. Which statement indicates the development of opioid tolerance?Larger doses of opioids are needed to control pain compared to several weeks earlier.Stimulants are needed to counteract the sedating effects of opioids.The patient becomes anxious about knowing the exact time of the next dose of opioid.The patient no longer experiences constipation from the usual dose of opioid.

2. When assessing a patient's cultural beliefs about pain, the pain management nurse asks about:a family history of pain.home remedies used to treat pain.the frequency of visits to health care facilities.the patient's dietary preferences.

3. When assessing a patient for possible side effects related to acetaminophen (Tylenol), the pain management nurse asks the patient about the use of:alcohol.marijuana.opioids.tobacco.

4. The pain management nurse observes a male patient with complex regional pain syndrome not wearing his right jacket sleeve. The patient reports intense, right arm pain on light touch. The nurse recognizes this pain as:allodynia.hypoalgesia.neuritis.paresthesia.

5. A 45-year-old male patient reports pain in his foot that moves up along his calf. The patient states, "My right foot feels like it is on fire." The patient further describes that he has no previous history of injuries or falls, and that his pain started yesterday. Which components of pain assessment has the patient reported?Aggravating and alleviating factorsExacerbation, and associated signs and symptomsIntensity, temporal characteristics, and functional impactLocation, quality, and onset

6. A 53-year-old patient, who is receiving ibuprofen (Motrin) 400 mg, twice a day, for chronic, low back pain, develops lower extremity edema. The pain management nurse suspects that the edema is caused by:a decrease in renal function.a low creatinine level.an increase in glomerular filtration rate.an increase in plasma proteins.

7. A distinguishing feature of a cluster headache is that it occurs:bilaterally.globally.occipitally.unilaterally.

8. A 73-year-old male patient with cancer is in the hospital for pain control and rates his pain as a 12 on a numeric pain rating scale of 0 to10. Thirty minutes after administering IV pain medication, the patient reports no pain relief. The pain management nurse calls the physician for additional orders for pain medication. The nurse's actions demonstrate:analgesic titration.empathy.independence.patient advocacy.

9. Which is an accurate statement about the administration of acetaminophen (Tylenol) to children?Acetaminophen (Tylenol) affects platelet aggregation.Acetaminophen (Tylenol) causes gastric irritation.Acetaminophen (Tylenol) does not have an analgesic ceiling.Acetaminophen (Tylenol) has an analgesic ceiling.

10. Which behavioral therapy works best to relieve pain with muscle tension and spasms in patients who are anxious about their pain?DistractionHypnosisRelaxationStress management

11. The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by:adding bulk fiber to the diet.giving the patient enemas as needed.increasing fluids and exercise.using a bowel stimulant and stool softener.

12. A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior:is an emotional reaction to the anticipated pain.is in anticipation of future pain.is more indicative of the need for pain medication than the pain rating.may be in conflict with the pain rating, and accepts the report of pain.

13. An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for neuropathic pain. Which statement indicates the patient's need for additional education?I will chew sugarless gum and mints.I will drink carbonated beverages.I will take my medication at breakfast.I will use a humidifier at bedtime.

14. Which nonpharmacologic intervention is difficult to use with older adults who are cognitively impaired?AromatherapyDistractionGuided imageryHeat application

15. An 85-year-old male patient, with a history of prostate cancer and metastasis to the lumbar spine, is receiving methadone (Dolophine), 10 mg, 3 times a day. The patient's wife tells the pain management nurse that her husband exhibits a lack of motivation, loss of appetite, and an inability to get out of bed. The nurse initially focuses on the patient's:need for antidepressants.pain assessment.physical therapy evaluation.psychological evaluation.

16. Which medication is the best choice to treat breakthrough pain for a patient who is currently receiving methadone (Dolophine), 10 mg, every 8 hours?Methadone (Dolophine)Immediate release morphine (MS IR)Sustained release morphine (MS Contin)Transdermal fentanyl (Duragesic)

17. A 75-year-old female patient comes to the oncology clinic for management of chronic cancer pain. The patient has been prescribed morphine sulfate (MS Contin), 30 mg, every 12 hours. The patient states that she is taking the medicine only when the pain becomes severe because of her husband's concern about addiction. The pain management nurse responds:It is okay to continue doing what you are doing.The risk of developing addiction when taking opioids for pain is very low.We need to consider other alternatives for managing your pain.You must take the medication as prescribed, regardless of your husband's concerns.

18. The pain management nurse assesses a male patient who has complex regional pain syndrome. The nurse is concerned about the patient's depressed mood because he has made comments that he "can't live with this pain." The nurse further assesses for suicide risk because:decreased pain thresholds and suicidal thoughts are frequently seen in patients with complex regional pain syndrome.suicidal thoughts are common in patients with chronic pain.suicidal thoughts are often expressed by patients with acute pain.verbalization of suicidal thoughts is a way for patients to get attention.

19. A focused examination for fibromyalgia includes assessment for:autonomic changes, peripheral neuropathy, and skin fold tenderness.morning fatigue, widespread body pain, and focal tenderness.skin rashes, edema, and constipation.unilateral weakness, hyperesthesia, and allodynia.

20. Biofeedback is a therapy used to:develop psycho-physiologic self-regulation.enhance drug delivery.increase release of serotonin.promote neuronal regeneration.

21. The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to:clarify the patient's report by reviewing the patient's nonverbal behavior.confronting the patient's denial of pain.obtaining an order for pain medication.supporting the patient's stoic behavior.

22. The pain management nurse assesses a 67-year-old patient for reports of episodic, sudden-onset, and right-sided facial pain. The patient describes the pain as fleeting, electric-like, and triggered by light touch and brushing of the teeth. The pain management nurse suspects:facet syndrome.myofascial pain syndrome.temporomandibular disorder.trigeminal neuralgia.

23. Which is the most effective method for teaching strengthening exercises to patients with chronic pain?Distributing a local listing of strengthening exercise classesProviding demonstration and return demonstrationProviding handouts with picturesViewing a self-instruction video

24. When teaching a 65-year-old patient to use a pain scale, a pain management nurse anticipates that:additional time is needed for the patient to process the information.older adults are unable to use pain scales reliably.the Pain Assessment in Advanced Dementia Scale is appropriate for the patient.the patient's family is included in the education sessions.

25. A 51-year-old female patient who has metastatic breast cancer is stabilized on oxycodone (OxyContin) for her pain. The patient exhausts her family medical leave act, is forced to leave her job, and, subsequently, loses her health insurance. What is the pain management nurse's best course of action for the patient?Encouraging the patient to cut the pain tablets in half to make them last longerOffering information to the patient about pharmaceutical assistance programsPreparing the patient to be weaned off of oxycodone (OxyContin)Providing the patient with information on the nearest free clinicQuestion 1The correct answer isLarger doses of opioids are needed to control pain compared to several weeks earlier..Question 2The correct answer ishome remedies used to treat pain..Question 3The correct answer isalcohol..Question 4The correct answer isallodynia..Question 6The correct answer isa decrease in renal function..Question 7The correct answer isunilaterally..Question 9The correct answer isAcetaminophen (Tylenol) has an analgesic ceiling..Question 10The correct answer isRelaxation.Question 12The correct answer ismay be in conflict with the pain rating, and accepts the report of pain..Question 13The correct answer isI will take my medication at breakfast..Question 14The correct answer isGuided imagery.Question 15The correct answer ispain assessment..Question 16The correct answer isImmediate release morphine (MS IR).Question 17The correct answer isThe risk of developing addiction when taking opioids for pain is very low..Question 19The correct answer ismorning fatigue, widespread body pain, and focal tenderness..Question 20The correct answer isdevelop psycho-physiologic self-regulation..Question 22The correct answer istrigeminal neuralgia..Question 23The correct answer isProviding demonstration and return demonstration.Question 24The correct answer isadditional time is needed for the patient to process the information..Which of the following is most important when assessing a client's pain?Your Answer:The client's perception of the pain

Objective:Identify subjective and objective data to collect and analyze when assessing pain.

Rationale:Pain is whatever the client perceives it is. The physical location of the pain, the client's vital signs, and the client's appearing uncomfortable are objective rather than subjective findings.

Nursing Process:Assessment

Client Need:Psychosocial Integrity

Cognitive Level:Analysis

Strategy:Use nursing knowledge and the process of elimination to make a selection.

2.When asked about pain, a client complains of having severe discomfort from arthritis. Vital signs are unchanged, and the client is calmly watching television. Which of the following nursing diagnoses is most appropriate?Your Answer:Acute pain

Correct Answer:Chronic pain

Objective:Identify examples of nursing diagnoses for clients with pain.

Rationale:Clients with chronic pain often live with their pain and show no outward signs. Clients with acute pain are more likely to show outward signs of pain. Those with chronic pain may not exhibit any overt signs, even when they experience severe pain.

Nursing Process:Assessment

Client Need:Psychosocial Integrity

Cognitive Level:Analysis

Strategy:Use nursing knowledge and the process of elimination to make a selection

3.A client with an acute bowel obstruction is having ischemic abdominal pain. This type of pain is best described as:Your Answer:Intractable

Correct Answer:Visceral

Objective:Identify examples of nursing diagnoses for clients with pain.

Rationale:Visceralbest describes the client with an acute bowel obstruction having ischemic abdominal pain.Somaticis generalized body pain.Intractableis pain that cannot be relieved.Cutaneousis superficial pain.

