28.

While conducting a home visit with a client who had a partial resection of t he ileum for Chron's Disease 4 weeks previously, a nurse becomes concerned when the client states: A. B. C. D. My stools float and seem to have fat in them. I have gaiend 5 pounds since I left the hospital. I am still avoiding milk products. I only have 2 formed stools per day.

29. A nurse is reviewing the history and physical of a teenager admitted to a ho spital with a diagnosis of ulcerative colitis. Based on this diagnosis, which in formation should the nurse expect to see on this client's medical record? A. B. C. D. Abdominal pain and bloody diarrhea. Weight gain and elevated blood glucose. Abdominal distention and hypoactive bowel sounds. Heartburn and regurgitation.

30. A RN overhears a LPN talking with a client who is being prepared for a total colectomy with the creation of an ileoanal reservoir for ulcerative colitis. To decrease the client's anxiety, the RN should intervene to clarify the informati on given by the LPN when the LPN is heard saying: A. B. C. al D. this surgery will prevent you from developing colon cancer. after this surgery you will no longer have ulcerative colitis. when you return from surgery you will not be able to eat solid food for sever days. you will have an ileostomy when you return from the surgery.

31. The nurse is assessing a client 24 hours following a cholecystectomy. The nu rse noted that the T tube has drained 750 mL of green-brown drainage since the s urgery. Which nursing intervention is appropriate? A. B. C. D. Clamp the T tube Irrigate the T tube Notify the physician Document the findings

CORRECT ANSWERS 1. C. the patient positioned in a lateral position with the head of the bed flat . After total laryngectomy and radical neck dissection, a patient should be plac ed in a semi-Fowler's position to decrease edema and limit tension on the suture line. 2. C = the older adults' taste buds retain their sensitivity to carbohydrates. I n addition, carbohydrates. Tend to be food items that are easy to chew. Older ad ults lose their sensitivity to sour and salty foods. Older adults may find greas y foods harder to digest and therefore may avoid them; however, preference for g reasy foods is not related to changes in taste associated with age. 3. A = caffeinated beverages and alcohol should be avoided because they stimulat e gastric acid production and irritate gastric mucosa. The client should avoid foods that cause discomfort; however, there is no need t

o follow a soft, bland diet. Eating six small meals daily is no longer a common treatment for peptic ulcer di sease. Milk in large quantities is not recommended because it actually stimulates furth er production of gastric acids. 4. C = A low sodium diet is frequently an effective mechanism for reducing the f requency and severity of the disease episodes. About three-quarters of clients with Meniere's disease respond to treatment with a low salt diet. 5. D Tympanoplasty involves surgical reconstruction as the tympanic membrane a nd is done to re-establish middle ear function, close perforation, prevent recur rent infections. 6. A = primary cancer prevention targets healthy individuals and includes steps to avoid factors that might lead to the development of diseases. 7. D = Fatigue is a common complaint of individuals receiving medication therapy . 8. D = When a wound eviscerates, the nurse should cover the open area with steri le dressing moistened with sterile normal saline and then cover it with a dry dr essing. The surgeon should then be notified to take the client back to the operating roo m to close the incision under general anesthesia. 9. D = the symptoms of BPH are related to obstruction as a result of an enlarged prostate. Difficulty in starting the urinary stream is a common symptom, along with dribbling, hesitancy and urinary retention. 10. A = There are many mechanisms of action for chemotherapeutic agents, but mos t affect the rapidly dividing cells-both cancerous and noncancerous. Cancer cell s are characterized by rapid cell division. Chemotherapy slows cell division 11. B = the nurse should notify the anesthesiologist because a serum potassium l evel of 5.8 mEq/L places the client at risk for dysrhythmias when under general anesthesia. 12. A = It is appropriate for an unlicensed assistant to mark the time of measur ement and fluid level in the collection container. 13. D = Nausea and gastrointestinal upset is a common but usually temporary side effects of Paroxetine (Paxil). Therefore, the nurse would instruct the client t o take the medication with food to minimize nausea and stomach upset. 14. B Vertigo is the most frequent complication of stapedectomy. The patient s hould move slowly to avoid triggering or worsening vertigo and should ask for as sistance with ambulation. Ringing in the ears rarely follows this surgery and sh ould be reported to the doctor if it does. Hearing typically decreases after surrey bc of ear packing and tissue swelling, but commonly returns over the next 2-6 weeks. Usually, post-op drainage and pain are minimal Excessive drainage should be reported. 15. D Complaints of a sudden burst of black spots or floaters indicates that bl

eeding has occurred as a result of the detachment. Options A, B, and C are not s igns of bleeding. 16. B Treatment for a contusion begins at the time of injury. Ice is applied immediately. The client then should be seen by a physician and receive a thoroug h eye examination to rule out the presence of other eye injuries. 17. B - If the laceration is the result of a penetrating injury, an object may be note d protruding from the eye. This object must never be removed except by the ophth almologist because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign bod y and cause further tearing of the cornea. 18. D Emergency care following a chemical burn to the eye includes irrigating the eye immediately with sterile normal saline or ocular irrigating solution. In the eme rgency department, the irrigation should be maintained for at least 10 minutes. Following this emergency treatment, visual acuity is assessed. Options B and C a re not a component of initial care. 19. A Fluctuation in the water-seal chamber is a normal finding that occurs as the cli ent breathes. No action is required except for continued monitoring of the clien t. The nurse doesn't need to notify the physician. Continuous bubbling in the wa ter-seal chamber indicates an air leak in the chest tube system, such as from a loose connection in the chest tube tubing. The water-seal chamber should be fill ed initially to the 2 cm line, and no more water should be added. 20. B Acknowledging that the client is going through changes and allowing her to expre ss her concerns will help the nurse assess her needs. Hemoglobin AIC shows the a verage blood glucose levels over a 3-month period. Diabetes should maintain the AIC <7%. Lecturing, threatening and comparing the clients to others belittles th e client and discourages discussion, but the patient must be provided adequate i nformation in order to make informed decisions about self-care. 21. D Asking the client to give a return demonstration of his injection technique is t he best way to assess whether the client can perform the procedure. It also give s the nurse the opportunity to provide feedback. Asking the client to recite the steps, pass a written test, or write out the steps shows the nurse whether the client is able to recall the steps but doesn't show that he has the necessary mo tor skills or the ability to perform the procedure. 22. C Medications such as iodine, contrast media, and antithyroid and thyroid drugs ca n affect the test results and should be withheld by the client for a week or lon ger, as directed by the physician. During a radioactive iodine uptake test, the client receives radioactive iodine by mouth or I.V. in small doses and doesn't r equire isolation. During magnetic resonance imaging--not radioactive iodine upta ke testing--a client needs to lie still inside a long tube. Any test, such as a bone scan, that requires iodine contrast media should be scheduled after the rad

ioactive iodine uptake test because the iodinated contrast medium can decrease u ptake. 23. D Rationale: AML is very aggressive, and survival after diagnosis is short without treatment. Induction therapy is followed by more chemotherapy, so the nurse sho uld not tell the patient that he or she will feel normal or not so ill. The surv ival with AML is not 80%. 24. D Rationale: GERD is exacerbated by eating late at night, and the nurse should pla n to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD. 25. C Rationale: The proton pump inhibitors decrease the rate of gastric acid secretio n. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastri c emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly. 26. B 27. B 28. A 29. A 30. D 31. D