Osteoporosis/GERD/Pancreatitis/Urinary Calculi Exam 2 NCLEX

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods containing cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one (1) vitamin a day with extra calcium."

1. "I should increase my fluid intake, especially in warm weather." rationale: 1. An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate. 2. Cocoa and chocolate are high in calcium and should be avoided or the amount should be decreased to help prevent formation of calcium phosphate renal stones. 3. Physical activity prevents bone absorption and possible hypercalciuria; therefore, the nurse should instruct the client to walk daily to help retain calcium in bone. 4. The renal calculi are caused by calcium; therefore, the client should not increase calcium intake.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. rationale: 1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. 2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. 3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result. 4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized. 5. The nurse can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates.

The nurse is administering a pancreatic enzyme to the client diagnosed with chronic pancreatitis. Which statement best explains the rationale for administering this medication? 1. It is an exogenous source of protease, amylase, and lipase. 2. This enzyme increases the number of bowel movements. 3. This medication breaks down in the stomach to help with digestion. 4. Pancreatic enzymes help break down fat in the small intestine.

1. It is an exogenous source of protease, amylase, and lipase. rationale: 1. Pancreatic enzymes enhance the digestion of starches (carbohydrates) in the gastrointestinal tract by supplying an exogenous (outside) source of the pancreatic enzymes protease, amylase, and lipase. 2. Pancreatic enzymes decrease the number of bowel movements. 3. The enzymes are enteric coated and should not be crushed because the hydrochloric acid in the stomach will destroy the enzymes; these enzymes work in the small intestine. 4. Pancreatic enzymes help break down carbohydrates, and bile breaks down fat.

The client with an acute exacerbation of chronic pancreatitis has a nasogastric (N/G) tube. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's bowel sounds. 2. Monitor the client's food intake. 3. Assess the client's intravenous site. 4. Provide oral and nasal care. 5. Monitor the client's blood glucose.

1. Monitor the client's bowel sounds. 3. Assess the client's intravenous site. 4. Provide oral and nasal care. 5. Monitor the client's blood glucose. rationale: 1. The return of bowel sounds indicates the return of peristalsis, and the nasogastric suction is usually discontinued within 24 to 48 hours thereafter. 2. The client will be NPO secondary to the chronic pancreatitis, and the client cannot eat with a nasogastric tube. 3. The nurse should assess for signs of infection or infiltration. 4. Fasting and the N/G tube increase the client's risk for mucous membrane irritation and breakdown. 5. Blood glucose levels are monitored because clients with chronic pancreatitis can develop diabetes mellitus.

Which intervention is an example of a secondary nursing intervention when discussing osteoporosis? 1. Obtain a bone density evaluation test. 2. Perform non-weight-bearing exercises regularly. 3. Increase the intake of dietary calcium. 4. Refer clients to a smoking cessation program.

1. Obtain a bone density evaluation test. rationale: 1. This is an example of a secondary nursing intervention, which includes screening for early detection. 2. The client should perform weight-bearing exercises, which promote osteoblast activity helping to maintain bone strength and integrity. This is a primary nursing intervention. 3. Increasing dietary calcium may be a primary intervention to help prevent osteoporosis or a tertiary intervention, which helps treat osteoporosis. 4. Smoking cessation is a primary intervention, which will help prevent the development of osteoporosis.

The nurse is preparing to administer a.m. medications to clients. Which medication should the nurse question before administering? 1. Pancreatic enzymes to the client who has finished breakfast. 2. The pain medication, morphine, to the client who has a respiratory rate of 20. 3. The loop diuretic to the client who has a serum potassium level of 3.9 mEq/L. 4. The beta blocker to the client who has an apical pulse of 68 bpm.

1. Pancreatic enzymes to the client who has finished breakfast. rationale: 1. Pancreatic enzymes must be administered with meals to enhance the digestion of starches and fats in the gastrointestinal (GI) tract. 2. The client's respiratory rate is within normal limits; therefore, the morphine should be administered to the client who is having pain. 3. This is a normal potassium level; therefore, the nurse does not need to question administering this medication. 4. The apical pulse is within normal limits; therefore, the nurse should not question administering this medication.

The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena.

1. Pyrosis, water brash, and flatulence. rationale: 1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD. 2. Gastroesophageal reflux disease does not cause weight loss. 3. There is no change in abdominal fat, no proteinuria (the result of a filtration problem in the kidney), and no alteration in bowel elimination for the client diagnosed with GERD. 4. Midepigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease.

The nurse is teaching a class to pregnant teenagers. Which information is most important when discussing ways to prevent osteoporosis? 1. Take at least 1,200 mg of calcium supplements a day. 2. Eat foods low in calcium and high in phosphorus. 3. Osteoporosis does not occur until around age 50 years. 4. Remain as active as possible until the baby is born.

1. Take at least 1,200 mg of calcium supplements a day. rationale: 1. The National Institutes of Health (NIH) recommends a daily calcium intake of 1,200 to 1,500 mg/day for adolescents, young adults, and pregnant and lactating women. 2. The pregnant teenager should eat foods high in calcium. 3. Osteoporosis may not occur before age 50 years, but taking calcium throughout the life span will help prevent it. Remember, teenagers tend to focus on the present, not the future, so the most important intervention to teach them is to take calcium supplements. 4. Activity will not help prevent osteoporosis in the teenager; the teenager must take calcium supplements.

The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking.

1. Teach the client to sleep with a foam wedge under the head. rationale: 1. The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. Behavior modification is changing one's behavior. 2. The client should be encouraged to quit smoking altogether. Referral to support groups for smoking cessation should be made. 3. The nurse should be careful when recommending OTC medications. This is not the most appropriate intervention for a client with GERD. 4. The client should be instructed to discontinue using alcohol, but the stem does not indicate the client is an alcoholic.

Which foods should the nurse recommend to a client when discussing sources of dietary calcium? 1. Yogurt and dark-green, leafy vegetables. 2. Oranges and citrus fruits. 3. Bananas and dried apricots. 4. Wheat bread and bran.

1. Yogurt and dark-green, leafy vegetables. rationale: 1. The best dietary sources of calcium are milk and other dairy products. Other sources include oysters; canned sardines or salmon; beans; cauliflower; and dark-green, leafy vegetables. 2. These foods are high in vitamin C. 3. These foods are high in potassium. 4. These foods are recommended for a high-fiber diet.

The client diagnosed with acute pancreatitis is being discharged home. Which statement by the client indicates the teaching has been effective? 1. "I should decrease my intake of coffee, tea, and cola." 2. "I will eat a low-fat diet and avoid spicy foods." 3. "I will check my amylase and lipase levels daily." 4. "I will return to work tomorrow but take it easy."

2. "I will eat a low-fat diet and avoid spicy foods." rationale: 1. Coffee, tea, and cola stimulate gastric and pancreatic secretions and may precipitate pain, so these foods should be avoided, not decreased. 2. High-fat and spicy foods stimulate gastric and pancreatic secretions and may precipitate an acute pancreatic attack. 3. Amylase and lipase levels must be checked via venipuncture with laboratory tests, and there are no daily tests the client can monitor at home. 4. The client will be fatigued as a result of decreased metabolic energy production and will need to rest and not return to work immediately.

The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? 1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?"

2. "What have you done to alleviate the heartburn?" rationale: 1. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss but not weight gain. 2. Most clients with GERD have been self-medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. 3. Milk and dairy products contain lactose, which are important if considering lactose intolerance but are not important for "heartburn." 4. Heartburn is not a symptom of a viral illness.

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

2. Assess the client's pain and rule out complications. rationale: 1. The client's urinary output should be monitored, but it is not the first nursing intervention. 2. Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vaso-vagal response, with resulting hypotension and syncope. 3. Increased fluid increases urinary output, which will facilitate movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention. 4. Ambulation will help facilitate movement of the renal stone through the ureter and safety is important, but it is not the first intervention.

