Med Surg Exam 1
The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following (Select all that apply.) A Alcohol B Caffeine C Corticosteroids D Fruit juice E Nonsteroidal anti-inflammatory drugs (NSAIDs)
A B C E
A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority A Document the findings in the chart. B Request an electrocardiogram (ECG). C Facilitate a serum potassium test. D Place the client on bed rest
B
A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective A "I can only take this medicine at night." B "I should take this on a full stomach." C "This drug decreases stomach acid." D "This should be taken 1 hour before meals."
B
A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best A Arrange an intensive care unit tour. B Assess the client's psychosocial status. C Document the teaching and response. D Have the client begin nutritional supplements.
B
A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client A Enteral tube feeding B Esophageal dilation C Nissen fundoplication D Photodynamic therapy
B
After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching A "Drinking at least 2 liters of water each day is suggested." B "I will decrease the amount of fatty foods in my diet." C "Drinking fluids with my meals will increase bloating." D "I will avoid concentrated sweets and simple carbohydrates.
B
After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching A Ham sandwich on white bread, cup of applesauce, glass of diet cola B Broiled chicken with brown rice, steamed broccoli, glass of apple juice C Grilled cheese sandwich, small banana, cup of hot tea with lemon D Baked tilapia, fresh green beans, cup of coffee with low-fat milk
B
The student nurse studying the gastrointestinal system understands that chyme refers to what A Hormones that reduce gastric acidity B Liquefied food ready for digestion C Nutrients after being absorbed D Secretions that help digest food
B
A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this client's teaching (Select all that apply.) A "Take a 20-minute walk at least 5 days each week." B "Attend local Alcoholics Anonymous (AA) meetings weekly." C "Choose whole grains rather than foods with simple sugars." D "Use cooking spray when you cook rather than margarine or butter." E "Stay away from milk and dairy products that contain lactose." F "We can talk to your doctor about a prescription for nicotine patches."
B D F
A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder (Select all that apply.) A Elevated aspartate transaminase B Elevated international normalized ratio (INR) C Decreased serum globulin levels D Decreased serum alkaline phosphatase E Elevated serum ammonia F Elevated prothrombin time (PT)
B E F
A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride (Versed). The client's respiratory rate is 8 breaths/min. What action by the nurse is best A Administer naloxone (Narcan). B Call the Rapid Response Team. C Provide physical stimulation. D Ventilate with a bag-valve-mask
C
A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate A Assess the client for iodine or shellfish allergies. B Educate the client on the side effects of sedation. C Inform the client a second scan may be needed. D Teach the client about bowel preparation for the scan.
C
A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate A "Aspirin must be avoided." B "Do not worry about black stools." C "Report diarrhea to your provider." D "Take 1 hour before meals."
C
A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first A Client who underwent diverticula removal with a pulse of 106/min B Client who had esophageal dilation and is attempting first postprocedure oral intake C Client who had an esophagectomy with a respiratory rate of 32/min D Client who underwent hernia repair, reporting incisional pain of 7/10
C
After teaching a client who has diverticulitis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching A "I'll ride my bike or take a long walk at least three times a week." B "I must try to include at least 25 grams of fiber in my diet every day." C "I will take a laxative nightly at bedtime to avoid becoming constipated." D "I should use my legs rather than my back muscles when I lift heavy objects."
C
A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis (Select all that apply.) A Anorexia B Dyspepsia C Intolerance of fatty foods D Pernicious anemia E Nausea and vomiting
C D
A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes (Select all that apply.) NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation A Indirect inguinal hernia - An enlarged plug of fat eventually pulls the peritoneum and often the bladder into a sac B Femoral hernia - A peritoneum sac pushes downward and may descend into the scrotum C Direct inguinal hernia - A peritoneum sac passes through a weak point in the abdominal wall D Ventral hernia - Results from inadequate healing of an incision E Incarcerated hernia - Contents of the hernia sac cannot be reduced back into the abdominal cavity
C D E
A nurse is examining a client reporting right upper quadrant (RUQ) abdominal pain. What technique should the nurse use to assess this client's abdomen A Auscultate after palpating. B Avoid any palpation. C Palpate the RUQ first. D Palpate the RUQ last.
