MCQs in Medical Surgical Nursing (With Explanatory Answers)

MCQs in Medical Surgical Nursing (With Explanatory Answers) Second Edition

Srinanda Ghosh MN Formerly, Principal Woodlands College of Nursing Kolkata, West Bengal, India

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Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2019, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale. Inquiries for bulk sales may be solicited at: [email protected] MCQs in Medical Surgical Nursing (With Explanatory Answers) First Edition: 2007 Second Edition: 2019 ISBN: 978-93-5270-539-9

Printed at Repro India Limited

Preface to the Second Edition The second edition of my book incorporates the most current pharmacological treatment modalities used in the Indian scenario, amongst the others discussed in the previous edition. The comprehensive and brainstorming Multiple Choice Questions (MCQs) in medical surgical nursing would help the students in general nursing and BSc nursing programs, preparing for competitive examinations. I am highly indebted to my colleagues and friends for the invaluable support they have provided me. I also dedicate this book to all my students over the years. Srinanda Ghosh

Preface to the First Edition The constant element in life and nature is “change”, and never more than now have I felt this truth, in the trends of changing examination papers for various admission tests. Multiple choice questions (MCQs) are the mainstay of any competitive examinations and students who have scored well in this examination have avenues opened to them. In my 28 years of academic experience, I have witnessed that a comprehensive book of MCQs on nursing in India is lacking. Taking cue from this, I have decided to write this book of MCQs on Medical Surgical Nursing (which I have taught for many years). The book would pave the path for detailed reviewing of the conditions, symptoms and management of the diseases. The book covers the 12 major areas, namely circulatory, hematological, urinary, respiratory, reproductive, endocrine, integumentary, musculoskeletal, gastrointestinal and nervous systems and immunology and oncology. They are mainly targeted to the BSc students and graduate nurses of both collegiate and diploma program, appearing for competitive examinations. There are some areas which I have not been able to touch upon in this book, and which I intend to cover in my next edition of MCQs. I am highly indebted to my family and friends for the invaluable support they have provided me, while I struggled on with the book for the last two years. I also dedicate this book to all my students over the years. Srinanda Ghosh

Contents 1. Nervous System Including Special Senses (Eye and Ear)

1

2. Circulatory System

37

3. Respiratory System

71

4. Gastrointestinal System and Nutrition

106

5. Urinary System

137

6. Endocrine System and Diabetes

155

7. Reproductive System

189

8. Hematological System, Oncology and Immunology

214

9. Musculoskeletal System

254

10. Integumentary System and Burns

279

1

Chapter

Nervous System Including Special Senses (Eye and Ear)

Q1.

Q2.

A. Chemicals that are manufactured in the nerve cell body B. Chemicals that are manufactured by the myelin sheath of axon C. Transfer information from one neuron to another across synapse D. Exhibit both excitatory and inhibitory action

Q5.

Which of the following neurotrans­ mitters exhibits excitatory action, transmits pleasurable sensation and inhibits pain transmission?

Q6.

A. B. C. D. Q3.

Gamma-aminobutyric acid (GABA) Dopamine Serotonin Endorphin

Frontal lobe Parietal lobe Temporal lobe Occipital lobe

The part of the brain, which is respon­ sible for coordination of movement is: A. Brainstem B. Cerebellum

After a head injury a patient has lost his recent memory. Which lobe of the brain is affected? A. B. C. D.

Q7.

Thalamus Hypothalamus Limbic system Medulla

What is the function of the cranial nerve IV? A. B. C. D.

Q8.

Frontal Occipital Parietal Temporal

The heat regulatory center is located in the: A. B. C. D.

The lobe of the brain that contains the primary sensory cortex, which ana­ lyzes sensory information is the: A. B. C. D.

Q4.

C. Thalamus D. Hypothalamus

Which of the following statements is not true about neurotransmitters?

Hearing Vision Eye movement Chewing

The cranial nerve that is responsible for hearing and maintaining balance is the: A. B. C. D.

Trochlear Vestibulocochlear Trigeminal Vagus

2

MCQs in Medical Surgical Nursing with explanatory answers Q9.

Drooping eyelid (Ptosis) is a disorder of which cranial nerve? A. B. C. D.

CN III CN V CN VI CN VIII

Q10. Bell’s palsy is a disorder of which cra­ nial nerve? A. B. C. D.

CN IV CN VII CN IX CN XII

Q11. What is the first thing a nurse should assess to determine the presence of neu­ rological changes?

