Review Ati bsn 0926 med surg exam

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Ati bsn 0926 med surg exam

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Total Questions : 69

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Question 1:

A nurse is caring for a client who has diverticular disease. When palpating the client's abdomen, in which of the following locations should the nurse expect the client to report abdominal pain?

A. Lower right quadrant B. Lower left quadrant C. Upper left quadrant D. Upper right quadrant

Answer and Explanation

Choice A:

Pain in this area is more commonly associated with appendicitis, not diverticular disease.

Choice B:

Lower left quadrant is the typical site of pain in diverticular disease, especially diverticulitis, because the sigmoid colon (most often affected) is located here.

Choice C:

Upper left quadrant; Pain in this area is more often linked to conditions involving the spleen, stomach, or pancreas.

Choice D:

Upper right quadrant; Pain here is usually related to gallbladder, liver, or biliary tract disorders.

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Question 2:

A nurse is planning care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan of care?

A. Encourage eating three large meals daily. B. Provide a high carbohydrate diet. C. Include high protein snacks. D. Administer acetaminophen for pain.

Answer and Explanation

Choice A:

Clients with hepatitis often experience anorexia and nausea. Small, frequent meals are better tolerated than three large meals.

Choice B:

Carbohydrates are the primary source of calories in clients with hepatitis. They help spare protein and allow the liver to rest and heal. This is the recommended dietary intervention.

Choice C:

Protein should be limited in clients with severe hepatitis, especially if liver function is impaired, because excess protein can worsen encephalopathy.

Choice D:

Acetaminophen is hepatotoxic and should be avoided in clients with hepatitis due to the risk of further liver damage.

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Question 3:

A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs?

pH 7.22
PaCO2 68 mm Hg
Base excess-2
PaO2 78 mm Hg
Saturation 80%
Bicarbonate 26 mEq/L

A. Metabolic acidosis B. Respiratory alkalosis C. Respiratory acidosis D. Metabolic alkalosis

Answer and Explanation

Choice A:

Metabolic acidosis would present with a low pH and low HCO₃⁻. Here HCO₃⁻ is near normal (26 mEq/L), so a primary metabolic disorder is unlikely. The elevated PaCO₂ explains the acidemia.

Choice B:

Respiratory alkalosis produces an increased pH and decreased PaCO₂. This ABG shows a low pH and markedly elevated PaCO₂ (68 mm Hg), so it is not respiratory alkalosis.

Choice C:

The low pH (7.22) with a markedly elevated PaCO₂ (68 mm Hg) indicates primary respiratory acidosis due to hypoventilation (consistent with RR 7/min). The bicarbonate (26 mEq/L) is near normal, suggesting an acute respiratory acidosis with little metabolic compensation. The low PaO₂ and low saturation indicate significant hypoxemia as well.

Choice D:

Metabolic alkalosis would show an elevated pH with an elevated HCO₃⁻. This ABG demonstrates acidemia with normal HCO₃⁻ and high PaCO₂, so metabolic alkalosis is not the cause.

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Question 4:

A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect?

A. Straw-colored urine B. Tenderness in the left upper abdomen C. Fatty stools D. Ecchymosis of the extremities

Answer and Explanation

Choice A:

An obstruction of the common bile duct causes dark amber or tea-colored urine due to increased bilirubin excretion.

Choice B:

The gallbladder and common bile duct are located in the right upper quadrant, so pain is typically felt there.

Choice C:

Obstruction of the common bile duct prevents bile from reaching the intestines, impairing fat digestion and absorption, leading to steatorrhea (fatty, foul-smelling stools).

Choice D:

Ecchymosis is not a typical sign of common bile duct obstruction. It may indicate coagulation disorders, but it is unrelated to chronic cholecystitis.

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Question 5:

What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?

A. Projectile vomiting B. Abdominal distention C. Metabolic alkalosis D. Referred back pain

Answer and Explanation

Choice A:

Vomiting is more common in small bowel obstruction and is usually less severe in large bowel obstruction.

Choice B:

A large bowel obstruction causes accumulation of gas and fecal material proximal to the blockage, leading to significant abdominal distention.

Choice C:

Large bowel obstruction may eventually cause metabolic acidosis due to impaired perfusion and tissue hypoxia, not alkalosis.

Choice D:

Back pain is not a typical sign of large bowel obstruction; the primary symptom is abdominal discomfort, distention, and constipation.

