Exam 2 Practice Questions- MED SURG

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? Administer prescribed analgesics. Monitor temperature every 4 hours. Encourage increased oral fluid intake. Give antiemetics as needed for nausea.

Administer prescribed analgesics. 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.

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take? Withhold both drugs. Administer both drugs. Administer the furosemide. Administer the spironolactone.

Administer the spironolactone. (potassium-sparing)

Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis? Hemoglobin Temperature Activity level Albumin level

Albumin level *decreased COP from impaired liver synthesis of albumin

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

Alcohol use 1-gallbladder disease 2-chronic alcohol use 2 major causes of pancreatitis

What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices? Bilirubin levels Ammonia levels Potassium levels Prothrombin time

Ammonia levels

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate? "Have you taken corticosteroids?" "Do you have a history of IV drug use?" "Do you use any over-the-counter drugs?" "Have you recently traveled to another country?"

"Do you use any over-the-counter drugs?"

The nurse is admitting a 67-yr-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you usually drink?" "Have you noticed a recent weight loss?" "What time of day do your bowels move?" "Do you eat meat or other animal products?"

"Have you noticed a recent weight loss?" *does pt have imbalance of nutrition due to steatorrhea?

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? "Have you been passing a lot of gas?" "What foods affect your bowel patterns?" "Do you have any abdominal distention?" "How long have you had abdominal pain?"

"How long have you had abdominal pain?" *criteria for IBS is presence of abdominal pain for at least 1day/week for 3 months (with a change in stool)

The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement? "I can take a shower and walk around the house tomorrow." "I need to limit my activities and not return to work for 4 weeks." "I can expect yellowish drainage from the incision for a few days." "I will follow a low-fat diet for life because I do not have a gallbladder."

"I can take a shower and walk around the house tomorrow." After a laparoscopic cholecystectomy, patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.

D.B. must undergo surgical intervention. Which comment indicates that additional instruction about the care of his new ileostomy is needed? "I should change the appliance daily to prevent odors." "When I change the appliance, I should check the skin for irritation." "I should clean around the stoma with mild soap and water and pat dry." "I'll need to alter the appliance opening when the stoma becomes smaller as the area heals."

"I should change the appliance daily to prevent odors."- appliance changed every 4-7 days unless leakage occurs

Which statement by a 22-yr-old female patient with cystitis indicates to the nurse that instruction regarding prevention of future urinary tract infections (UTIs) has been effective? "I can use vaginal antiseptic sprays to reduce bacteria." "I will drink a quart of water or other fluids every day.""I will wash with soap and water before sexual intercourse." "I will empty my bladder every 3 to 4 hours during the day."

"I will empty my bladder every 3 to 4 hours during the day."

Which statement by a patient who had a cystoscopy the previous day should the nurse report immediately to the health care provider? "My urine looks pink." "My IV site is bruised." "My sleep was restless." "My temperature is 101."

"My temperature is 101."- bladder infection

A patient passing bloody urine has scheduled a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate? "Your doctor will place a catheter into an artery in your groin and inject a dye to visualize the blood supply to the kidneys." "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidneys." "Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye to outline your bladder on x-ray." "Your doctor will inject a radioactive solution into a vein in your arm, then the isotope in your kidneys and bladder will be visible on a scanner."

"Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye to outline your bladder on x-ray."

A client presents at the ER complaining of severe "indigestion." The diagnosis is pancreatitis. The client asks how the physician is certain the problem is with his pancreas. Which nursing statements are appropriate? Select all that apply. A Your CT scan was consistent with pancreatitis. B The urine analysis we did shows you have pancreatitis C The electrolyte levels in your blood are consistent with pancreatitis. D Your amylase and lipase blood results were much higher than they should have been. E The history you gave about your illness matched common findings of pancreatitis.

A Your CT scan was consistent with pancreatitis. D Your amylase and lipase blood results were much higher than they should have been. E The history you gave about your illness matched common findings of pancreatitis.

A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient? A. Baked chicken with steamed carrots and rice B. Broccoli and cheese casserole with gravy and mashed potatoes C. Cheeseburger with fries D. Fried chicken with a baked potato

A. Baked chicken with steamed carrots and rice

After teaching D.B. about dietary modifications, you determine that teaching was effective when he chooses which menu? (ileostomy) A. Baked cod, baked sweet potato, and canned pears B. Barbecued brisket, coleslaw, baked beans, and angel food cake C. Fried shrimp with cocktail sauce, corn on the cob, and a fruit roll-up D. Turkey burger with cheese on a whole wheat bun, french fries, and an orange

A. Baked cod, baked sweet potato, and canned pears

On your nursing care plan for a patient with a urinary tract infection, which of the following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY: A. Encourage voiding every 3-4 hours while awake. B. Restrict fluid intake to 1-2 liters per day. C. Monitor intake and output daily. D. Monitor for symptoms. E. Teach to wipe the perineal area back to front

A. Encourage voiding every 3-4 hours while awake. C. Monitor intake and output daily. D. Monitor for symptoms.

A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness? Antibody to hepatitis D (anti-HDV) Hepatitis B surface antigen (HBsAg) Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG) Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM) *appears during acute phase! Anti-HAV IgG would indicate past infection and lifelong immunity

Which nursing action is essential for a patient immediately after a renal biopsy? Insert a urinary catheter and test urine for microscopic hematuria. Check blood glucose to assess for hyperglycemia or hypoglycemia. Apply a pressure dressing and position the patient on the affected side. Monitor blood urea nitrogen (BUN) and creatinine to assess renal function.

Apply a pressure dressing and position the patient on the affected side. *apply pressure, keep in side for 30-60 mins, splint site. Bed rest for 24 hrs!

How should the nurse prepare a patient with ascites for paracentesis? Place the patient on NPO status. Assist the patient to lie flat in bed. Ask the patient to empty the bladder. Position the patient on the right side.

Ask the patient to empty the bladder.

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? Request that the patient stand on one foot. Ask the patient to extend both arms forward. Request that the patient walk with eyes closed. Ask the patient to perform the Valsalva maneuver.

Ask the patient to extend both arms forward. *check for asterixis (hand tremors)

A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? Teach about a low-residue diet. Monitor output from the stoma. Assess the perineal drainage and incision. Encourage acceptance of the colostomy stoma.

Assess the perineal drainage and incision. *risk for infection highest priority initially

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? Asterixis and lethargy Jaundiced sclera and skin Elevated total bilirubin level Liver 3 cm below costal margin

Asterixis and lethargy

A patient has been diagnosed with urinary tract stones that are high in uric acid. Which foods will the nurse teach the patient to avoid? (Select all that apply.) a. Milk b. Liver c. Spinach d. Chicken e. Cabbage f. Chocolate

B, D

Results of an ERCP reveal that a client's acute pancreatitis is being caused by pancreatic duct obstruction. The nurse teaches the client that the most common cause of this obstruction is which occurrence? A. Edema B. A gallstone C. A stricture D. Severe spasms

B. A gallstone

Postoperatively, a patient with an incisional cholecystectomy has splinted respirations secondary to a high abdominal incision. Which action should the nurse take first? A. Assess heart and lung sounds. B. Administer the prescribed analgesic. C. Position the patient on the operative side. D. Instruct the patient to cough and deep breathe.

B. Administer the prescribed analgesic.- pain management first! *splinted respirations (shallow breathing bc it hurts to breathe)

Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient: A. Encourage the patient to consume clear liquids. B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply. A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficit E. Esophageal varices

B. Ascites C. Splenomegaly E. Esophageal varices

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? A. Thirst B. Fatigue C. Headache D. Abdominal pain

B. Fatigue

The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia. Which laboratory result the nurse should check? Schilling test Bilirubin level Stool occult blood Gastric acid analysis

Bilirubin level

Which finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? Flank tenderness to palpation Blood pressure 90/48 mm Hg Cloudy and foul-smelling urine Temperature 100.1° F (57.8° C)

Blood pressure 90/48 mm Hg *septic shock -other findings normal with UTI

The nurse is caring for a patient who has right renal calculus and indwelling urinary catheter. Which priority finding should the nurse report to the provider? A. Flank pain that radiates to the lower abdomen B. Patient reporting nausea C. Absent urine output for an hour D. Serum WBC count is 15.000/mm3

C. Absent urine output for an hour (WBC will be high, absent urine output is more concerning)

A client who has acute pancreatitis is complaining of pain. Which types of pain would the nurse expect to be the most common for this condition? Select all that apply. A. Slow onset B. Superficial C. Epigastric D. Piercing E. sharp

C. Epigastric D. Piercing E. sharp

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action? Auscultate for hypotonic bowel sounds. Notify the patient's health care provider. Check for tube placement and reposition it. Remove the tube and replace it with a new one.

Check for tube placement and reposition it.

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? Ask the patient about any arm pain. Retake the patient's blood pressure. Check the calcium level in the chart. Notify the health care provider immediately.

Check the calcium level in the chart. *positive Trousseau's sign = hypocalcemia

A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do? Collect a stool specimen. Prepare for colonoscopy. Schedule a barium enema. Have blood cultures drawn.

Collect a stool specimen. *infectious process usually causes diarrhea- check stool for parasites or WBCs

Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? Bladder distention Foul-smelling urine Suprapubic discomfort Costovertebral tenderness

Costovertebral tenderness *other s/s of UPPER UTI

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus? Cullen sign Rovsing sign McBurney sign Grey-Turner's sign

Cullen sign (Grey-Turner's sign = back bruising)

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below BEST demonstrates the medication is working effectively? A. Decrease albumin levels B. Patient is stuporous. D. Decreased ammonia blood level E. Presence of asterixis

D. Decreased ammonia blood level

The nurse is teaching a client is scheduled for ESWL. Which priority statement by the client indicates understanding of the teaching? A. I will be fully awake during the procedure. B. This procedure will reduce chances of having stones in future. C. I will report any bruises D. Straining my urine following the procedure is important.

D. Straining my urine following the procedure is important.

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? Blood in urine Left flank bruising Left flank discomfort Decreased urine output

Decreased urine output *complication is obstruction -other findings expected post procedure

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care? Administer IV metoclopramide (Reglan). Discontinue the patient's oral food intake. Administer cobalamin (vitamin B12) injections. Teach the patient about total colectomy surgery.

Discontinue the patient's oral food intake. *initial therapy = rest bowel by making patient NPO

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect? Hematocrit of 46% Hemoglobin of 13.8 g/dL Elevated reticulocyte count Decreased white blood cell count

Elevated reticulocyte count

The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding should the nurse expect? Cool extremities Pallor and weakness Elevated temperature Low oxygen saturation

Elevated temperature The term "shift to the left" indicates that the number of immature polymorphonuclear neutrophils (bands) is elevated and that finding is a sign of infection

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take? Administer morphine sulfate. Encourage the patient to ambulate. Offer the prescribed promethazine. Instill a mineral oil retention enema.

Encourage the patient to ambulate. Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.

Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? Encourage the patient to express concerns and ask questions about IBS. Suggest that the patient increase the intake of milk and other dairy products. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

Encourage the patient to express concerns and ask questions about IBS. -no milk (yogurt could be helpful) -NSAIDs fine -Alosetron reserved for pts who other drugs don't work for- side effects

A client is diagnosed with pancreatitis. She is obese, has smoked one package of cigarettes a day for the last 40 years, and reports drinking a glass of wine with her evening meal, reports that her gallbladder has bothered her occasionally for the last several years. She asks, "How did I get pancreatitis?" How should the nurse respond? Alcohol abuse is a primary cause of pancreatitis. You are overweight, and that causes most cases of pancreatitis. Gallbladder disease increases your risk for pancreatitis. Smoking puts you at high risk

Gallbladder disease increases your risk for pancreatitis.

