Adult Health Exam #5 (CH Review Qs, W9 Quiz, Misc. Quizlets)
The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.)
-Antacids neutralize acid in the stomach -Rebound hyperacidity may occur with calcium-based antacids -Magnesium-based antacids cause diarrhea
The nurse is caring for a client with a complete large bowel obstruction. What assessment findings would the nurse expect? Select all that apply. A. Obstipation B. Dehydration C. Metabolic alkalosis D. Abdominal distention E. Abdominal pain F. Profuse vomiting
A, D, E A. Obstipation D. Abdominal distention E. Abdominal pain
The total parenteral nutrition (TPN) order reads, "Infuse TPN #2 over 24 hours." Bag #2 of TPN contains 1800 mL. At what rate will the nurse set the infusion pump? _______
75 mL/hr
The nurse is caring for a client who is diagnosed with cirrhosis. Which serum laboratory value(s) will the nurse expect to be abnormal? Select all that apply. A. Prothrombin time B. Serum bilirubin C. Albumin D. Aspartate aminotransferase (AST) E. Lactate dehydrogenase (LDH) F. Acid phosphatase
A, B, C, D, E A. Prothrombin time B. Serum bilirubin C. Albumin D. Aspartate aminotransferase (AST) E. Lactate dehydrogenase (LDH)
A client with obesity tells the nurse, "My genes are the only thing that have made me obese." What is the appropriate nursing response? Select all that apply. A. "Genes can contribute to obesity." B. "Tell me about your family history." C. "Let's talk about your nutrition intake." D. "Have you considered bariatric surgery?" E. "How do you feel about physical activity?" F. "What lifestyle modifications have you tried?"
A, B, C, E, F
A client who had the Stretta procedure to treat severe GERD is being discharged. Which client statement requires further nursing teaching? Select all that apply. A. "Dysphagia after this procedure is normal." B. "It's important to stop my proton pump inhibitor." C. "I will not take NSAIDs and aspirin for at least 10 days." D. "I might cough up some blood following this procedure." E. "Today I will drink clear liquids and tomorrow I can eat soft food."
A, B, D A. "Dysphagia after this procedure is normal." B. "It's important to stop my proton pump inhibitor." D. "I might cough up some blood following this procedure."
A nurse is caring for a 34-year-old client newly diagnosed with GERD. Which lifestyle change will the nurse suggest? Select all that apply. A. Lose weight if needed. B. Do not eat before bed. C. Elevate the foot of your bed by 6 to 12 inches. D. Avoid pants with a tight waistband or belt. E. Eat fatty foods to minimize ongoing hunger.
A, B, D A. Lose weight if needed. B. Do not eat before bed. D. Avoid pants with a tight waistband or belt.
Which teaching will the nurse include when educating a client who is scheduled to have an esophagogastroduodenoscopy (EGD)? Select all that apply. A. "Anesthesia will be used for sedation." B. "The procedure takes about 20 to 30 minutes to complete." C. "Informed consent will be needed prior to the procedure." D. "A separate test will be required to obtain any needed biopsies." E. "You will need to refrain from eating for at least 6 to 8 hours before the EGD."
A, B, D, E A. "Anesthesia will be used for sedation." B. "The procedure takes about 20 to 30 minutes to complete." D. "A separate test will be required to obtain any needed biopsies." E. "You will need to refrain from eating for at least 6 to 8 hours before the EGD."
What health teaching will the nurse include to promote gastric health for an adult client? Select all that apply. A. "Stop smoking or using tobacco of any form." B. "Do not drink excessive amounts of alcohol." C. "Consume high-fat foods and decrease carbohydrates." D. "Avoid excessive amounts of pickled or smoked food." E. "Avoid taking large amounts of NSAIDs."
A, B, D, E A. "Stop smoking or using tobacco of any form." B. "Do not drink excessive amounts of alcohol." D. "Avoid excessive amounts of pickled or smoked food." E. "Avoid taking large amounts of NSAIDs."
Which daily behavior of a client with GI problems requires further nursing assessment? Select all that apply. A. Smokes a pack of cigarettes B. Uses Fleet enemas frequently to assist with bowel movements C. Practices intentional relaxation D. Eats multiple servings of fruits E. Takes 325 mg of aspirin at night for arthritic pain F. Exercises for 30 minutes three times weekly G. Travels extensively across the world
A, B, E, G
A client is receiving adefovir for management of hepatitis B. What health teaching will the nurse provide for the client about this drug? Select all that apply. A. "Avoid places with crowds and individuals who have infection." B. "Report increased bruising to your doctor because the drug can cause bleeding." C. "Get your lab work done regularly because the drug can affect your kidneys." D. "Be careful and avoid falls because the drug can cause fractures." E. "Follow up with the dietitian to ensure that you adhere to your special diet."
A, C A. "Avoid places with crowds and individuals who have infection." C. "Get your lab work done regularly because the drug can affect your kidneys."
What discharge teaching will the nurse provide to a client who had gastric bypass surgery? Select all that apply. A. Be certain to stay hydrated by drinking water. B. Solid food can be introduced back into the diet in a week. C. Report any back, shoulder, or abdominal pain to the surgeon. D. You are likely to have little urine output for the first few weeks. E. Each of your meals should initially contain about 5 tablespoons of food.
A, C, E A. Be certain to stay hydrated by drinking water. C. Report any back, shoulder, or abdominal pain to the surgeon. E. Each of your meals should initially contain about 5 tablespoons of food.
Which client statement regarding diet and nutrition after a total gastrectomy requires further teaching by the nurse? A. "I should stay sitting up for an hour after I eat." B. "I will avoid liquids with my meals." C. "I need to eat small frequent meals." D. "I need to stay away from concentrated sweets."
A. "I should stay sitting up for an hour after I eat."
The nurse is caring for four clients who have been recommended to consider bariatric surgery. Which assessment data require immediate nursing intervention? A. BMI of 23 with gastrointestinal reflux B. BMI of 36 with hypertension C. BMI of 40 with type II diabetes D. BMI of 43 with sleep apnea
A. BMI of 23 with gastrointestinal reflux
The nurse is teaching a client about nutrition and diverticulosis. Which food will the nurse teach the client to avoid? A. Cucumber B. Beans C. Carrot D. Radish
A. Cucumber
A 75-year-old woman comes into the clinic and states she has had muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate five or six times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with the overuse of sodium bicarbonate? A. Metabolic alkalosis B. Excessive gastric mucous C. Metabolic acidosis D. Constipation
A. Metabolic alkalosis
When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition? A. Renal failure B. Hypertension C. Peptic ulcer disease D. Heart failure
A. Renal failure
The nurse is caring for a client with peritonitis from a perforated appendix. Which abdominal assessment finding will the nurse most likely expect? A. Soft abdomen B. Board-like abdomen C. Slightly distended abdomen D. Absent bowel sounds
B. Board-like abdomen
The nurse is planning care for a client who had a laparoscopic Whipple surgery. For which complications will the nurse assess? Select all that apply. A. Bleeding B. Wound infection C. Intestinal obstruction D. Diabetes mellitus E. Abdominal abscess
ALL A. Bleeding B. Wound infection C. Intestinal obstruction D. Diabetes mellitus E. Abdominal abscess
A 63-year-old client with cirrhosis underwent paracentesis today. Which assessment finding alerts the nurse that the procedure was successful? A.Decrease in post-procedure weight B.No residual obtained during procedure C.Substantial decrease in blood pressure D.Immediate sensation of a need to urinate
ANS: A Weight should decrease as fluid is drained from the abdominal cavity. A substantial decrease in blood pressure can indicate shock. Residual should be obtained during the procedure. The client should not feel a sensation or need to urinate, because a primary safety measure is to have the client void right before the procedure to avoid injury to the bladder during the procedure.
AFTER ABDOMINAL SURGERY, WHICH NURSING ASSESSMENT QUESTION IS THE PRIORITY? A."HAVE YOU PASSED FLATUS?" B."DO YOU HAVE ANY NAUSEA?" C."ARE YOU READY FOR SOME FLUIDS?" D."CAN I GET YOU SOMETHING TO EAT?"
ANS: A "Have you passed flatus?" EVIDENCE INDICATES THAT THE CLIENT'S REPORT OF PASSING FLATUS IS THE BEST INDICATOR OF WHETHER PERISTALTIC MOVEMENT IS RETURNING AFTER SURGERY; THEREFORE THE NURSE WILL ASK THIS QUESTION AS THE PRIORITY. OTHER QUESTIONS CAN BE ASKED AND FURTHER ASSESSED AFTER DETERMINATION OF THE RETURN OF PERISTALSIS HAS BEEN MADE.
A 23-year old client admitted and just diagnosed with ulcerative colitis (UC) reports approximately 5 bloody stools daily. Vital signs show a pulse of 80 bpm, respiration rate of 18 breaths per minute, blood pressure of 124/88, and temperature of 97.6ºF. Mild abdominal tenderness on palpation is noted. The ESR is mildly elevated. The nurse reviews medications the client has been taking recently. Which medication will the nurse question? A.Ibuprofen (Motrin) B.Mesalamine (Asacol) C.Loperamide (Imodium) D.Prednisone (Deltasone)
ANS: A Ibuprofen (Motrin) Ibuprofen is a nonsteroidal antiinflammatorydrug (NSAID); NSAIDs increase the risk for bleeding.
