HCAL Exam 3 Practice Questions

What is the minimum # of points that would suggest a dx of RA?

7

Which prescribed intervention for a patient with chronic short bowel syndrome will the nurse question? a. Senna 1 tablet every day b. Ferrous sulfate 325 mg daily c. Psyllium (Metamucil) 3 times daily d. Diphenoxylate with atropine (Lomotil) prn loose stools

ANS: A Senna 1 tablet every day patients with SBS have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives

Match the location of the intestinal obstruction to the corresponding patient report of symptoms a. "I have been vomiting every few hours for 3 days." b. "The pain in my belly just will not go away." c. "I have gradually become more constipated." 1. distal SI 2. proximal SI 3. large intestine

ANS: "I have been vomiting every few hours for 3 days." → proximal SI "The pain in my belly just will not go away." → large intestine "I have gradually become more constipated." → distal SI

The lab results of a patient with UC indicate anemia. The nurse determines which factor is most likely responsible for this lab finding? a. Blood loss b. A diet low in iron c. Frequent diarrhea d. Intestinal malabsorption of B12

ANS: A blood loss

a nurse is assessing a client who has Crohn's disease. which of the following findings should the nurse expect? a. fatty diarrheal stools b. hyperkalemia c. weight gain d. sharp epigastric pain

ANS: A fatty diarrheal stools

A patient with Crohn's disease reports passing stool when urinating. Which surgical tx would the nurse anticipate? a. Fistula repair b. Colostomy formation c. Ileal pouch formation d. Total proctocolectomy

ANS: A fistula repair

A patient with intestinal obstruction receives stent placement under endoscopy prior to surgical intervention. Which assessment finding indicates that the stent has been effective? a. Flatus b. Normal stoma function c. Hypoactive bowel sounds d. Dark NG drainage

ANS: A flatus

The nurse provides discharge teaching for a patient who was hospitalized with a bowel impaction. Which instruction does the nurse give to the patient to prevent further episodes of constipation? a. maintain a high intake of fluid and fiber in the diet b. reduce the intake of medications that cause constipation c. eat several small meals per day to maintain bowel motility d. sit upright during meals to increase bowel motility by gravity

ANS: A maintain a high intake of fluid and fiber in the diet

a patient who experiences acute abdominal pain and nausea asks the nurse "why do I need to have a NGT inserted?" how does the nurse respond? a. the tube will help to drain the stomach contents and prevent further vomiting b. the tube will push past the area that is blocked and thus help to stop the vomiting c. the tube is a standard procedure before many types of abdominal surgeries d. the tube will let us measure your stomach contents to help us plan what type of IVF replacement will be most effective.

ANS: A the tube will help to drain the stomach contents and prevent further vomiting

A patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups daily. a. 2 b. 3 c. 4 d. 5

ANS: A 2 the average amount of ileostomy drainage is about 500 mL daily

A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value? a. IgE b. IgA c. Basophils d. Neutrophils

ANS: A IgE serum IgE is elevated in an allergic response

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

ANS: A Navy bean soup and vegetable salad a diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis

A patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

ANS: A Position patient with the knees flexed. there is less peritoneal irritation with the knees flexed, which will help decrease pain

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to a. administer IV fluids. b. prepare for colonoscopy. c. give stool softeners and enemas. d. order a diet high in fiber and fluids.

ANS: A administer IVF a patient with acute diverticulitis will be NPO and given parenteral fluids

The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should a. avoid activities requiring repetitive use of the same muscles and joints. b. protect the knee joints by sleeping with a small pillow under the knees. c. stand rather than sit when performing daily household and yard chores. d. strengthen small hand muscles by wringing out sponges or washcloths.

ANS: A avoid activities requiring repetitive use of the same muscles and joints. patients with RA are advised to avoid repetitious movements

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication? a. Blurred vision b. Joint tenderness c. Abdominal cramping d. Elevated blood pressure

ANS: A blurred vision plaquenil can cause retinopathy

A patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to a. collect a stool specimen. b. prepare for colonoscopy. c. schedule a barium enema. d. have blood cultures drawn.

