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WorksheetsTest 5- Gastro/Liver/Connective tissue
Total questions: 55
Worksheet time: 28mins
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?
“I take antacids between meals and at bedtime each night.”
“I sleep with the head of the bed elevated on 4-inch blocks.”
“I eat small meals during the day and have a bedtime snack.”
“I quit smoking several years ago, but I still chew a lot of gum.”
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
apical pulse.
bowel sounds.
breath sounds.
abdominal girth.
The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication
reduces gastroesophageal reflux by increasing the rate of gastric emptying.
neutralizes stomach acid and provides relief of symptoms in a few minutes.
coats and protects the lining of the stomach and esophagus from gastric acid.
treats gastroesophageal reflux disease by decreasing stomach acid production.
Which patient choice for a snack 2 hours before bedtime indicates that the nurse’s teaching about gastroesophageal reflux disease (GERD) has been effective?
Chocolate pudding
Glass of low-fat milk
Cherry gelatin with fruit
Peanut butter and jelly sandwich
Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori?
Sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol)
Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix)
Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan)
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
decrease nausea and vomiting.
inhibit development of stress ulcers.
lower the risk for H. pylori infection.
prevent aspiration of gastric contents.
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
contact the surgeon.
irrigate the NG tube.
monitor the NG drainage.
administer the prescribed morphine.
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
increase the amount of fluid with meals.
eat foods that are higher in carbohydrates.
lie down for about 30 minutes after eating.
drink sugared fluids or eat candy after meals.
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
“You will need to remain on a bland diet.”
“Avoid foods that cause pain after you eat them.”
“High-protein foods are least likely to cause you pain.”
“You should avoid eating any raw fruits and vegetables.”
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?
The patient is experiencing intermittent waves of nausea.
The patient complains of 7/10 (0 to 10 scale) abdominal pain.
The patient has absent breath sounds in the left anterior chest.
The patient has hypoactive bowel sounds in all four quadrants.
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
sucralfate at bedtime and antacids before each meal.
sucralfate and antacids together 30 minutes before meals.
antacids 30 minutes before each dose of sucralfate is taken.
antacids after meals and sucralfate 30 minutes before meals.
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
administer IV metoclopramide (Reglan).
discontinue the patient’s oral food intake.
administer cobalamin (vitamin B12) injections.
teach the patient about total colectomy surgery.
Which patient statement indicates that the nurse’s teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?
“The medication will be tapered if I need surgery.”
“I will need to use a sunscreen when I am outdoors.”
“I will need to avoid contact with people who are sick.”
“The medication will prevent infections that cause the diarrhea.”
Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?
Scrambled eggs
White toast and jam
Oatmeal with cream
Pancakes with syrup
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?
Bacteria in the perianal area can enter the urethra.
Fistulas can form between the bowel and bladder.
Drink adequate fluids to maintain normal hydration.
Empty the bladder before and after sexual intercourse.
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?
Teach about a low-residue diet.
Monitor output from the stoma.
Assess the perineal drainage and incision.
Encourage acceptance of the colostomy stoma.
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
place ice packs around the stoma.
notify the surgeon about the stoma.
monitor the stoma every 30 minutes.
document stoma assessment findings.
Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?
Restrict fluid intake to prevent constant liquid drainage from the stoma.
Use care when eating high-fiber foods to avoid obstruction of the ileum.
Irrigate the ileostomy daily to avoid having to wear a drainage appliance.
Change the pouch every day to prevent leakage of contents onto the skin.
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?
Soak in sitz baths several times each day.
Cough 5 times each hour for the next 48 hours.
Avoid use of acetaminophen (Tylenol) for pain.
Apply a scrotal support and ice to reduce swelling.
After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?
Notify the health care provider.
Obtain a stool specimen for analysis.
Teach the patient about handwashing.
Place the patient on contact precautions.
Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?
Navy bean soup and vegetable salad
Whole grain pasta with tomato sauce
Baked potato with low-fat sour cream
Roast beef sandwich on whole wheat bread
The nurse will plan to teach the patient diagnosed with acute hepatitis B about
side effects of nucleotide analogs.
measures for improving the appetite.
ways to increase activity and exercise.
administering a-interferon (Intron A).
The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for
leukopenia.
hypokalemia
polycythemia.
hypoglycemia.
Which information given by a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?
The patient had a blood transfusion in 2005.
