Midterm Med-Surg

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Sample questions from Midterm Med-Surg

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

1. 1.A 67-year-old client admitted with heart failure suddenly develops severe dyspnea, pink frothy sputum, and an oxygen saturation of 82%. Which action should the nurse take first?

   • A.Place the client upright and apply supplemental oxygen.
   • B.Encourage oral fluids to thin respiratory secretions.
   • C.Obtain a daily weight using the bedside scale.
   • D.Place the client supine and elevate the legs.

   Rationale: These findings indicate acute pulmonary edema, so positioning upright and providing oxygen address the immediate breathing problem while emergency assistance is activated. A daily weight helps evaluate fluid trends but must not delay stabilization. Oral fluids can worsen fluid overload, and supine positioning with elevated legs can increase venous return and worsen breathing. Acute respiratory compromise takes priority over routine heart failure monitoring.

2. 2.A client arrives in the emergency department with chest pressure lasting 40 minutes. The ECG shows ST-segment elevation in contiguous leads. Which prescription should the nurse implement promptly while preparations for reperfusion are made?

   • A.Give enteric-coated aspirin to swallow whole.
   • B.Administer chewable aspirin 324 mg if there is no contraindication.
   • C.Withhold antiplatelet therapy until troponin results are available.
   • D.Encourage walking to determine whether the discomfort improves.

   Rationale: Chewed aspirin rapidly inhibits platelet aggregation and is indicated in suspected acute myocardial infarction unless contraindicated. Enteric-coated aspirin swallowed whole has slower absorption and is not the preferred initial preparation. Treatment should not wait for troponin results when the ECG and presentation indicate an acute coronary occlusion. Walking increases myocardial oxygen demand; early antiplatelet therapy and timely reperfusion are priorities.

3. 3.A nurse teaches a 72-year-old client with heart failure about home management. Which statements indicate correct understanding? Select all that apply.

   • A.I will contact my care team if I gain 3 pounds in one day.
   • B.I will check food labels for sodium content.
   • C.I will use potassium-based salt substitutes without asking my provider.
   • D.I will stop my diuretic whenever my ankle swelling disappears.
   • E.I will weigh myself each morning after urinating and before breakfast.

   Rationale: Daily weights under consistent conditions help identify fluid retention, and a gain of 3 pounds in one day warrants reporting according to the heart failure action plan. Checking sodium labels supports reduction of dietary sodium and fluid retention. Diuretics should not be stopped independently because improved swelling does not mean the underlying disease has resolved. Potassium-based salt substitutes can cause hyperkalemia, especially with certain heart failure medications, and require provider approval.

4. 4.A client taking digoxin and furosemide reports nausea and seeing yellow halos around lights. The apical pulse is 52/min, and the potassium level is 3.0 mEq/L. What should the nurse do next?

   • A.Reassess the pulse after the client walks in the hallway.
   • B.Give the digoxin with food to reduce nausea.
   • C.Administer an additional dose of furosemide.
   • D.Withhold digoxin and notify the provider.

   Answer and rationale are in the full material.

5. 5.Four hours after femoral-access cardiac catheterization, a client reports new back pain. The blood pressure has fallen from 132/78 to 88/54 mm Hg, and the heart rate is 118/min. The groin dressing is dry. Which complication should the nurse suspect?

   • A.Acute left-sided heart failure
   • B.Expected soreness from prolonged bed rest
   • C.Retroperitoneal hemorrhage
   • D.A delayed contrast-related skin reaction

   Answer and rationale are in the full material.