A client is admitted to the hospital after vomiting

PEPTIC ULCER DISEASE bright red blood and is diagnosed with a bleeding
A nurse teaches a client experiencing heartburn to duodenal ulcer. The client develops a sudden,
take 1 ½ oz of Maalox when symptoms appear. sharp pain in the midepigastric region along with a
How many milliliters should the client take? rigid, boardlike abdomen. These clinical
________________________ mL. manifestations most likely indicate which of the
following?
45 mL
1. An intestinal obstruction has developed.
The nurse is caring for a client who has just had an 2. Additional ulcers have developed.
upper GI endoscopy. The client's vital signs must be 3. The esophagus has become inflamed.
taken every 30 minutes for 2 hours after the 4. The ulcer has perforated.
procedure. The nurse assigns an unlicensed nursing
personnel (UAP) to take the vital signs. One hour 4.
later, the UAP reports the client, who was The body reacts to perforation of an ulcer by
previously afebrile, has developed a temperature immobilizing the area as much as possible. This
of 101.8 ° F (38.8 ° C). What should the nurse do in results in boardlike abdominal rigidity, usually with
response to this reported assessment data? extreme pain. Perforation is a medical emergency
requiring immediate surgical intervention because
1. Promptly assess the client for potential peritonitis develops quickly after perforation. An
perforation. intestinal obstruction would not cause
2. Tell the assistant to change thermometers and midepigastric pain. The development of additional
retake the temperature. ulcers or esophageal inflammation would not cause
3. Plan to give the client acetaminophen (Tylenol) a rigid, boardlike abdomen.
to lower the temperature.
4. Ask the assistant to bathe the client with tepid
water. When obtaining a nursing history on a client with a
1. suspected gastric ulcer, which signs and symptoms
should the nurse expect to assess? Select all that
A sudden spike in temperature following an apply.
endoscopic procedure may indicate perforation of
the GI tract. The nurse should promptly conduct a 1. Epigastric pain at night.
further assessment of the client, looking for further 2. Relief of epigastric pain after eating.
indicators of perforation, such as a sudden onset of 3. Vomiting.
acute upper abdominal pain; a rigid, boardlike 4. Weight loss.
abdomen; and developing signs of shock. Telling 5. Melena.
the assistant to change thermometers is not an
appropriate action and only further delays the 3, 4, 5.
appropriate action of assessing the client. The
nurse would not administer acetaminophen Vomiting and weight loss are common with gastric
without further assessment of the client or without ulcers. The client may also have blood in the stools
a physician's order; a suspected perforation would (melena) from gastric bleeding. Clients with a
require that the client be placed on nothing-by- gastric ulcer are most likely to complain of a
mouth status. Asking the assistant to bathe the burning epigastric pain that occurs about 1 hour
client before any assessment by the nurse is after eating. Eating frequently aggravates the pain.
inappropriate. Clients with duodenal ulcers are more likely to
complain about pain that occurs during the night
and is frequently relieved by eating.
The nurse is caring for a client who has had a health care provider. The data do not support the
gastroscopy. Which of the following signs and other diagnoses.
symptoms may indicate that the client is
developing a complication related to the A client with peptic ulcer disease is taking
procedure? Select all that apply. ranitidine (Zantac). What is the expected outcome
of this drug?
1. The client has a sore throat.
2. The client has a temperature of 100 ° F (37.8 ° C). 1. Heal the ulcer.
3. The client appears drowsy following the 2. Protect the ulcer surface from acids.
procedure. 3. Reduce acid concentration.
4. The client has epigastric pain. 4. Limit gastric acid secretion.
5. The client experiences hematemesis.
4.
2, 4, 5. Histamine-2 (H2) receptor antagonists, such as
Following a gastroscopy, the nurse should monitor ranitidine, reduce gastric acid secretion.
the client for complications, which include Antisecretory, or proton-pump inhibitors, such as
perforation and the potential for aspiration. An omeprazole (Prilosec), help ulcers heal quickly in 4
elevated temperature, complaints of epigastric to 8 weeks. Cytoprotective drugs, such as
pain, or the vomiting of blood (hematemesis) are sucralfate (Carafate), protect the ulcer surface
all indications of a possible perforation and should against acid, bile, and pepsin. Antacids reduce acid
be reported promptly. A sore throat is a common concentration and help reduce symptoms.
occurrence following a gastroscopy. Clients are
usually sedated to decrease anxiety and the nurse
would anticipate that the client will be drowsy A client with a peptic ulcer reports epigastric pain
following the procedure. that frequently awakens her during the night. The
nurse should instruct the client to do which
A client with peptic ulcer disease tells the nurse activities? Select all that apply.
that he has black stools, which he has not reported
to his physician. Based on this information, which 1. Obtain adequate rest to reduce stimulation.
nursing diagnosis would be appropriate for this 2. Eat small, frequent meals throughout the day.
client? 3. Take all medications on time as ordered.
4. Sit up for one hour when awakened at night.
1. Ineffective coping related to fear of diagnosis of 5. Stay away from crowded areas.
chronic illness.
2. Deficient knowledge related to unfamiliarity with 1, 2, 3, 4.
significant signs and symptoms. The nurse should encourage the client to reduce
3. Constipation related to decreased gastric stimulation that may enhance gastric secretion.
motility. The nurse can also advise the client to utilize health
4. Imbalanced nutrition: Less than body practices that will prevent recurrences of ulcer
requirements related to gastric bleeding. pain, such as avoiding fatigue and elimination of
smoking. Eating small, frequent meals helps to
2. prevent gastric distention if not actively bleeding
and decreases distension and release of gastrin.
Black, tarry stools are an important warning sign of Medications should be administered promptly to
bleeding in peptic ulcer disease. Digested blood in maintain optimum levels. After awakening during
the stool causes it to be black. The odor of the the night, the client should eat a small snack and
stool is very offensive. Clients with peptic ulcer return to bed, keeping the head of the bed
disease should be instructed to report the elevated for an hour after eating. It is not
incidence of black stools promptly to their primary necessary to stay away from crowded areas.
 the diet, but it is not recommended in excessive
A client with peptic ulcer disease reports that he amounts.
has been nauseated most of the day and is now
feeling light-headed and dizzy. Based upon these The nurse finds a client who has been diagnosed
findings, which nursing actions would be most with a peptic ulcer surrounded by papers from his
appropriate for the nurse to take? Select all that briefcase and arguing on the telephone with a
apply. coworker. The nurse's response to observing these
actions should be based on knowledge that:
1. Administering an antacid hourly until nausea
subsides. 1. Involvement with his job will keep the client
2. Monitoring the client's vital signs. from becoming bored.
3. Notifying the physician of the client's symptoms. 2. A relaxed environment will promote ulcer
4. Initiating oxygen therapy. healing.
5. Reassessing the client in an hour. 3. Not keeping up with his job will increase the
client's stress level.
2, 3. 4. Setting limits on the client's behavior is an
The symptoms of nausea and dizziness in a client important nursing responsibility.
with peptic ulcer disease may be indicative of
hemorrhage and should not be ignored. The 2.
appropriate nursing actions at this time are for the A relaxed environment is an essential component
nurse to monitor the client's vital signs and notify of ulcer healing. Nurses can help clients understand
the physician of the client's symptoms. To the importance of relaxation and explore with
administer an antacid hourly or to wait 1 hour to them ways to balance work and family demands to
reassess the client would be inappropriate; prompt promote healing. Being involved with his work may
intervention is essential in a client who is prevent boredom; however, this client is upset and
potentially experiencing a gastrointestinal argumentative. Not keeping up with his job will
hemorrhage. The nurse would notify the physician probably increase the client's stress level, but the
of assessment findings and then initiate oxygen nurse's response is best if it is based on the fact
therapy if ordered by the physician. that a relaxed environment is an essential
component of ulcer healing. Nurses cannot set
The nurse is preparing to teach a client with a limits on a client's behavior; clients must make the
peptic ulcer about the diet that should be followed decision to make lifestyle changes.
after discharge. The nurse should explain that the
diet will most likely consist of which of the A client with a peptic ulcer has been instructed to
following? avoid intense physical activity and stress. Which
strategy should the client incorporate into the
1. Bland foods. home care plan?
2. High-protein foods.
3. Any foods that are tolerated. 1. Conduct physical activity in the morning so that
4. Large amounts of milk. he can rest in the afternoon.
2. Have the family agree to perform the necessary
3. yard work at home.
Diet therapy for ulcer disease is a controversial 3. Give up jogging and substitute a less demanding
issue. There is no scientific evidence that diet hobby.
therapy promotes healing. Most clients are 4. Incorporate periods of physical and mental rest
instructed to follow a diet that they can tolerate. in his daily schedule.
There is no need for the client to ingest only a
bland or high-protein diet. Milk may be included in 4.
It would be most effective for the client to develop
a health maintenance plan that incorporates 3.
regular periods of physical and mental rest in the It is most likely that the client is experiencing an
daily schedule. Strategies should be identified to adverse effect of the antacid. Antacids with
deal with the types of physical and mental aluminum salt products, such as aluminum
stressors that the client needs to cope with in the hydroxide, form insoluble salts in the body. These
home and work environments. Scheduling physical precipitate and accumulate in the intestines,
activity to occur only in the morning would not be causing constipation. Increasing dietary fiber intake
restful or practical. There is no need for the client or daily exercise may be a beneficial lifestyle
to avoid yard work or jogging if these activities are change for the client but is not likely to relieve the
not stressful. constipation caused by the aluminum hydroxide.
Constipation, in isolation from other symptoms, is
A client is to take one daily dose of ranitidine not a sign of a bowel obstruction.
(Zantac) at home to treat her peptic ulcer. The
client understands proper drug administration of A client is taking an antacid for treatment of a
ranitidine when she says that she will take the drug peptic ulcer. Which of the following statements
at which of the following times? best indicates that the client understands how to
correctly take the antacid?
1. Before meals.
2. With meals. 1. "I should take my antacid before I take my other
3. At bedtime. medications."
4. When pain occurs. 2. "I need to decrease my intake of fluids so that I
don't dilute the effects of my antacid."
3. 3. "My antacid will be most effective if I take it
Ranitidine blocks secretion of hydrochloric acid. whenever I experience stomach pains."
Clients who take only one daily dose of ranitidine 4. "It is best for me to take my antacid 1 to 3 hours
are usually advised to take it at bedtime to inhibit after meals."
nocturnal secretion of acid. Clients who take the
drug twice a day are advised to take it in the 4.
morning and at bedtime. It is not necessary to take Antacids are most effective if taken 1 to 3 hours
the drug before meals. The client should take the after meals and at bedtime. When an antacid is
drug regularly, not just when pain occurs. taken on an empty stomach, the duration of the
drug's action is greatly decreased. Taking antacids 1
A client has been taking aluminum hydroxide to 3 hours after a meal lengthens the duration of
(Amphojel) 30 mL six times per day at home to action, thus increasing the therapeutic action of
treat his peptic ulcer. He tells the nurse that he has the drug. Antacids should be administered about 2
been unable to have a bowel movement for 3 days. hours after other medications to decrease the
Based on this information, the nurse would chance of drug interactions. It is not necessary to
determine that which of the following is the most decrease fluid intake when taking antacids. If
likely cause of the client's constipation? antacids are taken more frequently than
recommended, the likelihood of developing
1. The client has not been including enough fiber in adverse effects increases. Therefore, the client
his diet. should not take antacids as often as desired to
2. The client needs to increase his daily exercise. control pain.
3. The client is experiencing an adverse effect of
the aluminum hydroxide.
4. The client has developed a gastrointestinal
obstruction.
Which of the following would be an expected The nurse is caring for a client diagnosed with rule-
outcome for a client with peptic ulcer disease? The out peptic ulcer disease. Which test confirms this
client will: diagnosis?

1. Demonstrate appropriate use of analgesics to 1. Esophagogastroduodenoscopy.

control pain. 2. Magnetic resonance imaging (MRI).
2. Explain the rationale for eliminating alcohol from 3. Occult blood test.
the diet. 4. Gastric acid stimulation.
3. Verbalize the importance of monitoring
hemoglobin and hematocrit every 3 months. ANS: 1
4. Eliminate contact sports from his or her lifestyle. The esophagogastroduodenoscopy (EGD) is an
invasive diagnostic test that visualizes the
2. esophagus, stomach, and duodenum to accurately
Alcohol is a gastric irritant that should be diagnose an ulcer and evaluate the effectiveness of
eliminated from the intake of the client with peptic the client's treatment.
ulcer disease. Analgesics are not used to control
ulcer pain; many analgesics are gastric irritants. The Which specific data should the nurse obtain from
client's hemoglobin and hematocrit typically do not the client who is suspected of having peptic ulcer
need to be monitored every 3 months, unless disease?
gastrointestinal bleeding is suspected. The client
can maintain an active lifestyle and does not need 1. History of side effects experienced from all
to eliminate contact sports as long as they are not medications.
stress-inducing. 2. Use of nonsteroidal anti-inflammatory drugs
(NSAIDs).
3. Any known allergies to drugs and environmental
Which assessment data supports the client's factors.
diagnosis of gastric ulcer to the nurse? 4. Medical histories of at least three (3)
generations.
1. Presence of blood in the client's stool for the
past month. ANS: 2
2. Reports of a burning sensation moving like a Use of NSAIDs places the client at risk for peptic
wave. ulcer disease and hemorrhage. NSAIDs suppress
3. Sharp pain in the upper abdomen after eating a the production of prostaglandin in the stomach,
heavy meal. which is a protective mechanism to prevent
4. Complaints of epigastric pain 30 to 60 minutes damage from hydrochloric acid.
after ingesting food.
Which physical examination should the nurse
ANS: 4 implement first when assessing the client
In a client diagnosed with a gastric ulcer, pain diagnosed with peptic ulcer disease?
usually occurs 30 to 60 minutes after eating but not
at night. In contrast, a cli- ent with a duodenal ulcer 1. Auscultate the client's bowel sounds in all four
has pain during the night often relieved by eating quadrants.
food. Pain occurs one (1) to three (3) hours after 2. Palpate the abdominal area for tenderness.
meals. 3. Percuss the abdominal borders to identify
organs.
4. Assess the tender area progressing to
nontender.
ANS: 1 Which expected outcome should the nurse include
Auscultation should be used prior to palpation or for a client diagnosed with peptic ulcer disease?
percussion when assess- ing the abdomen.
Manipulation of the abdomen can alter bowel 1. The client's pain is controlled with the use of
sounds and give false information. NSAIDs.
2. The client maintains lifestyle modifications.
Which problems should the nurse include in the 3. The client has no signs and symptoms of
plan of care for the client diagnosed with peptic hemoptysis.
ulcer disease to observe for physiological 4. The client takes antacids with each meal.
complications?
ANS: 2
1. Alteration in bowel elimination patterns. Maintaining lifestyle changes such as following an
2. Knowledge deficit in the causes of ulcers. appropriate diet and reducing stress indicate the
3. Inability to cope with changing family roles. client is complying with the medical regimen.
4. Potential for alteration in gastric emptying. Compliance is the goal of treatment to prevent
complications.
ANS: 4
Potential for alteration in gastric emptying is The nurse has been assigned to care for a client
caused by edema or scarring associated with an diagnosed with peptic ulcer disease. Which
ulcer, which may cause a feeling of "fullness," assessment data require further intervention?
vomiting of undigested food, or abdominal 1. Bowel sounds auscultated 15 times in one (1)
distention. minute.
2. Belching after eating a heavy and fatty meal late
The nurse is caring for a client diagnosed with at night.
hemorrhaging duodenal ulcer. Which collaborative 3. A decrease in systolic blood pressure (BP) of 20
interventions should the nurse implement? Select mm Hg from lying to sitting.
all that apply. 4. A decreased frequency of distress located in
the epigastric region.
1. Perform a complete pain assessment.
2. Assess the client's vital signs frequently. ANS: 3
3. Administer a proton pump inhibitor A decrease of 20 mm Hg in blood pressure after
intravenously. changing position from lying, to sitting, to standing
4. Obtain permission and administer blood is orthostatic hypotension. This could indicate the
products. client is bleeding.
5. Monitor the intake of a soft, bland diet.

