NURS 317 Unit 2 Chapter 37 Path Point Questions Flashcards
An older adult client is reporting chronic constipation. When evaluating the client’s medication regimen, the nurse will note that which medications may contribute to this constipation? Select all that apply.
A) Propylthiouracil for his hyperthyroidism
B) Antacids for his heartburn
C) Diuretics for his heart failure
D) Calcium channel blockers for his hypertension
B) Antacids for his heartburn
C) Diuretics for his heart failure
D) Calcium channel blockers for his hypertension
Rationale: Drugs such as narcotics, anticholinergic agents, calcium channel blockers, diuretics, calcium (antacids and supplements), iron supplements, and aluminum antacids tend to cause constipation. Propylthiouracil is indicated for hyperthyroidism. Hypothyroidism can be associated with constipation.
A client admitted to the emergency department with early symptoms of appendicitis should be assessed for which manifestation?
A) Left-sided abdominal pain relieved by rest that is not associated with nausea
B) Severe, sharp pain in the upper quadrants of the abdomen
C) Lower right quadrant pain that is relieved with movement
D) Vague pain that is referred to the epigastric or periumbilical area
D) Vague pain that is referred to the epigastric or periumbilical area
Rationale: Appendicitis usually has an abrupt onset, with pain that is referred to the epigastric or periumbilical area and the client experiences nausea. In the later stage, the pain becomes more severe and localizes to the right lower quadrant.
The nurse is reviewing the medical history of four clients. The nurse determines that the client at greatest risk for developing peptic ulcer disease is:
A) A client with a prior diagnosis of Helicobacter pylori and refused treatment
B) A client who overeats excessive amounts of fatty foods
C) A client diagnosed with arthritis who takes acetaminophen twice per day
D) A client who has a history of a ruptured appendix
A) A client with a prior diagnosis of Helicobacter pylori and refused treatment
Rationale: The two most important risk factors for peptic ulcer disease are infection with the bacteria H. pylori and use of aspirin and/or NSAIDs. Acetaminophen does not place the client at risk for liver injury. A history of a ruptured appendix will not cause peptic ulcer. The high fat intake may contribute to the development of atherosclerosis.
Which clinical manifestations would lead the nurse to suspect the postoperative client has developed a mechanical bowel obstruction? Select all that apply.
A) High-pitched bowel sounds
B) Severe, colicky pain
C) Extreme restlessness
D) Rectal bleeding
E) Increased abdominal distention
A) High-pitched bowel sounds
B) Severe, colicky pain
C) Extreme restlessness
E) Increased abdominal distention
Rationale: Major inciting causes of mechanical bowel obstruction include external hernia (i.e., inguinal, femoral, or umbilical) and postoperative adhesions. The major symptoms of acute intestinal obstruction are pain, absolute constipation, abdominal distention, and vomiting. With mechanical obstruction, the pain is severe and colicky, in contrast with the continuous pain and silent abdomen of paralytic ileus. There are also rumbling sounds made by propulsion of gas in the intestine. Audible, high-pitched peristalsis and peristaltic rushes are associated with abdominal pain. Visible peristalsis may appear along the course of the distended intestine. Extreme restlessness and conscious awareness of interstinal movements are also experienced.
A client has been admitted to the hospital with an exacerbation of peptic ulcer disease. The nurse is aware the client is at risk for: Select all that apply.
A) Hemorrhage
B) Obstruction
C) Weight gain
D) Increased urinary output
E) Perforation
A) Hemorrhage
B) Obstruction
E) Perforation
Rationale: The most common complications of peptic ulcer are hemorrhage, perforation, and gastric outlet obstruction. Weight gain and increased urinary output would not occur as the client may experience volume loss.
Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply.
A) Crohn disease
B) Salmonellosis
C) Celiac disease
D) Shigellosis
E) Ulcerative colitis
A) Crohn disease
E) Ulcerative colitis
Rationale: The term inflammatory bowel disease is used to designate two inflammatory conditions: Crohn disease, which affects the small and large bowel, and ulcerative colitis, which affects the colon and rectum. Salmonellosis and Shigellosis are infectious diseases. Celiac disease is an immune mediated disorder.
A client diagnosed with inflammatory diarrhea is having multiple small, bloody stools with a fever. Which could be a likely cause of this inflammatory diarrhea?
A) H. pylori
B) C. difficile
C) M. tuberculosis
D) S. aureus
B) C. difficile
Rationale: Inflammatory diarrhea is usually characterized by the presence of fever and bloody diarrhea. It is caused by bacterial invasion of intestinal cells (e.g., Shigella, Salmonella, Yersinia, and Campylobacter) or the toxins associated with C. difficile or E. coli O157:H7 infection. H. pylori can cause gastritis, and M. tuberculosis can result in the development of tuberculosis. S. aureus can cause noninflammatory diarrhea.
The nurse is teaching her client with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component?
A) Calcium
B) Protein
C) Starch
D) Fat
D) Fat
Rationale: The condidtions that impair one or more steps involved in digestion and absorption of nutrients can be divided into three broad categories: intraluminal maldigestion, disorders of transepithelial transport, and lymphatic obstruction. Hepatobiliary disease is a common cause of intraluminal maldigestion. Fats are not absorbed in the upper jejunum and the excretion of fat in the stool is steatorrhea.
The nurse has been providing dietary teaching to a client diagnosed with irritable bowel syndrome. The nurse determines that the teaching was effective when the client selects:
A) a bran muffin, fruit, and orange juice.
B) bacon, eggs, and coffee.
C) grilled steak, green beans, and a Coke.
D) fried fish and a glass of wine.
A) a bran muffin, fruit, and orange juice.
Rationale: Clients with irritable bowel syndrome should have adequate intake of fiber. All other options contain foods that should be avoided. Substances that should be avoided include fatty and gas-producing foods, caffeine, and alcohol.
A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:
A) surgery to release the bowel.
B) low fiber diet for 24 hours.
C) lower abdominal massage.
D) insertion of a nasogastric tube.
A) surgery to release the bowel.
Rationale: Strangulation and complete bowel obstruction require surgical intervention. Nasogastric tubes are used for adynamic obstructions that result from neurogenic or muscular impairment of peristalsis. Massage or diet would not relieve strangulation.
A nurse caring for a client with an intestinal obstruction anticipates which assessment findings? Select all that apply.
A) Abdominal distension
B) Vomiting
C) Diarrhea
D) Abdominal pain
A) Abdominal distension
B) Vomiting
D) Abdominal pain
Rationale: The nurse would anticipate the following when assessing a client with an intestinal obstruction: constipation, abdominal distension, vomiting, pain, and signs of fluid volume deficit.
A client in rehabilitation is recovering from a recent stroke and experiencing difficulty swallowing. The nurse would anticipate which diagnositc procedure or treatment approach to be prescribed to assess swallowing difficulty? Select all that apply.
A) Barium esophagoscopy
B) Multidisciplinary approach
C) Esophageal biopsy
D) pH monitoring
E) Endoscopy
A) Barium esophagoscopy
B) Multidisciplinary approach
E) Endoscopy
Rationale: Dysphagia refers to difficulty in swallowing. Dysphagia can result from neuromuscular or structural causes. An example of a neuromuscular cause involves lesions of the central nervous system, such as stroke, which often involve the cranial nerves that control swallowing. Endoscopy, barium esophagoscopy, and videoradiography may be used to determine the site and extent of a swallowing disorder. Esophageal manometry, a procedure in which a small pressure-sensing catheter is inserted into the esophagus, may be done to measure pressures in different parts of the esophagus. Treatment of dysphagia often involves a multidisciplinary team of health professionals, including a speech pathologist.
Which symptom is often observed in cases of peritonitis?
A) Decreased white blood cell count
B) Bradycardia
C) Deep, rhythmic breathing
D) Abdominal rigidity
D) Abdominal rigidity
Rationale: The abdomen is rigid and becomes boardlike because of reflex muscle guarding. The client typically becomes tachycardic, has increased WBC count, and breathes in a shallow way to avoid movement of the abdomen related to the pain.
Which client should the nurse observe most closely for the signs and symptoms of paralytic ileus?
A) A client who is first day postoperative following gallbladder surgery
B) A client whose acute diarrhea has necessitated the use of antidiarrheal medications
C) A client with a long-standing diagnosis of irritable bowel syndrome
D) An obese client who refuses to ambulate because he reports shortness of breath
A) A client who is first day postoperative following gallbladder surgery
Rationale: Paralytic ileus is a significant complication of abdominal surgery. The problem is not associated with the use of antidiarrheal medications, obesity, or irritable bowel syndrome.
A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be:
A) Difficulty swallowing
B) Excessive weight gain
C) Chronic constipation
D) Fistula formation
D) Fistula formation
Rationale: Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Clients with Crohn disease are at risk for weight loss and/or diarrhea. The disease does not cause difficulty swallowing as it typically is in the bowel.
