CM: Adult Health 1: Exam 4

The nurse is caring for a 76 year old client who is obese and has a history of epigastric distress, esophageal burning, binge drinking, and frequent episodes of bronchitis. A diagnosis of hiatal hernia is made. Which health problems most likely contributed to the development of the hiatal hernia? Select all that apply. One, some, we're all responses may be correct. A) Aging B) Obesity C) Bronchitis D) Esophagitis E) Binge drinking

ANS: A and B. Aging and obesity.

The nurse is providing discharge instructions for a client with a diagnosis of gastroesophageal reflux disease (GERD). Which recommendations would the nurse give to the client to limit symptoms of GERD? Select all that apply. One, some, or all responses may be correct. A) Avoid heavy lifting. B) Lie down after eating. C) Avoid drinking alcohol. D) Eat small, frequent meals. E) Increase fluid intake with meals. F) Wear an abdominal binder or girdle.

ANS: A,C,D. Avoid heavy lifting, avoid drinking alcohol, eat small, frequent meals.

How much volume is the gastric pouch able to hold after a Roux-en-Y surgery? A) 10-15mL B) 15-30mL C) 30-50mL D) 50-100mL

ANS: B) 15-30mL

The nurse provides teaching for a client with gastroesophageal reflux disease. The nurse should recommend that the client take which action after meals? A) drink 8 ounces of water. B) take a walk for 30 minutes. C) Lie down for at least 20 minutes. D) rest in a sitting position for one hour.

ANS: D) rest in a sitting position for one hour.

The nurse is reinforcing discharge instructions with a client following a partial gastrectomy. Which of the following instructions should the nurse include to prevent dumping syndrome? Select all that apply. A) Add high-protein foods to diet B) Consume high-carbohydrate meals C) Eat small, frequent meals D) Increase intake of fluids with meals E) Lie down after eating

ANS: A,C,E. Add high-protein foods to diet; Eat small, frequent meals; Lie down after eating.

Which medication would the nurse question when reviewing the home medication list for a client admitted with peptic ulcer disease (PUD)? A) Iron B) Ibuprofen C) Famotidine D) Acetaminophen

ANS: B) Ibuprofen

Which action would the nurse take to limit a common complication for a client who had an inguinal hernia repair? A) Apply an abdominal binder. B) Place a support under the scrotum. C) Teach the client to cough several times an hour. D) Encourage the client to eat a high-carbohydrate diet.

ANS: B) Place a support under the scrotum.

A client with chronic gastritis is being treated with medication and diet. Which would the nurse teach the client when discussing the therapeutic regimen? A) Lie down after eating when possible. B) Take an antacid preparation with meals. C) Limit high-carbohydrate foods in the diet. D) Avoid using analgesics that contain aspirin.

ANS: D) Avoid using analgesics that contain aspirin.

Which nutrient deficiencies are common with this type of surgery? Select all that apply. A) Iron B) Calcium C) Vitamin C D) Magnesium E) Cobalamin (B12)

ANS: A,B,E. Iron, Calcium, and Cobalamin (B12).

Which action would be a priority for the nurse after making a home visit to a client receiving total parenteral nutrition and noting that there is redness and tenderness at the intravenous line site and that the client has a temperature of 101.2°F (38.4°C)? A) Re-educate the client caregiver regarding appropriate catheter care. B) Schedule a visit for the next day to reassess the site. C) Inform the client's health care provider. D) Immediately remove the line.

ANS: C) Inform the client's health care provider.

A nurse conducting rounds checks on a client receiving continuous total parenteral nutrition (TPN). The infusion pump is found to be powered down, and TPN is no longer infusing. Which action should the nurse take first? A) Notify the health care provider that the infusion has stopped. B) Obtain a blood specimen for serum electrolyte testing. C) Obtain a STAT finger-stick capillary blood glucose level. D) Remove the infusion pump and tag the device as malfunctioning.

ANS: C) Obtain a STAT finger-stick capillary blood glucose level.

The laboratory values of a client with a new esophageal cancer diagnosis include a hemoglobin of 7 g/dL, hematocrit of 25%, and red blood cell count of 2.5 million/mm^3. Which priority goal would the nurse add to the plan of care? A) The client will be free of injury. B) The client will remain pain-free. C) The client will demonstrate improved nutrition. D) The client will maintain effective airway clearance.

ANS: C) The client will demonstrate improved nutrition.

A client who has gastroesophageal reflux disease (GERD) is unable to tolerate a backrest elevation. In which illustrated position would the nurse place a client? A) High Fowler B) Low Fowler C) Flat D) Reverse Trendelenburg

ANS: D) Reverse Trandelenberg

A client is scheduled for surgery to repair an irreducible (incarcerated) hernia. Which nursing intervention is the priority? A) Assessing the clients bowel movements. B) Maintaining the client in the proper position. C) Checking the client's vital signs periodically. D) Monitoring the client's serum enzyme levels.

ANS: A) Assessing to he client's bowel movements.

For which prescription would the nurse seek clarification when reviewing the plan of care for the geriatric client with less than adequate nutritional intake? A) Have clients sit in a chair for meals to prevent aspiration of food/liquid into the lungs. B) Provide six small feedings in 24 hours and whenever requested by the client. C) Give one can of diet supplement at 8 AM with breakfast end at 4 PM before evening meal. D) Encourage the client's family members to bring food from home, especially favorite dishes.

ANS: C) Give one can of diet supplement at 8:00am with breakfast and 4:00pm before evening meal.

A client with severe gastritis vomits a large amount of blood. The nurse performs gastric lavage, as prescribed, using an irrigating solution that is room temperature. Which response would the nurse expect? A) Coagulation of blood B) Neutralization of acids C) Constriction of blood vessels D) Stimulation of the vagus nerve

ANS: C) Constriction of blood vessels

Which finding is an indication of ulcer perforation in a client with peptic ulcer disease (PUD)? Select all that apply. One, some, or all responses may be correct. A) Tachycardia B) Hypotension C) Ridgid abdomen D) Nausea and vomiting E) Back and shoulder pain

ANS: A,B,C,D,E. Tachycardia, Hypotension, Rigid abdomen, Nausea and vomiting, and Back and shoulder pain.

The nurse reviews the health histories of clients being evaluated at a community cancer-screening event. The nurse recognizes that which of the following clients have a risk factor for developing oral cancer? Select all that apply. A) Client who drank alcohol almost daily for 25 years. B) Client who frequently consumes hot, spicy foods for lunch and dinner. C) Client who has dental cavities and gum disease due to poor oral hygiene. D) Client who is diagnosed with oral human papillomavirus . E) Client who smoked cigars for 30 years but quit 1 year ago.

ANS: A,C,D,E. Client who drank alcohol almost daily for 25 years; Client who has dental cavities and gum disease due to poor oral hygiene; Client who is diagnosed with oral human papillomavirus; Client who smoked cigars for 30 years but quit 1 year ago.

The nurse assess for cancer risk factors during a screening event at a gastroenterology clinic. Which of the following client statements include risk factors for esophageal cancer? Select all that apply. A) "A few years ago, I switched from smoking cigarettes to smoking cigars 1 or 2 times a week." B) "I am proud that I was able to lose 10 lbs, but I'm still considered obese for my height." C) "I drink 3 or 4 beers nightly to relax, but I did switch to light beer recently." D) "I have struggled with daily episodes of acid reflux for years, especially at nighttime." E) "I snack on a lot of salted foods like popcorn and peanuts."

ANS: A,B,C,D. "A few years ago, I switched from smoking cigarettes to smoking cigars 1 or 2 times per week; I am proud that I was able to lose 10lbs, but I'm still considered obese for my height; I drink 3 or 4 beers nightly to relax, but I did switch to light beer recently; I have struggled with daily episodes of acid reflux for years, especially at nighttime."

