UTA. N3661 Care of the Adult Summer Exam 3

Question 22

UTA. N3661 Care of the Adult Summer Exam 3. A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of intense abdominal tenderness. The nurse’s rapid assessment reveals that the client’s abdomen is uncharacteristically rigid on palpation. What is the nurse’s best response?

• Contact the health care provider promptly and report these signs of perforation.
• Position the client supine and insert an NG tube.
• Administer a Fleet enema as prescribed and remain with the client.
• Page the health care provider and report that the ileus may be obstructed.

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Question 23

A client seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?

• “Instead of eating three meals a day, try eating smaller amounts more often.”
• “Many clients obtain relief by taking over-the-counter antacids 30 minutes before eating.”
• “It’s best to avoid dry foods, such as rice and chicken, because they’re harder to swallow.”
• “Drinking beverages after your meal, rather than with your meal, may bring some relief.”

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Question 24

A client with a hiatal hernia is prescribed omeprazole (Prilosec). Which explanation by the nurse best describes the purpose of this medication?

• “It helps move food through your digestive tract more quickly.”
• “It neutralizes the acid in your stomach after meals.”
• “It reduces the amount of acid your stomach produces.”
• “It strengthens the lower esophageal sphincter to prevent herniation.”

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Question 25

A nurse teaches clients strategies to manage gastroesophageal reflux disease (GERD). Which of the following statements should the nurse include?

• Limit foods that are high in fiber.
• Avoid eating 2 to 3 hours before bedtime.
• Avoid snacking between meals.
• Elevate the head of your bed by 24 inches.

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Question 26

A client is postoperative on day 2 following bariatric surgery. The nurse’s most recent assessment reveals increasing abdominal pain that the client rates at 8 out of 10, a heart rate of 112 beats per minute, and an oral temperature of 38.1°C (100.6°F). What is the nurse’s best action?

• Continue to monitor the client.
• Communicate the findings to the healthcare provider because the client may have a complication, such as an anastomotic leak.
• Insert a nasogastric tube as prescribed to facilitate STAT gastric decompression.
• Slow the client’s oral intake in consultation with the dietitian to prevent further dumping syndrome.

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Question 27

The nurse is caring for a client with diarrhea. For which finding will the nurse suspect the diarrhea is caused by pancreatic insufficiency?

• Nocturnal diarrhea
• Oil droplets on the toilet water
• Voluminous greasy stools
• Blood, mucus, and pus in the stool

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Question 28

A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first?

• Check the client’s perineal skin integrity.
• Investigate the client’s emotional concerns.
• Review the client’s electrolyte values.
• Obtain a dietary history from the client.

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Question 29

A client presents to the emergency department with a history of frequent, watery diarrhea after traveling overseas. Which of the following interventions would the nurse implement first?

• Administer the antidiarrheal medication Lomotil.
• Obtain a stool sample for culture.
• Have the lab draw an erythrocyte sedimentation rate.
• Initiate antibiotic therapy intravenously.

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Question 30

A nurse is reviewing the chart of a client who has been taking pantoprazole (Protonix) daily for over a year. Which of the following findings should the nurse recognize as a potential complication of long-term therapy?

• Elevated hemoglobin level
• Bradycardia and hypotension
• Decreased bone mineral density
• Increased gastric acid production

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Question 31

A client who has been diagnosed with TB has been placed on drug therapy. The medication regimen includes rifampin. Which instruction will the nurse give the client about the potential side effects of rifampin?

• Urine may have a purple color to it.
• Decrease protein in the diet.
• Drink alcohol in moderation.
• Maintain follow-up monitoring of liver enzymes.

Question 32

The nurse recognizes that the teaching goals regarding TB transmission have been met when the client with TB:

• demonstrates correct use of medications.
• washes dishes and personal items after use.
• reports daily to the public health department.
• covers the mouth and nose when coughing.

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Question 33

A nurse is caring for a client with streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus (IVPB). Ten minutes into the third dose’s infusion, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?

• Elevate the head of the bed.
• Auscultate the client’s breath sounds.
• Stop the infusion.
• Call the client’s provider.

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Question 34

The nurse is caring for a client diagnosed with COPD. While evaluating the client’s response to treatment, which outcome requires a revision in the plan of care?

• The client has no signs of respiratory distress.
• The client shows improvement in their respiratory pattern.
• The client participates in establishing goals.
• The client demonstrates intolerance to activity.

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Question 35

The client diagnosed with asthma has been prescribed a glucocorticoid inhaled medication. Which information should the nurse teach regarding this medication?

• Immediately rinse the mouth following the administration of the drug.
• Do not abruptly stop taking this medication; it must be tapered off.
• Hold the medication in the mouth for 15 seconds before swallowing.
• Take the medication immediately when an attack starts.

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Question 36

The nurse is caring for a client with pneumonia. Which nursing observation would indicate the patient is responding to the treatment for the pneumonia infection? UTA. N3661 Care of the Adult Summer Exam 3

• Oral temperature of 101 degrees F (38.3° C), increased chest pain with non-productive cough.
• Respirations 18 with no complaints of dyspnea; a small amount of white sputum.
• White cell count of 15,000mm3 (4,500 – 11,000).
• Productive cough with thick green sputum; states they “feel.”

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Question 37

A nurse is teaching a client with asthma how to use an albuterol (salbutamol sulfate) inhaler with a spacer. Which of the following actions by the client indicates an understanding of the teaching?

• The client exhales as the medication is released from the inhaler.
• The client holds his breath for 10 seconds after inhaling the medication.
• The client takes a quick inhalation while releasing the medication from the inhaler.
• The client waits 10 min between inhalations.

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Question 38

A nurse is assessing a client admitted with an acute exacerbation of COPD. Which finding indicates the client is progressing from respiratory distress to respiratory failure?

• Increasing somnolence and difficulty arousing the client.
• Audible expiratory wheezes and prolonged expiration.
• Respiratory rate of 28/min with the use of accessory muscles.
• Pa O2 40 mm Hg and Pa CO2 50 mm Hg on arterial blood gas.

Question 39

A 64-year-old client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client’s history, the nurse learns that the client has osteoarthritis but still plays golf three times a week, follows a vegetarian diet, and is very concerned with cleanliness. Which client information would most likely be a risk factor for diagnosing pneumonia?

• Playing golf three times a week
• Osteoarthritis
• Advanced age
• Vegetarian diet ✓

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Question 40

A nurse is caring for a client admitted with an acute exacerbation of COPD. The client is dyspneic at rest, has a respiratory rate of 30/min, oxygen saturation of 86% on room air, and is using accessory muscles. Which intervention should the nurse implement first?

• Administer prescribed IV morphine for dyspnea
• Apply high-flow oxygen via nonrebreather mask at 15 L/min
• Place the client in high-Fowler’s position ✓
• Encourage the client to cough forcefully

Question 39

A 64-year-old client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client’s history, the nurse learns that the client has osteoarthritis but still plays golf three times a week, follows a vegetarian diet, and is very concerned with cleanliness. Which client information would most likely be a risk factor for diagnosing pneumonia?

• Playing golf three times a week
• Osteoarthritis
• Advanced age
• Vegetarian diet

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Question 40

A nurse is caring for a client admitted with an acute exacerbation of COPD. The client is dyspneic at rest, has a respiratory rate of 30/min, oxygen saturation of 86% on room air, and is using accessory muscles. Which intervention should the nurse implement first?

• Administer prescribed IV morphine for dyspnea
• Apply high-flow oxygen via nonrebreather mask at 15 L/min
• Place the client in high-Fowler’s position
• Encourage the client to cough forcefully

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Question 41

A nurse assesses a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

• Agitation
• Hypotension
• Dysphagia
• Nausea

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Question 42

A nurse is assessing the clients with chronic emphysema. Which of the following requires immediate intervention?

• Circumoral cyanosis
• Use of pursed-lipped breathing and prolonged expiration
• Appearance of barrel chest
• Coarse crackles are auscultated throughout all posterior lung fields bilaterally

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Question 43

A nurse instructs a client newly diagnosed with pulmonary tuberculosis (TB) about using antitubercular medications. Which of the following information should the nurse include in the teaching?

• Medication will need to be taken until the Mantoux test is negative
• The client’s entire family must also take medications to prevent infection
• A typical course of treatment involves 6 to 12 months of consistent medication use
• Medications must be taken for the rest of the client’s life, even if the client feels better

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Question 44

The RN is caring for a client who has COPD exacerbation and is receiving oxygen at 2 L/min via nasal cannula. The client reports difficulty breathing. Which of the following actions is the nurse’s priority?

• Increase the oxygen flow to 3 L/min
• Call emergency services for the client
• Assess the client’s respiratory status
• Have the client cough and expectorate secretions

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Question 45

Which intervention is most important for the nurse to implement for the client diagnosed with renal calculi?

• Assess the abdomen every 2 hours
• Strain all urine and send any sediment to the lab
• Take a 24-hour dietary recall during the client interview
• Monitor the client’s creatinine and BUN levels

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Question 46

An older adult has experienced a new onset of urinary incontinence, and family members identify this problem as being unprecedented. When assessing the client for factors that may have contributed to incontinence, the nurse should prioritize which assessment?

• Assessing for changes in the client’s level of psychosocial stress
• Reviewing the client’s medication administration record for recent changes
• Reviewing the client’s 24-hour food recall for changes in diet
• Assessing for recent contact with individuals who have urinary tract infections (UTIs)

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Question 47

A client is admitted to the medical unit with acute Pyelonephritis. The client reports flank pain rated 8/10, chills, nausea, and urinary urgency. Assessment findings include:

• Temperature: 103.1°F (39.5°C)
• Heart rate: 126/min
• Blood pressure: 86/54 mm Hg
• Respiratory rate: 24/min
• WBC: 18,500/mm³ (4,500-11,000)
• Lactate: 4.2 mmol/L (0.5-2.2)

Which intervention ordered by the health care provider should the nurse implement first?

• Obtain a clean-catch urine specimen for culture
• Administer acetaminophen for fever
• Initiate the IV bolus of normal saline stat
• Administer prescribed IV ciprofloxacin

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Question 48

A client comes to the emergency department reporting severe pain in the right flank, nausea, and vomiting. The health care provider tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client’s care, which nursing diagnosis should the nurse assign the highest priority?

• Impaired urinary elimination
• Imbalanced nutrition: Less than body requirements
• Acute pain
• Risk for infection

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Question 49

A client is experiencing recurrent urinary tract infections. Which health education will the nurse provide to this client?

• Clean the perineum from back to front
• Void every two to three hours
• Increase consumption of coffee and tea
• Limit fluids to meals

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Question 50

The nurse is caring for a client who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the client?

• Report any light, pink-tinged urine within 24 hours after the procedure
• Notify the health care provider about cloudy or foul-smelling urine
• Report the presence of fine, sand-like particles in the urine
• Limit oral fluid intake for 1-2 days

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Question 51

The nurse has implemented a bladder retraining program for an older adult client. The nurse places the client on a timed voiding schedule and performs an ultrasound bladder scan after each void. The nurse notes that the client typically has approximately 50 mL of urine remaining in the bladder after voiding. What would be the nurse’s best response to this finding?

• Perform a straight catheterization on this client
• Press on the client’s bladder in an attempt to encourage complete emptying
• Place an indwelling urinary catheter
• Avoid further intervention at this time, as this is a normal finding

Question 52

A nurse is providing discharge teaching to a 26-year-old female client with recurrent Cystitis. Which statement by the client indicates a need for further teaching?

• “I will urinate soon after sexual intercourse” UTA. N3661 Care of the Adult Summer Exam 3
• “I will take bubble baths regularly to help maintain personal hygiene”
• “I will avoid using spermicides for contraception”
• “I will increase my fluid intake to at least 2-3 liters per day”

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Question 53

A nurse is creating a care plan for a client with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?

• Inactivity reduces caloric need and gastrointestinal motility.
• Bed rest lowers the metabolic rate and reduces pancreatic enzyme production.
• Reduced activity protects the physical integrity of pancreatic cells.
• A slow walk minimizes the client’s metabolism and reduces the risk of metabolic acidosis.

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Question 54

A 57-year-old client presents at the emergency department (ED), reporting nausea, vomiting, and severe abdominal pain. The client’s abdomen is rigid, and there is bruising to the client’s flank. The client’s spouse states that the client was on a drinking binge for the past two days. The ED nurse should assist in assessing the client for what health problem?

• Acute appendicitis with possible perforation
• Acute cholecystitis
• Severe pancreatitis with possible peritonitis
• Chronic pancreatitis

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Question 55

A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows which assessment finding to report to the health care provider immediately.

• Decreased breath sounds
• Drainage of bile-colored fluid onto the abdominal dressing
• Acute pain with movement
• Rigidity of the abdomen

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Question 56

A nurse is teaching a client who has cholecystitis about the required dietary modifications. The nurse should include, as appropriate, which of the following foods in the client’s diet?

• Roast turkey
• Macaroni and cheese
• Caramel chicken
• Ice cream

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Question 57

A client is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

• Abdominal pain unresponsive to analgesics UTA. N3661 Care of the Adult Summer Exam 3
• Fever, increased heart rate, and decreased blood pressure
• Sudden increase in random blood glucose readings
• Increased abdominal girth accompanied by a decreased level of consciousness

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Question 58

A nurse is caring for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action?

• Encourage ambulation once fully awake
• Instruct the client not to lift over 4.5 kg (10 lb)
• Place the client in a supine position postoperatively
• Offer the client ice cream postoperatively

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Question 59

The client is diagnosed with acute pancreatitis. Which health care provider’s admitting order should the nurse question?

• Weigh the client daily
• Initiate IV therapy 0.9% NS at 125 mL/hr
• Low-fat, low-carbohydrate diet
• Bedrest with bathroom privileges

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Question 60

A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain?

• Aspirin every 4 to 6 hours as prescribed
• Application of heat for 15 to 20 minutes each hour to the right shoulder
• Apply an ice pack to the right shoulder for no more than 15 minutes
• Application of liniment rub to the right shoulder