MEDICAL SURGICAL NURSING

1. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and coughing
exercises. The nurses best response would be:
A. Pain will become less each day.
B. This is a normal reaction after surgery.
C. With a pillow, apply pressure against the incision.
D. I will give you the pain medication the physician ordered.

Answer: (C) With a pillow, apply pressure against the incision.
Applying pressure against the incision with a pillow will help lessen the intra-abdominal pressure created by coughing
which causes tension on the incision that leads to pain.
2. The nurse needs to carefully assess the complaint of pain of the elderly because older people
A. are expected to experience chronic pain
B. have a decreased pain threshold
C. experience reduced sensory perception
D. have altered mental function

Answer: (C) experience reduced sensory perception
Degenerative changes occur in the elderly. The response to pain in the elderly maybe lessened because of reduced
acuity of touch, alterations in neural pathways and diminished processing of sensory data.
3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR
is higher, than before the medication was administered. The nurses best
A. The patient is having an allergic reaction to the drug.
B. The patient needs a higher dose of this drug
C. This is normal side-effect of AtSO4
D. The patient is anxious about upcoming surgery

Answer: (C) This is normal side-effect of AtSO4
Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate.
4. Anas postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32.
Suspecting shock, which of the following orders would the nurse question?
A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100%.
C. Monitor urine output every hour.
D. Administer Demerol 50mg IM q4h

Answer: (D) Administer Demerol 50mg IM q4h
Administering Demerol, which is a narcotic analgesic, can depress respiratory and cardiac function and thus not
given to a patient in shock. What is needed is promotion for adequate oxygenation and perfusion. All the other
interventions can be expected to be done by the nurse.
5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the
morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach?
A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"
B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts.
C. Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."
D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"

Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"
The client is showing signs of anxiety reaction to a stressful event. Recognizing the clients anxiety conveys
acceptance of his behavior and will allow for verbalization of feelings and concerns.
6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place
following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take?
A. Call the physician immediately.
B. Administer the prescribed antiemetic.
C. Check the patency of the nasogastric tube for any obstruction.
D. Change the patients position.

Answer: (C) Check the patency of the nasogastric tube for any obstruction.
Nausea is one of the common complaints of a patient after receiving general anesthesia. But this complaint could be
aggravated by gastric distention especially in a patient who has undergone abdominal surgery. Insertion of the NGT
helps relieve the problem. Checking on the patency of the NGT for any obstruction will help the nurse determine the
cause of the problem and institute the necessary intervention.
7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief
and he refuses to move. The nurse should plan to:
A. Reassure him that the nurses will not hurt him
B. Let him perform his own activities of daily living
C. Handle him gently when assisting with required care
D. Complete A.M. care quickly as possible when necessary

Answer: (C) Handle him gently when assisting with required care
Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the
bone to appoint at which normal activities and even position changes can lead to fracture. During nursing care, the
patient needs to be supported and handled gently.
8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood
pressure is 120/80, respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are
stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action
is most appropriate?

A. Notify his physician.
B. Take his vital signs again in 15 minutes.
C. Take his vital signs again in an hour.
D. Place the patient in shock position.

Answer: (B) Take his vital signs again in 15 minutes.
Monitoring the clients vital signs following surgery gives the nurse a sound information about the clients condition.
Complications can occur during this period as a result of the surgery or the anesthesia or both. Keeping close track of
changes in the VS and validating them will help the nurse initiate interventions to prevent complications from
occurring.
9. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2-story building. When
assessing the client, the nurse would be most concerned if the assessment revealed:

A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature

Answer: (C) Bleeding from ears
The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function, increased
intracranial pressures, fractures and bleeding. Bleeding from the ears occurs only with basal skull fractures that can
easily contribute to increased intracranial pressure and brain herniation
10. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD?
A. I exercise every other day.
B. My father died of Myasthenia Gravis.
C. My cholesterol is 180.
D. I smoke 1 1/2 packs of cigarettes per day.

Answer: (D) I smoke 1 1/2 packs of cigarettes per day.
Smoking has been considered as one of the major modifiable risk factors for coronary artery disease. Exercise and
maintaining normal serum cholesterol levels help in its prevention.
11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge regarding this drug?
A. It has positive inotropic and negative chronotropic effects
B. The positive inotropic effect will decrease urine output
C. Toxixity can occur more easily in the presence of hypokalemia, liver and renal problems
D. Do not give the drug if the apical rate is less than 60 beats per minute.

