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This is that review. the one you were dreaming about, possibly even praying for, it has all of the questions from the first three exams (well almost all of them) and all the questions that Malpica will using to pull her 75 questions out of for tomorrows exam. Im serious.

here are some Malpica quotes

"this is not brain surgery, many of these questions will appear on the final examination"

"look for words that CUE YOU IN "

"a lot of my correct answers are the longer answers, I try to give you descriptions

always true

)

"

(use that tip wisely, its not

and just to cover my ass

Caveat Emptor

power points we were given, I gave them a quick read. I hope I'm right, but to be safe, I'd like to suggest you go take

a long walk off a short pier if the test she gives has none of these questions on them

let

the buyer beware - this is what I will be using to study for the med surg exam, plus all the

buyer beware :)

also my spelling sucks, and yours would too if you were typing this at 3am.

CHEERS!

Test 1

1. a pt w heart failure has tachypnea severe dyspnea and an 02 of 84. the nurse identifies the nursing diagnosis of

impaired gas exchange related to increased preload and mechanical failure. an appropriate intervention for this diagnosis is:

place patient in high fowlers position with the feet dangling over the bedside

2. Pt. being discharged after hospitalization of angina is prescribed Zocor an antilipidemic drug, what should nurse

include in teaching plan for this pt?

report muscular pain

3. which finding indicates that suctioning is required for the pt whose mechanically ventilated

wheezes are heard

4. in providing care to a pt on a mechanical ventilator, the nurse correlates the administration of warm humidified

oxygen with the rationale:

decrease the viscosity of secretions

5. pt with acute SOB is admitted to the hospital. which action should the nurse take during the initial assessment of

the pt?

perform a respiratory system assessment and ask questions about this episode of respiratory distress

6. while caring for a pt with a history of asthma the nurse observes the patients PO2 drops from 92 to 86 while on

the treadmill, which action by the nurse should be taken next?

administer the PRN 02 that was ordered

7. when a nurse is analyzing the results of ABG, which finding indicates the need for immediate action?

the PA02 being 59 (it should be 95)

8.

after receiving a change of shift report which of these patients should the nurse assess first?

the pt with possible cancer who just returned from a broncoschopy .

9. A patient scheduled for a total Laryengectomy and radical neck dissection for cancer of the larynx asks the nurse

"how will I talk after surgery?"

you will have a permanent opening in your neck and you will need to have rehab for some type of voice restoration

10. Ms M has a number 7 trach tube for the past 7 days, the nurse suctions the patient and the pt begins to cough

violently. the trach dislodges and comes out, which action by the nurse should be done first

Patent airway through their trach using the tool (NOT vent with manual bag)

11. a very early sign or symptom of inadequate oxygenation (hypoxia)

cyanosis , cool and clammy skin

12. stimulates the production of surficant is

air movement through the aveolar and pores of Kohn (not alveolar stretch through deep breathing)

13. the ability of the lungs to adequately oxygenate the arterial blood is best determined by

arterial oxygen tension

14. an appropriate nursing intervention for a pt with pneumonia with the nursing dx of ineffective airway clearance

related to thick secretions and fatigue

teach pt how to cough effectively (not pstural drainage)

15. a nurse is caring or a pt after a broncoscopy and biopsy which of the following

bronchospasms

16. nurse is caring for a client with emphysema who is receiving oxygen

2L of 02

17. the nurse instructs the client to use pursed lipped breathing and the client asks why

to promote CO2 elimination

18. nurse is suctioning the pt through an ET tube, during the suctioning the nurse notes that on the monitor the heart

rate is decreasing. which of the following is the appropriate action?

Stop suctioning and give them oxygen

19. which of the following statements describes the management of a patient following a transplantation (SATA)

use of home spiromoter will help to monitor lung function, immunosuppressive therapy, lung biopsied

20. the clients setting on the vent are IMV, tidal volume 400, SIO2 35 and a peak of 5, the client progressively

becomes more restless and anxious throughout the day, what action by the nurse express understanding of the situation

the nurse places a pulse oximeter on the pt

21. and advantage of a tracheostomy over a ET tube for long term mgmt of upper airway obstruction is that a

tracheostomy allows for

more comfort and more mobility

22. during the care of a pt with a cuffed tracheostomy the nurse notes that the trach tube has an inner cannula to care

for the trach appropriately

remove the inner cannula and clean the mucus around the tube

23. a distinctive sign of flail chest

is paradoxical chest movement

24. the nurse is teaching a patient about a treatment regimen for heart failure, which statement by the pt indicates a

need for further instruction ?

I must weigh myself once a month and watch for fluid retention

25. a pt with heart failure has tachpnea and mechanical failure

place in high fowler position dangle the legs

26. . Pt. being discharged after hospitalization of angina is prescribed Zocor an antilipidemic drug, what should

nurse include in teaching plan for this pt?

report excessive bruising

27. a pt who has been discharged a day ago after having abdominal surgery goes to the ED reporting crushing

substernal chest pain radiating down the left arm associated with dyspnea, the pt is pale and diaphoretic, which nursing intervention

give oxygen, maintain patency of their airway

28. a pt with heart failure with a dx of activity intolerance which should nurse implement based on this dz

they have to get frequent rest

29. a pt has been diagnosed with heart failure and he is started on lasix. pt is aware meds increase urinary output, but

asks how it helps the heart, when forming the response the nurse knows diuretics are effective at treating heart failure in that it

it improves contractility of the heart

30. pt is undergoing testing for chest pain, which test is done to determine location and extent of coronary artery

disease

cardiac cath

31. when caring for a patient with a cardiac cath, which of the findings is most impt to the nurse?

absence of distal pulses

32. nurse is prepping pt for cardiac cath what is the best explanation regarding the purpose of the cardiac cath

we need to see the coronary blood flow

33. the nurse is teaching a pt about risks factors about developing CAD for women versus men

Diabetes

34. a pt is dz with stable angina and has taken two nitro tablets sublingual, pt reports a headache

expected side effect

35. pt in ICU with acute decompensated heart failure and reports severe dysponea, and is anxious tachypnic and

tachycardic, which med would be ordered

morphine sulfate 2mg

36. when admitting a patient with an MI to the ICU which action should the nurse carry out first?

attach the cardiac monitor

37. why does the nurse document the precise location of crackles auscultated in the lungs of the pt with heart failure

the level of fluid is higher as the swelling gets worse (as edema gets worse)

38. a pt with an MI has a nursing Dx of anxiety related to possible lifestyle changes and perceived threat of death, a

good stated outcome criteria has been met by the pt when he says

I'm going to take this one step at a time

39. the nurse is assessing the situation of a pt who is being stabilized after an MI what finding by the nurse indicates

inadequate renal perfusion?

urine output of less than 30ml/hr

40. the nurse is providing discharge instructions to the patient who has experienced an acute MI, which statement by

the pt indicates the need for further teaching?

