Nur 114 Test 2

Front 1

The nurse is caring for patient with ulcerative colitis. Which finding would the nurse report to the physician?
hypotension
bloody diarrhea
rebound tenderness
hgb of 12

Back 1

rebound tenderness
(s/s peritonitis)

p.771

Front 2

nursing diagnosis should be in discharge planning for postop colostomy?
sexual dysfunction
body image, disturbed
fear r/t poor prognosis
nutrition: more than body requirements

Back 2

body image, disturbed

p. 771

Front 3

in recording stool for patient w/Crohn's disease, what characteristic should RN expect to see
diarrhea
chr constipation
constipation alt w/diarrhea
stool constantly oozing from rectum

Back 3

diarrhea

p. 771

Front 4

What r/f for colorectal cancer should RN include in teaching?
age older than 30
high-fiber, low-fat diet
distant relative w/colorectal ca
personal h/o ulcerative colitis or GI polyps

Back 4

personal h/o ulcerative colitis or GI polyps

p.777

Front 5

Patient has undergone EGD. RN highest priority
monitor temp
monitor c/o heartburn
warm gargle for sore throat
assess return of gag reflex

Back 5

gag reflex

p. 777

Front 6

Patient w/PUD, medication h/o reveals intermittent use of several meds. Which one should be avoided d/t GI tract irritation?
nizatidine (Axid)
ibuprofen
sucralfate (Carafate)
omeprazole (Prilosec)

Back 6

Ibuprofen

p. 772

Front 7

Patient w/colostomy has order for irrigation. RN uses what solution to irrigate?
tap water
sterile water
sterile distilled water
sterile LR

Back 7

warm tap water

p. 774

Front 8

RN is doing admission assessment on pt w/ hx of duodenal ulcer. To determine if ulcer active, which sx should RN assess for?
weight loss
n/v
pain relieved by food intake
pain radiating down r arm

Back 8

pain relieved by food intake

p. 772

Front 9

RN is assessing patient 24 hrs post choley. T tube has drained 750 ml green-brown drainage since surgery. What intervention appropriate?
clamp t tube
irrigate t tube
call MD
document

Back 9

document

p. 770

Front 10

Pt is 2 days postop colostomy and begins to pass malodorous flatus from stoma. What is RN's correct interpretation?
normal, expected
early s/s ischemic bowel
pt should not have nt removed
indicates inadequate preop bowel prep

Back 10

normal, expected

p. 773

Front 11

Pt has just had ileostomy. RN assesses client immediately postop for most frequent complication?
folate deficiency
malabsorption of fat
intestinal obstruction
fluid/elect imbalance

Back 11

fluid/elect

p. 774

Front 12

Pt with new colostomy is concerned about odor. RN teaches patient to include what food to reduce odor?
eggs
yogurt
broccoli
cucumbers

Back 12

yogurt

teach deodorizing foods

p. 773

Front 13

s/s acute cholecystitis

Back 13

-severe/steady epigastric/RUQ pain after eating
-RUQ tenderness
-N/V
-back, R scapula, shoulder pain
-fever, chills, anorexia

Front 14

s/s chronic cholecystitis

Back 14

may be asymptomatic

Front 15

diagnostic tests: cholecystitis

Back 15

CBC-infx/inflammation
bilirubin-r/o obstructed bile flow
amylase/lipase-r/o pancreatitis
abd xray: gallstones w/high Ca content
U/S: dx cholelithiasis, assess emptying of bladder
cholecystogram: oral dye to assess gb ability to concentrate and excrete bile
scans: IV radioactive dye-dx duct obstruction, acute/chr cholecystitis

Front 16

meds for cholecystitis

Back 16

narcotics
-Morphine
(pain relief during acute attack)
antibiotics:
-cure infection, reduce imflammation/edema
reduce chol content of stones, leading to dissolving:
-Actigal (ursodiol)
-Chenix (chenodiol)
(high cost, 2 year tx, high recurrence, hepatotoxic)
For itching d/t severe jaundice, accumulating bile salts on skin:
-Questran (cholestyramine)
(binds w/bile salts, excrete in feces)

