MED SURG QUIZ

2. A client wants to lose 1.5 pounds a week. After reviewing a diet history, the nurse determines the client typically eats 2450 calories a day. What should the clients calorie goal be to achieve this weight loss? (Record your answer using a whole number.) __ calories/day

ANS: 1700 calories/day

1. A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number.) ____ mL

ANS: 25 mL

3. A client is receiving continuous tube feeding at 70 mL/hr. When the bag is empty, how much formula does the nurse add? (Record your answer using a whole number.) _____ mL

ANS: 280 mL

1. A client weighs 228 pounds (103.6 kg) and is 53 (160 cm) tall. What is this clients body mass index (BMI)? (Record your answer using a decimal rounded up to the nearest tenth.) _____

ANS: 40.4

23. A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? a. Certified Wound, Ostomy, and Continence Nurse (CWOCN) b. Home health nursing agency c. Hospice d. Hospital chaplain

ANS: A

3. After teaching a client who has a femoral hernia, the nurse assesses the clients understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss? a. I will put on the truss before I go to bed each night. b. Ill put some powder under the truss to avoid skin irritation. c. The truss will help my hernia because I cant have surgery. d. If I have abdominal pain, Ill let my health care provider know right away.

ANS: A

51. A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? a. Ability of the patient and spouse to perform incision care and dressing changes b. Effective coping mechanisms for the patient and spouse after the surgical experience c. Knowledge about the patient's requested pain medications d. Understanding of the importance of keeping scheduled follow-up appointments

ANS: A

2. 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

ANS: A, B, C, E

4. A nurse plans care for a client who is recovering from an inguinal hernia repair. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Encouraging ambulation three times a day b. Encouraging normal urination c. Encouraging deep breathing and coughing d. Providing ice bags and scrotal support e. Forcibly reducing the hernia

ANS: A, B, D

7. A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this clients plan of care? (Select all that apply.) 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

ANS: A, B, D

1. 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.

ANS: A, B, D, E

3. A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this clients 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?

ANS: A, B, E

1. After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the clients 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

ANS: B

12. A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best? a. Slippery elm has no benefit for this problem. b. Slippery elm is often used for this disorder. c. There is no evidence that this will work. d. You should not take any herbal remedies.

ANS: B

12. A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, I need to have a bowel movement. Which action should the nurse take? a. Obtain a bedside commode for the client to use. b. Stay with the client while providing privacy. c. Make sure the call light is in reach to signal completion. d. Gather supplies to collect a stool sample for the laboratory.

ANS: B

13. A morbidly obese client is admitted to a community hospital that does not typically care for bariatric-sized clients. What action by the nurse is most appropriate? a. Assess the clients readiness to make lifestyle changes. b. Ensure adequate staff when moving the client. c. Leave siderails down to prevent pressure ulcers. d. Reinforce the need to be sensitive to the client.

ANS: B

53. A patient with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? a. Asks the patient whether family members could be trained in stoma care b. Has another patient with a stoma who performs self-care talk with the patient c. Requests that the primary health care provider request antidepressants and a psychiatric consult d. Suggests that the primary health care provider request a home health consultation so stoma care can be performed by a home health nurse

ANS: B

89. An older adult with severe rheumatoid arthritis in the upper extremities is malnourished. What does the nurse suspect as the cause of this client's malnutrition? a. A decrease in the client's appetite b. Decreasing ability to manipulate eating utensils c. Inadequate income to purchase sufficient food d. Metabolic requirements that are increased owing to immobility

ANS: B

9. 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

ANS: B

12. A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority? a. Assess the clients pain. b. Check the surgical incision. c. Ensure an adequate airway. d. Program the morphine pump.

ANS: C

17. A nurse attempted to assist a morbidly obese client back to bed and had immediate pain in the lower back. What action by the nurse is most appropriate? a. Ask another nurse to help next time. b. Demand better equipment to use. c. Fill out and file a variance report. d. Refuse to assist the client again.

ANS: C

18. A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this clients plan of care? a. You may experience nausea and vomiting for the first few weeks. b. Carbonated beverages can help decrease acid reflux from anastomosis sites. c. Take a stool softener to promote softer stools for ease of defecation. d. You may return to your normal workout schedule, including weight lifting.

ANS: C

26. A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? a. Steak with pasta b. Spaghetti with tomato sauce c. Steamed broccoli with turkey d. Tuna salad with wheat crackers

ANS: C

27. A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? a. "Have you asked your primary health care provider what he or she thinks your chances are?" b. "It is hard to know what can predispose a person to develop a certain disease." c. "No. Just because they both had CRC doesn't mean that you will have it, too." d. "The only way to know whether you are predisposed to CRC is by genetic testing."

ANS: D

37. A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? a. Administers medication for pain b. Changes the nasogastric suction level from "intermittent" to "constant" c. Positions the patient in high-Fowler's position d. Prepares the patient for emergency surgery

ANS: D

44. What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? a. It destroys the cancer's cell wall, which will kill the cell. b. It decreases blood flow to rapidly dividing cancer cells. c. It stimulates the body's immune system and stunts cancer growth. d. It blocks factors that promote cancer cell growth.

ANS: D

1. A nurse prepares to administer 12 mg/kg of 5-fluorouracil chemotherapy intravenously to a client who has colon cancer. The client weights 132 lb. How many milligrams should the nurse administer? (Record your answer using a whole number.) _____ mg

ANS: 720 mg

1. A client is in the family practice clinic. Today the client weighs 186.4 pounds (84.7 kg). Six months ago the client weighed 211.8 pounds (96.2 kg). What action by the nurse is best? a. Ask the client if the weight loss was intentional. b. Determine if there are food allergies or intolerances. c. Perform a comprehensive nutritional assessment. d. Perform a rapid bedside blood glucose test.

ANS: A

1. A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion

ANS: A

10. The nurse is teaching a patient with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge? a. "Nizatidine (Axid) needs to be taken three times a day to be effective." b. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." c. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." d. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

ANS: A

76. A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? a. "Be aware of the signs/symptoms of toxic megacolon that we discussed." b. "If diarrhea increases, you must let your primary health care provider know." c. "You must avoid pregnancy." d. "You will need to decrease your dose of sulfasalazine (Azulfidine)."

ANS: A

8. A nurse and a registered dietitian are assessing clients for partial parenteral nutrition (PPN). For which client would the nurse suggest another route of providing nutrition? a. Client with congestive heart failure b. Older client with dementia c. Client who has multiorgan failure d. Client who is post gastric resection

ANS: A

7. A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) 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

ANS: A, B, D

6. 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.

