College Exams & Notes

Master your nursing exams with comprehensive practice questions and detailed explanations

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QUESTION #1
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who underwent a recent transverse colostomy. Which of the following findings requires immediate notification to the primary health care provider (PHCP)?
A Skin excoriation around the stoma.
B Stoma is beefy red and shiny.
C Purple discoloration of the stoma.
D Semi-formed stool noted in the ostomy pouch.

Explanations

A
Skin irritation can occur from leakage of stool and requires treatment, but it is not an immediate life threatening complication.
B
A beefy red, moist stoma indicates healthy tissue with good blood supply and is an expected postoperative finding.
C
A purple or dusky stoma suggests compromised blood flow or ischemia, which is a surgical emergency requiring immediate provider notification.
D
Semi-formed stool is expected with a transverse colostomy because stool consistency becomes more formed as it moves through the colon.
QUESTION #2
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who is scheduled to undergo a hemicolectomy with the creation of a colostomy. The client reports feeling anxious and has many questions related to the surgery, the care of a stoma, and lifestyle modifications. Which of the following actions from the nurse is most appropriate?
A Encourage the client to write the concerns down and discuss them with the surgeon.
B Provide the client with educational materials that match the client’s learning style.
C Maintain an open dialogue with the client and make a referral to an ostomy support group.
D Reassure the client that the surgery is low risk and clients are usually successful in adjusting to an ostomy.

Explanations

A
This may help the client organize questions, but it does not directly address the client’s anxiety or provide emotional support.
B
Education is important for surgical preparation, but emotional support and coping assistance are priorities when the client expresses anxiety.
C
Open communication allows the nurse to address fears and questions while a support group helps the client learn coping strategies and adjust to living with an ostomy.
D
Providing false reassurance minimizes the client’s feelings and does not promote therapeutic communication.
QUESTION #3
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who has a decreased level of consciousness. The client is receiving continuous enteral feedings via gastrostomy tube due to severe dysphagia. Which of the following actions should the nurse prioritize?
A Elevate the head of bed 30–45 degrees.
B Monitor intake and output every 8 hours.
C Check residual volume every 4–6 hours.
D Observe the client’s respiratory status.

Explanations

A
Elevating the head of the bed reduces the risk of aspiration of enteral feedings, which is especially important in clients with decreased consciousness and dysphagia.
B
Monitoring fluid balance is important but does not immediately reduce the life threatening risk of aspiration.
C
Assessing gastric residual helps evaluate feeding tolerance but is not the first priority intervention to prevent aspiration.
D
Respiratory monitoring is important for detecting aspiration, but preventing aspiration by proper positioning is the priority action.
QUESTION #4
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who has peritonitis and suddenly develops a mental status change and becomes unresponsive. Which of the following actions should the nurse take first?
A Complete a full head to toe assessment.
B Transfer the client to the critical care unit.
C Administer oxygen via nasal cannula 2 L/min.
D Initiate a rapid response team.

Explanations

A
A complete assessment is important but delays urgent intervention for a client who is suddenly unresponsive.
B
The client may require ICU care, but immediate stabilization and emergency evaluation must occur first.
C
Oxygen may be necessary, but the sudden change in consciousness requires immediate emergency response rather than a single intervention.
D
Sudden unresponsiveness indicates a potential life threatening deterioration such as sepsis, shock, or respiratory failure, requiring immediate activation of the rapid response team.
QUESTION #5
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a group of clients who have Crohn’s disease. Which of the following clients should the nurse see first?
A Client requesting education on what to eat for lunch.
B Client with a temperature (T) of 101° F and decreased urine output.
C Client awaiting testing for osteoporosis testing.
D Client requiring post-surgical wound care education.

Explanations

A
Dietary education is important in Crohn’s disease management but is not an urgent priority compared with potential complications.
B
Fever and reduced urine output may indicate infection, dehydration, or possible sepsis, which requires immediate assessment and intervention.
C
Osteoporosis screening is relevant due to long term corticosteroid use in Crohn’s disease, but it is not an urgent concern.
D
Teaching is important for recovery but can be safely delayed until more acute client needs are addressed.
QUESTION #6
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who has appendicitis. While waiting for surgical intervention the client reports wanting to be discharged because they are no longer feeling any pain. Which of the following responses from the nurse is best?
A “No, you are not allowed to leave you already signed consent for surgery.”
B “Please allow me to do an additional assessment and contact the care provider.”
C “Sure, I will get the discharge paperwork.”
D “You are able to leave at any time Against Medical Advice (AMA).”

Explanations

A
Clients have the right to refuse treatment or leave the facility even after signing consent for surgery.
B
Sudden relief of appendicitis pain may indicate appendix rupture, so the nurse should reassess the client and notify the provider immediately.
C
Discharging the client without reassessment could miss a serious complication such as perforation and peritonitis.
D
Although clients have this right, the nurse should first assess the client and notify the provider before discussing AMA discharge.
QUESTION #7
Medical-Surgical Exam 4 Med-Surg
A client calls the primary health care provider’s (PHCP) office and reports abdominal pain, fatigue, dark urine, and bloody bowel movements. The nurse notes that the client has a past medical history of irritable bowel syndrome (IBS). Which of the following medications should the nurse review in the client’s records?
A Alosetron
B Fiber supplement.
C Amitriptyline.
D Psyllium hydrophilic mucilloid.

Explanations

A
Alosetron is used for severe IBS with diarrhea and is associated with serious adverse effects such as ischemic colitis and severe constipation, which can cause abdominal pain and bloody stools.
B
Fiber is commonly used to regulate bowel movements in IBS and is not associated with serious complications like bloody stools.
C
Low-dose tricyclic antidepressants may be used to reduce visceral pain in IBS but are not typically associated with bloody bowel movements.
D
Psyllium is a bulk forming fiber laxative used to improve bowel regularity and does not typically cause gastrointestinal bleeding.
QUESTION #8
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who has a hiatal hernia and has developed aspiration pneumonia. Which of the following nursing interventions should the nurse prioritize to address this complication?
A Encourage the client to consume large meals to increase caloric intake.
B Teach the client deep breathing exercises to enhance lung expansion.
C Position the client in an upright position during and after meals.
D Administer famotidine 20 mg by mouth (PO) twice daily.

Explanations

A
Large meals increase gastric pressure and reflux, which can worsen aspiration risk in clients with hiatal hernia.
B
Deep breathing can improve lung function but does not directly prevent gastric contents from being aspirated.
C
Upright positioning reduces reflux of gastric contents and helps prevent aspiration into the lungs.
D
amotidine reduces gastric acid production but does not directly prevent aspiration of stomach contents.
QUESTION #9
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who has peptic ulcer disease (PUD) and develops sudden abdominal pain. Upon assessment, the nurse identifies the client is hypotensive, tachycardic, and producing coffee-ground emesis. Which of the following interventions should the nurse prioritize?
A Administer pantoprazole 40 mg by mouth (PO).
B Encourage the client to deep breathe to reduce anxiety.
C Provide education about dietary modifications.
D Monitor vital signs and assess for signs of internal bleeding.

Explanations

A
Proton pump inhibitors reduce gastric acid, but this intervention does not address the immediate risk of hemorrhage and shock.
B
Anxiety management is not the priority when the client shows signs of possible gastrointestinal bleeding and hemodynamic instability.
C
Teaching is appropriate for long term management of PUD but is not relevant during an acute complication.
D
Hypotension, tachycardia, and coffee-ground emesis suggest gastrointestinal bleeding, so the priority is assessing hemodynamic status and monitoring for worsening hemorrhage.
QUESTION #10
Medical-Surgical Exam 4 Med-Surg
The nurse is caring for a client who has a small bowel obstruction. The primary health care provider (PHCP) has ordered insertion of a nasogastric (NG) tube. Which of the following does the nurse identify as the primary purpose of this intervention?
A To administer medications directly to the small intestine.
B To provide nutritional support.
C To monitor bowel sounds and abdominal girth.
D To decompress the stomach and relieve pressure.

Explanations

A
NG tubes deliver substances to the stomach, not directly to the small intestine, and medication delivery is not the primary reason in bowel obstruction.
B
Enteral feeding may be done through an NG tube, but in bowel obstruction feeding is usually withheld (NPO) to prevent worsening the obstruction.
C
These are assessment measures performed by the nurse and are not purposes of NG tube insertion.
D
In small bowel obstruction, an NG tube removes accumulated gastric contents, reducing distention, vomiting, and pressure in the gastrointestinal tract.
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