GASTRO/METAB/HEMA (MIDYEAR-RATIO)

Question 1

Ideal site for Total Parenteral Nutrition

Answer 1

Subclavian vein and Jugular vein because they are the major vessels

Question 2

Solution applicable for blood transfusion

Answer 2

PNSS

Question 3

Which of the following lab result demonstrates successful blood transfusion of 2 units PRBC?

a. Hemoglobin level 7 g/dL
b. Platelets 300,000 ?l
c. Hemoglobin level 15 g/dL
d. Prothrombin Time 12.5 seconds

Answer 3

C - because the hemoglobin is within normal values.

Question 4

What is the most appropriate nursing intervention once colostomy stoma has no fecal drainage day 1 post op.

a. Obtain an order to irrigate the stoma.
b. Call the doctor immediately.
c. Continue the current plan of care.
d. Place the patient on bed rest and call the doctor.

Answer 4

A - Fecal drainage will occur 3-4 days after colostomy. It is normal that fecal drainage is absent on the day 1 post-op. Instead, monitor the client.

Question 5

Patient Juan has ongoing blood transfusion of PRBC and it will be consumed at 12:00 noon. However, the IV antibiotic is due at 9:00am. Nurse Alex will:

Answer 5

Administer the IV Antibiotic as scheduled in a second IV access site.

Question 6

Which of the following should the nurse instruct in a client with colostomy to report to his physician:

a. Passage of flatus during expulsion of feces
b. Difficulty in inserting the irrigating tube
c. Abdominal cramps during fluid inflow
d. Inability to complete the procedure in half an hour

Answer 6

B

Question 7

Which statement below is NOT correct about red blood cells?

Select one:

a. “Red blood cells help remove carbon dioxide from the body.”
b. “Red blood cells help carry oxygen throughout the body with the help of

the protein hemoglobin.”

c. “Red blood cells are suspended in the blood’s plasma.”
d. “Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems.”

Answer 7

D. Because this statement pertains to WBC and Platelets

Question 8

Which nursing diagnosis should be included in the plan of care in the client following creation of colostomy?

Select one:

a. Body image, disturbed
b. Nutrition: more than body requirements, imbalanced
c. Sexual dysfunction
d. Fear related to poor prognosis

Answer 8

A - it is important to a client with colostomy to include disturbed body image in the plan of care because this gives an unusual appearance.

Question 9

Which of the following is TRUE in colostomy feeding?

Select one:

a. Insert the ostomy feeding tube 1 inch towards the stoma
b. Pour 30 ml of water before and after feeding administration
c. Hold the syringe 18 inches above the stoma and administer the feeding slowly
d. A Pink stoma means that circulation towards the stoma is all well

Answer 9

B - before and after colostomy feeding pour 30ml of water to see if there is an obstruction and to assess tube patency

Question 10

Nurse Florence should include on her discharge instruction about resuming activities for a client who had colostomy. Nurse Florence should plan to help the client understands that:

Select one:

a. Most sports activities, except for swimming, can be resumed based on the client?s overall physical condition.
b. After surgery, changes in activities must be made to accommodate for the physiologic changes caused by the operation.
c. With counseling and medical guidance, a near normal lifestyle, including complete sexual function is possible.
d. Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency.

Answer 10

C

Question 11

The most important nursing action before gastrostomy feeding is:

Select one:

a. Measure residual feeding
b. Assess for patency of the tube
c. Check the placement of the tube
d. Check V/S

Answer 11

B - Always assess for patency of the tube to make it sure that there is no obstruction

Question 12

Doctor Uy ordered to premeditated patient X with diphenhydramine and paracetamol before 1 unit of transfusion starts. Nurse Regina will administer these medications:

a. 15 minutes before starting the transfusion
b. Right before starting the transfusion
c. Immediately after starting the transfusion
d. 30 minutes before starting the transfusion

Answer 12

D

Question 13

A patient started receiving their first unit of blood at 10:00AM. It is now 10:10AM and the patient is reporting itching, chills, and a headache. In addition, the patient’s temperature is now 37.6 degrees Celsius from 37.2 degrees Celsius. Your next nursing action is:

a. Decrease the rate of the transfusion
b. Notify the physician
c. Reassure the patient that this is normal and will resolve in 30 minutes.
d. Stop the transfusion

Answer 13

D - because the manifestations that are presented by the client are signs of ALLERGIC REACTIONS

Question 14

Nurse Mark is preparing to give a total parenteral nutrition using a central line. Place the following steps for administration in the correct order?

1. Connect the tubing to the central line.
2. Regulate the electric infusion pump at the ordered rate.
3. Maintain aseptic technique when handling the injection cap.
4. Check the solution for cloudiness, particles, or a change in color.
5. Prime the IV tubing through an infusion pump.
6. Select and flush the correct tubing and filter.
   a. 6, 4, 5, 1, 3, and 2.
   b. 4, 3, 5, 6, 1, and 2.
   c. 3, 4, 6, 1, 5, and 2.
   d. 4, 6, 5, 3, 1, and 2.

Answer 14

D

Question 15

After receiving the 1 unit PRBC from the blood bank the nurse must start transfusing the blood within how many minutes?

Select one:

a. 1 hour
b. 15 minutes
c. 5 minutes
d. 30 minutes

Answer 15

D. 30 minutes

Question 16

The nurse ensure the availability of which of the equipment before hanging the Total Parenteral solution central line?

Select one:

a. Nebulizer.
b. Glucometer.
c. Dressing tray.
d. Infusion pump.

Answer 16

D. Infusion pump

The nurse should prepare an infusion pump prior hanging a parenteral solution. The use of an infusion pump is important to make sure that the solution does not infuse too quickly or delayed since the parenteral nutrition has a high glucose content. Option A: A glucometer is also needed since the client’s glucose level is monitored every 4 to 6 hours, but it is not an essential item needed. Options B and C are not used before hanging a PN solution.

Question 17

Which goal has the highest priority immediately after creation of ileostomy:

Select one:

a. Minimizing odor formation
b. Assisting the client with self-care activities
c. Provide relief from constipation
d. Maintaining fluid & electrolyte balance

Answer 17

D. Maintaining fluid & electrolyte imbalance

Question 18

Nurse Toyang obtains a residual amount of 90ml before feeding her client via NGT. Nurse Toyang appropriate action would be:

Select one:

a. Discard the residual amount.
b. Reinstill the amount and continue with administering the feeding.
c. Skip the feeding and administer the next feeding due in 4 hours.
d. Hold the due feeding.

Answer 18

B

Question 19

The two blood vessels most commonly used for TPN infusion are the:

Select one:

a. Femoral and subclavian veins
b. Brachial and subclavian veins
c. Brachial and femoral veins
d. Subclavian and jugular veins

Answer 19

D

Question 20

Watery stool has been leaking from Patient X rectum and complaining abdominal discomfort . The nurse notes that this could be a sign of:

Select one:

a. Diarrhea
b. Constipation
c. Bowel incontinence
d. Fecal impaction

Answer 20

D. Fecal impaction

Question 21

The intended outcome of administrating oral neomycin before ileostomy surgery is to :

Select one:

a. Decrease the potential for post operative hypostatic pneumonia
b. Increase the body’s immunologic response to the stressors of surgery
c. Prevent postoperative bladder infection
d. Reduce the number of intestinal bacteria

Answer 21

D. Reduce the number of intestinal bacteria

Question 22

Which patient or patients below can receive AB- type of blood safely?

Select one:

a. A patient with A- blood.
b. A patient with AB- blood.
c. A patient with O- blood.
d. A patient with B- blood.

Answer 22

B

Question 23

Nurse Nico observes that patient X’s stoma appears dusky on day 1 post ileostomy. Nurse Nico would interpret this assessment as:

Select one:

a. The ostomy bag should be adjusted.
b. Blood supply to the stoma has been interrupted.
c. This is a normal finding 1 day after surgery.
d. An intestinal obstruction has occurred.

Answer 23

B. The blood supply to the stoma has been interrupted and not enough which leads the stoma to appear dusky on day 1 post-op ileostomy

Question 24

The nurse determines that patient X with diarrhea and dehydration has received adequate fluid replacement once the blood urea nitrogen (BUN) decreases to:

Select one:

a. 18 mg/dL.
b. 27 mg/dL.
c. 6 mg/dL.
d. 36 mg/dL.

Answer 24

A

Question 25

How should the nurse position the client for colonoscopy?

a. Bent over with hands touching the floor
b. Prone with the torso elevated
c. Lying on the right side with legs straight
d. Lying on the left side with knees bent

Answer 25

D

Question 26

The blood type known as the universal donor?

Answer 26

The blood type known as the universal donor?

Question 27

The maximum height of irrigation solution for colostomy is

Select one:

a. 24 inches
b. 12 inches
c. 5 inches
d. 18 inches

Answer 27

B. 12 inches

Question 28

A patient with O+ blood received A+ blood. The patient is at risk for?

Answer 28

Hemolytic transfusion reaction

Question 29

During the irrigation of colostomy, Patient Dugong begins to complain abdominal cramps. What is the appropriate nursing action?

Answer 29

Stop the irrigation temporarily

Question 30

A diabetic patient has a glycosylated hemoglobin A1c level of 10%. From this result Nurse X plans to teach the client about the importance of:

Answer 30

Preventing hyperglycemia

Question 31

A 2 units of PRBC werw ordered to patient X. The first unit was consumed at 6:00pm. Nurse Florence knows that which of the following should be done before starting the 2nd unit of PRBC?

Select one:

a. type and crossmatch the patient
b. hang a new bag of dextrose to transfuse with the blood
c. obtain signed informed consent for the second unit of blood from the patient
d. obtain a new y-tubing set for this unit of blood

Answer 31

D

Question 32

How soon will the patient show any signs of hypoglycemia if NPH insulin was administered at 6:00 am?

Answer 32

10:00 AM because the peak time for NPH is 4-12 hours

Question 33

When irrigating a colostomy, the nurse lubricates the catheter and gently inserts it into the stoma no more than _______ inches

Answer 33

3”

Question 34

Which of the following statement is incorrect about Sengstaken-Blackmore Tube?

a. It is used in patient’s with esophageal varices
b. Scissors are kept at the beside at all times with this tubing type
c. A NG tube is inserted in the opposite nare to collect secretions
d. It is a four-lumen gastric tube

Answer 34

D.

Question 35

Which of the following measures would be an anticipated part of client’s preoperative care scheduled to undergo abdominal perineal resection with a permanent colostomy?

Select one:

a. Advise the client to limit physical activity
b. Inform the client that total parenteral nutrition will likely be implemented after surgery
c. Administer neomycin sulfate the evening before surgery
d. Keep the client NPO for 24 hrs before surgery

Answer 35

C

Question 36

The nurse will perform a verification process before starting a blood transfusion with ___________?

Answer 36

1. licensed personnel only (another RN)
2. physician’s order
3. patient’s identification
4. blood bank’s information
5. patient’s blood type and donor’s type along with Rh factor
6. expiration date
7. assess the bag of blood for damage or abnormal substances

Question 37

Nurse Florence assesses the client’s stoma during the first few hours postoperative period. Which of the following observations would be reported immediately to the physician?

Select one:

a. The stoma does not expel stool
b. The stoma is slightly edematous
c. The stoma is dark red to purple
d. The stoma oozes a small amount of blood

Answer 37

C - because there is poor oxygenation in the stoma

Question 38

Which of these interventions is the priority if the patient will receive total parenteral nutrition (TPN) and lipids during the acute IBD.

Select one:

a. Monitor the patient’s blood glucose per protocol
b. Infuse the solution in a large peripheral vein
c. Monitor urine specific gravity every shift
d. Change the administration set every 72 hours

Answer 38

A

Question 39

The BEST adaptation of patient with the new colostomy will shows which of the following?

Select one:

a. Talk about his ostomy openly to the nurse and friends
b. Ask for leaflets and contact numbers of ostomy support groups
c. Look at the ostomy site
d. Participate with the nurse in his daily ostomy care

Answer 39

D - participation of the client with the nurse in his daily ostomy care signifies acceptance to his body image.

