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NURS 1385 Final Exam Test Bank 2019/2020 – Niagara University | NURS1385 Final Exam Test Bank – updated 2019/2020

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NURS 1385 Final Exam Test Bank – Niagara University 370+ pages of questions and answers with explanations Chapter 10: Pain Test Bank MULTIPLE CHOICE 1. A 45-year-old woman has breast ... cancer that has spread to her liver and spine. She has been taking oxycodone (Percodan) and amitriptyline (Elavil) for pain control at home but now has constant severe pain and is hospitalized for pain control and development of a pain-management program. During assessment of the client, what information related to her pain is most important for the nurse to obtain initially? a. The pattern, area, intensity, and nature of her pain b. Identification of trigger points of pain by palpation of painful areas c. The schedule and total dosages of the drugs she is currently taking and when breakthrough pain occurs d. The presence of a sympathetic response, such as tachycardia, diaphoresis, and a rise in blood pressure ANS: A Pain is a complex experience involving physiological, sensory (i.e., the perception of pain by the individual that addresses the pain location, intensity, pattern, and quality), affective, behavioural, and cognitive dimensions; therefore, the nurse needs to assess the pattern, area, nature, and intensity of the pain immediately. DIF: Cognitive Level: Application REF: p. 151 2. The physician plans to titrate narcotic analgesic to provide pain relief for a client with surgical pain. What does the nurse’s role in analgesic titration include? a. Monitoring the effects of continuous intravenous (IV) infusion of narcotic analgesics b. Teaching the client to try to increase the time between doses of pain medication c. Assisting the client to plan the use of a specific total dose of analgesic over a 24-hour period d. Determining with the client the optimal analgesic dosage required for pain relief with attention to the side effects produced ANS: D The goal of titration is to use the smallest dosage of analgesic that provides effective pain control with the fewest side effects. DIF: Cognitive Level: Application REF: p. 161 3. It is determined that a step 3 drug as proposed by the World Health Organization (WHO) is necessary for a client whose cancer pain is unrelieved by step 2 drugs. Which is an appropriate drug and route for this client? a. Oral codeine b. Oral morphine c. Intramuscular meperidine (Demerol) d. Intravenous oxymorphone (Numorphan) ANS: B A step 2 drug that would be appropriate is morphine. Standard comparison for opioid analgesics and sustained-release preparation (e.g., MS Contin). DIF: Cognitive Level: Application REF: pp. 161, 164 4. A client using gabapentin (Neurontin) and ibuprofen (Motrin, Advil) for chronic neuropathic pain of diabetic neuropathy has moderate, persistent pain. The physician plans to implement step 2 of the WHO analgesic ladder. What should the nurse anticipate that the client’s drug protocol will include? a. Continuing the gabapentin b. Discontinuing the ibuprofen c. Adding aspirin to the protocol d. Adding oral methadone to the protocol ANS: A Gabapentin is an adjuvant drug and would be continued when implementing step 2 of the WHO analgesic ladder. DIF: Cognitive Level: Application REF: p. 165 5. The physician tells a client to use ibuprofen (Motrin, Advil) to relieve the pain after treating a laceration on the client’s forearm from a dog bite. The client tells the nurse that he does not think ibuprofen will control his pain. The nurse’s response is based on the knowledge that ibuprofen interferes with the pain by decreasing what process? a. Perception b. Modulation c. Transduction d. Transmission ANS: C Therapies directed at altering either the primary afferent nociceptor (PAN) environment or the sensitivity of the PAN are used to prevent the transduction and initiation of an action potential. An example is ibuprofen. DIF: Cognitive Level: Application REF: p. 153 6. A postoperative client who has undergone extensive bowel surgery moves as little as possible and does not use his incentive spirometer unless specifically reminded. He rates his pain severity as an 8 on a 10-point scale but tells the nurse that he can “tough it out.” To encourage the client to use pain medication, what should the nurse explain about the effects of withholding or delaying analgesics? a. Very few clients become addicted to opioids when using them for pain control. b. He should not worry about side effects because these problems usually decrease over time. c. Multiple options of medications are available, and if one drug does not relieve his pain, other drugs may be tried. d. Unrelieved pain can be harmful because it impairs respiratory and gastrointestinal function and can impair his recovery from surgery. ANS: D In the acutely ill client, unrelieved pain can result in increased morbidity as a result of respiratory dysfunction, increased heart rate and cardiac workload, increased muscular contraction and spasm, decreased gastrointestinal motility and transit, and increased catabolism. DIF: Cognitive Level: Application REF: pp. 150–151 7. A client with a kidney stone in her right ureter has pain in her right flank area and also complains of pain in her right inner thigh. She asks the nurse whether something is wrong with her leg. In responding to the question, on what knowledge does the nurse base the client’s understanding of pain? a. Referred pain results when dorsal horn neurons receive input from both C fibres and A-beta fibres. b. Stimulation of the cerebral cortex by small C fibres causes muscle spasm, leading to pain perception in large muscle groups. c. Radiating type of pain results from activation of normally inactive receptors by repetitive nociceptive signals to the dorsal horn. d. Poor localization of pain occurs when primary afferent nociceptors release neurotransmitters that inhibit nerve cells in the dorsal column. ANS: A Inputs from both C fibres and A-beta fibres converge on the wide dynamic range (WDR) neurons, and when the message is transmitted to the brain, the originating area of the body is poorly localized. The concept of referred pain must be considered when interpreting the location of pain reported by the person with injury to or disease involving visceral organs. DIF: Cognitive Level: Application REF: p. 154 8. Following an automobile accident, a client is brought to the emergency department with multiple fractures and lacerations. The client is dazed but oriented and denies severe pain. What is the client’s decreased pain perception most likely related to? a. The inability of the brain to recognize nociceptive input as pain as a result of head trauma b. The release of endogenous opioids in response to the physical and emotional stress of the accident c. The presence of spinal cord trauma, which prevents the transmission of pain impulses to higher nervous centres d. Damage of A-delta and C fibres at the injury sites, which results in a lack of stimulus for the physiological pain process ANS: B This is modulation, which includes neurons originating in the brainstem descend to the spinal cord and release substances (e.g., endogenous opioids) that inhibit nociceptive impulses. Endogenous opioids also play an important role by binding to opioid receptors and blocking the release of neurotransmitters, particularly substance P. DIF: Cognitive Level: Application REF: pp. 152–153 9. Imipramine (Tofranil), a tricyclic antidepressant, is being administered to a client with chronic cancer pain. What does the nurse recognize as the expected outcome of administration of this drug? a. Increased pain threshold by stimulating the release of endogenous enkephalins b. Decreased perception of pain by blocking opiate receptors in the brain and descending inhibitory nerves c. Decreased transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses d. Increased pain tolerance through relief of depression by increasing the amounts of norepinephrine in the brain ANS: C Tricyclic antidepressants have analgesic properties at doses lower than those effective for depression. They enhance the descending inhibitory system by preventing synaptic reuptake of serotonin and norepinephrine, thereby decreasing the transmission of pain impulses. DIF: Cognitive Level: Comprehension REF: p. 165 10. A client with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. What does the nurse recognize about how these cognitive strategies work? a. They reduce the sensory and affective components of pain. b. They prevent transmission of nociceptive stimuli to the cortex. c. They decrease the intensity of the pain that the client is willing to tolerate. d. They decrease sensitization by increasing the production of glutamate in the spinal cord. ANS: A Imagery is a structured technique that uses the client’s own imagination to develop sensory images that divert focus away from the pain sensation and emphasize other sensory experiences and pleasant memories. Hypnotic therapy is a structured technique that enables a client to achieve a state of heightened awareness and focused concentration that can be used to alter the client’s pain perception DIF: Cognitive Level: Application REF: p. 170 11. When administering mixed opioid agonist–antagonists, such as pentazocine (Talwin), what does the nurse recognize is an advantage of these drugs in comparison with opioid agonists? a. They cause less agitation b. They do not cause tolerance c. They do not have an analgesic ceiling d. They cause less respiratory depression ANS: D If respiratory depression is a concern, a mixed agonist–antagonist can be used, but the client must be carefully assessed for reversal of analgesia and withdrawal. DIF: Cognitive Level: Comprehension REF: p. 165 12. An 86-year-old man has severe degenerative arthritis in his hips. In planning care for the client, what does the nurse recognize about chronic pain in an older adult? a. It is more readily tolerated than in younger clients b. It does not require the use of narcotic drugs for control c. It is poorly tolerated because of past experiences with pain d. It is often believed by the client to be an