Abdomen and GU

T or F: The urine osmolality is greater than 500 mOsm/L in patients with postrenal ARF.

False

23. The patient is diagnosed with ARF. Which of the following conditions is the most common cause? a. Renal calculi b. Acute tubular necrosis c. Cardiac failure d. Acute glomerulonephritis

b. Acute tubular necrosis

6.The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this? a. As an attempt to get the nurses attention b. As asterixis c. As an indication of respiratory obstruction from varices d. As spasticity

b. As asterixis Asterixis is the flapping tremor seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy.

26. Which of the following examination findings should be expected in a patient with chronic renal failure (CRF)? a. Weak, thready pulse b. Auscultatory crackles c. Hypotension d. Pleural friction rub

b. Auscultatory crackles

4.The patient, age 43, has cancer of the urinary bladder. He has received a cystectomy with an ileal conduit. Which characteristics would be considered normal for his urine? a. Hematuria b. Clear amber with mucus shreds c. Dark bile-colored d. Dark amber

b. Clear amber with mucus shreds

20. Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer? a. Kidneys, ureter, bladder x-ray b. Cystoscopy with biopsy c. Magnetic resonance imaging d. Urine tumor marker (NMP22)

b. Cystoscopy with biopsy

2.The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit? a. Jaundice b. Edema c. Copious urine output d. Pallor

b. Edema Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema.

A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings? a. Decreased alanine aminotransferase and decreased aspartate aminotransferase b. Elevated alkaline phosphatase c. Elevated indirect bilirubin d. Decreased white blood cells

b. Elevated alkaline phosphatase

3.A patient with cystitis is receiving phenazopyridine (Pyridium) for pain and is voiding a bright red- orange urine. What should the nurse do? a. Report this immediately b. Explain to the patient that this is normal c. Increase fluid intake d. Collect a specimen

b. Explain to the patient that this is normal

8.Why are pediatric patients, especially girls, susceptible to urinary tract infections? a. Genetically females have a weaker immune system b. Females have a short and proximal urethra in relation to the vagina c. Girls are more sexually active than males d. Girls have a weakened musculature and sphincter tone

b. Females have a short and proximal urethra in relation to the vagina

14. A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be managed? a. 3-day course of oral antibiotics b. Hospitalization c. Encourage cranberry juice intake. d. 6-week course of antibiotics

b. Hospitalization

3.Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy? a. Assisting to ambulate for the bathroom b. Keeping the patient on the right side for a minimum of 2 hours c. Taking vital signs every 4 hours d. Keeping the patient on the left side for a minimum of 4 hours

b. Keeping the patient on the right side for a minimum of 2 hours Keep the patient lying on the right side for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours.

18. A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer the patient to a nephrologist for which of these treatments? a. Chemotherapy b. Nephrectomy c. Palliative treatment d. Radiation

b. Nephrectomy

4.Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect? a. Peritonitis b. Pneumothorax c. Hemorrhage of the liver d. Pleural effusion

b. Pneumothorax

2. The result of the patient's 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions? a. Repeat the test. b. Refer to a nephrologist. c. Measure the serum protein. d. Obtain a blood urea nitrogen (BUN) and creatinine.

b. Refer to a nephrologist.

A 46-year-old patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient? a. CBC with differential b. Urine human chorionic gonadotropin c. Barium enema d. Computed tomography of the abdomen

b. Urine human chorionic gonadotropin

The patient with GERD should be instructed to eliminate which of these activities? a. Swimming b. Weight lifting c. Golfing d. Walking

b. Weight lifting

1.The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is: a. stored in the gallbladder to make bile. b. water insoluble bilirubin that must be converted by the liver. c. a by-product which is excreted directly into the bowel for excretion. d. necessary for digestion of fats.

b. water insoluble bilirubin that must be converted by the liver. Unconjugated bilirubin is a water-insoluble product that must be converted in the liver to conjugated bilirubin (water soluble) so that it may be excreted through the bowel.

21. A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means. Which is the best response? a. "There is no such thing as Stage D cancer." b. "You have cancer that has spread to the surrounding tissue." c. "Your cancer has spread to other organs." d. "Your cancer can be cured by removing your bladder."

c. "Your cancer has spread to other organs."

28. Which of the following foods should be limited in a patient with CRF? a. Milk b. Bananas c. Soy sauce d. All of the above

d. All of the above

3. A patient is seen with complaints of diarrhea. Which of the following should be included in the patient's differential diagnosis? a. Gastroenteritis b. Inflammatory bowel disease c. Lactase deficiency d. All of the above

d. All of the above

8. Which of the following information is essential before prescribing Bactrim DS to a 24-year-old woman with a UTI? a. Last menstrual period b. Method of birth control c. Last unprotected sexual contact d. All of the above

d. All of the above

A 28-year-old patient is seen with complaints of diarrhea. Which of the following responses to the history questions would help the primary care physician (PCP) establish the diagnosis of irritable bowel syndrome? a. Feels relief after a bowel movement b. Sometimes is constipated c. Does not defecate in the middle of the night d. All of the above

d. All of the above

A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis? a. Endometriosis b. Colon cancer c. Diverticulitis d. All of the above

d. All of the above

A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett's epithelium. Which of the following should the PCP include in the explanation of the pathology report? a. This is a premalignant tissue. b. This tissue is resistant to gastric acid. c. This tissue supports healing of the esophagus. d. All of the above

d. All of the above

The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion? a. Use of NSAIDs b. Cigarette smoker c. Ethanol consumption d. All of the above

d. All of the above

5.A patient, age 78, has been admitted to the hospital with dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. Which nursing intervention does the nurse include in developing a plan of care? a. Restrict fluids after the evening meal b. Insert an indwelling catheter c. Assist the patient to the bathroom every 2 hours d. Apply absorbent incontinence pads

d. Apply absorbent incontinence pads

6.The home health nurse suggests the use of complementary and alternative therapies to prevent and/or treat urinary tract infections (UTIs). Which of the following is an example of such therapies? a. Grape juice b. Caffeine c. Tea d. Cranberry juice

d. Cranberry juice

7.Which action can reduce the risk of skin impairment secondary to urinary incontinence? a. Decreasing fluid intake b. Catheterization of the elderly patient c. Limiting the use of medication (diuretics, etc.) d. Frequent toileting and meticulous skin care

d. Frequent toileting and meticulous skin care

8.The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug: a. increases the rate of the regeneration of liver cells. b. can overcome complications presented by hepatitis C. c. increases blood supply to transplant. d. does not suppress bone marrow.

d. does not suppress bone marrow.

5.The nurse is planning care for a client diagnosed with an acute abdomen. Which of the following nursing diagnoses would be appropriate for this client? (Select all that apply.) 1.Fear 2.Deficient fluid volume 3.Ineffective coping 4.Acute pain 5.Risk of infection 6.Altered self-perception

1.Fear 2.Deficient fluid volume 4.Acute pain 5.Risk of infection

1.The nurse is instructing a client about symptoms associated with peptic ulcer disease. Which of the following should be included in these instructions? (Select all that apply.) 1.Abdominal pain 2.Pain in the middle of the night 3.Weight loss 4.Poor appetite 5.Bloating 6.Constipation

1.Abdominal pain 2.Pain in the middle of the night 3.Weight loss 4.Poor appetite 5.Bloating

9.A client is diagnosed with burning mouth syndrome. Which of the following interventions should be included in this clients plan of care? 1.Assess the condition of the clients teeth. 2.Collect a saliva specimen for analysis. 3.Tell the client to avoid vitamin supplements. 4.Teach the client how to conduct an oral self-assessment daily.

1.Assess the condition of the clients teeth.

4.The nurse is providing dietary instruction to a client diagnosed with Wilsons disease. Which of the following should be included in these instructions? (Select all that apply.) 1.Avoid liver. 2.Avoid shellfish. 3.Eat soy products. 4.Use avocados in salads. 5.Avoid nectarines. 6.Avoid mushrooms.

1.Avoid liver. 2.Avoid shellfish. 5.Avoid nectarines. 6.Avoid mushrooms.

13.A client is hospitalized with kidney trauma resulting in lacerations to the parenchyma. Which of the following would be included in the management of this clients care? 1.Bed rest with antibiotic therapy 2.Restrict fluids 3.Encourage early ambulation 4.Nephrectomy

1.Bed rest with antibiotic therapy

10.The nurse is assessing a client diagnosed with glomerulonephritis. Which of the following findings is consistent with this disorder? 1.Brown urine 2.Hip pain 3.Hypotension 4.Bradycardia

1.Brown urine

3.The nurse is instructing a client on conducting an oral self-assessment. Which of the following should be included in the nurses instructions? (Select all that apply.) 1.Check the face for symmetry. 2.Check skin on the face for changes. 3.Check the neck for swellings or lumps. 4.Check inside of cheeks for tenderness. 5.Check the tongue for changes. 6.Check urine for change in color.

1.Check the face for symmetry. 2.Check skin on the face for changes. 3.Check the neck for swellings or lumps. 4.Check inside of cheeks for tenderness. 5.Check the tongue for changes.

14.The nurse is reviewing a clients risk factors for the development of renal cancer. Which of the following would be considered a risk factor for the development of this disease? 1.Cigarette smoking 2.Being underweight 3.History of hypotension 4.History of type 2 diabetes mellitus

1.Cigarette smoking

1.A client is being evaluated for a lower urinary tract infection. Which of the following symptoms would the nurse expect to find? 1.Cloudy urine 2.Flank pain 3.Nausea 4.Temperature 102.9F

1.Cloudy urine Symptoms of a lower urinary tract infection include dysuria, frequency, urgency, hesitancy, cloudy urine, lower abdominal pain, chills, malaise, and mild fever (less than 101F). The other options are symptoms of upper urinary tract infection.

2.The nurse is assessing a client diagnosed with diverticulitis. Which of the following are clinical manifestations associated with this disorder? (Select all that apply.) 1.Constipation or diarrhea 2.Left lower quadrant abdominal pain 3.Low-grade fever 4.Increased excitability 5.Changes in level of consciousness 6.Thirst

1.Constipation or diarrhea 2.Left lower quadrant abdominal pain 3.Low-grade fever In diverticulitis, there may be a chronic asymptomatic condition two-thirds of the time. If there are manifestations, they would likely be constipation or diarrhea, lower abdominal pain in the left lower quadrant, and low-grade fever. Increased excitability, changes in level of consciousness, and thirst are not clinical manifestations of diverticulitis.

4.A client is diagnosed with renal vein thrombosis. The nurse realizes that which of the following could be indicated in this clients plan of care? (Select all that apply.) 1.Corticosteroids 2.Nephrectomy 3.Anticoagulants 4.Antihypertensives 5.Surgical intervention 6. Antibiotics

1.Corticosteroids 3.Anticoagulants 5.Surgical intervention

5.A client with a urinary tract infection is being discharged with a prescription for ciprofloxacin. The nurse should include which of the following discharge instructions? 1.Do not take within 2 hours of antacid use. 2.Limit fluids. 3.Restrict activity 4.Expect to be nauseated with this medication.

1.Do not take within 2 hours of antacid use.

1.The nurse is instructing a client on ways to prevent urinary tract infections. Which of the following should be included in these instructions? (Select all that apply.) 1.Drink cranberry juice. 2.Drink eight glasses of water. 3.Take baths instead of showers. 4.Urinate before and after intercourse. 5.In women, wipe back to front after voiding. 6.Take the prescribed medication until the symptoms subside

1.Drink cranberry juice. 2.Drink eight glasses of water. 4.Urinate before and after intercourse.

3.The nurse is instructing a client on ways to reduce formation of future kidney stones. Which of the following should be included in these instructions? (Select all that apply.) 1.Drink plenty of fluids. 2.Drink soft drinks. 3.Limit the intake of spinach. 4.Take a vitamin B-12 supplement or eat foods rich in vitamin B-12. 5.Take a magnesium citrate supplement or eating foods rich in magnesium citrate. 6.Adjust calcium intake.

1.Drink plenty of fluids. 3.Limit the intake of spinach. 5.Take a magnesium citrate supplement or eating foods rich in magnesium citrate. 6.Adjust calcium intake.

2.The nurse is planning care for a client diagnosed with oral ulcers. Which of the following should be included in this clients plan of care? (Select all that apply.) 1.Encourage frequent oral hygiene. 2.Rinse mouth with chlorhexidine. 3.Increase consumption of hot fluids. 4.Instruct in the use of topical corticosteroids. 5.Encourage the client to limit smoking. 6.Avoid the use of dental floss.

1.Encourage frequent oral hygiene. 2.Rinse mouth with chlorhexidine. 4.Instruct in the use of topical corticosteroids.

6.A client is diagnosed with portal hypertension. The nurse should assess the client for which of the following disorders associated with this diagnosis? (Select all that apply.) 1.Esophageal varices 2.Splenomegaly 3.Hemorrhoids 4.Caput medusae 5.Gastritis 6.Gallstone formation

1.Esophageal varices 2.Splenomegaly 3.Hemorrhoids 4.Caput medusae

1.A client diagnosed with cirrhosis is experiencing the complication of ascites. Which of the following would be considered treatment for this complication? (Select all that apply.) 1.Fluid restriction 2.Low-sodium diet 3.Increased exercise 4.Diuretic therapy 5.Pain medication 6.Bed rest

1.Fluid restriction 2.Low-sodium diet 4.Diuretic therapy

1.A child care worker complains of flu-like symptoms. On further assessment, hepatitis is suspected. The nurse realizes that this individual is at risk for which type of hepatitis? 1.Hepatitis A 2.Hepatitis B 3.Hepatitis C 4.Hepatitis D

1.Hepatitis A Hepatitis A virus (HAV) is spread through the fecal-oral route. Child care workers are at greater risk because of potentially poor hygiene practices. Child care workers are not at the same risk for contracting hepatitis B, C, or D.

3.A client is demonstrating yellow pigmentation of the skin and sclera. Which of the following can be used to describe this clients symptoms? (Select all that apply.) 1.Jaundice 2.Dyspepsia 3.Icterus 4.Sclerosis 5.Kernicterus 6.Cirrhosis

1.Jaundice 3.Icterus 5.Kernicterus

7.The nurse is caring for a client diagnosed with irritable bowel syndrome (IBS) who is experiencing diarrhea. What medication would the nurse expect to administer? 1.Loperamide (Imodium) 2.Docusate sodium (Colace) 3.Lorazepam (Ativan) 4.Haloperidol (Haldol)

1.Loperamide (Imodium) Antidiarrheal agents like Imodium can be given prophylactically or symptomatically on an as- needed basis. Docusate sodium (Colace), lorazepam (Ativan), and haloperidon (Haldol) are not indicated to treat this disorder.

5.A client is diagnosed with a disorder of the liver. The nurse realizes this client might experience which of the following? (Select all that apply.) 1.Low vitamin A levels 2.Increased bleeding 3.Poor digestion of fats 4.Insulin resistance 5.Elevated levels of vitamin E 6.Nerve damage

1.Low vitamin A levels 2.Increased bleeding 3.Poor digestion of fats 4.Insulin resistance 6.Nerve damage

4.A client, diagnosed with a vitamin B-12 deficiency, tells the nurse that she does not want to receive injections every month to treat the disorder. Which of the following should the nurse instruct the client regarding the effects of vitamin B-12 deficiency? (Select all that apply.) 1.Paresthesias in the hands 2.Paresthesias in the feet 3.Ataxia 4.Spinal cord degeneration 5.Loss of memory 6.Loss of the sense of smell

1.Paresthesias in the hands 2.Paresthesias in the feet 3.Ataxia 4.Spinal cord degeneration

2.A client is recovering from an endoscopic retrograde cholangiopancreatogram (ERCP). Which of the following should the nurse assess as possible complications from this procedure? (Select all that apply.) 1.Perforation of the stomach 2.Perforated duodenum 3.Pancreatitis 4.Aspiration of gastric contents 5.Anaphylactic reaction to the contrast dye 6.Perforated bladder

1.Perforation of the stomach 2.Perforated duodenum 3.Pancreatitis 4.Aspiration of gastric contents 5.Anaphylactic reaction to the contrast dye

8.A client who usually smokes a pack of cigarettes a day tells the nurse that he cannot stand the smell of smoke. The nurse realizes that this client is in which phase of hepatitis? 1.Preicteric 2.Icteric 3.Posticteric 4.Recovery

1.Preicteric In the preicteric phase of hepatitis, some smokers will have an aversion to smoking as a first sign of the disease. Smoking is not affected with the icteric or posticteric phases of the disease. Recovery is not a phase of hepatitis.

3.The nurse is assessing a client diagnosed with irritable bowel syndrome (IBS). Which of the following characteristics are associated with this disorder? (Select all that apply.) 1.Recurrent abdominal pain 2.Abdominal pain that improves with defecation 3.Pain associated with a change in stool frequency 4.Pain associated with a change in stool appearance 5.Pain that occurs only during defecation 6.Pain associated with passing flatus

1.Recurrent abdominal pain 2.Abdominal pain that improves with defecation 3.Pain associated with a change in stool frequency 4.Pain associated with a change in stool appearance

5.The nurse is assessing a client for type of urinary incontinence. Which of the following are considered types of this disorder? (Select all that apply.) 1.Stress 2.Radical 3.Urge 4.Temporary 5.Overflow 6.Functional

1.Stress 3.Urge 5.Overflow 6.Functional

4.The nurse is assisting a client with indirect techniques to improve swallowing. Which of the following are techniques included in the nurses assistance? (Select all that apply.) 1.Tongue mobility exercises 2.Application of ice 3.Repetitive head lift exercises 4.Positioning 5.Range-of-motion exercises for the neck 6.Range-of-motion exercises for the shoulders

1.Tongue mobility exercises 2.Application of ice 3.Repetitive head lift exercises

5.A client is diagnosed with esophageal pain. Which of the following medications would be indicated for this client? (Select all that apply.) 1.Vasodilators 2.Calcium channel blockers 3.Isosorbide dinitrate 4.Antibiotics 5.Antipyretics 6.Antihistamines

1.Vasodilators 2.Calcium channel blockers 3.Isosorbide dinitrate

10.A young client is experiencing acute abdominal pain. The nurse realizes that the most common cause for this type of pain would be: 1.appendicitis. 2.biliary tract disease. 3.kidney stones. 4.urinary tract infection.

