Ignatavicius: Medical-Surgical Nursing, 11TH Edition Study Guide

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Sample questions from Ignatavicius: Medical-Surgical Nursing, 11TH Edition Study Guide

This material has 24 questions with answers and rationales. Here are the first 5.

1. 1.Two hours after abdominal surgery, a patient receiving IV morphine through a patient-controlled analgesia pump is difficult to awaken. Respirations are shallow at 6/min, and oxygen saturation is 89% while receiving oxygen at 2 L/min by nasal cannula. Which action should the nurse take first?

   • A.Increase oxygen to 4 L/min and reassess the patient in 15 minutes.
   • B.Stop opioid delivery, activate emergency assistance, and support the airway and ventilation.
   • C.Administer the prescribed antiemetic to reduce the sedating effects of morphine.
   • D.Assist the patient to a chair and encourage incentive spirometry.

   Rationale: Severe sedation with slow, shallow breathing indicates opioid-associated respiratory depression. Stop opioid delivery, obtain emergency assistance, and support ventilation; administer naloxone according to orders or protocol. Increasing oxygen alone does not correct inadequate ventilation, and delayed reassessment is unsafe. An antiemetic does not reverse opioid effects and may worsen sedation. Mobilization and incentive spirometry require an alert, stable patient and do not treat this emergency.

2. 2.A patient with acute kidney injury has a potassium level of 6.8 mEq/L. The cardiac monitor shows new peaked T waves and widening QRS complexes. Which prescribed intervention should the nurse implement first?

   • A.Administer IV regular insulin with dextrose.
   • B.Administer an oral potassium-binding medication.
   • C.Arrange dietary counseling about potassium restriction.
   • D.Administer IV calcium gluconate.

   Rationale: IV calcium gluconate is the immediate priority when hyperkalemia produces ECG changes because it stabilizes the cardiac membrane and reduces the risk of lethal dysrhythmias. It does not lower potassium, so potassium-shifting and removal therapies must follow. Insulin with dextrose shifts potassium into cells but does not provide calcium's immediate membrane stabilization. Oral potassium binders act too slowly for this immediate threat. Dietary counseling helps prevent recurrence but cannot treat life-threatening hyperkalemia.

3. 3.A patient admitted with an acute ischemic stroke has expressive aphasia and right arm weakness. The patient is alert, follows commands, and has not yet undergone a swallowing screen. The patient's spouse asks to give the patient water and answer all questions for the patient. Which nursing response is most appropriate?

   • A.Keep the patient NPO until swallowing safety is screened, and use short questions and a communication board to involve the patient directly.
   • B.Allow small sips of water because following commands demonstrates adequate swallowing ability.
   • C.Ask the spouse to make all decisions because expressive aphasia indicates impaired decision-making capacity.
   • D.Give oral medications in applesauce and postpone communication until the patient's speech returns.

   Rationale: A stroke can impair swallowing even when a patient is alert and follows commands. Keep the patient NPO, including oral medications, until swallowing safety is established according to protocol. Supported communication preserves participation and autonomy. Following commands does not exclude aspiration risk. Expressive aphasia affects language production and does not by itself establish impaired decision-making capacity. Applesauce is not automatically safe, and delaying communication unnecessarily excludes the patient from care.

4. 4.A patient receiving chemotherapy for lymphoma arrives with a temperature of 38.6 C (101.5 F), heart rate of 124/min, blood pressure of 84/46 mm Hg, and new confusion. The absolute neutrophil count is 300/mm3. Which nursing action has the highest priority?

   • A.Administer an antipyretic and repeat the vital signs after the temperature decreases.
   • B.Move the patient to a private room and defer treatment until the oncology service arrives.
   • C.Activate the sepsis response and promptly implement ordered cultures, IV broad-spectrum antibiotics, and IV crystalloid resuscitation.
   • D.Obtain a urine specimen and wait for the culture result before initiating antimicrobial therapy.

   Answer and rationale are in the full material.

5. 5.A patient with a new ileostomy reports dizziness when standing. During the past 24 hours, watery ostomy output totaled 1800 mL and urine output totaled 350 mL. The skin beneath the pouch barrier is red and painful. Which plan best addresses the patient's priority problem while also protecting the skin?

   • A.Restrict fluid intake to decrease ostomy output and leave the leaking barrier in place until the scheduled change.
   • B.Notify the surgical team, assess volume status and electrolytes, replace fluid and sodium as prescribed, and refit the pouch barrier.
   • C.Encourage plain water as the only replacement fluid and enlarge the barrier opening to expose irritated skin to air.
   • D.Administer a laxative to regulate output and apply an oil-based lotion beneath the pouch adhesive.

   Answer and rationale are in the full material.