ANS: A, B, E

6. 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

ANS: A, B, E

7. 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.

ANS: A, B, E

19. The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? a. Apply antiembolism stockings. b. Place a nasogastric (NG) tube, and connect to suction. c. Insert an indwelling catheter, and check output hourly. d. Give famotidine (Pepcid) 20 mg IV every 12 hours.

ANS: B

8. After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. Ill 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.

ANS: B

81. An older client is at risk for malnutrition. Which nursing intervention is most appropriate to ensure optimum nutritional intake? a. Administering antiemetics and analgesics after meals b. Assisting the client with toileting and oral care prior to meals c. Turning on the television during meals to provide distraction d. Reminding UAPs to allow the client to remain in bed during meals

ANS: B

9. After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the clients 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.

ANS: B

90. Which serum albumin level does the nurse expect to see in a healthy, ambulatory adult client? a. 2.3 g/dL (23 g/L) b. 3.7 g/dL (37 g/L) c. 5.1 g/dL (51 g/L) d. 5.8 g/dL (58 g/L)

ANS: B

1. After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the clients understanding. Which statements made by the client indicate that the client correctly understands the teaching? (Select all that apply.) a. Ill have my housekeeper keep my toilet clean. b. I must take a shower or bathe every day. c. I should have my well water tested. d. I will ask my sexual partner to have a stool test. e. I must only eat raw vegetables from my own garden.

ANS: B, C, D

113. An obese client has been taking orlistat (Xenical) 60 mg orally three times a day for 4 weeks, but has only lost 10 pounds (4.5 kg). The health care provider doubles the dosage and recommends behavioral changes. What behavioral changes does the nurse include in the teaching plan? (Select all that apply.) a. Cognitive restructuring to learn negative coping statements b. Keeping a daily food diary c. Identifying emotional and situational factors that stimulate eating d. Increasing exercise e. Seeking behaviors in others that one can model

ANS: B, C, D

2. After teaching a client who is recovering from a colon resection, the nurse assesses the clients 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.

ANS: B, C, D

73. An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action? a. Pain when coughing b. States, "I am too tired to walk very much" c. States, "I feel like the incision is splitting open" d. Temperature of 100.8°F (38.2°C).

ANS: C

75. A patient with ulcerative colitis (UC) is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen? a. Corticosteroid therapy will be stopped. b. Sulfasalazine (Azulfidine) will be stopped. c. Corticosteroid therapy will be tapered. d. Sulfasalazine (Azulfidine) will be tapered.

ANS: C

79. A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient? a. Applying hydrocortisone cream b. Cleaning the area with soap and hot water c. Using sitz baths three times daily d. Wearing absorbent cotton underwear

ANS: C

8. A nurse answers a clients call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.

ANS: C

85. The nurse is performing a health assessment on an obese client who states, "I have tried many diets in an effort to lose weight, but have been unsuccessful." How does the nurse assess whether the client's response to stress is related to the client's obesity? a. "Do you have a history of mental problems, especially depression?" b. "Do you usually use alcohol or drugs when you feel stressed?" c. "Tell me what you do to relieve stress in your daily life." d. "What is it about your obesity that causes you to feel uncomfortable?"

ANS: C

5. A nurse working with a client who has possible gastritis assesses the clients 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

ANS: C, D

2. A nurse has delegated feeding a client to an unlicensed assistive personnel (UAP). What actions does the nurse include in the directions to the UAP? (Select all that apply.) a. Allow 30 minutes for eating so food doesnt get spoiled. b. Assess the clients mouth while providing premeal oral care. c. Ensure warm and cold items stay at appropriate temperatures. d. Remove bedpans, soiled linens, and other unpleasant items. e. Sit with the client, making the atmosphere more relaxed.

ANS: C, D, E

10. A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a. Albumin: 2.1 g/dL b. Hematocrit: 28% c. Hemoglobin: 8.1 mg/dL d. International normalized ratio (INR): 4.2

ANS: D

104. Which client on the medical-surgical unit does the charge nurse assign to the LPN/LVN? a. A 28-year-old with morbid obesity who had bariatric surgery today b. A 30-year-old recently admitted with severe diarrhea and Clostridium difficile infection c. A 36-year-old whose family needs instruction about how to use a gastric feeding tube d. A 39-year-old with a jejunal feeding tube who needs elemental feedings administered

ANS: D

6. After teaching a client with diverticular disease, a nurse assesses the clients understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice

ANS: D

62. A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? a. Administering a Fleet's enema when needed b. Applying heat to acute inflammation for pain relief c. Avoiding the use of bulk-forming agents d. Using hydrocortisone cream to relieve pain

ANS: D

68. An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse? a. A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula b. A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas c. A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir d. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

ANS: D

7. Which patient assessment information is correlated with a diagnosis of chronic gastritis? a. Anorexia, nausea, and vomiting b. Frequent use of corticosteroids c. Hematemesis and anorexia d. Radiation therapy, smoking, and excessive alcohol use

ANS: D

74. A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed? a. "It is to stop the diarrhea and bloody stools." b. "This will minimize your GI discomfort." c. "With this medication, your cramping will be relieved." d. "Your intestinal inflammation will be reduced."

ANS: D

13. A nurse reviews the chart of a client who has Crohns disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions? a. Serum potassium of 2.6 mEq/L b. Client ate 20% of breakfast meal c. White blood cell count of 8200/mm3 d. Clients weight decreased by 3 pounds

ANS: A

16. Several nurses have just helped a morbidly obese client get out of bed. One nurse accesses the clients record because I just have to know how much she weighs! What action by the clients nurse is most appropriate? a. Make an anonymous report to the charge nurse. b. State That is a violation of client confidentiality. c. Tell the nurse Dont look; Ill tell you her weight. d. Walk away and ignore the other nurses behavior.

ANS: B

14. For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age

ANS: C

101. The RN who usually works on the pediatric unit is floated to the GI medical-surgical unit. Which client is most appropriate for the charge nurse to assign to the float nurse? a. A 20-year-old with anorexia nervosa receiving total parenteral nutrition through a central venous line b. A 35-year-old who had a laparoscopic gastroplasty yesterday and is now taking sips of clear liquids c. A 60-year-old with gastric cancer receiving elemental feedings through a jejunostomy tube d. A 65-year-old with morbid obesity who requires a preoperative bariatric surgery assessment

ANS: A

13. The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal (GI) bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? a. "A fluid solution goes down the tube to help clean out your stomach." b. "The medication goes down the tube to help clean out your stomach." c. "The primary health care provider requested the tube to be placed just in case it was needed." d. "We'll start feeding you through it once your stomach is cleaned out."

ANS: A

15. A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurse's highest priority intervention? a. Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider b. Asking the primary health care provider for a referral for home health services to assist with dressing changes c. Asking the spouse if any other family members are in the medical profession and could help change the dressing d. Offer literature on dressing changes and schedule follow-up phone calls with the patient and spouse to talk them through dressing changes when at home.

ANS: A

16. An older female patient is diagnosed with gastric cancer. Which statement made by the patient's family demonstrates a correct understanding of the disorder? a. "This may be related to her recurring ulcer disease." b. "This cancer is probably curable with surgery." c. "Gastric cancer has a strong genetic component." d. "Thank goodness she won't have to undergo surgery."

ANS: A

20. The nurse working during the day shift on the medical unit has just received report. Which patient does the nurse plan to assess first? a. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy b. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal c. Middle-aged patient with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast d. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

ANS: A

3. A patient has been discharged home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? a. Schedule of the patient's follow-up examinations and diagnostic testing b. Information on family members' progress in learning how to perform dressing changes c. Copy of the diet plan prepared for the patient by the hospital dietitian d. Detailed account of what occurred during the patient's surgical procedure

ANS: A

33. A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? a. Encourage the patient to look at and touch the colostomy stoma b. Instruct the patient about complete care of the colostomy c. Schedule a visit from a patient who has a colostomy and is successfully caring for it d. Suggest that the patient involve family members in the care of the colostomy

ANS: A

99. The nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems? a. Discontinues the IVFE infusion and notifies the health care provider (HCP) b. Documents the findings and continues to monitor c. Slows the rate of flow of the IVFE infusion d. Switches to total parenteral nutrition (TPN)

ANS: A

3. 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)

ANS: A, B, C, E

5. When working with older adults to promote good nutrition, what actions by the nurse are most appropriate? (Select all that apply.) a. Allow uninterrupted time for eating. b. Assess dentures for appropriate fit. c. Ensure the client has glasses on when eating. d. Provide salty foods that the client can taste. e. Serve high-calorie, high-protein snacks.

ANS: A, B, C, E

5. After teaching a client with an anal fissure, a nurse assesses the clients understanding. Which client actions indicate that the client correctly understands the teaching? (Select all that apply.) a. Taking a warm sitz bath several times each day b. Utilizing a daily enema to prevent constipation c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories e. Taking a laxative each morning

ANS: A, C, D

1. The nurse understands that malnutrition can occur in hospitalized clients for several reasons. Which are possible reasons for this to occur? (Select all that apply.) a. Cultural food preferences b. Family bringing snacks c. Increased need for nutrition d. Need for NPO status e. Staff shortages

ANS: A, C, D, E

2. A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Wash leafy vegetables carefully before eating or cooking them. b. Do not ingest water from the garden hose or the pool. c. Wash your hands before and after using the bathroom. d. Be sure meat is cooked to the proper temperature. e. Avoid eating eggs that are sunny side up or undercooked.

ANS: A, C, D, E

47. The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) a. Acupuncture b. Decreasing physical activities c. Meditation d. Peppermint oil capsules e. Yoga

ANS: A, C, D, E

80. The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider? (Select all that apply.) a. Anorexia b. Depression c. Drowsiness d. Frequent urination e. Headache f. Vomiting

ANS: A, E, F

103. A client has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The client is receiving continuous enteral feedings through a nasogastric (NG) tube. What does the RN ask the LPN/LVN to do for this client? a. Assess nutritional parameters on the client every 3 days. b. Check the residual volume of the NG tube every 4 hours. c. Monitor the client for signs and symptoms of pneumonia. d. Teach the client about the purpose of enteral feedings.

ANS: B

14. The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching? a. "I will need to avoid sweetened fruit juice beverages." b. "I can eat ice cream in moderation." c. "I cannot drink alcohol at all." d. "It is okay to have a serving of sugar-free pudding."

ANS: B

12. A nurse assesses a client with Crohns 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

ANS: A

14. A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says I didnt know it would be this hard to live like this. What response by the nurse is best? a. Assess the clients coping and support systems. b. Inform the client that things will get easier. c. Re-educate the client on needed dietary changes. d. Tell the client lifestyle changes are always hard.

ANS: A

15. A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate? a. Increase the fiber and water in your diet. b. Reduce fat to less than 30% each day. c. Report dry mouth and decreased sweating. d. Lorcaserin may cause loose stools for a few days.

ANS: A

15. A nurse assesses a client who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider? a. White blood cell (WBC) count of 1500/mm3 b. Fatigue c. Nausea and diarrhea d. Mucositis and oral ulcers

ANS: A

17. Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? a. Retape the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy. b. Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. c. Document instructions for a patient with chronic gastritis about how to use "triple therapy." d. Assess the gag reflex for a patient who has arrived from the post anesthesia care unit after a laparoscopic gastrectomy.

ANS: B

18. A nurse is caring for a morbidly obese client. What comfort measure is most important for the nurse to delegate to the unlicensed assistive personnel (UAP)? a. Designating quiet time so the client can rest b. Ensuring siderails are not causing excess pressure c. Providing oral care before and after meals and snacks d. Relaying any reports of pain to the registered nurse

ANS: B

18. The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? a. Type and crossmatch for 4 units of packed red blood cells. b. Infuse 0.9% normal saline solution at 200 mL/hr. c. Give pantoprazole (Protonix) 40 mg IV now and then daily. d. Insert a nasogastric tube and connect to low intermittent suction.

ANS: B

19. A client is awaiting bariatric surgery in the morning. What action by the nurse is most important? a. Answering questions the client has about surgery b. Beginning venous thromboembolism prophylaxis c. Informing the client that he or she will be out of bed tomorrow d. Teaching the client about needed dietary changes

ANS: B

25. A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? a. "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." b. "I need to go for a walk every evening." c. "Maintaining a low-fiber diet will manage my constipation." d. "Limiting the amount of fluid that I drink with meals is very important."

