ECON MISC QUESTIONS AND ANSWERS WITH EXPLANATION

ECON MISC QUESTIONS AND ANSWERS WITH EXPLANATION A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? A. Flush the tube with water. B. Place the client in semi-Fowler's position. C. Cleanse the skin around the tube site. D. Aspirate the tube for residual contents. - CORRECT ANSWER B. Place the client in semi-Fowler's position. A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is used to do which of the following? A. To visualize polyps in the colon B. To detect an ulceration in the stomach C. To identify an obstruction in the biliary tract D. To determine the presence of free air in the abdomen - CORRECT ANSWER A. A sigmoidoscopy or barium enema is used to visualize the lower gastrointestinal tract, where polyps are found. B. CORRECT: An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect a tumor, ulceration, or obstruction. C. Identifying an obstruction in the biliary tract is performed during endoscopic retrograde cholangiopancreatography (ERCP). D. The measurement of free air, which is a gas, is obtained using fluoroscopy or an x-ray, not an EGD. A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? A. "This procedure is performed to measure the presence of acid in your esophagus." B. "This procedure can determine how well the lower part of your esophagus works." C. "This procedure is performed while you are under general anesthesia." D. "This procedure can determine if you have colon cancer." - CORRECT ANSWER A. A pH probe study, which involves the insertion of a specially designed probe into the distal esophagus. is performed to monitor for the presence of acid in the normally alkaline esophagus. B. CORRECT: An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures. C. An EGD is performed while the client receives moderate sedation. D. A colonoscopy is performed to detect colon cancer. A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention by the nurse? A. A full pitcher of water is sitting on the clients bedside table within the clients reach. B. The disposable feeding bag from the previous day at 1000, and contains 200 mL of feeding. C. The client is lying on the right side with a visible dependent loop in the feeding tube. D. The head of the bed is elevated 20 degrees. - CORRECT ANSWER A. the nurse should monitor the clients intake and output and should observe the client for manifestations of dehydration, such as dry mucous membranes, thirst, and decreased urinary output. A pitcher of water at the clients bedside does not require intervention by the nurse. B. The clients feeding bag should be changed every 24 hrs. The 200 mL remaining in the bag is sufficient to last until the bag needs to be changed. Because the rate is 75 mL/hr, the nurse will need 150 mL to cover the 2 hr until the bag needs to be changed. The 50 mL left in the bag will ensure that the bag does not run dry, causing air to enter the clients stomach. C. This observation does not require intervention because the feeding is not by gravity, but by a pump. and is set at a constant rate. The clients side-lying position will not affect the pump's rate of flow unless the client is lying on the tubing. D. CORRECT: The head of the bed should be elevated at least 30. (Semi-Fowler's position) while the tube feeding is administered. This position uses gravity to help the feeding move down through the digestive system and lessens the possibility of regurgitation. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis - CORRECT ANSWER A. A client experiencing fluid volume overload will exhibit hypertension. B. A client experiencing hyperglycemia will exhibit excessive thirst. C. A client who has an infection will have an increased temperature. D. CORRECT: The nurse should recognize that the client has the potential for the development of hypoglycemia due to the sudden withdrawal of the TPN solution. In addition to diaphoresis. other potential manifestations of hypoglycemia can include weakness, anxiety, confusion. and hunger. A nurse is caring for a client who has celiac disease. which of the following foods should the nurse remove from the client's meal tray? A. Wheat toast B. Tapioca pudding C. Hard-boiled egg D. Mashed potatoes - CORRECT ANSWER A. CORRECT: Celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Wheat toast contains gluten and should be removed from the clients tray. B. Tapioca pudding is rich in dairy and does not contain gluten. Therefore, it is an acceptable food to include in the clients diet. C. A hard-boiled egg does not contain gluten and is a good source of protein. Therefore, it is an acceptable food to include in the client's diet. D. Mashed potatoes do not contain gluten and are a good source of protein and potassium. Therefore mashed potatoes are an acceptable food to include in the clients diet. A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. which of the following laboratory findings should the nurse monitor prior to the procedure? A. Prothrombin time B. Serum lipase C. Bilirubin D. Calcium - CORRECT ANSWER A. CORRECT: A major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk for bleeding. Along with the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and the platelet count should be monitored. Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to an increased incidence of bruising nosebleeds, bleeding from wounds, and gastrointestinal bleeding. This is due to a deficient absorption of vitamin K from the gastrointestinal tract caused by the inability of liver cells to use vitamin K to make prothrombin. B. Serum lipase is monitored to detect pancreatic disease and does not need to be monitored prior to this procedure. C. Bilirubin is monitored to detect biliary obstruction and does not need to be monitored prior to this procedure. D. Calcium is monitored to detect kidney failure or pancreatitis and does not need to be monitored prior to this procedure. A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Increased blood pressure B. Decreased heart rate C. Yellowing of the skin D. Boardlike abdomen - CORRECT ANSWER A. The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of shock, including hypotension. B. The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of shock, including tachycardia. C. The nurse should expect a client who has liver disease to exhibit jaundice, or yellowing of the skin. D. CORRECT: The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a boardlike abdomen and severe pain in the abdomen or back that radiates to the right shoulder. Vomiting of blood and shock can occur if the perforation causes hemorrhaging. A nurse is caring for a client who has a history of cirrhosis and is admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? A. Gamma-gluramyl transferase (GGT) B. Alkaline phosphatase (ALP) C. Serum bilirubin D. Alanine aminotransferase (ALT] - CORRECT ANSWER A. CORRECT: The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring drug toxicity and excessive alcohol use. B. ALP is elevated in biliary obstruction and most forms of liver dysfunction. It does not differentiate between alcohol and other causative factors for liver disease. C. The serum bilirubin test is used to detect the function of the liver and its ability to excrete bilirubin. Elevated levels can determine liver disease or biliary tract disease. D. The largest concentration of the enzyme ALT is found in liver tissue. However. it