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. We offer online tutoring, help with assignments and essay writing for all Majors with a guaranteed pass. For assistance Email Tutor Lucas: The nurse administering -interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for  a. leukopenia. c. polycythemia. b. hypokalemia. d. hypoglycemia. ANS: A Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not associated with this drug therapy.  DIF: Cognitive Level: Apply (application) REF: 981 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 6. Which information given by a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation. ANS: B Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries. DIF: Cognitive Level: Apply (application) REF: 976 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate? a. “Do you have a history of IV drug use?” b. “Do you use any over-the-counter drugs?” c. “Have you used corticosteroids for any reason?” d. “Have you recently traveled to a foreign country?” ANS: B The patient’s symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used over-the-counter drugs such as acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed. DIF: Cognitive Level: Apply (application)