Med Surge Test 1

182 Questions

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Med Surge Test 1

Questions and Answers
  • 1. 
    The nurse is caring for a client who is recieving radiation treatment for oral cancer. which problem will the nurse anticipate for this client
    • A. 

      Failure to absorb nutrients for this client

    • B. 

      Inability to digest protein

    • C. 

      Impaired ability to soften and break down food

    • D. 

      Difficulty swallowing food

  • 2. 
    Which question will best assist the nurse in the assessment of a client with acute diarrhea
    • A. 

      Have you traveled outside the country recently

    • B. 

      Have you had a colonscopy lately

    • C. 

      Do you have any trouble swallowing

    • D. 

      Do you h ave any allergies

  • 3. 
    A client has been taking naproxen (Naproxyn) for several months. Which assessment question is important for the nurse to ask?
    • A. 

      Have you experienced any constipation

    • B. 

      Have you had any stomach pain or indigestion

    • C. 

      Have you had any difficulty swallowing

    • D. 

      Have you noticed any weight loss lately

  • 4. 
    The nurse screens clients at a health fair. Which client is at highest risk for the development of colon cancer?
    • A. 

      An older white female client with irritable bowel syndrome

    • B. 

      A middle aged African-American man who smokes four cigarettes a day

    • C. 

      A middle aged Asian man who travels and eats out frequently

    • D. 

      An older Native-American woman taking hormone replacement therapy

  • 5. 
    When performing an assessment, the nurse detects a fruity odor on the client's breath. which will the nurse do next
    • A. 

      Assess the clients blood sugar level

    • B. 

      Assess the clients stool for occult blood

    • C. 

      Instruct the client on oral hygiene techniques

    • D. 

      Assess the clients for petechiae, itching, and jaundice

  • 6. 
    The nurse is preparing to perform an abdominal assessment on a cient with suspected cholecystitis. In what sequence will the nurse palpate the client's abdomen
    • A. 

      Palpate the lower quadrants only

    • B. 

      Palpate the upper quadrants last

    • C. 

      Palpate the upper quadrants only

    • D. 

      Defer palpation and use percussion only

  • 7. 
    The nurse is caring for a client who has just had abdominal surgery. When auscultating the client's abdomen, the nurse does not hear any bowel sounds. Which is the nurse's best action?
    • A. 

      Notifying the physician

    • B. 

      Percussing the abdomen

    • C. 

      Documenting the finding

    • D. 

      Inserting a nasogastric tube

  • 8. 
    The nurse assesses dullness at the left anterior axillary line. The nurse is concerned about which condition that the client may have
    • A. 

      Cirrhosis

    • B. 

      Splenomegaly

    • C. 

      Bowel obstruction

    • D. 

      Abdominal aortic aneurysm

  • 9. 
    The nurse finds a positive Blumberg's sign in a client with abdominal pain. Which action will the nurse plan?
    • A. 

      Have the client be NPO in preparation for surgery

    • B. 

      Document this normal finding in the clients record

    • C. 

      Immediately auscultate the clients abdomen for bowel sounds

    • D. 

      Repeat the maneuver with the client in a supine position, whith the knees flexed

  • 10. 
    • A. 

      Amylase, 129 IU/L; alkaline phosphate, 45 U/L

    • B. 

      Reticulocyte, count 1%; magnesium, 1.5 mEq/L

    • C. 

      Hemoglobin, 13.4g/dL; direct bilirubin, 0.2 mg/dl

    • D. 

      Prothrombin time (PT), 17.5 seconds; albumin, 1.6 g/dl

  • 11. 
    The nurse is caring for a client who just completed a computed tomography CT scan with oral barium contrast. Which instructions will the nurse provide in the client?
    • A. 

      Drink plenty of fluids over the next few days

    • B. 

      Do not eat or drink anything for 6 hours after the test

    • C. 

      You may not drive or operate heavy machinery today

    • D. 

      Do not take any blood thinners for 24 hours after the test

  • 12. 
    Which statement indicated that the client needs additional teaching about her or his colonoscopy
    • A. 

      I may have gas and abdominal cramps after the test

    • B. 

      I will take strong laxatives the afternoon before the test

    • C. 

      I will take my coumadin with a sip of water tomorrow morning

    • D. 

      I will take nothing by mouth after midnight on the day of the test

  • 13. 
    The nurse is preparing the clint for a CT scan of the abdomen with IV contrast. Which question will the nurse ask the client prior to the examination.
    • A. 

      Are you allergic to shrimp, scallops, or shellfish

    • B. 

      Have you had anything to eat or drink in the past 12 hours

    • C. 

      Did you finish taking all the prescribed laxatives

    • D. 

      Can you tolerate being tilted from side to side

  • 14. 
    Which statement by the client indicated that the nurse's teaching about an abdominal ultrasound was effective
    • A. 

      The IV contrast may burn when it is injected

    • B. 

      I will drive myself home after the test is completed

    • C. 

      I will empty my bladder completely before the test

    • D. 

      I may have to take a laxative to pass the barium afterward

  • 15. 
    When obtaining a health history from a client with a new diagnosis of advanced pancreatic cancer, the client begins to cry. whcih is the nurse's best response?
    • A. 

      I am sorry for making you cry

    • B. 

      I will step out for a few minutes until you feel better

    • C. 

      I can see that you are upset about this, It is all right to cry

    • D. 

      I can see that I am upsetting you, Let's move on to something else

  • 16. 
    The nurse is performing an abdominal assessment on an older client. Which assessment finding will the nurse expect as a normal consequence of aging
    • A. 

      Increased salvation and drooling

    • B. 

      Hyperactive bowel sounds and loose stools

    • C. 

      Increased gastric acid production and heartburn

    • D. 

      Impaired sensation to defecate and constipation

  • 17. 
    The nurse is caring for a client who just has an esophagogastroduodenoscopy (EGD) completed. The client tells the nurse that her mouth is very dry after the procedure. Which is the nurse's best action
    • A. 

      Keep the client NPO

    • B. 

      Check the clients gag reflex

    • C. 

      Offer the client sips of clear liquids

    • D. 

      Provide the client with a few ice chips

  • 18. 
    The nurse performs percussion of a client abdomen. which finding may the nurse determine with this assessment technique (select all that apply)
    • A. 

      The client has hepatomegaly

    • B. 

      The client has kidney stones

    • C. 

      The client has ascites

    • D. 

      The client has a large mass below the liver

    • E. 

      The client has biliary colic

    • F. 

      The client has an ileus

    • G. 

      The client has peritoneal inflammation

  • 19. 
    The nurse is performing an abdominal assessment on a client who may have acute appendicitis. Which assessment techniques will the nurse use to help confirm this diagnosis? (select all that apply)
    • A. 

      Scratch test

    • B. 

      Obturator test

    • C. 

      Fluid wave test

    • D. 

      Iliopsoas muscle test

    • E. 

      Checking for the Murphy sign

    • F. 

      Checking for the Blumberg sign

    • G. 

      Checking for the Chadwick sign

  • 20. 
    The client reports that he has been passing black stools for the last few days. Which findings from the client's health history will the nurse consider as a possible cause? (Select all that apply)
    • A. 

      Cirrhosis

    • B. 

      Cholecystitis

    • C. 

      Hemorrhoids

    • D. 

      Diverticulitis

    • E. 

      Laxative use

    • F. 

      Long-term use of NSAIDs

    • G. 

      Use of iron supplements

  • 21. 
    In the client with less thatn normal amount of bicarbonate in the blood and other extracellular fluids, what response would the nurse anticipate?
    • A. 

      Increased risk for acidosis

    • B. 

      Decreased risk for acidosis

    • C. 

      Increased risk for alkalosis

    • D. 

      Decreased risk for alkalosis

  • 22. 
    The nurse recognizes which response as an example of compensation for an acid-base imbalance?
    • A. 

      Increased in the rate and depth of respiration when exercising

    • B. 

      Increased urinary output when blood pressure increases during heavy exercises

    • C. 

      Increased thirst when spending an extended period of time in a dry environment

    • D. 

      Shifting of body weight when pain occurs as a result of remaining in one position for too long

  • 23. 
    When a client has an arterial blood pH of 7.48, the nurse recognizes that which action by a buffer will bring the pH back to normal
    • A. 

      Absorption of bicarbonate ions from the blood

    • B. 

      Release of bicarbonate ions from the blood

    • C. 

      Absorption of hydrogen ions from the blood

    • D. 

      Release of hydrogen ions into the blood

  • 24. 
    When a client is NPO for 5 days and receiving 3L of crystalloid intravenous solutions containging 5% dextrose daily, what type of acid production could be expected to increase?
    • A. 

      Ketoacids

    • B. 

      Lactic acid

    • C. 

      Carbonic acid

    • D. 

      Sulfuric acid

  • 25. 
    In the client with hypoventilation, which change in acid-base does the nurse recognize as a compesatory response?
    • A. 

      Decreased arterial blood pH

    • B. 

      Decreased arterial blood carbon dioxide

    • C. 

      Increased arterial blood bicarbonate

    • D. 

      Increased arterial blood oxygen

  • 26. 
    In the client 4 minutes post-cardiac arrest, the nurse correlates the largest source of excess hydrogen ions to which cause?
    • A. 

