320 EXAM 3 PRACTICE NEWEST ACTUAL

320 EXAM 3 PRACTICE NEWEST ACTUAL /

QUESTIONS WITH ANSWERS. VERIFIED/GRADED A+

Which assessment data indicates to the nurse that client's gastric ulcer perforated?

• Complaints of sudden, sharp, substernal pain
• Rigid, boardlike abdomen with rebound tenderness
• Frequent clay-colored liquid stool
• Complaits of vague abdominal pain in the RUQ - ----

Answers---Rigid, boardlike abdomen with rebound tenderness

The client with a history of PUD is admitted into the ICU with frank gastric bleeding. Which priority intervention should the nurse implement?

• Maintain strict I&Os
• Insert a NG tube and begin saline lavage
• Assist the client with keeping a detailed calorie count
• Provide a quiet environment to promote rest - ----

Answers---Insert a NG tube and begin saline lavage

• Helps directly stop the bleeding

The client diagnosed with diverticulitis is complaining of severe pain in LLQ and has an oral temp of 100.6. Which intervention should the nurse implement first? 1 / 4

• Notify HCP
• Document findings
• Administer an oral antipyretic
• Assess the client's abdomen - ----Answers---Assess the

client's abdomen

• A rigid abdomen may indicate peritonitis so it is important to

assess

The nurse is teaching the client diagnosed with diverticulosis.What instruction should the nurse include in the teaching session?

• Discuss importance of drinking 1000 mL water daily
• Instruct the client to exercise at least 3 times a week
• Teach the client about eating a low-residue diet
• Explain need to have daily bowel movements - ----

Answers---Explain need to have daily bowel movements

• Constipation causes diverticulitis which can be life

threatening diverticulosis.

The client is admitted to the medical unit quit a diagnosis of acute diverticulitis. Which HCP's order should the nurse question?

• Insert NG tube
• Start IV with D5W at 125 mL/hr 2 / 4

• Put client on clear liquid diet
• Place the client on bedrest with bathroom privileges - ----

Answers---Put client on clear liquid diet

• Patient must be NPO so nurse should question clear liquid

diet

The nurse is discussing the therapeutic diet for the client diagnosed with diverticulosis. Which meal indicates the client understands the discharge teaching?

• Fried fish, mashed potatoes, and iced tea
• Ham sandwich, applesauce, and whole milk
• Chicken salad on whole-wheat bread and water
• Lettuce, tomato, cucumber salad and coffee - ----Answers-

--Chicken salad on whole-wheat bread and water

• Chicken salad has veggies and whole wheat bread

The client is 2 hours post colonoscopy. Which assessment data warrants intermediate intervention by the nurse?

• The client has a soft, nontender abdomen
• The client has a loose, watery stool
• The client has hyperactive bowel sounds
• The client's pulse is 104 and BP is 98/60 - ----Answers---

The client's pulse is 104 and BP is 98/60

• / 4

• Can be sign of perforation

The nurse is preparing to administering the initial dose of an aminoglycoside antibiotic to the client diagnosed with acute diverticulitis. Which intervention should the nurse implement?

• Obtain a serum trough level
• Ask about drug allergies
• Monitor the peak level
• Assess vital signs - ----Answers---Ask about drug

allergies

• Antibiotics are associated with numerous allergic reactions

The client diagnosed with cute diverticulitis is complaining of severe abdominal pain. On assessment, the nurse finds a hard, rigid abdomen, T 102 F. Which intervention should the nurse implement?

• Notify the HCP
• Prepare to administer a Fleet's enema
• Administer an antipyretic suppository
• Continue to monitor the client closely - ----Answers---

Notify the HCP

• All signs of peritonitis which is life threatening
• / 4