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WorksheetsPreliminary Examination in NCM 116 Medical-Surgical Nursing
Total questions: 50
Worksheet time: 4hrs 10mins
A nurse is reviewing the medication record of a client with acute gastritis. Which of the following medications, if noted on the client’s record, would the nurse question?
Digoxin (Lanoxin).
Ibuprofen (Alaxan).
Furosemide (Lasix).
Propanolol hydrochloride (Inderal).
The nurse must monitor a patient with gastritis for signs of bleeding or hemorrhage which includes
Diminishing pulse rate.
An incline in the patient’s blood pressure.
Vomiting of blood.
All of the above choices.
A hospitalized client with gastroesophageal reflux disease (GERD) is complaining of chest discomfort that feels like heartburn following a meal. After administering a prescribed antacid, the nurse would encourage a client to lie in which position?
Supine, with head of bed flat.
On the stomach with the head flat.
On the left side, with the head of bed elevated 30 degrees.
On the right side, with the head of bed elevated 30 degrees.
A nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances that would increase the lower esophageal sphincter (LES) pressure. The nurse tells the client to include which item in the diet?
Fatty foods.
Nonfat milk.
Tea.
Coffee.
The client attends two sessions with the dietician to learn about diet modifications to minimize GERD. The teaching would be judged successful if the client says that she will decrease her intake of.
Fats
High-sodium diet
Carbohydrates
High-calcium foods
Which of the following dietary measures would be useful in preventing esophageal reflux?
Eating small, frequent meals, avoiding overeating.
Belching frequently to reduce abdominal distention.
Avoiding air swallowing with meals.
While the client is bleeding, it will be essential for the nurse to assess frequently for signs of early shock. Which one of the following is an important indicator of early shock?
Tachycardia.
Dry, flushed skin.
Increased urine output.
Loss of consciousness.
If the client develops a sudden sharp pain in the mid-epigastric region along with a rigid, board-like abdomen, the nurse should understand that these clinical manifestations most likely indicate that:
An intestinal obstruction has developed.
Additional ulcers have developed.
The esophagus has become inflamed.
The ulcer has perforated.
The client tells the nurse that he had black stools before admission to the hospital but had not reported this to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?
Ineffective individual coping related to fear of diagnosis of chronic illness.
Knowledge deficit related to unfamiliarity with significant signs and symptoms.
Constipation related to decreased gastric motility.
Altered nutrition: less than body requirements related to gastric bleeding.
The client asks the nurse what causes ulcer to develop. The nurse responds that recent research indicates that many peptic ulcers are the result of:
Work-related stress.
Helicobacter pylori infection.
Diets high in fat and spicy foods.
A genetic defect in the gastric mucosa.
The client has been taking Gaviscon at home. The nurse should prepare a teaching plan for the client that indicates the medication acts primarily to:
Suppress gastric secretions.
Neutralize acid in the stomach.
Shorten the time required for digestion in the stomach.
Improve the mixing of foods and gastric secretions.
The nurse is preparing to teach the client with PUD about the diet he should follow at home after discharge. The nurse should explain that his diet will most likely consist of:
Full liquid and pureed food.
High fat, high protein foods.
Any food that he can tolerate, avoiding spices and caffeine.
A. Six meals a day.
Which one of the following statements indicates that the client with PUD did not understand the dietary modifications he will need to follow at home?
I should eat a bland, soft diet.
It is important to eat six small meals a day.
I should drink several glasses of milk a day.
I should avoid alcohol and caffeine.
Which of the following activities should the nurse encourage the client with a peptic ulcer to avoid?
Chewing gums.
Smoking cigarettes.
Eating chocolate.
A. Taking Paracetamol (Biogesic)
The client is admitted with duodenal ulcers. What will the nurse anticipate the history to include?
Recent weight loss.
Increasing indigestion after meals.
Awakening with pain at night.
Episodes of vomiting.
The client has been taking aluminum hydroxide (Amphogel), 30 ml. six times per day, at home. Hell tells the nurse at the clinic that he has not been able to have a bowel movement for 3 days. Based on this information, the nurse would determine that the client most likely :
Has not been including enough fiber in his diet.
Needs to increase his daily exercise.
Is experiencing a side effect of the aluminum hydroxide.
Has developed a GI obstruction.
The client has been taking magnesium hydroxide (Milk of Magnesia) at home is in an attempt to control her symptoms. The nurse should be aware that the most common complaint associated with the ongoing use of magnesium-based antacids is:
Anorexia.
Weight gain.
Diarrhea.
Constipation.
A nurse is monitoring a client with a diagnosis of peptic ulcer. Which finding would most likely indicate perforation of the ulcer?
Bradycardia.
Numbness in the legs.
Nausea and vomiting.
A rigid, board-like abdomen.
A client with peptic ulcer disease is scheduled for a pyloroplasty and the client asks the nurse about the procedure. The nurse bases the response on which of the following?
A pyloroplasty involves cutting the vagus nerve.
A pyloroplasty involves removing the distal portion of the stomach.
A pyloroplasty involves removal of the ulcer and a large portion of the cells that produce hydrochloric acid.
A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
A client with peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. The nurse tells the client that a vagotomy:
Decreases food absorption in the stomach.
Heals the gastric mucosa.
Halts stress reactions.
Reduces the stimulus to acid secretions.
The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to help prevent dumping syndrome?
Eat high-carbohydrate foods.
Limit the fluids taken with meals.
Ambulate following a meal.
A. Sit in a high Fowler’s position during meals.
A nurse is monitoring a client for the late signs and symptoms of dumping syndrome. Which of the following symptoms will indicate this occurrence?
Dry skin and stomach pain.
Bradycardia and indigestion.
Sweating and pallor.
Double vision and chest pain.
A client with ascites is scheduled for a paracentesis. The nurse is assisting the physician in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure?
Flat.
Left side-lying.
Right side-lying.
Upright.
A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse would interpret that which of the following items mentioned by the client is most likely responsible for the exacerbations?
Sleeping 8 to 10 hours at night.
Eating five or six small meals per day.
Ability to work at home periodically.
Frequent need to work overtime on short notice.
A client with hiatal hernia chronically experiences heartburn following meals. The nurse would teach the client to avoid which of the following, which is contraindicated with hiatal hernia?
Eating small, frequent, bland meals.
Lying recumbent following meals.
Raising the head of bed on six-inch blocks.
Taking histamine receptor antagonist medication, as prescribed.
The nurse instructs the client on health maintenance activities to help control her symptoms from hiatal hernia. Which of the following statements would indicate the client has understood the instructions?
I’ll avoid lying down after a meal.
I can still enjoy my potato chips and cola at bedtime.
I wish I didn’t have to give up swimming.
If I wear a girdle, I’ll have more support for my stomach.
Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent:
Esophageal reflux.
The feeling of fullness after meals.
Esophagitis.
Ulcer formation.
Of the following statements about Regional Enteritis, which one is considered to be incorrect?
Most commonly affects the large bowel, especially in the area of the terminal ileum. Lesions may also arise in the cecum and ascending colon.
Edema, inflammation, and fibrosis occur- involving the innermost layer of the bowel wall.
Inflammatory process occurs in patchy segments, separated by normal tissue.
Client may experience periods of complete remission that alternate with exacerbations.
Complications of Crohn’s disease include all of the following, except?
Perirectal and intraabdominal fistulas.
Perforation and generalized peritonitis.
Nutritional deficiencies.
Hypervolemia.
Which of the following is not considered a clinical manifestation of Ileitis?
Anemia.
Multiple diarrheal stools (<20)
Weight loss.
Severe hematochezia.
Which statement can be regarded as the best description for the etiology and risk factors of Crohn’s disease?
May begin in adolescence; peak incidence occurs between ages 20 and 40 years.
Familial tendencies.
Food allergies.
Smoking.
Common clinical manifestations of Crohn’s disease are:
Abdominal pain and diarrhea.
Edema and weight gain.
Nausea and vomiting.
Fever and chills.