A patient with pancytopenia will have a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure? Elevate the head of the bed to 45 degrees. Use a 1/2-in sterile gauze to pack the wound. Have the patient lie on the left side for 1 hour. Apply a sterile 2-in gauze dressing to the site.

Have the patient lie on the left side for 1 hour. *lie still for 30-60 mins post procedure

The nurse is caring for a patient with an indwelling catheter. The patient complains of spasm like pain at the catheter insertion site. Which of the following options below are other signs and symptoms the patient could experience or the nurse could observe if a urinary tract infection was present? SELECT-ALL-THAT-APPLY: Increased WBC Left lower abdominal pain Feeling the need to void even though a catheter is present Dark and cloudy urine Cramping

Increased WBC Feeling the need to void even though a catheter is present Dark and cloudy urine Cramping

Which potential complication should the nurse identify as a high risk for a patient admitted to the hospital with idiopathic aplastic anemia? Seizures Infection Neurogenic shock Pulmonary edema

Infection Because the patient with aplastic anemia has pancytopenia (LOW counts of all 3 blood cells- usually bone marrow problem), the patient is at risk for infection and bleeding.

What action should the nurse take first when a patient's urine dipstick test indicates a small amount of protein? Send a urine specimen to the laboratory to test for ketones. Obtain a clean-catch urine for culture and sensitivity testing. Inquire about which medications the patient is currently taking. Ask the patient about any family history of chronic renal failure.

Inquire about which medications the patient is currently taking.

A hospitalized patient who has possible renal insufficiency after coronary artery bypass surgery will have a creatinine clearance test. Which item will the nurse need to obtain? Urinary catheter Sterile specimen cup Cleansing towelettes Large urine container

Large urine container- 24 hr urine specimen

A patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? Urinary urgency Left-sided flank pain Intermittent hematuria Burning with urination

Left-sided flank pain *may have developed pyelonephritis as a complication

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

Maintaining normal respiratory function (all appropriate, this is highest priority)

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

Mealtime *pancreatic enzymes need to be taken w/ every meal (chronic pancreatitis)

What topic should the nurse plan to teach the patient diagnosed with ACUTE hepatitis B? Administering interferon Side effects of nucleotide analogs Measures for improving appetite Ways to increase activity and exercise

Measures for improving appetite *Maintaining adequate nutritional intake is important for regeneration of hepatocytes. *Rest important

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient? Medication use Fluid restriction Enteral nutrition Activity restrictions

Medication use

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)? Restrict oral fluid intake. Monitor stools for blood. Ambulate six times daily. Increase dietary fiber intake.

Monitor stools for blood. *do NOT restrict oral fluid intake (risk of dehydration), just restrict oral food intake

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? Instruct the patient to cough every hour. Monitor the patient for shortness of breath. Verify the position of the balloon every 4 hours. Deflate the gastric balloon if the patient reports nausea.

Monitor the patient for shortness of breath. *highest risk is aspiration pneumonia

The nurse is caring for a hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care? Monitor the urine output after the procedure. Assist with monitored anesthesia care (MAC). Give oral contrast solution before the procedure. Insert a large size urinary catheter before the IVP.

Monitor the urine output after the procedure. *contrast medium is nephrotoxic

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

Muscle twitching and finger numbness- *hypocalcemia

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of: antibiotics. NPO status antispasmodics. proton pump inhibitors.