inevitable part of aging ANS: D Older clients often believe that pain is a normal, inevitable part of aging. They may also believe that nothing can be done to relieve the pain. DIF: Cognitive Level: Comprehension REF: p. 174 13. In developing a concept of pain to use in working with clients experiencing pain, what does the nurse acknowledge about pain? a. Pain always causes suffering. b. All pain serves a physiological purpose. c. Pain is a multidimensional phenomenon. d. Pain is present whenever nociception occurs. ANS: C Pain is a complex, multidimensional, and subjective experience, and its management is influenced greatly by psychosocial, sociocultural, and legal and ethical factors. DIF: Cognitive Level: Comprehension REF: p. 172 14. To obtain the most complete assessment data about a client’s chronic pain pattern, what should the nurse ask the client? a. “Can you describe where your pain is the worst?” b. “What is the intensity of your pain on a scale of 0 to 10?” c. “Would you describe your pain as aching, throbbing, or sharp?” d. “Can you describe your daily activities in relation to your pain?” ANS: D At a bare minimum, the effects of the pain on the client’s sleep and daily activities, relationships with others, physical activity, and emotional well-being should be assessed. DIF: Cognitive Level: Application REF: p. 158 15. Morphine 10 mg IV every 4 to 6 hours PRN is ordered for a client with a pancreatic tumour who has a history of alcoholism. After 3 days of receiving the morphine every 6 hours, the client tells the nurse that the medication is needed more frequently to control the pain. In responding to the client’s request, what does the nurse recognize? a. A tolerance to the morphine is developing, and the client should receive the drug more frequently. b. Administering the morphine more frequently will increase the client’s physical dependence on the drug. c. Physical dependence should be avoided at all costs, and the drug should continue to be administered every 6 hours. d. The client is becoming addicted to the morphine, and it should be administered less frequently than every 6 hours. ANS: A People with past or current substance abuse are at high risk for inadequate pain management. Health care professionals must understand that adequate pain relief is a basic human right, be aware of their own biases, and ensure that all clients are treated respectfully. DIF: Cognitive Level: Application REF: p. 160 16. A client with extensive second-degree burns on his legs and trunk is using patient-controlled analgesia (PCA) with IV morphine to be delivered at 1 mg every 10 minutes to control his pain. Several times during the night, he awakens in severe pain, and it takes more than an hour to regain pain relief. What is the most appropriate nursing action at this time? a. Administer a dose of morphine every hour from the PCA machine while the client sleeps. b. Request that the physician order a bolus dose of morphine to be given when the client awakens with pain. c. Consult with the client’s physician about adding a continuous morphine infusion to the PCA regimen at night. d. Teach the client to push the button every 10 minutes for an hour before he goes to sleep, even if he has minimal pain at that time. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - A client who has recently been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the client about which of the following? a. Endoscopy procedures b. Barium swallow c. Radionuclide tests d. Proton pump inhibitors ANS: D Because diagnostic testing for heartburn that is probably caused by GERD is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. DIF: Cognitive Level: Comprehension REF: p. 1091 16. A 62-year-old client has been diagnosed with esophageal cancer. He tells the nurse that he understands his prognosis is very poor, but he is not ready to die yet. What is the best response to the client’s comment? a. “What are your plans for the next few years?” b. “This must be a very difficult time for you to cope with.” c. “You should keep a positive outlook because it will make you feel better.” d. “Everyone I have seen with esophageal cancer has only had a little time left.” ANS: B This response is open-ended and will encourage the client to further discuss feelings of anxiety or sadness about the diagnosis. DIF: Cognitive Level: Application REF: p. 1069 17. Which information will the nurse include when teaching a client with newly diagnosed GERD? a. “Peppermint tea may be helpful in reducing your symptoms.” b. “You will need to keep the head of your bed elevated on blocks.” c. “You should avoid eating between meals to reduce acid secretion.” d. “Vigorous physical activities may increase the incidence of reflux.” ANS: B Elevating the head of the bed will reduce the incidence of reflux while the client is sleeping. DIF: Cognitive Level: Comprehension REF: p. 1073 18. A client undergoes an esophagectomy with a synthetic graft replacement for treatment of esophageal cancer. Following his return to the surgical unit, why should the nurse place the client in a semi-Fowler’s position? a. To facilitate