MED SURG 211 Exam 2 Practice – Questions and Answers Latest 2022

MED SURG 211 Exam 2 Practice – Questions and Answers Latest 2022. The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG) injection? A. A caregiver who lives in the same household with the patient Correct B. A friend who delivers meals to the patient and family each week C. A relative with a history of hepatitis A who visits the patient daily D. A child living in the home who received the hepatitis A vaccine 3 months ago IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 mw3onth previously or who have a history of HAV infection do not require IG. 2. 2.ID: 59 The nurse provides discharge instructions for a 64-yr-old woman with ascites and peripheral edema related to cirrhosis. Which patient statement indicates teaching was effective? A. “Lactulose should be taken every day to prevent constipation.” B. “It is safe to take acetaminophen up to four times a day for pain.” C. “Herbs and other spices should be used to season my foods instead of salt.” Correct D. “I will eat foods high in potassium while taking spironolactone (Aldactone).” A low-sodium diet is indicated for patients with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided because these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces. 3. 3.ID: 67 The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect? A. Hematochezia B. Left upper abdominal pain Correct C. Ascites and peripheral edema D. Temperature over 102o F (38.9o C) Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner’s spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen’s sign, a bluish periumbilical discoloration). 4. 4.ID: 63 The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer? 1 A. A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia B. A 72-yr-old African American man who has smoked cigarettes for 50 years Correct C. A 23-yr-old man who has cystic fibrosis–related pancreatic enzyme insufficiency D. A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer compared with nonsmokers. The risk is related to duration and number of cigarettes smoked. 5. 5.ID: 61 The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates understanding of the instructions? A. “This medication will help me digest fats and fat-soluble vitamins.” B. “I will apply the medicated lotion sparingly to the areas where I itch.” C. “The medication is a powder and needs to be mixed with milk or juice.” Correct D. “I should take this medication on an empty stomach at the same time each day.” For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration. 6. 6.ID: 91 A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? A. Starvation B. Pancreatitis Correct C. Systemic sepsis D. Diabetic ketoacidosis The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal, 30-122 U/L) and serum lipase (normal, 31- 186 U/L) levels as shown. 7. 7.ID: 83 The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective? A. Relief of constipation B. Relief of abdominal pain C. Decreased liver enzymes D. Decreased ammonia levels Correct 2 Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy. An additional finding may be an improvement in level of consciousness. 8. 8.ID: 03 The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response by the nurse is most appropriate? A. “You will need to be tested first; then treatment can be determined.” B. “The hepatitis vaccine will provide immunity from this and future exposures.” C. “There is nothing you can do since the patient was infectious before admission.” D. “An immunoglobulin injection will be given to prevent infection or limit symptoms.” Correct Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis. 9. 9.ID: 87 When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? A. Impaired skin integrity related to edema, ascites, and pruritus B. Imbalanced nutrition: less than body requirements related to anorexia C. Excess fluid volume related to portal hypertension and hyperaldosteronism D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Correct Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities. We offer online tutoring, help with assignments and essay writing for all Majors with a guaranteed pass. For assistance Email Tutor Lucas: