Unit 4 test appendicitis, cholecystitis, ect

A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion

ANS: A Right lower quadrant pain, specifically at McBurney's point, is characteristic of appendicitis. Usually if nausea and vomiting begin first, the client has gastroenteritis. Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis. Abdominal pain due to appendicitis decreases with knee flexion. DIF: Remembering/Knowledge REF: 1169 KEY: Inflammatory bowel disorder| assessment/diagnostic examination MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? a. "Drink plenty of fluids to prevent dehydration." b. "You should only drink 1 liter of fluids daily." c. "Increase your protein intake by drinking more milk." d. "Sips of cola or tea may help to relieve your nausea."

a

which are the two most common manifestations of GERD? select all that apply a. dyspepsia b. eructations c. water drash d. regurgitation e. odynophagia f. flatulence

a, d

A patient on the unit has herpes zoster. Which staff members would be best to assign to the care of this patient? a. Any staff member, as long as personal protective equipment (PPE) is utilized. b. Staff members who have had chicken pox c. Staff members who have completed training on herpes zoster d. Staff members with no small children at home

b

What is the priority nursing concern for a pt with gastroenteritis a. Nutrition therapy b. Fluid replacement c. Skin care d. Drug therapy

b

Which group of drugs is the main treatment for GERD a. Antacids b. Histamine receptor agonist c. Proton pump inhibitors d. Gaviscon preparations

c

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy's sign c. Light-colored stools d. Upper abdominal pain after eating

ANS: C Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen equally with both chronic and acute cholecystitis.

The patient has been diagnosed with acute appendicitis. Which intervention does the nurse perform? a. start a bowel cleansing program b. prepare the pt for surgery c. apply a heating pad to the lower abdomen d. assess the patients knowledge about dietary modifications

B

The nurse is assessing a client with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? (Select all that apply.) Blood-tinged sputum Dyspepsia Excessive salivation Flatulence Regurgitation

Correct: Dyspepsia, also known as heartburn, is one of the main symptoms of GERD. Correct: Flatulence is common after eating. Correct: Regurgitation (backward flow into the throat) of food and fluids is common. Incorrect Feedback: Incorrect: Blood-tinged sputum is not a symptom of GERD. Incorrect: Excessive salivation is not a symptom of GERD.

the pt with GERD describes painful swallowing. Which symptom does the nurse identify ? a. dyspepsia b. regurgitation c. odynophagia d. dysphagia

c

the nurse is reviewing the lab results from a pt being evaluated for a lower urinary tract symptoms. what does an elevated prostate-specific antigen level and serum acid phosphatase level in the pt indicates? a. infection b. prostate cancer c. BPH d. infertility

b

which physiological factor contributes to GERD? a. accelerated gastric emptying b. irritation from reflux of stomach contents c. competent lower esophageal sphincter d. increased esophageal clearance

b

A pt with crohn's disease has a fistula. Which assessment finding indicates possible dehydration? a. Weigh gain of 2 pounds in one day b. Abdominal pain c. Foul-smelling urine d. Decreased urinary output

d

The nurse is assessing a pt with viral gastroenteritis. Which data is the nurse most concerned about? a. Orthostatic blood pressure changes b. Poor skin turgor c. Dry mucous membranes d. Rebound tenderness

d

Which man has the highest risk for prostate cancer? a. a 65 year old caucasian american man who has two cousins with prostate cancer b. a 45 year old asian american man with a history of BPH c. a 55 hispanic american man who has poor dietary practices d. a 75 african american man whose brother has prostate cancer

d

a pt is admitting to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. the pt develops a sudden sharp pain in the midepigastric region along with rigid board like abdomen. after obtaining the client's vital signs what should the nurse do next? a. administer pain medication as prescribed b. raise the head of the bed c. prepare to insert of NG tube d. notify the HCP

d

the advance practice nurse is preparing to examine a pt prostate gland. before the exam, what does the nurse tell the pt? a. he may feel the urge to defecate or faint as the prostate is palpated b. he should lie supine with knees bent in a fully flexed position c. the examination is very painful, but it only lasts a few seconds d. the gland will be massages to obtain a fluid samples for possible prostatitis

d

the nurse has provided teaching to a pt with GERD. Which statement by the pt indicates the teaching has been effective? a. i will eat three meals a day b. i will not snack 1 hour before i go to bed c. i will stay up for a least 15-30 minutes after eating dinner before going to bed d. i wont lift heavy objects

