EXAM 1

A. The client is malnourished B. The client reports that pain occurs during the night C. The client states that the pain is in the upper epigastrium

A nurse is assessing a client who has duodenal ulcer. Which of the following findings should the nurse expect?

Hypotension

A nurse is assessing a client who has upper GI bleeding. Which of the following findings should the nurse expect?

A. Chest pain B. Bradycardia C. Hiccups

A nurse is assigning a client who is post op following a gastrectomy. The nurse should identify which of the following findings as an indication of abdominal distention?

A. The CEA determines the efficacy of your chemotherapy B. The CEA determines if you are experiencing occult bleeding from the GI tract C. The CEA determines if the neutrophil count is below the expected reference range

A nurse is caring for a client who has colorectal cancer and is receiving chemotherapy. The client asks the nurse why his blood is being drawn for a CEA level. Which of the following responses should the nurse make?

I will eat beans to ensure I get enough fiber in my diet

The nurse is providing dietary teaching for a client who has a new diagnosis of celiac disease. Which of the following statements by the client indicates an understanding of the teaching?

"I chose broiled chicken with a baked potato for dinner"

A client is placed on a low-sodium (500 mg/day) diet. Which statement indicates that the nurses nutrition teaching plan has been effective?

A developmental disability

A 19 y/o client with a diagnosis of down syndrome is being admitted to the unit for the treatment of community-acquired pneumonia. When planning this client's care, the nurse recognizes that this client's disability is categorized as what?

Change positions slowly

A 77 y/o client has newly diagnosed stage 2 hypertension. The physician has prescribed the client a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about postural hypotension. Which of the following will the nurse be sure to include in the teaching for the client?

Instruct the client to sit for several minutes before standing

A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene?

There are things you can do to minimize the effects of this disease on your health

A client from a low socioeconomic background was diagnosed with a chronic health problem. The client states, "everyone has to die of something." the most appropriate response by this nurse is:

Sexual Health

A community health nurse has drafted a program that will address the health promotion needs of members of the community who live with one or more disabilities. Which of the following areas of health promotion education is known to be neglected among adults with disabilities?

A single elevated blood pressure does not confirm hypertension. You will need to have your BP reassessed several times before a diagnosis can be made

A group of nursing student nurses are practicing taking BP. A 56 y/o male student has a BP of 146/96. Upon hearing the reading he exclaims "my bp has never been this high. do you think my doctor will prescribe medication to reduce it". which of the following responses by the nursing instructor would be best?

"Who will care for our son once we're unable?"

A man and woman are in their early 80s and have provided constant care for their 44-y/o son who has down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have what concerns around what question?

Fatty diarrheal stools

A nurse is assessing a client who has crohn's disease. which of the following findings should the nurse expect?

~Increase dietary fiber intake ~Arrange activities to allow for daily rest periods ~Drink 240 mL glasses of milk per day ~use progressive relaxation techniques ~Restrict intake of carbonated beverages

A nurse is caring for a client who has ulcerative colitis. The client has several exacerbations over the past 3 years. Which of the following instructions should the nurse include in the plan of care to minimize the risk for further exacerbations (select all that apply)

A. Review serum electrolyte values B. Check the clients urine output C. Obtain the clients current weight

A nurse is caring for a client who was admitted for treatment of left-sided heart failure with IV loop diuretics and digitalis the therapy. The client is experiencing weakness and irregular heart rate. Which of the following should the nurse take first?

Eggs

A nurse is providing dietary teaching for a client who is post op following a gastrectomy. Which of the following foods should the nurse encourage the client to include in her diet to prevent dumping syndrome?

"I should eat a diet low in fiber"

A nurse is providing discharge instructions for an older adult client who has mild diverticulitis. Which of the following statements by the client indicates an understanding of the teaching?

Dark purple stoma

A nurse is providing discharge teaching for a client following a an ileostomy. The nurse should instruct the client to report which of the following findings to the provider?

