adult exam 3

Which action would the nurse include in the plan of care for a patient who is being admitted with a C. difficile infection?

a. Teach the patient about proper food storage.

b. Order a diet without dairy products for the patient.

c. Place the patient in a private room on contact isolation.

d. Teach the patient about why antibiotics will not be used.

c. Place the patient in a private room on contact isolation.

A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action would the nurse take first?

a. Encourage the patient to increase oral fluid intake.

b. Question the patient about risk factors for constipation.

c. Suggest that the patient increase intake of high-fiber foods.

d. Teach the patient that a daily bowel movement is unnecessary

b. Question the patient about risk factors for constipation.

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information would the nurse provide?

a. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins.

b. Dietary sources of fiber should be eliminated to prevent excessive gas formation.

c. Use of this type of laxative to prevent constipation does not cause adverse effects.

d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

a. What type of foods do you eat?

b. Is it possible that you are pregnant?

c. Can you tell me more about the pain?

d. What is your usual elimination pattern?

c. Can you tell me more about the pain?

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which action would the nurse take?

a. Administer morphine sulfate.

b. Encourage the patient to ambulate.

c. Offer the prescribed promethazine.

d. Instill a mineral oil retention enema.

b. Encourage the patient to ambulate.

A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?

a. Auscultate the bowel sounds.

b. Prepare the patient for surgery.

c. Check the patient's oral temperature.

d. Obtain information about the accident

b. Prepare the patient for surgery.

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action would the nurse take?

a. Assist the patient to cough and deep breathe.

b. Palpate the abdomen for rebound tenderness.

c. Suggest the patient lie on the side, flexing the right leg.

d. Encourage the patient to sip clear, noncarbonated liquids.

c. Suggest the patient lie on the side, flexing the right leg.

Which action will the nurse include in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)?

a. Encourage the patient to express concerns and ask questions about IBS.

b. Suggest that the patient increase the intake of milk and other dairy products.

c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).

d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

a. Encourage the patient to express concerns and ask questions about IBS.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. Which intervention would the nurse include in the patient's plan of care?

a. Administer oral metoclopramide.

b. Instruct the patient not to eat or drink.

c. Administer cobalamin (vitamin B12) injections.

d. Teach the patient about total colectomy surgery.

b. Instruct the patient not to eat or drink.

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

a. Restrict IV fluid intake.

b. Monitor stools for blood.

c. Ambulate six times daily.

d. Increase dietary fiber intake.

b. Monitor stools for blood.

Which prescribed intervention for a patient with chronic short bowel syndrome would the nurse question?

a. Senna 1 tablet daily

b. Ferrous sulfate 325 mg daily

c. Psyllium (Metamucil) 3 times daily

d. Diphenoxylate with atropine (Lomotil) PRN loose stools

a. Senna 1 tablet daily

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that the nurse's teaching about skin integrity has been effective?

a. The patient uses incontinence briefs to contain loose stools.

b. The patient uses witch hazel compresses to soothe irritation.

c. The patient asks for antidiarrheal medication after each stool.

d. The patient cleans the perianal area with soap after each stool.

b. The patient uses witch hazel compresses to soothe irritation.

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?

a. Scrambled eggs

b. White toast and jam

c. Oatmeal with cream

d. Pancakes with syrup

c. Oatmeal with cream

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, ―I cannot manage all this. I don't want to look at the stoma.‖ Which action would the nurse take?

a. Reassure the patient that ileostomy care will become easier.

b. Ask the patient about the concerns with stoma management.

c. Postpone any teaching until the patient adjusts to the ileostomy.

d. Develop a detailed written list of ostomy care tasks for the patient.

b. Ask the patient about the concerns with stoma management.

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What would the nurse plan to teach the patient?

a. Medication use

b. Fluid restriction

c. Enteral nutrition

d. Activity restrictions

a. Medication use

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. Which information will the nurse add to a teaching plan about UTIs for this patient that goes beyond a general teaching plan for UTIs?

a. Fistulas can form between the bowel and bladder.

b. Bacteria in the perianal area can enter the urethra.

c. Drink adequate fluids to maintain normal hydration.

d. Empty the bladder before and after sexual intercourse.

a. Fistulas can form between the bowel and bladder.

Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction?

a. Referred back pain

b. Metabolic alkalosis

c. Projectile vomiting

d. Abdominal distention

d. Abdominal distention

Which screening test would the nurse plan to teach a 45-yr-old male about during an annual wellness exam?

a. Endoscopy

b. Colonoscopy

c. Computerized tomography

d. Carcinoembryonic antigen (CEA)

b. Colonoscopy

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include?

a. The patient will need to be on bedrest for three days after surgery.

b. An ileal-anal reservoir will be surgically created in 8 to 12 weeks.

c. The patient will have a temporary colostomy for 6-12 months.

d. The site for the stoma will be marked on the abdomen before surgery.

d. The site for the stoma will be marked on the abdomen before surgery.

A patient who recently had a colon resection for cancer of the colon asks about the purpose of the carcinoembryonic antigen (CEA) test. Which explanation would the nurse provide?

a. Identify any metastasis of the cancer.

b. Monitor for tumor growth after surgery.

c. Confirm the diagnosis of a specific type of cancer.

d. Determine the need for postoperative chemotherapy.

b. Monitor for tumor growth after surgery.

A patient had an abdominal-perineal resection for colon cancer. Which action is most important for the nurse to include in the plan of care for the day after surgery?

a. Teach about a low-residue diet.

b. Monitor output from the stoma.

c. Assess the drainage and incision.

d. Encourage acceptance of the stoma.

c. Assess the drainage and incision.

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. Which action would the nurse take?

a. Place ice packs around the stoma.

b. Notify the surgeon about the stoma.

c. Monitor the stoma every 30 minutes.

d. Document stoma assessment findings.

d. Document stoma assessment findings.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

a. Restrict fluid intake to prevent constant liquid drainage from the stoma.

b. Use care when eating high-fiber foods to avoid obstruction of the ileum.

c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance.

d. Change the pouch every day to prevent leakage of contents onto the skin.

b. Use care when eating high-fiber foods to avoid obstruction of the ileum.

A patient with a new ileostomy asks how much it will drain after the bowel has adapted in a few months. How many cups of drainage per day would the nurse tell the patient to expect?

a. 2

b. 3

c. 4

d. 5

a. 2

Which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care?

a. Administer IV fluids.

b. Prepare for colonoscopy.

c. Encourage a high-fiber diet.

d. Give stool softeners and enemas

a. Administer IV fluids.

A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge?

a. Soak in Sitz baths several times each day.

b. Cough 5 times each hour for the next 48 hours.

c. Avoid using acetaminophen (Tylenol) for pain.

d. Apply a scrotal support and ice to reduce swelling.

d. Apply a scrotal support and ice to reduce swelling.

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching?

a. Maintain a low-residue diet until the area is healed.

b. Avoid using any topical preparations on the surgical area.

c. Take prescribed pain medications before you expect a bowel movement.

d. Delay having a bowel movement for several days until you are well healed.

c. Take prescribed pain medications before you expect a bowel movement.

A patient calls the clinic to report a severe diarrhea lasting 4 days. What would the nurse anticipate that the patient will need to do?

a. Collect a stool specimen.

b. Prepare for colonoscopy.

c. Schedule a barium enema.

d. Have blood cultures drawn.

a. Collect a stool specimen.

Which topic would the nurse plan to teach to a patient with Crohn's disease who has megaloblastic anemia?

a. Iron dextran infusions

b. Oral ferrous sulfate tablets

c. Routine blood transfusions

d. Cobalamin (B12) supplements

d. Cobalamin (B12) supplements

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus?

a. Cullen's sign

b. Rovsing sign

c. McBurney's sign

d. Grey-Turner's sign

a. Cullen's sign

A critically ill patient with sepsis is frequently incontinent of watery stools. Which action by the nurse will prevent complications associated with ongoing incontinence?

a. Apply incontinence briefs.

b. Use a fecal management system.

c. Insert a rectal tube with a drainage bag.

d. Assist the patient to a commode frequently.

b. Use a fecal management system.

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)?

a. ―Have you been passing a lot of gas?

b. ―What foods affect your bowel patterns?

c. ―Do you have any abdominal distention?

d. ―How long have you had abdominal pain?

d. ―How long have you had abdominal pain?

A patient calls the clinic reporting diarrhea for 24 hours. Which action would the nurse take first?

a. Inform the patient that testing of blood and stools will be needed.

b. Suggest that the patient drink clear liquid fluids with electrolytes.

c. Ask the patient to describe the stools and any associated symptoms.

d. Advise the patient to use over-the-counter antidiarrheal medication.

c. Ask the patient to describe the stools and any associated symptoms.

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102F (38.3C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention would the nurse implement first?

a. Administer IV ketorolac 15 mg for pain relief.

b. Send a blood sample for a complete blood count (CBC).

c. Infuse a liter of lactated Ringer's solution over 30 minutes.

d. Send the patient for an abdominal computed tomography (CT) scan.

c. Infuse a liter of lactated Ringer's solution over 30 minutes.

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. Which action would the nurse take first?

a. Auscultate for hypotonic bowel sounds.

b. Notify the patient's health care provider.

c. Check for tube placement and reposition it.

d. Remove the tube and replace it with a new one

c. Check for tube placement and reposition it.

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. Which action would the nurse take during the initial assessment of the patient?

a. Remove the knife and assess the wound.

b. Determine the presence of Rovsing sign.

c. Check for circulation and tissue perfusion.

d. Insert a urinary catheter and assess for hematuria.

c. Check for circulation and tissue perfusion.

Which activity in the care of a patient with a new colostomy could the nurse delegate to assistive personnel (AP)?

a. Document the appearance of the stoma.

b. Place a pouching system over the ostomy.

c. Drain and measure the output from the ostomy.

d. Check the skin around the stoma for breakdown.

c. Drain and measure the output from the ostomy.

Which information obtained by the nurse interviewing a patient is most important to communicate to the health care provider?

a. Blood in the stool

b. History of constipation

c. Appendectomy 3 years ago

d. Smokes a pack/day of cigarettes

a. Blood in the stool

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to assistive personnel (AP)?

a. Auscultating for bowel sounds

b. Brushing the teeth and tongue

c. Assessing the nares for irritation

d. Irrigating the nasogastric (NG) tube

b. Brushing the teeth and tongue

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action would the nurse take first?

a. Notify the health care provider.

b. Obtain a stool specimen for analysis.

c. Teach the patient about hand washing.

d. Place the patient on contact precautions

d. Place the patient on contact precautions

Which patient would the nurse assess first after receiving change-of-shift report?

a. A 40-yr-old patient who has a distended abdomen and tachycardia

b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours

c. A 30-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours

d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

a. A 40-yr-old patient who has a distended abdomen and tachycardia

A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider?

a. Fever

b. Nausea

c. Joint pain

d. Headache

a. Fever

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will the nurse include in patient teaching?

a. Stool will be expelled from both stomas.

b. This type of colostomy is usually temporary.

c. Soft, formed stool can be expected as drainage.

d. Irrigations can regulate drainage from the stomas.

b. This type of colostomy is usually temporary.

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action would the nurse take first?

a. Administer bulk-forming laxatives.

b. Assist the patient to sit on the toilet.

c. Manually remove the hard stool.

d. Increase the patient's oral fluid intake

c. Manually remove the hard stool.

A 72-yr-old patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?

a. Skin is dry with tenting and poor turgor.

b. Patient has not voided for the last 2 hours.

c. Crackles are heard halfway up the posterior chest.

d. Patient has had 5 loose stools over the previous 6 hours.

c. Crackles are heard halfway up the posterior chest.

