Exam 3 Practice Questions

Question 1

The male client tells the nurse he has been experiencing “heartburn” at night that awakens him. Which assessment questions should the nurse ask?

A. How much weight have you gained recently?
B. What have you done to alleviate the heartburn?
C. Do you consume many milk and dairy products?
D. Have you been around anyone with a stomach virus?

Answer 1

B

Most clients with GERD have been self-medicating with OTC medications prior to seeking medical advice. It is important to know what the client has done to help treat the problem

Question 2

The nurse caring for a client dx with GERD writes the client problem of “behavior modification.” Which intervention should be included for this problem?

A. Teach the client to sleep with a foam wedge under the head
B. Encourage the client to decrease amount of smoking
C. Instruct the client to take OTC medications for relief of pain
D. Discuss need to attend AAA meetings to stop drinking alcohol

Answer 2

A

The client should elevate the HOB on foam blocks to help gravity keep gastric acid in the stomach and to prevent reflux into esophagus. Behavior modification is changing ones behavior

Question 3

The nurse is preparing a client dx with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions?

A. I should not eat for at least 1 day following the procedure
B. I can lie down whenever I want after meals, it wont make a difference
C. The stomach contents wont bother my esophagus but will make me nauseas
D. I should avoid orange juice and tomatoes until my esophagus heals

Answer 3

D

Orange juice and tomatoes are are acidic; the client should avoid acidic foods until the esophagus has a chance to heal

Question 4

The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care?

A. Allow any of the clients favorite foods as long as the amount is limited
B. Have the client perform eructation exercises several times a day
C. Eat 4 to 6 meals a day and limit fluids during mealtime
D. Encourage the client to consume a glass of red wine with one meal a day

Answer 4

C

Clients should eat small frequent meals and avoiding drinking when eating to prevent reflux

Question 5

The nurse is caring for a client dx with GERD. Which nursing interventions should be implemented?

A. Place the client prone in bed and administer non steroidal and anti-inflammatory medications
B. Have the client remain upright at all times walk at least 30 minutes three times a week
C. Instruct the client to maintain a right lateral side lying position and take antacids before meals
D. Elevate the HOB 30 degrees and discuss lifestyle modifications with the client

Answer 5

D

HOB should be at least 30 degrees to prevent reflux. Lifestyle modifications include lose weight, dietary modifications, smoking cessation, discontinue alcohol, and do not stoop or bend at the waist

Question 6

The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD?

A. Adult-onset asthma
B. Peptic ulcer disease
C. Pancreatitis
D. Increased gastric emptying

Answer 6

A

Question 7

The nurse is administering morning medications at 0730, which medication should have priority?

A. A proton pump inhibitor
B. A nonarcotic analgesic
C. A histamine receptor agonist
D. A mucosal barrier agent

Answer 7

D

A mucosal barrier agent must be administered on an empty stomach in order to coat the stomach

Question 8

The nurse is preparing the client dx with GERD for surgery. Which information warrants notifying the HCP?

A. The clients Bernstein esophageal test was positive
B. Clients abdominal X-ray shows a hiatal hernia
C. WBC count is 14,000
D. Hemoglobin is 13.8

Answer 8

C

WBC is elevated indicating possible infection
Normal WBC = 5,000-10,000

Question 9

The charge nurse is making assignments. Staffing includes an RN with 5 years with med-surg experience, a new grad, and 2 CNAs. Which patient should be given to the nurse to the most experienced nurse?

A. 39 year old dx with lower esophageal dysfunction c/o pyrosis
B. 54 year old client dx with Barrett’s esophagus scheduled for an endoscopy this morning
C. 46 year old dx with GERD who has wheezes in all 5 lobes
D. 68 year old client 3 days post op that needs to be ambulated 4 times a day

Answer 9

C

Question 10

Which statement made by the client indicates to the nurse the client may be experiencing GERD?

A. My chest hurts when I walk up the stairs in my home
B. I take antacid tablets with me wherever I go
C. My spouse tells me I snore really loudly at night
D. I drink 6 to 7 soft drinks each day

Answer 10

B

Question 11

Which disease is the client dx with GERD at greatest risk for developing?

