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Medical-Surgical Nursing in Canada

Question 1 of 65

1

Which intraoperative complication is a widespread activation of the clotting cascade that results in the formation of clots in small blood vessels throughout the body, which as it consumes clotting factors and platelets disrupts normal clotting and can result in severe bleeding from various sites?

Select one of the following:

  • Malignant hyperthermia

  • Anaphylaxis

  • Disseminated intravascular coagulation

  • Medullary depression

Explanation

Question 2 of 65

1

If detected, which catastrophic event in the OR will result in anesthesia and surgery being halted, 100% oxygen administered, and client will be treated with dantrolene sodium?

Select one of the following:

  • Malignant hyperthermia

  • Anaphylaxis

  • Disseminated intravascular coagulation

  • Medullary depression

Explanation

Question 3 of 65

1

Malignant hyperthermia is a rare inherited disease where hyper metabolism of skeletal muscle resulting in altered control of intracellular calcium can occur in response to exposure to succinylcholine, a general anesthesia, but may also be triggered by trauma, heat and stress. This results in hyperthermia with rigidity of skeletal muscles. It can result in cardiac arrest and death. What is/are the first sign(s) of this occurring?

Select one of the following:

  • A rise in body temperature

  • Hypercarbia, tachypnea, and tachycardia

  • Hypercarbia, bradypnea, and bradycardia

  • Hypercarbia, tachypnea, and bradycardia

Explanation

Question 4 of 65

1

What is the most common cause of post-operative hypoxemia?

Select one of the following:

  • Pulmonary edema

  • Pneumonia

  • Atelactasis

  • Early ambulation

Explanation

Question 5 of 65

1

Most common immediate post-op complication include:

Select one or more of the following:

  • Hypotension

  • Hypertension

  • Dysrhythmias

  • Pneumonia

  • Atelectasis

Explanation

Question 6 of 65

1

Which of the following are interventions to prevent deep vein thrombosis and pulmonary emboli?

Select one or more of the following:

  • Leg exercises

  • Elastic stockings or compressive devices

  • Unfractionated or low-molecular weight heparin

  • Early ambulation

Explanation

Question 7 of 65

1

A transient cessation of bowel mobility that prevents effective passage of intestinal contents; typically resolves in 2-3 days with supportive treatment. Which condition is this?

Select one of the following:

  • Paralytic ileus

  • Postoperative ileus

Explanation

Question 8 of 65

1

Small bowel obstruction that results when peristalsis stops; bowel lumen remains patent, but contents of intestine are not propelled forward, producing severe nausea and vomiting; may be caused by neurogenic or muscular impairment. Which condition is this?

Select one of the following:

  • Paralytic ileus

  • Postoperative ileus

Explanation

Question 9 of 65

1

Meaghan, 26, should remain NPO after her abdominal surgery until

Select one of the following:

  • return of gag reflex

  • return of level of consciousness

  • return of bowel sounds

  • return of flatus

Explanation

Question 10 of 65

1

If no catheter, the post-operative patient is expected to void __________ within 6-8 hours after surgery.

Select one of the following:

  • 150 mL

  • 300 mL

  • 100 mL

  • 200 mL

Explanation

Question 11 of 65

1

Drainage from surgical wounds should change from sanguineous to serosanguineous to serous with progressively less output with surgical wound healing.

Select one of the following:

  • True
  • False

Explanation

Question 12 of 65

1

Infants and the elderly are at a higher risk for fluid-related problems/imbalances.

Select one of the following:

  • True
  • False

Explanation

Question 13 of 65

1

Fill the blank spaces to complete the text.

Potassium's normal range lab values are - mmol/L.

Explanation

Question 14 of 65

1

Fill the blank spaces to complete the text.

Sodium's normal range lab values are - mmol/L.

Explanation

Question 15 of 65

1

Fill the blank spaces to complete the text.

Normal arterial plasma pH is -

Explanation

Question 16 of 65

1

Fill the blank spaces to complete the text.

In arterial blood gases, a normal range for PaCO2 is - mmHg.

Explanation

Question 17 of 65

1

Fill the blank spaces to complete the text.