      Excess renal retention of carbon dioxide

    • B. 

      Release of intracellular acids as a result of a widespread tissue destruction

    • C. 

      Cellular metabolism under anaerobic conditions, leading to buildup of lactic acid

    • D. 

      Use of fat as an alternate fuel source, resulting in an increase in fat degradation

  • 27. 
    The nurse recognizes that low levels of hemoglobin affect acid-base balance by which mechanism
    • A. 

      Augments the release of carbon dioxide into inter-cellular spaces

    • B. 

      Reduces the amount of oxygen available to tissues and increases the formation of hydrogen ions

    • C. 

      Results in a slightly more alkaline environment of the blood

    • D. 

      Decreases ability to compensate for mild acidosis

  • 28. 
    The client has an arterial blood gas Ph of 7.48. how will the nurse interpret this client is acid-base status?
    • A. 

      The client has an uncompensated acidosis

    • B. 

      The client has a normal blood hydrogen ion concentration

    • C. 

      The client has a deficit in the blood hydrogen ion concentration

    • D. 

      The client has an excess in the blood hydrogen ion concentration

  • 29. 
    In the client with an arterial blood gas pH of 7.42, what is the nurse's interpretation of his or her acid-base status
    • A. 

      The client has an uncompensated alkalosis

    • B. 

      The client has a normal blood hydrogen ion concentration

    • C. 

      The client has a deficit in the blood hydrogen ion concentration

    • D. 

      The client has an excess in the blood hydrogen ion concentration

  • 30. 
    The nurse monitors for which acid base imbalance in the client who has hypoxemia?
    • A. 

      Reduced carbon dioxide production alkalosis

    • B. 

      Reduced carbon dioxide retention, alkalosis

    • C. 

      Excess carbon dioxide production, acidosis

    • D. 

      Excess carbon dioxide retention, acidosis

  • 31. 
    What acid base problem could result if a client being mechanically ventilated is ventilated at too high a respiratory rate?
    • A. 

      Acid deficit alkalosis

    • B. 

      Base excess alkalosis

    • C. 

      Acid excess acidosis

    • D. 

      Base deficit acidosis

  • 32. 
    The nurse monitors for which acid base problem in the client taking furosemide (lasix) for hypertension
    • A. 

      Acid excess secondary to respiratory acidosis

    • B. 

      Acid deficit secondary to respiratory alkalosis

    • C. 

      Acid excess secondary to metabolic acidosis

    • D. 

      Acid deficit secondary to metabolic alkalosis

  • 33. 
    The nurse correlates renal compensation for an acid-base imbalance in which situtation?
    • A. 

      Mild to moderate dehydration in a middle-aged man who jogged for 2 hours

    • B. 

      Acute asthma with wheezing of 6 hours duration in an older man

    • C. 

      Food poisoning with vomiting for 12 hours in a middle-aged women

    • D. 

      Hypoxia for 4 days from pneumonia in ad adult women

  • 34. 
    The nurse determines which client as at greatest risk for acidosis?
    • A. 

      The older client on diuretic therapy with furosemide (Lasix, Furoside)

    • B. 

      The middle -aged client with moderate hypertension

    • C. 

      The adult client with peptic ulcer disease

    • D. 

      The adult client with pneumonia

  • 35. 
    The nurse monotors for which acid base imbalance in a claint who has acute pancreatitis
    • A. 

      Metabolic acidosis

    • B. 

      Metabolic alkalosis

    • C. 

      Respiratory acidosis

    • D. 

      Respiratory alkalosis

  • 36. 
    The nurse assesses for acidosis in a client with which data?
    • A. 

      A serum sodium level of 130 mEq/L and peripheral edema

    • B. 

      A serum sodium level of 144 mEq/L and tachycardia

    • C. 

      A serum potassium level of 6.5 mEq/L and flacid paralysis

    • D. 

      A serum potassium level of 4.5 mEq/L and hyperactive deep tendon reflexes

  • 37. 
    The hand grasps of a client with acidosis have diminshed since the previous assessment 1 hour ago. what is the nurses best first action
    • A. 

      Assessing the client rate, rhythm, and depth or respiration

    • B. 

      Measuring the clients pulse and blood pressure

    • C. 

      Documenting the findings as the only action

    • D. 

      Notifying the physician

  • 38. 
    In evaluating the electrocardiogram (ECG) in a client with acidosis, the nurse correlates which ECG change to effectiveness of therapy,
    • A. 

      Small U wave

    • B. 

      Heart rate decreases to 62 beats/min

    • C. 

      T waves present, 2 mm high

    • D. 

      P wave preceding the QRS complex

  • 39. 
    The client has the following arterial blood results; pH 7.12; HCO3-22mEQ/l;PCO2,65 mm Hg; PO2 56 mm Hg. The nurse correlates these values to which clinical situtation
    • A. 

      Diabetic ketoacidosis in a person with emphysema

    • B. 

      Complete tracheal obstruction related to aspiration of a hot dog

    • C. 

      Anxiety induced hyperventilation

    • D. 

      Diarrhea for 36 hours

  • 40. 
    Which client will the nurse assess for potential metabolic acidosis
    • A. 

      A client admitted after collapsing during a marathon run

    • B. 

      A young adult following a carbohydrate free diet

    • C. 

      An older adult with asthma

    • D. 

      An older client who takes sodium bicarbonate for gastroesophageal reflux disease reflux disease (GERD)

  • 41. 
    The nurse interprets which arterial which arterial blood gas values are partially compensated metabolic acidosis
    • A. 

      Ph 7.28 hco3-19 meq/l pco2 45 mm hg po2 96 mm hg

    • B. 

      Ph 7.45 hco3-22 mEq/l pco2 40 mm Hg po2 98 mm hg

    • C. 

      Ph 7.32, hco3-17 mEq/L PCO2 25 mm Hg po2 mm Hg

    • D. 

      Ph 7.48 hco3 -28 mEq/L pco2 45 mm hg po2 92 mm hg

  • 42. 
    The client has just experienced a 90 second grand mal seizure and has these arterial blood gas values ph 6.88 hco3-22mEq/L, PCO2 60 mm Hg, po2 50mm HG how will the nurse intervene
    • A. 

      Applying oxygen by mask or nasal cannula

    • B. 

      Applying a paper bag over the clients nose and mount

    • C. 

      Administering 50 ml of sodium bicarbonate intravenously

    • D. 

      Administering 50ml of 20% glucose and 20 units of regular insulin

  • 43. 
    The nurse teaches the client which intervention to decrease risk for the development of metabolic acidosis
    • A. 

      Increase you intake of milk to at least three glasses daily

    • B. 

      Be sure to eat three well balanced meals and a snack daily

    • C. 

      Avoid taking pain medication and an antihistamine at the same time

    • D. 

      Restrict your use of sodium by not adding salt your food during meals

  • 44. 
    The nurse recognizes which client most at risk for the development of acute respiratory acidosis?
    • A. 

      An adult with allergic rhinitis and sinusitis

    • B. 

      A young adult with type 1 diabetes and urinary tract infection

    • C. 

      An older adult with emphysema who is undergoing nasogastric tube (NG) tube suctioning

    • D. 

      A man on mechanical ventilation and tidal volume set at 500 ml

  • 45. 
    The nurse correlates which condition to the following arterial blood gas values; pH 7.48, HCO3 -22mEq/L pco2 28 mm hg, PO2 98 mm Hg
    • A. 

      Diarrhea for 36 hours

    • B. 

      Anxiety induced hyperventilation

    • C. 

      Complete tracheal obstruction suffered as a result of aspirating a hot dog

    • D. 

      Diabetic ketoacidosis as a result of a urinary tract infection in a person with long standing emphysema

  • 46. 
    The nurse monitors for which acid base imbalance in the client who has recieved six units of packed red blood cells in the past 6 hours secondary to blood loss in surgery
    • A. 

      Metabolic alkalosis

    • B. 

      Metabolic acidosis

    • C. 

      Respiratory alkalosis

    • D. 

      Respiratory acidosis

  • 47. 
    The nurse correlates which arterial which arterial blood gas values as consistent with fully compensated respiratory acidosis?
    • A. 

      Ph 7.28 HCO3-12 MEQ/L,PCO2 45MM HG,PO2 96 MM HG

    • B. 

      PH 7.32 HCO3, -17 MEQ/L,PCO2 25 MM HG PO2 98MMHG

    • C. 

      PH 7.35 HCO3 -36 MEQ /L PCO2 65 MMHG, PO2 78 MM HG

    • D. 

      PH 7.48 HCO3 -12 MEQ/L. PCO2 35 MMHG PO2 85 MM HG

  • 48. 
    The nurse recognizes which client as at greatest risk for alkalosis?
    • A. 

      An adult client with a critical illness receiving total parenteral nutrition

    • B. 

      An adult client with type 1 diabetes, once daily insulin therapy

    • C. 

      A middle aged client with metastatic breast cancer on continuous IV morphine

    • D. 

      An older client with occupation induced asthma using an adrenergic agonist inhaler

  • 49. 
    Which assessment finding should the nurse expect in the client with salicylate poinsioning?
    • A. 

      Increased deep tendon reflexes

    • B. 

      Increased rate and depth of respiration

    • C. 

      Decreased capillary refill

    • D. 

      Decreased intestinal motility and paralytic ileus

  • 50. 
    In the client with prolonged fever, the nurse correlates this to which acid-base imblanace?
    • A. 

      Fever causes vasoconstriction, leading to decreased bicarbonate production

    • B. 

      Fever induces dehydration and hyperkalemia, resulting in a compesatory movement of hydrogen ions and metabolic alkalosis

    • C. 

      Fever increases the rate of metabolism, causing a metabolic acidosis by increasing the rate of carbon dioxide production

    • D. 

      Fever dries the pulmonary mucous membranes, impairing gas exchange and causing a respiratory alkalosis

  • 51. 
    Which statement by the client indicates the need for further teaching regarding an increased risk for metabolic alkalosis
    • A. 

      I dont drink milk because it gives me gas and diarrhea

    • B. 

      I have been taking digoxin every day for the last 15 days

    • C. 

      I take sodium bicarbonate after every meal to prevent heartburn

    • D. 

      In hot weather, I sweat so much that I drink six glasses of water each day

  • 52. 
    The client with chronic respiratory acidosis who is receiving oxygen by nasal cannula at 6 /L min now has a  respiratory rat of 8 breaths/min. what is the nurses best action?
    • A. 

      Documenting the observation as the only action

    • B. 

      Changing the nasal cannula to an oxygen mask

    • C. 

      Placing the client in a high Fowler position

    • D. 

      Decreasing the oxygen flow rate

  • 53. 
    Which acid base imbalance should the nurse be most alert for when providing care to a client who has several broken ribs?
    • A. 

      Respiratory alkalosis from anxiety

    • B. 

      Respiratory acidosis from inadequate ventilation

    • C. 

      Metabolic acidosis from calcium loss from broken bones

    • D. 

      Metabolic alkalosis from ingestion of base containing analgesics

  • 54. 
    The nurse prepares to administer bicarbonate intravenously to the client with which clienical manifestions
    • A. 

      Ph7.28 hco3 -22meq/l pco2 52 mm Hg, Ppo2 82 mm Hg secondary to an asthma attack

    • B. 

      Ph 7.28 hco3-16 mEq/L, pco2 98 mm Hg secondary to excessive diarrhea

    • C. 

      Client with chronic emphysema and bronchitis who has the following arterial blood gases ph 7.30 hco3 -30 mEq/L PCo2 60 mm HG po2 72 mm Hg secondary to chronic bronchitis and emphysema

    • D. 

      Ph7.31 hco3 -20 meq/l pco2 60 mm hg po2 96 secondary to a urinary tract infection and type 2 diabetes

  • 55. 
    The nurse assess for which electrolyte disorder in the client with metabolic alkalosis?
    • A. 

      Hyponatremia

    • B. 

      Hypomagnesemia

    • C. 

      Hypokalemia

    • D. 

      Hypocalcemia

  • 56. 
    The family of a client with a mixed respiratory and metabolic acidosis secondary to bronchitis and diabetic ketoacidosis aks the nurse whether the clients confusion is likely permenant. what is the nurses best response
    • A. 

      It is too early to tell if t he ketoacids will cause permanent changes

    • B. 

      Yes, although her memory w ill improve with time, some breain cell loss has occurred

    • C. 

      Probably not, The confusion s hould clear as soon as her oxygen and electrolyte levels are normal

    • D. 

      Probably not, the confusion should clear as soon as her pH and blood glucose levels are normal.

  • 57. 
    The nurse includes which statement in the discharge teacing for a client who is going home and continues to be at risk for the development of metabolic alkalosis
    • A. 

      Avoid excess use of antacids

    • B. 

      Increase your intake of milk to at least three glasses daily

    • C. 

      Avoid aspirin and aspirin-containing over the counter medications

    • D. 

      Restrict your use of sodium by not adding salt to your food du ring meals.

  • 58. 
    The nurse monitors which electrolyte level in the client with any t ype of acid base imbalance?
    • A. 

      Sodium

    • B. 

      Calcium

    • C. 

      Potassium

    • D. 

      Magnesium

  • 59. 
    The nursing monitors for which electrolyte value in the client with acidosis
    • A. 

      Sodium 154 mEq/L

    • B. 

      Potassium 5.8 meq/L

    • C. 

      Calcium 8.9 mg.dl

    • D. 

      Magnesium 2.1 mg/dl

  • 60. 
    In the client with alkalosis, the nurse assesses for which clinical manifestations (Select all the apply)
    • A. 

      Positive Chvosteks sign

    • B. 

      Positive Trousseau's sign

    • C. 

      Hyporeflexia

    • D. 

      Bradycardia

    • E. 

      Elevated blood pressure

    • F. 

      Elevated urinary output

  • 61. 
    With which are the followin gfactors, conditions, or pathologies most commonly associated? A. respiratory acidosis B. metabolic acisosis C. Both respiratory and metabolic acidosis D. Neither respiratory  nor metabolic acidosis ____ Hyperkalemia ____ decreased bicarbonate ____ elevated PaO2 ____ elevated PaCO2 ____ Increased concentration of hydrogen ions ____ increased binding of drugs to plasma proteins
  • 62. 
    The nurse is car ing for a client who is being disch arged following surgery for oral cancer.  Which sign will the clien t be instructed to watch for that indicates possible metastasis of the cancer?
    • A. 

      Fragile gums that bleed easily

    • B. 

      White patches on the tongue and back of the throat

    • C. 

      Painful ulcerated lesions on the gums or inside of the cheek

    • D. 

      Small hard lumps on the side of the neck or under the chin

  • 63. 
    The nurse is caring for a female client who has just undergone exsision of a parotid gland tumor. the client tells the nurse that she is experiencing facial weakness on the operati ve side. W hich is the nurses best response?
    • A. 

      You may be experiencing a slight stroke, and I will notify the doctor

    • B. 

      This is a temporary condition that will resolve once radiation treatment is be gun

    • C. 

      You are experiencing weakness because the facial nerve was damaged during surgery

    • D. 

      You probably have a pinched nerve after lying on the operating room table for so long.

  • 64. 
    The nurse is caring for a c l ie nt w ho is re ceiving radiation therapy for treatment for oral cancer. The client complains of a constant dry mouth.  wh ich is the nurses best response?
    • A. 

      Massage the area just over the lower jaw twice a day

    • B. 

      Use lemon and glycerin swabs to clean your mouth and help keep it moist

    • C. 

      Suck on lemon slices to help increase saliva production

    • D. 

      Rinse your mouth out often with saline or cool water.

  • 65. 
    The nurse is caring for a client who has just received a diagnosis of advanced oral cancer and learned that he will need to have a glossectomy with jaw resection. He states to the nurse, I would rather die that have half of my face removed. My life is over. which is the  best description of the clients response to the diagnosis
    • A. 

      The client is ready to die

    • B. 

      The client is in grief over the diagnosis

    • C. 

      The client has accepted his diagnosis

    • D. 

      The client is in denial about the diagnosis

  • 66. 
    The nurse is caring for a client who has just recieved a diagnosis of advanced oral cancer that will require extensive surgery. Which statement by the client indicates that he has accepted his diagnosis
    • A. 

      The biopsy test results will be double checked next week

    • B. 

      Of all the rotten things to happen to me now, I have cancer on top of it all

    • C. 

      Oif I can just live long enough to see my son get married, everything will be OK

    • D. 

      I don't like it, but I have cancer and that's the way it is

  • 67. 
    The nurse is caring for a client who has just had a radical jaw and neck resection. The  nurse is developing a teaching plan for the client and his wife avout care after discharge from the hopsital. Which is an effective teaching objective for this client and his wife
    • A. 

      The client wife will be able to change the clients t racheostomy ties correctly after three teaching sessions

    • B. 

      The client and his wife will verbalize the signs of readiness for oral feedings following placement of the tracheostomy

    • C. 

      The clients wife will correctly administer the clients tube feedings twice a daily

    • D. 

      The client and his wife will understand incision care and the importance of infections prevention

  • 68. 
    The nurse is caring for a client who has just had a radical jaw and neck resection for oral cancer. The  nurse has just completed teaching for the wife and the client about tracheostomy care. Which notation in the clients chart is the most accurate documentation fo the teaching that has occured.
    • A. 

      The client and his wife were instructed regarding management of mucous plugs and thick secretions

    • B. 

      Information about home oxygen therapy and equiptment was provided for the client and his wife

    • C. 

      The client and his wife were shown how to suction the trachestomy and change the ties

    • D. 

      Correct suctioning procedure was demonstrated and the clients wife was able to list four signs that indicate a need to suction the tracheostomy

  • 69. 
    The nurse is caring for client who will be going home following a radical jaw and neck resection. The cleints wife will be the primary caregiver at home and will need to care for the cleints feeding tube and tracheostomy. which skill is the highest priority for the nurse tot reach the clients wife before discharge from the hospital?
    • A. 

      Monitoring the incision ,lines for infection or leakage of saliva

    • B. 

      Assisting the client for readiness to resume oral feedings

    • C. 

      Cleaning the tracheotomy and suctioning as needed

    • D. 

