Patho/pharm II exam 1

A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: A. "Tell me about your husband's alcohol usage." B. "Is your husband being treated for tuberculosis?" C. "Has your husband recently fallen or injured his chest?" D. "Describe spices and condiments your husband uses on food."

A. "Tell me about your husband's alcohol usage." A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn't occur from chest injuries or falls and isn't associated with eating spicy foods.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A. "You may have eaten contaminated restaurant food."B. "You could have gotten it by using I.V. drugs."C. "You must have received an infected blood transfusion."D. "You probably got it by engaging in unprotected sex."

A. "You may have eaten contaminated restaurant food."

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. EndoscopyB. Upper GI seriesC. Hemoglobin (Hb) levels and hematocrit (HCT)D. Arteriography

A. Endoscopy

While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes cloggeD. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do? A. Irrigate the tube with cola.B. Advance the tube into the intestine.C. Apply intermittent suction to the tube.D. Withdraw the obstruction with a 30-ml syringe.

A. Irrigate the tube with cola.

A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? A. Notify the physicianB. Reposition the tubeC. Irrigate the tubeD. Increase the suction level

A. Notify the physician

A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: A. increasing fluid intake to prevent dehydration.B. wearing an appliance pouch only at bedtime.C. consuming a low-protein, high-fiber diet.D. taking only enteric-coated medications.

A. increasing fluid intake to prevent dehydration.

A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A. yellow sclera.B. light amber urine.C. circumoral pallor.D. black, tarry stools.

A. yellow sclera.

. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? A. "Lie down after meals to promote digestion."B. "Avoid coffee and alcoholic beverages."C. "Take antacids with meals."D. "Limit fluid intake with meals."

B. "Avoid coffee and alcoholic beverages."

A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur? A. 5 to 10 minutes B. 15 to 30 minutes C. 30 to 60 minutes D. 2 to 4 hours

B. 15 to 30 minutes

The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? A. Antiarrhythmic drugsB. Anticholinergic drugsC. Anticoagulant drugsD. Antihypertensive drugs

B. Anticholinergic drugs

What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated blood urea nitrogen (BUN)B. Elevated serum lipaseC. Elevated aspartate aminotransferase (AST)D. Increased lactate dehydrogenase (LD)

B. Elevated serum lipase

A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? A. Lying on the right side with legs straight B. Lying on the left side with knees bent C. Prone with the torso elevated D. Bent over with hands touching the floor

B. Lying on the left side with knees bent For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.C. The appendix may develop gangrene and rupture, especially in a middle-aged client.D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Cholecystitis D. Gastric ulcer

B. Pancreatitis

A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? A. The client doesn't exhibit rectal tenesmus.B. The client is free from esophagitis and achalasia.C. The client reports diminished duodenal inflammation.D. The client has normal gastric structures.

B. The client is free from esophagitis and achalasia.

A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A. severe abdominal pain radiating to the shoulder.B. anorexia, nausea, and vomiting.C. eructation and constipation.D. abdominal ascites.

B. anorexia, nausea, and vomiting.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. increased intracranial pressure.B. decreased urine output.C. bradycardia.D. hypertension.

B. decreased urine output Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: A. meperidine provides a better, more prolonged analgesic effect.B. morphine may cause spasms of Oddi's sphincter.C. meperidine is less addictive than morphine.D. morphine may cause hepatic dysfunction.

B. morphine may cause spasms of Oddi's sphincter.

A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: A. call the physician.B. place saline-soaked sterile dressings on the wound.C. take a blood pressure and pulse.D. pull the dehiscence closed.

B. place saline-soaked sterile dressings on the wound.

Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? A. HopelessnessB. PowerlessnessC. Chronic low self-esteemD. Deficient knowledge

C. Chronic low self-esteem

Which of the following factors can cause hepatitis A? A. Contact with infected bloodB. Blood transfusions with infected bloodC. Eating contaminated shellfishD. Sexual contact with an infected person

C. Eating contaminated shellfish

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? A. Regular dietB. Skim milkC. Nothing by mouthD. Clear liquids

C. Nothing by mouth

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy

C. Purpura and petechiae

A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: A. place the client in a private room.B. wear a mask when handling the client's bedpan.C. wash the hands after touching the client.D. wear a gown when providing personal care for the client.

C. wash the hands after touching the client.

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? A. Administering pain medicationB. Obtaining a blood sample for laboratory studiesC. Preparing to insert a nasogastric (NG) tubeD. Administering I.V. fluids

D. Administering I.V. fluids

While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? A. Sigmoid colonB. AppendixC. SpleenD. Liver

D. Liver

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? A. vitamin A B. vitamin D C. vitamin E D. vitamin K

D. Vitamin k Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.

Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: A. a sedentary lifestyle and smoking.B. a history of hemorrhoids and smoking.C. alcohol abuse and a history of acute renal failure.D. alcohol abuse and smoking.

D. alcohol abuse and smoking.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: A. whole blood and albumin.B. platelets and packed red blood cells.C. fresh frozen plasma and whole blood.D. cryoprecipitate and fresh frozen plasma.

D. cryoprecipitate and fresh frozen plasma.