NR 325: Adult Health III Complex Care Midterm Practice Questions and Quiz Review Ultimate Certification Success Companion: In-Depth Study Guide, Updated Practice Tests, Detailed Review Questions, and Comprehensive Exam Preparation Manual

During a comprehensive assessment of an 80-year-old patient, which finding should the nurse investigate most urgently? A. Decreased appetite during meals B. Difficulty chewing solid foods C. Unintentional loss of 6 kg over 3 months D. Occasional indigestion after eating fatty foods Correct Answer: C. Unintentional loss of 6 kg over 3 months Rationale: Unintentional weight loss is not considered a normal part of aging and may indicate a serious condition such as malignancy, depression, malabsorption, chronic infection, or another underlying disorder. Although decreased appetite, difficulty chewing, and occasional indigestion may occur in older adults and require attention, unexplained progressive weight loss is the most concerning finding. Question 2 A patient with chronic constipation is beginning a bowel-training program. When should the nurse recommend that the patient attempt to have a bowel movement? A. Immediately before breakfast B. Shortly after eating breakfast C. In the middle of the afternoon D. Immediately after awakening Correct Answer: B. Shortly after eating breakfast Rationale: Eating stimulates the gastrocolic and duodenocolic reflexes, which increase intestinal motility and promote defecation. These reflexes are often strongest after the first meal of the day. Attempting to defecate before eating or immediately after awakening is generally less effective at stimulating bowel activity. Question 3 A patient who underwent a total gastrectomy several years ago is admitted with fatigue and numbness in the feet. Which nutritional deficiency should the nurse suspect? A. Vitamin C deficiency B. Vitamin B12 deficiency C. Vitamin K deficiency D. Vitamin D deficiency Correct Answer: B. Vitamin B12 deficiency Rationale: A total gastrectomy eliminates the gastric cells responsible for producing intrinsic factor, which is necessary for vitamin B12 absorption. Vitamin B12 deficiency can cause megaloblastic anemia and neurological manifestations such as numbness and paresthesia. Vitamin C, vitamin D, and vitamin K absorption do not directly depend on gastric intrinsic factor. Question 4 A patient has an obstruction of the common bile duct. Which finding should the nurse expect? A. Black, tarry stools B. Fatty, foul-smelling stools C. Decreased serum cholesterol D. Increased indirect bilirubin only Correct Answer: B. Fatty, foul-smelling stools Rationale: An obstruction of the common bile duct prevents adequate bile from entering the small intestine. Without sufficient bile salts, dietary fats are not properly emulsified and absorbed, resulting in steatorrhea, which produces fatty, foul-smelling stools. Melena suggests gastrointestinal bleeding. Cholesterol may increase with biliary obstruction, and conjugated bilirubin typically rises because normal excretion is impaired. Question 5 A patient scheduled for a colonoscopy reports that the prescribed polyethylene glycol bowel-preparation solution was not taken. What should the nurse do first? A. Notify the healthcare provider B. Administer an antidiarrheal medication C. Send the patient for the procedure as scheduled D. Ask whether the patient has an iodine allergy Correct Answer: A. Notify the healthcare provider Rationale: An inadequately prepared colon may prevent adequate visualization and can make the procedure ineffective or unsafe. The healthcare provider should be notified because the colonoscopy may need to be delayed or rescheduled. Antidiarrheal medications would interfere with bowel preparation, and iodine allergy is generally unrelated to routine colonoscopy. Question 6 A patient with jaundice provides the following medication history. Which statement requires the most immediate follow-up teaching? A. “I take one low-dose aspirin every morning.” B. “I used cough syrup several times last week.” C. “I take an antacid two or three times each week.” D. “I take acetaminophen every four hours for chronic pain.” Correct Answer: D. “I take acetaminophen every four hours for chronic pain.” Rationale: Frequent or excessive acetaminophen use can cause significant liver injury and may contribute to jaundice. The nurse should determine the dose and duration of use and instruct the patient to avoid additional acetaminophen until evaluated. Although the other medications also require assessment, frequent acetaminophen use is the most directly concerning for dose-related hepatotoxicity. Question 7 While assessing a patient's abdomen, the nurse is unable to hear bowel sounds after listening for the recommended period. What should the nurse do next? A. Document the finding as normal B. Perform a focused abdominal assessment C. Encourage the patient to eat a meal D. Ask the patient to ambulate immediately Correct Answer: B. Perform a focused abdominal assessment Rationale: Absent bowel sounds may occur with conditions such as paralytic ileus, intestinal obstruction, peritonitis, or decreased intestinal perfusion and require further assessment. The nurse should assess for abdominal distention, pain, tenderness, vomiting, recent surgery, and medication use. Feeding or ambulating the patient before determining the cause may be unsafe. Question 8 Following a percutaneous liver biopsy, which nursing intervention is most appropriate? A. Position the patient on the right side with the bed flat B. Place the patient supine with the head elevated C. Apply a heating pad over the biopsy site D. Encourage coughing every 15 minutes Correct Answer: A. Position the patient on the right side with the bed flat Rationale: Positioning the patient on the right side applies pressure to the liver biopsy site and helps reduce the risk of bleeding. Keeping the bed flat supports effective pressure over the site. Elevating the head, applying heat, or encouraging frequent vigorous coughing may reduce pressure at the biopsy site or increase intra-abdominal pressure and potentially increase the risk of hemorrhage. Question 9 Which information would require the nurse to reschedule a patient's gallbladder ultrasound? A. The patient has a gastrostomy tube B. The patient used a laxative the previous evening C. The patient ate a bagel one hour before the examination D. The patient ate a high-fat dinner the previous evening Correct Answer: C. The patient ate a bagel one hour before the examination Rationale: Patients are generally instructed to remain NPO for approximately 8 to 12 hours before gallbladder ultrasonography. Eating shortly before the examination causes the gallbladder to contract, which can interfere with visualization and reduce diagnostic accuracy. A gastrostomy tube, a laxative taken the previous evening, or a fatty meal eaten many hours earlier generally does not interfere with the examination. Question 10 A patient has just returned from an upper endoscopy. Which assessment finding requires immediate communication with the healthcare provider? A. Mild sore throat B. Drowsiness C. Temperature of 38.7°C D. Pulse rate of 102 beats/minute Correct Answer: C. Temperature of 38.7°C Rationale: A fever following an upper endoscopy may indicate a serious complication such as gastrointestinal perforation or infection. Mild throat discomfort, temporary drowsiness from sedation, and slight tachycardia may occur during early recovery. The nurse should also monitor for severe abdominal pain, subcutaneous emphysema, bleeding, respiratory distress, and abdominal rigidity. A nursing assistant offers water to a patient who has just returned after an esophagogastroduodenoscopy. What should the registered nurse do? A. Allow the patient to take small sips B. Stop the assistant and assess the gag reflex C. Add thickener to the water D. Ask the patient to drink through a straw Correct Answer: B. Stop the assistant and assess the gag reflex Rationale: Topical anesthetic used during endoscopy suppresses the gag reflex and increases aspiration risk. Oral fluids must be withheld until the registered nurse confirms that the gag and swallowing reflexes have returned. Thickening the fluid, using a straw, or limiting the amount does not eliminate aspiration risk when protective reflexes remain impaired. Question 12: A healthcare provider orders an endoscopic retrograde cholangiopancreatography as soon as possible. Which action should the nurse implement first? A. Obtain the patient’s signature on the consent form B. Explain the expected sensations during the procedure C. Administer the prescribed sedative D. Place the patient on NPO status Correct Answer: D. Place the patient on NPO status Rationale: ERCP requires an empty stomach to reduce aspiration risk and permit safe endoscopic visualization. Because the patient may need to remain NPO for several hours, this restriction should begin immediately. Consent, teaching, and preprocedural sedation are also necessary, but they can be completed after the fasting period has started.