College Exams & Notes

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QUESTION #1
Medical-Surgical Exam 3 Med-Surg
A client has severe arterial occlusive disease with gangrene of the left great toe. Which of the following findings is expected?
A Edema around the ankle
B Loss of hair on the lower leg
C Thin and soft toenails
D Thin and soft toenails

Explanations

A
Edema is more commonly associated with venous insufficiency, not arterial occlusive disease.
B
Reduced arterial blood flow leads to trophic changes, including loss of hair on the legs and feet.
C
In arterial disease, toenails usually become thickened and brittle, not thin and soft.
D
Arterial insufficiency typically causes the affected extremity to feel cool or cold due to reduced blood flow.
QUESTION #2
Medical-Surgical Exam 3 Med-Surg
A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible osteomyelitis of the right femur. Which information obtained by the nurse indicates that the nurse should consult the health care provider before scheduling the MRI?
A The patient is claustrophobic.
B The patient wears a hearing aid.
C The patient is allergic to shellfish.
D The patient has a pacemaker.

Explanations

A
Open MRI systems are often used specifically for patients with claustrophobia, so this does not necessarily prevent the procedure.
B
Hearing aids are removed before the MRI, so this does not usually prevent the test.
C
Shellfish allergy is related to iodine-based contrast used in CT scans, not typically to MRI procedures.
D
MRI uses a strong magnetic field, which can interfere with or damage a pacemaker, making it a potential contraindication unless the device is MRI-compatible.
QUESTION #3
Medical-Surgical Exam 3 Med-Surg
When the health care provider tells a patient that the pain in the patient’s knee is caused by bursitis, the patient asks the nurse to explain what bursitis is. The nurse’s best response is that bursitis is an inflammation of
A the fibrocartilage that acts as a shock absorber in the knee joint.
B the fibrocartilage that acts as a shock absorber in the knee joint.
C any connective tissue that is found supporting the joints of the body.
D the synovial membrane that lines the area between two bones of a joint.

Explanations

A
This describes the meniscus, which cushions the knee joint but is not involved in bursitis.
B
A bursa is a fluid-filled sac that reduces friction between bones, tendons, and muscles, and bursitis occurs when this sac becomes inflamed.
C
This description refers generally to ligaments or other connective tissues, not bursae.
D
The synovial membrane lines the joint capsule, and inflammation there is called synovitis, not bursitis.
QUESTION #4
Medical-Surgical Exam 3 Med-Surg
The nurse observes a patient performing several activities after hip-replacement surgery. Which action requires the nurse to intervene immediately?
A The patient sits straight up on the edge of the bed.
B The patient leans over to pull shoes and socks on.
C The patient bends over the sink while brushing the teeth.
D The patient uses crutches with a swing-to gait.

Explanations

A
Sitting upright is generally safe as long as the patient avoids excessive hip flexion beyond 90°.
B
Leaning forward can cause hip flexion greater than 90°, increasing the risk of hip dislocation after surgery.
C
Slight bending may occur during hygiene activities, but it does not necessarily exceed the unsafe hip flexion limit.
D
Using crutches with a swing-to gait is an acceptable ambulation technique when properly instructed.
QUESTION #5
Medical-Surgical Exam 3 Med-Surg
A patient hospitalized for 3 days with a hip fracture and Buck's traction suddenly develops shortness of breath and tachypnea and says, “I feel like I am going to die!” What action should the nurse take first?
A Stay with the patient and offer reassurance.
B Administer oxygen at 4 L/min by a nasal cannula.
C Notify the health care provider about the patient's symptoms.
D Check the patient's legs for swelling or tenderness.

Explanations

A
Emotional support is important, but the priority is addressing the patient's respiratory distress and oxygenation.
B
Sudden dyspnea and tachypnea may indicate pulmonary embolism or fat embolism, so the immediate priority is improving oxygenation.
C
The provider should be notified, but stabilizing the patient’s airway and breathing comes first.
D
Assessing for deep vein thrombosis may help identify the cause, but oxygenation must be addressed immediately.
QUESTION #6
Medical-Surgical Exam 3 Med-Surg
When giving home-care instructions to a patient with multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include?
A Keep the hand immobile to prevent soft tissue swelling.
B Call the health care provider for increased swelling or numbness.
C Keep the right shoulder elevated on a pillow or cushion.
D Avoid the use of NSAIDs for the first 48 hours after the injury.