respiratory function b. To prevent reflux of gastric secretions c. To promote drainage from the NG tube d. To promote movement of fluids through the gastrointestinal (GI) tract ANS: B Postoperatively, the client is to be in a semi-Fowler`s position to prevent reflux of gastric secretions. DIF: Cognitive Level: Application REF: p. 1077 19. Which of the following will the nurse plan to teach the client with newly diagnosed achalasia? a. Drinking fluids with meals should be avoided. b. Lying down and resting after meals is recommended. c. A liquid or blenderized diet will be necessary. d. Endoscopic procedures may be used for treatment. ANS: D Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. DIF: Cognitive Level: Comprehension REF: p. 1078 20. A 62-year-old client develops an acute gastritis caused by the nonsteroidal anti-inflammatory drug (NSAID) she uses to treat her arthritis. In teaching the client about the effects of these drugs on the stomach’s mucosal barrier, what should the nurse explain? a. NSAIDs stimulate histamine receptors, which increase the release of hydrochloric acid. b. NSAIDs inhibit the synthesis of prostaglandins that normally decrease acid secretion in the stomach. c. NSAIDs stimulate the parietal cells of the stomach to release pepsin, which is capable of digesting stomach tissue. d. The inflammatory response stimulated by prostaglandin release in the stomach is increased with the use of NSAIDs. ANS: B NSAIDs are known to inhibit the synthesis of prostaglandins that are protective to the gastric mucosa. DIF: Cognitive Level: Application REF: p. 1079 21. Cobalamin injections have been prescribed for a client with chronic atrophic gastritis. The nurse determines that teaching regarding the injections has been effective when the client makes which following statement? a. “These injections will decrease my risk of stomach cancer.” b. “These injections will increase the hydrochloric acid in my stomach.” c. “The cobalamin injections need to be taken until my inflamed stomach heals.” d. “I must take these injections to prevent me from becoming anemic.” ANS: D Cobalamin supplementation prevents the development of pernicious anemia. DIF: Cognitive Level: Application REF: p. 1080 22. A client with chronic gastritis associated with the presence of Helicobacter pylori is treated with triple-drug therapy. Which of the following drugs should the nurse explain to the client are commonly included in this regimen? a. Tetracycline, bismuth subsalicylate, and amoxicillin b. Tetracycline, metronidazole (Flagyl), and bismuth subsalicylate c. Amoxicillin, clarithromycin (Biaxin), and omeprazole (Prilosec) d. Metronidazole (Flagyl), clarithromycin (Biaxin), and omeprazole (Prilosec) ANS: C The drugs used in triple-drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. DIF: Cognitive Level: Comprehension REF: p. 1080 (Table 43-13) 23. The physician orders insertion of a 20-gauge orogastric tube for a client experiencing massive hematemesis. As the nurse inserts the tube, which action is appropriate when resistance is met? a. Ask the client to hyperextend the neck. b. Stop and notify the physician of the resistance. c. Inject additional lubricant through the tube. d. Withdraw the tube a few centimetres and then reinsert. ANS: B No tube should be advanced against resistance because of the risk for mucosal damage or perforation of the esophagus. DIF: Cognitive Level: Application REF: p. 1100 24. A client is hospitalized with vomiting of “coffee ground” emesis of unknown cause. The client is very anxious about the source of the bleeding and asks the nurse whether it is possible to find the cause. Which of the following diagnostic tests should the nurse explain can most accurately identify the source of the bleeding? a. An endoscopy b. An angiography c. A gastric analysis d. Barium contrast studies ANS: A Endoscopy is the primary tool for visualization and diagnosis of upper GI bleeding. DIF: Cognitive Level: Comprehension REF: p. 1101 25. What information is most important for the nurse to obtain during the initial assessment of a client admitted to the emergency department with vomiting of bright red blood? a. Current medical problems b. Medications the client is taking c. History of prior bleeding episodes d. Vital signs and symptoms of hypovolemia ANS: D The nurse is concerned about blood loss and possible hypovolemic shock in a client with acute GI bleeding. Blood pressure and pulse are the best indicators of these complications. DIF: Cognitive Level: Comprehension REF: p. 1063 26. The physician orders IV vasopressin (Pitressin) to be administered to a client with esophageal bleeding. The nurse monitors for which of the following during administration of this drug? a. Polyuria b. Metabolic alkalosis c. Intention tremors d. Chest pain ANS: D Vasopressin decreases coronary artery perfusion and may cause coronary ischemia. DIF: Cognitive Level: Comprehension REF: p. 1083 27. The physician orders IV ranitidine (Zantac) every 6 hours for a client with an acute exacerbation of his chronic peptic ulcer disease. As the nurse administers the drug, the client asks about it, saying that the only ulcer drug he had been given IV before was cimetidine (Tagamet). In responding to the client, what should the nurse explain? a. Both drugs neutralize stomach acid, but ranitidine has fewer side effects than does cimetidine. b. Ranitidine and cimetidine work the same way to decrease the effect of histamine and decrease acidity. c. Ranitidine blocks histamine receptors to decrease acid production, but cimetidine acts on the nervous system to decrease gastric motility and secretions. d. Cimetidine creates a protective pastelike complex covering the ulcer during healing, whereas ranitidine coats the entire stomach and duodenum. ANS: B Ranitidine is an H2-receptor blocker, which decreases the secretion of gastric acid. DIF: Cognitive Level: Application REF: p. 1091 28. The family member of a client who has suffered massive abdominal trauma in an automobile accident asks the nurse why the client is receiving famotidine (Pepcid). The nurse will explain that the medication will do which of the following? a. Decrease the risk for nausea and vomiting b. Prevent aspiration of gastric contents c. Inhibit the development of stress ulcers d. Lower the chance for H. pylori infection ANS: C Famotidine is administered to prevent the development of physiological stress ulcers, which are associated with a major physiological insult such as massive trauma. DIF: Cognitive Level: Application REF: p. 1091 29. A client with a bleeding duodenal ulcer has an NG tube in place, and the physician orders 30 mL of aluminum hydroxide–magnesium hydroxide (Maalox) to be instilled through the tube every hour. How can the nurse evaluate the effectiveness of this treatment? a. Monitor arterial blood gas values. b. Check each stool for the presence of occult blood. c. Periodically aspirate and test stomach contents for pH. d. Measure the amount of residual stomach contents hourly. ANS: C The purpose of antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. DIF: Cognitive Level: Application REF: p. 1092 30. A client with a peptic ulcer who has an NG tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next? a. Irrigate the NG tube. b. Obtain the vital signs. c. Give the ordered antacid. d. Listen for bowel sounds. ANS: B The client’s symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. DIF: Cognitive Level: Application REF: p. 1095 31. A client undergoes a gastroduodenostomy (Billroth I) for treatment of a perforated ulcer. Postoperative orders include morphine with a patient-controlled analgesia (PCA) device and NPO status with low, intermittent NG suction in addition to IV fluids and antibiotics. Twelve hours after the client returns to the surgical unit, she complains of increasing abdominal pain. The nursing assessment reveals absence of bowel sounds and 200 mL of bright red NG drainage in the last hour. What is the most appropriate nursing action? a. Notify the physician. b. Irrigate the NG tube per orders. c. Assess the client’s use of the PCA. d. Splint the abdomen to relieve pressure on the incision. ANS: A Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion, a return to surgery, or both are needed. DIF: Cognitive Level: Application REF: p. 1100 32. The nurse implements discharge teaching for a client following a gastroduodenostomy for treatment of a peptic ulcer. Which client statement indicates that the teaching has been effective? a. “I will need to choose foods that are low in fat and high in carbohydrate.” b. “I will try to drink liquids along with my meals.” c. “Vitamin injections may be needed to prevent problems with anemia.” d. “The surgery has cured my peptic ulcer disease.” ANS: C Cobalamin deficiency may occur after partial gastrectomy, and the client may need to receive cobalamin injections. DIF: Cognitive Level: Application REF: p. 1100 33. A client recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations, with an urge to defecate about 20 minutes after eating. To avoid recurrence of these symptoms, what should the nurse teach the client to do? a. Increase fluid intake with meals. b. Lie down for about 30 minutes after each meal. c. Drink sugared fluids or eat candy after each meal. d. Eat a high-carbohydrate, low-fat diet in six small feedings a day. ANS: B The client is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. DIF: Cognitive Level: Application REF: p. 1098 34. The following orders are received for a client who has vomited 1500 mL of bright red blood. Which order will the nurse act on first? a. Infuse 1000 mL of lactated Ringer’s solution. b. Administer IV famotidine (Pepcid) 40 mg. c. Insert an NG tube and connect it to suction. d. Type and crossmatch for 4 units of packed red blood cells. ANS: A Because the client has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. DIF: Cognitive Level: Application REF: p. 1063 35. A client who uses an NSAID for management of severe osteoarthritis has recently developed melena. Which of the following changes in the treatment plan would the nurse expect to be made by the physician? a. Administration of ranitidine (Zantac) b. Substitution of corticosteroids for the NSAID c. Substitution