Download 2025 Comprehensive Medical-Surgical Nursing Exam Review– Ultimate Guide and more Exams Nursing in PDF only on Docsity!
2025 Comprehensive Medical-Surgical Nursing
Exam Review– Ultimate Guide with Practice
Questions, Rationales, and Test-Taking Strategies
for Nursing Students
1. Advantages of Using Informatics in Health Care Delivery (Select all that apply) Which of the following are advantages of using informatics in health care delivery? a. Reduced need for nurses in acute care b. Increased patient anonymity and confidentiality c. The ability to deliver high standards of safe, quality care d. Access to decision-making tools for health care team members e. Improved communication of the patient's health status to the health care team ✅ Correct Answers: C, D, E Rationale: Health informatics enhances care by improving the safety, quality , and efficiency of care delivery. It provides decision-support tools and communication systems that ensure team members are updated on patient status. However, it does not reduce the need for nurses or necessarily increase patient anonymity. 2. Using Evidence-Based Practice When using evidence-based practice, the nurse: a. Must use clinical practice guidelines developed by national health agencies b. Should use findings from randomized controlled trials to plan care for all patient problems c. Uses clinical decision making and judgment to decide what evidence is appropriate for a specific clinical situation d. Analyzes the relationship of nursing interventions to patient outcomes to discover evidence for patient interventions ✅ Correct Answer: c Rationale: Evidence-based practice involves combining research with clinical expertise and
patient values. Nurses must evaluate the relevance of the evidence and apply it judiciously , not follow guidelines blindly or use trials for every patient issue.
3. National Patient Safety Goals – Alarm Fatigue To address patient safety concerns, the nurse addresses the National Patient Safety Goals (NPSGs) to reduce alarm fatigue by: a. Responding to alarms promptly b. Decreasing the volume for all alarms c. Turning off all alarms when in a patient’s room d. Not responding to alarms for unassigned patients ✅ Correct Answer: a Rationale: Responding promptly to alarms prevents alarm fatigue and enhances patient safety. Turning off or ignoring alarms compromises care and is not supported by the NPSG standards. 4. Delegation to LPN/VN (Select all that apply) What patient care will the RN delegate to the LPN/VN? a. The day 2 postoperative patient ordered daily dressing changes b. The patient scheduled oral medications at 0800, 1000, and 1200 c. The patient awaiting admission to the unit from the emergency department d. The patient who requires teaching administering insulin for home use e. The patient who is ambulatory and stable awaiting for the provider ✅ Correct Answers: A, B, F Rationale: LPNs/VNs can manage stable patients and perform routine tasks such as dressing changes and administering oral meds. Teaching and initial assessments are reserved for RNs due to the need for professional judgment. 5. Nursing Process – Implementation Phase When the nurse encourages a patient with heart failure to alternate rest and activity periods to reduce cardiac workload, which phase of the nursing process is being used? a. Diagnosis b. Planning c. Implementation
likely require: a. A bachelor’s degree in nursing b. Formal education in advanced nursing practice c. Experience for a specific period in medical-surgical nursing d. Membership in a medical-surgical nursing specialty organization ✅ Correct Answer: c Rationale: To become certified, a nurse typically needs clinical experience in the specialty area. Certification does not require a BSN, advanced education, or membership in a professional organization. The nurse is assigned to care for a newly admitted patient. Number in order the steps for using the nursing process to prioritize care. (Number 1 is the first step, and number 5 is the last step.) ___ Determine whether the plan was effective. ___ Identify any clinical problems. ___ Collect patient information. ___ Carry out the plan. ___ Decide a plan of action. - - correct ans- - ANSWER: 5 Determine whether the plan was effective. 2 Identify any clinical problems. 1 Collect patient information. 4 Carry out the plan. 3 Decide a plan of action. Using the SBAR format, number in order the steps for how the nurse would communicate information with the provider. (Number 1 is the first step, and number 4 is the last step.) ____ "I would like you to order an IV medication and come evaluate the patient as soon as possible." ____ "This is Nurse M.H. I am calling from the unit because your patient, D.R., has a new onset of atrial fibrillation."
