Textbook Questions (ch 59, 56, 57, 61, 62)

The nurse is teaching a client about nutrition and diverticulosis. Which food will the nurse teach the client to avoid? a. Popcorn b. Oatmeal c. Bran d. Lettuce

ANS: A Foods such as nuts, corn, popcorn, cucumbers, tomatoes, figs, and strawberries—all of which contain seeds or indigestible material—may block a diverticulum and should be avoided. Oatmeal, bran, and lettuce are acceptable for patients with diverticulosis to eat.

1. Which hormone changes does the nurse expect when a client receives a continuous cortisol infusion for 24 hours when his or her endocrine feedback mechanisms are functioning normally? a. Lower than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels b. Lower than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin releasing hormone (CRH) levels c. Higher than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels d. Higher than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin releasing hormone (CRH) levels

ANS: A The release of CRH and ACTH is affected by the serum level of free cortisol acting through a negative feedback loop. The stimulus for release of CRH from the hypothalamus, which is responsible for stimulating the release of ACTH from the anterior pituitary gland, is a low blood level of cortisol. A continuous infusion of cortisol for 24 hours would be sensed by the hypothalamus as either adequate or elevated levels of cortisol, not low blood levels of cortisol. As a result, little if any CRH would be released from the hypothalamus and circulating levels would be lower than normal. With low levels of CRH, the anterior pituitary cells are not stimulated to release ACTH; thus circulating levels of this hormone would also be lower than normal. Adequate or elevated blood levels of cortisol inhibit the release of CRH and ACTH.

1. The nurse is caring for an older adult client who experiences an exacerbation of ulcerative colitis with severe diarrhea that have lasted a week. For which complications will the nurse assess? (Select all that apply.) a. Dehydration b. Hypokalemia c. Skin breakdown d. Deep vein thrombus e. Hyperkalemia

ANS: A, B, C The nurse will assess for complications such as dehydration, hypokalemia, and skin breakdown, all which can occur when diarrhea is profuse and fluid has been lost. Deep vein thrombosis and hyperkalemia are not complications that are associated with ulcerative colitis with severe diarrhea.

1. The emergency department nurse is assessing a client with a known inguinal hernia. Which assessment finding indicates that the hernia may have strangulated? (Select all that apply.) a. Fever b. Tachycardia c. Abdominal distention d. Mild abdominal pain e. Nausea and vomiting

ANS: A, B, C, E Strangulation of a hernia is accompanied by fever, tachycardia, abdominal distention, severe pain, nausea, and vomiting.

1. Which statements made by a client who has diabetes insipidus indicate to the nurse that more teaching is needed? (Select all that apply.) a. If I gain more than 2 lbs (1 kg) in a day, I will limit my fluid intake. b. If I become more thirsty, I will take another dose of the drug. c. I will avoid aspirin and aspirin-containing substances. d. I will stop taking the drug for 24 hours before I have any dental work performed. e. I will limit my intake of salt and sodium to no more than 2 g daily. f. I will wear my medical alert bracelet at all times.

ANS: A, C, D, E With diabetes insipidus (DI), output is excessive and does not vary to match intake. Thus the client is at risk for dehydration and should not limit his or her fluid intake. Although weight gain could indicate water toxicity, other symptoms would also be present. Aspirin is not a contraindication for the drugs used to treat DI and these drugs do not increase the risk for bleeding. Thus, there is no need to stop the drug before dental work. Limiting salt or sodium intake does not manage the problem of DI and is not a recommended action.

1. The nurse is caring for a client who has just been prescribed a glucocorticoid to treat an exacerbation of ulcerative colitis. What teaching will the nurse provide? a. Decrease the drug dose during the next exacerbation. b. Report fever to healthcare provider immediately. c. Determine if the client's insurance covers payment for this medication. d. This drug will act as an antidiarrheal.

ANS: B Glucocorticoid medication, a form of steroid therapy, can cause immunosuppression (not act as an antidiarrheal); therefore, any sign of infection should be immediately reported to the healthcare provider. The drug dose may be increased by the health care provider during the next exacerbation. The client will determine with the insurance provider (and possibly a social worker) whether the drug is covered for payment.

