EXAM 4

Impetigo tends to be most commonly found on: A . Mouth B. Ears C. Nose D. Torso E. Toes

ANS: A and C. Impetigo most commonly tends to be found on the face like the mouth and nose. It can be found on the hands, arms, and legs.

Select ALL of the following that are complications associated with Crohn's Disease: A. Cobble-stone appearance of GI lining B. Lead-pipe sign C. Toxic megacolon D. Fistula E. Abscess F. Anal Fissure

ANS: A, D, E, and F. These are all complications found with Crohn's Disease. Lead-pipe sign and toxic megacolon are complications associated with ulcerative colitis.

A client with human immune deficiency virus (HIV) has had a sudden decline in status with a large increase in viral load. What action should the nurse take first? a. Ask the client about travel to any foreign countries. b. Assess the client for adherence to the drug regimen. c. Determine if the client has any new sexual partners. d. Request information about new living quarters or pets.

ANS: B - Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients must take their medications on time and correctly at a minimum of 90% of the time. Since this clients viral load has increased dramatically, the nurse should first assess this factor. After this, the other assessments may or may not be needed.

A patient is 8 hours post-opt from an colostomy placement. Which finding requires immediate nursing action? A. The stoma is swollen and large. B. The stoma is black. C. The stoma is not draining any stool. D. The patient states the site is tender.

ANS: B. An assessment finding of a stoma being black is not a normal finding but represents compromised circulation to the stoma. It requires immediate physician notification. The stoma should look red and be shiny/moist. It is normal for a stoma to be swollen and large after surgery (this will subside after a few months), and it is normal for the site to be tender due to the surgery (this will subside as well) and for the stoma to not be draining any stool yet. It can take approximately 2 day before stool drains from a colostomy.

After a treatment plan for acne has been initiated, which time period should the nurse explain to an adolescent before improvement will be seen? a. 2 to 4 weeks b. 4 to 6 weeks c. 6 to 8 weeks d. 8 to 10 weeks

ANS: C - Inform patients that after a treatment plan for acne has been initiated, it will take 6 to 8 weeks to appreciate improvement in their skin.

A patient with Crohn's Disease is MOST likely to have the disease is what part of the GI tract? A. Rectum B. Duodenum of the small intestine C. Terminal Ileum D. Descending colon

ANS: C. Crohn's disease is MOST likely to affect the terminal ileum. However, it may affect any area of the GI tract.

A parent brings her child into the clinic due to skin lesions that fail to heal. The lesions are red, reported to be itchy, and exhibit exudate. You suspect the child may have impetigo. What is a hallmark finding with this condition? A. Round patches with light pink centers B. Short grey lines on the skin C. Silver colored scales over the lesions D. Yellow crusts over the lesions

ANS: D. Yellow crusted over lesions are a hallmark of impetigo. Option A is a hallmark found with ringworm (tinea corporis), Option C is psoriasis, and Option B is scabies.

A client came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the client during history taking? (Select all that apply.) a. Recent prostatectomy b. Long-term hypertension c. Diabetes mellitus d. Hour-long exercise sessions e. Consumption of beer each night

ANS: A, B, C, E - Organic erectile dysfunction can be caused by surgical procedures, hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no evidence that exercise is related to this problem.

You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education? A. Cough for a minimum of 6 weeks B. Night sweats C. Weight gain D. Hemoptysis E. Chills F. Fever G. Chest pain

ANS: B, D, E, F, and G. Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1 F (37.8 C) b. Positive Murphys sign c. Light-colored stools d. Upper abdominal pain after eating

ANS: C - Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen equally with both chronic and acute cholecystitis.

An HIV-positive client is admitted to the hospital with Toxoplasma gondii infection. Which action by the nurse is most appropriate? a. Initiate Contact Precautions. b. Place the client on Airborne Precautions. c. Place the client on Droplet Precautions. d. Use Standard Precautions consistently.

ANS: D - Toxoplasma gondii infection is an opportunistic infection that poses no threat to immunocompetent health care workers. Use of Standard Precautions is sufficient to care for this client.

True or False: An ileostomy is a surgical opening created to bring the large intestine to the surface of the abdomen.

ANS: FALSE. An ileostomy is a surgical opening created to bring the SMALL (not large) intestine to the surface of the abdomen.

True or False: NSAIDs are used as first-line treatment for pain relief with patients with ulcerative colitis.

ANS: FALSE. NSAIDs should be avoided in patients with ulcerative colitis because they can cause a "flare-up" in the condition. Tylenol should be used instead or a similar medication that isn't an NSAID.

True or False: Patients with an ileostomy are at greater risk for dehydration and an electrolyte imbalance.

ANS: True

True or False: A patient with Crohn's Disease can experience inflammation in the large intestine that affects mainly the mucosa (inner layer) of the bowel.

FALSE: A patient with Crohn's Disease can experience inflammation throughout the GI Tract (mainly in the terminal ileum and beginning of the colon) from the mouth to anus (not just the large intestine) and it affects the WHOLE bowel lining (not just the mucosa layer).

A patient with Crohn's Disease is taking corticosteroids. The patient is complaining of extreme thirst, polyuria, and blurred vision. What is your next nursing action? A. Check the patient's blood glucose B. Give the patient a food containing sugar (ex: orange juice) C. Administer oxygen via nasal cannula D. D. Assess bowel sounds

ANS: A - A side effect of corticosteroids is hyperglycemia. Extreme thirst, polyuria, and blurred vision are classic signs and symptoms of hyperglycemia. Therefore, the nurse should check the patient's blood glucose to confirm the hyperglycemia.

The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with human immune deficiency virus (HIV) from clients. Which practice is most effective? a. Consistent use of Standard Precautions b. Double-gloving before body fluid exposure c. Labeling charts and armbands HIV+ d. Wearing a mask within 3 feet of the client

ANS: A - According to The Joint Commission, the most effective preventative measure to avoid HIV exposure is consistent use of Standard Precautions. Double-gloving is not necessary. Labeling charts and armbands in this fashion is a violation of the Health Information Portability and Accountability Act (HIPAA). Wearing a mask within 3 feet of the client is part of Airborne Precautions and is not necessary with every client contact.

The nurse is presenting information to a community group on safer sex practices. The nurse should teach that which sexual practice is the riskiest? a. Anal intercourse b. Masturbation c. Oral sex d. Vaginal intercourse

ANS: A - Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear, creating a portal of entry for human immune deficiency virus.

The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will you collect this? A. Collect 2 different sputum specimens 12 hours apart B. Collect 3 different sputum specimens (one in the morning, afternoon, and at night) C. Collect 3 different sputum specimens on 3 different days D. Collect 2 different sputum specimens on 2 different days

ANS: C. This is how an AFB sputum culture is collected.

