378 Medical-surgical – Exam (76 To 100)
- 1.
SITUATION: Mr. Dela Isla, a client with early Dementia exhibits thought process disturbances The nurse is aware that in communicating with an elderly client, the nurse will:
- A.
Lean and shout at the ear of the client
- B.
Open mouth wide while talking to the client
- C.
Use a low-pitched voice
- D.
Use a medium-pitched voice
Correct Answer
D. Use a medium-pitched voiceExplanation
Talk as normally as possible. The client has dementia and is not deaf, although hearing might be impaired progressively as the client ages, the nurse should not alter his voice, shout or over enunciate the words. Client will preceive this things as belittling and direspectful.Rate this question:
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- 2.
SITUATION: Mr. Dela Isla, a client with early Dementia exhibits thought process disturbances As the nurse talks to the daughter of Mr. Dela Isla, which of the following statement of the daughter will require the nurse to give further teaching?
- A.
I know the hallucinations are parts of the disease
- B.
I told her she is wrong and I explained to her what is right
- C.
I help her do some tasks he cannot do for himself
- D.
I’ll turn off the TV when we go to another room
Correct Answer
B. I told her she is wrong and I explained to her what is rightExplanation
Hallucinations and delusions are part of DEMENTIA and is termed as ORGANIC PSYCHOSES. The daughter needs further teaching when she try to bargain, explain, dissprove or advice a client with dementia. The client has an impaired judgement, concentration, thinking, reasoning and memory and has inability to learn that is why institutional care for clients with dementia is always required. The disease is progressive and is not preventable.Rate this question:
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- 3.
SITUATION: Mr. Dela Isla, a client with early Dementia exhibits thought process disturbances Which of the following is most important discharge teaching for Mr. Dela Isla?
- A.
Emergency Numbers
- B.
Drug Compliance
- C.
Relaxation technique
- D.
Dietary prescription
Correct Answer
B. Drug ComplianceExplanation
Drug compliance is the most important teaching for Mr. Dela Isla to prevent the symptoms of psychoses and to control behavioral symptoms.Rate this question:
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- 4.
SITUATION: Knowledge of the drug PROPANTHELINE BROMIDE (Probanthine) Is necessary in treatment of various disorders What is the action of this drug?
- A.
Increases glandular secretion for clients affected with cystic fibrosis
- B.
Dissolve blockage of the urinary tract due to obstruction of cystine stones
- C.
Reduces secretion of the glandular organ of the body
- D.
Stimulate peristalsis for treatment of constipation and obstruction
Correct Answer
C. Reduces secretion of the glandular organ of the bodyExplanation
Probanthine reduces glandular secretion of the different organs of the body. It is an anti-cholinergic / anti spasmodic drug and still, not approved by the FDA for treatment with various disorders. Probanthine exerts benifits for treatment of severe diaphoresis, Ulcers due to over secretion of HCl, Spasms, PANCREATITS [ Please take note ] and other conditions of over secretion.Rate this question:
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- 5.
SITUATION: Knowledge of the drug PROPANTHELINE BROMIDE (Probanthine) Is necessary in treatment of various disorders What should the nurse caution the client when using this medication?
- A.
Avoid hazardous activities like driving, operating machineries etc
- B.
Take the drug on empty stomach
- C.
Take with a full glass of water in treatment of Ulcerative colitis
- D.
I must take double dose if I missed the previous dose
Correct Answer
A. Avoid hazardous activities like driving, operating machineries etcExplanation
Like other anti cholinergics/ anti spasmodics, Probanthine causes dizziness, blurred vision and drowsiness. Patients are advised not to drive, operate heavy machineries etc. Probanthine should be taken with a full glass of water but is contraindicated with inflammatory bowel diseases like ulcerative colitis and chrons disease. Drug is taken with meals to prevent irritation of the gastric mucosa and client is advised not to take double dose in case the previous dose is missedRate this question:
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- 6.
SITUATION: Knowledge of the drug PROPANTHELINE BROMIDE (Probanthine) Is necessary in treatment of various disorders Which of the following drugs are not compatible when taking Probanthine?
- A.
Caffeine
- B.
NSAID
- C.
Acetaminophen
- D.
Alcohol
Correct Answer
D. AlcoholExplanation
Probanthine on its own already cause severe dizziness and drowsiness. Addition of alcohol will further depress the CNS and might lead to potentiation of the side effects of probanthine. A,B,C are not contraindicated when taking probanthine EXCEPT when the disease entity itself do not permit intake of such drugs like in Pancreatitis, NSAID is not use. Pain is controlled using probanthine and meperidine [ demerol ] in cases of acute pancreatitis.Rate this question:
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- 7.
