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The nurse is preparing to assess a patient with diverticulitis. Which area of the patient's abdomen should the nurse expect to palpate a mass? 1. upper-right quadrant 2. lower-left quadrant 3. area of McBurney point 4. epigastric region

2. lower-left quadrant Reason: Diverticulitis can manifest as a palpable mass in the left lower quadrant as a result of the inflammatory response. A mass in the upper-right quadrant could involve a disorder of the liver or transverse colon. McBurney point is palpated to elicit rebound tenderness pain characteristic of appendicitis. A mass in the epigastric region could indicate a disorder of the stomach or pancreas.

Correct Answer: 1 Rationale 1: In bulimia and after binge eating, the patient may induce vomiting or take excessive quantities of laxatives or diuretics. Rationale 2: Anorexic behaviors involve avoidance of eating. Rationale 3: Laxative use is not a healthful means to control body weight. Rationale 4: There is no discussion of the patient's perceived body image. Global Rationale: In bulimia and after binge eating, the patient may induce vomiting or take excessive quantities of laxatives or diuretics. Anorexic behaviors involve avoidance of eating. Laxative use is not a healthful means to control body weight. There is no discussion of the patient's perceived body image.

A 33-year-old patient states, "I eat anything I want and just have a laxative for dessert!" The nurse realizes that this patient is exhibiting which behavior? 1. bulimia 2. anorexia 3. effective weight control 4. distorted body image

Correct Answer: 1 Rationale 1: To reduce weight gain commonly associated with aging, encourage patients to gradually reduce the amount of calories consumed. Rationale 2: There is no evidence that the patient is denying the truth about overeating. Rationale 3: There is no evidence that the patient is justifying the weight gain. Rationale 4: There is no evidence that the patient is seeking approval to gain weight. Global Rationale: To reduce weight gain commonly associated with aging, encourage patients to gradually reduce the amount of calories consumed. There is no evidence that the patient is denying the truth about overeating, justifying the weight gain, or seeking approval to gain weight.

A 45-year-old patient says, "I'm gaining weight but I'm not eating any differently than I did years ago." What should the nurse realize is occurring with this patient? 1. gaining weight associated with aging 2. denying the truth about overeating 3. justifying the weight gain 4. seeking approval to gain weight

Correct Answer: 1 Rationale 1: Very-low-calorie diets (VLCDs) are indicated for patients having elevated body mass indexes greater than 30 kg/m2. VLCD may not be appropriate for use in people over age 50 due to normal loss of lean body mass and adverse effects such as fatigue, constipation, nausea, diarrhea, and gallstone formation. Rationale 2: A very-low-calorie diet (VLCD) is a protein-sparing modified fast (450 kcal/day) under close medical supervision and results in rapid weight loss while maintaining lean body mass. Rationale 3: Very-low-calorie diets (VLCDs) are indicated for patients having elevated body mass indexes greater than 30 kg/m2. Rationale 4: VLCD may not be appropriate for use in people over age 50 due to normal loss of lean body mass and adverse effects such as fatigue, constipation, nausea, diarrhea, and gallstone formation. Global Rationale: Very-low-calorie diets (VLCDs) are indicated for patients having elevated body mass indexes greater than 30 kg/m2. VLCD may not be appropriate for use in people over age 50 due to normal loss of lean body mass and adverse effects such as fatigue, constipation, nausea, diarrhea, and gallstone formation. These diets are protein-sparing modified fasts (450 kcal/day) conducted under close medical supervision and result in rapid weight loss while maintaining lean body mass.

A patient desiring to begin a very-low-calorie diet (VLCD) for rapid weight reduction is concerned about the safety of the diet. What information should the nurse provide to the patient? 1. VLCDs are not recommended for people over age 50. 2. VLCDs result in significant losses of muscle mass in response to the protein restriction. 3. VLCDs are safe for patients who have a lower body mass index and need to lose a small amount of weight rapidly. 4. VLCDs are safest for middle-aged and senior patients.

Correct Answer: 1 Rationale 1: Alcohol use or abuse can be a contraindication for this medication. Rationale 2: The medication could cause insomnia but is not contraindicated for narcolepsy. Rationale 3: A patient's personal history for the development of cardiovascular problems could indicate an inability to take the medication. The choice regarding the family's health history is not applicable. Rationale 4: Phentermine is indicated for body mass index greater than 30 kg/m2. Global Rationale: Alcohol use or abuse can be a contraindication for this medication. The medication could cause insomnia but is not contraindicated for narcolepsy. A patient's personal history for the development of cardiovascular problems could indicate an inability to take the medication. The choice regarding the family's health history is not applicable. Phentermine is indicated for body mass index greater than 30 kg/m2.

A patient diagnosed with obesity asks about the appetite suppressant phentermine to assist with a weight loss program. Which information in the patient's health history might restrict the patient's ability to take this medication? 1. frequent use of alcohol 2. history of narcolepsy 3. a family history of thrombophlebitis 4. a body mass index of 31 kg/m2

Correct Answer: 1 Rationale 1: With the identification of H. pylori infection as the major cause of peptic ulcers and the development of medications to eradicate this organism, surgery is rarely necessary. Rationale 2: Surgery may be required to treat a complication of PUD, such as hemorrhage, perforation, or gastric outlet obstruction. Rationale 3: The success rate of pharmacologic intervention to eradicate H. pylori is 75% to 90%. Rationale 4: There are no specific dietary modifications for PUD. Global Rationale: With the identification of H. pylori infection as the major cause of peptic ulcers and the development of medications to eradicate this organism, surgery is rarely necessary. Surgery may be required to treat a complication of PUD, such as hemorrhage, perforation, or gastric outlet obstruction. The success rate of pharmacologic intervention to eradicate H. pylori is 75% to 90%. There are no specific dietary modifications for PUD.

A patient diagnosed with peptic ulcer disease (PUD) asks if surgery will be necessary. How should the nurse respond? 1. "Taking the appropriate medications makes surgery rarely necessary." 2. "Surgery is required in about 50% of cases." 3. "Surgery has a higher success rate than medication therapy alone." 4. "If you take your medications and follow the prescribed diet, you will likely not need surgery."

Correct Answer: 2 Rationale 1: A body mass index of 18.5-24.9 is considered normal weight. Rationale 2: A body mass index of 25-25.9 is considered overweight. Rationale 3: A body mass index of 30-34.9 is considered obese. Rationale 4: Metabolic syndrome is a constellation of cardiovascular risk factors, including increased waist circumference, hypertension, elevated blood triglycerides and fasting blood glucose, and low HDL cholesterol. Metabolic syndrome is an identified risk factor for atherosclerosis and coronary heart disease (CHD). Global Rationale: A body mass index of 25-25.9 is considered overweight. A body mass index of 18.5-24.9 is considered normal weight. A body mass index of 30-34.9 is considered obese. Metabolic syndrome metabolic syndrome is a constellation of cardiovascular risk factors, including increased waist circumference, hypertension, elevated blood triglycerides and fasting blood glucose, and low HDL cholesterol. Metabolic syndrome is an identified risk factor for atherosclerosis and coronary heart disease (CHD).

A patient has a body mass index (BMI) of 27. How should the nurse explain this finding to the patient? 1. normal weight 2. overweight 3. obese 4. metabolic syndrome

Correct Answer: 3 Rationale 1: Patients are typically discharged within 24 hours. Rationale 2: The patient will likely have bandages over the puncture sites. Rationale 3: A patient with a laparoscopic cholecystectomy is at risk for needing an open cholecystectomy if the procedure cannot be completed laparoscopically due to complications. Rationale 4: Nausea is common after surgery and should be reported to the nurse. Global Rationale: A patient with a laparoscopic cholecystectomy is at risk for needing an open cholecystectomy if the procedure cannot be completed laparoscopically due to complications. Patients are typically discharged within 24 hours. The patient will likely have adhesive bandages over the puncture sites. Nausea is common after surgery and should be reported to the nurse.

A patient has been given instructions about a laparoscopic cholecystectomy. Which patient statement indicates further teaching is needed? 1. "I should be able to go home within a day after the procedure." 2. "I will probably have bandages over the puncture sites." 3. "I am glad I won't need to have an open cholecystectomy." 4. "I will tell the nurse if I feel nauseated after surgery."

Correct Answer: 1 Rationale 1: A lipase inhibitor reduces fat absorption from the GI tract. Rationale 2: Antiepileptic medications are not prescribed for weight loss. Rationale 3: Anticholinergics are used in the treatment of Parkinson disease. Rationale 4: Adrenergics are generally used in the treatment of asthma. Global Rationale: A lipase inhibitor reduces fat absorption from the GI tract. Antiepileptic medications are not prescribed for weight loss. Anticholinergics are used in the treatment of Parkinson disease. Adrenergics are generally used in the treatment of asthma.

A patient has been researching medications to help achieve a weight loss goal. What is the medication classification that the nurse should review with the patient that could help meet the patient's goal? 1. lipase inhibitor 2. antiepileptic 3. anticholinergics 4. adrenergics

Correct Answer: 1 Rationale 1: Physical assessment information to suggest a vitamin C deficiency includes swollen bleeding gums. Rationale 2: A smooth tongue is consistent with an iron deficiency. Rationale 3: Manifestations of a thiamine deficiency includes muscle cramps. Rationale 4: Manifestations of a thiamine deficiency includes ataxia. Global Rationale: Physical assessment information to suggest a vitamin C deficiency includes swollen bleeding gums. A smooth tongue is consistent with an iron deficiency. Manifestations of a thiamine deficiency include muscle cramps and ataxia.

A patient is admitted for treatment of malnutrition. What assessment finding does the nurse identify that indicates the patient is experiencing a vitamin C deficiency? 1. bleeding gums 2. smooth tongue 3. muscle cramps 4. ataxia

Correct Answer: 1, 2 Rationale 1: Diagnostic tests for gastroesophageal reflux disease include a barium swallow, which evaluates the esophagus, stomach, and upper intestine. Rationale 2: Diagnostic tests for gastroesophageal reflux disease include upper endoscopy, which allows direct visualization of the esophagus. Rationale 3: A CT scan is not a diagnostic test for gastroesophageal reflux disease. Rationale 4: A complete blood count is not a diagnostic test for gastroesophageal reflux disease. Rationale 5: A colonoscopy is not a diagnostic test for gastroesophageal reflux disease. Global Rationale: Diagnostic tests for gastroesophageal reflux disease include a barium swallow, which evaluates the esophagus, stomach, and upper intestine, and upper endoscopy, which allows direct visualization of the esophagus. CT scan, complete blood count, and colonoscopy are not diagnostic tests for gastroesophageal reflux disease.

A patient is being evaluated for gastroesophageal reflux disease (GERD). Which diagnostic tests should the nurse expect to be prescribed for this patient? Standard Text: Select all that apply. 1. barium swallow 2. upper endoscopy 3. CT scan 4. complete blood count 5. colonoscopy

Correct Answer: 1, 2 Rationale 1: Potassium levels are low in severe malnutrition. Rationale 2: The total lymphocyte count (white blood cell count) is reduced in malnutrition. Rationale 3: Elevated serum albumin level indicates adequate nutrition. Rationale 4: There are no specific findings regarding red blood cell count with malnutrition. Rationale 5: There is no specific finding regarding serum sodium level with malnutrition. Global Rationale: Potassium levels are low in severe malnutrition. The total lymphocyte count (white blood cell count) is reduced in malnutrition. Elevated serum albumin level indicates adequate nutrition. There are no specific findings regarding red blood cell count with malnutrition. There is no specific finding regarding serum sodium level with malnutrition.

A patient is being evaluated for malnutrition. Which laboratory test results should the nurse recognize will support that finding? Standard Text: Select all that apply. 1. low serum potassium 2. low white blood cell count 3. elevated serum albumin 4. elevated red blood cell count 5. low serum sodium

Correct Answer: 3 Rationale 1: Hepatitis A usually resolves completely and rarely results in a carrier state. Rationale 2: Patients with hepatitis B are typically very ill following the preicteric phase, which is not consistent with this patient's history. Rationale 3: Hepatitis C is the primary worldwide cause of chronic hepatitis, cirrhosis, and liver cancer. It is transmitted through infected blood and body fluids. Injection drug use is the primary risk factor for HCV infection, accounting for nearly half of all new infections. Acute hepatitis C usually is asymptomatic; if symptoms do develop, they often are mild and nonspecific. The disease often is recognized long after exposure occurred, when secondary effects of the disease (such as chronic hepatitis or cirrhosis) develop. Few acute infections completely resolve; most progress to chronic active hepatitis. Rationale 4: Hepatitis D infects only people already infected with hepatitis B. Global Rationale: Hepatitis C is the primary worldwide cause of chronic hepatitis, cirrhosis, and liver cancer. It is transmitted through infected blood and body fluids. Injection drug use is the primary risk factor for HCV infection, accounting for nearly half of all new infections. Acute hepatitis C usually is asymptomatic; if symptoms do develop, they often are mild and nonspecific. The disease often is recognized long after exposure occurred, when secondary effects of the disease (such as chronic hepatitis or cirrhosis) develop. Few acute infections completely resolve; most progress to chronic active hepatitis. Hepatitis A usually resolves completely and rarely results in a carrier state. Patients with hepatitis B are typically very ill following the preicteric phase, which is not consistent with this patient's history. Hepatitis D infects only people already infected with hepatitis B.

A patient is notified of a diagnosis of hepatitis by the healthcare provider and informed that it can be transmitted to others even though the patient has not been ill. The patient has a distant history of injection substance use. For which type of hepatitis should the nurse plan care for this patient? 1. hepatitis A 2. hepatitis B 3. hepatitis C 4. hepatitis D

Correct Answer: 4 Rationale 1: A hypertonic solution with vitamins and minerals is not the usual intravenous fluid mixture for fluid support. Rationale 2: Total parenteral nutrition (TPN) would be administered through a central vein. Rationale 3: Enteral nutrition is delivered directly into the gastrointestinal system. Rationale 4: A peripherally-inserted central catheter (PICC) line may be used for short-term TPN.

A patient is prescribed a hypertonic solution with vitamins and minerals to be administered through a peripheral intravenous access line. The nurse recognizes this as being what treatment? 1. intravenous fluid support 2. total parenteral nutrition 3. enteral nutrition 4. short-term total parenteral nutrition

Correct Answer: 1, 2, 3 Rationale 1: In PCM, serum albumin level reduced. Rationale 2: In PCM, lymphocyte count is reduced. Rationale 3: In PCM, serum electrolytes are measured. Potassium levels are low in severe malnutrition. Rationale 4: CBC is an important measure, but it is not necessarily useful in determining protein calorie malnutrition. Rationale 5: Urinalysis is an important measure; it is not necessarily useful in determining protein calorie malnutrition. Global Rationale: In PCM, serum albumin and lymphocytes count are reduced. Serum electrolytes are measured and potassium levels are low in severe malnutrition. While a CBC and urinalysis are important measures, they are not necessarily useful in determining protein calorie malnutrition.

A patient is suspected of having protein calorie malnutrition (PCM) with a body mass index of less than 18. Which laboratory tests should the nurse expect to be prescribed for this patient? Standard Text: Select all that apply. 1. serum albumin 2. lymphocyte count 3. serum electrolytes 4. complete blood count (CBC) 5. Urinalysis

Correct Answer: 1 Rationale 1: The best diet is a balance of all nutrients. Ideally, it should consist of 1,000‒1,600 calories per day and consist of no more than 10% fat. Rationale 2: A diet of 750 to 1000 calories per day is too rigid and could lead to physiologic health problems. Rationale 3: Cutting 500 calories per day from the normal intake could also be too rigid for the patient. Excessive calorie restrictions can lead to failure to follow the prescribed diet, feelings of guilt, and overeating. Rationale 4: Consuming a diet of 1250 to 1500 calories per day may not be enough to achieve weight loss. Global Rationale: The best diet is a balance of all nutrients. Ideally, it should consist of 1,000‒1,600 calories per day and consist of no more than 10% fat. A diet of 750 to 1000 calories per day is too rigid and could lead to physiologic health problems. Cutting 500 calories per day from the normal intake could also be too rigid for the patient. Excessive calorie restrictions can lead to failure to follow the prescribed diet, feelings of guilt, and overeating. Consuming a diet of 1250 to 1500 calories per day may not be enough to achieve weight loss.

A patient planning to begin a weight loss diet asks the nurse for suggestions as to how to balance her eating. What information should the nurse provide to the patient? 1. The diet should reduce calories to 1,000‒1,600 per day, with less than 10% of the total calories coming from fat. 2. The diet should be between 750 and 1,000 calories per day, with less than 15% of the total calories coming from fat. 3. The diet should simply cut 500 calories per day from the normal intake. 4. The best diet will be between 1,250 and 1,500 calories per day, with 15% of the calories being sources of protein.

Correct Answer: 1 Rationale 1: Antacids may cause electrolyte imbalances, particularly involving sodium, calcium, and magnesium. Notify the healthcare provider so serum electrolytes can be drawn and reviewed. Rationale 2: There is no indication that the patient's dietary history is an issue. Rationale 3: There is no indication that the patient's elimination patterns are an issue. Rationale 4: Providing reassurance to the patient at this time would be premature, as the complaints are being reported and not adequately reviewed. Global Rationale: Antacids may cause electrolyte imbalances, particularly involving sodium, calcium, and magnesium. Notify the healthcare provider so serum electrolytes can be drawn and reviewed. There is no indication that the patient's dietary history or elimination patterns are an issue. Providing reassurance to the patient at this time would be premature, as the complaints are being reported and not adequately reviewed.

A patient receiving an antacid is experiencing muscle cramps. What should the nurse do to assist this patient? 1. Notify the healthcare provider. 2. Review the patient's diet history. 3. Review the patient's elimination patterns. 4. Provide reassurance to the patient.

Correct Answer: 1 Rationale 1: The potential risks associated with regaining weight make maintenance a critical issue. Patients are encouraged to continue exercise, self-monitoring, and treatment support. Rationale 2: Long-term weight loss and maintenance mean a lifelong commitment to significant lifestyle changes, including food and eating habits, activity and exercise routines, and behavior modification. Rationale 3: There is no evidence that the patient's body needs to have the extra 15 lbs. Rationale 4: There is no evidence that the patient is not obese. Global Rationale: The potential risks associated with regaining weight make maintenance a critical issue. Patients are encouraged to continue exercise, self-monitoring, and treatment support. Long-term weight loss and maintenance mean a lifelong commitment to significant lifestyle changes, including food and eating habits, activity and exercise routines, and behavior modification. There is no evidence that the patient's body needs to have the extra 15 lbs or that the patient is not obese.

A patient regained 15 pounds that had been lost the previous year. What should the nurse suggest to this patient? 1. Return to the diet, exercise, and behavior change techniques that worked before. 2. Switch to a new diet in which the weight could be lost again in two weeks. 3. Consider the possibility that the patient's body needs to have the extra 15 lbs. 4. Understand that the increased weight does not make the patient obese.

Correct Answer: 4 Rationale 1: Surgical consents are not signed in advance of procedures. Rationale 2: The consent is not intended to provide the surgeon with options. Rationale 3: The busyness of the operating rooms has nothing to do with the consent form. Rationale 4: There is a risk that a laparoscopic cholecystectomy may be converted to a laparotomy (surgical opening into the abdomen) during the procedure. Global Rationale: There is a risk that a laparoscopic cholecystectomy may be converted to a laparotomy (surgical opening into the abdomen) during the procedure. Surgical consents are not signed in advance of procedures. The consent is not intended to provide the surgeon with options. The busyness of the operating rooms has nothing to do with the consent form.

A patient scheduled for a laparoscopic cholecystectomy asks the nurse why a surgical consent for a laparotomy must also be completed. How should the nurse respond? 1. "By signing both now, you'll never have to sign another one. We'll keep the extra on file for the future." 2. "Surgeons base their decision on whether to do the procedure laparoscopically or with a full incision on many factors. With this signed, the surgeon has options." 3. "You will be ready if the laparoscopic operating rooms are busy today." 4. "The surgeon will start the procedure laproscopically but may need to make an incision to complete the procedure."

Correct Answer: 1 Rationale 1: For greatest comfort the patient should sit in the Fowler's position, which reduces pressure on the inflamed gallbladder. A person in the Fowler's position is sitting straight up or leaning slightly back. The legs may be either straight or bent. Fat intake should be reduced to minimize gallbladder contractions and pain. Rationale 2: Resting in bed will not help with pain control before the surgery. Milk contains fat and should not be ingested. Rationale 3: Lying on the back and abdomen will not promote comfort. The patient should not eat anything during an acute episode of pain. Rationale 4: Walking is not recommended during a gallbladder attack. The patient should take nothing by mouth, including coffee. Global Rationale: For greatest comfort the patient should sit in the Fowler's position, which reduces pressure on the inflamed gallbladder. A person in the Fowler's position is sitting straight up or leaning slightly back. The legs may be either straight or bent. Fat intake should be reduced to minimize gallbladder contractions and pain. Resting in bed, lying on the back and abdomen, and walking will not help with pain control before the surgery. The patient should not eat anything during an acute episode of pain.

A patient scheduled for a laparoscopic cholecystectomy in 4 days asks how pain can be controlled until the surgery. How should the nurse respond? 1. "You will feel better if you sit in a recliner and drink water and try not to eat anything. Do not eat any fat." 2. "You will feel better if you rest in bed and do not eat anything until the procedure. Drink only water and milk." 3. "You will feel better if you alternate lying on your back and lying on your abdomen. You may eat anything except fatty food." 4. "You will feel better if you walk as frequently as possible. You may drink coffee, but not soda."

Correct Answer: 1 Rationale 1: Pain is the classic symptom of peptic ulcer disease. The pain is typically described as gnawing, burning, aching, or hungerlike; it is experienced in the epigastric region and sometimes radiates to the back. The pain occurs when the stomach is empty (2 to 3 hours after meals and in the middle of the night) and is relieved by eating in a classic "pain-food-relief" pattern. Rationale 2: This classic pattern is not typical of gastroesophageal reflux disease (GERD). Rationale 3: This classic pattern is not typical of acute gastritis. Rationale 4: This classic pattern is not typical of chronic gastritis. Global Rationale: Pain is the classic symptom of peptic ulcer disease. The pain is typically described as gnawing, burning, aching, or hungerlike; it is experienced in the epigastric region and sometimes radiates to the back. The pain occurs when the stomach is empty (2 to 3 hours after meals and in the middle of the night) and is relieved by eating in a classic "pain-food-relief" pattern. This classic pattern is not typical of gastroesophageal reflux disease (GERD), acute gastritis, or chronic gastritis.

A patient tells the nurse, "I get these tremendous stomach pains in the middle of the night, but they disappear after I eat something. No wonder I can't lose any weight!" The nurse suspects that the patient is experiencing which health problem? 1. peptic ulcer disease 2. gastroesophageal reflux disease (GERD) 3. acute gastritis 4. chronic gastritis

Correct Answer: 1, 3, 4 Rationale 1: Physical activity can help reduce the incidence of cholelithiasis and cholecystitis. Rationale 2: A low-fiber, high-carbohydrate diet would not prevent the development of gallstones. Rationale 3: Eating a diet low on saturated fats helps reduce the risk for developing cholelithiasis and cholecystitis. Rationale 4: Eating a low-carbohydrate diet helps reduce the risk for developing cholelithiasis and cholecystitis. Rationale 5: The dangers of yo-yo dieting and extremely low-calorie diets should be reviewed with the patient. Global Rationale: Physical activity, a high-fiber, low-carbohydrate diet, and consumption of unsaturated fats all appear to have a protective effect, reducing the incidence of cholelithiasis and cholecystitis. A low-fiber, high-carbohydrate diet would not prevent the development of gallstones. The dangers of yo-yo dieting and extremely low-calorie diets should be reviewed with the patient.

A patient wants to reduce the risk of developing gallstones and cholecystitis. What should the nurse instruct this patient? Standard Text: Select all that apply. 1. Walk for 30 minutes five times a week. 2. Eat a low-fiber, high-carbohydrate diet. 3. Eat unsaturated rather than saturated fats. 4. Eat a low-carbohydrate diet. 5. Lose weight by any means possible.

Correct Answer: 1 Rationale 1: The cells of the stomach produce intrinsic factor, which is required for the absorption of vitamin B12. Vitamin B12 deficiency leads to pernicious anemia. Because of hepatic stores of vitamin B12, symptoms of anemia may not be seen for 1 to 2 years after surgery. Rationale 2: There are no clinical manifestations presented to support the recurrence of the cancer. Rationale 3: There are no clinical manifestations presented to support metastasis of the cancer. Rationale 4: The patient is seeking clarification of the condition, not demonstrating an inability to cope. Global Rationale: The cells of the stomach produce intrinsic factor, which is required for the absorption of vitamin B12. Vitamin B12 deficiency leads to pernicious anemia. Because of hepatic stores of vitamin B12, symptoms of anemia may not be seen for 1 to 2 years after surgery. There are no clinical manifestations presented to support the recurrence or metastasis of the cancer. The patient is seeking clarification of the condition, not demonstrating an inability to cope.

A patient who had stomach cancer surgery 2 years ago comes to the clinic fearful that "the cancer must be back because I'm so tired all the time." The nurse realizes that this patient is likely experiencing which health problem? 1. vitamin deficiency 2. a return of the stomach cancer 3. metastasis 4. ineffective coping

Correct Answer: 1 Rationale 1: A patient with the diagnosis of cancer may be in denial. The nurse should not negate denial if present because it is a coping mechanism that protects the patient from hopelessness. Rationale 2: There is no real need to remind the patient of the diagnosis. The patient is acting in a manner that can often be anticipated. Rationale 3: At this point, there is no need for a clinical psychologist to intervene. Making a referral to a clinical psychologist is beyond the duties of the nurse. Rationale 4: The patient is not emotionally prepared to discuss cancer survival at this time. Global Rationale: A patient with the diagnosis of cancer may be in denial. The nurse should not negate denial if present because it is a coping mechanism that protects the patient from hopelessness. There is no real need to remind the patient of the diagnosis. The patient is acting in a manner that can often be anticipated. At this point, there is no need for a clinical psychologist to intervene. Making a referral to a clinical psychologist is beyond the duties of the nurse. The patient is not emotionally prepared to discuss cancer survival at this time.

A patient who has had gastric surgery for cancer is denying the diagnosis of cancer. What should the nurse do? 1. The nurse should not argue with the patient but continue to provide emotional support as needed. 2. The nurse should remind the patient of the diagnosis. 3. The nurse should ask a clinical psychologist to talk with the patient. 4. The nurse should explain how many people with cancer live long, productive lives.

Correct Answer: 4 Rationale 1: Neomycin (neomycin sulfate) causes diarrhea, which decreases rather than increases potassium. Rationale 2: Asterixis, the downward flapping of the hands, is a sign of portal systemic encephalopathy and should improve with administration of Neomycin (neomycin sulfate). Rationale 3: Neomycin does not improve jaundice. Rationale 4: Portal systemic encephalopathy is characterized by impaired judgment, confusion, disorientation, and incoherence related to high level of ammonia in the blood. Administering Neomycin (neomycin sulfate) should reduce ammonia levels by decreasing the number of bacteria-producing microorganisms in the bowel. Global Rationale: Portal systemic encephalopathy is characterized by impaired judgment, confusion, disorientation, and incoherence related to high level of ammonia in the blood. Administering Neomycin (neomycin sulfate) should reduce ammonia levels by decreasing the number of bacteria-producing microorganisms in the bowel. Neomycin (neomycin sulfate) causes diarrhea, which decreases rather than increases potassium. Asterixis, the downward flapping of the hands, is a sign of portal systemic encephalopathy and should improve with administration of Neomycin (neomycin sulfate). Neomycin does not improve jaundice.

A patient who has portal systemic encephalopathy is receiving Neomycin (neomycin sulfate). Which manifestation should indicate to the nurse that the patient's condition is improving? 1. increase in potassium level 2. asterixis 3. relief of jaundice 4. increased level of consciousness

Correct Answer: 1 Rationale 1: BMI is calculated by dividing the weight (in kilograms) by the height in meters squared (m2). Utilizing the body mass index table, the patient has a body mass index of 24 kg/m2. A body mass index greater than 25 kg/m2 is considered overweight. Rationale 2: The patient is not slightly obese. Rationale 3: The patient is not slightly overweight. Rationale 4: The patient is not moderately obese. Global Rationale: BMI is calculated by dividing the weight (in kilograms) by the height in meters squared (m2). Utilizing the body mass index table, the patient has a body mass index of 24 kg/m2. A body mass index greater than 25 kg/m2 is considered overweight. The patient is not slightly obese, slightly overweight, or moderately obese.

A patient who is 5 feet 5 inches tall and weighs 144 lbs asks the nurse if she would be considered obese. How should the nurse respond to this patient? 1. "You are a normal weight for your height." 2. "Yes, you are slightly obese for your height." 3. "You are slightly overweight." 4. "You are moderately obese."

Correct Answer: 1 Rationale 1: With a barium swallow, esophageal cancer is seen as a narrowing of the lumen or an irregular mucosal pattern. Rationale 2: Other testing would be needed to detect an actual tumor. Rationale 3: Other testing would be needed to detect metastasis. Rationale 4: Other testing would be needed to detect bleeding. Global Rationale: With a barium swallow, esophageal cancer is seen as a narrowing of the lumen or an irregular mucosal pattern. Other testing would be needed to detect an actual tumor, metastasis, and any bleeding.

A patient who is experiencing difficulty swallowing is diagnosed with esophageal cancer after having a barium swallow. The nurse recognizes that the diagnostic test must have displayed which finding? 1. narrow esophageal lumen 2. tumor 3. metastasis 4. blood

Correct Answer: 1, 4, 5 Rationale 1: Pancrelipase enhances the digestion of starches and fats in the gastrointestinal tract by supplying an exogenous source of the enzymes protease, amylase, and lipase. The drug promotes nutrition and decreases the number of bowel movements. This medication should be taken with meals or snacks. Rationale 2: This medication should not be taken with alkaline foods such as milk or ice cream. Rationale 3: This medication should be taken as directed by the healthcare provider. Rationale 4: Pancrelipase enhances the digestion of starches and fats in the gastrointestinal tract by supplying an exogenous source of the enzymes protease, amylase, and lipase. The drug promotes nutrition and decreases the number of bowel movements. Enteric coated doses of this medication should not be crushed. Rationale 5: Pancrelipase enhances the digestion of starches and fats in the gastrointestinal tract by supplying an exogenous source of the enzymes protease, amylase, and lipase. The drug promotes nutrition and decreases the number of bowel movements. This medication should be taken until advised otherwise by the healthcare provider. Global Rationale: Pancrelipase enhances the digestion of starches and fats in the gastrointestinal tract by supplying an exogenous source of the enzymes protease, amylase, and lipase. The drug promotes nutrition and decreases the number of bowel movements. This medication should be taken with meals or snacks but should not be taken with alkaline foods such as milk or ice cream. Enteric coated doses of this medication should not be crushed. This medication should be taken until advised otherwise by the healthcare provider.

A patient with chronic pancreatitis is prescribed pancrelipase (Lipancreatin). What should the nurse instruct the patient about this medication? Standard Text: Select all that apply. 1. Take the medication with meals or snacks. 2. Take the medication with milk or ice cream. 3. Stop taking the medication if bowel movements increase. 4. Do not crush enteric coated doses of the medication. 5. Take this medication until advised otherwise by the healthcare provider.

Correct Answer: 1 Rationale 1: Dumping syndrome is typically self-limiting and lasts 6 to 12 months after surgery; however, a small percentage of people continue to experience long-term symptoms. Rationale 2: A small percentage of postoperative patients may continue to have dumping syndrome. Rationale 3: Treatment options for dumping syndrome include dietary modifications. Rationale 4: A clear-liquid diet is not recommended as a treatment for postoperative dumping syndrome. Global Rationale: Dumping syndrome is typically self-limiting and lasts 6 to 12 months after surgery; however, a small percentage of people continue to experience long-term symptoms. A small percentage of postoperative patients may continue to have dumping syndrome. Treatment options for dumping syndrome include dietary modifications. A clear liquid diet is not recommended as a treatment for postoperative dumping syndrome.

A patient who is recovering from surgery for stomach cancer a month ago continues to experience dumping syndrome. What should the nurse instruct this patient? 1. "It's usually self-limiting and will resolve within 6 to 12 months." 2. "It will be a problem for the rest of your life." 3. "There's no treatment." 4. "Eat only a clear-liquid diet."

Correct Answer: 1 Rationale 1: One strategy to control the psychological response to food is to use attractive dinnerware, and prepare a formal setting for eating which would occur in a dining room. Rationale 2: Eating out in restaurants should be reduced. Rationale 3: Reading or watching television while eating should not be encouraged. Rationale 4: Cooking so much that there are leftovers is also not a good strategy. Global Rationale: One strategy to control the psychological response to food is to use attractive dinnerware, and prepare a formal setting for eating which would occur in a dining room. Eating out in restaurants should be reduced. Reading or watching television while eating should not be encouraged. Cooking so much that there are leftovers is also not a good strategy.

A patient who lives alone has a BMI of 34. What strategy should the nurse suggest to help this patient reduce overeating? 1. Prepare a meal and eat it in the dining room. 2. Eat out more often to control portion size. 3. Read a book while eating as a distraction from the food. 4. Cook once a week and store the leftovers to reduce the need to cook again.

Correct Answer: 3 Rationale 1: These symptoms are unrelated to porcine intolerance. Rationale 2: These symptoms are unrelated to obesity. Rationale 3: Symptoms of cholelithiasis (gallstone) include severe, steady pain in the epigastric region or upper-right quadrant of the abdomen. The pain may radiate to the back, right scapula, or shoulder. The pain often begins suddenly following a meal, and may last as long as 5 hours. It often is accompanied by nausea and vomiting. Rationale 4: These symptoms are unrelated to pancreatitis. Global Rationale: Symptoms of cholelithiasis (gallstone) include severe, steady pain in the epigastric region or upper-right quadrant of the abdomen. The pain may radiate to the back, right scapula, or shoulder. The pain often begins suddenly following a meal, and may last as long as 5 hours. It often is accompanied by nausea and vomiting. These symptoms are not related to porcine intolerance, obesity, or pancreatitis.

A patient who reports a severe, steady pain in the epigastric area, nausea, and vomiting states, "This happens every time I eat barbecued ribs." What should the nurse consider as the most likely cause of the patient's symptoms? 1. intolerance to pork 2. obesity 3. cholelithiasis 4. pancreatitis

Correct Answer: 1 Rationale 1: Once jaundice develops, the amount of virus in the stool and the risk of spreading the disease decrease significantly. The nurse should teach that the patient was likely more contagious in the last 2 weeks than at the current time. Rationale 2: This disease is spread through the fecal-oral route. It is likely the patient contracted the illness on the trip. Rationale 3: Rest is recommended for the patient with hepatitis A. Rationale 4: Full recovery is the typical scenario with this illness. Global Rationale: Once jaundice develops, the amount of virus in the stool and the risk of spreading the disease decrease significantly. The nurse should teach that the patient was likely more contagious in the last 2 weeks than at the current time. This disease is spread through the fecal-oral route. It is likely the patient contracted the illness on the trip. Rest is recommended for the patient with hepatitis A. Full recovery is the typical scenario with this illness.

A patient who returned from a humanitarian trip to Central America 2 weeks ago is jaundiced and diagnosed with hepatitis A. The patient is the parent of three school-age children. Which patient statement should the nurse follow up with the patient? 1. "I can't go home and expose my children to this." 2. "We cared for several very ill people on our trip." 3. "I plan to get a lot of rest in the next few days." 4. "I am likely to recover fully eventually."

Correct Answer: 1 Rationale 1: A pound of body fat is equivalent to 3500 kilocalorie (kcal). To lose one pound, therefore, a person must reduce daily caloric intake by 250 kcal for 14 days or increase activity enough to burn the equivalent kcal. Rationale 2: There is no need for the nurse to refer the patient to a dietician. Dietary teaching about weight reduction is within the nurse's scope of practice. Rationale 3: Documenting the patient's comments is not the priority. Rationale 4: Discussing the time it took for the patient to gain the weight will not promote a therapeutic environment. Global Rationale: A pound of body fat is equivalent to 3500 kilocalorie (kcal). To lose one pound, therefore, a person must reduce daily caloric intake by 250 kcal for 14 days or increase activity enough to burn the equivalent kcal. There is no need for the nurse to refer the patient to a dietician. Dietary teaching about weight reduction is within the nurse's scope of practice. Documenting the patient's comments is not the priority. Discussing the time it took for the patient to gain the weight will not promote a therapeutic environment.

A patient with a BMI of 29 says, "I cut out all my sweet snacks last week, and I still can't lose any weight." How should the nurse respond to this patient? 1. "Let's calculate how many calories you are not eating each day." 2. "I recommend that you go see a dietician." 3. "I'll make a note in your file that you no longer eating sweet snacks." 4. "You didn't gain the weight overnight."

Correct Answer: 2 Rationale 1: The patient with a liver abscess is at risk for developing dehydration due to fever, nausea, and vomiting as a result of the infection. The patient is likely not experiencing a problem with too much fluid. Rationale 2: The patient with a liver abscess is at risk for developing dehydration due to fever, nausea, and vomiting as a result of the infection. It is important that the nurse assess for signs of dehydration. Rationale 3: The patient with a liver abscess is not usually in respiratory distress. Rationale 4: There should be no problems with self-image, as the infection is in the liver. Global Rationale: The patient with a liver abscess is at risk for developing dehydration due to fever, nausea, and vomiting as a result of the infection. It is important that the nurse assess for signs of dehydration. The patient is likely not experiencing a problem with too much fluid. The patient with a liver abscess is not usually in respiratory distress. There should be no problems with self-image, as the infection is in the liver.

A patient with a liver abscess is experiencing nausea and vomiting. Which problem should the nurse identify as a priority for this patient? 1. too much fluid 2. not enough fluid 3. problem breathing 4. altered self-image

Correct Answer: 3 Rationale 1: The surgeon will make the determination about the type of surgery to be performed. Rationale 2: Asking about the last meal consumed is not relevant. Rationale 3: Bacterial infection is often present in acute cholecystitis and may cause an elevated temperature and respiratory rate. Rationale 4: Offering to call the surgeon to postpone surgery is not an appropriate response. Global Rationale: Bacterial infection is often present in acute cholecystitis and may cause an elevated temperature and respiratory rate. Offering to call the surgeon to postpone surgery and asking about the last meal consumed are not appropriate responses. The surgeon will make the determination about the type of surgery to be performed.

A patient with acute cholecystitis is concerned about having the flu because of an oral temperature of 101.8°F. What should the nurse respond to the patient? 1. "Your cholecystectomy cannot be performed laparoscopically now." 2. "Tell me exactly what you ate for your last meal." 3. "Bacterial infection is often present in cholelithiasis." 4. "I will call the surgeon and ask to postpone the cholecystectomy."

Correct Answer: 3 Rationale 1: This is a dangerous response. The patient could be developing peritonitis. Rationale 2: The patient needs to be seen by the healthcare provider now. Rationale 3: Rupture of an acutely inflamed gallbladder may be heralded by abrupt but transient pain relief as contents are released from the distended gallbladder into the abdomen. This change should be promptly reported to the healthcare provider. Rationale 4: The ultrasound can wait. The change in symptoms needs to be reported immediately. Global Rationale: Rupture of an acutely inflamed gallbladder may be heralded by abrupt but transient pain relief as contents are released from the distended gallbladder into the abdomen. This change should be promptly reported to the healthcare provider. The patient should not go home, wait a day to be seen, or have an ultrasound before being seen by the healthcare provider.

A patient with an acutely inflamed gallbladder states that the pain has suddenly stopped. The patient wants to go home. What is the nurse's best response? 1. "It is your choice. You are feeling better and not required to stay." 2. "Please stay until your healthcare provider sees you tomorrow." 3. "I will inform your healthcare provider of the change in your symptoms." 4. "Yes, as soon as we perform the prescribed ultrasound of the gallbladder."

Correct Answer: 4 Rationale 1: Acute cholecystitis does not elevate amylase levels. Rationale 2: It would be highly unlikely for the gallstone to migrate to the neck of the pancreas. Rationale 3: The gallstone does not cause bile to back into the pancreas, although it can cause pancreatic enzymes to back up into the pancreas. Rationale 4: When a gallstone in the bile duct blocks the common bile duct, pancreatic enzymes cannot exit the common bile duct and back up into the pancreas, causing pancreatitis, which elevates pancreatic enzymes. A normal serum amylase level is 0-130 units/L. Global Rationale: When a gallstone in the bile duct blocks the common bile duct, pancreatic enzymes cannot exit the common bile duct and back up into the pancreas, causing pancreatitis, which elevates pancreatic enzymes. A normal serum amylase level is 0-130 units/L. Acute cholecystitis does not elevate amylase levels. It would be highly unlikely for the gallstone to migrate to the neck of the pancreas. The gallstone does not cause bile to back into the pancreas, although it can cause pancreatic enzymes to back up into the pancreas.

A patient with cholelithiasis has a serum amylase level of 300 units/L. What should the nurse consider as the most likely explanation for the laboratory finding? 1. The gallstone is causing acute cholecystitis. 2. The gallstone has migrated to the neck of the pancreas. 3. The gallstone has caused bile to back into the pancreas. 4. The gallstone is blocking the common bile duct.

Correct Answer: 2, 3, 5 Rationale 1: .The procedure usually takes an hour. Rationale 2: Mild sedation may be given during the procedure. Rationale 3: Nursing care after the procedure includes monitoring for biliary colic, which can result from the gallbladder contracting to remove stone fragments. The patient with biliary colic is often nauseated. Rationale 4: Positioning is important, and the patient most likely did not move around during the procedure. Rationale 5: A machine is used to deliver shock waves to break up the gallstones. Global Rationale: Mild sedation may be given during the procedure. Nursing care after the procedure includes monitoring for biliary colic, which can result from the gallbladder contracting to remove stone fragments. The patient with biliary colic is often nauseated. A machine is used to deliver shock waves to break up the gallstones. The procedure usually takes an hour. Positioning is important, and the patient most likely did not move around during the procedure.

A patient with cholelithiasis is recovering from extracorporeal shock wave lithotripsy. Which statements indicate that the patient remembers the procedure accurately? Standard Text: Select all that apply. 1. "It didn't take long, just a few hours." 2. "They gave me some medication in my IV. I didn't feel much." 3. "Afterwards the nurses kept asking me if my abdomen hurt or if I was nauseated." 4. "I was glad I could move around a lot during the procedure." 5. "They used a big machine to guide the shock waves to the stones."

Correct Answer: 3 Rationale 1: The patient could develop shock. Rationale 2: A dietitian is not needed at this time. Rationale 3: A normal level for serum amylase is between 0 and 130 units/L. In pancreatitis, the serum amylase increases to two to three times the normal level and remains elevated for 3 to 4 days. The primary healthcare provider should be notified of the patient's symptoms and the laboratory findings. Rationale 4: The nurse can assess the patient's alcohol intake at a later time. Global Rationale: A normal level for serum amylase is between 0 and 130 units/L. In pancreatitis, the serum amylase increases to two to three times the normal level and remains elevated for 3 to 4 days. The primary healthcare provider should be notified of the patient's symptoms and the laboratory findings. The patient could develop shock. A dietitian is not needed at this time. The nurse can assess the patient's alcohol intake at a later time.

A patient with epigastric pain has a serum amylase level of 369 units/L. What should the nurse do? 1. continue to monitor the patient 2. refer the patient to a dietician 3. contact the primary healthcare provider 4. question the patient regarding alcohol use patterns

Correct Answer: 1 Rationale 1: Manifestations of hiatal hernia include substernal chest pain. Rationale 2: Diverticulitis is not associated with substernal chest pain. Rationale 3: Constipation is not associated with substernal chest pain. Rationale 4: Bowel obstruction is not associated with substernal chest pain. Global Rationale: Manifestations of hiatal hernia include substernal chest pain. Diverticulitis, constipation, and bowel obstruction are not associated with substernal chest pain.

A patient with gastrointestinal dysfunction says, "I was having chest pain so bad last week I thought I was having a heart attack!" What should the nurse suspect the patient was experiencing? 1. hiatal hernia 2. diverticulitis 3. constipation 4. bowel obstruction

Correct Answer: 2 Rationale 1: Jaundice is characterized by yellow-tinged skin as a result of hepatitis. Rationale 2: The patient who is receiving interferon alpha may experience flulike symptoms such as fever, fatigue, body aches, headache, and chills. Rationale 3: Gallbladder pain is the result of stones in the gallbladder. Rationale 4: Clay-colored stools are associated with liver or biliary disease. Global Rationale: The patient who is receiving interferon alpha may experience flulike symptoms such as fever, fatigue, body aches, headache, and chills. Jaundice is characterized by yellow-tinged skin as a result of hepatitis. Gallbladder pain is the result of stones in the gallbladder. Clay-coloreds stool are associated with liver or biliary disease.

A patient with hepatitis is receiving interferon alpha. Which manifestation indicates that the patient is experiencing an untoward effect of this medication? 1. jaundice 2. flulike syndrome 3. gallbladder pain 4. clay-colored stools

Correct Answer: 2 Rationale 1: This medication does not increase the serum ammonia level. Rationale 2: Ammonia, a toxic by-product of protein metabolism, is converted to urea in the liver for elimination by the kidneys. Lactulose works by acidifying the contents of the bowel, which has the effect of keeping ammonia in the bowel, where it is excreted from the body in the stools, rather than being reabsorbed into the circulation. Rationale 3: This medication does not affect the ALT level. Rationale 4: This medication does not affect the ALT level. Global Rationale: Ammonia, a toxic by-product of protein metabolism, is converted to urea in the liver for elimination by the kidneys. Lactulose works by acidifying the contents of the bowel, which has the effect of keeping ammonia in the bowel, where it is excreted from the body in the stools, rather than being reabsorbed into the circulation. This medication should lower the serum ammonia level. It has no effect on the ALT level.

A patient with liver failure is taking lactulose (Chronulac). Which laboratory data indicates that the medication is having the desired effect? 1. increased serum ammonia level 2. decreased serum ammonia level 3. increased serum ALT level 4. decreased serum ALT level

Correct Answer: 1 Rationale 1: Refeeding can precipitate malabsorption and diarrhea. Rationale 2: The diarrhea occurs after each meal, not only with foods that may cause an allergy. Rationale 3: The diarrhea occurs after each meal, not only with foods that are carbohydrates. Rationale 4: Cardiovascular overload the development of diarrhea after eating. Global Rationale: Refeeding can precipitate malabsorption and diarrhea. The diarrhea occurs after each meal, not with foods that may cause an allergy or only with carbohydrates. Cardiovascular overload is not related to the development of diarrhea after eating.

A patient with malnutrition is experiencing ongoing diarrhea after every meal. The nurse realizes that this patient could have what health problem? 1. malabsorption 2. a food allergy 3. carbohydrate intolerance 4. pending cardiovascular overload

Correct Answer: 2 Rationale 1: Pancreatitis can lead to malnutrition, but steatorrhea is not a sign of malnutrition. This statement is inaccurate. Rationale 2: Steatorrhea is fatty, frothy, smelly stools associated with pancreatitis. It is caused by a decrease in pancreatic enzyme secretion; fat in the GI tract is not absorbed properly and a greater than normal amount of fat is excreted in the stool, causing the symptoms of steatorrhea. Rationale 3: Peptic ulcer disease can be related to pancreatitis, but it is not related to steatorrhea. Rationale 4: Diabetes mellitus causes increased urine production and could be the result of pancreatitis, but it does not affect stool characteristics. Global Rationale: Steatorrhea is fatty, frothy, smelly stools associated with pancreatitis. It is caused by a decrease in pancreatic enzyme secretion; fat in the GI tract is not absorbed properly and a greater than normal amount of fat is excreted in the stool, causing the symptoms of steatorrhea. Pancreatitis can lead to malnutrition, but steatorrhea is not a sign of malnutrition. Peptic ulcer disease can be related to pancreatitis, but it is not related to steatorrhea. Diabetes mellitus causes increased urine production and could be the result of pancreatitis, but it does not affect stool characteristics.

A patient with pancreatitis asks the nurse, "Why are my stools so frothy and smell so bad?" How should the nurse respond? 1. "This is a sign of malnutrition." 2. "This indicates your stools have more fat in them." 3. "This is a sign of peptic ulcer disease." 4. "You may be developing diabetes mellitus."

Correct Answer: 1 Rationale 1: In an attempt to avoid discomfort, the patient with PUD may gradually reduce food intake and sometimes jeopardize nutritional status. Anorexia and early satiety are additional problems associated with PUD. Rationale 2: The patient is not at increased risk for a sleep problem such as insomnia. Rationale 3: The patient is not at increased risk for ongoing pain. Rationale 4: The patient is not at increased risk for overhydration. Global Rationale: In an attempt to avoid discomfort, the patient with PUD may gradually reduce food intake and sometimes jeopardize nutritional status. Anorexia and early satiety are additional problems associated with PUD. The patient is not at increased risk for sleep problems, ongoing pain, or overhydration.

A patient with peptic ulcer disease (PUD) says, "I feel so much better now that I've stopped eating." The nurse realizes that this patient is at risk for which health problem? 1. insufficient nutritional intake 2. insomnia 3. ongoing pain 4. overhydration

Correct Answer: 1, 2, 3, 5 Rationale 1: Weight loss indicates a drop in body fluid or dehydration. Weighing daily helps monitor fluid balance. Rationale 2: Dry mucous membranes may indicate dehydration. Rationale 3: Increased urine specific gravity may indicate dehydration. Rationale 4: A new skin blister on the sacrum indicates a protein deficiency. Rationale 5: A change in level of consciousness may indicate dehydration. Global Rationale: Dry mucous membranes, increased urine specific gravity, and decreased level of consciousness may indicate dehydration. Daily weights help monitor fluid balance. Weight loss indicates a drop in body fluid or dehydration. A new skin blister on the sacrum indicates a protein deficiency.

A patient with protein-calorie malnutrition has been ingesting a hyperosmolar nutritional supplement three times a day for a week. Which assessment findings indicate that this patient is experiencing dehydration? Standard Text: Select all that apply. 1. weight loss 2. dry mucous membranes 3. high urine specific gravity 4. new skin blister on sacrum 5. change in level of consciousness

Correct Answer: 3, 4, 5 Rationale 1: An esophagectomy is indicated for esophageal cancer. Rationale 2: Gastric resection is indicated for gastric cancer. Rationale 3: Treatment of achalasia may include laparoscopic myotomy to reduce pressure and relieve symptoms. Rationale 4: Treatment of achalasia may include balloon dilation of the lower esophageal sphincter. Balloon dilation tears muscle fibers in the LES, reducing its pressure. Rationale 5: Treatment of achalasia may include endoscopically guided injection of botulinum toxin into the lower esophageal sphincter. Botulinum toxin injection lowers LES pressure, but may need to be repeated every 6 to 9 months. Global Rationale: Treatment of achalasia may include endoscopically guided injection of botulinum toxin into the lower esophageal sphincter or balloon dilation of the LES. Botulinum toxin injection lowers LES pressure, but may need to be repeated every 6 to 9 months. Balloon dilation tears muscle fibers in the LES, reducing its pressure. A laparoscopic myotomy reduces pressure and relieves symptoms. An esophagectomy is indicated for esophageal cancer. Gastric resection is indicated for gastric cancer.

A patient with severe esophageal spasms is diagnosed with achalasia. For which surgical procedures should the nurse prepare teaching for this patient? Standard Text: Select all that apply. 1. esophagectomy 2. gastric resection 3. laparoscopic myotomy 4. balloon dilation of the lower esophageal sphincter 5. endoscopically guided injection of botulinum toxin

Correct Answer: 1 Rationale 1: Insulin is needed by the body cells to facilitate glucose transport across cell walls. The greater the body's mass, the increase in likelihood the body's cells will become resistant to insulin. This will result in type 2 diabetes. Rationale 2: The more mass in the body, the greater the resistance of the body's cells to insulin. Rationale 3: The patient has reduced the amount of carbohydrates eaten to lose weight, but this response does not explain the patient's surprise in learning about the change in medication needs. Rationale 4: The reduction in size has resulted in a lower body glucose level in response. Global Rationale: Insulin is needed by the body cells to facilitate glucose transport across cell walls. The greater the body's mass, the increase in likelihood the body's cells will become resistant to insulin. This will result in type 2 diabetes. The more mass in the body, the greater the resistance of the body's cells to insulin. The patient has reduced the amount of carbohydrates eaten to lose weight, but this response does not explain the patient's surprise in learning about the change in medication needs.

After following a structured diet, a patient diagnosed with diabetes mellitus is surprised to learn that his blood glucose levels have decreased and oral medications are no longer required. What explanation regarding the impact of diet on diabetes management should the nurse give the patient? 1. Less body mass means less insulin is needed to maintain constant glucose levels. 2. Body mass reduces cellular resistance to insulin. 3. Reduced dietary intake of carbohydrates is responsible for the weight loss. 4. Reduced dietary intake results in a reduced need for insulin.

Correct Answer: 1 Rationale 1: Older patients are at increased risk for malnutrition. Functional limitations can impair the ability to shop and cook. Psychosocial issues also contribute to the problem. Loss of appetite is a problem that is commonly seen with depression. Social isolation and loneliness contribute to the problem. Rationale 2: There is no evidence that this patient is at risk for developing obesity. Rationale 3: There is no evidence that this patient is at risk for developing psychosis. Rationale 4: There is no evidence that this patient is at risk for developing immobility. Global Rationale: Older patients are at increased risk for malnutrition. Functional limitations can impair the ability to shop and cook. Psychosocial issues also contribute to the problem. Loss of appetite is a problem that is commonly seen with depression. Social isolation and loneliness contribute to the problem. There is no evidence that this patient is at risk for developing obesity, psychosis, or immobility.

An elderly patient who uses a walker tells the nurse, "I'm so alone now that my family is gone." The nurse realizes that this patient might be at risk for developing what health problem? 1. malnutrition 2. obesity 3. psychosis 4. immobility

Correct Answer: 1 Rationale 1: Family and social support is critical to successful adherence to the therapeutic regimen. Without family support, the patient will have difficulty adhering to the weight loss plan. Rationale 2: There is no evidence that the patient is eating more than is required for bodily functions. Rationale 3: There is no evidence that the patient is having difficulty with exercise and activity. Rationale 4: There is no evidence that the patient has generalized feelings of self-reproach. Global Rationale: Family and social support is critical to successful adherence to the therapeutic regimen. Without family support, the patient will have difficulty adhering to the weight loss plan. There is no evidence that the patient is eating more than is required for bodily functions, having difficulty with exercise and activity, or experiencing generalized feelings of self-reproach.

An overweight patient states, "I'm trying to stick to my diet and exercise plan, but my spouse tells me that I'm fine the way I am." What type of problem is this patient experiencing? 1. lack of family and social support to adhere to the plan 2. eating more than is required for bodily functions 3. difficulty with exercise and activity 4. generalized feelings of self-reproach

Correct Answer: 1 Rationale 1: Most overweight people are stimulated to eat by external cues, such as the proximity to food and the time of day. Rationale 2: In contrast, hunger and satiety are the cues that regulate eating in adults of normal weight. The patient's reports involve eating with no mention of hunger. Rationale 3: There is no evidence to support the presence of any addiction. Rationale 4: There is no evidence to support the presence of metabolic disorder. Global Rationale: Most overweight people are stimulated to eat by external cues, such as the proximity to food and the time of day. In contrast, hunger and satiety are the cues that regulate eating in adults of normal weight. The patient's reports involve eating with no mention of hunger. There is no evidence to support the presence of any addiction or metabolic disorder.

An overweight patient tells the nurse, "Every Monday at work we have bagels. I can't stop myself! Sometimes I eat two!" What should the nurse realize this patient is describing? 1. appetite stimulation by external cues 2. extreme hunger from calorie restriction 3. carbohydrate addiction in its early stage 4. metabolic syndrome development

A male patient comes to the emergency department with symptoms of renal colic. The nurse realizes that this patient likely has a calculus that is obstructing which body structure? 1. ureter 2. bladder 3. renal pelvis 4. urethra

Correct Answer: 1 Rationale 1: Renal colic is acute, severe flank pain on the affected side. It develops when a stone obstructs the ureter and causes ureteral spasm. Rationale 2: Calculi in the bladder would not cause flank pain or colic. Rationale 3: Calculi in the renal pelvis would not cause flank pain or colic. Rationale 4: Calculi in the urethra would not cause flank pain or colic. Global Rationale: Renal colic is acute, severe flank pain on the affected side. It develops when a stone obstructs the ureter and causes ureteral spasm. Calculi in the bladder, renal pelvis, or urethra would not cause flank pain or colic.

The nurse is caring for a patient with multiple skin lesions who reports following a very-low-calorie diet to maintain weight loss. What should the nurse identify as the patient's priority problem? 1. inadequate nutritional intake 2. issues with activity 3. tissue perfusion insufficiency 4. risk for self-harm

Correct Answer: 1 Rationale 1: A deficit of fats may cause excessive weight loss and skin lesions. Rationale 2: There is no evidence that the patient is having issues with activity. Rationale 3: The patient's skin lesions do not indicate a problem with tissue perfusion. Rationale 4: There is no evidence that the patient is at risk for self-harm. Global Rationale: A deficit of fats may cause excessive weight loss and skin lesions. There is no evidence that the patient has issues with activity or tissue perfusion. There is no evidence that the patient is at risk for self-harm.

During the assessment of a postoperative patient's bowel sounds, the nurse auscultates absent sounds over all four abdominal quadrants. The nurse realizes this finding could indicate what health problem? 1. paralytic ileus 2. normal bowel function 3. the onset of flatus 4. the onset of stool

Correct Answer: 1 Rationale 1: A distended abdomen with absent bowel sounds may indicate paralytic ileus. Rationale 2: Normal bowel sounds are low in pitch. Rationale 3: The onset or presence of flatus is accompanied by bowel sounds. Rationale 4: The onset of stool is accompanied by bowel sounds. Global Rationale: A distended abdomen with absent bowel sounds may indicate paralytic ileus. Normal bowel sounds are low in pitch. The onset or presence of flatus and stool is accompanied bowel sounds.

An older patient is completing preoperative diagnostic testing. The nurse notes that the patient's carbon dioxide level is elevated. What should the nurse be monitoring for this patient? 1. Respiratory status and arterial blood gases 2. Serum potassium level 3. Serum sodium level 4. Intake and output

Correct Answer: 1 Rationale 1: A patient with an altered carbon dioxide level could have a history of emphysema, chronic bronchitis, asthma, pneumonia, or respiratory acidosis, or it could be caused by vomiting or nasogastric suctioning. The best nursing intervention for this patient would be to monitor the patient's respiratory status and arterial blood gases. Rationale 2: A review of the potassium level is not the most beneficial to this patient at this time. Rationale 3: A review of the sodium level is not the most beneficial to this patient at this time. Rationale 4: A review of the intake and output is not the most beneficial to this patient at this time. Global Rationale: A patient with an altered carbon dioxide level could have a history of emphysema, chronic bronchitis, asthma, pneumonia, or respiratory acidosis, or it could be caused by vomiting or nasogastric suctioning. The best nursing intervention for this patient would be to monitor the patient's respiratory status and arterial blood gases. A review of the potassium, sodium levels, and intake and output are not the most beneficial to this patient at this time.

An older patient, recovering from surgery, is prescribed a soft diet. The nurse realizes that this diet supports which age-related change? 1. decline in gastric motility 2. reduced intestinal absorption 3. lactose intolerance 4. gall bladder insufficiency

Correct Answer: 1 Rationale 1: A soft diet helps with this change in the older adult. Rationale 2: Reduced intestinal absorption is not a gastrointestinal age-related change. Rationale 3: Lactose intolerance can occur at many ages. Rationale 4: Gall bladder insufficiency is not a gastrointestinal age-related change. Global Rationale: A soft diet helps with this change in the older adult. Reduced intestinal absorption is not a gastrointestinal age-related change. Lactose intolerance can occur at many ages. Gall bladder insufficiency is not a gastrointestinal age-related change.

A male patient has a history of calcium calculi. Which medication should the nurse expect to be prescribed for this patient? 1. furosemide (Lasix) 2. penicillin (Pentids) 3. allopurinol (Alloprim) 4. NSAIDs

Correct Answer: 1 Rationale 1: A thiazide diuretic, which is frequently prescribed for calcium calculi, acts to reduce urinary calcium excretion and is very effective in preventing further stones. Furosemide (Lasix) is a thiazide diuretic. Rationale 2: Penicillin (Pentids) is an antimicrobial and does not affect the development of calcium stones. Rationale 3: Allopurinol (Alloprim) is used to reduce serum levels of uric acid and has no effect on the development of calcium stones. Rationale 4: NSAIDs (nonsteroidal anti-inflammatory drugs) are used to reduce pain and fever and have no effect on the development of calcium stones. Global Rationale: A thiazide diuretic, which is frequently prescribed for calcium calculi, acts to reduce urinary calcium excretion and is very effective in preventing further stones. Furosemide (Lasix) is a thiazide diuretic. Penicillin (Pentids) is an antimicrobial. Allopurinol (Alloprim) is used to reduce serum levels of uric acid. NSAIDs (nonsteroidal anti-inflammatory drugs) are used to reduce pain and fever. Penicillin, allopurinol, and NSAIDs have no effect on the development of calcium stones.

A patient scheduled for outpatient surgery asks the nurse why he will not be admitted to the hospital for the surgery. What should the nurse explain as an advantage of having outpatient surgery? 1. reduced risk of healthcare-associated infections 2. ability to use home care for postoperative care in the home 3. reduced use of postoperative medications 4. inadequate staffing on the surgical care areas

Correct Answer: 1 Rationale 1: Advantages to outpatient surgery include a reduced risk of healthcare-associated infections. Rationale 2: The patient may or may not have home care for postoperative care in the home. Rationale 3: There is no evidence to suggest that patients who have outpatient surgery use fewer postoperative medications. Rationale 4: Saying that staffing on the surgical care areas is inadequate would be inappropriate. Global Rationale: Advantages to outpatient surgery include a reduced risk of healthcare-associated infections. The patient may or may not have home care for postoperative care in the home. There is no evidence to suggest that patients who have outpatient surgery use fewer postoperative medications. Saying that staffing on the surgical care areas is inadequate would be inappropriate.

A patient is prescribed a low-residue diet. What foods should the nurse instruct the patient to avoid while on this diet? 1. wine, vinegar, beer, liquor 2. rice, grains, pasta 3. canned vegetables 4. chilled fruit gelatin desserts

Correct Answer: 1 Rationale 1: Alcohol is not permitted on a low-residue diet. Rationale 2: Foods allowed on a low-residue diet include rice, grains, and pasta. Rationale 3: Foods allowed on a low-residue diet include canned vegetables. Rationale 4: Foods allowed on a low-residue diet include chilled fruit gelatin desserts. Global Rationale: Alcohol is not permitted on a low-residue diet. Foods allowed include rice, grains, pasta, canned vegetables, and chilled fruit gelatin desserts.

The patient who is preparing for surgery asks the nurse to keep his glasses and hearing aid in place until he is under anesthesia. Which nursing response demonstrates accurate therapeutic communication? 1. "I will contact the surgery department to discuss your requests." 2. "You cannot keep those in." 3. "The policies in the surgery unit will not allow it." 4. "Certainly, you can keep them for that time."

Correct Answer: 1 Rationale 1: Although communication will be enhanced if the patient can keep glasses and hearing aids for as long as possible, the nurse will need to check with the surgical department first before granting the patient's wish. Rationale 2: As a patient advocate, the nurse is responsible for making an inquiry. Rationale 3: The nurse does not have the authority to make decisions on behalf of the surgical department. Rationale 4: The nurse should not give information that may be inaccurate. Global Rationale: Although communication will be enhanced if the patient can keep glasses and hearing aids for as long as possible, the nurse will need to check with the surgical department first before granting the patient's wish. As a patient advocate, the nurse is responsible for making an inquiry. The nurse does not have the authority to make decisions on behalf of the surgical department and should not give information that may be inaccurate.

An older adult patient being prepared for surgery is scheduled for an electrocardiogram. What should the nurse explain to the patient regarding the purpose of this test? 1. It is routine for all patients having general anesthesia. 2. It is used to diagnose preexisting cardiac disease. 3. It is one way to validate laboratory values 4. It is a predictor of surgical procedure success.

Correct Answer: 1 Rationale 1: An electrocardiogram (ECG) is ordered routinely for patients undergoing general anesthesia when they are over 40 years of age or have cardiovascular disease. Rationale 2: The electrocardiogram might detect preexisting cardiac disease but will not diagnose disease. Rationale 3: The electrocardiogram will not validate laboratory values. Rationale 4: The electrocardiogram is not used to predict the success of surgical procedures. Global Rationale: An electrocardiogram (ECG) is ordered routinely for patients undergoing general anesthesia when they are over 40 years of age or have cardiovascular disease. The electrocardiogram might detect preexisting cardiac disease but will not diagnose disease. The electrocardiogram will not validate laboratory values and is not used to predict the success of surgical procedures.

A patient being prepared for surgery has been diagnosed with dehydration. Which laboratory values support the diagnosis for this patient? 1. hemoglobin and hematocrit 2. glucose 3. white blood cell count 4. platelet count

Correct Answer: 1 Rationale 1: An increase in hemoglobin and hematocrit levels would indicate dehydration. Rationale 2: An alteration in glucose level could indicate impaired glucose metabolism or inadequate glucose level. Rationale 3: An alteration in white blood cell count could indicate an infection or immune deficiencies. Rationale 4: An alteration in platelet count could indicate a malignancy or clotting deficiency disorder. Global Rationale: An increase in hemoglobin and hematocrit levels would indicate dehydration. An alteration in glucose level could indicate impaired glucose metabolism or inadequate glucose level. An alteration in white blood cell count could indicate an infection or immune deficiencies. An alteration in platelet count could indicate a malignancy or clotting deficiency disorder.

The nurse is instructing a patient who is experiencing diarrhea associated with a microorganism not to use an antidiarrheal medication. The patient asks, "Why can't I take something to stop the diarrhea?" How should the nurse respond to this patient? 1. "Antidiarrheal medication slows down the elimination of the microorganism causing the diarrhea." 2. "Antibiotics are always used to treat the microorganisms but antibiotics may worsen diarrhea." 3. "The potassium you are taking will help to slow down the diarrhea." 4. "Your physician does not like to use antidiarrheal medications."

Correct Answer: 1 Rationale 1: Antidiarrheal medications can prolong the discomfort by slowing the elimination of the bacteria from the bowel. Rationale 2: Antibiotics may be given but the antibiotics alter the normal flora of the bowel and may worsen diarrhea. Rationale 3: Potassium is given to achieve electrolyte balance. Rationale 4: This response does not address the patient's question. Global Rationale: Antidiarrheal medications can prolong the discomfort by slowing the elimination of the bacteria from the bowel. Antibiotics may be given but the antibiotics alter the normal flora of the bowel and may worsen diarrhea. Potassium is given to achieve electrolyte balance.

A patient who was recently diagnosed with hypertension and placed on propranolol (Inderal) is seen in the clinic for an unrelated issue. When the nurse notes that his blood pressure is elevated, she asks if the patient has been taking his medication and he says he quit because "I didn't like how I felt when I took it." Based on this statement, what would be an appropriate response? 1. "Many male patients experience side effects of this drug, which include altered libido and impotence. This is common. Tell me how you felt when you took the drug." 2. "You shouldn't stop taking the drug without first talking to the doctor!" 3. Write a note in the patient's record but say nothing to the patient. 4. "I'm going to give you some information about this medication for you to take home and read. At your next visit, I'll have the doctor talk to you about it."

Correct Answer: 1 Rationale 1: Antihypertensive drugs are a common cause of erectile dysfunction (ED) and loss of libido, and many men do not report the disorder. The side effects should be discussed at the time the prescription is given and reviewed at any follow-up visits. Offering an opening to discuss sexual dysfunction is relevant. Rationale 2: Admonishing a patient for not taking medications does not address the problem. Rationale 3: Merely noting the issue in the patient's chart does not address the problem. Rationale 4: Offering factual information is relevant, but in this case the patient's hypertension remains untreated. Global Rationale: Antihypertensive drugs are a common cause of erectile dysfunction (ED) and loss of libido, and many men do not report the disorder. The side effects should be discussed at the time the prescription is given and reviewed at any follow-up visits. Offering an opening to discuss sexual dysfunction is relevant. Admonishing a patient for not taking medications and merely noting the issue in the patient's chart does not address the problem. Offering factual information is relevant but, in this case, the patient's hypertension remains untreated.

A male patient is concerned about a recent increase in breast tissue. What should the nurse do to assist this patient? 1. Review the patient's health history. 2. Tell him that it is self-limiting and will go away in time. 3. Suggest that the patient have a mammogram to ensure he does not have breast cancer. 4. Recommend a breast biopsy to find out the reason for the increase in breast tissue.

Correct Answer: 1 Rationale 1: Any condition that increases estrogen activity or decreases testosterone production can contribute to gynecomastia. Conditions that increase estrogen activity include obesity, testicular tumors, liver disease, and adrenal carcinoma; conditions that decrease testosterone production include chronic illness such as tuberculosis or Hodgkin disease, injury, and orchitis. Drugs such as digitalis, opiates, and chemotherapeutic agents are also associated with gynecomastia. Rationale 2: Dismissing the patient's concerns is not therapeutic and, until further evaluation is completed, could be potentially dangerous. Rationale 3: Gynecomastia is usually bilateral. If it is unilateral, biopsy may be necessary to rule out breast cancer. Rationale 4: Gynecomastia is usually bilateral. If it is unilateral, biopsy may be necessary to rule out breast cancer. Global Rationale: Any condition that increases estrogen activity or decreases testosterone production can contribute to gynecomastia. Conditions that increase estrogen activity include obesity, testicular tumors, liver disease, and adrenal carcinoma; conditions that decrease testosterone production include chronic illness such as tuberculosis or Hodgkin' disease, injury, and orchitis. Drugs such as digitalis, opiates, and chemotherapeutic agents are also associated with gynecomastia. Dismissing the patient's concerns is not therapeutic and until further evaluation is completed this could be potentially dangerous. Gynecomastia is usually bilateral. If it is unilateral, biopsy may be necessary to rule out breast cancer.

The nurse is conducting an educational session with a patient who is newly diagnosed with diabetes. The nurse knows further education is needed when the patient states, "In the U.S.: 1. 6 million people are diagnosed with diabetes per year." 2. 25.8 million people have diabetes." 3. 18.8 million people have been diagnosed with diabetes." 4. 7 million people have diabetes but have not been diagnosed."

Correct Answer: 1 Rationale 1: Approximately 1.9 million new cases of DM are diagnosed each year in the United States. Rationale 2: This chronic illness affects an estimated 25.8 million people. Rationale 3: This chronic illness affects an estimated 25.8 million people, of that number, 18.8 million have been diagnosed. Rationale 4: An estimated 7 million are undiagnosed. Global Rationale: Approximately 1.9 million new cases of DM are diagnosed each year in the United States. This chronic illness affects an estimated 25.8 million people, of that number, 18.8 million have been diagnosed and an estimated 7 million are undiagnosed.

A 65-year-old male patient complains of problems emptying his bladder, especially at night. The nurse realizes that the patient is demonstrating symptoms of which health problem? 1. benign prostatic hypertrophy 2. urinary tract infection 3. bladder cancer 4. testicular cancer

Correct Answer: 1 Rationale 1: Benign prostatic hypertrophy (BPH) begins at 40 to 45 years of age, and continues slowly through the rest of life. It is estimated that more than half of all men over age 60 have BPH. Primary symptoms associated with benign prostatic hypertrophy are associated with voiding and difficulty starting the urine stream, dysuria, and nocturia. Rationale 2: Urinary tract infection may share the symptom of dysuria with BPH, but the patient would not have difficulty starting urine stream. Rationale 3: Bladder cancer may also have pain as a symptom, but is also accompanied frequently by hematuria. Rationale 4: Testicular cancer would first be manifested by a growth in the testicle. Global Rationale: Benign prostatic hypertrophy (BPH) begins at 40 to 45 years of age, and continues to progress slowly through the rest of life. It is estimated that more than half of all men over age 60 have BPH. Primary symptoms associated with benign prostatic hypertrophy are associated with voiding and difficulty starting the urine stream, dysuria, and nocturia. Urinary tract infection may share the symptom of dysuria with BPH, but the patient would not have difficulty starting urine stream. Bladder cancer may also have pain as a symptom, but is also accompanied frequently by hematuria. Testicular cancer would first be manifested by a growth in the testicle.

A male patient is admitted for removal of a bladder papilloma. What should the nurse assess in this patient? 1. history of cigarette smoking 2. daily fluid intake 3. pedal pulses 4. appetite level

Correct Answer: 1 Rationale 1: Carcinogenic breakdown products of certain chemicals and from cigarette smoke are excreted in the urine and stored in the bladder, which possibly causes a local influence on abnormal cell development. Cigarette smoking is the primary risk factor for bladder cancer. The risk in smokers is twice that of nonsmokers. Rationale 2: Daily fluid intake is an important assessment but is not related to an increased risk for bladder papilloma. Rationale 3: Pedal pulses are an important assessment but are not related to an increased risk for bladder papilloma. Rationale 4: Appetite is an important assessment but is not related to an increased risk for bladder papilloma. Global Rationale: Carcinogenic breakdown products of certain chemicals and from cigarette smoke are excreted in the urine and stored in the bladder, which possibly causes a local influence on abnormal cell development. Cigarette smoking is the primary risk factor for bladder cancer. The risk in smokers is twice that of nonsmokers. Daily fluid intake, pedal pulses, and appetite are all important assessments but are not related to an increased risk for bladder papilloma.

A patient with diabetes asks what can be done to prevent the development of corns on the feet. How should the nurse respond to this patient? 1. "Make sure that you select shoes that are appropriately fitted." 2. "Use corn pads to gradually remove the growths." 3. "Corns are best treated by shaving them off." 4. "A mild abrasive soap can be used to scrub the area to remove them."

Correct Answer: 1 Rationale 1: Corns can be prevented by wearing correctly fitting shoes. Rationale 2: Corn pads are not an option for the diabetic patient. Rationale 3: Shaving treatments to remove the corns and are not an option for the diabetic patient. Rationale 4: Scrubs to remove the corns are not option for the diabetic patient. Global Rationale: Corns can be prevented by wearing correctly fitting shoes. Corn pads, scrubs, and shaving treatments to remove the corns and are not options for the diabetic patient.

The nurse is providing care to a patient during the preoperative phase of surgery. Which of the following interventions would be appropriate for the nurse to provide during this time? 1. assisting with bathing 2. patient safety 3. assessing level of consciousness 4. monitoring intake and output

Correct Answer: 1 Rationale 1: During the preoperative phase of surgical care, the nurse will assist the patient physically become ready for the surgery. This may include assisting with bathing. Rationale 2: Patient safety is an intervention for the nurse during the intraoperative phase of surgical care. Rationale 3: Assessing level of consciousness is an intervention for the postoperative phase of surgical care. Rationale 4: Monitoring intake and output is an intervention for the postoperative phase of surgical care. Global Rationale: During the preoperative phase of surgical care, the nurse will assist the patient physically become ready for the surgery. This may include assisting with bathing. Patient safety is an intervention for the nurse during the intraoperative phase of surgical care. Assessing level of consciousness and monitoring intake and output are interventions for the postoperative phase of surgical care.

The nurse is caring for a patient recovering from surgery conducted in the previous 24 hours. What should the nurse do to assist this patient with pain control? 1. Administer prescribed analgesics around the clock. 2. Administer prescribed analgesics when the patient requests something for pain. 3. Assist the patient to a more comfortable position to reduce the amount of pain. 4. Offer the patient a back rub to reduce the amount of pain.

Correct Answer: 1 Rationale 1: Established, persistent, severe pain is more difficult to treat than pain that is at its onset. Postoperative analgesics should be administered at regular intervals around the clock to maintain a therapeutic blood level. Rationale 2: Administering analgesics as needed (prn) lowers this therapeutic level; delays in medication administration further increase pain intensity. "As needed" administration of analgesics is not recommended in the first 36 to 48 hours postoperatively. Rationale 3: The nurse could help the patient into a more comfortable position to reduce the amount of pain; however, the nurse should provide the patient with the prescribed analgesics around the clock. Rationale 4: The nurse could offer the patient a back rub to reduce the amount of pain; however, the nurse should provide the patient with the prescribed analgesics around the clock. Global Rationale: Established, persistent, severe pain is more difficult to treat than pain that is at its onset. Postoperative analgesics should be administered at regular intervals around the clock to maintain a therapeutic blood level. Administering analgesics as needed (prn) lowers this therapeutic level; delays in medication administration further increase pain intensity. "As needed" administration of analgesics is not recommended in the first 36 to 48 hours postoperatively. The nurse could help the patient into a more comfortable position and offer the patient a back rub to reduce the amount of pain, however, the nurse should provide the patient with the prescribed analgesics around the clock.

