GI/GU

The nurse is discharging a postpartum client and newborn baby. During the pregnancy and delivery, the client developed hemorrhoids. Which of the following statements by the client indicates the need for further teaching?

"I will sit on a heating pad to decrease pain"

After receiving a diagnosis of herpes simplex virus (HSV), the client tells the nurse "I can't possibly tell my partner I have Herpes." Which of the following responses by the nurse is the most appropriate?

"This conversation is a tough one to have. What concerns you the most about telling your partner?"

A client in a long-term care facility is having elimination problems and suffers from incontinence. Which nursing intervention would most likely help to prevent skin breakdown in this client?

Applying emollient to the skin after the client's bath

A client is being dismissed from the hospital after recovering from abdominal surgery. The client is an older adult who lives alone and has few measures of support. The nurse contacts a social worker for support and resources. Which of the following describes how the social worker advocates for a client being discharged from the hospital? Select all that apply.

Arranging for Meals on Wheels for the client Contacting a pain clinic to follow up with the client if pain is an issue Communicating with a senior day program for the client to attend

A client has been brought to the pre-op area to have his IV started before undergoing hernia surgery. The client is extremely anxious and starts crying when the nurse walks into the room. Which intervention would be most appropriate in this situation to help with the client's anxiety?

Ask the client if there is anyone that came with him that he wants nearby

A nurse is inserting a nasogastric tube into a client to remove excess secretions and decompress the stomach. Which action of the nurse would best help to ease the clients discomfort with the insertion?

Ask the client to swallow with insertion

A nurse on the medical-surgical unit has been assigned to a client who is legally blind and recovering from abdominal surgery. Which interventions would the nurse implement when caring for this client in order to best uphold the client's safety while in the hospital? Select all that apply.

Ask the client what he is able to see Remind the client to call for help whenever getting out of bed Place an identifier sign above the client's bed notifying staff of the clients vision loss Keep the client's belongings in the same place and do not move them unnecessarily

While a nurse is educating students at a middle school health fair, the nurse is approached by a student who shares there are some bumps that look like the pictures of herpes simplex virus. Which of the following responses by the nurse is most appropriate?

Asking the student if she would be comfortable speaking in a more private place about her concerns

A nurse is caring for a client with a nasogastric tube and is preparing to administer an enteral feeding. The nurse wants to check that the tube is in the proper place. Which of the following actions is appropriate for checking placement?

Aspirate gastric contents and check the pH

The client is scheduled for a cholangiogram. Which of the following pre-procedure nursing tasks can the nurse expect to perform? Select all that apply.

Assess for client allergy to seafood or iodine Assess the client's bilirubin level prior to the procedure Ensure the client is NPO after midnight the night before the test

A nurse is changing the colostomy bag for a client with a new colostomy. Which elements of skin care should the nurse provide during this process? Select all that apply.

Avoiding ripping the pouch off of the client's skin Cleaning around the stoma with warm water and a washcloth Drying the skin thoroughly before reapplying the pouch

A nurse has just inserted a nasogastric tube for continuous suction. The first hour of suctioning, the nurse notes that the client's output is clear and tinged with blood. Which of the following interventions should the nurse perform?

Document the drainage and continue to monitor

A nurse is assessing a client who is being seen for malnutrition associated with a history of anorexia. Which of the following characteristics of the nervous system would the nurse expect to see in this client?

Peripheral neuropathy

The nurse is caring for a client with an ileostomy. During assessment of the client, the nurse notes that the pouch opening is 1/2 inch larger than the stoma site. Which of the following poses a risk for this client?

Peristomal skin breakdown

When considering treatment options for endometriosis, on which of the following items does treatment depend? Select all that apply.

Presenting symptoms Desire for childbearing Stage of the disease

The nurse is caring for a client who is newly diagnosed with prostate cancer. The client asks the nurse which treatment will be recommended. Which of the following treatments are targeted therapy usually used for this type of cancer? Select all that apply.

Radiation Surgery

A 63-year-old patient with hepatitis C needs assistance with making food choices. The nurse should counsel the patient to restrict which type of food?

Red meat

A nurse is caring for a client who has been diagnosed with cirrhosis. The client has been prescribed corticosteroids. Which information describes how this drug helps the cirrhotic liver? Select all that apply.

Reduction in inflammation Suppression of immune system liver destruction

A client is post-operative day one from a Roux-en-y procedure. The nurse receives the following orders and knows that which of the following should be clarified?

Regular diet

The nurse is caring for a client who is recovering from an inguinal hernia repair. Which of the following nursing interventions are appropriate? Select all that apply.

Relieve urinary retention Teach turning and deep breathing Provide scrotal support

An 80-year-old client is confused because he has developed a urinary tract infection. The client cowers and screams when the nurse enters the room. Which action of the nurse best demonstrates that she is attempting to minimize the client's fear in this situation?

Remain calm and continue to try to reorient the client

A nurse is assessing a client and asking about symptoms. The nurse knows that which of the following symptoms would lead the nurse to suspect disseminated gonococcal infection (DGI)?

Swollen joints Purulent vaginal discharge Fever

A 92-year-old client with a history of smoking and COPD is found to have developed prostate cancer. The cancer is localized. The nurse knows that prostate cancer in this type of client will most likely be treated in which of the following ways?

Symptom management

The nurse is educating a client with renal failure on lifestyle changes necessary to manage this condition. Which of the following is appropriate to include? Select all that apply.

Take a phosphate binder before meals Attempt to consume extra calories Arrange dialysis appointments and transportation in advance

A client who has undergone a laparoscopic cholecystectomy is getting ready to be dismissed from the hospital. Which information would the nurse provide as part of post-op instructions for this client? Select all that apply.

Take short walks everyday Do not lift anything more than 10 pounds Avoid swimming or being submerged in the bathtub after going home

While educating a client at a 30-week prenatal appointment, which of the following statements by the client regarding a primary syphilis infection represents a need for further education?

"Congenital syphilis has been eradicated in the United States, so I do not need to worry about getting tested"

A nurse is caring for a client about to undergo a unilateral orchiectomy. Which statement by the client indicates the need for further teaching?

"I will not be able to produce sperm anymore"

The client's mother asks the nurse for more information on the HPV 9-valent vaccine. The nurse is providing information and knows that which of the following statements is true? Select all that apply.

"HPV 9-valent vaccine will protect your child from the 9 most common strains of HPV" "HPV 9-valent vaccine is delivered across 3 doses"

A nurse is caring for a client with herpes simplex virus. Which of the following statements by the client regarding herpes simplex virus represents an understanding of the plan of care? Select all that apply.

"I am most contagious when I have open sores" "My healthcare provider told me I am only required to take acyclovir if I experience an outbreak"

The nurse is educating a client on managing gout. Which of the following statements by the client indicates more education is necessary? Select all that apply.

"I can't wait to get home. My wife and I have our weekly wine and cheese night with friends" "When I have a flare-up, I try to increase my activity to get the blood flowing better and hopefully have it resolve faster" "I try to limit my intake of water. I feel like that helps my symptoms"

A client with stress incontinence is undergoing treatment through rehabilitation of the pelvic floor muscles. Which statement by the client suggests that the treatment is effective?

"I have not leaked urine the last several times I have coughed"

A nurse is providing education to a client diagnosed with gonorrhea. Which of the following statements by the client demonstrates a need for further education by the nurse?

"I will notify my partners from the last 6 months to come in, as I may have given them this infection"

A nurse is caring for a client who had a gastrectomy due to stomach cancer. The nurse is teaching the client how to avoid dumping syndrome. Which of the following statements by the client demonstrates that more education is necessary?

"I shouldn't ever lay down after eating."

A client tells the nurse, "I am afraid to tell my partner I have HPV because I might be broken up with." Which of the following is the best response from the nurse?

"I understand the conversation might be difficult. Would you like to practice?"

The nurse is caring for a client diagnosed with Crohn's disease. Which statement indicates more teaching is needed?

"I will deal with chronic constipation"

A nurse is providing discharge teaching to a client who just had a cholecystectomy. Which of the following statements by the client indicate that further education is required?

"I will keep my T-tube clamped at all times."

A nurse is providing dietary discharge teaching to a client who has been diagnosed with cirrhosis who has had an elevated ammonia level. Which of the following statements by the client demonstrate that more education is required?

"I'll make sure to eat a high-protein diet."

A nurse is performing pre-operative teaching with a client set to undergo the sleeve gastrectomy procedure. Which of the following statements by the client suggests they need further teaching?

"If I do not lose the weight as planned, I am able to have the surgery reversed"

While at a routine follow-up appointment for a lap band procedure from 2 years ago, the client asks the nurse for more information on plastic surgery. The nurse knows that which of the following therapeutic responses is appropriate?

"Many clients find plastic surgery after weight loss surgery to improve quality of life

A pregnant client is talking to the nurse about a current gonorrhea infection. Which of the following statements by the client demonstrates an understanding of the prevention of transmission to the neonate?

"My baby will receive a dose of IV antibiotics after birth to treat the infection"

A nurse is providing discharge education to a client with human papilloma virus (HPV). The nurse know that the client has a good understanding when which of the following statements is made?