1.appendicitis. The most common cause of acute abdominal pain is appendicitis. Biliary tract disease is the most common disorder in the elderly, causing pain in the right upper quadrant. Kidney stones and urinary tract infections do not necessarily cause abdominal pain.

12.A client is surprised to learn that his acute pain is caused by a kidney stone. The nurse should instruct the client that the most common type of renal calculi is composed of: 1.calcium. 2.cystine. 3.struvite. 4.uric acid.

1.calcium.

5.A client is being evaluated for symptoms associated with diverticular disease. The nurse realizes that the best diagnostic test to be used to aid in this diagnosis would be: 1.computed tomography (CT) scan. 2.barium enema. 3.ultrasound. 4.x-ray study.

1.computed tomography (CT) scan. A CT scan is the best method of detecting abscesses and complications evidenced in diverticulitis. Barium enema is contraindicated in acute diverticulitis because of the risk of contamination if there is an existing perforation. An ultrasound or x-rays would not adequately diagnose the presence of the disorder.

12.A client has been prescribed Zantac for gastroesophageal reflux disease. The nurse realizes this medication is classified as a: 1.histamine H2-receptor antagonist. 2.proton pump inhibitor. 3.prokinetic agent. 4.antihistamine.

1.histamine H2-receptor antagonist.

11.A client experiencing abdominal pain and diarrhea tells the nurse that he used to smoke. Which of the following gastrointestinal disturbances is this client most likely experiencing? 1.Irritable bowel syndrome 2.Crohns disease 3.Acute appendicitis 4.Small bowel obstruction

2. Crohns Current and former smokers appear to have a greater risk of developing Crohns disease than nonsmokers. Not smoking will not cause irritable bowel syndrome, acute appendicitis, or small bowel obstruction.

8.A client complains of acute gastrointestinal distress. While obtaining a health history, the nurse asks about the family history. Which disorder has a familial basis? 1.Hepatitis 2.Ulcerative colitis 3.Appendicitis 4.Bowel obstructions

2. Ulcerative colitis Genetic factors have been identified as susceptibility factors for the development of ulcerative colitis. None of the other choices have a genetic predisposition for developing the disorder.

14.The nurse is instructing a client on diagnostic tests used to screen for colorectal cancer. Which of the following should be included in these instructions? 1.A digital rectal exam should be done annually. 2.A test for fecal occult blood should be done annually. 3.A flexible sigmoidoscopy should be done annually. 4.A colonoscopy should be done every 5 years after age 40.

2.A test for fecal occult blood should be done annually. The nurse should instruct the client to have a fecal occult blood test done annually. A digital rectal exam is not a recommendation for this disease process. A flexible sigmoidoscopy should be done every 5 years after age 50. A colonoscopy should be done every 10 years after age 50.

12.A client is diagnosed with macrovesicular fatty liver. Which of the following should the nurse instruct this client? 1.Expect to develop jaundice. 2.Avoid all alcohol. 3.Increase exercise. 4.Treatment includes antibiotic therapy.

2.Avoid all alcohol.

6.An elderly client has noted blood in her stool for the past few months. Which information in the medical history would strongly suggest colorectal cancer? 1.Increased bouts of vomiting 2.Change in bowel habits 3.Recent infection in the blood 4.Decrease in appetite

2.Change in bowel habits Change in bowel habits is one of the seven danger signals for cancer. Changes in bowel habits and blood in the stool are common signs of colorectal cancer. Vomiting, decreased appetite, or recent blood infection could be symptoms of other health problems, but they are not necessarily colorectal cancer.

2.A client is diagnosed with an upper urinary tract infection. Which structures are affected by this infection? (Select all that apply.) 1.Bladder 2.Kidney 3.Prostate 4.Ureters 5.Urethra 6.Rectum

2.Kidney 4.Ureters

1.Laparoscopic surgery is scheduled for a client diagnosed with appendicitis. Which of the following may be a result of laparoscopic surgery? (Select all that apply.) 1.No risk of infection 2.Less pain 3.Faster recovery times 4.Maybe more complications 5.Shorter hospital stays 6.Better visualization of the abdominal organs

2.Less pain 3.Faster recovery times 5.Shorter hospital stays

11.A client is diagnosed with nephrotic syndrome. Which of the following is the nurse most likely going to assess in this client? 1.Glucosuria 2.Proteinuria 3.Hematuria 4.Oliguria

2.Proteinuria

10.During an assessment, the nurse learns that a client is inhaling while swallowing food. Which of the following does this assessment finding suggest to the nurse? 1.The client is recovering from a stroke. 2.The client is at risk for aspiration. 3.The client will experience dyspepsia. 4.The client has esophageal reflux disease.

2.The client is at risk for aspiration.

13.A client is diagnosed with peptic ulcer disease caused by NSAID use. Which of the following would be indicated for this client? 1.Antibiotic therapy 2.Treatment similar to a client with peptic ulcer disease 3.Preparation for surgery 4.Insertion of a nasogastric tube for gastric lavage

2.Treatment similar to a client with peptic ulcer disease

11.A client is experiencing brash water. The nurse realizes this symptom is associated with: 1.oral cancer. 2.gastric ulcers. 3.dysphagia. 4.Barretts esophagus.

4.Barretts esophagus. Brash water, or the sensation of the mouth filling with saliva because of acid backflow into the esophagus, is a symptom of Barretts esophagus. Brash water is not associated with oral cancer, gastric ulcers, or dysphagia.

6.A school age child is placed on a waiting list for a liver transplant. The nurse knows that the most common reason for children to need this type of transplant is because of: 1.cirrhosis due to hepatitis C. 2.biliary atresia. 3.diabetes. 4.Crohns disease.

2.biliary atresia. Biliary atresia is the most common reason for children to have a liver transplant. Cirrhosis due to hepatitis C is the reason for most adults to have a transplant. Children do not typically need a liver transplant for diabetes or Crohns disease.

4.A client is scheduled for a liver biopsy. The nurse realizes that the most important sign to assess for is: 1.infection. 2.bleeding. 3.pain. 4.nausea and vomiting.

2.bleeding.

9.A client diagnosed with appendicitis asks the nurse why this illness occurred. The nurse should respond that the most common cause of appendicitis is: 1.ulcerative colitis. 2.obstruction of the appendix. 3.low-fat diet. 4.infection.

2.obstruction of the appendix. An infection may occur with appendicitis, but the most common cause of infection is an obstruction of the appendix. The obstruction could be caused by lymph tissue, a fecalith, a foreign body, or worms. Ulcerative colitis, low-fat diet, or infection does not cause appendicitis.

3.During an assessment, the nurse determines a client is at risk for ulcerative stomatitis and gum disease because the client has a history of: 1.alcohol intake. 2.smoking. 3.kissing. 4.eating.

2.smoking.

1.Before administering an antacid, the nurse should instruct a client that this medication works in the: 1.blood. 2.stomach. 3.small intestine. 4.esophagus.

2.stomach. Antacids work in the stomach to neutralize stomach acids. They do not work in the esophagus or small intestines. Antacids do not work in the blood.

3.A client is diagnosed with appendicitis. One of the laboratory tests the nurse would expect to monitor would be: 1.serum sodium. 2.white blood cell (WBC) count. 3.hemoglobin (Hgb) and hematocrit (Hct). 4.bilirubin level.

2.white blood cell (WBC) count. Infection often accompanies the inflammation of the appendix. The nurse would be looking for an elevated WBC count. Serum sodium, hemoglobin, hematocrit, and bilirubin levels are not necessarily indicated in the care of a client diagnosed with appendicitis.

8.The nurse is instructing a client diagnosed with a hiatal hernia on ways to reduce the symptoms. Which of the following should be included in these instructions? 1.Eat large meals to keep the stomach full. 2.Drink lots of liquids so that the stomach does not have to work so hard. 3.Avoid lying down after meals. 4.Lie down after eating.

3.Avoid lying down after meals.

9.A female client is surprised to learn that she has been diagnosed with hemochromatosis. Which of the following should the nurse respond to this client? 1.It doesnt affect people until they are in their 50s. 2.I would ask the doctor if hes sure about the diagnosis. 3.Females often do not experience the effects of the disease until menopause. 4.All women have the disorder but not the symptoms.

3.Females often do not experience the effects of the disease until menopause.

4.A client is diagnosed with a swallowing disorder. The nurse realizes that which type of diet would be indicated for this client? ? 1.Regular diet 2.Clear liquid diet 3.Mechanical soft diet 4.Low-fat diet

3.Mechanical soft diet

7.A client is being treated for interstitial cystitis. Which of the following medications would not be prescribed for this client? 1.Cortisone acetate (Cortone) 2.Dimethyl sulfoxide (DMSO) 3.Pimecrolimus (Elidel) 4.Polysulfate sodium (Elmiron)

3.Pimecrolimus (Elidel)

2.The nurse is assessing a client diagnosed with gastroesophageal reflux disease. Which of the following should be included in this assessment? 1.Degree of mouth burning 2.Difficulty swallowing 3.Presence of pyrosis 4.Painful swallowing

3.Presence of pyrosis Mouth burning is not a symptom of gastroesophageal reflux disease. Difficulty swallowing or dysphagia is not associated with gastroesophageal reflux disease. Pain when swallowing is associated with esophagitis, not acid reflux disease. Presence of pyrosis or heartburn should be assessed in this client.

11.The nurse, caring for a client recovering from the placement of a shunt to treat portal hypertension, should assess the client for which of the following complications associated with this surgery? 1.Myocardial infarction 2.Pulmonary emboli 3.Pulmonary edema 4.Decreased peripheral pulses

3.Pulmonary edema Complications after shunt surgery include the development of pulmonary edema. Myocardial infarction, pulmonary emboli, and decreased peripheral pulses are not complications associated with this type of surgery.

9.The nurse is reviewing the health history of a client diagnosed with glomerulonephritis. Which of the medical conditions would be a risk factor for developing glomerulonephritis? 1.Asthma 2.Hypertension 3.Recent strep throat 4.Renal failure

3.Recent strep throat

6.A client is scheduled for diagnostic tests to determine the ability to swallow. Which of the following diagnostic tests will provide the best information regarding this clients status? 1.Pulse oximetry with water 2.Esophageal transit scintigraphy 3.Videofluoroscopy 4.Esophageal manometry

3.Videofluoroscopy

7.Because health care workers are at a greater risk of hepatitis B infection, it is recommended that all health care workers: 1.wash their hands often. 2.avoid foreign travel. 3.become vaccinated. 4.drink bottled water only.

3.become vaccinated.

2.An older male is diagnosed with cirrhosis of the liver. The nurse knows that the most likely cause of this problem is: 1.being in the military. 2.traveling to a foreign country. 3.drinking excessive alcohol. 4.eating bad food.

3.drinking excessive alcohol.

3.When the liver is seriously damaged, ammonia levels can rise in the body. One of the treatments for this is: 1.administering intravenous (IV) neomycin. 2.giving vitamin K. 3.giving lactulose. 4.starting the patient on insulin.

3.giving lactulose. Lactulose is a laxative that works by pulling water into the stool. It also helps pull ammonia from the blood into the colon for expulsion. IV antibiotics do not reduce serum ammonia levels. Vitamin K controls bleeding, but it does not reduce ammonia levels. Insulin is not used to reduce ammonia levels.

5.The nurse realizes that the organ which is a major site for metastases, harboring and growing cancerous cells that originated in some other part of the body, is the: 1.spleen. 2.gallbladder. 3.liver. 4.stomach.

3.liver. In most developed countries, this secondary type of liver cancer is more common than cancer that originates in the liver itself. The spleen, gallbladder, and stomach are not major sites for metastases.

4.When assessing the pain in a client diagnosed with appendicitis, the nurse would expect to assess: 1.extreme pain with slight palpation anywhere on the abdomen. 2.pain in the upper back when the right lower quadrant is palpated. 3.more pain when the pressure is released in the right lower quadrant. 4.no pain when the abdomen is palpated.

3.more pain when the pressure is released in the right lower quadrant. Typically rebound pain is associated with appendicitis. Rebound pain is described as more pain when pressure is released than when pressure is applied. Appendicitis pain is not associated with pain anywhere on the abdomen upon slight palpation. Appendicitis pain is not typically assessed in the upper back. Appendicitis is associated with pain.

15.A client is scheduled for surgery to remove the bladder and create a urinary diversion. If the client has a history of complications after surgery, the type of urinary diversion that might be indicated would be: 1.continent diversion with a surgical opening to the abdomen. 2.continent diversion with a replacement bladder made out of intestine. 3.noncontinent diversion with anastomose of the ureters to the anterior wall. 4.noncontinent diversion with anastomose of the ureters to the rectum.

3.noncontinent diversion with anastomose of the ureters to the anterior wall. Noncontinent urinary diversions are considered less technically demanding and are associated with the fewest postoperative complications. This type of diversion is performed by anastomosing the ureters to the anterior body wall. The rectum is not used as a site to anastomose the ureters. Continent diversions have more postoperative complications.

3.A nurse is collecting a post-void residual urine volume for a client. Which of the following volumes would be abnormal? 1.30 mL 2.60 mL 3.95 mL 4. 125mL

4. 125mL A residual volume of greater than 100 mL is abnormal. The other volumes would be considered within normal limits.

13.The nurse assesses no bowel sounds with occasional splashing sounds over the large intestines. Which of the following do these assessment findings suggest to the nurse? 1.Ulcerative colitis 2.Irritable bowel syndrome 3.Appendicitis 4.Bowel obstruction

4.Bowel obstruction Obstruction can be detected with absent bowel sounds and borborygmi or a splashing sound heard over the large intestine. Absent bowel sounds and borborygmi are not associated with ulcerative colitis, irritable bowel syndrome, or appendicitis.

2.An elderly client is diagnosed with a urinary tract infection. Which of the following will the nurse most likely assess in this client? 1.Jaundice 2.Vomiting 3.Poor eating habits 4.Change in mental status

4.Change in mental status

7.A client, diagnosed with a hiatal hernia, will experience which of the following symptoms most frequently? 1.Nausea 2.Vomiting 3.Diarrhea 4.Heartburn

4.Heartburn With a hiatal hernia, stomach acids reflux into the esophagus, causing pain and irritation that the patient will associate with heartburn. Nausea, vomiting, and diarrhea are not symptoms typically associated with a hiatal hernia.

10.A client is diagnosed with liver disease. Which of the following is one impact of this disorder on a clients fluid and electrolyte status? 1.Hyperkalemia 2.Hypercalcemia 3.Hypernatremia 4.Hyponatremia

4.Hyponatremia Liver disease effects the fluid and electrolyte status by causing ascites, edema, hypokalemia, hypocalcemia, and hyponatremia. Liver disease does not cause hyperkalemia, hypercalcemia, or hypernatremia.

6.A client is recovering from a cystoscopy. The nurse would expect to assess which of the following regarding the clients urine after the procedure? 1.Anuria 2.Blood clots 3.Hematuria 4.Pink-tinged

4.Pink-tinged

8.After being diagnosed, a client asks the nurse What is pyelonephritis? The nurse should respond: 1.Pyelonephritis is an infection of the bladder. 2.Pyelonephritis is an infection of the urethra. 3.Pyelonephritis is an infection of the prostate. 4.Pyelonephritis is a common infection that needs to be treated to prevent complications.

4.Pyelonephritis is a common infection that needs to be treated to prevent complications.

In caring for a client diagnosed with a small bowel obstruction, what would the nurse expect to do first? 1.Prepare to put in a nasogastric (NG) tube. 2.Give pain medication. 3.Draw lab work. 4.Start an intravenous (IV) line.

4.Start an intravenous (IV) line. Starting an IV to give fluids and electrolytes would be the first step in caring for this client. Although an NG tube will be ordered, fluid balance is more important. Administering pain medication may make the problem worse. Drawing lab work would not be the first intervention needed for this client.

4.A client is prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. Which of the following instructions would not be appropriate for this medication? 1.Complete all the medication even if you feel better. 2.Drink extra water during the day. 3.Take on an empty stomach with water. 4.Take with an antacid.

4.Take with an antacid.

5.To support the nutritional needs of a client with dysphagia, the nurse realizes that all of the following are mechanisms to provide enteral feeding EXCEPT: 1.nasogastric tube. 2.percutaneous endoscopic gastrostomy (PEG) tube. 3.jejunostomy tube. 4.hyperalimentation.

4.hyperalimentation. Hyperalimentation is associated with parenteral nutrition, not enteral nutrition. The others are forms of administration of nutrients into the gastrointestinal tract.

2.The nurse, instructing a client about malabsorption syndrome, should include that food is absorbed in the: 1.mouth. 2.bloodstream. 3.stomach. 4.small intestine.

4.small intestine. The mouth and stomach are used mostly for digestion. The small intestine is where most of the absorption of food nutrients occurs. Food is not directly absorbed into the bloodstream.

12.A client has a history of being treated for ulcerative colitis. The nurse realizes that a life- threatening complication of this disorder is: 1.Crohns disease. 2.small bowel obstruction. 3.peptic ulcer disease. 4.toxic megacolon.

