Missed questions from all chapters for exam 3

The nurse is assessing a client with hepatitis C. The client asks the nurse how it was possible to have this disease. What questions might the nurse ask to help the client determine how the disease was contracted? (Select all that apply.) a. "How old are you?" b. "Do you work in health care? c. "Are you receiving hemodialysis?" d. "Do you use IV drugs?" e. "Did you receive blood before 1992?" f. "Have you even been in prison or jail?"

(all) ABCDEF

The nurse is caring for a client who has possible acute pancreatitis. What serum laboratory findings would the nurse expect for thisclient? (Select all that apply.) a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte count

(all) ABCDEF

The nurse notes that the primary health care provider documented the presence of mucosal erythroplasia in a client. What does the nurse understand that this most likely means for this client? a. Early sign of oral cancer b. Fungal mouth infection c. Inflammation of the gums d. Obvious oral tumor

a. Early sign of oral cancer

Which teaching will the nurse provide to a community group about early detection of colorectal cancer? Select all that apply. A. Home testing kits are available with a prescription. B. Sigmoidoscopy should be performed every 10 years .C. People over 40 years old should be tested for colon cancer. D. Bowel preparation is necessary prior to performance of a colonoscopy.E. Virtual colonoscopies (CT colonography) can be performed every 5 years.

A, B, D, E

A client is receiving bolus feedings through a small-bore nasoduodenal tube. What action by the nurse is the priority? a. Auscultate lung sounds after each feeding. b. Weigh the client daily on the same scale. c. Check tube placement every 8 hours. d. Check tube placement before each feeding.

d. Check tube placement before each feeding. For bolus feedings, the nurse checks placement of the tube per institutional policy prior to each feeding, which is more often than every 8 hours during the day. Auscultating lung sounds is also important, but this may indicate a complication that has already occurred. Weighing the client is important to determine if nutritional goals are being met, but it is not the priority.

The nurse assesses a client with gastroenteritis. What risk factor would the nurse consider as the most likely cause of this disorder? a. Consuming too much fruit b. Consuming fried or pickled foods c. Consuming dairy products d. Consuming raw seafood

d. Consuming raw seafood

A nurse cares for a client who is recovering from a colonoscopy. Which actions would the nurse take? (Select all that apply.) a. Obtain vital signs every 15 to 30 minutes until alert .b. Assess the client for rectal bleeding and severe pain. c. Administer prescribed pain medications as needed. d. Monitor the client's serum and urine glucose levels .e. Confirm the client has a ride home and plans to rest.

A, B, E

The nurse is caring for a client who has a risk gene for developing cirrhosis. Which racial/ethnic group has this gene most often? a. Blacks b. Asian/Pacific Islanders c. Latinos d. French

C

The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods would be included in the plan? (Select all that apply.) A Annual mammogram B Magnetic resonance imaging (MRI) C Breast ultrasound D Breast self-awareness E Clinical breast examination F Self-breast examination

A Annual mammogram D Breast self-awareness E Clinical breast examination

After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the client's electronic medical record? (Select all that apply.) A Peau d'orange B Dense breast tissue C Nipple retraction D Mobile mass at 2 o'clock E Nontender axillary nodes F Skin ulceration

A Peau d'orange C Nipple retraction D Mobile mass at 2 o'clock F Skin ulceration

A nurse is preparing to administer pantoprazole intravenously to prevent stress ulcers during surgery. What action(s) by the nurse is (are) most appropriate? (Select all that apply.) A: Administer the drug through a separate IV line. B: Infuse pantoprazole using an IV pump. C: Keep the drug in its original brown container. D: Take vital signs frequently during infusion. E: Use an in-line IV filter when infusing.

A: Administer the drug through a separate IV line. B: Infuse pantoprazole using an IV pump. E: Use an in-line IV filter when infusing. When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.

What action(s) by the nurse is (are) appropriate to promote nutrition in a client who had a partial gastrectomy? (Select all that apply.) A: Administer vitamin B12 injections. B: Ask the primary health care provider about folic acid replacement .C: Educate the client on enteral feedings. D: Obtain consent for total parenteral nutrition. E: Provide iron supplements for the client.

A: Administer vitamin B12 injections. B: Ask the primary health care provider about folic acid replacement. E: Provide iron supplements for the client. After a partial or total gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse would provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) A: Apricots B: Coffee cake C: Milk shake D: Potato soup E: Steamed broccoli

A: Apricots D: Potato soup Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, and low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate? A: Arrange a dietary consult. B: Increase fluid intake. C: Limit the client's foods. D: Make the client NPO.

