Certified Medical-Surgical Nurse Quiz

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Questions and Answers

Mrs. Warren has a total proctocolectomy and permanent ileostomy. The nurse should contact the physician immediately if she has which finding?

The stoma appears red and shiny.

The stoma appears pale and dry. (correct)

There is 50 mL of serosanguinous drainage from the stoma.

There is 200 mL of dark green output from the stoma.

What action would be appropriate before reapplying Mrs. Warren's ileostomy bag due to irritated peristomal skin?

Use a solid skin barrier. (correct)

Clean the site with Dakin's solution.

Wash the area with antiseptic soap and water.

Obtain an order for a topical antibiotic.

Which comment made by Mrs. Warren indicates concerns about her body image?

I'm so afraid I may not survive the surgery.

I will have to stop my aerobics classes.

I'm concerned that this may be only the first of many surgeries.

I need to go shopping for some loose, baggy clothes. (correct)

Due to Mr. Palmer receiving heparin, what is essential for the nurse to do?

Check the femoral puncture site at frequent intervals. Signup and view all the answers

After Mr. Palmer's amputation, which question is most important for the nurse to ask when he reports chest pain?

Have you ever had this type of chest pain before? Signup and view all the answers

Which stat order for Mr. Palmer should the nurse question?

Enoxaparin (Lovenox) 40 mg subcutaneously. Signup and view all the answers

What is important for Mrs. Clark to monitor while taking Glucophage?

Monitor her glomerular filtration rate. Signup and view all the answers

Which symptom of hypoglycemia would be masked by Lopressor?

Tachycardia. Signup and view all the answers

Which website is the most reliable for prostate cancer information?

<a href="http://www.cancer.gov">www.cancer.gov</a>. Signup and view all the answers

What should the nurse encourage Mr. Haverford to do to help with incontinence after prostate surgery?

Perform pelvic floor exercises several times daily. Signup and view all the answers

What should the nurse's response be to a wife's concern about her husband possibly having a stroke?

Yes, he does have symptoms of a stroke. That's what the tests will help us find out. Signup and view all the answers

What should the nurse's first action be in the event of a fire in a hospital's dialysis unit?

Remove patients or staff in danger. Signup and view all the answers

When elder abuse is suspected, what action should the nurse take?

Report the findings. Signup and view all the answers

What should the nurse inform a patient refusing TB medication?

You should know that the health department can require you to take the medication. Signup and view all the answers

What instruction should be given when a patient is having a chest tube removed?

Take a deep breath and hold it. Signup and view all the answers

In cost analysis, what method uses the average cost of a problem and the cost of intervention to demonstrate savings?

A cost-benefit analysis. Signup and view all the answers

In Erikson's psychosocial model, which stage is typical for those entering young adulthood?

Intimacy vs isolation. Signup and view all the answers

What stage of grief is a patient with advanced ovarian cancer likely experiencing when blaming themselves?

Anger. Signup and view all the answers

What is the most appropriate nursing diagnosis for a sedentary patient at risk of disuse syndrome?

Risk for disuse syndrome. Signup and view all the answers

Which method measures the effectiveness of an intervention rather than monetary savings?

A cost-effective analysis. Signup and view all the answers

What is the main goal of treatment for acute glomerulonephritis?

Maintain fluid balance. Signup and view all the answers

How do nursing diagnoses primarily differ from medical diagnoses?

Primarily concerned with human response, while medical diagnoses are primarily concerned with pathology. Signup and view all the answers

What should patients taking phenytoin sodium (Dilantin) be instructed to do to prevent adverse effects?

Drink at least 2 L of fluids daily, including 8 to 10 glasses of water. Signup and view all the answers

During which stage of healing does granulation tissue form and epithelialization occur?

The Proliferative Phase Signup and view all the answers

Which of the following are external factors that subject the skin to injury?

Allergens and Radiation Signup and view all the answers

Where is a venous ulcer typically found on a patient?

The Medial Lower Leg and Ankle Signup and view all the answers

Which substance enables the transport of oxygen during wound healing?

Folate Signup and view all the answers

The first line of intervention for preventing the spread of infection is:

Hand Hygiene Signup and view all the answers

Of the following actions, which is the first for the nurse to take when a patient requests more pain medication?

