Free CMSRN Medical-Surgical Nursing Guide Questions and Answers — Questions and Answers
Question 1: Stephen Douglas was involved in a car accident. The best IV treatment for a patient hypovolemic shock sufferer would be:
- Colloids
- Hypertonic
- Isotonic (Correct answer)
- Hypotonic
Correct answer: Isotonic
For a patient experiencing hypovolemic shock, the primary goal of IV fluid resuscitation is to rapidly restore circulating blood volume. Isotonic solutions, such as normal saline (0.9% NaCl) or Lactated Ringer's, are the best choice because they expand the extracellular fluid volume without causing fluid shifts into or out of cells, effectively increasing intravascular volume.
Question 2: Stage II Hodgkins disease was identified in 18-year-old Ramona Gunther, who is getting ready to receive She informs the nurse that she is afraid ""of having to get radiation"" from external radiation therapy. treatments all over my body. What is the best course of action to do in response?
- You know you don't have to worry about being radioactive.
- The dose will be very low based on the disease staging.'
- With Stage II, you'll only have radiation over half your body. (Correct answer)
- I know it's scary, but it will help to decrease the potential of fractures.
Correct answer: With Stage II, you'll only have radiation over half your body.
Stage II Hodgkin's disease indicates that the cancer is localized to two or more lymph node regions on the same side of the diaphragm. Therefore, external radiation therapy for Stage II Hodgkin's is typically administered to specific, affected areas, not the entire body. This response helps alleviate the patient's fear by clarifying that the radiation will be targeted and not a full-body treatment.
Question 3: In her health sciences class, 20-year-old Allison Lynn requests you to elaborate on the cause of Type I Diabetes's insulin shortage. You mention that this is the most widely accepted theory:
- inflammation of the pancreas causes irregular release of insulin.
- the body's immune system destroyed the cells that make insulin. (Correct answer)
- not enough insulin is made to manage the metabolic needs.
- the insulin produced is not effective at the tissue level.
Correct answer: the body's immune system destroyed the cells that make insulin.
Type 1 Diabetes Mellitus is an autoimmune disease where the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This destruction leads to an absolute deficiency of insulin, which is essential for glucose uptake by cells. This autoimmune destruction is the most widely accepted theory for the cause of insulin shortage in Type 1 Diabetes.
Question 4: The most widely recognized explanation for Type I diabetes's underlying cause is an autoimmune mechanism. Lack of insulin results from the body's production of an antibody that targets and kills beta cells.
- perform a lower extremity neurovascular check. (Correct answer)
- elevate the extremity
- assess vital signs.
- remind the client of the PCA pump and re-instruct the client on its use.
Correct answer: perform a lower extremity neurovascular check.
Severe pain in an extremity after surgery, especially a total knee replacement, could indicate a serious complication such as compartment syndrome, deep vein thrombosis, or neurovascular compromise. The nurse's first action should be to perform a comprehensive neurovascular check of the affected extremity to assess circulation, sensation, and movement. This assessment is crucial for identifying potential limb-threatening conditions that require immediate intervention.
Question 5: This morning, a 44-year-old male client underwent stomach surgery. A tiny quantity of red discharge was seen by the nurse on the patient's surgical dressing. This style of guttering is:
- sanguineous (Correct answer)
- serosanguineous
- purulent
- catarrhal
Correct answer: sanguineous
Sanguineous drainage refers to fresh blood, which is typically bright red and thick in consistency. A small quantity of red discharge on a surgical dressing immediately post-op is characteristic of sanguineous drainage, indicating active bleeding from the wound. This type of drainage is expected in the immediate postoperative phase, though excessive amounts would be concerning.
Question 6: Two days ago, a hemicolectomy was performed on a customer. A tiny portion of the abdominal viscera was visible peeking through the wound when the nurse examined it today. This wound healing problem is referred to as:
- evisceration (Correct answer)
- excoriation
- dehiscence
- decortication
Correct answer: evisceration
Evisceration is a severe wound complication where the surgical incision separates, and internal organs (viscera) protrude through the opening. This is a medical emergency requiring immediate intervention to protect the exposed organs and prevent infection. Dehiscence, in contrast, is the separation of wound edges without organ protrusion.
Question 7: A client's surgical incision is noted by the nurse as having red, granulated tissue. This suggests that the injury is:
- healing (Correct answer)
- infected
- not healing
- necrotic
Correct answer: healing
Red, granulated tissue in a surgical incision is a positive sign of wound healing, specifically indicating the proliferation phase. Granulation tissue is new connective tissue and tiny blood vessels that form on the surface of a wound during the healing process. Its presence suggests healthy tissue regeneration and good blood supply, signifying that the wound is healing appropriately.
Question 8: A man who underwent a six-hour left femoral popliteal bypass graft has returned to the Unit. Later, the client's foot appears chilly and dark, and the nurse should have seen that his dorsalis pedis pulse was absent.
- assure the client that his foot is fine
- continue to monitor the foot.
- immediately notify the physician (Correct answer)
- notify the head nurse
Correct answer: immediately notify the physician
Following a femoral popliteal bypass graft, a cold, dark foot and an absent dorsalis pedis pulse are critical signs of acute arterial occlusion or graft failure. These findings indicate a severe lack of blood flow to the limb, which is a surgical emergency. Immediate notification of the physician is paramount to prevent limb ischemia, potential amputation, or other serious complications.
Question 9: A patient returns after a coronary artery bypass graft to the Cardiovascular Intensive Care Unit."Â (CABG). The most crucial electrolyte to keep an eye on when organizing the client's care is:
- potassium (Correct answer)
- chloride
- bicarbonate
- sodium
Correct answer: potassium
After a Coronary Artery Bypass Graft (CABG), patients are at high risk for electrolyte imbalances, particularly with potassium. Both hypokalemia and hyperkalemia can lead to life-threatening cardiac arrhythmias, which are a major concern in the immediate postoperative period. Close monitoring and management of potassium levels are therefore crucial to ensure cardiac stability and prevent serious complications.
Question 10: It's a left pneumonectomy for a client. Nursing interventions for a postoperative left pneumonectomy that would be planned for this client would include:
- positioning the client in the semi-Fowler's position with a pillow under the shoulder and back
- monitoring the right lung for an increase in rales (Correct answer)
- monitoring the chest tubes
- positioning the client on the right side
Correct answer: monitoring the right lung for an increase in rales
Following a left pneumonectomy, the remaining right lung must compensate for the removed lung. Monitoring the right lung for an increase in rales (crackles) is crucial because it can indicate fluid overload, pulmonary edema, or atelectasis in the remaining lung. Early detection of these complications allows for prompt intervention to maintain adequate respiratory function and prevent further compromise.
Question 11: Three hours after knee reduction surgery, a 27-year-old patient complains of soreness in his right leg. The nurse's initial course of action should be to:
- elevate the extremity
- assess vital signs
- remind the client of the PCA pump and re-instruct the client on its use
- perform a lower extremity neurovascular check (Correct answer)
Correct answer: perform a lower extremity neurovascular check
After orthopedic surgery like knee reduction, new or worsening pain can signify serious complications such as compartment syndrome or neurovascular compromise. Performing a lower extremity neurovascular check (assessing pulses, capillary refill, sensation, motor function, and pain) is the priority. This immediate assessment helps to quickly identify or rule out limb-threatening conditions, guiding subsequent interventions.
Free CMSRN Medical-Surgical Nursing Guide Questions and Answers
Stephen Douglas was involved in a car accident.
The best IV treatment for a patient hypovolemic shock sufferer would be: