USMLE pathology-265 Patho_Renal andGI_Practice Questions and answers complete and already graded A - $22.49   Add to cart

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USMLE pathology-265 Patho_Renal andGI_Practice Questions and answers complete and already graded A

1.Patho 265-Renal/GI Sac 2020USMLE pathology-265 Patho_Renal andGI_Practice Questions and answers A nurse is teaching a client who has gastroesophageal reflux disease about managing his illness. Which of the following recommendations should the nurse include in the teaching? A. Limit fluid intake not related to meals. Rationale: The nurse should recommend consuming liquids between meals rather than with meals to help reduce abdominal distention. B. Chew on mint leaves to relieve indigestion. Rationale: The nurse should instruct the client to avoid items like mint that can increase gastric acid secretion. C. Avoid eating within 3 hr of bedtime. Rationale: The nurse should instruct the client to eat small, frequent meals but to avoid eating with 3 hr of bedtime. D. Season foods with black pepper. Rationale: The nurse should instruct the client to avoid items such as black and red pepper that can increase gastric acid secretion. 2. A nurse is providing instructions for a 52-year-old client who is scheduled for a colonoscopy. The client reports that he has not had the procedure before and is very anxious about feeling pain during the procedure. Which of the following responses by the nurse is appropriate? A. "Don't worry; most clients dislike the prep more than the procedure itself." Rationale: This response is an example of unwarranted or false reassurance. It does not encourage the client to explain his feelings. B. "Before the examination, your provider will give you a sedative that will make you sleepy." Rationale: This therapeutic response appropriately addresses the client's concerns. The client is seeking information and this response provides the client with accurate information. It can also lead to further discussion about the procedure. C. "I know you’re anxious, but this procedure is recommended for people your age." Rationale: This statement is true. Routine screening for polyps and colon cancer is recommended starting at age 50; however, the nurse is changing the subject and this does not encourage the client to explain his feelings. D. "After you have signed the consent form, we can talk more about this." Rationale: The nurse should ensure that the client understands and agrees to the procedure before the client signs the consent form. 3. A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of following values? A. Calcium Rationale: The nurse should expect a decreased calcium level in a client who has acute pancreatitis. B. RBC count Rationale: The nurse should expect an elevated WBC count in a client who has acute pancreatitis. C. Magnesium Rationale: The nurse should expect to a decreased magnesium level in a client who has acute pancreatitis. D. Amylase Rationale: Amylase is an enzyme that changes complex sugars into simple sugars that can be used by the body. It is produced by the pancreas and salivary glands and released into the mouth, stomach, and intestines to aid in digestion. The amylase level of a client who has acute pancreatitis usually increases within 12 to 24 hr and can remain elevated for 2 to 3 days. 4. A nurse is admitting a client with suspected appendicitis. Identify where the nurse will palpate to assess for pain at McBurney's point. (Selectable areas, or “Hot Spots,” are outlined in the artwork below. Select only the outlined area that corresponds to your answer.) A. Answers cannot be displayed for this alternate item format. Rationale: McBurney's point is located by drawing a line from the navel to the right iliac crest. Divide the line into three equal lengths. McBurney's point is midway between the navel to the iliac crest. Pressure over this point will elicit pain in clients with appendicitis. 5. A nurse is teaching self-management to a client who has hepatitis B. Which of the following Instructions should the nurse include in the teaching? A. You may donate blood 6 months after completing the medication regimen. Rationale: The nurse should instruct the client that clients who contract hepatitis are restricted from donating blood, body organs or tissue for the remainder of their life. B. Consume a high-protein diet. Rationale: Adequate nutrition should be maintained, but protein intake should be moderated when the liver's ability to metabolize protein by-products is impaired. The nurse should recommend a diet high in carbohydrates and moderate in protein and fat. C. Rest frequently throughout the day. Rationale: Limiting activity is usually recommended until the symptoms of hepatitis have subsided. The nurse should recommend the client rest frequently throughout the day to reduce the metabolic demands upon the liver and decrease energy demands. D. Take acetaminophen every 4 hr, as needed, for discomfort Rationale: Pain-relief measures may be indicated, but medications that must be metabolized by the liver, such as acetaminophen, are avoided. The nurse should instruct the client to contact his provider before taking any medication, nutritional supplement, vitamin, or herbal preparation. 