____ "The atrial fibrillation started about 10 minutes ago. The heart rate is 124; BP 90/60. The patient is reporting dizziness." ____ "D.R., who is 2 days postoperative for a bowel resection for an obstruction, has a history of mitral valve disease." - - correct ans- - ANSWER: 4 "I would like you to order an IV medication and come evaluate the patient as soon as possible." 1 "This is Nurse M.H. I am calling from the unit because your patient, D.R., has a new onset of atrial fibrillation." 3 "The atrial fibrillation started about 10 minutes ago. The heart rate is 124; BP 90/60. The patient is reporting dizziness." 2 "D.R., who is 2 days postoperative for a bowel resection for an obstruction, has a history of mitral valve disease." The nurse is caring for a patient with diabetes in the ambulatory surgical unit who had a wound debridement. Which task is appropriate for the nurse to delegate to assistive personnel (AP)? a) Check the patient's vital signs. b) Assess the patient's pain level. c) Palpate the patient's pedal pulses. d) Monitor the patient's IV catheter site - - correct ans- - ANSWER: a) Check the patient's vital signs. The nurse's role in addressing the National Patient Safety Goals established by The Joint Commission includes (select all that apply) a. answering all patient monitoring alarms promptly. b. memorizing all the rules published by The Joint Commission. c. obtaining a correct list of the patient's medications on admission. d. encouraging patients to be actively involved in their health care. e. using side rails and alarm systems as necessary to prevent patient falls - - correct ans- - ANSWER: A,C,E
c) Assistive personnel (AP) d) Licensed practical/vocational nurse (LPN/VN) - - correct ans- - ANSWER: a) Registered nurse (RN) Nursing interventions that require independent nursing knowledge, skill, or judgment such as assessment, patient teaching, and evaluation of care cannot be delegated. These interventions are the responsibility of the RN. The scope of practice for LPN/VNs is determined by each state board of nursing. The RN must know the legal scope of LPN/VN practice and delegates and assigns nursing functions appropriately. In most states LPN/VNs may administer medications, perform sterile procedures, and provide a wide variety of interventions planned by the RN. AP are unlicensed individuals who serve in an assistive role to the RN and may include nursing assistants or technicians. The RN may delegate specific activities such as obtaining routine vital signs on stable patients, feeding/assisting patients at mealtimes, ambulating stable patients, and helping patients with bathing and hygiene A group of nurses has a plan to implement evidence-based practice (EBP) for care of patients with pressure injuries. What will this change in practice encompass? (Select all that apply.) a) Consulting with the wound care and ostomy nurse b) Nurses' expertise and bodies of experience and knowledge c) The preferences of patients and their particular circumstances d) The traditions that surround pressure injury practices on the unit e) Journal articles that address the care of patients with pressure injuries - - correct ans-
- ANSWER: A,B and D EBP draws on research, data from local quality improvement, professional organization standards, patient preferences, and clinical expertise. The particular traditions on the nursing unit are not part of EBP A registered nurse (RN) has delegated IV medication administration to a licensed practical/vocational nurse (LPN/VN). Which statement accurately describes delegation? a) The RN must teach the LPN/VN how to administer the IV medications. b) Ultimate responsibility for administering the medication lies with the LPN/VN. c) The RN is responsible for observing the LPN/VN administer the IV medication.
d) The RN is the one accountable for the quality of care that the patient receives - - correct ans- - ANSWER: The RN is the one accountable for the quality of care that the patient receives Delegation entails a redistribution of nursing work, but the RN remains ultimately responsible and accountable for the execution of the task. It would be inappropriate to delegate if the LPN/VN was unfamiliar with the task. The RN is not obliged to observe the LPN/VN's execution of the task. Which patient care delivery model, focusing on continuity of care and interprofessional collaboration, does the nurse use to plan and coordinate aspects of patient care with other disciplines even if the nurse is absent? a) Team nursing model b) Primary nursing model c) Total patient care model d) Case management nursing model - - correct ans- - ANSWER: b) Primary nursing model The primary nursing model includes planning the patient's care and coordinating and communicating all aspects of care with other disciplines and those providing care in the nurse's absence. The focus is on continuity of care and interprofessional collaboration. Team nursing uses the RN as the team leader to organize and manage the care for a group of patients with other ancillary workers. The RN has authority and accountability for the quality of care delivered by the team only during the work period. In a total patient care model, the nurse is accountable for the complete care of the patient during the assigned shift. Case management is not a model of care delivery but a collaborative process that involves assessing, planning, facilitating, and advocating for health services with a variety of resources to promote cost-effective outcomes. When nurses disagree about the effectiveness of a commonly practiced nursing intervention, the best evidence for determining which intervention to use is a) a systematic review of randomized controlled trials. b) a qualitative research study with a large sample size. c) a methodological Internet search using key medical terms. d) anecdotal evidence retrieved from two or more case studies. - - correct ans- - ANSWER: a) a systematic review of randomized controlled trials.
c) Implementation d) Evaluation - - correct ans- - ANSWER: b) Planning During the planning phase of the nursing process, patient outcomes or goals are developed, and nursing interventions are identified to accomplish the outcomes. The assessment phase of the nursing process includes the collection of subjective and objective patient information on which to base the plan of care. The evaluation phase of the nursing process determines if the patient outcomes have been met as a result of nursing interventions. Diagnosing is the act of analyzing the assessment data and making a judgment about the nature of the data. When planning care for a patient, the nurse may use a visual diagram of patient problems and interventions to illustrate the relationships among pertinent clinical data. This format is called a a) concept map. b) critical pathway. c) clinical pathway. d) nursing care plan. - - correct ans- - ANSWER:a) concept map. A concept map is another method of recording a nursing care plan. In a concept map, the nursing process is recorded in a visual diagram of patient problems and interventions. A clinical (critical) pathway is a prewritten plan that directs the entire interprofessional care team in the daily care goals for select health care problems Where is the blood flow altered when a patient has a tricuspid valve problem? a) Vena cava and right atrium b) Left atrium and left ventricle c) Right atrium and right ventricle d) Right ventricle and pulmonary artery - - correct ans- - ANSWER: c) Right atrium and right ventricle Which condition would the nurse teach the patient is a possible long-term consequence of rheumatic fever? a) Valvular heart disease
b) Pulmonary hypertension c) Superior vena cava syndrome d) Hypertrophy of the right ventricle - - correct ans- - ANSWER: a) Valvular heart disease A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to assistive personnel (AP)? (select all that apply) a) Obtain and record daily weight. b) Determine apical-radial pulse rate. c) Observe for overt signs of bleeding. d. Teach the patient how to avoid bruising and bleeding. e. Obtain and record vital signs, including pulse oximetry - - correct ans- - ANSWER: A,C and E The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy. Which intervention would be a priority? a) Encourage caregivers to learn CPR. b) Consider a consultation with hospice for palliative care. c) Monitor the patient's response to prescribed medications. d) Arrange for the patient to enter a cardiac rehabilitation program. - - correct ans- - ANSWER: c) Monitor the patient's response to prescribed medications. The nurse is teaching a community group about preventing rheumatic fever. Which information would the nurse include? a) Prompt recognition and treatment of streptococcal pharyngitis b) Avoiding respiratory infections in children born with heart defects c) Completion of 4 to 6 weeks of antibiotic therapy for infective endocarditis d) Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis -
- correct ans- - ANSWER: a) Prompt recognition and treatment of streptococcal pharyngitis
platelet count of 150,000/μL, and hemoglobin of 12.1 g/dL. Which action would the nurse take first? a) Start intravenous fluids. b) Assess for signs of bleeding. c) Contact the health care provider. d) Request a crossmatch for blood transfusion. - - correct ans- - ANSWER: c) Contact the health care provider. Patients with mechanical valve replacement are placed on anticoagulants and should be in a therapeutic INR range of 2.5 to 3.5. Administration of warfarin prolongs clotting time and prevents clot formation on the valve. The low INR would require a call to the health care provider for an order increase the medication dose. Intravenous fluids are not indicated. The patient is at risk of forming clots, not bleeding. Blood transfusions are unlikely to be needed. The nurse provides discharge instructions to a patient newly diagnosed with cardiomyopathy. Which statement indicates that further teaching is necessary? a) "I will avoid lifting heavy objects." b) "I can drink alcohol in moderation." c) "My family members can take a CPR course." d) "I will reduce stress by learning guided imagery." - - correct ans- - ANSWER: b) "I can drink alcohol in moderation." Patients with cardiomyopathy should avoid alcohol use, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points. An 80-yr-old patient with uncontrolled type 1 diabetes is diagnosed with aortic stenosis. Which intervention would the nurse anticipate when conservative therapy is no longer effective? a) Pacemaker insertion b) Aortic valve replacement c) Open commissurotomy (valvulotomy) procedure
d) Percutaneous transluminal balloon valvuloplasty (PTBV) - - correct ans- - ANSWER: d) Percutaneous transluminal balloon valvuloplasty (PTBV) The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes. Aortic valve replacement would not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Open commissurotomy procedure is used for mitral stenosis. The patient is not a candidate for a pacemaker. Which information would the nurse provide to the patient who had a biologic heart valve inserted? a) Long-term anticoagulation therapy b) Antibiotic prophylaxis for dental care c) Exercise plan to increase cardiac tolerance d) β-Adrenergic blockers to control palpitations - - correct ans- - ANSWER: b) Antibiotic prophylaxis for dental care The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement. On admission to the emergency department, a patient with cardiomyopathy has an ejection fraction of 10%. The nurse notes bilateral crackles and shortness of breath. Which additional assessment finding would indicate the most serious patient decline? a) Increased heart rate b) Increased blood pressure c) Decreased respiratory rate d) Decreased level of consciousness - - correct ans- - ANSWER: d) Decreased level of consciousness Decreased level of consciousness indicates a lack of perfusion, hypoxia, or both. A patient with an ejection fraction of 10% indicates very low cardiac output. Bilateral crackles and shortness of breath are consistent with decompensating heart failure. The nurse would expect an increase in heart rate, blood pressure, and respiratory rate in
c)Perfusion to the legs is interrupted d)Tamponade will soon stop the bleeding. e)Bleeding into the abdomen is continuing - - correct ans- - ANSWER: e)Bleeding into the abdomen is continuing The patient is likely bleeding into the abdominal space, and it is likely to continue without surgical repair. A tamponade blockade of the blood flow will not occur in the abdominal space as it would in the retroperitoneal space, where surrounding anatomic structures may control the bleeding. The lack of urine output does not indicate renal artery involvement but that the bleeding is occurring above the renal arteries, which decreases the blood flow to the kidneys. There is likely to be decreased rather than interrupted perfusion to the leg Which priority intervention will help maintain graft patency for a patient who had aortic aneurysm repair 6 hours ago? a) Assess urine output for renal dysfunction. b) Give IV fluids to maintain adequate perfusion. c) Administer diuretics to improve renal blood flow. d) Maintain a low BP to prevent pressure on surgical site. - - correct ans- - ANSWER:b) Give IV fluids to maintain adequate perfusion. The priority is to maintain an adequate blood pressure (BP) (determined by the surgeon) to maintain graft patency. A prolonged low BP may result in graft thrombosis, and hypertension may cause undue stress on arterial anastomoses resulting in leakage of blood or rupture at the suture lines, which is when IV antihypertensives may be used. Renal output will be assessed when the aneurysm repair is above the renal arteries to assess graft patency, not maintain it The nurse is admitting a patient who has a suspected leaking abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin daily. Which medication would the nurse be prepared to give? a) Vitamin K b) Cobalamin c)Heparin sodium d) Protamine sulfate - - correct ans- - ANSWER: a) Vitamin K
