POP3 Exam2 LA questions

A 35-year-old patient is admitted to the ED with fever, chills, and severe right flank pain. His heart rate is 112/min and respiratory rate is 32/min. He was recently treated for a urinary tract infection. Assessment reveals tenderness of the right costovertebral angle (CVA). What diagnosis does the nurse expect? What laboratory tests does the nurse anticipate?

1. Acute pyelonephritis. 2. Urinalysis - positive leukocyte esterase and nitrite dipstick test, presence of white blood cells (WBCs) and bacteria; urine culture and sensitivity (C&S); blood cultures; C-reactive protein; erythrocyte sedimentation rate.

The nurse is teaching a client with PUD about the prescribed drug regimen. Which statement made by the client 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." see tables on pages 1133-1134 Axid is given 2 a day or at bedtime to suppress nocturnal acid production Zantac is correct Carafate is a mucosal barrier works by protecting the mucosal lining Prilosec is a capsule do not crush so this is true

THE NURSE IS CARING FOR A PATIENT WITH A DIAGNOSES OF RULE-OUT PEPTIC ULCER DISEASE. WHICH TEST CONFIRMS THIS DIAGNOSIS? A. EGD (ESOHAGOGASTRODUODENSCOPY) B. MRI (MAGNETIC RESONANCE IMAGING) C. OCCULT BLOOD TEST D. GASTRIC ACID STIMULATION

A. EGD (ESOHAGOGASTRODUODENSCOPY)

Which of the following sites should the nurse use to assess McBurney's point? A. In the right lower quadrant, half-way between the anterior illiac crest and the umbilicus B. In the right upper quadrant, half-way between the lower sternum and the umbilicus C. In the left lower quadrant, half-way between the anterior iliac crest and the umbilicus D. In the left upper quadrant, half-way between the lower sternum and the umbilicus

A. In the right lower quadrant, half-way between the anterior illiac crest and the umbilicus

After abdominal surgery, what patient assessment finding alerts the nurse to the fact that peristaltic movement is returning? A. passing flatus B. reports of hunger C. absence of nausea D. presence of normal bowel sounds

A. passing flatus EBP suggests that patient report of passing flatus is more reliable than return of bowel sounds in assessing peristaltic movement after abdominal surgery.

A client 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 clients anxiety level

A. starting a large-bore IV @ risk for dehydration

A patient with chronic pancreatitis often has frequent, frothy, foul smelling stools, a condition known as________. A. Melena B. Meconium C. Steatorrhea D. C-Difficile

C. Steatorrhea

Which client should the charge nurse assign to an experienced LPN? A. A 28 year old who requires teaching about how to catharize a Kock ileostomy B. A 30 year old who must receive neomycin sulfate (Mycifradin) before a colectomy C. A 34 year old ulcerative colitis (UC) who has a white blood cell count of 23,000 D. A 38 year old with gastroenteritis who is receiving IV fluids at 250 ml/hr

B. A 30 year old who must receive neomycin sulfate (Mycifradin) before a colectomy scope of practice, most stable

The nurse suspects that which client is at highest risk for developing gallstones. A. Obese male with a history of COPD. B. Obese female on hormone replacement therapy. C. Thin male with a history of coronary artery bypass grafting. D. Thin female who has recently given birth.

B. Obese female on hormone replacement therapy.

A patient is just admitted to the medical surgical unit with acute exacerbation of Ulcerative Colitis. Which intervention should the nurse implement first? A. Provide a low residue diet. B. Rest the patient's bowel. C. Assess the vital signs daily. D. Administer antacids orally.

B. Rest the patient's bowel

The RN receives a change of shift report about four clients. Which of the clients does the nurse assess first? A. 20 year old with ulcerative colitis (UC) who had six liquid stools during the previous shift B. a 25 year old who just been admitted with possible appendicitis and a has a temperature of 102 F C. a 56 year old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it D. a 60 year old admitted with acute gastroenteritis who is reporting severe cramping and nausea

B. a 25 year old who just been admitted with possible appendicitis and a has a temperature of 102 F Prevent peritonitis

The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. pain occurs 1.5 to 3 hours before a meal, usually at night B. pain is worsened by the ingestion of food C. the client has a malnourished appearance D. the client is a man older than 50 years

B. pain is worsened by the ingestion of food gastric ulcer pain is LUQ or above the epigastrium Duodoenal is 90 min to 3 hours after eating

A client has been discharged to home after being hospitalized with an acute episode of pancreatits. The client, who is an alcoholic, is unwilling to participate in Alcoholic Anomymous (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? A. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." B. "Keep mentioning the AA meetings to your spouse on a regular basis." C. "I'll get you some information on the support group Al-Anon." D. "Tell me more about frustration with your spouse's refusal to participate in AA

C. "I'll get you some information on the support group Al-Anon."

The nurse finds a client vomiting coffee-ground emesis. On assessment, the client has a blood pressure of 100/74, he is acutely confused, and has a weak and thread pulse. Which intervention is the nurse's first priority? A. Administering a H2 antagonist B. Initiating enteral nutrition C. Administering IV fluids D. Administering antianxiety medication

C. Administering IV fluids risk for dehydration and hypovolemic shock

The nurse is providing discharge instructions for a client who has undergone a laparoscopic cholecystectomy. Which instructions will the nurse include in the discharge teaching? A. Keep dressings in place for 4 weeks. B. Report bile colored-drainage from any of the incisions. C. Expect dark, tarry stools after surgery. D. Be aware that no dietary changes will be necessary.

C. Expect dark, tarry stools after surgery.

The nurse closely monitors the client with acute pancreatitis for which complication? A. Duodenal Ulcer B. Infection C. Pneumonia D. Heart Failure

C. Pneumonia

The patient is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement first? A. Weigh the patient daily and document in the patient's chart. B. Teach coping strategies such as dietary modifications. C. Record the frequency, amount, and color of stools. D. Monitor the patient's oral fluid intake every shift.

C. Record the frequency, amount, and color of stools. worried about fluid deficit

The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? A. Steak and French fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

C. Turkey sandwich on wheat bread

An obese client is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the client's home health nurse requires immediate action? A. pain when coughing B. states, "I am too tired to walk very much" C. states, "I feel like the incision is splitting open" D. temperature of 100.8 F

C. states, "I feel like the incision is splitting open" Evisceration (organs coming out) and dehiscence (opening of the incision)

A patient with acute pancreatitis should be offered small frequent meals high in protein and fat. (True or False)

False

The secretions of the exocrine pancreas include insulin, glucagon, and somatostatin (True or False)

False- endocrine function

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? Select all that apply. a. "Your urine will be strained after the procedure." b. "Be sure to finish all of your antibiotics." c. "Immediately call the health care provider if you notice bruising." d. "Remember to drink at least 3 liters of fluid a day to promote urine flow." e. "You will need to change the incisional dressing once a day."

a. "Your urine will be strained after the procedure." b. "Be sure to finish all of your antibiotics." d. "Remember to drink at least 3 liters of fluid a day to promote urine flow."

The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. a. Acupuncture b. Decreasing physical activities c. Herbs (moxibustion) d. Meditation e. Peppermint oil capsules f. Yoga

a. Acupuncture c. Herbs (moxibustion) d. Meditation e. Peppermint oil capsules f. Yoga

The patient is diagnosed with possible acute pyelonephritis and is admitted to the acute medical unit. What is the nurse's priority concern on admission? a. Acute pain b. Potential for infection c. Activity intolerance d. Insufficient knowledge

a. Acute pain

Which are the priority interventions to be implemented on admission to the unit for a patient with acute pyelonephritis? (Select all that apply.) a. Administer analgesics as ordered. b. Assess patient pain level often. c. Send a daily urinalysis to the laboratory. d. Encourage 2 to 3 L of fluid intake per day. e. Administer nitrofurantoin (Macrodantin) 50 mg with meals and at bedtime.

