Postoperative Nursing Care and Patient Education, Exams of Nursing

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The nurse in the PACU performs postsurgical assessments on the newly admitted patient every _________ minutes. every 15 minutes A patient is on postoperative day 2 after a nephrectomy. What is the most effective way to increase her peristalsis? Ambulation A patient is transferred from the operating room to the recovery room after undergoing an open reduction and internal fixation (ORIF) of his left ankle. Which is the first assessment to make? Check airway for patency. A postoperative patient who had a left inguinal hernia repair is ready for his discharge instructions. Which information should the nurse provide? (Select all that apply.)

• Care of the wound site and any dressings
• When he may operate a motor vehicle
• Signs and symptoms to report to the physician
• Actions and side effects of any medications Anti-embolic stockings are in place on the obese post surgical patient. Which statement accurately describes the standard of care in regards to anti-embolic stockings? should be removed approximately 20 minutes every shift. Frequent assessment of a postoperative patient is essential. What is one of the first signs and symptoms of hemorrhage? Restlessness

The nurse educates the postsurgical patient about which potential effect of smoking on postsurgical recovery? Delayed healing The nurse is caring for a 90-year-old postoperative patient whose oxygen saturation is frequently dropping below 90%. Which age-related change is most likely related to this finding? weakened respiratory muscles The nurse is caring for a patient during the first postoperative day. Which goal works to prevent atelectasis and is most appropriate for the nursing care plan? Patient will "huff-cough" every 2 hours The nurse is caring for a patient following abdominal surgery. The patient asks the nurse when he will be able to eat a normal diet. Which response is best? "Once you have bowel sounds and are passing gas, you may have clear liquids, and your diet will be advanced based upon your tolerance." The nurse is caring for a patient who had spinal anesthesia. Which drink is the best choice for the nurse to offer the patient? Tea The nurse is caring for a surgical patient who complains of excessive gas. Which action should the nurse take? Ambulate the patient in the hall. The nurse is educating the patient about vitamins and wound healing. The nurse explains that which vitamin will enhance wound healing the most? Vitamin C The nurse is performing a neurological assessment on a patient who was just transferred from the PACU following abdominal surgery. Which action(s) correctly demonstrate(s) knowledge of a neurological assessment? (Select all that apply.)

• Asking the patient to identify where he is.
• Noting if the patient can identify the sensation of touch.
• Asking the patient to move his arms and legs.
• Assessing the patient's pupils for response to light. The nurse is performing the Aldrete scoring system. Which factor(s) must be assessed? (Select all that apply.)
• Activity
• Circulation
• Level of consciousness

• O2 saturation
• Respiration The PACU nurse is caring for a semiconscious patient immediately following abdominal surgery. The nurse correctly places the patient in which position? Lateral The PACU nurse is caring for an unconscious patient. Assessment reveals diminished breath sounds bilaterally. Which action should the nurse take? Document "diminished breath sounds in both lower lobes." The patient is brought into PACU still unconscious. What should the nurse do when the nurse assesses an oral temperature of 94° F? Cover with a warm blanket The postoperative nursing intervention that would be contraindicated for a 45-year-old patient who has had a repair of a cerebral aneurysm and is presenting signs of increased intracranial pressure (ICP) would be: coughing every 2 hours When the postoperative patient complains of sudden chest pain combined with dyspnea, cyanosis, and tachycardia, the nurse recognizes the signs of: pulmonary embolus Which action is most important for the nurse to take prior to ambulating the postsurgical patient for the first time? Raise the head of the bed Which of the following early postoperative observations should be reported immediately? "Coffee ground" emesis While turning a patient who had a bowel resection yesterday, the wound eviscerated. What is the initial nursing intervention? Apply a warm, moist normal saline sterile dressing. During the course of surgery, the patient exhibits tachycardia, diaphoresis, and rising body temperature. The priority intervention by the circulating nurse is to: Alert the anesthesiologist and surgeon immediately. In which situation might surgery be delayed? The patient is still taking anticoagulants The nurse clarifies the difference between regional anesthesia and procedural sedation anesthesia. Which statement about procedural sedation anesthesia is true?