A client has just been diagnosed with human immune deficiency virus (HIV). The client is distraught and does not know what to do. What intervention by the nurse is best? a. Assess the client for support systems. b. Determine if a clergy member would help. c. Explain legal requirements to tell sex partners. d. Offer to tell the family for the client.

ANS: A - This client needs the assistance of support systems. The nurse should help the client identify them and what role they can play in supporting him or her. A clergy member may or may not be welcome. Legal requirements about disclosing HIV status vary by state. Telling the family for the client is enabling, and the client may not want the family to know.

A child with impetigo has a 24 month old sister at home. What will you be sure to include in your teaching to the parents about this condition? A. Keep the child's nails short B. Separate towels and other linens used by the child C. Wash hands with antibacterial soap regularly D. Prevent the child from scratching the lesions E. Vacuum carpets and furniture regularly F. Store stuffed animals and toys in plastic bags for 5 days

ANS: A, B, C and D. Impetigo is contagious and can be spread to other family members. Therefore, the child with the lesions should have their nails cut short to prevent scratching and spreading the infection. In addition, the child's towels, linens, toys etc. should be separated from other family members until the lesions are healed and wash hands regularly with antibacterial soap. Option E represents steps on how to prevent the spreading of lice, and option F represents the steps on how to prevent the spread of scabies.

A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when: A. She has 3 negative sputum cultures B. Her signs and symptoms improve C. She has completed the full medication regime D. Her chest x-ray is normal E. She has been on tuberculosis medications for about 3 weeks

ANS: A, B, and E. These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.

A client is being admitted with suspected tuberculosis (TB). What actions by the nurse are best? (Select all that apply.) a. Admit the client to a negative-airflow room. b. Maintain a distance of 3 feet from the client at all times. c. Order specialized masks/respirators for caregiving. d. Other than wearing gloves, no special actions are needed. e. Wash hands with chlorhexidine after providing care.

ANS: A, C - A client with suspected TB is admitted to Airborne Precautions, which includes a negative-airflow room and special N95 or PAPR masks to be worn when providing care. A 3-foot distance is required for Droplet Precautions. Chlorhexidine is used for clients with a high risk of infection.

You're providing diet teaching to a patient with ulcerative colitis about what types of foods to avoid during a "flare-up". Which foods below should the patient avoid? SELECT-ALL-THAT-APPLY: A. Ice cream B. White Rice C. Fresh apples and pears D. Popcorn E. Cooked carrots

ANS: A, C, and D. Patients experiencing a flare-up with ulcerative colitis should avoid dairy products (ice cream), food that are high in fiber (fresh apples or pears) (cooked fruits without the skin would be okay), and foods that are hard to digest (popcorn). Instead, patients should consume foods low in fiber (low residue) like cooked vegetables (carrots), bland foods (white rice) etc.

Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-Tube. Which finding during your assessment of the T-Tube requires immediate nursing intervention? A. The drainage from the T-Tube is yellowish/green in color. B. There is approximately 750 cc of drainage within the past 24 hours. C. The drainage bag and tubing is at the patient's waist. D. The patient is in the Semi-Fowler's position.

ANS: B - A T-Tube should not drain more than about 500 cc of drainage per day (within 24 hours). A T-Tube's drainage will go from bloody tinged (fresh post-op) to yellowish/green within 2-3 days. The drainage bag and tubing should be below the site of insertion (at or below the patient's waist so gravity can help drainage the bile), and the patient should be in Semi-Fowler's to Fowler's position to help with draining the bile.

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. Drinking at least 2 liters of water each day is suggested. b. I will decrease the amount of fatty foods in my diet. c. Drinking fluids with my meals will increase bloating. d. I will avoid concentrated sweets and simple carbohydrates.

ANS: B - After cholecystectomy, clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients. Good fluid intake is healthy for all people but is not related to the surgery. Drinking fluids between meals helps with dumping syndrome, which is not seen with this procedure. Restriction of sweets is not required.

Thinking back to the patient in question 8, select ALL the correct statements on how to educate this patient about decreasing their symptoms: A. "It is best to eat 3 large meals a day rather than small frequent meals." B. "After eating a meal lie down for 30 minutes." C. "Eat a diet high in protein, fiber, and low in carbs." D. "Be sure to drink at least 16 oz. of milk with meals."

ANS: B and C. The patient in question 8 is exhibiting signs and symptoms of dumping syndrome. The patient should eat small but frequent meals (NOT 3 large meals a day), lie down for 30 minutes after meals, avoid sugary drinks and foods, and follow a high protein, high fiber, and low-carb diet, and avoid consuming drinks while eating but afterwards.

A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you anticipate the physician will order to help diagnose cholecystitis? Select all that apply: A. Lower GI series B. Abdominal ultrasound C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan) D. Colonoscopy

ANS: B and C. These two tests can assess for cholecystitis. A lower GI series would not assess the gallbladder but the lower portions of the GI system like the rectum and large intestine. Option D is wrong because it would also assess the lower portions of the GI system.

Select all the most common infectious agents that cause impetigo: A. Sacroptes scabiei B. Staphylococcus aureus C. Klebsiella pneumoniae D. Haemophilus influenzae E. Streptococcus pyogenes F. Listeria monocytogenes

ANS: B and E. These are the two types of bacteria that tend to cause impetigo....staphylococcus aureus and streptococcus pyogenes.

Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient: A. Encourage the patient to consume clear liquids. B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

ANS: B, C, D, E, and F. The treatment for cholecystitis includes managing pain, managing nausea/vomiting (a NG tube with GI decompression (removal of stomach contents) to low intermittent suction may be ordered to help severe cases), keep patient NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube, and administer IV fluids to keep the patient hydrated.

A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that: A. The patient will need to immediately be placed in droplet precautions and started on a medication regime. B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided. C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection. D. The patient will need to repeat the skin test in 48-72 hours to confirm the results.

ANS: B. A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.

Helicobacter pylori can live in the stomach's acidic conditions because it secretes ___________ which neutralizes the acid. A. ammonia B. urease C. carbon dioxide D. bicarbonate

ANS: B. H. pylori can live in the acidic conditions of the stomach because it secretes urease which produces ammonia to neutralize the acid.

A child has impetigo and is being treated with oral antibiotics. The father asks when the child can be allowed to return to school. Your answer is: A. After 72 hours from the start of the treatment B. After 24 hours from the start of the treatment C. After 48 hours from the start of the treatment D. After 1 week from the start of the treatment

ANS: B. Impetigo is highly contagious. Therefore, if the child is taking oral antibiotics for the treatment of this condition they are no longer contagious after 24 hours from the start of treatment. If the child was using topical antibiotic ointment for the treatment of this condition, they would no longer be contagious after 48 hours from the start of treatment. Therefore, the child can return to school after being on oral antibiotics for 24 hours.

