NU216 Medical Surgical Nursing II Baton Rouge General School of Nursing
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Free NU216 Medical Surgical Nursing II Baton Rouge General School of Nursing Questions
1.
The nurse is caring for a post carotid endarterectomy patient who has just been brought to the medical-surgical unit. Which of the following should the nurse include on the patient care plan? (Select all that apply.)
- A Assessment of affect and mood
- B Provide range of motion to upper arms
- C Airway assessment
- D Monitor hemoglobin and hematocrit
- E Assessment ability to swallow
Explanation
Explanation
C. Airway assessmentCorrect. Swelling, hematoma, or bleeding at the surgical site can obstruct the airway. Monitoring for stridor, dyspnea, and changes in breathing is a top priority.
D. Monitor hemoglobin and hematocrit
Correct. Carotid endarterectomy poses a risk of hemorrhage. Monitoring H&H helps detect bleeding complications early.
E. Assessment ability to swallow
Correct. Nerve injury or swelling after the procedure may impair swallowing and increase aspiration risk. This assessment is essential to maintain safety.
Correct Answer Is:
C. Airway assessment, D. Monitor hemoglobin and hematocrit, E. Assessment ability to swallowWhy the other options are incorrect:
A. Assessment of affect and moodNot an immediate priority post-op. Neurological checks (level of consciousness, motor strength, speech) are more appropriate than affect or mood at this stage.
B. Provide range of motion to upper arms
This is not a priority immediately after surgery. The focus should be on airway, bleeding, and neurological function. ROM can be addressed later during recovery.
2.
A patient arrives to the emergency department with complaints of a rash that "appeared about two days after doing yard work." The nurse knows that the patient is experiencing which type of hypersensitivity reaction?
- Type III Immune-Complex Reaction
- Type II Cytotoxic / Cytolytic Reaction
- Type I Immediate Hypersensitivity Reaction
- Type IV Delayed Hypersensitivity Reaction
Explanation
Explanation
Type IV hypersensitivity is cell-mediated, involving T lymphocytes rather than antibodies. It is characterized by a delayed onset, typically 24 to 72 hours after exposure to an allergen such as poison ivy, nickel, or latex. The patient’s presentation of a rash appearing two days after yard work matches this delayed mechanism. This is why it is often referred to as “delayed-type hypersensitivity.”Correct Answer Is:
Type IV Delayed Hypersensitivity ReactionWhy the other options are incorrect:
Type III Immune-Complex ReactionThis is incorrect because type III hypersensitivity involves immune complex deposition, leading to conditions like serum sickness, systemic lupus erythematosus, and some forms of vasculitis. It usually manifests with systemic symptoms such as fever, arthralgia, or nephritis, not a localized rash after contact exposure.
Type II Cytotoxic / Cytolytic Reaction
This is incorrect because type II hypersensitivity involves antibody-mediated destruction of specific cells, such as in hemolytic anemia, transfusion reactions, or Goodpasture’s syndrome. It does not present as a contact dermatitis rash days after exposure.
Type I Immediate Hypersensitivity Reaction
This is incorrect because type I hypersensitivity is mediated by IgE antibodies and occurs within minutes of exposure. Examples include anaphylaxis, asthma, or urticaria. The delayed rash occurring two days after exposure rules out type I hypersensitivity.
3.
After the IV catheter has been inserted through the patient’s skin and into the vein, what would the nurse do next?
- Flush the cannula with normal saline.
- Advance the cannula until the hub rests at the insertion site.
- Look for blood return in the flash-back chamber.
- Stabilize the cannula and release the tourniquet.
Explanation
Explanation
Once the IV catheter has been inserted through the skin and into the vein, the nurse must confirm correct placement by checking for blood return in the flash-back chamber. This confirms that the catheter tip is in the vein. Only after this verification can the nurse proceed with advancing the cannula, stabilizing it, releasing the tourniquet, and flushing with saline.Correct Answer Is:
C. Look for blood return in the flash-back chamber.Why the other options are incorrect:
A. Flush the cannula with normal salineFlushing comes much later, after proper placement has been confirmed and the cannula is secured. Doing this first could risk infiltration if the catheter is not in the vein.
B. Advance the cannula until the hub rests at the insertion site
Advancement is only done after blood return is seen in the flash-back chamber, ensuring the vein is entered. Advancing prematurely may push the catheter through the vessel wall.
D. Stabilize the cannula and release the tourniquet
This step is important, but it comes after blood return has been confirmed and the catheter advanced properly.
4.
The nurse teaches a patient newly diagnosed with chronic obstructive pulmonary disease the correct use of salmeterol without a spacer. Which statement made by the patient indicates a need for additional teaching?
