Adult Quiz 3 ATI, Textbook, Evolve Practice Questions

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? "It would be beneficial for you to stop drinking alcohol." "You'll need to drink at least 2 to 3 glasses of milk daily." "Many people find that a minced or pureed diet eases their symptoms of PUD." "You can keep your present diet and minimize symptoms by taking medication."

"It would be beneficial for you to stop drinking alcohol." Alcohol increases the amount of stomach acid produced, so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some dietary modifications to minimize symptoms. Milk may worsen PUD.

Which instructions would the nurse include in a teaching plan for a patient with mild GERD?

"The best time to take an as-needed antacid is 1 to 3 hours after meals."

adverse effect of Isoniazid

"You might notice tingling of your hands."

Nurse is teaching a client with TB, what statement should the nurse include?

"You will need to provide sputum samples every 4 weeks to monitor the effectiveness of medication."

manifestations of TB to teach group of clients at local community center?

-persistent cough -weight loss -fatigue -night sweats -purulent sputum

Active TB teaching with 4 medication regimen?

-wash hands each time you cough -wear a mask in public area -do not replace medications for one another -collect sputum cultures every 2-4 weeks until 3 consecutive sputum cultures come back negative -continue to avoid overcrowded areas if possible and take preventative measures, such as wearing a mask when going out.

A nurse is caring for a client who has pneumonia. Assessment findings include temperature 37.8C 100F, respirations 30, BP 130/76, HR 100, SAO2 91% RA, prioritize the following nursing interventions: a. administer antibiotics b. administer oxygen therapy c. perform a sputum culture d. instruct the client to obtain a yearly influenza vaccination

1. administer oxygen therapy (ABC framework) 2. perform a sputum culture (prior to administering oral meds) 3. administer antibiotics (sputum culture obtained before antibiotic administration) 4. instruct the client to obtain a yearly influenza vaccination (reduce risk of acquiring influenza that can lead to pneumonia)

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? Antibiotic(s), antacid, and corticosteroid Antibiotic(s), aspirin, and antiulcer/protectant Antibiotic(s), proton pump inhibitor, and bismuth Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

Antibiotic(s), proton pump inhibitor, and bismuth To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia

Dumping syndrome After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

The nurse determines a patient has experienced the beneficial effects of famotidine when which symptom is relieved? Nausea Belching Epigastric pain Difficulty swallowing

Epigastric Pain Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. It is not indicated for nausea, belching, and dysphagia.

A patient has a sliding hiatal hernia. What priority nursing intervention will reduce the symptoms of heartburn and dyspepsia? Keeping the patient NPO Putting the bed in the Trendelenburg position Having the patient eat 4 to 6 smaller meals each day Giving various antacids to determine which one works for the patient

Having the patient eat 4 to 6 smaller meals each day Eating smaller meals during the day will decrease the gastric pressure and symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenburg position is not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the health care provider's prescription, so this is not a nursing intervention.

A 74-year-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? Sucralfate Cimetidine Omeprazole Metoclopramide

Omeprazole There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine.

The nurse is caring for a patient who reports abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient's condition is declining? Pallor and diaphoresis Reddened peripheral IV site Guaiac-positive diarrhea stools Heart rate 90, respiratory rate 20, BP 110/60

Pallor and diaphoresis A patient with hematemesis has some degree of bleeding from an unknown source. Guaiac-positive diarrhea stools would be an expected finding. When monitoring the patient for stability, the nurse observes for signs of hypovolemic shock such as tachycardia, tachypnea, hypotension, altered level of consciousness, pallor, and cool and clammy skin. A reddened peripheral IV site will require assessment to determine the need for reinsertion. Access would be critical in the immediate treatment of shock, but the IV site does not represent a decline in condition.

A patient with a history of peptic ulcer disease presents to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate? Providing IV fluids and inserting a nasogastric (NG) tube Administering oral bicarbonate and testing the patient's gastric pH level Performing a fecal occult blood test and administering IV calcium gluconate Starting parenteral nutrition and placing the patient in a high Fowler's position

Providing IV fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

After receiving a dose of metoclopramide, which patient assessment finding would indicate the medication was effective? Decreased blood pressure Absence of muscle tremors Relief of nausea and vomiting No further episodes of diarrhea

Relief of nausea and vomiting Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? ack pain 3 or 4 hours after eating a meal Chest pain relieved with eating or drinking water Burning epigastric pain 90 minutes after breakfast Rigid abdomen and vomiting following indigestion

Rigid abdomen and vomiting following indigestion A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3 to 4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1 to 2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

A patient reporting nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? Tremors Constipation Double vision Numbness in fingers and toes

Tremors Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur with metoclopramide administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? a. "I plan to eat small, frequent meals." b. "I will eat easy-to-digest foods with limited spice." c. "I will use skim milk when cooking." d. "I plan to drink regular cola." e. "I will limit alcohol intake to two drinks per day."

a. "I plan to eat small, frequent meals." b. "I will eat easy-to-digest foods with limited spice." (bland) c. "I will use skim milk when cooking." (low-fat foods recommended) -also recommend caffeine-free beverages and avoiding any alcohol intake

A nurse is caring for a new client who has a diagnosis of GERD. The nurse should expect prescriptions for which of the following medications? a. Antacids b. Histamine2 Receptor Antagonists c. Opioid analgesics d. Fiber laxatives e. Proton Pump Inhibitors

a. Antacids (neutralize gastric acid which irritates the esophagus during reflux) b. Histamine2 Receptor Antagonists (decrease acid secretion, which contributes to reflux) e. Proton Pump Inhibitors (decrease gastric acid production, which contributes to reflux)

Nursing management of the patient with acute pancreatitis includes a. administering pain medication b. checking for signs of hypocalcemia c. providing a diet low in carbohydrates d. giving insulin based on a sliding scale e. monitoring for infection, particularly respiratory tract infection

a. administering pain medication b. checking for signs of hypocalcemia e. monitoring for infection, particularly respiratory tract infection

Nurse is monitoring a group of clients for increased risk of developing pneumonia, which of the following clients at risk?

a. client who has dysphagia (difficulty swallowing- aspiration) b. client who has AIDS (immunocompromised- increased risk of opportunistic infections) e. client who has closed head injury and is receiving mechanical ventilation (ventilator-associated pneumonia) f. client who has myasthena gravis (generalized weakness and may have difficulty clearing airway secretions)

A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? a. evaluate intake and output b. monitor laboratory reports of electrolytes c. provide three large meals a day d. administer ibuprofen for pain e. observe stool characteristics

a. evaluate intake and output (prevent electrolyte loss and dehydration) b. monitor laboratory reports of electrolytes (prevent fluid loss and dehydration) e. observe stool characteristics (instruct to report any indication of the presence of blood in the stools, which can indicate GI bleeding)

A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following are a risk factor for cholecystitis? a. obesity b. rapid weight gain c. decreased blood triglyceride level d. male sex

a. obesity also rapid weight loss, increased blood cholesterols, female sex

Which patients have the greatest risk for aspiration pneumonia? a. patients with seizures b. patients with head injury c. patients who had thoracic surgery d. patients who had a myocardial infarction e. patient who is receiving nasogastric tube feeding

a. patients with seizures b. patients with head injury e. patient who is receiving nasogastric tube feeding

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? a. rigid abdomen b. tachycardia c. elevated blood pressure d. circumoral cyanosis e. rebound tenderness

a. rigid abdomen (board-like) b. tachycardia (due to GI bleeding that accompanies perforation) e. rebound tenderness

A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? a. take the medication 1hr before a meal b. limit NSAIDS when taking this medication c. Expect skin flushing when taking this medication d. Increase fiber intake when taking this medication e. Chew the medication thoroughly before swallowing

a. take the medication 1hr before a meal b. limit NSAIDS when taking this medication swallow whole (do not crush/chew)

A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? a. "I can take my medications with soda." b. "Peppermint tea will increase my indigestion." c. "Wearing an abdominal binder will limit my manifestations." d. "I will drink hot chocolate at bedtime to help me sleep." e. "I can lift weights as a way to exercise."

b. "Peppermint tea will increase my indigestion." (decreases LES pressure, should be avoided with HH)

A charge nurse is teaching a group of nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements by a unit nurse indicates an understanding of the purpose of the procedure? a. "The client will have increased duodenal gastric emptying." b. "The client will have a reduction of gastric acid secretions." c. "The client will have an increase of gastric mucous secretion." d. "The client will have an increased secretion of hydrogen/potassium ATPase enzymes."

b. "The client will have a reduction of gastric acid secretions."

