MedSurg Test 5

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MedSurg Test 5
2012-05-31 21:58:46
dsn medsurg

MedSurg Test 5
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  1. Which of the following
    assessments should the nurse prioritize in the care of a patient who has
    recently begun receiving parenteral nutrition (PN)?
    • B) Electrolyte levels and
    • daily weights
  2. After administering a dose of
    promethazine (Phenergan) to a patient with nausea and vomiting, the nurse
    explains that which of the following may be experienced as a common temporary
    adverse effect of the medication?
    A) Drowsiness
  3. The nurse is caring for a
    68-year-old patient admitted with abdominal pain, nausea, and vomiting. The
    patient has an abdominal mass and a bowel obstruction is suspected. The nurse
    auscultating the abdomen listens for which of the following types of bowel sounds
    that is consistent with the patient’s clinical picture?
    D) High pitched and hyperactive above the area of obstruction
  4. Which of the following tasks can
    the RN delegate to the NAP?
    • c. Empty drainage devices and
    • measure output
  5. All of the following decrease lower
    esophageal sphincter pressure except:
    d. metoclopramide (Reglan)
  6. Which drug therapy is usually the fastest acting for
    relief of constipation?
    b. Saline and osmotic solutions
  7. 1. The most important reason for
    elevating the head of a patient's bed to at least 30 degrees prior to
    administration of a tube-feeding is:
    • b) to minimize the patient's risk
    • for aspiration of gastric contents
  8. . __________ is one of the top five
    pathogens contributing to food-borne illnesses acquired in the USA.
    c) Norovirus
  9. 3. A 2-year old patient presents in
    the ED with rapid radial pulses, mild tenting of the skin at the sternum,
    increased respiration rate, and blood pressure within normal limits. The parent
    indicates the 2-year old has been vomiting for over 48 hours and is not
    "keeping anything down". The nurse knows that it's likely the patient
    __________, and calls the doc for orders.
    d) is hypovolemic
  10. 1,
    When planning nutritional intervention for a healthy 83- year old man, the
    nurse recognizes that the factor most likely to affect his
    nutritional status is
    • A,
    • Living alone on a fixed income
  11. 2,
    A patient with a history of peptic ulcer disease is hospitalized with symptoms
    of perforation. During the initial assessment, the nurse would expect the
    patient to report
    • C,
    • sudden, severe upper abdominal pain and shoulder pain
  12. 3,
    The nurse teaches the patient with Diverticulosis to
    • C,
    • maintain a high-fiber diet and use bulk laxatives to increase fecal volume
  13. 1)
    The RN can delegate all of the following to the
    LPN except:
    Evaluate nutritional status of patient receiving enteral feeding
  14. 1) The
    nurse teaches the patient with a hiatal hernia or GERD to control symptoms by
    Sleeping with the head of the bed elevated on 4-6-in blocks
  15. 1) The
    preferred immediate treatment for an acute episode of constipation is the
    administration of
    An enema
  16. A patient receiving a gastrostomy or
    jejunostomy feeding may experience what complications? (select all that apply)
    A. Skin irritation