Question 40

Nurse Florence is assessing patient X diagnosed with ulcerative colitis. Nurse Florence would be most concerned about which of the following findings?

Select one:

a. Oral temperature of 37.2 C
b. Bloody diarrhea
c. Borborygmi
d. Rebound tenderness

Answer 40

D - rebound tenderness

Question 41

During the first 15 minutes of blood transfusion the nurse should:

Answer 41

run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient.

Question 42

Which patient below is at most RISK for a febrile (non-hemolytic) blood transfusion reaction?

Select one:

a. A 38 year old male who has received multiple blood transfusions in the past year.
b. A 42 year old female who is immunocompromised.
c. A 25 year old female who is AB+ and just received B+ blood.
d. A 78 year old male who is B+ that just received AB+ blood during a transfusion.

Answer 42

A. Person who has received multiple blood transfusion in the past year, the WBC is sensitive and will react to another WBC which causes fever.

Question 43

The nurse is teaching the client how to care for an ileostomy. The client ask the nurse how long to wear the pouch before changing it. The nurse should tell the client which of the following?

Select one:

a. “it depends on your activity level and your diet.”
b. “The pouch is changed only when it leaks”
c. “You can wear the pouch for about 4 to 7 days.”
d. “You should change the pouch every evening before bedtime.”

Answer 43

C

Question 44

Dr. Marinas has ordered a blood test for H. pylori for patient X. Nurse should prepare the patient X by:

Select one:

a. Explaining that a small dose of radioactive isotope will be used
b. Telling the client that no special preparation is needed
c. Giving an oral suspension of glucose 1 hour before the test
d. Withholding intake after midnight

Answer 44

B - blood test does not need special preparation it can perform anytime.

Question 45

Nurse Alex recognizes that the least likely candidate for TPN would be which of the following patients.

Select one:

a. A 59-year old client who had an appendectomy.
b. A 44-year old client with ulcerative colitis.
c. A 25-year old client with a Hirschprung?s Disease.
d. A 55-year-old with persistent nausea and vomiting from chemotherapy.

Answer 45

A

Question 46

Indicates normal stool drainage 4 days after sigmoid colostomy

Answer 46

Loose, bloody

Question 47

The nurse evaluates the effectiveness of the high-protein diet in the client with liver cirrhosis if the total protein level is which of the following values?

a. 6.9 g/dL.
b. 0.9 g/dL.
c. 4.9 g/dL.
d. 2.9 g/dL.

Answer 47

A. 6.9 g/dL

The normal value for total serum protein is 6 to 8 g/dL. The client with liver cirrhosis has low total protein levels secondary to inadequate nutrition.

Question 48

Which of the following laboratory tests does NOT assess coagulation?

a. Hematocrit
b. Platelet count
c. Partial thromboplastin time
d. Prothrombin time

Answer 48

A. Hematocrit

Question 49

Before initiating blood transfusion the nurse will gather which of the following supplies?

a. Y-tubing with in-line and 0.9% Normal Saline
b. PVC free tubing and dextrose
c. Polyethylene-line tubing and 0.9% Normal Saline
d. Y-tubing with in-line filter and dextrose

Answer 49

A

Question 50

The nurse obtain the following baseline VS: HR 100, BP 120/70, RR 18 and T 38.2 deg celsius before initiating the blood transfusion. The nurse next action is to:

a. Hold the blood transfusion and reassess vital signs in 1 hour.
b. Administer the blood transfusion as ordered.
c. Notify the physician before starting the transfusion.
d. Administer 200 mL of the blood and then reassess the patient’s vital signs.

Answer 50

C - because the pt has hyperthermia

Question 51

The nurse should do which of the following actions if a patient’s fat emulsion infusion is 2 hours delay?

a. Make sure the infusion rate is infusing at the ordered rate.
b. Adjust the infusion rate to catch up over the next hour.
c. Adjust the infusion rate to full blast until the solution is back on time.
d. Increase the infusion rate to catch up over the next few hours.