- "I will wait a minute or two before each puff."
- "After I press down, I will breathe in for 30 seconds."
- "I will take a deep breath out before I take my first puff."
- "After I breathe in, I will hold my breath for 10 or so seconds before I breathe out again."
Explanation
Explanation
The patient should inhale slowly and deeply over about 3 to 5 seconds, not 30 seconds. A 30-second inhalation is not physiologically possible and reflects a misunderstanding of correct technique. Correct inhaler use involves exhaling fully, pressing down while beginning a slow, deep inhalation, holding the breath for about 10 seconds, and then exhaling slowly.Correct Answer Is:
"After I press down, I will breathe in for 30 seconds."Why the other options are incorrect:
"I will wait a minute or two before each puff."This is correct because when multiple puffs are prescribed, waiting 1 to 2 minutes between them allows the medication to distribute properly in the airways and improves effectiveness.
"I will take a deep breath out before I take my first puff."
This is correct because exhaling fully before inhaling ensures the lungs are emptied, allowing for deeper medication delivery during the subsequent inhalation.
"After I breathe in, I will hold my breath for 10 or so seconds before I breathe out again."
This is correct because holding the breath for about 10 seconds maximizes drug absorption in the lungs before exhalation. It is an essential part of proper inhaler technique.
5.
A patient is receiving a blood transfusion. Which nursing intervention would most likely prevent a potential blood transfusion complication?
- Infusing the blood over 4 hours.
- Administering prescribed antipyretics and antihistamines.
- Using warmed blood.
- Assessing vital signs.
Explanation
Explanation
The most important nursing intervention to prevent and detect transfusion complications is frequent assessment of vital signs. Monitoring temperature, heart rate, blood pressure, and respiratory status helps identify early signs of a transfusion reaction such as fever, chills, dyspnea, or hypotension. Prompt recognition allows for immediate intervention, preventing serious complications such as hemolytic reactions, sepsis, or circulatory overload.Correct Answer Is:
Assessing vital signs.Why the other options are incorrect:
Infusing the blood over 4 hoursThis is incorrect because while blood must be infused within 4 hours to reduce bacterial growth, this practice alone does not prevent transfusion reactions. Monitoring the patient’s response is more critical to preventing complications.
Administering prescribed antipyretics and antihistamines
This is incorrect because premedication may mask early signs of a transfusion reaction, delaying recognition. These medications are sometimes used for patients with a history of mild reactions, but they do not prevent serious transfusion complications.
Using warmed blood
This is incorrect because warmed blood is only necessary in specific situations, such as massive transfusion, hypothermia, or neonatal transfusion. Routine warming does not prevent transfusion reactions and is not considered a standard safety measure for all patients.
6.
A patient arrives at the ambulatory surgery center for a scheduled outpatient surgery. Which information is most important for the nurse to determine?
- Medical coverage for outpatient surgery.
- Someone is available for transportation and care at home.
- Plans to stay overnight at the surgical center.
- History of outpatient surgeries in the past.
Explanation
Explanation
For outpatient (ambulatory) surgery, patients receive anesthesia or sedation and are discharged the same day. The highest priority is ensuring the patient has a responsible adult available for transportation and care at home after discharge. Without this, the patient’s safety could be compromised due to lingering effects of anesthesia and inability to self-care effectively.Correct Answer Is:
Someone is available for transportation and care at home.Why the other options are incorrect:
Medical coverage for outpatient surgeryThis is incorrect because financial/insurance coverage is important administratively but not the nurse’s immediate safety priority before surgery.
Plans to stay overnight at the surgical center
This is incorrect because outpatient surgeries are specifically designed for same-day discharge. Overnight stays are not standard practice unless complications occur.
History of outpatient surgeries in the past
This is incorrect because while past surgical history is part of the medical record, it is not the most critical safety factor for the upcoming procedure. Ensuring safe discharge planning takes precedence.
7.
The registered nurse is providing nutritional information to a patient with recurrent renal calculi by limiting purines in their diet. Which patient statement indicates understanding of the proper diet?
- "I will limit red meat and shellfish."
- "I will limit the amount of fluid I drink."
- "I will limit fruits and vegetables in general."
- "I will limit milk and dairy products."
Explanation
Explanation
Purines are broken down into uric acid, which can contribute to the formation of uric acid kidney stones. Foods high in purines include red meats, organ meats, shellfish, and some fish (e.g., sardines, anchovies). Limiting these foods helps prevent recurrent renal calculi in patients prone to uric acid stones.Correct Answer Is:
A. "I will limit red meat and shellfish."Why the other options are incorrect:
B. "I will limit the amount of fluid I drink."This is incorrect because patients with recurrent renal calculi are encouraged to increase fluid intake (at least 2–3 liters/day) to dilute urine and reduce stone formation.
