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
The nurse knows to prevent an acute hemolytic reaction in a patient receiving blood therapy, which action must be done?
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A Verify and document product-to-patient identification.
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B Transfuse blood products within 4 hours of starting time.
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C Infuse leukocyte-poor blood products.
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D Adjust transfusion volumes and flow rate.
Explanation
Explanation
The most common cause of an acute hemolytic transfusion reaction is ABO incompatibility due to administration of the wrong blood product to the wrong patient. The only way to reliably prevent this is through strict verification of patient identification and blood product labeling before starting the transfusion. This double-check process is the highest-priority safety step.Correct Answer Is:
A. Verify and document product-to-patient identification.Why the other options are incorrect:
B. Transfuse blood products within 4 hours of starting timeThis prevents bacterial growth and sepsis, not acute hemolytic reaction.
C. Infuse leukocyte-poor blood products
This reduces the risk of febrile non-hemolytic reactions, not acute hemolytic reactions.
D. Adjust transfusion volumes and flow rate
This helps prevent fluid overload but does not prevent an acute hemolytic reaction.
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?
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Airway narrowing
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Pulmonary edema
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Laryngospasm
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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.
A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin’s disease. Which of the following symptoms is typical of Hodgkin’s disease?
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Low body temperature
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Bradycardia
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Weight gain
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Painless cervical lymph nodes
Explanation
Explanation
The hallmark symptom of Hodgkin’s disease is painless enlargement of cervical or supraclavicular lymph nodes. These nodes are usually firm and rubbery but not tender. Patients may also present with systemic “B symptoms” such as fever, night sweats, and weight loss, but the classic diagnostic feature is painless lymphadenopathy. This symptom is often what leads patients to seek medical evaluation and guides further diagnostic testing.Correct Answer Is:
Painless cervical lymph nodesWhy the other options are incorrect:
Low body temperatureThis is incorrect because patients with Hodgkin’s disease more commonly experience intermittent fevers rather than a consistently low body temperature. Low temperature is not a defining symptom and does not align with the typical clinical presentation. Therefore, it is not considered a key diagnostic indicator of Hodgkin’s disease.
Bradycardia
This is incorrect because Hodgkin’s disease does not directly cause bradycardia. Cardiac symptoms are not a typical manifestation of this condition. While fatigue and systemic illness may indirectly affect overall health, bradycardia is not recognized as a hallmark symptom of Hodgkin’s disease and should not be considered in diagnostic criteria.
Weight gain
This is incorrect because patients with Hodgkin’s disease are more likely to experience unintentional weight loss, which is part of the systemic “B symptoms.” Weight gain is not associated with the disease process and would misdirect the clinical assessment. Recognizing weight loss instead of weight gain is essential for accurate identification and treatment planning.
What is the most important action a nurse can take to prevent a patient from developing an anaphylactic reaction?
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Assessing and documenting allergies.
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Patient teaching on corticosteroids.
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Administering parenteral epinephrine.
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Administering safe antibiotics.
Explanation
Explanation
The best way to prevent an anaphylactic reaction is to identify and document allergies before administering medications or treatments. This ensures avoidance of allergens altogether. Preventing exposure is always safer than treating a reaction after it occurs.Correct Answer Is:
A. Assessing and documenting allergies.Why the other options are incorrect:
B. Patient teaching on corticosteroidsCorticosteroids may reduce inflammation but do not prevent or treat anaphylaxis. They are not the priority preventive measure.
C. Administering parenteral epinephrine
Epinephrine is the emergency treatment after anaphylaxis occurs, not a preventive measure.
D. Administering safe antibiotics
While selecting safe antibiotics is important, the only way to know what is safe is by first assessing and documenting allergies.
Which of the following assessment findings would the nurse expect in a patient diagnosed with thyroid storm?
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A Increased body temperature, decreased pulse, and increased blood pressure
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B Increased body temperature, increased pulse, and increased blood pressure
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C Increased body temperature, increased pulse, and decreased blood pressure
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D Increased body temperature, decreased pulse, and decreased blood pressure
Explanation
Explanation
Thyroid storm is an acute, life-threatening complication of hyperthyroidism. It is characterized by a high fever, tachycardia, and hypertension due to excessive thyroid hormone stimulating the sympathetic nervous system. Patients may also present with agitation, delirium, and potential progression to heart failure or shock.Correct Answer Is:
B. Increased body temperature, increased pulse, and increased blood pressureWhy the other options are incorrect:
A. Increased body temperature, decreased pulse, and increased blood pressureBradycardia (decreased pulse) is not consistent with thyroid storm.
C. Increased body temperature, increased pulse, and decreased blood pressure
While hypotension may occur late as the condition worsens, the initial expected finding is hypertension, not decreased blood pressure.
D. Increased body temperature, decreased pulse, and decreased blood pressure
Both bradycardia and hypotension are not expected early in thyroid storm; these findings suggest late decompensation or another condition.
The nurse monitors the patient with an acute myocardial infarction (AMI) closely. Which complication does the nurse know is the most common with an AMI?
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Dysrhythmias
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Pericarditis
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Congestive heart failure
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Cardiogenic shock
Explanation
Explanation
The most common complication of an acute myocardial infarction is dysrhythmias. Ischemia and infarction of heart muscle disrupt the normal conduction pathways, leading to abnormal rhythms such as premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation. Dysrhythmias can occur in over 80–90% of AMI patients, making them the most frequent complication and a leading cause of sudden cardiac death post-MI.Correct Answer Is:
DysrhythmiasWhy the other options are incorrect:
PericarditisThis is incorrect because while pericarditis (inflammation of the pericardial sac) can occur after an AMI, particularly in the days following, it is not the most common complication. It is relatively rare compared to dysrhythmias.
