Med-Surg 223

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Sample questions from Med-Surg 223

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

1. 1.In the emergency department, a client with acute chest pressure has a 12-lead ECG showing ST-segment elevation in leads II, III, and aVF. Which action is the priority?

   • A.Obtain a fasting lipid panel before initiating treatment
   • B.Schedule an exercise stress test to assess inducible ischemia
   • C.Administer a sublingual nitrate and reassess in 30 minutes before notifying the provider
   • D.Activate the facility's STEMI response and prepare for emergent reperfusion

   Rationale: ST elevation in leads II, III, and aVF is consistent with an acute inferior-wall STEMI and requires immediate reperfusion planning. Delaying for lipid testing or stress testing is unsafe when an acute infarction is suspected. A nitrate may be prescribed if appropriate, but giving it and waiting before activating the STEMI response delays definitive treatment.

2. 2.A client states, "I have heart failure, but I feel fine today, so I stopped checking my weight." Which instructions should the nurse include in the teaching plan? Select all that apply.

   • A.Report a gain of 2 lb (0.9 kg) in 24 hours or 5 lb (2.3 kg) in a week, or the threshold set by your clinician
   • B.Limit fluids only if your clinician has prescribed a fluid restriction
   • C.Weigh yourself each morning after urinating and before eating, using the same scale
   • D.Use salt substitutes freely because they do not contain sodium
   • E.Take prescribed diuretics as directed and discuss bothersome effects with your clinician before changing the dose

   Rationale: Daily weights under consistent conditions help detect fluid retention early, and a rapid gain should be reported according to the client's heart-failure plan. Taking diuretics as prescribed and following an individually prescribed fluid restriction support safe volume management. Salt substitutes may contain potassium and can be dangerous, especially with medications such as ACE inhibitors or potassium-sparing diuretics; they should not be used freely.

3. 3.A client's potassium is 6.3 mEq/L (reference range 3.5-5.0 mEq/L), and the ECG shows peaked T waves. Which prescription should the nurse anticipate implementing first to stabilize the myocardium?

   • A.A high-potassium diet
   • B.Oral potassium chloride
   • C.IV calcium gluconate
   • D.IV furosemide as the sole immediate treatment

   Rationale: IV calcium gluconate is used urgently to reduce the risk of lethal dysrhythmias by stabilizing the cardiac membrane; it does not lower the serum potassium. Potassium replacement and high-potassium foods would worsen hyperkalemia. Furosemide may help remove potassium in selected clients, but it does not provide the immediate myocardial stabilization indicated by ECG changes.

4. 4.At change of shift, the nurse receives report on four clients. Which client should be assessed first?

   • A.A client with chronic venous insufficiency who has bilateral ankle edema
   • B.A client 6 hours after femoral cardiac catheterization with a cool, pale affected foot and absent pedal pulse
   • C.A client with stable angina who reports the usual brief discomfort after climbing stairs
   • D.A client with peripheral artery disease who reports intermittent calf pain while walking

   Answer and rationale are in the full material.

5. 5.A client with atrial fibrillation is prescribed warfarin. Which statements indicate correct understanding of home teaching? Select all that apply.

   • A.I will use a soft-bristled toothbrush and an electric razor
   • B.I will tell my health care provider before starting an over-the-counter medicine or herbal product
   • C.I will keep my intake of foods containing vitamin K fairly consistent
   • D.I will take an extra dose if I miss a dose the previous day
   • E.I will report black, tarry stools or blood in my urine

   Answer and rationale are in the full material.