I'm not good at remembering at taking my meds

41. a pt is admitted to the ED with complaints of severe radiating pain the pt is restless frightened

apply oxygen first

42. which diagnostic test would be most useful in determining whether pt admitted with SOB after heart failure

Beta type naturemic peptide (BNP)

43. Pt is admitted to the ED with severe chest pain with a list of meds he takes at home is most critical?

Viagra

44. a diagnostic procedure done for pleural fluid analysis

thoriocentisis

45. type of trach tube that prevents speech

inflated foam cuff

46. pt has episode of epitaxis which is controlled by packing, during discharge teaching nurses tells him

avoiding blowing nose or lifting heavy objects

47. pt has had total laryngectomy, during suctioning there is some bloody mucus and clots which of the following

interventions would apply

continue your assessment (don't run to the MD)

48. pt should receive 40 lasix and pharm sends 10mg/5ml = 20

50. I missed one; nobody's perfect. I can literally hear your collective groans while I type this. Get a life it's one

question.

Test 2

1. a pt with r sided hemyphssia and aphasia from a stroke most likely has involvement of

The left middle cerebral artery

2. for a pt who is suspected of having a stroke one of the most important pieces of information that the nurse can

obtain is:

the time the stroke symptoms began

3. a pt experiencing TIAs is scheduled for a carotid endorectomy the nurse explains that this procedure is done to:

prevent a stroke by removing the plaque

4. when promoting health maintenance for the prevention of stroke the nurse understands that the highest risk for the

most common type of stroke is in

pts with diabetes and hypertension

5. a thrombus has developed in the cerebral artery doesnt always cause a loss of neurological functioning because

circle of willis can provide blood supply as collateral circulation

6. the nurse at the eye clinic advises patients to wear sunglasses that protect the eyes from UV light because

it is associated with the development of cataracts

7. in order to asses the visual acuity of a pt in the outpatient clinic the nurse wil need to obtain a

Snellen chart

8. the nurse is observing students who are preparing to perform an ear exam of a 24 yr old man, the nurse intervenes

if the student

pulls the ear down and backwards (it's up and back for adults, but down and back for kids)

9. nurse performing assessment with the patient who has chronic PAD of the legs and an ulcer of the left great tow

would expect to find

prolonged capillary refill in all of the toes

10. after teaching a pt with newly diagnoses Reynaud's phenomena about how to manage the condition, which pt

statement shows teaching has been effective?

I will exercise indoors during the winter months

11. healthcare provider has prescribes bed rest for a pt admitted to the hospital with DVT the best method for the

nurse to use in elevating the pts feet

one pillows under thigh, two pillows under the lower leg relieving pressure from heels and feet

12. the pt is admitted to the hospital dz with chronic venous insufficiency which statement by pt is most consistent

with diagnosis

13.

when developing a teaching plan for a newly diagnosed pt with PAD . which info should the nurse include

it's important that you stop smoking cigarettes

14. when caring for a patient with critical ischemia from PAD who has just arrived to the nursing unit after having a

percutaneous transluminal angioplasty by means of right femoral artery which action should nurse take first?

Tests for signs of bleeding and hematoma

15. the nurse is performing an otoscopic exam on pt with acute otitis media. on exam of tempanic membrane

red bulging, purulent thick immobile membrane

16. the nurse is developing a plan of care for a client scheduled for cataract surgery, most appropriate nursing dz in

this plan is

disturbed sensory perception

17. pt is diagnosed with disorder involving the inner ear, which following is most impt. client complaint re their

inner ear

tinnitus

18. in prep for cataract surgery, nurse is preparing to administer eye drops to dilate the eye

Mydriatic (Xalantin)

19. during early post op period, client who has had a catarct extraction complains of nasuea and vommiting sudden

eye pain over occlear site intitial action is

call the MD

20. a pt with meyneires disease is experiencing severe vertigo, which instruction should nurse give client

avoid sudden head movements

21. nurse is caring for hearing impaired pt which of the following approaches will facilitate communication?

face the client and speak at a normal volume

22. 55 y old woman sprays insecticide into right eye, calls ER frantic, nurse instructs woman to

irrigate the eyes with water

23. client seeks treatment for unsightly varicose veins, how does sclerotherpay work

inject the vein with agent to damage vein wall, and closes off the vein

24. pt had OIRF of left hip as result of femur fracture, pt complains of severe lower leg pain and has positive

Hommans sign, a lower extremity doppler and confirms a DVT which instruction should nurse give pt

avoid prolonged sitting or standing, don't cross legs, wear antiembolic stockings (all the above)

25. pt has IV of normal saline at 100ccs an hr, running thru right anti cubital

pt complains of pain at site.

stop infusion elevate arm and apply warm compress

it

becomes red warm and vein is hard,

26. to assess functioning of autonomic reflexes of trigeminal facial nerve

nurse should take cotton across pt face.

27.

nursing student is caring for a client who had a brain attack, experiencing unilateral neglect, nurse intervenes if

student plans to use which strategy to help client adopt to this deficit.

approach client from unaffected side

28. nurse is trying to communicate with client who had a stroke and aphasia. which action by nurse is least helpful?

completing sentences client cannot finish

29. the nurse is assessing the adaptation of the client to changes in functional status after a brain attack. nurse assess

the client is adopting most successfully if client

consistently uses adoptive equipment when dressing self.

30. client is recovering from a head injury, is arousable and participates in their own care , nurse determines client

understands how to prevent elevations in intercranial pressure if client is observed doing what?

they exhale during repositioning

31. nurse is assessing patient in coma, as part of the assessment the nurse uses the Glasgow coma scale and

identifies the pt is a 5 on the scale the nurse understands

the lower on the scale the more neurologically compromised the pt, the glasgow scale assesses the pts neurological condition (all the above)

32. 46 y old female had a left hemorrhagic stroke, pt is confused and combative, initial action of nurse

obtain pulse ox and vital signs

33. clear liquid leaking from nose following basal skull fracture, the nurse assesses that this is cerebral spinal fluid if

clear liquid and tests positive for glucose

34. nurse is assigned to the care of a patient with a left CVA w right sided hemiperesis, the nurse plans care knowing

in this condition the client has

client has weakness on right side of body including face and tongue, safety is a huge concern

35. client with a brain attack has residual dysphagia, when a diet is initiated the nurse avoids which of the

following?

giving the client thin liquids

36. presbyopia occurs in older people because

the lens becomes inflexible

37. the client has a sensory neural hearing loss what would the nurse expect to see

has difficulty understanding speech

38. the neurological functions affected by a stroke are primarily related to

the brain area perfused by the affected artery

39. ms m comes to ED immediately after experiencing numbness of the face and the inability to speak, symptoms

disappear and pt requests discharge, important for pt to stay and be evaluated because:

pt has probably experienced a TIA which is a sign of progressive

40. pts wife asks nurse why her husband has not received clot busting medication TpA husband had been diagnosed

with Hemorrhagic stroke, nurses best response

the medication can dissolve clots and it can cause more bleeding in your husband's head

41. the incidence of ischemic strokes in pts with TIAs and other risk factors is reduced with administration of

aspirin

42. pt is admitted to hospital with left hemplesia, to determine size and location and to ascertain whether a stroke is

ischemic or hemorrhagic, the nurse anticipates the MD will request

a CT without contrast.

43. nurse teaches patients with any venous disorder that the best way to prevent stasis and increase venous return is:

to walk

44. The Nurse identifies the nursing diagnosis of risk for injury following a stapedectomy

stimulation of the labyrinth during surgery may cause a loss of balance

45. Information provided by a patient will help differentiate a hemorrhagic stroke from a thrombolic stroke includes

sudden onset of severe head pain

46. the nurse explains to the patient with a stroke who is scheduled to have an angiography that this test is used to

determine the presence

patency of cerebral blood vessel

47. bladder training for a male patient after a stroke who has urinary incontinence includes

assist the pt to stand and void

48. Malpica didnt have the sheet with the last 3 questions for test 2

49. Malpica didnt have the sheet with the last 3 questions for test 2

50. Malpica didnt have the sheet with the last 3 questions for test 2

Test 3

1.a pt with intracranial monitoring has an intracranial pressure of 12, this pressure is

normal

2. the nurse plans for care of the patient with an increase in cranial pressure with the knowledge that the best way to

position the pt is

with the head of the bed at 30 degrees

3. during admission of the pt with a sever neck injury to the ER, highest priority is placed on

airway patency

4. nursing mgmt for a pt with a brain tumor and potential for seizures include

assisting and supporting the family in understanding the changes in behavior, plans for seizure precautions, and teach pt and family members about meds (all the above)

5. the nurse in the ICU is assigned four patients, which pt should the nurse assess first?

pt with meningitis who is suddenly agitated and reports 10 on the pain scale

6. nurse measure that is indicated to reduce the potential for seizures and increased intracranial pressure is

controlling the fever with meds and cooling techniques

7. pt suspected of having a cranial tumor, exhibits mood swings, personality changes

frontal lobe

8. 50 yr old man complains of recurring headaches, describes as sharp stabbing and left eye seems to swell and

teary

cluster headaches

9. 65 yr old woman just diagnosed with Parkinson's, priority nursing intervention is

promoting physical exercise and a well balanced diet

10. the nurse assess that an 87 yr old woman with Alzheimer's disease continuously rubs and kicks her legs, gets

worse at night

restless leg syndrome

11. social effects of a chronic neurological disorder include:

Divorce, Low self-esteem, depression (all the above)

12. planning to institute seizure precautions for a pt who has been recently admitted to the ED. which of the

following measures would the nurse avoid in planning for the pts safety?

putting a tongue blade at the head of the bed and be ready to restrain the patient

13. a major goal of Huntington's disease is

symptomatic relief

14. the pt who begins to have seizures, which actions should be contraindicated

restraining the pts arms and legs

15. the pt is experiencing an episode of monasthesia crisis, the nurse is assessing for contributing factors

did they miss their medication

16. the pt with Parkinson's disease dz of risk for falls related to abnormal gait

shuffling and rocking in chair

17. the nurse instructs the patient on how to get more mobility

the pt has to rock back and forth to get up from the chair

18. nurse giving suggestions to client with trigeminal neuralgia, strategies to minimize pain?

I'll try to eat my food either very hot or very cold

don't expose the face to cold or drafts

20. pt admitted with a DZ of giullian berrier, nurse inquires for a history

they had a GI or respiratory infection in last month

21. classic symptoms of bacterial meningitis

high fever and severe headache, and nucchal rigidity

22. drug therapy for acute migraine and cluster headaches that appears to alter the pathophysiological process

includes

specific serotonin (imitrex)

23. most important aspect of DZ headaches is

a thorough history of their headaches

24. nurse is prepping newly admitted pt with clonic tonic seizures, which of the actions can be delegated to UAP

obtain suction equipment from the supply closet

25. 21 yr old female admitted with acute attack of status epilepticus

give diazepam (valium) or lorazapam (ativan) 5mg IV stat

26. when teaching a pt with seizure disorder about the medication regimen, important that the nurse stress that

don't abruptly stop taking the meds may increase intensity of seizures

27. during the assessment of pt admitted to hospital with acute exacerbation of MS the nurse expects to find

motor impairment, visual disturbances , and weakness

28. classic signs associated with Parkinson's disease

tremors, rigidity and bradykinesia (all the above)

29. pt with dementia has manifestations of depression nurse knows administering anti-depressants will most likely

result in

increased cognitive functioning

30. during assessment of pt with dementia the nurse determines that the condition is potentially reversible on finding

the patient

recently developed symptoms of hypothyroidism

31. a wife of a pt who is manifesting deterioration in memory asks the nurse whether her husbands has Alzheimer's

dz, nurse explains that a dx of AD is made

when all forms of dementia are ruled out first

32. pt with Alzheimer's wandering the halls very agitated, best action with for the nurse

distract them by asking them if they want to go to the cafe for a snack

33. pt with AD has a nursing Dx of impaired memory related to effects dementia best nursing action

establish a daily schedule for the pt

34. caregiver for a pt with AD expresses an impaired ability to make decision to concentrate

caregiver role-strain

35. son of a client Dx with ALS ask is he can get this disease

it is genetic and it does run in family's

36. nurse is admitting a pt with suspected Parkinson's, which assessment data supports diagnosis

mask like face and shuffling gait

37. client had a 3 minute tonic clonic seizure with no apparent injury and is oriented to time, person and place, ut is

very lethargic and just wants to sleep

turn pt to side, dim lights allow pt to sleep

38. nurse is caring for a pt with meningial meningitis, which measure would the nurse expect MD to order

administer Antibiotics

39. pt Dx with acute MS is placed on high doses of IV injection of corticoid steroid medications, which nursing

intervention

monitor pts serum blood glucose levels frequently

40. nurse writes the client problem of altered sexual for a male pt dx with MS which intervention would be

implemented

encourage the couple to explore other sexual alternatives to maintain intimacy

41. pt is being evaluated for myanthesia gravis and is being administered tensilon , which response by the pt

indicates the pt has Disease?

improved muscle rigidity when given tensilon

42. the nurse is providing discharge instructions to a 12 yr old and parents with a broken arm

keep arm at heart level

43. nurse is preparing care plan for pt with fractured lower extremity, what is a desirable outcome

maintain function of lower leg

44. the nurse is preparing a pre op client for a total hip replacement , which intervention should she implement post

operatively

placed in high seated chair , flexion less than 90 degrees

45. pt is in bucks traction with 15 lbs of weight, but complains of severe pain, which intervention shoudl nurse

implement .

ensure weights are off the floor and administer the pain medication

46. which should the nurse should teach regarding joint injuries

immobilize injury, ice the affected area, and elevate for 24 - 48 hrs. RICE

47. pt has leg cast and complains of unrelenting severe pain , and numbness which complication should nurse expect

deep vein thrombosis

48. pt is DZ with encephalopathy , which outcome should be planned for and strived to be met

pt will regain as much neurological functioning as possible

49. med calculation

50. med calculation

New Chapters, end of chapter questions (Thank you Donna C and Co.!)

Ch 42

M.J. calls to tell the nurse that her elderly mother, who is 85 years of age, has been nauseated all day and has vomited twice. Before the nurse hangs up and telephones the health care provider to communicate your assessment data, she should instruct M.J. to

a.

administer antispasmodic drugs and observe skin turgor

b.

give her mother sips of water and elevate the head of her bed to prevent aspiration

c.

offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs

d.

offer her mother large quantities of Gatorade to drink because elderly people are at risk for sodium

depletion

The nurse explains to the patient with Vincent’s infection that treatment will include

a. smallpox vaccinations

b. viscous lidocaine rinses

c. amphotericin B suspension

d. topical application of antibiotics

The nurse is involved in health promotion related to oral cancer. Teaching young adults about behaviors that put them at risk for oral cancer includes

a. discouraging use of chewing gum

b. avoiding use of perfumed lip gloss

c. avoiding use of smokeless tobacco

d. discouraging drinking of carbonated beverages

The nurse explains to the patient with gastroesophageal reflux disease that this disorder

a.

results in acid erosion and ulceration of the esophagus caused by frequent vomiting

b.

will require surgical wrapping or repair of the pyloric sphincter to control the symptoms

c.

is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm

d.

often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up

into the esophagus

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea

when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of

a.

an intolerance to the feedings

b.

extension of the tumor into the aorta

c.

leakage of fluid or foods into the mediastinum

The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will include information concerning the importance of

a.

only taking aspirin with milk or bread products

b.

avoiding taking aspirin and drugs containing aspirin

c.

taking only drugs prescribed by the health care provider

d.

taking all drugs 1 hour before mealtime to prevent further bleeding

e.

reading all OTC drug labels to avoid those containing stearic acid and calcium

The pernicious anemia that may accompany gastritis is due to which of the following?

a.

chronic autoimmune destruction of cobalamin stores in the body

b.

progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss

c.

a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa

d.

hyperchlorhydria resulting from an increase in acid-secreting parietal cells and degradation of RBCs

The nurse is teaching the patient and family about possible causative factors for peptic ulcers. The nurse explains that ulcer formation is

a.

caused by a stressful lifestyle and other acid-producing factors such as H. pylori

b.

inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood

c.

promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylori

d.

promoted by a combination of possible factors that may result in erosion of the gastric mucosa,

including certain drugs and alcohol An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about

a.

cancer support groups, alopecia, and stomatitis

b.

avitaminosis, ostomy care, and community resources

c.

prosthetic devices, skin conductance, and grief counseling

d.

wound and skin care, nutrition, drugs, and community resources

Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing

a. beef

b. meat and milk

c. poultry and eggs

d. home-preserved vegetables

Ch 43

The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to

a. increase fluid intake

b. administer an antibiotic

c. administer antimotility drugs

d. quarantine the patient to prevent spread of the virus

During the assessment of a patient with acute abdominal pain, the nurse should

a.

perform deep palpation before auscultation

b.

obtain blood pressure and pulse rate to determine hypervolemic changes

c.

auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus

d.

measure body temperature because an elevated temperature may indicate an inflammatory or infectious process

The nurse would increase the comfort of the patient with appendicitis by

a. having the patient lie prone

b. flexing the patient’s right knee

c. sitting the patient upright in a chair

d. turning the patient onto his or her left side

In planning the care for the patient with Crohn’s disease, the nurse recognizes that a major difference between

ulcerative colitis and Crohn’s disease is that Crohn’s disease

a. frequently results in toxic megacolon

b. causes fewer nutritional deficiencies than does ulcerative colitis

c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy

d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that a manifestation of an obstruction in the large intestine is

a.

a largely distended abdomen

b.

diarrhea that is loose or liquid

c.

persistent, colicky abdominal pain

d.

profuse vomiting that relieves abdominal pain

A patient with metastatic colorectal cancer is scheduled for both chemotherapy and radiation therapy. Patient

teaching regarding these therapies for this patient would include an explanation that

a.

chemotherapy can be used to cure colorectal cancer

b.

radiation is routinely used as adjuvant therapy following surgery

c.

both chemotherapy and radiation can be used as palliative treatments

d.

the patient should expect few if any side effects from chemotherapeutic agents

The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is

a. a sigmoid colostomy

b. a tranverse colostomy

c. a descending colostomy

d. an ascending colostomy

In contrast to diverticulitis, the patient with diverticulosis

a.

has rectal bleeding

b.

often has no symptoms

c.

has localized cramping pain

d.

frequently develops peritonitis

A nursing intervention that is most appropriate to decrease post-operative edema and pain following an inguinal

herniorrhaphy is

a.

applying a truss to the hernia site

b.

allowing the patient to stand to void

c.

supporting the incision during coughing

d.

applying a scrotal support with ice bag

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu

a. scrambled eggs and sausage

b. buckwheat pancakes with syrup

c. oatmeal, skim milk, and orange juice

Which of the following should a patient be taught after a hemorrhoidectomy?

a.

take mineral oil prior to bedtime

b.

eat a low-fiber diet to rest the colon

c.

administer oil-retention enema to empty the colon

d.

use prescribed pain medication before a bowel movement

The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea states

a.

“I can use A&D ointment or Vaseline jelly around the anal area to protect my skin.”

b.

“Gatorade is a good liquid to drink because it replaces the fluid and salts I have lost.”

c.

“I must wash my hands after every bowel movement to prevent spreading the diarrhea to my family.”

d.

“I may use over-the-counter loperamide (Imodium) or Parepectolin (paregoric, pectin, kaolin) as needed to control the diarrhea.”

In instituting a bowel training program for a patient with fecal incontinence, the nurse plans to

a.

Teach the patient to use a perianal pouch

b.

Place the patient on a bedpan 30 minutes before breakfast

c.

Insert a rectal suppository at the same time every morning

d.

Assist the patient to the bathroom at the time of the patient’s normal defecation

Explain the significance of each of the following pieces of information obtained from the patient with chronic constipation during the nursing assessment

a. Suppressing the urge to defecate while at work

b. A history of diverticulosis

c. Belief in necessity of daily bowel movement

d. History of hemorrhoids and hypertension

e. High dietary fiber with low fluid intake

The nurse teaches the patient with chronic constipation that, of the following foods, dietary fiber is highest in

a.

Bananas

b.

Popcorn

c.

Dried beans

d.

Shredded wheat

The preferred immediate treatment for an acute episode of constipation is the administration of

a.

An enema

b.

Increased fluid

c.

Stool-softeners

A patient is admitted to the emergency department with acute abdominal pain. The nursing intervention that should

be implemented first is

a.

Measurement of vital signs

b.

Administration of prescribed analgesics

c.

Assessment of the onset, location, intensity, duration, and character of the pain

d.

Physical assessment of the abdomen for distention, masses, abnormal pulsations, bowel sounds, and pigmentation changes

A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction, IV fluids, and a

Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four

hours after admission, the patient experiences nausea and vomiting. A priority nursing intervention for the patient is

to

 

a.

Assess the abdomen for distention and bowel sounds

b.

Inspect the surgical site and drainage in the Jackson-Pratt

c.

Administer prescribed hydroxine (Vistaril) to control the nausea and vomiting

d.

Check the amount and character of gastric drainage and the patency of the NG tube

A

postoperative patient has a nursing diagnosis of pain related to effects of medication and decreased GI motility as

evidenced by abdominal pain and distention and inability to pass flatus. An appropriate nursing intervention for the patient is to

a.

Ambulate the patient more frequently

b.

Assess the abdomen for bowel sounds

c.

Place the patient in high Fowler’s position

d.

Withhold opioids because they decrease bowel motility

A 22-year-old patient calls the outpatient clinic complaining of nausea and vomiting and righ lower abdominal pain.

The nurse advises the patient to

a.

Use a heating pad to relax the muscles at the site of the pain

b.

Drink at least 2 quarts of juice to replace the fluid lost in vomiting

c.

Take a laxative to empty the bowel before examination at the clinic

d.

Have the symptoms evaluated by a health care provider right away

When caring for a patient with irritable bowel syndrome (IBS), it is most important for the nurse to

a.

Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed

b.

Develop a trusting relationship with the patient to provide support and symptomatic care

c.

Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation

d.

Inform the patient that new medications for IBS are available and effective for treatment of IBS manifested by either diarrhea or constipation

A

patient with a gunshot wound to the abdomen complains of increasing abdominal pain several hours after surgery

to

repair the bowel. What action should the nurse take first?

a.

Take the patient’s vital signs

b.

Notify the health care provider

c.

Position the patient with the knees flexed

d.

Determine the patient’s IV intake since the end of surgery

Extraintestinal symptoms that are seen in both ulcerative colitis and Crohn’s disease are

a.

Osteoporosis and conjunctivitis

b.

Peptic ulcer disease and uveitis

c.

Erythema nodosum and arthritis

d.

Gluten intolerance and gallstones

A patient with ulcerative colitis undergoes the first phase of a total colectomy with ileoanal anastomosis and

formation of an ileal reservoir. On postoperative assessment of the patient, the nurse would expect to find

a.

And unopened loop ileostomy

b.

A rectal tube set to low continuous suction

c.

An ileostomy stoma with a catheter in place to provide pouch irrigations

d.

A permanent ileostomy stoma in the right lower quadrant of the abdomen

A patient with ulcerative colitis has a total colectomy with formation of a terminal ileum stoma. An important

nursing intervention for this patient postoperatively is to

a.

Measure the ileostomy output to determine the status of the patient’s fluid balance

b.

Change the ileostomy appliance every 3 to 4 hours to prevent leakage of the drainage onto the skin

c.

Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals

d.

Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage

A patient with IBD has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased

nutritional intake and decreased intestinal absorption. Assessment data that support this nursing diagnosis are

a.

Pallor and hair loss

b.

Frequent diarrhea stools

c.

Anorectal excoriation and pain

d.

Hypotension and urine output below 30 mL/hr

An important nursing intervention for the patient with a small bowel obstruction who has an NG tube is to

a.

Offer ice chips to suck PRN

b.

Provide mouth care every 1 to 2 hours

c.

Irrigate the tube with normal saline every 8 hours

During routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. The best response by the nurse is,

a.

“it is very rare for polyps to become malignant, but you should continue to have routine colonoscopies.”

b.

“individuals with polyps have a 100% lifetime risk of developing colorectal cancer, and at an earlier age than those without polyps.”

c.

“all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present.”

d.

“all polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps

When obtaining a nursing history from the patient with colorectal cancer, the nurse asks the patient specifically about

a.

Dietary intake

b.

History of smoking

c.

History of alcohol intake

d.

Environmental exposure to carcinogens

On examining a patient 8 hours after formation of a colostomy, the nurse would expect to find

a.

Hypoactive, high-pitched bowel sounds

b.

A brick-red, puffy stoma that oozes blood

c.

A purplish stoma, shiny and moist with mucus

d.

A small amount of liquid fecal drainage from the stoma

The RN coordinating the care for a patient who is 2 days postoperative following an anterior-posterior resection with colostomy may delegate which of the following interventions to the LPN (SATA)

a.

Irrigate the colostomy

b.

Teach ostomy and skin care

c.

Assess and document stoma appearance

d.

Monitor and record the volume, color, and odor of all the drainage

e.

Empty the ostomy bag and measure and record the amount of drainage

A male patient who has undergone an abdominal-perineal resection has a nursing diagnosis of ineffective sexuality pattern. An appropriate nursing intervention for the patient is to

a. Have the patient’s sexual partner reassure the patient that he is still desirable

b. Reassure the patient that sexual function will return when healing is complete

c. Remind the patient that affection can be expressed in other ways besides sexual intercourse

The nurse plans teaching for the patient with a colostomy, but the patient refuses to look at the nurse or the stoma, statin “I just can’t see myself with this thing.” An appropriate nursing diagnosis for the patient is

a.

Self-care deficit related to refusal to care for colostomy

b.

Disturbed body image related to presence of colostomy stoma

c.

Ineffective coping related to feelings of helplessness and lack of coping skills

d.

Ineffective self-health management related to lack of knowledge for care of colostomy

In teaching a patient about colostomy irrigation, the nurse tells the patient to

a.

Infuse 1500 to 2000 mL of warm tap water as irrigation fluid

b.

Allow 30 to 45 minutes for the solution and feces to be expelled

c.

Insert a firm plastic catheter 3 to 4 inches into the stoma opening

d.

Hang the irrigation bag on a hook about 36 inches above the stoma

The nurse teaches the patient with diverticulosis to

a.

Use anticholinergic drugs routinely to prevent bowel spasm

b.

Have an annual colonoscopy to detect malignant changes in the lesions

c.

Maintain a high-fiber diet and use bulk laxatives to increase fluid volume

d.

Exclude whole grain breads and cereals from the diet to prevent irritating the bowel

During an acute attack of diverticulitis, the patient is

a.

Monitored for signs of peritonitis

b.

Treated with daily medicated enemas

c.

Prepared for surgery to resect the involved colon

d.

Provided with a heating pad to apply to the left lower quadrant

A nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy is

a.

Applying heat to the inguinal area

b.

Elevating the scrotum with a scrotal support

c.

Applying a truss to support the operative site

d.

Encouraging the patient to cough and deep-breathe

The most common form of a malabsorption syndrome is treated with

a.

Administration of antibiotics

b.

Avoidance of milk and milk products

c.

Supplementation with pancreatic enzymes

A patient is diagnosed with celiac disease following a workup for iron-deficiency anemia and decreased bone

density. The nurse identifies that additional teaching about disease management is needed when the patient says,

a.

“I should ask my close relatives to be screened for celiac disease.”

b.

“if I do not follow the gluten-free diet, I might develop a lymphoma.”

c.

“I don’t need to restrict gluten intake because I don’t have diarrhea or bowel symptoms.”

d.

“it is going to be difficult to follow a gluten-free diet because it is found in so many foods.”

Short bowel syndrome is most likely to occur in the patient with

a.

Ulcerative colitis

b.

Irritable bowel syndrome

c.

An extensive resection of the ileum

d.

A colostomy performed for cancer of the bowel

Following anal surgery, the nurse advises the patient to

a.

Use daily laxatives to facilitate bowel emptying

b.

Use ice packs to the perineum to prevent swelling

c.

Avoid having a bowel movement for several days until healing occurs

d.

Take warm sitz baths several times a day to promote comfort and healing

Ch 44

During assessment of a patient with obstructive jaundice, the nurse would expect to find

a. clay-colored stools

b. dark urine and stools

c. pyrexia and severe pruritus

d. elevated urinary urobilinogen

A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that

a.

pruritus is a common problem with jaundice in this phase

b.

the patient is most likely to transmit the disease during this phase

c.

gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B

d.

extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase

A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include

instructions to

a.

avoid alcohol for the first 3 weeks

b.

use a condom during sexual intercourse

c.

have family members get an injection of immunoglobulin

d. follow a low-protein, moderate-carbohydrate, moderate-fat diet

A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The

nursing teaching plan should include

a.

having genetic testing done

b.

recommending a heart-healthy diet

c.

the necessity to reduce weight rapidly

d.

avoiding alcohol until liver enzymes return to normal

The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse’s response is based on the knowledge that

a.

a lack of clotting factors promotes the collection of blood in the abdominal cavity

b.

portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space

c.

decreased peristalsis in the GI tract contributes to gas formation and distension of the bowel

d.

bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid

In planning care for a patient with metastatic liver cancer, the nurse should include interventions that

a.

focus primarily on symptomatic and comfort measures

b.

reassure the patient that chemotherapy offers a good prognosis

c.

promote the patient’s confidence that surgical excision of the tumor will be successful

d.

provide information necessary for the patient to make decisions regarding liver transplantation

The nurse explains to the patient with acute pancreatitis that the most common pathogenic mechanism of the disorder is

a. cellular disorganization

b. overproduction of enzymes

c. lack of secretion

d. autodigestion of the pancreas

Nursing management of the patient with acute pancreatitis includes

a.

checking for signs of hypocalcemia

b.

providing a diet low in carbohydrates

c.

giving insulin based on a sliding scale

d.

observing stools for signs of steatorrhea

e.

monitoring for infection, particularly respiratory infection

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient

asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves

a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum

b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common

bile duct and stomach into the duodenum

c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, common bile duct, and stomach into the jejunum

d. radical removal of the pancreas, duodenum, and spleen, and attaching the stomach to the jejunum, which

requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy

The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge

that

a. shock-wave therapy should be tried initially

b. once gallstones are removed, they tend not to recur

c. the disorder can be successfully treated with oral bile salts that dissolve gallstones

d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

Teaching in relation to home management following a laparoscopic cholecystectomy should include

a. keeping the bandages on the puncture site for 48 hours

b. reporting any bile-colored drainage or pus from any incision

c. using over-the-counter antiemetics if nausea and vomiting occur

d. emptying and measuring the contents of the bile bag from the T tube every day

The systemic effects of viral hepatitis are caused primarily by

a.

Cholestasis

b.

Impaired portal circulation

c.

Toxins produced by the infected liver

d.