Explanations

A
Patients should move their fingers frequently to promote circulation and reduce swelling.
B
Increased swelling, numbness, tingling, or severe pain may indicate circulatory impairment or compartment syndrome, which requires immediate medical attention.
C
Increased swelling, numbness, tingling, or severe pain may indicate circulatory impairment or compartment syndrome, which requires immediate medical attention.
D
NSAIDs may be used for pain and inflammation unless specifically contraindicated, so this instruction is not routinely required.
QUESTION #7
Medical-Surgical Exam 3 Med-Surg
A patient with severe osteoarthritis of the left knee has undergone total knee arthroplasty with a plastic prosthesis. Postoperatively, the nurse expects care of the leg to include
A bed rest for 3 days with the left leg immobilized in an extended position.
B use of a compression bandage to hold the left knee in a flexed position.
C progressive leg exercises to obtain 90-degree flexion.
D early ambulation with full weight bearing on the left leg.

Explanations

A
Prolonged bed rest is avoided because early movement helps prevent complications such as stiffness, muscle weakness, and thromboembolism.
B
The knee is usually kept in extension initially, and flexion positioning is not maintained with compression bandages.
C
Early rehabilitation focuses on gradually increasing knee range of motion, often aiming for about 90° of flexion to restore function.
D
Ambulation usually begins early, but full weight bearing depends on the surgeon’s orders and patient condition.
QUESTION #8
Medical-Surgical Exam 3 Med-Surg
A patient is to be discharged 4 days after a total hip arthroplasty. Which statement by the patient indicates a need for additional discharge instructions?
A "I should not cross my legs while sitting."
B "I can sleep in any position that is comfortable for me."
C "I will use a toilet elevator on the toilet seat."
D "I will have someone else put on my shoes and socks."

Explanations

A
Crossing the legs can cause hip dislocation after hip replacement surgery.
B
After total hip arthroplasty, patients must avoid certain positions such as crossing the legs or excessive hip flexion, and often need to sleep with a pillow between the legs.
C
Using a raised toilet seat helps prevent excessive hip flexion greater than 90 degrees, reducing the risk of dislocation.
D
Assistance or adaptive devices are recommended because bending forward can flex the hip beyond the safe range.
QUESTION #9
Medical-Surgical Exam 3 Med-Surg
On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. What is the most appropriate action by the nurse?
A administer prescribed opioids to relieve the pain.
B explain the reasons for phantom limb pain.
C loosen the compression bandage to decrease incisional pressure.
D remind the patient that this phantom pain will diminish over time.

Explanations

A
Postoperative and phantom limb pain are common after amputation, and prompt pain management with prescribed analgesics is the priority.
B
Education is helpful but does not address the patient’s immediate pain, which requires treatment first.
C
Compression dressings help control swelling and shape the residual limb, and loosening them could increase complications.
D
While phantom pain may decrease with time, this response minimizes the patient’s discomfort and does not provide immediate relief.
QUESTION #10
Medical-Surgical Exam 3 Med-Surg
A patient with severe peripheral arterial disease and ischemic foot ulcers is upset about the recommendation for an above-the-knee amputation. The patient states, “If they want to cut off my leg, they should just shoot me instead.” What is the most appropriate response by the nurse?
A "Let's talk about how you feel this surgery will affect you."
B "If you do not want the surgery, you do not have to have it."
C "I understand why you are upset, but there really is no choice because your leg is so badly diseased."
D "Many people are able to function normally with a prosthesis after amputation, and you can too."

Explanations

A
This response encourages the patient to express feelings and concerns, which is appropriate therapeutic communication when a patient is distressed.
B
Although patients have the right to refuse treatment, this response does not address the patient’s emotional distress or encourage discussion.
C
This statement dismisses the patient’s feelings and removes the patient’s sense of autonomy.
D
This response offers reassurance but minimizes the patient’s emotional reaction instead of exploring their concerns.
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