Procedural sedation anesthesia uses both intravenous (IV) sedation and regional anesthesia The nurse is caring for a patient who has just been given medication to reverse neuromuscular blocking agents. The nurse is aware that the patient is in which general anesthetic stage? Emergence The nurse is caring for a patient who has received epoetin alfa (Epogen) 2 to 3 weeks prior to a scheduled surgery. The nurse understands that this patient will likely: not require a blood transfusion during surgery The nurse is caring for an 82-year-old pre-surgical patient. Which abnormal finding is most important for the nurse to report immediately? Temperature of 99.8° F The nurse is caring for an Asian patient who received atropine as a preoperative drug. For which problem should the nurse should carefully monitor the patient? Tachycardia The nurse is performing a preoperative assessment on a patient scheduled for surgery today. The patient reports drinking two glasses of wine daily, smoking one pack of cigarettes daily for 20 years, completing a round of corticosteroids for asthma control 2 days ago, and taking a dose of passion flower extract yesterday. Which action should the nurse take next? Notify the physician immediately regarding the patient's recent use of corticosteroids. The nurse is reviewing the pre-surgical patient's laboratory reports and notes an elevated aspartate aminotransferase (AST) and bilirubin. The nurse understands that this patient is most at risk for which potential complication? Excessive bleeding during or after surgery The patient questions the nurse about robotics surgery. Which information should the nurse include? (Select all that apply.)

• "Robotics gives the surgeon greater magnification than the human eye."
• "Robotics allows the surgeon to be more precise than normal."
• "Robotics allows for a smaller incision."
• "Robotics procedures generally cause less postoperative pain." The patient refuses to take off her diamond wedding band before going to the op room. What action should the nurse take? Tape the ring to finger, covering the ring What are the purposes of preoperative medication? (Select all that apply.)

• To reduce anxiety
• To decrease mucus secretion
• To counteract nausea
• To synergize anesthesia What is the ideal time for preoperative teaching? 1 to 2 days before the surgery when anxiety is not as high What is the responsibility of the nurse as a witness to informed consent? Verify/obtain the patient's signature When the patient asks the nurse to make sure no one sees her with her dentures out, the nurse recognizes the common preoperative fear of: loss of control Prior to administering the preoperative medication of Demerol and atropine, the nurse should confirm that: Verify that a consent form is signed Which factor(s) may contribute to hypothermia during surgery? (Select all that apply.
• Infusion of cool IV fluids
• Inhalation of cool anesthetic gases
• Exposure of body surfaces
• Lowered metabolism Which medication would cause surgery to be delayed if it had not been discontinued several days before surgery? Anticoagulant agent Which physiological change(s) explain why the older adult is at greater surgical risk? (Select all that apply.)
• Fewer physiologic reserves
• Greater probability of a chronic illness
• Greater vulnerability to fluid loss Which responses indicate to the nurse that the patient understands preoperative teaching? (Select all that apply.)
• "I will need to sign a consent form before I am given my medications prior to my surgery."
• "The surgeon will want me to ambulate as soon as possible after my surgery."
• "My nurse will want me to take the deepest breaths I can tolerate following my surgery."
• "I may experience some constipation if I am taking much pain medication after my surgery." Does general anesthesia prevent the patient to have any pain? No

Which statement made by a patient during a preoperative assessment would be significant to report to the charge nurse and surgeon? "I have been taking an herbal product of feverfew for my migraines." Although the patient with a kidney stone denies pain, the nurse assess cues that indicate that pain is perceived. Which assessments indicate that pain may be present?

• muscle tension
• diaphoresis
• nausea
• increased pulse rate The nurse is constructing a teaching plan about fatigue management for a patient who is taking radiation treatments. Which information should the nurse include? Prioritize activities and alternate rest with periods of activity. A 32-year-old mother is undergoing radiation from a sealed-source modality and has been isolated in a private room for 3 days. How should the nurse best prepare for the patient's 8-year-old twins to visit? Put chairs in the hall for "long-distance" visitation. Which description(s) is/are characteristic of a malignant neoplasm? (Select all that apply.)
• Disorganization
• Altered DNA
• Invasion of nearby organs
• Travel through body fluid The nurse is instructing a patient who is on a biologic response modifier (BRM) colony-stimulating drug. The nurse teaches that about which desired action from this medication? Enhanced recovery of bone marrow A patient who has malignant cancer secondary to a high-grade lymphoma has been admitted with muscle weakness, tetany, paresthesia, and convulsion. Lab studies reveal hyperkalemia and Hyperuricemia the nurse recognizes that the patient is most likely suffering from? Tumor Lysis Syndrome (TLS) A patient receiving chemotherapy has thrombocytopenia. What is the most appropriate that the nurse should teach the patient? Do not take aspirin for a headache

