1st SEMESTER FINAL EXAM REVIEWER

in MEDICAL-SURGICAL NURSING

MS Final Exam Coverage: Type of Exam:

• Tuberculosis • Situational
• Leukemia • Multiple Choice
• SLE (Systemic Lupus Erythematosus) • Matching Type
• BPH (Benign Prostatic Hyperplasia)
• GBS (Guillain-Barré Syndrome)
• Diabetes Mellitus (DM)

PULMONARY TUBERCULOSIS (PTB)

• is an infectious disease that primarily affects the lung parenchyma.
• it is bacterial infection caused by mycobacterium tuberculosis.

Stages:

Assessment & Diagnostic Findings:

Nursing Diagnosis:
• Ineffective Airway Clearance related to secretions that may be thick, bloody, or viscous as
evidenced by dyspnea
• Infection related to suppressed immune system secondary to PTB as evidenced by fever
• Imbalanced Nutrition: Less than body requirements related to disease process secondary to
PTB as evidenced by loss of appetite and unintentional weight loss

LEUKEMIA
• is an increased level of White Blood Cells in the circulation and is caused by genetic changes
in blood cells produced in bone marrow cells. Leukemia is an umbrella term for cancers of the
blood and the blood-forming tissues of the body.

Signs & Symptoms:

• Fatigue, tiring easily
• Fever or night sweats
• Frequent infections
• Pale skin
• Unexplained weight loss
• Bone/joint pain or tenderness
• Pain or full feeling under your ribs on the left side
• Swollen lymph nodes in your neck, underarm, groin or stomach
• Bruising and bleeding easily, including nosebleeds, bleeding gums, a rash that looks like tiny
red spots in skin (petechiae) or purplish/darkened skin patches

Certain factors may increase your risk, including:

• Previous Cancer Treatment
• Smoking
• Exposure to Industrial Chemicals
• Certain Genetic Disorders
• Family History of Leukemia

Common treatments used to fight leukemia include:

• Chemotherapy
• Targeted Therapy
• Radiation Therapy
• Bone Marrow Transplant
• Immunotherapy

Common Medicine to fight leukemia include:

• INQOVI
• AZACITIDINE
• ARZERRA
• BOSULIF

Nursing Diagnosis:
• Acute pain related to bone hyperplasia secondary to leukemia
• Risk for infection related to immaturation of WBC
• Fatigue related to chemotherapy as evidenced by exhaustion with minimal activity/
increased need for resting or naps

SLE (Systemic Lupus Erythematosus)

• is an inflammatory, autoimmune disorder that affects nearly every organ in the body.

Sign & Symptoms:

• Fever
• Fatigue
• Skin rashes
• Joint pain
• Swelling

Laboratory Findings:
TEST RESULT SIGNIFICANT

Complete blood count Anemia A protein in red blood cells, result may
indicate you have anemia, which
commonly occurs in lupus.
ANA test (antinuclear antibodies) (+) To help diagnose autoimmune disorders

Lupus anti-coagulant (+) To measure level of antibody

Common Signs & Symptoms:

• Fever • Hair loss
• Fatigue • Swelling
• Skin rashes • Blood clots
• Joint pain • Shortness of breath (dyspnea)

Nursing Diagnosis:
• Impaired physical mobility related to joint pain and swelling secondary to SLE
• Impaired skin integrity related to skin manifestations such as rashes or lesions
BPH (Benign Prostatic Hyperplasia)
• a noncancerous enlargement of the prostate.

Signs & Symptoms:

• Urinary urging • Incomplete voiding sensation
• Urinary Incontinence • Decreased urine volume and flow
• Urinary frequency

Nursing Diagnosis:
• Acute pain related to bladder distention secondary to BPH as evidenced by facial grimace
when urinating
• Urinary retention related to enlargement of prostate secondary to BPH as
evidenced by inability to empty bladder completely
• Impaired urinary elimination related to increase urethral occlusion secondary to BPH as
evidenced by difficulty urinating

GBS (Guillain-Barré Syndrome) autoimmune disorder

• is an acute, rapidly progressive demyelination of peripheral nervous system (peripheral nerves
and some cranial nerves), producing ascending weakness or paralysis.

