Advanced Med-Surg Exam 4 Neuro, Endocrine & Musculoskeletal Disorders

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Sample questions from Advanced Med-Surg Exam 4 Neuro, Endocrine & Musculoskeletal Disorders

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

1. 1.In the emergency department, a client with chronic heart failure reports worsening shortness of breath when lying flat. The client is alert, has bilateral crackles, and has an SpO2 of 89% on room air. Which action should the nurse take first?

   • A.Encourage oral fluids to thin respiratory secretions.
   • B.Administer the prescribed oral diuretic and reassess in 1 hour.
   • C.Place the client in high-Fowler position and apply supplemental oxygen.
   • D.Obtain a daily weight before initiating any intervention.

   Rationale: High-Fowler positioning and oxygen address the immediate problems of impaired oxygenation and pulmonary congestion. A daily weight is useful for ongoing evaluation but does not treat the current hypoxemia. Oral fluids can worsen fluid overload, and waiting for an oral diuretic to take effect delays support for breathing. In acute dyspnea, stabilize oxygenation while promptly escalating care as indicated.

2. 2.A client taking warfarin for a mechanical mitral valve reports black, tarry stools and increasing fatigue. The INR is 5.8, and the client is hemodynamically stable. Which action is the priority?

   • A.Teach the client to add more leafy green vegetables to the diet today.
   • B.Hold warfarin and notify the provider about the bleeding and elevated INR.
   • C.Administer vitamin K without a prescription because the INR is elevated.
   • D.Give the scheduled warfarin dose with food to reduce gastric irritation.

   Rationale: Melena with an INR of 5.8 indicates possible clinically significant bleeding, so the nurse should hold warfarin and promptly notify the provider for further management. Giving another dose could worsen bleeding. Vitamin K may be indicated depending on bleeding severity and the treatment plan, but the nurse should not independently administer it without an order. A sudden increase in vitamin K intake can also alter anticoagulation and is not an immediate treatment for suspected bleeding.

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

   • A.Activate the rapid response system for the acute deterioration.
   • B.Encourage the client to ambulate to assess exercise tolerance.
   • C.Place the client supine with the legs elevated.
   • D.Apply oxygen and support breathing while help is coming.
   • E.Prepare for emergency treatment of a suspected acute coronary syndrome.

   Rationale: The new chest pressure, diaphoresis, falling blood pressure, rising heart rate, and new ST-segment depression require immediate escalation and preparation for acute coronary syndrome treatment. Applying oxygen and supporting breathing are appropriate while the team responds, particularly as the SpO2 has fallen to 91%. Supine positioning with leg elevation is not appropriate for a client with crackles and worsening dyspnea, and ambulation could worsen myocardial oxygen demand and instability. The rapid change between 0800 and 1000 is more concerning than the initially stable vital signs.

4. 4.A client with atrial fibrillation is receiving an IV infusion of heparin. The aPTT is 118 seconds, and the client has new bleeding from the gums while brushing teeth. Which action should the nurse take?

   • A.Continue the infusion and recheck the aPTT in 6 hours.
   • B.Administer aspirin to reduce the risk of embolic stroke.
   • C.Increase the infusion rate because atrial fibrillation increases clot risk.
   • D.Stop the infusion temporarily and follow the heparin protocol, notifying the provider.

   Answer and rationale are in the full material.

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

   • A.A client 4 hours after femoral cardiac catheterization with a cool, pale foot and newly absent pedal pulse on the affected side.
   • B.A client with chronic stable angina who reports the usual brief discomfort after walking to the bathroom.
   • C.A client taking a beta blocker whose heart rate is 58/min and who denies dizziness or weakness.
   • D.A client with heart failure who has gained 0.5 kg (1.1 lb) over the past week and has unchanged ankle edema.

   Answer and rationale are in the full material.