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Unit 4 NTB

Total questions: 102

Worksheet time: 1hrs 26mins

Name
Class
Date
1.

A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient’s nausea?

a)

Keep the patient NPO for 2 hours before and after dressing changes.

b)

Avoid performing dressing changes close to the patient’s mealtimes.

c)

Administer the prescribed morphine sulfate before dressing changes.

d)

Give the ordered prochlorperazine (Compazine) before dressing changes.

2.

Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?

a)

Glass of orange juice

b)

Dish of lemon gelatin

c)

Cup of coffee with cream

d)

Bowl of hot chicken broth

3.

A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for

a)

hydrogen peroxide rinses.

b)

the use of antiviral agents.

c)

administration of nystatin (Mycostatin) tablets.

d)

referral to a dentist for professional tooth cleaning.

4.

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

a)

Bleeding during tooth brushing

b)

Painful blisters at the lip border

c)

Red, velvety patches on the buccal mucosa

d)

White, curdlike plaques on the posterior tongue

5.

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

a)

Avoid use of cigarettes and smokeless tobacco.

b)

Use sunscreen when outside even on cloudy days.

c)

Complete antibiotic courses used to treat throat infections.

d)

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

6.

A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed?

a)

“I take antacids between meals and at bedtime each night.”

b)

“I sleep with the head of the bed elevated on 4-inch blocks.”

c)

“I eat small meals during the day and have a bedtime snack.”

d)

“I quit smoking several years ago, but I still chew a lot of gum.”

7.

A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient’s...

a)

apical pulse.

b)

bowel sounds.

c)

breath sounds.

d)

abdominal girth.

8.

The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication

a)

reduces gastroesophageal reflux by increasing the rate of gastric emptying.

b)

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

c)

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

d)

treats gastroesophageal reflux disease by decreasing stomach acid production.

9.

Which patient choice for a snack 2 hours before bedtime indicates that the nurse’s teaching about gastroesophageal reflux disease (GERD) has been effective?

a)

Chocolate pudding

b)

Glass of low-fat milk

c)

Cherry gelatin with fruit

d)

Peanut butter and jelly sandwich

10.

The nurse will anticipate teaching a patient experiencing frequent heartburn about

a)

a barium swallow

b)

radionuclide tests.

c)

endoscopy procedures.

d)

proton pump inhibitors.

11.

A 58-year-old woman who recently has been diagnosed with esophageal cancer tells the nurse, “I do not feel ready to die yet.” Which response by the nurse is most appropriate?

a)

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

b)

“Thinking about dying will only make you feel worse.”

c)

“Having this new diagnosis must be very hard for you.”

d)

“It is important that you be realistic about your prognosis.”

12.

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

a)

“Peppermint tea may reduce your symptoms.”

b)

“Keep the head of your bed elevated on blocks.”

c)

“You should avoid eating between meals to reduce acid secretion.”

d)

“Vigorous physical activities may increase the incidence of reflux.”

13.

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

a)

Notify the doctor about bloody nasogastric (NG) drainage.

b)

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

c)

Reposition the NG tube if drainage stops.

d)

Start oral fluids when the patient has active bowel sounds.

14.

When a 72-year-old patient is diagnosed with achalasia, the nurse will teach the patient that

a)

lying down after meals is recommended.

b)

a liquid or blenderized diet will be necessary.

c)

drinking fluids with meals should be avoided.

d)

treatment may include endoscopic procedures.

15.

A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about

a)

the amount of saturated fat in the diet.

b)

any family history of gastric or colon cancer.

c)

a history of a large recent weight gain or loss.

d)

use of nonsteroidal antiinflammatory drugs (NSAIDs).

16.

The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following?

a)

“The cobalamin injections will prevent gastric inflammation.”

b)

“The cobalamin injections will prevent me from becoming anemic.”

c)

“These injections will increase the hydrochloric acid in my stomach.”

d)

“These injections will decrease my risk for developing stomach cancer.”

17.

Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori?

a)

Sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol)

b)

Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

c)

Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix)

d)

Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan)

18.

Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?

a)

Obtain a stool specimen for culture.

b)

Administer antidiarrheal medication.

c)

Provide teaching about antibiotic therapy.

d)

Teach about adverse effects of acetaminophen (Tylenol).

19.

The nurse will anticipate preparing a 71-year-old female patient who is vomiting “coffee-ground” emesis for

a)

endoscopy.

b)

angiography.

c)

barium studies.

d)

gastric analysis.

20.

A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question?

a)

Infuse lactated Ringer’s solution at 250 mL/hr.

b)

Monitor blood urea nitrogen and creatinine daily.

c)

Administer loperamide (Imodium) after each stool.

d)

Provide a clear liquid diet and progress diet as tolerated.

21.

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?

a)

“Ranitidine absorbs the gastric acid.”

b)

“Ranitidine decreases gastric acid secretion.”

c)

“Ranitidine constricts the blood vessels near the ulcer.”

d)

“Ranitidine covers the ulcer with a protective material.”

22.

A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will

a)

decrease nausea and vomiting.

b)

inhibit development of stress ulcers.

c)

lower the risk for H. pylori infection.

d)

prevent aspiration of gastric contents.

23.

A 68-year-old patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse

a)

monitors arterial blood gas values daily.

b)

periodically aspirates and tests gastric pH.

c)

checks each stool for the presence of occult blood.

d)

measures the volume of residual stomach contents.

24.

A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?

a)

Irrigate the NG tube.

b)

Check the vital signs.

c)

Give the ordered antacid.

d)

Elevate the foot of the bed.

25.

A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The highest priority action by the nurse is to

a)

contact the surgeon.

b)

irrigate the NG tube.

c)

monitor the NG drainage.

d)

administer the prescribed morphine.

26.

Which patient statement indicates that the nurse’s teaching following a gastroduodenostomy has been effective?

a)

“Vitamin supplements may prevent anemia.”

b)

“Persistent heartburn is common after surgery.”

c)

“I will try to drink more liquids with my meals.”

d)

“I will need to choose high carbohydrate foods.”

27.

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

a)

increase the amount of fluid with meals.

b)

eat foods that are higher in carbohydrates.

c)

lie down for about 30 minutes after eating.

d)

drink sugared fluids or eat candy after meals.

28.

A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about

a)

substitution of acetaminophen (Tylenol) for the NSAID.

b)

use of enteric-coated NSAIDs to reduce gastric irritation.

c)

reasons for using corticosteroids to treat the rheumatoid arthritis.

d)

misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.

29.

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient’s peptic ulcer. The nurse will teach the patient to take

a)

sucralfate at bedtime and antacids before each meal.

b)

sucralfate and antacids together 30 minutes before meals.

c)

antacids 30 minutes before each dose of sucralfate is taken.

d)

antacids after meals and sucralfate 30 minutes before meals.

30.

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?

a)

“You will need to remain on a bland diet.”

b)

“Avoid foods that cause pain after you eat them.”

c)

“High-protein foods are least likely to cause you pain.”

d)

“You should avoid eating any raw fruits and vegetables.”

31.

A 73-year-old patient is diagnosed with stomach cancer after an unintended 20-pound weight loss. Which nursing action will be included in the plan of care?

a)

Refer the patient for hospice services.

b)

Infuse IV fluids through a central line.

c)

Teach the patient about antiemetic therapy.

d)

Offer supplemental feedings between meals.

32.

A 26-year-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid

a)

emotionally stressful situations.

b)

smoked foods such as ham and bacon.

c)

foods that cause distention or bloating.

d)

chronic use of H2 blocking medications.

33.

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?

a)

Absent bowel sounds

b)

Complaints of incisional pain

c)

Temperature 102.1° F (38.9° C)

d)

Scant nasogastric (NG) tube drainage

34.

A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?

a)

The patient has been vomiting for 4 days.

b)

The patient takes antacids 8 to 10 times a day.

c)

The patient is lethargic and difficult to arouse.

d)

The patient has undergone a small intestinal resection.

35.

A 26-year-old woman has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?

a)

Auscultate the bowel sounds.

b)

Assess for signs of dehydration.

c)

Assist the patient with oral care.

d)

Ask the patient about the nausea.

36.

A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which order from the health care provider will the nurse implement first?

a)

Insert a nasogastric (NG) tube.

b)

Infuse normal saline at 250 mL/hr.

c)

Administer IV ondansetron (Zofran).

d)

Provide oral care with moistened swabs.

37.

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

a)

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

b)

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

c)

A patient with esophageal varices who has a blood pressure of 92/58 mm Hg

d)

A patient admitted yesterday with gastrointestinal (GI) bleeding who has melena

38.

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately?

a)

The patient is experiencing intermittent waves of nausea.

b)

The patient complains of 7/10 (0 to 10 scale) abdominal pain.

c)

The patient has absent breath sounds in the left anterior chest.

d)

The patient has hypoactive bowel sounds in all four quadrants.

39.

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

a)

Measuring the quantity of emesis

b)

Palpating the abdomen for distention

c)

Auscultating the chest for breath sounds

d)

Taking the blood pressure (BP) and pulse

40.

Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood?

a)

Give an IV H2 receptor antagonist.

b)

Draw blood for typing and crossmatching.

c)

Administer 1000 mL of lactated Ringer’s solution.

d)

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

41.

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

a)

The bowel sounds are hyperactive in all four quadrants.

b)

The patient’s lungs have crackles audible to the midchest.

c)

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

d)

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

42.

After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective?

a)

Patient orders nonfat milk for each meal.

b)

Patient uses the prescribed corticosteroid inhaler.

c)

Patient schedules an appointment for allergy testing.

d)

Patient takes ibuprofen (Advil) to control throat pain.

43.

An 80-year-old who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration?

a)

Sucralfate (Carafate)

b)

Omeprazole (Prilosec)

c)

Metoclopramide (Reglan)

d)

Aluminum hydroxide (Amphojel)

44.

The nurse and a licensed practical/vocational nurse (LPN/LVN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/LVN requires that the nurse intervene?

a)

The LPN/LVN uses soft swabs to provide for oral care.

b)

The LPN/LVN positions the head of the bed in the flat position.

c)

The LPN/LVN encourages the patient to use pain medications before coughing.

d)

The LPN/LVN includes the enteral feeding volume when calculating intake and output.

45.

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

a)

42-year-old who has acute gastritis and ongoing epigastric pain

b)

70-year-old with a hiatal hernia who experiences frequent heartburn

c)

53-year-old who has dumping syndrome after a recent partial gastrectomy

d)

60-year-old with nausea and vomiting who has dry oral mucosa and lethargy

46.

Vasopressin (Pitressin) 0.2 units/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 100 units/250 mL normal saline. How many mL/hr will the nurse infuse?

(a)  

47.

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?

a)

Educate the patient about proper food storage.

b)

Order a diet with no dairy products for the patient.

c)

Place the patient in a private room on contact isolation.

d)

Teach the patient about why antibiotics will not be used.

48.

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first?

a)

Encourage the patient to increase oral fluid intake.

b)

Assess the patient about risk factors for constipation.

c)

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

d)

Teach the patient that a daily bowel movement is unnecessary.

49.

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?

a)

Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.

b)

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

c)

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

d)

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

50.

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

a)

“What type of foods do you eat?”

b)

“Is it possible that you are pregnant?”

c)

“Can you tell me more about the pain?”

d)

“What is your usual elimination pattern?”

51.

A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take?

a)

Encourage the patient to ambulate.

b)

Instill a mineral oil retention enema.

c)

Administer the ordered IV morphine sulfate.

d)

Offer the ordered promethazine (Phenergan) suppository.

52.

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?

a)

Auscultate the bowel sounds.

b)

Prepare the patient for surgery.

c)

Check the patient’s oral temperature.

d)

Obtain information about the accident.

53.

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?

a)

Encourage the patient to sip clear liquids.

b)

Assess the abdomen for rebound tenderness.

c)

Assist the patient to cough and deep breathe.

d)

Apply an ice pack to the right lower quadrant.

54.

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?

a)

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

b)

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

c)

Educate the patient about the use of alosetron (Lotronex) to reduce symptoms.

d)

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

55.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to...

a)

administer IV metoclopramide (Reglan).

b)

discontinue the patient’s oral food intake.

c)

administer cobalamin (vitamin B12) injections.

d)

teach the patient about total colectomy surgery.

56.

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

a)

Restrict oral fluid intake.

b)

Monitor stools for blood.

c)

Ambulate four times daily.

d)

Increase dietary fiber intake.

57.
Which patient statement indicates that the nurse’s teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?
a)
“The medication will be tapered if I need surgery.”
b)
“I will need to use a sunscreen when I am outdoors.”
c)
“I will need to avoid contact with people who are sick.”
d)
“The medication will prevent infections that cause the diarrhea.”
58.
A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?
a)
The patient uses incontinence briefs to contain loose stools.
b)
The patient asks for antidiarrheal medication after each stool.
c)
The patient uses witch hazel compresses to decrease irritation.
d)
The patient cleans the perianal area with soap after each stool.
59.
Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?
a)
Scrambled eggs
b)
White toast and jam
c)
Oatmeal with cream
d)
Pancakes with syrup
60.
After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, “I cannot manage all these changes. I don’t want to look at the stoma.” What is the best action by the nurse?
a)
Reassure the patient that ileostomy care will become easier.
b)
Ask the patient about the concerns with stoma management.
c)
Develop a detailed written list of ostomy care tasks for the patient.
d)
Postpone any teaching until the patient adjusts to the ileostomy.
61.
A 51-year-old male patient has a new diagnosis of Crohn’s disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about
a)
medication use.
b)
fluid restriction.
c)
enteral nutrition.
d)
activity restrictions.
62.
A 24-year-old woman with Crohn’s disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?
a)
Bacteria in the perianal area can enter the urethra.
b)
Fistulas can form between the bowel and bladder.
c)
Drink adequate fluids to maintain normal hydration.
d)
Empty the bladder before and after sexual intercourse.
63.
A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for
a)
referred back pain.
b)
metabolic alkalosis.
c)
projectile vomiting.
d)
abdominal distention.
64.
The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about
a)
endoscopy.
b)
colonoscopy.
c)
computerized tomography screening.
d)
carcinoembryonic antigen (CEA) testing.
65.
The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include?
a)
Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir.
b)
The patient will begin sitting in a chair at the bedside on the first postoperative day.
c)
The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively.
d)
IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.
66.
A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to
a)
identify any metastasis of the cancer.
b)
monitor the tumor status after surgery.
c)
confirm the diagnosis of a specific type of cancer.
d)
determine the need for postoperative chemotherapy.
67.
A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?
a)
Teach about a low-residue diet.
b)
Monitor output from the stoma.
c)
Assess the perineal drainage and incision.
d)
Encourage acceptance of the colostomy stoma.
68.
A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should
a)
place ice packs around the stoma.
b)
notify the surgeon about the stoma.
c)
monitor the stoma every 30 minutes.
d)
document stoma assessment findings.
69.
Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?
a)
Restrict fluid intake to prevent constant liquid drainage from the stoma.
b)
Use care when eating high-fiber foods to avoid obstruction of the ileum.
c)
Irrigate the ileostomy daily to avoid having to wear a drainage appliance.
d)
Change the pouch every day to prevent leakage of contents onto the skin.
