Exam 4 Practice Questions

The nurse is providing discharge education to a patient after a roux-en-Y gastric bypass procedure. Which nutritional supplements must this patient take for the rest of his life? (Select all that apply.) A. Iron B. Calcium C. Folic acid D. Vitamin C E. Vitamin D F. Vitamin B12

A. Iron B. Calcium C. Folic acid F. Vitamin B12

A nurse is reviewing nutrition teaching to 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. Brownie with nuts

A nurse is assessing a client with appendicitis. Which of the following would the nurse expect to find. a. Right lower quadrant pain b. Oral temperature 101.1 c. Nausea and vomiting d. WBC count 6,000 e. Blood diarrhea

a. Right lower quadrant pain b. Oral temperature 101.1 c. Nausea and vomiting *WBC of 18,000 expected, blood diarrhea is a finding of colorectal cancer

A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? a. "I can take my medications with soda" b. "Peppermint tea will increase my indigestion" c. "Wearing an abdominal binder will limit my symptoms" d. "I will drink hot chocolate at bedtime to help me sleep" e. "I can lift weights as a way to exercise"

b. "Peppermint tea will increase my indigestion"

A nurse is providing discharge instructions to a client who is post-op following a TURP. Which of the following instruction should the nurse include? (select all) a. Avoid sex for 3 months after surgery b. If urine appears bloody, stop activity and rest c. Avoid drinking caffeinated beverages d. Take a stool softener once a day e. Treat pain with ibuprofen

b. If urine appears bloody, stop activity and rest c. Avoid drinking caffeinated beverages d. Take a stool softener once a day

A nurse is assessing a client who has acute hepatitis B. Which of the following findings should the nurse except? a. Periumbilical discoloration b. Joint pain c. Abdominal distention d. Obstipation

b. Joint pain

1. When teaching a 22-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that a. BSE will reduce the risk of dying from breast cancer. b. performing BSE right after the menstrual period will improve comfort. c. BSE should be done daily while taking a bath or shower. d. annual mammograms should be scheduled in addition to BSE.

b. performing BSE right after the menstrual period will improve comfort. The evidence is not clear that BSE reduces breast cancer mortality. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40.

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 hr before meals" d. "I will monitor for bleeding from my nose"

c. "I will take my pill 1 hr before meals"

A nurse is providing dietary teaching for a client who has chronic pancreatitis. Which of the following food selections by the client indicates the teaching was effective? a. 1 oz cheddar cheese b. Once slice of beef bologna c. 1 cup sliced banana d. 8 oz whole milk

c. 1 cup sliced banana - because it is low fat

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 the right shoulder b. Report of pain being worse when sitting upright c. Pain relieved with defecation d. Epigastric pain radiating to the left shoulder

d. Epigastric pain radiating to the left shoulder

When planning care for the patient with acute pancreatitis, the LPN/LVN knows that which intervention is a priority of care? A. Pain control B. Nutritional supplementation C. Observation for mental changes D. Observation for intestinal obstruction

A. Pain control

A nurse is teaching a client about pernicious 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 and increased production of intrinsic factor

b. Expect a monthly injection of vitamin B12

8. A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. When discussing this issue with the patient, the nurse explains that a. HRT does not appear to increase the risk for breast cancer unless there are other risk factors. b. she and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer. c. HRT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. d. alternative therapies with herbs and natural drugs are as effective as estrogen in relieving the symptoms of menopause.

b. she and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer. Because HRT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increase the risk for non-BRCA-associated cancer as well as for BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

A nurse is assessing a client who has cirrhosis. Which of the following findings is a priority for the nurse to report to the provider? a. Spider angiomas b. Jaundice c. Bloody stools d. Peripheral edema

c. Bloody stools - hemorrhage shock due to bleeding in the esophageal varices. Therefore, bloody stools is the priority finding to report to the provider. the rest are expected findings

A nurse is reviewing the prescriptions for a client who has Campylobacter enteritis. Which of the following prescriptions should the nurse clarify with the provider? a. Potassium b. Ciprofloxacin c. Magnesium Hydroxide d. 0.5% NaCl IV

c. Magnesium Hydroxide - increases gastric motility, can dehydrate

A nurse is providing discharge teaching for an older adult client who has mild diverticulitis. Which of the following client statements indicates an understanding of the teaching? a. "I will remain active by working in my garden every day." b. "I will use a mild laxative every day." c. "I may experience right lower quadrant pain." d. "I should eat foods that are low in fiber."

d. "I should eat foods that are low in fiber." *Should not do activities which pressure on abdomen such as working in garden Laxatives exacerbate diverticulosis Left lower quadrant pain not right

A nurse is providing teaching for a client who has cirrhosis and a new prescription for lactulose. The nurse should include which of the following instructions in the teaching? a. Restrict carbohydrates in the diet b. Limit oral fluid intake to 1,000 mL/day c. Notify the provider if bloating occurs d. Expect 2-3 soft stools per day

d. Expect 2-3 soft stools per day * Diet should be high in carbs and protein Adequate fluids Bloating flatulence and belching are side effects - expected

