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C. Decrease the potential for postoperative hypostatic pneumonia D. Increase the body’s immunologic response to the stressors of surgery 15. Of the following outcomes for the care of Reese after an ileostomy, which has the highest priority? A. Providing relief from constipation B. Assisting the client with self- care activities C. Maintaining fluid and electrolyte balance D. Minimizing odor formation 16. The nurse explains to Reese that a skin barrier must be used around the stoma at all times. The primary function of a skin barrier is to A. Help prevent the formation of odor B. Help maintain an accurate output record C. Protect against irritation from ileostomy effluent D. Allow the client to keep the Ostomy pouch on longer 17. Which of the following signs should Reese report immediately? A. Passage of liquid stool from the stoma B. Occasional presence of undigested food in the effluent C. Absence of drainage from the ileostomy for 6 or more hours D. Temperature of 37.7 C 18. Reese is about to get discharged today. Nurse Hanna evaluates the client’s understanding of ileostomy care. Which of the following statements indicates that discharge teaching has been effective? A. “I should be able to resume weight lifting in 2 weeks” B. “I can return to work in 2 weeks” C. “I need to drink at least 3L of fluids a day” D. “I will need to avoid getting my stoma wet while bathing” 19. Selena consults via teleconsult the sudden onset of abdominal cramps, vomiting, and watery discharge from her ileostomy. How should the nurse respond to this client? A. Tell the client to come into the clinic for an examination if the symptoms persist for longer than 24 hours B. Encourage the client to increase fluid intake to 3L/day to replace fluid lost through vomiting C. Instruct the client to take 30ml of milk of magnesia to stimulate a bowel movement D. Tell the client that he needs to be examined immediately by the physician 20. Enecita was put on bowel rest due to exacerbation of Crohn’s disease. Total parenteral nutrition was prescribeD. While administering the solution, it is important for the nurse to remember that total parental solutions are used to A. Increase cell nutrition B. Treat metabolic acidosis C. Provide hydration D. Reverse a positive nitrogen balance 21. You would regularly assess which parameter to gauge the client’s ability to metabolize the TPN solution? A. Tachycardia B. Hypertension C. Elevated BUN concentration D. Hyperglycemia 22. Which of the following is the most appropriate nursing diagnosis for Enecita who is currently receiving TPN? A. Impaired swallowing B. Impaired gas exchange C. Risk for fluid volume excess D. Ineffective tissue perfusion 23. You assessed Enecita’s line during one of your rounds when you noticed that the tubing got disconnected. Which complication can this cause? A. Phlebitis B. Pneumothorax C. Hemorrhage D. Air embolus 24. You monitored Enecita 4 hours later and discovers that a client’s TPN solution was running at an incorrect rate and is now 4 hours behind schedule. Which action is most appropriate for the nurse to take to correct the problem? A. Readjust the solution to infuse the desired amount B. Continue the infusion at the current rate, but run the next bottle at an increased rate C. Double the infusion rate for 2 hours D. Notify the physician 25. You are currently hanging a new TPN infusion. Enecita asks why a fat emulsion solution is needed. You reply that it: A. Provides essential fatty acids B. Provide extra carbohydrates C. Promotes effective metabolism of glucose D. Maintains a normal body weight 26. You plan to monitor Enecita after the first few days of TPN. Which of the following signs should you consider to be indicative of a complication A. Glycosuria B. A 1- to 2- lbs weight gain C. Decreased appetite D. Elevated temperature 27. You keenly monitor the flow rate of Enecita’s TPN. You prevent a too rapid rate to prevent which of the following complications? A. Negative nitrogen balance B. Circulatory overload C. Hypoglycemia D. Hypokalemia 28. Edelweiss was diagnosed with diverticulitis recently. You review her chart for admission. Which of the following laboratory findings would the nurse expect to find in a client with diverticulitis? A. Elevated RBC count B. Decreased platelet count C. Elevated WBC count D. Elevated serum BUN concentration 29. You review the orders for Edelweiss and you saw a barium enema was ordereD. You are aware that barium enema should not be ordered for this patient because: A. Can perforate an intestinal abscess B. Would greatly increase the client’s pain C. Is of minimal diagnostic value in diverticulitis D. Is too lengthy a procedure for the client to tolerate 30. During your health teaching, you advise the Edelweiss to integrate which intervention into her daily routine at home? A. Using enemas to relieve constipation B. Decreasing fluid intake to increase the formed consistency of the stool C. Eating a high-fiber diet when symptomatic with diverticulitis D. Refraining from straining and lifting activities 31. Which of the following medications would you anticipate to administer to a Jamie, a patient with diverticulosis? A. Psyllium hydrophilic mucilloid (Metamucil) B. Diphenoxylate with atropine sulfate (Lomotil) C. Diazepam (valium) D. Aluminum Hydroxide (Amphojel) 32. Edelweiss came back to the ER due to sudden abdominal pain. Which of the following signs would suggest perforation of an inflamed diverticula? A. Hyperactive bowel sounds B. Rigid abdominal wall C. Explosive diarrhea D. Excessive flatulence TOP RANK REVIEW ACADEMY, INC. Page 2 | 3

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