ATI RN
NP125 Med Surg Exam Questions
Extract:
Question 1 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 2 of 5
The patient's meal has been delivered, and the nurse checks the patient's pre-meal blood sugar. The result is 50 mg/dL. The patient is clammy, diaphoresis, and non-arousable. The next step the nurse should take is:
Correct Answer: B
Rationale: Administering 1 mg of glucagon intramuscularly stimulates glycogenolysis in the liver, increasing blood glucose levels. However, it is slower in onset compared to IV dextrose, which is critical in a non-arousable patient with a dangerously low blood glucose level of 50 mg/dL. Time efficiency is vital in this emergency. Administering 25 g of dextrose IV pushes glucose directly into the bloodstream, providing an immediate increase in blood glucose. This is the most appropriate action for a non-arousable, hypoglycemic patient. Normal blood glucose ranges between 70-100 mg/dL fasting, making this an emergency requiring prompt correction. Encouraging the patient to eat may be effective in mild hypoglycemia, but not for a critically low level like 50 mg/dL in a non-arousable patient. This delay can result in prolonged neuroglycopenic effects, worsening the patient's condition. Administering 7 units of Humalog insulin would worsen the hypoglycemia by facilitating glucose uptake into cells, which is contraindicated in this situation. Instead, glucose administration is required to correct the hypoglycemia immediately.
Question 3 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 4 of 5
When caring for a patient after lumbar spinal surgery, the nurse would immediately report which finding to the healthcare provider?
Correct Answer: A
Rationale: Loss of sensation to the perineum, buttocks, inner thighs, and back of the legs may indicate cauda equina syndrome, a surgical emergency. This condition involves compression of the spinal nerve roots and can lead to permanent neurological damage if not promptly addressed. Immediate medical intervention is critical. Nausea and delayed voiding postoperatively are common, potentially due to anesthesia effects or limited mobility. While these findings warrant monitoring, they do not typically indicate an urgent issue unless prolonged or associated with other complications. Mild low back pain is expected after lumbar spinal surgery due to manipulation of spinal structures. Pain management with prescribed analgesics and gradual mobilization is part of the standard postoperative care plan, and it does not usually necessitate immediate reporting. A single episode of emesis can result from anesthesia effects or medication. Unless accompanied by persistent vomiting, signs of aspiration, or electrolyte imbalances, isolated emesis is not typically urgent and should be managed with antiemetics if necessary.
Question 5 of 5
If both Insulin glargine (Lantus) and insulin lispro (Humalog) are due simultaneously, the nurse can mix the two insulins in the same syringe and administer them as one injection.
Correct Answer: B
Rationale: Mixing insulin glargine and lispro in the same syringe is contraindicated due to their incompatible chemical formulations. Glargine's acidic pH alters lispro's effectiveness when mixed, impairing glycemic control. Separate administration preserves their individual pharmacokinetics and therapeutic actions. Separate injections ensure each insulin maintains its unique action profile. Glargine provides basal control, while lispro manages rapid postprandial spikes. Their chemical incompatibility mandates separate administration, optimizing glycemic management and reducing potential adverse effects from mixed formulations.