d

the nurse is preparing to assess an obese pt who reports subjective symptoms and urinary patterns associated with BPH. Which technique does the nurse use to perform the physical assessment? a. instruct the pt to undress form the waist down, then inspect and palpate the bladder b. have the pt drink several large glasses of water and percuss the bladder c. apply gently pressure to the bladder to elicit urgency, then instruct the pt to void d. instruct the pt to void and then use the bedside ultrasound bladder scanner

d

the nurse is using the international prostate symptom score to assess a pt. which data does the nurse intend to obtain through the use of this assessment tool? a. pt attitudes and beliefs about prostate surgery b. pattern of growth of prostate and correlation with symptoms c. data in aggregate that can be used for prostate research d. effect of urinary symptoms on the quality of life

d

which statement is true about the drug rabeprazole for treatment of GERD? a. it is rapidly released into the body after it is administered b. The tablets are large and may be crushed if the pt has difficulty swallowing them. c. It is a histamine receptor antagonist. d. If once-a-day dosing does not control symptoms, it may be taken bid.

d

An adult with appendicitis has severe abdominal pain. which action will be the most effective to assist the client to manage pain prior to surgery? a. place the client in semi fowler's positions with knees to chest b. apply moist heat to the abdomen c. teach client to massage the painful area d. provide distractions with music

A. appendicitis typically beings with periumbilical pain followed by anorexia, nausea and vomiting

A nurse cares for a client who has obstructive jaundice. The client asks, "Why is my skin so itchy?" How should the nurse respond? a. "Bile salts accumulate in the skin and cause the itching." b. "Toxins released from an inflamed gallbladder lead to itching." c. "Itching is caused by the release of calcium into the skin." d. "Itching is caused by a hypersensitivity reaction."

ANS: A In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.

ANS: B This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.

the nurse on the surgical unit is expecting to admit the patient who has had an appendectomy with abscess. What does the nurse anticipate care for the patient with include? a. clear liquids b. wound drains c. iv antibiotics d. nsaids for pain control e. NG tube care f. prescribed opioid pain drug

B,C,E,F

Postoperative nursing care for a client after an appendectomy should include: a. administering sitz baths four times a day b. noting the first bowel movement after surgery c. limiting the clients activity to bathroom privileges d. measuring abdominal girth every 2 hours

b noting the client first bowel movement after surgery important because this indicates that normal peristalsis has returned

A pt is suspected to have UC. Which diagnostic tests does the nurse expect the patient to undergo to confirm the diagnosis? Select all that apply a. Sigmoidoscopy b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate e. Magnetic resonance enterography (MRE) f. Clotting studies

b,c,d,e

a client is undergoing a lap chole. Which dietary instructions should the nurse give the client immediately after surgery? a. you cannot eat or drink anything for 24 hr b. you may resume your normal diet the day after your surgery c. drink liquids today and eat lightly for a few days d. you can progress from a liquid to a bland diet as tolerated

C. immediately after surgery . the client will drink liquids

A client with gastroesophageal reflux disease (GERD) is newly diagnosed by the nurse practitioner, who prescribes pantoprazole (Protonix) 40 mg. What teaching will the nurse provide for this client about this drug? A. "Be sure to take this drug every day until you feel better." B. "Be aware that this drug can cause anxiety and restlessness." C. "Do not crush the drug because it has a delayed release." D. "Do not take the drug with tomato-based foods or drinks."

C. "Do not crush the drug because it has a delayed release." Protonix is a delayed-release medication; the client should be informed to not crush, break, or chew delayed-release tablets. The client should continue to take the medication even after the GERD-associated symptoms are relieved; if the medication is stopped, the symptoms will return. Although clients with GERD should limit their intake of acidic foods, no specific food-drug interactions have been documented for Protonix. Anxiety and restlessness is not a common adverse effect documented with Protonix

Which laboratory finding does the nurse expect may occur with a diagnosis of appendicitis? a. decreased hematocrit and hemoglobin b. increased coagulation time c. decreased potassium d. increased WBC count

D presence of an infection

Which of these assigned clients does the nurse assess first after receiving the change-of-shift report? Young adult admitted the previous day with abdominal pain who is scheduled for a computed tomography (CT) scan in 30 minutes Adult with gastroesophageal reflux disease (GERD) who is describing epigastric pain at a level of 6 (0-to-10 pain scale) Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube Older adult admitted with an ileus who has absent bowel sounds and a prescription for metoclopramide (Reglan) on an as-needed (PRN) basis

Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube

A client has undergone a lap chole. Which instruction should the nurse include in the discharge instructions? a. empty the bile bag daily b. breathe deeply into a paper bag with nauseated c. keep adhesive dressings in place for 6 weeks d. report bile-colored drainage from any incision

d. there should be no bile colored drainage coming from any incision postoperatively a lap chole does not involve a bile bag

the nurse should specifically assess a cleint with prostatic hypertophy for a voiding in less frequent intervals b difficulty starting the flow of urine c. painful urination d increased force of the urine stream

b

a pt admitted to the hospital with peptic ulcer disease tells the nurse about having black tarry stools. the nurse should: a. encourage the pt to increase fluid intake b. advise the client to avoid iron rich foods c. place the client on contract precautions d. report the finding to the HCP

4

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond? a. "Ambulating in the hallway twice a day will help." b. "I will apply a cold compress to the painful area on your back." c. "Drinking a warm beverage can relieve this referred pain." d. "You should cough and deep breathe every hour."

ANS: A The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Cold compresses and drinking a warm beverage would not be helpful. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide.

A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this group's teaching? (Select all that apply.) a. "Rotavirus is more common among infants and younger children." b. "Escherichia coli diarrhea is transmitted by contact with infected animals." c. "To prevent E. coli infection, don't drink water when swimming." d. "Clients who have botulism should be quarantined within their home." e. "Parasitic diseases may not show up for 1 to 2 weeks after infection."

ANS: A, C, E Rotavirus is more common among the youngest of clients. Not drinking water while swimming can help prevent E. coli infection. Parasitic diseases may take up to 2 weeks to become symptomatic. People with botulism need to be hospitalized to monitor for respiratory failure and paralysis. Escherichia coli is not transmitted by contact with infected animals. DIF: Applying/Application REF: 1172 KEY: Inflammatory bowel disorder| infection control MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this client's condition? (Select all that apply.) a. Body mass index of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

ANS: A, D, F Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasis. A diet low in saturated fats and moderate alcohol intake may decrease the risk. Although metabolic syndrome is a precursor to diabetes, it is not a risk factor for cholelithiasis. The client should be informed of the connection.

After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I'll rinse my rectal area with warm water after each stool and apply zinc oxide ointment." b. "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." c. "I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry." d. "I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."

ANS: B Toilet paper can irritate the sensitive perineal skin, so warm water rinses or soft cotton washcloths should be used instead. Although aloe vera may facilitate healing of superficial abrasions, it is not an effective skin barrier for diarrhea. Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools. Patting the skin is recommended instead of rubbing the skin dry. DIF: Applying/Application REF: 1179 KEY: Bowel care| inflammatory bowel disorder MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "Drinking at least 2 liters of water each day is suggested." b. "I will decrease the amount of fatty foods in my diet." c. "Drinking fluids with my meals will increase bloating." d. "I will avoid concentrated sweets and simple carbohydrates."

ANS: B After cholecystectomy, clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients. Good fluid intake is healthy for all people but is not related to the surgery. Drinking fluids between meals helps with dumping syndrome, which is not seen with this procedure. Restriction of sweets is not required.

A nurse cares for a client who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The client states, "When I wake up I am in pain." Which action should the nurse take? a. Administer intravenous morphine while the client sleeps. b. Encourage the client to use the PCA pump upon awakening. c. Contact the provider and request a different analgesic. d. Ask a family member to initiate the PCA pump for the client

ANS: B The nurse should encourage the client to use the PCA pump prior to napping and upon awakening. Administering additional intravenous morphine while the client sleeps places the client at risk for respiratory depression. The nurse should also evaluate dosages received compared with dosages requested and contact the provider if the dose or frequency is not adequate. Only the client should push the pain button on a PCA pump.

A nurse prepares to admit a client who has herpes zoster. Which actions should the nurse take? (Select all that apply.)a.Prepare a room for reverse isolation.b.Assess staff for a history of or vaccination for chickenpox.c.Check the admission orders for analgesia.d.Choose a roommate who also is immune suppressed.e.Ensure that gloves are available in the room.

ANS: B, C, EHerpes zoster (shingles) is caused by reactivation of the same virus, varicella zoster, in clients who have previously had chickenpox. Anyone who has not had the disease or has not been vaccinated for it is at high risk for getting chickenpox. Herpes zoster is very painful and requires analgesia. Use of gloves and good handwashing are sufficient to prevent spread. It is best to put this client in a private room. Herpes zoster is a disease of immune suppression, so no one who is immune-suppressed should be in the same room.

A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.

