MCA I - Exam 3 - Practice Questions (Professor Stacy)
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
D
The nurse is awaiting the arrival of a client from the recovery room who just had surgery. Unless contraindicated, the nurse should expect to administer which drug combinations to relieve post-operative pain most effectively? A. An opioid and an NSAID B. Two different types opioids C. An opioid and an anti-emetic D. An opioid and a sedative
A
Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma? A. Document the patient's oral intake. B. Apply prescription capsaicin (Zostrix) cream to hands. C. Check finger strength and movement. D. Monitor for difficulty in breathing.
A
A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed? A. "I eat small meals during the day and have a bedtime snack." B. "I quit smoking several years ago, but I still chew a lot of gum." C. "I sleep with the head of the bed elevated on 4-inch blocks." D. "I sometimes take antacids between meals."
A
A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink/red with minimal edema and a small amount of sanguineous drainage. The nurse should A. document stoma assessment findings. B. place ice packs around the stoma. C. monitor the stoma every 15 minutes. D. notify the surgeon about the stoma.
A
A client who had surgery has extreme postoperative pain lasting more than 12-hours. The pain is exacerbated when trying to participate in physical therapy. What intervention for pain management does the nurse include in the client's care plan? A. Round-the-clock analgesia with PRN analgesics for therapy B. Pain medications prior to therapy only C. Client-controlled analgesia with a basal rate only D. As-needed pain medication after therapy
A
A client with peptic ulcer disease asks the nurse how her omeprazole (Prilosec) a proton pump inhibitor (PPI) will make her feel better. What response by the nurse is best? A. Proton pump inhibitors (PPIs) decrease acid secretions in the stomach. B. Proton pump inhibitors (PPIs) are the drugs of choice for treating patients with stomach-acid related disorders. C. Proton pump inhibitors (PPIs) blocks the action of histamine to prevent acid secretion in the stomach. D. Proton pump inhibitors (PPIs) act by buffering stomach acids.
A
A nurse in the family clinic is teaching a 67-year old client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching? A. Ibuprofen (Motrin) B. Oxyocodone (OxyContin) C. Acetaminophen (Tylenol) D. Cyclobenzaprine hydrochloride (Flexeril)
A
A woman with RA comes to your clinic for her yearly physical. You review her laboratory values before completing your review of systems and physical assessment and note her hematocrit to be 39%. Your most appropriate action is? A. Continue with the review of systems and physical assessment. B. Ask whether she has had any black, tarry stools in the past few weeks. C. Ask her if she has been feeling fatigued. D. Contact the physician and update him using SBAR
A
An 82-year old man is admitted with an acute attack of diverticulitis. What is most important for the nurse to include in his care plan? A. Monitor for signs of peritonitis. B. Treat with daily medicated enemas. C. Prepare for surgery to resect the involved bowel. D. Provide a heating pad to apply to the left lower quadrant.
A
An older adult has diabetic neuropathy and often reports unbearable foot pain. About which medication would the nurse plan to educate the client? A. gabapentin (Neurontin) a gabapentinoid B. fentanyl (Abstral) a short-acting opioid C. morphine sulfate a long-acting opioid D. acetaminophen (Tylenol) a salicylic acid
A
The nurse has taught a patient about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) A. "I sure hate to give up coffee, but I can manage without it." B. I just joined a gym, so I hope that helps me lose weight." C. "Sitting upright and not lying down after meals will help." D. "I will eat small meals."
A, B, C, D
For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel? (select all that apply) A. NPO B. Nasogastric (NG) tube suctioning C. Opioid medications D. IV fluids E. Sedatives F. Bed rest
A, B, D
During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (select all that apply)? A. Sleep disturbances B. Widespread burning pain C. Multi-joint pain with inflammation and swelling D. Cardiac palpitations and dizziness E. Multiple tender points
A, B, E
The nurse will anticipate teaching and educating a patient experiencing frequent heartburn about? (select all that apply) A. proton pump inhibitors. B. a barium enema. C. possible endoscopy procedures D. radionuclide tests
A, C
The nurse is aware that which factors contribute to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) A. Obesity B. Viral infections C. Barrett's Esophagus D. Eating large meals
A, D
A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for A. projectile vomiting. B. abdominal distention. C. metabolic alkalosis. D. referred back pain.
