TEST BANK FOR Introductory Medical-Surgical Nursing 10th Editon By Timby and Smith

Introductory Medical-Surgical Nursing 10e Comprehensive Test Bank
by Barbara K Timby, Nancy E. Smith
Pub. Date: September 2009
Converted From Electronic Source - 11/7/2009 12:43:33 am
Table of Contents
Unit I Nursing Roles and Responsibilities
Unit II Psychosocial Aspects of Client Care
Unit III Concepts of Health and Illness
Unit IV Common Medical-Surgical Problems
Unit V Caring for Clients with Respiratory Disorders
Unit VI Caring for Clients with Cardiovascular Disorders
Unit VII Caring for Clients with Hematopoietic and Lymphatic Disorders
Unit VIII Caring for Clients with Immune Disorders
Unit IX Caring for Clients with Neurologic Disorders
Unit X Caring for Clients with Sensory Problems
Unit XI Caring for Clients with Gastrointestinal Problems
Unit XII Caring for Clients with Endocrine Problems
Unit XIII Disturbances of Sexual Structures or Reproductive Function
Unit XIV Caring for Clients with Urinary and Renal Problems
Unit XV Caring for Clients with Musculoskeletal Problems
Unit XVI Caring for Clients with Integumentary Problems
Appendix: Answers
MULTIPLE CHOICE. Choose the one alternative that best completes the statement
or answers the question.
1)The nurse is assisting a postoperative client in using an incentive spirometer. Which
of the following postoperative complications is this nurse attempting to avoid with
this client? 1) _______
A)Hemorrhage B) Pulmonary embolism
C)Deep vein thrombosis D) Atelectasis
2)A client who is recovering from abdominal surgery has a penrose drain. Which of
the following should the nurse include in the care of this client? 2) _______
A)Make sure there is a safety pin on the end of the drain.
B)Clean the wound with normal saline every two hours.
C)Empty the drain every 30 minutes.
D)Remove the drain four hours postoperatively.
3)A client is in the recovery room. Which of the following members of the healthcare
team should the nurse contact regarding the client's level of pain control? 3) _______
A)The surgeon B) The anesthesiologist
C)The scrub nurse D) The circulating nurse
4)During the assessment of a postoperative client's bowel sounds, the nurse
auscultates high-pitched sounds over all four abdominal quadrants. The nurse realizes
this finding could indicate: 4) _______
A)Normal bowel function. B) The onset of stool.
C)The onset of flatus. D) Paralytic ileus.
5)A client is being transferred from the operating room to the recovery room. The
nurse in the recovery room will be providing which phase of nursing care? 5)
_______
A)Intraoperative B) Preoperative
C)Restorative D) Postoperative
6)A client is being scheduled for surgery. Which of the following should be included
in the preoperative teaching provided by the nurse? 6) _______
A)The credentials of the anesthesiologist
B)Information concerning the surgical procedure which will be performed by the
surgeon
C)Cost of the procedure
D)Planned length of stay at the hospital
7)A client is being positioned for a hip replacement procedure. In which of the
following positions will this client most likely be placed? 7) _______
A)Dorsal recumbent B) Lateral chest
C)Semi-sitting D) Prone
8)A postoperative client tells the nurse, "A book I read said that I should not eat after
surgery for at least a week." Which of the following statements would be an
appropriate nursing response? 8) _______
A)"You don't need any food to heal anyway."
B)"That's true."
C)"That's not true. You could get an infection in your stomach."
D)"I'll be giving you intravenous feedings anyway."
9)An elderly postoperative client is given an antiemetic for nausea. Which of the
following signs would indicate this client is experiencing a possible reaction to the
medication? 9) _______
A)Dry mouth
B)Involuntary muscle movements
C)Breakthrough vomiting
D)Confusion
10)A client is signing a surgical consent. Afterwards, the nurse also signs the form.
What is the meaning of the nursing signature? 10) ______
A)It means the client was alert and aware of what was being signed.
B)It means there is a likelihood of a successful outcome.
C)It means the client understood the procedure as described by the nurse.
