Med/Surg 8

A client is admitted for suspected cholecystitis. On reviewing laboratory results, the nurse notes that the client's amylase is elevated. Which action by the nurse is best? Select one: a. Document the finding in the chart. b. Notify the health care provider. c. Ask the client about drinking habits. d. Place the client on clear liquids.

c. Ask the client about drinking habits.

The nurse is caring for a client with acute pancreatitis. The client's health care provider has ordered gentamicin (Garamycin) 3 mg/kg/day in three divided doses. The client weighs 264 lb. The client will receive ___________ milligrams/dose of Garamycin.

120

The nurse is to administer an infliximab (Remicade) infusion to a client who weighs 110 lb. The client is to receive 5 mg/kg of the drug, which is available as a 100-mg/10 mL solution. The nurse will draw up _____________ milliliters of solution for the client's infusion.

25

A client is admitted with end-stage cirrhosis and severe vomiting. Which problem should the nurse monitor the client most carefully for? Select one: a. Decreased excretion of bilirubin b. Intrahepatic bile stasis c. Bleeding esophageal varices d. Accumulation of ascites in the abdomen

c. Bleeding esophageal varices

The nurse is caring for a client with severe ulcerative colitis who has been prescribed adalimumab (Humira). Which client statement indicates that additional teaching about the medication is needed? Select one: a. "Nausea and vomiting are common side effects." b. "I will avoid large crowds and people who are sick." c. "I will take this medication with food or milk." d. "I will wash my hands after I play with my dog."

c. "I will take this medication with food or milk."

The nurse is assessing a client for asterixis. Which instruction to the client is most appropriate? Select one: a. "Extend your arm, flex your wrist upward, and extend your fingers." b. "Close your eyes and take turns touching your nose with your fingers." c. "Sit on the edge of the bed and hold your legs straight out for 30 seconds." d. "Say 'EEEEE' while I listen to your lungs in the back on both sides."

a. "Extend your arm, flex your wrist upward, and extend your fingers."

The nurse is providing discharge teaching for a client who will be going home with a T-tube following cholecystectomy surgery. Which statement by the client indicates the need for additional teaching? Select one: a. "I will slowly pull about an inch of the tube out each day until it's out." b. "I will be careful not to pull on the tube or to accidentally pull it out." c. "I will inspect the T-tube drainage site daily for signs of infection." d. "I will keep the drainage bag lower than the tube itself."

a. "I will slowly pull about an inch of the tube out each day until it's out."

Which client is at highest risk for developing dehydration and hypernatremia as a result of enteral feedings? Select one: a. Client receiving a hypertonic enteral feeding solution and an IV of normal saline (0.9 NS) at 125 mL/hr b. Client receiving an isotonic enteral feeding solution and an IV of D5W (dextrose 5% in water) at 83 mL/hr c. Client who can drink liquids and is receiving a supplemental hypertonic enteral feeding solution d. Client receiving a hypertonic enteral feeding solution and an IV of 0.45% NS (0.45 NS) infusing at 125 mL/hr

a. Client receiving a hypertonic enteral feeding solution and an IV of normal saline (0.9 NS) at 125 mL/hr

A client is admitted with cirrhosis and hepatopulmonary syndrome. Which clinical manifestation does the nurse monitor for progression or resolution of this problem? Select one: a. Crackles on auscultation b. Skin and scleral jaundice c. Nausea and vomiting d. Right upper quadrant pain

a. Crackles on auscultation

A client with an esophagogastric tube suddenly experiences acute respiratory distress. Which is the nurse's first action? Select one: a. Cut the balloon ports and remove the tube. b. Place the client upright and apply oxygen. c. Call the health care provider. d. Reduce the balloon pressure slightly.

a. Cut the balloon ports and remove the tube.

Which laboratory data does the nurse correlate with advanced disease in a client with cirrhosis? Select one: a. Elevated serum ammonia level b. Decreased serum ammonia level c. Decreased lactate dehydrogenase level d. Elevated serum protein level

a. Elevated serum ammonia level

The nurse is caring for a client with ulcerative colitis and severe diarrhea. Which nursing assessment is the highest priority? Select one: a. Heart rate and rhythm b. Abdominal percussion c. Skin integrity d. Blood pressure

a. Heart rate and rhythm

The nurse is preparing to administer tube feedings through a client's new Salem sump nasogastric tube. The nurse is unable to withdraw any fluid from the tube before starting the feeding. Which is the priority action of the nurse? Select one: a. Obtain orders for a chest x-ray to confirm placement before starting the feeding. b. Lower the head of the client's bed and attempt to aspirate fluid again. c. Start the tube feeding as ordered and check the residual in 30 minutes. d. Inject air into the nasogastric tube while auscultating the client's epigastric area.

a. Obtain orders for a chest x-ray to confirm placement before starting the feeding.