The 52-year-old male who was diagnosed with a benign growth in her colon is concerned about the growth spreading. Which explanation best allays the patient's anxiety? "Benign growths are surrounded by fibrous tissue that prevents spread." The nurse assesses several patients in the outpatient clinic. Which patient has the greatest risk for developing cancer? 45 - year-old farmer from Texas who has worked on his family's cotton farm since the age of 12 The nurse assesses a man who is scheduled for a prostate-specific antigen (PSA) test. The nurse understands that which situation could delay the test? The patient reports having a recent urinary tract infection (UTI). The nurse is educating the 40-year-old female patient about the American Cancer Society (ACS) recommendations for early detection of cancer. Which information should she include when teaching? Obtain a mammogram every year The 26-year-old patient with a malignant neoplasm has experienced a 10-pound weight loss in 3 weeks. To which factor is this patient's rapid weight loss most likely related? The malignancy's high nutritional demand The nurse cautions that the most common site of cancer in adult men is the: Prostate A patient has developed stomatitis from chemotherapy. What should the appropriate intervention for this condition include? Using a soft toothbrush A patient is undergoing external radiation and helping the patient with effects the nurse would? Instruct the patient to wear loose fitting, cotton clothing Which viruses are responsible for specific cancers? (Select all that apply.)

• Liver cancer from hepatitis B virus
• Burkitt lymphoma from Epstein-Barr virus
• Cervical cancer from human papillomavirus
• Kaposi sarcoma from human immunodeficiency virus The patient has terminal cancer of the prostate and screams at you. What type of emotion he he experiencing? Anger The nurse reinforces patient instructions regarding neutropenic precautions. Important topics should include which of the following?

• No fresh fruit
• No raw vegetables or salads
• Encourage hand hygiene The nurse is teaching a 50-year-old male patient who is taking estrogens as treatment of prostate cancer. The nurse should educate the patient about which expected side effect? Gynecomastia The nurse is caring for a terminally ill cancer patient who is receiving palliative care. The patient's wife asks how her husband's pain will be controlled as he nears death. Which is the nurse's best response? "Most of the time we can manage the pain with oral morphine and transdermal pain medication." The nurse explains that metastasis from the original site to a new site can occur in a variety of ways. Which mechanisms do malignant cells use to metastasize? (Select all that apply.)
• "Transplantation" via surgical instruments during surgery.
• Entering a body cavity and attaching to an organ.
• Traveling through the lymphatic system.
• "Relocation" from contaminated gloves during surgery. The nurse found a pellet in the bed of a patient receiving sealed internal radiation. What should the nurse do? Pick it up with a long handled lead tong and place it in lead container. Radiation has an immediate and delayed effect on cells. What statement holds true? The delayed effect is that it alters the DNA and impairs the ability to replicate or reproduce Using the TNM staging classification system, what does a tumor staged as T2N2M2 mean? large tumor, with lymph node involvement, and metastases Tumors originating from epithelial tissues and epithelial cells are? melanomas Which of the following are thrombocytopenic precautions? Using an electric razor Which of the following people should avoid visiting a patient receiving internal-beam radiation? Pregnant woman in her third trimester Which statement is most appropriate for a nurse to tell the patient before insertion of radioactive implant? "Nurses will always be available but will only spend short periods of time at your bedside." In order to provide optimum nursing care it is important for the nurse to know that the standard of pain and pain control is best determined by who?

