NUR-265 Exam 1 Questions with Correctly Solved Answers, Exams of Nursing

Download NUR-265 Exam 1 Questions with Correctly Solved Answers and more Exams Nursing in PDF only on Docsity! 1 / 56 NUR-265 Exam 1 Questions with Correctly Solved Answers 1.Absorption: Transferring food products into circulation 2.Bilirubin: a pigment derived from the breakdown of hemoglobin and eliminated by the liver in bile 3.Borborygmi: loud, gurgling bowel sounds signaling increased motility or hyper- peristalsis; occurs with early bowel obstruction, gastroenteritis, diarrhea 4.Cheilosis: a disorder of the lips characterized by crack-like sores at the corners of the mouth 5.Digestion: Physical and chemical breakdown of food into absorbable substances 6.Endoscopy: A medical procedure that allows a doctor to examine the inside of the body without performing major surgery 7.Hematemesis: Vomiting blood 8. Ingestion: Intake of food 9.Kupffer cells: Macrophages in the liver 10.Melena: abnormal black, tarry stool containing digested blood 11.Pyrosis: heartburn; burning sensation in upper abdomen due to reflux of gastric acid 12.Pyorrhea: Recessed gingivae, purulent pockets 13.Steatorrhea: Fatty, frothy, foul-smelling stool 14.Tenesmus: painful, ineffective defecation 15.Valsalva Maneuver: A physical action that involves forcefully exhaling against a closed airway 16.Ghrelin: Hormone released from the stomach to stimulate appetite 17.Leptin: Hormone involved in appetite suppression 18.A patient is admitted to the hospital with diarrhea and dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be relat- ed to: Parasympathetic Stimulation 19.A patient has a high blood level of indirect (unconjugated) bilirubin. One cause of this finding is that: Bilirubin is not being conjugated and excreted into the bile by the liver 20.As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the: Secretion of mucus by goblet cells 21.A patient has jaundice with pale colored stools. This is MOST likely related to: Decreased bile flow into the intestine 22.An 80 yo man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the 2 / 56 knowledge that the older adult: Has a loss of taste buds, especially for sweet and salt 5 / 56 fatty acids.: a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. 35.Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last com- ponent. a. Skeletal protein b. Glycogen c. Visceral protein d. Fat stores: b. Glycogen a. Skeletal protein d. Fat stores c. Visceral protein 36.A complete nutrition assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2. b. reports episodes of nightly nocturia. c. reports a 5-year history of chronic constipation. d. reports unintentional weight loss of 10 lb in 2 months.: d. reports unintentional weight loss of 10 lb in 2 months. 37.Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. X-ray b. Air insertion c. Observing patient for coughing d. pH measurement of gastric aspirate: a. X-ray 38.A patient is receiving peripheral parenteral nutrition. The solution is com- pleted before the new solution arrives on the unit. The nurse gives a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.: b. 5% dextrose solution. 39.A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) 6 / 56 a. hypokalemia. 7 / 56 b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia.: a. hypokalemia d. hypomag e. hypopho 40.Bariatric Surgery: Involves surgery on the stomach and/or intestines to help a person with extreme obesity lose weight 41.Extreme Obesity: Is used for those with a BMI greater than 40 kg/m2. 42.Lipectomy: The surgical removal of excess skin and adipose tissue 43.Metabolic Syndrome: A group of metabolic risk factors that increase a person's chance of developing CVD, stroke, and diabetes 44.Obese: A BMI of 30 kg/m2 or above 45.Overweight: A BMI of 25 to 29.9 kg/m2 46.Obesity: An excessively high amount of body fat or adipose tissue 47.Waist-to-hip Ratio (WHR): Another way to assess obesity by dividing the waist measurement by the hip measurement 48.Which statement best describes the cause of obesity? a. Obesity primarily results from a genetic predisposition. b. Psychosocial factors can override the effects of genetics in causing obesity. c. Genetic factors are more important than environmental factors in causing obesity. d. Obesity is the result of complex interactions between genetic and environ- mental factors.: d. Obesity is the result of complex interactions between genetic and environmental factors. 49.Health risks associated with obesity include (select all that apply) a. colorectal cancer. b. rheumatoid arthritis. c. polycystic ovary syndrome. d. nonalcoholic steatohepatitis. e. systemic lupus erythematosus.: a. colorectal cancer. c. polycystic ovary syndrome. d. nonalcoholic steatohepatitis. 50.The obesity classification that is most often associated with cardiovascu- lar health problems is a. primary obesity. 10 / a. discouraging use of chewing gum. b. avoiding use of perfumed lip gloss. c. avoiding use of smokeless tobacco. d. discouraging drinking of carbonated beverages.: c. avoiding use of smokeless tobacco. 69.Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest.": a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." 70.A patient who had an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea after starting a full-liquid diet. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings. b. extension of the tumor into the aorta. c. leakage of fluids into the mediastinum. d. esophageal perforation with fistula formation into the lung.: c. leakage of fluids into the mediastinum. 71.The nurse monitors a patient with gastritis for pernicious anemia due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs.: c. a lack of intrinsic factor normally produced by acid-se- creting cells of the gastric mucosa. 72.The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococ- cus aureus in childhood. 11 / c. promoted by factors that cause oversecretion of acid, such as excess diet 12 / fats, smoking, and alcohol use. d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.: d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori. 73.An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources.: d. wound and skin care, nutrition, drugs, and community resources. 