MDC 2 Exam 2 NCLEX Style Practice Questions
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? A.Acute gastritis B.Duodenal ulcer C.Gastric cancer D.Gastric ulcer
A.Acute gastritis
The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? A.Duodenum B.Esophagus C.Pylorus D.Stomach
A.Duodenum
A client has been taking famotidine at home. What teaching should the nurse include with the client? A.Famotidine will inhibit gastric acid secretions. B.Famotidine will neutralize acid in the stomach. C.Famotidine will shorten the time required for digestion in the stomach. D.Famotidine will improve the mixing of foods and gastric secretions.
A.Famotidine will inhibit gastric acid secretions.
Which of the following is the most common complication associated with peptic ulcer? A.Hemorrhage B.Vomiting C.Elevated temperature D.Abdominal pain
A.Hemorrhage
The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? A.Abdominal mass B.Agitation C.Hepatomegaly D.Ascites
B.Agitation
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? A.Bradycardia B.Mental confusion C.Bradypnea D.Hypertension
B.Mental confusion
The nurse advises the patient who has just been diagnosed with acute gastritis to: A.Take an emetic to rid the stomach of the irritating products. B.Refrain from food until the GI symptoms subside. C.Restrict food and fluids for 12 hours. D.Restrict all food for 72 hours to rest the stomach.
B.Refrain from food until the GI symptoms subside.
The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid A.acetaminophen. B.decaffeinated coffee. C.skim milk. D.octreotide.
B.decaffeinated coffee.
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? A."My ulcer will heal because these medications will kill the bacteria." B. "I should take these medications only when I have pain from my ulcer." C."The medications will kill the bacteria and stop the acid production." D."These medications will coat the ulcer and decrease the acid production in my stomach."
C."The medications will kill the bacteria and stop the acid production."
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? A.Vomiting B.Hemorrhage C.Awakening in pain D.Constipation
C.Awakening in pain
Which term refers to the first portion of the small intestine? A.Pylorus B.Peritoneum C.Omentum D. Duodenum
D. Duodenum
Which is a true statement regarding the nursing considerations in administration of metronidazole? A.It may cause weight gain. B.The drug should be given before meals. C.Metronidazole decreases the effect of warfarin. D.It leaves a metallic taste in the mouth.
D.It leaves a metallic taste in the mouth.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. A.Nizatidine B.Cimetidine C.Famotidine D.Omeprazole
D.Omeprazole
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? a.Respiratory alkalosis b.Metabolic alkalosis c.Respiratory acidosis d.Metabolic acidosis
b.Metabolic alkalosis
The nurse is caring for a postoperative client who had an extensive oral and neck surgery. The client is now describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client? a.Diphenhydramine (Benadryl) b.Midazolam (Versed) intravenously c.Morphine sulfate intravenously d.Oxycodone plus acetaminophen (Percocet, Tylox)
c.Morphine sulfate intravenously
The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? a.Pernicious anemia b.Systemic infection c.Peptic ulcers d.Colostomy
c.Peptic ulcers
After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best? a."Bacteria can often cause ulcers." b."This operation often causes ulcers." c."The medication keeps your blood pH low." d."It prevents stress-related ulcers."
d."It prevents stress-related ulcers."
A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a.Alcohol intake of 1 to 2 drinks per week b.Family history of H. pylori infection c.Former smoker still using nicotine patches d.Willingness to adhere to drug therapy
d.Willingness to adhere to drug therapy
A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a.a sedentary lifestyle and smoking. b.a history of hemorrhoids and smoking. c.alcohol abuse and a history of acute renal failure. d.alcohol abuse and smoking.
d.alcohol abuse and smoking.
The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). The nurse notes in the client's record that the client is taking carbidopa/levodopa. Which order for the client by the health care provider should the nurse question? a.a low-fat diet b.elevation of upper body on pillows c.pantoprazole d.metoclopramide
d.metoclopramide
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? a.pH, 7.5. PaCO2 30 mm Hg b.pH, 7.40. PaCO2 35 mm Hg c.pH, 7.35. PaCO2 40 mm Hg d.pH, 7.25. PaCO2 50 mm Hg
d.pH, 7.25.PaCO2 50 mm Hg
Which term refers to the symptom of gastroesophageal reflux disease (GERD), which is characterized by a burning sensation in the esophagus? a.Pyrosis b.Dyspepsia c.Dysphagia d.Odynophagia
a.Pyrosis
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: A.Hemorrhage B.Intractable ulcer C.Perforation D.Pyloric obstruction
A.Hemorrhage
A client has a new order for metoclopramide. The nurse identifies that this medication can be safely administered for which condition? a.Gastroesophageal reflux disease b.Peptic ulcer with melena c.Diverticulitis with perforation d.Gastritis
a.Gastroesophageal reflux disease
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? a.Hematemesis b.Bradycardia c.Hypertension d.Polyuria
a.Hematemesis
Which of the following appears to be a significant factor in the development of gastric cancer? a.Diet b.Age c.Ethnicity d.Gender
a.Diet
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? a."Take the medication with milk." b."Be sure to wear sunscreen while taking this medicine." c."You will not experience GI upset while taking this medication." d."Do not drive when taking this medication."
b."Be sure to wear sunscreen while taking this medicine."
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH 7.55, partial pressure of arterial oxygen (PaO2), 90 mm Hg, partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg, and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: a.metabolic acidosis. b.metabolic alkalosis. c.respiratory acidosis. d.respiratory alkalosis.
d.respiratory alkalosis.
Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? a.Broiled fish b.Ice cream c.Salted pretzels d.Scrambled eggs
c.Salted pretzels
Which statement correctly identifies a difference between duodenal and gastric ulcers? a.Malignancy is associated with duodenal ulcer. b.Weight gain may occur with a gastric ulcer. c.A gastric ulcer is caused by hypersecretion of stomach acid. d.Vomiting is uncommon in clients with duodenal ulcers.
d.Vomiting is uncommon in clients with duodenal ulcers.