"I will decrease the amount of carbonated beverages I drink"

A nurse is providing discharge teaching for a client who has GERD. Which of the following statements by the client indicates an understanding of the teaching?

drink clear liquids for 24 hours prior to the procedure, and then take nothing by mouth for 6 hr before the procedure

A nurse is teaching a client how to prepare for a colonoscopy. Which of the following instructions should the nurse include in the teaching?

Managing chronic conditions must be a collaborative process

A nursing instructor is discussing characteristics of chronic illness with a class. The instructor asks the students to name one characteristic. Which of the following answers is correct

8:00 PM

A total of 1000 mL of an IV solution is to infuse at 100 mL/hour. If it is 10:00 AM when the infusion starts, at what time will it be completed?

False

Abdominal pain and constipation are common clinical manifestations of Crohn's disease (True or False)

True

An advance directive applies only if a patient is incapacitated

With age, biologic changes reduce the efficiency of body systems

An elderly client has presented to the clinic with a new diagnosis of osteoarthritis. The client's daughter is accompanying him and the nurse has explained why the incidence of chronic diseases tends to increase with age. What rationale for the phenomenon should the nurse describe?

True

Celiac disease is a disorder of malabsorption caused by an autoimmune response to consumption of products that contain the protein gluten.

False

Disability is the loss of abnormality of psychological, physiologic, or anatomic structure or function at the organ level:

False

Diverticulosis is the sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer (True or False)

~Have you discussed your end-of-life choices with your family and/or designated surrogate and health care team? ~Do you have basic information about advance medical directives ~Do you wish to initiate an advance medical directive

During patient assessment, a holistic nurse may ask the following questions: Select all that apply

True

IBS is a functional disorder chracterized by recurrent abdominal pain that affects frequency of defecation and consistency of stool; is associated with no specific structural or biomedical alterations (True or False)

False

Irritable bowel disease is a functional disorder characterized by recurrent abdominal pain that affects frequency of defecation and consistency of stool; is associated with no specific structural or biomedical alterations. (True or False)

3 months or longer

Medical or health problems are considered chronic that require long term management of:

Family history of hypertension

Nonmodifiable risk factor for hypertension

A. Are efforts made to direct all conversations/questions to the patients family B. Does the patient require or prefer special accommodations C. Are special accommodations made to communicate with the patient

Questions to ask to ensure quality of care include all of the following except:

True

The most common site for peptic ulcer formation is in the duodenum (True or False)

~nausea and vomiting ~Right lower quadrant pain ~Oral temperature 101 F

The nurse is assessing a client who has appendicitis. Which of the following findings should the nurse expect? Select all that apply

Absence of adventitious breath sounds

The nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the clients condition?

Provide a sign language interpreter

The nurse is caring for a client who communicates via sign language. To promote communication, the nurse should do which of the following?

Hypertensive emergencies are associate with evidence of target organ damage

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?

A. Provider directives B. Treatment directives C. Appointment directives D. Practical Directives

Two type of advance directives are:

Polyethylene glycol and electrolytes (Colyte)

What is an example of a laxative osmotic agent?

Bisacodyl (Dulcolax)

What is an example of a stimulant laxative agent?

Address the individual's physical, emotional, and social needs.

Working with individuals who are diagnosed with a chronic illness requires healthcare providers to not only address the medical aspects of their disorder but also working with the person as a whole, thus plan a holisitic approach. WHich of the following is considered a holisitic in approach.

maintaining a low sodium diet

a client hospitalized for treatment of hypertension is being prepared for discharge. Which topic should the nurse be sure to cover?

persistent cough

a nurse is teaching a client who is starting to take an ace inhibitor to treat hypertension. The nurse should instruct the client to notify the provider if he experiences which of the following?

Secondary

according to the classification of hypertension diagnosed in the older adult, hypertension that can be attributed to an underlying cause is termed

true

diverticulum is the sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer (True or False)

weak peripheral pulses

the nurse is assessing a client who has left-sided failure. Which of the following manifestations should the nurse expect to find?

BP of 96/58

the physician order reads: administer metoprolol 75 mg orally once a day. before giving metoprolol which vital sign should the nurse recheck prior to calling the provider?