of acetaminophen (Tylenol) for the NSAID d. Administration of misoprostol (Cytotec) with the NSAID ANS: D Misoprostol, a prostaglandin analogue, is the only drug approved for preventing gastric ulcers induced by NSAIDs. DIF: Cognitive Level: Application REF: p. 1085 36. The physician prescribes antacids and sucralfate (Carafate) for treatment of a client’s peptic ulcer. To promote the effects of these drugs, what should the nurse teach the client to take? a. Sucralfate and antacids together 30 minutes before each meal b. Antacids every 2 hours while awake and sucralfate at bedtime c. Antacids 1 hour before each meal and sucralfate between meals d. Sucralfate 30 minutes before each meal and antacids 1 and 3 hours after meals and at bedtime ANS: D Sucralfate is most effective when the pH is low and should not be given with or soon after an antacid. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. DIF: Cognitive Level: Comprehension REF: p. 1072 37. In teaching a client with peptic ulcer disease about nutritional management of the disorder, what should the nurse stress that the client should do? a. Avoid raw fruits and vegetables. b. Avoid foods that cause discomfort. c. Eat six small meals a day with bland foods. d. Eliminate milk and milk products from the diet. ANS: B The best information is that each individual should choose foods that are not associated with postprandial discomfort. DIF: Cognitive Level: Comprehension REF: p. 1093 38. A client with acute GI bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which of the following assessment data obtained by the nurse is most important to communicate immediately to the physician? a. The NG suction is returning coffee ground material. b. The client’s lungs have crackles audible to the midline. c. The client’s blood pressure has increased to 142/94 mm Hg. d. The bowel sounds are very hyperactive in all four quadrants. ANS: B The client’s lung sounds indicate that pulmonary edema may be developing as a result of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. DIF: Cognitive Level: Comprehension REF: p. 1085 39. A 68-year-old client has had intermittent epigastric distress, anorexia, and weight loss over a period of 6 months. She is hospitalized, with anemia and ascites, and an endoscopic examination reveals cancer located in the fundus of the stomach. The nurse plans care for the client with the knowledge that these findings indicate which of the following? a. The client has a poor prognosis with any therapy. b. Surgical intervention is not indicated for the client. c. Radiation therapy is the treatment of choice for the client. d. The client has a good prognosis with the use of combination chemotherapy. ANS: A The survival rate for clients with stomach cancer is low, and the presence of ascites indicates metastasis and is a poor prognostic sign. DIF: Cognitive Level: Application REF: p. 1101 40. Which of the following foods are associated with an increased incidence of gastric cancer that the nurse should specifically question the client about when obtaining a nursing history? a. Milk and milk products b. Raw fruits and vegetables c. Smoked, highly salted, or spiced foods d. Beans and other gas-forming foods ANS: C Smoked foods such as bacon, ham, and smoked sausage, highly salted foods, and spiced foods increase the risk for stomach cancer. DIF: Cognitive Level: Comprehension REF: p. 1100 41. Which will the nurse teach to the client with GERD who is being discharged after a Stretta procedure? a. Acetaminophen (Tylenol) tablets can be used for pain. b. Postoperative nausea is an expected symptom. c. Gelatin, clear broth, and tea are appropriate foods for the next 24 hours. d. Intake and output should be measured and reported to the physician. ANS: C The client should remain on clear liquids for the first 24 hours after the Stretta procedure. DIF: Cognitive Level: Comprehension REF: p. 1073 42. A client undergoes a total gastrectomy with an anastomosis of the esophagus to the jejunum for treatment of gastric cancer. The nurse anticipates a long-term indication for which of the following nursing diagnoses? a. Pain related to altered gastric function b. Risk for infection related to total parenteral nutrition c. Risk for impaired skin integrity related to leakage from jejunostomy tube d. Imbalanced nutrition: less than body requirements related to inability to digest and absorb nutrients ANS: D After this procedure, there will be less surface area for nutrient absorption, and vitamins that are normally absorbed in the duodenum will have poor absorption. DIF: Cognitive Level: Application REF: p. 1099 43. The nurse suspects the possibility of Escherichia coli food poisoning when several individuals eating at the same establishment develop the onset of which of the following symptoms? a. Fever and chills b. Nausea and vomiting c. Hemorrhagic diarrhea d. Headache, dizziness, and muscular incoordination ANS: C E. coli O157:H7 causes hemorrhagic colitis with bloody diarrhea. DIF: Cognitive Level: Comprehension REF: p. 1105 (Table 43-27) [Show More]

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