is also present in kidney, heart. and skeletal muscle tissues. Because it is elevated in various toes of tissue damage. it is not helpful in identifying excessive alcohol use. A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. which of the following foods should the nurse recommend? A. Foods high in vitamin C B. Foods low in fat C. Foods high in fiber D. Foods low in calories - CORRECT ANSWER A. Vitamin C functions as an antioxidant as well as a coenzyme. It can be associated with prevention of cancer of the stomach. esophagus and colon. However, it does not improve or prevent acute diverticulitis attacks. B. Low-fat foods do not improve or prevent acute diverticulitis attacks. C. CORRECT: The result of long-term, low-fiber eating habits along with increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain active motility of the gastrointestinal tract. D. Low-calorie foods do not improve or prevent acute diverticulitis attacks. A nurse is caring for a client who is 4 hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? A. Right shoulder pain B. Urine output 20 mL/hr C. Temperature 38.4 degrees C (101.1 degrees F) D. Oxygen saturation 92% - CORRECT ANSWER A. CORRECT: The client can experience pain in the right upper shoulder due to gas (carbon dioxide) injected into the abdominal cavity during the laparoscopic procedure, which can irritate the diaphragm and cause referred pain in the shoulder area. The pain disappears in 1-2 days. Mild analgesics and a recumbent position can help with client comfort. B. Urine output following surgery should be at least 30 mL/hr. Less than this amount can indicate hypovolemia or renal complications and should be reported to the provider immediately. C. A temperature greater than 38.4. C (101.1 F) can indicate infection and should be reported to the provider immediately. D. An oxygen saturation of less than 95% can indicate an impaired gas exchange following surgery and should be reported to the provider immediately. A nurse in the emergency dependent is caring for a client who has bleeding esophageal varies. The nurse should anticipate a prescription for which of the following medications? A. Famotidine B. Esomeprazole C. Vasopressin D. Omeprazole - CORRECT ANSWER A. Famotidine is an H2 receptor antagonist used to treat stress ulcers. B. Esomeprazole is a proton pump inhibitor used to treat gastrointestinal reflux disease. C. CORRECT: Vasopressin constricts the splanchnic bed and decreases portal pressure. Vasopressin also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varies. D. Omeprazole is a proton pump inhibitor used to treat duodenal and gastric ulcers. A nurse is assessing a client who is in the early stages of hepatitis A. which of the following manifestations should the nurse expect? A. Jaundice B. Anorexia C. Dark urine D. Pale feces - CORRECT ANSWER A. Jaundice is a late manifestation of hepatitis A. B. CORRECT: Anorexia is an early manifestation of hepatitis A and is often severe. It is thought to result from the release of a toxin by the damaged liver or by the failure of the damaged liver cells to detoxify an abnormal product. C. Dark urine is a late manifestation of hepatitis A. D. Pale feces is a late manifestation of hepatitis A. A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hr after treatment begins? A. Aldolase B. Lipase C. Amylase D. Lactic dehydrogenase - CORRECT ANSWER A. Elevated aldolase levels are caused by inflammation of the muscles, also known as myositis. The levels of aldolase are not affected by pancreatic disorders. B. Lipase levels in clients who have pancreatitis increase after a rise in serum amylase and stay elevated for up to 14 days longer than amylase. C. CORRECT: Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3 to 6 hr following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hr and returns to the expected reference range within 2 to 3 days. D. Lactic dehydrogenase (LDH) increases are typically seen in clients who have anemia, leukemia, or liver damage. A nurse is caring for a client who is 2 days postoperative following a gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding? A. Vanilla pudding B. Apple juice C. Diet ginger ale D. Clear liquids - CORRECT ANSWER A. Vanilla pudding contains sugar, which can cause diarrhea due to hyperosmolarity. Clear liquids should be given as the first oral feeding. B. The sugar content of apple juice can cause diarrhea due to hyperosmolarity. Clear liquids should be given as the first oral feeding. C. The client should avoid carbonated beverages because they can distend the stomach. causing pressure on the internal sutures or staples. Pressure can cause leaking into the peritoneum resulting in peritonitis. D. CORRECT: Clear liquids. such as water or broth. can be given for the first oral feedings. but should be limited to only 30 mL (1 oz) per feeding. Water does not contain sugar. which could cause diarrhea due to hyperosmolarity. A nurse is completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High-calorie diet B. Prior gastrointestinal illnesses C. Tobacco use D. Alcohol use - CORRECT ANSWER A. A high-calorie diet can contribute to heart disease and obesity but it does not cause chronic pancreatitis. B. A prior gastrointestinal illness does not cause or contribute to chronic pancreatitis. C. tobacco use can contribute to heart disease and increases the risk of cancer development. but it does not cause chronic pancreatitis. D. CORRECT: Alcohol consumption is one of the major causes of chronic pancreatitis in the U.S. Long-term alcohol use disorder produces hyper secretion of protein in pancreatic secretions. The result is protein plugs and calculi within the pancreatic ducts. Alcohol also has a direct toxic effect on the cells of the pancreas. Damage to these cells is more likely to occur and to be more severe in clients whose diets are poor in protein content and either very high or very low in fat. A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing hepatitis A? A. Children B. Older adults C. Women who are pregnant D. Middle-aged men - CORRECT ANSWER A. CORRECT: The hepatitis A virus can be contracted from the feces. bile, and blood of infected clients. The usual mode of transmission is the fecal-oral route. Children and young adults are the two groups most often affected by the hepatitis A virus. Typically, a child or young adult acquires the infection at school, through poor hygiene, hand-to-mouth contact, or another form of close contact. B. Older adults are not often affected by or at risk for developing hepatitis A. C. Women who are pregnant are not often affected by or at risk for developing hepatitis A. D. Middle-aged men are not often affected by or at risk for developing hepatitis A. A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? A. Elevated blood pressure B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food - CORRECT ANSWER A. A client who has experienced a bowel perforation will not display an elevated blood pressure. However, hypotension or shock can be present. B. Intestinal peristalsis increases in frequency and intensity as the bowel attempts to move intestinal contents past the obstructed area. Bowel sounds are silent with a bowel perforation C. CORRECT: Abdominal tenderness and rigidity occur with a bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume and a lowered blood pressure. or hypotension, results. D. Vomiting