ANS: B

30. A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? a. Femoral b. Reducible c. Strangulated d. Incarcerated

ANS: B

31. A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? a. "I may have trouble urinating immediately after the surgery." b. "I will need to stay in the hospital overnight." c. "I will not eat after midnight the day of the surgery." d. "My chances of having complications after this procedure are slim."

ANS: B

4. A patient has a long-term history of Crohn's disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? a. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." b. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." c. "What has your doctor told you about how your gastritis developed?" d. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

ANS: B

57. A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)? a. Abdominal pain relieved by bending the knees, constipation b. Chronic diarrhea, abdominal colicky pain, and fever c. Epigastric cramping & persistent rectal bleeding d. Hypotension with vomiting and headache

ANS: B

71. The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first? a. A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift b. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C) c. A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it d. A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

ANS: B

77. A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? a. "You may have contracted it from an infected infant." b. "You may have consumed contaminated food or water." c. "You may have come into contact with an infected animal." d. "You may have had contact with the blood of an infected person."

ANS: B

112. The nurse is instructing a group of overweight clients on the complications of obesity that develop when weight is not controlled through diet and exercise. Which lifestyle changes does the nurse emphasize? (Select all that apply.) a. "Begin a weight-training program for building muscle mass." b. "Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." t c. "Eat a variety of foods, especially grain products, vegetables, and fruits." d. "Engage in moderate physical activity for at least 30 minutes each day." e. "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home." f. "Liquid dietary supplements can be substituted safely for solid food while attempting to lose weight."

ANS: B, C, D, E

4. A clients small-bore feeding tube has become occluded after the nurse administered medications. What actions by the nurse are best? (Select all that apply.) a. Attempt to dissolve the clog by instilling a cola product. b. Determine if any of the medications come in liquid form. c. Flush the tube before and after administering medications. d. Mix all medications in the formula and use a feeding pump. e. Try to flush the tube with 30 mL of water and gentle pressure.

ANS: B, C, E

86. A young adult man says that he cannot stay on a diet because of trouble finding one that will incorporate his food preferences. How does the nurse mosteffectively plan nutritional care for this client? a. Calculates his body mass index (BMI) b. Records a 24-hour diary of his physical activities c. Obtains a 24-hour recall (diary) of his food intake d. Measures his accurate height and weight measurements

ANS: C

88. The nurse is teaching a middle-aged adult client with a body mass index (BMI) of 27.5 and a height of 5'2" (157.5 cm) about what the BMI number means, and about malnutrition. Which client statement indicates a need for further instruction? a. "If I could get my BMI below 25, my risk for malnutrition would decrease." b. "I realize that this means that I have some increased health risks." c. "My goal should be to get my BMI below 18.5." d. "This means that I have an increased amount of total fat stored in my body."

ANS: C

93. A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing? a. Calcium imbalance b. Fluid volume deficit c. Fluid volume overload d. Potassium imbalance

ANS: C

94. A female client is concerned that her inability to conceive a child is connected to her morbid obesity. How does the nurse respond? a. "Do you feel that your obesity is keeping you from getting pregnant?" b. "Have you considered adoption as an option?" c. "Tell me about any changes in your menstrual cycle each month." d. "What has your health care provider told you about your problems in getting pregnant?"

ANS: C

95. A client is placed on orlistat (Xenical) as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the client to expect from using this drug? a. Dry mouth, constipation, and insomnia b. Insomnia, dry mouth, and blurred vision c. Loose stools, abdominal cramps, and nausea d. Palpitations, constipation, and restlessness

ANS: C

105. An RN receives the change-of-shift report about these four clients. Which client does the nurse assess first? a. A 30-year-old admitted 2 hours ago with malnutrition associated with malabsorption syndrome b. A 45-year-old who had gastric bypass surgery and is reporting severe incisional pain c. A 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL (16.7 mmol/L) d. A 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min

ANS: D

35. A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? a. Cramping intermittently, metabolic acidosis, and minimal vomiting b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis c. Metabolic acidosis, upper abdominal distention, and intermittent cramping d. Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

ANS: D

39. A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? a. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." b. "It is inherited, so it could run in your family." c. "It might be caused by a virus, so you could have gotten it almost anywhere." d. "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

ANS: D

15. 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 clients foods. d. Make the client NPO.

ANS: A

16. A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, The stool in my pouch is still liquid. How should the nurse respond? a. The stool will always be liquid with this type of colostomy. b. Eating additional fiber will bulk up your stool and decrease diarrhea. c. Your stool will become firmer over the next couple of weeks. d. This is abnormal. I will contact your health care provider.

ANS: A

17. A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Sulfasalazine (Azulfidine) d. Ceftriaxone (Rocephin)

ANS: A

2. A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. Have you been experiencing any constipation? b. Are you eating a diet high in fiber and fluids? c. Do you have a history of high blood pressure? d. What vitamins and supplements are you taking?

ANS: A

20. A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Pale and bluish stoma b. Liquid stool c. Ostomy pouch intact d. Blood-smeared output

ANS: A

20. A nurse cares for a client who has a new colostomy. Which action should the nurse take? a. Empty the pouch frequently to remove excess gas collection. b. Change the ostomy pouch and wafer every morning. c. Allow the pouch to completely fill with stool prior to emptying it. d. Use surgical tape to secure the pouch and prevent leakage.

ANS: A

4. After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will let my husband do all of the cooking for my family. b. Ill take the ciprofloxacin until the diarrhea has resolved. c. I should wash my hands with antibacterial soap before each meal. d. I must place my dishes into the dishwasher after each meal.

ANS: B

6. 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.

ANS: B

10. A client tells the nurse about losing weight and regaining it multiple times. Besides eating and exercising habits, for what additional data should the nurse assess as the priority? a. Economic ability to join a gym b. Food allergies and intolerances c. Psychosocial influences on weight d. Reasons for wanting to lose weight

ANS: C

10. 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.

ANS: C

11. 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

ANS: C

13. 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.

ANS: C

16. After teaching a client who has diverticulitis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. Ill 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.

ANS: C

19. A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? a. Eat low-fiber and low-residual foods. b. White rice and bread are easier to digest. c. Add vegetables such as broccoli and cauliflower to your new diet. d. Foods high in animal fat help to protect the intestinal mucosa.

ANS: C

3. A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The clients blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.

ANS: C

4. 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.

ANS: C

5. A client having a tube feeding begins vomiting. What action by the nurse is most appropriate? a. Administer an antiemetic. b. Check the clients gastric residual. c. Hold the feeding until the nausea subsides. d. Reduce the rate of the tube feeding by half.