B
A 24-year-old 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. Bacteria in the perianal area can enter the urethra. B. Fistulas can form between the bowel and bladder. C. Empty the bladder before and after sexual intercourse D. Drink adequate fluids to maintain normal hydration.
B
A 26-year-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. "Can you tell me more about the pain?" C. "Is it possible that you are pregnant?" D. "What is your usual elimination pattern?"
B
A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? A. Avoid use of acetaminophen (Tylenol) for pain. B. Apply a scrotal support and ice to reduce swelling. C. Cough 5 times each hour for the next 48 hours. D. Soak in sitz baths several times each day.
B
A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about A. The amount of saturated fat in the diet. B. Use of nonsteroidal antinflammatory drugs (NSAIDs). C. Any family history of gastric or colon cancer. D. A history of a large recent weight gain or loss.
B
A patient with rheumatoid arthritis asks the nurse how to manager her disease at home and decrease her morning stiffness. The nurse correctly responds: A. "Plasmapheresis will remove antibodies and improve stiffness." B. "Take a hot shower." C. "Apply ice packs for 20 minutes right after you wake up." D. "Soak in a tub of cool water."
B
Amytriptyline is prescribed for a patient with chronic pain from fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse's best response to the patient? A. Chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring. B. Some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain. C. Antidepressants will improve the patient's attitude and prevent a negative emotional response to the pain. D. Certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain.
B
The nurse determines that additional instruction is needed when a patient diagnosed with scleroderma says which of the following? A. "I should perform range-of-motion exercises daily." B. "I should lie down for an hour after each meal." C. "Paraffin baths/warm water baths can be used to help my hands." D. "Lotions will help if I rub them in for a long time."
B
The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding A. increased urine output. B. relief of joint pain. C. elevated serum uric acid. D. increased white blood cells (WBC).
B
Which finding will the nurse expect when assessing a 58-year-old patient who has osteoarthritis (OA) of the knee A. Stiffness that increases with movement B. Discomfort with joint movement C. Heberden's and Bouchard's nodes D. Redness and swelling of the knee joint
B
Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)? A. Educate the patient about the use of omeprazole (Prilosec) to reduce symptoms. B. Encourage the patient to express concerns and ask questions about IBS. C. Suggest that the patient increase the intake of milk and other dairy products. D. Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).
B
Which patient should the nurse assess first after receiving change-of-shift report? A. A patient admitted yesterday with gastrointestinal (GI) bleeding who has melena B. A patient with nausea who has a dose of metoclopramide (Reglan) due C. A patient with peptic ulcer disease who has a blood pressure of 92/58 mmHg D. A patient who is crying after receiving a diagnosis of esophageal cancer
C
A 25-year-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." An appropriate nursing diagnosis for the patient is A. impaired skin integrity related to itching and skin sloughing. B. activity intolerance related to fatigue and inactivity. C. social isolation related to embarrassment about the effects of SLE. D. impaired social interaction related to lack of social skills.
C
A 37-year-old patient with 2 school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that home life is very stressful. Which response by the nurse is most appropriate? A. "Perhaps it would be helpful for your family to be involved in a support group." B. Your family should understand the impact of your rheumatoid arthritis." C. "Tell me more about situations that are causing you stress." D. "You need to see a family therapist for some help with stress."
C
A 44-year-old man 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. Give the ordered antacid. C. Check the vital signs. D. Elevate the foot of the bed.
C
A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. On assessment, the patient has no bowel sounds and had 150 mL of bright red nasogastric (NG) drainage in the last hour. The priority action by the nurse is to A. monitor the NG drainage. B. administer the prescribed morphine. C. contact the surgeon. D. irrigate the NG tube.
C
A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first? A. Suggest that the patient increase intake of high-fiber foods. B. Encourage the patient to increase oral fluid intake. C. Assess the patient's risk factors for constipation. D. Teach the patient that a daily bowel movement is unnecessary.
C
A patient recovering from an acute exacerbation of RA tells the nurse that she is too tired to bathe. What should the nurse do for this patient? A. Tell the patient that she can skip bating if she will walk in the hall later. B. Give the patient a bed bath to conserve her energy. C. Allow the patient a rest period before showering with the nurse's help. D. Inform the patient that she must maintain her self-care activities and complete them daily.