A 2 year old with impetigo is ordered topical antibiotic ointment. You're teaching the child's mother how to apply the ointment. Which action by the mother during application of the ointment requires you to re-educate the parent? A. The mother washes her hands before and after the application of the ointment. B. The mother applies a layer of ointment directly over the crust of the lesion. C. The mother uses warm water and antibacterial soap to cleanse the lesions prior to application of ointment. D. The mother uses a cotton swab to apply the ointment.

ANS: B. It is very important to REMOVE any crust from the lesion BEFORE applying antibiotic ointment to the lesion. This allows the ointment to come into contact with the skin, which is where the bacteria reside. To remove the crust, use warm water and antibacterial soap. All the other options are correct.

You're providing education to a group of parents about impetigo. Which statement is CORRECT about this disease? A. "It tends to affect the preadolescent and adolescent population." B. "Cases of impetigo most likely to occur during the summer when the weather is warm." C. "Most cases of impetigo are not contagious." D. "Impetigo is caused by a mite parasite."

ANS: B. This is the only correct statement about impetigo. All the other statements are FALSE.

A client with human immune deficiency virus is admitted to the hospital with fever, night sweats, and severe cough. Laboratory results include a CD4+ cell count of 180/mm3 and a negative tuberculosis (TB) skin test 4 days ago. What action should the nurse take first? a. Initiate Droplet Precautions for the client. b. Notify the provider about the CD4+ results. c. Place the client under Airborne Precautions. d. Use Standard Precautions to provide care.

ANS: C - Since this clients CD4+ cell count is low, he or she may have anergy, or the inability to mount an immune response to the TB test. The nurse should first place the client on Airborne Precautions to prevent the spread of TB if it is present. Next the nurse notifies the provider about the low CD4+ count and requests alterative testing for TB. Droplet Precautions are not used for TB. Standard Precautions are not adequate in this case.

A 55-year-old African-American client is having a visit with his health care provider. What test should the nurse discuss with the client as an option to screen for prostate cancer, even though screening is not routinely recommended? a. Complete blood count b. Culture and sensitivity c. Prostate-specific antigen d. Cystoscopy

ANS: C - The prostate-specific antigen test should be discussed as an option for prostate cancer screening. A complete blood count and culture and sensitivity laboratory test will be ordered if infection is suspected. A cystoscopy would be performed to assess the effect of a bladder neck obstruction.

A 4 year old is admitted to your unit with a severe case of impetigo. It is important the nurse follows _______________ while providing care to this patient: A. Droplet precautions B. Standard precautions only C. Contact precautions D. Airborne precaution

ANS: C. The nurse will follow contact precautions, which includes following standard precautions as well. Impetigo is a HIGHLY contagious skin infection. Therefore, the nurse should always where a gown and gloves when providing care to the patient to prevent transmission of the infection.

Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube) is TRUE? A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the gallbladder. B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to ensure patency. C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder. D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the tube is draining properly.

ANS: C. This is the only correct statement about a cholecystostomy. A cholecystostomy, also sometimes called a C-Tube, is placed when a patient can't immediately have the gallbladder removed (cholecystectomy) due to cholecystitis. It is placed through the abdominal wall and into the gallbladder. It will drain infected bile (NOT gallstones). The tubing and drainage bag should be at or below waist level so it drains properly.

A patient taking Isoniazid (INH) should be monitored for what deficiency? A. Vitamin C B. Calcium C. Vitamin B6 D. Potassium

ANS: C. This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication.

A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result? A. 5 mm induration B. 15 mm induration C. 9 mm induration D. 10 mm induration

ANS: D. 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.

As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is: A. Incorrect medication ordered B. Increase in tuberculosis cases nationwide C. Incorrect route of drug ordered D. Noncompliance due to duration of medication treatment needed

ANS: D. Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete.

A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to assess the patient's? A. hearing B. mental status C. vitamin B6 level D. vision

ANS: D. This medication can cause inflammation of the optic nerve. Therefore, it is very important the nurse asks the patient about their vision. If the patient has blurred vision or reports a change in colors, the MD must be notified immediately.

You note your patient's sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding? A. Ethambutol B. Streptomycin C. Isoniazid D. Rifampin

ANS: D. This medication will cause body fluids to turn orange.

A physician is explaining to a patient that the patient has a type of Crohn's Disease that is found in both the ileum and colon. As the nurse, you know this type of Crohn's Disease is called? A. Gastroduodenal Crohn's Disease B. Granulomatous Colitis C. Ileitis D. Ileocolitis

ANS: D. This patient has ileocolitis which affects parts of the colon and ileum. Gastroduodenal Crohns affects the stomach and duodenum which is the first part of the small intestine. Granulomatous colitis affects only the colon. Ileitis affects the ileum.

The gallbladder is found on the __________ side of the body and is located under the ____________. It stores __________. A. right; pancreas; bilirubin B. left; liver; bile C. right; thymus' bilirubin D. right; liver; bile

ANS: D. The gallbladder is found in the RIGHT side of the body and is located under the LIVER. It stores BILE.

A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond? a. Bile salts accumulate in the skin and cause the itching. b. Toxins released from an inflamed gallbladder lead to itching. c. Itching is caused by the release of calcium into the skin. d. Itching is caused by a hypersensitivity reaction.

ANS: A - In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.

A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the luteinizing hormonereleasing hormone (LH-RH) agonist leuprolide (Lupron) and the bisphosphonate pamidronate (Aredia). Which statement by the nurse is most appropriate? a. The treatment reduces testosterone and prevents bone fractures. b. The medications prevent erectile dysfunction and increase libido. c. There is less gynecomastia and osteoporosis with this drug regimen. d. These medications both inhibit tumor progression by blocking androgens.

ANS: A - Lupron, an LH-RH agonist, stimulates the pituitary gland to release luteinizing hormone (LH) to the point that the gland is depleted of LH and testosterone production is lessened. This may decrease the prostate cancer since it is hormone dependent. Lupron can cause osteoporosis, which results in the need for Aredia to prevent bone loss. Erectile dysfunction, decreased libido, and gynecomastia are side effects of the LH-RH medications. Antiandrogen drugs inhibit tumor progression by blocking androgens at the site of the prostate.

A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? (Select all that apply.) a. Contact the provider immediately. b. Lower the head of the bed. c. Decrease intravenous fluids. d. Ask the client to bear down. e. Administer prescribed opioids.

ANS: A, B - Clients who are experiencing biliary colic may present with tachycardia, pallor, diaphoresis, prostration, or other signs of shock. The nurse should stay with the client, lower the clients head, and contact the provider or Rapid Response Team for immediate assistance. Treatment for shock usually includes intravenous fluids; therefore, decreasing fluids would be an incorrect intervention. The clients tachycardia is a result of shock, not pain. Performing the vagal maneuver or administering opioids could knock out the clients compensation mechanism.

