Medical Surgical Nursing MCQ Quiz - Objective Question with Answer for Medical Surgical Nursing - Download Free PDF

• A lumbar puncture (LP), also known as a spinal tap, is a procedure in which a needle is inserted into the spinal canal to collect cerebrospinal fluid (CSF) for diagnostic or therapeutic purposes. One of the most common complications following this procedure is a post-lumbar puncture headache (PLPH), which occurs due to a leak of CSF from the puncture site.
• The correct intervention to alleviate symptoms of post-lumbar puncture headache is to position the bed with the foot end raised (Trendelenburg position). This position helps by redistributing CSF and reducing the downward pull of gravity on the brain and meninges, thereby relieving the headache.
• Encouraging the patient to stay well-hydrated and lie flat for a period after the procedure can also help reduce the risk of headache.

• Rationale: The lithotomy position involves lying on the back with the legs flexed and elevated, typically used for gynecological, urological, and rectal procedures. This position is not relevant for managing headaches following a lumbar puncture.

• Rationale: In the Semi-Fowler position, the head of the bed is elevated to 30-45 degrees, commonly used for patients with respiratory distress or to facilitate digestion. However, this position may exacerbate post-lumbar puncture headaches by increasing the downward pull of gravity on the brain and meninges.

• Rationale: Raising the head end of the bed is contraindicated in cases of post-lumbar puncture headache. This position can worsen the headache by further reducing CSF pressure in the cranial cavity.

• Post-lumbar puncture headaches can be severe and are more common in younger patients, women, and those with a smaller body mass index. To minimize the risk of this complication, the use of a smaller-gauge needle and adequate hydration is recommended.
• If conservative management (e.g., bed rest, hydration, caffeine) does not alleviate the headache, a blood patch procedure may be performed. This involves injecting a small amount of the patient’s blood into the epidural space to seal the CSF leak.

• Raising the foot end of the bed is the most appropriate intervention for managing post-lumbar puncture headache. This position helps alleviate symptoms by redistributing cerebrospinal fluid and relieving intracranial tension caused by CSF leakage.

• Candida vaginitis is a fungal infection caused by Candida species, most commonly Candida albicans. It is one of the most common causes of vaginal itching and discharge.
• The clinical presentation described in the question aligns with Candida vaginitis, which typically includes severe itching, redness, swelling of the vulva, and a thick, curdy white discharge adhering to the vaginal walls.
• Candida thrives in warm and moist environments and can be triggered by factors such as pregnancy, diabetes, antibiotic use, immunosuppression, or hormonal changes.

• Symptoms: Intense vaginal itching, burning sensation, thick white discharge with a cottage cheese-like texture, and erythema (redness) of the vulva and vagina.
• Diagnosis: Clinical observation combined with laboratory tests such as wet mount microscopy, where budding yeast or pseudohyphae can be identified, or fungal culture for confirmation.
• Treatment: Antifungal medications such as fluconazole (oral) or clotrimazole/miconazole (topical) are commonly used.
• Prevention: Maintaining good hygiene, avoiding tight clothing, managing underlying conditions like diabetes, and limiting unnecessary antibiotic use.

• Rationale: Trichomonal vaginitis is caused by the protozoan Trichomonas vaginalis. Symptoms typically include frothy, yellow-green vaginal discharge with a foul odor, itching, and strawberry cervix (petechiae on the cervix). The description provided in the question does not match these clinical features.

• Rationale: Tubercular vaginitis is a rare condition caused by Mycobacterium tuberculosis. It often presents with nonspecific symptoms like pelvic pain, irregular menstrual cycles, and discharge. It is not associated with thick curdy white discharge or severe itching, making this option incorrect.

• Rationale: Chlamydia-related infections typically involve the cervix (cervicitis) rather than causing vaginitis. Symptoms may include mucopurulent cervical discharge, pelvic pain, and intermenstrual bleeding. It does not present with curdy white discharge or red swollen vulva as described in the question.

• The clinical features provided, including severe vaginal itching, red swollen vulva, and thick curdy white discharge adhering to the vaginal walls, strongly suggest Candida vaginitis. Other options do not align with the described symptoms and presentation.

