Adult Quiz 3 exam 4 practice questions
A nurse is admitting a patient with advanced renal carcinoma. Which clinical manifestations represent the "classic triad" observed in patients with renal cancer? Fever, chills, and flank pain Hematuria, flank pain, and palpable mass Hematuria, proteinuria, and palpable mass Flank pain, palpable abdominal mass, and proteinuria
b
A nurse is assessing an older adult client in an extended care facility. This nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to a fecal impaction? a. the client reports he had a bowel movement yesterday b. the client is having small, frequent liquid stools c. the client is flatulent d. the client indicates he vomited once this morning
b
A nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice is most appropriate? a. iced tea b. dry toast c. hot coffee d. plain yogurt
b
A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? Immediately start enteral feeding to prevent malnutrition. Insert an NG and maintain NPO status to allow pancreas to rest. Initiate early prophylactic antibiotic therapy to prevent infection. Administer acetaminophen (Tylenol) every 4 hours for pain relief.
b
A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 7:00 AM, 10:00 AM, and 1:00 PM 8:00 AM, 12:00 PM, and 4:00 PM 9:00 AM and 3:00 PM 9:00 AM, 12:00 PM, and 3:00 PM
b
A pregnant woman is experiencing amenorrhea, morning sickness, and breast tenderness. In the ninth week after her last menstrual period, she is rushed to the hospital with severe left shoulder pain, blood pressure of 90/60 mm Hg, and heart rate of 112 beats/min. What is the best diagnostic test is expected? Serum hemoglobin Transvaginal ultrasound 12-lead electrocardiogram (ECG) Serial ß-human chorionic gonadotropin levels
b
After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected? Tinnitus Drowsiness Reduced hearing Sensation of falling
b
The nurse identifies that which patient is at highest risk for developing colon cancer? A 28-yr-old man who has a body mass index of 27 kg/m2 A 32-yr-old woman with a 12-year history of ulcerative colitis A 52-yr-old man who has followed a vegetarian diet for 24 years A 58-yr-old woman taking prescribed estrogen replacement therapy
b
The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect? Hematochezia Left upper abdominal pain Ascites and peripheral edema Temperature over 102o F (38.9o C)
b
The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer? A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia A 72-yr-old African American man who has smoked cigarettes for 50 years A 23-yr-old man who has cystic fibrosis-related pancreatic enzyme insufficiency A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus
b
The nurse is caring for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention? Offer the patient an herbal supplement such as ginseng. Apply a cool washcloth to the forehead and provide mouth care. Take the patient for a walk in the hallway to promote peristalsis. Discontinue any medications that may cause nausea or vomiting.
b
The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? Osteoarthritis History of colorectal polyps History of lactose intolerance Use of herbs as dietary supplements
b
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What is the nurse's priority? Prevent all oral intake. Control abdominal pain. Provide enteral feedings. Avoid dietary cholesterol.
b
What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for a colectomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery
b
When providing discharge teaching for a patient after a laparoscopic cholecystectomy, what information should the nurse include? Do not return to work or normal activities for 3 weeks. A lower-fat diet may be better tolerated for several weeks. Bile-colored drainage will probably drain from the incision. Keep the bandages on and the puncture site dry until it heals.
b
Which task could the registered nurse delegate to unlicensed assistive personnel (UAP) during the care of a patient who has had recent transverse rectus abdominis musculocutaneous (TRAM) flap surgery? Document the condition of the patient's incisions. Mobilize the patient in a slightly hunched position. Change the patient's abdominal and chest dressings. Change the parameters of the patient-controlled analgesic (PCA) pump.
b
A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities
c
A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? Requires two tablets of Tylenol #3 during the night Complains of fatigue and claims to have minimal appetite Continuous bladder irrigation (CBI) infusing, but output has decreased Expressed anxiety about his planned discharge home the following day
c
A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A nursing assistant on the unit who also has hospice experience A licensed practical nurse that has worked on the unit for 10 years A registered nurse with 6 months of experience on the surgical unit A registered nurse who has floated to the surgical unit from pediatrics
c
A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants? Inappropriate lactation necessitates breast biopsy. Nipple discharge of any type is considered a precursor to cancer. Unexpected nipple discharge of any type warrants medical follow-up. Galactorrhea is a normal age-related change and a frequent perimenopausal symptom.