A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. A.Ingestion of strong acids B.Irritating foods C.Overuse of aspirin D.DASH diet E.Participation in highly competitive sports
A.Ingestion of strong acids B.Irritating foods C.Overuse of aspirin
A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. A.Liver B.Pancreas C.Bladder D.Duodenum E.Lungs
A.Liver B.Pancreas D.Duodenum
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? A.Pelvic x-ray B.Stool specimen C.Nasogastric tube insertion D.Oral contrast
C.Nasogastric tube insertion
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? A.Works best when taken on an empty stomach B.Increases the speed of gastric emptying C.Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) D.Decreases mucus production
C.Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)
The nurse and the dietitian are planning sample diet menus for a patient who is experiencing dumping syndrome. Which sample meal is best for this patient? a.Chicken salad on whole wheat bread b.Liver and onions c.Chicken and rice d.Cobb salad with buttermilk ranch dressing
c.Chicken and rice
The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal (GI) bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? a."A fluid solution goes down the tube to help clean out your stomach." b."The medication goes down the tube to help clean out your stomach." c."The primary health care provider requested the tube to be placed just in case it was needed." d."We'll start feeding you through it once your stomach is cleaned out."
a."A fluid solution goes down the tube to help clean out your stomach."
A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? a."After the operation I can eat anything I want." b"I will have to eat smaller, more frequent meals." c."I will take stool softeners for several weeks." d."This surgery may not totally control my symptoms."
a."After the operation I can eat anything I want."
A patient has been diagnosed with mild gastroesophageal reflux disease (GERD) and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient? a."Avoid caffeine-containing foods and beverages." b."Eat three meals each day and avoid snacking between meals." c."Peppermint lozenges help to reduce stomach upset." d."Sleep on your left side with a pillow between your knees."
a."Avoid caffeine-containing foods and beverages."
The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a."I just joined a gym, so I hope that helps me lose weight." b."I sure hate to give up my coffee, but I guess I have to." c."I will eat three small meals and three small snacks a day." d."Sitting upright and not lying down after meals will help." e."Smoking a pipe is not a problem and I don't have to stop."
a."I just joined a gym, so I hope that helps me lose weight." b."I sure hate to give up my coffee, but I guess I have to." c."I will eat three small meals and three small snacks a day." d."Sitting upright and not lying down after meals will help."
A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) a."It can be caused by ingestion of strong acids." b."It is a hereditary disease." c."You may have ingested some irritating foods." d."Is it possible that you are overusing aspirin." e."It is probably your nerves."
a."It can be caused by ingestion of strong acids." c."You may have ingested some irritating foods." d."Is it possible that you are overusing aspirin."
The nurse is teaching a patient with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge? a."Nizatidine (Axid) needs to be taken three times a day to be effective." b."Taking ranitidine (Zantac) at bedtime should decrease acid production at night." c."Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." d."Omeprazole (Prilosec) should be swallowed whole and not crushed."
a."Nizatidine (Axid) needs to be taken three times a day to be effective."
An older female patient is diagnosed with gastric cancer. Which statement made by the patient's family demonstrates a correct understanding of the disorder? a."This may be related to her recurring ulcer disease." b."This cancer is probably curable with surgery." c."Gastric cancer has a strong genetic component." d."Thank goodness she won't have to undergo surgery."
a."This may be related to her recurring ulcer disease."
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be a.7.50 b.7.45 c.7.35 d.7.30
a.7.50
When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. How is aphthous stomatitis best described by the nurse? a.A canker sore of the oral soft tissues b.An acute stomach infection c.Acid indigestion d.An early sign of peptic ulcer disease
a.A canker sore of the oral soft tissues
The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.) a.Achlorhydria b.Chronic atrophic gastritis c.Helicobacter pylori infection d.Iron deficiency anemia e.Pernicious anemia
a.Achlorhydria b.Chronic atrophic gastritis c.Helicobacter pylori infection e.Pernicious anemia
The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? a.Acyclovir (Zovirax) b.Diphenhydramine (Benadryl) c.Nystatin (Mycostatin) d.Tetracycline syrup (Sumycin syrup)
a.Acyclovir (Zovirax)
The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction between gastric and duodenal ulcers. a.Amount of hydrochloric acid (HCL) secretion in the stomach b.Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) c.Presence of H. pylori d.Patient's age
a.Amount of hydrochloric acid (HCL) secretion in the stomach
The nurse is examining the mouth of a client who is HIV positive. On the inner side of the lip, the nurse sees a shallow ulcer with a yellow center and red border. The client says the area has been painful for about 5 days or so. Which condition is most consistent with these findings? a.Aphthous stomatitis b.Kaposi's sarcoma c.Chancre d.Hairy leukoplakia
a.Aphthous stomatitis
A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The client's arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3- 22 mEq/L. Which action should the nurse take first? a.Apply oxygen by mask or nasal cannula. b.Apply a paper bag over the client's nose and mouth. c.Administer 50 mL of sodium bicarbonate intravenously. d.Administer 50 mL of 20% glucose and 20 units of regular insulin.
a.Apply oxygen by mask or nasal cannula.
A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood? (Select all that apply.) a.Ask a second nurse to double-check the blood. b.Prime the IV tubing with normal saline. c.Prime the IV tubing with dextrose in water. d.Take and record a set of vital signs. e.Teach the client about reaction manifestations.
a.Ask a second nurse to double-check the blood. b.Prime the IV tubing with normal saline. d.Take and record a set of vital signs. e.Teach the client about reaction manifestations.
A nurse assesses a client who is admitted with an acid-base imbalance. The client's arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3- 16 mEq/L. What action should the nurse take next? a.Assess client's rate, rhythm, and depth of respiration. b.Measure the client's pulse and blood pressure. c.Document the findings and continue to monitor. d.Notify the physician as soon as possible.
a.Assess client's rate, rhythm, and depth of respiration.
A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. What would be the first activity performed by the nurse? a.Assess lung sounds bilaterally. b.Administer prescribed morphine intravenously. c.Obtain consent for the esophagogastroscopy. d.Suction the oral cavity of the client.
a.Assess lung sounds bilaterally.
A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the client's neck. What action by the nurse takes priority? a.Assess the client's oxygenation. b.Facilitate a STAT chest x-ray. c.Prepare for immediate surgery. d.Start two large-bore IVs.
a.Assess the client's oxygenation.
