Exam4 Practice Questions

A nurse is conducting nutritional counseling with a client who is in her second trimester of pregnancy. The nurse should recommend the client increase her caloric intake by how many calories during this trimester? 110 cal/day 225 cal/day 340 cal/day 450 cal/day

340 cal/day Rationale: The nurse should recommend the client increase her calorie intake by 340 cal/day.

A nurse at a health fair is assessing the weight status of four clients. Which of the following clients are classified as overweight? A client who has a body mass index of 24 A client who has a body mass index of 29 A client who body mass index of 18.5 A client who has a body mass index of 32

A client who has a body mass index of 29 Rationale: A client who has a BMI of 25 to 29.9 is classified as overweight.

A nurse is caring for a client who has dysphagia. Which of the following actions should the nurse take? Elevate the client's head of the bed to 45° during meals Instruct the client to tilt their head back while swallowing Turn on the client's television during meals Alternate the client's liquids and solids during meals

Alternate the client's liquids and solids during meals. Rationale: The nurse should alternate liquids and solids so the client can clear their mouth before adding additional food. This action promotes swallowing and decreases the risk of aspiration.

A nurse is providing teaching for a client who has experienced an acute episode of gastritis. Which of the following instructions should the nurse include in the teaching? Limit drinking milk. Take NSAIDs for pain. Avoid drinking alcohol. Limit strenuous exercise.

Avoid drinking alcohol. Rationale: The nurse should teach the client to avoid drinking alcohol because it increases manifestations of gastritis.

A nurse is caring for a client who has a percutaneous endoscopicgastrostomy (PEG) tube and is receiving intermittent feedings. Prior toinitiating the feeding, which of the following actions should the nursetake first? A. Flush the tube with water B. Place the client in semi-fowler's position C. Cleanse the skin around the tube site D. Aspirate the tube prior to each feeding

B. Place the client in semi-fowler's position ** The nurse should apply the ABC priority-setting framework. A client receiving PEG tube feedings should be positioned with the head of the bed elevated at least 30 degrees during and after feedings to decrease the risk of aspiration.

A nurse is preparing to insert a peripheral IV catheter. Which of the following antiseptics is the nurse's best choice for preparing the client's skin at the insertion site? Alcohol Chlorhexidine Tincture of iodine Povidone-iodine

Chlorhexidine Rationale: Chlorhexidine is the antiseptic preferred by the Infusion Nurses Society (INS) to decrease peripheral catheter insertion site infections.

A nurse is assessing a client who has an inadequate dietary intake of fiber. Which of the following findings should the nurse expect? Memory loss Bleeding gums Constipation Brittle hair

Constipation Rationale: Inadequate intake of fiber can cause constipation.

A nurse is monitoring the laboratory results of a client who has end-stage liver failure. Which of the following results should the nurse expect? A.Decreased lactate dehydrogenase B.Increased serum albumin C.Decreased serum ammonia D.Increased prothrombin time

D.Increased prothrombin time Clients who have end-stage liver failure have an inadequate supply of clotting factors and an increased (i.e. prolonged) prothrombin time.

A nurse is instructing a group of clients about nutrition. The nurse should include that which of the following is a trigger for the formation of vitamin D in the body? Calcium Vitamin A depletion Exposure to sunlight Weight-bearing exercise

Exposure to sunlight Rationale: Exposure to sunlight triggers the formation of vitamin D in the body.

A nurse is caring for a client who experienced an infection at the insertion site of her intravenous catheter. Which of the following findings should the nurse expect? The client reports numbness at the site. Purulent drainage is noted from the site. The vein appears cordlike. Skin over the site is sloughing.

Purulent drainage is noted from the site. Rationale: Signs of infection include warmth, redness, swelling, and possible purulent drainage.

A nurse is preparing a client for placement of a catheter for total parenteral nutrition. Which of the following access sites should the nurse plan to prepare for catheter insertion? Left antecubital vein Right subclavian vein Right femoral artery Left arm radial artery

Right subclavian vein Rationale: The right subclavian vein is the most common access site for total parenteral nutrition.

A nurse is providing teaching to the parent of a toddler about appropriate snacks. Which of the following foods should the nurse include? Sliced bananas Raw celery Peanut butter Grapes

Sliced bananas Rationale: Sliced bananas are appropriate to include as a snack for a toddler.

A nurse is providing teaching for a client who has gastroesophageal reflux disease (GERD) about ways to manage his condition. Which of the following instructions should the nurse include? "Sleep on your left side "Drink milk to soothe your stomach "Eat four small meals each day "Wait to go to bed for 1 hr after eating."

"Eat four small meals each day." Rationale: The client should avoid eating large meals because of the pressure it places on the stomach. Instead, he should eat four to six small meals per day.

A nurse is reinforcing teaching about food choices with the mother of an 8-month-old infant. Which of the following statements by the mother indicates a need for further teaching? "I will give my child strained carrots and mashed egg yolks "I will give my child rice cereal and crackers "I will give my child pureed liver and strained pears "I will give my child applesauce and green peas

"I will give my child strained carrots and mashed egg yolks." Rationale: It is acceptable to introduce strained, mashed, or pureed foods from the ages of 6 months to 1 year. Eggs and cheese products should not be introduced during the first year. New foods should be introduced in small amounts, such as 1 tsp, to detect an allergy. Eggs are a common food for allergies and can cause a severe allergic reaction in an infant resulting in constriction of the airway.

A nurse is providing teaching about the Mediterranean diet to a client newly who has a new diagnosis of hypertension. Which of the following statements by the client indicates a need for further teaching? "I will limit my intake of red meat to twice weekly "I can have dairy in moderate portions daily. "I can have fish two times a week. "I can drink wine in moderation.

"I will limit my intake of red meat to twice weekly. Rationale: This statement by the client indicates a need for further teaching. Following the Mediterranean diet, red meat should be limited to two times monthly.

A nurse is providing teaching to a client who has peptic ulcer disease and a new prescription for sucralfate tablets. Which of the following information should the nurse provide? "An antacid may be taken with the medication if indigestion occurs." "Take sucralfate 1 hr before meals." "Take the tablets whole." "Store sucralfate in the refrigerator."

"Take sucralfate 1 hr before meals." Rationale: Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness.

A nurse is teaching a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? A. Digesting fats B. Producing chyme C. Stimulating gastric acid secretion D. Providing energy

A. Digesting fats Bile is a product of the liver and aids in the digestion of fats.

A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A.Emesis with a coffee-ground appearance B.Increased blood pressure C.Decreased heart rate D.Bright green stools

A.Emesis with a coffee-ground appearance The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee-grounds or is bright red in color. Hematemesis indicates upper gastrointestinal bleeding, occurring at or above the duodenojejunal junction.

A nurse is recommending dietary modifications for a client who has GERD. The nurse should suggest eliminating which of the following foods from the client's diet? A.Oranges and tomatoes B.Carrots and bananas C.Potatoes and squash D.Whole wheat and beans

A.Oranges and tomatoes Symptoms of GERD worsen following the oral intake of substances that decrease lower esophageal stricture (LES) pressure. These include alcohol, caffeine, nicotine, chocolate, fatty foods, citrus fruits, tomatoes, and peppermint.

A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report which of the following manifestations? (Select all that apply.) A.Regurgitation B.Nausea C.Belching D.Heartburn E.Weight loss

A.Regurgitation B.Nausea C.Belching D.Heartburn Regurgitation and heartburn are primary manifestations of GERD. Nausea and belching are also common manifestations.

A nurse is presenting an in-service training session about nutrition. How many of the amino acids must be obtained from dietary intake? A. 6 B. 9 C. 11 D. 15

B. 9 Proteins are made up of chains of amino acids, which are composed of carbon, hydrogen, oxygen, and nitrogen. Nine amino acids are considered essential for the human body and must be obtained from diet. These include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

A nurse is providing discharge teaching to the partner of a client who has a new diagnosis of hepatitis A. Which of the following instructions should the nurse include in the teaching? A."During this illness, she may take acetaminophen for fevers or discomfort." B."Encourage her to eat foods that are high in carbohydrates." C."The provider will prescribe a medication to help her liver heal faster." D."Have her perform moderate exercise to restore her strength more quickly."