A student nurse is learning about human immune deficiency virus (HIV) infection. Which statements about HIV infection are correct? (Select all that apply.) a. CD4+ cells begin to create new HIV virus particles. b. Antibodies produced are incomplete and do not function well. c. Macrophages stop functioning properly. d. Opportunistic infections and cancer are leading causes of death. e. People with stage 1 HIV disease are not infectious to others.

ANS: A, B, C, D - In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produces are incomplete and do not function well. Macrophages also stop functioning properly. Opportunistic infections and cancer are the two leading causes of death in clients with HIV infection. People infected with HIV are infectious in all stages of the disease.

Which findings are AIDS-defining characteristics? (Select all that apply.) a. CD4+ cell count less than 200/mm3 or less than 14% b. Infection with Pneumocystis jiroveci c. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) d. Presence of HIV wasting syndrome e. Taking antiretroviral medications

ANS: A, B, D - A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as Pneumocystis jiroveci and HIV wasting syndrome. Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining characteristics.

A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI? A. Pantoprazole B. Famotidine C. Magnesium Hydroxide D. Metronidazole

ANS: A. Pantoprazole is the only PPI listed. Remember PPIs tend to end with the letters "prazole".

A nurse cares for a client who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The client states, When I wake up I am in pain. Which action should the nurse take? a. Administer intravenous morphine while the client sleeps. b. Encourage the client to use the PCA pump upon awakening. c. Contact the provider and request a different analgesic. d. Ask a family member to initiate the PCA pump for the client.

ANS: B - The nurse should encourage the client to use the PCA pump prior to napping and upon awakening. Administering additional intravenous morphine while the client sleeps places the client at risk for respiratory depression. The nurse should also evaluate dosages received compared with dosages requested and contact the provider if the dose or frequency is not adequate. Only the client should push the pain button on a PCA pump.

Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition: A. "The patient will not need treatment unless it progresses to an active tuberculosis infection." B. "The patient is not contagious and will have no signs and symptoms." C. "The patient will have a positive tuberculin skin test or IGRA test. D. "The patient will have an abnormal chest x-ray." E. "The patient's sputum will test positive for mycobacterium tuberculosis."

ANS: B and C. The patient WILL need medical treatment to prevent this case of LBTI from developing into an active TB infection later on. The patient will NOT have an abnormal chest x-ray or a positive sputum test. This is only in active TB.

Which statements below are CORRECT regarding the role of bile? Select all that apply: A. Bile is created and stored in the gallbladder. B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin.

ANS: B, C, and D. Option A is INCORRECT because bile is created in the LIVER (not gallbladder), but bile is stored in the gallbladder.

A patient has developed a duodenal ulcer. As the nurse, you know that which of the following plays a role in peptic ulcer formation. Select ALL that apply: A. Spicy foods B. Helicobacter pylori C. NSAIDs D. Milk E. Zollinger-Ellison Syndrome

ANS: B, C, and E. Helicobacter pylori and NSAIDS are the most common causes for peptic ulcer formation. Zollinger-Ellison Syndrome can cause peptic ulcers but it is not as common as H. pylori or NSAIDS. Foods and stress are no longer thought to cause ulcers. Certain foods and stress can irritate ulcers or prolong healing but there is no evidence to suggest they cause them.

You're educating a group of outpatients about signs and symptoms of ulcerative colitis. Which of the following are NOT typical signs and symptoms of ulcerative colitis? SELECT-ALL-THAT-APPLY: A. Rectal Bleeding B. Abdominal mass C. Bloody diarrhea D. Fistulae E. Extreme Hungry F. Anemia

ANS: B, D, and E. Rectal bleeding, bloody diarrhea, and anemia are present in ulcerative colitis. However, an abdominal mass or fistulae tends to be present with Crohn's Disease. Loss of appetite rather than extreme hungry presents in ulcerative colitis.

Tretinoin (Retin-A) is a commonly used topical agent for the treatment of acne. What do nursing considerations with this drug include? a. Sun exposure increases effectiveness. b. Cosmetics with lanolin and petrolatum are preferred in acne. c. Applying of the medication occurs at least 20 to 30 minutes after washing. d. Erythema and peeling are indications of toxicity and need to be reported.

ANS: C - The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. The avoidance of sun and the use of sunscreen agents must be emphasized because sun exposure can result in severe sunburn. Cosmetics with lanolin, petrolatum, vegetable oil, lauryl alcohol, butyl stearate, and oleic acid can increase comedone production. Erythema and peeling are common local manifestations.

Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply: A. Right lower quadrant pain with rebound tenderness B. Negative Murphy's Sign C. Epigastric pain that radiates to the right scapula D. Pain and fullness that increases after a greasy or spicy meal E. Fever F. Tachycardia G. Nausea

ANS: C, D, E, F, and G. Option A and B are not associated with cholecystitis, but a POSITIVE Murphy's Sign is.

You receive a doctor's order for a patient to take Aspirin EC by mouth daily. The patient has the following medication history: diabetes type 2, peripheral vascular disease, and a permanent ileostomy. What is your next nursing action? A. Administer the medication as ordered. B. Crush the medication and mix it in applesauce. C. Hold the medication and notify the doctor the patient has an ileostomy. D. Crush the medication and mix it in pudding.

ANS: C. Aspirin EC is an enteric-coated form of Aspirin. A patient with an ileostomy should not take enteric-coated or sustained-released medications. Enteric-coating medications don't dissolve until reaching a specific part of the small intestine, and sustained-released medications release slowly over a period of time. Remember a patient with an ileostomy does not have the ability to fully utilize the function of the small intestine and this medication will not be able to perform properly. The nurse should hold the medication and notify the doctor for further orders.

The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present? A. Ammonia B. Urea C. Hydrochloric acid D. Carbon dioxide

ANS: D. If h. pylori are present, the bacteria will release urease which produces ammonia and carbon dioxide. For the test, the patient will ingest a urea tablet and breath samples will be analyzed for carbon dioxide levels.

True or False: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the small intestine, specifically the terminal ileum.

ANS: FALSE: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the LARGE (not small) intestine. The inflammation tends to start in the rectum and spreads throughout the colon. The small intestine is usually not involved.

Which statement is correct regarding mycobacterium tuberculosis? A. This bacterium is an anaerobic type of bacteria. B. It is an alkali bacterium that stains bright red during an acid-fast smear test. C. It is known as being an aerobic type of bacteria. D. It's an acid-fact bacterium that stains bright green during an acid-fast smear test.

ANS: C. Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an acid-fast smear it will turn BRIGHT RED.

Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear? A. N95 mask B. Surgical mask C. No special PPE is needed D. Face mask with shield

ANS: C. Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport.

