Med Surg Exam 4
Lubiprostone 0.008 mg BID is prescribed for irritable bowel syndrome with constipation. Available are 8 mcg soft gelatin capsules. How many capsules will the nurse administer?
1
The nurse teaches the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which of the following statements made by the client indicates that more teaching is needed? a. "I will be sure to drink tea instead of coffee." b. "I will take a walk after I eat." c. "I will try to eat smaller meals more frequently." d. "I will sleep with the head of the bed elevated about 12 in."
a
Which action should the nurse in the emergency department anticipate for a young adult who has had several 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
a
Which of the following comments made by the patient indicates that additional instruction about the care of a new ileostomy is needed? a. "I should change the appliance daily to prevent odors." b. "When I change the appliance, I should check the skin for irritation." c. "I should clean around the stoma with mild soap and water and pat dry." d. "I'll need to alter the appliance opening when the stoma becomes smaller as the area heals."
a
Which of the following dietary measures would be useful in preventing esophageal reflux? a. eating small, frequent meals b. increasing fluid intake c. avoiding air swallowing with meals d. adding a bedtime snack to the dietary plan
a
A the change of the shift you notice 200 mL left to count in the IV bag. The IV is infusing at 80 ml/hr. How much longer will the IV run?
2h 30m
A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (sata) a. take the medication 1 hr before a meal b. limit NSAIDs when taking this medication c. expect skin flushing when taking this medication d. increase fiber intake when taking this medication e. chew the medication thoroughly before swallowing
a,b
A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first? a. review the client's electrolyte values b. check the client's perianal skin integrity c. assess the client's emotional concerns d. obtain a dietary history from the client
a
A nurse is caring for a client who is receiving TPN solution. The current bag of solution was hung 24 hr ago and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? a. remove the current bag and hang a new bag b. infuse the remaining solution at the current rate and then hang a new bag c. increase the infusion rate so the remaining solution is administered within the hour and hang a new bag d. remove the current bag and hang a bag of lactated ringers
a
A nurse is completing discharge teaching with a client who has IBS. Which of the following instructions should the nurse include? a. keep a food diary to identify triggers of exacerbation b. consume 15-20 g of fiber daily c. plan 3 moderate to large meals per day d. limit fluid intake to 1 L each day
a
A nurse is having difficulty arousing a client following an esophagogastroduodenoscopy. Which of the following is the priority action by the nurse? a. assess the client's airway b. allow the client to sleep c. prepare to administer an antidote to the sedative d. evaluate preprocedural laboratory findings
a
A nurse is reviewing bowel prep using polyethylene glycol with a client scheduled for a colonoscopy. Which of the following instructions should the nurse include? a. check with the provider about taking current medications when consuming bowel prep b. consume a normal diet until starting bowel prep c. expect the bowel prep to not begin acting until the day after all the prep is consumed d. discontinue the bowel prep once feces start to be expelled
a
After teaching a patient about dietary modifications for ulcerative colitis, you determine that teaching was effective when he chooses which menu? a. baked cod, baked sweet potato, and canned pears b. barbecued brisket, coleslaw, baked beans, and angel food cake c. fried shrimp with cocktail sauce, corn on the cob, and a fruit roll up d. turkey burger with cheese on a whole wheat bun, french fries, and an orange
a
Diagnostic testing is planned for a patient with a suspected peptic ulcer. The nurse explains to the patient that the most reliable test for determining the presence and location of an ulcer is a(n): a. endoscopy b. gastric analysis c. barium swallow d. serologic test for H. pylori
a
Postoperatively, a patient with an incisional cholecystectomy has a nursing diagnosis of ineffective breathing pattern related to splinted respirations secondary to a high abdominal incision. Which action should the nurse take first? a. assess heart and lung sounds b. administer the prescribed analgesic c. position the patient on the operative side d. instruct the patient to cough and deep breath
a
