Med surg 2 exam 1

The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? "It is okay to continue to drink coffee in the morning when I get to work." "I will need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day."

"I should avoid alcohol and tobacco."

The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? "I will have my spouse change the bag for me." "If I have any leakage, I'll put a towel over it." "I can put aspirin tablets in the pouch in order to reduce odor" "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

"I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? "Are you afraid of what your spouse will think of the colostomy?" "Don't worry. You will get used to the colostomy eventually." "Tell me what worries you the most about this procedure." "Why are you so afraid of having this procedure done?"

"Tell me what worries you the most about this procedure."

The nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them? "One to two hours of cardiovascular exercise every day is a good idea." "Joining a fitness program or gym will help greatly with your exercise." "Walking 30 to 40 minutes provides the same benefit as long periods of exercise." "You will benefit most if you get into a group that shares your exercise goals."

"Walking 30 to 40 minutes provides the same benefit as long periods of exercise."

A patient has a long-term history of Crohn's disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." "What has your doctor told you about how your gastritis developed?" "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

"We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."

A patient has been diagnosed with terminal esophageal cancer. The patient is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? "Haven't you received adequate pain management in the hospital?" "Would you like me to get a nurse from hospice to come talk with you?" "Do you want me to call the hospital chaplain to explain hospice to you?" "Talk to your primary health care provider about hospice services."

"Would you like me to get a nurse from hospice to come talk with you?"

A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? "You may have contracted it from an infected infant." "You may have consumed contaminated food or water." "You may have come into contact with an infected animal." "You may have had contact with the blood of an infected person."

"You may have consumed contaminated food or water."

A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed? "It is to stop the diarrhea and bloody stools." "This will minimize your GI discomfort." "With this medication, your cramping will be relieved." "Your intestinal inflammation will be reduced."

"Your intestinal inflammation will be reduced."

The nurse is caring for a client who has celiac disease. Which food will the nurse remove from the client's dietary tray? (Select all that apply.) a. Rice b. Graham crackers c. Croissant d. Fresh peaches e. Chicken breast

B, C

What is a common gastrointestinal problem that older adults experience more frequently as they age? Decreased hydrochloric acid levels Excess lipase production Increased liver size Increased peristalsis

Decreased hydrochloric acid levels

As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What collaborative resource does the nurse suggest for this client's care? Dentist Occupational therapist Psychiatrist Speech therapist

Dentist

The nurse is assessing a patient 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

Dyspepsia Excessive salivation Flatulence Regurgitation

A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? Encourage the patient to look at and touch the colostomy stoma Instruct the patient about complete care of the colostomy Schedule a visit from a patient who has a colostomy and is successfully caring for it Suggest that the patient involve family members in the care of the colostomy

Encourage the patient to look at and touch the colostomy stoma

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? Patients with CD experience about 20 loose, bloody stools daily. Patients with UC may experience hemorrhage. The peak incidence of UC is between 15 and 40 years of age. Very few complications are associated with CD

Patients with UC may experience hemorrhage.

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? Broiled fish Ice cream Salted pretzels Scrambled eggs

Salted pretzels

A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? "A combination of chemotherapeutic agents has caused them." "GI problems are symptoms of the advanced stage of your disease." "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." "You have these as a result of the radiation treatment."

"5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea."

A male patient with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? "A change in position may be what is needed for you to have intercourse with your wife." "Have you considered going to see a marriage counselor with your wife?" "What has your wife said about your pouch system?" "You must get clearance from your primary health care provider before you attempt to have intercourse."

"A change in position may be what is needed for you to have intercourse with your wife."

The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal (GI) bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? "A fluid solution goes down the tube to help clean out your stomach." "The medication goes down the tube to help clean out your stomach." "The primary health care provider requested the tube to be placed just in case it was needed." "We'll start feeding you through it once your stomach is cleaned out."

"A fluid solution goes down the tube to help clean out your stomach."

A patient has been diagnosed with mild gastroesophageal reflux disease (GERD) and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient? "Avoid caffeine-containing foods and beverages." "Eat three meals each day and avoid snacking between meals." "Peppermint lozenges help to reduce stomach upset." "Sleep on your left side with a pillow between your knees."

"Avoid caffeine-containing foods and beverages."

A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient? "Avoid large crowds and anyone who is sick." "Do not take the medication if you are allergic to foods with fatty acids." "Expect difficulty with wound healing while you are taking this drug." "Monitor your blood pressure and report any significant decrease in it."

"Avoid large crowds and anyone who is sick."

A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? "Be aware of the signs/symptoms of toxic megacolon that we discussed." "If diarrhea increases, you must let your primary health care provider know." "You must avoid pregnancy." "You will need to decrease your dose of sulfasalazine (Azulfidine)."

"Be aware of the signs/symptoms of toxic megacolon that we discussed."

A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed? "Begin a clear liquid diet at least 24 hours before the test." "Do not eat or drink anything for 12 hours before the test." "Give yourself tap water enemas until the fluid returns are clear." "Be sure to take all currently prescribed medications prior to the procedure."

"Begin a clear liquid diet at least 24 hours before the test."

A Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include? "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." "Call your primary health care provider if your stoma has a bluish or pale look." "Notify the primary health care provider if output from your stoma has a sweetish odor." "Remember that you must wear a pouch system at all times."

"Call your primary health care provider if your stoma has a bluish or pale look."

The nurse is instructing a group of overweight clients on the complications of obesity that develop when weight is not controlled through diet and exercise. Which lifestyle changes does the nurse emphasize? Select all that apply. "Begin a weight-training program for building muscle mass." "Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." "Eat a variety of foods, especially grain products, vegetables, and fruits." "Engage in moderate physical activity for at least 30 minutes each day." "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home." "Liquid dietary supplements can be substituted safely for solid food while attempting to lose weight."

"Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." "Eat a variety of foods, especially grain products, vegetables, and fruits." "Engage in moderate physical activity for at least 30 minutes each day." "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home."

A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient? "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."

A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime? "Avoid all solid foods to allow complete bowel rest." "Consume extra fluids to replace fluid losses." "Take an over-the-counter antidiarrheal medication." "Contact your primary health care provider for an antibiotic medication."

"Consume extra fluids to replace fluid losses."

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? "I can drive my car in about 2 weeks." "I need to avoid drinking carbonated sodas." "It may take 6 weeks to see the effects of some foods on my bowel patterns." "Stool softeners will help me avoid straining."

"I can drive my car in about 2 weeks."