D)It means the surgeon was too busy to wait for the client to sign the form.
11)A client's endotracheal tube is being removed after the surgical procedure. The
intra-operative nurse realizes this client is in which phase of the general anesthesia
process? 11) ______
A)Induction B) Maintenance
C)Reduction D) Emergence
12)An elderly client is being prepared for orthopedic surgery. The nurse realizes this
client is at risk for which of the following? 12) ______
A)Prolonged effects of anesthesia because of herbal supplements
B)Decreased tolerance of general anesthesia
C)Increased hypotensive effects of anesthesia
D)Wound dehiscence
13)The client who is preparing for surgery asks the nurse to keep their glasses and
hearing aid in-place until they are under anesthesia. Which of the following
statements by the nurse demonstrates accurate, therapeutic communication? 13)
______
A)"I will contact the surgery department to discuss you requests."
B)"Certainly, you can keep them for that time."
C)"You cannot keep those in."
D)"The policies in the surgery unit will not allow it."
14)A client has just arrived in the recovery room. How often should the nurse assess
the client? 14) ______
A)Every 15 minutes for 30 minutes and then every one hour afterwards.
B)Every 15 minutes for the first hour.
C)Every hour.
D)Every two hours.
15)A client who is being admitted for surgery asks the nurse why information is being
collected about the client's use of herbal and natural supplements. Which of the
following statements is an appropriate nursing response? 15) ______
A)"The physician is in charge of medications."
B)"Herbal supplements may interact with anesthesia agents."
C)"Herbal remedies may cause pain relievers to be ineffective."
D)"There is no need to take these preparations."
16)An elderly client is completing preoperative diagnostic testing. The nurse notes
that the client's carbon dioxide level is elevated. Which of the following nursing
interventions would be indicated for this client? 16) ______
A)Monitor serum sodium level.
B)Monitor serum potassium level.
C)Monitor respiratory status and arterial blood gases.
D)Monitor intake and output.
17)A client is prescribed patient-controlled analgesia for postoperative pain. Which of
the following should the nurse instruct the client about this analgesia? 17) ______
A)"Use this analgesia every hour on the hour."
B)"Use this analgesia only when the pain is extremely severe."
C)"Avoid the use of this because of the risk of addiction."
D)"Use this analgesia regularly."
18)A client has received conscious sedation for a surgical procedure. The nurse
realizes this client will most likely: 18) ______
A)Respond to physical and verbal stimuli.
B)Not respond to any stimuli.
C)Need an endotracheal tube inserted.
D)Need blood product replacements.
19)A client is in his fifth postoperative day and has sanguineous drainage with a thick,
reddish appearance. The nurse realizes this client's wound is in which stage of healing?
19) ______
A)Stage III B) Stage IV C) Stage I D) Stage II
20)A recovery room nurse is consulting with a circulating nurse about a client who is
having a surgical procedure. These nurses are most likely in which zone of the
surgical department? 20) ______
A)Banned B) Semi-restricted
C)Restricted D) Unrestricted
21)A nurse has delegated the collection of vital signs, including blood pressure
readings, to two unlicensed assistive personnel. The of this work means the nurse is:
21) ______
A)Not accountable for these vital signs.
B)Responsible to re-measure all of the vital signs.
C)Not responsible for these vital signs.
D)Accountable for the care that was delegated.
22)The nurse working on a quality improvement study wants to evaluate a client care
process. Which of the following can the nurse use to evaluate this process? 22)
______
A)Variance analysis B) Critical pathway
C)Evidence-based practice D) Nursing process
23)The new nurse is studying the five core competencies for healthcare providers.
Which of the following are a part of these core competencies? (Select all that apply.)
23) ______
A)Work in interdisciplinary teams.
B)Use informatics to deliver care.
C)Use evidence-based practice.
D)Replace quality improvement initiatives with work redesign methods.
E)Use primary nursing to deliver care.
24)A client tells the nurse, "I have an advance directive that I want you to follow."
