargling prevents further issues, making this incorrect, as it misdiagnoses the cause compared to the nurse’s appropriate action for budesonide-related oral symptoms.

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Question 3:

A patient is being admitted with a diagnosis of Cushing syndrome. Which three findings will the nurse expect during the assessment? (Select all that apply)

A. Bronzed appearance of the skin. B. Purplish streaks on the abdomen. C. Anorexia, nausea, and vomiting. D. Hyperglycemia. E. Truncal obesity, thin extremities, rounding of face (moon face).

Answer and Explanation

Choice A:

Bronzed skin is typical of Addison’s disease, not Cushing syndrome, which causes striae and moon face. Hyperglycemia is expected, making this incorrect, as it’s unrelated to the nurse’s anticipated findings in a patient with Cushing syndrome.

Choice B:

Purplish streaks (striae) on the abdomen result from cortisol excess in Cushing syndrome, weakening skin tissue. This aligns with endocrine assessment, making it a correct finding the nurse would expect during the patient’s physical examination.

Choice C:

Anorexia, nausea, and vomiting are more common in Addison’s disease, not Cushing syndrome, which causes weight gain. Striae are typical, making this incorrect, as it’s not a primary finding the nurse would expect in Cushing syndrome.

Choice D:

Hyperglycemia occurs in Cushing syndrome due to cortisol-induced insulin resistance, a common metabolic effect. This aligns with laboratory assessment, making it a correct finding the nurse would anticipate in the patient with Cushing syndrome.

Choice E:

Truncal obesity, thin extremities, and moon face are classic Cushing syndrome signs from fat redistribution due to hypercortisolism. This aligns with physical assessment, making it a correct finding the nurse would expect in the patient’s evaluation.

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Question 4:

A patient admitted with acute renal failure asks for pain medication for a headache described as five out of ten on the pain scale. The nurse checks the MAR and sees that the only pain medication ordered is ibuprofen (an NSAID). Which of the following actions should the nurse take first to ensure patient safety?

A. Consult the healthcare provider about ordering a different pain medication. B. Administer the ibuprofen as ordered since ibuprofen is used to treat headaches. C. Monitor the patient closely after administering the ibuprofen for pain. D. Inform the patient that the pain medication is contraindicated and offer to dim the room lights.

Answer and Explanation

Choice A:

Ibuprofen is contraindicated in acute renal failure, as NSAIDs worsen kidney function. Consulting the provider for a safer alternative like acetaminophen ensures safety, making this the correct first action for the nurse to take for the patient’s headache.

Choice B:

Administering ibuprofen risks further renal damage in acute renal failure, an unsafe action. Consulting the provider is priority, making this incorrect, as it compromises patient safety compared to the nurse’s need to avoid harmful medication administration.

Choice C:

Monitoring after giving ibuprofen doesn’t prevent renal injury, which is a risk in acute renal failure. Consulting the provider avoids harm, making this incorrect, as it’s unsafe compared to the nurse’s priority to ensure appropriate pain management.

Choice D:

Informing the patient and dimming lights delays pain relief and doesn’t address the need for safe medication. Consulting the provider is proactive, making this incorrect, as it’s less effective than the nurse’s first action to secure a safe alternative.

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Question 5:

The arterial blood gas (ABG) report of a patient with a spinal cord injury indicates hypoxia. Select two interventions the nurse would perform to improve the patient’s respiratory status.

A. Administer steroids. B. Administer antibiotic drugs. C. Perform assisted coughing. D. Administer oxygen.

Answer and Explanation

Choice A:

Steroids reduce inflammation in spinal cord injury but don’t directly address hypoxia, which requires oxygen delivery. Assisted coughing clears airways, making this incorrect, as it’s not a primary intervention for the nurse to improve the patient’s respiratory status.

Choice B:

Antibiotics treat infection, not hypoxia, which results from impaired ventilation in spinal cord injury. Oxygen administration is key, making this incorrect, as it’s unrelated to the nurse’s focus on correcting the patient’s low oxygen levels immediately.

Choice C:

Assisted coughing clears secretions in spinal cord injury patients with weak respiratory muscles, improving ventilation and hypoxia. This aligns with respiratory care, making it a correct intervention the nurse would perform to enhance the patient’s respiratory status.

Choice D:

Administering oxygen directly corrects hypoxia by increasing available oxygen for tissue perfusion. This is a standard intervention for spinal cord injury patients, making it a correct action the nurse would take to improve the patient’s respiratory status.

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Question 6:

The patient with Addison disease needs an increased dosage of corticosteroids in stressful situations to prevent addisonian crisis.

A. True. B. False. C. Choices:

Answer and Explanation

Choice A:

Addison disease patients require increased corticosteroids during stress to compensate for adrenal insufficiency, preventing addisonian crisis. This aligns with endocrine management, making it the correct statement, as the nurse would expect dose adjustments to maintain stability in stressful situations.

