Week 3 Test

The nurse prepares to administer the measles, mumps, and rubella vaccine to a young adult female client. The nurse teaches the client about the vaccine before administration. Which statement is most important for the nurse to include in the teaching? 1- "Avoid becoming pregnant for 3 months after receiving the vaccine." 2- "Take acetaminophen 30 minutes before receiving the vaccine." 3- "Report a low-grade fever to the health care provider." 4- "A mild maculopapular skin rash with a few lesions may occur after receiving the vaccine."

1

The nurse provides an older client, who was recently widowed, with a list of activities available at a local library. For which nursing diagnosis is this action most appropriate? 1- Risk for loneliness. 2- Risk for ineffective coping. 3- Risk for complicated grieving. 4- Risk for situational low self-esteem.

1

The nurse provides care for a client diagnosed with chronic obstructive pulmonary disease (COPD). Which finding indicates to the nurse that the client is experiencing cor pulmonale? 1- Jugular vein distension 2- Whitish frothy sputum. 3- Finger clubbing. 4- Chest tightness.

1

The nurse provides care for a client diagnosed with urinary incontinence. Upon review of the client's current medications, which prescription does the nurse question? 1- Hydrochlorothiazide. 2- Imipramine. 3- Oxybutynin. 4- Dicyclomine.

1

The nurse provides care for a client who reports waking up with heartburn every night. Which client statement requires the nurse to provide further education to the client? 1- "I eat 3 meals a day." 2- "I do not eat 2 hours before going to bed." 3- "I will work on losing weight." 4- "I will elevate the head of my bed 6 to 12 inches."

1

The nurse provides care to a client diagnosed with methicillinresistant Staphylococcus aureus (MRSA) pneumonia. Which type of isolation will the nurse implement for this client? 1- Contact. 2- Droplet. 3- Airborne. 4- Reverse.

1

The nurse provides care to a client receiving intravenous heparin. Which laboratory test result causes the nurse to be most concerned? 1- Platelet count 50 mm3/L (50×109/L). 2- Sodium level 130 mEq/L (130 mmol/L). 3- Potassium level 3.2 mEq/L (3.2 mmol/L). 4- Partial thromboplastin time 70 seconds.

1

A nurse from a pediatric unit works a shift on an adult surgical unit. The charge nurse makes client assignments. Which client is most appropriate for the charge nurse to assign to the pediatric nurse? (Select all that apply.) 1- A preschool-age client who had a tonsillectomy. 2- A young adult client who had a pilonidal cyst removed. 3- An adult client diagnosed with Stage 3 cancer who had a partial removal of the colon. 4- An older adult client who had a right total hip arthroplasty. 5-An adolescent client who had an appendectomy.

1,2,5

The nurse cares for a client diagnosed with gastroesophageal reflux disease. The nurse counsels the client on diet changes that need to be implemented. Which statement indicates to the nurse that the client needs further teaching? (Select all that apply.) 1- "I will have trouble to get vegetables without my daily salad." 2- "We must reduce the spicy flavors in our tacos." 3- "I wish I could continue to eat eggs and toast." 4- "I will eat dinner earlier in the evening." 5- "I'm glad that I can still eat chocolate and drink coffee."

1,3,5

The nurse teaches parents about the nutritional needs of their 6- month-old infant. Which statement by a parent indicates a need for further teaching? 1- "Fruit juice should be limited to 2 to 4 ounces per day." 2- "I'll make sure I offer more fruit juice than fruit." 3- "Fruit juice is not necessary in my baby's diet." 4- "I'll avoid offering a no-spill sippy cup to prevent tooth decay."

2

A client recovers from general anesthesia. Which medication will the nurse identify as causing respiratory depression? (Select all that apply.) 1- Ketorolac. 2- Hydromorphone hydrochloride. 3- Ibuprofen. 4-Codeine sulfate. 5- Hydrocodone.

2,4,5

The nurse provides care for a client that dies unexpectedly. Which task will the nurse safely delegate to nursing assistive personnel (NAP)? (Select all that apply.) 1- Removal of tubes to perform post mortem care. 2- Gather the client's belongings for the family to take home. 3- Have the family sign an organ donation form. 4- Notify the funeral home. 5- Notify the kitchen to not send a meal tray.

