Medical-Surgical Nursing Exam 15

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1. The nurse recognizes that the patient with a duodenal ulcer will likely experience

  1. pain 2-3 hours after a meal.
    The patient with a gastric ulcer often awakens between 1-2 A.M. with pain and ingestion of food brings relief.
  2. vomiting.
    Vomiting is uncommon in the patient with duodenal ulcer.
  3. hemorrhage.
    Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer.
  4. weight loss.
    The patient with a duodenal ulcer may experience weight gain.

2. Of the following categories of medications, which is used in combination with bismuth salts to eradicate Helicobacter pylori?

  1. Antibiotics
    Antibiotics and bismuth salts are given to eradicate H. pylori.
  2. Antacids
    Antacids are given to manage gastric acidity.
  3. Proton pump inhibitors
    Proton pump inhibitors are given to decrease acid secretion.
  4. Histamine-2 receptor antagonists
    Histamine-2 receptor antagonists are given to decrease the acid secretion in the stomach.

3. Which of the following medications represents the category proton (gastric acid) pump inhibitors?

  1. Omeprazole (Prilosec)
    Omeprazole decreases gastric acid by slowing the hydrogen-potassium-adenosine-triphosphatase pump on the surface of the parietal cells.
  2. Sucralfate (Carafate)
    Sucralfate is a cytoprotective drug.
  3. Famotidine (Pepcid)
    Famotidine is a histamine-2 receptor antagonist.
  4. Metronidazole (Flagyl)
    Metronidazole is an antibiotic, specifically an amebicide.

4. Which of the following medications used for the treatment of obesity prevents the absorption of triglycerides?

  1. Orlistat (Xenical)
    Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins.
  2. bupropion hydrochloride (Wellbutrin)
    buproprion hydrochloride (Wellbutrin) is an antidepressant medication.
  3. Sibutramine hydrochoride (Meridia)
    Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephine. Meridia decreases appetite.
  4. Fluoxetine hydrochloride (Prozac)
    Fluoxetine hydrochloride (Prozac) has not been approved by the FDA for use in the treatment of obesity.

5. Of the following bariatric surgical procedures, which is the best procedure for long-term weight loss?

  1. Roux-en-Y
    The Roux-en-Y gastric bypass is the recommended procedure for long-term weight loss. In this procedure, a horizontal row of staples creates a stomach pouch with a 1-cm stoma that is anastomosed with a portion of distal jejunum, creating a gastroenterostomy.
  2. Vertical banded gastroplasty
    In vertical banded gastroplasty, a double row of staples is applied vertically along the lesser curvature of the stomach, beginning at the angle of His. Over time, the gastric restriction may fail.
  3. Gastric ring application
    Application of a silicone ring to the fundus of the stomach may fail.
  4. Jejuno-ileal bypass
    The first surgical procedure to treat morbid obesity was the jejuno-ileal bypass. This procedure, which resulted in significant complications, has been largely replaced by gastric restriction procedures

6. Which of the following statements regarding gastric cancer is accurate?

  1. The incidence of cancer of the stomach continues to decrease in the United States.
    While the incidence continues to decrease, gastric cancer still accounts for 12,800 deaths annually.
  2. Most gastric cancer deaths occur in people younger than 40 years.
    While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years.
  3. Females have a higher incidence of gastric cancers than males.
    Males have a higher incidence of gastric cancers than females.
  4. A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer.
    More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.

7. Which of the following categories of laxatives draw water into the intestines by osmosis?

  1. Saline agents (milk of magnesia)
    Saline agents use osmosis to stimulate peristalsis and act within 2 hours of consumption.
  2. Bulk-forming agents (Metamucil)
    Bulk-forming agents mix with intestinal fluids, swell, and stimulate peristalsis.
  3. Stimulants (Dulcolax)
    Stimulants irritate the colon epithelium.
  4. Fecal softeners (Colace)
    Fecal softeners hydrate the stool by surfactant action on the colonic epithelium, resulting in mixing of aqueous and fatty substances.

