Restorative Nursing I Final
A client who recently has been started on enteral feedings begins to complete abdominal cramping followed by the passage of two liquid stools. A nurse notes that the client has abdominal distension as well. The nurse reviews the nutritional content on the label of the can of feeding to see if it has which of the following ingredients: a) maltose b) lactose
b) lactose
The 22 year old female who is obese is discussing weight loss program with the nurse. Which information should the nurse teach: a) jog for two to three hours per day b) lifestyle behaviors must be modified c) eat one large meal every day in the morning d) eat 1,000 calories a day and don't take vitamins
b) lifestyle behaviors must be modified
Which of the phases of swallowing actually triggers the swallow reflex: a) oral preparatory b) oral c) pharyngeal d) esophageal
b) oral
While performing a head-to-toe assessment of a client the nurse hears dullness over the left upper quadrant during percussion. What would be the next assessment the nurse should perform: a) inspection of the area b) palpitation of the area c) auscultation of the entire abdomen d) inspection of respiratory ecursion
b) palpitation of the area
The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate: a) increase calories b) restrict sodium c) restrict potassium d) reduce fat to 10%
b) restrict sodium
The female client presents to the clinic for an exam because she has not had a menstrual cycle for several months and wonders if she could be pregnant. The client is 5 ft 10 in tall and weighs 45 kg. Which assessment data should the nurse obtain first: a) ask the client to recall what she ate for the last 24 hours b) determine what type of birth control the client has been using c) reweigh the client to confirm the data d) take the client's pulse and BP
a) ask the client to recall what she ate for the last 24 hours
The client in end-stage liver failure with ascites is prescribed Aldactone. Which interventions should the nurse implement? Select all that apply: a) check the serum potassium level b) weight the client daily at the same time c) assess the client's bowel sounds d) monitor the client's intake and output e) monitor the client's adnominal girth
a) check the serum potassium level b) weight the client daily at the same time d) monitor the client's intake and output e) monitor the client's abdominal girth
Which metabolic problem is associated with chronic pancreatitis: a) hyperglycemia b) hypoglycemia c) hypercalcemia d) hypokalemia
a) hyperglycemia
Because of systemic vasodilation and increased vascular permeability, the individual with pancreatitis is predisposed to: a) hypovolemic shock b) sepsis c) adult respiratory distress syndrome d) hypertensive crisis
a) hypovolemic shock
The doctor is able to stop the bleeding and stabilize Mr.Barry. He decides that Mr. Barry may benefit from sclerotherapy. The nursing care would include: a) preparing the patient for endoscopy procedure b) preparing the patient for surgery c) administering vasopressors d) administering antibiotics
a) preparing the patient for endoscopy procedure
The nurse is discharging a client 2 days postoperative hiatal hernia repair. Which discharge instructions should the nurse include: Select all that apply: a) take all the prescribed antibiotic b) eat six small meals per day c) use the legs to bend down, not the back d) take Nexium twice per day e) use the pain medication when the pain is an 8-10
a) take all the prescribed antibiotic b) eat six small meals per day c) use the legs to bend down, not the back
The nurse is administering morning medications at 0730. Which medication should the nurse administer first? a) the mucosal barrier agent to a client who is going home this morning b) the proton pump inhibitor to a client diagnosed with peptic ulder disease c) the non-narcotic analgesics to a client complaining of mild headache d) the histamine receptor antagonist toa client scheduled for an endoscopy
a) the mucosal barrier agent to a client who is going home this morning
The nurse palpates an accumulation of fluid in the abdomen and documents this as ascites. The nurse should also assess the client for which health problems as possible etiologies? Select all that apply: a) COPD b) Cirrhosis c) CHF d) Renal failure e) appendicitis
b) Cirrhosis c) CHF d) renal failure
In caring for the patient with acute pancreatitis during the critical stage, which nursing action would have the highest priority: a) have the patient turn every two hours b) assess hemodynamic status and urine output hourly c) maintain patency of the NG tube d) medicate for pain every three hours