A. Hiatal hernia
B. Gastroenteritis
C. Esophageal cancer
D. Gastric cancer

Answer 11

C

Barrett’s esophagus is chronic exposure to acids in esophagus; pre-cancerous

Question 12

Which sign/symptom should the nurse expect find in a client dx with ulcerative colitis?

A. Twenty bloody stools a day
B. Oral temp of 102
C. Hard, rigid abdomen
D. Urinary stress incontinence

Answer 12

A

Question 13

The client dx with inflammatory bowel disease has a potassium of 3.0. What action should the nurse implement first?

A. Notify HCP
B. Assess for muscle weakness
C. Request tele monitoring
D. Prepare to admin potassium IV

Answer 13

B

Muscle weakness is a sign of hypokalemia
3.5-5.5

Question 14

The client dx with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement?

A. Provide low residue diet
B. Rest the clients bowels
C. Assess VS daily
D. Administer antacids orally

Answer 14

B

Whenever the client has an acute exacerbation of a gastrointestinal disorder, the first intervention to do is place pt on bowel rest. Client should be NPO with IV fluids to prevent dehydration

Question 15

The client dx with Crohn’s disease is crying and tells the nurse, “I can’t take it anymore. I never know when I will get sick and end up here in the hospital.” Which statement by the nurse is the best response?

A. I understand how frustrating this must be for you
B. You must keep thinking about the good things in your life
C. I can see you are very upset. I’ll sit down and we can talk
D. Are you thinking about doing anything like committing suicide?

Answer 15

C

Question 16

The client dx with Crohn’s disease, which statement by the client supports this diagnosis?

A. My pain goes away when I have a BM
B. I have bright red blood in my stool each time
C. I have episodes of diarrhea and constipation
D. My abdomen is hard and rigid and I have a temperature

Answer 16

A

Question 17

Which assessment data supports the clients dx of gastric ulcers?

A. Presence of blood in stool for the past month
B. Reports burning sensation moving like a wave
C. Sharp pain in the upper abdomen after having a heavy meal
D. Complaints of epigastric pain 30 to 60 minutes after eating

Answer 17

D

Question 18

The nurse is caring for a client dx with rule-out peptic ulcer disease. Which test confirms this diagnosis?

A. EGD
B. MRI
C. Occult blood test
D. Gastric acid stimulation

Answer 18

A

Question 19

Which specific data should the nurse obtain from the client suspected to have peptic ulcer disease?

A. Hx of side effects from all medications
B. Use of NSAIDS
C. Any known allergies to drugs and environment factors
D. Medical hx of last 3 generations

Answer 19

B

Question 20

Which assessment data indicates to the nurse the clients gastric ulcer has perforated?

A. C/o sudden, sharp, substernal pain
B. Rigid, boardlike abdomen with rebound tenderness
C. Frequent, clay colored, liquid stool
D. C/o vague abdominal pain in the RUQ

Answer 20

B

Question 21

The client with a hx of peptic ulcer disease is admitted into the ICU with frank gastric bleeding. Which priority intervention should the nurse implement?

A. Maintain strict I&O
B. Insert an NG tube and begin gastric lavage
C. Assist client with keeping detailed calorie count
D. Provide quiet environment for rest

Answer 21

B

This directly stops the bleeding

Question 22

An 85 year old client dx with cancer of the colon asks the nurse, “why did I get this cancer?” Which statement is the nurses best response?

A. Research shows lack of fiber in diet can cause colon cancer
B. It is not common to get colon cancer at your age, it usually occurs in young people
C. Nobody knows why anyone gets cancer, it just happens
D. Women usually get colon cancer more often than men but not always

Answer 22

A

Question 23

The nurse is teaching the client dx with diverticulosis, which instruction should the nurse include in the teaching session?

A. Discuss importance of drinking 1,000 ml of water daily
B. Instruct client to exercise 3x weekly
C. Teach client about eating low residue diet
D. Explain the need to have daily BMs

Answer 23

C

Question 24

The client is admitted to the medical unit with acute diverticulitis. Which health care order should the nurse question?

