NURS 3700 Exam 3 | Questions and Answers (Complete Solutions)

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NURS 3700 Exam 3 | Questions and Answers (Complete Solutions) The nurse is giving a patient instructions regarding the management of GERD. What statement indicates that further teaching is required... ? A. I should avoid drinking any red wine B. Chewing gum may help me relieve my symptoms C. I should eat small, frequent meals throughout the day D. I can have warm milk at bedtime but not chocolate milk A 54 year old patient admitted with cancer has not been able to eat because of nausea. What strategies would the nurse implement? (Select all that apply) A. Serve foods that are warm-to-hot in temperature B. Offer the patient meats and foods with mild spices C. Offer a diet that appeals to the patient's preferences D. Administer antiemetics one hour before meals to prevent nausea E. Offer the patient foods such as cooked cereal and soft or canned fruits. A patient reports hematemesis and burning pain in the stomach. The nurse suspects peptic ulcer disease and anticipates that which diagnostic test will be prescribed. A. Colonoscopy B. Upper GI study C. Abdominal ultrasound D. MRI A patient who is scheduled for gastric bypass surgery asks for information about dumping syndrome. How does the nurse explain dumping syndrome? A. The inability to digest high-fat foods B. When the passage of food into the small intestine occurs too rapidly C. A decrease in the secretion of insulin caused by carbohydrates. D. An increase in secretion of both bile and pancreatic enzymes. Which assessment finding is considered a classic manifestation in lower extremity PAD? A. Rest pain B. Skin ulcerations C. Intermittent claudication D. Paresthesia in the feet and bones The nurse provides care for a patient one day after the patient underwent peripheral artery bypass surgery. Which intervention will the nurse include in the patient's care? A. Maintain patient bed rest B. Assist the patient with walking several times C. Encourage the patient to sit in the chair several times D. Place the patient in a side-lying position with the knees flexed. A patient reports fingers and toes that change color from pallor to cyanosis to rubor when exposed to cold temperatures. The patient states that, after the color change, the digits are throbbing, achy, and tingly. Which condition would the nurse suspect? A. Aortic aneurysm B. Raynaud's phenomenon C. Post- thrombotic syndrome D. Superficial vein thrombus The nurse is assessing a patient with lower extremity PAD. Which clinical manifestation would the nurse expect to find. A. Presence of peripheral pulses B. Heaviness in the calf or thigh C. Loss of hair on legs, feet, and toes D. Presence of edema in the lower leg A male Hispanic patient is diagnosed with PAD. The patient's health history includes smoking and depression. Which risk factor does this patient have for PAD? A. Gender B. Tobacco C. Ethnicity D. Comorbidity The results of a patient's recent endoscopy indicate the presence of PUD. Which teaching point would the nurse provide to the patient? A. You'll need to drink 2 to 3 glasses of milk daily B. It would be beneficial for you to eliminate drinking alcohol. C. Many people find that a minced or pureed diet eases the symptoms of PUD. D. Medications will allow you to maintain your present diet while minimizing symptoms. A nurse is caring for a patient diagnosed with PUD. Which complication would result in gastric contents spilling into the patient's peritoneal cavity? A. Perforation B. Hemorrhage C. Dumping syndrome D. Gastric outlet obstruction The nurse is caring for a patient with PUD. On a follow up visit, the health care provider identifies spillage of gastric contents into the space between the abdominal cavity and the abdominal wall. Which complication may occur if the condition is untreated? A. Pernicious anemia B. Bile reflux gastritis C. Bacterial peritonitis D. Postprandial hypoglycemia A patient reports gastric distress that occurs to to five hours after meals, with "burning" and "cramping" pain just below the xiphoid process. Which disorder would the nurse suspect that the patient may have? A. Esophagitis B. Gastric ulcer C. Bacterial peritonitis D. Chronic gastritis Following a gastrectomy performed for PUD, the patient is ready for discharge. Which instructions would the nurse include in discharge teaching? A. Take fluids along with meals B. Reduce protein and fats in the diet C. Divide meals into six small feedings D. Use concentrated sweets like honey, jam, and jelly. A patient with PUD starts vomiting. Which type of emesis is associated with the bleeding in the stomach? A. Fecal B. Bilious C. "Coffee Ground" D. Undigested food A 72-year old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? A. Chest pain relived with eating or drinking water B. Back pain three or four hours after eating a meal C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen Which symptom would the nurse expect in a patient who has a gastric ulcer perforation? A. Pyrosis B. Rigid abdomen C. Bright-red emesis D. Clay-colored stools A patient receives a prescription for 60 mg enoxaparin. Which injection site would the nurse use to administer the medication safely? A. Flank B. Thigh C. Deltoid D. Abdomen The health care provider prescribes warfarin for a patient VTE. Which information would the nurse include in the patient's discharge teaching plan? A. No routine laboratory monitoring is needed B. Avoid contact sports and high risk activities C. Increase daily intake of dark-green, leafy vegetables. D. Continue