The client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nruse? a. this is a normal, expected event b. the client is experiencing early signs of ischemic bowel c. the client should not have the nasogastric tube removed d. this indications inadequate preoperative bowel preparation
a
The competent nurse understands that a patient receiving enteral nutrition via a NG tube is at increased risk for: a. hypoglycemia b. dehydration c. excessive weight gain d. pressure injury
a
A nurse is teaching a client who will undergo a sigmoidoscopy. Which of the following information about the procedure should the nurse include? (sata) a. increased flatulence can occur following the procedure b. NPO status should be maintained preprocedural c. conscious sedation is used d. repositioning will occur throughout the procedure e. fluid intake is limited the day after the procedure
a,b
A nurse is caring for a client who has a small bowel obstruction from adhesions. which of the following findings are consistent with this diagnosis? (sata) a. emesis greater than 500 mL b. report of spasmodic abdominal pain c. high pitched bowel sounds d. abdomen flat with rebound tenderness and palpation e. laboratory findings indicating metabolic acidosis
a,b,c
A nurse is caring for a client who has a new diagnosis of GERD. The nruse should expect prescriptions for which of the following medications (sata) a. antacids b. histamine 2 receptor antagonists c. opioid analgesics d. fiber laxatives e. proton pump inhibitors
a,b,e
A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (sata) a. evaluate I+O b. monitor lab reports of electrolytes c. provide three large meals per day d. administer ibuprofen for pain e. observe stool characterisstics
a,b,e
A nurse is the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (sata) a. rigid abdomen b. tachycardia c. elevated blood pressure d. circumoral cyanosis e. rebound tenderness
a,b,e
A nurse is planning care for a client who has a new prescription for total parenteral nutrition. Which of the following interventions should be included in the plan of care? (sata) a. obtain a capillary blood glucose four times daily b. administer prescribed medications through a secondary port on the TPN IV tubing c. monitor vital signs three times during the 12 hr shift d. change the TPN IV tubing every 24 hr e. ensure a daily aPTT is obtained
a,c,d
A nurse is planning care for a client who has a small bowel obstruction and a NG tube in place. which of the following interventions should the nurse include? (sata) a. document the NG drainage with the client's output b. irrigate the NG tube every 8 hr c. assess bowel sounds d. provide oral hygiene every 2 hours e. monitor NG tube for placement
a,c,d,e
Which statements are true regarding laparoscopic cholecystectomy? (sata) a. considered the "gold standard" and is more common b. patients with chronic lung or heart disease may be unable to tolerate the laparoscopic procedure c. reduces the risk of wound infection d. patients should be encouraged to ambulate early to promote absorption of carbon dioxide e. puts the patient at increased risk for bile duct injuries f. after the procedure, O2 saturation should be assessed frequently until the effects of anesthesia have passed
a,c,d,f
A 26 year old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid: a. emotionally stressful situations b. smoked foods such as ham and bacon c. foods that can cause distention or bloating d. chronic use of H2 blocking medications
b
A charge nurse is teaching a group of nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements y a unit nurse indicates understanding of the purpose of the procedure? a. "The client will have increased duodenal gastric emptying" b. "the client will have a reduction of gastric acid secretions" c. "the client will have an increase of gastric mucus secretions" d. "the client will have an increased secretion of hydrogen/potassium ATPase enzymes
b
A nurse is assessing a client in an extended care facility. The nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to a fecal impaction? a. the client reports one bowel movement yesterday b. the client is having small, frequent liquid stools c. the client is flatulent d. the client indicates vomiting once this morning
b
A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? a. absence of saliva b. painful swallowing c. sweet taste in mouth d. absence of eructation
b
A nurse is providing care to a client who is 1 day postoperative following paracentesis. The nurse observes clear, pale yellow fluid leaking from the operative site. Which of the following is an appropriate nursing intervention? a. place a clean towel near he drainage site b. apply a dry, sterile dressing c. apply direct pressure to the site d. place the client in a supine position
b
