NRSG 337 Exam #5 Class Questions
Your client must undergo surgical intervention for IBD. Which comment indicates that additional instruction about the care of their new ileostomy is needed? A."I should change the appliance daily to prevent odors." B."When I change the appliance, I should check the skin for irritation." C."I should clean around the stoma with warm water and pat dry." D."I'll need to alter the appliance opening when the stoma becomes smaller as the area heals."
A
Which type of precautions should the nurse implement to prevent hepatitis B exposure? A.Airborne B.Standard C.Droplet D.Exposure
B
The emergency department nurse is caring for a patient presenting with a fractured left leg following a fall from a tree stand. What action should the nurse take first? A.Elevate the left leg B.Auscultate all lung fields C.Assess CMS in the affected extremity D.Provide ordered pain medication
C
The medications prescribed for the patient with Crohn's disease include cobalamin and iron injections. What is the rationale for these drugs? A.Alleviate stress B.Combat infection C.Correct malnutrition D.Improve quality of life
C
The nurse is caring for a 42-year-old female whose stool is positive for blood per the hemoccult results from the lab. What assessment question is most important for the nurse to ask next? A.Have you recently noticed any changes in your bowel pattern? B.When was your last bowel movement? C.When was your last period? D.Have you been experiencing abdominal pain?
C
When admitting a client to the hospital with suspected acute pancreatitis, which electrolyte disorder would be expected? a.Hypoglycemia b.Hypernatremia c.Hypocalcemia d.hyperkalemia
C
Adam is very anxious about being in the hospital and keeps saying he can't afford to be away from work right now. When discussing the management of his illness after he is discharged, you recognize that at this time it is probably most important for him to A.stop smoking again. B.recognize symptoms of disease recurrence. C.avoid the use of over-the-counter medications for minor pains. D.use effective coping mechanisms to reduce business-related stress.
D
What associated disorder might a client with ulcerative colitis exhibit? A.Gallstones B.Hydronephrosis C.Nephrolithiasis D.Toxic megacolon
D
Which factor is most commonly associated with the development of pancreatitis? a.Alcohol use b.Hypercalcemia c.Hyperlipidemia d.Pancreatic duct obstruction
D
Which factor should be the initial focus of nursing management in a client with acute pancreatitis? a.Dietary management b.Prevention of skin breakdown c.Management of hypoglycemia d.Pain control
D
Which of the following would be the priority focus of nursing care for a client with peritonitis? a.Fluid and electrolyte balance b.Gastric irrigation c.Pain management d.Psychosocial issues
A
Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis? A.Fifteen bloody stools a day B.Oral temperature of 102 degrees F C.Hard, rigid abdomen D.Urinary stress incontinence
A
While reviewing the clinical presentation of clients with diverticular disease, the nurse understands that which of the following symptoms indicates diverticulosis? A.No symptoms exist B.Nausea C.Anorexia and low-grade fever D.Episodic, dull or steady midabdominal pain
A
The nurse is teaching a client with a peptic ulcer about discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate? a.Aspirin b.Acetaminophen c.Naproxen d.Ibuprofen
B
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? A.Malaise B.Dark stools C.Weight gain D.Left upper quadrant discomfort
A
A client is admitted with a diagnosis of hepatic encephalopathy. The nurse's assessment documentation would most likely include which of the following? A.Altered mental status B.Proficient concentration C.Increased energy D.Talkativeness
A
A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item? A.Black, tarry stools B.Frequent nausea C.Joining Alcoholics Anonymous D.Pain that increases after meals
A
Based on P.J.'s report of his drinking habits, you recognize the importance of monitoring the patient for withdrawal symptoms. Select the statements that accurately reflect alcohol withdrawal symptoms. There are four correct answers. A.Withdrawal should be anticipated if the patient reports consumption of over 10 drinks every day for a period of 2 weeks. B.Anxiety, agitation, weakness, nausea and/or vomiting are symptoms of alcohol withdrawal. C.Withdrawal symptoms will not begin until at least 12 hours after the last drink. D.Withdrawal symptoms usually peak at 24-48 hours after the last drink. E.Visual or auditory hallucinations may be present with alcohol withdrawal delirium.
A, B, D, E
Adam is discharge on quadruple therapy of a PPI, bismuth, metronidazole, and tetracycline. Ten days after his discharge from the hospital, Adam is readmitted with a suspected perforation of the ulcer. Select the assessment findings that indicate a perforation. There are five correct answers. A.Decreased bowel sounds B.Projectile vomiting of undigested food C.Grunting, shallow respiration D.Rigid, boardlike abdomen E.Shoulder pain F.Sudden, severe upper abdominal pain G.Visible peristaltic waves
A, C, D, E, F
The nurse is prioritizing care for a client 2 days after surgery for a stoma creation that resulted from ulcerative colitis. What is the most important issue for the nurse to address? A.Body image B.Ostomy care C.Sexual concerns D.Skin care
B
The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective ? A."I will take my lipid-lowering medication at the same time each night." B."I may experience some discomfort if I eat a high-fat meal in the next few weeks." C."I need someone to stay wit me for about a week after surgery." D."I should not splint my incision when I deep breathe and cough."
B
A 53-yr-old with advanced cirrhosis now has hepatic encephalopathy. He is confused and restless. The nurse formulated the nursing diagnosis of disturbed thought process r/t A.Massive ascites formation B.Increased serum ammonia levels C.Fluid volume excess D.Altered clotting mechanisms
B
A STAT hemoglobin and hematocrit (H&H) is ordered for Adam, IV fluids are started at 125 mL/hr, and a nasogastric tube is inserted and connected to low continuous suction. Additional laboratory tests are also ordered. The results of Adam's initial H&H are 14.3 g/dL and 42%. You know that these results.... A.Should increase as fluid replacement is continued. B.Reflect an equal loss of plasma and red blood cells (RBCs). C.Indicate that A.D. has not lost a significant amount of blood. Are an indication for immediate transfusion with packed RBCs.
B
A client is hospitalized with dehydration and dysphagia. Which task would not be appropriate to delegate to a licensed practical nurse? A.Administer a subcutaneous injection B.Perform initial swallow screen C.Assist the CNA with ambulating client D.Record vital signs on the electronic health record
B
Adam has no postoperative complications and progresses well in his recovery. You plan teaching for Adam in preparation for his discharge. There are five correct answers. A.Drink at least 8 oz of fluid with meals. B.Teaching about dumping syndrome management. C.Eat small, frequent meals with moderate amounts of protein and fat. D.Follow-up visits will be needed to evaluate the need for cobalamin injections. E.Maintain lifestyle changes previously used to prevent ulcer redevelopment. F.Notify the health care provider of any continuous epigastric distress after meals. G.Limit fluid intake to 1 quart a day.
B, C, D, E, F
A 46-yr-old client has been experiencing frequent episodes of "heart burn" and regurgitation of sour-tasting fluid, especially after a large meal. The client is diagnosed with a hiatal hernia. The nurse knows that the client understands her treatment regimen when she states she will: A.Elevate her legs when she is sleeping. B.Increase her roughage in her diet C.Drink more fluids with her meals. D.Avoid caffeine, alcohol, and chocolate.
D
A nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun caring for the client. What is the best nursing intervention in preparing for the client's discharge? A.Contact the client's healthcare provider to ask to substitute a liquid form of medications for the pill form. B.Teach the client and family members to crush the pills and administer them with applesauce. C.Teach the client and family members about addiction that may occur as a result of regular opioid use. D.Contact the client's healthcare provider to discuss use of transdermal medications for pain control.
D
A patient is admitted for appendicitis. What manifestations does the nurse expect? A.LUQ or epigastric pain, radiating to the back B.LLQ pain, fever, and constipation C.RUQ pain, fatigue, anorexia, and jaundice D.RLQ pain, guarding, rebound tenderness
D
A patient with acute hepatitis B will be discharged tomorrow. The nurse should include which measures in the discharge teaching plan? a.Choose foods that are very hot or very cold. b.Participate in an exercise regimen to build stamina. c.Avoid alcohol for the first three weeks. d.Be sure to allow for periods of rest during the day.
D
A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. What is the most appropriate action by the nurse? A.Initiate oxygen therapy at 2 L/min to increase gas exchange. B.Notify the health care provider so that a paracentesis can be performed. C.Ask the patient to cough and breathe deeply to clear respiratory secretions. D.Place the patient in semi-Fowler's position to relieve pressure on the diaphragm.
D
The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which vitamin deficiency? a.Vitamin A b.Vitamin B12 c.Vitamin C d.Vitamin E
B
A patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements r/t decreased nutritional intake and decreased intestinal absorption. Which assessment data support this diagnosis? A.Pallor and hair loss B.Frequent diarrheal stools C.Anorectal excoriation and pain D.Hypotension and urine output below 30 mL/hr
A
A self-help group of clients with irritable bowel syndrome have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to minimize in the diet to decrease gastrointestinal (GI) irritability? A.Cola drinks B.Gelatin C.Fiber D.Rice
A
Adam's bleeding is controlled with treatment. His lowest H&H, occurring 24 hours after admission, is 11.5 g/dl (115 g/L) and 32%. Two days after admission his NG tube is removed and oral intake is started. In reviewing Adam's diet with him, you evaluate that he understands the dietary recommendations for PUD when he says: A."I can eat and drink most foods and fluids that don't cause me distress." B."I should substitute coffee and tea for alcohol at my social business functions." C."I must eat bland foods at least six times a day to promote healing of my ulcer." D."I should eliminate all milk and milk products because they stimulate gastric acid production."
A
Diagnostic testing is planned for a patient with suspected peptic ulcer disease. The nurse tells patient that the most reliable test to determine the presence and location of an ulcer is A. endoscopy. B. gastric analysis. C. a barium swallow test. D. a serologic test for Helicobacter pylori.
A
P.J. has a nursing diagnosis of ineffective breathing pattern related to reduced lung volume. The mostappropriate nursing intervention for him is to A.Place him in semi-Fowler's position. B.Promote deep breathing and coughing. C.Ensure that he is maintaining a low-protein diet. D.Perform oral and pharyngeal suctioning to reduce the risk of aspiration.
A
The colonoscopy reveals numerous diverticuli with the majority located in a section of the descending colon. What teaching should this patient receive? A.Increase fiber, fluids, and physical activity B.Avoid all foods with nuts and seeds C.Take acetaminophen for discomfort D.Take laxatives such as bisocodyl to prevent future episodes
A
The emergency department nurse is caring for a patient presenting with a fractured left leg following a fall from a tree stand. What action should the nurse take first? A.Ensure an open airway B.Assess CMS in all extremities C.Provide ordered pain medication D. Elevate the left leg
A
The nurse is caring for a client diagnosed with GERD. Which intervention should be included for this problem? A.Teach the client to sleep with a foam wedge under the head. B.Encourage the client to decrease the amount of smoking. C.Instruct the client to take over the counter medications for pain relief. D.Discuss the need to attend Alcoholics Anonymous to quit drinking.
A
The nurse provides preprocedural instructions to a client scheduled for a barium swallow. The nurse tells the client to: A.Avoid eating or drinking after midnight before the test. B.Limit self to only two cigarettes or the morning of the test. C.Have a clear liquid breakfast only on the morning of the test. D.Take all routine medications with a glass of water on the morning of the test.
A
Which condition is the most common comorbid disease associated with GERD? A.Adult-onset asthma B.Pancreatitis C.Peptic ulcer disease D.Increased gastric emptying
A
Which intervention is most important when preventing the transmission of hepatitis A? A.Careful hand washing B.Standard precautions C.Effective sewage disposal D.Good personal hygiene
A
Which nursing problem is the priority for the 76-year-old client diagnosed with gastroenteritis from staphylococcal food poisoning? A.Fluid volume deficit B.Nausea C.Risk for aspiration D.Impaired urinary elimination
A
The nurse is counseling a client on how to prevent cholecystitis. What is the most important guideline for the nurse to include? A.Eat a low protein diet B.Eat a low fat, low cholesterol diet C.Limit exercise to 10 minutes a day D.Keep weight proportional to height
D
A nurse is caring for a group of clients. On review of the clients' medical records, the nursing determines that which client is at risk for excess fluid volume? A.The client on diuretics B.The client with renal failure C.The client with an ileostomy D.The client on gastrointestinal suctioning
B
An important nursing intervention for the patient with a small intestinal obstruction who has an NG tube is to A.Offer clear liquids to sip PRN. B.Provide mouth care every 1 - 2 hours. C.Irrigate the tube with normal saline every 8 hours. D.Keep the patient supine.
B
Postoperatively, a patient with an incisional cholecystectomy has a nursing diagnosis of ineffective breathing pattern related to incisional pain. Which action should the nurse take first? a. Assess heart and lung sounds. b. Administer the prescribed analgesic. c. Position the patient on the operative side. d. Instruct the patient to cough and deep breathe.
B
The client diagnosed with liver problems asks the nurse "Why are my stools clay-colored?" On which scientific rationale should the nurse base the response? A.There is an increase in serum ammonia levels. B.The liver is unable to excrete bilirubin. C.The liver is unable to metabolize fatty foods. D.A damaged liver cannot detoxify vitamins.
B
The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain through suppression of pancreatic secretions is the use of a. antibiotics. b. NPO status. c. antispasmodics. d. proton pump inhibitors.
B
The nurse is preparing to administer ranitidine (Zantac) to a client diagnosed with peptic ulcer disease. The client asks the nurse what the purpose of the medication is. That is the most appropriate response by the nurse? a.Neutralize acid b.Reduce acid secretions c.Stimulate gastrin release d.Protect the mucosal barrier
B
Which assessment data best indicates the client recovering from an open cholecystectomy may require pain medication? a.Pulse is 65 beats per minute b.Shallow respirations c.Hypoactive bowel sounds d.Use of a pillow to splint when coughing
B
A 42-yr-old nurse has been diagnosed with PUD. The medication regimen includes misoprostol, a cytoprotective agent. The nurse understands that this medication exerts its therapeutic effect by: A.Neutralizing excess gastric acid B.Inhibiting HCl production C.Supporting mucous production D.Increasing gastric emptying time
C
A client recently diagnosed with colon cancer tells the nurse that he's been having trouble sleeping due to the thoughts about how his life may change after surgery. Which is the most appropriate nursing diagnosis? A.Anxiety related to upcoming surgery B.Powerlessness related to illness C.Disturbed sleep pattern related to fear of the unknown D.Ineffective coping related to the diagnosis of colon cancer
C
A client with irritable bowel syndrome has instructions to take psyllium 2 rounded teaspoons full twice a day for constipation. What is most important for the nurse to include in the teaching plan? A.Urine may be discolored. B.Stop taking the laxative once a bowel movement occurs. C.Each dose should be taken with a full glass of water or juice. D.Daily use may inhibit the absorption of some fat-soluble vitamins.
C
A patient with Crohn's disease is receiving iron and cobalamin (B12) supplements for anemia from malabsorption. What assessment information will best indicate the treatment is effective? A.The patient adheres to the prescribed regimen, taking the iron twice daily with orange juice. B.The patient reports lessening of Crohn's-related diarrhea and abdominal pain. C.The patient reports less fatigue and increased activity tolerance. D.The patient denies any GI upset when taking the supplements.
C
A patient with persistent vomiting of 3 days' duration is seen at the urgent care center because of increasing weakness. IV therapy with lactated Ringer's solution is started, and arterial blood gases (ABGs) are measured. Which ABG result would the nurse expect? a. pH 7.4; PaCO2 40 mmHg; HCO3− 25 mEq/L b. pH 7.3; PaCO2 45 mmHg; HCO3− 20 mEq/L c. pH 7.49; PaCO2 47 mmHg; HCO3− 35 mEq/L d. pH 7.48; PaCO2 30 mmHg; HCO3− 18 mEq/L
C
After several contacts with his HCP for LLQ pain, initially labeled constipation, a 33 y/o male is admitted with a diagnosis of acute diverticulitis. What assessment findings do you think would indicate the need for hospitalization rather than outpatient treatment? A.LLQ pain B.Need for antibiotics C.Elevated WBC and guarding D.Decreased appetite and constipation
C
After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? A."I should have a glass of low-fat milk at bedtime." B."I will have to eliminate all spicy foods from my diet." C."I will have to drink water instead of caffeinated drinks." D."I should keep something in my stomach all the time to neutralize the excess acids."
C
For a definitive diagnosis of cirrhosis, the nurse will assist with which diagnostic test? a.Albumin level b.Colonoscopy c.Liver biopsy d.Liver enzyme levels
C
In a client with diarrhea, which outcome indicates that fluid resuscitation is successful? A.The client passes formed stools at regular intervals B.The client reports a decrease in stool frequency and liquidity C.The client exhibits firm skin turgor D.The client no longer experiences perianal burning
C
The client presents to the outpatient clinic complaining of diarrhea for two days, Which laboratory data should the nurse monitor? A.Sodium level B.Albumin level C.Potassium level D.Glucose level
C
The client with type 2 diabetes is prescribed prednisone for an acute exacerbation of inflammatory bowel disease (IBD). Which instructions are most important for the nurse to discuss with the client? A.Take this medication on an empty stomach B.Notify the HCP if experiencing a moon face C.Take the steroid medication as prescribed D.Notify the HCP if the blood glucose is over 160
C
The clinic nurse is talking on the phone to a client who has diarrhea. Which intervention should the nurse discuss with the client? a.Tell the client to measure the amount of stool b.Recommend the client come to the clinic immediately c.Explain the client should follow the BRAT diet d.Discuss taking an over-the-counter histamine-2 blocker
C
The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data requires further intervention? A.Bowel sounds auscultated 15 times in one minute B.Belching after eating a heavy and fatty meal late at night C.A decrease in systolic blood pressure of 22 mm Hg from lying to sitting D.A decreased frequency of distress located in the epigastric region
C
The nurse is planning care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? A.Allow any of the client's favorite foods as long asthe amount is limited. B.Have the client perform eructation exercises several times a day. C.Eat 4 to 6 small meals a day and limit fluids during mealtimes. D.Encourage client to consume a glass of red wine per day.
C
Which associated disorder might a client with Crohn's disease exhibit most often? a.Toxic megacolon b.Colon cancer c.Malabsorption d.Weight gain
C
Which of the following assessment findings would be consistent with a client's diagnosis of cirrhosis? a.Increased amylase b.Increased pH level c.Increased prothrombin time d.Increased white blood cell count
C
Which of the following orders would you question for this patient? A.Daily weights, abdominal girth measures, and I & O B.CIWA protocol to assess for ETOH withdrawal C.Acetaminophen prn for pain D.Nutritional support: multivitamins (po or IV), high carb/low fat diet (individualized orders for protein and fluids); oral care E.Prep for paracentesis
C
You are caring for the patient on post-op day 2. Bowel sound are hypoactive, abdomen is distended and tender to light palpation, patient denies passing flatus and reports spasms of abdominal pain. What intervention is most appropriate? A.Administer morphine sulfate IV per the prn order B.Report findings to the surgeon C.Assist the patient to ambulate in the hall D.Advise the patient this is expected due to NPO status.
C
The client diagnosed with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temp of 100.6 degrees F. Which intervention should the nurse implement first? A.Notify the health-care provider B.Document the findings in the chart C.Administer an oral antipyretic D.Assess the client's abdomen
D
The client has been experiencing difficulty and straining when expelling feces. Which intervention should the nurse discuss with the client? A.Explain some blood in the stool will be normal. B.Instruct the client in manual removal of feces. C.Encourage the client to use a cathartic laxative on a daily basis. D.Teach the client to eat a high-fiber diet.
D
The client is two hours post colonoscopy. Which assessment data warrants immediate intervention by the nurse? A.Soft, nontender abdomen B.Loose, watery stool C.Hyperactive bowel sounds D.Pulse 106, BP 94/58
D
The home health nurse is caring for a client with viral hepatitis. Which intervention should the nurse discuss with the client? a.Limit water intake to 1000 mL per day. b.Eat a high fat diet. c.Take acetaminophen for fever. d.Eat small, frequent meals.
D
The nurse is working with an admitted nursing student who completed the hepatitis B vaccination series 2 months ago. The student returns from the clinic with the following results: Hepatitis B Surface Antigen (HBsAg) = negative. How should the nurse interpret this result? A.The student is immune to hepatitis B B.The student is not immune to hepatis B C.The student is infected with hepatitis B D.The student needs to return to the clinic
D
The patient with inflammatory bowel disease (IBD) is receiving the following medications. Which one is prescribed to relieve symptoms, rather than to treat the disease? A.Corticosteroids B.Sulfasalizine (Azulfidine) C.Infliximab (Remicade) D.Diphenoxylate with atropine (Lomotil)
D
The surgical treatment of choice for the patient with symptomatic gallbladder disease is a A. cholecystotomy. B. choledocholithotomy. C. cholecystoduodenostomy. D. laparoscopic cholecystectomy.
D
Upon reviewing the history of a client with chronic gastritis, which of the following may be a risk factor for the development of this condition? a.Adolescent client b.Antibiotic usage c.Gallbladder disease d.Helicobacter pylori infection
D