C
The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? Keep affected arm flat at the patient's side. Apply an elastic bandage on the affected arm. Assess blood pressure only on unaffected arm. Restrict exercise of the affected arm for 1 week.
C
The nurse is caring for an obese 67-yr-old woman after a right mastectomy with axillary lymph node dissection. Which discharge instruction should the nurse include? "Arm exercises should not be started for 4 to 6 weeks." "Discontinue arm exercises if you have discomfort or pain." "Special massage therapy can decrease swelling in your arm." "Keep your right arm in a sling to decrease pain and swelling."
C
A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the physician. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.
c
After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate.
c
The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer? A 25-yr-old female patient with fibrocystic breast disease A 59-yr-old male patient who has inherited the APC gene A 72-yr-old female patient with a family history of breast cancer A 43-yr-old male patient who is obese and leads a sedentary lifestyle
c
The nurse determines a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? a. nausea b. belching c. epigastric pain d. difficulty swallowing
c
The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates understanding of the instructions? "This medication will help me digest fats and fat-soluble vitamins." "I will apply the medicated lotion sparingly to the areas where I itch." "The medication is a powder and needs to be mixed with milk or juice." "I should take this medication on an empty stomach at the same time each day."
c
The nurse performs a breast examination on a 68-yr-old female patient. Which clinical manifestation indicates further evaluation for breast cancer is needed? Bilateral pendulous breasts Right breast is warm, painful to touch Irregular, nontender lump with induration Palpable lump that is tender and movable
c
The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? Antibiotic(s), antacid, and corticosteroid Antibiotic(s), aspirin, and antiulcer/protectant Antibiotic(s), proton pump inhibitor, and bismuth Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
c
To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? Uroflowmetry Transrectal ultrasound Digital rectal examination (DRE) Prostate-specific antigen (PSA) monitoring
c
When doing breast self-examination, the female patient should report which findings to her health care provider? Palpable rib margins Denser breast tissue Left nipple deviation Different sized breasts
c
Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? Tighten both buttocks together. Squeeze thighs together tightly. Contract muscles around rectum. Lie on back and lift the legs together.
c
Which patient would be at highest risk for developing oral candidiasis? A 74-yr-old patient who has vitamin B and C deficiencies A 22-yr-old patient who smokes 2 packs of cigarettes per day A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks A 58-yr-old patient who is receiving amphotericin B for 2 days
c
Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? Assessing the patient's incision Irrigating the patient's urinary catheter Reporting complaints of pain or bladder spasms Evaluating the patient's pain and selecting analgesia
c
The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? Grilled steak, French fries, and vanilla shake Hamburger with cheese, pudding, and coffee Baked chicken, peas, apple slices, and skim milk Grilled cheese sandwich, onion rings, and hot tea
c (A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.)
A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? a. pain in the RUQ radiating to right shoulder b. report of pain being worse when sitting upright c. pain releived with defecation d. epigastric pain radiating to the left shoulder
d
A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to report? a. history of cholelithiasis b. elevated serum amylase levels c. decrease in bowel sounds upon auscultation d. hand spasms present when blood pressure checked
d
A patient was admitted with epigastric pain because of a gastric ulcer. which patient care assessment warrants an urgent change in the nursing plan of care? a. back pain 3-4 hours b. chest pain relieved with eating or drinking water c. burning epigastric pain 90 minutes after breakfast d. rigid abdomen and vomiting following indigestion
d
A patient with cholelithiasis is being prepared for surgery. Which patient assessment represents a contraindication for a cholecystectomy? Low-grade fever of 100°F and dehydration Abscess in the right upper quadrant of the abdomen Multiple obstructions in the cystic and common bile duct Activated partial thromboplastin time (aPTT) of 54 seconds
d
The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Wipe equipment with ammonia-based disinfectant. Instruct visitors to use the alcohol-based hand sanitizer. Don gloves and gown before entering the patient's room.