Congestive heart failure
This is incorrect because heart failure can develop if the infarcted area is large and impairs the heart’s pumping ability. While serious, it is less common than dysrhythmias in the immediate phase following an AMI.
Cardiogenic shock
This is incorrect because cardiogenic shock is a severe but uncommon complication of massive MI where the heart cannot pump enough blood to meet body demands. It is less frequent than dysrhythmias and typically associated with extensive myocardial damage.
Prescribed: Infuse 500 mL D5W over 3 hours
Drop factor: 15 gtt/mL
Calculate the flow rate in gtt/min. Round to the nearest whole number.
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100 gtt/min
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42 gtt/min
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150 gtt/min
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175 gtt/min
Explanation
Explanation
Formula:Flow rate (gtt/min) = (Total volume × Drop factor) ÷ Time (in minutes)
Step 1: Plug in the numbers
= (500 mL × 15 gtt/mL) ÷ (3 × 60 minutes)
= 7500 ÷ 180
Step 2: Solve
= 41.67 gtt/min
Step 3: Round to the nearest whole number
= 42 gtt/min
Correct Answer Is:
42 gtt/minWhy the other options are incorrect:
100 gtt/minToo high. This would deliver the infusion much faster than prescribed, finishing in less than 2 hours instead of 3, which could cause fluid overload.
150 gtt/min
Extremely high and unsafe, infusing 500 mL in roughly 40 minutes, which contradicts the 3-hour order and can lead to adverse effects.
175 gtt/min
This rate would be dangerously fast, infusing the entire bag in less than 30 minutes, which would cause serious harm.
The nurse is conducting a neurologic examination of an unconscious patient. Which of the following should be assessed? SELECT ALL THAT APPLY.
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Lower limb strength
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Pupillary response
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Trend of vital signs
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Breathing pattern
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Posturing in response to pain point
Explanation
Explanation
Pupillary responseAssessment of pupillary size and reaction to light is essential for evaluating brainstem function and detecting neurological deterioration. Abnormal findings can indicate increased intracranial pressure or brain herniation.
Trend of vital signs
Monitoring vital signs is critical in an unconscious patient. Changes such as widening pulse pressure, bradycardia, and irregular respirations (Cushing’s triad) may indicate increased intracranial pressure and impending herniation.
Breathing pattern
The respiratory pattern provides important clues about neurological function. Abnormal patterns such as Cheyne-Stokes or agonal breathing are often associated with brain injury and need close monitoring.
Posturing in response to pain point
Assessing motor response to painful stimuli helps determine the level of brain injury. Decorticate or decerebrate posturing indicates severe brain damage and helps guide prognosis and treatment decisions.
Correct Answer Is:
Pupillary responseTrend of vital signs
Breathing pattern
Posturing in response to pain point
Why the other options are incorrect:
Lower limb strengthThis is incorrect because an unconscious patient cannot follow commands to assess strength reliably. While motor response is evaluated, it is done through observation of reflexes or posturing, not voluntary strength testing.
A patient who is just waking up after having a general anesthetic is agitated and confused. Which action would the nurse take first?
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A Assess the O₂ saturation.
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B Assess the blood pressure and pulse.
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C Notify the anesthesia care provider.
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D Administer the ordered opioid.
Explanation
Explanation
Agitation and confusion in the immediate postoperative period are most often caused by hypoxemia. The nurse’s first priority is to assess oxygen saturation to determine if the client is receiving adequate oxygenation. If saturation is low, immediate intervention such as providing supplemental oxygen can prevent complications like respiratory arrest.Correct Answer Is:
A. Assess the O₂ saturation.Why the other options are incorrect:
B. Assess the blood pressure and pulseWhile vital signs are important, airway and breathing always take priority before circulation (ABCs of nursing care).
C. Notify the anesthesia care provider
The nurse should assess and intervene first. Contacting the provider without assessing oxygen status delays critical intervention.
D. Administer the ordered opioid
Opioids can worsen respiratory depression and confusion if the underlying cause is hypoxemia, making this unsafe before assessing oxygenation.
The nurse is caring for a patient who is having an acute asthma attack. What is the highest priority nursing action?
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Position patient supine
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Identify asthma triggers
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Increase room temperature
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Administer prescribed bronchodilator
Explanation
Explanation
During an acute asthma attack, the airway is narrowed due to bronchospasm, swelling, and mucus production. The highest priority is to restore airway patency and improve ventilation. Administering a prescribed bronchodilator (such as albuterol) provides rapid relief by relaxing bronchial smooth muscles and improving airflow, making it the most immediate life-saving intervention.Correct Answer Is:
Administer prescribed bronchodilatorWhy the other options are incorrect:
Position patient supineThis is incorrect because placing a patient supine can worsen breathing difficulty. Patients in respiratory distress should be placed in high-Fowler’s position to maximize lung expansion.
Identify asthma triggers
This is incorrect because identifying triggers is part of long-term asthma management, not the priority during an acute attack. The urgent need is airway stabilization.
Increase room temperature
This is incorrect because room temperature changes have no therapeutic effect in relieving bronchospasm. Increasing the temperature could even make the patient more uncomfortable and does not address the airway issue.
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