DOS

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

Ingestion of parasites in the water A main cause of gastroenteritis when traveling outside the country is ingestion of water that is infested with parasites. Bacteria on the client's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.

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

"A change in position may be what is needed for you to have intercourse with your wife." A simple change in positioning during intercourse may alleviate the client's apprehension and facilitate sexual relations with his wife. Suggesting marriage counseling may address the client's concerns, but it focuses on the wrong issue; the client has not stated that he has relationship problems. Asking the client what his wife has said about the pouch may address the client's concerns, but it similarly focuses on the wrong issue. Telling the client that he needs to get clearance from his health care provider is an evasive response that does not address the client's primary concern.

The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information? a. "Do you usually binge drink?" b. "Do you tend to drink more on holidays or weekends?" c. "Tell me more about your alcohol intake." d. "Estimate how many episodes of binge drinking you do in a week."

"Tell me more about your alcohol intake." Asking the client about his or her alcohol intake is the only way that will allow the client to provide information in the client's own words and to the extent that the client wishes to provide it. Asking the client if he or she binge drinks or tends to drink more on holidays or weekends may put the client on the defensive rather than provide the desired information. It has not yet been determined whether the client engages in binge drinking.

The nurse is providing discharge teaching to a patient who is being discharged home after hospitalization for acute pancreatitis. Which statement by the patient indicates a need for further teaching? 1"I may have caffeine and chocolate in moderation." 2"I should avoid alcohol even after symptoms resolve." 3"I may need to take fat-soluble vitamins and other supplements." 4"I will consume a diet high in carbohydrates and protein and low in fats."

1"I may have caffeine and chocolate in moderation." Patients recovering from pancreatitis should avoid caffeine, chocolate, and other gastrointestinal stimulants. Fat-soluble vitamins may be prescribed. Patients should avoid alcohol, which could trigger a return of symptoms. The diet should be high in carbohydrates and protein and low in fats.

Which is the primary risk factor for chronic calcifying pancreatitis? 1Alcoholism 2Cholecystitis 3Viral infection 4Metabolic disturbances

1Alcoholism Alcoholism is the primary risk factor for chronic calcifying pancreatitis. Cholecystitis is a risk factor for chronic obstructive pancreatitis. Metabolic disturbances and viral infection are risk factors for acute pancreatitis, not chronic calcifying

Which factors increase the risk of developing pancreatic cancer? Select all that apply. 1 Aging 2 Cirrhosis 3 Smoking 4 Vitamin deficiency 5 Chronic pancreatitis

2, 3, 5 Pancreatic cancer is an abnormal growth in the pancreas. Cirrhosis, cigarette smoking, and chronic pancreatitis cause chronic irritation of the pancreatic tissue, increasing the risk for pancreatic cancer. Aging and vitamin deficiencies are not risk factors associated with pancreatic cancer.

A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis? 1Acute 2Chronic 3Calculous 4Acalculous

2Chronic Patients with chronic cholecystitis are more likely to have jaundice and icterus caused by obstruction of bile flow, causing increased circulating levels of bilirubin. Patients with acute cholecystitis present with abdominal pain. Acalculous cholecystitis and calculous cholecystitis are both types of acute cholecystitis.

Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin? 1Lipase 2Trypsin 3Elastase 4Kallikrein

4Kallikrein Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. These substances cause vasodilation and increased vascular permeability, compounding the hemorrhagic process. Lipase enzyme is involved in enzymatic fat necrosis. Trypsin activates elastase, which dissolves elastic fibers of the blood vessels and ducts.

Which menu items would the nurse remove from the meal tray of a patient with chronic kidney disease who is not currently receiving dialysis?Select all that apply. A. Bananas B. White rice C. Hard-boiled eggs D. White bread rolls E. Apple slices and grapes F. Salad with olive oil and vinegar

A. Bananas Bananas are high-potassium food and should be avoided for patients with CKD on dietary restrictions. Further education regarding high-potassium foods is required. C. Hard-boiled eggs Hard-boiled eggs are high in protein, and the yolk contains cholesterol; thus they should be avoided for patients with CKD on dietary restrictions. Further education would be necessary to discuss restricting protein and cholesterol.

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A. Increased blood urea nitrogen (BUN) B. Increased creatinine level C. Pale-colored urine D. Decreased sodium level

A. Increased blood urea nitrogen (BUN) An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

What is the recommendation regarding the use of diuretics for a patient with acute kidney injury (AKI) during the oliguric phase? A. Not recommended, may be harmful B. Use transiently with increased fluids C. Use a high dose continuously and push IV fluids D. Use a moderate dose continuously and push IV fluids

A. Not recommended, may be harmful Diuretic therapy is not recommended during the oliguric phase and can cause additional harm

A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood ureanitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this clients history? a. Have you been taking any aspirin, ibuprofen, or naproxen recently? b. Do you have anyone in your family with renal failure? c. Have you had a diet that is low in protein recently? d. Has a relative had a kidney transplant lately?

ANS: A There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen,aspirin, and naproxen. This would be a good question to initially ask the client since both the serum creatinineand BUN are elevated, indicating some renal problems. A family history of renal failure and kidneytransplantation would not be part of the questioning and could cause anxiety in the client. A diet high in proteincould be a factor in an increased BUN.

A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerularfiltration rate and is not undergoing dialysis. Which result would give the nurse the most concern? a. Albumin level of 2.5 g/dL b. Phosphorus level of 5 mg/dL c. Sodium level of 135 mmol/L d. Potassium level of 5.5 mmol/L

ANS: A Protein restriction is necessary with chronic renal failure due to the buildup of waste products from proteinbreakdown. The nurse would be concerned with the low albumin level since this indicates that the protein inthe diet is not enough for the clients metabolic needs. The electrolyte values are not related to the proteinrestricteddiet.