ANS: C This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

ANS: D Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

a client's stools are light gray in color. For what findings should the nurse assess the clients? select all that apply a. intolerance to fatty foods b. fever c. jaundice d. respiratory destress e. pain at mcburney point f. peptic ulcer disease

a, b, c mcburney's point is associated with appendicitis

A pt is prescribed sulfasalazine for the treatment of UC. Which pt statement indicates the pt is experiencing a side effect of this drug? a. My skin is covered with a rash b. My knees hurt c. My appetite has increased d. I wake up at night sweating sometimes

a

An older adult with GERD is prescribed Omeprazole. What priority teaching point must the nurse instruct the pt about while taking this drug? a. Older adults taking this drug may be at increased risk for hip fracture because it interferes with calcium absorption. b. Because of this drugs effect of decreasing potassium, the pt may be prescribed a potassium supplement. c. This drug causes sodium retention so the pt may be prescribed a sodium restriction. d. A heart monitor may be needed because of changes in magnesium that can lead to life threatening dysrhythmias.

a

a client who has been scheduled to have a choledocholithotomy expresses anxiety about having surgery. Which nursing intervention would be the most appropriate to achieve the outcome of anxiety reduction? a. providing the client with information about what to expect post operatively b. telling the client not to be afraid c. reassuring the client by staying that surgery is a common procedure d. stressing the importance of following the HCO instructions after surgery

a

a pt has an enlarged prostate. which procedure does the nurse anticipate that the health care provider will order to test for bladder outlet obstruction? a. urodynamic pressure flow study b. bladder scan c. transrectal ultrasound d computer tomography

a

a pt who has been prescribed famotidine is being discharged home. which statement by the pt indicates a need for further discharge teaching by the nurse a. i will double up on the first dose if i begin to feel increased heartburn b. i will avoid all alcohol c. i will call the HCP if i continue to have heartburn d. this drug is available OTC

a

an adult male client has been unable to void for the past 12 hours. the best method for the nurse to use when assessing for bladder distention in a male client is to check for : a. a round swelling above the pubis b. dullness in the lower left quadrant c. rebound tenderness below the symphysis d. urine discharge from the urethral meatus

a

the nurse is designing a teaching plan for a pt with an enlarged prostate with obstructive symptoms. which action could the pt perform that might help to relieve the obstruction? a. increased frequency of sexual intercourse d. void before going to bed and upon waking c urinate forcefully after drinking fluids d. spread fluid intake throughout the day

a

the nurse sees that the pt is taking tamsulosin. which question would the nurse ask to determine if the med is achieving the desired therapeutic effects a. are you still having trouble passing urine b. does your urine have a strong odor or cloudy appearance c. are you having any problems with achieving an erection d. have you had a green or yellow discharge from your penis

a

which statement is true about barretts epithelium in the pt with GERD? a. it is considered premalignant and is associated with higher risk for cancer b. this new temperature is less resistant to acid so it must be removed c. barretts epithelium is resistant to the development of cancer d. esophageal strictures are less likely to occur with this type of epithelium

a

the pt has been diagnosed with shingles. the nurse should include which information in a teaching plan? select all that apply a. instruct the pt about taking antivirals agents as prescribed b. demonstrate how to apply wet to dry dressings c. explain how to follow proper hand washing d. assure the pt that the pain from shingles will be gone in 7 days e. tell the pt to remain in isolation in a bedroom until the lesions have healed

a, b, c

a nurse is caring for an older adult with shingles. the client is experiencing considerable pain related to open blisters on the client abdomen and back. the client is taking acyclovir and low-dose prednisone. the nurse has several prescriptions available. what additional medications or nursing care strategies to promote comfort may be helpful a diphenhydramine 25 mg by mouth every 6 hours prn b. calamine lotion applied to the affected areal c cool wet compresses to the affected area d acetaminophen 325 mg by mouth every 6 hours prn e. ondansetron 4 mg by mouth every 4 hours prn f. diversionary activities to prevent client scratching

a, b, c ,d, f

which conditions meet the criteria for having a surgical interventions for BPH? select all that apply a. acute urinary retention b. hydronephrosis c. acute urinary tract infection that does not respond to first line antibiotics d. recurrent kidney stones e hematuria f. chronic urinary tract infections secondary to residual urine in the bladder

a, b, e, f

which are advantages of minimally invasive surgery laparoscopic cholecystectomy? select all that apply a. complications are uncommon b. the mortality is similar to traditional cholecystectomy c. patients recover more rapidly d. postoperative pain is less severe e. bile duct injuries are rare f. IV antibiotics are never needed because of decreased infection rates

