GI and Neuro Questions and Answers for Final Exam

Which patient response requires a focused GI assessment? A. "I take ibuprofen 600 mg three times a day for arthritis pain." B. "I experience occasional constipation." C. "I have had dentures for 3 years." D. "Spicy foods upset my stomach." Correct answer- A After abdominal surgery, what is the most reliable assessment finding that suggests return of peristaltic movement? A. Presence of normal bowel sounds B. Patient report of passing flatus C. Patient report of hunger D. Absence of nausea Correct answer- B When administering a new medication to an older patient, the nurse understands that: A. The dose may need to be increased to greater-than-normal levels. B. Close monitoring is needed because toxic levels may develop. C. The dose may need to be decreased to lower-than-normal levels. D. Nausea and vomiting may develop rapidly and are Correct answer- B The patient with a long history of osteoarthritis is at risk for developing gastroesophageal reflux disease (GERD) if he or she: A. Weighs 220 pounds B. Frequently takes NSAIDs for pain C. Consumes foods with calcium supplementation D. Has limited physical mobility Correct answer- B A priority nursing intervention in the care of a patient with a hiatal hernia is: A. Providing nutrition education B. Promoting regular exercise C. Providing medication education D. Instructing the patient on signs and symptoms of intestinal strangulation Correct answer- A Which assessment variable requires immediate intervention post esophagectomy? A. Blood pressure of 170/88 B. Respiratory rate of 28 C. Temperature of 38.1° C D. Pain assessment of 6 on a scale of 0-10 Correct answer- B Which diagnostic results support the diagnosis of peptic ulcer disease? (Select all that apply.) A. Low hemoglobin B. Low WBC level C. Low hematocrit D. Positive for H. Pylori bacteria E. Low potassium of 3.4 mEq/L. Correct answer- A, C, D Which statement made by the patient would cause the nurse to suspect that she may have Zollinger-Ellison syndrome (ZES)? A. "I feel much better after taking Zantac (ranitidine)." B. "I can't lie flat for awhile after I've eaten." C. "The stomach pain hurts, but the foul-smelling diarrhea is worse." D. "Occasionally I have pain in my left lower Correct answer- C Which teaching does the nurse provide for behaviors that reduce symptoms of peptic ulcers? (Select all that apply.) A. Sit upright 30 to 60 minutes after meals. B. Spices should be added to food to enhance flavor. C. A vagotomy will be needed in the future. D. Extreme vomiting should be reported to your physician. E. H. pylori can be a concern in patients with peptic ulcers. F. The goal of initial intervention is to control symptoms and prevent further complications. Correct answer- A, D, E, F A 64-year-old patient with a history of arthritis and hypertension is admitted with progressive epigastric cramping, dyspepsia, nausea, and dark sticky stools for 2 days. Which order should the nurse question? A. IV fluids, normal saline at 125 ml/hr B. Guaiac stool sample × 2 C. Naproxen (Naprosyn) 500 mg twice daily D. Stool sample for bacterial testing Correct answer- C What is the nursing priority in the management of a patient with an active upper GI bleed? A. Obtain vital signs. B. Apply oxygen by nasal cannula. C. Type and crossmatch the patient for blood products. D. Notify the physician. Correct answer- A At the oncologist's office, the patient tells the nurse that he has been experiencing vomiting and diarrhea. He states that he is tired all the time and has lost about 15 pounds over the past month. What diagnostic test would take priority at this time? A. Stool for fecal occult blood B. Serum electrolytes C. Colonoscopy D. EGD Correct answer- A The patient's stool is positive for occult blood and he is admitted to the inpatient oncology unit 3 hours later. Two hours after admission, the patient is passing bright red blood from his rectum. Which location does this suggest for the patient's tumor? A. Transverse colon B. Descending colon C. Ascending colon D. Rectosigmoid colon Correct answer- D 3 days postop, what assessment of stool would the nurse expect? A. Very little stool and mostly gas B. Diarrhea liquid stool C. Pasty stool D. More solid stool Correct answer- D What symptom does the nurse expect the patient with intussusception to exhibit? A. Decrease in pulse B. Extremely elevated body temperature C. Singultus (hiccups) D. Frequent bloody stools Correct answer- C Which ethnic group has a higher incidence of colorectal cancer? A. Hispanic/Latino B. Asian C. Caucasian D. African-American Correct answer- D An older patient diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse should monitor the patient for what priority assessment? A. Dehydration B. Hypokalemia C. Hypernatremia D. Perineal skin breakdown Correct answer- A A patient has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor the patient's laboratory results for evidence of which condition? A. Hypernatremia B. Hypercalcemia C. Hyperglycemia D. Hyperkalemia Correct answer- C The patient's assessment reveals yellowish coloration of skin and sclerae. Which laboratory values would the nurse expect to find with this patient? A. Increased direct bilirubin, decreased indirect bilirubin B. Decreased direct bilirubin, increased indirect bilirubin C. Increased direct bilirubin, increased indirect bilirubin D. Increased urine bilirubin, decreased direct bilirubin Correct answer- C Which assessment parameter requires immediate intervention in a patient with severe ascites? A. Shallow respirations, rate 32 breaths/min B. Temperature 38.2° C C. Confusion D. Tachycardia, rate 110 beats/min Correct answer- A What is the priority intervention in the management of a patient with decompensated cirrhosis? A. Limiting protein intake B. Monitoring fluid intake and output C. Managing nausea and vomiting D. Elevating the head of bed 30 degrees Correct answer- C What is a primary reason for a higher incidence of liver cancer in the United States? A. Incidence of illicit drug use B. Rising obesity C. Incidence of hepatitis C D. Increased Asian population Correct answer- C Which laboratory finding corroborates the