A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) a. Lower gastrointestinal bleeding - Erosion of the bowel wall b. Abscess formation - Localized pockets of infection develop in the ulcerated bowel lining c. Toxic megacolon - Transmural inflammation resulting in pyuria and fecaluria d. Nonmechanical bowel obstruction - Paralysis of colon resulting from colorectal cancer e. Fistula - Dilation and colonic ileus caused by paralysis of the colon

ANS: A, B, D Lower GI bleeding can lead to erosion of the bowel wall. Abscesses are localized pockets of infection that develop in the ulcerated bowel lining. Nonmechanical bowel obstruction is paralysis of the colon that results from colorectal cancer. When the inflammation is transmural, fistulas can occur between the bowel and bladder resulting in pyuria and fecaluria. Paralysis of the colon causing dilation and subsequent colonic ileus is known as a toxic megacolon.

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What isthe priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Take a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

ANS: B An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent tothe laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate ina microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction isa viable option but will not treat the peritonitis.

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this clients medication administration record to prevent a common complication of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Sal-Tropine) d. Lidocaine (Xylocaine)

ANS: B Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which conditionwould the nurse expect to find in the clients recent history? a. Pyelonephritis b. Myocardial infarction c. Bladder cancer d. Kidney stones

ANS: B Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction.Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidneystones are post-renal causes of AKI related to urine flow obstruction.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the majorconcern of the nurse regarding this clients care? a. Edema and pain b. Electrolyte and fluid imbalance c. Cardiac and respiratory status d. Mental health status

ANS: B This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding thefluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are notusually a problem with fluid loss. There could be changes in the clients cardiac, respiratory, and mental healthstatus if the electrolyte imbalance is not treated.

A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition? a. Sinus tachycardia b. Speech alterations c. Fatigue d. Dyspnea with activity

ANS: B Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a rapid ventricular response as a result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have dyspnea as a result of the decreased cardiac output caused by the rhythm disturbance.

Which laboratory findings does the nurse recognize as potentially causing complications of liver disease? a. Elevated aspartate transaminase (AST) and lactate dehydrogenase (LDH) levels b. Elevated prothrombin time and international normalized ratio (INR) c. Decreased serum albumin and serum globulin levels d. Decreased serum alkaline phosphatase and alanine aminotransferase (ALT) levels

ANS: B Elevated prothrombin time and INR are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. The other values do not necessarily place the client at increased risk for complications.

The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess firstupon initial rounding? a. Woman with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Man with skin itching from head to toe d. Client with halitosis and stomatitis

ANS: B Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rateand depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most clientswith CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD.Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations? (Select all that apply.) a. Aphasia b. Dysphagia c. Eructation d. Halitosis e. Weight gain

ANS: B, C, D Common signs of esophageal disorders include dysphagia, eructation, halitosis, and weight loss. Aphasia is difficulty with speech, commonly seen after stroke.

A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, "I am having trouble swallowing this pill." Which action should the nurse take? a. Contact the clinical pharmacist and request the medication in suspension form. b. Empty the contents of the capsule into applesauce or pudding for administration. c. Ask the health care provider to prescribe the medication as an enema instead. d. Crush the pill carefully and administer it in applesauce or pudding.

ANS: C Asacol is the oral formula for mesalamine and is produced as an enteric-coated pill that should not be crushed, chewed, or broken. Asacol is not available as a suspension or elixir. If the client is unable to swallow the Asacol pill, a mesalamine enema (Rowasa) may be administered instead, with a provider's order.DIF: Applying/Application REF: 1176KEY: Ulcerative colitis| medication safetyMSC: Integrated Process: Nursing Process: ImplementationNOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

After teaching a client with diverticular disease, a nurse assesses the client's understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice

ANS: D Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup of bean soup) should be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.

The nurse caring frequently for older adults in the hospital is aware of risk factors that place them at a higher risk for shock. For what factors would the nurse assess? (Select all that apply.) a. Altered mobility/immobility b. Decreased thirst response c. Diminished immune response d. Malnutrition e. Overhydration

Answer: A, B, C, D

A client had an open Whipple procedure yesterday for pancreatic cancer. Which nursing interventions are appropriate for this client? Select all that apply. A. Monitor and document the client's nasogastric tube drainage. B. Place the client in a side-lying position to promote wound drainage. C. Assess the abdomen for signs of peritonitis. D. Monitor the client's hemoglobin and hematocrit. E. Check the client's blood glucose frequently.

Answer: A, C, D, E Rationale: Immediately after surgery, the client who has had an open Whipple procedure is NPO (nothing by mouth) and usually has a NGT tube to decompress the stomach. Monitor gastrointestinal drainage and tube patency. The client should be placed in the semi-Fowler's position to reduce tension on the suture line and anastomosis site as well as to optimize lung expansion. The client should be monitored for signs of peritonitis. Because the open Whipple procedure is extensive and can take many hours to complete, maintaining fluid and electrolyte balance can be difficult. Patients often have significant intraoperative blood loss and postoperative bleeding, so hemoglobin and hematocrit should be monitored. Immediately after the Whipple procedure, the patient may have hyperglycemia or hypoglycemia as a result of stress and surgical manipulation of the pancreas, so frequent monitoring of glucose is important.

A client previously diagnosed with liver cirrhosis visits the medical clinic. What assessment findings does the nurse expect in this client? Select all that apply. A. Ecchymosis B. Soft abdomen C. Moist, clammy skin D. Jaundice E. Ankle edema F. Fever

Answer: A, D, E Rationale: Clients with advanced cirrhosis often have symptoms such as gastrointestinal (GI) bleeding, jaundice, ascites, and spontaneous bruising. They may also have dry skin, rashes, purpuric lesions (e.g., petechiae), warm and bright red palms of the hands, vascular lesions (spider angiomas), and peripheral dependent edema of the extremities and sacrum.

Which foods will the nurse teach the client with chronic pancreatitis to avoid? Select all that apply. A. Blueberries B. Green beans C. Bacon D. Baked fish E. Fried potatoes

Answer: C, E Rationale: Foods high in fat are avoided because they cause or increase diarrhea in clients with chronic pancreatitis. Bacon and fried potatoes are considered fatty foods.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A. "Should we filter air circulation?" B. "Can we use less radiographic contrast dye?" C. "Should we add low-dose dobutamine?" D. "Should we decrease IV rates?"

B. "Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

Which physiological factor contributes to gastroesophageal reflux disease (GERD)? A. Accelerated gastric emptying B. Irritation from reflux of stomach contents C. Competent lower esophageal sphincter D. Increased esophageal clearance

B. irritation from reflux of stomach contents

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? A. Abdominal pain relieved by bending the knees B. Chronic diarrhea, abdominal pain, and fever C. Epigastric cramping D. Hypotension with vomiting

Chronic diarrhea, abdominal pain, and fever Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

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

Clients with UC may experience hemorrhage. Hemorrhage is commonly experienced by clients with UC. Five to six stools daily is common with CD. The peak incidences of UC are between 15 to 25 and 55 to 65 years of age. Fistulas commonly occur as a complication of CD.

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a client's hiatal hernia. Which change does the nurse recommend to this client? A. Eat only two or three meals daily. B. Sleep flat in a left side-lying position. C. Drink tea instead of coffee. D. Avoid working while bent over the computer.

D. Avoid working while bent over the computer.The client should avoid working while bent over because this position presses on the diaphragm, causing discomfort. The client with a hiatal hernia should eat four to six meals a day. The head of the client's bed should be elevated approximately 6 inches. Both tea and coffee should be eliminated from this client's diet because of the caffeine content.

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? a. Carbohydrates b. High fat c. High fiber d. Protein

Protein Enzyme preparations should not be mixed with foods containing protein because the enzymes will dissolve the food into a watery substance. No evidence suggests that enzyme preparations should not be mixed with carbohydrates, food with high fat content, and food with high fiber content.

Which of the following are classic symptoms of celiac disease? Select all that apply. 1Weight gain 2Steatorrhea 3Osteoporosis 4Abdominal pain 5Diarrhea and/or constipation

Steatorrhea Abdominal pain Diarrhea and/or constipation

What is the normal measurement of the QRS complex in an ECG? a Less than 0.12 second b. 0.10 to 0.16 second c. 0.12 to 0.20 second d. 0.16 to 0.24 second

a Less than 0.12 second

A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications?Select all that apply. a. Check blood glucose often. b. Check bowel sounds and stools .c. Ensure that drainage color is clear.d . Monitor mental status. e. Place the client in the supine position.

a, b, d Glucose should be checked often to monitor for diabetes mellitus. Bowels sounds and stools should be checked to monitor for bowel obstruction. A change in mental status or level of consciousness could be indicative of hemorrhage. Clear, colorless, bile-tinged drainage or frank blood with increased output may indicate disruption or leakage of a site of anastomosis. The client should be placed in semi-Fowler's position to reduce tension on the suture line and the anastomosis site and to optimize lung expansion.

5. Which are common manifestations of acute cholecystitis? (Select all that apply.) a. Anorexia b. Ascites c. Eructation d. Steatorrhea e. Jaundice f. Rebound tenderness

a,c,e,f

What is the most common and serious complication after a Whipple procedure? a. Diabetes mellitus b. Wound infection c. Fistula development d. Bowel obstruction

c

The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication? a. Administer pancrelipase before taking an antacid. b. Chew tablets before swallowing. c. Take pancrelipase before meals. d. Wipe your lips after taking pancrelipase.

d Wipe your lips after taking pancrelipase.Pancrelipase is a pancreatic enzyme used for enzyme replacement for clients with chronic pancreatitis. To avoid skin irritation and breakdown from residual enzymes, the lips should be wiped. Pancrelipase should be administered after antacids or histamine2 blockers are taken. It should not be chewed to minimize oral irritation and allow the drug to be released more slowly. It should be taken with meals and snacks and followed with a glass of water.

What is the total time required for ventricular depolarization and repolarization as represented on the ECG? a. PR interval b. QRS complex c. ST segment d. QT interval

d. QT interval

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

"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." The most effective way to manage diverticulitis is with a low-fiber diet while inflammation is present, followed by a high-fiber diet once the inflammation has subsided. Neither an exclusively low-fiber diet or an exclusively high-fiber diet will effectively manage diverticulitis. A high-fiber diet while diverticulitis is active will only worsen the disease and its symptoms.

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

"Lactose-containing foods should be reduced or eliminated from your diet." Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of clients with UC. Carbonated beverages are GI stimulants that can cause discomfort and should be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms; nurses should never advise clients that any amount of cigarette smoking is "OK." Raw vegetables and high-fiber foods can cause GI symptoms in clients with UC.

What risk factors are associated with the development of gastroesophageal reflux disease (GERD)? Select all that apply

-Ascites -Obesity -Pregnancy -Wearing tight girdles

Which clinical findings in a patient indicate ulcerative colitis? 1Bowel fistulas 2Thickened bowel wall 3Inflammation of the ileum and colon 4Presence of blood and mucus in the stool

4 Presence of blood and mucus in the stool is caused by bleeding in the intestinal mucosa. This symptom is indicative of ulcerative colitis. Strictures and deep ulcerations occur in Crohn's disease, which put the patient at risk for developing bowel fistulas. Thickened bowel walls and inflammation of ileum and colon are seen in Crohn's disease.

Which statements about GERD are correct? (Select all that apply) A. Overweight and obese patients are at an increased risk. B. Thin and underweight patients are at an increased risk. C. It is a common disorder in the Asian and his Hispanic populations. D. There is a high incidence in patients who eat mostly hot and spicy foods. E. It is a common upper gastrointestinal disorder in the United States.

A. Overweight and obese pts are at an increased risk E. It is a common upper GI disorder in the United States

Which nutritional food group limitations would the nurse recommend to a patient with CKD and renal osteodystrophy in order to help manage the diagnosis?Select all that apply .A. Protein B. Calcium C. Fats/lipids D. Phosphorus E. Carbohydrates

A. Protein Foods that are rich in protein are often high in phosphorus and should be avoided. Phosphorus exchanges with calcium in the blood, increasing calcium excretion. D. Phosphorus Foods high in phosphorus include nuts, dried beans, bran, and garlic. Phosphorus exchanges with calcium in the blood, increasing calcium excretion. These foods should be avoided to prevent the worsening of osteodystrophy.

The nurse instructs a patient with CKD and mineral bone disorder to take which medications with food in order to maximize function?Select all that apply. A. Vitamin D B. Calcimimetics C. Loop diuretics D. Iron supplements E. Phosphate binders

A. Vitamin D B. Calcimimetics Calcimimetics can be taken with food or shortly after a meal. This medication helps with secondary hyperparathyroidism caused by the low blood calcium levels. E. Phosphate bindersPhosphate binders should be taken with food, because phosphate binding occurs in the bowel. The phosphate is then eliminated with the stool.