A: Arrange a dietary consult.

The nurse is teaching a client about the risk of uncontrolled or untreated the client's gastroesophageal reflux disease (GERD). What complication(s) may occur if the GERD is not successfully managed? (Select all that apply.) a. Asthma b. Laryngitis c. Dental caries d. Cardiac disease e. Cancer

ABCDE

The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease (GERD). What assessment finding(s)would the nurse expect? (Select all that apply.) a. Dyspepsia b. Regurgitation c. Belching d. Coughing e. Chest discomfort f. Dysphagia

ABCDEF

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What assessment findings would the nurse expect? (Select all that apply.) a. Jaundice b. Clay-colored stools c. Icterus d. Ascites e. Petechiae f. Dark urine

ABCDEF

The nurse is caring for a client who just had a minimally invasive inguinal hernia repair. Which nursing actions would the nurse implement? (Select all that apply.) a. Apply ice to the surgical area for the first 24 hours after surgery. b. Encourage ambulation with assistance within the first few hours after surgery. c. Encourage deep breathing after surgery but teach the client to avoid coughing. d. Assess vital signs frequently for the first few hours after surgery. e. Teach the client to rest for several days after surgery when at home. f. Teach the client not to lift more than 10 lb (4.5 kg) until allowed by the surgeon.

ABCDEF

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse teaches the client and family about the signs of potential complications which include what problems?(Select all that apply.) a. Cholangitis b. Pancreatitis c. Perforation d. Renal lithiasis e. Sepsis

ABCE

A nurse cares for an older adult who is admitted to the hospital with complications of diverticulitis. Which actions would the nurse include in the client's plan of care? (Select all that apply.) a. Administer pain medications as prescribed. b. Palpate the abdomen for distention. c. Assess for sudden changes in mental status. d. Provide the client with a high-fiber diet. e. Evaluate stools for occult blood.

ABCE

A nurse prepares to discharge a client who is newly diagnosed with a chronic inflammatory bowel disease. Which questions would the nurse ask in preparation for discharge? (Select all that apply.) a. Does your gym provide yoga classes? b. When should you contact your provider? c. What do you plan to eat for dinner? d. Do you have a scale for daily weights? e. How many bathrooms are in your home?

ABCE

The nurse recalls that the risk factors for acute gastritis include which of the following? (Select all that apply.) A: Alcohol B: Caffeine C: Corticosteroids D: Fruit juice E: Nonsteroidal anti-inflammatory drugs (NSAIDs)

ABCE

Which of the following is (are) (a) risk factor(s) for gastric cancer? (Select all that apply.) A: Achlorhydria B: Chronic atrophic gastritis C: H. pylori infection D: Iron deficiency anemia E: Pernicious anemia

ABCE

After teaching a patient who has a permanent ileostomy, a nurse assesses the client's understanding. Which dietary items chosen for dinner indicate that the client needs further teaching? (Select all that apply.) a. Corn b. String beans c. Carrots d. Wheat rice e. Squash

ABD

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

ABD

A client being treated for syphilis visit the office with a possible allergic reaction to penicillin G which abnormal findings with the nurse expect to document select all that apply A. Red rash B. shortness of breath C. Heart irregularity D. chest tightness E. anxiety F. confusion

ABDE

The nurse is caring for a client who is diagnosed with celiac disease and preparing to start natalizumab. Which health teaching would the nurse include in the teaching? (Select all that apply.) a. Need to have drug administered by a primary health care provider .b. Need to avoid crowds and individuals who have infection. c. Need to report injection reactions such as redness and swelling. d. Awareness of a rare but potentially fatal drug complication. e. Need to report any signs and symptoms of infection immediately.

ABDE

Which teaching will the nurse include when educating a client who is scheduled to have an esophagogastroduodenoscopy (EGD)? Select all that apply. A. "Anesthesia will be used for sedation." B. "The procedure takes about 20 to 30 minutes to complete." C. "Informed consent will be needed prior to the procedure." D. "A separate test will be required to obtain any needed biopsies." E. "You will need to refrain from eating for at least 6 to 8 hours before the EGD."

ABDE

1. The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) A Age greater than 65 years B Increased breast density C Osteoporosis D Multiparity E Genetic factors F Early menarche

ABEF

A nurse plans care for an older adult client. Which interventions should the nurse include in this client's plan of care to promote kidney health? (Select all that apply.) a. Ensure adequate fluid intake. b. Leave the bathroom light on at night. c. Encourage use of the toilet every 6 hours. d. Delegate bladder training instructions to the unlicensed assistive personnel (UAP). e. Provide thorough perineal care after each voiding. f. Assess for urinary retention and urinary tract infection.