Diagnostic Procedure:
• Cerebrospinal Fluid (CSF) Analysis
• Electromyography (EMG)
• Serological Tests
• Autoimmune Antibody Testing

Nursing Diagnosis:
• Impaired physical mobility related to muscle weakness
• Risk for ineffective breathing pattern related to respiratory muscle weakness secondary to
GBS
• Risk for impaired skin integrity related to decreased physical mobility secondary to GBS

Diabetes Mellitus (DM)

• is a chronic disorder of absolute or relative insulin deficiency or resistance.
• characterized by disturbances in carbohydrate, protein, and fat metabolism.
• Two (2) Primary Forms:
Type 1: characterized by absolute insulin insufficiency
Type 2: characterized by insulin resistance with varying degrees of insulin secretory
defects

Nursing Diagnosis:
• Imbalanced Nutrition: Less than Body Requirements r/t insulin deficiency as evidenced by
(unexplained) weight loss, increased urinary output, high blood glucose levels, fatigue, and
weakness
• Impaired Skin Integrity r/t decreased sensation and circulation caused by peripheral
neuropathy secondary to diabetes mellitus as evidenced by impaired/poor wound healing and
paresthesia.

Q1. Which of the following nursing diagnoses is especially important in nursing the client with
leukemia?
1. Potential for injury
2. alteration in renal perfusion
3. altered body image
4. alteration in comfort

Q2. A client with pernicious anemia is treated by:

1. increased iron intake
2. corticosteroids
3. vitamin B12 injections (IM)
4. transfusions of whole blood

Q3. Which of the following is a classic symptom of Hodgkin's disease?

1. elevated blood pressure
2. painless swelling of the lymph nodes
3. low white blood cell count
4. increase lymphocytes

Q4. The best evidence that the client with hypertension understands his dietary restrictions is if
the client says he must avoid:
1. soy sauce
2. honey syrup
3. lemon juice
4. garlic powder

Q5. If a client reports all of the following, which one is most indicative that the client is
hypertensive?
1. client says that he has had unexplained nosebleeds
2. client says he has difficulty sleeping all night
3. client says he has observed blood in his urine
4. client says he experiences abdominal fullness

Q6. When collecting data from a client with varicose veins who is to have veins tripping and
ligation, the nurse should expect the client to report:
1. a feeling of heaviness in both legs
2. calf pain on dorsiflexion of the foot
3. severe of the legs4. hematomas on lower extremities

Q7. A client with peripheral arterial insufficiency tells the nurse that sometimes walking causes
severe pain in the calf muscles. When preparing a teaching plan, the nurse should
recognize that this pain is called:
1. rest pain
2. Raynaud's phenomenon
3. phantom limb sensation
4. intermittent claudication

Q8. Buerger-Allen exercises are ordered for clients with a diagnosis of:
1. Pericarditis
2. thromboangitis obliterans
3. thrombophlebitis
4. cardiomyopathy

Q9. Which instruction should the nurse discuss with the client diagnosed with Raynaud's
phenomenon?
1. Explain exacerbations will not occur in the summer
2. Use nicotine gum to help quit smoking
3. Wear extra-warm clothing during cold exposure
4. Avoid prolonged exposure to direct sunlight.

Q10. A client is experiencing postural hypotension. Which nursing intervention may assist the
client with this side effect of anti- hypertensives?
1. avoid standing
2. notify MD
3. change positions slowly
4. remain supine in bed at all times

Q11. The nurse understands that the purpose of heparin therapy in treating deep vein
thrombosis is to:
1. dissolve the thrombus
2. inhibit new clot formation
3. reduce vein inflammation
4. reestablish blood flow

Q12. The MD prescribes an HMG-CoA reductase inhibitor (statin) medication to a client with
CAD. Which should the nurse teach the client about this medication?
1. Take this medication on an empty stomach
2. This medication should be taken in the evening
3. Do not be concerned if muscle pain occurs
4. Check your cholesterol level daily

Q13. Some clients with Hodgkin's disease have also previously been diagnosed
with:
1. AIDS
2. lymphedema
3. Non-Hodgkin's lymphoma
4. Epstein Barr virus

Q14. The client has been diagnosed with abdominal aortic aneurysm. The nurse evaluates that
the client understands her condition when she describes an aneurysm as which of the
following?
1. a deposit of plaque in the wall of the artery
2. an incompetent valve in a large vein
3. an outpouching in the wall of the artery
4. a blood clot in the artery

Q15. A client is diagnosed with leukemia. Typically, the client will present with:
1. joint pain, fever, and stomatitis
2. weakness, headaches, and pruritus
3. vague pain that is relieved by rest
4. infection, fatigue, and easy bruising

Q16. Which client would be most likely to develop an abdominal aortic aneurysm?
1. A 45-year-old female with a history of osteoporosis.
2. An 80-year-old female with congestive heart failure
3. A 69-year-old male with peripheral vascular disease
4. A 30-year-old male with a genetic predisposition to AAA

