Exam 4 Endocrine and Gastrointestinal

A hospitalized patient has just been diagnosed with diarrhea due to C. difficile. Which nursing interventions should be included in the patient's plan of care? (Select all that apply.) A. Initiate contact isolation precautions. B. Place the patient on a clear liquid diet. C. Teach any visitors to wear gloves and gowns. D. Disinfect the room with 10% bleach solution as needed. E. Use hand sanitizer before and after any bodily fluid contact.

A, C, D Initiate contact isolation precautions. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Rationale: Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. D. The patient may be excreting sodium and retaining potassium from malnutrition. E. This level shows adequate treatment of the cellulitis and acceptable glucose control.

A,B and C Correct Answer: The level is consistent with renal insufficiency from renal nephropathy. The level may be high because of dehydration that accompanies hyperglycemia. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. Rationale: The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The increased potassium level does not show adequate treatment of cellulitis or acceptable glucose control.

The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should be included in the plan of care? (Select all that apply.) A. Obtain daily weights. B. Limit fluids to 1000 mL/day. C. Administer diuretics as ordered. D. Monitor for signs of hypernatremia. E. Minimize turning and range of motion. F. Elevate the head of the bed at 10 degrees or less.

A,B,C, and F Correct Answer: Obtain daily weights. Limit fluids to 1000 mL/day. Administer diuretics as ordered. Elevate the head of the bed at 10 degrees or less. Rationale: The care for the patient with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

The nurse is caring for a patient admitted with suspected hyperparathyroidism. Which manifestations would represent the expected electrolyte imbalance? (Select all that apply.) A. Nausea and vomiting B. Neurologic irritability C. Lethargy and weakness D. Increasing urine output E. Hyperactive bowel sounds

A,C, and D Correct Answer: Nausea and vomiting Lethargy and weakness Increasing urine output Rationale: Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability and hyperactive bowel sounds do not occur with hypercalcemia.

Which assessment finding would the nurse expect in a patient who has been taking oral prednisone several weeks and is experiencing sudden withdrawal? (Select all that apply.) A. BP 80/50 B. Heart rate 54 C. Glucose 63 mg/dL D. Sodium 148 mEq/L E. Potassium 6.3 mEq/L F. Temperature 101.1° F

A,C,E and F Correct Answer: BP 80/50 Glucose 63 mg/dL Potassium 6.3 mEq/L Temperature 101.1° F Rationale: Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. During acute adrenal insufficiency, the patient exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies, including hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? A. "I will be able to regulate when I have stools." B. "I will be able to wear a pouch until it leaks." C. "The drainage from my stoma can damage my skin." D. "Dried fruit and popcorn must be chewed very well."

A. "I will be able to regulate when I have stools." Correct Answer: "I will be able to regulate when I have stools." Rationale: An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75° F) for up to 1 month."

A. "I will discard any insulin bottle that is cloudy in appearance." Correct Answer: "I will discard any insulin bottle that is cloudy in appearance." Rationale: Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (<32°F [0°C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

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? A. "It would be beneficial for you to stop drinking alcohol." B. "You'll need to drink at least 2 to 3 glasses of milk daily." C. "Many people find that a minced or pureed diet eases their symptoms of PUD." D. "You can keep your present diet and minimize symptoms by taking medication."

A. "It would be beneficial for you to stop drinking alcohol." Correct Answer: "It would be beneficial for you to stop drinking alcohol." Rationale: 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.

The nurse teaches older adults at a community center how to prevent food poisoning at social events. Which community member statement reflects accurate understanding? A. "Pasteurized juices and milk are safe to drink." B. "Raw cookie dough is safe to eat if it is cold." C. "Fresh fruits do not need washed before eating." D. "Ground beef is safe to eat if it is slightly pink."

A. "Pasteurized juices and milk are safe to drink." Correct Answer: "Pasteurized juices and milk are safe to drink." Rationale: Drink only pasteurized milk, juice, or cider. Ground beef should be cooked thoroughly. Browned meat can still harbor live bacteria. Cook ground beef until a thermometer reads at least 160° F. If a thermometer is unavailable, decrease the risk of illness by cooking the ground beef until there is no pink color in the middle. Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. Do not eat raw food products, such as dough, that are supposed to be cooked.

The nurse is teaching a patient with acromegaly from an unresectable benign pituitary tumor about octreotide therapy. The nurse should provide further teaching if the patient makes which statement? A. "The provider will infuse this medication through an IV." B. "I will inject the medication in the subcutaneous layer of the skin." C. "The medication should decrease the growth hormone production to normal." D. "I will have my growth hormone level measured every 2 weeks for several weeks."

A. "The provider will infuse this medication through an IV." Correct Answer: "The provider will infuse this medication through an IV." Rationale: Drug therapy is an option for patients whose tumors are not surgically resectable. The primary drug used is octreotide, a somatostatin analog. It reduces growth hormone (GH) levels to normal in many patients. Octreotide is given by subcutaneous injection three times a week. GH levels are measured every 2 weeks to K guide drug dosing, and then every 6 months until the desired response is obtained.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? A. "The tube will help to drain the stomach contents and prevent further vomiting." B. "The tube will push past the area that is blocked and help to stop the vomiting." C. "The tube is just a standard procedure before many types of surgery to the abdomen." D. "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

A. "The tube will help to drain the stomach contents and prevent further vomiting." Rationale: The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? A. A 48-yr-old woman with a hemoglobin A1C of 8.4% B. A 58-yr-old man with a fasting blood glucose of 111 mg/dL C. A 68-yr-old woman with a random plasma glucose of 190 mg/dL D. A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

A. A 48-yr-old woman with a hemoglobin A1C of 8.4% Correct Answer: A 48-yr-old woman with a hemoglobin A1C of 8.4% Rationale: Criteria for a diagnosis of diabetes include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.

The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

A. Excessive thirst Correct Answer: Excessive thirst Rationale: The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

The nurse is caring for a patient after a parathyroidectomy. The nurse would prepare to administer IV calcium gluconate if the patient has which manifestations? A. Facial muscle spasms and laryngospasms B. Tingling in the hands and around the mouth C. Decreased muscle tone and muscle weakness D. Shortened QT interval on the electrocardiogram

A. Facial muscle spasms and laryngospasms Correct Answer: Facial muscle spasms and laryngospasms Rationale: Nursing care for a patient after a parathyroidectomy includes monitoring for a sudden decrease in serum calcium levels causing tetany, a condition of neuromuscular hyperexcitability. If tetany is severe (e.g., muscular spasms or laryngospasms develop), IV calcium gluconate should be administered. Mild tetany, characterized by unpleasant tingling of the hands and around the mouth, may be present but should decrease over time without treatment. Decreased muscle tone, muscle weakness, and shortened QT interval are manifestations of hyperparathyroidism.

Two days after a bowel resection for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? A. Impaired peristalsis B. Irritation of the bowel C. Nasogastric suctioning D. Inflammation of the incision site

A. Impaired peristalsis Correct Answer: Impaired peristalsis Rationale: Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? A. Maintain a high intake of fluid and fiber in the diet. B. Discontinue intake of medications causing constipation. C. Eat several small meals per day to maintain bowel motility. D. Sit upright during meals to increase bowel motility by gravity.

A. Maintain a high intake of fluid and fiber in the diet Correct Answer: Maintain a high intake of fluid and fiber in the diet. Rationale: Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

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? A. Pallor and diaphoresis B. Reddened peripheral IV site C. Guaiac-positive diarrhea stools D. Heart rate 90, respiratory rate 20, BP 110/60

A. Pallor and diaphoresis Correct Answer: Pallor and diaphoresis Rationale: 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.

What is a nursing priority when caring for a patient with hypothyroidism? A. Patient teaching related to levothyroxine B. Providing a dark, low-stimulation environment C. Closely monitoring the patient's intake and output D. Initiating precautions related to radioactive iodine therapy

A. Patient teaching related to levothyroxine Correct Answer: Patient teaching related to levothyroxine Rationale: A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to closely monitor intake and output. Low stimulation and radioactive iodine therapy are used to treat hyperthyroidism.

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? A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high Fowler's position

A. Providing IV fluids and inserting a nasogastric (NG) tube Correct Answer: Providing IV fluids and inserting a nasogastric (NG) tube Rationale: 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.

A patient with ulcerative colitis is scheduled for a colon resection with placement of an ostomy. The nurse should plan to include which prescribed measure in the preoperative preparation? A. Selecting the stoma site B. Where to purchase ostomy supplies C. Teaching about how to irrigate a colostomy D. Following a high-fiber diet the day before surgery

A. Selecting the stoma site Rationale: Care that is unique to ostomy surgery includes selecting the best site for the stoma. Instructions to irrigate the colostomy and where to purchase ostomy supplies will be done postoperatively. A clear liquid diet will be used the day before surgery with the bowel cleansing.

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

A. Tremors Correct Answer: Tremors Rationale: 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 patient with oral cancer is not eating. A small-bore feeding tube was inserted, and the patient started on enteral feedings. Which patient goal would best indicate improvement? A. Weight gain of 1 kg in 1 week B. Tolerated the tube feeding without nausea C. Consumed 50% of clear liquid tray this shift D. The feeding tube remained in proper placement

A. Weight gain of 1kg in 1 week Correct Answer: Weight gain of 1 kg in 1 week Rationale: The best goal for a patient with oral cancer that is not eating would be to note weight gain rather than loss. Consuming 50% of the clear liquid tray is not a realistic goal. The absence of nausea and proper tube placement, while desired, do not indicate nutritional improvement.

The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level.

A. assess the patient's perception of what is means to have diabetes. Correct Answer: Assess patient's perception of what it means to have diabetes. Rationale: For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

A. cheese Correct Answer: Cheese Rationale: Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? A. Chooses a puncture site in the center of the finger pad. B. Washes hands with soap and water to cleanse the site to be used. C. Warms the finger before puncturing the finger to obtain a drop of blood. D. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

A. chooses a puncture site in the center of the finger pad. Correct Answer: Chooses a puncture site in the center of the finger pad. Rationale: The patient should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction about desmopressin acetate would be most appropriate? A. Expect to have some nasal irritation while using this drug. B. Monitor for symptoms of hypernatremia as a drug side effect. C. Report any decrease in urinary output to the health care provider. D. Drink at least 3000 mL of water per day while taking this medication.

A. expect to have some nasal irritation while using this drug. Correct Answer: Expect to have some nasal irritation while using this drug. Rationale: Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention if they have severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? A. Fecal impaction B. Perineal hygiene C. Dietary fiber intake D. Antidiarrheal agent use

A. fecal impaction Correct Answer: Fecal impaction Rationale: Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

A. increased triglyceride levels Correct Answer: Increased triglyceride levels Rationale: Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The nurse is caring for a patient receiving high-dose oral corticosteroid therapy after a kidney transplant. Which side effect would the nurse monitor for as it presents the greatest risk? A. Infection B. Low blood pressure C. Increased urine output D. Decreased blood glucose

A. infection Correct Answer: Infection Rationale: Side effects of corticosteroid therapy include increased susceptibility to infection, edema related to sodium and water retention (decreasing urine output), hypertension, and hyperglycemia.

A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the medication states: methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse administer?

ANS: 1.6 A concentration of 125 mg in 2 mL will result in 100 mg in 1.6 mL.

Vasopressin 0.2 unit/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 100 units/250 mL normal saline. How many mL/hr will the nurse infuse?

ANS: 30 There are 0.4 unit/1 mL. An infusion of 30 mL/hr will result in the patient receiving 0.2 units/min as prescribed.

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

ANS: A A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat.