ANS: 3, 4 Which oral medication should the nurse question

3. This is a collaborative intervention the nurse before administering to the client with peptic ulcer
should implement. It requires an order from the disease?
HCP.
4. Administering blood products is collab- orative, 1. E-mycin, an antibiotic.
requiring an order from the HCP. 2. Prilosec, a proton pump inhibitor.
3. Flagyl, an antimicrobial agent.
4. Tylenol, a nonnarcotic analgesic.
ANS: 1

E-mycin is irritating to the stomach,and its use in a

client with peptic ulcer disease should be
questioned.
 stomach with saline is the most im- portant
The nurse has administered an antibiotic, a proton intervention because this directly stops the
pump inhibitor, and Pepto-Bismol for peptic ulcer bleeding.
disease secondary to H. pylori. Which data would
indicate to the nurse the medications are effective?
1. In the stomach lining, the parietal cells release
1. A decrease in alcohol intake. _________ and the chief cells release __________
2. Maintaining a bland diet. which both play a role in peptic ulcer disease.*
3. A return to previous activities. A. pepsin, hydrochloric acid
4. A decrease in gastric distress. B. pepsinogen, pepsin
C. pepsinogen, gastric acid
ANS: 4 D. hydrochloric acid, and pepsinogen
Antibiotics, proton pump inhibitors, and Pepto-
Bismol are administered to decrease the irritation D
of the ulcerative area and cure the ulcer. A
decrease in gastric dis- tress indicates the 2. A patient has developed a duodenal ulcer. As the
medication is effective. nurse, you know that which of the following plays a
role in peptic ulcer formation. Select ALL that
Which assessment data indicate to the nurse the apply:*
client's gastric ulcer has perforated?
A. Spicy foods
1. Complaints of sudden, sharp, substernal pain. B. Helicobacter pylori
2. Rigid, boardlike abdomen with rebound C. NSAIDs
tenderness. D. Milk
3. Frequent, clay-colored, liquid stool. E. Zollinger-Ellison Syndrome
4. Complaints of vague abdominal pain in the right B,C,E
upper quadrant.
ANS: 2 3. You're educating a group of patients at an
outpatient clinic about peptic ulcer formation.
A rigid, boardlike abdomen with rebound Which statement is correct about how peptic
tenderness is the classic sign/symptom of ulcers form?*
peritonitis, which is a complication of a perforated
gastric ulcer. A. "An increase in gastric acid is the sole cause of
peptic ulcer formation."
B. "Peptic ulcers can form when acid penetrates
The client with a history of peptic ulcer disease unprotected stomach mucosa. This causes
is admitted into the intensive care department histamine to be released which signals to the
with frank gastric bleeding. Which priority parietal cells to release more hydrochloric acid
intervention should the nurse implement? which erodes the stomach lining further."
C. "Peptic ulcers form when acid penetrates
1. Maintain a strict record of intake and output. unprotected stomach mucosa. This causes pepsin
2. Insert a nasogastric (N/G) tube and begin saline to be released which signals to the parietal cells to
lavage. release more pepsinogen which erodes the
3. Assist the client with keeping a detailed calorie stomach lining further."
count. D. "The release of prostaglandins cause the
4. Provide a quiet environment to promote rest. stomach lining to breakdown which allows ulcers to
form."
ANS: 2
Inserting a nasogastric tube and lavaging the B
4. Your patient is diagnosed with peptic ulcer 8. A patient with chronic peptic ulcer disease
disease due to h.pylori. This bacterium has a underwent a gastric resection 1 month ago and is
unique shape which allows it to penetrate the reporting nausea, bloating, and diarrhea 30
stomach mucosa. You know this bacterium is:* minutes after eating. What condition is this patient
most likely experiencing?*
A. Rod shaped
B. Spherical shaped A. Gastroparesis
C. Spiral shaped B. Fascia dehiscence
D. Filamentous shaped C. Dumping Syndrome
D. Somogyi effect
C C

5. Helicobacter pylori can live in the stomach's 9. Thinking back to the patient in question 8, select
acidic conditions because it secretes ___________ ALL the correct statements on how to educate this
which neutralizes the acid.* patient about decreasing their symptoms:*
A. ammonia
B. urease A. "It is best to eat 3 large meals a day rather than
C. carbon dioxide small frequent meals."
D. bicarbonate B. "After eating a meal lie down for 30 minutes."
C. "Eat a diet high in protein, fiber, and low in
B carbs."
D. "Be sure to drink at least 16 oz. of milk with
6. The physician orders a patient with a duodenal meals."
ulcer to take a UREA breath test. Which lab value
will the test measure to determine if h. pylori is B,C
present?*
10. A patient is recovering from discomfort from a
A. Ammonia peptic ulcer. The doctor has ordered to advance
B. Urea the patient's diet to solid foods. The patient's lunch
C. Hydrochloric acid tray arrives. Which food should the patient avoid
D. Carbon dioxide eating?*

D A. Orange
B. Milk
7. A patient arrives to the clinic for evaluation of C. White rice
epigastric pain. The patient describes the pain to D. Banana
be relieved by food intake. In addition, the patient
reports awaking in the middle of the night with a A
gnawing pain in the stomach. Based on the
patient's description this appears to be what type 11. Which statement is INCORRECT about
of peptic ulcer?* Histamine-receptor blockers?*

A. Duodenal A. "H2 blockers block histamine which causes the

B. Gastric chief cells to decrease the secretion of hydrochloric
C. Esophageal acid."
D. Refractory B. "Ranitidine and Famotidine are two types of
histamine-receptor blocker medications."
A C. "Antacids and H2 blockers should not be given
together." C. Perforation
D. All the statements are CORRECT. D. Peritonitis
B
A
The client has a long-term history of Crohn's
12. You are providing discharge teaching to a disease and has recently developed acute gastritis.
patient taking Sucralfate (Carafate). Which The client asks the nurse whether Crohn's disease
statement by the patient demonstrates they was a direct cause of the gastritis. What is the
understand how to take this medication?* nurse's best response?

A. "I will take this medication at the same time I A. "Yes, Crohn's disease is known to be a direct
take Ranitidine." cause of the development of chronic gastritis."
B. "I will always take this medication on an empty B. "We know that there can be an association
stomach." between Crohn's disease and chronic gastritis, but
C. "It is best to take this medication with antacids." Crohn's does not directly cause acute gastritis to
D. "I will take this medication once a week." develop."
B C. "What has your doctor told you about how your
gastritis developed?"
13. Select all the medications a physician may D. "Yes, a familial tendency to inherit Crohn's
order to treat a H. Pylori infection that is causing a disease as well as gastritis has been reported. Have
peptic ulcer?* your other family members been tested for Crohn's
disease?"
A. Proton-Pump Inhibitors
B. Antacids B. This is the only accurate statement. Crohn's
C. Anticholinergics disease may be an underlying disease process
D. 5-Aminosalicylates when chronic gastritis develops, but not when
E. Antibiotics acute gastritis occurs.
F. H2 Blockers
G. Bismuth Subsalicylates The client with peptic ulcer disease (PUD) asks the
A,E,F,G nurse whether licorice and slippery elm might be
useful in managing the disease. What is the nurse's
14. A physician prescribes a Proton-Pump Inhibitor best response?
to a patient with a gastric ulcer. Which medication
is considered a PPI?* A. "No, they probably won't be useful. You should
use only prescription medications in your
A. Pantoprazole treatment plan."
B. Famotidine B. "These herbs could be helpful. However, you
C. Magnesium Hydroxide should talk with your physician before adding them
D. Metronidazole to your treatment regimen."
A C. "Yes, these are known to be effective in
managing this disease, but make sure you research
15. A patient with a peptic ulcer is suddenly the herbs thoroughly before taking them."
vomiting dark coffee ground emesis. On D. "No, herbs are not useful for managing this
assessment of the abdomen you find bloating and disease. You can use any type of over-the-counter
an epigastric mass in the abdomen. Which drugs though. They have been shown to be safe."
complication may this patient be experiencing?*
B. Although these herbs may be helpful in
A. Obstruction of pylorus managing PUD, the client should consult his or her
B. Upper gastrointestinal bleeding
physician before making a change in the treatment The client is exhibiting symptoms of gastritis. The
regimen. nurse is assessing the client to determine whether
the form of gastritis being experienced is acute or
The nurse is teaching the client how to prevent chronic. Which data are correlated with a diagnosis
recurrent chronic gastritis symptoms before of chronic gastritis?
discharge. Which statement by the client
demonstrates correct understanding of the nurse's A. Anorexia, nausea, and vomiting
instruction? B. Frequent use of corticosteroids
C. Hematemesis and anorexia
A. "It is okay to continue to drink coffee in the D. Treatment with radiation therapy
morning when I get to work."
B. "I will need to take vitamin B12 shots for the rest D. Treatment with radiation therapy
of my life."
C. "Ibuprofen (Advil, Motrin, others) can be taken The nurse is caring for an older adult male client
for my headaches instead of aspirin." who reports stomach pain and heartburn. Which
D. "Small meals should be eaten about six times a syndrome is most significant in determining
day." whether the client's ulceration is gastric or
duodenal in origin?
D. "Small meals should be eaten about six times a
day A. Pain occurs 1 1/2 to 3 hours after a meal, usually
The client with chronic gastritis should eat six small at night.
meals daily to avoid symptoms. B. Pain is worsened by the ingestion of food.
C. The client has a malnourished appearance.
The client has been diagnosed with terminal gastric D. The client is a man older than 50 years.
cancer and is interested in obtaining support from
hospice, but expresses concern that pain A. Pain occurs 1 1/2 to 3 hours after a meal, usually
management will not be adequate. What is the at night.
nurse's best response? A key symptom characteristic of duodenal ulcers is
that pain usually awakens the client between 1 AM
A. "Pain control is a major component of the care and 2 AM, occurring 1 1/2 to 3 hours after a meal.
provided by hospice and its staff members."
B. "What has your doctor told you about The client is experiencing bleeding related to peptic
participating in hospice?" ulcer disease (PUD). Which nursing intervention is
C. "I can speak to your physician about requesting the highest priority
adequate pain medication."
D. "You don't want to become too dependent on A. Starting a large-bore intravenous (IV)
pain medication and become an addict." B. Administering intravenous (IV) pain medication
C. Preparing equipment for intubation
A. "Pain control is a major component of the care D. Monitoring the client's anxiety level
provided by hospice and its staff members."
This response correctly describes the services A. Starting a large-bore intravenous (IV)
provided by hospice and its staff members, and A large-bore IV should be placed as requested, so
helps reassure the client about their expertise in that blood products can be administered.
pain management.
The nurse is teaching the client with peptic ulcer The client is scheduled to be discharged after a
disease (PUD) about the prescribed drug regimen. gastrectomy. The client's spouse expresses concern
Which statement made by the client indicates a that the client will be unable to change the surgical
need for further teaching before discharge? dressing adequately. What is the nurse's highest
priority intervention?
A. "Nizatidine (Axid) needs to be taken three times
a day to be effective." A. Providing both oral and written instructions on
B. "Taking ranitidine (Zantac) at bedtime should changing the dressing and on symptoms of
decrease acid production at night." infection that must be reported to the physician
C. "Sucralfate (Carafate) should be taken 1 hour B. Asking the physician for a referral for home
before and 2 hours after meals." health services to assist with dressing changes
D. "Omeprazole (Prilosec) should be swallowed C. Asking the spouse whether other family
whole and not crushed." members could be taught how to change the
dressing
A. "Nizatidine (Axid) needs to be taken three times D. Trying to determine specific concerns that the
a day to be effective." spouse has regarding dressing changes
Nizatidine (Axid) is most effective if administered
twice daily. A. Providing both oral and written instructions on
changing the dressing and on symptoms of
The nurse is monitoring the client with gastric infection that must be reported to the physician
cancer for signs and symptoms of upper GI Providing the spouse with both oral and written
bleeding. Which change in vital signs is most instructions on symptoms to report to the
indicative of bleeding related to cancer? physician, as well as on how to perform the
dressing change, will reinforce important points
A. Respiratory rate from 24 to 20 breaths/min and boost the spouse's confidence.
B. Apical pulse from 80 to 72 beats/min
C. Temperature from 98.9° F to 97.9° F The client with peptic ulcer disease (PUD) asks the
D. Blood pressure from 140/90 to 110/70 mm Hg nurse whether a maternal history of ovarian cancer
will cause the client to develop gastric cancer.
D. Blood pressure from 140/90 to 110/70 mm H What is the nurse's best response?
A decrease in blood pressure is the most indicative
sign of bleeding. A. "Yes, it is known that a family history of ovarian
cancer will cause someone to develop gastric
The nurse finds a client vomiting coffee ground- cancer."
type material. On assessment, the client has blood B. "If you are concerned that you are at high risk to
pressure of 100/74 mm Hg, is acutely confused, develop gastric cancer, I would recommend that
and has a weak and thready pulse. Which you speak to your physician about the possibility of
intervention will be the nurse's first priority? genetic testing."
C. "Have you spoken to your physician about your
A. Administering an H2 antagonist concerns?"
B. Initiating enteral nutrition D. "I wouldn't be too concerned about that as long
C. Administering intravenous (IV) fluids as your diet limits pickled, salted, and processed
D. Administering antianxiety medication food."

C. Administering intravenous (IV) fluids B. "If you are concerned that you are at high risk to
Administration of IV fluids is necessary to treat the develop gastric cancer, I would recommend that
hypovolemia caused by acute GI bleeding. you speak to your physician about the possibility of
genetic testing."
Genetic counseling will help the client determine
whether he is at exceptionally high risk to develop experiencing dizziness and diaphoresis after each
gastric cancer. meal
C. Middle-aged client with Zollinger-Ellison
The admission assessment for a client with acute syndrome who needs to receive omeprazole
gastric bleeding indicates blood pressure 82/40, (Prilosec) before breakfast
pulse 124, and respiratory rate 26. Which D. Older adult with advanced gastric cancer who is
admission request will the nurse implement first scheduled to receive combination chemotherapy

A. Type and crossmatch for 4 units of packed red A. Young adult with epigastric pain, hiccups, and
blood cells. abdominal distention after having a total
B. Infuse lactated Ringer's solution at 200 mL/hr. gastrectomy
C. Give pantoprazole (Protonix) 40 mg IV now and
than daily. This client is experiencing symptoms of acute
D. Insert nasogastric tube and connect to low gastric dilation, which can disrupt the suture line.
intermittent suction. The surgeon should be notified immediately
because the nasogastric tube may need irrigation
B. Infuse lactated Ringer's solution at 200 mL/hr. or repositioning.
The client's most immediate concern is the
hypotension associated with volume loss. The most The nurse reviews a medication history for a client
rapidly available volume expanders are crystalloids newly diagnosed with peptic ulcer disease (PUD)
to treat hypovolemia. who has a history of using ibuprofen (Advil, Motrin,
others) frequently for chronic knee pain. The nurse
The nurse is reviewing admitting requests for a anticipates that the health care provider will
client admitted to the intensive care unit with request which medication for this client?
perforation of a duodenal ulcer. Which request will
the nurse implement first? A. Bismuth subsalicylate (Pepto-Bismol)
B. Magnesium hydroxide (Maalox, Mylanta)
A. Apply antiembolism stockings. C. Metronidazole (Flagyl)
B. Place nasogastric (NG) tube, and connect to D. Misoprostol (Cytotec)
suction.
C. Insert an indwelling catheter, and check output D. Misoprostol (Cytotec)
hourly.
D. Give famotidine (Pepcid) 20 mg IV every 12 Misoprostol (Cytotec) is a prostaglandin analogue
hours. that protects against NSAID-induced ulcers.

B. Place nasogastric (NG) tube, and connect to

suction. A client with a recent diagnosis of acute gastritis
To decrease spillage of duodenal contents into the needs health teaching about nutrition therapy.
peritoneum, NG suction should be rapidly initiated. Which foods and beverages should the nurse teach
This will minimize the risk for peritonitis. the client to avoid? Select all that apply.

The nurse working during the day shift on the A. Potatoes

medical unit has just received report. Which client B. Onions
will the nurse plan to assess first? C. Apples
D. Milk
A. Young adult with epigastric pain, hiccups, and E. Orange juice
abdominal distention after having a total F. Tomato juice
gastrectomy
B. Adult who had a subtotal gastrectomy and is
B,E,F (A balanced diet includes following the intake of high-fiber foods will decrease a person's
recommendations of the USDA and limiting the risk for development of gastric cancer.
intake of foods and spices that can cause gastric
distress. Acidic foods such as citrus fruits and juices Which assessment data indicate to the nurse the
and tomatoes should be avoided. Gas-forming clients gastric ulcer has perforated?
foods such as onions should also be eliminated
from the diet. Potatoes are relatively bland and A. Complaints of sudden, sharp, substernal pain
often do not cause gastric upset. Apples are not B. Rigid, boardlike abdomen with rebound
acidic or irritating to the gastric mucosa and need tenderness
not be avoided. Milk may actually have a beneficial C. Frequent, clay-colored, liquid stool
coating effect on the gastric mucosa. D. Complaints of vague abdominal pain in the right
upper quadrant
When taking a history of a client diagnosed with a
duodenal ulcer, which assessment finding does the B. A rigid, boardlike abdomen with rebound
nurse expect? tenderness is the classic sign/symptom of
peritonitis, which is a complication of a perforated
A. Severe weight loss gastric ulcer
B. Pain while eating
C. Hematemesis after eating Which assessment data support to the nurse the
D. Waking at night with pain clients diagnosis of gastric ulcer?

