MEDSURGE FINAL EXAM 2022-LATEST UPDATE

MEDSURGE FINAL EXAM 2022-LATEST UPDATE How should the nurse determine the correct length of a nasogastric tube for placement into the stomach? A) Place the distal tip to the nose, then the ear tip and the end of the xyphoid process. B) Instruct the patient to lie prone and measure tip of nose to umbilical area. C) Insert the tube into nose until the tube fills with secretions. D) Obtain an order from the physician for the number of inches to insert the tube. Ans A To insert the nasal gastric tube, the patient should be in a neutral position. The tube is measured by placing the distal tip to the nose, to the ear tip, and the end of the xyphoid process, adding 6 inches. Which of the following should be included in the nursing management of a nasogastric tube? A) Confirm the placement of the nasogastric tube prior to medication administration. B) Have the patient sip cool water to stimulate saliva production. C) Keep the patient in a low-Fowler's position. D) Connect the tube to continuous wall suction. Ans A Nursing management of the nasogastric tube includes checking placement of the tube when using it for administration of medication. If the NG tube is used for decompression, it is attached to intermittent low suction. Patients with a nasogastric tube should be maintained on an NPO status. During the placement of a nasogastric tube, the patient should be positioned in a Fowler's position. A patient who is having difficulty clearing the airway, has a respiratory rate of 28 and a temperature of 38.9° C. The patient has a nasogastric tube. What might this assessment indicate? A) Angina B) Hyperglycemia C) Fistula D) Aspiration pneumonia Ans D Pulmonary complications from nasogastric tube placement can occur from aspiration or impairment of clearing the airway. Signs and symptoms include difficulty clearing the airway, tachypnea, and fever. The nurse is reviewing discharge instructions with a patient ordered to take ursodeoxycholic acid (UDCA). The nurse recognizes that additional teaching is needed regarding this medication when the patient states: A) "It is important that I see my physician for scheduled follow-up appointments while taking this medication." B) "I will take this medication for 2 weeks and then gradually stop taking it." C) "If I loose weight, the dose of the medication may change." D) "This medication will help dissolve small gallstones made of cholesterol." Ans B Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. This drug can reduce the size of existing stones, dissolve small stones, and prevent new stones from forming. Six to 12 months of therapy is required in many patient to dissolve stones, and monitoring of the patient is required during this time. The effective dose of medication depends on body weight. The nurse is caring for a patient who had surgery for gallbladder disease. Which of the following finding should the nurse immediately report to the physician? A) Decreased breath sounds B) Drainage of bile-colored fluid onto the abdominal dressing C) Rigidity of the abdomen D) Acute pain with movement Ans C The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain and this may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery, and analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, and this will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure. While assessing an elderly patient with gallstones, the nurse in aware that the patient may not exhibit typical symptoms. The elderly patient may exhibit symptoms including: A) Fever and pain B) Chills and jaundice C) Nausea and vomiting D) Septic shock and oliguria Ans D The elderly patient may not exhibit the typical symptoms of fever, pain, chills jaundice, and nausea and vomiting. Symptoms of biliary tract disease in the elderly may be accompanied or preceded by those of septic shock, which include oliguria, hypotension, change in mental status, tachycardia, and tachypnea. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown? a. Ileostomy. b. Ascending colostomy. c. Transverse colostomy. d. Descending colostomy. Ans A Based upon the pathophysiology of acute pancreatitis, select the priority nursing diagnosis: A) Hyperthermia B) Acute pain C) Diarrhea D) Nausea The patient with pancreatitis is at risk for numerous complications related to the disorder. The nurse is aware that is it necessary to assess for the onset of complications and take measures to decrease the risk. Considering this information, the nurse positions the patient in a: A) Supine position B) Lithotomy position C) Trendelenburg position D) Semi-Fowler's position Ans D The priority nursing diagnosis related to the care of a patient with chronic pancreatitis with drainage through the skin and abdominal wall is: A) Disturbed body image B) Impaired skin integrity C) Nausea D) Risk for deficient fluid volume Ans B What technique will the nurse use to palpate a patient's liver? A) Place the hand under the left lower rib cage and press down lightly with the other hand B) Place the left hand over the abdomen and behind the left side at the 11th rib C) Place hand under the right lower rib cage and press down lightly with the other hand D) Hold the hand 90 degrees to the abdomen and push down firmly Ans C The nurse is aware that a patient with liver failure often requires vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? A) Vitamin B12 B) Vitamin A C) Vitamin D D) Vitamin K Ans D The liver requires vitamin K for the synthesis of prothrombin and some of the other clotting factors. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of metabolism is limited, as during starvation or in uncontrolled diabetes. Vitamins stored in the liver include A, B12, D, and several of the B-complex vitamins. A nurse practitioner teaching a class on hepatitis informs the participants that which of the following occupations provides the greatest risk for contracting hepatitis B? A) Flight attendants B) Health care workers C) Firefighters D) Educators Ans B A patient has cancer of the liver and has a percutaneous biliary drainage system. Which of the following assessments should the nurse record on the patient's data sheet? A) Amount and color of drainage B) Temperature of drainage C) Odor of drainage D) Consistency of drainage Ans A The nurse who is assessing a patient in the emergency room with a history of chronic alcoholism is aware that the patient is at risk for which disease? A) Cirrhosis B) Renal failure C) Hepatitis D) Cardiovascular disease Ans A The nurse practicing in a community health clinic provides care to patients with varying histories. Which of the following individuals would the nurse consider to be at the highest risk for developing hepatitis D? A) Someone who traveled to a country where this is endemic B) A person who had sexual intercourse with a person infected with hepatitis A C) A patient who has hepatitis B D) Someone who came in contact with a person with hepatitis E Ans C : Hepatitis D requires hepatitis B surface antigen for its replication. While instructing a patient with ascites on dietary modification, the nurse will discuss the patient's need to restrict: A) Potassium B) Sodium C) Calcium D) Glucose Ans B While assessing a typical patient with cholecystitis who complains of localized pain, the nurse asks if the pain has radiated to the: A) Left upper arm B) Lower abdomen C) Neck or jaw D) Right shoulder Ans D The patient may have biliary colic with excruciating upper right abdominal pain that radiates to the back or right shoulder. The critical care nurse admitting a 55-year-old male with acute pancreatitis is aware that acute pancreatitis occurs when: A) Toxic substances inflame the pancreas. B) The patient abuses alcohol. C) Viruses digest the pancreas. D) Pancreatic enzymes digest the pancreas. Ans D Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the autodigestion of the pancreas. When assessing the patient with chronic pancreatitis, the nurse anticipates potential dysfunction of which of the following? A) Pancreatic islet cells B) Peristalsis C) Decrease in biliary stenosis D) Large bowel absorption Ans A For the patient with chronic pancreatitis, nonsurgical management of diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The patient has a gallstone blocking the bile duct. Upon assessment of the patient's laboratory studies, the nurse will expect to find a(n): A) Increased bilirubin level in the blood B) Decreased cholesterol level C) Increased BUN level D) Decreased serum alkaline phosphatase level Ans A : If the flow of blood is impeded, bilirubin, a pigment derived from the breakdown of red blood cells, does not enter the intestines. As a result, bilirubin levels in the blood increase. The operating nurse is assisting during a procedure in which the patient's gallbladder is removed with litigation of the cystic duct and artery. This procedure is known as a: A) Cholecystectomy B) Cholecystotomy C) Choledochostomy D) Choledocholithotomy Ans A A cholecystectomy is a procedure in which the gallbladder is removed through an abdominal incision after the cystic duct and artery are ligated. The patient is complaining of pain related to pancreatitis. The nurse would expect the patient's pain to be in the abdomen and the: A) Left lower quadrant B) Midepigastric area C) Back D) Midclavicular area Ans C Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical attention. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas. The nurse assesses that the patient is jaundiced. When the patient has a bowel movement, the nurse expects that the stool will be: A) Green B) Black C) Orange D) Pale-colored Ans D : If the flow of blood is impeded, bilirubin, a pigment derived from the breakdown of red blood cells, does not enter the intestines. As a result the stool is a pale-colored. The nurse in a health clinic cares for a wide range of individuals. On this given morning, which of the following patients seeking care has the greatest risk for developing gallbladder disease? A) A 45-year-old woman with two children B) A 35-year-old man who is a social drinker C) A 48-year-old obese woman with four children D) A 17-year-old girl with a high-fat diet Ans C Four times more women than men develop cholesterol stones and gallbladder disease; the women are usually older than 40, multiparous, and obese. The nurse in a health clinic cares for a wide range of individuals. Which of the following patients is at an increased risk for an acute pancreatitis attack? A) A 45-year-old woman with a high-fat diet B) An 18-year-old man who is a weekend binge drinker C) A 45-year-old man with chronic alcoholism D) A 51-year-old woman who smokes one pack of cigarettes per day Ans C Patients who are typically affected by pancreatitis are men between 40 and 45 years of age with a history of alcoholism. A 40-year-old male patient enters the emergency department complaining of nausea and vomiting and severe abdominal pain. While assessing the patient, the patient's wife informs the nurse that the patient had ingested 24 oz of alcohol last evening. The patient's abdomen is rigid, and there is bruising to the patient's flank. The patient is exhibiting signs of: A) Severe pancreatitis with possible peritonitis B) Acute cholecystitis C) Obstruction of the bowel D) Acute appendicitis Ans A Severe abdominal pain is the major symptom of pancreatitis that causes patients to seek medical care. The pain of pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. During an acute pancreatitis attack, what intervention will the nurse include in the patient's plan of care? A) Administer morphine injections every 4 hours as ordered for pain. B) Withhold oral intake as ordered. C) Limit coffee intake to 2 cups a day. D) Administer 1 oz of brandy at bedtime to aid relaxation. Ans B pancreatic stimulation and secretion of pancreatic enzymes. Morphine should not be used because it has been thought to cause spasm at the sphincter of Oddi. Coffee and alcohol should also be restricted. The nurse is analyzing the diagnostic study results of a patient admitted with acute pancreatitis. What diagnostic findings are consistent with the diagnosis of acute pancreatitis? A) Decrease in amylase and lipase levels B) Fluid and electrolyte imbalance C) Hypercalcemia D) Proteinuria Ans B Fluid and electrolyte imbalances are common complications of pancreatitis because of nausea and vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? A) Fried chicken B) Mashed potatoes C) Dinner roll D) Tapioca pudding Ans A The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, coffee, or tea may be added as tolerated. The patient should avoid fried foods such as fried chicken, as fatty foods may bring on an episode of cholecystitis. The nurse is reviewing discharge instructions with a patient ordered to take ursodeoxycholic acid (UDCA). The nurse recognizes that additional teaching is needed regarding this medication when the patient states: A) "It is important that I see my physician for scheduled follow-up appointments while taking this medication." B) "I will take this medication for 2 weeks and then gradually stop taking it." C) "If I loose weight, the dose of the medication may change." D) "This medication will help dissolve small gallstones made of cholesterol." A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the health care provider for which type of diet for this client? a. A high-carbohydrate diet b. A high-protein diet c. A low-fiber diet d. A low-fat diet Ans C A patient admitted with diverticulitis is being prepared for discharge from the hospital. The nurse is providing patient teaching related to dietary considerations. The nurse will instruct the patient to consume a diet that is: A) High in fiber and low in fat B) High in fiber and high in fat C) Low in fiber and low in fat D) Low in fiber and high in fat Ans A Initially, the diet for diverticulitis is clear liquids until the inflammation subsides; then, a high-fiber, low-fat diet is recommended. The nurse plans care for a client postoperatively following creation of a colostomy. Which potential client problem should the nurse include in the plan of care? a. Sexual dysfunction b. Upset about appearance c. Fear d. Anxiety Ans B Which of the following should be included in patient teaching to prevent constipation? A) Establish a bowel routine based upon the fact that the best time for defecation is after dinner. B) Exercise may prolong a bowel movement. C) Consume high-residue, high-fiber foods. D) Resist the urge to defecate until the scheduled time. Ans C The patient arrives in the clinic with a complaint of altered bowel habits and has a family history of ulcerative colitis. The stools of these patients are characteristically: A) Watery with blood and mucus B) Hard and black C) Long and cylinder shaped D) Loose and fatty Ans A The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? a. Chalky gray stool b. Dry, hard, constipated stool c. Loose, watery stool d. Blood in the stool Ans C Which of the following terms will the nurse expect to see documented on the patient's chart to describe intestinal obstruction caused by a telescoped shortening of the intestine? A) Intussusception B) Volvulus C) Herniation D) Adhesion Ans A : Intussusception refers to a telescoped shortening of the intestine, while herniation refers to protrusion of intestine through