A client has been admitted to the hospital for a virulent infection and is started on antibiotics. The client has laboratory work pending to determine if the diagnosis is meningitis. After starting the antibiotics, what action by the nurse is best? a. Assess the client frequently for worsening of his or her condition. b. Delegate comfort measures to unlicensed assistive personnel. c. Ensure the client is placed on Contact Precautions. d. Restrict visitors to the immediate family only.

ANS: A - Meningitis is a disease caused by endotoxins, which are released with cell lysis. Antibiotics often work by lysing cell membranes, which would increase the amount of endotoxin present in the clients body. The nurse should carefully monitor this client for a worsening of his or her condition. Delegating comfort measures is appropriate for any client. Clients with meningitis are placed on Droplet Precautions, and initiating isolation should have been done on admission. The client does not need to have visitors restricted.

A nurse is talking with a client about a negative enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) antibodies. The test is negative and the client states Whew! I was really worried about that result. What action by the nurse is most important? a. Assess the clients sexual activity and patterns. b. Express happiness over the test result. c. Remind the client about safer sex practices. d. Tell the client to be retested in 3 months.

ANS: A - The ELISA test can be falsely negative if testing occurs after the client has become infected but prior to making antibodies to HIV. This period of time is known as the window period and can last up to 36 months. The nurse needs to assess the clients sexual behavior further to determine the proper response. The other actions are not the most important, but discussing safer sex practices is always appropriate.

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond? a. Ambulating in the hallway twice a day will help. b. I will apply a cold compress to the painful area on your back. c. Drinking a warm beverage can relieve this referred pain. d. You should cough and deep breathe every hour.

ANS: A - The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Cold compresses and drinking a warm beverage would not be helpful. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide.

A nurse assesses an older client who is scratching and rubbing white ridges on the skin between the fingers and on the wrists. Which action should the nurse take? a. Place the client in a single room. b. Administer an antihistamine. c. Assess the clients airway. d. Apply gloves to minimize friction.

ANS: A - The clients presentation is most likely to be scabies, a contagious mite infestation. The client needs to be admitted to a single room and treated for the infestation. Secondary interventions may include medication to decrease the itching. This is not an allergic manifestation; therefore, antihistamine and airway assessments are not indicated. Gloves may decrease skin breakdown but would not address the clients infectious disorder.

A nurse works on a unit that has admitted its first client with acquired immune deficiency syndrome. The nurse overhears other staff members talking about the AIDS guy and wondering how the client contracted the disease. What action by the nurse is best? a. Confront the staff members about unethical behavior. b. Ignore the behavior; they will stop on their own soon. c. Report the behavior to the units nursing management. d. Tell the client that other staff members are talking about him or her.

ANS: A - The professional nurse should be able to confront unethical behavior assertively. The staff should not be talking about clients unless they have a need to do so for client care. Ignoring the behavior may be more comfortable, but the nurse is abdicating responsibility. The behavior may need to be reported, but not as a first step. Telling the client that others are talking about him or her does not accomplish anything.

You're precepting a nursing student who is helping you provide T-Tube drain care. You explain to the nursing student that the t-shaped part of the drain is located in what part of the biliary tract? A. Cystic duct B. Common hepatic duct C. Common bile duct D. Pancreatic duct

ANS: C. The "T-shaped" part of the drain is located in the common bile duct and helps deliver bile to the duodenum (small intestine).

A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the clients gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the clients job risks.

ANS: A - This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating.

The nurse is caring for a client diagnosed with human immune deficiency virus. The clients CD4+ cell count is 399/mm3. What action by the nurse is best? a. Counsel the client on safer sex practices/abstinence. b. Encourage the client to abstain from alcohol. c. Facilitate genetic testing for CD4+ CCR5/CXCR4 co-receptors. d. Help the client plan high-protein/iron meals.

ANS: A - This client is in the Centers for Disease Control and Prevention stage 2 case definition group. He or she remains highly infectious and should be counseled on either safer sex practices or abstinence. Abstaining from alcohol is healthy but not required. Genetic testing is not commonly done, but an alteration on the CCR5/CXCR4 co-receptors is seen in long-term nonprogressors. High-protein/iron meals are important for people who are immunosuppressed, but helping to plan them does not take priority over stopping the spread of the disease.

An HIV-negative client who has an HIV-positive partner asks the nurse about receiving Truvada (emtricitabine and tenofovir). What information is most important to teach the client about this drug? a. Truvada does not reduce the need for safe sex practices. b. This drug has been taken off the market due to increases in cancer. c. Truvada reduces the number of HIV tests you will need. d. This drug is only used for postexposure prophylaxis.

ANS: A - Truvada is a new drug used for pre-exposure prophylaxis and appears to reduce transmission of human immune deficiency virus (HIV) from known HIV-positive people to HIV-negative people. The drug does not reduce the need for practicing safe sex. Since the drug can lead to drug resistance if used, clients will still need HIV testing every 3 months. This drug has not been taken off the market and is not used for postexposure prophylaxis.

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

ANS: A, D, E, F - Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer. Smoking and obesity are not known risk factors.

A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this clients condition? (Select all that apply.) a. Body mass index of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

ANS: A, D, F - Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasis. A diet low in saturated fats and moderate alcohol intake may decrease the risk. Although metabolic syndrome is a precursor to diabetes, it is not a risk factor for cholelithiasis. The client should be informed of the connection.

Select all the medications a physician may order to treat a H. Pylori infection that is causing a peptic ulcer? A. Proton-Pump Inhibitors B. Antacids C. Anticholinergics D. 5-Aminosalicylates E. Antibiotics F. H2 Blockers G. Bismuth Subsalicylates

ANS: A, E, F, and G. All these medications can be used to treat an h. pylori infection that is causing a peptic ulcer.

A patient is newly diagnosed with mild ulcerative colitis. What type of anti-inflammatory medication is typically prescribed as first-line treatment for this condition? A. 5-Aminosalicylates (Sulfasalazine) B. Immunomodulators (Adalimumab) C. Corticosteroids (Prednisone) D. Immunosupressors (Azathioprine)

ANS: A. 5-Aminosalicylates (Sulfasalazine) are usually prescribed for mild to moderate cases of ulcerative colitis as first-line treatment. If Aminosalicylates are not working (or the patient is allergic to sulfa) corticosteriods are prescribed. Corticosteriods may be used in combination with immunosupressors. Immunosupressors and immunomodulators are used in severe cases of ulcerative colitis when other medications have not worked.

A patient with ulcerative colitis is scheduled for ileoanal anastomosis (J-Pouch) surgery. You know that this procedure: A. Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus. B. Removes the colon and rectum and creates a permanent ileostomy. C. Removes the colon and creates a temporary colostomy. D. Removes the rectum which allows a pouch to be created from the colon. This will allow stool to pass from the colon to the anus.

