Exam 4 Med-Surg 1

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Sample questions from Exam 4 Med-Surg 1

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 16-year-old client with a history of rheumatic heart disease reports sudden palpitations and dizziness. The monitor shows a regular narrow-complex tachycardia at 190/min. The client is alert, with BP 112/70 mm Hg and palpable peripheral pulses. Which action should the nurse anticipate first?

   • A.Begin chest compressions
   • B.Administer an unsynchronized shock
   • C.Instruct the client to perform a vagal maneuver
   • D.Prepare for synchronized cardioversion

   Rationale: A stable client with supraventricular tachycardia may be treated initially with a vagal maneuver, which can interrupt reentry through the atrioventricular node. Synchronized cardioversion is appropriate if the client becomes unstable or the rhythm does not respond to initial treatment. Chest compressions are not indicated while the client is alert and has a pulse, and an unsynchronized shock is reserved for pulseless ventricular rhythms.

2. 2.Refer to the client's chart. Which findings require immediate follow-up by the nurse? Select all that apply.

   • A.The client has gained 1.8 kg in 3 days
   • B.Urine output has averaged 20 mL/hr over the last 2 hours
   • C.Oxygen saturation has fallen from 94% to 88% on room air
   • D.The client reports that prescribed medications were taken this morning
   • E.The client now needs three pillows to breathe comfortably
   • F.The client reports less ankle swelling than yesterday

   Rationale: The drop in oxygen saturation, new orthopnea, and urine output below 30 mL/hr signal worsening congestion or reduced cardiac output; each needs prompt assessment and escalation. A 1.8-kg gain in 3 days suggests significant fluid retention and also requires follow-up. Less ankle swelling is an improvement, and taking the prescribed medications is not itself an urgent abnormal finding.

3. 3.A client states, "I take nitroglycerin for angina, and I used sildenafil last night." The client now reports chest pressure. Which action is most important?

   • A.Give the prescribed sublingual nitroglycerin immediately
   • B.Have the client walk to determine whether the pain worsens
   • C.Ask the client to chew an aspirin and then give nitroglycerin
   • D.Withhold nitroglycerin and notify the provider

   Rationale: Nitrates taken after sildenafil can cause profound hypotension because both medications promote vasodilation, so nitroglycerin must be withheld and the provider notified. Aspirin may be appropriate for suspected acute coronary syndrome, but it does not make the nitrate combination safe. Walking can increase myocardial oxygen demand and is not an appropriate assessment maneuver during active chest pain.

4. 4.On a postpartum unit, a 28-year-old client who had a cesarean birth reports sudden shortness of breath and sharp chest pain. The client is restless and has an SpO2 of 89% on room air. Which action should the nurse take first?

   • A.Apply oxygen and activate the rapid response system
   • B.Encourage oral fluids and reassess in 30 minutes
   • C.Massage the client's calves to assess for tenderness
   • D.Assist the client to walk to reduce venous stasis

   Answer and rationale are in the full material.

5. 5.A client's potassium is 6.2 mEq/L, and the electrocardiogram shows tall peaked T waves. Which prescribed intervention should the nurse implement first?

   • A.Give oral potassium chloride
   • B.Administer IV calcium gluconate
   • C.Administer a loop diuretic and wait for the next potassium result
   • D.Restrict dietary calcium

   Answer and rationale are in the full material.