exam 3 nursing 203
What is the most appropriate method used by high-risk health workers to prevent hepatitis B?
Hepatitis B vaccine
The nurse is educating a patient with inflammatory bowel disease (IBD) about recommended nutritional choices. Which statement indicates that the nurse's teaching has been successful?
I should try to eat foods like white rice and lean poultry."
The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis?
Increased prothrombin time
Conservative treatment of diverticulosis includes which management? (select all that apply.)
Increasing fluid intake Taking stool softeners Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for discomfort Taking bulk laxatives
The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient?
Instruct the patient to sit and lean forward.
The nurse is aware that an unresolved intestinal obstruction can lead to which complications?
Intestinal rupture and shock
What is the most common procedure for the removal of the gallbladder?
Laparoscopic cholecystectomy
The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test?
Liver biopsy
The nurse clarifies that deterioration progresses through stages before presenting with liver disease. The first stage is destruction. What is the last stage?
Liver disease
The nurse is caring for an older adult patient diagnosed with diverticulitis. Which medication is the best choice to manage the patient's pain?
Morphine
The nurse is caring for a patient with a 4-day-old ileostomy. The patient complains of cramping, the nurse notes a drop in the effluent for the ileostomy, and the bowel sounds are rapid with a "tinkling" sound. What action should the nurse take?
Notify the charge nurse immediately.
The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (select all that apply.)
Obesity- Diabetes mellitus- Taking cholesterol lowering drugs -Mexican American ethnicity
Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect?
Pneumothorax
The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis blocks the blood flow through the liver, it can lead to which complication(s)? (select all that apply.)
Portal hypertension Decrease in metabolic processes of the liver Decrease in clotting factors Increase in ascites
The nurse is aware that the liver synthesizes products essential to health. Which products are synthesized by the liver? (Select all that apply.)
Protein albumin
The nurse caring for the patient who is immediately postoperative with a new ileostomy. Which intervention is most important for the nurse to implement at this time?
Provide emotional support.
A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A?
Recent ingestion of raw fish
The nurse explains to the patient receiving bevacizumab (Avastin) for a tumor in the colon that the drug slows cancer cell growth by which process?
Reducing blood flow to the tumor
The nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology?
Hepatitis causes liver congestion that obstructs bile flow.
A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate?
"Hepatitis A is not transmitted as a result of close contact with an infected individual
The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse's teaching has been successful?
"I should let these Steri-Strips fall off on their own.
The nurse is educating a patient with diverticulitis. Which statement indicates that the nurse's teaching about the importance of seeking treatment has been successful?
"If left untreated, the inflamed bowel can perforate and cause peritonitis."
The nurse is caring for a patient who has been diagnosed with Crohn disease. When providing education concerning dietary recommendations, which statement indicates that the nurse's teaching has been successful?
"Reducing dietary fat and fiber will be helpful in managing my condition."
The nurse is caring for a patient being treated for new onset of gallstones. The patient asks the nurse if he will have to have surgery. How should the nurse respond?
"Treatment for gallstones may include diet modification and weight loss, medications, or surgery.
Hepatitis D virus
- inflammation of liver and are prone to developing hepatitis an cirrhosis -transmitted by sexual activity, injected drugs, or needle sticks 0 mostly likely to infect pp. who are already infected with HBV
The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (.02 mL/kg) be?
0.9 mL
The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as _____ after the onset of pancreatic disease.
2 HOURS
The nurse is aware that the hepatitis A immunization provides immunity in:
30 days
The nurse is teaching a group of patients about the process of a mechanical bowel obstruction. Which example should the nurse include in the teaching?
A tumor obstructs the lumen of the bowel
The presence of which diagnostic criteria are used to confirm the diagnosis of irritable bowel syndrome (IBS)? (select all that apply.)
Abdominal pain that increases with defecation Abdominal pain with a change in stool consistency Mucorrhea Bloating
What is the second step in the normal process of protein metabolism?
Ammonia produced in the bowel.
A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse anticipates that the health care provider will likely recommend which treatment?
An injection of hepatitis B immune globulin (HBIG)
he patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this?
As asterixis
How does the administration of neomycin (Mycifradin) reduce the production of ammonia?
By decreasing the bacteria in the gut
What is an ileostomy?
Bypasses the entire large intestine-Stools are frequent and liquid-Indications: Crohn's disease, ulcerative colitis, cancer, familial polyposis
The nurse is caring for a patient with esophageal varices with a new order for vasopressin (Pitressin). The nurse reviews the patient's history and notes that the patient's comorbidities include coronary artery disease (CAD), type 2 diabetes, gastroesophageal reflux disease (GERD), and fibromyalgia. The nurse should immediately notify the physician about which component of the patient's history
CAD
The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem?
Cholecystitis
Which age-related change predisposes older adult patients to diverticula?
Chronic constipation increases intra-abdominal pressure and allows herniation.