8. Crohn’s disease is a condition of malabsorption caused by

  1. inflammation of all layers of intestinal mucosa.
    Crohn’s disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon.
  2. infectious disease.
    Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption.
  3. disaccharidase deficiency.
    Disaccharidase deficiency leads to lactose intolerance.
  4. gastric resection.
    Postoperative malabsorption occurs after gastric or intestinal resection.

9. The nurse teaches the patient whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

  1. solid.
    With a sigmoid colostomy, the feces are solid.
  2. semi-mushy.
    With a descending colostomy, the feces are semi-mushy.
  3. mushy.
    With a transverse colostomy, the feces are mushy.
  4. fluid.
    With an ascending colostomy, the feces are fluid.

10. When irrigating a colostomy, the nurse lubricates the catheter and gently inserts it into the stoma no more than _______ inches

  1. 3”
    The nurse should insert the catheter no more than 3 inches.
  2. 2”
    Insertion of the catheter 2 inches is inadequate.
  3. 4”
    Insertion of the catheter 4 inches is excessive and not recommended.
  4. 5”                                                                                                                                                           Insertion of the catheter 5 inches is excessive and not recommended.

11. A longitudinal tear or ulceration in the lining of the anal canal is termed a (an)

  1. anal fissure.
    Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety(leading to constipation).
  2. anorectal abscess.
    An anorectal abscess is an infection in the pararectal spaces.
  3. anal fistula.
    An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus.
  4. hemorrhoid.
    A hemorrhoid is a dilated portion of vein in the anal canal.

12. Which type of diarrhea is caused by increased production and secretion of water and electrolyes by the intestinal mucosa into the intestinal lumen?

  1. Secretory diarrhea
    Secretory diarrhea is usually high volume diarrhea and is caused by increased production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen.
  2. Osmotic diarrhea
    Osmotic diarrhea occurs when water is pulled into the intestines by the osmotic pressure of nonabsorbed particles, slowing the reabsorption of water.
  3. Mixed diarrhea
    Mixed diarrhea is caused by increased peristalsis (usually from inflammatory bowel disease) and a combination of increased secretion or decreased absorption in the bowel.
  4. Diarrheal disease
    The most common cause of diarrheal disease is contaminated food.

13. Which of the following terms is used to refer to intestinal rumbling?

  1. Borborygmus
    Borborygmus is the term used to refer to intestinal rumbling which accompanies diarrhea.
  2. Tenesmus
    Tenesmus is the term used to refer to ineffectual straining at stool.
  3. Azotorrhea
    Azotorrhea is the term used to refer to excess of nitrogenous matter in the feces or urine.
  4. Diverticulitis
    Diverticulitis is the term used to refer to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

14. The presence of mucus and pus in the stools suggests

  1. Inflammatory colitis
    The presence of mucus and pus in the stools suggests inflammatory colitis or enteritis.
  2. Small bowel disease
    Watery stools are characteristic of small bowel disease.
  3. Disorders of the colon
    Loose, semisolid stools are associated more often with disorders of the colon.
  4. Intestinal malabsorption
    Voluminous, greasy stools suggest intestinal malabsorption.

15. Celiac sprue is an example of which category of malabsorption?

  1. Mucosal disorders causing generalized malabsorption
    In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders.
  2. Infectious diseases causing generalized malabsorption
    Examples of infectious diseases causing generalized malabsorption include small bowel bacterial overgrowth, tropical sprue, and Whipple’s disease.
  3. Luminal problems causing malabsorption
    Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger Ellison syndrome, and pancreatic insufficiency.
  4. Postoperative malabsorption
    Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

16. Typical signs and symptoms of appendicitis include:

  1. Nausea
    Nausea is typically associated with appendicitis with or without vomiting.
  2. Left lower quadrant pain
    Pain is generally felt in the right lower quadrant.
  3. Pain when pressure is applied to the right lower quadrant of the abdomen.
    Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis.
  4. High fever
    Low-grade fever is associated with appendicitis.

17. Regional enteritis is characterized by:

  1. Transmural thickening
    Transmural thickeneing is an early pathologic change of Crohn’s disease. Later pathology results in deep, penetrating granulomas.
  2. Diffuse involvement
    Regional enteritis is characterized by regional discontinuous lesions.
  3. Severe diarrhea
    Severe diarrhea is characteristic of ulcerative colitis while diarrhea in regional enteritis is less severe.
  4. Exacerbations and remissions
    Regional enteritis is characterized by a prolonged and variable course while ulcerative colitis is characterized by exacerbations and remissions.

18. What is the most common cause of small bowel obstruction?

  1. Adhesions
    Adhesions are scar tissue that forms as a result of inflammation and infection.
  2. Hernias
    Hernias are one of the second most common causes of small bowel obstruction.
  3. Neoplasms
    Neoplasms are one the second most common causes of small bowel obstruction.
  4. Volvulus
    Volvulus (twisting of the bowel) is a less common cause of small bowel obstruction.

19. Which of the follow statements provides accurate information regarding cancer of the colon and rectum?

  1. Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
    Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
  2. Rectal cancer affects more than twice as many people as colon cancer.
    Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum).
  3. The incidence of colon and rectal cancer decreases with age.
    The incidence increases with age (the incidence is highest in people older than 85).
  4. There is no hereditary component to colon cancer.
    Colon cancer occurrence is higher in people with a family history of colon cancer.

20. Which of the following characteristics are risk factors for colorectal cancer?

  1. Familial polyposis
    Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer.
  2. Age younger than 40
    Being older than age 40 is a risk factor for colorectal cancer.
  3. Low fat, low protein, high fiber diet
    A high-fat, high-protein, low-fiber diet is a risk factor for colorectal cancer.
  4. History of skin cancer                                                                                                                            History of skin cancer is not a recognized risk factor for colorectal cancer.

21. Which type of jaundice in adults is the result of increased destruction of red blood cells?

  1. Hemolytic
    Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed.
  2. Hepatocellular
    Hepatocellular jaundice is the result of liver disease.
  3. Obstructive
    Obstructive jaundice is the result of liver disease.
  4. Non-obstructive
    Non-obstructive jaundice occurs with hepatitis.

22. The nurse places the patient after liver biopsy in which of the following positions?

  1. On the right side
    In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded.
  2. On the left side
    Positioning the patient on his left side is not indicated.
  3. Trendelenburg
    Positioning the patient in the Trendelenburg position may be indicated if the patient is in shock, but is not the position designed for the patient after liver biopsy.
  4. High Fowler’s
    High Fowler’s position is not indicated for the patient after liver biopsy.

23. Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?

  1. Alcoholic cirrhosis
    This type of cirrhosis is due to chronic alcoholism and is the most common type of cirrhosis.
  2. Postnecrotic cirrhosis
    In postnecrotic cirrhosis, there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis.
  3. Biliary cirrhosis
    In biliary cirrhosis, scarring occurs in the liver around the bile ducts.
  4. Compensated cirrhosis
    Compensated cirrhosis is a general term given to the state of liver disease in which the liver continues to be able to function effectively.

24. Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid?

  1. Paracentesis
    Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise.
  2. Astrerixis
    Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction.
  3. Ascites
    Ascites refers to accumulation of serous fluid within the peritoneal cavity.
  4. Dialysis
    Dialysis refers to a form of filtration to separate crystalloid from colloid substances.

25. Which of the following terms most precisely refers to the incision of the common bile duct for removal of stones?

  1. Choledocholithotomy
    Choledocholithotomy refers to incision of the common bile duct for the removal of stones (liths).
  2. Cholecystostomy
    Cholecystostomy refers to opening and drainage of the gallbladder.
  3. Choledochotomy
    Choledochotomy refers to opening into the common duct.
  4. Choledochoduodenostomy
    Choledochoduodenostomy refers to anastomosis of the common duct to the duodenum.

26. Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus [IDDM])?

  1. Presence of islet cell antibodies
    Individuals with Type 1 diabetes often have islet cell antibodies.
  2. Obesity
    Individuals with Type 1 diabetes are usually thin or demonstrate recent weight loss at the time of diagnosis
  3. Rare ketosis
    Individuals with Type 1 diabetes are ketosis-prone when insulin is absent.
  4. Requirement for oral hypoglycemic agents
    Individuals with Type 1 diabetes need insulin to preserve life.

27. Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM])?

  1. Can control blood glucose through diet and exercise
    Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful.
  2. Usually thin at diagnosis
    Individuals with Type 2 diabetes are usually obese at diagnosis.
  3. Ketosis-prone
    Individuals with Type 2 diabetes rarely demonstrate ketosis, except in stress or infection.
  4. Demonstrate islet cell antibodies
    Individuals with Type 2 diabetes do not demonstrate islet cell antibodies.

28. Of the following types of insulin, which is the most rapid acting?

  1. Humalog
    The onset of action of rapid-acting Humalog is within 10-15 minutes.
  2. Regular
    The onset of action of short-acting regular insulin is 30 minutes-1 hour.
  3. NPH
    The onset of action of intermediate acting NPH is 3-4 hours.
  4. Ultralente
    The onset of action of long-acting Ultralente is 6-8 hours.

29. Of the following categories of oral antidiabetic agents, which exert their primary action by directly stimulating the pancreas to secrete insulin?

  1. Sulfonylureas
    Therefore, a functioning pancreas is necessary for sulfonylureas to be effective.
  2. Thiazolidinediones
    Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas
  3. Biguanides
    Biguanides facilitate insulin’s action on peripheral receptor sites.
  4. Alpha glucosidase inhibitors
    Alpha glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

30. The nurse teaches the patient about diabetes including which of the following statements?

  1. Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.  When blood glucose levels are well controlled, the potential for complications of diabetes is reduced.
  2. Sugar is found only in dessert foods.
    Several types of foods contain sugar, including cereals, sauces, salad dressing, fruit, and fruit juices.
  3. The only diet change needed in the treatment of diabetes is to stop eating sugar.
    It is not feasible, nor is it advisable, to remove all sources of sugar from the diet.
  4. Once insulin injections are started in the treatment of Type 2 diabetes, they can never be discontinued.  If the diabetes had been well controlled without insulin prior to the period of acute stress causing the need for insulin, the patient may be able to resume previous methods for control of diabetes when the stress is resolved.

31. The nurse teaches the patient about glargine (Lantus), a “peakless” basal insulin including which of the following statements?

  1. Do not mix the drug with other insulins
    Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
  2. Administer the total daily dosage in two doses.
    Glargine is absorbed very slowly over a 24-hour period and can be given once a day.
  3. Draw up the drug first, then add regular insulin.
    Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation.
  4. The drug is rapidly absorbed and has a fast onset of action
    Glargine is a “peakless” basal insulin that is absorbed very slowly over a 24-hour period.

32. Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

  1. Cushing’s syndrome
    The patient with Cushing’s syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension.
  2. Addison’s disease
    In Addison’s disease, the patient experiences chronic adrenocortical insufficiency.
  3. Graves’ disease
    In Graves’ disease, the patient experiences hyperthyroidism.
  4. Hashimoto’s disease
    The individual with Hashimoto’s disease demonstrates inflammation of the thyroid gland, resulting in hypothyroidism.

33. Of the following disorders, which results from excessive secretion of somatotropin?

  1. Acromegaly
    The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet.
  2. Cretinism
    Cretinism occurs as a result of congenital hypothyroidism.
  3. Dwarfism
    Dwarfism is caused by insufficient secretion of growth hormone during childhood.
  4. Adrenogenital syndrome
    Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.