The patient The home health nurse educates the 75-year-old patient about the warm compresses he is using on his swollen elbow. Which information is most important to include in the teaching plan? Allow the compress to remain in place for 15 to 20 minutes. The hospitalized post surgical is reluctant to take the opioid pain medication because of drowsiness. Which response is most informative for the nurse to make? "Sleep and pain relief promote helping." The nurse clarifies the basics of the gate theory of pain control. Which information should the nurse include? The "gate" can be closed to pain by the use of non-painful stimuli. The nurse explains that the pain threshold and pain tolerance are different. Which statement about the pain threshold is true? Pain threshold is the point at which pain is perceived. The nurse is caring for a 45-year-old male Arab patient who is in pain. Which action can most likely be attributed to the patients' cultural belief about pain? The patient asks for pain relief to control pain. The nurse is caring for a patient that is receiving intravenous morphine sulfate. The patient breaks out in hives and begins to itch. What should the nurse do first? Stop the infusion The nurse is caring for a patient who is having constant nociceptor pain. Which intervention best addresses the patient's pain during the perception phase of pain? Engage the patient in conversation regarding his family, hobbies, and plans following discharge from the facility. The nurse is caring for a patient who is having neuropathic pain. Which agents will most effectively control his pain?

• anti-depressant
• anti-inflammatory
• anti-convulsant The nurse is educating the home health patient about indications for acetaminophen. Which information should the nurse include in the teaching plan? Take acetaminophen before pain becomes severe. The nurse is planning to teach a family member about effective massage techniques. Which information is most important to include in the teaching plan? Use long, firm strokes while avoiding areas of inflammation.

The patient is experiencing phantom pain following the amputation of her foot. which type of pain is most associated with phantom pain? Neuropathic The patient on frequent doses of merperidine (Demerol) complains of constipation. Which initial intervention is best? Increase oral fluid intake. To help with pain control, how should the nurse time the distraction activities for a patient? To bridge the time between administration and onset. What are the functions of endorphins?

• Inhibition of unpleasant stimuli
• diminished anxiety
• feelings of euphoria When giving care to a 30-year-old Hispanic male, which action can most likely be attributed to the patients cultural beliefs about pain? The patient maintains a stoic affect about pain. While bathing a patient, the nurse notes that a transdermal patch that was meant to be on the patient for 3 days now is now gone on the second day. What action should the nurse take? Document the loss and apply a fresh patch to be replaced in 3 days. A patient reports pain relief after having received a placebo. Which conclusion is most accurate for the nurse to determine? The patient was relieved of the anxiety that there is no ready source of pain remedy. A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. What is the purpose of the T-tube? To keep the duct open and allow drainage of the bile until edema resolves. Why is it advantageous for a live person to be a liver donor? Because the donor donates only a part of the liver Esophageal varices is a common side effect of Cirrhosis While assessing a patient with suspected acute pancreatitis, the nurse would expect to find: elevated amylase Which would be most appropriate in the prevention of hepatitis B in high-risk health workers? Hepatitis B vaccine

Which procedure is used to remove gallstones obstructing the common bile duct? endoscopic retrograde cholangiopancreatography (ERCP) The nurse watches a patient perform an insulin injection. Which observation(s) indicate(s) that the patient needs additional instruction? (select all that apply.)

• The patient rubs the injection site after administration of the insulin injection.
• The patient draws up the cloudy insulin and then the clear insulin.
• The patient shakes the insulin bottle before administration. The nurse is caring for a patient suspected of having ketoacidosis. Which manifestation(s) is/are characteristic with early ketoacidosis? (select all that apply.)
• Fruity breath
• Polyuria
• Thirst When discussing exercise programs with the diabetic, which instruction(s) is/are important for the nurse to include? (select all that apply.)
• Delay exercise until glucose controlled.
• Keep a quick source of glucose readily available while exercising.
• Begin slowly and build up to 30 to 45 minutes.
• Only use the abdominal injection site for insulin. What are the advantages of fixed-combination insulins, like Humulin 70/30? To minimize the amount of injections daily Which of the following is characterized by blood glucose over 600 severe dehydration with type 2 diabetes (HHS) To decrease the risk of microvascular complications associated with diabetes the recommended level of A1C is: 6.5% Hypoglycemia may be caused by which of the following:
• going for a last minute 8 mile hike
• missing a meal Which reason best explains why diabetics are prone to infection? Atherosclerotic vascular changes decrease blood supply to tissues. What are the three P's?