4.toxic megacolon. Toxic megacolon is a life-threatening complication of ulcerative colitis, and it requires immediate surgical intervention. Crohns disease, small bowel obstruction, and peptic ulcer disease are not life- threatening complications of ulcerative colitis.

16.Exercises to increase muscle tone of the pelvic floor are known as __________ exercises.

ANS: Kegel

17.In the nephrotic syndrome, the glomeruli are damaged by inflammation and allow small _____________ to pass through into the urine.

ANS: proteins

11.The nurse clarifies that deterioration progresses through stages before presenting with liver disease. Place the stages in order. (Separate letters by a comma and space as follows: A, B, C, D) a. Liver disease b. Inflammation c. Hepatic insufficiency d. Destruction e. Fibrotic regeneration

Destruction > Inflammation > Fibrotic regeneration > hepatic insufficiency > liver disease

T or F - Cigarette smoking is a risk factor for CRF.

True

11. A patient is diagnosed with overactive bladder. Which of the following instructions should be given to this woman? a. "Limit the amount of water that you drink." b. "Eliminate caffeine from your diet." c. "Wear panty liners." d. All of the above

b. "Eliminate caffeine from your diet."

A patient has acute pancreatitis with seven of the diagnostic criteria from Ranson's criteria. In order to plan care, the NP must understand that this criteria score has which of the following meanings? a. A high mortality rate b. An increased chance of recurrence c. A 7% chance of the disease becoming chronic d. All of the above

a. A high mortality rate

9.Which foods should the home health nurse counsel hypokalemic patients to include in their diet? a. Bananas, oranges, cantaloupe b. Carrots, summer squash, green beans c. Apples, pineapple, watermelon d. Winter squash, cauliflower, lettuce

a. Bananas, oranges, cantaloupe

11.What should the nurse counsel the young man with chronic prostatitis to avoid? a. Cessation of intercourse b. Warm baths c. Stool softeners d. Continuing antibiotics when symptoms abate

a. Cessation of intercourse

12.What are the indications for a liver transplant? (Select all that apply.) a. Congenital biliary abnormalities b. Hepatic malignancy c. Chronic hepatitis d. Cirrhosis due to alcoholism e. Gallbladder disease

a. Congenital biliary abnormalities b. Hepatic malignancy c. Chronic hepatitis

Which of the following dietary instructions should be given to a patient with GERD? a. Eliminate coffee. b. Drink peppermint tea to relieve stomach distress. c. Recline and rest after meals. d. Limit the amount of antacids.

a. Eliminate coffee.

On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis? a. Hepatitis A virus (HAV) IgM b. HAV IgG c. Anti-HAcAg d. Anti-HAsAg

a. Hepatitis A virus (HAV) IgM

A 28-year-old patient is seen in the clinic with colicky abdominal pain particular with meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely? a. Her age b. Frequent constipation c. Flatulence d. Colicky abdominal pain

a. Her age

Which of the following is part of the treatment plan for the patient with irritable bowel syndrome? a. High fiber diet b. Tylenol with codeine c. Daily laxatives d. All of the above

a. High fiber diet

Which of the following is most effective in diagnosing appendicitis? a. History and physical b. Sedimentation rate c. Kidney, ureter, and bladder x-ray d. Complete blood count (CBC) with differentials

a. History and physical

9. A patient is seen in the office complaining of severe flank pain. The clinician should assess this patient for which risk factor for kidney stones? a. Hypertension b. Constipation c. Tubal ligation d. Diabetes

a. Hypertension

14.Which of the following are signs of fluid overload in the patient with nephrosis? (Select all that apply.) a. Increase in pulse rate b. Increase in daily weight c. Clear lung sounds d. Edema e. Labored respirations

a. Increase in pulse rate b. Increase in daily weight d. Edema e. Labored respirations

6. A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis? a. Lower urinary tract infection b. Chlamydia infection c. Candidiasis d. Pyelonephritis

a. Lower urinary tract infection

Which of the following is associated with celiac disease (celiac sprue)? a. Malabsorption b. Constipation c. Rectal bleeding d. Esophageal ulceration

a. Malabsorption

4. A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria? a. NSAIDs b. Beets c. Vitamin A d. Red meat

a. NSAIDs

1. A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis, which of the following questions should be asked? a. "Do you have a history of liver disease?" b. "What medications are you currently taking?" c. "Have you noticed swelling in your ankles?" d. All of the above

b. "What medications are you currently taking?"

A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be? a. Obtain a complete history. b. Order a barium enema. c. Schedule a Bernstein's test. d. Prescribe a trial of antispasmodics.

a. Obtain a complete history.

13.Why are urinary tract infections (UTI) common in older adults? (Select all that apply.) a. Older adults have weakened musculature in the bladder and urethra. b. Older adults have urinary stasis. c. Older adults have increased bladder capacity. d. Older adults have diminished neurologic sensation. e. The effects of medications such as diuretics that many older adults take.

a. Older adults have weakened musculature in the bladder and urethra. b. Older adults have urinary stasis. d. Older adults have diminished neurologic sensation. e. The effects of medications such as diuretics that many older adults take.

1.An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter of a newly admitted patient. Physician orders include meperidine (Demerol) 100 mg IM q4h PRN, strain all urine, and encourage fluids to 4000 mL/day. What should be the nurses highest priority when planning care for this patient? a. Pain related to irritation of a stone b. Anxiety related to unclear outcome of condition c. Ineffective health maintenance related to lack of knowledge about prevention of stones d. Risk for injury related to disorientation

a. Pain related to irritation of a stone

13. Which of the following are predisposing factors for pyelonephritis? a. Pregnancy b. Dehydration c. Smoking d. Alkaline urine

a. Pregnancy

25. Which of the following clinical manifestations are consistent with a patient in ARF? a. Pruritis b. Glycosuria c. Irritability d. Hypotension

a. Pruritis

7. A patient presents with CVA tenderness and a several-day history of high fever, chills, and dysuria. Which of the following diagnoses is most likely given the above information? a. Pyelonephritis b. Cystitis c. Renal calculi d. Bladder tumor

a. Pyelonephritis

22. The patient is diagnosed with acute renal failure (ARF). Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia? a. Recent heat stroke b. Nephrolithiasis c. Recent infection where gentamicin was used in treatment d. All of the above

a. Recent heat stroke

12. A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy. Which of the following actions should be taken next? a. Send a urine specimen for microscopy and evaluate for fungal colonies. b. Increase the dose of antibiotic. c. Order a cytoscopy. d. Order a different antibiotic.

a. Send a urine specimen for microscopy and evaluate for fungal colonies.