9. When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? A. Transports fatty acids into the brush border B. Breaks down fat into fatty acids and glycerol C. Triggers cholecystokinin to contract the gallbladder D. Breaks down protein into dipeptides and amino acids

B. Breaks down fat into fatty acids and glycerol

The nurse is caring for a client after a Billroth II ( gastojejunostomy) procedure. On review of the post-op prescriptions should the nurse clarify? A. Leg exercises B. Early ambulation C. Irrigating the nasogastic tube (NG) D. Coughing an deep breathing exercises

C. Irrigating the nasogastic tube (NG)

A patient with a sigmoid colostomy is taught to irrigate her colostomy daily to accomplish which goal? A. Prevent infection B. Keep the bowel sterile C. Increase the diameter of the bowel D. Gain control over the time elimination occurs

D. Gain control over the time elimination occurs

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation should indicate that a prolapse has occurred? A. Dark and bluish B. Sunken and hidden C. Narrowed and flattened D. Protruding and swollen

D. Protruding and swollen

24. Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and an axillary lymph node dissection is appropriate to assign to an LPN/LVN? a. Administering an analgesic 30 minutes before the scheduled arm exercises b. Teaching the patient how to avoid injury to the right arm c. Assessment of the patient's range of motion for the right arm d. Evaluation of the patient's understanding of discharge instructions about drain care

a. Administering an analgesic 30 minutes before the scheduled arm exercises

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

a. Navy bean soup and vegetable salad High in fiber

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to peptic ulcer. Which of the following findings should the nurse expect? (select all) a. Rigid abdomen b. Tachycardia c. Elevated BP d. Circumoral cyanosis e. Rebound tenderness

a. Rigid abdomen b. Tachycardia e. Rebound tenderness

A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (select all) a. Take the med 1 hour before a meal b. Limit NSAIDs when taking this med c. Expect skin flushing when taking this med d. Increase fiber intake e. Chew the med thoroughly before swallowing

a. Take the med 1 hour before a meal b. Limit NSAIDs when taking this med

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following? a. "I can expect yellow-green drainage from the incision for a few days." b. "I can remove the bandages on my incisions tomorrow and take a shower." c. "I should plan to limit my activities and not return to work for 4 to 6 weeks." d. "I will always need to maintain a low-fat diet since I no longer have a gallbladder."

b. "I can remove the bandages on my incisions tomorrow and take a shower."

4. A patient with a small breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. only a small incision is necessary, resulting in minimal breast pain and scarring. b. if the specimen is positive for malignancy, the patient can be told at the visit. c. if the specimen is negative for malignancy, the patient's fears of cancer can be put to rest. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

b. if the specimen is positive for malignancy, the patient can be told at the visit. An FNA should only be done when an experienced cytologist is available to read the specimen immediately. If the specimen is positive for malignancy, the patient can be given this information immediately. No incision is needed. If the specimen is negative for malignancy, the patient will require biopsy of the lump. FNA is not guided by mammography.

23. Which statement by a 32-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that the goals of therapy are being met? a. "I am not sure how my husband will react when I tell him about this cancer." b. "I am ready to die if that is God's plan for me." c. "I need to know all the options before making a decision about treatment." d. "I will do whatever the doctor thinks is best."

c. "I need to know all the options before making a decision about treatment." One goal for the patient with breast cancer is active participation in the decision-making process. The response beginning, "I am not sure how my husband will react" indicates that the goal of satisfaction with the support provided by significant others is still unmet. The response, "I am ready to die if that is God's plan for me" suggests that the patient may not be willing to have treatment. The response, "I will do whatever the doctor thinks is best" indicates that the patient is not participating actively in treatment decisions.

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart.

A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's a. apical pulse. b. bowel sounds. c. breath sounds. d. abdominal girth.

c. breath sounds.

13. Following a modified radical mastectomy, the health care provider recommends chemotherapy even though the lymph nodes were negative for cancer cells. The patient tells the nurse that she does not know what to do about chemotherapy because she has heard that she may not even need chemotherapy and that the side effects are uncomfortable. The nursing diagnosis that best reflects the patient's problem is a. anxiety related to prospect of additional cancer therapy. b. fear related to uncomfortable side effects of chemotherapy. c. decisional conflict related to lack of knowledge about prognosis and treatment options. d. risk for ineffective health maintenance related to reluctance to consider additional treatment.

c. decisional conflict related to lack of knowledge about prognosis and treatment options. The patient's statements indicate that she is having difficulty making a decision about treatment because of a lack of understanding about prognosis and treatment. Although she may have some anxiety and fear, these are not the priorities at this time. The patient expresses concerns about chemotherapy rather than reluctance to consider additional treatment.

