366 Exam #3 Book questions
4. A patient is jaundiced, and her stools are clay colored. This is most likely related to a. decreased bile flow into the intestine. b. increased production of urobilinogen. c. increased bile and bilirubin in the blood. d. increased production of cholecystokinin.
A
4. The nurse assessed the patient's skin lesions as firm, edematous, irregularly shaped with a variable diameter. They would be called a. wheals. b. papules. c. pustules. d. plaques.
A
4. Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. X-ray b. Air insertion c. Observing patient for coughing d. pH measurement of gastric aspirate
A
6. Persons with dark skin are more likely to develop a. keloids. b. wrinkles. c. skin rashes. d. skin cancer.
A
8. Important patient teaching after a chemical peel includes a. avoidance of sun exposure. b. application of firm bandages. c. limitation of vigorous exercise. d. use of moist heat to relieve discomfort.
A
6. A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia
A,D,E
5. The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.
a, b
2. A patient with osteosarcoma of the humerus shows understanding of his treatment options when he states a. "I accept that I have to lose my arm with surgery." b. "The chemotherapy before surgery will shrink the tumor." c. "This tumor is related to the melanoma I had 3 years ago." d. "I'm glad they can take out the cancer with such a small scar."
b
3.A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include a. having genetic testing done. b. recommending a heart-healthy diet. c. the necessity to reduce weight rapidly. d. avoiding alcohol until liver enzymes return to normal.
b
4. The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that a. a lack of clotting factors promotes the collection of blood in the abdominal cavity. b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space. c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel. d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.
b
5. In caring for a patient after a spinal fusion, the nurse would report which finding to the health care provider? a. The patient has a single episode of emesis. b. The patient is unable to move the lower extremities. c. The patient is nauseated and has not voided in 4 hours. d. The patient reports of pain at the bone graft donor site.
b
7. An abnormal assessment finding of the musculoskeletal system is a. equal leg length bilaterally. b. ulnar deviation and subluxation. c. full range of motion in all joints. d. muscle strength of 5/5 in all muscles.
b
7. What is most important to include in the teaching plan for a patient with osteopenia? a. Lose weight. b. Stop smoking. c. Eat a high-protein diet. d. Start swimming for exercise.
b
8. In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. usually develops peritonitis. d. has localized cramping pain.
b
9. Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture sites for 48 hours. b. reporting any bile-colored drainage or pus from any incision. c. using over-the-counter antiemetics if nausea and vomiting occur. d. emptying and measuring the contents of the bile bag from the T tube every day
b
1. A patient with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (select all that apply) a. "Oral or IV antibiotics are not effective in most cases of bone infection." b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection." d. "This is the safest method to deliver long-term antibiotic therapy for bone infection." e. "Ischemia and bone death related to osteomyelitis are impenetrable to IV antibiotics."
b, c
8. The nurse caring for a patient with suspected acute cholecystitis would anticipate (select all that apply) a. ordering a low-sodium diet. b. administration of IV fluids. c. monitoring of liver function tests. d. administration of antiemetics for patients with nausea. e. insertion of an indwelling catheter to monitor urinary output.
b, c, d
8. A patient with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.
b, d
3. The nurse is completing an assessment of a 2-month-old girl during a well-child visit. The infant was born breech and weighed 9 lbs. 2 oz. She is growing well and is being breast fed. She is to receive her 2-month vaccinations today. The nurse completes the assessment and finds the following on examination. Which findings would be immediate concern that require follow-up? Select all that apply. A. Back is rounded B. Limb may turn outward C. Limb may appear shorter D. Gluteal folds are unequal E. Posterior fontanel is closed F. Both limbs are of equal length G. Restricted abduction of the hip on one side
b,c,e
1. Which statement best describes the etiology of obesity? a. Obesity primarily results from a genetic predisposition. b. Psychosocial factors can override the effects of genetics in causing obesity. c. Obesity is the result of complex interactions between genetic and environmental factors. d. Genetic factors are more important than environmental factors in the etiology of obesity.
c
3. A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. other nonsurgical methods cannot achieve adequate alignment. d. a temporary cast would be too unstable to provide normal mobility.
c
3. The nurse teaching young adults about behaviors that put them at risk for oral cancer includes a. discouraging use of chewing gum. b. avoiding use of perfumed lip gloss. c. avoiding use of smokeless tobacco. d. discouraging drinking of carbonated beverages.
c
4. In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. often results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, while ulcerative colitis is curable with a colectomy. d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.
c
4. The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture.
c
5. A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full-liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings. b. extension of the tumor into the aorta. c. leakage of fluids into the mediastinum. d. esophageal perforation with fistula formation into the lung.
c
6. A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify the site for the ostomy.
c
6. The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs.
c
A 12-year-old who was in an all-terrain vehicle (ATV) accident has a long leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2:00 AM for pain he rates as 10/10 on the numeric scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot and she has difficulty slipping a finger under the cast; no pulse is found, and the capillary refill is difficult to visualize. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. The nurse notes that these may be signs of a __________1__________. The nurse would immediately call the physician since permanent damage can occur within __________2__________. The nurse would __________3__________ and continue to assess for a pulse __________4__________ the fracture.
1.?? bone fracture severed nerve compartment syndrome bone contusion bone rotation 2.hours 3.keep limb at heart level 4.distal to
3. A 5-year-old boy with spina bifida has bladder dysfunction and is unable to empty his bladder without assistance. He also struggles with bowel control and is taking dietary fiber supplements, and suppositories to assist with regular bowel movements. He was born with a myelomeningocele and had surgical repair 48 hours after birth. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Based on the child's diagnosis and history, the nurse understands that a __________1__________ may produce urinary system __________2__________ The nurse would teach the parents and child a method to empty the bladder such as __________3__________.
1.?? renal cyst kidney stone neuropathic bladder rectal fissure 2.distress 3.clean intermittent catheterization
4. A mother and her two children have been diagnosed with pediculosis corporis at a health care center. An appropriate measure to treat this condition is a. applying pyrethrins to the body. b. topical application of griseofulvin. c. moist compresses applied frequently. d. administration of systemic antibiotics.
A
2. A 14-year old client is preparing to travel outside of the United States on a mission trip. When the client meets with the pediatric nurse to review immunizations, the nurse determines that the client needs an immunization to remain safe while traveling. Based upon this information, the nurse will administer hepatitis __________1__________ vaccine __________2__________ in the __________3__________ muscle. 1: A virus, B virus, Tetanus, Infection 2: subcutaneously, intravenously, intramuscularly, intrathecally 3: dorsogluteal, vastus lateralis, pectoral, subclavicular
1: A virus 2: Intramuscularly 3. Vastus Lateralis
A 3-year-old has a history of chronic diarrhea, lack of weight gain, and abdominal distension. He has a positive serological blood test and small intestine biopsy confirming Celiac Disease. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Because children with celiac disease must limit their intake of products containing __________1__________ in many food items, one being __________2__________ , they are at most risk for __________3__________ as well as a number of other deficiencies. 1:sugar/meat/gluten/salt/milk/eggs 2.:yogurt/corn/salad/toast/chicken/carrots 3.Iron-deficiency anemia/bleeding/asthma/hepatitis/Pyloric stenosis/Hoarseness and difficulty swallowing
1:gluten 2:Toast 3:Iron-deficiency anemia
A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous fluids, has tolerated some oral fluids in the emergency department, and is being discharged home.Which intervention will the nurse implement at this time? Select all that apply. 1.Keep on clear liquids and toast for 24 hours 2.Offer a regular diet as child's appetite warrants 3.Sterilize the infant's eating utensils before each meal 4.Give a BRAT diet (bananas, rice, applesauce, and toast) for 24 hours, then a soft diet as tolerated 5.Find out what the infant's favorite food is 6.Give chicken or beef broth for 24 hours, then resume a soft diet
2
1. The percentage of daily calories for a healthy person consists of a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.
A
2. When teaching a patient with melanoma about this disorder, the nurse recognizes that the patient's prognosis is most dependent on a. the thickness of the lesion. b. the degree of asymmetry in the lesion. c. the amount of ulceration in the lesion. d. how much the lesion has spread superficially.