74.The discharge teaching plan for the patient after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) a. limiting alcohol intake to 1 serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.: c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. 75.Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing a. beef. b. meat and milk. c. poultry and eggs. d. home-preserved vegetables.: b. meat and milk. 76.Anal fistula: An abnormal tunnel from the anus or rectum to the surface of the skin around the anus or the vagina 77.Appendicitis: Inflammation of the appendix 78.Bowel obstruction: Occurs when intestinal contents cannot pass through the GI tract 15 / intake. 99.A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as 16 / possible causes of her pain? (select all that apply) a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease: a. Gastroenteritis b.Ectopic pregnancy c.Gastrointestinal bleeding d.Irritable bowel syndrome e.Inflammatory bowel disease 100. Assessment findings suggestive of peritonitis include (select all that apply) a. abdominal pain. b. rebound tenderness. c. a soft, distended abdomen. d. shallow respirations with bradypnea. e. observing that the patient is lying still.: a. abdominal pain. b. rebound tenderness. e. observing that the patient is lying still. 101. In planning care for the patient with Crohn's disease, the nurse recog- nizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. often results in toxic megacolon. b. causes fewer nutrition deficiencies than ulcerative colitis. c. often recurs after surgery, while ulcerative colitis is curable with a colecto- my. d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.: c. often recurs after surgery, while ulcerative colitis is curable with a colec- tomy. 102. The nurse performs an abdominal assessment of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. 17 / d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.: a. persistent abdominal pain. b. marked abdominal distention. 103. A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify the site for the ostomy.: c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. 104. The nurse determines a patient undergoing ileostomy surgery under- stands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stools." c. "I may not need to wear a drainage pouch if I irrigate it daily." d. "Limiting my fluid intake should decrease the amount of output.": a. "I should only have to change the pouch every 4 to 7 days." 105. In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. usually develops peritonitis. d. has localized cramping pain: b. often has no symptoms 106. A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is to a. maintain the patient on bedrest. b. allow the patient to stand to void. c. support the incision during coughing. d. apply a scrotal support with an ice bag.: d. apply a scrotal support with an ice bag. 107. The nurse determines that the goals of diet teaching have been met when the patient with celiac disease selects from the menu 20 / which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small 21 / amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation. 112. The nurse is caring for a patient with a biliary obstruction. Which condi- tion would the nurse expect? a. Melena b. Steatorrhea c. Decreased serum cholesterol level d. Increased serum indirect bilirubin level: ANS: B A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction. 113. The nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information would the nurse communi- cate to the health care provider before preparing the patient for the procedure? a.The patient declined to drink the prescribed laxative solution. b.The patient has had an allergic reaction to shellfish and iodine. c.The patient has a permanent pacemaker to prevent bradycardia. d.The patient is worried about discomfort during the examination.: ANS: A If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure would be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindi- cation to magnetic resonance imaging but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort. 114. Which statement by a patient with jaundice indicates a need for teaching? a. "I used cough syrup several times a day last week" b. "I take a baby aspirin every day to prevent strokes" c. "I take an antacid for indigestion several times a week" d. "I use acetaminophen (Tylenol) every 4 hours for pain": ANS: D Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assess- ment by the nurse but do not indicate a need for patient education. 115. Which is the correct technique for the nurse to palpate the liver 22 / during a head-to-toe physical assessment? a. Place one hand on top of the other and use the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. b. Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin. 25 / b.The patient ate a bagel 4 hours ago. c.The patient took a laxative the day before. d.The patient had a high-fat meal the previous evening.: ANS: B Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient would be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study. 120. The nurse is assessing an alert and independent older adult patient for malnutrition risk. Which is the most useful initial question? a. "How do you get to the store to buy your food?" b. "Can you tell me the food that you ate yesterday?" c. "Do you have any difficulty in preparing or eating food?" d. "Are you taking any medications that alter your taste for food?": ANS: B This question is the most open-ended and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question. 121. A patient has arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a.The patient is very drowsy. b.The patient reports a sore throat. c.The patient's temperature is 101.4F. d.The patient's pulse rate is 100 beats/min.: ANS: C A temperature elevation may indicate that an acute perforation has occurred. The other assessment data are normal immediately after the procedure. 