Chapter 30 Medical-Surgical Disorders

Chapter 30  Medical-Surgical Disorders

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?
a.
Regular heart rate and hypertension
b.
Increased urinary output, tachycardia, and dry cough
c.
Shortness of breath, bradycardia, and hypertension
d.
Dyspnea, crackles, and an irregular, weak pulse

ANS: D
Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nailbeds. A regular heart rate and hypertension are not generally associated with cardiac decompensation. Of the symptoms of increased urinary output, tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation. Of the symptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative of cardiac decompensation.

DIF: Cognitive Level: Understand REF: p. 716
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. Which condition would require prophylaxis to prevent subacute bacterial endocarditis (SBE) both antepartum and intrapartum?
a.
Valvular heart disease
b.
Congestive heart disease
c.
Arrhythmias
d.
Postmyocardial infarction

ANS: A
Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. Prophylaxis for intrapartum endocarditis is not indicated for a client with congestive heart disease, underlying arrhythmias, or postmyocardial infarction.

DIF: Cognitive Level: Understand REF: p. 712
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease?
a.
The plan of care for a postpartum client is the same as the plan for any pregnant woman.
b.
The plan of care includes rest, stool softeners, and monitoring of the effect of activity.
c.
The plan of care includes frequent ambulating, alternating with active range-of-motion exercises.
d.
The plan of care includes limiting visits with the infant to once per day.

ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluids. Care of the woman with cardiac disease in the postpartum period is tailored to the woman’s functional capacity. The woman will be on bed rest to conserve energy and to reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

DIF: Cognitive Level: Understand REF: pp. 718-719 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

4. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?
a.
Perform a guaiac test, and record the results.
b.
Recognize the finding as abnormal, and report it to the primary health care provider.
c.
Recognize the finding as a normal result of iron therapy.
d.
Check the woman’s next stool to validate the observation.

ANS: C
The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. A guaiac test would be indicated if gastrointestinal (GI) bleeding was suspected. GI irritation, including dark stools, is also a common side effect of iron therapy. Observation of stool formation is a normal nursing activity.

DIF: Cognitive Level: Apply REF: p. 716 TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiologic Integrity

5. A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma?
a.
Oxytocin (Pitocin)
b.
Nonsteroidal antiinflammatory drugs (NSAIDs)
c.
Hemabate
d.
Fentanyl

ANS: C
Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Oxytocin is the drug of choice to treat this woman’s bleeding; it will not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding.

DIF: Cognitive Level: Analyze REF: p. 722 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity