CH 56 – Flashcard
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A 21-year-old with a stab wound to the abdomen has come to the emergency department. Once stabilized, the client is admitted to the medical-surgical unit. What does the admitting nurse do first for this client? Administer pain medication. Assess skin temperature and color. Check on the amount of urine output. Take vital signs.
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D
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The nurse case manager is discussing community resources with a client who has colorectal cancer and is scheduled for a colostomy. Which referral is of greatest value to this client initially? Certified Wound, Ostomy, and Continence Nurse (CWOCN) Home health nursing agency Hospice Hospital chaplain
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A
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The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions? "A dark or purplish-looking stoma is normal and should not concern me." "If the skin around the stoma is red or scratched, it will heal soon." "I need to check for leakage underneath my colostomy." "I should strive for a very tight fit when applying the barrier around the stoma."
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C
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A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? "A drink of diet soda with dinner is OK for me." "I need to go for a walk every evening." "Maintaining a low-fiber diet will manage my constipation." "Watching the amount of fluid that I drink with meals is very important."
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B
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A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? Steak with pasta Spaghetti with tomato sauce Steamed broccoli with turkey Tuna salad with wheat crackers
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C
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A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond? "Have you asked your health care provider what he or she thinks your chances are?" "It is hard to know what can predispose a person to develop a certain disease." "No. Just because they both had CRC doesn't mean that you will have it, too." "The only way to know whether you are predisposed to CRC is by genetic testing."
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D
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The Certified Wound, Ostomy, and Continence Nurse is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects a correct understanding of the necessary self-management skills? "I will have my spouse change the bag for me." "If I have any leakage, I'll put a towel over it." "I need to call my home health nurse to come out if I have any problems." "I will make certain that I always have an extra bag available."
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D
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A client with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client? "Are you afraid of what your spouse will think of the colostomy?" "Don't worry. You will get used to the colostomy eventually." "Tell me what worries you the most about this procedure." "Why are you so afraid of having this procedure done?"
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C
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A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? Femoral Reducible Strangulated Ventral
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B
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A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which client statement indicates a need for further teaching about this procedure? "I may have trouble urinating immediately after the surgery." "I will need to stay in the hospital overnight." "I should not eat after midnight the day of the surgery." "My chances of having complications after this procedure are slim.
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B
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A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? Decrease in liver function test results Elevated carcinoembryonic antigen Elevated hemoglobin levels Negative test for occult blood
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B
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A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client? Encourages the client to look at and touch the colostomy stoma Instructs the client about complete care of the colostomy Schedules a visit from a client who has a colostomy and is successfully caring for it Suggests that the client involve family members in the care of the colostomy
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A
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The nurse is caring for a client who is to be discharged after a bowel resection and the creation of a colostomy. Which client statement demonstrates that additional instruction from the nurse is needed? "I can drive my car in about 2 weeks." "I should avoid drinking carbonated sodas." "It may take 6 weeks to see the effects of some foods on my bowel patterns." "Stool softeners will help me avoid straining."
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A
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A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? Cramping intermittently, metabolic acidosis, and minimal vomiting Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis Metabolic acidosis, upper abdominal distention, and intermittent cramping Upper abdominal distention, metabolic alkalosis, and great amount of vomiting
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D
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A client with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client? Attaching the tube to high continuous suction Auscultating for bowel sounds and peristalsis while the suction runs Connecting the tube to low intermittent suction Flushing the tube with 30 mL of normal saline every 24 hours
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C
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A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? Administers medication for pain Changes the nasogastric suction level from "intermittent" to "constant" Positions the client in high-Fowler's position Prepares the client for emergency surgery
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D
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The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates a correct understanding of the nurse's instructions? "I should take Ex-Lax after the surgery to 'keep things moving'." "I will need to eat a diet high in fiber." "Limiting my fluids will help me with constipation." "To help with the pain, I'll apply ice to the surgical area."
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B
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A client with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." "It is inherited, so it could run in your family." "It might be caused by a virus, so you could have gotten it almost anywhere." "Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine."
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D
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A client suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the client about this test? "During the test, you will drink small amounts of an antacid as directed by the technician." "If you have IBS, hydrogen levels may be increased in your breath samples." "The test will take between 30 and 45 minutes to complete." "You must have nothing to drink (except water) for 24 hours before the test."
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B
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After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? LPN/LVN who has worked with many home health clients after colostomy surgeries LPN/LVN with 20 years of experience in the home health agency RN who is new to the agency with 5 years experience in the emergency department Social worker who is experienced with case management of older clients
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C
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A male client in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing the client's incision for signs of infection Assisting the client to stand to void Instructing the client in how to deep-breathe Monitoring the client's pain level
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B
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Which client does the medical-surgical unit charge nurse assign to an LPN/LVN? A 41-year-old who needs assistance with choosing a site for a colostomy stoma A 47-year-old who needs to receive "whole gut" lavage before a colon resection A 51-year-old who has recently arrived on the unit after having an open herniorrhaphy A 56-year-old who has obstipation and a recent emesis of foul-smelling liquid
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B
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The RN on the medical-surgical unit receives a shift report about four clients. Which client does the nurse assess first? A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern A 40-year-old with pneumonia who has abdominal distention and decreased bowel sounds in all quadrants A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy
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B
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After an automobile crash, a client is admitted to the emergency department with possible abdominal trauma. Which health care provider request does the nurse implement first? Insert a nasogastric tube and connect it to intermittent suction. Obtain a complete blood count and coagulation panel. Start an IV line and infuse normal saline at 200 mL/hr. Arrange for a computed tomography (CT) scan of the abdomen.
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C
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A client with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to the treatment regimen. What does the nurse tell the client about the diarrhea and mouth ulcers? "A combination of chemotherapeutic agents has caused them." "GI problems are symptoms of the advanced stage of your disease." "5-FU cannot discriminate between your cancer and your healthy cells." "You have these as a result of the radiation treatment."
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C
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What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? It destroys the cancer's cell wall, which will kill the cell. It decreases blood flow to rapidly dividing cancer cells. It stimulates the body's immune system and stunts cancer growth. It blocks factors that promote cancer cell growth.
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D
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Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a client with advanced colorectal cancer for relief of symptoms? Analgesics and antiemetics Analgesics and benzodiazepines Steroids and analgesics Steroids and anti-inflammatory medications
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A
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What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? Bulk-forming laxatives Saline laxatives Stimulant laxatives Stool-softening agents
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A
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A client diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the client states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this client? Antidiarrheal agent Muscarinic receptor antagonist Serotonin antagonist Tricyclic antidepressant
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B
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The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) Acupuncture Decreasing physical activities Herbs (moxibustion) Meditation Peppermint oil capsules Yoga
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ACDEF
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The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) Broccoli Buttermilk Mushrooms Onions Peas Yogurt
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ACDE
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A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem? (Select all that apply.) Antihistamines Caffeinated drinks Stress Sleeping pills Anxiety
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BCE