a, c, d ,e

a pt with severe GERD tells the nurse that she has pain after each meal that lasts for 45 minutes and is worse when she lies down. What interventions should the nurse teach this pt? select all that apply a. drink fluids b. when you lie does, try lying on your side c. take an antacid as prescribed by your HCP d. eat something bland such as a slice of white bread e. maintain an upright position for at least 1 hour after you eat f. try pressuring over you abdomen to mobilize the food in your stomach

a, c, e

In caring for a patient with Crohn's disease, the nurse observes for which complications? Select all that apply. a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas e. Appendicitis f. Severe nausea and vomiting

a,b,c,d

Which people should be advised to get the meningococcal vaccine? Select all that apply a. Healthy 12 -year-old school child b. 25-year old school child who had splenectomy due to an auto accident. c. Healthy 18-year-old who has enlisted in the military d. Healthy 20-year-old who is planning to live in a university dormitory e. Healthy 24-year-old who is interning with a lawyer for the summer. f. Healthy 22 year-old who is unsure about the vaccination status and plans to go to Asia

a,b,c,d,f

Uncontrolled GERD can be a cause of which adult onset disorders? Select all that apply a. Dental decay b. Aspiration pneumonia c. Laryngitis d. Diverticulitis e. Asthma f. Cardiac disease

a,b,c,e,f

Which interventions are useful in preventing spread of gastroenteritis? Select all that apply a. Careful handwashing b. Sanitizing all surfaces that may be contaminated c. Prophylactic use of antibiotics d. Easily accessible hand sanitizers e. Testing all food preparation employees f. Proper food and beverage preparation

a,b,d,f

A pt with UC who has had an ileostomy is being discharged home. Which statements by the PT indicate the discharge teaching has been effective? Select all that apply a. I will avoid foods that cause gas b. I will call the healthcare provider if I have a fever over 101 F (38.3C) c. I will change the adhesive for the appliance daily d. I know the pouch needs emptying when I feel pain in that area e. I will call the healthcare provider if I feel my heart beating faster f. I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss.

a,b,e,f

The nurse is caring for the patient with acute appendicitis. Which interventions will the nurse perform? select all that apply a. maintain the patient on NPO status b. administer IV fluids as prescribed c. apply warm compresses to the right lower abdominal quadrant d. maintain the patient in supine position e. administer laxatives f. If tolerated, maintain the pt. in semi-fowler's position

a,b,f Warm compress adds more inflamation to site pt should not be in supine position, they should be in semi fowlers administers of laxatives can cause perforations in the appendix

Which statements about Barrett's esophagus is accurate? Select all that apply. a. It is considered to be a premalignant condition b. It is associated with excessive intake of fresh fruits and vegetables. c. It results from exposure to acid and pepsin d. It is associated with pickles and fermented foods. e. Normal cells undergo dysplasia to become cancerous. f. It is more common in younger adults.

a,c,d,e

the nurse is interviewing a pt to determine the presence of lower urinary tract symptoms associated with BPH. which questions would the nurse ask? select all that apply a. do you have difficulty stating and continuing urination b. have you ever had testicular infection do you have reduced force and size of the urinary stream d. have you noticed dripping or leaking after urinating e. how many times do you have to get up during the night to urinate f. have you noticed blood at the start or at the end of urinating

a,c,d,e,f

By which actions do drugs used to treat GERD hlp to decrease the pain and discomfort the pt experiences? Select all that apply a. Inhibition of gastric acid production b. Blocking of pain sensation in the CNS c. Accelerating gastric emptying d. Decreasing lower esophageal sphincter pressure e. Protecting the gastric mucosa f. Destroying H. pylori bacteria

a,c,e

which statement of GERD is correct? a. overweight and obese pt are at an increased risk b. thin and underweight patients are at an increased risk c. it is common disorder in the asian and hispanic populations d. there is a high incidence in pt who eat mostly hot and spicy foods e. it is a common upper gastrointestinal disorder in the US f. eating large meals predisposes a pt to reflux

a,e,f

a client with cholecystitis continues to have severe right upper quadrant pain. the nurse obtains the following VS: temp 101.1, BP 142/90 mm. RR 22 min, pulse 114 bpm. Using the SBAR technique form communication, the nurse recommends to the healthcare provider for the client to receive a. hydromorphone iv b. diltiazem po c. meperidine IM d. promethazine IM

a.