ANS: A. A J-pouch surgery (ileoanal anastomosis) removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus.

A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you that the patient has a positive Murphy's Sign. You know that this means: A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line. B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line. C. The patient verbalizes pain when the lower right quadrant is palpated. D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase in pain intensity when the pressure is released.

ANS: A. Murphy's Sign can occur with cholecystitis. This occurs when the patient is placed in the supine position and the examiner palpates under the ribs on the right upper side of the abdomen. The examiner will have the patient breathe out and then take a deep breath in. The examiner will simultaneously (while the patient is breathing in) palpate on this area under the ribs at the midclavicular line (hence the location of the gallbladder). It is a POSITIVE Murphy's Sign when the patient stops breathing in during palpation due to pain.

A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in _________ so the results can be interpreted? A. 24-48 hours B. 12-24 hours C. 48-72 hours D. 24-72 hours

ANS: C. The patient should report back in 48-72 hours. If they fail to, the test must be repeated.

A patient is receiving treatment for Crohn's Disease. Which food found on the patient's food tray should the patient avoid? A. Fresh Salad B. White rice C. Baked chicken D. Cooked skinless apples

ANS: A. Patients who are experiencing flare-ups of Crohn's Disease should avoid high fiber foods, foods that are hard to digest, spicy foods, dairy products etc. Therefore, the patient should avoid a fresh salad. This contain vegetables which are high in fiber and hard to digest. The gut needs to rest. It is best for the patient to consume low fiber and high protein foods. White rice and fruits/vegetables that are cooked/skinless are low in fiber. Baked chicken is a good source of protein for the patient.

A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification? A. PPD (Mantoux test) B. Chest X-ray C. QuantiFERON-TB Gold (QFT) D. Sputum culture

ANS: A. Patients who have received the BCG vaccine will have a false positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the person has already been exposed to the bacteria via vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test.

Which type of colostomy can allow a patient to have bowel continence? A. Descending or Sigmoid Colostomy B. Ascending or Transverse Colostomy C. Transverse or Descending Colostomy D. Ascending or Descending Colostomy

ANS: A. Patients with a colostomy in locations most distal in the GI track have the highest chance of bowel continence (hence, learn to control their bowel movements).

Thinking back to the patient in Question 1, what type of stool would you expect the stoma to be excreting? A. Liquid stool B. Lose to partly formed stool C. Similar to normal stool D. Semi-solid stool

ANS: A. Stool from an ascending colostomy will be liquid. Stool from a Transverse Colostomy: lose to partly formed stool, Descending/Sigmoid: similar to normal solid consistency. An ileostomy will always excrete liquid stool.

A patient, who has a colostomy, asks what type of foods they should avoid to decrease odorous gas. You would tell the patient to avoid: A. Onions, alcoholic beverages, eggs, and cabbage B. Beef, fried foods, lettuce, and rice C. Apple, pears, nuts, and wheat D. Potatoes, peas, carrots, and chicken

ANS: A. The patient should avoid foods like: onions, alcoholic beverages, eggs, and cabbage etc. to decrease odorous gas.

A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient? A. Baked chicken with steamed carrots and rice B. Broccoli and cheese casserole with gravy and mashed potatoes C. Cheeseburger with fries D. Fried chicken with a baked potato

ANS: A. The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods. Option B is wrong because this contains dairy/animal fat like the cheese and gravy, and broccoli is known to cause gas. Option C and D are greasy food options.

A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer? A. Duodenal B. Gastric C. Esophageal D. Refractory

ANS: A. The patient signs and symptoms describe a duodenal ulcer. Gastric ulcer tend to not cause pain in the middle of the night and epigastric pain in worst with food.

A patient has a double-barrel colostomy of the transverse colon. You note on assessment two stomas, a proximal and distal stoma. What type of stool do you expect to drain from the proximal and distal stomas? A. Proximal: lose to partly formed stool; Distal: mucous B. Proximal: liquid stool; Distal: mucous C. Proximal: mucous; Distal: lose to partly formed stool D. Proximal & Distal: lose to partly formed stool

ANS: A. The proximal will drain stool while the distal will NOT. The distal will drain mucous. Since it is a double-barrel colostomy of the transverse colon, you can expect the stool to be lose to partly formed.

Your patient with Crohn's Disease is admitted with an opening that has formed between the bowel and bladder. As the nurse, you know this is what type of complication associated with this disease? A. Enterovesical Fistula B. Rectovaginal Stricture C. Enteroenteric Fistula D. Perianal Fissure

ANS: A. These scenario describes a fistula which is an abnormal passage that forms deep in the wall of the intestine to form an opening between intestine to intestine, intestine to organ, or intestine to skin's surface. This specific patient is experiencing an enterovesical fistula which is an abnormal passage between the bowel and bladder.

Which statement is INCORRECT about Histamine-receptor blockers? A. "H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric acid." B. "Ranitidine and Famotidine are two types of histamine-receptor blocker medications." C. "Antacids and H2 blockers should not be given together." D. All the statements are CORRECT.

ANS: A. This statement is false. H2 blockers block histamine which causes the PARTIETAL (not chief) cells to decrease the secretion of hydrochloric acid.

A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to advance the patient's diet to solid foods. The patient's lunch tray arrives. Which food should the patient avoid eating? A. Orange B. Milk C. White rice D. Banana

ANS: A. When an ulcer is actively causing signs and symptoms, the patient should avoid acidic foods like tomatoes or citric fruits/juices, chocolate, alcohol, fried foods and caffeine. These foods can irritate the ulcer site. Instead the patient should consume alkalotic or bland foods like milk, white rice or bananas.

A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing? A. Gastroparesis B. Fascia dehiscence C. Dumping Syndrome D. Somogyi effect

ANS: C. After a gastric resection the stomach is not able to regulate the movement of food due to the removal of sections of the stomach (usually the pyloric valve and duodenum). Therefore, the food enters into the small intestine too fast before the stomach can finish digesting it. The partially digested food will act hypertonically and cause water from the blood to enter jejunum. This will cause a fluid shift leading to bowel swelling, diarrhea, and nausea etc.

A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in ___________________ precautions and will always wear _____________________ when providing patient care? A. droplet, respirator B. airborne, respirator C. contact and airborne, surgical mask D. droplet, surgical mask

ANS: B. A patient with ACTIVE TB is contagious. The bacterium, mycobacterium tuberculosis which causes TB, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In addition, a special mask must be worn called a respirator (also referred to as an N95 mask.....a surgical mask does NOT work with this condition).

A patient is 2 days post-opt from an ileostomy placement. Which finding requires immediate nursing action? A. The stoma is excreting liquid stool. B. The patient's potassium level is 2.0 C. The stoma is bright red and moist. D. The patient reports mucoid drainage from the anus.

ANS: B. A patient with an ileostomy is at risk for electrolyte imbalances. The nurse should monitor the patient (especially after ileostomy surgery) for these imbalances. A normal potassium is 3.5 to 5.1. Therefore, a level of 2.0 requires immediate nursing action. The nurse should contact the physician for further orders. All the other options are normal findings found with an ileostomy.

You're providing education to a patient with severe ulcerative colitis about Adalimumab. Which statement by the patient is CORRECT? A. "This medication is used as first-line treatment for ulcerative colitis." B. "My physician will order a TB skin test before I start taking this medication." C. "This medication works by increasing the tumor necrosis factor protein which helps decrease inflammation." D. "This medication is a corticosteroid. Therefore, I need to monitor my blood glucose levels regularly."

ANS: B. Before starting Adalimumab, the physican may order the patient to be checked for TB. Adalimumab is a immunomodulator (NOT corticosteriod) that suppresses the immune system by BLOCKING (not increasing) the tumor necrosis factor protein which helps decrease inflammation. Therefore, the patient is at risk for developing infections such as TB (tuberculosis). In addition, if the patient has or had TB, this medication could exacerbate the disease. This medication is used for only severe cases (NOT first-line treatment).

You're providing diet teaching to a patient with an ileostomy. Which foods should the patient consume in very small amounts or completely avoid? A. Peanut butter, bananas, rice B. Corn, popcorn, nut and seeds C. Grape juice, bread, and pasta D. Vinegar, soft drinks, and cured meats

ANS: B. The foods in option B are difficult to digest and could block the stoma. The patient should either consume these foods in VERY small amounts or avoid them all together.

A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing? A. Obstruction of pylorus B. Upper gastrointestinal bleeding C. Perforation D. Peritonitis

ANS: B. This patient is most likely experiencing an upper GI bleeding. Signs and symptoms of a possible GI bleeding with a peptic ulcer include: vomiting coffee ground emesis along with bloating, and abdominal mass.

You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication? A. "I will take this medication at the same time I take Ranitidine." B. "I will always take this medication on an empty stomach." C. "It is best to take this medication with antacids." D. "I will take this medication once a week."

ANS: B. This statement is the only correct statement about how to take Carafate. It should always be taken on an empty stomach without food so it can coat the site of ulceration. This medication should NOT be taken with H2 blockers (Ranitidine) or antacids because these drugs affect the absorption of Carafate.

A patient is receiving treatment for ulcerative colitis by taking Azathioprine. Which physician's order would the nurse question if received? A. Ambulate the patient twice day B. Low-fiber and high-protein diet C. Administer varicella vaccine intramuscularly D. Administer calcium carbonate by mouth daily

ANS: C. Azathioprine is an immunosuppression medication that decreases the immune system. Therefore, the patient should never receive a live vaccine, such as Varicella. Other vaccinations that are live include: MMR, Shingles, Nasal influenza mist etc.

Your patient is diagnosed with peptic ulcer disease due to h.pylori. This bacterium has a unique shape which allows it to penetrate the stomach mucosa. You know this bacterium is: A. Rod shaped B. Spherical shaped C. Spiral shaped D. Filamentous shaped

ANS: C. Helicobacter pylori (h. pylori) are spiral shaped which all them to penetrate down into the stomach lining to reside.

A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician? A. Patient reports a change in vision. B. Patient reports a metallic taste in the mouth. C. The patient has ringing in their ears. D. The patient has a persistent dry cough.

ANS: C. This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is alarming if the patient reports ringing in their ears, which could represent ototoxicity.

You're educating a group of patients at an outpatient clinic about peptic ulcer formation. Which statement is correct about how peptic ulcers form? A. "An increase in gastric acid is the sole cause of peptic ulcer formation." B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be released which signals to the parietal cells to release more pepsinogen which erodes the stomach lining further." D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form."

ANS: B. Ulcers form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further...hence why option C is wrong. Option A is wrong because although peptic ulcers can from with increase gastric acid, this is not the sole cause of peptic ulcer formation. A breakdown in the defense mechanisms along with gastric acid leads to peptic ulcer formation. For example, h. pylori and regular NSAID usage leads to the breakdown of the stomach lining which allows stomach acid to penetrate and erode the lining. Option D is wrong because prostaglandins actually protect the stomach lining by causing the stomach cells to release mucous rich in bicarb, controls acid amounts via the parietal cells, and regulates perfusion to the stomach.

You're providing a community in-service about gastrointestinal disorders. During your teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for cholelithiasis that you will include in your teaching to the participants? Select all that apply: A. Being male B. Underweight C. Being female D. Older age E. Native American F. Caucasian G. Pregnant H. Family History I. Obesity

ANS: C, D, E, G, H and I. Cholelithiasis is the formation of gallstones. Risk factors include: being female, older age (over 40), Native American or Mexican American descent, pregnant, obesity, and family history.

You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient's risk for developing tuberculosis: A. Diabetes B. Liver failure C. Long-term care resident D. Inmate E. IV drug user F. HIV G. U.S. resident

ANS: C, D, E, and F. Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic "TB Risk". It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5....all these are risk factors.

The physician orders a patient's T-Tube to be clamped 1 hour before and 1 hour after meals. You clamp the T-Tube as prescribed. While the tube is clamped which finding requires you to notify the physician? A. The T-Tube is not draining. B. The T-Tube tubing is below the patient's waist. C. The patient reports nausea and abdominal pain. D. The patient's stool is brown and formed.

ANS: C. A nurse should ONLY clamp a T-Tube with a physician's order. Most physicians will prescribe to clamp the T-tube 1 hour before and 1 hour after meals. WHY? So, bile will flow down into the small intestine (instead out of the body) during times when food is in the small intestine to help with the digestion of fats. This is to help the small intestine adjust to the flow of bile in preparation for the removal of the t-tube (remember normally it received bile when the gallbladder contracted but now it will flow from the liver to the small intestine continuously). Option C is an abnormal finding. The patient should not report nausea or abdominal pain when the tube is blocked. This could indicate a serious problem. Option A is correct because the T-tube should not be draining because it's clamped. Option B is correct because the T-tube tubing should be below or at the patient's waist level. Option D is correct because this shows the body is digesting fats and bilirubin is exiting the body through the stool (remember bilirubin is found in the bile and gives stool its brown color...it would be light colored if the bilirubin was not present). You would NOT want to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn't being delivered to help digest the fats.

A patient, who had a colostomy placed yesterday, calls on the call light to say their surgical dressing "fell off". You will re-apply what type of dressing over the stoma? A. Wet to dressing B. No dressing is needed. You will keep it open to air. C. Petroleum gauze dressing D. Telfa gauze

ANS: C. A petroleum gauze dressing will be kept in place (or a sterile dry dressing) until a pouch system is in place.

