CMSRN - Medical-Surgical Nursing Medical Surgical Nurse 1 — Questions and Answers
Question 1: A patient recovering from a sigmoid colectomy on postoperative day 2 reports nausea and abdominal distension. Bowel sounds are hypoactive and the patient has not passed flatus. What is the priority nursing intervention?
- Administer an antiemetic and advance the diet to clear liquids
- Encourage the patient to ambulate in the hallway (Correct answer)
- Insert a rectal tube to relieve accumulated gas
- Request an order for a stimulant laxative
Correct answer: Encourage the patient to ambulate in the hallway
Early ambulation is the first-line intervention for postoperative ileus because movement stimulates peristalsis and the return of bowel function. Laxatives and diet advancement are premature before bowel sounds return, and a rectal tube is not indicated for a postoperative ileus.
Question 2: A nurse is reviewing laboratory results for a patient suspected of having SIADH. Which finding is most consistent with this diagnosis?
- Serum sodium 152 mEq/L
- Serum osmolality 310 mOsm/kg
- Urine specific gravity 1.030 (Correct answer)
- Blood urea nitrogen 8 mg/dL
Correct answer: Urine specific gravity 1.030
In SIADH, excess ADH causes water retention and urine concentration, resulting in a high urine specific gravity (>1.020–1.030). Serum sodium and osmolality are characteristically LOW due to dilutional hyponatremia, not elevated.
Question 3: A patient develops sudden pleuritic chest pain, dyspnea, and tachycardia 72 hours after a total hip arthroplasty. What is the nurse's priority action?
- Obtain a 12-lead ECG and prepare for cardioversion
- Administer supplemental oxygen and notify the provider immediately (Correct answer)
- Place the patient in a high Fowler's position and administer an analgesic
- Encourage deep breathing and splinted coughing
Correct answer: Administer supplemental oxygen and notify the provider immediately
The presentation is classic for pulmonary embolism, a life-threatening post-orthopedic surgery complication. Administering supplemental oxygen addresses hypoxemia and notifying the provider allows for rapid diagnostic workup and anticoagulation. Oxygen delivery is the immediate physiologic priority.
Question 4: A patient admitted with acute pancreatitis has a serum amylase of 520 U/L, back-radiating pain rated 9/10, Cullen's sign, and a blood pressure of 84/52 mmHg. Which finding requires the most immediate nursing intervention?
- Serum amylase of 520 U/L
- Pain radiating to the back rated 9/10
- Periumbilical ecchymosis (Cullen's sign)
- Blood pressure of 84/52 mmHg (Correct answer)
Correct answer: Blood pressure of 84/52 mmHg
Hypotension (84/52 mmHg) indicates hemodynamic instability and possible hypovolemic or distributive shock, which is immediately life-threatening and requires urgent fluid resuscitation and provider notification. Elevated amylase, pain, and Cullen's sign confirm the diagnosis but do not pose the same immediate threat to perfusion.
Question 5: A patient with a traumatic brain injury has an intracranial pressure (ICP) reading of 24 mmHg. Which nursing intervention should be implemented first?
- Administer acetaminophen for pain management
- Elevate the head of the bed to 30–45 degrees (Correct answer)
- Apply sequential compression devices to the lower extremities
- Encourage the patient to cough and perform deep breathing exercises
Correct answer: Elevate the head of the bed to 30–45 degrees
Elevating the head of the bed to 30–45 degrees promotes cerebral venous drainage and reduces ICP. Normal ICP is below 20 mmHg, so 24 mmHg requires prompt intervention. Coughing increases intrathoracic pressure and worsens ICP elevation; it should be avoided.
Question 6: A patient with a crush injury to the right lower leg reports pain that is unrelieved by IV opioids, along with tingling and numbness in the foot. On assessment, the extremity is pale, tense to palpation, and cool. Which condition does the nurse most suspect?
- Deep vein thrombosis
- Acute arterial occlusion
- Compartment syndrome (Correct answer)
- Rhabdomyolysis
Correct answer: Compartment syndrome
Compartment syndrome is characterized by pain disproportionate to injury and unrelieved by opioids, paresthesia, pallor, tense/woody texture, and coolness — the classic '6 Ps.' It is a surgical emergency requiring fasciotomy to prevent permanent nerve and muscle damage. DVT typically presents with warmth and swelling, not pallor and coolness.
CMSRN - Medical-Surgical Nursing Medical Surgical Nurse 1
A patient recovering from a sigmoid colectomy on postoperative day 2 reports nausea and abdominal distension.
Bowel sounds are hypoactive and the patient has not passed flatus.
What is the priority nursing intervention?