NCLEX-RN MedSurg Practice Questions and Answers, Exams of Medicine

Download NCLEX-RN MedSurg Practice Questions and Answers and more Exams Medicine in PDF only on Docsity! MedSurg Final NCLEX PRACTICE QUESTIONS WITH VERIFIED ANSWERS LATEST UPDATE Upon entering the room of a patient who has just returned from surgery for total laryngectomy and radical neck dissection, a nurse should recognize a need for intervention when finding A. a gastrostomy tube that is clamped. B. the patient coughing blood-tinged secretions from the tracheostomy. C. the patient positioned in a lateral position with the head of the bed flat. D. 200 ml of serosanguineous drainage in the patient's portable drainage device. - Correct answer C. the patient positioned in a lateral position with the head of the bed flat. After total laryngectomy and radical neck dissection, a patient should be placed in a semi-Fowler's posi1tion to decrease edema and limit tension on the suture line. A 78-year-old does not want to eat lunch and complains that the food that is serving does not taste good. Consistent with knowledge about age-related changes to taste, the nurse may find that the client is more willing to eat. A) Greasy foods B) Sour foods C) Sweet foods D) Salty foods. - Correct answer C = the older adults' taste buds retain their sensitivity to carbohydrates. In addition, carbohydrates. Tend to be food items that are easy to chew. Older adults lose their sensitivity to sour and salty foods. Older adults may find greasy foods harder to digest and therefore may avoid them; however, preference for greasy foods is not related to changes in taste associated with age. The nurse is preparing a discharge plan to a female client with peptic ulcer for the dietary modification she will need to follow at home. Which of the following statements indicates that the client understands the instruction of the nurse? A) "I should not drink alcohol and caffeine." B) "I should eat a bland, soft diet." C) "It is important to eat six small meals a day." D) "I should drink several glasses of milk a day." - Correct answer A = caffeinated beverages and alcohol should be avoided because they stimulate gastric acid production and irritate gastric mucosa. The client should avoid foods that cause discomfort; however, there is no need to follow a soft, bland diet. Eating six small meals daily is no longer a common treatment for peptic ulcer disease. Milk in large quantities is not recommended because it actually stimulates further production of gastric acids. A client has disabling attacks of vertigo. The nurse suspects that the client has Meniere's disease. The nurse is aware that the diet of the client must be modified. Which of the following is the best diet for the client? A) High protein B) Low Carbohydrates C) Low Sodium D) Low Fat - Correct answer C = A low sodium diet is frequently an effective mechanism for reducing the frequency and severity of the disease episodes. About three-quarters of clients with Meniere's disease respond to treatment with a low salt diet. Which of the following is the most common surgical procedure for chronic otitis media? A) Myringotomy B) Ossiculoplasty C) Mastoidectomy D) Tympanoplasty - Correct answer D Tympanoplasty involves surgical reconstruction as the tympanic membrane and is done to re-establish middle ear function, close perforation, prevent recurrent infections. - sew the tympanic membrane back up! A community health nurse is teaching smoking cessation program to a group of healthy adult smokers. What type of prevention activity is this? A) Primary B) Secondary C) Tertiary D) None of the above - Correct answer A = primary cancer prevention targets healthy individuals and includes steps to avoid factors that might lead to the development of diseases. A female client with breast cancer is currently receiving radiation therapy for treatment. The client is complaining of apathy, hard to concentrate on something, and feeling tired despite of having time to rest and more sleep. These complain suggest symptoms of: A) Hypocalcaemia Excessive drainage should be reported. The nurse is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of the retinal detachment? a) Total loss of vision b) A reddened conjunctiva c) A sudden sharp pain in the eye d) Complaints of a burst of black spots or floaters - Correct answer D D Complaints of a sudden burst of black spots or floaters indicate that bleeding has occurred as a result of the detachment. Options A, B, and C are not signs of bleeding. The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which intervention is initiated immediately? a) Notify the physician b) Apply ice to the affected eye c) Irrigate the eye with cool water d) Accompany the client to the emergency room - Correct answer B Treatment for a contusion begins at the time of injury. Ice is applied immediately. The client then should be seen by a physician and receive a thorough eye examination to rule out the presence of other eye injuries. The client arrives in the emergency room with a penetrating eye injury from wood chips that occurred while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye. What is the initial nursing action? a) Apply an eye patch b) Perform visual acuity tests c) Irrigate the eye with sterile saline d) Remove the piece of wood using a sterile eye clamp - Correct answer B - If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. This object must never be removed except by the ophthalmologist because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the