Quincey Hamilton

Med-Surg Post Review

240B
Fall – 2019

1.) A nurse is caring for a client following an infratentorial craniotomy. How should the nurse
position this client in the immediate post-operative period?

Post-op position for infratentorial craniotomy = Supine, on the patients back and position on either side
for 24 for 48 hours.

2.) A nurse is caring for a client following a bone marrow biopsy. What information should the
nurse include in the discharge education?
 Following a bone marrow biopsy, you should try to rest for the remainder of the day after your
procedure. For at least 2-3 days, you will feel sore. For the first 24 hours, it’s best to keep the
operative site clean and dry. If the bandage becomes soiled, be sure to change it as soon as
possible. Contact your doctor if the you have pain in the biopsy site that becomes severe for
more than a day. Contact your doctor if the biopsy area becomes swollen, red, warm to touch,
or if it begins draining pus like fluid, because this may indicate infection in the area. Other signs
and symptoms of infection include coughing and body aches.

3.) A nurse is providing client education regarding modes of hepatitis transmission. What are the
routes of transmission and risk factors for Hepatitis A, B, C, D and E?

 Hep A = Routes of transmission include, fecal, oral,

Risk Factors, Eating contaminated food and water, especially shellfish. Closer personal
contact with an infected person is increased risk of transmission.

 Hep B = Routes of transmission include, blood.

Risk factors include unprotected sex with an infected person. Infants born to infected
mothers. Contact with infected blood. Substance use disorders with injectable
substances increases the risk of transmission.

 Hep C = Routes of transmission include, blood.

Risk Factors include blood products. Organ transplants. Contaminated needle sticks.
Unclean tattoo equipment. Substance use disorders with injectables. Sexual contact.

 Hep D = Routes of transmission: Blood.

Risk factors: -Blood, blood products, or organ transplants-Contaminated needle sticks,
unsanitary tattoo equipment-Substance use disorders with injectables. Sexual contact.
 Hepatitis E = Route of transmission: Fecal oral.
Risk factors: Ingestion of contaminated food or water contaminated with fecal waste.

4.) What are three (3) risk factors for testicular cancer? List three (3) subjective and objective
findings in the client with testicular cancer?
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

 Risk Factors for testicular cancer include:

1.) HIV infection, 2.) Family history of testicular cancer. 3.) Males who are known to
have an undescended testis.

 Testicular cancer Subjective (patient words) risk factors:

1. Evidence of metastasis which include gyro, back pain.2. Feeling of heaviness in the
testicles.3. Swelling and lumps of testes

 Objective data risk factors of testicular cancer include.

1. Swelling of lymph nodes in groin 2. Lump which is palpable. 3.Enlarged testes which
will have no pain.

5.) What dietary education should the nurse provide to a client diagnosed with a hiatal hernia?
 The nurse should instruct a patient with hiatal hernia to eat a low fat diet. A low fat diet will help
with the possible side effects of hiatal hernia which can include GERD, among other side effects.

6.) What are the recommendations for vaccinations in the adult population?
 Older adults should get vaccinated for the pneumococcal vaccine, Hepatitis A and B.

7.) A nurse is providing education regarding risk factors for gout. What information should be
provided?
 Risk factors for Gout include:
 1. Eating a diet that's high in meat and sugar increases the risk of gout.
 2. Untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome,
and heart and kidney diseases also increase the risk.
 3. Family history of gout.
 4. Gout occurs more often in men, primarily because women tend to have lower uric acid levels

• Gout is a kind of arthritis. High levels of uric acid in the body and it forms sharp crystals
in your joints. The big toe is the most common location to see gout. Flare ups can last 10 days
but the first 36 hours is usually the most painful. It usually affects only one joint at a time, but if
it’s not treated, you might end up with it in your knee, ankle, foot, hand, wrist, or elbow. Gout is
accompanied by signs and symptoms which may include pain with stiff joints, red tender and
warm areas around joints.
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

8.) A nurse is providing education to a group of workers regarding risk factors for carpal tunnel
syndrome. What information should be provided?
 Risk factors for carpal tunnel syndrome include:

Repetitive motions or movements

Work with repeated exposure to cold or vibration seems to increase the risk of carpal
tunnel syndrome.

Females are more often affected by carpal tunnel.

Having a small carpal tunnel (the space in the wrist that the median nerve passes
through), which can be hereditary is thought to play a role in the risk of getting carpal
tunnel syndrome.

Having certain conditions such as an overactive pituitary gland, hypothyroidism,

rheumatoid arthritis, diabetes, or other neurological disorders increase the risk of capal
tunnel.

Due to the risk factors associated with carpal tunnel, a nurse should educate the group of workers on
ways to prevent carpal tunnel in the type of work they do. Education on getting up and taking breaks
from the repetitive motion on the wrists and hands is essential to prevention of carpal tunnel. Avoiding
long periods of cold, vibrating work which can stress the nerve in the wrist. Allowing for periods to
stretch the hands and avoid stiff uncomfortable joints which most often occur in repetitive motions.

9.) A nurse is caring for a client with chronic gastritis. Provide three (3) dietary recommendations
the nurse should include in client education?

 The nurse should provide 3 dietary recommendations for patients with chronic gastritis, which
include: 1.) Small frequent meals 2.) Encourage the patient to eat slow 3.) Educate the patient
to avoid alcohol, caffeinated beverages and foods that can irritate the GI system.

10.) A nurse is caring for a client who has been admitted with renal calculi. List three (3)
interventions the nurse will take in the management of renal calculi.
 Some of the interventions the nurse will take in the management of renal calculi are:
 Strain all urine to check for passage of stone and save the stone for laboratory analysis
 Encourage increased fluid intake 2 to 3L/day unless contraindicated
 Encourage ambulation to promote passage of stone
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

11.) Define the following types of urinary incontinence: Stress, urge, overflow, reflex, functional,
total.

• Stress: Loss of small amounts of urine from increased abdominal pressure without ladder muscle
contraction with laughing, sneezing, or lifting

• Urge: Inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor
muscle with increased bladder pressure

• Overflow: Urinary retention from bladder over distention and frequent loss of small amounts of urine
due to obstruction of the urinary outlet or an impaired detrusor muscle

• Reflex: Involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of
the detrusor muscle, usually from spinal cord dysfunction

• Functional: loss of urine due to factors that interfere with responding to the need to urinate, such as
cognitive, mobility and environmental barriers

• Total: Unpredictable, involuntary loss of urine that generally dose not respond to treatment

12.) A nurse has provided education to a client regarding the correct way to take prescribed
nitroglycerin for the treatment of angina. Which of the following client statements indicates a
need for further education?"When I have angina I will stop what I am doing and sit down.""I will
place the tablet under my tongue.""If I still have pain after 5 minutes I will take two more
tablets.""If I still have pain after 5 minutes of taking my first tablet, I will call 911."
 If I still have pain after 5 minutes of taking my first tablet, I will call 911. This is not correct.
Patients should be taught to take oral nitroglycerin initially for chest pain and 1 every 5 minutes,
up to 3 pills sublingual. After 3 pills if the patient still has chest pain the patient should call 911
and seek medical assistance.

13.) A nurse is caring for a client prescribed fentanyl for acute pain. Two hours after initiation of the
medication the nurse notes the client’s respiratory rate has dropped from 14 breaths/min to 8
breaths/min. What action should the nurse take?

 With fentanyl being a narcotic, first remove the patch if it is a transdermal and then give
naloxone to reverse the effects of too much narcotic which affect the respiratory rate and need
to be reversed.
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

14.) A nurse is caring for a client with Rheumatoid arthritis who is prescribed a non-steroidal anti-
inflammatory drug (NSAID) for the treatment of joint pain. Provide three (3) teaching points in
client education the nurse should provide regarding this medication therapy.

• Instruct the client to take the medication with food or with a full glass of water or milk. If taking
routinely, an H2-receptor antagonist can also be prescribed

• Instruct the client to observe for GI bleeding (coffee-ground emesis; dark, tarry stools)

• Instruct the client tom avoid alcohol, which can increase the risk of GI complications

15.) A nurse is caring for a client experiencing metabolic acidosis. What are three (3) causes of
metabolic acidosis?

• DKA

• Starvation

• Excess production from hydrogen ions

• Excess diarrhea

• Excessive intake of acids

• Lactic acidosis can result from: heavy exercise, seizure activity, hypoxia

16.) A nurse is caring for a client with pneumonia. What are three (3) physical assessment findings
that are noted with the development of pneumonia?

Physical Assessment Findings with Development of pneumonia include :

1) Fever. 2.) Chills. 3.) Short of Breath.

Some other findings in pneumonia include:

Egophony on palpation. ARDS can occur with in 72 hours. Which is

acute respiratory distress syndrome.