A physician has prescribed a patient with a severe case of Crohn's Disease to take a drug that works by suppressing the immune system. This medication achieves this by blocking a protein that plays a role the inflammatory process. Which drug does this describe? A. Azathioprine B. Sulfasalazine C. Infliximab D. Prednisone

ANS: C. Infliximab (Remicade) is a TNF-blocker (biologic drug) which blocks tumor necrosis factor which plays a role in the inflammatory response system. Azathioprine is an immunosupressor which suppresses the immune system but does NOT block TNF. Sulfasalazine is an 5-Aminosalicylate which is an anti-inflammatory medication. Prednisone is a corticosteroid which decreases inflammation.

Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you anticipated the doctor will order? A. Calcium level B. Vitamin B6 level C. Uric acid level D. Amylase level

ANS: C. This medication can increase uric acid levels which can lead to gout. The patient's signs and symptoms are classic findings in a gout attack.

You're providing teaching to a patient with an ileostomy on how to change their pouch drainage system. Which statement is INCORRECT about how to change a pouching system for an ostomy? A. Empty the pouch when it is 1/3 to 1/2 full. B. Change the pouching system every 3-5 days. C. When measuring the stoma for skin barrier placement, be sure the opening of the skin barrier is a 2/3 inch larger than the stoma. D. Keep the skin around the stoma clean and dry at all times.

ANS: C. This statement is INCORRECT. When measuring the stoma for skin barrier placement, be sure the opening of the skin barrier is a 1/8 inch larger than the stoma.....not 2/3 inch.

The nurse is teaching an adolescent about acne care. What statement by the adolescent indicates a need for further teaching? a. I will cleanse my face twice a day. b. I will frequently shampoo my hair. c. I will brush my hair away from my forehead. d. I will use my antibacterial soap to cleanse my face.

ANS: D - Antibacterial soaps are ineffective and may be drying when used in combination with topical acne medications. Further teaching is needed if the adolescent indicates using antibacterial soap. Gentle cleansing with a mild cleanser once or twice daily is usually sufficient. For some adolescents, hygiene of the hair and scalp appears to be related to the clinical activity of acne. Acne on the forehead may improve with brushing the hair away from the forehead and more frequent shampooing.

After teaching a client who has a history of cholelithiasis, the nurse assesses the clients understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

ANS: D - Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

Describe, in order, how food travels from the stomach to the rectum: A. It exits the stomach into: the cecum to the jejunum to the ileum, then into the duodenum, descending colon, transverse colon, ascending colon, sigmoid colon, and rectum. B. It exits the stomach into: the duodenum to the ileum to the jejunum, then into the cecum, ascending colon, sigmoid colon, descending colon, transverse colon, and rectum. C. It exits the stomach into: the ileum to the jejunum to the duodenum, then into the cecum, sigmoid colon, transverse colon, descending colon, ascending colon, and rectum. D. It exits the stomach into: the duodenum to the jejunum to the ileum, then into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

ANS: D.

You're providing teaching to a patient who has been newly diagnosed with Crohn's Disease. Which statement by the patient's spouse requires re-education? A. "Crohn's Disease can be scattered throughout the GI tract in patches with some areas appearing healthy while others are diseased." B. "There is no cure for Crohn's Disease." C. "Strictures are a common complication with Crohn's Disease." D. "Crohn's Disease can cause the haustra of the large intestine to lose its form."

ANS: D. All the statements are true except option D. ULCERATIVE COLITIS can cause the haustra of the large intestine to lose its form. This is not common with Crohn's Disease.

In the stomach lining, the parietal cells release _________ and the chief cells release __________ which both play a role in peptic ulcer disease. A. pepsin, hydrochloric acid B. pepsinogen, pepsin C. pepsinogen, gastric acid D. hydrochloric acid, and pepsinogen

ANS: D. In the stomach lining, the parietal cells release HYDROCHLORIC ACID and the chief cells release PEPSINOGEN which both plays a role in peptic ulcer disease. Pepsinogen then mixes with the hydrochloric acid and turns into pepsin.

A patient is admitted with ulcerative colitis. In the physician's notes, it is stated that the patient's barium enema results showed the patient has colitis that starts in the rectum and extends into the sigmoid and descending colon. As the nurse, you know that this is what type of ulcerative colitis? A. Right-sided colitis B. Proctosigmoiditis C. Ulcerative procotitis D. Left-sided colitis

ANS: D. Left-sided colitis (distal colitis) starts in the rectum and goes to the sigmoid and descending colon. Ulcerative proctitis affects the rectum only. Proctosigmoiditis affects the rectum and sigmoid colon. Right-sided colitis is NOT a type of ulcerative colitis.

A patient diagnosed with pancolitis is experiencing extreme abdominal distension, pain 10 on 1-10 scale in the abdomen, temperature of 103.6 'F, HR 120, and profuse diarrhea. What complication due you suspect the pain is experiencing? A. Fistulae B. Stricture C. Bowel obstruction D. Toxic megacolon

ANS: D. Pancolitis affects all the colon and is a very severe form of ulcerative colon. The patient is at risk for toxic megacolon. In toxic megacolon, the large intestine dilates due to the overwhelming inflammation. The large intestine is unable to function properly and becomes paralyzed. Typical signs and symptoms of toxic megacolon include: abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia.

A patient experiencing a flare-up with Crohn's Disease is ordered complete bowel rest by the physician. You are administering TPN (total parental nutrition) per physician order. When developing the patient's nursing plan of care, which nursing diagnosis is MOST important to include in the care plan? A. Risk for allergy response B. Risk for unstable blood glucose level C. Risk for imbalance nutrition: more than body requirements D. Risk for imbalanced nutrition: less than body requirements

ANS: D. Patients with Crohn's Disease are at risk for undernourishment due to how the disease process effects the body (small intestine is inflamed which is the area of the gut that absorbs most of the nutrients from food). With severe cases of Crohn's Disease, the physician may order complete bowel rest (where the patient will be nothing by mouth (NPO) and nothing will enter the GI system....so the patient is at even more risk for imbalance nutrition. Physicians may prescribe an IV solution (total parental nutrition) which will be given through a central line that contains nutrients (so it enters the bloodstream...bypassing the gut). However, there is still a risk for imbalanced nutrition (less than body requirements) for the patient. The nurse must monitor the patient's nutrition status very closely such as daily weights, hydration status, electrolytes, skin, etc.

On assessment of a patient with a colostomy, you note the stoma is located on the right area of the abdomen. Due to its location, this is known as what type of colostomy? A. Descending Colostomy B. Transverse C. Ileostomy D. Ascending Colostomy

ANS: D. This is known as an ascending colostomy.

True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs.

ANS: FALSE....tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis that affects the lungs AND other systems of the body like the joints, kidneys, brain, spine, liver etc.