the nurse is caring for a client who had an open cholecystectomy 24 hours ago . the clients VS have been stable over the last 24 hours, BP 118/76, most recent temperature 98.6 F, RR of 16 p/min, but now changing. Which set of VS indicate that the nurse should contact the HCP? a. temp of 101.8, BP of 140/86 mm hg, HR 94 bpm, RR 24 minute b. temp 100.7, BP of 118/68 mm/hg, Hr 84 bpm, RR 20/min c. temp 99.5, BP of 126/80 mm/hg, Hr 58 bpm, RR 16/ min d. temp 97.5, BP of 98/64 mm/hg, HRn 98 bpm, RR 18/min

a. this client is exhibiting the three of four signs of systemic inflammatory response syndrome (SSRI)

the primary reason for lubricating the urinary cath generously before inserting the cath into a male client is that this technique helps reduce: a. spasms at the orifice of the bladder b. friction along the urethra when the cath is being inserted c. the number or organisms gaining entrance to the bladder d. the formation of encrustation that may occur at the end of the cath

b

which is an expected outcome for a client with peptic ulcer disease? the client will: a. demonstrate appropriate use of analgesics to control pain b explain the rationale for eliminating alcohol from the diet c. verbalize the importance of monitoring hemoglobin and hematocrit every 3 months d. eliminate engaging in contact sports

b

The nurse measured the amount of bile drainage from a T tube and records it by which method? a. adding it to the clients urine output b. charting it separately on the output record c. adding it to the amount of wound drainage d. subtraction it from the total intake for each day

b t tube bile is recorded separately on the output record

which pt should recieve a shigles vaccine? a pt who: a. has never had chickenpox b. is at risk for genital herpes c. is over 60 years d. has a compromised immune system

c

The nurse is evaluating electrolyte values for a pt with acute pancreatitis and notes that the serum calcium is 6.8 mEq/L. How does the nurse interpret this finding? a. Within normal limits considering the diagnosis of acute pancreatitis b. a result of the body not being able to use bound calcium c. A protective measure that will reduce the risk of complications d. Full compensation of the parathyroid gland

b

The nurse is reviewing the electrolyte values for a patient with bacterial meningitis and notes that the serum sodium is 126 mEq/L( 126 mmol/L). How does the nurse interpret this finding? a. Within normal limits considering the diagnosis of bacterial meningitis but warrants repeat laboratory testing for downward trends b. Evidence of syndrome of inappropriate antidiurectic hormone, which is complication of bacterial meningitis. c. A protective measure that causes increased urination and therefore reduces the risk of increased intracranial pressure. d. An early warning sign that the electrolyte imbalances will potentiate an acute myocardial infarction or shock.

b

The nurse notes that the pt has just started taking an alpha-blocker medication to treat BPH. what instruction, related to the medication side effects, will the nurse give to unlicensed assistive personnel who will assist the pt with activities of daily living? a. frequently offer the pt the urinal b. have him sit up slowly and pause before standing c. remind the pt to drink plenty of extra fluids d. frequently check the linens for soiling and moisture

b

The patient with acute cholecystitis has a pacemaker. Which diagnostic test is contraindicated? a. Extracorporeal shock wave lithotripsy (ERCP) b. Magnetic resonance cholangiopancreatography (MRCP) c. Ultrasonography of the right upper quadrant d. Hepatobiliary (HIDA) scan

b

The pt with gastroenteritis due to infection with the norovirus asks the nurse how this illness occurred. Which statement by the pt indicates correct understanding of the nurses teaching? a. I got this infection by being around my grandchildren when they had a respiratory illnesses. b. It is likely that I got this illness from either contaminated water or food. c. I may have gotten sick when I was travelling last month d. Its really important that everything I eat is cooked until it is well done.

b

Which lifestyle adjustment may a pt have to make to best control GERD A. Sleep in a trendelenburg position b. Attain and maintain ideal body weight c. Wear snug fitting belts and waistbands d. Engage in strenuous exercise such as weightlifting

b

Which statement is true about drug therapy for Crohn's disease or UC? a. Infliximab is used to manage episodes of diarrhea with Crohn's disease. b. Sulfasalazine is the first aminosalicylate approved for UC. c. Metronidazole has been helpful in pt's with fistulas and UC. d. Adalimumab is a glucocorticoid approved for the treatment of Crohn's disease.

b

Which statement is true about the medical treatment of UC? a. Infliximab is approved as a first-line therapy. b. Immunomodulators are not thought to be effective; however, in combination with steroids, they may offer a synergistic effect. c. When a therapeutic level of glucocorticoids is reached, the dosage of the drug stays the same to maintain the therapeutic effect. d. The method of action for the aminosalicylate is interruption of the pain pathway.