An EGD (Esophagogastroduodenoscopy) confirms the client has PUD and a prescription for triple therapy is initiated. Which combination of drugs does the nurse prepare to administer? A.PPI and two antibiotics B.Antibiotic and two PPIs C.Histamine antagonist, antacid, and PPI D.Antacid, PPI, and prostaglandin analogue
ANS: A PPI and two antibiotics For H. pylori infections, a common drug regimen is triple therapy, which includes a PPI, such as lansoprazole (Prevacid), and two antibiotics, such as metronidazole (Flagyl) and clarithromycin (Biaxin).
On assessment, the client is noted to have conjunctival xerosis, dry skin, follicular hyperkeratosis, and a purple tongue. Which vitamin deficiency does the nurse anticipate? A.Vitamin A B.Vitamin C C.Vitamin D D.Vitamin K
ANS: A Vitamin A
While reviewing laboratory results, which value does the nurse identify that support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.) A.Low hematocrit (Hct) B.Low hemoglobin (Hgb) C.Positive for H. pylori bacteria D.Low potassium of 3.1 mEq/L E.Low white blood cells (WBC)
ANS: A, B, C Low hematocrit, Low hemoglobin, Positive H. pylori bacteria Low Hct and Hgb often occur related to bleeding. Presence of infection with H. pyloriis the second most common factor associated with development of PUD. The client would have a high, not low, WBC count. Potassium level is not a diagnostic factor for PUD.
A 23-year old client admitted and just diagnosed with ulcerative colitis (UC) reports approximately 5 bloody stools daily. Later in the afternoon, the client states that the abdominal pain is worsening. Which nursing intervention is appropriate to address the client's discomfort? (Select all that apply.) A.Provide sitz baths as needed B.Administer analgesics as ordered C.Teach music therapy or guided imagery D.Give antidiarrheal medications if ordered E.Evaluate tomorrow's diet for foods that cause pain
ANS: A, B, C Sitz bath as needed, music therapy, antidiarrheal medication as ordered. Sitz baths will help prevent skin excoriation or irritation. Complementary therapies used in conjunction with analgesics can be very helpful in controlling pain. Antidiarrheal medications may provide symptomatic relief but does not directly address pain or discomfort. Evaluating tomorrow's foods would not address the client's immediate symptom of pain.
A client with malnutrition is ordered daily multiple vitamins with zinc and iron supplements. Which nursing intervention promotes oral nutrition intake? (Select all that apply.) A.Delegating an AP to feed the client B.Providing mouth care before each meal C.Placing a small-bore nasoduodenal tube D.Assisting the client to sit upright in a chair E.Ordering foods that the client likes and prefers to eat
ANS: A, B, D, E Placing a feeding tube with continuous feedings will cause the client to have a decreased appetite. Having assistive personnel (AP) feed the client can increase oral nutrition intake, especially since the client is weak and may be too tired to feed himself.
As a client with PUD prepares for discharge, the nurse provides discharge teaching. Which education does the nurse provide? (Select all that apply.) A. Sit upright 30 to 60 minutes after meals. B. Spices should be added to food to enhance flavor. C. Extreme vomiting should be reported to the health care provider. D. Continue taking triple therapy as prescribed until the medication is finished. E. The goal of initial intervention is to control symptoms and prevent further complications.
ANS: A, C, D, E Clients should avoid spicy foods because they irritate the ulcer and gastric tissue. All other teaching points are necessary in treatment of PUD with H. pylori.
The nurse is caring for a client with peptic ulcer disease (PUD). Which client statement requires further nursing teaching? A."I eat out but I avoid spicy foods." B."I have to take ibuprofen for back pain." C."I sit up for an hour after I eat my meals." D."I am changing jobs to decrease my stress."
ANS: B NSAID use can aggravate symptoms associated with PUD, so the nurse needs to provide teaching about this factor. Avoidance of spicy foods, sitting up after meals, and reducing stress are appropriate self-management behaviors to decrease symptoms associated with PUD.
WHEN ADMINISTERING A NEW GI MEDICATION TO AN OLDER CLIENT, WHAT OUTCOME DOES THE NURSE ANTICIPATE? A.A HIGHER-THAN-NORMAL DOSE MAY BE NEEDED. B.CLOSE MONITORING IS IMPORTANT BECAUSE TOXIC LEVELS MAY DEVELOP. C.OLDER ADULTS ALWAYS REQUIRE A LOWER-THAN-NORMAL DOSE THAN YOUNGER CLIENTS. D.NAUSEA AND VOMITING MAY DEVELOP RAPIDLY AND ARE COMMON SIDE EFFECTS IN OLDER ADULTS.