ANS: C

5. A nurse assesses a client who is hospitalized with an exacerbation of Crohns disease. Which clinical manifestation should the nurse expect to find? a. Positive Murphys 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

ANS: C

6. A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

ANS: C

7. A nurse is caring for four clients receiving enteral tube feedings. Which client should the nurse see first? a. Client with a blood glucose level of 138 mg/dL b. Client with foul-smelling diarrhea c. Client with a potassium level of 2.6 mEq/L d. Client with a sodium level of 138 mEq/L

ANS: C

11. A client asks the nurse about drugs for weight loss. What response by the nurse is best? a. All weight-loss drugs can cause suicidal ideation. b. No drugs are currently available for weight loss. c. Only over-the-counter medications are available. d. There are three drugs currently approved for this.

ANS: D

13. An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first? a. Send a blood sample for a type and crossmatch. b. Insert a large intravenous line for fluid resuscitation. c. Obtain the heart rate and blood pressure. d. Assess and maintain a patent airway.

ANS: D

21. A nurse cares for a client who has a family history of colon cancer. The client states, My father and my brother had colon cancer. What is the chance that I will get cancer? How should the nurse respond? a. If you eat a low-fat and low-fiber diet, your chances decrease significantly. b. You are safe. This is an autosomal dominant disorder that skips generations. c. Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer. d. You should have a colonoscopy more frequently to identify abnormal polyps early.

ANS: D

5. A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

ANS: D

5. A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily b. A 44-year-old with irritable bowel syndrome (IBS) c. A 60-year-old lawyer who works 65 hours per week d. A 72-year-old who eats fast food frequently

ANS: D

3. A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this clients teaching? a. Drink plenty of fluids to prevent dehydration. b. You should only drink 1 liter of fluids daily. c. Increase your protein intake by drinking more milk. d. Sips of cola or tea may help to relieve your nausea.

ANS: A

6. A nurse is caring for a client receiving enteral feedings through a Dobhoff tube. What action by the nurse is best to prevent hyperosmolarity? a. Administer free-water boluses. b. Change the clients formula. c. Dilute the clients formula. d. Slow the rate of infusion.

ANS: A

9. A client is receiving total parenteral nutrition (TPN). On assessment, the nurse notes the clients pulse is 128 beats/min, blood pressure is 98/56 mm Hg, and skin turgor is dry. What action should the nurse perform next? a. Assess the 24-hour fluid balance. b. Assess the clients oral cavity. c. Prepare to hang a normal saline bolus. d. Turn up the infusion rate of the TPN.

ANS: A

7. A nurse cares for a teenage girl with a new ileostomy. The client states, I cannot go to prom with an ostomy. How should the nurse respond? a. Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance. b. The pouch wont be as noticeable if you avoid broccoli and carbonated drinks prior to the prom. c. Lets talk to the enterostomal therapist about options for ostomy supplies and dress styles. d. You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable.

ANS: C

7. A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, My doctor told me that the fecal occult blood test was negative for colon cancer. I dont think I need the colonoscopy and would like to cancel it. How should the nurse respond? a. Your doctor should not have given you that information prior to the colonoscopy. b. The colonoscopy is required due to the high percentage of false negatives with the blood test. c. A negative fecal occult blood test does not rule out the possibility of colon cancer. d. I will contact your doctor so that you can discuss your concerns about the procedure.

ANS: C

7. The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor

ANS: C

1. 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-Fowlers 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 clients 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

ANS: A, C, E

4. A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this groups teaching? (Select all that apply.) a. Rotavirus is more common among infants and younger children. b. Escherichia coli diarrhea is transmitted by contact with infected animals. c. To prevent E. coli infection, dont drink water when swimming. d. Clients who have botulism should be quarantined within their home. e. Parasitic diseases may not show up for 1 to 2 weeks after infection.

ANS: A, C, E

5. 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

ANS: A, C, E

3. A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this groups teaching? (Select all that apply.) a. Wash your hands after any contact with animals. b. It is not necessary to buy a meat thermometer. c. Stay away from people who are ill with diarrhea. d. Use separate cutting boards for meat and vegetables. e. Avoid swimming in backyard pools and using hot tubs.

ANS: A, D

4. 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

ANS: A, D

1. The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients 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.

ANS: B

17. 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.

ANS: B

19. A nurse plans care for a client with Crohns disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this clients plan of care? a. Low-fiber diet b. Skin protection c. Antibiotic administration d. Intravenous glucocorticoids

ANS: B

2. 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 bedrest.

ANS: B

2. A nurse cares for an older adult client who has Salmonella food poisoning. The clients vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first? a. Apply oxygen via nasal cannula. b. Administer intravenous fluids. c. Provide perineal care with a premedicated wipe. d. Teach proper food preparation to prevent contamination.

ANS: B

21. A nurse cares for a client with a new ileostomy. The client states, I dont think my friends will accept me with this ostomy. How should the nurse respond? a. Your friends will be happy that you are alive. b. Tell me more about your concerns. c. A therapist can help you resolve your concerns. d. With time you will accept your new body.

ANS: B

3. A nurse is reviewing laboratory values for several clients. Which value causes the nurse to conduct nutritional assessments as a priority? a. Albumin: 3.5 g/dL b. Cholesterol: 142 mg/dL c. Hemoglobin: 9.8 mg/dL d. Prealbumin: 28 mg/dL

ANS: B

2. A nursing student is studying nutritional problems and learns that kwashiorkor is distinguished from marasmus with which finding? a. Deficit of calories b. Lack of all nutrients c. Specific lack of protein d. Unknown cause of malnutrition

ANS: C

9. A nurse cares for a client with colon cancer who has a new colostomy. The client states, I think it would be helpful to talk with someone who has had a similar experience. How should the nurse respond? a. I have a good friend with a colostomy who would be willing to talk with you. b. The enterostomal therapist will be able to answer all of your questions. c. I will make a referral to the United Ostomy Associations of America. d. Youll find that most people with colostomies dont want to talk about them.

ANS: C

22. A nurse cares for a client with ulcerative colitis. The client states, I feel like I am tied to the toilet. This disease is controlling my life. How should the nurse respond? a. Lets discuss potential factors that increase your symptoms. b. If you take the prescribed medications, you will no longer have diarrhea. c. To decrease distress, do not eat anything before you go out. d. You must retake control of your life. I will consult a therapist to help.

