Exam 1: NUR2392/ NUR 2392 (New 2023/ 2024) Multidimensional Care II/ MDC 2 Exam| Questions and Verified Answers| 100% Correct| Grade A- Rasmussen
Exam 1: NUR2392/ NUR 2392 (New 2023/
2024) Multidimensional Care II/ MDC 2
Exam| Questions and Verified Answers|
100% Correct| Grade A- Rasmussen
QUESTION
The nurse is monitoring a patient with gastric cancer for signs and symp- toms of upper
gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding?
Answer:
Blood pressure from 140/90 to 110/70 mm Hg
QUESTION
A patient has a positive HX of colon cancer. which of the following is
a recommendation you would want them to adhere to?
Answer:
Encourage baseline colonoscopy screening
QUESTION
the patient asks the nurse how radiation works to destroy cancer cells. how would you respond?
Answer:
The goal of radiation therapy is to destroy the cancer cells, while minimizing further damage to
the boy.
QUESTION
A patient asks the nurse to explain what radiation expousre refers to, which response is correct?
Answer:
it refers to the amoun of radiation being delivered
QUESTION
a patient asks the nurse to explain the difference between a benign tumor and a malignant tumor.
what is an appropriate response?
Answer:
a benign tumor is a normal cells growing in the wrong place at the wrong time, but they are not
cancerous
QUESTION
a patient is undergoing chemotherapy and is receiving education about the reduction of infection
risk, which action reduces the risk of infection
Answer:
Hand hygeine
QUESTION
A patient would like to know what it means that her breast cancer has metastasized?
Answer:
Cancer cells have moved from their primary site
QUESTION
the patient who has undergone which procedure is at most risk for hypocal- cemia
Answer:
thyroidectomy
QUESTION
what serum laboratory value does the nurse expect to see with a patient who is hypokalemic
Answer:
potassium less than 3.5
QUESTION
the nurse uses which phrase to describe palliative care?
Answer:
patient care with focus on treatment of symptoms
QUESTION
a nurse is caring for a 72-year-old female, she has a diagnosis of dehydra- tion. Which of the
following nursing diagnoses should NOT be included in their plan?
Answer:
Fluid volume overload
QUESTION
A nurse is caring for a patient that recently diagnosed with cancer and is undergoing
chemotherapy. A review of the morning labs show they have hyperphosphatemia, hyperkalemia,
hyperuricemia. based on the laboratory findings, what condition are you expected to find?
Answer:
Tumor lysis syndrome
QUESTION
a nurse is caring for a patient recently diagnosed with cancer and they are exhibiting signs and
symptoms of superior vena syndrome. which would be priority for relief of airway obstruction?
Answer:
high dose of radiation
QUESTION
a nurse is caring for a patient that was recently diagnosed with lung cancer. based on testing
there is no indication that cancer has spread to the other organs. the patient is scheduled for
surgery to have a lobectomy performed. this classification of surgery is what type of treatment?
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The nurse is educating a group of older adults about screening for colorectal cancer. Which statement by a group member indicates the need for further clarification about these guidelines?
“I will need to have a routine colonoscopy every 5 years.”
The nurse is assessing an alert client who had abdominal surgery yesterday. What method provides the most accurate data about resumption of peristalsis in the client?
Asking the client whether he or she has passed gas within the previous 12-24 hours.
The nurse is assessing a client who comes to the emergency department with acute abdominal pain. The nurse notes a bulging, pulsating mass when inspecting the abdomen. Which action by the nurse is correct?
Notify the provider about this finding immediately.
A bulging, pulsating mass may indicate an abdominal aortic aneurysm, and the nurse should notify the provider immediately. Palpating the abdomen or even touching the abdomen with a stethoscope may cause this to rupture, which would be a life-threatening emergency. Because this is a potential life-threatening situation, questioning the client about stool habits is not appropriate.
The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect?
intestinal obstruction
A client is admitted to the hospital with severe right upper quadrant abdominal pain. Which assessment technique does the nurse use for this client?
Examines the RUQ of the abdomen last following all other assessment techniques.
Which substance produced in the stomach, facilitated the absorption of vitamin b12?
Intrinsic factor
Which client does the charge nurse assign to an experienced LPN/LVN working in the adult medical unit?
A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis
The outpatient clinic nurse is caring for a recovering client who had a colonoscopy. The clients asks for a drink. How does the nurse respond to this request?
When you are able to pass flatus (gas), you can have a drink
Which factors place a client at risk for gastrointestinal (GI) problems?
Smoking a half pack of cigarettes per day
Socioeconomic status
Some herbal preparations
Use of non-steroidal anti inflammatory drugs (NSAIDS)
The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods?
Cheese
Nuts
Potatoes
As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What collaborative resource does the nurse suggest for this clients care?
Dentist
The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the clients teaching plan?
Rinse the mouth with warm saline or sodium bicarbonate
A client had recently developed acute sialadenitis. Which intervention does the nurse include in the clients care?
Massaging the salivary gland
A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home?
American Cancer Society (ACS)
A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first?
A. Suction the client’s oral secretions to clear the airway.
B. Place the client on humidified oxygen per nasal cannula.
C. Assist the client to an upright position to facilitate breathing.
D. Assess the respiratory effort and quantities and types of oral secretions.
Assess the respiratory effort and quantities and types of oral secretions.
Assessment is the first step of the nursing process; the nurse should assess the client’s respiratory effort and quantities and types of oral secretions first. Suctioning the client, placing the client on humidified oxygen, and assisting the client to an upright position are not the first steps in the nursing process. These interventions may or may not be necessary if the nurse follows the nursing process.
Which practice does the nurse include when teaching a client about proper oral care?
Perform self examination of the moth every week, and report any unusual findings
The nurse is reinforcing the instructions on swallowing provided by the speech language pathologist to a patient diagnosed with esophageal cancer. Which of the following instructions should be included in the teaching?
Place food at the back of the mouth as you eat
The nurse is caring for a patient with esophageal cancer who has received photodynamic therapy using porfirmer sodium (Photofrin). What instructions does the nurse include in teaching the patient about porfirmer sodium?
Cover or shield all exposed body areas from sunlight
Follow a clear liquid diet for 3-5 days after the procedure
Tissue particles may be found in the sputum
The nurse is observing a coworker who is caring for a patient with a nasogastric tube following esophageal surgery. Which actions by the coworker require the nurse to intervene?
Checking the tube placement every 12 hrs
Keeping the bed flat
Providing mouth care every 8 hrs
The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associate with a patients gastroesophageal reflux disease (GERD). Which change does the nurse recommend to this patient?
Avoid working while bent over the computer
The nurse is assessing a patient with GERD. Which findings does the nurse expect to observe?
Dyspepsia
Flatulence
Regurgitation
Which patient assessment information is correlated with a diagnosis of chronic gastritis?
Radiation therapy, smoking, and excessive alcohol use
The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first?
A. Type and crossmatch for 4 units of packed red blood cells.
B. Infuse lactated Ringer’s solution at 200 mL/hr.
C. Give pantoprazole (Protonix) 40 mg IV now and then daily.
D. Insert a nasogastric tube and connect to low intermittent suction.
B. Infuse lactated Ringer’s solution at 200 mL/hr.
A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The patient is not drinking the vanilla flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient?
Ask the patient if a change in flavor would make the supplement more palatable
The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding?
Blood pressure from 140/90 to 110/70
The nurse finds a patient vomiting coffee ground emesis. On assessment the patient has a blood pressure of 100/74, is acutely confused, and has a weak and thready pulse. Which intervention is the nurses first priority?
Administering intravenous (IV) fluids
A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurses highest priority intervention?
Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider.
The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patients ulceration is duodenal in origin and not gastric?
Pain occurs 1.5-3 hrs after a meal usually at night
The nurse working during the day shift on the medical unit has just receive report. Which patient does the nurse plan to see first?
Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy.
An older female patient is diagnosed with gastric cancer. Which statement made by the patients family demonstrates a correct understanding of the disorder?
This may be related to her recurring ulcer disease
The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching?
I can eat ice cream in moderation
The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurses instructions?
I should avoid alcohol and tobacco
The nurse has placed a nasogastric (NG) tube in a client with upper gastrointestinal (GI) bleeding to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse’s best response?
A. “Saline goes down the tube to help clean out your stomach.”
B. “Medication goes down the tube to help clean out your stomach.”
C. “The provider requested the tube to be placed just in case it was needed.”
D. “We’ll start feeding you through it once your stomach is cleaned out.”
A. “Saline goes down the tube to help clean out your stomach.”
The nurse is teaching a patient with peptic ulcer disease about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge?
Nizatidine (Axid) needs to be taken three times a day to be effective.
Which nursing action is best for the charge nurse to delegate to an experience LPN/LVN?
Reinforce the teaching preciously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis.
A patient is experiencing bleeding related to peptic ulcer disease. Which nursing intervention is the highest priority?
Starting a large bore IV
A patient with peptic ulcer disease asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurses best response?
These herbs could be helpful. However you should talk with your primary health care provider before adding them to your treatment regimen.
The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first?
Place a nasogastric (NG) tube and connect to suction
A patient has been discharge home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority?
Schedule of the patients follow up examinations and diagnostic testing
The nurse and the dietitian are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is best for this client?
A. Chicken salad on whole wheat bread
B. Liver and onions
C. Chicken and rice
D. Cobb salad with buttermilk ranch dressing
C. Chicken and rice
A patient has a long history of Crohn’s disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn’s disease was a direct cause of the gastritis. What is the nurses best response?
We know that there can be an association between Crohn’s disease and chronic gastritis, but Crohn’s does not directly cause acute gastritis to develop.
The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease who has a history of using Ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health are provider will request which medication for this patient?
Misoprostol (Cytotec)
What does the nurse advise a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation?
Bulk forming laxatives
A 24 year old male is scheduled for a minimally invasive inguinal hernia repair (MIHR). Which patient statement indicates a need for further teaching about this procedure?
I will need to stay in the hospital overnight
A male patients sister was recently diagnosed with colorectal cancer and his brother died of CRC 5 year ago. The patient asks the nurse whether he will inherit the disease too. What does the nurse respond?
The only way to know whether you are predisposed to CRC is by genetic testing.
A patient is being evaluated in the emergency department for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess?
Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting.
A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue,diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers?
5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea
A 67 year old male patient with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have?
Reducible
A patient with a bowel obstruction is ordered a Salem pump nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this patient?
Connecting the tube to low continuous suction.
A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurses teaching?
I need to go for a walk every morning
The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colonoscopy. Which patient statement demonstrates the additional instruction from the nurse is needed?
I can drive my car in about two weeks
The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities?
Acupuncture
Meditation
Peppermint oil capsules
Yoga
Which patient does the charge nurse assign to an experienced LPN/LVN?
A 30 year old who must receive neomycin sulfate (Mycifradin) before a colectomy
The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider?
Anorexia
Headache
Vomiting
A male patient with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond?
A change in position may be what is needed for you to have intercourse with your wife
The RN receives a change-of-shift report about four clients. Which client does the nurse assess first?
A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F
A patient diagnosed with ulcerative colitis is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication?
Be aware of signs/symptoms of toxic megacolon that we discussed
An obese patient is discharge 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment funding by the patients home health nurse requires immediate action?
States I feel like the incision is splitting open
A patient who had surgery for inflammatory bowel disease is being discharge. The case manager will arrange for home health care follow up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members?
Written and oral instructions regarding signs/symptoms to report to the primary health care provider.
A nurse is teaching a patient with Crohn’s disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient?
Avoid large crowds and anyone who is sick
A patient with an exacerbation or ulcerative colitis has been prescribed vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply?
It is absorbed quickly and allows the affected part of the GI tract to rest and heal
A patient has been newly diagnosed with ulcerative colitis. What does the nurse teach the patient about diet and lifestyle?
Lactose containing foods should be reduced or eliminated from your diet
A patient with ulcerative colitis has stage 1 of a restorative proctocolectomy with ileoanal anastomosis procedure preformed. The patient asks the nurse how long do people with this procedure usually have a temporary ileostomy? How does the nurse reply?
It is usually ready to be closed in about 1-2 months
A nurse is teaching a patient about dietary methods to help manage exacerbations of diverticulitis. What does the nurse advise the patient?
Consume a low fiber diet while your diverticulitis is active. When inflammation resolves, consume a high fiber diet.
A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime?
Consume extra fluids to replace fluid losses
A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patients symptoms?
Ingestion of parasites in the water
A patient newly diagnosed with ulcerative colitis is started in sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed?
Your intestinal inflammation will be reduced
A patient with recent surgically created ileostomy refuses to look at the atoms and asks the nurse to perform all required stoma care. What does the nurse do next?
Has another patient with a stoma who performs self care talk with the patient
A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient?
Using hydrocortisone cream to relive pain
A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient?
Using sitz bath three times daily
A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department by her family. She states she has been taking her diuretics for congestive heart failure. What nursing actions are indicated at this time?
Place the client of bed rest
Evaluate the electrolyte levels
Assess for orthostatic hypotension
Indicate cardiac monitoring
The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care?
Assess daily weights
Encourage consumption of citrus fruits
Monitor serum potassium
The nurse is discussing safety when administrating bumetanide with a nursing student. The nurse recognizes that the student understands side effects of this medication when the student makes which statement?
Inverted T waves and a U wave may appear on the ECG
The nurse is assessing a client with a sodium level of 118. Which activity takes priority?
Instructing the client not to ambulate without assistance
The nurse is caring for a client who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical?
Assessing the blood pressure hourly
A client with hypermagnesemia is seen in the emergency departmen. Which of these interventions is most appropriate?
Place the client on a cardiac monitor
The step down unit receives a new admission who has uncontrolled diabetes, polyuria, and a blood pressure of 86/46. Which staff member is assigned to care for her?
RN who has floated from the intensive care unit
The nurse is caring for an older adult with hypernatremia. Which of these interventions does the nurse perform first?
Encourage fluid intake
The rapid response team is called to the bedside of a client with a heart rate of 38 beats per minute and a potassium level of 7.0. For which medication will the nurse anticipate a prescription?
Insulin
A client is admitted to the hospital with dehydration secondary to influenza and vomiting m. The provider orders an intravenous (IV) potassium replacement for potassium level of 2.7. Which of these best practice techniques does the nurse include when administering this medication?
Ensuring the concentration is no greater than 1?9?ml of solution.
Use an IV pump to deliver the medication
The nurse is caring for a client with acute respiratory failure and a PaCO2 level of 88. For which Of these signs and symptoms will the nurse assess?
Headache
Shallow breathing
Fatigue
The nurse is caring for a client with long standing emphysema and respiratory acidosis. For which of these compensatory mechanisms will the nurse assess?
Decreased loss of bicarbonate though the kidney
Which of these findings cause the critical care nurse to notify the primary care provider for evaluation for intubation?
Increasing somnolence
The nursing assistant reports that the client with metabolic acidosis due to kidney failure is breathing rapidly and deeply. The nurse explains this to the nursing assistant in which of these manners?
Rapid breathing is a way to compensate for acidosis caused by his condition
He nurse is caring for a client who has developed postoperative respiratory acidosis. Which of these interventions will the nurse use to help correct this problem?
Encourage use of incentive spirometer
The nurse and nursing student are caring for a client with a new diagnosis of diabetes whose blood glucose is 974. Which of these statements indicates the student understands the relationship between blood glucose and acid base balance?
The hyperglycemia is caused by inability of glucose to enter the cell causing a starvation state and break down of fats.
When caring for a client who has the following blood has results, which of these interventions does the nurse plan to use to correct the acid base disturbance? pH 7.47, pCO2 37, HCO3 30, pO2 88.
Administering an antiemetic
When caring for a client with a burn injury and Eschar banding the chest, the nurse plans to observe the client for which of these acid base disturbances?
Respiratory acidosis
The nurse is caring for a client with sepsis and impending septic shock. Which of these interventions will help prevent lactic acidosis?
Ensure adequate oxygenation
The nurse is caring for a group of clients. Which client will the nurse carefully observe for signs and symptoms of hyperkalemia?
The client who has metabolic acidosis
The nurse is documenting peripheral venous catheter insertion for a client. What does the nurse include in the route?
Clients response to the insertion
Date and time inserted
Type and size of device
Type of dressing applied
Vein used for insertion
When flushing a client’s central line with normal saline, a nurse feels resistance. Which action does the nurse take first?
A. Decreases the pressure being used to flush the line
B. Obtains a 10-mL syringe and reattempts flushing the line
C. Stops flushing and tries to aspirate blood from the line
D. Uses “push-pull” pressure applied to the syringe while flushing the line
Stops flushing and tries to aspirate blood from the line
The nurse is administering a drug to a client through an implanted port. Before giving the medication, what does the nurse do to ensure safety?
Check for blood return
A client who takes corticosteroids daily for rheumatoid arthritis requires insertion of an IV catheter to receive IV antibiotics for 5 days. Which type of IV catheter does the nurse teach the new graduate nurse to use for this client?
Midline catheter
The nurse is teaching a hospitalized client who is being discharged about how to care for a peripherally inserted central catheter (PICC) line. Which client statement indicates a need for further education?
“I can continue my 20-mile running schedule as I have for the past 10 years.”
Which client does the charge nurse in a medical surgical units assign to the LPN/LVN?
Older client admitted for confusion who has a heparin lock that needs to be flushed every 8 hrs.
A client is being admitted to the burn unit from another hospital. The client has an intraosseous IV that was started 2 days ago, according to the clients medical record. What does the admitting nurse do first?
Anticipate an order to discontinue the intraosseous IV and start an epidural IV
A 22 yr old client is seen in the emergency department which acute right lower quadrant abdominal pain, nausea, and rebound tenderness. It appears that surgery is imminent. What gauge catheter does the ED nurse choose when starting the clients intravenous sodium?
18 gauge
The nurse is starting a peripheral IV catheter on a recently admitted client. What actions does the nurse perform before insertion of the line?
Apply providone-iodine to clean skin, dry for 2 minutes
Clean the skin around the site
Prepare the skin with 70% alcohol or chlorhexidine
The nurse is admitting clients to the same day surgery unit. Which insertion site for routine peripheral venous catheters does the nurse choose most often?
Cephalic vein of the forearm
A client is admitted to the intensive cate unit is expected to remain for 3 weeks. The nurse has orders to start an IV. Which vascular access device is best for this client?
Midline catheter
A client who used to work as a nurse asks, “Why is the hospital using a ‘fancy new IV’ without a needle? That seems expensive.” How does the nurse respond?
A. “OSHA, the government, requires us to use this new type of IV.”
B. “These systems are designed to save time, not money.”
C. “They minimize health care workers’ exposures to contaminated needles.”
D. “They minimize your exposure to contaminated needles.”
“They minimize health care workers’ exposures to contaminated needles.”
A client is admitted to the cardiothoracic surgical intensive cate unit after cardiac bypass surgery. The client is still sedated on a ventilator and has an arterial catheter in the right wrist. What assessment does the nurse make to determine patency of the clients arterial line?
Capillary refill and pulse
A 70 yr old client with severe dehydration is ordered an infusion of an isotonic solution at 250ml /hr through a midline IV catheter. After 2 hrs the nurse notes that the client has crackles throughout all lung fields. Which action does the nurse take first?
Slow the rate of the IV infusion.