Med Surg Exam #3 NCLEX
The nurse is instructing a group of overweight clients on the complications of obesity that develop when weight is not controlled through diet and exercise. Which lifestyle changes does the nurse emphasize? (Select all that apply.)
"Eat a variety of foods, especially grain products, vegetables, and fruits." "Engage in moderate physical activity for at least 30 minutes each day." "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home."
A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response?
"I'll get you some information on the support group Al-Anon."
An obese client is prescribed orlistat (Xenical). The client asks the nurse how the drug works. How does the nurse respond?
"It inhibits enzymes and changes the way your body digests fats. Because fats are only partially digested and absorbed, calorie intake is decreased."
The nurse is teaching a middle-aged adult client with a body mass index (BMI) of 27.5 and a height of 5'2" about what the BMI number means. Which client statement indicates a need for further instruction?
"My goal should be to get my BMI below 18.5."
A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis?
"See your health care provider immediately when experiencing symptoms of a gallbladder attack."
A female client is concerned that her inability to conceive a child is connected to her morbid obesity. How does the nurse respond?
"Tell me about changes, if any, in your menstrual cycle each month."
The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information?
"Tell me more about your alcohol intake."
The nurse is performing a health assessment on an obese client who states, "I have tried many diets in an effort to lose weight, but have been unsuccessful." How does the nurse assess whether the client's response to stress is related to the client's obesity?
"Tell me what you do to relieve stress in your daily life."
A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response?
"This type of gallbladder inflammation is associated with hypovolemia."
The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response?
"Type 1 diabetes can occur when the pancreas is destroyed by disease."
The nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them?
"Walking 30 minutes provides the same benefit as long periods of exercise."
A client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response?
"Would you like me to contact the hospital chaplain for you?"
An obese client has been taking orlistat (Xenical) 60 mg orally three times a day for 4 weeks, but has only lost 10 pounds. The health care provider doubles the dosage and recommends behavioral changes. What behavioral changes does the nurse include in the teaching plan? (Select all that apply.)
-Keeping a daily food diary Identifying emotional and situational factors that stimulate eating -Increasing exercise
Which serum albumin level does the nurse expect to see in a healthy, ambulatory adult client?
3.7 g/dL
A malnourished client is being discharged on enteral nutrition products. Which suggestion from the registered dietitian does the nurse implement to make the enteral feeding experience more normal for the client?
Bringing the enteral product and napkin to the client on a tray
The RN who usually works on the pediatric unit is floated to the GI medical-surgical unit. Which client is appropriate for the charge nurse to assign to the float nurse?
A 20-year-old with anorexia nervosa receiving total parenteral nutrition through a central venous line
Which morbidly obese client is the least likely candidate for bariatric surgery?
A 34-year-old woman experiencing mental confusion
Which client on the medical-surgical unit does the charge nurse assign to the LPN/LVN?
A 39-year-old with a jejunal feeding tube who needs elemental feedings administered
An RN receives the change-of-shift report about these four clients. Which client does the nurse assess first?
A 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min
A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client?
Administer opioid analgesic medication
How does the nurse accurately calculate a client's body mass index (BMI)?
BMI = weight (kg)/height (in meters)2
A client has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The client is receiving continuous enteral feedings through a nasogastric (NG) tube. What does the RN ask the LPN/LVN to do for this client?
Check the residual volume of the NG tube every 4 hours
The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client?
Turkey sandwich on wheat bread
A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be best for the nurse to delegate to unlicensed assistive personnel (UAP)?
Obtaining the admission weight, height, and vital signs
An older adult with severe rheumatoid arthritis in the upper extremities is malnourished. What does the nurse suspect as the cause for this client's malnutrition?
Decreasing ability to manipulate eating utensils
The nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems?
Discontinues the IVFE infusion
The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results?
Elevated lipase, elevated white blood cell count, elevated glucose
A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing?
Fluid volume overload
Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease?
Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall
A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength?
Limiting the client's activities to one floor of the home
A client is placed on orlistat (Xenical) as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the client to expect from using this drug?
Loose stools, abdominal cramps, and nausea
An obese client with a body mass index of 30 and hypertension has been taking over-the-counter (OTC) orlistat (Xenical) 60 mg orally three times a day for 4 weeks and has lost only 10 pounds. What does the nurse anticipate the health care provider will do for this client?
Order the prescription-strength orlistat
A young adult man says that he cannot stay on a diet because of trouble finding one that will incorporate his food preferences. How does the nurse effectively plan nutritional care for this client?
Maintains a 24-hour recall (diary) of his food intake
A client is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the client?
Makes certain the client is weighed daily at the same time
Which nursing care activity for a malnourished client does the nurse safely delegate to unlicensed assistive personnel (UAP)?
Measuring current height and weight
The nurse manager in a long-term care facility plans nutritional assessments of all residents. Which nutritional assessment activity does the nurse delegate to unlicensed assistive personnel (UAP) at the facility?
Measuring the daily food and fluid intake of residents
The nurse is teaching a group of adults in the community about the 2010 Dietary Guidelines for Americans. What does the nurse include with respect to the consumption of alcohol?
Men may have 2 drinks every day
The nurse expects that which client will be discharged to the home environment first?
Middle-aged thin adult who has had a laparoscopic cholecystectomy
The nurse suspects that which client is at highest risk for developing gallstones?
Obese female on hormone replacement therapy
An older malnourished client who is taking digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel) develops a severe case of diarrhea. What does the nurse suspect is a possible cause?
Potassium chloride (Kay Ciel)
Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis?
Presence of jaundice, pain worsening when lying supine
A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element?
Protein
An older adult client needs additional dietary protein, but refuses to drink the prescribed liquid protein supplements. Which nursing intervention is most effective in increasing the client's protein intake?
Providing protein modular supplements in the form of puddings
A client has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this client?
Providing six small feedings daily and offering fluids frequently
The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client?
Side-lying position, with knees drawn up to the chest
A client who is receiving total enteral nutrition exhibits acute confusion and shallow breathing and says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's signs and symptoms?
This is refeeding syndrome
The nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately?
Urine output total is 15 mL for the past 2 hours
A client who has undergone a bariatric surgical procedure is recuperating after surgery. Which nursing intervention most effectively prevents injury to the client who is being re-positioned postoperatively?
Using a weight-rated extra-wide bed for the client
The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication?
Wipe your lips after taking pancrelipase
Based on nutritional screening findings and assessments, which client will be most successful with surgical treatment for obesity?
Woman with a BMI of 42, weight 100% above ideal body weight
An 87-year-old resident from an extended-care facility has not been eating for several days and is admitted to the hospital with a diagnosis of malnutrition. She has an enteral feeding tube placed in her left nostril. Her medications include digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel). The nurse checks the gastric pH of the feeding tube and obtains a value of 6.0, which may indicate that the feeding tube is in the client's lungs. Is there another possible explanation for the nurse to consider?
Yes; the client is taking Zantac
After receiving change-of-shift report on these clients, which client does the nurse plan to assess first?
Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min
A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications? (Select all that apply.)
check blood glucose often check bowel sounds and stools monitor mental status