Which instructions should the nurse include when providing discharge teaching to a client with peptic ulcer disease due to Helicobacter pylori infection? Select all that apply. A) "Avoid foods that may cause epigastric distress such as spicy or acidic foods." B) "It is best if you refrain from consuming alcohol products." C) "Report black tarry stools to your health care provider immediately." D) "Take your amoxicillin, clarithromycin, and omeprazole for the next 14 days." E) "You may take over-the-counter drugs such as aspirin if you have mild epigastric pain."

ANS: A,B,C,D. "Avoid foods that may cause epigastric distress such as spicy or acidic foods; It is best if you refrain from consuming alcohol products; Report black tarry stools to your health care provider immediately; Take your amoxicillin, clarithromycin, and omeprazole for the next 14 days."

Which of these are potential risk factors for GERD? Select all that apply. A) Obesity B) Alcohol use C) Caffeine use D) Cardiac history E) Cigarette smoking

ANS: A,B,C,E.

The nurse is collecting health histories from clients during a community cancer screening event. Which of the following client statements should cause the nurse to recommend further evaluation for oral cancer? Select all that apply. A) "I discovered a small lump in my cheek a month ago, and it still hasn't gone away." B) "I have had a full aching pain in the roof of my mouth for the past few weeks." C) "It often feels like I have a piece of food stuck in the back of my throat after I swallow." D) "My two front teeth have been sore and loose since I fell 3 days ago." E) "This rough, red patch on my lip won't heal, but I am able to cover it with lipstick."

ANS: A,B,C,E. "I discovered a small lump in my cheek a month ago, and it still hasn't gone away; I have had a dull aching pain in the roof of my mouth for the past few weeks; It often feels like I have a piece of food stuck in the back of my throat after I swallow; This rough, red patch on my lip won't heal, but I am able to cover it with lipstick."

The nurse is caring for a client with dysphagia who coughs vigorously after drinking water to swallow an oral medication. Which of the following nursing interventions are appropriate? Select all that apply. A) Avoid providing thin liquids. B) Collaborate with the speech therapist. C) Eliminate the use of straws. D) Instruct the client to tilt the head back when swallowing. E) Raise the head of the bed to 90 degrees during meals.

ANS: A,B,C,E. Avoid providing thin liquids; Collaborate with the speech therapist; Eliminate the use of straws; Raise the head of the bed to 90 degrees during meals.

The nurse is preparing to educate a client with gastroesophageal reflux disease on factors that may increase symptoms. Which of the following client factors should the nurse plan to address? Select all that apply. A) Client drinks 2 or 3 glasses of red wine daily B) Client drinks peppermint tea nightly. C) Client has a BMI of 45 D) Client performs vigorous exercise daily E) Client smokes a pack of cigarettes daily.

ANS: A,B,C,and E. Client drinks 2 or 3 glasses of red wine daily; Client drinks peppermint tea nightly; Client has a BMI of 45; Client smokes a pack of cigarettes daily.

Which interventions would the nurse include in the plan of care for a client with gastroesophageal reflux disease (GERD)? Select all that apply. One, some, we're all responses may be correct. A) Encourage client to follow the prescribed a treatment regimen. B) Keep the head of the bed elevated to approximately 30°. C) Avoid placing the client in the supine position for 2 to 3 hours after a meal. D) Instruct the client to eat six small meals a day with the last just before bedtime. E) Instruct the client to take a proton pump inhibitor before the first meal of the day.

ANS: A,B,C. Encourage client to follow the prescribed a treatment regimen; Keep the head of the bed elevated to approximately 30°; Avoid placing the client in the supine position for 2 to 3 hours after a meal.

You are giving instructions to a pt on how to use an IS. Which statements are correct about the proper use of the IS? Select all that apply. A) "Incentive Spirometry should be done every hour." B) "If able, sit in the chair or as far up in bed as possible." C) "Place the mouthpiece in your mouth, but there should not be an airtight seal." D) "After each set of deep breaths using the IS, cough to make sure your lungs are clear." E) "Breath in slowly and as deeply as possible, until you see the piston reach the goal amount for volume." F) "After breathing in, hold the breath and the piston in place for 3-5 seconds and then release the breath."

ANS: A,B,D,E,F.

The nurse is teaching a client with newly diagnosed lactase deficiency about dietary management. Which statements by the client indicate a correct understanding of this condition? Select all that apply. A) "I can still eat cheese and yogurt as long as they don't make me feel sick." B) "I should take a daily calcium and vitamin D supplement." C) "Most dairy products should be eliminated from my diet, but ice cream is okay." D) "My lactase enzyme supplement should be taken with meals containing dairy." E) "This means that I have developed an allergy to milk."

ANS: A,B,and D. "I can still eat cheese and yogurt as long as they don't make me feel sick; I should take a daily calcium and vitamin D supplement; My lactase enzyme supplement should be taken with meals containing dairy."

The clinic nurse is obtaining a health history from an adult client who reports dull, aching, mid-epigastric pain and loss of appetite for the last 3 weeks. Which of the following findings are concerning to the nurse? Select all that apply. A) Client consumes a diet high in spicy foods B) Client drinks 2 or 3 cups of green tea each day C) Client reports drinking 3 or 5 alcoholic beverages per day D) Client reports having a high stress level due to job loss E) Client takes celecoxib daily for osteoarthritis

ANS: A,C,D,E. Client consumes a diet high in spicy foods; Client reports drinking 3 or 5 alcoholic beverages per day; Client reports having a high stress level due to job loss; Client takes celecoxib daily for osteoarthritis.

The nurse is reviewing lifestyle and nutritional strategies to help reduce symptoms in a client with newly diagnosed gastroesophageal reflux disease. Which strategies should the nurse include? Select all that apply. A) Choose foods that are low in fat. B) Do not consume any foods containing dairy C) Eat three large meals a day and minimize snacking D) Limit or eliminate the use of alcohol and tobacco E) Try to avoid caffeine, chocolate, and peppermint

ANS: A,D,E. Choose foods that are low in fat; Limit or eliminate the use of alcohol and tobacco; Try to avoid caffeine, chocolate, and peppermint.

The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What's that for? I don't take it at home." Which reply by the nurse is most appropriate? A) "Omeprazole helps prevent nausea by making your stomach empty faster." B) "Omeprazole helps prevent you from developing an ulcer due to the stress of surgery." C) "Omeprazole protects you from getting an infection while on antibiotics." D) "This medication will treat your gastroesophageal reflux disease (GERD)."

ANS: B) "Omeprazole helps prevent you from from developing an ulcer due to the stress of surgery."

Which condition is it most important for the nurse to assess for in a client admitted to the hospital for acute gastritis and ascites secondary to alcohol use and cirrhosis? A) Nausea B) Blood in the stool C) Food intolerances D) Hourly urinary output

ANS: B) Blood in the stool.

A client is receiving an infusion of total parent wrap nutrition (TPN) with 20% dextrose through a central line at 75 ml/hr. The nurse responds to the client's IV pump alarm, which indicates that the bag is empty. The new bag is not expected to arrive from the pharmacy for an hour. What is the most appropriate nursing action? A) Hang 0.9% NS until new bag arrives, then increase TPN to 150 ml/hr for 1 hour. B) Hang 10% dextrose in water until the new bag arrives, then resume TPN at 75ml/hr C) Hang dextran in saline until the new bag arrives, then resume TPN at 75 ml/hr. D) Hang lactated Ringer's until the new bag arrives, then resume TPN at 75ml/hr.

ANS: B) Hang 10% dextrose in water until the new bag arrives, then resume TPN at 75mL/hr.

A client had surgery for a strangulated hernia. One hour after surgery the clients blood pressure drops from 134/80 to 114/76 mm Hg. Assessment reveals that the client does not have postoperative bleeding. Which action would the nurse take? A) Place the client and the left side lying position. B) Instruct the client to move both legs. C) Notify the primary healthcare provider immediately. D) Administer the prescribed pain medication.

ANS: B) Instruct the client to move both legs.

Which client factor would the nurse consider to have the greatest effect on the effectiveness of bariatric surgery? A) Freedom from concurrent high-risk conditions. B) Motivation to cooperate with required lifestyle changes. C) Willingness to have a panniculectomy a year after weight is stabilized. D) Ability to tolerate a large abdominal incision if it is necessary for this surgery.