A patient is diagnosed with benign prostatic hypertrophy. The nurse realizes that this patient's blood pressure should be closely measured to determine what? 1. whether the patient can tolerate doxazosin mesylate (Cardura) 2. whether surgery is indicated 3. the volume of urine being retained in the bladder 4. the dose of finasteride (Proscar)

Correct Answer: 1 Rationale 1: Excessive smooth muscle contraction in benign prostatic hypertrophy (BPH) may be blocked with the alpha-adrenergic antagonists such as doxazosin mesylate (Cardura). This medication relieves obstruction and increases the flow of urine. It may cause orthostatic hypotension. Rationale 2: The use of surgical intervention to manage BPH is not determined by monitoring blood pressure alone. Rationale 3: The volume of urinary residual does not have bearing in this question. Rationale 4: Finasteride (Proscar) does not impact blood pressure. Global Rationale: Excessive smooth muscle contraction in benign prostatic hypertrophy (BPH) may be blocked with the alpha-adrenergic antagonists such as doxazosin mesylate (Cardura). This medication relieves obstruction and increases the flow of urine. It may cause orthostatic hypotension. The use of surgical intervention to manage BPH is not determined by monitoring blood pressure. The volume of urinary residual does not have bearing in this question. Finasteride (Proscar) does not impact blood pressure.

A patient is scheduled for a lithotripsy for renal calculi. What should the nurse explain to the patient as the purpose of a bowel preparation prior to this procedure? 1. ensuring maximum visualization of the kidney and the stones 2. ensuring that there is no evidence of constipation prior to the procedure 3. increasing comfort 4. reducing postoperative pain

Correct Answer: 1 Rationale 1: Fecal material in the bowel may impede fluoroscopic visualization of the kidney and stone. Rationale 2: Constipation prior to the procedure has no bearing on the procedure if bowel preparation is completed. Rationale 3: Bowel preparation would not contribute to patient comfort. Rationale 4: Bowel preparation would not reduce postoperative pain. Global Rationale: Fecal material in the bowel may impede fluoroscopic visualization of the kidney and stone. Constipation prior to the procedure has no bearing on the procedure if bowel preparation is completed. Bowel preparation would not contribute to patient comfort or reducing postoperative pain.

The nurse is completing the health history of a patient with documented androgen deficiency and erectile dysfunction (ED). Which patient response would be a contraindication for this patient's use of hormone replacement therapy to treat his ED? 1. "I am being treated for prostate cancer." 2. "I hate the idea of having an injection directly in my penis." 3. "I am currently taking antibiotics." 4. "Yes, I have a lot of hair on my chest and probably can't wear a patch."

Correct Answer: 1 Rationale 1: Hormone replacement therapy (HRT) to treat ED may be used for men with documented androgen deficiency who do not have prostate cancer. Rationale 2: Hormone replacement therapy (HRT) is via intramuscular injections or topical patches, not intrapenile injections. This response does not relate to contraindications of HRT. Rationale 3: Antibiotics are not a contraindication to hormone replacement therapy (HRT). Rationale 4: Excessive chest hair is not a contraindication. The patient may place the patch on an area other than the chest or hair could be removed to permit adherence of the patch. Global Rationale: Hormone replacement therapy (HRT) to treat ED may be used for men with documented androgen deficiency who do not have prostate cancer. HRT involves intramuscular injections or topical patches, not intrapenile injections. This response does not relate to contraindications of HRT. Antibiotics are not a contraindication to HRT. Excessive chest hair is not a contraindication. The patient may place the patch on an area other than the chest or hair could be removed to permit adherence of the patch.

A patient is being seen for a "sudden lump" in the groin after lifting a heavy box to a shelf. The nurse realizes that this patient might be experiencing which health problem? 1. an indirect inguinal hernia 2. a direct inguinal hernia 3. a femoral hernia 4. an incisional hernia

Correct Answer: 1 Rationale 1: Indirect inguinal hernias are caused by improper closure of the tract that develops as the testes descend into the scrotum before birth. A sac of abdominal contents protrudes through the internal inguinal ring into the inguinal canal. It often descends into the scrotum. Although indirect inguinal hernias are congenital defects, they often are not evident until adulthood, when increased intra-abdominal pressure and dilation of the inguinal ring allow abdominal contents to enter the channel. Rationale 2: Direct inguinal hernias are acquired defects that result from weakness of the posterior inguinal wall and a palpable mass may be present in the groin. Direct inguinal hernias usually affect older adults. Rationale 3: Femoral hernias are also acquired defects in which a peritoneal sac protrudes through the femoral ring. Rationale 4: Inadequate information is provided to support the presence of an incisional hernia. Global Rationale: Indirect inguinal hernias are caused by improper closure of the tract that develops as the testes descend into the scrotum before birth. A sac of abdominal contents protrudes through the internal inguinal ring into the inguinal canal. It often descends into the scrotum. Although indirect inguinal hernias are congenital defects, they often are not evident until adulthood, when increased intra-abdominal pressure and dilation of the inguinal ring allow abdominal contents to enter the channel. Direct inguinal hernias are acquired defects that result from weakness of the posterior inguinal wall and a palpable mass may be present in the groin. Direct inguinal hernias usually affect older adults. Femoral hernias are also acquired defects in which a peritoneal sac protrudes through the femoral ring. Inadequate information is provided to support the presence of an incisional hernia.

During a physical assessment, the nurse suspects that the patient might be experiencing metabolic syndrome. Which assessment finding provides evidence for this nurse's assumption? 1. blood pressure 150/96 2. difficulty ambulating 3. low waist-to-hip ratio 4. heart rate 72 and regular

Correct Answer: 1 Rationale 1: Individuals with metabolic syndrome are found to have three or more specific manifestations, one of which is hypertension. Rationale 2: Difficulty ambulating is not a manifestation of metabolic syndrome. Rationale 3: A low-waist-to hip ratio is not a manifestation of metabolic syndrome. Rationale 4: The heart rate is within normal limits and not a manifestation of metabolic syndrome. Global Rationale: Individuals with metabolic syndrome are found to have three or more specific manifestations, one of which is hypertension. Difficulty ambulating and a low-waist-to hip ratio are not manifestations of metabolic syndrome. The heart rate is within normal limits and is not a manifestation of metabolic syndrome.

A female patient asks the nurse for help because her husband has not been able to attain an erection in several months. What can the nurse do to help this patient? 1. Assess for the most recent sexual practices. 2. Suggest that she seek psychiatric counseling. 3. Suggest that they both see a marriage counselor. 4. Provide a prescription for tadalafil (Cialis).

Correct Answer: 1 Rationale 1: It is essential for healthcare providers to understand the patient and partner's sexual pattern in order to provide appropriate, individualized care. Rationale 2: It is premature to suggest marital or psychiatric counseling. Rationale 3: It is premature to suggest marital or psychiatric counseling. Rationale 4: Prescribing medications is beyond the nurse's scope of practice. Global Rationale: It is essential for health care providers to understand the patient and partner's sexual pattern in order to provide appropriate, individualized care. It is premature to suggest marital or psychiatric counseling. Prescribing medications is beyond the nurse's scope of practice.

The nurse is reviewing the lipid panel of a patient with a body mass index (BMI) of 31. What should the nurse expect this patient's values to be? 1. low high-density lipoprotein (HDL) 2. elevated HDL 3. normal thyroid hormone (TH) level 4. low-density lipoprotein (LDL)

Correct Answer: 1 Rationale 1: LDL levels are elevated in obese patients. Rationale 2: HDL levels are reduced in obese patients. Rationale 3: There is no relationship between BMI and TH. Rationale 4: LDL levels are elevated in obese patients. Global Rationale: This BMI value indicates obesity. HDL levels are reduced in obese patients, whereas LDL levels are elevated. There is no relationship between BMI and TH.

A patient is diagnosed with struvite kidney stones. What interventions should the nurse anticipate being prescribed for this patient? 1. surgical intervention and antibiotic therapy 2. limiting foods high in calcium and taking thiazide diuretics 3. sodium-restricted diet and taking penicillamine 4. low-purine diet and taking potassium citrate

Correct Answer: 1 Rationale 1: Management of the patient with struvite kidney stones includes surgical intervention or lithotripsy to remove the stone and antibiotic therapy for urinary tract infections (UTIs). Rationale 2: Limiting foods high in calcium and prescribing thiazide diuretics is common management for the patient with calcium phosphate and/or oxalate kidney stones. Rationale 3: Sodium restriction and penicillamine therapy are part of the treatment for cystine stones. Rationale 4: A low-purine diet and potassium citrate are prescribed commonly for uric acid stones. Global Rationale: Management of the patient with struvite kidney stones includes surgical intervention or lithotripsy to remove the stone and antibiotic therapy for urinary tract infections (UTIs). Limiting foods high in calcium and prescribing thiazide diuretics is common management for the patient with calcium phosphate and/or oxalate kidney stones; sodium restriction and penicillamine therapy are part of the treatment for cystine stones; a low-purine diet and potassium citrate are commonly prescribed for uric acid stones.

The nurse is assessing a patient who has a family history of type 2 diabetes mellitus. Which finding would require follow-up by the nurse? 1. a new prescription for levothyroxine (Synthroid) for hypothyroidism 2. decreased waist-to-hip ratio through dietary changes 3. delivery of a baby that weighed 8 pounds and 12 ounces 4. a fasting blood glucose level of 89 mg/dL

Correct Answer: 1 Rationale 1: Many drugs, including thyroid hormone, impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Rationale 2: This is a desired finding. Rationale 3: This is an acceptable birth weight for a patient with diabetes. Rationale 4: This is a desirable level for a patient with diabetes. Global Rationale: Many drugs, including thyroid hormone, impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Decreasing the waist-to-hip ration, delivering a baby that weighted 8 lbs. and 12 ounces, and having a fasting blood glucose level of 89 are all desirable findings for the patient with a family history of type 2 diabetes mellitus.

A patient comes into the emergency department with complaints of an erection that has lasted for more than four hours. What should the nurse include in the patient's assessment? 1. prescribed medications 2. substance abuse 3. blood pressure 4. number of sexual partners

Correct Answer: 1 Rationale 1: Men who use intracavernous injection therapy or tadalafil (Cialis) for erectile dysfunction are at risk for priapism. Rationale 2: Substance abuse assessment would be included in any admission process but does not have a direct influence on the sustained erection. Rationale 3: Blood pressure measurements would be included in any admission process but do not have a direct influence on the sustained erection. Rationale 4: Number of sexual partners is not related to the problem. Global Rationale: Men who use intracavernous injection therapy or tadalafil (Cialis) for erectile dysfunction are at risk for priapism. Substance abuse assessment and blood pressure measurements would be included in any admission process but do not have a direct influence on the sustained erection. Number of sexual partners is not related to the problem.

A patient being prepared for surgery has a history of chronic obstructive pulmonary disease. Which diagnostic test should the nurse expect to be completed prior to this patient's surgical procedure? 1. Pulmonary function tests 2. CT scan of the brain 3. Lumbar puncture 4. Abdominal MRI

Correct Answer: 1 Rationale 1: Pulmonary function studies often are performed with patients who have chronic obstructive pulmonary disease to determine the extent of respiratory dysfunction. Rationale 2: There is no reason for a CT scan of the brain to be completed. Rationale 3: There is no reason for a lumbar puncture to be completed. Rationale 4: There is no reason for an abdominal MRI to be completed. Global Rationale: Pulmonary function studies often are performed with patients who have chronic obstructive pulmonary disease to determine the extent of respiratory dysfunction. There is no reason for the patient to have a CT scan of the brain, lumbar puncture, or MRI of the abdomen.

A 35-year-old male is concerned about his inability to sustain an erection. What topic should the nurse question the patient about when assessing this health problem? 1. substance use or abuse 2. marital status 3. employment history 4. education level

Correct Answer: 1 Rationale 1: Most problems with erection are the result of a disease (with a three-times greater incidence in men with diabetes mellitus), injury, or chemical substances (such as prescribed medications, alcohol, nicotine, cocaine, or marijuana) that affect nerve conduction or hormone levels or decrease blood flow in the penis. Rationale 2: Marital status is not associated with an inability to sustain an erection. Rationale 3: Employment status is not associated with an inability to sustain an erection. Rationale 4: Educational level is not associated with an inability to sustain an erection. Global Rationale: Most problems with erection are the result of a disease (with a three-times greater incidence in men with diabetes mellitus), injury, or chemical substances (such as prescribed medications, alcohol, nicotine, cocaine, or marijuana) that affect nerve conduction or hormone levels or decrease blood flow in the penis. Marital status, employment status, and educational level are not associated with an inability to sustain an erection.

A patient complains of constipation. Which question should the nurse ask to learn more about the problem? 1. "Are you taking any narcotic medication?" 2. "Have you been taking over-the-counter pain relievers?" 3. "Have you been taking over-the-counter sleep aids?" 4. "Are you taking oral contraceptives?"

Correct Answer: 1 Rationale 1: Narcotics may cause constipation. Rationale 2: Over-the-counter pain relievers do not affect elimination patterns. Rationale 3: Over-the-counter medications for insomnia do not affect elimination patterns. Rationale 4: Oral contraceptives do not affect elimination patterns. Global Rationale: Narcotics may cause constipation. Over-the-counter pain relievers, sleep aids, and oral contraceptives do not affect elimination patterns.

During a health history interview the nurse learns that a patient is experiencing recent-onset impotence. Which question is most appropriate for the nurse to ask to identify a potential cause of the manifestation? 1. "For what disorders have you been treated in the past? 2. "Does this occur often?" 3. "How does your partner feel about this problem?" 4. "Are you on any medications?

Correct Answer: 1 Rationale 1: Nurses in any healthcare setting may encounter men with ED, either through routine examinations or through assessment of patients' conditions and treatments that may incidentally cause ED. A patient's health history can provide clues to the underlying cause of impotence. Rationale 2: Open-ended questions will elicit the most information. Determining the frequency of impotence is important, but a closed question will limit the amount of information obtained. Rationale 3: The patient's partner is important, but is not the primary focus of this question. Rationale 4: The patient should be asked to list any medications being taken; however, this question is closed and will provide limited information. Global Rationale: Nurses in any healthcare setting may encounter men with ED, either through routine examinations or through assessment of patients' conditions and treatments that may incidentally cause ED. A patient's health history can provide clues to the underlying cause of impotence. Open-ended questions will elicit the most information. Determining the frequency of impotence is important, but a closed question will limit the amount of information obtained. The patient's partner is important, but is not the primary focus of this question. The patient should be asked to list any medications being taken; however, this question is closed and will provide limited information.

A male patient with breast cancer is being seen at the cancer center, and one of the nurses says, "I'm not sure what to do for this patient. He doesn't have the same issues as a woman!" What is the most appropriate response? 1. "Caring for the man with breast cancer is essentially the same as for the woman with breast cancer." 2. "Most issues are the same for men and women, but he probably won't die because of his disease." 3. "There are different types of cancers in men than women, and that needs to be reviewed." 4. "Treatments are different, so you will need to explain these."

Correct Answer: 1 Rationale 1: Nursing care for the man with breast cancer is essentially the same as for the woman with breast cancer. Psychosocial concerns, embarrassment or shame about his condition, fear about the life-threatening aspect of the disease, and family concerns should be addressed to help the patient and family move toward healing. Rationale 2: Because many men believe breast cancer is a woman's disease, they often delay seeking medical attention and may present with more advanced disease. Rationale 3: Male breast cancer is clinically and histologically similar to female breast cancer. Rationale 4: Treatment of male breast cancer is much the same as for women. Global Rationale: Nursing care for the man with breast cancer is essentially the same as for the woman with breast cancer. Psychosocial concerns, embarrassment or shame about his condition, fear about the life-threatening aspect of the disease, and family concerns should be addressed to help the patient and family move toward healing. Because many men believe breast cancer is a woman's disease, they often delay seeking medical attention and may present with more advanced disease. Male breast cancer is clinically and histologically similar to female breast cancer. Treatment of male breast cancer is much the same as for women.

An older patient, being prepared for surgery, has a low glomerular filtration rate. Which aspect of the patient's care should the nurse realize this finding will impact? 1. medication dosages 2. postoperative activity level 3. intraoperative bleeding 4. oxygenation status

Correct Answer: 1 Rationale 1: Older adults are susceptible to renal insufficiency, which puts them at risk for accumulation of metabolic by-products and medications dependent on renal clearance. Medication dosages will need to be adjusted for the older patient with a low glomerular filtration rate. Rationale 2: The glomerular filtration rate will not impact the patient's postoperative activity level. Rationale 3: The glomerular filtration rate will not impact the amount of intraoperative bleeding. Rationale 4: The glomerular filtration rate will not impact the patient's oxygenation status. Global Rationale: Older adults are susceptible to renal insufficiency, which puts them at risk for accumulation of metabolic by-products and medications dependent on renal clearance. Medication dosages will need to be adjusted for the older patient with a low glomerular filtration rate. The glomerular filtration rate will not impact the patient's postoperative activity level, amount of intraoperative blooding, or oxygenation status.

The nurse is conducting a physical assessment and wants to palpate for hernias. Place an "X" over the location on the diagram where the nurse should palpate for the most common type of hernia.

Rationale: Most hernias (femoral or inguinal) occur in the groin.

An older patient is being prepared for orthopedic surgery. For what potential risk should the nurse plan care? 1. decreased tolerance of general anesthesia 2. prolonged effects of anesthesia because of herbal supplements 3. wound dehiscence 4. decreased cognitive acuity

Correct Answer: 1 Rationale 1: Older adults have age-related changes that affect physiologic, cognitive, and psychosocial responses to the stress of surgery in addition to decreased tolerance of general anesthesia and postoperative medications and delayed wound healing. Rationale 2: No information is provided to indicate the use of herbal supplements. Rationale 3: Despite delayed wound healing, there is no information to support the increased risk for wound dehiscence. Rationale 4: Cognition remains stable in older adults, but information processing slows. Global Rationale: Older adults have age-related changes that affect physiologic, cognitive, and psychosocial responses to the stress of surgery in addition to decreased tolerance of general anesthesia and postoperative medications and delayed wound healing. No information is provided to indicate the use of herbal supplements. Despite delayed wound healing, there is no information to support the increased risk for wound dehiscence. Cognition remains stable in older adults, but information processing slows.

A patient says that his condition must be getting worse since he was receiving 10 mg morphine sulfate through the IV for pain but now is prescribed Demerol 50 mg by mouth at home. How should the nurse respond to this patient? 1. "Oral doses need to be higher than those given through an IV. It does not mean your condition is worse." 2. "The doctor is making sure that you do not have any pain once you go home." 3. "I will get the doctor so he can explain what is going on with your condition." 4. "All patients have more pain when they go home so the doctor is making sure you have enough medication."

Correct Answer: 1 Rationale 1: Oral doses of analgesics are not equal to parenteral doses. The oral dose of an opioid such as morphine, codeine, or hydromorphone may be two to five times higher than the parenteral dose to achieve equivalent pain relief. This is what the nurse should explain to the patient. Rationale 2: The physician is not making sure the patient has no pain at home. Rationale 3: The nurse does not need to get the physician to explain the patient's condition. Rationale 4: Not all patients have more pain when they are discharged after surgery. Global Rationale: Oral doses of analgesics are not equal to parenteral doses. The oral dose of an opioid such as morphine, codeine, or hydromorphone may be two to five times higher than the parenteral dose to achieve equivalent pain relief. This is what the nurse should explain to the patient. The physician is not making sure the patient has no pain at home. The nurse does not need to get the physician to explain the patient's condition. Not all patients have more pain when they are discharged after surgery.

The nurse is placing an indwelling urinary catheter in an uncircumcised male patient and replaces the foreskin after insertion. What is the rationale for this nursing action? 1. Paraphimosis may occur as a result of long-term retraction of the foreskin causing ischemia of the glans. 2. Phimosis may occur due to chronic infections and adhesions under the foreskin which results in constriction of the foreskin. 3. Priapism may occur as a result of impaired blood flow in the penis. 4. Replacement of the foreskin prevents malignant changes of the penis.

Correct Answer: 1 Rationale 1: Paraphimosis may occur as a result of long-term retraction of the foreskin, which can result in ischemia of the glans. Rationale 2: The foreskin may not be retracted in the patient with phimosis due to the constriction resulting from chronic infections and adhesions and the nurse should not attempt this action during catheterization. Rationale 3: Priapism occurs with sustained painful erections, which impair blood flow in the penis, and does not involve the foreskin. Rationale 4: Phimosis or the presence of the foreskin can prevent adequate hygiene, which may lead to malignant changes of the penis. Global Rationale: Paraphimosis may occur as a result of long-term retraction of the foreskin, which can result in ischemia of the glans. The foreskin may not be retracted in the patient with phimosis due to the constriction resulting from chronic infections and adhesions and the nurse should not attempt this action during catheterization. Priapism occurs with sustained painful erections, which impair blood flow in the penis, and does not involve the foreskin. Phimosis or the presence of the foreskin can prevent adequate hygiene, which may lead to malignant changes of the penis.

The nurse is instructing a patient with benign prostatic hypertrophy about techniques to reduce urinary retention. What should these instructions include? 1. Avoid alcoholic beverages. 2. Encourage ingesting large amounts of fluids at one time. 3. Urinate until all of the urine is drained from the bladder. 4. Over-the-counter cold remedies are permitted with other medications.

Correct Answer: 1 Rationale 1: Patient teaching for urinary retention should include limiting liquids that stimulate voiding, such as coffee and alcoholic beverages. Rationale 2: Patient teaching for urinary retention should include avoiding the intake of large volumes of liquid at any one time. Rationale 3: Patient teaching for urinary retention should include how to use double-voiding technique. Rationale 4: Patient teaching for urinary retention should include the risk of developing urinary retention increases with over-the-counter decongestant medications. Global Rationale: Patient teaching for urinary retention should include: manifestations of acute urinary retention; the risk of developing urinary retention increases with over-the-counter decongestant medications; avoiding the intake of large volumes of liquid at any one time; how to use double-voiding technique; and limiting liquids that stimulate voiding, such as coffee and alcoholic beverages.

A patient recovering from surgery reports a pain level of 6 on a 0-10 pain scale but refuses additional pain medication since he does not want to "become addicted." The nurse's response should focus on which concept? 1. Physical dependence on pain medication is uncommon during the short-term postoperative use. 2. This patient already might have an addiction problem. 3. This patient might benefit from a placebo dose. 4. The physician should be notified to discuss pain management.

Correct Answer: 1 Rationale 1: Patients might fear "addiction" or physical dependence on pain medications, especially opioids, postoperatively. The duration of use is typically short-term, and this concern should be discussed, but is not anticipated to occur. Rationale 2: The patient who already has an addiction problem most likely would be requesting more medication, not refusing it. Rationale 3: The patient is verbalizing pain, so administration of a placebo is unethical, against patient rights for pain management, and should not be administered. Rationale 4: It is within the scope of the nurse to review and make decisions with the patient regarding safe use of pain medications that have been ordered by the physician. The physician does not need to be called at this time unless the nurse's interventions with the patient are unsuccessful. Global Rationale: Patients might fear "addiction" or physical dependence on pain medications, especially opioids, postoperatively. The duration of use is typically short-term, and this concern should be discussed, but is not anticipated to occur. The patient who already has an addiction problem most likely would be requesting more medication, not refusing it. The patient is verbalizing pain, so administration of a placebo is unethical, against patient rights for pain management, and should not be administered. It is within the scope of the nurse to review and make decisions with the patient regarding safe use of pain medications that have been ordered by the physician. The physician does not need to be called at this time unless the nurse's interventions with the patient are unsuccessful.

A patient with a history of sleep apnea is experiencing difficulty maintaining an airway during conscious sedation. What should the nurse do to assist this patient? 1. Prepare to administer a reversal agent. 2. Begin artificial ventilations. 3. Measure oxygen saturation. 4. Apply prescribed oxygen via face mask.

Correct Answer: 1 Rationale 1: Patients with a history of sleep apnea may have difficulty with conscious sedation. The nurse should prepare to administer a reversal agent to the patient. Rationale 2: The patient may or may not need artificial ventilations at this time. Rationale 3: The nurse should have been measuring the patient's oxygen saturation throughout the procedure. Rationale 4: The patient is having difficulty maintaining an airway so applying oxygen via face mask may not be appropriate. Global Rationale: Patients with a history of sleep apnea may have difficulty with conscious sedation. The nurse should prepare to administer a reversal agent to the patient. The patient may or may not need artificial ventilations at this time. The nurse should have been measuring the patient's oxygen saturation throughout the procedure. The patient is having difficulty maintaining an airway so applying oxygen via face mask may not be appropriate.

A patient with type 1 diabetes mellitus has a serum hematocrit level of 24%. What additional finding should the nurse report to the health care provider? 1. capillary blood glucose of 60 mg/dL 2. glycosylated hemoglobin of 7.0 3. the presence of albumin in urine 4. the presence of glucose in urine

Correct Answer: 1 Rationale 1: Patients with low hematocrit levels will test falsely high. This patient's hematocrit is critically low. The serum glucose of 60 mg/dL may be a falsely high reading and the primary health care provider must be notified of this finding. Rationale 2: This glycosylated level does not require immediate notification of the primary health care provider. Rationale 3: The presence of albumin in the urine does not require immediate notification of the primary health care provider. Rationale 4: The presence of glucose in the urine does not require immediate notification of the primary health care provider. Global Rationale: Patients with lower hematocrit levels will test falsely high. This patient's hematocrit is critically low. The serum glucose of 60 mg/dL may be a falsely high reading and the primary health care provider must be notified of this finding. The glycosylated level, and presence of albumin and glucose in the urine do not need to be immediately reported to the health care provider.

A patient who is recovering from abdominal surgery has a Penrose drain. What should the nurse include in the care of this patient? 1. Make sure there is a safety pin on the end of the drain. 2. Empty the drain every 30 minutes. 3. Clean the wound with normal saline every two hours. 4. Remove the drain four hours postoperatively.

Correct Answer: 1 Rationale 1: Penrose drains need a safety pin at the exposed end to prevent the drain from slipping down into the wound. Rationale 2: Unless full or assessing for a potential problem, there is no need to empty the drain until the end of the shift. Rationale 3: There is no need to clean the wound with saline. Rationale 4: Removal of the drain requires a physician's order. Global Rationale: Penrose drains need a safety pin at the exposed end to prevent the drain from slipping down into the wound. Unless full or assessing for a potential problem, there is no need to empty the drain until the end of the shift. There is no need to clean the wound with saline. Removal of the drain requires a physician's order.

The nurse is implementing a bowel training program for a patient. What should be included in this patient's plan of care? 1. Assess the patient to determine the best time of day to use the commode for defecation. 2. Keep the bedpan near the patient at all times. 3. Instruct the patient not to attempt to use the bathroom unattended. 4. Stay with the patient while defecating.

Correct Answer: 1 Rationale 1: Placing the patient in a normal position to defecate at a consistent time of day stimulates the defecation reflex and helps reestablish a pattern of stool evacuation. Ideally, the bowel training program should focus on use of the commode or toilet. Rationale 2: Ideally, the bowel training program should focus on use of the commode or toilet. Rationale 3: Providing the patient with assistance to the bathroom is a safety measure and does not influence the success of the bowel training program. Rationale 4: Remaining with the patient may reduce comfort level and interfere with defecation. Global Rationale: Placing the patient in a normal position to defecate at a consistent time of day stimulates the defecation reflex and helps reestablish a pattern of stool evacuation. Ideally, the bowel training program should focus on use of the commode or toilet. Providing the patient with assistance to the bathroom is a safety measure and does not influence the success of the bowel training program. Remaining with the patient may reduce comfort level and interfere with defecation.

A male patient is concerned about ongoing premature ejaculation. What should the nurse do to assist this patient? 1. Suggest that the patient wear a condom with sexual activity. 2. Suggest that the patient talk with the physician about changing prescribed medications. 3. Tell the patient that the condition is temporary and will disappear in time. 4. Review any newly prescribed medications, and check for side effects.

Correct Answer: 1 Rationale 1: Premature ejaculation is very responsive to medical management. The man can experiment with wearing condoms to decrease sensitivity. Rationale 2: Premature ejaculation is not a side effect of medications. Premature ejaculation is very responsive to medical management. Rationale 3: Using relaxation and guided imagery can delay sexual excitement. Mechanical devices, such as constrictive rings around the base of the penis, can help the man delay ejaculation and sustain an erection. Rationale 4: Premature ejaculation is not generally a side effect of medications. Global Rationale: The man can experiment with wearing condoms to decrease sensitivity. Premature ejaculation is very responsive to medical management. Using relaxation and guided imagery can delay sexual excitement. Mechanical devices, such as constrictive rings around the base of the penis, can help the man delay ejaculation and sustain an erection. Premature ejaculation is not generally a side effect of medications.

The nurse is assisting a postoperative patient in using an incentive spirometer. Which postoperative complications is this nurse attempting to avoid? 1. atelectasis 2. deep vein thrombosis 3. hemorrhage 4. pulmonary embolism

Correct Answer: 1 Rationale 1: Promoting lung expansion and systemic oxygenation of tissues is a goal in preventing atelectasis. Nursing care includes assisting with incentive spirometry. Rationale 2: Deep vein thrombosis is not related to incentive spirometer use. Rationale 3: Hemorrhage is not related to incentive spirometer use. Rationale 4: Pulmonary embolism is not related to incentive spirometer use. Global Rationale: Promoting lung expansion and systemic oxygenation of tissues is a goal in preventing atelectasis. Nursing care includes assisting with incentive spirometry. Deep vein thrombosis, hemorrhage, and pulmonary embolism are not related to incentive spirometer use.

The nurse hears a parent say to a child, "If you behave, we'll stop and get you an ice cream cone when we're done here." What should the nurse realize is occurring with the parent? . rewarding behavior with food 2. frustration with the child's behavior 3. anxiety due to parenting 4. hunger as a motivating factor

Correct Answer: 1 Rationale 1: Sociocultural influences that contribute to obesity include overeating at family meals, rewarding behavior with food, religious and family gatherings that promote food intake, and sedentary lifestyles. Rationale 2: This comment does not indicate that the parent is frustrated with the child's behavior. Rationale 3: There is no evidence that the parent is anxious. Rationale 4: There is no evidence that the parent is hungry. Global Rationale: Sociocultural influences that contribute to obesity include overeating at family meals, rewarding behavior with food, religious and family gatherings that promote food intake, and sedentary lifestyles. There is no evidence that the parent is frustrated, anxious, or hungry.

A patient with type 2 diabetes mellitus is scheduled for laparoscopic adjustable gastric banding (LAGB) surgery. What should the nurse explain to the patient about this procedure and diabetes? 1. "Evidence indicates positive outcomes for many patients with diabetes who undergo surgical weight loss procedures." 2. "Surgical procedures can be dangerous for patients with diabetes." 3. "Do you feel that a surgical weight loss procedure will cure your obesity?" 4. "This procedure is more appropriate for a patient who has a diagnosis of type 1 diabetes mellitus."

Correct Answer: 1 Rationale 1: Studies of patients with DM who have gastrointestinal surgery for morbid obesity show complete remission of type 2 DM in over three-quarters of cases. Rationale 2: While this is true, studies of patients with DM who have gastrointestinal surgery for morbid obesity show complete remission of type 2 DM in over three-quarters of the cases. Rationale 3: The procedure is performed to decrease body weight. Rationale 4: The procedure is shown to elicit complete remission of type 2 DM in over three-fourths of the cases. Global Rationale: Studies of patients with DM who have gastrointestinal surgery for morbid obesity show complete remission of type 2 DM in over three-quarters of the cases. The procedure is performed to decrease body weight.

A patient is scheduled for extraction of a cataract. How should the nurse classify this patient's surgical procedure? 1. minor elective 2. minor diagnostic 3. major constructive 4. major elective

Correct Answer: 1 Rationale 1: Surgical procedures are classified according to purpose, risk factor, and urgency. Cataract extraction would be considered a minor elective surgery. Minor procedures carry minimal risk and minimal physical assault. Rationale 2: A minor diagnostic surgery is used to determine or confirm a condition. Rationale 3: Major constructive procedures require extensive physical assault and/or serious risk. Constructive procedures are used to build tissue/organs which are absent. Rationale 4: Major elective procedures are suggested to the patient by the physician but there is little risk if they are not performed. Global Rationale: Surgical procedures are classified according to purpose, risk factor, and urgency. Cataract extraction would be considered a minor elective surgery. Minor procedures carry minimal risk and minimal physical assault. A minor diagnostic surgery is used to determine or confirm a condition. Major constructive procedures require extensive physical assault and/or serious risk. Constructive procedures are used to build tissue/organs which are absent. Major elective procedures are suggested to the patient by the physician but there is little risk if they are not performed.

The nurse is teaching a patient about a scheduled small bowel series. Which statement by the patient indicates that further teaching is required? 1. "It is normal to experience constipation for a few days after the procedure." 2. "I will need to increase my fluid intake the first few days after the procedure." 3. "I might have a laxative prescribed after the procedure." 4. "The barium will be inserted through my rectum."

Correct Answer: 1 Rationale 1: The barium instilled during the procedure must be evacuated after the procedure. The patient will experience white, chalky stools for the first few days. Rationale 2: An increase in fluid intake will facilitate the stool's evacuation. Rationale 3: Laxative use will facilitate the stool's evacuation. Rationale 4: Barium in a small bowel series is administered orally, into the bowel via an endoscope, or through a weighted tube. Global Rationale: The barium instilled during the procedure must be evacuated after the procedure. The patient will experience white, chalky stools for the first few days. Laxative use and an increase in fluid intake will facilitate the stool's evacuation. Barium in a small bowel series is administered orally, into the bowel via an endoscope, or through a weighted tube.

A patient diagnosed with emphysema is being prepared for surgery. What laboratory value should the nurse review to obtain information about the patient's respiratory status? 1. carbon dioxide 2. white blood cell count 3. serum creatinine 4. blood urea nitrogen

Correct Answer: 1 Rationale 1: The carbon dioxide level will be elevated in a patient with emphysema. This is the laboratory value that would provide information about the patient's respiratory status. Rationale 2: The white blood cell count would provide information regarding an infection or immune deficiency. Rationale 3: The serum creatinine level provides information about the patient's renal status. Rationale 4: The blood urea nitrogen level also provides information about the patient's renal status. Global Rationale: The carbon dioxide level will be elevated in a patient with emphysema. This is the laboratory value that would provide information about the patient's respiratory status. White blood cell count would provide information regarding an infection or immune deficiency. The serum creatinine and blood urea nitrogen levels provide information about the patient's renal status.

A patient tells the nurse that he must be having minor surgery since it will be done as an outpatient. How should the nurse respond to this patient? 1. "Every surgical procedure is serious, and I will make sure you have information to have a successful recovery." 2. "You are right." 3. "If it were more serious, you would be admitted to the hospital." 4. "Your insurance plan does not cover inpatient surgical procedures. That's why your surgery is being done as an outpatient."

Correct Answer: 1 Rationale 1: The complexity of the surgery and recovery and the expected level of care needed on completion of the surgery are the major differences between inpatient and outpatient surgical procedures. The outpatient surgical patient and family must cope with the additional stress of needing to learn a great deal of information in a short span of time. The nurse should explain that every surgical procedure is serious and that the patient will be given information to have a successful recovery. Rationale 2: The nurse should not agree with the patient about outpatient surgery being minor. Rationale 3: The nurse does not know if the patient needs to be admitted to the hospital. Rationale 4: The nurse does not have enough information about the patient's insurance coverage to make the statement about the patient having surgery as an outpatient. Global Rationale: The complexity of the surgery and recovery and the expected level of care needed on completion of the surgery are the major differences between inpatient and outpatient surgical procedures. The outpatient surgical patient and family must cope with the additional stress of needing to learn a great deal of information in a short span of time. The nurse should explain that every surgical procedure is serious and that the patient will be given information to have a successful recovery. The nurse should not agree with the patient about outpatient surgery being minor. The nurse does not know if the patient needs to be admitted to the hospital. The nurse does not have enough information about the patient's insurance coverage to make the statement about the patient having surgery as an outpatient.

The nurse takes the form identified below to a patient's room in preparation for an emergency surgical procedure. The patient states, "Doc said he would tell me all about the surgery when he gets here. Do you know what they are going to do?" What is the nurse's best response? 1. "Let's wait on signing this until your physician has talked to you." 2. "Let me go get a medical surgical textbook so I can use the pictures to explain the procedure." 3. "I am not certain; let me call the nursing supervisor to explain it to you." 4. "Go ahead and sign this so we will have that part done when the physician gets here."

Correct Answer: 1 Rationale 1: The form pictured is an informed consent document. It should not be signed until the procedure has been explained to the patient, and the explanation is the responsibility of the physician. Rationale 2: This nurse should not explain the procedure. Rationale 3: This nurse should not ask another nurse to do so. Rationale 4: The signing of this document must wait until the patient is educated about the procedure so that true "informed" consent can be given. Global Rationale: The form pictured is an informed consent document. It should not be signed until the procedure has been explained to the patient, and the explanation is the responsibility of the physician. This nurse should not explain the procedure or ask another nurse to do so. The signing of this document must wait until the patient is educated about the procedure so that true "informed" consent can be given.

After a company barbecue three people out of a group of 12 developed signs of enteritis. Which assessment finding should the nurse use as an indication of the source of the health problem? 1. The three patients ate hamburgers. 2. Nine people ate hotdogs. 3. Most of the people drank canned soda. 4. All of the people ate ice cream.

Correct Answer: 1 Rationale 1: The highly pathogenic E. coli serotype O157:H7 is present in the gut of infected animals. Meats from the animal may be contaminated with bowel contents. The organism is readily destroyed by heat, so cuts of meat such as steaks or roasts are less likely to cause infection, since the organism is on the outside of the meat. However, the process of grinding hamburger allows E. coli to be mixed throughout the meat. Rationale 2: Hotdogs are not associated with the bacteria. Rationale 3: Canned soda is not associated with the bacteria. Rationale 4: Ice cream is not associated with the bacteria. Global Rationale: The highly pathogenic E. coli serotype O157:H7 is present in the gut of infected animals. Meats from the animal may be contaminated with bowel contents. The organism is readily destroyed by heat, so cuts of meat such as steaks or roasts are less likely to cause infection, since the organism is on the outside of the meat. However, the process of grinding hamburger allows E. coli to be mixed throughout the meat. Hot dogs, canned soda, and ice cream are not associated with the bacteria.

A patient's postoperative wound has sanguineous drainage with a thick, reddish appearance. The nurse realizes this patient's wound is in which phase of healing? 1. Inflammatory 2. Proliferative 3. Stationary 4. Remodeling

Correct Answer: 1 Rationale 1: The inflammatory phase begins with the surgical incision. Sanguineous drainage contains both serum and red blood cells and has a thick, reddish appearance. Rationale 2: The proliferative phase begins within 2 to 3 days after surgery. Rationale 3: Stationary is not a phase of wound healing. Rationale 4: In the remodeling phase, scar tissue is remodeled by a process of collagen synthesis and breakdown to increase its strength. This phase begins about 3 weeks after surgery and can continue for 6 or more months. Global Rationale: The inflammatory phase begins with the surgical incision. Sanguineous drainage contains both serum and red blood cells and has a thick, reddish appearance. The proliferative phase begins within 2 to 3 days after surgery. Stationary is not a phase of wound healing. In the remodeling phase, scar tissue is remodeled by a process of collagen synthesis and breakdown to increase its strength. This phase begins about 3 weeks after surgery and can continue for 6 or more months.

The nurse in the same-day surgical care area is preparing a patient for surgery. What should the nurse do to ensure that this patient has a successful recovery from the surgery? 1. Provide teaching and additional resources to help the patient when at home. 2. Measure intake and output. 3. Assess vital signs. 4. Limit pain control measures since the patient will need to ambulate when leaving after the surgery.

Correct Answer: 1 Rationale 1: The major differences between inpatient and outpatient care lie in the degree of teaching and emotional support that are necessary for outpatient surgical patients and their families. The degree of teaching that is necessary for outpatient surgical patients and their families is greater than for postoperative patients who recover as inpatients. Rationale 2: The nurse may or may not need to measure the patient's intake and output. Rationale 3: The nurse will assess all surgical patients' vital signs. Rationale 4: The nurse should ensure the patient's pain is controlled and not limit pain medication. Global Rationale: The major differences between inpatient and outpatient care lie in the degree of teaching and emotional support that are necessary for outpatient surgical patients and their families. The degree of teaching that is necessary for outpatient surgical patients and their families is greater than for postoperative patients who recover as inpatients. The nurse may or may not need to measure the patient's intake and output. The nurse will assess all surgical patients' vital signs. The nurse should ensure the patient's pain is controlled and not limit pain medication.

A patient is signing a surgical consent. Afterwards, the nurse also signs the form. What is the meaning of the nurse's signature? 1. It means the patient was alert and aware of what was being signed. 2. It means the patient understood the procedure as described by the nurse. 3. It means the surgeon was too busy to wait for the patient to sign the form. 4. It means there is a likelihood of a successful outcome.

Correct Answer: 1 Rationale 1: The nurse also signs the form to indicate that the correct person is signing the form and that the patient was alert and aware of what was being signed. Rationale 2: Providing a description of the surgical procedure is not the responsibility of the nurse. Obtaining the consent form is a nursing function. Rationale 3: The physician's schedule is not a factor. Rationale 4: Success of the outcome is not dependent upon the completion of the consent form. Global Rationale: The nurse also signs the form to indicate that the correct person is signing the form and that the patient was alert and aware of what was being signed. Providing a description of the surgical procedure is not the responsibility of the nurse. It is the responsibility of the physician. Obtaining the consent form is a nursing function. The physician's schedule is not a factor. Success of the outcome is not dependent upon the completion of the consent form.

The nurse is assessing a patient who has returned to the care area after surgery. What should the nurse do to ensure the patient receives appropriate care? . Check the physician's orders to see if preoperative orders have been reordered. 2. Schedule the patient for vital signs assessments every four hours. 3. Orient the patient to person, place, and time. 4. Assess the patient's mental status.

Correct Answer: 1 Rationale 1: The nurse needs to check the patient's medical record to ensure that all orders written before surgery have been reordered after surgery, since the patient's condition has changed. Rationale 2: Even though vital signs should be assessed according to hospital policy, the frequency of a postoperative patient's vital signs assessment will be more frequent than every four hours. Rationale 3: Orienting the patient to person, place, and time, is an activity of the PACU nurse. Rationale 4: Assessing the patient's mental status is an activity of the PACU nurse.

An older patient is recovering from a surgical procedure. What should the nurse do to ensure the patient is comfortable? 1. Provide warm blankets. 2. Limit movement to once every eight hours. 3. Explain all activities using a loud voice. 4. Limit fluids.

Correct Answer: 1 Rationale 1: The older patient may need extra blankets for warmth. This is what the nurse should do to ensure for the patient's comfort. Rationale 2: The patient should be carefully turned and repositioned frequently to prevent the onset of pressure ulcers. Rationale 3: The nurse should speak in a low tone and not loudly. Rationale 4: The older patient needs an adequate fluid intake and may not need to have fluids limited. Global Rationale: The older patient may need extra blankets for warmth. This is what the nurse should do to ensure for the patient's comfort. The patient should be carefully turned and repositioned frequently to prevent the onset of pressure ulcers. The nurse should speak in a low tone and not loudly. The older patient needs an adequate fluid intake and may not need to have fluids limited.

A patient with peritonitis develops a temperature of 103° F (39.4° C), is restless, has blood pressure of 85/45 and has a urinary output of 76 mL in 8 hours. The nurse should develop a plan of care related to which health problem? 1. hypovolemic shock 2. inflammation 3. third spacing 4. bowel dysfunction

Correct Answer: 1 Rationale 1: The patient experiencing peritonitis may develop an abscess, which can lead to shock. The patient developing shock may present with oliguria, hypotension, fever, restlessness, confusion, and hypovolemia. Rationale 2: The symptoms do not indicate inflammation. Rationale 3: The symptoms do not indicate third spacing. Rationale 4: The symptoms do not indicate bowel dysfunction. Global Rationale: The patient experiencing peritonitis may develop an abscess, which can lead to shock. The patient developing shock may present with oliguria, hypotension, fever, restlessness, confusion, and hypovolemia. The symptoms do not indicate inflammation, third spacing, or bowel dysfunction.

While completing item number 4 in the preoperative preparation section of the form provided below, the nurse notes that the patient depends on a hearing aid. What action should the nurse take? 1. Leave the device in the patient's ear and notify the OR nurse of its presence. 2. Remove the device and place it in a denture cup in the patient's room. 3. Remove the device and give it to the patient's family member. 4. Place a piece of tape across the patient's ear and the device.

Correct Answer: 1 Rationale 1: The patient must be able to hear and understand instruction that will be part of the universal protocol to reduce surgical errors, so the nurse should leave the device in the patient's ear and notify the OR nurse of its presence. Rationale 2: Removing the device and placing it in a denture cup in the room will make it unavailable to the patient in the OR. Rationale 3: Giving the device to the family will make it unavailable to the patient in the OR. Rationale 4: Taping the device into the ear might damage it or cause injury to the patient's ear. Global Rationale: The patient must be able to hear and understand instruction that will be part of the universal protocol to reduce surgical errors, so the nurse should leave the device in the patient's ear and notify the OR nurse of its presence. Removing the device and placing it in a denture cup in the room or giving it to the family will make it unavailable to the patient in the OR. Taping the device into the ear might damage it or cause injury to the patient's ear.

After providing a patient with a preoperative sedative, the nurse notes that the surgical consent form has not been signed by the patient. What should the nurse do? 1. Contact the surgeon. 2. Ask the patient to sign the consent form. 3. Send the patient for surgery with an unsigned consent form. 4. Phone the operating room suite to notify the nurse that the patient has not signed the consent form.

Correct Answer: 1 Rationale 1: The patient should be aware and alert before signing the consent form. The nurse should contact the surgeon in the event the patient receives preoperative sedative medication and has not yet signed the consent for surgery form. The surgeon who performs a procedure is responsible for obtaining the patient's consent for care. Rationale 2: The nurse should not ask the patient to sign the consent form if the patient is under the influence of a sedative. Rationale 3: The nurse should not send the patient for surgery with an unsigned consent form. Rationale 4: The nurse should not phone the operating room suite to notify the nurse that the patient has not signed the consent form. Global Rationale: The patient should be aware and alert before signing the consent form. The nurse should contact the surgeon in the event the patient receives preoperative sedative medication and has not yet signed the consent for surgery form. The surgeon who performs a procedure is responsible for obtaining the patient's consent for care. The nurse should not ask the patient to sign the consent form if the patient is under the influence of a sedative. The nurse should not send the patient for surgery with an unsigned consent form. The nurse should not phone the operating room suite to notify the nurse that the patient has not signed the consent form.

The nurse is instructing a patient with uric acid stones on methods to prevent lithiasis. Which patient statement indicates that teaching has been effective? 1. "I should avoid organ meats and sardines in my diet." 2. "I will increase purine-rich foods in my diet." 3. "I know to avoid eating vitamin D-enriched foods." 4. "I will have to make my urine more acidic by eating cheese, cranberries, grapes, and tomatoes."

Correct Answer: 1 Rationale 1: The patient with uric acid stones requires a diet low in purines, which are found in organ meats and sardines. Rationale 2: The patient with uric acid stones requires a diet low in purines. Rationale 3: Patients with calcium stones should limit vitamin D. Rationale 4: A patient with uric acid stones should not try to make the urine more acidic. Global Rationale: The patient with uric acid stones requires a diet low in purines, which are found in organ meats and sardines. Patients with calcium stones should limit vitamin D. A patient with uric acid stones should not try to make the urine more acidic.

A patient is being transferred from the operating room to the recovery room. In which phase of the surgical process will the nurse in the recovery room provide care? 1. postoperative 2. preoperative 3. intraoperative 4. restorative

Correct Answer: 1 Rationale 1: The postoperative phase begins when the patient is admitted to the recovery room and ends with the patient's recovery from the surgical intervention. Rationale 2: The preoperative phase is prior to surgery. Rationale 3: The intraoperative phase occurs during the surgery. Rationale 4: Restorative is not a phase of the surgical experience. Global Rationale: The postoperative phase begins when the patient is admitted to the recovery room and ends with the patient's recovery from the surgical intervention. The preoperative phase is prior to surgery. The intraoperative phase occurs during the surgery. Restorative is not a phase of the surgical experience.

A patient was instructed on exercises to perform as part of preoperative teaching. While recovering from surgery, the patient experiences a deep vein thrombosis (DVT). Which preoperative exercise should the nurse identify as not having been effective for this patient? 1. leg exercises 2. deep breathing and coughing 3. use of incentive spirometry 4. splinting when coughing

Correct Answer: 1 Rationale 1: The preoperative patient is taught leg exercises in order to reduce the onset of the complication deep vein thrombosis. Rationale 2: Deep breathing and coughing are helpful to prevent complications of pneumonia and atelectasis. Rationale 3: Use of incentive spirometry is helpful to prevent complications of pneumonia and atelectasis. Rationale 4: Splinting when coughing is taught so that thoracic and abdominal incisions are maintained and protected from an increase in intra-abdominal pressure that occurs when coughing. Global Rationale: The preoperative patient is taught leg exercises in order to reduce the onset of the complication deep vein thrombosis (DVT). In this case, the leg exercises were ineffective and did not prevent DVT from occurring. Deep breathing and coughing and use of incentive spirometry are helpful to prevent complications of pneumonia and atelectasis. Splinting when coughing is taught so that thoracic and abdominal incisions are maintained and protected from an increase in intra-abdominal pressure that occurs when coughing.

The nurse is planning care for a patient with type 1 diabetes mellitus. Which action should the nurse identify as being the most effective to reduce the development of complications? 1. self-monitoring of blood glucose levels 2. performance of effective foot care 3. the necessity of a yearly eye exam 4. knowing symptoms of urinary tract infections

Correct Answer: 1 Rationale 1: The results of a 10-year DM Control and Complications Trial (DCCT), sponsored by the National Institutes of Health (NIH), have significant implications for the management of type 1 DM. People in the study who kept their blood glucose levels close to normal by frequent monitoring, several daily insulin injections, and lifestyle changes that included exercise and a healthier diet reduced by 60% their risk for the development and progression of complications involving the eyes, the kidneys, and the nervous system. Rationale 2: Effective foot care will not reduce the development of complications. Rationale 3: Yearly eye exams will not reduce the development of complications. Rationale 4: Knowing the symptoms of a urinary tract infection will not reduce the development of complications. Global Rationale: The results of a 10-year DM Control and Complications Trial (DCCT), sponsored by the National Institutes of Health (NIH), have significant implications for the management of type 1 DM. People in the study who kept their blood glucose levels close to normal by frequent monitoring, several daily insulin injections, and lifestyle changes that included exercise and a healthier diet reduced by 60% their risk for the development and progression of complications involving the eyes, the kidneys, and the nervous system. Effective foot care, yearly eye exams, and prompt reporting of infections are all important but are not the priority for reducing the development of complications.

A patient is planning to have surgery for the treatment of benign prostatic hypertrophy. Which procedure should the nurse explain has the fewest postoperative complications? 1. transurethral needle ablation (TUNA) 2. transurethral incision of the prostate (TURP) 3. perineal prostatectomy 4. suprapubic prostatectomy

Correct Answer: 1 Rationale 1: The transurethral needle ablation (TUNA) system uses low-level radiofrequency through twin needles to burn away a region of the enlarged prostate. Shields protect the urethra. TUNA improves the flow of urine through the urethra and does not cause impotence or incontinence. Rationale 2: Transurethral incision of the prostate (TURP) involves the insertion of a surgical instrument and optical device into the urethra to the prostate. Erectile dysfunction is not a common occurrence with this procedure; however, there may be retrograde ejaculation. Rationale 3: Perineal prostatectomy removes the gland by way of a perineal incision. This procedure has a high incidence of complications including impotence and rectal injury. Rationale 4: The suprapubic prostatectomy utilizes an abdominal incision. It involves greater blood loss and an increased risk of infection. Global Rationale: The transurethral needle ablation (TUNA) system uses low-level radiofrequency through twin needles to burn away a region of the enlarged prostate. Shields protect the urethra. TUNA improves the flow of urine through the urethra and does not cause impotence or incontinence. Transurethral incision of the prostate (TURP) involves the insertion of a surgical instrument and optical device into the urethra to the prostate. Erectile dysfunction is not a common occurrence with this procedure; however, there may be retrograde ejaculation. Perineal prostatectomy removes the gland by way of a perineal incision. This procedure has a high incidence of complications including impotence and rectal injury. The suprapubic prostatectomy utilizes an abdominal incision. It involves greater blood loss and an increased risk of infection.

A patient who is being admitted for surgery asks the nurse why information is being collected about the patient's use of herbal and natural supplements. How should the nurse respond to this patient? 1. "Herbal supplements may interact with anesthetic agents." 2. "Herbal remedies may cause pain relievers to be ineffective." 3. "The physician is in charge of medications." 4. "There is no need to take these preparations."

Correct Answer: 1 Rationale 1: The use of herbal supplements must be documented prior to surgery. It is possible for these elements to interact with anesthetic agents. Rationale 2: Herbal remedies have not been shown to render analgesics ineffective. Rationale 3: Stating that the physician is in charge of medications does not adequately respond to the patient's inquiry. Rationale 4: Stating that there is no need to take these prescriptions does not adequately respond to the patient's inquiry. Global Rationale: The use of herbal supplements must be documented prior to surgery. It is possible for these elements to interact with anesthetic agents. Herbal remedies have not been shown to render analgesics ineffective. Stating that the physician is in charge of medications and that there is no need to take these prescriptions does not adequately respond to the patient's inquiry.

A 55-year-old patient who takes nitroglycerin for angina asks for a prescription to aid with erectile dysfunction. What should the nurse do in response to this patient's request? 1. Explain why the erectile dysfunction medication is not a good idea with the heart medication. 2. Provide education about the medication once the prescription is provided. 3. Remind the patient to stop taking the heart medication when planning to take the erectile dysfunction medication. 4. Suggest a behavioral health consult to analyze the reason for the erectile dysfunction.

Correct Answer: 1 Rationale 1: The use of medications for erectile dysfunction is contraindicated for the patient who is taking medications used to manage cardiac conditions. Rationale 2: Sildenafil (Viagra) and vardenafil (Levitra) should not be taken by men who are also taking nitrate-based drugs. Tadalafil (Cialis) should not be taken if the man is also taking nitrates. Rationale 3: Discontinuing cardiac drugs is not advisable. Rationale 4: A behavioral health consult would not be the first or primary suggestion in this case as physical issues should be explored. Global Rationale: The use of medications for erectile dysfunction is contraindicated for the patient who is taking medications used to manage cardiac conditions. Sildenafil (Viagra) and vardenafil (Levitra) should not be taken by men who are also taking nitrate-based drugs. Tadalafil (Cialis) should not be taken if the man is also taking nitrates. Discontinuing cardiac drugs is not advisable. A behavioral health consult would not be the first or primary suggestion in this case as physical issues should be explored.

The patient who had an emergency abdominal surgery looks at his incision on the first postoperative day and says, "I sure hope this doesn't leave much of a scar. Is there some type of medicine or ointment I can put on it?" What should the nurse consider prior to responding to that comment? 1. This incision will heal by primary intention and will probably leave only a hairline scar. 2. This incision will fill in with granulation tissue and leave a moderately big scar despite any medication applied. 3. This incision was done in an emergent fashion but continuous application of steroid creams will prevent scarring. 4. This incision will have to be reclosed later and will leave a large scar unless a topical antibiotic is used continuously.

Correct Answer: 1 Rationale 1: This picture shows a clean, straight incision that was closed early, so it will probably leave a hairline scar. This is called healing by primary intention. Rationale 2: Healing by secondary intention is when the incision is left open and granulation begins. This leaves a large scar. Rationale 3: The fact that this was an emergency surgery should have nothing to do with the scarring potential if the incision is clean and closed immediately. Rationale 4: Healing by secondary intention occurs when the incision is left open and granulation begins. This leaves a large scar. Global Rationale: This picture shows a clean, straight incision that was closed early, so it will probably leave a hairline scar. This is called healing by primary intention. Healing by secondary intention is when the incision is left open and granulation begins. This leaves a large scar. The fact that this was an emergency surgery should have nothing to do with the scarring potential if the incision is clean and closed immediately. Healing by secondary intention is when the incision is left open and granulation begins.

An older surgical patient is having an epidural catheter inserted for pain control. What does the nurse realize is an advantage of using this method of pain medication for this patient? 1. improved bowel activity 2. faster wound healing 3. earlier ambulation 4. improved appetite

Correct Answer: 1 Rationale 1: This type of intraspinal anesthesia provides safe and effective pain relief for patients of all ages with less risk of adverse effects than general anesthesia. Rationale 2: Patient-controlled epidural analgesia does not cause faster wound healing in the older patient. Rationale 3: Patient-controlled epidural analgesia does not cause earlier ambulation in the older patient. Rationale 4: Patient-controlled epidural analgesia does not cause improved appetite in the older patient. Global Rationale: This type of intraspinal anesthesia provides safe and effective pain relief for patients of all ages with less risk of adverse effects than general anesthesia. Patient-controlled epidural analgesia does not cause faster wound healing, earlier ambulation, or improved appetite in the older patient.

The nurse is planning care to support the cognitive-psychosocial status for an older patient having surgery. Which intervention would be appropriate for this patient? 1. Provide time for teaching and learning. 2. Set limits with the patient. 3. Tell the patient that his physician will make all care decisions. 4. Remind the patient that the call bell is for emergencies only.

Correct Answer: 1 Rationale 1: To support the older patient's cognitive-psychosocial status, the nurse should provide ample time for teaching and learning. Rationale 2: The nurse should not treat the older patient as a child by setting limits. Rationale 3: The nurse should not treat the older patient as a child by stating that all care decisions will be made by the physician. Rationale 4: The nurse should not treat the older patient as a child by reminding that the call bell is for emergencies only. Global Rationale: To support the older patient's cognitive-psychosocial status, the nurse should provide ample time for teaching and learning. The nurse should not treat the older patient as a child by setting limits, by stating that all care decisions will be made by the physician, or by reminding that the call bell is for emergencies only.

A patient is recovering from a penile implant procedure. What should be included in the care of and teaching about the implant? Standard Text: Select all that apply. 1. Encourage the patient to practice inflating and deflating the device during the recovery period. 2. Suggest wearing snug-fitting underwear and loose-fitting trousers to conceal the semi-erection. 3. Encourage the patient to resume sexual activity within three weeks. 4. Remind the patient to not inflate or deflate the device for at least four weeks. 5. Suggest wearing loose-fitting underwear and trousers.

Correct Answer: 1, 2 Rationale 1: For a penile implant, teach the patient and his partner how to use the pump, including how to inflate and deflate the device. Suggest that he practice inflation and deflation during the postoperative period. Rationale 2: Suggest wearing snug-fitting underwear with the penis placed in an upright position on the abdomen and loose trousers. Rationale 3: Provide information about length of healing, and that sexual activity may resume within six to eight weeks following surgery. Recovery from surgery is necessary before resuming sexual activity. Rationale 4: Practice using the pump will maintain the pump position and promote tissue growth around the implant. Rationale 5: Suggest wearing snug-fitting underwear and loose trousers with the penis placed in an upright position on the abdomen. Global Rationale: For a penile implant, teach the patient and his partner how to use the pump, including how to inflate and deflate the device. Suggest that he practice inflation and deflation during the postoperative period. Suggest wearing snug-fitting underwear with the penis placed in an upright position on the abdomen and loose trousers. The type of clothing worn can improve the ability to conceal the semi-rigid prosthesis and decrease embarrassment. Provide information about length of healing, and that sexual activity may resume within six to eight weeks following surgery. Recovery from surgery is necessary before resuming sexual activity. Practice using the pump will maintain the pump position and promote tissue growth around the implant.

A patient recently diagnosed with diabetes wants to check the urine for glucose instead of using capillary blood because of the cost. Which response should the nurse make to the patient? 1. "Urine testing is best when combined with serum testing." 2. "Urine testing is as reliable as finger stick testing." 3. "Yes, urine testing is cheaper than glucose test strips." 4. "Would you like to switch to this method of monitoring?"

Correct Answer: 1 Rationale 1: Urine glucose testing is no longer recommended for the patient with diabetes who is self-managing the condition. The blood glucose level is likely to be drastically different than a urine level because urine may sit in the bladder for several hours. If the result is negative, the blood glucose could be normal, hyperglycemic (up to 180 mg/dL), or hypoglycemic (less than 70 mg/dL). Rationale 2: Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. Rationale 3: Telling the patient he is correct does not provide adequate information. Rationale 4: It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized by the patient. Global Rationale: Urine glucose testing is no longer recommended for the patient with diabetes who is self-managing the condition. The blood glucose level is likely to be drastically different than a urine level because urine may sit in the bladder for several hours. If the result is negative, the blood glucose could be normal, hyperglycemic (up to 180 mg/dL), or hypoglycemic (less than 70 mg/dL). Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. Telling the patient he is correct does not provide adequate information. It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized to the patient.

A male patient with type I diabetes mellitus and coronary artery disease is able to achieve an erection but cannot maintain it. What could be done to assist this patient? 1. Suggest an O ring. 2. Provide tadalafil (Cialis) teaching material. 3. Provide sildenafil (Viagra) teaching material. 4. Discuss penile implant surgery.

Correct Answer: 1 Rationale 1: When managing an erectile dysfunction condition, the least invasive treatments should be employed first. The least invasive measure would be to provide or offer information about the O ring, which is a small band placed on the base of the penis that helps to maintain an erection. Rationale 2: Since the patient has coronary artery disease, it is assumed that the patient might be prescribed nitroglycerin for transient chest pain. Erectile dysfunction medications would be contraindicated in this case. Rationale 3: Since the patient has coronary artery disease, it is assumed that the patient might be prescribed nitroglycerin for transient chest pain. Erectile dysfunction medications would be contraindicated in this case. Rationale 4: Penile implant surgery may not be an option due to this patient's physical health and is an invasive procedure. Other options should be considered first, before surgery is considered. Global Rationale: When managing an erectile dysfunction condition, the least invasive treatments should be employed first. The least invasive measure would be to provide or offer information about the O ring, which is a small band placed on the base of the penis that helps to maintain an erection. Since the patient has coronary artery disease, it is assumed that the patient might be prescribed nitroglycerin for transient chest pain. Erectile dysfunction medications would be contraindicated in this case. Penile implant surgery may not be an option due to this patient's physical health and is an invasive procedure. Other options should be considered first, before surgery is considered.

A patient is scheduled for total hip replacement surgery. What medication should the nurse provide to the patient prior to the surgical procedure? 1. antibiotic 2. antacid 3. antiemetic 4. anticholinergic

Correct Answer: 1 Rationale 1: Antibiotics are given preoperatively to orthopedic patients to prevent postoperative infections. Rationale 2: Antacids increase the gastric pH and reduce the volume of gastric fluid. Rationale 3: Antiemetics enhance gastric emptying. Rationale 4: Anticholinergics reduce oral and respiratory secretions to decrease the risk of aspiration and vomiting. Global Rationale: Antibiotics are given preoperatively to orthopedic patients to prevent postoperative infections. Antacids increase the gastric pH and reduce the volume of gastric fluid. Antiemetics enhance gastric emptying. Anticholinergics reduce oral and respiratory secretions to decrease the risk of aspiration and vomiting.

An older postoperative patient is given an antiemetic for nausea. Which manifestation indicates to the nurse that this patient is experiencing a possible reaction to the medication? 1. involuntary muscle movements 2. confusion 3. dry mouth 4. breakthrough vomiting

Correct Answer: 1 Rationale 1: Antiemetics, such as Metoclopramide (Reglan) and Droperidol (Inapsine), can have tranquilizing effects as well as cause an extrapyramidal reaction. The patient would demonstrate involuntary movements, muscle tone changes, and abnormal posturing. Rationale 2: Elderly patients may also experience drowsiness, which reduces orientation, after being given antiemetics. Rationale 3: A dry mouth may be experienced as a result of having been or currently being unable to have oral intake. Rationale 4: Breakthrough vomiting is not an indication of an adverse reaction. Global Rationale: Antiemetics, such as metoclopramide (Reglan) and droperidol (Inapsine), can have tranquilizing effects as well as cause an extrapyramidal reaction. The patient would demonstrate involuntary movements, muscle tone changes, and abnormal posturing. Elderly patients may also experience drowsiness, which reduces orientation, after being given antiemetics. A dry mouth may be experienced as a result of having been or currently being unable to have oral intake. Breakthrough vomiting is not an indication of an adverse reaction.

A patient received lorazepam (Ativan) as preoperative medication. What should the nurse assess when caring for this patient? 1. respiratory depression 2. nausea and vomiting 3. confusion 4. rash

Correct Answer: 1 Rationale 1: For the patient who received lorazepam (Ativan), the nurse should monitor for respiratory depression, hypotension, lack of coordination, and drowsiness. Rationale 2: Nausea and vomiting is not associated with the use of lorazepam (Ativan). Rationale 3: Confusion is not associated with the use of lorazepam (Ativan). Rationale 4: Rash is not associated with the use of lorazepam (Ativan). Global Rationale: For the patient who received lorazepam (Ativan), the nurse should monitor for respiratory depression, hypotension, lack of coordination, and drowsiness. Nausea and vomiting, confusion, and rash are not associated with the use of lorazepam (Ativan).

The nurse is caring for a patient recovering from prostate surgery. Which actions should the nurse take if the patient's urine in the urinary irrigation drainage bag is very dark red? Standard Text: Select all that apply. 1. Check for catheter occlusion. 2. Increase the flow rate of irrigant solution. 3. Check vital signs. 4. Ask the patient to drink more oral fluids. 5. Assess the patient for hyponatremia.

Correct Answer: 1, 2 Rationale 1: Following prostatectomy, urine should appear light pink to clear with an occasional blood clot. If the urine appears very dark red, this may indicate increased venous bleeding or inadequate urine dilution. The catheter is at risk for being occluded and should be checked first. Rationale 2: If the man has continuous bladder irrigation (CBI), assess the catheter and the drainage tubing at regular intervals. Maintain the rate of flow of irrigating fluid to keep the output light pink or colorless. Rationale 3: Checking vital signs is important but not specific to this situation. Rationale 4: Asking the patient to increase fluid intake may increase urine output and assist in diluting the urine, but this may take several hours. Rationale 5: Assessing for hyponatremia is a nursing action to detect absorption of bladder irrigation solution. Global Rationale: Following prostatectomy, urine should appear light pink to clear with an occasional blood clot. If the urine appears very dark red, this may indicate increased venous bleeding or inadequate urine dilution. The catheter is at risk for being occluded and should be checked first, followed by increasing the flow rate of irrigant which should assist in making the urine clear. Checking vital signs is important but not specific to this situation. Asking the patient to increase fluid intake may increase urine output and assist in diluting the urine, but this may take several hours. Assessing for hyponatremia is a nursing action to detect absorption of bladder irrigation solution.

The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. The nurse anticipates which counterregulatory serum hormonal changes to occur in this patient? Standard Text: Select all that apply. 1. increased epinephrine levels 2. increased growth hormone levels 3. increased insulin levels 4. decreased thyroxine levels 5. decreased glucocorticoid levels

Correct Answer: 1, 2 Rationale 1: If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Epinephrine (often referred to as a glucose counterregulatory hormone) stimulates an increase in glucose in times of hypoglycemia, stress, growth, or increased metabolic demand. Rationale 2: If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Growth hormone (often referred to as a glucose counterregulatory hormone) stimulates an increase in glucose in times of hypoglycemia, stress, growth, or increased metabolic demand. Rationale 3: Insulin is not released as a counterregulatory hormone. Rationale 4: Thyroxine level would increase with hypoglycemia. Rationale 5: Glucocorticoids levels would increase with hypoglycemia. Global Rationale: If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Epinephrine, growth hormone, thyroxine, and glucocorticoids (often referred to as glucose counterregulatory hormones) also stimulate an increase in glucose in times of hypoglycemia, stress, growth, or increased metabolic demand. Insulin is not released as a counterregulatory hormone. Thyroxine and glucocorticoids levels would increase with hypoglycemia.

A patient is scheduled to have a hernia repair done today on an outpatient basis. The patient's sibling angrily says, "When I had this done 20 years ago, they kept me in the hospital nearly a week. Why can't my brother stay here where someone can take care of him?" What are appropriate responses by the nurse? Standard Text: Select all that apply. 1. "He will be at less risk of getting an infection at home." 2. "He will probably be more comfortable in his own bed at home." 3. "It is cheaper for the insurance company if he goes home today." 4. "The government won't let him stay." 5. "If you ask the physician, the hospital will probably let him stay."

Correct Answer: 1, 2 Rationale 1: The best answers to this angry sibling focus on what is best for the patient, so replying about reduction of infection risk and comfort are the best choice. Rationale 2: The best answers to this angry sibling focus on what is best for the patient, so replying about reduction of infection risk and comfort are the best choice. Rationale 3: While it is probably cheaper for the insurance company for the patient to go home and there are governmental regulations about hospital admission and Medicare, this is not the best time to bring those concepts into the conversation. Rationale 4: While it is probably cheaper for the insurance company for the patient to go home and there are governmental regulations about hospital admission and Medicare, this is not the best time to bring those concepts into the conversation. Rationale 5: It is also not advisable to infer that the hospital has a decision to make in whether this patient stays or goes home. Global Rationale: The best answers to this angry sibling focus on what is best for the patient, so replying about reduction of infection risk and comfort are the best choice. While it is probably cheaper for the insurance company for the patient to go home and there are governmental regulations about hospital admission and Medicare, this is not the best time to bring those concepts into the conversation. It is also not advisable to infer that the hospital has a decision to make in whether this patient stays or goes home.

The nurse is changing the surgical dressing on an older patient's abdomen and sees the item pictured in the diagram below. How should the nurse care for this device? Standard Text: Select all that apply. 1. Plan to replace the precut gauze as part of the dressing change. 2. Cleanse around the tube with the cleanser ordered or according to protocol. 3. Use the safety pin to secure the outermost bandage to the dressing. 4. Remove the tube, culture the wound, and cleanse it with saline gauze 5. Remove the safety pin

Correct Answer: 1, 2 Rationale 1: The nurse cares for this device by cleansing around it per hospital protocol and replacing the precut gauze dressing as necessary. Rationale 2: The nurse cares for this device by cleansing around it per hospital protocol and replacing the precut gauze dressing as necessary. Rationale 3: The pin should not be used to secure the dressing as that would make it very easy to inadvertently pull the drain out when the dressings are removed to be changed. Rationale 4: The drain is there to passively remove drainage from the wound bed, and it should not be removed until there is a physician order to do so. A culture is necessary only if there are assessment findings that indicate possible infection. Rationale 5: The safety pin is in place to keep the drain from slipping back into the patient, so it should not be removed.

The nurse is changing the abdominal surgical dressing of an older patient who has developed pneumonia and a cough. Upon removing the dressing, the nurse notes the situation as pictured below. What should be the nurse's intervention? Standard Text: Select all that apply. 1. Place saline moistened sterile dressing over the incision. 2. Notify the patient's surgeon of the occurrence. 3. Don sterile gloves and insert the loop of bowel back into the abdomen. 4. Document the presence of a dehiscence in the medical record. 5. Replace the dressing and ask the oncoming shift to advise the physician about the situation when rounds are made.

Correct Answer: 1, 2 Rationale 1: The tissue must be kept moist, so application of a sterile dressing that is moistened with sterile saline is appropriate. Rationale 2: The surgeon should be made aware of the situation immediately, as a return to the OR will probably be necessary. Rationale 3: The nurse should not attempt to put the loop of bowel back into the abdomen, as this might cause additional trauma. Rationale 4: Documentation is not a priority in this emergency situation. Rationale 5: The surgeon should be made aware of the situation immediately, as a return to the OR will probably be necessary, so having the next shift notify the surgeon is wrong. Global Rationale: This situation depicts an evisceration, which is an emergency situation, not a dehiscence. Older patients may be at greater risk for this postoperative complication because of thinning of the skin and subcutaneous tissues. The tissue must be kept moist, so application of a sterile dressing that is moistened with sterile saline is appropriate. The surgeon should be made aware of the situation immediately, as a return to the OR will probably be necessary, so having the next shift notify the surgeon is wrong. The nurse should not attempt to put the loop of bowel back into the abdomen as this might cause additional trauma. Documentation is not a priority in this emergency situation.

Which patient information is essential for the nurse to provide the physician who is preparing to administer conscious sedation to a patient? Standard Text: Select all that apply. 1. The patient has a history of snoring. 2. The patient drank a cup of coffee two hours ago. 3. The patient wants to be asleep for the procedure. 4. The patient's father was hypertensive. 5. The patient has a history of gout.

Correct Answer: 1, 2 Rationale 1: While all of this information leads to a greater understanding of the patient, that the patient snores is essential information at this time. Rationale 2: While all of this information leads to a greater understanding of the patient, that the patient is not NPO is essential information at this time. Rationale 3: That the patient wishes to be asleep for the procedure is not essential information. Rationale 4: That the patient's father was hypertensive is not essential information at this time. Rationale 5: That the patient has a history of gout is not essential information at this time. Global Rationale: While all of this information leads to a greater understanding of the patient, the essential information is that the patient snores and that the patient is not NPO. The other information is not relevant at this time.

The nurse is planning a class on nutrition for middle-school students. Which data points should be included in the presentation? Standard Text: Select all that apply. 1. Sufficient dietary fats help people absorb vitamins. 2. Cholesterol is needed for proper hormonal function. 3. Fat tissue helps insulate the internal organs. 4. Vitamin K is formed by the action of ultraviolet radiation on the skin. 5. Vitamin D is synthesized by bacteria in the intestine.

Correct Answer: 1, 2, 3 Rationale 1: Dietary fat is needed to absorb fat-soluble vitamins. Rationale 2: Cholesterol is needed for proper hormonal function. Rationale 3: Fat tissue helps insulate the internal organs. Rationale 4: Vitamin D, not K, is formed by the action of ultraviolet radiation on the skin. Rationale 5: Vitamin K, not D, is synthesized by bacteria in the intestine. Global Rationale: Sufficient dietary fat is needed to absorb fat-soluble vitamins. Cholesterol is needed for proper hormonal function, and fat tissue helps insulate the internal organs. Vitamin K is synthesized by bacteria in the intestine and vitamin D is formed by the action of ultraviolet light on the skin.

A patient recovering from prostate surgery is being discharged. What should the nurse include in this patient's instructions? Standard Text: Select all that apply. 1. Do not drive for two weeks. 2. Sexual intercourse should not occur for six weeks. 3. Call the physician if the scrotum becomes swollen and tender. 4. Take aspirin or NSAIDs for discomfort. 5. You may return to work in two weeks.

Correct Answer: 1, 2, 3 Rationale 1: Discharge teaching following prostate surgery should include instructions to avoid driving for two weeks, except for short rides. Rationale 2: Discharge teaching following prostate surgery should include instructions to avoid sexual intercourse for six weeks to avoid bleeding. Rationale 3: Discharge teaching following prostate surgery should include instructions to call the physician if the scrotum becomes swollen and tender. Rationale 4: NSAIDs and aspirin should be avoided for at least two weeks. Rationale 5: The patient may return to work after four weeks if the work is not strenuous; otherwise, the patient should wait six to eight weeks. Global Rationale: Discharge teaching following prostate surgery should include instructions to avoid driving for two weeks, except for short rides; no sexual intercourse for six weeks to avoid bleeding; and to call the physician if the scrotum becomes swollen and tender. NSAIDs and aspirin should be avoided for at least two weeks. The patient may return to work after four weeks if the work is not strenuous; otherwise, the patient should wait six to eight weeks.

The nurse is preparing information for a community seminar on the hazards of obesity. Which disorders should the nurse include as being complications of obesity? Standard Text: Select all that apply. 1. cardiovascular diseases 2. obstructive sleep apnea 3. diabetes mellitus type 2 4. hypotension 5. renal insufficiency

Correct Answer: 1, 2, 3 Rationale 1: Obesity leads to atherosclerosis, which increases vascular resistance, predisposing the patient to cardiovascular diseases. Rationale 2: Respiratory airway collapse can occur during sleep in obese patients. Rationale 3: Obesity increases the risk of developing diabetes mellitus type 2 in adults. Rationale 4: Hypertension, not hypotension, is associated with obesity. Rationale 5: Patients who are obese are not necessarily at risk for developing renal insufficiency. Global Rationale: Obesity leads to atherosclerosis, which increases vascular resistance, predisposing the patient to cardiovascular diseases; respiratory airway collapse can occur during sleep in obese patients; obesity increases the risk of developing diabetes mellitus type 2 in adults. Hypertension, not hypotension, is associated with obesity. Patients who are obese are not necessarily at risk for developing renal insufficiency.

At the conclusion of a physical assessment the nurse determines that a patient is experiencing health-related problems of obesity. What information from the patient's health history does the nurse use to make this decision? Standard Text: Select all that apply. 1. osteoarthritis 2. varicose veins 3. low back pain 4. allergy to sulfa 5. lactose intolerance

Correct Answer: 1, 2, 3 Rationale 1: Osteoarthritis is an obesity-related problem of the musculoskeletal system. Rationale 2: Varicose veins are an obesity-related problem of the cardiovascular system. Rationale 3: Low back pain is an obesity-related problem of the musculoskeletal system. Rationale 4: A drug allergy is not an obesity-related problem. Rationale 5: Lactose intolerance is not an obesity-related problem. Global Rationale: Osteoarthritis and low back pain are obesity-related problems of the musculoskeletal system. Varicose veins are an obesity-related problem of the cardiovascular system. Drug allergies and lactose intolerance are not obesity-related problems.