Which of the following will this document provide for the nurse? 24) ______
A)A complete plan of care for the client
B)The answers to any care dilemmas for the client
C)The client's preferences for healthcare should the client become mentally
incapacitated
D)Directions regarding when to use universal precautions for the client
25)Client chart audits provide the nurses with information that impacts the future
outcomes of client care. What should the nurses do with this information? 25) ______
A)Use the information to create an action plan to address any negative findings.
B)Nothing
C)Submit it to the agency's accrediting body.
D)Place it in a file to compare with the next set of audits.
26)The nurse is preparing a client to go home. Which of the following skills are the
most important for the nurse to adequately prepare this client? 26) ______
A)Familiarity with adult learning principles
B)The ability to support client decision making
C)The ability to use critical thinking
D)The ability to follow written orders
27)The nurse is implementing a plan of care for a client. After providing care, what
should the nurse do as the final step in the process? 27) ______
A)Reassess the client.
B)Give the charge nurse a report.
C)Document
D)Nothing
28)At the completion of an assessment, the nurse chooses a nursing diagnosis that
best defines the client's health problems. Which type of clinical judgment will this
nurse use? 28) ______
A)Diagnostic reasoning B) Evidence-based practice
C)Nursing process D) Critical pathway
29)A client tells the nurse, "I have pain in my leg when I stand too long." This
information would be considered: 29) ______
A)Subjective data B) Objective data
C)Evaluative data D) Qualitative data
30)The nurse is consulting a critical pathway to help make client care decisions.
Which type of care delivery model is this nurse most likely using to provide client
care? 30) ______
A)Team nursing B) Primary nursing
C)Functional nursing D) Case management
31)While providing care to a client, the nurse stops to assess a new client problem.
The assessment in this situation would be: 31) ______
A)An objective assessment B) An initial assessment
C)A focused assessment D) A subjective assessment
32)A graduate nurse is attending a seminar regarding the role of the nurse as a client
advocate. After the session, the students engage in a discussion. Which of the
following statements by the graduate nurse indicates the need for further education?
32) ______
A)"Being a client advocate entails making efforts to improve client outcomes."
B)"Client advocates have the authority to make decisions for the client."
C)"Communicating client needs to the members of the healthcare team is a role of the
client advocate."
D)"Providing education to the client and family is a key way to be a positive client
advocate."
33)The nurse is using a specific process to plan smoking cessation activities for a
client. Which of the following is this nurse most likely using to plan the care for this
client? 33) ______
A)Evidence-based practice B) Nursing process
C)Variance analysis D) Critical pathways
34)The nurse is creating outcome criteria for the nursing diagnoses for a client. Which
of the following should the nurse include when creating the criteria? 34) ______
A)They should be written as psychomotor only.
B)They should be written to address the client, and be time-specific and measurable.
C)They should be written as statements.
D)They should be written as nursing goals.
35)The nurse stops to think about a previous client care situation before providing
care to a current client. This nurse is using what critical thinking skill? 35) ______
A)Divergent thinking B) Reflection
C)Reasoning D) Clarifying
36)A client care issue has been raised about the actions taken by a nurse who was
asked to provide care to a client whose healthcare decisions were considered
controversial. The unit's nurse manager is concerned that care was not appropriately
provided. Which of the following should be consulted to protect the client and to
evaluate the care in question? 36) ______
A)Nursing code of ethics
B)Hospital quality improvement guidelines
C)Critical pathway
D)Nurse practice act
37)The nurse is reviewing the outcome of client care that was provided. Which of the
following nursing process steps should the nurse use next? 37) ______
A)Implementation B) Planning
C)Assessment D) Evaluation
38)The nurse is preparing to provide client care information to a group of unlicensed
assistive personnel. Which type of care delivery system is this nurse most likely using
to provide client care? 38) ______
A)Primary nursing B) Team nursing
C)Functional nursing D) Case management
39)A new nurse tells her mentor "you always seem so poised when you interact with
the client. It is as if you always know what to do. Can you teach me how to do that?"
What characteristic does this mentor possess in relation to critical thinking? 39)
______
A)Independent thinking B) Discipline
C)Empathy D) Self-confidence
40)Which of the following best demonstrates a nurse using critical thinking when
providing client care? 40) ______
A)A nurse checks a laboratory manual before providing care.
