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Text Mode – Text version of the exam 1. The nurse recognizes that the patient with a duodenal ulcer will likely experience 2. Of the following categories of medications, which is used in combination with bismuth salts to eradicate Helicobacter pylori? 3. Which of the following medications represents the category proton (gastric acid) pump inhibitors? 4. Which of the following medications used for the treatment of obesity prevents the absorption of triglycerides? 5. Of the following bariatric surgical procedures, which is the best procedure for long-term weight loss? 6. Which of the following statements regarding gastric cancer is accurate? 7. Which of the following categories of laxatives draw water into the intestines by osmosis? 8. Crohn’s disease is a condition of malabsorption caused by 9. The nurse teaches the patient whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be 10. When irrigating a colostomy, the nurse lubricates the catheter and gently inserts it into the stoma no more than _______ inches 11. A longitudinal tear or ulceration in the lining of the anal canal is termed a (an) 12. Which type of diarrhea is caused by increased production and secretion of water and electrolyes by the intestinal mucosa into the intestinal lumen? 13. Which of the following terms is used to refer to intestinal rumbling? 14. The presence of mucus and pus in the stools suggests 15. Celiac sprue is an example of which category of malabsorption? 16. Typical signs and symptoms of appendicitis include: 17. Regional enteritis is characterized by: 18. What is the most common cause of small bowel obstruction? 19. Which of the follow statements provides accurate information regarding cancer of the colon and rectum? 20. Which of the following characteristics are risk factors for colorectal cancer? 21. Which type of jaundice in adults is the result of increased destruction of red blood cells? 22. The nurse places the patient after liver biopsy in which of the following positions? 23. Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas? 24. Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid? 25. Which of the following terms most precisely refers to the incision of the common bile duct for removal of stones? 26. Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus [IDDM])? 27. Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM])? 28. Of the following types of insulin, which is the most rapid acting? 29. Of the following categories of oral antidiabetic agents, which exert their primary action by directly stimulating the pancreas to secrete insulin? 30. The nurse teaches the patient about diabetes including which of the following statements? 31. The nurse teaches the patient about glargine (Lantus), a “peakless” basal insulin including which of the following statements? 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? 33. Of the following disorders, which results from excessive secretion of somatotropin? 34. Which of the following hormones is secreted by the posterior pituitary? 35. Trousseau’s sign is positive when 36. The digestion of carbohydrates is aided by 37. The term used to describe total urine output of less than 400 mL in 24 hours is 38. When fluid intake is normal, the specific gravity of urine should be 39. Of the following terms, which refers to casts in the urine? 40. When the nurse observes the patient’s urine to be orange, she further assesses the patient for 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? 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? 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)? 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)? 45. When providing care to the patient with bilateral nephrostomy tubes, the nurse never does which of the following? 46. Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder? 47. Which of the following is a reversible cause of urinary incontinence in the older adult? 48. Bladder retraining following removal of an indwelling catheter begins with instructing the patient to follow a 2-3 hour timed voiding schedule. 49. Which of the following terms is used to refer to inflammation of the renal pelvis? 50. If an indwelling catheter is necessary, nursing interventions that should be implemented to prevent infection includePractice Mode
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The patient with a gastric ulcer often awakens between 1-2 A.M. with pain and ingestion of food brings relief.
Vomiting is uncommon in the patient with duodenal ulcer.
Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer.
The patient with a duodenal ulcer may experience weight gain.
Antibiotics and bismuth salts are given to eradicate H. pylori.
Antacids are given to manage gastric acidity.
Proton pump inhibitors are given to decrease acid secretion.
Histamine-2 receptor antagonists are given to decrease the acid secretion in the stomach.
Omeprazole decreases gastric acid by slowing the hydrogen-potassium-adenosine-triphosphatase pump on the surface of the parietal cells.
Sucralfate is a cytoprotective drug.
Famotidine is a histamine-2 receptor antagonist.
Metronidazole is an antibiotic, specifically an amebicide.
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.
buproprion hydrochloride (Wellbutrin) is an antidepressant medication.
Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephine. Meridia decreases appetite.
Fluoxetine hydrochloride (Prozac) has not been approved by the FDA for use in the treatment of obesity.
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.
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.
Application of a silicone ring to the fundus of the stomach may fail.
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
While the incidence continues to decrease, gastric cancer still accounts for 12,800 deaths annually.
While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years.
Males have a higher incidence of gastric cancers than females.
More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.
Saline agents use osmosis to stimulate peristalsis and act within 2 hours of consumption.
Bulk-forming agents mix with intestinal fluids, swell, and stimulate peristalsis.
Stimulants irritate the colon epithelium.