A. Insert an NG tube
B. Start an IV with D5W at 125ml/hr
C. Put the client on a clear liquid diet
D. But the client on bedrest

Answer 24

C

Bowel must be put on total rest, pt should be NPO

Question 25

The nurse is discussing therapeutic diet for the client dx with diverticulosis. Which meal indicates the client understands the discharge teaching?

A. Fried fish, mashed potatoes, iced tea
B. Ham sandwich, applesauce, whole milk
C. Chicken salad on whole wheat bread and water
D. Lettuce, tomato, and cucumber salad and coffee

Answer 25

C

Question 26

The client is 2 hours post colonoscopy, which assessment warrants intermediate intervention by the nurse?

A. The client has soft, nontender abdomen
B. Client has loose, watery stool
C. Client has hyperactive bowel sounds
D. Pulse 104 and BP 98/60

Answer 26

D

Could indicate perforation: high pulse with low BP

Question 27

The client dx with diverticulitis is c/o severe abdominal pain. On assessment the nurse finds a hard, rigid abdomen with temp 102. Which intervention should the nurse implement?

A. Notify HCP
B. Prepare to admin a fleet’s enema
C. Admin antipyretic suppository
D. Continue to monitor closely

Answer 27

A

Peritonitis = life threatening

Question 28

The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when teaching ways to prevent an acute exacerbation of diverticulosis? SATA

A. High fiber diet
B. Increase fluid intake
C. Elevate HOB after eating
D. Walk 30 minutes a day
E. Take an antacid every 2 hours

Answer 28

A, B, D

Primary concern with diverticulosis = prevent constipation

Question 29

The client dx with gastroenteritis is being discharged from the ED. Which intervention should be included in discharge teaching?

A. If diarrhea persists for more than 98 hours, contact the HCP
B. Wash hands thoroughly before handling any food
C. Explain the importance of decreasing steroids gradually
D. Discuss how to collect stool samples for the next 24 hours

Answer 29

B

Question 30

The nurse is preparing a client dx with peptic ulcer disease for a barium study of the stomach and esophagus. Which nursing intervention is the priority for this client?

A. Obtain informed consent
B. Discuss the need to increase oral fluid intake after the procedure
C. Explain to the client that he or she will have to drink a white, chalky substance
D. Tell the client not to eat or drink anything prior to the procedure

Answer 30

D

Question 31

Which client warrants immediate in retention from the nurse on the medical unit?

A. The client dx with dyspepsia who has eructation and bloating
B. Client dx with pancreatitis with steatorrhea and pyrosis
C. Client with diverticulitis with LLQ pain and fever
D. Client with Crohn’s with RLQ pain and diarrhea

Answer 31

D

Question 32

Which client should the nurse assess first after receiving the pm shift assessment?

A. Client with Barrett’s esophagus who has dysphagia and pyrosis
B. The client with proctitis who has tenesmus and passage of mucous through the rectum
C. Client with liver failure with jaundice and ascites
D. Client with abdominal pain who has an 8 hour urinary output of 150 ml/hr

Answer 32

D

Question 33

The nurse is planning the care of a client dx with acute gastroenteritis. Which nursing problem is priority?

A. Altered nurtrition
B. Self care deficit
C. Impaired body image
D. Fluid and electrolyte imbalance

Answer 33

D

Question 34

The nurse has received report. Which client should the nurse assess first?

A. Client 6 hours post-op of small bowel resection who has hypoactive bowel sounds in all 4 quadrants
B. The client scheduled for abdominal-peritoneal resection this morning and is crying and upset
C. Client 1 day post-op abdominal surgery with rigid, hard abdomen
D. Client 2 days post-op from emergency appendectomy and c/o 8/10 pain

Answer 34

C

Question 35

The charge nurse is reviewing morning lab results. Which data should be reported to the HCP?

A. Client 4 hours post-op with WBC 15,000
B. Client 1 day post-op total colectomy with creation of ileal conduit with H/H 12/36
C. Client 4 days post-op gastric bypass with fasting BG 180
D. Client 8 hours post-op laparotomy with potassium 4.5

Answer 35

A

Question 36

The nurse is preparing clients for surgery. Which client has the greatest potential for experiencing complications?