6. A nurse is teaching a client who is postpartum and has been diagnosed with iron deficiency anemia. Which of the following dietary recommendations should the nurse include in the teaching plan? A. Yogurt and mozzarella Rationale: Yogurt and mozzarella cheese are sources of calcium and protein and are not high in iron and therefore would not be recommended for this client as sources of iron. B. Spinach and beef Rationale: Spinach and beef are high in iron and would be recommended for this client. C. Milk and turkey slices Rationale: Milk is a source of calcium and protein, and turkey is a source of protein. They are not high in iron and would not be recommended for this client as sources of iron. D. Fish and cottage cheese Rationale: Fish is a source of protein, and cottage cheese is a source of protein and calcium. They are not high in iron and would not be recommended for this client as sources of iron. 7. A nurse working for a home health agency is assessing an older adult male client. Which of the following findings is the priority for the nurse to address? A. Swollen gums Rationale: Swollen gums is nonurgent because it is an expected finding for an older adult client due to increased risk for periodontal disease; therefore, there is another finding that is the priority. B. Pruritus Rationale: Pruritus is nonurgent because it is an expected finding for an older adult client due to decreased function of glands that produce oil and moisture; therefore, there is another finding that is the priority. C. Urinary hesitancy Rationale: Urinary hesitancy is nonurgent because it is an expected finding for an older adult male client due to prostate enlargement; therefore, there is another finding that is the priority. D. Dysphagia Rationale: Dysphagia poses the greatest safety risk to the client because it can cause choking, or result in aspiration of food or liquids leading to pneumonia and respiratory compromise. This is the priority finding for the nurse to address. 8. A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? A. Include foods high in starch and proteins. Rationale: Foods high in starch and proteins do not affect the episodes of biliary colic. B. Include foods high in fiber. Rationale: A high-fiber diet does not affect the episodes of biliary colic. C. Avoid foods high in fat. Rationale: The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods. D. Avoid foods high in sodium. Rationale: A low-sodium diet does not affect the episodes of biliary colic.   9. A nurse is caring for a client who had total hip arthroplasty 1 day ago and is receiving morphine sulfate by PCA pump for pain control. The client reports nausea and vomiting. Which of the following actions should the nurse take? A. Insert a nasogastric tube. Rationale: The client is experiencing decreased peristalsis as an effect of the morphine, an opioid. Inserting a nasogastric tube is not an appropriate action at this time. B. Administer an antiemetic. Rationale: The client is experiencing decreased peristalsis as an effect of the morphine, an opioid. Administering an antiemetic may become necessary but is not an appropriate initial action. C. Encourage use of the incentive spirometer. Rationale: The client is experiencing decreased peristalsis as an effect of the morphine, an opioid. Use of the incentive spirometer can improve oxygenation but will not affect the client’s nausea and thus is not an appropriate action at this time. D. Auscultate bowel sounds. Rationale: Using the nursing process, assessing for the presence or absence of bowel sounds and the passage of flatus is an appropriate action at this time. Determining the cause of the nausea and reducing contributing factors should precede any treatment. 10. A nurse is providing discharge teaching for a client who has chronic pancreatitis. Which of the following statements should the nurse make? A. “You should decrease your caloric intake when abdominal pain is present.” Rationale: Clients who have chronic pancreatitis are at risk for malnutrition and should increase their caloric intake in order to maintain weight. B. “You should increase your daily intake of protein.” Rationale: Clients who have chronic pancreatitis should consume a diet that is high in protein. C. “You should increase fat intake when experiencing loose stools.” Rationale: Clients who have chronic pancreatitis should consume a low-fat diet to prevent stimulation of the pancreas and steatorrhea. D. “You should limit alcohol intake to 2-3 drinks per week.” Rationale: Clients who have chronic pancreatitis should avoid alcohol intake to prevent stimulation of the pancreas. 