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MedSurg Review

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Question
Answer
The nurse is planning to teach the client with GERD about substances that lower esophageal sphincter pressure. Which item should the nurse include on this list?   A. Coffee B. Chocolate C. Fatty foods. D. Nonfat milk  
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Nonfat milk   Foods that inc. LES will dec. reflux and lessen s/s of GERD. Coffee, Chocolate, Fatty foods, and alcohol dec. LES and aggravate GERD s/s.  
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The client has undergone an EGD. The nurse places highest priority on which item as part of the client's care plan?   A. Monitoring the temp. B. Monitoring complaints of heartburn C. Giving warm gargles for a sore throat D. Assessing for return of gag reflex  
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D. Assessing for return of gag reflex   Address ABC.  
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The nurse is monitoring a client with a dx of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?   A. Bradycardia B. Numbness in the leg C. Nausea and vomiting D. A rigid, board-like abdomen  
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D. A rigid, board-like abdomen   Perforation is characterized by sudden, sharp, intolerable pain in the midepigastric area and spreading over the abdomen, which then becomes rigid and board-like.  
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The nurse is providing discharge instructions to a client follwoing gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome?   A. Ambulate following a meal B. Eat a high carbohydrate diet C. Limit the fluids taken with meals D. Sit in a high Fowler's position during meals  
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C. Limit fluids taken with meals.   Dumping syndrome is a vasomotor issue commonly following a Billroth II procedure. S/S include vertigo, tachycardia, syncope, sweating, pallor, palpitations and desire to lie down. Avoid high-carbs and eat in low Fowler's position.  
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The nurse is monitoring a client for the early s/s of dumping syndrome. Which of the following indicate this occurrence?   A. Sweating and Pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain  
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A. Sweating and pallor   Early manifestations of dumping syndrome occur 5-30 min after eating. S/s include vertigo, tachycardia, syncope, pallor, sweating, palpitations, and a desire to lie down.  
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The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to note documented in the client's record.   A. Diarrhea B. Chronic constipation C. Constipation alternating with diarrhea D. Stool constantly oozing from rectum  
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A. Diarrhea   Chron's disease is characterized by nonbloody diarrhea of usualy not more than four to five stools daily.  
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Pt has hx of duodenal ulcer. To determine whether problem is active, the nurse should assess the client for which symptom?   A. Weight loss B. Nausea and vomiting C. Pain relieved by food intake D. Pain radiating down the right arm  
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C. Pain relieved by food intake   A common symptom of duodenal ulcer is pain relieved by food Bain is usually burning, heavy, sharp, or 'hungry.' Midepigastric. No weight loss or N/V.  
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A client presents to the ED w/ upper GI bleed and moderate distress. Which nursing action would be the first priority for this client?   A. thorough investigation of precipitating events. B. Insertion of a nasogastric tube and Hematest of emesis C. Complete abdominal examination D. Assessment of vital signs  
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D. Assessment of vital signs   Vital signs can indicate amount of blood loss and provide baseline for further treatment. A and C are correct but not priority  
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Pt admitted to hospital w/ dx of acute appendicitis. Which lab result would the nurse expect to note if this is an accurate dx?   A. Leukopenia w/ a shift to the right B. Leukocytosis w/ a shift to the right C. Leukocytosis w/ a shift to the left D. Leukopenia w/ a shift to the left  
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C. Leukocytosis w/ a left shift   Lab findings do not establish appy dx, but there is often an inc. in WBC with a left shift (Inc. of immature WBCs)  
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The nurse is caring for a client nwith a peptic ulcer who has just had an EGD. Which nsg dx would be the priority?   A. Risk for aspiration r/t poor gag reflex r/t anesthesia B. Deficient knowledge r/t postop care C. Risk for deficient fluid volume r/t hemorrhage D. Impaired comfort r/t passage of endoscope through throat  
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A. Risk for aspiration r/t poor gag reflex r/t anesthesia   EGD is an endoscope going down the throat to the stomach and duodenum. General anesthesia is typically used. ABCs take priority.  
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A client experiencing chronic dumping syndrome makes all of the following comments to the nurse. Which one needs further discussion?   A. I eat at least three large meals each day B. I eat while lying in a semirecumbent position C. I have eliminated taking liquids with my meals D. I eat a high-protein, low-to-moderate-carb diet  
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A. I eat three large meals a day   Rapid dumping of gastric contents pulls fluid into intestine. So eliminating fluids is good, low carb-high protein is good, and semirecumbent is good.  
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Nurse does admin hx on client with suspected PUD. Which factor documented by nurse increases PUD risk?   A. Recently retired from a job B. Significant other has a gastric ulcer C. Takes ibuprophen (Motrin) for osteoarthritis D. Occasionally drinks onen cup of coffee in the morning  
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C. Take ibuprophen (motrin) for osteoarthritis   Risk factors for PUD include H. pylori, smoking, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress.  
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In performing a physical assessment of a client with a dx of ulcerative colitis, the nurse would expect which of the following findings?   A. Hypercalcemia B. Fibrous stricture C. Frothy, fatty stools D. Decreased hemoglobin  
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D. Decreased hemoglobin   S/s of UC include diarrhea 10-20x/day, weight loss, anorexia, fatigue, Inc. WBC, Inc. ESR, dehydration, hyponatremia, and hypokalemia. Due to bloody stool, H/H lvls decrease  
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A client with acute ulcerative colitis requests a snack. Which of hte following would be an appropriate snack for this client?   A. Carrots and ranch dip B. Whole-grain cereal and milk C. A cup of popcorn and cola drink D. Applesauce and a graham cracker  
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D. Applesauce and a graham cracker   Diet for UC should be low-fiber. Avoid whole-wheat, nuts, fresh fruits, vegetables, lactose foods, caffeine, pepper, and alcohol.  