Activation of the complement system by antigen-antibody complexes

During the incubation period of viral hepatitis, the nurse would expect the patient to report

a.

Pruritis and malaise

b.

Dark urine and easy fatigability

c.

Anorexia and right upper quadrant discomfort

d.

Constipation or diarrhea with light-colored stools

Fulminant viral hepatitis as a complication of viral hepatitis is highest in those individuals with

a.

Hepatitis A

b.

Hepatitis C

c.

Hepatitis B accompanied with hepatitis C

d.

Hepatitis B accompanied with hepatitis D

The family members of a patient with hepatitis A asks if there is anything that will prevent them from developing the disease. The best response by the nurse is

a.

“no immunization is available for hepatitis A, nor are you likely to get the disease.”

b.

“only individuals who have had sexual contact with the patient should receive immunization.”

c.

“all family members should receive the hepatitis A vaccine to prevent or modify the infection.”

d.

“those who have had household or close contact with the patient should receive immune globulin.”

A patient newly diagnosed with acute hepatitis B asks about drug therapy to treat the disease. The most appropriate response by the nurse is informing the patient that

a. There are no specific drug therapies that are effective for treating acute viral hepatitis

b. Only chronic hepatitis C is treatable, primarily with antiviral agents and a-interferon

c. No drugs can be used for treatment of viral hepatitis because of the risk of additional liver damage

d. A-interferon combined with lamivudine (Epivir) will decrease viral load and liver damage if taken for 1 year

The nurse identifies a need for further teaching when the patient with hepatitis B states,

a.

“I should avoid alcohol completely for as long as a year.”

b.

“I must avoid all physical contact with my family until the jaundice is gone.”

c.

“I should use a condom to prevent spread of the disease to my sexual partner.”

d.

“I will need to rest several times a day, gradually increasing my activity as I tolerate it.”

One of the most challenging nursing interventions to promote healing in the patient with viral hepatitis is

a.

Providing adequate nutritional intake

b.

Promoting strict bed rest during the icteric period

c.

Providing pain relief without using liver-metabolized drugs

d.

Providing quiet diversional activities during periods of fatigue

When caring for a patient with autoimmune hepatitis, the nurse recognizes that, unlike viral hepatitis, the patient

a.

Does not manifest hepatomegaly or jaundice

b.

Experiences less liver inflammation and damage

c.

Is treated with corticosteroids or other immunosuppressant agents

d.

Is usually an older adult who has used a wide variety of prescription and over-the-counter drugs

Laboratory test results that the nurse would expect to find in a patient with cirrhosis include

a.

Serum albumin: 7.0g/dL (70 g/L)

b.

Bilirubin: total 3.2 mg/dL (54.7 mmol/L)

c.

Serum cholesterol: 260 mg/dL (6.7 mmol/L)

d.

Aspartate aminotransferase (AST): 6.0 U/L (o.1 mkat/L)

The nurse recognizes early signs of hepatic encephalopathy in the patient who

a.

Manifests asterixis

b.

Becomes unconscious

c.

Has increasing oliguria

d.

Is irritable and lethargic

A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia and inadequate food intake. Appropriate midday snack for the patient would be

a. Peanut butter and salt-free crackers

b.

A fresh tomato sandwich with salt-free butter

c.

Popcorn with salt-free butter and herbal seasoning

d.

Canned chicken noodle soup with low-protein bread

During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse

a.

Prepare the patient for immediate portal shunting surgery

b.

Perform guaiac testing on all stools to detect occult blood

c.

Maintain the patient’s airway and prevent aspiration of blood

d.

Monitor for the cardiac effects of IV vasopressin and nitroglycerin

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a peritoneovenous

shunt. As a result of this procedure, the nurse would expect the patient to experience

a.

An improved survival rate

b.

Decreased serum ammonia levels

c.

Improved metabolism of nutrients

d.

Improved hemodynamic function and renal perfusion

In discussing long-term management with the patient with alcoholic cirrhosis, the nurse advises the patient that

a.

A daily exercise regimen is important to increase the blood flow through the liver

b.

Cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition

c.

Abstinence from alcohol is the most important factor in improvement of the patient’s condition

d.

The only over-the-counter analgesic that should be used for minor aches and pains is acetaminophen

A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on the

knowledge that

a.

Chemotherapy is highly successful in the treatment of liver cancer

b.

The patient will undergo surgery to remove the involved portions of the liver

c.

Supportive care that is appropriate for all patients with severe liver damage is indicated

d.

Metastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver

A patient with cirrhosis asks the nurse about the possibility of a liver transplant. The best response by the nurse is,

a.

“liver transplants are only indicated in children with irreversible liver disease.”

b.

“if you are interested in a transplant, you really should talk to your doctor about it.”

c.

“rejection is such a problem in liver transplants that it is seldom attempted in patients with cirrhosis.”

d.

“cirrhosis is an indication for transplantation in some cases. Have you talked to you doctor about this?”

When assessing a patient with acute pancreatitis, the nurse would expect to find

a.

Hyperactive bowel sounds

b.

Hypertension and tachycardia

c.

Severe midepigastric or left upper quadrant (LUQ) pain

d.

A temperature greater than 102F (38.9C)

Combined with clinical manifestations, the laboratory finding that is most commonly used to diagnose acute pancreatitis is

a.

Increased serum calcium

b.

Increased serum amylase

c.

Increased urine amylase

d.

Increased serum glucose

Management of the patient with acute pancreatitis includes

a.

Surgery to remove the inflamed pancreas

b.

Pancreatic enzymes administered with meals

c.

NG suction to prevent gastric contents from entering the duodenum

d.

Endoscopic pancreatic sphincterotomy using endoscopic retrograde cholangiopancreatography (ERCP)

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of pancreas and peritoneal irritation. In addition to effective use of analgesics, the nurse should

a.

Provide diversional activities to distract the patient from the pain

b.

Provide small frequent meals to increase the patient’s tolerance to food

c.

Position the patient on the side with the head of the bed elevated 45 degrees for pain relief

d.

Ambulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion

The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis states,

a.

“I should observe for fat in my stools.”

b.

“I mist not use alcohol to prevent further attacks of pancreatitis.”

c.

“I shouldn’t eat salty foods or foods with high amounts of sodium.”

d.

“I will need to continue to monitor my blood glucose levels until my pancreas is healed.”

The patient with chronic pancreatitis is more likely than the patient with acute pancreatitis to

a.

Need to abstain from alcohol

b.