Front 17

risk factors: cholecystitis

Back 17

age
family h/o gallstones
race: Native American, Northern European
obesity
hyperlipidemia
rapid weight loss
female
use of OCP
biliary stasis (pregnancy, fasting, prolonged parenteral nutrition)
diseases/conditions: cirrhosis, ileal disease/resection, sickle cell, glucose intolerance

Front 18

dietary tx for cholecystitis

Back 18

limit fat (esp if obese)
fat soluble vit (Vit A, D, E, K) and bile salts (if bile flow obstructed)
NPO and NG tube (acute attack, reduce n/v)

Front 19

lithotripsy

Back 19

U/S guided
used w/drug therapy to dissolve large gallstones
shock waves
mild sedation
assess for biliary colic after procedure

Front 20

what is goldenseal contraindicated in?

Back 20

pregnancy, nursing mothers

Front 21

surgery for cholecystitis

Back 21

lap choley
minimally invasive
quick hospital stay
r/f laparotomy (open choley)
gall bladder removed
t-tube placed
excess bile drained

Front 22

purpose for t tube in choley

Back 22

maintain patency of bile duct
promote passage of bile till edema decreases
bile collected in drainage back below op site

Front 23

Nursing dx: cholecystitis

Back 23

pain
imbalanced nutrition: less than body requirements
risk for infection

Front 24

what assessment finding indicates likely perforated ulcer?
bradycardia
numbness in legs
n/v
rigid, boardlike abdomen

Back 24

rigid abdomen

p. 770

Front 25

RN is performing colostomy irrigation. Pt c/o abd cramps. What is appropriate action?
notify MD
stop irrigation temporarily
increase height of irrigation
med for pain and continue irrigation

Back 25

stop temporarily

p. 772

Front 26

ileostomy client is instructed on essential care of stoma:
massage area below stoma
limit fluid intake to prevent diarrhea
eat high-fiber foods such as nuts
cleans peristomal skin meticulously

Back 26

clean skin

p. 773

Front 27

Pt has RN dx of body image, disturbed. What action by pt indicates progress toward identified goals?
looking at ostomy site
reading ostomy literature
watch RN empty bag
practice cutting ostomy appliance

Back 27

practice cutting

p. 773

Front 28

definition: PUD

Back 28

an erosion/ulcer/break in mucosal layer of esophagus, stomach, small intestine

Front 29

patho: PUD

Back 29

ulcer develops d/t mucous gel and bicarb unable to protect against gastric juices

Front 30

etiology: PUD

Back 30

1) H.pylori bacteria: decrease efficiency of mucous gel, damages epithelial cells
2) NSAIDS-interrupt prostaglandin synthesis
3) increased gastric acid secretion
4) decreased secretion of adequate mucous protection

Front 31

prostaglandins: PUD

Back 31

type of hormone:
in GI system:
decrease gastric acid secretion
increase gastric mucous secretion

Front 32

risk factors: PUD

Back 32

family hx
excessive smoking/alcohol use
foods and beverages w/caffeine
glucocorticoids
NSAIDS
stress
H. Pylori infections
chronic gastritis

Front 33

definition ulcer

Back 33

break in GI mucosa
develops when mucosa cannot protect from damage from hydrochloric acid and pepsin

Front 34

location: peptic ulcer

Back 34

any area of GI tract exposed to acid-pepsin secretions
-esophagus
-stomach
-duodenum

Front 35

duodenal ulcers:
location,age, gender

Back 35

duodenum
most common
age 30-55
more males

Front 36

gastric ulcers: location, age

Back 36

stomach
55-70

Front 37

2 major risk factors for PUD

Back 37

use of NSAIDS
chronic H. Pylori infx

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Front 38

what risk factor doubles chance of PUD?

Back 38

cigarette smoking

Front 39

which type of peptic ulcer most common?
which type increase r/f gastric ca?

Back 39

-duodenal
-gastric

Front 40

H. Pylori infection

Back 40

-in 70% people with PUD
-spread fecal-oral/oral-fecal
-produces enzymes that reduce mucous gel's efficiency
-usually gastric, can affect duodenal