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following information should the nurse include in the teaching? a. "the scope will be passed through your rectum." b. "you might have shoulder pain after surgery." c. "you will have a jackson-pratt drain in place after surgery." d. "you should limit how often you walk for 1-2 weeks."

b. "you might have shoulder pain after surgery." (due to free air that is introduced into the abdomen during laparoscopic surgery)

A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? a. Absence of saliva b. Painful swallowing c. Sweet taste in mouth d. Absence of Eructation

b. Painful swallowing (due to esophageal stricture/inflammation)

The nursing care for a patient with suspected acute cholecystitis would anticipate a. ordering a low-sodium diet b. administration of IV fluids c. monitoring of liver function tests d. administration of antiemetics for patients with nausea e. insertion of an indwelling catheter to monitor urine output

b. administration of IV fluids c. monitoring of liver function tests d. administration of antiemetics for patients with nausea

A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? a. pernicious anemia is caused when the cells producing gastric acid are damaged b. expect a monthly injection of vitamin B12 c. plan to take vitamin K supplements d. pernicious anemia is caused by an increased production of intrinsic factor

b. expect a monthly injection of vitamin B12 (due to decrease of the intrinsic factor by the stomach parietal cells)

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? a. instruct the client to chew the medication before swallowing b. offer a glass of water following medication administration c. administer the medication 30mim before meals d. sprinkle the contents on peanut butter

b. offer a glass of water following medication administration (drink a full glass of water after administration) -swallow without chewing to reduce irritation + slow the release of medication, administer with every meal and snack, contents of capsule can be sprinkled onto NONprotein foods

Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture site for 48 hours b. reporting any bile-colored drainage or pus from any incision c. using over-the-counter antiemetics if nausea and vomiting occur d. emptying and measuring the contents of the bile bag from the T tube every day

b. reporting any bile-colored drainage or pus from any incision

A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the teaching? a. take baths rather than showers b. resume a diet of choice c. cleanse the puncture site using mild soap and water d. remove adhesive strips from the puncture site in 24hrs e. report nausea and vomiting to the surgeon

b. resume a diet of choice (upon discharge) c. cleanse the puncture site using mild soap and water (to decrease the risk of infection) e. report nausea and vomiting to the surgeon (also report abdominal pain) bath or shower within 1-2 days following surgery, adhesive strips should remain in place until they fall off naturally

A patient has a high level of indirect (unconjugated) bilirubin. One cause of this finding is that...

bilirubin is not being conjugated and excreted into the bile by the liver

A nurse is completing discharge teaching with a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching? a. "When sitting in my lounge chair after a meal, I will lower the back of it." b. "I will try to eat three large meals a day." c. "I will elevate the head of my bed on blocks." d. "I will avoid eating within 1 hour before bedtime."

c. "I will elevate the head of my bed on blocks." (to limit reflux)

A nursing is completing discharge teaching for a client who has an infection due to Heliobacter Pylori. Which if the following statements by the client indicates an understanding of the teaching? a. "I will continue my prescription for corticosteroids." b. "I will schedule a CT scan to monitor improvement." c. "I will take a combination of medications for treatment." d. "I will have my throat swabbed to recheck for this bacteria."

c. "I will take a combination of medications for treatment." (combination of antibiotics, a histamine2 receptor antagonist used to treat infection)

A nurse is teaching a client who has a new prescription for famotidine. Which of the following statements by the client indicates an understanding of the teaching? a. "the medicine coats the lining of my stomach." b. "the medication should stop the pain right away." c. "I will take my pill at bedtime." d. "I will monitor for bleeding from my nose."

c. "I will take my pill at bedtime." (suppresses nocturnal acid production)

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? a. blood amylase 80 b. WBC 9,000 c. Direct bilirubin 2.1 d. alkaline phosphate 25

c. Direct bilirubin 2.1 (if bile duct is unobstructed then elevated direct bilirubin) -elevated blood amylase if pancreatic involvement is present (80 is normal) -expected elevated WBC due to inflammation (9,000 is normal) -elevated alkaline phosphate ALP level if common bile duct is unobstructed (25 is low)

