Med/Surg PT#4

The home care nurse instruct a pt diagnosed with Addison's disease about precautions to take to avoid Addison's Crisis. Which pt statement indicated the teaching is successful? "I should decrease my caloric intake if I gain weight." "I should decrease my medication prior to going to the dentist." "I should increase my salt intake during very hot weather." "I should rest if I have problems with weakness."

"I should increase my salt intake during very hot weather." Addison's crisis is acute adrenal insufficiency precipitated by physical and psychological stressors; manifestations include nausea and vomiting, extreme weakness, severe hypoglycemia, signs and symptoms of shock, nursing care includes administering hydrocortisone therapy and vasopressors, rest, monitor vital signs, should increase fluids and salt during hot weather. Weakness indicates onset of Addison's crisis, contact the health care provider.

The home care nurse visits a pt diagnosed with hepatitis. It is most important for the nurse to intervene if the pt makes which statement: "I take acetaminophen when I get a headache" "I keep my fingernails short" "I do not drink wine with meals anymore" "I wash my hands before I eat"

"I take acetaminophen when I get a headache" Acetaminophen is contraindicated because it is hepatotoxic. Instruct the client to avoid all medications unless prescribed by the health care provider

A pt is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? "I should take my antacid before I take my other medications." "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." "It is best for me to take my antacid 1 to 3 hours after meals." "My antacid will be most effective if I take it whenever I experience stomach pains." "I should take my antacid before I take my other medications."

"It is best for me to take my antacid 1 to 3 hours after meals."

The nurse gives discharge instructions to a family of a patient diagnosed with hepatic encephalopathy. The nurse determines further teaching is necessary if the family makes which statement? "Lactulose will cause our patent to have 2-3 stools per day" "Lactulose may cause bloating and cramps" "We should contact the PCP if our parent is restless at night" "Our parent should eat meat with every meal"

"Our parent should eat meat with every meal" a low protein, high-calorie diet, instruct family to observe for and report mental changes.

You promote hemodynamic stability in a patient with upper GI bleeding by: A. Encouraging oral fluid intake. B. Monitoring central venous pressure. C. Monitoring laboratory test results and vital signs. D. Giving blood, electrolyte and fluid replacement.

Giving blood, electrolyte and fluid replacement

The nurse in the outpatient clinic cares for a pt with the diagnosis of Cushing's disease. The nurse should expect to observe which symptom? Hypotension Hypoglycemia Thin legs and arms Weight loss

Thin legs and arms Even though there is tuncal obesity, patients will have thin arms and legs due to muscle wasting; will also have edema, purple skin striations, and a decreased resistance to infection

A pt who has had ulcerative colitis i=for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which factor is of greater significance in causing an exacerbation of ulcerative colitis? Changing to a modified vegetarian diet Walking 2 miles every day A demanding and stressful job Beginning a weight-training program

A demanding and stressful job

The nurse on the surgical unit cares for several pt with new colostomies. Immediately after surgery, the nurse identifies which of the following: A stoma is grey and small A stoma is beefy-red A stoma is bluish and dry A stoma is dark and pulsating

A stoma is beefy-red Immediately following surgery, the stoma which part of the intestine, is brought out to the abdominal wall and appears beefy-red. A stoma bluish and dry indicates necrosis, report to physician A stoma gray and small should be moist and protrudes about 2cm from the abdominal wall

The nurse is caring for a pt in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100mg intravenously rate of 10 mL/hr for a pt in acute adrenal crisis. The nurse must understand that his treatment is common in pt with disease process? Addison's disease Cushing's syndrome Hyperthyroidism Hypoparathyroidsm

Addison's disease Intravenous hydrocortisone for patients in acute adrenal crisis is the proper treatment for individuals with Addison's disease.

The pt with gastroesophageal reflux disease (GERD) has a chronic cough. The symptoms may indicate: Irritation of the esophagus Development of laryngeal cancer Esophageal scar tissue formation Aspiration of gastric contents

Aspiration of gastric contents Patients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

A patient with cirrhosis is receiving lactulose. The nurse notes the patient is more confused and has asterixis. The nurse should: Monitor serum bilirubin levels Increases protein in the diet Assess for GI bleeding Withhold the lactulose

Assess for GI bleeding Asterixis, a flapping tremor, is a characteristic symptom of increased ammonia levels.