is frequent and copious with a small bowel obstruction. This does not indicate a bowel perforation. A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for this client? A. Endoscopic sclerotherapy B. Liver lobectomy C. Liver transplant D. Transjugular intrahepatic portal-systemic shunt placement - CORRECT ANSWER A. Endoscopic sclerotherapy is the injection of a sclerotherapy agent during endoscopy to target esophageal varies that are actively bleeding. This promotes thrombosis, which eventually leads to sclerosis. B. A liver lobectomy is used for a client who has localized cancer of a lobe of the liver. This is not appropriate for a client experiencing rapidly progressive liver failure. C. CORRECT: Fulminant hepatic failure, most often caused by viral hepatitis, is characterized by the development of hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence of hepatic dysfunction. Mortality remains high. even with treatment modalities such as blood or plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, liver transplantation has become the treatment of choice for these clients. D. A transjugular intrahepatic portal-systemic shunt is placed to treat esophageal varies through placement of a stent into the portal vein. The stent serves as a shunt between the portal circulation and the hepatic vein, thereby reducing portal hypertension. It is not used for fulminant hepatic failure. A nurse is preparing a community education program about hepatitis B. Which of the following statements should the nurse include in the teaching? A. "A hepatitis B immunization is recommended for those who travel, especially military personnel." B. "A hepatitis B immunization is given to infants and children." C. "Hepatitis B is acquired by earring foods that are contaminated during handling." D. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation." - CORRECT ANSWER A. The hepatitis A vaccine is recommended for those who travel, especially military personnel It is also recommended for other at-risk groups. B. CORRECT: Hepatitis B immune globulin is given as part of the standard childhood immunizations. It can be administered as early as birth. especially in infants born to hepatitis B Surface antigen (HBSAg) negative mothers. These infants should receive the second dose between 1 and 4 months of age. C. Hepatitis A is acquired by eating fruits. vegetables, shellfish. or other foods that are contaminated during handling. Hepatitis B is acquired by exposure to blood or body fluids from an infected person. D. Good personal hygiene habits and proper sanitation can help prevent the spread of hepatitis A. Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis? A. Severe, radiating abdominal pain B. Black, tarry stools and dark urine C. Increased and painful urination D. Increased appetite and weight gain - CORRECT ANSWER A. Severe, radiating abdominal pain A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? A. Maintain a high-fat diet and drink at least 3 L of fluid a day. B. Maintain a high sodium, high-calorie diet C. Maintain a high carbohydrate, low-fat diet D. Maintain a high-fat, high-carbohydrate diet - CORRECT ANSWER C. Maintain a high carbohydrate, low-fat diet A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? A. Fried chicken B. Mashed potatoes C. Dinner roll D. Tapioca pudding - CORRECT ANSWER A. Fried chicken A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? A. Alterations in glucose metabolism B. Retention of bile salts C. Inadequate production of albumin by hepatocytes D. Inability of the liver to use vitamin K - CORRECT ANSWER D. Inability of the liver to use vitamin K Which of the following is a true statement regarding regional enteritis (Crohn's disease)? A. It has a progressive disease pattern B. It is characterized by lower left quadrant abdominal pain. C. The clusters of ulcers take on a cobble stone appearance. D. The lesions are in continuous contact with one another. - CORRECT ANSWER C. The clusters of ulcers take on a cobble stone appearance. A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patients stools will have what characteristics? A. Watery with blood and mucus B. Hard and black or tarry C. Dry and streaked with blood D. Loose with visible fatty streaks - CORRECT ANSWER A. Watery with blood and mucus What is the cause of a 'non-mechanical' bowel obstruction? A. A tumor or twisting of the bowel B. Constipation. C. General anesthesia, narcotics, and handling of the bowel during surgery. D. Adhesions - CORRECT ANSWER C. General anesthesia, narcotics, and handling of the bowel during surgery. What should the nurse advise a pt. who has diverticulosis to eat? A. High fiber foods. B. Low fiber foods. C. Low carb foods. D. High carb foods - CORRECT ANSWER A. High fiber foods. What should the nurse advise a pt. who has diverticulitis to eat? A. High fiber foods. B. Low fiber foods. C. Low carb foods. D. High carb foods - CORRECT ANSWER B. Low fiber foods. Which of the following is an appropriate nursing intervention for a patient who has had an EGD? A. Give food and water as soon as the test is completed. B. Enemas until clear. C. Monitor for hemorrhage r/t organ perforation. D. Administer a sedative. - CORRECT ANSWER C. Monitor for hemorrhage r/t organ perforation. Which of the following is an appropriate nursing intervention for a pt. who has GERD? A. Advise pt. to remain upright after meals. B. Withhold fluids during meal time. C. Administer the appropriate immunoglobulin. D. Give the prescribed steroids with half a glass of milk. - CORRECT ANSWER A. Advise pt. to remain upright after meals. Which of the following is a priority for a pt. who is hemorrhaging from a perforated duodenal ulcer? A. Administer the sedative prior to the PY test. B. Monitor for shock. C. Position the pt. on his back with a pillow under his right ribs and his right hand under his head. D. Guiac his stool - CORRECT ANSWER B. Monitor for shock. Which of the following is an appropriate nursing intervention for a pt. who has gastritis? A. Lavage the NG tube with iced saline. B. Give sucralfate with meals and follow it with antacids. C. Advise the pt. to avoid irritating foods such as spicy foods. D. Advise the pt. to drink milk every two hours. - CORRECT ANSWER C. Advise the pt. to avoid irritating foods such as spicy foods. Which of the following is an appropriate nursing intervention for a pt. who has an inguinal hernia? A. Turn, cough, & deep breath every hour while awake to prevent pneumonia. B. Avoid prolonged standing. C. Decrease fiber intake to control diarrhea. D. Monitor your stools for occult blood. - CORRECT ANSWER B. Avoid prolonged standing. Which of the following should the nurse advise a pt who has ulcerative colitis to call the doctor for? A. Occasional abdominal cramping B. Nine mucous bloody stools per day. C. Signs of colon perforation and peritonitis. D. Diarrhea. - CORRECT ANSWER C. Signs of colon perforation and peritonitis. Which of the following promotes rest and healing of the bowel in a pt. who has ulcerative colitis? A. High fiber diet B. Maintaining NPO status as ordered C. Low carb diet D. Avoiding licorice and caffeine - CORRECT ANSWER B. Maintaining NPO status as ordered Which of the following nursing diagnosis might be appropriate for a pt with ulcerative colitis? A. Pain R/T the passage of stones. B. Risk for injury from falling R/T dizziness and low BP immediately after meals. C. Fatigue