What should the nurse admitting a patient with acute diverticulitis plan for initial care? a. Administer IV fluids. b. Prepare for colonoscopy. c. Encourage a high-fiber diet. d. Give stool softeners and enemas

ANS: A A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

Which patient should the nurse assess first after receiving change-of-shift report? A. A patient with esophageal varices who has a rapid heart rate B. A patient with a history of gastrointestinal bleeding who has melena C. A patient with nausea who has a dose of metoclopramide (Reglan) due D. A patient who is crying after receiving a diagnosis of esophageal cancer

ANS: A A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients do not indicate acutely life-threatening complications.

A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do? a. Collect a stool specimen. b. Prepare for colonoscopy. c. Schedule a barium enema. d. Have blood cultures drawn.

ANS: A Acute diarrhea is usually caused by an infectious process, so stool specimens are obtained for culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect? a. 2 b. 3 c. 4 d. 5

ANS: A After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? A. Increased thyroxine (T4) level B. Blood pressure 112/62 mm Hg C. Distant and difficult to hear heart sounds D. Elevated thyroid stimulating hormone level

ANS: A An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine.

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy? A. "Do you feel bloated after eating?" B. "Have you seen any skin changes?" C. "Do you need to increase your insulin dosage when you are stressed?" D. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: A Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask but would not help in identifying autonomic neuropathy.

Which nursing action is most important in assisting an older patient who has diabetes to engage in moderate daily exercise? A. Determine what types of activities the patient enjoys. B. Remind the patient that exercise improves self-esteem. C. Teach the patient about the effects of exercise on glucose level. D. Give the patient a list of activities that are moderate in intensity.

ANS: A Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions may be helpful but are not the most important in improving compliance.

Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

ANS: A Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? A. Assess the patient's perception of what it means to have diabetes. B. Ask the patient's family to participate in the diabetes education program. C. Demonstrate how to check glucose using capillary blood glucose monitoring. D. Discuss the need for the patient to actively participate in diabetes management.

ANS: A Before planning teaching, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be specific to each patient.

A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention should the nurse anticipate? A. Nystatin tablets B. Antiviral agents C. Referral to a dentist D. Hydrogen peroxide rinses

ANS: A C. albicans infections are treated with an antifungal such as nystatin. Peroxide rinses would be painful. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? A. New-onset changes in the patient's voice B. Elevation in the patient's T3 and T4 levels C. Resting apical pulse rate 112 beats/min D. Bruit audible bilaterally over the thyroid gland

ANS: A Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action.

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? A. Measure the ankle-brachial index. B. Check for changes in skin pigmentation. C. Assess for unilateral or bilateral foot drop. D. Ask the patient about symptoms of depression.

ANS: A Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a procedure that can be done by UAP who have been trained in the procedure. The other assessments require more education and critical thinking and should be done by the registered nurse (RN).

Which finding indicates to the nurse that the current therapies are effective for a patient who has acute adrenal insufficiency? A. Increasing serum sodium levels B. Decreasing blood glucose levels C. Decreasing serum chloride levels D. Increasing serum potassium levels

ANS: A Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus? a. Cullen sign b. Rovsing sign c. McBurney sign d. Grey-Turner's sign

ANS: A Cullen sign is ecchymosis around the umbilicus. Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower quadrant. Grey Turner's sign is bruising over the flanks. Deep tenderness at McBurney's point (halfway between the umbilicus and the right iliac crest), known as McBurney's sign, is a sign of acute appendicitis

What diagnostic test should the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis? A. Endoscopy B. Angiography C. Barium studies D. Gastric analysis

ANS: A Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? a. Fistulas can form between the bowel and bladder. b. Bacteria in the perianal area can enter the urethra. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

ANS: A Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? A. Place the patient on a cardiac monitor. B. Administer IV potassium supplements. C. Ask the patient about home insulin doses. D. Start an insulin infusion at 0.1 units/kg/hr

ANS: A Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Discussion of home insulin and possible causes can wait until the patient is stabilized.

Which patient action indicates an accurate understanding of the nurse's teaching about the use of an insulin pump? A. The patient programs the pump for an insulin bolus after eating. B. The patient changes the location of the insertion site every week. C. The patient takes the pump off at bedtime and starts it again each morning. D. The patient plans a diet with more calories than usual when using the pump.

ANS: A In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used, but it does not provide for consuming a higher calorie diet. The pump will deliver a basal insulin rate 24 hours a day.

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient? a. Medication use b. Fluid restriction c. Enteral nutrition d. Activity restrictions

ANS: A Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test? A. The patient uses oral contraceptives. B. The patient runs several days a week. C. The patient has been pregnant three times. D. The patient has a family history of diabetes.

ANS: A Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT. History of previous pregnancies may provide informational about gestational glucose tolerance but will not lead to misleading information from the OGTT.

Which action should the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? A. Obtain a stool specimen for culture. B. Administer antidiarrheal medication. C. Provide teaching about antibiotic therapy. D. Teach the adverse effects of acetaminophen (Tylenol).

ANS: A Patients with bloody diarrhea should have a stool culture for Escherichia coli O157:H7. Antidiarrheal medications are usually avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications. Acetaminophen does not cause bloody diarrhea.

Which prescribed intervention for a patient with chronic short bowel syndrome should the nurse question? a. Senna 1 tablet daily b. Ferrous sulfate 325 mg daily c. Psyllium (Metamucil) 3 times daily d. Diphenoxylate with atropine (Lomotil) PRN loose stools

ANS: A Patients with short bowel syndrome have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives. Iron supplements are used to prevent iron-deficiency anemia, bulk-forming laxatives help make stools less watery, and opioid antidiarrheal drugs are helpful in slowing intestinal transit time.

A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage? A. Lispro (Humalog) B. Glargine (Lantus) C. Detemir (Levemir) D. NPH (Humulin N)

ANS: A Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? a. Fever b. Nausea c. Joint pain d. Headache

ANS: A Since infliximab suppresses the immune response, rapid treatment of infection is essential. Nausea, joint pain, and headache are common side effects of the medication, but they do not indicate any potentially life-threatening complications.

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "I should apply sunscreen before going outdoors." b. "The medication will be tapered if I need surgery." c. "I will need to avoid contact with people who are sick." d. "The medication prevents the infections that cause diarrhea."

ANS: A Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? A. Give the patient 4 to 6 oz more orange juice. B. Administer the PRN glucagon (Glucagon) 1 mg IM. C. Have the patient eat some peanut butter with crackers. D. Notify the health care provider about the hypoglycemia.

ANS: A The "rule of 15" indicates that administration of quickly acting carbohydrates should be done two or three times for a conscious patient whose glucose remains less than 70 mg/dL before notifying the health care provider. More complex carbohydrates and fats may be used after the glucose has stabilized. Glucagon should be used if the patient's level of consciousness decreases so that oral carbohydrates can no longer be given.

6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient? A. The patient will reach a glycosylated hemoglobin level of less than 7%. B. The patient will follow a diet and exercise plan that results in weight loss. C. The patient will choose a diet that distributes calories throughout the day. D. The patient will state the reasons for eliminating simple sugars in the diet

ANS: A The complications of diabetes are related to elevated blood glucose and the most important patient outcome is the reduction of glucose to near-normal levels. A BMI of 30.9/kg/m2 or above is considered obese, so the other outcomes are appropriate but are not as high in priority.

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first? A. Infuse 1 L of normal saline per hour. B. Give sodium bicarbonate 50 mEq IV push. C. Administer regular insulin 10 U by IV push. D. Start a regular insulin infusion at 0.1 units/kg/hr

ANS: A The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? A. Choose flat-soled leather shoes. B. Set heating pads on a low temperature. C. Use a callus remover for corns or calluses. D. Soak feet in warm water for an hour each day

ANS: A The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.

Which patient should the nurse assess first after receiving change-of-shift report? a. A 30-yr-old patient who has a distended abdomen and tachycardia b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours c. A 40-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

ANS: A The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients should be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? A. The patient is confused and lethargic. B. The patient reports a recent head injury. C. The patient has a urine output of 400 mL/hr. D. The patient's urine specific gravity is 1.003.

ANS: A The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? A. 10:00 AM B. 12:00 AM C. 2:00 PM D. 4:00 PM

ANS: A The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough

ANS: A There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort.

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]). A. Rotate NPH vial. B. Withdraw regular insulin. C. Withdraw 20 units of NPH. D. Inject 20 units of air into NPH vial. E. Inject 2 units of air into regular insulin vial

ANS: A, D, E, B, C When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and the additives in the NPH that slow the onset, peak, and duration of activity in the long-acting insulin.

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). What should the nurse anticipate doing? A. Giving 50% dextrose B. Inserting an IV catheter C. Initiating O2 by nasal cannula D. Administering glargine (Lantus) insulin

ANS: B HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires O2. Dextrose solutions will increase the patient's blood glucose and would be contraindicated

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching? a. Stool will be expelled from both stomas. b. This type of colostomy is usually temporary. c. Soft, formed stool can be expected as drainage. d. Irrigations can regulate drainage from the stomas.

ANS: B A loop, or double-barrel stoma, is usually temporary. Stool will be expelled from the proximal stoma only. The stool from the transverse colon will be liquid and regulation through irrigations will not be possible.

A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? A. "Have you had a recent head injury?" B. "Do you have to wear larger shoes now?" C. "Is there a family history of acromegaly?" D. "Are you experiencing tremors or anxiety?"

ANS: B Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.

A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? A. "Weigh yourself daily to monitor for weight gain." B. "The prednisone dose should be decreased gradually." C. "A weight-bearing exercise program will help minimize risk for osteoporosis." D. "Call the health care provider if you have mood changes with the prednisone."

ANS: B Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods

A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Titrate the infusion of 5% dextrose in water. B. Administer prescribed subcutaneous DDAVP. C. Assess the patient's overall hydration status every 8 hours. D. Teach the patient to use desmopressin (DDAVP) nasal spray.

ANS: B Administration of medications is included in LPN/VN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? A. Palpate extremities for edema. B. Measure urine volume every hour. C. Check hematocrit every 2 hours for 8 hours. D. Monitor continuous pulse oximetry for 24 hours.

ANS: B After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

The nurse is admitting a 67-yr-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you usually drink?" b. "Have you noticed a recent weight loss?" c. "What time of day do your bowels move?" d. "Do you eat meat or other animal products?"

ANS: B Although all the questions provide useful information, it is most important to determine if the patient has an imbalance in nutrition because of the steatorrhea.

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take? a. Administer morphine sulfate. b. Encourage the patient to ambulate. c. Offer the prescribed promethazine. d. Instill a mineral oil retention enema.

ANS: B Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider? A. Hemoglobin (Hgb) 10.8 g/dL B. Temperature 102.1° F (38.9° C) C. Absent bowel sounds in all quadrants D. Scant nasogastric (NG) tube drainage

ANS: B An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action

The nurse and a licensed practical/vocational nurse (LPN/VN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/VN requires that the nurse intervene? A. The LPN/VN uses soft swabs to provide oral care. B. The LPN/VN positions the head of the bed in the flat position. C. The LPN/VN includes the enteral feeding volume when calculating intake. D. The LPN/VN encourages the patient to use pain medications before coughing.

ANS: B The patient's bed should be in Fowler's position to prevent reflux and aspiration of gastric contents. The other actions by the LPN/LVN are appropriate.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care? a. Administer IV metoclopramide (Reglan). b. Discontinue the patient's oral food intake. c. Administer cobalamin (vitamin B12) injections. d. Teach the patient about total colectomy surgery.

ANS: B An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate

What should the nurse preparing for the annual physical exam of a 45-yr-old man plan to teach the patient about? a. Endoscopy b. Colonoscopy c. Computerized tomography screening d. Carcinoembryonic antigen (CEA) testing

ANS: B At age 45 years, persons with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 45 years.

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Ambulate six times daily. d. Increase dietary fiber intake

ANS: B Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

After change-of-shift report, which patient should the nurse assess first? A. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% B. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL C. A 50-yr-old patient who uses exenatide (Byetta) and is reporting acute abdominal pain D. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL

ANS: B Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The other patients also have symptoms that require assessments or interventions, but they are not at immediate risk for life-threatening complications.

A 49-yr-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first? A. Insert a nasogastric (NG) tube. B. Infuse normal saline at 250 mL/hr. C. Administer IV ondansetron (Zofran). D. Provide oral care with moistened swabs.

ANS: B Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished after the IV fluids are initiated.

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider? a. The patient has a history of constipation. b. The patient has noticed blood in the stools. c. The patient had an appendectomy at age 27. d. The patient smokes a pack/day of cigarettes

ANS: B Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further assessment by the health care provider. The other patient information will also be communicated to the health care provider but does not indicate an urgent need for further testing or intervention.

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test? a. Identify any metastasis of the cancer. b. Monitor the tumor status after surgery. c. Confirm the diagnosis of a specific type of cancer. d. Determine the need for postoperative chemotherapy

ANS: B CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made based on the biopsy. Chemotherapy use is based on factors other than CEA.

The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Which assessment finding is consistent with panhypopituitarism? A. High blood pressure B. Decreased facial hair C. Elevated blood glucose D. Intermittent tachycardia

ANS: B Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism because of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.

Which patient action indicates accurate understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? A. The patient avoids injecting the insulin into the upper abdominal area. B. The patient cleans the skin with soap and water before insulin administration. C. The patient stores the insulin in the freezer after administering the prescribed dose. D. The patient pushes the plunger down while removing the syringe from the injection site.

ANS: B Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

Which item should the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting? A. Glass of orange juice B. Dish of lemon gelatin C. Cup of coffee with cream D. Bowl of hot chicken broth

ANS: B Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated

A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? A. Restrict the patient to bed rest. B. Encourage 4000 mL of fluids daily. C. Institute routine seizure precautions. D. Assess for positive Chvostek's sign.

ANS: B The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.

Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective? A. "The cobalamin injections will prevent gastric inflammation." B. "The cobalamin injections will prevent me from becoming anemic." C. "These injections will increase the hydrochloric acid in my stomach." D. "These injections will decrease my risk for developing stomach cancer."

ANS: B Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer

Which finding indicates to the nurse that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Weight has increased. B. Urinary output is increased. C. Peripheral edema is increased. D. Urine specific gravity is increased

ANS: B Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? A. "Peppermint tea may reduce your symptoms." B. "Keep the head of your bed elevated on blocks." C. "You should avoid eating between meals to reduce acid secretion." D. "Vigorous physical activities may increase the incidence of reflux."

ANS: B Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? A. Reposition the NG tube if drainage stops. B. Elevate the head of the bed to at least 30 degrees. C. Start oral fluids when the patient has active bowel sounds. D. Notify the doctor for any bloody nasogastric (NG) drainage.

ANS: B Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? A. Patient with Hashimoto's thyroiditis and a heart rate of 102 B. Patient with tetany who has a new order for IV calcium chloride C. Patient with Cushing syndrome and a blood glucose of 140 mg/dL D. Patient with Addison's disease who takes IV hydrocortisone twice daily

ANS: B Emergency treatment of tetany requires IV administration of calcium; electrocardiographic monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." What action should the nurse take? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Postpone any teaching until the patient adjusts to the ileostomy. d. Develop a detailed written list of ostomy care tasks for the patient.

ANS: B Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching could be postponed, the nurse should begin to offer teaching about some aspects of living with an ostomy.

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). What should the nurse explain about the action of the medication? A. "It decreases nausea and vomiting." B. "It inhibits development of stress ulcers." C. "It lowers the risk for H. pylori infection." D. "It prevents aspiration of gastric contents."

ANS: B Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.

A critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence? a. Apply incontinence briefs. b. Use a fecal management system. c. Insert a rectal tube with a drainage bag. d. Assist the patient to a commode frequently.

ANS: B Fecal management systems are designed to contain loose stools and can be in place for as long as 4 weeks without causing damage to the rectum or anal sphincters. Although incontinence briefs may be helpful, unless they are changed frequently, they are likely to increase the risk for skin breakdown. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. A critically ill patient will not be able to tolerate getting up frequently to use the commode or bathroom.

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed? A. "I quit smoking years ago, but I chew gum." B. "I eat small meals and have a bedtime snack." C. "I take antacids between meals and at bedtime each night." D. "I sleep with the head of the bed elevated on 4-inch blocks."

ANS: B GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin

ANS: B High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

What action should the nurse take when providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism? A. Check blood glucose level every 4 hours. B. Monitor the blood pressure every 4 hours. C. Elevate the patient's legs to relieve edema. D. Order the patient a potassium-restricted diet.

ANS: B Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.

Which nursing assessment of a 70-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? A. Fluid balance B. Apical pulse rate C. Nutritional intake D. Orientation and alertness

ANS: B In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.

A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. What is the highest priority action by the nurse? A. Monitor drainage. B. Contact the surgeon. C. Irrigate the NG tube. D. Give prescribed morphine.

ANS: B Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both). Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is not an adequate response. The patient may need morphine, but this is not the highest priority action

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? A. A 31-year-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL B. A 70-year-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134 C. A 53-year-old male patient who has Addison's disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef). D. A 22-year-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

ANS: B Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

Which information will the nurse plan to teach a patient who has lactose intolerance? a. Ice cream is relatively low in lactose. b. Live-culture yogurt is usually tolerated. c. Heating milk will break down the lactose. d. Nonfat milk is tolerated better than whole milk.

ANS: B Lactose-intolerant persons can usually eat yogurt without experiencing discomfort. Ice cream, nonfat milk, and milk that have been heated are all high in lactose.

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? A. "How much milk do you drink?" B. "What medications are you taking?" C. "Have you had a recent neck injury?" D. "Are your immunizations up to date?"

ANS: B Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter.

Which statement by the patient who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse? A. "I will need a bedtime snack because I take an evening dose of NPH insulin." B. "I can choose any foods, as long as I use enough insulin to cover the calories." C. "I can have an occasional beverage with alcohol if I include it in my meal plan." D. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: B Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. What topic should the nurse plan to teach the patient? A. Bisphosphonates to reduce bone demineralization B. Calcium supplements to normalize serum calcium levels C. Increasing fluid intake to decrease risk for nephrolithiasis D. Including whole grains in the diet to prevent constipation

ANS: B Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

After change-of-shift report, which patient should the nurse assess first? a. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea b. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting c. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown d. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafe

ANS: B Pain and vomiting with a femoral hernia suggest strangulation, which will require emergency surgery. All the other patients require assessment or care but have less urgent problems.

The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? A. Teach the patient about administering regular insulin. B. Schedule the patient for a fasting blood glucose level. C. Teach about an increased risk for fetal problems with gestational diabetes. D. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy

ANS: B Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. Teaching plans would depend on the outcome of a fasting blood glucose test and other tests.

A 19-yr-old patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care? a. Obtain blood samples for DNA analysis. b. Schedule the patient for yearly colonoscopy. c. Provide preoperative teaching about total colectomy. d. Discuss lifestyle modifications to decrease cancer risk

ANS: B Patients with FAP should have annual colonoscopy starting at age 16 years and usually have total colectomy by age 25 years to avoid developing colorectal cancer. DNA analysis is used to make the diagnosis but is not needed now for this patient. Lifestyle modifications will not decrease cancer risk for this patient.

Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)? A. "I should weigh myself daily and report sudden weight loss or gain." B. "I need to shop for foods low in sodium and avoid adding salt to food." C. "I need to limit my fluid intake to no more than 1 quart of liquids a day." D. "I should eat foods high in potassium because diuretics cause potassium loss.

ANS: B Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)? A. "Ranitidine absorbs the excess gastric acid." B. "Ranitidine decreases gastric acid secretion." C. "Ranitidine constricts the blood vessels near the ulcer." D. "Ranitidine covers the ulcer with a protective material."

ANS: B Ranitidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. Ranitidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer.

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness? A. Assess the patient for symptoms of hyperglycemia. B. Give the patient a snack of peanut butter and crackers. C. Have the patient drink a glass of orange juice or nonfat milk. D. Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: B Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patient's oral temperature. d. Obtain information about the accident.

ANS: B Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.

Which patient statement to the nurse indicates a need for additional instruction in administering insulin? A. "I can buy the 0.5-mL syringes because the line markings are easier to see." B. "I need to rotate injection sites among my arms, legs, and abdomen each day." C. "I do not need to aspirate the plunger to check for blood before injecting insulin." D. "I should draw up the regular insulin first, after injecting air into the NPH bottle."

ANS: B Rotating sites is no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.

A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What should the nurse teach the patient to avoid? A. Emotionally stressful situations B. Smoked foods such as ham and bacon C. Foods that cause distention or bloating D. Chronic use of H2 blocking medications

ANS: B Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.

Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)? A. The medication will be needed for 3 to 6 months. B. Inject the medication subcutaneously every day. C. Blood glucose levels may decrease when taking the medication. D. Stop taking the medication if swelling of the hands or feet occurs.

ANS: B Somatropin is injected subcutaneously daily, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? A. "You will need to remain on a bland diet." B. "Avoid foods that cause pain after you eat them." C. "High-protein foods are least likely to cause pain." D. "You should avoid eating any raw fruits and vegetables."

ANS: B The best information is that each person should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients may tolerate these foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their use.

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. What advice should the clinic nurse plan to give the patient? A. Increase the morning dose of NPH insulin (Novolin N). B. Check glucose level before, during, and after swimming. C. Time the morning insulin injection to peak while swimming. D. Delay eating the noon meal until after finishing the swimming.

ANS: B The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise

What finding should the nurse plan to assess for in a patient diagnosed with a pheochromocytoma? A. Flushing B. Headache C. Bradycardia D. Hypoglycemia

ANS: B The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider? A. Hemoglobin A1C level is 7.9%. B. Glomerular filtration rate is decreased. C. Last eye examination was 18 months ago. D. Patient has questions about the prescribed diet.

ANS: B The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication. In older patients, the goal for A1C may be higher in order to avoid complications associated with hypoglycemia. The nurse will plan on scheduling the patient for an eye examination and addressing the questions about diet, but the area for prompt intervention is the patient's decreased renal function.

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? A. Fasting blood glucose B. Glycosylated hemoglobin C. Oral glucose tolerance test D. Urine dipstick for glucose and ketones

ANS: B The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control after diabetes has been diagnosed.

A patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon? A. Difficult to awaken. B. Increasing neck swelling. C. Reports 7/10 incisional pain. D. Cardiac rate 112 beats/min.

ANS: B The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 beats/min is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching? A. "I frequently eat at restaurants, and my food has a lot of added salt." B. "I had the flu earlier this week, so I couldn't take the hydrocortisone." C. "I always double my dose of hydrocortisone on the days that I go for a long run." D. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon."

ANS: B The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease

Which laboratory value reported by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse to assess the patient? A. Bedtime glucose of 140 mg/dL B. Noon blood glucose of 52 mg/dL C. Fasting blood glucose of 130 mg/dL D. 2-hr postprandial glucose of 220 mg/dL

ANS: B The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice. The other values are within an acceptable range or not immediately dangerous for a patient with diabetes.

A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Question the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

ANS: B The nurse's initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.

Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching? A. Washes the puncture site using warm water and soap. B. Chooses a puncture site in the center of the finger pad. C. Hangs the arm down for a minute before puncturing the site. D. Says the result of 120 mg indicates good blood sugar control.

ANS: B The patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerve endings along the side of the finger pad. The other patient actions indicate that teaching has been effective.

Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos? A. Place cold packs on the eyes to relieve pain and swelling. B. Elevate the head of the patient's bed to reduce periorbital fluid. C. Apply alternating eye patches to protect the corneas from irritation. D. Teach the patient to blink every few seconds to lubricate the corneas.

ANS: B The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? A. Plan for emergency tracheostomy. B. Administer IV calcium gluconate. C. Prepare for endotracheal intubation. D. Begin thyroid hormone replacement.

ANS: B The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Thyroid hormone replacement may be needed eventually but will not improve the symptoms of hypocalcemia.

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? A. The bowel sounds are hyperactive in all four quadrants. B. The patient's lungs have crackles audible to the midchest. C. The nasogastric (NG) suction is returning coffee-ground material. D. The patient's blood pressure (BP) has increased to 142/84 mm Hg.

ANS: B The patient's lung sounds indicate that pulmonary edema may be developing because of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding.

A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? A. Irrigate the NG tube. B. Check the vital signs. C. Give the ordered antacid. D. Elevate the foot of the bed.

ANS: B The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide? A. Glyburide decreases glucagon secretion from the pancreas. B. Glyburide stimulates insulin production and release from the pancreas. C. Glyburide should be taken even if the morning blood glucose level is low. D. Glyburide should not be used for 48 hours after receiving IV contrast media.

ANS: B The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking glyburide because hypoglycemia can occur with this class of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glyburide does not affect glucagon secretion.

Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa? A. Use sunscreen even on cloudy days. B. Avoid cigarettes and smokeless tobacco. C. Complete antibiotic courses used to treat throat infections. D. Use antivirals to treat herpes simplex virus (HSV) infections.

ANS: B Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer.

A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline? A. Amitriptyline decreases the depression caused by your foot pain. B. Amitriptyline helps prevent transmission of pain impulses to the brain. C. Amitriptyline corrects some of the blood vessel changes that cause pain. D. Amitriptyline improves sleep and makes you less aware of nighttime pain.

ANS: B Tricyclic antidepressants (TCAs) decrease the transmission of pain impulses to the spinal cord and brain. TCAs also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. TCAs do not affect the blood vessel changes that contribute to neuropathy.

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? a. Auscultating for bowel sounds b. Brushing the teeth and tongue c. Assessing the nares for irritation d. Irrigating the nasogastric (NG) tube

ANS: B UAP education and scope of practice include patient hygiene such as oral care. The other actions require education and scope of practice appropriate to the RN.

A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result should the nurse expect? A. Elevated hematocrit B. Decreased serum sodium C. Increased serum chloride D. Low urine specific gravity

ANS: B When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient uses witch hazel compresses to soothe irritation. c. The patient asks for antidiarrheal medication after each stool. d. The patient cleans the perianal area with soap after each stool.

ANS: B Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with plain water or pH balanced cleanser after each stool.

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home? A. Delay teaching until closer to discharge date. B. Provide written reminders of information taught. C. Offer multiple options for management of therapies. D. Ensure privacy for teaching by asking the family to leave.

ANS: B Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is complex, teaching should be started well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.) a. Stimulant and saline laxatives can be used regularly. b. Bulk-forming laxatives are an excellent source of fiber. c. Walking or cycling frequently will help bowel motility. d. A good time for a bowel movement may be after breakfast. e. Some over-the-counter (OTC) medications cause constipation.

ANS: B, C, D, E Stimulant and saline laxatives should be used infrequently. Use of bulk-forming laxatives, regular early morning timing of defecation, regular exercise, and avoiding many OTC medications will help the patient avoid constipation.

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually? (Select all that apply.) A. Chest x-ray B. Blood pressure C. Serum creatinine D. Urine for microalbuminuria E. Complete blood count (CBC) F. Monofilament testing of the foot

ANS: B, C, D, F Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient with diabetes presents with symptoms of respiratory or infectious problems but are not routinely included in screening.

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer? A. Bleeding during tooth brushing B. Painful blisters at the lip border C. Red patches on the buccal mucosa D. Curdlike plaques on the posterior tongue

ANS: C A red, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes simplex).

A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

ANS: C A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms.

A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? A. The patient has been vomiting for 4 days. B. The patient takes antacids 8 to 10 times a day. C. The patient is lethargic and difficult to arouse. D. The patient has had a small intestinal resection.

ANS: C A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration.

The nurse is caring for a patient following an adrenalectomy. What is the highest priority in the immediate postoperative period? A. Protecting the patient's skin B. Monitoring for signs of infection C. Balancing fluids and electrolytes D. Preventing emotional disturbances

ANS: C After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. The other goals are also important for the patient but are not as immediately life threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? A. Observe the dressing for bleeding. B. Check the blood pressure and pulse. C. Assess the patient's respiratory effort. D. Support the patient's head with pillows.

ANS: C Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority.

What topic should the nurse teach a patient who had a pituitary adenoma after the hypophysectomy? A. Sodium restriction to prevent fluid retention B. Insulin to maintain normal blood glucose levels C. Oral corticosteroids to replace endogenous cortisol D. Chemotherapy to prevent malignant tumor recurrence

ANS: C Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed.

Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile? a. Teach the patient about proper food storage. b. Order a diet without dairy products for the patient. c. Place the patient in a private room on contact isolation. d. Teach the patient about why antibiotics will not be used.

ANS: C Because C. difficile is highly contagious, the patient should be placed in a private room, and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and storage do not cause C. difficile

A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), what should the nurse plan to assess more frequently than is routine? A. Apical pulse B. Bowel sounds C. Breath sounds D. Abdominal girth

ANS: C Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine

Which patient statement indicates that the nurse's teaching about exenatide (Byetta) has been effective? A. "I may feel hungrier than usual when I take this medicine." B. "I will not need to worry about hypoglycemia with the Byetta." C. "I should take my daily aspirin at least an hour before the Byetta." D. "I will take the pill at the same time I eat breakfast in the morning."

ANS: C Because exenatide slows gastric emptying, oral medications should be taken at least 1 hour before the exenatide to avoid slowing absorption. Exenatide is injected and increases feelings of satiety. Hypoglycemia can occur with this medication

A 30-yr-old patient has a new diagnosis of type 2 diabetes. When should the nurse recommend the patient schedule a dilated eye examination? A. Every 2 years B. Every 6 months C. As soon as available D. At the age of 39 years

ANS: C Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and annually thereafter

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Send the patient for a CT scan. b. Insert a urinary catheter to drainage. c. Infuse metronidazole (Flagyl) 500 mg IV. d. Place a nasogastric tube to intermittent low suction.

ANS: C Because peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated.

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? A. Give an IV H2 receptor antagonist. B. Draw blood for type and crossmatch. C. Administer 1 L of lactated Ringer's solution. D. Insert a nasogastric (NG) tube and connect to suction

ANS: C Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.

A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace has severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea? A. Keep the patient NPO for 2 hours before dressing changes. B. Give the prescribed prochlorperazine before dressing changes. C. Administer prescribed morphine sulfate before dressing changes. D. Avoid performing dressing changes close to the patient's mealtimes.

ANS: C Because the patient's nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occurs at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain. However, an antiemetic may be added later if the nausea persists despite pain management.

Which information will the nurse provide for a patient with achalasia? A. A liquid diet will be necessary. B. Avoid drinking fluids with meals. C. Lying down after meals is recommended. D. Treatment may include endoscopic procedures

ANS: D Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying. Patients are advised to drink fluids with meals

A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a. Teach about a low-residue diet. b. Monitor output from the stoma. c. Assess the perineal drainage and incision. d. Encourage acceptance of the colostomy stoma

ANS: C Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching? a. Maintain a low-residue diet until the surgical area is healed. b. Use ice packs on the perianal area to relieve pain and swelling. c. Take prescribed pain medications before you expect a bowel movement. d. Delay having a bowel movement for several days until you are well healed.

ANS: C Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. A high-residue diet will increase stool bulk and prevent constipation. Delay of bowel movements is likely to lead to constipation. Warm Sitz baths rather than ice packs are used to relieve pain and keep the surgical area clean

Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? A. "I will drink more liquids with my meals." B. "I should choose high carbohydrate foods." C. "Vitamin supplements may prevent anemia." D. "Persistent heartburn is common after surgery."

ANS: C Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome

A hospitalized patient who is diabetic received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. What is the best action by the nurse to prevent hypoglycemia? A. Plan to discontinue the evening dose of insulin. B. Save the lunch tray for the patient's later return. C. Request that if testing is further delayed, the patient will eat lunch first. D. Send a glass of orange juice to the patient in the diagnostic testing area.

ANS: C Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Holding the insulin dose later will not prevent hypoglycemia form the peak of the NPH dose. A glass of juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? A. The patient reports 7/10 (0 to 10 scale) abdominal pain. B. The patient is experiencing intermittent waves of nausea. C. The patient has no breath sounds in the left anterior chest. D. The patient has hypoactive bowel sounds in all four quadrants.

ANS: C Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The nausea and abdominal pain should be addressed, but they are not as high priority as the patient's respiratory status. Decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown

ANS: C Draining and measuring the output from the ostomy is included in UAP education and scope of practice. The other actions should be implemented by LPNs or RNs

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

ANS: C During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.

After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective? A. Patient orders nonfat milk for each meal. B. Patient uses the prescribed corticosteroid inhaler. C. Patient schedules an appointment for allergy testing. D. Patient takes ibuprofen (Advil) to control throat pain.

ANS: C Eosinophilic esophagitis is frequently associated with environmental allergens, so allergy testing is used to determine possible triggers. Corticosteroid therapy may be prescribed, but the medication will be swallowed, not inhaled. Milk is a frequent trigger for attacks. NSAIDs are not used for eosinophilic esophagitis.

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate? A. Insulin is not used to control blood glucose in patients with type 2 diabetes. B. Complications of type 2 diabetes are less serious than those of type 1 diabetes. C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. D. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic coma.

ANS: C For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? A. Chocolate pudding B. Glass of low-fat milk C. Cherry gelatin with fruit D. Peanut butter and jelly sandwich

ANS: C Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. What should the nurse anticipate? A. The patient may need a diet higher in calories while receiving prednisone. B. The patient may develop acute hypoglycemia while taking the prednisone. C. The patient may require administration of insulin while taking prednisone. D. The patient may have rashes caused by metformin-prednisone interactions.

ANS: C Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories

The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AMblood glucose is 230 mg/dL. Which action will the nurse teach the patient to take? A. Avoid snacking right before bedtime. B. Increase the rapid-acting insulin dose. C. Check the blood glucose during the night. D. Administer a larger dose of long-acting insulin.

ANS: C If the Somogyi effect is causing the patient's increased morning glucose level, the patient will experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night

A 26-yr-old female who has type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and reports a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. What should the nurse advise the patient to do? A. Use only the lispro insulin until the symptoms are resolved. B. Limit intake of calories until the glucose is less than 120 mg/dL. C. Monitor blood glucose every 4 hours and contact the clinic if it rises. D. Decrease carbohydrates until glycosylated hemoglobin is less than 7%.

ANS: C Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate short-term alterations in blood glucose.

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? A. The patient administers the glargine 30 minutes before each meal. B. The patient's family prefills the syringes with the mix of insulins weekly. C. The patient discards the open vials of glargine and regular insulin after 4 weeks. D. The patient draws up the regular insulin and then the glargine in the same syringe.

ANS: C Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, and glargine is given once daily.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? A. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. B. Discuss the reason for the use of insulin therapy during the immediate postoperative period. C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. D. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

ANS: C LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments, planning, and patient teaching are skills that require RN education and scope of practice.

Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease? A. Exercise is contraindicated to avoid increasing metabolic rate. B. Restriction of iodine intake is needed to reduce thyroid activity. C. Antithyroid medications may take several months for full effect. D. Surgery will eventually be required to remove the thyroid gland.

ANS: C Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease, although surgery may be used

Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus? A. Generalized edema B. Fluid volume overload C. Disturbed sleep pattern D. Decreased gas exchange

ANS: C Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)? A. Auscultate the bowel sounds. B. Assess for signs of dehydration. C. Assist the patient with oral care. D. Ask the patient about the nausea.

ANS: C Oral care is included in UAP education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice.

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin? A. Thigh B. Buttock C. Abdomen D. Upper arm

ANS: C Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.

A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will the nurse expect during the assessment? A. Chronically low blood pressure B. Bronzed appearance of the skin C. Purplish streaks on the abdomen D. Decreased axillary and pubic hair

ANS: C Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action? a. Auscultate for hypotonic bowel sounds. b. Notify the patient's health care provider. c. Check for tube placement and reposition it. d. Remove the tube and replace it with a new one

ANS: C Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded.

Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Encourage fluids to 2 to 3 L/day. B. Monitor for increasing peripheral edema. C. Offer the patient hard candies to suck on. D. Keep head of bed elevated to 30 degrees.

ANS: C Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider? A. Patient's blood pressure is 148/94 mm Hg. B. Patient has bilateral 2+ pitting ankle edema. C. Patient stopped taking the medication 2 days ago. D. Patient has not been taking the prescribed vitamin D.

ANS: C Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent or treat adrenal insufficiency. The other information will also be reported but does not require rapid treatment.

A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient? A. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) B. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine C. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) D. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix)

ANS: C The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? a. Administer bulk-forming laxatives. b. Assist the patient to sit on the toilet. c. Manually remove the impacted stool. d. Increase the patient's oral fluid intake

ANS: C The initial action with a fecal impaction is manual disimpaction. The other actions will be used to prevent future constipation and impactions

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. What should the nurse do during the initial assessment of the patient? a. Remove the knife and assess the wound. b. Determine the presence of Rovsing sign. c. Check for circulation and tissue perfusion. d. Insert a urinary catheter and assess for hematuria.

ANS: C The initial assessment is focused on determining whether the patient has hypovolemic shock. The knife should not be removed until the patient is in surgery, where bleeding can be controlled. Rovsing sign is assessed in the patient with suspected appendicitis. Assessment for bladder trauma is not part of the initial assessment.

A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first? a. Inform the patient that testing of blood and stools will be needed. b. Suggest that the patient drink clear liquid fluids with electrolytes. c. Ask the patient to describe the stools and any associated symptoms. d. Advise the patient to use over-the-counter antidiarrheal medication.

ANS: C The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. What should the nurse teach the patient to do? A. Increase the amount of fluid with meals. B. Eat foods that are higher in carbohydrates. C. Lie down for about 30 minutes after eating. D. Drink sugared fluids or eat candy after meals

ANS: C The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? a. Assist the patient to cough and deep breathe. b. Palpate the abdomen for rebound tenderness. c. Suggest the patient lie on the side, flexing the right leg. d. Encourage the patient to sip clear, noncarbonated liquids.

ANS: C The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? A. Infuse dextrose 50% by slow IV push. B. Administer 1 mg glucagon subcutaneously. C. Obtain a glucose reading using a finger stick. D. Have the patient drink 4 ounces of orange juice.

ANS: C The patient's clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). What should the nurse plan to teach the patient? A. Self-monitoring of blood glucose B. Using low doses of regular insulin C. Lifestyle changes to lower blood glucose D. Effects of oral hypoglycemic medications

ANS: C The patient's impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid temporary relief from the symptoms? A. Start the PRN O2 at 2 L/min per cannula. B. Administer the prescribed muscle relaxant. C. Have the patient rebreathe from a paper bag. D. Stretch the muscles with passive range of motion

ANS: C The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. Applying as-needed O2 or range of motion will have no impact on the ionized calcium level. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.

Which assessment finding for an adult admitted with Graves' disease requires the most rapid intervention by the nurse? A. Heart rate 136 beats/min B. Severe bilateral exophthalmos C. Temperature 103.8° F (40.4° C) D. Blood pressure 166/100 mm Hg

ANS: C The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.

A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Skin is dry with tenting and poor turgor. b. Patient has not voided for the last 2 hours. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the previous 6 hours.

ANS: C The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. The other data will be reported but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment.

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first? a. Administer IV ketorolac 15 mg for pain relief. b. Send a blood sample for a complete blood count (CBC). c. Infuse a liter of lactated Ringer's solution over 30 minutes. d. Send the patient for an abdominal computed tomography (CT) scan.

ANS: C The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information should the nurse include in discharge teaching? A. Take radioactive precautions with all body secretions. B. Symptoms of hyperthyroidism should be relieved in about a week. C. Symptoms of hypothyroidism will occur as the RAI therapy takes effect. D. Discontinue the antithyroid medications that were taken before the RAI therapy

ANS: C There is a high incidence of post radiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.

After change-of-shift report, which patient should the nurse assess first? A. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain B. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn C. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa D. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy

ANS: C This patient is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.

A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate? A. "You may have quite a few years still left to live." B. "Thinking about dying will only make you feel worse." C. "Having this new diagnosis must be very hard for you." D. "It is important that you be realistic about your prognosis."

ANS: C This response is open ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have a low survival rate, so the response "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. The response beginning, "It is important that you be realistic" discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis

A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. What should the nurse include in preoperative teaching? A. Cough and deep breathe every 2 hours postoperatively. B. Remain on bed rest for the first 48 hours postoperatively. C. Avoid brushing teeth for at least 10 days after the surgery. D. You will be positioned flat with a cervical collar after surgery.

ANS: C To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches. A cervical collar is not needed.

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test? A. The patient's most recent A1C was 7.5%. B. The patient's blood glucose is 128 mg/dL. C. The patient took the prescribed metformin today. D. The patient took the prescribed enalapril 4 hours ago.

ANS: C To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary angiogram and should not be used for 48 hours after IV contrast media are administered. The other patient data will be reported but do not indicate any need to reschedule the procedure.

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider? A. Hemoglobin A1C level of 6.2% B. Heart rate at rest of 58 beats/min C. Blood pressure of 140/88 mmHg D. High-density lipoprotein (HDL) level of 65 mg/dL

ANS: C To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the blood pressure should be kept in normal range. An A1C less than 6.5%, a low resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are well controlled.

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What should the nurse ask the patient about to determine possible risk factors for gastritis? A. The amount of saturated fat in the diet B. A family history of gastric or colon cancer C. Use of nonsteroidal antiinflammatory drugs D. A history of a large recent weight gain or loss

ANS: C Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis

An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question? A. Infuse lactated Ringer's solution at 250 mL/hr. B. Monitor blood urea nitrogen and creatinine daily. C. Administer loperamide (Imodium) after each stool. D. Provide a clear liquid diet and progress diet as tolerated.

ANS: C Use of antidiarrheal agents is avoided with this type of food poisoning. IV fluids, clear oral fluids, and monitoring renal function are appropriate for dehydration.

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? A. "Are you anorexic?" B. "Is your urine dark colored?" C. "Have you lost weight lately?" D. "Do you crave sugary drinks?"

ANS: C Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

An 82-year-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed A. Docusate (Colace) B. Ibuprofen (Motrin) C. Diazepam (Valium) D. Cefoxitin (Mefoxin)

ANS: C Worsening of mental status and myxedema coma can be precipitated using sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient.

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? a. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins. b. Dietary sources of fiber should be eliminated to prevent excessive gas formation. c. Use of this type of laxative to prevent constipation does not cause adverse effects. d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction

ANS: D A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.

A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? a. Soak in Sitz baths several times each day. b. Cough 5 times each hour for the next 48 hours. c. Avoid using acetaminophen (Tylenol) for pain. d. Apply a scrotal support and ice to reduce swelling

ANS: D A scrotal support and ice are used to reduce edema and pain. Coughing will increase pressure on the incision. Sitz baths will not relieve pain and would not be of use after this surgery. Acetaminophen can be used for postoperative pain.

Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)? A. The patient has a recent weight gain of 9 pounds. B. The patient complains of dyspnea with activity. C. The patient has a urine specific gravity of 1.025. D. The patient has a serum sodium level of 118 mEq/L.

ANS: D A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include? a. The patient will need to remain on bedrest for three days after surgery. b. An additional surgery in 8 to 12 weeks will be done to create an ileal-anal reservoir. c. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria. d. The site where the stoma will be located will be marked on the abdomen preoperatively

ANS: D A wound, ostomy, continence nurse (WOCN) should select the site where the ostomy will be positioned and mark the abdomen preoperatively. The site should be within the rectus muscle, on a flat surface, and in a place that the patient is able to see. A permanent colostomy is created with this surgery. The patient will be encouraged to walk the day after surgery. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria.

What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction? a. Referred back pain b. Metabolic alkalosis c. Projectile vomiting d. Abdominal distention

ANS: D Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? a. Wheat toast with butter b. Oatmeal with nonfat milk c. Bagel with low-fat cream cheese d. Corn tortilla with scrambled eggs

ANS: D Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not contain gluten, but oatmeal and wheat do.

What should the nurse anticipate teaching a patient with a new report of heartburn? A. A barium swallow B. Radionuclide tests C. Endoscopy procedures D. Proton pump inhibitors

ANS: D Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia? a. Iron dextran infusions b. Oral ferrous sulfate tablets c. Routine blood transfusions d. Cobalamin (B12) supplements

ANS: D Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. Cobalamin must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions.

An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? A. Sucralfate (Carafate) B. Aluminum hydroxide C. Omeprazole (Prilosec) D. Metoclopramide (Reglan)

ANS: D Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids

A patient who takes a nonsteroidal antiinflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What should the nurse anticipate teaching the patient? A. Substitution of acetaminophen (Tylenol) for the NSAID B. Use of enteric-coated NSAIDs to reduce gastric irritation C. Reasons for using corticosteroids to treat the rheumatoid arthritis D. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

ANS: D Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis.

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? A. Changes in visual field B. Milk leaking from breasts C. Blood glucose 150 mg/dL D. Nausea and projectile vomiting

ANS: D Nausea and projectile vomiting may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid action to prevent life-threatening complications.

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?"

ANS: D One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria.

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication? A. The patient's blood pressure is 154/92. B. The patient's blood glucose is 86 mg/dL. C. The patient reports a history of emphysema. D. The patient has chest pressure when walking.

ANS: D Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. A blood glucose level of 86 mg/dL indicates a positive effect from the medication. Hypertension and a history of emphysema do not contraindicate this medication.

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. What should the nurse teach the patient to take? A. Sucralfate at bedtime and antacids before each meal B. Sucralfate and antacids together 30 minutes before meals C. Antacids 30 minutes before each dose of sucralfate is taken D. Antacids after meals and sucralfate 30 minutes before meals

ANS: D Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.

Which assessment finding in a patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? A. The blood glucose is 192 mg/dL. B. The lungs have bibasilar crackles. C. The patient reports 6/10 incisional pain. D. The blood pressure (BP) is 88/50 mm Hg.

ANS: D The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency are the priorities after adrenalectomy.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? A. The patient's blood glucose level is 174 mg/dL. B. The patient is scheduled for a chest x-ray in an hour. C. The patient has gained 2 lb (0.9 kg) in the past 24 hours. D. The patient's estimated glomerular filtration rate is 42 mL/min.

ANS: D The glomerular filtration rate indicates possible renal impairment, and metformin should not be used in patients with significant renal impairment. The other findings are not contraindications to the use of metformin.

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be helpful for the patient problem of disturbed body image related to changes in appearance? A. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. B. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. C. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. D. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

ANS: D The most reassuring and accurate communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome minimize the patient's concerns. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? A. Measuring the quantity of emesis B. Palpating the abdomen for distention C. Auscultating the chest for breath sounds D. Taking the blood pressure (BP) and pulse

ANS: D The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.

A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care? A. Refer the patient for hospice services. B. Infuse IV fluids through a central line. C. Teach the patient about antiemetic therapy. D. Offer supplemental feedings between meals.

ANS: D The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? A. "If I overeat at a meal, I will still take the usual dose of medication." B. "Other medications besides the Glucotrol may affect my blood sugar." C. "When I am ill, I may have to take insulin to control my blood sugar." D. "My diabetes won't cause complications because I don't need insulin."

ANS: D The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of glipizide.

After change-of-shift report, which patient will the nurse assess first? A. A 19-yr-old patient with type 1 diabetes who was admitted with dawn phenomenon B. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL C. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and reports burning foot pain D. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

ANS: D The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed. The other patients also need assessment and intervention but do not have life-threatening complications.

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? a . Notify the health care provider. b. Obtain a stool specimen for analysis. c. Teach the patient about hand washing. d. Place the patient on contact precautions.

ANS: D The patient's history and new onset diarrhea suggest a C. difficile infection, which requires implementation of contact precautions to prevent spread of the infection to other patients. The other actions are also appropriate but can be accomplished after contact precautions are implemented

After obtaining the information shown in the accompanying figure regarding a patient with Addison's disease, which prescribed action will the nurse take first? A. Give 4 oz of fruit juice orally. B. Recheck the blood glucose level. C. Administer O2 therapy as needed. D. Infuse 5% dextrose and 0.9% saline.

ANS: D The patient's poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis. Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may also be needed but are not the initial action for the patient.

How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn? A. "It reduces gastroesophageal reflux by increasing the rate of gastric emptying." B. "It neutralizes stomach acid and provides relief of symptoms in a few minutes." C. "It coats and protects the lining of the stomach and esophagus from gastric acid." D. "It treats gastroesophageal reflux disease by decreasing stomach acid production."

ANS: D The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take? a. Place ice packs around the stoma. b. Notify the surgeon about the stoma. c. Monitor the stoma every 30 minutes. d. Document stoma assessment findings.

ANS: D The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery. An ice pack is not needed

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? A. The patient always carries hard candies when engaging in exercise. B. The patient goes for a vigorous walk when his glucose is 200 mg/dL. C. The patient has a peanut butter sandwich before going for a bicycle ride. D. The patient increases daily exercise when ketones are present in the urine.

ANS: D When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients with type 1 diabetes should be taught to avoid exercise when ketosis is present. The other statements are correct.

Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? A. Iodine B. Methimazole C. Propylthiouracil D. Propranolol (Inderal)

ANS: D β-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.

The nurse is caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy. In which order will the nurse take actions? (Put a comma and a space between each answer choice [A, B, C, D].) A. Contact the health care provider. B. Assess blood pressure and heart rate. C. Give the PRN acetaminophen (Tylenol). D. Place the patient on contact precautions.

ANS: D, B, A, C Proton pump inhibitors including omeprazole (Prilosec) may increase the risk of Clostridium difficile-associated colitis. Because the patient's history and symptoms are consistent with C. difficile infection, the initial action should be initiation of infection control measures to protect other patients. Assessment of blood pressure and pulse is needed to determine whether the patient has symptoms of hypovolemia or shock. The health care provider should be notified so that actions such as obtaining stool specimens and antibiotic therapy can be started. Tylenol may be administered but is the lowest priority of the actions.

The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

B. "I can help control my blood pressure by avoiding foods high in salt." Correct Answer: "I can help control my blood pressure by avoiding foods high in salt." Rationale: Patients with type 2 diabetes to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with type 2 diabetes need to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment of retinopathy.

The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet."

B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach". Correct Answer: "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Rationale: Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes. High-protein diets are not recommended for weight loss.

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I will need to cut back the number of times I shower per week." D. "My shoes should fit nice and tight because they will give me firm support."

B. "I should look at the condition of my feet every day." Correct Answer: "I should look at the condition of my feet every day." Rationale: Patients with diabetes need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Routine care includes regular bathing.

The nurse is preparing to administer famotidine to a patient after a laparotomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? A. "It will prevent air from accumulating in the stomach, causing gas pains." B. "It will reduce the amount of acid in the stomach while you are not eating." C. "It will prevent the heartburn that occurs as a side effect of general anesthesia." D. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

B. "It will reduce the amount of acid in the stomach while you are not eating." Correct Answer: "It will reduce the amount of acid in the stomach while you are not eating." Rationale: Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse receives a phone call from a patient taking cyclophosphamide for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that she has muscle cramps, weakness, and very little urine output. Which response by the nurse is best? A. "Start taking supplemental potassium, calcium, and magnesium." B. "Stop taking the medication now and call your health care provider." C. "These symptoms will decrease with continued use of the medication." D. "Increase your fluid intake to 3000 mL for 24 hours to improve your urine output."

B. "Stop taking the medication now and call your health care provider" Correct Answer: "Stop taking the medication now and call your health care provider." Rationale: Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL/day. A loop diuretic such as furosemide (Lasix) is used to promote diuresis, and supplements of potassium, calcium, and magnesium may be needed.

A patient is given a bisacodyl suppository and asks the nurse how long it will take to work. What is the best response by the nurse? A. 2 to 5 minutes B. 15 to 60 minutes C. 2 to 4 hours D. 6 to 8 hours

B. 15 to 60 minutes Correct Answer: 15 to 60 minutes Rationale: Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM

B. 8:00 AM, 12:00 PM, and 4:00 PM Correct Answer: 8:00 AM, 12:00 PM, and 4:00 PM Rationale: A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

The nurse identifies that which patient is at highest risk for developing colon cancer? A. A 28-yr-old man who has a body mass index of 27 kg/m2 B. A 32-yr-old woman with a 12-year history of ulcerative colitis C. A 52-yr-old man who has followed a vegetarian diet for 24 years D. A 58-yr-old woman taking prescribed estrogen replacement therapy

B. A 32-yr-old woman with a 12-year history of ulcerative colitis Correct Answer: A 32-yr-old woman with a 12-year history of ulcerative colitis Rationale: Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity; family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, or hereditary nonpolyposis colorectal cancer syndrome; eating red meat; cigarette use; and drinking alcohol.

Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? A. A 58-yr-old patient with diabetic retinopathy B. A 73-yr-old patient who takes propranolol (Inderal) C. A 19-yr-old patient who is on the school track team D. A 24-yr-old patient with a hemoglobin A1C of 8.9%

B. A 73-year-old patient who takes propranolol Correct Answer: A 73-yr-old patient who takes propranolol (Inderal) Rationale: Hypoglycemic unawareness is a condition in which a person does not have the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

The nurse is caring for a patient recently started on levothyroxine for hypothyroidism. What information reported by the patient requires immediate action? A. Weight gain or weight loss B. Chest pain and palpitations C. Muscle weakness and fatigue D. Decreased appetite and constipation

B. Chest pain and palpitations Correct Answer: Chest pain and palpitations Rationale: Levothyroxine is used to treat hypothyroidism. With replacement, the patient can be overmedicated, causing hyperthyroidism. Any chest pain, heart palpitations, or heart rate greater than 100 beats/min experienced by a patient starting thyroid replacement should be reported immediately, and electrocardiography and serum cardiac enzyme tests should be performed.

After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected? A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

B. Drowsiness Correct Answer: Drowsiness Rationale: Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

The nurse is caring for a patient being treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate? A. Iced tea B. Dry toast C. Hot coffeePlain D. yogurt

B. Dry toast Correct Answer: Dry toast Rationale: Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot or cold liquids and fatty foods are generally not well tolerated.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcohol use, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? A. Barium swallow B. Endoscopic biopsy C. Capsule endoscopy D. Endoscopic ultrasonography

B. Endoscopic biopsy Correct Answer: Endoscopic biopsy Rationale: Because of this patient's history of alcohol use, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of cancer, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show esophageal problems but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer.

The patient with a history of irritable bowel disease and gastroesophageal reflux disease (GERD) is admitted with a diagnosis of diverticulitis and has received a dose of Mylanta 30 mL PO. The nurse will determine the medication was effective when which symptom has been resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain

B. Heartburn Correct Answer: Heartburn Rationale: Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

B. History of colorectal polyps Correct Answer: History of colorectal polyps Rationale: A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for an exploratory laparotomy? A. How to care for the wound B. How to deep breathe and cough C. The location and care of drains after surgery D. Which medications will be used during surgery

B. How to deep breathe and cough Rationale: Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

The patient in the emergency department after a car accident is wearing medical identification listing Addison's disease. What should the nurse expect to be included in the care of this patient? A. Low-sodium diet B. Increased glucocorticoid replacement C. Limiting IV fluid replacement therapy D. Withholding mineralocorticoid replacement

B. Increased glucocorticoid replacement Correct Answer: Increased glucocorticoid replacement Rationale: The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's may need large volumes of IV fluid replacement and a high-sodium diet. Withholding mineralocorticoid replacement cannot be done for patients with Addison's disease.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy only occurs in patients with type 2 diabetes who have severe disease. B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. C. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes. D. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.

B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. Correct Answer: Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. Rationale: Microangiopathy occurs in diabetes. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

A patient with diabetes is scheduled for a fasting blood glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time? A. 6:00 PM on the evening before the test B. Midnight before the test C. 4:00 AM on the day of the test D. 7:00 AM on the day of the test

B. Midnight before the test Correct Answer: Midnight before the test Rationale: Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

The nurse should administer an as-needed dose of magnesium citrate after noting what information when reviewing a patient's medical record? A. Abdominal pain and bloating B. No bowel movement for 3 days C. A decrease in appetite by 50% over 24 hours D. Muscle tremors and other signs of hypomagnesemia

B. No bowel movement for 3 days Correct Answer: No bowel movement for 3 days Rationale: Magnesium citrate is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? A. Avoid sick people and wash hands. B. Obtain comprehensive dental care. C. Maintain hemoglobin A1C below 7%. D. Coughing and deep breathing with splinting

B. Obtain comprehensive dental care Correct Answer: Obtain comprehensive dental care. Rationale: A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? A. Zolpidem B. Ondansetron C. Dexamethasone D. Morphine sulfate

B. Ondansetron Correct Answer: Ondansetron Rationale: Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

The provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? A. White blood cell levels and signs of infection B. Serum calcium levels and signs of hypocalcemia C. Hemoglobin, hematocrit, and red blood cell levels D. Level of consciousness and signs of acute delirium

B. Serum calcium levels and signs of hypocalcemia Correct Answer: Serum calcium levels and signs of hypocalcemia Rationale: Loss of the parathyroid gland is associated with hypocalcemia. Whereas infection and anemia are not associated with loss of the parathyroid gland, cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.

A patient with ulcerative colitis is scheduled for a total proctocolectomy with permanent ileostomy. The wound, ostomy, and continence nurse is selecting the site where the ostomy will be placed. What should be included in site consideration? A. Protruding areas make the best sites. B. The patient must be able to see the site. C. The site should be outside the rectus muscle area. D. The appliance will need to be placed at the waist line.

B. The patient must be able to see the site. Correct Answer: The patient must be able to see the site. Rationale: In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply) A. Restricted to rectum B. Strictures are common C. Bloody, diarrhea stools D. Cramping abdominal pain E. Lesions penetrate intestine

C, D Bloody, diarrhea stools Cramping abdominal pain Rationale: Manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM

C. 10:30 PM to 1:30 AM Correct Answer: 10:30 PM to 1:30 AM Rationale: Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A. An UAP on the unit who has hospice experience B. An LPN that has worked on the unit for 10 years C. An RN with 6 months of experience on the surgical unit D. An RN who has floated to the surgical unit from pediatrics

C. An RN with 6 months of experience on the surgical unit Rationale: The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a LPN/VN or UAP.

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? A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

C. Antibiotic(s), proton pump inhibitor, and bismuth Correct Answer: Antibiotic(s), proton pump inhibitor, and bismuth Rationale: 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.

The nurse is caring for a postoperative patient who has just vomited yellow-green liquid. Which action would be an appropriate nursing intervention? A. Offer the patient an herbal supplement such as ginseng. B. Discontinue medications that may cause nausea or vomiting. C. Apply a cool washcloth to the forehead and provide mouth care. D. Take the patient for a walk in the hallway to promote peristalsis.

C. Apply a cool washcloth to the forehead and provide mouth care. Correct Answer: Apply a cool washcloth to the forehead and provide mouth care. Rationale: Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily held until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.

What should be included in the interprofessional plan of care for a patient with Cushing disease? A. Lab monitoring for hyperkalemia B. Vital sign monitoring for hypotension C. Counseling related to body image changes D. Diet consultation to determine low protein choices

C. Counseling related to body image changes Correct Answer: Counseling related to body image changes Rationale: Elevated corticosteroid levels can cause body changes, including truncal obesity, moon face, and hirsutism in women and gynecomastia in men. Counseling and support should be offered because of the changes in body image. Hypokalemia and hypertension are consistent with Cushing disease. Sodium restriction and potassium supplementation are indicated. High-protein choices are necessary to counteract catabolic processes and assist with wound healing.

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? A. Malnutrition B. Bile reflux gastritis C. Dumping syndrome D. Postprandial hypoglycemia

C. Dumping syndrome Correct Answer: Dumping syndrome Rationale: 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? A. Nausea B. Belching C. Epigastric pain D. Difficulty swallowing

C. Epigastric pain Correct Answer: Epigastric pain Rationale: 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 is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? A. Nausea and vomiting B. Hyperactive bowel sounds C. Firmly distended abdomen D. Abrasions on all extremities

C. Firmly distended abdomen Correct Answer: Firmly distended abdomen Rationale: Manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

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

C. Having the patient eat 4 to 6 smaller meals each day Correct Answer: Having the patient eat 4 to 6 smaller meals each day Rationale: 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 patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

C. Kussmaul respirations Correct Answer: Kussmaul respirations Rationale: In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? A. Deep breathe, cough, and use spirometer every 4 hours. B. Maintain an upright position for at least 2 hours after eating. C. NG will have bloody drainage and it should not be repositioned. D. Keep in a supine position to prevent movement of the anastomosis.

C. NG will have bloody drainage and it should not be repositioned. Correct Answer: NG will have bloody drainage and it should not be repositioned. Rationale: The patient will have bloody drainage from the nasogastric (NG) tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. Deep breathing and spirometry will be done every 2 hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.

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? A. Sucralfate B. Cimetidine C. Omeprazole D. Metoclopramide

C. Omeprazole Correct Answer: Omeprazole Rationale: 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 newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas and inhibits glucagon secretion.

C. Reduces glucose production by the liver and enhances insulin sensitivity Correct Answer: Reduces glucose production by the liver and enhances insulin sensitivity. Rationale: Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

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

C. Relief of nausea and vomiting Correct Answer: Relief of nausea and vomiting Rationale: 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 with an intestinal obstruction has a nasogastric (NG) tube to suction but reports of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? A. Notify the provider. B. Auscultate for bowel sounds. C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one.

C. Reposition the tube and check for placement. Correct Answer: Reposition the tube and check for placement. Rationale: The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The provider does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration

C. cardiac monitoring to detect potassium changes Correct Answer: Cardiac monitoring to detect potassium changes Rationale: This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.

C. eat 15 grams of simple carbohydrates Correct Answer: Eat 15 g of simple carbohydrates. Rationale: When a patient with type 1 diabetes is unsure about the meaning of the symptoms they are experiencing, they should treat for hypoglycemia to prevent seizures and coma from occurring. Have the patient check the blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? A. Return the patient to NPO status. B. Place cool compresses on the abdomen. C. Encourage the patient to ambulate as ordered. D. Administer an as-needed dose of IV morphine sulfate.

C. encourage the patient to ambulate as ordered Correct Answer: Encourage the patient to ambulate as ordered. Rationale: Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

A patient who smokes reports having significant stress and has some eye problems. On assessment, the nurse notes exophthalmos. What additional abnormal findings should the nurse assess for? A. Muscle weakness and slow movements B. Puffy face, decreased sweating, and dry hair C. Systolic hypertension and increased heart rate D. Decreased appetite, increased thirst, and pallor

C. systolic hypertension and increased heart rate Correct Answer: Systolic hypertension and increased heart rate Rationale: The manifestations are consistent with Graves' disease or hyperthyroidism. Systolic hypertension, increased heart rate, and increased thirst are associated with hyperthyroidism. Cigarette smoking places the patient at increased risk for Graves' disease. The inhaled cigarette toxins may absorb via the eye orbits, causing exophthalmos. A puffy face; decreased sweating; dry, coarse hair; muscle weakness and slow movements; decreased appetite; and pallor are all manifestations of hypothyroidism.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

Correct Answer: C "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." Rationale: In type 2 diabetes, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes.

After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on A. frequent monitoring of serum and urine osmolarity B. parenteral administration of a GH-receptor antagonist C. keeping the patient in a recumbent position at all times D. patient teaching about the need for lifelong hormone therapy

Correct answer: a Rationale: A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To assess for DI, urine output and serum and urine osmolarity should be monitored closely.

The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to A. increase fluid intake B. administer an antibiotic C. administer an antimotility drug D. Quarantine the patient to prevent spread of virus

Correct answer: a Rationale: Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting. The major concerns are transmission prevention, fluid and electrolyte replacement, and resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, wash your hands before and after contact with the patient and when handling body fluids of any kind. Flush vomitus and stool down the toilet and wash contaminated clothing at once with soap and hot water.

The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states A. "I should only have to change the pouch every 4-7 days." B. "The drainage pouch will look like my normal stools." C. "I may not need to wear a drainage pouch if I irrigate it daily" D. "Limiting my fluid intake should decrease the amount of output."

Correct answer: a Rationale: Because ileostomy drainage is a liquid to thin paste, the patient will need to wear a drainage bag at all times. The patient should use an open-ended drainable pouch. It is worn for 4 to 7 days. Output from a sigmoid colostomy resembles normally formed stool. Some patients can regulate emptying time so they do not need to wear an ostomy pouch.

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to A. increase calcium intake to 1500 mg/day B. perform glucose monitoring for hypoglycemia C. obtain immunizations due to high risk for infections D. avoid abrupt position changes because of orthostatic hypotension

Correct answer: a Rationale: Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce bone resorption may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate), and taking part in a low-impact exercise program.

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu A. scrambled eggs and sausage B. buckwheat pancakes with syrup C. oatmeal, skim milk, and orange juice D. yogurt, strawberries, and rye toast with butter

Correct answer: a Rationale: Celiac disease is treated with lifelong avoidance of dietary gluten (wheat, barley, oats, rye products). Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is found in some medications and in many food additives, preservatives, and stabilizers.

Which instruction would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? A. "The best time to take an as needed antacid is 1 to 3 hours after meals." B. "A glass of warm milk at bedtime will decrease your discomfort at night." C. "Do not chew gum; the excess saliva will cause you to excrete more acid." D. "Limit your intake of foods high in protein because they take longer to digest."

Correct answer: a Rationale: Patients who use an as-needed antacid should do so 1 to 3 hours after eating. Teach patients that the increased saliva production associated with chewing gum will help with GERD symptoms. The patient should not eat meals within 3 hours of bedtime. Some foods, such as red wine, decrease lower esophageal sphincter pressure and worsen symptoms. Milk increases gastric acid secretion. There is no need for the patient to limit protein intake.

Which statement by the patient with type 2 diabetes is accurate? A. "I will limit my alcohol intake to 1 drink each day." B. "I am not allowed to eat any sweets because of my diabetes." C. "I cannot exercise because I take a blood glucose-lowering medication." D. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

Correct answer: a Rationale: The guideline for alcohol consumption in men with diabetes is 0-2 drinks per day. For women with diabetes it is 0-1 drink per day.

M.J. calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to A. administer antiemetic drugs and observe skin turgor. B. give her mother sips of water and elevate the head of her bed to prevent aspiration. D. offer her mother large quantities of Gatorade to decrease the risk of sodium depletion. D. give her mother a high-protein liquid supplement to drink to maintain her nutritional needs.

Correct answer: b Rationale: Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. Older adults are susceptible to the central nervous system (CNS) side effects of antiemetic drugs and may develop confusion. Dosages should be reduced, and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances. High-protein drinks and high-sodium liquids may be contraindicated.

The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching about this drug, the nurse determines that further instruction is needed when the patient says A. "I can expect the medication dose may need to be adjusted." B. "I only need to take this drug until my symptoms are improved." C. "I can expect to return to normal function with the use of this drug." D. " I will report any chest pain or difficulty breathing to the doctor right away."

Correct answer: b Rationale: Levothyroxine is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong.

In contrast to diverticulitis, the patient with diverticulosis A. has rectal bleeding B. often has no symptoms C. usually develops peritonitis D. has localized cramping pain

Correct answer: b Rationale: Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.

Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing A. beef B. meat and milk C. poultry and eggs D. home-preserved vegetables

Correct answer: b Rationale: Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.

Polydipsia and polyuria related to diabetes are primarily due to A. the release of ketones from cells during the fat metabolism B. fluid shifts resulting from the osmotic effect of hyperglycemia C. damage to the kidneys from exposure to high levels of glucose D. changes in RBCs resulting from attachment of excess glucose to hemoglobin

Correct answer: b Rationale: The osmotic effect of glucose cause the manifestations of polydipsia and polyuria.

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full-liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of A. an intolerance to the feedings B. extension of the tumor in the aorta C. leakage of fluids into the mediastinum D. esophageal perforation with fistula formation into the lung

Correct answer: c Rationale: After esophageal surgery, the nurse should observe the patient for signs of leakage into the mediastinum. Symptoms of a leakage are pain, increased temperature, and dyspnea.

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to A. monitor blood glucose level B. restrict fluid and sodium intake C. Administer potassium sparing diuretics D. advise the patient to make postural changes slowly

Correct answer: c Rationale: Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone, eplerenone) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney. This increases sodium excretion, water excretion, and potassium retention. Oral potassium supplements may be needed.

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include A. hypernatremia and edema B. muscle spasticity and hypertension C. low urine output and hyponatremia D. weight gain and decreased glomerular filtration rate

Correct answer: c Rationale: Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Thus, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. At first, the patient has thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) have low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include headache, vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, seizures, and coma.

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 RBCs

Correct answer: c Rationale: Gastritis may cause a loss of parietal cells because of atrophy. This results in a lack of intrinsic factor, which is essential for the absorption of cobalamin in the terminal ileum, and cobalamin deficiency. Because cobalamin is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications.