2,5

A client with transient confusion coughs constantly while being fed by nursing assistive personnel (NAP). Which action will the nurse take first? 1- Auscultate breath sounds. 2- Offer the client sips of water. 3- Direct the NAP to stop feeding the client. 4- Assess the oral cavity for pocketing of food.

3

The nurse plans care for four clients. Which client requires the nurse to initiate contact precautions? 1- Client receiving radiation therapy for uterine cancer. 2- Client receiving nebulizer treatments for pneumonia. 3- Client receiving antibiotic therapy for shigella. 4- Client receiving enteral tube feedings following a gastrectomy.

3

The nurse provides care for four clients. Which client need will the nurse address first? 1- Client on a ventilator needing to be repositioned. 2- Client diagnosed with lung disease with an oxygen saturation of 90%. 3- Client reporting chest pain after ambulating. 4- Client with pneumonia needing the first dose of intravenous antibiotics.

3

The nurse provides care to an adolescent client with a history of frequent urinary tract infections (UTIs). Upon assessment the nurse learns that the client has symptoms of a UTI , is having difficulty in school, and does not want to be at home alone with the parent's spouse. Which action will the nurse take first? 1-Ask the client to use the bathroom and obtain a urinalysis. 2-Discuss the client's concerns with the health care provider. 3-Ask the parent to leave the room so the nurse can ask the client assessment questions privately. 4-Call the social worker to come and talk to the client.

3

The nurse teaches a client about complications of venous insufficiency. Which complication will the nurse include as the most serious complication? 1- Varicose veins. 2- Stasis pruritus. 3- Venous ulcerations. 4- Neuropathic ulcers.

3

The health care provider prescribes isoniazid for a client with active tuberculosis. Which statement is most important for the nurse to include when teaching the client about the medication? 1- "You should begin to feel better in 2 to 3 days. If you don't, notify your health care provider." 2- "You can safely have one to two glasses of wine daily while taking the medication." 3- "You should always take the medication with food, even if it upsets your stomach." 4- "Vitamin B6 prevents leg tingling and numbness that can occur with isoniazid."

4

The nurse notes that a newly admitted client quickly consumes 360 mL of soda and two hamburgers in one meal. The client also voided 800 mL of pale yellow urine over the past hour. Which health care provider (HCP) prescription does the nurse question? 1- 1800-calorie diet with carbohydrate count. 2- Capillary blood glucose level now. 3- Fasting blood glucose the next morning. 4- Intravenous dextrose 5% in water at 125 mL per hour.

4

The nurse prepares to teach a client about measures to prevent falls at home. Which point will the nurse include in the teaching plan? 1- Place a small area rug on the bathroom floor in front of the bathtub. 2- Avoid using step stools. 3- Allow damp areas on the floor to air dry. 4- Do not attempt to do anything beyond reach.

4

The nurse provides care for four clients. Which client will benefit the most from a multidisciplinary conference? 1- A 3-month-old client with intussusception who is vomiting, has colicky abdominal pain, and is having jelly-like stools. 2- A 2-month-old client with respiratory syncytial virus (RSV), who is wheezing and has moderate subcostal retractions and copious nasal discharge. 3- A 3-day-old client with developmental dysplasia of the hip, who has unequal leg length, limited abduction of the left hip, and asymmetry of the gluteal folds. 4- A 2-day-old client with body tremors and hyperirritability, who has intermittent episodes of sneezing and whose mother abused substances while pregnant.

4

The nurse receives report for a group of adult clients. Which client will the nurse see first? 1- The client receiving treatment for osteomyelitis of the lumbar spine, with a white blood cell count of 22,000/mm3 (22 x 109/L). 2- The client with right-sided heart failure and 4+ pitting edema of the legs, ankles, and feet. 3- The adult client with pneumonia, rhonchi clear with coughing, and oxygen saturation level of 93%. 4- The client with esophageal strictures lying supine with a parenteral tube feeding infusing.

4

The nurse teaches a group of nursing students about managed care. Which information will the nurse include in the teaching session? 1- Provides full coverage of health care costs. 2- Allows providers to focus on illness care. 3- Assumes the financial risk involved. 4- Encourages providers to focus on prevention.

4

A client takes a beta 2 adrenergic agonist. Which finding indicates to the nurse that the client is experiencing an adverse reaction? 1- Drowsiness. 2- Dysphagia. 3- Palpitation. 4- Paresthesias.