      Administering tube feedings and cleaning the feeding tube site

  • 70. 
    The wife of a cleint has just completed tracheostomy care for the first time, with minimal assistance fromt he nurse. Which statement offers teh most constructie feedback from the nurse
    • A. 

      I see that you had a tough time, bur you will do better with practice

    • B. 

      You were able to clean the inner cannula very well, Now, what you need to do is practice changing the tracheotomy ties

    • C. 

      You seem to have has a tough time because it was your first attempt

    • D. 

      You seem to understand what I said, is there anything else I can helop you with.

  • 71. 
    The nurse  is caring for a claient who has just completed treatment for basal cell carcinoma on his lip. The cleint says tot he nurse. Cigarrettes are ruining my life. Ill do anything to quit smoking. what is the nurses best response
    • A. 

      Here is some information about smoking cessation programs in the area

    • B. 

      Here are some pamphlets that show the financial benefits of quitting smoking

    • C. 

      If you quit smoking, your risk for developing cancer again will decrease dramatically

    • D. 

      Your chest x-ray is still clear so you could prevent permanent lung damage if you quit smoking now

  • 72. 
    Which statment by the client's family indicates that additional discharge teaching is needed about care after radical neck dissection
    • A. 

      The american cancer society can help MOM find a support group in the area.

    • B. 

      The social worker will help arrange for delivery for Mom's tube feeding supplies

    • C. 

      The case manager will come by every day to check on how Mom's incisions is healing

    • D. 

      The home care nurse will make sure that wer are taking care of Mom's tracheostomy correctly

  • 73. 
    Which client statement indicates that the nurse was successful in teaching cleints about methods to decrease the risk of developing mouth cancer
    • A. 

      I will chew tobacco rather than smoking it

    • B. 

      I will use sugar rather than artificial sweeteners

    • C. 

      I will use lip balm that contains sunscreen regularly

    • D. 

      I will use a tanning salon rather than sunbathing at the beach

  • 74. 
    The nurse is caring for a cleint who will be taking Mycostatin (nystatin) for treatment of oral candidiasis. Which instructions will the nurse provide for the client before administering the medicaiton.
    • A. 

      Let the tablet dissolve slowly in your mouth

    • B. 

      Take the medicine with a snack or a light meal

    • C. 

      Swallow the pills whole, followed by a full glass of water

    • D. 

      Swish the liquid around your mouth for a minute before swallowing it

  • 75. 
    The nurse is caring for a client who has undergone a  radical jaw and neck resection. The cleint tells the nurse that the area feels very swollen and painful. Which is the best intervention for the nurse to make this client more comfortable
    • A. 

      Suction the clients mouth and airway frequently

    • B. 

      Apply warm moist compresses to the area

    • C. 

      Elevate teh head of the clients bed 30 degrees

    • D. 

      Administer Ibuprofen (Motrin) mg every 6 hours around the clock

  • 76. 
    The nurse is caring for client who will be undergoing a radical jaw and throat resection for oral cancer. Which statement by the client indicates that further teaching is needed?
    • A. 

      I will have a temporary tracheostomy placed for three days after the surgery

    • B. 

      I will not be able to get out of bed for three days after the surgery

    • C. 

      The doctor will put in a feeding tube for nutrition until I can swallow and eat

    • D. 

      My speech my be slurred for a long time after the surgery

  • 77. 
    The nurse is caring fora  cleint who has just undergone surgery for oral cancer. Which direction will the nurse include for the client to assist in clearing his airway
    • A. 

      Inhale deeply and cough immediately afterword

    • B. 

      Flex your head forward slightly; cough inhale and repeat

    • C. 

      Sit with your neck craned back; inhale and cough twice

    • D. 

      Take several deep breaths, hod for two seconds and then cough twice

  • 78. 
    The nurse is caring for a client who has just undergone surgery for oral cancer. Which nursing diagnosis is the highest priority for this client?
    • A. 

      Ineffective airway clearance

    • B. 

      Impaired oral mucous membranes

    • C. 

      Disturbed body image

    • D. 

      Impaired comfort

  • 79. 
    Which statement concerning the risk of oral cancer made by a client during a routine physical examination indicates that further teaching is needed.
    • A. 

      I will brush my teeth and floss regularly

    • B. 

      I will begin a smoking cessation program

    • C. 

      I can still use chewing tobacco since I stopped smoking

    • D. 

      I will limit my intake of alcoholic beverages

  • 80. 
    Which statement will be included in the nurses teachinf about oral care for the client with stomatitis
    • A. 

      Rinse your mouth out twice a day with mouthwash

    • B. 

      Clean your mouth three times a day with a gentle foam sponge

    • C. 

      Use lemon glycerin swabs to clean your mouth after meals and at bedtime

    • D. 

      Suck on ice cubes to minimize the discomfort

  • 81. 
    The nurse is performing oral health scrreenings at a local community center. Which cleints are at higher risk for developing oral cancer (Select all that apply)
    • A. 

      A female who has taken oral contraceptives for the last four years

    • B. 

      An adult male with a history of alcoholism

    • C. 

      An adult female who eats spicy food regularly

    • D. 

      A middle aged male who smokes a pipe

    • E. 

      An older adult male who wears dentures

    • F. 

      64 year old female who chews gum frequently

  • 82. 
    What is th epH range of the distal espohagus
    • A. 

      1.5-2.0

    • B. 

      3.0-4.5

    • C. 

      4.5-6. 4.5-6.0

    • D. 

      6.0-7.0

  • 83. 
    Which is an elplanation of conditions that foster esophageal reflux
    • A. 

      Decreased lower esophageal sphincter(LES) tone

    • B. 

      Spasms of the lower esophageal sphincter

    • C. 

      Tensing of the upper esophageal sphincter

    • D. 

      Decreased intra abdominal pressure

  • 84. 
    Which characteristic puts a client at risk for gastroesphageal reflux disease?
    • A. 

      Drinking decaffeinated beverages

    • B. 

      Losing weight

    • C. 

      Taking oral hypoglycemic agents

    • D. 

      Nasogastric tube

  • 85. 
    A client with esophageal reflux who experiences regurgitation whlie lying flat is at risk for which complication
    • A. 

      Auscultating lungs for crackles

    • B. 

      Inspecting the oral cavity

    • C. 

      Palpating the cervical lymph nodes

    • D. 

      Culturing the throat for bacterial infection

  • 86. 
    Which client response to the Bernstein test would confirm the diagnosis of esophagitis?
    • A. 

      Dysphagia during the test

    • B. 

      Heartburn during the test

    • C. 

      No symptoms during the test

    • D. 

      Painful swallowing during the test

  • 87. 
    Which is the most accurate method of diagnosing gastroesophageal reflux disease (GERD)
    • A. 

      Endoscopy

    • B. 

      Schilling test

    • C. 

      24 hour ambulatory pH monitoring

    • D. 

      Stool testing for occult blood

  • 88. 
    The nurse should assess for which complication in a cient with Barrett's esophagus who is complaining of dysphasia.
    • A. 

      Achalasia

    • B. 

      Esophageal stricture

    • C. 

      Paraesophageal hernia

    • D. 

      Oropharyngeal dysphagia

  • 89. 
    Which teaching is a priority for t he client with gastroesophageal reflux
    • A. 

      Eat four to six meals each day

    • B. 

      Eat a small evening snack 2 to hours before bed

    • C. 

      Drink carbonated beverages between meals only

    • D. 

      You may include orange or tomato juice with your breakfast

  • 90. 
    Which instruction will the nurse give the client to prevent nighttime reflux
    • A. 

      Sleep in the right lateral decubitus position

    • B. 

      Have a light evening snack before bedtime

    • C. 

      Have alcoholic beverages early in the evening

    • D. 

      Elevate the head of the bed 6-8 inches for sleep

  • 91. 
    A client with severe GERD id still having symptoms of reflux despite takeing omeprazole, (Prilosec) 20 mg daily. what will the nurse do next?
    • A. 

      Document the finding as the only action

    • B. 

      Obtains an order for omeprazole twice daily

    • C. 

      Instruct the client to stop the medication immediately

    • D. 

      Instruct the client to take an antacid in addition to the omeprazole

  • 92. 
    When initiating treatment for GERD with metoclopramide (Reglan) what is the essential for the nurse to teach the client?
    • A. 

      Take this medication 60 minutes before each meal

    • B. 

      This medication will promote healing of espohageal tissue if taken at regular intervals

    • C. 

      This medication can make you feel tired

    • D. 

      This medication can cause abdominal cramping and diarrhea

  • 93. 
    A client who has undergone Nissen fundoplication for GERD is ready for discharge home. which statement made by the client indicates understanding of the disease?
    • A. 

      I will no longer need any medication

    • B. 

      I will avoid spicy foods because they can irritate the suture line

    • C. 

      I should take antireflux medications when I eat a large meal

    • D. 

      I will need to continue to watch my diet and take my medications

  • 94. 
    Which symptom indicates a need for immediate intervention in the client with a rolling hernia
    • A. 

      Reflux

    • B. 

      Vomiting

    • C. 

      Pneumonia

    • D. 

      Obstruction

  • 95. 
    Which statement indicates that the client understands the management of his or her hiatal hernia?
    • A. 

      I will lie flat for 30 minutes after each meal

    • B. 

      I will remain upright for several hours after each meal

    • C. 