ANS: A

10. An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the clients lower abdomen. Which action should the nurse take first? a. Measure the clients abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the clients hemoglobin and hematocrit. d. Obtain the clients complete health history.

ANS: B

11. A nurse cares for a client who states, My husband is repulsed by my colostomy and refuses to be intimate with me. How should the nurse respond? a. Lets talk to the ostomy nurse to help you and your husband work through this. b. You could try to wear longer lingerie that will better hide the ostomy appliance. c. You should empty the pouch first so it will be less noticeable for your husband. d. If you are not careful, you can hurt the stoma if you engage in sexual activity.

ANS: A

34. The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? a. "I can drive my car in about 2 weeks." b. "I need to avoid drinking carbonated sodas." c. "It may take 6 weeks to see the effects of some foods on my bowel patterns." d. "Stool softeners will help me avoid straining."

ANS: A

45. Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? a. Analgesics and antiemetics b. Analgesics and benzodiazepines c. Steroids and analgesics d. Steroids and anti-inflammatory medications

ANS: A

46. What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? a. Bulk-forming laxatives b. Saline laxatives c. Stimulant laxatives d. Stool-softening agents

ANS: A

52. A patient with a history of osteoarthritis has a 10-inch (25.5 cm) incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the primary health care provider before the patient's discharge? a. Having a home health consultation for wound care b. Requesting an antianxiety medication c. Requesting pain medication for the patient's osteoarthritis d. Placing the patient in a skilled nursing facility for rehabilitation

ANS: A

54. A patient with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply? a. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." b. "It provides key nutrients and extra calories to promote healing." c. "It is bland and reduces the secretion of gastric acids." d. "It does not contain caffeine or other GI tract stimulants."

ANS: A

56. A male patient with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? a. "A change in position may be what is needed for you to have intercourse with your wife." b. "Have you considered going to see a marriage counselor with your wife?" c. "What has your wife said about your pouch system?" d. "You must get clearance from your primary health care provider before you attempt to have intercourse."

ANS: A

60. A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient? a. "Avoid large crowds and anyone who is sick." b. "Do not take the medication if you are allergic to foods with fatty acids." c. "Expect difficulty with wound healing while you are taking this drug." d. "Monitor your blood pressure and report any significant decrease in it."

ANS: A

66. A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? a. "It is usually ready to be closed in about 1 to 2 months." b. "You need to talk to your primary health care provider about how long you will have this temporary ileostomy." c. "The period of time is indefinite—I am sorry that I cannot say." d. "You will probably have it for 6 months or longer, until things heal."

ANS: A

67. The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include? a. A slice of 5-grain bread b. Chuck steak patty (6 ounces [170 grams]) c. Strawberries (1 cup [160 grams]) d. Tomato (1 medium)

ANS: A

8. The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patient's ulceration is duodenal in origin and not gastric? a. Pain occurs 1½ to 3 hours after a meal, usually at night. b. Pain is worsened by the ingestion of food. c. The patient has a malnourished appearance. d. The patient is a man older than 50 years.

ANS: A

84. How does the nurse accurately calculate a client's body mass index (BMI)? a. BMI = weight (kg)/height (in meters)2 b. BMI = weight (lb)/height (in inches)2 c. BMI = weight (kg)/height (in meters) d. BMI = weight (lb)/height (in meters)

ANS: A

9. A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? a. Starting a large-bore IV b. Administering IV pain medication c. Preparing equipment for intubation d. Monitoring the patient's anxiety level

ANS: A

96. Which morbidly obese client is the least likely candidate for bariatric surgery? a. A 34-year-old woman experiencing mental confusion b. A 44-year-old man with a history of hypertension c. A 50-year-old woman with a history of sleep apnea d. A 52-year-old man with a history of type 1 diabetes mellitus

ANS: A

82. A client who has undergone a bariatric surgical procedure is recuperating after surgery. Which nursing intervention most effectively prevents injury to the client who is being re-positioned postoperatively? a. Administering pain medication b. Making sure not to move the client's nasogastric (NG) tube c. Monitoring skinfold areas and keeping them clean and dry d. Using a weight-rated extra-wide bed for the client t

ANS: D

55. A Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include? a. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." b. "Call your primary health care provider if your stoma has a bluish or pale look." c. "Notify the primary health care provider if output from your stoma has a sweetish odor." d. "Remember that you must wear a pouch system at all times."

ANS: B

48. The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) a. Broccoli b. Buttermilk c. Mushrooms d. Onions e. Peas f. Yogurt

ANS: A, C, D, E

58. A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? a. Bacteria on the patient's hands b. Ingestion of parasites in the water c. Insufficient vaccinations d. Overcooked food

ANS: B

59. Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? a. Patients with CD experience about 20 loose, bloody stools daily. b. Patients with UC may experience hemorrhage. c. The peak incidence of UC is between 15 and 40 years of age. d. Very few complications are associated with CD.

ANS: B

8. A nurse cares for a client who has a nasogastric (NG) tube. Which actions should the nurse take? (Select all that apply.) 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 clients upper lip. d. Disconnect suction when auscultating bowel peristalsis. e. Monitor the clients skin around the tube site for irritation.

ANS: A, D, E

11. A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a. Do you have family or friends for support? b. Id like to know what you are feeling now. c. Well, we knew this would probably happen. d. Would you like me to refer you to hospice?

ANS: B

14. After teaching a client who has a new colostomy, the nurse provides feedback based on the clients 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?

ANS: B

15. A nurse assesses a client who is hospitalized for botulism. The clients vital signs are temperature: 99.8 F (37.6 C), heart rate: 100 beats/min, respiratory rate: 10 breaths/min, and blood pressure: 100/62 mm Hg. Which action should the nurse take? a. Decrease stimulation and allow the client to rest. b. Stay with the client while another nurse calls the provider. c. Increase the clients intravenous fluid replacement rate. d. Check the clients blood glucose and administer orange juice.

ANS: B

16. An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the familys wishes. d. Tell the family that such secrets cannot be kept.

ANS: B

32. A patient with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? a. Decrease in liver function test results b. Elevated carcinoembryonic antigen c. Elevated hemoglobin levels d. Negative test for occult blood

ANS: B

38. The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? a. "I would take Ex-Lax after the surgery to 'keep things moving'." b. "I will need to eat a diet high in fiber." c. "Limiting my fluids will help me with constipation." d. "To help with the pain, I'll apply ice to the surgical area."

