Chapter 41 practice questions

5. A nurse at an EENT clinic is prioritizing patient referrals. Which patient should be seen first? A. 45-year-old Caucasian female with painless ulceration on tongue and difficulty swallowing. B. 52-year-old Hispanic male with painless, hardened in labial commissure of right lip. C. 50-year-old Caucasian male with velvety-red lesion on the buccal mucosa. D. 61-year-old African American female with hard, leathery white patch on side of tongue.

a. Answer: A b. Rationale: All patients represented have signs and symptoms of oral cancer. However, patient A is having symptoms that may indicate spread of the cancer and is affecting proper nutrition.

8. A patient diagnosed with gastroesophageal reflux disease (GERD) caused by H. pylori is discussing his medication regime with the clinical nurse. He is currently taking quadruple drug therapy consisting of Omeprazole (Prilosec), Doxycycline (Doryx), Metronidazole (Flagyl), and Bismuth subsalicylate (Kaopectate). Which of the follow. Which statement made by the patient indicates a need for further education? A. "I take a Tums (calcium carbonate) along with my therapy prophylactically." B. "I understand that the therapy may not by successful even if taken correctly." C. "My Barrett's esophagus will not go away with successful treatment." "My stools have had a black appearance since beginning the therapy.

a. Answer: A b. Rationale: Antacids can bind with antibiotics used in H. pylori therapy which can decrease their effectiveness. H. pylori therapy is only between 70-85% effective. Barrett's esophagus is a non-reversible condition. Bismuth subsalicylate causes stools to appear black.

7. Biopsies from a patient's EGD reveal columnar epithelial cells in the esophagus. The nurse knows that this finding is consistent with: A. Barrett's esophagus* B. Esophageal cancer C. Esophageal varices D. Gastroesophageal reflux disease (GERD)

a. Answer: A b. Rationale: Chronic GERD can cause changes in the cells that line the esophagus. This pathological change is call Barrett's esophagus. This condition is considered pre-cancerous, but is not an active sign of cancer. Esophageal varices are associated with liver failure.

13. An OB nurse has been floated to the gastrointestinal unit. What would be the best patient assignment for this nurse? A. 20-year-old, black male one hour postoperative appendectomy with a fever of 101°F B. 37-year-old, white female with a newly inserted NG tube that has just put out 500 ml of greenish-brown fluid C. 51-year-old, black female admitted from the ER with acute abdominal pain radiating to the back and upper abdomen D. 76-eyear-old, Asian male who is being discharged after being diagnosed with stomach cancer

a. Answer: A b. Rationale: The OB nurse should be comfortable assessing surgical sites and monitoring s/s of infection. This is the least acute patient of all those represented.

3. A patient list their home medications as follows: Metformin (Glucophage) PO 500 mg BID, Fluticasone (Flovent) INHL 88 mcg BID, Furosemide (Lasix) PO 20 mg DAILY, and Metoprolol (Lopressor) PO 50 mg BID. Which of the following would indicate incorrect medication administration? A. Hemoglobin A1C of 5% B. Orthostatic hypotension C. Polyuria D. Yeasty breath odor

a. Answer: D b. Rationale: Symptoms of oral candidiasis include yeasty smelling breath. Oral candidiasis can be caused by not rinsing the mouth after use of inhaled corticosteroids.

16. The nurse is providing discharge instructions to a patient who has undergone a Billroth I surgery for gastric cancer. Which of the following instructions should be included in the patient's teaching? (SELECT ALL THAT APPLY) A. Carry hard candy with you. B. Supraclavicular lymphedema is normal following this surgery. C. Follow a low-carbohydrate diet. D. Long-term antiemetic use is necessary. E. Wear a medical alert bracelet.

a. Answer: A, C, E b. Rationale: Patients undergoing this surgery are susceptible to dumping syndrome and postprandial hypoglycemia; therefore, they should follow and low-carbohydrate diet and keep hard candy in case s/s of hypoglycemia manifest. Patients should also wear a medical alert bracelet for emergency situations to help with diagnosis and NG tube insertion in emergency situations. Supraclavicular lymphedema (Virchow node) is an abnormal finding and indicates spread of cancer. Antiemetic use is necessary until surgical incisions heal but not long term.

2. When doing an oral assessment on a patient, the nurse notes bleeding gums. The nurse would further question the patient about: A. Antibiotic use B. Diet C. Family medical history D. Occupation

a. Answer: B b. Rationale: Bleeding gums are a symptom of gingivitis. Gingivitis can be caused by lack of vitamins B and C in the diet.

11. A 76-year-old patient is admitted to the hospital for nausea and vomiting related to the flu. The patient also has a medical history of Crohn's disease, congestive heart failure, hypothyroidism, and osteoarthritis. Which maintenance medication would the nurse consider holding? A. Celecoxib (Celebrex) B. Furosemide (Lasix) C. Levothyroxine (Synthroid) D. Mercaptopurine (Purinethol)

a. Answer: B b. Rationale: Nausea and vomiting can cause electrolyte disturbances. This especially true in geriatric patients. Lasix causes loss of potassium.

12. A nurse is assessing a patient diagnosed with chronic gastritis. Upon inspection of the oral cavity, the nurse notes a red, swollen tongue and bleeding gums. Which diagnostic would best help the nurse plan further care of this patient? A. Biopsy B. CBC C. Gastric pH D. Occult blood

a. Answer: B b. Rationale: Red, swollen tongue and bleeding gums are signs of a B12 deficiency. A B12 deficiency can also cause pernicious anemia. RBC are evaluated using a CBC.