The patient used IV drugs about 20 years ago.
The patient frequently eats in fast-food restaurants.
The patient traveled to a country with poor sanitation.
Which finding indicates to the nurse that lactulose (Cephulac) is effective for a 72-year-old man who has advanced cirrhosis?
The patient is alert and oriented.
The patient denies nausea or anorexia.
The patient’s bilirubin level decreases.
The patient has at least one stool daily.
The nurse is caring for a 73-year-old man who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?
The patient complains of right upper-quadrant pain with palpation.
The patient’s hands flap back and forth when the arms are extended.
The patient has ascites and a 2-kg weight gain from the previous day.
The patient’s skin has multiple spider-shaped blood vessels on the abdomen.
Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?
Advise limiting alcohol intake to 1 drink daily.
Schedule for liver cancer screening every 6 months.
Initiate administration of the hepatitis C vaccine series.
Monitor anti-hepatitis B surface antigen (anti-HBs) levels annually.
A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical exam?
Start the hepatitis B immunization series.
Teach the patient about hepatitis A immune globulin.
Ask whether the patient has been screened for hepatitis C.
Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).
3. A 36-year-old female patient is receiving treatment for chronic hepatitis C with pegylated interferon (PEG-Intron, Pegasys), ribavirin (Rebetol), and telaprevir (Incivek). Which finding is most important to communicate to the health care provider?
Weight loss of 2 lb (1 kg)
Positive urine pregnancy test
Hemoglobin level of 10.4 g/dL
Complaints of nausea and anorexia
After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)?
Administer hepatitis B vaccine.
Test for antibodies to hepatitis B.
Teach about a-interferon therapy.
Give hepatitis B immune globulin.
Teach about choices for oral antiviral therapy.
1. Which finding will the nurse expect when assessing a 58-year-old patient who has osteoarthritis (OA) of the knee?
Discomfort with joint movement
Heberden’s and Bouchard’s nodes
Redness and swelling of the knee joint
Stiffness that increases with movement
Which assessment finding about a patient who has been using naproxen (Naprosyn) for 6 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?
The patient has gained 3 pounds.
The patient has dark-colored stools.
The patient’s pain has become more severe.
The patient is using capsaicin cream (Zostrix).
After the nurse has finished teaching a 68-year-old patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching?
“I can take glucosamine to help decrease my knee pain.”
“I will take 1 g of acetaminophen (Tylenol) every 4 hours.”
“I will take a shower in the morning to help relieve stiffness.”
“I can use a cane to decrease the pressure and pain in my hip.”
Which action will the nurse include in the plan of care for a 33-year-old patient with a new diagnosis of rheumatoid arthritis?
Instruct the patient to purchase a soft mattress.
Suggest that the patient take a nap in the afternoon.
Teach the patient to use lukewarm water when bathing.
Suggest exercise with light weights several times daily.
A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is most appropriate?
Teach the patient about adverse effects of the RA medications.
Suggest that the patient use over-the-counter (OTC) artificial tears.
Reassure the patient that dry eyes are a common problem with RA.
Ask the health care provider about discontinuing methotrexate (Rheumatrex) .
Which information will the nurse include when preparing teaching materials for patients with exacerbations of rheumatoid arthritis?
Affected joints should not be exercised when pain is present.
Application of cold packs before exercise may decrease joint pain.
Exercises should be performed passively by someone other than the patient.
Walking may substitute for range-of-motion (ROM) exercises on some days.
Which information will the nurse include when teaching a 38-year-old male patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition?
Exercise by taking long walks.
Do daily deep-breathing exercises.
Sleep on the side with hips flexed.
Take frequent naps during the day.
The nurse notices a circular lesion with a red border and clear center on the arm of an 18-year-old summer camp counselor who is in the camp clinic complaining of chills and muscle aches. Which action should the nurse take next?
Palpate the abdomen.
Auscultate the heart sounds.
Ask the patient about recent outdoor activities.
Question the patient about immunization history.
21. Which statement by a patient with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse’s teaching about the condition?
“I will exercise even if I am tired.”
“I will use sunscreen when I am outside.”
“I should take birth control pills to keep from getting pregnant.”
“I should avoid aspirin or nonsteroidal antiinflammatory drugs.”
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?