Answer 51

A

The nurse should maintain the prescribed rate of a fat emulsion even if the infusion’s time consume is behind. Options A, C, and D are incorrect since increasing the rate will potentially cause a fluid overload.

Question 52

Nurse Samantha should plan which of the following measures to prevent injury while caring for a combative patient receiving Total Parental Nutrition (TPN)?

Select one:

a. Instruct the relative to stay with the nurse.
b. Monitor blood glucose twice a day.
c. Measure 24-hour intake and output.
d. Secure all connections in the parenteral system.

Answer 52

D

Question 53

Which of the following items prepared by the PGNT indicates that the PGNT needs further instructions about colostomy irrigation?

Select one:

a. K-Y Jelly
b. Plain NSS / Normal Saline
c. Tap water
d. Irrigation sleeve

Answer 53

B - NSS is not necessary for colostomy irrigation because the colostomy itself is not sterile

Question 54

Stool of patient with sigmoid colostomy would be ____.

Answer 54

Formed

Question 55

To enhance the effectiveness of the colostomy irrigation and fecal returns, which of the following measures should Nurse Linda instruct to her client?

Answer 55

Increase fluid intake

instructed to increase fluid intake and to take other measures to prevent constipation

Question 56

Nurse Florence notice that the TPN bag of patient X is empty. Nurse Florence should hang which of the following solutions while waiting for another PN solution is delivered to the nursing station.

Select one:

a. 5% dextrose in water.
b. 5% dextrose in lactated Ringer solution.
c. 10% dextrose in water.
d. 5% dextrose in normal saline.

Answer 56

C

The client is at risk for hypoglycemia; therefore the solution containing the highest amount of glucose should be hung until the new PN solution becomes available. Because PN solutions contain high glucose concentrations, the 10% dextrose in water solution is the best of the choices presented. The solution selected should be one that minimizes the risk of hypoglcemia. The remaining options will not be as effective in minimizing the risk of hypoglycemia.

Question 57

Which of the following is not TRUE regarding the types of a nasogastric tube?

Select one:

a. Sengstaken-Blakemore tube is a three-lumen tube.
b. Miller-Abbott tube is a long double-lumen used to drain and decompress the small intestine.
c. Levin tube is a double lumen nasogastric tube with an air vent.
d. Cantor tube is a single-lumen long tube with a small inflatable bag at the distal end.

Answer 57

C

Question 58

The nurse would know that dietary teaching had been effective for a client with colostomy when he states that he will eat:

Select one:

a. Bland foods so that his intestines do not become irritated
b. Soft foods that are more easily digested and absorbed by the large intestines
c. Food low in fiber so that there is less stool
d. Everything he ate before the operation but will avoid those foods that cause gas

Answer 58

D - There is no special diets for clients with colostomy. These clients can eat a regular diet. Only gas-forming foods that cause distention and discomfort should be avoided.

Question 59

Before receiving a transfusion of whole blood, the laboratory and blood bank require a sample of the patient’s blood. Which test will be run?

Answer 59

Blood type and crossmatch

Question 60

. A patient receiving parenteral nutrition is administered via the following routes except:

a. Subclavian line.
b. Central Venous Catheter.
c. PICC (Peripherally inserted central catheter) line.
d. PEG tube.

Answer 60

D. PEG TUBE

Percutaneous endoscopic gastrostomy (PEG tube) is inserted into a person’s stomach through the abdominal wall that is used to provide a means of feeding when oral intake is not adequate. While Parenteral nutrition bypasses the digestive system by the administration to the bloodstream.

Question 61

The nurse teaches the patient whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

A.solid.
B. semi-mushy.
C. mushy.
D. fluid.

Answer 61

A. With a sigmoid colostomy, the feces are solid.

With a descending colostomy, the feces are semi-mushy.

With a transverse colostomy, the feces are mushy.

With an ascending colostomy, the feces are fluid.

Question 62

The nurse knew that the normal color of Michiel’s stoma should be

Brick Red
Gray
Blue
Pale Pink

Answer 62

BRICK RED

Pale pink - pt with anemia

blue - pt with altered tissue perfusion