3

The nurse plans to assess a client with acquired immune deficiency syndrome (AIDS). Which question provides the least amount of information to plan this client's care? 1- What method of birth control do you use? 2- Do you use intravenous drugs? 3- How many sexual partners do you have? 4- How old were you when you became sexually active?

4

The nurse makes an error when administering a medication to a client. It is unlikely that anyone else will find out about the error. Which principle does the nurse follow to uphold ethical standards of nursing practice? 1-Fidelity. 2-Justice. 3-Veracity. 4-Confidentiality.

3

The nurse performs an assessment on a full-term newborn. Which finding does the nurse report to the health care provider? 1-The client's blood pressure of 70/44 mm Hg. 2-The umbilical cord is whitish-gray in color. 3- Bowel sounds cannot be auscultated in the abdomen. 4- The big toe dorsiflexes when the side of the foot is stroked.

3

A client in her third trimester of pregnancy asks the nurse how to differentiate between true labor and false labor. Which is the best explanation by the nurse to describe false labor to the client? 1- The intensity, frequency, and duration of contractions do not change. 2- Discomfort begins in the back and radiates to the abdomen. 3- Contractions are accompanied by pink mucus from the vagina. 4- Progressive effacement and dilation of the cervix begin to occur.

1

A client with a history of intravenous drug abuse experiences a low-grade fever, cough, night sweats, fatigue, weight loss, and a productive cough with mucopurulent sputum. Which transmission-based precaution will the nurse use for this client? 1- Airborne. 2- Contact. 3- Droplet. 4- Standard.

1

After being told the diagnosis of terminal cancer, a client says "Why is God doing this to me?" Which nursing diagnosis does the nurse include in the plan of care for this client? 1- Spiritual distress. 2- Ineffective coping. 3- Anticipatory grieving. 4- Readiness for enhanced spiritual well-being.

1

An older adult client is admitted with bilateral fractures of the arms. The client is brought to the emergency department (ED) by a family member. Which action by the nurse is appropriate in determining if the client has been a victim of physical abuse? 1- Have the family member stay in the waiting area while the client is assessed. 2- Ask the client how the injury occurred and observe the family member's reaction. 3- Make a referral for a home assessment visit by the visiting nurse. 4- Notify an elder protective services agency about the possible abuse.

1

The nurse is providing care to a client diagnosed with measles. Which transmission-based precaution does the nurse implement when caring for this client? 1- Airborne. 2- Droplet. 3- Contact. 4- Neutropenic.

1

The nurse is teaching the parent of a 2-year-old client on how to correctly administer ear drops. Which action by the parent indicates to the nurse a need for further education? 1- Pulls the pinna up and back. 2- Directs the drops along the side of the ear canal. 3- Removes the ear drops from the fridge 30 minutes before giving. 4- Keeps the child lying down for 5 to 10 minutes before administering drops in the other ear.

1

The nurse observes a student nurse flush a central venous access device (CVAD). Which action by the student requires the nurse to intervene? 1- Flushes the central line in one steady push of saline. 2- Performs hand hygiene using alcohol-based solution. 3- Assesses the date on the central line dressing. 4- Inspects the integrity of the transparent dressing.

1

The nurse plans to teach an adolescent female, newly diagnosed with systemic lupus erythematosus (SLE), about measures to prevent complications. Which information does the nurse include in the teaching session? 1- Apply sunscreen daily. 2- Protect against warm weather by wearing light clothing. 3- Take aspirin to control joint pain. 4- Avoid intake of calcium-rich foods.

1

The nurse assesses a client diagnosed with gestational hypertension (GH). Which finding is the priority for the nurse to report to the health care provider? 1- 1+ protein in the urine. 2- A continuous headache. 3- 2+ ankle edema. 4- A weight gain of 2 lb. (0.9 kg) in the past week.

2

The nurse provides care for a client admitted with a substance addiction. The client reports feeling shaky. The nurse suspects that the client is experiencing withdrawal. From which substance should the nurse suspect the client is experiencing withdrawal? 1- Cocaine. 2- Heroin. 3- Alcohol. 4- Amphetamines.