11. A nurse is providing discharge teaching for a client who has acute pancreatitis and has a prescription for fatsoluble vitamin supplements. The nurse should instruct the client to take a supplement for which of the following? A. Vitamin A Rationale: The nurse should instruct the client that fat-soluble vitamins include vitamins A, D, E, and K. B. Vitamin B1 Rationale: Vitamin B1 is a water-soluble vitamin and would not be prescribed as a fat-soluble vitamin, which includes vitamins A, D, E, and K. C. Vitamin C Rationale: Vitamin C is a water-soluble vitamin and would not be prescribed as a fat-soluble vitamin, which includes vitamins A, D, E, and K. D. Vitamin B12 Rationale: Vitamin B12 is a water-soluble vitamin and would not be prescribed as a fat-soluble vitamin, which includes vitamins A, D, E, and K. 12. A nurse is preparing a teaching plan for a client who has neutropenia as a result of radiation therapy for the treatment of lung cancer. Which of the following should the nurse plan to include in the teaching? A. Bottled water is an appropriate choice to increase fluid intake. Rationale: Clients who have neutropenia are at risk for foodborne illness. Bottled water prevents client exposure to pathogens that may be found in other water sources. B. The salad bar is a healthy choice when dining out. Rationale: Clients who have neutropenia should avoid salad bars due to a higher risk of exposure to pathogens from raw foods, as well as from other individuals. C. Soft-boiled eggs are an appropriate source of protein. Rationale: Clients who have neutropenia should avoid foods that are not fully cooked due to a higher risk of foodborne illness. D. Eating at a buffet is a good choice to increase caloric intake. Rationale: Clients who have neutropenia should avoid buffets due to a higher risk of foodborne illness and pathogen exposure. 13. A nurse is caring for a client who has Crohn’s disease and is receiving parenteral nutrition. Which of the following interventions should the nurse include in the care of this client? A. Remove the parenteral nutrition solution from the refrigerator 2 hr before infusion. Rationale: Parenteral nutrition solutions should be removed from the refrigerator 1 hr before infusion to allow them to reach room temperature. B. Remove unused parenteral nutrition after 12 hr of use. Rationale: Parenteral nutrition solutions must be used or discarded within 24 hr. C. Monitor daily laboratory values and report as needed. Rationale: Laboratory data, as well as observation of clinical signs, are important to prevent the development of nutrient deficiencies or toxicities. D. Monitor the flow rate of the parenteral nutrition carefully and increase the rate as needed if it falls behind. Rationale: If the rate of delivery falls behind, no attempt should be made to “catch up” as this may cause severe hyperglycemia. 14. A nurse is teaching a client who is at risk for iron-deficiency anemia about optimizing her dietary intake of iron. The nurse should explain that which of the following sources of iron is easiest for the body to absorb? A. Spinach Rationale: Spinach is a good source of iron, but it is a nonheme iron that the body does not absorb as easily as heme iron. B. Cantaloupe Rationale: Cantaloupe is a good source of iron, but it is a nonheme iron that the body does not absorb as easily as heme iron. C. Chicken Rationale: Food sources of iron fall into two categories – heme iron (from lean red meat, poultry, and fish) and nonheme iron (from fruit, vegetables, grains, and dried peas and beans). The body more easily absorbs heme iron. D. Lentils Rationale: Lentils are a good source of iron, but they are a nonheme iron that the body does not absorb as easily as heme iron. 15. A nurse is providing care for a client who is 2 days postoperative following abdominal surgery and is about to progress from a clear liquid diet to full liquids. Which of the following items should the nurse tell the client he may now request to have on his meal tray? A. Cranberry juice Rationale: Clients consuming a clear liquid diet may have cranberry juice. B. Flavored gelatin Rationale: Clients consuming a clear liquid diet may have flavored gelatin. C. Skim milk Rationale: Full liquids include milk and milk products, so the client may now ask for skim milk. D. Chicken broth Rationale: Clients consuming a clear liquid diet may have chicken broth. 