b) assess hemodynamic status and urine output hourly
The nurse palpates an accumulation of fluid in the abdomen and documents this as acute ascites. The nurse should also assess the client for which health problem as possible etiologies? Select all that apply: a) COPD b) Cirrhosis c) CHF d) Renal failure e) appendicitis
b) cirrhosis c) CHF d) renal failure
While performing an admission assessment on an infant, a nurse notes all of the following abnormal findings. Which one is the most indicative sign of Hirschsprung's disease: a) anorexia b) constipation c) abdominal distention d) coffee-ground emesis
b) constipation
Mr. Barry is complaining of dry, itchy skin. The nurse is aware that this is a result of which problem associated with cirrhosis: a) elevated protime b) elevated bilirubin c) decreased sodium and potassium d) impaired synthesis of vitamin K
b) elevated bilirubin
The nurse explains that Carafate enables the client's ulcer to heal by: a) coating the stomach mucosa, thus preventing gastric acid irritation b) forming a paste like substance at the ulcer site that serves as a protective barrier c) binding with gastric contents to inactivate their function in the stomach d) attracting white and red blood cells to the stomach to increase circulation
b) forming a paste like substance at the ulcer site that serves as a protective barrier
Individuals with a colostomy are generally taught to avoid foods that cause diarrhea, odor, and excessive flatus. From the foods listed below, which are likely to have these side effects: a) cheese, chocolate, milk b) fresh broccoli, mushrooms, cabbage c) nuts, cereal, pasta d) yogurt, buttermilk, parsley
b) fresh broccoli, mushrooms, cabbage
Presence of muscle twitching and tremors can indicate which condition in a patient with acute pancreatitis: a) hypokalemia b) hypocalcemia c) dehydration d) acidosis
b) hypocalcemia
When an elderly patient with Type II diabetes develops influenza, he or she is at greatest risk for: a) hypoglycemia b) diabetic ketoacidosis c) HHNK d) system infection
c) HHNK
The client with inflammatory bowel disease is prescribed the glucocorticoid prednisone. Which priority invention should the nurse implement: a) monitor the client's blood glucose level b) discuss the long-term side effects of prednisone c) administer the medication with food d) explain that the prednisone will be tapered when it is to be discontinued
c) administer the medication with food
Which of the following hormones promotes sodium and water retention and potassium excretion: a) insulin b) somatotropin c) aldosterone d) antidiuretic hormone
c) aldosterone
Which diagnostic test should the nurse monitor for the client diagnosed with severe anorexia nervosa: a) liver function tests b) kidney function tests c) cardiac function tests d) bone density scan
c) cardiac function tests
Which information should the nurse discuss with the 75-year old client diagnosed with diverticulitis who is prescribed methylcellulose (Citrucel), a bulk laxative: a) notify the doctor if abnormal cramping occurs b) explain that results should be evident with 24 hours c) encourage the client to increase the intake of fluids, especially water d)
c) encourage the client to increase the intake of fluids, especially water
Which diet would likely be ordered for the client with hypothyroidism: a) high protein, high calorie b) restricted fluids, low protein c) high roughage, low calorie d) high carbohydrates, low roughage
c) high roughage, low calorie
The main treatment for diabetic retinopathy is: a) medication b) corrective lenses c) laser treatment d) surgical correction
c) laser treatment
When assessing a patient following an appendectomy, the nurse notices abdominal distention and an absence of bowel sounds. These findings suggest: a) peritonitis b) diverticulitis c) paralytic ileus d) septicemia
c) paralytic ileus
In caring for Mrs. Miller, the nurse realizes that her diagnosis means that she has: a) an infection in gallbladder b) an obstruction in the bile duct c) presence of stones in the gall bladder d) all of the above
c) presence of stones in the gall bladder
The nurse is considering the commonalities and differences of equipment used for gastric decompression. What is the major advantage to using a Salem pump: a) minimizes the risk of bowel obstruction b) ensures the drainage of the intestines c) prevents gastric mucosal damage d) promotes gastric rest