17.) A nurse is caring for a client following an abdominal aortic aneurysm resection. What are three
(3) postoperative nursing actions that should be taken for this client?
 Monitor Vital Signs
 Maintain the head of the bed at 45 degrees to prevent graft flexion or movement.
 Report graft occlusion or rupture, changes in pulses, temperature changes coolness below the
graft area, white or blue mottling in extremities or flank pain, severe pain, abdominal distention
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

and decreased urine output should all be signs and symptoms to watch for after an abdominal
aortic graft resection.

18.) A nurse is caring for a client after a knee arthroplasty procedure. What are three (3)
interventions to implement to aid with recovery?
 1) Provide and encourage early ambulation out of bed post knee arthroplasty. 2.) Do passive
range of motion exercises. 3.) Treat for pain management, antibiotic to prevent infection and
anticoagulant to prevent clots post surgical.

19.) A client diagnosed with asthma recently had pulmonary function testing. The client asks the
nurse ‘What is peak expiratory flow?’ What information should the nurse provide?
 Peak expiratory flow is the fastest airflow rate reached during exhalation. The nurse should also
provide information to educate the patient about the prescribed asthma medication, educate
the patient to take the medication to PREVENT asthma, not just at the onset of the attach.
Hydration and drinking plenty of water is important. Don’t discontinue the prescribed
medication abruptly.

20.) A nurse is caring for a client scheduled for a liver biopsy. What nursing actions should be taken
before, during and after this procedure?

•Position the client on the RIGHT side for 1-2h after to ensure hemostasis

•Monitor for hemorrhage (coagulation studies, frank bleeding)

21.) A nurse is caring for a client with colorectal cancer who is scheduled for a colectomy. What
preoperative and post-operative education should be provided to this client?

• Pre-op education

o Educate the client regarding preoperative die (clear liquids several days prior to surgery)

o Instruct the client to complete bowel prep with cathartics as prescribed

o Inform the client of the administration of antibiotics (neomycin, metronidazole) to eradicate intestinal
flora

• Post-op education

o Teach client regarding turning and deep breathing

o Educate the client regarding the care of the incision activity limits, and ostomy care
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

o Provide instructions regarding management of postop complications, including incontinence or sexual

dysfunction (most likely to occur with AP resection

22.) A nurse is caring for a client with Cushing’s disease. Would the nurse expect this client’s plasma
cortisol levels to be increased or decreased?
 Cushing’s Disease will increase the cortisol levels.

23.) A nurse is caring for a client following a colposcopy with cervical biopsy. What post-procedure
information should be provided?
 Client Education: Instruct the client to abstain from sexual intercourse and avoid using a douche,
vaginal creams, or tampons until all discharge has stopped which usually takes about two weeks.
Educate and inform the patient that minimal bleeding may occur after the procedure from the
cervix. Also let the patient know when to expect the results of the biopsy.

A colposcopy is the examination of the tissues of the vagina and cervix using an electric microscope.
Typically, the provider also performs a biopsy. Several options are available. Suspicious areas are
biopsied and sent to a laboratory for microscopic examination.

24.) A nurse is evaluating the client's understanding of post cataract surgery instructions. The client
needs further education when they state."I will report any yellow drainage to my provider"."I
can return to my normal activities like cleaning my house and vacuuming.""I will report any
nausea or vomiting"."My vision will improve over the next 4 to 6 weeks".

25.) A nurse is providing pre-procedural instructions to the client having a barium swallow. What
instructions should be included in this teaching? Select all that apply.

1. NPO after midnight

2. No smoking after midnight 6-12 hours prior

3. Stools will be white for 24 to 72 hours post procedure

4. The feeling of abdominal fullness is normal post procedure

5. Client can have a regular diet before the procedure

Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

26.) A nurse is caring for a client receiving a gastric tube feeding. What nursing actions should be
taken to prevent overfeeding?
 To prevent overfeeding with GI tubes the nurse should check the residual ever 4 to 6 hours.
Slow or with hold feedings for excess residual volume. Check with your facility protocol but
often 100-200ml residual volume and than restarting feedings at a lower rate with
progression after some time of rest. Ensure the pump is operating properly and ensure that
your following the correct rate of feeding as prescribed.

27.) What is a potassium hydroxide (KOH) test and what specific nursing actions should be taken
when obtaining fungal skin specimens?