Rheumatoid factor (RF)
Antinuclear antibody (ANA)
Anti-Smith antibody (Anti-Sm)
Lupus erythematosus (LE) cell prep
The nurse is planning care for a patient with hypertension and gout who has a red and painful right great toe. Which nursing action will be included in the plan of care?
Gently palpate the toe to assess swelling.
Use pillows to keep the right foot elevated.
Use a footboard to hold bedding away from the toe.
Teach patient to avoid use of acetaminophen (Tylenol).
The nurse determines that additional instruction is needed when a patient diagnosed with scleroderma says which of the following?
“Paraffin baths can be used to help my hands.”
“I should lie down for an hour after each meal.”
“Lotions will help if I rub them in for a long time.”
“I should perform range-of-motion exercises daily.”
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate (Rheumatrex). The patient tells the nurse, “My arthritis isn’t that bad yet. The side effects of methotrexate are worse than the arthritis.” The most appropriate response by the nurse is
“You have the right to refuse to take the methotrexate.”
“Methotrexate is less expensive than some of the newer drugs.”
“It is important to start methotrexate early to decrease the extent of joint damage.”
“Methotrexate is effective and has fewer side effects than some of the other drugs.”
Which assessment information obtained by the nurse indicates that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone (Deltasone)?
The patient has joint pain and stiffness.
The patient’s blood glucose is 165 mg/dL.
The patient has experienced a recent 5-pound weight loss.
The patient’s erythrocyte sedimentation rate (ESR) has increased.
30. The home health nurse is doing a follow-up visit to a 41-year-old patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed?
The patient takes a 2-hour nap each day.
The patient has been taking 16 aspirins daily.
The patient sits on a stool while preparing meals.
The patient sleeps with two pillows under the head.
A patient with an acute attack of gout in the right great toe has a new prescription for probenecid (Benemid). Which information about the patient’s home routine indicates a need for teaching regarding gout management?
The patient sleeps about 8 to 10 hours every night.
The patient usually eats beef once or twice a week.
The patient takes one aspirin a day to prevent angina.
The patient usually drinks about 3 quarts water daily.
A 31-year-old woman is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which information from the patient’s health history is important for the nurse to report to the health care provider about the methotrexate?
The patient had a history of infectious mononucleosis as a teenager.
The patient is trying to get pregnant before her disease becomes more severe.
The patient has a family history of age-related macular degeneration of the retina.
The patient has been using large doses of vitamins and health foods to treat the RA.
Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)?
A 38-year-old man who plays on a summer softball team
A 56-year-old man who is a member of a construction crew
A 56-year-old woman who works on an automotive assembly line
A 49-year-old woman who is newly diagnosed with diabetes mellitus
Which action will the nurse include in the plan of care for a 40-year-old with newly diagnosed ankylosing spondylitis?
Advise the patient to sleep on the back with a flat pillow.
Emphasize that application of heat may worsen symptoms.
Schedule annual laboratory assessment for the HLA-B27 antigen.
Assist patient to choose physical activities that allow the spine to flex.
After the nurse has taught a 28-year-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management?
“I am going to join a soccer team to get more exercise.”
“I will need to stop drinking so much coffee and soda.”
“I will call the doctor every time my symptoms get worse.”
“I should avoid using over-the-counter medications for pain.”
After the nurse assesses a 78-year-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management, which information is most important to report to the health care provider?
Knee crepitation is noted with normal knee range of motion.
Patient reports embarrassment about having Heberden’s nodes.
Patient’s knee pain while golfing has increased over the last year.
Laboratory results indicate blood urea nitrogen (BUN) is elevated.
During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (select all that apply)?
Sleep disturbances
Multiple tender points
Cardiac palpitations and dizziness
Multijoint pain with inflammation and swelling
Widespread bilateral, burning musculoskeletal pain
A 28-year-old with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider?
Crackles are heard in both lung bases.
Red, scaly patches are noted on the arms.
Hemoglobin level is 11.1g/dL and hematocrit is 35%.
Patient reports continued back pain after a week of etanercept therapy.
The health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question?
Draw anti-DNA blood titer.
Administer varicella vaccine.
Naproxen (Aleve) 200 mg BID.
Famotidine (Pepcid) 20 mg daily.
The nurse will anticipate the need to teach a 57-year-old patient who has osteoarthritis (OA) about which medication?
Adalimumab (Humira)
Prednisone (Deltasone)
Capsaicin cream (Zostrix)
Sulfasalazine (Azulfidine)
