ATI RN
NP125 Med Surg Exam Questions
Extract:
Question 1 of 5
After a change-of-shift report, which patient should the nurse assess first?
Correct Answer: A
Rationale: Twelve hours without voiding indicates potential acute urinary retention due to ureteral obstruction, risking hydronephrosis or kidney damage, which requires immediate attention to preserve renal function. Hematuria is common with kidney stones and generally not urgent unless accompanied by clots causing retention or excessive bleeding causing hemodynamic instability. Fever indicates infection but at 37.7°C, it is considered low-grade and less urgent compared to obstruction. Normal body temperature is typically 36.1-37.2°C. Cloudy urine suggests infection but lacks the immediacy of urinary retention or acute obstruction, which are potentially life-threatening.
Question 2 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 3 of 5
Appendicitis is the most common reason for emergency abdominal surgery.
Correct Answer: A
Rationale: Appendicitis is the leading cause of emergency abdominal surgeries, accounting for a significant percentage globally. It results from inflammation of the appendix, often due to obstruction by fecalith or lymphoid hyperplasia. This condition progresses to localized infection, abscess formation, and potential rupture, requiring urgent surgical intervention to prevent life-threatening complications. The assertion that appendicitis is not the most common reason for emergency abdominal surgery contradicts epidemiological data. Diseases like cholecystitis or bowel obstructions occur less frequently and often have alternate non-surgical management options. Appendicitis's acute presentation and high risk of complications necessitate surgery, maintaining its predominance in emergency settings.
Question 4 of 5
What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?
Correct Answer: B
Rationale: Referred back pain is not a hallmark of large bowel obstruction. It typically occurs in conditions with retroperitoneal organ involvement, such as renal or pancreatic pathology. Large bowel obstruction presents primarily with abdominal distention and pain localized to the affected bowel segment due to obstruction-induced pressure and stretching. Abdominal distention is a classic sign of large bowel obstruction. Accumulated gas and stool proximal to the obstruction result in bloating and visible distention. This presentation reflects impaired bowel motility, pressure build-up, and reduced passage of contents, commonly seen in large bowel pathology. Projectile vomiting is more indicative of upper GI obstruction, such as pyloric stenosis, due to immediate pressure effects. Large bowel obstructions manifest with late vomiting as distal obstruction delays content passage. Vomiting in this case is less forceful and often accompanied by fecal material. Metabolic alkalosis is more associated with vomiting-related losses of gastric acid, as seen in upper GI pathology. Large bowel obstruction typically leads to metabolic acidosis from ischemia or bacterial overgrowth, not alkalosis, as the obstruction hampers normal bowel function and circulation.
Question 5 of 5
Which topic would the nurse include when teaching the patient ways to prevent the recurrence of kidney stones?
Correct Answer: A,D
Rationale: Using a urine filter ensures the recovery of passed stones for laboratory analysis, assisting in identifying stone composition and tailoring prevention strategies. Calcium intake is essential for bone health and reducing oxalate absorption. Avoiding calcium increases oxalate availability, worsening stone formation. Diuretic fluids like coffee promote dehydration and concentration of urine, increasing the risk of stone recurrence. Diuretics should be prescribed for specific stone types. Maintaining hydration prevents urine concentration and the supersaturation of stone-forming crystals, which are primary risk factors for nephrolithiasis.