The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching? "I will need to avoid sweetened fruit juice beverages." "I can eat ice cream in moderation." "I cannot drink alcohol at all." "It is okay to have a serving of sugar-free pudding."

"I can eat ice cream in moderation." (dairy is a no go)

The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? "A dark or purplish-looking stoma is normal and would not concern me." "If the skin around the stoma is red or scratched, it will heal soon." "I need to check for leakage underneath my colostomy." "I need to strive for a very tight fit when applying the barrier around the stoma."

"I need to check for leakage underneath my colostomy."

A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." "I need to go for a walk every evening." "Maintaining a low-fiber diet will manage my constipation." "Limiting the amount of fluid that I drink with meals is very important."

"I need to go for a walk every evening."

The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? "I would take Ex-Lax after the surgery to 'keep things moving'." "I will need to eat a diet high in fiber." "Limiting my fluids will help me with constipation." "To help with the pain, I'll apply ice to the surgical area."

"I will need to eat a diet high in fiber."

The nurse is educating a group of older adults about screening for colorectal cancer. Which statement by a group member indicates the need for further clarification about these guidelines? "A barium enema every 5 years is a screening option." "I will need to have a routine colonoscopy every 5 years." "My routine flexible sigmoidoscopy every 5 years is OK." "The 'virtual' colonoscopy every 5 years is acceptable."

"I will need to have a routine colonoscopy every 5 years."

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? "I may have trouble urinating immediately after the surgery." "I will need to stay in the hospital overnight." "I will not eat after midnight the day of the surgery." "My chances of having complications after this procedure are slim."

"I will need to stay in the hospital overnight."

A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? "During the test, you will drink small amounts of an antacid as directed by the technician." "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." "The test will take between 30 and 45 minutes to complete." "You must have nothing to drink (except water) for 24 hours before the test."

"If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS."

A patient with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply? "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." "It provides key nutrients and extra calories to promote healing." "It is bland and reduces the secretion of gastric acids." "It does not contain caffeine or other GI tract stimulants."

"It is absorbed quickly and allows the affected part of the GI tract to rest and heal."

A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? "It is usually ready to be closed in about 1 to 2 months." "You need to talk to your primary health care provider about how long you will have this temporary ileostomy." "The period of time is indefinite—I am sorry that I cannot say." "You will probably have it for 6 months or longer, until things heal."

"It is usually ready to be closed in about 1 to 2 months."

An obese client is prescribed orlistat (Xenical). The client asks the nurse how the drug works. How does the nurse respond? "It decreases the amount of norepinephrine in your brain. This action will increase your feeling of being satisfied on less food." "It increases the amount of serotonin in your brain. This action will greatly increase your metabolic rate, and you will burn calories quicker." "It inhibits enzymes and changes the way your body digests fats. Because fats are only partially digested and absorbed, calorie intake is decreased." "It will alter the chemistry of your brain. Consequently, you will feel full before you overeat."

"It will alter the chemistry of your brain. Consequently, you will feel full before you overeat."

A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? "Drinking carbonated beverages will help with your abdominal distress." "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." "Lactose-containing foods should be reduced or eliminated from your diet." "Raw vegetables and high-fiber foods may help to diminish your symptoms."

"Lactose-containing foods should be reduced or eliminated from your diet."

The nurse is teaching a middle-aged adult client with a body mass index (BMI) of 27.5 and a height of 5'2" (157.5 cm) about what the BMI number means, and about malnutrition. Which client statement indicates a need for further instruction? "If I could get my BMI below 25, my risk for malnutrition would decrease." "I realize that this means that I have some increased health risks." "My goal should be to get my BMI below 18.5." "This means that I have an increased amount of total fat stored in my body."

"My goal should be to get my BMI below 18.5."

The nurse is teaching a patient with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge? "Nizatidine (Axid) needs to be taken three times a day to be effective." "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." "Omeprazole (Prilosec) should be swallowed whole and not crushed."

"Nizatidine (Axid) needs to be taken three times a day to be effective." (normal does once daily)

A patient with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? "Consume carbonated beverages if you experience stomach upset." "Remain on a soft diet for about a week and avoid raw vegetables that are difficult to swallow." "You may resume running and weight lifting if you wish." "You may stop taking your antireflux medications after 1 week."

"Remain on a soft diet for about a week and avoid raw vegetables that are difficult to swallow."

A female client is concerned that her inability to conceive a child is connected to her morbid obesity. How does the nurse respond? "Do you feel that your obesity is keeping you from getting pregnant?" "Have you considered adoption as an option?" "Tell me about any changes in your menstrual cycle each month." "What has your health care provider told you about your problems in getting pregnant?"

"Tell me about any changes in your menstrual cycle each month."

A patient who has been diagnosed recently with esophageal cancer states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response? "I understand your concerns, but you can't give up your normal activities. You should go anyway and try not to worry about it." "Tell me more about the lunch, what will be served and who is going with you." "Why not take one of your antianxiety pills before going? That will keep you from worrying about everything so much." "You need to talk to your doctor about your concerns. The doctor may recommend that you join a support group for cancer survivors."

"Tell me more about the lunch, what will be served and who is going with you."

The nurse is performing a health assessment on an obese client who states, "I have tried many diets in an effort to lose weight, but have been unsuccessful." How does the nurse assess whether the client's response to stress is related to the client's obesity? "Do you have a history of mental problems, especially depression?" "Do you usually use alcohol or drugs when you feel stressed?" "Tell me what you do to relieve stress in your daily life." "What is it about your obesity that causes you to feel uncomfortable?"

"Tell me what you do to relieve stress in your daily life."

A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? "Have you asked your primary health care provider what he or she thinks your chances are?" "It is hard to know what can predispose a person to develop a certain disease." "No. Just because they both had CRC doesn't mean that you will have it, too." "The only way to know whether you are predisposed to CRC is by genetic testing."

"The only way to know whether you are predisposed to CRC is by genetic testing."

A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." "It is inherited, so it could run in your family." "It might be caused by a virus, so you could have gotten it almost anywhere." "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

"There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? "No, they probably won't be useful. You should use only prescription medications in your treatment plan." "These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." "Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them." "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

"These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen."

An older female patient is diagnosed with gastric cancer. Which statement made by the patient's family demonstrates a correct understanding of the disorder? "This may be related to her recurring ulcer disease." "This cancer is probably curable with surgery." "Gastric cancer has a strong genetic component." "Thank goodness she won't have to undergo surgery."

"This may be related to her recurring ulcer disease."