122. A patient has just returned to the nursing unit after an esophagogastro- duodenoscopy (EGD). Which action by assistive personnel (AP) requires that the registered nurse (RN) intervene? a. Offering the patient a pitcher of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with a wet cloth: ANS: A Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the AP are appropriate. 123. A patient is being scheduled for endoscopic retrograde cholangiopan- creatography (ERCP) as soon as possible. Which prescribed 26 / action would the nurse take first? a. Place the patient on NPO status. 27 / b. Administer sedative medications. c. Ensure the consent form is signed. d.Teach the patient about the procedure.: ANS: A The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO. 124. While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). Which area of patient knowledge would the nurse plan to assess? a. Preventing noninfectious hepatitis b.Treating inflammatory bowel disease c. Risk for developing colorectal cancer d. Using antacids and proton pump inhibitors: ANS: C FAP is a genetic condition that greatly increases the risk for colorectal cancer. Noninfectious hepatitis, use of medications that treat increased gastric pH, and inflammatory bowel disease are not related to FAP. 125. Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation? a. Glossitis b. Ecchymoses c. Dry, scaly skin d. Gingival swelling: ANS: A Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as glossitis, anorexia, sore mouth and tongue, pallor, neurologic problems (e.g., depression, dizziness), weight loss, nausea, constipation, and anemia. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet. 126. A 76-yr-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted. Which assessment finding would the nurse expect? a. Restlessness b. Hypertension c. Pitting edema d. Food allergies: ANS: C Edema occurs when serum albumin levels and plasma oncotic pressure decrease. The blood pressure and level of consciousness are not directly affected by malnu- trition. Food allergies are not an indicator of 30 / d. Obtain a daily abdominal radiograph to verify tube placement.: ANS: B The tube is flushed every 4 hours during continuous feedings to avoid tube obstruc- tion. The patient should be positioned with the head of the bed elevated. Crushed medications mixed in with the formula are likely to clog the tube. An x-ray is obtained 31 / immediately after placement of the PEG tube to check position, but daily x-rays are not needed. 131. A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung with a new tubing and filter 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action would the nurse take? a. Add a new container of PN using the current tubing and filter. b. Hang a new container of PN and change the IV tubing and filter. c. Infuse the remaining 50 mL and then hang a new container of PN. d. Ask the health care provider to clarify the written PN prescription.: ANS: B All PN solutions and tubings are changed at 24 hours. Infusion of the additional 50 mL will increase patient risk for infection. The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes. 132. A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. Which action would the nurse take? a. Obtain a venous blood glucose specimen. b. Slow the infusion rate of the PN infusion. c. Recheck the blood glucose level in 4 to 6 hours. d. Contact the health care provider for infusion rate changes.: ANS: C Mild hyperglycemia is expected during the first few days after PN is started and requires ongoing monitoring. Because the glucose elevation is small and expected, infusion rate changes are not needed. There is no need to obtain a venous specimen for comparison. Slowing the rate of the infusion is beyond the nurse's scope of practice and will decrease the patient's nutritional intake. 133. After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which data is the best indicator that the patient is receiving adequate nutrition? a. Serum albumin level is 3.5 mg/dL. b. Fluid intake and output are balanced. c. Surgical incision is healing normally. d. Blood glucose is less than 110 mg/dL.: ANS: C Because poor wound healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia, but it does not 32 / indicate that the patient's nutrition is adequate. The intake and output will be monitored, but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient. 35 / will the nurse recommend? a. 53 b. 66 c. 79 d. 98: ANS: A The recommended daily protein intake is 0.8 to 1 g/kg of body weight. Therefore, the minimum for this patient is 66 kg x 0.8 g = 52.8 or 53 g/day. 138. A 20-yr-old woman is being admitted with electrolyte disorders of un- known etiology. Which assessment finding is most important to report to the health care provider? a.The patient uses laxatives daily. b.The patient's knuckles are macerated. c.The patient's serum potassium level is 2.9 mEq/L. d.The patient has a history of extreme weight fluctuations.: ANS: C The low serum potassium level may cause life-threatening cardiac dysrhythmias, and potassium supplementation is needed rapidly. The other information will also be reported because it suggests that bulimia may be the etiology of the patient's electrolyte disturbances, but it does not suggest imminent life-threatening complica- tions. 139. Which action for a patient receiving enteral nutrition through a percuta- neous endoscopic gastrostomy (PEG) may be delegated to a licensed practi- cal/vocational nurse (LPN/VN)? a. Assessing the patient's nutritional status weekly b. Providing skin care to the area around the tube site c.Teaching the patient how to administer the feedings d. Determining the need for adding water to the feedings: ANS: B LPN/VN education and scope of practice include actions such as dressing changes and wound care. Patient teaching and complex assessments (such as patient nutrition and hydration status) require registered nurse (RN)-level education and scope of practice. 