Med-Surg Hiv, Lupus, Angina, Pulmonary Embolism, Mi, Multiple Sclerosis

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Sample questions from Med-Surg Hiv, Lupus, Angina, Pulmonary Embolism, Mi, Multiple Sclerosis

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 stable angina reports that chest pressure began while carrying groceries and has not eased after stopping for 10 minutes. The client took one prescribed nitroglycerin tablet 5 minutes ago. The blood pressure is 132/78 mm Hg, and the client is alert. Which action should the nurse take first?

   • A.Wait 5 minutes before reassessing because the first nitroglycerin dose may still work
   • B.Administer the client's scheduled beta blocker before obtaining further assessment data
   • C.Obtain a 12-lead electrocardiogram and activate the chest-pain evaluation protocol
   • D.Assist the client to walk to determine whether the pain is reproducible

   Rationale: Persistent chest pressure at rest despite stopping activity and taking nitroglycerin is a change from stable angina and may indicate acute coronary syndrome. A 12-lead electrocardiogram and prompt evaluation help identify ischemia without delaying care. Waiting, provoking symptoms with walking, or giving a scheduled medication before evaluating the new symptom could delay recognition of an emergency.

2. 2.A client's potassium is 6.1 mEq/L (reference range 3.5-5.0 mEq/L) 2 hours after admission for an acute myocardial infarction. The monitor shows new peaked T waves. Which action is the priority?

   • A.Notify the provider immediately and prepare to administer prescribed emergency treatment for hyperkalemia
   • B.Administer the prescribed oral potassium supplement to prevent a later decrease
   • C.Document the finding as an expected effect of myocardial injury
   • D.Encourage the client to drink water and repeat the potassium level in 4 hours

   Rationale: A potassium of 6.1 mEq/L with peaked T waves signals dangerous cardiac electrical instability and requires immediate escalation and treatment. Waiting to repeat the level or encouraging fluids does not address the current risk of dysrhythmia. Potassium supplementation would worsen the hyperkalemia, and this finding is not an expected benign effect of myocardial injury.

3. 3.At a community clinic, a 16-year-old with systemic lupus erythematosus reports new ankle swelling and foamy urine. Which findings or actions should the nurse prioritize when evaluating possible lupus nephritis? Select all that apply.

   • A.Review serum creatinine and estimated glomerular filtration rate trends
   • B.Recommend stopping prescribed immunosuppressive medication until the swelling resolves
   • C.Ask about urine output and any recent change in its amount
   • D.Obtain a urinalysis and quantify urine protein as prescribed
   • E.Reassure the client that foamy urine is an expected effect of photosensitivity
   • F.Assess blood pressure and compare it with the client's baseline

   Rationale: New edema and foamy urine can indicate proteinuria and renal involvement, so urine testing, renal-function trends, blood pressure, and urine-output assessment are priorities. Foamy urine is not explained by photosensitivity and should not be dismissed. Stopping immunosuppressive therapy without prescriber guidance can worsen lupus activity rather than treat a possible renal complication.

4. 4.During a home visit, a client with multiple sclerosis says, "My legs feel much weaker after I take a hot bath, but they improve when I cool off." Which response by the nurse is best?

   • A.Explain that this change confirms a new permanent relapse and requires bed rest
   • B.Explain that heat can temporarily worsen neurologic symptoms and discuss cooler bathing options
   • C.Advise the client to stop all prescribed disease-modifying therapy because the symptoms are reversible
   • D.Recommend increasing bath temperature gradually to build heat tolerance

   Answer and rationale are in the full material.

5. 5.A client with an acute myocardial infarction has a prescription for sublingual nitroglycerin for recurrent chest pain. Before administering the dose, which finding requires the nurse to hold the medication and contact the provider?

   • A.The client reports a headache after the previous nitroglycerin dose
   • B.The client's heart rate is 96/min
   • C.The client reports pain rated 7 on a 0-to-10 scale
   • D.The client took sildenafil 6 hours ago

   Answer and rationale are in the full material.