CMSRN Medical-Surgical Nursing MCQ 5 — Questions and Answers
Question 1: A patient with heart failure is ordered furosemide 40 mg IV. Which laboratory value must be checked before administration?
- Serum sodium
- Serum potassium (Correct answer)
- Blood urea nitrogen
- Serum creatinine
Correct answer: Serum potassium
Furosemide is a loop diuretic that causes potassium wasting; baseline potassium must be checked because hypokalemia increases the risk of fatal cardiac dysrhythmias.
Question 2: A patient who underwent thyroidectomy 8 hours ago complains of tingling around the mouth and muscle cramps. Which complication does the nurse suspect?
- Thyroid storm
- Hypocalcemia from parathyroid damage (Correct answer)
- Respiratory obstruction from hematoma
- Recurrent laryngeal nerve injury
Correct answer: Hypocalcemia from parathyroid damage
Perioral tingling and carpopedal spasm (Trousseau's sign) after thyroidectomy indicate hypocalcemia from inadvertent parathyroid gland removal or injury.
Question 3: A patient is receiving total parenteral nutrition (TPN) via a central line. The TPN bag runs out before a replacement bag arrives. Which action should the nurse take?
- Flush the line with normal saline and wait for the new bag
- Infuse 10% dextrose in water at the same rate (Correct answer)
- Stop the infusion and cap the line until the new bag arrives
- Administer 0.9% normal saline at the TPN rate
Correct answer: Infuse 10% dextrose in water at the same rate
Infusing 10% dextrose prevents rebound hypoglycemia that can occur when high-concentration glucose infusion is abruptly stopped, as insulin secretion continues momentarily.
Question 4: Which assessment technique is most effective for detecting early compartment syndrome in a patient with a long-bone fracture?
- Measuring capillary refill time
- Assessing pain with passive stretch of muscles in the compartment (Correct answer)
- Checking skin temperature distal to the fracture
- Monitoring pulse oximetry on the affected limb
Correct answer: Assessing pain with passive stretch of muscles in the compartment
Pain that is out of proportion to the injury and worsened by passive stretch is the earliest and most sensitive indicator of compartment syndrome before vascular compromise occurs.
Question 5: A patient with a stage 3 pressure injury has a wound that appears yellow with slough. Which wound care intervention is most appropriate?
- Apply a dry sterile dressing and change daily
- Use a hydrocolloid dressing to promote autolytic debridement (Correct answer)
- Irrigate with hydrogen peroxide twice daily
- Pack the wound tightly with saline-soaked gauze
Correct answer: Use a hydrocolloid dressing to promote autolytic debridement
Hydrocolloid dressings create a moist wound environment that facilitates autolytic debridement, removing slough and promoting granulation tissue formation.
Question 6: A patient with a myocardial infarction develops a new systolic murmur and sudden cardiogenic shock on day 3. Which complication is most likely?
- Pericarditis
- Papillary muscle rupture causing acute mitral regurgitation (Correct answer)
- Right ventricular infarction
- Ventricular aneurysm
Correct answer: Papillary muscle rupture causing acute mitral regurgitation
Papillary muscle rupture is a mechanical complication of MI that causes acute severe mitral regurgitation, presenting with a new harsh systolic murmur and rapid hemodynamic deterioration.
Question 7: A patient with spinal cord injury at T4 develops sudden severe hypertension (210/120 mmHg), bradycardia, and profuse sweating above the level of injury. What is the priority nursing action?
- Administer IV labetalol as ordered
- Sit the patient upright and identify the triggering stimulus (Correct answer)
- Place the patient in Trendelenburg position
- Administer sublingual nitroglycerin
Correct answer: Sit the patient upright and identify the triggering stimulus
Autonomic dysreflexia requires immediately sitting the patient upright (drops BP) and identifying/removing the noxious stimulus (commonly a full bladder or bowel) to halt the reflex.
CMSRN Medical-Surgical Nursing MCQ 5
A patient with heart failure is ordered furosemide 40 mg IV.
Which laboratory value must be checked before administration?