Nutrition practice questions part 1

A client admits to the medical floor with viral hepatitis. The nurse expects to see which symptoms? Select All That Apply A. Abdominal pain B. Yellow sclerae C. Pruritus D. Dark urine E. Fever

Answer: A, B, C, D, E Explanation Yellow sclerae, dark urine, fever, abdominal pain, and pruritus are symptoms of viral hepatitis. Viral hepatitis is the most common type of hepatitis and causes diffuse inflammation of the liver cells. Viral hepatitis can be caused by an infection from the hepatitis A, B, C, D, or E viruses; however, some forms of viral hepatitis are not caused by any of these. Other types of hepatitis can be caused by chemicals, drugs, and some herbals. Additional symptoms of viral hepatitis include joint and muscle pain, diarrhea and constipation, malaise, nausea, and vomiting.

The nurse cares for a patient after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement? A. "Fluid intake should be at least 2000 mL/day with meals to avoid dehydration." B. "A high-protein diet that is low in carbohydrates and fat will prevent diarrhea." C. "Food should be high in fiber to prevent constipation from the pain medication." D. "Three meals a day with no snacks between meals will provide optimal nutrition."

Correct Answer: "A high-protein diet that is low in carbohydrates and fat will prevent diarrhea." Rationale: The diet generally prescribed is high in protein and low in carbohydrates, fat, and roughage and consists of 6 small feedings daily. Fluids should not be ingested with the meal, and in some cases, fluids should be restricted to less than 1000 mL/day. Fluids and foods high in carbohydrate tend to promote diarrhea and symptoms of the dumping syndrome. Calorically dense foods, such as foods high in fat, should be avoided to permit more nutritionally sound food to be consumed.

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

Correct Answer: Antibiotic(s), proton pump inhibitor, and bismuth Rationale: To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

Correct Answer: "I can help control my blood pressure by avoiding foods high in salt." Rationale: Patients with type 2 diabetes to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with type 2 diabetes need to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment of retinopathy.

The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet." Next

Correct Answer: "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Rationale: Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes. High-protein diets are not recommended for weight loss.

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I will need to cut back the number of times I shower per week." D. "My shoes should fit nice and tight because they will give me firm support."

Correct Answer: "I should look at the condition of my feet every day." Rationale: Patients with diabetes need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Routine care includes regular bathing.

The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75° F) for up to 1 month."

Correct Answer: "I will discard any insulin bottle that is cloudy in appearance." Rationale: Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (<32°F [0°C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I will go running when my blood sugar is too high to lower it." B. "I will go fishing frequently and pack a healthy lunch with plenty of water." C. "I do not need to increase my exercise routine since I am on my feet all day at work." D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Next

Correct Answer: "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Rationale: The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and walking at work are light activity, and running is considered vigorous activity.

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? A. "It would be beneficial for you to stop drinking alcohol." B. "You'll need to drink at least 2 to 3 glasses of milk daily." C. "Many people find that a minced or pureed diet eases their symptoms of PUD." D. "You can keep your present diet and minimize symptoms by taking medication."

Correct Answer: "It would be beneficial for you to stop drinking alcohol." Rationale: Alcohol increases the amount of stomach acid produced, so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some dietary modifications to minimize symptoms. Milk may worsen PUD.

A patient with morbid obesity has elected to have the Roux-en-Y gastric bypass (RYGB) procedure. The nurse will know the patient understands the preoperative teaching when the patient makes which statement? A. "This surgery will preserve the function of my stomach." B. "This surgery will remove the fat cells from my abdomen." C. "This surgery can be modified whenever I need it to be changed." D. "This surgery decreases how much I can eat and how many calories I can absorb."

Correct Answer: "This surgery decreases how much I can eat and how many calories I can absorb." Rationale: The RYGB decreases the size of the stomach to a gastric pouch and attaches it directly to the small intestine so food bypasses 90% of the stomach, the duodenum, and a small segment of the jejunum. The vertical sleeve gastrectomy removes 85% of the stomach but preserves the function of the stomach. Lipectomy and liposuction remove fat tissue from the abdomen or other areas. Adjustable gastric banding can be modified or reversed at a later date.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

Correct Answer: "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." Rationale: In type 2 diabetes, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM

Correct Answer: 10:30 PM to 1:30 AM Rationale: Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

Which patient is at highest risk for developing oral candidiasis? A. A 74-yr-old patient who has vitamin B and C deficiencies B. A 22-yr-old patient who smokes 2 packs of cigarettes per day C. A 58-yr-old patient who is receiving amphotericin B for 2 days. D. A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks.

Correct Answer: A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks. Rationale: Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies may lead to Vincent's infection. Use of tobacco products leads to stomatitis, not candidiasis.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? A. A 48-yr-old woman with a hemoglobin A1C of 8.4% B. A 58-yr-old man with a fasting blood glucose of 111 mg/dL C. A 68-yr-old woman with a random plasma glucose of 190 mg/dL D. A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

Correct Answer: A 48-yr-old woman with a hemoglobin A1C of 8.4% Rationale: Criteria for a diagnosis of diabetes include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.

Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? A. A 58-yr-old patient with diabetic retinopathy B. A 73-yr-old patient who takes propranolol (Inderal) C. A 19-yr-old patient who is on the school track team D. A 24-yr-old patient with a hemoglobin A1C of 8.9% Next

Correct Answer: A 73-yr-old patient who takes propranolol (Inderal) Rationale: Hypoglycemic unawareness is a condition in which a person does not have the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

The nurse is caring for a patient after bariatric surgery. What should be included in the plan of care? (Select all that apply.) A. Assist with early ambulation as needed. B. Teach the patient to consume liquids with meals. C. Maintain elevation of the head of bed at 45 degrees. D. Monitor for vomiting as it is a common complication. E. Provide a diet high in carbohydrate and fat intake. F. Assess for incisional pain versus an anastomosis leak

Correct Answer: A. Assist with early ambulation as needed. C. Maintain elevation of the head of bed at 45 degrees. D. Monitor for vomiting as it is a common complication. F. Assess for incisional pain versus an anastomosis leak. Rationale: After bariatric surgery, the nurse needs to assess for incisional pain versus anastomosis leak. Because vomiting is a common postoperative complication, maintain elevation of the head of bed to reduce the risk of vomiting and aspiration. Dietary recommendations include 6 small meals that are high in protein and low in carbohydrates and fat. Fluids should be avoided during meals to prevent dumping syndrome. Early ambulation with assistance is recommended.

A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. D. The patient may be excreting sodium and retaining potassium from malnutrition. E. This level shows adequate treatment of the cellulitis and acceptable glucose control.

Correct Answer: A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. Rationale: The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The increased potassium level does not show adequate treatment of cellulitis or acceptable glucose control.

The nurse is caring for a postoperative patient who has just vomited yellow-green liquid. Which action would be an appropriate nursing intervention? A. Offer the patient an herbal supplement such as ginseng. B. Discontinue medications that may cause nausea or vomiting. C. Apply a cool washcloth to the forehead and provide mouth care. D. Take the patient for a walk in the hallway to promote peristalsis.

Correct Answer: Apply a cool washcloth to the forehead and provide mouth care. Rationale: Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily held until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.

The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level.

Correct Answer: Assess patient's perception of what it means to have diabetes. Rationale: For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration Next

Correct Answer: Cardiac monitoring to detect potassium changes Rationale: This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

Correct Answer: Cheese Rationale: Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? A. Chooses a puncture site in the center of the finger pad. B. Washes hands with soap and water to cleanse the site to be used. C. Warms the finger before puncturing the finger to obtain a drop of blood. D. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

Correct Answer: Chooses a puncture site in the center of the finger pad. Rationale: The patient should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

The nurse is caring for a patient being treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate? A. Iced tea B. Dry toast C. Hot coffee D. Plain yogurt

Correct Answer: Dry toast Rationale: Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot or cold liquids and fatty foods are generally not well tolerated.

A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? A. Malnutrition B. Bile reflux gastritis C. Dumping syndrome D. Postprandial hypoglycemia

Correct Answer: Dumping syndrome Rationale: After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.

Correct Answer: Eat 15 g of simple carbohydrates. Rationale: When a patient with type 1 diabetes is unsure about the meaning of the symptoms they are experiencing, they should treat for hypoglycemia to prevent seizures and coma from occurring. Have the patient check the blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcohol use, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? A. Barium swallow B. Endoscopic biopsy C. Capsule endoscopy D. Endoscopic ultrasonography

Correct Answer: Endoscopic biopsy Rationale: Because of this patient's history of alcohol use, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of cancer, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show esophageal problems but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer.

The nurse determines a patient has experienced the beneficial effects of famotidine when which symptom is relieved? A. Nausea B. Belching C. Epigastric pain D. Difficulty swallowing

Correct Answer: Epigastric pain Rationale: Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. It is not indicated for nausea, belching, and dysphagia.

The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

Correct Answer: Excessive thirst Rationale: The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

The nurse caring for a patient hospitalized with diabetes would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

Correct Answer: Glycosylated hemoglobin level Rationale: A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

A patient has a sliding hiatal hernia. What priority nursing intervention will reduce the symptoms of heartburn and dyspepsia? A. Keeping the patient NPO B. Putting the bed in the Trendelenburg position C. Having the patient eat 4 to 6 smaller meals each day D. Giving various antacids to determine which one works for the patient

Correct Answer: Having the patient eat 4 to 6 smaller meals each day Rationale: Eating smaller meals during the day will decrease the gastric pressure and symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenburg position is not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the health care provider's prescription, so this is not a nursing intervention.

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

Correct Answer: Increased triglyceride levels Rationale: Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

Correct Answer: Kussmaul respirations Rationale: In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy only occurs in patients with type 2 diabetes who have severe disease. B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. C. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes. D. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.

Correct Answer: Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. Rationale: Microangiopathy occurs in diabetes. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

A patient with diabetes is scheduled for a fasting blood glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time? A. 6:00 PM on the evening before the test B. Midnight before the test C. 4:00 AM on the day of the test D. 7:00 AM on the day of the test

Correct Answer: Midnight before the test Rationale: Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? A. Deep breathe, cough, and use spirometer every 4 hours. B. Maintain an upright position for at least 2 hours after eating. C. NG will have bloody drainage and it should not be repositioned. D. Keep in a supine position to prevent movement of the anastomosis.

Correct Answer: NG will have bloody drainage and it should not be repositioned. Rationale: The patient will have bloody drainage from the nasogastric (NG) tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. Deep breathing and spirometry will be done every 2 hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.

A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? A. Avoid sick people and wash hands. B. Obtain comprehensive dental care. C. Maintain hemoglobin A1C below 7%. D. Coughing and deep breathing with splinting Next

Correct Answer: Obtain comprehensive dental care. Rationale: A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

The nurse is caring for a patient who reports abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient's condition is declining? A. Pallor and diaphoresis B. Reddened peripheral IV site C. Guaiac-positive diarrhea stools D. Heart rate 90, respiratory rate 20, BP 110/60 Next

Correct Answer: Pallor and diaphoresis Rationale: A patient with hematemesis has some degree of bleeding from an unknown source. Guaiac-positive diarrhea stools would be an expected finding. When monitoring the patient for stability, the nurse observes for signs of hypovolemic shock such as tachycardia, tachypnea, hypotension, altered level of consciousness, pallor, and cool and clammy skin. A reddened peripheral IV site will require assessment to determine the need for reinsertion. Access would be critical in the immediate treatment of shock, but the IV site does not represent a decline in condition.

A patient with a history of peptic ulcer disease presents to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high Fowler's position

Correct Answer: Providing IV fluids and inserting a nasogastric (NG) tube Rationale: A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas and inhibits glucagon secretion.

Correct Answer: Reduces glucose production by the liver and enhances insulin sensitivity. Rationale: Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? A. Back pain 3 or 4 hours after eating a meal B. Chest pain relieved with eating or drinking water C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen and vomiting following indigestion

Correct Answer: Rigid abdomen and vomiting following indigestion Rationale: A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3 to 4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1 to 2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

A patient with oral cancer is not eating. A small-bore feeding tube was inserted, and the patient started on enteral feedings. Which patient goal would best indicate improvement? A. Weight gain of 1 kg in 1 week B. Tolerated the tube feeding without nausea C. Consumed 50% of clear liquid tray this shift D. The feeding tube remained in proper placement

Correct Answer: Weight gain of 1 kg in 1 week Rationale: The best goal for a patient with oral cancer that is not eating would be to note weight gain rather than loss. Consuming 50% of the clear liquid tray is not a realistic goal. The absence of nausea and proper tube placement, while desired, do not indicate nutritional improvement.

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: A. Pork B. Milk C. Chicken D. Broccoli

Correct Answer: A. Pork The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Thiamine helps turn carbohydrates into energy. It is required for the metabolism of glucose, amino acids, and lipids. Option B: Milk contains vitamins A, D, and B2. Milk and dairy foods provide the right amount of bone-building nutrients, specifically calcium, vitamin D, protein, phosphorus, magnesium, potassium, vitamin B12, and zinc. Option C: Poultry contains niacin. Meat represents an excellent source of the majority of hydrophilic vitamins, and it is the ideal dietary source of vitamin B12. The amounts of B-group vitamins (e.g. niacin, vitamin B6, and pantothenic acid) in poultry are very similar to those of other meats and do not significantly diminish during cooking. Option D: Broccoli contains vitamins C, E, and K, and folic acid. Broccoli is a rich source of multiple vitamins, minerals, and fiber. Different cooking methods may affect the vegetable's nutrient composition, but broccoli is a healthy addition to the diet whether cooked or raw.

Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: A. 45 units/L B. 100 units/L C. 300 units/L D. 500 units/L

Correct Answer: C. 300 units/L The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Basic lab studies for chronic pancreatitis can include a CBC, BMP, LFTs, lipase, amylase, lipid panel, and a fecal-elastase-1 value. Lipase and amylase levels can be elevated, but they are usually normal secondary to significant pancreatic scarring and fibrosis. Of note, amylase and lipase values should not be considered diagnostic or prognostic. Option A: 45 units/L is within normal limits. Serum amylase and lipase levels may be slightly elevated in chronic pancreatitis; high levels are found only during acute attacks of pancreatitis. In the later stages of chronic pancreatitis, atrophy of the pancreatic parenchyma can result in normal serum enzyme levels because of significant fibrosis of the pancreas, resulting in decreased concentrations of these enzymes within the pancreas. Option B: 100 units/L is within normal limits. When pancreatic tissue damage (eg. pancreatitis) or pancreatic duct is blocked, serum amylase levels increased. In acute pancreatitis, lipase levels are often very high; 10.5 times the normal level can be increased Option D: 500 units/L is an extremely elevated level seen in acute pancreatitis. In acute pancreatitis, blood amylase increased. Sometimes up to 4-6 times the highest normal level rises.

A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client? A. Tea B. Gelatin C. Custard D. Popsicle

Correct Answer: C. Custard Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding, and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. A patient prescribed a full liquid diet follows a specific diet type requiring all liquids and semi-liquids but no forms of solid intake. Option A: Tea is included in the clear liquid diet. Unlike a clear liquid diet, which includes only liquids and semi-liquids that are non-opaque, a full liquid diet is more inclusive, as it allows all types of liquids. Option B: A clear liquid diet is a specific dietary plan that only includes liquids that are fully transparent at room temperature. Some items that may be allowed include water, ice, fruit juices without pulp, sports drinks, carbonated drinks, gelatin, tea, coffee, clear broths, and clear ice pops. Option D: A popsicle is included in the clear liquid diet. The clear liquid diet assists in maintaining hydration, it provides electrolytes and calories, and offers some level of satiety when a full diet is not appropriate, but may struggle to provide adequate caloric needs if employed for more than five days.

What is the MOST common transmission route of Hepatitis C?* A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

The answer is D. IV drug use is the MOST common transmission route of Hepatitis C.

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

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

How is Hepatitis E transmitted?* A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

The answer is A.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient?* A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

The answer is A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

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

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

You're collecting a patient's medication history that has GERD. Which medication below is NOT typically used to treat GERD?* A. Colesevelam "Welchol" B. Omeprazole "Prilosec" C. Metoclopramide "Reglan" D. Ranitidine HCL "Zantac"

The answer is A. Options B is a proton-pump Inhibitors (PPIs) and it decreases stomach acid and helps the esophagus heal. Option C is a type of prokinetic drug and prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and it improves peristalsis of the GI tract. Option D is a histamine receptor blocker and it blocks histamine. When histamine is released it causes the parietal cells to release HCL but this response will be blocked so gastric acid secretion will be decreased. Option A is a drug used in gallbladder disease.

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

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

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

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

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

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

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

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

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

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

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change?* A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

The answer is A. When ammonia levels become high (normal 10-80 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

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

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

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

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

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective.* A. 2 weeks B. 24 hours C. 1 month D. 7 days

The answer is B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver.* A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

The answer is B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver.

After dinner time, during hourly rounding, a patient awakes to report they feel like "food is coming up" in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention will you perform next? A. Perform deep suctioning B. Assist the patient into the Semi-Fowler's position C. Keep the patient NPO D. Instruct the patient to avoid milk products

The answer is B. The patient is experiencing regurgitation. The clues in this scenario are the patient signs and symptoms along with the time of day (after dinner time...the patient just ate a meal and is sleeping..we can assume they are lying down). If a patient has reflux disease, the lower esophageal sphincter is weak and after a meal when a person lies down to sleep the food can regurgitate into the throat which will cause the patient to feel like "food in coming up" in the back of the throat and bitter taste in the mouth. Placing the patient in semi-fowler's position will help alleviate this.

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

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

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

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

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

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

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as?* A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

The answer is B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

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

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

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

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

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

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

Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus' ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm having later today?" You tell the patient the name of the test is:* A. Lower Esophageal Gastrointestinal Series ' B. Transesophageal echocardiogram C. Esophageal manometry D. Esophageal pH monitoring

The answer is C. An esophageal manometry assesses the function of the esophagus' ability to squeeze the food down and how the lower esophageal sphincter closes.

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

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

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful?* A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

The answer is C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 10-80 mcg/dL).

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

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

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is?* A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

The answer is C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

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

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

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B?* A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

The answer is D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

Which of the following does NOT play a role in the development of GERD?* A. Pregnancy B. Hiatal hernia C. Usage of antihistamines or calcium channel blockers D. All the above play a role in GERD

The answer is D. All the options above play a role in the development of GERD. These options can weaken the lower esophageal sphincter and cause it to not close properly.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is?* A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

The answer is D. Hepatitis A is most commonly transmitted via the fecal-oral route.

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

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

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient?* A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

The answer is D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

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

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

After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?* A. "It is best to try to consume small meals throughout the day than eat 3 large ones." B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love eating those types of hard candies." C. "It is important I avoid eating right before bedtime." D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter."

The answer is D. This statement is incorrect. The patient should have said I will AVOID lying down after eating a meal to help decrease pressure on the lower esophageal sphincter. It is important a patient does not immediately lie down after eating but wait for about 1 hour.

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear.* True False

The answer is TRUE.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply:* A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

The answers are A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply:* A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

The answers are A and C. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply:* A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

The answers are A and E. Only Hepatitis A and E cause ACUTE infections...not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

. During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY:* A. Hot and Spicy Pork Rinds B. Peppermint Patties C. Green Beans D. Tomato Soup E. Chocolate Fondue F. Almonds G. Oranges

The answers are A, B, D, E, G. Patients with GERD should avoid foods that relax the lower esophageal sphincter such as greasy/fatty foods (Hot and Spicy Pork Rinds), peppermint (peppermint patties), acidic or citrus foods/juice (tomato soup and oranges), chocolate (chocolate fondue), along with coffee and soft drinks.

A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:* A. Bitter taste in mouth B. Dry cough C. Melena D. Difficulty swallowing E. Smooth, red tongue F. Murphy's Sign

The answers are A, B, D. These are signs and symptoms seen with GERD. Melena is seen with gastrointestinal bleeding as in peptic ulcer disease. Smooth, red tongue is seen with vitamin B12 deficiency, and Murphy's Signs is seen with cholecystitis.

Select all the signs and symptoms associated with Hepatitis?* A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

The answers are A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 10-80 mcg/dL.

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

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

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

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

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

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

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

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

Select all the ways a person can become infected with Hepatitis B:* A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

The answers are B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply:* A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

The answers are B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

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

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

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply:* A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

The answers are B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply:* A. Water B. Food C. Semen D. Blood

The answers are C and D. The most common source for transmission of Hepatitis A is water and food.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply:* A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

The answers are C and D. The patient should NOT take acetaminophen (Tylenol) due to its effect on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

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

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

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

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