CMSRN FREE Medical-Surgical Nursing Questions and Answers 2 — Questions and Answers
Question 1: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which intervention should the nurse implement first?
- Administer sodium polystyrene sulfonate as ordered
- Place the patient on continuous cardiac monitoring (Correct answer)
- Restrict dietary potassium intake
- Obtain a repeat blood sample to confirm the result
Correct answer: Place the patient on continuous cardiac monitoring
Hyperkalemia at this level poses an immediate risk for fatal cardiac dysrhythmias, making cardiac monitoring the priority intervention.
Question 2: A nurse is caring for a patient 12 hours after a total hip arthroplasty. Which finding requires immediate intervention?
- Moderate incisional pain rated 5 out of 10
- Serosanguineous drainage on the surgical dressing
- The affected leg appears shorter and externally rotated (Correct answer)
- A hemoglobin drop from 12.0 to 10.8 g/dL
Correct answer: The affected leg appears shorter and externally rotated
A shortened and externally rotated leg after total hip arthroplasty indicates posterior hip dislocation, which requires emergent medical intervention.
Question 3: Which assessment finding in a patient receiving heparin therapy should prompt the nurse to notify the provider immediately?
- An aPTT of 68 seconds with a target range of 60-80 seconds
- Slight bruising at the subcutaneous injection site
- A platelet count that dropped from 240,000 to 95,000 over 5 days (Correct answer)
- A hemoglobin of 13.2 g/dL
Correct answer: A platelet count that dropped from 240,000 to 95,000 over 5 days
A greater than 50% drop in platelets during heparin therapy is a hallmark sign of heparin-induced thrombocytopenia (HIT), a potentially fatal complication.
Question 4: A patient with cirrhosis develops increasing abdominal girth and a fluid wave on examination. Which laboratory value should the nurse monitor most closely?
- Serum albumin (Correct answer)
- Serum glucose
- Hemoglobin A1C
- Erythrocyte sedimentation rate
Correct answer: Serum albumin
Low serum albumin reduces oncotic pressure, directly contributing to ascites formation in cirrhotic patients.
Question 5: A nurse is teaching a patient newly diagnosed with myasthenia gravis. Which statement by the patient indicates correct understanding of the disease?
- I should take my pyridostigmine after meals to reduce nausea
- My muscle weakness will be worst in the morning when I first wake up
- I need to plan activities early in the day when I have the most strength (Correct answer)
- I can safely stop my medication once my symptoms improve
Correct answer: I need to plan activities early in the day when I have the most strength
Myasthenia gravis causes progressive muscle fatigue throughout the day, so patients typically have more strength in the morning and should schedule demanding activities accordingly.
Question 6: A patient with type 2 diabetes is admitted with a blood glucose of 748 mg/dL, serum osmolality of 340 mOsm/kg, and minimal ketones. What is the priority nursing intervention?
- Administer a bolus of regular insulin per protocol
- Initiate aggressive intravenous fluid resuscitation (Correct answer)
- Begin a sodium bicarbonate infusion
- Prepare for emergent hemodialysis
Correct answer: Initiate aggressive intravenous fluid resuscitation
Hyperosmolar hyperglycemic state causes severe dehydration, and aggressive IV fluid replacement is the initial priority to restore circulating volume before insulin therapy.
CMSRN FREE Medical-Surgical Nursing Questions and Answers 2
A patient with chronic kidney disease has a potassium level of 6.2 mEq/L.
Which intervention should the nurse implement first?