2023 Med-Surg Proctored

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Sample questions from 2023 Med-Surg Proctored

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a client with chest pressure has a blood pressure of 86/54 mm Hg, cool clammy skin, and new confusion. Which action should the nurse take first?

   • A.Ask the client to rate the pain
   • B.Activate emergency response and support circulation
   • C.Administer prescribed sublingual nitroglycerin
   • D.Obtain a 12-lead electrocardiogram

   Rationale: Hypotension, cool skin, and confusion indicate impaired perfusion and possible cardiogenic shock, requiring an immediate emergency response. Nitroglycerin can worsen hypotension, and pain assessment or an ECG must not delay stabilization. In unstable clients, address circulation and summon help promptly.

2. 2.A client taking warfarin for atrial fibrillation asks how to reduce the risk of complications at home. Which instructions should the nurse include? Select all that apply.

   • A.Keep intake of vitamin K-containing foods consistent
   • B.Take aspirin for a headache unless bleeding occurs
   • C.Use an electric razor
   • D.Keep scheduled INR appointments
   • E.Report black, tarry stools promptly

   Rationale: Consistent vitamin K intake helps keep anticoagulation stable; clients should not eliminate these foods but should avoid major intake changes. An electric razor, prompt reporting of melena, and regular INR monitoring reduce or identify bleeding risks. Aspirin can increase bleeding and should not be started without prescriber guidance.

3. 3.Which electrocardiogram finding is most associated with acute myocardial injury requiring immediate evaluation?

   • A.A prolonged PR interval without symptoms
   • B.An isolated premature atrial contraction
   • C.A rate of 58/min in a trained athlete
   • D.ST-segment elevation in contiguous leads

   Rationale: ST-segment elevation in contiguous leads can indicate acute myocardial infarction and requires rapid evaluation and reperfusion planning. The other findings may be benign or require assessment depending on context, but do not by themselves indicate acute myocardial injury. New ischemic ECG changes should be treated as time-sensitive.

4. 4.A client taking digoxin reports nausea and yellow halos around lights. The apical pulse is 54/min. What should the nurse do?

   • A.Reassess the pulse after the dose
   • B.Give the scheduled dose with food
   • C.Hold the dose and notify the provider
   • D.Encourage a potassium-free diet

   Answer and rationale are in the full material.

5. 5.Refer to the client's chart. Which actions are appropriate now? Select all that apply.

   • A.Give the prescribed sublingual nitroglycerin despite the current blood pressure
   • B.Prepare for urgent provider evaluation and reperfusion planning
   • C.Reassess vital signs and perfusion frequently
   • D.Encourage the client to walk to reduce anxiety
   • E.Place the client on continuous cardiac monitoring

   Answer and rationale are in the full material.