The female client diagnosed with osteoporosis tells the nurse she is going to perform swim aerobics for 30 minutes every day. Which response is most appropriate by the nurse? 1. Praise the client for committing to do this activity. 2. Explain to the client walking 30 minutes a day is a better activity. 3. Encourage the client to swim every other day instead of daily. 4. Discuss with the client how sedentary activities help prevent osteoporosis.

2. Explain to the client walking 30 minutes a day is a better activity. rationale: 1. Swimming is not as beneficial as walking in maintaining bone density because of the lack of weight-bearing activity. 2. Weight-bearing activity, such as walking, is beneficial in preventing or slowing bone loss. The mechanical force of weight-bearing exercises promotes bone growth. 3. Swimming is not as beneficial in maintaining bone density because of the lack of weight-bearing activity. 4. A sedentary lifestyle is a risk factor for the development of osteoporosis.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

2. Nausea; vomiting; pallor; and cool, clammy skin. rationale: 1. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney. 2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder. 4. Kidney stones and bladder stones may produce no signs/symptoms, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter.

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1. Assess the client's neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

2. Strain all urine and send any sediment to the laboratory. rationale: 1. Assessment is important, but the neurological system is not priority for a client with a urinary problem. 2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone. 3. These are laboratory studies evaluating kidney function, but they are not pertinent when passing a renal stone. These values do not elevate until at least half the kidney function is lost. 4. A dietary recall can be done to determine what types of foods the client is eating that may contribute to the stone formation, but it is not the most important intervention.

The male client diagnosed with chronic pancreatitis calls and reports to the clinic nurse he has been having a lot of "gas," along with frothy and very foul-smelling stools. Which intervention should the nurse implement? 1. Explain this is common for chronic pancreatitis. 2. Ask the client to bring in a stool specimen to the clinic. 3. Arrange an appointment with the HCP for today. 4. Discuss the need to decrease fat in the diet so this won't happen.

3. Arrange an appointment with the HCP for today. rationale: 1. Any change in the client's stool should be a cause for concern to the clinic nurse. 2. This is not necessary because the nurse knows changes in stool occur as a complication of pancreatitis, and the client needs to see the HCP. 3. Steatorrhea (fatty, frothy, foul-smelling stool) is caused by a decrease in pancreatic enzyme secretion and indicates impaired digestion and possibly an increase in the severity of the pancreatitis. The client should see the HCP. 4. Decreasing fat in the diet will not help stop this type of stool.

The client is immediate postprocedure endoscopic retrograde cholangiopancreatogram (ERCP). Which intervention should the nurse implement? 1. Assess for rectal bleeding. 2. Increase fluid intake. 3. Assess gag reflex. 4. Keep in supine position.

3. Assess gag reflex. rationale: 1. During this procedure, a scope is placed down the client's mouth; therefore, assessing for rectal bleeding is not an intervention. 2. The client's throat has been anesthetized to insert the scope; therefore, fluid and food are withheld until the gag reflex has returned. 3. The gag reflex will be suppressed as a result of the local anesthesia applied to the throat to insert the endoscope into the esophagus; therefore, the gag reflex must be assessed prior to allowing the client to resume eating or drinking. 4. The client should be in a semi-Fowler's or side-lying position to prevent aspiration.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

3. Come to the clinic and provide a urinalysis specimen. rationale: 1. The client needs to be evaluated for a possible urinary tract infection, which may accompany renal calculi. Therefore, the clinic nurse should not give advice without knowing what is wrong with the client. 2. The nurse should not recommend any medication (even Tylenol) unless the nurse is absolutely sure what is wrong with the client. 3. A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI. 4. The client needs to strain the urine if there is a possibility of renal calculi, which these signs/symptoms do not support. Further diagnostic testing is needed to determine the presence of renal calculi.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3. Discuss the importance of limiting vitamin D-enriched foods. rationale: 1. This is appropriate for the client who has uric acid stones. 2. The nurse should recommend drinking one (1) to two (2) glasses of water at night to prevent concentration of urine during sleep. 3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract. 5. This is a treatment for an existing renal stone, not a discharge teaching intervention for a client who has successfully passed a renal calculus.

The nurse is completing discharge teaching to the client diagnosed with acute pancreatitis. Which instruction should the nurse discuss with the client? 1. Instruct the client to decrease alcohol intake. 2. Explain the need to avoid all stress. 3. Discuss the importance of stopping smoking. 4. Teach the correct way to take pancreatic enzymes.

3. Discuss the importance of stopping smoking. rationale: 1. Alcohol must be avoided entirely because it can cause stones to form, blocking pancreatic ducts and the outflow of pancreatic juice, causing further inflammation and destruction of the pancreas. 2. Stress stimulates the pancreas and should be dealt with, but it is unrealistic to think a client can avoid all stress. By definition, the absence of all stress is death. 3. Smoking stimulates the pancreas to release pancreatic enzymes and should be stopped. 4. The client has acute pancreatitis, and pancreatic enzymes are only needed for chronic pancreatitis.

The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate when diagnosing osteoporosis? 1. X-ray of the femur. 2. Serum alkaline phosphatase. 3. Dual-energy x-ray absorptiometry (DEXA). 4. Serum bone Gla-protein test.

3. Dual-energy x-ray absorptiometry (DEXA). rationale: 1. Osteoporotic changes do not occur in the bone until more than 30% of the bone mass has been lost. 2. This serum blood study may be elevated after a fracture, but it does not help diagnose osteoporosis. 3. This test measures bone density in the lumbar spine or hip and is considered to be highly accurate. 4. This test is most useful to evaluate the effects of treatment, rather than as an indicator of the severity of bone disease.

The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day.

3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. rationale: 1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach. 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux.

The nurse is discussing osteoporosis with a group of women. Which factor will the nurse identify as a nonmodifiable risk factor? 1. Calcium deficiency. 2. Tobacco use. 3. Female gender. 4. High alcohol intake.

3. Female gender. rationale: 1. Calcium deficiency is a modifiable risk factor, which means the client can do something about this factor—namely, increase the intake of calcium—to help prevent the development of osteoporosis. 2. Smoking is a modifiable risk factor because the client can quit smoking. 3. A nonmodifiable risk factor is a factor the client cannot do anything to alter or change. Approximately 50% of all women will experience an osteoporosis-related fracture in their lifetime. 4. The client can quit drinking alcohol; therefore, this is a modifiable risk factor.

The client is taking calcium carbonate (Tums) to help prevent further development of osteoporosis. Which teaching should the nurse implement? 1. Encourage the client to take Tums with at least eight (8) ounces of water. 2. Teach the client to take Tums with the breakfast meal only. 3. Instruct the client to take Tums 30 to 60 minutes before a meal. 4. Discuss the need to get a monthly serum calcium level.

3. Instruct the client to take Tums 30 to 60 minutes before a meal. rationale: 1. There is no reason to take Tums with eight (8) ounces of water. Tums are usually chewed. 2. Tums should not be taken with meals. 3. Free hydrochloric acid is needed for calcium absorption; therefore, Tums should be taken on an empty stomach. 4. To determine the effectiveness of calcium supplements, the client must have a bone density test, not a serum calcium level measurement.

The nurse is discussing complications of chronic pancreatitis with a client diagnosed with the disease. Which complication should the nurse discuss with the client? 1. Diabetes insipidus (DI). 2. Crohn's disease. 3. Narcotic addiction. 4. Peritonitis.