A. Client scheduled for removal of abdominal mass who is overweight
B. Client scheduled for gastrectomy with arterial hypertension
C. Client scheduled for open cholecystectomy who smokes 2 packs of cigs a day
D. Client scheduled for emergency appendectomy who smokes marijuana on a daily basis

Answer 36

C

Question 37

The nurse just received report. Which client should the nurse assess first?

A. Client who’s paralytic ileus has absent bowel sounds
B. Client 2 days post-op abdominal surgery who has soft, tender abdomen
C. Client 6 hours postop and has abdominal wound dehiscence
D. Client who had liver transplant and being transferred to rehab

Answer 37

C

Question 38

The client is experiencing urinary incontinence. Which intervention should the nurse implement?

A. Teach the client to drink prune juice weekly
B. Encourage client to eat high fiber diet
C. Discuss the need to urinate every 6 hours
D. Explain the importance of wearing cotton underwear

Answer 38

B

Avoid constipation - can cause increased pressure on the bladder

Question 39

Which information indicates to the nurse that teaching has been effective regarding urinary incontinence?

A. The client prepares a scheduled voiding plan
B. The client verbalizes need to increase fluid intake
C. Client explains how to perform pelvic floor exercises
D. Client attempts to retain the vaginal cone in place for the entire day

Answer 39

A

Fluid intake should not be increased but enough to avoid dehydration

Question 40

Which intervention should the nurse implement first for the client with an incontinent episode?

A. Palpate bladder to assess for retention
B. Obtain BSC for client
C. Assist client with changing wet clothes
D. Request CNA to change client linens

Answer 40

C

Question 41

Which nursing intervention is most important before attempting to catheterize a patient

A. Determine hx of catheter use
B. Evaluate level of anxiety with client
C. Verify client is not allergic to latex
D. Assess clients sensation level and ability to void

Answer 41

C

Question 42

The nurse is caring for an elderly client with an indwelling catheter. What data warrants further investigation?

A. Client temp of 98
B. Client has become confused and irritable
C. Clients urine is clear and yellow
D. Client feels the need to urinate

Answer 42

B

Could indicate UTI

Question 43

The nurse is assessing a client dx with urethral strictures. What data supports this dx?

A. C/o frequency and urgency
B. Clear yellow drainage from urethra
C. C/o burning during urination
D. Diminished force and stream during voiding

Answer 43

D

Question 44

The nurse is caring for a client with chronic pyelonephritis. Which assessment data supports the dx?

A. Client has fever, chills, flank pain, and dysuria
B. Client c/o fatigue, headaches, and increased urination
C. Client had a group B beta-hemolytic strep infection in last week
D. Client has acute viral pneumonia infection

Answer 44

B

These are symptoms of CHRONIC pyelonephritis, answer A is symptoms of acute pyelonephritis

Question 45

Female client in an outpatient clinic being sent home with dx of UTI. Which instruction should the nurse teach to prevent recurrence of UTI?

A. Clean from back to front after BM
B. Take warm bubble baths instead of hot showers daily
C. Void only before intercourse
D. Avoid coffee, tea, colas, and alcohol

Answer 45

D

Question 46

Which clinical manifestations should the nurse expect to assess with a client dx with a ureteral renal stone?

A. Dull, aching flank pain and microscopic hematuria
B. Nausea, vomiting, pallor, cool and clammy skin
C. Gross hematuria and dull suprapubic pain with voiding
D. Client will be asymptomatic

Answer 46

B

Question 47

The client diagnosed with renal calculi is scheduled for 24 hour urine collection. Which interventions should the nurse implement? SATA

A. Check for the ordered diet and medication modifications
B. Instruct client to urinate, discard this urine when starting collection
C. Collect all urine during 24 hours and place in appropriate specimen containe
D. Insert indwelling catheter after having the client empty bladder
E. Instruct UAP to notify nurse when client urinates

Answer 47

A, B, C

Question 48

1
Which client should the nurse assess first?

A.