ANS: A collect a stool specimen acute diarrhea is usually caused by an infectious process and stool specimens are obtained for culture and examines for parasites or WBC

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? a. Fever b. Nausea c. Joint pain d. Headache

ANS: A fever infliximab suppresses the immune response so rapid treatment of infection is essential

A patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months. The nurse will plan to teach about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions

ANS: A medication use medications are used to induce and maintain remission in patients with IBD

During an assessment, the patient states that his bowel movements cause discomfort because the stool is hard and difficult to pass. As the nurse, you make which of the following suggestions to assist the patient with improving the quality of his bowel movement? (SATA) a. increase fiber intake b. increase water consumption c. decrease physical exercise d. refrain from alcohol e. refrain from smoking

ANS: A, B increase fiber intake increase water consumption

The nurse is caring for a patient with intestinal obstruction. The patient has an NGT in place and is receiving IV fluid therapy. The nurse understands that which assessment findings indicate the treatment is effective? (SATA) a. normoactive bowel sounds b. decrease in N and V c. serum K of 3.8 mEq/L d. FBG of 91 mg/dL e. WBC of 14.0 cells/mcL

ANS: A, B, C normoactive bowel sounds decrease in N and V serum K of 3.8 mEq/L

A patient with RA presents to the clinic for a routine check up. The nurse notes that the patient may develop a disease exacerbation because of which assessment findings? (SATA) a. Presence of rheumatoid nodules b. Extreme dryness of the eyes of mouth c. Elevated ESR d. Report of a demanding job with long hours e. New-onset paresthesias in the extremities

ANS: A, B, D, E Presence of rheumatoid nodules Extreme dryness of the eyes of mouth Report of a demanding job with long hours New-onset paresthesias in the extremities

The nurse is providing post-op care for a patient with an intestinal obstruction. The nurse takes the patient's vital signs and notes a HR of 105, RR 12, SpO2 92%, and T or 102.3°F. Which intervention should be implemented? (SATA) a. Provide stoma care b. Administer antibiotic c. Assess NG tube d. Administer antipyretic e. Assess abdominal incision f. Ask patient to turn, cough, and breathe deeply

ANS: A, B, D, E Provide stoma care Administer antibiotic Administer antipyretic Assess abdominal incision

When conducting a health history assessment, the nurse would want to know what important information about the patients elimination status? (SATA) a. recent changes in elimination patterns b. change in color, consistency, or odor of stool or urine c. time of day patient defecates d. discomfort or pain with elimination e. list of medications taken by patient f. patients preferences with toileting

ANS: A, B, D, E recent changes in elimination patterns change in color, consistency, or odor of stool or urine discomfort or pain with elimination list of medications taken by patient

The nurse is caring for a patient with IBD who reports frequent diarrhea, nausea, poor appetite, and a weight loss of 10 lbs in the past 2 weeks. The nurse notes pallow, poor skin turgor, mild peripheral edema, and dry mucous membranes. Which actions would be a priority for the nurse to take? (SATA) a. Calculate I and O b. Administer narcotic analgesic c. Infuse IV albumin d. Administer IVF e. Provide dose IV antibiotic

ANS: A, C, D calculate I and O infuse IV albumin administer IVF

The nurse is assessing a patient with Crohn's disease. Which assessment findings suggest the development of complications related to the disorder? a. Jaundice b. Nystagmus c. Clubbed fingers d. Aphthous ulcers e. Peripheral neuropathy

ANS: A, C, D jaundice clubbed fingers peripheral neuropathy

Which factors will the nurse include when planning to teach a group of teens about IBD? (SATA) a. Stress b. HTN c. A high-fat diet d. Cigarette smoking e. STD

ANS: A, C, D stress high fat diet cigarette smoking

A female patient with RA states that she has been treated for years with different medications but is frustrated that she still hasn't achieved relief. Which responses from the nurse are appropriate? (SATA) a. Maybe you should try yoga or Tai Chi b. Try adding some herbal supplements to the medication regimen c. You should ask your HCP about joint replacement d. Symptoms of RA can be alleviated with weight loss and some adjustments to activities e. You can speak to your HCP about transcutaneous electrical nerve stimulation (TENS)

ANS: A, C, E Maybe you should try yoga or Tai Chi You should ask your HCP about joint replacement You can speak to your HCP about transcutaneous electrical nerve stimulation (TENS)

Which information should the nurse obtain when assessing an older adult patient who is taking multiple medications for osteoarthritis? (SATA) a. Mental status b. Level of activity c. List of medications d. Recent lab results e. Changes in arthritic symptoms

ANS: A, C, E mental status list of medications changes in arthritis symptoms

a nurse is caring for a client who has UC. the client has had several exacerbations over the past 3 years. which of the following instructions should the nurse include in the plan of care to minimize the risk of further exacerbations? (SATA) a. use progressive relaxation techniques b. increase dietary fiber c. drink two 240 mL (8 oz) glasses of milk per day d. arrange activities to allow for daily rest periods e. restrict intake of carbonated beverages

ANS: A, D, E use progressive relaxation techniques arrange activities to allow for daily rest periods restrict intake of carbonated beverages

The nurse is caring for a patient with suspected IBD. Which assessment finding warrants immediate health care provider notification? a. Albumin level 2.8 g/dL b. K level 2.6 mEq/L c. HBG level 10.0 g/dL d. WBC 11.2 cells/mcL