1. The community nurse is talking with a group of individuals about colorectal cancer (CRC) risk factors. Which community participant is at the highest risk for development of CRC? a. 23-year-old vegetarian b. 30-year old with Crohn's disease c. 39-year old with no family history of cancer d. 46-year old with genetic predisposition to cancer

ANS: B The major risk factors for the development of colorectal cancer (CRC) include being older than 50 years, genetic predisposition, personal or family history of cancer, and/or diseases that predispose the patient to cancer such as familial adenomatous polyposis (FAP), Crohn's disease, and ulcerative colitis. Only a small percentage of colorectal cancers are familial and transmitted genetically.

1. The nurse is caring for a client who has celiac disease. Which food will the nurse remove from the client's dietary tray? (Select all that apply.) a. Rice b. Graham crackers c. Croissant d. Fresh peaches e. Chicken breast

ANS: B, C Clients with celiac disease cannot eat gluten. Foods containing gluten, such as graham crackers and toast, must be removed from the client's tray. The other foods listed do not contain gluten.

1. A client who recently had laparoscopic surgery to treat a ruptured appendix has developed subsequent peritonitis. The client currently has two Jackson-Pratt drains placed in the abdomen. Which finding(s) would the nurse report immediately to the surgeon? (Select all that apply.) a. Serosanguineous drainage b. Fever c. Cloudy drainage d. Painful abdominal distension e. Pain level "3" on a scale of 1 to 10

ANS: B, C, D Fever, cloudy drainage, and painful abdominal distention can be signs of infection that should be immediately reported to the surgeon. Serosanguineous drainage is expected at this time, as is a manageable pain level of "3" on a 1 to 10 scale.

1. A client had an open partial colectomy and ascending colostomy 3 days ago. What assessment findings does the nurse expect? (Select all that apply.) a. Black, moist stoma b. Gas inside the pouch c. Pain controlled with analgesics d. Small amount of formed stool from the colostomy e. Serosanguineous fluid draining from 2 Jackson-Pratt drains.

ANS: B, C, E Gas is expected to collect in the pouch following surgery. The client's pain should be controlled by analgesia at this time. It is expected that 2 drains will be in place, which will be draining serosanguineous fluid. The stoma should be pink and moist, and will drain liquid stool since it is an ascending colostomy.

Which problems does the nurse expect in an older adult as a result of age-related changes in endocrine function? (Select all that apply.) a. Increased basal metabolic rate (BMR) b. Decreased core body temperature c. Dehydration d. Diarrhea e. Hyperglycemia f. Polyuria

ANS: B, C, E, F The aging process generally causes a decline in the secretion of hormones from endocrine glands, especially those of the thyroid, pancreas, and adrenal glands. Decreased thyroid hormone secretion causes a decrease in overall metabolism and basal metabolic rate. The slower metabolism results in lower core body temperatures and constipation. Decreased adrenal gland secretion limits the ability of the older adult to reabsorb water and sodium or to concentrate urine. This condition increases the risk for dehydration. The decreased secretion of insulin from the pancreas and the decline in metabolism both result in hyperglycemia. When hyperglycemia is present, the osmolarity (osmolality) of the blood increases, causing the adult to have increased thirst and to move interstitial and intracellular fluids into the plasma volume, leading to polyuria. If insufficient fluid intake occurs, this situation also increases the risk for dehydration.

1. The community nurse is talking with four clients who have reported digestive concerns. Which client does the nurse recognize as most likely to experience gallstone production? (Select all that apply.) a. 23-year-old Caucasian vegetarian who is a dancer b. 35-year-old American Indian who works in construction c. 48-year-old Canadian who manages a fast food restaurant d. 59-year-old Asian American who is an investment banker e. 64-year-old Mexican American who resides with grandchildren

ANS: B, E The highest frequency of gallstone production in North America lies among the American-Indian and Mexican-American populations.