3

The nurse evaluates laboratory values for a client experiencing diaphoresis and weight loss. Which value will the nurse immediately report to the health care professional? 1- Calcium 9.0 mg/dL (2.25 mmol/L). 2- Hemoglobin A1C 8% (0.08). 3- Magnesium 2.2 mg/dL (1.10 mmol/L). 4- Blood glucose 118 mg/dL (6.55 mmol/L).

2

The nurse learns that a client's adult child contacted an attorney about a situation that occurred while the client received care. Which situation will the nurse use to prepare a response? 1- Nurse administered intravenous antibiotics after surgery. 2- Nurse removed an oral airway while the client was receiving anesthesia. 3- Nurse reinforced a surgical wound with sterile packing and gauze. 4- Nurse measured vital signs every hour until transfer to the general care area.

2

The nurse measures a client's vital signs to be: temperature 101°F (38.3°C), heart rate 110 beats/min, blood pressure 82/46 mm Hg, and respiratory rate 32 breaths/min. The most recent white blood cell count is 18,000 cells/mm3. Which intravenous fluid will the nurse anticipate being prescribed for this client? 1- 5% dextrose in water. 2- Normal saline solution. 3- 50% dextrose in water. 4- Half-strength normal saline solution.

2

The nurse prepares to instruct a client diagnosed with diabetes mellitus on self-injection of insulin. Which gauge and needle length does the nurse teach the client to choose? 1- 23-gauge syringe with a 1 inch needle. 2- 28-gauge syringe with a 0.5 inch needle. 3- 18-gauge syringe with a 1 1/2 inch needle. 4- 20-gauge syringe with a 2 inch needle.

2

The nurse provides care for a client after an above the knee amputation (AKA) 2 days ago. The nurse places the client in which position? 1- Reverse Trendelenburg position. 2- Prone position. 3- Lithotomy position. 4- High Fowler position.

2

Which activity appropriately demonstrates the nurse's role as client advocate? (Select all that apply.) 1- Defending client participation in decisions affecting them. 2- Protecting clients from incompetent or unethical practice. 3- Safeguarding the client's autonomy and independence. 4- Telling clients they must take all medications prescribed by health care providers. 5- Communicating client needs to the interdisciplinary team.

1,2,3,5

A nurse prepares to administer medication to a client. Which information should the nurse use as client identifiers? (Select all that apply.) 1- The client's birth date. 2- The client's room number. 3- The client's provider's name. 4- The client's medical record number. 5- The client's first and last name.

1,4,5

An older client is discharged from the hospital to home following treatment for a fall. The nurse makes a home safety survey. Which findings does the nurse report as fall safety risks? (Select all that apply.) 1- Bathroom is located on the second floor. 2- Meals are prepared using a gas stove. 3- Bilateral hearing aids are used regularly. 4- Throw rugs are in the pathway to the kitchen. 5- Mailbox is located at the end of the driveway.

1,4,5

The nurse provides care for a client diagnosed with migraines. The client indicates to the nurse wanting to try acupressure for treatment of the migraines. The nurse reviews the client's medications. Which medication does the nurse identify as having the potential to cause complications with acupressure? 1- Amoxicillin. 2- Clopidogrel. 3- Acetaminophen. 4- Metoprolol.

2

The nurse provides care for a client reporting crushing chest pain. Which electrocardiogram (ECG) changes support the current nursing diagnosis of cardiac tissue injury? 1- ST segment depression of 2 mm or more. 2- ST segment elevation of 2 mm or more. 3- QRS duration greater than 0.12 seconds. 4- PR interval greater than 0.20 seconds.

2

The nurse provides care for a client that reports difficulty falling asleep several nights a week. The nurse reviews the client's bedtime pattern. Which client statement requires an intervention by the nurse? 1- "I turn the TV off about an hour before bed and try to read." 2- "I will go to bed when I am wide awake and relax in bed." 3- "I will drink some herbal tea to help me wind down for the night." 4- "I will limit my naps to 20 minutes a day."

2

A client receives treatment with internal radiation for cervical cancer. Which observation by the charge nurse poses the greatest risk to the person involved? 1- Housekeeper leaves the client's room with full trash bags for disposal. 2- Food service worker who is pregnant delivers a breakfast tray into the room. 3- Client's spouse visits for 1 hour and brings flowers into the room. 4- Client's nurse enters the room without the dosimeter badge during shift report.