R/T blood loss caused by frequent bloody stools. D. Risk of injury R/T auto digestion of the pancreas. - CORRECT ANSWER C. Fatigue R/T blood loss caused by frequent bloody stools. The prototype drug for proton pump inhibitors: - CORRECT ANSWER Omeprazole (prilosec) The action of H2 Receptor Antagonists : - CORRECT ANSWER They block histamine and reduce gastric acid production The use of metroclopramide: - CORRECT ANSWER GI stimulant to Treat GERD and Antiemetic Method ondansetron (Zofran) prevents nausea & Vomiting: - CORRECT ANSWER blocks 5- HT3 Serotonin receptors The serious side effects associated with ondansetron (Zofran): - CORRECT ANSWER arrhythmias, hypotension, & extrapyramidal effects The prototype drug for H2 Receptor antagonists: - CORRECT ANSWER ranitidine (Zantac) Reason omeprazole should not be crushed or chewed: - CORRECT ANSWER enteric Coated granules & Acid labile The drug that used to be the prototype for H2 receptor Antagonists: - CORRECT ANSWER cimetidine (Tagamet) Serious Side effects of ranitidine (Zantac): - CORRECT ANSWER neutropenia, Agranulocytosis, Thrombocytopenia Aplastic anemia The potential electrolyte imbalances w/use of aluminum hydroxide w/magnesium hydroxide: - CORRECT ANSWER Hypophosphatemia & hypermagnesiemia The diet restrictions that should be taught for treatment of peptic ulcers: - CORRECT ANSWER avoiding Highly acidic, Spicey foods, alcohol, & caffeine The reason omeprazole dose may need to be adjusted in Asians: - CORRECT ANSWER the duration Of action is lengthened The common adverse effects of magnesium hydroxide: - CORRECT ANSWER cramps, Diarrhea, and nausea Caused by overactive GI activity Barium swallow: - CORRECT ANSWER Fluoroscopic observation of a client swallowing a flavored barium solution and its progress down the esophagus to detect structural abnormalities of the esophagus as well as swallowing discoordination and oral aspiration. Barium enema: - CORRECT ANSWER Radiographic study used to identify polyps, tumors, inflammation, strictures, and other abnormalities of the colon after instilling barium solution rectally. Endoscopic retrograde cholangio-pancreatography: - CORRECT ANSWER Procedure in which an endoscope is used to visualize the common bile duct and the pancreatic and hepatic ducts through the ampulla of Vater in the duodenum. Esophagogastro-duodenoscopy: - CORRECT ANSWER Examination of the esophagus, stomach, and duodenum through an endoscope to inspect, treat, or obtain specimens from any of the upper GI structures. Melena: - CORRECT ANSWER Black, tarry stools. PY test: - CORRECT ANSWER Test in which a client's breath is analyzed after consuming 14 C-urea capsules to detect Helicobacter pylori, the bacteria associated with peptic ulcer disease. Percutaneous liver biopsy: - CORRECT ANSWER Procedure in which a small core of liver tissue is obtained by placing a needle directly into the liver through the lateral abdominal wall. Radionuclide imaging: - CORRECT ANSWER Technique used to detect lesions in organs using a radioactive natural or synthetic element that is injected intravenously or ingested orally. Ultrasonography: - CORRECT ANSWER Technique that uses high-frequency sound waves to show the size and location of organs and to outline structures and abnormalities. A nurse is completing an admission assessment of a client who has pancreatitis. which of the following is an expected finding? A. Pain in right upper quadrant radiating to right shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation D. Epigastric pain radiating to left shoulder - CORRECT ANSWER D. Epigastric pain radiating to left shoulder A nurse is reviewing the health record of a client who has pancreatitis. The physical exam report by the provider indicates the presence of cullens sign. Which of the following is an appropriate action by the nurse to identify this finding? A. Tap lightly at the costovertebral margin on the clients back. B. Palpate the clients Right lower quadrant C. Inspect the skin around the umbilicus D. Auscultate the area below the clients scapula - CORRECT ANSWER C. Inspect the skin around the umbilicus A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to be reported to the provider? A. A history of cholelithiasis B. Serum amylase levels three times greater than the expected value C. Client report of severe pain radiating to the back that is rated at an "8" D. Hand spasms present when blood pressure is checked - CORRECT ANSWER D. Hand spasms present when blood pressure is checked "trouso's sign" Which dietary modification is utilized for a patient diagnosed with acute pancreatitis? A. High-protein diet B. Elimination of Coffee C. Low carbohydrate diet D. High-fat diet - CORRECT ANSWER B. Elimination of Coffee A nurse is providing care to a client who is 1 day post paracentesis. The nurse observes clear, pale-yellow fluid leaking from the puncture site. Which of the following is an appropriate nursing intervention? A. Place a clean towel near the drainage site B. Apply a dry, sterile dressing C. Attach an ostomy back D. Place the client in a supine position - CORRECT ANSWER B. Apply a dry, sterile dressing The nurse notes that the clients total bilirubin is 1.0 mg/dl. Which action by the nurse is correct? A. Access the clients sclerae for evidence of jaundice B. Check the clients stool for presence of occult blood C. Record the results as normal D. Test the clients urine for blood. - CORRECT ANSWER C. Record the results as normal You are working in the paracentesis clinic. Which of the following clients is most likely to have an adverse reaction to the lidocaine local anesthetic? A. Asian (Chinese) B. African american C. Caucasian D. Hispanic (Puerto rican) E. Native american (Navajo) - CORRECT ANSWER E. Native american (Navajo) A nurse is caring for a client who had a Paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A. Client report of upper chest pain B. Decreased urine output C. Pallor D. Temperature elevation - CORRECT ANSWER D. Temperature elevation The physician orders cholestyramine (questran) for the client with cirrhosis. The nurse determines that the drug is effective when the client exhibits which of the following? A. Reduced serum ammonia levels B. Improved clotting ability C. Decreased complaints of pruritus D. Improved serum protein levels - CORRECT ANSWER C. Decreased complaints of pruritus A college student is diagnosed with Hepatitis A (HAV). Which of the following actions by the nurse best accomplishes the goal of reducing potential transmission of HAV? A. The nurse dons a mask and gown when providing direct care B. The nurse maintains the client in private room at all times C. The nurse preforms vigorous handwashing after leaving the room. D. The nurse wears gloves whenever entering the clients room - CORRECT ANSWER C. The nurse preforms vigorous handwashing after leaving the room. A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the clients recent laboratory findings and recognizes that which of the following findings will place the client at risk for complications? A. Low platelet count B. Low sodium level C. Decreased prothrombin time D. Low hemoglobin - CORRECT ANSWER A. Low platelet count ? You are assigned to a client who is recovering from abdominal surgery. She tells you that the client in the next room has chronic hepatitis and she is afraid she will catch it. Which answer would best help this client? A. "Don't