A
The nurse is completing an assessment on a 3-month-old male who is in the pediatrician's office because the infant had fever and diarrhea the past 2 days. The infant's history reveals he was exposed to maternal chorioamnionitis and born prematurely at 32 weeks' gestation. The nurse performs a history and assessment and finds the following. Which assessment findings require follow-up by the nurse? Select all that apply. A. head lag B. arms are stiff C. does not smile D. floppy posture E. unable to roll over F. feeding difficulties G. irritable and cries often H. unable to sit without support I. unable to pass object between hands
A, B, C, D, F, G
A 9-year-old boy in the emergency department for a "skin rash." His boy scout troop was camping three weeks ago. The mother noted a large red raised lesion on his ankle when he returned from camp, but the child did not complain about it. The nurse completes a history and physical assessment and notes the following. Which assessment findings require follow-up by the nurse? Select all that apply. A. Fatigue B. Headache C. Temperature 100.4° F D. Cough for past week E. Pulse = 88 beats/minute F. Respirations = 20/minute G. Blood pressure = 100/66 mmHg H. Spleen 1 cm below left costal margin I. Small, red, annular lesions on the lower legs and arms J. Inguinal and axillar lymph nodes 1 cm in circumference
A, B, C, D, H, I, J
1. A 9-month-old girl is in the pediatrician office because of a diaper rash that is getting worse. The child has no fever, is bottle fed and is in the 50% for weight and height for age. On examination the nurse notes a soiled diaper with a strong ammonia odor. The skin is beefy red with numerous maculopapular lesions across the front. The lesions extend into the skin folds and across the upper thighs. The child's axillary temperature is 98.9° F, pulse = 80 beats/min, respirations = 28/min. Which of the following would the nurse discuss with the mother? Select all that apply. A. "Change the diaper as soon as it becomes wet or soiled." B. "Use a hair dryer or heat lamp to dry the area." C. "Use a super-absorbent disposable diaper if you can." D. "Keep the skin dry." E. "Wash the area often as possible using a wipe." F. "Diapers that are unscented can be purchased." G. "Apply ointment such as zinc oxide or petrolatum to the skin." H. "Avoid removing the skin barrier cream with each diaper change."
A, C, D, G, H
4. A 7-year-old child is brought by a parent to the clinic due to an outbreak of pediculosis capitis at the school. Assessment confirms that the child is scratching her scalp and there are nits on the hair. Which intervention will the nurse implement at this time? Select all that apply. A. Teach parent to soak combs, brushes and hair accessories in lice-killing products for 1 hour or in boiling water for 10 minutes. B. Shave the child's head and cleanse the scalp with rubbing alcohol. C. Tell parent to machine wash clothing, towels and bed linens in hot water and dry in hot dryer for at least 20 minutes. D. Dispose of the child's clothing in a plastic garbage bag at the clinic. E. Recommend that parent vacuum carpets, car seats, pillows, stuffed animals, rugs, mattresses and upholstered furniture. F. Explain to child that she can only share hats, scarves, combs and brushes with family members. G. Administer intramuscular antibiotics to limit the spread of infection. H. Use a natura l remedy such a mayonnaise on the hair to suffocate nits.
A, C, E
A school nurse is seeing several children who have evidence of pediculosis capitis. Most of these children are coming from one first grade class. Children have been evaluated by carefully assessing the scalp by spreading the hair to look for lice and observing for nits or eggs that adhere to the hair shafts close to the scalp. These children were treated with a lice treatment and recommended to treat the scalp again in 10 days. The nurse is working with the teacher to educate parents on how to prevent pediculosis. What are the most appropriate responses for the nurse to provide to help prevent another outbreak? Select all that apply. A. Inspect the child for head lice on a regular basis once an outbreak occurs. B. Seal non-washable items in plastic bags for 2 months before using again. C. Keep clothing items such as hats and scarves in separate cubicles at school. D. Treat infected children monthly with a lice treatment during the school year. E. Teach children not to share hats, scarves, hair accessories, combs or brushes. F. Machine wash all washable clothing, towels and linens in water hotter than 130° F.