140. The nurse is preparing to teach a frail 79-yr-old Hispanic man who lives with an adult daughter about ways to improve nutrition. Which action would the nurse take first? a. Ask the daughter about the patient's food preferences. b. Determine who shops for groceries and prepares the meals. c. Question the patient about how many meals per day are eaten. d. Assure the patient that culturally preferred foods will be included.: ANS: B The family member who shops for groceries and cooks will be in 36 / control of the patient's diet, so the nurse will need to ensure that this family member is involved 37 / in any teaching or discussion about the patient's nutritional needs. The other infor- mation will also be assessed and used but will not be useful in meeting the patient's nutritional needs unless nutritionally appropriate foods are purchased and prepared. 141. After change-of-shift report, which patient will the nurse assess first? a. A 40-yr-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left b. A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles c. A 30-yr-old man with 4+ generalized pitting edema and severe protein- calo- rie malnutrition d. A 30-yr-old woman whose gastrostomy tube is plugged after crushed medications were administered: ANS: B The patient data suggest aspiration may have occurred, and rapid assessment and intervention are needed. The other patients should also be assessed soon, but the data about them do not suggest any immediately life-threatening complications. 142. A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action would the nurse take first? a.Teach the patient about the importance of good nutrition. b. Serve multiple small feedings of high-calorie, high-protein foods. c. Consult with the health care provider about parenteral nutrition (PN). d. Obtain an order for enteral feedings of liquid nutritional supplements.: ANS: B Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients. Teaching the patient may be appropriate but will not address the patient's inability to eat more because of fatigue. Enteral nutrition or PN may be needed if the patient is unable to take in enough nutrients orally but increasing the oral intake should be attempted first. 143. A patient's peripheral parenteral nutrition (PN) bag is nearly empty, and a new PN bag has not arrived yet from the pharmacy. Which action would the nurse take? a. Monitor the patient's capillary blood glucose every 6 hours. 40 / The other actions may also be appropriate, based on the information obtained during the assessment. 147. Which patients would the nurse refer to the dietitian for a complete nutritional assessment? (Select all that apply.) a. A 35-yr-old patient who reports intermittent nausea for the past 2 days b. A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily 41 / c. A 23-yr-old patient who has a history of fluctuating weight gains and losses d. A 64-yr-old patient who is admitted for debridement of an infected surgical wound e. A 52-yr-old patient admitted with chest pain and possible myocardial infarc- tion (MI): ANS: B, C, D Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition. 148. Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet? a. "It will be necessary to change lifestyle habits permanently to maintain weight loss." b. "You are likely to notice changes in how you feel after a few weeks of diet and exercise." c. "You will decrease your risk for future health problems such as diabetes by losing weight now." d. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat.": ANS: B Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. Future health problems are unlikely to motivate a 22-yr-old patient. Telling a patient that the initial weight loss is water would be discouraging, although this may be correct. Changing lifestyle habits permanently is recommended, but this process occurs over time, and discussing this is not likely to motivate the patient. 149. After the nurse teaches about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the patient understands the diet instructions? a. 3 oz of lean beef, 2 oz of low-fat cheese, and a sliced tomato b. 3 oz of roasted pork, a cup of broccoli, and a cup of carrot sticks c. Cup of tossed salad and nonfat dressing topped with a chicken breast d. Half cup of tuna mixed with nonfat mayonnaise and a half cup of celery: ANS: B This selection is most consistent with the recommendations to limit foods from animal sources and increase plant source foods. The other choices 42 / all have higher ratios of animal origin foods to plant source foods than would be recommended. 45 / counselor; however, there is no indication given that the concern about skinfolds is dysfunctional. 153. After sleeve gastrectomy, a 42-yr-old male patient returns to the surgi- cal nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action would be included in the postoperative plan of care? a. Offer sips of fruit juices at frequent intervals. b. Irrigate the nasogastric (NG) tube frequently. c. Remind the patient that PCA use may slow the return of bowel function. d. Support the surgical incision during patient coughing and turning in bed.- : ANS: D Protecting the incision from strain decreases the risk for wound dehiscence. The patient should be encouraged to use the PCA because pain control will improve the cough effort and patient mobility. NG irrigation may damage the suture line or overfill the stomach pouch. Sugar-free clear liquids are offered during the immediate postoperative time to decrease the risk for dumping syndrome. 154. Which information would the nurse teach patients about self- manage- ment after gastric bypass surgery? a. Drink fluids between meals but not with meals. b. Choose high-fat foods for at least 30% of intake. c. Developing flabby skin can be prevented by exercise. d. Choose foods high in fiber to promote bowel function.: ANS: A Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin. 155. Which assessment action would help the nurse determine if an obese patient has metabolic syndrome? a.Take the patient's apical pulse. b. Check the patient's blood pressure. c. Ask the patient about dietary intake. d. Dipstick the patient's urine for protein.: ANS: B Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information will not assist with the diagnosis of metabolic syndrome. 156. When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? a. Blood glucose test b. Cardiac enzyme tests 46 / c. Postural blood pressures d. Resting electrocardiogram: ANS: A 47 / A fasting blood glucose result greater than 100 mg/dL is one of the diagnostic criteria for metabolic syndrome. The other tests are not used to diagnose metabolic syndrome, but they may be used to check for cardiovascular complications of the disorder. 