d
The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia and symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? White blood cell count is 7500 cells/μL. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. Glucose, protein, and ketones are present in the urine. Nitrites and leukocyte esterase are present in the urine.
d
The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? "It will increase bulk in the stool." "It will lubricate the intestinal tract to soften feces." "It will increase fluid retention in the intestinal tract." "It will increase peristalsis by stimulating nerves in the colon wall."
d
The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with three positive for malignant cells. The patient has stage IIB breast cancer. Which nursing intervention would be most effective in planning care? Evaluate left arm lymphatic accumulation. Maintain joint flexibility and left arm function. Teach her about chemotherapy and radiation therapy. Assess the patient's response to the diagnosis of breast cancer.
d
When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries
d
The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked and thus help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."
a
The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? A 30-yr-old white man with a history of cryptorchidism A 48-yr-old African American man with erectile dysfunction A 19-yr-old Asian man who had surgery for testicular torsion A 28-yr-old Hispanic man with infertility caused by a varicocele
a
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? "It would be beneficial for you to eliminate drinking alcohol." "You'll need to drink at least two to three glasses of milk daily." "Many people find that a minced or pureed diet eases their symptoms of PUD." "Taking medication will allow you to keep your present diet while minimizing symptoms."
a
Two days after a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site
a
What is the nurse's priority when changing the appliance for a patient with an ileal conduit? Keep the skin free of urine. Inspect the peristomal area. Cleanse and dry the area gently. Affix the appliance to the faceplate.
a
When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? "I will be able to regulate when I have stools." "I will be able to wear the pouch until it leaks." "The drainage from my stoma can damage my skin." "Dried fruit and popcorn must be chewed very well."
a
Which nursing diagnosis is priority when caring for a patient with renal calculi? Acute pain Risk for constipation Deficient fluid volume Risk for powerlessness
a
The wound, ostomy, and continence nurse (WOCN) selects the site where the ostomy will be placed. What should be included in site consideration? The patient must be able to see the site. The site should be outside the rectus muscle area. It is easier to seal the drainage bag to a protruding area. A waistline site will allow using a belt to hold the appliance in place.
a (In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance.)
A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure? "You might have pink-tinged urine and burning after your cystoscopy." "You'll need to refrain from eating or drinking after midnight the day before the test." "The morning of the test, you will drink some water that contains a contrast solution." "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days."
a (Pink-tinged urine, burning, and frequency are common after a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.)
A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? a. brownie with nuts b. bowl of mixed fruit c. grilled turkey d. baked potato
a (high in fat)
A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomerprazole. Which of the following information should the nurse include in the teaching? a. take the medication 1 hour before a meal b. limit NSAID use when taking this medication c. Expect flushing when using this medication d. Increase fiber intake when taking this medication e. Chew the medication thoroughly before swallowing
a, b
A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis a. emesis greater than 500 mL with a fecal odor b. report of spasmodic abdominal pain c. high-pitched bowel sounds d. abdomen flat with rebound tenderness to palpation e. laboratory findings indicating metabolic acidosis
a, b, c
A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? a. "I plan to eat small frequent meals." b. "I will eat easy to digest foods with limited spice" c. "I will use skim milk when cooking." d. "I plan to drink regular cola." e. "I will limit alcohol intake to two drinks per day
a, b, c
When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply.)? Select all that apply. Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B
a, b, c, d
A nurse is caring for a client who has a new diagnosis of GERD. the nurse should naticipate prescriptions for which of the following medications? Select all that apply a. antacids b. histamine2 receptor antagonists c. opioid analgesics d. fiber laxatives e. proton pump inhibitors
a, b, e
A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? Select all that apply a. evaluate intake and output b. monitor lab reports of electrolytes c. provide three large meals a day d. administer ibuprofen for pain e. observe stool characteristics
a, b, e
A nurse is planning care for a client who has a small bowel obstruction and a NGT in place. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) a. Document the NG drainage with the client's output B. irrigate the NGT every 8 hours c. assess bowel sounds d. provide oral hygiene every 2 hours e. monitor NGT for placement
a, c, d, e
A patient with a history of PUD presents to the ED with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which intervention should the nurse anticipate? a. providing IV fluids and inserting an NGT b. administering oral bicarbonate and testing the patient's gastric pH level c. performing a fecal occult blood test and administering IV calcium gluconate d. starting parenteral nutrition and placing the patient in a high-fowler's position
a.