SITUATION: Knowledge of the drug PROPANTHELINE BROMIDE (Probanthine) Is necessary in treatment of various disorders What should the nurse tell clients when taking Probanthine?
- A.
Avoid hot weathers to prevent heat strokes
- B.
Never swim on a chlorinated pool
- C.
Make sure you limit your fluid intake to 1L a day
- D.
Avoid cold weathers to prevent hypothermia
Correct Answer
A. Avoid hot weathers to prevent heat strokesExplanation
Probanthine alters the ability of the body to secrete sweat. Telling the client to avoid hot weathers to prevent heat stroke is appropriate. Chlorinated pool is discouraged for patients undergoing skin radiation for skin cancer to prevent breakdown. Limiting fluid intake and avoiding cold weather are unecessary teachings.Rate this question:
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- 8.
SITUATION: Knowledge of the drug PROPANTHELINE BROMIDE (Probanthine) Is necessary in treatment of various disorders Which of the following disease would Probanthine exert the much needed action for control or treatment of the disorder?
- A.
Urinary retention
- B.
Peptic Ulcer Disease
- C.
Ulcerative Colitis
- D.
Glaucoma
Correct Answer
B. Peptic Ulcer DiseaseExplanation
Probanthine is use in PUD to decrease gastric acid secretion. It is also used in Pancreatitis to rest the pancreas from over secretion of pancreatic enzyme and to prevent pain and spasm. Probanthine is contraindicated in clients with UC, Glaucoma. Since this is an anti spasmodic drug, Urinary retention will be a side effectRate this question:
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- 9.
SITUATION: Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA Which of the following is the most important assessment during the acute stage of an unconscious patient like Mr. Franco?
- A.
Level of awareness and response to pain
- B.
Papillary reflexes and response to sensory stimuli
- C.
Coherence and sense of hearing
- D.
Patency of airway and adequacy of respiration
Correct Answer
D. Patency of airway and adequacy of respirationExplanation
Airway is always a priority in an unconscious client. Refer to maslows hierarchy of needs for prioritization. Although this is not absolute, knowledge with pathophysiology will best lead you to the correct option.Rate this question:
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- 10.
SITUATION: Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA Considering Mr. Franco’s conditions, which of the following is most important to include in preparing Franco’s bedside equipment?
- A.
Hand bell and extra bed linen
- B.
Sandbag and trochanter rolls
- C.
Footboard and splint
- D.
Suction machine and gloves
Correct Answer
D. Suction machine and glovesExplanation
CVA patients has impaired swallowing ability and if not absent, depressed gag reflex. Client is at the highest risk for aspiration when eating or drinking that is why NGT is initiated early in the hospitalization. B prevent EXTERNAL ROTATION in hip or leg fracture. Footboards and splint prevents FOOTDROP seen in clients that has a severed peroneal nerve or prolonged immobilization usually due to fractures that eventually puts pressure on the peroneal nerve. A is not specific to clients with CVA.Rate this question:
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- 11.
SITUATION: Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA What is the rationale for giving Mr. Franco frequent mouth care?
- A.
He will be thirsty considering that he is doesn’t drink enough fluids
- B.
To remove dried blood when tongue is bitten during a seizure
- C.
The tactile stimulation during mouth care will hasten return to consciousness
- D.
Mouth breathing is used by comatose patient and it’ll cause oral mucosa dying and cracking
Correct Answer
D. Mouth breathing is used by comatose patient and it’ll cause oral mucosa dying and crackingExplanation
Client will be on NGT once comatose, A is removed first. Client with CVA MAY have seizures, but it is RARE enough that it must require a frequent mouth care, B is eliminated next. Knowing that tactile stimulation is done by touching the patient and not by peforming mouth care will lead you to letter D. Comatose patient uses the mouth to breathe predisposing himself to drying, cracking and infections.Rate this question:
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- 12.
SITUATION: Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA One of the complications of prolonged bed rest is decubitus ulcer. Which of the following can best prevent its occurrence?
- A.
Massage reddened areas with lotion or oils
- B.
Turn frequently every 2 hours
- C.
Use special water mattress
- D.
