GI
This is the correct method for determining the length of a nasogastric tube before insertion.
measuring from the nose to the ear and then to the xiphoid process?
A terminally ill patient does not want to eat dinner, Which is an appropriate response?
1. Let them know food is available but do not insist they eat
2. Offer different foods
3. Tell them they need to try and eat it will help them feel better
Let them know food is available but do not insist they eat
A nurse is examining a patient postoperatively who has a warm red, tender incision. She documents this as a normal finding is this normal?
No
Functions of the kidney include: regulation of electrolytes, regulation of fluid volume, secretion of erythropoietin. is this true or false?
True
Upon performing a full abdominal assessment on your patient, you notice that you did not hear any bowel sounds in the right lower quadrant (RLQ) for at least 35 seconds. How would you document this finding?
Hint: _______active_________sounds in the _________quadrant
Hypoactive bowel sounds in the right lower quadrant
What is the lining of the stomach called?
Mucosa
A 42-year-old male client receiving radiation therapy for cancer reports extreme fatigue and generalized weakness during a follow-up clinic visit. Which response by the nurse is most appropriate?
1. You may need to increase your physical activity to fight the fatigue. 2.These are normal symptoms; however, I will continue to monitor your laboratory studies. 3.“That sounds unusual. I’ll notify the healthcare provider immediately.” 4.“You must not be getting enough sleep at night.”
These are normal symptoms; however, I will continue to monitor your laboratory studies.”
A high school student attending a nutrition class asks the school nurse about dietary choices that may reduce the risk of cancer. Which of the following meals should the nurse recommend as the healthiest option?
A. Fried chicken sandwich with French fries B. Baked apricot chicken and steamed broccoli C. Pepperoni pizza and soda D. Hot dog with macaroni and cheese
Baked apricot chicken and steamed broccoli
The provider has prescribed Tylenol 850 mg PO q6h PRN for a client. The bottle label reads that the medication is available as 1000 mg/mL. How many milligrams of medication should the nurse administer per dose? Round to the nearest whole number.
850
Which infection control method should the nurse determine to be the priority to include in the plan of care to prevent hepatitis B in a client considered to be at high risk for exposure?
1. Hep B Vaccine
2. Handwashing
3. Avoid sharing of razors
Hep B vaccine
The liver is a very vascular organ and holds a lot of blood. The liver is prone to bleeding if lacerated or punctured. True or False
True
A client is scheduled to begin external radiation therapy for a malignant tumor in the neck. During the education session, which potential adverse effect should the nurse emphasize as important to monitor during treatment?
A. Visual disturbances
B. Changes in nutrition
C. Lower extremity edema
D. Insomnia
A nurse is providing preoperative education to a client scheduled for cardiac bypass surgery. Why does the teaching plan include leg exercises?
A. To strengthen muscles for faster ambulation after surgery B. To reduce postoperative pain and stiffness C. To improve circulation and prevent deep vein thrombosis D. To promote lung expansion and prevent pneumonia
C. To improve circulation and prevent deep vein thrombosis
A doctor has prescribed normal saline 1.5 L to infuse over 2 hours. At what rate, in mL/hr, should the nurse program the electronic infusion device? Round to the nearest whole number.
750
Fortified cereals and tofu is a good addition to the diet of a vegan client who has this vitamin deficiency?
B12
A client with a possible hiatal hernia complains of difficulty swallowing. The nurse should also look for these two symptoms.
Heartburn & Regurgitation
A middle-aged client with lung cancer asks the nurse whether his adult children are at increased risk for the disease. What is the best response?
A. “It’s mostly inherited.” B. “Environment is more of a concern.” C. “Smoking is the main cause—help them not smoke.” D. “Healthy habits eliminate the risk.”
“Smoking is the main cause—help them not smoke.”
A nurse is caring for a client with a new colostomy who is experiencing disturbed body image. Which nursing intervention is most appropriate to support the client’s adjustment?
A. Provide detailed educational pamphlets B. Encourage the client to cover the ostomy when visitors arrive C. Engage the client in the care of the ostomy D. Arrange for all ostomy care to be performed by nursing staff
C. Engage the client in the care of the ostomy
The healthcare provider has written a prescription for a client to receive normal saline 750 mL over 8 hours. If the nurse begins the infusion at 0830, at what time will the infusion complete? Record the response in military time.
1630
You are teaching a bariatric patient prior to discharge. Teaching should include eating several ___________ meals per day.
Small
Your patient complains of bloating and cramping associated with accumulation of flatus and asks if there is anything that you can do to help them.This intervention involves putting the patient in __________ position
Trendelenberg
A nurse is evaluating a client undergoing chemotherapy. Which of the following findings is the most concerning and requires immediate intervention?
A. Fatigue B. Mild nausea C. Hair loss D. Heavy bruising
D. Heavy bruising
A client with Crohn’s disease asks the nurse to explain an upcoming colostomy. What’s the best response?
A. “Your whole colon will be removed.” B. “A loop of colon will be brought to your abdomen.” C. “A pouch will collect waste inside your belly.” D. “A tube will drain your intestines through your nose.”
A loop of colon will be brought to your abdomen.
A nurse is preparing to administer liquid famotidine 20 mg PO every 6 hr for GERD. Available is famotidine 40 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
2.5 mL
A nurse is assessing a client admitted with abdominal pain and a suspected bowel obstruction. Which of the following findings requires immediate intervention?
1. Abdominal distention 2. Inability to pass flatus 3.Hyperactive bowel sounds 4. Fecal vomiting
Fecal Vomiting