worry. That kind of hepatitis can only be transmitted sexually" B. "There are many kinds of hepatitis. Do you know which one she has?" C. "Hospital staff always use precautions to prevent any possibility of transmission of infectious diseases to other clients" D. "There is no problem, that client is not a carrier of the disease" - CORRECT ANSWER C. "Hospital staff always use precautions to prevent any possibility of transmission of infectious diseases to other clients" ?? The nurse is providing care for a patient who just had a paracentesis to treat ascites. Which of the following findings indicate that the procedure was effective? A. Increased heart rate B. Presence of a fluid wave C. Decreased shortness of breath D. Post procedure weight unchanged from pre procedure weight - CORRECT ANSWER C. Decreased shortness of breath The nurse is providing care for a patient who has acute Hepatitis B. Which of the following findings should the nurse expect? A. Joint pain B. Obstipation C. Periumbilical discoloration D. Right upper quadrant tenderness - CORRECT ANSWER D. Right upper quadrant tenderness The nurse is providing discharge teaching for a patient who has chronic hepatitis C. Which of the following statements by the patient indicates an understanding of the teaching? A. "I will decrease my intake of calories." B. "I will need treatment for 3 months" C. "I will avoid alcohol until i am no longer contagious" D. "I will avoid medications that contain acetaminophen" - CORRECT ANSWER D. "I will avoid medications that contain acetaminophen" The nurse is providing care for a patient who has peritonitis. The patient expresses anxiety about the impending surgery. Which of the following actions should the nurse take? A. "Why are you feeling so anxious?" B. "Tell me more about your concerns." C. "You should distract yourself by reading a magazine" D. "You have nothing to worry about. Your surgeon is excellent." E. "Others who have had this procedure have had great results." - CORRECT ANSWER B. "Tell me more about your concerns." A client is diagnosed with Hepatitis A (HAV). Which of the following should the nurse include in client education? A. "This type of hepatitis can now be cured by using a new medication every day for 12 weeks." B. "You cannot transmit this type of Hepatitis to others unless you have unprotected sex." C. "It's just fine to continue working as a food handler as long as you wear gloves." D. "You and everyone in your household should preform good handwashing." - CORRECT ANSWER D. "You and everyone in your household should preform good handwashing." Which layer of the uterus is responsible for labor and delivery? - CORRECT ANSWER Myometrium The smooth muscle of the prostate gland contributes to what function? - CORRECT ANSWER Ejaculation What hormone stimulates the release of milk from the breast of a nursing mother ? - CORRECT ANSWER Oxytocin Women secrete less estrogen as they age. What is one effect of this decrease? - CORRECT ANSWER Osteoporosis What change in the reproductive system do men experience as a normal part of aging? - CORRECT ANSWER Prostatic hypertrophy A woman has had two pregnancies. The first pregnancy produced a healthy baby girl. The second pregnancy produced a set of twins, a boy and a girl. How would the nurse document this history? - CORRECT ANSWER GII, PII What does the term abortus mean in an obstetrical history? - CORRECT ANSWER Loss of a fetus before it was mature enough to live outside of the mother The nurse is assisting with teaching a woman about early detection of cancer. According to the American Cancer Society, how should a 52-year-old woman be instructed to monitor for breast cancer? - CORRECT ANSWER Monthly BSE and a mammogram and clinical examination yearly A woman is advised by her physician to have a mammogram. What instructions should the nurse provide to assist the patient to prepare for the examination? - CORRECT ANSWER Avoid applying deodorant or powder before the test. Which palpation pattern should women be taught to use when practicing breast self-examination ? - CORRECT ANSWER Any pattern that is consistent and covers all breast tissue The nurse is preparing a woman for a pelvic examination. Which action should the nurse take prior to the examination? - CORRECT ANSWER Have the patient void The nurse is helping a young woman prepare for her first pelvic examination. Which of the following actions by the nurse is best? - CORRECT ANSWER Teach the patient a relaxation exercise The nurse is assisting with a Papanicolaou (Pap) smear. Following specimen placement on the slide, what should the nurse do first with the slide? - CORRECT ANSWER Spray it with a fixative The nurse notes that insufflation was used on a patient who has had an endoscopic examination. What care should the nurse provide for the patient during the recovery period after the procedure? - CORRECT ANSWER Have the patient lie flat for several hours. A nurse is teaching a 30-year-old male patient about testicular self-examinations (TSE). Which of the following instructions would be included in the teaching? - CORRECT ANSWER "Monthly TSE is an important part of cancer screening." The nurse assists with patient education related to testicular self-examination (TSE). The nurse determines that teaching was effective when the patient makes which of the following statements? - CORRECT ANSWER "The TSE examination is easiest after a warm bath or shower." What should a nurse teach a 50-year-old man about monitoring for prostate problems? - CORRECT ANSWER Have a yearly digital rectal examination (DRE). The nurse provides care for an elderly man with noted breast enlargement. He denies discomfort. Which of the following statements, recorded in the chart, is most appropriate? - CORRECT ANSWER "Gynecomastia noted bilaterally, no complaints of tenderness." While performing a physical examination on a male patient, the nurse notes that the urethral opening is located on the underside of the penis. Which of the following terms best describes this condition? - CORRECT ANSWER Hypospadias The nurse is helping a patient who is scheduled to have a cystourethroscopy. Which of the following questions is most important for the nurse to ask? - CORRECT ANSWER "Do you have any allergies?" The nurse is caring for a patient who recently underwent cystourethroscopy. Which of the following instructions should the nurse provide before the patient is discharged? - CORRECT ANSWER "You should report any changes in your usual urination pattern." A patient learns he has an elevated prostate-specific antigen (PSA) and asks the nurse what this means. What is the best response? - CORRECT ANSWER "An elevated PSA can indicate prostatic hypertrophy or cancer. You should follow up as your physician advises." According to the American Cancer Society, how often should a breast self-examination (BSE) be performed? - CORRECT ANSWER Monthly The vulva includes which of the following structures? (Select all that apply.) - CORRECT ANSWER Mons pubis Bartholin's glands Clitoris Which glands produce secretions that become part of semen? (Select all that apply.) - CORRECT ANSWER Bulbourethral glands Prostate gland Seminal vesicles What assessment findings on breast palpation should the nurse report to the physician for follow-up? (Select all that apply.) - CORRECT ANSWER Puckering or dimpling of skin Asymmetrical movement of the breasts Areas of