22. A patient with an abnormal mammogram is scheduled for stereotactic core biopsy. Which information will the nurse include when teaching the patient about the procedure? a. "You will need to avoid eating or drinking anything for 6 hours before the procedure." b. "Any discomfort after the biopsy may be treated with mild pain relievers such as aspirin." c. "The core biopsy is evaluated immediately and you will get the results before leaving." d. "Several samples of tissue in the abnormal area will be obtained during the procedure."

d. "Several samples of tissue in the abnormal area will be obtained during the procedure." During stereotactic breast biopsy, a biopsy gun is used to remove several core samples in the area of abnormality. The procedure is done using a local anesthetic, so there is no need to be NPO before the procedure. Aspirin should not be used because it will increase bleeding at the site. The biopsy is sent to pathology, and results are not usually available immediately.

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take a. sucralfate at bedtime and antacids before each meal. b. sucralfate and antacids together 30 minutes before meals. c. antacids 30 minutes before each dose of sucralfate is taken. d. antacids after meals and sucralfate 30 minutes before meals.

d. antacids after meals and sucralfate 30 minutes before meals.

A nurse is providing teaching about dietary management to prevent dumping syndrome for a client who is postoperative following a gastrectomy. The nurse should encourage the client to include which of the following food in his diet? a. Grape juice b. Ice cream c. Eggs d. Honey

c. Eggs *Avoid high sugar

The nurse is reinforcing teaching to a client about an upcoming colonoscopy procedure. The nurse should include in the instructions that the client will be placed in which position for the procedure? A. Left Sims Position B. Lithotomy position C. Knee-chest postion D. Right Sims position

A. Left Sims Position

Patients with ileostomies should be given which instruction? A."Do not take enteric-coated tablets." B. "Increase your intake of dried fruits." C. "Add more high-fiber foods to your diet." D. "If you notice a blockage, take a laxative."

A."Do not take enteric-coated tablets."

The nurse is assessing the stooling patterns of an assigned patient. The patient reports stools as being clay colored. The nurse knows this may indicate which condition? A.Bile is not reaching the intestines. B. The stool contains undigested fat. C. The stool has an excessive amount of bilirubin. D. The patient is experiencing upper gastrointestinal (GI) bleeding.

A.Bile is not reaching the intestines.

The nurse is caring for the patient following abdominal surgery. Which symptom, if demonstrated by the patient, indicates the development of peritonitis? A. Fever B. Projectile vomiting C. Severe abdominal pain D. Anorexia with weight loss

C. Severe abdominal pain

The nurse is providing education to a patient with a body mass index (BMI) of 42. The nurse should educate the patient about which conditions for which he is at risk? (Select all that apply.) A. Insomnia B. Hypertension C. Hyperlipidemia D. Hyperthyroidism E. Obstructive sleep apnea F. Type 1 diabetes mellitus

B. Hypertension C. Hyperlipidemia E. Obstructive sleep apnea

The nurse is reviewing the health history of an assigned patient. Which data in a patient's history might indicate a predisposition to diverticular disease? (Select all that apply.) A. Frequent laxative use B. Low dietary fiber intake C. High dietary fiber intake D. History of passing scant, small stools E. History of chronic diarrhea; vomiting

B. Low dietary fiber intake D. History of passing scant, small stools

The nurse is caring for a patient with ulcerative colitis who recently underwent a colectomy and the creation of an ileal reservoir. How will this patient eliminate stool from his body? A. Continuously into a collection pouch B. With a catheter inserted into the reservoir C. Via his anus, over which he retains control D. Intermittently via the ostomy into a collection pouch

B. With a catheter inserted into the reservoir

3. Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful? A. 4-6 small meals of low-carbohydrate foods daily B. High-fat, high-carbohydrate meals C. Low-fat, high-carbohydrate meals D. High-fat, low protein meals

C. Low-fat, high-carbohydrate meals

An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. Which should the nurse explain to the client about this test? A. The test is uncomfortable B. The test requires that the client be NPO C. The test requires the client to lie still for short intervals D. The test is preceded by the administration of oral tablets

C. The test requires the client to lie still for short intervals

7. Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to exhibit? A. Jaundice, dark urine, and steatorrhea B. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration C. Ecchymosis petechiae, and coffee-ground emesis D. Nausea, vomiting, and anorexia

D. Nausea, vomiting, and anorexia

A patient has been diagnosed with gastritis. Which medication can the nurse anticipate will be prescribed? A. Aspirin B. Carafate C. Ampicillin D. Ranitidine

D. Ranitidine

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? (select all) a. "I plan to eat small, frequent meals" b. "I will eat east-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. "I plan to eat small, frequent meals" b. "I will eat east-to-digest foods with limited spice" c. "I will use skim milk when cooking"

A nurse is providing discharge teaching for a client who has chronic hepatitis c. Which of the following statements made by the client indicates and understanding? a. "I will avoid medications that contain acetaminophen." b. "I will decrease my intake of calories." c. "I will need treatment for 3 months." d. "I will avoid alcohol until I'm no longer contagious."

a. "I will avoid medications that contain acetaminophen." * Additional liver damage Need small frequent high calorie meals treatment usually lasts around 12 weeks avoid alcohol at all times

19. After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that no further teaching is needed? a. "I will avoid reaching over the stove with my left hand." b. "I will need to do breast self-examination on my right breast monthly." c. "I will keep my left arm elevated until I go to bed." d. "I will remember to use my right arm and to rest the left one."

a. "I will avoid reaching over the stove with my left hand."