3. Narcotic addiction. rationale: 1. The client is at risk for diabetes mellitus (destruction of beta cells), not diabetes insipidus, a disorder of the pituitary gland. 2. Crohn's disease is an inflammatory disorder of the lining of the gastrointestinal system, especially of the terminal ileum. 3. Narcotic addiction is related to the frequent, severe pain episodes often occurring with chronic pancreatitis, which require narcotics for relief. 4. Peritonitis, an inflammation of the lining of the abdomen, is not a common complication of chronic pancreatitis.

The client diagnosed with acute pancreatitis is in pain. Which position should the nurse assist the client to assume to help decrease the pain? 1. Recommend lying in the prone position with legs extended. 2. Maintain a tripod position over the bedside table. 3. Place in side-lying position with knees flexed. 4. Encourage a supine position with a pillow under the knees.

3. Place in side-lying position with knees flexed. rationale: 1. Lying on the stomach will not help to decrease the client's pain. 2. This is a position used by clients with chronic obstructive pulmonary disease to help lung expansion. 3. This fetal position decreases pain caused by the stretching of the peritoneum as a result of edema. 4. Laying supine causes the peritoneum to stretch, which increases the pain.

The client is admitted to the medical department with a diagnosis of rule-out (R/O) acute pancreatitis. Which laboratory values should the nurse monitor to confirm this diagnosis? 1. Creatinine and (BUN). 2. Troponin and (CK-MB). 3. Serum amylase and lipase. 4. Serum bilirubin and calcium.

3. Serum amylase and lipase. rationale: 1. These laboratory values are monitored for clients in kidney failure. 2. These laboratory values are elevated in clients with a myocardial infarction. 3. Serum amylase increases within two (2) to 12 hours of the onset of acute pancreatitis to two (2) to three (3) times normal and returns to normal in three (3) to four (4) days; lipase elevates and remains elevated for seven (7) to 14 days. 4. Bilirubin may be elevated as a result of compression of the common duct, and hypocalcemia develops in up to 25% of clients with acute pancreatitis, but these laboratory values do not confirm the diagnosis.

The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett's esophagus who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today.

3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. rationale: 1. Pyrosis is heartburn and is expected in a client diagnosed with GERD. The new graduate can care for this client. 2. Barrett's esophagus is a complication of GERD; new graduates can prepare a client for a diagnostic procedure. 3. This client is exhibiting symptoms of asthma, a complication of GERD. This client should be assigned to the most experienced nurse. 4. This client can be cared for by the new graduate, and ambulating can be delegated to the unlicensed assistive personnel (UAP).

The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client's Bernstein esophageal test was positive. 2. The client's abdominal x-ray shows a hiatal hernia. 3. The client's WBC count is 14,000/mm3. 4. The client's hemoglobin is 13.8 g/dL.

3. The client's WBC count is 14,000/mm3. rationale: 1. In a Bernstein test, acid is instilled into the distal esophagus, causing immediate heartburn for a client diagnosed with GERD. This would not warrant notifying the HCP. 2. Hiatal hernias are frequently the cause of GERD; therefore, this finding would not warrant notifying the HCP. 3. The client's WBC count is elevated, indicating a possible infection, which warrants notifying the HCP. 4. This is a normal hemoglobin result and would not warrant notifying the HCP.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.

3. Venison and sardines. rationale: 1. Beer and colas are foods high in oxalate, which can cause calcium oxalate stones. 2. Asparagus and cabbage are foods high in oxalate, which can cause calcium oxalate stones. 3. Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones. 4. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions? 1. "I should not eat for at least one (1) day following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid orange juice and eating tomatoes until my esophagus heals."

4. "I should avoid orange juice and eating tomatoes until my esophagus heals." rationale: 1. The client is allowed to eat as soon as the gag reflex has returned. 2. An esophagogastroduodenoscopy is a diagnostic procedure, not a cure. Therefore, the client still has GERD and should be instructed to stay in an upright position for two (2) to three (3) hours after eating. 3. Stomach contents are acidic and will erode the esophageal lining. 4. Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal.

The client diagnosed with osteoporosis asks the nurse, "Why does smoking cigarettes cause my bones to be brittle?" Which response by the nurse is most appropriate? 1. "Smoking causes nutritional deficiencies, which contribute to osteoporosis." 2. "Tobacco causes an increase in blood supply to the bones, causing osteoporosis." 3. "Smoking low-tar cigarettes will not cause your bones to become brittle." 4. "Nicotine impairs the absorption of calcium, causing decreased bone strength."

4. "Nicotine impairs the absorption of calcium, causing decreased bone strength." rationale: 1. This is the rationale for heavy alcohol use leading to the development of osteoporosis. 2. Smoking decreases, not increases, blood supply to the bone. 3. Cigarette smoking has long been identified as a risk factor for osteoporosis, and it doesn't matter if the cigarettes are low tar. 4. Nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density.

The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent.

4. A mucosal barrier agent. rationale: 1. Proton pump inhibitors can be administered at routine dosing times, usually 0900 or after breakfast. 2. Pain medication is important, but a nonnarcotic medication, such as Tylenol, can be administered after a medication, which must be timed. 3. A histamine receptor antagonist can be administered at routine dosing times. 4. A mucosal barrier agent must be administered on an empty stomach for the medication to coat the stomach.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3.

4. A white blood cell count of 14,000/mm3. rationale: 1. This potassium level is within normal limits, 3.5 to 5.5 mEq/L. 2. Hematuria is not uncommon after removal of a kidney stone. 3. A normal creatinine level is 0.8 to 1.2 mg/100 mL. 4. The white blood cell count is elevated; normal is 5,000 to 10,000/mm3.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort.

4. Alteration in comfort. rationale: 1. The client's fluid volume is increased and there is usually not a fluid volume loss. 2. Knowledge deficit is important to help prevent future renal calculi, but this is not priority when the client is in pain, which will occur with an acute episode. 3. Impaired urinary elimination may occur, but it is not priority for the client with an acute episode of calculi. 4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.

The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side-lying position and take antacids before meals. 4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client.

4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client. rationale: 1. The client is encouraged to lie with the head of the bed elevated, but this is difficult to achieve when on the stomach. NSAIDs inhibit prostaglandin synthesis in the stomach, which places the client at risk for developing gastric ulcers. The client is already experiencing gastric acid difficulty. 2. The client will need to lie down at some time, and walking will not help with GERD. 3. If lying on the side, the left side-lying position, not the right side, will allow less chance of reflux into the esophagus. Antacids are taken one (1) and three (3) hours after a meal. 4. The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux.

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shellfish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.

4. Explain the test is noninvasive and there is no discomfort. rationale: 1. An ultrasound does not require administration of contrast dye. 2. Food, fluids, and ordered medication are not restricted prior to this test. 3. This is not an invasive procedure, so a signed consent is not required. 4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied, which produces sound waves, resulting in a picture.

The client is diagnosed with acute pancreatitis. Which health-care provider's admitting order should the nurse question? 1. Bedrest with bathroom privileges. 2. Initiate IV therapy of D5W at 125 mL/hr. 3. Weigh the client daily. 4. Low-fat, low-carbohydrate diet.

4. Low-fat, low-carbohydrate diet. rationale: 1. Bedrest will decrease metabolic rate, gastrointestinal secretion, pancreatic secretions, and pain; therefore, this HCP's order should not be questioned. 2. The client will be NPO; therefore, initiating IV therapy is an appropriate order. 3. Short-term weight gain changes reflect fluid balance because the client will be NPO and receiving IV fluids. Daily weight is an appropriate HCP's order. 4. The client will be NPO, which will decrease stimulation of the pancreatic enzymes, resulting in decreased autodigestion of the pancreas, therefore decreasing pain.

The 84-year-old client is a resident in a long-term care facility. Which intervention should be implemented to help prevent complications secondary to osteoporosis? 1. Keep the bed in the high position. 2. Perform passive range-of-motion exercises. 3. Turn the client every two (2) hours. 4. Provide nighttime lights in the room.

4. Provide nighttime lights in the room. rationale: 1. The bed should be kept in the low position. Preventing falls is a priority for a client diagnosed with osteoporosis. 2. Range-of-motion (ROM) exercises will help prevent deep vein thrombosis or contractures, but they do not help prevent osteoporosis. 3. Turning the client will help prevent pressure ulcers but does not help prevent osteoporosis. 4. Nighttime lights will help prevent the client from falling; fractures are the number one complication of osteoporosis.

The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray. Which assessment data indicate to the nurse an adverse effect of the medication? 1. The client complains of nausea and vomiting. 2. The client is drinking two (2) glasses of milk a day. 3. The client has a runny nose and nasal itching. 4. The client has had numerous episodes of nosebleeds.

4. The client has had numerous episodes of nosebleeds. rationale: 1. Nausea and vomiting may occur during initial stages of therapy, but they will disappear as treatment continues. 2. The client should be sure to consume adequate amounts of calcium and vitamin D while taking calcitonin. 3. Rhinitis (runny nose) is the most common side effect with calcitonin nasal spray along with itching, sores, and other nasal symptoms. 4. Nosebleeds are adverse effects and should be reported to the client's HCP.

The nurse is caring for an elderly client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this medication? Select all that apply. A) "The most common adverse effect is hypercalcemia caused by taking too much of the supplement." B) "Oral calcium supplements are best taken on an empty stomach." C) "Adults 50 years of age and over should obtain at least 500-750 mg per day of elemental calcium." D) "If you have a condition called ventricular fibrillation, this medication might help." E) "Report symptoms of weakness, increased urination, and thirst."

A) "The most common adverse effect is hypercalcemia caused by taking too much of the supplement." E) "Report symptoms of weakness, increased urination, and thirst." rationale: Calcium gluconate and other calcium compounds are used to treat and prevent osteoporosis. Oral calcium supplements are best taken with meals or within 1 hour following meals. It is recommended that adults 50 years of age and over obtain at least 1,000-1,200 mg per day of elemental calcium. The most common adverse effect is hypercalcemia caused by taking too much of the supplement. Symptoms include lethargy, drowsiness, weakness, headache, anorexia, nausea and vomiting, increased urination, and thirst. Calcium supplementation is contraindicated in clients with ventricular fibrillation.

A graduate nurse has joined the staff in the care of renal clients. The graduate asks the preceptor what puts a client at risk urinary calculi. The nurse identifies which client as having the greatest risk for urinary stones? A) A 35-year-old female with quadriplegia from an auto accident B) A 65-year-old male with a recent history of myocardial infarction C) A 50-year-old male with type II diabetes mellitus D) A 25-year-old female with several episodes of urinary infection

A) A 35-year-old female with quadriplegia from an auto accident rationale: The 35-year-old female with quadriplegia from an auto accident experiences prolonged immobility, which will increase calcium loss from bones and therefore increase the chance of calcium stones precipitating in the urinary system. A 65-year-old male with a recent history of myocardial infarction, 50-year-old male with type II diabetes mellitus, and 25-year-old female with several episodes of urinary infection do not have as great a risk because they do not remain immobile for long periods of time.

A 54-year-old male is admitted to the ED with symptoms of acute pancreatitis. What are some probable nursing diagnoses that should be evaluated in this patient? Select all that apply. A) Acute Pain related to inflammation and edema B) Impaired Swallowing C) Deficient Fluid Volume D) Nausea related to irritation of the gastrointestinal system

A) Acute Pain related to inflammation and edema C) Deficient Fluid Volume D) Nausea related to irritation of the gastrointestinal system rationale: Acute pancreatitis develops suddenly, typically with an abrupt onset of continuous severe epigastric and abdominal pain. Impaired swallowing is not associated with pancreatitis. Systemic complications of acute pancreatitis include intravascular volume depletion. Other manifestations of acute pancreatitis include nausea and vomiting.

A 57-year-old client was admitted to the hospital with chest pressure. After myocardial infarction was ruled out, he was diagnosed with erosive esophagitis through upper GI endoscopy. He owns and operates a bakery with his wife and adult son. His BMI is 39. He smokes 1 pack of cigarettes per day. The patient is now refusing all medications and states "I'm not getting hooked on any pills." What would the nurse recommend for the multidisciplinary collaborative plan? Select all that apply. A) Assess the client's readiness for change in smoking cessation and weight loss. B) Interview the client and his wife for a 24-hour recall of usual food content, intake, and meal times. C) Enlist the patient's son to elevate the foot of the client's bed at home 6 inches. D) Offer the client a surgical consult to reduce the necessity of medication. E) Omit the pharmacist notification of the Multidisciplinary Team meeting about the client.

A) Assess the client's readiness for change in smoking cessation and weight loss. B) Interview the client and his wife for a 24-hour recall of usual food content, intake, and meal times. rationale: Weight loss and smoking cessation will improve the symptoms of GERD. Determining food types, amounts, and times of consumption can help the client avoid foods that stimulate acid production and avoid eating prior to lying down. The head of the bed should be elevated and the team should recommend this to the client rather than enlisting the client's son. A surgical consult should come from the primary provider and will not necessarily reduce the need for medication. The pharmacist should be included in the Multidisciplinary Team meeting to give input to strategies to improve the client's receptivity to medication therapy

Helen J., a 77-year-old with a history of alcohol abuse, has been admitted to the hospital with acute pancreatitis. In order to address possible complications that would require immediate interventions, what are some of the functions the nurse should monitor? Select all that apply. A) Cardiac function B) Mobility function C) Respiratory function D) Renal function

A) Cardiac function C) Respiratory function D) Renal function rationale: Clients at risk for fluid and electrolyte imbalance are at risk for a fluid shift from the intravascular space into the abdominal cavity, requiring the nurse to assess cardiovascular status, including vital signs, cardiac rhythm, central venous and pulmonary artery pressures, peripheral pulses and capillary refill, and skin color, temperature, moisture, and turgor. Mobility is not a relevant function to assess in acute pancreatitis. Regularly assess respiratory function and report tachypnea, adventitious or absent breath sounds, oxygen saturation levels below 92%, and PaO2 < 70 mmHg or PaCO2 > 45 mmHg. Clients at risk for fluid and electrolyte imbalance also require ongoing monitoring of renal function. The nurse assesses urine output hourly, reporting if less than 30 mL/hr.

A client admitted to the hospital with a diagnosis of gout has also been diagnosed with uric acid renal calculi. Which diet should the nurse anticipate may be ordered by the physician? A) Low-purine diet B) Low-sodium diet C) A diet high in calcium D) A diet low in calcium

A) Low-purine diet rationale: A low-purine diet is appropriate in the management of a client with uric acid renal calculi. A low-sodium diet is useful in the management of a client with cystine renal calculi, and a diet limiting foods high in calcium is useful when managing a client with calcium phosphate renal calculi.

Which of the following lab results would be consistent with a diagnosis of acute pancreatitis? Select all that apply. A) Serum calcium level of 8.8 mg/dL B) Urine amylase 15 units/L/2 hr C) Serum lipase 1400 U/L D) White blood cells 7500/mm E) Serum glucose 87 mg/dL

A) Serum calcium level of 8.8 mg/dL C) Serum lipase 1400 U/L rationale: Hypocalcemia develops in up to 25% of clients with acute pancreatitis. Urine amylase levels rise in acute pancreatitis. Serum lipase levels rise in acute pancreatitis and remain elevated for 7-14 days. Leukocytosis indicates inflammation and is usually present in acute pancreatitis. There may be a transient elevation in serum glucose in acute pancreatitis.

A client was discharged after hospitalization for acute pancreatitis with instructions on the use of analgesics, cautions on the importance of avoiding alcohol and smoking, and recommendations for a low-fat diet. What would indicate that the client has implemented the recommendations? Select all that apply. A) The client experiences reduction or elimination of pain. B) The client is able to resume eating. C) The client remains free from alterations in fluid and nutrition status. D) The client returns to work. E) The client is free from nausea.