different consistency Different pointing position of nipples The LPN is providing instructions on testicular self-examination. Which of the following statements would be included in the teaching? (Select all that apply.) - CORRECT ANSWER "If you notice any lumps or unusual changes, you should call your doctor." "The left side of the scrotum usually hangs a little lower than the right." "The testicles should be round, smooth, and egg-shaped." An LPN is caring for a woman whose obstetrical history is noted as GIV, PIII, AI. The nurse knows which of the following is true about the patient's history? (Select all that apply.) - CORRECT ANSWER The woman gave birth three times One pregnancy failed to result in a live birth A client who is bedridden is complaining of joint pain. Which of the following interventions would be most helpful for providing comfort? a. Encourage the client to lie still and do not move the affected joints b. Apply a cold pack or an ice bag to the affected joints c. Administer anticonvulsant medications to use as an adjuvant therapy d.Apply a warm water bath for 15 minutes to painful joints - CORRECT ANSWER d. Rationale: An immobile client may be more likely to have joint pain from lack of movement. A non-pharmacological form of therapy is warmth from a warm water bath to the affected areas. Warm water improves circulation and can provide comfort to the site. The nurse should use a basin with warm water carefully and only for a few minutes at a time to avoid burning the client's skin. In some cases a heating pad can be substituted for the warm water. A client is told by the provider that he needs knee replacement surgery because of osteoarthritis. Which best describes shared decision making when making choices for this client's care? a. The client chooses a treatment plan presented by the provider based on the client's preferences b. The client is told of the severe consequences of not having surgery c. The client calls a meeting of providers who can teach him about his options d. The provider recruits other professionals to talk together the client about his care - CORRECT ANSWER a. Rationale: "The client chooses a treatment plan presented by the provider based on the client's preferences" is correct. Shared decision making is an important component of patient-centered healthcare in which the client and the provider work together to make a decision for a treatment plan. Shared decision making in this case would involve the client discussing his options for surgery with his provider and then making a decision based on the client's preferences and on clinical outcomes. A client is suffering from osteoarthritis in the knees and the nurse is providing care. The nurse is assessing the client's pain level and pain tolerance. Based on the nurse's understanding of pain, the nurse knows that a client's pain tolerance is most likely increased by which of the following? a. Sleep b. Boredom c. Introversion d. Anger - CORRECT ANSWER a. People have varying levels of pain tolerance, which is described as the amount of pain a person can endure. Some activities and conditions may positively affect a client's pain tolerance and may improve how pain is handled. Regular and restorative sleep can help a person to manage pain better than being sleep deprived. Other conditions that can raise pain tolerance include relaxation therapy, diversion, and social inclusion. A nurse is educating a client about his osteoarthritis and how best to manage his condition at home. Which of the following statements made by the client indicate that more teaching is necessary? a. I am going to quit smoking because it will help with my disease b. I can sit at my computer and perform my data entry job like I usually do c. I play football, but I am going to switch to walking instead d. I'm going to work on losing weight - CORRECT ANSWER b. Rationale: "I can sit at my computer and perform my data entry job like I usually do" is correct. Osteoarthritis is a type of joint disease in which the cartilage between the bones and joints breaks down, causing pain and deformity in the affected areas. A client who has osteoarthritis can make some lifestyle changes that will improve quality of life and help to control pain and disability. The client should be taught to quit smoking if he does smoke and to limit activities that cause significant pressure or damage to the joints, such as with certain contact sports. The client should also avoid or modify activities that involve repetitive actions, like data entry, which can cause further damage from repeated stress to the joints. The nurse received report on 4 clients and has decided that the client who needs methotrexate should be seen first. Which of the following clients needs methotrexate? a. A client with osteoarthritis b. A client with a bowel obstruction c. A client with rheumatoid arthritis d. A client with seizures - CORRECT ANSWER c. rationale: Methotrexate is an anti-rheumatic used to treat psoriasis or rheumatoid arthritis. Etanercept is a subcutaneous DMARD injection. The nurse understands that this drug does which of the following? a. Increases endogenous endorphins b. Reduces substance P in the tissues c. Blocks tumor necrosis factor receptors d. Decreases perception of pain - CORRECT ANSWER c. rationale: Etanercept binds with tumor necrosis factor (TNF) and blocks the TNF receptors on the cells, decreasing the symptoms of the disease. This reduces swelling and inflammation, therefore improving symptoms for the client with RA. A client takes medication for rheumatoid arthritis. The nurse reviews the client's list of medications and knows that which of the following medications is used to treat and manage rheumatoid arthritis? a. Immodium b. Indomethacin c. Imdur d. Inderal - CORRECT ANSWER b. rationale: "Indomethacin" is correct. This is an anti-rheumatic medication used most often for clients with rheumatoid arthritis. A 68-year-old patient suffers from rheumatoid arthritis in the joints of her arms, legs, and hands. The doctor has prescribed oral corticosteroid treatment for the patient's condition. Which information should the nurse include about how this medication works to treat arthritis? a. Corticosteroids counteract many neurotransmitters secreted by the brain b. Corticosteroids decrease prostaglandin levels that affect inflammation c. Corticosteroids stimulate opioid receptors to increase pain control d. Corticosteroids prevent the body from releasing the stress hormone cortisol - CORRECT ANSWER b. rationale: "Corticosteroids decrease prostaglandin levels that affect inflammation" is correct. Corticosteroids are drugs commonly prescribed for management of inflammatory conditions such as rheumatoid arthritis. They mimic the effects of the hormone cortisol in the body and decreas in prostaglandin levels, which are responsible for inflammation. They may be taken as oral tablets, used as topical treatments, or injected for relief of arthritis symptoms. "Corticosteroids prevent the body from releasing the stress hormone cortisol" is incorrect because cortisol IS a corticosteroid hormone. A client who has suffered from severe rheumatoid arthritis for 10 years has decided not to have surgery after injuring a leg in a fall. Which of the following describes how the nurse would advocate for this client in this case? Select all that apply. a. Notify the anesthesiologist about the client's need for pain control b. Seek to educate the client about the procedure c. Develop an alliance between the client and the provider d. Contact the client's family to suggest talking to the client e. Discuss the case with hospital administrators who can convince the client to change her mind - CORRECT ANSWER b. , c. rationale: "Develop an alliance between the client and the provider" and "Seek to educate the client about the procedure" are correct. A nurse must act as a client advocate, even if the nurse does not agree with all of the client's decisions. In this case, the nurse should continue to provide client care by acting as a liaison and continuing to educate the client about treatment options and outcomes. A nurse is working with a community group promoting healthy aging. What recommendation is best to help prevent osteoarthritis? a. Avoid contact sports. b. Get plenty of calcium. c. Lose weight if needed. d. Engage in weight-bearing exercise. - CORRECT ANSWER c. rationale: Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or reduce symptoms once it occurs. Arthritis can be caused by contact sports, but this is less common than obesity. Calcium and weight-bearing exercise are both important for osteoporosis. A nurse is caring for a 78-year-old client with severe, debilitating rheumatoid arthritis who lives at home with the spouse. The nurse assesses the client's level of safety in the home. Which aspects should be included as part of this home safety assessment? Select all that apply. a. Whether there is sufficient lighting b. Whether the home has ceiling fans c. Whether there is space available for a caregiver to help with the client d. Whether there are changes in floor levels e. Whether there are stairs in the home - CORRECT ANSWER a., c., d., e. rationale: When caring for a client in the home, the nurse may notice safety hazards that could protect the client if changed. The client should be able to move about in the home and have assistive devices, such as grab bars in the bathroom, levers instead of round handles, and railings on stairs. The nurse should point out any obvious hazards so they can be changed as soon as possible. When caring for a client in the home, the nurse may notice safety hazards that could protect the client if changed. The client should be able to move about in the home and have assistive devices, such as grab bars in the bathroom, levers instead of round handles, and railings on stairs. The nurse should point out any obvious hazards so they can be changed as soon as possible.When caring for a client in the home, the nurse may notice safety hazards that could protect the client if changed. The client should be able to move about in the home and have assistive devices, such as grab bars in the bathroom, levers instead of round handles, and railings on stairs. The nurse should point out any obvious hazards so they can be changed as soon as possible. When caring for a client in the home, the nurse may notice safety hazards that could protect the client if changed. The client should be able to move about in the home and have assistive devices, such as grab bars in the bathroom, levers instead of round handles, and railings on stairs. The nurse should point out any obvious hazards so they can be changed as soon as possible. A client with potential rheumatoid arthritis is having laboratory testing and requires an ESR blood test. Which of the following best describes the ESR? a. The rate at which blood cells settle to the bottom of a tube containing blood b. The amount of by-product produced with muscle breakdown c. The presence of a gene that increases rheumatoid factor d. The level of antibodies present in response to an inflammatory antigen - CORRECT ANSWER a. ratoinale: A client with rheumatoid arthritis may have a laboratory test of an ESR (erythrocyte sedimentation rate), or 'sed rate' to determine the amount of inflammation present. Inflammation causes red blood cells to clump. When the cells clump, they become denser and sink to the bottom of the tube more quickly. The ESR is the rate at which blood cells settle to the bottom of a tube containing blood. The nurse is educating a client on managing gout. Which of the following statements by the client indicates more education is necessary? Select all that apply. a. "I can't wait to get home. My wife and I have our weekly wine and cheese night with friends" b. "When I have a flare-up, I try to increase my activity to get the blood flowing better and hopefully have it resolve faster" c. "I try to limit my intake of water. I feel like that helps my symptoms" d. I need to make sure I get a refill of my allopurinol for my gout" e. "Man, these tophi are incredibly painful" - CORRECT ANSWER a. , b., , c. rationale: "I can't wait to get home. My wife and I have our weekly wine and cheese night with friends" This statement indicates that more education is necessary. Wine and cheese are high in purines, which worsen symptoms of gout. Foods high in purines should be avoided. "When I have a flare-up, I try to increase my activity to get the blood flowing better and hopefully have it resolve faster" This statement indicates that more education is necessary. While activity and blood flow can help decrease pain and prevent flare ups, rest is always recommended during an actual flare up. "I try to limit my intake of water. I feel like that helps my symptoms" This statement indicates that more education is necessary. Adequate hydration is necessary to help flush the excess crystals in the system. Limiting water intake is never recommended for a client with gout. A client is being seen for treatment of gout. The client is in the acute stage of an attack of gouty arthritis. For which of the following signs or symptoms should the nurse assess? a. Pain and inflammation b. Uric acid crystals under the skin c. Kidney stones d. Bloody urine - CORRECT ANSWER a. rationale: "Pain and inflammation" is correct. Gout is a type of arthritis that develops when uric acid crystals accumulate and inflame the joints. Gout may be considered acute or chronic. During the acute stage of gout, the client may have severe pain and joints that are inflamed, red, and tender. If left untreated, gout can become chronic which leads to kidney stones, blood in the urine, and collections of uric acid crystals under the skin. "Kidney stones", "Uric acid crystals under the skin", and "Bloody urine" are incorrect. These are symptoms of chronic gout, NOT acute gout. A 67-year-old patient is being seen following an arm fracture. The patient was diagnosed with osteoporosis last year and has been making lifestyle changes to manage the condition. The physician now wants to start the patient on medication to control the disease. Which type of medication would most likely be prescribed to prevent the breakdown of bone tissue in the body? a. Bismuth Subsalicylate b. Cholinergics c. Biphosphonates d. Biological response modifiers - CORRECT ANSWER c. rationale: "Biphosphonates" is correct. Biphosphonates are drugs used for the treatment of osteoporosis. They work by preventing the breakdown of bone tissue in the body that leads to bone loss. Examples of biphosphonates include Fosamax and Boniva. A 55 year old woman has been prescribed ibandronate sodium (Boniva) for the prevention of osteoporosis. The nurse is giving the patient her prescription and should include which of the following information