A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? a. "I can take my medications with soda" b. "peppermint tea will increase my indigestion" c. wearing an abdominal binder will limit my manifestations d. "I will drink hot chocolate at bedtime to help me sleep" e. "I can lift weights as a way to exercise"
b
A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? a. pernicious anemia is caused when the cells producing gastric acid are damaged b. expect a monthly injection of vitamin B12 c. plan to take vitamin K supplements d. pernicious anemia is caused by an increased production of gastric factor
b
A patient admitted with a peptic ulcer has a NG tube in place. When the patient develops sudden, sever 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
b
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to: 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
b
A patient is experiencing an acute episode of diverticulitis. The patient is having abdominal pain, temperature 102,6, and elevated WBCs. As the nurse, you know it is important to: a. encourage intake of high fiber foods b. monitor the patient for peritonitis c. apply a heating pad to the patient's abdomen to alleviate pain d. encourage intake of full fluids
b
A patient with known peptic ulcer disease has developed a fever, sudden sever abdominal pain that spreads to the back and shoulder, N/V, and a distended/rigid abdomen. The nurse suspects what complication? a. diverticulitis b. peritonitis c. gastric cancer d. PUD
b
A young woman who has Crohn's disease develops a fever and symptoms of a urinary tract infection 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. drink adequate fluids to maintain normal hydration d. empty the bladder before and after sexual intercourse
b
The client with GERD complains of chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? a. development of laryngeal cancer b. irritation of the esophagus c. esophageal scar tissue formation d. aspiration of gastric contents
b
The nurse identifies which laboratory value as the usual indication of hepatic encephalopathy? a. elevated sodium b. elevated ammonia c. increased BNP d. increased BUN e. increased clotting time
b
The nurse is caring for a client with an exacerbation of ulcerative colitis. Which laboratory finding for the client will the nurse expect? a. decreased erythrocyte sedimentation rate (ESR) b. potassium 3.0 c. decreased C-reactive protein (CRP) d. platelet count of 100k
b
The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? a. irrigate the JP drain b. avoiding coughing c. maintaining bedrest d. restricting pain medicaton
b
Which assessment variable requires immediate intervention post esophagectomy? a. blood pressure of 170/88 b. respiratory rate of 36 c. temperature of 38.1 d. pain assessment of 6/10
b
A nurse is completing an admission assessment for a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (sata) a. emesis prior to insertion of the NG tube b. urine specific gravity 1.04 c. hematocrit 60% d. blood potassium 3.0 e. WBC 10,000
b,c,d
A physician suspects a patient has a perforated appendix. What assessment findings will the nurse expect the client will have? (sata) a. bradycardia b. dizziness c. distended abdomen d. fever e. diarrhea f. fistulas g. incontinence
b,c,d,e
Which of the following conditions can cause a hiatal hernia? (SATA) a. increased intrathoracic pressure b. weakness of the esophageal sphincter c. increased esophageal muscle pressure d. weakness of the diaphragmic muscles
b,d
A 38 year old woman receiving chemotherapy for breast cancer develops a C. albicans oral infection. The nurse will anticipate the need for: a. hydrogen peroxide rinses b. the use of antiviral agents c. administration of nystatin oral solution d. referral to a dentist for professional tooth cleaning
c
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 has been vomiting for 4 days b. that patient takes antacids 8-10 times a day c. the patient is lethargic and difficult to arouse d. the patient has had a small intestinal resection
c
A 76 year old woman with a BMI of 17 and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find? a. restlessness b. hypertension c. pitting edema d. food allergies
c
A client with a subtotal gastrectomy is scheduled for discharge. Which of these instructions should the nurse give the client to reduce the possibility of dumping syndrome? a. be sure to eat foods high in complex carbohydrates b. it is helpful to take a walk after eating c. avoid drinking fluids with your meal d. don't lie down for at least 2 hours after eating
c
A home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates correct understanding of the instructions? a. "A dark or purplish looking stoma is normal and should not concern me." b. "If the skin around the stoma is red or scratched, it will heal soon." c. "I need to check for leakage underneath my colostomy." d. "I should strive for a very tight fit when applying the barrier around the stoma."