D
A nurse studying cancer knows that job-related risks for developing oral cancer include which occupations (Select all that apply.) A Coal miner B Electrician C Metal worker D Plumber E Textile worker
A C D E
A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client (Select all that apply.) A Registered dietitian B Nursing assistant C Clinical pharmacist D Certified herbalist E Health care provider
A C E
A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition (Select all that apply.) A Canned unsweetened apricots B Coffee cake C Milk shake D Potato soup E Steamed broccoli
A D
A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites A Monitor intake and output. B Provide a low-sodium diet. C Increase oral fluid intake. D Weigh the client daily
B
A nurse cares for a middle-aged male client who has irritable bowel syndrome (IBS). The client states, "I have changed my diet and take bulk-forming laxatives, but my symptoms have not gotten better. I heard about a drug called Amitiza. Do you think it might help" How should the nurse respond A "This drug is still in the research phase and is not available for public use yet." B "Unfortunately, lubiprostone is approved only for use in women." C "Lubiprostone works well. I will recommend this prescription to your provider." D "This drug should not be used with bulk-forming laxatives."
B
A nurse plans care for a client with Crohn's disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client's plan of care A Low-fiber diet B Skin protection C Antibiotic administration D Intravenous glucocorticoids
B
The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority A Administer the prescribed pain medication. B Notify the health care provider immediately. C Percuss all four abdominal quadrants. D Take and document a set of vital signs.
B
A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP) A Lavaging the tube with ice water B Performing frequent oral care C Re-positioning the tube every 4 hours D Taking and recording vital signs
B COMFORT MEASURE KEY WORD
A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is in the healing phase of acute pancreatitis. Which statements focused on nutritional requirements should the nurse include when delegating care for this client (Select all that apply.) A "Do not allow the client to eat between meals." B "Make sure the client receives a protein shake." C "Do not allow caffeine-containing beverages." D "Make sure the foods are bland with little spice." E "Do not allow high-carbohydrate food items."
B C D
The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations (Select all that apply.) A Aphasia B Dysphagia C Eructation D Halitosis E Weight gain
B C D
A client is 1 day postoperative after having Zenker's diverticula removed. The client has a nasogastric (NG) tube to suction, and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate A Document the findings as normal. B Irrigate the NG tube with sterile saline. C Notify the surgeon about this finding. D Remove and reinsert the NG tube
C
A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute A Temperature of 100.1° F (37.8° C) B Positive Murphy's sign C Light-colored stools D Upper abdominal pain after eating
C
A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first A Inspection of oral mucosa B Recent dietary intake C Heart rate and rhythm D Percussion of abdomen
C
A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find A Positive Murphy's sign with rebound tenderness to palpitation B Dull, hypoactive bowel sounds in the lower abdominal quadrants C High-pitched, rushing bowel sounds in the right lower quadrant D Reports of abdominal cramping that is worse at night
C
A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, "I am having trouble swallowing this pill." Which action should the nurse take A Contact the clinical pharmacist and request the medication in suspension form. B Empty the contents of the capsule into applesauce or pudding for administration. C Ask the health care provider to prescribe the medication as an enema instead. D Crush the pill carefully and administer it in applesauce or pudding.
C
A nurse cares for a client with acute pancreatitis. The client states, "I am hungry." How should the nurse reply A"Is your stomach rumbling or do you have bowel sounds" B "I need to check your gag reflex before you can eat." C "Have you passed any flatus or moved your bowels" D "You will not be able to eat until the pain subsides."
C
A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful A Arrange a dietary consult. B Increase fluid intake. C Limit the client's foods. D Make the client NPO
A
To promote comfort after a colonoscopy, in what position does the nurse place the client A Left lateral B Prone C Right lateral D Supine
A
The nurse is caring for a client with sialadenitis. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP) (Select all that apply.) A Applying warm compresses B Massaging salivary glands C Offering fluids every hour D Providing lemon-glycerin swabs E Reminding the client to avoid speaking
A C
A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP (Select all that apply.) A "Apply lotion to the client's dry skin areas." B "Use a basin with warm water to bathe the client." C "For the client's oral care, use a soft toothbrush." D "Provide clippers so the client can trim the fingernails." E "Bathe with antibacterial and water-based soaps."
A C D
An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan (Select all that apply.) A Policies related to consistent use of Standard Precautions B Hepatitis vaccination mandate for workers in high-risk areas C Implementation of a needleless system for intravenous therapy D Number of sharps used in client care reduced where possible E Postexposure prophylaxis provided in a timely manner
A C D E
A nurse obtains a client's health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client A "I drink two glasses of red wine each week." B "I take a lot of Tylenol for my arthritis pain." C "I have a cousin who died of liver cancer." D "I got a hepatitis vaccine before traveling."
B
After teaching a client who has a new colostomy, the nurse provides feedback based on the client's ability to complete self-care activities. Which statement should the nurse include in this feedback A "I realize that you had a tough time today, but it will get easier with practice." B "You cleaned the stoma well. Now you need to practice putting on the appliance." C "You seem to understand what I taught you today. What else can I help you with" D "You seem uncomfortable. Do you want your daughter to care for your ostomy"
B
After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching A "I will avoid large crowds and people who are sick." B "I will take this medication with my breakfast each morning." C "Nausea and vomiting are common side effects of this drug." D "I must wash my hands after I play with my dog."
B
After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching A "I'll rinse my rectal area with warm water after each stool and apply zinc oxide ointment." B "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." C "I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry." D "I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."
B
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client A Check with the pharmacist before taking other medications. B Increase intake of calcium and vitamin D. C Report any worsening of symptoms to the provider. D Take the medication as prescribed by the provider.
B
A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood (Select all that apply.) A Ask a second nurse to double-check the blood. B Prime the IV tubing with normal saline. C Prime the IV tubing with dextrose in water. D Take and record a set of vital signs. E Teach the client about reaction manifestations
A B D E
A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition (Select all that apply.) A Administer vitamin B12 injections. B Ask the provider about folic acid replacement. C Educate the client on enteral feedings. D Obtain consent for total parenteral nutrition. E Provide iron supplements for the client.
A B E
A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this client's assessment (Select all that apply.) A "Which food types cause an exacerbation of symptoms" B "Where is your pain and what does it feel like" C "Have you lost a significant amount of weight lately" D "Are your stools soft, watery, and black in color" E "Do you experience nausea associated with defecation"
A B E
A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find (Select all that apply.) A Distended abdomen B Inability to pass flatus C Bradycardia D Hyperactive bowel sounds E Decreased urine output
A B E
A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result (Select all that apply.) A "How frequently do you drink alcohol" B "Have you ever had sex with a man" C "Do you have a family history of cancer" D "Have you ever worked as a plumber" E "Were you previously incarcerated"
A B E
A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate (Select all that apply.) A Administer the drug through a separate IV line. B Infuse pantoprazole using an IV pump. C Keep the drug in its original brown bag. D Take vital signs frequently during infusion. E Use an in-line IV filter when infusing.
A B E
The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to what organ dysfunctions (Select all that apply.) A Alanine aminotransferase: biliary system B Ammonia: liver C Amylase: liver D Lipase: pancreas E Urine urobilinogen: stomach
B D
A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis (Select all that apply.) A Serum potassium of 2.8 mEq/L B Loss of 15 pounds without dieting C Abdominal pain in upper quadrants D Low-pitched bowel sounds E Serum sodium of 121 mEq/L
A C E
A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching A "It's a good thing I love orange and cherry gelatin." B "My spouse will be here to drive me home." C "I should refrigerate the GoLYTELY before use." D "I will buy a case of Gatorade before the prep.
A
A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best A Ask the client about shellfish allergies. B Document this information on the chart. C Ensure that the client has a ride home. D Instruct the client on bowel preparation
A
A nurse assesses a client with Crohn's disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider A Distended abdomen B Temperature of 100.0° F (37.8° C) C Loose and bloody stool D Lower abdominal cramps
A
A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, "I do not want to take this medication because it causes diarrhea." How should the nurse respond A "Diarrhea is expected; that's how your body gets rid of ammonia." B "You may take Kaopectate liquid daily for loose stools." C "Do not take any more of the medication until your stools firm up." D "We will need to send a stool specimen to the laboratory."
A
An older client has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best A "Changes in your liver cause drugs to be metabolized differently." B "Perhaps you don't need as high a dose of the drug as before." C "Stomach muscles atrophy with age and you digest more slowly." D "Your body probably can't tolerate as much medication anymore."
A
A client has been discharged to an inpatient rehabilitation center after an esophagogastrectomy. What menu selections by the client at the rehabilitation center indicate a good understanding of dietary instructions (Select all that apply.) A Boost™ supplement B Greek yogurt C Scrambled eggs D Whole milk shake E Whole wheat toast
A B C D
The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching (Select all that apply.) A "I just joined a gym, so I hope that helps me lose weight." B "I sure hate to give up my coffee, but I guess I have to." C "I will eat three small meals and three small snacks a day." D "Sitting upright and not lying down after meals will help." E "Smoking a pipe is not a problem and I don't have to stop."