A client with hepatitis C is being treated with ribavirin (Copegus). What nursing action takes priority? a. Educating the client on ways to remain complaint with the drug regimen b. Teaching the client that transient muscle aching is a common side effect c. Ensuring that the client returns to the clinic each week for follow-up care d. Showing the client how to take and record a radial pulse for 1 minute

ANS: A Treatment with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. The other actions are not warranted

A nurse reviews the chart of a client who has Crohn's disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions? a. Serum potassium of 2.6 mEq/L b. Client ate 20% of breakfast meal c. White blood cell count of 8200/mm3 d. Client's weight decreased by 3 pounds

ANS: A Fistulas place the client with Crohn's disease at risk for hypokalemia which can lead to serious dysrhythmias. This potassium level is low and should cause the nurse to intervene. The white blood cell count is normal. The other two findings are abnormal and also warrant intervention, but the potassium level takes priority.DIF: Applying/Application REF: 1184KEY: Crohn's disease| electrolyte imbalanceMSC: Integrated Process: Nursing Process: AnalysisNOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Sulfasalazine (Azulfidine) d. Ceftriaxone (Rocephin)

ANS: A Metronidazole is the drug of choice for a Giardia infection. Ciprofloxacin and ceftriaxone are antibiotics used for bacterial infections. Sulfasalazine is used for ulcerative colitis and Crohn's disease.DIF: Remembering/Knowledge REF: 1190KEY: Parasitic infection| medicationMSC: Integrated Process: Nursing Process: PlanningNOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections

ANS: A, B, C, D Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.

A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Distended abdomen b. Inability to pass flatus c. Bradycardia d. Hyperactive bowel sounds e. Decreased urine output

ANS: A, B, E A client with peritonitis may present with a distended abdomen, diminished bowel sounds, inability to pass flatus or feces, tachycardia, and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associated with peritonitis.

A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this clients teaching? (Select all that apply.) a. Until your incision is healed, do not submerge your pacemaker. Only take showers. b. Report any pulse rates lower than your pacemaker settings. c. If you feel weak, apply pressure over your generator. d. Have your pacemaker turned off before having magnetic resonance imaging (MRI). e. Do not lift your left arm above the level of your shoulder for 8 weeks.

ANS: A, B, E The client should not submerge in water until the site has healed; after the incision is healed, the client may take showers or baths without concern for the pacemaker. The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min. The client should be advised of restrictions on physical activity for 8 weeks to allow the pacemaker to settle in place. The client should never apply pressure over the generator and should avoid tight clothing. The client should never have MRI because, whether turned on or off, the pacemaker contains metal. The client should be advised to inform all health care providers that he or she has a pacemaker.

A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?

ANS: A, B, E When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis.

A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce

ANS: A, C, D, E Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided.

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. Thenurse is teaching the clients spouse about the kidney-specific formulation for the enteral solution compared tostandard formulas. What components should be discussed in the teaching plan? (Select all that apply.) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories

ANS: A, C, E Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulasthat are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.

A client is 1 day postoperative after having Zenker's diverticula removed. The client has a nasogastric (NG) tube to suction, and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate? a. Document the findings as normal. b. Irrigate the NG tube with sterile saline. c. Notify the surgeon about this finding. d. Remove and reinsert the NG tube.

ANS: C NG tubes placed during surgery should not be irrigated or moved unless prescribed by the surgeon. The nurse should notify the surgeon about this finding. Documentation is important, but this finding is not normal.

A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response? a. Decreased intraocular pressure b. Increased heart rate c. Short period of asystole d. Hypertensive crisis

ANS: C Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain. Adenosine has no conclusive impact on intraocular pressure.

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg .c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

The nurse is teaching a patient with a permanent pacemaker. What information about the pacemaker does the nurse tell the patient? (select all that apply) a. Report any pulse rate lower than what is set on the pacemaker. b. If the surgical incision is near the shoulder, avoid overextending the joint. c. Keep handheld cellular phones at least 6 inches away from the generator. d. Avoid sources of strong electro magnetic fields, such as magnets. e. Avoid strenuous activities that may cause the device to discharge inappropriately f. Carry a pacemaker identification card and wear a medical alert bracelet

Acdf

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output .b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

B

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A. Consuming a low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Increasing dairy products enriched with vitamin D

B. Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

A 60-year-old African-American client is newly diagnosed with mild chronic kidney disease (stage 2 CKD). She has a history of diabetes, and her current A1C is 8.0%. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? A. She heavily salted her food as a child and teenager but added no extra salt to her food as an adult. B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. C. Her paternal grandparents had type 2 diabetes and hypertension. D. She drinks 2 cups of coffee water daily.

B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. Rationale: Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) needing dialysis. Managing hyperglycemia delays the onset and progression of CKD. This level of caffeine intake would not lead to either kidney damage or hypertension. The fact that she has reduced her salt intake during adulthood would only help prevent hypertensive kidney disease. The family history of type 2 diabetes and hypertension is a potential risk factor, but her own diabetes and lack of glycemic control manifested by the elevated A1C have a more direct and great adverse effect on kidney function.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

C

A nurse assesses a client with Crohn's disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Distended abdomen b. Temperature of 100.0° F (37.8° C) c. Loose and bloody stool d. Lower abdominal cramps

a. Distended abdomen Could indicate obstruction

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? a. The client must not consume alcohol. b. Avoid sharing the bathroom with the client. c. Members of the household must not share toothbrushes. d. Drink only bottled water and avoid ice.

c Members of the household must not share toothbrushes. Toothbrushes, razors, towels, and items that may spread blood and body fluids should not be shared. The client should not consume alcohol, but abstention will not prevent spread of the virus. The client may share a bathroom if he or she is continent. To prevent hepatitis A when traveling to foreign countries, bottled water should be consumed and ice made from tap water should be avoided.

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? a. Provides enzymes necessary to digest dairy products b. Reduces portal pressure c. Promotes gastrointestinal (GI) excretion of ammonia d. Decreases GI bleeding

c Promotes gastrointestinal (GI) excretion of ammonia Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is the enzyme that digests dairy products. The mechanism of action of lactulose is not to reduce portal pressure. Lactulose does not affect bleeding.

Which of these assigned clients does the nurse assess first after receiving the change-of-shift report? A. Young adult admitted the previous day with abdominal pain who is scheduled for a computed tomography (CT) scan in 30 minutes B. Adult with gastroesophageal reflux disease (GERD) who is describing epigastric pain at a level of 6 (0-to-10 pain scale) C. Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube D. Older adult admitted with an ileus who has absent bowel sounds and a prescription for metoclopramide (Reglan) on an as-needed (PRN)

c-The presence of blood in NG drainage is an unexpected finding 2 days after esophagogastrectomy and requires immediate investigation. The young adult scheduled for a CT scan, the adult with GERD, and the older adult with an ileus are all stable and do not require the nurse's immediate attention.

The nurse is reviewing ECG results of a patient admitted for fluid and electrolyte imbalances. The T waves are tall and peaked. The nurse reports this finding to the provider and obtains an order for which serum level tests? a. Sodium b. Glucose c. Potassium d. Phosphorus

c. Potassium

How is neomycin sulfate (Mycifradin) used to treat patients with cirrhosis? a. It treats the current infection the patient has. b. It prevents future infections of the liver. c. It restores normal function to the liver cells. d. It decreases the rate of ammonia

d. It decreases the rate of ammonia production

What laboratory finding signifies an immune response to liver disease? 1Elevated serum globulin 2Elevated serum ammonia 3Decreased serum albumin 4Decreased serum total protein

1 An increase in the serum globulin level indicates an immune response to liver disease. A decrease in serum total protein signifies chronic liver disease, and a decrease in serum albumin signifies severe liver disease. The serum ammonia level is elevated in advanced liver disease or portal-systemic encephalopathy because the liver is unable to detoxify protein byproducts.

What are potential complications of Crohn's disease? Select all that apply. 1 Fistulas 2 Osteoporosis 3 Malabsorption 4 Stomach cancer 5 Abscess formation

1,2,3,5 The complications of Crohn's disease include abscess formation, colon cancer, malabsorption, fistulas, and osteoporosis. Stomach cancer is not a complication of Crohn's disease; colorectal cancer, however, is a possible complication of ulcerative colitis.

Which sign of peritonitis appears first in an older adult? 1Chills 2Fever 3Confusion 4Abdominal pain

3 The first sign of peritonitis in older adults may be a sudden change in mental status (e.g., acute confusion). For those who have dementia, the confusion worsens. Fever and chills may not be present because of normal physiologic changes associated with aging. Abdominal pain will be present but will not be the first sign.

A client in the progressive or intermediate stage of hypovolemic shock will exhibit which manifestation? 1Polyuria 2Metabolic alkalosis 3Moist, warm skin 4Feeling of impending doom

4. Feeling of impending doom Rationale: As shock progresses, tissue perfusion to the brain continues to be reduced, causing a sense of anxiety or that "something bad" is about to happen. Oliguria or anuria occurs in the nonprogressive stage rather than polyuria. A lack of perfusion to the skin results in cool, moist skin rather than warm skin. Due to decreased tissue perfusion, buildup of lactic or metabolic acid occurs; the arterial blood gases reflect metabolic acidosis at this time.

What type of cirrhosis is caused by hepatitis C? 1Biliary 2Laennec's 3Cholestatic 4Postnecrotic

4Postnecrotic The hepatitis C virus causes postnecrotic cirrhosis. Laennec's cirrhosis is caused by chronic alcoholism. Biliary cirrhosis is also called cholestatic cirrhosis; it is caused by chronic biliary obstruction or autoimmune disease.

The nurse is observing a co-worker who is caring for a client with a nasogastric tube following esophageal surgery. Which actions by the co-worker require the nurse to intervene? (Select all that apply.) A. Checking tube placement every 12 hours B. Keeping the bed flat C. Placing the client upright when taking sips of water D. Providing mouth care every 8 hours E. Securing the tube

A, B, D The nasogastric tube should be checked every 4 to 8 hours. The head of the bed should be elevated at least 30 degrees. Oral hygiene should be provided every 2 to 4 hours. The client should be placed upright when taking sips or small amounts of water to prevent choking and to allow observation of the client for dysphagia. The tube should be secured to prevent dislodgment.

A patient undergoing hemodialysis will likely have an arteriovenous fistula or graft. Which specific safety precautions would the nurse take to care for these patients, in regards to their dialysis access?Select all that apply. A. Interventions to prevent clotting of the vascular access B. The meticulous aseptic technique to prevent infection of vascular access C. Immobilization of the extremity to prevent rupture of the AV fistula or graft D. Peripheral venous access and venipuncture should be in the contralateral extremity E. Blood pressure measurements should be in the contralateral extremity

A. Interventions to prevent clotting of the vascular access. The AV fistula or graft forms a large vascular access point with high volume, turbulent blood flow. Precautions to prevent clotting are essential. B. Meticulous aseptic technique to prevent infection of vascular accessPrevention of infection is always of the utmost importance when a patient has direct vascular access. D. Peripheral venous access and venipuncture should be in the contralateral extremity.For vein preservation and hemodialysis fistula/graft protection, IV line placement and venipuncture should be done on the opposite extremity. E. Blood pressure measurements should be in the contralateral extremity.Blood pressure should not be taken on the extremity that has the AV fistula/graft. This is to prevent significant increases in pressure at the fistula/graft area.

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

ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. The other statements are not correct.

The nurse is assessing a male patient with cirrhosis. Which male-specific characteristics does the nurse expect to find? Select all that apply. a. Gynecomastia b. Testicular atrophy c. Ascites d. Impotence e. Spider angiomas f. Petechiae

a. Gynecomastia b. Testicular atrophy d. Impotence

Which dysrhythmia causes the ventricles to quiver, resulting in absence of cardiac output? a. Ventricular tchycardia b. Ventricular fibrillation c. Asystole d. Third-degree heart block

b. Ventricular fibrillation

The nurse is assessing an older patient with diverticulitis. Which instructions given by the nurse will be beneficial to this patient? Select all that apply. 1 "Refrain from drinking alcohol." 2 "Use mild laxatives three times a day." 3 "Refrain from physical activities like bending." 4 "Add tomatoes and strawberries in your diet." 5"Eat a high-fiber diet during severe abdominal pain."