NPO status. - pain from acute pancreatitis is aggravated by eating; NPO status will help alleviate pain by decreasing pancreatic secretions

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? Scrambled eggs White toast and jam Oatmeal with cream Pancakes with syrup

Oatmeal with cream *avoid high-fiber, lactose intolerance

A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? Offering the patient a pitcher of water Positioning the patient on the right side Checking the vital signs every 30 minutes Swabbing the patient's mouth with a wet cloth

Offering the patient a pitcher of water *gag reflex

Which menu choice indicates that the patient understands the nurse's recommendations about dietary choices for iron-deficiency anemia? Omelet and whole wheat toast Cantaloupe and cottage cheese Strawberry and banana fruit plate Cornmeal muffin and orange juice

Omelet and whole wheat toast

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

Palpable abdominal mass *sign of pancreatic abscess (complication)

Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine? Take phenazopyridine for at least 7 days. Phenazopyridine may cause photosensitivity. Phenazopyridine may change the urine color. Take phenazopyridine before sexual intercourse.

Phenazopyridine may change the urine color. red/orange color

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first? Place the patient on NPO status. Administer sedative medications. Ensure the consent form is signed. Teach the patient about the procedure.

Place the patient on NPO status.

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care? Restrict daily dietary protein intake. Reposition the patient every 4 hours. Perform passive range of motion twice daily. Place the patient on a pressure-relief mattress.

Place the patient on a pressure-relief mattress. *decrease risk for skin breakdown

What action should the nurse take after assisting with a needle biopsy of the liver at a patient's bedside? Elevate the head of the bed to facilitate breathing. Place the patient on the right side with the bed flat. Check the patient's postbiopsy coagulation studies. Position a sandbag over the liver to provide pressure.

Place the patient on the RIGHT SIDE with the bed flat (has to be splinted for a period of time)

The nurse is caring for a patient with an obstructed common bile duct. What condition should the nurse expect? Melena Steatorrhea Decreased serum cholesterol level Increased serum indirect bilirubin level

Steatorrhea (fatty stools) *bilirubin level will also be increased?

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago? Dry palpebral and oral mucosa Crackles at bilateral lung bases Temperature 100.8° F (38.2° C) No bowel movement for 4 days

Temperature 100.8° F (38.2° C) *Sign of acute graft rejection- immediate intervention required (or infection)

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices? The medication will reduce the risk for aspiration. The medication will inhibit development of gastric ulcers. The medication will prevent irritation of the enlarged veins. The medication will decrease nausea and improve the appetite.

The medication will prevent irritation of the enlarged veins

A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? The patient is very drowsy. The patient reports a sore throat. The oral temperature is 101.4° F. The apical pulse is 100 beats/min.

The oral temperature is 101.4° F. *possible perforation

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? The patient is alert and oriented. The patient denies nausea or anorexia. The patient's bilirubin level decreases. The patient has at least one stool daily.

The patient is alert and oriented. *purpose is to lower ammonia levels and prevent encephalopathy- which DECREASES LOC

A patient gives the admitting nurse health information before a scheduled intravenous pyelogram (IVP). Which item requires the nurse to intervene before the procedure? The patient has not had food or drink for 8 hours. The patient lists allergies to shellfish and penicillin. The patient reports costovertebral angle (CVA) tenderness. The patient used a bisacodyl (Dulcolax) tablet the previous night.

The patient lists allergies to shellfish and penicillin. -IVP uses contrast dye- usually iodine based

When caring for a patient after cystoscopy, what should the nurse include in the plan of care? The patient learns to request narcotics for pain. The patient understands to expect blood-tinged urine. The patient restricts activity to bed rest for 4 to 6 hours. The patient remains NPO for 8 hours to prevent vomiting.

The patient understands to expect blood-tinged urine.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? The patient uses incontinence briefs to contain loose stools. The patient uses witch hazel compresses to soothe irritation. The patient asks for antidiarrheal medication after each stool. The patient cleans the perianal area with soap after each stool.

The patient uses witch hazel compresses to soothe irritation. *perianal area should be washed w/ plain water or pH balanced cleanser

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? The patient reports right upper-quadrant pain with palpation. The patient's hands flap back and forth when the arms are extended. The patient has ascites and a 2-kg weight gain from the previous day. The patient's abdominal skin has multiple spider-shaped blood vessels.