The nurse is reviewing the chart of a patient who recently underwent a total gastrectomy and notes the patient is receiving total parenteral nutrition (TPN). The nurse understands which information about TPN? A. A form of intravenous (IV) feeding B. A type of intestinal decompression C. A new method of tube-feeding a patient with dysphagia D. A method of feeding a patient through a tube inserted through an incision in the stomach

A. A form of intravenous (IV) feeding

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions should the nurse expect to note? select all that apply A. Administer antacids and prescribed B. encourage small, frequent, high calorie feedings C. Encourage coughing and deep breathing D. Administer anticholinergics as prescribed E. Maintain the client in a supine and flat position

A. Administer antacids and prescribed C. Encourage coughing and deep breathing D. Administer anticholinergics as prescribed

For which reason are patients with esophageal varices prone to hemorrhage? A. They have portal hypotension. B. There is poor circulation within the veins. C. They are no longer able to produce vitamin K. D. There is an accumulation of ammonia in the blood

C. They are no longer able to produce vitamin K.

A nurse at a provider's office is caring for an older adult client who is having an annual physical exam. Which of the following findings indicates additional follow-up is needed in regard to the prostate gland? (select all) a. PSA 7.1 b. DRE reveals enlarged and nodular prostate c. The client reports weak urine stream d. The client reports urinating once during the night e. Smegma is present below the glans of the penis

a. PSA 7.1 b. DRE reveals enlarged and nodular prostate c. The client reports weak urine stream

18. A 38-year-old woman is scheduled for a breast-conservation therapy with a lumpectomy. As the nurse prepares her for surgery, she begins to cry and says, "I just do not know how to handle all of this." An appropriate response to the patient by the nurse is, a. "Would you like to talk about how you are feeling right now?" b. "I can see you are really upset. Would you like to be alone for a while?" c. "The important thing is that the tumor was found and is going to be removed." d. "With this surgery you will have very little change in the appearance of your breast."

a. "Would you like to talk about how you are feeling right now?" The nurse encourages the patient to express feelings about the diagnosis and surgery. The response beginning, "I can see you are really upset" may indicate that the nurse is uncomfortable being with the patient while she is upset. The response beginning, "The important thing is that the tumor was found" places the nurse's value system above the patient's current concerns. And the response, "With this surgery you will have very little change in the appearance of your breast" does not address all the patient's possible concerns and is not true.

A nurse is instructing a client who is scheduled for a transurethral resection of the prostate (TURP) about his post-op care. Which of the following information should the nurse include in the teaching? a. "You may have a continuous sensation of needing to void even though you have a catheter" b. "You will be on bed rest for the first 2 days after the procedure" c. "You will be instructed to limit your fluid intake after the procedure" d. "Your urine should be clear yellow the evening after surgery"

a. "You may have a continuous sensation of needing to void even though you have a catheter"

The nurse is reviewing the lab results of a client who has hepatic cirrhosis. Which of the following should the nurse report to the health care provider? a. Ammonia 180 mcg/dL b. Direct bilirubin 0.5 mg/dL c. INR 1.0 d. Albumin 4.0 g/dL

a. Ammonia 180 mcg/dL *An ammonia level of 180 mcg/dL is above the expected reference range of 10 to 80 mcg/dL. The nurse should report an increased ammonia level because it can indicate portal-systemic encephalopathy. Bilirubin 0.3-1.0 INR 0.8-1.1 Albumin 3.5-5

A nurse is caring for a client who has a new diagnosis of GERD. The nurse should anticipate prescriptions for which of the following medications? a. Antacids b. Histamine2 receptor antagonists c. Opioid analgesics d. Fiber laxatives e. PPIs

a. Antacids b. Histamine2 receptor antagonists e. PPIs

A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? a. Board-like abdomen b. Periumbilical cyanosis c. Increased bowel sounds d. Blood diarrhea

a. Board-like abdomen

A nurse is assessing a client immediately after a paracentesis for the treatment of ascites. Which of the following findings indicates the procedure was effective? a. Decreased SOB b. Increase heart rate c. Presence of fluid wave d. Equal pre and post-procedure weights

a. Decreased SOB

A nurse is planning care for a client who has gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (select all) a. Evaluate intake and output b. Monitor lab reports of electrolytes c. Provide three large meals per day d. Administer inuprofen for pain e. Observe stool characteristics

a. Evaluate intake and output b. Monitor lab reports of electrolytes e. Observe stool characteristics

