Exam 3 workshop

A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse plan to implement? 1. Vitamin B12 injections 2. Iron supplements 3. Blood transfusions 4. Vitamin B6 supplements

1) Vitamin B12 injections Answer Rationale: The nurse should administer vitamin B12 injections to treat pernicious anemia when diet fails to improve the anemia due to poor absorption.

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of following values? 1. Calcium 2. RBC count 3. Magnesium 4. Amylase

4) Amylase Answer Rationale: Amylase is an enzyme that changes complex sugars into simple sugars that can be used by the body. It is produced by the pancreas and salivary glands and released into the mouth, stomach, and intestines to aid in digestion. The amylase level of a client who has acute pancreatitis usually increases within 12 to 24 hr and can remain elevated for 2 to 3 days.

A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care? 1. Decrease the clients fluid intake 2. increase the clients saturated fat intake 3. Increase the clients sodium intake 4. Decrease the clients carbohydrate intake

1) Decrease the client's fluid intake. Answer Rationale: The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client's risk for increased fluid retention.

A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal hypertension. The nurse recognizes which of the following laboratory findings as indicating the client's gastrointestinal (GI) tract is digesting and absorbing blood? 1. Elevated blood urea nitrogen (BUN) 2. Elevated HbA1c 3. Decreased chloride 4. Decreased bilirubin

1) Elevated blood urea nitrogen (BUN) Answer Rationale: As the body digests blood, BUN rises. An elevated BUN is an indication of GI bleeding.

A nurse is teaching a client who has cholecystitis about required dietary modifications. The nurse should include which of the following foods as appropriate for the client's diet? 1. Creamed chicken 2. Roast turkey 3. Ice cream 4. Macaroni and cheese

2) Roast turkey Answer Rationale: Roast turkey is a low-fat protein that is an appropriate choice for inclusion in the client's diet. Low-fat food decreases stimulation of the gallbladder, thereby reducing associated symptoms.

nurse is assessing a client who is on long term omeprazole therapy. Which of the following findings should indicate to the nurse the medication is effective? 1. Increased appetite 2. Regular bowel movements 3. Absence of headache 4. Reduced dyspepsia

4) Reduced dyspepsia Answer Rationale: Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis.

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history? 1. Gallstones 3. Hypolipidemia 3. COPD 4. Diabetes mellitus

1) Gallstones Answer Rationale: The client's history might reveal biliary obstruction from a gallstone causing bile to inflame the pancreas.

A nurse is caring for a client who has diverticular disease. When palpating the client's abdomen, in which of the following locations should the nurse expect the client to report abdominal pain? 1. Lower left quadrant 2. Upper left quadrant 3. Lower right quadrant 4. Upper right quadrant

1) Lower left quadrant Answer Rationale: The nurse should expect the client to have abdominal pain in the lower left quadrant of the abdomen. The disease is usually found in the sigmoid colon, where high pressure to move fecal contents from the rectum causes pouch formation.

A nurse is planning care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan of care? 1. Provide a high carbohydrate diet 2. Administer acetaminophen for pain 3. Encourage eating three large meals daily 4. Include high protein snacks

1) Provide a high carbohydrate diet. Answer Rationale: A client with hepatitis should have a diet high in carbohydrates due to altered nutrient metabolism.

A nurse is assisting a group of clients in an outpatient clinic. For which of the following clients should the nurse anticipate scheduling a colonoscopy? 1. 56-year-old who had a colonoscopy 6 years ago 2. 34-year-old who reports a new onset of constipation 3. 32-year-old who has a sister who died of colon cancer 4. 51-year-old who is being seen for an annual physical examination

4) 51-year-old who is being seen for an annual physical examination Answer Rationale: Colorectal cancer (CRC) is not common prior to the age of 40 years. When an adult turns 40, the provider should begin screening the client for risk factors of CRC (e.g., family history, inflammatory bowel disease, tobacco and alcohol use, high-fat and low-fiber diet, diet high in animal fats and red meat, sedentary lifestyle). The provider also may begin fecal occult blood testing depending on the client's risk. Screening colonoscopies are recommended starting at age 50 for those clients considered to be at normal risk with no family history and repeated every 10 years. It may begin earlier and performed more often for clients at high risk.