2

The hospice client receives 10 mg of oral oxycodone every 4 hours around the clock for 1 week. The client has become unable to swallow and exhibits moderate restlessness. Which action does the nurse take? 1- Hold the oxycodone, noting in the client's record the inability to swallow. 2- Ask the health care provider (HCP) to prescribe an alternative pain medication. 3- Dissolve the oxycodone in water and deliver it as a sublingual dose. 4- Discontinue the oxycodone and administer a reversal agent for the overdose.

2

The new graduate nurse notices that one of the other nurses has been sleeping on the unit during the night shift. The other staff members seem to have seen this nurse asleep, but they have said nothing. Which action does the new graduate nurse take? 1- Tell the nurse manager in the morning. 2- Contact the nursing supervisor. 3- Tell the nurse you have seen the sleeping and it needs to stop. 4- Tell the nurse if you see the sleeping again, you will report it.

2

The nurse administers medications to several clients. The nurse realizes that an anti-hypertensive and a diuretic were given to the wrong client. Which action should the nurse take first? 1- Notify the health care provider of the medication error. 2- Assess the client who received the incorrect medications. 3- Administer the medications to the correct client. 4- Complete an incident report describing the situation.

2

The nurse delegates care of a client diagnosed with osteoporosis to a nursing assistive personnel (NAP). Which instruction is most important for the nurse to include? 1- "Monitor the urinary output." 2- "Clean up clutter in the room." 3- "Encourage the client to bathe independently." 4- "Perform passive range-of-motion exercises."

2

The nurse provides care for a client undergoing an exercise stress test. The cardiologist is suddenly called away for an emergency. Which action should the nurse take next? 1- Continue the test, as the client was almost finished. 2- Stop the test and reschedule for another day. 3- Ask the client to stay until the doctor returns. 4- Inform the client that the test is finished.

2

The nurse provides care for a pediatric client experiencing an acute episode of croup. It is most important for the nurse to assess the client for which acid-base imbalance? 1- Respiratory alkalosis. 2- Respiratory acidosis. 3- Metabolic alkalosis. 4- Metabolic acidosis.

2

The nurse provides care for a group of clients. Which condition puts the client at risk for metabolic acidosis? (Select all that apply.) 1- Pneumonia. 2- Diabetes mellitus. 3- Asthma. 4- Renal failure. 5- Malnourishment.

2,4,5

The client's health care provider advises the client to undergo chemotherapy. The client, who has not yet signed the consent form, requests more information about the chemotherapy medications and the side effects. The nurse answers all the client's questions honestly, even though the client may decide not to proceed with the chemotherapy. Which ethical principle is guiding the nurse's practice? 1- Beneficence. 2- Fidelity. 3- Veracity. 4- Justice.

3

The nurse assesses a newborn's penis 2 days after a circumcision. The nurse notes a yellow exudate around the head of the penis. Which is the appropriate nursing intervention? 1- Wash the penis with soap and a warm washcloth. 2- Take the newborn's temperature to determine if an infection is present. 3- Leave the area alone, as this is a normal finding. 4- Report the finding to the health care provider.

3

The nurse caring for a client with an acute myocardial infarction and chest pain delegates 5-minute vital sign assessments to nursing assistive personnel (NAP). The charge nurse intervenes and changes the assignment. Which right of delegation does the charge nurse following in this situation? 1- Right direction. 2- Right communication. 3- Right circumstance. 4- Right supervision.

3

The nurse provides care for a client with a small bowel obstruction and stage 4 stomach cancer. The client verbalizes an interest in palliative care and the spouse does not agree. Which statement by the nurse to the client is appropriate? 1- "We need to insert a nasogastric tube." 2- "Would you two like to speak in private?" 3- "What are your treatment goals?" 4- "I know this process is very stressful."

3

The nurse provides care to a client who is unconscious. In which position will the nurse place the client to provide oral care? 1- Dorsal recumbent. 2- Orthopneic. 3- Side-lying. 4- High Fowler.

3

The nurse teaches the client diagnosed with anal-rectal cancer about the side effects of external radiation therapy. Which side effect is most important for the nurse to include in this teaching plan? 1- Alopecia occurrence is reduced by the use of a cooling cap during therapy. 2- Stomatitis is prevented by using salt and soda mouth rinses after meals. 3- Fatigue is managed by incorporating frequent rest periods during activity. 4- Thrombocytopenia can be treated with platelet infusions for bleeding

3

The nurse teaches the parent of a child diagnosed with celiac disease. Which statement does the nurse identify as an indication that the parent understands the teaching? 1- "I will give my child barley soup for lunch." 2- "I will make my child sandwiches on rye bread." 3- "I will make my child popcorn as a snack." 4- "I will give my child oatmeal for breakfast."