• Myopia, also known as nearsightedness, is a common refractive error of the eye where distant objects appear blurry while nearby objects can be seen clearly. This occurs because the light entering the eye focuses in front of the retina instead of directly on it.
• A concave lens is used to correct myopia as it diverges the incoming light rays before they enter the eye. This divergence shifts the focal point further back, allowing the light to focus directly on the retina and thus enabling clear vision of distant objects.
• Concave lenses are prescribed based on the severity of myopia, measured in diopters. The stronger the myopia, the higher the power of the concave lens required.
• These lenses are characterized by their thinner center and thicker edges, which create the diverging effect needed for correction.

• Rationale: Convex lenses converge light rays and are used to correct hyperopia (farsightedness), not myopia. Hyperopia occurs when the light focuses behind the retina, and the convex lens helps bring the focal point forward onto the retina.

• Rationale: Cylindrical lenses are used to correct astigmatism, a condition caused by irregular curvature of the cornea or lens. Unlike myopia or hyperopia, astigmatism affects vision clarity in all directions, and cylindrical lenses help focus the light correctly on the retina.

• Rationale: A plain lens, also known as a plano lens, has no refractive power and does not alter the focus of light. It is typically used in protective eyewear or fashion glasses, not for correcting refractive errors like myopia.

• Myopia is often diagnosed during routine eye exams, and corrective lenses are the most common treatment. Other options include contact lenses, orthokeratology (special reshaping lenses worn overnight), or refractive surgery such as LASIK.
• Lifestyle factors, such as prolonged screen usage and lack of outdoor activities, can contribute to the progression of myopia, especially in children. Preventive measures, such as regular breaks during close work and spending time outdoors, are recommended.

• Among the given options, concave lenses are the correct choice for correcting myopia as they address the underlying issue of light focusing in front of the retina. Other lens types serve different corrective purposes and are not suitable for treating nearsightedness.

• The priority intervention for a male patient presenting with burns to the face, chest, and arms, along with difficulty in breathing and chest pain, is to assess his airway. This is because airway management is critical in burn injuries, especially when facial burns are involved, as they may lead to swelling, obstruction, or inhalation injuries.
• Burn injuries to the face and chest heighten the risk of airway compromise due to edema, soot inhalation, or thermal injury to the upper airway. This can result in respiratory distress or failure if not promptly addressed.
• Difficulty in breathing suggests potential airway obstruction, smoke inhalation, or damage to the respiratory tract, necessitating immediate evaluation and possible interventions such as oxygen administration, intubation, or securing the airway.
• Airway assessment includes inspecting for signs of facial burns, singed nasal hairs, soot in the mouth or nose, hoarseness, stridor, and respiratory effort. Early intervention can prevent life-threatening complications.

• Rationale: Cleaning the burn wound is important for infection control and wound management. However, it is not the priority in this scenario. The patient’s immediate airway and breathing must be stabilized before addressing burn wound care.
• Cleaning the wound can be delayed until after the patient is stabilized and life-threatening issues are addressed.

• Rationale: Monitoring cardiovascular status is essential in burn patients because severe burns can lead to hypovolemia and shock. However, this step comes after ensuring the airway is secure and breathing is adequate. Immediate airway assessment takes precedence over cardiovascular monitoring.
• Once airway and breathing are stabilized, cardiovascular status can be monitored for signs of hypovolemic shock or fluid loss.

• Rationale: Initiating IV fluid resuscitation is crucial in burn patients to prevent hypovolemic shock and maintain tissue perfusion. However, this is not the first priority in this scenario. Securing the airway and addressing breathing difficulties must be the initial focus before fluid resuscitation.
• Fluid therapy is typically guided by the Parkland formula, but it is implemented after life-threatening airway and breathing issues are managed.

• In the given scenario, assessing the airway is the immediate priority because of the risk of airway compromise due to facial burns and difficulty in breathing. While other interventions like wound cleaning, cardiovascular monitoring, and IV fluid resuscitation are important, they are secondary to securing the airway and ensuring proper ventilation. Early airway management is critical to prevent potentially fatal complications.