A, C, E, F
3. A 6-year-old girl is brought to the clinic by a foster parent who assumed care of her a week ago. The foster parent reports that the girl has "not been acting right for a couple of days" after developing a fever and cough 2 days ago. The foster parents also states, "she had a rash on her face and some small red spots in her mouth 2 days ago, but they are gone now." When asked about an outbreak of measles she states the teacher called her last night about another child in the school who had measles. The foster parent reports that no immunizations records exist, so it is unknown whether the child has ever been immunized. Which assessment findings require follow-up? Select all that apply. A. Temperature of 101.5 F (38.6 C) B. Pulse 95 beats/min C. Respirations 20 breaths/min D. Cough for 2 days E. Small spots on the buccal mucosa 3 days ago that disappeared, described as white with a red ring F. Weight in the 25th% for age G. Rash on the face, chest and arms H. Abdominal pain I. Generalized lymphadenopathy
A, D, E, G, H, I
1. A newborn is born with a myelomeningocele and a surgical repair is planned for the next day. What actions would the nurse take to care for the myelomonocyte sac before the surgical repair? Select all that apply. A. Apply a sterile, moist nonadherent dressing to the sac. B. Take a rectal temperature every 2 hours before surgery. C. Irrigate the sac and surrounding skin with chlorhexidine. D. Diaper the infant while making sure it does not touch the sac. E. Maintain the legs in abduction with a pad between the knees. F. Position the newborn in a prone position with hips slightly flexed. G. Place the newborn in an incubator or warmer without clothing or cover.
A, E, F, G
3. A preterm infant who had surgery for necrotizing enterocolitis is now 6 months old and has short bowel syndrome. He is unable to absorb most nutrients taken by mouth and is totally dependent on parenteral nutrition, which he receives via a central venous catheter. The clinic nurse following the care for this infant is aware that he should be closely observed for the development of which complications? Select all that apply. A. Cholestasis B. Constipation C. Failure to thrive D. Chronic diarrhea E. Intestinal stricture F. Intestinal failure G. Hepatic dysfunction H. Gastroesophageal reflux
A, E, F, G
1. Which safe sun practices would the nurse include in the teaching plan for a patient who has photosensitivity (select all that apply)? a. Wear protective clothing. b. Apply sunscreen liberally and often. c. Emphasize the short-term use of a tanning booth. d. Avoid exposure to the sun, especially during midday. e. Wear any sunscreen as long as it is bought at a drugstore.
A,B,D
8. Normal physical assessment findings of the gastrointestinal system are (select all that apply) a. nonpalpable spleen. b. borborygmi in upper right quadrant. c. tympany on percussion of the abdomen. d. liver edge 2 to 4 cm below the costal margin. e. finding of a firm, nodular edge on the rectal examination.
A,C
1. Indicate which type of precautions the nurse will place these patients into in order to prevent transmission of various pathogens. Precautions: Transfusion-based, airborne, standard, droplet, respiratory hygiene/cough etiquette, none Patients: A. 15-year-old returning from summer in India who presents with symptoms of tuberculosis B. 3-year-old who has a respiratory illness with cough C. 5-year-old admitted with fever and productive cough; bacterial pneumonia confirmed by lab and x-ray D. 7-year-old admitted tonsillectomy
A: Airborne precautions B: Respiratory Hygiene/Cough etiquette C: Droplet precautions D: Standard precautions
1. The primary function of the skin is a. insulation. b. protection. c. sensation. d. absorption.
B
2. A patient has a high blood level of indirect (unconjugated) bilirubin. One cause of this finding is that a. the gallbladder is unable to contract to release stored bile. b. bilirubin is not being conjugated and excreted into the bile by the liver. c. the Kupffer cells in the liver are unable to remove bilirubin from the blood. d. there is an obstruction in the biliary tract preventing flow of bile into the small intestine.
B
3. As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the a. inhibition of secretin release. b. secretion of mucus by goblet cells. c. release of pancreatic digestive enzymes. d. release of gastrin by the duodenal mucosa.
B
3. The nurse determines that a patient with which disorder is most at risk for spreading the disease? a. Tinea pedis b. Impetigo on the face c. Candidiasis of the nails d. Psoriasis on the palms and soles
B
5. A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution
B
5. An 80-yr-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult a. should not have any changes in taste. d. has a loss of taste buds, especially for sweet and salt. c. has some loss of taste but no problems chewing food. d. loses the sense of taste because the ability to smell is decreased.
B
6. During the assessment of a patient, you note an area of red, sharply defined plaques covered with silvery scales that are mildly itchy on the patient's knees and elbows. You would describe this finding as a. lentigo. b. psoriasis. c. actinic keratosis. d. seborrheic keratosis.