The outpatient clinic nurse is caring for a recovering client who had a colonoscopy. The client asks for a drink. How does the nurse respond to this request? "After I hear bowel sounds, you can have a drink." "Twenty minutes after the procedure was completed, you may have some liquids." "When you are able to pass flatus (gas), you can have a drink." "You can have fluids when you get home and are settled."

"When you are able to pass flatus (gas), you can have a drink."

Which serum albumin level does the nurse expect to see in a healthy, ambulatory adult client? 2.3 g/dL (23 g/L) 3.7 g/dL (37 g/L) 5.1 g/dL (51 g/L) 5.8 g/dL (58 g/L)

3.7 g/dL (37 g/L)

The nurse is teaching a client about nutrition and diverticulosis. Which food will the nurse teach the client to avoid? a. Popcorn b. Oatmeal c. Bran d. Lettuce

A

When caring for a patient who has just had an upper GI endoscopy, the nurse assesses that the client has developed a temperature of 101.8°F (38.8°C). What is the appropriate nursing intervention? a. Promptly assess the patient for potential perforation. b. Ask the nursing assistant to bathe the client with tepid water. c. Administer acetaminophen (Tylenol) to lower the temperature. d. Delegate to an unlicensed assistive personnel (UAP) to retake the temperature.

A

Which client on the medical-surgical unit does the charge nurse assign to the LPN/LVN? A 28-year-old with morbid obesity who had bariatric surgery today A 30-year-old recently admitted with severe diarrhea and Clostridium difficile infection A 36-year-old whose family needs instruction about how to use a gastric feeding tube A 39-year-old with a jejunal feeding tube who needs elemental feedings administered

A 20-year-old with anorexia nervosa receiving total parenteral nutrition through a central venous line

The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first? A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C) A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C)

Which patient does the charge nurse assign to an experienced LPN/LVN? A 28-year-old who requires teaching about how to catheterize a Kock ileostomy A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 (23 × 109/L) A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy

Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit? A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis A 36-year-old who needs teaching about an endoscopic retrograde cholangiopancreatography A 40-year-old who will need administration of IV midazolam hydrochloride (Versed) during an upper endoscopy A 46-year-old who was recently admitted with abdominal cramping and diarrhea of unknown causes

A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis

Which morbidly obese client is the least likely candidate for bariatric surgery? A 34-year-old woman experiencing mental confusion A 44-year-old man with a history of hypertension A 50-year-old woman with a history of sleep apnea A 52-year-old man with a history of type 1 diabetes mellitus

A 34-year-old woman experiencing mental confusion

The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern A 40-year-old with a reducible inguinal hernia asking questions about surgery. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern

An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse? A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

The RN who usually works on the pediatric unit is floated to the GI medical-surgical unit. Which client is most appropriate for the charge nurse to assign to the float nurse? A 20-year-old with anorexia nervosa receiving total parenteral nutrition through a central venous line A 35-year-old who had a laparoscopic gastroplasty yesterday and is now taking sips of clear liquids A 60-year-old with gastric cancer receiving elemental feedings through a jejunostomy tube A 65-year-old with morbid obesity who requires a preoperative bariatric surgery assessment

A 39-year-old with a jejunal feeding tube who needs elemental feedings administered

Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient gastrointestinal (GI) clinic? A 38-year-old who needs discharge instructions after having an endoscopic retrograde cholangiopancreatography (ERCP) A 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy A 43-year-old recently admitted with nausea, abdominal pain, and abdominal distention A 50-year-old with epigastric pain who needs conscious sedation during a scheduled endoscopy procedure

A 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy

While working in the outpatient procedure unit, the RN is assigned to these clients. Which client does the nurse assess first? A 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP) A 54-year-old who is ready for discharge following a colonoscopy A 58-year-old who has just arrived for basal gastric secretion and gastric acid stimulation testing A 60-year-old with questions about an endoscopic ultrasound examination

A 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP)

An RN receives the change-of-shift report about these four clients. Which client does the nurse assess first? A 30-year-old admitted 2 hours ago with malnutrition associated with malabsorption syndrome A 45-year-old who had gastric bypass surgery and is reporting severe incisional pain A 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL (16.7 mmol/L) A 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min

A 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min

The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include? A slice of 5-grain bread Chuck steak patty (6 ounces [170 grams]) Strawberries (1 cup [160 grams]) Tomato (1 medium)

A slice of 5-grain bread

The nurse is caring for an older adult client who experiences an exacerbation of ulcerative colitis with severe diarrhea that have lasted a week. For which complications will the nurse assess? (Select all that apply.) a. Dehydration b. Hypokalemia c. Skin breakdown d. Deep vein thrombus e. Hyperkalemia

A, B, C

A hospitalized client reports lack of appetite to the nurse. What nursing intervention is appropriate to encourage nutrition intake? (Select all that apply.) a. Assess the client's level of pain and provide interventions as necessary. b. Remove objects from sight in the client's room such as bedpans or urinals at mealtimes. c. Provide a quiet environment during meal times. d. Provide washcloth and towel for washing hands before each meal. e. Encourage the client to eat quickly to get the entire meal consumed. f. Provide food to the client only when hunger is reported.

A, B, C, D

The nurse is performing medication reconciliation for a newly admitted client. The nurse recognizes that which drugs contribute to signs and symptoms of gastritis? (Select all that apply.) a. Aspirin, taken once daily to prevent cardiac concerns b. Naproxen, taken once daily for joint pain associated with arthritis c. Amoxicillin, taken over a 10-day period for an acute sinus infection d. Bacitracin ointment (over the counter), applied to minor scrapes on arms and legs e. Prednisone, tapered over a 14-day period to decrease inflammation associated with an acute sinus infection

A, B, E

A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? Ability of the patient and spouse to perform incision care and dressing changes Effective coping mechanisms for the patient and spouse after the surgical experience Knowledge about the patient's requested pain medications Understanding of the importance of keeping scheduled follow-up appointments

Ability of the patient and spouse to perform incision care and dressing changes

The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. Acupuncture Decreasing physical activities Meditation Peppermint oil capsules Yoga

Acupuncture Meditation Peppermint oil capsules Yoga

The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? Acyclovir (Zovirax) Diphenhydramine (Benadryl) Nystatin (Mycostatin) Tetracycline syrup (Sumycin syrup)

Acyclovir (Zovirax)

The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? Administering a histamine2 (H2) antagonist Initiating enteral nutrition Administering intravenous (IV) fluids Administering antianxiety medication

Administering intravenous (IV) fluids

The nurse is teaching a group of adults in the community about the 2015-2020 Dietary Guidelines for Americans. What does the nurse emphasize as a dietary strategy suggested in these guidelines? Half of each meal should consist of dairy, fruits, and proteins. Adults should focus on variety and nutrient density and not calories. Older adults should consider lacto-ovarian diets for improved health. Adults should include a multivitamin with iron and vitamin B12 in their diet.

