Medical-Surgical NCLEX Practice QUIZ

CHAPTER 42 - PRE-TEST (UPPER GASTROINTESTINAL PROBLEMS)

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CHAPTER 43 - PRE-TEST (LOWER GASTROINTESTINAL PROBLEMS)

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CHAPTER 44 - NCLEX (Liver, Pancreas, and Biliary Tract Problems)

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CHAPTER 44 - PRE-TEST (Liver, Pancreas, and Biliary Tract Problems)

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The patient had a car accident and was "scared to death." The patient is now reporting constipation. What affecting the gastrointestinal (GI) tract does the nurse know could be contributing to the constipation? A. The patient is too nervous to eat or drink, so there is no stool. B. The sympathetic nervous system was activated, so the GI tract was slowed. Correct C. The parasympathetic nervous system is now functioning to slow the GI tract. D. The circulation in the GI system has been increased, so less waste is removed.

- >The constipation is most likely related to the sympathetic nervous system activation from the stress related to the accident. SNS activation can decrease peristalsis. Even without oral intake for a short time, stool will be formed. >The parasympathetic system stimulates peristalsis. >The circulation to the GI system is decreased with stress

A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral nutrition (PN). Which principle should guide the nurse's administration of the patient's nutrition? A. Administration of PN requires clean technique. B. Central PN requires rapid dilution in a large volume of blood. Correct C. Peripheral PN delivery is preferred over the use of a central line. D. Only water-soluble medications may be added to the PN by the nurse.

- >Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is an excellent medium for microbial growth, aseptic technique is necessary during administration. >Administration through a central line is preferred over the use of peripheral PN, and the nurse may not add any medications to PN.

The nurse cares for a 34-year-old woman after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement? A. "A high protein diet that is low in carbohydrates and fat will prevent diarrhea." B. "Food should be high in fiber to prevent constipation from the pain medication." C. "Three meals a day with no snacks between meals will provide optimal nutrition." D. "Fluid intake should be at least 2000 mL per day with meals to avoid dehydration."

- "A high protein diet that is low in carbohydrates and fat will prevent diarrhea." >The diet generally prescribed is high in protein and low in carbohydrates, fat, and roughage and consists of six small feedings daily. > Fluids should not be ingested with the meal, and in some cases, fluids should be restricted to less than 1000 mL per day. >Fluids and foods high in carbohydrate tend to promote diarrhea and symptoms of the dumping syndrome. >Generally, calorically dense foods (foods high in fat) should be avoided to permit more nutritionally sound food to be consumed.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate? A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

- "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure." +Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. +It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. +The hepatitis vaccine is only used for preexposure prophylaxis.

The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective? A. "It is safe to take acetaminophen up to four times a day for pain." B. "Lactulose (Cephulac) should be taken every day to prevent constipation." C. "Herbs and other spices should be used to season my foods instead of salt." D. "I will eat foods high in potassium while taking spironolactone (Aldactone)."

- "Herbs and other spices should be used to season my foods instead of salt." +A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. +Table salt is a well-known source of sodium and should be avoided. +Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. +Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided as these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. +Spironolactone is a potassium-sparing diuretic. +Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.

When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching? A. "I will be able to regulate when I have stools." B. "I will be able to wear the pouch until it leaks." C. "Dried fruit and popcorn must be chewed very well." D. "The drainage from my stoma can damage my skin."

- "I will be able to regulate when I have stools." +The ileostomy is in the ileum and drains liquid stool frequently, unlike the colostomy which has more formed stool the further distal the ostomy is in the colon. +The ileostomy pouch is usually worn 4-7 days or until it leaks. +It must be changed immediately if it leaks because the drainage is very irritating to the skin. +To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient makes which statement? A. "I plan to lose 4 lb a week until I have lost the 60-pound goal." B. "I will keep a diary of weekly weights to illustrate my weight loss." C. "I will restrict my carbohydrate intake to less than 30 g/day to maximize weight loss." D. "I should not exercise more than my program requires since increased activity increases the appetite."

- "I will keep a diary of weekly weights to illustrate my weight loss." >The patient should monitor and record weight once per week. >This prevents frustration at the normal variations in daily weights and may help the patient to maintain motivation to stay on the prescribed diet. >Weight loss should occur at a rate of 1 to 2 lb/week. >The diet should be well balanced rather than lacking in specific components that may cause an initial weight loss but is not usually sustainable. >Exercise is a necessary component of any successful weight loss program.

The nurse is caring for a patient who is 5'6" tall and weighs 186 lb. The nurse has discussed reasonable weight loss goals and a low-calorie diet with the patient. Which statement made by the patient indicates a need for further teaching? A. "I will limit intake to 500 calories a day." B. "I will try to eat very slowly during mealtimes." C. "I'll try to pick foods from all of the basic food groups." D. "It's important for me to begin a regular exercise program."

- "I will limit intake to 500 calories a day." >Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie energy restriction would place this patient at risk for multiple nutrient deficiencies. >Decreasing caloric intake at least 500 to 1000 calories a day is recommended for weight loss of one to two pounds per week. >The other options show understanding of the teaching.

When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement? A. "I will use care when kissing my wife to prevent giving it to her." B. "I will need to take adofevir (Hepsera) to prevent chronic HCV." C. "Now that I have had HCV, I will have immunity and not get it again." D. "I will need to be checked for chronic HCV and other liver problems."

- "I will need to be checked for chronic HCV and other liver problems." +The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. +HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. +The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with liver failure. +Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected with another type of HCV.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? A. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." B. "I need to take good care of my belly and ankle skin where it is swollen." C. "A scrotal support may be more comfortable when I have scrotal edema." D. "I can use pillows to support my head to help me breathe when I am in bed."

- "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." +If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, as this is not normal for cirrhosis. +Edematous tissue is subject to breakdown and needs meticulous skin care. +Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency. +A scrotal support may improve comfort if there is scrotal edema.

At the first visit to the clinic, the female patient with a BMI of 29 kg/m2 tells the nurse that she does not want to become obese. Which question used for assessing weight issues is the most important question for the nurse to ask? A. "What factors contributed to your current body weight?" B. "How is your overall health affected by your body weight?" C. "What is your history of gaining weight and losing weight?" D. "In what ways are you interested in managing your weight differently?"

- "In what ways are you interested in managing your weight differently?" >Asking the patient about her desire to manage her weight in a different manner helps the nurse determine the patient's readiness for learning, degree of motivation, and willingness to change lifestyle habits. >The nurse can help the patient set realistic goals. >This question will also lead to discussing the patient's history of gaining and losing weight and factors that have contributed to the patient's current weight. >The patient may be unaware of the overall health effects of her body weight, so this question is not helpful at this time.

A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement? A. "I am allergic to bee stings." B. "My tongue swells when I eat shrimp." C. "I have had epigastric pain for 2 months." D. "I have a pacemaker because my heart rate was slow."

- "My tongue swells when I eat shrimp." >The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium. Having a pacemaker will not affect the patient during this procedure. It would be expected that the patient would have some epigastric pain given the patient's condition.

The nurse teaches senior citizens at a community center how to prevent food poisoning at their informal social events. The nurse determines that teaching is successful if a community member makes which statement? A. "Pasteurized juices and milk are safe to drink." B. "Alfalfa sprouts are safe if rinsed before eating." C. "Fresh fruits do not need to be washed before eating." D. "Ground beef is safe to eat if cooked until it is brown."

- "Pasteurized juices and milk are safe to drink." +Drink only pasteurized milk, juice, or cider. +Ground beef should be cooked thoroughly. +Browned meat can still harbor live bacteria. +Cook ground beef until a thermometer reads at least 160° F. If a thermometer is unavailable, decrease risk of illness by cooking the ground beef until there is no pink color in the middle. +Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. +Persons who are immunocompromised or older should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured.

The nurse instructs an obese 22-year-old man with a sedentary job about the health benefits of an exercise program. The nurse evaluates that teaching is effective when the patient makes which statement? A. "The goal is to walk at least 10,000 steps every day of the week." B. "Weekend aerobics for 2 hours is better than exercising every day." C. "Aerobic exercise will increase my appetite and result in weight gain." D. "Exercise causes weight loss by decreasing my resting metabolic rate."

- "The goal is to walk at least 10,000 steps every day of the week." >A realistic activity goal is to walk 10,000 steps a day. Increased activity does not promote an increase in appetite or lead to weight gain. >Exercise should be done daily, preferably 30 minutes to an hour a day. Exercise increases metabolic rate.

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions? A. "This medication will help me digest fats and fat-soluble vitamins." B. "I will apply the medicated lotion sparingly to the areas where I itch." C. "The medication is a powder and needs to be mixed with milk or juice." D. "I should take this medication on an empty stomach at the same time each day."

- "The medication is a powder and needs to be mixed with milk or juice." +For treatment of pruritus, cholestyramine may provide relief. +This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. +Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.

The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? A. "The tube will help to drain the stomach contents and prevent further vomiting." B. "The tube will push past the area that is blocked and thus help to stop the vomiting." C. "The tube is just a standard procedure before many types of surgery to the abdomen." D. "The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best."

- "The tube will help to drain the stomach contents and prevent further vomiting." +The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. +The NG tube will not push past the blocked area. +Potential surgery is not currently indicated. +The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

The severely obese patient has elected to have the Roux-en-Y gastric bypass (RYGB) procedure. The nurse will know the patient understands the preoperative teaching when the patient makes which statement? A. "This surgery will preserve the function of my stomach." B. "This surgery will remove the fat cells from my abdomen." C. "This surgery can be modified whenever I need it to be changed." D. "This surgery decreases how much I can eat and how many calories I can absorb."

- "This surgery decreases how much I can eat and how many calories I can absorb." >The RYGB decreases the size of the stomach to a gastric pouch and attaches it directly to the small intestine so food bypasses 90% of the stomach, the duodenum, and a small segment of the jejunum. >The vertical sleeve gastrectomy removes 85% of the stomach, but preserves the function of the stomach. >Lipectomy and liposuction remove fat tissue from the abdomen or other areas. >Adjustable gastric banding can be modified or reversed at a later date.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate? A. "This will prevent air from accumulating in the stomach, causing gas pains." B. "This will prevent the heartburn that occurs as a side effect of general anesthesia." C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

- "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again." +Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. +Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse is teaching a group of high school students about the prevention of food poisoning. Which comment by the student shows understanding of foodborne illness protection? A. "We like to mix up the ingredients so the flavors will melt before we cook our beef stew." B. "For a snack, I like to eat raw cookie dough from the package instead of baking the cookies." C. "We only have one cutting board, so we cut up our chicken and salad vegetables at the same time." D. "When they gave me a pink hamburger I sent it back and asked for a new bun and clean plate."

- "When they gave me a pink hamburger I sent it back and asked for a new bun and clean plate." +The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the pink meat may not have reached 160° and could be contaminated with bacteria. +Mixing ingredients and leaving them long enough for the flavors to melt, eating raw cookie dough from a refrigerated package, and only using one cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to food poisoning from contamination.

CHAPTER 43 - NCLEX (LOWER GASTROINTESTINAL PROBLEMS)

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A patient who is given a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which time frame after administration? A. 2-5 minutes B. 15-60 minutes C. 2-4 hours D. 6-8 hours

- 15-60 minutes +Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

In developing a weight reduction program with a 45-year-old female patient who weighs 197 lb, the nurse encourages the patient to set a weight loss goal of how many pounds in 4 weeks? A. 1-2 B. 3-5 C. 4-8 D. 5-10

- 4-8 >A realistic weight loss goal for patients is 1 to 2 lb/wk, which prevents the patient from becoming frustrated at not meeting weight loss goals.

The nurse is caring for a patient admitted to the hospital for asthma who weighs 186 lb (84.5 kg). During dietary counseling, the patient asks the nurse how much protein he should ingest each day. How many grams of protein does the nurse recommend should be included in the diet based on the patient's current weight? A. 24 B. 41 C. 68 D. 93

- 68 >The daily intake of protein should be between 0.8 and 1 g/kg of body weight. Thus this patient should take in between 68 and 84 g of protein per day in the diet.

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM

- 8:00 AM, 12:00 PM, and 4:00 PM +A nasogastric tube should be checked for patency routinely at 4-hour intervals. +Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

The nurse identifies that which patient is at highest risk for developing colon cancer? A. A 28-year-old male who has a body mass index of 27 kg/m2 B. A 32-year-old female with a 12-year history of ulcerative colitis C. A 52-year-old male who has followed a vegetarian diet for 24 years D. A 58-year-old female taking prescribed estrogen replacement therapy

- A 32-year-old female with a 12-year history of ulcerative colitis +Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index ≥ 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, hereditary nonpolyposis colorectal cancer syndrome; red meat (=7 servings/week); cigarette use; and alcohol (=4 drinks/week).

Which patients would be at highest risk for developing oral candidiasis? A. A 74-year-old patient who has vitamin B and C deficiencies B. A 22-year-old patient who smokes 2 packs of cigarettes per day C. A 58-year-old patient who is receiving amphotericin B for 2 days D. A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks

- A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks +Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. +Amphotericin B is used to treat candidiasis. +Vitamin B and C deficiencies are rare but may lead to Vincent's infection. +Use of tobacco products leads to stomatitis.