"My healthcare provider might want me to get the gardasil shot even though I already have HPV

A nurse is caring for a client with herpes simplex virus. Which of the follow statements by the client regarding herpes simplex virus represents a need for further teaching by the nurse?

"Once more sores heal up, I don't need to use a condom anymore"

A nurse working with clients in a reproductive health clinic. The nurse knows that which of the following statements by the client demonstrates an understanding of a syphilis Infection?

"Syphilis is reportable to the health department, so they can help me notify my sexual partners"

The nurse is caring for a client who was recently diagnosed with testicular cancer. The client appears anxious and asks the nurse questions about his condition. Which of the following statements by the nurse is correct?

"Testicular cancer is highly treatable, and has a high survival rate."

The clinic nurse is discussing recommended screenings with a 55-year-old male client. The client mentions that his father had prostate cancer and asks what he can do to minimize the risk of getting this type of cancer. Which response by the nurse is correct?

"The biggest risk factors are age and family history, so there is not much you can do to minimize the chance of getting prostate cancer."

A client presents with complaints of nausea, vomiting, and abdominal pain for the last 12 hours. The client states to the nurse, "I have had gastritis before and think I might have it again." Which of the following statements from the client would lead the nurse to believe it is something other than gastritis?

"The pain is a 7/10 in the lower right area of my abdomen."

The nurse is caring for a client who has pancreatitis and an order to insert a nasogastric (NG) tube. Which response by the nurse is accurate?

"This is used for removing gastric contents to suppress pancreatic secretions"

The nurse is caring for a client who has been diagnosed with hepatitis A. Which of the following teaching methods is most important to prevent reoccurrence of this particular type of hepatitis?

"This type of hepatitis is spread from poor hand washing techniques and through the fecal-oral route. It is really important to practice strict hand hygiene to prevent this from happening again"

A client presents to the emergency departments complaining of pelvic and lower back pain. The client was recently diagnosed with chlamydia and gonorrhea infections and underwent treatment with the primary healthcare provider. The nurse suspects the client may have pelvic inflammatory disease (PID). The client asks the nurse "Does this mean I won't be able to have children?" Which of the following therapeutic responses by the nurse is most appropriate?

"We won't know for certain until we treat this infection, but you did the right thing by coming in today

The nurse is caring for a client who will undergo surgery for a right-sided colectomy due to colon cancer. The client asks about what changes to expect after surgery. Which is the accurate response?

"You will need to make sure you are getting enough nutrients because absorption time is shortened due to the lack of bowel."

A client is scheduled for a proctocolectomy. The nurse is explaining the procedure to the client. Which of the following is the best explanation by the nurse?

"Your colon and rectum will be removed surgically"

The nurse is caring for a client who had an ileostomy placed yesterday. The client calls the nurse and frantically states, "My stoma looks really weird and I'm worried something is wrong with it." The nurse notes the stoma to be beefy red. Which response is most appropriate?

"Your stoma looks great. A healthy stoma with good circulation should have a beefy red appearance"

The nurse is caring for a client scheduled for dialysis at 0930 and is giving the client's 0900 medications. Which of the following medications requires further clarification?

100 mg metoprolol PO

A nurse must perform gastric lavage on a 34-year-old client who tried to commit suicide by swallowing too many pills. The nurse has set up the fluid infusion system and has inserted a nasogastric tube into the client's nose. How much fluid should the nurse instill into the tubing?

200 to 300 mL

A client who has been brought into the emergency department requires a gastric lavage. Place the following steps in the correct order in which the nurse would perform them. 1) Check tube placement. 2) Connect lavage solution to the nasogastric tube. 3) Insert the nasogastric tube. 4) Instill up to 300 mL of warmed fluid into the client's stomach.

3, 1, 2, 4

The nurse receives report on a client who will be coming to the floor following a TURP (transurethral resection of the prostate). The nurse prepares for the client's arrival by gathering which of the following supplies for continuous bladder irrigation? Select all that apply.

3,000 mL bags of 0.9% saline IV pole

A 36-year-old client presents complaining of nausea and vomiting for the last 24 hours. The client has not been able to keep food or medications down and complains of LUQ abdominal pain rated a 4/10. The nurse knows that which of the following orders should be questioned?

400 mg ibuprofen

The nurse is caring for a client with right lower quadrant abdominal pain, nausea and a fever of 101.5 degrees Fahrenheit. Which of the following interventions is appropriate for the nurse to perform prior to the diagnosis?

Apply an ice bag to alleviate the pain

The nurse is caring for a client that just underwent bariatric surgery and is continuously rushing to the bathroom after meals. The nurse explains that this is called dumping syndrome and understands that which of the following statements regarding dumping syndrome are true?

Anxiety is a common symptom Clients may experience diarrhea Syncope and collapse can occur

A 19-year-old client presents to the emergency room with pain in the right lower quadrant. The nurse knows that which of the following is located in this area?

Appendix

The clinic nurse is explaining different types of dialysis to a client. Which of the following statements is true regarding dialysis?

A client with an active lifestyle benefits most from peritoneal dialysis rather than hemodialysis

A nurse is caring for a client who is in end-stage renal disease and requires dialysis. Choose which alternative best describes the type of diet the nurse should recommend for this client.

A diet high in protein

The perioperative nurse is reviewing the operating room schedule for the day. Which of the following clients is the most likely candidate for an orchiectomy?

A 30-year-old male

A 16-year-old client is being seen for treatment of an inguinal hernia. The client's parents are present while the child talks to the provider. The client decides against undergoing the recommended treatment. The parents are considering their child's position as a mature minor to allow the child to make the decision. Which of the following best describes a mature minor?

A minor client who is considered developmentally old enough to make the decision to consent or refuse

The client has a hiatal hernia. How does the nurse describe this to the client?

A part of the stomach has exited through the diaphragm

A client has urinary incontinence diagnosed because of instability of the detrusor muscle. Which of the following describes a form of management of this type of incontinence? Select all that apply.

Anticholinergic drugs Bladder training Avoiding caffeine

A client is preparing to undergo anorectal manometry to determine the cause of their constipation. Which of the following elements is associated with this test? Select all that apply.

A radial catheter is inserted into the anus A balloon on the end of a catheter is inflated in the rectum A catheter is pulled through part of the colon to determine sphincter tone

The nurse is caring for a 30-year-old female who has three children and does not wish to conceive again. She was recently diagnosed with endometriosis and has ovarian masses as well as severe dysmenorrhea. When exploring surgical treatment options, which of the following surgeries does the nurse expect is indicated in this situation?

Abdominal hysterectomy with bilateral salpingooophorectomy

The nurse is caring for a client with an abdominal injury. Which of the following is a typical finding with an injury to this area?

Abdominal rigidity

A 61-year-old client has chronic constipation as a result of prescription medication. Which food should the nurse advise the client to increase to help resolve the constipation?

Acorn squash

A nurse is admitting a client with severe upper abdominal pain, nausea and vomiting, and an elevated amylase and lipase. What is the likely diagnosis?

Acute pancreatitis

A 63-year-old client with cirrhosis is telling the nurse about his extreme fatigue that he must work around every day. Which intervention could the nurse suggest that would best help in this situation?

Add an exercise routine to maintain physical activity

The nurse is caring for a client with a hiatal hernia. Which of the following is an appropriate treatment? Select all that apply.

Administer antacids Teach the client to avoid straining Teach the client to avoid anticholinergics

The nurse is caring for a client with gastritis. Which of the following is an appropriate nursing intervention?

Administer anti-emetics as ordered

The nurse is caring for a cirrhotic client with jaundice. Which of the following is a nursing priority?

Administer lactulose

The nurse is caring for a client admitted to the floor following orchiectomy surgery. Which of the following interventions is most important for this nurse to employ?

Administering antibiotics

A nurse notes an order to check a client's blood sugars 1 hour postprandial. What does the term postprandial mean?

After a meal

The nurse is caring for a client who has vomiting and dizziness. The nurse administered several doses of prochlorperazine to this client. For which adverse reactions should the nurse monitor? Select all that apply.

Akathisia Orthostatic hypotension Acute dystonia

A nurse who is caring for an adult client with urinary incontinence is concerned about the possible consequences of overflow urinary incontinence. Which of the following considerations should the nurse utilize when managing this type of incontinence? Select all that apply.

Allow plenty of time to void Teach the client how to perform pelvic floor exercises Contact the provider about checking a post-void residual

The client has a chronic peptic ulcer and wants to know the difference between an acute and chronic peptic ulcer. How does the nurse educate the client?

An acute ulcer is a superficial erosion, while a chronic ulcer extends through the muscular wall of the stomach

The nurse is discussing colon cancer risks with a 40-year-old client. Which of the following are modifiable factors that contribute to an increased risk for colon cancer? Select all that apply.

An inactive lifestyle A diet high in alcohol consumption Smoking

A 17-year-old client needs to undergo a surgical appendectomy. What is the nurse's role in obtaining informed consent? Select all that apply.

Answering questions from the client and the client's parents Ensuring that the parents are competent to sign for the client

A client with a gastric ileus is on bed rest with a nasogastric tube in place for nutrition. Which actions should the nurse perform that would best prevent aspiration of stomach contents in this client? Select all that apply.