34. Which of the following hormones is secreted by the posterior pituitary?

  1. Vasopressin
    Vasopressin causes contraction of smooth muscle, particularly blood vessels.
  2. Calcitonin
    Calcitonin is secreted by the parafollicular cells of the thyroid gland.
  3. Corticosteroids
    Corticosteroids are secreted by the adrenal cortex.
  4. Somatostatin
    Somatostatin is released by the anterior lobe of the pituitary.

35. Trousseau’s sign is positive when

  1. carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
    A positive Trousseau’s sign is suggestive of latent tetany.
  2. a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.
    A positive Chvostek’s sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.
  3. after making a clenched fist, the palm remains blanched when pressure is placed over the radial artery.
    A positive Allen’s test is demonstrated by the palm remaining blanched with the radial artery occluded. The radial artery should not be used for an arterial puncture.
  4. The patient complains of pain in the calf when his foot is dorsiflexed.
    A positive Homans’ sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

36. The digestion of carbohydrates is aided by

  1. amylase.
    Amylase is secreted by the exocrine pancreas.
  2. lipase.
    Lipase aids in the digestion of fats.
  3. trypsin.
    Trypsin aids in the digestion of proteins.
  4. secretin.
    Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.

37. The term used to describe total urine output of less than 400 mL in 24 hours is

  1. oliguria.
    Oliguria is associated with acute and chronic renal failure.
  2. anuria.
    Anuria is used to describe total urine output of less than 50 mL in 24 hours.
  3. nocturia.
    Nocturia refers to awakening at night to urinate.
  4. dysuria.
    Dysuria refers to painful or difficult urination.

38. When fluid intake is normal, the specific gravity of urine should be

  1. 1.010-1.025.
    Urine specific gravity is a measurement of the kidney’s ability to concentrate urine.
  2. 1.000.
    The specific gravity of water is 1.000.
  3. less than 1.010.
    A urine specific gravity of less than 1.010 may indicate inadequate fluid intake.
  4. greater than 1.025.
    A urine specific gravity greater than 1.025 may indicate overhydration.

39. Of the following terms, which refers to casts in the urine?

  1. Cylindruria
    Casts may be identified through microscopic examination of the urine sediment after centrifuging.
  2. Crystalluria
    Crystalluria is the term used to refer to crystals in the urine.
  3. Pyuria
    Pyuria is the term used to refer to pus in the urine.
  4. Bacteriuria
    Bacteriuria refers to a bacterial count higher than 100,000 colonies/mL in the urine.

40. When the nurse observes the patient’s urine to be orange, she further assesses the patient for

  1. intake of medication such as phenytoin (Dilantin).
    Urine that is orange may be caused by intake of Dilantin or other medications. Orange to amber colored urine may also indicate concentrated urine due to dehydration or fever.
  2. bleeding.
    Urine that is pink to red may indicate lower urinary tract bleeding.
  3. intake of multiple vitamin preparations.
    Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation.
  4. infection.                                                                                                                                                    Yellow to milky white urine may indicate infection, pyruria, or in the female patient, the use of vaginal creams.

41. To assess circulating oxygen levels the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests?

  1. Hemoglobin
    Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements, as it is more accurate in assessment of circulating oxygen.
  2. Hematocrit
    Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit.
  3. Serum iron levels
    Serum iron levels measure iron storage in the body.
  4. Arterial blood gases
    Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.

42. Which of the following types of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure?

  1. Stress
    Stress incontinence may occur with sneezing and coughing.
  2. Overflow
    Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder.
  3. Urge
    Urge incontinence refers to involuntary loss of urine associated with urgency.
  4. Reflex
    Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.

43. To facilitate entry of a catheter into the male urethra, the penis should be positioned at which of the following degree angles (in relation to the body)?