C. "I will limit fruits and vegetables in general."
This is not appropriate. Fruits and vegetables are beneficial and help alkalinize urine, reducing stone risk. They are not significant sources of purines.
D. "I will limit milk and dairy products."
This is unnecessary unless specifically indicated for calcium oxalate stones. In fact, moderate calcium intake can be protective by binding oxalates in the gut.
8.
A nurse is assessing a patient who has peripheral artery disease (PAD). Which finding should the nurse expect?
- Hairy legs
- Leg pain that goes away with rest
- Bounding peripheral pulses
- Edema in lower extremities
Explanation
Explanation
Patients with PAD commonly experience intermittent claudication, which is pain or cramping in the legs that occurs with activity due to inadequate blood flow and is relieved by rest. This classic finding reflects impaired arterial circulation and helps distinguish PAD from venous conditions.Correct Answer Is:
Leg pain that goes away with restWhy the other options are incorrect:
Hairy legsThis is incorrect because PAD often causes hair loss on the legs and shiny, thin skin due to poor circulation. Hairy legs would not be an expected finding.
Bounding peripheral pulses
This is incorrect because PAD decreases arterial blood flow, leading to diminished or absent pulses, not bounding ones. Bounding pulses are more commonly associated with conditions like fluid overload.
Edema in lower extremities
This is incorrect because PAD does not typically cause significant edema. Edema is more commonly associated with venous insufficiency, heart failure, or renal disease. PAD primarily causes ischemic symptoms like pain, pallor, and decreased pulses.
9.
How would the nurse document the patient’s central venous access device? Review the attached picture.
- Right triple lumen vascular catheter.
- Right jugular triple lumen central line catheter.
- Right triple lumen peripheral catheter.
- Right triple lumen central line catheter.
Explanation
Explanation
The image shows a central venous catheter inserted into the right internal jugular vein with three separate lumens. This makes it a triple lumen central line. Documentation should be precise, including both the type of line and the anatomical location. Identifying it as a right jugular triple lumen central line catheter ensures clarity for other providers and supports safe medication and fluid administration.Correct Answer Is:
Right jugular triple lumen central line catheter.Why the other options are incorrect:
Right triple lumen vascular catheterThis is incorrect because the term “vascular catheter” is too vague. While technically true that the catheter is vascular, this description lacks the necessary specificity regarding location and type. Documentation must clearly identify both central access and placement site to avoid errors in care and communication.
Right triple lumen peripheral catheter
This is incorrect because a peripheral catheter is not the same as a central line. Peripheral lines are inserted into smaller veins in the arms or hands, not the jugular vein. The image clearly shows a central line, making this option inaccurate. Using “peripheral” here would mislead other clinicians and compromise patient safety.
Right triple lumen central line catheter
This is incorrect because although it identifies the correct type of device, it does not specify the insertion site. Central line documentation must include location (jugular, subclavian, or femoral). Without identifying it as a jugular line, the documentation is incomplete and could cause confusion in clinical settings.
10.
The nurse is providing teaching for a patient diagnosed with uric acid renal calculi. Which medication is prescribed to prevent the formation of uric acid stones?
- Allopurinol
- Oxybutynin
- Finasteride
- Tamsulosin
Explanation
Explanation
Allopurinol is prescribed to reduce uric acid levels in the blood and urine by inhibiting xanthine oxidase, the enzyme responsible for uric acid production. Lowering uric acid levels prevents the crystallization that leads to uric acid stone formation. It is the standard therapy for prevention of uric acid calculi and is often combined with hydration and dietary modifications.Correct Answer Is:
AllopurinolWhy the other options are incorrect:
OxybutyninThis is incorrect because oxybutynin is an anticholinergic used to treat overactive bladder. It does not affect uric acid metabolism or prevent renal stone formation. Using this drug would not reduce the risk of uric acid calculi.
Finasteride
This is incorrect because finasteride is used to treat benign prostatic hyperplasia (BPH) and male pattern baldness. It works by inhibiting the conversion of testosterone to dihydrotestosterone, which is unrelated to uric acid production or kidney stones.
Tamsulosin
This is incorrect because tamsulosin is an alpha-adrenergic blocker that relaxes smooth muscle in the bladder neck and prostate. It can aid in the passage of stones but does not prevent their formation. It has no role in lowering uric acid levels.
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