c) prevents gastric mucosal damage
Assuming all the following patient's have ascites, which one would be most likely to have a paracentesis? A patient with: a) a 10-lb weight gain b) irregular heart rhythm c) respiratory difficulty d) recent change in mental status
c) respiratory difficulty
Medical management for the patient with acute viral hepatitis would include: a) hospitalization and antibiotic therapy b) bed rest, hydration, and antibiotics c) rest, avoid fatigue, and a well-balanced diet d) bed rest, low calorie diet, and force fluids
c) rest, avoid fatigue, and a well-balanced diet
Which lab date should the nurse monitor for the client with inflammatory bowel disease who is prescribed sulfasalazine (Azulfidine) a sulfonamide antibiotic: a) the client's liver function tests b) the client's serum potassium level c) the client's serum creatinine level d) the client's INR
c) the client's serum creatinine level
When caring for a patient with stomatitis, what is the most important for the nurse to assess: a) nutritional status b) level of pain c) self-care abilities d) airway status
d) airway status
All of the following are counterregulatory hormones and will oppose the action of insulin except: a) glucagons b) cortisol c) growth hormone d) antidiuretic hormone
d) antidiuretic hormone
Which intervention is most important when teaching the parents of a child diagnosed with celiac disease: a) promote as normal a life as possible for child b) stress the importance of good health in preventing infection c) introduce the parents and child to another child with celiac disease d) assist the parents and child to follow the prescribed dietary restrictions
d) assist the parents and child to follow the prescribed dietary restictions
Miss Anderson is admitted with fatigue, anorexia, and jaundice. She is homeless and was brought to the hospital by police. A tentative diagnosis of hepatitis is made. Because of the symptoms that Miss Anderson currently has, the nurse would see an increase in serum: a) WBC b) BUN c) ammonia d) bilirubin
d) bilirubin
Which of the following menu selections is the best for a child diagnosed with celiac disease: a) pizza and chocolate cake b) spaghetti and blueberry muffin c) chicken sandwich on whole-wheat bread d) corn tortilla and fresh fruit
d) corn tortilla and fresh fruit
When a patient has an acute exacerbation of Crohn's disease, the pharmacologic treatment that takes priority would be the administration of: a) analgesics b) antibiotics c) antidiarrheal d) corticosteroids
d) corticosteroids
The 36 year old female client diagnosed with anorexia nervosa tells the nurse "I am so fat. I won't be able to eat today." Which response by the nurse is most appropriate: a) can you tell me why you think you are fat? b) you are skinny. Many women wish they had your problem. c) if you don't eat, we will restrain you and feed you d) not eating might cause physical problems
d) not eating might cause physical problems
What statement is true about Candida albicans form of stomatitis: a) it is a common type of primary stomatitis b) Candida albicans is a bacterial infection c) this infection is uncommon in patients who are immunocompromised d) patients on steroid therapy and or antibiotic therapy often experience this infection
d) patients on steroid therapy and or antibiotic therapy often experience this infection
The nurse is caring for a client diagnosed with GERD. Which interventions should the nurse implement: a) have the client lie prone in bed when sleeping b) administer NSAIDs for pain c) encourage the client to drink 8-10 glasses of water each day d) place the head of the bed on 6-inch blocks
d) place the head of the bed on 6-inch blocks
Which of the following is most characteristic for an infant with pyloric stenosis: a) constipation b) loss of appetite c) chronic diarrhea d) projectile vomiting
d) projectile vomiting
Assessment findings that would demonstrate to the nurse that the patient with hepatitis is in the recovery phase would indicate: a) weight returns to normal, ascites disappears b) jaundice disappears, normal energy levels return c) normal heart and breath sounds, as well as normal bowel sounds d) stool and urine are normal in color, and appetite improves
d) stool and urine are normal in color, and appetite improves
A patient who is taking antithyroid drugs should not stop them abruptly because it may precipitate a) respiratory distress b) hypothyroidism c) exophthamlmos d) thyroid crisis
d) thyroid crisis