Assess placement of the feeding tube prior to each feeding Avoid giving bolus feedings Get a swallowing assessment before introducing oral feedings

A client has returned to the unit after a retrograde pyelogram. Which of the following interventions would the nurse employ? Select all that apply.

Assess the client for evidence of infection Monitor for ability to void after the procedure Monitor for bleeding

A nurse is caring for a client that just had an uncomplicated esophogogastroduondenoscopy (EGD) to assess for ulcerations. What is the priority intervention after this procedure?

Assessing for gag reflex

A diabetic client is in the hospital with exacerbation of symptoms of gastroparesis. The client is experiencing severe nausea, vomiting, and abdominal bloating. Which of the following nursing interventions should be used in this situation?

Assist with placement of a jejunostomy tube

The nurse is caring for a client who is recovering from a gastric resection. The nurse provides teaching about how to prevent dumping syndrome. Which of the following statements are correct? Select all that apply.

Avoid consuming sugar, salt and milk Do not consume fluids with meals Lie down after each meal

The nurse is teaching a client how to avoid getting Giardia gastroenteritis. Which of the following is appropriate to recommend?

Avoid drinking contaminated water

A 45-year-old client is preparing to undergo hernia surgery. What information would the nurse provide for this client during the pre-operative teaching session? Select all that apply.

Avoid eating or drinking anything for eight hours before surgery Remove all jewelry and body piercings Leave valuables at home when coming to the hospital

After reviewing a client's colonoscopy images, the nurse is preparing discharge teaching. What instructions regarding dietary requirements would be most appropriate for this client?

Avoid high fiber foods

A client comes to the urgent care clinic complaining of right upper quadrant pain. The nurse is examining a client and knows which of the following is NOT located in the RUQ?

Spleen

A nurse is caring for a client who has a nasogastric tube in place and is receiving intermittent tube feedings for nutrition. The nurse has noted changes in the amount of gastric residuals that the client has when the tube is checked before each feeding. Which actions should the nurse perform that would best prevent complications when managing gastric residuals in this client? Select all that apply.

Check the level of gastric residuals every 4 to 6 hours Check tube placement prior to bolus feedings

The dialysis nurse is working with a client in the client's home who is receiving automated peritoneal dialysis (APD). The nurse ensures that which of the following equipment is available for this client? Select all that apply.

Bags of dialysate A cycler Surgical maks

A client has a serious complication of chronic acid entering the esophagus over many years. The client's esophageal lining has pathologically changed to resemble tissue in the intestine. What is this called?

Barrett's esophagus

When assessing a male client suspected to have testicular torsion, which of the following assessment findings would the nurse understand is not related to the condition?

Bilateral groin pain

The dialysis nurse has initiated a hemodialysis session with the client. Which of the following is most important to monitor?

Blood pressure

A nurse is educating middle school students on sexually transmitted infections and knows that which of the following is true regarding syphilis and HPV infection?

Both STIs are contagious even when symptoms are not present

A nurse is working on the GI disorders unit of a hospital and has been assigned three clients. Client A has newly diagnosed celiac disease and requires teaching about a gluten free diet. Client B has abdominal adhesions and is rating his pain at a 6 out of 10. Client C had surgery yesterday, complains of increased abdominal pressure and has a small amount of blood in his mouth. Which client should the nurse see first?

C, B, A

The nurse is caring for a client with a recent diagnosis of male infertility. Which of the following laboratory tests would not be related to this client's diagnosis?

CBC

A client presents to the emergency department complaining of right upper quadrant pain which worsens with palpation. The client has clay-colored stools. Which of the following tests will likely be ordered? Select all that apply.

CT scan Urinalysis Ultrasound Complete blood count

The nurse is assessing a client who had abdominal surgery six days ago. When the nurse takes down the dressing, it is noted that the edges of the incision are separated and something is protruding through the wound. Which of the following actions are appropriate for the nurse to take? Select all that apply.

Call for help, but stay with the client Cover the wound with a dressing moistened with sterile saline Take vital signs and monitor for signs of shock Ask staff to notify the surgeon right away

The nurse on a post-surgical nursing unit is caring for a client who had a colectomy two days ago and a history of CAD. The vital signs suddenly change. Current vital signs include a BP decreased to 84/48 and a HR increase to 110. The client is short of breath and complains of chest pain. What should be done first?

Call the rapid response team

The process of the breakdown of large molecules into small ones, such as when proteins are broken down into amino acids, is known as which of the following?

Catabolism

A client is recovering from surgery for a trans-urethral resection of the prostate (TURP) and has continuous bladder irrigation in place. The nurse notes that the system has a triple-lumen catheter and knows that one of the lumens allows inflow of the irrigation solution. What best describes the purposes of the other two lumens in this situation?

Catheter balloon inflation and continuous outflow

The nurse is caring for a client recently diagnosed with polycystic ovarian syndrome (PCOS) who presents to the emergency department with polydipsia and polyuria. Which of the following nursing interventions should the nurse implement first?

Check blood sugar

The nurse is teaching a client how to avoid getting E. coli gastroenteritis. Which of the following is appropriate for the nurse to recommend?

Check cooked meat with a food thermometer

Before starting a session of hemodialysis, a nurse assesses her client's AV fistula. The nurse listens to the fistula with a stethoscope and notes a swishing sound under the skin. Which action of the nurse is most appropriate?

Check for distal pulses and prepare to start the dialysis procedure

A client with a paralytic ileus has an order to insert an NG tube and set to low-intermittent suction. Which of the following steps would be included as part of inserting an NG tube? Select all that apply.

Check the client's coagulation studies prior to insertion Inspect the client's nares for polyps

A nurse is examining a client who has a nursing diagnosis of fluid volume excess due to renal insufficiency. Which of the following clinical signs is most associated with fluid volume excess in the client with renal insufficiency?

Decreased urine output

A 61-year-old client is being seen at a healthcare clinic for help with management of kidney disease. The client is in renal failure and has high phosphorus levels. Which food should the nurse counsel the client to avoid in this situation?

Chicken

A nurse working in a reproductive clinic is caring for a client with gonorrhea. The nurse knows that which of the following sexually transmitted infection is most often found to co-exist with this infection?

Chlamydia

A client has been diagnosed with gall stones. The nurse knows that which of the following is the appropriate term for this?

Cholelithiasis

An 18-year-old has chronic kidney insufficiency and must take an injection of growth hormone. He takes his own injections and his parents bring him to the healthcare clinic every four weeks for follow-up evaluation. What laboratory levels would need to be monitored in a client taking growth hormones?

Cholesterol levels

A nurse is performing an intake assessment on an older adult. While taking the client's history, the nurse discovers that the client used over-the-counter laxatives for years in order to promote bowel regularity. Based on the nurse's knowledge of laxative use, the nurse knows that in this situation, the client is at risk for which of the following?

Chronic constipation

A nurse is performing a gastric lavage on an adult client. The nurse has placed the nasogastric tube, positioned the client, and instilled 200 mL of warm water into the tubing. Which step does the nurse perform next?

Clamp the instillation tubing and aspirate gastric contents

A client is hooked up to low intermittent suction through a nasogastric tube, and the nurse is preparing to irrigate the tube. After assessing the client's abdomen and determining that the tip of the tube is located in the stomach, the nurse draws up 30 mL of normal saline into a syringe. Which best describes the next step in this process?

Clamp the suction and disconnect the tube

A nurse is preparing to insert a nasogastric tube into a client's nose per provider orders. After inserting the tube, what describes an appropriate method of securing the tube so that it does not come out? Select all that apply.

Cleanse the skin with an alcohol swab where the tube will be secured Use hypoallergenic tape to secure the tube Secure the tube to the client's gown to reduce the weight of the tube

A nurse if providing client education on various sexually transmitted infections and knows that which of the following is true of both human papillomavirus (HPV) and herpes simplex virus (HSV)?

Clients are contagious even when no symptoms are present

A 30-year-old female client has been diagnosed with infertility as a result of polycystic ovary syndrome. The client and her husband have been trying to become pregnant for over a year. The provider prescribes clomiphene citrate. Which of the following best describes how this drug can help to achieve pregnancy?

Clomiphene stimulates ovulation when a woman does not ovulate with PCOS

A client receiving medication as an anti-infective starts showing signs of nephrotoxicity. The nurse knows that which of the following are signs of nephrotoxicity?

Decreased urine output Fluid retention

A client who has been utilizing peritoneal dialysis for 1 month presents to the clinic with complaints of abdominal pain and nausea. The nurse notes a distended abdomen. Which of the following interventions will the nurse need to do first?

Collect PD fluid for analysis

The clinic nurse is reviewing the plan of care for a 50-year-old client. The nurse recognizes that which of the following is the diagnostic tool of choice for colorectal cancer screening?

Colonoscopy

A nurse is giving education to middle schoolers on preventing human papilloma virus (HPV) and knows that which of the following statements are true? Select all that apply.