to use garlic as a dietary supplement. A patient presents with symptoms of VTE in the calf. Which study would the nurse expect to be prescribed to investigate for VTE? A. Duplex ultrasound B. Contrast venography C. Magnetic resonance venography D. Computed tomography venography The nurse is performing a physical assessment on a patient with CVI. Which manifestation involving the lower extremities would the nurse expect? A. Shiny skin B. Absent pulses C. Brownish color D. Lack of sensation Which intervention would the nurse include in the care of a patient who has CVI? A. Application of topical antibiotics to venous ulcers B. Administering oral or subcutaneous anticoagulants C. Maintaining the patient's legs in a dependent position D. Teaching the patient the correct use of compression stockings Which organism causes gastritis? A. Streptococcus B. Fusiform bacteria C. Candida albicans D. Helicobacter Pylori Assessment findings of a patient include anorexia, nausea, and vomiting, and epigastric tenderness. Which condition would the nurse suspect? A. Gastritis B. Achalasia C. Stomach cancer D. Upper GI bleeding To prevent the recurrence of gastritis, which instruction would the nurse provide to the patient? A. Take Tylenol and ibuprofen for pain B. Stop smoking and drinking C. Consume a regular diet with moderate spices and seasonings D. Request a prescription for corticosteroids from the health care provider Which condition is the most common cause for hematemesis? A. Thalassemia B. Sickle cell disease C. Pernicious anemia D. PUD A patient with acute gastritis has an NG tube to low-intermittent suction with bilious drainage. Later the nurse observes that the drainage is blood-tinged. What action would the nurse take next? A. Assess the patient's pain B. Obtain a set of vital signs C. Page the health care provider D. Document the data in the patient's record Which surgical treatment may result in the complications of weight loss, dumping syndrome, and impaired wound healing? A. Mandibulectomy B. Total gastrectomy C.Hemiglossectomy D. Nissen Fundoplication The nurse notes that a patient who had a total gastrectomy the day before has a very small amount of fluid draining from the NG tube. Which action would the nurse take? A. Increase the power on the suction device B. Irrigate the NG tube with 50 mL of sterile saline C. Continue to monitor the patient and the drainage D. Notify the health care provider immediately. A patient reports nausea and burning epigastric pain. The patient takes NSAIDS on a regular basis to relieve headaches. Which condition would the nurse suspect? A. Gastritis B. Achalasia C. Oral cancer D. Esophageal varices What type of medication increases a patient's risk for upper GI bleeding? A. Antacids B. Anticholinergics C. Tricyclic antidepressants D. NSAIDS A patient with abdominal trauma is at a risk for the development of hypovolemic shock. The nurse expect which assessment finding? A. Respiratory rate of 16 BPM B. Heart rate of 58 BPM C. BP of 80/42 mmHg D. Increased pulse pressure The nurse provides post-op care 8 hours after a patient underwent a laparotomy. The nurse assesses the drainage rom the nasogastric tube and notifies the health care provider immediately about which finding? A. Bright red drainage B. Bright green drainage C. Dark-brown drainage D. Dark-red drainage The nurse assesses a patient and suspects appendicitis based on which findings? Select all that apply A. Muscle guarding B. High grade fever C. Pain at McBurney's point D. Pain decreased by coughing E. Patient prefers to lie still, with the right leg flexed The nurse is caring for a patient with an acute onset of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. When auscultating the patient's abdomen, the nurse expects which bowel sounds? A. Borborygmus B. Absent C. Low-pitched below the area of the obstruction D. High-pitched above the area of obstruction The nurse provides preoperative care for a patient with a ruptured appendix and the presence of peritonitis. The nurse prepares to administer which type of medication? A. Benzodiazepine B. Antiemetic C. NSAID D. Antibiotic Which condition involves inflammation of all layers of the bowel wall? A. Peritonitis B. Gastroenteritis C. Crohn's Disease D. Ulcerative Colitis The nurse assigns which diagnostic statement as the highest priority in the plan of care for a patient who has ulcerative colitis? A. Activity intolerance B. Deficient fluid volume C. Impaired tissue integrity D. Risk for impaired skin integrity A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. Which condition does the nurse suspect? A. Peritonitis B. Appendicitis C. Gastroenteritis D. Ulcerative Colitis When selecting the site for a patient's ostomy, which consideration does the health team make? A. The patient should be able to see the site B. Outside the rectus muscle area is the best site C. It is ideal if an abdominal stoma site can easily be bend D. The ostomy should be conveniently located to allow for routine irrigation. The nurse provides postoperative care one day after a patient undergoes colotomy surgery. The patient's stoma is most and dark pink, with no obvious drainage. Which action does the nurse take? A. Document the normal findings B. Consult the wound, ostomy, and continence nurse C. Irrigate the ostomy with normal saline D. Palpate the abdomen around the stoma The nurse provides education about a double-barreled stoma for a group of nursing students and includes which information? A. It has distal functioning stoma called a mucus fistula B. It involves the creation of a proximal