c
A nurse is caring for a client who has a C. diff infection. Which of the following cleansing agents should the nurse use for hand hygiene? a. chlorhexidine b. providone-iodine c. soap and water d. alcohol-based hand rub
c
A nurse is completing discharge teaching for a client who has an infection due to H. pylori. Which of the following statements by the client indicates understanding of the teaching? a. "I will continue my prescription for corticosteroids" b. "I will schedule a CT scan to monitor improvement" c. "I will take a combination of medications for treatment" d. "I will have my throat swabbed to recheck for this bacteria"
c
A nurse is completing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse include in the teaching? a. mucus will be present in stool for 5-7 days after surgery b. expect 500-1000 mL of semiliquid stool after 2 weeks c. stoma should be moist and pink d. change the ostomy ag when it is 3/4 full
c
A nurse is completing discharge teaching with a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching. a. "When sitting in my lounge chair after a meal, I will lower the back of it" b. "I will try to eat three large meals a day" c. "I will elevate the head of my bed on blocks" d. "I will avoid eating within 1 hour before bedtime
c
A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? a. take the medication with food b. monitor for diarrhea c. wait 1 hr before taking other oral medications d. maintain a low fiber diet
c
A nurse is teaching a client who has a new prescription for famotidine. Which of he following statements by the client indicates understanding of the teaching? a. "The medicine coats the lining of my stomach" b. "The medication should stop the pain right away" c. "I will take my pill at bedtime" d. "I will monitor for bleeding from my nose"
c
A patient is admitted to a medical unit with a diagnosis of malnutrition. The student nurse asks the nurse assigned to this patient about the relationship between drugs and nutrition. What is the most appropriate response for the nurse to make? a. "Foods alter the absorption or bioavailability of all drugs." b. "If the patient skips a meal, drugs may not be taken." c. "Some drugs increase the requirements for essential nutrients." d. "Drugs should be taken with food to prevent GI irritation
c
A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 and rates abdominal pain 9/10. In addition, the abdomen is distended and the patient states, "I was feeling better last night, but it seems that pain has become worse." The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing? a. pulmonary embolism b. colon fistulae c. peritonitis d. hemorrhage
c
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 take antacids between meals and at bedtime each night." b. "I sleep with the head of the bed elevated on 4 in blocks." c. "I eat small meals during the day and have a bedtime snack." d. "I quit smoking several years ago, but I still chew a lot of gum."
c
After discharge instructions for a patient who has had bariatric surgery for treatment of obesity, the nurse determines that additional teaching is needed when the patient says: a. "I shouldn't eat concentrated sweets." b. "I can eat small, frequent meals throughout the day." c. "I should drink several glasses of fluids with my meals." d. "I will need to have a cobalamin injection once a month."
c
After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? a. "I can have a glass of low-fat milk at bedtime." b. "I will have to eliminate all spicy foods from my diet." c. "I need to avoid caffeinated drinks." d. "I should keep something in my stomach at all times to neutralize excess acids."