The nurse is teaching a client with a history of cholelithiasis to select menu items for dinner. Which selections made by the client indicate that the nurse's teaching was effective? Select one: a. Roasted chicken breast, baked potato with chives, hot tea with sugar b. Grilled cheese sandwich, tomato soup, coffee with cream c. Lasagna, tossed salad with Italian dressing, 2% milk d. Caesar salad with chicken, soft breadstick with butter, diet cola

a. Roasted chicken breast, baked potato with chives, hot tea with sugar

A client is hospitalized with acute pancreatitis. The nursing assistant reports to the nurse that when a blood pressure cuff was applied, the client's hand had a spasm. Which additional finding does the nurse correlate with this condition? Select one: a. Serum calcium, 5.8 mg/dL b. Serum creatinine, 0.9 mg/dL c. Serum sodium, 166 mEq/L d. Serum potassium, 4.2 mEq/dL

a. Serum calcium, 5.8 mg/dL

The nurse is caring for a client after a Whipple procedure. Which manifestations might indicate that a complication from the operation has occurred? (Select all that apply.) Select one or more: a. Urine output of 20 mL/6 hr b. Urinary retention c. Substernal chest pain d. Lack of bowel sounds or flatus e. Shortness of breath

a. Urine output of 20 mL/6 hr c. Substernal chest pain d. Lack of bowel sounds or flatus e. Shortness of breath

A client is refusing to take lactulose (Heptalac) because of diarrhea. Which is the nurse's best response to this client? Select one: a. "You may take Kaopectate liquid daily for loose stools." b. "Diarrhea is expected; that's how your body gets rid of ammonia." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory."

b. "Diarrhea is expected; that's how your body gets rid of ammonia."

The nurse is providing discharge teaching for a client who will be receiving pancreatic enzyme replacement at home. Which statement by the client indicates that additional teaching is needed? Select one: a. "I will wipe my lips carefully after I drink the enzyme preparation." b. "The best time to take the enzymes is immediately after I have a meal or a snack." c. "I will not mix the enzyme powder with food or liquids that contain protein." d. "The capsules can be opened and the powder sprinkled on applesauce if needed."

b. "The best time to take the enzymes is immediately after I have a meal or a snack."

A client is in the emergency department after a motor vehicle crash. In assessing the client, which clinical sign alerts the nurse to the presence of possible liver trauma? Select one: a. Abdominal pain with accompanying rebound tenderness b. Abdominal pain referred to the right shoulder c. Left upper quadrant abdominal pain and swelling d. Abdominal pain referred to the spine and legs

b. Abdominal pain referred to the right shoulder

The nurse is caring for a client with acute pancreatitis. During the physical assessment, the nurse notes a grayish-blue discoloration of the client's flanks. Which is the nurse's priority action? Select one: a. Prepare the client for emergency surgery. b. Ensure that the client has a patent large-bore IV site. c. Insert a nasogastric (NG) tube to low intermittent suction. d. Place the client in high Fowler's position.

b. Ensure that the client has a patent large-bore IV site.

A client just returned to the nursing unit after having a trans-jugular intrahepatic portal-systemic shunt (TIPS) procedure. Which clinical finding does the nurse expect to observe in this client? Select one: a. Increased abdominal girth b. Increased blood pressure c. Decreased urinary volume d. Decreased level of consciousness

b. Increased blood pressure

A client with Crohn's disease has a draining fistula. Which finding leads the nurse to intervene most rapidly? Select one: a. White blood cell count of 8200/mm3 b. Serum potassium of 2.6 mEq/L c. The client not wanting to eat anything d. The client losing 3 pounds in a week

b. Serum potassium of 2.6 mEq/L

The nurse is preparing a client with diverticulitis for discharge from the hospital. Which statement by the client indicates that additional teaching is needed? Select one: a. "I will try to include at least 25 g of fiber in my diet every day." b. "I will use my legs rather than my back muscles when I lift heavy objects." c. "I will take a senna laxative at bedtime to avoid becoming constipated." d. "I will ride my bike or take a long walk at least three times a week."

c. "I will take a senna laxative at bedtime to avoid becoming constipated."

The nursing care plan specifies obtaining abdominal girth measurements each shift. The nurse takes the measurement, but when compared with the previous measurement, the new finding is several millimeters off. Which action by the nurse is best? Select one: a. Look to see when the client last had a dose of diuretic. b. Obtain the measurement while the client sits upright. c. Ensure that the client's abdomen and flanks are marked with pen. d. Document the finding in the client's chart.

c. Ensure that the client's abdomen and flanks are marked with pen.

