255 final

A client is admitted to the icu after a motor vehicle crash. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the clients hypervolemia and hyperkalemia. Which of the following therapies will the clients hemodynamic status best tolerate?

Continuous renal replacement therapy

A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of the stoma, and necessary lifestyle changes. What nursing action is MOST appropriate?

Maintain open dialogue with the client and facilitate a referral to the wound ostomy nurse

to veerify patency of vascular access site (fistula/graft)

palpate thrill listen for bruit

A client has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the client may have developed liver metastases

Abdominal pain and hepatomegaly

The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury?

Average urine output has been 10mL/hr for several hours

The nurse notes that a client who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning the client?

Avoid applying suction on or near the graft

patient diagnosed with esophageal reflux disorder has been admitted to your floor. When planning for teaching, what to do advise the patient to do?

Avoid carbonated drinks

The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?

Assessment of the quantity of urine

The nurse is caring for a client who has just returned from an ERCP removal of gallstones. The nurse should monitor the client for signs of what complication?

Bleeding and perforation

A patient comes to the bariatic clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?

Emotional stability and understanding of required lifestyle changes

A client has received treatment for oral cancer. The combination of medications and radiation has resulted in leukopenia (low WBC). What is the nurses best response to this change in health status?

Ensure that none of the clients visitors have an infection

A client is receiving care in the ICU for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

Fever, increased heart rate, and decreased blood pressure

The nurse is caring for a client who is undergoing diagnostic testing for suspected malabsorption. When taking this clients health history and performing the physical assessment, the nurse should recognize what finding a most consistent with this diagnosis?

Foul smelling diarrhea that contains fat

An emergency room nurse is admitting a 3 year old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body?

Glucagon

A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?

High levels of alcohol consumption

The nurse is reviewing the patients medical history and recognizes the following as a risk factor for gastritis:

History of Addison's disease

diverticulitis management

IV abx NPO NGT

A client is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the client to first seek care?

Intermittent pain and bloody stool

Client has been diagnosed with a malignancy of the oral cavity and was undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head & neck cancers is often poor because of what characteristics of these malignancies?

Metastases are common and rarely respond to treatment

A client comes to the clinic reporting pain in the epigastric region. What statement by the client is specific to the presence of a duodenal ulcer?

My pain resolves after I have something to eat

A nurse is caring for an older adult who has been experiencing c. diff related diarrhea. When reviewing the clients most recent lab results, the nurse prioritizes what finding?

Potassium level

Client who has had a radical neck dissection is being prepared for discharge. The plan includes a referral to an outpatient rehab center for physical therapy. What should the goals of physical therapy include for this client?

Promoting maximum shoulder function

purpose of propranolol

increase vessel diameter -this reduces pressure on veins & prevents bleding in esophageal varices

A patient with a history of peptic ulcer disease is hospitalized with symptoms of perforation. During the initial assessment, the nurse would expect the patient to report:

Sudden, severe, abdominal pain and shoulder pain with rigidness in the abdomen

A client with obesity is early in the process of preparing for a gastic bypass. The client states "after the surgery, the amount of food that I consume will be limited and ill absorb fewer calories from what I do eat." When responding to the client, the nurse should

Validate what the client understands about the surgical procedure

An 84 year old female with hypertension and diabetes, diagnosed with cancer is admitted to your unit for surgical treatment. The patient has been on chemo to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient contributes to chronic renal failure? Select all that apply a) Chronic systemic disease b) Minimal social support c) Aging d) Low sodium diet e) Hypertension

a) Chronic systemic disease c) Aging e) Hypertension

The nurse discharged a patient after a routine endoscopy. The patient calls back 3 hours later reporting severe chest pain, and difficulty swallowing. The nurse instructs the patient to do the following (select all that apply 1) Wait 4 hours and see if symptoms resolve 2) Take an aspirin and go to the ED to rule out myocardial event 3) Do not eat or drink anything 4) These types of symptoms are expected after an endoscopic procedure. Take an OTC pain reliever and follow up at the clinic as scheduled 5) Seek medical attention in the ED immediately 6) Drink a warm beverage such as hot tea to dilate the esophagus and to calm down any spasming. Call back in an hour if symptoms do not improve

a) Do not eat or drink anything b) Seek medical attention in the ED immediately

A clients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is preforming the health interview, what assessment question(s) addresses likely etiologic factors? Select all that apply a) Have you ever been diagnosed with gallstones b) Does anyone in your family have cystic fibrosis c) How many alcoholic drinks do you typically consume in a week d) Would you say that you eat a particularly high-fat diet e) Have you ever been tested for diabetes

a) Have you ever been diagnosed with gallstones c) How many alcoholic drinks do you typically consume in a week d) Would you say that you eat a particularly high-fat diet e) Have you ever been tested for diabetes