• The patient’s complaint of persistent restlessness and the need to move constantly is indicative of akathisia, a common extrapyramidal symptom (EPS). Extrapyramidal symptoms are side effects of antipsychotic medications, particularly first-generation antipsychotics, which affect the dopaminergic pathways in the brain.
• Akathisia is characterized by an inner sense of restlessness, inability to stay still, and constant movement, such as pacing or fidgeting. It is essential for the nurse to assess the patient for other EPS like dystonia (muscle contractions), parkinsonism (tremors, rigidity, bradykinesia), or tardive dyskinesia (involuntary movements).
• A thorough assessment will help determine the severity of the symptoms and guide appropriate interventions, which may include adjusting the medication dosage, switching to another antipsychotic, or prescribing medications like beta-blockers or anticholinergics to manage EPS.

• Rationale: While rest may seem like a logical suggestion, it does not address the underlying cause of the patient’s restlessness. Akathisia is a physiological side effect of antipsychotic medications and cannot be relieved through rest alone. This approach risks dismissing the patient’s concerns and may lead to frustration or noncompliance with treatment.

• Rationale: Encouraging physical activity like walking may provide temporary relief for the patient’s restlessness but does not address the root cause of akathisia. This option might also overlook the need for a detailed assessment to identify the severity and other possible EPS symptoms.

• Rationale: Psychomotor agitation is a symptom of schizophrenia, but the patient’s description of restlessness and constant movement is more likely related to akathisia caused by antipsychotic medication. Educating the patient about psychomotor agitation may confuse them and divert attention from addressing the medication side effects.

• Assessing for extrapyramidal symptoms is the correct approach as it allows the nurse to identify akathisia and other potential side effects of antipsychotic medications. Early recognition of EPS is crucial for providing appropriate interventions, improving patient comfort, and ensuring compliance with treatment.
• Understanding the nature of akathisia and distinguishing it from psychomotor agitation or other conditions is vital for providing effective care and improving the patient's overall quality of life.

The correct answer is Joints.

• Arthritis is the disease of Joints.

Key Points

• Arthritis:
  • The main symptoms of Arthritis are the swelling and tenderness of our joints.
  • The other symptoms of arthritis are joint pain and stiffness, which typically become worsen with age.
  • Arthritis occurs when your body's immune system attacks the tissues of the body.
  • There are two most common types of arthritis:
    • Osteoarthritis: Most common type of Arthritis.
    • Rheumatoid arthritis: Caused due to attack of the immune system on part of our body.

Additional Information

• Skin: 
  • ​The most common form of skin disease is
    • Acne
    • Eczema
    • Psoriasis 
• Kidney: 
  • ​The most common form of kidney disease is chronic kidney disease. 
    • Type 1 or type 2 diabetes
    • High blood pressure
• Liver: 
  • ​The most common types of liver infection are hepatitis viruses, including: 
    • Hepatitis A
    • Hepatitis B
    • Hepatitis C

Concept:

• As per the Centers for Disease Control and Prevention (CDC) guidelines says hand hygiene takes at least 20- 30 seconds. Duration of Hand Hygiene varies as per the type of Handwashing.

Types of Hand Washing

Social Handwashing

• It is the process of cleansing of hands from all the physical debris and to prevent from infectious diseases. It helps to remove the microorganisms from the skin surface. This is preferred when hands are visibly soiled or before eating etc.
• Duration: 20 to 30 seconds with soap and water.

Antiseptic Handwashing

• It is the procedure to maintenance od hand hygiene with the help of Anti Septic Solutions including chlorhexidine and iodine.
• This is used when hands are not visibly soiled and after touching and before touching the patient.
• Duration is at least 20 Seconds.

Surgical Hand Washing

• As the name suggests, this is used prior to sterile operations, including surgical procedures.
• This procedure mainly removes resident microorganisms that live on the surface of the skin in addition to transient microorganisms.
• Immediately after surgical handwashing surgical gloves are donned to prevent microorganisms from returning to the surface of the skin.
• Duration: is for 2–6 minutes

The correct answer is option 2, i.e. Myopia is caused due to excessive curvature of the eye lens and can be corrected by using a concave lens.