B."Encourage her to eat foods that are high in carbohydrates." The client's diet should be high in carbohydrates and calories with only moderate amounts of protein and fat, especially if nausea is present.

A nurse is assessing a client who is 12 hr postoperative following an open cholecystectomy. Which of the following findings should the nurse report to the provider? A.Hypoactive bowel sounds B.Indwelling urinary catheter output of 25 mL/hr C.Heart rate of 96/min D.Serous drainage at the surgical incision site

B.Indwelling urinary catheter output of 25 mL/hr The nurse should report a urinary output of <30 mL/hr to the provider, as this can indicate hypovolemia or renal complication.

A nurse in a provider's office is assessing a client who has GERD. When documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions? A.Stair-climbing B.Bending over C.Sitting D.Walking

Bending over Gastroesophageal reflux symptoms are most evident with activities that increase intraabdominal pressure (e.g. bending over, straining, lifting, and lying down).

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected range within 72 hours after treatment begins? A. Aldolase B.Lipase C. Amylase D. Lactic dehydrogenase

C. Amylase ** Pancreatitis is the most common diagnosis for marked elevations in serum amylase. serum amylase begins to increase about 3 to 6 hours following the onset of acute pancreatitis. the amylase level peaks in 20 to 30 hr and returns to the expected reference range within 2 to 3 days

A nurse is checking a client who was admitted with a down obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? A. Elevated blood pressure B. Bowel sound increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

C. Rigid abdomen ** Abdominal tenderness and rigidity occur with bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume and a lowered blood pressure, or hypotension>

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicates that a possible bowel perforation has occurred? A.Elevated blood pressure B.Bowel sounds increased in frequency and pitch C.Rigid abdomen D.Emesis of undigested food

C.Rigid abdomen Abdominal tenderness and rigidity indicate a bowel perforation. As fluid escapes into the peritoneal cavity, a reduction in circulating blood volume occurs, lowering blood pressure.4

A nurse is providing teaching for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The client asks about foods he should avoid eating. Which of the following foods should the nurse tell him to avoid Nonfat milk Chocolate Apples Oatmeal

Chocolate Rationale: The client should avoid foods that reduce pressure on the lower esophageal sphincter. These include fatty and fried foods, chocolate, caffeine, alcohol, and carbonated drinks.

A nurse is collecting data from a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High-calorie diet B. Prior gastrointestinal illness C. tobacco use D. Alcohol use

D. Alcohol use ** alcohol consumption is one of the major causes of chronic pancreatitis in the u.s Long-term Alcohol use disorder produces hyper secretion of protein in pancreatic secretions. Alcohol has a direct toxic effect on the cells of the pancreas

A nurse is assisting with the care of a client who is receiving total parenteral nutrition therapy and has just returned to the room following physical therapy. The nurse noted that the infusion pump for the client's TPN is turned off. After restarting the infusion pump the nurse shoal monitors the client for which of the following? A. Hypertension B. Excessive thirst C. Fever D.Diaphoresis

D.Diaphoresis ** The Nurse should recognize that the client has the potential for the development of hypoglycemia due to the sudden withdrawal of the ten solutions in addition to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusions, and hunger

A nurse is providing dietary teaching to a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? A.Avoid foods containing protein B.Drink liquids during each meal C.Eat foods that contain simple sugars D.Maintain a supine position after meals

D.Maintain a supine position after meals The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at once, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper gastrointestinal tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine and decreasing blood volume, which causes the client to experience nausea and vomiting, sweating, syncope, palpitations, increased heart rate, and hypotension.

A nurse is planning an in-service training session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes plays a role in the digestion of protein? A.Amylase B.Lipase C.Steapsin D.Pepsin

D.Pepsin Pepsin is an enzyme secreted by the gastric mucosa that breaks down protein into polypeptides. Other enzymes such as trypsin and aminopeptidase further break down the polypeptides into amino acids, which can be used by the body.

A nurse is providing teaching to the guardian of a child who has celiac disease. Which of the following foods should the nurse instruct the guardian to omit from the child's diet? A.Cornflakes B.Reduced-fat milk C.Canned fruits D.Wheat bread

D.Wheat bread Clients who have celiac disease should eliminate as much gluten as possible from their diets. Wheat, rye, and barley contain gluten and should be eliminated from the diet of a child who has celiac disease.

A nurse is assessing a client who has malnutrition. Which of the following findings should the nurse expect? Increased vital capacity Moist skin Heat intolerance Decreased mental status

Decreased mental status Rationale: Lethargy and depression are manifestation of malnutrition. The brain requires glucose to function. When the body lacks adequate glucose, the body will metabolize tissue such as muscle and fat. The resulting metabolic acidosis can further decrease the client's mental status.

A nurse is caring for a client who is experiencing postoperative nausea and vomiting. The nurse should monitor the client for which of the following complications of vomiting? Dehydration Diarrhea Urinary frequency Peripheral edema

Dehydration Rationale: The client is at risk for dehydration and electrolyte imbalance. Therefore, the nurse should monitor the client for hypotension, tachycardia, and reduced urine output.

A client has a new order for metoclopramide. What potential side effects should the nurse educate the client about? Extrapyramidal Peptic ulcer disease Gastric slowing Nausea

Extrapyramidal Rationale: Metoclopramide (Reglan) is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely.Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 39: Management of Patients with Oral and Esophageal Disorders, Benign Tumors of the Esophagus, p. 1258.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse recognize as a complication of this therapy? Hyperglycemia Aspiration Diarrhea Stomatitis

Hyperglycemia Rationale: TPN is prescribed when extensive nutritional support for prolonged periods of time is required. It is delivered through a central venous access device, usually via the internal jugular or subclavian vein. TPN contains a high concentration of dextrose, which can result in hyperglycemia. Frequent glucose monitoring should be implemented in clients receiving TPN.

A nurse is providing dietary teaching for a client who has a new diagnosis of celiac disease which of the following statements by the client indicates an understanding of teaching I can return to my regular diet when I am free of symptoms I will need to avoid taking vitamin supplements while on his diet I will need to avoid taking vitamin supplements while on his diet I will eat beans to ensure I get enough fiber in my diet

I will eat beans to ensure I get enough fiber in my diet Clients who have celiac disease must maintain a gluten-free diet which illuminates fiber rich whole wheat products clients should eat beans nuts fruits and vegetables ensuring adequate intake of fiber

A client diagnosed with gastritis is asking the nurse why famotidine is being prescribed instead of cimetidine, which they have been prescribed in the past. Which statement by the nurse is appropriate for this client? "It has fewer drug to drug interactions. "It helps heal the lining of the stomach." "It reduces the amount of bleeding from ulcers." "It enhances the effects of antibiotics given for H. pylori."

It has fewer drug to drug interactions." Rationale: Famotidine decreases the amount of hydrochloric acid produced by the stomach by blocking the action of histamine on histamine receptors of parietal cells in the stomach. Famotidine has a lower risk of drug-drug interactions than cimetidine, which has many drug-drug interactions.Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 40: Management of Patients with Gastric and Duodenal Disorders, Gastritis, p. 1269.

A client with a new prescription for Metoclopramide (Reglan). Which symptom should the nurse instruct the client to report immediately as a potentially serious adverse effect? Constipation Diarrhea Lip Smacking Agitation

Lip smacking Rationale: Involuntary lip smacking and other uncontrollable movements of the face, head, legs, arms, or body are characteristic of tardive dyskinesia, This condition is a potential side effect of neuroleptic drugs, including antipsychotic medications, as well as antiemetics such as metoclopramide. Movements characteristic of tardive dyskinesia include torticollis and a protruding of twisting tongue. the risk of tardive dyskinesia incre3ases in older clients, in those on high doses, and in clients on long-term therapy. Tardive dyskinesia is frequently an irreversible condition.Metoclopramide blocks dopaminergic receptors in the chemoreceptor trigger zone of the central nervous system, stimulates increased motility of the upper GI tract, and increases the rate of gastric emptying. It is also used to treat post-operative nausea and vomiting, GERD, and intractable hiccups. Other adverse effects associated with metoclopramide include neuroleptic malignant syndrome and extrapy

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? Iron deficiency anemia Aplastic anemia Megaloblastic anemia Sickle cell anemia

Megaloblastic anemia Rationale: Strict vegetarians are at risk for megaloblastic anemias, characterized by abnormally large, nucleated RBCs, if they do not supplement their diet with vitamin B12.