A 19-yr-old patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?

a. Obtain blood samples for DNA analysis.

b. Schedule the patient for yearly colonoscopy.

c. Provide preoperative teaching about total colectomy.

d. Discuss lifestyle modifications to decrease cancer risk.

b. Schedule the patient for yearly colonoscopy.

After change-of-shift report, which patient would the nurse assess first?

a. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea

b. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting

c. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown

d. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer

b. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting

The nurse is admitting a patient with new-onset steatorrhea. Which question is most important for the nurse to ask?

a. ―How much milk do you drink?

b. ―Have you had a recent weight loss?

c. ―What time of day do your bowels move?

d. ―Do you eat meat or other animal products?

b. ―Have you had a recent weight loss?

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.)

a. Stimulant and saline laxatives can be used regularly.

b. Bulk-forming laxatives are an excellent source of fiber.

c. Walking or cycling frequently will help bowel motility.

d. A good time for a bowel movement may be after breakfast.

e. Some over-the-counter (OTC) medications cause constipation.

b. Bulk-forming laxatives are an excellent source of fiber.

c. Walking or cycling frequently will help bowel motility.

d. A good time for a bowel movement may be after breakfast.

e. Some over-the-counter (OTC) medications cause constipation.

After change-of-shift report, which patient would the nurse assess first?

a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain

b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn

c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa

d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy

c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa

Which item would the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting?

a. Glass of orange juice

b. Dish of lemon gelatin

c. Cup of coffee with cream

d. Bowl of hot chicken broth

b. Dish of lemon gelatin

A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention would the nurse anticipate?

a. Nystatin tablets

b. Antiviral agents

c. Referral to a dentist

d. Hydrogen peroxide rinses

a. Nystatin tablets

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?

a. Bleeding during tooth brushing

b. Painful blisters at the lip border

c. Red patches on the buccal mucosa

d. Curdlike plaques on the posterior tongue

c. Red patches on the buccal mucosa

Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?

a. Use sunscreen even on cloudy days.

b. Avoid cigarettes and smokeless tobacco.

c. Complete antibiotic courses used to treat throat infections.

d. Use antivirals to treat herpes simplex virus (HSV) infections

b. Avoid cigarettes and smokeless tobacco.

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD?

a. ―I quit smoking years ago, but I chew gum.

b. ―I eat small meals and have a bedtime snack.

c. ―I take antacids between meals and at bedtime each night.

d. ―I sleep with the head of the bed elevated on 4-inch blocks.

b. I eat small meals and have a bedtime snack.

A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine?

a. Apical pulse

b. Bowel sounds

c. Breath sounds

d. Abdominal girth

c. Breath sounds

How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?

a. ―It reduces gastroesophageal reflux by increasing the rate of gastric emptying.

b. ―It neutralizes stomach acid and provides relief of symptoms in a few minutes.

c. ―It coats and protects the lining of the stomach and esophagus from gastric acid.

d. ―It treats gastroesophageal reflux disease by decreasing stomach acid production.

d. ―It treats gastroesophageal reflux disease by decreasing stomach acid production.

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective?

a. Chocolate pudding

b. Glass of low-fat milk

c. Cherry gelatin with fruit

d. Peanut butter and jelly sandwich

c. Cherry gelatin with fruit

Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn?

a. Radionuclide tests

b. Barium swallow exam

c. Endoscopy procedures

d. Proton pump inhibitors

d. Proton pump inhibitors

A woman who was recently diagnosed with esophageal cancer tells the nurse, ―I do not feel ready to die yet. Which response would the nurse provide?

a. ―You may have quite a few years still left to live.

b. ―Thinking about dying will only make you feel worse.

c. ―Having this new diagnosis must be very hard for you.

d. ―It is important that you be realistic about your prognosis.

c. Having this new diagnosis must be very hard for you.

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?

a. ―Peppermint tea may reduce your symptoms.

b. ―Keep the head of your bed elevated on blocks.

c. ―Avoid eating between meals to reduce acid secretion.

d. ―Vigorous exercise may increase the incidence of reflux.

b. Keep the head of your bed elevated on blocks.