ANS: B Close monitoring is important bc toxic levels may develop. THE OLDER CLIENT SHOULD BE MONITORED CLOSELY FOR ADVERSE EFFECTS OF ALL MEDICATIONS, EVEN THOSE ADMINISTERED IN NORMAL DOSES, BECAUSE TOXIC LEVELS CAN DEVELOP RAPIDLY. MEDICATIONS SHOULD NEVER BE INCREASED TO GREATER-THAN-NORMAL LEVELS BECAUSE AGE-RELATED CHANGES IN THE LIVER AND INTESTINAL ABSORPTION MAY CAUSE DEVELOPMENT OF TOXIC DRUG LEVELS. THE CLIENT ALSO SHOULD NOT RECEIVE DRUG DOSES THAT ARE LOWER THAN NORMAL. NAUSEA AND VOMITING IN RESPONSE TO MEDICATION ARE NOT EXPECTED SIDE EFFECTS OF A CLIENT'S USE OF PRESCRIBED MEDICATION IN APPROPRIATE DOSAGES.
What priority laboratory analysis will the nurse review when caring for a client with Crohn's disease? A. Potassium B. Hemoglobin C. Serum albumin D. C-reactive protein
ANS: B Hemoglobin Crohn's disease presents as transmural inflammation that causes a thickened bowel wall, strictures, and deep ulcerations that result in severe diarrhea and malabsorption of vital nutrients. Anemia is common, usually from iron deficiency or malabsorption issues. C-reactive protein may be monitored as a marker of inflammation, albumin to assess nutritional status, and potassium related to losses from diarrhea.
The client's assessment reveals yellowish coloration of skin and sclerae. Which laboratory values does the nurse anticipate? A.Increased urine bilirubin, decreased direct bilirubin B.Increased direct bilirubin, increased indirect bilirubin C.Decreased direct bilirubin, increased indirect bilirubin D.Increased direct bilirubin, decreased indirect bilirubin
ANS: B Increased direct bilirubin, increased indirect bilirubin When a client's skin is jaundiced, laboratory values of indirect and direct bilirubin are increased. Urine bilirubin is also increased. Urobilinogen in stool is normal to decreased, but in urine it is normal to increased.
What symptom does the nurse expect the client with intussusception to exhibit? A.Decrease in pulse B.Singultus (hiccups) C.Frequent bloody stools D.Extremely elevated body temperature
ANS: B Singultus Intussusception is a telescoping of the intestine within itself. Singultus (hiccups) is common with all types of intestinal obstruction. The vagus and phrenic nerves stimulate the hiccup reflex. Intestinal obstruction can increase the intraabdominal pressure, causing pressure on the phrenic nerve and the symptom of singultus (hiccups).
A client with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which priority laboratory finding will the nurse assess? A.Lipase level B.Total bilirubin C.Liver function tests D.White blood cell count
ANS: B Total bilirubin Excess circulating bilirubin present with chronic cholecystitis is responsible for pruritus and changes in stool and urine color. Cholecystitis is associated with several risks including hepatic disease, pancreatitis, and peritonitis. Monitoring liver function, pancreatic laboratory values, and white blood cell counts is also very important.
When a complete assessment of the client is performed, what other signs and symptoms does the nurse expect? (Select all that apply.) A.Muscle twitching B.Dry skin with rash C.Personality changes D.Peripheral dependent edema E.Ecchymosis, spider angiomas
ANS: B, D, E Dry skin with rash, Peripheral dependent edema, Ecchymosis, spider angiomas Personality changes and muscle twitching are findings that may be seen when the client with cirrhosis has developed portal-systemic encephalopathy. Dry skin, peripheral dependent edema, and ecchymosis are signs that are associated with cirrhosis. Additional manifestations that may be found on assessment include palmar erythema, clubbing of fingernails, and fixed flexion of fingers.
A 23-year old client admitted and just diagnosed with ulcerative colitis (UC) reports approximately 5 bloody stools daily. Vital signs show a pulse of 80 bpm, respiration rate of 18 breaths per minute, blood pressure of 124/88, and temperature of 97.6ºF. Mild abdominal tenderness on palpation is noted. The ESR is mildly elevated. How is the severity of the client's ulcerative colitis documented? A.Mild B.Moderate C.Severe D.Fulminant
ANS: B, Moderate In moderate UC, vital signs are often normal and there are less than 6 blood stools daily. C-reactive protein and/or EST may be elevated.
What possible complication does the nurse observe for when administering total parenteral nutrition (TPN)? A.Infection B.Dehydration C.Hyperglycemia D.Electrolyte imbalance
ANS: C Monitor serum electrolytes and glucose daily or per facility protocol. (Some facilities require finger-stick blood sugars [FSBSs] every 4 hours.) If insulin is added to the TPN to manage hyperglycemia, FSBSs should be checked frequently. Infection at the catheter site is a serious risk, as are fluid and electrolyte imbalances.