B
7. During an examination of the abdomen the nurse should a. position the patient in the supine position with the bed flat and knees straight. b. listen for bowel sounds in the epigastrium and all four quadrants for 2 minutes. c. describe bowel sounds as absent if no sound is heard in a quadrant after 2 minutes. d. use the following order of techniques: inspection, palpation, percussion, auscultation.
B
8. Diagnostic testing is recommended for skin lesions when a. a health history cannot be obtained. b. a more definitive diagnosis is needed. c. percussion reveals an abnormal finding. d. treatment with prescribed medication has failed.
B
9. In preparing a patient for a colonoscopy, the nurse explains that a. a signed permit is not needed. b. sedation will be used during the procedure. c. one cleansing enema part of the required preparation. d. light meals should be eaten for 3 days before the procedure
B
2. Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component. a. skeletal protein. b. glycogen. c. visceral protein. d. fat stores.
B,AA,D,C
6. When the nurse is assessing the health perception-health maintenance pattern as related to gastrointestinal function, an appropriate question to ask is a. "What is your usual bowel elimination pattern?" b. "What percentage of your income is spent on food?" c. "Have you traveled to a foreign country in the last year?" d. "Do you have diarrhea when you are under a lot of stress?"
C
7. In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (select all that apply) a. the cream form is the most efficient system of delivery. b. short-term use of topical corticosteroids usually does not cause systemic side effects. c. use a glove to apply small amounts of creams or ointments to prevent further infection. d. abruptly stopping the use of topical corticosteroids may cause the dermatitis to reappear. e. systemic side effects from topical corticosteroids are likely if the patient is malnourished.
B,D
2. Age-related changes in the hair and nails include (select all that apply) a. oily scalp. b. scaly scalp. c. thinner nails. d. thicker, brittle nails. e. longitudinal nail ridging.
B,D,E
3. When assessing the nutritional-metabolic pattern in relation to the skin, the nurse asks the patient about a. joint pain. b. the use of moisturizing shampoo. c. recent changes in wound healing. d. self-care habits related to daily hygiene.
C
5. A common site for the lesions associated with atopic dermatitis is the a. buttocks. b. temporal area. c. antecubital space. d. plantar surface of the feet.
C
5. During the physical examination of a patient's skin, the nurse would a. use a flashlight in a poorly lit room. b. note cool, moist skin as a normal finding. c. pinch up a fold of skin to assess for turgor. d. perform a lesion-specific examination first and then a general inspection.
C
7. On inspection of a patient's dark skin, the nurse notes a blue-gray birthmark on the forehead and eye area. This assessment finding is called a. vitiligo. b. intertrigo. c. Nevus of Ota. d. telangiectasia.
C
1. A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to a. sympathetic inhibition. b. mixing and propulsion. c. sympathetic stimulation. d. parasympathetic stimulation.
D
3. A complete nutritional assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2. b. reports episodes of nightly nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months
D
Week 11: Adult Skin Assessment
Harding: Chapter 22
Week 11: Adult Skin
Harding: Chapter 23
Week 12: Adult GI Assessment
Harding: Chp 38 (GI Assessment)
Week 12: Adult GI Disorders
Harding: Chp 39 (Nutritional problems) Harding: Chp 40 (Obesity) Harding: Chp 41 (Upper GI problems) Harding: Chp 42 (Lower GI problems)
Week 13: Adult Musculoskeletal
Harding: Chp 60 (Musculoskeletal Assessment) Harding: Chp 62 (Musculoskeletal trauma/ ortho surgery) Harding: Chp 63 (Musculoskeletal Problems)
Week 10: Pediatric Skin Disorders
Hockenberry chapter 31
Week 10: Pediatric Infectious Disease
Hockenberry chapter 6
Week 13: Peds Musculoskeletal
Hockenberry: Chapter 29
Week 13: Peds Neuromuscular
Hockenberry: Chapter 30
Week 11: Pediatric GI
Hockenberry: Chp 8 (Cleft Lip/Palate) Hockenberry: Chp 16 (Encopresis) Hockenberry Chp 22
1. A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that a. itching is a common problem with jaundice in this phase. b. the patient is most likely to transmit the disease during this phase. c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.
a
1. The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to a. increase fluid intake. b. administer an antibiotic. c. administer an antimotility drug. d. quarantine the patient to prevent spread of the virus.