Which indicates a potential complication of diabetes mellitus? Stooped appearance Hemoglobin 9 g/dL Blood pressure of 160/100 mmHg Inflamed, painful joints

Blood pressure of 160/100 mmHg The patient with diabetes mellitus is especially prone to hypertension due to atherosclerotic changes, which leads to problems of the microvascular and macrovascular systems.

A barium enema is not prescribed as a diagnostic test for a patient with diverticulitis because barium enema: Would greatly increase the patient's pain Is of minimal diagnostic value in diverticulitis Can perforate an intestinal abscess Is too lengthy a procedure for a pt to tolerate

Can perforate an intestinal abscess

Within 6 hours following a subtotal gastrectomy, the drainage from the pt's NG is bright red. They nurse should first: Remove the existing NG tube Irrigate the NG tube with iced saline Clamp the NG tube Chart the finding in the pt's medical record.

Chart the finding in the pt's medical record NG drainage is expected to be bright red during the first 12 hours after surgery and then darken within 24 hours. The nurse notes the color of the drainage on the medical record and then monitors the change of color of the drainage throughout the immediate postoperative period.

A patient with acute pancreatitis is reporting excessive thirst, excessive vomiting and blurred vision. As the nurse, it is priority you: Reassure the pt this is normal with pancreatitis Provide a dark and calm environment Assist the pt with drinking a simple sugar drink like orange juice Check the pt's blood glucose

Check the pt's blood glucose. Patients with acute pancreatitis are at risk for hyperglycemia (the signs and symptoms the patient are reporting are classic symptoms of hyperglycemia). Remember the endocrine function of the pancreas (which is to release insulin/glucagon etc. is insufficient) so the nurse must monitor the patient's blood glucose levels even if the patient is not diabetic.

Which of the following is the most definitive test for diagnosing Ulcerative Colitis? Endoscopic retograde cholangiopancretography (ERCP) Esophagogastroduodenoscopy (EGD) Colonoscopy Magnetic resonance enterography (MRE)

Colonoscopy A colonoscopy is the MOST definitive test for diagnosing Ulcerative Colitis (UC). EGD: is a visual examination of the esophagus, stomach, and duodenum ERCP: includes visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify the cause and location of obstruction. MRE is the main EXAMINATION used to STUDY the bowel in patients who have irritable bowel syndrome.

Which position would be appropriate for a patient with sever ascites? Side-lying Sims Reverse trendelenburg Fowler's

Fowlers Ascites can compromise the action of the diaphragm and increase the patient's risk of respiratory problems. Ascites also greatly increases the risk of skin breakdown. Frequent position changes are important, but the preferred position is Fowler's. Placing the patient in Fowler's position helps facilitate the patient's breathing by relieving pressure on the diaphragm.

After a subtotal gastrectomy, the nurse should anticipate the nasogastric tube drainage will be what color for about 12 to 24 hours after surgery Cloudy white Bright red Dark brown Bile green

Dark brown

The nurse understands the most common reason for inserting of a NG tube is a post pt diagnosed with a duodenal ulcer includes which reason? Permit saline irrigations Take samples of gastric acids Assess the stomach for bleeding Decompress the stomach

Decompress the stomach The stomach is decompressed postoperatively to prevent distention and pressure on the suture lines

The physician orders Lactose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medications is working effectively? Decreased albumin levels decreased in Fetor Hepaticus Decreased ammonia blood levels Patient is stuporous

Decreased ammonia blood levels

The nurse monitors a patient with cirrhosis for the development of hepatic encephalopathy. Which would be an indication that hepatic encephalopathy is developing? Labored respirations Elevated blood pressure Decreased urine output Decreased mental status

Decreased mental status The patient should be monitored closely for changes in mental status. Ammonia has a toxic effect on central nervous system tissue and produces an altered level of consciousness, marked by drowsiness and irritability.