ANS: B K level 2.6 mEq/L

Jan is a 70-year-old retired nurse who is interested in nondrug, mind-body therapies, self-management, and alternative strategies to deal with joint discomfort from rheumatoid arthritis. What options should you consider in her plan of care considering her expressed wishes? a. Stationary exercise bicycle, free weights, and spinning class b. Mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy c. Chamomile tea and IcyHot gel d. Acupuncture and attending church services

ANS: B Mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy

Which changes can be seen in bones of a patient diagnosed with osteoarthritis? a. Osteopenia b. Osteophytes c. Osteoporosis d. Osteomyelitis

ANS: B Osteophytes

A nurse is caring for a patient with Crohn's disease after surgery to tx an intestinal stricture. The pt has normal respiratory effort, is lethargic, and reports a 7/10 pain. THe nurse notes redness and inflammation around the incision, absent bowel sounds, and a 101.8°F fever. Which action is most important for the nurse to take? a. Administer O2 nasal cannula b. Administer scheduled antibiotic c. Administer laxative suppository d. Change dressing to incision

ANS: B administer scheduled antibiotic

A patient with IBD presents with a weight loss of 10 pounds in the past month. The patient reports poor appetite and frequent diarrhea. Which lab value is most concerning? a. HCT 35% b. Albumin level 2.2 g/dL c. FBG 76 g/dL d. WBC 10.9 cells/mcL

ANS: B albumin level 2.2

Which teaching should the nurse provide to a patient with RA who has just started taking azathioprine? a. Increase oral fluid intake b. Avoid people who are sick c. Adhere to a weekly blood test d. Refrain from being out in the sun

ANS: B avoid people who are sick (bc this is an immunosuppressant drug)

A patient is being treated with an antibiotic. The nurse explains to the patient that this medication is required for the reduction of inflammation at the injury site because this medication a. will decrease the pain at the site b. helps to kill the infection causing the inflammation c. inhibits COX d. will reduce the patients fever

ANS: B helps to kill the infection causing the inflammation

the nurse identifies which important goal for a hospitalized patient with fecal incontinence? a. eliminate once a day b. maintain perianal skin integrity c. cope with depression by having alone time d. alleviate all nonessential activities

ANS: B maintain perianal skin integrity

The nurse is caring for a patient with N, V, and severe pain. For which health care provider order would the nurse anticipate to prepare the patient? a. fecal occult blood b. obstructive series c. expiatory laprotomy d. MRI

ANS: B obstructive series

a patient with IBD receives a prescription for a corticosteroid. the nurse identifies that the patient is at risk for which condition that is associated with the medication? a. tuberculosis b. osteoporosis c. hepatotoxicity d. hypersensitivity

ANS: B osteoporosis

A patient presents with colicky abdominal pain, N, V, and abdominal distension. The HCP has prescribed diagnostic tests to determine if the pt has an intestinal obstruction. Which physical assessment finding would indicate the condition has worsened? a. Hypoactive bowel sounds b. Rigid, board-like abdomen c. Diarrheal bowel movement d. Positive stool for occult blood

ANS: B rigid, board-like abdomen

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "The medication will be tapered if I need surgery." b. "I will need to use a sunscreen when I am outdoors." c. "I will need to avoid contact with people who are sick." d. "The medication prevents the infections that cause diarrhea."

ANS: B "I will need to use a sunscreen when I am outdoors." sulfasalazine may cause photosensitivity in some patients

A patient who collects honey to earn supplemental income has developed a hypersensitivity to bee stings. Which statement, if made by the patient, would indicate a need for additional teaching? a. "I need to find a different way to earn extra money." b. "I will take oral antihistamines before going to work." c. "I will get a prescription for epinephrine and learn to self-inject it." d. "I should wear a Medic-Alert bracelet indicating my allergy to bee stings."

ANS: B "I will take oral antihistamines before going to work." because the patient is at risk for bee stings and the severity of allergic reactions tend to increase with added exposure to allergen, taking oral antihistamines will not adequately control the patient's hypersensitivity reaction

Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present. b. Applying cold packs before exercise may decrease joint pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.

ANS: B Applying cold packs before exercise may decrease joint pain. cold application is helpful in reducing pain during periods of exacerbation of RA

A 25-yr-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first? a. Inform the patient that laboratory testing of blood and stools will be necessary. b. Ask the patient to describe the character of the stools and any associated symptoms. c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. d. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility

ANS: B Ask the patient to describe the character of the stools and any associated symptoms.

Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis? a. Blood glucose b. C-reactive protein c. Serum electrolytes d. Liver function tests

ANS: B CRP CRP is a serum marker for inflammation, a decrease in CRP would indicate that corticosteroid therapy was effective

A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider? a. Red, scaly patches are noted on the arms. b. Crackles are auscultated in the lung bases. c. Hemoglobin is 11.1g/dL, and hematocrit is 35%. d. Patient has continued pain after first week of etanercept therapy

ANS: B Crackles are auscultated in the lung bases. heart failure is a possible adverse effect of etanercept, the medication needs to be discontinued

Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about management of the condition? a. Exercise by taking long walks. b. Do daily deep-breathing exercises. c. Sleep on the side with hips flexed. d. Take frequent naps during the day

ANS: B Do daily deep-breathing exercises. deep breathing exercises are used to decrease the risk for pulmonary complications that may result from reduced chest expansion that occurs with AS

The nurse taking a health history learns that the patient, who has worked in rubber tire manufacturing, has allergic rhinitis and multiple food allergies. Which action by the nurse is correct? a. Recommend that the patient use latex gloves in preventing blood-borne pathogen contact. b. Document the patient's history and teach about clinical manifestations of a type I latex allergy. c. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops. d. Advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves

ANS: B Document the patient's history and teach about clinical manifestations of a type I latex allergy. the patient's allergy history and occupation indicate a risk for developing a latex allergy

Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)? a. Instruct the patient to purchase a soft mattress. b. Encourage the patient to take a nap in the afternoon. c. Teach the patient to use lukewarm water when bathing. d. Suggest exercise with light weights several times daily.

ANS: B Encourage the patient to take a nap in the afternoon. adequate rest helps decrease fatigue and pain associated with RA

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Insert a urinary catheter to drainage. b. Infuse metronidazole (Flagyl) 500 mg IV. c. Send the patient for a computerized tomography scan. d. Place a nasogastric (NG) tube to intermittent low suction.

ANS: B Infuse metronidazole (Flagyl) 500 mg IV. peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy

A 74-yr-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Question the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

ANS: B Question the patient about risk factors for constipation. the nurse's initial action should be further assessment of the patient for risk factors of constipation and for his usual bowel pattern

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider? a. The patient has a history of constipation. b. The patient has noticed blood in the stools. c. The patient had an appendectomy at age 27. d. The patient smokes a pack/day of cigarettes.

ANS: B The patient has noticed blood in the stools. blood in the stools is a possible indication of colorectal cancer

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate? a. The patient had a history of infectious mononucleosis as a teenager. b. The patient is trying to get pregnant before her disease becomes more severe. c. The patient has a family history of age-related macular degeneration of the retina. d. The patient has been using large doses of vitamins and health foods to treat the RA

ANS: B The patient is trying to get pregnant before her disease becomes more severe. methotrexate is tetarogenic and the patient should be taking contraceptives during methotrexate therapy

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? a. The patient uses incontinence briefs to contain loose stools. b. The patient uses witch hazel compresses to soothe irritation. c. The patient asks for antidiarrheal medication after each stool. d. The patient cleans the perianal area with soap after each stool.

ANS: B The patient uses witch hazel compresses to soothe irritation. witch hazel compresses are suggested to reduce anal irritation and discomfort

Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone? a. The patient has joint pain and stiffness. b. The patient's blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.

ANS: B The patient's blood glucose is 165 mg/dL. corticosteroids have the potential to cause diabetes mellitus

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

ANS: B Use care when eating high-fiber foods to avoid obstruction of the ileum high fiber foods should be introduced gradually and be well chewed to avoid obstruction

The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a. a brief routine of isometric exercises. b. a warm bath followed by a short rest. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness

ANS: B a warm bath followed by a short rest. taking a warm shower or bath is recommended to relieve joint stiffness which is worse in the morning

The nurse preparing for the annual physical exam of a 50-yr-old man will plan to teach the patient about: a. endoscopy. b. colonoscopy. c. computerized tomography screening. d. carcinoembryonic antigen (CEA) testing

ANS: B colonoscopy at age 50, individuals with an average risk for colorectal cancer should begin screening for CRC

A patient being admitted with an acute exacerbation of ulcerative colitis reports cramping abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to: a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery

ANS: B discontinue the patient's oral food intake an initial therapy for an acute exacerbation of IBD is to rest the bowel by making the patient NPO

A young woman who has 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? a. Bacteria in the perianal area can enter the urethra. b. Fistulas can form between the bowel and bladder. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse

ANS: B fistulas can form between the bowel and bladder fistulas between the bowel and bladder can occur in Crohn's disease and lead to a UTI

Which nursing action will the nurse include in the plan of care for a 35-yr-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Ambulate six times daily. d. Increase dietary fiber intake.

ANS: B monitor stools for blood anemia or hemorrhage may occur with IBD, stools should be assessed for presence of blood

A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA) and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate? a. "You need to see a family therapist for some help with stress." b. "Tell me more about the situations that are causing you stress." c. "Your family should understand the impact of your rheumatoid arthritis." d. "Perhaps it would be helpful for your family to be involved in a support group."

ANS: B "Tell me more about the situations that are causing you stress."

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? a. Stimulant and saline laxatives can be used regularly. b. Bulk-forming laxatives are an excellent source of fiber. c. Walking or cycling frequently will help bowel motility. d. A good time for a bowel movement may be after breakfast. e. Some over-the-counter (OTC) medications cause constipation.

ANS: B, C, D, E Bulk-forming laxatives are an excellent source of fiber. Walking or cycling frequently will help bowel motility. A good time for a bowel movement may be after breakfast. Some over-the-counter (OTC) medications cause constipation.

A nurse is caring for a patient with UC and abdominal cramping who reports 10-15 episodes of diarrhea daily. Which lab tests would the nurse anticipate? (SATA) a. Lipase b. Albumin c. Hemoglobin d. Total cholesterol e. ESR

ANS: B, C, E albumin hemoglobin ESR

During assessment of a patient with reports of N, V, and severe abdominal pain, the nurse notes increased abdominal girth and tenderness. Which additional symptoms indicate the presence of intestinal obstruction? (SATA) a. Hyperkalemia b. Abdominal rigidity c. Respiratory alkalosis d. Hypoactive bowel sounds e. Presence of skip lesions in colonoscopy

ANS: B, D abdominal rigidity hypoactive bowel sounds

A patient with UC is admitted to the med surg unit for tx of symptoms. Which provider orders should the nurse anticipate? a. Elevate HOB b. Initiate IVF c. Prepare pt for surgery d. Place pt on NPO e. Administer antibiotic therapy

ANS: B, D, E initiate IVF, place pt on NPO, administer antibiotic therapy

Which assessment findings would the nurse expect to find for a patient with diagnosed Crohn's disease that has developed complications outside of the GI tract? (SATA) a. Epistaxis b. Joint pain c. Periorbital edema d. Red patches on the legs e. Eye redness and itching

ANS: B, D, E joint pain red patches on legs eye redness and itching

A patient diagnosed with osteoarthritis (OA) would have which manifestations? (SATA) a. Low-grade fever b. Joint pain and stiffness c. Generalized body malaise d. Grating sensation with movement e. Nodes at the proximal interphalangeal joints

ANS: B, D, E joint pain and stiffness grating sensation with movement nodes at the proximal interphalangeal joints

Which information about a patient would indicate an increased risk for developing osteoarthritis? a. A pt is 20 years old b. Pt installs flooring for a living c. Pt has spouse with OA d. Pt has hx of DM e. Pt has sustained knee injury while attending college

ANS: B, D, E pt installs floors for a living pt has a hx of DM pt has sustained a knee injury while attending college

Which patients are at an increased risk for developing a mechanical obstruction? (SATA) a. Patient with a L5 spinal compression fracture b. Patient with 10-year history of Crohn's disease c. Patient with serum K of 2.5 mEq/L d. Patient with atherosclerosis of mesenteric artery e. Patient who has undergone multiple abdominal surgeries

ANS: B, E Patient with 10-year history of Crohn's disease Patient who has undergone multiple abdominal surgeries

A patient with suspected IBD reports 15-20 diarrheal stools per day. Which question would the nurse ask the patient to help determine a diagnosis of UC vs. Crohn's disease a. "Do you have family members with IBD?" b. "Have you been tested for colorectal cancer?" c. "Have you noticed a lot of blood in your stool?" d. "When did you first begin these symptoms?"

ANS: C "Have you noticed a lot of blood in your stool?"

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? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

ANS: C Can you tell me more about the pain

Which condition involves inflammation of all layers of the bowel wall? a. peritonitis b. gastroenteritis c. Crohn's disease d. ulcerative colitis

ANS: C Crohn's disease

A nurse is instructing her patient with ulcerative colitis regarding the need to avoid enteric coated medications. The nurse knows that the patient understands the reason for this teaching when he states which of the following? a. the coating of these medications is irritating to my intestines b. I need a more immediate response from my medications that can be obtained from enteric coated medications. c. Enteric coated medications are absorbed lower in the GI tract and can be irritating to my intestines or inadequately absorbed by my inflamed tissue d. I don't need to use these medications because they cause diarrhea, and I have had enough trouble with diarrhea and rectal bleeding over the past weeks.

ANS: C Enteric coated medications are absorbed lower in the GI tract and can be irritating to my intestines or inadequately absorbed by my inflamed tissue

Which patient statement indicates correct understanding about the management of RA? a. I like to knit to keep my joints active b. I only use ice packs to try to relieve pain c. I have started taking a yoga class weekly d. I wear my hand splints except when gardening

ANS: C I have started taking a yoga class weekly

a nurse is providing discharge teaching for a client who has mild diverticulitis. Which of the following statements by the client indicates an understanding go the teaching? a. I may experience right lower quadrant pain b. I will remain active by working in my garden everyday c. I should eat foods that are low in fiber d. I will use a mild laxative everyday

ANS: C I should eat foods that are low in fiber

the nurse provides education for a patient who has diverticular disease but is not experiencing an acute episode at this time. which statement by the patient indicates understanding of the teaching? a. I will eat a diet that is low in fiber b. I will avoid eating nuts and seeds c. I will decrease my intake of fat and red meat d. I will continue to work out by lifting weights

ANS: C I will decrease my intake of fat and red meat

Which neurological condition is associated with constipation? a. dementia b. spina bifida c. parkinson's d. myeomeningocele

ANS: C Parkinson's disease

The nurse is caring for a patient with intestinal obstruction who reports severe abdominal pain, N, and V. The nurse notes 36 mL of urine output in 3 hours and an elevated BUN. Which action is most important for the nurse to take? a. Auscultate bowel sounds b. Measure abdominal girth c. Administer bolus of IVF d. Prepare pt for surgery

ANS: C administer bolus of IVF

The nurse is caring for a patient with IBD who reports frequent diarrhea and vomiting and a pain level of 8/10. The nurse notes poor skin turgor, dry mucous membranes, and abdominal tenderness and palpation. Which provider order would the nurse implement first? a. Administer corticosteroids b. Administering bulking agent c. Administer pain meds d. Administer IVF

ANS: C administer pain meds

The nurse is preparing to administer medications to a patient with RA. The nurse explains to the patient that the goal of medication treatments for RA is to a. eradicate the disease b. enhance immune response c. control inflammation d. manage pain

ANS: C control inflammation

A patient with an intestinal obstruction recently had surgery to create an ileostomy. In the immediate post-op period, the nurse who is caring for the patient anticipates assessing for which frequent complication of this surgery? a. Fatty stools b. Rectal bleeding c. Electrolyte imbalances d. Formation of adhesions

ANS: C electrolyte imbalances

The nurse is caring for a pt who presents with N and V. The x-ray reveals a lower intestinal obstruction. Which provider order would the nurse implement first? a. Administer oral laxative b. Provide bland, low-fat diet c. Insert NGT d. Offer pt pain meds

ANS: C insert NGT

When assessing a patient with a GI disorder, the nurse finds an absence of bowel sounds. The assessment findings are indicative of which condition? a. volvulus b. borborygmi c. paralytic ileus d. pseudopolyps

ANS: C paralytic ileus

A nurse is caring for a patient with intestinal obstruction who has been vomiting for 4 days. The nurse notes pallor, dry mucosa, and poor skin turgor. Which diagnostic tests are most important for the nurse to obtain? a. Hemoglobin b. Total bilirubin c. Serum electrolytes d. Amylase and lipase

ANS: C serum electrolytes

A nurse is caring for a patient with IBD who reports palpitations and weakness. The nurse notes a thready, irregular heartbeat. Which lab result would the nurse review first? a. Serum glucose b. Serum albumin c. Serum potassium d. CBC

ANS: C serum potassium

The nurse is caring for a patient with an intestinal obstruction caused by strictures. For which procedure would the nurse anticipate to prepare the patient? a. obstructive series b. surgical ileostomy formation c. stent placement via endoscopy d. computerized tomography scan (CT)

ANS: C stent placement via endoscopy

Which is a cause of nonmechanical intestinal obstruction? a. hernia b. intussusception c. thoracic spinal fracture d. strictures from Crohn's disease

ANS: C thoracic spinal fracture

Etanercept (Enbrel) is prescribed for a patient with stage 2 RA. The nurse determines that the medication is effective if what is observed? a. decreased lymphocyte count b. absence of Rh factor in the blood c. decreased CRP d. increased IgG

ANS: C decreased CRP Enbrel inhibits binding of TNF resulting in decreased inflammation

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is a. "You have the right to refuse to take the methotrexate." b. "Methotrexate is less expensive than some of the newer drugs." c. "It is important to start methotrexate early to decrease the extent of joint damage." d. "Methotrexate is effective and has fewer side effects than some of the other drugs."

ANS: C "It is important to start methotrexate early to decrease the extent of joint damage." DMARD's are prescribed early to prevent joint degeneration that occurs as soon as the first year of having RA

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? a. Auscultation for bowel sounds b. Nasogastric (NG) tube irrigation c. Applying petroleum jelly to the lips d. Assessment of the nares for irritation

ANS: C Applying petroleum jelly to the lips

The nurse reviewing a clinic patient's medical record notes that the patient missed the previous appointment for weekly immunotherapy. Which action by the nurse is appropriate? a. Schedule an additional dose the following week. b. Administer the scheduled dosage of the allergen. c. Consult with the health care provider about giving a lower allergen dose. d. Re-evaluate the patient's sensitivity to the allergen with a repeat skin test.