70.
The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient
a)
inserts the irrigation tubing 4 to 6 inches into the stoma.
b)
hangs the irrigating container 18 inches above the stoma.
c)
stops the irrigation and removes the irrigating cone if cramping occurs.
d)
fills the irrigating container with 1000 to 2000 mL of lukewarm tap water.
71.
A 34-year-old female patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups.
a)
2
b)
3
c)
4
d)
5
72.
The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to
a)
administer IV fluids.
b)
give stool softeners and enemas.
c)
order a diet high in fiber and fluids.
d)
prepare the patient for colonoscopy.
73.
A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge?
a)
Soak in sitz baths several times each day.
b)
Cough 5 times each hour for the next 48 hours.
c)
Avoid use of acetaminophen (Tylenol) for pain.
d)
Apply a scrotal support and ice to reduce swelling.
74.
Which breakfast choice indicates a patient’s good understanding of information about a diet for celiac disease?
a)
Oatmeal with nonfat milk
b)
Whole wheat toast with butter
c)
Bagel with low-fat cream cheese
d)
Corn tortilla with scrambled eggs
75.
A 62-year-old patient has had a hemorrhoidectomy at an outpatient surgical center. Which instructions will the nurse include in discharge teaching?
a)
Maintain a low-residue diet until the surgical area is healed.
b)
Use ice packs on the perianal area to relieve pain and swelling.
c)
Take prescribed pain medications before a bowel movement is expected.
d)
Delay having a bowel movement for several days until healing has occurred.
76.
A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to
a)
collect a stool specimen.
b)
prepare for colonoscopy.
c)
schedule a barium enema.
d)
have blood cultures drawn.
77.
The nurse will plan to teach a patient with Crohn’s disease who has megaloblastic anemia about the need for
a)
oral ferrous sulfate tablets.
b)
regular blood transfusions.
c)
iron dextran (Imferon) infusions.
d)
cobalamin (B12) spray or injections.
78.
The nurse is assessing a 31-year-old female patient with abdominal pain. Th nurse,who notes that there is ecchymosis around the area of umbilicus, will document this finding as
a)
Cullen sign.
b)
Rovsing sign.
c)
McBurney sign.
d)
Grey-Turner’s signt.
79.
A 54-year-old critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence?
a)
Apply incontinence briefs.
b)
Use a fecal management system
c)
Insert a rectal tube with a drainage bag.
d)
Assist the patient to a commode frequently.
80.
Which question from the nurse would help determine if a patient’s abdominal pain might indicate irritable bowel syndrome?
a)
“Have you been passing a lot of gas?”
b)
“What foods affect your bowel patterns?”
c)
“Do you have any abdominal distention?”
d)
“How long have you had abdominal pain?”
81.
A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first?
a)
Insert a urinary catheter to drainage.
b)
Infuse metronidazole (Flagyl) 500 mg IV.
c)
Send the patient for a computerized tomography scan.
d)
Place a nasogastric (NG) tube to intermittent low suction.
82.
A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first?
a)
Inform the patient that laboratory testing of blood and stools will be necessary.
b)
Ask the patient to describe the character of the stools and any associated symptoms.
c)
Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.
d)
Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.
83.
A 45-year-old patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120, respirations 32, and blood pressure (BP) 82/54. Which prescribed intervention should the nurse implement first?
a)
Administer IV ketorolac (Toradol) 15 mg.
b)
Draw blood for a complete blood count (CBC).
c)
Obtain a computed tomography (CT) scan of the abdomen.
d)
Infuse 1 liter of lactated Ringer’s solution over 30 minutes.
84.
Four hours after a bowel resection, a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to
a)
auscultate for hypotonic bowel sounds.
b)
notify the patient’s health care provider.
c)
reposition the tube and check for placement.
d)
remove the tube and replace it with a new one.
85.
A 19-year-old female is brought to the emergency department with a knife handle protruding from the abdomen. During the initial assessment of the patient, the nurse should
a)
remove the knife and assess the wound.
b)
determine the presence of Rovsing sign.
c)
check for circulation and tissue perfusion.
d)
insert a urinary catheter and assess for hematuria.
86.
Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?