about taking this drug? a. The patient should not have a vitamin D deficiency b. The patient must not have suffered a fracture in the past c. The patient must have had osteoporosis for at least five years prior d. The patient cannot have a history of cancer - CORRECT ANSWER a. rationale: "The patient should not have a vitamin D deficiency" is correct. Ibandronate is a type of medication known as a biphosphonate, which works for the treatment of osteoporosis. Ibandronate works by changing how bone is formed and broken down in the body, slowing the progression of osteoporosis. The patient who takes this drug must be able to sit up for at least 60 minutes after administration. It is also not intended for those who have vitamin D deficiency, because this affects calcium levels in the body. Additionally, the patient with kidney disease should not take biphosphonates because of the risk of renal toxicity. A client with osteoporosis asks the nurse why it is important to take vitamin D. Which response by the nurse is correct? a. Vitamin D reduces excretion of calcium in the kidneys b. Vitamin D minimizes the risk of kidney stones c. Vitamin D helps prevent constipation from increased calcium intake d. Vitamin D improves the absorption of calcium - CORRECT ANSWER d. rationale: "Vitamin D improves the absorption of calcium" is correct. Taken with calcium, vitamin D aids with calcium absorption which is essential for bone building and slowing the progression of osteoporosis. A 70-year-old client has been diagnosed with osteoporosis after undergoing a bone mineral density test. When reviewing the results of the test, the nurse explains to the client that the T score is which of the following? a. The amount of bone density compared to that of a healthy 30-year-old b. The test results of the DEXA scan, expressed in mg/mL c. The level of calcium found in a particular bone in the body d. The amount of radiation used with the test - CORRECT ANSWER a. rationale: "The amount of bone density compared to that of a healthy 30-year-old" is correct. A T-score of a bone mineral density test checks the amount of bone density the client has and compares it to the bone density of a healthy 30-year-old. The T-score is given so that the client understands if their bone density is above or below average levels. A home care nurse is working with a client who has osteoporosis. Which guideline for home safety would be most appropriate in preventing fractures in this client? a. Avoid using the shower and only use the bathtub to bathe every day b. Keep lights on in the stairwell, with switches accessible at the top and bottom c. Cover all cords with a throw rug taped to the floor d. Keep most items on lower shelves and in cupboards under the counter to avoid reaching high - CORRECT ANSWER d. rationale: Lower shelves is appropriate for placement of items, but not too low in cupboards. Items should be within easy reach. A client with osteoporosis asks the nurse how to prevent fractures from the condition. The nurse should tell the client to avoid which of the following positions? a. Standing with the shoulders back b. Bending at the knees c. Sitting slumped, with the head forward d. Keeping a close center of gravity - CORRECT ANSWER c. rationale: This is the only response that describes improper body alignment. A client with osteoporosis is at risk of fractures from even minor injuries. Having proper body alignment places less stress on the client's spine and can prevent fractures. The nurse should counsel the client to avoid sitting in a slumped position with the head forward and twisting at the waist while turning. The nurse is caring for a newly admitted client with osteomyelitis. Which of the following is a not a nursing priority when caring for this client? a. Applying heat for comfort b. Monitoring signs of worsening infection c. Assessing pain control d. Frequent neurovascular checks - CORRECT ANSWER a. rationale: Heat increases circulation and swelling which is contraindicated with osteomyelitis, so this is not a nursing priority. The nurse could use elevation to help with edema rather than heat, which would also help with comfort. The nurse is caring for a client with suspected osteomyelitis. Which of the following are key features of this condition? Select all that apply. a. Temperature of 101.5 degrees Fahrenheit b. Increased drainage from the affected area c. Skin ulceration around the affected area d. Constant bone pain that increases with movement e. Increased swelling around the affected area - CORRECT ANSWER a., d. , e. rationale: A fever is usually seen with acute osteomyelitis. Constant bone pain is typically how a client with osteomyelitis describes their pain. The client may also say the pain is localized and pulsating. Increased edema is associated with the infection and inflammatory response. As for increased drainage, it is often seen with CHRONIC osteomyelitis. When osteomyelitis is suspected, it is likely in the ACUTE phase. The home care nurse is caring for a client who was recently discharged from the hospital with a diagnosis of osteomyelitis. The nurse learns that the client stopped taking the prescribed oral antibiotics once symptoms improved. What is an appropriate response from the nurse? a. "I'm glad you are feeling better! You are correct that antibiotic therapy should be discontinued once you start to feel better" b. "I'm not sure why you were discharged on oral antibiotics in the first place. They are less effective than other forms of treatment" c. "The whole course of antibiotics should be completed. Even though you are feeling better, you should continue to take the medication" d. "Since you are diabetic it is important that you stop the antibiotics as soon as possible. I'm glad you were able to stop them" - CORRECT ANSWER c. rationale: The full course of antibiotics should always be taken to ensure that the infection is resolved, and resistant strains of bacteria do not develop. The nurse is working with a client who is hospitalized for osteomyelitis. The nurse notes that this is the client's third hospitalization for osteomyelitis in three months. Which of the following conditions in this client's health history does NOT put the client at higher risk for developing osteomyelitis? a. Type 2 diabetes b. Kidney stones c. Malnutrition d. Alcoholism - CORRECT ANSWER b. rationale: A history of kidney stones does not increase a client's risk of developing osteomyelitis. However, kidney disease would increase a person's risk for developing osteomyelitis because diseased kidneys increase the risk for infection, and one way infection can reach the bone is by traveling through the bloodstream. Remember, Type II DM, malnutrition, and ETOH increase a person's risk for developing osteomyelitis because they all decrease the body's defense against infection. The nurse is caring for a client who is admitted for acute osteomyelitis. The client's vital signs are as follows: Temperature: 102.1 degrees fahrenheit Blood pressure: 88/50 Heart rate: 107 Respiratory rate: 20 Pulse oximetry: 97% on room air Which orders does the nurse expect the provider to order for this client based on this set of vital signs? Select all that apply. a. Morphine 4 mg Q4H PRN b. 1,000 ml fluid bolus c. Two sets of blood cultures d. Tylenol 650 mg Q4H PRN e. STAT Lactic Acid level - CORRECT ANSWER b. , c., d., e. rationale: This client is showing cla