Q17. The nurse is reviewing the laboratory results of a patient diagnosed with multiple
myeloma. Which of the following would be expected by the nurse?
1. Increased calcium level
2. Increased WBC
3. Decreased BUN level
4. Decreased number of plasma cells in the bone marrow

Q18. The nurse is demonstrating the use of a blood pressure sphygmomanometer to a client
newly diagnosed with hypertension. Which should the nurse not teach the client?
1. Tell the client to make sure the cuff is placed over a vein
2. Teach the client to notify the health-care provider if the BP is >160/100
3. Instruct the client about orthostatic hypotension
4. Encourage the client to keep a record of the blood pressure readings

Q19. In patients with thrombocytopenia, which of the following will not be part of your nursing
care plan?
1. use of straight razor when shaving
2. use of analgesics like acetaminophen for pain
3. avoid use of IM injections
4. provide good oral care
Q20. The nurse knows the client understands the teaching concerning a low-fat, low-cholesterol
diet when the client selects which meal?
1. Fried fish, garlic mashed potatoes, and iced tea
2. Ham and cheese on white bread and whole milk.
3. Baked chicken, baked potato, and skim milk
4. A hamburger, French fries, and carbonated beverage

Q21. A newly diagnosed hypertensive client asks the nurse how the physician will most likely
treat his disorder. The nurse would be most be most correct in stating that the last measure that
may be used would be:
1. dietary modifications
2. increasing exercise
3. weight reduction
4. medication therapy

Q22. A patient is diagnosed with chronic gastritis. The nurse knows that this patient is at risk for
which vitamin deficiency?
1. Vitamin A
2. Vitamin B12
3. Vitamin C
4. Vitamin E

Q23. Which client behavior would be a causative factor for developing Buerger's disease
(thromboangiitis obliterans)?
1. Drinking alcohol daily
2. Eating a high-fat diet.
3. Chewing tobacco
4. Inhaling gasoline fumes.

Q24. The nurse is caring for a male client diagnosed with essential hypertension. Which
information regarding antihypertensive medication should the nurse teach?
1. Teach the client to take his blood pressure four (4) times each day
2. Instruct the client to have regular blood levels of the medication checked
3. Explain the need to rise slowly from a lying or sitting position
4. Demonstrate how to use a blood glucose meter daily.

Q25. The nurse is developing a plan of care for the patient with multiple myeloma and includes
which priority intervention in the plan?
1. Encouraging fluids
2. Providing frequent oral care
3. Coughing and deep breathing
4. Monitoring the RBC count

Q26. A patient is diagnosed with multiple myeloma and the patient asks the nurse about the
diagnosis. The nurse bases the response on which description of this disorder?
1. Altered red blood cell production
2. Altered production of lymph nodes
3. Malignant exacerbation in the number of leucocytes
4. Malignant proliferation of plasma cells within the bone

Q27. A client has bowel resection in which a large portion of his ileum is removed. The client is
at increased risk for:
1. pernicious anemia
2. folic acid deficiency anemia
3. hemolytic anemia
4. thalassemia

Q28. Which of the ff. foods should the nurse teach a client with heart failure to avoid or limit
when following a 2-g sodium diet?
1. Apples.
2. Canned Tomato juice.
3. Whole wheat bread.
4. Tea

Q29. Which interventions should the nurse discuss with the client diagnosed with
atherosclerosis?
1. Include the nutritionist in the discussion
2. Stop smoking or using any type of tobacco products
3. Maintain a sedentary lifestyle as much as possible
4. Stressful situations are normal and unavoidable in everyday life

Q30. The nurse plans to initiate bleeding precautions if which of the following laboratory results
are noted?
1. A clotting time of 5-10minutes
2. An ammonia level of 20mcg/dl
3. A platelet count of 50,000/mm3
4. A WBC count of 5,000/mm3

Q31. Iron injections should be given as a Z-track because the:

1. medication will be better absorbed
2. iron will be less likely leak into the subcutaneous tissue
3. injection will be less painful
4. iron will be delivered into the bloodstream more readily

Q32. The oncology nurse provides a teaching class on Hodgkin's disease. The nurse
determines that further teaching be done if a staff nurse states that which of
the following is a characteristic of this disease?
1. Presence of Reed Sternberg cells
2. Occurs most often in the older adult
3. Prognosis depends upon the stage
4. Involvement of lymph nodes, spleen and liver

Q33. A nurse obtains a client's blood pressure measurement and finds that it is 210/115
the left arm while lying down. The most appropriate action to take is to recommend:
1. rechecking the blood pressure within 2 years
2. re-measuring the blood pressure within 1 year
3. evaluating the measurement again in 1 week
4. referring the client for prompt medication assessment