  1. 90 degrees
    A right angle straightens the urethra and makes it easier to insert the catheter.
  2. 45 degrees
    A 45-degree angle will not straighten the urethra.
  3. 180 degrees
    A 180-degree angle will result in the penis being parallel to the body and inappropriately positioned for catheterization.
  4. 270 degrees
    A 270-degree angle is a physical impossibility.

44. In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the patient’s residual urine must be less than which of the following amounts on two separate occasions (morning and evening)?

  1. 100 cc
    If the patient complains of discomfort or pain, however, the suprapubic catheter is usually left in place until the patient can void successfully.
  2. 30 cc
    Residual urine may be greater than 30 cc and still allow discontinuance of a suprapubic catheter.
  3. 50 cc
    Residual urine may be greater than 50 cc and still allow discontinuance of a suprapubic catheter.
  4. 400 cc
    Residual urine that is greater than 100 cc indicates that the suprapubic catheter cannot be discontinued.

45. When providing care to the patient with bilateral nephrostomy tubes, the nurse never does which of the following?

  1. Clamps each nephrostomy tube when the patient is moved
    The nurse must never clamp a nephrostomy tube because it could cause obstruction and resultant pyelonephritis.
  2. Reports a dislodged nephrostomy tube immediately
    A dislodged nephrostomy tube must be reported immediately to allow the surgeon to replace the tube immediately to prevent the opening from contracting.
  3. Measures urine output from each tube separately
    The output from each tube is assessed, indicating the functioning of the tube.
  4. Irrigates each nephrostomy tube with 30 cc of normal saline q8h as ordered
    The nurse may irrigate a nephrostomy tube with specific orders to do so.

46. Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder?

  1. Anticholinergic agent
    Anticholinergic agents are considered first-line medications for urge incontinence.
  2. Estrogen hormone
    Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra.
  3. Tricyclic antidepressants
    Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance.
  4. Over-the-counter decongestant
    Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

47. Which of the following is a reversible cause of urinary incontinence in the older adult?

  1. Constipation.
    Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in the menopausal women.
  2. Increased fluid intake
    A decreased fluid intake, rather than increased fluid intake, is a reversible cause of urinary incontinence in the older adult.
  3. Age
    Age is a risk factor for urinary incontinence, not a reversible cause.
  4. Decreased progesterone level in the menopausal woman.
    A decreased estrogen, not progresterone, level in the menopausal woman is a reversible cause of urinary incontinence in the older woman.

48. Bladder retraining following removal of an indwelling catheter begins with instructing the patient to follow a 2-3 hour timed voiding schedule.

  1. Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually two to three hours.                                                                                                           At the given time interval, the patient is instructed to void.
  2. encouraging the patient to void immediately.
    Immediate voiding is not usually encouraged. The patient is commonly placed on a timed voiding schedule, usually within two to three hours.
  3. advising the patient to avoid urinating for at least 6 hours.
    Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually two to three hours, not six.
  4. performing straight catherization after 4 hours.
    If bladder ultrasound scanning shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed for complete bladder emptying.

49. Which of the following terms is used to refer to inflammation of the renal pelvis?

  1. Pyelonephritis
    Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic.
  2. Cystitis
    Cystitis is inflammation of the urinary bladder.
  3. Urethritis
    Urethritis is inflammation of the urethra.
  4. Interstitial nephritis
    Interstitial nephritis is inflammation of the kidney.

50. If an indwelling catheter is necessary, nursing interventions that should be implemented to prevent infection include

  1. performing meticulous perineal care daily with soap and water.
    Cleanliness of the area will reduce potential for infection.
  2. using clean technique during insertion.
    Strict aseptic technique must be used during insertion of a urinary bladder catheter.
  3. using sterile technique to disconnect the catheter from tubing to obtain urine specimens.
    The nurse must maintain a closed system and use the catheter’s port to obtain specimens.
  4. placing the catheter bag on the patient’s abdomen when moving the patient.                The catheter bag must never be placed on the patient’s abdomen unless it is clamped because it may cause backflow of urine from the tubing into the bladder.

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