Adults should focus on variety and nutrient density and not calories.

A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home? Oral Cancer Foundation American Cancer Society (ACS) Client Advocate Foundation American Medical Supply Foundation

American Cancer Society (ACS)

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? Analgesics and antiemetics Analgesics and benzodiazepines Steroids and analgesics Steroids and anti-inflammatory medications

Analgesics and antiemetics

The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider? Select all that apply. Anorexia Depression Drowsiness Frequent urination Headache Vomiting

Anorexia Headache Vomiting

A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? Teach the patient about antacid effects and side effects. Ask the patient about oral intake, current medications and description of episodes. Suggest that the patient sleep with the head elevated 6 inches (15 cm). Tell the patient to avoid drinking alcohol late in the evening.

Ask the patient about oral intake, current medications and description of episodes.

A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds (2.3 kg) of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? Explain to the patient the importance of drinking the enteral supplements prescribed. Ask the patient's family to try to persuade the patient to drink the supplements. Inform the patient that a nasogastric tube may be necessary if he or she fails to comply. Ask the patient if a change in flavor would make the supplement more palatable.

Ask the patient if a change in flavor would make the supplement more palatable.

The nurse is assessing an alert client who had abdominal surgery yesterday. What method provides the most accurate data about resumption of peristalsis in the client? Asking the client whether he or she has passed flatus (gas) within the previous 12 to 24 hours. (p. 17) Auscultating bowel sounds in all abdominal quadrants Counting the number of bowel sounds in each abdominal quadrant over one minute. Observing the abdomen for symmetry and distention

Asking the client whether he or she has passed flatus (gas) within the previous 12 to 24 hours. (p. 17)

A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? Suction the client's oral secretions to clear the airway. Place the client on humidified oxygen per nasal cannula. Assist the client to an upright position to facilitate breathing. Assess the respiratory effort and quantities and types of oral secretions.

Assess the respiratory effort and quantities and types of oral secretions.

An older client is at risk for malnutrition. Which nursing intervention is most appropriate to ensure optimum nutritional intake? Administering antiemetics and analgesics after meals Assisting the client with toileting and oral care prior to meals Turning on the television during meals to provide distraction Reminding UAPs to allow the client to remain in bed during meals

Assisting the client with toileting and oral care prior to meals

A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing the patient's incision for signs of infection Assisting the patient to stand to void Instructing the patient in how to deep-breathe Monitoring the patient's pain level

Assisting the patient to stand to void

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient's gastroesophageal reflux disease (GERD). Which change does the nurse recommend to this patient? Eat only two or three meals daily. Sleep flat in a left side-lying position. Drink tea instead of coffee. Avoid working while bent over the computer.

Avoid working while bent over the computer.

The community nurse is talking with a group of individuals about colorectal cancer (CRC) risk factors. Which community participant is at the highest risk for development of CRC? a. 23-year-old vegetarian b. 30-year old with Crohn's disease c. 39-year old with no family history of cancer d. 46-year old with genetic predisposition to cancer

B

The nurse is caring for a client who has just been prescribed a glucocorticoid to treat an exacerbation of ulcerative colitis. What teaching will the nurse provide? a. Decrease the drug dose during the next exacerbation. b. Report fever to healthcare provider immediately. c. Determine if the client's insurance covers payment for this medication. d. This drug will act as an antidiarrheal.

B

The nurse is caring for a client with a bleeding duodenal ulcer who was admitted to the hospital after vomiting bright, red blood. Which condition does the nurse anticipate when the client develops a sudden, sharp pain in the midepigastric region and a rigid, board-like abdomen? a. Pancreatitis b. Ulcer perforation c. Small bowel obstruction d. Development of additional ulcers

B

The nurse is performing a physical assessment on a client's abdomen. The nurse inspects the abdomen and finds the abdomen asymmetrical, with a non-pulsating mass in the RUQ. What is the appropriate priority nursing intervention? a. Document the findings in the electronic health record. b. Auscultate for bowel sounds and bruits. c. Lightly palpate the mass. d. Notify the health care provider of the findings.

B

Upon assessment of a client with GERD, which statement requires nursing intervention? a. "I quit smoking several years ago." b. "Sometimes I wake up gasping for air in the middle of the night." c. "My family likes to eat small meals every 3 to 4 hours throughout the day." d. "When I buy meat, I ask for the leanest cut that is available."

B

A client who recently had laparoscopic surgery to treat a ruptured appendix has developed subsequent peritonitis. The client currently has two Jackson-Pratt drains placed in the abdomen. Which finding(s) would the nurse report immediately to the surgeon? (Select all that apply.) a. Serosanguineous drainage b. Fever c. Cloudy drainage d. Painful abdominal distension e. Pain level "3" on a scale of 1 to 10

B, C, D

A client with obesity tells the nurse, "I would not be overweight if it weren't for my genes." What is the appropriate nursing response? (Select all that apply.) a. "Genes are responsible for obesity." b. "Tell me about your family history." c. "Let's talk about your nutrition intake." d. "How do you feel about exercise?" e. "You should get bariatric surgery."

B, C, D

A client had an open partial colectomy and ascending colostomy 3 days ago. What assessment findings does the nurse expect? (Select all that apply.) a. Black, moist stoma b. Gas inside the pouch c. Pain controlled with analgesics d. Small amount of formed stool from the colostomy e. Serosanguineous fluid draining from 2 Jackson-Pratt drains.

B, C, E

When taking a history for a client with GI problems, which daily client behavior requires further nursing assessment? (Select all that apply.) a. Eats multiple servings of vegetables b. Takes 800 mg of ibuprofen for arthritic pain c. Walks 30 minutes d. Chews tobacco e. Takes senna to assist with bowel movements f. Listens to music to promote relaxation

B, D, E

How does the nurse accurately calculate a client's body mass index (BMI)? BMI = weight (kg)/height (in meters)2 BMI = weight (lb)/height (in inches)2 BMI = weight (kg)/height (in meters) BMI = weight (lb)/height (in meters)

BMI = weight (kg)/height (in meters)2

The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding? Respiratory rate from 24 to 20 breaths/min Apical pulse from 80 to 72 beats/min Temperature from 97.9° F to 98.9° F (36.6°C to 37.2°C) Blood pressure from 140/90 to 110/70 mm Hg

Blood pressure from 140/90 to 110/70 mm Hg

A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? Administers medication for pain Changes the nasogastric suction level from "intermittent" to "constant" Positions the patient in high-Fowler's position Prepares the patient for emergency surgery

Broccoli Buttermilk Mushrooms Onions Peas

The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. Broccoli Buttermilk Mushrooms Onions Peas Yogurt

Broccoli Mushrooms Onions Peas

What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? Bulk forming laxatives Saline Laxatives Stimulant Laxatives Stool-softening laxatives

Bulk forming laxatives

. Which client statement regarding treatment for gastric cancer requires the nurse to immediately intervene? a. "I understand my treatment regimen." b. "My prognosis is frightening to me and my partner." c. "Life just does not seem to be worth living anymore." d. "There is a list of community resources stored in my computer for when I need them."

