Medical Surgical Practice Exam 1 (25 Questions)

NCLEX Nursing School Practice Exam

Medical Surgical Practice exam 25 questions

#1. A client admitted in the coronary care unit (CCU) has developed atrial fibrillation. The ventricular rate is at 155 beats per minute. The nurse should assess the client for:

Answer: Hypotension and dizziness Rationale: A client with atrial fibrillation (AF) who develops a ventricular rate of 150 beats per minute or more may have loss of atrial kick. This can result in low cardiac output, which can manifest as hypotension and dizziness. In addition, the nurse should assess for palpitations, chest discomfort or pain, distended neck veins, shortness of breath, fatigue, and syncope.

#2. A nurse is caring for a male client admitted in the CCU due to cardiac dysrhythmia. While the nurse delivers personal care for him, the patient suddenly develops ventricular fibrillation. After calling for help, the nurse should immediately:

Answer:  Defibrillate the patient

 

Rationale: Ventricular fibrillation (VF) is a type of fatal dysrhythmia that requires immediate defibrillation or precordial shock. Once VF is identified, the nurse should deliver a shock of 120 to 200 joules using a biphasic defibrillator, or 360 joules using a monophasic defibrillator. The nurse working in the CCU would be able to initiate defibrillation on a client with VF as this is usually a standing order in this unit.

#3. A client diagnosed with folate deficiency anemia is being discharged. The nurse should primarily recommend which of the following foods to the patient?

Answer: Meats and dairy products

 

Rationale: Folate deficiency anemia involves the lack of vitamin B12 or folate. Meats and dairy products are the best sources of vitamin B12 for a patient with folate deficiency anemia. Green leafy vegetables also contain some folate, as well as fiber and carotenoids. Whole grains contain thiamine, while eggs are rich in iron.

 

#4. A client is admitted with suspected pernicious megaloblastic anemia. The laboratory results are now reported. Which of the following findings confirm the diagnosis of pernicious anemia?

Answer: Gastric assay shows absence of intrinsic factor

Rationale: Pernicious anemia is characterized by a lack of the intrinsic factor due to the atrophy of the stomach wall. This results in the failure in absorbing vitamin B12 in the small intestines. Vitamin B12 is needed for folic acid to undergo DNA synthesis of red blood cells (RBCs). Analysis of gastric juice or gastric assay is an important diagnostic test to confirm pernicious anemia.

#5. The doctor orders cardiac catheterization for a client admitted in the CCU. The procedure will involve the use of a radiopaque dye. The nurse is aware that the most important part of the pre-procedure assessment is checking:

Answer:  Allergy to iodine or shellfish

 

Rationale: Clients who are allergic to iodine or shellfish are at a higher risk for developing an allergic reaction or anaphylaxis to the iodine in the radiopaque dye. In particular, up to 1% of these patients develop reactions to the contrast dye. Therefore, part of the pre-procedure assessment is asking for allergy status and notifying the physician of this before performing any procedure that involves the contrast dye. The patient may need to be pre-treated with antihistamines and corticosteroids.

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