A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should be the nurse expect. a. rigid abdomen b. tachycardia c. elevated blood pressure d. circumoral cyanosis e. rebound tenderness
a. rigid abdomen c. elevated blood pressure e. rebound tenderness
A patient complaining of nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? a. tremors b. constipation c. double vision d. numbness in fingers and toes
a. tremors
A 22-yr-old patient's blood pressure during a pre-employment physical examination was 110/68 mm Hg. During a health fair 2 months later, the blood pressure is 154/96 mm Hg. What renal problem could contribute to this rise in blood pressure? Renal trauma Renal artery stenosis Renal vein thrombosis Benign nephrosclerosis
b
The nurse teaches a 53-yr-old patient about screening for early detection of breast cancer. Which statement by the patient requires clarification by the nurse? "I should plan to have a mammogram every year." "I will see a health care provider every year for a breast examination." "A breast examination should be done right after my menstrual period." "Self-breast examination is a reliable way to detect breast cancer early."
D
A 24-yr-old patient had breast augmentation surgery and will be discharged the same day. What instructions should the nurse provide to minimize the risk of complications in the immediate recovery period? Avoid wearing a bra until postoperative day 3. Ask the patient to avoid strenuous exercise during her recovery period. Sleep in a semi-Fowler's position until her scheduled follow-up appointment. Enlist a friend or family member to perform passive range-of-motion exercises.
b
A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? Starvation Pancreatitis Systemic sepsis Diabetic ketoacidosis
b
A 73-yr-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance regarding what condition? A tumor of the prostate Benign prostatic hyperplasia Bladder atony because of age Age-related altered innervation of the bladder
b
A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? E. coli bacteria in his urine A very tender prostate gland Complaints of chills and rectal pain Complaints of urgency and frequency
b
A 21-yr-old female patient came to the clinic for instruction to prevent recurrence of urinary tract infections. Which patient statement indicates that teaching was effective? "I will urinate before and after having intercourse." "I will use vinegar as a vaginal douche every week." "I should drink three 8-oz glasses of water daily." "I can stop the antibiotics when symptoms disappear."
a
A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? Ultrasound Cremasteric reflex Doppler ultrasound Transillumination with a flashlight
a
A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? Resumption of normal urinary drainage Maintenance of normal sexual functioning Prevention of acute or chronic renal failure Prevention of fluid and electrolyte imbalances
a
A 72-yr-old patient had a mastectomy for breast cancer 6 months ago and wants to have breast reconstructive surgery. Which motivation for surgery would be most likely? Improve the woman's self-image Be able to experience sexual arousal To get a tummy tuck as well as the breast mound Restore the premastectomy appearance of the breast
a
A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? Fecal impaction Perineal hygiene Dietary fiber intake Antidiarrheal agent use
a
A patient with oral cancer is not eating. A small-bore feeding tube was inserted and the patient started on enteral feedings. Which patient goal would indicate improvement? Weight gain of 1 kg in 1 week Administer tube feeding at 25 mL/hr. Consume 50% of clear liquid tray this shift. Monitor for tube for placement and gastrointestinal residual.
a
A patient with type 2 diabetes is reporting a second urinary tract infections(UTI)within the past month. Which medication should the nurse expect to be ordered for the recurrent infection? Ciprofloxacin Fosfomycin Nitrofurantoin Trimethoprim-sulfamethoxazole
a
Eight months after the delivery of her first child, a 31-yr-old woman sought care for occasional incontinence when sneezing or laughing. Which measure should the nurse recommend first? Kegel exercises Use of adult incontinence pads Intermittent self-catheterization Dietary changes including fluid restriction
a
The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? a. venison, crab, and liver b. spinach, cabbage, and tea c. milk, yogurt, and dried fruit d. asparagus, lentils, and chocolate
a
The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? Avoid straining during defecation. Restrict fluids to prevent incontinence. Sexual functioning will not be affected. Prostate examinations are not needed after surgery.
a
The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Discontinue intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity.
a
The nurse is preparing to administer famotidine to a postoperative patient with a colostomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will reduce the amount of acid in the stomach." "It will prevent air from accumulating in the stomach, causing gas pains." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it."
a
A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? Barium swallow Endoscopic biopsy Capsule endoscopy Endoscopic ultrasonography
b (Because of this patient's history of excessive alcohol intake, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer.)