D. Waking at night with pain A. Presence of blood in the clients stool for the past
The pain associated with duodenal ulcers is often month.
described as occurring 90 minutes to 3 hours after B. Reports of a burning sensation moving like a
a meal and at night and often awakens the client wave.
between 1 and 2 AM. C. Sharp pain in the upper abdomen after eating a
heavy meal.
D. Complaints of epigastric pain 30-60 minutes
The nurse assesses a client for the risk for gastric after ingesting food.
cancer. Which of these factors would likely
increase the client's risk? Select all that apply. D. The client diagnosed with a gastric ulcer, pain
usually occurs 30 to 60 minutes after eating, but
A. Having a history of untreated gastroesophageal not at night. In contrast,no client with a duodenal
reflux disease ulcer has pain during the night often relieved by
B. Being an adult between 20 and 40 years of age eating food. Pain occurs 1-3 hours after meals.
C. Eating a diet high in smoked and pickled foods
D. Eating a diet with high-fiber foods The nurse is caring for a client diagnosed with rule
E. Eating a diet high in salt and adding salt to food out peptic ulcer disease. Which test confirms this
diagnosis?
A,C,E Gastric cancer seems to be correlated with
eating pickled foods, nitrates from processed A. Esophagogastroduodenoscopy
foods, and salt added to food. The ingestion of B. Magnetic resonance imaging
these foods over a long period can lead to atrophic C. Occult blood test
gastritis, a precancerous condition. Clients with D. Gastric acid stimulation.
Barrett's esophagus from prolonged or severe
GERD have an increased risk for cancer in the A. The esophagogastroduodenoscopy (EGD) is an
cardia (at the point where the stomach connects to invasive diagnostic test which visualizes the
the esophagus). The average age for developing esophagus, stomach, and duodenum to accurately
gastric cancer is 70 years of age. Increasing the
diagnose an ulcer and evaluate the effectiveness of D. Potential for alteration in gastric emptying is
the clients treatment. caused by edema or scarring associated with an
ulcer, which may cause a feeling of "fullness",
Which specific data should the nurse obtain from vomiting of undigested food or abdominal
the client who is suspected of having peptic ulcer distention
disease?
The nurse is caring for a client diagnosed with
A. History of side effects experienced from all hemorrhage get duodenal ulcer. Which
medications collaborative interventions shoulder nurse
B. Use of non steroidal anti inflammatory drugs implement?
(NSAIDs) Select all that apply.
C. Any known allergies to drugs and environmental
factors A. Perform a complete pain assessment
D. Medical histories of at lease 3 generations B. Assess the clients vital signs frequently
C. Administer a proton pump inhibitor
B. Use of NSAIDs places the client at risk for peptic intravenously
ulcer and hemorrhage. NSAIDs suppress the D. Obtain permission and administer blood
production of prostaglandin in the stomach, which products
is a protective mechanism to prevent damage from E. Monitor the intake of a soft, bland diet
hydrochloric acid.
C. This is a collaborative intervention the nurse
Which physical examination should the nurse should implement. It requires an order from the
implement first when assessing the client HCP.
diagnosed with peptic ulcer disease?
D. Administering blood products is collaborative,
A. Auscultate the clients bowel sounds in all four requiring an order from the HCP.
quadrants
B. Palpate the abdominal area for tenderness Which expected outcome should the nurse include
C. Percuss the abdominal borders to identify for a client diagnosed with peptic ulcer disease?
organs
D. Assess the tender area progressing to nontender A. The clients pain is controlled with the use of
NSAIDs
A. Auscultation should be used prior to palpitation B. The client maintains lifestyle modifications
or percussion when assessing the abdomen. C. The client has no signs and symptoms of
Manipulation of the abdomen can alter bowel hemoptysis
sounds and give false information D. The client takes antacids with each meal

Which problems should the nurse include in the B. Maintaining lifestyle changes such as following
plan of care for the client diagnosed with peptic an appropriate diet and reducing stress indicate
ulcer disease to observe for physiological the client is complying with the medical regimen.
complications? Compliance is the goal of treatment to prevent
complications.
A. Alteration in bowel elimination patterns
B. Knowledge deficit in the causes of ulcers The nurse has been assigned to care for a client
C. Inability to cope with changing family roles diagnosed with peptic ulcer disease. Which
D. Potential for alteration in gastric emptying assessment data require further intervention?

A. Bowel sour s auscultated 15 times in 1 minute

B. Belching after eating a heavy and fatty meal late
at night
C. A decrease in systolic BP of 20 mm Hg from lying B. Inserting a nasogastric tube and lavaging the
to sitting stomach with saline is the most important
D. A decreased frequency of distress located in the intervention because this directly stops the
epigastric region bleeding

C. A decrease of 20 mm Hg in blood pressure after The client with peptic ulcer disease (PUD) asks the
changing position from lying, to sitting, to standing nurse whether licorice and slippery elm might be
is orthostatic hypotension. This could indicate useful in managing the disease. What is the nurse's
client is bleeding. best response?

Which oral medication should the nurse question A. "No, they probably won't be useful. You should
before administering to the client with peptic ulcer use only prescription medications in your
disease? treatment plan."
B. "These herbs could be helpful. However, you
A. E-mycin, an antibiotic should talk with your physician before adding them
B. Prilosec, a proton pump inhibitor to your treatment regimen."
C. Flagyl, an anti microbial agent C. "Yes, these are known to be effective in
D. Tylenol, a nonnarcotic analgesic managing this disease, but make sure you research
the herbs thoroughly before taking them."
A. E-mycinis irritating to stomach, and it's use in a D. "No, herbs are not useful for managing this
client with peptic ulcer disease should be disease. You can use any type of over-the-counter
questioned drugs though. They have been shown to be safe."

The nurse has administered an antibiotic, a proton B. Although these herbs may be helpful in
pump inhibitor, and Pepto- Bismol for peptic ulcer managing PUD, the client should consult his or her
disease secondary to H. pylori. Which data would physician before making a change in the treatment
indicate to the nurse the medications are effective? regimen.

A. A decrease in alcohol intake The nurse is caring for an older adult male client
B. Maintaining a bland diet who reports stomach pain and heartburn. Which
C. A return to previous activities syndrome is most significant in determining
D. A decrease in gastric distress whether the client's ulceration is gastric or
duodenal in origin?
D. Antibiotics, proton pump inhibitors, and Pepto-
Bismol are administered to decrease the irritation A. Pain occurs 1 1/2 to 3 hours after a meal, usually
of the ulcerative area and cure the ulcer. A at night.
decrease in gastric distress indicates the B. Pain is worsened by the ingestion of food.
medication is effective C. The client has a malnourished appearance.
The client with a history of peptic ulcer disease is D. The client is a man older than 50 years.
admitted into the intensive care unit with frank
gastric bleeding. Which priority intervention should A. Pain occurs 1 1/2 to 3 hours after a meal, usually
the nurse implement? at night.

A. Maintain a strict record of intake and output A key symptom characteristic of duodenal ulcers is
B. Insert a nasogastric tube and begin saline lavage that pain usually awakens the client between 1 AM
C. Assist the client with keeping a detailed calorie and 2 AM, occurring 1 1/2 to 3 hours after a meal.
count
D. Provide a quiet environment to promote rest
The client is experiencing bleeding related to peptic D. right upper quadrant
ulcer disease (PUD). Which nursing intervention is
the highest priority? 4) The celiac artery supplies blood to which part of
the GI tract?
A. Starting a large-bore intravenous (IV)
B. Administering intravenous (IV) pain medication A. duodenum
C. Preparing equipment for intubation B. jejunum
D. Monitoring the client's anxiety level C. small intestine and proximal colon
D. mid-transverse colon to rectum
A. Starting a large-bore intravenous (IV) E. cecum

A large-bore IV should be placed as requested, so 5) During defecation, movement of feces into the
that blood products can be administered. rectum initiates (click all that apply)

A. rectoanal inhibitory reflex

APPENDICITIS B. voluntary relaxation of the pelvic floor and
1) What are diagnostic features of acute external sphincter mechanism
appendicitis? click all that apply C. voluntary increase in intra-abdominal
pressure
D. voluntary contraction of external sphincter
A. Low grade fever less than 100.4F/38C
B. Moderate leukocytosis (10,000-20,000)
6) What is the primary cause of appendicitis?
C. Ultrasound
D. CT (with contrast depending on body
A. obstruction of the lumen between the
habitus)
cecum and appendix
E. CT (helpful if perforation is suspected to
B. inflammation due to an immune response
diagnose periappendiceal abscess)
C. constipation
D. overuse of antibiotics
2) What best explains what happens to the
appendix when it is obstructed?
7) Jerry has diagnosed with appendicitis. He
develops a fever, hypotension and tachycardia. The
A. the inflamed tissue becomes infected and
nurse suspects which of the following
dies from lack of blood supply and
complications?
eventually bursts
B. the inflamed tissue dies from lack of blood
A. Intestinal obstruction
supply causing the appendix to burst
B. Peritonitis
C. the obstruction causes pressure to build up
C. Bowel ischemia
and eventually causes the appendix to burst
D. Deficient fluid volume
D. the obstruction hardens the appendix
eventually causing it to burst
8) What are some possible causes of an obstructed
appendix?
3) Roxy is admitted to the hospital with a possible
diagnosis of appendicitis. On physical examination,
A. inflammatory bowel disease, infection, fecal
the nurse should be looking for tenderness on
stasis, calcium salts or undigested fiber-
palpation at McBurney’s point, which is located in
fecaliths, parasites, fb, and neoplasms
the
B. infection, fecal stasis, calcium salts or
undigested fiber-fecaliths, parasites, FB,
A. left lower quadrant
and neoplasms, diarrhea
B. left upper quadrant
C. right lower quadrant
 C. fecal stasis, fecaliths, FB, gastric ulcer, 13) What type of tissue is the appendix made up
infection, calcium salts or undigested fiber- of?
fecaliths, parasites,and neoplasms
D. suppositories, FB, neoplams, undigested A. lymphatic
fiber and calcium salts, calcium salts or B. connective
undigested fiber-fecaliths, infection, fecal C. fibrinous
stasis, parasites D. intestinal mucosa

9) What is the blind sac that is in the RLQ below the 14) The inferior mesenteric artery supplies blood to
ileocecal valve? which part of the GI tract?

A. cecum A. mid-transverse colon to rectum

B. appendix B. colon and anal canal
C. transverse colon C. descending colon and rectum
D. ascending colon D. colon and rectum
E. colon, cecum, and rectum
10) The middle rectal artery supplies blood to
which part of the rectum? 15) Situation : Mr. Gerald Liu, 19 y/o, is being
admitted to a hospital unit complaining of severe
A. The lower rectum pain in the lower abdomen. Admission vital signs
B. The middle rectum reveal an oral temperature of 101.2 0F. Which of
C. The anal sphincters the following would confirm a diagnosis of
D. upper and middle rectum appendicitis?

11) Situation: Mr. Gerald Liu, 19 y/o, is being A. The pain is localized at a position halfway
admitted to a hospital unit complaining of severe between the umbilicus and the right iliac
pain in the lower abdomen. Admission vital signs crest.
reveal an oral temperature of 101.2 0F. Signs and B. Mr. Liu describes the pain as occurring 2
symptoms include pain in the RLQ of the abdomen hours after eating
that may be localize at McBurney’s point. To C. The pain subsides after eating
relieve pain, Mr. Liu should assume which position? D. The pain is in the left lower quadrant

A. Prone 16) Situation: A 20 year old college student was

B. Supine, stretched out rushed to the ER of PGH after he fainted during
C. Sitting their ROTC drill. Complained of severe right iliac
D. Lying with legs drawn up pain. Upon palpation of his abdomen, Ernie jerks
even on slight pressure. Blood test was ordered.
12) A patient presents with periumbilical pain that Diagnosis is acute appendicitis. Stat appendectomy
moves to the RLQ over 24 hrs. the pain is was indicated. Pre op care would include all of the
exacerbated by walking, coughing, or a car ride. following except?
The patient presents with nausea, vomiting, and a
low grade fever of less than 38C or 100.4. What is A. Consent signed by the father
the suspected diagnosis? B. Enema STAT
C. Skin prep of the area including the pubis
A. Acute appendicitis D. Remove the jewelries
B. Ovarian cyst
C. Volvulus
D. Acute pancreatitis
E. Acute cholecystitis
17) Situation: A 20 year old college student was C. The appendix may develop gangrene and
rushed to the ER of PGH after he fainted during rupture, especially in a middle-aged client.
their ROTC drill. Complained of severe right iliac D. Infection of the appendix diminishes
pain. Upon palpation of his abdomen, Ernie jerks necrotic arterial blood flow and increases
even on slight pressure. Blood test was ordered. venous drainage.
Diagnosis is acute appendicitis. Pre-anesthetic med
of Demerol and atrophine sulfate were ordered to : 22) The superior rectal artery supplies blood to
which part of the GI tract?
A. Allay anxiety and apprehension
B. Reduce pain A. The rectum
C. Prevent vomiting B. The upper and middle rectum
D. Relax abdominal muscle C. lower rectum
D. anal sphincters and rectum
18) Which condition is most likely to have a nursing E. anal sphincters only
diagnosis of fluid volume deficit?
23) Typical signs and symptoms of appendicitis
A. Appendicitis include:
B. Pancreatitis
C. Cholecystitis A. Nausea
D. Gastric ulcer B. Left lower quadrant pain
C. Pain when pressure is applied to the right
19) Post op care for appendectomy include the lower quadrant of the abdomen.
following except D. High fever

A. Early ambulation 24) What stimulates the contraction of propulsive

B. Diet as tolerated after fully conscious waves that move stool distally from the cecum?
C. Nasogastric tube connect to suction
D. Deep breathing and leg exercise A. distention of the colonic wall
B. distention of the small intestinal wall
20) Other condition/s that could produce pain C. the fermenting vat located in the cecum
similar to appendicitis include D. distention of the cecum wall

A. Inflammation of gall bladder 25) The superior mesenteric artery supplies blood
B. Stone in ureter to which part of the GI tract?
C. Inflammation of right colon
D. All of the above A. small intestine (other than duodenum) and
proximal colon
21) When preparing a male client, age 51, for B. mid-transverse colon to rectum
surgery to treat appendicitis, the nurse formulates C. duodenum
a nursing diagnosis of Risk for infection related to D. cecum
inflammation, perforation, and surgery. What is the E. rectum only
rationale for choosing this nursing diagnosis?

A. Obstruction of the appendix may increase

venous drainage and cause the appendix to
rupture.
B. Obstruction of the appendix reduces
arterial flow, leading to ischemia,
inflammation, and rupture of the appendix.
26) Situation: Mr. Gerald Liu, 19 y/o, is being 29) The __________ extends from the
admitted to a hospital unit complaining of severe rectosigmoid junction to the anal canal and is
pain in the lower abdomen. Admission vital signs composed of insensitive columnar epithelium.
reveal an oral temperature of 101.2 0F. After a few
minutes, the pain suddenly stops without any A. Anal Canal
intervention. Nurse Ray might suspect that: B. Rectum
C. Colon
A. the appendix is still distended D. Large bowel
B. the appendix may have ruptured
C. an increased in intrathoracic pressure will 30) Surgery is the definitive treatment for
occur appendicitis.
D. signs and symptoms of peritonitis occur
A. True
27) During the rectoanal inhibitory reflex, the B. False
internal sphincter ________ allowing the contents
into the anal canal, then the external sphincter 31) If after surgery the patient’s abdomen becomes
____________ and contents are pushed back into distended and no bowel sounds appreciated, what
the rectum. This occurs up to 7 times daily. would be the most suspected complication? [1]

A. relaxes, relaxes A. Intussusception

B. contracts, contracts B. Paralytic Ileus
C. relaxes, contracts C. Hemorrhage
D. contracts, relaxes D. Ruptured colon

28) While examining a patient with suspected 32) The _____________ is 3-4 cm long, starts at the
appendicitis, you would expect to find pain (with or dentate line, is supported by the internal and
without) gaurding, (with or without) rebound external anal sphincters, and composed of sensitive
tenderness, pain (with or without) passive flexion squamous epithelium.
of R hip, pain (with or without) passive flexion of L
hip, and a postitive or negative obturator sign? A. Rectum
B. Anal Canal
A. Pain: with gaurding, with rebound C. Colon
tenderness, with passive flexion of R hip, D. Anal sphincter canal
without passive flexion of L hip, and a
positive obturator sign 33) The inferior rectal artery supplies blood to
B. Pain: without gaurding, with rebound which part of the rectum?
tenderness, with passive flexion of R hip,
without passive flexion of L hip, and a A. the internal and external anal sphincters
postivie obturator sign B. the lower rectum
C. Pain: without gaurding, with rebound C. the upper, middle, and lower rectum
tenderness, with passive flexion of R hip, D. the external sphincter only
with passive flexion of L hip, and a positive E. the internal sphincter only
obturator sign
D. Pain: with gaurding, with rebound 34) What percentage of people have appendicitis in
tenderness, with passive flexion of R hip, their lifetime?
with passive flexion of L hip, and a positive
obturator sign A. 10%
B. 20%
C. 30%
 D. 50% even on slight pressure. Blood test was ordered.
Diagnosis is acute appendicitis. Which result of the
35) The appendix is located on the _____ lower lab test will be significant to the diagnosis?
side of the abdomen.
A. RBC : 4.5 TO 5 Million / cu. mm.
A. Right B. Hgb : 13 to 14 gm/dl.
B. Left C. Platelets : 250,000 to 500,000 cu.mm.
D. WBC : 12,000 to 13,000/cu.mm
36) Peritonitis may occur in ruptured appendix and
may cause serious problems which are 40) Worms do not cause appendicitis.

1. Hypovolemia, electrolyte imbalance A. True

2. Elevated temperature, weakness and B. False
diaphoresis
3. Nausea and vomiting, rigidity of the 41) When preparing a male client, age 51, for
abdominal wall surgery to treat appendicitis, the nurse formulates
4. Pallor and eventually shock a nursing diagnosis of Risk for infection related to
inflammation, perforation, and surgery. What is the
A. 1 and 2 rationale for choosing this nursing diagnosis?
B. 2 and 3
C. 1,2,3 A. Obstruction of the appendix may increase
D. All of the above venous drainage and cause the appendix to
rupture.
37) Situation : Mr. Gerald Liu, 19 y/o, is being B. Obstruction of the appendix reduces
admitted to a hospital unit complaining of severe arterial flow, leading to ischemia,
pain in the lower abdomen. Admission vital signs inflammation, and rupture of the appendix.
reveal an oral temperature of 101.2 0F. Which of C. The appendix may develop gangrene and
the following complications is thought to be the rupture, especially in a middle-aged client.
most common cause of appendicitis? D. Infection of the appendix diminishes
necrotic arterial blood flow and increases
A. A fecalith venous drainage.
B. Internal bowel occlusion
C. Bowel kinking 42) What 3 major branches of the aorta supply
D. Abdominal wall swelling blood to the intestines?

