Question

A 65-year-old patient with a history of osteoarthritis reports increased pain and stiffness in the knees, particularly in the morning and after prolonged inactivity. Which intervention is most appropriate to recommend to this patient to help alleviate these symptoms?

Answer 1

Correct Answers:

Apply heat therapy to the affected joints before engaging in physical activity.

Rationale :

✓ In osteoarthritis, joint stiffness and pain worsen after periods of inactivity. ✓ Applying heat before physical activity increases blood flow to the joint capsule, improves tissue elasticity, and promotes muscle relaxation—thereby reducing stiffness. ✓ Heat therapy also helps enhance joint mobility and can improve client participation in prescribed exercises or daily tasks. It is a non-pharmacological, evidence-based intervention for managing chronic joint discomfort in OA.

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Answer 2

Correct Answers:

Electromyography (EMG) and nerve conduction studies

Rationale :

✔️Carpal tunnel syndrome results from compression of the median nerve at the wrist. ✔️EMG and nerve conduction studies are the gold standard diagnostic tools used to assess the electrical activity of muscles and the speed of nerve impulse conduction. ✔️These tests objectively confirm the presence and severity of nerve compression, guiding surgical or non-surgical management. ✔️Clinical tests (e.g., Phalen’s or Tinel’s) may raise suspicion, but EMG provides diagnostic confirmation.

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Answer 3

Correct Answers:

Sudden, brief involuntary muscle jerks typically occurring on both sides of the body.

Rationale :

✔️Myoclonic seizures are a type of generalized seizure characterized by rapid, shock-like muscle jerks that occur without warning. ✔️These jerks are typically bilateral and may affect the arms, shoulders, or neck. Unlike tonic-clonic seizures, they do not cause loss of consciousness or postictal confusion. ✔️They may occur as isolated events or in clusters and can be mistaken for tics or spasms. ✔️Recognizing this pattern is essential for accurate seizure classification and medication management.

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Answer 4

Correct Answers:

Gastrointestinal bleeding
Perforation of the stomach or duodenum
Gastric outlet obstruction

Rationale :

✔️Chronic mucosal erosion from acid and pepsin can lead to GI bleeding, evidenced by hematemesis or melena. ✔️Perforation occurs when the ulcer penetrates through the stomach or duodenal wall, causing peritonitis and requiring emergency surgery. ✔️Gastric outlet obstruction results from chronic inflammation and scarring that narrow the pyloric canal, leading to vomiting and abdominal distention. ✔️ Recognizing these risks helps in early identification and prevention of life-threatening complications.

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Answer 5

Correct Answers:

Place the patient in a side-lying position.

Rationale :

✔️After a tonic-clonic seizure, placing the patient in a side-lying (lateral) position is a priority intervention to maintain airway patency and reduce aspiration risk. ✔️ Postictal patients often have impaired protective reflexes and may have oral secretions or vomit. ✔️The side-lying position allows gravity to drain secretions from the mouth and prevents airway obstruction. ✔️ It is safer than supine positioning, especially in clients who are still recovering consciousness.

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Answer 6

Correct Answers:

Paresthesia
Dysphagia
Spasticity
Vertigo

Rationale :

✔️Paresthesia MS damages the myelin sheath around sensory nerves, disrupting signal transmission and causing tingling, numbness, or burning sensations. These paresthesias commonly affect the limbs and face, reflecting lesion locations in the CNS. ✔️Dysphagia Brainstem demyelination impairs cranial nerves controlling swallowing, leading to choking risks and aspiration. Nurses monitor for coughing during meals and recommend thickened liquids to maintain safety. ✔️Spasticity Disrupted motor neuron signals cause involuntary muscle stiffness, spasms, and pain, particularly in the legs. This results from spinal cord lesions altering muscle tone regulation. ✔️ Vertigo: Cerebellar or brainstem lesions disrupt balance pathways, triggering dizziness and nausea with movement. This reflects MS's impact on coordination centers in the CNS.