• polydipsia
• polyuria
• polyphagia A nurse is assisting with teaching a group of clients about monitoring for diabetic peripheral neuropathy. Which if the following client statements indicates understanding of the information? I might lose awareness of when I'm stepping on a harmful object An adult client newly diagnosed with type 2 diabetes mellitus asks a nurse to explain how he developed the condition. Which of the following responses should the nurse make? Your body doesn't process glucose well The nurse is educating a 50-year-old patient about diabetes monitoring. Which statement reinforces the American Diabetes Association's (ADA's) recommendation? Obtain regularly scheduled fasting blood glucose levels. A patient with diabetes asks her nurse about foot care when she is discharged home. What is the nurse's best response? "Inspect each foot daily for cuts, cracks, blisters, or abrasions." Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes? 95% Type 1 diabetes cases compose approximately what percentage of all known cases of diabetes? 5 - 10% The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest? Begin an exercise program and lose weight A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst. Which explanation is most appropriate? High glucose levels in the blood pull cellular water into circulating volume and increase thirst. The nurse is caring for a patient with Ketoacidosis. Which statement indicates that the patient correctly understands the phenomenon? "The condition resulted when my body tried to break down and use my stores of fats." The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next? Give 6 ounces of orange juice

The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What can the nurse infer from these findings? The patient's blood glucose control has improved over the last several months. The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours. Which statement correctly explains the reason for this problem? Counterregulatory hormones produce hyperglycemia. "Dawn Phenomenon" A patient with type 1 diabetes mellitus (DM) is preparing for a moderate 30-minute exercise period. Which action best indicates that the patient understands condition management? The patient consumes a simple carbohydrate snack after 30 minutes of activity. A nurse is caring for a client who has cholelithiasis with bile obstruction and should expect which of the following findings upon assessment? (Select all that apply)

• Amber urine
• Yellow sclera
• Right clavicle pain A nurse is assessing a client with advanced cirrhosis which the following manifestation should the nurse expect to find? (Select all that apply)
• Spider angiomas
• Blueish veins around the belly button A nurse is caring for a patient who has a history of pancreatitis. Which of the following food choices should the client avoid? Cheddar Cheese The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of: Esophageal varices What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis? Have patient void immediately before procedure What should the nurse expect of a patient with a malabsorption of vitamin K? Increased prothrombin time When caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for in the plan of care?

Skin care to relieve pruritus Which medical intervention and management system control the bleeding of esophageal varices? Band ligation The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem? Cholecystitis Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.)

• Peanut butter
• Whole milk
• Glazed chocolate doughnuts A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A? Recent ingestion of raw fish A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response? "The pancreas is stimulated whenever you eat or drink, and causes pain." The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse's teaching has been successful "I should let these Steri-Strips fall off on their own." A nurse is caring for a patient who is 4 hours postoperative after a laparoscopic cholecystectomy. The patient reports abdominal fullness and mild discomfort. After verifying that the patient's vital signs are stable, what action is most important for the nurse to take next? Ambulate the patient The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis? Increased prothrombin time The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test? Liver biopsy

The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention? Confusion A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate? "Hepatitis A is not transmitted as a result of close contact with an infected individual." The nurse is preparing to administer liquid laxative to a patient in preparation for a colonoscopy. Which action should the nurse take? Chill the laxative and pour it over ice The nurse is caring for a client who has hemorrhoids. What can the nurse do to help the client. Follow a high fiber diet to establish bowel regularity. The nurse lists foods and beverages that may trigger an attack of irritable bowel syndromes (IBS), which include: (Select all that apply.)

• coffee
• whole wheat bread
• yoghurt The nurse is aware that the diagnostic criteria for the confirmation of irritable bowel syndrome include: (Select all that apply.)
• mucorrhea
• abdominal pain with change of stool consistency
• bloating The nurse cautions that constant stress can cause which alteration to the gastrointestinal (GI) system? Increased digestive juices resulting in a gastric ulcer In pernicious anemia, intrinsic factor deficiency impairs Vitamin B12 absorption When chyme leaves the stomach it passes through which structures in which order? Duodenum, Jejunum, ileum, ileocecal valve, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus Common causes of dysphagia include include all of the following except? barium swallow test The nurse is discussing bariatric surgery complications with a patient. Which statement indicates that the patient accurately understands the nurse's teaching about common procedural side effects?