Fecal softeners hydrate the stool by surfactant action on the colonic epithelium, resulting in mixing of aqueous and fatty substances.
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.
Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption.
Disaccharidase deficiency leads to lactose intolerance.
Postoperative malabsorption occurs after gastric or intestinal resection.
With a sigmoid colostomy, the feces are solid.
With a descending colostomy, the feces are semi-mushy.
With a transverse colostomy, the feces are mushy.
With an ascending colostomy, the feces are fluid.
The nurse should insert the catheter no more than 3 inches.
Insertion of the catheter 2 inches is inadequate.
Insertion of the catheter 4 inches is excessive and not recommended.
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).
An anorectal abscess is an infection in the pararectal spaces.
An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus.
A hemorrhoid is a dilated portion of vein in the anal canal.
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.
Osmotic diarrhea occurs when water is pulled into the intestines by the osmotic pressure of nonabsorbed particles, slowing the reabsorption of water.
Mixed diarrhea is caused by increased peristalsis (usually from inflammatory bowel disease) and a combination of increased secretion or decreased absorption in the bowel.
The most common cause of diarrheal disease is contaminated food.
Borborygmus is the term used to refer to intestinal rumbling which accompanies diarrhea.
Tenesmus is the term used to refer to ineffectual straining at stool.
Azotorrhea is the term used to refer to excess of nitrogenous matter in the feces or urine.
Diverticulitis is the term used to refer to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.
The presence of mucus and pus in the stools suggests inflammatory colitis or enteritis.
Watery stools are characteristic of small bowel disease.
Loose, semisolid stools are associated more often with disorders of the colon.
Voluminous, greasy stools suggest intestinal malabsorption.
In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders.
Examples of infectious diseases causing generalized malabsorption include small bowel bacterial overgrowth, tropical sprue, and Whipple’s disease.
Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger Ellison syndrome, and pancreatic insufficiency.
Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.
Nausea is typically associated with appendicitis with or without vomiting.
Pain is generally felt in the right lower quadrant.
Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis.
Low-grade fever is associated with appendicitis.
Transmural thickeneing is an early pathologic change of Crohn’s disease. Later pathology results in deep, penetrating granulomas.
Regional enteritis is characterized by regional discontinuous lesions.
Severe diarrhea is characteristic of ulcerative colitis while diarrhea in regional enteritis is less severe.
Regional enteritis is characterized by a prolonged and variable course while ulcerative colitis is characterized by exacerbations and remissions.
Adhesions are scar tissue that forms as a result of inflammation and infection.
Hernias are one of the second most common causes of small bowel obstruction.
Neoplasms are one the second most common causes of small bowel obstruction.
Volvulus (twisting of the bowel) is a less common cause of small bowel obstruction.
Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum).
The incidence increases with age (the incidence is highest in people older than 85).
Colon cancer occurrence is higher in people with a family history of colon cancer.
Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer.
Being older than age 40 is a risk factor for colorectal cancer.
A high-fat, high-protein, low-fiber diet is a risk factor for colorectal cancer.
Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed.
Hepatocellular jaundice is the result of liver disease.
Obstructive jaundice is the result of liver disease.
Non-obstructive jaundice occurs with hepatitis.
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.
Positioning the patient on his left side is not indicated.
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.
High Fowler’s position is not indicated for the patient after liver biopsy.
This type of cirrhosis is due to chronic alcoholism and is the most common type of cirrhosis.
In postnecrotic cirrhosis, there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis.
In biliary cirrhosis, scarring occurs in the liver around the bile ducts.
Compensated cirrhosis is a general term given to the state of liver disease in which the liver continues to be able to function effectively.
Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise.
Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction.
Ascites refers to accumulation of serous fluid within the peritoneal cavity.
Dialysis refers to a form of filtration to separate crystalloid from colloid substances.
Choledocholithotomy refers to incision of the common bile duct for the removal of stones (liths).
Cholecystostomy refers to opening and drainage of the gallbladder.
Choledochotomy refers to opening into the common duct.
Choledochoduodenostomy refers to anastomosis of the common duct to the duodenum.
Individuals with Type 1 diabetes often have islet cell antibodies.
Individuals with Type 1 diabetes are usually thin or demonstrate recent weight loss at the time of diagnosis
Individuals with Type 1 diabetes are ketosis-prone when insulin is absent.
Individuals with Type 1 diabetes need insulin to preserve life.
Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful.
Individuals with Type 2 diabetes are usually obese at diagnosis.
Individuals with Type 2 diabetes rarely demonstrate ketosis, except in stress or infection.
Individuals with Type 2 diabetes do not demonstrate islet cell antibodies.
The onset of action of rapid-acting Humalog is within 10-15 minutes.
The onset of action of short-acting regular insulin is 30 minutes-1 hour.
The onset of action of intermediate acting NPH is 3-4 hours.
The onset of action of long-acting Ultralente is 6-8 hours.
Therefore, a functioning pancreas is necessary for sulfonylureas to be effective.
Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas
Biguanides facilitate insulin’s action on peripheral receptor sites.
Alpha glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
Several types of foods contain sugar, including cereals, sauces, salad dressing, fruit, and fruit juices.
It is not feasible, nor is it advisable, to remove all sources of sugar from the diet.
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.
Glargine is absorbed very slowly over a 24-hour period and can be given once a day.
Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation.
Glargine is a “peakless” basal insulin that is absorbed very slowly over a 24-hour period.
The patient with Cushing’s syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension.
In Addison’s disease, the patient experiences chronic adrenocortical insufficiency.
In Graves’ disease, the patient experiences hyperthyroidism.
The individual with Hashimoto’s disease demonstrates inflammation of the thyroid gland, resulting in hypothyroidism.
The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet.
Cretinism occurs as a result of congenital hypothyroidism.
Dwarfism is caused by insufficient secretion of growth hormone during childhood.
Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.
Vasopressin causes contraction of smooth muscle, particularly blood vessels.
Calcitonin is secreted by the parafollicular cells of the thyroid gland.
Corticosteroids are secreted by the adrenal cortex.
Somatostatin is released by the anterior lobe of the pituitary.
A positive Trousseau’s sign is suggestive of latent tetany.
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.
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.
A positive Homans’ sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
Amylase is secreted by the exocrine pancreas.
Lipase aids in the digestion of fats.
Trypsin aids in the digestion of proteins.
Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.
Oliguria is associated with acute and chronic renal failure.
Anuria is used to describe total urine output of less than 50 mL in 24 hours.
Nocturia refers to awakening at night to urinate.
Dysuria refers to painful or difficult urination.
Urine specific gravity is a measurement of the kidney’s ability to concentrate urine.
The specific gravity of water is 1.000.
A urine specific gravity of less than 1.010 may indicate inadequate fluid intake.
A urine specific gravity greater than 1.025 may indicate overhydration.
Casts may be identified through microscopic examination of the urine sediment after centrifuging.
Crystalluria is the term used to refer to crystals in the urine.
Pyuria is the term used to refer to pus in the urine.
Bacteriuria refers to a bacterial count higher than 100,000 colonies/mL in the urine.
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.
Urine that is pink to red may indicate lower urinary tract bleeding.
Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation.
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.
Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit.
Serum iron levels measure iron storage in the body.
Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.
Stress incontinence may occur with sneezing and coughing.
Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder.
Urge incontinence refers to involuntary loss of urine associated with urgency.
Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.
A right angle straightens the urethra and makes it easier to insert the catheter.
A 45-degree angle will not straighten the urethra.
A 180-degree angle will result in the penis being parallel to the body and inappropriately positioned for catheterization.
A 270-degree angle is a physical impossibility.
If the patient complains of discomfort or pain, however, the suprapubic catheter is usually left in place until the patient can void successfully.
Residual urine may be greater than 30 cc and still allow discontinuance of a suprapubic catheter.
Residual urine may be greater than 50 cc and still allow discontinuance of a suprapubic catheter.
Residual urine that is greater than 100 cc indicates that the suprapubic catheter cannot be discontinued.
The nurse must never clamp a nephrostomy tube because it could cause obstruction and resultant pyelonephritis.
A dislodged nephrostomy tube must be reported immediately to allow the surgeon to replace the tube immediately to prevent the opening from contracting.
The output from each tube is assessed, indicating the functioning of the tube.
The nurse may irrigate a nephrostomy tube with specific orders to do so.
Anticholinergic agents are considered first-line medications for urge incontinence.
Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra.
Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance.
Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.
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.
A decreased fluid intake, rather than increased fluid intake, is a reversible cause of urinary incontinence in the older adult.
Age is a risk factor for urinary incontinence, not a reversible cause.
A decreased estrogen, not progresterone, level in the menopausal woman is a reversible cause of urinary incontinence in the older woman.
Immediate voiding is not usually encouraged. The patient is commonly placed on a timed voiding schedule, usually within two to three 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.
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.
Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic.
Cystitis is inflammation of the urinary bladder.
Urethritis is inflammation of the urethra.
Interstitial nephritis is inflammation of the kidney.
Cleanliness of the area will reduce potential for infection.
Strict aseptic technique must be used during insertion of a urinary bladder catheter.
The nurse must maintain a closed system and use the catheter’s port to obtain specimens.
Medical-Surgical Nursing Exam 15
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