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nurs 321 exam 1
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Exam of 35 pages for the course NUR 321 - problems with excretion - renal system p at NUR 321 - problems with excretion - renal system p (nurs 321 exam 1)
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nurs 321 exam 1"The nurse is caring for an adult client diagnosed with gastroesophageal reflux
disease(GERD). Which condition is the most common comorbid disease associated
with GERD? 1.Adult-onset asthma.2.Pancreatitis.3.Peptic ulcer disease.4.Increased
gastric emptying - ANS-1.Adult-onset asthma
"The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The
client asks the nurse which type of analgesic he may take. Which of the following
responses by the nurse would be most accurate?"
1. Aspirin
2. Acetaminophen
3. Naproxen
4. Ibuprofen - ANS-2.Acetaminophen is recommended for pain relief because it does no
promote irritation of the mucosa. Aspirin, and nonsteroidal anti-inflammatory drugs such
as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent
bleeding
•The client with a BMI of 30 is attending a health promotion program at a clinic. Which
outcome is best for the nurse to document in the client's plan of care?
•A. The client will lose 2 lb per week for the next 4 weeks.
•B. The client will gain 2 lb per week for the next 4 weeks.
•C. Teach the client to increase intake of fruits and vegetables.
D. Inform the client to call the clinic weekly with weight results - ANS-A. The client will
lose 2 lb per week for the next 4 weeks.
A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to
take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that
which of the following prescriptions regarding the PN solution will accompany the diet
order?
Decrease the PN rate to 60ml/hr.
Start 0.9% normal saline at 30 ml/hr.
Maintain the present infusion rate.
Discontinue the PN. - ANS-Decrease the PN rate to 60ml/hr.
A client is discharged home with an enteral feeding tube. What does the home health
nurse do to determine the patency of the client's enteral tube?
A. Arranges for the client to have an x-ray performed periodically
B. Auscultates the client's abdomen for bowel sounds before each feeding
,C. Instills air into the tube to check for placement and patency before each feeding
D. Tests aspirated tube contents for pH level before each feeding - ANS-D. Tests
aspirated tube contents for pH level before each feeding
A client is receiving nutritional supplements to restore nutritional status. What does the
nurse do to assess the effectiveness of the supplements for the client?
A. Keeps an accurate and precise food and fluid intake record daily
B. Makes certain the client is weighed daily at the same time
C. Monitors vital signs every 4 hours and as needed
D. Weekly assesses the client's skin for evidence(s) of breakdown - ANS-B. Makes
certain the client is weighed daily at the same time
A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5
lb in 1 week. The nurse next assesses the client to identify the presence of which of the
following?
Hypotension.
Crackles upon auscultation of the lungs.
Thirst.
Polyuria - ANS-Crackles upon auscultation of the lungs.
Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight
gain of five (5) pounds over a week indicates a client is experiencing fluid retention that
can result to hypervolemia. Signs of hypervolemia includes weight gain more than
desired, headache, jugular vein distention, bounding pulse, and crackles on lung
auscultation
A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies
the physician and the physician initially prescribes that the solution and tubing be
changed. The nurse should do which of the following with the discontinued materials?
Send them to the laboratory for culture.
Save them for a return to the manufacturer.
Return them to the hospital pharmacy.
Discard them in the unit trash. - ANS-Send them to the laboratory for culture.
A client presents to the emergency department with upper GI bleeding and is in
moderate distress. In planning care, what is the priority nursing action for this client?
1. assessment of vital signs
2. completion of abdominal examination
3. insertion of the prescribed nasogastric tube
4. thorough investigation of precipitating causes - ANS-1. assessment of vital signs
,A client receiving parenteral nutrition (PN) complains of shortness of breath and
shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse
determines that the client is experiencing which complication of PN therapy?
Air embolism.
Hypervolemia.
Hyperglycemia.
Pneumothorax. - ANS-Pneumothorax.
A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart
failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely
experiencing?
A. Calcium imbalance
B. Fluid volume deficit
C. Fluid volume overload
D. Potassium imbalance - ANS-C. Fluid volume overload
A client who is receiving total enteral nutrition (TEN) exhibits acute confusion and
shallow breathing and says, "I feel weak." As the client begins to have a generalized
seizure, how does the nurse interpret this client's signs and symptoms?
A. The enteral tube is misplaced or dislodged.
B. Abdominal distention is present.
C. A fluid and electrolyte imbalance is present.
D. This is refeeding syndrome. - ANS-D. This is refeeding syndrome.
Incorrect: If the enteral tube becomes misplaced or dislodged, the client may develop
aspiration pneumonia displayed by increased temperature, increased pulse,
dehydration, diminished breath sounds, and shortness of breath.
Incorrect: Abdominal distention is most frequently accompanied by nausea and
vomiting.Incorrect: Signs and symptoms of fluid and electrolyte problems resulting in
circulatory overload can include peripheral edema, sudden weight gain, crackles,
dyspnea, increased blood pressure, and bounding pulse.
Correct: Symptoms of refeeding syndrome include shallow respirations, weakness,
acute confusion, seizures, and increased bleeding tendency.
A group of nursing students are studying together. They are discussing the differences
between parenteral and enteral nutrition. Which statement, if made by one of the
students, indicates further instruction is needed?
A) "Parenteral nutrition is the administration of nutrients directly into the GI tract by way
of a feeding tube."
B) "Enteral nutrition is preferred because it is less expensive than parenteral nutrition
and maintains functioning of the gut."
, C) "An example of the parenteral route is subcutaneous or IM injections, or the IV
route."
D) "Gastric feedings may be given to patients with a low risk of aspiration. If there is a
risk of aspiration, jejunal feeding is the preferred method. - ANS-A) "Parenteral nutrition
is the administration of nutrients directly into the GI tract by way of a feeding tube."
A key part of the nursing process when caring for a client who is receiving
immunosuppressant therapy should be to
1. assess nutritional status.
2. monitor vital signs.
3. assess renal function
.4. monitor liver function studies. - ANS-Correct Answer: 3
Rationale: Renal function is key because these drugs can cause nephrotoxicity because
of physiological changes in the kidneys.
A malnourished client is being discharged on enteral nutrition products. Which
suggestion from the registered dietitian does the nurse implement to make the enteral
feeding experience more normal for the client?
A. Administering the feeding product on a regular schedule
B. Bringing the enteral product and napkin to the client on a tray
C. Emphasizing the need to take iron medications before the feeding
D. Once feeding is completed, putting equipment out of view - ANS-B. Bringing the
enteral product and napkin to the client on a tray
Rationales:
Incorrect: Although the feeding product should be administered according to the
prescribed schedule, this will not necessarily normalize the experience for the client.
Correct: "Serving" the enteral product and napkin on a tray will help normalize the
feeding experience for the client.
Incorrect: Although iron medications may be helpful in preventing constipation,
encouraging their use will not normalize the experience for the client.
Incorrect: Although putting equipment away after use may be helpful in taking the client
out of the dependent "client" role, this will not serve to normalize the feeding experience
itself.
A nurse has educated a client on an epinephrine auto-injector (EpiPen). What statement
by the client indicates additional instruction is needed?
a. "I don't need to go to the hospital after using it."
b. "I must carry two EpiPens with me at all times."
c. "I will write the expiration date on my calendar."
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