a
2. A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue
a
3. A patient with a torn ligament in the knee asks what the ligament does. The nurse's response is based on the knowledge that ligaments a. connect bone to bone. b. provide strength to muscle. c. lubricate joints with synovial fluid. d. relieve friction between moving parts.
a
4. Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."
a
5. In planning care for a patient with metastatic liver cancer, the nurse should include interventions that a. focus primarily on symptomatic and comfort measures. b. reassure the patient that chemotherapy offers a good prognosis. c. promote the patient's confidence that surgical excision of the tumor will be successful. d. provide information needed for the patient to make decisions about liver transplantation.
a
5. The nurse is obtaining a health history of a patient with a fracture. Which condition poses the most concern related to the musculoskeletal system? a. Diabetes b. Hypertension c. Chronic bronchitis d. Nephrotic syndrome
a
6. A patient who has had surgical correction of bilateral hallux valgus is being discharged from the same-day surgery unit. The nurse will teach the patient to a. rest frequently with the feet elevated. b. wear shoes continually except when bathing. c. soak the feet in warm water several times a day. d. expect the feet to be numb for the next few days.
a
6. A patient with a pelvic fracture should be monitored for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.
a
7. The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stools." c. "I may not need to wear a drainage pouch if I irrigate it daily." d. "Limiting my fluid intake should decrease the amount of output."
a
7. The nurse teaches the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture. b. clot formation at the incision. c. skin irritation and breakdown. d. increased risk for wound dehiscence.
a
3. Which persons are at high risk for chronic low back pain? (select all that apply) a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine e. A 28-yr-old female yoga instructor who is 5 ft, 6 in and weighs 130 lb
a, b, c, d
7. Which criteria must be met for a diagnosis of metabolic syndrome? (select all that apply) a. Hypertension b. High triglycerides c. Elevated plasma glucose d. Increased waist circumference e. Decreased low-density lipoproteins
a, b, c, d
2. A 35-yr-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain? (select all that apply) a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease
a, b, c, d, e
4. The increased risk for falls in the older adult is likely due to (select all that apply) a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. d. erosion of articular cartilage. e. decrease in muscle mass and strength.
a, b, c, e
6. Nursing management of the patient with acute pancreatitis includes (select all that apply) a. administering pain medication. b. checking for signs of hypocalcemia. c. providing a diet low in carbohydrates. d. giving insulin based on a sliding scale. e. monitoring for infection, particularly respiratory tract infection.
a, b, e
2. While performing passive range of motion for a patient, the nurse puts the elbow joint through the movements of (select all that apply) a. flexion and extension. b. inversion and eversion. c. pronation and supination. d. flexion, extension, abduction, and adduction. e. pronation, supination, rotation, and circumduction.
a, c
2. Health risks associated with obesity include (select all that apply) a. colorectal cancer. b. rheumatoid arthritis. c. polycystic ovary syndrome. d. nonalcoholic steatohepatitis. e. systemic lupus erythematosus.
a, c, d
3. Assessment findings suggestive of peritonitis include (select all that apply) a. rebound tenderness. b. a soft, distended abdomen. c. dull, intermittent abdominal pain. d. shallow respirations with bradypnea. e. observing that the patient is lying still.
a, e
A 6-year-old boy has experienced significant trauma in a motor vehicle crash 4 days ago. He has been in the intensive care unit and is now stabilized and being transferred to the pediatric orthopedic unit to continue recovery. He is immobilized with a fractured femur and humerus, and multiple lacerations.Which intervention will the nurse implement at this time? Select all that apply. A.Monitor peripheral pulses and skin temperature changes B.Use compression stockings or intermittent compression devices to decrease pooling C.Reposition every 8 hours D.Monitor intake and output closely E.Place on a hard mattress to prevent movement F.Encourage cough and deep breathing G.Complete a dietary assessment H.Monitor vital signs
a,b,d,f,h
10. The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu a. scrambled eggs and sausage. b. buckwheat pancakes with syrup. c. oatmeal, skim milk, and orange juice. d. yogurt, strawberries, and rye toast with butter
aa
1. M.J. calls the clinic and tells the nurse that her 85-yr-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to a. administer antiemetic drugs and assess her mother's skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother large quantities of Gatorade to decrease the risk for sodium depletion. d. give her mother a high-protein liquid supplement to drink to maintain her nutritional needs.