1,3 Inflammation of diverticula indicates diverticulitis. A patient with diverticulitis should avoid alcohol because it irritates the bowel. An older patient with diverticulitis should refrain from physical activities such as bending and coughing to prevent an increase in intra-abdominal pressure, which can result in perforation of the diverticulum. An older patient should refrain from taking laxatives because laxatives increase intestinal motility. Tomatoes and strawberries should not be consumed as they contain seeds that may block the diverticula. In the acute phase of diverticulitis, the patient should refrain from eating a high-fiber diet.

Which findings does the nurse expect with a diagnosis of acute peritonitis? Select all that apply. 1 Fever 2 Diarrhea 3 Vomiting 4 Tachycardia 5 Rigid abdomen

1,3,4,5 Fever, vomiting, tachycardia, and a rigid, boardlike abdomen accompany the diagnosis of peritonitis from the inflammation of the peritoneal cavity. Diarrhea would not be present, as bowel motility slows, bowel sounds become more distant, and the passage of flatus and feces cease.

The nurse is administering continuous intravenous infusion of norepinephrine (Levophed) to a client in shock. Which finding causes the nurse to decrease the rate of infusion? 1Blood pressure 170/96 mm Hg 2Respiratory rate 22 breaths/min 3Urine output of 70 mL/hr 4Heart rate 98 beats/min

1. Blood pressure 170/96 mm Hg Rationale:Signs of excess vasoconstricting drugs include headache, hypertension, and decreased renal perfusion manifested by oliguria. While vasoconstricting medications and the shock state may cause tachycardia (heart rate greater than 100 beats/min), this client's heart rate is within normal range. Vasoconstricting drugs do not affect the respiratory rate; shock itself causes an increased respiratory rate in an effort to deliver more oxygen to the tissues.

Which assessment findings are consistent with the nonprogressive (compensatory) phase of shock? Select all that apply. 1Cool skin 2Bradycardia 3Elevated liver function tests 4Restlessness 5Tachypnea 6Anxiety

1. Cool skin 4. Restlessness 5. Tachypnea 6. Anxiety Rationale:Thirst, anxiety, restlessness, tachycardia, and increased respiratory rate (tachypnea) along with oliguria and narrowing pulse pressure appear in the nonprogressive (compensatory) stage of shock. Organ damage manifested by increased liver enzymes or kidney function occur in the progressive or intermediate phase of shock. Tachycardia, rather than bradycardia, occurs in shock states secondary to catecholamines released as compensatory mechanisms.

Which are cardiovascular manifestations of hypovolemic shock? Select all that apply. 1Narrow pulse pressure 2Postural hypotension 3Decreased pulse rate 4Decreased cardiac output 5Bounding peripheral pulses

1. Narrow pulse pressure 2. Postural hypotension 4. Decreased cardiac output Rationale:In hypovolemic shock, total body fluid is reduced; therefore, the difference between systolic and diastolic pressure (pulse pressure) is decreased. Blood pressure in the body drops also causing postural hypotension. The decrease in blood volume causes a simultaneous decrease in cardiac output. There is a compensatory increase in pulse rate to restore cardiac output in shock. Peripheral pulses become weak in hypovolemic shock.

What surgical techniques are involved in the treatment of Crohn's disease? 1Minimal invasive surgery (MIS) and ileostomy 2Minimal invasive surgery (MIS) and stricturoplasty 3Ileostomy and natural orifice transluminal endoscopic surgery (NOTES) 4Stricturoplasty and natural orifice transluminal endoscopic surgery (NOTES)

2 MiIS is performed for treating Crohn's disease which involves one or more small incisions, less pain, and quicker surgical recovery. Stricturoplasty is performed for bowel strictures related to Crohn's disease.Ileostomy and NOTES are the surgical techniques performed for treating ulcerative colitis.

The nurse is caring for a patient with peritonitis. What assessment findings will the nurse observe? Select all that apply. 1 Diarrhea 2 Anorexia 3 Low-grade fever 4 Distended abdomen 5 Increased urine output

2,4 Peritonitis is an acute inflammation of the visceral and the parietal peritoneum and the endothelial lining of the abdominal cavity. A patient with peritonitis presents with a distended abdomen and anorexia. The patient has a high fever rather than a low-grade fever. Urine output is decreased because fluid shifts from the vascular compartment to the peritoneal cavity. There is no diarrhea; rather, the patient is unable to pass flatus because peristalsis slows or stops due to severe peritoneal inflammation.

A client with septic shock has been started on dopamine (Intropin) at 12 mcg/kg/min. Which response indicates a positive outcome?1Hourly urine output 10-12 mL/hr 2Blood pressure 90/60 and mean arterial pressure (MAP) 70 3Blood glucose 245 4Serum creatinine 3.6 mg/d

2. Blood pressure 90/60 and mean arterial pressure (MAP) 70 Rationale: Dopamine improves blood flow by increasing peripheral resistance, which increases blood pressure—a positive response. Urine output less than 30 mL/hr or 0.5 mL/kg/hr and elevations in serum creatinine indicate poor tissue perfusion to the kidney and is a negative consequence of shock, not a positive response. Although a blood glucose of 245 is an abnormal finding, dopamine increases blood pressure and myocardial contractility, not glucose levels.

Which individual has the greatest risk for developing hepatitis A? 1Health care worker 2Intravenous drug user 3Patient receiving hemodialysis 4Person who consumes raw oysters

4 Undercooked or raw shellfish from contaminated waters and food handled by those who have not washed their hands thoroughly are at risk for hepatitis A. Intravenous drug users, those undergoing hemodialysis, and health care workers are more at risk for hepatitis B or C, which is spread by blood or body fluids.