A patient with a leaking aneurysm may go to surgery for repair. Warfarin is a vitamin K antagonist anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected. Vitamin K is given as the antidote for warfarin. Which person would the nurse identify as having the highest risk for abdominal aortic aneurysm? a) A 70-yr-old man with high cholesterol and hypertension b) A 40-yr-old woman with obesity and metabolic syndrome c) A 60-yr-old man with renal insufficiency who is physically inactive d) A 65-yr-old woman with high homocysteine levels and substance use] - - correct ans-
- ANSWER: a) A 70-yr-old man with high cholesterol and hypertension The most common cause of descending abdominal aortic aneurysm (AAA) is atherosclerosis. Male gender, age 65 years or older, and tobacco use are the major risk factors for AAAs of atherosclerotic origin. Other risk factors include the presence of coronary or peripheral artery disease, high blood pressure, and high cholesterol. A patient with syncope has continuous ECG monitoring. The rhythm strip shows: Atrial rate 74 beats/min and regular; ventricular rate 62 beats/min and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. Which intervention would the nurse prioritize? a) Administer epinephrine 1 mg IV push. b) Prepare the patient for synchronized cardioversion. c) Observe for symptoms of hypotension and angina. d) Apply transcutaneous pacemaker pads on the patient - - correct ans- - ANSWER: c) Observe for symptoms of hypotension and angina. Which patient teaching points would the nurse include when providing discharge instructions to a patient with a new permanent pacemaker? (select all that apply) a) Avoid or limit air travel. b) Take and record a daily pulse rate. c) Obtain and wear a Medic Alert ID device at all times. d) Avoid lifting arm on the side of the pacemaker above shoulder.
The nurse obtains a 6-second rhythm strip and charts the following analysis: Atrial data: Rate 70, regular Variable PR interval Independent beats Ventricular data: Rate 40, regular Isolated escape beats Additional data: QRS: 0.04 secP wave and QRS complexes unrelated Which rhythm is described by the data? a) Sinus dysrhythmia b) Third-degree heart block c) Wenckebach phenomenon d) Premature ventricular contractions - - correct ans- - ANSWER: b) Third-degree heart block The nurse is caring for a patient 24 hours after a pacemaker insertion. Which intervention would the nurse implement? a) Reinforcing the pressure dressing as needed b) Encouraging range-of-motion exercises of the involved arm c) Assessing the incision for any redness, swelling, or discharge d) Applying wet-to-dry dressings every 4 hours to the insertion site - - correct ans- - ANSWER: c) Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The nonpressure dressing is kept dry until removed, usually 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement. The patient has atrial fibrillation with a rapid ventricular response. Which electrical treatment option would the nurse prepare the patient to receive? a) Defibrillation b) Synchronized cardioversion c) Automatic external defibrillator (AED) d) Implantable cardioverter-defibrillator (ICD) - - correct ans- - ANSWER: b) Synchronized cardioversion
Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response). Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death, have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias. Which dysrhythmia would indicate that the nurse should prepare to immediately defibrillate a patient? a) Ventricular fibrillation b) Third-degree AV block c) Uncontrolled atrial fibrillation d) Ventricular tachycardia with a pulse - - correct ans- - ANSWER: a) Ventricular fibrillation Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (if the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block. The nurse obtains the following measurements on the patient's rhythm strip: Heart rate of 86 with a regular rhythm, the P wave is 0.06 seconds (sec) and normal shape, the PR interval is 0.24 seconds, and the QRS is 0.09 seconds. How would the nurse document this rhythm? a) First-degree AV block b) Second-degree AV block c) Premature atrial contraction (PAC) d) Premature ventricular contraction (PVC) - - correct ans- - ANSWER: a) First-degree AV block In first-degree atrioventricular (AV) block, there is prolonged duration of AV conduction that lengthens the PR interval above 0.20 seconds. In type I second-degree AV block, the PR interval continues to increase in duration until a QRS complex is blocked. In type II, the PR interval may be normal or prolonged, the ventricular rhythm may be irregular, and the QRS is usually greater than 0.12 seconds. PACs cause an irregular rhythm with
