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.
During assessment of a patient with a history of asthma, the nurse notes wheezing and dyspnea. The nurse will anticipate giving medications to reduce which complication?
- Airway narrowing
- Pulmonary edema
- Laryngospasm
- Alveolar collapse
Explanation
Explanation
Asthma is characterized by chronic inflammation and hyperresponsiveness of the airways, leading to bronchoconstriction and narrowing of the bronchial passages. This narrowing results in wheezing, shortness of breath, and difficulty moving air in and out of the lungs. Medications such as bronchodilators and corticosteroids are given to relax airway smooth muscle, decrease inflammation, and prevent airway obstruction. Thus, reducing airway narrowing is the primary therapeutic goal.Correct Answer Is:
Airway narrowingWhy the other options are incorrect:
Pulmonary edemaThis is incorrect because pulmonary edema is fluid accumulation in the alveoli and interstitial spaces, typically related to heart failure or fluid overload, not asthma. While asthma causes airway obstruction, it does not lead to alveolar flooding. Therefore, reducing pulmonary edema is not the target of asthma medications.
Laryngospasm
This is incorrect because laryngospasm refers to sudden closure of the vocal cords, which is more often associated with anesthesia complications or airway trauma. Asthma affects the bronchi and bronchioles, not the larynx, so treatment focuses on reducing bronchospasm and inflammation rather than laryngeal closure.
Alveolar collapse
This is incorrect because alveolar collapse, or atelectasis, occurs when alveoli deflate or fail to expand, often from obstruction, surgery, or hypoventilation. While asthma may cause air trapping, it does not directly result in alveolar collapse. Asthma therapy targets airway narrowing, not alveolar expansion issues.
2.
Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for abdominal surgery?
- Coughing and deep breathing techniques
- Medications used during surgery
- Care for the surgical incision
- Oral antibiotic therapy after discharge home
Explanation
Explanation
Teaching coughing and deep breathing techniques preoperatively is the most important topic. After abdominal surgery, patients are at high risk for postoperative pulmonary complications such as atelectasis and pneumonia due to pain and shallow breathing. By teaching these techniques beforehand, patients can practice and better perform them postoperatively, promoting lung expansion and preventing complications.Correct Answer Is:
A. Coughing and deep breathing techniquesWhy the other options are incorrect:
B. Medications used during surgeryThis is important, but it is usually the responsibility of the anesthesiologist to explain. It is not the nurse’s main preoperative teaching focus.
C. Care for the surgical incision
This is important but can be discussed postoperatively when the patient is more able to understand and apply instructions.
D. Oral antibiotic therapy after discharge home
This is not typically the nurse’s priority preoperatively. Postoperative discharge teaching would cover this when appropriate.
3.
A patient is admitted to the hospital with dysphasia and right-sided weakness that resolves in a few hours. Which medication would the nurse anticipate the patient will receive?
- Atorvastatin
- Aspirin
- Alteplase
- Labetalol
Explanation
Explanation
The patient’s symptoms (dysphasia and right-sided weakness resolving within hours) indicate a transient ischemic attack (TIA), often called a “mini-stroke.” TIAs are a warning sign for stroke, and the primary treatment goal is to prevent clot formation. Aspirin (an antiplatelet agent) is the first-line medication because it reduces platelet aggregation and lowers the risk of future ischemic stroke.Correct Answer Is:
AspirinWhy the other options are incorrect:
AtorvastatinThis is incorrect because while statins may be prescribed long-term to manage cholesterol and reduce stroke risk, they are not the immediate treatment for TIA.
Alteplase
This is incorrect because alteplase (tPA) is used for acute ischemic stroke when deficits do not resolve. Since the patient’s symptoms resolved in a few hours, alteplase is not indicated.
Labetalol
This is incorrect because labetalol is an antihypertensive used for blood pressure control in stroke management, but it is not the primary or most appropriate medication for TIA.
4.
The nurse is preparing to administer a vaccine to a patient in the health clinic. Which type of immunity will be achieved through the administration of the vaccine?
- Active immunity
- Titer
- Passive immunity
- Vaccine
Explanation
Explanation
Vaccines stimulate the body’s immune system to produce antibodies and memory cells against a specific pathogen. This is active immunity, because the patient’s own immune system is activated to provide long-term protection. Unlike passive immunity, which is temporary, vaccine-induced active immunity can last for years or even a lifetime depending on the vaccine.Correct Answer Is:
Active immunityWhy the other options are incorrect:
TiterThis is incorrect because a titer is a blood test used to measure the amount of antibodies present in the blood. It does not describe a type of immunity, but rather an assessment tool to check immunity levels.
Passive immunity
This is incorrect because passive immunity involves the transfer of preformed antibodies from another source, such as maternal antibodies through breast milk or immunoglobulin therapy. It provides immediate but short-term protection, not what vaccines provide.
Vaccine
This is incorrect because a vaccine is the method used to achieve immunity, not the type of immunity itself. The type of immunity achieved through vaccination is specifically active immunity.
5.
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.
6.
As the nurse, which intervention would be the priority when managing a patient with a cerebrovascular accident (CVA)?
- Initiation of hypothermia to decrease the oxygen needs of the brain
- Intravenous fluid replacement to promote perfusion
- Administration of osmotic diuretics to reduce cerebral edema
- Maintenance of respiratory function with a patent airway and oxygen
Explanation
Explanation
The priority intervention for a patient with a CVA follows the ABCs (Airway, Breathing, Circulation). Maintaining a patent airway and ensuring adequate oxygenation is the most critical step because brain tissue survival depends on oxygen supply. Without immediate attention to airway and breathing, other interventions will be ineffective.Correct Answer Is:
D. Maintenance of respiratory function with a patent airway and oxygenWhy the other options are incorrect:
A. Initiation of hypothermia to decrease the oxygen needs of the brainThis is not a first-line intervention in stroke care. While hypothermia has been studied in neuroprotection, it is not prioritized over ensuring airway and oxygen.