Keep skin clean and dry
Correct Answer
B. Turn frequently every 2 hoursExplanation
Frequent turning and positioning is the single most important nursing intervention to prevent ulcer formation. Skins are massaged but once the areas are reddened already [ CLASS I Ulcer ], It is not anymore massaged as not to prevent further breakdown. Lotions and Oils are not use in clients skin because it will further enhance skin breakdown. Water matress are used in BURN patients to limit the pressure on the skin by his own body weight. An alternating-inflatable air matress is much more compatible in periodic distribution of pressure in clients with prolong immobility. Keeping skin clean and dry is important but not as important as frequent turning and positioning.Rate this question:
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- 13.
SITUATION: Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA If Mr. Franco’s Right side is weak, What should be the most accurate analysis by the nurse?
- A.
Expressive aphasia is prominent on clients with right sided weakness
- B.
The affected lobe in the patient is the right lobe
- C.
The client will have problems in judging distance and proprioception
- D.
Clients orientation to time and space will be much affected
Correct Answer
A. Expressive apHasia is prominent on clients with right sided weaknessExplanation
If the client's right side is weak, the affected lobe is the LEFT LOBE which is where the broca's area is located. Client will exhibit expressive aphasia, careful and slow movements and right sided weakness. Judging distance and proprioception is usually impaired in clients with RIGHT sided stroke. Telling that the clients orientation to time and space will be much affected is a blind shot analysis. This is seen on clients with severe and massive hemorrhagic stroke with recovery failure related to aneurysms producing long term and permanent coma. Mr. Franco right side is weak, not paralysed, meaning, some functions are still left intact.Rate this question:
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- 14.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis Which result of the lab test will be significant to the diagnosis?
- A.
RBC : 4.5 TO 5 Million / cu. mm
- B.
Hgb : 13 to 14 gm/dl
- C.
Platelets : 250,000 to 500,000 cu.mm
- D.
WBC : 12,000 to 13,000/cu.mm
Correct Answer
D. WBC : 12,000 to 13,000/cu.mmExplanation
WBC increases with inflammation and infection.Rate this question:
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- 15.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis Stat appendectomy was indicated. Pre op care would include all of the following except?
- A.
Consent signed by the father
- B.
Enema STAT
- C.
Skin prep of the area including the pubis
- D.
Remove the jewelries
Correct Answer
B. Enema STATExplanation
Refer to ABDOMINAL ASSESSMENT : STORY TOWARDS MASTERYRate this question:
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- 16.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis Pre-anesthetic med of Demerol and atropine sulfate were ordered to:
- A.
Allay anxiety and apprehension
- B.
Reduce pain
- C.
Prevent vomiting
- D.
Relax abdominal muscle
Correct Answer
A. Allay anxiety and apprehensionExplanation
Pain is not reduced in appendicits. Clients are not given pain medication as to assess whether the appendix ruptured. A sudden relief of pain indicates the the appendix has ruptured and client will have an emergency appendectomy and prevent peritonitis. Demerol and Atropine are used to allay client's anxiety pre operatively.Rate this question:
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- 17.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis Common anesthesia for appendectomy is:
- A.
Spinal
- B.
General
- C.
Caudal
- D.
Hypnosis
Correct Answer
A. SpinalExplanation
Spinal anesthesia is the most common method used in appendectomy. Using this method, Only the area affected is anesthetized preventing systemic side effects of anesthetics like dizziness, hypotension and RR depression.Rate this question:
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- 18.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis Post op care for appendectomy include the following, except:
- A.
Early ambulation
- B.
Diet as tolerated after fully conscious
- C.
Nasogastric tube connect to suction
- D.
Deep breathing and leg exercise
Correct Answer
B. Diet as tolerated after fully consciousExplanation
Client's peristalsis will return in 48 to 72 hours post-op therefore, Fluid and food are witheld until the bowel sounds returns. Remember that ALL PROCUDURES requiring GENERAL and SPINAL anesthesia above the nerves that supply the intestines will cause temporary paralysis of the bowel. Specially when the bowels are traumatized during the procedure, it may take longer for the intestinal peristalsis to resume.Rate this question:
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- 19.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis Peritonitis may occur in ruptured appendix and may cause serious problems which are: 1. Hypovolemia, electrolyte imbalance; 2. Elevated temperature, weakness and diaphoresis; 3. Nausea and vomiting, rigidity of the abdominal wall; 4. Pallor and eventually shock
- A.
1 and 2
- B.
2 and 3
- C.
1, 2 and 3
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
Peritonitis will cause all of the above symptoms. The peritoneum has a natural tendency to GUARD and become RIGID as to limit the infective exudate exchange inside the abdominal cavity. Hypovolemia and F&E imbalance are caused by severe nausea and vomiting in patients with peritonitis because of acute pain. As inflammation and infection spreads, fever and chills will become more apparent causing elevation in temperature, weakness and sweating. If peritonitis is left untreated, Client will become severely hypotensive leading to shock and death.Rate this question:
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- 20.
