Final Review- Old stuff

Question 1

Q: A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this client’s pain?

a. Meperidine (Demerol) injections every 4 hours around the clock

b. Patient-controlled analgesia (PCA) pump with morphine
c. Ibuprofen (Motrin) 600 mg orally every 4 hours PRN for pain
d. Morphine 4 mg intravenous push every 2 hours PRN for pain

Answer 1

B

• The older adult client should never be treated with meperidine because toxic metabolites can cause seizures. The client should be managed with a PCA pump to control pain best. Motrin most likely would not provide complete pain relief with multiple fractures. IV morphine PRN would not control pain as well as a pump that the client can control.

Question 2

Q: A nurse on the postoperative inpatient unit receives a hand-off report on four clients using patient-controlled analgesia (PCA) pumps. Which client should the nurse see first?

a. Client who appears to be sleeping soundly

b. Client with no bolus request in 6 hours
c. Client who is pressing the button every 10 minutes
d. Client with a respiratory rate of 8 breaths/min

Answer 2

B

-Continuous delivery of opioid analgesia can lead to respiratory depression and extreme sedation. A respiratory rate of 8 breaths/min is below normal, so the nurse should first check this client. The client sleeping soundly could either be overly sedated or just comfortable and should be checked next. Pressing the button every 10 minutes indicates the client has a high level of pain, but the device has a lockout determining how often a bolus can be delivered. Therefore, the client cannot overdose. The nurse should next assess that client’s pain. The client who has not needed a bolus of pain medicine in several hours has well-controlled pain.

Question 3

Q: A nurse is caring for a client on an epidural patient-controlled analgesia (PCA) pump. What action by the nurse is most important to ensure client safety?


a. Assess and record vital signs every 2 hours.

b. Have another nurse double-check the pump settings.
c. Instruct the client to report any unrelieved pain.
d. Monitor for numbness and tingling in the legs.

-

Answer 3

B

PCA-delivered analgesia creates a potential risk for the client. Pump settings should always be double-checked. Assessing vital signs should be done per agency policy and nurse discretion, and may or may not need to be this frequent. Unrelieved pain should be reported but is not vital to client safety. Monitoring for numbness and tingling in the legs is an important function but will manifest after something has occurred to the client; monitoring does not prevent the event from occurring.

Question 4

Q: The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority?
a.
Check the respiratory rate.
b.
Assess for nausea after eating.
c.
Inspect the abdomen and auscultate bowel sounds.
d.
Evaluate the sacral and heel areas for signs of redness.

Answer 4

a.
Check the respiratory rate.

The patient’s respiratory rate is the highest priority of care while using PCA medication because of the possible respiratory depression. The other information may also require intervention but is not as urgent to report as the respiratory rate.

Question 5

NSAIDs (Ibuprofen, Naproxen, Celecoxibl, Diclofenac) should be used with caution in older adults because of

Answer 5

adverse effects, such as GI disturbances, bleeding, and sodium and water retention, decrease-clotting time.

Question 6

Gerd S/S

Answer 6

Dyspepsia, aka heartburn, is the main symptom of GERD. The pain of “heartburn” is described as a substernal burning sensation that moves up and down the chest in a wavelike fashion.
Other symptoms include eructation (belching), flatulence, and dysphagia (difficulty swallowing) or odynophagia (painful swallowing).

Question 7

Q: The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.)


a. Delayed gastric emptying

b. Eating large meals
c. Hiatal hernia

d. Obesity

e. Viral infections
- 
Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.

Answer 7

A<b></b>

Question 8

Peptic ulcer disease (PUD) results when

Answer 8

mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin.
Acute: Superficial erosion, minimal inflammation, short durations
Chronic: muscular wall erosion with formation of fibrous tissue, long duration, more common

Question 9

A patient diagnosed with peptic ulcer disease (PUD) asks if surgery will be necessary. How should the nurse respond?

1. “Taking the appropriate medications makes surgery rarely necessary.”
2. “Surgery is required in about 50% of cases.”
3. “Surgery has a higher success rate than medication therapy alone.”
4. “If you take your medications and follow the prescribed diet, you will likely not need surgery.”

Answer 9

1.

Global Rationale: With the identification of H. pylori infection as the major cause of peptic ulcers and the development of medications to eradicate this organism, surgery is rarely necessary. Surgery may be required to treat a complication of PUD, such as hemorrhage, perforation, or gastric outlet obstruction. The success rate of pharmacologic intervention to eradicate H. pylori is 75% to 90%. There are no specific dietary modifications for PUD.

Question 10

The nurse learns that a patient who is being treated for peptic ulcer disease is “still having problems.” What should the nurse instruct this patient to do?

1. try smoking cessation techniques
2. eat a bland diet
3. avoid eating breakfast
4. have the largest meal of the day at lunchtime

Answer 10

Global Rationale: Smoking should be discouraged, because it slows the rate of healing and increases the frequency of relapses. Diet therapy for peptic ulcer disease includes having the patient eat several small meals per day and avoid foods that produce symptoms, rather than prescribing a particular diet such as a bland diet. There is no need to avoid eating breakfast or have the largest meal of the day at lunchtime.

Question 11

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
a.
“You will need to remain on a bland diet.”
b.
“Avoid foods that cause pain after you eat them.”
c.
“High-protein foods are least likely to cause you pain.”
d.
“You should avoid eating any raw fruits and vegetables.”

Answer 11

B

The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa, but chewing well seems to decrease this problem and some patients may tolerate these foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.

Question 12

High risk factors for developing pancreatic cancer

Answer 12

, age history etc

Question 13

A nurse assesses clients at a community health center. Which client is at highest risk for pancreatic cancer?

a. A 32-year-old with hypothyroidism

b. A 44-year-old with cholelithiasis

c. A 50-year-old who has the BRCA2 gene mutation

d. A 68-year-old who is of African-American ethnicity

Answer 13

C

Mutations in both the BRCA2 and p16 genes increase the risk for developing pancreatic cancer in a small number of cases. The other factors do not appear to be linked to increased risk.

Question 14

Q: A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer?


a. A 26-year-old with a body mass index of 21

b. A 33-year-old who frequently eats sushi
c. A 48-year-old who often drinks wine
d. A 66-year-old who smokes cigarettes

Answer 14

D

Risk factors for pancreatic cancer include obesity, older age, high intake of red meat, and cigarette smoking. Sushi and wine intake are not risk factors for pancreatic cancer.

Question 15

Cirrhosis is

Answer 15

extensive irreversible scarring of the liver, usually caused by:
Post necrotic cirrhosis: caused by viral hepatitis (hepC) certain drugs or other toxins
Laennec’s or alcoholic cirrhosis: caused by chronic alcoholism
Biliary cirrhosis: (cholestatic) caused by chronic biliary obstruction or autoimmune disease
It typically has a progressive, slow, destructive course resulting in end-stage disease.
Ascites- collection of free fluid within peritoneal cavity caused by increased hydrostatic pressure from portal hypertension. It reduces the circulating plasma protein in the blood. Decreased serum osmotic pressure due to decrease in production of albumen due to impaired liver results in fluid shift from vascular system into abdomen called ‘third spacing”
Patient might have hypovolemia and edema at the same time
Massive ascites cause renal vasoconstriction triggering reninangiotesin system resulting in sodium and water retention that increases hydrostatic pressure and vascular volume that further leads to more ascites
Supportive measures to control abdominal ascites include nutritional therapy, drug therapy, paracentesis- remove the ascites fluid, and respiratory support.
Low sodium diet to control fluid accumulation in the abdominal cavity
Diuretics- to reduce fluid accumulation in ascites and to prevent cardiac and respiratory problem

Question 16

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites?


a. Monitor intake and output.

b. Provide a low-sodium diet. 

c. Increase oral fluid intake.
d. Weigh the client daily. 


-

Answer 16

B

A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful. 


Question 17

osteoarthritis manifestations osteoarthritis

Answer 17

• joint pain
• occurs in women
• crepitus may be felt or heard

Question 18

A patient is experiencing status epilepticus. Which medication should the nurse expect to be prescribed for this patient?

1. lorazepam (Ativan) IV
2. oral glucose
3. phenytoin (Dilantin) orally
4. gabapentin (Neurontin) and lamotrigine (Lamictal)

Answer 18

Global Rationale: Lorazepam (Ativan) can be used IV to stop the seizure and is an appropriate treatment order. No drug would be given orally during status epilepticus, although glucose IV would be appropriate. The drug needs to be given IV in this situation, and phenytoin (Dilantin) could be an option if ordered IV. The type of drug therapy used to treat epilepsy uses only one drug at a time.

Question 19

patio of SIADH

Answer 19

ADH excess caused fluid RETENTION, dilutinal hyponatremia, fluid OVERLOAD, (concentrated urine)

Question 20

S?S of SIADH

Answer 20

LOW urine output (concentrated) : decreased osmolarity r/t RETENTION of so much FLUID
Na levels can be 110- (normal 135-145) 🡪 sodium may appear LOW because of increased fluid

Question 21

treatment of SIADH

Answer 21

Fluid restriction, replace Na

Question 22

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client’s serum sodium level is 114 mEq/L. Which action should the nurse take first?


a. Consult with the dietitian about increased dietary sodium.
b. Restrict the client’s fluid intake to 600 mL/day.

c. Handle the client gently by using turn sheets for re-positioning.
d. Instruct unlicensed assistive personnel to measure intake and output.

Answer 22

B

With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client’s diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the client’s intake, so it is not the best answer. Reducing intake will help increase the client’s sodium.

Question 23

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?
a.
Observe the dressing for bleeding.
b.
Check the blood pressure and pulse.
c.
Assess the patient’s respiratory effort.
d.
Support the patient’s head with pillows.

Answer 23

C

Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority.

Question 24

Q: A patient has returned to the unit after having a parathyroidectomy. What drug is kept at the bedside for emergency use?
A)  Digitalis
B)  Ergocalciferol
C)  Amphojel
D)  Calcium gluconate

Answer 24

Feedback: Calcium gluconate is kept at the bedside with equipment necessary for emergency IV administration. Digitalis is used to slow the ventricular rate; ergocalciferol is vitamin D; Amphojel is aluminum hydroxide gel; none of these are emergency drugs kept at the bedside for a patient who has had a parathyroidectomy.

Question 25

: The nurse is assessing a patient with Guillain-Barré syndrome. What should the nurse expect to assess in this patient? Standard Text: Select all that apply.

1. increased muscular weakness
2. increased lower extremity edema
3. increased confusion
4. increased intolerance to light
5. decreased deep tendon reflexes

Answer 25

1,5

Global Rationale: As Guillain-Barré develops, the patient will, experience muscle weakness with paralysis from altered nerve conduction (motor nerves become demyelinated). One manifestations of the acute stage is decreased deep tendon reflexes. Increased lower extremity edema, confusion, and intolerance to light are not manifestations of this disorder.

Question 26

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client’s plan of care to reduce discomfort?


a. Administer morphine sulfate intravenously every 4 hours as needed.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids.
c. Provide small, frequent feedings with no concentrated sweets.

d. Place the client in semi-Fowler’s position with the head of bed elevated.

Answer 26

B

The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort.

Question 27

Q: While caring for a patient hospitalized with chronic gastritis it is important to educate the patient about what?
A) How to eat nutritiously
B) The correct use of medications to relieve acute gastritis
C) How to position themselves to relieve pain
D) Avoiding irritating foods and beverages

Answer 27

D

Feedback: Measures to help relieve pain include instructing the patient to avoid foods and beverages that may be irritating to the gastric mucosa and instructing the patient about the correct use of medications to relieve chronic gastritis. Education for chronic gastritis does not routinely include how to eat nutritiously or positioning themselves to relieve pain. Since the patient has chronic gastritis, option B is incorrect.

Question 28

Patient with c.diff what are safety management

Answer 28

Contact isolation

Question 29

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile (select all that apply)?
a.
Mask
b.
Gown
c.
Gloves
d.
Shoe covers
e.
Eye protection

Answer 29

B,C

• Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.

Question 30

Q: Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?
a.
Educate the patient about proper food storage.
b.
Order a diet with no 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.

Answer 30

Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.

Question 31

what is perontinitis?

Answer 31

is a life-threatening, acute inflammation and infection of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity.