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer? A. A 38-year-old Hispanic female who is obese and has hyperinsulinemia B. A 23-year-old who has cystic fibrosis-related pancreatic enzyme insufficiency C. A 72-year-old African American male who has smoked cigarettes for 50 years D. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus

- A 72-year-old African American male who has smoked cigarettes for 50 years +Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and exposure to chemicals such as benzidine. +African Americans have a higher incidence of pancreatic cancer than whites. +The most firmly established environmental risk factor is cigarette smoking. +Smokers are two or three times more likely to develop pancreatic cancer as compared with nonsmokers. +The risk is related to duration and number of cigarettes smoked.

The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobin (IG) injection? A. A caregiver who lives in the same household with the patient B. A friend who delivers meals to the patient and family each week C. A relative with a history of hepatitis A who visits the patient daily D. A child living in the home who received the hepatitis A vaccine 3 months ago

- A caregiver who lives in the same household with the patient +IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or foodborne exposure. +Persons who have received a dose of HAV vaccine more than 1 month previously or who have a history of HAV infection do not require IG.

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. A lower-fat diet may be better tolerated for several weeks. B. Do not return to work or normal activities for 3 weeks. C. Bile-colored drainage will probably drain from the incision. D. Keep the bandages on and the puncture site dry until it heals.

- A lower-fat diet may be better tolerated for several weeks. +Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery. +Normal activities can be gradually resumed as the patient tolerates. +Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. +The bandage may be removed the day after surgery, and the patient can shower.

A 58-year-old woman is being discharged home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A. A nursing assistant on the unit who also has hospice experience B. A licensed practical nurse who has worked on the unit for 10 years C. A registered nurse with 6 months of experience on the surgical unit D. A registered nurse who has floated to the surgical unit from pediatrics

- A registered nurse with 6 months of experience on the surgical unit +The patient needs ostomy care directions/reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. +Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status? A. Ingestion B. Digestion C. Absorption D. Elimination

- Absorption >Substances that interface with the absorptive surfaces of the GI tract (primarily in the small intestine) diffuse across the intestinal membranes into intestinal capillaries and are then carried to other parts of the body for use in energy production. >The cardiac output provides the blood flow for this absorption of nutrients to occur.

The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity? A. Nitroglycerin B. Digoxin (Lanoxin) C. Ciprofloxacin (Cipro) D. Acetaminophen (Tylenol)

- Acetaminophen (Tylenol) >Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) may be hepatotoxic.

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy? A. Low-grade fever of 100° F and dehydration B. Abscess in the right upper quadrant of the abdomen C. Activated partial thromboplastin time (aPTT) of 54 seconds D. Multiple obstructions in the cystic and common bile duct

- Activated partial thromboplastin time (aPTT) of 54 seconds +An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. +Fluids can be given to eliminate the dehydration; the abscess can be assessed, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.

The stable patient has a gastrostomy tube for enteral feeding. Which care could the RN delegate to the LPN (select all that apply)? A. Administer bolus or continuous feedings. Correct B. Evaluate the nutritional status of the patient. C. Administer medications through the gastrostomy tube. D. Monitor for complications related to the tube and enteral feeding. E. Teach the caregiver about feeding via the gastrostomy tube at home.

- Administer medications through the gastrostomy tube. >For the stable patient, the LPN can administer bolus or continuous feedings and administer medications through the gastrostomy. >The RN must evaluate the nutritional status of the patient, monitor for complications related to the tube and the enteral feeding, and teach the caregiver about feeding via the gastrostomy tube at home.

The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take? A. Administer the medication subcutaneously for fast absorption. B. Administer the medication into an arterial line to prevent extravasation. C. Administer the medication deep into the muscle to prevent tissue damage. D. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.

- Administer the medication deep into the muscle to prevent tissue damage. +Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. +Deep muscle injection is the preferred route of injection administration. +This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. +When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.

A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient? A. Instruction on irrigating a colostomy B. Administration of a cleansing enema C. A high-fiber diet the day before surgery D. Administration of IV antibiotics for bowel preparation

- Administration of a cleansing enema +Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. +Instructions to irrigate the colostomy will be done postoperatively. +Oral antibiotics are given preoperatively, and an IV antibiotic may be used in the OR. +A clear liquid diet will be used the day before surgery with the bowel cleansing.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings? A. Malnutrition B. Osteomyelitis C. Alcohol abuse D. Diabetes mellitus

- Alcohol abuse +The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.

The nurse is reviewing the laboratory test results for a 71-year-old patient with metastatic lung cancer. The patient was admitted with a diagnosis of malnutrition. The serum albumin level is 4.0 g/dL, and prealbumin is 10 mg/dL. What should this indicate to the nurse? A. The albumin level is normal, and therefore the patient does not have protein malnutrition. B. The albumin level is increased, which is a common finding in patients with cancer who have malnutrition. C. Both the serum albumin and prealbumin levels are reduced, consistent with the admitting diagnosis of malnutrition. D. Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status.

- Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status. >Prealbumin has a half-life of 2 days and is a better indicator of recent or current nutritional status. >Serum albumin has a half-life of approximately 20 to 22 days. The serum level may lag behind actual protein changes by more than 2 weeks and is therefore not a good indicator of acute changes in nutritional status.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

- Antibiotic(s), proton pump inhibitor, and bismuth +To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The nurse cares for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention? A. Offer the patient a herbal supplement such as ginseng. B. Apply a cool washcloth to the forehead and provide mouth care. C. Take the patient for a walk in the hallway to promote peristalsis. D. Discontinue any medications that may cause nausea or vomiting.

- Apply a cool washcloth to the forehead and provide mouth care. +Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. +Ginseng is not used to treat postoperative nausea and vomiting. +Unnecessary activity should be avoided. +The patient should rest in a quiet environment. +Medications may be temporarily withheld until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.

When assessing a patient's abdomen, what would be most appropriate for the nurse to do? A. Palpate the abdomen before auscultation. B. Percuss the abdomen before auscultation. C. Auscultate the abdomen before palpation. D. Perform deep palpation before light palpation.

- Auscultate the abdomen before palpation. >During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.

A community health nurse is conducting an initial assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome (select all that apply)? A. Blood pressure B. Resting heart rate C. Physical endurance D. Waist circumference E. Fasting blood glucose

- Blood pressure - Waist circumference - Fasting blood glucose >The diagnostic criteria for metabolic syndrome include elevated blood pressure, fasting blood glucose, waist circumference, triglycerides, and HDL cholesterol. >Resting heart rate and physical endurance are not part of the diagnostic criteria.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)? A. Restricted to rectum B. Strictures are common. C. Bloody, diarrhea stools D. Cramping abdominal pain E. Lesions penetrate intestine.

- Bloody, diarrhea stools - Cramping abdominal pain +Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. +Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. +Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? A. Spiral CT scan B. A PET/CT scan C. Abdominal ultrasound D. Cancer-associated antigen 19-9

- Cancer-associated antigen 19-9 +The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment. +Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, this test and the PET/CT scan or abdominal ultrasound do not provide additional information.

Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What is the most likely etiology for this abnormal assessment finding? A. Herpesvirus B. Candida albicans C. Vitamin deficiency D. Irritation from ill-fitting dentures

- Candida albicans >White, curd-like lesions surrounded by erythematous mucosa are associated with oral candidiasis. Herpesvirus causes benign vesicular lesions in the mouth. Vitamin deficiencies may cause a reddened, ulcerated, swollen tongue. Irritation from ill-fitting dentures will cause friable, edematous, painful, bleeding gingivae.

A 22-year-old female is admitted with anorexia nervosa and a serum potassium level of 2.4 mEq/L. What complication is most important for the nurse to observe for in this patient? A. Muscle weakness B. Cardiac dysrhythmias C. Increased urine output D. Anemia and leukopenia

- Cardiac dysrhythmias >A serum potassium level less than 2.5 mEq/L indicates severe hypokalemia, which can lead to life-threatening cardiac dysrhythmias (e.g., bradycardia, tachycardia, ventricular dysrhythmias). Other manifestations of potassium deficiency include muscle weakness and renal failure. Patients with anorexia nervosa commonly have iron-deficiency anemia and an elevated blood urea nitrogen level related to intravascular volume depletion and abnormal renal function.

The nurse is preparing to administer a scheduled dose of docusate sodium (Colace) when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? A. Write an incident report about this untoward event. B. Attempt to have the family convince the patient to take the ordered dose. C. Withhold the medication at this time and try to administer it later in the day. D. Chart the dose as not given on the medical record and explain in the nursing progress notes.

- Chart the dose as not given on the medical record and explain in the nursing progress notes. +Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. +In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

The patient has parenteral nutrition infusing with amino acids and dextrose. In report, the oncoming nurse is told that the tubing, the bag, and the dressing were changed 22 hours ago. What care should the nurse coming on be prepared to do (select all that apply)? A. Give the patient insulin. B. Check amount of feeding left in the bag. Correct C. Check that the next bag has been ordered. Correct D. Check the insertion site and change the tubing. E. Check the label to ensure ingredients and solution are as ordered.

- Check the label to ensure ingredients and solution are as ordered. >The nurse should check the amount of feeding left in the bag, and that the next bag has been ordered to be sure the solution will not run out before the next bag is available. >Parenteral nutrition solutions are only good for 24 hours and usually take some time for the pharmacy to mix for each patient. >The label on the bag should be checked to ensure that the ingredients and solution are what was ordered. >The patient would only receive insulin if the patient is experiencing hyperglycemia and was receiving sliding scale insulin or had diabetes mellitus. >The insertion site should be checked, but the tubing is only changed every 72 hours unless lipids are being used.

The nurse is teaching a female patient with type 1 diabetes mellitus about nutrition before discharge. She had surgery to revise a lower leg stump with a skin graft. What food should the nurse teach the patient to eat to best facilitate healing? A. Non-fat milk B. Chicken breast C. Fortified oatmeal D. Olive oil and nuts

- Chicken breast >High quality protein such as chicken breast is important for tissue repair. Although the non-fat milk, nuts, and fortified oatmeal have some protein, they do not have as much as the chicken breast.

When the nurse identifies an individual at risk for malnutrition with nutritional screening, what is the next step for the nurse to take? A. Supply supplements between meals. B. Encourage eating meals with others. C. Have family bring in food from home. D. Complete a full nutritional assessment.

- Complete a full nutritional assessment. >A full nutritional assessment includes history and physical examination and laboratory data. >The nutritional assessment will need to be done to provide the basis for nutrition intervention. >The interventions may include supplements if ordered, family bringing food from home, and socializing with meals.

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? A. Prevent all oral intake. B. Control abdominal pain. C. Provide enteral feedings. D. Avoid dietary cholesterol.

- Control abdominal pain +Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. +NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. +Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis.

The nurse teaches a 50-year-old woman who has a body mass index (BMI) of 39 kg/m2 about weight loss. Which dietary change would be appropriate for the nurse to recommend to this patient? A. Decrease fat intake and control portion size B. Increase vegetables and decrease fluid intake C. Increase protein intake and avoid carbohydrates D. Decrease complex carbohydrates and limit fiber

- Decrease fat intake and control portion size >The safest dietary guideline for weight loss is to decrease caloric intake by maintaining a balance of nutrients and adequate hydration while controlling portion size and decreasing fat intake.

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what? A. Relief of constipation B. Relief of abdominal pain C. Decreased liver enzymes D. Decreased ammonia levels

- Decreased ammonia levels +Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. +Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.

The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? A. Ask family members whether they have discussed the surgical procedure with the physician. B. Have the patient sign the form and state the physician will visit to explain the procedure before surgery. C. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. D. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

- Delay the patient's signature on the consent and notify the physician about the conversation with the patient. +The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. +The nurse should notify the physician, who has the responsibility for obtaining consent.

The nurse should recognize that the liver performs which functions (select all that apply)? A. Bile storage B. Detoxification C. Protein metabolism D. Steroid metabolism E. Red blood cell (RBC) destruction

- Detoxification - Protein metabolism - Steroid metabolism >The liver performs multiple major functions that aid in the maintenance of homeostasis. These include metabolism of proteins and steroids as well as detoxification of drugs and metabolic waste products. The Kupffer cells of the liver participate in the breakdown of old RBCs. The liver produces bile, but storage occurs in the gall bladder.

The nurse is admitting a 68-year-old man with severe dehydration and frequent watery diarrhea. He just completed a 10-day outpatient course of antibiotic therapy for bacterial pneumonia. It is most important for the nurse to take which action? A. Wear a mask to prevent transmission of infection. B. Wipe equipment with ammonia-based disinfectant. C. Instruct visitors to use the alcohol-based hand sanitizer. D. Don gloves and gown before entering the patient's room.

- Don gloves and gown before entering the patient's room. +Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. +Patients with suspected or confirmed infection with C. difficile should be placed in a private room and gloves and gowns should be worn by visitors and health care providers. +Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all of the spores. +Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? A. White bread, cheese, and green beans B. Fresh tomatoes, pears, and corn flakes C. Oranges, baked potatoes, and raw carrots D. Dried beans, All Bran (100%) cereal, and raspberries

- Dried beans, All Bran (100%) cereal, and raspberries +A high fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots. Awarded 0.0 points out of 1.0 possible points.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

- Drowsiness +Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. +Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice does the nurse understand would be most appropriate? A. Iced tea B. Dry toast C. Hot coffee D. Plain hamburger

- Dry toast +Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. +Water is the initial fluid of choice. +Extremely hot or cold liquids and fatty foods are generally not well tolerated.

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating? A. Malnutrition B. Bile reflux gastritis C. Dumping syndrome D. Postprandial hypoglycemia

- Dumping syndrome +After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. +Malnutrition may occur but does not cause these symptoms. +Bile reflux gastritis cannot happen when the stomach has been removed. +Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating? A. Malnutrition B. Bile reflux gastritis C. Dumping syndrome D. Postprandial hypoglycemia

- Dumping syndrome +After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. +Malnutrition may occur but does not cause these symptoms. +Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

A patient who is scheduled for surgery with general anesthesia in 1 hour is observed with a moist, but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water? A. Flat abdomen without movement upon inspection B. Tenderness at left upper quadrant upon palpation C. Easily heard, loud gurgling in the right upper quadrant D. High-pitched, hollow sounds in the left upper quadrant

- Easily heard, loud gurgling in the right upper quadrant >If the patient drank water on an empty stomach, gurgling can be assessed without a stethoscope or assessed with auscultation. >High-pitched, hollow sounds are tympanic and indicate an empty cavity. >A flat abdomen and tenderness do not indicate that the patient drank a glass of water.

Which assessment should the nurse prioritize in the care of a patient who has recently begun receiving parenteral nutrition (PN)? A. Skin integrity and bowel sounds B. Electrolyte levels and daily weights C. Auscultation of the chest and tests of blood coagulability D. Peripheral vascular assessment and level of consciousness (LOC)

- Electrolyte levels and daily weights >The use of PN necessitates frequent and thorough assessments. >Key focuses of these assessments include daily weights and close monitoring of electrolyte levels. >Assessments of bowel sounds, integument, peripheral vascular system, LOC, chest sounds, and blood coagulation may be variously performed, but close monitoring of fluid and electrolyte balance supersedes these in importance.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? A. Barium swallow B. Endoscopic biopsy C. Capsule endoscopy D. Endoscopic ultrasonography

- Endoscopic biopsy +Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. +A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. +An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. +A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.

When preparing a patient for a capsule endoscopy study, what should the nurse do? A. Ensure the patient understands the required bowel preparation. B. Have the patient return to the procedure room for removal of the capsule. C. Teach the patient to maintain a clear liquid diet throughout the procedure. D. Explain to the patient that conscious sedation will be used during placement of the capsule.

- Ensure the patient understands the required bowel preparation. >A capsule endoscopy study involves the patient performing a bowel prep to cleanse the bowel before swallowing the capsule. >The patient will be on a clear liquid diet for 1 to 2 days before the procedure and will remain NPO for 4 to 6 hours after swallowing the capsule. >The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? A. Nausea B. Belching C. Epigastric pain D. Difficulty swallowing

- Epigastric pain +Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. +Famotidine is not indicated for nausea, belching, and dysphagia.

A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first? A. Fecal impaction B. Perineal hygiene C. Dietary fiber intake D. Antidiarrheal agent use

- Fecal impaction +Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. +Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

Which patient has the highest morbidity risk? A. Male 6 ft. 1 in. tall, BMI 29 kg/m2 B. Female 5 ft. 6 in. tall, weight 150 lb. C. Male with waist circumference 46 in. D. Female 5 ft. 10 in. tall, obesity Class III

- Female 5 ft. 10 in. tall, obesity Class III >The patient in Class III obesity has the highest risk for disease because Class III denotes severe obesity or a BMI greater than 40 kg/m2. >The patient with waist circumference 46 in. has a high risk for disease, but without the BMI or obesity class, a more precise determination cannot be made. >The female who is 5 ft. 6 in. tall has a normal weight for her height. >The male patient who is over 6 ft. tall is overweight, which increases his risk of disease, but a more precise determination cannot be made without the waist circumference.

A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately? A. Fever and abdominal pain B. Flatulence and liquid stool C. Loudly audible bowel sounds D. Sleepiness and abdominal cramps

- Fever and abdominal pain >The patient should be taught to observe for signs of rectal bleeding and peritonitis. >Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.

A 20-year-old man is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? A. Nausea and vomiting B. Hyperactive bowel sounds C. Firmly distended abdomen D. Abrasions on all extremities

- Firmly distended abdomen +Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

A patient who has dysphagia as a consequence of a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into this patient's care? A. Flush the tube with 30 mL of normal saline every 4 hours. B. Flush the tube before and after feedings if the patient's feedings are intermittent. C. Flush the PEG with 100 mL of sterile water before and after medication administration. D. To prevent fluid overload, avoid flushing when the patient is receiving continuous feeding.

- Flush the tube before and after feedings if the patient's feedings are intermittent. >The nurse should flush feeding tubes with 30 mL of water (not normal saline) every 4 hours and before and after medication administration during continuous feeding or before and after intermittent feeding. >Flushes of 100 mL are excessive and may cause fluid overload in the patient.

A patient had a stomach resection for stomach cancer. The nurse should teach the patient about the loss of the hormone that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Which hormone will be decreased with a gastric resection? A. Gastrin B. Secretin C. Cholecystokinin D. Gastric inhibitory peptide

- Gastrin >Gastrin is the hormone activated in the stomach (and duodenal mucosa) by stomach distention that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. >Secretin inhibits gastric motility and acid secretion and stimulates pancreatic bicarbonate secretion. >Cholecystokinin allows increased flow of bile into the duodenum and release of pancreatic digestive enzymes. >Gastric inhibitory peptide inhibits gastric acid secretion and motility.

The patient being admitted has been diagnosed with anorexia nervosa. What clinical manifestations should the nurse expect to see on admission assessment? A. Tan skin, blonde hair, and diarrhea B. Sensitivity to heat, fatigue, and polycythemia C. Dysmenorrhea, gastric ulcer pain, and hunger D. Hair loss; dry, yellowish skin; and constipation

- Hair loss; dry, yellowish skin; and constipation >The patient with anorexia nervosa, along with abnormal weight loss, is likely to have hair loss; dry, yellow skin; constipation; sensitivity to cold, and absent or irregular menstruation. >Other signs of malnutrition are also noted during physical examination.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? A. Keep the patient NPO. B. Put the bed in the Trendelenberg position. C. Have the patient eat 4 to 6 smaller meals each day. D. Give various antacids to determine which one works for the patient.

- Have the patient eat 4 to 6 smaller meals each day. +Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. +Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. +Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain

- Heartburn +Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. +Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer? A. Serum α-fetoprotein level B. Ventilation/perfusion scan C. Hepatic structure ultrasound D. Abdominal girth measurement

- Hepatic structure ultrasound +Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer. +Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. +Ventilation/perfusion scans do not diagnose liver cancer. +Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction

- High-pitched and hyperactive above the area of obstruction +Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling" above the level of the obstruction. +This occurs because peristaltic action increases to "push past" the area of obstruction. +As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient? A. Tympany to abdominal percussion B. Aortic pulsation visible in epigastric region C. High-pitched sounds on abdominal auscultation D. Liver border palpable 1 cm below the right costal margin

- High-pitched sounds on abdominal auscultation >The bowel sounds are more high pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. >Bowel sounds may also be diminished or absent with an intestinal obstruction. >Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

- History of colorectal polyps +A history of colorectal polyps places this patient at risk for colorectal cancer. +This tissue can degenerate over time and become malignant. +Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy? A. How to care for the wound B. How to deep breathe and cough C. The location and care of drains after surgery D. Which medications will be used during surgery