The client tells the nurse that once he is discharged to home, he has no intention to stop drinking alcohol. What is the appropriate nursing response? A."Why do you continue to drink?" B."It's your choice to drink or not to drink." C."Does it frighten you to consider quitting?" D."If you continue to drink, you are going to die."
ANS: C "Does it frighten you to consider quitting?" Asking the client about quitting allows him to express his feelings about drinking. Response A demands an answer and is nontherapeutic. Response B does not give recognition to the problem of drinking. Response D gives an ultimatum rather than to listening to the client's concerns.
A 23 year old client with ulcerative colitis is preparing for discharge. She asks what is the best way to take care of her skin. Which teaching will the nurse provide? A."Add high-fiber or high-cellulose foods to your diet." B."Apply a pectin-based skin barrier after each bowel movement." C."Wash with mild soap and warm water after each bowel movement." D."Take a laxative bedtime to facilitate morning bowel movements."
ANS: C "Wash with mild soap and warm water after each bowel movement." Good skin care after each bowel movement is the best way to protect from excoriation or irritation due to frequent bowel movements. Pectin skin barriers are only used for ostomies; not UC. High-fiber or high-cellulose foods should be avoided, as should laxatives.
An older adult with anemia requests help with menu choices. What type of food will the nurse encourage the client to eat? A.Prunes B.Oranges C.Skim milk D.Wheat bread
ANS: C Skim Milk Vitamin B12 deficiency in a client's diet can result in anemia. Older adults are at risk for several nutritional concerns including anemia from vitamin B12 and iron deficiencies. Vitamin B12 can be found in meats, fish, dairy, and egg food products. Prunes and oranges can assist with adding fiber and vitamins to the diet. Encouraging complex carbohydrates such as wheat bread is also important for good nutrition.
The nurse is interviewing a client who reports abdominal pain after meals for the past several months. The pain occurs often after eating or lying down to sleep. OTC antacids provide some relief. 1. Which assessment finding does the nurse anticipate that increases the client's risk for development of a peptic ulcer? A.Weight loss of 20 pounds B.History of GERD 4 years ago C.Use of NSAIDs to control arthritis pain D.Recent discontinuation of prednisone taper
ANS: C Use of NSAIDs to control arthritis pain. Peptic ulcer development is associated primarily with nonsteroidal antiinflammatorydrug (NSAID) use and bacterial infections with Helicobacter pylori. A weight loss is associated with gastric cancer; not PUD. Having a history of GERD 4 years ago does not increase today's risk for PUD. Prednisone is not associated with PUD, whereas high use of NSAIDs is.
Which assessment finding requires immediate nursing intervention in a client with severe ascites? A.Confusion B.Temperature 38.2º C C.Tachycardia, rate 110 beats/min D.Shallow respirations, rate 32 breaths/min
ANS: D Ascites can increase abdominal distention, which interferes with lung expansion and compromises ventilation and oxygenation. Risk for infection, fluid displacement, and confusion are also assessment variables requiring monitoring in a client with ascites.
Which client is more likely to develop gallstones? A.42-year-old Caucasian female with colon cancer B.51-year-old African-American male with a history of hypertension C.63-year-old Hispanic/Latino female with a history of irritable bowel syndrome D.70-year-old American-Indian female with obesity
ANS: D Risk factors for developing gallstones include female gender, obesity, family history of gallstones, diabetes mellitus, American-Indian and Caucasian descent, rapid change in weight, and advanced age. More risk factors increase the likelihood of developing gallstones.
WHICH CLIENT STATEMENT REGARDING INTAKE WILL THE NURSE ASSESS AS THE PRIORITY? A."SPICY FOODS ARE NOT MY FAVORITE." B."I FINALLY GOT A NEW PAIR OF DENTURES." C."FIBER HELPS WHEN I HAVE CONSTIPATION." D."I TAKE IBUPROFEN THREE TIMES DAILY FOR ARTHRITIS."
ANS: D "I take Ibuprofen three times daily for arthritis." LARGE AMOUNTS OF ASPIRIN OR OTHER NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) SUCH AS IBUPROFEN CAN PREDISPOSE THE CLIENT TO PEPTIC ULCER DISEASE AND GI BLEEDING. THE NURSE CAN FURTHER ASSESS OTHER COMMENTS ONCE THE PRIORITY ASSESSMENT HAS BEEN ACCOMPLISHED.
A 23 year old client with ulcerative colitis states, "I am afraid I'll never get to go out with my friends again because I can't be away from the toilet." Which nursing response is appropriate? A."What makes you say that?" B."Your friends will understand." C."I wouldn't worry about it if I were you." D."It sounds like you are concerned about managing this disorder."