ABEF

Which daily behavior of a client with GI problems requires further nursing assessment? Select all that apply. A. Smokes a pack of cigarettes B. Uses Fleet enemas frequently to assist with bowel movements C. Practices intentional relaxation D. Eats multiple servings of fruits E. Takes 325 mg of aspirin at night for arthritic pain F. Exercises for 30 minutes three times weekly G. Travels extensively across the world

ABEG

The nurse is teaching assistive personnel (AP) about care of a client who has advanced cirrhosis. Which statements would the nurse include in the staff teaching? (Select all that apply.) a. "Apply lotion to the client's dry skin areas." b. "Use a basin with warm water to bathe the patient." c. "For the patient's oral care, use a soft toothbrush." d. "Provide clippers so the patient can trim the fingernails." e. "Bathe with antibacterial and water-based soaps."

ACD Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush would be used to prevent gum bleeding, and the client's nails would need to be trimmed short to prevent the patient from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

The nurse is caring for a client with peritonitis. What assessment findings would the nurse expect? (Select all that apply.) a. Nausea and vomiting b. Distended rigid abdomen c. Abdominal pain d. Bradycardia e. Decreased urinary output f. Fever

ACDEF

A nurse is caring for a client who has been diagnosed with a small bowel obstruction. Which assessment findings would the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L (2.8 mmol/L) b. Loss of 15 lb (6.8 kg) without dieting c. Abdominal pain in upper quadrantsd. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L (121 mmol/L)

ACE

The nurse is aware of the most recent American Cancer Society Screening Guidelines forcolon cancer, which include which accepted testing modalities for people over the age of 50?(Select all that apply.) a. Colonoscopy every 10 years b. Endoscopy every 5 years c. Computed tomography (CT) colonography every 5 years d. Double-contrast barium enema every 10 years e. Flexible sigmoidoscopy every 5 years

ACE

The nurse is caring for a client who has perineal surgical wound. Which actions would the nurse take to promote comfort and wound healing? (Select all that apply.) a. Assist the client into a side-lying position. b. Use a rubber donut device when sitting up. c. Apply warm compresses three to four times a day. d. Instruct the client to wear boxer shorts. e. Place an absorbent dressing over the wound.

ACE

A nurse assesses a client recovering from a cystoscopy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.) a. Decrease in urine output b. Tolerating oral fluids c. Prescription for metformin d. Blood clots present in the urine e. Burning sensation when urinating

AD

The nurse is planning health teaching for a client starting mirabegron for urinary incontinence. What health teaching would the nurse include? (Select all that apply.) a. "Monitor blood tests carefully if you are prescribed warfarin." b. "Avoid crowds and individuals with infection." c. "Report any fever to your primary health care provider." d. "Take your blood pressure frequently at home." e. "Report palpitations or chest soreness that may occur."

AD

The nurse is caring for a client who has a nasogastric tube (NGT). Which actions would the nurse take for client care? (Select all that apply.) a. Assess for proper placement of the tube every 4 hours or per agency policy. b. Flush the tube with water every hour to ensure patency. c. Secure the NG tube to the client's chin. d. Disconnect suction when auscultating bowel peristalsis. e. Monitor the client's skin around the tube site for irritation.

ADE

the nurse is caring for a client with a complete large bowel obstruction. what assessment findings would the nurse expect? SATA a. obstipation b. dehydration c. metabolic alkalosis d. abdominal distention e. abdominal painf. profuse vomiting

ADE

15. A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.) a. First-degree relative with prostate cancer b. Smoking c. Obesity d. Advanced age e. Eating too much red meat f. Race

ADEF

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses theclient's understanding. Which statement by the client indicates a need for further teaching? (Select all that apply.) a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein foods."

AE

A nurse assesses a client who presents with renal calculi. Which question would the nurse ask? a. "Do any of your family members have this problem?" b. "Do you drink any cranberry juice?" c. "Do you urinate after sexual intercourse?" d. "Do you experience burning with urination?"

ANS: A There is a strong association between family history and stone formation and recurrence.Nephrolithiasis is associated with many genetic variations; therefore, the nurse should askwhether other family members have also had renal stones. The other questions do not refer torenal calculi but instead are questions that should be asked of a patient with a urinary tractinfection.