Experience acute abdominal pain

c.

Have malabsorption and diabetes mellitus

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided? (SATA)

a.

Avoid nicotine

b.

Eat bland foods

c.

Observe stools for steatorrhea

d.

Eat high-fat, low-protein, high-carbohydrate meals

e.

Take prescribed pancreatic enzymes immediately following meals

A risk factor associated with cancer of the pancreas is

a.

Alcohol intake

b.

Cigarette smoking

c.

Exposure to asbestos

d.

Increased dietary intake of milk and milk products

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. The nurse explains

to the patient that this test

a.

Is noninvasive and is a very reliable method of detecting gallstones

b.

Is used only when other tests cannot be used because of allergy to contrast media

c.

Is an adjunct to liver function tests to determine whether the gallbladder is inflamed

d.

Will outline the gallbladder and the ductal system to enable visualization of stones

Following a laparoscopic cholecystectomy, the nurse would expect the patient to

a.

Return to work in 2 to 3 weeks

b.

Be hospitalized for 3 to 5 days postoperatively

c.

Have four small abdominal incisions covered with small dressings

d.

Have a T-tube placed in the common bile duct to provide bile drainage

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a

cholecystectomy. The best response by the nurse is

a.

“a low-fat diet will prevent the development of further gallstones and should be continued.”

b.

“yes, because you will not have a gallbladder to store bile, you will not be able to digest fats adequately.”

c.

A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile.”

d.

“removal of the gallbladder will eliminate the source of your pain associated with fat intake, so you may eat whatever you like.”

To care for a T-tube in a patient following a cholecystectomy, the nurse

a. Keeps the tube supported and free of kinks

b. Attaches the tube to low continuous suction

c. Clamps the tube when ambulating the patient

d. Irrigates the tube with 10-mL sterile saline every 2 to 4 hours

During discharge instructions for a patient following a laparoscopic cholecystectomy, the nurse advises the patient to

a.

Keep the incision area clean and dry for at least a week

b.

Report the need to take pain medication for shoulder pain

c.

Report any bile-colored or purulent drainage from the incision

d.

Expect some postoperative nausea and vomiting for a few days

Chapter 48

A characteristic common to all hormones is that they

a.

Circulate the blood bound to plasma proteins

b.

Influence cellular activity of specific target tissues

c.

Accelerate the metabolic processes of all body cells

d.

Enter a cell to alter the cells metabolism or gene expression

A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for signs and

symptoms of damage to the

a.

Pancreas

b.

Thyroid gland

c.

Adrenal glands

d.

Posterior pituitary gland

A patient has a serum sodium level of 152 meq/l The normal hormonal response to the situation is

a.

Release of ADH

b.

Release of rennin

c.

Secretion of aldosterone

d.

Secretion of corticotrophin-releasing hormone

All cells of the body are believed to have intracellular receptors for

a. Insulin

b. Glucagon

d.

Thyroid hormone

When obtaining subjective data from a patient during assessment of the endocrine system the nurse asks specifically about

a. Energy level

b. Intake of vitamin c

c. Employment history

d. Frequency of sexual intercourse

An appropriate technique to use during physical assessment of the thyroid gland is

a.

Asking the patient to hyperextend the neck during palpation

b.

Percussing the neck for dullness to define the size of the thyroid

c.

Having the patient swallow water during inspection and palpation of the gland

d.

Using deep palpation to determine the extent of a visibly enlarged thyroid gland

Endocrine disorders often go unrecognized in the older adult because

a.

Symptoms are often attributed to aging

b.

Older adults rarely have identifiable symptoms

c.

Endocrine disorders are relatively rare in older adults

d.

Older adults usually have subclinical endocrine disorders that maximize symptoms

An abnormal finding by the nurse during an endocrine assessment would be (all that apply)

a.

Blood pressue 100/70

b.

Excessive facial hair in a women

c.

Soft formed stool every other day

d.

3 lb weight gain over 6 months

e.

Hyper pigmented coloration in lower legs

A patient has a total serum calcium level of 3 mg/dl. If this finding reflects hyperparathyroidism the nurse would expect further diagnostic testing to reveal

a.

Decreased serum PTH

b.

Increased serum ACTH

c.

Increased serum glucose

d.

Decreased serum cortisol levels

Chapter 50

Following a hypophysectomy to acromegaly postoperative nursing care should focus on

a.

Frequent monitoring of serum and urine osmolarity

b.

Parenteral administration of a GH-receptor antagonist

c.

Keeping the patient in a recumbent position at all times

d.

Patient education regarding the need for lifelong ACTH, TSH, FSH, AND LH hormone replacement

A patient with a head injury develops SIADH. Symptoms the nurse would expect to find include

a.

Hypernatremia and edema

b.

Low urinary output and thirst

c.

Muscle spasticity and hypertension

d.

Weight gain and decreased glomerular filtration rate

The health care provider prescribes levothyroxine for a patient with hypothyroidism. Following teaching regarding this drug the nurse determines that further instruction is needed when the patient says

a.

I can expect the medication dose may need to be increased

b.

I can expect to return to normal function with the use of this drug

c.

I only need to take this drug until my symptoms are improved

d.

I will report any chest pain or difficulty breathing to the doctor right away

Following thyroid surgery the nurse suspects damage or removal of the parathyroid glands when the patient develops

a.

Muscle weakness and weight loss

b.

Hyperthermia and severe tachycardia

c.

Hypertension and difficulty swallowing

d.

Laryngeal stridor and tingling in the hands and feet

Important nursing interventions when caring for a patient with Cushing syndrome include (all that apply)

a.

Restricting protein intake

b.

Monitoring blood glucose levels

c.

Observing signs of hypotension

d.

administering medication in equal doses

e.

Protecting patient from exposure to infection

After an adrenalectomy for pheochromocytoma the patient is most likely to experience

a. Hypokalemia

b. Hyperglycemia

c. Marked sodium and water retention

d. Marked fluctuations in blood pressure

To control the side effects of corticosteroid therapy the nurse teaches the patient who is taking corticosteroids to

a.

Increase calcium intake to 1500 mg/day

b.

Perform glucose monitoring for hypoglycemia

c.

Obtain immunization due to high risk of infections

d.

Avoid abrupt position changed because of orthostatic hypotension

The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is

a.

Once a day at bedtime

b.

Every other day on awakening

c.

On arising and in the late afternoon

d.

At consistent intervals every 6 to 8 hours