Answer: (B) The positive inotropic effect will decrease urine output
Inotropic effect of drugs on the heart causes increase force of its contraction. This increases cardiac output that
improves renal perfusion resulting in an improved urine output.
12. Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate Valsalva's
maneuver?
A. Use of stool softeners.
B. Enema administration
C. Gagging while toothbrushing.
D. Lifting heavy objects

Answer: (A) Use of stool softeners.
Straining or bearing down activities can cause vagal stimulation that leads to bradycardia. Use of stool softeners
promote easy bowel evacuation that prevents straining or the valsalva maneuver.
13. The nurse is teaching the patient regarding his permanent artificial pacemaker. Which information
given by the nurse shows her knowledge deficit about the artificial cardiac pacemaker?

A. take the pulse rate once a day, in the morning upon awakening
B. may be allowed to use electrical appliances
C. have regular follow up care
D. may engage in contact sports

Answer: (D) may engage in contact sports
The client should be advised by the nurse to avoid contact sports. This will prevent trauma to the area of the
pacemaker generator.
14. A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the
following instructions does the nurse include in the teaching?

A. When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take
another tablet in 5 minutes.
B. Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.
C. Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one
every 5 minutes for 15 minutes, then go lie down.
D. Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the
pain is unrelieved.

Answer: (D) Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the
hospital if the pain is unrelieved.
Angina pectoris is caused by myocardial ischemia related to decreased coronary blood supply. Giving nitroglycerine
will produce coronary vasodilation that improves the coronary blood flow in 3 5 mins. If the chest pain is unrelieved,
after three tablets, there is a possibility of acute coronary occlusion that requires immediate medical attention.
15. A client with chronic heart failure has been placed on a diet restricted to 2000mg. of sodium per day. The client
demonstrates adequate knowledge if behaviors are evident such as not salting food and avoidance of which food?

A. Whole milk
B. Canned sardines
C. Plain nuts
D. Eggs

Answer: (B) Canned sardines
Canned foods are generally rich in sodium content as salt is used as the main preservative.
16. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this team
member is most appropriate?
A. Apply a heating pad to the involved site.
B. Elevate the client's legs 90 degrees.
C. Instruct the client about the need for bed rest.
D. Provide active range-of-motion exercises to both legs at least twice every shift.

Answer: (C) Instruct the client about the need for bed rest.
In a client with thrombophlebitis, bedrest will prevent the dislodgment of the clot in the extremity which can lead to
pulmonary embolism.
17. A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the
nurse include in the explanation to the client?
A. It dissolves existing thrombi.
B. It prevents conversion of factors that are needed in the formation of clots.
C. It inactivates thrombin that forms and dissolves existing thrombi.
D. It interferes with vitamin K absorption.

Answer: (B) It prevents conversion of factors that are needed in the formation of clots.
Heparin is an anticoagulant. It prevents the conversion of prothrombin to thrombin. It does not dissolve a clot.
18. The nurse is conducting an education session for a group of smokers in a stop smoking class.
Which finding would the nurse state as a common symptom of lung cancer? :

A. Dyspnea on exertion
B. Foamy, blood-tinged sputum
C. Wheezing sound on inspiration
D. Cough or change in a chronic cough

Answer: (D) Cough or change in a chronic cough
Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough
which initially maybe dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and
the cough may become productive due to infection.
19. Which is the most relevant knowledge about oxygen administration to a client with COPD?
A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath.
C. Oxygen is administered best using a non-rebreathing mask
D. Blood gases are monitored using a pulse oximeter.

Answer: (A) Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2 stimulation for breathing. The
hypoxic state of the client then becomes the stimulus for breathing. Giving the clientoxygen in low concentrations will
maintain the clients hypoxic drive.
20. When suctioning mucus from a client's lungs, which nursing action would be least appropriate?
A. Lubricate the catheter tip with sterile saline before insertion.
B. Use sterile technique with a two-gloved approach
C. Suction until the client indicates to stop or no longer than 20 second
D. Hyperoxygenate the client before and after suctioning

Answer: (C) Suction until the client indicates to stop or no longer than 20 second
One hazard encountered when suctioning a client is the development of hypoxia. Suctioning sucks not only the