A) The client experiences reduction or elimination of pain. B) The client is able to resume eating. C) The client remains free from alterations in fluid and nutrition status. E) The client is free from nausea. rationale: Nursing interventions to help the client manage pain, restore nutritional status, and restore and maintain fluid and electrolyte balance will help reduce the client's risk for a life-threatening event and increase the client's chances for success in meeting and maintaining a healthy lifestyle and therapeutic regimen following discharge. Employment is not an evaluative measure for managing acute pancreatitis.

The nurse is updating the plan of care for a client with renal calculi. The nurse is aware that which are expected outcomes of a client with renal calculi? Select all that apply. A) The client rates pain at a 2 on a scale of 1-10 and states that a 2 is acceptable. B) The client is able to comfortably perform ADLs. C) The client demonstrates a fluid intake of 800-1,000mL/day. D) The client remains free of signs and symptoms of infection. E) The client chooses the appropriate diet to prevent the reoccurrence of renal calculi.

A) The client rates pain at a 2 on a scale of 1-10 and states that a 2 is acceptable. B) The client is able to comfortably perform ADLs. D) The client remains free of signs and symptoms of infection. E) The client chooses the appropriate diet to prevent the reoccurrence of renal calculi. rationale: While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.

A 67-year-old client diagnosed with chronic pancreatitis has been admitted for an episode of acute gastric and abdominal pain. What are some of the essential elements in a nursing assessment? Select all that apply. A) The location of the client's pain B) Weight loss C) Heartburn D) Possible opioid dependency

A) The location of the client's pain B) Weight loss D) Possible opioid dependency rationale: Chronic pancreatitis typically causes recurrent episodes of epigastric and left upper abdominal pain that radiates to the back. Manifestations of chronic pancreatitis include anorexia, nausea, vomiting, and weight loss. Heartburn is characteristic of GERD. Clients with chronic pancreatitis may also require analgesics, but must be closely monitored to prevent drug dependence.

The nurse is planning care for a female adult client who is​ high-risk for developing osteoporosis. Which interventions will decrease the​ client's risk of developing this health​ problem? Select all that apply. A. Weight-bearing exercises such as walking B. Increasing the intake of alcoholic beverages C. Isometric exercise for at least 30 minutes three times per week D. A diet with adequate amounts of calcium and vitamin D E. Having a yearly​ dual-energy x-ray absorptiometry​ (DEXA) test

A. Weight-bearing exercises such as walking D. A diet with adequate amounts of calcium and vitamin D Rationale: Interventions that may decrease this​ client's risk of developing osteoporosis include regular​ weight-bearing exercise, such as​ walking, as this activity slows bone loss. Other intervention include encouraging clients to consume adequate amounts of calcium and vitamin D in their diets to prevent osteoporotic fracture. A DEXA test measures bone​ density, but it does not decrease the​ client's risk for developing osteoporosis. Measures to prevent or treat osteoporosis include limiting the intake of beverages containing​ alcohol, caffeine, and phosphorus. Isometric exercises are not effective against osteoporosis.

Which of the following clients are at high risk of developing GERD? A) A client who is 6 weeks pregnant B) A client who is morbidly obese C) A client who follows a strict vegetarian diet D) A client who drinks one glass of wine monthly

B) A client who is morbidly obese rationale: Obesity is a risk factor for GERD. Pregnancy is an increasing risk factor in the later stages due to pressure on the stomach. A vegetarian diet is not a risk factor for GERD. Rare alcohol consumption is not as strong a risk factor for GERD as morbid obesity.

A 47-year-old man comes to the ED following a dinner party presenting with nausea, vomiting, and abdominal pain. His wife reports that only ate the appetizers but consumed a lot of alcohol and that no one else at the party is ill. For what condition is the client most likely at risk? A) Lactase deficiency B) Acute pancreatitis C) Short bowel syndrome D) Food poisoning

B) Acute pancreatitis rationale: Risk factors for lactose intolerance include previous radiation therapy for abdominal cancer, history of celiac disease or Crohn's disease, and increasing age. Alcoholism and gallstones are the primary risk factors for acute pancreatitis. Resection of significant portions of the small intestine may result in a condition known as short bowel syndrome. Those most at risk for food poisoning are older adults, pregnant women, infants, and those with a chronic disease.

The nurse on the medical unit is admitting a 96-year-old client whose primary symptoms include fatigue, pruritus, and pain in the right flank area. Which assessment technique should not be used while assessing this client? A) Palpation over the costovertebral angles and flanks B) Blunt percussion over the costovertebral angles and flanks C) Palpation of the lower pole of both kidneys D) Capturing of both kidneys

B) Blunt percussion over the costovertebral angles and flanks rationale: Blunt percussion in a frail older individual is contraindicated. Instead, palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness. All other assessments are appropriate.

A 78-year-old female client with osteoporosis has a history of falls and dementia. Which interventions will best aid in meeting an outcome goal for injury prevention? A) Using furniture as obstacles to keep the client in the bed B) Keeping the bed in the lowest position C) Keeping a nightlight on in the room D) The use of wrist restraints

B) Keeping the bed in the lowest position rationale: Keeping the bed in the lowest position will reduce the incidence of injury should the client attempt to get up. The use of restraints could increase the incidence of injury. Using the furniture as an obstacle could cause injury if the client is able to get up. A nightlight is useful but is not the best means to prevent injury.

The nurse has implemented a care plan for a 22-year-old client with GERD. On the next clinic visit, which of the following statements by the client indicate adherence to the plan of care? Select all that apply. A) "Spandex camisoles are worth heartburn." B) "I have switched from margaritas to wine." C) "I've lost 6 pounds because I eat every 3 hours and never before bed." D) "I take a TUMS with the ranitidine to make it work better." E) "I haven't had any heartburn for 3 weeks."

C) "I've lost 6 pounds because I eat every 3 hours and never before bed." rationale: Appropriate client outcomes are freedom from pain and knowledge of lifestyle changes to manage GERD. Weight loss, small, frequent meals, and avoiding lying down within 3 hours of eating indicate correct management. Changing from margaritas to wine will not improve GERD. Antacids like TUMS should be avoided within 1 hour before or after an H2-receptor blocker like ranitidine. Although the client knows tight-fitting spandex camisoles can worsen GERD, she is not willing to stop wearing them.

A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and cigarettes and their link to osteoporosis? Select all that apply. A) "Smoking decreases nerve supply to the bones." B) "Nicotine increases calcium absorption, leading to decreased bone density." C) "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral content." D) "Alcohol has a direct toxic effect on osteoclast activity, suppressing bone formation." E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis."

C) "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral" E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis." rationale: Both cigarette smoking and excess alcohol intake are risk factors for osteoporosis. Smoking decreases the blood supply to bones, and nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density. Alcohol has a direct toxic effect on osteoblast activity, suppressing bone formation during periods of alcohol intoxication. In addition, heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis. Interestingly, moderate alcohol consumption in postmenopausal women actually may increase bone mineral content, possibly by increasing levels of estrogen and calcitonin.

A 60-year-old client is concerned about the development of osteoporosis and wants to begin preventative activities. What response by the nurse is the most appropriate? A) "You should first determine if you are at risk for the development of osteoporosis." B) "After menopause, the decline is too rapid to begin preventative interventions." C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." D) "Hormone replacement therapy should be initiated as soon as possible."

C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." rationale: Osteoporosis risk factors increase after menopause. Preventative activities include implementing weight-bearing exercise and beginning calcium supplements. It is not too late to begin prevention activities. Without additional information, it is not possible to determine if the client is a candidate for hormone replacement therapy. Generally, hormone replacement therapy is limited to those women who are experiencing vasomotor manifestations. The client in the scenario has two risk factors presented. Although a full analysis would be beneficial, it does not answer the client's request for information.