a weakened area in the abdominal muscle or wall. Adhesion is the adherence of loops of intestine to areas that heal slowly or scar after abdominal surgery. Volvulus causes gas and fluid to accumulate in the tapped bowel. A patient suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis? A) Stool Hematest B) Carcinoembryonic antigen (CEA) C) Colonoscopy D) Abdominal computed tomography (CT) scan Ans C Used to visualize the entire colon, colonoscopy aids in the detection of colorectal cancers. Abdominal CT scans are used to stage the presence of colorectal cancer. CEA may be elevated in colorectal cancer but isn't considered a confirming test. A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment? a. Nausea and vomiting b. A rigid, boardlike abdomen c. Bradycardia d. Numbness in the legs Ans B The nurse is caring for a client with pernicious anemia. Which prescription by the health care provider (HCP) should the nurse anticipate? a. Folic acid b. Vitamin B6 c. Vitamin B12 d. Iron Ans C A nurse plans care for a client with Crohn’s disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client’s plan of care? a. Intravenous Glucocorticoids b. Antibiotic administration c. Skin protection d. Low-fiber diet Ans C The nurse is assessing a patient diagnosed with appendicitis. Which of the following signs or symptoms should the nurse expect to find? A) Rigid abdomen, Levine's sign, pain relief leaning forward B) Rebound tenderness, McBurney's sign, low-grade fever C) Right lower-quadrant pain, Chvostek's sign, muscle guarding D) Periumbilical pain, Trousseau's sign, pain relief with pressure Ans B Rebound tenderness, McBurney's sign (pain midway between the umbilicus and the right iliac crest), and a low-grade fever are all signs of appendicitis. Other clinical findings include a rigid abdomen, a preference to lie still with right leg flexed, right lower quadrant pain, muscle guarding, periumbilical pain, anorexia, nausea, and vomiting. The other findings aren't signs of appendicitis. The nurse is caring for a patient with a mechanical intestinal obstruction. Diagnostic studies indicate that the bowel is twisted and turned on itself. The nurse is aware that this condition is a(n): A) Intussusception B) Volvulus C) Hernia D) Tumor Ans B A volvulus occurs when the bowel twists and turns on itself. Intussusception occurs when one part of the intestine slips into another part located below it (like a telescope shortening). A hernia is the protrusion of the intestine through a weakened area in the abdominal muscle or wall. A tumor that exists within the wall of the intestine extends into the intestinal lumen, or a tumor outside the intestine causes pressure on the wall of the intestine. The nurse is aware that a patient with liver failure often requires vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? A) Vitamin B12 B) Vitamin A C) Vitamin D D) Vitamin K Ans D The liver requires vitamin K for the synthesis of prothrombin and some of the other clotting factors. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of metabolism is limited, as during starvation or in uncontrolled diabetes. Vitamins stored in the liver include A, B12, D, and several of the B-complex vitamins. A patient has a blocked bile duct from a tumor. The nurse can expect the patient's urine to be: A) Dark amber and concentrated B) Orange and foamy C) Rust colored and concentrated D) Pale yellow and dilute ANs B If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. The nurse caring for a patient with portal hypertension will assess for which finding? A) Bowel obstruction B) Vitamin A deficiency C) Ascites D) Hepatic encephalopathy Ans C Obstruction of blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity The nurse who is assessing a patient in the emergency room with a history of chronic alcoholism is aware that the patient is at risk for which disease? A) Cirrhosis B) Renal failure C) Hepatitis D) Cardiovascular disease The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication? a. Malnutrition b. Infection c. Dehydration d. Bleeding Ans D A nurse received an accidental needle stick while giving an IM injection. The greatest threat for the nurse is: A) Hepatitis B (HBV) B) Hepatitis C (HCV) C) Human immunodeficiency virus (HIV) D) Hepatitis A (HAV) Ans A The nurse assisting with a percutaneous liver biopsy assists the physician in positioning the patient at the completion of the procedure. The patient will be: A) Positioned on his right side with a pillow under the costal margin B) Placed in a supine position C) Positioned on his left side with a pillow under his knees D) Placed in a Trendelenburg position Ans A Immediately after a percutaneous liver biopsy, assist the patient in turning onto the right side and place a pillow under the costal margin. Instruct the patient to remain in this position, recumbent and immobile, for several hours. When assessing the patient with liver dysfunction for jaundice, the nurse will assess the patient's: A) Skin, nail beds, and body temperature B) Skin, mucosa, and sclera C) Mucosa, hair, and nail beds D) Sclera, lips, and hair Ans B The nurse will inspect the skin, mucosa, and sclera for jaundice. Jaundice is caused by an increased bilirubin concentration in the blood. It does not lead to changes in the hair or body temperature of the patient. Upon review of the history a patient ordered to receive vasopressin for bleeding esophageal varices, the nurse calls the physician to question the use of this medication when she reads that the patient has a history of: A) Diabetes mellitus B) Chronic kidney disease C) Arthritis D) Coronary artery disease Ans D Coronary artery disease is a contraindication to the use of vasopressin because coronary vasoconstriction is a side effect that may precipitate myocardial infarction. The nurse assessing that the patient with hepatic encephalopathy who has a flapping tremor of the hands will document this condition in the patient's chart as: A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Palmar erythema Ans A The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath that is not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but it is not a flapping tremor. A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the health care provider for which type of diet for this client? a. A high-carbohydrate diet b. A high-protein diet c. A low-fiber diet d. A low-fat diet Ans C A patient admitted with diverticulitis is being prepared for discharge from the hospital. The nurse is providing patient teaching related to dietary considerations. The nurse will instruct the patient to consume a diet that is: A) High in fiber and low in fat B) High in fiber and high in fat C) Low in fiber and low in fat D) Low in fiber and high in fat Ans A Initially, the diet for diverticulitis is clear liquids until the inflammation subsides; then, a high-fiber, low-fat diet is recommended. The nurse plans care for a client postoperatively following creation of a colostomy. Which potential client problem should the nurse include in the plan of care? a. Sexual dysfunction b. Upset about appearance c. Fear d. Anxiety Ans B Which of the following should be included in patient teaching to prevent constipation? A) Establish a bowel routine based upon the fact that the best time for defecation is after dinner. B) Exercise may prolong a bowel movement. C) Consume high-residue, high-fiber foods. D) Resist the urge to defecate until the scheduled time. Ans C The patient arrives in the clinic with a complaint of altered bowel habits and has a family history of ulcerative colitis. The stools of these patients are characteristically: A) Watery with blood and mucus B) Hard and black C) Long and cylinder shaped D) Loose and fatty Ans A The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? a. Chalky gray stool b. Dry, hard, constipated stool c. Loose, watery stool d. Blood in the stool Ans C Which of the following terms will the nurse expect to see documented on the patient's chart to describe intestinal obstruction caused by a telescoped shortening of the intestine? A) Intussusception B) Volvulus C) Herniation D) Adhesion Ans A : Intussusception refers to a telescoped shortening of the intestine, while herniation refers to protrusion of intestine through a weakened area in the abdominal muscle or wall. Adhesion is the adherence of loops of intestine to areas that heal slowly or scar after abdominal surgery. Volvulus causes gas and fluid to accumulate in the tapped bowel. A patient suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis? A) Stool Hematest B) Carcinoembryonic antigen (CEA) C) Colonoscopy D) Abdominal computed tomography (CT) scan Ans C Used to visualize the entire colon, colonoscopy aids in the detection of colorectal cancers. Abdominal CT scans are used to stage the presence of colorectal cancer. CEA may be elevated in colorectal cancer but isn't considered a confirming test. A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment? a. Nausea and vomiting b. A rigid, boardlike abdomen c. Bradycardia d. Numbness in the legs Ans B The nurse is caring for a client with pernicious anemia. Which prescription by the health care provider (HCP) should the nurse anticipate? a. Folic acid b. Vitamin B6 c. Vitamin B12 d. Iron Ans C A nurse plans care for a client with Crohn’s disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client’s plan of care? a. Intravenous Glucocorticoids b. Antibiotic administration c. Skin protection d. Low-fiber diet Ans C The nurse is assessing a patient diagnosed with appendicitis. Which of the following signs or symptoms should the nurse expect to find? A) Rigid abdomen, Levine's sign, pain relief leaning forward B) Rebound tenderness, McBurney's sign, low-grade fever C) Right lower-quadrant pain, Chvostek's sign, muscle guarding D) Periumbilical pain, Trousseau's sign, pain relief with pressure Ans B Rebound tenderness, McBurney's sign (pain midway between the umbilicus and the right iliac crest), and a low-grade fever are all signs of appendicitis. Other clinical findings include a rigid abdomen, a preference to lie still with right leg flexed, right lower quadrant pain, muscle guarding, periumbilical pain, anorexia, nausea, and vomiting. The