38) What part of the colon propels retrograde A. celiac artery, superior mesenteric artery,
waves of contraction to allow the cecum to retain inferior mesenteric artery
liquid feces and act as a ‘fermenting vat’? B. celiac artery, superior mesenteric artery,
and right and left gastric artery
A. mid-transverse colon C. superior mesenteric artery, inferior
B. entire transverse colon mesenteric artery, and internal and external
C. ascending colon iliac arteries
D. descending colon D. common iliac artery, superior mesenteric
E. ileum artery, inferior mesenteric arteries

39) Situation: A 20 year old college student was 43) What is the treatment for appendicitis?
rushed to the ER of PGH after he fainted during
their ROTC drill. Complained of severe right iliac A. surgical removal of inflamed appendix
pain. Upon palpation of his abdomen, Ernie jerks before it ruptures
 B. pain control and antibiotics B. Nausea
C. pain control C. Constipation
D. antibiotics and observation D. All of the above

44) What vein carries venous blood from the 50) Common anesthesia for appendectomy is
intestines to the liver?
A. Spinal
A. portal vein B. General
B. iliac veins C. Caudal
C. middle colic vein D. Hypnosis
D. inferior mesenteric vein
E. superior mesenteric vein Answers and Rationales

45) McBurney Point is located ________ 1. A. Low grade fever less than 100.4F/38C
, B. Moderate leukocytosis (10,000-20,000)
A. Around the umbilicus , C. Ultrasound , D. CT (with contrast
B. In the right lower abdomen depending on body habitus) , E. CT (helpful
C. In the left lower abdomen if perforation is suspected to diagnose
D. In the upper abdomen periappendiceal abscess)
2. A. the inflamed tissue becomes infected
46) Perforation is not a complication of and dies from lack of blood supply and
appendicitis. eventually bursts
3. C. right lower quadrant . To be exact, the
A. True appendix is anatomically located at the Mc
B. False Burney’s point at the right iliac area of the
right lower quadrant.
47) Situation : Mr. Gerald Liu, 19 y/o, is being 4. A. duodenum
admitted to a hospital unit complaining of severe 5. B. voluntary relaxation of the pelvic floor
pain in the lower abdomen. Admission vital signs and external sphincter mechanism, C.
reveal an oral temperature of 101.2 0F. The doctor voluntary increase in intra-abdominal
ordered for a complete blood count. After the test, pressure
Nurse Ray received the result from the laboratory. 6. A. obstruction of the lumen between the
Which laboratory values will confirm the diagnosis cecum and appendix
of appendicitis? 7. B. Peritonitis . Complications of acute
appendicitis are peritonitis, perforation and
A. RBC 5.5 x 106/mm3 abscess development.
B. Hct 44 % 8. A. inflammatory bowel disease, infection,
C. WBC 13, 000/mm3 fecal stasis, calcium salts or undigested
D. Hgb 15 g/dL fiber- fecaliths, parasites, fb, and
neoplasms
48) Diet does not influence the development of 9. A. cecum
appendicitis. 10. A. The lower rectum
11. D. Lying with legs drawn up . Posturing by
A. True lying with legs drawn up can relax the
B. False abdominal muscle thus relieve pain.
12. A. Acute appendicitis
49) Symptoms of appendicitis include ______ 13. A. lymphatic
14. A. mid-transverse colon to rectum
A. Abdominal pain
15. A. The pain is localized at a position drainage. The pressure continues to rise
halfway between the umbilicus and the with venous obstruction; arterial blood flow
right iliac crest. Pain over McBurney’s then decreases, leading to ischemia from
point, the point halfway between the lack of perfusion. Inflammation and
umbilicus and the iliac crest, is diagnosis for bacterial growth follow, and swelling
appendicitis. Options b and c are common continues to raise pressure within the
with ulcers; option d may suggest ulcerative appendix, resulting in gangrene and
colitis or diverticulitis. rupture. Geriatric, not middle-aged, clients
16. B. Enema STAT are especially susceptible to appendix
17. A. Allay anxiety and apprehension . Pain is rupture.
not reduced in appendicits. Clients are not 22. B. The upper and middle rectum
given pain medication as to assess whether 23. A. Nausea . Nausea is typically associated
the appendix ruptured. A sudden relief of with appendicitis with or without vomiting.
pain indicates the the appendix has Pain is generally felt in the right lower
ruptured and client will have an emergency quadrant. Rebound tenderness, or pain felt
appendectomy and prevent peritonitis. with release of pressure applied to the
Demerol and Atropine are used to allay abdomen, may be present with
client’s anxiety pre operatively. appendicitis. Low-grade fever is associated
18. B. Pancreatitis . Hypovolemic shock from with appendicitis.
fluid shifts is a major factor in acute 24. A. distention of the colonic wall
pancreatitis. The other conditions are less 25. A. small intestine (other than duodenum)
likely to exhibit fluid volume deficit. and proximal colon
19. B. Diet as tolerated after fully 26. B. the appendix may have ruptured . If a
conscious. Client’s peristalsis will return in confirmed diagnosis is made and the pain
48 to 72 hours post-op therefore, Fluid and suddenly without any intervention, the
food are witheld until the bowel sounds appendix may have ruptured; the pain is
returns. Remember that ALL PROCUDURES lessened because the appendix is no longer
requiring GENERAL and SPINAL anesthesia distended thus surgery is still needed.
above the nerves that supply the intestines 27. C. relaxes, contracts
will cause temporary paralysis of the bowel. 28. A. Pain: with gaurding, with rebound
Specially when the bowels are traumatized tenderness, with passive flexion of R hip,
during the procedure, it may take longer for without passive flexion of L hip, and a
the intestinal peristalsis to resume. positive obturator sign
20. D. All of the above . Other conditions like 29. B. Rectum
gall stones, inflammation of gall bladder, 30. A. True. Surgery is the definitive treatment
stone in the ureter, ruptured ovarian for appendicitis. It may be performed as an
follicle, a ruptured tubal pregnancy, open surgery or through a laparoscope.
perforation of stomach or duodenal ulcer, Antibiotics are also useful in treating
and inflammation of the right colon can appendicitis, but usually require to be
produce pain similar to appendicitis. followed by surgery due to recurrence.
21. B. Obstruction of the appendix reduces 31. B. Paralytic Ileus . Paralytic Ileus is a
arterial flow, leading to ischemia, mechanical bowel obstruction where in, the
inflammation, and rupture of the patients intestine fails to regain its motility.
appendix. A client with appendicitis is at It is usually caused by surgery and
risk for infection related to inflammation, anesthesia. Intusussusception, Appendicitis
perforation, and surgery because and Peritonitis also causes paralytic ileus.
obstruction of the appendix causes mucus 32. B. Anal Canal
fluid to build up, increasing pressure in the 33. A. the internal and external anal sphincters
appendix and compressing venous outflow 34. A. 10%
35. A. Right 42. A. celiac artery, superior mesenteric artery,
36. D. All of the above . Peritonitis will cause all inferior mesenteric artery
of the above symptoms. The peritoneum 43. A. surgical removal of inflamed appendix
has a natural tendency to GUARD and before it ruptures
become RIGID as to limit the infective 44. A. portal vein
exudate exchange inside the abdominal 45. B. In the right lower abdomen. Pain in
cavity. Hypovolemia and F&E imbalance are appendicitis normally starts around the
caused by severe nausea and vomiting in umbilicus but later settles in the right lower
patients with peritonitis because of acute abdomen near the appendix. This point is
pain. As inflammation and infection called the McBurney Point and is located
spreads, fever and chills will become more midway between the umbilicus and the top
apparent causing elevation in temperature, of the right pelvic bone.
weakness and sweating. If peritonitis is left 46. B. False. The inflamed appendix can burst
untreated, Client will become severely resulting in inflammation of the lining of the
hypotensive leading to shock and death. abdomen (peritoneum), the condition being
37. A. A fecalith . A fecalith is a hard piece of called peritonitis.
stool which is stone like that commonly 47. C. WBC 13, 000/mm3 . Increase in WBC
obstructs the lumen. Due to obstruction, counts is suggestive of appendicitis because
inflammation and bacterial invasion can of bacterial invasion and inflammation.
occur. Tumors or foreign bodies may also Normal WBC count is 5, 000 – 10,
cause obstruction. 000/mm3. Other options are normal values.
38. A. mid-transverse colon 48. B. False . Diet lacking in fiber is a risk factor
39. D. WBC : 12,000 to 13,000/cu.mm . WBC for appendicitis.
increases with inflammation and infection. 49. D. All of the above . Symptoms of
40. B. False . Worms can block the opening of appendicitis include abdominal pain,
the appendix resulting in appendicitis. In nausea, vomiting, loss of appetite, low
addition, fecaliths, infection or grade fever, constipation, diarrhea and an
inflammation can also block the opening of inability to pass gas. A swelling may
the appendix leading to appendicitis. subsequently appear in the abdomen
41. B. Obstruction of the appendix reduces overlying the appendix.
arterial flow, leading to ischemia, 50. A. Spinal . Spinal anesthesia is the most
inflammation, and rupture of the common method used in appendectomy.
appendix. A client with appendicitis is at Using this method, Only the area affected is
risk for infection related to inflammation, anesthetized preventing systemic side
perforation, and surgery because effects of anesthetics like dizziness,
obstruction of the appendix causes mucus hypotension and RR depression.
fluid to build up, increasing pressure in the
appendix and compressing venous outflow
drainage. The pressure continues to rise
with venous obstruction; arterial blood flow
then decreases, leading to ischemia from
lack of perfusion. Inflammation and
bacterial growth follow, and swelling
continues to raise pressure within the
appendix, resulting in gangrene and
rupture. Geriatric, not middle-aged, clients
are especially susceptible to appendix
rupture.
A client telephones the health clinic with Which condition may occur if the client does not
complaints of generalized abdominal pain which is seek medication attention for acute appendicitis
aggravated by moving or walking. The client has within 24dash36 hours? (Select all that apply.)
not been able to eat for a day and is nauseated.
Which advice should the nurse provide to this A. Seizure
client? B. Constipation
C. Nausea
A. "Take a warm shower and apply a heating pad to D. Peritonitis
the abdomen." E. Perforation
B. "Rest in bed and drink warm fluids."
C. "Seek immediate medical attention." Answer: D, E
D. "Take an over-the-counter laxative." Rationale: If treatment is not initiated, tissue
necrosis and gangrene result within 24-36 hours,
Answer: C leading to perforation (rupture). Perforation allows
Rationale: The initial characteristic manifestation of the contents of the gastrointestinal (GI) tract to
acute appendicitis is continuous, mild, generalized flow into the peritoneal space of the abdomen,
or upper abdominal pain. Over the next 4 hours, resulting in peritonitis. Appendicitis does not cause
the pain intensifies and localizes in the right lower seizures, nausea, or constipation.
quadrant of the abdomen. Pain associated with
appendicitis is aggravated by moving, walking, or A teenage boy presents with suspected
coughing. If medical attention is not provided, appendicitis. The caregiver asks, "Why did my son
gangrene can develop within 24dash36 hours. The get this?" Which response by the nurse is the most
client should be instructed to seek immediate appropriate?
medical attention. Resting in bed and drinking
warm fluids is not going to prevent the appendix A. "Your son has been eating too much fiber."
from developing gangrene. When appendicitis is B. "Your son is eating too many fruits and
suspected, the client should be instructed to avoid vegetables."
laxatives and not to apply heat to the abdomen C. "Your son has not been getting enough
because heat could encourage the appendix to exercise."
rupture. D. "Your adolescent son is in a risk group."

Which clinical manifestation does the nurse expect Answer: D

with acute appendicitis? Rationale: Adolescent boys are at greatest risk for
appendicitis. Appendicitis cannot be prevented, but
A. High fever certain dietary habits may reduce the risk of
B. Nausea and vomiting developing this condition. Eating foods that contain
C. Rebound tenderness high fiber content, such as fresh fruits and
D. Pain relieved with ambulation vegetables, decreases the incidence of
appendicitis.
Answer: C
Appendicitis almost always results from an
Rationale: One manifestation of acute appendicitis obstruction in the appendiceal lumen. Which
is localized and rebound tenderness of McBurney problem should the nurse identify as the cause of
point upon palpation. A high fever is a this obstruction?
manifestation of a perforated appendix. Nausea
and vomiting are generalized symptoms and are A. Monolith
not present exclusively with appendicitis. B. Fecalith
Ambulation increases pain in appendicitis. C. Tonsillolith
D. Ptyalith
 A teenage girl is being assessed for the possibility
Answer: B of appendicitis. Which other condition should the
nurse consider? (Select all that apply.)
Rationale: The obstruction is often caused by a
hard mass of feces (fecalith). Ptyalith is a calculus in A. Pelvic inflammatory disease
the salivary gland. Tonsillolith is a calculus in the B. Ovulation
tonsil. A monolith is a large stone used in sculpture. C. Menstruation
D. Urinary tract infection
Which statement by a client diagnosed with acute E. Ruptured ectopic pregnancy
appendicitis leads the nurse to believe the client
needs teaching about dietary interventions? Answer: A, B, E

A. "I eat raw vegetables for a snack several days Rationale: In adolescent and young women,
per week." symptoms must be differentiated from those
B. "I don't like fruits and vegetables." associated with ovulation, ruptured ectopic
C. "I prefer to have meat with each meal." pregnancy and pelvic inflammatory disease.
D. "I eat fruit with breakfast every day." Although a urinary tract infection may cause
abdominal pain, it typically does not present in the
Answer: B same way as appendicitis. Menstruation does not
have the same symptoms as appendicitis.
Rationale: Certain dietary habits may reduce the
risk of developing acute appendicitis. Eating foods Appendicitis in a pregnant woman is a complex
that contain high fiber content, such as fresh fruits problem. Which statement is true based on the
and vegetables, decreases the incidence of given premise?
appendicitis.
A. Appendicitis is the most common surgical
Which assessment finding leads the nurse to presentation in pregnant women.
suspect that an older client may have appendicitis? B. Appendicitis does not occur in pregnant women.
(Select all that apply.) C. Appendicitis will cause fetal death.
D. A pregnant woman will have surgery
A. Pain migrating from the lower left to the upper postpartum.
right quadrant
B. Tenderness when pressing McBurney point Answer: A
C. Confusion Rationale: Acute appendicitis is the most common
D. No abdominal pain surgical presentation in pregnant women. It can be
E. Internal rotation of the left hip increases pain successfully managed by the surgical and
obstetrical teams. A recent study has found that
Answer: B, C, E appendicitis during pregnancy can be managed
Rationale: Fewer than 30% of older adults who successfully without any dangerous fetal outcomes.
have appendicitis present with classic symptoms.
Classic signs of acute appendicitis are pain that is A client presents with suspected appendicitis. The
aggravated by moving or walking, rebound nurse should prepare the client for which
tenderness of McBurney point, and extension or collaborative intervention?
internal rotation of the right hip that increases pain
and confusion. A little less than half demonstrate A. Chest x-ray
no rebound or involuntary guarding. Pain typically B. Abdominal ultrasound
migrates down to the lower right quadrant in C. Electrolytes
appendicitis. D. Complete blood count (CBC)
Answer: B provided after the surgery. A laparoscopic
Rationale: Abdominal ultrasound is the most appendectomy is performed for clients whose
effective test for diagnosing acute appendicitis. appendix has not ruptured.
Electrolyte testing provides information relating to
the mineral balance in the body. A CBC would be Which condition prompts the nurse to recommend
drawn, but it is not a definitive test to diagnose a clear liquid diet to a postappendectomy client?
acute appendicitis. Chest x-rays are not used to A. Client denies any nausea
diagnose abdominal conditions. B. Client no longer reports pain
C. Client is afebrile
For which collaborative therapy for peritonitis D. Client's bowel sounds have returned
following a ruptured appendix should the nurse
prepare the client? (Select all that apply.) Answer: D
Rationale: Once bowel sounds return, a client can
A. Antibiotics begin taking clear fluids. The postoperative client is
B. A low-fat, high-calorie diet expected to be afebrile. Pain will subside as healing
C. Passive range of motion continues. Nausea would be subsided for the client
D. Fluid resuscitation to resume a PO diet, but it is the presence of bowel
E. Surgery sounds that would indicate the gastrointestinal
tract's ability to handle digestion.
Answer: A, D, E
Rationale: Clinical therapies for the treatment of A client had a laparoscopic appendectomy last
peritonitis include removal of the ruptured night. Which assessment finding should concern
appendix, antibiotics, and fluid resuscitation. A the nurse?
low-fat, high-calorie diet and passive range of
motion are not therapies used to treat peritonitis A. Dry wound
after a ruptured appendix. B. Adequate fluid intake
C. Pain
The nurse is caring for a client admitted for a D. Fever
ruptured appendix. Which information should the
nurse expect to provide to this client? (Select all Answer: D
that apply.) Rationale: Fever would be an indication of a
possible infection. Postoperative pain is expected.
A. A laparotomy will be performed. Adequate fluid intake and a dry wound are positive
B. Intravenous fluids will be provided. recovery signs.
C. Antibiotic medication will be provided before
and after the surgery. For which intervention are African American
D. Pain medication will be provided after the children with appendicitis less likely to receive in
surgery. the emergency department?
E. A laparoscopic appendectomy will be performed.
A. IV fluids
Answer: A, B, C, D B. Adequate pain medication
C. Postoperative teaching
Rationale: For a ruptured appendix, a laparotomy D. Surgical intervention
will be performed. The client will receive antibiotics
before and after the surgery to prevent the Answer: B
development of infection from fecal contents, Rationale: African American children are less likely
which have spilled into the abdominal cavity. to receive adequate medication in emergency
Intravenous fluids will be provided to maintain fluid departments for pain during episodes of
and electrolyte balance. Pain medication will be
appendicitis. Nurses should advocate for D. Notifying the healthcare provider with changes
appropriate pain management for all clients. E. Avoiding nonsteroidal anti-inflammatory drugs
(NSAID)
A client with acute appendicitis asks the nurse,
"Why don't you give me a heating pad? I think that Answer: A, B, C, D
will help me with my pain." The nurse's response
should be based on which reason? Rationale: The client with uncomplicated
appendectomy is often discharged home the day of
A. It increases the need for fluids. the surgery or the day after. Postoperative
B. It increases the spread of infection. teaching includes wound care, including hand
C. It reduces white blood cell count. hygiene and dressing changes as indicated; to
D. It encourages perforation. report to the healthcare provider fever, increased
abdominal pain, swelling, redness, drainage,
Answer: D bleeding, or warmth of the operative site; activity
Rationale: Heat should not be applied to the limitations (e.g., lifting); and return to work if
abdomen since this increases circulation to the appropriate. The client can take NSAIDs for pain.
appendix and could cause perforation. It is not true
that heat is avoided in acute appendicitis because The nurse is evaluating a client recovering at home
it increases the need for fluids, increases the after an emergency appendectomy. Which
spread of infection, or reduces white blood cell observation indicates that self-care has been
count. effective? (Select all that apply.)

A client is admitted with acute appendicitis. Which A. The client snacks on pretzels and club soda
nursing diagnosis may be appropriate for this during the visit.
client? (Select all that apply.) B. The client plans to recover at home until cleared
by the surgeon.
A. Nutrition, Imbalanced: Less than Body C. The client uses a pillow to splint the incision
Requirements before coughing.
B. Fluid Volume: Deficit, Risk for D. The client performs abdominal wound care
C. Tissue Perfusion: Peripheral, Ineffective appropriately.
D. Infection, Risk for E. The client requests a prescription for more pain
E. Pain, Acute medication.
Answer: B, D, E
Rationale: A client with acute appendicitis would Answer: B, C, D
experience pain at the site. Any patient who has Rationale: Observations that indicate that the
undergone surgery is at risk for fluid depletion and client is appropriately providing self-care after an
infection of the wound. Nutritional status and appendectomy include using a pillow to splint the
change in peripheral perfusion are not nursing incision before coughing, performing wound care
problems appropriate for the client with appropriately, and planning to recover at home
appendicitis. until cleared by the surgeon. Observations that
indicate that self-care could improve include the
The nurse is providing discharge teaching to a need for more pain medication and ingesting a
client who is recovering from an uncomplicated less-than-nutritious snack.
appendectomy. Which information should the
nurse include? (Select all that apply.)

A. Caring for the wound

B. Recognizing manifestations of infection
C. Increasing physical activity
The nurse is preparing to conduct a physical Answer A
examination on a client diagnosed with In patients with suspected appendicitis, Rovsing
appendicitis. Which intervention should the nurse sign may be elicited by palpation of the left lower
include in this assessment? (Select all that apply.) quadrant, causing pain to be felt in the right lower
quadrant.
A. Characteristics of bowel sounds
B. Presence of abdominal pain on palpation Which of the following position should the client
C. Presence of blood in the stool with appendicitis assume to relieve pain ?
D. Contour of the abdomen
E. Current body temperature A. Prone B. Sitting C. Supine D. Lying with legs
drawn up
Answers: A, B, D, E
Rationale: When conducting the physical Correct Answer: D Lying still with legs drawn up
assessment on a client with appendicitis, the nurse towards chest helps relive tension on the
should include abdominal contour, current body abdominal muscle, which helps to reduce the
temperature, characteristics of bowel sounds, and amount of discomfort felt. Lying flat or sitting may
whether the client is experiencing tenderness to increase the amount of pain experienced
light palpation. Blood in the stool is not an area to
assess in the client with appendicitis. "When evaluating a male client for complications
of acute pancreatitis, the nurse would observe for:
The nurse would increase the comfort of the
patient with appendicitis by: "a. increased intracranial pressure.
b. decreased urine output.
"a. Having the patient lie prone c. bradycardia.
b. Flexing the patient's right knee d. hypertension."
c. Sitting the patient upright in a chair
d. Turning the patient onto his or her left side Correct Answer: B
Rationale: Acute pancreatitis can cause decreased
Correct answer: B" urine output, which results from the renal failure
The patient with appendicitis usually prefers to lie that sometimes accompanies this condition.
still, often with the right leg flexed to decrease Intracranial pressure neither increases nor
pain. decreases in a client with pancreatitis. Tachycardia,
not bradycardia, usually is associated with
"The nurse is caring for a patient in the emergency pulmonary or hypovolemic complications of
department with complaints of acute abdominal pancreatitis. Hypotension can be caused by a
pain, nausea, and vomiting. When the nurse hypovolemic complication, but hypertension
palpates the patient's left lower abdominal usually isn't related to acute pancreatitis."
quadrant, the patient complains of pain in the right
lower quadrant. The nurse will document this as
which of the following diagnostic signs of
appendicitis?

"a. Rovsing sign

b. referred pain
c. Chvostek's sign
d. rebound tenderness

correct answer: A"

"A client is admitted with a diagnosis of acute A client is admitted with right lower quadrant pain,
appendicitis. When assessing the abdomen, the anorexia, nausea, low-grade fever, and elevated
nurse would expect to find rebound tenderness at white blood cell count. Which complication is most
which location? likely the cause?

a) Left lower quadrant 1. A. fecalith 2. Bowel Kinking 3. Internal blowel

b) Left upper quadrant occlusion 4. Abdominal wall swelling
c) Right upper quadrant
d) Right lower quadrant "Answer 1
Rational: The client is experiencing appendicitis. A.
Correct answer: d) Right lower quadrant" fecalith is a fecal calculus, or stone, that occludes
Rationale: The pain of acute appendicitis localizes the lumen of the appendix and is the most
in the right lower quadrant (RLQ) at McBurney's common cause of appendicitis. Bowel wall swelling,
point, an area midway between the umbilicus and kinking of the appendix, and external occlusion not
the right iliac crest. Often, the pain is worse when internal occlusion, of the bowel by adhesions can
manual pressure near the region is suddenly also be cause of appendicitis."
released, a condition called rebound tenderness.
A client with acute appendicitis develops a fever,
The nurse is monitoring a client diagnosed with tachycardia, and hypotension. Based on these
appendicitis who is scheduled for surgery in 2 assessment findings, the nurse should
hours. The client begins to complain of increased further assess the client for which of the following
abdominal pain and begns to vomit. On complications?...
assessment, the nurse notes that the abdomen is
distended and bowel sounds are diminished. Which "1. Deficient fluid volume.
is the appropriate nursing intervention? 2. Intestinal obstruction.
3. Bowel ischemia.
"1. Notify the Physician 4. Peritonitis
2. Administer the prescribed pain medication
3. Call and ask the operating room team to perform Correct 4
the surgery as soon as possible "Complications of acute appendicitis are
4. Reposition the client and apply a heating pad on perforation, peritonitis, and
warm setting to the client's abdomen abscess development. Signs of the development of
peritonitis include
CORRECT ANSWER: 1" abdominal pain and distention, tachycardia,
"1. Based on the assessment information the nurse tachypnea, nausea, vomiting,
should suspect peritonitis, a complication that is and fever. Because peritonitis can cause
associated with appendicitis, and notify the hypovolemic shock, hypotension
physician. can develop. Deficient fluid volume would not
2. Administering pain medication is not an cause a fever. Intestinal
appropriate intervention obstruction would cause abdominal distention,
3. Scheduling surgical time is not within the scope diminished or absent
of practice of an RN. bowel sounds, and abdominal pain. Bowel ischemia
4. Heat should never be applied to the abdomen of has signs and symptoms
a patient suspected of having peritonitis because of similar to those found with intestinal obstruction."
the risk of rupture."
 appendix, and external occlusion, not internal
"The client diagnosed with appendicitis has occlusion, of the bowel by adhesions can also be
undergone an appendectomy. At two hours causes of appendicitis.
postoperative, the nurse takes the vital signs and
notes T 102.6 F, P 132, R 26, and BP 92/46. Which "During the assessment of a patient with acute
interventions should the nurse implement? List in abdominal pain, the nurse should:
order of priority.
a. perform deep palpation before auscultation
1. Increase the IV rate. b. obtain blood pressure and pulse rate to
2. Notify the health care provider. determine hypervolemic changes
3. Elevate the foot of the bed. c. auscultate bowel sounds because hyperactive
4. Check the abdominal dressing. bowel sounds suggest paralytic ileus
5. Determine if the IV antibiotics have been d. measure body temperature because an elevated
administered. temperature may indicate an inflammatory or
infectious process.
Order of priority: 1, 3, 4, 5, 2."
"1. The nurse should increase the IV rate to Correct D
maintain the circulatory system function until Rationale: for the patient complaining of acute
further orders can be obtained. abdominal pain, nurse should take vital signs
3. The foot of the bed should be elevated to help immediately. Increased pulse and decreasing blood
treat shock, the symptoms of which include pressure are indicative of hypovolemia. An
elevated pulse and decreased BP. Those signs and elevated temperature suggests an inflammatory
an elevated temperature indicate an infection may infectious process. Intake and output
be present and the client could be developing measurements provide essential information about
septicemia. the adequate of vascular volume. Inspect abdomen
4. The dressing should be assessed to determine if first and then auscultate bowel sounds. Palpation is
bleeding is occurring. performed next and should be gentle.
5. The nurse should administer any IV antibiotics
ordered after addressing hypovolemia. The nurse
will need this information when reporting to the A client complains of severe pain in the right lower
HCP. quadrant of the abdomen. To assist with pain
2. The HCP should be notified when the nurse has relief, the nurse should take which of the following
the needed information." actions?
"
A client is admitted with right lower quadrant pain, "1. Encourage the client to change positions
anorexia, nausea, low-grade fever, and an elevated frequently in bed
white blood cell count. Which complication is most 2. Massage the right lower quadrant fo the
likely the cause? abdomen
3. Apply warmth to the abdomen with a heating
"1. A fecalith pad
2. Bowel kinking 4. Use comfort measures and pillows to position
3. Internal bowel occlusion the client"
4. Abdominal wall swelling"
Correct 1 Correct 4
"1. ""Encourage the client..."" - unnecesary
The client is experiencing appendicitis. A fecalith is movement will increase pain and should be
a fecal calculus, or stone, that occludes the lumen avoided
of the appendix and is the most common cause of 2. ""Massage the lower..."" - if appendicitis is
appendicitis. Bowel wall swelling, kinking of the suspected, massorge or palpation should never be
performed as thes actions may cause the appendix Blood glucose, gastric pH, and potassium levels are
to rupture not direct indicators of acute pancreatic
3. ""Apply warmth..."" - if pain is casused by dysfunction.
appendicitis, increased circulation from the heat
may cause appendix to rupture Which client requires immediate nursing
4. ""Use comfort measures..."" - CORRECT: non- intervention? "The client who:
pharmacological methods of pain relief"
a) complains of epigastric pain after eating.
b) complains of anorexia and periumbilical pain.
"A nurse is caring for a client admitted to the c) presents with ribbonlike stools.
hospital with a suspected diagnosis of acute d) presents with a rigid, boardlike abdomen.
appendicitis. Which of the following laboratory
results would the nurse expect to note if the client Correct: D
does have appendicitis? A rigid, boardlike abdomen is a sign of peritonitis, a
possibly life-threatening condition. Epigastric pain
1. Leukopenia with a shift to the right occurring 90 minutes to 3 hours after eating
2. Leukocytosis with a shift to the right indicates a duodenal ulcer. Anorexia and
3.Leukocytosis with a shift to the left periumbilical pain are characteristic of appendicitis.
4. Leukopenia with a shift to the left" Risk of rupture is minimal within the first 24 hours,
Answer 2 - no rationale but increases significantly after 48 hours. A client
with a large-bowel obstruction may have ribbonlike
An 18 yr old is admitted with an acute onset of stools.
right lower quadrant pain. Appendicitis is
suspected. For which clinical indicator should the "The nurse is admitting a client with acute
nurse assess the client to determine if the pain is appendicitis to the emergency department. The
secondary to appendicitis client has abdominal pain of 10 on a pain scale of 1
to 10. The client will be going to surgery as soon as
A) urinary retention possible. The nurse should:
B) gastric hyperacidity
C) rebound tenderness "1. Contact the surgeon to request an order for a
D) increased lower bowel motility narcotic for the pain.
2. Maintain the client in a recumbent position.
C) rebound tenderness is a classic subjective sign of 3. Place the client on nothing-by-mouth (NPO)
appendicitis status.
4. Apply heat to the abdomen in the area of the
"The health care team is assessing a patient for pain."
acute pancreatitis after he presented to the Correct: 3 - no rationale
emergency department with severe abdominal
pain. Which laboratory value is the best diagnostic "A client with appendicitis is experiencing
indicator of acute pancreatitis? excruciating abdominal pain. An abdominal X-ray
film reveals intraperitoneal air. The nurse should
A. Gastric pH prepare the client for:
B. Blood glucose
C. Serum amylase a) colonoscopy.
D. Serum potassium b) surgery.
c) nasogastric (NG) tube insertion.
Correct: C d) barium enema."
Serum amylase levels indicate pancreatic function, "
and they are used to diagnose acute pancreatitis.
B) Surgery The nurse is admitting a client with the diagnosis of
The client should be prepared for surgery because appendicitis to the surgical unit. Which question is
his signs and symptoms indicate bowel perforation. essential to ask?
Appendicitis is the most common cause of bowel
perforation in the United States. Because A."When did you last eat?"
perforation can lead to peritonitis and sepsis, B."Have you had surgery before?"
surgery wouldn't be delayed to perform other C."Have you ever had this type of pain before?"
interventions, such as colonoscopy, NG tube D."What do you usually take to relieve your pain?"
insertion, or a barium enema. These procedures
aren't necessary at this point." answer A. When a person is admitted with possible
appendicitis, the nurse should anticipate surgery. It
A client has surgery for a perforated appendix with will be important to know when she last ate when
localized peritonis. In which position should the considering the type of anesthesia so that the
nurse place the client? chance of aspiration can be minimized. The other
inoformation is "nice to know", but not essential.
A) Sims position
B) trendelenburg Which of the nursing interventions should be
C) semi-fowlers implemented to manage appendicitis?
D)dorsal recumbant
a. Assess pain
C. Semi-fowlers aids in drainage and prevents b. encourage oral intake of clear fluids.
spread of infection throughout the abodominal c. provide discharge teaching
cavity. D. assess for symptoms of peritonitis.

A nurse is making a home health visit and finds the answer D. Monitor for peritonitis because if the
client experiencing right lower quadrant abdominal appendix ruptures, bacteria can enter the
pain, which has decreased in intensity over the last peritoneum. Pain will be managed with analgesics,
day. The client also has a rigid abdomen and a and pt should be NPO for surgery. Discharge is not
temperature of 103.6 F. The nurse should done at this time
intervene by:
A client with complaints of right lower quadrant
a) administer Tylenol (acetaminophen) for the pain is admitted to the emergency department.
elevated temperature Blood specimens are drawn and sent to the
b) advising the client to increase oral fluids laboratory. Which laboratory finding should be
c) asking the client when she last had a bowel reported to the physician immediately?
movement
d) notifying the physician "a) Hematocrit 42%
b) Serum potassium 4.2 mEq/L
Correct D c) Serum sodium 135 mEq/L
D. The client symptoms indicate appendicitis which d) White blood cell (WBC) count 22.8/mm3.
requires immediate attention Answer: D
"D) White blood cell (WBC) count 22.8/mm3
The nurse should report the elevated WBC count.
This finding, which is a sign of infection, indicates
that the client's appendix might have ruptured.
Hematocrit of 42%, serum potassium of 4.2 mEq/L,
and serum sodium of 135 mEq/L are within normal
limits. Alterations in these levels don't indicate
appendicitis."
 "A client has an appendectomy and develops
The doctor ordered for a complete blood count. peritonitis. The nurse should asses the client for an
After the test, Nurse Ray received the result from elevated temperature and which additional clinical
the laboratory. Which laboratory values will indication commonly associated with peritonitis?
confirm the diagnosis of appendicitis?
"1. hyperactivity
a. RBC 5.5 x 106/mm3 2. extreme hunger
b. Hct 44 % 3. urinary retention
c. WBC 13, 000/mm3 4. local muscular rigidity
d. Hgb 15 g/dL"
Correct: 4
Answer C muscular rigidity over the affected area is a classic
"Rationale: Increase in WBC counts is suggestive of sign of peritonitis
appendicitis because of bacterial invasion and
inflammation. Normal WBC count is 5, 000 - 10, A nurse is caring for a child who had a laproscopic
000/mm3. Other options are normal values." appendectomy. What interventions should the
nurse document on the child's clinical record?
A client has an appendectomy. This is an example Select all that apply.
of what kind of surgery?
1) Intake and Output
a. Diagnostic b. palliative c. ablative d. constructive 2) Measurement of Pain
3) Tolerance to low-residue diet
Correct: C 4) Frequency of dressing changes
Appendectomy is an example of ablative surgery. 5) Auscultation of bowel sounds
Diagnostic confirms or establishes a diagnosis,
palliative relieves or reduces pain, and constructive Answer: 1, 2, 5
restores function or appearance.
1) Assessment and documentation of fluid balance
A school-aged child has an emergency are critical aspects of all postoperative care. 2)
appendectomy. The nurse should report which of Laparoscopic surgery involves insufflating the
the following to the HCP if notes in the immediate abdominal cavity with air, which is painful until it is
postoperative period. absorbed. The amount of pain should be measured
and documented with either a 1-10 scale or the
1. abdominal pain, Wong's FACES for younger children. 3) A special
2. tugging at the incision line, diet is not indicated after this surgery. 4) After a
3. thirst, laparoscopic appendectomy there is little drainage
4 a rigid abdomen and no dressings. 5) Auscultating for bowel sounds
and documenting their presennce or absence
Answer: 4 evaluate the child's adaptation to the intestinal
trauma caused by the surgery.
Rationale: A tense, rigid abdomen is an early
symptom of peritonitis. The other findings are The nurse is assessing an adolescent who is
expected in the immediate postoperative period. admitted to the hospital with appendicitis. The
nurse should report which of the following to the
HCP?

"1) change in pain rating of 7 to 8 on a 10 point

scale.
2) sudden relief of sharp pain, shifting to diffuse
pain. temperature may indicate an inflammatory or
3)shallow breathing with normal vital signs. infectious process"
4) decrease of pain rating from 8 to 6 when parents
visit. "Correct answer: d
Rationale: For the patient complaining of acute
Answer: 2 abdominal pain, the nurse should take vital signs
Rationale: The nurse notifies the HCP if the client immediately. Increased pulse and decreasing blood
has sudden relief of sharp pain and on presence of pressure (BP) are indicative of hypovolemia. An
more diffuse pain. this change in the pain indicates elevated temperature suggests an inflammatory or
the appendix has ruprured. The diffuse pain is infectious process. Intake and output
typically accompanied by rigid guarding of the measurements provide essential information about
abdomen, progressive abdominal distension, the adequacy of vascular volume. Inspect the
tachycardia, pallor, chills, and irritability. The slight abdomen first and then auscultate bowel sounds.
increase pain can be expected; the decrease in pain Palpation is performed next and should be gentle."
when parents visit may be attributed to being
distracted from the pain. shallow breathing is likely A nurse is providing wound care to a client 1 day
due to the pain and is insignificant when other vital after the client underwent an appendectomy. A
signs are normal drain was inserted into the incisional site during
surgery. Which action should the nurse perform
Bobby, a 13 year old is being seen in the when providing wound care?
emergency room for possible appendicitis. An
important nursing action to perform when 1. Remove the dressing and leave the incision open
preparing Bobby for an appendectomy is to:"" to air.
2. Remove the drain if wound drainage is minimal.
a) administer saline enemas to cleanse the bowels 3. Gently irrigate the drain to remove exudate.
b) apply heat to reduce pain 4. Clean the area around the drain moving away
c) measure abdominal girth from the drain.
d) continuously monitor pain
Correct 4
Answer: D The nurse should gently clean the area around the
Rationale: Pain is closely monitored in appendicitis. drain by moving in a circular motion away from the
In most cases, pain medication is not given until drain. Doing so prevents the introduction of
prior to surgery or until the diagnosis is confirmed microorganisms to the wound and drain site. The
to be able to closely monitor the progression of the incision cannot be left open to air as long as the
disease. A sudden change in the character of pain drain is intact. The nurse should note the amount
may indicate rupture or bowel perforation. and character of wound drainage, but the surgeon
Administering an enema or applying heat may will determine when the drain should be removed.
cause perforation and abdominal girth may not Surgical wound drains are not irrigated.
change with appendicitis.
which statement made by the client who is
During the assessment of a patient with acute postoperative abdominal surgery indicates the
abdominal pain, the nurse should: discharge teaching has been effective?

a. Perform deep palpation before ascultation 1. "i will take my temp each week and report any
b. Obtain blood pressure and pulse rate to elevation."
determine hypervolemic changes 2. "i will not need any pain meds when i go home."
c. Ascultate bowel sounds because hyperactive 3. i will take all of my antibiotics until they are
bowel sounds suggest paralytic ileus gone."
d. Measure body temperature because an elevated
 4. i will not take a shower until my three month Correct A
check up. "Pain over McBurney's point, the point halfway
between the umbilicus and
Correct 3 the iliac crest, is diagnosis for appendicitis. Options
1. the client should check the temp twice a day. b and c are
2. it is not realistic to expect the client to common with ulcers; option d may suggest
experience no pain after surgery. ulcerative"
3 (CORRECT): this statement about taking all the
antibiotics ordered indicates the teaching is Which of the following would indicate that Bobby's
effective. appendix has ruptured? "
4. clients may shower after surgery, but not taking
a tub bath for three months after surgery is too a) diaphoresis
long a time. b) anorexia
c) pain at Mc Burney's point
The nurse is admitting a client with acute d) relief from pain
appendicitis to the emergency department. The
client has abdominal pain of 10 on a pain scale of 1 Correct D
to 10. The client will be going to surgery as soon as all are normal signs of having appendicits and once
possible. The nurse should: you have relief from pain means you could have a
rupture.
"1. Contact the surgeon to request an order for a
narcotic for the pain. Which of the following complications is thought to
2. Maintain the client in a recumbent position. be the most common cause of appendicitis?
3. Place the client on nothing-by-mouth (NPO)
status. a. A fecalith
4. Apply heat to the abdomen in the area of the b. Internal bowel occlusion
pain." c. Bowel kinking
d. Abdominal wall swelling"
Correct: 3
Answer: A. A fecalith
The nurse should place the client on NPO status in
anticipation of surgery. The nurse can initiate pain Rationale: A fecalith is a hard piece of stool which
relief strategies, such as relaxation techniques, but is stone like that commonly obstructs the lumen.
the surgeon will likely not order narcotic Due to obstruction, inflammation and bacterial
medication prior to surgery. The nurse can place invasion can occur. Tumors or foreign bodies may
the client in a position that is most comfortable for also cause obstruction."
the client. Heat is contraindicated because it may
lead to perforation of the appendix The client with severe abdominal pain is being
evaluated for appendicitis. What is the most
Which of the following would confirm a diagnosis common cause of appendicistis?
of appendicitis?
1. Rupture of the appendix
"a. The pain is localized at a position halfway 2.Obstruction of the appendix
between the umbilicus and the right iliac crest. 3 A high-fat diet
b. Mr. Liu describes the pain as occurring 2 hours 4. A duodenal ulcer
after eating
c. The pain subsides after eating Correct 2
d. The pain is in the left lower quadrant" Appendicitis most commonly results from
obstruction of the appendix, which may lead to
rupture. A high-fat diet or duodenal ulcer doesn't could lead to peritonitis, a life-threatening
cause appendicitis; however, a client may require complication; therefore, thenurse should assess
dietary restrictions after an appendectomy this client first.
3.Bowel sounds should return within 24 hoursafter
"A client with acute appendicitis develops a fever, abdominal surgery. Absent bowel soundsat four (4)
tachycardia, and hypotension. Based on these hours postoperative would not beof great concern
assessment findings, to the nurse
the nurse should further assess the client for which 4.The client being discharged would be stableand
of the following complications?" " not a priority for the nurse"

1. Deficient fluid volume. "The nurse is caring for a patient following an

2. Intestinal obstruction. appendectomy. The patient
3. Bowel ischemia. takes a deep breath, coughs, and then winces in
4. Peritonitis. pain. Which of the
following statements, if made by the nurse to the
Answer 4 patient, is BEST?
Complications of acute appendicitis are "
perforation, peritonitis, and abscess development. A.) "Take three deep breaths, hold your incision,
Signs of the development of peritonitis include and then cough."
abdominal pain and distention, tachycardia, B.) "That was good. Do that again and soon it won't
tachypnea, nausea, vomiting, and fever. Because hurt as much."
peritonitis can cause hypovolemic shock, C.) "It won't hurt as much if you hold your incision
hypotension can develop. Deficient fluid volume when you cough."
would not cause a fever. Intestinal obstruction D.) "Take another deep breath, hold it, and then
would cause abdominal distention, diminished or cough deeply."
absent bowel sounds, and abdominal paIn. Bowel
ischemia has signs and symptoms similar to those "(1) correct-most effective way of deep breathing
found with intestinal obstruction. and coughing, dilates airway and
expands lung surface area
The nurse is caring for the following clients on a (2) should splint incision before coughing to reduce
surgical unit. Which client would the nurse assess discomfort and increase
first? efficiency
(3) partial answer, should take three deep breaths
1.The client who had an inguinal hernia repair and before coughing
has not voided in four (4) hours. (4) implies coughing routine is adequate, incision
2.The client who was admitted with abdominal needs to be splinted"
pain who suddenly has no pain.
3.The client four (4) hours postoperative abdominal
surgery with no bowel sounds.
4.The client who is one (1) day postoperative
appendectomy who is being discharged"

Correct: 2
"1. A client who has not voided within four
(4)hours after any surgery would not be priority.
This is an acceptable occurrence, but if the client
hasn't voided for eight (8) hours, then the nurse
would assess further.
2.This could indicate a ruptured appendix, which
 A 54-year-old patient admitted with type 2
DIABETES MELLITUS diabetes, asks the nurse what "type 2" means.
Which of the following is the most appropriate
"1. A patient with newly diagnosed type 2 diabetes response by the nurse?
mellitus asks the nurse what ""type 2"" means in
relation to diabetes. The nurse explains to the "1. ""With type 2 diabetes, the body of the
patient that type 2 diabetes differs from type 1 pancreas becomes inflamed."
diabetes primarily in that with type 2 diabetes 2. "With type 2 diabetes, insulin secretion is
decreased and insulin resistance is increased."
a. the pt is totally dependent on an outside source 3. "With type 2 diabetes, the patient is totally
of insulin dependent on an outside source of insulin."
b. there is a decreased insulin secretion and cellular 4. "With type 2 diabetes, the body produces
resistance to insulin that is produced autoantibodies that destroy b-cells in the
c. the immune system destroys the pancreatic pancreas.""
insulin-producing cells
d. the insulin precurosr that is secreted by the "Right Answer: 2
pancreas is not activated by the liver Rationale: In type 2 diabetes mellitus, the secretion
of insulin by the pancreas is reduced and/or the
Answer B - Rationale: In type 2 diabetes, the cells of the body become resistant to insulin"
pancreas produces insulin, but the insulin is
insufficient for the body's needs or the cells do not "A client is admitted to the hospital with signs and
respond to the insulin appropriately. The other symptoms of diabetes mellitus. Which findings is
information describes the physiology of type 1 the nurse most likely to observe in this client?
diabetes Select all that apply:
"
18. The benefits of using an insulin pump include 1. Excessive thirst
all of the following except: " 2. Weight gain
3. Constipation
a. By continuously providing insulin they eliminate 4. Excessive hunger
the need for injections of insulin 5. Urine retention
b. They simplify management of blood sugar and 6. Frequent, high-volume urination
often improve A1C
c. They enable exercise without compensatory 1, 4, 6 Rationale: Classic signs of diabetes mellitus
carbohydrate consumption include polydipsia (excessive thirst), polyphagia
d. They help with weight loss (excessive hunger), and polyuria (excessive
urination). Because the body is starving from the
D: Using an insulin pump has many advantages, lack of glucose the cells are using for energy, the
including fewer dramatic swings in blood glucose client has weight loss, not weight gain. Clients with
levels, increased flexibility about diet, and diabetes mellitus usually don't present with
improved accuracy of insulin doses and delivery; constipation. Urine retention is only a problem is
however, the use of an insulin pump has been the patient has another renal-related condition.
associated with weight gain.
A client is brought to the emergency department in c. irritability, diaphoresis, and tachycardia
an unresponsive state, and a diagnosis of d. diarrhea, abdominal pain, and weight loss
hyperglycemic hyperosmolar nonketotic syndrome "
is made. The nurse would immediately prepare to a. Polydispisa, polyuria, and weight loss"Symptoms
initiate which of the following anticipated of hyperglycemia include polydipsia, polyuria, and
physician's prescriptions? weight loss. Metformin and sulfonylureas are
commonly ordered medications.
1. Endotracheal intubation
2. 100 units of NPH insulin Weight gain, tiredness, and bradycardia are
3. Intravenous infusion of normal saline symptoms of hypothyroidism.
4. Intravenous infusion of sodium bicarbonate
Irritability, diaphoresis, and tachycardia are
CORRECT ANSWER: 3. Intravenous infusion of symptoms of hypoglycemia.
normal saline Rationale: The primary goal of
treatment is hyperglycemic hyperosmolar Symptoms of Crohn's disease include diarrhea,
nonketotic syndrome (HHNS) is to rehydrate the abdominal pain, and weight loss."
client to restore the fluid volume and to correct
electrolyte deficiency. Intravenous fluid A client with diabetes mellitus demonstratees
replacement is similar to that administered in acute anxiety when first admitted for the
diabetic keto acidosis (DKA) and begins with IV treatment of hyperglycemia. The most appropriate
infusion of normal saline. Regular insulin, not NPH intervention to decrease the client's anxiety would
insulin, would be administered. The use of sodium be to
bicarbonate to correct acidosis is avoided because
it can precipitate a further drop in serum 1. administer a sedative
potassium levels. Intubation and mechanical 2. make sure the client knows all the correct
ventilation are not required to treat HHNS. medical terms to understand what is happening
3. ignore the signs and symptoms of anxiety so
"A client is taking Humulin NPH insulin daily every that they will soon disappear
morning. The nurse instructs the client that the 4. convey empathy, trust, and respect toward the
mostlikely time for a hypoglycemic reaction to client
occur is:
4. The most appropriate intervention is to address
A) 2-4 hours after administration the client's feelings related to the anxiety
B) 4-12 hours after administration
C) 16-18 hours after administration A client with diabetes melllitus has a blood glucose
D) 18-24 hours after administration of 644mg/dl. The nurse intreprets that this client is
most at risk of developing which type of acid base
B: Rationale: Humulin is an intermediate acting imbalance? "
insulin. The onset of action is 1.5 hours, it peaks in
4-12 hours, and its duration is 24 hours. A. Metabolic acidosis
Hypoglycemic reactions to insulin are most likely to B. Metabolic alkalosis
occur during the peak time. C. Respiratory Acidosis
D. Respiratory Alkalosis"
"A client who is started on metformin and "
glyburide would have initially presented with which Correct Answer: A, Metabolic Acidosis
symptoms? Rationale: DM can lead to metabolic acidosis.
When the body does not have sufficient circulating
"a. Polydispisa, polyuria, and weight loss insulin, the blood glucose level rises. At the same
b. weight gain, tiredness, & bradycardia time, the cells of the body use all available glucose.
The body then breaks down glycogen and fat for A diabetic patient has a serum glucose level of 824
fuel. The by-products of fat metabolism are mg/dL (45.7 mmol/L) and is unresponsive.
acidotic and can lead to the condition known as Following assessment of the patient, the nurse
diabetic ketoacidosis." suspects diabetic ketoacidosis rather than
hyperosmolar hyperglycemic syndrome based on
A client with DKA is being treated in the ED. What the finding of
would the nurse suspect? "
a. polyuria
1. Comatose state b. severe dehydration
2. Decreased Urine Output c. rapid, deep respirations )
3. Increased respirations and an increase in pH. d. decreased serum potassium"
4. Elevated blood glucose level and low plasma
bicarbonate level. C is correct, Signs and symptoms of DKA include
manifestations of dehydration such as poor skin
Correct Answer: 4 Rationale: In DKA the arteriole turgor, dry mucous membranes, tachycardia, and
pH is lower than 7.35, plasma bicarbonate is lower orthostatic hypotension. Early symptoms may
than 15 mEq/L, the blood glucose is higher than include lethargy and weakness. As the patient
250, and ketones are present in the blood and becomes severely dehydrated, the skin becomes
urine. The client would be experiencing polyuria dry and loose, and the eyeballs become soft and
and Kussmauls respirations would be present. A sunken. Abdominal pain is another symptom of
comatose state may occur if DKA is not treated. DKA that may be accompanied by anorexia and
vomiting. Kussmaul respirations (i.e., rapid, deep
breathing associated with dyspnea) are the body's
A client with type I diabetes is placed on an insulin attempt to reverse metabolic acidosis through the
pump. The most appropriate short-term goal when exhalation of excess carbon dioxide. Acetone is
teaching this client to control the diabetes is: " identified on the breath as a sweet, fruity odor.
Laboratory findings include a blood glucose level
1) adhere to the medical regimen greater than 250 mg/dL, arterial blood pH less than
2) remain normoglycemic for 3 weeks 7.30, serum bicarbonate level less than 15 mEq/L,
3) demonstrate the correct use of the and moderate to large ketone levels in the urine or
administration equipment. blood ketones.
4) list 3 self care activities that are necessary to
control the diabetes" "A frail elderly patient with a diagnosis of type 2
diabetes mellitus has been ill with pneumonia. The
3.) is correct cliet's intake has been very poor, and she is
"1) this is not a short-term goal admitted to the hospital for observation and
2) this is measurable, but it's a long-term goal management as needed. What is the most likely
3) this is a short-term goal, client oriented, problem with this patient?
necessary for the client to control the diabetes, and
measurable when the client performs a return "A. Insulin resistance has developed.
demonstration for the nurse B. Diabetic ketoacidosis is occuring.
4) although this is measurable and a short-term C. Hypoglycemia unawareness is developing.
goal, it is not the one with the greatest priority D. Hyperglycemic hyperosmolar non-ketotic coma.
when a client has an insulin pump that must be
mastered before discharge" D.Illness, especially with the frail elderly patient
" whose appetite is poor, can result in dehydration
and HHNC. Insulin resisitance is inidcated by a daily
insulin requirement of 200 units or more. Diabetic
ketoacidosis, an acute metabolic condition, usually
is caused by absent or markedly decreased C. Administer regular insulin intravenously Lack
amounts of insulin. (absolute or relative) of insulin is the primary cause
of DKA. Treatment consists of insulin
A home health nurse is at the home of a client with administration (regular insulin), intravenous fluid
diabetes and arthritis. The client has difficulty administration (normal saline initially), and
drawing up insulin. It would be most appropriate potassium replacement, followed by correcting
for the nurse to refer the client to: acidosis. Applying an electrocardiogram monitor is
not a priority action.
"A) A social worker from the local hospital
B) An occupational therapist from the community A nurse is interviewing a client with type 2 diabetes
center mellitus. which statement by the client indicated
C) A physical therapist from the rehabilitation an understanding of the treatment for this
agency disorder?
D) Another client with diabetes mellitus and takes
insulin" "1. ""i take oral insulin instead of shots""
2. ""by taking these medications I am able to eat
B) An occupational therapist can assist a client to more""
improve the fine motor skills needed to prepare an 3. ""when I become ill, I need to increase the
insulin injection. number of pills I take""
4. ""the medications I'm taking help release the
A nurse is caring for a cient with type 1 diabetes insulin I already make""
mellitus. which client complaint would alert the
nurse to the presence of a possible hypoglycemic 4.)Clients with type 2 diabetes mellitus have
reaction? decreased or imparied insulin secretion. Oral
hypoglycemic agents are given to these clients to
"1. Tremors facilitate glucose uptake. Insulin injections may be
2. Anorexia given during times of stress-induced
3. Hot, dry skin hyperglycemia. Oral insulin is not available because
4. Muscle cramps of the breakdown of the insulin by digestion.
Options 1, 2 and 3 are incorrect
1) tremors decreased blood glucose levels produce
autonomic nervous system symptoms, which are A nurse is preparing a plan of care for a client with
manifested classically as nervousness, irritability, diabetes mellitus who has hyerglycemia. The
and tremors. option 3 is more likely for priority nursing diagnosis would be:
hyperglycemia, and options 2 and 4 are unrelated
to the signs of hypoglycemia. 1. Deficient knowledge
2. Deficient fluid volume
"A nurse is caring for a client admitted to the 3. Compromised family coping
emergency department with diabetic ketoacidosis 4. Imbalanced nutrition less than body
(DKA). In the acute phase, the priority nursing requirements
action is to prepare to:
2) deficient fluid volume An increased blood
"A. Correct the acidosis glucose level will cause the kidneys to excrete the
B. Administer 5% dextrose intravenously glucose in the urine. This glucose is accompanied
C. Administer regular insulin inraVenously by fluids and electrolytes, causing an osmotic
D. Apply a monitor for an electrocardiogram." diuresis leading to dehydration. This fluid loss must
be replaced when it becomes severe.
A nurse is preparing a teaching plan for a client A patient is admitted with diabetes mellitus, has a
with diabetes Mellitus regarding proper foot care. glucose level of 380 mg/dl, and a moderate level of
Which instruction is included in the plan? ketones in the urine. As the nurse assesses for signs
of ketoacidosis, which of the following respiratory
1. Soak feet in hot water patterns would the nurse expect to find?"
2. apply a moisturizing lotion to dry feet but not
between the toes A-Central apnea
3. Always have a podiatrist cut your toenails, never B-Hypoventilation
cut them yourself C-Kussmaul respirations
4. avoid using mild soap on the feet D- Cheyne-Stokes respirations"

2. The client is instructed to use a moisturizing C-Kussmaul respirationsIn diabetic ketoacidosis,

lotion on the feet and to avoid applying the lotion the lungs try to compensate for the acidosis by
between the toes. blowing off volatile acids and carbon dioxide. This
leads to a pattern of Kussmaul respirations, which
"A nurse performs a physical assessment on a are deep and nonlabored.
client with type 2 diabetes mellitus. Findings
include a fasting blood glucose of 120 mg/dL, temp "A patient with type 1 diabetes has received diet
of 101 F, pulse of 88 bpm, respirations of 22, and instruction as part of the treatment plan. The nurse
blood pressure of 100/72. Which finding would be determines a need for additional instruction when
of most concern to the nurse? the patient says,
"
1. Pulse a. ""I may have an occasional alcoholic drink if I
2. Respiration include it in my meal plan.""
3. Temperature
4. Blood pressure" b. ""I will need a bedtime snack because I take an
evening dose of NPH insulin.""
3) temp. An elevated temperature may indicate
infection. Infection is a leading cause of c. ""I will eat meals as scheduled, even if I am not
hyperglycemic hyperosmolar nonketotic syndrome hungry, to prevent hypoglycemia.""
or diabetic ketoacidosis. The other findings noted
in the question are within normal limits. d. ""I may eat whatever I want, as long as I use
enough insulin to cover the calories.
"A nurse shoud recognize which symptom as a
cardinal sign of diabetes mellitus? "D. ""I may eat whatever I want, as long as I use
enough insulin to cover the calories.""
"a. Nausea
b. Seizure Rationale: Most patients with type 1 diabetes need
c. Hyperactivity to plan diet choices very carefully. Patients who are
d. Frequent urination using intensified insulin therapy have considerable
flexibility in diet choices but still should restrict
"D. Frequent Urination dietary intake of items such as fat, protein, and
alcohol. The other patient statements are correct
Polyphagia, polyuria, polydipsia, and weight loss and indicate good understanding of the diet
are cardinal signs of DM. Other signs include instruction."
irritability, shortened attention span, lowered
frustration tolerance, fatigue, dry skin, blurred
vision, sores that are slow to heal, and flushed
skin."
"An 18-year-old female client, 5'4'' tall, weighing "An adolescent client with type I diabetes mellitus
113 kg, comes to the clinic for a non-healing wound is admitted to the emergency department for
on her lower leg, which she has had for two weeks. treatment of diabetic ketoacidosis. Which
Which disease process should the nurse suspect assessment findings should the nurse expect to
the client is developing? note?

"A. Type 1 diabetes a) sweating and tremors

B. Type 2 diabetes b) hunger and hypertension
C. Gestational diabetes c) cold, clammy skin
D. Acanthosis nigricans" and irritability
d) fruity breath and decreasing
"A: Type 1 diabetes usually occurs in young clients level of consciousness
who are underweight.
In this disease, there is no production of insulin d) fruity breath and decreasing
from the beta cells level of consciousness"Hyperglycemia occurs with
in the pancreas. People with type 1 diabetes are diabetic ketoacidosis. Signs of hyperglycemia
insulin dependent with a include fruity breath and a decreasing
rapid onset of symptoms, including polyuria, level of consciousness. Hunger can be a sign of
polydipsia, and hypoglycemia or hyperglycemia, but hypertension
polyphagia. is not a sign of diabetic ketoacidosis. Instead,
hypotension occurs because of a decrease in blood
CORRECT -->B. Type 2 diabetes is a disorder usually volume related to the dehydrated state
occurring that occurs during diabetic ketoacidosis. Cold,
around the age of 40, but it is now being detected clammy skin, irritability, sweating, and tremors are
in children and young all signs of hypoglycemia."
adults as a result of obesity and sedentary
lifestyles. Non-healing An external insulin pump is prescribed for a client
wounds are a hallmark sign of type 2 diabetes. This with DM. The client asks the nurse about the
client weights 248.6 functioning of the pump. The nurse bases the
lbs and is short. response on the information that the pump:

C. Gestational diabetes occurs during pregnancy. "a. Gives small continuous dose of regular insulin
There is no mention of this. subcutaneously, and the client can self-administer
a bolus with an additional dosage from the pump
D. before each meal.
Acanthosis nigricans (AN), dark pigmentation and b. Is timed to release programmed doses of regular
skin creases in the or NPH insulin into the bloodstream at specific
neck, is a sign of hyperinsulinemia. The pancreas is intervals.
secreting excess c. Is surgically attached to the pancreas and infuses
amounts of insulin as a result of excessive caloric regular insulin into the pancreas, which in turn
intake. It is releases the insulin into the bloodstream.
identified in young children and is a precursor to d. Continuously infuses small amounts of NPH
the development of insulin into the bloodstream while regularly
type 2 diabetes." monitoring blood glucose levels"

ANSWER A. An insulin pump provides a small

continuous dose of regular insulin subcutaneously
throughout the day and night, and the client can
self-administer a bolus with additional dosage from
the pump before each meal as needed. Regular d.) although there is a tendency for children of
insulin is used in an insulin pump. An external people with type 2 diabetes to develop diabetes,
pump is not attached surgically to the pancreas. the risk is higher for those with type 1 diabetes."

Analyze the following diagnostic findings for your "B

patient with type 2 diabetes. Which result will need Rationale: Offspring of people with type 2 diabetes
further assessment? are at higher risk for developing type 2 diabetes.
A) BP 126/80 The risk can be decreased, but not prevented, by
B) A1C 9% maintenance of normal weight and exercising. The
C)FBG 130mg/dL risk for children of a person with type 1 diabetes to
D) LDL cholesterol 100mg/dL develop diabetes is higher when it is the father
who has the disease. Offspring of people with type
"B) A1C 9% 2 diabetes are more likely to develop diabetes than
Rationale: Lowering hemoglobin A1C (to average of offspring of those with type 1 diabetes."
7%) reduces microvascular and neuropathic
complications. Tighter glycemic control(normal A1C "Excessive thirst and volume of very dilute urine
< 6%) may further reduce complications but may be symptoms of:
increases hypoglycemia risk."
"A. Urinary tract infection
Blood sugar is well controlled when Hemoglobin B. Diabetes insipidus
A1C is... C. Viral gastroenteritis
D.Hypoglycemia"
"a. Below 7%
b. Between 12%-15% "Correct answer: B
c. Less than 180 mg/dL Diabetes insipidus is a condition in which the
d. Between 90 and 130 mg/dL" kidneys are unable to conserve water, often
because there is insufficient antidiuretic hormone
"a. Below 7% (ADH) or the kidneys are unable to respond to
ADH. Although diabetes mellitus may present with
A1c measures the percentage of hemoglobin that is similar symptoms, the disorders are different.
glycated and determines average blood glucose Diabetes insipidus does not involve
during the 2 to 3 months prior to testing. Used as a hyperglycemia."
diagnostic tool, A1C levels of 6.5% or higher on two
tests indicate diabetes. A1C of 6% to 6.5% is In educating a client with diabetes, what response
considered prediabetes." would reveal need for further education?

During a diabetes screening program, a patient A. I should avoid tights

tells the nurse, "My mother died of complications B. I should take good care of my toe nails
of type 2 diabetes. Can I inherit diabetes?" The C. I should not go more than 3 days without
nurse explains that washing my feet
D. I should avoid going barefoot and should wear
"a.) as long as the patient maintains normal weight clean socks
and exercises, type 2 diabetes can be prevented.
b.) the patient is at a higher than normal risk for C)I should not go more than 3 days w/o washing
type 2 diabetes and should have periodic blood my feet"The recommended self-care routine is to
glucose level testing. wash feet on a daily basis without
c.) there is a greater risk for children developing soaking and carefully cleaning."
type 2 diabetes when the father has type 2
diabetes.
Of which of the following symptoms might an older hyperglycemia
woman with diabetes mellitus complain? c. Damage to the kidneys from exposure to high
levels of glucose
1) anorexia d. Changes in RBCs resulting from attachment of
2)pain intolerance excessive glucose to hemoglobin"
3) weight loss
4) perineal itching b. Fluid shifts resulting from the osmotic effect of
hyperglycemia Rationale: The osmotic effect of
4) perineal itchingRationale: Older women might glucose produces the manifestations of polydipsia
complain of perineal itching due to vaginal and polyuria.
candidiasis.
"Polydipsia and polyuria related to diabetes
One of the benefits of Glargine (Lantus) insulin is its mellitus are primarily due to:
ability to:
"a. The release of ketones from cells during fat
"a.Release insulin rapidly throughout the day to metabolism
help control basal glucose. b. Fluid shifts resulting from the osmotic effect of
b. Release insulin evenly throughout the day and hyperglycemia
control basal glucose levels. c. Damage to the kidneys from exposure to high
c. Simplify the dosing and better control blood levels of glucose
glucose levels during the day. d. Changes in RBCs resulting from attachment of
d. Cause hypoglycemia with other manifestation of excessive glucose to hemoglobin
other adverse reactions.
b. Fluid shifts resulting from the osmotic effect of
B)Release insulin evenly throughout the day and hyperglycemia Rationale: The osmotic effect of
control basal glucose levels"Glargine (Lantus) glucose produces the manifestations of polydipsia
insulin is designed to release insulin evenly and polyuria.
throughout the day and control basal glucose
levels. "Prediabetes is associated with all of the following
except:
Patients with type 1 diabetes mellitus may require
which of the following changes to their daily " a. Increased risk of developing type 2 diabetes
routine during times of infection? b. Impaired glucose tolerance
c. Increased risk of heart disease and stroke
a. no change d. Increased risk of developing type 1 diabetes"
b. less insulin
c. more insulin "ANSWER: D
d. oral diabetic agents" Persons with elevated glucose levels that do not
yet meet the criteria for diabetes are considered to
answer C: during times of infection and illness have prediabetes and are at increased risk of
diabetic patients may need even more insulin to developing type 2 diabetes. Weight loss and
compensate for increased blood glucose levels. increasing physical activity can help people with
prediabetes prevent or postpone the onset of type
"Polydipsia and polyuria related to diabetes 2 diabetes."
mellitus are primarily due to:

"a. The release of ketones from cells during fat

metabolism
b. Fluid shifts resulting from the osmotic effect of
Risk factors for type 2 diabetes include all of the "The client diagnosed with type 1 diabetse is
following except: " receiving Humalog, a rapid-acting insulin, by sliding
scale. The order reads blood glucose level: <150,
a. Advanced age zero (0) units; 151 to 200, three (3) units; 201 to
b. Obesity 250, six (6 units); >251, contact health-care
c. Smoking provider. The unlicensed assistive personnel (UAP)
d. Physical inactivity" reports to the nurse the client's glucometer
reading is 189. How much insulin should the nurse
Smoking administer to the client?
"Additional risk factors for type 2 diabetes are a
family history of diabetes, 3 units
impaired glucose metabolism, history of
gestational diabetes, and race/ethnicity. African- The client's result is 189, which is between 151 and
Americans, Hispanics/Latinos, Asian Americans, 200, so the nurse should administer 3 units of
Native Hawaiians, Pacific Islanders, and Native Humalog insulin subcutaneously.
Americans are at greater risk of developing
diabetes than whites."

"The client diagnosed with Type 1 diabetes has a The client diagnosed with Type I diabetes is found
glycosylated hemoglobin (A1 lying unconscious on the floor of the bathroom.
c) of 8.1%. Which interpretation should the nurse Which interventions should the nurse implement
make based on this result? first?

1.This result is below normal levels. A. Administer 50% dextrose IVP.

2.This result is within acceptable levels. B. Notify the health-care provider.
3.This result is above recommended levels C. Move the client to ICD.
4.This result is dangerously high. D. Check the serum glucose level.

"1.The acceptable level for an A1c for a client with A) admin 50% dextrose IVPThe nurse should
diabetes is between 6% and 7%, which corresponds assume the client is hypoglycemic and administer
to a 120-140 mg/dL average blood glucose level. IVP dextrose, which will rouse the client
2.This result is not within acceptable levelsfor the immediately. If the collapse is the result of
client with diabetes, which is 6% to7%. hyperglycemia, this additional dextrose will not
3.(CORRECT) This result parallels a serum blood further injure the client.
glucoselevel of approximately 180 to 200 mg/dL.
An A1 "The client, an 18-year-old female, 5'4'' tall,
c is a blood test that reflects average blood glucose weighing 113 kg, comes to the clinic for a wound
levels over a period of 2-3months; clients with on her lower leg that has not healed for the last
elevated blood glucose levels are at risk for two (2) weeks. Which disease process would the
developing long-term complications. nurse suspect that the client has developed?
4.An A1c of 13% is dangerously high; it reflects a
300-mg/dL average blood glucose level overthe "1.Type 1 diabetes.
past 3 months." 2.Type 2 diabetes.
3.Gestational diabetes.
4.Acanthosis nigricans"

"Correct Answer: 2
Type 2 diabetes is a disorder that usually occurs
around the age of 40, but it is now being detected
in children and young adultsas a result of obesity The nurse assisting in the admission of a client with
and sedentary life-styles. Wounds that do not heal diabetic ketoacidosis will anticipate the physician
are a hall-mark sign of Type 2 diabetes. This client ordering which of the following types of
weighs 248.6 pounds and is short" intravenous solution if the client cannot take any
fluids orally? "
"The guidelines for Carbohydrate
Counting as medical nutrition therapy for diabetes a. 0.45% normal saline solution
mellitus includes all b. Lactated Ringer's solution
of the following EXCEPT: c. 0.9 normal saline solution
a. Flexibility in types and amounts of foods d. 5% dextrose in water (D5W)"
consumed
b. Unlimited intake of total fat, saturated fat and a. 0.45% normal saline solution Helps to hydrate
cholesterol patient and keep electrolyte levels balanced
c. Including adequate servings of fruits, vegetables
and the dairy group "The nurse caring for a 54-year-old patient
d. Applicable to with either Type 1 or Type 2 hospitalized with diabetes mellitus would look for
diabetes mellitusb. Unlimited intake of total fat, which of the following laboratory test results to
saturated fat and cholesterol" obtain information on the patient's past glucose
control?
B. You want to be careful of how much you eat in
any food group. a. prealbumin level
b. urine ketone level
"The nurse administered 28 units of Humulin N, an c. fasting glucose level
intermediate-acting insulin, to a client diagnosed d. glycosylated hemoglobin level
with Type 1 diabetes at 1600. Which action should
the nurse implement? Answer d: A glycosylated hemoglobin level detects
the amount of glucose that is bound to red blood
"1. Ensure the client eats the bedtime snack. cells (RBCs). When circulating glucose levels are
2. Determine how much food the client ate at high, glucose attaches to the RBCs and remains
lunch. there for the life of the blood cell, which is
3. Perform a glucometer reading at 0700. approximately 120 days. Thus the test can give an
4. Offer the client protein after administering indication of glycemic control over approximately 2
insulin. to 3 months.