C

A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? Select all that apply. Antihistamines Caffeinated drinks Stress Sleeping pills Combinations of genetic, immunological, and hormonal factors

Caffeinated drinks Stress Combinations of genetic, immunological, and hormonal factors

A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? Certified Wound, Ostomy, and Continence Nurse (CWOCN) Home health nursing agency Hospice Hospital chaplain

Certified Wound, Ostomy, and Continence Nurse (CWOCN)

The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium) once daily. The patient reports that this proton pump inhibitor medication doesn't completely control the symptoms. The nurse contacts the primary health care provider to discuss which intervention? Adding a second proton pump inhibitor medication Increasing the dose of esomeprazole Changing to a twice-daily dosing regimen Switching to omeprazole (Prilosec)

Changing to a twice-daily dosing regimen

A client has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The client is receiving continuous enteral feedings through a nasogastric (NG) tube. What does the RN ask the LPN/LVN to do for this client? Assess nutritional parameters on the client every 3 days. Check the residual volume of the NG tube every 4 hours. Monitor the client for signs and symptoms of pneumonia. Teach the client about the purpose of enteral feedings.

Check the residual volume of the NG tube every 4 hours.

A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care? Instructing the patient about the use of electrolyte-containing oral rehydration products Administering loperamide (Imodium) 4 mg from the patient's medicine cabinet Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions Teaching the patient how to clean the perineal area after each loose stool

Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions

The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? Select all that apply. Apples Bananas Cheese Nuts Potatoes

Cheese Nuts Potatoes

The nurse and the dietitian are planning sample diet menus for a patient who is experiencing dumping syndrome. Which sample meal is best for this patient? Chicken salad on whole wheat bread Liver and onions Chicken and rice Cobb salad with buttermilk ranch dressing

Chicken and rice (high protein less milk and wheat)

A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)? Abdominal pain relieved by bending the knees, constipation Chronic diarrhea, abdominal colicky pain, and fever Epigastric cramping & persistent rectal bleeding Hypotension with vomiting and headache

Chronic diarrhea, abdominal colicky pain, and fever

A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? Attaching the tube to low intermittent suction Auscultating for bowel sounds and peristalsis while the suction runs Connecting the tube to low continuous suction Flushing the tube with 30 mL of normal saline every 24 hours

Connecting the tube to low continuous suction

An older adult is admitted to the hospital. The client's height is 5 feet 10 inches (1.78 meters) and weight is 286 lbs (129.7 kg). The nurse calculates the client's current body mass index (BMI) as ______. (Round your answer to the nearest whole number.)

41 BMI is calculated by dividing weight in kg by height squared in meters. The client's height (1.78 meters) squared is 3.17 (1.78 × 1.78 = 3.17). The client's weight is 129.7 kg. 129.7 kg divided by 3.17 = 40.9, which is 41 rounded to the nearest whole number.

The emergency department nurse is assessing a client with a known inguinal hernia. Which assessment finding indicates that the hernia may have strangulated? (Select all that apply.) a. Fever b. Tachycardia c. Abdominal distention d. Mild abdominal pain e. Nausea and vomiting

A, B, C, E

A nurse is preparing a health teaching session about early detection of colorectal cancer. Which test should the nurse include? (Select all that apply.) a. Colonoscopy every 10 years b. Single sample fecal immunochemical test (FIT). c. Flexible sigmoidoscopy every 5 years d. Stool DNA test (sDNA) every 3 years e. Double contrast barium enema every 5 years f. Take home yearly guaiac fecal occult blood test (gFOBT)

A, C, D, E, F

A patient with ulcerative colitis (UC) is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen? Corticosteroid therapy will be stopped. Sulfasalazine (Azulfidine) will be stopped. Corticosteroid therapy will be tapered. Sulfasalazine (Azulfidine) will be tapered.

Corticosteroid therapy will be tapered.

The nurse is caring for a patient with esophageal cancer who has received photodynamic therapy using porfimer sodium (Photofrin). What instructions does the nurse include in teaching the patient about porfimer sodium? Select all that apply. Avoid sunlight for 2 weeks. Cover or shield all exposed body areas from sunlight. Follow a clear liquid diet for 3 to 5 days after the procedure. Monitor for hypertension. Tissue particles may be found in the sputum.

Cover or shield all exposed body areas from sunlight. Follow a clear liquid diet for 3 to 5 days after the procedure. Tissue particles may be found in the sputum.

The nurse is working with the dietitian to plan a menu for a patient who has persistent difficulty swallowing. What is a suitable breakfast selection for this patient? Scrambled eggs and toast Oatmeal and orange juice Puréed fruit and English muffin Cream of wheat and applesauce

Cream of wheat and applesauce

A client with rectal bleeding who is preparing to undergo a colonoscopy tells the nurse, "I am very afraid of having polyps and cancer." What is the appropriate nursing response? a. "Let's worry about that after the procedure." b. "Polyps are never cancerous, so you do not need to worry." c. "Unfortunately all polyps are malignant, so you may already have cancer." d. "It is understandable that you are fearful. Tell me what frightens you most."

D

An older adult with severe rheumatoid arthritis in the upper extremities is malnourished. What does the nurse suspect as the cause of this client's malnutrition? A decrease in the client's appetite Decreasing ability to manipulate eating utensils Inadequate income to purchase sufficient food Metabolic requirements that are increased owing to immobility

Decreasing ability to manipulate eating utensils

The nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems? Discontinues the IVFE infusion and notifies the health care provider (HCP) Documents the findings and continues to monitor Slows the rate of flow of the IVFE infusion Switches to total parenteral nutrition (TPN)

Discontinues the IVFE infusion and notifies the health care provider (HCP)

A patient with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? Decrease in liver function test results Elevated carcinoembryonic antigen Elevated hemoglobin levels Negative test for occult blood

Elevated carcinoembryonic antigen

A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation Examines the RUQ of the abdomen last following all other assessment techniques. Have the client lie in a supine position with legs straight and arms at the sides Gently palpates any bulging mass and documents findings.

Examines the RUQ of the abdomen last following all other assessment techniques.

A client had a routine sigmoidoscopy with a tissue biopsy. What postprocedure complication would the nurse report to the health care provider? Gas and flatulence Excessive bleeding Nausea and vomiting Severe rectal pain

Excessive bleeding

A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing? Calcium imbalance Fluid volume deficit Fluid volume overload Potassium imbalance

Fluid volume overload

A patient with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? Asks the patient whether family members could be trained in stoma care Has another patient with a stoma who performs self-care talk with the patient Requests that the primary health care provider request antidepressants and a psychiatric consult Suggests that the primary health care provider request a home health consultation so stoma care can be performed by a home health nurse

Has another patient with a stoma who performs self-care talk with the patient

A patient with a history of osteoarthritis has a 10-inch (25.5 cm) incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the primary health care provider before the patient's discharge? Having a home health consultation for wound care Requesting an antianxiety medication Requesting pain medication for the patient's osteoarthritis Placing the patient in a skilled nursing facility for rehabilitation

Having a home health consultation for wound care

The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? Type and crossmatch for 4 units of packed red blood cells. Infuse 0.9% normal saline solution at 200 mL/hr. Give pantoprazole (Protonix) 40 mg IV now and then daily. Insert a nasogastric tube and connect to low intermittent suction.

Infuse 0.9% normal saline solution at 200 mL/hr. (due to hypotension)

A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? Bacteria on the patient's hands Ingestion of parasites in the water Insufficient vaccinations Overcooked food

Ingestion of parasites in the water

The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect? Acute diarrhea Aortic aneurysm Intestinal obstruction Pancreatitis

Intestinal obstruction

Which substance, produced in the stomach, facilitates the absorption of vitamin B12? Glucagon Hydrochloric acid Intrinsic factor Pepsinogen

Intrinsic factor

What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? It destroys the cancer's cell wall, which will kill the cell. It decreases blood flow to rapidly dividing cancer cells. It stimulates the body's immune system and stunts cancer growth. It blocks factors that promote cancer cell growth.

It blocks factors that promote cancer cell growth.

The nurse is reviewing orders for a patient with possible esophageal trauma after a car crash. Which request does the nurse implement first? Give total parenteral nutrition (TPN) through a central venous catheter. Administer cefazolin (Kefzol) 1 g intravenously. Obtain a computed tomography (CT) scan of the chest and abdomen. Keep the patient nothing by mouth (NPO) to prevent further leakage of esophageal contents.

Keep the patient nothing by mouth (NPO) to prevent further leakage of esophageal contents.

An obese client has been taking orlistat (Xenical) 60 mg orally three times a day for 4 weeks, but has only lost 10 pounds (4.5 kg). The health care provider doubles the dosage and recommends behavioral changes. What behavioral changes does the nurse include in the teaching plan? Select all that apply. Cognitive restructuring to learn negative coping statements Keeping a daily food diary Identifying emotional and situational factors that stimulate eating Increasing exercise Seeking behaviors in others that one can model

Keeping a daily food diary Identifying emotional and situational factors that stimulate eating Increasing exercise

The nurse is observing a coworker who is caring for a patient with a nasogastric tube following esophageal surgery. Which actions by the coworker require the nurse to intervene? Select all that apply. Checking tube placement every 12 hours Keeping the bed flat Placing the patient upright when taking sips of water Providing mouth care every 8 hours Securing the tube

Keeping the bed flat Providing mouth care every 8 hours

A client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? Listen to the client and then explain that it is normal to feel depressed about the diagnosis. Explain the grieving process and listen to what the client has to say. Suggest that the client talk with friends and family and seek their support. Listen to the client's concerns and feelings and then suggest that the client join a community group of cancer survivors.

Listen to the client's concerns and feelings and then suggest that the client join a community group of cancer survivors.

A client is placed on orlistat (Xenical) as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the client to expect from using this drug? Dry mouth, constipation, and insomnia Insomnia, dry mouth, and blurred vision Loose stools, abdominal cramps, and nausea Palpitations, constipation, and restlessness

Loose stools, abdominal cramps, and nausea

A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe? Balsalazide (Colazal) Loperamide (Imodium) Mesalamine (Asacol) Milk of Magnesia (MOM)

Loperamide (Imodium)

The nurse is caring for a patient diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the primary health care provider will request which medication to manage diarrhea? Loperamide (Imodium) Mesalamine (Pentasa) Minocycline (Minocin) Pantoprazole (Protonix)

Loperamide (Imodium)

An underweight client is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the client? Keeps an accurate and precise food and fluid intake record daily Makes certain the client is weighed daily at the same time Monitors vital signs every 4 hours and as needed Assesses the client's skin for evidence of breakdown weekly

Makes certain the client is weighed daily at the same time

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? Applying cold compresses Avoiding the use of fruit or citrus-flavored candy Massaging the salivary gland Restrict fluids

Massaging the salivary gland (inflammation of salivary gland)

Which nursing care activity for a malnourished client does the nurse safely delegate to unlicensed assistive personnel (UAP)? Completing the Mini Nutritional Assessment Determining body mass index (BMI) Estimating body fat using skinfold measurements Measuring current height and weight

Measuring current height and weight

The nurse manager in a long-term care facility plans nutritional assessments of all residents. Which nutritional assessment activity does the nurse delegate to unlicensed assistive personnel (UAP) at the facility? Assessing residents' abilities to swallow Determining residents' functional status Measuring the daily food and fluid intake of residents Screening a portion of the residents with the Mini Nutritional Assessment

Measuring the daily food and fluid intake of residents

Which of these assigned patients 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 esophagectomy 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 esophagectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube

The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health care provider will request which medication for this patient? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl) Misoprostol (Cytotec)

Misoprostol (Cytotec)

The nurse is caring for a postoperative client who had an extensive oral and neck surgery. The client is now describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client? Diphenhydramine (Benadryl) Midazolam (Versed) intravenously Morphine sulfate intravenously Oxycodone plus acetaminophen (Percocet, Tylox)

Morphine

The nurse is assessing a client who comes to the emergency department with acute abdominal pain. The nurse notes a bulging, pulsating mass when inspecting the abdomen. Which action by the nurse is correct? Auscultate the abdomen to determine the presence of bowel sounds. Notify the provider about this finding immediately. Palpate the client's abdomen to determine the outlines of the mass. Question the client about recent stool habits.