"Gallstones are a common occurrence in patients who have bariatric surgery." All of the following are important for colostomy care except? vigorously scrub the skin while changing the appliance to ensure no fecal material remains on the skin Which of the following are appropriate nursing interventions for a patient with appendicitis waiting for surgery the next day?

• apply cool compress for pain management
• assess abdomen for rigidity which may indicate rupture All of the following statements about ulcerative colitis are true except? that it leads to anal fissures and fistulas A nurse is reinforcing teaching with a client who has Crohn's disease about foods to include in her diet, Which of the following foods should the nurse include in the teaching? Grilled Chicken Breast The nurse caring for a patient who has peritonitis and has developed a paralytic ileus assesses that the patient is passing gas (flatus). The assessment is an indication of: returned peristalsis. The nurse is caring for a patient with a 4-day-old ileostomy. The patient complains of cramping, the nurse notes decreased output, and the bowel sounds have a high pitched sound. What action should the nurse take? Notify the charge nurse immediately. The nurse is reinforcing teaching with a client who is post-op following an ileostomy. Which of the following instructions should the nurse include in the teaching? Avoid medications encapsulated Which type of hernia can lead to necrosis? Strangulated hernia The nurse is aware that an unresolved intestinal obstruction can lead to which complications? Intestinal rupture and shock The nurse explains which advantage benefits patients with a Kock pouch ileostomy? The patient does not have to wear a collection device. The nurse is educating a patient with diverticulitis. Which statement indicates that the nurse's teaching about the importance of seeking treatment has been successful? "If left untreated, the inflamed bowel can perforate and cause peritonitis." The nurse is aware that the person with ulcerative colitis is a risk factor for developing which disorder?

Colon cancer The mechanical bowel obstruction caused when the bowel twists on itself is known as _________. Volvulus The nurse explains that the diagnosis of morbidly obese is reserved for people who exceed which percentage of their recommended weight? 100% A nurse is collecting data from a client who has squamous cell carcinoma of the lower lip. Which of the following is an expected finding? an ulcerated lesion that is bleeding and painful A nurse is collecting data from a client and observes multiple cradle like abscess ulcers in the clients oral cavity. The nurse should use which of the following terms when documenting the findings? Stomatitis To best assist a patient with dysphagia, the nurse should implement which action(s)? (select all that apply.)

• Encourage "practice swallowing" before the meal.
• Coach the patient to chew thoroughly.
• Assist the patient to sit upright with the head forward and chin tucked. The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen. The patient is receiving total parenteral nutrition (TPN), and the physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response is best for the nurse to make? "The TPN you are receiving has high amounts of glucose." The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur at which time? At bedtime A patient is admitted with GI bleeding. His vital signs are BP - 140/80, Pulse - 72, Respirations - 14, and temperature is 98.9F. Which of these findings should be reported to the Registered Nurse or Physician immediately? Blood pressure - 100/ Which of these would you recognize as the most common cause of acute diarrhea? Bacterial or viral infection You note on rounds that your patient's NG tube has not been draining as much as usual. Your patient is complaining of nausea, and you note abdominal distention. Which of the following is your next course of action? Assess patency of the tube

Medications that neutralize gastric acid secretion:

• Proton-pump inhibitors
• Histamine receptors
• Antacids The nurse is caring for a patient whose home medications include bismuth subsalicylate (pepto). The nurse should educate the patient about which side effects of this medication? Black stools The nurse is caring for a patient with anorexia nervosa. Which intervention(s) might the nurse use to stimulate appetite? (select all that apply.)
• Arrange for preferred foods to be served.
• Encourage family members to bring food from home.
• Suggest that family members or friends come and socialize during the meal.
• Allow ample time to eat and enjoy the meal. Which causative agent is the primary cause of Barrett esophagus? GERD The nurse is educating a patient with a hiatal hernia. Which statement indicates that the patient understands the nurse's teaching? "I should avoid tea and chocolate." The nurse is caring for a patient with a peptic ulcer. The patient also has a history of chronic bronchitis, diabetes, and arthritis. Which component of the patient's history is the most likely contributing factor to the patient's ulcer? The patient takes ibuprofen daily for arthritis pain. How long should the nurse auscultate the bowel sounds before documenting "absent bowel sounds"? 5 minutes Which alternative therapy helps with nausea and vomiting? Ginger Which action(s) should the nurse recommend to promote a patient's bowel health? (select all that apply.)
• Drink adequate water.
• Include adequate bulk in the diet.
• Defecate at approximately the same time every day.
• Exercise regularly.