other findings aren't signs of appendicitis. The nurse is caring for a patient with a mechanical intestinal obstruction. Diagnostic studies indicate that the bowel is twisted and turned on itself. The nurse is aware that this condition is a(n): A) Intussusception B) Volvulus C) Hernia D) Tumor Ans B A volvulus occurs when the bowel twists and turns on itself. Intussusception occurs when one part of the intestine slips into another part located below it (like a telescope shortening). A hernia is the protrusion of the intestine through a weakened area in the abdominal muscle or wall. A tumor that exists within the wall of the intestine extends into the intestinal lumen, or a tumor outside the intestine causes pressure on the wall of the intestine. The nurse is aware that a patient with liver failure often requires vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? A) Vitamin B12 B) Vitamin A C) Vitamin D D) Vitamin K Ans D The liver requires vitamin K for the synthesis of prothrombin and some of the other clotting factors. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of metabolism is limited, as during starvation or in uncontrolled diabetes. Vitamins stored in the liver include A, B12, D, and several of the B-complex vitamins. A patient has a blocked bile duct from a tumor. The nurse can expect the patient's urine to be: A) Dark amber and concentrated B) Orange and foamy C) Rust colored and concentrated D) Pale yellow and dilute ANs B If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. The nurse caring for a patient with portal hypertension will assess for which finding? A) Bowel obstruction B) Vitamin A deficiency C) Ascites D) Hepatic encephalopathy Ans C Obstruction of blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity The nurse who is assessing a patient in the emergency room with a history of chronic alcoholism is aware that the patient is at risk for which disease? A) Cirrhosis B) Renal failure C) Hepatitis D) Cardiovascular disease The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication? a. Malnutrition b. Infection c. Dehydration d. Bleeding Ans D A nurse received an accidental needle stick while giving an IM injection. The greatest threat for the nurse is: A) Hepatitis B (HBV) B) Hepatitis C (HCV) C) Human immunodeficiency virus (HIV) D) Hepatitis A (HAV) Ans A The nurse assisting with a percutaneous liver biopsy assists the physician in positioning the patient at the completion of the procedure. The patient will be: A) Positioned on his right side with a pillow under the costal margin B) Placed in a supine position C) Positioned on his left side with a pillow under his knees D) Placed in a Trendelenburg position Ans A Immediately after a percutaneous liver biopsy, assist the patient in turning onto the right side and place a pillow under the costal margin. Instruct the patient to remain in this position, recumbent and immobile, for several hours. When assessing the patient with liver dysfunction for jaundice, the nurse will assess the patient's: A) Skin, nail beds, and body temperature B) Skin, mucosa, and sclera C) Mucosa, hair, and nail beds D) Sclera, lips, and hair Ans B The nurse will inspect the skin, mucosa, and sclera for jaundice. Jaundice is caused by an increased bilirubin concentration in the blood. It does not lead to changes in the hair or body temperature of the patient. Upon review of the history a patient ordered to receive vasopressin for bleeding esophageal varices, the nurse calls the physician to question the use of this medication when she reads that the patient has a history of: A) Diabetes mellitus B) Chronic kidney disease C) Arthritis D) Coronary artery disease Ans D Coronary artery disease is a contraindication to the use of vasopressin because coronary vasoconstriction is a side effect that may precipitate myocardial infarction. The nurse assessing that the patient with hepatic encephalopathy who has a flapping tremor of the hands will document this condition in the patient's chart as: A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Palmar erythema Ans A The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath that is not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but it is not a flapping tremor. An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the client’s lower abdomen. Which action should the nurse take first? a. Measure the client’s abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the client’s hemoglobin and hematocrit. d. Obtain the client’s complete health history. B An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first? a. Send a blood sample for a type and crossmatch. b. Insert a large intravenous line for fluid resuscitation. c. Obtain the heart rate and blood pressure. d. Assess and maintain a patent airway. Ans D A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this client’s plan of care? a. “You may experience nausea and vomiting for the first few weeks.” b. “Carbonated beverages can help decrease acid reflux from anastomosis sites.” c. “Take a stool softener to promote softer stools for ease of defecation.” d. “You may return to your normal workout schedule, including weight lifting.” Ans C 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 Ans 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. Hyperkalemia B. Hypernatremia C. Hypercalcemia D. Hyperglycemia Ans D A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion Ans A A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion A 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 probably got it by engaging in unprotected sex.” b. “You could have gotten it by using I.V. drugs.” c. “You may have eaten contaminated restaurant food.” d. “You must have received an infected blood transfusion.” Ans C Which of the following dietary measures would be useful in preventing esophageal reflux? Select one: a. Adding a bedtime snack to the dietary plan b. Eating small, frequent meals c. Avoiding air swallowing with meals d. Increasing fluid intake Ans B A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client’s teaching? a. “Drink plenty of fluids to prevent dehydration.” b. “You should only drink 1 liter of fluids daily.” c. “Increase your protein intake by drinking more milk.” d. “Sips of cola or tea may help to relieve your nausea.” Ans A A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a. Inspection of oral mucosa b. Recent dietary intake c. Heart rate and rhythm d. Percussion of abdomen Ans C A nurse obtains a client’s health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. “I drink two glasses of red wine each week.” b. “I take a lot of Tylenol for my arthritis pain.” c. “I have a cousin who died of liver cancer.” d. “I got a hepatitis vaccine before traveling.” Ans B A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. “A low-protein diet will help the liver rest and will restore liver function.” b. “Less protein in the diet will help prevent confusion associated with liver failure.” c. “Increasing dietary protein will help the client gain weight and muscle mass.” d. “Low dietary protein is needed to prevent fluid from leaking into the abdomen.” Ans B A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner Ans A A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition Ans C 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. Skim milk b. Clear liquids c. Regular diet d. Nothing by mouth Ans D A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Ostomy pouch intact b. Pale and bluish stoma c. Liquid stool d. Blood-smeared output Ans B A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? a. The esophagus has become inflamed b. Additional ulcers have developed c. The ulcer has perforated d. An intestinal obstruction has developed Ans C An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider. Ans B The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor Ans C The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome? a. Limit the fluids taken with meals b. Eat high-carbohydrate foods c. Sit in a high-Fowlers position during meals d. Ambulate following a meal Ans A A nurse answers a client’s call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs. Ans c For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age Ans C The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question? a. Digoxin (Lanoxin) b. Indomethacin (Indocin) c. Furosemide (Lasix) d. Propranolol hydrochloride (Inderal) Ans B To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? a. “Avoid coffee and alcoholic beverages.” b. “Lie down after meals to promote digestion.” c. “Limit fluid intake with meals.” d. “Take antacids with meals.” Ans A . An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the family’s wishes. d. Tell the family that such secrets cannot be kept. Ans B The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs) Ans ABCE An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the client’s lower abdomen. Which action should the nurse take first? a. Measure the client’s abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the client’s hemoglobin and hematocrit. d. Obtain the client’s complete health history. Ans B A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to: a. take a blood pressure and pulse. b. pull the dehiscence closed. c. place saline-soaked sterile dressings on the wound. d. call the physician. Ans C You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority? a. Obtain vital signs, call the doctor, and obtain emergency orders. b. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees. c. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution. d. Ask the patient what happened, call the doctor, and cover the area with a water- soaked bedsheet. Ans C A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective? a. “I can only take this medicine at night.” b. “I should take this on a full stomach.” c. “This drug decreases stomach acid.” d. “This should be taken 1 hour before meals.” Ans B A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the client’s neck. What action by the nurse takes priority? a. Assess the client’s oxygenation. b. Facilitate a STAT chest x-ray. c. Prepare for immediate surgery. d. Start two large-bore IVs. Ans A A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac) Ans C The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections Ans ABCD The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a. “I just joined a gym, so I hope that helps me lose weight.” b. “I sure hate to give up my coffee, but I guess I have to.” c. “I will eat three small meals and three small snacks a day.” d. “Sitting upright and not lying down after meals will help.” e. “Smoking a pipe is not a problem and I don’t have to stop.” Ans ABCD Which of the following symptoms is common with a hiatal hernia? a. Lower back pain b. Left arm pain c. Abdominal cramping d. Esophageal reflux Ans D The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client’s abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs. Ans B The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? a. Supine with the head of the bed flat b. On the right side with the head of the bed elevated 30 degrees c. On the left side with the head of the bed elevated 30 degrees d. On the stomach with the head flat Ans C The nurse is caring for a patient who had a radical neck dissection for treatment of a malignant tumor. Which of the following nursing assessments would be a priority for this patient? A) Presence of acute pain and anxiety B) Tissue integrity and color of the operative site C) Respiratory status and airway clearance D) Self-esteem and body image Ans C All of the assessments above are part of the plan of care for a patient who has had a radical neck dissection but are not the nurse's chief priority. Assessment of respirations, a vital function, is the most important. It is crucial for the nurse to establish that the patient's breathing is within normal limits and that he is not experiencing initial symptoms of aspiration pneumonia due to inability to manage oral secretions. The nurse is developing a teaching plan for a patient with GERD who has a diagnosis of Barrett's esophagus. Which of the following information is essential to include? A) He will need to undergo an upper endoscopy every 6 to 12 months to detect malignant changes. B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C) Small amounts of blood are likely to be present in his stools and should not cause concern. D) Antacids may be discontinued when symptoms of heartburn subside. Ans A In the patient with Barrett's esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 to 12 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or which are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic Which of the following is the most significant risk factor for esophageal cancer? A) Delayed gastric emptying time B) Ingestion of 2 or more carbonated drinks daily C) Chronic gastroesophageal reflux disease (GERD) D) Persistent hiccups Ans C Chronic irritation of the esophagus is a major risk factor for esophageal cancer. GERD may progress to Barrett's esophagus, which may later progress to adenocarcinoma. Delayed gastric emptying time is a risk factor for gastric cancer. Persistent hiccups are associated with advanced gastric cancer and are caused by pressure placed on the phrenic nerve by a tumor. Ingestion of carbonated beverages is not associated with esophageal cancer; however, they do precipitate reflux. Which of the following patients is at the greatest risk for developing cancer of the tongue? A) A 65-year-old man with alcoholism who smokes B) A 45-year-old woman who smokes and has diabetes C) A 32-year-old man who uses smokeless tobacco and has hypertension D) A 57-year-old man with alcoholism and a history of dental caries Ans A Oral cancers are often associated with the use of alcohol and tobacco, which if used together have a synergistic carcinogenic effect. Research shows that about 75% cases of oral cancers occur in people over the age of 60. Men are more affected than women, but this is starting to change. A nurse is obtaining a health history. How might the nurse best determine the integrity to cranial nerve XII during the examination of the patient's oral cavity? A) Have the patient smile. B) Ask the patient to pucker his or her lips. C) Have the patient stick out his or her tongue and move it laterally. D) Have the patient roll his or her tongue. Ans C The patient is instructed to protrude his or her tongue and move it laterally to assess the integrity of cranial nerve XII. A nurse is caring for a patient diagnosed with esophageal reflux disorder. The patient should be advised to: A) Keep the head of the bed lowered. B) Drink a cup of hot tea before bedtime. C) Avoid carbonated drinks. D) Drink a carbonated drink after meals. Ans C For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. A high-fiber low-fat diet should be eaten daily. The patient is complaining of dysphagia, substernal pain, and regurgitation of undigested food. Based upon these symptoms, the nurse anticipates that the physician will schedule the patient for: A) An esophagogastroduodenoscopy (EGD) B) A colonoscopy C) A CAT scan of the head and neck D) A barium swallow Ans A The patient is exhibiting symptoms of cancer of the esophagus. Diagnosis is confirmed in 95% of cases by an EGD with biopsy and brushings.