Question 32

S/s of peritonitis ?

Answer 32

abdominal pain, tenderness, and distention.

Question 33

Q: A patient with peritonitis develops a temperature of 103° F (39.4° C), is restless, has blood pressure of 85/45 and has a urinary output of 76 mL in 8 hours. The nurse should develop a plan of care related to which health problem?

1. hypovolemic shock
2. inflammation
3. third spacing
4. bowel dysfunction

Answer 33

1

Global Rationale: The patient experiencing peritonitis may develop an abscess, which can lead to shock. The patient developing shock may present with oliguria, hypotension, fever, restlessness, confusion, and hypovolemia. The symptoms do not indicate inflammation, third spacing, or bowel dysfunction.

Question 34

Q: A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.)


a. Distended abdomen

b. Inability to pass flatus
c. Bradycardia

d. Hyperactive bowel sounds
e. Decreased urine output

Answer 34

A,B,E

• A client with peritonitis may present with a distended abdomen, diminished bowel sounds, inability to pass flatus or feces, tachycardia, and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associated with peritonitis

Question 35

patient in the clinic is concerned because her family has a strong history of colon cancer. The patient asks you what she can do to find out if she is going to get colon cancer. Why would you suggest genetic testing?
A) Just to calm the patient’s concerns.
B) There is a chance genetic testing can tell the patient whether she has colon cancer.
C) Genetic testing cannot yet identify people at risk for colon cancer.
D) Researchers have refined methods for genetics risk assessment, and preclinical diagnosis to identify people at risk for some GI disorders.

Answer 35

D

Question 36

Q: A nurse is presenting an educational event to a local community group. The nurse is speaking about colorectal cancer. What would the nurse identify as a risk factor associated with colorectal cancer?
A)  Over 50 years of age
B)  History of bowel obstruction
C)  Family history of stomach cancer
D)  Low-fat, low-protein, low-fiber diet

Feedback: Risk factors include age older than 50; history of rectal or colon polyps; presence of adenomatous polyps or villous adenomas; family history of colon cancer or familial polyposis; history of inflammatory bowel disease; and high-fat, high-protein (with high intake of beef), low-fiber diet.

Answer 36

A

Question 37

safety precaution for hiatal hernia

Answer 37

The primary focus of care after conventional surgery is the prevention of respiratory complications.
Elevate the head of the patient’s bed at least 30 degrees.
Assist the patient out of bed and begin ambulation as soon as possible.
Be sure to support the incision during coughing to reduce pain and to prevent excessive strain on the suture line, especially with obese patients.
Lifestyle modifications- eliminate alcohol, elevate bed, stop smoking, avoid lifting, reduce weight, use anti-secretory agents and antacids

Question 38

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test?
A) Stool will be yellow for the first 24 hours postprocedure.
B) The barium may cause diarrhea.
C) Fluids must be increased to facilitate the evacuation of the stool.
D) This series includes analysis of gastric secretions.

Answer 38

C

Feedback: Postprocedural patient education includes information about increasing fluid intake; evaluating bowel movements for evacuation of barium; and noting increased number of bowel movements, because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. The barium series does not analyze gastric secretions.

Question 39

Diabetes insipidus

Answer 39

ADH deficiency causes excretion of LARGE volumes of DILUTE urine (polyuria, dehydration) – can secrete up to 20L daily!

Question 40

S?S of DI

Answer 40

S/S- Increased urine output (dilute, low gravity)- Low levels of FLUID causes SODIUM to appear elevated

Hypotension, tachycardia, hemoconcentration (INCREASED BUN, H&H)

Question 41

Q: A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?
A) Glucose in the urine
B) Albumin in the urine
C) Urine specific gravity of 1.001 to 1.005
D) Leukocytes in the urine

Answer 41

C

Feedback: Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.

Question 42

Q: A nurse plans care for a client with Cushing’s disease. Which action should the nurse include in this client’s plan of care to prevent injury?


a. Pad the siderails of the client’s bed.

b. Assist the client to change positions slowly.
c. Use a lift sheet to change the client’s position.

d. Keep suctioning equipment at the client’s bedside. 


-

Answer 42

Cushing’s syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The client should not require suctioning.