Final Med surg

Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction? a. Referred back pain b. Metabolic alkalosis c. Projectile vomiting d. Abdominal distention

D. Abdominal distention

Which finding indicates to the nurse that demeclocycline has been effective for a patient withsyndrome of inappropriate antidiuretic hormone (SIADH)? a. Weight has increased. b. Urinary output has increased. c. Peripheral edema has increased. d. Urine specific gravity has increased.

b. Urinary output has increased.

The nurse is planning care for a patient with acute myeloid leukemia (AML). Which is the priority nursing diagnosis to minimize the risk of complications associated with AML? 1) Risk for Bleeding 2) Ineffective Thermoregulation 3) Imbalanced Nutrition 4) Fluid Volume Excess

1) Risk for Bleeding

Syndrome caused by hormones, cytokines, enzymes secreted by the tumor, or antibodies. Symptoms: HYPERcalcemia, SIADH, cushing syndrome, polycythemias, adrenal HYPERsecretion

Paraneoplastic syndrome

Nursing management of the patient with acute pancreatitis includes (select all that apply) a. checking for signs of hypocalcemia. b. providing a diet low in carbohydrates. c. giving insulin based on a sliding scale. d. observing stools for signs of steatorrhea. e. monitoring for infection, particularly respiratory tract infection.

a, e Rationale: During the acute phase, it is important to monitor vital signs. Hemodynamic stability may be compromised by hypotension, fever, and tachypnea. Intravenous fluids are ordered, and the response to therapy is monitored. Fluid and electrolyte balances are closely monitored. Frequent vomiting, along with gastric suction, may result in decreased levels of chloride, sodium, and potassium. Because hypocalcemia can occur in acute pancreatitis, the nurse should observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. Numbness or tingling around the lips and in the fingers is an early indicator of hypocalcemia. The patient should be assessed for Chvostek's sign or Trousseau's sign. A patient with acute pancreatitis should be observed for fever and other manifestations of infection. Respiratory infections are common because the retroperitoneal fluid raises the diaphragm, which causes the patient to take shallow, guarded abdominal breaths.

A patient with a new ileostomy asks how much it will drain after the bowel has adapted in a few months. How many cups of drainage per day would the nurse tell the patient to expect? a. 2 b. 3 c. 4 d. 5

a. 2

When is a fat embolism most likely to occur? a. 24 to 48 hours after a fractured tibia b. 36 to 72 hours after a skull fracture c. 4 to 5 days after a fractured femur d. 5 to 6 days after a pelvic fracture

a. 24 to 48 hours after a fractured tibia

Which action should the nurse take to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur? a. Assess for hip pain. b. Check for contractures. c. Palpate peripheral pulses. d. Monitor for hip dislocation.

a. Assess for hip pain.

A patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result would the nurse expect? a. Elevated hematocrit b. Decreased serum sodium c. Increased serum chloride d. Low urine specific gravity

b. Decreased serum sodium

A patient with a fractured right hip has an anterior ORIF of the fracture. What should the nurse plan to do postoperatively? a. Get the patient up to the chair on the first postoperative day. b. Ambulate the patient with partial weight bearing by discharge .c. Keep the leg abductor pillow on the patient even when bathing. d. Position the patient only on the back and the nonoperative side.

a. Get the patient up to the chair on the first postoperative day.

Which finding indicates to the nurse that the current therapies are effective for a patient who has acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels

a. Increasing serum sodium levels

Which kind of hip fracture is usually repaired with a hip prosthesis? a. Intracapsular b. Extracapsular c. Subtrochanteric d. Intertrochanteric

a. Intracapsular

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information ismost important to report to the health care provider? a. The patient is confused and lethargic. b. The patient reports a recent head injury c. The patient has a urine output of 400 mL/hr. d. The patient's urine specific gravity is 1.003.

a. The patient is confused and lethargic.

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whoseplatelet count drops to 18,000/μL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.

a. check all stools for occult blood.

The patient asks, "What does the doctor mean when he says that I have an avulsion fracture in my leg? I thought I had a sprain!" What is the best response by the nurse? a. "It is a fracture with more than 2 fragments." b. "It means that a ligament pulled a bone fragment loose." c. "The line of the fracture is twisted along the shaft of the bone." d. "The line of the fracture is at right angles to the longitudinal axis of the bone."

b. "It means that a ligament pulled a bone fragment loose."