Nursing Process:Assessment

Client Need:Physiological Integrity

Cognitive Level:Analysis

Strategy:Use nursing knowledge and the process of elimination to make a selection.

4.A postoperative client is prescribed acetaminophen (Tylenol) with codeine at discharge. When performing discharge teaching, the nurse:Your Answer:Warns of signs of addiction

Correct Answer:Recommends that the client take milk of magnesia at bedtime

Objective:Individualize a pain treatment plan based on clinical and personal goals, while setting objective outcome criteria by which to evaluate a client's response to interventions for pain.

Rationale:Short-term use of codeine is not addicting. The client is instructed to take the medication as often as prescribed for pain. As the patient recovers, this will gradually decrease. There is no validity to the statement in Answer 3. Milk of Magnesia will prevent stomach discomfort, a common side effect of acetaminophen.

Nursing Process:Implementation

Client Need:Physiological Integrity

Cognitive Level:Application

Strategy:Use nursing knowledge and the process of elimination to make a selection

5.While waiting to perform x-rays on an injured right hand according to nonpharmacological pain management practice, pain can be modulated or reduced if the nurse:Your Answer:Turns off the light and shuts the door

Correct Answer:Applies ice to the right elbow

Objective:Individualize a pain treatment plan based on clinical and personal goals, while setting objective outcome criteria by which to evaluate a client's response to interventions for pain.

Rationale:Applying ice to the right elbow can help reduce pain. Frequent assessment is important, but does not reduce pain. Answers 2 and 4 are not considered nonpharmacological pain management practices.

Nursing Process:Implementation

Client Need:Physiological Integrity

Cognitive Level:Application

Strategy:Use nursing knowledge and the process of elimination to make a selection

6.An 8-year-old client is crying with pain after a tonsillectomy. Which nursing intervention is most appropriate for this client?Your Answer:Tell him he is too big to cry.

Correct Answer:Hold him and provide comfort.

Objective:Individualize a pain treatment plan based on clinical and personal goals, while setting objective outcome criteria by which to evaluate a client's response to interventions for pain.

Rationale:Holding and comforting the client while in pain is most appropriate. Children often regress in behavior when ill or in pain. Punishing, rewarding, or humiliating the child is not appropriate. Crying is an appropriate response to pain.

Nursing Process:Implementation

Client Need:Health Promotion and Maintenance

Cognitive Level:Application

Strategy:Decide what is the best action for client and situation

7.Patient-controlled analgesia (PCA) effectiveness is evaluated by:Your Answer:When the client is sleeping

Correct Answer:The client's indicating that pain is a 1 on a scale of 1 to 10

Objective:Identify risks and benefits of various analgesic delivery routes and analgesic delivery technologies.

Rationale:PCA is evaluated by the clientindicates that pain is a 1 on a scale of 1 to 10. Answer 1 is a preset safety interval set by the physician to prevent overdose. Many factors determine the size of the loading dose, including size of the patient, amount of medication already received, and degree of sedation. Clients in pain may still sleep.

Nursing Process:Evaluation

Client Need:Physiological Integrity

Cognitive Level:Analysis

Strategy:Use nursing knowledge and the process of elimination to make a selection.

8.Severe cancer pain is most effectively treated with analgesics given:Your Answer:Sparingly, to avoid side effects

Correct Answer:Around the clock, with extra doses available as needed

Objective:Give an example of rational polypharmacy described by the American Pain Society.

Rationale:Analgesics can be given around the clock as needed. A bolus may occasionally be needed for a flare-up of pain. Pain is better controlled if analgesia is given before pain returns. Analgesics are not limited in severe cancer pain.

Nursing Process:Implementation

Client Need:Physiological Integrity

Cognitive Level:Application

Strategy:Use nursing knowledge and the process of elimination to make a selection.

9.Both clients and nurses have misconceptions about pain. Which statement reflects a misconception?Your Answer:People can adapt to severe pain.

Correct Answer:Regular administration of analgesics leads to addiction.

Objective:Differentiate tolerance, dependence, and addiction.

Rationale:All of the answers are true statements except for Answer 4. The common misbelief that analgesics lead to addiction often prevents clients from receiving the best control of pain as possible.

Nursing Process:Assessment

Client Need:Safe, Effective Care Environment

Cognitive Level:Analysis

Strategy:Use nursing knowledge and the process of elimination to make a selection.

10.Following surgery, a client has great difficulty getting out of bed, walking, and coughing and deep breathing. Although patient-controlled analgesia (PCA) is in place, it is rarely used, even when suggested by the nurse. This concerns the nurse. Which statement is the best way to address this concern with the client?Your Answer:"I noticed you haven't used your pain medication as often as you could, even though it is painful for you to get out of bed and to walk. Many people are reluctant to take pain medication. Tell me what makes you reluctant."

Objective:Identify risks and benefits of various analgesic delivery routes and analgesic delivery technologies.