B)A nurse lists alternative interventions available to provide client care.
C)A nurse checks every intervention with the charge nurse before providing care.
D)A nurse is confused when the only planned intervention fails to help a client.
SHORT ANSWER. Write the word or phrase that best completes each statement or
answers the question.
41)The nurse assesses a client's weight loss as being 22 lbs. How many liters of fluid
did this client lose? 41) _____________
MULTIPLE CHOICE. Choose the one alternative that best completes the statement
or answers the question.
42)A client is admitted with hypernatremia caused by being stranded on a boat in the
Atlantic Ocean for five days without a fresh water source. Which of the following is
this client at risk for developing? 42) ______
A)Pulmonary edema B) Stress fractures
C)Atrial dysrhythmias D) Cerebral bleeding
43)The blood gases of a client with an acid-base disorder show a blood pH outside of
normal limits. The nurse realizes that this client is: 43) ______
A)Fully compensated.
B)In need of intravenous fluids.
C)Demonstrating anaerobic metabolism.
D)Partially compensated.
44)A client with fluid retention related to renal problems is admitted to the hospital.
The nurse realizes that this client could possibly have which of the following
electrolyte imbalances? 44) ______
A)Hypokalemia B) Magnesium
C)Carbon dioxide D) Hypernatremia
45)An elderly client who is being medicated for pain had an episode of incontinence.
The nurse realizes that this client is at risk for developing: 45) ______
A)Fecal incontinence. B) Dehydration.
C)Over-hydration. D) A stroke.
46)The nurse is reviewing a client's blood pH level. Which of the systems in the body
regulate blood pH? (Select all that apply.) 46) ______
A)Buffers B) Respiratory
C)Renal D) Cardiac
47)A client is prescribed 20 mEq of potassium chloride. The nurse realizes that the
client is receiving this replacement: 47) ______
A)To help regulate acid-base balance.
B)To keep a vein open.
C)To sustain respiratory function.
D)To encourage urine output.
48)An elderly client with peripheral neuropathy has been taking magnesium
supplements. The nurse realizes that which of the following symptoms can indicate
hypermagnesemia? 48) ______
A)Excessive urination
B)Hyper reflexia
C)Hypotension, warmth, and sweating
D)Nausea and vomiting
49)An elderly client with a history of sodium retention arrives to the clinic with the
complaints of "heart skipping beats" and leg tremors. Which of the following should
the nurse ask this client regarding these symptoms? 49) ______
A)"Are you using a salt substitute?"
B)"Were you doing any unusual physical activity?"
C)"Have you stopped taking your digoxin medication?"
D)"When was the last time you had a bowel movement?"
50)A client who is taking digoxin (Lanoxin) is admitted with possible hypokalemia.
Which of the following does the nurse realize might occur with this client? 50)
______
A)A higher dose of digoxin (Lanoxin) may be needed.
B)A diuretic may be needed.
C)Digoxin toxicity
D)Fluid volume deficit
51)The nurse is admitting a client who was diagnosed with acute renal failure. Which
of the following electrolytes will be most affected with this disorder? 51) ______
A)Phosphorous B) Calcium
C)Potassium D) Magnesium
52)A client is admitted with burns over 50% of his body. The nurse realizes that this
client is at risk for which of the following electrolyte imbalances? 52) ______
A)Hypophosphatemia B) Hypernatremia
C)Hypercalcemia D) Hypermagnesemia
53)The nurse observes a client's respirations and notes that the rate is 30 per minute
and the respirations are very deep. The metabolic disorder this client might be
demonstrating is: 53) ______
A)Hypertension.
B)Pain.
C)Increasing carbon dioxide in the blood.
D)Hypernatremia.
54)A client is admitted for treatment of hypercalcemia. The nurse realizes that this
client's intravenous fluids will most likely be: 54) ______
A)Dextrose 5% and ½ normal saline.
B)Normal saline.
C)Dextrose 5% and water.