ANS: D "It sounds like you are concerned about managing this disorder." This response verbalizes the implied concern. Response A does not address the concern and requires the client to give an answer that defends her feelings. Responses B and C minimize the client's feelings and do not address concerns.
A client has recently been placed on corticosteroids to treat ulcerative colitis. The nurse will monitor the client's laboratory results for evidence of which condition? A.Hyperkalemia B.Hypernatremia C.Hypercalcemia D. Hyperglycemia
ANS: D Hyperglycemia Long-term adverse effects that commonly occur with steroid therapy include hyperglycemia, osteoporosis, peptic ulcer disease, and increased risk for infection.
A 66-year-old client with a history of arthritis and hypertension is admitted with epigastric cramping, dyspepsia, nausea, and dark, sticky stools for 3 days. Which order will the nurse discuss with the health care provider? A.Guaiac stool sample X 2 B.Stool sample for bacterial testing C.IV fluids, normal saline at 125 ml/hr D.Naproxen (Naprosyn) 500 mg twice daily
ANS: D Naproxen 500 mg tid Long-term NSAID use creates a high risk for acute gastritis. Naproxen is an NSAID that may be used to treat arthritis, so the nurse will discuss this order with the health care provider. IV fluids may be needed to replace fluids or blood lost from the client's gastritis, so this does not need to be questioned. Stool guaiac is nonspecific but may be ordered to confirm blood in the stool, and a stool sample may be used to test for the presence of H. pylori infection.
A client received one positive fecal occult blood test. Which response is most appropriate? A.The client has colon cancer B.The client has bleeding in the GI tract C.The client may be taking Aspirin D.The client will need two samples on three consecutive days.
ANS: D The client will need two samples on three consecutive days. Two to three fecal occult blood tests on 3 consecutive days are needed to fully assess for blood in the stool. While a positive result may mean that the client has cancer, or bleeding in the GI tract, or has been taking medication, one test could be a false positive. The most appropriate response is to obtain additional samples for testing.
The nurse is caring for a client with a long history of osteoarthritis. Which risk factor will the nurse teach that may contribute to development of gastroesophageal reflux disease (GERD)? A.Weight of 150 pounds B.Walks 15 minutes once daily C.Chooses foods high in calcium D.Frequently takes NSAIDs for pain
Answer: D Frequently takes NSAIDs for pain Rationale: Some drugs can cause GERD, such as oral contraceptives, anticholinergic agents, sedatives, and nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen, nitrates, and calcium channel blockers. The possibility of eliminating those drugs causing reflux should be explored with the health care provider. Maintaining a normal weight , performing daily exercise, and choosing foods that are vitamin-rich and mineral-rich are not risk factors for developing GERD.
The nurse is administering a parenteral nutrition infusion to a patient. The nurse will implement which measures to prevent infection? (Select all that apply.) a. Change the intravenous tubing set every 72 hours. b. Change the intravenous tubing set every time a new bag is added to the infusion. c. Use a 1.2-micron filter with each tubing set. d. Monitor the patient's temperature every shift during the infusion. e. Report any increase in the patient's temperature over 100° F (37.8° C).
B, C, E b. Change the intravenous tubing set every time a new bag is added to the infusion. c. Use a 1.2-micron filter with each tubing set. e. Report any increase in the patient's temperature over 100° F (37.8° C).
The nurse is caring for a client diagnosed with peptic ulcer disease (PUD). For which potential complications will the nurse monitor? Select all that apply. A. Pneumonia B. Peritonitis C. Anemia D. Stroke E. Hypotension F. Cirrhosis
B, C, E B. Peritonitis C. Anemia E. Hypotension
Which client statement about GERD triggers requires further nursing teaching? Select all that apply. A. "I will decrease my alcohol intake." B. "Smoking one or two cigarettes a day won't hurt." C. "My plan is to eat six small meals daily." D. "Tomato-based foods should be avoided."' E. "I love soda but I'm going to stop drinking it." F. "Our family eats tacos and burritos several times weekly."
B, F B. "Smoking one or two cigarettes a day won't hurt." F. "Our family eats tacos and burritos several times weekly."
The primary health care provider prescribes bismuth subsalicylate for a client as part of treating H. pylori infection. What health teaching will the nurse include for the client about this drug? A. "Do not crush this drug before taking." B. "The drug may cause your tongue and stool to turn black." C. "Take the drug at night only." D. "The drug may cause you to have diarrhea."
