Advanced Med Surge Exam 2 review test with correct marking scheme 2024, Exams of Nursing

Download Advanced Med Surge Exam 2 review test with correct marking scheme 2024 and more Exams Nursing in PDF only on Docsity! Advanced Med Surge Exam 2 review test with correct marking scheme 2024 1. External Fixation - Correct Answers The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. 2. A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? - Correct Answers "We will need to monitor the status of the laceration to be sure it does not get infected." 3. A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? - Correct Answers Buck's 4. An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction. 5. A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? - Correct Answers Assess for complications 6. Unrelieved pain can be an indicator of a complication, such as compartment syndrome. 7. A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied? - Correct Answers Sensation of warmth or heat with application 8. A continuous passive motion (CPM) machine is used to promote healing and flexibility in the knee and hip joint and increase circulation to the operative area. What is true about the use of CPM? Select all that apply. - Correct Answers The physician orders the amount of extension and flexion produced by the machine. 9. The physician orders the frequency of use of the machine. 10. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. 11. A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? - Correct Answers osteomyelitis 12. Chronic osteomyelitis may occur after persistent infection in the late postoperative period. 13. A nurse would most likely expect the need for open reduction for a client with which of the following? - Correct Answers Joint fracture 14. An open reduction is required when soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured. It is also done when wound debridement or internal fixation is needed. 15. The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? - Correct Answers pulmonary embolism 16. A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? - Correct Answers Open reduction 17. Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) - Correct Answers "Place pillows between your legs when you lay on your side." 18. "Avoid bending forward when sitting in a chair." 19. "Use a raised toilet seat and high-seated chair. 37. The provider asks a nurse to test a patient for Tinsel’s sign to diagnose carpal tunnel syndrome. The nurse asked the patient to: - Correct Answers Hold his palm up while the nurse percussed over the median nerve 38. A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? - Correct Answers L4, L5, and S1 39. The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? - Correct Answers Arthroscopy 40. The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? - Correct Answers Alendronate 41. The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? - Correct Answers raloxifene (Evita) 42. During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? - Correct Answers Hammer toe 43. What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? - Correct Answers Dupuytren contracture 44. A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? - Correct Answers Alkaline phosphatase 45. Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. 46. Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg? - Correct Answers Complaints of numbness and tingling in toes of affected leg 47. A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur: - Correct Answers The onset of symptoms for a fat embolism is rapid, usually within 12 to 48 hours after injury, but may occur up to 10 days after injury. 48. A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? - Correct Answers One side of the bone is broken and the other side is bent. 49. A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? - Correct Answers Compound 50. A client has delayed bone healing in a fractured right homers. What should the nurse prepare the client for that promotes bone growth? - Correct Answers Electrical stimulation 51. A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? - Correct Answers Apply ice packs for the first 24 to 48 hours, then apply heat packs." 52. What assessment findings of the leg are consistent with a fracture of the femoral neck? - Correct Answers Shortened, adducted, and externally rotated 53. A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time? - Correct Answers 6-8 weeks 54. Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? - Correct Answers maintain Buck's traction 55. An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture is referred to as - Correct Answers depressed 56. Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? - Correct Answers autologous 57. When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. - Correct Answers Hyperkalemia 58. Hyperuricemia 59. Hyperphosphatemia 60. A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? - Correct Answers 7-14 days 61. According to the TNM classification system, T0 means there is - Correct Answers no evidence of primary tumor. 62. Which is a sign or symptom of septic shock? - Correct Answers altered mental status 63. A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, and M0. What does this classification mean? - Correct Answers Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis 80. T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do? - Correct Answers T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. 81. A client who is being treated for complications related to acquire immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used? - Correct Answers Digestive enzymes destroy its protein structure. 82. Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm? - Correct Answers CDC category A: HIV asymptomatic 83. A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection? - Correct Answers trimethoprim- sulfamethoxazole 84. Antiretroviral medications should be offered to clients with T-cell counts less than - Correct Answers 350 cells/mm3. 