A nurse is assessing a client who has Crohn's disease. Which of the following findings should the nurse except? a. Fatty diarrhea stools b. Hyperkalemia c. Sharp epigastric pain d. Weight gain

a. Fatty diarrhea stools *RLQ pain not epigastric weight loss not gain

A nurse is completing pre-op 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 Jackson-Pratt drain after surgery" d. "You should limit how often you walk for 1-2 weeks"

b. "You might have shoulder pain after surgery"

A nurse at a provider's office is caring for an older adult a client who is having an annual physical exam. Which of the following findings indicates additional follow-up is needed in regard to the prostate gland? (select all) a. Prostate-specific antigen (PSA) is 7.1 ng/mL b. A digital rectal exam (DRE) reveals an enlarged and nodular prostate c. The client reports a weak urine stream d. The client reports urinating once during the night e. Smegma is present below the glans of the penis

a. Prostate-specific antigen (PSA) is 7.1 ng/mL b. A digital rectal exam (DRE) reveals an enlarged and nodular prostate c. The client reports a weak urine stream

7. During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. The nurse's first action should be to a. palpate the breasts for the presence of any discrete lumps. b. explain that this is a temporary condition caused by hormonal changes. c. refer the patient for mammography and biopsy of the breast tissue. d. teach the patient about dietary changes to reduce the breast size.

a. palpate the breasts for the presence of any discrete lumps. If discrete, circumscribed lumps are present, the patient should be referred for further testing to determine whether breast cancer is present. Gynecomastia is usually a temporary change, but it can be caused by breast cancer. Mammography and biopsy will not be needed unless lumps are present in the breast tissue. Dietary changes will not affect the condition.

20. A patient has a permanent breast implant inserted in the outpatient surgery area. Which instructions will the nurse include in the discharge teaching? a. Resume normal activities 2 to 3 days after the mammoplasty. b. Check wound drains for excessive blood or any foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Take aspirin every 4 hours to reduce inflammation.

b. Check wound drains for excessive blood or any foul odor. The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

A nurse is providing discharge teaching to a client who is post-op following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (select all) a. Take baths rather than showers b. Clamp T-tube 1 hr before and after meals c. Keep the drainage above the level of the abdomen d. Expect to have T-tube removed 3 days post-op e. Report brown-green drainage to provider

b. Clamp T-tube 1 hr before and after meals c. Keep the drainage above the level of the abdomen

A nurse in a provider's office is obtaining a history from a client who is undergoing an evaluation for BPH. The nurse should identify that which of the following findings are indicative of this condition? (select all) a. Backache b. Frequent UTIs c. Weight loss d. Hematuria e. Urinary incontinence

b. Frequent UTIs d. Hematuria e. Urinary incontinence

A nurse is assessing a client who is post-op following a gastrectomy. The nurse should identify which of the following findings as an indication of abdominal distention? a. HTN b. Hiccups c. Bradycardia d. Chest pain

b. Hiccups - Irritation of phrenic nerve

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 med before swallowing b. Offer a glass of water following med administration c. Administer the med 30 minutes before meals d. Spinkle to contents on peanut butter

b. Offer a glass of water following med administration should take with full glass of water

12. A woman with a positive biopsy for breast cancer is considering whether to have a modified radical mastectomy or breast conservation surgery (lumpectomy) with radiation therapy. Which information should the nurse provide? a. The postoperative survival rate for each is about the same, but there is a decreased rate of cancer recurrence after mastectomy. b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity. c. The hair loss associated with post-lumpectomy chemotherapy is not acceptable to some patients. d. The treatment period for the mastectomy is shorter, and breast reconstruction can provide a normal-appearing breast.

b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity. The impact on breast function and appearance is less with lumpectomy and radiation, but there is some effect on breast sensitivity. The rate of cancer recurrence is the same for the two procedures. Chemotherapy may be used after either lumpectomy or mastectomy, but it is not always needed. The treatment period is shorter after mastectomy, but breast reconstruction does not provide a normal-appearing breast.

9. At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that a. her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer. b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer. c. because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes. d. genetic mutations increase cancer risk only in combination with other risk factors such as obesity.

b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer. Family history is a risk factor for breast cancer, and the nurse should discuss testing for BRCA genes with the patient. Although the BRCA gene is associated with increased risk for breast and ovarian cancer, the patient may be at risk if her mother had either one. About 5% to 10% of patients with breast cancer may have a genetic abnormality that contributes to breast cancer development. Risk factors are cumulative, but a family history alone will increase breast cancer risk.

6. A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse's response to the patient is based on the knowledge that the most likely cause of the breast lump is a. fibrocystic complex. b. fibroadenoma. c. breast abscess. d. adenocarcinoma.

b. fibroadenoma.

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 eructation

b. loss of tooth enamel

10. When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a a. cousin who was diagnosed with breast cancer at age 38. b. mother who was diagnosed with breast cancer at age 42. c. sister who died from ovarian cancer at age 56. d. grandmother who died from breast cancer at age 72.

b. mother who was diagnosed with breast cancer at age 42. A significant family history of breast cancer means that the patient has a first-degree relative who developed breast cancer, especially if the relative was premenopausal.