A client admitted with a bleeding duodenal ulcer is NPO and has a nasogastric tube in place connected to low continuous suction. What assessment finding does the nurse report to the provider as a possible indicator of nonprogressive stage of shock? 1Serum potassium level of 4.7 mEq/L 2Decrease in mean arterial pressure (MAP) from 76 mm Hg to 62 mm Hg 3Urine output of 30 mL/hour 4Increased confusion

2. Decrease in mean arterial pressure (MAP) from 76 mm Hg to 62 mm Hg Rationale:When shock progresses from the initial stage to the nonprogressive stage, symptoms are subtle but present. Once the client enters the progressive and refractory stage of shock, manifestations are more obvious and may not be responsive to therapy. Recognizing early manifestations of shock are important to client outcomes. The nonprogressive stage of shock is present when the MAP decreases by 10-15 mm Hg from baseline, urine output decreases, and heart rate and respiratory rate increase. Confusion and moderate hyperkalemia is observed in the progressive stage of shock. The client's urine output is still within normal limits as may be seen in the initial stage of shock, but urine output will continue to decrease as the shock stages progress.

Which term best describes the symptoms that occur in the nonprogressive (compensatory) phase of shock?1Hypoxemia 2Oliguria 3Decreased tissue perfusion 4Blood loss related to hemorrhage

2. Oliguria Rationale: Compensatory mechanisms in the nonprogressive stage of shock result from increased sympathetic nervous stimulation and release of antidiuretic hormone (ADH); vasoconstriction and water retention to maintain fluid volume occur with oliguria as a result. Problems such as reduction in mean arterial pressure and tissue perfusion, hypoxemia, and acid-base imbalances occur in the compensatory phase, but compensatory mechanisms keep the pulse oximetry reading within 2-5% of baseline. Blood loss may occur in hemorrhagic or hypovolemic shock; this question addresses the overall shock state.

Which activity by the nurse will best relieve symptoms associated with ascites? 1Administering oxygen 2Elevating the head of the bed 3Administering intravenous fluids 4Monitoring serum albumin levels

2Elevating the head of the bed The enlarged abdomen of ascites limits respiratory excursion; Fowler's position will increase excursion and reduce shortness of breath. The patient may need oxygen, but first the nurse should raise the head of the bed to improve respiratory excursion and oxygenation. Monitoring will detect anticipated decreased serum albumin levels associated with cirrhosis and hepatic failure but does not relieve the symptoms of ascites. Administering IV fluids will contribute to fluid volume excess and fluid shifts into the peritoneal cavity, worsening ascites.

Which complication is seen exclusively in patients with ulcerative colitis? 1Cholelithiasis 2Malabsorption 3Colorectal cancer 4Abscess formation

3 Colorectal cancer is a major complication of ulcerative colitis that is seen in patients who have a history of that disease for more than 10 years. Cholelithiasis is an extraintestinal complication observed in patients with both ulcerative colitis and Crohn's disease. Malabsorption is a common complication seen both in ulcerative colitis and Crohn's disease; however, this condition is more common in Crohn's disease. Abscess formation is also seen in patients with both ulcerative colitis and Crohn's disease.

The nurse is instructing a client about infection prevention strategies to reduce the risk of sepsis. Which client response suggests further self-management teaching is needed prior to discharge? 1"I will avoid crowds and large gatherings until I am better." 2"I'll make sure the dishwasher is set on hot to wash and dry my dishes." 3"I won't need help anymore to care for my cats and change the litter box." 4"I guess I won't work in the garden for a few more months."

3. "I won't need help anymore to care for my cats and change the litter box." Rationale: Protecting clients from infection and sepsis at home through education is an important nursing function. Clients need to understand the importance of good handwashing, balanced diet, rest and exercise, as well as staying away from large crowds and other sources of infection like dirt and animal litter boxes.

A client in hypovolemic shock has been placed on an infusion of the vasopressor agent norepinephrine (Levophed). Which parameter indicates a desired client response to the therapy?1Heart rate change from 112 to 123 beats/min 2Decreased peripheral pulses 3Mean arterial pressure change from 66 to 78 mm Hg 4Urine output remains at 30 mL/hour

3. Mean arterial pressure change from 66 to 78 mm Hg Rationale: If fluid therapy is not effective in increasing blood pressure, vasoconstricting drugs may be added to increase tissue perfusion. When vasoactive agents are administered, the nurse monitors for effectiveness by evaluating improvements in cardiac output and mean arterial pressure. An increase, not decrease, in urine output is a desired response. An increased heart rate is expected due to sympathetic nervous system stimulation of norepinephrine. Decreased peripheral pulses may occur due to vasoconstrictor effects, but it is not a desired response.

What typical sign/symptom indicates the early stage of septic shock? 1Pallor and cool skin 2Blood pressure 84/50 mm Hg 3Tachypnea and tachycardia 4Respiratory acidosis

3. Tachypnea and tachycardia Rationale: Signs of systemic inflammatory response syndrome, which precede sepsis, include rapid respiratory rate, leukocytosis, and tachycardia. In the early stage of septic shock, the client is usually warm and febrile. Hypotension does not develop until later in septic shock due to compensatory mechanisms. Respiratory alkalosis occurs early in shock because of an increased respiratory rate.

Which is a risk factor for the development of hepatitis C? 1Consuming shellfish 2Traveling internationally 3Chronic alcohol consumption 4Employment in the health care field

4 Risk factors for hepatitis C include illicit drug use by IV or intranasal route, unsanitary tattoo equipment, and current or former employment in the health care field (because health care workers can easily be exposed to blood and body fluids). Hepatitis A can be contracted by consuming contaminated shellfish. Hepatitis E can be contracted by individuals who travel to countries with poor sanitation. Chronic alcohol consumption is a risk factor for cirrhosis, not hepatitis.

Which medication is used as the first line treatment for mild ulcerative colitis? 1Infliximab 2Prednisone 3Loperamide 4Sulfasalazine

4 Sulfasalazine is an aminosalicylate used to treat mild-moderate ulcerative colitis. Infliximab alone is not effective in treating ulcerative colitis. Glucocorticoids such as prednisone are prescribed during exacerbations of the disease. Antidiarrheal drugs such as loperamide provide symptomatic management of the disease.