A nurse in a public clinic is planning a health fair for older adult clients in the community. In teaching medication safety, which of the following foods should the nurse advise the clients to avoid when taking their prescriptions? 1. Carbonated beverage 2. Milk 3. Orange juice 4. Grapefruit juice

4) Grapefruit juice Answer Rationale: There is a high rate of food-drug interactions between grapefruit juice and many medications frequently taken by older adults, especially lipid-lowering agents. It is thought that one or more of the chemicals (most likely flavonoids) in grapefruit juice alter the activity of specific enzymes (such as CYP3A4 and CYP1A2) in the intestinal tract. These enzymes decrease the rate at which medications enter the systemic circulation. This could allow a larger amount of these drugs to reach the bloodstream, resulting in increased drug levels and possibly toxicity.

A nurse is preparing a client who is scheduled to undergo a paracentesis. Into which of the following positions should the nurse assist the client for this procedure? 1. High-Fowlers 2. Side-lying 3. Leaning forward 4. Supine

1) High-Fowler's Answer Rationale: Sitting upright facilitates pooling of peritoneal fluid for easier drainage.

A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H2 receptor antagonist (H2RA). Which of the following outcomes indicates the H2RA is therapeutic? 1. Relief of heartburn 2. Cessation of diarrhea 3. Passage of flatus 4. Absence of constipation

1) Relief of heartburn Answer Rationale: H2RAs are used to treat duodenal ulcers and prevent their return. In over-the-counter strengths, these medications, such as cimetidine and famotidine, are used to relieve or prevent heartburn, acid indigestion, and sour stomach.

A nurse is providing teaching to a client with gastroesophageal reflux. Which of the following statements by the client indicates a need for further teaching? 1. I should elevate the head of my bed while sleeping 2. I drink no more than 4 cups of coffee a day 3. I take my time when I am eating 4. I avoid food and drinks with chocolate

2) "I drink no more than 4 cups of coffee a day." Answer Rationale: The client should not consume regular or decaffeinated beverages; therefore, this statement by the client indicates a need for further teaching.

A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse recognize as a risk factor for this condition? 1. History of bulimia 2. History of NSAID use 3. Drinks green tea 4. Has a glass of wine with dinner each day

2) History of NSAID use Answer Rationale: The nurse should recognize that long-term use of NSAIDs is a risk factor for peptic ulcer disease. NSAIDs break down the mucosal barrier and cause production of prostaglandins to decrease, which results in local gastric mucosal injury.

A nurse admits a client to the emergency department who reports nausea and vomiting that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following laboratory test results should the nurse expect to see? 1. Decreased WBC 2. Increased serum amylase 3. Decreased serum lipase 4. Increased serum calcium

2) Increased serum amylase Answer Rationale: With acute pancreatitis, serum amylase rises within 24 hr of the start of the client's symptoms.

A nurse is teaching a client who is lactose intolerant. Which of the following statements regarding lactose intolerance should the nurse include in the teaching plan? 1. You should increase the fiber in your diet 2. You should increase the calories in your diet 3. You should decrease the dairy products in your diet 4. You should decrease the protein in your diet

3) "You should decrease the dairy products in your diet." Answer Rationale: Dairy products are lactose-containing foods and therefore should be decreased or avoided by the client who is lactose intolerant.

A nurse is reviewing the medical record of a client who reports drinking three to four glasses of wine each night and taking 3,000 mg of acetaminophen daily. Which of the following laboratory values is the priority for the nurse to assess? 1. Amylase 2. Creatine 3. Aspartate aminotransferase (AST) 4. Antidiuretic hormone (ADH)

3) Aspartate aminotransferase (AST) Answer Rationale: The greatest risk to this client is liver injury from the combined adverse effects of alcohol and acetaminophen. Therefore, the priority laboratory value for the nurse to evaluate is AST because an elevated level is an indication of liver damage.

A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider? 1. Stoma oozing red drainage 2. Shiny, moist stoma 3. Purplish-colored stoma 4. Rosebud-like stoma orifice

3) Purplish-colored stoma Answer Rationale: A stoma that is purplish in color indicates ischemia. The nurse should notify the provider immediately.

A nurse is providing teaching to a parent of a child who has celiac disease. The nurse should include which of the following food choices for this child? 1. Barley 2. Rye 3. Rice 4. Wheat

3) Rice Answer Rationale: Because rice is naturally gluten-free, it is an acceptable food choice for a child who has celiac disease.

A nurse is providing discharge teaching to a client who has gastroesophageal reflux disease. Which of the following statements by the client indicates an understanding of the teaching? 1. The type of food I eat does not affect this condition 2. I will sleep on my left side 3. I will eat a snack just before going to bed 4. I will sleep with the head of my bed elevated

4) "I will sleep with the head of my bed elevated." Answer Rationale: The client should sleep with the head of the bed elevated by 6 to 12 inches to prevent reflux at night.