Advanced Medical Surgical Nursing
A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic What response by the nurse instructor is best?
a. It is due to side effects of medications for bronchodilation.
b. It is from overactive bone marrow in response to chronic disease.
c. It combats the anemia caused by an increased metabolic rate.
d. It compensates for tissue hypoxia caused by lung disease.
A nurse assesses a client who had a myocardial infarction and is hypotensive Which additional assessment finding should the nurse expect?
a. Heart rate of 120 beats/min
b. Cool, clammy skin
c. Oxygen saturation of 90%
d. Respiratory rate of 8 breaths/min
A nurse assesses a client in an outpatient clinic Which statement alerts the nurse to the possibility of left-sided heart failure?
a.“I have been drinking more water than usual.”
b.“I am awakened by the need to urinate at night.”
c.“I must stop halfway up the stairs to catch my breath.”
d.“I have experienced blurred vision on several occasions.”
A nurse assesses clients on a cardiac unit Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure?
a. A 36-year-old woman with aortic stenosis
b. A 42-year-old man with pulmonary hypertension
c. A 59-year-old woman who smokes cigarettes daily
d. A 70-year-old man who had a cerebral vascular accident
A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain What response by the nurse is best?
a. “It inhibits thrombin.”
b. “It inhibits fibrinogen.”
c. “It thins your blood.”
d. “It works against vitamin K.”
A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 05 mm Hg What action by the nurse is most appropriate?
a. Level the transducer at the phlebostatic axis.
b. Lay the client in the supine position.
c. Prepare to administer diuretics.
d. Prepare to administer a fluid bolus.
A nurse assesses a client with atrial fibrillation Which manifestation should alert the nurse to the possibility of a serious complication from this condition?
a. Sinus tachycardia
b. Speech alterations
d. Dyspnea with activity
A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms What response by the nurse is best?
a.“Do you have trouble affording your medications?”
b.“Most people with hypertension do not have symptoms.”
c.“You are lucky; most people get severe morning headaches.”
d.“You need to take your medicine or you will get kidney failure.”
A client received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin The client’s spouse asks why the client needs this medication What response by the nurse is best?
a.“The t-PA didn’t dissolve the entire coronary clot.”
b.“The heparin keeps that artery from getting blocked again.”
c.“Heparin keeps the blood as thin as possible for a longer time.”
d.“The heparin prevents a stroke from occurring as the t-PA wears off.”
The nurse is reviewing the lipid panel of a male client who has atherosclerosis Which finding is most concerning?
a. Cholesterol: 126 mg/dL
b. High-density lipoprotein cholesterol (HDL-C): 48 mg/dL
c. Low-density lipoprotein cholesterol (LDL-C): 122 mg/dL
d. Triglycerides: 198 mg/dL
A hospitalized client has a platelet count of 58,000/mm3 What action by the nurse is best?
a. Encourage high-protein foods.
b. Institute neutropenic precautions.
c. Limit visitors to healthy adults.
d. Place the client on safety precautions.
A client is in the hospital after suffering a myocardial infarction and has bathroom privileges The nurse assists the client to the bathroom and notes the client’s O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed What action by the nurse is best?
a. Administer oxygen at 2 L/min.
b. Allow continued bathroom privileges.
c. Obtain a bedside commode.
d. Suggest the client use a bedpan
A nurse is working with a client who takes atorvastatin (Lipitor) The client’s recent laboratory results include a blood urea nitrogen (BUN) of 33 mg/dL and creatinine of 28 mg/dL What action by the nurse is best?
a. Ask if the client eats grapefruit.
b. Assess the client for dehydration.
c. Facilitate admission to the hospital.
d. Obtain a random urinalysis.
While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop Which action should the nurse take next?
a. Assess for symptoms of left-sided heart failure.
b. Document this as a normal finding.
c. Call the health care provider immediately.
d. Transfer the client to the intensive care unit.
The nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel What meal selection indicates the client is managing this condition well with diet?
a. A 4-ounce steak, French fries, iceberg lettuce
b. Baked chicken breast, broccoli, tomatoes
c. Fried catfish, cornbread, peas
d. Spaghetti with meat sauce, garlic bread
A client is in shock and the nurse prepares to administer insulin for a blood glucose reading of 208 mg/dL The spouse asks why the client needs insulin as the client is not a diabetic What response by the nurse is best?
a. “High glucose is common in shock and needs to be treated.”
b. “Some of the medications we are giving are to raise blood sugar.”
c. “The IV solution has lots of glucose, which raises blood sugar.”
d. “The stress of this illness has made your spouse a diabetic.”
The nurse gets the hand-off report on four clients Which client should the nurse assess first?
a. Client with a blood pressure change of 128/74 to 110/88 mm Hg
b. Client with oxygen saturation unchanged at 94%
c. Client with a pulse change of 100 to 88 beats/min
d. Client with urine output of 40 mL/hr for the last 2 hours
A nurse cares for a client with right-sided heart failure The client asks, “Why do I need to weigh myself every day?” How should the nurse respond?
a. “Weight is the best indication that you are gaining or losing fluid.”
b. “Daily weights will help us make sure that you’re eating properly.”
c. “The hospital requires that all inpatients be weighed daily.”
d. “You need to lose weight to decrease the incidence of heart failure.”
A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
a. “Make certain that your bath water is warm.”
b.“Avoid straining while having a bowel movement.”
c.“Limit your intake of caffeinated drinks to one a day.”
d.“Avoid strenuous exercise such as running.”
A nurse is caring for a client after surgery The client’s respiratory rate has increased from 12 to 18 breaths/min and the pulse rate increased from 86 to 98 beats/min since they were last assessed 4 hours ago What action by the nurse is best?
a. Ask if the client needs pain medication.
b. Assess the client’s tissue perfusion further.
c. Document the findings in the client’s chart.
d. Increase the rate of the client’s IV infusion.
An emergency room nurse obtains the health history of a client Which statement by the client should alert the nurse to the occurrence of heart failure?
a. “I get short of breath when I climb stairs.”
b. “I see halos floating around my head.”
c. “I have trouble remembering things.”
d. “I have lost weight over the past month.”
The health care provider tells the nurse that a client is to be started on a platelet inhibitor About what drug does the nurse plan to teach the client?
a. Clopidogrel (Plavix)
b. Enoxaparin (Lovenox)
c. Reteplase (Retavase)
d. Warfarin (Coumadin)
A nurse assesses a client’s electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave How should the nurse interpret this observation?
a. The client has hyperkalemia causing irregular QRS complexes.
b. Ventricular tachycardia is overriding the normal atrial rhythm.
c. The client’s chest leads are not making sufficient contact with the skin.
d. Ventricular and atrial depolarizations are initiated from different sites.
A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory work Which finding should the nurse report to the provider?
a. Creatinine: 2.9 mg/dL
b. Hematocrit: 30%
c. Sodium: 147 mEq/L
d. White blood cell count: 12,000/mm3
A nurse assesses clients on a medical-surgical unit Which client should the nurse identify as having the greatest risk for cardiovascular disease?
a. An 86-year-old man with a history of asthma
b. A 32-year-old Asian-American man with colorectal cancer
c. A 45-year-old American Indian woman with diabetes mellitus
d. A 53-year-old postmenopausal woman who is on hormone therapy
A student nurse is assessing the peripheral vascular system of an older adult What action by the student would cause the faculty member to intervene?
a. Assessing blood pressure in both upper extremities
b. Auscultating the carotid arteries for any bruits
c. Classifying capillary refill of 4 seconds as normal
d. Palpating both carotid arteries at the same time
A nurse assesses a client after administering a prescribed beta blocker Which assessment should the nurse expect to find?