A client with which problem or condition is at highest risk for septic shock? 1Obese 2Post-uncomplicated appendectomy 3Post-myocardial infarction 4On prednisone (Deltasone) therapy for rheumatoid arthritis

4. On prednisone (Deltasone) therapy for rheumatoid arthritis Rationale: Clients who do not have intact immune systems are at highest risk for sepsis and septic shock including those who have had organ transplants, with HIV/AIDS, kidney or liver disease, the very old, and those with invasive lines and procedures. Prednisone, taken for autoimmune diseases such as rheumatoid arthritis, suppresses the immune system and prevents further damage to the joints. While obesity, surgery, and hospitalization for MI pose some risk for infection and sepsis, the use of corticosteroid medications is an actual risk for the development of sepsis and septic shock.

Why are the clinical signs and symptoms of most types of shock the same, regardless of what condition caused the shock to occur?1An increase in heart rate is always the first physiologic adjustment the body makes to all stress states. 2Because blood loss occurs with all types of shock, the most common first clinical symptom is hypotension. 3Every type of shock interferes with cellular oxygenation in the same sequence. 4The sympathetic nervous system is triggered by any type of shock and initiates the stress response.

4. The sympathetic nervous system is triggered by any type of shock and initiates the stress response. Rationale: Most manifestations of shock are similar regardless of what starts the process or which tissues are affected first. These common manifestations result from physiologic adjustments (compensatory mechanisms) in an attempt to ensure continued oxygenation of vital organs. These adjustment actions are performed by the sympathetic nervous system triggering the stress response and activating the endocrine and cardiovascular systems.

Which is a risk factor for the development of hepatitis C? 1Consuming shellfish 2Traveling internationally 3Chronic alcohol consumption 4Employment in the health care field

4Employment in the health care field Risk factors for hepatitis C include illicit drug use by IV or intranasal route, unsanitary tattoo equipment, and current or former employment in the health care field (because health care workers can easily be exposed to blood and body fluids). Hepatitis A can be contracted by consuming contaminated shellfish. Hepatitis E can be contracted by individuals who travel to countries with poor sanitation. Chronic alcohol consumption is a risk factor for cirrhosis, not hepatitis.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub. B. Assess for crackles. C. Monitor for decreased peripheral pulses. D. Determine if the client is able to ambulate.

A. Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? a. Mid-sternal chest pain b. Increased urine output c. Mild orthostatic hypotension d. P wave touching the T wave

ANS: A Chest pain, possibly angina, indicates that tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain. Increased urinary output and mild orthostatic hypotension are not life-threatening conditions and therefore do not require immediate intervention. The P wave touching the T wave indicates significant tachycardia and should be assessed to determine the underlying rhythm and cause; this is an important assessment but is not as critical as chest pain, which indicates cardiac cell death.DIF: Applying/Application REF: 663KEY: Cardiac electrical conductionMSC: IntegratedProcess:NursingProcess:AssessmentNOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the clients confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)

ANS: C Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.

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

a-Teach the client to limit or eliminate foods that decrease lower esophageal sphincter (LES) pressure and that irritate inflamed tissue, causing heartburn, such as peppermint, chocolate, alcohol, fatty foods (especially fried), caffeine, and carbonated beverages. Large meals increase the volume of and pressure in the stomach and delay gastric emptying. Remind the client to eat four to six small meals each day rather than three large ones. Peppermint decreases LES pressure and increases the risk of symptoms. Clients should be taught to elevate the head by 6 to 12 inches for sleep to prevent nighttime reflux.

The nurse is reviewing preliminary ECG results of a patient admitted for mental status changes. The nurse alerts the health care provider about ST elevation or depression in the patient because it is an indication of which condition? a. Myocardial injury or ischemia b. Ventricular irritability c. Subarachnoid hemorrhage d. Prinzmetal's angina

a. Myocardial injury or ischemia

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? a. Clients who work with shellfish b. Men who prefer sex with men c. Clients traveling to a third-world country d. Clients with elevations of aspartate aminotransferas e and alanine aminotransferase

b Men who prefer sex with men Men who prefer sex with men are at increased risk for hepatitis B, which is spread by the exchange of blood and body fluids during sexual activity. Consuming raw or undercooked shellfish may cause hepatitis A, not hepatitis B. Travel to third-world countries exposes the traveler to contaminated water and risk for hepatitis A; hepatitis B is not of concern, unless the client is exposed to blood and body fluids during travel. Clients who have liver disease should receive the vaccine, but men who have sex with men are at higher risk for contracting hepatitis B.

Which statements about hepatitis are accurate?Select all that apply .a. Hepatitis D is the leading cause of cirrhosis and liver failure in the U.S. b. Hepatitis A is spread through the fecal- oral route. c. Hepatitis B can be transmitted through unprotected sexual intercourse. d. Hepatitis carriers have chronic obvious signs of hepatitis B. e. Hepatitis C is transmitted by casual contact or intimate household contact. f. Hepatitis D only occurs with hepatitis B to cause viral replication.

b. Hepatitis A is spread through the fecal- oral route c. Hepatitis B can be transmitted through unprotected sexual intercourse. f. Hepatitis D only occurs with hepatitis B to cause viral replication.

The nurse is caring for a client in the refractory stage of cardiogenic shock. Which intervention does the nurse consider? a. Admission to rehabilitation hospital for ambulatory retraining b. Collaboration with home care agency for return to home c. Discussion with family and provider regarding palliative care d. Enrollment in a cardiac transplantation program

c Discussion with family and provider regarding palliative care In this irreversible phase, therapy is not effective in saving the client's life, even if the cause of shock is corrected and mean arterial pressure temporarily returns to normal. A discussion on palliative care should be considered. Rehabilitation or returning home is unlikely. The client with sustained tissue hypoxia is not a candidate for organ transplantation.

The nurse is reviewing the medication history for a client diagnosed with gastroesophageal reflux disease who has been prescribed esomeprazole (Nexium) once daily. The client reports that the drug doesn't completely control the symptoms. The nurse contacts the provider to discuss which intervention? A. Adding a second proton pump inhibitor medication B. Increasing the dose of esomeprazole C. changing to a twice-daily dosing regimen D. Switching to omeprazole (Prilosec)

c-The proton pump inhibitors are usually effective when given once daily, but can be given twice daily if symptoms are not well controlled. Adding a second medication, increasing the dose, or switching to another proton pump inhibitor is not recommended.