It is important for the nurse to monitor a pt with Addison's disease for the development of which condition? Glycosuria Dysrhythmias Urinary retention Water intoxication

Dysrhythmias Addison's disease causes increased retention of potassium, which may result in cardiac dysrhythmias

Your pt with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts and gallbladder. The pt asks you "What is the name of the test I'm going for later today?" You tell the patient it is called: MRCP ERCP CT scan of the abdomen EGD

ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is used to diagnosis and sometimes treat the causes of pancreatitis. It will assess the pancreas, bile ducts, and gallbladder. In addition, the doctor may be able to remove gallstones, dilate the blocked ducts with a stent or balloon, drain presenting cysts etc.

The nurse is instructing the male patient who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the pt? Limit oral fluids Apply heat to the abdomen Remain in a low-fiber diet Elevate the scrotum

Elevate the scrotum

Which of the following tests can be used to diagnose ulcers? Abdominal X-ray Barium swallow Esophagogastroduodenoscopy (EGD) Computed tomography (CT) scan

Esophagogastroduodenoscopy (EGD)

Assessment of the diabetic pt for common complications should include examination of the : Pharynx Abdomen Lymph glands Eyes

Eyes Diabetic retinopathy, cataracts, and glaucoma are common complications in diabetics, necessitating eye assessment and examination. The feet should also be examined at each patient

The nurse recognizes which symptoms are characteristics of impending diabetic ketoacidosis? Hot flashes, sever hunger, bradycardia Hot, dry, flushed skin, excessive thirst, rapid pulse Hyperreflexia, Babinski reflux, numbness Profuse diaphoresis, headache, bradycardia

Hot, dry, flushed skin, excessive thirst, rapid pulse Signs of impending DK are signs of sever hyperglycemia; confusion, got, flushed, dry skin, increased temperature, this, anorexia, increased pulse, possibly vomiting; clients then become lethargic, develop acetone breath and Kussmaul's respiration

The nurse cares for a pt after an appendectomy. The day after surgery, the pt has sever abdominal pain, a temperature of 101F and a rigid abdomen. The nurse suspects that the pt is experiencing which of the following? Abnormal pain tolerance Infection of the peritoneal sac Anesthesia intolerance Bladder distension

Infection of the peritoneal sac Peritonitis can be caused by ruptured appendix, signs and symptoms of peritonitis include severe abdominal pain, abdominal rigidity, decreased bowel sounds, nausea and vomiting, increased temp, shock, paralytic ileus, monitor vital signs, administer antibiotics and IVs, NG tub to suction, NPO, and relaxation technique. Rigid abdomen is a characteristic of peritonitis.

A 36 y/o female pt has been diagnosed with hemorrhoids. Which factor in the pt's history would most likely be a primary cause of her hemorrhoids? Varicosities in her legs Three vaginal delivery pregnancy Her job as a schoolteacher Her age

Three vaginal delivery pregnancies Hemorrhoids are associated with prolonged sitting or standing, portal hypertension, chronic constipation, and prolonged increased intra-abdominal pressure, as associated with pregnancy and the strain of vaginal childbirth.

Anna is a 45 y/o and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dL and HCT is 27%. her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes: Flushing the NG tube with sterile water Positioning her in high fowler's position Giving pain medication Q6hr Keeping her NPO until the return of peristalsis

Keeping her NPO until return of peristalsis

A pt with colon cancer is having a barium enema. The nurse should instruct the pt to take which type of medication after the procedure is completed? Demulcent Laxative Anticholinergic Antacid

Laxative After a barium enema, a laxative is ordinarily prescribed. This is done to promote elimination of the barium.

A pt with peptic ulcer disease is taking ranitidine. What is the expected outcome of this drug? Reduce acid concentration Heal the ulcer Protect the ulcer surface from acids Limit gastric acid secretion

Limit gastric acid secretion Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretories, or proton pump inhibitors such as omperazole, help ulcers heal quickly in 4 to 8 weeks.

