MEDSURG 2 QUIZ 1
The nursing instructor is teaching the beginning nursing students how to palpate a liver. What technique will the student nurse use to palpate a patient's liver?
Place hand under right lower rib cage and press down lightly with the other hand
An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best?
a. Assess family concerns and fears.
A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)?
a. Assist the client to void before the procedure.
The nurse is caring for a client scheduled to have a transjugular intrahepatic portal-systemic shunt (TIPS) procedure. What client assessment would the nurse perform prior to this procedure?
a. Cardiovascular assessment
A nurse assesses a client with Crohns disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider?
a. Distended abdomen
A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider?
a. Drainage from a fistula
The nurse reads a clients chart and sees that the health care provider assessed mucosal erythroplasia. What should the nurse understand that this means for the client?
a. Early sign of oral cancer
The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk?
a. Electrolyte imbalance
A client has Crohns disease. What type of anemia is this client most at risk for developing?
a. Folic acid deficiency
A nurse assesses a client who is hospitalized with an exacerbation of Crohns disease. Which clinical manifestation should the nurse expect to find?
a. High-pitched, rushing bowel sounds in the right lower quadrant
The nurse is teaching a client a client about taking elbasvir for hepatitis C. What information in the client's history would the nurse need prior to drug administration?
a. History of hepatitis B
After teaching a client who has diverticulitis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?
a. I will take a laxative nightly at bedtime to avoid becoming constipated.
The nurse is caring for a client who has a risk gene for developing cirrhosis. Which racial/ethnic group has this gene most often?
a. Latinos
A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best?
a. Obtain daily weights of the client.
A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client?
a. Omeprazole (Prilosec)
Which of these client assessment findings is typically associated with oral cancer?
a. Painless red or raised lesion
The nurse assesses a patient who is recovering from an ileostomy placement. Which assessment finding would alert the nurse to immediately contact the primary health care provider?
a. Pale and bluish stoma
A new nurse is caring for a client with an abdominal aneurysm. What action by the new nurse requires the nurse's mentor to intervene?
a. Palpates the abdomen in four quadrants.
The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed?
a. Semi-Fowler
A nurse plans care for a client with Crohns disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this clients plan of care?
a. Skin protection
You are presenting an educational event at the local high school. You have been asked to talk about oral cancer. What would you tell the students is critical in preventing oral cancers?
A) Avoiding high-risk behaviors
While caring for a patient hospitalized with chronic gastritis it is important to educate the patient about what?
A) Avoiding irritating foods and beverages
You are talking with a group of nursing students about esophageal cancer. What would you tell the students is the most significant risk factor for esophageal cancer?
A) Chronic gastroesophageal reflux disease
The nurse is participating in a local health fair where he is assessing patients' mouths for signs of oral cancer. What is most characteristic of oral cancer in its early stages?
A) Presence of a painless sore with raised edges
You are caring for a patient whose bone marrow has been replaced by scar tissue in many of the areas that produce blood cells for the body. What organs can become active in blood cell production by the process of extramedullary hematopoiesis?
A) Liver and spleen
A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction?
A) Nausea and vomiting
A 55-year-old male with acute pancreatitis is being admitted. What is the critical care nurse aware of concerning the common description of acute pancreatitis?
A) Pancreatic enzymes digest the pancreas.
A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is?
A) Peritonitis
The triage nurse in the emergency department is assessing a patient who presented with complaints of not feeling well. The patient has ascites and an enlarged liver. The patient reports a history of drinking a 12 pack of beer every evening for the past 15 years. The nurse is aware that the patient is at risk for which disease
A) Cirrhosis
A patient is admitted to the unit you work on with a diagnosis of enterocutaneous fistula. What is this fistula secondary to?
A) Crohn's disease
A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse?
"Pain relief occurs by 6 months in more than 85% of the patients who undergo this procedure, and it has been 2 months since your surgery."
The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease.What would be especially important to monitor this patient for?
A) Dehydration
A patient has just been diagnosed with acute gastritis. What would be the nursing care needed by this patient?
A) Physical and emotional support
The nurse is admitting a patient to the unit after having a gastrostomy. What is a potential postoperative complication of a gastrostomy?
A) Premature removal of the tube
The nurse planning discharge teaching for a 71-year-old female patient with ulcerative colitis knows that an assessment related to the family will need to be done. What assessment finding related to the family will have the greatest impact on the patient's rehabilitation after discharge?
A) Emotional support from the family
A nurse is caring for a patient with Crohn's disease. The patient is scheduled for a barium enema. What is an appropriate nursing intervention the day before the test?
A) Encourage plenty of fluids.
You are caring for a patient with advanced cirrhosis. You know that the most significant source of bleeding in a patient with cirrhosis is what?
A) Esophageal varices
A nurse practitioner is teaching a health class in the local high school. The nurse practitioner informs the class about hepatitis B. What occupation does the nurse practitioner inform the class is at the greatest risk for contracting hepatitis B?
A) Health care workers
There are vaccines that are available to nurses in the health care setting because of the risk of contracting blood-borne diseases in the work setting. What vaccine will reduce the risk of contracting a blood borne virus?
A) Hepatitis B vaccine
The nursing instructor is teaching new nursing students how to perform an abdominal assessment. When performing an abdominal assessment, what examination sequence should the nurse follow?
A) Inspection, auscultation, percussion, and palpation
A patient with colon cancer is 2 days postoperative removal of the malignancy. What is a potential complication that the nurse would assess for?
A) Intraperitoneal infection
A patient admitted with acute diverticulitis is being cared for by a staff nurse and a student nurse. The student asks the staff nurse what the signs of bowel perforation are. What should the staff nurse answer the student?
A) An elevated white cell count
A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B?
A 20-year-old college student who has had several sexual partners
A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver?
A 66-year-old who has a history of cirrhosis
The nurse in the walk-in clinic cares for a wide range of individuals. The nurse knows that the patient at increased risk for an acute pancreatitis attack is which of the following?
A) A 39-year-old man with chronic alcoholism
You are caring for four oncology patients. What patient is at the greatest risk for developing cancer of the tongue?
A) A 65-year-old man with alcoholism who smokes
A 5 year-old boy with muscular dystrophy has a bowel obstruction. What kind of bowel obstruction would this boy most likely have? A) A functional obstruction
A) A functional obstruction
Postnectrotic cirrhosis is a late result of what?
A) Acute viral hepatitis
A patient with advanced dental caries is at risk for what?
A) Alteration in nutrition—less than required
You are caring for a patient who underwent surgery for esophageal cancer 24 hours ago. You know that what is a common postoperative complication of surgery for esophageal cancer?
A) Aspiration pneumonia
The student nurse is caring for a patient on parenteral nutrition who has a diagnosis of acute pancreatitis. The instructor asks the student what needs to monitored closely in this patient. What should the student nurse answer?
A) Serum glucose levels
A 37-year-old male patient presents at the emergency department complaining of nausea and vomiting and severe abdominal pain. While the nurse is assessing the patient, the patient's wife informs the nurse that the patient had ingested 24 ounces of alcohol last evening. The patient's abdomen is rigid, and there is bruising to the patient's flank. What is the patient exhibiting signs of?
A) Severe pancreatitis with possible peritonitis
The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem?
A) Smokes two packs of cigarettes daily.
A patient who experienced a gastric hemorrhage has had the bleeding controlled. The patient's condition is now stable. The nurse caring for this patient should have as her priority frequent assessment of the patient for what?
A) Tachycardia, hypotension, and tachypnea
How is hepatitis C transmitted?
A) Unintentional needlesticks
You are caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively the patient verbalizes that the stoma is a dark purplish color. This nurse is aware of what?
A) Vascular supply to the stoma may be compromised.
The nurse is caring for a client who has a postoperative paralytic ileus following abdominal surgery. What drug is appropriate to manage this nonmechanical bowel obstruction?
ALVIMOPAN
A patient with portal hypertension has been admitted to the floor you work on. What will you assess for related to portal hypertension?
ASCITES
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals who ate at this restaurant and have never received the hepatitis A vaccine? An immune globulin injection
An immune globulin injection
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has?
Bleeding esophageal varices
Your patient has been admitted for a liver biopsy because the physician believes the patient may have liver cancer. The family has told both you and the physician that if the patient is terminal, the family does not want the patient to know. The biopsy results are positive for a very aggressive form of liver cancer. The patient asks you repeatedly what the results of the biopsy show. What strategy can you use to give ethical care to this patient?
Communicate the patient's request for information to the family and the physician.
A nurse is caring for a patient who has just returned from the ERCP removal of gallstones. What would the nurse know to monitor the patient for?
B) Development of pancreatitis
. The nursing instructor is teaching the senior nursing students about liver disease. What would the instructor teach the students is the most common surgical procedure for liver cancer?
C) A lobectomy
A patient with liver cancer is at the clinic to talk with the physician. The physician tells the patient that it is to risky to do surgery on their hepatic tumor. The patient asks the nurse why surgery is so risky for them. The nurse explains that while surgical resection of the liver tumor is possible in some patients, the risks associated with this procedure increase when the patient has a history of what?
CIRRHOSIS
Review Cullen Sign, Rovsing sing and Grey Tuner 's sing.
CULLEN SIGN HEMATOMA AT THE UMBILLICUS, TURNER HEMATOMA IAT THE SIDE OS THE ABDOMEN RELATED TO ACUTE PANCREATITIS, PANCREATIC HEMORRAGIC, RETROPERITONRAL, ABDOMINAL TRAUMA ETC. ROVSING SIGN WHEN YOU PALPATE THE LEFT SIDE AND THE PT FEEL PAIN IN THE RIGHT SIDE.
A nurse has conducted a community screening event for oral cancer. What client is the highest priority for referral to a dentist?
Client who smokes and drinks daily
The Home Health Nurse is preparing for an initial home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?
D) Monthly administration of injections of vitamin B
A nurse is assessing a 77-year-old male admitted to the unit for suspected liver dysfunction. What assessment finding will the nurse expect to find?
D) The liver is decreased in size and weight.
The nurse is doing triage at the community clinic when a middle-aged patient presents with abdominal pains and heartburn. The patient states the symptoms have persisted for several days following a particularly spicy meal. When assessing the patient, the nurse notes the patient has a history of acute gastritis. What complication would the nurse be particularly likely to assess for?
Esophageal or pyloric obstruction related to scarring
The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis?
HEPATITIC C
The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis?
HEPATITIS C
A student nurse is preparing a plan of care for a patient with chronic pancreatitis. What nursing diagnosis related to the care of a patient with chronic pancreatitis with drainage through the skin and abdominal wall is a priority?
IMPAIRED SKIN INTEGRITY
A nurse assesses a client who was started on intraperitoneal therapy 5 days ago. The client reports abdominal pain and "feeling warm." For which complication of this therapy will the nurse assess the client?
INFECTION
The nurse documents the vital signs of a client diagnosed with acute pancreatitis: Apical pulse = 116 beats/min Respirations = 28 breaths/min Blood pressure = 92/50 What complication of acute pancreatitis would the nurse suspect that the client might have?
INTERNAL BLEEDING
A) A nurse knows that performing oral and mouth care is an important nursing intervention. Why are patients who are ill at increased risk for developing dental caries?
Inadequate nutrition and a decrease in the production of saliva
A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond?
Less protein in the diet will help prevent confusion associated with liver failure.
The staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD?
Lower esophageal sphincter
A patient with a liver mass is undergoing a percutaneous liver biopsy. After the procedure the nurse assists the physician in positioning the patient. What position should they position the patient in?
On the right side with a pillow under the costal margin
After surgery for esophageal cancer, the patient is instructed to remain upright for at least 2 hours to allow the food to move through the gastrointestinal tract. What drug is used to promote gastric motility in these patients?
REGLAN
The nurse is assessing a typical patient with cholecystitis. The patient complains of localized pain. Where would the nurse also ask the patient if the pain has radiated to?
RIGHT SHOULDER
The school nurse is planning a health fair for a group of fifth graders. Dental health is one topic that will be covered during the health fair. What would be most likely to increase the risk of tooth decay?
SOFT DRINKS
. Nursing students have learned that removal of specific organs may place the patient at risk for impaired immune function. The students are taught that it is important, while taking the patient's health history, to ask the patient if he or she had surgical removal of what organ that may lead to impairment of the immune system?
SPLEEN
The nurse is caring for a patient with liver failure. The nurse understands that patients in liver failure often require vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin?
VITAMIN K
The nurse is teaching a client who has been treated for acute gastritis. What statement by the client indicates a need for further teaching?
a. "I can continue smoking cigarettes which is better than chewing tobacco."
After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates correct understanding of the teaching?
a. "I may have been exposed when we ate shrimp last weekend."
After teaching a client who is prescribed adalimumab for severe ulcerative colitis (UC), the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching?
a. "I will take this medication with my breakfast each morning."
A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism?
a. A 41-year-old male receiving dialysis for end-stage kidney disease
A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer?
a. A 72-year-old who eats fast food frequently
A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate?
a. Arrange a dietary consult.
A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider?
a. The ileostomy stoma is pale and cyanotic in appearance.
A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse?
a. Urine output via indwelling urinary catheter is 20 mL/hr
A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond?
a. Viral hepatitis is not spread through casual contact.
The primary health care provider documents that a client has a bruit over the abdominal aorta. What teaching will the nurse provide for assistive personnel (AP) based on this assessment finding?
b. "Avoid washing the client's abdomen too aggressively."
An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel Mark across the clients chest. Which action should the nurse take?
b. Assess the client by gently palpating the abdomen for tenderness.
An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take?
b. Assess the client by gently palpating the abdomen for tenderness.
A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspect?
b. Dumping syndrome
A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take?
b. Encourage the client to verbalize feelings about the diagnosis.
A nurse cares for a client who has a family history of colorectal cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer?" How would the nurse respond?
d. "You should have a colonoscopy more frequently to identify abnormal polyps early.
A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately?
d. International normalized ratio (INR): 4.2