NUR 242 Exam 1 NUR 242 Med-Surg Exam 1
LATEST UPDATE 2024-2025 ACTUAL EXAM 500
QUESTIONS AND 100% VERIFIED CORRECT
ANSWERS GUARANTEED A+
A biopsy is what type of procedure? - CORRECT ANSWER: Diagnostic
A patient has received 10 mg of Morphine via IV 20 minutes ago and is noticeably groggy. The physician requests you witness the signature of his informed consent. How
would you, as a patient advocate, proceed? - CORRECT ANSWER: Informed consent
should be received before patient is given any preop analgesics to ensure a clear state of mind.
Side note: A nurse is not responsible for clarification of risks or procedure explanation.
A nurse can witness signature.
A pt asks you why what he eats has anything to do with wound healing. What is your
response? - CORRECT ANSWER: Successful healing of pressure injuries depends on
adequate intake of calories protein, vitamins, minerals and water.
A pt goes to the ER for swelling and pain in her right calf. The PT states that it occurred after she accidentally cut herself. Based on her symptoms, what skin condition might
the nurse suspect the patient has? - CORRECT ANSWER: Cellulitis.
Cellulitis is inflammation of the skin and subq tissue.
A pt is receiving a blood transfusion and breaks out in hives. What is the nurses first
step? - CORRECT ANSWER: Immediately stop the the transfusion and start normal
saline
A pt presents with muscle weakness, trouble walking, and a beefy red tongue. Based on these symptoms, what might we conclude the patient will be diagnosed with? -
CORRECT ANSWER: B-12 Deficiency
A pt's health history states that they are on corticosteroids. The PACU nurse that this
increases the risk of what? - CORRECT ANSWER: wound dehiscence
After a procedure, a pt's vitals signs are the following:
BP: 90/50
RR: 26
HR: 110
O2: 88% 1 / 4
What is this a potential sign of?
A.Infection
- Heavy blood loss
C. These vitals are to be expected after a procedure - CORRECT ANSWER: B
After a procedure, what should the nurse assess immediately? - CORRECT ANSWER:
ABC's
Make sure airway is clear, note respiration depth, listen to lung sounds
After receiving shift report, the night nurse looks at the lab values for a patient with
cellulitis. What abnormal lab values might you see? - CORRECT ANSWER: -WBC -
elevated -Creatinine- elevated -Bicarbonate- low -Albumin- low -Calcium- low
After surgery, Pt A verbalizes they do not want to cough because it is uncomfortable.What are some things the nurse can do to minimize discomfort? - CORRECT
ANSWER: Analgesic administration and educating on splinting incision site when
coughing.
An 85 year old woman is admitted to the hospital. When doing the initial assessment, what are some factors that you know put her at risk for pressure injuries? - CORRECT
ANSWER: -if the pt is immobile
-if the pt is incontinent -if the pt has comorbidities such as diabetes or PVD -if the pt is malnourished or dehydrated -if the pt suffers from decreased sensory perception
How often should the nurse monitor patient's vital signs when they are receive a blood
transfusion? - CORRECT ANSWER: Vital sings must be checked after 15 minutes, 30
minutes, and one hour followed by every hour after.
Immobility effects multiple body systems. What are some interventions that you can implement to decrease these effects? Select all that apply.
- Utilizing waffle mattress to reduce the need for repositioning
- Teds/SCDs
- Rubbing reddened areas
- Limiting fluid intake
- ROM exercises - CORRECT ANSWER: Answer: B and E
- / 4
Rational:
-A is incorrect because regardless of implemented mattress, positioning should be every 2 hours -C is incorrect. You should not rub at reddened areas. This increases the risk for skin break.-D is incorrect. You should encourage proper hydration to promote well hydrated and healthy skin.
Match the following infections with the precaution type
- Standard
- Droplet
- Airborne
- __ MRSA. 5. __ Measles
- __ TB 6. __ Varicella
- __ Influenza 7. __ Pneumonia
4. __ Pediculosis 8 .__ Meningitis - CORRECT ANSWER: A, C, B, A, C, C, B, B
Normal RBC Lab Values - CORRECT ANSWER: Women: 4.2 to 5.4 million/uL
Men: 4.7 to 6.1 million/uL
Children: 4.6 to 4.8 million/uL
Patricia is an RN working at a rehabilitation center and witnesses a nurse aid struggling to lift and reposition an elderly, bed ridden patient. She explains to the nurse aide that there is a No Lift Policy in place in the establishment. What does this policy entail? -
CORRECT ANSWER: The concept of a no-lift policy is a pledge from administrators
that proper equipment, adequately maintained and in sufficient numbers, will be available to care providers to reduce the risks associated with manual patient handling
Pneumonia and Atelectasis are serious concerns post op. What are some things that we can encourage the patient to do to prevent these complications? - CORRECT
ANSWER: Incentive spirometry, coughing, and deep breathing
Pt A is admitted from a nursing home with a stage 3 pressure ulcer. When creating his plan of care, who else would be involved besides the primary care physician? -
CORRECT ANSWER: Wound care nurse, Dietician, Physical therapist. OT can also be
included, however they deal more with fine motor skills.
The nurse notices a localized red area that is nonblanchable on the the patient's coccyx.
What stage pressure injury is this recognized as? - CORRECT ANSWER: Stage 1
Stage 1 pressure injury means the skin is intact with a localized area of nonblanchable erythema (fancy word for redness).
- / 4
The patient is undergoing surgery to fix a cleft palate. What type of surgery is this
considered? - CORRECT ANSWER: Constructive
This type of surgery prolongs life but does not cure the underlying disease - CORRECT
ANSWER: Palliative
True or False: Nurses should do skin assessments once a week. - CORRECT
ANSWER: False
Rational: Nurses should do full skin assessments a minimum of once per shift.
What is the most common side effect of analgesic use and how can we prevent it? -
CORRECT ANSWER: Constipation.
A high fiber diet, plenty of fluids, and stool softeners are prophylactic measures.
What pain rating scale might you use for a child or a nonverbal patient? - CORRECT
ANSWER: Wong Baker-Faces Scale
What signs and symptoms might you suspect a patient exhibit if they were iron deficient? Select all that apply.
- weakness
- palor
- tachypnea
- fatigue
- beefy red tongue - CORRECT ANSWER: Answer:
A, B, and D
When adjusting a TENs machine on a patient, how do you know the conduction of
electricity has reached a therapeutic level? - CORRECT ANSWER: The patient will
verbalize feeling a sensation of pins and needles.
When assessing a pt's pain. He tells you that the pain comes and goes. What part of the pain assessment is he describing?
- Quality
- Intensity
- Onset and Duration
D. Location - CORRECT ANSWER: C. Onset and Duration
When caring for a patient with Sickle Cell Anemia, what are some nursing interventions
you'll need to implement? - CORRECT ANSWER: - Avoid extreme temperatures
- Keep room warm
- Encourage fluid intake
- / 4