Which nursing action would be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?

a. Reposition the NG tube if drainage stops.

b. Elevate the head of the bed to at least 30 degrees.

c. Start oral fluids when the patient has active bowel sounds.

d. Notify the doctor for any bloody nasogastric (NG) drainage.

b. Elevate the head of the bed to at least 30 degrees.

Which action would the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea?

a. Obtain a stool specimen for culture.

b. Administer antidiarrheal medication.

c. Provide teaching about antibiotic therapy.

d. Teach the adverse effects of acetaminophen (Tylenol).

a. Obtain a stool specimen for culture.

Which diagnostic test would the nurse anticipate for an older patient who is vomiting ―coffee-ground‖ emesis?

a. Endoscopy

b. Angiography

c. Barium studies

d. Gastric analysis

a. Endoscopy

An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question?

a. Infuse lactated Ringer's solution at 250 mL/hr.

b. Monitor blood urea nitrogen and creatinine daily.

c. Administer loperamide (Imodium) after each stool.

d. Provide a clear liquid diet and progress diet as tolerated.

c. Administer loperamide (Imodium) after each stool.

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks about the purpose of receiving famotidine (Pepcid). Which information would the nurse explain about the action of the medication?

a. ―It decreases nausea and vomiting.

b. ―It inhibits development of stress ulcers.

c. ―It lowers the risk for H. pylori infection.

d. ―It prevents aspiration of gastric contents.

b. It inhibits development of stress ulcers.

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. Which action would the nurse teach the patient to take?

a. Increase the amount of fluid with meals.

b. Eat foods that are higher in carbohydrates.

c. Lie down for about 30 minutes after eating.

d. Drink sugared fluids or eat candy after meals.

c. Lie down for about 30 minutes after eating.

A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?

a. The patient has been vomiting for 4 days.

b. The patient takes antacids 8 to 10 times a day.

c. The patient is lethargic and difficult to arouse.

d. The patient had a small intestinal resection 2 years ago.

c. The patient is lethargic and difficult to arouse.

A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to assistive personnel (AP)?

a. Auscultate the bowel sounds.

b. Assess for signs of dehydration.

c. Assist the patient with oral care.

d. Ask more questions about the nausea

c. Assist the patient with oral care.

A patient has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first?

a. Insert a nasogastric (NG) tube.

b. Infuse normal saline at 250 mL/hr.

c. Administer IV ondansetron (Zofran).

d. Provide oral care with moistened swabs.

b. Infuse normal saline at 250 mL/hr.

Which patient would the nurse assess first after receiving change-of-shift report?

a. A patient with esophageal varices who has a rapid heart rate

b. A patient with a history of gastrointestinal bleeding who has melena

c. A patient with nausea who has a dose of metoclopramide (Reglan) due

d. A patient who is crying after receiving a diagnosis of esophageal cancer

a. A patient with esophageal varices who has a rapid heart rate

Which assessment would the nurse perform first for a patient who just vomited bright red blood?

a. Measuring the quantity of emesis

b. Palpating the abdomen for distention

c. Auscultating the chest for breath sounds

d. Taking the blood pressure (BP) and pulse

d. Taking the blood pressure (BP) and pulse

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood?

a. Give an IV H2 receptor antagonist.

b. Draw blood for type and crossmatch.

c. Administer 1 L of lactated Ringer's solution.

d. Insert a nasogastric (NG) tube and connect to suction

c. Administer 1 L of lactated Ringer's solution.

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider?

a. The bowel sounds are hyperactive in all four quadrants.

b. The patient's lungs have crackles audible to the midchest.

c. The nasogastric (NG) suction is returning coffee-ground material.

d. The patient's blood pressure (BP) has increased to 142/84 mm Hg.

b. The patient's lungs have crackles audible to the midchest.

Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?

c. Unintended weight loss

An older patient reports chronic constipation. To promote bowel evacuation, when should the nurse suggest that the patient attempt defecation?

b. After eating breakfast

What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy?

d. Cobalamin (vitamin B12) deficiency

The nurse is caring for a patient with an obstructed common bile duct. What condition should the nurse expect?

b. Steatorrhea

The nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?

a. The patient declined to drink the prescribed laxative solution.

Which statement to the nurse from a patient with jaundice indicates a need for teaching?

d. "I use acetaminophen (Tylenol) every 4 hours for pain."

Which is the correct technique for the nurse to palpate the liver during a head-to-toe physical assessment?

b. Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin

Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?

Absent bowel sounds

What action should the nurse take after assisting with a needle biopsy of the liver at a patient's bedside?

b. Place the patient on the right side with the bed flat.

A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?

d. The patient ate a low-fat bagel 4 hours ago for breakfast.

The nurse is assessing an alert and independent older adult patient for malnutrition risk. Which is the most appropriate initial question?

b. "Can you tell me the food that you ate yesterday?"

A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?

c. The oral temperature is 101.4° F.

An adult with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding should the nurse report to the health care provider?

b. Liver edge 3 cm below the costal margin

A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?

a. Offering the patient a pitcher of water

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first?

a. Place the patient on NPO status.

While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). What area of patient knowledge should the nurse plan to assess?

c. Risk for developing colorectal cancer

To decrease the risk for future hearing loss, which action should the nurse implement with college students at the on-campus health clinic?

d. Discuss exposure to amplified music.

A patient who has Ménière's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan?

a. Dim the lights in the patient's room.

b. Encourage increased oral fluid intake.

c. Change the patient's position every 2 hours.

d. Keep the head of the bed elevated 45 degrees.

a. Dim the lights in the patient's room.

An older patient who is being admitted to the hospital repeatedly asks the nurse to "speak up so that I can hear you." Which action should the nurse take?

a. Increase the speaking volume.

b. Overenunciate while speaking.

c. Speak normally but more slowly.

d. Use more facial expressions when talking.

c. Speak normally but more slowly.

Unlicensed assistive personnel (UAP) perform the following actions when caring for a patient with Ménière's disease who is experiencing an acute attack. Which action by UAP indicates that the nurse should intervene?

a. UAP raises the side rails on the bed.

b. UAP turns on the patient's television.

c. UAP places an emesis basin at the bedside.

d. UAP helps the patient turn to the right side.

b. UAP turns on the patient's television.

What is the priority problem for a patient experiencing an acute attack with Meniere's disease?

a. Being at risk for falls.

b. Imbalanced nutritional intake.

c. Difficulty performing self-care.

d. Impaired verbal communication.

a. Being at risk for falls

The nurse recording health histories in the outpatient clinic would plan a focused hearing assessment for adult patients taking which medication?

a. Atenolol

b. Albuterol

c. Ibuprofen

d. Acetaminophen

c. Ibuprofen

Which action should the nurse take when teaching a patient with mild presbycusis?

a. Use patient education handouts rather than discussion.

b. Use a high-pitched tone of voice to provide instructions.

c. Ask for permission to turn off the television before teaching.

d. Wait until family members have left before initiating teaching.

c. Ask for permission to turn off the television before teaching

A patient with Ménière's disease had decompression of the endolymphatic sac to reduce the frequent and incapacitating attacks. What should the nurse include in the discharge teaching for this patient?

Avoid sudden head movements or position changes.

A patient is prescribed intravenous (IV) gentamicin after repair of an intestinal perforation. The nurse should assess for which adverse effect of this medication?

Hearing loss

The nurse is providing care for a patient with loss of hearing acuity over the past several years. Which statement by the nurse is most accurate?

a. "This is often due to an infection that will resolve on its own."

b. "Many people experience an age-related decline in their hearing."

c. "This is likely an effect of your medications. Try stopping them for a few days."

d. "You can likely accommodate for your hearing loss with a few small changes in your routine."

b. "Many people experience an age-related decline in their hearing."