Practice Questions

Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client's chart and understands that normal intraocular pressure is: 1. 2-7 mmHg 2. 10-21 mmHg 3. 22-30 mmHg 4. 31-35 mmHg

2. 10-21 mmHg Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mmHg are considered within normal range.

6. The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: 1. Eye pain 2. Floating spots 3. Blurred vision 4. Diplopia

3. Blurred vision A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception.

22. 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. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

10. The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is: 1. "Although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." 2. "Your vision will return as soon as the medications begin to work." 3. "Your vision will never return to normal." 4. "Your vision loss is temporary and will return in about 3-4 weeks."

1. "Although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. Option C does not provide reassurance to the client.

16. The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid. The initial nursing action is to: 1. Begin visual acuity testing 2. Irrigate the eye with sterile normal saline 3. Swab the eye with antibiotic ointment 4. Cover the eye with a pressure patch.

2. Irrigate the eye with sterile normal saline

20. After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic examination, which of the following instructions would be given to the client? 1. "Be careful because the blink reflex is paralyzed." 2. "Avoid wearing your regular glasses when driving." 3. "Be aware that the pupils may be unusually small." 4. "Wear dark glasses in bright light because the pupils are dilated."

4. "Wear dark glasses in bright light because the pupils are dilated." Atropine, an anticholinergic drug, has mydriatic effects causing pupil dilation. This allows more light onto the retina and may cause photophobia and blurred vision. Atropine doesn't paralyze the blink reflex or cause miosis (pupil constriction). Driving may be contraindicated to blurred vision.

11. The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? 1. Decrease fluid intake to control the intraocular pressure 2. Avoid overuse of the eyes 3. Decrease the amount of salt in the diet 4. Eye medications will need to be administered lifelong.

4. Eye medications will need to be administered lifelong. The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life.

4. You're advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend? 1. Peas 2. Cabbage 3. Broccoli 4. Yogurt

4. Yogurt High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.

5. A characteristic associated with peptic ulcer pain is a: A. Burning sensation localized in the back or midepigastrium. B. Feeling of emptiness that precedes meals from 1 to 3 hours. C. Severe gnawing pain that increases in severity as the day progresses. D. Combination of all of the above.

A. Burning sensation localized in the back or midepigastrium.

6. You're collecting a patient's medication history that has GERD. Which medication below is NOT typically used to treat GERD? A. Colesevelam B. Omeprazole C. Metoclopramide D. Ranitidine

A. Colesevelam

7. A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer? A. Duodenal B. Gastric C. Esophageal D. Refractory

A. Duodenal

7. Peptic ulcer disease may be caused by which of the following? A. Helicobacter pylori B. Clostridium difficile C. Candida albicans D. Staphylococcus aureus

A. Helicobacter pylori Helicobacter pylori is considered to be the major cause of ulcer formation. Other choices are not related to ulcer formation.

4. During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY: A. Hot and Spicy Pork Rinds B. Peppermint patties C. Green Beans D. Tomato Soup E. Chocolate Fondue F. Almonds G. Oranges

A. Hot and Spicy Pork Rinds B. Peppermint patties D. Tomato Soup E. Chocolate Fondue G. Oranges

10. A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to advance the patient's diet to solid foods. The patient's lunch tray arrives. Which food should the patient avoid eating? A. Orange B. Milk C. White rice D. Banana

A. Orange

14. A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI? A. Pantoprazole B. Famotidine C. Magnesium Hydroxide D. Metronidazole

A. Pantoprazole

8. A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing? A. Gastroparesis B. Fascia dehiscence C. Dumping Syndrome D. Somogyi effect

C. Dumping Syndrome

24. For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications? 1. Acetazolamide (Diamox) 2. Atropine 3. Furosemide (Lasix) 4. Urokinase (Abbokinase)

1. Acetazolamide (Diamox) Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren't used for the treatment of glaucoma.

A patient's vomitus is dark brown and has a coffee-ground appearance. the nurse recognizes that this emsis is charactristic of: a. stomach bleeding b. an intestinal obstruction c. bile reflux d. active bleeding of lower esophagus

a. stomach bleeding

8. During the early postoperative period, the client who had a cataract extraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to: 1. Call the physician 2. Administer the ordered main medication and antiemetic 3. Reassure the client that this is normal. 4. Turn the client on his or her operative side

1. Call the physician Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be reported to the physician immediately. The other options are inappropriate.

13. The nurse is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of the retinal detachment? 1. Complaints of a burst of black spots or floaters 2. A sudden sharp pain in the eye 3. Total loss of vision 4. A reddened conjunctiva

1. Complaints of a burst of black spots or floaters

7. In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled? 1. An osmotic diuretic 2. A miotic agent 3. A mydriatic medication 4. A thiazide diuretic

3. A mydriatic medication A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the cataract client. These medication act by dilating the pupils. They also constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract.

3. After dinner time, during hourly rounding, a patient awakes to report they feel like "food is coming up" in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention will you perform next? A. Perform deep suctioning B. Assist the patient into the Semi-Fowler's position C. Keep the patient NPO D. Instruct the patient to avoid milk products

B. Assist the patient into the Semi-Fowler's position

2. Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus' ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm having later today?" You tell the patient the name of the test is: A. Lower Esophageal Gastrointestinal Series B. Transesophageal echocardiogram C. Esophageal manometry D. Esophageal pH monitoring

C. Esophageal manometry

7. A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of drug? A. Proton-pump inhibitor B. Histamine receptor blocker C. Prokinetic D. Mucosal Healing Agent

C. Prokinetic

5. After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT? A. "It is best to try to consume small meals throughout the day than eat 3 large ones." B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love eating those types of hard candies." C. "It is important I avoid eating right before bedtime." D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter."

