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NCM 116 - SEMIFINAL EXAMINATION

Total questions: 50

Worksheet time: 25mins

Name
Class
Date
1.

The client with proctitis is asking the nurse about disease process. The nurse on duty correctly responds that the frequent cause is:

a)

trauma

b)

inflammation

c)

infection

d)

fistula formation

2.

Proctitis is prevalent among the following group:

a)

Middle Aged Males

b)

Post Menopausal Females

c)

Sexually Active Homosexuals

d)

Older Heterosexuals

3.

The most common pathogenic agents of Colonic enteritis are the following:

a)

Treponema Pallidum and Chlamydia Trachomatis

b)

Neisseria Gonorrhea and Herpes Simplex Virus

c)

Shigella and Campylobacter Species

d)

E. Histolytica and Dracunculus Medinensis

4.

The patient is admitted with diagnosis of Herpes Simplex 1 and he is taking Acyclovir (Zorivax). Before taking the medication, the nurse must assess the patient for ______.

a)

Flushing

b)

Diarrhea

c)

Orthostatic hypotension

d)

Urticaria

5.

The patient with inflammation of the mucosa of rectum is taking oral Erythromcin antibiotic. The nurse in charge of the patient must include health teachings about not giving the medication with fruit juices because.

a)

It increases gastric acid secretions in the stomach which dilute the medication

b)

Acids in fruit juices decrease the activity of the drug

c)

It decreases gastric acid secretions in the stomach which alters the potency of the drug

d)

Acids in fruit juices increase the activity of the drug

6.

A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). What intervention by the nurse will determine the effectiveness of treatment?

a)

Carrying out hematest on gastric fluids after the infusion is completed

b)

Checking the frequency and consistency of bowel movements.

c)

Monitoring the leukocyte count for 2 days after the infusion

d)

Checking serum liver enzyme levels before and after the infusion

7.

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching?

a)

"It is normal to feel gassy or bloated after the procedure."

b)

"The abdominal muscles may be tender from the procedure."

c)

"It is alright to drive once I've been home for an hour or so."

d)

"Intake should be light at first and then progress to regular intake."

8.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding if noted on assessment of the client, would the nurse report to the physician?

a)

Hypotension

b)

Bloody diarrhea

c)

Rebound tenderness

d)

A hemoglobin level of 12 mg/dl

9.

The nurse is caring for a client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care?

a)

Sexual dysfunction

b)

Body image, disturbed

c)

Fear related to poor diagnosis

d)

Nutrition: more than body requirements, imbalanced

10.

The nurse is reviewing the record of a client with Crohn's disease. Which stool charactersitic should the nurse expect to note documented in the client's record?

a)

Diarrhea

b)

Chronic constipation

c)

Constipation alternating with diarrhea

d)

Stool constantly oozing from the rectum

11.

The nurse is performing a colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action?

a)

Notify the physician

b)

Stop the irrigation temporarily

c)

Increase the height of the irrigation

d)

Medicate for pain and resume the irrigation

12.

The nurse is assessing the stoma prolapse in a client with a colostomy. What should the nurse observe if stoma prolapse occurs?

a)

Protruding stoma

b)

Sunken and hidden stoma

c)

Narrowed and flattened stoma

d)

Dark and bluish-colored stoma

13.

The client had a new colostomy created from Hartmann procedure 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

a)

This is a normal, expected event

b)

The client is experiencing early signs of ischemic bowel

c)

The client should not have the nasogastric tube removed

d)

This indicates inadequate preoperative bowel preparation

14.

The client with a new colostomy is concerned about the odor from stool in the ostomy drainage bag. The nurse teaches the client to include which food in the diet to reduce odor?

a)

Eggs

b)

Yogurt

c)

Broccoli

d)

Cucumbers

15.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the appropriate nursing intervention?

a)

Notify the physician

b)

Administer the prescribed pain medication

c)

Call and ask the operating room team to perform the surgery as soon as possible

d)

Repositioning the client and apply a heating pad on warm setting to the client's abdomen

16.

The client with Crohn's disease has a nursing diagnosis of pain, acute. The nurse should teach the client to avoid which action in managing this problem?

a)

Massaging the abdomen

b)

Using relaxation techniques

c)

Using antispasmodic medication

d)

Lying supine with legs straight

17.

The client with ulcerative colitis has an order to begin a salicylate medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication?

a)

On arising

b)

After meals

c)

On an empty stomach

d)

30 minutes before meals

18.

A client is admitted with a diagnosis of acute diverticulitis. What nursing intervention is appropriate for this client?

a)

Instruct the client to remain NPO

b)

Encourage ambulation at least four times daily

c)

Administer cholinergic medications to reduce pain

d)

Encourage coughing and deep breathing every 2 hours

19.