In arterial blood gases, a normal range for HCO3 is - mmol/L.

Explanation

Question 18 of 65

1

When using arterial blood gases and pH to determine acid-base imbalances, remember the acronym ROME: respiratory opposite metabolic equal.

Select one of the following:

  • True
  • False

Explanation

Question 19 of 65

1

Select from the dropdown list to complete the text.

Hypotonic solution results in cellular ( swelling, shrinking ).

Explanation

Question 20 of 65

1

Select from the dropdown list to complete the text.

Hypertonic solution results in cellular ( shrinking, swelling ).

Explanation

Question 21 of 65

1

Select from the dropdown list to complete the text.

Serum creatinine levels ( increase, decrease ) when renal function decreases.

Explanation

Question 22 of 65

1

Sudden body weight change is an excellent indicator of overall fluid volume. One litre of water weighs ______.

Select one of the following:

  • 1 lb.

  • 1 kg

  • 1 mg

  • 2 lbs.

Explanation

Question 23 of 65

1

The average daily urine output is 1500 mL, or 1 mL/kg/hr.

Select one of the following:

  • True
  • False

Explanation

Question 24 of 65

1

These are clinical presentations of fluid volume deficit, or hypovolemia:

Select one or more of the following:

  • dry mucous membranes

  • poor skin turgor

  • tachycardia

  • postural hypotension

  • distended neck veins

  • confusion

  • concentrated urine

  • weak, rapid heart rate

Explanation

Question 25 of 65

1

These are clinical presentations of fluid volume excess, or hypervolemia:

Select one or more of the following:

  • edema

  • distended neck veins

  • adventitious lung sounds

  • weak, rapid heart rate

  • tachycardia

  • weight loss

  • increased urine output

Explanation

Question 26 of 65

1

Select from the dropdown list to complete the text.

( Hyponatremia, Hypokalemia, Hypernatremia, Hyperkalemia ) is a frequently overlooked cause of confusion in the elderly.

Explanation

Question 27 of 65

1

Which electrolyte imbalance has the following clinical manifestations: fatigue, N/V, decreased bowel mobility; parenthesis, decreased reflexes, muscle weakness, leg cramps, polyuria; weak, irregular pulse; ECG changes; hyperglycemia.

Select one of the following:

  • Hypocalcemia

  • Hypokalemia

  • Hyperkalemia

  • Hypernatremia

Explanation

Question 28 of 65

1

Which medication, in hyperkalemia, binds to potassium for excretion in feces?

Select one of the following:

  • Kayexalate

  • Naloxone

  • Dantrolene sodium

  • Vitamin K

Explanation

Question 29 of 65

1

Select from the dropdown lists to complete the text.

Chvostek's and Trousseau signs are used to detect hypocalcemia, which often presents with numbness and tingling in extremities and around the mouth, as well as hyper reflexes and muscle cramps. ( Chvostek's sign, Trousseau's sign ) is the twitching of the facial muscles in response to tapping over the area of the facial nerve. ( Trousseau's sign, Chvostek's sign ) is carpopedal spasm caused by inflating the blood-pressure cuff to a level above systolic pressure for 3 minutes.

Explanation

Question 30 of 65

1

Metabolic acidosis is most commonly caused by renal failure. With acidosis, hyperkalemia may occur as potassium shifts out of the cell.

Select one of the following:

  • True
  • False

Explanation

Question 31 of 65

1

Metabolic alkalosis is most commonly caused by severe vomiting or excessive gastric suction. Hypokalemia will produce alkalosis.

Select one of the following:

  • True
  • False

Explanation

Question 32 of 65

1

Respiratory acidosis is always caused by a respiratory problem (hypoventilation) with inadequate excretion of CO2. Treatment is aimed at improving ventilation.

Select one of the following:

  • True
  • False

Explanation

Question 33 of 65

1

Respiratory alkalosis is caused by hyperventilation.

Select one of the following:

  • True
  • False

Explanation

Question 34 of 65

1

The RPN should not take blood pressures, nor should blood draws be done, on the extremity with the PICC line.