The nurse cares for the pt diagnosed with type 1 diabetes. The nurse identifies which is the primary cause of dehydration in the patient with diabetic ketoacidosis (DKA)? Loss of fluid through perspiration Loss of fluids due to vomiting Inability to take fluid due to nausea Loss of fluid due to osmotic diuresis

Loss of fluid due to osmotic diuresis

A pt with a peptic ulcer disease (PUD) is admitted to the hospital for a gastric resection. The patient reports a sudden sharp pain in the mid-epigastric area that radiates to the shoulder. The nurse should first: Administer pain medication Call for a stat ECG Notify the surgeon Establish an IV line

Notify the surgeon The sharp, sudden midepigastric pain indicates the patient may have a perforated ulcer.

An adult with appendicitis has sever abdominal pain.Which action will be the most effective to assist the pt to manage pain prior to surgery? Teach pt to massage the painful area Provide distraction with music Place the pt in semi-fowler's position with the knees to the chest Apply moist heat to the abdomen

Place the pt in semi-fowler's position with the knees to the chest

Which goal is the priority for a pt in Addison's crisis? Preventing infection Relieving anxiety Preventing irreversible shock Controlling hypertension

Preventing irreversible shock Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in sever hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorotiocid function.

The nurse is teaching a patient with hep A about preventing transmission of the disease. The nurse should focus teaching on: Proper food handling Insulin syringe disposal Use of condoms Alpha-interferon

Proper food handling

The nurse cares for a pt diagnosed with adrenal hyper section (Cushing's disease). The nurse expects to observe which finding? Hypoglycemia and decreased blood pressure Symptoms of dehydration and hyponatremia Protruding abdomen and increased facial fat Anorexia and weight loss

Protruding abdomen and increased facial fat Excess amounts of glucocorticoids (cortisol) cause alterations in fat metabolism and accumulation of adipose tissue in the facial, trunk, and cervical areas; increased fate deposits described as "moon face", a "buffalo hump" and truncal obesity; increased cortisol levels due to problem with pituitary gland, hypothalmus, or adrenal gland. Cushing's disease indications: fatigue, weakness, osteoporosis, muscle-wasting, cramps, edema, increased blood pressure, hypernatremia, hypokalemia, hyperglycemia

A pt with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss? Warm, dry skin Decreased serum potassium level Rapid, deep respirations Hypotension

Rapid, deep respirations Due to the rapid, deep respirations, the patient is losing fluid from vaporization from the lungs and skin (Insensible fluid loss).

The nurse understands which of these factors is the most likely source of hepatitis D? Eating infected shellfish Overly exerting oneself Receiving a blood transfusion Practicing poor hand hygiene

Receiving a blood transfusion Correct: Receiving a blood transfusion Hepatitis D coinfects with Hepatitis B, spread by contact with blood and body fluids.

Which of the following is NOT a role of the liver Producing albumin Absorbing water Producing bile Removing hormones from the body

Removing hormones from the body

The nurse cares for the pt after a traditional cholecystectomy. It is most important for the nurse to position the pt in which of the following positions? Side-lying with bed flat Knees elevated Spin with bed flat Semi-fowler's

Semi-fowler's Semi-Fowler's is optimal for the patient because it will allow her to take the necessary deep breaths that are important to prevent pneumonia after surgery.

In teaching a pt with Addison;s disease about dietary needs, the nurse should emphasize the importance of consuming which nutrient? Magnesium Chloride Sodium Potassium

Sodium Hypo function of the adrenal glands causes hyponatremia and hypovolemia; symptoms of hyponatream is include nausea, muscle cramps, increased intracranial pressure, confusion, muscular twitching, and convulsion; adjust intake of sodium

While assisting a pt with chronic pancreatitis to the bathroom, you note the pt's stool to be oily/greasy in appearance. In your documentation you note this as: Currant Hematochezia Steatorrhea Melena

Steatorrhea is an oily/greasy appearance of the stool which can occur in chronic pancreatitis. This occurs due to the inability of the pancreas to produce digestive enzymes which help break down fats. Fats are not being broken down; therefore, it is being excreted into the stool.

The nurse is assessing the pt's understanding of the use of medications. Which medication may cause a complication with the treatment plan of pt with diabetes? Angiotensin-Converting enzyme (ACE) inhibitors Sulfonylureas Aspirin Steroids

Steroids Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult.

A patient who has a history of an inguinal hernia is admitted to the hospital with sudden, sever abdominal pain, vomiting and and distention. The nurse should assess the pt further for which complication? Incarcerated hernia Strangulated hernia Peritonitis Intestinal perforation

Strangulated hernia The symptoms are indicative of a strangulated hernia. In a strangulated hernia, the hernia cannot be reduced back into the abdominal cavity. The intestinal lumen and the blood supply to the intestine are obstructed, causing an acute intestinal obstruction. Without immediate intervention, necrosis and gangrene may develop. Surgery is required to release the strangulation.

A pt has been taking aluminum hydroxide 30 mL 6x/day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the pt's constipation? The pt needs to increase his daily exercise The pt is experiencing a side effect of the aluminum hydroxide The pt has developed a gastrointestinal obstruction The pt has not been including enough fiber in his diet

The pt is experiencing a side effect of the aluminum hydroxide

The nurse cares for a pt 18 hr after a gastrectomy. The nurse is most concerned if which of the following is observed? The Levin's tube is attached to low continuous suctioning The pt output during the previous 6 hr was 500cc The pt asks for pain medications The patient performs deep breathing every 2 hours

The Levin's tube is attached to low continuous suctioning Levin's tube is a single lumen tube with no air vent, suction should be intermittent, continuous suction is appropriate for a Salem sump tube

Which topic is most important to include in the teaching plan for a pt newly diagnosed with Addison's disease who will be taking corticosteroids? How to decrease the dose of the corticosteroids when the pt experiences stress To notify the health care provider when the blood pressure is suddenly high The importance of watching for signs of hyperglycemia The need to adjust the steroid dose based on dietary intake and exercise

The importance of watching for signs of hyperglycemia Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the patient. A serious adverse effect of corticosteroids is hyperglycemia.

The nurse cares for a pt admitted with a diagnosis of acute pancreatitis. An IV is begun and the nurse inserts a NG tube and attaches it to intermittent low suction. The nurse gives frequent oral hygiene and administers morphine for reports of pain. Which pt behavior indicated to the nurse the medication is effective? The patient sleeps for one hour The patient frequently changes position in bed The pt does not report thirst The pt states there is less nausea

The patient sleeps for one hour Acute pancreatitis causes severe abdominal pain; pain increases body metabolism , which increases recreation of pancreatic and gastric enzyme; client sleeping indicates morphine is effective; important to evaluate the effectiveness of the medication

A pt is 2 day post-opt from an ileostomy placement. Which finding requires immediate nursing action? The patient reports mucoid drainage from the anus The stoma is bright read and moist The patients's potassium level is 2.0 The stoma is excreting liquid stool

The patients's potassium level is 2.0 A patient with an ileostomy is at risk for electrolyte imbalances. The nurse should monitor the patient (especially after ileostomy surgery) for these imbalances. A normal potassium is 3.5 to 5.1. Therefore, a level of 2.0 requires immediate nursing action. The nurse should contact the physician for further orders. All the other options are normal findings found with an ileostomy.

The nurse cares for a pt diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse is most concerned if which is observed? The pt's serum sodium is 137 mEq/L The pt is eating ice chips The pt is lying in bed with the rails up The pt is orientated to persons, place and time

The pt is eating ice chips Water intake is restricted because of water excess; irrigate tube and mixed medication with normal saline solution

A pt is admitted to the hospital after vommitting bright red blood and is diagnosed with a bleeding duodenal ulcer. The pt develops a sudden, sharp pain in the mid epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicated which of the following? A intestinal obstruction has developed Additional ulcers have developed The ulcer has perforated The esophagus has become inflamed.

The ulcer has perforated

The nurse is caring for a male pt with a diagnosis of chronic gastritis. The nurse monitors the pt knowing that this pt is at risk for which vitamin deficiency? Vitamin E Vitamin C Vitamin B12 Vitamine A

Vitamin B12

Which of the following conditions can cause a hiatal hernia Weakness of the diaphragm muscle Increased esophageal muscle pressure Weakness of the esophageal muscle Increased intrathoracic pressure

Weakness of the diaphragm muscle