      I will have my blood count done in 2 weeks to cheek for anemia

    • D. 

      I will sleep at night lying on my left side to prevent nighttime reflux

  • 96. 
    Which is the first intervention that the nurse will take for the client post-sliding hernia repair to prevent complications
    • A. 

      Range of motion exercises to the lower extremities

    • B. 

      Elevation of the head of the bed to 30 degrees

    • C. 

      Monitoring of input and output

    • D. 

      Assessment of bowel sounds

  • 97. 
     client who has undergone a fundoplication wrap for hernia repair has returned from the postanesthesia care  unit with a nasogastric tube draining dark brown fluid. which is the nurses priority action
    • A. 

      Assessing the placement of the tube

    • B. 

      Documenting the finding and continuing to monitor

    • C. 

      Clamping the nasogastric tube for 30 minutes

    • D. 

      Irrigating the nasogastric tube with normal saline

  • 98. 
    Which statement in the client postfundoplication indicates a need for additional dietary teaching
    • A. 

      I should eat three meals a day

    • B. 

      I will drink only decaffeinated coffee

    • C. 

      I can begin oral intake by taking only clear fluids

    • D. 

      I must eliminate carbonated beverages from my diet

  • 99. 
    A client who has undergone  a fundoplication wrap for hernia repair is preparing for discharge. which intervention is  essential for the nurse to include in discharge instructions.
    • A. 

      Avoid taking stool softeners

    • B. 

      Eat three normal sized meals daily

    • C. 

      Notify your physician if you develop symptoms of a cold

    • D. 

      Return to your former level of activity as soon as you are discharged

  • 100. 
    A client is admitted who progressive dypshagia. which assessment finding does the nurse expect in this client
    • A. 

      Headaches

    • B. 

      Weight loss

    • C. 

      Breathing difficulty

    • D. 

      Esophageal varices

  • 101. 
    A client 2 hours post-esophageal dilation developes chest and shoulder pain. which is the best action of the nurse?
    • A. 

      Administering an analgesic

    • B. 

      Documenting the finding as the only action

    • C. 

      Repositioning the client

    • D. 

      Further assessing the client for perforation

  • 102. 
    Which factor would place a cleint at risk for esophageal cancer
    • A. 

      A high stress occupation

    • B. 

      A preference for high fat foods

    • C. 

      A 20 pack year smoking history

    • D. 

      A history of myocardial infarction

  • 103. 
    The nurse is performing an assessment of a cleint with suspected esophageal cancer. which statement made by the client is indicative of advanced disease
    • A. 

      I have difficulty swallowing solids, particularly meat

    • B. 

      I usually have a sticking feeling in my throat

    • C. 

      I have difficulty swallowing soft foods

    • D. 

      I have difficulty swallowing liquids

  • 104. 
    Which is the priority intervention in the care of a cleint with esphageal cancer?
    • A. 

      Maintaining nutritional intake

    • B. 

      Allowing grieving

    • C. 

      Preventing aspiration

    • D. 

      Managing pain relief

  • 105. 
    A client with esophageal cancer and dysphagia states that it has become more difficult to swallow, and the client has experienced several choking epsiodes during meals. which strategy would the nurse recommend to assist this client in obtaining adequate nutrition?
    • A. 

      Monitor caloric intake

    • B. 

      Instruct the client to drink only clear liquids

    • C. 

      Tell the client that artificial feeding will now be required

    • D. 

      Encourage the client to eas semisoft foods and thickened liquids

  • 106. 
    Which finding alerts the nurse to a possible complication in a client whith esophageal cancer receiving radiation therapy
    • A. 

      Redness of the skin at the site of radiation

    • B. 

      Worsening of dysphagia or odynophagia

    • C. 

      Development of nausea or vomiting

    • D. 

      A profound feeling of tiredness

  • 107. 
    A client has undergone an esophagogastrostomy for cancer of the esophagus. how will the nurse best support the client's respiratory status?
    • A. 

      Assessing the client's breath sounds every 4 hours

    • B. 

      Performing chest physiotherapy every 6 hours

    • C. 

      Maintaining the client in a supine position

    • D. 

      Administering analgesia regularly

  • 108. 
    The nurse notes frank red blood in the drainage container from the nasogastric (NG) tube of a client who is 2 days postesophagogastrostomy. which is the nurses priority intervention
    • A. 

      Irrigating the NG tube

    • B. 

      Documenting the drainage

    • C. 

      Repositioning the tube in the opposite nostril

    • D. 

      Notifying the physician that the suture like is bleeding

  • 109. 
    Which discharge teacing is essential for the client who is postesophagogastrostomy?
    • A. 

      Eat only three meals daily

    • B. 

      Lie flat after meals to prevent vomiting

    • C. 

      Drink fluids between, rather that with meals

    • D. 

      Avoid high protein foods because they are irritating

  • 110. 
    A client is admitted with a chemical injury tot he esophagus after ingestion of alkaline substances the nurse assesses for which potiental complication.
    • A. 

      Infection

    • B. 

      Stricture

    • C. 

      Aspiration

    • D. 

      Perforation

  • 111. 
    Which is the primary nursing intervention for a client with early esophageal cancer?
    • A. 

      Nutritional support

    • B. 

      Pulmonary toileting

    • C. 

      Fluid and electrolyte balance

    • D. 

      Therapeutic treatments

  • 112. 
    The nurse is obtaining the history of a client with a sliding hernia. Which of the following symptoms would the nurse expect to see in this client. (select all that apply)
    • A. 

      Reflux

    • B. 

      Bleeding

    • C. 

      Dysphagia

    • D. 

      Belching

    • E. 

      Breathlessness

    • F. 

      Vomiting

  • 113. 
    Which intervention can the nurse delegate to unlicensed personnel when carring for a client with espohageal cancer (Select all that apply)
    • A. 

      Maintaining intake and output

    • B. 

      Maintaining calorie count

    • C. 

      Administering tube feeding

    • D. 

      Assessing the vital signs

    • E. 

      Teaching changes in daily activities

    • F. 

      Changing incision dressing

  • 114. 
    Which referrals will the nurse make for an older adult client being discharged with esophageal cancer(select all that apply)
    • A. 

      IV infusionist

    • B. 

      Home health aide

    • C. 

      Medicare of medicaid

    • D. 

      Meals on wheels

    • E. 

      Housecleaning service

    • F. 

      Transportation to and from treatment

  • 115. 
    The nurse is caring for a client who is at risk for developing gastritis. which finding from the clients history leads the nurse to this conclusion?
    • A. 

      The client is lactose-intolerant and cannot drink milk

    • B. 

      The client recently traveled to Mexico and South America

    • C. 

      The client works at least 60 hours per week in a stressful job

    • D. 

      The client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain.

  • 116. 
    The nurse is caring for a client with a gastric ulcer who suddenly devolps sharp mid-epigastric pain. the nurse notes that the clients abdomen is fard and very tender to light palpation. which is the priority action of the nurse.
    • A. 

      Placing the client in a knee-chest position

    • B. 

      Preparing the client for emergency surgery

    • C. 

      Inserting a nasogastric tube to low intermittent suction

    • D. 

      Administering morphine 2mg IV as ordered by the physician

  • 117. 
    The nurse is caring for a client with peptic ulcer disease. the client vomits a large amount of undigested food after breakfast. which intervention will the nurse prepare to do for the client?
    • A. 

      Administer a soap suds cleansing enema

    • B. 

      Change the clients diet to clear liquids

    • C. 

      Insert a nasogastric (NG) tube to low intermittent suction

    • D. 

      Administer prochlorperazine (Compazine) 10 mg IM

  • 118. 
    The home care nurse is caring for a client who has recently undergone a Billroth II operation. The nurse notes that the client's tongue is shiny an dbeefy red. Which assessment question should the nurse ask the client regarding this finiding?
    • A. 

      Min every day

    • B. 

      How much weight have you lost since your surgery

    • C. 

      Have you been experiencing heartburn or nausea after eating

    • D. 

      What kind of mouthwash do you use after you brush your teeth

  • 119. 
    The nurse is providing discharge teaching for a client who has peptic ulcer disease caused by Helicobacter pylori infection. Which statement by the clients indicates that additional teaching is needed
    • A. 

      I will avoid drinking coffee, even if it is decaffeinated

    • B. 

      I will take a multivitamin every morning with breakfast

    • C. 

      I will go to my tai chi class to wind down after a busy day

    • D. 

      I will take my medication every day until my heartburn is gone

  • 120. 
    The nurse is teaching a health promotion class about preventing cancer. Which statement by the student indicates understanding of gastric cancer development
    • A. 

      I should skip my morning bacon and egg sandwich to reduce my risk of gastric cancer

    • B. 

      I have been lactos-intolerant for many years, so I sh ould have a yearly test for gastric cancer

    • C. 

      Ted coffee to reduce my risk of gastric cancer

    • D. 

      I am at low risk for developing gastric cancer because I am a vegetarian and i only eat organic produce

  • 121. 
    The nurse is caring for a client with complaints of epigastric pain and nausea. Which assessment finding leads the nurse to conclude that the client problem is chronic rather than acute.
    • A. 

      Low-grade fever and loose tarry stools

    • B. 

      Low of appetite and abdominal bloating

    • C. 

      Lactose intolerance and hypoalbuminemia

    • D. 

      Macrocytic, normochromic anemia and tachycardia

  • 122. 
    The nurse is caring for a cleint with acute gastritis, the client asks the nurse how to prevent getting gastritis again. which is the nurses best response
    • A. 

      Join a support group to help you stop smoking

    • B. 

      Take a multivitamin with iron and folic acid every day

    • C. 

      Make sure to include plenty of fiber and fresh vegetables in your diet

    • D. 

      Make sure that your weight stays within normal limits for your height

  • 123. 
    The nurse is caring for a male client with peptic ulcer disease. which assessent indicators to the nurse that the client most likely has an ulcer in the stomach rather than the duodenum
    • A. 

      The clients body mass index (BMI) is 17.6

    • B. 

      The client's stool is positive for occult blood

    • C. 

      The client has had four ulcers in the last 5 years

    • D. 

      The client's hemoglobin in 13bg/L and hematoctit is 43%

  • 124. 
    The nurse is caring for a client who has been brought to the emergency room with upper GI bleeding. The client is unconscious and requires lavage to stop the bleeeding. which is the nurses priority action?
    • A. 

      Preparing to intubate the client with an endotracheal tube

    • B. 

      Inserting a 20 guage IV and starting a normal saline IV infusion

    • C. 

      Obtaining a 14 French nasogastric tube and iced normal saline for the procedure

    • D. 

      Setting up the suction unit with collection canister and medium intermittent suction

  • 125. 
    The nurse is caring for a client who has just arrived in the emergency room with complaints of epigastric pain. The client reports that an emesis earlier in the day looked like coffee grounds. What will the nurse prepare to do for the client first.
    • A. 

      Check the clients stool for occult blood

    • B. 

      Insert an 18 gauge IV line with a normal saline infusion

    • C. 

      Insert a nasogastric tube and prepare for gastric lavage

    • D. 

      Determine if the client has been takint NSAID's or has a history of ulcers

  • 126. 
    The nurse is caring for a client who presents with chronic epigastric pain, heartburn, and anorexia. the client asks the nurse how the doctor can best determine if the symptoms are caused by gastritis. which is the nurses best response.
    • A. 

      You will be asked to drink barium solution while x-rays are taken of your stomach

    • B. 

      The doctor will take a look inside your stomach using a tube with a light on the end of it.

    • C. 

      A CT scan of your abdomen will shoe if there is inflammation present in your stomach

    • D. 

      A blood sample will be sent to the laboratory to determine if you have stomach infection or bleeding

  • 127. 
    The nurse is caring for a client with congestive heart failure and chronic gastritis. The client tells the nurse that he takes 2 teaspoons of sodium bicarbonate every night before bed to prevent heartburn
    • A. 

      You should let your doctor know right away if you develop stomach cramps

    • B. 

      I will let you r doctor know so that a safer antacid can be prescribed for you

    • C. 

      Do not take the sodium bicarbonate with mile, because it can cause kidney stones

    • D. 

      Make sure that you mix the sodium bicarbonate with at least 8 ounces of water

  • 128. 
    The nurse is caring for a client with suspected upper GI bleeding. The nurse inserts an NG tube for gastric lavage and checks placement of the tube in the stomach. when aspirating fluid from the tube, the pH is found to be ^. which is the prioirty action of the nurse
    • A. 

      Obtaining an order for a STAT chest x-ray

    • B. 

      Asking the client to speak and auscultating over the lung fields

    • C. 

      Checking to determine if the tube is coiled in the back of the clients throat

    • D. 

      Instilling an air bolus into the tube while auscultation over the epigastric area

  • 129. 
    The nurse is caring for a client with gastritis who will undergo urea breath testing in the morning. Which instructions will the nurse provide for the client?
    • A. 

      You will need to have and IV started just before the test

    • B. 

      You should drink eight glasses of water 3 hours before the test

    • C. 

      You may not have anything to eat or drink after midnight tonight

    • D. 

      You will be given a sedative, so you will need someone to drive you home

  • 130. 
    The nurse is caring for a client who has recently undergone a Billroth II procedure. The client states that whenever he eats, he becomes dizzy and sweaty. whigh heart palpations. the client tells the nurse that he is now afraid to eat anything. which is the nurses best response
    • A. 

      You should drink at least 6 ounces of fluid before each meal

    • B. 

      You should go back to a clear liquid diet for the next few days

    • C. 

      You might be lactose intolerant now, try avoiding dairy products

    • D. 

      You should avoid eating foods that contain large amounts of sugar

  • 131. 
    The nurse is caring for a client who recently has undergone a Billroth II procedure. Two hours after eating lunch, the client becomes dizzy, diaphoretic, and confused. which is the nurses priority action
    • A. 

      Checking the client blood sugar level

    • B. 

      Increasing the client IV infusion rate

    • C. 

      Auscultating the clients bowel sounds

    • D. 

      Placing the client in high Fowler's position

  • 132. 
    The nurse is caring for a client with advanced gastric cancer who is scheduled for palliative surgery to relative gastric outlet obstruction. The client asks the nurse why he should bother having surgery because he will not be cured. Which is the nurses best response
    • A. 

      The surgery will allow the doctors to deterine more accurately how long you have to live

    • B. 

      The surgery will relieve the obstruction so you will be more comfortable and able to eat again

    • C. 

      The surgery will remove much of the tumor sos that chemotherapy will be more effective

    • D. 

      The surgery will prevent the tumor from spreading to other parts of the body

  • 133. 
    The nurse is caring for a cleint who will be discharged from the hospital following surfery for4 advanced gastric cancer. The client's daughter verbalizes the fear that she will not be able to manage her fathers symptoms adequately at home. Which is the nurse's best response?
    • A. 

      The nursing staff has taught you everything that you will need to k now about the dressing changes and medications

    • B. 

      The dressing only needs to be changed once a day and the pain pillw will keep him comfortable

    • C. 

      I will ask the social worker to arrange for a hospice nurse to help you care for your father at home

    • D. 

      I will ask the physician to review the postoperative care instructions with you again

  • 134. 
    The nurse is caring for a client who reports persistent epigastric pain, heartburn and nausea, despite faithfully taking ranitidine (Zantac) aluminum hydroxide (Amphojel) and metronidazole (Flagyl) as prescribed. Whic is the nurses best response
    • A. 

      Is your pain better or worse after you eat

    • B. 

      Have you tried elevating the head of your bed at night

    • C. 

      Have you been taking the Amphojel and Flagyl together

    • D. 

      Have you been experiencing foul smelling diarrhea lately

  • 135. 
    A client with Zollinger-Ellison syndrom will be admitted tot he medical unit. Which intervention will the nurse include in the clients nursing plan of care?
    • A. 

      Performing a urine test for ketones every morning before breakfast

    • B. 

      Performing perineal care with warm water and applying a moisture barrier twice daily

    • C. 

      Assessing the abdomen for fluid wave and shifting dullness evry 8 hours and PRNKeeping 2 units of packed red blood cells on hold, transfusing if hemoglobin

  • 136. 
    The urse is caring for a client who takes magnesium hydroxide with aluminum hydroxide (Maalox) at home to control epigastric pain. Which finding from the clients health history leads the nurse to reccomend taking aluminum hydroxide (Amphojel) instead.
    • A. 

      The client takes 81 mg of aspirin every day

    • B. 

      The client has a history of chronic constipation

    • C. 

      The client has a history of chronic kidney disease

    • D. 

      The client takes omeprazole (Prilosec) 40mg daily at bedtime

  • 137. 
      The nurse is to insert a nasogastric tube for a client with an upper GI bleeding Which instructions will the nurse give to the client before starting the procedure?                                                                                                                                                                                                                     
    • A. 

      You make take sips of water when I begin to insert the tube into your nose

    • B. 

      Please hold your breath when I insert this small tube through your nose down into your stomach

    • C. 

      Please tilt your head down toward your chest when the tube gets tot he back of your throat

    • D. 

      I will measure the distance from the end of your nose to you navel to know how far to insert the tube

  • 138. 
    The nurse is caring for a client who has recently undergone Billroth II surgery. The client asks the nurse which foods whould be best for hjm to have for breakfast. Which menu items will the nurse recommend for the client (select all that apply)
    • A. 

      Blueberry pancakes with maple syrup

    • B. 

      A half grapefruit with a blueberry muffin

    • C. 

      Whole wheat bagel with low fat cream cheese

    • D. 

      Raisin bran with milk and artificial sweetner

    • E. 

      Scrambled eggs with cheese and a slice of bacon

    • F. 

      One half cup of cottage cheese with half an apple

    • G. 

      Strawberry nonfat yogurt with a slice of whole wheat toast

  • 139. 
    The nurse is caring for a client with peptic  ulcer disease. Which intervention will be included in the nursing care plan to monitor for complications? (select all that apply)
    • A. 

      Monitor and record intake and output

    • B. 

      Monitor hemoglobin and hematocrit laboratory values

    • C. 

      Send samples of all stools to the laboratory for hemoccult testing

    • D. 

      Percuss the abdomen for shifting dullness every shift and PRN

    • E. 

      Perform iliopsias muscles test and obturator test every shift and PRN

    • F. 

      Check for positive scratch test and Murphys sign every shift and PRN

    • G. 

      Check vital signs and orthostatic blood pressure every 4 hours and PRN

  • 140. 
    TThe nurse is caring for a client who will undergo Billroth I surgery the following day. Which interventions will be included in the postoperative plan of carone for the client? ( select all that apply)
    • A. 

      Monitor and record accurate intake and output (I&O)

    • B. 

      Reposition the client in bed at least every 2 hours

    • C. 

      Remind the client to use the incentive spirometer twice daily

    • D. 

      Change abdominal dressing daily using medical asepsis

    • E. 

      Remind the client daily to use PCA before pain becomes severe

    • F. 

      Teach the client to select high carbohydrate, high protein food

    • G. 

      Irrigate the nasogastric tube with normal saline every 8 hours PRN

  • 141. 
    Which menue selections by the client with irritable bowel syndrome indicates that teaching was understood
    • A. 

      Tuna salad on white bread, cup of applesauce, glass of diet soda

    • B. 

      Broiled chicken with brown rice, tossed green salad, glass of apple juice

    • C. 

      Grilled cheese sandwich, small ripe banana, cup of hot tea with lemon

    • D. 

      Grilled steak, green beans, dinner roll with butter, cup of coffee with cream

  • 142. 
    Which assessment finding leads the nurse to check the clients abdomen for an acquired umbilical hernia
    • A. 

      The clients body mass index is 41.9

    • B. 

      The client had a cholecystectomy last year

    • C. 

      The client has a history of irritable bowel syndrome

    • D. 

      The client is taking lansoprazole (Prevacid) 30mg PO daily

  • 143. 
    The nurse notes a bulge in the clients groin that is present whent he client stands and dissappears when the client lies down. Which conclusion does the nurse draw from the assessment findings
    • A. 

      The client has a reducible inguinal hernia

    • B. 

      The client has an indirect umbilical hernia

    • C. 

      The client has a strangulated ventral hernia

    • D. 

      The client has an incarcerated femoral hernia

  • 144. 
    The nThe nurse is caring for a client with an unbilical hernia who complains of abdominal pain, nausea, and vomiting. The nurse notes hypoactive, high pitched bowel sounds. which conclusion does the nurse draw from these assessment findings?
    • A. 

      The client has developed a bowel obstruction

    • B. 

      TA client has developed perforation of a bowel

    • C. 

      The client has developed adhesion within the hernia

    • D. 

      The client hernia has become dangerously enlarged

  • 145. 
    The nurse is teaching the client how to use a truss for a femorial hernia. Which statement by the client indicates the need for further teaching?
    • A. 

      I will put on the truss before I go to bed each night

    • B. 

      I will wear the truss over a T shirt to avoid skin irritation

    • C. 

      I will wipe the truss with a damp cloth three times a week

    • D. 

      If I have abdominal pain, I will let the doctor know right away

  • 146. 
    The nurse is providing properative teaching for a client who will have herniorrhaphy surgery. which instructions will the nurse five to the client?
    • A. 

      Eat a low residue diet for the first week after surgery

    • B. 

      Change the dressing every day until the staples are removed

    • C. 

      Take acetaminophen (Tylenol) 1000 mg every 4 hours for pain

    • D. 

      Cough and deep breath every 2 hours for the first week after surgery

  • 147. 
    The nurse is performing a physical assessment for a client who  underwent bowel resection surgery the previous day. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the destended area. which is the nurses priority action
    • A. 

      Assessing the clients vital signs

    • B. 

      Determining the last time the client voided

    • C. 

      Inserting a rectal tube to facilitate passage of flatus

    • D. 

      Documenting the expected finding in the clients chart

  • 148. 
    The nurse is screening cleints at a community health fair. which client is at the highest risk for the development of colerectal cancer
    • A. 

      A young adult who drinks eight cups of coffee every day

    • B. 

      A middle aged woman with a history or irritable bowel syndrome

    • C. 

      An older woman with a BMI of 19.2 who works 65 hours/week

    • D. 

      An older man who travels extensively and east fast food frequently

  • 149. 
    The nurse is performing a physical assessment of a client with a new diagnosis of colorectal cancer. The nurse notes the presence of visible peristaltic waves and, on auscultation hears high pitched bowel sounds. Which conclusion does the nurse draw from these findings?
    • A. 

      The clients tumor has metastasized to the liver and biliary tract

    • B. 

      The clients tumor has caused an intussusception of the intestine

    • C. 

      The client growing tumor has caused a partial bowel obstruction

    • D. 

      The client has developed toxic megacolon from the growing tumor

  • 150. 
    The nurse is caring for a client who is scheduled to have fecal occult blood testing. which instructions will the nurse give to the client.
    • A. 

      You will need to fast for 12 hours before the test

    • B. 

      You will be given a cleansing enema the morning of the test

    • C. 

      you will need to avoid eating meat for 48 hours before the test

    • D. 

      You will be sedated and will require someone to accompany you home

  • 151. 
    A client who has had fecal occult blood testing tell the nurse that the test was negative for colon cancer and wishes to cancel a colonoscopy scheduled for the next day. which is the nurses best response?
    • A. 

      I will call and cancel the test for tomorrow

    • B. 

      You will need two negative fecal occult blood tests

    • C. 

      This does not rule out the possibility of colon cancer

    • D. 

      You should wait at least a week to have the colonoscopy

  • 152. 
    The nurse is caring for a client who has been newly diagnosed with colon cancer. The client has become withdrawn from family members. Which strategy will the nurse use to assist the client at this time?
    • A. 

      Asking the physician for a psychiatric consult for the client

    • B. 

      Explaining the improved prognosis for colon cancer with new treatment

    • C. 

      Encouraging the client to verbalize feelings about the diagnosis

    • D. 

      Allowing the client to remain withdrawn

  • 153. 
    The nurse is caring for a client with colon cancer and a new colostomy. the client wishes to talk to someone with a similar experience. Which is the nurses best response
    • A. 

      Most people who have has a colostomy are reluctant to talk about it

    • B. 

      I will make a referral to the local chapter of the american cancer society

    • C. 

      You can get all the information you need from the enterostomal therapist

    • D. 

      I do not think that we have any other clients with colostomies on th eunit right now

  • 154. 
    The nurse is caring for a client who has suffered abdominal trauma in a motor vehicle crash. which laboratory finding indicates that the client's liver was injured
    • A. 

      Serum lipas, 49 U/L

    • B. 

      Serum amylase, 68 IU/L

    • C. 

      Serum creatinine 0.8 mg/dl

    • D. 

      Serum transaminase, 129 IU/L

  • 155. 
    The nurse is caring for a client who is brought to the emergency department following a motor vehicle crash. The nurse notes that the client has ecchymotic area across the lower abdomen. which is the priority action of the nurse
    • A. 

      Measuring the abdominal girth

    • B. 

      Assessing for abdominal guarding or rigidity

    • C. 

      Checking the clients hemoglobin and hematocrit levels

    • D. 

      Asking the clientif he was riding in the from or back seat of the car

  • 156. 
    The cleint tells the nurse that her husband is repulsed by her colostomy and refuses to be intimate with her after surgery. Which is the nurses best response?
    • A. 

      Lets talk to the ostomy nurse to help you and your husband work through this

    • B. 

      Ou could try to wear longer fuller lingerie that will better hide the ostomy appliance

    • C. 

      You should empty the pouch forst so that is will be less noticeable for your husband

    • D. 

      If you are not careful, you can hurt the stoma if you get intimate with your husband.

  • 157. 
    The nurse is caring for a client who just has colon resection surgery with a new colostomy. Which teaching objective will the nurse include in the clients plan of care?
    • A. 

      The client will understand colostomy care and lifestyle implications

    • B. 

      The client will learn how to change the appliance

    • C. 

      The client will demonstrate correct changing of the appliance before discharge

    • D. 

      The client will not be afraid to handle the ostomy appliance tomorrow

  • 158. 
    The nurse is caring for a client who has been diagnosed with a bowel obstruction. Which assessment finding leads the nurse to conclude that the obstruction is in the small bowel?
    • A. 

      The client's potassium is 2.8 mEq/L with a sodium calue of 121 mEq/L

    • B. 

      The client has lost 15 pounds over the last month without dieting

    • C. 

      The client reports crampy abdominal pain across the lower quadrants

    • D. 

      The client has high picthed hyperactive bowel sounds in all quadrants

  • 159. 
    The nurse is caring for a female cleint who is chronically anemic following gastric bypass surgery. the client aske the nurse why this is happenig . Which is the nurses best response
    • A. 

      Inflammation following major surgery impedes red blood cell formation

    • B. 

      The rapid weigh loss affects hormones so your periods have become much heavier since the surgery

    • C. 

      Youhave less small bowel, so essential nutrients for red blood cell formation are not being absorbed

    • D. 

      You developed a bleeding ulcer because of the stress of the surgery and weight loss

  • 160. 
    The nurse is planning discharge teaching for a client who has developed a bowel obstruction from fecal impaction. which instructions will the nurse provide to the client?
    • A. 

      Take fiber supplements every day with at least 16 ounces of water

    • B. 

      Take 2 teaspoons of castor oil every morning to prevent constipation

    • C. 

      Take 2 teaspoons of aluminum hydroxide (Amphojel) if you become constipated

    • D. 

      Avoid carbonated drinks to help prevent becoming constipated

  • 161. 
    A client with a mechanical bowel obstruction reports that the abdominal pain that was previously intermittent and colicky is now more constant. which is the priority action of the nurse?
    • A. 

      Measuring the abdominal girth

    • B. 

      Placing the client in a knee-chest position

    • C. 

      Medicating the client with an opioid analgesic

    • D. 

      Checking the abdomen for bowel sounds and rebound tenderness

  • 162. 
    The nurse is caring for a clinet who has just had hemorrhoid surgery. Which nursing intervention will the nurse include in the plan of care for the client?
    • A. 

      Having the client soak in a warm bath with chamomile

    • B. 

      Placing the client on a full liquid diet for a few days after surgery

    • C. 

      Allowing the client to spend long periods of time on the toilet for defecation

    • D. 

      Having the client clean the rectal area with moist witch hazel wipes after defecation

  • 163. 
    The nurse is caring for a client who is to recieve 5-fluirouracil (5-FU) chemotherapy IV for the treatment of colon cancer. which assessment finding leads the nurse to contact the physician and reschedule the infusion for another day.
    • A. 

      The client white blood cell counts it 3500/mm3

    • B. 

      The client is very fatigued and has a headache

    • C. 

      The client is slightly nauseated and has no appetite

    • D. 

      The client has developed a generalized itchy dermatitis

  • 164. 
    A client who has had a colonostomy placed in the ascending colon expresses concern that the effluent collected in teh colostomy pouch has remained liquid for 2 weeks after surgery. which is the nurses best response
    • A. 

      This is normal for your type of colostomy

    • B. 

      I will let the doctor know so that he can look into it

    • C. 

      You should add extra fiber to your diet to stop the diarrhea

    • D. 

      Your stool will gradually become firmer over the next few weeks

  • 165. 
    Which instructions will the nurse provide to the client who has just been prescribed oxaliplatin (Eloxatin) for the treatment of colon cancer?
    • A. 

      Do not consume more that one alcoholic drink per week

    • B. 

      Wear gloves whenever you get food out of the freezer

    • C. 

      Your urine may have an orange tinge after you start taking the medication

    • D. 

      Take the pills once a day on an empty stomach

  • 166. 
    The nurse is caring for a client who has undergone removal of benign colonic polyp. the client asks the nurse hwy a follow up colonoscopy is necessary. which is the nurses best response?
    • A. 

      You are at risk for developing more polyps in the future

    • B. 

      You may have other cancerous lesions that could not be seenright now

    • C. 

      The doctor can only remove a few of the polyps during each colonoscopy

    • D. 

      This test will ensure that healing has occured where the polyphas been removed

  • 167. 
    The nurse is helping a student prepare to insert a nasogastric tube for an adult client with a bowel obstruction. which actions by the student indicate to the nurse that a review of the procedure is needed (select all that apply)
    • A. 

      The student gathers supplies, including a 8 fr levin tube, sterile gloves, tape and water soluble lubricant

    • B. 

      The student performs hand hygiene and positions the client is a high fowlers position, with pillows behind the head and shoulders

    • C. 

      The student attaches a 60ml irrigation syringe to the end of the nasogastric tube before insertion into the nose

    • D. 

      The student instructs the client to extend the neck against the pillow once the nasogastric tube as reached the oropharynx

    • E. 

      The student checks for correct placement by checking the ph of th e fluid aspirated from the tube

    • F. 

      The student secures the nadogastric tube by taping it to the clients nose and pinning the end to the pillowcase

    • G. 

      The student connects the nasogastric tube to intermittent medium suction with an antireflux valve on the air vent

  • 168. 
    The nurse is providing discharge teaching for a client who has undergone colon resection surgery with a colostomy. which statements by the client indicate that the instruction was understood?
    • A. 

      I will change the ostomy appliance daily and as needed

    • B. 

      I will use warm water and a soft washcloth to clean around the stoma

    • C. 

      I will start bicycling and swimming again once my incision has healed

    • D. 

      I will notify the doctor right away if there is any bleeding from the stoma

    • E. 

      I will check the stoma regularly to make sure that is stays a deep red color

    • F. 

      I will avoid eating or drinking dairy products to reduce gas and odor in the pouch

    • G. 

      I will cut the flange so that it fits tightly around the stoma to avoid skin breakdown

  • 169. 
    The client is to recieve 12mg/kg of 5 fluorouracil (5-FU) chemotherapy IV treatment of colon cancer. The client weighs 132 lb. how many milligrams if 5-FU will the client recieve?___________mg
  • 170. 
    Which action will the nurse take to improve the quality of the electrocardiographic rhythm transmission to the monitoring sy stem
    • A. 

      Apply lotion tot he clients chest before attaching the chest leads

    • B. 

      Remove the hair from the chest area before attaching the chest leads

    • C. 

      Instruct the cleint not to wear any clothing made form synthetic fabrics during the test

    • D. 

      Apply skin protectant to area prior to placing electrode

  • 171. 
    The nurse correlates which pathophysiologic processes with the development of coronary artery disease(CAD)
    • A. 

      Atherosclerotic plaques cause spasms and subsequent narrowing of the coronary vessels

    • B. 

      Coronary vessels become inflamed and injured as a result of excess cholesterol and triglycerides

    • C. 

      Macrophages and T cells form a connective tissue matrix inthe vessel intima where lipids accumulate

    • D. 

      Atherosclerosis causes coronary vessels to become stiff, limiting their ability to respond to increases in blood flow

  • 172. 
    The nurse is taking the history of a client with suspected CAD who has had episodes of chest discomfort while mowing the lawn. Bescause the chest discomfort subsides when the client rests, the nurse correlates this with which condition
    • A. 

      Variant angina

    • B. 

      Stable angina

    • C. 

      Myocardial infarction

    • D. 

      Aortic aneurysm

  • 173. 
    The nurse correlates which clinical manifestation with a diagnosis of variant (Prinzmetal's angina?
    • A. 

      Chest discomfort that appears with exertion and is relieved with nitroglycerin

    • B. 

      Chest pain occuring with minimal exertion that limits the client's activity

    • C. 

      A burning sensation in the chest wall that is relieved with rest

    • D. 

      Chest pressure or tightness that radiates to the arm and jaw

  • 174. 
    The client with a history of stable angina de4scribes a recent increase in the number of attacks and the intensity of the pain. THe nurse correlates this with which condition
    • A. 

      Stable angina

    • B. 

      Unstable angina

    • C. 

      Acute myocardial infarction

    • D. 

      Subendocardial necrosis

  • 175. 
    The nurse assesses for which modifiable risk factor in the client with coronary artery disease
    • A. 

      Age

    • B. 

      Gender

    • C. 

      Smoking

    • D. 

      Family history

  • 176. 
    The nurse assesses for modifiable risk factors in the client with coronary artery disease. WHich intervention in the priority to assist the client in decreasing the risk for coronary artery disease
    • A. 

      Age

    • B. 

      Gender

    • C. 

      Smoking

    • D. 

      Family history

  • 177. 
    For which clinical manifestation of myocardial infarction should the nurse monitor in the older adult
    • A. 

      Pain on inspiration

    • B. 

      Posterior wall chest pain

    • C. 

      Disorientation or confusion

    • D. 

      Numbness and tingling of the arm

  • 178. 
    Which statement made by the client with coronary artery disease alerts the nurse that the client may be experiencing difficulty in adapting to the illness
    • A. 

      I usually wait about 2 hours after I feel chest discomfort before calling my doctor to sure it is really angina

    • B. 

      I know I will have some chest discomfort with some activities, so I carry my nitroglycerin with me

    • C. 

      Where i was in the hospital last time for my heart attack, I felt afraid

    • D. 

      I feel a little anxious whenever I get chest discomfort

  • 179. 
    Eight hours after presenting to the emergency department with complaints of substernal chest pain, a client's laboratory results demonstrate that myoglobin levels have not risen. What is the nurse's interpretation of these results
    • A. 

      The client has not experienced a myocardial infarction

    • B. 

      The client is experiencing an evolving myocardial infarction

    • C. 

      The client most likely had a myocardial infarction within the last 24 hours

    • D. 

      The client has experienced a myocardial infarction within the last 24 hours

  • 180. 
    The nurse evaluates the results of which laboratory test as a diagnostic for acute coronary syndrome in the client with unstable angina
    • A. 

      Troponin T

    • B. 

      Serum lactate dehydrogenast (LDH)

    • C. 

      Serum myoglobin

    • D. 

      Creatine Kinase (CK) -MB isoenzyme

  • 181. 
    The nurse evaluates the results of which laboratory test as a diagnostic for acute coronary syndrome in the client with unstable angina
    • A. 

      Troponin T

    • B. 

      Serum lactate dehydrogenast (LDH)

    • C. 

      Serum myoglobin

    • D. 

      Creatine Kinase (CK) -MB isoenzyme

  • 182. 
    The nurse recognizes which laboratory test as most specific in diagnosing an acute myocardial infarction
    • A. 

      Myoglobin

    • B. 

      Serum LDH

    • C. 

      CK-MB isoenzyme

    • D. 

      Troponin T