Select one of the following:

  • True
  • False

Explanation

Question 35 of 65

1

Clinical manifestations of infiltration include swelling, pallor and coolness, and pain at insertion site. Treatment for the peripheral IV site complication of infiltration is to stop the infusion and discontinue the IV, then elevate the affected extremity.

Select one of the following:

  • True
  • False

Explanation

Question 36 of 65

1

Extravasation, similar to infiltration but with an administration of a vesicant or irritant solution/medication into the surrounding tissues. Clinical manifestations are similar to infiltration, but blistering and necrosis of tissue can occur. Treatment for the peripheral IV site complication of extravasation is stopping the infusion and notifying the physician immediately, but leaving the IV cannula in place with warm or cold compresses based on the medication.

Select one of the following:

  • True
  • False

Explanation

Question 37 of 65

1

Phlebitis, manifesting as pain, swelling and a reddened area around the insertion site or along the path of the vein is treated by discontinuing the IV and applying a warm moist compress.

Select one of the following:

  • True
  • False

Explanation

Question 38 of 65

1

Thrombophlebitis is the presence of a clot plus inflammation. Manifests the same as phlebitis but client may experience immobility of the extremity because of pain, sluggish flow rate. Treatment is to discontinue the IV, initially apply cold compress followed by warm compress.

Select one of the following:

  • True
  • False

Explanation

Question 39 of 65

1

Treatment for the peripheral IV site complication of a hematoma is to discontinue the IV, apply pressure with a sterile dressing and ice to prevent extension of the hematoma.

Select one of the following:

  • True
  • False

Explanation

Question 40 of 65

1

Treatment for the peripheral IV site complication of an air embolism is clamping the cannula, placing the client on left hand side in Trendelenburg position, assessing vital signs, administering oxygen and notifying the physician.

Select one of the following:

  • True
  • False

Explanation

Question 41 of 65

1

For blood product administration, a larger diameter cannula is needed, usually 18-20 gauge.

Select one of the following:

  • True
  • False

Explanation

Question 42 of 65

1

For most IV therapy a 22 gauge catheter is sufficient.

Select one of the following:

  • True
  • False

Explanation

Question 43 of 65

1

The RPN should monitor the client and IV site _______ for signs of systemic and local complications related to peripheral IV therapy.

Select one of the following:

  • every 1-2 hours

  • every 4-6 hours

  • every half hour

  • qshift

Explanation

Question 44 of 65

1

Total parenteral nutrition tubing should be changed every 24 hours.

Select one of the following:

  • True
  • False

Explanation

Question 45 of 65

1

IV line tubing should be changed no more frequently than at a _______ hour interval, but at least every 7 days or immediately if contamination occurs.

Select one of the following:

  • 24

  • 96

  • 36

  • 48

Explanation

Question 46 of 65

1

You are caring for a 72-year-old female who underwent a hysterectomy, salpingo-oopherectomy, and bilateral pelvic lymph node dissection (LND). She is post-op day 2. You received handover this morning and the night nurse told you that the patient has had a low urine output. During your assessment, you notice that her extremities are cold, her BP is low, her HR is high, and she seems restless. You suspect that the patient may be experiencing...

Select one of the following:

  • Hemorrhage

  • Orthostatic hypotension

  • Emergent delerium

  • Hypovolemic shock

Explanation

Question 47 of 65

1

Signs & symptoms of ______________ shock include narrowing pulse pressure, tachypnea, hypotension, decreased urinary output, weak & thready pulse, hypoactive or absent bowel sounds, decreased cerebral perfusion (anxiety, confusion) and skin hypoperfusion (pale, cool, clammy).

Select one of the following:

  • Cardiogenic

  • Hypovolemic

  • Anaphylactic

  • Neurogenic

Explanation

Question 48 of 65

1

Signs & symptoms of ____________ shock include narrowing pulse pressure, tachycardia, tachypnea with crackles, hypotension and peripheral hypoperfusion.

Select one of the following:

  • Cardiogenic

  • Hypovolemic

  • Anaphylactic

  • Neurogenic

Explanation

Question 49 of 65

1

Signs & symptoms of ____________ shock include hypotension, bradycardia, skin dry with poikilothermia, temperature and dysregulation (risk for hypothermia).