A client has just had a hemorrhoidectomy. What nursing intervention is appropriate for this client?

a)

Instruct the client to limit fluid intake to avoid urinary retention

b)

Instruct the client to eat low-fiber foods to decrease the bulk of the stool

c)

Apply and maintain ice packs over the dressing until the packing is removed

d)

Help the client to a fowler's position to place pressure on the rectal area and decrease bleeding

20.

The nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. Which risk factor for colorectal cancer should the nurse include?

a)

Age older than 30 years

b)

High fiber, low-fat diet

c)

Distant relative with colorectal cancer

d)

Personal history of ulcerative colitis or gastrointestinal polyps

21.

A nurse instruct the client with Diverticulitis to avoid high-fiber foods when inflammation occurs because:

a)

Foods rich in fiber increase fluids in the intestine

b)

Foods rich in fiber causes less absorption of nutrients

c)

Foods rich in fiber irritate the mucosa further

d)

Foods rich in fiber stimulates peristalsis

22.

The patient admitted in the hospital with diagnosis of diverticulosis was given instruction to avoid foods that might cause inflammation. The nurse determines that the patient understood the instructions by avoiding the following foods EXCEPT.

a)

Gas forming foods

b)

Foods containing indigestible roughage

c)

Soft high-fiber foods

d)

Seeds or nuts

23.

The patient with Ulcerative Colitis is likely to experience deficiency in_____.

a)

Vitamin A

b)

Vitamin B

c)

Vitamin C

d)

Vitamin K

24.

WHich of the following findings in a 13 year old girl who has Crohn's disease would indicate that corticosteroid therapy has been effective?

a)

Expansion of muscle mass

b)

Iincrease in the number of stools

c)

Moon-like appearance of the face

d)

Decreased complaints of abdominal pain

25.

A patient who had an excision of an anal fistula has sitz bath ordered. The nurse should instruct the patient that the purpose of the sitz bath is to

a)

Prevent infection

b)

Relax the anal sphincter

c)

Localize the drainage

d)

Promote comfort

26.

A six year old child who has celiac disease is selecting food items from a hospital menu. Based on an understanding of celiac disease, a nurse would discourage the child from selecting which of the following foods?

a)

Fried sweet potatoes

b)

Corn meal muffin

c)

Puffed rice cereal

d)

Whole wheat toast

27.

A six month old infant is suspected of having intussusception. A nurse should expect the child to undergo which of the following procedures?

a)

Colonoscopy

b)

Rectal biopsy

c)

Barium enema

d)

Cholangiography

28.

A patient who has ulcerative colitis does not respond to the prescribed therapy and is admitted to the hospital for a total colectomy and creation of an ileostomy. Which of the following measures should be given priority in the patient's preoperative care plan?

a)

Promoting the patient's acceptance of an ileostomy

b)

Monitoring the patient's emotional state

c)

Preventing the patient from developing pressure sores

d)

Correcting the patient's fluid balance

29.

A patient who has had an ileostomy says to the nurse, "I will have to be isolated for the rest of my life because no one will be able to stand this terrible odor." Which of the following responses by the nurse would most likely be reassuring?

a)

"The odor will gradually become less noticeable."

b)

"I can understand your concern, but remaining in isolation does not reduce the odor."

c)

"There are techniques that can reduce the odor."

d)

"The odor is a normal part of your condition and will not offend people."

30.

The treatment plan for a 14 year old child who has ulcerative colitis includes chronic use of high-dose corticosteroids. Because of the use of this medication, the child is at risk for

a)

Growth retardation

b)

Peripheral neuropathy

c)

Muscular degeneration

d)

Hyperkalemia

31.

A nurse would expect a patient who has ulcerative colitis to report which of the following manifestations of the disease?

a)

Abdominal distention

b)

Bloody diarrhea

c)

Esophageal reflux

d)

Flank pain

32.

Lomotil is prescribed for a patient. When the patient returns to the clinic, the nurse should evaluate the therapeutic effectiveness of Lomotil by assessing the patient's

a)

Weight

b)

Number of daily bowel movements

c)

Amount of daily food intake

d)

Skin turgor

33.

The patient is suspected f having necrotizing enterocolitis, which of the following assessments is essential that a nurse perform?

a)

Probe the anus for patency

b)

Percuss the liver to determine size

c)

Palpate the abdomen for rebound tenderness

d)

Check the stool for occult blood

34.