ANS: C Consult with the health care provider about giving a lower allergen dose. there is an increased risk for adverse reactions after a patient misses a scheduled dose of an allergen so the nurse should check with the HCP before administration of the injection

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? a. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the previous 6 hours

ANS: C Crackles are heard halfway up the posterior chest. the presence of crackles in an older patient receiving ICF at a high rate suggests possible fluid overload

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown

ANS: C Drain and measure the output from the ostomy

A male patient diagnosed with RA asks why he developed this disease when his parents and siblings do not have it. Which response by the nurse is appropriate a. Do you have a hx of sickle cell disease? b. When did you notice the onset of symptoms? c. Have you ever been diagnosed with EBV d. Do you have cousins or other relatives diagnosed with RA?

ANS: C Have you ever been diagnosed with EBV? RA is an autoimmune disease that can be caused by infectious organisms such as EBV

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? a. Administer bulk-forming laxatives. b. Assist the patient to sit on the toilet. c. Manually remove the impacted stool. d. Increase the patient's oral fluid intake.

ANS: C Manually remove the impacted stool. this is the initial action, the other actions will be used to prevent future constipation and impactions

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? a. Assist the patient to cough and deep breathe. b. Palpate the abdomen for rebound tenderness. c. Suggest the patient lie on the side, flexing the right leg. d. Encourage the patient to sip clear, noncarbonated liquids

ANS: C Suggest the patient lie on the side, flexing the right leg. the clinical manifestations are consistent with appendicitis - this is the most comfortable position

A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is appropriate? a. Ask the HCP about discontinuing methotrexate b. Remind the patient that RA is a chronic health condition. c. Suggest the patient use over-the-counter (OTC) artificial tears. d. Teach the patient about adverse effects of the RA medication

ANS: C Suggest the patient use over-the-counter (OTC) artificial tears. The patient's dry eyes are consistent with Sjogren's syndrome which is a common manifestation of RA

Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)? a. Rheumatoid factor is positive. b. Fasting blood glucose is 90 mg/dL. c. The white blood cell (WBC) count is 1500/µL. d. The erythrocyte sedimentation rate is elevated.

ANS: C The white blood cell (WBC) count is 1500/µL. bone marrow suppression is a possible side effect of methotrexate, and the patient's low WBC count places the patient at a high risk for infection

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? a. Draw blood for rheumatoid factor analysis. b. Teach the patient about injections for the nodules. c. Assess the nodules for skin breakdown or infection. d. Discuss the need for surgical removal of the nodules.

ANS: C assess the nodules for skin breakdown or infection nodules can break down or become infected

A patient is anxious and reports difficulty breathing after being stung by a wasp. What is the nurse's priority action? a. Provide high-flow oxygen. b. Administer antihistamines. c. Assess the patient's airway. d. Remove the stinger from the site.

ANS: C assess the patient's airway the initial action with any patient with difficulty breathing is to assess and maintain the airway

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to a. auscultate for hypotonic bowel sounds. b. notify the patient's health care provider. c. check for tube placement and reposition it. d. remove the tube and replace it with a new one.

ANS: C check for tube placement and reposition it. repositioning the tube will frequently facilitate drainage

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

ANS: C oatmeal with cream during acute exacerbations of IBD, the patient should avoid high fiber foods

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about a. avoiding concurrent aspirin use. b. symptoms of gastrointestinal (GI) bleeding. c. self-administration of subcutaneous injections. d. taking the medication with at least 8 oz of fluid

ANS: C self-administration of subcutaneous injections. Anakinra is administered subQ

Which patient has the highest risk for developing IBD a. A 45-year-old Asian female b. A 35-year-old Hispanic female c. A 55-year-old African American male d. A 25-year-old Ashkenazic Jewish male

ANS: D A 25-year-old Ashkenazic Jewish male

The nurse is caring for a patient with an intestinal obstruction and severe vomiting who reports palpitations and fatigue. The nurse notes a serum K of 2.2 mEq/L and a thready pulse. Which action would the nurse take first? a. Administer antiemetic b. Administer O2 via nasal cannula c. Administer bolus of IV fluid d. Administer IVPB with K

ANS: D Administer IVPB with K

The healthcare team is planning care for a patient with RA who reports having difficulty dressing and undressing and bathing. Which team members services would the patient benefit from? a. Dietician b. Social worker c. Physical therapist d. Occupational therapist