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A nurse has provided dietary instructions to a client with a dx of PUD. Which statement by the client indicates an understanding of the instruction?   A. Citrus fruit and raw vegetables need to be included in my daily diet B. Beer is ok in moderation C. Chicken and fish baked are ok D. Coffee and tea should be limited to two cups daily  
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C. Chicken and fish baked are ok to eat   Dietary mods for PUD include spiced foods, alcohol, caffeine, chocolate, and citrus foods.  
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A nurse is providingn instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse says to:   A. Inc. fluid intake at meal time B. Maintain a high-card diet C. Maintain a low-Fowler's position while eating D. Ambulate for a least 30 min after each meal  
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C. Maintain a low-Fowler's position while eating   Pts at risk for DS should maintain low Fowler's while eating and lie down for 30 min after eating. Eat more small frequent meals. Dec. fluids with meals. Avoid high carbs.  
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A pt with PUD has exacerbations with stress. Which item mentioned by pt is most likely responsible?   A. Sleeping 8 to 10 hrs a night B. Eating 5-6 small meals a day C. Ability to work at home at times D. Frequent need to work overtime on short notice  
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D. Frequent need to wo rk overtime on short notice   Psychological or emotional stressors can exacerbate PUD.  
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Client arrives in ED w/ acute RLQ pain. Appendicity suspected. WBC's elevated. Which physician order should the nurse question?   A. Maintain NPO status B. Initiate IV for fluids C. Apply a cold pack to abdomen D. Admin 30 mL of MOM (laxative)  
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D. Admin 30 mL of MOM (Laxative)   Client would be NPO, IV fluids started, and cold pack used to relieve pain. Laxatives could cause perforation and are contraindicated in appendicitis.  
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A nurse is providing dietary teaching to a client with IBS. Which food stated by client shows an understanding of proper dietary understanding?   A. Cream of wheat B. Corn C. Rice D. Broiled chicken  
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B. Corn   Corn is high in fiber, which pts with IBS should have, but is irritating to the bowels.  
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A client has been diagnosed with GERD. The nurse plans care knowing client has dysfunction of which part of the digestive system?   A. Chief cells of the stomach B. Parietal cells of the stomach C. LES D. UES  
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C. LES   The lower esophageal sphincter relaxes too much and gastric contents push up into esophagus.  
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A client w/ appendicitis is having an appendectomy. The nurse describes the location of the appendix as being in the:   A. RLQ B. RUQ C. LLQ D. LUQ  
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A. RLQ   The appendix is in the RLQ  
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Pt w/ hx of gastric ulcer has sharp, sudden pain in midepigastric area. Abdomen become board-like and rigid (guarding). Which complication of gastric ulcer is the pt experiencing?   A. Perforation B. Obstructionn C. Hemorrhage D. Intractability  
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A. Perforation   This assessment describes the s/s of perforation. Labs would show increased WBC.  
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Pt presents to ED with appendicitis. Which prescription would the nurse question?   A. Maintain NPO B. Initiate IV for fluids C. Maintain semi-fowlers position D. Apply a heating pad to lower abdomen for comfort  
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D. Apply a heating pad to lower abdomen for comfort   The first three interventions should be done. Heat should never ben applied to abdomen as it increases perfusion to appendix and can cause perforation  
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A client has duodenal ulcer as shown by endoscopy. Postop, the nurse should assess most carefully for which s/s?   A. N/V B. A rigid board-like abdomen C. Bradycardia D. Numbness in the legs  
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B. A rigid board-like abdomen   This is indicative of perforation. Aside**Perforation has similar symptoms irregardless of where it occurs. IE appendix, duodenum, or stomach.  
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Client with Crohn's disease has just had a bowel movement. The nurse assess the stool for which of the following characteristics as expected with this disease?   A. Dry, hard, constipated stool B. Chalky gray stool C. Loose, watery stool D. Blood in the stool  
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C. Loose, water stool   Crohn's involves nonblood diarrhea. 4-5 stools/day.  
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Pt hospitalized w/ dx of ulcerative colitis. Which assessment finding would nurse report to the provider?   A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. A hemoglobin of 12 mg/dl  
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C. Rebound tenderness   Rebound tenderness may indicate peritonitis. Bloody diarrhea is normal. Hypotension and low hemoglobin are expected with bloody diarrhea.  
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Nurse is reviewing RxHx of pt w/PUD. Which med should the nurse encourage pt to avoid?   A. Nizatidine (Axid) B. Ibuprofen (Motrin) C. Sucralfate (Carafate) D. Omeprazole (Prilosec)  
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B. Ibuprofen (Motrin)   Motrin is an NSAID. These drugs can be irritable to the lining of the GI tract.  
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Pt admitted to hospital w/ dx of acute diverticulitis. Which would hte nurse expect to be prescribed for this client?   A. NPO status B. Ambulation QID C. Cholinergic medications to reduce pain D. Coughing and deep breathing q2h  
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A. NPO status   During the acute phase of diverticulitits the bowels should be rested.  
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Which risk factor for colorectal cancer should the nurse include?   A. Age older than 30 years B. High-fiber, low-fat diet C. Distant relative w/ colorectal cancer D. Persona hx of UC or GI polyps  
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D. Personanl hx of UC or GI polyps   These cause chronic inflammation which can lead to cancer  
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