b

a patients arrives in the ED reporting headache, nausea, and photosensitivity. The pt has been living with two people who were diagnosed with meningitis. Which diagnostic test does the nurse anticipate the health care provider will order to rule out meningitis? a. xray of the skull b. lumbar puncture c. myelography d. cerebral angiogram

b

a pt is scheduled to have several diagnostic tests to verify the medical diagnosis of GERD. Which diagnostic test is the most accurate method of diagnosing this disorder? a. EGD b. ambulatory pH monitoring exam c. esophageal manometry d. motility testing

b

a pt tells the nurse that he was idagnosed with BPH. based on this diagnosis, which symptom is the pt most likely to report? a. pain in the scrotum b. trouble passing urine c. erectile dysfunction d. constipation

b

a pt with GERD is on medications that raises the pH of gastric contents. Which drug does the nurse expect to administer? a. ranitidine d. mylanta c. gaviscon d. omeprazole

b

The nurse is teaching a pt with GERD about lifestyle changes. Which key points would the nurse include. Select all that apply a. Consume 4-6 large meals qd b. Limit or eliminate tobacco and alcohol c. Eat slowly and chew food thoroughly d. Elevate the head of your bed 3-5 inches using wooden blocks e. Do not wear restrictive clothing f. Reduce or eliminate spicy foods that cause increased gastric acid.

b,c,e,f

Which are common manifestations in a 28 year old pt with dehydration secondary to gastroenteritis? Select all that apply a. Peripheral edema b. Elevated temperature c. Dry mucous membranes d. Hypertension e. Oliguria f. Poor skin turgor

b,c,e,f

Which characteristics pertain to Crohn's disease? Select all that apply. a. It begins in the rectum and proceeds in a continuous manner toward the cecum. b. Fistulas commonly develop. c. There are five to six soft, loose, nonbloody stools per day. d. There is an increased risk of colon cancer e. Some pts experience extraintestinal manifestations such as migratory polyarthritis, ankylosing spondylitis, and erythema nodosum. f. There is a cobblestone appearance of the internal intestine.

b,c,f

a forty year old client is admitted to the hospital with a diagnosis of acute cholecystitis. The nurse should contact the healthcare provided to question witch prescription? a. iv fluid therapy of normal saline solution to be infused at 100ml/ h until further prescription b. administer morphine sulfate 10 mg IM every 4 hours for severe abdominal pain c. NPO until further prescriptions d. insert a NG tube, and connect to low intermittent suction

b. the nurse should question morphine sulfate because there is a link between it and biliary spasm

A patient with meningitis reports a headache, and the nurse gives the appropriate IV push medication. Several hours later, the patient reports pain in the left hand; the radial pulse is very weak, the hand feels cool, and capillary refill is sluggish compared to the left. What does the nurse suspect is occurring in this patient? a. Stroke secondary to increased intracranial pressure resulting from meningitis b. Sickle cell crisis associated with an increased risk of meningitis c. Thrombotic or embolic complication causing vascular compromise d. Local phlebitis from the IV push pain medication that was given.

c

An adolescent has a painful and unsightly herpes simplex blister on her lip and would like to have her school photo delayed until after the lesion has resolved. What does the nurse tell the patient about the duration of the outbreak? a. IT should resolve completely in 2-3 days. b. Within 3-5 days the blister will be gone. c. Symptoms can last 3-10 days d. It will begin to improve in 2 weeks.

c

The nurse hears in report that a patient admitted for an elective surgery also has herpes zoster. The nurse initiates contact isolation for which factor? a. Fever and malaise are present as accompanying symptoms. b. Other patients or staff members have never had chickenpox. c. Lesions are present as fluid-filled blisters. d. Lesions are present and crusted over.

c

The nurse is caring for a patient who was admitted for a diagnosis of meningococcal meningitis. Which nursing action is specific to this type of meningitis? a. Administering an antifungal agent such as amphotericin B b. Observing the patient for genital lesions c. Placing the patient in isolation per hospital procedure d. Checking to see if the patient is HIV positive

c

The nurse is caring for a pt who has symptoms and risk factors for bacterial meningitis. For which symptoms must the nurse alert the health care provider? a. cap refill of 3 seconds b. headache with nausea and vomiting c. inability to move eyes laterally d. oral temp of 1q01.6

c

The nurse is caring for a pt with gastroenteritis who has frequent stools. Which task is best to delegate to the UAP? a. Teach the pt to avoid use of toilet paper and harsh soaps b. Instruct the pt on how to take a sitz bath c. Use a warm washcloth to remove stool from the skin d. Dry the skin with absorbent cotton.

c

When emptying the client's bladder during a urinary catheterization, the nurse should allow the urine to drain from the bladder slowly to prevent: a. renal failure b. abdominal cramping c. possible shock d atrophy of bladder musccccularutre

c

Which common complication should the nurse monitor for in an older patient diagnosed with herpes zoster? a. Nausea and vomiting b. Infections of the arms and legs c. Severe pain after the lesions have resolved d. Severe itching after the lesions have resolved

c

a client is admitted to the hospital with a diagnosis of cholecystitis from cholelithiasis. The client has severe abdominal pain and nausea and has vomited 120 ml . based on these date. which nursing action would have the highest priority at this time? a. manage anxiety b. restore fluid loss c. manage the pain d. replace nutritional loss

c

a pt is to take one daily dose of ranitidine at home to treat a peptic ulcer. The pt understands proper drug administration of ranitidine when the client will take the drug a. beofre meals b. with meals. c. at bedtime d. when pain occurs

c

a pt with PUD is admitted to the hospital for a gastric resection . the pt reports a sudden sharp pain in the midepigastric area the radiates to the shoulder. the nurse should first a establish an iv line b administer pain medications c notify the surgeon d call for a stat ECG

c

the nurse is talking with an older pt who has BPH. Which report by the pt requires emergency care? a. i leak and dribble urine b. i have to getup at night to pee c. i cant pass my urine today d. i am passing dark yellow urine

c

the nurse is teaching a pt with a peptic ulcer about the diet that should be followed after discharge. the nurse should explain that the diet should include a. bland foods b high protein foods c. any foods that are tolerated d. a glass of milk with each meal

c

a client has an open cholecystectomy with bile duct exploration. following surgery, the client has a T tube. To evaluate the effectiveness of the T tube, the nurse should: a. irrigate the tube with 20 ml of NS every 4 h b. unclamp the T tube and empty the contents every day c. assess the color and amount of drainage every shift d. monitor the multiple incision sites for bile drainage

c a t tube is inserted in the common bile duct to maintain patency when there is a likelihood of edema

when obtaining a nursing history from a client with a suspected gastric ulcer, which signs and symptoms should the nurse assess? select all that apply? a . epigastric pain at night b relief or epigastric pain after eating c. vomiting d. weight loss e. melena

c, d, e

the nurse teaches a pt with BPH to follow which instructions? select all that apply a. take diuretics to increase output b. avoid sexual intercourse. c. avoid antihistamines d. avoid caffeine e. avoid drinking large amounts of fluid in a short time f. void when the urge occurs

c, d, e, f

after a cholecystectomy. the client is to follow a low-fat diet. Which food would be most appropriate to include in a low-fat diet? a. cheese omelet with onions b. peanut butter on wheat toast c. ham salad sandwich made with mayo d. roast beef sandwich with lettuce and tomato

d. lean meats, such as beef, lamb, veal, and well-trimmed lean ham are low in fat

The patient comes to the emergency department with right lower quadrant pain. What does the Ed nurse suspect? a. gastroenteritis b. ulcerative colitis c. appendicitis d. crohn's disease

c. appendicitis

A pt has returned to the unit after a Stretta procedure for GERD. Which action by the student nurse requires the supervising nurse to intervene? a. The pt is offered clear liquids in the early postprocedure period. b. The pts routine 81 mg ASA is held c. A proton pump inhibitor is administered d. A nasogastric tube is prepared for insertion.

d

As part of the routine treatment plan for a patient with bacterial gastroenteritis, which drugs does the nurse anticipate the patient will most likely be prescribed? a. anticholinergics b. Antiemetics c. Antiperistaltic drugs d. Antibiotics

d

a pt diagnosed with PUD has an H. pylori infection. the pt is following a 2 week drug regimen that includes clarithromycin along with omeprazole and amoxicillin. the nurse should instruct the cline to a. alternate that use of the drugs b. take the drugs at different times during the day c. discontinue all drugs is nausea occurs d. take the drugs for the entire 2 week period

d

a pt is taking an antacid for treatment of peptic ulcer. which statement best indicates that the pt understands how to correctly take the antacid a. i should take my antacid before i take my other meds b. i need ot decreases my intake of fluids so that i do not dilute the effects of my antacid c. my antacid will be most effective if i take it whenever i experience stomach pains d. it is best for me to take m y antacid 1 to 3 hours after meals

d

An nurse is providing wound care to a client 1 day following an appendectomy. A drain was inserted into the incisional site during surgery. When providing wound care the nurse should: a. remove the dressing and leave the incision open to air b. remove the drain if wound drainage is minimal c. gently irrigate the drain to remove exudate d. clean the area around the drain moving away from the drain

d doing this prevents the introductions of microorganisms to the wound and drain site