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 teaching a patient about taking oral iron preparations for a moderate iron-deficiency anemia. Which statement indicates a need for further instruction?
- “I will take the iron tablets with orange juice about an hour before meals.”
- “I will increase my fiber and fluids if the iron tablets make me constipated.”
- “I will call the doctor if the tablets cause a lot of stomach upset.”
- “I will notify my physician if my stools turn dark.”
Explanation
Explanation
Dark or black stools are an expected and harmless side effect of oral iron therapy. This does not require physician notification. The statement reflects a misunderstanding and indicates the patient needs further teaching.Correct Answer Is:
“I will notify my physician if my stools turn dark.”Why the other options are incorrect:
“I will take the iron tablets with orange juice about an hour before meals.”This is correct because vitamin C (orange juice) enhances iron absorption, and iron is best absorbed on an empty stomach before meals.
“I will increase my fiber and fluids if the iron tablets make me constipated.”
This is correct because constipation is a common side effect of iron therapy, and increasing fluids and fiber helps manage it effectively.
“I will call the doctor if the tablets cause a lot of stomach upset.”
This is correct because some patients experience significant gastrointestinal distress with iron. If the upset is severe, the provider may adjust the dose or suggest taking the medication with food.
2.
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.
3.
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.
4.
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.
5.
Which instruction concerning the administration of levothyroxine should the nurse teach a patient?
- Take the drug whenever convenient.
- Take the drug in the evening.
- Take the drug on an empty stomach one hour before eating.
- Take the drug with meals.
Explanation
Explanation
Levothyroxine should be taken consistently in the morning on an empty stomach, at least one hour before eating. Food, fiber, and other medications (such as calcium or iron supplements) can impair absorption of the drug. Taking it on an empty stomach ensures maximum absorption and therapeutic effectiveness in managing hypothyroidism.Correct Answer Is:
Take the drug on an empty stomach one hour before eating.Why the other options are incorrect:
Take the drug whenever convenient.This is incorrect because levothyroxine must be taken consistently at the same time each day, and preferably in the morning. Inconsistent timing or taking it “whenever” can cause fluctuating thyroid hormone levels and reduce effectiveness.
Take the drug in the evening.
This is incorrect because evening dosing is not recommended for most patients, since food and other medications consumed during the day may interfere with absorption. Morning dosing on an empty stomach is the standard practice.
Take the drug with meals.
This is incorrect because taking levothyroxine with meals significantly decreases absorption. Meals interfere with the medication’s effectiveness, making it less reliable in controlling hypothyroidism.
6.
Prescribed: Linezolid 600 mg IVPB q12h, infuse over 2 hours
Available: Linezolid 600 mg/300 mL D5W
How many mL/hr will the nurse program the IV pump? Record your answer in whole number.
- 100 mL/hr
- 125 mL/hr
- 150 mL/hr
- 175 mL/hr
Explanation
Explanation
The bag volume is 300 mL and it must infuse over 2 hours. Pump rate (mL/hr) = total volume ÷ time = 300 mL ÷ 2 hr = 150 mL/hr. The dose (600 mg) is already contained in the 300 mL, so no further conversion is needed. Programming the pump to 150 mL/hr delivers the full dose exactly over the prescribed 2 hours.Correct Answer Is:
150 mL/hrWhy the other options are incorrect:
100 mL/hrThis rate would deliver only 200 mL in 2 hours, leaving 100 mL remaining. At 100 mL/hr, the infusion would take 3 hours to complete, exceeding the ordered time frame. Extending the infusion can alter peak levels and delay subsequent care steps. Therefore, it does not meet the prescription of “infuse over 2 hours.”
125 mL/hr
At 125 mL/hr, the infusion would require 300 mL ÷ 125 mL/hr = 2.4 hours to complete. That is longer than the ordered 2 hours, so the medication would run too slowly. Under-infusion may delay therapeutic levels during an acute infection. This rate does not match the prescriber’s timing requirement.
175 mL/hr
This rate would complete 300 mL in 300 ÷ 175 ≈ 1.71 hours, which is faster than ordered. Infusing more rapidly than prescribed can increase the risk of adverse effects and line-related discomfort. It also deviates from the specified administration parameters. Thus, it is not appropriate for this order.
7.
The nurse is caring for a patient who has a left renal calculi and has an indwelling urinary catheter. Which of the following assessment findings is the priority to report to the provider?
- Blood WBC count 15,000/mm³
- Patient report of nausea
- Absent urine output for 2 hours
- Flank pain that radiates to the lower abdomen
Explanation
Explanation
The absence of urine output in a patient with a urinary catheter is the most urgent concern. It suggests obstruction or complete blockage of urine flow, which can rapidly lead to hydronephrosis, acute kidney injury, or permanent renal damage. This finding requires immediate provider notification to restore urinary drainage and prevent complications.Correct Answer Is:
Absent urine output for 2 hoursWhy the other options are incorrect:
Blood WBC count 15,000/mm³While an elevated WBC suggests infection, it is not the most urgent problem compared to acute obstruction and lack of kidney function.
Patient report of nausea
Nausea is a common symptom in renal calculi but not life-threatening or urgent compared to anuria.
Flank pain that radiates to the lower abdomen
Pain is expected with renal calculi and, although distressing, it does not pose the same immediate risk as no urine output.
8.
Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed as the bowel prep for a patient scheduled for a colonoscopy. The patient begins to experience diarrhea following the administration of the solution. What action by the nurse is appropriate?
- Administer a PRN antidiarrheal agent
- Start an IV infusion to prevent dehydration
- Explain that diarrhea is expected
- Request that the diagnostic test be postponed
Explanation
Explanation
GoLYTELY is prescribed as a bowel-cleansing solution before colonoscopy. The expected therapeutic effect is profuse watery diarrhea, which clears the bowel of stool for accurate visualization during the procedure. The appropriate nursing response is to reassure the patient that diarrhea is expected and is a sign the medication is working.Correct Answer Is:
Explain that diarrhea is expectedWhy the other options are incorrect:
Administer a PRN antidiarrheal agentThis is incorrect because giving an antidiarrheal would counteract the purpose of the bowel prep, preventing effective colon cleansing.
Start an IV infusion to prevent dehydration
This is incorrect because mild diarrhea with GoLYTELY is anticipated and not usually severe enough to require IV hydration. Patients are typically instructed to drink fluids as part of the prep.
Request that the diagnostic test be postponed
This is incorrect because diarrhea indicates the prep is working as intended, not a complication that requires postponing the test.
9.
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.
10.
Which action should the nurse perform prior to administering a preoperative medication to a patient going to surgery?
- Pack all personal belongings
- Say goodbye to family members
- Transfer to the OR stretcher
- Check the chart for the signed consent
Explanation
Explanation
Before giving preoperative medications, the nurse must confirm that informed consent has been obtained and documented. Once preoperative medications are administered, the patient may be sedated or impaired, making it invalid to obtain consent afterward. Ensuring the consent form is signed is a legal and ethical responsibility prior to surgery.Correct Answer Is:
D. Check the chart for the signed consentWhy the other options are incorrect:
A. Pack all personal belongingsThis is part of routine preparation for transfer to surgery but is not a priority before giving preoperative medications.
B. Say goodbye to family members
Patients should have the opportunity to see family, but this is not a legal or priority action before giving medication.
C. Transfer to the OR stretcher
The patient is only transferred after preoperative preparations are completed, including confirming informed consent and medication administration.
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