11. A patient with a breast biopsy positive for cancer is to undergo lymphatic mapping and sentinel lymph node dissection (SLND). The nurse explains that this procedure a. can identify specific lymph nodes that have malignant cells, so only involved nodes need to be excised. b. reduces the need for extensive lymph node dissection for pathologic examination. c. eliminates the need for excision of more than one lymph node for staging of breast cancer. d. will confirm the absence of tumor spread if the sentinel lymph node is negative for malignant changes.

b. reduces the need for extensive lymph node dissection for pathologic examination. The SLND may eliminate further lymph node dissection if the initial nodes are negative for malignancy. The procedure identifies which lymph nodes drain first from the tumor site, but not which ones are malignant. Several lymph nodes may be dissected for pathologic examination. Tumor may have distant metastases even when no malignancies are found in the lymph nodes.

3. A 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure. She says she does breast self-examination (BSE) monthly and asks whether it is necessary to have an annual mammogram. The nurse's best response to the patient is, a. "If your mammogram was painful, it is especially important that you have it done annually." b. "An ultrasound examination of the breasts, which is not painful or a source of radiation, can be substituted for a mammogram." c. "Because of your age, it is even more important for you to have annual mammograms." d. "Unless you find a lump while examining your breasts, a mammogram every 2 years is recommended after age 60."

c. "Because of your age, it is even more important for you to have annual mammograms." Annual mammograms are recommended for women over age 40 as long as they are in good health. The incidence of breast cancer increases in women over 60. Pain with a mammogram does not indicate any greater risk for breast cancer. Ultrasound may be used in some situations to differentiate cystic breast problems from cancer but is not a substitute for annual mammograms. Got this one wrong on the test even though i put this answer so idk??

A nurse is providing discharge teaching for a client who has GERD. Which of the following client statements indicates the teaching was effective? a. "I will avoid drinking liquids for 30 minutes after taking a chewable antacid tablet." b. "I will lie down for at least 30 minutes after eating each meal." c. "I will decrease the amount of carbonated beverages I drink." d. "I will eat a snack before going to bed."

c. "I will decrease the amount of carbonated beverages I drink."

A nurse is providing dietary teaching to a client who has a new diagnosis of celiac disease. Which of the following statements by the client indicates an understanding of the teaching? a. "I need to avoid drinking liquids with my meals while on this diet." b. "I can return to my regular diet when I am free of symptoms." c. "I will eat beans to ensure I get enough fiber in my diet." d. "I will need to avoid taking vitamin supplements while on this diet."

c. "I will eat beans to ensure I get enough fiber in my diet." *Clients who have celiac disease must maintain a gluten-free diet which eliminates fiber-rich whole wheat products. Clients should eat beans, nuts, fruits, and vegetables to ensure an adequate intake of fiber. Celiac disease is an autoimmune disorder that causes changes to the intestinal mucosa, resulting in an intolerance to gluten, which is found in wheat, barley, and rye. The client should continue to avoid eating foods that contain gluten. Dumping syndrome should avoid drinking liquids with meals Clients who have celiac disease are at risk for malabsorption of vitamins and minerals; therefore, the client should continue taking vitamin and mineral supplements.

A nurse is completing discharge teaching to a client who is post-op following a fundoplication. Which of the following statements by the client indicates understanding of 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. "I will elevate the head of my bed on blocks"

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 combo of meds for treatment" d. "I will have my throat swabbed to recheck for this bacteria"

c. "I will take a combo of meds for treatment"

A nurse is providing information to a client who is scheduled for a transrectal ultrasound (TRUS). Which of the following information should the nurse include? a. "This procedure will determine whether you have prostate cancer" b. "The procedure is contraindicated if you have an allergy to eggs" c. "Sound waves will be used to create a picture of your prostate" d. "You should avoid having a bowel movement 1 hour prior to the procedure"

c. "Sound waves will be used to create a picture of your prostate"

A nurse is providing information to a client who is scheduled for a transrectal ultrasound (TRUS). Which of the following information should the nurse include? a. "This procedure will determine whether you have prostate cancer" b. "The procedure is contraindicated if you have an allergy to eggs" c. "Sound waves will be used to create a picture of your prostate" d. "You should avoid having a bowel movement for 1 hour prior to the procedure"

c. "Sound waves will be used to create a picture of your prostate"

A nurse is caring for a client who has colorectal cancer and is receiving chemotherapy. The client asks the nurse why blood is being drawn for a CEA level. which of the following responses by the nurse is appropriate? a. "The CEA determines if you are experiencing occult bleeding from the gastrointestinal tract." b. "The CEA determines if the neutrophil count is below the expected reference range." c. "The CEA determines the efficacy of your chemotherapy." d. "The CEA determines the current stage of your colon cancer."

c. "The CEA determines the efficacy of your chemotherapy."