3

The parent of a 22-month-old toddler plans to begin toilet training the child. Which is the most important factor for the nurse to stress to the mother? 1- Consistency in method. 2- Maintain a positive attitude. 3- Developmental readiness of the child. 4- Avoid comparing the child to peers.

3

A client reports having difficulty falling asleep at night. With which statement will the nurse respond to this client? (Select all that apply.) 1- "Exercising immediately before bed will reduce stress." 2- "Reading or watching television in bed will help you relax." 3- "Eating a heavy meal before bedtime can interfere with sleep." 4- "Maintaining a regular sleep/wake schedule promotes sleep." 5- "Napping during the day can interfere with sleep at night."

3,4,5

The charge nurse supervises the care of several clients. Which situation requires immediate intervention by the charge nurse? 1- A nurse puts on an isolation gown and gloves before entering the room of a client with localized herpes zoster. 2- An LPN/LVN gathers all necessary supplies before entering the room of a client needing a sterile dressing change. 3- A nurse talks with family about a client's condition after receiving the client's permission. 4- A nursing assistive personnel (NAP) changes the linens on a client's bed while the client with Meniere disease ambulates in the hall.

4

The nurse instructs a client receiving intramuscular cyanocobalamin injections. Which client statement indicates that teaching is effective? 1- "I should limit eating egg yolks and red meat." 2- "I should avoid eating organ meats and shellfish." 3- "This medication does not interact with any other medications." 4- "I should not drink any alcohol while receiving these injections."

4

The nurse observes a student nurse perform closed urinary catheter irrigation on a client with decreased urinary output. Which observation indicates that the student requires additional teaching to perform the procedure correctly? 1-Clamps the urinary drainage tubing below the irrigation port. 2-Draws up 50 mL of sterile saline into a syringe. 3-Cleanses the irrigation port with alcohol. 4-Quickly instills the sterile saline.

4

The nurse provides care for a client diagnosed with systemic lupus erythematosus (SLE). Which finding will the nurse find most concerning? 1- Pallor observed on fingers of the right hand. 2- Blood pressure reading of 152/90 mm Hg. 3- Pain reported as severe in the left knee and ankle. 4- Blood urea nitrogen (BUN) level of 40 mg/dL.

4

The nurse provides care for a client dying from cervical cancer. The client states that the pain is "excruciating." Which is the best strategy for the nurse to add to the client's plan of care?" 1- Administer increased opioids as needed. 2- Dim the lights and perform guided imagery. 3- Use distraction such as music and crossword puzzles. 4- Obtain a prescription to deliver analgesics on a schedule.

4

The nurse provides care for a client experiencing a sickle cell crisis. Which nursing diagnosis is the priority for the nurse to include in the plan of care? 1- Risk for infection. 2- Risk for ineffective cerebral tissue perfusion. 3- Activity intolerance. 4- Ineffective peripheral tissue perfusion.

4

The nurse provides care for a client who requests testing for human immunodeficiency virus infection (HIV). Which intervention is most important for the nurse to perform before administering testing? 1- Discuss prevention practices to prevent the transmission of HIV to others. 2- Explain that all tests must be repeated twice to be valid. 3- Ask the client to identify all sexual partners. 4- Determine when the client thinks the exposure to HIV occurred.

4

The nurse tells a client that an influenza vaccine will fully protect the client against getting the flu this year. The nurse is aware that the vaccine only protects against certain strains of the flu. Which ethical principle has the nurse most clearly violated? 1- Justice. 2- Nonmaleficence. 3- Beneficence. 4- Veracity.

4

The nurse provides care for a client who reports severe right shoulder pain. Which abdominal organ should the nurse suspect is causing this client's discomfort? 1- Spleen. 2- Pancreas. 3- Stomach. 4- Gall bladder.

4)R shoulder pain is referred from gall bladder --L shoulder pain is referred from spleen (1) and pancreas (2) ?? Substernal pain is referred form stomach (3)