Q34. Which of the following should be done by the nurse for a patient who is prone to bleeding?
1. Monitor closely for infection
2. Monitor the temperature for every 4hours
3. Initiate protective isolation precautions
4. Use a small soft bristled toothbrush for mouth care

Q35. The nurse is teaching a client how to prevent varicose veins. Which of the following would
be appropriate to teach the client?
1. stand for long periods of time
2. sleep with the head elevated
3. wear support stockings
4. sit with legs crossed

Q36. The client is diagnosed with a small abdominal aortic aneurysm. Which interventions
should not be included in the discharge teaching?
1. Tell the client to exercise three (3) times a week for 30 minutes
2. Encourage the client to eat a low-fat, low cholesterol diet
3. Instruct the client to decrease tobacco use
4. Discuss the importance of losing weight with the client

Q37. A client is receiving instructions on how to self-administer a liquid iron preparation. Which
of the following instructions given by the nurse is correct?
1. mix the medication with caffeine and drink
2. drink the liquid through a straw
3. take the medication after drinking an antacid
4. take the medication before meals
Q38. When the nurse is asked to give the reason why clients with lymphoma have a decreased
resistance to infection, the most correct reply is the:
1. rapid proliferation of abnormal lymphocytes
2. decrease in leucocytes
3. increase in abnormal thrombocytes
4. decrease in erythrocytes

Q39. The client is diagnosed with an abdominal aortic aneurysm. Which statement would the
nurse expect the client to make during the admission assessment?
1. "I have stomach pain every time I eat a big, heavy meal."
2. "I don't have any abdominal pain or any type of problems."
3. "I have periodic episodes of constipation and then diarrhea."
4. "I belch a lot, especially when I lie down after eating."

Q40. Which assessment data would the nurse recognize to support the diagnosis of abdominal
aortic aneurysm (AAA)?
1. Shortness of breath
2. Abdominal bruit
3. Ripping abdominal pain
4. Decreased urinary output

Q41. The nurse is discussing discharge teaching with the client who is three (3) days
postoperative abdominal aortic aneurysm repair. Which discharge instructions should the nurse
include when teaching the client?
1. Notify the MD of any redness or irritation of the incision.
2. Do not lift anything that weighs more than 20 pounds
3. Inform the client there may be pain not relieved with pain medication
4. Stress the importance of having daily bowel movements.

Q42. Which of the following is indicative of iron deficiency anemia?

1. Elevated hemoglobin
2. Decreased reticulocyte count
3. Elevated RBC count
4. Red blood cells that are microcytic and hypochromic

Q43. During a routine physical examination, an AAA is diagnosed. The client is immediately
admitted to the hospital and surgery is scheduled for the next AM. When performing the
admission assessment, the nurse should expect:
1. severe radiating abdominal pain
2. a pattern of visible peristaltic waves
3. cyanosis and symptoms of shock
4. a palpable pulsating abdominal mass

Q44. The nurse is teaching a class to clients diagnosed with hypertension. Which should the
nurse teach the clients?
1. The blood pressure target range should be 120/80
2. Take the medication even when feeling well
3. Get up quickly when rising from a recumbent position
4. Consume a 3,000-mg sodium diet.

Q45. The client had an abdominal aortic aneurysm repair two (2) days ago.
Which intervention should the nurse implement first?
1. Assess the client's bowel sounds
2. Administer an IV prophylactic antibiotic
3. Encourage the client to splint the incision
4. Ambulate the client in the room with assistance

Q46. Which assessment data would require immediate intervention by the nurse for the client
who is six (6) hours postoperative abdominal aortic aneurysm repair?
1. Absent bilateral pedal pulses
2. Complaints of pain at the site of the incision
3. Distended, tender abdomen
4. An elevated temperature of 37.9C

Q47. The client presents to the outpatient clinic complaining of calf pain. The client reports
returning from an airplane trip the previous day. Which should the nurse assess first?
1. The nurse should auscultate the lung fields and heart sounds
2. The nurse should determine the length of the airplane trip
3. The nurse should determine if the client has had chest pain
4. The nurse should measure the calf and palpate the calf for warmth.

Q48. A female client is diagnosed with Raynaud's disease. In discharge planning, it is most
important for the nurse to instruct the client to avoid:
1. microwaves
2. cold weather
3. aspirin
4. warm baths

Q49. The nurse can help relieve lymphedema by:

1. elevating the affected part
2. having the client ambulate at frequent intervals
3. encouraging the client to drink 8 or more glasses of fluid per day
4. keeping the client flat in bed 16 hours or more per day

Q50. Which of the following types of isolation is indicated for a client with low WBC counts?
1. respiratory
2. enteric
3. reverse
4. strict