ANS: B) Motivation to cooperate with required lifestyle changes.

A nurse is preparing a presentation about behavioral modifications to support weight loss for clients at an obesity clinic. Which of the following points should the nurse include in the teaching plan? Select all that apply. A) Avoid social gatherings that occur in restaurants or around meals. B) Create multiple small goals with rewards for achievement. C) Identify a list of desired outcomes not directly related to weight loss. D) Perform anxiety-reducing activities rather than using food to cope with stress. E) Utilize visual cues such as motivational quotes to encourage positive behavior.

ANS: B,C,D,E. Create multiple small goals with rewards for achievement; Identify a list of desired outcomes not directly related to weight loss; Perform anxiety-reducing activities rather than using food to cope with stress; Utilize visual cues such as motivational quotes to encourage positive behavior.

Which would the nurse assess using the PASS acronym to prevent aspiration pneumonia in a client with dermatitis? Select all that apply. One, some, or all responses may be correct. A) is the client's airway open? B) does the client have any difficulty swallowing? C) does the client have a history of trouble swallowing? D) has a speech language-pathologist been consulted? E) does the client have any signs or symptoms of dysphagia? F) What have been the client's dietary intake patterns?

ANS: B,C,D,E. Does the client have any difficulty swallowing? Does the client have a history of trouble swallowing? Has a speech language-pathologist been consulted? Does the client have any signs or symptoms of dysphagia?

The nurse is reinforcing discharge education to a client admitted with peptic ulcer disease. Which of the following client statements indicate that the teaching has been effective? Select all that apply. A) "I am glad that I can continue to enjoy my morning cup of coffee." B) "I will choose acetaminophen instead of aspirin for my headaches." C) "I will immediately report any dark stools to my health care provider." D) "I will talk to my health care provider about ways to quit smoking." E) "If I drink alcohol with food, I can continue drinking several beers a day."

ANS: B,C,D. "I will choose acetaminophen instead of aspirin for my headaches; I will immediately report any dark stools to my health care provider; I will talk with my health care provider about ways to quit smoking."

The nurse is counseling a client with obesity who is starting a weight reduction diet. The client reports consuming 4-5 regular cola beverages daily. Which of the following beverages should the nurse recommend as healthier substitutes? Select all that apply. A) Commercial fruit juice B) Flavored club soda C) Fresh vegetable juice D) Sports beverages E) Unsweetened tea

ANS: B,C,and E. Flavored club soda, Fresh vegetable juice, and Unsweetened tea.

The nurse teaches a client about limiting the discomfort associated with a hiatal hernia. Which statement by the client indicates the nurse's teaching is effective? A) "After meals, I will take a 10-minute walk." B) "After meals, I will drink 8 ounces of water." C) "After meals, I will rest in a sitting position for one hour." D) " after meals, I will lie down in bed for at least 20 minutes."

ANS: C) "After meals, I will rest in a sitting position for one hour."

Which administration instruction would the nurse give a client prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD)? A) as needed B) with meals C) at bedtime D) before meals

ANS: C) At bedtime

Which group of food selections would be appropriate for a client on a full liquid diet 3 days after bariatric surgery? A) Apple juice, mashed potatoes, and chocolate pudding. B) Chicken broth, low-fat cheese omelet, and strawberry ice cream. C) Creamy wheat cereal, blended cream of chicken soup, and a protein shake. D) Low-fat yogurt, smooth peanut butter, and vegetable juice.

ANS: C) Creamy wheat cereal, blended cream of chicken soup, and a protein shake.

Which advantage does aluminum and magnesium hydroxide have over baking soda (sodium bicarbonate) for the treatment of heartburn? A) They can be used for short-term relief. B) Absorption by the stomach mucosa is markedly enhanced. C) There is no direct effect on the systemic acid-base balance when taken as directed. D) Fewer side effects, such as diarrhea or constipation, are experienced when they are used properly.

ANS: C) There is no direct effect on these stomach acid-base balance one taken as directed.

