Med-Surg Exam 2 Practice Questions with correct answers

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? a. Assessment of vital signs b. Completion of abdominal examination c. Insertion of the prescribed nasogastric tube d. Thorough investigation of precipitating events A The pernicious anemia that may accompany gastritis is due to which of the following? a. Chronic autoimmune destruction of cobalamin stores in the body b. Progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss c. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa d. Hyperchlorhydria resulting from an increase in acid-secreting parietal cells and degradation of RBS's C The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that a manifestation of an obstruction in the small intestine is (select all that apply) a. Projectile vomiting b. Diarrhea that is loose or liquid c. Persistent, colicky abdominal pain d. Increased, tinkling bowel sounds above the blockage A, C, D The nurse anticipates a patient will need an esophagastroduodenoscopy (EGD). Select all the actions that are appropriate in this patient's care. A. Signed informed consent B. Teaching related to conscious sedation C. Full set of vital signs prior to procedure D. Clear liquids until procedure E. Keep the patient NPO until gag reflex returns post-procedure A, B, C, E A patient with chronic gastritis associated with the presence of H. pylori is treated with triple-drug therapy. The nurse explains to the patient that the drugs commonly included in this regimen include a. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix). b. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec). c. Sucralfate (Carafate), nystatin (Mycostatin), and bismuth subsalicylate (Pepto-Bismol). d. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan). B The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which assessment data should alert the nurse to this occurrence? a. Inability to pass flatus b. Loss of anal sphincter control c. Severe, constant pain with rapid onset d. Firm, nontender mass palpable at the lower right costal margin A In caring for a client with cholelithiasis and a possible biliary obstruction what clinical findings would you expect? Select all that apply a. Clay colored or light colored bowel movements b. Abdominal pain c. Dilute yellow urine d. Jaundice e. Normal appetite A, B, D The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where should the nurse anticipate the location of the pain? a. Right lower quadrant, radiating to the back b. Right lower quadrant, radiating to the umbilicus c. Right lower quadrant, radiating to the left scapula and shoulder d. Right upper quadrant, radiating to the right scapula and shoulder D Which of the following would be the most important for a nurse to teach a client who is hospitalized with acute pancreatitis prior to discharge? a. The importance of monitoring amylase and lipase levels b. Avoidance of alcohol use for up to a year c. Use of aspirin instead of acetaminophen as an OTC medication d. How to care for a T-tube B You are a nurse caring for a client that has just returned from a cholecystectomy. All of the following interventions are appropriate for this patient except a. Encourage early ambulation b. Deep breathe and cough every hour c. Regular diet d. Splint abdomen when moving and coughing C The nurse knows that an important role of the pancreas that may be diminished during pancreatitis is a. release of secretin b. release of bicarbonate to decrease acidity of gastric chyme. c. decrease in cholesterol metabolism. d. release of gastrin by duodenal mucosa B The nurse is taking the patient's blood pressure, while inflating the cuff the nurse notices jerking motions of the patient's arm and hand. The nurse suspects the patient has a. Hypokalemia b. Hypocalcemia c. Hypernatremia d. Hypercalcemia B With acute pancreatitis, what lab value rises within 12 hours and stays elevated for 4 days? a. Serum amylase b. Serum lipase. c. Serum potassium d. Serum triglyceride A A patient admitted with a GI bleed has an initial hemoglobin of 12.5g/dL and hematocrit of 40%. Four hours later the patient has a hemoglobin of 9.8d/dL and hematocrit of 24%. The patient has stable vital signs, is receiving lactated ringers at 150ml/hr and has had drainage but no sign of blood from the nasogastric tube. You interpret these findings as a. The nasogastric tube needs to be replaced. b. The patient needs to go to surgery ASAP. c. This decrease is hemoglobin and hematocrit was caused by hemodilution from fluid replacement therapy. The lab needs to be called to re-draw the hemoglobin and hematocrit C