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GALEN MEDSURG EXAM QUESTIONS WITH COMPLETE
SOLUTIONS WITH RATIONALE GUARANTEED PASS BRAND NEW
A client is provided with materials to obtain three fecal occult blood tests (Hem occult). What health teaching does the nurse provide? Select all that apply. A. "Avoid red meat and raw vegetables for a week before getting the samples." B. "Drink a gallon of GoLYTELY before you collect the first sample." C. "Do not take food or fluids for 24 hours before the test." D. "Do not take ibuprofen for a week before obtaining the samples." E. "Avoid vitamin C tablets, foods, and juices a week before getting the samples." - ANSWER - > Answer: A, D, E Rationale: To avoid obtaining false-positive results associated with fecal occult blood tests (Hem occult), patients must avoid certain foods before the test, such as raw fruits and vegetables and red meat. Vitamin C-rich foods, juices, and tablets must also be avoided. Anticoagulants, such as warfarin (Coumadin), and nonsteroidal antiinflammatory drugs should be discontinued for 7 days before testing begins.
What is a common gastrointestinal problem that older adults experience more frequently as they age? Decreased hydrochloric acid Excess lipase production Increased liver enzymes Increased peristalsis - ANSWER - > Atrophy of the gastric mucosa causes a decreased ratio of gastrin-secreting cells to somatostatinsecreting cells. This results in a decrease in hydrochloric acid, causing decreased absorption of iron and vitamin B12. In the pancreas, calcification of pancreatic vessels occurs, with a decrease in lipase production. The decrease in lipase results in decreased fat absorption and digestion. Steatorrhea and diarrhea can subsequently occur. The number and size of hepatic cells are decreased, which results in decreased enzyme activity; decreased liver enzyme activity depresses drug metabolism, and therefore may cause accumulation of drugs to toxic levels. In the large intestine, peristalsis is decreased and nerve impulses are dulled, which can result in postponement of bowel movements in older adults. A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation Examines the RUQ of the abdomen last
The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect? Acute diarrhea Aortic aneurysm Intestinal obstruction Pancreatitis - ANSWER - > Peristaltic movements are rarely seen except in thin clients and should be reported since the finding may indicate an intestinal obstruction. Acute diarrhea does not cause visible peristaltic movements. Aortic aneurysm may cause a bulging, pulsatile mass. Pancreatitis is characterized by severe pain. The nurse practitioner is performing an abdominal assessment on a newly admitted client. In which order should the nurse proceed with assessment technique? Auscultation, percussion, palpation, inspection Inspection, auscultation, percussion, palpation Palpation, percussion, inspection, auscultation Percussion, auscultation, palpation, inspection - ANSWER - > The abdomen is assessed by using the four techniques of examination, but in a sequence different from that used for other body systems: inspection, auscultation, percussion, and then palpation. This sequence is preferred so that palpation and percussion do not increase intestinal activity and bowel sounds. Nurse generalists may perform inspection, auscultation, and light palpation; percussion and deep palpation may be done by advanced practice nurses.
A client with gastroesophageal reflux disease (GERD) is prescribed to start pantoprazole (Protonix) 40 mg every day. Which statement by the client requires further teaching by the nurse? A. "When I feel better, I can stop taking this drug." B. "I'll take this drug at 8 AM every morning." C. "This drug can cause headache and dizziness." D. "I should not crush the drug because it has a delayed release." - ANSWER - > Answer: A Rationale: Treatment for GERD should be continued even if a client begins to feel better. Discontinuation of therapy can result in return of original GERD symptoms, which can further damage esophageal tissues. Side effects of pantoprazole (Protonix) can include headache and dizziness, which should immediately be reported to the client's health care provider. This medication should be taken on a regular, predictable schedule because proton pump inhibitors provide effective, long-acting inhibition of gastric acid secretion by affecting the proton pump of the gastric parietal cells. This medication should not be crushed because of its delayed release properties. Over the past 3 months, a client with a history of gastroesophageal reflux disease and obesity has implemented lifestyle changes. What lifestyle changes does the nurse recognize as important for the client to decrease chances of development of cancer of the esophagus? Select all that apply. A. Lost 10 pounds
should be elevated approximately 6 inches. Both tea and coffee should be eliminated from this client's diet because of the caffeine content. The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a client diagnosed with esophageal cancer. Which instruction to the client is the highest priority? Place food at the back of the mouth as you eat. Do not be overly concerned with tongue or lip movements. Before swallowing, tilt the head back to straighten the esophagus. Do not attempt to reach food particles that are on the lips or around the mouth. - ANSWER
- > Placing food at the back of the mouth when eating will help the client avoid aspirating. Both tongue movements and sealing of the lips should be monitored in this client. The client's head should be tilted forward in the chin-tuck position. The client should be able to reach food particles on her or his lips and around the mouth with the tongue. A client has undergone conventional esophageal surgery. The client's diet has been advanced to semi-solid, and feedings are well tolerated. The client reports experiencing diarrhea about 1 hour after each meal. What is the priority nursing intervention to help prevent further diarrhea? Ensure that the client takes adequate amounts of fluids with meals. Advance the diet to solid food and encourage eating as much as possible at meals. Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal.
Encourage the client to take fluids between meals rather than with meals. - ANSWER - > Diarrhea is believed to be the result of vagotomy syndrome and can be managed by taking fluids between meals rather than with meals. For this client, fluids with meals can lead to the development of diarrhea immediately after eating. The client may not be physically ready to advance to a solid diet. The client should eat six to eight small meals daily. Magnesium hydroxide is a magnesium-based antacid that can cause diarrhea. The nurse is reviewing orders for a client with possible esophageal trauma after a car crash. Which request does the nurse implement first? Give total parenteral nutrition (TPN) through a central venous catheter. Administer cefazolin (Kefzol) 1 g intravenously. Obtain a computed tomography (CT) scan of the chest and abdomen. Keep the client nothing by mouth (NPO) for possible surgery. - ANSWER - > Clients with possible esophageal tears should be NPO until diagnostic testing is completed, because leakage of anything taken orally into the sterile mediastinum could occur. In addition, esophageal rest is maintained for about 10 days after esophageal trauma to allow time for mucosal healing. TPN is prescribed to provide calories and protein for wound healing; although this is important, it is not a priority for the nurse to implement first. Antibiotics may be requested to prevent possible infection, but this is not the priority. A CT of the chest and abdomen will be needed, but is not the nurse's initial action.
The nurse is caring for a client diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the health care provider will request which medication to manage diarrhea? Loperamide (Imodium) Mesalamine (Pentasa) Minocycline (Minocin) Pantoprazole (Protonix) - ANSWER - > Diarrhea is thought to be the result of vagotomy syndrome, which develops as a result of interruption of vagal fibers to the abdominal viscera during surgery. It can occur 20 minutes to 2 hours after eating and can be symptomatically managed with loperamide. Mesalamine is used to treat clients with mild to moderate ulcerative colitis. Minocycline is an antibiotic used for treatment of infection. Pantoprazole is used to treat gastroesophageal reflux disease. The nurse is observing a co-worker who is caring for a client with a nasogastric tube following esophageal surgery. Which actions by the co-worker require the nurse to intervene? (Select all that apply.) Checking tube placement every 12 hours Keeping the bed flat Placing the client upright when taking sips of water Providing mouth care every 8 hours
Securing the tube - ANSWER - > The nasogastric tube should be checked every 4 to 8 hours. The head of the bed should be elevated at least 30 degrees. Oral hygiene should be provided every 2 to 4 hours. The client should be placed upright when taking sips or small amounts of water to prevent choking and to allow observation of the client for dysphagia. The tube should be secured to prevent dislodgment. The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order does the nurse assess these clients? A. A client planned for an esophagogastroduodenoscopy (EGD) at 1 PM (1300) B. A client requesting pain medication 2 days after a partial gastrectomy C. A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain D. A client who is NPO for tests to rule out gastric cancer - ANSWER - > Answer: C, B, A, D Rationale: A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain is at risk for local gastric mucosal injury. Peptic ulcer perforation is a surgical emergency and can be life threatening; therefore, this client should be seen first. The client who had a gastrectomy is not expected to have moderate to severe pain 2 days after surgery and may be experiencing a complication. Therefore, this client should be assessed next. Although the client scheduled for an EGD and the client who is NPO are both scheduled for testing and do not require immediate attention, the client having an EGD needs to receive pretest
A. Management of alopecia B. Medication management C. Nutritional intake D. Skin care - ANSWER - > Answer: D Rationale: Although all of the choices should be part of the client's teaching plan, the priority is to ensure that the client has special skin care associated with external radiation. Radiation can cause problems with skin and tissue integrity. A client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." "What has your doctor told you about how your gastritis developed?" "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?" - ANSWER - > Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. It is not known to be a direct cause of the disease. Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease
process in and of itself. Asking the client what the doctor has said is an evasive response on the part of the nurse and does not help answer the client's question. The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? "It is okay to continue to drink coffee in the morning when I get to work." "I will need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day." - ANSWER - > The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia. The client should not eat six small meals daily. This practice may actually stimulate gastric acid secretion. Which client assessment information is correlated with a diagnosis of chronic gastritis? Anorexia, nausea, and vomiting Frequent use of corticosteroids Hematemesis and anorexia Treatment with radiation therapy - ANSWER - > Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Anorexia, nausea, and vomiting
should decrease acid production throughout the night. Sucralfate should be taken 1 hour before and 2 hours after meals. Because omeprazole is a delayed-release capsule, it should be swallowed whole and not crushed. The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? Respiratory rate from 24 to 20 breaths/min Apical pulse from 80 to 72 beats/min Temperature from 98.9° F to 97.9° F Blood pressure from 140/90 to 110/70 mm Hg - ANSWER - > A decrease in blood pressure is the most indicative sign of bleeding. A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding. Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Document instructions for a client with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a client who has arrived from the postanesthesia care unit after a laparoscopic gastrectomy. - ANSWER - > Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex
task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN. The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? Apply antiembolism stockings. Place a nasogastric (NG) tube, and connect to suction. Insert an indwelling catheter, and check output hourly. Give famotidine (Pepcid) 20 mg IV every 12 hours. - ANSWER - > To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolism stockings will need to be applied, monitoring output is important, and famotidine (Pepcid) will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis. The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl)
B. The nasogastric tube is draining yellowish green fluid. C. The client has pain that is controlled by analgesics. D. The colostomy is not draining any stool. E. The perineal incision is covered with a surgical dressing. - ANSWER - > Answer: B, C Rationale: A healthy stoma should be reddish pink and moist. A NG tube may be in place, draining yellowish green fluid. The client may experience pain postoperatively, which will be controlled with analgesics. The colostomy should start functioning in 2 to 3 days postoperatively; initially, gas will be passed, then liquid stool, followed by more solid stool. Perineal incisions are associated with an AP resection, not an open partial colectomy, which is an abdominal surgery. A client is admitted to the emergency department in severe pain with a gunshot wound to the right upper abdomen. Admitting vital signs are TPR 98- 96 - 28; BP 118/70; oxygen saturation 94%. What is the nurse's priority when monitoring this client? A. Open the airway to improve breathing. B. Give oxygen via nasal cannula at 2 L/min. C. Monitor vital signs frequently. D. Determine how the client was shot and by whom. - ANSWER - > Answer: C
Rationale: Penetrating abdominal trauma is caused by GSWs, stabbing, or impalement with an object. The liver is the most commonly injured organ from penetrating abdominal trauma, and trauma is the leading cause of death in adults younger than 40 years in the United States. With what appears to be stable vital signs at this time, the nurse should monitor vital signs for any changes that may indicate complications from the penetrating abdominal trauma. It is not within the nurse's scope to determine who shot the client. A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? Decrease in liver function test results Elevated carcinoembryonic antigen Elevated hemoglobin levels Negative test for occult blood - ANSWER - > Carcinoembryonic antigen may be elevated in many clients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC. A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client? Encourages the client to look at and touch the colostomy stoma