1. When reviewing the laboratory values of a client who has chronic obstructive pulmonary disease and pneumonia, the nurse observes these findings. Which one does the nurse report to the provider immediately? a. International normalized ratio (INR) 2.1 b. Serum chloride 96 nEq/L (mmol/L) c. Serum sodium 117 mEq/L (mmol/L) d. pH 7.28

ANS: C All of the values are out of the normal range. The only one that is at a critical level, given the client's diagnoses of COPD and pneumonia, is the serum sodium level. This client is in danger of seizures and action must be taken immediately to prevent complications.

1. The hospice nurse is caring for a client with pancreatic cancer who has been given two to three months to live. What is the appropriate nursing response when the client's spouse states, "I know he is going to get better." a. Use therapeutic silence, and say nothing. b. "Your spouse will die in 2-3 months." c. "Let's talk about how you are feeling about your spouse's prognosis." d. "Yes, if your spouse adheres to the entire treatment plan, recovery is possible."

ANS: C At different times within the conversation, the nurse may use therapeutic silence, yet the appropriate response at this time is to open the conversation so the spouse can freely express feelings. This can lead the nurse to clarify information, or nonjudgmentally support the spouse and client through this prognosis.

1. Which teaching will the nurse provide when discharging a client with chronic pancreatitis? a. Weight reduction and daily exercise regimen b. Constipation precautions including daily laxative use c. Dietary adjustments to include avoiding high-fat foods, caffeine, and alcohol d. Relaxation techniques and stress management

ANS: C The nurse will teach the client about a diet low in fat and avoiding caffeine and alcohol, which is recommended for those with chronic pancreatitis. Weight reduction, exercise programs, bowel retraining program, relaxation techniques, and stress management are not interventions pertinent to pancreatitis.

1. In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion. What is the nurse's best action? a. Request a "time-out" to determine whether this is a valid prescription. b. Ask the client whether he or she usually takes prednisone. c. Hold the dose because the client has a high cortisol level. d. Administer the drug as prescribed.

ANS: D Although the client has hypercortisolism, removal of the adrenal gland will stop the secretion of this important hormone that is essential for life. Further, the stress of surgery also increases the client's need for this hormone. Supplying the hormone throughout surgery prevents the complication (or at least reduces the risk for) acute adrenal crisis.

1. The nurse closely monitors the client with acute pancreatitis for which life-threatening complication? a. Jaundice b. Type I diabetes mellitus c. Abdominal pain d. Disseminated intravascular coagulation (DIC)

ANS: D DIC is a life-threatening condition involving hypercoagulation of the blood, with consumption of clothing factors and the development of microthrombi. This can take place when complex physiologic changes in the pancreas cause the release of necrotic tissue and enzymes into the bloodstream, resulting in altered coagulation. The client with acute pancreatitis may have jaundice and abdominal pain, and develop type 1 diabetes mellitus, as the pancreas is totally destroyed, however these are not considered life-threatening conditions.

1. A client with rectal bleeding who is preparing to undergo a colonoscopy tells the nurse, "I am very afraid of having polyps and cancer." What is the appropriate nursing response? a. "Let's worry about that after the procedure." b. "Polyps are never cancerous, so you do not need to worry." c. "Unfortunately all polyps are malignant, so you may already have cancer." d. "It is understandable that you are fearful. Tell me what frightens you most."

ANS: D Polyps can be benign or malignant. Telling the client to worry about the outcome after the procedure devalues his or her feelings. The nurse will respond therapeutically and allow the client to express feelings.

1. The nurse will include what post-operative teaching when caring for the client who is preparing to undergo endoscopic cholecystectomy? (Select all that apply.) a. "You will have a small, midline abdominal incision." b. "You cannot eat or drink for a few days after the procedure." c. "You will not be able to return to regular activity for several weeks." d. "Generally, the pain associated with this procedure is minimal." e. "This procedure has a low incidence of infection." f. "The hospital stay after this procedure is typically 1 to 2 days."

ANS: D, E, F The laparoscopic cholecystectomy is a minor procedure with few associated complications. There is decreased wound infection than associated with a traditional open cholecystectomy, minimal pain and a 1 to 2 day stay in the hospital. An abdominal incision, nasogastric tube, nothing by mouth, low fat diet, Jackson-Pratt drain, and restricted activity are associated with an open cholecystectomy procedure.