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) 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 epigastric region

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 epigastric region

A nurse in a clinic is reviewing the lab reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? a. Serum amylase 80units/L b. WBC 9,000 mm3 c. Direct bilirubin 2.1 mg/dL d. Alkaline phosphates 25units/L

c. Direct bilirubin 2.1 mg/dL should have elevated amylase and WBC and ALP

A nurse is reviewing the laboratory values of a client who has colorectal cancer. Which of the following findings should the nurse expect? a. Negative fecal occult blood test b. Hematocrit 43% c. Hemoglobin 9.1 g/dL d. Decreased serum carcinoembryonic antigen (CEA) level

c. Hemoglobin 9.1 g/dL - below the expected range *Elevated CEA

A nurse is admitting a client who has acute pancreatitis. Which of the following actions should the nurse take first? a. Instruct the client to remain NPO b. Insert an NG tube c. Identify the client's current level of pain d. Administer ceftazidime to the client

c. Identify the client's current level of pain * Nursing process - assessment

A nurse is reviewing lab results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? a. Decreased bilirubin b. Blood glucose 110 mg/dL c. Increased serum amylase d. WBC 9,000/mm3

c. Increased serum amylase - due to pancreatic cell injury * Increased bilirubin elevated glucose elevated WBC

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 costrovertebral margin on the client's back b. Palpate the RLQ c. Insect skin around umbilicus d. Auscultate the area below the scapula

c. Insect skin around umbilicus blue/gray discoloration

A nurse is caring for a client who has ulcerative colitis. the client has had several exacerbations over the past 3 years. Which of the following instructions should the nurse include in the plan of care to minimize the risk of further exacerbations? a. Increase fiber intake b. Drink two 240 mL (8 oz) glass of milk/day c. Use progressive relaxation techniques. d. Arrange activities to allow for daily rest periods e. Restrict intake of carbonate beverages.

c. Use progressive relaxation techniques. d. Arrange activities to allow for daily rest periods e. Restrict intake of carbonate beverages.

A nurse is providing discharge instructions to a client who has a new prescription for aliuminum hydroxide. Which of the following information should the nurse include in the teaching? a. Take the medication with food b. Monitor for diarrhea c. Wait 1 hour before taking other oral meds d. Maintain a low-fiber diet

c. Wait 1 hour before taking other oral meds

A nurse is reviewing a new prescription for ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? a. This med is used to decrease acute biliary pain b. This med required thyroid function monitoring every 9 months c. This med is not recommended for client who have DM d. This med dissolves gallstones gradually over a period of up to 2 years

d. This med dissolves gallstones gradually over a period of up to 2 years

14. A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to a. teach the patient about the need to monitor serum electrolyte levels. b. ask the patient to call the health care provider before using any over-the-counter (OTC) pain relievers. c. instruct the patient to call if she notices ankle swelling. d. have the patient schedule frequent eye examinations.

c. instruct the patient to call if she notices ankle swelling. Herceptin can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. OTC pain relievers do not interact with Herceptin. Changes in visual acuity may occur with tamoxifen, but not with Herceptin.

5. A 33-year-old patient tells the nurse that she has fibrocystic breasts but reducing her sodium and caffeine intake and other measures have not made a difference in the fibrocystic condition. An appropriate patient outcome for the patient is a. calls the health care provider if any lumps are painful or tender. b. states the reason for immediate biopsy of new lumps. c. monitors changes in size and tenderness of all lumps in relation to her menstrual cycle. d. has genetic testing for BRCA-1 and BRCA-2 to determine her risk for breast cancer.

c. monitors changes in size and tenderness of all lumps in relation to her menstrual cycle. Because fibrocystic breasts may increase in size and tenderness during the premenstrual phase, the patient is taught to monitor for this change and to call if the changes persist after menstruation. Pain and tenderness are typical of fibrocystic breasts, and the patient should not call for these symptoms. New lumps may be need biopsy if they persist after the menstrual period, but the biopsy is not done immediately. The existence of fibrocystic breasts is not associated with the BRCA genes.

16. A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate intervention for the nurse to include in implementing postoperative care for the patient includes a. teaching the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes for the best pain relief. b. insisting that the patient examine the surgical incision when the dressings are removed. c. posting a sign at the bedside warning against blood pressures or venipunctures in the right arm. d. encouraging the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.

c. posting a sign at the bedside warning against blood pressures or venipunctures in the right arm. The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

21. Following a modified radical mastectomy, a patient tells the nurse the health care provider has recommended a flap procedure for breast reconstruction but that she did not understand how this was done. The nurse explains that the most common procedure, a transverse rectus abdominis musculocutaneous (TRAM) flap, involves a. relocating muscle tissue from the back and using it to form a breast. b. removing a portion of an abdominal muscle to use as breast tissue. c. pulling part of the abdominal muscle up to the breast area through a tunnel in the chest. d. relocating the arteries from the abdominal muscle to improve circulation to the implant.

c. pulling part of the abdominal muscle up to the breast area through a tunnel in the chest. In the TRAM flap, part of the rectus abdominis muscle is tunneled to the breast area and molded to form a breast. In the latissimus dorsi musculocutaneous flap, muscle tissue from the back is used to replace breast tissue. The abdominal muscle is not detached but is still attached to the rectus muscle. The arteries are not relocated.