The nurse should administer an as-needed dose of magnesium hydroxide after noting what information when reviewing a patient's medical record? Abdominal pain and bloating No bowel movement for 3 days A decrease in appetite by 50% over 24 hours Muscle tremors and other signs of hypomagnesemia
b (Magnesium hydroxide is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.)
A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? a. the scope will be passed through your rectum b. you might have shoulder pain after surgery c. you will have a JP drain in place after surgery d. you should limit how often you walk for 1-2 weeks
b (free air in abdomen)
A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? a. instruct the client to chew the medication before swallowing b. offer a glass of water following medication administration c. administer the medication 30 minutes before meals d. sprinkle the contents on peanut butter
b (the patient should drink a whole glass of water)
A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with t tube placement. Which of the following instructions should the nurse include in the teaching? a. take baths rather than showers b. clamp t tube for 1 hour before and after meals c. keep the drainage system above the level of the abdomen d. expect to have the t tube removed 3 days post op e. report brown-green drainage to the provder
b, c,
A nurse is completing an admission assessment for a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (select all that apply) a. emesis prior to insertion of the NGT b. urine specific gravity 1.040 c. Hematocrit 60% d. serum potassium 3.0 mEq/L e. WBC 10,000
b, c, d
A female patient is recovering from rectocele repair surgery. Which interventions should be included in the plan of care (select all that apply.)? Select all that apply. Maintain complete bed rest. Administer a stool softener. Provide a cleansing enema. Apply ice to the perineal area. Urinary catheter care twice a day. Sitz bath may be used in a few days.
b, c, d, e
The nurse coordinates postoperative care for a 70-yr-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply.)? Select all that apply. Clean around the catheter daily. Increase flow of irrigation solution. Teach the patient how to perform Kegel exercises. Provide instructions to the patient on catheter care. Administer oxybutynin (Ditropan) for bladder spasms. Manually irrigate the urinary catheter to restore catheter flow.
b, d
A charge nurse is teaching a group of unit nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statement by a unit nurse indicates understanding of the purpose of the procedure? a. "The client will have increased duodenal gastric emptying." b. "The client will have a reduction of gastric acid secretions." c. "The client will have an increase of gastric mucus secretion." d. "the client will have an increased secretion of hydrogen/potassium ATPase enzymes"
b.
A nurse is teaching about perniciouis anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? a. Pernicious anemia is caused when the cells producing gastric acid are damaged b. expect a monthly injection of vitamin B12 c. plan to take vitamin K supplements d. pernicious anemia is caused by increased production of intrinsic factor
b. expect a monthly injection of vitamin B12
A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? a. absence of saliva b. loss of tooth enamel c. sweet taste in mouth d. absence of eructiation
b. loss of tooth enamel
A 58-yr-old woman is 1-day postoperative after an abdominal hysterectomy. Which intervention should the nurse perform to prevent deep vein thrombosis (DVT)? Place the patient in a high Fowler's position. Provide pillows to place under the patient's knees. Encourage the patient to change positions frequently. Teach the patient deep breathing and coughing exercises.
c
A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching a. Take with food b. Monitor for diarrhea c. Wait 1 hour before taking other oral medications d. Maintain a low fiber diet
c
A nurse is reviewing the lab report of a client who has suspected cholelithiasis. Which of the following is an expected finding? a. serum amylase 80 units b. WBC 9,000 c. direct bilirubin 2.1 d. alkaline phosphatase 15 u
c
A patient has a sliding hiatal hernia. What nursing intervention will reduce the symptoms of heartburn and dyspepsia? Keeping the patient NPO Putting the bed in the Trendelenburg position Having the patient eat 4 to 6 smaller meals each day Giving various antacids to determine which one works for the patient
c
The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement? "I should drink plenty of fluids to prevent complications." "If my urine is cloudy, I should contact my health care provider." "Bright red bleeding is normal for a few days after the procedure." "Sitz baths and acetaminophen will help to reduce my discomfort."
c (Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.)
The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? Turn, deep breathe, cough, and use spirometer every 4 hours. Maintain an upright position for at least 2 hours after eating. NG will have bloody drainage and it should not be repositioned. Keep in a supine position to prevent movement of the anastomosis.
c (The patient will have bloody drainage from the nasogastric (NG) tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. Turning and deep breathing will be done every 2 hours, and the spirometer will be used more often than every 4 hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.)
A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? Sucralfate Cimetidine Omeprazole Metoclopramide
c (There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine.)
The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? Venison, crab, and liver Spinach, cabbage, and tea Milk, yogurt, and dried fruit Asparagus, lentils, and chocolate
c (limit sodium, protein, and saturated fat)
A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15-30 minutes after eating. Which long-term complication does the nurse suspect? a. malnutrition b. bile reflux gastritis c. dumping syndrome d. postprandial hypoglycemia
c (post prandial hypoglycemia has similar symptoms but 2 hours after eating)
You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. To best promote the participants' learning and adherence, you would include: a. a short audiotape on the BSE procedure b. a packet of articles from the medical literature c. written guidelines for mammography and CBE d. a discussion of the value of early breast cancer detection e. community resources where they can obtain an ultrasound and MRI
c, d,
A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply) a. Client reports pain relieved by eating b. Client states that pain often occurs at night c. Client reports a sensation of bloating d. Client states that pain occurs 30 min-1 hour after a meal e. Client experiences pain upon palpation of the gastric region
c, d, e,
The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care (select all that apply.)? Select all that apply. Casts in his urine Presence of α-fetoprotein Serum PSA level 10 ng/mL Onset of erectile dysfunction Nodularity of the prostate gland Development of a urinary tract infection
c, e
A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign a. tap lightly at the costovertebral margin on the client's back b. palpate the right lower quadrant c. inspect the skin around the umbilicus d. ausculate the area below the scapula
c.
A nurse is completing discharge teaching to a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching? a. "When sitting in my lounge chair after a meal, I will lower the back of it." b. "I will try to eat three large meals a day." c. "I will elevate the head of my bed on blocks." d. "When sleeping, I will lay on my left side."
c.
After administration of a dose of metoclopramide, which patient assessment finding would show the medication was effective? a. decreased blood pressure b. absence of muscle tremors c. relief of nausea and vomiting d. no further episodes of diarrhea
c.
A nurse is completing discharge teaching for a client who has an infection due to H. pylori. Which of the following statements by the client indicates understanding of the teaching? a. "I will continue my prescription for corticosteroids." b. "I will schedule a CT scan to monitor improvement." c. "I will take a combination of medications for treatment." d. "I will have my throat swabbed to recheck for this bacteria."
c. "I will take a combination of medications for treatment."
A nurse is teaching a client who has a new prescription for famotidine. which of the following statements by the client indicates understanding of the teaching? a. "The medicine coats the lining of my stomach." b. "the medication should stop the pain right away." c. "I will take my pill 1 hour before meals." d. "I will monitor for bleeding from my nose."
c. "I will take my pill 1 hour before meals."
A 51-yr-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? Immobilize the patient's right arm until postoperative day 3. Maintain the patient's right arm in a dependent position when at rest. Administer diuretics prophylactically for the prevention of lymphedema. Promote gradually increasing mobility as soon as possible following surgery
d
The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction
d (Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.)
The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? Spiral CT scan A PET/CT scan Abdominal ultrasound Cancer-associated antigen 19-9
d (The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, this test and the positron emission tomography (PET)/CT scan or abdominal ultrasonography does not provide additional information.)
A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? a. eat three moderate sized meals a day b. drink at least one glass of water with each meal c. eat a bedtime snack that contains a milk product d. increase protein in the diet
d. (the client should eat a high-protein, high-fat, low fiber, and moderate to low-carb diet)