- How to deep breathe and cough +Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. +Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. +Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. +Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications? A. Tramadol (Ultram) B. Hydromorphone (Dilaudid) C. Oxycodone with aspirin (Percodan) D. Hydrocodone with acetaminophen (Vicodin)

- Hydrocodone with acetaminophen (Vicodin) +The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. +Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way? A. Increases bulk in the stool B. Lubricates the intestinal tract to soften feces C. Increases fluid retention in the intestinal tract D. Increases peristalsis by stimulating nerves in the colon wall

- Increases peristalsis by stimulating nerves in the colon wall +Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. +It is available in oral and suppository forms. +Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? A. Impaired skin integrity related to edema, ascites, and pruritus B. Imbalanced nutrition: less than body requirements related to anorexia C. Excess fluid volume related to portal hypertension and hyperaldosteronism D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

- Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume +Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care? A. Immediately start enteral feeding to prevent malnutrition. B. Insert an NG and maintain NPO status to allow pancreas to rest. C. Initiate early prophylactic antibiotic therapy to prevent infection. D. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

- Insert an NG and maintain NPO status to allow pancreas to rest. +Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. +The pain will be treated with IV morphine because of the NPO status. +Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit? A. Hematochezia B. Left upper abdominal pain C. Ascites and peripheral edema D. Temperature over 102o F (38.9o C)

- Left upper abdominal pain +Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. +Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. +Abdominal tenderness with muscle guarding is common. +Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. . +Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. +Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).

The nurse would question the use of which cathartic agent in a patient with renal insufficiency? A. Bisacodyl (Dulcolax) B. Lubiprostone (Amitiza) C. Cascara sagrada (Senekot) D. Magnesium hydroxide (Milk of Magnesia)

- Magnesium hydroxide (Milk of Magnesia) +Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. +The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? A. Maintain a high intake of fluid and fiber in the diet. B. Reduce intake of medications causing constipation. C. Eat several small meals per day to maintain bowel motility. D. Sit upright during meals to increase bowel motility by gravity.

- Maintain a high intake of fluid and fiber in the diet. +Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. +Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be reduced. +Other medications may decrease constipation, but it is best to avoid laxatives. +Eating several small meals per day and position do not facilitate bowel motility. +Defecation is easiest when the person sits on the commode with the knees higher than the hips.

After an abdominal hysterectomy, a 45-year-old woman complains of severe gas pains. Her abdomen is distended. It is most appropriate for the nurse to administer which prescribed medication? A. Morphine sulfate B. Ondansetron (Zofran) C. Acetaminophen (Tylenol) D. Metoclopramide (Reglan)

- Metoclopramide (Reglan) +Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. +Early ambulation helps restore peristalsis and eliminate flatus and gas pain. +Medications used to reduce gas pain include metoclopramide (Reglan) or alvimopan (Entereg) to stimulate peristalsis.

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? A. Milk thistle may affect liver enzymes and thus alter drug metabolism. B. Milk thistle is generally safe in recommended doses for up to 10 years. C. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. D. Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

- Milk thistle may affect liver enzymes and thus alter drug metabolism. +There is good scientific evidence that there is no real benefit from using milk thistle to protect the liver cells from toxic damage in the treatment of cirrhosis. +Milk thistle does affect liver enzymes and thus could alter drug metabolism. . +Therefore patients will need to be monitored for drug interactions. It is noted to be safe for up to 6 years, not 10 years, and it may lower, not elevate, blood glucose levels.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? A. Turn, deep breathe, cough, and use spirometer every 4 hours. B. Maintain an upright position for at least 2 hours after eating. C. NG will have bloody drainage, and it should not be repositioned. D. Keep in a supine position to prevent movement of the anastomosis.

- NG will have bloody drainage, and it should not be repositioned. +The patient will have bloody drainage from the NG tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. +Turning and deep breathing will be done every 2 hours, and the spirometer will be used more often than every 4 hours. +Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. +The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical record? A. Abdominal pain and bloating B. No bowel movement for 3 days C. A decrease in appetite by 50% over 24 hours D. Muscle tremors and other signs of hypomagnesemia.

- No bowel movement for 3 days +MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. +This medication would benefit the patient who has not had a bowel movement for 3 days. +MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

A frail 74-year-old man with recent severe weight loss is instructed to eat a high-protein, high-calorie diet at home. If the man likes all of the items below, which would be the most appropriate for the nurse to suggest? A. Orange juice and dry toast B. Oatmeal, butter, and cream C. Steamed carrots and chicken broth D. Banana and unsweetened applesauce

- Oatmeal, butter, and cream >Oatmeal, butter, and cream are examples of food items that would be appropriate to include for a patient on a high-protein, high-calorie diet.

A 74-year-old female patient with gastroesophageal reflux disease (GERD) takes over-the-counter medications. For which medication, if taken long-term, should the nurse teach about an increased risk of fractures? A. Sucralfate (Carafate) B. Cimetidine (Tagamet) C. Omeprazole (Prilosec) D. Metoclopramide (Reglan)

- Omeprazole (Prilosec) +There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. +Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. +Lower doses or shorter duration of therapy should be considered.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? A. Morphine sulfate B. Zolpidem (Ambien) C. Ondansetron (Zofran) D. Dexamethasone (Decadron)

- Ondansetron (Zofran) > Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. +Morphine sulfate may cause nausea and vomiting. +Zolpidem does not relieve nausea and vomiting. +Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

A 50-year-old African American woman has a BMI of 35 kg/m2, type 2 diabetes mellitus, hypercholesterolemia, and irritable bowel syndrome (IBS). She is seeking assistance in losing weight, because, "I have trouble stopping eating when I should, but I do not want to have bariatric surgery." Which drug therapy should the nurse question if it is prescribed for this patient? A. Orlistat (Xenical) B. Locaserin (Belviq) C. Phentermine (Adipex-P) D. Phentermine and topiramate (Qsymia)

- Orlistat (Xenical) >Orlistat (Xenical), which blocks fat breakdown and absorption in the intestine, produces some unpleasant GI side effects. >This drug would not be appropriate for someone with IBS. >Locaserin (Belviq) suppresses the appetite and creates a sense of satiety that may be helpful for this patient. >Phentermine (Adipex-P) needs to be used for a limited period of time (3 months or less). >Qsymia is a combination of two drugs, phentermine and topiramate. >Phentermine is a sympathomimetic agent that suppresses appetite and topiramate induces a sense of satiety.

The nurse is caring for a 45-year-old woman with a herniated lumbar disc. The patient realizes that weight loss is necessary to lessen back strain. The patient is 5'6" tall and weighs 186 lb (84.5 kg) with a body mass index (BMI) of 28 kg/m2. The nurse explains to the patient that this measurement places her in which of the following weight categories? A. Normal weight B. Overweight C. Obese D. Severely obese

- Overweight >A normal BMI is 18.5 to 24.9 kg/m2, whereas a BMI of 25 to 29.9 kg/m2 is considered overweight. A BMI of 30.0-39.9 is considered obese, and a BMI of 40 or greater is severely obese.

In the immediate postoperative period a nurse cares for a severely obese 72-year-old man who had surgery for repair of a lower leg fracture. Which assessment would be most important for the nurse to make? A. Cardiac rhythm B. Surgical dressing C. Postoperative pain D. Oxygen saturation

- Oxygen saturation >After surgery an older and/or severely obese patient should be closely monitored for oxygen desaturation. >The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue (e.g., obesity, older) at risk for resedation. As adipose cells release anesthetic back into the bloodstream, the patient may become sedated after surgery. >This may depress the respiratory rate and result in a drop in oxygen saturation.

The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem? A. Hepatic cirrhosis B. Hypersplenomegaly C. Gall bladder distention D. Peritoneal inflammation

- Peritoneal inflammation >When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. >Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness.

The nurse recognizes that the majority of patients' caloric needs should come from which source? A. Fats B. Proteins C. Polysaccharides D. Monosaccharides

- Polysaccharides >Carbohydrates should constitute between 45% and 65% of caloric needs, compared with 20% to 35% from fats and 10% to 35% from proteins. >Polysaccharides are the complex carbohydrates that are contained in breads and grains. >Monosaccharides are simple sugars.

A patient who is unable to swallow because of progressive amyotrophic lateral sclerosis is prescribed enteral nutrition through a newly placed gastrostomy tube. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Irrigate the tube between feedings. B. Provide wound care at the gastrostomy site. C. Administer prescribed liquid medications through the tube. D. Position the patient with a 45-degree head of bed elevation.

- Position the patient with a 45-degree head of bed elevation. >Rationale: Unlicensed assistive personnel (UAP) may position the patient receiving enteral feedings with the head of bed elevated. >A licensed practical nurse/licensed vocational nurse (LPN/LVN) or an RN could perform the other activities.

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? A. Digoxin (Lanoxin) B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan)

- Promethazine (Phenergan) +A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. +Common side effects of digoxin are yellow halos and bradycardia. +Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. +Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position

- Providing IV fluids and inserting a nasogastric (NG) tube +A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. +Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? A. Decreased blood pressure B. Absence of muscle tremors C. Relief of nausea and vomiting D. No further episodes of diarrhea

- Relief of nausea and vomiting > Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. +Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse?. A. Notify the physician. B. Auscultate for bowel sounds. C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one.

- Reposition the tube and check for placement. +The tube may be resting against the stomach wall. +The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. +The physician does not need to be notified unless the tube function cannot be restored by the nurse. +The patient does not have bowel sounds, which is why the NG tube is in place. +The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen? A. Left lower quadrant B. Left upper quadrant C. Right lower quadrant D. Right upper quadrant

- Right upper quadrant >Although the left lobe of the liver is located in the left upper quadrant of the abdomen, the bulk of the liver is located in the right upper quadrant.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? A. Chest pain relieved with eating or drinking water B. Back pain 3 or 4 hours after eating a meal C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen and vomiting following indigestion

- Rigid abdomen and vomiting following indigestion +A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. +Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. +Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. +Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis? A. Gastric pH B. Blood glucose C. Serum amylase D. Serum potassium

- Serum amylase >Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction.

An older patient was admitted with a fractured hip after being found on the floor of her home. She was extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding would be of most concern to the nurse? A. Blood glucose level of 125 mg/dL B. Serum phosphate level of 1.9 mg/dL C. White blood cell count of 10,500/µL D. Serum potassium level of 4.6 mEq/L

- Serum phosphate level of 1.9 mg/dL >Refeeding syndrome can occur if a malnourished patient is started on aggressive nutritional support. >Hypophosphatemia (serum phosphate level less than 2.4 mg/dL) is the hallmark of refeeding syndrome and could result in cardiac dysrhythmias, respiratory arrest, and neurologic problems. >An increase in the blood glucose level is expected during the first few days after PN is started. The goal is to maintain a glucose range of 110 to 150 mg/dL. >An elevated white blood cell count (greater than 11,000/µL) could indicate an infection. >Normal serum potassium levels are between 3.5 and 5.0 mEq/L.

The nurse is evaluating the nutritional status of a 55-year-old man who is undergoing radiation treatment for oropharyngeal cancer. Which laboratory test would be the best indicator to determine if the patient has protein-calorie malnutrition? A. Serum transferrin B. C-reactive protein C. Serum prealbumin D. Alanine transaminase (ALT)

- Serum prealbumin >In the absence of an inflammatory condition, the best indicator of protein-calorie malnutrition (PCM) is prealbumin; prealbumin is a protein synthesized by the liver and indicates recent or current nutritional status. Decreased albumin and transferrin levels are other indicators that protein is deficient. C-reactive protein (CRP) is elevated during inflammation and is used to determine if prealbumin, albumin, and transferrin are decreased related to protein deficiency or an inflammatory process. Other indicators of protein deficiency include elevated serum potassium levels, low red blood cell counts and hemoglobin levels, decreased total lymphocyte count, elevated liver enzyme levels (ALT), and decreased levels of both fat-soluble and water-soluble vitamins.

The nurse is providing care for a 23-year-old woman who is a strict vegetarian. To prevent the consequences of iron deficiency, what should the nurse recommend? A. Brown rice and kidney beans B. Cauliflower and egg substitutes C. Soybeans and hot breakfast cereal D. Whole-grain bread and citrus fruits

- Soybeans and hot breakfast cereal >Vegetarians are at a particular risk for iron deficiency, a problem that can be prevented by regularly consuming high-iron foods such as hot cereals and soybeans. >The other foods listed are not classified as high sources of iron.

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium (Colace)? A. Take a dose of mineral oil at the same time. B. Add extra salt to food on at least one meal tray. C. Ensure dietary intake of 10 g of fiber each day. D. Take each dose with a full glass of water or other liquid.

- Take each dose with a full glass of water or other liquid. +Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. +The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. +Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. +Mineral oil and extra salt are not recommended.

During the initial postoperative period following bariatric surgery, the nurse recognizes the importance of monitoring obese patients for respiratory insufficiency based on what knowledge? A. The body stores anesthetics in adipose tissue. B. Postoperative pain may cause a decreased respiratory rate. C. Intubation may be difficult because of extra chin skinfolds. D. The patient's head must remain flat for a minimum of 2 hours postprocedure.

- The body stores anesthetics in adipose tissue. >The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue at risk for re-sedation. >As adipose cells release anesthetics back into the bloodstream, the patient may become sedated after surgery, increasing the risk of hypoventilation and resultant respiratory insufficiency. >Difficult intubation does not cause respiratory insufficiency. >Pain usually increases respiratory rate. >The patient's head should be elevated after bariatric surgery to decrease abdominal pressure and facilitate respirations.

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? A. Has completed a college education B. Has been able to stop smoking cigarettes C. Has well-controlled type 1 diabetes mellitus D. The chest x-ray showed another lung cancer lesion.

- The chest x-ray showed another lung cancer lesion. +Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug and/or alcohol abuse, and the inability to comprehend or comply with the rigorous post-transplant course.

The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site? A. The patient must be able to see the site. B. Outside the rectus muscle area is the best site. C. It is easier to seal the drainage bag to a protruding area. D. The ostomy will need irrigation, so area should not be tender.

- The patient must be able to see the site. +In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag.

In developing an effective weight reduction plan for an overweight patient who states a willingness to try to lose weight, it is most important for the nurse to first assess which factor? A. The length of time the patient has been obese B. The patient's current level of physical activity C. The patient's social, emotional, and behavioral influences on obesity D. Anthropometric measurements, such as body mass index and skinfold thickness

- The patient's social, emotional, and behavioral influences on obesity >Eating patterns are established early in life, and eating has many meanings for people. >To establish a weight reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient's eating patterns. >The duration of obesity, current physical activity level, and current anthropometric measurements are not as important for the weight reduction plan.

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)? A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. Correct B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. Correct C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.Correct D. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally. E. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

- There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.- Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. - Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. +The ascites related to cirrhosis are caused by decreased colloid oncotic pressure from the lack of albumin from liver inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. +The intake of fluids orally and the removal of blood cells by the spleen do not directly contribute to ascites.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect? A. Tremors B. Constipation C. Double vision D. Numbness in fingers and toes

- Tremors +Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. +Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)? A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D. Apply gentle pressure for the shortest possible time period after performing venipuncture. E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

- Use smallest gauge needle possible when giving injections or drawing blood - Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. - Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present. +Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. +Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. +The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. +The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. +Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding.

A patient received a small-bore nasogastric (NG) tube after a laryngectomy. What should be the nurse's priority intervention before starting the enteral feeding? A. Aspiration B. Auscultation of air C. Set head of bed at 40 degrees. D. Verify NG tube placement on x-ray.

- Verify NG tube placement on x-ray. >It is imperative to ensure that an NG tube is situated in the GI tract rather than the patient's lungs. >When an NG tube has been recently inserted, it is important to confirm this placement with an x-ray that will identify the tube's radiopaque tip. >Aspiration and air auscultation may not differentiate between gastric and respiratory placement of the tube. >The head of bed elevated at least 30 degrees is to prevent aspiration. >To determine the maintenance of the feeding tube's proper position, the exit site of the tube is marked at the time of the x-ray and the external portion measured to allow for assessment of a change position with a change in the length of the tube.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)? A. Vitamin A Correct B. Vitamin D Correct C. Vitamin E Correct D. Vitamin K Correct E. Vitamin B

- Vitamin A Correct - Vitamin D - Vitamin E - Vitamin K +Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. +Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.

The patient cannot afford to buy the food she needs for her family, so she makes sure her children eat first, and then she eats. When she comes to the clinic, she reports bleeding gums, loose teeth, and dry, itchy skin. The nurse should know that this patient is most likely lacking which vitamin? A. Folic acid B. Vitamin C C. Vitamin D D. Vitamin K

- Vitamin C >This patient is lacking Vitamin C as evidenced by the bleeding gums, loose teeth, and dry, itchy skin. >Clinical manifestations of folic acid deficiency include megaloblastic anemia, anorexia, fatigue, sore tongue, diarrhea, or forgetfulness. >Clinical manifestations of Vitamin D deficiency include muscular weakness, excess sweating, diarrhea, bone pain, rickets, or osteomalacia. >Clinical manifestations of Vitamin K deficiency include defective blood coagulation.

A 90-year-old healthy man is suffering from dysphagia. The nurse explains what age-related change of the GI tract is the most likely cause of his difficulty? A. Xerostomia B. Esophageal cancer C. Decreased taste buds D. Thinner abdominal wall

- Xerostomia >Xerostomia, decreased volume of saliva, leads to dry oral mucosa and dysphagia. >Esophageal cancer is not an age-related change. >Decreased taste buds and a thinner abdominal wall do not contribute to difficulty swallowing.

An 85-year-old woman seen in the primary care provider's office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause? A. Anosmia B. Xerostomia C. Hypochlorhydria D. Salivary gland tumor

- Xerostomia >Xerostomia (decreased saliva production), or dry mouth, affects many older adults and may be associated with difficulty swallowing (dysphagia). >Anosmia is loss of sense of smell. >Hypochlorhydria, a decrease in stomach acid, does not affect swallowing. Salivary gland tumors are not common.

The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a A. colectomy B. cholecystectomy C. choledocholithotomy D. choledochojejunostomy

- choledocholithotomy >A choledocholithotomy is an opening into the common bile duct for the removal of stones. >A colectomy is the removal of the colon. >The cholecystectomy is the removal of the gallbladder. >The choledochojejunostomy is an opening between the common bile duct and the jejunum.

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of A. impaired peristalsis. B. irritation of the bowel. C. nasogastric suctioning. D. inflammation of the incision site.

- impaired peristalsis + Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. +Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? A. "You'll need to drink at least two to three glasses of milk daily." B. "It would likely be beneficial for you to eliminate drinking alcohol." C. "Many people find that a minced or pureed diet eases their symptoms of PUD." D. "Your medications should allow you to maintain your present diet while minimizing symptoms."

-"It would likely be beneficial for you to eliminate drinking alcohol." + Alcohol increases the amount of stomach acid produced so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.

CHAPTER 42 - NCLEX (UPPER GASTROINTESTINAL PROBLEMS)

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CHAPTER 41 - NCLEX (OBESITY)

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CHAPTER 41 - PRE-TEST - (OBESITY)

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Chapter 39 - NCLEX Review Questions (GASTROINTESTINAL SYSTEM)

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Chapter 39 - Pre-Test (GASTROINTESTINAL SYSTEM)

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Chapter 40 - Pre-Test (NUTRITIONAL PROBLEMS)

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Which patient is at highest risk for developing metabolic syndrome? A) A 62-year-old white man who has coronary artery disease with chronic stable angina B) A 54-year-old Hispanic woman who is sedentary and has nephrogenic diabetes insipidus C. A 27-year-old Asian American woman who has preeclampsia and gestational diabetes mellitus D.) A 38-year-old Native American man who has diabetes mellitus and elevated hemoglobin A1C Correct

A 38-year-old Native American man who has diabetes mellitus and elevated hemoglobin A1C.- - - - African Americans, Hispanics, Native Americans, and Asians are at an increased risk for development of metabolic syndrome. Other risk factors include individuals who have diabetes that cannot maintain a normal glucose level, have hypertension, and secrete a large amount of insulin, or who have survived a heart attack and have hyperinsulinemia.