c
An important factor associated with both short term and long term weight loss success is: a. higher initial BMI b. simultaneous smoking cessation c. a strong desire to improve appearance d. fewer dieting attempts in the past year
c
An important factor associated with both short term and long term weight loss success is: a. higher initial body mass index b. simultaneous smoking cessation c. a strong desire to improve appearance d. fewer dieting attempts in the past
c
The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? a. supine with the HOB flat b. on the stomach w the HOB flat c. supine with the HOB elevated 30 degrees d. on the left side with the HOB elevated 10 degrees
c
The nurse is admitting a male client with a diagnosis of colorectal cancer. Which assessment data supports this diagnosis? a. reports up to 20 bloody stools per day b. states he has a feeling of fullness after a heavy meal c. has diarrhea alternating with constipation d. complains of RLQ pain with rebound tenderness
c
Which action will the nurse include in the plan of care for a patient who is being admitted with C. diff? 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 or contact isolation d. teach the patient about why antibiotics will not be used
c
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, velvety patches on the buccal mucosa d. white, curdlike plaques on the posterior tongue
c
A nurse is reviewing the health record of a client who has a suspected tumor of the jejunum. The nurse should expect a prescription for which of the following tests? (sata) a. blood alpha fetoprotein b. endoscopic retrograde cholangiopancreatography c. gastrointestinal x-ray with contrast d. small bowel capsule endoscopy e. colonoscopy
c,d
A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (sata) a. client reports pain relieved by eating b. client states that pain often occurs at night c. client reports a sensation of bloating d. client states that pain occurs 30 min - 1 hr after a meal e. client experiences pain upon palpation of the epigastric region
c,d,e
A 60 year old man who is hospitalized with an abdominal wound infection has been eating very little and states, "Nothing on the menu sounds good." Which action by the nurse will be the most effective in improving the patient's oral intake? a. order six small meals daily b. make a referral to the dietitian c. teach the patient about high calorie foods d. have family members bring favorite foods
d
A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding? a. "I will continue taking my warfarin while I complete these tests" b. "I'm glad I don't have to follow any special diet at this time" c. "This test determines if I have parasites in my bowel" d. "This is an easy way to screen for colon cancer
d
A nurse is admitting a client who has bleeding esophageal varices. The nurse should expect a prescription for which of the following medications? a. propranolol b. metoclopramide c. ranitidine d. vasopressin
d
A nurse is caring for a client following paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? a. client report of upper chest pain b. decreased urine output c. pallor d. temperature elevation
d
A nurse is caring for a client who is in the immediate postoperative period following a radial neck dissection. Which of the following parameters should the nurse assess first? a. pain severity b. wound drainage c. tissue integrity d. airway patency
d
A nurse is reviewing the home medication list for a patient admitted with suspected acute liver failure. Which medication reviewed by the nurse would be concerning? a. digoxin b. nitroglycerin c. ciprofloxacin d. acetaminophen
d
A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? a. eat three moderate-sized meals each day b. drink at least one glass of water with each meal c. eat a bedtime snack that contains a milk product d. increase protein in the diet
d
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. absorption of fat soluble vitamins may be reduced by fiber containing laxatives 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
d
A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should: a. initiate O2 therapy at 2 l/min to increase gas exchange b. notify the health care provider so that a paracentesis can be performed c. ask the patient to cough and deep breathe to clear respiratory secretions d. place the patient in Fowler's position to relieve pressure on the diaphragm
d
For which patient is it most important for the nurse to refer to a dietitian for a complete nutritional assessment? a. a 38 year old diabetic who is undergoing laser eye surgery b. a 55 year old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall c. a 24 year old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an asthma exacerbation d. a 45 year old hospitalized with nausea and abdominal pain who has had no oral intake and has only received IV fluids of D51/2NS for 6 days
d
The nurse teaches a patient about safe and successful weight loss. Which statement, if made by the patient, would indicate an understanding of the instructions? a. "I will keep a diary of daily weights to chart my weight loss." b. "I plan to lose 4 pounds per week until I have lost my goal of 60 pounds." c. "I should not exercise more than what is required because increased activity increases the appetite." d. "I plan to join a behavior modification group to make permanent changes necessary for weight control."
d
The nurse will anticipate teaching a patient experiencing frequent heartburn about a. a barium swallow b. radionuclide tests c. endoscopy procedures d. proton pump inhibitors
d
The surgical treatment of choice for the patient with symptomatic gallbladder disease is a: a. cholecystotomy b. choledocholithotomy c. cholecystoduodenostomy d. laparoscopic cholecystecotmy
d