2. While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent? a. "Do you currently smoke cigarettes?" b. "Have you ever had any breast injuries?" c. "Is there any family history of fibrocystic breast changes?" d. "At what age did you start having menstrual periods?"

d. "At what age did you start having menstrual periods?" Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

A nurse if providing discharge teaching for a client who has peptic ulcer disease and a new prescription for famotidine. Which of the following client statements indicates the teaching was effective? a. "I will monitor my blood glucose level regularly while taking this medication." b. "I should expect this medication to discolor my stools." c. "I will drink iced tea with my meals and snacks." d. "I should take this medication at bedtime."

d. "I should take this medication at bedtime."

17. The nurse provides discharge teaching for a patient who has had a left modified radical mastectomy and axillary lymph node dissection. The nurse determines that teaching has been successful when the patient says, a. "I should keep my left arm supported in a sling when I am up until my incision is healed." b. "I may expose my left arm to the sun for several hours each day to increase circulation and promote healing." c. "I can do whatever exercises and activities I want as long as I do not elevate my left hand above my head." d. "I will continue to exercise my left arm with finger-walking up the wall or combing my hair."

d. "I will continue to exercise my left arm with finger-walking up the wall or combing my hair." The patient should continue with arm exercises to regain strength and range of motion. The left arm should be elevated to the level of the heart when the patient is up. Sun exposure is avoided because of the risk of sunburn. The left hand should be elevated at or above heart level to reduce swelling and lymphedema.

A nurse is providing discharge instructions to a client following an ileostomy. The nurse should instruct the client to report which of the following findings to the provider? a. Intolerance to high-fiber foods b. Liquid ileostomy output c. Sensation of burning during bowel elimination d. Dark purple stoma

d. Dark purple stoma * Indicates bowel ischemia The rest are expected findings

A nurse is teaching a client how to prepare for a colonoscopy. Which of the following instructions should the nurse including in the teaching? a. Begin drinking the oral liquid preparation for bowel cleansing on the morning of the procedure. b. Drink full liquids for breakfast the day of the procedure, and then take nothing by mouth for 2 hr prior to the procedure. c. Drink the oral liquid preparation for bowel cleansing slowly. d. Drink clear liquids for 24 hr prior to colonoscopy and NPO for 6 hr prior to procedure

d. Drink clear liquids for 24 hr prior to colonoscopy and NPO for 6 hr prior to procedure

A nurse is providing discharge teaching for a client who has a new prescription for medication to treat peptic ulcer disease. The nurse should identify that which of the following medications inhibits gastric acid secretion? a. Aluminum Hydroxide b. Sucrafate c. Calcium carbonate d. Famotidine

d. Famotidine * Ca Carbonate is an antacid that neutralizes gastric acid but does not inhibit its secretion. Sucralfate is a mucosal barrier fortifier that forms a protective coating over the ulcer but does not inhibit gastric acid secretion. Aluminum hydroxide is an antacid that neutralizes gastric acid but does not inhibit its secretion.

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 level c. Decrease in bowel sounds upon auscultation d. Hand spasms when BP is checked

d. Hand spasms when BP is checked hypocalcemia - ECG changes

A nurse is assessing a client who has upper gastrointestinal bleeding. Which of the following findings should the nurse except? a. Bradycardia b. Bounding peripheral pulses c. Increased hematocrit d. Hypotension

d. Hypotension - risk of shock *Tachycardia, weak peripheral pulse, decreased hematocrit

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 moderately side 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. Increase protein in the diet

A nurse is developing a plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include? a. Provide a daily intake of 4 mg sodium b. Check mental status once a day c. Assess the client's breath sounds every 12 hr d. Measure the client's abdominal girth daily

d. Measure the client's abdominal girth daily *1-2 g Na 4-8 hr mental check because risk of hepatic encephalopathy breath sounds 4-8 hrs

A nurse is caring for a client who has a new diagnosis of BPH. The nurse should anticipate a prescription for which of the following medications? a. Oxybutynin b. Diphenhydramine c. Ipratropium d. Tamsulosin

d. Tamsulosin

A nurse is caring for a client who has a duodenal ulcer. Which of the following findings should the nurse expect? a. The client states that the pain is in the upper epigastrium. b. The client states that ingesting food intensifies the pain. c. The client is malnourished d. The client reports that pain occurs during the night.

d. The client reports that pain occurs during the night. *Pain below/to the right of epigastrum ingesting food should decrease pain

15. A 34-year-old woman has undergone a modified radical mastectomy for a breast tumor. The pathology report identified the tumor as a stage I, estrogen-receptor-positive adenocarcinoma. The nurse will plan on teaching the patient about a. raloxifene (Evista). b. estradiol (Estrace). c. trastuzumab (Herceptin). d. tamoxifen (Nolvadex).

d. tamoxifen (Nolvadex). Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used post-mastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2/neu antigen.