16. A nurse is providing teaching to a client who has stomatitis. Which of the following statements by the client indicates a need for further teaching? A. “I will drink liquids through a straw.” Rationale: Drinking liquids through a straw is an appropriate action; therefore, this statement by the client does not indicate a need for further teaching. B. “I will season foods with dried spices before cooking.” Rationale: The client should avoid spices, acidic foods, and salty foods because they can cause additional irritation to the oral mucosa; therefore, this statement by the client indicates a need for further teaching. C. “I will rinse my mouth with baking soda and water frequently.” Rationale: Rinsing the mouth with baking soda and water frequently is an appropriate action; therefore, this statement by the client does not indicate a need for further teaching. D. “I will eat frozen bananas as a snack.” Rationale: Eating frozen bananas as a snack will numb the mouth, which is an appropriate action. This statement by the client does not, therefore, indicate a need for further teaching. 17. A nurse is caring for a child who has acute gastroenteritis but is able to tolerate oral fluids. The nurse should anticipate providing which of the following types of fluid? A. Broth Rationale: Broth provides fluid and sodium but does not replace other vital elements lost in diarrhea. B. Water Rationale: Water provides fluid but does not replace other vital elements lost in diarrhea. C. Diluted apple juice Rationale: Diluted apple juice provides fluid and sugar but does not replace other vital elements lost in diarrhea. D. Oral rehydration solution Rationale: Oral rehydration solution is the fluid of choice for infants and children who have dehydration due to diarrhea. 18. A nurse is planning care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan of care? A. Provide a high carbohydrate diet. Rationale: A client with hepatitis should have a diet high in carbohydrates due to altered nutrient metabolism. B. Administer acetaminophen for pain. Rationale: A client with hepatitis should avoid acetaminophen which is metabolized in the liver. C. Encourage eating three large meals daily. Rationale: A client with hepatitis should eat small frequent meals daily to provide adequate calories and nutrition. D. Include high protein snacks. Rationale: A client with hepatitis should consume protein in moderation to promote healing. 19. A nurse is caring for a client who has impaired renal function. For which of the following findings should the nurse notify the provider? A. Urine output of175 mL in the past 8 hr Rationale: The nurse should notify the provider if the client’s urinary output is less than 30 mL/hr. This finding indicates a fluid imbalance, decreased circulating fluid volume, and possibly inadequate renal perfusion. B. Urine output of 2,200 mL in the past 24 hr Rationale: The nurse does not need to notify the provider if the client’s urinary output is 2,200 mL in the past 24 hr, as this is within the accepted reference range. C. First-voided urine in the morning has a strong odor Rationale: Urine is usually more concentrated in the morning and has a stronger odor. The nurse does not need to notify the provider of this finding. D. Urine is cloudy after sitting in the urinal for 6 hr Rationale: The nurse does not need to notify the provider if the client’s urine appears cloudy after sitting for an extended period. This is an expected finding. 20. A nurse is providing teaching about ileostomy care to a client. Which of the following statements by the client indicates a need for further teaching? A. "I will empty my pouch when it becomes 1/3 full." Rationale: This is an appropriate statement and does not require additional teaching. The client should empty the pouch when it becomes 1/3 to 1/2 full. B. "I will be certain to take enteric-coated medications." Rationale: This is not an appropriate statement and indicates a need for additional teaching. Enteric-coated medications should be avoided to reduce the risk of blockage caused by the coating. C. "I will change my entire pouch system at least weekly." Rationale: This is an appropriate statement and does not require additional teaching. The client should change the entire pouch system every 3 to 7 days. D. "I will use caution when eating high fiber foods." Rationale: This is an appropriate statement and does not require additional teaching. The client should eat high-fiber foods with caution, as these foods may lead to diarrhea, constipation, or obstruction. 21. A nurse is caring for a client who has ulcerative colitis and is teaching the client about the common link with Crohn's disease. Which of the following information should the nurse include? A. Both are inflammatory Rationale: The nurse should inform the client that both disease processes are an inflammatory process of the gastrointestinal tract. B. Both begin in the rectum Rationale: The nurse should inform the client ulcerative colitis begins in the rectum and proceeds up toward the cecum, whereas Crohn's disease is found primarily in the ileum, with scattered lesions throughout the bowel. C. Both manifest fistula formation Rationale: The nurse should inform the client who has ulcerative colitis that fistula formation is not a common link with Crohn's disease. D. Both require frequent surgery Rationale: The nurse should inform the client who has ulcerative colitis that surgery is infrequent compared to Crohn's disease. 