The patient's hands flap back and forth when the arms are extended *asterixis- indicates hepatic encephalopathy (neuro status priority)

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis? The patient's urine is bright yellow. The patient's stools are tan colored. The patient reports chronic heartburn. The patient has increased pain after eating.

The patient's stools are tan colored. *indicates biliary obstruction

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? Restrict fluid intake to prevent constant liquid drainage from the stoma. Use care when eating high-fiber foods to avoid obstruction of the ileum. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. Change the pouch every day to prevent leakage of contents onto the skin.

Use care when eating high-fiber foods to avoid obstruction of the ileum.

A nurse reviews the laboratory data for an older adult. The nurse would be most concerned about which finding? Hematocrit of 35% Hemoglobin of 11.8 g/dL Platelet count of 400,000/μL White blood cell count of 2800/μL

White blood cell count of 2800/μL

The nurse identifies that the patient with the greatest risk for a urinary tract infection is: a 37-year-old man with renal colic associated with kidney stones. a 26-year-old pregnant woman who has a history of urinary tract infections. a 69-year-old man who has urinary retention caused by benign prostatic hyperplasia. a 72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence.

a 72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence.

A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect? a. 2 b. 3 c. 4 d. 5

a. 2 about 500 mL/day

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 *primary lab values that will be ELEVATED in acute pancreatitis- lipase and amylase

A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Question the patient about risk factors for constipation. c. Suggest that the patient incUrease intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

b. Question the patient about risk factors for constipation. *further assess first

The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding will the nurse expect? a. Cool extremities c. Elevated temperature b. Pallor and weakness d. Low oxygen saturation

c. Elevated temperature The term "shift to the left" indicates that the number of immature polymorphonuclear neutrophils (bands) is elevated and that finding is a sign of infection.

The surgical treatment of choice for the patient with symptomatic gallbladder disease is a: cholecystotomy. choledocholithotomy. cholecystoduodenostomy. laparoscopic cholecystectomy

laparoscopic cholecystectomy (minimally invasive)

A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should: -initiate oxygen therapy at 2 L/min to increase gas exchange. -notify the health care provider so that a paracentesis can be performed. -ask the patient to cough and breathe deeply to clear respiratory secretions. -place the patient in Fowler's position to relieve pressure on the diaphragm.

place the patient in Fowler's position to relieve pressure on the diaphragm. - allows for maximal respiratory efficiency

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

sardines and liver. *avoid organ meats, poultry, fish, red wine, + gravy

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? • Lactated Ringer's • 5% dextrose in water • 0.9% sodium chloride • 0.45% sodium chloride

• 0.9% sodium chloride

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply: • A. Thrombocytopenia • B. Vision changes • C. Increased PT/INR • D. Leukopenia

• A. Thrombocytopenia • C. Increased PT/INR • D. Leukopenia

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? • A. Decreased magnesium level • B. Increased calcium level • C. Increased ammonia level • D. Increased creatinine level

• C. Increased ammonia level

A 80 year old female is admitted with confusion and agitation. The family members report that this is not normal behavior for the patient. They explain that the patient is very active in the community and cares for herself. Based on the information you have gathered about the patient, which order takes priority? • Collect a urinalysis • Collect a T3 and T4 level • Insert a Foley Catheter • Keep patient NPO

• Collect a urinalysis

A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient? • Plan for 30 minutes of rest before and after every meal. • Encourage foods high in protein, iron, vitamin C, and folate. • Instruct the patient to select soft, bland, and nonacidic foods. • Give the patient a list of medications that inhibit iron absorption.

• Encourage foods high in protein, iron, vitamin C, and folate.

A client's admitting diagnosis is possible pancreatitis. Which nutrition order would the nurse anticipate for this client? • Regular diet • Clear liquids • NPO • Mechanical soft foods

• NPO