Choice B:

It’s false to claim Addison disease patients don’t need increased corticosteroids in stress; inadequate cortisol risks crisis. The true statement is correct, making this incorrect, as it contradicts the nurse’s understanding of managing adrenal insufficiency during stress.

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Question 7:

A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition?

A. Tapazole. B. Propranolol. C. PTU (Propylthiouracil). D. Synthroid.

Answer and Explanation

Choice A:

Tapazole treats hyperthyroidism, not hypothyroidism, which requires thyroid hormone replacement. Synthroid is the standard, making this incorrect, as it’s inappropriate for the nurse’s expectation of medication prescribed for a patient with hypothyroidism at discharge.

Choice B:

Propranolol manages hyperthyroidism symptoms like tachycardia, not hypothyroidism, which needs hormone replacement. Synthroid is correct, making this incorrect, as it’s not the nurse’s anticipated medication for treating hypothyroidism in the discharged patient.

Choice C:

PTU treats hyperthyroidism by inhibiting thyroid hormone production, not hypothyroidism. Synthroid provides thyroid hormone, making this incorrect, as it’s irrelevant compared to the nurse’s expectation of the most common hypothyroidism medication.

Choice D:

Synthroid (levothyroxine) is the most commonly prescribed medication for hypothyroidism, replacing deficient thyroid hormone. This aligns with endocrine treatment, making it the correct choice for the nurse to expect in the patient’s discharge plan.

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Question 8:

Choose appropriate three interventions to stabilize the patient with acute anemia.

A. O2 therapy. B. PRBC transfusion. C. Fluid restrictions. D. Iron supplements.

Answer and Explanation

Choice A:

Oxygen therapy improves tissue oxygenation in acute anemia, compensating for reduced hemoglobin. This aligns with anemia management, making it a correct intervention the nurse would include to stabilize the patient by addressing hypoxia caused by low red blood cells.

Choice B:

PRBC transfusion rapidly restores hemoglobin levels in acute anemia, improving oxygen-carrying capacity. This is a standard intervention, making it a correct action the nurse would implement to stabilize the patient with acute anemia effectively.

Choice C:

Fluid restrictions are inappropriate for acute anemia, as hydration supports circulation. PRBC transfusion is key, making this incorrect, as it’s not a stabilizing intervention compared to the nurse’s focus on improving oxygen delivery and blood volume.

Choice D:

Iron supplements address underlying iron deficiency in anemia, supporting long-term recovery. This aligns with anemia treatment, making it a correct intervention the nurse would include to stabilize the patient by correcting the cause of low hemoglobin.

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Question 9:

Which patient problem is a significant risk factor for the development of delirium on the intensive care unit (ICU)?

A. Alcohol abuse. B. Impaired communication. C. Type 2 diabetes mellitus. D. Anxiety.

Answer and Explanation

Choice A:

Alcohol abuse is a significant risk factor for ICU delirium, as withdrawal or chronic effects disrupt brain function. This aligns with neurological risk assessment, making it the correct problem the nurse would identify as a key contributor to delirium risk.

Choice B:

Impaired communication may result from delirium but isn’t a primary risk factor. Alcohol abuse is more causative, making this incorrect, as it’s less significant than the nurse’s focus on a direct risk like alcohol-related neurological changes.

Choice C:

Type 2 diabetes may contribute to delirium via hyperglycemia but is less direct than alcohol abuse, which triggers withdrawal. This is incorrect, as it’s a secondary factor compared to the nurse’s priority risk factor for ICU delirium.

Choice D:

Anxiety can exacerbate delirium but is less causative than alcohol abuse, which has a stronger neurological impact. This is incorrect, as it’s not the primary risk factor the nurse would identify for delirium in the ICU setting.

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Question 10:

The nurse would ask which health care team member to assist when checking a unit of packed red blood cells before administration?

A. The nursing assistant. B. The unit secretary. C. Another registered nurse (RN). D. The physician’s assistant.

Answer and Explanation

Choice A:

Nursing assistants cannot verify blood products, as this requires clinical judgment. Another RN ensures safety, making this incorrect, as it’s outside the assistant’s scope compared to the nurse’s need for a qualified team member to check blood.

Choice B:

Unit secretaries lack the clinical training to verify blood products, a task requiring RN expertise. Another RN is required, making this incorrect, as it’s inappropriate for the nurse’s protocol to ensure safe blood administration with proper verification.

Choice C:

Another RN is required to verify packed red blood cells, ensuring accurate patient and product identification per safety protocols. This aligns with transfusion standards, making it the correct team member for the nurse to involve in blood checks.

Choice D:

Physician’s assistants may not be trained in blood verification protocols, which require RN involvement. Another RN is standard, making this incorrect, as it’s not the nurse’s protocol to involve a PA for blood product verification.

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Med Surg Exam(MCA Samuel Merit University)

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