SITUATION: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication?
- A.
Intussusception
- B.
Paralytic Ileus
- C.
Hemorrhage
- D.
Ruptured colon
Correct Answer
B. Paralytic IleusExplanation
Paralytic Ileus is a mechanical bowel obstruction where in, the patients intestine fails to regain its motility. It is usually caused by surgery and anesthesia. Intusussusception, Appendicitis and Peritonitis also causes paralytic ileus.Rate this question:
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- 21.
NGT was connected to suction. In caring for the patient with NGT, the nurse must:
- A.
Irrigate the tube with saline as ordered
- B.
Use sterile technique in irrigating the tube
- C.
Advance the tube every hour to avoid kinks
- D.
Offer some ice chips to wet lips
Correct Answer
A. Irrigate the tube with saline as orderedExplanation
NGT after appendectomy is used not to deliver nutrients but to decompress the GI tract because of the absence of peristalsis after appendectomy. The stomach and intestines are not sterile, Clean technique is sufficient during irrigation. NGT is placed and not anymore advanced as long as it already reach the stomach. Naso enteric tubes are the one that are advanced periodically until obstruction is reached in the intestine. The client still needs assessment and confirmation of the return of peristalsis before anything is given per orem. Irrigations are done to prevent obstruction in the tube.Rate this question:
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- 22.
When do you think the NGT tube to be removed?
- A.
When patient requests for it
- B.
Abdomen is soft and patient asks for water
- C.
Abdomen is soft and flatus has been expelled
- D.
B and C only
Correct Answer
C. Abdomen is soft and flatus has been expelledExplanation
When flatus is expelled, it means that peristalsis has returned and theres is no need for continuing the NGT.Rate this question:
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- 23.
SITUATION: Amanda is suffering from chronic arteriosclerosis Brain syndrome she fell while getting out of the bed one morning and was brought to the hospital, and she was diagnosed to have cerebrovascular thrombosis thus transferred to a nursing home What do you call a stroke that manifests a bizarre behavior?
- A.
Inorganic Stroke
- B.
Inorganic Psychoses
- C.
Organic Stroke
- D.
Organic Psychoses
Correct Answer
D. Organic PsychosesExplanation
Organic psychoses is a broad and collective term used for psychoses and schizophrenia that has an organic cause. [ Due to Creutzfeldt jakob disease, huntington, hydrocephalus, increase ICP, dementia, stroke etc. ] Manifesting signs and symptoms like hallucination, delustions, illusion, ideas of reference etc. that is similar to schizophrenia and psychoses in absence of organic causes.Rate this question:
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- 24.
SITUATION: Amanda is suffering from chronic arteriosclerosis Brain syndrome she fell while getting out of the bed one morning and was brought to the hospital, and she was diagnosed to have cerebrovascular thrombosis thus transferred to a nursing home The main difference between chronic and organic brain syndrome is that the former:
- A.
Occurs suddenly and reversible
- B.
Is progressive and reversible
- C.
Tends to be progressive and irreversible
- D.
Occurs suddenly and irreversible
Correct Answer
C. Tends to be progressive and irreversibleExplanation
Chronic brain syndrome tends to be progressive and irreversible. Organic brain syndrome is acute and irreversible or reversible depending on the causative factor.Rate this question:
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- 25.
SITUATION: Amanda is suffering from chronic arteriosclerosis Brain syndrome she fell while getting out of the bed one morning and was brought to the hospital, and she was diagnosed to have cerebrovascular thrombosis thus transferred to a nursing home Which behavior results from organic psychoses, except:
- A.
Memory deficit
- B.
Disorientation
- C.
Impaired Judgement
- D.
Inappropriate affect
Correct Answer
A. Memory deficitExplanation
B, C and D are all behaviors that results from organic psychoses. The questions seems to ask EXCEPTION which is A. MEMORY DEFICIT. Organic psychoses is the same as the usual psychoses except that the causative factor of organic psychoses is evidently caused by a disease process of the brain or affecting the brain. Example are patients who suffer stroke suddenly experience hallucinations and delusions. Organic psychoses is simply a psychoses that has an IDENTIFIED CAUSE. Knowing this will lead you to understand that psychoses is manifested by B,C, and D but NOT MEMORY DEFICIT.Rate this question:
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Aug 21, 2023Quiz Edited by
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Jan 19, 2012Quiz Created by
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