A nurse assesses a client who is prescribed alosetron. Which assessment question would the nurse ask this client before starting the drug? a. "Have you been experiencing any constipation?" b. "Are you eating a diet high in fiber and fluids?" c. "Do you have a history of high blood pressure?" d. "What vitamins and supplements are you taking?"

ANS: A Ischemic colitis is a life-threatening complication of alosetron. The nurse would assess the client for constipation because it places the client at risk for this complication. The otherquestions do not identify the risk for complications related to alosetron.

A nurse is providing health teaching to a middle-age male-to-female (MtF) client who hasundergone gender-reaffirming surgery. What information is most important to this patient? a. "Be sure to have an annual prostate examination." b. "Continue your normal health screenings." c. "Try to avoid being around people who are ill." d. "You should have an annual flu vaccination."

ANS: A The MtF client retains the prostate, so annual screening examinations for prostate cancer remain important. The other statements are good general health teaching ideas for any patient.

A nurse works with many transgender patients. What routine monitoring is important for the nurse to facilitate in this population? (Select all that apply.) a. Lipid profile b. Liver function tests c. Mammograms if breast tissue is present d. Prostate-specific antigen (PSA) for natal malese. Renal profile f. Cervical cancer screening

ANS: A, B, C, D, F Common routine monitoring for this population includes lipid and liver panels, mammogramsif any breast tissue is present, and PSA for natal males as the prostate is not removed during avaginoplasty/penectomy. Cervical cancer screening is needed if the client has not had a totalhysterectomy with a BSO. Renal profiles are not required based on treatment options for this population.

A nurse is learning about the health care needs of individuals who identify as LGBTQIA+ and transgender. Which terms are correctly defined? (Select all that apply.) a. Gender dysphoria—distress caused by incongruence between natal sex and genderidentity. b. Gender identity—a person's inner sense of being a male, a female, or an alternative gender. c. Natal sex—the sex one is born with or is assigned to at birth. d. Transgender—a person who dresses in the clothing of the opposite sex. e. Trans-woman—a male who identified or lives as a woman.

ANS: A, B, C, E Gender dysphoria is emotional distress caused by the incongruence between natal sex (sexassigned at birth) and gender identity. Gender identity is a person's inner sense of being amale, a female, or an alternative gender Natal sex describes the gender a person is born with or is assigned to at birth. Transgender is an adjective that describes individuals who self-identify as the opposite gender or a gender that does not match their natal sex. Atrans-woman is a natal male who identifies and/or lives as a woman.

The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Selectall that apply.) a. Ascites b. Weight gain c. Steatorrhea d. Jaundice e. Polydipsia f. Polyuria

ANS: A, C, D, E, F The client who has chronic pancreatitis has all of these signs and symptoms except he or she loses weight. Ascites and jaundiceresult from biliary obstruction; ascites is associated with portal hypertension. Steatorrhea is fatty stool that occurs because lipase isnot available in the duodenum; because it is released by the disease pancreas into the bloodstream. Polydipsia, polyuria, andpolyphagia result from diabetes mellitus, a common problem seen in clients whose pancreas is unable to release adequate amountsof insulin.

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions would the nurse include in this client's assessment? (Select all that apply.) a. "Which food types cause an exacerbation of symptoms?" b. "Where is your pain or or discomfort and what does it feel like?" c. "Have you lost a significant amount of weight lately?" d. "Are your stools soft, watery, and black?" e. "Do you often experience nausea and vomiting"

ANS: A,B The nurse would ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse would also assess the location, intensity, and quality of the patient's pain or discomfort. Clients who have IBS do not usually lose weight, have nausea and vomiting, or have stools that are black.

The nurse assists the wound care/ostomy nurse assess a client prior to ostomy surgery. Which assessments would the nurse complete before making the placement for the ostomy? (Select all that apply.) a. Contour of the abdomen when standing b. Location of the client's belt line c. Contour of the abdomen when lying d. Location of abdominal muscles e. Contour of the abdomen when sitting

ANS: A,B,C,E Before marking the placement for the ostomy, the nurse would consider the contour of the abdomen in lying, sitting, and standing positions, the location of the belt line and possible location in the rectus muscle. The location of abdominal muscles is not considered.