The patient asks, "What does the doctor mean when he says that I have an avulsion fracture in my leg? I thought I had a sprain!" What is the best response by the nurse? a. "It is a fracture with more than 2 fragments." b. "It means that a ligament pulled a bone fragment loose." c. "The line of the fracture is twisted along the shaft of the bone." d. "The line of the fracture is at right angles to the longitudinal axis of thebone."

b. "It means that a ligament pulled a bone fragment loose."

A patient who has acute myelogenous leukemia (AML) asks the nurse whether the plannedchemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stemcell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes intoremission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make ratherthan asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress slowly."

b. "The side effects of chemotherapy are difficult, but AML frequently goes intoremission with chemotherapy."

A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse(LPN/VN)? a. Titrate the infusion of 5% dextrose in water. b. Administer prescribed subcutaneous DDAVP. c. Assess the patient's overall hydration status every 8 hours. d. Teach the patient to use desmopressin (DDAVP) nasal spray.

b. Administer prescribed subcutaneous DDAVP.

Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Encourage fluids to 2 to 3 L/day. b. Offer the patient sugarless gum to chew. c. Monitor for increasing peripheral edema. d. Keep head of bed elevated to 30 degrees.

b. Offer the patient sugarless gum to chew.

A patient who has acute myelogenous leukemia develops an absolute neutrophil count of850/μL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurseis most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.

b. Teach the patient to administer filgrastim (Neupogen) injections.

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates the patient can safely ambulate independently? a. The patient moves the right crutch with the right leg and then the left crutch with the left leg. b. The patient advances the left leg and both crutches together and then advances the right leg. c. The patient uses the bedside chair to assist in balance as needed when ambulating in the room. d. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

b. The patient advances the left leg and both crutches together and then advances the right leg.

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will the nurse include in patient teaching? a. Stool will be expelled from both stomas b. This type of colostomy is usually temporary. c. Soft, formed stool can be expected as drainage. d. Irrigations can regulate drainage from the stomas.

b. This type of colostomy is usually temporary.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

b. Use care when eating high-fiber foods to avoid obstruction of the ileum.

A patient who has acute myelogenous leukemia (AML) is considering treatment with ahematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist thepatient with a treatment decision is to a. discuss the need for insurance to cover post-HSCT care. b. ask whether there are questions or concerns about HSCT. c. emphasize the positive outcomes of a bone marrow transplant. d. explain that a cure is not possible with any treatment except HSCT.

b. ask whether there are questions or concerns about HSCT.

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statementsupports the need to plan additional teaching? a. ―I frequently eat at restaurants, and my food has a lot of added salt.‖ b. ―I had the flu earlier this week, so I couldn't take the hydrocortisone.‖ c. ―I always double my dose of hydrocortisone on the days that I go for a long run.‖ d. ―I take twice as much hydrocortisone in the morning dose as I do in the afternoon.‖

b. ―I had the flu earlier this week, so I couldn't take the hydrocortisone.‖

Which patient statement indicates to the nurse that further instruction is needed about chronicsyndrome of inappropriate antidiuretic hormone (SIADH)? a. ―I should weigh myself daily and report sudden weight loss or gain b. ―I need to shop for foods low in sodium and avoid adding salt to food c. ―I need to limit my fluid intake to no more than 1 quart of liquids a day d. ―I should eat foods high in potassium because diuretics cause potassium loss

b. ―I need to shop for foods low in sodium and avoid adding salt to food

A patient with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. What early sign would alert the nurse that the patient is developing compartment syndrome? a. Paralysis of the toes b. Absence of peripheral pulses c. Distal pain unrelieved by opioid analgesics d. Skin over the injury site is blanched when the bandage is removed

c. Distal pain unrelieved by opioid analgesics

Which activity in the care of a patient with a new colostomy could the nurse delegate to assistive personnel (AP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy d. Check the skin around the stoma for breakdown.

c. Drain and measure the output from the ostomy

How should the nurse assess the neurologic status of the patient with a fractured humerus? a. Have the patient evert, invert, dorsiflex, and plantar flex the foot. b. Assess the location, quality, and intensity of pain below the site of theinjury. c. Have the patient abduct the fingers, oppose the thumb and fingers, and flexand extend the wrist .d. Assess the color, temperature, capillary refill, peripheral pulses, andedema in the extremity.

c. Have the patient abduct the fingers, oppose the thumb and fingers, and flexand extend the wrist