When assessing a patient who has ulcerative colitis, a nurse would expect to identify a decrease in which of the following laboratory serum values?

a)

Albumin

b)

Calcium

c)

Platelets

d)

Prothrombin time

35.

To which of the following nursing diagnosis would a nurse give priority in caring for a patient who has inflammatory bowel disease?

a)

Social Isolation

b)

Risk for Impaired Skin Integrity

c)

Constipation

d)

Altered Nutrition: Less than body requirements

36.

A patient who has ulcerative colitis is scheduled for surgery for creation of an ileostomy. The patient asks a nurse why the surgery is necessary. The nurse would respond that the purpose is to

a)

Removed the diseased portion of the bowel

b)

Prevent the development of colon cancer

c)

Limit the spread of disease in the intestine

d)

Reduce the loss of nutrients from the gut

37.

The patient returns to the unit following the surgical creation of a double-barreled colostomy. Which type of drainage from the patient's bowel would a nurse expect to find postoperatively?

a)

Mucoid drainage from the distal stoma

b)

Fecal material from the distal stoma

c)

Black tarry stool from the rectum

d)

Bright red blood from the rectum

38.

A nurse obtains a diet history from a patient who has ulcerative colitis. The nurse should determine that the patient needs teaching if the patient indicated which of these foods as being part of the diet?

a)

Celery

b)

Bananas

c)

White rice

d)

Roast chicken

39.

Because of an outbreak of Escherichia coli - related diarrhea in the community, a public health nurse should instruct parents about measures to prevent further occurence, which include

a)

Cooking all chopped meats thoroughly

b)

Drinking bottled mineral water

c)

Sanitizing kitchen surfaces daily

d)

Swimming in chlorine-treated water

40.

Which of the following teaching instructions would a nurse include for a patient who has regional enteritis?

a)

"Limit your dietary protein intake."

b)

"Reduce exposure to air pollutants."

c)

"Decrease your activity level."

d)

"Avoid drinking fruit juices."

41.

Which of the following statements would a nurse include in the preoperative instruction of a patient who is scheduled for an ileostomy?

a)

"You will have one bowel movement per day."

b)

"The stool drainage will be of liquid consistency."

c)

"The pouch will be located on the left side of your abdomen."

d)

"You will be taught how to irrigate your bowel through the stoma.'

42.

Which of the following statements if made by the client who is scheduled for a sigmoid colostomy, would indicate to a nurse that the patient needs further instruction?

a)

"I will have one formed bowel movement daily."

b)

"I will have continuous drainage of liquid stool."

c)

"The pouch will be located on the left side of my abdomen."

d)

"I will be taught how to irrigate my bowel through the stoma."

43.

Which of the following statements, if made by a patient who has diverticulosis, would indicate to a nurse that the patient is following the diet plan correctly?

a)

"I eat meat five times a week.'

b)

"I do not eat fried foods."

c)

"I drink decaffeinated coffee."

d)

"I eat a green salad every day."

44.

A 10 year old boy is admitted to the hospital with a history of fever and right, lower quadrant abdominal pain. Which of the following comfort measures would be taken until a diagnosis is made?

a)

Maintain the child in a recumbent position

b)

Apply warm compresses to the affected area

c)

Obtain an order for an age-appropriate analgesic

d)

Distact the child with an age-appropriate video

45.

When a 12 year old child has a diagnosis of appendicitis, which of the following manifestations would be most important for the nurse to follow up?

a)

Tympanic temperature of 38.4 degrees celsius

b)

Absence of stool for 24 hours

c)

Nausea when exposed to food odors

d)

Cessation of abdominal pain

46.

When assessing a patient who underwent a colostomy several months ago, a nurse would expect the stoma to appear

a)

Dry

b)

Red

c)

Edematous

d)

Retracted

47.

Which of the following snacks would be appropriate for a patient on a low-fat diet?

a)

A slice of baked apple pie

b)

Cheddar cheese and crackers

c)

Vanilla yogurt

d)

Mixed nuts

48.

The nurse should monitor a patient who is receiving lactulose for which of the following adverse side effects?

a)

Diarrhea

b)

Petechiae

c)

Polyuria

d)

Flushing

49.

Which of the following factors, if noted in a patient's history, would predispose the patient to the development of diverticulitis?

a)

Occupational stress

b)

Cigarrette smoking

c)

Low-fiber diet

d)

Sedentary lifestyle

50.

Which of the following findings, if identified in a patient who is receiving Intravenous Ceftriaxone sodium (Rocephin) for the treatment of bacterial infections, indicates that the nurse should question using Rocephin?

a)

Urinary frequency

b)

Frontal headache

c)

Back pain

d)

Moderate itching