    C. Accidental removal of the tube
  17. A 45 year old single mother of 2 comes
    to the clinic with complaints of a burning sensation in the upper region of her
    abdomen, nausea and vomiting. She states the symptoms started several months
    ago, but have been getting worse over the last several weeks, especially after
    her pad Thai noodles. She smokes a pack of cigarettes a day, drinks 3-4 cups of
    coffee a day to "keep her going," has two glasses of vodka a day to
    help her unwind from her day, nurse suspects:
    B. Gastric ulcer
  18. A nursing intervention that is
    indicated for a male patient following an inguinal herniorrhaphy is
    • B. Elevating the scrotum with a
    • scrotal support.
  19. Which
    of the following procedures can be delegated to LPN?
    • a.
    • Empty drainage devices and measure output
  20. A patient
    is recovering from sever vomiting and is beginning to tolerate oral intake.
    Which of the following food choices would not be most appropriate?
    Iced tea
  21. A
    patient is complaining of acute abdominal pain. RN should immediately
    a. Obtain vital signs
  22. 1.
    The nurse is planning to teach the client with gastroesophageal reflux disease
    about substances that will increase the lower esophageal sphincter pressure.
    Which item should the nurse include on the list?
    • a.
    • Nonfat milk
  23. 2. The nurse us monitoring a client with a
    diagnosis of peptic ulcer. Which assessment finding would most likely indicate
    perforation of the ulcer?
    • A
    • rigid, board like abdomen
  24. The nurse is reviewing the record of a client with Crohn’s
    disease. Which stool characteristic should the nurse expect to note documented
    in the client’s record?
    • a.
    • Diarrhea
  25. 1.) A Nurse noticed newly written orders for
    insertion of a NG feeding tube in her patient. Once the tube is inserted, what
    is the best way to confirm initial placement of the NG tube?
    c. X-ray
  26. 2.)
    The Dietician is teaching Nutritional therapy to a Postgastrectomy patient.
    During the discussion the Dietician understands the patient needs further
    teaching when she states:
    • a.
    • “ So…proteins and fats are decreased to help decrease energy for a safe recovery?”
  27. Inflammatory bowel disease (IBD) is best characterized
    • Chronic inflammation of the
    • GI tract.
  28. A patient is about to be discharged following the insertion of an
    enteral feeding device. The LPN is
    educating the patient and caregiver regarding the self-care regime they
    will need to follow. The RN should…
    intervene and educate the patient
  29. A patient who has recently undergone esophageal surgery continues to
    have bloody drainage via his NG tube.
    The RN should be concerned if it last longer than…
    12 hours
  30. In contrast to diverticulitis, the patient with diverticulosis…
    often has no symptoms
  31. The
    2005 Dietary Guidelines for Americans recommends that ________________percent
    of total calories should come from carbohydrates.
    • c. 45
    • to 65
  32. If
    untreated bacterial peritonitis may occur within _______________hours.
    a. 6 to 12
  33. A
    healthy and viable ostomy stoma should appear________________.
    b. rose to beefy red
  34. The nurse is taking care of a
    critically ill patient on parental nutrition containing fat emulsion.
    Which labs may be requested to monitor closely for this patient?
    A. Triglycerides
  35. A patient has been consistently
    vomiting for 2 days. Upon arrival to the ER labs indicating electrolyte
    imbalances are drawn. What would you expect the outcome to be from the loss of
    stomach contents?
    D. Metabolic alkalosis
  36. A 19 year old male enters the ER
    with pain in the RLQ with rebound tenderness. You suspect he has appendicitis
    and take special consideration to limit the life threatening risk of
    B. Perforation
  37. 1.
    A nurse is caring for a patient presenting with
    symptoms of peptic ulcer disease and receives an order to draw labs for serum
    amylase. The nurse knows this test is used to check for which complication of
    • a.
    • penetration of the pancreas by duodenal ulcer
  38. 1.
    Why does central parenteral nutrition have to be
    given through a large central vein?
    • a.
    • because the solution is hypertonic (1600 mOsm/L)
  39. 1.
    What are some major roles of the nurse in caring
    for a patient with a new ostomy? (select all that apply)
    • a.
    • Emotional support as patient copes with changes in body image.

    • b.
    • Psychologically prepare the patient for the
    • changes before surgery.

    • c.
    • Encourage patient to drink plenty of fluids and
    • maintain a healthy diet.

    • d.
    • Patient and caregiver teaching about how to care
    • for the ostomy and the stoma.
  40. When
    providing a tube feeding to a patient, sterile water should be used to flush
    the tube for which of the following patients?
    • a)
    • HIV patients
  41. A
    patient is being treated for a gastric ulcer at a ambulatory care clinic. The nurse is educating the patient on post
    treatment expectations. The nurse notes
    that the patient understands when they state which of the following:
    • a)
    • It could take up to 9 weeks for
    • my ulcers to commpletey heal even if I am no longer experiencing pain.
  42. When
    assessing a patient who is in postoperative recovery following a newly placed
    colostomy. The nurse notes some mild to
    moderate swelling the cause is most likely:
    • a)
    • Normal in the initial post operative period
  43. A
    patient is receiving enteral tube feeding and is at risk for aspiration. Prior to feeding, the action that the nurse
    should take first is:
    • . Ensure the tube is in the proper location with
    • head of bed at least 30°
  44. A
    patient has been recently diagnosed with Peptic Ulcer Disease. The nurse should teach the patient to:
    • A. Eat
    • as normally as possible, avoiding foods that cause pain
  45. Which
    statement is FALSE when teaching a newly diagnosed Irritable Bowel
    Syndrome (IBS) patient?
    Prolonged use of antibiotics
  46. 1. When performing an abdominal
    assessment, do the four basic steps in which order?
    • B. inspection, auscultation,
    • percussion, palpation
  47. 2. Your pt. had severe midepigastric
    or RUQ pain radiating to the back or referred to the right scapula, belching
    that leaves a sour taste in the mouth, and flatulence. She most likely has?
    • B. Acute cholecystitis, acute
    • cholelithiasis, or choledocholithiasis
  48. 3. In a pt. with suspected
    appendicitis, which of these interventions are appropriate?
    • C. Give I.V. Fluids, give pt.
    • nothing by mouth, but give analgesics judiciously; and place him in fowler's
    • position to reduce pain.
  49. A
    patient who has dysphagia as a consequence of a stroke is receiving enteral
    feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the
    following interventions should the nurse integrate into this patient's care?
    • b.
    • flush the tube before and after feedings if the patient's feedings are
    • intermittent
  50. A
    patient reports having dry mouth and asks for some liquid to drink.
    The nurse reasons that this symptom can most likely be attributed to a common
    adverse effect of which of the following medications?
    • d.
    • promethazine (phenergan)
  51. The
    nurse would question the use of which of the following cathartic agents in
    a patient with renal insufficiency?
    . milk of magnesia
  52. 1.) During the bodies pathophysiology of starvation,
    what does the body use first?
    . carbohydrates
  53. 2.) Which of the 5 restrictive surgeries is
    completely reversible?
    c. gastric banding
  54. 3.) These are all common causes of upper
    gastrointestinal bleeding EXCEPT
    c.excessive alcohol use
  55. The
    nurse is preparing to administer enteral nutrition to her patient. The
    patient’s residual volume is 510 ml. Which of the following is the proper
    nursing action
    • a) Hold enteral nutrition and
    • reassess patient tolerance
  56. When
    teaching a patient recently diagnosed with Peptic Ulcer Disease (PUD) ways to
    prevent recurrence or complications of ulcers which of the following should be
    • a) Patient should avoid alcohol
    • intake
  57. When
    caring for a patient with Clostridium difficle
    (C. diff) which nursing actions are important to prevent spread of
    infection (Select All That Apply)
    • a) Wash hands before and after
    • contact with each patient

    • b) Place patient in a private
    • room

    • d) Use gown and glove contact
    • precautions
  58. The nurse explains to the patient
    with gastroesophageal reflux disease that this disorder
    • D often involves the relaxation of
    • the lower esophageal sphincter allowing stomach contents to back up into the
    • esophagus.
  59. A patient with anorexia nervosa
    shows signs of malnutrition. During initial refeeding, the nurse carefully
    assesses the patient for what abnormal lab value
    D hypophosphatemia
  60. During the assessment of patient with acute abdominal pain, the nurse should...
    measure body temperature because an elevated temperature may indicate an inflammatory or infectious process.