The nurse teaching young adults about behaviors that put them at risk for oral cancer includes A. discouraging use of chewing gum B. avoiding use of perfumed lip gloss C. avoiding use of smokeless tobacco D. discouraging drinking of carbonated beverages

Correct answer: c Rationale: Oral cancer has several predisposing risks factors: • Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression • Tongue: tobacco, alcohol, chronic irritation, and syphilis • Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection)

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of A. polyuria B. severe dehydration C. rapid, deep respirations D. decreased serum potassium

Correct answer: c Rationale: Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.

A patient with stage 1 colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that A. chemotherapy will begin after the patient recovers from the surgery B. both chemotherapy and radiation can be used as palliative treatments C. follow-up colonoscopies will be needed to ensure that the cancer does not recur D. a wound, ostomy, and continence nurse will visit the patient to identify the site for the ostomy

Correct answer: c Rationale: Stage I colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease A. often results in toxic megacolon B. causes fewer nutritional deficiencies than ulcerative colitis C. often recurs after surgery, while ulcerative colitis is curable with a colectomy D. is manifested by rectal bleeding and anemia more often than is ulcerative colitis

Correct answer: c Rationale: Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn's disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common

What should a patient be taught after a hemorrhoidectomy? A. take mineral oil before bedtime B. eat a low-fiber diet to rest the colon C. use oil-retention enemas to empty the colon D. take prescribed pain medications before a bowel movement

Correct answer: d Rationale: After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Give pain medication before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener, such as docusate (Colace), is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oilretention enema is given.

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? A. call the provider B. give insulin as ordered C. assess for other neurological symptoms D. check the patient's blood glucose level

Correct answer: d Rationale: Check blood glucose whenever hypoglycemia is suspected so that immediate action can be taken if necessary.

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. the patient must receive insulin therapy to prevent ketoacidosis B. the patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin. C. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. the patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome

Correct answer: d Rationale: Hyperosmolar hyperglycemia syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to make enough insulin to prevent diabetes related ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops A. muscle weakness and weight loss B. hyperthermia and severe tachycardia C. hypertension and difficulty swallowing D. laryngospasms and tingling in the hands and feet

Correct answer: d Rationale: Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia

The nurse is teaching 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 staphylococcus aureus 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

Correct answer: d Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) is not necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and decaffeinated) is a strong stimulant of gastric acid secretion.

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about A. cancer support groups, alopecia and stomatits. B. nutrition supplements, ostomy care, and support groups C. prosthetic devices, wound and skin care, and grief counseling D. wound and skin care, nutrition, drugs, and community resources

Correct answer: d Rationale: Radiation therapy is an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.

A nursing intervention that is most appropriate to decrease post-operative edema and pain after an inguinal herniorrhaphy is to A. apply a truss to the hernia site B. allow the patient to stand to void C. support the incision during coughing D. apply a scrotal support with an ice bag

Correct answer: d Rationale: Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.

The nurse explains to the patient with Vincent's infection that treatment will include A. tetanus vaccination B. viscous lidocaine rinses C. amphotericin B suspension D. topical application of antibiotics

Correct answer: d Rationale: Vincent's infection is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoiding tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? A. A1C 9% B. BP 126/80 mmHG C. FBG 130 mg/dL (7.2 mmol/L) D. LDL cholesterol 100 mg/dL (2.6 mmol/L)

Correct answers: a Rationale: Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications. Keeping blood glucose levels in a tighter range (normal hemoglobin A1C level, less than 6%) may further reduce complications but increases hypoglycemia risk.

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) A. persistent abdominal pain B. marked abdominal distention C. Diarrhea that is loose or liquid D. colicky, severe, intermittent pain E. profuse vomiting that relieves abdominal pain

Correct answers: a, b Rationale: With lower intestinal obstructions, abdominal distention is markedly increased, and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually obstipation, not diarrhea.

A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnosis should you consider as a possible causes of her pain? (select all that apply) A. gastroenteritis B. ectopic pregnancy C. gastrointestinal bleeding D. irritable bowel syndrome E. inflammatory bowel disease

Correct answers: a, b, c, d, e Rationale: All these conditions could cause acute abdominal pain.

Which are appropriate therapies for patients with diabetes? (select all that apply) A. use of statins to reduce CVD risk B. use of diuretics to treat nephropathy C. use of ACE inhibitors to treat nephropathy D. use of serotonin agonists to decrease appetite E. use of laser photocoagulation to treat retinopathy

Correct answers: a, c, e Rationale: In patients with diabetes who have albuminuria, angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g., losartan [Cozaar]) are used. Both classes of drugs are used to treat hypertension and delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely used lipid-lowering agents. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, in those with macular edema, and in some cases of Nonproliferative retinopathy.

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) A. insulin administration B. elimination of sugar from diet C. need to reduce physical activity D. use of a portable blood glucose monitor E. hypoglycemia prevention, symptoms, and treatment

Correct answers: a, d, e Rationale: The nurse ensures that the patient understands the proper use of insulin. The nurse teaches the patient how to use the portable blood glucose monitor and how to recognize and treat signs and symptoms of hypoglycemia and hyperglycemia. These are referred to as "survival skills."

Assessment findings suggestive of peritonitis include (select all that apply) A. rebound tenderness B. a soft, distended abdomen C. dull, intermittent abdominal pain D. shallow respirations with bradypnea E. observing that the patient is lying still

Correct answers: a, e Rationale: With peritoneal irritation, the abdomen is hard, and the patient has severe continuous abdominal pain that is worse with any sudden movement. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness. The patient lies very still and takes shallow breaths. Abdominal distention, tachypnea, fever, and tachycardia may occur.

Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) A. restricting protein intake B. monitoring blood glucose levels C. observing for signs of hypotension D. administering medication in equal doses E. protecting patient from exposure to infection

Correct answers: b, e Rationale: Hyperglycemia occurs with Cushing disease because of glucose intolerance associated with cortisol-induced insulin resistance and increased gluconeogenesis by the liver. High levels of corticosteroids increase risk of infection and delay wound healing.

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) A. limiting alcohol intake to 1 serving per day B. only taking aspirin with milk or bread products C. avoiding taking aspirin and drugs containing aspirin D. only taking drugs prescribed by the health care provider E. taking all drugs 1 hour before meal time to prevent further bleeding

Correct answers: c, d Rationale: Before discharge, teach the patient with upper gastrointestinal (GI) bleeding and the caregiver how to avoid future bleeding episodes. Drug and alcohol use can be a source of irritation and interfere with tissue repair. Their use should be eliminated. Help make the patient and caregiver aware of the consequences of nonadherence with drug therapy. Emphasize not to take any drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the HCP. Taking drugs with meals may decrease irritation.

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? A. "It will increase bulk in the stool." B. "It will lubricate the intestinal tract to soften feces." C. "It will increase fluid retention in the intestinal tract." D. "It will increase peristalsis by stimulating nerves in the colon wall."

D. " It will increase peristalsis by stimulating nerves in the colon wall." Correct Answer: "It will increase peristalsis by stimulating nerves in the colon wall." Rationale: Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk-forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I will go running when my blood sugar is too high to lower it." B. "I will go fishing frequently and pack a healthy lunch with plenty of water." C. "I do not need to increase my exercise routine since I am on my feet all day at work." D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Correct Answer: "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Rationale: The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and walking at work are light activity, and running is considered vigorous activity.

A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in determining a diagnosis for this patient? A. Administration of β-blocker medications B. Abdominal palpation to search for a tumor C. Administration of potassium-sparing diuretics D. A 24-hour urine collection for fractionated metanephrines

D. A 24-hour urine collection for fractionated metanephrines Correct Answer: A 24-hour urine collection for fractionated metanephrines Rationale: Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma, an α-adrenergic receptor blocker is used preoperatively to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed. Most likely they would be used for hyperaldosteronism, which is another cause of hypertension.

Which patient is at highest risk for developing oral candidiasis? A. A 74-yr-old patient who has vitamin B and C deficiencies B. A 22-yr-old patient who smokes 2 packs of cigarettes per day C. A 58-yr-old patient who is receiving amphotericin B for 2 days. D. A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks.

D. A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks. Correct Answer: A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks. Rationale: Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies may lead to Vincent's infection. Use of tobacco products leads to stomatitis, not candidiasis.

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? A. Write an incident report about this untoward event. B. Attempt to have the family convince the patient to take the ordered dose. C. Withhold the medication at this time and try to administer it later in the day. D. Chart the dose as not given on the medical record and explain in the nursing progress notes.

D. Chart the dose as not given on the medical record and explain in the nursing progress notes. Correct Answer: Chart the dose as not given on the medical record and explain in the nursing progress notes. Rationale: Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

The nurse asks a patient scheduled for colectomy to sign the operative permit as directed in the provider's preoperative orders. The patient states that the provider has not explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? A. Ask family members whether they have discussed the surgical procedure with the provider. B. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. C. Have the patient sign the form and state the provider will visit to explain the procedure before surgery. D. Delay the patient's signature on the consent and notify the provider about the conversation with the patient.

D. Delay the patient's signature on the consent and notify the provider about the conversation with the patient. Rationale: The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the provider, who has the responsibility for obtaining consent.

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? A. Wear a mask to prevent transmission of infection. B. Have visitors use the alcohol-based hand sanitizer. C. Wipe down equipment with ammonia-based disinfectant. D. Don gloves and gown before entering the patient's room.

D. Don gloves and gown before entering the patient's room. Correct Answer: Don gloves and gown before entering the patient's room. Rationale: Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room, and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? A. White bread, cheese, and green beans B. Fresh tomatoes, pears, and corn flakes C. Oranges, baked potatoes, and raw carrots D. Dried beans, All Bran (100%) cereal, and raspberries

D. Dried beans, All Bran (100%) cereal, and raspberries Rationale: A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

The nurse caring for a patient hospitalized with diabetes would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

D. Glycosylated hemoglobin level Correct Answer: Glycosylated hemoglobin level Rationale: A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction

D. High-pitched and hyperactive above the area of obstruction Rationale: Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The patient with an adrenal hyperplasia is returning from surgery after an adrenalectomy. The nurse should monitor the patient for what immediate postoperative complication? A. Vomiting B. Infection C. Thromboembolism D. Rapid blood pressure changes

D. Rapid blood pressure changes Correct Answer: Rapid blood pressure changes Rationale: The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.

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? A. Back pain 3 or 4 hours after eating a meal B. Chest pain relieved with eating or drinking water C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen and vomiting following indigestion

D. Rigid abdomen and vomiting following indigestion Correct Answer: Rigid abdomen and vomiting following indigestion Rationale: 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.

The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? A. Take a dose of mineral oil at the same time B. .Add extra salt to food on at least one meal tray. C. Ensure a dietary intake of 10 g of fiber each day. D. Take each dose with a full glass of water or other liquid.

D. Take each dose with a full glass of water or other liquid. Rationale: Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

The nurse is teaching a group of college students how to prevent food poisoning. Which comment shows an understanding of foodborne illness protection? A. "To save refrigerator space, leftover food can be kept on the counter if it is in a sealed container." B. "Eating raw cookie dough from the package is a great snack when you do not have time to bake." C. "Since we only have one cutting board, we can cut up chicken and salad vegetables at the same time." D. "When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."

D. When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate." Correct Answer: "When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate." Rationale: The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the pink meat may not have reached 160° F and could be contaminated with bacteria. Improperly storing cooked foods, eating raw cookie dough from a refrigerated package, and only using one cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to food poisoning from contamination.

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? A. Bisacodyl B. Lubiprostone C. Cascara sagrada D. Magnesium hydroxide

D. magnesium hydroxide Correct Answer: Magnesium hydroxide Rationale: Milk of magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.