diagnosis of acute pancreatitis? A. Serum lipase, 150 U/L B. Serum amylase, 200 U/L C. White blood cells, 6000 mcL D. Serum glucose, 80 mg/dL Correct answer- B In preparing to care for the patient, which conditions does the nurse recognize as potential complications of acute pancreatitis? (Select all that apply.) A. Pancreatic infection B. Pleural effusion C. Diabetes mellitus D. Acute kidney failure E. Hemorrhage F. Pneumonia Correct answer- A, B, C, D, E, F A patient with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which laboratory analysis is a priority in the nurse's assessment of this patient? A. Liver function tests B. Total bilirubin C. Lipase level D. White blood cell count Correct answer- B In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention? A. Heart rate of 105 beats/min B. Blood pressure of 102/76 mm Hg C. Respiratory rate of 28 breaths/min D. Serum glucose of 136 mg/dL Correct answer- C A client is scheduled for an EMG. The nurse provides teaching to the patient about the EMG. Which statement made by the patient signifies the need for more teaching? A. "I may have discomfort after the procedure." B. "I will not put on any lotion before the procedure." C. "I will receive a sedative shortly before the procedure." D. "I should not smoke 2-3 hours before the procedure." Correct answer- C A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? A. Anxiety B. Powerlessness C. Ineffective denial D. Risk for disuse syndrome Correct answer- B A nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect? A. Confusion B. Loss of half of visual field C. Shallow respirations D. Tonic-clonic seizures Correct answer- C When the family of the client newly diagnosed with amyotrophic lateral sclerosis (ALS) asks the nurse what the disease will eventually cause, the nurse responds that the client will eventually demonstrate which of the following signs of the disease? A. Paralysis of the extremities B. Dementia C. Blindness D. Deafness Correct answer- A Which of the following is false, regarding the use of riluzole? A. Riluzole promotes the build-up of glutamate in the nerve-cell junction. B. If a dose is missed, omit that dose and take it at the next scheduled time. C. When taking riluzole, it is important to notify the doctor of any febrile illnesses. D. Hepatitis is a life-threatening side effect of taking riluzole. Correct answer- A A client has a diagnosis of a CVA versus a TIA. Which of the following statements show a difference between a TIA and a CVA? A. TIA typically resolve in 24 hours B. TIA may cause permanent motor deficit C. TIA may be hemorrhagic in origin. D. TIA may predispose a client to a myocardial infraction (MI). Correct answer- A Which of the following symptoms would the nurse expect to find when assessing a client for TIA? (Select all that apply) A. Weakness in arm, hand, or leg B. Numbness in the face, arm or hand C. Blurred vision D. Tachypnea E. Dysarthria (slurred speech) Correct answer- A, B, C, E All of the following statements are true regarding a transient ischemic attack (TIA) except: A. It is not unusual for symptoms to resolve by the time the patient reaches the ED B. A TIA lasts few minutes to fewer than 24 hours C. TIA symptoms normally last fewer than 30 minutes D. Multiple TIAs indicates a high stroke risk Correct answer- C Common modifiable risk factors for developing a stroke include (Select all that apply): A. Smoking B. Cocaine abuse C. Oral contraceptive use D. Migraine headaches E. Obesity Correct answer- A, B, C, E The nurse is assessing a 37 year old client diagnosed with MS. Which of the following symptoms would the nurse expect to find? A. Vision changes B. Absent deep tendon reflexes C. Tremors at rest D. Flaccid muscles Correct answer- A A patient with MS tells the nursing assistant that after physical therapy she is too tired to take a bath. What is your priority nursing diagnosis at this time? A. Fatigue r/t disease state B. Activity intolerance due to generalized weakness C. Impaired physical mobility r/t neuromuscular impairment D. Self-care deficient r/t fatigue and neuromuscular weakness Correct answer- D When teaching patients who are at risk for Bell's Palsy because of previous herpes simplex infection, which information should the nurse include? A. You should call the doctor if pain or herpes lesions occur near the ear B. Treatment of herpes with antiviral agents will prevent development of Bell's Palsy C. Medications to treat Bell's Palsy work only if started before paralysis onset D. You may be able to prevent Bell's Palsy by doing facial exercises regularly Correct answer- A A patient with Bell's Palsy refuses to eat while others are present because of embarrassment about drooling. The best response by the nurse to the patient's behavior is to: A. Respect the patient's desire and arrange for privacy at mealtimes B. offer the patient liquid nutritional supplements at frequent intervals C. discuss the patient's concerns with visitors who arrive at mealtimes D. teach the patient to chew food on the unaffected side of the mouth Correct answer- A HSV-1; corticosteroids (high dose, then taper for 7 days) A. Most common cause of Bell's Palsy is ... infection and treatment with ... B. Most common treatment is ... ... C. Lesion is in L/R D. RHS also involves a painful ... and treatment with ... Correct answer- A The patient reports falling when he his foot got "stuck" on a crack in the sidewalk, hitting his head when he fell, and describing "the worst headache of my life." This is a classic scenario for which complication? A. Epidural hematoma B. Subdural hematoma C. Subarachnoid bleed D. Diffuse axial injury Correct answer- C Which would NOT be a nursing intervention for a patient with an aneurysm at risk for a subarachnoid hemorrhage? A. Place patient on bedrest B. Provide laxative and stool softeners C. Treat headache and anxiety D. Ensure head of bed is between 60 - 90 degrees Correct answer- D Mrs. M-W has been diagnosed with grade II subarachnoid hemorrhage secondary to cerebral aneurysm rupture. What is an appropriate IV solution for the nurse to administer? A. 0.25% NaCl B. Lactated Ringer's solution C. D5 NaCl D. 2.5% dextrose Correct answer- C