FREE NCLEX Medical Surgical Nursing Questions and Answers 2

Question 1

A nurse is caring for a client with acute myocardial infarction who is receiving IV morphine sulfate. Which finding requires the nurse to take immediate action?

Accepted Answer

Respiratory rate of 10 breaths per minute

Answer

Blood pressure of 100/70 mmHg

Answer

Pain rating of 4/10

Answer

Heart rate of 88 beats per minute

Question 2

A postoperative client who had abdominal surgery 2 days ago reports sudden onset of shortness of breath and pleuritic chest pain. The nurse suspects pulmonary embolism. What is the priority nursing action?

Accepted Answer

Administer oxygen and notify the physician immediately

Answer

Obtain a 12-lead ECG and document findings

Answer

Elevate the affected leg and apply a warm compress

Answer

Encourage deep breathing and incentive spirometry

Question 3

A client with type 2 diabetes mellitus is scheduled for a CT scan with contrast dye. Which medication should the nurse anticipate holding before and after the procedure?

Accepted Answer

Metformin (Glucophage)

Answer

Glipizide (Glucotrol)

Answer

Insulin glargine (Lantus)

Answer

Sitagliptin (Januvia)

Question 4

A nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. The client becomes increasingly confused and lethargic. Which action should the nurse take first?

Accepted Answer

Assess oxygen saturation and notify the physician

Answer

Increase the oxygen flow rate to 4 L/min

Answer

Encourage the client to cough and deep breathe

Answer

Reorient the client and dim the room lights

Question 5

Among the following signs and symptoms, which cluster indicates a client is experiencing cardiogenic shock following an acute MI?

Accepted Answer

Hypotension, tachycardia, cool clammy skin, and decreased urine output

Answer

Hypertension, bradycardia, flushed warm skin, and polyuria

Answer

Normal blood pressure, bradycardia, diaphoresis, and nausea

Answer

Hypotension, bradycardia, warm dry skin, and normal urine output

Question 6

Because older adults frequently underreport pain, the nurse must carefully evaluate pain in this population. Which assessment approach is most appropriate for an elderly client with moderate dementia who has had a hip replacement?

Accepted Answer

Use a behavioral pain scale such as PAINAD to assess nonverbal cues

Answer

Ask the client to rate pain on a numeric scale from 0 to 10

Answer

Administer routine analgesics only when the client requests them

Answer

Rely solely on vital signs to determine the presence of pain