ANS: B

4. A client is receiving bolus feedings through a Dobhoff tube. What action by the nurse is most important? a. Auscultate lung sounds after each feeding. b. Check tube placement before each feeding. c. Check tube placement every 8 hours. d. Weigh the client daily on the same scale.

ANS: B

4. A nurse assesses a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which action should the nurse take? a. Assess the clients heart rate and blood pressure. b. Determine when the client last voided. c. Ask if the client is experiencing flatus. d. Auscultate all quadrants of the clients abdomen.

ANS: B

40. A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? a. "During the test, you will drink small amounts of an antacid as directed by the technician." b. "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." c. "The test will take between 30 and 45 minutes to complete." d. "You must have nothing to drink (except water) for 24 hours before the test."

ANS: B

41. A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient's incision for signs of infection b. Assisting the patient to stand to void c. Instructing the patient in how to deep-breathe d. Monitoring the patient's pain level

ANS: B

42. The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? a. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. b. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern c. A 40-year-old with a reducible inguinal hernia asking questions about surgery. d. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

ANS: B

5. A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's bestresponse? a. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." b. "These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." c. "Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them." d. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

ANS: B

83. An older adult client needs additional dietary protein, but refuses to drink the prescribed liquid protein supplements. Which nursing intervention is mosteffective in increasing the client's protein intake? a. Administering the liquid supplement with routine medications b. Giving a glucose polymer modular supplement c. Keeping a food and fluid intake diary for at least 3 days d. Providing protein modular supplements in the form of puddings

ANS: D

61. A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient? a. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." c. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." d. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

ANS: B

63. A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime? a. "Avoid all solid foods to allow complete bowel rest." b. "Consume extra fluids to replace fluid losses." c. "Take an over-the-counter antidiarrheal medication." d. "Contact your primary health care provider for an antibiotic medication."

ANS: B

70. Which patient does the charge nurse assign to an experienced LPN/LVN? a. A 28-year-old who requires teaching about how to catheterize a Kock ileostomy b. A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy c. A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 (23 × 109/L) d. A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

ANS: B

78. A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe? a. Balsalazide (Colazal) b. Loperamide (Imodium) c. Mesalamine (Asacol) d. Milk of Magnesia (MOM)

ANS: B

8. A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? a. Contact the provider and recommend a psychiatric consult for the client. b. Encourage the client to verbalize feelings about the diagnosis. c. Provide education about new treatment options with successful outcomes. d. Ask family and friends to visit the client and provide emotional support.

ANS: B

91. An underweight client is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the client? a. Keeps an accurate and precise food and fluid intake record daily b. Makes certain the client is weighed daily at the same time c. Monitors vital signs every 4 hours and as needed d. Assesses the client's skin for evidence of breakdown weekly

ANS: B

98. The nurse is teaching a group of adults in the community about the 2015-2020 Dietary Guidelines for Americans. What does the nurse emphasize as a dietary strategy suggested in these guidelines? a. Half of each meal should consist of dairy, fruits, and proteins. b. Adults should focus on variety and nutrient density and not calories. c. Older adults should consider lacto-ovarian diets for improved health. d. Adults should include a multivitamin with iron and vitamin B12 in their diet.

ANS: B

65. A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? a. "Drinking carbonated beverages will help with your abdominal distress." b. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." c. "Lactose-containing foods should be reduced or eliminated from your diet." d. "Raw vegetables and high-fiber foods may help to diminish your symptoms."

ANS: C

72. An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? a. Administer acetaminophen (Tylenol) 650 mg rectally. b. Draw blood for a complete blood count and serum electrolytes. c. Obtain a stool specimen for culture and sensitivity. d. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

ANS: D

69. A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care? a. Instructing the patient about the use of electrolyte-containing oral rehydration products b. Administering loperamide (Imodium) 4 mg from the patient's medicine cabinet c. Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions d. Teaching the patient how to clean the perineal area after each loose stool

ANS: C

49. A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? (Select all that apply.) a. Antihistamines b. Caffeinated drinks c. Stress d. Sleeping pills e. Combinations of genetic, immunological, and hormonal factors

ANS: B, C, E

3. A nurse is designing a community education program to meet the Healthy People 2020 objectives for nutrition and weight status. What information about these goals does the nurse use to plan this event? (Select all that apply.) a. Decrease the amount of fruit to 1.1 cups/1000 calories. b. Increase the amount of vegetables to 1.1 cups/1000 calories. c. Increase the number of adults at a healthy weight by 25%. d. Reduce the number of adults who are obese by 10%. e. Reduce the consumption of saturated fat by nearly 10%.

ANS: B, D, E

1. The nurse and the dietitian are planning sample diet menus for a patient who is experiencing dumping syndrome. Which sample meal is best for this patient? a. Chicken salad on whole wheat bread b. Liver and onions c. Chicken and rice d. Cobb salad with buttermilk ranch dressing

ANS: C

100. The nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them? a. "One to two hours of cardiovascular exercise every day is a good idea." b. "Joining a fitness program or gym will help greatly with your exercise." c. "Walking 30 to 40 minutes provides the same benefit as long periods of exercise." d. "You will benefit most if you get into a group that shares your exercise goals."

ANS: C

102. The nurse manager in a long-term care facility plans nutritional assessments of all residents. Which nutritional assessment activity does the nurse delegate to unlicensed assistive personnel (UAP) at the facility? a. Assessing residents' abilities to swallow b. Determining residents' functional status c. Measuring the daily food and fluid intake of residents d. Screening a portion of the residents with the Mini Nutritional Assessment

ANS: C

108. An 87-year-old resident from an extended care facility has not been eating for several days and is admitted to the hospital with a diagnosis of malnutrition. She has an enteral feeding tube placed in her left nostril. Her medications include digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel). The nurse checks the gastric pH of the feeding tube and obtains a value of 6.0, which may indicate that the feeding tube is in the client's lungs. Is there another possible explanation for the nurse to consider? a. No; the feeding tube must be removed. b. No; the potassium effect will prevent the pH from reaching 6.0. c. Yes; the client is taking Zantac. d. Yes; the pH paper has expired and is giving a false reading.