A B C D
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD) (Select all that apply.) A Delayed gastric emptying B Eating large meals C Hiatal hernia D Obesity E Viral infections
A B C D
A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly (Select all that apply.) A Performs hand hygiene and positions the client in high-Fowler's position, with pillows behind the head and shoulders B Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx C Checks for correct placement by checking the pH of the fluid aspirated from the tube D Secures the NG tube by taping it to the client's nose and pinning the end to the pillowcase E Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent
A C E
After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching (Select all that apply.) A "I must change the ostomy appliance daily and as needed." B "I will use warm water and a soft washcloth to clean around the stoma." C "I might start bicycling and swimming again once my incision has healed." D "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." E "I will check the stoma regularly to make sure that it stays a deep red color." F "I must avoid dairy products to reduce gas and odor in the pouch."
B C D
A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond A "Ambulating in the hallway twice a day will help." B "I will apply a cold compress to the painful area on your back." C "Drinking a warm beverage can relieve this referred pain." D "You should cough and deep breathe every hour."
A
The nurse working in the gastrointestinal clinic sees clients who are anemic. What are common causes for which the nurse assesses in these clients (Select all that apply.) A Colon cancer B Diverticulitis C Inflammatory bowel disease D Peptic ulcer disease E Pernicious anemia
A B C D
A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse instructs the client and family about the signs of potential complications, which include what problems (Select all that apply.) A Cholangitis B Pancreatitis C Perforation D Renal lithiasis E Sepsis
A B C E
The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include (Select all that apply.) A Decreased hydrochloric acid production B Diminished sensation that can lead to constipation C Fat not digested as well in older adults D Increased peristalsis in the large intestine E Pancreatic vessels become calcified
A B C E
The student nurse learns about risk factors for gastric cancer. Which factors does this include (Select all that apply.) A Achlorhydria B Chronic atrophic gastritis C Helicobacter pylori infection D Iron deficiency anemia E Pernicious anemia
A B C E
A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes (Select all that apply.) NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation A Lower gastrointestinal bleeding - Erosion of the bowel wall B Abscess formation - Localized pockets of infection develop in the ulcerated bowel lining C Toxic megacolon - Transmural inflammation resulting in pyuria and fecaluria D Nonmechanical bowel obstruction - Paralysis of colon resulting from colorectal cancer E Fistula - Dilation and colonic ileus caused by paralysis of the colon
A B D
A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this client's plan of care (Select all that apply.) NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort A Using premoistened disposable wipes for perineal care B Turning the client from right to left every 2 hours C Using an antibacterial soap to clean after each stool D Applying a barrier cream to the skin after cleaning E Keeping broken skin areas open to air to promote healing
A B D
The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the unlicensed assistive personnel (UAP) (Select all that apply.) A Assisting with position changes and getting out of bed B Keeping the head of the bed elevated to at least 30 degrees C Reminding the client to use the spirometer every 4 hours D Taking and recording vital signs per hospital protocol E Titrating oxygen based on the client's oxygen saturations
A B D
The nurse is aware of the 2014 American Cancer Society Screening Guidelines for colon cancer, which include which testing modalities for people over the age of 50 (Select all that apply.) A Colonoscopy every 10 years B Colonoscopy every 5 years C Computed tomography (CT) colonography every 5 years D Double-contrast barium enema every 10 years E Flexible sigmoidoscopy every 10 years
A C
A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching (Select all that apply.) A Chocolate B Decaffeinated coffee C Citrus fruits D Peppermint E Tomato sauce
A C D E
A nurse cares for a client who has a nasogastric (NG) tube. Which actions should the nurse take (Select all that apply.) NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control A Assess for proper placement of the tube every 4 hours. B Flush the tube with water every hour to ensure patency. C Secure the NG tube to the client's upper lip. D Disconnect suction when auscultating bowel peristalsis. E Monitor the client's skin around the tube site for irritation.
A D E
A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this client's condition (Select all that apply.) A Body mass index of 46 B Vegetarian diet C Drinking 4 ounces of red wine nightly D Pregnant with twins E History of metabolic syndrome F Glycosylated hemoglobin level of 15%
A D F