The nurse is caring for a client with early encephalopathy due to cirrhosis of the liver. Which factors may contribute to increased encephalopathy for which the nurse would assess? (Select all that apply. a. Infection b. GI bleeding c. Irritable bowel syndrome d. Constipation e. Anemia f. Hypovolemia

ANS: A,B,D,F Anemia and irritable bowel syndrome are unrelated to developing or worsening encephalopathy, which is caused by increased protein which breaks down into ammonia. Infection can cause hypovolemia which would increase serum protein concentration. Constipation and GI bleeding causes a large protein load in the intestines

After delegating care to assistive personnel (AP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the AP's understanding. Which action indicates that the AP needs additional teaching? a. Toileting the client after breakfast b. Changing the client's incontinence brief when wet c. Encouraging the client to drink fluids d. Recording the client's incontinence episodes

ANS: B Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should reeducate the AP on the technique of habit training. The AP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes.

The nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question would the nurse ask first? a. "Are you drinking plenty of water?" b. "What medications are you taking?" c. "Have you tried laxatives or enemas?" d. "Has this type of thing ever happened before?"

ANS: B Some types of incontinence or other health problems are treated with anticholinergicmedications. Anticholinergic side effects include dry mouth, constipation, and urinaryretention. The nurse needs to assess the client's medication list to determine whether the he or she is taking an anticholinergic medication. The other questions are not as helpful to understanding the current situation.

The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic, and the family expresses distress that the patient is receiving little dietary protein. How would the nurse respond? a. "A low-protein diet will help the liver rest and will restore liver function." b. "Less protein in the diet will help prevent confusion associated with liver failure." c. "Increasing dietary protein will help the patient gain weight and muscle mass." d. "Low dietary protein is needed to prevent fluid from leaking into the abdomen."

ANS: B A low-protein diet is prescribed when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the patient's dietary protein will cause complications of liver failure and would not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

A nurse cares for a client who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone? a. Pneumonia b. Dehydration c. Renal failure d. Edema

ANS: B ADH increases tubular permeability to water, leading to absorption of more water into the capillaries. ADH is triggered by a rising extracellular fluid osmolarity, as occurs in dehydration. Pneumonia, renal failure, and edema would not trigger the release of ADH.

The nurse is caring for a client who has been prescribed lubiprostone for irritable bowel syndrome (IBS-C). What health teaching will the nurse include about taking this drug? a. "This drug will make you very dry because it will decrease your diarrhea." b. "Be sure to take this drug with food and water to help manage constipation." c. "Avoid people who have infection as this drug will suppress your immune system." d. "Include high-fiber foods in your diet to help produce more solid stools."

ANS: B Lubiprostone is an oral laxative approved for women who have IBS with constipation (IBS-C). Water and food will also help to improve constipation. The drug is not used for clients who have diarrhea and does not affect the immune system. Although high-fiber foods are important for clients who have IBS, this client does not need fiber to help make stool more solid. Instead the fiber will help prevent constipation.

A client is preparing to have a fecal occult blood test (FOBT). What health teaching would the nurse include prior to the test? a. "This test will determine whether you have colorectal cancer." b. "You need to avoid red meat and NSAIDs for 48 hours before the test." c. "You don't need to have this test because you can have a virtual colonoscopy." d. "This test can determine your genetic risk for developing colorectal cancer."

ANS: B The FOBT is a screening test that is sometimes used to assess for microscopic lower GI bleeding. To help prevent false positive results, the client needs to avoid red meat, Vitamin C, and NSAIDs. The test is not diagnostic nor does it determine a client's genetic risk for colorectal cancer.

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

ANS: B The client who has acute pancreatitis reports severe boring abdominal pain that is often rated by clients as a 10+ on a 0-10 painscale. Nausea, vomiting, and fever may also occur, but that is not the client's priority for care.

A nurse assesses clients on the medical-surgical unit. Which clients are at risk for kidney problems? (Select all that apply.) a. A 24-year-old pregnant woman prescribed prenatal vitamins b. A 32-year-old bodybuilder taking synthetic creatine supplements c. A 56-year-old who is taking metformin for diabetes mellitus d. A 68-year-old taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic back pain e. A 75-year-old with chronic obstructive pulmonary disease (COPD) who is prescribed an albuterol nebulizer

ANS: B, C, D Many medications can affect kidney function. Clients who take synthetic creatine supplements, metformin, and high-dose or long-term NSAIDs are at risk for kidney dysfunction. Prenatal vitamins and albuterol nebulizers do not place these clients at risk.

A transgender client taking spironolactone is in the internal medicine clinic reporting heartpalpitations. What action by the nurse takes priority? a. Draw blood to test serum potassium. b. Have the client lie down and rest. c. Obtain a STAT electrocardiogram (ECG) d. Take a set of vital signs.