nonfunctioning stoma C. IT is usually performed in a patient who requires a permanent ostomy D. It involves brining both the proximal and distal ends through the abdominal wall as two separate stomas The nurse assess the stoma of a patient who has undergone ostomy surgery and identifies that which finding indicates ischemia? A. Pale stoma B. Dark-pink stoma C. Dusky-blue stoma D. Brown-black stoma The nurse teaches self-care of a stoma to a patient who as undergone ostomy surgery. Which statement made by the patient indicated need for further teaching? A. I should limit my fluid intake B. I should empty my pouch before it is one-third full C. I can irrigate the colostomy to stimulate emptying of my colon D. I should replace the skin barrier when the one in place no longer lies flat on my skin and is leaking. A patient who is being admitted with severe abdominal pain vomits a large amount of emesis that looks like coffee grounds. Which action would the nurse take first? A. Ask the patient about the timing of the last meal B. Complete the admission history and documentation C. Monitor the patient for any further episodes of nausea and vomiting D. Notify the health care provider about the patient's condition The nurse is caring for a patient in the initial postoperative period after an ileostomy surgery. Which is the priority nursing action? A. Using charcoal filters to release patient flatus B. Providing the patient with a list of foods to avoid C. Giving the patient the names and contact information for their support groups. D. Using transparent pouches for the patient After the patient has undergone an esophagogastroduodenoscopy (EGD), which is the nursing priority. A. Provide warm saline gargles for relief of sore throat B. Assess the patient's bowel sounds C. Keep the patient NPO until the gag reflex returns D. Address the patient's anxieties about the results of the EGD Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)? A. Restricted to rectum B. Strictures are common. C. Bloody, diarrhea stools D. Cramping abdominal pain E. Lesions penetrate intestine. The nurse provides postoperative care to a patient who underwent peripheral artery bypass surgery. Thirty minutes after the initial assessment, the nurse reassesses the patient and detects a change in the Doppler sound over a pulse. What action should the nurse take? A. Contact the health care provider B. Administer an oral anticoagulant C. Measure the ankle-brachial index D. Recheck the pulse in another 30 minutes A patient who has undergone peripheral artery bypass surgery report increased pain and tingling in the extremities. The nurse notes the loss of a previously palpable pulse and cyanosis. Which condition is consistent with these findings? A. Blockage of the graft B. Compartment syndrome C. Thoracic aortic aneurysms D. Superficial vein thrombosis The nurse provides discharge teaching for a patient's caregiver about stoma care, one week after the patient underwent ostomy surgery. Which statement made by the caregiver indicates effective learning? A. I will observe the stoma color every four hours B. I will measure the size of the stoma using a properly calibrated scale C. I will contact the health care provider if the stoma color is rosy pink to red D. I will contact the health care provider if the swelling of the stoma persists for more than a week after surgery. A patient with a gastric ulcer develops abdominal pain, a rigid board like abdomen, and shallow grunting respirations. Which procedure would the nurse expect to be planned for the patient. A. Vagotomy B. Endoscopy C. Laparoscopy D. Pyloroplasty A patient who is admitted to the hospital with a duodenal ulcer develops signs of acute duodenal perforation. Which action would the nurse expect to take first. A. Administer an H2 blocker B. Administer pain medication C. Insert an NG tube D. Prepare the patient for a laparoscopic surgery The nurse provides teaching to a patient with Raynaud's phenomenon about how to prevent recurrent episodes. Which actions would the nurse instruct the patient to avoid? Select all that apply. A. Wearing gloves B. Drinking caffeinated coffee C. Exposure to sun D. Emotional upsets E. Cigarette smoking A patient is admitted with GI bleeding. Which findings would support the nurse's conclusion that the patient is in shock? Select all that apply. A. Warm skin B. Rapid, weak pulse C. Slow capillary refill D. High BP E. Increased temperature A patient is hospitalized with abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. The nurse expects which assessment findings? A. Diarrhea and absent bowel sounds B. Abdominal distention and high-pitched bowel sounds above the obstruction C. Localized abdominal pain and generalized hypoactive bowel sounds D. High pitched and hypoactive bowel sounds below the area of obstruction The nurse is assessing the client diagnosed with long-term peripheral artery disease. Which assessment data support the diagnosis? A. Hairless skin on legs B. Brittle flaky toenails C. Petechiae on the soles of feet D. Nonpitting ankle edema A. Hairless skin on legs The lack of oxygen rich blood will cause the loss of hair on the tops of the feet and the lower legs The client is being admitted with Coumadin (Warfarin) toxicity. Which laboratory data should the nurse monitor? A. Blood urea nitrogen (BUN) B. Unfractionated heparin (UFH) C. International normalized ratio (INR) D. Partial thromboplastin time (PTT) The client is receiving a low molecular weight heparin subcutaneously to prevent DVT following a hip replacement and complains of small purple hemorrhagic area on the upper abdomen. Which action should the nurse implement? A. Notify the HCP immediately B. Check the client's PTT levels C. Explain this results from the medication D. Assess the client's vital signs This is not hemorrhaging, and the client should be reassured that this is a side effect of the medication With peripheral arterial disease, leg pain during rest can be reduced by: A. Elevating the limb above heart level B. Lowering the limb so it is dependent C. Massaging the limb after application of cold compresses D. Placing the limb in a plane horizontal to the body Lower the legs will help blood flow to the limb by allowing gravity to help. A cold compress with cause vasoconstriction. Elevating the limb or placing it in a plane horizontal to the body will further decrease blood flow to the limb. A significant cause of venous thrombosis is: A. Altered blood coagulation B. Stasis of blood C. Vessel wall injury D. All of the above (Virchow's Triad) When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows not to expect therapeutic benefits for: A. At least 12 hours B. The first 24 hours C. 2-3 days D. 1 week Coumadin- onset 48-72hrs Peak (therapeutic) 5-7days Duration 2-5 days Mike, a 43-year-old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with stress. His current concern is calf pain during minimal exercise that decreased with rest. The nurse assesses Mike's symptoms as being associated with peripheral arterial disease. The nursing diagnosis is probably: A. Alteration in tissue perfusion related to compromised circulation B. Dysfunctional use of extremities related to muscle spasms C. Impaired mobility related to stress associated with pain D. Impairment in muscle use associated with pain on exertion Intravenous heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? A. Vitamin K B. Potassium chloride C. Enoxaparin (Lovenox) D. Protamine sulfate A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and slight edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is: A. Normal because of the increased blood flow through the leg B. Slightly deteriorating and should be monitored for another hour C. Moderately impaired, and the surgeon should be called. D. Adequate from the arterial approach, but venous complications are arising. As blood flow is re-established to the limb it can become red, warm, slight edematous and painful. In preparation for the discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include: A. Walking several times each day as an exercise program B. Keeping the heat up so that the environment is warm C. Wearing TED hose during the day D. Using hydrotherapy for increasing oxygenation You want to avoid cold as this causes vasoconstriction and can precipitate an exacerbation. You don't want constrict blood flow so you would not wear TED hose. An older patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. After the nurse notifies the health care provider, what should the nurse do next? A. Apply a compression stocking to the leg. B. Elevate the leg above the level of the heart. C. Assist the patient in gently exercising the leg. D. Keep the patient in bed in the supine position. Patient's signs and symptoms are consistent with arterial occlusion. Resting the leg will decrease the oxygen demand of the tissues and minimized ischemic damage until circulation can be restored. Elevation or elastic wrap will further compromise blood flow and exercise will increase oxygen demand. A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." What focused assessment should the nurse make? A. Look for the presence of tortuous veins bilaterally on the legs. B. Ask about any skin color changes that occur in response to cold. C. Assess for unilateral swelling, redness, and tenderness of either leg. D. Palpate for the presence of dorsalis pedis and posterior tibial pulses. This question suggests the patient has PAD, look for the answer that has signs and symptoms of PAD. A is signs of venous insufficiency, B is signs of Raynaud's and C is signs of DVT. A young adult patient tells the health care provider about experiencing cold, numb fingers and Raynaud's phenomenon is suspected. What type of testing should the nurse anticipate explaining to the patient? A. Hyperglycemia B. Hyperlipidemia C. Autoimmune disorders D. Coronary artery disease Patients with Raynaud's disease should have routine follow-up to monitor for the development of connective tissue or auto-immune disorders. Secondary Raynaud's has underlying disease. The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first? A. Obtain vital signs. B. Teach wound care. C. Assess pedal pulses. D. Check the wound site Bleeding is a possible complication. First action is to assess for changes to vital signs that may indicate hemorrhage Other options are correct but need to assess vital signs first. A patient who is 2 days post femoral popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/VN) caring for the patient requires the registered nurse (RN) to intervene? A. The LPN/VN tells the patient sit in a chair for 2 hours. B. The LPN/VN gives the prescribed aspirin after breakfast. C. The LPN/VN assists the patient to walk 40 ft in the hallway. D. The LPN/VN places the patient in Fowler's position for meals. Patient should not sit for prolonged periods of time because of increase stress on the suture line caused by edema and because of risk of DVT. Which instructions should the nurse include in a teaching plan for an older adult patient newly diagnosed with peripheral artery disease (PAD)? [Show More]

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