CMSRN - Medical-Surgical Nursing CMSRN-FREE Cmsrn Medical Surgical Nursing 1 — Questions and Answers
Question 1: A nurse is caring for a post-operative patient who underwent a bowel resection 24 hours ago. The patient's abdomen is distended and he reports no bowel sounds. Which intervention should the nurse prioritize?
- Administer a Fleet enema as ordered
- Encourage the patient to ambulate in the hallway (Correct answer)
- Insert a nasogastric tube and connect to suction
- Increase the IV fluid rate to 150 mL/hr
Correct answer: Encourage the patient to ambulate in the hallway
Early ambulation stimulates peristalsis and helps resolve post-operative ileus, which is the most common cause of abdominal distension after bowel surgery. It is the first-line, least invasive intervention before escalating to NGT insertion.
Question 2: A patient with type 2 diabetes is scheduled for a CT scan with contrast dye in the morning. The nurse notes the patient takes metformin 1000 mg twice daily. What is the priority nursing action?
- Administer the metformin dose as scheduled the morning of the procedure
- Hold the metformin and notify the provider before the procedure (Correct answer)
- Switch the patient to insulin coverage for the day of the procedure
- Increase the patient's IV fluid rate to prevent dehydration
Correct answer: Hold the metformin and notify the provider before the procedure
Metformin must be held before and after contrast administration due to the risk of contrast-induced nephropathy, which can reduce renal clearance of metformin and lead to lactic acidosis, a life-threatening complication.
Question 3: A nurse is assessing a patient with deep vein thrombosis who is receiving a heparin infusion. The patient's aPTT is 180 seconds. What is the nurse's priority action?
- Continue the infusion at the current rate and recheck in 6 hours
- Increase the heparin infusion rate per the protocol
- Stop the infusion and notify the provider immediately (Correct answer)
- Administer vitamin K as an antidote
Correct answer: Stop the infusion and notify the provider immediately
A therapeutic aPTT for heparin therapy is 60–100 seconds (1.5–2.5 times the normal of 30–40 seconds). An aPTT of 180 seconds indicates supratherapeutic anticoagulation and a high bleeding risk, requiring immediate cessation of the infusion and provider notification.
Question 4: A patient is admitted with an acute exacerbation of COPD. The nurse notes the patient's SpO2 is 88% on room air. Which oxygen delivery device is most appropriate for this patient?
- Non-rebreather mask at 15 L/min
- Nasal cannula at 6 L/min
- Venturi mask set to deliver 28% FiO2 (Correct answer)
- Simple face mask at 8 L/min
Correct answer: Venturi mask set to deliver 28% FiO2
Patients with COPD rely on hypoxic drive and require controlled, low-flow oxygen. The Venturi mask delivers a precise, consistent FiO2 (starting at 24–28%), preventing excessive oxygen delivery that could suppress the hypoxic drive and cause respiratory depression.
Question 5: A nurse is caring for a patient with a serum sodium of 122 mEq/L who is confused and complaining of a headache. Which intervention should the nurse implement first?
- Administer 0.9% normal saline IV bolus at 500 mL over 1 hour
- Place the patient on seizure precautions and notify the provider (Correct answer)
- Encourage oral fluid intake to dilute the sodium concentration
- Restrict IV fluid administration to prevent further dilution
Correct answer: Place the patient on seizure precautions and notify the provider
A serum sodium of 122 mEq/L with neurological symptoms (confusion, headache) indicates severe symptomatic hyponatremia with risk of seizures and cerebral edema. The priority is patient safety — implementing seizure precautions and notifying the provider for further orders.
Question 6: A patient with a pulmonary embolism is receiving thrombolytic therapy with alteplase. During the infusion, the nurse observes new-onset neurological changes and facial drooping. What is the nurse's priority action?
- Slow the infusion rate and continue monitoring neurological status
- Stop the alteplase infusion immediately and notify the provider (Correct answer)
- Administer protamine sulfate to reverse the thrombolytic
- Obtain a stat ECG and increase oxygen delivery
Correct answer: Stop the alteplase infusion immediately and notify the provider
New neurological changes during thrombolytic therapy are a critical warning sign of intracranial hemorrhage, the most serious complication. The infusion must be stopped immediately and the provider notified for emergent neuroimaging and management.
CMSRN - Medical-Surgical Nursing CMSRN-FREE Cmsrn Medical Surgical Nursing 1
A nurse is caring for a post-operative patient who underwent a bowel resection 24 hours ago.
The patient's abdomen is distended and he reports no bowel sounds.
Which intervention should the nurse prioritize?