Potassium hydroxide test (KOH) confirms a fungal skin lesion. A microscopic examination of the scales
scraped off a lesion is mixed with potassium hydroxide (KOH)

•Collect scales using a wooden tongue depressor and placing the specimen in a clean container to be
sent to the laboratory

•If a fungal culture is needed because of inconclusive results due to a deeper fungal infection, a punch
biopsy is performed.

•Specimens must be properly labeled and delivered to the laboratory promptly for appropriate storage
and analysis.

28.) What are the expected assessment findings for a herniated lumbar disk?

Previous traumatic injury or back strain

Unilateral, lower back pain

Pain that may radiate to the buttocks, legs, and feet

Pain that may begin suddenly, subside in a few days, and then recur at shorter intervals with progressive
intensity

Sciatic pain beginning as a dull ache in the buttocks, worsening with Valsalva's maneuver, coughing,
sneezing, or bending

Pain that may subside with rest

Muscle spasms
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

Chronic repetitive injury

Sensory alterations, such as paresthesia and numbness

Assessment-Physical Findings

Limited ability to bend forward (see Testing for a herniated disk)

Posture favoring the affected side

Gait difficulty

Muscle atrophy, in later stages

Constipation or incontinence

Urgency difficulties or incontinence

Tenderness over the affected region

Radicular pain with straight leg raising in lumbar herniation

Increased pain with neck movement in cervical herniation

Referred upper trunk pain with cervical neck compression

Weakness in affected area

29.) A nurse is caring for a client with multiple risk factors for peripheral vascular disease. List four
(4) risk factors associated with peripheral vascular disease.

 Risk factors for peripheral vascular disease include :

Hypertension, hyperlipidemia, DM, cigarette smoking

30.) A nurse is caring for a client following a hypophysectomy. What postoperative nursing actions
should be taken for this client?

• Monitor and correct electrolytes, especially Na+, K+, and chloride. Monitor and adjust serum glucose
levels. Monitor EKG.

• Protect patient from developing an infection by using good hand hygiene and avoiding contact with
individuals who have infections. Use caution to prevent a fracture by helping getting out of bed and
raising side rails.

• Monitor for bleeding. Monitor nasal drainage for possible cerebral spinal fluid leak. Assess drainage for
presence of glucose or a halo sign

• Assess neurologic condition every hour for the first 25 hours, and then every 4 hours
Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

• Administer glucocorticoids to prevent an abrupt drop in cortisol level

• Administer stool softeners to prevent straining

31.) What type of respiratory failure is caused by Guillain-Barre’ syndrome?

Respiratory failure occurs when gas echange at the lungs is sufficiently impaired to cause a drop-in
blood levels of oxgyen (hypoxaemia); this may occur with or without an increase in carbon dioxide
levels. The definition of respiratory failure is PaO27kPa (55mmHg). Respiratory failure is divided into
type I and type II. Gullian-Barre syndrome is respiratory failure type 2, which is associated with COPD.
Type 2 respiratory failure is also known as ventilatory failure which occurs when you can’t get the CO2
out. Inadequate ventilation is due to reduced ventilatory effort, or inability to overcome increased
resistance to ventilation. Because this affects the lungs entirely it causes carbon dioxide to accumulate.
Complications include damage to vital organs caused by the hypoxemia, CNS depression due to
increased carbon dioxide levels, respiratory acidosis which is carbon dioxide retention.

Type I respiratory failure involves low oxygen, and normal or low carbon dioxide levels.

Type II respiratory failure involves low oxygen, with high carbon dioxide.

32.) A client is diagnosed with Addisonian Crisis. List the lab values that will be affected by this
disease process.

- Electrolytes: increased potassium , decreased sodium, increased calcium.

- Increased BUN & Creat

- Decreased glucose

- Decreased cortisol

33.) A client with peripheral vascular disease had a below the knee amputation three months ago.
The client now complains of phantom limb pain. List three (3) interventions to address the pain
associated with this condition.

Administering beta blockers such as propranolol (Inderal) may relieve the continual dull,

burning sensation associated with the amputated limb.

Quincey Hamilton
Med-Surg Post Review
240B
Fall – 2019

Administering antiepileptics such as gabapentin (Neurontin) or carbamazepine (Tegretol)

may relieve sharp, stabbing, and burning phantom limb pain.

Some clients may have relief from antispasmodics and antidepressant medication.

The nurse should recognize the pain is real and manage it accordingly.

Alternative treatment such as massage, heat, biofeedback, or relaxation therapy.

Teach the client how to push the residual limb down toward the bed while supported on a

soft pillow; it helps to reduce phantom limb pain and prepare the limb for a prosthesis.