D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter."

2. Peritonitis can occur as a complication of: A. septicemia B. multiple organ failure C. hypovolemic shock D. peptic ulcer disease

D. peptic ulcer disease' Perforation is a life-threatening complication of peptic ulcer disease and can result in peritonitis.

11. During initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate: A. ischemic bowel B. peritonitis C. hypovolemic shock D. perforated bowel

D. perforated bowel Invasive diagnostic testing can cause perforated bowel.

2. The most common site for peptic ulcer formation is the: A. Duodenum. B. Esophagus. C. Pylorus. D. Stomach.

A. Duodenum.

22. Cataract surgery results in aphakia. Which of the following statements best describes this term? 1. Absence of the crystalline lens 2. A "keyhole" pupil 3. Loss of accommodation 4. Retinal detachment

1. Absence of the crystalline lens Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is a normal response to aging. A retinal detachment is usually associated with retinal holes created by vitreous traction.

25. Which of the following symptoms would occur in a client with a detached retina? 1. Flashing lights and floaters 2. Homonymous hemianopia 3. Loss of central vision 4. Ptosis

1. Flashing lights and floaters Signs and symptoms of retinal detachment include abrupt flashing lights, floaters, loss of peripheral vision, or a sudden shadow or curtain in the vision. Occasionally visual loss is gradual.

12. You're developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include? 1. Omit fluids with meals. 2. Increase carbohydrate intake. 3. Decrease protein intake. 4. Decrease fat intake.

1. Omit fluids with meals. Gastric emptying time can be delayed by omitting fluids from your patient's meal. A diet low in carbs and high in fat & protein is recommended to treat dumping syndrome.

64. A patient has an acute upper GI hemorrhage. Your interventions include: 1. Treating hypovolemia. 2. Treating hypervolemia. 3. Controlling the bleeding source. 4. Treating shock and diagnosing the bleeding source.

1. Treating hypovolemia.

9. The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions? 1. "I will take Aspirin if I have any discomfort." 2. "I will sleep on the side that I was operated on." 3. "I will wear my eye shield at night and my glasses during the day." 4. "I will not lift anything if it weighs more that 10 pounds."

3. "I will wear my eye shield at night and my glasses during the day." The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications containing aspirin are not to be administered or taken by the client and the client is instructed to take acetaminophen as needed for pain. The client is instructed not to sleep on the side of the body on which the operation occurred. The client is not to lift more than 5 pounds.

12. The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which of the following is associated with this eye disorder? 1. Pain in the affected eye 2. Total loss of vision 3. A sense of a curtain falling across the field of vision 4. A yellow discoloration of the sclera.

3. A sense of a curtain falling across the field of vision A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is falling across the field of vision. No pain is associated with detachment of the retina. Options B and D are not characteristics of this disorder. A retinal detachment is an ophthalmic emergency and even more so if visual acuity is still normal.

1. The correct sequence for abdominal assessment is: A. inspection, percussion, palpation, auscultation. B. inspection, auscultation, palpation, percussion. C. inspection, palpation, auscultation, percussion. D. inspection, percussion, auscultation, palpation.

B. inspection, auscultation, palpation, percussion. Auscultation is done before palpation to avoid stimulating peristaltic movements and distorting auscultatory sounds.

12. Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system? A. Ultrasonography. B. MRI C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Computed tomography scan (CT scan)

C. Endoscopic retrograde cholangiopancreatography (ERCP) ERCP permits direct visualization of the pancreatic and common bile ducts. Its therapeutic value is in retrieving gallstones from the distal and common bile ducts and dilating strictures

23. When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress? 1. Glaucoma is easily corrected with eyeglasses 2. White and Asian individuals are at the highest risk for glaucoma. 3. Yearly screening for people ages 20-40 years is recommended. 4. Glaucoma can be painless and vision may be lost before the person is aware of a problem.

4. Glaucoma can be painless and vision may be lost before the person is aware of a problem. Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of peripheral vision. A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased chance of blindness than other groups. Individuals older than 40 should be screened.

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understands the discharge instructions? 1. I should not eat for at least one day following this procedure. 2. I can lie down whenever I want after a meal. It won't make a difference. 3. The stomach contents won't bother my esophagus but will make me nauseous. 4. I should avoid orange juice and eating tomatoes until my esophagus heals

4. I should avoid orange juice and eating tomatoes until my esophagus heals Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods u Tio the esophagus has had a chance to heal.

8. Pain control with peptic ulcer disease includes all of the following except: A. promoting physical and emotional rest. B. identifying stressful situations. C. eating meals when desired. D. administering medications that decrease gastric acidity.

C. eating meals when desired. Meals should be regularly spaced in a relaxed environment. Choices A, B, and D are proper interventions in providing pain control.

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? A. Administering pain medication B. Obtaining a blood sample for laboratory studies C. Preparing to insert a nasogastric (NG) tube D. Administering I.V. fluids

D. Administering I.V. fluids I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.