Notify the Practitioner That the Patient Is Still Experiencing Pain Signup and view all the answers

A patient with disorientation and weakness is taking hydrochlorothiazide. What electrolyte imbalance does the patient most likely suffer from?

Hypokalemia Signup and view all the answers

Early signs and symptoms of dehydration include:

Thirst and Confusion Signup and view all the answers

Which sign or symptom would be most indicative of infection in a postoperative patient?

Redness, Warmth, and Tenderness at the Incision Site Signup and view all the answers

When planning postoperative care for a patient after a lacerated spleen repair, what intervention should take priority?

Monitoring the Patient for Signs and Symptoms of Alcohol Withdrawal Signup and view all the answers

Which diet would be most appropriate for a patient with ulcerative colitis?

A Low-Residue Diet Signup and view all the answers

What should be practiced to maintain good dental health?

Good dental hygiene Signup and view all the answers

What is the most common, preventable complication of abdominal surgery?

Atelectasis Signup and view all the answers

Which of the following could be an early sign of malnutrition for a patient postoperative after a lobectomy?

A Retinal-Binding Protein Level of 2.0 mg/dL Signup and view all the answers

What is the best approach to discharge planning for a patient whose spouse has chronic obstructive pulmonary disease?

Discuss community resources with the spouse and offer to make referrals Signup and view all the answers

Which of the following is an example of restrictive weight-loss surgery?

Adjustable Gastric Banding Signup and view all the answers

In what type of electrolyte imbalance would the nurse observe tall, tented T waves and a widened QRS complex on the patient's ECG?

Hyperkalemia Signup and view all the answers

During an assessment of a patient who sustained a head injury, what is the nurse's initial action upon noting slurred speech and disorientation?

Inform the neurosurgeon of the patient's status Signup and view all the answers

The nurse hears an extra heart sound immediately after the second heart sound (S2) in a patient with mitral insufficiency. What should the nurse document this sound as?

A Third Heart Sound (S3) Signup and view all the answers

For the evaluation feedback process to be effective, what should a manager do?

Inform staff members regularly of how well they are performing their jobs Signup and view all the answers

What are the changes in mental status associated with isolation in an infected patient?

Sensory deprivation Signup and view all the answers

What should the nurse do if a 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a worksite health screening?

Recommend He Have His Blood Pressure Rechecked Within 2 Weeks Signup and view all the answers

Which laboratory value indicates warfarin is at therapeutic levels for a patient with deep vein thrombophlebitis?

PT 1½ to 2 Times the Control Signup and view all the answers

What should a medical-surgical nurse do to prepare a patient for a bronchoscopic procedure?

Measure the patient's blood pressure and pulse readings Signup and view all the answers

The nurse should notify the practitioner that captopril therapy is ineffective if an assessment reveals:

Peripheral Edema Signup and view all the answers

Which physiological response is often associated with surgery-related stress?

Sodium and water retention Signup and view all the answers

What reflects the family's assumption about a patient's end-of-life care preferences?

Paternalism Signup and view all the answers

What indicates a patient's understanding of insulin glargine (Lantus)?

"There is no peak time for Lantus" Signup and view all the answers

Which action occurs primarily during the evaluation phase of the nursing process?

Reassessment and audit Signup and view all the answers

What describes a sentinel event alert?

Signaling the need for immediate investigation and response Signup and view all the answers

What is primarily a developmental task of middle age?

Rediscovering or developing satisfaction in one's relationship with a significant other Signup and view all the answers

What is the best approach to diffuse an emotionally charged discussion with a cancer patient?

Direct the discussion and validate emotion, without false reassurance Signup and view all the answers

What type of analysis is conducted by auditing nursing records for compliance with digoxin administration policy?

Process analysis Signup and view all the answers

What is the patient outcome criterion for a nursing diagnosis of activity intolerance after a myocardial infarction?

Ambulating 50 feet without experiencing dyspnea Signup and view all the answers

Which theorist supports the concept that caring is key in nursing practice?

Watson Signup and view all the answers

What reflects an accurate understanding of herbal supplements by a patient?