The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss c. a lack of intrinsic factor normally produced by acid secreting cells of the gastric mucosa d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBC

c. a lack of intrinsic factor normally produced by acid secreting cells of the gastric mucosa

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught (select all that apply)? a. Expect routine TB testing to evaluate the infection. b. Visitors will not be allowed while in airborne isolation. c. adherence to precautions including coughing into a paper tissue d. Take all medications for full length of time to prevent multidrug-resistant TB. e. Wear a standard isolation mask if leaving the airborne infection isolation room.

c. adherence to precautions including coughing into a paper tissue d. Take all medications for full length of time to prevent multidrug-resistant TB. e. Wear a standard isolation mask if leaving the airborne infection isolation room.

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? a. client reports pain relieved by eating b. client states that pain often occurs at night c. client reports a sensation of bloating d. client states that pain occurs 30 mins to 1 hour after meal e. client experiences pain upon palpation of the epigastric region

c. client reports a sensation of bloating d. client states that pain occurs 30 mins to 1 hour after meal e. client experiences pain upon palpation of the epigastric region -pain will rarely occur at night -for duodenal ulcers, clients will report pain that is relieved by eating

A nurse is assessing a client who has pancreatitis. Which of the following manifestations should the nurse identify as a manifestation of pancreatitis? a. generalized cyanosis b. hyperactive bowel sounds c. gray-blue discoloration of the skin around the umbilicus d. wheezing in the lower lung fields

c. gray-blue discoloration of the skin around the umbilicus (periumbilical area) -generalized jaundice, absent/decreased bowel sounds, and diminished breath sounds as well as dyspnea or orthopnea are also expected

A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? a. take the medication with food b. monitor for diarrhea c. wait 1hr before taking other oral medications d. maintain a low-fiber diet

c. wait 1hr before taking other oral medications

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? a. pain in the upper quadrant radiating to right shoulder b. report of pain being worse when sitting upright c. pain relieved by defecation d. epigastric pain radiating to the left shoulder

d. epigastric pain radiating to the left shoulder (severe, boring epigastric pain that radiates to the back, left flank, or left shoulder) -cholecystitis will report pain in right upper quadrant radiating to right shoulder -pancreatitis will report pain worsening when lying down -pancreatitis will report pain that is relieved by assuming the fetal positon

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? a. eat three moderate-sized meals a day b. drink at least one glass of water with each meal c. eat a bedtime snack that contains a milk product d. increase protein in the diet

d. increase protein in the diet (eat a high-protein, high-fat, low-fiber, and moderate-to-low carbohydrate diet)

A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? a. decreased blood lipase level b. decreased blood amylase level c. increased blood calcium level d. increased blood glucose level

d. increased blood glucose level (due to pancreatic cell injury, which results in impaired metabolism of CHO due to a decrease in the release of insulin) -also elevated blood lipase and blood amylase due to pancreatic cell injury, decreased blood calcium level due to fat necrosis

A nurse is reviewing a prescription for chenodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? a. this medication is used to decrease acute biliary pain b. this medication requires thyroid function monitoring every 6 months c. this medication is not recommended for clients who have diabetes mellitus d. this medication dissolves gallstones gradually for a period of up to 2 years

d. this medication dissolves gallstones gradually for a period of up to 2 years (bile acid that gradually dissolves cholesterol-based gall stones, can be taken for up to 2 years) -use cautiously in hepatic conditions or disorders with varices -ultrasound of gallbladder q6 months during first year of treatment to determine effectiveness of medication -opioid analgesics are preferred for treatment of acute biliary pain

A patient is jaundiced, and her stools are clay colored. This is most likely related to...

decreased bile flow into the intestine

The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will...

give both vaccines at the same time in different arms

The nurse is teaching the patient and family that peptic ulcers are... a. caused by a stressful lifestyle and other acid-producing factors, such as H. Pylori b. inherited within families and reinforced by bacterial spread of staph in childhood c. promoted by factors that cause oversecretion of acid, such as excess dietary fats, smoking, and alcohol use d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. Pylori

promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. Pylori

An appropriate nursing intervention to assist a patient with pneumonia manage thick secretions and fatigue would be to...

teach the patient how to cough effectively and expectorate secretions

Instructions nurse should give client related to ethambutol?

watch for any changes in vision