Med-Surg 2 PN 2023 PDF Study Guide

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Sample questions from Med-Surg 2 PN 2023 PDF Study Guide

This material has 20 questions with answers and rationales. Here are the first 5.

1. 1.A PN is monitoring a client 2 hours after abdominal surgery. The client's pulse has increased from 84 to 122/min, blood pressure has decreased from 128/76 to 88/54 mm Hg, and the dressing is rapidly becoming saturated with blood. Which action should the PN take first?

   • A.Reinforce the dressing and repeat vital signs in 30 minutes before reporting.
   • B.Help the client sit upright and walk a short distance to improve circulation.
   • C.Stay with the client and immediately summon the RN and emergency assistance according to facility protocol.
   • D.Offer oral fluids and document the drainage at the end of the shift.

   Rationale: Rapid bleeding with tachycardia and hypotension suggests hemorrhage with shock and requires immediate assistance. Reinforcing a dressing must not delay reporting or emergency response. Sitting upright and walking can worsen hypotension and cause a fall. Oral fluids are inappropriate during this emergency, and delayed documentation does not address the immediate threat.

2. 2.A client with heart failure is prescribed oral furosemide and digoxin. Before administering the morning medications, the PN counts an apical pulse of 52/min for one full minute. The client reports nausea, and the latest potassium level is 3.0 mEq/L. The digoxin order states to hold for a pulse below 60/min. What should the PN do?

   • A.Withhold digoxin according to the order and promptly report the pulse, nausea, and potassium result to the RN/provider.
   • B.Administer both medications because a slow pulse is an expected treatment goal.
   • C.Give digoxin with food to reduce nausea and recheck the pulse after administration.
   • D.Administer an extra potassium tablet from the client's home supply before giving digoxin.

   Rationale: The pulse meets the ordered hold parameter. Hypokalemia increases susceptibility to digoxin toxicity, and nausea with bradycardia is concerning. Giving both medications ignores the hold order and safety findings. Food does not correct possible toxicity. Giving extra potassium without an order, especially from a home supply, is unsafe.

3. 3.A client has a chest tube connected to a drainage system for treatment of a pneumothorax. During routine monitoring, the PN notices new continuous bubbling in the water-seal chamber. The client is breathing comfortably with an oxygen saturation of 95% on prescribed oxygen. Which action is appropriate?

   • A.Clamp the chest tube until the bubbling stops.
   • B.Raise the drainage system above the client's chest.
   • C.Increase wall suction until the water-seal bubbling stops.
   • D.Check visible tubing connections for looseness and promptly report the new continuous bubbling to the RN.

   Rationale: New continuous bubbling in the water-seal chamber suggests an air leak. Checking external connections and reporting the finding are appropriate PN actions. Routine clamping can trap air and cause a tension pneumothorax. Raising the system above the chest can promote backflow. Increasing suction without an order does not safely correct an air leak.

4. 4.A client receiving insulin becomes sweaty and shaky before lunch. The PN checks the blood glucose, which is 54 mg/dL. The client is awake, follows directions, and swallows without difficulty. Which action should the PN take under the facility's hypoglycemia protocol?

   • A.Administer the scheduled mealtime insulin and then bring the lunch tray.
   • B.Give 4 ounces of regular fruit juice and recheck blood glucose in 15 minutes.
   • C.Give diet soda and recheck blood glucose in 1 hour.
   • D.Keep the client NPO and wait for the provider before treating.

   Answer and rationale are in the full material.

5. 5.A client receiving chemotherapy has an absolute neutrophil count of 400/mm3. During scheduled vital-sign monitoring, the PN obtains an oral temperature of 100.8 F (38.2 C). The client reports feeling chilled. What is the PN's priority action?

   • A.Encourage additional fluids and check the temperature again at the next scheduled round.
   • B.Give a prescribed PRN antipyretic and report only if the fever persists.
   • C.Promptly report the temperature and neutrophil count to the RN/provider using the facility's neutropenic-fever procedure.
   • D.Obtain a rectal temperature to confirm the oral reading before reporting.

   Answer and rationale are in the full material.