H. pylori can be detected with other diagnostic testing. Which tests are potential diagnostic tests for H. pylori? Select all that apply. A) Urine test B) Stool culture C) Urea breath test D) Stool antigen test E) serum or whole antibody tests.

ANS: C,D,E. Urea breath test, stool antigen test, and serum or whole antibody tests.

The nurse is evaluating the effectiveness of parenteral nutrition for a client with severe oropharyngeal and esophageal mucositis who has been receiving total parenteral nutrition for the past 10 days. Which of the following findings would indicate that parenteral nutrition has been effective? Select all that apply. (*adm results are as follows: BG 90, Na 138, K 3.8, Prealbumin 11.5, BUN 9, and Creatinine 0.7, Weight day 1: 108lb, Day 3: 111 lb, Day 4: 116 lb) A) BUN: 25 B) Glucose: 223 C) Potassium: 3.3 D) Prealbumin: 30 E) Weight: 116lbs

ANS: D and E. Prealbumin of 30, and Weight of 116 lbs.

The nurse is reinforcing teaching to a client with a hiatal hernia. Which statement by the client indicates that further teaching is needed? A) "I need to raise the head of my bed on blocks by at least 6 inches." B) "I will remain sitting up for several hours after I eat any food." C) "If my reflux and abdominal pain don't improve, I might need surgery." D) "Losing weight may reduce my reflux, so I plan to take a weight-lifting class."

ANS: D) "Losing weight may reduce my reflux, so I plan to take a weight-lifting class."

The nurse assesses a client who has followed a vegan diet for several years. Which client statement indicates a potential nutritional deficiency? A) "I have had some visual disturbances while driving at night." B) "I have had trouble falling asleep over the past few months." C) "Scaly patches of skin are developing on my elbows and knees." D) "Sometimes my hands and feet get a tingling sensation."

ANS: D) "Sometimes my hands and feet get a tingling sensation."

Which information would the nurse reinforce when teaching a client with gastroesophageal reflux disease (GERD) about antacid therapy? A) Antacids should be taken one hour before meals. B) These should be scheduled at four-hour intervals. C) Antacid tablets are just as fast and effective as the liquid form. D) Antacids commonly interfere with the absorption of other medications.

ANS: D) Antacids commonly interfere with the absorption of other medications.

Which statement is important to include when teaching a client with dyspepsia about famotidine? A) Lowers the stress level. B) Neutralize gastric acidity. C) Reduces gastrointestinal peristalsis. D) Decreases secretions in the stomach.

ANS: D) Decreasing secretions in the stomach.

Which mechanism is specifically responsible for the action of the medication ranitidine? A) Inhibiting proton pumps. B) Promoting the release of gastrin. C) Regenerating the gastric mucosa. D) Inhibiting the histamine at H2 receptors.

ANS: D) Inhibiting the histamine at H2 receptors.

Which mechanism of action is a characteristic of famotidine prescribed for a client with peptic ulcer disease? A) Increases gastric motility B) neutralizes gastric acidity C) facilitates histamine release D) inhibits gastric acid secretion

ANS: D) Inhibits gastric acid secretion

The nurse performs nasogastric (NG) tube insertion using a large-bore NG tube on a hospitalized client with a gastrointestinal bleed. During insertion, after the tube passes the nasopharynx, the client begins to cough and gag. Which action should the nurse take first? A) Ask the client to take several small sips of water B) Continue to slowly advance the tube until placement is reached C) Gently remove the tube and reinsert in the other naris if possible D) Pull back on the tube slightly and then pause to give the client time to breathe.

ANS: D) Pull back on the tube slightly and then pause to give the client time to breathe.

The nurse is evaluating the effectiveness of the treatment regimen for a client with malnutrition. Which of the following findings would indicate that the treatment regimen has been effective? A) Decreased WBC count B) Consumes 90% of each meal. C) Decreased serum prealbumin level D) Weight gain of 3.2lb (1.5kg) in the past 2 weeks.

ANS: D) Weight gain of 3.2lb (1.5kg) in the past 2 weeks.