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NR 511 Midterm Guide Questions and Answers Graded A+
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NR 511 Midterm Guide
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NR 511 Midterm GuideAll of the following medications are used for the control of nausea and vomiting. Which
medication works by affecting the chemoreceptor trigger zone, thereby stimulating
upper gastrointestinal motility and increasing lower esophageal sphincter pressure?
1.Anticholinergics, such as scopolamine (Donnatal).
2.Antidopaminergic agents, such as prochlorperazine (Compazine).
3.Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan).
4.Tetrahydrocannabinols, such as dronabinol (Marinol) - answer Antidopaminergic and
cholinergic agents, such as metoclopramide (Reglan)
rationale: Metoclopramide (Reglan) is used for diabetic gastroparesis and postoperative
nausea and vomiting. It works by affecting the chemoreceptor trigger zone, thereby
stimulating upper gastrointestinal motility and increasing lower esophageal sphincter
pressure
You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do
you rule out?
1.Peritonitis.
2.A liver or spleen abscess.
3.A liver or spleen metastatic tumor.
4.Irritable bowel syndrome. - answerIBS
rationale: IBS does not produce a friction rub
You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know
she misunderstands the teaching when she tells you she can have:
1. Yogurt.
2.Foods containing whey.
3.Prehydrolyzed milk.
4.Oranges. - answerFoods containing whey
rationale: Advise clients who are lactose intolerant to avoid foods containing whey.
Whey is a lactose-rich ingredient found in some foods, so clients who are lactose
intolerant need to read labels on all foods. To control symptoms, dietary lactose should
be reduced or restricted by using lactose-reduced and lactose-free dairy products or by
eating lactose-rich foods in small amounts or in combination with low-lactose or lactose-
free foods.
,Simon, age 72, states that he is worried because he has a bowel movement only every
third day. You respond:
1."You should have two to three stools per day."
2."You should defecate once a day."
3."You should have at least three stools per week."
4."There is no such thing as a 'normal' pattern of defecation." - answerThere is no such
thing as a normal pattern of defecation
rationale: There is no such thing as a "normal" pattern of defecation. Patterns of
defecation vary widely and may in part be affected by dietary habits, fluid intake,
bacteria in the stool, psychological stress, or voluntary postponement of defecation.
Defecating every third day could be the routine pattern for Simon. He should be
questioned if this is routine for him.
Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate
him for:
1.Constipation.
2.Colorectal cancer.
3.Irritable bowel syndrome.
4.Acute appendicitis. - answerColorectal cancer
rationale: A middle-aged or older client with an abrupt change in defecation pattern
must be evaluated for colorectal cancer
Ruby has a colostomy and complains that her stools are too loose. What food(s) do you
suggest to help thicken the stools?
1.Cheese.
2.Leafy green vegetables.
3.Raw fruits and vegetables.
4.Dried beans. - answerCheese
rationale: Cheese, bread, pasta, rice, pretzels, and yogurt all help to thicken stools.
Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission.
You respond:
1."Do not donate blood until one year after diagnosis."
2."Abstain from sex altogether."
3."There is no possibility of transmission through razors or toothbrushes."
4."Abstain from sex during your period." - answerAbstain from sex during your period
rationale: Because the hepatitis C virus is transmitted in blood, including menstrual
blood, clients should abstain from sex during menstruation. You might also test Tina to
see which genotype her hepatitis C is to see if she is a candidate for Harvoni or
Epclusa.
,Your client's 2-month-old daughter is admitted with gastroenteritis and dehydration after
2 days of vomiting and diarrhea. When the father asks you what is causing the child's
diarrhea, how do you respond?
1."She must be lactose intolerant from the formula, and this is altering the fluid
balance."
2."Her body's telling you that it's time to introduce some solids into her system."
3."The virus is causing irritation of the gastrointestinal lining, which causes diarrhea."
4."The infectious agent invaded the stomach lining and is affecting the balance of water
and nutrients." - answer"The infectious agent invaded the stomach lining and is
affecting the balance of water and nutrients."
rationale: In 80% of cases, gastroenteritis is viral in nature. This viral infection causes
diarrhea by stimulating the secretion of electrolytes into the intestine. This is rapidly
followed by water along the osmotic gradient, resulting in watery stools.
Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that
she is slightly improved over last week's symptoms. Which stage of viral hepatitis do
you suspect?
1.Incubation.
2.Prodromal.
3.Icteric.
4.Convalescent. - answerIcteric
rationale: In the icteric stage of viral hepatitis, there is jaundice, dark urine, and light-
colored stools. There are continued prodromal complaints, with gradual improvement.
Rose, a client with gastroesophageal reflux disease (GERD), has many other
concurrent conditions. In teaching Rose about medications to avoid, what do you
recommend she refrain from using?
1.Antibiotics.
2.Nonsteroidal anti-inflammatory drugs (NSAIDs).
3.Oral contraceptives.
4.Antifungals. - answerNSAIDS
rationale: Clients with GERD should avoid taking NSAIDs because they tend to
aggravate the already irritated gastric mucosa.
Lucy, age 49, has pain in both the left and right lower quadrants. What might you
suspect?
1.A gastric ulcer.
2.Gastritis.
3.Pelvic inflammatory disease.
4.Pancreatitis. - answerPID
rationale: The pain associated with pelvic inflammatory disease can be palpated in both
the right and left lower quadrants.
, In a 2-month-old infant with vomiting and diarrhea, the most effective way of
determining a fluid deficit is to check for:
1.Decreased peripheral perfusion.
2.Hyperventilation.
3.Irritability.
4. Hyperthermia. - answerDecreased peripheral perfusion
rationale: In a 2-month-old infant with vomiting and diarrhea, the most effective way of
determining a fluid deficit is to check for decreased peripheral perfusion, dry oral
mucous membranes, and sunken fontanels. The body compensates for loss of fluid by
shifting the interstitial fluid into the intravascular space, thereby maintaining perfusion of
vital organs. If the fluid loss continues, circulating volume is diminished and
vasoconstriction occurs in the peripheral vessels, resulting in decreased perfusion
You suspect that Harry has a peptic ulcer and tell him that it has been found to be
strongly associated with:
1.Anxiety and panic attacks.
2.Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).
3.Infection by Helicobacter pylori.
4.A family history of peptic ulcers. - answerInfection by H. Pylori
rationale: About 90% of cases of peptic ulcers have been found to be caused by
infection with the bacteria H pylori
You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and
plan to treat her empirically. What medications should you order?
1.A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole
(Flagyl).
2.Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec).
3.Amoxicillin (Amoxil) and omeprazole (Prilosec).
4.Clarithromycin (Biaxin) and metronidazole (Flagyl) - answerAmoxicillin (Amoxil) and
omeprazole (Prilosec)
rationale: Both drugs listed are used in the eradication of H pylori, but do not complete
the regimen.
A 7-year-old male presents with his mother to the urgent care clinic complaining of
abdominal pain. He started to complain of pain prior to going to bed; however, it has
gotten progressively worse and is now preventing him from sleeping. He is nauseous
but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is
complaining of right-sided abdominal pain. His vitals are as follows: blood pressure
130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical
exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a
white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis?
1.Appendicitis.
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