ANS: C

109. An older malnourished client who is taking digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel) develops a severe case of diarrhea. What does the nurse suspect is a possible cause? a. Digoxin (Lanoxin) b. Gastritis c. Potassium chloride (Kay Ciel) d. Ranitidine (Zantac)

ANS: C

110. An obese client is prescribed orlistat (Xenical). The client asks the nurse how the drug works. How does the nurse respond? a. "It decreases the amount of norepinephrine in your brain. This action will increase your feeling of being satisfied on less food." b. "It increases the amount of serotonin in your brain. This action will greatly increase your metabolic rate, and you will burn calories quicker." c. "It inhibits enzymes and changes the way your body digests fats. Because fats are only partially digested and absorbed, calorie intake is decreased." d. "It will alter the chemistry of your brain. Consequently, you will feel full before you overeat."

ANS: C

12. The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? a. Administering a histamine2 (H2) antagonist b. Initiating enteral nutrition c. Administering intravenous (IV) fluids d. Administering antianxiety medication

ANS: C

24. The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? a. "A dark or purplish-looking stoma is normal and would not concern me." b. "If the skin around the stoma is red or scratched, it will heal soon." c. "I need to check for leakage underneath my colostomy." d. "I need to strive for a very tight fit when applying the barrier around the stoma."

ANS: C

29. A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? a. "Are you afraid of what your spouse will think of the colostomy?" b. "Don't worry. You will get used to the colostomy eventually." c. "Tell me what worries you the most about this procedure." d. "Why are you so afraid of having this procedure done?"

ANS: C

36. A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? a. Attaching the tube to low intermittent suction b. Auscultating for bowel sounds and peristalsis while the suction runs c. Connecting the tube to low continuous suction d. Flushing the tube with 30 mL of normal saline every 24 hours

ANS: C

43. A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? a. "A combination of chemotherapeutic agents has caused them." b. "GI problems are symptoms of the advanced stage of your disease." c. "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." d. "You have these as a result of the radiation treatment."

ANS: C

6. The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? a. "It is okay to continue to drink coffee in the morning when I get to work." b. "I will need to take vitamin B12 shots for the rest of my life." c. "I should avoid alcohol and tobacco." d. "I should eat small meals about six times a day."

ANS: C

64. A patient returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this patient after the patient is situated in bed? a. High Fowler's b. Lateral Sims' (side-lying) c. Semi-Fowler's d. Supine

ANS: C

28. The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? a. "I will have my spouse change the bag for me." b. "If I have any leakage, I'll put a towel over it." c. "I can put aspirin tablets in the pouch in order to reduce odor" d. "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

ANS: D

50. A patient who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? a. A list of medical supply facilities where wound care supplies may be purchased b. Proper handwashing techniques to avoid cross-contamination of the patient's wound c. The amount of pain medication that the patient is allowed to take in each dose d. Written and oral instructions regarding signs/symptoms to report to the primary health care provider

ANS: D

6. A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes? (Select all that apply.) 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

ANS: C, D, E

106. The nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately? a. Bowel sounds are not audible in all quadrants. b. Client's skin under the panniculus is excoriated. c. The client reports pain when being repositioned. d. Urine output total is 15 mL for the past 2 hours.

ANS: D

107. Which nursing care activity for a malnourished client does the nurse safely delegate to unlicensed assistive personnel (UAP)? a. Completing the Mini Nutritional Assessment b. Determining body mass index (BMI) c. Estimating body fat using skinfold measurements d. Measuring current height and weight

ANS: D

11. The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is mostindicative of bleeding? a. Respiratory rate from 24 to 20 breaths/min b. Apical pulse from 80 to 72 beats/min c. Temperature from 97.9° F to 98.9° F (36.6°C to 37.2°C) d. Blood pressure from 140/90 to 110/70 mm Hg

ANS: D

111. An obese client with a body mass index of 30 and hypertension has been taking prescription orlistat for 4 weeks and reports loose stools, abdominal cramps, and nausea. What does the nurse recommend for this client? a. Asking the provider to change the medication to phendimetrazine (Bontril). b. Changing to the lower dose, over-the-counter form of orlistat to reduce these effects. c. Increasing the daily activity level to improve overall metabolism. d. Reducing nutritional fat intake to less than 30% of the client's daily food intake.

ANS: D

14. A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the clients bowel sounds.

ANS: D

18. A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection. Which assessment should the nurse complete first? a. Heart rate and rhythm b. Bowel sounds c. Urinary output d. Respiratory rate

ANS: D

2. A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds (2.3 kg) of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? a. Explain to the patient the importance of drinking the enteral supplements prescribed. b. Ask the patient's family to try to persuade the patient to drink the supplements. c. Inform the patient that a nasogastric tube may be necessary if he or she fails to comply. d. Ask the patient if a change in flavor would make the supplement more palatable.

ANS: D

20. A client is receiving total parenteral nutrition (TPN). What action by the nurse is most important? a. Assessing blood glucose as directed b. Changing the IV dressing each day c. Checking the TPN with another nurse d. Performing appropriate hand hygiene

ANS: D

21. A nurse is weighing and measuring a client with severe kyphosis. What is the best method to obtain this clients height? a. Add the trunk and leg measurements. b. Ask the client how tall he or she is. c. Estimate by measuring clothing. d. Use knee-height calipers.

ANS: D

21. The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health care provider will request which medication for this patient? a. Bismuth subsalicylate (Pepto-Bismol) b. Magnesium hydroxide (Maalox) c. Metronidazole (Flagyl) d. Misoprostol (Cytotec)

ANS: D

22. A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? a. Administer pain medication. b. Assess skin temperature and color. c. Check on the amount of urine output. d. Take vital signs.

ANS: D

87. Based on nutritional screening findings and assessments, which client will be the preferred candidate for surgical treatment for obesity? a. Man with a body mass index (BMI) of 40, weight 75% above ideal body weight b. Man with a BMI of 41, weight 80% above ideal body weight c. Woman with a BMI of 38, weight 50% above ideal body weight d. Woman with a BMI of 42, weight 100% above ideal body weight

ANS: D

92. A client who is receiving total enteral nutrition exhibits acute confusion and shallow breathing and says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's signs and symptoms? a. The enteral tube is dislodged. b. Abdominal distention is present. c. Severe hyperglycemia is present. d. Refeeding syndrome is occurring. e. Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to clients who are starved, severely malnourished or metabolically stressed due to severe illness.

ANS: D

97. A client has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this client? a. Ambulating the client as quickly as possible after surgery b. Applying an abdominal binder daily when the client is out of bed c. Observing for tachycardia, nausea, diarrhea, and abdominal cramping d. Providing six small feedings daily and offering fluids frequently

ANS: D