Which of the following is the most common site of diverticulitis?
Ascending colon.
Jejunum.
Sigmoid colon.
Ileum.
A positive Rovsing’s sign is indicative of appendicitis. The nurse knows to assess for this indicator by palpating the:
RLQ.
LLQ.
RUQ.
LUQ.
Clinical manifestations associated with small-bowel obstruction include all of the following, except:
Dehydration.
Pain that is wave-like.
Vomiting.
The passage of blood-tinged stool.
An indicator of probable esophageal varices is:
Hematemesis.
Melena.
(+) Guaiac test.
All of the above choices.
Clinical manifestations of common bile duct obstruction include all of the following, except:
Amber-colored urine.
Clay-colored feces.
Pruritus.
Jaundice.
A nurse is caring for a client with possible cholelithiasis who is being prepared for a cholangiogram and provides instructions to the client about the procedure. Which client statement indicates that the client understands the purpose of this test?
“They are going to look at my gallbladder and ducts.”
“This procedure will drain my gallbladder.”
“My gallbladder will be irrigated.”
“They will put medication in my gallbladder.”
A nurse is caring for a client with acute pancreatitis and a history of alcoholism and is monitoring the client for complications. Which of the following data would be a sign of paralytic ileus?
Firm, nontender mass palpable at the lower right costal margin.
Severe, constant pain with rapid onset.
Inability to pass flatus.
Loss of anal sphincter control.
A nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The client has tolerated the tube being clamped every two hours for 1 hour and the physician has now ordered the nasogastric tube to be discontinued. To determine the client’s readiness for discontinuation of the nasogastric tube, the nurse should check for:
Proper nasogastric tube placement.
The client’s serum electrolyte levels.
Presence of bowel sounds in all four quadrants.
The pH of the gastric aspirate.
A nurse is reviewing the record of a client with Crohn’s disease. Which of the following stool characteristics would the nurse expect to note documented in the record?
Bloody stools.
Diarrhea.
Constipation.
stool constantly oozing from the rectum.
A nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. To check for the presence of this sign, the nurse would do which of the following?
Ask the client to extend the arms.
Check for the presence of Homan’s sign.
Instruct the client to lean forward.
Measure the abdominal girth.
A nurse is reviewing the laboratory results of a client with cirrhosis and notes that the ammonia level is elevated. Which of the following diets would the nurse anticipate would most likely be prescribed for this client?
High-carbohydrate.
Moderate fat.
High-protein.
Low-protein.
Lactulose (Chronulac) is prescribed for a client with a diagnosis of hepatic encephalopathy. Which finding indicates that the client is responding to this medication therapy as anticipated?
The fecal pH is acidic.
The client experiences diarrhea.
The client is able to tolerate a full diet.
Vomiting occurs.
A nurse is reviewing the physician’s orders written for a client admitted with acute pancreatitis. Which physician’s order would the nurse verify if noted on the client’s chart?
NPO status.
Prepare to insert a nasogastric tube.
An anticholinergic medication.
Morphine sulfate for pain.
The client with chronic pancreatitis needs information on dietary modification to manage health problems. The nurse teaches the client to limit which of the following items in the diet?
Carbohydrate.
Protein.
Fat.
Water-soluble vitamins.
A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse tells the client to avoid which position that could aggravate the pain?
Sitting up.
Lying flat.
Leaning forward.
Flexing the left leg.
A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse would plan a dietary consult to limit the amount of which ingredient in the client’s diet?
Fat.
Carbohydrate.
Protein.
Minerals.
The client with liver cirrhosis experiences ascites. This is due to:
Elevated serum ammonia level.
Impaired excretion of bilirubin.
Portal hypertension, hyperaldosteronism, hypoalbuminemia.
Inability of the liver to metabolize nutrients and to store fat-soluble vitamins.
The purpose of administering neomycin sulfate to the client with liver cirrhosis is to:
Reduce colonic bacterial flora and inhibit ammonia formation.
Lower the pH of the colon and inhibit the formation of alkaline ammonia.
Remove digested blood from the colon.
Reduce serum potassium levels.