One of the effects created by activation or increased release of substance P is(A) vasoconstriction.(B) membrane stabilization.(C) analgesia.(D) vasodilation.2. A 23-year-old female patient, who was recently discharged from the hospital following open reduction and internal fixation of a fractured femur, suddenly develops severe chest pain. Which of the following medications in her history would seem to be implicated in the etiology of her pain?(A) Oral contraceptives(B) Nonsteroidal anti-inflammatory agents(C) Opioid analgesics(D) Benzodiazepines3. Patients who present with fever and pain of recent onset over the neck, upper back, chest, and upper limbs should be assessed for the possibility of abscess in the(A) cervical epidural space.(B) posterior nasopharynx.(C) subdiaphragmatic space.(D) T 7-8 disk space.4. Disability due to chronic pain is felt to be primarily related to the(A) number of somatic sites in which pain exists.(B) reinforcement of pain behaviors.(C) presence of a life-threatening disease.(D) presence of neuropathic, as opposed to muscular, pain causes.5. Further testing with CT scan or MRI is mandatoryin headaches accompanied by all of the following EXCEPT(A) prolonged long-term, unchanging band-like headaches.(B) hemiparesis and contralateral sensory deficit.(C) the appearance of seizures.(D) olfactory hallucinations.6. Referral to a multidisciplinary pain center is usually most appropriate when patients demonstrate evidence of(A) purely psychiatric mechanisms.(B) purely neuropathic mechanisms.(C) both psychological tension and physical muscle tension.(D) both somatic and psychological factors.7. Which tricyclic antidepressant is most appropriate for treatment of pain in an 80-year-old male with postherpetic neuralgia and urinary retention?(A) Amitriptyline (Elavil)(B) Doxepin (Sinequan)(C) Desipramine (Norpramin)(D) Imipramine (Tofranil)8. In disability determination under most workers' compensation systems, the presence of pain is given(A) more attention than the underlying physical impairment.(B) as much attention as the underlying physical impairment.(C) less attention than the underlying physicalimpairment.(D) no attention whatsoever.9. Which of the following is true regarding the use of antidepressants to reduce chronic pain?(A) Only tertiary amine tricyclics are effective.(B) Serotonergic agents are not clearly superior to noradrenergic ones.(C) Serotonin potentiation is a necessary characteristic of effective agents.(D) Only noradrenergic agents are effective.10. DREZ lesions have been documented to provide long-term pain relief in(A) cervical root avulsion.(B) sciatica.(C) diabetic neuropathy.(D) thalamic pain syndrome.11. A 52-year-old patient presents with a history of acute low back pain, without trauma, which is unrelieved by bed rest and is associated with paroxysms of pain and an elevated erythrocyte sedimentation rate. Radiographs of the spine reveal an absent pedicle. The most likely diagnosis is(A) lupus erythematosus.(B) multiple myeloma.(C) metastatic lesion.(D) disc space infection.12. Which of the following is true regarding patients with cluster headaches?(A) They are more likely to be female.(B) They are likely to lie in a quiet, dark room with an ice pack over the affected temple during an attack.(C) They are usually nonsmokers and nondrinkers.(D) They are known to attempt suicide secondary to their pain.13. Which of the following is true of the physical or sensory component of pain perception?(A) It is less variable than the anxiety produced by the pain.(B) It is more variable than the anxiety produced by the pain.(C) It is generally equal to the anxiety produced by the pain.(D) It is reduced in patients with hypochondriasis.14. A patient who has been taking high doses of benzodiazepines and opioids experiences withdrawal symptoms during detoxification. Which of the following specifically indicates that the opioid is being tapered too rapidly?(A) Hyperreflexia(B) Diaphoresis(C) Hyperactive bowel sounds(D) Tachycardia15. The depression commonly seen in those with chronic pain of nonmalignant origin differs from the most typical major depressions in that in the former there is likely to be(A) anhedonia.(B) weight gain.(C) guilty ruminations.(D) insomnia.16. All of the following are true of migraine headache EXCEPT(A) Aura (prodrome) is not present in common migraine.(B) The neurologic symptoms of classic migraine may persist beyond the headache phase.(C) Ergotamine (Ergostat) is effective in treating acute attacks when used daily for 7-14 days.(D) 70% of migraine patients have a positive family migraine history.17. The essential feature of pain that can be used to differentiate it from other somatic sensations is its(A) intensity.(B) threshold.(C) chronicity.(D) unpleasantness.18. Aching pain in the suprapubic region is most likely caused by abnormalities of the(A) ureter.(B) prostate.(C) coccyx.(D) sacroiliac joints.Answer Key:1. D, 2. A, 3. A, 4. B, 5. A, 6. D, 7. C, 8. C, 9. B, 10. A, 11. C, 12. D, 13. A, 14. C, 15. B, 16. C, 17. D, 18. B

An elderly client is being treated with a fentanyl transdermal patch for moderate pain. The nurse advised this client to:Your Answer:Change the patch site every 2 hours for the first 48 hours.

Correct Answers:Expect pain relief within 1 hour of application.

Take another oral pain medication for 24 hours.

Rationale: Fentanyl patches are replaced every three days, so answer 1 is incorrect. Answer 2 is not a good choice because the peak effect form fentanyl patches is about 24 hours after the first application, so the pain needs to be "covered" by other medications until the fentanyl reaches its peak. At this point, other pain medications should be discontinued. Persons using a transdermal patch may shower, but they should not use soap over the area of the patch.Integrated Process: Nursing Process; ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Physiological Integrity

2.Pain often is undertreated in the elderly. What is the rationale given most often by healthcare providers for that undertreatment?Your Answer:Pain is an abstract concept.

Correct Answers:Pain is merely the absence of feeling good.

Pain is subjective, and therefore hard to communicate its quality.

Rationale: For any individual, pain is what the client says it is. Answers 1 and 2 are incorrect because the intensity, quality, and duration are hard to communicate effectively for anyone. The last response is wrong because the nurse should accept the client's description of her pain and respond appropriately.

3.The safest narcotic choice for an elderly client with acute pain is:Your Answer:Oxycodone.

Correct Answer:Morphine sulfate.

Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.Integrated Process: Nursing Process; EvaluationCognitive Level: AnalysisNCLEX-RN Test Plan: Physiological Integrity

4.An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is:Your Answer:Administer a PRN dose of IV pain medication as ordered.

Correct Answer:Question the client further about discomfort to assess the meaning of pain.

Rationale: Answer 3 is correct, because a denial of pain does not mean the client is not experiencing any pain. The client might have a different meaning for the term "pain," so the nurse should explore the situation using a variety of terms, like "discomfort" or "aching." Without a careful assessment, the first response is inappropriate, and a postoperative patient who had abdominal surgery six hours previously will require medication in preparation for ambulation. While assessing the abdominal dressing is important, unless there are indications of complications, the surgeon would not need to be notified.Integrated Process: Nursing Process; ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Physiological Integrity

5.A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should:Your Answer:Make sure that the medication is not a narcotic.

Correct Answer:Give the medication before the activity session in the day room.

Rationale: Answer 1 is the correct response, because when an elder has chronic pain, as from arthritis, the analgesic should be given before an increase in activity that might aggravate the pain. Answer 2 is incorrect because the goal is to prevent a higher level of pain. Narcotics might be appropriate medication for chronic pain of arthritis.Integrated Process: Nursing Process; ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Physiological Integrity

6.Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that:Your Answer:Side effects that occur in the elderly mean that medications will be discontinued as soon as possible.

Correct Answer:Short-term use of narcotics is not likely to cause a person to become dependent on them.

Rationale: When clients are experiencing pain that is likely to be limited in duration, the decreasing frequency of administration of medications means that dependence is not likely. Answers 1, 3, and 4 are incorrect statements.Integrated Process: Nursing Process: ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Physiological Integrity

7.When assessing for pain in an elderly nursing home resident who has dementia, the nurse should:Your Answer:Know that only family members could reliably point out pain in their loved one.

Correct Answer:Look for signs of increased agitation or restlessness.

Rationale: Answer 2 is correct, because pain can adversely affect all body systems of the elderly, and the nurse needs to carefully assess all residents with dementia, especially those who are nonverbal, for changes in behavior, because they frequently are indicators of pain. While family members can point out pain in their loved ones reliably, they are not always present. Incontinence can occur with acute pain but is not a typical sign.Integrated Process: Nursing Process; AnalysisCognitive Level: AnalysisNCLEX-RN Test Plan: Physiological Integrity

8.When administering IV analgesics to the elderly, the nurse should expect:Your Answer:To "start low and go slow."

Rationale: As people age, their response to many medications is altered. For this reason, the elderly have higher peak levels and longer duration of action from IV analgesics, so dosing is initiated at lower levels and titrated upwards slowly. Answers 2 and 3 are incorrect. Answer 4 is not a correct response because a "more thorough" assessment would be important after the medication is administered.Integrated Process: Nursing Process; ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Physiological Integrity

9.Non-pharmacological interventions for pain that the nurse might employ for an elderly client with osteoporosis would include:Your Answer:Evening back rubs.

Rationale: Many non-pharmacological interventions, such as a back rub, can be effective in reducing pain. This is the only response listed that includes an intervention that focuses on pain relief. A support group would offer education and emotional support. Answers 3 and 4 offer suggestions that could be used as part of the treatment designed to interrupt the disease process.Integrated Process: Nursing Process; ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Physiological Integrity

10.When an elderly client with cancer experiences "breakthrough pain," the nurse should expect that pharmacological treatment will include:Your Answer:Increasing the dose of the narcotic.

