Free CMSRN Medical-Surgical Nursing Questions and Answers — Questions and Answers
Question 1: When Dervid realized that the elderly woman's leg was
- Shortened, Abducted and Externally Rotated
- Lengthened, Abducted and Internally Rotated
- Shortened, Adducted and Externally Rotated (Correct answer)
- Shortened, Adducted and Internally Rotated.
Correct answer: Shortened, Adducted and Externally Rotated
The classic presentation of a hip fracture, especially an extracapsular fracture, involves the affected leg appearing shortened, adducted (pulled inward), and externally rotated. This characteristic positioning is due to muscle spasms pulling the fractured bone fragments into this specific alignment. Recognizing these signs is essential for prompt diagnosis and management of a hip injury.
Question 2: The elderly woman laments her suffering. John saw that the knee was swelled, reddish, and warm to the touch. According to John, these symptoms and indicators are probably connected to:
- Thrombophlebitis
- Infection
- Degenerative disease
- Infammation (Correct answer)
Correct answer: Infammation
The symptoms described—swelling, redness, and warmth to the touch—are the cardinal signs of inflammation (tumor, rubor, calor). These physical findings indicate a localized protective response to injury or infection, characterized by increased blood flow and fluid accumulation in the affected area. While infection can cause inflammation, inflammation itself is the direct physiological process manifesting these specific signs.
Question 3: The nurse cares for a patient diagnosed sickle cell anemia.  The patient queries the nurse about signs that might indicate a crisis. Which among the following does not indicate a sickle cell crisis?
- Blurred vision (Correct answer)
- Fever
- Pain
- Shortness of breath
Correct answer: Blurred vision
Common signs and symptoms of an acute sickle cell crisis include severe pain (due to vaso-occlusion), fever (indicating infection or inflammatory response), and shortness of breath (often from acute chest syndrome or severe anemia). While sickle cell disease can eventually lead to ocular complications, blurred vision is not typically an immediate or primary indicator of an acute sickle cell crisis. The other options represent urgent manifestations requiring prompt attention.
Question 4: The principal goal of treatment for acute glomerulonephritis is to maintain fluid balance.
- Liver
- Joints (Correct answer)
- Skin
- Kidney
Correct answer: Joints
Acute glomerulonephritis (AGN), particularly post-streptococcal glomerulonephritis (PSGN), is an immune-mediated kidney disease often following a streptococcal infection. While AGN primarily affects the kidneys, streptococcal infections can also lead to other systemic complications like rheumatic fever, which is characterized by inflammation and pain in the joints. Therefore, joint involvement can be an associated finding in the broader context of streptococcal-related diseases that can also cause AGN.
Question 5: What signs and symptoms accompany tuberculosis?
- Decreased or poor muscle tone. Short neck, with excess skin at the back of the neck. Flattened facial profile and nose. Small head, ears, and mouth.
- Short attention span. Poor judgment. Impulsive behaviour. Slow learning Delayed language and speech development.
- Chest pain, or pain with breathing or coughing. Unintentional weight loss. Fatigue. Fever. Night sweats. Chills. (Correct answer)
- Nausea. Headaches. Cranky and agitated. Gains weight too quickly. Nausea. Headaches. Cranky and agitated. Gains weight too quickly.
Correct answer: Chest pain, or pain with breathing or coughing. Unintentional weight loss. Fatigue. Fever. Night sweats. Chills.
The symptoms listed—chest pain with breathing/coughing, unintentional weight loss, fatigue, fever, night sweats, and chills—are classic indicators of active pulmonary tuberculosis. These signs reflect the chronic inflammatory and destructive processes occurring in the lungs and the body's systemic response to the mycobacterial infection. The other options describe symptoms of unrelated conditions.
Question 6: When treating acute glomerulonephritis, the primary objective is to:
- teach intermittent urinary catheterization.
- encourage activity.
- encourage high protein intake.
- maintain fluid balance. (Correct answer)
Correct answer: maintain fluid balance.
Acute glomerulonephritis often impairs kidney function, leading to fluid retention, edema, and hypertension. Therefore, the primary objective in managing AGN is to maintain fluid and electrolyte balance, often through dietary restrictions (sodium, fluid) and diuretics. This helps prevent severe complications such as pulmonary edema and uncontrolled hypertension, which can be life-threatening.
Question 7: A medical-surgical nurse treating a patient with Crohn's disease suggests a diet that is:
- low in potassium
- high in potassium
- high in fiber, and low in protein and calories
- low in fiber, and high in protein and calories (Correct answer)
Correct answer: low in fiber, and high in protein and calories
For patients with Crohn's disease, especially during active flares, a low-fiber (low-residue) diet is often recommended to reduce bowel irritation and inflammation. Simultaneously, a diet high in protein and calories is crucial to combat malnutrition, weight loss, and muscle wasting, which are common issues due to malabsorption and increased metabolic demands from chronic inflammation.
Question 8: A medical-surgical nurse who examines a patient who is paralyzed below the T4 level anticipates finding:
- impaired diaphragmatic function requiring ventilator support.
- independent use of upper extremities and efficient cough. (Correct answer)
- flaccidity of the upper extremities.
- hyperreflexia and spasticity of the upper extremities.
Correct answer: independent use of upper extremities and efficient cough.
A spinal cord injury at the T4 level means that the diaphragm (innervated by C3-C5) and most intercostal muscles remain functional, allowing for independent breathing and an efficient cough. Patients with T4 injuries typically retain full use of their upper extremities because the nerves controlling arm and hand function originate from the cervical spinal cord, which is above the injury level.
Question 9: When implementing the quality improvement process for a clinical activity, the initial step is to:
- select an activity for improvement. (Correct answer)
- set a measurable standard for the activity.
- collect data to measure the status of the activity.
- assemble a team to review and revise the activity.
Correct answer: select an activity for improvement.
The initial step in any quality improvement process is to identify and select a specific area, process, or activity that requires improvement. Without clearly defining what needs to be improved, it is impossible to establish measurable standards, collect relevant data, or assemble an appropriate team. This foundational step sets the direction for the entire improvement cycle.
Question 10: Activity intolerance is the nursing diagnostic given to a patient who has had a myocardial infarction. The following patient outcome criteria are part of the plan of care:
- experiencing no dyspnea on exertion
- agreeing to discontinue smoking.
- tolerating activity well.
- ambulating 50 feet without experiencing dyspnea. (Correct answer)
Correct answer: ambulating 50 feet without experiencing dyspnea.
Outcome criteria for activity intolerance should be specific, measurable, achievable, relevant, and time-bound (SMART). 'Ambulating 50 feet without experiencing dyspnea' is a concrete, measurable goal that directly addresses the nursing diagnosis of activity intolerance in a patient recovering from a myocardial infarction. This provides a clear benchmark for evaluating the patient's progress and the effectiveness of interventions.
Question 11: What action sums up a sentinel event alert the best?
- Signaling the need for immediate investigation and response. (Correct answer)
- Documenting the breakdown in communication during a shift report.
- Indicating that a community or institution is unsafe.
- Recording the harm done when a medication error occurs.
Correct answer: Signaling the need for immediate investigation and response.
A sentinel event alert signifies an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Its primary purpose is to signal the immediate need for a thorough investigation (root cause analysis) and a rapid, comprehensive response to prevent recurrence. It is a critical call to action within healthcare organizations to address serious safety issues.
Free CMSRN Medical-Surgical Nursing Questions and Answers
When Dervid realized that the elderly woman's leg was