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Answer 7

Correct Answers:

Muscle weakness

Rationale :

✔️Hypokalemia, often due to diarrhea, diuretic use, or poor intake, leads to decreased excitability of skeletal muscles. ✔️Potassium is essential for maintaining normal nerve and muscle cell function. ✔️ As serum potassium levels drop, it impairs depolarization, resulting in muscle weakness, cramps, and in severe cases, paralysis. ✔️Early signs may present as weakness in the lower extremities or difficulty standing. ✔️If not corrected, it can progress to respiratory muscle impairment or cardiac arrhythmias.

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Answer 8

Correct Answers:

Monitor the patient's respiratory rate and effort frequently.
Adjust oxygen flow rate to maintain a saturation level of 88-92%.
Encourage the patient to take deep breaths frequently.

Rationale :

✔️Monitor the patient's respiratory rate and effort frequently. COPD patients are at risk of oxygen-induced hypercapnia, so continuous assessment of respiratory status is essential. Increased work of breathing or altered respiratory patterns may indicate worsening retention of CO2. ✔️Adjust oxygen flow rate to maintain a saturation level of 88-92%. Unlike other patients, those with severe COPD rely on hypoxic drive for ventilation. Excessive oxygen can suppress breathing, so target saturations are kept lower (88–92%) to prevent CO2 narcosis while ensuring adequate oxygenation. ✔️Encourage the patient to take deep breaths frequently. Deep breathing helps prevent atelectasis and improves gas exchange, especially in COPD patients with chronic hyperinflation. This also reduces the risk of respiratory fatigue.

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Answer 9

Correct Answers:

"It is important to follow up with a Gl specialist for recommended surveillance for Barrett's esophagus".

Rationale :

✓ Chronic gastroesophageal reflux disease (GERD) can lead to Barrett's esophagus, a condition where normal esophageal squamous cells are replaced by columnar epithelium (metaplasia). ✓ This change increases the risk of developing esophageal adenocarcinoma. ✓ Surveillance with regular EGD (esophagogastroduodenoscopy) and biopsy is required to monitor for dysplasia or malignant transformation. ✓ Follow-up care ensures early detection of cancer and timely intervention.

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Answer 10

Correct Answers:

1440

Rationale :

✓ The provider orders 18 units/kg/hr. ✓ The client weighs 80 kg. ✓ Multiply: 18 units × 80 kg = 1440 units/hr. ✓ This calculation is essential for insulin or heparin infusions where dosing is individualized to the patient's body weight. Accuracy is critical to avoid under- or overdosing.

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RN Medicalsurgical Final Exam

No.

1 : A 65-year-old patient with a history of osteoarthritis reports increased pain and stiffness in the knees, particularly in the morning and after prolonged inactivity. Which intervention is most appropriate to recommend to this patient to help alleviate these symptoms?

2 : A 38-year-old construction worker reports hand weakness and difficulty gripping tools. Examination reveals atrophy of the thenar eminence and decreased sensation in the thumb, index, and middle fingers. What diagnostic test would most likely confirm the diagnosis of carpal tunnel syndrome?

3 : A 23-year-old patient is diagnosed with myoclonic seizures. Which of the following characteristics is most indicative of this type of seizure?

4 : A nurse is reviewing the potential complications associated with peptic ulcer disease (PUD). Which of the following conditions should the nurse recognize as possible complications of PUD? (Select All that Apply.)

5 : A nurse is caring for a patient who has just experienced a tonic-clonic seizure. Which of the following actions should the nurse perform first after ensuring the patient's safety?

6 : A nurse is assessing a client who has multiple sclerosis. Which of the following assessment findings should the nurse anticipate? (Select All that Apply.)

7 : A nurse is assessing a client who has diarrhea. Which of the following findings is a manifestation of hypokalemia?

8 : A patient with COPD is receiving oxygen therapy. Which considerations are important to ensure safe and effective oxygen administration for this patient? (Select All that Apply.)

9 : A nurse is providing teaching to a client who has long-term symptoms of GERD (gastroesophageal reflux disease). Which of the following statements should the nurse include in the educational materials?

10 : A 65-year-old adult patient weighing 80 kg is prescribed a continuous heparin infusion. The order is for 18 units/kg/hour. The pharmacy supplies heparin in a concentration of 25,000 units/500 mL. Determine the total units of heparin the patient should receive per hour.

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