A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. a.Burning sensation localized in the back or mid-epigastrium b.Feeling of emptiness that precedes meals from 1 to 3 hours c.Vomiting without associated nausea d.Severe gnawing pain that increases in severity as the day progresses e.Pain that radiates to the shoulder or jaw
a.Burning sensation localized in the back or mid-epigastrium b.Feeling of emptiness that precedes meals from 1 to 3 hours d.Severe gnawing pain that increases in severity as the day progresses
A nurse assesses a client who is experiencing an acid-base imbalance. The client's arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3- 19 mEq/L. Which assessment should the nurse perform first? a.Cardiac rate and rhythm b.Skin and mucous membranes c.Musculoskeletal strength d.Level of orientation
a.Cardiac rate and rhythm
The nurse is observing a coworker who is caring for a patient with a nasogastric tube following esophageal surgery. Which actions by the coworker require the nurse to intervene? Select all that apply. a.Checking tube placement every 12 hours b.Keeping the bed flat c.Placing the patient upright when taking sips of water d.Providing mouth care every 8 hours e.Securing the tube
a.Checking tube placement every 12 hours b.Keeping the bed flat d.Providing mouth care every 8 hours
A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a.Chocolate b.Decaffeinated coffee c.Citrus fruits d.Peppermint e.Tomato sauce
a.Chocolate c.Citrus fruits d.Peppermint e.Tomato sauce
The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. a.Compare ABG findings with previous results. b.Maintain intake and output records. c.Document presenting signs and symptoms. d.Administer IV bicarbonate. e.Suction the client's airway.
a.Compare ABG findings with previous results. b.Maintain intake and output records. c.Document presenting signs and symptoms.
Upon shift report, the nurse states the following laboratory values: pH, 7.44, PCO2, 30mmHg, and HCO3,21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state? a.Compensated respiratory alkalosis b.Uncompensated respiratory alkalosis c.Compensated metabolic acidosis d.Compensated metabolic alkalosis
a.Compensated respiratory alkalosis
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a.Delayed gastric emptying b.Eating large meals c.Hiatal hernia d.Obesity e.Viral infections
a.Delayed gastric emptying b.Eating large meals c.Hiatal hernia d.Obesity
As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What collaborative resource does the nurse suggest for this client's care? a.Dentist b.Occupational therapist c.Psychiatrist d.Speech therapist
a.Dentist
The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? a.Dysphagia b.Malnutrition c.Pain d.Regurgitation of food
a.Dysphagia
The nurse is caring for a client with sepsis and impending septic shock. Which of these interventions will help prevent lactic acidosis? a.Ensure adequate oxygenation b.Restrict carbohydrates c.Supplement potassium d.Monitor hemoglobin
a.Ensure adequate oxygenation
Cancer of the esophagus is most often diagnosed by which of the following? a.Esophagogastroduodenoscopy (EGD) with biopsy and brushings b.X-ray c.Barium swallow d.Fluoroscopy
a.Esophagogastroduodenoscopy (EGD) with biopsy and brushings
An elderly client states, "I don't understand why I have so many caries in my teeth." What assessment made by the nurse places the client at risk for dental caries? a.Exhibiting hemoglobin A1C 8.2 b.Drinking fluoridated water c.Eating fruits and cheese in diet d.Using a soft-bristled toothbrush
a.Exhibiting hemoglobin A1C 8.2
A client has a new order for metoclopramide. What potential side effects should the nurse educate the client about? a.Extrapyramidal b.Peptic ulcer disease c.Gastric slowing d.Nausea
a.Extrapyramidal
Which medication is classified as a histamine-2 receptor antagonist? a.Famotidine b.Lansoprazole c.Metronidazole d.Esomeprazole
a.Famotidine
A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? a.Hemorrhage b.Penetration c.Perforation d.Pyloric obstruction
a.Hemorrhage
A nurse assesses a client with diabetes mellitus who is admitted with an acid-base imbalance. The client's arterial blood gas values are pH 7.36, PaO2 98 mm Hg, PaCO2 33 mm Hg, and HCO3- 18 mEq/L. Which manifestation should the nurse identify as an example of the client's compensation mechanism? a.Increased rate and depth of respirations b.Increased urinary output c.Increased thirst and hunger d.Increased release of acids from the kidneys
a.Increased rate and depth of respirations
Which of these findings causes the critical care nurse to notify the primary care provider (PCP) for evaluation for intubation? a.Increasing somnolence b.Pallor c.Deep respirations d.Bounding pulse
a.Increasing somnolence
The nurse is caring for a patient diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the primary health care provider will request which medication to manage diarrhea? a.Loperamide (Imodium) b.Mesalamine (Pentasa) c.Minocycline (Minocin) d.Pantoprazole (Protonix)
a.Loperamide (Imodium)
Which of the following are functions of saliva? Select all that apply. a.Lubrication b.Protection against harmful bacteria c.Digestion d.Elimination e.Metabolism
a.Lubrication b.Protection against harmful bacteria c.Digestion
The client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap? a.Metabolic acidosis b.Respiratory alkalosis c.Metabolic alkalosis d.Respiratory acidosis
a.Metabolic acidosis
The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? a.Metabolic acidosis b.Respiratory acidosis c.Metabolic alkalosis d.Respiratory alkalosis
a.Metabolic acidosis
Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? a.Metoclopramide (Reglan) b.Famotidine (Pepcid) c.Nizatidine (Axid) d.Esomeprazole (Nexium)
a.Metoclopramide (Reglan)
Which is a true statement regarding gastric cancer? a.Most clients are asymptomatic during the early stage of the disease. b.Women have a higher incidence of gastric cancer. c.The prognosis for gastric cancer is good. d.Most cases are discovered before metastasis.
a.Most clients are asymptomatic during the early stage of the disease.
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. a.Nizatidine b.Lansoprazole c.Famotidine d.Cimetidine e.Esomeprazole
a.Nizatidine c.Famotidine d.Cimetidine
A client has been taking a 10-day course of antibiotics for pneumonia. The client has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the client about? a.Nystatin b.Cephalexin c.Fluocinolone acetonide oral base gel d.Acyclovir
a.Nystatin
The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patient's ulceration is duodenal in origin and not gastric? a.Pain occurs 1½ to 3 hours after a meal, usually at night. b.Pain is worsened by the ingestion of food. c.The patient has a malnourished appearance. d.The patient is a man older than 50 years.
a.Pain occurs 1½ to 3 hours after a meal, usually at night.
Which practice does the nurse include when teaching a client about proper oral care? a.Perform self-examination of the mouth every week, and report any unusual findings. b.Brush the teeth daily and floss as needed. c.Use drugs that reduce the flow of saliva unless lesions are present. d.Regularly rinse mouth with alcohol-based agent.
a.Perform self-examination of the mouth every week, and report any unusual findings.