"There is no standardization among the manufacturers of herbs in this country" Signup and view all the answers

What diet should be recommended for a patient with Crohn's disease?

Low in fiber, and high in protein and calories Signup and view all the answers

What is expected when examining a patient paralyzed below the T4 level?

Independent use of upper extremities and efficient cough Signup and view all the answers

What is the next step after completing a neurological and physical assessment for a patient suspected of having a stroke?

Obtaining a computed tomography scan of the head without contrast Signup and view all the answers

What is the first step in applying the quality improvement process in a clinical setting?

Select an activity for improvement Signup and view all the answers

What task does the nurse assign to an unlicensed assistant?

Collect clinical data Signup and view all the answers

What nursing diagnosis is indicated by impaired coordination, decreased muscle strength, limited range of motion, and reluctance to move?

Impaired physical mobility Signup and view all the answers

In prioritizing a patient's care plan based on Maslow's hierarchy of needs, what is the nurse's first priority?

Administering pain medication Signup and view all the answers

What type of consultation does a nurse seek when asking another nurse for advice on managing a patient problem?

Patient-centered case consultation Signup and view all the answers

What is the most important factor to ensure the success of an evidence-based nursing program to decrease pressure ulcers?

Obtaining support from management, administration, and physicians Signup and view all the answers

What is the first step a nurse should take when planning the implementation of evidence-based practices to prevent falls?

Gather and review currently existing literature and guidelines for the prevention of falls Signup and view all the answers

What is the most effective measure to reduce the risk of health care-associated infections?

Performing hand hygiene Signup and view all the answers

What should a nurse do when receiving a telephone order from a physician?

Write down the order and then read back the complete order to the physician Signup and view all the answers

What is referred to as a secondary latency phase that occurs in some diseases, commonly followed by another acute phase?

Remission Signup and view all the answers

What term in qualitative research describes the act of a researcher laying aside what is known about the experience being studied?

Bracketing Signup and view all the answers

Why is the nurse at fault for the patient's fall after leaving them alone?

Arranged for continual care of the patient Signup and view all the answers

Under the law, when must a nurse obtain informed consent before treatment?

Only if the patient is conscious and competent Signup and view all the answers

Which of the following acts committed by a nurse is an intentional tort?

Battery Signup and view all the answers

OSHA is responsible for:

Inspecting high-hazard workplaces for compliance with protective standards Signup and view all the answers

Who is most likely to be held liable if a patient suffered after receiving the wrong medication from a nurse?

The nurse and the hospital Signup and view all the answers

Which of the following is incorrect about informed consent?

The name of the procedure, its risks and benefits, and other alternative procedures make up all the essential elements of informed consent Signup and view all the answers

Which of the following is considered identifiable health information?

A photograph of a patient's leg showing a unique tattoo Signup and view all the answers

In a negligence suit against a nurse, what must the plaintiff prove?

The nurse's actions caused harm Signup and view all the answers

A nurse failed to administer a medication to a patient according to accepted standards. What is this called?

Breach of duty Signup and view all the answers

The belief that one's own cultural values and beliefs are superior is:

Ethnocentrism Signup and view all the answers

Which initial statement or question is most effective in assessing pain in a patient with appendicitis?

Tell me how you feel. Signup and view all the answers

When performing an abdominal assessment, the nurse should follow which examination sequence?

Inspection, auscultation, percussion, palpation Signup and view all the answers

An example of clarification in therapeutic communication is?

What do you mean when you say...? Signup and view all the answers

In the stages of death and dying defined by Elisabeth Kübler-Ross, loss, grief, and intense sadness are symptoms of:

Depression Signup and view all the answers

In the levels of basic human needs defined by Abraham Maslow, which is the most basic?

Physiologic Signup and view all the answers

According to the stages of development, what conflict does the older adult experience?

Integrity versus despair Signup and view all the answers

What type of therapeutic communication is the nurse using when allowing a patient time to gather thoughts?

Silence Signup and view all the answers

Which response by the nurse best demonstrates clarification when a patient complains about a treatment group?

Can you tell me what about the treatment group made you angry? Signup and view all the answers

Which of Piaget's cognitive developmental stages occurs from ages 7 to 11?

Concrete operations Signup and view all the answers

Which interaction style describes a nurse who cannot clearly separate her own emotional responses from the patient's needs?

Sympathetic Signup and view all the answers

A patient with an arterial ulcer is in pain. What is the most common cause of this pain?

Ischemia Signup and view all the answers

Which assessment finding is common in a patient with venous ulceration?

Heavy exudate Signup and view all the answers

What guideline is appropriate when caring for a patient with a wet-to-dry dressing?

The dressing should be allowed to dry before it's removed Signup and view all the answers

Which laboratory value indicates a patient with an abdominal wound healing by secondary intention is receiving adequate nutrition?

Total lymphocyte count of 1,900 mL Signup and view all the answers

What term describes the softening of tissue by wetting or soaking?

Maceration Signup and view all the answers

What stage pressure ulcer is characterized by visible subcutaneous fat but no exposure of bone, tendon, or muscle?

Stage III Signup and view all the answers

Study Notes

Nursing Care and Patient Management

Ileostomy Observations: Pale and dry stoma indicates ischemia; normal should be red and moist.
Skin Irritation: Use a solid skin barrier for irritated peristomal skin to protect against drainage irritation.
Body Image Concerns: Reference to shopping for loose clothing indicates worry about body image post-surgery.

Patient History and Health Monitoring

Myocardial Infarction Patient: Continuous observation of the femoral puncture site is critical due to heparin use which increases bleeding risk.
Postoperative Symptoms: Chest pain after surgery in a patient with a history of myocardial infarctions requires immediate evaluation of previous pain experiences.

Medication Management

Anticoagulation Orders: Question the use of enoxaparin if heparin drip is already in place to avoid duplicate anticoagulation therapy.
Diabetic Patient Discharge: Monitor glomerular filtration rate before starting metformin due to renal function implications.

Emergency and Crisis Action

Responding to Chest Pain: Ask if the patient has experienced similar pain before, given the history of myocardial issues.
Fire Response Protocol: Prioritize removing patients and staff in danger from the area before activating fire systems or extinguishing fire.

Clinical Assessments and Nursing Diagnoses

Signs of Elder Abuse: Report findings of multiple bruises and pressure ulcers in an elderly patient suspected of neglect.
Patient Noncompliance: For tuberculosis treatment, emphasize public health obligations if a patient refuses medication.

Patient Safety and Postoperative Care

Chest Tube Removal Protocol: Instruct the patient to take a deep breath and hold it during chest tube removal to prevent air entry into the pleural space.
Management of Pain: Immediate intervention for postoperative incisional pain includes appropriate pain medication administration.

Medical and Nursing Diagnosis Differentiation

Nursing Diagnosis Focus: Nursing diagnoses emphasize human responses to health issues compared to medical diagnoses that focus on pathology.

Health Maintenance and Community Resources

Community Resources for Home Care: Discuss available community resources for the spouse of a patient post-heart disease treatment, offering necessary referrals.

Neurologic Assessments Post-Injury

Head Injury Assessment: Immediate reporting to the neurosurgeon is required upon observation of slurred speech and disorientation after head injury.

Staff Management and Evaluation

Performance Feedback: Regular communication of job performance is essential for effective staff evaluation feedback processes.### Patient Care and Assessment
Isolation precautions are essential for patients with methicillin-resistant Staphylococcus aureus (MRSA), especially in elderly patients facing cognitive changes.
Hallucinations in an isolated patient may indicate sensory deprivation as a cause of altered mental status.
For patients undergoing bronchoscopic procedures, monitoring vital signs post-sedation is crucial for patient safety.

Nursing and Physiological Responses

Surgery-related stress often triggers sodium and water retention, which can complicate recovery and patient care.
Paternalism in healthcare can occur when family members believe they know the best treatment plan for the patient without confirming their wishes.

Diabetes Management

Insulin glargine (Lantus) has a unique pharmacokinetic profile; it does not have a peak effect, distinguishing it from other insulins.

Nursing Process

The evaluation phase of the nursing process involves reassessment and audit of patient outcomes to ensure that care is on track.
Sentinel events require immediate investigation to prevent future occurrences and maintain patient safety.