a. Administer analgesics as ordered. b. Assess patient pain level often. d. Encourage 2 to 3 L of fluid intake per day. e. Administer nitrofurantoin (Macrodantin) 50 mg with meals and at bedtime. Daily urinalysis is not necessary. The major patient concern with acute pyelonephritis is acute pain. Pain should be assessed regularly and analgesics administered. Nitrofurantoin is a urinary antiseptic drug that can also help with comfort. Adequate fluid intake of 2 to 3 L per day is essential.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Begin an infusion of metoclopramide (Reglan) 10 mg IV. c. Obtain a urine specimen for urinalysis. d. Start an infusion of 0.9% normal saline at 100 mL/hr.

a. Administer morphine sulfate 4 mg IV. The patient's pain needs addressed before any other nursing interventions.

After returning from transurethral resection of the prostate, the client's urine in the continuous bladder irrigation system is a burgundy color. Which client needs does the nurse anticipate after the surgeon sees the client? Select all that apply. a. Antispasmodic drugs b. Emergency surgery c. Forced fluids d. Increase rate of continuous irrigation e. Monitoring for anemia

a. Antispasmodic drugs d. Increase rate of continuous irrigation e. Monitoring for anemia Antispasmodic drugs help with decreasing bladder spasms and increased flow of urine/fluid through bladder. When urine is dark burgundy color, this is an indication that flow is slowing and to prevent clots and further pain, the bladder irrigation rate can be temporarily increased. With the increased blood, patient should be monitored for blood loss - H & H labs should be ordered and monitored closely. Pt should also be monitored for s/s anemia such as shortness of breath, pale skin

A client with benign prostatic hyperplasia is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? Select all that apply. a. Avoid drugs used to treat erection problems. b. Be careful when changing positions. c. Keep all appointments for follow-up laboratory testing. d. Hearing tests will need to be conducted periodically. e. Take the medication in the afternoon.

a. Avoid drugs used to treat erection problems. b. Be careful when changing positions. c. Keep all appointments for follow-up laboratory testing. Alpha-adrenergic blockers may lower blood pressure and cause dizziness and orthostatic hypotension. ED drugs also cause a decrease in blood pressure, so they should not be used concurrently when using alpha-1 adrenergic blockers. Educate patient on changing positions slowly to avoid falling. Patients should be monitored by a physician when taking any medications.

Which patient is at greatest risk of developing a kidney stone? a. Overweight Caucasian male b. African-American female with family history of kidney stones c. Female with history of frequent urinary tract infections d. Hispanic/Latina female who eats animal protein at every meal

a. Overweight Caucasian male Rationale: Anyone can form a kidney stone, but you may be more likely to have one if you are male, Caucasian, very overweight, have had kidney infections, have a family member with kidney stones, have had kidney stones before, eat a lot of animal protein (such as meat and eggs), or do not drink enough

A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? a. "A drink of diet soda with dinner is OK for me." b. "I need to go for a walk every evening." c. "Maintaining a low-fiber diet will manage my constipation." d. "Watching the amount of fluid that I drink with meals is very important."

b. "I need to go for a walk every evening." Walking increases gastric motility. Patient needs a high-fiber diet and increased fluids

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease? a. Abdominal pain relieved by bending knees b. Chronic diarrhea, abdominal pain, and fever c. Epigastric cramping d. Hypotension with vomiting

b. Chronic diarrhea, abdominal pain, and fever Rationale: A is common with appendicitis C is an ulcer D bleeding ulcer

What priority laboratory analysis should the nurse review when caring for a patient with Ulcerative Colits disease? a. Potassium b. Hemoglobin c. Serum albumin d. C-reactive protein

b. Hemoglobin Rationale: blood in the stool with UC.

