Exam 3 Lewis. Chapter 43, Exam 3 Lewis. Chapter 42, Exam 3 Lewis. Chapter 41, Exam 3 Lewis. Chapter 23, Exam 3 Chapter 11. Lewsis

A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

"Can you tell me more about the pain?"

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate?

"Do you use any over-the-counter drugs?"

The nurse is admitting a 67-yr-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask?

"Have you noticed a recent weight loss?"

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)?

"How long have you had abdominal pain?"

The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement?

"I can take a shower and walk around the house tomorrow."

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?

"I should apply sunscreen before going outdoors."

A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect?

. 2 After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider?

. Fever

What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B?

. Measures for improving appetite

In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change.

3

After change-of-shift report, which patient should the nurse assess first?

A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting

Which patient should the nurse assess first after receiving change-of-shift report?

A 30-yr-old patient who has a distended abdomen and tachycardia

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?

A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)

What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?

Abdominal distention

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?

Abdominal pain is decreased.

What should the nurse admitting a patient with acute diverticulitis plan for initial care?

Administer IV fluids.

The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority?

Administer prescribed opioids to relieve pain as needed.

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?

Administer the spironolactone

Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis?

Albumin level

What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?

Ammonia levels

A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness?

Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge?

Apply a scrotal support and ice to reduce swelling.

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." What action should the nurse take?

Ask the patient about the concerns with stoma management.

A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first?

Ask the patient to describe the stools and any associated symptoms

How should the nurse prepare a patient with ascites for paracentesis?

Ask the patient to empty the bladder.

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

Ask the patient to extend both arms forward.

A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC)guidelines,which actionshould the nurse include in care when the patient is seen for a routine annual physical examination?

Ask whether the patient has been screened for hepatitis C

A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?

Assess the perineal drainage and incision.

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?

Asterixis and lethargy

Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?

Avoiding all alcohol use

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)?

Brushing the teeth and tongue

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?

Check blood pressure and heart rate.

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. What should the nurse do during the initial assessment of the patient?

Check for circulation and tissue perfusion

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action?

Check for tube placement and reposition it.

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next?

Check the calcium level in the chart.

What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis?

Cigarette smoking

What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia?

Cobalamin (B12) supplements

A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do?

Collect a stool specimen.

What should the nurse preparing for the annual physical exam of a 45-yr-old man plan to teach the patient about?

Colonoscopy

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease?

Corn tortilla with scrambled eggs

A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?

Crackles are heard halfway up the posterior chest.

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus?

Cullen sign

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care?

Discontinue the patient's oral food intake.

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take?

Document stoma assessment findings.

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?

Drain and measure the output from the ostomy

A patient reports gas pains andabdominaldistention 2 days after a small bowel resection. Which nursing action should the nurse take?

Encourage the patient to ambulate.

Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowelsyndrome(IBS)?

Encourage the patient to express concerns and ask questions about IBS.

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?

Fewer episodes of bleeding varices

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

Fistulas can form between the bowel and bladder.

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first?

Infuse a liter of lactated Ringer's solution over 30 minutes.

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first?

Infuse metronidazole (Flagyl) 500 mg IV

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?

Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

Lipase

Which information will the nurse plan to teach a patient who has lactose intolerance?

Live-culture yogurt is usually tolerated.

Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless?

Maintain adequate nutrition.

The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome?

Maintaining normal respiratory function

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first?

Manually remove the impacted stool.

What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)?

Mealtime

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient?

Medication use

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

Monitor stools for blood.

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

Monitor the patient for shortness of breath.

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test?

Monitor the tumor status after surgery

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis?

Muscle twitching and finger numbness

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?

Navy bean soup and vegetable salad

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?

Oatmeal with cream

Which assessment finding is of most concern for a patient with acute pancreatitis?

Palpable abdominal mass

A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice?

Patient who requires pain management for chronic pancreatitis

A patient with chronic hepatitis B infection has several medications prescribed. Which medication order requires clarification with the health care provider before administration?

Pegylated -interferon (Pegasys) orally once daily

Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile?

Place the patient in a private room on contact isolation.

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

Place the patient on a pressure-relief mattress.

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?

Place the patient on contact precautions.

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care?

Position patient with the knees flexed.

A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy?

Positive urine pregnancy test

A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?

Prepare the patient for surgery.

For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?

Providing oral hygiene after a meal

A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first?

Question the patient about risk factors for constipation.

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

Review the patient's current medication list.

Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?

Schedule for liver cancer screening every 6 months.

A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate?

Schedule the patient for HCV genotype testing.

A 19-yr-old patient has familial adenomatouspolyposis(FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?

Schedule the patient for yearly colonoscopy

Which prescribed intervention for a patient with chronic short bowel syndrome should the nurse question?

Senna 1 tablet daily

A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?

Stools test negative for occult blood.

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?

Suggest the patient lie on the side, flexing the right leg

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching?

Take prescribed pain medications before you expect a bowel movement.

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago?

Temperature 100.8° F (38.2° C)

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices?

The medication will prevent irritation of the enlarged veins.

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider?

The patient has noticed blood in the stools

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis?

The patient is alert and oriented.

Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?

The patient used IV drugs about 20 years ago.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

The patient uses witch hazel compresses to soothe irritation.

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

The patient's hands flap back and forth when the arms are extended.

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis?

The patient's stools are tan colored.

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include?

The site where the stoma will be located will be marked on the abdomen preoperatively.

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching?

This type of colostomy is usually temporary.

A critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence?

Use a fecal management system

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

Use care when eating high-fiber foods to avoid obstruction of the ileum.

After an unimmunized person isexposedtohepatitisBthrough a needle-stick injury, which actions will the nurse plan to take? (Select all that apply.)

a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. d. Give hepatitis B immune globulin

The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient's blood specimen reveals:

anti-HBs

The nurse administering -interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for:

leukopenia

A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to:

turn, cough, and deep breathe every 2 hours