The nurse is caring for a patient who returns to the floor at lunch time after undergoing an upper GI (UGI series). Which action is most important for the nurse to perform first? Administer a laxative. Metabolism is defined as: Chemical process to make substances needed by the body A 45-year-old man has a history of calcium oxalate stones which can result in further renal calculi. What should you include about diet in this patient's education? He should increase fluids and dietary calcium. A nurse is providing teaching to a male client who has a ileal conduit following surgery to treat bladder cancer. Which of the following statements by the patient indicates further teaching? "I must insert a catheter through your stoma to drain the urine." What are ways to prevent UTIs? drink at least 8 full glasses of water everyday What is the purpose of the creatinine test? to determine kidney function A nurse is caring for a client with hemodialysis. Which measurement should the nurse compare before and after the procedure to determine fluid losses? Measure body weight Which statement best indicates that the patient understands teaching about dietary restrictions in glomerulonephritis? "I should avoid canned soups and hot dogs." As chronic glomerulonephritis progresses, how is the kidney usually affected? The kidney atrophies. The home health nurse is caring for a patient with chronic renal failure. Which assessment finding(s) indicate(s) that the patient is experiencing uremic syndrome? (select all that apply.)

• Restless legs
• Dry, scaly skin
• Nausea A home health patient with end-stage renal disease (ESRD) has a nursing diagnosis of powerlessness related to life- altering disease. Which nursing intervention would be most helpful include the patient in making the plan of care

A patient with cystitis is receiving phenazopyridine (Pyridium) for pain and is voiding a bright red-orange urine. What should the nurse do explain to the patient that this is normal A patient age 69 is admitted to the hospital with gross hematuria and history of a 20-lb weight loss during the last 3 months. The physician suspects renal cancer. In obtaining a nursing history from this patient, the nurse recognizes which of the following as a significant risk factor for renal cancer cigarette smoking An intravenous pyelogram confirms the presence of a large renal calculus in the proximal left ureter of a newly admitted patient. The patient is not a candidate for conservative measures, so surgical correction is ordered. A temporary stent is inserted. In addition to observing the patient for hemorrhage, what should be the nurse's postsurgical interventions include for this patient? Providing aseptic care of the surgical site As the body breaks down protein, nitrogen wastes are broken down into urea, ammonia, and creatinine It is 2 days after a 42 year old male patient's urinary diversion surgery. He continues to be critical of the hospital and the nursing care even though the staff has spent time explaining the care to him. What is the most likely explanation for his behavior he is reacting to the loss of self-esteem and altered body image The nurse is caring for a 90-year-old resident in a long-term care facility who is becoming progressively confused and irritable. What should the nurse do next? Request an order for a urinalysis. A 25-year-old woman comes to the emergency department with nonspecific urethritis. Which information is most important for the nurse to obtain? "How often do you use bath salts or take bubble baths?" A 25-year-old man comes to the college clinic with fever of 101° F, nausea, and flank pain that radiates into the thigh and genitals. The nurse anticipates that the patient will undergo workup for which infection? Pyelonephritis The nurse is caring for a young man who has been prescribed ciprofloxacin (Cipro) for pyelonephritis. Which information should the nurse include in order to prevent recurrence? Take this medication with a full glass of water.