Notify the provider about this finding immediately.

A young adult man says that he cannot stay on a diet because of trouble finding one that will incorporate his food preferences. How does the nurse most effectively plan nutritional care for this client? Calculates his body mass index (BMI) Records a 24-hour diary of his physical activities Obtains a 24-hour recall (diary) of his food intake Measures his accurate height and weight measurements

Obtains a 24-hour recall (diary) of his food intake

The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patient's ulceration is duodenal in origin and not gastric? Pain occurs 1½ to 3 hours after a meal, usually at night. Pain is worsened by the ingestion of food. The patient has a malnourished appearance. The patient is a man older than 50 years.

Pain occurs 1½ to 3 hours after a meal, usually at night.

Which practice does the nurse include when teaching a client about proper oral care? Perform self-examination of the mouth every week, and report any unusual findings. Brush the teeth daily and floss as needed. Use drugs that reduce the flow of saliva unless lesions are present. Regularly rinse mouth with alcohol-based agent.

Perform self-examination of the mouth every week, and report any unusual findings.

The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? Apply antiembolism stockings. Place a nasogastric (NG) tube, and connect to suction. Insert an indwelling catheter, and check output hourly. Give famotidine (Pepcid) 20 mg IV every 12 hours.

Place a nasogastric (NG) tube, and connect to suction.

The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a patient diagnosed with esophageal cancer. Which of the following instructions should be included in the teaching? Place food at the back of the mouth as you eat. Do not be overly concerned with tongue or lip movements. Before swallowing, tilt the head back to straighten the esophagus. Do not attempt to reach food particles that are on the lips or around the mouth.

Place food at the back of the mouth as you eat.

An older malnourished client who is taking digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel) develops a severe case of diarrhea. What does the nurse suspect is a possible cause? Digoxin (Lanoxin) Gastritis Potassium chloride (Kay Ciel) Ranitidine (Zantac)

Potassium chloride (Kay Ciel)

When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the unlicensed assistive personnel (UAP)? Provide oral care using disposable foam swabs. Inspect the oral mucosa for evidence of oral candidiasis. Instruct the client on how to use nystatin (Mycostatin) oral rinses. Teach the client how to make appropriate dietary choices.

Provide oral care using disposable foam swabs.

After a colonoscopy, a client reports severe abdominal pain. The nurse obtains these data: temperature 100.2°F (37.9°C), pulse 122 beats/min, blood pressure 100/45 mm Hg, respirations 44 breaths/min, and O2 saturation 89%. Which request from the health care provider does the nurse implement first? Give cefazolin (Ancef) 500 mg IV. Infuse normal saline at 200 mL/hr. Give morphine sulfate 2 mg IV. Provide oxygen at 6 L/min per nasal cannula.

Provide oxygen at 6 L/min per nasal cannula.

A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurse's highest priority intervention? Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider Asking the primary health care provider for a referral for home health services to assist with dressing changes Asking the spouse if any other family members are in the medical profession and could help change the dressing Offer literature on dressing changes and schedule follow-up phone calls with the patient and spouse to talk them through dressing changes when at home.

Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider

An older adult client needs additional dietary protein, but refuses to drink the prescribed liquid protein supplements. Which nursing intervention is most effective in increasing the client's protein intake? Administering the liquid supplement with routine medications Giving a glucose polymer modular supplement Keeping a food and fluid intake diary for at least 3 days Providing protein modular supplements in the form of puddings

Providing protein modular supplements in the form of puddings

A client has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this client? Ambulating the client as quickly as possible after surgery Applying an abdominal binder daily when the client is out of bed Observing for tachycardia, nausea, diarrhea, and abdominal cramping Providing six small feedings daily and offering fluids frequently

Providing six small feedings daily and offering fluids frequently

A client arrives at the emergency department with acute abdominal pain in the left lower quadrant. In which order does the nurse examine and assess the client's abdomen? (left lower quadrant (LLQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and right upper quadrant (RUQ))? LLQ, RLQ, LUQ, RUQ LUQ, LLQ, RUQ, RLQ RLQ, LLQ, RUQ, LUQ RUQ, LUQ, RLQ, LLQ

RUQ, LUQ, RLQ, LLQ

Which patient assessment information is correlated with a diagnosis of chronic gastritis? Anorexia, nausea, and vomiting Frequent use of corticosteroids Hematemesis and anorexia Radiation therapy, smoking, and excessive alcohol use

Radiation therapy, smoking, and excessive alcohol use

A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? Femoral Reducible Strangulated Incarcerated

Reducible

An obese client with a body mass index of 30 and hypertension has been taking prescription orlistat for 4 weeks and reports loose stools, abdominal cramps, and nausea. What does the nurse recommend for this client? Asking the provider to change the medication to phendimetrazine (Bontril). Changing to the lower dose, over-the-counter form of orlistat to reduce these effects. Increasing the daily activity level to improve overall metabolism. Reducing nutritional fat intake to less than 30% of the client's daily food intake.

Reducing nutritional fat intake to less than 30% of the client's daily food intake.

A client who is receiving total enteral nutrition exhibits acute confusion and shallow breathing and says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's signs and symptoms? The enteral tube is dislodged. Abdominal distention is present. Severe hyperglycemia is present. Refeeding syndrome is occurring.

Refeeding syndrome is occurring.

The nurse is instructing a client on measures to maintain effective oral health. Which measures does the nurse include in the client's teaching plan? Select all that apply. Regular dental checkups Use of mouthwashes containing alcohol Ensuring that dentures are slightly loose-fitting Managing stress as much as possible Eating a balanced diet

Regular dental checkups Managing stress as much as possible Eating a balanced diet

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? Retape the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. Document instructions for a patient with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a patient who has arrived from the post anesthesia care unit after a laparoscopic gastrectomy.

Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis.

A patient with an inoperable esophageal tumor is receiving swallowing therapy. Which task does the home health nurse delegate to an experienced home health aide? Teaching family members how to determine whether the patient is obtaining adequate nutrition Assessing lung sounds for possible aspiration when the patient is swallowing clear liquids Reminding the patient to use the chin-tuck technique each time the patient attempts to swallow Instructing family members about symptoms that may indicate a need to call the primary health care provider

Reminding the patient to use the chin-tuck technique each time the patient attempts to swallow

The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the client's teaching plan? Encourage the client to eat acidic foods to decrease bacteria. Mouth care should be performed twice daily. Rinse the mouth with warm saline or sodium bicarbonate. Use a medium-bristled toothbrush for oral care.