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Question 6:

Which type of enema is typically used to relieve constipation by instilling and retaining fluid for a short period before expelling?

A. Lactulose Enema B. Fleet Enema C. Tap water enema D. Mineral Enema

Answer and Explanation

Choice A:

Lactulose is usually administered orally to soften stools, not as a short-retention enema.

Choice B:

A Fleet enema is a hypertonic solution that draws fluid into the colon, is retained briefly, and promotes rapid evacuation of stool to relieve constipation.

Choice C:

Tap water enemas are hypotonic and typically require immediate expulsion, not short retention.

Choice D:

Mineral oil enemas are retention enemas, meant to soften stool over a longer period, not for rapid evacuation.

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Question 7:

Which of the following are contraindications for administering a tap water enerna? (Select all that apply)

A. Electrolyte imbalance risk B. Acute appendicitis C. Severe dehydration D. Regular use of laxatives E. History of bowel surgery F. Normal bowel function G. Increased fluid intake

Answer and Explanation

Choice A:

Tap water enemas are hypotonic, and repeated or large-volume use can lead to hyponatremia or other electrolyte disturbances, particularly in infants, elderly clients, or those with renal or cardiac issues.

Choice B:

Administering a tap water enema in a client with suspected appendicitis can increase intra-abdominal pressure, potentially causing perforation or worsening the condition.

Choice C:

Tap water enemas can further disrupt fluid and electrolyte balance in clients who are already dehydrated, exacerbating their condition.

Choice D:

Regular use of laxatives is not a strict contraindication for a tap water enema but may reduce its effectiveness over time due to bowel adaptation.

Choice E:

Clients with recent bowel surgery or structural abnormalities are at higher risk for perforation or injury when receiving an enema.

Choice F:

Tap water enemas are not indicated for clients with normal bowel function because they are unnecessary and can cause discomfort or dependence.

Choice G:

While maintaining hydration is important, it does not contraindicate the use of a tap water enema; it may actually support bowel function.

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Question 8:

A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching?

A. Hepatotoxic medications B. Excessive alcohol consumption C. Obstruction of the bile duct D. Hepatitis C

Answer and Explanation

Choice A:

Hepatotoxic medications can cause toxic or drug-induced liver injury, but they are not the primary cause of biliary cirrhosis.

Choice B:

Excessive alcohol consumption is a major cause of alcoholic cirrhosis, not biliary cirrhosis.

Choice C:

Obstruction of the bile duct—whether from gallstones, strictures, or autoimmune disorders—leads to cholestasis. Over time, the retained bile damages liver cells, causing inflammation, fibrosis, and ultimately biliary cirrhosis.

Choice D:

Hepatitis C primarily causes viral hepatitis-related cirrhosis, not biliary cirrhosis.

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Question 9:

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?

A. Dietary sources of fiber should be eliminated to prevent excessive gas formation. B. Use of this type of laxative to prevent constipation does not cause adverse effects. C. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins. D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

Answer and Explanation

Choice A:

Dietary sources of fiber should not be eliminated; in fact, fiber from food complements the effect of psyllium and supports normal bowel function.

Choice B:

Fiber-containing laxatives can have adverse effects, such as bloating, gas, or, rarely, intestinal obstruction if not taken with adequate fluid.

Choice C:

Psyllium does not significantly reduce absorption of fat-soluble vitamins; this concern is more relevant to certain other medications, like cholestyramine.

Choice D:

Psyllium absorbs water in the intestines, forming a bulky stool. To prevent fecal impaction or bowel obstruction, it is essential to take large amounts of fluid when using this type of laxative.

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Question 10:

A nurse is assessing a client who has peptic ulcer disease. Which of the following findings should the nurse identify as the priority?

A. Hematemesis B. Dyspepsia C. Epigastric discomfort D. Constipation

Answer and Explanation

Choice A:

Hematemesis (vomiting blood) indicates active gastrointestinal bleeding, which can lead to hypovolemic shock and is a life-threatening complication of peptic ulcer disease. It is therefore the priority assessment finding.

Choice B:

Dyspepsia (indigestion) is a common symptom of peptic ulcer disease but is not immediately life-threatening.

Choice C:

Epigastric discomfort is a typical symptom but is less urgent compared to active bleeding.

Choice D:

Constipation is a non-specific gastrointestinal symptom and does not pose an immediate threat in peptic ulcer disease.

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Ati bsn 0926 med surg exam

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