22. A nurse is teaching a client about strategies to manage gastroesophageal reflux disease (GERD). Which of the following statements should the nurse include? A. "Elevate the head of your bed by 18 inches." Rationale: The nurse should instruct the client to elevate the head of the bed by 6 to 12 inches to prevent nighttime reflux. B. "Avoid snacking between meals." Rationale: The nurse should instruct the client to eat six small meals during the day, including snacks, to control reflux. C. "Limit foods that are high in fiber." Rationale: The nurse should instruct the client to limit foods that are high in fat or caffeine to control reflux. D. "Lie on your right side when sleeping." Rationale: The nurse should instruct the client to lie on the right side when sleeping to prevent nighttime reflux. 23. A nurse is providing discharge teaching to a client who has gastroesophageal reflux disease. Which of the following statements by the client indicates an understanding of the teaching? A. "The type of foods I eat does not affect this condition." Rationale: The nurse should instruct the client to avoid spicy foods, caffeine, and carbonated beverages. B. "I will sleep on my left side." Rationale: The nurse should instruct the client to lie on her right side to increase swallowing and improve oxygenation, which will decrease symptoms of nighttime reflux. C. "I will eat a snack just before going to bed." Rationale: The nurse should tell the client to avoid eating 3 hr before bedtime. D. "I will sleep with the head of my bed elevated." Rationale: The client should sleep with the head of the bed elevated by 6 to 12 inches to prevent reflux at night. 24. A nurse is teaching a client who has a history of ulcerative colitis and a new diagnosis of anemia. Which of the following manifestations of colitis should the nurse identify as a contributing factor to the development of the anemia? A. Dietary iron restrictions Rationale: Dietary approaches to ulcerative colitis do not restrict iron; in fact, they often include supplemental iron in an attempt to prevent anemia. B. Intestinal malabsorption syndrome Rationale: Ulcerative colitis is an inflammatory bowel disease affecting primarily the sigmoid colon and rectum, although the entire colon may be affected. A malabsorption syndrome is more likely to be caused by a condition affecting the small intestine. C. Chronic blood loss Rationale: A client with long-standing ulcerative colitis is most likely anemic due to chronic blood loss in small amounts that occurs over time, although the colitis may result in erosion of the intestine and hemorrhage. These clients often report bloody stools and are therefore at increased risk for developing anemia. D. Intestinal parasites Rationale: Intestinal parasites are not a manifestation of ulcerative colitis. This inflammatory bowel disease can cause dehydration, fever, weight loss and anorexia. 25. A nurse is caring for a client who has a postoperative ileus and an NG tube that has drained 2,500 mL in the past 6 hr. Which of the following electrolyte imbalances should the nurse monitor the client for? A. Elevated sodium level Rationale: Hypernatremia is an imbalance of sodium in which the serum sodium level is greater than 145 mEq/L. It can occur as a result of renal failure, dehydration, Cushing's disease, or excessive intake of sodium; however, loss of gastric fluid does not increase sodium levels. B. Decreased potassium level Rationale: Hypokalemia is an electrolyte imbalance in which the serum potassium level is less than 3.5 mEq/L. Hypokalemia may be the result of diuretic use, diarrhea, vomiting, and prolonged nasogastric suctioning. C. Elevated magnesium level Rationale: Hypermagnesemia is an imbalance of magnesium in which the serum level is greater than 2.1 mEq/L. Hypermagnesemia is a result of renal failure or excessive magnesium intake. D. Decreased calcium level Rationale: Hypocalcemia an electrolyte imbalance in which the serum calcium level is less than 9.0 mg/dL. Hypocalcemia is a result of renal failure, cellular damage, or other metabolic disorders. 26. A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client? A. Moist skin Rationale: Dry skin is an expected finding for a client who has cirrhosis. B. Spider angiomas Rationale: Spider angiomas are lesions with a red center and numerous extensions that spread out like a spider web. This is an expected finding for a client who has cirrhosis. C. Tarry stools Rationale: Clay colored stools is an expected finding for a client who has cirrhosis. D. Blood in the urine Rationale: Dark colored, foamy urine is an expected finding for a client who has cirrhosis. 