ANS: C Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause cardiac dysrhythmias. The nurse's priority is to obtain an ECG, and then to facilitate a serum potassium level being drawn. Having the client lie down and obtaining vital signs are also important care measures, but are not the most important at this time.

A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily. b. A 44-year-old with irritable bowel syndrome (IBS). c. A 60-year-old lawyer who works 65 hours per week. d. A 72-year-old who eats fast food frequently.

ANS: D Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

A nurse teaches a client with functional urinary incontinence. Which statement would the nurse include in this client's teaching? a. "You must clean around your catheter daily with soap and water." b. "You will need to be on your drug therapy for life." c. "Operations to repair your bladder are available, and you can consider these." d. "You might want to get pants with elastic waistbands."

ANS: D Functional urinary incontinence occurs as the result of problems not related to the client'sbladder, such as trouble ambulating or difficulty accessing the toilet. One desired outcome isthat the client will be able to manage his or her clothing independently. Elastic waistbandslacks that are easy to pull down and back up can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence. 15 / 34

A nurse plans care for a client with overflow incontinence. Which intervention does the nurse include in this client's plan of care to assist with elimination? a. Stroke the medial aspect of the thigh. b. Use intermittent catheterization. c. Provide digital anal stimulation. d. Use the Valsalva maneuver.

ANS: D In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanicalpressure, such as that achieved through the Valsalva maneuver (holding the breath andbearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh orproviding digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful.

A nurse cares for a client who has kidney stones from gout ricemia. Which medication does the nurse anticipate administering? a. Phenazopyridine b. Doxycyline c. Tolterodine d. Allopurinol

ANS: D Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol.Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an antibiotic.Tolterodine is an anticholinergic with smooth muscle-relaxant properties.

The nurse is caring for a client who has a postoperative paralytic ileus following abdominal surgery. What drug is appropriate to manage this nonmechanical bowel obstruction? a. Alosetron b. Alvimopan c. Amitiptyline d. Amlodipine

b. Alvimopan

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to which organ functions or dysfunctions? (Select all that apply.) a. Alanine aminotransferase: biliary system b. Ammonia: liver c. Amylase: liver d. Lipase: pancreas e. Urine urobilinogen: stomach

B, D

A client who has peptic ulcer disease is prescribed quadruple drug therapy for Helicobacter pylori infection. What health teaching related to bismuth would the nurse include?' A: "Report stool changes to your primary health care provider immediately." B: "Do not take aspirin or aspirin products of any kind while on bismuth." C: "Take bismuth about 30 minutes before each meal and at bedtime." D: "Be aware that bismuth can cause frequent vomiting and diarrhea."

B: "Do not take aspirin or aspirin products of any kind while on bismuth."

The nurse is caring for a client who had an open traditional esophagectomy. Which assessment findings would the nurse report immediately to the primary health care provider? (Select all that apply.) a. Nausea b. Wound dehiscence c. Fever d. Tachycardia e. Moderate pain f. Fatigue

BCD

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidneydisease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I can continue to take antacids to relieve heartburn." b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch for bleeding when taking my anticoagulants."

BCDE

The nurse is caring for a client with probable colorectal cancer (CRC). What assessment findings would the nurse expect? (Select all that apply.) a. Weight gain b. Rectal bleeding c. Anemia d. Change in stool shape e. Electrolyte imbalances f. Abdominal discomfort

BCDF

A nurse cares for a patient who has a chronic inflammatory bowel disease. Which actions would the nurse take to prevent skin excoriation? (Select all that apply.) a. Cleanse the perineum with an antibacterial soap. b. Use medicated wipes instead of toilet paper. c. Identify foods that decrease constipation. d. Apply a thin coat of aloe cream to the perineum. e. Gently pat the perineum dry after cleansing.

BDE

Which finding in a female client by the nurse would receive the highest priority for further diagnostics? A Tender moveable masses throughout the breast tissue B Nipple discharge without a palpable mass C Nontender fixed mass in the upper outer quadrant of the breast D Small, painful mass under warm reddened skin and nipple discharge

C Nontender fixed mass in the upper outer quadrant of the breast

The nurse notes bright red urinary drainage from a client who had a transurethral resection of the prostate (TURP) with continuous bladder irrigation yesterday. What is the appropriate initial nursing action? A. Calculate intake and output. B. Monitor hemoglobin and hematocrit. C. Increase the rate of the bladder irrigation. D. Document findings in the electronic health record.