6. The nurse is creating a care plan for a patient with gastroesophageal reflux disease (GERD). Which instructions should be included? (SELECT ALL THAT APPLY) A. Eat three large, regularly spaced meals a day. B. Eliminate drinks containing caffeine from the diet. C. Start a weight loss program if BMI > 25. D. Take your antacid and proton-pump inhibitor together. E. Wear an abdominal binder for support.

a. Answer: B, C b. Rationale: Caffeinated beverages tend to be highly acidic which increases gastric mucosa irritation which can stimulate reflux. Patients with BMI > 25 are considered overweight. Increased weight is associated with increased abdominal pressure which can cause GERD. Patients with GERD should eat small, frequent meals to avoid abdominal overdistention and increased abdominal pressure. Antacids can bind to PPIs and negate their effectiveness. Abdominal binder use can increase intrabdominal pressure.

9. An 83-year-old patient presents to the clinic complaining of chronic nighttime cough. The patient has no other respiratory complaints or history, and a chest x-ray is negative for lung changes. Which diagnostic test would be most beneficial for this patient? A. Barium swallow B. Manometry C. pH monitoring D. Urea breath test

a. Answer: C Rationale: Reflux disease may manifest as respiratory symptoms in geriatric patients. Out of the diagnostics represented, pH monitoring provides positive diagnosis for reflux. Barium swallows, manometry, and urea breath test are better used to diagnose why the patient has reflux.

17. A community health nurse is assessing patient health histories. Which of the following patients is the MOST at risk for developing colorectal cancer? A. 32-year-old, white male with Chron's disease who drinks 3 alcoholic beverages a week B. 49-year-old, Hispanc female vegetarian with a family history of colorectal polyps C. 65-year-old, black male truck driver who smokes and has a BMI of 34 D. 74-year-old, Asian female with a history of hemorrhoids and chronic constipation

a. Answer: C b. Rationale: This patient has the most risk factors (age, ethnicity, tobacco use, and overweight).

1. The nurse is assessing an oncology patient diagnosed with stomatitis. Which of the following would the nurse recommend? (SELECT ALL THAT APPLY) A. Add ice to all beverages B. Rinse the moth with Listerine after meals C. Suck on hard candy D. Supplement meals with protein shakes E. Use a soft bristle toothbrush

a. Answer: C, D, E b. Rationale: Sucking on hard candy can relieve dry mouth associated with stomatitis. Supplementing meals with protein shakes helps to meet nutritional needs of the patient without having to chew food which may irritate the mucosa. Soft bristle toothbrush use is less irritating to sensitive gums. Ice and alcohol-based mouthwashes irritate sensitive mucosa.

15. A patient newly diagnosed with stomach cancer states, "I knew I should have stopped smoking years ago. I should have never started in the first place. Now I'm going to die." What is the most appropriate response by the nurse? A. "Perhaps you can be a spokesman for smoking cessation." B. "You can't change the past. You should focus on what you can do now." C. "Your cancer hasn't been staged yet. It probably is not that bad." D. "Many people feel guilty when they are diagnosed with cancer. Can you tell me more?"

a. Answer: D b. Rationale: Answer D recognizes the patient's feelings and provides an open-ended question for continued therapeutic communication. A, B, and C answers do not facilitate therapeutic communication and belittle the patient's' feelings.

14. A 35-year-old female diagnosed with peptic ulcer disease (PUD) after chronic NSAID use is being discharged with a prescription for Misoprostol (Cytotec). What should the nurse further assess for? A. Antacid use B. Chronic pain C. Diet and alcohol use D. Sexual activity

a. Answer: D b. Rationale: Misoprostol (Cytotec) causes uterine contractions. It should not be prescribed to patient who can become pregnant because it would result in loss of pregnancy.

4. The nurse is planning discharge teaching for a patient recently diagnosed with Herpes Simplex Type 1. Which statement by the patient indicates the need for further teaching? A. "Antiviral medications can decrease frequent outbreaks." B. "Condom use is necessary to protect my partner during oral sex." C. "I should apply sunscreen on and around my lips daily." "The virus can only be transmitted when I have active symptoms.

a. Answer: D b. Rationale: Patients with herpes are most contagious when there is open ulceration of the blisters, but viral shedding can happen before symptoms appear.

10. A 35-year-old male presents to the emergency department (ED) with complaints of nausea and severe epigastric pain. His vitals on arrival are BP: 99/46; HR: 115; RR: 26; Oxygen Saturation: 93%, and temperature: 101.1 F. While in the ED, the patient vomits 100 ml of coffee-ground emesis. What is the nurse's priority action? A. Give supplemental oxygen via simple mask B. Insert two large bore IVs C. Insert a nasogastric tube D. Place patient on a cardiac monitor

a. Answer: D b. Rationale: This patient is demonstrating signs of shock. Cardiac monitoring can show changes in heart rhythms related to electrolyte and blood loss. Simple mask would not be the ideal method of oxygen administration because of active vomiting and oxygen saturation is still within the normal range. IV access is necessary but not first action (Cardiac monitoring = Assess in nursing process; IV insertion = Implementation). This patient has symptoms of perforation, so an NG tube should not be inserted by the nurse.