The nurse is reviewing a history and physical examination of a 22-year-old man hospitalized for acute glomerulonephritis. Which finding best alerts the nurse to a potential causative agent? A recent strep throat infection The nurse is caring for a patient diagnosed with glomerulonephritis. The patient reports feeling "bored and caged," and asks when he can resume normal activities. Which finding indicates that bed rest may be discontinued? The patient's blood pressure is 110/74. A patient has a kidney stone lodged in the ureter. He questions why it must be removed. What response is most appropriate? "If the stone is not removed, it could block urine flow from the kidney and cause swelling within the kidney." The nurse is caring for a patient who underwent a right nephrostomy to relieve hydro nephrosis. Which intervention is most important for this patient? Assess urinary output from the left kidney. The nurse is caring for a 50-year-old female who presented to the emergency department after being involved in a motor vehicle collision. The patient displays marked tenderness and spasm in the suprapubic area and a non- pulsating mass. The nurse anticipates that this patient will undergo additional workup for which complication? Bladder trauma The nurse is assessing a patient who is being treated for acute pyelonephritis. When finding best indicates to the nurse that the patient is in the early stages of pyelonephritis? flank pain What should the nurse instruct the patient to do before obtaining the urine specimen for a urine culture obtain a clean catch specimen Why are women more susceptible than men to urinary tract infections females have a short and proximal urethra in relation to the vagina When a patient asks why he has so many UTIs the nurse informs that the patient's recurrent UTIs most likely resort from which causative factor: from bacteria that colonize the kidney An 85-year-old patient who has been NPO since midnight last night for diagnostic testing just completed the procedure. Which intervention is most important? Offer 4 ounces of water or juice every hour A patient is receiving chlorothiazide (Diuril) a thiazide diuretic for hypertension. What nursing action is most important for prevention of complications

assess for hypokalemia The nurse cautions the diabetic patient that diabetes affects the blood flow through the kidney. Which statement indicates that the patient understands the nurse's teaching? "Diabetes causes changes to blood vessels, which impacts blood flow to my kidneys." In order to keep optimal flow through the urinary system, a person should have a minimum daily intake of how many mL of fluid? 2000mL A patient is scheduled to undergo a cystogram. Which statement indicates that the patient accurately understands the nurse's teaching about prevention of potential complications after the test? "I should drink plenty of fluids after the test is over." The nurse is caring for a woman suspected of having a vaginal fistula. Which finding supports the potential diagnosis? Pneumaturia When the nurse is caring for a patient who reports he has blood that begins when he initiates the urine stream and then abates. Based on underlying pathophysiology, the nurse concludes that the hematuria is occurring in which location? In the urethra The nurse is collecting data from a patient who complains of having urinary frequency. The nurse should inquire about which dietary habit? Caffeine intake The student nurse is attempting to irrigate an indwelling catheter. Which action best indicates that the student nurse accurately understands the correct procedure? The student nurse irrigates using a steady, gentle stream. The patient confides that sneezing makes her "wet her pants." The nurse recognizes this cardinal sign of which type of incontinence? Stress incontinence A patient has just returned to the nursing unit after having a renal biopsy. Which intervention is most important to include in the patient's nursing care plan? Instruct the patient to avoid laughing and use a pillow to splint when sneezing. Which age-related change(s) occur(s) in the urinary system? (select all that apply.)

• Prostate hypertrophy
• Decreased renin secretion
• Decreased bladder muscle tone When discussing bladder health with a patient, the nurse emphasizes the importance of regular voiding in a timely manner. Which statement(s) indicate(s) that the patient accurately understands the underlying rationale for this recommendation? (select all that apply.)
• "Urinating regularly will prevent prolonged exposure of the bladder wall to harmful wastes."
• "Allowing my bladder to overfill causes the walls to overstretch."
• "A full bladder can cause undue strain on the urinary sphincters." While caring for a patient with an indwelling catheter, which intervention(s) is/are important for the nurse to include in the plan of care? (select all that apply.)
• Observe tube placement and note the level of urine in the collection bag.
• Use a syringe to deflate the balloon before discontinuing the catheter.
• Clean the meatus and catheter with soap and water. The nurse is caring for a patient with urinary retention. Which measure(s) should the nurse take when assisting the patient to void? (select all that apply.)
• Offer the patient tea or soda.
• Provide a warm bath.
• Run water in the lavatory. The basic functional unit of the kidney is the ________. nephron The nurse explains that the urge to void occurs when the bladder contain as little as ______ mL of urine. 150mL Anuria: Absence of urine Oliguria: Diminished urine Polyuria: High urinary output Nocturia: Urination at night

Hematuria: Blood in the urine Dysuria: painful urinatio