B. "The drug may cause your tongue and stool to turn black."
A public health nurse is assessing community clients for oral health disorders. Which client is identified at highest risk? A. 23-year-old with three dental fillings B. 34-year-old with schizophrenia C. 55-year-old with stable angina D. 62-year-old with irritable bowel syndrome
B. 34-year-old with schizophrenia
A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor lab results for which therapeutic effect? A. Increased hemoglobin and hematocrit levels B. Decreased uric acid levels C. Decreased white blood cell count D. Decreased prothrombin time
B. Decreased uric acid levels
A patient is receiving a nutritional supplement via an enteral feeding tube. The nurse will monitor for which common adverse effect? A. Fluid overload B. Diarrhea C. Heartburn D. Constipation
B. Diarrhea
A patient has been receiving total parenteral nutrition. Upon assessment, the nurse notes these assessment findings: BP 150/92 (elevated from previous readings); pulse rate 110 and weak; pitting edema on both ankles; and new-onset confusion. The nurse suspects that the patient is experiencing which condition? A. Hypoglycemia B. Fluid overload C. Hyperglycemia D. Infection
B. Fluid overload
A client had an exploratory laparotomy to treat the cause of peritonitis and has a large incision that is closed with staples and two abdominal drains. Which finding(s) would the nurse report immediately to the surgeon? Select all that apply. A. Serosanguineous drainage B. Increased abdominal distention C. Fever and chills D. Pain level 2 on a scale of 0 to 10 E. Passing flatus
B. Increased abdominal distention C. Fever and chills
The nurse caring for a patient with pericarditis who is taking the nonsteroidal anti-inflammatory drug indomethacin (Indocin) as treatment for it would teach the patient to watch for which adverse effect? A. Tachycardia B. Nausea and Vomiting C. Nervousness D. Dizziness
B. Nausea and Vomiting
The nurse is preparing a plan of care for a patient undergoing therapy with vitamin A. Which of these are possible effects of vitamin A deficiency? A. Muscle twitching B. Night blindness C. Impaired wound healing D. Confusion
B. Night blindness
The nurse is preparing to administer medications to a patient who is receiving a feeding via a gastric tube. When reviewing the patient's medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed? A. Metoclopramide (Reglan) B. Phenytoin (Dilantin) C. Warfarin (Coumadin) D. Multivitamin solution
B. Phenytoin (Dilantin)
When providing education regarding the use of PPIs, which statement will the nurse include? A."Take the medication along with the first meal of the day." B."Take the medication on an empty stomach, 30 to 60 minutes before eating." C."Take the medication when you have symptoms of heartburn." D."Take the medication at bedtime with a snack."
B."Take the medication on an empty stomach, 30 to 60 minutes before eating." Food may decrease absorption of the PPIs, and it is recommended that they be taken on an empty stomach. They are taken on a daily basis, not as needed for heartburn.
Immediately following a colonoscopy, which client behavior will the nurse report to the health care provider? Select all that apply. A. Passing of flatus B. Blood pressure 128/80 mm Hg C. Abdominal guarding D. Change in mental status E. Report of mild abdominal cramping
C, D C. Abdominal guarding D. Change in mental status
A client has a new diagnosis of irritable bowel syndrome (IBS) with diarrhea. What health teaching by the nurse is appropriate for this client? A. "Take a stool softener every day to ease defecation." B. "Avoid high-fiber foods in your diet." C. "Avoid dairy products and caffeinated beverages." D. "Ask your primary health care provider for an antidepressant."
C. "Avoid dairy products and caffeinated beverages."
A young adult client admitted with a diagnosis of cholecystitis from cholelithiasis has severe abdominal pain, nausea, and vomiting. Based on these assessment findings, which client problem is the highest priority for nursing intervention at this time? A. Anxiety B. Risk for dehydration C. Acute pain D. Malnutrition
C. Acute pain
A client has been diagnosed with an active upper GI bleed. What is the nurse's priority action? A.Obtain vital signs. B.Initiate IV fluids as prescribed. C.Apply oxygen by nasal cannula. D.Type and cross match for blood products.
C. Apply oxygen by nasal cannula. Oxygen will assist with delivery of oxygen to the tissues, so this is the priority action. All other actions can be implemented after oxygen is applied.
A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect?
Constipation
A client had a colectomy with creation of an ileo-anal pouch and temporary ileostomy yesterday morning. The nurse assesses the ostomy and its functioning. Which assessment finding will the nurse report to the primary health care provider? A. Client's report of abdominal pain of 3 on a 0 to 10 pain intensity scale B. Slight abdominal distention C. No drainage from the ileostomy D. Serosanguinous effluent from the drain
C. No drainage from the ileostomy
While performing an abdominal assessment on a client, the nurse notes a bruit over the aorta. What is the appropriate nursing action? A. Consult another nurse to verify the bruit. B. Auscultate each quadrant for 5 minutes each. C. Notify the health care provider of the findings. D. Perform light palpation to further assess the pulsation.