A client has cirrhosis and has developed ascites and edema. Which laboratory value does the nurse correlate with this condition? Select one: a. Serum sodium, 135 mEq/L b. Blood urea nitrogen, 18 mg/dL c. Serum albumin, 2.1 g/dL d. Blood glucose, 120 mg/dL

c. Serum albumin, 2.1 g/dL

The nurse conducts a physical assessment for a client with severe right lower quadrant (RLQ) abdominal pain. The nurse notes that the abdomen is rigid and the client's temperature is 101.1° F (38.4° C). Which laboratory value does the nurse bring to the attention of the health care provider as a priority? Select one: a. Serum sodium, 149 mEq/L b. Serum creatinine, 0.7 mg/dL c. White blood cell count, 22,000/mm3 d. A "left shift" in the white blood cell count

c. White blood cell count, 22,000/mm3

The nurse is reviewing a client's history. Which statement by the client indicates a need for health teaching? Select one: a. "I drink 1 to 2 glasses of red wine a week." b. "One of my cousins died of liver cancer 10 years ago." c. "I got a hepatitis vaccine before traveling last year." d. "Because of my arthritis, I take a lot of Tylenol."

d. "Because of my arthritis, I take a lot of Tylenol."

A thin, cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE). The family expresses distress that the client is receiving so little protein in the diet. Which explanation by the nurse is most appropriate? Select one: a. "Despite looking so thin, protein will not help with weight gain." b. "Less protein is needed to prevent fluid from leaking into the abdomen." c. "A low-protein diet will help the liver rest and will restore liver function." d. "Less protein in the diet will help with the confusion."

d. "Less protein in the diet will help with the confusion."

A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C) and right flank pain. Which is the nurse's best response? Select one: a. "You should take an additional dose of cyclosporine today." b. "Take acetaminophen (Tylenol) every 4 hours until you feel better." c. "The anti-rejection drugs you are taking made you susceptible to infection." d. "You should go to the hospital immediately to have your new liver checked out."

d. "You should go to the hospital immediately to have your new liver checked out."

The nurse is caring for a client who was started on total parenteral nutrition (TPN) 2 days previously. The client reports blurred vision, dry mouth, and frequent urination. Which is the nurse's priority action? Select one: a. Assess the client's vital signs. b. Weigh the client. c. Slow down the TPN infusion. d. Assess the client's blood sugar.

d. Assess the client's blood sugar

The nurse is caring for a client who is taking mesalamine (5-aminosalicylic acid) (Asacol, Rowasa) for ulcerative colitis. The client has trouble swallowing the pill. Which action by the nurse is most appropriate? Select one: a. Empty the contents of the capsule into applesauce or pudding for administration. b. Crush the pill carefully and administer it to the client in applesauce or pudding. c. Contact the client's health care provider to request an order for Asacol suspension. d. Contact the client's health care provider to request an order for Rowasa enemas instead.

d. Contact the client's health care provider to request an order for Rowasa enemas instead.

A female client is admitted with an exacerbation of ulcerative colitis. Which laboratory value does the nurse correlate with this condition? Select one: a. Potassium, 5.5 mEq/L b. Sodium, 144 mEq/L c. Hemoglobin, 14.2 g/dL d. Erythrocyte sedimentation rate (ESR), 55 mm/hr

d. Erythrocyte sedimentation rate (ESR), 55 mm/hr

The nurse is caring for a client who is a vegan and has developed B12 deficiency. Which foods does the nurse encourage the client to include in the diet? Select one: a. Pumpkin seeds and blackstrap molasses b. Kale, spinach, and whole grain bread c. Strawberries and sweet red peppers d. Fortified cereals and tofu

d. Fortified cereals and tofu

The nurse is caring for a client with acute pancreatitis. Which nursing intervention best reduces discomfort for the client? Select one: a. Administering morphine sulfate IV every 4 to 6 hours as needed b. Providing small, frequent feedings, with no concentrated sweets c. Placing the client in semi-Fowler's position at elevation of 30 degrees d. Maintaining NPO status for the client with IV fluids

d. Maintaining NPO status for the client with IV fluids

A severely malnourished client was started on enteral feedings. The following day, the client is confused, has a heart rate of 112 beats/min, and reports feeling weak. Which laboratory value does the nurse correlate with this condition? Select one: a. Serum potassium, 3.1 mEq/L b. Serum sodium, 143 mEq/L c. Serum glucose, 110 mg/dL d. Serum phosphate, 1.8 mg/dL

d. Serum phosphate, 1.8 mg/dL

A client had a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? Select one: a. Systolic blood pressure increase of 10 mm Hg b. A 3-pound drop in weight c. Respiratory rate drop from 18 to 14 d. Urine output of 20 mL/hr

d. Urine output of 20 mL/hr