D)Dextrose 5% and ¼ normal saline.
55)An elderly postoperative client is demonstrating lethargy, confusion, and a
respiratory rate of 8 per minute. The nurse sees that the last dose of pain medication
administered via a patient controlled anesthesia (PCA) pump was within 30 minutes.
Which of the following acid-base disorders might this client be experiencing? 55)
______
A)Metabolic acidosis B) Respiratory alkalosis
C)Metabolic alkalosis D) Respiratory acidosis
56)A 28-year-old male client is admitted with diabetic ketoacidosis. The nurse
realizes that this client will have a need for which of the following electrolytes? 56)
______
A)Sodium B) Magnesium
C)Calcium D) Potassium
57)An elderly client does not complain of thirst. What should the nurse do to assess
that this client is not dehydrated? 57) ______
A)Ask the physician to order a chest x-ray.
B)Assess the urine for osmolality.
C)Ask the physician for an order to begin intravenous fluid replacement.
D)Ask the physician for an order for a brain scan.
58)An elderly client is at home after being diagnosed with fluid volume overload.
Which of the following should the home care nurse instruct this client to do? 58)
______
A)Avoid wearing shoes while in the home.
B)Try to sleep without extra pillows.
C)Keep legs in a dependent position.
D)Wear support hose.
59)An elderly client comes into the clinic with the complaint of watery diarrhea for
several days with abdominal and muscle cramping. The nurse realizes that this client
is demonstrating: 59) ______
A)Hyponatremia. B) Fluid volume excess.
C)Hyperkalemia. D) Hypernatremia.
60)A client's blood gases show a pH greater of 7.53 and bicarbonate level of 36
mEq/L. The nurse realizes that the acid-base disorder this client is demonstrating is:
60) ______
A)Respiratory acidosis. B) Metabolic alkalosis.
C)Respiratory alkalosis. D) Metabolic acidosis.
61)After abdominal surgery a client has difficulty coughing, saying, "It hurts too
much." The nurse teaches the client to: 61) ______
A)support the abdomen with a pillow during the coughing exercises.
B)ask for pain medication if the pain is severe.
C)turn and deep breathe without coughing.
D)cough without straining the abdomen.
62)The preoperative client asks the nurse for some tea before surgery. The nurse
explains that it is important to have nothing by mouth (NPO) prior to surgery to
prevent: 62) ______
A)aspiration. B) urine formation.
C)hyperglycemia. D) abdominal cramping.
63)A nurse is preparing to discharge a client who has had outpatient surgery. It is
important for the nurse to assess the client's: 63) ______
A)family support at home.
B)food preferences.
C)knowledge of sterile technique.
D)understanding of the surgical procedure.
64)When changing the client's sterile dressings on the second postoperative day, the
nurse notes that the suture line is red and slightly inflamed. The nurse recognizes
these findings are: 64) ______
A)abnormal and need to be documented.
B)normal signs of the inflammatory response.
C)abnormal and need to be reported to the charge nurse.
D)signs of infection and need to be reported to the physician.
65)During the preoperative assessment, the nurse learns that the client had gestational
diabetes with her three pregnancies. The nurse will obtain an order for the following
test: 65) ______
A)electrolytes.
B)urinalysis.
C)partial thromboplastin time (PTT).
D)blood sugar.
66)After abdominal surgery, a client feels bloated and is unable to pass gas.
Appropriate nursing interventions include: 66) ______
A)encourage fluid intake of 3000 mL/day.
B)assist with ambulation.
C)restrict foods to reduce gas production.
D)press gently on the abdomen to promote expulsion of gas.
67)A postoperative client complains of dizziness when getting out of bed to ambulate.
The nurse should: 67) ______
A)have the client use a walker.
B)administer medication for dizziness.
C)return the client to bed.
D)walk alongside the client.
68)The nurse is preparing to obtain a client's signature on an informed consent. It is
the nurse's responsibility to: 68) ______
A)witness the signature.
B)determine the client's understanding about the procedure.
C)describe surgical risks.
D)explain the procedure.
69)A client is being given 0.6 mg atropine (