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QUESTION #1
Medical-Surgical Exam 3 Med-Surg
The nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client’s electrocardiogram. What action should the nurse take next?
A Administer intravenous diltiazem (Cardizem)
B Assess vital signs and level of consciousness
C Administer sublingual nitroglycerin
D Assess capillary refill and oral temperature

Explanations

A
Diltiazem slows heart rate and would worsen bradycardia and pacemaker failure.
B
A pacing spike without a QRS means failure to capture so the priority is to assess the client’s perfusion and stability immediately.
C
Nitroglycerin treats chest pain and can lower blood pressure which may worsen instability.
D
These are not priority assessments in a possible pacemaker malfunction.
QUESTION #2
Medical-Surgical Exam 3 Med-Surg
The nurse administers the prescribed medication Adenosine Adenocard to a client. Which response should the nurse assess for as the expected therapeutic response?
A Decreased intraocular pressure
B Increased heart rate
C Short period of asystole
D Hypertensive crisis

Explanations

A
This effect is related to glaucoma medications not adenosine.
B
Adenosine briefly slows AV node conduction rather than increasing heart rate.
C
Adenosine temporarily blocks AV node conduction causing a brief pause that can terminate supraventricular tachycardia.
D
Adenosine does not cause severe hypertension as a therapeutic effect.
QUESTION #3
Medical-Surgical Exam 3 Med-Surg
The nurse reviews the prescriptions for a client with chronic cardiac atrial fibrillation. Which medication would 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)

Explanations

A
Sotalol helps control heart rhythm but does not prevent clot formation, which is the major complication of atrial fibrillation.
B
Clients with atrial fibrillation are at high risk for thromboembolism and stroke so anticoagulation is used to prevent clots.
C
Atropine treats symptomatic bradycardia not atrial fibrillation complications.
D
Lidocaine treats ventricular arrhythmias not atrial fibrillation related stroke risk.
QUESTION #4
Medical-Surgical Exam 3 Med-Surg
Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates that learning has occurred when the client makes which statement?
A "I should check my blood sugar immediately prior to the administration."
B "I should provide direct pressure over the site following the injection."
C "I should use the abdominal area only for insulin injections."
D "I should only use an insulin syringe for the injections."

Explanations

A
Checking glucose may be ordered but it is not required before every insulin dose unless specified.
B
Rubbing or pressing the site is not recommended because it can alter insulin absorption.
C
Insulin can be given in several sites and rotation is important to prevent lipodystrophy.
D
Insulin syringes are calibrated in units to ensure accurate dosing and safe administration.
QUESTION #5
Medical-Surgical Exam 3 Med-Surg
A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can’t just take pills instead. What is the best response by the nurse?
A "Insulin must be injected because it needs to work quickly."
B "Insulin can't be in a pill because it is destroyed in stomach acid."
C "Have you talked to your doctor about taking pills instead?"
D "I know it is tough but you will get used to the shots soon."

Explanations

A
Speed is not the main reason because some injected insulins act slowly.
B
Insulin is a protein that would be broken down by digestive enzymes before it could be absorbed.
C
This avoids answering the question and does not provide teaching.
D
This response dismisses the client’s question instead of educating.
QUESTION #6
Medical-Surgical Exam 3 Med-Surg
Serge who has diabetes mellitus is taking oral agents and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications?
A Administer the oral agents immediately after the test.
B Notify the diagnostic department and request orders.
C Notify the physician and request orders.
D Administer the oral agents with a sip of water before the test.

Explanations

A
Medication timing changes should not be made without provider direction.
B
The diagnostic department does not prescribe medications.
C
Oral antidiabetics may need to be held when NPO to prevent hypoglycemia so the provider must adjust orders.
D
Giving oral antidiabetics while NPO may cause hypoglycemia because the client is not eating.
QUESTION #7
Medical-Surgical Exam 3 Med-Surg
A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at the highest risk for developing diabetes?
A The 50 year old client who does not get any physical exercise
B The 56 year old client who drinks three glasses of wine each evening
C The 42 year old client who is 50 pounds overweight
D The 38 year old client who smokes one pack of cigarettes per day

Explanations

A
Lack of exercise increases risk but obesity is a stronger single risk factor.
B
Alcohol can affect health but is not as strong a predictor of diabetes as obesity.
C
Obesity especially central obesity greatly increases insulin resistance and risk for type 2 diabetes.
D
Smoking increases cardiovascular risk but is not the strongest predictor of diabetes.
QUESTION #8
Medical-Surgical Exam 3 Med-Surg
Ben injects his insulin as prescribed but then gets busy and forgets to eat. What will the best assessment of the nurse reveal?
A The client will be very thirsty.
B The client will complain of nausea.
C The client will need to urinate.
D The client will have moist clammy skin.

Explanations

A
Excess thirst is more typical of hyperglycemia not hypoglycemia.
B
Nausea can occur but is not a classic early sign of low blood sugar.
C
Frequent urination is associated with hyperglycemia not missed meals after insulin.
D
Skipping a meal after insulin can cause hypoglycemia which leads to sweating tremors and clammy skin.
QUESTION #9
Medical-Surgical Exam 3 Med-Surg
Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?
A No changes
B Less insulin
C More insulin
D Oral antidiabetic agents

Explanations

A
Illness increases stress hormones which raise blood glucose so adjustments are usually needed.
B
Infection raises insulin resistance and glucose levels so reducing insulin would worsen hyperglycemia.
C
During infection the body releases stress hormones like cortisol and epinephrine which increase blood glucose and require more insulin.
D
Type 1 diabetes requires insulin not oral medications especially during illness.
QUESTION #10
Medical-Surgical Exam 3 Med-Surg
A client is in diabetic ketoacidosis secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?
A Kussmaul respirations and a fruity odor on the breath
B Shallow respirations and severe abdominal pain
C Decreased respiration and increased urine output
D Cheyne Stokes respirations and foul smelling urine

Explanations

A
DKA causes metabolic acidosis so the body uses deep rapid respirations to blow off carbon dioxide and ketones produce a fruity breath odor.
B
Respirations in DKA are deep not shallow though abdominal pain may occur.
C
Respirations increase in DKA and urine output eventually decreases with dehydration.
D
Cheyne Stokes breathing is linked to neurologic or cardiac issues not DKA.
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