C
A student asks the nurse what is the best way to assess whether or not a client is experiencing pain. Which response by the nurse is best? A. Use the numeric pain scale to quantify the pain B. Conduct a behavioral assessment C. Ask the client if he/she is experiencing pain and to describe it. D. Use objective observation
C
When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching? A. "I will be able to wear the pouch until it leaks." B. "The drainage from my stoma can damage my skin." C. "I will be able to regulate when I have stools." D. "Dried fruit and popcorn must be chewed very well."
C
When obtaining a history from a patient with a suspected gastric ulcer, what would the nurse expect? A. Intussusception of the small intestine B. Pain relieved 2-4 hours after ingestion of food C. Pain that worsens 1-2 hours after ingesting food D. A rigid, board-like abdomen
C
Which esophageal disorder is described as a precancerous lesion and is associated with GERD? A. Achalasia B. Esophageal diverticula C. Barrett's esophagus D. Esophageal strictures
C
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. Strictures are common. B. Restricted to rectum. C. Bloody, diarrhea stools. D. Lesions penetrate intestine E. Cramping abdominal pain.
C, E
A 26-year-old woman 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. Ask the patient about the nausea. C. Assess for signs of dehydration. D. Assist the patient with oral care.
D
A 49-year-old man has been admitted with significant hypotension and dehydration after 3 days of nausea and vomiting. Which order from the health care provider will the nurse implement first? A. Insert a feeding tube. B. Provide oral care with moistened swabs. C. Administer IV ondansetron (Zofran). D. Infuse normal saline at 250 mL/hr.
D
A 58-year-old 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 takes antacids 8 to 10 times a day. B. The patient has been vomiting for 4 days. C. The patient has undergone a small intestinal resection. D. The patient is lethargic and difficult to arouse.
D
A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which intervention will the nurse implement first? A. Place the patient in reverse trendelenberg to maintain blood pressure. B. Send the patient for a computerized tomography scan. C. Insert a urinary catheter to drainage. D. Infuse broad spectrum antibiotics IV as ordered.
D
A patient presents to the emergency department complaining of flu-like symptoms, round rash on his thigh, and joint pain. What would be the priority assessment question? A. "Do you ever get a butterfly like rash on your face?" B. "Do you have a cough?" C. "Does anyone in your family have rheumatoid arthritis?" D. "Have you been hiking in the woods recently?"
D
A patient with chronic neck pain is seen in the pain clinic for follow-up. To evaluate whether the overall pain management regimen is effective, which question is best for the nurse to ask? A. "Can you describe the quality of your pain?" B. "How would you rate your pain on a 0 to 10 scale?" C. Has there been a change in pain location?" D. "Does the pain keep you from activities that you enjoy?"
D
A student nurse asks why several clients are getting more than one type of pain medication instead of very high doses of one medication. What response by the registered nurse is best? A. "A multimodal approach is the preferred method even though there is a decreased risk of side effects." B. "Doctors are much more liberal with pain medications now." C. "Clients are consumers and they demand lots of pain medicine." D. "Pain is complex and targeting different pain mechanisms provides best control."
D
The normal adult male hemoglobin (hgb) values are: A. 12.0 - 15 g/dL B. 36 - 44 g/dL C. 39.5 - 50.8 g/dL D. 13.5 - 16.5 g/dL
D
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 nasogastric (NG) suction is returning coffee-ground material. B. The bowel sounds are hyperactive in all four quadrants. C. The patient's blood pressure (BP) has increased to 142/84 mmHg. D. The patient's lungs have crackles audible to the midchest.
D
The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A. High-pitched and hypoactive below the area of obstruction B. Low-pitched and hyperactive below the area of obstruction C. Low-pitched and rumbling above the area of obstruction D. High-pitched and hyperactive above the area of obstruction
D
Which assessment finding about a patient who has been using ibuprofen (Motrin) for 6 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider? A. The patient is occasionally using capsaicin cream (Zostrix). B. The patient has gained 3 pounds. C. The patient's pain has become more severe. D. The patient has dark/black-colored stools.
D