Select one of the following:

  • Cardiogenic

  • Hypovolemic

  • Anaphylactic

  • Neurogenic

Explanation

Question 50 of 65

1

Signs & symptoms of ____________ shock include wheezing, stridor, flushing, pruritus, urticaria, respiratory distress and circulatory failure, sense of impending doom, chest pain, and swelling of the lips and tongue.

Select one of the following:

  • Cardiogenic

  • Hypovolemic

  • Anaphylactic

  • Neurogenic

Explanation

Question 51 of 65

1

Septic shock manifests with tachypnea/hyperventilation, temperature dysregulation, decreased urine output, altered neurological status, GI dysfunction, and respiratory failure is common.

Select one of the following:

  • True
  • False

Explanation

Question 52 of 65

1

Normal pulse pressure is 30-40 mmHg.

Select one of the following:

  • True
  • False

Explanation

Question 53 of 65

1

A modified Trendelenburg position (head elevated, feet elevated 30 degrees) is recommended for hypovolemic shock to promote venous return and increases circulating blood volume.

Select one of the following:

  • True
  • False

Explanation

Question 54 of 65

1

Blood is infused within 30 mins of pickup from blood bank and over 6 hours with Y-tubing.

Select one of the following:

  • True
  • False

Explanation

Question 55 of 65

1

Blood transfusion is recommended when Hgb is below 70 g/L.

Select one of the following:

  • True
  • False

Explanation

Question 56 of 65

1

Plasma is infused immediately after thawed, as rapidly as tolerated over 30-60 mins and is compatible for all with "O" type or own ABO group.

Select one of the following:

  • True
  • False

Explanation

Question 57 of 65

1

Blood should be infused slowly to start, no greater than 2 mL/min for first 15 minutes as most reactions occur within first 50 mL of administration.

Select one of the following:

  • True
  • False

Explanation

Question 58 of 65

1

________ reaction usually occurs when blood is transfused too quickly, presents with hypertension, bounding pulse, distended jugular veins, dyspnea, and restlessness/confusion. Nursing management is to stop transfusion, administer diuretics, apply O2 as needed and restart infusion slowly as directed.

Select one of the following:

  • TRALI

  • TACO

  • Febrile non-hemolytic

  • Acute hemolytic

Explanation

Question 59 of 65

1

____________ reaction in blood transfusion typically occurs within 2 hours of infusion and usually resolves within 24-72 hours. Manifests as hypoxia and bilateral pulmonary edema. Nursing management is to stop the transfusion, provide O2, and mechanical ventilation is required in 75% of cases.

Select one of the following:

  • TRALI

  • TACO

  • Acute hemolytic

  • Febrile non-hemolytic

Explanation

Question 60 of 65

1

Which of the following should the RPN teach the patient to avoid 72 hours prior to a fecal occult blood test?

Select one or more of the following:

  • Red meat

  • Vitamin C

  • NSAIDs

  • Poultry/fish

Explanation

Question 61 of 65

1

Post procedural education for a barium enema includes teaching the patient that bowel movements should change from chalky white/gray progressively to normal colour.

Select one of the following:

  • True
  • False

Explanation

Question 62 of 65

1

Ileostomy pouch should be emptied when _____ full.

Select one of the following:

  • 1/3

  • almost

  • 3/4

  • 1/4

Explanation

Question 63 of 65

1

Ostomy appliances should be changed ever 5-7 days and should be early in the morning before breakfast or 2-4 hrs after a meal.

Select one of the following:

  • True
  • False

Explanation

Question 64 of 65

1

Patients receiving enteral feedings should have HOB elevated 30-45 degrees during meal and for at least 30 mins afterwards to prevent risk of aspiration

Select one of the following:

  • True
  • False

Explanation

Question 65 of 65

1

Autonomic dysreflexia occurs in persons with an injury above T6. Symptoms include: severe pounding headache, sudden increase in blood pressure, profuse diaphoresis above level of injury, bradycardia.

Select one of the following:

  • True
  • False

Explanation

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