85. A client is suspected of having an immune system disorder. The health care provider wants to perform a diagnostic test to confirm the diagnosis. What test should the nurse prepare the client for? - Correct Answers Enzyme-linked immunosorbent assay 86. More than 50% of individuals with this disease develop pernicious anemia: - Correct Answers Common variable immunodeficiency (CVID) 87. A client with HIV will be started on a medication regimen of three medications. What drug will the nurse instruct the client about? - Correct Answers Reverse transcriptase inhibitors are drugs that interfere with the virus' ability to make a genetic blueprint. 88. When a nurse infuses gamma globulin intravenously, the rate should not exceed - Correct Answers 3 mL/min 89. A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? - Correct Answers diarrhea 90. A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses. As part of the presentation, the nurse is planning to describe the events that occur once HIV enters the host cell. What would the nurse describe as the first step? - Correct Answers attachment 91. The period from infection with HIV to the development of antibodies to HIV is known as which of the following? - Correct Answers primary infection 92. A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? - Correct Answers Stool specimen for ova and parasites 93. The term used to define the amount of virus in the body after the initial immune response subsides is - Correct Answers viral set point 94. Which of the following are antidepressants used in the treatment of AIDS? Select all that apply. - Correct Answers Tornal 95. Norpramin 96. Prozac 97. The majority of patient with primary immunodeficiency are in which age group? - Correct Answers younger than 20 98. Which of the following is the medication of choice for early syphilis? - Correct Answers Penicillin G benzathine 99. Which of the following describes microorganisms present without host interference or interaction? - Correct Answers colonization 100. Painless chancres are associated with which systemic disease? - Correct Answers syphilis 101. A client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and physical findings, the physician suspects Legionnaires ‘disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What's the drug of choice for treating Legionnaires ‘disease? - Correct Answers Azithromycin 102. Which of the following is the most frequent route of exposure to a latex allergy? - Correct Answers Cutaneous 103. There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction: - Correct Answers Inge-mediated hypersensitivity. 104. When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? - Correct Answers dorsal aspect of the hand 105. A client with allergic rhinitis is prescribed a mast cell stabilizer. Which would the nurse expect to be used? - Correct Answers Commonly sodium 106. Which term indicates an accumulation of crystalline depositions in particular surfaces, bones, soft tissue, and cartilage? - Correct Answers Tophi 107. Which of the following disorders is characterized by an increased autoantibody production? - Correct Answers Systemic lupus erythematosus (SLE) 108. The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying ant rheumatic drug (DMARD) will the nurse educate the client about? - Correct Answers Methotrexate (Rheumatrex) 129. Preventing renal failure and electrolyte balance is a priority - Correct Answers in the setting of tumor lysis syndrome 130. Hypercalcemia is an oncologic emergency and is marked by - Correct Answers a progressive change in LOC, hyporeflexemia, ileus, constipation, polyuria, and polydipsia. 131. Graft vs. Host disease - Correct Answers could present as blistering skin rash, diffuse inflammation to the GI tract with massive diarrhea or hepatomegaly. 132. Advice clients with stomatitis - Correct Answers to avoid mouthwashes that contain alcohol or tobacco be they dry the mucous, use a soft toothbrush, avoid rough hot or spicy foods and remove dentures unless eating. 133. Malignant neoplasms - Correct Answers invade other areas and branch off while benign tumors do not metastases. 134. Cancer develops when - Correct Answers the immune system fails to recognize and destroy abnormal cells 135. Colony stimulating factors - Correct Answers Erythropoietin stimulate rob production decreasing the need for blood transfusions 136. Neogene stimulates neutrophil production to decrease the risk for infection 137. Provide PCA - Correct Answers to help reduce complications r/t pain 138. Methotrexate - Correct Answers contributes to folic acid deficiency and results in cell death. Med for Rheumatoid Arthritis. 139. Prevent dislodgement of intravavitary low dose radiation by - Correct Answers maintain cl on bed rest, in private room, give low residue foods, give antidiarrheal agents to prevent bowel movements, log roll to prevent dislodgement of device and insert Foley 140. Radiation safety precautions ( brachytherapy) - Correct Answers limiting time w client, wear dosimeter badge, keeping prig staff or visitors and children out of room, limiting visits to 30 min and keeping 6 feet away from the radiation source and keep a lead container in the room in case a radioactive device dislodges. 141. Treat wet desquamation - Correct Answers by leaving blisters intact and notifying pop, avoid frequent washing of area be of increased irritation, obtain an order for a cream or ointment and use a no adhesive pad over the area 142. Reduce the risk of infection with elderly; - Correct Answers drink plenty of fluids unless contraindicated, use lotion, assess for signs of skin breakdown, change incontinence pads frequently, void after intercourse, pneumococcal and flu vaccine, cough and deep breathing exercising, and sitting up while eating 143. CD4 cells - Correct Answers HELPER T cells- stimulate the immune system and help to destroy organisms 144. Natural immunity - Correct Answers allows the body to resist infection by responding to foreign substances with WBC, an inflammatory response and chemicals are all used to destroy pathogens 145. Acquired immunity - Correct Answers is the type response that allows the body to respond to pathogens either actively or passive 146. a vaccine or poor exposure to a disease provides - Correct Answers active immunity since your immune system will actively generate antibodies in response to the antigen 147. Breast feeding and immune globin are types of - Correct Answers acquired immunity since they contain antibodies that are given to you. 148. Immunodeficiency is marked by - Correct Answers frequent infections that could be severe, infections from organisms that do not typically cause a problem, poor treatment response and chronic diarrhea. 