C. Increase the rate of the bladder irrigation.

During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect? A: Hematemesis B: Pain when eating C: Melena D: Weight loss

C: Melena dark sticky feces containing partly digested blood

A client with peptic ulcer disease is in the emergency department and reports gastric pain that has gotten much worse over the last 24 hours. The client's blood pressure when lying down is 112/68 mm Hg and when standing is 98/52 mm Hg. What action by the nurse is most appropriate? A: Administer a proton pump inhibitor (PPI). B: Call the Rapid Response Team. C: Start a large-bore IV with normal saline. D: Tell the patient to remain lying down.

C: Start a large-bore IV with normal saline. This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse would start a large-bore IV with isotonic solution. PPIs are not a treatment for an ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the most appropriate action at this time.

The nurse assesses a client who has possible gastritis. Which assessment finding(s) indicate(s) that the client has chronic gastritis? (Select all that apply.) A: Anorexia B: Dyspepsia C: Intolerance of fatty foods D: Pernicious anemia E: Nausea and vomiting

CD

After teaching a client who is recovering from a colon resection to treat early-stage colorectal cancer (CRC), the nurse assesses the client's understanding. Which statements by the client indicate understanding of the teaching? (Select all that apply.) a. "I must change the ostomy appliance daily and as needed." b. "I will use warm water and a soft washcloth to clean around the stoma." c. "I might start bicycling and swimming again once my incision has healed." d. "I will make sure that I make lifestyle changes to prevent constipation." e. "I will be sure to have the recommended colonoscopies."

CDE

Which nursing action decreases the risk for health care disparities for transgender clients? Select all that apply. A. Refer to the client's identification card for name. B. Determine gender identity based on clothing worn. C. Seek to understand the experience of the transgender client. D. Apologize several times if the wrong name is used for the client. E. On meeting the client, ask what name and which pronouns are desired. F. Explain how the health history and assessment are affected by gender identity.

CEF

1. The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis? a. Metabolic syndrome b. Liver cancer c. Nonalcoholic fatty liver disease d. Hepatitis C

D

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse? a. Albumin level of 2.5 g/dL (3.63 mcmol/L) b. Phosphorus level of 5 mg/dL (1.62 mmol/L) c. Sodium level of 135 mEq/L (135 mmol/L) d. Potassium level of 5.5 mEq/L (5.5 mmol/L)

a Protein restriction is necessary with CKD due to the buildup of waste products from proteinbreakdown. The nurse would be concerned with the low albumin level since this indicates thatthe protein in the diet is not enough for the client's metabolic needs. The electrolyte values arenot related to the protein-restricted diet.

A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client? a. Calcium acetate b. Doxycyline c. Magnesium sulfate d. Lisinopril

a The client with CKD often has a high phosphorus level which tends to lower the calcium level in an inverse relationship, and causes osteodystrophy. To prevent this bone disease, the client needs to take a drug that can bind with phosphorus for elimination via the GI tract. When phosphorus is lowered to within normal limits, normal calcium levels may be restored.

The nurse is assessing a client with acute pyelonephritis. What assessment findings would thenurse expect? (Select all that apply.) a. Fever b. Chills c. Tachycardia d. Tachypnea e. Flank or back pain f. Fatigue

a b c d e f All of these assessment findings commonly occur in clients who have acute pyelonephritis because this health problem is a kidney infection.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are correct regarding PD? (Select all that apply.) a. "You will not need vascular access to perform PD." b. "There is less restriction of protein and fluids." c. "You will have no risk for infection with PD." d. "You have flexible scheduling for the exchanges." e. "It takes less time than hemodialysis treatments."

a b d PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is noneed for vascular access. Protein is lost in the exchange, which allows for more protein andfluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longerperiod of time compared to hemodialysis. There still is risk for infection with PD, especiallyperitonitis.

A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client's history? a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" b. "Do you have anyone in your family with renal failure?" c. "Have you had a diet that is low in protein recently?" d. "Has a relative had a kidney transplant lately?"

a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"

A client is receiving total parenteral nutrition (TPN). On assessment, the nurse notes that the client's pulse is 128 beats/min, blood pressure is 98/56 mm Hg, skin is dry, and skin turgor is poor. What action should the nurse perform next? a. Assess the 24-hour intake and output. b. Assess the client's oral cavity. c. Prepare to hang a normal saline bolus. d. Increase the infusion rate of the TPN.

a. Assess the 24-hour intake and output. This client has clinical indicators of dehydration, so the nurse calculates the patient's 24-hour intake, output, and fluid balance. This information is then reported to the health care provider. The client's oral cavity assessment may or may not be consistent with dehydration. The nurse may need to give the client a fluid bolus, but not as an independent action. The client's dehydration is most likely due to fluid shifts from the TPN, so increasing the infusion rate would make the problem worse, and is not done as an independent action for clients receiving TPN.

After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the diet therapy for this condition? a. "I must decrease my intake of fat." b. "I will increase my intake of protein." c. "A decreased intake of carbohydrates will be required." d. "An increased intake of vitamin C is necessary."

b In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss would be matched by increased intake of protein. The client would not need to adjust fat,carbohydrates, or vitamins based on this disorder.

A male client is diagnosed with primary syphilis Which question by the nurse is a priority at this time a Have you been using latex condoms ? " b Are you allergic to penicillin ? " c When was your last sexual encounter d .Do you have a history of sexually transmitted infections ?

b Are you allergic to penicillin ? "

The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority complications would the nurse anticipate? (Select all that apply.) a. Dehydration b. Anemia c. Hypertension d. Dysrhythmias e. Heart failure

b c d e The client who has CKD has fluid overload and electrolyte imbalances, especiallyhyperkalemia, that can cause hypertension, heart failure, and dysrhythmias. Anemia resultsbecause erythropoietin production by the kidneys is decreased. 25 / 28

After teaching a client who is prescribed adalimumab for severe ulcerative colitis (UC), the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "I will avoid large crowds and people who are sick." b. "I will take this medication with my breakfast each morning." c. "Nausea and vomiting are common side effects of this drug." d. "I should wash my hands after I play with my dog."

b. "I will take this medication with my breakfast each morning."

A nurse participates in a community screening event for oral cancer. What client is the highest priority for referral to a primary health care provider? a. Client who has poor oral hygiene practices. b. Client who smokes and drinks daily. c. Client who tans for an upcoming vacation. d. Client who occasionally uses illicit drugs.

b. Client who smokes and drinks daily.

The nurse is caring for a client diagnosed with oral cancer. What is the nurse's priority for client care? a. Encourage fluids to liquefy the client's secretions. b. Place the client on Aspiration Precautions. c. Remind the client to use an incentive spirometer. d. Manage the client's pain and inflammation.

b. Place the client on Aspiration Precautions.

A nurse reviews the laboratory values of a client who returned from kidney transplantation 12hours ago:Sodium 136 mEq/L (135 mmol/L)Potassium 5 mEq/L (5 mmol/L)Blood urea nitrogen (BUN) 44 mg/dL (15.7 mmol/L)Serum creatinine 2.5 mg/dL (221 mcmol/L)What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

c The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point

The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk? a. Abdominal distention b. Nausea c. Electrolyte imbalance d. Obstipation

c. Electrolyte imbalance

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is appropriate? a. Ask the client to call back if this happens again today. b. Instruct the client to go to the emergency department. c. Remind the client that a small amount of bleeding is possible. d. Tell the client to come to the clinic this afternoon.

c. Remind the client that a small amount of bleeding is possible.

A client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The client reports headache and dizziness. What action by the nurse is most appropriate? a. Consider starting a blood transfusion. b. Slow the bladder irrigation down. c. Report the findings to the surgeon immediately. d. Take the vital signs every 15 minutes.

c. Report the findings to the surgeon immediately.

The nurse is teaching a client about the use of viscous lidocaine for oral pain. What health teaching would the nurse include? a. "Use the drug before every meal to prevent aspiration." b. "Increase your intake of citrus foods to help with healing." c. "Use the drug only at bedtime because you won't be eating." d. "Be sure to check food temperatures before eating."

d. "Be sure to check food temperatures before eating."

The nurse teaches a client about how to prevent transmission of gastroenteritis. Which statement by the nurse indicates a need for further teaching? a. "I won't let anyone use my dishes or glasses." b. "I'll wash my hands with antibacterial soap." c. "I'll keep my bathroom extra clean." d. "I'll cook all the meals for my family."

d. "I'll cook all the meals for my family."

The nurse is preparing to teach a client with chronic hepatitis B about lamivudine therapy. What health teaching would the nurse include? a. "Follow up on all appointments to monitor your lab values." b. "Do not take amiodorone at any time while on this drug." c. "Monitor for jaundice, rash, and itchy skin while on this drug." d. "Report any changes in urinary elimination while on this drug."

d. "Report any changes in urinary elimination while on this drug."