C. Notify the health care provider of the findings.
During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)? A. Rheumatoid Arthritis B. Diabetes Mellitus C. Renal Disease D. Headaches
C. Renal Disease
The nurse is caring for a patient with cirrhosis who has hepatic encephalopathy. Which assessment finding should the nurse report to the primary health care provider? A. Fatigue B. Difficulty sleeping C. Seizure D. Disorientation
C. Seizure
The nurse is assessing a patient admitted to the unit after major bowel surgery. The nurse anticipates administering which type of nutrition for this patient? A.Enteral feedings through a percutaneousendoscopic gastrostomy tube B.PPN C.TPN D.A high-residue diet
C. TPN Patients who have had major bowel surgery will not be able to take feedings via the GI tract. TPN is indicated for long-term nutritional support when oral feeding is not possible.
The nurse is caring for a client diagnosed with hepatitis A. Which transmission-based precautions are required when providing care for this client? Select all that apply. A. Place client in a private room. B. Wear a mask when handling patient bedpan. C. Wear gloves when touching the client. D. Wear a gown when providing personal care to this patient. E. Wear eye goggles when providing care.
C. Wear gloves when touching the client. D. Wear a gown when providing personal care to this patient.
A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient? A.A magnesium-containing antacid B.A calcium-containing antacid C.An aluminum-containing antacid D.Because of renal problems, the patient should not take antacids for this problem.
C.An aluminum-containing antacid Aluminum- and sodium-based antacids are recommended for patients with renal compromise because they are more easily excreted. Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are often avoided in this patient group.
Which statement by the client who is prescribed to take pancreatic enzyme replacements indicates a need for further teaching by the nurse? A. "I need to take the enzymes at every meal and with snacks." B. "After taking the enzymes, I should drink a glass of water." C. "I should wipe my mouth in case any of the enzyme got on my lips." D. "I should chew each capsule carefully so that it works in my stomach."
D. "I should chew each capsule carefully so that it works in my stomach."
A patient is taking omeprazole (Prilosec) for the treatment of GERD. The nurse will include which statement in the teaching plan about this medication? A. "Take this medication once a day after breakfast." B. "You will be on this medication for only 2 weeks for treatment of the reflux disease." C. "The medication may be dissolved in a liquid for better absorption." D. "The entire capsule must be taken whole, not crushed, chewed, or opened."
D. "The entire capsule must be taken whole, not crushed, chewed, or opened."
When caring for a patient receiving PPN, it is most important for the nurse to assess for the development of which adverse effect? A. Hypertension B. Anemia C. Renal failure D. Phlebitis
D. Phlebitis The most devastating adverse effect of PPN is phlebitis, which is vein irritation or inflammation of a vein. If phlebitis is severe and is not treated appropriately, it can lead to the loss of a limb, although this is rare. Another potential adverse effect is fluid overload.
The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect? a. Anxiolytic b. Sedative c. Antipyretic d. Antimicrobial
c. Antipyretic
The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct?
Long-term use of these drugs may contribute to osteoporosis.
A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used? a. Jevity b. Ensure Plus c. Glucerna d. Polycose
c. Glucerna
A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect?
Prevent stress ulcers
The peripheral parenteral nutrition bag that has been infusing into the patient is empty, and the nurse realizes that the next bag is not ready. The nurse should immediately hang which of these intravenous solutions until the new bag arrives? a. 10% dextrose in water b. 20% dextrose in water c. 0.9% sodium chloride d. Lactated Ringer's solution
a. 10% dextrose in water
A woman has been receiving both radiation and chemotherapy for her cancer. Lately, she has developed anorexia caused by the treatments, so she needs short-term nutrition supplementation. The nurse anticipates that the physician will initiate which therapy? a. Central total parenteral nutrition b. Peripheral parenteral nutrition c. Oral nutritional supplements with meals d. Nasogastric enteral supplementation
b. Peripheral parenteral nutrition
When monitoring a patient who has been receiving peripheral parenteral nutrition for more than 3 weeks, the nurse will watch for which potential complication? a. Diarrhea b. Phlebitis c. Hypernatremia d. Hypoglycemia
b. Phlebitis
A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct? a. "Aspirin is given reduce anxiety." b. "It helps to reduce inflammation." c. "Aspirin is given to relieve pain." d. "It will help to prevent clot formation."
d. "It will help to prevent clot formation."
During the night shift, a patient's total parenteral nutrition (TPN) infusion ran out, and the nurse discovered that there was no TPN solution on hand to continue the infusion. The pharmacy is closed and will not reopen for 5 hours. The nurse will have to implement measures to prevent which consequence of abruptly discontinuing TPN infusions? a. Dehydration b. Hyperglycemia c. Dumping syndrome d. Rebound hypoglycemia
d. Rebound hypoglycemia