Developmental Tasks and Emotional Care

Middle age is often characterized by a rediscovery of satisfaction in relationships, highlighting emotional and social development during this period.
When dealing with emotions and anger in patients with new cancer diagnoses, validating emotions without false reassurance can help diffuse tension.

Quality Improvement

Quality assessment in nursing practices often involves process analysis to ensure compliance with protocols (e.g., monitoring pulse before administering digoxin).
Effective implementation of nursing programs relies on obtaining support from management and adherence to evidenced-based practices, such as fall prevention strategies.

Patient Interaction and Legal Considerations

Informed consent is not required in emergency situations, allowing healthcare providers to act swiftly in life-threatening circumstances.
Nurses are liable for their actions, demonstrating the need for quality training and adherence to protocols to reduce medical errors.

Ethical and Regulatory Standards

The importance of hand hygiene is underscored as the most effective measure to prevent healthcare-associated infections.
Nurses must be familiar with the legal aspects of their practice, including the implications of informed consent requirements and intentional torts such as battery.

Research Methodologies

Qualitative research uses bracketing to keep researchers open to new insights while studying experiences, crucial for developing a nuanced understanding of patient care.

Patient Safety and Abandonment

Ensuring continual care is vital to prevent patient abandonment; leaving a confused patient without supervision can lead to serious consequences.

Health Information and Compliance

OSHA focuses on workplace safety and compliance, vital for maintaining safe environments in healthcare settings and protecting employee health.

These notes compile essential insights into patient care, legal responsibilities, and quality improvement frameworks relevant to nursing practice and patient safety.### Health Information Privacy

Identifiable health information includes any data that can link back to an individual or their health state, such as a laboratory report with personal details removed.
Unique identifiers like photographs or tattoos can also classify as identifiable health information.

Negligence Lawsuit Criteria

In a negligence case, the plaintiff must demonstrate that the nurse's actions caused harm to the patient.

Breach of Duty

Failure to follow accepted nursing standards and provide adequate care is termed breach of duty.
Courts assess care by comparing actions to those of a reasonable and prudent nurse in similar situations.

Cultural Concepts

Ethnocentrism is the belief in the superiority of one's own cultural values over others.
Cultural competency refers to the ability to effectively engage with diverse populations.

Pain Assessment Techniques

An effective initial question for assessing pain is open-ended, such as asking patients to express their feelings.

Abdominal Assessment Technique

The proper order for abdominal assessment is: inspection, auscultation, percussion, and palpation to avoid altering bowel sounds.

Therapeutic Communication

Clarification involves asking questions like, "What do you mean when you say...?" to gain deeper understanding.
Silence can be a powerful tool for allowing patients time to articulate feelings.

Stages of Grief

Loss and intense sadness are key indicators of the depression stage as per Kübler-Ross’s model.

Maslow's Hierarchy of Needs

Physiologic needs are the most fundamental, essential for life, followed by safety, love, and esteem in increasing order.

Stages of Development

Older adults face the conflict of integrity versus despair according to developmental stages.

Pressure Ulcer Staging

A Stage III pressure ulcer features full-thickness tissue loss with visible subcutaneous fat, where slough may be present.

Healing Phases

Granulation tissue formation and epithelialization occur during the proliferative phase of wound healing.

Nutritional Considerations

Adequate nutrition during wound healing is indicated by a total lymphocyte count greater than 1,800 mL.

Infection Control

Hand hygiene is the first line of defense against infection spread.

Pain Management Protocol

If a patient requests more pain medication, the nurse's initial action should be to notify the practitioner to review the pain management plan.

Electrolyte Imbalance Indicators

Hypokalemia can present with disorientation, weakness, and irregular pulse, especially in patients on potassium-wasting diuretics.

Dehydration Symptoms

Early signs of dehydration include thirst and confusion.

Postoperative Infection Indicators

Redness, warmth, and tenderness at the incision site are strong indicators of possible infection in a postoperative patient.

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Test your knowledge with these sample questions designed for aspiring Certified Medical-Surgical Registered Nurses. The flashcards cover critical definitions and clinical scenarios related to post-operative care and complications. Perfect for exam preparation and understanding key concepts in medical-surgical nursing.