157. Which information will the nurse include in teaching for a 35- yr-old woman who is overweight and starting a weight-loss plan? a. Weigh yourself at the same time every morning and evening. b. Stick to a 600- to 800-calorie diet for the most rapid weight loss. c. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. d. Weighing all foods on a scale is necessary to choose appropriate portion sizes.: ANS: C The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category and need to be closely supervised. Patients should weigh weekly rather than daily. 158. Which adult would the nurse plan to teach about risks associated with obesity? a. Man who has a BMI of 18 kg/m2 b. Man with a 42 inch waist and 44 inch hips c. Woman who has a body mass index (BMI) of 24 kg/m2 d. Woman with a waist circumference of 34 inches (86 cm): ANS: B The waist-to-hip ratio for this patient with a 42 inch waist and 44 inch hips is 0.95, which exceeds the recommended level of less than 0.80. A patient with a BMI of 18 kg/m2 is considered underweight. A BMI of 24 kg/m2 is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm). 159. A patient is being admitted for bariatric surgery. Which nursing action can the nurse delegate to assistive personnel (AP)? a. Demonstrate use of the incentive spirometer. b. Plan methods for turning the patient after surgery. c. Assist with IV insertion by holding adipose tissue out of the way. d. Develop strategies to provide privacy and decrease embarrassment.: ANS: C AP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require registered nurse (RN)-level education and scope of practice. 160. After successfully losing a pound per week for several months, a 50 / d. Use of patient-controlled analgesia (PCA) several times an hour for pain: - ANS: C 51 / Vomiting with an NG tube in place indicates that the NG tube needs to be repo- sitioned by the provider to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the provider. Frequent PCA use after bariatric surgery is expected. 164. Which information will the nurse prioritize in planning preoperative edu- cation for a patient undergoing a Roux-en-Y gastric bypass? a. Explaining the nasogastric (NG) tube to the patient b.Teaching the patient coughing and breathing techniques c. Discussing necessary postoperative modifications in lifestyle d. Demonstrating passive range-of-motion exercises for the legs: ANS: B Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery. 165. After bariatric surgery, a patient who is being discharged tells the nurse, I prefer to be independent. I am not interested in any support groups. Whic initial response would the nurse provide? a. "I hope you change your mind so that I can suggest a group for you." b. "Tell me what types of resources you think you might use after this surgery." c. "Support groups have been found to lead to more successful weight loss after surgery." d. "Because there are many lifestyle changes after surgery, we recommend support groups.": ANS: B This statement allows the nurse to assess the individual patient's potential needs and preferences. The other statements offer the patient more information about the benefits of support groups but do not acknowledge the patient's preferences. 166. To evaluate an obese patient for adverse effects of Plenity, which action will the nurse take? a. Measure the apical pulse. b. Check sclera for jaundice. c. Ask about bowel movements. d. Assess for agitation or restlessness.: ANS: C Constipation is a common side effect of Plenity, a gel substance taken 52 / to increase the volume of stomach and small intestine contents and induce satiety. The other assessments would be appropriate for other weight-loss medications. 167. After change-of-shift report, which patient would the nurse assess first? a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain 55 / a. Use sunscreen even on cloudy days. b. Avoid cigarettes and smokeless tobacco. c. Complete antibiotic courses used to treat throat infections. d. Use antivirals to treat herpes simplex virus (HSV) infections.: ANS: B Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa, although it increases risk for cancer of the lip. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer 172. A patient who has gastroesophageal reflux disease (GERD) is experienc- ing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD? a. "I quit smoking years ago, but I chew gum." b. "I eat small meals and have a bedtime snack." c. "I take antacids between meals and at bedtime each night." d. "I sleep with the head of the bed elevated on 4-inch blocks.": ANS: B GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of the bed are appropriate actions to control symptoms of GERD. 173. A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine? a. Apical pulse b. Bowel sounds c. Breath sounds d. Abdominal girth: ANS: C Because GERD may cause aspiration, the unconscious patient is at risk for devel- oping aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine. 174. How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn? a. "It reduces gastroesophageal reflux by increasing the rate of gastric emp- tying." b. "It neutralizes stomach acid and provides relief of symptoms in a 56 / few minutes." 57 / c. "It coats and protects the lining of the stomach and esophagus from gastric acid." d. "It treats gastroesophageal reflux disease by decreasing stomach acid production.": ANS: D The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cry- oprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly. 175. Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a. Chocolate pudding b. Glass of low-fat milk c. Cherry gelatin with fruit d. Peanut butter and jelly sandwich: ANS: C Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure. 176. Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn? a. Radionuclide tests b. Barium swallow exam c. Endoscopy procedures d. Proton pump inhibitors: ANS: D Because diagnostic testing for heartburn that is probably caused by gastroe- sophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis. 177. A woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response would the nurse provide? a. "You may have quite a few years still left to live." b. "Thinking about dying will only make you feel worse." c. "Having this new diagnosis must be very hard for you." d. "It is important that you be realistic about your prognosis.": ANS: C 60 / with acute gastritis. What would the nurse ask the patient about to determine possible risk factors for gastritis? a.The amount of saturated fat in the diet b. A family history of gastric or colon cancer 61 / c. Use of nonsteroidal antiinflammatory drugs d. A history of a large recent weight gain or loss: ANS: C Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis. 182. Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective? a. "The cobalamin injections will prevent gastric inflammation.' b. "The cobalamin injections will prevent me from becoming anemic." c. "These injections will increase the hydrochloric acid in my stomach." d. "These injections will decrease my risk for developing stomach cancer.": - ANS: B Cobalamin supplementation prevents the development of pernicious anemia. Chron- ic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer. 183. A patient has peptic ulcer disease associated with Helicobacter pylori. Which medications will the nurse plan to teach the patient? a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) b. Metoclopramide (Reglan), bethanechol, and promethazine c. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole: - ANS: C The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combina- tions listed are not included in the protocol for H. pylori infection. 184. Which action would the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? a. Obtain a stool specimen for culture. b. Administer antidiarrheal medication. c. Provide teaching about antibiotic therapy. d. Teach the adverse effects of acetaminophen (Tylenol).: ANS: A Patients with bloody diarrhea should have a stool culture for 62 / Escherichia coli O157:H7. Antidiarrheal medications are usually avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications. Acetaminophen does not cause bloody diarrhea. 65 / Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection. 189. A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, di- aphoresis, and a firm abdomen, which action would the nurse take? a. Irrigate the NG tube. b. Check the vital signs. c. Give the ordered antacid. d. Elevate the foot of the bed.: ANS: B The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe. 190. A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. Which nursing action is the highest priority? a. Monitor drainage. b. Contact the surgeon. c. Irrigate the NG tube. d. Give prescribed morphine.: ANS: B Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both). Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is needed but not an adequate response to the findings. The patient may need morphine, but this is not the highest priority action. 191. Which patient statement indicates that the nurse's postoperative teach- ing after a gastroduodenostomy has been effective? a. "I will drink more liquids with my meals." b. "I should choose high carbohydrate foods." 66 / c. "Vitamin supplements may prevent anemia." d. "Persistent heartburn is expected after surgery.": ANS: C Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may 67 / recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome. 192. At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. Which action would the nurse teach the patient to take? a. Increase the amount of fluid with meals. b. Eat foods that are higher in carbohydrates. c. Lie down for about 30 minutes after eating. d. Drink sugared fluids or eat candy after meals.: ANS: C The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down for a short rest after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome. 193. A patient who takes a nonsteroidal antiinflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What would the nurse anticipate teaching the patient? a. Substitution of acetaminophen (Tylenol) for the NSAID b. Use of enteric-coated NSAIDs to reduce gastric irritation c. Reasons for using corticosteroids to treat the rheumatoid arthritis d. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa: ANS: D Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis. 194. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. Which medication schedule would the nurse teach the patient? a. Sucralfate at bedtime and antacids before each meal b. Sucralfate and antacids together 0 minutes before meals c. Antacids 30 minutes before each dose of sucralfate is taken d. Antacids after meals and sucralfate 30 minutes before meals: ANS: D 70 / 198. The nurse is assessing a patient who had a total gastrectomy 8 hours ago. Which information is most important to report to the health care provider? a. Hemoglobin (Hgb) 10.8 g/dL b.Temperature 102.1F (38.9C) 71 / c. Absent bowel sounds in all quadrants d. Scant nasogastric (NG) tube drainage: ANS: B An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action. 199. A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? a.The patient has been vomiting for 4 days. b.The patient takes antacids 8 to 10 times a day. c.The patient is lethargic and difficult to arouse. d.The patient had a small intestinal resection 2 years ago.: ANS: C A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration. 200. A young adult has been admitted to the emergency department with nau- sea and vomiting. Which action could the RN delegate to assistive personnel (AP)? a. Auscultate the bowel sounds. b. Assess for signs of dehydration. c. Assist the patient with oral care. d. Ask more questions about the nausea.: ANS: C Oral care is included in AP education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice 201. A patient has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse imple- ment first? a. Insert a nasogastric (NG) tube. b. Infuse normal saline at 250 mL/hr. c. Administer IV ondansetron (Zofran). d. Provide oral care with moistened swabs.: ANS: B Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders would be accomplished after the IV fluids are initiated. 