A client presents at the Emergency Department reporting 7/10 chest burning. GERD secondary to hiatal hernia is diagnosed. Based on your assessment, which of the following is the priority nursing diagnosis? A) Dysfunctional Gastrointestinal Motility B) Anxiety C) Acute Pain D) Ineffective Health Maintenance

C) Acute Pain rationale: Acute pain management is the priority of nursing care. Anxiety may be decreased by relieving pain. Dysfunctional gastrointestinal motility and ineffective health maintenance are less urgent.

A client recently diagnosed with osteoporosis asks what can be done to slow the progress of the disease. Which intervention would be the most beneficial for this client? A) Decreasing the amount of calcium in the client's diet B) Providing the client with assisted range of motion exercising twice daily C) An exercise plan that includes weight-bearing activities D) Protecting the client's bones with strict bed rest

C) An exercise plan that includes weight-bearing activities rationale: Osteoporosis is a demineralization of the bone in which calcium leaves the bone matrix. One causative factor is lack of weight-bearing activity. Weight bearing helps to move calcium back into the bone, thereby strengthening them. A standard intervention for those attempting to prevent or reverse osteoporosis is beginning an exercise plan that includes weight-bearing activities. Strict bed rest may well make the osteoporosis worse because there is no weight-bearing activity. Calcium in the diet is increased with osteoporosis. Assisted range of motion exercises are not weight-bearing and do not help delay or reverse osteoporosis.

A female client is admitted to the Emergency Department and diagnosed with urinary calculi. The client reports that she has had symptoms for 1 week. The nurse is planning care for the client. Which nursing diagnosis is appropriate for this client? A) Risk for Constipation B) Risk for Disuse Syndrome C) Imbalanced Nutrition D) Activity Intolerance

C) Imbalanced Nutrition rationale: The client with urinary calculi, or kidney stones, of lengthy duration is at risk for imbalanced nutrition from the resulting nausea. Activity intolerance, risk for constipation, and risk for disuse syndrome are not as appropriate because the symptoms of urinary calculi do not lead to these diagnoses.

The nurse is explaining the alteration in normal function to a client recently diagnosed with gastrointestinal reflux disease (GERD). Which of the following etiologies contribute to GERD? A) Transient constriction of the lower esophageal sphincter B) Decreased pressure within the stomach C) Incompetent lower esophageal sphincter D) Prolonged constriction of the upper esophageal sphincter

C) Incompetent lower esophageal sphincter rationale: An incompetent lower esophageal sphincter remains open, allowing gastric acid to reflux into the esophagus. The lower esophageal sphincter is normally constricted except during swallowing. Increased pressure in the stomach can cause acid to reflux into the esophagus. The action of the upper esophageal sphincter is not a cause of GERD.

A 30-year-old female is concerned because the healthcare provider states that the client is demonstrating signs consistent with early onset of osteoporosis. What should the nurse explain to assist the client at this time? A) Suggest that the client stop all physical activity. B) Recommend reducing the intake of diary in the diet. C) Instruct on a diet with an adequate intake of calcium and vitamin D. D) Discuss the use of estrogen replacement therapy.

C) Instruct on a diet with an adequate intake of calcium and vitamin D. rationale: Walking and weight-bearing exercise help prevent the onset of osteoporosis. A diet that includes dairy products will have calcium and vitamin D, which are nutrients needed to prevent the onset of the disorder. The client is 30 years old and most likely does not need estrogen replacement therapy at this time.

A pediatric client has GERD. The nurse is observing a return demonstration of the mother preparing and feeding the infant formula. Which of the following observations demonstrates correct procedure for preventing GERD symptoms? A) Burping the infant after 4 ounces of formula are taken B) Thinning the formula with water prior to feeding C) Positioning the infant upright for a minimum of 30 minutes D) Warming the formula prior to feeding

C) Positioning the infant upright for a minimum of 30 minutes rationale: Positioning the infant upright for 30 minutes after a feeding can reduce GERD symptoms. Infants with GERD should be burped after every 1-2 ounces of formula are taken. Pre-thickened formulas can also reduce GERD symptoms. Warming the formula does not impact GERD symptoms.

A client with urinary calculi has been admitted to the hospital. The nurse is planning care for this client. Which goal is appropriate for this client? A) The client will lose 25 pounds in 3 months. B) The client will ambulate three times a day. C) The client will request pain medication at the onset of pain. D) The client will shower independently.

C) The client will request pain medication at the onset of pain. rationale: Intense pain is the hallmark of urinary calculi, or kidney stones, that are passing through the urinary system. The nurse teaches the client to request pain medication at the onset of pain in order to provide faster relief. The client with urinary calculi is able to ambulate and shower independently. Dietary changes will need to be made to prevent further formation of stones, but weight loss is not necessarily a goal with this disease process.

Which change in bone structure contributes to​ osteoporosis? A. The diaphysis of the bone becomes longer. B. The outer cortex of the bone becomes thicker. C. The diameter of the bone increases. D. Trabeculae are increased in cancellous bone.

C. The diameter of the bone increases. Rationale: In​ osteoporosis, the diameter of the bone​ increases, thinning the outer supporting cortex. Trabeculae are lost from cancellous bone. Osteoporosis does not affect the length of the bone.

The nurse identifies the diagnosis of Imbalanced Nutrition as appropriate for a client with osteoporosis. Which client statement did the nurse use to identify this diagnosis? A) "I have removed all scatter rugs from my home." B) "I frequently take long walks in the sun." C) "My pain is relieved by Tylenol." D) "I am allergic to dairy products."

D) "I am allergic to dairy products." rationale: The client states that she is allergic to dairy products and therefore may not take in much calcium, so focusing on diet would be a priority for this client. The statements about taking long walks, removing scatter rugs, and taking acetaminophen (Tylenol) for pain would not elicit the nursing diagnosis Imbalanced Nutrition.

What is the primary cause of loss of height in individuals with​ osteoporosis? A. Decrease in length of long bones B. Cervical lordosis C. Flexion of the knees and hips D. Collapse of vertebral bodies

D. Collapse of vertebral bodies rationale: The loss of height in individuals with osteoporosis occurs primarily as a result of vertebral body collapse. Osteoporosis also contributes to cervical​ lordosis, and the knees and hips flex to help maintain the center of​ gravity; however, these do not contribute to overall loss of height. Osteoporosis does not cause a decrease in the length of long bones.

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a. "Peppermint tea may reduce your symptoms." b. "Keep the head of your bed elevated on blocks." c. "You should avoid eating between meals to reduce acid secretion." d. "Vigorous physical activities may increase the incidence of reflux."

b. "Keep the head of your bed elevated on blocks." rationale: Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

What action should the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis? a. Ask about any leg cramps or hot flashes. b. Assist the patient to sit up at the bedside. c. Be sure that the patient has recently eaten. d. Administer the ordered calcium carbonate.

b. Assist the patient to sit up at the bedside. rationale: To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates.

What should the nurse include when teaching an adult patient to prevent the recurrence of kidney stones? a. Using a filter to strain all urine b. Drinking 3000 mL of fluid each day c. Avoiding dietary sources of calcium d. Choosing diuretic fluids such as coffee

b. Drinking 3000 mL of fluid each day rationale: A fluid intake of 2000 to 3000 mL/day is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with kidney stones. Coffee tends to increase stone recurrence. Straining all urine routinely after a stone has passed will not prevent stones.

Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis? a. Bowed legs b. Loss of height c. Report of frequent falls d. Aversion to dairy products

b. Loss of height rationale: Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia and osteoarthritis. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis.

The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome? a. Having fluid and electrolyte balance b. Maintaining normal respiratory function c. Expressing satisfaction with pain control d. Developing no ongoing pancreatic disease

b. Maintaining normal respiratory function rationale: Respiratory failure can occur as a complication of acute pancreatitis and maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

After ureterolithotomy, a patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? a. Provide teaching about home care for both catheters. b. Apply continuous steady tension to the ureteral catheter. c. Call the health care provider if the ureteral catheter output drops suddenly. d. Clamp the ureteral catheter off when output from the urethral catheter stops.

c. Call the health care provider if the ureteral catheter output drops suddenly. rationale: The health care provider should be notified if the ureteral catheter output decreases because obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter should be avoided to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Because the patient is not usually discharged with a ureteral catheter in place, patient teaching about both catheters is not needed.

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart. rationale: The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a. Chocolate pudding b. Glass of low-fat milk c. Cherry gelatin with fruit d. Peanut butter and jelly sandwich

c. Cherry gelatin with fruit rationale: Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Muscle twitching and finger numbness d. Upper abdominal tenderness and guarding

c. Muscle twitching and finger numbness rationale: Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings should also be reported to the health care provider, they do not indicate complications that require rapid action.

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

d. Abdominal pain is decreased. rationale: NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status has been effective. Electrolyte levels may be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this to occur to determine whether treatment was effective.

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient? a. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. b. Estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. c. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. d. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

d. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise. rationale: Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. Estrogen replacement therapy is no longer routinely given to prevent osteoporosis because of increased risk of heart disease as well as breast and uterine cancer. Corticosteroid therapy increases the risk for osteoporosis.

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective? a. Pancakes with syrup and bacon b. Whole wheat toast and fresh fruit c. Egg-white omelet and a half grapefruit d. Oatmeal with skim milk and fruit yogurt

d. Oatmeal with skim milk and fruit yogurt rationale: Skim milk and yogurt are high in calcium. The other choices do not contain any high-calcium foods.

Which assessment finding is of most concern for a patient with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

d. Palpable abdominal mass rationale: A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

What should the nurse anticipate teaching a patient with a new report of heartburn? a. A barium swallow b. Radionuclide tests c. Endoscopy procedures d. Proton pump inhibitors

d. Proton pump inhibitors rationale: Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying.

1. Adult-onset asthma. rationale: 1. Of adult-onset asthma cases, 80% to 90% are caused by gastroesophageal reflux disease (GERD). 2. Pancreatitis is not related to GERD. 3. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levels of gastric acid, but it is not related to reflux. 4. GERD is not related to increased gastric emptying. Increased gastric emptying would be a benefit to a client with decreased functioning of the lower esophageal sphincter.

Which signs/symptoms indicate to the nurse the client has developed osteoporosis? 1. The client has lost one (1) inch in height. 2. The client has lost 12 pounds in the last year. 3. The client's hands are painful to the touch. 4. The client's serum uric acid level is elevated.

1. The client has lost one (1) inch in height. rationale: 1. The loss of height occurs as vertebral bodies collapse. 2. Weight loss is not a sign of osteoporosis. 3. This may indicate rheumatoid arthritis but not osteoporosis. 4. This is a sign of gout.

Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. "My spouse tells me I snore very loudly at night." 4. "I drink six (6) to seven (7) soft drinks every day."

2. "I take antacid tablets with me wherever I go." rationale: 1. Pain in the chest when walking up stairs indicates angina. 2. Frequent use of antacids indicates an acid reflux problem. 3. Snoring loudly could indicate sleep apnea but not GERD. 4. Carbonated beverages increase stomach pressure. Six (6) to seven (7) soft drinks a day would not be tolerated by a client with GERD.

Which client problem has priority for the client diagnosed with acute pancreatitis? 1. Risk for fluid volume deficit. 2. Alteration in comfort. 3. Imbalanced nutrition: less than body requirements. 4. Knowledge deficit.

2. Alteration in comfort. rationale: 1. The client will be NPO to help decrease pain, but it is not the priority problem because the client will have intravenous fluids. 2. Autodigestion of the pancreas results in severe epigastric pain, accompanied by nausea, vomiting, abdominal tenderness, and muscle guarding. 3. Nutritional imbalance is a possible client problem, but it is not priority. 4. Knowledge deficit is always a client problem, but it is not priority over pain.

Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer.

3. Esophageal cancer rationale: 1. A hiatal hernia places the client at risk for GERD; GERD does not predispose the client for developing a hiatal hernia. 2. Gastroenteritis is an inflammation of the stomach and intestine, usually caused by a virus. 3. Barrett's esophagus results from long-term erosion of the esophagus as a result of reflux of stomach contents secondary to GERD. This is a precursor to esophageal cancer. 4. The problems associated with GERD result from the reflux of acidic stomach contents into the esophagus, which is not a precursor to gastric cancer

A client is with a history of GERD presents with metabolic alkalosis. Which medication do you suspect contributed to metabolic alkalosis? A) Aluminum hydroxide B) Omeprazole C) Ranitidine D) Metoclopramide

A) Aluminum hydroxide rationale: Aluminum hydroxide antacids neutralize gastric acid. Overuse of antacids may cause metabolic acidosis. Omeprazole, ranitidine, and metoclopramide are all GERD medications that do not cause metabolic alkalosis.

The nurse is preparing the client for treatment of renal calculi that have failed to respond to medication therapy. What is the preferred treatment? A) Lithotripsy B) Surgery on the kidney to remove the stones C) Diet control D) Increasing fluids

A) Lithotripsy rationale: When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system. Depending on the location of the stones, surgery may be the next step in the treatment process. Diet and fluids are used to prevent further stone formation.

The nurse is assessing a 70-year-old postmenopausal client. Which question should the nurse ask to assess for signs of osteoporosis? A) "Have you experienced any palpitations?" B) "Are you having any low back pain?" C) "Are you having problems with swelling in your feet?" D) "Is constipation a problem for you?"

B) "Are you having any low back pain?" Rationale: A client with osteoporosis will often present with low back pain as well as a decrease in height. Palpitations, constipation, and swelling are not early signs of osteoporosis.

Harold K., a 51-year-old diagnosed with chronic pancreatitis, asks if there are any alternative therapies that might help with his condition. The nurse advises him that there is positive evidence for the benefits of which of the following? Select all that apply. A) Aerobic exercise B) Low-salt, low-fat vegetarian diet C) Qigong D) Magnetic field therapy

B) Low-salt, low-fat vegetarian diet C) Qigong D) Magnetic field therapy rationale: There is no evidence for the benefit of aerobic exercise in the treatment of chronic pancreatitis. Fasting or use of low-salt, low-fat vegetarian diets may reduce episodes of recurrent pain. Qigong, a system of gentle exercise, meditation, and controlled breathing, lowers the metabolic rate, and may reduce the stimulation of pancreatic enzyme secretion. Magnetic field therapy also may be employed for clients with pancreatitis.

The nurse is triaging a client who presents to the urgent care clinic with symptoms of severe flank pain with spasms, nausea, vomiting, and oliguria. The client states that the pain was initially intermittent and radiated from the lower back to the lower quadrants of the abdomen. What should the nurse do next? A) Complete the physical assessment. B) Refer the client to a urologist immediately. C) Instruct the client to increase fluids. D) Obtain a urine specimen for culture.

B) Refer the client to a urologist immediately. rationale: Hydroureter is a complication that occurs when a renal calculus moves into the ureter and blocks and dilates the ureter. Symptoms include severe pain and spasms, nausea, vomiting, and diminished volume of urine. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; medical collaboration should be initiated immediately. All other options, while important to complete, would not be appropriate in an emergency situation.