B. Intravenous fluid replacement to promote perfusion
IV fluids may be needed, but they are secondary to maintaining oxygenation. Overhydration may also worsen cerebral edema.
C. Administration of osmotic diuretics to reduce cerebral edema
Mannitol or hypertonic saline may be used later, but reducing cerebral edema is not more important than securing airway and breathing initially.
7.
When obtaining a nursing history from a patient with benign prostatic hypertrophy, which symptom would the nurse expect the patient to report?
- A Grossly bloody urine
- B Low back pain that radiates to the hips during urination
- C Difficulty maintaining an erection
- D A feeling of incomplete bladder emptying after voiding
Explanation
Explanation
Benign prostatic hypertrophy (BPH) causes obstruction of urine flow due to prostate enlargement compressing the urethra. Patients often report hesitancy, weak stream, dribbling, nocturia, and the sensation of incomplete bladder emptying. This is the hallmark symptom of BPH.Correct Answer Is:
D. A feeling of incomplete bladder emptying after voidingWhy the other options are incorrect:
A. Grossly bloody urineHematuria is not a common finding in BPH. If present, it may indicate infection, stones, or malignancy.
B. Low back pain that radiates to the hips during urination
This is not typical of BPH. Such pain is more consistent with renal calculi or musculoskeletal conditions.
C. Difficulty maintaining an erection
Erectile dysfunction is not directly caused by BPH. While both conditions may occur in older men, BPH’s primary symptoms are urinary, not sexual.
8.
The nurse is working on the general med-surg floor. Which patient is at risk for embolic stroke?
- The patient who is one day post MI.
- The patient who has had a previous stroke.
- The patient who is walking the hall following bowel surgery.
- The patient who sustained compound fracture of the left femur.
Explanation
Explanation
A patient who is one day post–myocardial infarction is at significant risk for embolic stroke. After an MI, the heart muscle may be weakened, leading to stasis of blood in the chambers and potential clot formation. Emboli formed in the heart can travel to the brain and cause an ischemic stroke. Early post-MI patients are closely monitored for embolic complications.Correct Answer Is:
The patient who is one day post MI.Why the other options are incorrect:
The patient who has had a previous strokeThis is incorrect because although a prior stroke increases overall stroke risk, it does not specifically predispose the patient to embolic stroke in the immediate setting. A previous stroke indicates damage but not necessarily active clot formation as seen after MI.
The patient who is walking the hall following bowel surgery
This is incorrect because ambulating after surgery decreases risk of embolism. This patient is actively preventing complications like deep vein thrombosis (DVT) and pulmonary embolism. They are not currently at high risk for embolic stroke compared to the post-MI patient.
The patient who sustained compound fracture of the left femur
This is incorrect because a compound femur fracture puts the patient at risk for fat embolism, which typically affects the lungs (pulmonary embolism), not the brain. While fat emboli can rarely cause neurologic symptoms, they are not the same as embolic strokes from cardiac thrombi.
9.
Upon assessing a patient's central line IV site, the nurse notes moisture under the transparent dressing and that it has become loose. The next scheduled site care and dressing change is for the next day. The nurse would perform which action?
- A Reinforce with gauze dressing and change as scheduled.
- B Remove the dressing, perform site care and re-dress.
- C Notify the physician of leaking at the IV insertion site.
- D Chart findings and continue to observe.
Explanation
Explanation
A central line dressing must remain dry and occlusive to prevent infection. If the dressing is moist or loose, it no longer protects the insertion site and must be changed immediately, even if the next scheduled change is not due. The nurse should remove the compromised dressing, perform sterile site care, and apply a new sterile transparent dressing to protect the site.Correct Answer Is:
B. Remove the dressing, perform site care and re-dress.Why the other options are incorrect:
A. Reinforce with gauze dressing and change as scheduledReinforcing a moist or loose dressing is unsafe because it allows bacterial entry and increases the risk of central line-associated bloodstream infection (CLABSI).
C. Notify the physician of leaking at the IV insertion site
There is no evidence of leaking from the insertion site itself, only moisture under the dressing. This is a nursing action and does not require physician notification unless complications are observed.
D. Chart findings and continue to observe
Simply documenting without intervention leaves the site unprotected and increases the risk of infection, which is unsafe.
10.
The nurse is assigned to a patient receiving total parenteral nutrition (TPN) who had a blood glucose measurement done at 0600. The nurse anticipates that the next blood glucose level would be checked at which time?
- 0800
- 1200
- 1800
- 1600
Explanation
Explanation
Patients receiving total parenteral nutrition (TPN) are at high risk for hyperglycemia due to the dextrose content in the solution. Blood glucose levels are typically monitored every 6 hours during TPN therapy unless otherwise specified by the provider. Since the last glucose check was done at 0600, the next scheduled check would occur at 1200.Correct Answer Is:
1200Why the other options are incorrect:
0800This is incorrect because rechecking in 2 hours is unnecessary unless there is evidence of hypoglycemia, insulin titration, or unstable glucose levels.
1800
This is incorrect because waiting 12 hours between glucose checks during TPN therapy would delay detection of abnormal glucose levels and increase patient risk.
1600
This is incorrect because it represents a 10-hour interval, which is too long and unsafe for a patient on continuous TPN infusion.
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