The nurse is preparing to conduct a physical assessment of a patient with obesity. What equipment should the nurse have available for this assessment? Standard Text: Select all that apply. 1. scale 2. skinfold calipers 3. calculator 4. glucose meter 5. supplies for blood draw

Correct Answer: 1, 2, 3 Rationale 1: The nurse will require a scale to weigh the patient. Rationale 2: The nurse will require skinfold calipers to assess the patient's body fat. Rationale 3: The nurse will require a calculator to help determine the patient's body mass index and ideal body weight. Rationale 4: A glucose meter may be used in the future but is not needed during the initial assessment. Rationale 5: Supplies for a blood draw may be needed eventually but are not indicated for the initial assessment. Global Rationale: For the initial assessment of a patient with a diagnosis of obesity, the nurse will gather supplies that include a scale for weighing the patient, skinfold calipers for assessing body fat, and a calculator for determining body mass index and ideal body weight. A glucose meter and supplies for blood draw may be needed eventually but are not indicated for the initial assessment.

The nurse is preparing to administer insulin to an underweight patient. Which actions should the nurse take when providing this injection? Standard Text: Select all that apply. 1. Ensure insulin is at room temperature. 2. Make sure no air bubbles are present in the syringe. 3. Massage the site of insertion. 4. Rotate injection sites. 5. Insert the needle at a 90-degree angle.

Correct Answer: 1, 2, 4 Rationale 1: Insulin is used at room temperature. Rationale 2: No air bubbles should be in the syringe. This will reduce complications and will aid in ensuring correct dosages. Rationale 3: Massage of administration sites will alter absorption rates. Rationale 4: Insulin injection sites should be rotated. Rationale 5: The thin individual will require an administration angle of 45 degrees. Global Rationale: Insulin is used at room temperature. No air bubbles should be in the syringe. This will reduce complications and will aid in ensuring correct dosages. Massage of administration sites will alter absorption rates. Insulin injection sites should be rotated. The thin individual will require an administration angle of 45 degrees.

After complaining of discomfort from a surgical procedure, the patient voices fear of addiction with taking analgesics as prescribed. What information should be provided to the patient regarding these concerns? Standard Text: Select all that apply. 1. "Addiction to opioid analgesics is rare when used for short-term postoperative pain management." 2. "Psychological tolerance is not commonly experienced by patients who take narcotic analgesics during the postoperative experience." 3. "Pain tolerance and the need for opioid analgesics are individualized." 4. "Patients should be screened for addiction potential prior to being given narcotics." 5. "I'll turn the TV on to help distract you from your pain."

Correct Answer: 1, 2, 3 Rationale 1: The use of opioid analgesics during the postoperative period is rarely associated with physical dependency concerns. Rationale 2: The use of opioid analgesics during the postoperative period is rarely associated with psychological dependency concerns. Rationale 3: The pain management needs of patients will vary and should be managed individually. Rationale 4: Screening is not routinely recommended for surgical patients. Rationale 5: This does not address the patient's need for pain control or the patient's concern over addiction from postoperative opioid analgesics. Global Rationale: The use of opioid analgesics during the postoperative period is rarely associated with physical or psychological dependency concerns. The pain management needs of patients will vary and should be managed individually. Screening is not routinely recommended for surgical patients. Offering to turn on the TV to distract the patient does not address the patient's need for pain control or the patient's concern over addiction from postoperative opioid analgesics.

The nurse determines that a patient recovering from spinal anesthesia is experiencing complications from the anesthesia. Which actions should the nurse expect to be provided to this patient? Standard Text: Select all that apply. 1. Caffeine 2. Analgesics 3. Intravenous fluids 4. Epidural blood patch 5. Vasoactive medication

Correct Answer: 1, 2, 3, 4 Rationale 1: Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include caffeine. Rationale 2: Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include analgesics. Rationale 3: Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include hydration. Rationale 4: Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include an epidural blood patch. Rationale 5: Vasoactive medications are used if hypotension occurs. Global Rationale: Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include hydration, caffeine, analgesics, or administration of an epidural blood patch. Vasoactive medications are used if hypotension occurs.

A patient seen in the emergency department for priapism is sent to the medical unit. The admitting nurse should anticipate which actions as part of the nursing care plan? Standard Text: Select all that apply. 1. Assess the penis to include color changes and degree of erection. 2. Palpate the penis for firmness and rigidity. 3. Administer analgesic as prescribed for pain. 4. Administer iced saline enemas as prescribed. 5. Push oral fluids.

Correct Answer: 1, 2, 3, 4 Rationale 1: Priapism is an involuntary, sustained, painful erection that is not associated with sexual arousal. Impaired blood flow results in ischemia. The nurse will assess the penis for color changes and degree of erection. Rationale 2: The nurse will palpate for firmness and rigidity. Rationale 3: Analgesics are given for pain control. Rationale 4: Iced saline enemas induce anesthesia. Rationale 5: Intake and output should be monitored as acute urinary retention can occur. Excessive oral intake would be inappropriate. Global Rationale: Priapism is an involuntary, sustained, painful erection that is not associated with sexual arousal. Impaired blood flow results in ischemia. The nurse will assess the penis for color changes, degree of erection, and palpate for firmness and rigidity. Analgesics are given for pain control and iced saline enemas to induce anesthesia. Intake and output should be monitored as acute urinary retention can occur. Excessive oral intake would be inappropriate.

After prostate surgery a patient is being discharged with an indwelling urinary catheter in place. What teaching should the nurse provide to this patient? Standard Text: Select all that apply. 1. Use the larger urinary drainage bag at night. 2. Keep the larger urinary drainage bag at a level that permits gravity drainage. 3. Do not strap the leg bag too tightly. 4. Place a soft cloth between the leg bag and the skin. 5. Empty the leg bag at least twice a day.

Correct Answer: 1, 2, 3, 4 Rationale 1: Teaching for the patient who is going home with an indwelling urinary catheter should include using the larger urinary drainage bag at night. Rationale 2: Teaching for the patient who is going home with an indwelling urinary catheter should include using the larger urinary drainage bag at night and hanging it on the bed frame to permit gravity drainage. Rationale 3: Teaching for the patient who is going home with an indwelling urinary catheter should include avoiding strapping the leg bag too tightly to prevent decreased venous return. Rationale 4: Teaching the patient who is going home with an indwelling urinary catheter should include placing a soft cloth between the leg bag and the skin to prevent skin irritation. Rationale 5: Teaching the patient who is going home with an indwelling urinary catheter should include emptying the leg bag every three to four hours during waking hours to prevent overfilling. Global Rationale: Teaching for the patient who is going home with an indwelling urinary catheter should include using the larger urinary drainage bag at night and hanging it on the bed frame to permit gravity drainage; avoiding strapping the leg bag too tightly to prevent decreased venous return; placing a soft cloth between the leg bag and the skin to prevent skin irritation; and emptying the leg bag every three to four hours during waking hours to prevent overfilling.

The nurse is concerned that a patient with type 1 diabetes mellitus is at risk for developing diabetic ketoacidosis. What did the nurse assess to come to this conclusion? 1. reports of anxiety 2. pale, cool skin 3. serum glucose level of 325 mg/dL 4. ulcer on plantar aspect of right foot

Correct Answer: 3 Rationale 1: Anxiety is a symptom of hypoglycemia. Rationale 2: Pale, cool skin is a symptom of hypoglycemia. Rationale 3: In diabetic ketoacidosis, the blood glucose level is above 250 mg/dL. Rationale 4: An ulcer is not a symptom of diabetic ketoacidosis. Global Rationale: Anxiety and pale, cool skin are symptoms of hypoglycemia. In diabetic ketoacidosis, the blood glucose level is above 250 mg/dL. An ulcer is not a symptom of diabetic ketoacidosis.

The nurse instructs a patient with type 2 diabetes mellitus on the use of a glucometer for self-monitoring. Which patient statements about glucometer performance indicate that teaching has been effective? Standard Text: Select all that apply. 1. Correctly apply the blood to the meter strip. 2. Follow manufacturer's recommendation regarding cleaning of meter. 3. A patient with sickle cell anemia may need another way to check blood glucose levels. 4. Grapefruit juice should not be ingested when using the glucometer. 5. A sufficient amount of blood must be applied to the strip.

Correct Answer: 1, 2, 3, 5 Rationale 1: Many factors may affect glucose meter performance, including correctly applying the blood to the meter strip. Rationale 2: Many factors may affect glucose meter performance, including failure to follow the manufacturer's recommendations regarding meter cleaning. Rationale 3: Many factors may affect glucose meter performance, including a diagnosis of anemia or sickle cell anemia. Rationale 4: The ingestion of grapefruit juice is not a known cause of poor meter performance. Rationale 5: Many factors may affect glucose meter performance, including insufficient amounts of blood on the meter strip. Global Rationale: Many factors may affect glucose meter performance, including correctly applying blood to the meter strip, following the manufacturer's recommendations regarding meter cleaning, a diagnosis of anemia or sickle cell anemia, and insufficient amounts of blood on the meter strip. The ingestion of grapefruit juice is not a known cause of poor meter performance.

A male patient is concerned about the inability to ejaculate during sexual intercourse. What information in the patient's medical record should the nurse use to help determine the cause for the patient's health problem? Standard Text: Select all that apply. 1. medication for hypertension 2. medication for anxiety 3. treatment for bipolar disorder 4. topical steroid for psoriasis 5. narcotic for chronic back pain

Correct Answer: 1, 2, 3, 5 Rationale 1: The inability to ejaculate may be caused by certain medications such as antihypertensives. Rationale 2: The inability to ejaculate may be caused by certain medications such as anxiolytics. Rationale 3: The inability to ejaculate may be caused by certain medications such as antidepressants. Rationale 4: Topical steroids are not identified as affecting ejaculation. Rationale 5: The inability to ejaculate may be caused by certain medications, such as narcotics. Global Rationale: The inability to ejaculate may be caused by certain medications, such as antihypertensives, antidepressants, anxiolytics, and narcotics. Topical steroids are not identified as affecting ejaculation.

The nurse suspects that a patient with ulcerative colitis has taken a dose of diphenoxylate (Lomotil) to help with diarrhea. What did the nurse assess to make this clinical decision? Standard Text: Select all that apply. 1. fever 2. tachycardia 3. hypotension 4. low urine output 5. abdominal cramps

Correct Answer: 1, 2, 3, 5 Rationale 1: Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include fever. Rationale 2: Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include tachycardia. Rationale 3: Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include hypotension. Rationale 4: Low urine output is not a manifestation of toxic megacolon. Rationale 5: Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include abdominal cramps. Global Rationale: Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include fever, tachycardia, hypotension, and abdominal cramps. Low urine output is not a manifestation of toxic megacolon.

The nurse is teaching a patient with diabetes about the illness. The nurse knows the teaching has been effective when the patient identifies which statements as being true of pancreatic cells? Standard Text: Select all that apply. 1. Alpha cells produce glucagon. 2. Beta cells secrete insulin. 3. Cephalon cells produce creatine. 4. Delta cells produce somatostatin. 5. Epsilon cells produce erythropoietin.

Correct Answer: 1, 2, 4 Rationale 1: Alpha cells produce the hormone glucagon, which stimulates the breakdown of glycogen in the liver, the formation of carbohydrates in the liver, and the breakdown of lipids in both the liver and adipose tissue. Rationale 2: Beta cells secrete the hormone insulin, which facilitates the movement of glucose across cell membranes into cells, decreasing blood glucose levels. Rationale 3: Cephalon cells are not pancreatic cells. Rationale 4: Delta cells produce somatostatin, which acts within the islets of Langerhans to inhibit the production of both glucagon and insulin. It also slows gastrointestinal motility, allowing more time for food to be absorbed. Rationale 5: Epsilon cells are not pancreatic cells. Global Rationale: Alpha cells produce the hormone glucagon, which stimulates the breakdown of glycogen in the liver, the formation of carbohydrates in the liver, and the breakdown of lipids in both the liver and adipose tissue. Beta cells secrete the hormone insulin, which facilitates the movement of glucose across cell membranes into cells, decreasing blood glucose levels. Insulin prevents the excessive breakdown of glycogen in the liver and in muscle, facilitates lipid formation while inhibiting the breakdown of stored fats, and helps move amino acids into cells for protein synthesis. Delta cells produce somatostatin, which acts within the islets of Langerhans to inhibit the production of both glucagon and insulin. It also slows gastrointestinal motility, allowing more time for food to be absorbed. Cephalon cells are not pancreatic cells. Epsilon cells are not pancreatic cells.

The nurse is teaching a patient with type 2 diabetes mellitus about glyburide (DiaBeta). The nurse knows teaching has been effective when the patient states, "I need to monitor for dizziness, lightheadedness, and sweating if I take: Standard Text: Select all that apply. 1. ibuprofen (Motrin) for pain." 2. ranitidine (Zantac) for heartburn." 3. cetirizine (Zyrtec) for allergies." 4. metoprolol (Lopressor) for hypertension." 5. docusate sodium (Colace) for constipation."

Correct Answer: 1, 2, 4 Rationale 1: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen (Motrin). Rationale 2: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is taking ranitidine (Zantac). Rationale 3: Zyrtec does not interact with glyburide. Rationale 4: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking a beta blocker such as metoprolol (Lopressor). Rationale 5: Colace does not interact with glyburide. Global Rationale: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking nonsteroidal anti-inflammatory agents (NSAIDs), ranitidine, or beta blockers. Zyrtec and Colace do not interact with glyburide.

A patient comes into the emergency department with suspected appendicitis. What should the nurse do for this patient? 1. Provide a hot water bottle to place over the abdomen. 2. Provide with clear water to drink. 3. Inspect the abdomen and assess bowel sounds. 4. Prepare to administer a biscodyl (Dulcolax) suppository.

Correct Answer: 3 Rationale 1: No heat should be applied to the abdomen; this may increase circulation to the appendix and also cause perforation. Rationale 2: Keep the patient with suspected appendicitis NPO. Rationale 3: Assessing the abdomen and bowel sounds is the priority action for the nurse to take. Rationale 4: Do not administer laxatives or enemas, which may cause perforation of the appendix. Global Rationale: Keep the patient with suspected appendicitis NPO, and do not administer laxatives or enemas, which may cause perforation of the appendix. No heat should be applied to the abdomen; this may increase circulation to the appendix and also cause perforation.

A patient is prescribed pain medication to assist in the treatment of bacterial prostatitis. What additional nonpharmacological interventions should the nurse suggest to the patient to help control the pain of this health problem? Standard Text: Select all that apply. 1. warm bath 2. avoiding sitting 3. taking a walk 4. stress-reduction activities 5. applying ice to the rectal area

Correct Answer: 1, 2, 4 Rationale 1: When pain is most severe with bacterial prostatitis, warm baths have been reported to assist in pain reduction. Rationale 2: When pain is most severe with bacterial prostatitis, avoidance of sitting has been reported to assist in pain reduction. Rationale 3: Walking is not identified as a way to reduce the pain associated with bacterial prostatitis. Rationale 4: When pain is most severe with bacterial prostatitis, stress-reducing activities have been reported to assist in pain reduction. Rationale 5: Application of ice to the rectal area is not identified as a way to reduce the pain associated with bacterial prostatitis. Global Rationale: When pain is most severe with bacterial prostatitis, stress-reducing activities, warm baths, and avoidance of sitting have been reported to assist in pain reduction. Walking and applying ice to the rectal area are not identified as ways to reduce the pain associated with bacterial prostatitis.

During a health interview a male patient expresses the desire to avoid developing prostate cancer with aging. What should the nurse recommend to reduce this patient's risk factors for the health problem? Standard Text: Select all that apply. 1. avoiding vasectomy 2. reducing the intake of animal fat 3. increasing the intake of vitamin C 4. restricting exposure to spermicides 5. taking vitamin A supplements

Correct Answer: 1, 2, 5 Rationale 1: Risk factors for prostate cancer include having a vasectomy because it is believed to increase the levels of circulating free testosterone. Rationale 2: A diet high in animal fat is believed to increase the risk for prostate cancer. Rationale 3: Vitamin C does not impact the risk for prostate cancer. Rationale 4: Spermicides are not identified as increasing the risk for prostate cancer. Rationale 5: Excessive supplemental vitamin A is believed to increase the risk for prostate cancer. Global Rationale: One risk factor for prostate cancer is having a vasectomy because it is believed to increase the levels of circulating free testosterone. A diet high in animal fat and excessive supplemental vitamin A is also believed to increase the risk for prostate cancer. Vitamin C does not impact the risk for prostate cancer. Spermicides are not identified as increasing the risk for prostate cancer. Excessive supplemental vitamin A is believed to increase the risk for prostate cancer.

The intraoperative nurse is caring for a patient in the maintenance phase of anesthesia. Which actions should the nurse prepare to provide to the patient at this time? Standard Text: Select all that apply. 1. Prepare the skin. 2. Assess oxygen saturation level. 3. Participate in the surgical procedure. 4. Position the patient for the surgical procedure. 5. Measure blood pressure and heart rate.

Correct Answer: 1, 3, 4 Rationale 1: During the maintenance phase of anesthesia, the skin is prepared. Rationale 2: The anesthesiologist monitors the patient's blood pressure, heart rate, and oxygen saturation level at this time. Rationale 3: During the maintenance phase of anesthesia, the surgery is performed. Rationale 4: During the maintenance phase of anesthesia, the patient is positioned. Rationale 5: The anesthesiologist monitors the patient's blood pressure, heart rate, and oxygen saturation level at this time. Global Rationale: During the maintenance phase of anesthesia, the patient is positioned, the skin is prepared, and surgery is performed. The anesthesiologist monitors the patient's blood pressure, heart rate, and oxygen saturation level at this time.

A patient with chronic diarrhea has been advised by the healthcare provider to avoid foods containing sorbitol and mannitol. What should the nurse instruct the patient to avoid consuming for this health problem? Standard Text: Select all that apply. 1. mints 2. honey 3. pear juice 4. apple juice 5. orange juice

Correct Answer: 1, 3, 4 Rationale 1: Mints may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. Rationale 2: Honey contains fructose. Rationale 3: Pear juice may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. Rationale 4: Apple juice may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. Rationale 5: Orange juice is not identified as a food item that aggravates chronic diarrhea. Global Rationale: Apple and pear juice and mints may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. Orange juice is not identified as a food item that aggravates chronic diarrhea.

While the nurse is assisting a patient recovering from epidural anesthesia to ambulate, the patient becomes dizzy and has a blood pressure of 78/48 mmHg. What actions should the nurse take? Standard Text: Select all that apply. 1. Notify the anesthesiologist. 2. Notify the pharmacy to obtain atropine. 3. Continuously monitor blood pressure. 4. Prepare to administer intravenous fluids. 5. Prepare to administer vasoactive medications.

Correct Answer: 1, 3, 4, 5 Rationale 1: Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. Rationale 2: Atropine is not indicated in the treatment of this adverse effect of epidural anesthesia. Rationale 3: Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. Rationale 4: Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. Rationale 5: Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. Global Rationale: Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. Atropine is not indicated in the treatment of this adverse effect of epidural anesthesia.

The nurse is reviewing data collected from a patient with a predisposition to developing insulin resistance. Which medications should the nurse identify as potentially causing this patient to develop diabetes? Standard Text: Select all that apply. 1. nicotinic acid (Niacor) 2. acetaminophen (Tylenol) 3. levothyroxine (Synthroid) 4. furosemide (Lasix) 5. phenytoin (Dilantin)

Correct Answer: 1, 3, 4, 5 Rationale 1: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include nicotinic acid (Niacor). Rationale 2: Acetaminophen (Tylenol) is not a medication that impairs insulin secretion, precipitating DM in people with predisposing insulin resistance. Rationale 3: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include levothyroxine (Synthroid), which is a thyroid hormone. Rationale 4: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include furosemide (Lasix), which is a thiazide diuretic. Rationale 5: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include phenytoin (Dilantin). Global Rationale: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples are nicotinic acid, thyroid hormone, thiazides, and phenytoin. Acetaminophen (Tylenol) does not impair insulin secretion and precipitate diabetes mellitus in people with predisposing insulin resistance.

The nurse is caring for an older patient recovering from a bleeding ulcer. Which manifestations should the nurse use to determine whether the patient is experiencing peritonitis? Standard Text: Select all that apply. 1. confusion 2. bradycardia 3. restlessness 4. abdominal discomfort 5. decreased urinary output

Correct Answer: 1, 3, 4, 5 Rationale 1: Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Increased confusion may be the only manifestation present. Rationale 2: Bradycardia is not a manifestation of peritonitis in an older patient. Rationale 3: Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Restlessness may be the only manifestation present. Rationale 4: Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Vague abdominal complaints may be the only manifestation present. Rationale 5: Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Decreased urinary output may be the only manifestation present. Global Rationale: Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Increased confusion and restlessness, decreased urinary output, and vague abdominal complaints may be the only manifestations present. Bradycardia is not a manifestation of peritonitis in an older patient.

A patient has been experiencing diarrhea for several days. What should the nurse assess to determine if adverse effects are occurring within this patient? Standard Text: Select all that apply. 1. skin turgor 2. muscle tone 3. serum potassium level 4. serum magnesium level 5. orthostatic blood pressure

Correct Answer: 1, 3, 4, 5 Rationale 1: The nurse should monitor skin turgor to identify and respond to possible adverse effects of diarrhea. Rationale 2: Muscle tone will not help identify possible adverse effects of diarrhea. Rationale 3: Water and electrolytes are lost in diarrheal stool. The nurse should monitor serum potassium level to help identify a possible adverse effect of diarrhea. Rationale 4: Water and electrolytes are lost in diarrheal stool. The nurse should monitor serum magnesium level to help identify a possible adverse effect of diarrhea. Rationale 5: Water is lost in the stool which can lead to dehydration. The nurse should monitor orthostatic vital signs to identify possible adverse effects of diarrhea. Global Rationale: Diarrhea can have devastating effects. Water and electrolytes are lost in diarrheal stool. This can lead to dehydration. With severe diarrhea, potassium and magnesium are lost, potentially leading to hypokalemia and hypomagnesemia Monitor orthostatic vital signs and skin turgor to identify and respond to possible adverse effects of diarrhea. Muscle tone will not help identify possible adverse effects of diarrhea.

The nurse is caring for a patient experiencing diabetic ketoacidosis. What actions should the nurse take when preparing this patient's insulin infusion? Standard Text: Select all that apply. 1. Attach insulin infusion to an intravenous pump. 2. Have one ampule of Dextrose 10% at the bedside. 3. Flush the tubing with the insulin solution before connecting. 4. Prepare an infusion of Dextrose 5% and 0.45% normal saline. 5. Discontinue the infusion after first dose of subcutaneous insulin.

Correct Answer: 1, 3, 5 Rationale 1: Insulin infusions are always administered using an intravenous pump. Rationale 2: Dextrose 50 should be kept at the bedside in the event of a hypoglycemic reaction. Rationale 3: Flush the intravenous tubing with 50 mL of insulin mixed with normal saline solution to saturate binding sites on the tubing before administering the insulin to the patient. Rationale 4: Insulin infusions are diluted in 0.9% or 0.45% saline. Rationale 5: Do not discontinue the intravenous infusion until subcutaneous administration of insulin is resumed. Global Rationale: Insulin infusions are always administered using an intravenous pump. Flush the intravenous tubing with 50 mL of insulin mixed with normal saline solution to saturate binding sites on the tubing before administering the insulin to the patient. Do not discontinue the intravenous infusion until subcutaneous administration of insulin is resumed. Dextrose 50 should be kept at the bedside in the event of a hypoglycemic reaction. Dextrose 50 should be kept at the bedside in the event of a hypoglycemic reaction.

A older patient recovering from total hip replacement surgery 8 hours ago has not been able to void spontaneously. Which actions should the nurse take to assist this patient? Standard Text: Select all that apply. 1. Increase fluids. 2. Turn onto the left side. 3. Palpate the bladder for distention. 4. Insert an indwelling urinary catheter. 5. Complete a bladder scan at the bedside.

Correct Answer: 1, 3, 5 Rationale 1: Promote fluid intake as allowed, monitoring intake and output. Rationale 2: Turning onto the left side will not promote urinary elimination. Rationale 3: Assess for bladder distention if the patient has not voided within 7 to 8 hours after surgery. Rationale 4: Urinary catheterizations should be avoided to reduce the potential for urinary tract infections and urethral trauma. Rationale 5: Use a portable ultrasound scanner to determine the amount of urine in the bladder. Global Rationale: The nurse should promote fluid intake as allowed, monitoring intake and output. Assess for bladder distention if the patient has not voided within 7 to 8 hours after surgery. Use a portable ultrasound scanner to determine the amount of urine in the bladder. Turning onto the left side will not promote urinary elimination. Urinary catheterizations should be avoided to reduce the potential for urinary tract infections and urethral trauma.

The nurse is caring for a patient with liver disease. What nutritional issues should the nurse expect this patient to exhibit? Standard Text: Select all that apply. 1. alteration in fat metabolism 2. increase in glucose utilization 3. reduction in fat-soluble vitamins 4. lower amount of bile being stored 5. change in production of red blood cells

Correct Answer: 1, 3, 5 Rationale 1: The liver synthesizes fats from carbohydrates and proteins to be used for energy or stored as adipose tissue. Rationale 2: The liver releases glucose during times of hypoglycemia. Rationale 3: The liver stores fat-soluble vitamins. Rationale 4: The liver secretes but does not store bile. Rationale 5: The liver stores iron as ferritin, which is released as needed for the production of red blood cells. Global Rationale: The liver synthesizes fats from carbohydrates and proteins to be used for energy or stored as adipose tissue, stores fat-soluble vitamins, and stores iron as ferritin, which is released as needed for the production of red blood cells. The liver releases glucose during times of hypoglycemia. The liver secretes but does not store bile.

A patient recovering from surgery for a small bowel obstruction is prescribed enteral feedings. Which actions should the nurse take to ensure the feedings are provided safely to the patient? Standard Text: Select all that apply. 1. Keep the head of the bed elevated 30 to 45 degrees. 2. Check for tube placement by flushing with normal saline. 3. Flush the tube with club soda after administering medications. 4. Measure external tube length after verifying placement with an x-ray. 5. Stop the tube feeding 10 minutes before changing the position to supine.

Correct Answer: 1, 4 Rationale 1: The head of the bed should be elevated 30 to 45 degrees. Rationale 2: Flushing with normal saline is not an appropriate method to check for tube placement. Rationale 3: Flushing the tube with club soda after medication administration is not appropriate. Rationale 4: The external tube length should be measured after placement has been verified with an x-ray. Rationale 5: Tube feedings should be stopped 30 to 60 minutes before placing the patient in the supine position. Global Rationale: The head of the bed should be elevated 30 to 45 degrees. The external tube length should be measured after placement has been verified with an x-ray. Flushing with normal saline is not an appropriate method to check for tube placement. Flushing the tube with club soda after medication administration is not appropriate. Tube feedings should be stopped 30 to 60 minutes before placing the patient in the supine position.

The nurse is planning instructions for a patient diagnosed with prostatitis. What should be included in these instructions? Standard Text: Select all that apply. 1. Increase fluid intake up to 3 liters per day. 2. Adhere to a daily bowel movement regime. 3. Remind the patient that the condition is not contagious. 4. Only take antibiotics when symptoms are present. 5. Withhold voiding for as long as possible.

Correct Answer: 1,2,3 Rationale 1: Teaching for the man with prostatitis focuses on symptom management. Men with acute and chronic bacterial prostatitis should be taught to increase fluid intake to around 3 liters daily and to void often. Rationale 2: Regular bowel movements help to ease pain associated with defecation. Rationale 3: Men with chronic prostatitis/chronic pelvic pain syndrome need to know that the condition is not contagious. Rationale 4: It is important to teach the man to finish the course of antibiotic therapy. Rationale 5: Men with acute and chronic bacterial prostatitis should be taught to increase fluid intake to around 3 liters daily and to void often. Global Rationale: Teaching for the man with prostatitis focuses on symptom management. Men with acute and chronic bacterial prostatitis should be taught to increase fluid intake to around 3 liters daily and to void often. Regular bowel movements help to ease pain associated with defecation. Men with chronic prostatitis/chronic pelvic pain syndrome need to know that the condition is not contagious. It is important to teach the man to finish the course of antibiotic therapy.

The nurse is preparing to discharge a patient after having outpatient surgery. Which criteria should the nurse use to determine whether the patient is eligible to be discharged? Standard Text: Select all that apply. 1. stable vital signs 2. no nausea or dizziness 3. pain controlled 4. adequate urine output 5. patient's expressed readiness to go home

Correct Answer: 1,2,3,4 Rationale 1: Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. Rationale 2: Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. Rationale 3: Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. Rationale 4: Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. Rationale 5: The patient's expressing readiness to go home is not a criterion that would make him or her eligible for discharge after outpatient surgery. Global Rationale Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. The patient's expressing readiness to go home is not a criterion that would make him or her eligible for discharge after outpatient surgery.

The nurse suspects that a patient recovering from surgery in the postanesthesia recovery unit (PACU) is developing malignant hyperthermia. Place these interventions in the order in which they should be performed. Standard Text: Click and drag the options below to move them up or down. Choice 1. Administer oxygen with a nonrebreather mask. Choice 2. Check IV access. Choice 3. Notify the anesthesia provider. Choice 4. Administer Dantrolene.

Correct Answer: 1,2,3,4 Rationale 1: As soon as the nurse suspects malignant hyperthermia is occurring, oxygen should be administered by nonrebreather mask. Oxygen is necessary to support tissues that rapidly become hypermetabolic. Rationale 2: The nurse should then be certain IV access is still patent and should notify the anesthesia provider. The IV access step is done first as it is quick and if not patent, can be restarted while the anesthesia provider responds. Rationale 3: The nurse should then be certain IV access is still patent and should notify the anesthesia provider. The IV access step is done first as it is quick and if not patent, can be restarted while the anesthesia provider responds. Rationale 4: Dantrolene is given IV, so a patent IV is essential. Global Rationale: As soon as the nurse suspects malignant hyperthermia is occurring, oxygen should be administered by nonrebreather mask. Oxygen is necessary to support tissues that rapidly become hypermetabolic. The nurse should then be certain IV access is still patent and should notify the anesthesia provider. The IV access step is done first as it is quick and if not patent, can be restarted while the anesthesia provider responds. Dantrolene is given IV, so a patent IV is essential.

The nurse is preparing to teach an older patient scheduled for surgery on performing diaphragmatic breathing. Place the steps of this breathing technique in the order in which the nurse should teach the patient. Standard Text: Click and drag the options below to move them up or down. Choice 1. Sit up straight in bed. Choice 2. Place your hands lightly on your abdomen. Choice 3. Breathe in deeply through your nose. Choice 4. Hold your breath for five seconds. Choice 5. Completely exhale through pursed lips.

Correct Answer: 1,2,3,4,5 Rationale 1: The patient should be placed in high or semi-Fowler's position. Rationale 2: The patient should be asked to place hands lightly on the abdomen. Rationale 3: The patient should be asked to take a deep breath in through the nose. Rationale 4: The patient should be asked to hold the breath to the count of five. Rationale 5: The patient should be asked to exhale completed through pursed lips. Global Rationale: The patient should be placed in high or semi-Fowler's position, asked to place hands lightly on the abdomen, asked to take a deep breath in through the nose, asked to hold the breath to the count of five, asked to exhale completed through pursed lips, then encouraged to repeat the exercise five times consecutively.

The nurse is teaching a patient scheduled for a colonoscopy. Which patient statement indicates a need for further teaching? 1. "The procedure will only take about an hour." 2. "It might be quite painful." 3. "I will likely have medications that will make me drowsy during the test." 4. "The physician might take tissue samples for further analysis."

Correct Answer: 2 Rationale 1: A colonoscopy takes approximately 1 hour to perform. Rationale 2: The colonoscopy is not painful, as patients are given sedating medications. Rationale 3: Patients undergoing colonoscopies are given sedating medications. Rationale 4: The physician may take a small tissue sample during the procedure. Global Rationale: The colonoscopy is not painful, as patients are given sedating medications. A colonoscopy takes approximately 1 hour to perform, and the physician may take a small tissue sample during the procedure.

The nurse is planning the diet for a patient scheduled to have a barium enema in 2 days. What kind of diet should the nurse plan for the next 48 hours? 1. general diet 2. full diet today, clear liquids tomorrow 3. full liquids today, nothing by mouth tomorrow 4. clear liquids both today and tomorrow

Correct Answer: 2 Rationale 1: A general diet would not adequately prepare the patient's bowel for the examination. Rationale 2: Prior to undergoing a barium enema, patients are asked to follow a clear liquid diet for 24 hours before the examination. Rationale 3: A full liquid diet would not adequately prepare the patient's bowel for the examination. Rationale 4: Clear liquids are needed for only 1 day before the examination. Global Rationale: Prior to undergoing a barium enema, patients are asked to follow a clear liquid diet for 24 hours before the examination. A general diet or full liquid diet would not adequately prepare the patient's bowel for the examination. Clear liquids are needed for only 1 day before the examination.

A patient with type 1 diabetes mellitus who had one episode of vomiting in the past 2 hours asks if the routine insulin injection should be taken. What action by the nurse is best at this time? 1. Contact the physician. 2. Explain the need to take the insulin. 3. Document the refusal and continue on with the planned care. 4. Check the patient's fasting serum glucose level.

Correct Answer: 2 Rationale 1: Contacting the physician at this time is premature. Rationale 2: Taking the insulin is the best course of action. The usual dose of insulin should be taken even if ill. Rationale 3: Documentation of the patient's refusal is premature, as efforts have not been made to discuss the need for the medication. Rationale 4: Checking the morning fasting serum glucose will not reflect the patient's current glucose level. Global Rationale: Taking the insulin is the best course of action. The usual dose of insulin should be taken even if ill. Contacting the physician at this time is premature. Documentation of the patient's refusal is premature, as efforts have not been made to discuss the need for the medication. Checking the morning fasting serum glucose will not reflect the patient's current glucose level.

The nurse has instructed the patient who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the patient understands the dietary changes if the patient selects which menu choices? 1. yogurt, crackers, and sweet tea 2. salad with chicken, whole wheat crackers 3. bacon, tomato, lettuce with mayonnaise, and a soft drink 4. tuna on white bread and green grapes

Correct Answer: 2 Rationale 1: Dairy increases diarrhea. Foods high in carbohydrates increase diarrhea. Rationale 2: Salad and whole wheat crackers may decrease diarrhea due to increased fiber. Rationale 3: Bacon, tomato, lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar, both contributing to diarrhea. Rationale 4: Foods high in carbohydrates increase diarrhea. Green grapes may increase diarrhea. Global Rationale: Bacon, tomato, lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar, both contributing to diarrhea. Salad and whole wheat crackers may decrease diarrhea due to increased fiber. Dairy increases diarrhea. Foods high in carbohydrates increase diarrhea. Green grapes may increase diarrhea.

The community nurse is teaching a group of members with type 1 or 2 diabetes mellitus who are planning to participate in an athletic triathlon. On which potential complication from this event should the nurse focus when teaching? 1. diabetic ketoacidosis 2. hypoglycemia 3. hyperosmolar hyperglycemic state 4. impaired glucose tolerance

Correct Answer: 2 Rationale 1: Diabetic ketoacidosis is not associated with exercise. Rationale 2: One reason for the development of severe hypoglycemia is too much exercise. Rationale 3: Hyperosmolar hyperglycemic state is not associated with exercise. Rationale 4: Exercise does not impact glucose tolerance. Global Rationale: One reason for the development of severe hypoglycemia is too much exercise. Diabetic ketoacidosis and hyperosmolar hyperglycemic state are not associated with exercise. Exercise does not impact glucose tolerance.

A patient with type 1 diabetes mellitus has difficulty swallowing and takes milk of magnesium every day for nausea and constipation. What should the nurse suspect is occurring with this patient? 1. age-related changes 2. visceral neuropathy 3. peripheral neuropathy 4. reaction to insulin injections

Correct Answer: 2 Rationale 1: Difficulty swallowing and nausea are not specifically attributed to aging. Rationale 2: The visceral neuropathies cause various manifestations, depending on the area of the autonomic nervous system involved. Gastrointestinal dysfunction caused by autonomic neuropathy causes changes in upper gastrointestinal motility, leading to dysphagia and nausea. Constipation is one of the most common gastrointestinal manifestations associated with diabetes, possibly a result of hypomotility of the bowel. Rationale 3: Peripheral neuropathies affect the sensory and motor function of the extremities. Rationale 4: Swallowing, nausea, and constipation are not adverse effects of insulin. Global Rationale: The visceral neuropathies cause various manifestations, depending on the area of the autonomic nervous system involved. Gastrointestinal dysfunction caused by autonomic neuropathy causes changes in upper gastrointestinal motility, leading to dysphagia and nausea. Constipation is one of the most common gastrointestinal manifestations associated with diabetes, possibly a result of hypo-motility of the bowel. Difficulty swallowing and nausea are not specifically attributed to aging. Peripheral neuropathies affect the sensory and motor function of the extremities. Swallowing, nausea, and constipation are not adverse effects of insulin.

The manager observes a graduate nurse teaching a 5-year-old patient with diabetes mellitus. The manager determines that content being instructed is appropriate when the nurse states, "Insulin acts like: 1. building blocks that help make protein into strong muscles." 2. a wagon that carries sugar into the cells of the body." 3. a mud pie that makes the blood vessels thick and sticky." 4. salty potato chips that make people feel very thirsty."

Correct Answer: 2 Rationale 1: Insulin does not make protein into muscle. Rationale 2: The manifestations of type 1 DM are the result of a lack of insulin to transport glucose across the cell membrane into the cells. Insulin acts as a transport mechanism, allowing insulin into the body's cells. The analogy of the wagon carrying sugar into the cells of the body is appropriate for teaching a 5-year-old child about insulin therapy. Rationale 3: Insulin does not make blood vessels thick and sticky. Rationale 4: A scarcity of insulin may lead to polydipsia. Global Rationale: The manifestations of type 1 DM are the result of a lack of insulin to transport glucose across the cell membrane into the cells. Insulin acts as a transport mechanism, allowing insulin into the body's cells. The analogy of the wagon carrying sugar into the cells of the body is appropriate for teaching a 5-year-old child about insulin therapy. Insulin does not make protein into muscle or make blood vessels thick and sticky. A scarcity of insulin may lead to polydipsia.

An 85-year-old patient is concerned about the loss of sensation of the need to defecate. How should the nurse respond? 1. "This is a normal part of aging due to slowed intestinal absorption." 2. "As you age, the rectum loses tone, and there is a reduced sensation of the need to defecate." 3. "Have you had a colonoscopy in the past year to evaluate the condition?" 4. "Reduced vitamin K absorption is associated with this condition."

Correct Answer: 2 Rationale 1: Intestinal absorption does slow with aging but is not responsible for the concerns raised by the patient. Rationale 2: The loss of muscle tone within the internal sphincter is responsible for the patient's clinical manifestations. Rationale 3: Asking about a colonoscopy does not address the patient's concern. Rationale 4: Vitamin K absorption is reduced with aging but is not responsible for the changes being reported. Global Rationale: The loss of muscle tone within the internal sphincter is responsible for the patient's clinical manifestations. Intestinal absorption slows and vitamin K absorption is reduced with aging, but neither is responsible for the concerns raised by the patient. Asking about a colonoscopy does not address the patient's concern.

The healthcare provider determines that a pregnant patient is at risk for having a baby with a weak neurological system. Which foods should the nurse counsel the patient to consume to address this potential problem? 1. potatoes, tomatoes, and sweet potatoes 2. dark green vegetables, lean beef, and eggs 3. liver, legumes, and citrus fruits 4. whole grains, yeast breads, and milk

Correct Answer: 2 Rationale 1: Potatoes, sweet potatoes, and tomatoes are sources of vitamin B6. Another nutrient is particularly beneficial for nervous system health. Rationale 2: Foods high in folic acid help in growth and development and nervous system health. These foods include dark green vegetables, lean beef, and eggs. Rationale 3: Not all of these food choices supply a nutrient that is particularly beneficial for nervous system health. Rationale 4: Not all of these food choices supply a nutrient that is particularly beneficial for nervous system health. Global Rationale: Foods high in folic acid help in growth and development and nervous system health. These foods include dark green vegetables, lean beef, eggs, liver, and whole grains. The other food choices are good sources of other nutrients.

A patient with Crohn disease is recovering from a bowel resection. What does the nurse realize will most likely occur in this patient? 1. The patient will never have another recurrence of the disease. 2. The patient will possibly have a recurrence in another portion of the bowel. 3. The patient will develop ulcerative colitis. 4. The patient will experience intestinal strictures.

Correct Answer: 2 Rationale 1: The disease process for Crohn disease tends to recur in other areas following removal of affected bowel segments. Rationale 2: The disease process for Crohn disease tends to recur in other areas following removal of affected bowel segments. Rationale 3: The processes involving Crohn disease and ulcerative colitis are different. Rationale 4: There is no increased risk for the development of intestinal strictures. Global Rationale: The disease process for Crohn disease tends to recur in other areas following removal of affected bowel segments. The processes involving Crohn disease and ulcerative colitis are different. There is no increased risk for the development of intestinal strictures.

The nurse is caring for a patient with a fecal impaction. Which type of enemas will best assist in relieving the fecal impaction? 1. normal saline 2. oil retention 3. tap water 4. soap suds

Correct Answer: 2 Rationale 1: The normal saline enema is used to soften the fecal mass and promote defecation in the least irritating manner. Rationale 2: Oil retention enemas instill mineral or vegetable oil into the bowel to soften the fecal mass. The instilled oil is retained overnight or for several hours before evacuation. This is the most suitable choice for the patient with fecal impaction. Rationale 3: Tap water enemas soften the bowel and irritate the bowel to promote defecation. Rationale 4: Soap suds provide an increased means to irritate the bowel to promote a bowel movement. Global Rationale: Oil retention enemas instill mineral or vegetable oil into the bowel to soften the fecal mass. The instilled oil is retained overnight or for several hours before evacuation. This is the most suitable choice for the patient with fecal impaction. The normal saline enema is used to soften the fecal mass and promote defecation in the least irritating manner. Tap water enemas soften the bowel and irritate the bowel to promote defecation. Soap suds provide an increased means to irritate the bowel to promote a bowel movement.

A patient with no previous history of diabetes mellitus has ketones in the urine. Which question should the nurse ask this patient? 1. "What did you eat for breakfast and lunch today?" 2. "Can you please describe any weight loss strategies you've been using?" 3. "Have you donated blood recently?" 4. "Have you ever been told you have albumin in your urine?"

Correct Answer: 2 Rationale 1: The patient's food choices for breakfast and lunch will not address the problem of ketonuria. Rationale 2: The cellular use of fats for fuel results in ketosis. Rationale 3: Donation of blood is not related to ketonuria. Rationale 4: Albuminuria is a complication of uncontrolled diabetes mellitus. Global Rationale: The cellular use of fats for fuel results in ketosis. The patient's food choices for breakfast and lunch will not address the problem of ketonuria. Albuminuria is a complication of uncontrolled diabetes mellitus. Donation of blood is not related to ketonuria.

The nurse reviews the functions of the gastrointestinal system for a patient with celiac disease. Which statement by the patient indicates that teaching has been effective? 1. "The stomach begins the process of absorbing nutrients." 2. "The stomach turns food into liquid so it can be digested." 3. "The stomach begins the digestion of carbohydrates." 4. "The stomach secretes sulfuric acid."

Correct Answer: 2 Rationale 1: The process of absorption begins in the small intestine. Rationale 2: The stomach mixes the food with gastric juices into a thick fluid called chyme. Rationale 3: The start of carbohydrate digestion occurs in the mouth. Rationale 4: The stomach secretes hydrochloride, not sulfuric acid. Global Rationale: The stomach mixes the food with gastric juices into a thick fluid called chyme. The process of absorption begins in the small intestine. The start of carbohydrate digestion occurs in the mouth. The stomach secretes hydrochloride, not sulfuric acid.

A patient at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of the condition. Which response by the nurse is most accurate? 1. "The amount of foods taken in require more insulin to adequately metabolize them, resulting in diabetes." 2. "Excess body weight impairs the body's release of insulin." 3. "Thin people are less likely to become diabetic." 4. "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin."

Correct Answer: 2 Rationale 1: This is not a true statement. Rationale 2: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. Rationale 3: While obesity is a risk factor for the development of diabetes, this does not answer the patient's question. Rationale 4: Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin. Global Rationale: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food ingested does not mean that diabetes will develop because more insulin is needed to process the food eaten. While obesity is a risk factor for the development of diabetes, this does not answer the patient's question. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin.

The nurse is teaching a group of older adults about expected changes in dental health related to aging. Which statement by one of the older adults indicates that teaching has been effective? 1. "Tooth enamel is more pliable." 2. "The loss of bone density with aging results in tooth decay and breakage." 3. "Increases in saliva production increase exposure of the tooth's enamel to corrosive agents." 4. "Metabolic changes in aging contribute to dental destruction."

Correct Answer: 2 Rationale 1: Tooth enamel becomes more brittle with aging. Rationale 2: Changes in bone health related to aging increase the risk of tooth loss and teeth fractures. Rationale 3: Saliva production decreases with aging. Rationale 4: Metabolic changes do not cause dental decay or fractures. Global Rationale: Changes in bone health related to aging increase the risk of tooth loss and teeth fractures. Tooth enamel becomes more brittle with aging. Saliva production decreases with aging. Metabolic changes do not cause dental decay or fractures.

After learning that a patient has abdominal pain that occurs at least 3 days per month over the last 3 months, the nurse suspects that a patient is experiencing irritable bowel syndrome. What findings did the nurse use to make this clinical decision? Standard Text: Select all that apply. 1. abdominal pain that is relieved by eating 2. abdominal pain that improves with defecation 3. abdominal pain that is associated with a change in stool form 4. abdominal pain that is associated with a change in bowel frequency 5. abdominal pain that improves with physical activity and limiting food intake

Correct Answer: 2, 3, 4 Rationale 1: Abdominal pain that is relieved by eating is not a characteristic of irritable bowel syndrome. Rationale 2: Improvement of abdominal pain with defection is one characteristic used to diagnose irritable bowel syndrome in a patient who has had abdominal pain or discomfort 3 days per month in the past 3 months. Rationale 3: A change in stool form is one characteristic used to diagnose irritable bowel syndrome in a patient who has had abdominal pain or discomfort 3 days per month in the past 3 months. Rationale 4: A change in bowel frequency is one characteristic used to diagnose irritable bowel syndrome in a patient who has had abdominal pain or discomfort 3 days per month in the past 3 months. Rationale 5: Abdominal pain that improves with physical activity and limiting food intake is not characteristic of irritable bowel syndrome. Global Rationale: Irritable bowel syndrome is diagnosed based on the presence of abdominal pain or discomfort at least 3 days per month in the past 3 months that has at least two of the following characteristics: (1) improved with defecation, (2) associated with a change in frequency of elimination, (3) or associated with a change in stool form. Abdominal pain that is relieved by eating is not a characteristic of irritable bowel syndrome. Abdominal pain that improves with physical activity and limiting food intake is not characteristic of irritable bowel syndrome.

The nurse notes that a patient with type 2 diabetes mellitus is not prescribed aspirin 81 mg as recommended for the prevention of cardiovascular complications. What information in the patient's health history should the nurse use to understand why this medication has not been prescribed for the patient? Standard Text: Select all that apply. 1. Patient receives a vitamin B12 injection every month. 2. Patient admitted for gastrointestinal bleeding 3 months ago. 3. Patient prescribed warfarin (Coumadin) 2.5 mg by mouth every day. 4. Patient treated for chronic alcoholism and liver cirrhosis the past year. 5. Patient develops a rash and urticaria when taking medications with sulfa.

Correct Answer: 2, 3, 4 Rationale 1: Aspirin therapy is not contraindicated in individuals receiving vitamin B12 injections. Rationale 2: Aspirin therapy is contraindicated in patients with recent gastrointestinal bleeding. Rationale 3: Aspirin therapy is contraindicated in patients on anticoagulation therapy. Rationale 4: Aspirin therapy is contraindicated in patients with active liver disease. Rationale 5: Aspirin therapy is not contraindicated in patients with an allergy to sulfa medications. Global Rationale: Cardiovascular disease is the most common cause of morbidity and mortality in people with diabetes mellitus. Aspirin therapy is contraindicated for patients with recent gastrointestinal bleeding, anticoagulation therapy, or active liver disease. It is not contraindicated in patients receiving vitamin B12 injections or those with an allergy to sulfa medications.

The nurse is reviewing the contents of a nutritional supplement that a 32-year-old female patient takes each day. Which minerals in this supplement adhere to the recommended daily intake amounts? Standard Text: Select all that apply. 1. iron 8 mg 2. zinc 8 mg 3. calcium 1000 mg 4. phosphorus 700 mg 5. magnesium 420 mg

Correct Answer: 2, 3, 4 Rationale 1: Eight milligrams of iron is the recommended daily amount for males; for females it is 18 mg. Rationale 2: Eight milligrams of zinc is the recommended daily amount for females. Rationale 3: One thousand milligrams of calcium is the recommended daily amount for females before menopause. Rationale 4: Seven hundred milligrams of phosphorus is the recommended daily amount for females. Rationale 5: Four hundred twenty milligrams of magnesium is the recommended daily amount for males. Global Rationale: Eight milligrams of zinc and 700 mg of phosphorus are the recommended daily amounts for females. One thousand milligrams of calcium is the recommended daily amount of females before menopause. Eight milligrams of iron and 420 mg of magnesium are the recommended daily amount for males.

The nurse is identifying patients at risk for needing insulin. Which patients should the nurse identify as potentially needing insulin to maintain a normal blood glucose level? Standard Text: Select all that apply. 1. patients who are fasting or malnourished 2. patients with type 2 diabetes who are diagnosed with an infection 3. patients with type 2 diabetes who are undergoing surgical procedures 4. patients with gestational diabetes 5. patients receiving total parenteral nutrition

Correct Answer: 2, 3, 4 Rationale 1: Fasting and malnourished patients are not at increased risk for insulin and are often hypoglycemic. Rationale 2: Insulin may be necessary for patients with diabetes mellitus who are experiencing an infection. Rationale 3: Insulin may be necessary for patients with diabetes mellitus who are scheduled for surgery. Rationale 4: Insulin may be necessary for patients with gestational diabetes mellitus. Rationale 5: Patients receiving total parenteral nutrition are not identified as potentially needing insulin. Global Rationale: Insulin may be necessary for patients with diabetes mellitus who are experiencing an infection or surgery or have gestational diabetes mellitus. Insulin is not prescribed for patients who are malnourished or are receiving total parenteral nutrition.

A patient tells the nurse, "I am going to eat an all-fruit diet. Nothing is more healthful than fruit. Do you think this is a good idea?" How should the nurse respond? Standard Text: Select all that apply. 1. "Fruit is natural and a good source of carbohydrates." 2. "Fruit is a good source of carbohydrates but a poor source of fats and protein." 3. "Fruit supplies many important vitamins but is a relatively poor source of minerals." 4. "Incorporating fruit with complete sources of protein and healthful fats provides complete nutrition." 5. "A fruit-based diet will reduce your risk of developing diabetes mellitus."

Correct Answer: 2, 3, 4 Rationale 1: Fruit is a good source of carbohydrates, but a patient who eats only fruit will likely not be able to ingest enough protein and fat to maintain health. Rationale 2: Fruit is a good source of carbohydrates, but a patient who eats only fruit will likely not be able to ingest enough protein and fat to maintain health. Rationale 3: Fruit is a good source of vitamins but does not supply minerals in the range and quantity needed for good health. The best sources of minerals are vegetables, legumes, milk, and some meats. Rationale 4: Incorporating fruit into a diet that includes healthful proteins and fats is the best way to assure adequate nutrition. Rationale 5: There is no evidence that a fruit-based diet protects patients from diabetes mellitus. Global Rationale: Fruit is a good source of carbohydrates, but a patient who eats only fruit will likely not be able to ingest enough protein and fat to maintain health. Fruit is a good source of vitamins but does not supply minerals in the range and quantity needed for good health. The best sources of minerals are vegetables, legumes, milk, and some meats. Incorporating fruit into a diet that includes healthful proteins and fats is the best way to assure adequate nutrition. There is no evidence that a fruit-based diet protects patients from diabetes mellitus.

A patient tells the nurse, "I am going to eat an all-fruit diet. Nothing is more healthful than fruit. Do you think this is a good idea?" How should the nurse respond? Standard Text: Select all that apply. 1. "Fruit is natural and a good source of carbohydrates." 2. "Fruit is a good source of carbohydrates but a poor source of fats and protein." 3. "Fruit supplies many important vitamins but is a relatively poor source of minerals." 4. "Incorporating fruit with complete sources of protein and healthful fats provides complete nutrition." 5. "A fruit-based diet will reduce your risk of developing diabetes mellitus."

Correct Answer: 2, 3, 4 Rationale 1: Fruit is a good source of carbohydrates, but a patient who eats only fruit will likely not be able to ingest enough protein and fat to maintain health. Rationale 2: Fruit is a good source of carbohydrates, but a patient who eats only fruit will likely not be able to ingest enough protein and fat to maintain health. Rationale 3: Fruit is a good source of vitamins but does not supply minerals in the range and quantity needed for good health. The best sources of minerals are vegetables, legumes, milk, and some meats. Rationale 4: Incorporating fruit into a diet that includes healthful proteins and fats is the best way to assure adequate nutrition. Rationale 5: There is no evidence that a fruit-based diet protects patients from diabetes mellitus. Global Rationale: Fruit is a good source of carbohydrates, but a patient who eats only fruit will likely not be able to ingest enough protein and fat to maintain health. Fruit is a good source of vitamins but does not supply minerals in the range and quantity needed for good health. The best sources of minerals are vegetables, legumes, milk, and some meats. Incorporating fruit into a diet that includes healthful proteins and fats is the best way to assure adequate nutrition. There is no evidence that a fruit-based diet protects patients from diabetes mellitus.

A patient with a 2-month history of diarrhea is prescribed a diagnostic test that uses a narrow x-ray beam to provide a 360-degree view of abdominal structures. For which diagnostic test should the nurse prepare the patient? 1. liver biopsy 2. cholecystography 3. gastric emptying study 4. computed tomography

Correct Answer: 4 Rationale 1: A liver biopsy takes a piece of the liver to assess for the presence of pathology. Rationale 2: A cholecystography assesses for gallbladder stones or tumors. Rationale 3: Gastric emptying studies provide information about the body's ability to empty the stomach. Rationale 4: The computed tomography (CT) scan produces a narrow x-ray beam that examines the body sections from 360 degrees. Global Rationale: The computed tomography (CT) scan produces a narrow x-ray beam that examines the body sections from 360 degrees. A liver biopsy takes a piece of the liver to assess for the presence of pathology. A cholecystography assesses for gallbladder stones or tumors. Gastric emptying studies provide information about the body's ability to empty the stomach.

The nurse is assessing a patient with type 2 diabetes mellitus. What questions should the nurse ask to determine the patient's risk for a lower extremity amputation? Standard Text: Select all that apply. 1. "Do you use insulin or oral hypoglycemic agents?" 2. "What were your glycosylated hemoglobin values over the past year?" 3. "Do you have any problems with your eyes related to diabetes?" 4. "Do you have any problems with your kidney related to diabetes?" 5. "When were you first diagnosed with diabetes mellitus?"

Correct Answer: 2, 3, 4 Rationale 1: The treatment of the diabetes is not a risk factor. Rationale 2: People with diabetes mellitis, especially those who are not meeting recommended glycemic goals, are at high risk for amputation of a lower extremity. Rationale 3: The high incidence of foot problems and amputations in people with diabetes mellitus is the result of angiopathy. Rationale 4: The high incidence of foot problems and amputations in people with diabetes mellitus is the result of angiopathy Rationale 5: Age of diagnosis has no influence on the patient's risk of needing an amputation in the future. Global Rationale: The high incidence of foot problems and amputations in people with diabetes mellitus is the result of angiopathy, neuropathy, and infection. People with diabetes mellitus, especially those who not meeting recommended glycemic goals, are at high risk for amputation of a lower extremity. Age of diagnosis has no influence on the patient's risk of needing an amputation in the future.

The nurse teaches a patient with Crohn disease about surgery to create a continent ileostomy. Which patient statements indicate that teaching has been effective? Standard Text: Select all that apply. 1. "I will need to change my diet." 2. "Stool will collect in an internal pouch." 3. "Stool will not leak through the stoma." 4. "I will use a catheter to drain the stool." 5. "I will need to change the bag every day."

Correct Answer: 2, 3, 4 Rationale 1: There is no evidence that the patient will need to change the diet for a continent ileostomy. Rationale 2: In a continent ileostomy an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. Stool collects in the internal pouch. Rationale 3: In a continent ileostomy an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. A nipple valve prevents stool from leaking through the stoma. Rationale 4: In a continent ileostomy an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. A catheter is inserted into the pouch to drain the stool. Rationale 5: An ostomy bag does not need to be worn with a continent ileostomy. Global Rationale: In a continent ileostomy an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. Stool collects in the internal pouch; the nipple valve prevents it from leaking through the stoma. A catheter is inserted into the pouch to drain the stool. An ostomy bag does not need to be worn with a continent ileostomy.

The nurse is reviewing the actions that a patient with type 1 diabetes mellitus should take if mild hypoglycemia is experienced. What should the nurse include in this teaching? Standard Text: Select all that apply. 1. Test blood glucose 30 minutes after reaching 70 mg/dL. 2. Ingest 4 ounces of fruit juice when blood glucose is below 70 mg/dL. 3. Measure blood glucose 15 minutes after ingesting a carbohydrate source. 4. Add table sugar to 8 ounces of fruit juice when blood glucose is below 70 mg/dL. 5. Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15 minutes.

Correct Answer: 2, 3, 5 Rationale 1: Blood glucose should be tested 1 hour after the blood glucose has reached ≥ 70 mg/dL because blood glucose levels may start to fall again after 1 hour. Rationale 2: When mild hypoglycemia occurs, immediate treatment is necessary. People experiencing hypoglycemia should take about 15 g of a rapid-acting sugar. This amount of sugar is found in 1/2 cup (4 ounces) of fruit juice. Rationale 3: After eating a carbohydrate source, the patient should wait 15 minutes and then monitor blood glucose level. Rationale 4: Adding sugar to the fruit sugar already in the juice could cause a rapid rise in blood glucose, with persistent hyperglycemia. Rationale 5: If the blood glucose remains low after 15 minutes, eat another 15 grams of carbohydrate. Global Rationale: When mild hypoglycemia occurs, immediate treatment is necessary. People experiencing hypoglycemia should take about 15 g of a rapid-acting sugar. This amount of sugar is found in 1/2 cup (4 ounces) of fruit juice. After eating a carbohydrate source the patient should wait 15 minutes and then monitor blood glucose level. If the blood glucose remains low after 15 minutes, eat another 15 grams of carbohydrate. Blood glucose should be tested 1 hour after the blood glucose has reached ≥ 70 mg/dL because blood glucose levels may start to fall again after 1 hour. Adding sugar to the fruit sugar already in the juice could cause a rapid rise in blood glucose, with persistent hyperglycemia.

The nurse instructs a patient with irritable bowel syndrome about the newly prescribed medication sulfasalazine (Azulfidine). Which patient statements indicate that no additional teaching about this medication is required? Standard Text: Select all that apply. 1. "I should take this medication before meals." 2. "I should use sunscreen while taking this medication." 3. "I should not take any aspirin while taking this medication." 4. "I should restrict my fluid intake while taking this medication." 5. "I should not take any vitamin C while taking this medication."

Correct Answer: 2, 3, 5 Rationale 1: The patient should be instructed to take this medication after meals to decrease gastric distress. Rationale 2: This medication increases sensitivity to the sun, so sunscreen should be used. Rationale 3: This medication should not be taken with aspirin. Rationale 4: The patient should be instructed to drink at least 2 quarts of fluid each day to reduce the risk of kidney damage. Rationale 5: This medication should not be taken with vitamin C. Global Rationale: This medication increases sensitivity to the sun so sunscreen should be used. This medication should not be taken with aspirin or vitamin C. The patient should be instructed to take this medication after meals to decrease gastric distress. The patient should be instructed to drink at least 2 quarts of fluid each day to reduce the risk of kidney damage.

An older patient is diagnosed with severe acute diverticulitis. What treatment should the nurse expect to be prescribed for this patient? Standard Text: Select all that apply. 1. complete bed rest 2. intravenous fluids 3. nothing by mouth 4. aspirin or NSAIDs for pain 5. intravenous cefoxitin (Mefoxin)

Correct Answer: 2, 3, 5 Rationale 1: There is no need for this patient to be on complete bed rest. Rationale 2: Severe, acute attacks of diverticulitis often necessitate hospitalization and treatment with intravenous fluids. Rationale 3: The patient initially may be NPO. Rationale 4: There is no specific recommendation for pain medications for acute diverticulitis. Rationale 5: Severe, acute attacks of diverticulitis often necessitate hospitalization and treatment with a second-generation cephalosporin such as cefoxitin (Mefoxin). Global Rationale: Severe, acute attacks of diverticulitis often necessitate hospitalization and treatment with intravenous fluids and antibiotics such as cefoxitin (Mefoxin) a second-generation cephalosporin. The patient initially may be NPO. There is no need for the patient to be on complete bed rest. There is no specific recommendation for pain medications for acute diverticulitis.

The nurse is preparing to examine a patient's abdomen. In which order should the nurse complete this examination? Standard Text: Click and drag the options below to move them up or down. Choice 1. percussion Choice 2. inspection Choice 3. palpation Choice 4. auscultation

Correct Answer: 2, 4, 1, 3 Rationale 1: Percussion in each quadrant is the third step. Rationale 2: The sequencing of the assessment is important to obtain the maximum amount of information. Before touching the abdomen, the nurse should first inspect it for symmetry, contour, and general appearance. Rationale 3: Palpation is the final step. It might result in discomfort, and should be completed last. Rationale 4: Second, each quadrant of the abdomen should be auscultated for the presence of bowel sounds. Global Rationale: The sequencing of the assessment is important to obtain the maximum amount of information. Before touching the abdomen, the nurse should first inspect it for symmetry, contour, and general appearance. Next, each quadrant of the abdomen should be auscultated for the presence of bowel sounds. Percussion in each quadrant is the third step. Palpation is the final step. It might result in discomfort, and should be completed last.

The nurse is teaching a group of 6-year-olds about the digestive system. Which statements by the children indicate that teaching has been effective? Standard Text: Select all that apply. 1. "Grown-ups have 28 teeth." 2. "Spit helps you taste your food." 3. "Food starts breaking down in the stomach." 4. "It's like a tube. Food I need goes in one end. What I don't need comes out the other." 5. "The food moves through the tube in waves, like a snake eating a mouse."

Correct Answer: 2, 4, 5 Rationale 1: Adults have 32 teeth. Rationale 2: Saliva begins the process of breaking down food and does help one taste food. Rationale 3: Food begins to digest in the mouth due to the action of enzymes such as amylase. Rationale 4: The GI tract is like a tube in which food enters one end and waste products exit the other end. Rationale 5: Food is propelled through the tube in peristaltic waves, which a child might equate to the motion of a snake eating a mouse. Global Rationale: Saliva begins the process of breaking down food and does help one taste food; the GI tract is like a tube in which food enters one end and waste products exit the other end; and food is propelled through the tube in peristaltic waves, which a child might equate to the motion of a snake eating a mouse. Adults have 32 teeth, and food begins to digest in the mouth due to the action of enzymes such as amylase.

A patient with Crohn disease is instructed to ingest a low-residue diet. Which dietary choices indicate that the patient needs additional information about this eating plan? Standard Text: Select all that apply. 1. corn flakes 2. poppy seed roll 3. tapioca pudding 4. steamed broccoli 5. whole grain bread

Correct Answer: 2, 4, 5 Rationale 1: Cereals made from refined flours such as corn flakes are permitted on a low-residue diet. Rationale 2: Raw or cooked seeds should be avoided on a low-residue diet. Rationale 3: Desserts such as tapioca are permitted on a low-residue diet. Rationale 4: Cooked vegetables are to be avoided on a low-residue diet. Rationale 5: Whole grain breads are to be avoided on a low-residue diet. Global Rationale: Raw or cooked seeds, cooked vegetables, and whole grain breads should be avoided on a low-residue diet. Cereals such as corn flakes and desserts such as tapioca are permitted on a low-residue diet.

A patient receiving long-term antibiotic therapy for an infected joint replacement begins to experience diarrhea, abdominal cramps, malaise, fever, and anorexia. What interventions should the nurse prepare to administer to this patient? Standard Text: Select all that apply. 1. Maintain nothing by mouth status. 2. Prepare to administer metronidazole. 3. Insert a nasogastric tube for feedings. 4. Collect all urine for a 24-hour specimen. 5. Discontinue the currently prescribed antibiotic.

Correct Answer: 2, 5 Rationale 1: Nothing by mouth status is not a treatment for Clostridium difficile. Rationale 2: The patient is demonstrating manifestations of Clostridium difficile. Treatment with metronidazole is specific for C. difficile. Rationale 3: A nasogastric tube for feedings is not a treatment for Clostridium difficile. Rationale 4: Collecting 24-hour urine is not indicated for Clostridium difficile. Rationale 5: The patient is demonstrating manifestations of Clostridium difficile. Stopping the antibiotic causing the diarrhea is the first step in the treatment of this health problem. Global Rationale: The patient is demonstrating manifestations of Clostridium difficile. Stopping the antibiotic causing the diarrhea is the first step in the treatment of this health problem. Treatment with metronidazole is specific for C. difficile. Nothing by mouth, insertion of a nasogastric tube, and 24-hour urine are not treatments for Clostridium difficile.

The nurse is reviewing data within a patient's health history. Which factor in the history should the nurse recognize as related to the development of familial adenomatous polyposis? 1. The patient eats a diet high in red meat. 2. The patient has never had the recommended screening colonoscopy. 3. The patient's grandfather died of colon cancer. 4. The patient had a basal cell skin cancer removed 2 year ago.

Correct Answer: 3 Rationale 1: A high intake of red meat does not predispose the patient to familial adenomatous polyposis. Rationale 2: Not completing a screening colonoscopy does not predispose the patient to familial adenomatous polyposis. Rationale 3: Familial adenomatous polyposis (FAP) is an inherited disorder characterized by progressive development of colorectal adenomas. Unless treated, colorectal cancer inevitably occurs by the fourth or fifth decade of life. Rationale 4: Basal cell skin cancer does not predispose the patient to familial adenomatous polyposis. Global Rationale: Familial adenomatous polyposis (FAP) is an inherited disorder characterized by progressive development of colorectal adenomas. Unless treated, colorectal cancer inevitably occurs by the fourth or fifth decade of life. Red meat, not having colonoscopies, and having basal cell skin cancer do not predispose the patient to this disorder.

The nurse is caring for a patient with type 1 diabetes mellitus. Which patient statement requires immediate intervention by the nurse? 1. "I am allergic to eggs." 2. "I will take my lispro insulin 15 minutes before I eat breakfast." 3. "I won't mix my cloudy regular insulin with other insulins." 4. "I will not use insulin detemir in my insulin pump."

Correct Answer: 3 Rationale 1: Allergies to eggs do not require immediate nursing intervention. Rationale 2: Lispro insulin is properly administered 15 minutes prior to a meal. Rationale 3: Regular insulin is clear in appearance. The patient may not understand insulin therapy or that regular insulin may be contaminated. Rationale 4: Insulin detemir is not used in insulin pumps. Global Rationale: Regular insulin is clear in appearance. The patient may not understand insulin therapy or the regular insulin may be contaminated. Allergy to eggs does not require immediate nursing intervention. Lispro insulin is properly administered 15 minutes prior to a meal. Insulin detemir is not used in insulin pumps.

An older patient with type 2 diabetes mellitus is upset because family members do not believe the patient has an illness and resist helping with diet and activity modifications. What should the nurse suggest to help this patient? 1. Limit discussions about the illness with family members. 2. Store health-related items away from common family areas in the home. 3. Invite family to participate in a support group. 4. Explain the risk for family also to develop the illness.

Correct Answer: 3 Rationale 1: Chronic illness affects all dimensions of an individual's life, as well as the lives of family members and significant others. Limiting discussions about the illness will not help them understand the impact of diabetes has on the patient. Rationale 2: Storing health-related items away from common family areas in the home strengthens denial of the health problem. Rationale 3: Chronic illness affects all dimensions of an individual's life, as well as the lives of family members and significant others. Sharing with others who have similar problems provides opportunities for mutual support and problem solving. Using available resources improves the ability to cope. Rationale 4: There is no evidence to suggest that family members are at risk for developing diabetes. Global Rationale: Chronic illness affects all dimensions of an individual's life, as well as the lives of family members and significant others. Sharing with others who have similar problems provides opportunities for mutual support and problem solving. Using available resources improves the ability to cope. Limiting discussions about the illness will not help them understand the impact of diabetes has on the patient. Storing health-related items away from common family areas in the home strengthens denial of the health problem. There is no evidence to suggest that family members are at risk for developing diabetes.

A patient is recovering from a sigmoidoscopy with removal of a benign polyp. What should the nurse include in this patient's discharge instructions? 1. Contact the primary healthcare provider if experiencing large amounts of flatus. 2. Avoid heavy lifting for 2 weeks after procedure. 3. Report abdominal pain, fever, or chills. 4. Beginning the evening after the procedure, eat foods high in fiber.

Correct Answer: 3 Rationale 1: Flatus after the procedure is anticipated and does not warrant contacting the physician. Rationale 2: Heavy lifting is to be avoided for only 1 week. Rationale 3: The patient who has had a sigmoidoscopy must report potential complications such as abdominal pain, fever, or chills. Rationale 4: High-fiber foods are to be avoided for 1-2 days. Global Rationale: The patient who has had a sigmoidoscopy must report potential complications such as abdominal pain, fever, or chills. Flatus after the procedure is anticipated and does not warrant contacting the physician. Heavy lifting is to be avoided for only 1 week. High-fiber foods are to be avoided for 1-2 days.

A patient is scheduled for a liver biopsy. What should the nurse include in this patient's preprocedure teaching? 1. Abstain from all food and fluids for at least 8 hours prior to the procedure. 2. Consume a low-fat diet 1-3 days prior to the procedure. 3. Complete blood tests prior to the procedure. 4. Restrict activity for 4-6 weeks after the procedure.

Correct Answer: 3 Rationale 1: Food and fluids are withheld for 4-6 hours before the procedure. Rationale 2: Dietary changes before the test are not indicated. Rationale 3: The patient will require prothrombin time and platelet count prior to the procedure. Rationale 4: Activity will be limited for 1-2 weeks. Global Rationale: The patient will require prothrombin time and platelet count prior to the procedure. Food and fluids are withheld for 4-6 hours before the procedure. Dietary changes before the test are not indicated. Activity will be limited for 1-2 weeks.

The nurse is planning care for a patient with end-stage renal disease who has a moderate daily protein restriction. Which meal choice would be most appropriate for this patient? 1. peanut butter sandwich and apple slices 2. bean soup and spinach salad 3. salmon fillet and asparagus 4. fried rice and fresh strawberries

Correct Answer: 3 Rationale 1: Legumes such as peanuts contain incomplete proteins. These sources are low in or lack one or more of the amino acids essential for building complete proteins. Rationale 2: Legumes and vegetables contain incomplete proteins. These sources are low in or lack one or more of the amino acids essential for building complete proteins. Rationale 3: Because the patient's protein intake is limited, it is important that the protein choices are complete proteins. Complete proteins are found in animal products such as eggs, milk, milk products, and meat. They contain the greatest amount of amino acids and meet the body's requirements for tissue growth and maintenance. Rationale 4: Grains and vegetables contain incomplete proteins. These sources are low in or lack one or more of the amino acids essential for building complete proteins. Global Rationale: Because the patient's protein intake is limited, it is important that the protein choices are complete proteins. Complete proteins are found in animal products such as eggs, milk, milk products, and meat. They contain the greatest amount of amino acids and meet the body's requirements for tissue growth and maintenance. Incomplete proteins are found in legumes, nuts, grains, cereals, and vegetables. These sources are low in or lack one or more of the amino acids essential for building complete proteins.

A patient with diabetes mellitus has albuminuria, hypertension, and edema. What should the nurse expect to be prescribed for this patient? 1. Restrict activity. 2. Increase salt intake. 3. Review weight loss strategies. 4. Provide antibiotic therapy as prescribed.

Correct Answer: 3 Rationale 1: Management of diabetic nephropathy includes control of hypertension with exercise. Rationale 2: Management of diabetic nephropathy includes control of hypertension with reduced salt intake. Rationale 3: Management of diabetic nephropathy includes control of hypertension with weight loss. Rationale 4: Management of diabetic nephropathy includes control of hypertension with ACE inhibitors. Global Rationale: Management of diabetic nephropathy includes control of hypertension with ACE inhibitors, weight loss, reduced salt intake, and exercise. Antibiotics are not used to control diabetic nephropathy.

A nurse is teaching a group of patients about the prevalence of type 2 diabetes in older adults. The nurse knows teaching has been effective when a patient states, "Statistically, in a group of 100 older adults in the United States, approximately: 1. 10 will have type 2 diabetes." 2. 17 will have type 2 diabetes." 3. 27 will have type 2 diabetes." 4. 33 will have type 2 diabetes."

Correct Answer: 3 Rationale 1: More than 10 will have type 2 diabetes. Rationale 2: More than 17 will have type 2 diabetes. Rationale 3: The National Institute of Diabetes and Digestive and Kidney Diseases estimates that 26.9% of the U.S. population over the age of 65 have DM. Rationale 4: Fewer than 33 will have type 2 diabetes. Global Rationale: The National Institute of Diabetes and Digestive and Kidney Diseases estimates that 26.9% of the U.S. population over the age of 65 have DM.

The nurse is reviewing data collected for a patient's health history. Which factor should the nurse identify as increasing the patient's risk of developing type 2 diabetes mellitus? 1. body mass index of 23 kg/m2 2. blood pressure of 120/70 3. physical inactivity 4. low waist-to-hip ratio

Correct Answer: 3 Rationale 1: Patients with obesity, defined as being at least 20% over desired body weight or having a body mass index (BMI) of at least 27 kg/m2 are at major risk for type 2 DM. A patient with a body mass index of 23 kg/m2 is the patient most at risk for type 2 DM. Rationale 2: A blood pressure of 120/70 is normal and carries no increased risk for type 2 DM. Rationale 3: Physical inactivity is a major risk factor for type 2 DM. Rationale 4: A high waist-to-hip ratio is a risk factor for type 2 DM. A low waist-to-hip ratio carries no increased risk of the disease. Global Rationale: Physical inactivity is a major risk factor for type 2 DM. Patients with obesity, defined as being at least 20% over desired body weight or having a body mass index (BMI) of at least 27 kg/m2, are at major risk for type 2 DM. A blood pressure of 120/70 is normal and carries no increased risk for type 2 DM. A high waist-to-hip ratio is a risk factor for type 2 DM. A low waist-to-hip ratio carries no increased risk of the disease.

The nurse is preparing to assess a patient's gastrointestinal system. What should the nurse say to gain the most information about this patient's elimination pattern? 1. "Are you having any bowel problems?" 2. "Have you had any recent difficulties with your stools?" 3. "Tell me about your usual bowel habits." 4. "Are your bowel movements normal?"

Correct Answer: 3 Rationale 1: Questions that allow the patient to respond with a yes or no can limit communication and data gathering. Rationale 2: Questions that allow the patient to respond with a yes or no can limit communication and data gathering. Rationale 3: Open-ended questions provide the greatest amount of information. Rationale 4: Questions that allow the patient to respond with a yes or no can limit communication and data gathering. Global Rationale: Open-ended questions provide the greatest amount of information. Questions that allow the patient to respond with a yes or no can limit communication and data gathering.

A patient of Jewish heritage is experiencing body aches and fatigue. The nurse notes that the patient's skin appears pale and yellow-tinged. What nutritional health problem should the nurse suspect is occurring in this patient? 1. Tangier disease 2. hypercholesterolemia 3. Gaucher disease 4. Lynch Syndrome

Correct Answer: 3 Rationale 1: Tangier disease is a disease of cholesterol transport characterized by orange tonsils, very low levels of high-density lipoprotein, and an enlarged liver and spleen. Rationale 2: These findings are not characteristic of hypercholesterolemia. Rationale 3: This patient's findings are most consistent with Gaucher disease, which is more common in descendants of Jewish people from Eastern Europe. The disorder results in lack of an enzyme to break down fats, which accumulate in the liver, spleen, and bone marrow, causing pain, fatigue, jaundice, bone damage, anemia, and even death. Rationale 4: Lynch syndrome is a type of inherited cancer of the GI system, especially the colon and rectum. Colon polyps occur at an early age and are more likely to become malignant. Global Rationale: This patient's findings are most consistent with Gaucher disease, which is more common in descendants of Jewish people from Eastern Europe. The disorder results in lack of an enzyme to break down fats, which accumulate in the liver, spleen, and bone marrow, causing pain, fatigue, jaundice, bone damage, anemia, and even death. Tangier disease is a disease of cholesterol transport characterized by orange tonsils, very low levels of high-density lipoprotein, and an enlarged liver and spleen. These findings are not characteristic of hypercholesterolemia. Lynch syndrome is a type of inherited cancer of the GI system, especially the colon and rectum. Colon polyps occur at an early age and are more likely to become malignant.