Viral hepatitis may be treated at home. What should be taught to the patient's family? (Select all that apply.)
Clothes should be laundered separately with hot water. Personal items and drinking glasses should not be shared. Contaminated items may be disposed of with regular trash.
Which foods or beverages may trigger an attack of irritable bowel syndromes (IBS)? (select all that apply.)
Coffee b.Yogurt c.Whole wheat bread
The nurse is caring for patient with a history of a chronic incarcerated hernia. The patient suddenly complains of abdominal pain and vomits dark material with a fecal odor. The nurse recognizes these signs as indications of which complication?
Complete intestinal obstruction
The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention?
Confusion
The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (select all that apply.)
Diabetes mellitus (DM) Taking cholesterol-lowering drugs Mexican American ethnicity Obesity
The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit?
Edema
The nurse caring for a patient admitted with peritonitis who has developed a paralytic ileus. While auscultating bowel sounds, the nurse assesses flatus. What is the significance of this finding?
Flatus indicates returning peristalsis.
The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make?
Gallstones are usually treated with surgery. Tell me more about your concerns.
The nurse is teaching a patient about peristomal skin care. Which information is most important for the nurse to include? (select all that appl
Gently remove the faceplate of the appliance to avoid skin irritation Thoroughly rinse the skin. d. Apply a skin barrier to the peristomal area.
What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis?
Have patient void immediately before procedure
What is the most appropriate method used by high-risk health workers to prevent hepatitis B
Hepatitis B vaccine
The physician has prescribed rifaximin (Xifaxan) for a patient with cirrhosis. The patient questions why he must take this medication. Which response by the nurse is most appropriate?
Rifaximin (Xifaxan) kills intestinal flora.
The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found which type(s) of body fluid(s) or secretions? (select all that apply.)
Semen Sweat Breast milk Vaginal secretions
The nurse explains that a hernioplasty is a surgery that involves which process?
Sewing synthetic mesh over the abdominal wall defect to reduce the hernia
Which type of hernia can lead to necrosis?
Strangulated hernia
A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response?
The pancreas is stimulated whenever you eat or drink and causes pain."
A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T tube inserted into the common bile duct. What is the purpose of the T tube?
To keep the duct open and allow drainage of the bile until edema resolves.
A patient with a T tube for an open cholecystectomy has resumed oral intake. The T tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate?
Unclamp the tube immediately.
A 36-year-old woman who had an ascending colostomy angrily declares, "I don't want this hateful thing on my body! This nasty thing is not me." Which response is most appropriate for the nurse to make?
What about this colostomy concerns you the most?"
Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.)
Whole milk Glazed chocolate doughnuts Peanut Butter
The nurse preparing a teaching plan for a 20-year-old woman who is taking sulfasalazine (Azulfidine) for Crohn disease. Which information should the nurse include in the teaching plan? (select all that apply.)
avoid tanning beds or going outside during peak hours of sun while taking sulfasalazine Be aware that sulfasalazine may turn the urine orange be aware that sulfasalazine may cause GI upset If taking sulfasalazine while on oral contraceptives use a backup method of birth control
Which contributing factor(s) may lead to hernia development? (select all that apply.)
a. Heavy lifting b. Chronic cough c. Straining with defecation. d. Ascites
The nurse caring for a patient recently admitted with acute pancreatitis. Which action(s) should the nurse include in the daily assessments? (select all that apply.)
a.Auscultate bowel sounds .c.Measure abdominal girth. d.Monitor for effectiveness of pain control. e.Monitor urine output.
The presence of which diagnostic criteria are used to confirm the diagnosis of irritable bowel syndrome (IBS)? (select all that
bloating not finished
The nurse is aware that the person with ulcerative colitis is a risk factor for developing which disorder
colon cancer
The nurse is aware that the person with ulcerative colitis is a risk factor for developing which disorder?
colon cancer
The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug
does not suppress bone marrow
The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug:
does not suppress bone marrow.
The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for:
evidence of cardiac ischemia.
Hepatitis A virus transmission
fecal-oral via shellfish, travel, daycare
the nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology
hepatitis causes liver congestion that obstructs bile flow
The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent:
infection
Ascending colon
liquid, frequent stool
Sigmoid
near normal stool
The nurse caring for a patient who has had an open cholecystectomy with a T Tube will
position and secure the drainage bag at the chest level.
The nurse is caring for a patient 1-day postoperative after a transverse colostomy. When assessing the stoma, which finding requires the nurse's immediate action?
purplish-red stoma
Transverse colon-
solid, formed stool
Hepatitis C Virus
the virus that causes hepatitis C infection and is transmitted by contact with infected blood or other body fluids
The nurse is educating a group of patients about high-fiber dietary selections. Which patient menu selection indicates that the nurse's teaching has been successful?
turkey sandwich on whole wheat toast, pears, and tea
Hepatitis B Virus (HBV)
virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood