Nurs 327 Exam #3

Ace your homework & exams now with Quizwiz!

A client with achalasia recently underwent pneumatic dilation. The nurse intervenes after the procedure by

Assessing lung sounds

The nurse is planning care for a patient following an incisional cholecystectomy for cholelithiasis. Which of the following interventions is the highest nursing priority for this patient?

Assisting client to turn, cough, and deep breath every 2hrs

Which of the following is the most common presenting symptom of colon cancer?

Change in bowel habits

A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unitwith signs and symptoms of hypovolemia—minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting?

Third-spacing

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:

Troussaui's sign

An elderly client states, "I don't understand why I have so many caries in my teeth." The nurse assesses the following as placing the client at risk:

Exhibiting hemoglobin AIC 8.2

Patients diagnosed with hypervolemia should avoid sweet or dry food because

It increases the patients desire to consume fluid

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

Test all stools for occult blood

A client experienced extensive burns and 72 hours later has developed an ulcer. Which of the following types of ulcer is most likely in this client?

Curling's Ulcer

Which of the following ulcers is associated with extensive burn injury?

Curling's Ulcer

The nurse is performing a community screening for colorectal cancer. Which of the following characteristics should the nurse include in the screening?

Familial polyposis

Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels?

Frequent vomiting leading to loss of fluid volume

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Hemoglobin and hematocrit

Diet therapy for patients diagnosed with IBS include what?

High-fiber diet

Patient's medications is digitalis (digoxin [Lanoxin]), the nurse monitors the patient closely for which of the following?

Hypokalemia

Oral intake is controlled by the thirst center, located in which of the following cerebral areas?

Hypothalamus

To confirm an acid-base imbalance, it is necessary to assess which of the following findings from the results of a client's arterial blood gas (ABG) results?

pH , PaCO2, HCO3

When caring for a client with acute pancreatitis, the nurse should use which comfort measure?

positioning patient on the side with knees flexed

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

severe abdominal pain with direct palpation or rebound tenderness

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

yellow sclerae

Which of the following is considered an isotonic solution?

0.9% normal saline

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic?

Administer analgesic to the client

A longitudinal tear or ulceration in the lining of the anal canal is termed a (an

Anal Fissure

A patient with acute pancreatitis has been started on total parenteral nutrition (TPN). Following the administration of the TPN, which of the following should the nurse plan to monitor?

Blood glucose every 4 to 6 hours

A patient with acute pancreatitis has been started on total parenteral nutrition (TPN). Following the administration of the TPN, which of the following should the nurse plan to monitor?

Blood glucose levels every 4 to 6 hours

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the patient then experiences diarrhea, the nurse documents the presence of which of the following?

Borborygmus

In women, which of the following types of cancer exceeds colorectal cancer?

Breast Cancer

What is the most appropriate nursing diagnosis for the client with acute pancreatitis?

Deficient fluid volume

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?

Increases arterial pH

The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following?

Inhibit gastric acid secretions

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?

Maintain a high-carbohydrate, low-fat diet

Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis?

Pancreatic necrosis

The nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelitiasis can interfere with the absorption of

Vitamin A

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

light-headedness or paresthesia

Semi-Fowler's position is maintained for at least which time frame following completion of an intermittent tube feeding?

1 hour

Morbid obesity is defined as being how many pounds over the person's ideal body weight?

100

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is

15%

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use?

30mL

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve?

6 to 12

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?

6 to 12 months

A nurse is helping to plan a teaching session for a client who will be discharged with a colostomy. Which statement describes a healthy stoma?

At first the stoma may bleed a little when touched

The primary source of microorganisms for catheter-related infections are the skin and which of the following?

Catheter Hub

Which foods should be avoided following acute gallbladder inflammation?

Cheese

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?

Chest Pain

The nurse is irrigating a patient's colostomy when the patient begins to complain of cramping. What is the appropriate action by the nurse?

Clamp the tubing and allow the patient to rest

Which of the following is clinical manifestation of cholelithiasis?

Clay-colored stools

Which of the following laxatives should be used by a cardiac patient who should avoid straining?

Colace

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:

Diaphoresis, vomiting, diarrhea

What is one of the primary symptoms of irritable bowel syndrome (IBS)?

Diarrhea

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes?

Dysfunction of pancreatic islet cells

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by:

Edema and inflammation

A physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist?

Endoscopy

A patient with an ileostomy should avoid which of the following?

Enteric-coated products

Which nerve is implicated in the Chvostek's sign?

Facial

Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

Jugular vein distention

Which of the following enzymes aids in the digestion of fats?

Lipase

Which of the following medications, used in the treatment of GERD, accelerate gastric emptying?

Metoclopramide(Reglan)

A priority nursing intervention for a client with hypervolemia involves which of the following?

Monitoring respiratory status for signs and symptoms of pulmonary complications

Celiac sprue is an example of which category of malabsorption?

Mucosal disorders causing generalized malabsorption

The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions?

Neurological (because that would indicate hypocalcemia)

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?

Pancreatitis

Which of the following are classified as a histamine-2 receptor antagonist?

Pepcid

The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time?

Peritonitis

Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances?

Positron emission tomography (PET)

A client with a history of peptic ulcer disease is admitted for hematemesis associated with gastric bleeding. Which is the most appropriate action of the nurse?

Prepare for nasogastric irrigations

he nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first?

Radiography of the Gallbladder

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?

Rectal Bleeding

Which of the following is the most common symptom of a polyp?

Rectal Bleeding

Which type of diarrhea is caused by increased production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen?

Secretory Diarrhea

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?

Serum antibodies for H.pylori

The nurse is caring for patient scheduled to undergo radical neck dissection. During preoperative teaching, the nurse includes that which of the following as associated complications?

Shoulder drop

Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland?

Sialolithiasis

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?

Sigmoidoscopy

The nurse teaches the patient whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

Solid

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find?

Stool cultures negative for microorganisms or parasite

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient?

Suggest fluid intake of 2L per day

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?

Tachycardia

Hickman and Groshong are examples of which type of central venous access device?

Tunneled central catheters

The digestion of carbohydrates is aided by what?

amylase

Cancer of the esophagus is most often diagnosed by which of the following?

Esophagogastroduodenoscopy (EGD) with biopsy and brushing

A patient underwent a continent ileostomy. Within which timeframe should the patient expect to empty the reservoir?

Every 4 to 6 hours


Related study sets

Federal Government | Chapter 4: Supreme Court and 4th Amendment Challenges

View Set

Maternal-Newborn Ch 24 Care Related to Gestational Age, Size, Injury, and Pain in the Newborn

View Set

Chapter 3: Techniques of Assessment & Safety

View Set

Global Marketing Test 2 - Jensen

View Set

C++ Chapter 11: Inheritance and Composition

View Set

日本語総まとめN2語彙 第1週 1日目

View Set

Book Notes Ch. 8 - First Contact: Police and Diversionary Measures

View Set