a. Blood pressure increased from 98/42 mm Hg to 132/60 mm Hg
b. Respiratory rate decreased from 25 breaths/min to 14 breaths/min
c. Oxygen saturation increased from 88% to 96%
d. Pulse decreased from 100 beats/min to 80 beats/min
A nurse evaluates prescriptions for a client with chronic atrial fibrillation Which medication should the nurse expect to find on this client’s medication administration record to prevent a common complication of this condition?
a. Sotalol (Betapace)
b. Warfarin (Coumadin)
c. Atropine (Sal-Tropine)
d. Lidocaine (Xylocaine)
A nurse assesses an older adult client who has multiple chronic diseases The client’s heart rate is 48 beats/min Which action should the nurse take first?
a. Document the finding in the chart.
b. Initiate external pacing.
c. Assess the client’s medications.
d. Administer 1 mg of atropine.
A client presents to the emergency department in sickle cell crisis What intervention by the nurse takes priority?
a. Administer oxygen.
b. Apply an oximetry probe.
c. Give pain medication.
d. Start an IV line.
A nurse assesses a client admitted to the cardiac unit Which statement by the client alerts the nurse to the possibility of right-sided heart failure?
a.“I sleep with four pillows at night.”
b.“My shoes fit really tight lately.”
c.“I wake up coughing every night.”
d.“I have trouble catching my breath.”
A nursing student is caring for a client who had a myocardial infarction The student is confused because the client states nothing is wrong and yet listens attentively while the student provides education on lifestyle changes and healthy menu choices What response by the faculty member is best?
a.“Continue to educate the client on possible healthy changes.”
b.“Emphasize complications that can occur with noncompliance.”
c.“Tell the client that denial is normal and will soon go away.”
d.“You need to make sure the client understands this illness.”
A client is receiving an infusion of tissue plasminogen activator (t-PA) The nurse assesses the client to be disoriented to person, place, and time What action by the nurse is best?
a. Assess the client’s pupillary responses.
b. Request a neurologic consultation.
c. Stop the infusion and call the provider.
d. Take and document a full set of vital signs.
A client in sickle cell crisis is dehydrated and in the emergency department The nurse plans to start an IV Which fluid choice is best?
a.0.45% normal saline
b.0.9% normal saline
c. Dextrose 50% (D50)
d. Lactated Ringer’s solution
A student is caring for a client who suffered massive blood loss after trauma How does the student correlate the blood loss with the client’s mean arterial pressure (MAP)?
a. It causes vasoconstriction and increased MAP.
b. Lower blood volume lowers MAP.
c. There is no direct correlation to MAP.
d. It raises cardiac output and MAP.
A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells What action by the nurse is best?
a. Encourage high-protein Foods.
b. Perform a Hemoccult test on the client’s stools.
c. Offer Frequent oral care.
d. Prepare to administer cobalamin (vitamin B12).
A nurse is assessing clients on a medical-surgical unit Which client should the nurse identify as being at greatest risk for atrial fibrillation?
a. A 45-year-old who takes an aspirin daily
b. A 50-year-old who is post coronary artery bypass graft surgery
c. A 78-year-old who had a carotid endarterectomy
d. An 80-year-old with chronic obstructive pulmonary disease
A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose The nurses on the unit believe the client is drug seeking When the client requests pain medication, what action by the nurse is best?
a. Give the client pain medication if it is time for another dose.
b. Instruct the client not to request pain medication too early.
c. Request the provider leave a prescription for a placebo.
d. Tell the client it is too early to have more pain medication.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.
Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- The is a great resource
A nurse is caring for a client after surgery who is restless and apprehensive The unlicensed assistive personnel (UAP) reports the vital signs and the nurse sees they are only slightly different from previous readings What action does the nurse delegate next to the UAP?
a. Assess the client for pain or discomfort.
b. Measure urine output from the catheter.
c. Reposition the client to the unaffected side.
d. Stay with the client and reassure him or her.
A nurse is assessing a dark-skinned client for pallor What action is best?
a. Assess the conjunctiva of the eye.
b. Have the client open the hand widely.
c. Look at the roof of the client’s mouth.
d. Palpate for areas of mild swelling.