Practice Quiz

ANCC Medical-Surgical Nursing Exam Prep - Question List

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61. Which nursing action is the first priority during a generalized tonic-clonic seizure episode?
  1. Observe and record all events that occur before, during, and after the seizure
  2. Maintain a patent airway by turning the head to the side
  3. Protect the client from injury
  4. Monitor vital signs, with special attention directed to respiratory status
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62. Levin, age 27, was driving home when his car collided with another moving vehicle. He obtained multiple injuries and a concussion. The paramedics placed a hard neck brace to immobilize the spine. Upon arriving at the hospital, X-rays are inconclusive because of swelling. To assess and care for the skin under the collar, the nurse should:
  1. Place the client flat and supine; remove the anterior section of the collar, turning the head to the right or left to remove the back section.
  2. Have the client sit up in a chair to remove the front and back sections without turning the head from side to side.
  3. Have at least one nurse stabilize the head in line with the torso, while the other nurse removes the collar sections.
  4. Wait until the X-rays are conclusive for any trauma before assessing the skin or providing skin care under the collar.
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63. Troy, 27 years old, suffered from multiple injuries after his car crashed into a moving vehicle. He was then rushed to a nearby hospital where his left leg was amputated below the knee. After surgery, the physician’s orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under Troy’s amputated limb. The nursing action is to:
  1. Leave the pillow, as his stump is elevated
  2. Remove the pillow and elevate the foot of the bed
  3. Leave the pillow and elevate the foot of the bed
  4. Check with the physician and clarify the orders
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64. A client is scheduled for an electroencephalogram (EEG) early in the morning. The nurse working the night shift prior to the procedure would write a note to do which of the following per protocol order in the early morning on the day of the test?
  1. Instruct the client to refrain from washing the hair
  2. Hold the daily dose of anticonvulsant
  3. Place the client on NPO status
  4. Reinforce client teaching that the test is only mildly uncomfortable
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65. S. McCormick, R.N., is one of several persons who witness a vehicle hit a pedestrian at fairly low speed on a street. The person is dazed and tries to get up. The leg appears fractured. Ms. McCormick would plan to:
  1. Try to reduce the fracture manually
  2. Assist the person to get up and walk to the sidewalk
  3. Leave the person for a few moments to call an ambulance
  4. Stay with the person and encourage the person to remain still
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