Rinse the mouth with warm saline or sodium bicarbonate. (will decrease inflammation and pain

A patient has been discharged home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? Schedule of the patient's follow-up examinations and diagnostic testing Information on family members' progress in learning how to perform dressing changes Copy of the diet plan prepared for the patient by the hospital dietitian Detailed account of what occurred during the patient's surgical procedure

Schedule of the patient's follow-up examinations and diagnostic testing

A patient returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this patient after the patient is situated in bed? High Fowler's Lateral Sims' (side-lying) Semi-Fowler's Supine

Semi-Fowler's The patient is maintained in this position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion

Which factors place a client at risk for gastrointestinal (GI) problems? Select all that apply. Eating a high-fiber diet Smoking a half-pack of cigarettes per day Socioeconomic status Some herbal preparations Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Smoking Socioeconomic status Some herbal preparations NSAIDS

An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? Administer acetaminophen (Tylenol) 650 mg rectally. Draw blood for a complete blood count and serum electrolytes. Obtain a stool specimen for culture and sensitivity. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? Starting a large-bore IV Administering IV pain medication Preparing equipment for intubation Monitoring the patient's anxiety level

Starting large bore IV

An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action? Pain when coughing States, "I am too tired to walk very much" States, "I feel like the incision is splitting open" Temperature of 100.8°F (38.2°C).

States, "I feel like the incision is splitting open"

A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? Steak with pasta Spaghetti with tomato sauce Steamed broccoli with turkey Tuna salad with wheat crackers

Steamed broccoli with turkey

"A patient is being discharged, 8 days postoperatively following a total esophagectomy." Which teaching point does the nurse consider to be of the highest priority during the transition to home? Instruct the patient to eat three meals daily. Emphasize the importance of lying down after meals. Encourage the patient to ask his or her health care provider for antidepressant medication. Stress the importance of notifying the primary health care provider if leaking is noted at the incision site.

Stress the importance of notifying the primary health care provider if leaking is noted at the incision site.

A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? Administer pain medication. Assess skin temperature and color. Check on the amount of urine output. Take vital signs.

Take vital signs.

A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? Cramping intermittently, metabolic acidosis, and minimal vomiting Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis Metabolic acidosis, upper abdominal distention, and intermittent cramping Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

The nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately? Bowel sounds are not audible in all quadrants. Client's skin under the panniculus is excoriated. The client reports pain when being repositioned. Urine output total is 15 mL for the past 2 hours.

Urine output total is 15 mL for the past 2 hours.

A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? Use saliva substitutes, especially when eating dry foods. This condition is common but is temporary. Use lozenges and hard candies to prevent dry mouth. This indicates a complication of therapy.

Use saliva substitutes, especially when eating dry foods.

A client who has undergone a bariatric surgical procedure is recuperating after surgery. Which nursing intervention most effectively prevents injury to the client who is being re-positioned postoperatively? Administering pain medication Making sure not to move the client's nasogastric (NG) tube Monitoring skinfold areas and keeping them clean and dry Using a weight-rated extra-wide bed for the client

Using a weight-rated extra-wide bed for the client

A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? Administering a Fleet's enema when needed Applying heat to acute inflammation for pain relief Avoiding the use of bulk-forming agents Using hydrocortisone cream to relieve pain

Using hydrocortisone cream to relieve pain

A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient? Applying hydrocortisone cream Cleaning the area with soap and hot water Using sitz baths three times daily Wearing absorbent cotton underwear

Using sitz bath

Based on nutritional screening findings and assessments, which client will be the preferred candidate for surgical treatment for obesity? Man with a body mass index (BMI) of 40, weight 75% above ideal body weight Man with a BMI of 41, weight 80% above ideal body weight Woman with a BMI of 38, weight 50% above ideal body weight Woman with a BMI of 42, weight 100% above ideal body weight

Woman with a BMI of 42, weight 100% above ideal body weight

A patient who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? A list of medical supply facilities where wound care supplies may be purchased Proper handwashing techniques to avoid cross-contamination of the patient's wound The amount of pain medication that the patient is allowed to take in each dose Written and oral instructions regarding signs/symptoms to report to the primary health care provider

Written and oral instructions regarding signs/symptoms to report to the primary health care provider

An 87-year-old resident from an extended care facility has not been eating for several days and is admitted to the hospital with a diagnosis of malnutrition. She has an enteral feeding tube placed in her left nostril. Her medications include digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel). The nurse checks the gastric pH of the feeding tube and obtains a value of 6.0, which may indicate that the feeding tube is in the client's lungs. Is there another possible explanation for the nurse to consider? No; the feeding tube must be removed. No; the potassium effect will prevent the pH from reaching 6.0. Yes; the client is taking Zantac. Yes; the pH paper has expired and is giving a false reading.

Yes; the client is taking Zantac.

The nurse working during the day shift on the medical unit has just received report. Which patient does the nurse plan to assess first? Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal Middle-aged patient with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy

The community clinic nurse is discussing risk factors for esophageal cancer with a group of clients. Which client behavior requires further teaching? a. Smokes 1 pack of cigarettes daily b. Walks at the shopping mall three times weekly c. Elevates pillows at night d. Eats a small snack each night before bedtime

a. Smokes 1 pack of cigarettes daily

The nurse is caring for a client who has been diagnosed with esophageal cancer. The client appears anxious and asks the nurse, "Does this mean I am going to die?." Which nursing responses are appropriate? (Select all that apply.) a. "No, surgery can cure you." b. "It sounds like death frightens you." c. "Let me call the hospital chaplain to talk with you." d. "You can beat this disease if you just put your mind to it." e. "Let me sit with you for awhile and we can discuss how you are feeling about this."

b. "It sounds like death frightens you." e. "Let me sit with you for awhile and we can discuss how you are feeling about this."

Upon assessment of a client with GERD, which statement requires nursing intervention? a. "I quit smoking several years ago." b. "Sometimes I wake up gasping for air in the middle of the night." c. "My family likes to eat small meals every 3 to 4 hours throughout the day." d. "When I buy meat, I ask for the leanest cut that is available."

b. "Sometimes I wake up gasping for air in the middle of the night."

A client reports ongoing episodes of heartburn. The nurse educates the client on prevention and control of reflux by recommending dietary elimination of which food item? a. Lean steak b. Carrot sticks c. Chocolate candy d. Air-popped popcorn

c. Chocolate candy