The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a patient diagnosed with esophageal cancer. Which of the following instructions should be included in the teaching? a.Place food at the back of the mouth as you eat. b.Do not be overly concerned with tongue or lip movements. c.Before swallowing, tilt the head back to straighten the esophagus. d.Do not attempt to reach food particles that are on the lips or around the mouth.
a.Place food at the back of the mouth as you eat.
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? a.Prepare to assist with ventilation. b.Monitor the client's heart rhythm. c.Prepare for gastric lavage. d.Obtain a urine specimen for drug screening.
a.Prepare to assist with ventilation.
When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the unlicensed assistive personnel (UAP)? a.Provide oral care using disposable foam swabs. b.Inspect the oral mucosa for evidence of oral candidiasis. c.Instruct the client on how to use nystatin (Mycostatin) oral rinses. d.Teach the client how to make appropriate dietary choices.
a.Provide oral care using disposable foam swabs.
A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurse's highest priority intervention? a.Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider b.Asking the primary health care provider for a referral for home health services to assist with dressing changes c.Asking the spouse if any other family members are in the medical profession and could help change the dressing d.Offer literature on dressing changes and schedule follow-up phone calls with the patient and spouse to talk them through dressing changes when at home.
a.Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider
Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. a.Rabeprazole (AcipHex) b.Esomeprazole (Nexium) c.Famotidine (Pepcid) d.Nizatidine (Axid) e.Lansoprazole (Prevacid)
a.Rabeprazole (AcipHex) b.Esomeprazole (Nexium) e.Lansoprazole (Prevacid)
The nurse is instructing a client on measures to maintain effective oral health. Which measures does the nurse include in the client's teaching plan? Select all that apply. a.Regular dental checkups b.Use of mouthwashes containing alcohol c.Ensuring that dentures are slightly loose-fitting d.Managing stress as much as possible e.Eating a balanced diet
a.Regular dental checkups d.Managing stress as much as possible e.Eating a balanced diet
Which of the following is the most successful treatment for gastric cancer? a.Removal of the tumor b.Chemotherapy c.Radiation d.Palliation
a.Removal of the tumor
When caring for a client with a burn injury and eschar banding the chest, the nurse plans to observe the client for which of these acid base disturbances? a.Respiratory Acidosis b.Respiratory Alkalosis c.Metabolic Acidosis d.Metabolic Alkalosis
a.Respiratory Acidosis
A patient has been discharged home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? a.Schedule of the patient's follow-up examinations and diagnostic testing b.Information on family members' progress in learning how to perform dressing changes c.Copy of the diet plan prepared for the patient by the hospital dietitian d.Detailed account of what occurred during the patient's surgical procedure
a.Schedule of the patient's follow-up examinations and diagnostic testing
Which of the following arterial blood gas results would be consistent with metabolic alkalosis? a.Serum bicarbonate of 28 mEq/L b.PaCO2 less than 35 mm Hg c.Serum bicarbonate of 21 mEq/L d.pH 7.26
a.Serum bicarbonate of 28 mEq/L
A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? a.Starting a large-bore IV b.Administering IV pain medication c.Preparing equipment for intubation d.Monitoring the patient's anxiety level
a.Starting a large-bore IV
The nurse is caring for a group of clients. Which client will the nurse carefully observe for signs and symptoms of hyperkalemia? a.The client who has metabolic acidosis b.The client receiving total parenteral nutrition c.The client who has profuse vomiting d.The client taking a thiazide diuretic
a.The client who has metabolic acidosis
A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? a.Use saliva substitutes, especially when eating dry foods. b.This condition is common but is temporary. c.Use lozenges and hard candies to prevent dry mouth. d.This indicates a complication of therapy.
a.Use saliva substitutes, especially when eating dry foods.
The nurse working during the day shift on the medical unit has just received report. Which patient does the nurse plan to assess first? a.Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy b.Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal c.Middle-aged patient with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast d.Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy
a.Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy
A client with emphysema is at a greater risk for developing which acid-base imbalance? a.chronic respiratory acidosis b.metabolic alkalosis c.metabolic acidosis d.respiratory alkalosis
a.chronic respiratory acidosis
A client is in the initial stages of oral cancer diagnosis and is frightened about the side effects of treatment and subsequent prognosis. The client has many questions regarding this type of cancer and asks where oral cancer typically occurs. What is the nurse's response? a.floor of the mouth b.base of the tongue c.roof of the mouth d.inside of the cheeks
a.floor of the mouth
A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. a.maintaining an upright position following meals b.avoiding foods that intensify symptoms c.sleeping in a supine position d.ensuring intake of food and fluids 2 to 3 hours before bedtime
a.maintaining an upright position following meals b.avoiding foods that intensify symptoms
A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? a.metabolic alkalosis b.metabolic acidosis c.respiratory acidosis d.respiratory alkalosis
a.metabolic alkalosis
The healthcare provider of a client with oral cancer has ordered the placement of a GI tube to provide nutrition and to deliver medications. What would be the preferred route? a.nasogastric intubation b.orogastric intubation c.nasoenteric intubation d.gastrostomy
a.nasogastric intubation
The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? a.pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L b.pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L c.pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L d.pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L
a.pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L
The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.) a.Alcohol b.Caffeine c.Corticosteroids d.Fruit juice e.Nonsteroidal anti-inflammatory drugs (NSAIDs)
aAlcohol b. Caffeine c.Corticosteroids e.Nonsteroidal anti-inflammatory drugs (NSAIDs)
The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching? a."I will need to avoid sweetened fruit juice beverages." b."I can eat ice cream in moderation." c."I cannot drink alcohol at all." d."It is okay to have a serving of sugar-free pudding."
b."I can eat ice cream in moderation."
An adolescent client with multiple dental caries is discussing diet with the nurse. What client statement identifies a risk factor for dental caries? a."I brush my teeth in the morning and evening." b."I drink a can of carbonated soda at lunch every day." c."I floss before I go to bed each night." d."I visit my dentist every year."
b."I drink a can of carbonated soda at lunch every day."
After teaching a client who was malnourished and is being discharged, a nurse assesses the client's understanding. Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis? a."I will drink at least three glasses of milk each day." b."I will eat three well-balanced meals and a snack daily." c."I will not take pain medication and antihistamines together." d."I will avoid salting my food when cooking or during meals."
b."I will eat three well-balanced meals and a snack daily."