b
10. Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing a. beef. b. meat and milk. c. poultry and eggs. d. home-preserved vegetables.
b
2. A patient with acute hepatitis B is being discharged. The discharge teaching plan should include instructions to a. avoid alcohol for the first 3 weeks. b. use a condom during sexual intercourse. c. have family members get an injection of immunoglobulin. d. follow a low-protein, moderate-carbohydrate, moderate-fat diet.
b
7. A patient with pancreatic cancer is admitted to the hospital for evaluation of treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum. b. resection of the entire pancreas and the distal part of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum. c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum. d. removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy
c
8. A patient is scheduled for a bone scan. The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule. b. insertion of small needles into certain muscles. c. administration of a radioisotope before the procedure. d. placement of skin electrodes to record muscle activity.
c
9. The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) a. limiting alcohol intake to 1 serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.
c, d
4. A 6-year-old boy is admitted with increasing symptoms of muscle weakness including difficulties running, riding his bike and climbing stairs. In the hospital he undergoes numerous lab tests, muscle biopsy and EMG. He is diagnosed with Duchene Muscular Dystrophy (DMD). The nurse plans to provide discharge teaching and answer questions the parents and patient ask.What will the nurse say at this time? Select all that apply. A."DMD is inherited as an X-linked recessive trait and affects boys." B."Your child may need to have casts on his legs to help him walk." C."You will learn stretching exercises and strength and muscle training to help your child." D.""You should call your health care provider if any respiratory symptoms occur."" E."Your child should be hospitalized when ambulation becomes impossible." F."It is important for your child to remain as independent as possible." G."Breathing exercises will help maintain his vital lung capacity."
c,d,f,g
1. The bone cells that function in the formation of new bone tissue are called a. osteoids. b. osteocytes. c. osteoclasts. d. osteoblasts.
d
1. The nurse suspects an ankle sprain when a patient at the urgent care center describes a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10-lb weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game.
d
11. What should a patient be taught after a hemorrhoidectomy? a. Take mineral oil before bedtime. b. Eat a low-fiber diet to rest the colon. c. Use oil-retention enemas to empty the colon. d. Take prescribed pain medications before a bowel movement.
d
2. The nurse explains to the patient with Vincent's infection that treatment will include a. tetanus vaccinations. b. viscous lidocaine rinses. c. amphotericin B suspension. d. topical application of antibiotics.
d
3. The obesity classification that is most often associated with cardiovascular health problems is a. primary obesity. b. secondary obesity. c. gynoid fat distribution. d. android fat distribution.
d
4. A patient with suspected disc herniation has acute pain and muscle spasms. The nurse's responsibility is to a. encourage total bed rest for several days. b. teach principles of back strengthening exercises. c. stress the importance of straight-leg raises to decrease pain. d. promote use of cold and hot compresses and pain medication.
d
4. The best nutritional therapy plan for a person who is obese a. is high in animal protein. b. is fat-free and low in carbohydrates. c. restricts intake to under 800 calories per day. d. lowers calories with foods from all the basic groups
d
5. A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse notifies the provider of possible early compartment syndrome when the patient has a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.
d
5. This bariatric surgical procedure involves creating a gastric pouch that is reversible, and no malabsorption occurs. Which surgical procedure is this? a. Vertical gastric banding b. Biliopancreatic diversion c. Roux-en-Y gastric bypass d. Adjustable gastric banding
d
6. A patient with extreme obesity has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient a. may have severe diarrhea early in the postoperative period. b. will not be allowed to ambulate for 1 to 2 days postoperatively. c. will require nasogastric suction until the drainage is pale yellow. d. may have limited amounts of oral liquids during the early postoperative period.
d
6. When grading muscle strength, the nurse records a score of 3/5, which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.
d
7. The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that cause oversecretion of acid, such as excess dietary fats, smoking, and alcohol use. d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.
d
8. An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources.
d
9. A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is to a. apply a truss to the hernia site. b. allow the patient to stand to void. c. support the incision during coughing. d. apply a scrotal support with an ice bag.
d
9. A patient is scheduled for total ankle replacement. The nurse should tell the patient that after surgery he should avoid a. lifting heavy objects. b. sleeping on the back. c. abduction exercises of the affected ankle. d. bearing weight on the affected leg for 6 weeks.
d