1: ensure the client eats the bedtime snack"1. The nurse is caring for a client who has normal
Humulin N peaks in 6-8 hours, making the client at glucose levels at bedtime, hypoglycemia at 2am
risk for hypoglycemia around midnight, which is and hyperglycemia in the morning. What is this
why the client should receive a bedtime snack. This client likely experiencing?
snack will prevent nighttime hypoglycemia.
(Correct) "A. Dawn phenomenon
2. The food intake at lunch will not affect the B. Somogyi effect
client's blood glucose level at midnight. C. An insulin spike
3. The client's glucometer reading should be done D. Excessive corticosteroids"
around 2100 to assess the effectiveness of insulin "1. B
at 1600. The Somogyi effect is when blood sugar drops too
4. Humulin N is an intermediate-acting insulin that low in the morning causing rebound hyperglycemia
has an onset in 2-4 hours but does not peak until 6- in the morning. The hypoglycemia at 2am is highly
8 hours." indicative. The Dawn phenomenon is similar but
would not have the hypoglycemia at 2am."
The nurse is caring for a client with long-term Type 2. You will need to initially increase your insulin
2 diabetes and is assessing the feet. Which after the baby is born.
assessment data would warrant immediate 3. You will be able to take an oral hypoglycemic
intervention by the nurse? instead of insulin after the baby is born.
4. You will probably require the same dose of
"1)The client has crumbling toenails insulin that you are now taking."
2)The client has athlete's feet
3)The client has a necrotic big toe "1. breastfeeding has an antidiabetogenic effect,
4)The client has thickened toenails." less insulin is needed. (correct)
2. insulin needs will decrease due to
3) Nectrotic big toe" antidiabetogenic effect of breastfeeding and
physiological changes during immediate
1)Crumbling toenails indicate tinea unguium, which postpartum period.
is a fungus infection of the toenail. 3. client has IDDM, insulin required.
2)Athlete's foot is a fungal infection that is not life 4. during third trimester insulin requirements
threatening. increase due to increased insulin resistance"
3)A necrotic big toe indicates "dead" tissue. The
client does not feel pain in the lower extremity and "The nurse is discussing the importance of
does not realize there has been an injury and exercising to a client diagnosed with Type
therefore does not seek treatment. Increased 2diabetes whose diabetes is well controlled with
blood glucose levels decrease oxygen supply that is diet and exercise. Which information should the
needed to heal the wound and increase the risk for nurse include in the teaching about diabetes?
developing an infection.
4)Big, thick toenails are fungal infections and would 1.Eat a simple carbohydrate snack before
not require immediate intervention by the nurse; exercising.
50% of the adult population has this." 2.Carry peanut butter crackers when exercising.
3.Encourage the client to walk 20 minutes three (3)
"The nurse is caring for a patient whose blood times a week.
glucose level is 55mg/dL. What is the likely nursing 4.Perform warmup and cooldown exercises
response?
4. [correct] All clients who exercise should perform
"A. Administer a glucagon injection warmup and cool down exercises to help prevent
B. Give a small meal muscle strain and injury"
C. Administer 10-15 g of a carbohydrate
D. Give a small snack of high protein food" The nurse is educating a pregnant client who has
gestational diabetes. Which of the following
"C statements should the nurse make to the client?
The client has low hypoglycemia. This is generally Select all that apply.
treated with a small snack." "a. Cakes, candies, cookies, and regular soft drinks
should be avoided.
"The nurse is caring for a woman at 37 weeks b. Gestational diabetes increases the risk that the
gestation. The client was diagnosed with insulin- mother will develop diabetes later in life.
dependent diabetes mellitis (IDDM) at age 7. The c. Gestational diabetes usually resolves after the
client states, ""I am so thrilled that I will be baby is born.
breastfeeding my baby."" Which of the following d. Insulin injections may be necessary.
responses by the nurse is best? e. The baby will likely be born with diabetes
f. The mother should strive to gain no more weight
"1. You will probably need less insulin while you are during the pregnancy.
breastfeeding.
"ANS: A, B, C, D of three months
c. Lose a pound a week until weight is in normal
Gestational diabetes can occur between the 16th range for height and exercise 30 minutes daily
and 28th week of pregnancy. d. Practice relaxation techniques for at least five
minutes five times a day for at least five months"
If not responsive to diet and exercise, insulin
injections may be necessary. c. Lose a pound a week until weight is in normal
range for height and exercise 30 minutes daily
Concentrated sugars should be avoided. When type II diabetics lose weight through diet and
Weight gain should continue, but not in excessive exercise they sometimes have an improvement in
amounts. insulin efficiency sufficient to the degree they no
longer require oral hypoglycemic agents.
Usually, gestational diabetes disappears after the
infant is born. However, diabetes can develop 5 to "The principal goals of therapy for older patients
10 years after the pregnancy" who have poor glycemic control are:

"The nurse is teaching a community class to peole "A. Enhancing quality of life.
with Type 2 diabetes mellitus. Which explanation B. Decreasing the chance of complications.
would explain the development of Type 2 C. Improving self-care through education.
diabetes? D. All of the above."

1. The islet cells in the pancreas stop producing "D. All of the above.
insulin.
2. The client eats too many foods that are high in Rationale: The principal goals of therapy for older
sugar. persons with diabetes mellitus and poor glycemic
3 The pituitary gland does not produce control are enhancing quality of life, decreasing the
vasopression. chance of complications, improving self-care
4. The cells become resistant to the circulating through education, and maintaining or improving
insulin. general health status."

4. (CORRECT) Normally insulin binds to special "The risk factors for type 1 diabetes include all of
receptor sites on the cells and initiates a series of the following except:
reactions involved in metabolism. In Type 2
diabetes these reactions are diminished primarily "a. Diet
as a result of obesity and aging." b. Genetic
c. Autoimmune
"The nurse is working with an overweight client d. Environmental"
who has a high-stress job and smokes. This client
has just received a diagnosis of Type II Diabetes A: Type 1 diabetes is a primary failure of pancreatic
and has just been started on an oral hypoglycemic beta cells to produce insulin. It primarily affects
agent. Which of the following goals for the client children and young adults and is unrelated to diet.
which if met, would be most likely to lead to an
improvement in insulin efficiency to the point the "What insulin type can be given by IV? Select all
client would no longer require oral hypoglycemic that apply:
agents? "
A. Glipizide (Glucotrol)
"a. Comply with medication regimen 100% for 6 B. Lispro (Humalog)
months C. NPH insulin
b. Quit the use of any tobacco products by the end
D. Glargine (Lantus) "When an older adult is admitted to the hospital
E. Regular insulin with a diagnosis of diabetes mellitus and
complaints of rapid-onset weight loss, elevated
E) Regular insulin blood glucose levels, and polyphagia, the
The only insulin that can be given by IV is regular gerontology nurse should anticipate which of the
insulin. following secondary medical diagnoses?

"What will the nurse teach the client with diabetes "1.Impaired glucose tolerance
regarding exercise in his or her treatment 2.Gestational diabetes mellitus
program? 3.Pituitary tumor
4. Pancreatic tumor
1. During exercise the body will use carbohydrates
for energy production, which Pancreatic tumor
in turn will decrease the need for insulin. Rationale: The onset of hyperglycemia in the older
2. With an increase in activity, the body will use adult can occur more slowly. When the older adult
more carbohydrates; therefore reports rapid-onset weight loss, elevated blood
more insulin will be required. glucose levels, and polyphagia, the healthcare
3. The increase in activity results in an increase in provider should consider pancreatic tumor."
the use of insulin; therefore the client should
decrease his or her carbohydrate intake. "When assessing the patient experiencing the
4. Exercise will improve pancreatic circulation and onset of symptoms of type 1 diabetes, which
stimulate the islets of Langerhans to increase the question should the nurse ask?
production of intrinsic insulin.
a. ""Have you lost any weight lately?""
1. During exercise the body will use carbohydrates b. ""Do you crave fluids containing sugar?""
for energy production, which in turn will decrease c. ""How long have you felt anorexic?""
the need for insuli" d. ""Is your urine unusually dark-colored?""
Rationale: As carbohydrates are used for energy,
insulin needs decrease. A) lost any weight?"a. Weight loss occurs because
Therefore during exercise, carbohydrate intake the body is no longer able to absorb glucose and
should be increased to cover the starts to break down protein and fat for energy.
increased energy requirements. The beneficial b. The patient is thirsty but does not necessarily
effects of regular exercise may crave sugar- containing fluids.
result in a decreased need for diabetic medications c. Increased appetite is a classic symptom of type 1
in order to reach target diabetes.
blood glucose levels. Furthermore, it may help to d. With the classic symptom of polyuria, urine will
reduce triglycerides, LDL be very dilute."
cholesterol levels, increase HDLs, reduce blood
pressure, and improve When taking a health history, the nurse screens for
circulation." manifestations suggestive of diabetes type I. Which
of the following manifestations are considered the
primary manifestations of diabetes type I and
would be most suggestive of diabetes type I and
require follow-up investigation? "

a. Excessive intake of calories, rapid weight gain,

and difficulty losing weight
b. Poor circulation, wound healing, and leg ulcers,
c. Lack of energy, weight gain, and depression
d. An increase in three areas: thirst, intake of fluids, TEST-TAKING HINT:
and hunger Option "1" should be elim-inated because the
problem with DKA iselevated glucose so the HCP
d. An increase in three areas: thirst, intake of fluids, would not bereplacing it. The test taker should use
and hunger "The primary manifestations of physiol-ogy knowledge and realize potassium is in
diabetes type I are polyuria (increased urine thecell."
output), polydipsia (increased thirst), polyphagia
(increased hunger). "Which of the following factors are risks for the
Excessive calorie intake, weight gain, and difficulty development of diabetes mellitus? (Select all that
losing weight are common risk factors for type 2 apply.)
diabetes.
Poor circulation, wound healing and leg ulcers are "a) Age over 45 years
signs of chronic diabetes. b) Overweight with a waist/hip ratio >1
c) Having a consistent HDL level above 40 mg/dl
Lack of energy, weight gain and depression are not d) Maintaining a sedentary lifestyle
necessarily indicative of any type of diabetes."
which are symptoms of hypoglycemia? Correct: a,b,d"Rationale: Aging results in reduced
ability of beta cells to respond with insulin
A. irritability, effectively. Overweight with waist/hip ratio
B. drowsiness increase is part of the metabolic syndrome of DM
c. Abdominal pain II. There is an increase in atherosclerosis with DM
D. nausea and vomiting due to the metabolic syndrome and sedentary
lifestyle.
A. Irritability: signs of hypoglycemia include
irritability, shaky feeling, hunger, headache, "Which of the following is accurate pertaining to
dizziness. Other symptoms are hyperglycemia. physical exercise and type 1 diabetes mellitus?

Which electrolyte replacement should the nurse "1. Physical exercise can slow the progression of
anticipate being ordered by thehealth-care diabetes mellitus.
provider in the client diagnosed with DKA who has 2. Strenuous exercise is beneficial when the blood
just been admitted tothe ICD? glucose is high.
3. Patients who take insulin and engage in
1.Glucose. strenuous physical exercise might experience
2.)Potassium. hyperglycemia.
3.Calcium. 4. Adjusting insulin regimen allows for safe
4.Sodium participation in all forms of exercise."

Potassium"1.Glucose is elevated in DKA; therefore, 1) physical exercise can slow the progression of
theHCP would not be replacing glucose. diabetes mellitus Rationale: Physical exercise slows
2.(CORRECT)-->The client in DKA loses potassium the progression of diabetes mellitus, because
from increased urinary output, acidosis, cata-bolic exercise has beneficial effects on carbohydrate
state, and vomiting. Replacement isessential for metabolism and insulin sensitivity. Strenuous
preventing cardiac dysrhyth-mias secondary to exercise can cause retinal damage, and can cause
hypokalemia. hypoglycemia. Insulin and foods both must be
3.Calcium is not affected in the client with adjusted to allow safe participation in exercise.
DKA.4.The IV that is prescribed 0.9% normal
salinehas sodium, but it is not specifically
orderedfor sodium replacement. This is an
isotonicsolution.
"Which of the following persons would most likely A patient is admitted with Diabetic Ketoacidosis.
be diagnosed with diabetes mellitus? A 44-year- The physician orders intravenous fluids of 0.9%
old.. Normal Saline and 10 units of intravenous regular
"A. Caucasian Woman insulin IV bolus and then to start an insulin drip per
B. Asian Woman protocol. The patient's labs are the following: pH
C. African-American woman 7.25, Glucose 455, potassium 2.5. Which of the
D. Hispanic Male following is the most appropriate nursing
intervention to perform next?*
"Correct answer: African-American woman
Rationale: Age-specific prevalence of diagnosed A. Start the IV fluids and administer the insulin
diabetes mellitus (DM) is higher for African- bolus and drip as ordered
Americans and Hispanics than for Caucasians. B. Hold the insulin and notify the doctor of the
Among those younger than 75, black women had potassium level of 2.5
the highest incidence." C. Hold IV fluids and administer insulin as ordered
D. Recheck the glucose level
Which statement by the patient with type 2
diabetes is accurate. " B
Remember when insulin is given it helps take
a. ""I am supposed to have a meal or snak if I drink potassium back into the cell which will cause
alcohol"" potassium blood levels to fall. Insulin therapy is to
b. ""I am not allowed to eat any sweets because of be started only if the patient's potassium level is
my diabetes."" 3.3 or greater.
c. I do not need to watch what I eat because my
diabetes is not the bad kind."" Which patient is MOST likely to develop Diabetic
d. The amunt of fat in my diet is not important; it is Ketoacidosis?*
just the carbohydrates that raise my blood
sugar.""" A. A 25 year old female newly diagnosed with
Cushing's Disease taking glucocorticoids.
"Correct Answer: A B. A 36 year old male with diabetes mellitus who
Alcohol should be consumed with food to reduce has been unable to eat the past 2 days due to a
the risk of hypoglycemia." gastrointestinal illness and has been unable to take
insulin.
C. A 35 year old female newly diagnosed with Type
DIABETIC KETOACIDOSIS 2 diabetes.
Which of the following is not a sign or symptom of D. None of the options are correct.
Diabetic Ketoacidosis?*
B
A. Positive Ketones in the urine
B. Oliguria Which of the following statements are INCORRECT
C. Polydipsia about Diabetic Ketoacidoisis?*
D. Abdominal Pain
B A. Extreme Hyperglycemia that presents with blood
glucose >600 mg/dL
Oliguria means low urinary output....in DKA you B. Ketones are present in the urine
have high urinary ouput (POLYURIA). C. Metabolic acidosis is present with Kussmaul
breathing
D. Potassium levels should be at least 3.3 or higher
during treatment of DKA with insulin therapy
A A patient diagnosed with diabetes mellitus is being
Extreme Hyperglycemia that presents with blood discharged home and you are teaching them about
glucose >600 mg/dL is present only in preventing DKA. What statement by the patient
Hyperglycemic Hyperosmolar Nonketotic demonstrates they understood your teaching
Syndrome. about this condition?*

True or False: When priming the tubing for an A. "I should not be alarmed if ketones are present
Insulin infusion it is best practice to waste 50cc to in my urine because this is expected during illness."
100cc of insulin prior to starting the infusion B. "It is normal for my blood sugar to be 250-350
because insulin absorbs into the plastic lining of the mg/dL while I'm sick."
tubing.* C. "I will hold off taking my insulin while I'm sick."
D. "It is important I check my blood glucose every
True 3-4 hours when I'm sick and consume liquids."
False D

True

You are providing care to a patient experiencing Hyperglycemic

diabetic ketoacidosis. The patient is on an insulin
drip and their current glucose level is 300. In Hyperosmolar
addition to this, the patient also has 5% Dextrose
0.45% NS infusing in the right antecubital vein.
Which of the following patient signs/symptoms
Nonketotic Syndrome
causes concern?*
Which of the following patients is MOST LIKELY
experiencing Hyperglycemic Hyperosmolar
A. Patient complains of thirst.
Nonketotic Syndrome based on their symptoms?*
B. Patient has a potassium level of 2.3
C. Patient's skin and mucous membranes are dry.
A.)A 72 year old with a health history of diabetes
D. Patient is nauseous.
who has a blood glucose of 300 mg/dL and is
complaining of thirst and frequent urination.
B
B.)A 66 year old with type I diabetes that has
Insulin causes potassium to enter back into the cell;
ketones present in their urine.
therefore removing it from the blood. If the
C.)A 69 year old admitted with an infection of the
potassium is already 2.3, the patient can bottom
right foot with a health history of diabetes that
out their potassium level. Therefore, the patient
reports missing several doses of Metformin and has
needs potassium supplements which requires a
a blood glucose of 600 mg/dL.
doctor's order.
D.)A 6 year old that is presenting with polyuria,
polydipsia, abdominal pain, and vomiting
What type of insulin do you expect the doctor to
order for treatment of DKA?*
C
Which of the following is NOT a typical finding in
A. IV Novolog
HHNS?*
B. IV Levemir
C. IV NPH
A.)Blood pH <7.35
D. IV Regular Insulin
B.)Dehydration
D
C.)Mental status changes
D.)Osmotic diuresis
B
True or False: Treatment of Hyperglycemic D.)Intravenous Regular insulin is used to treat
Hyperosmolar Nonketotic Syndrome is similar to hyperglycemia.
the treatment of Diabetic Ketoacidosis.*
C
True
False A patient undergoing treatment for Hyperglycemic
True Hyperosmolar Nonketotic Syndrome has a blood
glucose of 799. The doctor has ordered intravenous
A patient is being discharged home after fluids and intravenous Regular insulin therapy.
recovering from HHNS. Which statement by the Which of the following findings causes concern
patient requires patient re-education about this before starting insulin therapy?*
condition?*
A.)Regular insulin cannot be given intravenously;
A.)"I will monitor my blood glucose levels therefore, the nurse needs to clarify the doctor's
regularly." order.
B.)"If I become sick I will monitor my blood glucose B.)The patient's potassium level is 3.1.
more frequently and drink lots of fluids." C.)The patient is complaining of severe thirst and
C.)"This condition happens suddenly without any has dry mucous membranes.
warning signs." D.)The patient is confused and drowsy.
D.)"It is important I take my medication as
prescribed." B

True or False: DKA and HHNS mainly occur in type 2

diabetics.*

True
False

False

True or False: Hypertonic fluids, such as 3% saline,

are the first line of treatment to correct
dehydration in HHNS.*

True
False

False

Which of the following statements is INCORRECT

about Hyperglycemic Hyperosmolar Nonketotic
Syndrome?*

A.)HHNS occurs mainly in type 2 diabetics.

B.)This condition presents without ketones in the
urine.
C.)Metabolic alkalosis presents in severe HHNS.