Medical-Surgical Nursing I (NSG123-CLK-1)

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Sample questions from Medical-Surgical Nursing I (NSG123-CLK-1)

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

1. 1.In the emergency department, a client with crushing chest pressure has a 12-lead ECG showing ST-segment elevation in leads II, III, and aVF. Which action should the nurse anticipate as the priority?

   • A.Obtain a fasting lipid panel before initiating treatment
   • B.Prepare the client for rapid reperfusion therapy
   • C.Administer oral fluids to prevent dehydration
   • D.Schedule an exercise stress test for the next morning

   Rationale: ST elevation in leads II, III, and aVF indicates an acute inferior ST-elevation myocardial infarction and requires rapid reperfusion to limit myocardial damage. A lipid panel is useful for long-term risk assessment but must not delay acute treatment. Oral fluids and a stress test do not treat an acute coronary occlusion, and stress testing is inappropriate during an active infarction.

2. 2.Refer to the client's chart. Which actions should the nurse take in response to the client's current findings? Select all that apply.

   • A.Encourage the client to walk to reduce venous stasis
   • B.Give the next dose of a beta blocker without checking the blood pressure
   • C.Administer prescribed oxygen and titrate to the ordered target
   • D.Notify the rapid response team or provider of the deterioration
   • E.Place the client on continuous cardiac monitoring

   Rationale: The chart shows new chest pressure, worsening dyspnea, an oxygen saturation decrease from 95% to 88%, and a heart rate increase from 94 to 118/min, so continuous monitoring and prompt escalation are appropriate. Administering prescribed oxygen and titrating it to the ordered target addresses hypoxemia while the cause is evaluated. Walking could increase myocardial oxygen demand during deterioration, and giving a beta blocker without checking the blood pressure is unsafe because hypotension may be present.

3. 3.A client states, "I take warfarin, so I will use a soft toothbrush and call the clinic if I notice black stools." Which response by the nurse is best?

   • A.Those are appropriate precautions; also report unusual bruising or bleeding.
   • B.Avoid all foods containing vitamin K while taking warfarin.
   • C.Stop warfarin whenever you have a nosebleed, then restart it the next day.
   • D.Take aspirin for minor pain because it does not affect warfarin.

   Rationale: A soft toothbrush, monitoring for melena, and reporting unusual bruising or bleeding help reduce harm from warfarin-associated bleeding. Clients should keep vitamin K intake consistent rather than eliminate vitamin K foods. Warfarin should not be stopped or adjusted without prescriber guidance, and aspirin can increase bleeding risk.

4. 4.Which assessment finding in a client with heart failure is most important to report as a possible sign of worsening fluid retention?

   • A.Mild fatigue after a full day of activity
   • B.Heart rate of 82/min after walking
   • C.Weight gain of 1.8 kg (4 lb) over 2 days
   • D.Urine output of 450 mL over 8 hours

   Answer and rationale are in the full material.

5. 5.A client's potassium is 6.1 mEq/L (reference 3.5-5.0 mEq/L), and the ECG shows peaked T waves. Which prescribed medication should the nurse expect to administer first to reduce the immediate risk of dysrhythmia?

   • A.Oral potassium chloride
   • B.Intravenous furosemide
   • C.Oral sodium polystyrene sulfonate
   • D.Intravenous calcium gluconate

   Answer and rationale are in the full material.