A nurse is conducting a health history on an older woman who is a new client in a medical practice. Which assessment finding places the client at risk for osteoporosis? A) The client is obese and has hip pain with ambulation. B) The client has been taking corticosteroids for 10 years because of chronic obstructive pulmonary disease (COPD). C) The client eats 3-5 servings of shrimp and liver per week. D) The client states she drinks three glasses of skim milk daily.

B) The client has been taking corticosteroids for 10 years because of chronic obstructive pulmonary disease (COPD). Rationale: Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis but predisposes the woman to osteoarthritis. Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis. A diet rich in shellfish and organ meats is high in purine, which may predispose the client to gout.

The nurse educator is speaking with a group of students about renal disorders. The educator knows that which statement is true about renal stones? A) The elderly are particularly at risk for urolithiasis. B) Young- or middle-adulthood men are at an increased risk for stones. C) Women are affected more than men. D) Frequency is greater in the northern United States.

B) Young- or middle-adulthood men are at an increased risk for stones. rationale: Men who are in young to middle adulthood are affected 2-3 times more than women of that age. The frequency of the occurrence of renal stones in the United States is greatest in the southern and midwestern states.

The nurse is caring for an older adult client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this​ medication? Select all that apply. A. "Adults 50 years of age and over should obtain at least 500 to 750 mg per day of elemental​ calcium." B. "The most common adverse effect is hypercalcemia caused by taking too much of the​ supplement." C.​"If you have a condition called ventricular​ fibrillation, this medication might​ help." D. ​"Oral calcium supplements are best taken on an empty​ stomach." E. "Report symptoms of​ weakness, increased​ urination, and​ thirst."

B. "The most common adverse effect is hypercalcemia caused by taking too much of the​ supplement." E. "Report symptoms of​ weakness, increased​ urination, and​ thirst." Rationale: Calcium gluconate and other calcium compounds are used to treat and prevent osteoporosis. Oral calcium supplements are best taken with meals or within 1 hour following meals. It is recommended that adults 50 years of age and over obtain at least 1000 to 1200 mg per day of elemental calcium. The most common adverse effect is hypercalcemia caused by taking too much of the supplement. Symptoms include​ lethargy, drowsiness,​ weakness, headache,​ anorexia, nausea and​ vomiting, increased​ urination, and thirst. Calcium supplementation is contraindicated in clients with ventricular fibrillation.

The nurse is planning care for a 66-year-old client who is in one of the high-risk groups for developing osteoporosis. Which interventions will decrease the client's risk of developing this health problem? Select all that apply. A) Increasing the intake of beverages that contain phosphorous B) Isometric exercise for at least 30 minutes three times per week C) Weight-bearing exercises such as walking D) Having a yearly bone mineral density (BMD) test E) A diet with adequate amounts of calcium and vitamin D

C) Weight-bearing exercises such as walking E) A diet with adequate amounts of calcium and vitamin D rationale: Patients, especially women, are encouraged to include adequate calcium and vitamin D in their diets to prevent osteoporotic fracture. A BMD test is used to determine bone strength and risk for osteoporotic fracture. A BMD test is recommended for women under age 65 with risk factors, all women over 65, and after a fracture, but not yearly. BMD tests are sometimes repeated to monitor effects from medications used to treat osteoporosis. Measures to prevent or treat osteoporosis include limiting the intake of beverages containing alcohol, caffeine, and phosphorus. Regular weight-bearing exercise, such as walking, slows bone loss. Isometric exercises are not effective against osteoporosis.

A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and​ cigarettes? Select all that apply. A. ​"Alcohol has a direct toxic effect on osteoclast​ activity, suppressing bone​ formation." B. "Nicotine increases calcium​ absorption, leading to decreased bone​ density." C. "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral​ content." D. ​"Heavy alcohol use may be associated with nutritional deficiencies that contribute to​ osteoporosis." E. "Smoking decreases nerve supply to the​ bones."

C. "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral​ content." D. ​"Heavy alcohol use may be associated with nutritional deficiencies that contribute to​ osteoporosis."

The nurse is preparing to discharge a client who was admitted with a kidney stone. The client underwent a lithotripsy. What should the nurse teach the client to prevent further complications of urinary calculi after discharge? A) "You will need to increase your oral fluid intake to 1L/day." B) "It will be important that you not drive while taking pain medications." C) "It will be important to maintain a diet high in purines." D) "You will need to monitor for the signs and symptoms of a urinary tract infection (UTI)."

D) "You will need to monitor for the signs and symptoms of a urinary tract infection (UTI)." rationale: The client with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider. By discharge, the stones should have passed and there would be no need for pain medication. Fluid intake per day should be 2.5-3.0 L. Foods high in purines, such as organ meats, are to be avoided.

The nurse is caring for a client with a history of kidney stones. The stones have been analyzed and are all composed of calcium phosphate. The nurse teaches this client to reduce intake of which foods? A) Chicken, beef, and ham products B) Organ meats, sardines, and seafood C) Tomatoes, fruits, and nuts D) Flour, milk, and ice cream

D) Flour, milk, and ice cream rationale: Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi. Organ meats, sardines, seafood, tomatoes, fruits, nuts, chicken, beef, and ham products are not high in calcium and do not need to be restricted for this client.

A client admitted to the hospital with a diagnosis of inflammatory bowel disease has also been diagnosed with calcium phosphate renal calculi. Which medication should the nurse anticipate may be ordered by the physician to prevent further formation of stones? A) Potassium citrate B) Indomethacin C) Morphine sulfate D) Hydrochlorothiazide

D) Hydrochlorothiazide rationale: Hydrochlorothiazide is a thiazide diuretic used to prevent the formation of calcium stones. Potassium citrate alkalinizes urine (raises the pH) and is often prescribed to prevent stones that tend to form in acidic urine (uric acid, cystine, and some forms of calcium stones). Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat pain and discomfort and may reduce the amount of narcotic analgesia required for acute renal colic. Morphine sulfate is a narcotic analgesic used to relieve pain.

Which nursing action is of highest priority for a patient with kidney stones who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? a. Administer prescribed analgesics. b. Monitor temperature every 4 hours. c. Encourage increased oral fluid intake. d. Give antiemetics as needed for nausea.

a. Administer prescribed analgesics. rationale: Although all the nursing actions may be used for patients with kidney stones, the patient's presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis? a. Lipase b. Calcium c. Bilirubin d. Potassium

a. Lipase rationale: Lipase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed? a. "I quit smoking years ago, but I chew gum." b. "I eat small meals and have a bedtime snack." c. "I take antacids between meals and at bedtime each night." d. "I sleep with the head of the bed elevated on 4-inch blocks."

b. "I eat small meals and have a bedtime snack." rationale: GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)? a. Bedtime b. Mealtime c. When nauseated d. For abdominal pain

b. Mealtime rationale: Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis? a. Diabetes b. Alcohol use c. High-protein diet d. Cigarette smoking

b. alcohol use rationale: Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.

To prevent recurrence of uric acid kidney stones, the nurse teaches the patient to avoid eating: a. milk and cheese. b. sardines and liver. c. spinach and chocolate. d. legumes and dried fruit.

b. sardines and liver. rationale: Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.

A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), what should the nurse plan to assess more frequently than is routine? a. Apical pulse b. Bowel sounds c. Breath sounds d. Abdominal girth

c. Breath sounds rationale: Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.

How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn? a. "It reduces gastroesophageal reflux by increasing the rate of gastric emptying." b. "It neutralizes stomach acid and provides relief of symptoms in a few minutes." c. "It coats and protects the lining of the stomach and esophagus from gastric acid." d. "It treats gastroesophageal reflux disease by decreasing stomach acid production."

d. "It treats gastroesophageal reflux disease by decreasing stomach acid production." rationale: The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? a. Blood in urine b. Left flank bruising c. Left flank discomfort d. Decreased urine output

d. Decreased urine output rationale: Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to report a drop in urine output. Left flank pain, bruising, and hematuria are common after lithotripsy.