PCN 101 FINAL Questions & Answers Correct 100%

1. The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the blood stream by the: a. gastric lining of the stomach. b. villi of the small intestine. c. bile of the liver in the large intestine. d. excretion from the cecum. - ANSWER ANS: B The inner surface of the small intestine contains millions of tiny, fingerlike projections called villi, which contain small blood vessels. They are responsible for absorbing the products of digestion. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-6 OBJ: 2 TOP: Digestive KEY: Nursing Process Step: Assessment ventrogluteal site - ANSWER deltoid site - ANSWER vastus lateralis site - ANSWER Z track injection technique - ANSWER prevents medication from leaking back into the subQ tissue - ventrogluteal site is prefered 2. A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of 102° F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock? a. Chest pain b. Seizure c. Tachycardia d. Massive diarrhea - ANSWER ANS: C The patient with diverticulitis who has fever and an elevated white count has an infection that could lead to septic shock, which will present as tachycardia and hypotension. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-98 OBJ: 9 TOP: Diverticulitis KEY: Nursing Process Step: Assessment 3. Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care? a. Evaluation and assessment of dietary intake of fiber b. Evaluation and assessment of patient cleanliness c. Evaluation and assessment of periostomal skin integrity d. Evaluation and assessment of the adequacy of the collection device - ANSWER ANS: C The nurse should assess the periostomal skin for impairment of integrity. The fecal material is liquid and has a potential for severe skin excoriation from the digestive enzymes. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-5-84 OBJ: 8 TOP: Ulcerative colitis KEY: Nursing Process Step: Assessment 4. The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that the family provide: a. a tablet and pencil as a communication aid. b. a TV for diversion. c. a bell to summon help. d. a walkie-talkie. - ANSWER ANS: A The provision of an alternative method of communicating will lessen the frustration of the patient who has trouble speaking understandably. The call bell would be helpful also, but without a way to communicate, the bell is not as essential as a method of communication. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-28 OBJ: 5 TOP: Cancer of esophagus KEY: Nursing Process Step: Assessment 5. Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia? a. Consume only liquid b. Avoid fruit juices c. Drink 10 oz of fluid with each meal d. Lie down for 30 minutes after each meal - ANSWER ANS: C The patient should drink fluid with each meal to increase lower esophageal pressure to push food into the stomach. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-41 OBJ: 5 TOP: Esophageal dilation KEY: Nursing Process Step: Implementation 6. A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition? a. Duodenal ulcer b. Gastritis c. Achalasia d. Peptic ulcer - ANSWER ANS: D A significant subjective data assessment for a peptic ulcer is the patient report that pain is associated with eating, but not with an empty stomach, because there would be pain with a duodenal ulcer. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-46 OBJ: 5 TOP: Peptic ulcer KEY: Nursing Process Step: Assessment 7. The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental: a. protein due to the loss of some of the digestive processes. b. vitamin B12 due to the loss of the intrinsic factor. c. bulk to prevent constipation. d. vitamin A due to the loss of the gastric lining. - ANSWER ANS: B It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-61 OBJ: 6 TOP: Gastrectomy KEY: Nursing Process Step: Assessment 8. The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the most appropriate suggestion to lessen these symptoms? a. Eat a diet high in fiber content b. Increase dietary fat intake c. Exercise to increase intra-abdominal pressure d. Take daily laxatives - ANSWER ANS: A The symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet, reduction of meat and fats in the diet, and avoiding activities that increase intra-abdominal pressure. Although laxatives might be prescribed sparingly, daily laxatives are not recommended. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-99 OBJ: 9 TOP: Diverticulitis KEY: Nursing Process Step: Implementation 9. The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube; the patient complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of? a. Hiatal hernia b. Gastritis c. Perforation d. Bowel obstruction - ANSWER ANS: C Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the result of a perforation. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-47 OBJ: 5 TOP: Ulcer perforation KEY: Nursing Process Step: Assessment 10. Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. What would the nurse suggest to reduce the risk of dumping syndrome? a. Eating a high-carbohydrate diet b. Drinking 10 oz of fluids with meals c. Remaining upright for 2 hours after meals d. Eating six small daily meals high in protein and fat - ANSWER ANS: D Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If possible, the patient should lie down for 1 hour after meals. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-60 OBJ: 4 TOP: Dumping syndrome KEY: Nursing Process Step: Planning 11. The patient has come to the PACU following an ileostomy for the treatment of ulcerative colitis. The patient is conscious and has a nasogastric tube in place and a pouch over the stoma. What should be the nurse's initial action? a. Turn patient to right side b. Give patient ice chips to moisten mouth c. Attach NG tube to suction d. Irrigate NG tube - ANSWER ANS: C Initially, the NG tube should be attached to suction to decompress the stomach and prevent nausea. Assessing the tube for the need of future irrigation will be part of the postoperative care. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-85, Box 5-5 OBJ: 4 TOP: Appendicitis KEY: Nursing Process Step: Planning 12. The home health nurse evaluates a patient being treated for a peptic ulcer with Riopan (antacid) and famotidine (histamine receptor blocker). Which statement made by the patient indicates a need for further instruction? a. "I know famotidine will not interfere with my Coumadin." b. "I take the Riopan at least 2 hours after any of my other drugs." c. "Boy! That Riopan keeps my stomach happy!" d. "I take both those meds at the same time every morning." - ANSWER ANS: D Antacids should not be taken with other drugs, because the absorption of the other drugs may be affected. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-49, Table 5-1 OBJ: 4 TOP: Pharmacology KEY: Nursing Process Step: Evaluation 13. What should a nurse do when obtaining a stool specimen to be examined for ova and parasites? a. Use an oil retention enema to facilitate collection b. Refrigerate the specimen immediately c. Obtain three different stool specimens on subsequent days d. Check the specimen for the presence of occult blood - ANSWER ANS: C Diagnosing a parasitic infection requires three different stool specimens on subsequent days. Use only normal saline or tap water enemas to prevent alteration of results. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-18 OBJ: 3 TOP: Diagnostic studies KEY: Nursing Process Step: Implementation 14. The nurse explains to the patient with Crohn disease that the tube feedings allow for: a. Rapid absorption in the upper GI tract b. Decompression of the stomach c. Reduction of diarrheic episodes d. A permanent nutritional support - ANSWER ANS: A The tube feedings allow for rapid absorption of the nutrients in the upper GI tract. The tube feedings are not permanent and will be followed by oral intake of a low-residue, high-protein, high-calorie diet. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-91 OBJ: 7 TOP: Crohn disease KEY: Nursing Process Step: Implementation 15. A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse recognizes these as indicators of which type of hernia? a. Strangulated b. Hiatal c. Ventral d. Umbilical - ANSWER ANS: A The hernia is strangulated when the blood supply and intestinal flow are occluded, which results in pain and distention. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-105 OBJ: 10 TOP: Inguinal hernia KEY: Nursing Process Step: Assessment 16. A patient with a ruptured diverticulum in the descending colon has undergone a transverse loop colostomy. The patient is upset and says, "I didn't know it was going to be this awful. I hate this!" Which response made by the nurse would be most helpful? a. "This is a temporary solution. It will be closed in 6 weeks." b. "This seems awful now, but you won't have the problems you had before." c. "If everything goes well the surgeon can close this colostomy in about a year." d. "With the appropriate pouch and loose clothing, no one will notice a thing." - ANSWER ANS: A The loop colostomy is a temporary colostomy that allows for complete bowel rest. It can be closed in as short a time as 6 weeks. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-100 OBJ: 8 TOP: Diverticulum KEY: Nursing Process Step: Implementation 17. A male patient complains that he will never adjust to his colostomy. Which is the best action for the nurse in this situation? a. Encourage him to express his concern b. Suggest that he discuss his concerns with his physician c. Counsel him that everything will be all right d. Assure him that his concerns will diminish when he is able to care for his colostomy - ANSWER ANS: A When a colostomy is performed, the patient or significant other should be able to verbalize and demonstrate understanding of ostomy care to the nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-137 OBJ: 8 TOP: Colostomy KEY: Nursing Process Step: Implementation 18. In caring for a patient with gastric bleeding who has a nasogastric tube in place, the nurse should include in the plan of care to ensure that the NG tube is: a. Clamped for 10 minutes every hour b. Kept patent with irrigation c. Frequently repositioned to the opposite nostril d. Changed every 72 hours - ANSWER ANS: B Irrigating the NG tube PRN will keep the tube patent and ensure effective decompression. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-52, Nursing care plan 5-1 OBJ: 4 TOP: NG tube KEY: Nursing Process Step: Implementation 19. What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce the frequency of heartburn? a. Drinking 10 oz of milk with every meal b. Lie down after eating c. Panting through mouth when symptoms begin d. Eating small meals - ANSWER ANS: D Taking care not to overeat is the best defense again pyrosis (heartburn) for the person with a hiatal hernia. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-109 OBJ: 10 TOP: Hiatal hernia KEY: Nursing Process Step: Implementation 20. The nurse points out which of the following as an example of a nonmechanical bowel obstruction? a. A paralytic ileus b. Narrowed bowel lumen from an inflammatory process c. Tumor of the bowel d. Fecal impaction - ANSWER ANS: A A nonmechanical bowel obstruction can be caused by a paralytic ileus. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-111 OBJ: 4 TOP: Cancer KEY: Nursing Process Step: Implementation 21. Bowel sound assessment on a patient with an obstruction who has distention, nausea, and visible peristaltic waves would be: a. loud and clearly audible. b. high pitched. c. hyperactive. d. absent. - ANSWER ANS: B Because there are visible peristaltic waves, there will be bowel sounds that will be faint and high pitched. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-113 OBJ: 11 TOP: Bowel obstruction KEY: Nursing Process Step: Assessment 22. The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate (Pepto-Bismol) to combat H. pylori. What color will this drug turn the stool? a. Gray-black b. Dark green c. Red-orange d. Yellow - ANSWER ANS: A Bismuth products turn the stool gray-black. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-49, Table 5-1 OBJ: 4 TOP: Shock KEY: Nursing Process Step: Planning 23. Which of the following should be included in the patient teaching of a patient with a peptic ulcer? a. Introducing irritating foods in minute amounts to desensitize the stomach b. Restricting fluid to 1000 mL per day c. Eating 6 small meals a day d. Drinking alcohol and caffeine in moderation - ANSWER ANS: C The patient with a peptic ulcer should eat frequently to keep food in the stomach. Eating 6 small meals daily is helpful. Restriction of fluid is not necessary and irritating foods, alcohol, and caffeine should be discouraged. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-56 OBJ: 4 TOP: Peptic ulcer KEY: Nursing Process Step: Planning 24. Which of the following would be the most helpful nursing intervention to increase the comfort of a patient with appendicitis? a. Application of ice bag b. Administration of small tap water enema c. Warm compress over entire abdomen d. Ambulate for short periods in the room - ANSWER ANS: A Application of an ice bag will decrease the flow of blood to the area and impede the inflammatory process. PTS: 1 DIF: Cognitive Level: Application REF: Page 5-95 OBJ: 9 TOP: Appendicitis KEY: Nursing Process Step: Implementation 25. To assist a family with a bowel training program to reduce fecal incontinence, the nurse would suggest the use of a at an optimal time to stimulate defecation. a. Warm bath b. A tap water enema c. Glycerin suppository d. Large glass of warm lemonade - ANSWER ANS: C The use of a glycerin suppository for fecal stimulation is a helpful aid in a bowel-training program. The suppository is administered at what the family and patient have determined is the optimal time for a bowel movement. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-124 OBJ: 13 TOP: Bowel training KEY: Nursing Process Step: Implementation 26. What is the most lethal complication of a peptic ulcer? a. Bleeding b. Perforation c. Severe pain d. Gastric outlet obstruction - ANSWER ANS: B Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur when the ulcer erodes into a blood vessel; however, perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum. Gastric outlet obstruction can occur at any time and can be relieved by NG aspiration of stomach contents. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-47 OBJ: 4 TOP: Disorders of the stomach KEY: Nursing Process Step: Planning 27. The nurse takes into consideration that a proton pump inhibitor drug, such as , will completely eradicate gastric acid production. a. omeprazole (Prilosec) b. ranitidine (Zantac) c. sucralfate (Carafate) d. olsalazine (Dipentum) - ANSWER ANS: A Omeprazole (Prilosec) is a proton pump inhibitor that interferes with the production of gastric acid. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5- 32 OBJ: 4 TOP: Disorders of the stomach KEY: Nursing Process Step: Planning 28. Which of the following is the purpose of antibiotic therapy in treating peptic ulcers? a. It eradicates H. pylori b. It inhibits gastric acid secretion c. It protects the gastric mucosa d. It neutralizes or reduces the acidity of stomach contents - ANSWER ANS: A Antibiotic therapy eradicates H. pylori. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-49, 5-50 OBJ: 4 TOP: Peptic ulcers KEY: Nursing Process Step: Assessment 29. Why are peptic ulcers a common problem of aging? a. Because of overuse of antibiotics b. Because of overuse of antacids c. Because of overuse of NSAIDs d. Because of overuse of laxatives - ANSWER ANS: C Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) taken for arthritis or degenerative joint conditions may contribute to ulcer formation. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-110 OBJ: 4 TOP: Disorders of the stomach KEY: Nursing Process Step: Assessment 30. The patient with irritable bowel syndrome tells the home health nurse she is going to an acupuncturist for therapy for her condition. Which of the following would be the best nursing response? a. "Go for it. Alternative medicine does great things." b. "YIKES! An acupuncturist?" c. "It may help, but there has been no clinical proof of its effectiveness." d. "You should confirm that the acupuncturist is licensed." - ANSWER ANS: C While it is true that some have found relief there is no evidence that these therapies relieve the symptoms of IBS. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-76 OBJ: 4 TOP: Alternative therapy KEY: Nursing Process Step: Implementation 31. Which of the following are indicators of colorectal cancer? (Select all that apply.) a. Constant diarrhea b. Excessive flatulence c. Cachexia d. Cramps e. Rectal bleeding f. Anemia - ANSWER ANS: B, C, D, E, F The indicators for colorectal cancer are changing bowel habits between diarrhea and constipation, flatulence, cachexia, cramps, rectal bleeding, and anemia. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-118 OBJ: 12 TOP: Colorectal cancer KEY: Nursing Process Step: Implementation 32. How should the nurse counsel the 34-year-old woman who has been prescribed sulfasalazine (Azulfidine) for Crohn disease? (Select all that apply.) a. Expose her to sunlight at least 30 minutes a day for vitamin D synthesis b. Tell her to drink at least 1500 mL of fluid a day c. Advise assessing self for rash d. Use alternate birth control methods to oral contraception e. Take drug on an empty stomach - ANSWER ANS: B, C, D Cautionary information about sulfasalazine (Azulfidine) would include having adequate fluid intake to prevent crystallization in the kidneys, avoiding exposure to the sun, and using alternate birth control methods as oral contraception is made unreliable by this drug. The drug should be taken with meals and the patient should be assessing for rash. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 5-49, Table 5-1, 5-82 OBJ: 7 TOP: Crohn disease KEY: Nursing Process Step: Planning 33. In designing a teaching plan to present to a group of older adults regarding the prevention of esophageal cancer, the nurse would include information about the significance of (select all that apply): a. cessation of smoking. b. good oral care. c. regular checkups if dysphagia is present. d. reducing excessive weight. e. limiting alcohol consumption. f. reduction of consumption of citrus fruits. - ANSWER ANS: A, B, C, E Preventative measures include cessation of smoking and alcohol consumption, good oral care, and medical evaluation of dysphagia. Weight and reduction of citrus fruits are non-contributory to prevention of esophageal cancer. PTS: 1 DIF: Cognitive Level: Application REF: Pages 5-24, 5-25 OBJ: 6 TOP: Esophageal cancer KEY: Nursing Process Step: Implementation 34. Which activities should the home health nurse suggest to an elderly patient to avoid constipation? (Select all that apply.) a. Increasing physical activity b. Taking bulk-forming laxatives c. Increasing fiber intake d. Drinking at least 1000 mL fluid e. Taking a daily stool softener f. Using tap water enemas for persons with altered mobility - ANSWER ANS: A, B, C, D