• Myopia:
  • Also known as near-sightedness.
  • The far point is nearer than infinity.
  • A person with this defect can see nearby objects but cannot see distant objects distinctly.
  • Image of the distant object is formed in front of the retina.
  • Arise due to - (a) excessive curvature of the eye lens, (b) elongation of the eyeball.
  • Correction - concave lens of suitable power.

• Hypermetropia:
  • The focal length of the eye lens is too long and can be corrected by the convex lens of suitable power.
• Presbyopia:
  • Decreases the power of accommodation and can be corrected by using bi-focal lenses.

Concept:

• Endocrine glands lack ducts and are hence, also called ductless glands. Their secretions are called hormones which are directly released into the bloodstream.
• The adrenal cortex produces three main types of steroid hormones: mineralocorticoids, glucocorticoids, and androgens.
• Mineralocorticoids (aldosterone) -> zona glomerulosa ->blood pressure and electrolyte balance.
• Glucocorticoids cortisol and cortisone -> zona fasciculata -> metabolism and immune system suppression.
• Androgens -> zona reticularis -> converted to fully functional sex hormones in the gonads

Regulation:

• Glucocorticoids are under the regulatory influence of the hypothalamus-pituitary-adrenal HPA axis. Glucocorticoid synthesis is stimulated by the adrenocorticotropic hormone ACTH.
• Mineralocorticoid secretion is regulated mainly by the renin-angiotensin-aldosterone system RAAS. The juxtaglomerular apparatus of the kidneys release the enzyme renin into the blood, which starts reactions that lead to the formation of Angiotensin II. [Mineralocorticoids are not under influence of the pituitary so even if the adrenal gland is endocrine it does not answer]

Explanation:

• The pituitary gland is the master gland of the body as it controls the functioning of many other endocrine glands.
• The pituitary gland is located in a bony cavity called Sella tursica and is attached to the hypothalamus by a stalk.
• It secretes several hormones like growth hormone (GH), prolactin (PRL), thyroid-stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), and luteinizing hormone (LH), follicle-stimulating hormone, melanocyte-stimulating hormone (MSH), oxytocin and vasopressin.
• Thyroid-stimulating hormone (TSH) stimulates the synthesis and secretion of thyroid hormones from the thyroid gland.
• In males, Luteinizing hormone (LH) stimulates the synthesis and secretion of hormones called androgens from the testis.

Hence, the two endocrine glands which secrete their hormones when they receive orders from the pituitary through its hormones are the thyroid & testis.

Mistake Points In this Question the thyroid and testis are exclusively endocrine and receive their order from the pituitary gland to secrete their hormones. The adrenal gland and part of its secretion are independent of the pituitary.

The correct answer is Eye.

Key Points

• The conjunctiva is a thin, transparent mucous membrane.
• It lines the inner surface of the eyelids and covers the sclera (the white part of the eye). 
• The conjunctiva contains glands that produce secretions that help to keep the eyes moist, and antibodies, which reduce infection.
• Conjunctivitis means ‘inflammation of the conjunctiva’.

Additional Information

• It is usual for both eyes to be affected in infectious cases. 
• Some causes include: 
  • The commonest cause is an infection by viruses or bacteria.
  • Due to chemical irritants.
  • Traditional eye remedies or allergies.

Important Points

• Effects:
  • The eyes are red and uncomfortable. 
  • Make the eyelids stick together.
  • The vision is usually not affected.

   Concept:

• Glasgow Coma Scale is the scoring system used to describe the level of consciousness in a person having a traumatic brain injury. It is used to rule out the level of acute brain injury.
• The minimum score on Glasgow Coma Scale is 3 indicates a deep coma or a brain-dead state. The maximum score is 15 which indicates a fully awake patient. 

Components of the Glasgow Coma Scale

• Eye-opening
• Motor Response
• Verbal Responses

Interpretation

 Patients with  3 to 8 scores are usually considered to be in coma. Generally, brain injury is classified as:

• Severe: GCS < 8–9
• Moderate: GCS 8 or 9–12 
• Minor: GCS ≥ 13.

Explanation-

Cushing's syndrome

• It is also known as hypercortisolism.
• It happens when there’s extra cortisol in the body.
• Signs and symptoms are high blood pressure, abdominal obesity etc.
• It can be fatal if untreated.

Additional Information

Acromegaly

• It is a hormonal disorder.
• It happens when the pituitary gland produces too much growth hormone during adulthood.
• Bones size increases which lead to increased height and are called gigantism.

Addison's disease

• It is also called adrenal insufficiency.
• It causes inadequate production of the steroid hormones cortisol and aldosterone.
• Tuberculosis is the most common cause of Addison's disease.

Pituitary dwarfism

• It is also known as growth hormone deficiency.
• It is caused by insufficient amounts of growth hormone (pituitary) in the body.
• It can be congenital or acquired.

The correct answer is inflammation in the airway.

• Asthma is an inflammatory disease of the airways to the lungs which makes breathing difficult and affects some physical activities in humans.

Key Points

• In this disease, the air passages of the lungs become too narrow because of excessive production of mucus.
• The most common symptoms of asthma include wheezing, tightness in the chest, fatigue, coughing, and shortness of breath.
• Cystic fibrosis is a hereditary disease that affects the lungs and digestive system.
• It can be life-threatening.

Additional Information 

• Pneumonia is an infection that causes the inflammation of the air sacs in one or both lungs. It is caused by a variety of organisms, including bacteria, viruses, and fungi.
• Tuberculosis (TB) is a contagious infection that attacks our lungs. It is caused by a type of bacteria called Mycobacterium tuberculosis.

Acromegaly-

• A disorder in adults in which the pituitary gland produces too much growth hormone. This leads to overgrowth of bone known as Acromegaly in adulthood.
• In childhood overproduction of growth hormone leads to an excessive increase in height known as Gigantism.
• Acromegaly is usually caused by a non-cancerous tumor. 
• Middle-aged adults are most commonly affected.
• Symptoms include enlargement of the face, hands, and feet.
• Gigantism occurs when there is an increase in the secretion of growth hormone before the fusion of the long bone epiphysis and is characterized by tall stature.
• Acromegaly occurs when hypersecretion of Growth Hormone occurs after the fusion of the epiphysis leading to large extremities and characteristic faces.
• Surgery of the Pituitary Gland cures acromegaly but in some cases, tumor size is so large to remove entirely so radiation therapy is given.

Additional Information

• Cushing Syndrome Defined:
  • A metabolic disorder caused by the overproduction of corticosteroid hormones by the adrenal cortex often involves obesity and high blood pressure.
  • The most common cause is the use of steroid drugs.
  • But it can also occur from an overproduction of cortisol by the adrenal glands.
  • Too much cortisol can produce some of the hallmark signs of Cushing syndrome :
    •  A fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin.
• Lack of iodine causes an abnormal enlargement of the thyroid gland which is called a goitre.
  • Thyroid Gland:
    • The hormones secreted by it are Thyroxine and Triiodothyronine.
    • Iodine is secreted in more quantity.
• Tetany is a symptom described as an involuntary contraction of muscles that leads to painful muscle cramps, spasms of the larynx, and sensory disturbances.

Concept:

• Stomach -> A muscular organ which is located on the left side of the upper abdomen.
• The stomach receives food from esophagus through lower esophageal sphincter.
• The stomach secretes acids and enzymes for the digestion of food.

Explanation:

• G-cells or Gastrin Cells responsible for the synthesis and secretion of gastrin.
• Primarily, gastrin is produced by antrum of the stomach.
• But it can also secreted by the duodenum and pancreas when stimulated by vagal efferent neurons and GRP neurons.
• Functions:
  • Enhancing gastric mucosal growth
  • Gastric motility
  • Secretion of HCL into the stomach.

Additional Information

• Cardia -> Upper portion of the stomach, prevents acidic contents of the stomach from moving upward into the esophagus.
• Fundus -> Dome shaped superior dilation of the stomach, collects digestive gases.
• Duodenum -> This also produces less amount of gastrin.