A patient with cancer of the rectum is scheduled for surgery and the placement of a permanent ostomy. Which type of ostomy will this patient most likely have performed during the surgery? 1. ileostomy 2. double-barrel 3. sigmoid 4. transverse loop

Correct Answer: 3 Rationale 1: The ileostomy is not in the correct area to manage cancer in this location. Rationale 2: The double-barrel ostomy is not in the correct area to manage cancer in this location. Rationale 3: A sigmoid colostomy is the most common permanent colostomy performed, particularly for cancer of the rectum. It is usually created during an abdominoperineal resection. Rationale 4: The transverse loop ostomy is not in the correct area to manage cancer in this location. Global Rationale: A sigmoid colostomy is the most common permanent colostomy performed, particularly for cancer of the rectum. It is usually created during an abdominoperineal resection. The ileostomy, double-barrel, and transverse loop ostomies are not in the correct area to manage cancer in this location.

During the admission assessment, the nurse learns that a patient is having her menstrual period. Which ordered tests could be impacted by this finding? 1. small bowel series 2. barium enema 3. stool culture 4. colonoscopy

Correct Answer: 3 Rationale 1: The small bowel series will not be impacted by menstrual bleeding. Rationale 2: The barium enema will not be impacted by menstrual bleeding. Rationale 3: For a stool culture the stool is collected immediately after defecation. With vaginal bleeding, it is possible that menstrual blood could mix with the stool during defecation. Rationale 4: The colonoscopy will not be impacted by menstrual bleeding. Global Rationale: For a stool culture the stool is collected immediately after defecation. With vaginal bleeding, it is possible that menstrual blood could mix with the stool during defecation. The small bowel series, barium enema, and colonoscopy will not be impacted by menstrual bleeding.

A patient with diabetes mellitus and poor circulation has thick and ingrown toenails. What should the nurse instruct the patient to do? 1. Soak feet in Epsom salts daily. 2. Use a clean sharp razor blade to trim nails. 3. Make an appointment with a podiatrist. 4. Cut toenails immediately prior to bathing.

Correct Answer: 3 Rationale 1: There is no indication for this patient to soak feet daily in Epsom salts. Rationale 2: The use of a clean sharp razor could cause an injury. Rationale 3: The toenails of the patient with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Rationale 4: Cutting the nails before a bath would be difficult because the nails are thick and ingrown. Global Rationale: The toenails of the patient with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails before a bath would be difficult because the nails are thick and ingrown. There is no indication of a need for soaking feet daily in Epsom salts.

The nurse is instructing a patient newly diagnosed with celiac disease. The nurse knows follow-up is needed when the patient identifies which foods as appropriate choices? 1. spinach salad and corn 2. beefsteak and green beans 3. whole-wheat toast and baked chicken 4. apple slices and tuna salad

Correct Answer: 3 Rationale 1: This is a healthy choice for this patient because these foods do not contain gluten. Rationale 2: This is a healthy choice for this patient because these foods do not contain gluten. Rationale 3: Whole-wheat toast is not a healthful choice for this patient. If people with celiac disease eat certain types of proteins (glutens, found in wheat, barley, rye, and oats), an autoimmune response causes damage to the small intestine, and nutrients are not absorbed. Rationale 4: This is a healthy choice for this patient because these foods do not contain gluten. Global Rationale: Whole-wheat toast is not a healthful choice for this patient. If people with celiac disease eat certain types of proteins (glutens, found in wheat, barley, rye, and oats), an autoimmune response causes damage to the small intestine, and nutrients are not absorbed. The remaining menu choices do not contain gluten and are healthy choices for this patient.

The nurse is providing care to a patient admitted with acute diarrhea. What intervention would assist in this patient's care? 1. Provide a normal diet as tolerated. 2. Hold all medications until the diarrhea stops. 3. Provide clear liquids in small amounts. 4. Encourage normal activities of daily living in the hospital room.

Correct Answer: 3 Rationale 1: This patient should have limited food intake, reintroducing solid foods slowly. Rationale 2: The nurse should provide antidiarrheal medication as prescribed. Rationale 3: Fluid replacement is of primary importance in managing the patient with diarrhea. Solid food is withheld in the first 24 hours of acute diarrhea to rest the bowel. Rationale 4: Because of the potential for orthostatic hypotension, this patient should be instructed to move slowly and not engage in normal activities of daily living until the blood pressure is assessed. Global Rationale: Fluid replacement is of primary importance in managing the patient with diarrhea. Solid food is withheld in the first 24 hours of acute diarrhea to rest the bowel. The nurse should provide antidiarrheal medication as prescribed. Because of the potential for orthostatic hypotension, this patient should be instructed to move slowly and not engage in normal activities of daily living until the blood pressure is assessed.

A 60-year-old patient who is pale and weak has a hemoglobin level of 9 gm/dL. The patient states, "I eat a healthful diet. Why am I not well?" How should the nurse respond? 1. "You might not be eating as well as you think." 2. "This happens as you get older." 3. "As we age, the amount of iron absorbed by our body decreases." 4. "Menopause is responsible for these changes."

Correct Answer: 3 Rationale 1: This response is potentially argumentative and does not provide education regarding the underlying cause of the problem. Rationale 2: The iron deficiency is indirectly related to aging, but it is the responsibility of the nurse to provide as much information as possible. Rationale 3: A reduction in the absorption rate of ingested iron is a normal part of aging. Dietary modifications might be indicated to counteract life-span-related changes. Rationale 4: The patient is likely well past menopause, and blaming this life event for the difficulty being experienced does not fulfill the nurse's responsibility. Global Rationale: A reduction in the absorption rate of ingested iron is a normal part of aging. Dietary modifications might be indicated to counteract life-span-related changes. Telling the patient dietary intake is not what she believes it to be is potentially argumentative and does not provide education regarding the underlying cause of the problem. The iron deficiency is indirectly related to aging, but it is the responsibility of the nurse to provide as much information as possible. The patient is likely well past menopause, and blaming this life event for the difficulty being experienced does not fulfill the nurse's responsibility.

The nurse is planning teaching for a patient scheduled for an abdominal ultrasound. How should the nurse instruct the patient to prepare for this test? 1. "Advise the technician if you suspect you are pregnant." 2. "Drink 1 to 2 quarts of water 1 hour before the procedure." 3. "Do not eat anything 8 to 12 hours before the procedure." 4. "Take a laxative the evening before the procedure."

Correct Answer: 3 Rationale 1: This test is not contraindicated in pregnancy. Rationale 2: The patient will need to avoid oral intake 8-12 hours before the procedure. Rationale 3: The patient will need to avoid oral intake 8-12 hours before the procedure. Rationale 4: Laxative use is not needed for this procedure. Global Rationale: The patient will need to avoid oral intake 8-12 hours before the procedure. This test is not contraindicated in pregnancy. Laxative use is not needed for this procedure.

The nurse is trying to determine if a patient is experiencing manifestations of type 1 or type 2 diabetes mellitus. Which question should the nurse ask the patient to help determine the type? 1. "Have you been urinating in greater amounts than in the past?" 2. "Have you been drinking more liquids than in the past?" 3. "Have you been hungrier than in the past?" 4. "Have you noticed any changes in your vision?"

Correct Answer: 3 Rationale 1: Type 1 and type 2 diabetes have similar manifestations, especially polyuria and polydipsia. Rationale 2: Type 1 and type 2 diabetes have similar manifestations, especially polyuria and polydipsia. Rationale 3: Polyphagia is not often seen, and weight loss is uncommon with type 2 diabetes. Rationale 4: Vision changes are seen in both type 1 and type 2 diabetes mellitus. Global Rationale: Type 1 and type 2 diabetes have similar manifestations, especially polyuria and polydipsia. Polyphagia is not often seen, and weight loss is uncommon. Vision changes are seen in both type 1 and type 2 diabetes mellitus.

A patient beginning insulin for type 2 diabetes is experiencing blurred vision and is concerned about becoming blind. What response by the nurse is most appropriate? 1. "I will make an appointment for you to see an ophthalmologist." 2. "I will call the physician to report your symptoms." 3. "Blurry vision is very common. Do not worry." 4. "This is a normal response when insulin therapy is initiated."

Correct Answer: 4 Rationale 1: It is beyond the scope of practice for the nurse to make a referral to another physician. Rationale 2: Contacting the physician is premature. Rationale 3: Telling the patient it is "nothing" minimizes the concerns voiced, and does not provide adequate information to the patient. Rationale 4: Vision changes are normal during the first weeks of insulin therapy. They will gradually resolve. Global Rationale: Vision changes are normal during the first weeks of insulin therapy. They will gradually resolve. It is beyond the scope of practice for the nurse to make a referral to another physician. Contacting the physician is premature. Telling the patient it is "nothing" minimizes the concerns voiced, and does not provide adequate information to the patient.

A patient recently diagnosed with type 1 diabetes mellitus does not understand why the disease developed because the patient is thin and eats all of the time. What is the most appropriate response by the nurse? 1. "Thin people can be diabetic, too." 2. "Your condition makes it impossible for you to gain weight." 3. "Diabetes makes it difficult for your body to obtain energy from the foods you eat." 4. "Your lab tests indicate the presence of diabetes."

Correct Answer: 3 Rationale 1: While the statement about diabetics being thin is correct, it does not answer the patient's question. Rationale 2: It is not impossible for diabetics to gain weight. Rationale 3: The diabetic patient is unable to obtain the needed glucose for the body's cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. Rationale 4: Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient's needs for teaching. Global Rationale: The diabetic patient is unable to obtain the needed glucose for the body's cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. While the statement about diabetics being thin is correct, it does not answer the patient. It is not impossible for diabetics to gain weight. Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient's needs for teaching.

A patient reports epigastric abdominal pain, nausea, and vomiting. The serum amylase level is 450 units/dL. For which health problem should the nurse plan care? 1. gastritis 2. malnutrition 3. pancreatitis 4. diverticulitis

Correct Answer: 3 Rationale 1: The serum amylase level is not elevated in gastritis. Rationale 2: Epigastric pain and an elevated serum amylase level are not manifestations of malnutrition. Rationale 3: Epigastric pain and an elevated serum amylase level are manifestations of pancreatitis. Rationale 4: Epigastric pain and an elevated serum amylase level are not manifestations of diverticulitis. Global Rationale: Epigastric pain and an elevated serum amylase level are manifestations of pancreatitis but not of malnutrition or diverticulitis. The serum amylase level is not elevated in gastritis.

A patient who has reacted poorly to general anesthesia in the past is scheduled for surgery to repair a rotator cuff tear. For which types of anesthesia should the nurse prepare educational materials for this patient? Standard Text: Select all that apply. 1. Spinal 2. Topical 3. Epidural 4. Nerve block 5. Local nerve infiltration

Correct Answer: 3, 4 Rationale 1: Spinal anesthesia is effective for approximately 90 minutes. Surgeries of the lower abdomen, perineum, and lower extremities are likely to use this type of regional anesthesia. Rationale 2: Topical anesthesia would not be an option for this case. Rationale 3: Epidural blocks are local anesthetic agents injected into the epidural space, outside the dura mater of the spinal cord. It is indicated for surgeries of the shoulders. Rationale 4: Nerve blocks are accomplished by injecting an anesthetic agent at the nerve trunk to produce a lack of sensation over a specific larger area, such as an extremity. Rationale 5: Local nerve infiltration is achieved by injecting an anesthetic agent around a local nerve to suppress sensation over a limited area of the body. This technique may be used when a skin or muscle biopsy is obtained or when a small wound is sutured. Global Rationale: Epidural blocks are local anesthetic agents injected into the epidural space, outside the dura mater of the spinal cord. It is indicated for surgeries of the shoulders. Nerve blocks are accomplished by injecting an anesthetic agent at the nerve trunk to produce a lack of sensation over a specific larger area, such as an extremity. Spinal anesthesia is effective for approximately 90 minutes. Surgeries of the lower abdomen, perineum, and lower extremities are likely to use this type of regional anesthesia. Topical anesthesia would not be an option for this case. Local nerve infiltration is achieved by injecting an anesthetic agent around a local nerve to suppress sensation over a limited area of the body. This technique may be used when a skin or muscle biopsy is obtained or when a small wound is sutured.

A patient is being evaluated for liver disease. Which laboratory tests should the nurse expect to be conducted for this patient? Standard Text: Select all that apply. 1. serum sodium 2. serum potassium 3. alkaline phosphatase 4. alanine aminotransferase 5. aspartate aminotransferase

Correct Answer: 3, 4, 5 Rationale 1: Serum sodium is not a laboratory test specific for liver function. Rationale 2: Serum potassium is not a laboratory test specific for liver function. Rationale 3: Alkaline phosphatase is a laboratory test specific for liver function. Normal levels range from 42 to 136 units/L. Rationale 4: Alanine aminotransferase is a laboratory test specific for liver function. Normal levels range from 10 to 35 units/L. Rationale 5: Aspartate aminotransferase is a laboratory test specific for liver function. Normal levels range from 8 to 38 units/L. Global Rationale: Alkaline phosphatase is a laboratory test specific for liver function. Normal levels range from 42 to 136 units/L. Alanine aminotransferase is a laboratory test specific for liver function. Normal levels range from 10 to 35 units/L. Aspartate aminotransferase is a laboratory test specific for liver function. Normal levels range from 8 to 38 units/L. Serum sodium and serum potassium are not laboratory tests specific for liver function.

The nurse is completing a health history with a male patient and decides to include an assessment of the patient's sexual history for potential erectile dysfunction. What information in the history caused the nurse to make this decision? Standard Text: Select all that apply. 1. brother treated for testicular cancer 2. hip replacement surgery 6 months ago 3. aortic aneurysm repair 2 years ago 4. acetaminophen (Tylenol) for arthritis pain 5. coronary artery bypass surgery 10 years ago

Correct Answer: 3, 5 Rationale 1: A family history of testicular cancer will not increase the patient's risk for erectile dysfunction. Rationale 2: Hip replacement surgery is not implicated as a cause for erectile dysfunction. Rationale 3: Aortic aneurysm surgery is identified as a potential cause for erectile dysfunction. Rationale 4: Acetaminophen (Tylenol) is not implicated as a cause for erectile dysfunction. Rationale 5: Coronary artery bypass is identified as a potential cause for erectile dysfunction. Global Rationale: Aortic aneurysm and coronary artery bypass surgeries are identified as a potential causes for erectile dysfunction. A family history of testicular cancer will not increase the patient's risk for erectile dysfunction. Hip replacement surgery and acetaminophen (Tylenol) use are not implicated as causes for erectile dysfunction.

A 16-year-old patient in an outpatient setting with a body mass index of 35 tells the nurse, "I am going to lose weight by eliminating all fat from my diet." Which action should the nurse take first? 1. Contact the physician. 2. Notify the patient's parents. 3. Refer the patient to a dietitian. 4. Discuss the role of fat in metabolism.

Correct Answer: 4 Rationale 1: A discussion with the physician is likely warranted, but it can wait until after a discussion with the patient. Rationale 2: A discussion with the parents is likely warranted, but it can wait until after a discussion with the patient. Rationale 3: A referral from the physician is needed to contact the dietitian. Rationale 4: All individuals require some fat in the diet. It is important for the nurse to discuss this with the patient. The interaction will provide additional information concerning the patient's knowledge of a healthy diet. Global Rationale: All individuals require some fat in the diet. It is important for the nurse to discuss this with the patient. The interaction will provide additional information concerning the patient's knowledge of a healthy diet. A discussion with the parents and the physician is likely warranted, but this can wait until after a discussion with the patient. A referral from the physician is needed in order to contact the dietitian.

A 78-year-old patient without polyuria, polydipsia, or polyphagia has a serum glucose level of 130 mg/dL. What should the nurse conclude about this patient? 1. The patient might have eaten a meal with high sugar content prior to the testing. 2. The laboratory results might be erroneous. 3. The patient has type 1 diabetes mellitus. 4. The patient will need to be assessed for other manifestations of diabetes.

Correct Answer: 4 Rationale 1: A slight elevation in serum glucose level warrants further investigation. Rationale 2: There is no reason to question the laboratory results at this time. Rationale 3: There is inadequate information to make a diagnosis of type 1 diabetes mellitus. Rationale 4: Older adults with diabetes might not present with the classic symptoms of polyuria, polyphagia, or polydipsia. Symptoms of diabetes in older patients can include hypotension, periodontal disease, infections, and strokes. A slight elevation in serum glucose level warrants further investigation. Global Rationale: Older adults with diabetes might not present with the classic symptoms of polyuria, polyphagia, or polydipsia. Symptoms of diabetes in older patients can include hypotension, periodontal disease, infections, and strokes. A slight elevation in serum glucose level warrants further investigation. In an adequately functioning endocrine system, dietary intake is managed by the needed amounts of insulin produced by the pancreas. There is no reason to question the laboratory results at this time. There is inadequate information to make a diagnosis of type 1 diabetes mellitus.

The nurse is providing medications to a patient with diverticular disease. Which medication should the nurse question for this patient? 1. docusate (Colace) 2. metronidazole (Flagyl) 3. trimethoprim-sulfamethoxazole (Bactrim) 4. bisacodyl (Dulcolax) suppository

Correct Answer: 4 Rationale 1: Although a stool softener such as docusate (Colace) may be prescribed, it is important to note that laxatives can further increase intraluminal pressure in the colon and should be avoided for the patient with diverticular disease. Rationale 2: Systemic broad-spectrum antibiotics effective against usual bowel flora are prescribed to treat acute diverticulitis. Oral antibiotics such as metronidazole (Flagyl) may be prescribed if manifestations are mild. Rationale 3: Systemic broad-spectrum antibiotics effective against usual bowel flora are prescribed to treat acute diverticulitis. Oral antibiotics such as trimethoprim-sulfamethoxazole (Septra, Bactrim) may be prescribed if manifestations are mild. Rationale 4: Although a stool softener such as docusate (Colace) may be prescribed, it is important to note that laxatives can further increase intraluminal pressure in the colon and should be avoided for the patient with diverticular disease. Global Rationale: Although a stool softener such as docusate (Colace) may be prescribed, it is important to note that laxatives can further increase intraluminal pressure in the colon and should be avoided for the patient with diverticular disease. Systemic broad-spectrum antibiotics effective against usual bowel flora are prescribed to treat acute diverticulitis. Oral antibiotics such as metronidazole (Flagyl) or trimethoprim-sulfamethoxazole (Septra, Bactrim) may be prescribed if manifestations are mild.

A patient is diagnosed with gastroenteritis. The nurse should assess which serum laboratory value first? 1. sodium 2. bicarbonate 3. calcium 4. potassium

Correct Answer: 4 Rationale 1: Although electrolyte and acid‒base imbalances may result from gastroenteritis and extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach, sodium would not be the first lab value assessed by the nurse. Rationale 2: Although electrolyte and acid‒base imbalances may result from gastroenteritis and extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach, bicarbonate would not be the first lab value assessed by the nurse. Rationale 3: Although electrolyte and acid‒base imbalances may result from gastroenteritis and extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach, calcium would not be the first lab value assessed by the nurse. Rationale 4: Electrolyte and acid‒base imbalances may result from gastroenteritis. Extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach. When diarrhea predominates, metabolic acidosis is more likely. Potassium is lost in either case, which leads to hypokalemia. Global Rationale: Electrolyte and acid‒base imbalances may result from gastroenteritis. Extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach. When diarrhea predominates, metabolic acidosis is more likely. Potassium is lost in either case, which leads to hypokalemia. Sodium, bicarbonate, and calcium are not the primary electrolyte lost with gastroenteritis.

The nurse is reviewing the patient's current medications as a part of preparation for an elective surgery. What information should the nurse reinforce with the patient? 1. "Continue to take your regular prescribed dose of warfarin (Coumadin)." 2. "You may take your regular herbal supplements up until the day before surgery." 3. "Discontinue your antihypertensive medications two days prior to surgery." 4. "Stop taking your daily aspirin at least three days prior to surgery."

Correct Answer: 4 Rationale 1: Anticoagulant medications, including warfarin (Coumadin), should be discontinued prior to surgery to prevent excessive blood loss during surgery. Rationale 2: Herbs or nutritional supplements that impair clotting should be discontinued 2 weeks prior to surgery. Rationale 3: Antihypertensive medications will be analyzed by the healthcare provider on an individual basis. Rationale 4: Anticoagulant medications should be discontinued prior to surgery to prevent excessive blood loss during surgery. These include aspirin. Global Rationale: Anticoagulant medications, including warfarin (Coumadin) and aspirin, should be discontinued prior to surgery to prevent excessive blood loss during surgery. Herbs or nutritional supplements that impair clotting should be discontinued 2 weeks prior to surgery. Antihypertensive medications will be analyzed by the healthcare provider on an individual basis.

The nurse is planning care for a patient scheduled for a barium enema the next morning. What should be included in the plan of care? 1. enemas after the procedure 2. full-liquid diet for 24 hours before the procedure 3. positioning the patient on the right side during the procedure 4. nothing by mouth for 8 hours prior to the procedure

Correct Answer: 4 Rationale 1: Enemas or laxatives are administered before the procedure, not after. Rationale 2: A full-liquid diet is recommended for 2 days before the procedure. Rationale 3: The patient will be positioned on the left side during the procedure. Rationale 4: Preprocedural care for a colonoscopy requires that the patient take nothing by mouth for 8 hours. Global Rationale: Preprocedural care for a colonoscopy requires that the patient take nothing by mouth for 8 hours. Enemas or laxatives are administered before the procedure, not after. A full-liquid diet is recommended for 2 days before the procedure. The patient will be positioned on the left side during the procedure.

A patient with Crohn disease is experiencing weight loss. What should be included in this patient's plan of care? 1. a low-calorie, high-milk diet 2. a low-calorie, low-residue diet 3. a high-calorie, low-protein diet 4. a high-calorie, low-fat diet

Correct Answer: 4 Rationale 1: Provide a high-kilocalorie, high-protein, and low-fat diet and restrict milk and milk products if lactose intolerance is present. Rationale 2: The Crohn patient needs an elevation in calories related to the nutrients lost as a result of diarrhea. Rationale 3: The DASH diet is appropriate for the patient wanting to lower elevated blood pressure. Rationale 4: Provide a high-kilocalorie, high-protein, and low-fat diet, and restrict milk and milk products if lactose intolerance is present. The Crohn patient needs an elevation in calories related to the nutrients lost as a result of diarrhea. Global Rationale: Provide a high-kilocalorie, high-protein, and low-fat diet, and restrict milk and milk products if lactose intolerance is present. The Crohn patient needs an elevation in calories related to the nutrients lost as a result of diarrhea. A high-calorie, low-protein diet (called the DASH diet) is appropriate for the patient wanting to lower elevated blood pressure.

The home health nurse is teaching a patient about vitamin requirements. Which statement indicates that the patient requires additional teaching? 1. "I will follow the National Academy of Sciences recommendations for daily intake of vitamins." 2. "I might need more or fewer vitamins than someone else, based on my lifestyle." 3. "Evidence-based practice sometimes changes the recommended amount of a specific vitamin." 4. "Vitamins obtained through food are superior to those obtained through tablets and pills."

Correct Answer: 4 Rationale 1: The National Academy of Sciences does publish the results of research and make recommendations regarding minimum daily vitamin intake. Rationale 2: It is true that vitamin requirements are not the same for all people. Rationale 3: Evidence-based practice sometimes results in changes in recommended doses of vitamins. Rationale 4: There is no current data to support a preference for one source of vitamins over another. Global Rationale: There is no current data to support a preference for one source of vitamins over another. The National Academy of Sciences does publish the results of research and make recommendations regarding minimum daily vitamin intake. It is true that vitamin requirements are not the same for all people. Evidence-based practice sometimes results in changes in recommended doses of vitamins.

A patient has a waist-to-hip ratio of 0.5. The nurse realizes that this patient is at risk for developing what disorder? 1. gastrointestinal dysfunction 2. hyperinsulinemia 3. heart disease 4. obesity

Correct Answer: 4 Rationale 1: The low waist-to-hip ratio does not predispose this patient to develop gastrointestinal dysfunction. Rationale 2: The risk for hyperinsulinemia is lower in people with lower body obesity than in those with upper body obesity. Rationale 3: The risk for heart disease is lower in people with lower body obesity than in those with upper body obesity. Rationale 4: Lower body obesity may be more difficult to treat. Global Rationale: Lower body obesity may be more difficult to treat. The low waist-to-hip ratio does not predispose this patient to develop gastrointestinal dysfunction. The risk for hyperinsulinemia and heart disease is lower in people with lower body obesity than in those with upper body obesity.

A patient with irritable bowel syndrome asks the nurse, "Why did the doctor order something for depression?" How should the nurse respond? 1. "Didn't the doctor tell you that you are depressed?" 2. "Depression can be caused by irritable bowel syndrome." 3. "Did the doctor not give you an opportunity to ask questions?" 4. "These medications help with the symptoms associated with your bowel problem."

Correct Answer: 4 Rationale 1: There is no indication the patient is depressed. Rationale 2: Bowel disorders do not usually cause depression. Rationale 3: The patient is asking for clarification, and this response does not address the patient's concern. Rationale 4: Antidepressant drugs, including tricyclics and selective serotonin reuptake inhibitors (SSRIs), may help relieve abdominal pain associated with IBS. Global Rationale: Antidepressant drugs, including tricyclics and selective serotonin reuptake inhibitors (SSRIs), may help relieve abdominal pain associated with IBS. There is no indication the patient is depressed. Bowel disorders do not usually cause depression. The patient is asking for clarification, and asking whether the doctor provided the opportunity to ask questions does not address the patient's concern.

The nurse notes that a 41-year-old patient's fasting blood glucose level is 125 mg/dL. What should the nurse suspect is occurring with the patient? 1. severe hyperglycemia 2. consistent with diabetes 3. normal results 4. consistent with prediabetes

Correct Answer: 4 Rationale 1: This is not severe hyperglycemia. If it were, the nurse would immediately notify the health care provider. Rationale 2: Diabetes is fasting blood glucose level of 126 mg/dL or greater. Rationale 3: A normal fasting blood glucose level is less than or equal to 100 mg/dL. Rationale 4: Prediabetes is a fasting blood glucose level greater than 100 mg/dL and under 126 mg/dL. Global Rationale: Fasting blood glucose of 125 mg/dL is not severe hyperglycemia. If it were, the nurse would immediately notify the health care provider. This is not an indication of diabetes. A normal fasting blood glucose level is less than or equal to 100 mg/dL. Prediabetes is a fasting blood glucose level greater than 100 mg/dL and under 126 mg/dL.

A patient tells the nurse about taking large doses of vitamin A for skin health. What should the nurse respond to this patient? 1. "That is a great idea." 2. "That will not benefit your skin. You excrete high doses of vitamin A in your urine." 3. "You should take vitamin C to balance the large dose of A." 4. "Too much vitamin A can be toxic to your body."

Correct Answer: 4 Rationale 1: This response supports a potentially harmful practice. Rationale 2: Excessive intake of fat-soluble vitamins is not managed by urinary excretion. Rationale 3: Vitamin C does not balance out excess intake of vitamin A. Rationale 4: Vitamin A is a fat-soluble vitamin. Excessive intake of fat-soluble vitamins results in toxicity. Global Rationale: Vitamin A is a fat-soluble vitamin. Excessive intake of fat-soluble vitamins results in toxicity and is not managed by urinary excretion. Vitamin C does not balance out excess intake of vitamin A.

The nurse is teaching a patient with diabetes about self-management. What should the nurse include regarding medications to treat diabetes mellitus? 1. Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications. 2. Patients with type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled. 3. Patients with type 2 diabetes will always need an exogenous source of insulin. 4. Patients with type 2 diabetes may achieve normal blood glucose levels with a combination of oral medications and insulin.

Correct Answer: 4 Rationale 1: Type 1 diabetes mellitus is not treated with oral medications. Rationale 2: Patients with diabetes do not progress from type 1 to type 2. Rationale 3: People with type 1 must have insulin. Rationale 4: People with type 2 diabetes mellitus are usually able to control glucose levels with an oral hypoglycemic medication, but they may require insulin if control is inadequate. Global Rationale: People with type 2 diabetes mellitus are usually able to control glucose levels with an oral hypoglycemic medication, but they may require insulin if control is inadequate. Type 1 diabetes mellitus is not treated with oral medications. The person with type 1 DM requires a lifelong exogenous source of the insulin hormone to maintain life. Patients with diabetes do not progress from type 1 to type 2.

A 28-year-old female patient is diagnosed with inflammatory disease of the small bowel. The nurse realizes that this patient most likely is experiencing what health problem? 1. ulcerative colitis 2. chronic diarrhea 3. gastroenteritis 4. Crohn disease

Correct Answer: 4 Rationale 1: Ulcerative colitis affects the large intestine. Rationale 2: A diagnosis of chronic diarrhea is not supported by the information provided. The diarrhea associated with Crohn disease is frequent, causing watery stools several times a day. Rationale 3: Gastroenteritis results from ingesting contaminated foods or beverages. Rationale 4: In Crohn disease, a patchy pattern of involvement is seen, which affects primarily the small intestine. Global Rationale: In Crohn disease, a patchy pattern of involvement is seen, which affects primarily the small intestine. Ulcerative colitis affects the large intestine. A diagnosis of chronic diarrhea is not supported by the information provided. The diarrhea associated with Crohn disease is frequent, causing watery stools several times a day. Gastroenteritis results from ingesting contaminated foods or beverages. Ulcerative colitis affects the large intestine.

A patient with diabetes is diaphoretic, has a heart rate of 112 beats per minute, and is feeling nervous and shaky. What action should the nurse take first? 1. Provide the patient with a snack of milk and crackers. 2. Administer insulin utilizing the prescribed sliding scale dosages. 3. Contact the laboratory and order a serum glucose level. 4. Obtain a capillary serum glucose level reading with a glucose meter.

Correct Answer: 4 Rationale 1: While the patient is demonstrating manifestations consistent with hypoglycemia, providing a snack is not the first action the nurse should take. Rationale 2: The patient is hypoglycemic, so insulin administration would be incorrect, as it would only add to the problem. Rationale 3: It would be more appropriate to use the nursing unit's glucometer than to wait for the laboratory to obtain a reading. In addition, there is no indication an order for laboratory values exists. Rationale 4: The first action would be to verify the patient's blood glucose level. Global Rationale: The first action would be to verify the patient's blood glucose level. It would be more appropriate to use the nursing unit's glucometer than to wait for the laboratory to obtain a reading. In addition, there is no indication an order for laboratory values exists. While the patient is demonstrating manifestations consistent with hypoglycemia, obtaining the glucose levels first would be most beneficial. The patient is hypoglycemic, so insulin administration would be incorrect, as it would only add to the problem.

The nurse is reviewing instruction provided to a graduate nurse regarding insulin therapy. Which statement made by the graduate indicates that further instruction is needed? Standard Text: Select all that apply. 1. Lispro is a rapid-acting insulin. 2. Regular insulin can be administered intravenously. 3. NPH insulin may be mixed with lispro insulin. 4. Insulin detemir is administered prior to each meal. 5. Insulin glargine may be used to treat gestational diabetes.

Correct Answer: 4, 5 Rationale 1: Lispro is a rapid-acting insulin. Rationale 2: Regular insulin can be administered intravenously. Rationale 3: NPH insulin may be mixed with lispro or regular insulin. Rationale 4: Insulin detemir is administered once or twice daily, not before each meal. Rationale 5: Insulin glargine is not used during pregnancy. Global Rationale: Lispro is a rapid-acting insulin. Regular insulin can be administered intravenously. NPH insulin may be mixed with lispro or regular insulin. Insulin detemir is administered once or twice daily, not before each meal. Insulin glargine is not used during pregnancy.

A patient with type 1 diabetes mellitus voided 4,000 mL of urine in the past 24 hours. The patient's skin turgor is poor, and the patient is reporting polyphagia and polydipsia. Which blood glucose level should the nurse expect when assessing this patient? 1. 60 mg/dL 2. 110 mg/dL 3. 125 mg/dL 4. 180 mg/dL

Correct Answer: D Rationale 1: A blood glucose level of 60 mg/dL is hypoglycemia. Polyuria is not a manifestation of hypoglycemia. Rationale 2: A blood glucose level of 110 mg/dL is considered as being a normal blood glucose level. Polyuria is not a manifestation of a normal blood glucose level. Rationale 3: A blood glucose level of 125 mg/dL is consistent with prediabetes. Polyuria is not a manifestation of prediabetes. Rationale 4: Hyperglycemia causes serum hyperosmolality, drawing water from the intracellular spaces into the general circulation. The increased blood volume increases renal blood flow, and the hyperglycemia acts as an osmotic diuretic. The resulting osmotic diuresis increases urine output. This condition is called polyuria. When the blood glucose level exceeds the renal threshold for glucose usually about 180 mg/dL glucose is excreted in the urine, a condition called glucosuria. The decrease in intracellular volume and the increased urinary output cause dehydration. The mouth becomes dry and thirst sensors are activated, causing the person to drink increased amounts of fluid (polydipsia). Global Rationale: Hyperglycemia causes serum hyperosmolality, drawing water from the intracellular spaces into the general circulation. The increased blood volume increases renal blood flow, and the hyperglycemia acts as an osmotic diuretic. The resulting osmotic diuresis increases urine output. This condition is called polyuria. When the blood glucose level exceeds the renal threshold for glucose usually about 180 mg/dL glucose is excreted in the urine, a condition called glucosuria. The decrease in intracellular volume and the increased urinary output cause dehydration. The mouth becomes dry and thirst sensors are activated, causing the person to drink increased amounts of fluid (polydipsia). A blood glucose level of 60 mg/dL is hypoglycemia. Polyuria is not a manifestation of hypoglycemia. A blood glucose level of 110 mg/dL is considered as being a normal blood glucose level. Polyuria is not a manifestation of a normal blood glucose level. A blood glucose level of 125 mg/dL is consistent with prediabetes. Polyuria is not a manifestation of prediabetes.

Correct Answer: 1, 2, 4, 5 Rationale 1: Risk factors for pancreatic cancer include cigarette smoking. Rationale 2: Risk factors for pancreatic cancer include obesity. Rationale 3: Osteoarthritis is not a risk factor for pancreatic cancer. Rationale 4: Risk factors for pancreatic cancer include a genetic predisposition. Rationale 5: Risk factors for pancreatic cancer include chronic pancreatitis. Global Rationale: Identified risk factors for pancreatic cancer include cigarette smoking, obesity, a genetic predisposition, and chronic pancreatitis. Osteoarthritis is not a risk factor for pancreatic cancer.

During a health assessment the nurse becomes concerned that a patient is at high risk for pancreatic cancer. What assessment findings caused this concern? Standard Text: Select all that apply. 1. The patient smokes cigarettes. 2. The patient has a body mass index of 32.5. 3. The patient has been treated for osteoarthritis. 4. The patient's uncle died from pancreatic cancer. 5. The patient has been diagnosed with chronic pancreatitis.

Correct Answer: 1, 2, 3, 4 Rationale 1: Increasing the amount of protein and fat in the diet will help slow the transit time through the digestive tract. Rationale 2: The patient should be instructed to lie down for 30 to 60 minutes after eating to slow transit time through the digestive tract. Rationale 3: The symptoms can be managed by eating small, more frequent meals. Rationale 4: Carbohydrate consumption should be reduced to help slow the transit time through the digestive tract. Rationale 5: Drinking before eating might intensify the problem. Global Rationale: Increasing the amount of protein and fat in the diet, lying down for 30 to 60 minutes after eating, and reducing carbohydrate consumption will help slow the transit time through the digestive tract. The symptoms can be managed by eating small, more frequent meals. Drinking before eating might intensify the problem.

Four weeks post gastric resection surgery, a patient is experiencing cramping, nausea, and diarrhea within 10 minutes after eating. Suspecting that the patient may have dumping syndrome, what should the nurse suggest? Standard Text: Select all that apply. 1. Increase protein in the diet. 2. Lie down for 30 minutes immediately after eating. 3. Eat frequent, small meals. 4. Reduce the amount of carbohydrates eaten daily. 5. Drink a glass of water prior to each meal.

Correct Answer: 1, 2, 3 Rationale 1: Nutritional counseling is directed at establishing a regular meal pattern and encouraging an appropriate amount of regular exercise. Rationale 2: Cognitive‒behavioral therapy focuses on the patient's excessive concerns about weight, persistent dieting, and binge‒purge behaviors. Rationale 3: Many times patients binge eat and then purge because they are depressed. Using antidepressants may help the bulimic patient to prevent a relapse. Rationale 4: Vitamin therapy is usually associated with anorexia nervosa. Rationale 5: Hospitalization is usually associated with anorexia nervosa. Global Rationale: Nutritional counseling is directed at establishing a regular meal pattern and encouraging an appropriate amount of regular exercise. Cognitive‒behavioral therapy focuses on the patients excessive concerns about weight, persistent dieting, and binge‒purge behaviors. Many times patients binge eat and then purge because they are depressed. Using antidepressants may help the bulimic patient to prevent a relapse. Vitamin therapy and hospitalization are usually associated with anorexia nervosa.

The goal of reducing or eliminating binge eating and purging behavior has been established for a patient with bulimia nervosa. What interventions should the nurse expect to be prescribed to help the patient achieve this goal? Standard Text: Select all that apply. 1. nutritional counseling 2. cognitive‒behavioral therapy 3. antidepressants 4. vitamin therapy 5. hospitalization

Correct Answer: 1 Rationale 1: Bulimia nervosa is a disorder in which patients eat large quantities of foods and then purge themselves by means of vomiting. Laxatives also may be employed. Rationale 2: Anorexia nervosa patients display behaviors in which intake is avoided and excessive exercise rituals are initiated. Rationale 3: Patients with binge eating disorders will eat large amounts of food. They are often overweight. Rationale 4: There is no evidence to support the patient having a metabolic disorder. Global Rationale: Bulimia nervosa is a disorder in which patients eat large quantities of foods and then purge themselves by means of vomiting. Laxatives also may be employed. Anorexia nervosa patients display behaviors in which intake is avoided and excessive exercise rituals are initiated. Patients with binge eating disorders will eat large amounts of food. They are often overweight. There is no evidence to support the patient having a metabolic disorder.