A client had a transurethral resection of the prostate (TURP) with continuous bladder irrigation yesterday. The staff nurse notes that the urinary drainage is bright red and thick. What is the nurse's best action? a. Notify the charge nurse as soon as possible. b. Increase the rate of the bladder irrigation. c. Document the assessment in the medical record. d. Prepare the patient for a blood transfusion

b. Increase the rate of the bladder irrigation. After a TURP procedure, the flow of the irrigant should be sufficient to keep the urine clear. Because the client's urinary drainage is bright red and thick, the nurse's initial action should be to increase the rate of bladder irrigation. The nurse will subsequently document the assessment in the medical record, and monitor the client's laboratory work, particularly hemoglobin and hematocrit values.

A patient with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which laboratory analysis is a priority in the nurse's assessment of this patient? a. Lipase level b. Total bilirubin c. Liver function tests d. White blood cell count

b. Total bilirubin Rationale: Excess circulating bilirubin present with chronic cholecystitis is responsible for pruritus and changes in stool and urine color. Cholecystitis is associated with several risks including hepatic disease, pancreatitis, and peritonitis. Monitoring liver function, pancreatic laboratory values, and white blood cell counts is also very important.

The client passes a urinary stone that laboratory analysis indicates is composed of calcium oxalate. Based on this analysis, which instruction does the nurse specifically include for dietary prevention of the problem? a. "Increase your intake of meat, fish, and cranberry juice." b. "Avoid citrus fruits and citrus juices such as oranges." c. "Avoid dark green leafy vegetables such as spinach." d. "Decrease your intake of dairy products, especially

c. "Avoid dark green leafy vegetables such as spinach." For stone types of calcium oxalate, pts should avoid oxalate sources, such as spinach, black tea, and rhubarb. Reduction of urinary oxalate content may help prevent these stones from forming. Urinary pH is not a factor. Patients should also decrease sodium intake.

Which of one of these patients is more likely to develop a gallstone? a. 35 year old male b. 49 year old female with a history of alcohol abuse c. 45 year old obese female with 4 children d. 36 year old male with history of smoking and alcohol abuse

c. 45 year old obese female with 4 children 4 f's

The RN's shift assignment consists of the following patients. Which patient should the nurse see first? a. 28-year old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula. b. A 32 year old with Ulcerative Colitis (UC) who needs a discharge teaching about the use hydrocortisone enemas c. A 34 year old who has questions about how to care for a newly created ileostomy d. A 36 year old with peritonitis who just returned from surgery with multiple drains in place

d. A 36 year old with peritonitis who just returned from surgery with multiple drains in place most critical patient all other patients are presenting with normal findings

A patient has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor the patient's laboratory results for evidence of which condition? a. Hyperkalemia b. Hypernatremia c. Hypercalcemia d. Hyperglycemia

d. Hyperglycemia Rationale: Long-term adverse effects that commonly occur with steroid therapy include hyperglycemia, osteoporosis, peptic ulcer disease, and increased risk for infection

The physician prescribes Predisone (Deltasone) for a client with UC. What health teaching is most important before the client begins the medication? a. Determine if the client's insurance pays for the drug. b. Teach the client to take the drug at night. c. Ask the client if he has any allergies to sulfa-type drugs. d. Teach the client the importance of avoiding crowds.

d. Teach the client the importance of avoiding crowds. Risk for infection

Which patient statement requires a focused GI assessment? a. "Spicy foods upset my stomach." b. "I have had dentures for 3 years." c. "I experience occasional constipation." d."I take ibuprofen 600 mg three times a day for arthritis pain."

d."I take ibuprofen 600 mg three times a day for arthritis pain." Rationale: Large amounts of aspirin or other nonsteroidal anti inflammatory drugs (NSAIDs) such as ibuprofen can predispose the patient to peptic ulcer disease and GI bleed