cornea. The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid. The initial nursing action is to: a) Begin visual acuity testing b) Cover the eye with a pressure patch c) Swab the eye with antibiotic ointment d) Irrigate the eye with sterile normal saline - Correct answer D Emergency care following a chemical burn to the eye includes irrigating the eye immediately with sterile normal saline or ocular irrigating solution. In the emergency department, the irrigation should be maintained for at least 10 minutes. Following this emergency treatment, visual acuity is assessed. Options B and C are not a component of initial care. The nurse is caring for a client after a lung lobectomy. The nurse notes fluctuating water levels in the water-seal chamber of the client's chest tube. What action should the nurse take? A. Do nothing, but continue to monitor the client. B. Call the physician immediately. C. Check the chest tube for a loose connection. D. Add more water to the water-seal chamber - Correct answer correct answer: A Fluctuation in the water-seal chamber is a normal finding that occurs as the client breathes. No action is required except for continued monitoring of the client. The nurse doesn't need to notify the physician. Continuous bubbling in the water-seal chamber indicates an air leak in the chest tube system, such as from a loose connection in the chest tube tubing. The water-seal chamber should be filled initially to the 2 cm line, and no more water should be added. A client with type 2 diabetes has a hemoglobin A1C level of 8.8 after 6 months of oral therapy with metformin (Glucophage®). The client tells the nurse that she often forgets to take her medication and doesn't really follow her diet. Which of the following is the nurse's best first response? A. "If you don't get control of your blood sugar, you'll need to take insulin." B. "It can be hard to get used to having a disease like diabetes. What are some of the things you find challenging about it?" C. "Uncontrolled diabetes can lead to eye problems and kidneys problems." D. "Many people have diabetes." - Correct answer correct answer: B Acknowledging that the client is going through changes and allowing her to express her concerns will help the nurse assess her needs. Hemoglobin AIC shows the average blood glucose levels over a 3-month period. Diabetes should maintain the AIC <7%. Lecturing, threatening and comparing the clients to others belittle the client and discourage discussion, but the patient must be provided adequate information in order to make informed decisions about self-care. The nurse is teaching a client newly diagnosed with type 1 diabetes how to self- administer subcutaneous insulin injections. How does the nurse best evaluate the effectiveness of her teaching? A. Have the client repeats the steps back to the nurse. B. Give the client a written test on self-administration of insulin. C. Ask the client to write out the steps for self-administration of insulin injections. D. Ask the client to give a return demonstration of self-administration of insulin. - Correct answer correct answer: D Asking the client to give a return demonstration of his injection technique is the best way to assess whether the client can perform the procedure. It also gives the nurse the opportunity to provide feedback. Asking the client to recite the steps, pass a written test, or write out the steps shows the nurse whether the client is able to recall the steps but doesn't show that he has the necessary motor skills or the ability to perform the procedure. The nurse is writing the teaching plan for a client undergoing a radioactive iodine uptake test to study thyroid function. Which of the following instructions should the nurse include? A. "You need to stay at least 4 feet (1.2 m) away from other people after the test because you'll be radioactive." B. "You need to lie very still on a stretcher that is placed in a long tube for the scan" C. "Don't take any iodine or thyroid medication before the test." D. "Schedule the bone scans before your radioactive iodine uptake test." - Correct answer correct answer: C Medications such as iodine, contrast media, and ant thyroid and thyroid drugs can affect the test results and should be withheld by the client for a week or longer, as directed by the physician. During a radioactive iodine uptake test, the client receives radioactive iodine by mouth or I.V. in small doses and doesn't require isolation. During magnetic resonance imaging--not radioactive iodine uptake testing--a client needs to lie still inside a long tube. Any test, such as a bone scan, that requires iodine contrast media should be scheduled after the radioactive iodine uptake test because the iodinated contrast medium can decrease uptake. 31. A 64-year-old patient with newly diagnosed acute myelogenous leukemia (AML) who is undergoing induction therapy with chemotherapeutic agents tells the nurse, "I feel so sick that I don't know if the treatment is worth completing." The nurse's best response to the patient is a. "I know you feel really ill right now, but after this therapy your disease will go into a remission and you will feel normal again." b. "Induction therapy is very aggressive and causes the most side effects, so when this phase is completed you won't feel so ill." c. "Your type of leukemia has an 80% survival rate if aggressive therapy is started, so the effects of treatment will be worth it to you." d. "The chemotherapy is difficult, but it is necessary to put the disease into remission and give you time to make choices about your life. - Correct answer D