Condoms can help to prevent the spread of HPV, but they are not 100% effective An individual might be contagious even if they have not had warts for a few weeks Getting the gardasil vaccine helps prevent pre-cancerous growths

A 68-year-old client complains to the nurse that she has been struggling with constipation. The nurse is discussing the different causes of constipation with this client. Which of the following best describes slow-transit constipation? Select all that apply.

Constipation is caused by dysfunctional reflex mechanisms in the colon Hirschsprung disease is an example of this type of constipation Constipation develops because of poor glucose control

A 36-year-old client with a history of short bowel syndrome has had a colostomy placed. The nurse is educating the client on dietary management of the syndrome. Which of the following instructions should the nurse include for this client?

Consume a serving of protein at each snack or meal

A client who is recovering from abdominal surgery has come into the care clinic for suture removal at the wound site. The nurse notes that the wound is red, warm and painful, and the sutures appear tight. Which of the following action is most appropriate for the nurse to take?

Contact the primary care provider

A client who is recovering from abdominal surgery has developed an infection at the surgical site. The nurse notes that the edges of the wound have come apart and many of the sutures are not intact. What interventions are most appropriate in this situation? Select all that apply.

Contact the provider about the condition Cover the wound with sterile saline-soaked gauze until it is managed

A nurse checks the contents of a client's indwelling catheter and notes that the urine output has been 10 mL/hr for the last four hours. Which response of the nurse is most appropriate?

Contact the provider and document the information

Your patient had an ileostomy placed 2 weeks ago. Which bowel pattern would be expected for this patient?

Continuous output

The nurse is caring for a preoperative infant who has pyloric stenosis. Which of the following is an appropriate action for the nurse to take?

Correct fluid and electrolyte abnormalities

During a head-to-toe assessment, the nurse knows which of the following findings is suggestive of a gonorrhea infection?

Creamy, white exudate from client's penis

An immobile client is at risk of aspiration because of difficulty with chewing and swallowing food. Which of the following nursing interventions is most appropriate?

Crush medications and put them in applesauce

A nurse is providing post-operative care for a client who is recovering from bowel surgery. The client had excess bleeding during the procedure and the physician has ordered a colloid solution to replete intravascular volume. What best describes the difference between colloids and crystalloids?

Crystalloids are cheaper to administer when compared to colloids because normal saline is less expensive than albumin

A nurse is caring for a client with chronic alcohol abuse and is concerned the client may have developed pancreatitis. Which of the following signs are indicative of this? Select all that apply.

Cullen's Sign Turner's Sign

A nurse is caring for a client who is complaining of abdominal pain. Upon inspection of the abdomen, what sign should the nurse be looking for to alert you to potential pancreatitis?

Cullen's sign

A client is scheduled to undergo a procedure in which a camera will be inserted in the bladder. The nurse knows this procedure is called what?

Cystoscopy

A nurse is caring for a client with cirrhosis. Which of the following lab values would the nurse NOT expect to see with this disease process?

Decreased PT/INR

Which of the following lab test results are consistent with menopause?

Decreased estrogen

A nurse is assessing the dietary intake of an 80-year-old client who is in the healthcare clinic. Which of the following is related to changes associated with eating that contribute to impaired nutrition?

Decreased intake of fiber because of difficulties chewing these foods

A nurse is caring for a client with pancreatitis. Which of the following labs would the nurse NOT expect to see? Select all that apply.

Decreased liver enzymes Hypermagnesmia Hypercalcemia

A client comes in to the hospital in severe pain and is diagnosed with a 2 mm kidney stone. Which best describes how the nurse would teach this client about treatment?

Explain that the client can attempt management at home with pain medication

The nurse knows that which of the following most accurately describes the rationale for administering famotidine to a client with gastritis?

Decrease inflammation in the stomach

Which of the following medications would NOT be administered to a client experiencing pancreatitis? Select all that apply.

Dextrose Cholinergics

The nurse is caring for a client who has been diagnosed with chronic kidney failure. Which of the following aspects of this client's history could have contributed to this?

Diabetes mellitus Hypertension Rheumatoid arthritis

The dialysis nurse is educating a client who will begin hemodialysis. Which of the following statements by the client is correct?

Dialysate is the fluid in the filter that causes waste to be pulled from my blood

A nurse is working in the OR preparing a client for surgery. The nurse is cleansing the surgical site using an alcohol-based antiseptic. Which practice best describes how the nurse can practice fire safety when using a flammable solution?

Do not allow the solution to soak into the surrounding linens or the client's hair

A nurse is caring for a client who recently had an NG tube placed. Before starting the first enteral feeding, the nurse wants to check for proper placement. Which of the following techniques is most appropriate to confirm placement?

Draw back a small amount of gastric fluid and test the pH

The nurse is caring for a client who receives hemodialysis. The client has phosphate binders ordered. When should the nurse administer these?

During meals

The nurse is caring for a client who has just been diagnosed with Irritable Bowel Syndrome (IBS). Which of the following dietary recommendations are appropriate for the nurse to include in teaching the client? Select all that apply.

Eat more fiber Avoid gluten Avoid certain carbohydrates

A nurse is caring for a client who is suffering from a gastric ulcer. Which of the following is an appropriate nursing intervention? Select all that apply.

Eat small, frequent meals Take a histamine blocker Take a proton pump inhibitor

A 66-year-old client has become dehydrated after being outside in the sun for too long. The client complains of feeling dizzy and lightheaded. Which of the following potential side effects should the nurse monitor in this situation?

Electrolyte imbalance

The nurse is caring for a client who has been admitted with an acute exacerbation of ulcerative colitis (UC). Which of the following orders would the nurse question?

High protein diet

The nurse is caring for a client who is experiencing urinary retention. Which intervention is appropriate to help this client to void?

Encourage fluid intake

The nurse is caring for a 25-year-old female who presents with constant pelvic pain that begins six days before her monthly menses, and lasts two to three days into her menses. Additional symptoms include painful sexual intercourse and hematuria. Which of the following conditions does that nurse suspect given these presenting symptoms?

Endometriosis

The nurse is taking care of a post-operative client. The client's post-op care includes interventions such as implementing scrotal support, administering antibiotics and NSAIDs, and applying ice PRN. Which of the following surgeries did the client likely have given these interventions?

Epididymectomy

The nurse is assessing a male client in the emergency department complaining of intermittent scrotal pain and swelling, and cloudiness in his urine over the past week. The client currently has a fever of 101.5. Given these assessment findings, which of the following conditions would the nurse suspect?

Epididymitis

A client with a peptic ulcer has been brought in to the healthcare clinic and is being assessed by the nurse for an upper GI bleed. Which of the following signs or symptoms would the nurse expect to see with this condition? Select all that apply.

Epigastric pain Melena Hematemesis

A nurse takes report in the morning for 4 clients with the following active diagnoses. Which client would be the priority to see first?

Esophageal varices

The nurse is caring for a client who is scheduled to be evaluated for possible GERD. The nurse is aware that diagnostic tests for GERD include which of the following? Select all that apply.

Esophagram Esophageal manometry Esophageal impedance pH study Upper endoscopy

A client is scheduled for an esophagogastroduodenoscopy (EGD). The client asks the nurse what structures they will be looking at during that procedure. Which responses by the nurse would be the most appropriate? Select all that apply.

Esophagus Stomach small intestine

Which of the following hormonal abnormalities prevents the release of an egg during a menstrual cycle in polycystic ovarian syndrome?

Excess androgen levels

In which of the following client populations is polycystic ovarian syndrome seen?

Females of childbearing age

When assessing a client's level of nutrition risk, the nurse uses the DETERMINE scale to determine if the client is at high risk of malnutrition or poor intake. Which best describes how the nurse would assess the D (disease) portion of the assessment?

Find out if the client has a diagnosis of a chronic illness

The nurse is assigned to a client with an acute kidney injury. The nurse understands that hemodialysis will become necessary when which of the following signs or symptoms are demonstrated?

Fluid overload with K 6.4

A nurse is assessing a client's nutritional status. In addition to checking the client's weight, which of the following assessments would the nurse include to check for malnutrition?

Fluid retention

The nurse is discussing hormonal analysis with a male client being tested for infertility. Which of the following hormones are tested in this type of hormonal workup? Select all that apply.

Follicle stimulating hormone Luteinizing hormone Thyroid stimulating hormone Testosterone Prolactin

The nurse is caring for a client who has had an indwelling urinary catheter for 2 weeks. The nurse suspects that the client is developing a urinary tract infection. Which of the following assessment findings is inconsistent with this disease process?

Fruity breath

The nurse is caring for a client who has gallbladder disease. The nurse has an order to give ursodiol. What would the nurse expect the priority outcome to be?

Gallstone dissolution

A nurse is planning medication administration for a client who has all of the following oral medications due at 0900: Calcium carbonate, Codeine, Levetiracetam, Metoclopramide. What is the most appropriate action by the nurse?

Give Calcium carbonate 1 hour after the others

After surgery for peritonitis, a priority nursing intervention would be which of the following?

Give IV antibiotics and electrolyte replacement

Prior to the client's colonoscopy, nursing interventions include which of the following? Select all that apply.

Give a gallon of GoLYTELY the evening before the procedure Instruct the client to avoid consuming red, orange, and purple liquids Clear liquid diet until eight hours prior to the procedure

A nurse is caring for a client with a gastric ulcer who begins to have active bleeding. Which of the following is the priority nursing intervention?

Give blood if low hemoglobin

A client is suspected of having peritonitis. Which of the following actions should the nurse take to prevent complications? Select all that apply.

Give prescribed antibiotics Monitor intake and output Provide NG drainage Provide analgesic medication PRN

The nurse is caring for a client with a new diagnosis of testicular torsion. Which of the following are correct about this condition?

Immediate intervention is needed

The nurse is working with a client who has peptic ulcer disease. Which of the following labs is important to monitor with this condition?

H/H

A 21-year-old client with anorexia has been given the nursing diagnosis of Altered Nutrition: Less than Body Requirements related to an unwillingness to eat and demonstrated by severe weight loss to less than 100 lbs. Which nursing intervention is most appropriate that should be included as part of the client's ongoing assessment?

Have the client document all food intake

What information should the nurse gather about a client's diet during the nutrition screening? Select all that apply.

Have you had any unplanned weight loss or gain in the past six months? Do you eat regular meals each day? Do you have any chronic diseases?

The nurse is providing discharge teaching to a client who has been treated for a testicular torsion. Which of the following is an incorrect teaching point?

Heat application for pain control

After developing influenza, a 75-year-old client is suffering from severe diarrhea and dehydration. The nurse is providing help and guidance over the phone to the client's family. Which information should the nurse give to the family that would best help this client?

Help the client to drink fluids by taking frequent spoonfuls or small sips

A client who is in renal failure must start to use dialysis. Which of the following best describes a difference between hemodialysis and peritoneal dialysis?

Hemodialysis requires a dialysis machine to filter the blood while peritoneal dialysis uses the client's body for the same function

A nurse is caring for a client post-op colon resection and notes a decreased blood pressure, rigid abdomen and the client reports severe pain. Based on these findings and knowing the possible complications, which of the following lab values would be the MOST appropriate to evaluate at this time?

Hemoglobin

The nurse is caring for a client who is receiving continuous renal replacement therapy (CRRT). Which of the following is the least important for the nurse to monitor?

Hemoglobin and hematocrit

The dietary plan for a client with diverticulitis includes which of the following?

High fiber, increased fluids

A nurse is preparing to administer the next enteral feeding to a client with a gastrostomy tube. The client complains of nausea. The nurse checks for residual before starting the feeding and returns 200 mL. Which of the following actions of the nurse is most appropriate?

Hold the feeding

Which of the following assessment findings is most commonly seen with menopause?

Hot flashes

Which of the following assessment findings are consistent with menopause? Select all that apply.

Hot flashes Vaginal dryness

A nurse is performing an intake assessment on a new client. The nurse reaches the nutrition portion of the assessment and wants to learn about the client's food intake. Which of the following questions would be most appropriate to gain information about a client's intake?

How many meals and snacks do you eat in a 24-hour period?

A nurse is caring for a 15-year-old client who is recovering from an appendectomy. The nurse is assessing the client's level of pain. Which question from the nurse would be most appropriate for determining the intensity of pain the client is experiencing?

How would you rate your pain on a scale of 0-10?

A client has diarrhea. What should the nurse expect when auscultating the abdomen?

Hyperactive bowel sounds

A 46-year-old female client is in the healthcare clinic and complains of stress incontinence. The client has five children and says that she has had difficulties controlling voiding since giving birth to her last child. In addition to multiparity, which of the following describe other causes of stress incontinence? Select all that apply.

Hypoestrogenism Obesity Pelvic trauma

A client has been hospitalized for symptoms of abdominal pain and diarrhea following exacerbation of stress. The nurse is teaching the client about ways to minimize environmental stress in her life. Which statement from the client indicates that teaching has been effective?

I am going to organize my home so that I do not have so much clutter lying around

Which of the following client comments obtained during a client history would lead the nurse to believe a client's vomiting and abdominal pain are caused by acute gastritis? Select all that apply.

I ate sushi last night for dinner I have been taking naproxen 220mg twice a day for the last 2 weeks

A client has cirrhosis of the liver and has developed abdominal pain and ascites. The nurse must administer certain medications, but the client refuses. Which of the following responses from the nurse best indicates that the nurse is acting in a paternalistic manner?

I know you do not want this medication, but you need to get your pain under control

The nurse is teaching a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client reflects an appropriate understanding of this type of dialysis?

I will need to set aside time in my schedule for 5 different episodes of dialysis per day

A nurse is caring for a client with chlamydia. The nurse knows that which of the following statements by the client with Chlamydia demonstrate an understanding of the plan of care?

I will return in 3 months for a follow-up visit.

A client who is recovering from surgery has been ordered to have a full liquid diet. Which foods can the client eat on this diet? Select all that apply.

Ice cream Strained soup Pudding

Which of the following non-surgical treatment options is not indicated for treatment of endometriosis?

Ice pack application

An ostomy nurse is caring for a client who is scheduled for surgery for placement of a colostomy. The nurse explains that it is important to choose the most appropriate site for the stoma. Which of the following regarding stoma location is accurate for the nurse to include in teaching?

If the stoma is not in the right place, you may have trouble reaching it to take care of it

A client with diverticulosis had a colostomy placed 5 days ago and is now being discharged. Which of the following would NOT be appropriate discharge teaching for this client?

Increase fiber intake to 25-30 g/day

A client with irritable bowel syndrome has asked the nurse if there is anything that can be done to decrease the frequency of diarrhea. Which of the following advice is appropriate for a client to develop regular bowel functioning? Select all that apply.

Increase intake of fiber Drink 8 to 10 glasses of liquids per day

A client who has lost weight because of cancer has asked the nurse about what foods to eat to help increase calorie intake and gain weight. Which suggestions could the nurse make that would best help promote weight gain in this client? Select all that apply.

Increase intake of unsaturated oils in the diet Include nuts and seeds in the diet Eat high-protein snacks such as trail mix and granola bars Add cheese or hummus to vegetables

A 68-year-old female client is talking with the nurse about the body changes she has experienced since going through menopause. Which of the following skin changes is associated with a decrease in estrogen levels?

Increased irritation and pruritus

A nurse is caring for a client receiving vasopressin for diabetes inspidus after pituitary tumor resection. Which of the following does NOT demonstrate that this medication is achieving its desired effect?

Increased urine output

The nurse is performing an assessment of a client's abdomen. Upon palpation, the nurse feels an abnormal lump in the left upper quadrant that is extremely painful for the client. The nurse is likely palpating which of the following?

Inflamed spleen

Which best describes sinography as used to evaluate a stab wound to the abdomen?

Injecting a contrast agent through a catheter into the wound and taking an x-ray

A client has been brought into the emergency department after overdosing at home on acetaminophen tablets. The nurse sets up a gastric lavage kit according to provider orders. The nurse prepares to insert the tube into the client's nose. Which action should the nurse perform first?

Inspect the inside of the clients nose to assess for obstructions

When assessing the client's abdomen, what is the first thing the nurse will do?

Inspection

Which best describes the order in which the nurse should assess a client's abdomen?

Inspection, auscultation, percussion, palpation

A nurse is performing bladder irrigation on a client. The catheter has been inserted and has drained the urine from the client's bladder. Which of the following steps is performed next? Select all that apply.

Instill irrigation solution into the catheter and then remove the syringe and allow the solution to flow out of the catheter Allow irrigation solution to empty out of the bladder into a sterile receptacle

The nurse is providing education to a client recently diagnosed with pelvic inflammatory disease. Which of the following answers is not appropriate to include when providing education?

Instructing how to take their blood pressure

A client recovering from gastric surgery has been placed NPO with a nasogastric tube to low intermittent suction. Select all of the following actions associated with care of a client with this system in place.

Intermittent suction can be used with most nasogastric tubes A client with low intermittent suction can use a throat spray for comfort The suction gauge should be checked every 2 to 4 hours while low intermittent suction is in place

The nurse is caring for a client who has been diagnosed with testicular torsion. Which of the following does the nurse understand is not characteristic for the pathophysiology of testicular torsion?

Interrupts blood flow to bilateral testis

The nurse is caring for a client who is scheduled for hemodialysis during the day shift. The nurse knows that which of the following items is NOT filtered out the client's blood during hemodialysis?

Interstitial fluid

The nurse is caring for a client who is post-operative day 1 for surgery that resulted in a transverse colostomy. Which of the following is the priority nursing intervention?

Intestinal decompression until peristalsis returns

A nurse is caring for a client with continuous bladder irrigation in place. The nurse uses a three-way catheter for the irrigation system. Which best describes the purpose of this type of catheter?

It allows for irrigant to flow in and out of the bladder

The client is scheduled for a gastric emptying study. Which of the following best describes a gastric emptying study?

It is a radionuclide study that scans the stomach emptying

A client needs to undergo a hemicolectomy. The nurse provides information to the client and asks questions during a pre-operative phone call. The nurse asks if the client has any religious preferences to be considered during the client's stay. The client says, "That's personal information. I do not want to share that with you." Which response from the nurse would most likely explain this client's rights in this situation?

It is our policy to ask so that we could accommodate any preferences, but you do not have to tell me

A client who has been incontinent of stool needs skin cream to prevent skin breakdown. How does application of skin barrier prevent wound development?

It prevents skin maceration from exposure to stool

The nurse is caring for a client who just had surgery for testicular torsion. Which of the following orders would the nurse question in the post surgical care of this client?

Leave the wound open to air

An 89-year old client has been diagnosed with a urinary tract infection. Which best describes a psychological effect of this type of infection?

Lethargy

A nurse is talking to an overweight client about weight loss strategies. Which describes an initial recommendation target for weight loss that would be implemented for most overweight or obese clients?

Loss of 10 percent of body weight in 6 months

A recovery room nurse is caring for a client who is recovering from anesthesia after colon surgery. The nurse is providing IV fluids of Normal Saline at a rate of 150 mL/hr to the client. In order to avoid complications associated with fluid overload, which intervention would the nurse most likely perform?

Maintain IV administration with a fluid pump instead of gravity

A client presents to the emergency department with active bleeding from esophageal varices. Which of the following actions by the nurse is appropriate?

Maintain NPO status

The nurse is caring for a client with acute bacterial gastroenteritis. Which of the following nursing recommendations is appropriate to make? Select all that apply.

Maintain fluid and electrolytes Give antibiotics if prescribed

A client who is preparing to undergo abdominal surgery has been ordered to receive a bowel preparation the evening before. Which best explains the reason for this procedure?

Manipulation of the intestines can cause changes in peristalsis

The nurse is caring for a client with an intestinal obstruction. Which of the following is the priority nursing intervention?

NG tube for intestinal decompression

A nurse is talking with a client about starting dialysis for kidney failure. The nurse uses short and concise statements to explain what the client should expect. Which best describes the rationale for this?

Medical jargon may be difficult for the client to understand

The nurse is caring for a 50-year-old client who presents with hot flashes, insomnia, vaginal dryness, and weight gain. Which of the following diagnoses do you suspect given these assessment findings?

Menopause

A client is suffering from fluid overload due to a history of severe liver disease. Which of the following interventions would be the highest priority for this client?

Monitor for heart arrhythmias and the presence of crackles on auscultation

A nurse is receiving a client from GI lab after a colonoscopy. Which of the following post-procedure nursing tasks are appropriate for this client? Select all that apply.

Monitor for signs of colon perforation Remind client that cramping is expected for several hours Provide fluids to rehydrate

The nurse is caring for a client who has returned to the floor from the PACU after an appendectomy. Based on this surgical procedure, the nurse knows to implement which of the following interventions for this client?

Monitor temperature and pulse to assess for infection

A client is preparing to undergo a colonoscopy for evaluation of polyps. The nurse would perform which of the following actions when assisting during a colonoscopy?

Monitor the client for pain and excess bleeding

A client's urinalysis is being evaluated for infection. What amount of bacteria indicates the normal threshold for confirming the presence of infection?

More than 100,000 colony forming units/mL

A 48-year-old female is at an appointment with the healthcare provider for a gynecological exam. The nurse asks the client about birth control methods and menopause. The client asks, "How long will I remain fertile?" Which response from the nurse is accurate?

Most women have stopped being fertile by the time they are 55, but this varies

A nurse works in a long-term care facility and is caring for a client who has esophageal dysphagia. Which condition would most likely contribute to development of this form of dysphagia? Select all that apply.

Motility disorder Mechanical obstruction

A nurse knows that which of the following layers of the stomach lining are most often inflamed in a client with acute gastritis? Select all that apply.

Mucosa Submucosa

A nurse is caring for a client who is complaining of RUQ pain. Which sign should the nurse look for to indicate potential cholecystitis?

Murphy's sign

In which of the following scenarios would hospitalization for pelvic inflammatory disease be expected?

No response to antibiotics

The nurse is calling a client scheduled for a colonoscopy in three days to give instructions. Which of the following should the nurse include?

No solids the day before procedure

Which of the following assessment findings can be seen with pelvic inflammatory disease? Select all that apply.

No symptoms Painful urination

A 50-year-old client has arrived for a colonoscopy, and states she is worried that the gastroenterologist will find cancer. Which assessment finding would the nurse expect for a client who is in the early stages of colon cancer?

Nothing, because colon cancer is asymptomatic in the early stages

While working in the reproductive clinic, the nurse receives the following orders for the treatment of a client with chlamydia. Which of the following orders should the nurse seek clarification of?

Notify client's sexual partners of risk for infection

A client has a nasogastric tube placed after developing a paralytic ileus following surgery. The nurse maintains the NG tube and performs interventions to ensure adequate hydration for the client. Which intervention is most closely associated with assessment of fluid intake and output in a client with an NG tube?

Noting insensible fluid losses from the client's perspiration, hyperventilation, and wound drainage

A client is being treated for syphilis and the nurse knows that which of the following statements regarding tertiary syphilis infection are true? Select all that apply.

Once in the tertiary stage, the client is no longer contagious Detecting and treating syphilis in the first two stages of infection prevents late-stage infection Tertiary syphilis can cause aortic aneurysm and seizures if untreated Intramuscular pencillin G halts the progression of tertiary syphillis

A nurse is educating a group of middle school students on locations of human papilloma virus (HPV). The nurse is correct in explaining that In addition to the cervix, cancers related to HPV are most commonly found in which of the following sites?

Oral cavity

The nurse suspects that a client has a duodenal ulcer. Which of the following signs would indicate this condition?

Pain 1.5-3 hours after eating, relieved by eating

A client has a gastric ulcer. Which of the following clinical manifestations does the nurse expect to see with this client? Select all that apply.

Pain 30-60 minutes after a meal Weight loss Left upper quadrant pain or back pain

A client has been given a nursing diagnosis of Altered Nutrition: Less than Body Requirements. Which of the following would most likely be seen as evidence of malnutrition?

Pale conjunctiva

The nurse is assessing a client with suspected varicoceles. Which of the following assessment findings confirm this condition? Select all that apply.

Palpable, worm-like veins in the scrotum

A client in the emergency department reports pain in the left upper quadrant (LUQ) of the abdomen. The nurse knows that which of the following is located in the LUQ?

Pancreas

While completing an intake assessment for a 25-year-old client for a routine exam, the client tells the nurse about being treated for a chlamydia infection 3 months prior. The nurse anticipates which of the following interventions? Select all that apply.

Pelvic exam Chlamydia and gonorrhea screening

A nurse is working with a client in the primary care clinic who presents with urinary symptoms. This client experiences urine leakage upon coughing, sneezing and climbing stairs. Based on these symptoms, which of the following types of treatment would most likely be prescribed for management of this client's condition?

Pelvic floor physiotherapy

The nurse is caring for a client who complains of yellow vaginal discharge, dysuria, fever, and lower abdominal pain. Which of the following diagnoses do you expect given these assessment findings?

Pelvic inflammatory disease

A 30-year-old client has had gallbladder surgery. The client arrives in the recovery room with a surgical wound drain in place, which the nurse notes as a passive wound drain. Which of the following types of wound drains is classified as a passive drain?

Penrose

The nurse is caring for a client and suspects cholecystitis. Upon notification of the provider, the nurse is asked to discover whether the client has a positive Murphy's sign. Which of the following will verify the presence of a positive Murphy's sign in this client?

Place a hand below the client's costal margin on the right side at the midclavicular line. Ask the client to breathe in. If client cannot breathe in due to pain, the test is considered positive

A nurse is caring for a client who is recovering from abdominal surgery. The client has developed a cough and at once tells the nurse, "I just felt something pop." The nurse checks the incision site and notes the appearance of bowel loops through the wound opening. What should the nurse do first?

Place the client in the low Fowler's position and with knees slightly flexed

The nurse is caring for a female client of childbearing age who presents with infrequent periods, increased acne, facial hair, and obesity. Which of the following conditions do you expect given these assessment findings?

Polycystic ovarian syndrome

A nurse is caring for a client who has a nasogastric tube in place and is receiving enteral feedings. The nurse must administer formula to the client that has been prepared by the hospital dietary staff and consists of milk-based, blenderized foods. This type of formula is known as:

Polymeric formula

An 86-year-old client has developed protein energy malnutrition as a result of poor eating habits and difficulties with chewing and swallowing. Which best describes how poor nutrition contributes to skin breakdown in an elderly client?

Poor nutrition is associated with slow and nonhealing wounds

A nurse is caring for a client who has been diagnosed with inflammation of the prostate gland. Which of the following terms is most appropriate for this condition?

Prostatitis

The client has an acute flare up of diverticulitis. Nursing interventions to prevent complications include which of the following? Select all that apply.

Provide IV fluids Maintain NPO status Give antibiotics by IV

The nurse is caring for an infant who will undergo surgery for esophageal atresia. What is an appropriate preoperative treatment?

Provide IV fluids via umbilical artery catheter

The nurse is caring for an infant who had surgery for pyloric stenosis. Which of the following is a priority nursing intervention?

Provide parenteral fluids at the ordered rate

Twelve hours after abdominal surgery, the nurse assesses the client and notes restlessness and complaints of thirst. The nurse notes that the client has cool, pale extremities, tachycardia and has become diaphoretic. The nurse notes that the dressing to the surgical site is soaked with blood. Which of the following is the next action the nurse should take?

Provide pressure to the surgical site

The nurse is caring for a client who just returned to the floor after a partial gastrectomy for a gastric ulcer. What is an appropriate nursing intervention?

Provide vitamin B12 parenterally

Which of the following answers are correct in relation to how hormone replacement therapy is used with menopause?

Provides relief of symptoms

A client with diverticulosis had a colostomy placed yesterday. Which of the following assessment findings would be the MOST concerning to the nurse?

Purple stoma

Which of the following terms indicates and infection in the renal pelvis?

Pyelonephritis

A nurse is caring for a client with hematuria. Which of the following findings would be indicative of this condition?

RBC's present on urinalysis

A client who is in the hospital for gallbladder surgery starts to complain of severe chest pain that radiates to the left arm. The client is sweating and breathing rapidly. The nurse contacts the provider, who orders a consult with a cardiologist. What is the nurse's role during the consultation process? Select all that apply.

Remaining with the client during the consult if possible Explaining the implications of the consult to the client if questions arise afterward

The nurse is caring for a client who is at risk for dumping syndrome after a partial gastrectomy. Nursing interventions to prevent this from happening include which of the following? Select all that apply.

Restrict fluids with meals Increase consumption of fat and protein Lie down for 30 minutes after eating Choose whole grains over simple carbohydrates

A nurse is caring for a client that has been diagnosed with pancreatitis. Which of the following is NOT a complication commonly associated with this disease process?

Right lung effusion

A nurse receives a client from radiology that just underwent a liver biopsy. Which position should the nurse place the client in to decrease risk of bleeding?

Right side-lying

A nurse is caring for a client with bariatric surgery who is continuously rushing to the bathroom after every meal. The nurse knows that this is common in clients who have undergone which of the following types of bariatric surgeries where the GI tract is redirected? Select all that apply.

Roux-en-Y Duodenal switch

A patient who is morbidly obese is discussing surgical options for treatment. Which of the following procedures is classified as a malabsorptive procedure for treatment of obesity? Select all that apply.

Roux-en-Y gastric bypass Vertical sleeve gastrectomy Biliopancreatic diversion

A client with chronic diarrhea tells the nurse that she wants to start taking probiotics to regulate her digestive system. In which products are probiotics most commonly found? Select all that apply.

Saurkraut Yogurt

The nurse is caring for a male client with suspected varicoceles. The client asks questions about how the condition will be diagnosed. Which of the following options are available for diagnosis of a varicocele?

Scrotal palpation

The community health nurse is teaching a class on early detection of testicular cancer. The nurse accurately teaches the class all of the following points except which?

Self-exams should begin at age 20

A client just returned from the OR after a gastrectomy. What position would be most appropriate for the client after this particular surgery?

Semi-Fowler's

The nurse is repositioning a client diagnosed with pelvic inflammatory disease in bed. Which of the following positions helps with drainage of infection?

Semi-fowler's position

A 65-year-old client is in the hospital for surgery for a colon resection. The client requires total parenteral nutrition, which is administered through a central venous catheter. The nurse notes that the client has a red area of induration around the catheter exit site. The client's latest blood glucose result is 176 mg/dL and a current temperature of 38 degrees celsius. Which of the following conditions should the nurse suspect?

Sepsis

The nurse is initiating bowel and bladder retraining for a client with paraplegia. Which of the following is not a factor for the nurse to consider?

Sexual function

The nurse is examining a client who has been waiting to be seen in the emergency department. The client reports they have pain in the left lower quadrant (LLQ) of the abdomen. The nurse knows which of the following is located in the LLQ?

Sigmoid colon

A nurse is talking with a client and knows that which of the following statements regarding secondary syphilis is true?

Some clients never realize they have had secondary syphilis Infection

An older adult client is often incontinent of stool in his bed. He has started to develop an area of skin breakdown on his sacrum. In which ways does stool incontinence contribute to skin breakdown? Select all that apply.

Stool contains certain enzymes that contribute to skin breakdown A mix of stool and urine changes the consistency of the excretion to become more caustic to skin Frequent cleaning of the perianal area can increase friction and pressure to the area

The nurse is assessing a client following a varicocelectomy. Which of the following interventions would be inappropriate?

Straight catheterization

The nurse is teaching the client diagnosed with polycystic ovarian syndrome about lifestyle modifications for the disease. Which of the following topics is most important for the nurse to teach?

Strategies for weight loss

The nurse is caring for a client who has been diagnosed with appendicitis and is scheduled for surgery later today. Which of the following assessment findings is the MOST concerning?

Sudden pain relief

A nurse who works in a long-term care facility has noted that one of her clients is frequently incontinent of urine and stool. The client also has mobility issues and the nurse is concerned about skin breakdown in this client. Which actions should the nurse perform to prevent skin breakdown? Select all that apply.

Support the client's adequate oral intake and hydration Apply barrier ointment to minimize contact between urine and stool and the skin Use a moisturizing skin care product

A nurse is assessing a client with an indwelling urinary catheter for signs of a catheter-associated urinary tract infection (CAUTI). Which assessment finding would best help to identify a CAUTI?

Suprapubic pressure and pain

A nurse is helping a client who will be going home with an ostomy after surgery. Which of the following demonstrates how the nurse would prepare the client for ostomy care at home? Select all that apply.

Talking with the client about alterations in body image Educating the client about signs and symptoms of stoma dermatitis Overseeing appropriate measurement of the stoma barrier

A 58-year-old client with multiple sclerosis is suffering from bowel incontinence after having a stroke. Which intervention would most likely help the client to manage this condition?

Teach the client about what foods to eat and how much fluid to drink to help with stool consistency

A 56-year-old client is struggling with a diagnosis of kidney disease. The client says to the nurse, "I do not think I can handle this. How can I watch everything I eat and drink and then still go to dialysis?" The nurse can best help the client with recognizing coping mechanisms with which of the following responses?

Tell me about what makes you feel better when you are in an unfamiliar situation

A 21-year-old female client is being seen following a sexual assault by her boyfriend. A nurse who specializes in examination of sexual assault victims has been called to come in to work with the client. Which best describes the activity of this nurse?

Testing for pregnancy or sexually transmitted infection

A client is brought to the emergency room with complaints of abdominal pain. The nurse performs a focused abdominal assessment. Which of the following is an element of the inspection portion of the exam? Select all that apply.

The abdomen is rounded There is visible peristalsis The stoma site is red

A client with a spinal cord injury has difficulty determining when the bladder needs emptied. The nurse teaches the client about tapping to stimulate voiding. How would the nurse describe tapping to this client?

The area over the bladder is tapped to stimulate the bladder muscles

A recovery room nurse is caring for a client who has just undergone a transurethral prostatectomy. The client has continuous bladder irrigation in place. Which of the following is a true statement regarding this type of system? Select all that apply.

The bladder irrigation prevents clots from forming after surgery The catheter must be drained and color noted periodically as ordered

The clinic nurse is performing an assessment on a 35-year-old male client who presents to the clinic with a painless testicular lump and pain in the pelvis. The nurse carefully assesses the client's lungs and asks if the client has had any trouble breathing. Which of the following explains the actions of the nurse?

The nurse suspects testicular cancer and is checking for metastases

A client who had an indwelling catheter has developed a urinary tract infection that has spread to the kidneys. The nurse should include which of the following information as part of her teaching?

The client can continue to recover with antibiotics at home

A nurse is assisting a provider with obtaining informed consent for a client who is preparing to undergo a laparoscopic cholecystectomy. What must the nurse consider when determining if the client is competent to sign the informed consent?

The client has a low level of health literacy

A 21-year-old college student is being seen at the healthcare clinic for symptoms of a sexually transmitted infection. Which information should the nurse provide that would best teach this client about the consequences of the likely behavior that led to this condition?

The client is at high risk of further sexually transmitted infections if he or she practices unsafe sex

A 67-year-old client has been given a nursing diagnosis of Altered Patterns of Urinary Elimination related to stress incontinence. Which of the following most accurately explains this condition?

The client loses urine with increased abdominal pressure

A client who has undergone a hysterectomy is experiencing pain after the procedure. The nurse ensures that other distractions and stressors in the room are removed by keeping the door closed and the lights low. Which best describes the rationale for this?

The client may feel more pain with stressors present

The nurse is caring for a client who suffers from chronic constipation. The nurse asks questions to evaluate whether the client uses laxatives to manage this condition. Which of the following best describes the rationale for this action?

The client may have used laxatives incorrectly and contributed to constipation

A nurse is performing an abdominal assessment on a client who complains of abdominal pain. Which of the following would be subjective information about the client? Select all that apply.

The client rates his or her pain at a 6 on a 0-10 scale The client said he or she took ibuprofen for the pain

The new graduate nurse is training on continuous renal replacement therapy (CRRT) in the intensive care unit. The nurse correctly understands which of the following about CRRT versus regular hemodialysis?

The client receives CRRT due to hypotension

A client with a gastrointestinal condition is suffering from chronic constipation. The nurse recommends that the client increase fiber intake to 25 or 30 g per day. Which of the following factors must the nurse consider when counseling the client to increase fiber intake?

The client should increase fiber intake slowly over the course of several days

A 46-year-old woman is starting to have symptoms of menopause and comes in to the healthcare provider's clinic. Which element of anticipatory guidance should the nurse include in teaching this client?

The client will experience symptoms that may be different from others in menopause

A nurse is caring for a client who is scheduled for a renal angiogram. Which of the following items is appropriate to teach the client regarding this procedure?

The client will have dye injected via the femoral artery

A client has been ordered to receive a voiding cystourethrogram because he has difficulty emptying his bladder. Which of the following actions would take place during this test? Select all that apply.

The client will lie on a table during the test The nurse inserts a catheter into the clients bladder Contrast dye is administered into the bladder for the test Images will be taken while emptying the bladder

A nurse is caring for an 86-year-old client who is undergoing surgery for a bladder suspension. The nurse assesses the client's medical history prior to surgery and documents that the client also has arthritis. Which best describes why this information is important?

The client with arthritis has a higher risk for a cardiovascular event

The nurse is preparing a male client who is about to have a digital rectal exam to check the prostate. The nurse asks the client if the lab has drawn a blood sample yet. What is the reason for the nurse to ask about a blood draw at this time?

The digital rectal exam can affect PSA levels, so the blood must be drawn prior to the exam

A nurse is palpating a client's abdomen to check for an abdominal aortic aneurysm during a physical assessment. Which part of the hand would the nurse most likely use to palpate for this finding?

The pads of the fingers

A nurse is setting up an infusion of peripheral parenteral nutrition (PPN) for nutrition support. Which of the following patients would be most suited to receive PPN instead of TPN?

The patient can take some food by mouth

A nurse is inserting an indwelling catheter in a male client. Select the following steps that the nurse performed that indicate that aseptic technique was followed when inserting the catheter. Select all that apply.

The nurse attaches the syringe to the tubing after donning sterile gloves The nurse used the forceps and cottonballs from the catheter package to swab the urinary meatus with betadine The nurse lubricated the tip of the catheter after donning sterile gloves

A 57-year-old client is preparing to undergo a total hysterectomy. The surgeon has discussed the procedure with the client, including its risks, benefits, and alternatives, and the client has asked a few questions before signing the informed consent document. Which of the following demonstrates that the nurse's role has been completed in obtaining the informed consent?

The nurse determines that the client is mentally competent to make decisions

The dialysis nurse is preparing to start dialysis on a client. The nurse assesses the client's vascular access site. Which of the following is a finding that would concern the nurse?

The nurse notes ballooning at the vascular access site

A nurse is caring for a client who is scheduled for a urea breath test. The nurse knows that this test detects which of the following substances?

The presence of Helicobacter pylori

A client with limited mobility and a history of urinary incontinence is being admitted to a long-term care facility. Which of the following would the nurse note as relevant to potential issues for this client from the history and assessment?

The presence of an endocrine disorder

The client notices that the dialysis nurse is preparing heparin for continuous renal replacement therapy (CRRT), and asks about the purpose of heparin. Which of the following responses by the nurse is correct?

The purpose of heparin is to prevent clots inside the filter

A nurse is caring for a client who is undergoing prostate surgery. Which best describes the elements of informed consent?

The risks, benefits, and alternatives to having the procedure

A nurse is providing discharge teaching to a client who has had a colostomy surgically placed during the hospital stay. What information would the nurse most likely include about the stoma for this clent? Select all that apply.

The stoma is typically round or oval in shape The stoma is usually red in color The stoma may be slightly swollen just after surgery

A nurse is helping a client with colostomy irrigation. Which best describes effluent, which is part of this process?

The stool that comes out of the colostomy

A nurse is caring for a client who has developed a surgical site infection following surgery for an open cholecystectomy. Which of the following factors contribute to infection rates in surgical wounds? Select all that apply.

The time between the client's skin preparation and the actual surgery The presence of an existing infection before surgery The client having diabetes or being immunocompromised

The provider has ordered a nephrostomy tube for a client in the nurse's care. How should the nurse explain the procedure for nephrostomy tube placement to the client?

The tube is placed directly into the kidney to drain urine

A nurse is caring for a client about to undergo a vasectomy. Which of the following is the best explanation of the procedure by the nurse?

The vas deferens will be disconnected

A physician has ordered calorie counts for a patient who needs to lose weight. Choose the answer that best describes how the nurse would instruct the client in this process.

This method includes learning common amounts of calories in foods and you keep track of what you eat every day

A nurse is working with a client who had bowel surgery with placement of a colostomy one month ago. The client has not had any complications following colostomy surgery so far. Which nutritional recommendation should the nurse give that is appropriate for a client in this stage of recovery?

Thoroughly chew food

The client is scheduled for a cholangiogram and asks about the purpose of the test. Which of the following responses from the nurse is correct?

To assess the patency of the hepatic and common bile duct

A provider has ordered a nurse to perform bladder irrigation on a client in the hospital. Which of the following describes a purpose of performing bladder irrigation in a client? Select all that apply.

To clear the bladder of blood clots To promote bladder healing To decrease bleeding

A nurse receives an order to perform a gastric lavage on a client who is in the emergency department. In which of the following conditions would a gastric lavage be performed? Select all that apply.

To empty the stomach for endoscopy To control GI bleeding To remove drugs ingested as an overdose

A client with malnutrition is receiving TPN for nutrient replacement. The nurse uses aseptic technique when preparing the TPN solution. Which best describes the rationale for this action?

To prevent transmission of pathogens

The nurse is educating a client regarding epididymitis. Which of the following pieces of information is not correct regarding this condition?

Treating sexual partners regardless of epididymitis cause

The nurse is caring for a postoperative client who just underwent an orchiectomy. The nurse understands that which of the following is a risk factor for this client's condition?

Undescended testicle

The nurse is caring for male client who wants more information about what things are tested for in a semen analysis test. Which of the following are not included in a semen analysis test?

Urinalysis

The nurse is discussing infertility with a couple in the clinic. Which of the following factors is not a factor that can cause male infertility?

Urinary tract abnormalities

The nurse is answering questions from a client who is diagnosed with epididymitis. Which of the following conditions could have caused epididymitis? Select all that apply.

Urinary tract infection Sexually transmitted infection

A 63-year-old female client complains of urinary retention and an inability to empty her bladder. The nurse understands that the client is likely experiencing which of the following conditions? Select all that apply.

Uterine prolapse Urethral stricture Bladder tumor

The nurse is educating a client regarding management of varicoceles. Which of the following recommendations would be inappropriate for varicocele management?

Utilize heat to help decrease swelling

The nurse is assessing a client who presents with painless, palpable veins on his scrotum. Which of the following diagnoses does the nurse suspect?

Varicocele

The nurse is caring for a client in renal failure who has recently learned that she must begin dialysis. Which of the following is an indication that the client would benefit from peritoneal dialysis instead of hemodialysis? Select all that apply.

Vascular access failure Congestive heart failure An active lifestyle A fear of needles Intolerance to hemodialysis

The nurse is caring for a male client with infertility. The client asks what treatment options are available to treat this condition. Which of the following is correct?

Vasovasostomy

A 70-year-old client is at the primary care clinic for a routine physical exam. The nurse is talking to the client about changes in nutrition needs as an older adult. Which type of nutrient is the client at the greatest risk of a deficiency?

Vitamin D

A provider has ordered a serum creatinine test for a client who is being assessed for chronic kidney disease. The client asks the nurse about the test. Which of the following responses correctly explains serum creatinine?

We are testing to see if your kidneys are able to excrete waste through your urine

A client with Crohn's disease has been using whey protein shakes for weight gain. What information should the nurse give to this client about the safety of using these types of shakes? Select all that apply.

Whey protein is usually safe for use in adults when used at recommended amounts Whey protein may cause changes in cholesterol levels Whey protein has been known to lower blood pressure in some people

A client is preparing to undergo a radical prostatectomy. During the pre-operative visit, the client asks the nurse, "When do I get to eat again?" Which response from the nurse is accurate?

You will most likely have something to drink starting soon after your surgery

A client with a history of ulcerative colitis is having surgery for placement of an ileoanal reservoir. The nurse is educating the client about what to expect from the procedure. Which of the following statements by the nurse is correct?

You will most likely need more than one surgery before this process is complete

A nurse is counseling a client who has abdominal pain. The client says to the nurse, "My father died of colon cancer and now that I'm over 50, I'm sure that I have it, too!" Which of the following responses from the nurse is most appropriate?

Your age and family history do put you at greater risk, but we should look at your test results before coming to further conclusions

The nurse is caring for an infant who has just undergone surgery for Hirschsprung's disease. Which of the following statements would be appropriate to tell the infant's parent?

Your baby will have a temporary colostomy

The nurse is caring for a client who is scheduled for a gastrin test. The nurse explains to the client that the gastrin test is primarily to evaluate a client for which of the following conditions?

Zollinger-Ellison Syndrome

During an admission assessment of a client with rectal cancer, the nurse recognizes which of the following as a symptom directly related to this type of cancer?

blood in the stool