The mother of a teen is concerned that her daughter's nutritional status is compromised since the daughter has an increased interest in losing weight, weighs herself several times each day, and at times ingests large amounts of food. The daughter has not lost or gained much weight, but the mother wonders if her daughter has anorexia nervosa. How should the nurse respond to this mother? 1. These are behaviors consistent with bulimia nervosa. 2. These are behaviors consistent with early-onset anorexia nervosa. 3. These are behaviors consistent with binge-eating disorder. 4. These are behaviors consistent with a metabolic disorder.

Correct Answer: 1 Rationale 1: When dieting, a small nonfood reward can serve as an incentive for working toward a goal. Rationale 2: Eating is a social activity. Talking with others during mealtime promotes involvement. Rationale 3: Drinking a beverage before eating promotes feelings of fullness and reduces intake at mealtime. Rationale 4: A meal should be slated to last only 20 minutes. Eating longer can promote eating more. Global Rationale: When dieting, a small nonfood reward can serve as an incentive for working toward a goal. Eating is a social activity. Talking with others during mealtime promotes involvement. Drinking a beverage before eating promotes feelings of fullness and reduces intake at mealtime. A meal should be slated to last only 20 minutes. Eating longer can promote eating more.

The nurse is helping a patient identify ways to adhere to a weight reduction plan. What should the nurse suggest to help this patient? 1. Set aside small nonfood rewards when you meet a goal. 2. Eat alone to reduce outside distractions. 3. Drink water or a diet beverage after eating to promote feelings of fullness. 4. Allow at least 45 minutes to 1 hour to promote full enjoyment of a meal.

Correct Answer: 1, 2, 3, 4 Rationale 1: Complications of cholecystitis include empyema, a collection of infected fluid within the gallbladder. Rationale 2: Gangrene and perforation with resulting peritonitis may occur. An abscess may form. Rationale 3: A fistula may form into an adjacent organ (such as the duodenum, colon, or stomach). Rationale 4: The small intestine may be obstructed by a large gallstone (gallstone ileus). Rationale 5: The gallbladder will not turn inside out into the bile duct. Global Rationale: Complications of cholecystitis include empyema, a collection of infected fluid within the gallbladder. Gangrene and perforation with resulting peritonitis may occur. An abscess may form. A fistula may form into an adjacent organ (such as the duodenum, colon, or stomach). The small intestine may be obstructed by a large gallstone (gallstone ileus). The gallbladder will not turn inside out into the bile duct.

The nurse has instructed a patient about the possible complications of unresolved cholecystitis. Which patient statements indicate that teaching has been effective? Standard Text: Select all that apply. 1. "I could have infected pus stored in my gallbladder." 2. "My gallbladder could rot and cause a big infection in my abdomen." 3. "A hole could form a connection between my gallbladder and intestines."' 4. "My intestines could be blocked with a gallstone." 5. "My gallbladder could turn inside out into the bile duct."

Correct Answer: 2, 4, 5 Rationale 1: The pain of acute cholecystitis usually lasts longer than that of biliary colic, continuing for 12 to 18 hours. Rationale 2: Descriptions of feeling hot and diaphoretic, then cold and shivering, should be recognized as describing a febrile state. Fever often is present in acute cholecystitis and may be accompanied by chills. Rationale 3: The pain related to cholecystitis is not located in the lower-right quadrant. Rationale 4: Nausea and vomiting are seen in acute cholecystitis. Rationale 5: Acute cholecystitis features pain that involves the entire upper-right quadrant (RUQ) and may radiate to the back, right scapula, or shoulder. Movement or deep breathing may aggravate the pain. Global Rationale: Acute cholecystitis features pain that involves the entire upper-right quadrant (RUQ) and may radiate to the back, right scapula, or shoulder. Movement or deep breathing may aggravate the pain. Anorexia, nausea, and vomiting are common. Fever often is present and may be accompanied by chills. The RUQ is tender to palpation. Descriptions of feeling hot and diaphoretic, then cold and shivering, should be recognized as describing a febrile state. The pain usually lasts longer than that of biliary colic, continuing for 12 to 18 hours.

The nurse is assessing a patient with cholelithiasis. Which statements by the patient indicate a progression to cholecystitis? Standard Text: Select all that apply. 1. "I've been in terrible pain for 2 hours." 2. "I'm hot and sweating, then cold and shivering." 3. "The pain's in the same location as when I had appendicitis." 4. "I need an emesis basin; I've vomited four times." 5. "My abdomen and my back both hurt."

Correct Answer: 1, 2, 3 Rationale 1: The liver produces clotting factors. Two episodes of epistaxis are likely related to the patient's liver failure. Rationale 2: The liver metabolizes medications. Toxic levels of prescribed medication in the absence of other factors are likely related to liver failure. Rationale 3: The patient who is disoriented may be experiencing high serum ammonia levels, an effect of liver failure. Rationale 4: Decreased urinary output is not associated with liver failure, but with kidney failure. Rationale 5: Cholelithiasis is not caused by liver failure. Global Rationale: The liver produces clotting factors. Two episodes of epistaxis are likely related to the patient's liver failure. The liver metabolizes medications. Toxic levels of prescribed medication in the absence of other factors are likely related to liver failure. The patient who is disoriented may be experiencing high serum ammonia levels, an effect of liver failure. Decreased urinary output is not associated with liver failure, but with kidney failure. Cholelithiasis is not caused by liver failure.

The nurse is assessing a patient with liver cirrhosis. Which findings should the nurse relate to the patient's failed liver function? Standard Text: Select all that apply. 1. The patient had two episodes of epistaxis. 2. The patient had toxic levels of a prescribed medication. 3. The patient is oriented to person and place but not to time. 4. The patient's urinary output has decreased. 5. The patient has cholelithiasis.

Correct Answer: 1 Rationale 1: Hemolytic jaundice develops when excess RBC destruction releases more bilirubin into circulation than the liver is able to process. Rationale 2: Darkened urine is more commonly associated with hepatic or obstructive jaundice. Rationale 3: Light or clay-colored stools are more commonly associated with hepatic or obstructive jaundice. Rationale 4: Patients with gallbladder disorders are also at risk for jaundice; however, this patient's liver failure is a given. Global Rationale: Hemolytic jaundice develops when excess RBC destruction releases more bilirubin into circulation than the liver is able to process. Darkened urine and light or clay-colored stools are more commonly associated with hepatic or obstructive jaundice. Patients with gallbladder disorders are also at risk for jaundice; however, this patient's liver failure is a given.

The nurse is assessing a patient with liver failure and jaundice. Which question should the nurse ask to determine if the cause of the jaundice is hemolytic? 1. "Have you been diagnosed with a disorder of red blood cell destruction?" 2. "What color is your urine?" 3. "What color are your stools?" 4. "Do you have any gallbladder problems?"

Correct Answer: 4 Rationale 1: While all patients should be instructed to reduce sodium intake, this step would not assist in reducing cholelithiasis or its pain. Rationale 2: Increasing fluids would not assist in reducing cholelithiasis or its pain. Rationale 3: While all patients should cease smoking, there is no relationship between smoking and cholelithiasis. Rationale 4: Most gallstones consist primarily of cholesterol. Excess cholesterol in the bile is associated with obesity and a high-calorie, high-cholesterol diet. Global Rationale: Most gallstones consist primarily of cholesterol. Excess cholesterol in the bile is associated with obesity and a high-calorie, high-cholesterol diet. While all patients should be instructed to reduce sodium intake and stop smoking, these steps would not assist in reducing cholelithiasis or its pain. Increasing fluids would also not assist in reducing cholelithiasis or its pain.

The nurse is preparing instructions for a patient who is at risk for cholelithiasis. What lifestyle modification should the nurse include in this teaching? 1. Reduce sodium intake. 2. Increase fluids. 3. Reduce smoking. 4. Reduce fat consumption.

Correct Answer: 1 Rationale 1: The nurse begins by assessing nutritional status, particularly diet history, height and weight, and skinfold measurements. Rationale 2: Even though often obese, patients with gallbladder disease may have an imbalanced diet. Discussing strategies used to manage weight may be important in assessing causes of cholelithiasis pain, as fluctuating weight gains and losses can contribute to cholelithiasis, but this is the not the priority when assessing the patient's nutritional status. Rationale 3: Vitamin C is a water-soluble vitamin. Fat-soluble vitamins might be deficient in the patient with cholelithiasis. Rationale 4: Asking if the patient has been skipping meals is important, but not as important as another aspect of nutritional status. Global Rationale: The nurse begins by assessing nutritional status, particularly diet history, height and weight, and skinfold measurements. Even though often obese, patients with gallbladder disease may have an imbalanced diet or specific vitamin deficiencies, particularly of the fat-soluble vitamins. Vitamin C is a water-soluble vitamin. Discussing strategies used to manage weight may be important in assessing causes of cholelithiasis pain, as fluctuating weight gains and losses can contribute to cholelithiasis, but this is the not the priority when assessing the patient's nutritional status. Asking if the patient has been skipping meals is important, but not as important as the diet history and typical food choices.

The nurse is assessing the nutritional status of a patient who has cholelithiasis and a body mass index of 35. What action should the nurse take initially? 1. ask the patient to discuss typical daily menu choices 2. ask the patient to discuss strategies used to manage weight 3. ask if the patient takes daily supplemental vitamin C 4. ask if the patient has been skipping meals to reduce gallbladder pain

Correct Answer: 1, 2, 3, 4 Rationale 1: Chenodiol (Chenix) reduces the cholesterol content of gallstones, leading to their gradual dissolution. It may take 2 years for this medication to work. Rationale 2: Chenodiol has a high incidence of diarrhea at therapeutic doses. Rationale 3: Chenodiol (Chenix) is hepatotoxic, so periodic liver function studies are required during therapy. Rationale 4: A primary disadvantage of pharmacologic treatment for gallstones is its cost. Rationale 5: Because of the gradual rate at which the medication acts, pieces of gallstones are not visible in the patient's stools. Global Rationale: Chenodiol (Chenix) reduces the cholesterol content of gallstones, leading to their gradual dissolution. Chenodiol has a high incidence of diarrhea at therapeutic doses and is hepatotoxic, so periodic liver function studies are required during therapy. A primary disadvantage of pharmacologic treatment for gallstones is its cost. Because of the gradual rate at which the medication acts, pieces of gallstones are not visible in the patient's stools.

The nurse is caring for a patient taking chenodiol (Chenix). Which patient statements indicate the need for immediate follow-up by the nurse? Standard Text: Select all that apply. 1. "I could see the big gallstone on the x-ray, but this medication doesn't seem to be helping at all. I don't feel better after taking it for 4 months." 2. "My rectal area is tender from all the diarrhea I've been having." 3. "My skin looks yellow." 4. "I can't afford my medication and have been cutting pills in half to make it last longer." 5. "I can see bits of gallstones in my stools."

Correct Answer: 2 Rationale 1: A low-residue diet is prescribed for patients experiencing bowel disorders. Rationale 2: After the serum amylase level returns to normal, the patient experiencing pancreatitis should be instructed to consume a diet low in fat with no alcohol. Rationale 3: Almost all patients should consume a low-fat diet, but most patients need increased fiber. Rationale 4: A mechanical soft diet is reserved for the patient who needs to conserve energy or has a mouth or dentition disorder. Global Rationale: After the serum amylase level returns to normal, the patient experiencing pancreatitis should be instructed to consume a diet low in fat with no alcohol. A low-residue diet is prescribed for patients experiencing bowel disorders. Almost all patients should consume a low-fat diet, but most patients need increased fiber. A mechanical soft diet is reserved for the patient who needs to conserve energy or has a mouth or dentition disorder.

The nurse is caring for a patient with chronic pancreatitis and a serum amylase level of 180 units/L. Which dietary plan should the nurse instruct the patient to follow? 1. low residue, no alcohol 2. low fat, no alcohol 3. low fat, no fiber 4. mechanical soft

Correct Answer: 1, 3 Rationale 1: The patient should avoid eating anything within 3 hours of bedtime. Rationale 2: The patient should be instructed to eat small, frequent meals. Rationale 3: The head of the bed should be elevated on 6- to 8-inch blocks. Rationale 4: An exercise routine is not identified in the treatment of GERD. Rationale 5: Coffee increases gastric acidity and interferes with gastric emptying, increasing the incidence of gastroesophageal reflux. Global Rationale: The patient should avoid eating anything within 3 hours of bedtime. The head of the bed should be elevated on 6- to 8-inch blocks. The patient should be instructed to eat small, frequent meals. An exercise routine is not identified in the treatment of GERD. Coffee increases gastric acidity and interferes with gastric emptying, increasing the incidence of gastroesophageal reflux.

The nurse is caring for a patient with gastroesophageal reflux disease (GERD). What should the nurse include when teaching the patient about this health problem? Standard Text: Select all that apply. 1. Limit last food intake to 3 hours before bedtime. 2. Eat the largest meal of the day at midday. 3. Sleep in a bed with the head elevated 6 to 8 inches. 4. Follow a daily exercise routine. 5. Drink coffee with meals.

Correct Answer: 2 Rationale 1: Feeling tired is expected in a patient with hepatitis C. Rationale 2: Herbalists may use licorice root to treat hepatitis. It has both antiviral and anti-inflammatory effects. Long-term use of licorice root, however, can lead to hypertension and affect fluid and electrolyte balance. Reports of numbness and tingling in the fingers may be a sign of electrolyte imbalance. Rationale 3: A dull ache in the abdomen is often seen in patients with hepatitis. Rationale 4: It is expected that this patient would have antibodies to hepatitis C in the blood. Global Rationale: Herbalists may use licorice root to treat hepatitis. It has both antiviral and anti-inflammatory effects. Long-term use of licorice root, however, can lead to hypertension and affect fluid and electrolyte balance. Reports of numbness and tingling in the fingers may be a sign of electrolyte imbalance. Feeling tired is expected in a patient with hepatitis C. A dull ache in the abdomen is often seen in patients with hepatitis. It is expected that this patient would have antibodies to hepatitis C in the blood.

The nurse is caring for a patient with hepatitis C who is treating the illness with licorice root. Which statement by the patient requires follow-up regarding this medication? 1. "I feel so tired all the time." 2. "My fingers feel numb and tingly." 3. "I have a dull ache in my abdomen." 4. "I have antibodies for hepatitis C in my blood."

Correct Answer: 1 Rationale 1: Antacids interfere with the absorption of many drugs given orally, and administration times should be separated by at least 2 hours. Rationale 2: Medication administration should not be delayed. Rationale 3: Antacids should be provided after other medications. Rationale 4: Antacids may not be appropriate at the hour of sleep. Global Rationale: Antacids interfere with the absorption of many drugs given orally, and administration times should be separated by at least 2 hours. Medication administration should not be delayed. Antacids should be provided 2 hours after other medication. Antacids may not be appropriate at the hour of sleep.

The nurse is preparing the morning medications for a patient with gastroesophageal reflux disease (GERD). Which nursing intervention would be appropriate for this patient's medications? 1. Hold the antacids for at least 2 hours after oral medications are taken. 2. Provide all prescribed medications at 1000. 3. Provide the antacids first, then follow with the oral medications. 4. Provide the antacids only at the hour of sleep.

Correct Answer: 1 Rationale 1: Vitamin K is the only fat soluble vitamin that cannot be administered intravenously. Rationale 2: Vitamin A can be given IV. Rationale 3: Vitamin D can be given IV. Rationale 4: Vitamin E can be given IV. Global Rationale: Vitamin K is the only fat soluble vitamin that cannot be administered intravenously. Vitamins A, D, and E can be given IV.

The nurse is preparing to administer total parenteral nutrition intravenously to a patient with malnutrition. What fat soluble vitamin should the nurse note is absent from the nutritional mixture? 1. vitamin K 2. vitamin A 3. vitamin D 4. vitamin E

Correct Answer: 1, 2 Rationale 1: Peppermint relaxes the lower esophageal sphincter or delays gastric emptying and should be avoided. Rationale 2: The patient should be advised to eat smaller meals. Rationale 3: The patient should be advised to refrain from eating for 3 hours before bedtime. Rationale 4: Acidic foods such as citrus fruits should be eliminated from the diet. Rationale 5: Alcohol relaxes the lower esophageal sphincter and should be avoided. Global Rationale: Fatty foods, chocolate, peppermint, and alcohol relax the lower esophageal sphincter or delay gastric emptying, so they should be avoided. Acidic foods such as citrus fruits should be eliminated from the diet. The patient should be advised to eat smaller meals and refrain from eating for 3 hours before bedtime.

The nurse is preparing to instruct a patient newly diagnosed with gastroesophageal reflux disease (GERD) about dietary considerations. What should the nurse include in these instructions? Standard Text: Select all that apply. 1. "Avoid peppermint." 2. "Meals should be small and more frequent." 3. "Have a bedtime snack." 4. "Be sure to eat at least one citrus fruit per day." 5. "Alcohol should be limited to two drinks per day."

Correct Answer: 3, 5 Rationale 1: Patients recovering from bariatric surgery should eat small meals. Rationale 2: Tea and toast will not prevent dumping syndrome. Rationale 3: Patients recovering from bariatric surgery should be instructed not to eat liquids and solids together. Rationale 4: It is not necessary for the patient recovering from bariatric surgery to lie down after eating. This will not prevent dumping syndrome. Rationale 5: Patients recovering from bariatric surgery should be instructed to avoid foods high in simple carbohydrates. Global Rationale: Patients recovering from bariatric surgery should be instructed to avoid foods high in simple carbohydrates. Meals should be small, and liquids and solids should not be taken together. Tea and toast will not prevent dumping syndrome. It is not necessary for the patient to lie down after eating. This will not prevent dumping syndrome.

The nurse is providing discharge teaching to a patient recovering from bariatric surgery. Which patient statements indicate that teaching about dumping syndrome has been effective? Standard Text: Select all that apply. 1. "I should eat three large meals each day." 2. "I should have tea and toast for breakfast." 3. "I should drink fluids frequently while eating a meal." 4. "I should lie down for 30 minutes after eating a meal." 5. "I should avoid eating foods high in simple carbohydrates."

Correct Answer: 1, 2 Rationale 1: Anorexia nervosa is an eating disorder characterized by distorted body image. Rationale 2: Anorexia nervosa is an eating disorder characterized by loss of control over food intake. Rationale 3: Purging is characteristic of bulimia nervosa. Rationale 4: Binge eating is characteristic of bulimia nervosa. Rationale 5: Normal or above average weight is characteristic of bulimia nervosa. Global Rationale: Anorexia nervosa is an eating disorder characterized by a distorted body image and loss of control over food intake. Purging, binge eating, and normal or above average weight are characteristics of bulimia nervosa.

The nurse is reviewing data collected from an adolescent patient suspected of having anorexia nervosa. Which findings should the nurse identify as contributing to this diagnosis? Standard Text: Select all that apply. 1. distorted body image 2. loss of control over food intake 3. purging 4. binge eating 5. normal or above average body weight

Correct Answer: 3 Rationale 1: Phototherapy is used in the care of a newborn. Rationale 2: The laboratory finding does not provide information to identify red blood cell death. Rationale 3: Elevated direct (conjugated) bilirubin may indicate obstructed bile flow in the biliary duct system. Rationale 4: The laboratory finding does not provide information to identify small bowel obstruction. Global Rationale: Elevated direct (conjugated) bilirubin may indicate obstructed bile flow in the biliary duct system. The laboratory finding does not provide information to identify red blood cell death or small bowel obstruction. Phototherapy is used in the care of the newborn.

The nurse is reviewing pathophysiology concepts to understand what is occurring with an adult patient who has abdominal pain and a serum conjugated bilirubin level of 1.2 mg/dL. What should the nurse suspect is occurring with this patient? 1. a disease that requires phototherapy 2. a disorder that causes large amounts of red blood cell death 3. a disorder of the biliary system 4. a small bowel obstruction

Correct Answer: 2, 5 Rationale 1: There is no reason to question providing lorcaserin (Belviq) with aspirin (ASA). Rationale 2: Lorcaserin (Belviq) activates the serotonin 5-HT 2c receptor in the brain, causing an individual to feel full after eating smaller amounts and therefore eating less. Coadministration with other drugs that increase serotonin levels can lead to serotonin syndrome or even neuroleptic malignant syndrome. This medication should be avoided or used with extreme caution by patients taking St. John's wort. Rationale 3: There is no reason to question providing lorcaserin (Belviq) with ibuprofen (Motrin). Rationale 4: There is no reason to question providing lorcaserin (Belviq) with furosemide (Lasix). Rationale 5: Lorcaserin (Belviq) activates the serotonin 5-HT 2c receptor in the brain, causing an individual to feel full after eating smaller amounts and therefore eating less. Coadministration with other drugs that increase serotonin levels can lead to serotonin syndrome or even neuroleptic malignant syndrome. This medication should be avoided or used with extreme caution for patients taking bupropion (Wellbutrin). Global Rationale: Lorcaserin (Belviq) activates the serotonin 5-HT 2c receptor in the brain, causing an individual to feel full after eating smaller amounts and therefore eating less. Coadministration with other drugs that increase serotonin levels can lead to serotonin syndrome or even neuroleptic malignant syndrome. This medication should be avoided or used with extreme caution by patients taking bupropion (Wellbutrin) or St. John's wort. There is no reason to question providing lorcaserin (Belviq) with aspirin (ASA), ibuprofen (Motrin), or furosemide (Lasix).

The nurse is reviewing prescribed medications for a patient with obesity. Which medications would the nurse recognize as contraindicated for patients taking lorcaserin (Belviq)? Standard Text: Select all that apply. 1. aspirin (ASA) 2. St. John's wort 3. ibuprofen (Motrin) 4. furosemide (Lasix) 5. bupropion (Wellbutrin)

Correct Answer: 2, 3, 5 Rationale 1: Age is not a modifiable risk factor. Rationale 2: Obesity is a modifiable risk factor for cholelithiasis. Rationale 3: The patient should not lose and gain weight frequently. This is a modifiable risk factor. Rationale 4: Family history is not a modifiable risk factor. Rationale 5: Elevated serum cholesterol levels increase the risk for developing cholelithiasis. This is a modifiable risk factor. Global Rationale: Modifiable risk factors for cholelithiasis include obesity, hyperlipidemia, and yo-yo dieting. Age and family history are not modifiable risk factors.

The nurse is teaching a patient about modifiable risk factors for cholelithiasis. What risk factors will the nurse discuss? Standard Text: Select all that apply. 1. age 2. obesity 3. alternating weight loss and gain 4. family history 5. elevated serum cholesterol

Correct Answer: 3, 5 Rationale 1: Hepatitis A virus, not hepatitis B virus, is spread by fecal-oral transmission. Rationale 2: Laënnec cirrhosis is related to alcohol consumption and to chronic hepatitis B or C. Rationale 3: Hepatitis B is contracted through contaminated blood and body fluids. Strategies that reduce exposure to the blood and body fluids of others reduce the risk of hepatitis B transmission. Rationale 4: Hepatitis A virus, not hepatitis B virus, is spread through contaminated food and water. Rationale 5: Hepatitis B is contracted through contaminated blood and body fluids. Using safe sex techniques reduces the risk of hepatitis B transmission. Global Rationale: Hepatitis B is contracted through contaminated blood and body fluids. Strategies that reduce exposure to the blood and body fluids of others, including using safe sex techniques, reduce the risk of hepatitis B transmission. Hepatitis A is transmitted via the fecal-oral route and through contaminated food and water. Laënnec cirrhosis is related to alcohol consumption and to chronic hepatitis B or C.

The nurse is teaching a patient about strategies for reducing the risk of hepatitis B transmission. Which statements by the patient indicate teaching has been effective? Standard Text: Select all that apply. 1. "I will wash my hands frequently to prevent fecal-oral transmission." 2. "I will avoid alcohol." 3. "I will avoid contact with blood and body fluids." 4. "I will avoid contaminated food and water." 5. "I will use safe sex techniques."

Correct Answer: 1, 2 Rationale 1: Chronic H. pylori infection is a major risk factor for PUD. Rationale 2: The use of aspirin and NSAIDs is a major risk factor for PUD. Rationale 3: Alcohol use is not a major risk factor for PUD. Rationale 4: Dietary intake is not a major risk factor for PUD. Rationale 5: The role of stress is uncertain in PUD. Global Rationale: Chronic H. pylori infection and the use of aspirin and NSAIDs are the two major risk factors for PUD. Alcohol and dietary intake do not seem to cause PUD, and the role of stress is uncertain in PUD.

The nurse is teaching a patient about the major risk factors for peptic ulcer disease (PUD). Which risk factors should the nurse discuss? Standard Text: Select all that apply. 1. chronic H. pylori infection 2. use of aspirin and NSAIDs 3. use of alcohol 4. dietary intake 5. stress

Correct Answer: 3 Rationale 1: Food intake may be eliminated during an acute attack of cholecystitis. Rationale 2: A nasogastric tube may be inserted to relieve nausea and vomiting. Rationale 3: If bile flow is obstructed, fat-soluble vitamins (A, D, E, and K) may need to be administered. Rationale 4: Bile salts may need to be administered. Global Rationale: Food intake may be eliminated during an acute attack of cholecystitis, and a nasogastric tube may be inserted to relieve nausea and vomiting. If bile flow is obstructed, fat-soluble vitamins (A, D, E, and K) and bile salts may need to be administered.

The nurse is teaching a patient with an acute attack of cholecystitis about nutritional interventions. Which patient statement indicates additional teaching is required? 1. "I need to stop eating and drinking everything for a while." 2. "I may need a tube inserted into my nose that goes all the way into my stomach." 3. "I may be prescribed vitamins B and C." 4. "I may need extra bile salts to promote health."

Correct Answer: 1, 2 Rationale 1: A CBC with platelets should be monitored. A low RBC count, hemoglobin, and hematocrit indicate anemia related to bone marrow suppression, increased RBC destruction, bleeding, and deficiencies of folic acid and vitamin B12. Platelets are low, related to increased destruction by the spleen. Leukopenia (low WBC count) also relates to splenomegaly. Rationale 2: Coagulation studies reveal the patient's tendency to bleed and the ability of the blood to clot and should be monitored. These studies show a prolonged prothrombin time due to impaired production of coagulation proteins and lack of vitamin K. Rationale 3: Albumin levels reflect liver impairment and/or nutritional status and are not related to risk for bleeding. Rationale 4: Serum ammonia levels elevate during liver failure due to the liver's inability to convert ammonia to urea for renal excretion. This test does not provide information regarding bleeding risk. Rationale 5: Testing for the presence of hepatitis antibodies in the blood does not provide information regarding coagulation. Global Rationale: A CBC with platelets should be monitored. A low RBC count, hemoglobin, and hematocrit indicate anemia related to bone marrow suppression, increased RBC destruction, bleeding, and deficiencies of folic acid and vitamin B12. Platelets are low, related to increased destruction by the spleen. Leukopenia (low WBC count) also relates to splenomegaly. Coagulation studies reveal the patient's tendency to bleed and the ability of the blood to clot. These studies show a prolonged prothrombin time due to impaired production of coagulation proteins and lack of vitamin K. Both the CBC and coagulation studies are key parts of the nurse's analysis of this patient's condition. Albumin levels reflect liver impairment and/or nutritional status and are not related to risk for bleeding. Serum ammonia levels elevate during liver failure due to the liver's inability to convert ammonia to urea for renal excretion. This test does not provide information regarding bleeding risk. Testing for the presence of hepatitis antibodies in the blood does not provide information regarding coagulation.

The nurse notes new areas of ecchymosis on the arms and legs of a patient with liver cirrhosis. Which laboratory test results should the nurse monitor because of this finding? Standard Text: Select all that apply. 1. complete blood count with platelets 2. coagulation studies 3. serum albumin 4. serum ammonia levels 5. serum hepatitis antibodies

Correct Answer: 1, 2, 3 Rationale 1: Vitamin C is critical for wound healing. Rationale 2: A manifestation of vitamin C deficiency is swollen, bleeding gums. Rationale 3: A manifestation of vitamin C deficiency is depression. Rationale 4: Night blindness is associated with vitamin A deficiency. Rationale 5: Muscle wasting is associated with calorie and thiamine deficiencies. Global Rationale: Vitamin C is critical for wound healing. Additional manifestations of vitamin C deficiency include swollen, bleeding gums, and depression. Night blindness is associated with vitamin A deficiency. Muscle wasting is associated with calorie and thiamine deficiencies.

The nurse suspects that a patient has a vitamin C deficiency. What did the nurse assess to come to this conclusion? Standard Text: Select all that apply. 1. delayed wound healing 2. swollen bleeding gums 3. depression 4. night blindness 5. muscle wasting

Correct Answer: 2, 4 Rationale 1: Nausea is not a manifestation of Zollinger-Ellison syndrome. Rationale 2: The peptic ulcers of Zollinger-Ellison syndrome may affect any portion of the stomach or duodenum, as well as the esophagus or jejunum. The high levels of hydrochloric acid entering the duodenum may cause diarrhea. Rationale 3: Belching is not a manifestation of Zollinger-Ellison syndrome. Rationale 4: The peptic ulcers of Zollinger-Ellison syndrome may affect any portion of the stomach or duodenum, as well as the esophagus or jejunum. The high levels of hydrochloric acid entering the duodenum may cause steatorrhea from impaired fat digestion and absorption. Rationale 5: Abdominal pain is not a manifestation of Zollinger-Ellison syndrome. Global Rationale: The peptic ulcers of Zollinger-Ellison syndrome may affect any portion of the stomach or duodenum, as well as the esophagus or jejunum. Characteristic ulcerlike pain is common. The high levels of hydrochloric acid entering the duodenum may cause diarrhea and steatorrhea (excess fat in the feces) from impaired fat digestion and absorption. Nausea, belching, and abdominal pain are not manifestations of Zollinger-Ellison syndrome.

The nurse suspects that a patient is exhibiting manifestations of Zollinger-Ellison syndrome. What did the nurse assess to make this clinical judgment? Standard Text: Select all that apply. 1. nausea 2. diarrhea 3. belching 4. steatorrhea 5. abdominal pain

Correct Answer: 1 Rationale 1: The medication must be taken at mealtime or within the first hour of eating. Rationale 2: It is used to reduce the amount of fat absorbed from dietary intake. Rationale 3: Fat-soluble vitamins will be excreted, and must be replaced by supplements. Rationale 4: To maximize results, the patient must incorporate a low-calorie, low-fat diet into the daily routine. Global Rationale: Orlistat (Xenical) is a lipase inhibitor. The medication must be taken at mealtime or within the first hour of eating. It is used to reduce the amount of fat absorbed from dietary intake. Fat-soluble vitamins will be excreted, and must be replaced by supplements. To maximize results, the patient must incorporate a low-calorie, low-fat diet into the daily routine.

The nurse teaches a patient about the medication orlistat (Xenical). Which patient statement indicates the need for additional teaching? 1. "I should take this medication 30 minutes before eating." 2. "This medication will reduce the amount of fat my body absorbs." 3. "I will need to take supplements of vitamins A, D, E, and K daily." 4. "A low-calorie diet will need to be followed."

Correct Answer: 1 Rationale 1: Portal hypertension, increased pressure in the portal system, has several effects when it is prolonged, including dilation of veins in the gastrointestinal tract and the abdominal wall. Rationale 2: Portal hypertension does not mean blood is leaking from the liver. Portal hypertension tends to suppress (not increase) the appetite. Rationale 3: Portal hypertension is not fast-spreading hypertension, and it is not defined as high blood pressure throughout the abdomen. In advanced liver failure, superficial varices may develop around the umbilicus (not on the arms), a feature known as caput medusae. Rationale 4: Portal systemic encephalopathy (or hepatic encephalopathy), impaired consciousness and mental status, results from the accumulation of toxic waste products in the blood (ammonia in particular) as blood bypasses the congested liver. This is not caused by high abdominal blood pressure. Global Rationale: Portal hypertension, increased pressure in the portal system, has several effects when it is prolonged, including dilation of veins in the gastrointestinal tract and the abdominal wall. This congestion tends to suppress (not increase) the appetite, and lead to formation of collateral vessels in the distal esophagus, stomach, and rectum. The dilated, congested vessels in the esophagus are known as esophageal varices; in the rectum, they lead to the development of hemorrhoids. In advanced liver failure, superficial varices may develop around the umbilicus (not on the arms), a feature known as caput medusae. Portal hypertension does not mean blood is leaking from the liver. It is not fast-spreading hypertension, and it is not defined as high blood pressure throughout the abdomen. Portal systemic encephalopathy (or hepatic encephalopathy), impaired consciousness and mental status, results from the accumulation of toxic waste products in the blood (ammonia in particular) as blood bypasses the congested liver. This is not caused by high abdominal blood pressure

The nurse, teaching a patient about portal hypertension, knows teaching has been effective when the patient makes which statement? 1. "In portal hypertension, blood backs up in the liver. It causes enlarged blood vessels in my esophagus." 2. "In portal hypertension, blood leaks from my liver. It causes me to feel hungry frequently." 3. "Portal hypertension means fast-spreading high blood pressure. It causes red veins on my arms." 4. "Portal hypertension means high blood pressure throughout my abdomen. It causes me to feel confused."

Correct Answer: 1 Rationale 1: Anorexia nervosa typically begins during adolescence. Patients with anorexia nervosa have a distorted body image and irrational fear of gaining weight. Rationale 2: Defiant behaviors involve rebellion. The child is not demonstrating that type of behavior. Rationale 3: It is not normal for a preadolescent child to discontinue eating. Rationale 4: The child is not demonstrating behaviors consistent with an internal power struggle. Global Rationale: Anorexia nervosa typically begins during adolescence. Patients with anorexia nervosa have a distorted body image and irrational fear of gaining weight. Defiant behaviors involve rebellion. The child is not demonstrating that type of behavior. It is not normal for a preadolescent child to discontinue eating. The child is not demonstrating behaviors consistent with an internal power struggle.

The parent of a 12-year-old states, "My child saw an older adolescent who was extremely overweight. Ever since then, my child won't eat." The nurse realizes that the child might be demonstrating what behavior? 1. an irrational fear of gaining weight 2. defiance directed at the parent 3. normal preadolescent behavior 4. an internal power struggle

Correct Answer: 1 Rationale 1: There is no specific diagnostic test for bulimia. Rationale 2: It is not necessary to refer the parent to the physician. Rationale 3: A psychiatric evaluation may be indicated after a diagnosis is made. The information being sought by the patient's parent can be provided by the nurse. Rationale 4: Bulimia can be diagnosed by a competent physician when adequate information is present. Global Rationale: There is no specific diagnostic test for bulimia. It is not necessary to refer the parent to the physician. A psychiatric evaluation may be indicated after a diagnosis is made. The information being sought by the patient's parent can be provided by the nurse. Bulimia can be diagnosed by a competent physician when adequate information is present.

The parent of a 19-year-old patient being evaluated for bulimia asks what diagnostic tests can be done. What is the nurse's best response? 1. "There is no specific test that can determine bulimia." 2. "You should ask the doctor about this." 3. "Your child will need a psychiatric evaluation to determine the diagnosis." 4. "Bulimia is rarely diagnosed correctly."

Correct Answer: 2 Rationale 1: The liver continues to make bilirubin, even during hepatitis. Rationale 2: The icteric (jaundiced) phase usually begins 5 to 10 days after the onset of symptoms. It is heralded by jaundice of the sclera, skin, and mucous membranes. Inflammation of the liver and bile ducts prevents bilirubin from being excreted into the small intestine. As a result, the serum bilirubin levels are elevated, causing yellowing of the skin and mucous membranes. The stools are light brown or clay colored because bile pigment is not excreted through the normal fecal pathway. Rationale 3: The blood does not become darker when bilirubin levels are elevated. Rationale 4: The cause of this phenomenon is known. Global Rationale: The icteric (jaundiced) phase usually begins 5 to 10 days after the onset of symptoms. It is heralded by jaundice of the sclera, skin, and mucous membranes. Inflammation of the liver and bile ducts prevents bilirubin from being excreted into the small intestine. As a result, the serum bilirubin levels are elevated, causing yellowing of the skin and mucous membranes. The stools are light brown or clay colored because bile pigment is not excreted through the normal fecal pathway. Instead, the pigment is excreted by the kidneys, causing the urine to turn brown. The liver continues to make bilirubin, even during hepatitis. The blood does not become darker when bilirubin levels are elevated. The cause of this phenomenon is known.

The patient in the icteric phase of hepatitis asks the nurse, "Why are my stools no longer brown?" How should the nurse respond? 1. "Your liver isn't making any of the substance that makes stools brown." 2. "The pigment is backing up into your blood and turning your skin yellow." 3. "It is being released into your bloodstream and turning your blood darker red." 4. "The answer is not known. More research is needed regarding this question."

Correct Answer: 3 Rationale 1: This is not the reason a nasogastric tube is placed. Rationale 2: This is not the reason a nasogastric tube is placed. Rationale 3: Emptying the stomach reduces the amount of chyme entering the duodenum and the stimulus for gallbladder contractions, thus reducing pain. Rationale 4: The nasogastric tube reduces nausea and vomiting; its use is not related to the prevention of pancreatitis. Global Rationale: Emptying the stomach reduces the amount of chyme entering the duodenum and the stimulus for gallbladder contractions, thus reducing pain. The nasogastric tube is not placed because the patient has not been following a prescribed diet or exercise plan. The tube is not inserted to remove bile. It reduces nausea and vomiting; its use is not related to the prevention of pancreatitis.

The patient with acute cholelithiasis asks why a nasogastric tube has to be inserted. What is the nurse's best response? 1. "You have not been able to follow your prescribed diet and exercise plan." 2. "We need to suck the bile out through your nose as it isn't going to your duodenum." 3. "Keeping your stomach empty allows your gallbladder to rest, reducing pain." 4. "The tube will prevent pancreatitis."

Correct Answer: 1 Rationale 1: The patient is demonstrating a binge-eating disorder. The excessive eating eventually will result in weight gain. Individuals with a body mass index greater than recommended are at an increased risk for the development of type 2 diabetes mellitus. Rationale 2: Type 1 diabetes mellitus is most often seen in children. Individuals who have type 1 diabetes mellitus are usually underweight. Rationale 3: Dehydration is a complication of anorexia nervosa and bulimia nervosa. Rationale 4: Electrolyte imbalances are complications of anorexia nervosa and bulimia nervosa. Global Rationale: The patient is demonstrating a binge-eating disorder. The excessive eating eventually will result in weight gain. Individuals with a body mass index greater than recommended are at an increased risk for the development of type 2 diabetes mellitus. Type 1 diabetes mellitus is most often seen in children. Individuals who have type 1 diabetes mellitus are usually underweight. Dehydration and electrolyte imbalances are complications of anorexia nervosa and bulimia nervosa.

While completing the health history, the nurse learns that a patient often eats excessive amounts of food when alone and when not hungry, and has intense feelings of self-disgust afterwards. The patient denies purging after these episodes. The nurse realizes that the patient is at risk of developing which health problem? 1. type 2 diabetes mellitus 2. type 1 diabetes mellitus 3. dehydration 4. electrolyte imbalances