ATI RN
NP125 Med Surg Exam Questions
Extract:
Question 1 of 5
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?
Correct Answer: D
Rationale: Chewing gum can increase salivary production, and while saliva may neutralize some stomach acid, the act of chewing can stimulate swallowing and possibly exacerbate symptoms by introducing excess air into the stomach. For GERD patients, avoiding gum may help reduce bloating and gas discomfort. Elevating the head of the bed reduces the likelihood of acid reflux during sleep by using gravity to prevent stomach contents from flowing backward into the esophagus. This strategy aligns with GERD management guidelines and reduces nighttime symptoms. Taking antacids between meals and at bedtime helps neutralize stomach acid temporarily, providing short-term relief of GERD symptoms. While effective, long-term use without addressing dietary and lifestyle factors is not ideal for managing GERD. Eating small meals is beneficial for GERD, as it prevents overdistension of the stomach, but having a bedtime snack contradicts GERD management principles. Late-night eating may increase the risk of acid reflux when lying down, thus requiring more teaching.
Question 2 of 5
Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy?
Correct Answer: B
Rationale: Moving the legs independently before turning can strain the spine and disrupt the surgical site. It does not ensure spinal alignment, which is critical after a laminectomy and discectomy to promote healing and prevent complications. Placing a pillow between the legs and turning the body as a unit maintains spinal alignment, reducing stress on the surgical site. This technique, known as logrolling, ensures the spine remains stable during movement. Turning the head and shoulders first, followed by the hips, legs, and feet, can result in twisting of the spine, which could compromise the surgical site and delay healing. It is not recommended. Using side rails for movement requires significant upper body strength and may cause twisting of the spine, which is contraindicated post-spinal surgery. This method poses a risk of disrupting the surgical repair.
Question 3 of 5
The nurse is assessing a client with peptic ulcer disease (PUD). Which finding, if observed by the nurse, would require immediate follow-up?
Correct Answer: C
Rationale: Low urine output could be due to dehydration, medication effects, or stress. While it warrants further assessment, it is not typically associated with immediate life-threatening complications in the context of PUD. Vomiting after a meal can occur in PUD due to delayed gastric emptying or irritation. However, it does not immediately indicate a complication requiring urgent follow-up unless accompanied by other symptoms such as severe pain or hematemesis. Blood in the stool may indicate gastrointestinal bleeding, a serious complication of PUD. This finding requires immediate evaluation to determine the source and extent of bleeding, as it can lead to hypovolemic shock if untreated. Abdominal discomfort is common in PUD due to gastric irritation or acid-related issues. While it requires management, it does not typically signal an urgent complication unless associated with other alarming symptoms.
Question 4 of 5
Indicate four assessment findings which require immediate follow-up.
Correct Answer: A,B,C
Rationale: Blood pressure of 85/55 indicates hypotension, which can compromise perfusion to vital organs such as the brain and kidneys. Immediate assessment is necessary to determine the underlying cause, such as dehydration or internal bleeding. Hemoglobin level of 7 g/dL is critically low, falling below the normal range of 12–16 g/dL for women or 13–18 g/dL for men. This reflects severe anemia, which may require urgent intervention, including blood transfusion or addressing the cause of anemia. Massive bleeding from the right lower leg is an emergency due to the risk of hypovolemic shock and significant blood loss. Stabilization of the bleeding site and monitoring for signs of systemic impact is required immediately. A temperature of 96.5°F (35.8°
C) may signal mild hypothermia or a systemic condition. While it requires follow-up, it is not as immediately life-threatening as the other findings and therefore does not warrant immediate prioritization.
Question 5 of 5
Nursing management for a patient with a bowel obstruction includes which of the following interventions?
Correct Answer: A,B,D
Rationale: Keeping the patient NPO minimizes gastrointestinal motility and prevents further accumulation of intestinal contents, reducing the risk of perforation and worsening obstruction. Bowel rest is crucial in promoting resolution. Nasogastric tube placement alleviates distention by decompressing the stomach and removing gastric contents, reducing vomiting and the risk of aspiration while improving patient comfort. Rectal tubes are not effective in decompressing small bowel obstructions since the obstruction prevents material from reaching the rectum. Frequent oral care prevents mucosal dryness and infection risk in patients who are NPO and receiving suction therapy, promoting overall oral hygiene.