A nurse is assessing a client who has an inadequate dietary intake of omega-3 fatty acids. Which of the following findings should the nurse expect? Memory loss Bleeding gums Constipation Brittle hair

Memory loss Rationale: Inadequate intake of omega-3 fatty acids can cause memory loss and fatigue.

A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug? Metoclopramide Omeprazole Lansoprazole Calcium carbonate

Metoclopramide Rationale: Metoclopramide (Reglan) is useful in promoting gastric motility.Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 39: Management of Patients with Oral and Esophageal Disorders, p. 1258.

The nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action should the nurse include in the plan of care? Prepare the client for emergency antrectomy. Insert a nasogastric tube to drain stomach contents Assess vital signs every shift Monitor hourly urine output

Monitor hourly urine output. Rationale: The treatment of hemorrhage includes obtaining frequent vital signs, monitoring hemoglobin and hematocrit levels, and assessing hourly urine output to detect oliguria as soon as possible.Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 40: Management of Patients with Gastric and Duodenal Disorders, Peptic Ulcer Disease, p. 1276.

A nurse is providing dietary teaching for a client who has a burn injury and adheres to a vegan diet. The nurse should recommend which of the following foods as the best source of protein to promote wound healing? One cup of brown rice One cup of orange juice One cup of pureed avocado One cup of lentils

One cup of lentils Rationale: The nurse should determine that nuts and legumes, such as lentils, are the best foods to recommend for protein intake for this client. One cup of lentils contains 17.86 g of protein. A diet high in protein and calories is required to promote wound healing. Nuts and legumes are good sources of protein to include in a plant based diet such as a vegan diet.

A nurse caring for a client who is vomiting. Which of the following actions should the nurse take first? Provide the client with an emesis basin Notify housekeeping Prevent the client from aspirating Administer an antiemetic to the client

Prevent the client from aspirating Rationale: When using the airway, breathing, circulation approach to client care, the nurse determines the priority action is to prevent the client from aspiration by turning the client to his side and suctioning his airway.

A client with gastroesophageal reflux disease (GERD) comes to the physician's office reporting a burning sensation in the esophagus. The nurse documents that the client is experiencing Pyrosis Dyspepsia Dysphagia Odynophagia

Pyrosis Rationale: Pyrosis refers to a burning sensation in the esophagus and indicates GERD.Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 39: Management of Patients with Oral and Esophageal Disorders, Gastroesophageal Reflux Disease, p. 1257.

A nurse is teaching a client who is on a low sodium diet. Which of the following instructions should the nurse include? Limit intake of canned soups to 2 servings Replace fresh meats with processed meats Choose bottled salad dressings Read labels on foods before eating

Read labels on foods before eating Rationale: The client should read food labels to determine sodium content of foods in order to choose foods that are low in sodium.

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: stress and anxiety gram-negative bacteria alcohol and tobacco ibuprofen and aspirin

gram-negative bacteria. Rationale: The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 40: Management of Patients with Gastric and Duodenal Disorders, Gastritis, p. 1267and 1271

A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed? isotonic fluid no intravenous solution hypertonic solution hypotonic solution

hypertonic solution Rationale: A hypertonic solution is used to pull water back in to circulation, as it has more particles than the body's water. If hypertonics are given too rapidly or in large quantities, they may cause an extracellular volume excess and precipitate circulatory overload and dehydration. As a result, these solutions must be given cautiously and usually only when the serum osmolality has decreased to dangerously low levels. Hypertonic solutions exert an osmotic pressure greater than that of the extracellular fluid. The hospitalized client requires treatment for the tissue edema. An isotonic solution is the same concentration as the body's water and is used as an intravenous volume expander. A hypotonic solution has fewer particles than the body's water, thus shifting water from the vascular space to the tissue.