27. A nurse is providing teaching for a client who has gastroesophageal reflux disease (GERD) about ways to manage his condition. Which of the following instructions should the nurse include? A. "Sleep on your left side." Rationale: The nurse should recommend that the client sleep with the head of his bed elevated or that the client uses a large wedge-style pillow to elevate his head. B. "Drink milk to soothe your stomach." Rationale: Although in the past, clients who have GERD were encouraged to increase their intake of milk, this approach is no longer recommended. C. "Eat four small meals each day." Rationale: The client should avoid eating large meals because of the pressure it places on the stomach. Instead, he should eat four to six small meals per day. D. "Wait to go to bed for 1 hr after eating." Rationale: The client should wait at least 3 hr after eating before going to bed. 28. A nurse is instructing a client who has GERD about positions that can help minimize the effects of reflux during sleep. Which of the following statements indicates to the nurse that the client understands the instructions? A. "I will lie on my left side to sleep at night." Rationale: Sleeping in a left side-lying position is unlikely to help reduce the manifestations of nighttime reflux. B. "I will lie on my right side to sleep at night." Rationale: Sleeping in a right side-lying position helps reduce the manifestations of nighttime reflux. The client can also elevate the head of the bed about 15 cm (6 in) on blocks. C. "I will sleep on my back with my head flat." Rationale: Lying supine interferes with esophageal clearance and worsens manifestations of reflux. D. "I will sleep on my stomach with my head flat." Rationale: Lying prone interferes with esophageal clearance and worsens manifestations of reflux. 29. A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history? A. Gallstones Rationale: The client's history might reveal biliary obstruction from a gallstone causing bile to inflame the pancreas. B. Hypolipidemia Rationale: The client's history might reveal hyperlipidemia, which is a metabolic disturbance that causes an inflamed pancreas. C. COPD Rationale: A history of COPD does not cause pancreatitis. D. Diabetes mellitus Rationale: A history of diabetes mellitus can be a result of pancreatitis, rather than the cause of it. 30. A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan? (Select all that apply.) A. Administer furosemide. B. Administer warfarin. C. Implement a low-sodium diet. D. Measure the client's abdominal girth. E. Encourage weight lifting during physical therapy. Rationale: Administer furosemide is correct. The nurse should administer furosemide to the client to reduce fluid accumulation in the abdomen. Administer warfarin is incorrect. The nurse should avoid administering warfarin to the client due to possible destruction of platelets caused by splenomegaly, which can result in spontaneous bleeding.Propranolol is prescribed instead to discourage bleeding. Implement a low-sodium diet is correct. The nurse should implement a lowsodium diet to control fluid accumulation in the abdomen. Measure the client's abdominal girth is correct. The nurse should measure the client's abdominal girth. Daily weights are an even more reliable indicator of fluid accumulation. Encourage weight lifting during physical therapy is incorrect. The nurse should understand weight lifting can cause bleeding. 31. A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider? A. Stoma oozing red drainage Rationale: Oozing of red drainage is expected finding immediately following surgery. B. Shiny, moist stoma Rationale: A stoma that appears shiny and moist is healthy. C. Purplish-colored stoma Rationale: A stoma that is purplish in color indicates ischemia. The nurse should notify the provider immediately. D. Rosebud-like stoma orifice Rationale: A rosebud-like appearance of the stoma orifice is an expected finding. 32. A nurse is planning care for a client who has hepatitis B. Which of the following interventions should the nurse include in the plan? A. Administer antibiotics. Rationale: The nurse should administer antiviral medication to a client who has hepatitis B. B. Provide a diet high in fat. Rationale: The nurse should provide a client who has hepatitis B a diet that is high in carbohydrates. C. Restrict fluids. Rationale: The nurse should not restrict fluids for a client who has hepatitis B unless other medical conditions warrant fluid restrictions. D. Encourage short periods of ambulation. Rationale: The nurse should encourage a client who has hepatitis B to alternate between activity and rest. 33. A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse plan to implement? A. Vitamin B12 injections Rationale: The nurse should administer vitamin B12 injections to treat pernicious anemia when diet fails to improve the anemia due to poor absorption. B. Iron supplements Rationale: Iron supplements treat iron deficiency anemia, rather than pernicious anemia. C. Blood transfusions Rationale: Blood transfusions do not resolve pernicious anemia. D. Vitamin B6 supplements Rationale: Vitamin B6 supplements are not used to treat pernicious anemia as failure to absorb vitamin B12 is the cause of the anemia. 34. A nurse is caring for a client who has gastrointestinal bleeding. Which of the following actions should the nurse take first? A. Assess orthostatic blood pressure. Rationale: Using the nursing process, the first action the nurse should take is to assess the client by measuring the client's orthostatic blood pressure. This action determines if the client is hypovolemic and establishes a baseline for further measurements. B. Explain the procedure for an upper gastrointestinal series. Rationale: The nurse should explain the procedure for an upper gastrointestinal series, but this action is not the priority. C. Administer pain medication. Rationale: The nurse should administer pain medication as needed, but this action is not the priority. D. Test the client's emesis for blood. Rationale: The nurse should test the client's emesis for blood, but this action is not the priority. Additionally, the nurse should have suction equipment available at the bedside. 35. A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestations should the nurse expect? A. Petechiae Rationale: A manifestation of advanced cirrhosis is petechiae due to impaired coagulation from a dysfunctional liver. B. Hypertension Rationale: A client who has advanced cirrhosis will experience hypotension. C. Osteoarthritis Rationale: A client who has advanced cirrhosis will develop osteoporosis, especially with primary biliary cirrhosis. D. Peripheral ulcers Rationale: Peripheral ulcers are a manifestation of atherosclerosis, rather than cirrhosis. 36. A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse recognize as a risk factor for this condition? A. History of bulimia Rationale: A history of bulimia is not a risk factor for peptic ulcer disease. B. History of NSAID use Rationale: The nurse should recognize that long-term use of NSAIDs is a risk factor for peptic ulcer disease. NSAIDs break down the mucosal barrier and cause production of prostaglandins to decrease, which results in local gastric mucosal injury. C. Drinks green tea Rationale: Green tea does not contain caffeine. Caffeine-containing beverages are a risk factor for peptic ulcer disease. D. Has a glass of wine with dinner each day Rationale: Excessive use of alcohol is considered a risk factor for peptic ulcer disease. 37. A nurse is caring for a client who has a history of alcohol use disorder and reports bruising and frequent nosebleeds. The nurse should recognize that this client in manifesting which of the following conditions? A. Malnutrition Rationale: Malnutrition alters a client's albumin and hemoglobin levels but does not cause altered bleeding. B. Hepatitis A Rationale: Hepatitis B, C, and D are the leading causes of liver disease and cirrhosis, which affects bleeding time. C. Diabetes Rationale: Diabetes does not cause altered bleeding. D. Cirrhosis Rationale: The nurse should recognizes this client is displaying manifestations of cirrhosis. A history of alcohol use disorder increases the client's risk of developing cirrhosis and coagulation defects are a common complication of cirrhosis. 38. A nurse is planning care for a client who ingested a large amount of acetylsalicylic acid. Which of the following actions should the nurse take? A. Induce vomiting with syrup of ipecac. Rationale: The nurse should not induce vomiting with syrup of ipecac for poisonings. B. Administer N-acetylcysteine. Rationale: N-acetylcysteine is used in the treatment of hydrocarbon poisoning. C. Initiate chelation therapy with deferoxamine. Rationale: Chelation therapy with deferoxamine is the treatment for iron poisoning. D. Perform gastric lavage with activated charcoal. Rationale: The nurse should plan to perform gastric lavage with activated charcoal, which acts to adsorb drugs and other chemicals in the gastrointestinal tract to prevent absorption into the bloodstream. 39. A nurse is performing gastric lavage on a client using a large-bore NG tube. Which of the following actions should the nurse take? A. Instill 500 mL of sterile saline. Rationale: The nurse should instill 200 to 300 mL of room temperature tap water. B. Position the client on her right side. Rationale: The nurse should place the client on her left side during gastric lavage to limit the flow of the lavage solution out of the stomach. C. Withdraw fluid until it is clear. Rationale: The nurse should continue to instill and withdraw the lavage fluid until it is clear. D. Connect the NG tube to intermittent suction. Rationale: The nurse should manually withdraw the lavage fluid. 40. A nurse is caring for a client who has an active upper gastrointestinal bleed. After inserting a NG tube into the client, which of the following findings should the nurse anticipate? A. Frothy pink drainage Rationale: Frothy pink drainage from the NG tube indicates incorrect tube placement. B. Dark amber drainage Rationale: Dark amber drainage indicates the presence of bile and is seen in clients who have gallbladder or bile duct problems. C. Coffee-ground drainage Rationale: "Coffee-ground" drainage or emesis indicates the presence of blood. The coffee ground appearance is the result of the effects of methemoglobin on the hemoglobin. D. Greenish-yellow drainage Rationale: NG drainage that is greenish-yellow due to bile an expected finding from a typical NG tube. 41. A nurse is teaching a client who has stomatitis. Which of the following instructions should the nurse include? A. Rinse with a commercial mouthwash. Rationale: Many commercial mouthwashes contain alcohol, which can irritate stomatitis. B. Use toothpaste that contains sodium laurel sulfate. Rationale: Sodium laurel sulfate is associated with stomatitis. The client should avoid toothpastes that contain sodium laurel sulfate. C. Cleanse the mouth with lemon-glycerine swabs. Rationale: Lemon-glycerine swabs can irritate stomatitis. D. Brush teeth with a soft toothbrush. Rationale: The client should use a soft toothbrush and gently brush after each meal to reduce mouth irritation and prevent superinfections. 42. A nurse is providing teaching to a client who has a new colostomy. Which of the following information should the nurse include in the teaching? A. "You can expect fecal output within 24 hours." Rationale: The client should expect fecal output from the colostomy stoma in 2 to 3 days. B. "You will need to increase your dietary intake of raw vegetables." Rationale: Many raw vegetables, such as onions, cucumbers, mushrooms, broccoli, cabbage, and cauliflower, increase gas and odor. The client should limit or avoid consuming these foods. C. "You can expect the stoma to be purplish in color for the first week." Rationale: A stoma that deepens in color to a purplish hue can indicate ischemia. The client should report this finding to the surgeon. D. "You may experience a small amount of bleeding around the stoma." Rationale: A small amount of bleeding around the stoma and its stem can occur. However, the client should report an increase in bleeding to the surgeon. 43. A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect? A. Fatty stools Rationale: Chronic cholecystitis occurs following several bouts of acute cholecystitis. The repeated episodes of inflammation result in a fibrotic and contracted gallbladder. Because of inflammation in the gallbladder, bile needed to absorb fat and fatsoluble vitamins is unable to enter the bowel, resulting in steatorrhea (fatty stools). B. Straw-colored urine Rationale: Biliary obstruction results in excretion of bile through the kidneys, rather than the bowel, which results in dark colored urine. C. Tenderness in the left upper abdomen Rationale: A blockage of the common bile duct, often referred to as biliary colic, results in severe pain to the right upper quadrant of the abdomen that can radiate to the back or the right scapular area. D. Ecchymosis of the extremities Rationale: A blockage of the bile duct prevents bile from being carried to the duodenum. As a result, bile is absorbed by the blood and causes the skin and mucous membranes to develop jaundice (a yellow coloring of the skin). 44. A nurse is assessing a client who is African-American and has jaundice. Which of the following areas is the most reliable for the nurse to inspect the client for jaundice? A. Palms of the hands Rationale: The nurse should inspect the palms of a client who is Caucasian for jaundice. However, evidence-based practice indicates calloused palms may appear yellow in African-American clients. Therefore, there is another area the nurse should assess. B. Hard palate Rationale: According to evidence-based practice, inspecting the client's oral mucous membrane and hard palate are the most reliable methods to determine jaundice for a client who is African-American. C. Conjunctiva Rationale: The nurse should inspect the conjunctiva of a client who is Caucasian as mucous membranes develop a yellow tinge. However, evidence-based practice indicates that clients who are African-American do not develop this manifestation with jaundice. Therefore, there is another area the nurse should assess. D. Back of the neck Rationale: The nurse should inspect the skin color of a Caucasian client who has jaundice as the skin develops a yellow tone. However, evidence-based practice indicates clients who are African-American do not develop this manifestation with jaundice. Therefore, there is another area the nurse should assess. End of Test CAA_DetailedAnswerKey created 05/03/2017

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