What assessment findings distinguish a fat embolism from a pulmonary embolism in a patient with a fracture? a. Tachycardia and dyspnea b. A sudden onset of chest pain c. Petechiae around the neck and upper chest d. Electrocardiographic (ECG) changes and decreased partial pressure of oxygen in arterial blood (PaO2)

c. Petechiae around the neck and upper chest

A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will thenurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c. Purplish streaks on the abdomen d. Decreased axillary and pubic hair

c. Purplish streaks on the abdomen

A patient with an extracapsular hip fracture is admitted to the orthopedic unit and placed in Buck's traction. How should the nurse explain the purpose of the traction to the patient? a. Pulls bone fragments back into alignment b. Immobilizes the leg until healing is complete c. Reduces pain and muscle spasms before surgery d. Prevents damage to the blood vessels at the fracture site

c. Reduces pain and muscle spasms before surgery

Which assessment finding in a patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? a. The blood glucose is 192 mg/dL. b. The lungs have bibasilar crackles. c. The patient reports 6/10 incisional pain. d. The blood pressure (BP) is 88/50 mm Hg.

c. The patient reports 6/10 incisional pain.

Which problem would the nurse anticipate for a patient admitted to the hospital with diabetes Insipidus? a. Generalized edema b. Respiratory distress c. Fluid volume overload d. Disturbed sleep pattern

d. Disturbed sleep pattern

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. Which action would the nurse take? a. Place ice packs around the stoma. b. Notify the surgeon about the stoma. c. Monitor the stoma every 30 minutes. d. Document stoma assessment findings.

d. Document stoma assessment findings.

do the whole chapter on endocrine problems and chapter 61 week 10

whole chapter 62 stroke, chapter 40: Inflammatory and Structural Heart Disorders, 41: Vascular Disorders, 37: Coronary Artery Disease and Acute Coronary Syndrome, 38: Heart Failure, 14: Immune Responses and Transplantation, not too much Chapter 27 pg 534-536 Chapter 28 pg 546-552 Chapter 30 pg 612-616 Chapter 50, pg 1200-1206 Chapter 51, pg 1247-1255' Chapter 37 pg 819-843 Chapter 35 pg 788-791

A nurse is planning care for a patient with leukemia. The nurse chooses Risk for Bleeding as the nursing diagnosis. Which intervention supports this nursing diagnosis? 1) Educate patient in use of soft toothbrush for oral care 2) Limit parenteral injections 3) Apply pressure to arterial puncture sites for five minutes 4) Encourage patient to deep breathe and huff cough

1) Educate patient in use of soft toothbrush for oral care

A child who has polycythemia is prescribed radiation. The child's parents ask why this is necessary since the child does not have cancer. Which response by the nurse is accurate? 1) "It stimulates red blood cell production." 2) "It suppresses the bone marrow." 3) "It provides vitamin supplementation." 4) "It decreases the risk of transfusion reactions."

2) "It suppresses the bone marrow."

A pediatric nurse is caring for a child with acute lymphoblastic leukemia (ALL). When providing education to the child's parents regarding this disease, which topic should the nurse include? 1) ALL is characterized by abnormal proliferation of all bone marrow elements. 2) This form of leukemia is the most common type among children and adolescents. 3) This form of leukemia is very rarely seen in children. 4) The onset of ALL is usually gradual.

2) This form of leukemia is the most common type among children and adolescents.

An adult patient reports to the nurse an inability to tolerate usual exercise and the feeling of fatigue. The patient states that these symptoms have been gradual over time. Which physical assessment findings, along with the patient's verbal reports, would indicate chronic lymphocytic leukemia (CML)? Select all that apply. 1) Joint pain 2)Pallor 3)Splenomegaly 4)Abnormal bleeding 5)Edema

2)Pallor 3)Splenomegaly 4)Abnormal bleeding

A pediatric patient being treated for acute lymphocytic leukemia (ALL) has a white blood cell count of 1,000/mm3. Which nursing diagnosis would be a priority for this patient? 1) Readiness for Enhanced Immunization Status 2) Impaired Gas Exchange 3) Risk for Infection 4) Activity Intolerance

3) Risk for Infection

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

A . Position patient with the knees flexed. There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort.

Which patient would the nurse assess first after receiving change-of-shift report? a. A 40-yr-old patient who has a distended abdomen and tachycardia b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours c. A 30-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

A. A 40-yr-old patient who has a distended abdomen and tachycardia The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients would be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis? a. Lipase b. Calcium c. Bilirubin d. Potassium

A. Lipase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

The nurse sees that the patient has a positive Cullen's sign. Indicate the area in where the nurse will assess for this change.