202. Which patient would the nurse assess first after receiving change- of-shift report? 72 / a. A patient with esophageal varices who has a rapid heart rate b. A patient with a history of gastrointestinal bleeding who has melena c. A patient with nausea who has a dose of metoclopramide (Reglan) due 75 / a.The bowel sounds are hyperactive in all four quadrants. b.The patient's lungs have crackles audible to the midchest. c.The nasogastric (NG) suction is returning coffee-ground material. d. The patient's blood pressure (BP) has increased to 142/84 mm Hg.: ANS: B The patient's lung sounds indicate that pulmonary edema may be developing because of the rapid infusion of IV fluid and that the fluid infusion rate would be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding. 207. The nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease. Which patient action indicates that the teaching has been effective? a. Patient orders nonfat milk for each meal. b. Patient uses the prescribed corticosteroid inhaler. c. Patient schedules an appointment for allergy testing. d. Patient takes ibuprofen (Advil) to control throat pain.: ANS: C Eosinophilic esophagitis is frequently associated with environmental allergens, so allergy testing is used to determine possible triggers. Corticosteroid therapy may be prescribed, but the medication will be swallowed, not inhaled. Milk is a frequent trigger for attacks. NSAIDs are not used for eosinophilic esophagitis. 208. An 80-yr-old patient who is hospitalized with peptic ulcer disease devel- ops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? a. Sucralfate (Carafate) b. Aluminum hydroxide c. Omeprazole (Prilosec) d. Metoclopramide (Reglan): ANS: D Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids. 209. The nurse and a licensed practical/vocational nurse (LPN/VN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/VN requires that the nurse intervene? a.The LPN/VN uses soft swabs to provide oral care. b.The LPN/VN positions the head of the bed in the flat position. c.The LPN/VN includes the enteral feeding volume when calculating intake. 76 / d.The LPN/VN encourages the patient to use pain medications before cough- ing.: ANS: B 77 / The patient's bed would be in Fowler's position to prevent reflux and aspiration of gastric contents. The other actions by the LPN/LVN are appropriate. 210. After change-of-shift report, which patient would the nurse assess first? a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa d. A 53-yr-old patient who has dumping syndrome after a recent partial gas- trectomy: ANS: C A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening. 211. A patient is admitted with possible botulism poisoning after eating home-canned green beans. Which intervention ordered by the health care provider would the nurse question? a. Encourage oral fluids to 3 L/day. b. Document neurologic symptoms. c. Position patient lying on the side. d. Observe respiratory status closely.: ANS: A The patient should not have oral fluids because neuromuscular weakness increases risk for aspiration. Side-lying position and assessment of neurologic and respiratory status are expected interventions. 212. Which action would the nurse include in the plan of care for a patient who is being admitted with a C. difficile infection? a.Teach the patient about proper food storage. b. Order a diet without dairy products for the patient. c. Place the patient in a private room on contact isolation. d. Teach the patient about why antibiotics will not be used.: ANS: C Because C. difficile is highly contagious, the patient would be placed in a private room, and contact precautions would be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and storage do not cause C. 80 / a. Administer morphine sulfate. b. Encourage the patient to ambulate. c. Offer the prescribed promethazine. 81 / d. Instill a mineral oil retention enema.: ANS: B Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention. 217. A patient with blunt abdominal trauma from a motor vehicle crash un- dergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patient's oral temperature. d. Obtain information about the accident.: ANS: B Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery. 218. A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action would the nurse take? a. Assist the patient to cough and deep breathe. b. Palpate the abdomen for rebound tenderness. c. Suggest the patient lie on the side, flexing the right leg. d. Encourage the patient to sip clear, noncarbonated liquids.: ANS: C The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time. 219. Which action will the nurse include in the plan of care for a 25-yr- old male patient with a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Teach the patient to avoid using nonsteroidal antiinflammatory 82 / drugs (NSAIDs). d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.: ANS: A Because psychologic and emotional factors can affect the symptoms for IBS, 85 / behavior indicates that the nurse's teaching about skin integrity has been effective? a.The patient uses incontinence briefs to contain loose stools. b.The patient uses witch hazel compresses to soothe irritation. c.The patient asks for antidiarrheal medication after each stool. d. The patient cleans the perianal area with soap after each stool.: ANS: B Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications cannot be given 15 to 20 times a day. The perianal area should be washed with plain water or pH balanced cleanser after each stool. 224. Which diet choice by the patient with an acute exacerbation of inflamma- tory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup: ANS: C During acute exacerbations of IBD, the patient would avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient. 225. After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, I cannot manage all this. I don't want to look at the stoma. Which action would the nurse take? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Postpone any teaching until the patient adjusts to the ileostomy. d. Develop a detailed written list of ostomy care tasks for the patient.: ANS: B Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching could be postponed, the nurse should begin to offer teaching about some aspects of living with an ostomy. 226. After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) 86 / over 2 months, a patient has a new diagnosis of Crohn's disease. What would the nurse plan to teach the patient? a. Medication use b. Fluid restriction c. Enteral nutrition 87 / d. Activity restrictions: ANS: A Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings if the patient is able to eat. 227. A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. Which information will the nurse add to a teaching plan about UTIs for this patient that goes beyond a general teaching plan for UTIs? a. Fistulas can form between the bowel and bladder. b. Bacteria in the perianal area can enter the urethra. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.: ANS: A Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse. 228. Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction? a. Referred back pain b. Metabolic alkalosis c. Projectile vomiting d. Abdominal distention: ANS: D Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction. 229. Which screening test would the nurse plan to teach a 45-yr-old male about during an annual wellness exam? a. Endoscopy b. Colonoscopy c. Computerized tomography d. Carcinoembryonic antigen (CEA): ANS: B At age 45 years, persons with an average risk for colorectal cancer (CRC) would begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 45 years. 90 / a. Place ice packs around the stoma. b. Notify the surgeon about the stoma. c. Monitor the stoma every 30 minutes. 91 / d. Document stoma assessment findings.: ANS: D The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery. An ice pack is not needed. 234. Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.: ANS: B High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies do not have a colon for the absorption of water; they need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible. 235. A patient with a new ileostomy asks how much it will drain after the bowel has adapted in a few months. How many cups of drainage per day would the nurse tell the patient to expect? a. 2 b. 3 c. 4 d. 5: ANS: A After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL. 236. Which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care? a. Administer IV fluids. b. Prepare for colonoscopy. c. Encourage a high-fiber diet. d. Give stool softeners and enemas.: ANS: A A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. 92 / The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis. 237. A 40-yr-old male patient has had a herniorrhaphy to repair an incarcer- ated inguinal hernia. Which patient teaching will the nurse provide before 95 / 241. Which topic would the nurse plan to teach to a patient with Crohn's disease who has megaloblastic anemia? a. Iron dextran infusions b. Oral ferrous sulfate tablets c. Routine blood transfusions d. Cobalamin (B12) supplements: ANS: D Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. Cobalamin must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions. 242. The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus? a. Cullen's sign b. Rovsing sign c. McBurney's sign d. Grey-Turner's sign: ANS: A Cullen's sign is ecchymosis around the umbilicus. Rovsing sign occurs when palpa- tion of the left lower quadrant causes pain in the right lower quadrant. Grey Turner's sign is bruising over the flanks. Deep tenderness at McBurney's point (halfway between the umbilicus and the right iliac crest), known as McBurney's sign, is a sign of acute appendicitis. 243. A critically ill patient with sepsis is frequently incontinent of watery stools. Which action by the nurse will prevent complications associated with ongoing incontinence? a. Apply incontinence briefs. b. Use a fecal management system. c. Insert a rectal tube with a drainage bag. d. Assist the patient to a commode frequently.: ANS: B Fecal management systems are designed to contain loose stools and can be in place for as long as 4 weeks without causing damage to the rectum or anal sphincters. Although incontinence briefs may be helpful, unless they are changed frequently, they are likely to increase the risk for skin breakdown. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. A critically ill patient will not be able to tolerate getting up frequently to use the commode or bathroom. 96 / 244. Which question from the nurse would help determine if a patient's abdom- inal pain might indicate irritable bowel syndrome (IBS)? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" 97 / c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?": ANS: D One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria. 245. A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Send the patient for a CT scan. b. Insert a urinary catheter to drainage. c. Infuse metronidazole (Flagyl) 500 mg IV. d. Place a nasogastric tube to intermittent low suction: ANS: C Because peritonitis can be fatal if treatment is delayed, the initial action would be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated. 246. A patient calls the clinic reporting diarrhea for 24 hours. Which action would the nurse take first? a. Inform the patient that testing of blood and stools will be needed. b. Suggest that the patient drink clear liquid fluids with electrolytes. c. Ask the patient to describe the stools and any associated symptoms. d. Advise the patient to use over-the-counter antidiarrheal medication.: ANS: C The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment. 247. A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102F (38.3C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention would the nurse implement first? a. Administer IV ketorolac 15 mg for pain relief. b. Send a blood sample for a complete blood count (CBC). c. Infuse a liter of lactated Ringer's solution over 30 minutes. d. Send the patient for an abdominal computed tomography (CT) scan.: ANS: C The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion. 248. Four hours after a bowel resection, a 74-yr-old male patient with a