10.To help a patient control incontinence, what should the nurse recommend the patient avoid? a. Spicy foods b. Citrus fruits c. Organ meats d. Shellfish

a. Spicy foods

16. Which of the following instructions should be given to the patient with nephrolithiasis? a. Take ibuprofen, 600 mg every 8 hours. b. Take Tums for stomach upset. c. Drink more black tea. d. Increase intake of vegetables, like spinach.

a. Take ibuprofen, 600 mg every 8 hours.

15.The nurse is reviewing the urinalysis report on an assigned patient. The nurse recognizes which findings to be normal? (Select all that apply.) a. Turbidity clear b. pH 6.0 c. Glucose negative d. Red blood cells, 15 to 20 e. White blood cells

a. Turbidity clear c. Glucose negative

A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? a. Very early b. 3 to 4 hours after perforation c. Late in inflammation d. Appendicitis never presents with vague pain.

a. Very early

9.A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet? The liver cannot rid the body of ammonia that is made by the breakdown of protein in the a. digestive system. b. The liver heals better with a high-carbohydrate diet rather than with a diet high in protein. c. Most people have too much protein in their diets. The amount in this diet is better for liver d. Because of portal hypertension, the blood flows around the liver, and ammonia made from protein collects in the brain, causing hallucinations.

a. digestive system.

5.The patients cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of: a. esophageal varices. b. diverticulosis. c. Crohn disease. d. esophageal reflux (GERD).

a. esophageal varices.

12.The nurse reassures the patient recovering from acute glomerulonephritis that after all other signs and symptoms of the disease subside, it is normal to have some residual (select all that apply): a. proteinuria b. oliguria c. hematuria d. anasarca e. oliguria

a. proteinuria c. hematuria

A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point? a. Stool culture b. Liver enzymes c. Antihepatitis D virus d. Thyroid-stimulating hormone test

c. Antihepatitis D virus

2.A patient is receiving chlorothiazide (Diuril), a thiazide diuretic for hypertension. What nursing action is most important for prevention of complications? a. Measure output b. Increase fluid intake c. Assess for hypokalemia d. Assess for hypernatremia

c. Assess for hypokalemia

A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin. Which of the following could be a cause of this problem? a. Increased breakdown of red blood cells b. Inadequate hepatocyte function c. Biliary obstruction d. All of the above

c. Biliary obstruction

5. A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a diagnosis of lower UTI? a. Back and abdominal pain b. Fever, chills, costovertebral angle (CVA) tenderness c. Blood in urine and frequency d. Foul-smelling discharge, perineal itch

c. Blood in urine and frequency

7.How does the administration of neomycin (Mycifradin) reduce the production of ammonia? a. By assisting the hepatic cells to regenerate b. By reducing ascites c. By decreasing the bacteria in the gut d. By helping to digest fats and proteins

c. By decreasing the bacteria in the gut The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced.

10. A patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication? a. Diarrhea b. Parkinson's disease c. Closed-angle glaucoma d. Breast cancer

c. Closed-angle glaucoma

27. Which of the following tests is most useful in determining renal function in a patient suspected of CRF? a. BUN and creatinine b. Electrolytes c. Creatinine clearance d. Urinalysis

c. Creatinine clearance

Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes Tums® with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain? a. The pain seems better when he smokes to relieve his nerves. b. Coffee and fried foods don't bother him, c. He wakes at night coughing with a bad taste in his mouth. d. All of the above

c. He wakes at night coughing with a bad taste in his mouth.

A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer? a. His gender b. His age c. His use of Alka-Seltzer d. His ethnic origin

c. His use of Alka-Seltzer

24. A patient is seen in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the NP to a diagnosis of inflammatory bowel disease? a. Intermittent constipation with periods of diarrhea b. Wakens at night with diarrhea c. History of international travel d. All of the above

c. History of international travel

3. A patient is seen complaining of "leaking urine when I sneeze." Which of the following actions should the clinician take first? a. Order a cystometrogram. b. Obtain a computed tomography scan. c. Instruct the patient on Kegel exercises. d. Prescribe imipramine.

c. Instruct the patient on Kegel exercises.

A patient is diagnosed with giardia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment? a. Vancomycin b. Penicillin c. Metronidazole d. Bactrim

c. Metronidazole

A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? a. Multivitamin b. Magnesium hydroxide c. Pepto-Bismol® d. Ibuprofen

c. Pepto-Bismol®

10.The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent: a. fluid congestion. b. fatigue. c. infection. d. urinary retention.

c. infection.

19. An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following data from the history is considered a risk factor for this type of cancer? a. History of alcoholism b. Sedentary lifestyle c. Obesity d. 65-year smoking history

d. 65-year smoking history

1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical examination? a. Digital rectal exam b. Pelvic exam c. Sexual history d. All of the above

d. All of the above

15. A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses? a. Pancreatitis b. Peptic ulcer disease c. Diverticulitis d. All of the above

d. All of the above

17. Which of the following patients is at risk for developing urinary tract cancer? a. The 45-year-old woman who is 100 lbs overweight b. The 78-year-old man who smokes three packs of cigarettes a day c. The 84-year-old man who worked in the asbestos mines d. All of the above

d. All of the above

24. An 82-year-old woman with renal failure is seen in the clinic. The provider should question the patient about the intake of which of these substances that can cause renal toxicity? a. Ibuprofen b. Captopril c. Losartan d. All of the above

d. All of the above