A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a."Do you have family or friends for support?" b."I'd like to know what you are feeling now." c."Well, we knew this would probably happen." d."Would you like me to refer you to hospice?"
b."I'd like to know what you are feeling now."
The nursing assistant reports that the client with metabolic acidosis due to kidney failure is breathing rapidly and deeply. The nurse explains this to the nursing assistant in which of these manners? a."The client is acting out and we should pay him no mind" b."Rapid breathing is a way to compensate for acidosis caused by his condition" c."Normally a client with this disorder will breathe slowly, I will go assess him" d."Deep breathing is a symptom of diabetes, I will check his blood glucose"
b."Rapid breathing is a way to compensate for acidosis caused by his condition"
A patient with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? a."Consume carbonated beverages if you experience stomach upset." b."Remain on a soft diet for about a week and avoid raw vegetables that are difficult to swallow." c."You may resume running and weight lifting if you wish." d."You may stop taking your antireflux medications after 1 week."
b."Remain on a soft diet for about a week and avoid raw vegetables that are difficult to swallow."
A patient who has been diagnosed recently with esophageal cancer states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response? a."I understand your concerns, but you can't give up your normal activities. You should go anyway and try not to worry about it." b."Tell me more about the lunch, what will be served and who is going with you." c."Why not take one of your antianxiety pills before going? That will keep you from worrying about everything so much." d."You need to talk to your doctor about your concerns. The doctor may recommend that you join a support group for cancer survivors."
b."Tell me more about the lunch, what will be served and who is going with you."
The nurse and nursing student are caring for a client with a new diagnosis of diabetes whose blood glucose is 974 mg/dL (54.1 mmol/L). Which of these statements indicates the student understands the relationship between blood glucose and acid base balance? a."The excess glucose in the blood causes the client to hypoventilate and retain carbon dioxide resulting in respiratory acidosis" b."The hyperglycemia is caused by inability of glucose to enter the cell causing a starvation state and break down of fats" c."The client has a hyperosmolar condition causing polyuria and polyphagia, but the acid base balance is normal" d."The client is retaining carbon dioxide which led to respiratory acidosis and somnolence"
b."The hyperglycemia is caused by inability of glucose to enter the cell causing a starvation state and break down of fats"
A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? a."No, they probably won't be useful. You should use only prescription medications in your treatment plan." b."These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." c."Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them." d."No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."
b."These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen."
A patient has a long-term history of Crohn's disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? a."Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." b."We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." c."What has your doctor told you about how your gastritis developed?" d."Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"
b."We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."
A patient has been diagnosed with terminal esophageal cancer. The patient is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? a."Haven't you received adequate pain management in the hospital?" b."Would you like me to get a nurse from hospice to come talk with you?" c."Do you want me to call the hospital chaplain to explain hospice to you?" d."Talk to your primary health care provider about hospice services."
b."Would you like me to get a nurse from hospice to come talk with you?"
A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. a.High intake of fruits and vegetables b.Age 55 years c.Female gender d.European ancestry e.Previous infection with H. pylori
b.Age 55 years e.Previous infection with H. pylori
A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home? a.Oral Cancer Foundation b.American Cancer Society (ACS) c.Client Advocate Foundation d.American Medical Supply Foundation
b.American Cancer Society (ACS)
A nurse evaluates the following arterial blood gas values in a client: pH 7.48, PaO2 98 mm Hg, PaCO2 28 mm Hg, and HCO3- 22 mEq/L. Which client condition should the nurse correlate with these results? a.Diarrhea and vomiting for 36 hours b.Anxiety-induced hyperventilation c.Chronic obstructive pulmonary disease (COPD) d.Diabetic ketoacidosis and emphysema
b.Anxiety-induced hyperventilation
A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? a.Teach the patient about antacid effects and side effects. b.Ask the patient about oral intake, current medications and description of episodes. c.Suggest that the patient sleep with the head elevated 6 inches (15 cm). d.Tell the patient to avoid drinking alcohol late in the evening.
b.Ask the patient about oral intake, current medications and description of episodes.
A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best? a.Arrange an intensive care unit tour. bAssess the client's psychosocial status. c.Document the teaching and response. d.Have the client begin nutritional supplements.
b.Assess the client's psychosocial status.
Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. a.Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. b.Avoid beer, especially in the evening. c.Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. d.Elevate the head of the bed on 6- to 8-inch blocks. e.Elevate the upper body on pillows.
b.Avoid beer, especially in the evening. d.Elevate the head of the bed on 6- to 8-inch blocks. e.Elevate the upper body on pillows.
The nurse is creating a plan of care for a client who is not able to tolerate brushing his teeth. The nurse includes which mouth irrigation in the plan of care? a.Dextrose and water b.Baking soda and water c.Full-strength peroxide d.Mouthwash and water
b.Baking soda and water
Which clinical manifestation is not associated with hemorrhage? a.Tachycardia b.Bradycardia c.Tachypnea d.Hypotension
b.Bradycardia
A nurse is caring for a client who has the following arterial blood values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3- 22 mEq/L. Which clinical situation should the nurse correlate with these values? a.Diabetic ketoacidosis in a person with emphysema b.Bronchial obstruction related to aspiration of a hot dog c.Anxiety-induced hyperventilation in an adolescent d.Diarrhea for 36 hours in an older, frail woman
b.Bronchial obstruction related to aspiration of a hot dog
When a client's ventilation is impaired, the body retains which substance? a.Sodium bicarbonate b.Carbon dioxide c.Nitrous oxide d.Oxygen
b.Carbon dioxide
The nurse is caring for a patient with esophageal cancer who has received photodynamic therapy using porfimer sodium (Photofrin). What instructions does the nurse include in teaching the patient about porfimer sodium? Select all that apply. a.Avoid sunlight for 2 weeks. b.Cover or shield all exposed body areas from sunlight. c.Follow a clear liquid diet for 3 to 5 days after the procedure. d.Monitor for hypertension. e.Tissue particles may be found in the sputum.
b.Cover or shield all exposed body areas from sunlight. c.Follow a clear liquid diet for 3 to 5 days after the procedure e.Tissue particles may be found in the sputum.