The nurse is taking care of a gastric bypass post op patient. The nurse anticipates the following interventions to prevent complications. Select all that apply a) IS 10x every hour while awake b) Bedrest x72 hours c) Dobhoff with tube feeds x 5 day s d) Lovenox daily

a) IS 10x every hour while awake d) Lovenox daily

A nurse educator is teaching a group of recent nursing grads about their occupational risks for contracting hep B. what preventative measures should the educator promote? Select all that apply a) Immunization b) Annual vitamin K injections c) Use of standard precautions d) Consumption of vitamin rich diet Annual vitamin b12 injections

a) Immunization c) Use of standard precautions

The nurse is caring for a client after a motor vehicle crash. The client has developed AKI. What are the nurses roles in caring for this client? (select all that apply) a) Monitor for complications b) Participating in emergency treatment of fluid and electrolyte imbalances c) Directing nutritional interventions d) Providing emotional support for the family

a) Monitor for complications b) Participating in emergency treatment of fluid and electrolyte imbalances d) Providing emotional support for the family

The nurse is preparing the admission of a client diagnosed with a complicated diverticulitis. What interventions would the nurse expect the provider to order? Select all that apply a) NPO b) Serial CT abdomen an pelvis scans c) Cear liquid diet and progress as patient tolerates d) Nasogastric tube e) IV antibiotics

a) NPO d) Nasogastric tube e) IV antibiotics

A 17 year old male presents to the ED with abdominal pain. A CT of the abdomen results with an acute appendicitis. Which of the following symptoms would the nurse expect the client to present with? Select all that apply a) Positive rovsings sign b) Positive chvosteks sign c) Constipation d) Right upper quadrant pain e) Fever

a) Positive rovsings sign c) Constipation e) Fever

A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurses most recent assessment reveals subtle changes in the clients condition and behavior. Which intervention would the nurse NOT expect to preform? a) Restrict dietary protein to 0.5-1g/kg b) Administer IV glucose c) Frequent assessment of neuro status d) Assess potential sites for infection

a) Restrict dietary protein to 0.5-1g/kg

S/S of IBS

abd pain precipitated eating relieved by defecation

A client with end stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the clients fluid volume excess? Select all that apply a) Implementing a 1500 kcal/day restriction b) Implementing fluid restrictions c) Administering calcium channel blockers d) Enhancing client positioning e) Administer diuretics

b) Implementing fluid restrictions d) Enhancing client positioning e) Administer diuretics

An adult client has been diagnosed with diverticular disease after ongoing challenges with constipation. The client will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply a) Anticholinergic medications b) Increase fiber intake c) Reduce fat intake d) Fluid reduction e) Enemas on alternating days

b) Increase fiber intake c) Reduce fat intake

A nurse is caring for a client with hepatic encephalopathy. While making the initial shift assessment, the nurse knows the patient may experience the following symptoms EXCEPT for: a) Fetor hepaticus b) Constructional apraxia c) Expressive aphasia d) Asterixis

c) Expressive aphasia

The nurse is caring for a postoperative patient who has just undergone surgery to remove a section of his kidney due to a renal carcinoma. The patient has a distended abdomen, absent bowel sounds, nauseated. Which of the following interventions would the nurse expect to preform? Select all that apply a) Initiation of tube feeds b) Renal diet c) NPO d) NG tube to low suction e) Ambulate patient as tolerated

c) NPO d) NG tube to low suction e) Ambulate patient as tolerated

esophageal reflux- what should patient avoid?

carbonated beverages

The nurse is evaluating patinents in a transplant center. Which of the following patients would be good candidates for a liver transplant? Select all that apply a) A 67 year old male diagnose with acute liver failure undergoing current treatment for viral hepatitis b) A 58 year old male with a history of major depressive disorder, chronic liver disease, and noncompliant with blood pressure meds c) A 61 year old female with a history of breast cancer with metastasis to the liver. Good social support and no history of drug or alcohol abuse d) A 47 year old female with a history of cirrhosis and alcohol abuse. Last alcoholic drink was 1 year prior.

d) A 47 year old female with a history of cirrhosis and alcohol abuse. Last alcoholic drink was 1 year prior.

AKI suspicion

decreased urine output

risk factors for gallstones

high fat diet PMH of gallstones alcohol diabetes frequent changes in weight obesity

what is the risk associated with laxative overuse?

risk for dependence

CP/dysphagia after endoscopy what do you do?

seek immediate medical attention

priority assessment abd girth/weight or variceal bleeding

variceal bleeding (b/c this is life threatening)

liver abscess sx

vomiting