Area around the umbilicus would be indicated. Cullen's sign consists of ecchymosis (bruise) around the umbilicus. Cullen's sign occurs because of seepage of bloody exudates from the inflamed pancreas and indicates severe acute pancreatitis.

Which risk factor would the nurse specifically ask about when a patient is being admitted with acute pancreatitis? a. Diabetes b. Alcohol use c. High-protein diet d. Cigarette smoking

B. Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.

The nurse is planning care for a patient with acute severe pancreatitis. Which outcome would the nurse identify as the highest priority? a. Achieving fluid and electrolyte balance b. Maintaining normal respiratory function c. Expressing satisfaction with pain control d. Developing no ongoing pancreatic disease

B. Respiratory failure can occur as a complication of acute pancreatitis and maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

Which scheduling would the nurse teach a patient with chronic pancreatitis to use for the prescribed pancrelipase (Viokase)? a. Bedtime b. Mealtime c. When needed for pain d. When feeling nauseated

B. Pancreatic enzymes are used to help with digestion of nutrients and would be taken with every meal

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit? a. Hematochezia b. Left upper abdominal pain c. Ascites and peripheral edema d. Temperature over 102o F (38.9o C)

B.Left upper abdominal pain Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer? a. A 38-year-old Hispanic female who is obese and has hyperinsulinemia b. A 23-year-old who has cystic fibrosis-related pancreatic enzyme insufficiency c. A 72-year-old African American male who has smoked cigarettes for 50 years d. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus

C. A 72-year-old African American male who has smoked cigarettes for 50 years Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer as compared with nonsmokers. The risk is related to duration and number of cigarettes smoked.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis? a. Calcium b. Bilirubin c. Amylase d. Potassium

C. Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

The nurse is caring for a patient with pancreatic cancer. Which nursing action would be the highest priority? a. Offer psychologic support for depression. b. Offer high-calorie, high-protein dietary choices. c. Administer prescribed opioids to relieve pain as needed. d. Teach about the need to avoid scratching any pruritic areas.

C. Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to teaching, or manage anxiety or depression

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action would 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 health record. d. Notify the health care provider immediately.

C. The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider would be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102F (38.3C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention would the nurse implement first? a. Administer IV ketorolac 15 mg for pain relief. b. Send a blood sample for a complete blood count (CBC). c. Infuse a liter of lactated Ringer's solution over 30 minutes. d. Send the patient for an abdominal computed tomography (CT) scan.

C. Infuse a liter of lactated Ringer's solution over 30 minutes. The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Muscle twitching and finger numbness d. Upper abdominal tenderness and guarding

C. Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings should also be reported to the health care provider, they do not indicate complications that require rapid action.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings? a. Malnutrition b. Osteomyelitis c. Alcohol abuse d. Diabetes mellitus

C. Alcohol abuse The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.

Which assessment finding is of most concern for a patient with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

D. A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased

D. NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain.

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? a. Spiral CT scan b. A PET/CT scan Incorrect c. Abdominal ultrasound d. Cancer-associated antigen 19-9

D. Cancer-associated antigen 19-9 The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, this test and the PET/CT scan or abdominal ultrasound do not provide additional information.

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care? Immediately start enteral feeding to prevent malnutrition. Insert an NG and maintain NPO status to allow pancreas to rest. Initiate early prophylactic antibiotic therapy to prevent infection Administer acetaminophen (Tylenol) every 4 hours for pain relief.

Insert an NG and maintain NPO status to allow pancreas to rest. CorrectInitial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

•An injury to the ligamentous structures surrounding the joint •Wrenching, twisting •Ankle, wrist, knee

Sprain

•Excessive stretching of a muscle, facial sheath, tendon •Low back, calf, hamstring

Strain

In relation to lung cancer and gender, which of the following statements is true? a. More women than men are diagnosed with lung cancer. b. Men are more likely to develop small-cell carcinoma than women. c. Women develop lung cancer after fewer years of smoking than men do. d. Lung cancer incidence and deaths are increasing in men

c. Women develop lung cancer after fewer years of smoking than men do.

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum. b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum. c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum. d. radical removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy.

c The classic operation for pancreatic cancer is a radical pancreaticoduodenectomy, or Whipple procedure. This entails resection of the proximal pancreas (i.e., proximal pancreatectomy), the adjoining duodenum (i.e., duodenectomy), the distal portion of the stomach (i.e., partial gastrectomy), and the distal segment of the common bile duct. The pancreatic duct, common bile duct, and stomach are anastomosed to the jejunum.

A 52-year-old patient has a 40-pack-year history of smoking and has been diagnosed with cancer of the lung. He tells the nurse that he did not know that anything was wrong until he had a routine chest X-ray. The nurse explains that symptoms of lung cancer occur late in the disease. What is the first thing people usually notice? a. Fatigue b. Chest pain c. A persistent cough d. Shortness of breath

c. A persistent cough

A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. Which information would the nurse include in preoperative teaching? a. Cough and deep breathe every 2 hours postoperatively. b. Remain on bed rest for the first 48 hours postoperatively. c. Avoid brushing teeth for at least 10 days after the surgery. d. You will be positioned flat with a cervical collar after surgery.

c. Avoid brushing teeth for at least 10 days after the surgery.

The nurse is caring for a patient following an adrenalectomy. Which goal is the highestpriority in the immediate postoperative period? a. Protecting the patient's skin b. Monitoring for signs of infection c. Balancing fluids and electrolytes d. Preventing emotional disturbances

c. Balancing fluids and electrolytes

A young patient with a fractured femur has a hip spica cast applied. What is the most important action the nurse should take while the cast is drying? a. Elevate the legs above the level of the heart for 24 hours. b. Turn the patient to both sides and prone to supine every 2 hours. c. Cover the cast with a light blanket to avoid chilling from evaporation. d. Assess the patient frequently for abdominal pain, nausea, and vomiting.

d. Assess the patient frequently for abdominal pain, nausea, and vomiting.

After obtaining the information shown in the accompanying figure regarding a patient withAddison's disease, which prescribed action will the nurse take first?Assessment Reports fatigue Bronze-colored skin Poor skin turgor Vital Signs BP 76/40 mm HgHeart rate 126 beats/min Respiration 24 breaths/min Oxygen saturation 94%Laboratory Data Sodium 123 mEq/LPotassium 5.1 mEq/L Glucose 62 mg/dL a. Give 4 oz of fruit juice orally. b. Recheck the blood glucose level. c. Administer O2 therapy as needed. d. Infuse 5% dextrose and 0.9% saline.

d. Infuse 5% dextrose and 0.9% saline.

A patient who has non-Hodgkin's lymphoma is receiving combination treatment withrituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia c. Oral ulcers b. Vomiting d. Lip swelling

d. Lip swelling

Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topicwill the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy

d. Need for follow-up appointments to screen for malignancy

When developing a teaching plan for a patient with a 42-pack-year history of cigarette smoking, it will be most important for the nurse to include information about which of the following? a. Reasons for annual sputum cytology testing b. Computed tomography screening for lung cancer c. Erlotinib (Tarceva) therapy to prevent tumour risk d. Options for smoking cessation

d. Options for smoking cessation

A patient who fell in the bathroom of the hospital room reports pain in the upper right arm and elbow. Which action should the nurse take first in managing a possible fracture before splinting the injury? a. Elevate the arm b. Apply ice to the site c. Notify the health care provider d. Perform a neurovascular check below the injury

d. Perform a neurovascular check below the injury

A patient with Cushing syndrome is admitted for an adrenalectomy. Which information wouldlikely help the patient cope with a disturbed body image related to changes in appearance? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated withCushing syndrome. c. Teach the patient that the metabolic impact of Cushing syndrome is of moreimportance than appearance d. Remind the patient that most of the physical changes caused by Cushing syndromewill resolve after surgery.

d. Remind the patient that most of the physical changes caused by Cushing syndromewill resolve after surgery.

Which information is most important for the nurse to communicate rapidly to the health careprovider about a patient admitted with possible syndrome of inappropriate antidiuretichormone (SIADH)? a. The patient has a weight gain of 9 pounds. b. The patient reports some dyspnea with activity. c. The patient has a urine specific gravity of 1.025. d. The patient has a serum sodium level of 118 mEq/L.

d. The patient has a serum sodium level of 118 mEq/L.

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include? a. The patient will need to be on bedrest for three days after surgery. b. An ileal-anal reservoir will be surgically created in 8 to 12 weeks. c. The patient will have a temporary colostomy for 6-12 months. d. The site for the stoma will be marked on the abdomen before surgery.

d. The site for the stoma will be marked on the abdomen before surgery.