The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? Select all that apply. a.Blood-tinged sputum b.Dyspepsia c.Excessive salivation d.Flatulence e.Regurgitation
b.Dyspepsia c.Excessive salivation d.Flatulence e.Regurgitation
The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations? (Select all that apply.) a.Aphasia b.Dysphagia c.Eructation d.Halitosis e.Weight gain
b.Dysphagia c.Eructation d.Halitosis
The nurse is caring for a client who has developed postoperative respiratory acidosis. Which of these interventions will the nurse use to help correct this problem? a.Medicate for pain. b.Encourage use of incentive spirometer. c.Perform fingerstick blood glucose. d.Encourage protein intake.
b.Encourage use of incentive spirometer.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? a.Barium study of the upper gastrointestinal tract b.Endoscopy c.Gastric secretion study d.Stool antigen test
b.Endoscopy
A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client? a.Enteral tube feeding b.Esophageal dilation c.Nissen fundoplication d.Photodynamic therapy
b.Esophageal dilation
A patient is experiencing painful, inflamed, and swollen gums, and when brushing the teeth, the gums bleed. What common disease of the oral tissue does the nurse understand these symptoms indicate? a.Candidiasis b.Gingivitis c.Herpes simplex d.Cancer of the oral mucosa
b.Gingivitis
The nurse is caring for a client with acute respiratory failure and PaCO2 level of 88 mm Hg For which of these signs and symptoms will the nurse assess? Select all that apply. a.Hyperactivity b.Headache c.Shallow breathing d.pH 7.49 e.Fatigue
b.Headache c.Shallow breathing e.Fatigue
Which could be a potential cause of respiratory acidosis? a.Vomiting b.Hypoventilation c.Diarrhea d.Hyperventilation
b.Hypoventilation
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? a.No effect b.Increases arterial pH c.Decreases arterial pH d.Provides long-term pH regulation
b.Increases arterial pH
The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? a.Type and crossmatch for 4 units of packed red blood cells. b.Infuse 0.9% normal saline solution at 200 mL/hr. c.Give pantoprazole (Protonix) 40 mg IV now and then daily. d.Insert a nasogastric tube and connect to low intermittent suction.
b.Infuse 0.9% normal saline solution at 200 mL/hr.
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? a.Administer an ordered decongestant. b.Instruct the client to breathe into a paper bag. c.Offer the client fluids frequently. d.Administer ordered supplemental oxygen.
b.Instruct the client to breathe into a paper bag.
A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance. For which manifestation of this acid-base imbalance should the nurse assess? a.Agitation b.Kussmaul respirations c.Seizures d.Positive Chvostek's sign
b.Kussmaul respirations
A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met? a.Choosing foods that are easy to swallow b.Lungs clear after meals and snacks c.Properly performing swallowing exercises d.Weight unchanged after 2 weeks
b.Lungs clear after meals and snacks
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? a.Respiratory alkalosis b.Metabolic alkalosis c.Respiratory acidosis d.Metabolic acidosis
b.Metabolic alkalosis
The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority? a.Administer the prescribed pain medication. b.Notify the health care provider immediately. c.Percuss all four abdominal quadrants. d.Take and document a set of vital signs.
b.Notify the health care provider immediately.
A patient reports an inflamed salivary gland below the right ear. The nurse documents probable inflammation of which gland? a.Buccal b.Parotid c.Sublingual d.Submandibular
b.Parotid
The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? a.Apply antiembolism stockings. b.Place a nasogastric (NG) tube, and connect to suction. c.Insert an indwelling catheter, and check output hourly. d.Give famotidine (Pepcid) 20 mg IV every 12 hours.
b.Place a nasogastric (NG) tube, and connect to suction.
A client with oral cancer reports dryness of the mouth. What is the nurse's best response? a.State, "This is a normal consequence of oral cancer." b.Provide a humidifier for the client to use while sleeping. c.Ensure that the client maintains a fluid intake of 2000 mL per day. d.Allow the client to continue with his or her usual diet.
b.Provide a humidifier for the client to use while sleeping.
A client has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first? a.Notify the surgeon. b.Put on a pair of gloves. c.Reinsert the NG tube. d.Take a set of vital signs.
b.Put on a pair of gloves.
Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? a.Retape the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy. b.Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. c.Document instructions for a patient with chronic gastritis about how to use "triple therapy." d.Assess the gag reflex for a patient who has arrived from the post anesthesia care unit after a laparoscopic gastrectomy.
b.Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis.
A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? a.Document the findings in the chart. b.Request an electrocardiogram (ECG). c.Facilitate a serum potassium test. d.Place the client on bedrest.
b.Request an electrocardiogram (ECG).
The nurse notes that a client has inflammation of the salivary glands. The nurse documents which finding? a.Parotitis b.Sialadenitis c.Stomatitis d.Pyosis
b.Sialadenitis
A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? a.renin-angiotensin-aldosterone system b.bicarbonate-carbonic acid buffer system c.sodium-potassium pump d.ADH-ANP buffer system
b.bicarbonate-carbonic acid buffer system
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a.HCO3 21 mEq/L b.pH 7.48 c.PaCO2 36 d.O2 saturation 95%
b.pH 7.48
Which set of arterial blood gas (ABG) results requires further investigation? a.pH 7.38, PaCO2 36 mm Hg, PaO2 95 mm Hg, and HCO3- 24 mEq/L b.pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L c.pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L d.pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L
b.pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? a."I should stop all my medications if I develop any side effects." b."I should continue my treatment regimen as long as I have pain." c."I have learned some relaxation strategies that decrease my stress." d."I can buy whatever antacids are on sale because they all have the same effect."
c."I have learned some relaxation strategies that decrease my stress."
The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? a."It is okay to continue to drink coffee in the morning when I get to work." b."I will need to take vitamin B12 shots for the rest of my life." c."I should avoid alcohol and tobacco." d."I should eat small meals about six times a day."
c."I should avoid alcohol and tobacco."
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? a.4 to 6 days b.7 to 9 days c.10 to 14 days d.15 to 20 days
c.10 to 14 days
When caring for a client who has the following blood gas results, which of these interventions does the nurse plan to use to correct the acid base disturbance? pH 7.47—pCO2 37 mm hg- HCO3 30 mEq/L (30 mmol/L)—pO2 88mm hg a.Endotracheal suctioning b.Applying oxygen c.Administering an antiemetic d.Administering sodium bicarbonate
c.Administering an antiemetic
The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? a.Administering a histamine2 (H2) antagonist b.Initiating enteral nutrition c.Administering intravenous (IV) fluids d.Administering antianxiety medication
c.Administering intravenous (IV) fluids
A client has been receiving radiation therapy to the lungs and now has erythema, edema, and pain of the mouth. What instruction will the nurse give to the client? a.Use a hard-bristled toothbrush. b.Rinse with an alcohol-based solution. c.Brush and floss daily. d.Continue with the usual diet.
c.Brush and floss daily.
Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis? a.Lichen planus b.Actinic cheilitis c.Chancre d.Leukoplakia
c.Chancre
The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium) once daily. The patient reports that this proton pump inhibitor medication doesn't completely control the symptoms. The nurse contacts the primary health care provider to discuss which intervention? a.Adding a second proton pump inhibitor medication b.Increasing the dose of esomeprazole c.Changing to a twice-daily dosing regimen d.Switching to omeprazole (Prilosec)
c.Changing to a twice-daily dosing regimen
The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? Select all that apply. a.Apples b.Bananas c.Cheese d.Nuts e.Potatoes
c.Cheese d.Nuts e.Potatoes
A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first? a.Client who underwent diverticula removal with a pulse of 106/min b.Client who had esophageal dilation and is attempting first postprocedure oral intake c.Client who had an esophagectomy with a respiratory rate of 32/min d.Client who underwent hernia repair, reporting incisional pain of 7/10
c.Client who had an esophagectomy with a respiratory rate of 32/min
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? a.Myasthenia gravis b.Type 1 diabetes mellitus c.Extreme anxiety d.Opioid overdose
c.Extreme anxiety
A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? a.Peptic ulcer disease b.Esophageal cancer c.Gastroesophageal reflux disease d.Diverticulitis
c.Gastroesophageal reflux disease
A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a.Assess the client for iodine or shellfish allergies. b.Educate the client on the side effects of sedation. c.Inform the client a second scan may be needed. d.Teach the client about bowel preparation for the scan.
c.Inform the client a second scan may be needed.
A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting
c.Intolerance of fatty foods d.Pernicious anemia
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? a.Kidney and liver b.Heart and lungs c.Lungs and kidney d.Pancreas and stomach
c.Lungs and kidney
A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? a.Applying cold compresses b.Avoiding the use of fruit or citrus-flavored candy c.Massaging the salivary gland d.Restrict fluids
c.Massaging the salivary gland
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis
c.Metabolic acidosis
Which of these assigned patients does the nurse assess first after receiving the change-of-shift report? a.Young adult admitted the previous day with abdominal pain who is scheduled for a computed tomography (CT) scan in 30 minutes b.Adult with gastroesophageal reflux disease (GERD) who is describing epigastric pain at a level of 6 (0-to-10 pain scale) c.Middle-aged adult with an esophagectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube d.Older adult admitted with an ileus who has absent bowel sounds and a prescription for metoclopramide (Reglan) on an as-needed (PRN) basis
c.Middle-aged adult with an esophagectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube
A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a.Famotidine (Pepcid) b.Magnesium hydroxide (Maalox) c.Omeprazole (Prilosec) d.Ranitidine (Zantac)
c.Omeprazole (Prilosec)
A client has a nasogastric (NG) tube. What action by the nursing student requires the registered nurse to intervene? a.Checking tube placement every 4 to 8 hours b.Monitoring and documenting drainage from the NG tube c.Pinning the tube to the gown so the client cannot turn the head d.Providing oral care every 4 to 8 hours
c.Pinning the tube to the gown so the client cannot turn the head
A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an): a.Extension of the esophagus through an opening in the diaphragm. b.Involution of the esophagus, which causes a severe stricture. c.Protrusion of the upper stomach into the lower portion of the thorax. d.Twisting of the duodenum through an opening in the diaphragm.
c.Protrusion of the upper stomach into the lower portion of the thorax.
A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which strategy should the nurse use to assist the client? a.Urge the client to regularly rinse the mouth with tap water. b.Recommend that the client drink a small glass of alcohol at the end of the day to kill germs. c.Provide the client with an irrigating solution of baking soda and warm water. d.Regularly wipe the outside of the client's mouth to prevent germs from entering.
c.Provide the client with an irrigating solution of baking soda and warm water.
A patient with an inoperable esophageal tumor is receiving swallowing therapy. Which task does the home health nurse delegate to an experienced home health aide? a.Teaching family members how to determine whether the patient is obtaining adequate nutrition b.Assessing lung sounds for possible aspiration when the patient is swallowing clear liquids c.Reminding the patient to use the chin-tuck technique each time the patient attempts to swallow d.Instructing family members about symptoms that may indicate a need to call the primary health care provider
c.Reminding the patient to use the chin-tuck technique each time the patient attempts to swallow
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis
c.Respiratory acidosis
The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the client's teaching plan? a.Encourage the client to eat acidic foods to decrease bacteria. b.Mouth care should be performed twice daily. c.Rinse the mouth with warm saline or sodium bicarbonate. d.Use a medium-bristled toothbrush for oral care.
c.Rinse the mouth with warm saline or sodium bicarbonate.
A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a.Administer ibuprofen (Motrin). b.Call the Rapid Response Team. c.Start a large-bore IV with normal saline. d.Tell the client to remain lying down
c.Start a large-bore IV with normal saline.
Which condition leads to chronic respiratory acidosis in older adults? a.Decreased renal function b.Erratic meal patterns c.Thoracic skeletal change d.Overuse of sodium bicarbonate
c.Thoracic skeletal change
A client has a new order for metoclopramide. What extrapyramidal side effect should the nurse assess for in the client? a.Anxiety or irritability b.Hyperactivity c.Uncontrolled rhythmic movements of the face or limbs d.Dry mouth not relieved by sugar-free hard candy
c.Uncontrolled rhythmic movements of the face or limbs
The most common symptom of esophageal disease is a.nausea. b.vomiting. c.dysphagia. d.odynophagia.
c.dysphagia.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience a.vomiting. b.hemorrhage. c.pain 2 to 3 hours after a meal. d.weight loss.
c.pain 2 to 3 hours after a meal.
The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they state a."Most oral cancers are painful at the outset." b."Blood testing is used to diagnose oral cancer." c."A typical lesion is soft and craterlike." d."Many oral cancers produce no symptoms in the early stages."
d."Many oral cancers produce no symptoms in the early stages."
A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds (2.3 kg) of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? a.Explain to the patient the importance of drinking the enteral supplements prescribed. b.Ask the patient's family to try to persuade the patient to drink the supplements. c.Inform the patient that a nasogastric tube may be necessary if he or she fails to comply. d.Ask the patient if a change in flavor would make the supplement more palatable.
d.Ask the patient if a change in flavor would make the supplement more palatable.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? a.Notify the health care provider. b.Irrigate the client's NG tube. c.Place the client in the high-Fowler's position. d.Assess the client's abdomen and vital signs.
d.Assess the client's abdomen and vital signs.
A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? a.Suction the client's oral secretions to clear the airway. b.Place the client on humidified oxygen per nasal cannula. c.Assist the client to an upright position to facilitate breathing. d.Assess the respiratory effort and quantities and types of oral secretions.
d.Assess the respiratory effort and quantities and types of oral secretions.
The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient's gastroesophageal reflux disease (GERD). Which change does the nurse recommend to this patient? a.Eat only two or three meals daily. b.Sleep flat in a left side-lying position. c.Drink tea instead of coffee. d.Avoid working while bent over the computer.
d.Avoid working while bent over the computer.
The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? a.PaO2 b.SPO2 c.Carbonic acid d.Bicarbonate
d.Bicarbonate
The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding? a.Respiratory rate from 24 to 20 breaths/min b.Apical pulse from 80 to 72 beats/min c.Temperature from 97.9° F to 98.9° F (36.6°C to 37.2°C) d.Blood pressure from 140/90 to 110/70 mm Hg
d.Blood pressure from 140/90 to 110/70 mm Hg
The nurse is working with the dietitian to plan a menu for a patient who has persistent difficulty swallowing. What is a suitable breakfast selection for this patient? a.Scrambled eggs and toast b.Oatmeal and orange juice c.Puréed fruit and English muffin d.Cream of wheat and applesauce
d.Cream of wheat and applesauce
The nurse is caring for a client with long standing emphysema and respiratory acidosis. For which of these compensatory mechanisms will the nurse assess? a.Decreased rate of breathing b.Increased loss of bicarbonate through the kidney c.Decreased depth of breathing d.Decreased loss of bicarbonate through the kidney
d.Decreased loss of bicarbonate through the kidney
The nurse is caring for an older adult who reports xerostomia. The nurse evaluates for use of which medication? a.Steroids b.Antibiotics c.Antiemetics d.Diuretics
d.Diuretics
A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document? a.Aphthous stomatitis b.Nicotine stomatitis c.Erythroplakia d.Hairy leukoplakia
d.Hairy leukoplakia
A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a.Albumin: 2.1 g/dL b.Hematocrit: 28% c.Hemoglobin: 8.1 mg/dL d.International normalized ratio (INR): 4.2
d.International normalized ratio (INR): 4.2
The nurse is reviewing orders for a patient with possible esophageal trauma after a car crash. Which request does the nurse implement first? a.Give total parenteral nutrition (TPN) through a central venous catheter. b.Administer cefazolin (Kefzol) 1 g intravenously. c.Obtain a computed tomography (CT) scan of the chest and abdomen. d.Keep the patient nothing by mouth (NPO) to prevent further leakage of esophageal contents.
d.Keep the patient nothing by mouth (NPO) to prevent further leakage of esophageal contents.
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a.Nausea or vomiting b.Abdominal pain or diarrhea c.Hallucinations or tinnitus d.Light-headedness or paresthesia
d.Light-headedness or paresthesia
A client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? a.Listen to the client and then explain that it is normal to feel depressed about the diagnosis. b.Explain the grieving process and listen to what the client has to say. c.Suggest that the client talk with friends and family and seek their support. d.Listen to the client's concerns and feelings and then suggest that the client join a community group of cancer survivors.
d.Listen to the client's concerns and feelings and then suggest that the client join a community group of cancer survivors.
A client has the following arterial blood gas (ABG) values: pH, 7.12, partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg, and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a.Respiratory alkalosis b.Respiratory acidosis c.Metabolic alkalosis d.Metabolic acidosis
d.Metabolic acidosis
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis
d.Metabolic alkalosis
A nurse assesses a client who is prescribed furosemide (Lasix) for hypertension. For which acid-base imbalance should the nurse assess to prevent complications of this therapy? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis
d.Metabolic alkalosis
The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health care provider will request which medication for this patient? a.Bismuth subsalicylate (Pepto-Bismol) b.Magnesium hydroxide (Maalox) c.Metronidazole (Flagyl) d.Misoprostol (Cytotec)
d.Misoprostol (Cytotec)
Which patient assessment information is correlated with a diagnosis of chronic gastritis? a.Anorexia, nausea, and vomiting b.Frequent use of corticosteroids c.Hematemesis and anorexia d.Radiation therapy, smoking, and excessive alcohol use
d.Radiation therapy, smoking, and excessive alcohol use
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? a.Metabolic acidosis b.Respiratory acidosis c.Metabolic alkalosis d.Respiratory alkalosis
d.Respiratory alkalosis
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51, PaCO2, 28 mm Hg, PaO2, 70 mm Hg,and HCO3--, 24 mEq/L. What do these values indicate? a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis
d.Respiratory alkalosis
"A patient is being discharged, 8 days postoperatively following a total esophagectomy." Which teaching point does the nurse consider to be of the highest priority during the transition to home? a.Instruct the patient to eat three meals daily. b.Emphasize the importance of lying down after meals. c.Encourage the patient to ask his or her health care provider for antidepressant medication. d.Stress the importance of notifying the primary health care provider if leaking is noted at the incision site.
d.Stress the importance of notifying the primary health care provider if leaking is noted at the incision site.
A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? a Document the findings in the chart. b.Notify the surgeon immediately. c.Reassess the drainage in 1 hour. d.Take a full set of vital signs.
d.Take a full set of vital signs.
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a.Check with the pharmacist before taking other medications. b.Increase intake of calcium and vitamin D. c.Report any worsening of symptoms to the provider. d.Take the medication as prescribed by the provider.
d.Take the medication as prescribed by the provider.
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which action should the nurse take? a.Monitor daily hemoglobin and hematocrit values. b.Administer furosemide (Lasix) intravenously. c.Encourage the client to take deep breaths. d.Teach the client fall prevention measures.
d.Teach the client fall prevention measures.
The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? a.The lungs are unable to breathe in sufficient oxygen. b.The lungs are unable to exchange oxygen and carbon dioxide. c.The lungs have ineffective cilia from years of smoking. d.The lungs are not able to blow off carbon dioxide.
d.The lungs are not able to blow off carbon dioxide.