ANS: D Occupational therapist

The nurse is developing a care plan for a patient with RA. Which priority goal would guide the nurse in addressing the patient's condition? a. Pt will understand need for hospitalization b. Pt will demonstrate home exercise program c. Pt will verbalize feelings of self-worth and content d. Patient will perform ADLs independently

ANS: D Patient will perform ADLs independently

Which information should a community health nurse include when educating a group of middle-aged adults about diagnostic testing for OA a. Patient will undergo synovial fluid analysis b. Dx is made based on patient's symptoms c. OA symptoms develop in people before age of 40 d. Presence of Heberden's and Bouchard's nodes is suggestive of OA

ANS: D Presence of Heberden's and Bouchard's nodes is suggestive of OA

Which patient is at an increased risk for a nonmechanical obstruction? a. Pt with hx of hernia b. Pt tx with diverticulitis c. Pt admitted who had colonoscopy d. Pt who underwent open cholecystectomy

ANS: D Pt who underwent open cholecystectomy

Which is the rationale for the nurse to instruct the patient with IBD who is receiving antibiotics to eat yogurt daily? a. To alleviate nausea and calm the stomach b. To provide a source of protein for the patient c. To meet calcium needs when a deficiency is present d. To prevent the occurrence of C. diff infection

ANS: D To prevent the occurrence of C. diff infection

The nurse is caring for a patient with intestinal obstruction. Which lab finding would be most concerning? a. K of 5.0 mEq/L b. HBG of 11.0 g/dL c. Platelet of 150,000 mcL d. WBC of 18.0 cells/mcL

ANS: D WBC of 18.0 cells/mcL

The nurse is caring for a patient with an intestinal obstruction with severe N and V. The HCP orders insertion of NGT, administer of bolus of IVF, hydromorphone 2mg IVP q3h PRN, and urinalysis. Which intervention is most important for a nurse to implement first? a. Obtain urinalysis b. Give hydromorphone c. Administer bolus of IVF d. Insert NGT

ANS: D insert NGT

The nurse is caring for a patient admitted with nausea, vomiting, and abdominal pain. Which additional finding indicates the possibility of intestinal obstruction? a. active bowel sounds b. soft and rounded abdomen c. report of occasional flatulence d. last bowel movement was a week ago

ANS: D last bowel movement was a week ago

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?"

ANS: D "How long have you had abdominal pain?" one criterion for the diagnosis of IBS is the presence of abdominal discomfort or pain for at least 3 months

Which patient should the nurse assess first after receiving change-of-shift report? a. A 60-yr-old patient whose new ileostomy has drained 800 mL over the previous 8 hours b. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool c. A 40-yr-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours d. A 30-yr-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

ANS: D A 30-yr-old patient who has abdominal distention and an apical heart rate of 136 beats/minute the patient's abdominal dissension and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction

After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? a. Notify the health care provider. b. Obtain a stool specimen for analysis. c. Teach the patient about handwashing. d. Place the patient on contact precautions

ANS: D Place the patient on contact precautions the patient's history and new onset diarrhea suggest C. diff infection

The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates more patient teaching is needed? a. The patient takes a 2-hour nap each day. b. The patient has been taking 16 aspirins each day. c. The patient sits on a stool while preparing meals. d. The patient sleeps with two pillows under the head.

ANS: D The patient sleeps with two pillows under the head. the joint should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping

A patient who is receiving immunotherapy has just received an allergen injection. Which assessment finding is most important to communicate to the health care provider? a. The patient's IgG level is increased. b. The injection site is red and swollen. c. The patient's symptoms did not improve in 2 months. d. There is a 2-cm wheal at the site of the allergen injection

ANS: D There is a 2-cm wheal at the site of the allergen injection a local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed

A patient with diverticulosis has a large bowel obstruction. The nurse will monitor for a. referred back pain. b. metabolic alkalosis. c. projectile vomiting. d. abdominal distention.

ANS: D abdominal distension abdominal dissension is seen in lower intestinal obstruction

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for a. iron dextran infusions b. oral ferrous sulfate tablets. c. routine blood transfusions. d. cobalamin (B12) supplements

ANS: D cobalamin (B12) supplements crohn's disease frequently affects the ileum where the absorption of cobalamin occurs

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? a. Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives. b. Dietary sources of fiber should be eliminated to prevent excessive gas formation. c. Use of this type of laxative to prevent constipation does not cause adverse effects. d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

ANS: D large amounts of fluid should be taken to prevent impaction or bowel obstruction a high fluid intake is needed when patients are using bulf-forming laxatives to avoid worsening constipation

Which manifestations would indicate that a patient is in the late stage of rheumatoid arthritis (RA)? (SATA) a. Weakness b. Paresthesias c. Low-grade fever d. Gel phenomenon e. Peripheral neuropathy

ANS: D, E gel phenomenon (morning joint stiffness) peripheral neuropathy