medical surgical Flashcards by Stefany Mae Bacay

The client who has cervical cancer, is scheduled to receive internal radiation therapy using a vaginal implant for 72 hours. The nurse caring for the client should plan to:

Wear latex gloves at all times while in the room.

Spend no more than 30 minutes each shift performing bedside care.

Sit at the client’s bedside for 15-minute periods several times daily.

Wear a lead apron while providing physical care to the client.

Spend no more than 30 minutes each shift performing bedside care.

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The nurse in a college setting is conducting a healthy living class for the freshman and teaching the young men about testicular examination. Which information should the nurse include in the discussion?

Self testicular examination should be performed once a month by all men.

The procedure is difficult to learn and should be practiced on a mannequin before doing it on one’s self.

The term self testicular exam is really a misnomer; the exam is best done by someone else, such as a nurse or provider.

Frequency of examination should be increased as a person ages

Self testicular examination should be performed once a month by all men.

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The home care nurse is caring for a client who has cancer. The client has been hospitalized several times due to infections and the side effects of chemotherapy and radiation therapy. In developing a plan of care to improve the management of this client a goal should be to:

Prevent readmission and manage the client at home.

Teach the family to care for the client.

Have weekly family meetings to evaluate progress.

Perform personal care for the client.

Prevent readmission and manage the client at home.

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The client is receiving chemotherapy for cancer and is in protective isolation. His wife comes to visit. She asks the nurse if she really has to put the mask on since she has a cold and it is hard for her to breathe with the mask. The nurse should recommend that the woman:

Must put the mask on before entering the room.

Speak to her husband from the doorway, but not enter the room even with a mask.

Does not need to put on a mask if it is uncomfortable for her.

Put on a mask and change it frequently while in the room.

Speak to her husband from the doorway, but not enter the room even with a mask.

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The nurse is planning a community class on the prevention and early detection of breast cancer. Which one of the following instructions should the nurse include?

A breast self-examination should be done in order to determine normal from abnormal conditions.

Breasts should be examined every month, about five to seven days after the onset of the menstrual period.

Annual mammogram for all women of reproductive age is recommended.

With breast self-examination and periodic mammogram, yearly clinical breast exams are not needed

Breasts should be examined every month, about five to seven days after the onset of the menstrual period.

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A woman who has breast cancer of the left breast has just undergone a mastectomy. In the immediate post-op period the nurse would encourage exercise for the affected arm by having the client:

Touch the right ear with the affected arm.

Raise her affected arm above her head repetitively.

Raise her affected arm above her head while holding a one pound weight.

Flex and extend the fingers and hand on the affected side.

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Which symptom is a warning sign of colon cancer?

Hoarseness

Indigestion

Rectal bleeding

Sore that doesn’t heal

Rectal bleeding

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The client asks the nurse what is the purpose of getting a glycosolated hemoglobin (HgbA1C) done? The nurse’s best response is “ the purpose of a glycosolated hemoglobin (Hgb A1C) is to:

Assess the client’s management of diabetes.

Monitor the ability of oxygen to attach to hemoglobin.

Accurately diagnose DM

Confirm fasting blood glucose levels.

Assess the client’s management of diabetes.

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The nurse is caring for a client who is receiving growth hormone replacement therapy. The nurse monitors the client for which side effect of this therapy?

Hyperglycemia

Hyperthyroidism

Hypoglycemia

Hypocalcuria

Hyperglycemia

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Somatropin (Humatrope), a growth hormone, is prescribed for a client. The nurse reviews the assessment data in the client’s health record, knowing that the medication is contraindicated in which of the following conditions?

A child with growth hormone deficiency

A child with pituitary dwarfism

A 20-year-old with growth failure

A child with growth failure

A 20-year-old with growth failure

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A client with acromegaly will most likely experience which symptom?

Bone pain

Frequent infections

Fatigue

Weight loss

Frequent infections

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A nurse is preparing to provide instructions to a client with Addison’s disease regarding diet therapy. The nurse knows that which of the following diets most likely would be prescribed for this client?

High-fat intake

Low-protein intake

Normal sodium intake

Low-carbohydrate intake

Normal sodium intake

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The nurse caring for a client with Addison’s disease would expect to note which of the following on assessment of the client?

Obesity

Edema

Hypotension

Hirsutism

Hypotension

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A nurse is caring for a client with a diagnosis of Addison’s disease. The nurse is monitoring the client for signs of addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis?

Diaphoresis

Agitation

Restlessness

Severe abdominal pain

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A nurse is providing instructions to a client with a diagnosis of Addison’s disease regarding the administration of prescribed glucocorticoids. The nurse should instruct client:

To avoid taking the medication if nausea occurs

To stop the medication if side effects occur

That minimal side effects will occur with use of this medication

That an increased dose of medication may be needed during times of stress

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A nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which of the following signs and symptoms would indicate adrenal insufficiency in this client?

Subnormal temperature and hypotension

Hypotension and fever

Mental status changes and hypertension

Complaints of weakness and hypertension

Hypotension and fever

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A nurse is developing a plan of care for a client with Addison’s disease. The nurse has identified a nursing diagnosis of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing intervention is an inappropriate component of the plan of care?

Encourage fluid intake of at least 3000mL per day.

Encourage an intake of low-sodium and low-protein foods.

Monitor for changes in mentation.

Monitor vital signs, skin turgor, and intake and output.

Encourage an intake of low-sodium and low-protein foods.

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A nurse is providing home care instructions to a client with a diagnosis of Addison’s disease. Which statement by the client indicates a need for further instruction?

“I need to wear a Medic-Alert bracelet.”

“I will need to take daily medications until my symptoms decrease.”

“I need an increased dose of glucocorticoid medication during stressful minor illnesses.”

“I need to purchase a travel kit that contains

“I will need to take daily medications until my symptoms decrease.”

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A hospitalized client is diagnosed with dysfunction of the adrenal medulla. The nurse monitors for changes in client status related to altered production and secretion of which of the following substances?

A. Cortisol

B. Epinephrine

C. Aldosterone

D. Androgens

B. Epinephrine

Epinephrine and norepinephrine are produced by the adrenal medulla. The other substances listed (cortisol,aldosterone, and the androgens) are produced by the adrenal cortex.

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A nurse is providing discharge instructions to a client who has Cushing’s syndrome. Which client statement indicates that instructions related to dietary management are understood?

“I can eat foods that have a lot of potassium in them.”

“I will need to limit the amount of protein in my diet.”

“I am fortunate that I can eat all the salty foods I enjoy.”

“I am fortunate that I do not need to follow any special diet.”

“I can eat foods that have a lot of potassium in them.”

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The client with Cushing’s syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement by the nurse is appropriate?

“This is permanent, but looks are deceiving and are not that important.”

“Don’t be concerned; this problem can be covered with clothing.”

“Try not to worry about it; there are other things to be concerned about.”

“Usually these physical changes slowly improve following treatment.”

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A nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing’s syndrome. Which of the following laboratory findings would the nurse expect to note in this client?

A blood glucose level of 110mg/dl

A potassium (K+) level of 5.5 mEq/L

A white blood cell (WBC) count of 6,000/uL

A platelet count of 200,000/uL

A potassium (K+) level of 5.5 mEq/L

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A nurse is performing an assessment on a client with a diagnosis of Cushing’s syndrome. Which of the following would the nurse expect to note on assessment of the client?

Drooping on one side of the face

Skin atrophy

A rounded “moon-like” appearance to the face

The presence of sunken eyes

A rounded “moon-like” appearance to the face

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A nurse is developing a plan of care for a client with Cushing’s syndrome. The client has a nursing diagnosis of excess fluid volume. Which of the following nursing actions is incorrect to include in the care for this client?

Monitor daily weight.

Monitor intake and output.

Maintain a low-potassium, high-sodium diet.

Monitor jugular venous pressure and assess extremities for edema.

Maintain a low-potassium, high-sodium diet.

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A nurse has developed a nursing diagnosis of risk for disturbed body image for a client with a diagnosis of Cushing’s syndrome. The nurse identifies nursing interventions related to this nursing diagnosis and includes these interventions in the plan of care. Which of the following is a inappropriate nursing intervention? Encourage client expression of feelings. Assess the client’s understanding of the disease process. Encourage family members to share their feelings about the disease process. Encourage the client to recognized that the body changes need to be dealt with.

Encourage the client to recognized that the body changes need to be dealt with.

A nurse is providing home care instructions to the client with a diagnosis of Cushing’s syndrome and prepares a list of instructions for the client. Which of the following is inappropriate to include on the list? Instructions to take the medications exactly as prescribed A reminder to read the labels on over-the-counter medications before purchase The signs and symptoms of hypoadrenalism The signs and symptoms of hyperadrenalism

A reminder to read the labels on over-the-counter medications before purchase

A registered nurse (RN) is caring for a client with a diagnosis of Cushing’s syndrome. A student nurse (SN) is working with the RN for the day. The RN determines that the SN has an understanding of Cushing’s syndrome when the SN states that the condition is caused by: Excessive amounts of cortisol Decreased amounts of cortisol Excessive amounts of antidiuretic hormone Decreased amounts of antidiuretic hormone

Excessive amounts of cortisol

A client has overactivity of the thyroid gland. The nurse anticipates that the client will experience which of the following effects from this hormonal excess? Low blood glucose level Nutritional deficiencies Weight gain Increased body fat stores

Nutritional deficiencies

An antihypocalcemic medication has been prescribed for a client with hypoparathyroidism for the management of hypocalcemia. The client arrives at the clinic for follow up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation. The nurse determines that the client needs additional information if the client states to: Increase his daily fluid intake Add ½ ounce of mineral oil to the daily diet Increase his daily intake of high fiber foods Increase his activity level as tolerated

Add ½ ounce of mineral oil to the daily diet

Which item should be kept at bedside of a client who has just returned from having a thyroidectomy? A ventilator An endotracheal tube An airway A tracheostomy tray

A tracheostomy tray

When caring for a client who has had a thyroidectomy, the nurse’s initial assessment in the immediate postoperative period should be to evaluate the: Ability to cough. Urinary output. Temperature and heart rate. Ability to hyperextend head and neck.

Temperature and heart rate.

A hospitalized client is experiencing an episode of hypoglycemia. The nurse understands that the physiological mechanism that should take place to combat this decline in the blood glucose level is: Decreased epinephrine release Decreased cortisol release Increased insulin secretion Increased glucagon secretion

Increased glucagon secretion

A client with diabetes mellitus who refuses to take insulin as prescribed exhibits markedly increased blood glucose levels after meal. The nurse caring anticipates that which of the following initial body responses to elevated glucose levels will worsen the situation for the client? Glycogenolysis Gluconeogenesis Binding of glucose onto cell membranes Transport of glucose across cell membranes

Glycogenolysis

A client with diabetes mellitus is at risk for a serious metabolic disorder from breakdown of fats for conversion to glucose. The nurse caring for the client determines that pathological fat metabolism is occurring if the client has elevated levels of which of the following substances? Glucose Ketones Glucagon Lactate dehydorgenase

Ketones

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto: Muscle tissue Adipose tissue Red blood cells Platelets

Red blood cells

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse caring for the client anticipates that which of the following factors is an unlikely cause of the beta cell destruction that accompanies this disorder? Genetic factors Autoimmune factors Primary failure of glucagon secretion Viruses

Primary failure of glucagon secretion

A nurse is completing a health history for a female client with diabetes mellitus who has been taking insulin for many years. At present, the client states that she is experiencing periods of hypoglycemia followed by periods of hyperglycemia. The most likely cause for this pattern of diabetic control is: Injecting insulin at a site of lipodystrophy Adjusting insulin according to blood glucose levels Eating snacks between meals Initiating the use of insulin pump

Injecting insulin at a site of lipodystrophy

A client has been hospitalized for an endocrine system dysfunction of the pancreas. The nurse providingcare for the client anticipates that the client will exhibit impaired secretion of which of the followingsubstances? a) Amylase b) Lipase c) Trypsin* d) Insulin

d) Insulin R: The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organsecretes insulin as a key endocrine hormone to regulate the blood glucose level. Other pancreatic endocrinehormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase,lipase, and trypsin.

A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse providingcare for the client anticipates that the client may exhibit altered secretion of which of the following hormones?* a) Antidiuretic hormone (ADH) b) Growth hormone (GH) c) Follicle-stimulating hormone (FSH) d) Luteinizing hormone (LH)

a) Antidiuretic hormone (ADH) R: ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland isoxytocin. Both ADH and oxytocin are produced by the hypothalamus and stored in the posterior pituitary gland.These hormones are released as needed into the bloodstream for use. The anterior pituitary gland produces GH,FSH, and LH.

A client is experiencing delayed gastric emptying. The nurse determines that dysfunction of which of the following structures is responsible for the client’s symptoms? Pyloric sphincter Cardiac sphincter Jejunum Ileum

Pyloric sphincter

A nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which of the following procedures is most likely to have some long-term residual difficulty with absorption of nutrients? Appendectomy Colectomy Ascending colostomy Small bowel resection

Small bowel resection

The nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the: Stomach Small intestine Large intestine Rectum

Small intestine

A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GIT. Which age-related change increases the risk of anemia? Atrophy of the gastric mucosa Decrease in intestinal flora Increase in bile secretion Dulling of nerve impulses

Atrophy of the gastric mucosa

The nurse is teaching an elderly client about good bowel habits. Which statement by the client would indicate to the nurse that additional teaching is required? “I should eat a fiber-rich with raw, leafy vegetables, unpleeled fruit, and whole grain bread.” “I need to use laxatives regularly to prevent constipation.” “I need to drink 2 to 3 liters of fluid every day.” “I should exercise four times per week.”

“I need to use laxatives regularly to prevent constipation.”

To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air into the tube with a syringe and listening with a stethoscope for air passing into the stomach. Which is another test method? Aspiration of gastric contents and testing for a pH less than 6 Instillation of 30 ml of water while listening with a stethoscope Cessation of reflex Ensuring proper measurement of the tube before insertion

Aspiration of gastric contents and testing for a pH less than 6

Neutralize gastric acid

ANTACIDS

Promote the digestion of proteins, fats, and carbohydrates

PANCREATIC ENZYMES

Prevent and control emesis and motion sickness

ANTIEMETICS

Acidity suppresses pathologic bacterial overgrowth

ANTIDIARRHEALS

Inhibit gastric acid secretion

ANTISECRETORY AGENTS

Inhibit smooth muscle contraction in the GIT; Alleviate pain associated with peptic ulcer EX: Atropine sulfate

ANTICHOLINERGICS

Suppress the desire for food at the hypothalamic appetite centers Generally produce CNS stimulation EX: Amphetamine sulfate

ANOREXIANTS

Lactulose

CATHARTICS/LAXATIVES

Metronidazole

INTESTINAL ANTIBIOTICS

During clindamycin therapy, the nurse monitors a client for pseudomembranous colitis. This serious adverse reaction to clindamycin results from superinfection with which organism? Staphylococcus aureus Bacteroides fragilis Escherichia coli Clostridium difficile

Clostridium difficile

A client with peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? “Eat three balanced meals every day.” “Stop taking the drugs when your symptoms subside.” “Avoid aspirin and products that contain aspirin.” “Increase your intake of fluids containing caffeine.”

“Avoid aspirin and products that contain aspirin.”

A client admitted for treatment of gastric ulcer is being prepared for discharge on antacid therapy. Discharge teaching should include which instruction? “Continue to take antacids even if your symptoms subside.” “You may take antacids with other medications.” “Avoid taking magnesium-containing antacids if you develop a heart problem.” “be sure to take antacids with meals.”

“Continue to take antacids even if your symptoms subside.”

A client with a bleeding peptic ulcer is admitted to an acute care facility. As part of therapy, the physician prescribes cimetidine I.V. The nurse must avoid administering this drug too rapidly because doing so may cause: Tetany Bronchospasm Hallucinations Bradycardia

Bradycardia

A client has been diagnosed with gastrointestinal reflux disease (GERD). The nurse interprets that the client has dysfunction of which of the following parts of the digestive system? Chief cells of the stomach Parietal cells of the stomach Lower esophageal sphincter (LES) Upper esophageal sphincter (UES)

Lower esophageal sphincter (LES)

The nurse teaches the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which of the following statements made by the client indicates that more teaching is needed? "I will be sure to drink tea instead of coffee.“ "I will take a walk after I eat.“ "I will try to eat smaller meals more frequently.“ "I will sleep with the head of the bed elevated about 12 inches."

"I will be sure to drink tea instead of coffee.“

The client with gastroesophageal reflux disease (GERD) is prescribed famotidine (Pepcid). In order to provide effective teaching, the nurse must have which of these understandings about the action of the drug? The drug improves gastric motility. The drug coats the distal portion of the esophagus. The drug increases LES tone. The drug decreases the secretion of gastric acid.

The drug decreases the secretion of gastric acid.

To prevent GERD in a client with hiatal hernia, the nurse should provide which discharge instructions? “Lie down after meals to promote digestion.” “Avoid coffee and alcoholic beverages.” “Take antacids with meals.” “Limit fluid intake with meals”

“Avoid coffee and alcoholic beverages.”

The nurse is preparing a client with hiatal hernia for discharge. Which of the following statements made by the client would indicate that teaching has been effective? "I will join the gym and get in shape by lifting weights.“ "I know I need to eat a high-fat diet to slow down my digestion.“ "I will join a support group. “ "I will take a walk after dinner each night."

"I will take a walk after dinner each night."

A client has had a gastrectomy is not producing sufficient intrinsic factor. The nurse interprets that the client has lost the ability to absorb cyanocobalamin (Vitamin B12) in the: Stomach Small intestine Large intestine Colon

Small intestine

A client with a diagnosis of stomach ulcer due to gastric hyperacidity asks the nurse why the acid hasn’t’ caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in the: Liver enzymes Bile Parietal cells Pancreatic juice

Pancreatic juice

The client with peptic ulcer disease needs dietary modification to reduce episodes of epigastric pain. The nurse tells the client that which item does not need to be limited or eliminated with this disease? Wine Coffee Fresh fruit Baked chicken

Baked chicken

The medication history of a client with peptic ulcer disease reveals intermittent use of several medications. The nurse would teach the client to avoid which of these medications because of the irritating effects on the lining of the gastrointestinal tract? Nizatidine (Axid) Ibuprofen (Motrin) Sucralfate (Carafate) Omeprazole (Prilosec)

Ibuprofen (Motrin)

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? Vitamin A Vitamin B12 Vitamin C Vitamin E

Vitamin B12

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question? Digoxin (Lanoxin) Furosemide (Lasix) Indomethacin (Indocin) Propranolol hydrochloride (Inderal)

Indomethacin (Indocin)

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? Bradycardia Numbness in the legs Nausea and vomiting A rigid, board-like abdomen

A rigid, board-like abdomen

The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? “Antacids will coat my stomach.” “Sucralfate (Carafate) will change the fluid in my stomach.” “Omeprazole (Losec) will coat the ulcer and help it heal.” “The cimetidine (Tagamet) will cause me to produce less stomach acid.”

“The cimetidine (Tagamet) will cause me to produce less stomach acid.”

A client is undergoing an extensive GI problem. The nurse discovers that the client has a family history of ulcer disease. Which blood type is a risk factor for duodenal ulcers? Type A Type B Type AB Type O

Type O

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Endoscopy Upper GI series Hemoglobin levels and hematocrit Arteiography

Hemoglobin levels and hematocrit

The nurse is caring for a client who underwent a subtotal gastrectomy 24 hours ago. The client has a nasogastric tube (NGT). The nurse should: Apply suction to the NGT every hour. Clamp the NGT if the client complains of nausea. Irrigate the NGT gently with normal saline solution if ordered. Reposition the NGT if pulled out.

Irrigate the NGT gently with normal saline solution if ordered.

The nurse is providing discharge instructions to a client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? Ambulate following a meal Eat high carbohydrates foods Limit the fluids taken with meals Sit in a high-Fowler’s position during meals

Limit the fluids taken with meals

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? Sweating and pallor Bradycardia and indigestion Double vision and chest pain Abdominal cramping and pain

Sweating and pallor

The nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: Restrict fluid intake to 1 qt (1000 ml)/day. Drink liquids only with meals. Don’t drink liquids 2 hours before meals. Drink liquids only between meals.

Drink liquids only between meals.

Nurse Jordan is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? Hypotension Bloody diarrhea Rebound tenderness A hemoglobin level 0f 12 mg /dL

Rebound tenderness

Nurse Marvin John is reviewing the record of a client with Crohn’s disease. Which stool characteristic should the nurse expect to note documented in the client’s record? Diarrhea Chronic constipation Constipation alternating with diarrhea Stool constantly oozing from the rectum

Diarrhea

A client with diarrhea, fever, and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD). Diarrhea is the most common sign of IBD. Transmural inflammation with fistula formation occurs in ulcerative colitis, one form of IBD. Abscesses may occur in IBD as poor nutrition causes breakdown of cells in the GIT. Bowel cancer is common in clients with a history of Crohn’s disease, one form of IBD.

Diarrhea is the most common sign of IBD.

A client with IBD undergoes an ileostomy. On the first day after surgery, the nurse notes that the client’s stoma appears dusky. How should the nurse interpret this finding? Blood supply to the stoma has been interrupted. This is a normal finding 1 day after surgery. The ostomy bag should be adjusted. An intestinal obstruction has occurred.

Blood supply to the stoma has been interrupted.

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix as attached to the: Ascending colon Ileum Cecum Rectum

Cecum

The client is admitted with a suspected appendicitis. The nurse would question which of these orders by the doctor if noted? Maintain NPO status Initiate an intravenous (IV) line administration of fluids Apply a cold pack to the abdomen Administer 30 mL of Milk of Magnesia

Administer 30 mL of Milk of Magnesia

A 32-year-old male client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for: Surgery Colonoscopy Nasogastric tube insertion Barium enema

Surgery

A client has just had a hemorrhoidectomy. What nursing intervention is appropriate for this client? Instruct the client to limit fluid intake to avoid urinary retention. Instruct the client to eat low-fiber foods to decrease the bulk of the stool. Apply and maintain ice packs over the dressing until the packing is removed. Help the client to a Fowler’s position to place pressure on the rectal area and decrease bleeding.

Apply and maintain ice packs over the dressing until the packing is removed.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T tube has drained 750 ml of green-brown drainage since the surgery. Which nursing intervention is appropriate? Clamp the T tube. Irrigate the T tube. Notify the physician. Document the findings.

Notify the physician.

The client who has acute cholecystitis tells the nurse, "I just want my gallbladder taken out now." Which of the following is the best response by the nurse? "I don't blame you, but they want your pain under control first.“ "Would you like me to ask if your physician will schedule surgery today?“ "The symptoms are distressing, but the surgeon must wait until your gallbladder is less infected.“ "They will try to dissolve the stones before they do the surgery."

"The symptoms are distressing, but the surgeon must wait until your gallbladder is less infected.“

Which of the following food items identified by the client with cholecystitis indicates an understanding of foods to avoid? Fresh fruit Fresh vegetables Poultry without skin Brown gravy

Brown gravy

The client is admitted to the hospital for possible cholelithiasis. While taking the history, the nurse notes that the client has which of the following risk factors for the development of gallstones? Black race History of hypertension Age of 37 years Use of oral contraceptives

Use of oral contraceptives

In caring for the client 4 days post-cholecystectomy, the nurse notices that the drainage from the T-tube is 600 mL in 24 hours. Which is the appropriate action by the nurse? Clamp the tube q 2 hours for 30 minutes Place the patient in a supine position Notify the physician Encourage an increased fluid intake

Notify the physician

A client is in late stage of cirrhosis. When planning the client’s diet, the nurse focus on providing increased amounts of: Fat Fiber Protein Carbohydrate

Carbohydrate

After undergoing a liver biopsy, the client would be placed in which position? Semi-Fowler’s position Right lateral decubitus position Supine position Prone position

Right lateral decubitus position

For a client with cirrhosis, deterioration of hepatic function is best indicated by: Fatigue and muscle weakness Difficulty in arousal Nausea and anorexia Weight gain

Difficulty in arousal

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer: Spironolactone Phytomenadione Furosemide Warfarin

Phytomenadione

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? Fatigue Excess fluid volume Ineffective breathing pattern Imbalanced nutrition: Less than body requirements

Ineffective breathing pattern

When caring for a client with acute pancreatitis, the nurse should use comfort measure? Administering an analgesic once per shift, as prescribed, to prevent drug addiction Positioning the client on the side with the knees flexed Encouraging frequent visits from family and friends Administering frequent oral feedings

Positioning the client on the side with the knees flexed

A home care nurse visits a client who was recently diagnosed with cirrhosis. The nurse provides home care management instructions to the client. Which of the following statements, if made by the client, indicates a need for further instruction? “I will take Tylenol if I get a headache.” “I will obtain adequate rest.” “I need to include sufficient amounts of carbohydrates in my diet.” “I should monitor my weight on a regular basis.”

“I will take Tylenol if I get a headache.”

The client has just had a liver biopsy. Which of the following nursing actions would be the priority after the biopsy? Monitor pulse and blood pressure every 30 minutes until stable and then hourly for up to 24 hours. Ambulate every 4 hours for the first day as long as client can tolerate this. Measure urine specific gravity every 8 hours for the next 48 hours. Maintain NPO status for 24 hours post-biopsy.

Monitor pulse and blood pressure every 30 minutes until stable and then hourly for up to 24 hours.

The client with cirrhosis of the liver asks the nurse why he has edema. The nurse would use which of the following statements to explain how edema results from pathophysiologic changes in cirrhosis. "The edema occurs because your liver produces fewer proteins that help draw fluid into the blood stream.“ "The high osmotic pressure of proteins in your blood pushes fluid into body tissues.“ "Because of the liver disease, the kidneys are able to filter less fluid, so the body cannot excrete it as urine very easily.“ "Your body is metabolizing sex hormones more quickly, leading to fluid retention."

"The edema occurs because your liver produces fewer proteins that help draw fluid into the blood stream.“

Lactulose (Cephulac) is ordered for the client with cirrhosis. Which of the following serum laboratory tests should the nurse monitor to determine if the drug is having the desired effect? Albumin Ammonia Sodium Lactate

Ammonia

The client is admitted to the hospital with acute pancreatitis. The nurse taking a history should question the client about which of these risks for developing pancreatitis? Inflammatory bowel disease Alcoholism Diabetes mellitus High-fiber diet

Alcoholism

The client is diagnosed with chronic pancreatitis, and pancrelipase (Lipancreatin) is prescribed. Which of the following instructions should the nurse give to this client about the administration of this medication? "Take the drug with meals.“ "Take the drug with a large glass of milk.“ "Take the drug between meals.“ "Take the drug after it is crushed and mixed with ice cream."

"Take the drug with meals.“