Medical Surgical 2 Final Helene Fuld

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Sample questions from Medical Surgical 2 Final Helene Fuld

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

1. 1.In the emergency department, a client with a history of heart failure reports worsening shortness of breath when lying flat. The client is sitting upright, has an SpO2 of 88% on room air, and has bilateral crackles. Which action should the nurse take first?

   • A.Obtain a daily weight before initiating treatment
   • B.Place the client in high-Fowler position and apply oxygen as prescribed
   • C.Encourage the client to increase oral fluid intake
   • D.Administer the scheduled oral beta blocker

   Rationale: Positioning upright and supporting oxygenation address the immediate problem of impaired gas exchange from pulmonary congestion. A daily weight is useful for evaluating fluid trends but does not stabilize the client's current respiratory status. Increasing fluids can worsen congestion, and a scheduled beta blocker is not the first action for acute hypoxemia.

2. 2.A client states, "I take warfarin for atrial fibrillation, and my stool has been black since yesterday." The client's INR is 5.8, and the client feels light-headed when standing. Which action is the priority?

   • A.Recheck the INR at the next routine appointment
   • B.Encourage the client to eat more leafy green vegetables today
   • C.Hold the warfarin and notify the provider promptly
   • D.Give the scheduled warfarin with food to reduce stomach irritation

   Rationale: Black stool, orthostatic light-headedness, and an INR of 5.8 suggest active bleeding with excessive anticoagulation, so warfarin should be held and the provider notified promptly. Taking the dose with food does not reduce bleeding risk. Increasing vitamin K intake is not a reliable immediate intervention, and waiting for a routine test delays care for a potentially serious bleed.

3. 3.At change of shift, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A client 6 hours after femoral cardiac catheterization who reports new back pain and has a BP decrease from 128/76 to 92/58 mm Hg
   • B.A client with stable angina who reports the same brief chest discomfort that occurs with walking
   • C.A client taking furosemide who has potassium of 3.4 mEq/L and denies weakness
   • D.A client with chronic heart failure who has bilateral ankle edema unchanged from yesterday

   Rationale: New back pain with hypotension after femoral catheterization can indicate retroperitoneal bleeding, a time-sensitive complication requiring immediate assessment and escalation. The stable exertional angina described is not a change from baseline. Mild hypokalemia needs follow-up but is less urgent without symptoms, and unchanged ankle edema is a chronic finding rather than evidence of acute deterioration.

4. 4.Refer to the client's chart. Which actions should the nurse take now in response to the client's changing condition? Select all that apply.

   • A.Encourage oral fluids to improve renal perfusion
   • B.Assist the client to walk to assess activity tolerance
   • C.Place the client upright and apply oxygen according to protocol
   • D.Notify the provider or rapid response team about the worsening findings
   • E.Prepare to administer the prescribed IV loop diuretic after checking the order and relevant parameters

   Answer and rationale are in the full material.

5. 5.The provider prescribes IV nitroglycerin for a client with acute coronary syndrome and ongoing chest pain. Before starting the infusion, which finding requires the nurse to clarify the prescription?

   • A.The client reports pain rated 7 out of 10
   • B.The client has a history of hypertension
   • C.The client has a heart rate of 104/min
   • D.The client took sildenafil 8 hours ago

   Answer and rationale are in the full material.