149. Protein deficiency - Correct Answers increases the risk for infection 150. An increase in neutrophils indicates - Correct Answers a bacterial infection while an increase in lymphocytes indicate a viral infection. 151. The reduction in t cells increases the risk for - Correct Answers opportunistic infections 152. Instruct on factors that increase the risk for infection - Correct Answers excess alcohol, poor nutrition, smoking, gluccocorticosterioids and diabetes. 153. Notify the provider if a culture and sensitivity - Correct Answers reveals that the organism is resistant to the antibiotic 154. Classic signs of infection - Correct Answers redness, swelling, drainage, fever and chills, Elevated web. 155. Metformin should be stopped 48 hours before and after the administration - Correct Answers iodinated contrast medium 156. Acute respiratory failure is manifested by a - Correct Answers decrease in pa02 and an increase in paCO2 with respiratory acidosis. 157. Diarrhea could lead to - Correct Answers metabolic acidosis and electrolyte imbalances esp. hypernatremia and hypokalemia. 158. Encourage cl. who have diarrhea - Correct Answers to avoid foods that stimulate peristalsis (fiber rich foods, lactulose and avoid nicotine which stimulates bowel motility. 159. A positive HIV test shows - Correct Answers that the individual has antibodies and has been infected with the virus 160. HIV is primarily transmitted - Correct Answers thru blood, breast milk, semen and vaginal secretions, this is also passed thru urine, saliva, and tears. 183. The formation of immune complexes is followed by - Correct Answers phagocytic clearing 184. Prepare to give diphenhydramine for - Correct Answers mild allergic ax: urticarial, pruritus, flushing, give epi corticosteroids and vasopressors for severe reactions (bronchospasms, hypoptension, shock, laryngeal edema). 185. Antihistamines (H1 blockers) - Correct Answers prevent histamine from binding to receptor sites thus preventing the development of new 186. symptoms (this drug does not stop the release of histamine from mast cells so administer early) 187. allergen injections - Correct Answers could induce systemic reactions and should only be given where epi is available 188. TX for anaphylaxis - Correct Answers epi, corticosteroids, and antihistamines. 189. Limit adrenergic agents (vasoconstriction) to a few days because of the risk for - Correct Answers rebound congestion 190. Corticosteroids inhibit the inflammatory response - Correct Answers suppress adrenal gland activity, increase the risk for hyperglycemia and hypernatremia and hypokalemia and could mask infection 191. Rinse mouth after using - Correct Answers corticosteroid metered dose inhaler 192. Leukotriene modifiers - Correct Answers zafirlukast, montelukast, zileuton) liit production or block the inflammatory effects of leukotrienes. 193. Long term use of corticosteroids (prednisone) - Correct Answers contributes to adrenal atrophy and hypofunction. Abrupt s=cessation could lead to addisonian crisis. (Acute renal failure). 194. Rhinitis medicaments - Correct Answers is a rebound rhinitis that accords with overuse of nasal decongestants, nasal mucosa is more edematous with med use prompting the use for more meds. 195. Gout attacks can be triggered by - Correct Answers alcohol, foods high in purines (shellfish, organ meets) or illness. 196. Gout is typically marked by - Correct Answers pain and edema to the joint of the big toe 197. An increase in erythrocyte sedimentation rate - Correct Answers suggests there is an infection or inflammation 198. Systemic lupus erythematosus (SLE) - Correct Answers the immune system creates antibodies to part of the cell’s nucleus; this disease affects nearly every organ in the body. 199. Osteoarthritis - Correct Answers is initially treated with Tylenol 200. Clinical s/s of osteoarthritis - Correct Answers Heber dens nodes (distal interphalangeal joint and orchards nodes (proximal interphalangeal joint, pain, loss of function, ambulating with a limp and crepitus in the affected joint. 201. S/s of Rheumatic diseases - Correct Answers pain joint swelling with limited movement, stiffness, weakness and fatigue. 202. Biologic disease-modifying ant rheumatic drugs help to - Correct Answers suppress inflammation and prevent joint erosion however, these drugs increase the risk for infection so monitor closely. 203. Manage pain in the setting of rheumatic diseases - Correct Answers exercise, joint protection, relaxation, foam mattress, splints and the app of heat or cold 204. Movement opt inflamed joints can be limited by - Correct Answers applying splints to the area and allowing the join to rest. 205. Maintaining or improving functional joint status and mobility - Correct Answers reducing inflammation and controlling pain are key goals in the management of rheumatic diseases. 206. RA - Correct Answers is marked by symmetrical joint pain and swelling involving small joints that last more than one hour. 207. Osteoarthritis (OA) - Correct Answers is a no inflammatory degeneration of articular cartilage marked by joint pain that last less than 30 men and resolves with rest. 208. Jorgen’s syndrome - Correct Answers drying of the mucous membranes and can make swallowing difficult. 209. Educate on foods high in calcium and magnesium - Correct Answers dairy products and dark green leafy veggies. 210. A classic sign for low magnesium is - Correct Answers tetany like hypocalcemia. 211. Complications of Bone Marrow Transplantation - Correct Answers Graft vs. Host Disease can present as blistering skin rash, diffuse inflammation to the GI tract with massive diarrhea or hepatomegaly. 212. Management of Rheumatic Diseases - Correct Answers Maintaining or improving functional joint status and mobility by reducing inflammation and controlling pain are key goals in the management of rheumatic diseases. 213. Signs of Low Magnesium Levels - Correct Answers a classic sign for low magnesium is tetany, similar to hypocalcemia. 214. Preventing Infection in Immunocompromised Clients - Correct Answers Reduce the risk of infection by instituting neutropenic precautions, avoiding rectal or vaginal procedures, using electric razors, avoiding stagnant water, and reducing exposure to sources of infection.