A. B. C. D.

Vital signs Level of consciousness Mental status Reflexes

Q12. Objective measurement of patient’s lev­ el of consciousness is best determined by using Glasgow:

A. B. C. D.

Consciousness scale Communication scale Coma scale Stimuli scale

Q13. During neurological assessment the nurse asks the patient to close his eyes and then to smell and identify different odors. Ability to correctly perceive any one smell signifies proper functioning of which of the following cranial nerves?

A. B. C. D.

Cranial nerve I Cranial nerve II Cranial nerve V Cranial nerve VII

Q14. The nurse is assessing a patient to detect the status of cranial nerves. Which of the following findings is an abnormality noted with cranial nerve VII dysfunc­ tion? A. Face movements symmetrical with smiling

B. Increased tearing C. Inability to differentiate different taste D. Presence of nasolabial fold Q15. Which of the following assessment find­ ings indicates dysfunction of cranial nerve XI? A. Inability to swallow B. Hoarse voice C. Inability to move the tongue from side to side D. Inability to shrug shoulders Q16. The nurse is performing a routine neu­ rological assessment of a patient. To assess the function of the cranial nerve XII (hypoglossal) the nurse should ask the patient to: A. B. C. D.

Make chewing movements Drink a small amount of water Taste different food items Stick out the tongue and move it from side to side and in and out

Q17. Nurse understands that assessment of mental status is an essential component of neurological assessment. Which part of the brain is evaluated by mental sta­ tus examination? A. B. C. D.

Cerebrum Cerebellum Midbrain Thalamus

Q18. One of the important components of neurological assessment is examination of motor system. Motor system exami­ nation includes: A. Assessment of bulk, tone, and power of the major muscle groups of the body B. Assessment of mechanical sensation C. Assessment of balance and coordination D. All except B Q19. The heel­to­shin test assesses: A. Muscle strength of lower extremities B. Muscle coordination of lower extremities

Nervous System Including Special Senses (eye and ear) C. Involuntary movements of lower extremities D. All of the above

Q25. Which of the following reflexes if found in a patient during neurological exami­ nation is considered abnormal? A. B. C. D.

Q20. Which of the following assessment find­ ings indicates cerebeller disease? A. B. C. D.

Pronator drift Spasticity Ataxic gait Chorea

Q21. Which of the following terms describes discrete, jerky, purposeless movements in distal extremities and face? A. B. C. D.

A. B. C. D.

Akinesia Athetosis Apraxia Agnosia

Q23. The nurse is assessing best motor res­ ponse in an unconscious patient. With painful stimuli the patient flexes, ad­ ducts and internally rotates the wrists and arms to the chest and rigidly ex­ tends the legs. She records her findings as: A. B. C. D.

Normal posturing Spastic posturing Decorticate posturing Decerebrate posturing

Q24. All of the following reflexes are exam­ ples of superficial reflexes except: A. B. C. D.

Q26. A patient with a space­occupying lesion is scheduled for a CT scan of head. The nurse prepares the patient for the test by: A. Keeping the patient NPO 4–6 hours before the test B. Ensuring that the patient is not allergic to iodine, contrast medium or shellfish C. Obtaining an informed consent D. Both B and C

Chorea Myoclonus Tic Tremors

Q22. Which of the following terms refers to in­ ability to carry out a learned movement on command in the absence of weakness or paralysis?

Planter Corneal Patellar Pharyngeal or Gag

Corneal Pupillary Achilles or ankle jerk Chewing

Q27.

A patient with suspected brain tumor is scheduled for a CT scan. To prepare the patient for this test the nurse should: A. Describe the equipment involved in this procedure B. Shampoo patient’s hair C. Explain that no radiation will be involved in this test D. Withhold routine medication before the test

Q28. Which of the following tests enables vi­ sualization of physiologic functions in body areas? A. B. C. D.

Computed tomography (CT) Magnetic resonance imaging (MRI) Positron emission tomography (PET) Doppler scanning

Q29. X­ray examination of the spinal cord and vertebral canal following introduc­ tion of a contrast material into the spinal subarachnoid space is known as: A. B. C. D.

Angiography Myelography Spinal tap Electromyography

3

4

MCQs in Medical Surgical Nursing with explanatory answers Q30. All of the following statements regarding lumbar puncture is true except:

D. Asking the patient to cough when the needle has been inserted

A. The needle is inserted into the lumbar subarachnoid space of the spinal canal B. Purposes may be diagnostic or therapeutic C. Strict aseptic technique must be observed D. Sh o u l d i m m e d i at e l y p re c e d e encephalography or myelography

Q34. A patient who demonstrates a stuporous level of consciousness:

Q31. Which of the following nursing inter­ ventions after a lumbar puncture will prevent spinal headache in patient? A. Instruct the patient to lie in bed for 3–4 hours B. Encourage drinking extra fluids C. Withheld food and fluids for 3–4 hours D. Both A and B Q32. A patient who had an episode of sei­ zure for the first time has been ordered an electroencephalogram (EEG). The nurse is instructing the patient regard­ ing preprocedure care. Which of the following instructions is not appropri­ ate? A. “You can have normal food and fluids before the test” B. “Avoid taking stimulants, e.g. tea, coffee, alcohol, cola and cigarettes for 24–48 hours” C. “Avoid shampooing your hair for 3 days before the test” D. “Withheld anticonvulsant 48 hours before the test” Q33. A patient has to undergo a lumbar punc­ ture. The nursing responsibilities will include all of the following except: A. Obtaining an informed consent B. Encouraging the patient to evacuate bladder and rectum C. Placing the patient laterally with the knees drawn-up to the abdomen and the chin drawn to the chest

A. Is oriented but sleeps often, has slowed speech B. Sleeps almost constantly, can be aroused, follows simple command C. Awakens only with vigorous stimulation D. Does not respond to environmental stimuli Q35. A patient has been admitted in medical surgical unit in a comatose state. Coma in an individual may be caused by: A. Structural lesions in the brain affecting reticular activating system (RAS) B. Functional lesions in the brain C. Metabolic disorders D. Both A and C Q36. The following types of seizures are all examples of generalized seizures except: A. B. C. D.

Myoclonic Tonic Clonic Myoclonic-tonic

Q37. Which of the following types of seizure is most common? A. B. C. D.

Partial seizures Tonic-clonic Atonic Absence

Q38. In which of the following types of sei­ zures there is sudden uncontrollable jerking movements of single or multi­ ple muscle groups, sometimes causing the patient to fall? A. B. C. D.

Tonic-clonic Tonic Myoclonic Clonic

Nervous System Including Special Senses (eye and ear) Q39. A patient who had an attack of seizures reports seeing a flashes of light before his seizures. Which of the following terms describes this condition? A. B. C. D.

Autonomic manifestation Precipitating factor Aura Postictal experience

Q40. While assessing vital signs of a patient having recurrent attacks of seizures the nurse should: A. Take an axillary temperature every 4 hourly B. Observe for bradycardia C. Observe for bradypnea D. All of the above Q41. A patient admitted with epilepsy for in­ vestigation suddenly started having a tonic­clonic seizure. The nurse should: A. Lay the patient to the bed, remove pillows, raise side rails and insert an oral airway B. Lay the patient to the bed, remove pillows, raise side rails and restrain his arms C. Lay the patient on bed, place the patient on one side, remove pillows, raise side rails, and ensure patent airways D. Lay the patient on bed, place the patient on his back, remove pillows, raise the side rails, and insert an oral airway Q42. The nurse teaching the family members of a patient who has recently been diag­ nosed as a case of idiopathic epilepsy, regarding precaution to be taken dur­ ing a seizure. Which of the following the nurse should include in the teaching? A. Lay the patient on a flat surface, insert a padded spoon between the teeth B. Lay the patient on a flat surface, turn him on his side and protect his head C. Lay the patient on a flat surface, remove all furniture out of his way D. Lay the patient and hold his arms and legs still

Q43. A patient with new onset tonic clonic seizures has been prescribed phenyt­ oin 100 mg BD. The nurse should teach which of the following regarding treat­ ment with phenytoin? A. Discontinue to the drug if you experience palpitation B. If you continue to feel sleepy reduce the dose by half of the daily dose C. Attend regular follow-up visits and periodical assessment of plasma concentration of the drug D. Stop taking the drug once you are symptom free for 3 months Q44. A patient with seizure disorder is be­ ing taught about self­care. Which of the following statements by the patient indi­ cates further teaching? A. “I should not go for swimming alone” B. “I need to avoid alcohol, coffee and tea” C. “Meditation and relaxation therapy will be good for me” D. “I can continue driving my two wheeler as much as I like” Q45. The patients with seizures are usually advised to refrain from alcoholic beve­ rages. Which of the following statements supports the rationale behind this ad­ vice? A. Alcohol lowers seizure threshold B. Alcohol is detoxified by the liver, interrupting metabolism of anticonvulsant drugs C. Alcohol necessitates increase dosing of antiepileptic drugs D. Both A and B Q46. Which of the following side effects may occur during phenytoin therapy? A. B. C. D.

Thickened gum Dry mouth Drowsiness Tachycardia

5

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