a)
Document the appearance of the stoma.
b)
Place a pouching system over the ostomy.
c)
Drain and measure the output from the ostomy.
d)
Check the skin around the stoma for breakdown.
87.
Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the health care provider?
a)
The patient has a history of constipation.
b)
The patient has noticed blood in the stools.
c)
The patient had an appendectomy at age 27.
d)
The patient smokes a pack/day of cigarettes.
88.
Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)?
a)
Auscultation for bowel sounds
b)
Nasogastric (NG) tube irrigation
c)
Applying petroleum jelly to the lips
d)
Assessment of the nares for irritation
89.
After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?
a)
Notify the health care provider.
b)
Obtain a stool specimen for analysis.
c)
Teach the patient about handwashing.
d)
Place the patient on contact precautions.
90.
Which patient should the nurse assess first after receiving change-of-shift report?
a)
60-year-old patient whose new ileostomy has drained 800 mL over the previous 8 hours
b)
50-year-old patient with familial adenomatous polyposis who has occult blood in the stool
c)
40-year-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours
d)
30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute
91.
A 51-year-old woman with Crohn’s disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider?
a)
Fever
b)
Nausea
c)
Joint pain
d)
Headache
92.
A 33-year-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching?
a)
Stool will be expelled from both stomas.
b)
This type of colostomy is usually temporary.
c)
Soft, formed stool can be expected as drainage.
d)
Irrigations can regulate drainage from the stomas.
93.
A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first?
a)
Administer bulk-forming laxatives.
b)
Assist the patient to sit on the toilet.
c)
Manually remove the impacted stool.
d)
Increase the patient’s oral fluid intake.
94.
A female patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care?
a)
Position patient with the knees flexed.
b)
Avoid use of opioids or sedative drugs.
c)
Offer frequent small sips of clear liquids.
d)
Assist patient to breathe deeply and cough.
95.
A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?
a)
Patient has not voided for the last 4 hours.
b)
Skin is dry with poor turgor on all extremities.
c)
Crackles are heard halfway up the posterior chest.
d)
Patient has had 5 loose stools over the last 6 hours.
96.
A new 19-year-old male patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?
a)
Obtain blood samples for DNA analysis.
b)
Schedule the patient for yearly colonoscopy.
c)
Provide preoperative teaching about total colectomy.
d)
Discuss lifestyle modifications to decrease cancer risk.
97.
Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?
a)
Navy bean soup and vegetable salad
b)
Whole grain pasta with tomato sauce
c)
Baked potato with low-fat sour cream
d)
Roast beef sandwich on whole wheat bread
98.
After change-of-shift report, which patient should the nurse assess first?
a)
40-year-old male with celiac disease who has frequent frothy diarrhea
b)
30-year-old female with a femoral hernia who has abdominal pain and vomiting
c)
30-year-old male with ulcerative colitis who has severe perianal skin breakdown
d)
40-year-old female with a colostomy bag that is pulling away from the adhesive wafer
99.
Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)?
a)
Many over-the-counter (OTC) medications can cause constipation.
b)
Stimulant and saline laxatives can be used regularly.
c)
Bulk-forming laxatives are an excellent source of fiber.
d)
Walking or cycling frequently will help bowel motility.
e)
A good time for a bowel movement may be after breakfast.
100.
Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question?
a)
Ferrous sulfate (Feosol) 325 mg daily
b)
Senna (Senokot) 1 tablet every day
c)
Psyllium (Metamucil) 2.1 grams 3 times daily
d)
Diphenoxylate with atropine (Lomotil) prn loose stools
101.
Which information will the nurse teach a 23-year-old patient with lactose intolerance?
a)
Ice cream is relatively low in lactose.
b)
Live-culture yogurt is usually tolerated.
c)
Heating milk will break down the lactose.
d)
Nonfat milk is a better choice than whole milk.
102.
The nurse is admitting a 67-year-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask?
a)
“How much milk do you usually drink?”
b)
“Have you noticed a recent weight loss?”
c)
“What time of day do your bowels move?”
d)
“Do you eat meat or other animal products?”