1. A chronic pain client reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action?a. Check the MARs and nurses notes for the past several days.b. Ask the nurse educator to give an in-service about pain management.c. Perform a complete pain assessment and history on the client.d. Have a conference with the nurses responsible for the care of this client2. Family members are encouraging your client to tough it out rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the familys wishes. Priority nursing interventions for this client should target which dimension of pain?a. Sensoryb. Affectivec. Socioculturald. Behaviorale. Cognitive3. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?a. Amitriptyline (Elavil)b. Corticosteroidsc. Methylphenidate (Ritalin)d. Lorazepam (Ativan)4. Which client is most likely to receive opioids for extended periods of time?a. A client with fibrolyalgiab. A client with phantom limb painc. A client with progressive pancreatic cancerd. A client with trigeminal neuralgia5. As the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. What action should you take first?a. Make a note in the nurses file and continue to observe clinical performanceb. Refer the new nurse to the in-service education department.c. Quiz the nurse about knowledge of pain managementd. Give praise for the correct dose and time and discuss the deficits in charting.6. In caring for a young child with pain, which assessment tool is the most useful?a. Simple description pain intensity scaleb. 0-10 numeric pain scalec. Faces pain-rating scaled. McGill-Melzack pain questionnaire7. In applying the principles of pain treatment, what is the first consideration?a. Treatment is based on client goals.b. A multidisciplinary approach is needed.c. The client must be believed about perceptions of own pain.d. Drug side effects must be prevented and managed.8. Which route of administration is preferred if immediate analgesia and rapid titration are necessary?a. Intraspinalb. Patient-controlled analgesia (PCA)c. Intravenous (IV)d. Sublingual9. When titrating an analgesic to manage pain, what is the priority goal?a. Administer smallest dose that provides relief with the fewest side effects.b. Titrate upward until the client is pain free.c. Titrate downwards to prevent toxicity.d. Ensure that the drug is adequate to meet the clients subjective needs.10. In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function under your continued support and supervision?a. Therapeutic touchb. Use of heat and cold applicationsc. Meditationd. Transcutaneous electrical nerve stimulation (TENS)11. Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder.a. Morphine, hydromorphone, acetaminophen and lorazepamb. NSAIDs and corticosteroidsc. Codeine, oxycodone and diphenhydramine_b____, __c___, __a___12. Which client is at greater risk for respiratory depression while receiving opioids for analgesia?a. An elderly chronic pain client with a hip fractureb. A client with a heroin addiction and back painc. A young female client with advanced multiple myelomad. A child with an arm fracture and cystic fibrosis13. A client appears upset and tearful, but denies pain and refuses pain medication, because my sibling is a drug addict and has ruined out lives. What is the priority intervention for this client?a. Encourage expression of fears on past experiencesb. Provide accurate information about use of pain medicationc. Explain that addiction is unlikely among acute care clients.d. Seek family assistance in resolving this problem.14. A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?a. Feverb. Nauseac. Diaphoresisd. Abdominal cramps15. In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?a. Assist the client with preparation of a sitz bath.b. Monitor the client for signs of discomfort while ambulatingc. Coach the client to deep breathe during painful proceduresd. Evaluate relief after applying a cold application.16. The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?a. Prepare the medication and hand it to the physicianb. Check the hospital policy regarding use of the placebo.c. Follow a personal code of ethics and refuse to give it.d. Contact the charge nurse for advice.17. For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?a. Closely assess for nonverbal signs such as grimacing or rocking.b. Obtain baseline behavioral indicators from family members.c. Look at the MAR and chart, to note the time of the last dose and response.d. Give the maximum PRS dose within the minimum time frame for relief.18. Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?a. IVb. IM or subcutaneousc. Orald. Transdermale. PCA19. A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?a. Deliver the bolus dose per standing order.b. Contact the physician to increase the dose.c. Try non-pharmacological comfort measures.d. Assess the pain for location, quality, and intensity.20. Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?a. Diversional therapy, such as playing cards or board gamesb. Massage of back and neck with warmed lotionc. Side-lying position with knees to chest and pillow against abdomend. Transcutaneous electrical nerve stimulation (TENS)21. What is the best way to schedule medication for a client with constant pain?a. PRN at the clients requestb. Prior to painful proceduresc. IV bolus after pain assessmentd. Around-the-clock22. Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)a. A client who needs pre-op teaching for use of a PCA pumpb. A client with a leg cast who needs neurologic checks and PRN hydrocodonec. A client post-op toe amputation with diabetic neuropathic paind. A client with terminal cancer and severe pain who is refusing medication23. For a client who is taking aspirin, which laboratory value should be reported to the physician?a. Potassium 3.6 mEq/Lb. Hematocrit 41%c. PT 14 secondsd. BUN 20 mg/dL24. Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)a. An anxious, chronic pain client who frequently uses the call buttonb. A client second day post-op who needs pain medication prior to dressing changesc. A client with HIV who reports headache and abdominal and pleuritic chest paind. A client who is being discharged with a surgically implanted catheter25. A family member asks you, Why cant you give more medicine? He is still having a lot of pain. What is your best response?a. The doctor ordered the medicine to be given every 4 hours.b. If the medication is given too frequently he could suffer ill effects.c. Please tell him that I will be right there to check of him.d. Lets wait about 30-40 minutes. If there is no relief Ill call the doctor.Answers and RationaleHere are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores. If you have any disputes or need more clarification to a certain question, please direct them to the comments section.1. Answer: D As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem.2. Answer: C The family is part of the sociocultural dimension of pain. They are influencing the client should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism3. Answer: A Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic.4. Answer: C Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opiod and adjuvant medicatios. Trigeminal neuralgia is treated with anti-seizure medications such as carbamezapine (Tegretol). Phantom limb pain usually subsides after ambulation begins.5. Answer: D In supervising the new RN, good performance should be reinforced first and then areas of improvement can be addressed. Asking the nurse about knowledge of pain management is also an option; however, it would be a more indirect and time-consuming approach. Making an ote and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.6. Answer: C The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.7. Answer: C The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options in developing the treatment plan.8. Answer: C the IV route is preferred as the fastest and most amenable to titration. A PCA bolus can be delivered; however, the pump will limit the dosage that can be delivered unless the parameters are changed. Intraspinal administration requires special catheter placement and there are more potential complications with this route. Sublingual is reasonably fast, but not a good route for titration, medication variety in this form is limited.9. Answer: A the goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until pain is controlled. Downward titration occurs when the pain begins to subside. Adequate dosing is important; however, the concept of controlled dosing applies more to potent vasoactive drugs.10. Answer: B Use of heat and cold applications is a standard therapy with guidelines for safe use and predictable outcomes, and an LPN/LVN will be implementing this therapy in the hospital, under the supervision of an RN. Therapeutic touch requires additional training and practice. Meditation is not acceptable to all clients and an assessment of spiritual beliefs should be conducted. Transcutaneous electrical stimulation is usually applied by a physicaltherapist.11. Answer: B, C, A Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.12. Answer: D at greatest risk are elderly clients, opiate nave clients, and those with underlying pulmonary disease. The child has two of the three risk factors.13. Answer: A This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.14. Answer: C Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.15. Answer: A The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.16. Answer: D the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following ones own ethical code is correct, you must ensure that the client is not abandoned and that care continues.17. Answer: B Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.18. Answer: C If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.19. Answer: D Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.20. Answer: C The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.21. Answer: D IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control22. Answer: B, C The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.23. Answer: C When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).24. Answer: B A second day post-operative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although chronic pain clients can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The HIV client has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.25. Answer: C directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.

1. The teaching plan for an individual receiving transcutaneous electrical nerve stimulation (TENS) should include the information that:a- the client can adjust both voltage and pulsation.b- one electrode only is used over the painful site.c- this therapy is useful for very few clients.d- the electrode wires should be visible to detect early problems.1. ANS: aVoltage and pulsation are controlled by the person wearing the device. Positive and negative poles (electrodes) are placed within several inches of each other. TENS has been shown to relieve pain effectively in many people.2. A patient with cancer-related pain and a history of opioid abuse complains ofbreakthrough pain 2 hours before the next dose of sustained-release morphine sulfate(MS Contin) is due. Which action should the nurse take first?a- Suggest the use of alternative therapies such as heat or cold.b- Administer the prescribed PRN immediate-acting morphinec- Utilize distraction by talking about things the patient enjoys.d- Consult with the doctor about increasing the MS Contin dose.2. ANS: bThe patients pain requires rapid treatment and the nurse should administer theimmediate-acting morphine. Increasing the MS Contin dose and use of alternativetherapies also may be needed, but the initial action should be to use the prescribedanalgesic medications.3. The nurse caring for a client with suspected appendicitis knows that the pain associated with appendicitis isa- cutaneous pain.b- visceral pain.c- superficial pain.d-somatic pain.ANS: bVisceral pain originates from body organs, or viscera, and often includes pain caused by acute appendicitis, cholecystitis, inflammation of the biliary and hepatic tract, gastroduodenal disease, cardiovascular disease, pleurisy, and renal and ureteral colic. Somatic pain is from ligaments, tendons, bones, blood vessels, and nerves. It is often poorly localized, may produce nausea, and may be associated with sweating and blood pressure changes. Cutaneous pain would arise from the skin structures. Superficial pain is not a defining designation.4.The most effective way for the nurse to administer pain medication to a client who is experiencing severe pain related to metastatic liver cancer is toa- administer medication only when other methods of pain relief are ineffective.b- respond promptly to as-needed (prn) pain requests.c- dispense pain medications on a regular basis.d- give only intravenous pain medications.ANS: cPatients experiencing pain caused by widespread cancer require routine pain-relieving medication in order to function, often at higher doses.5. In providing care to a client with chronic pain, which of the following characteristics or client responses should the nurse expect?a- Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain.b- Opioid-based analgesics may have little if any effect on reducing the quality of chronic pain.c- The client may have adapted so successfully to the presence of chronic pain that measures for relief are unnecessary.d- The actual intensity of chronic pain is difficult to assess because the client may complain constantlyANS: aAdaptation to the presence of chronic pain is physiologic. Thus, the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.6. A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests something for pain that will work quickly. The nurse will document this asa. somatic pain.b. referred pain.c. breakthrough pain.d. neuropathic pain.ANS: cPain that occurs beyond the chronic pain already being treated by appropriate analgesicsis termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nervesor the central nervous system (CNS). Somatic pain is localized and arises from bone,joint, muscle, skin, or connective tissue. Referred pain is pain that is localized inuninjured tissue.7- A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse shoulda- request the physician order different basal and bolus rates.b- question the client about how he/she has been using the button on the pump.c- check the IV pump to ensure the basal rate is set correctly.d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.ANS: cThe patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe range for a postoperative client. On a PCA pump, the demand feature has a lock-out device limiting the amount of opioid the client can administer. This could have been set incorrectly, allowing the client to overdose him/herself; however, a sleepy postoperative client often cannot use the demand feature without reminders. This leaves the basal rate as the most likely source of error and the nurse should check to see that it was set correctly. Giving prn pain medications often results in undertreatment of pain and should not be used on a postoperative client. If the pump was set incorrectly, there is no need to adjust the rates. Questioning the client and re-educating him/her if needed are always appropriate, but it is not the priority since the pump most likely was set incorrectly.8- Which physiologic or behavioral manifestation is more commonly associated with acute pain rather than chronic pain?a- Reduced tendency to touch or move the affected areab- Psychosocial withdrawalc- Inability to concentrated-Dry skin and moist oral mucous membranesANS: cThe characteristic most common to chronic pain is psychosocial withdrawal. Dry skin and moist mucous membranes indicate an absence of or physiologic adaptation to the stress response associated with chronic pain. Clients experiencing either acute or chronic pain tend to protect the painful area. The inability to concentrate is associated much more with acute pain before any physiologic or behavioral adaptation has occurred.9- The nurse instructs the client taking ibuprofen that the drug is effective for pain relief because it acts toa- slow painful stimuli through type A-delta pain fibers.b- reduce inflammation and block prostaglandins.c-interrupt the transmission of pain impulses.d-interfere with the relay of pain information through the dorsal horn.ANS: bThe site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery at the receptor site, where NSAIDs serve an anti-inflammatory function and prevent the production of prostaglandins.10- When caring for a patient who is receiving epidural morphine, which informationobtained by the nurse indicates that the patient may be experiencing a side effect of themedication?d. The patient complains of a pounding headache.c. The patient has not voided for over 10 hours.b. The patient becomes restless and agitated.a. The patient has cramping abdominal pain.ANS: bUrinary retention is a common side effect of epidural opioids. Headache is not ananticipated side effect of morphine, although if there is a cerebrospinal fluid leak, thepatient may develop a spinal headache. Sedation (rather than restlessness or agitation)would be a possible side effect. Hypotonic bowel sounds and constipation (rather thanabdominal cramping) are concerns.

1. A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patients blood pressure because of which change that is associated with the liver failure?1. Hypoalbuminemia2. Increased capillary permeability3. Abnormal peripheral vasodilation4. Excess rennin release from the kidneys2. Youre assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear:1. Pale, pink and moist2. Red and moist3. Dark or purple colored4. Dry and black3. Youre caring for a patient with a sigmoid colostomy. The stool from this colostomy is:1. Formed2. Semisolid3. Semiliquid4. Watery4. Youre advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend?1. Peas2. Cabbage3. Broccoli4. Yogurt5. You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer:1. To the exact size of the stoma.2. About 1/16 larger than the stoma.3. About 1/8 larger than the stoma.4. About 1/4 larger than the stoma.6. Youre performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed?1. Observation, percussion, palpation, auscultation2. Observation, auscultation, percussion, palpation3. Percussion, palpation, auscultation, observation4. Palpation, percussion, observation, auscultation============================================================================Answers to Gastrointestinal NCLEX Questions1. Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidneys arent direct ramifications of liver failure.2. Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma appears red and moist.3. A colostomy in the sigmoid colon produces a solid, formed stool.4. High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.5. A proper fit protects the skin, but doesnt impair circulation. A 1/16 should be cut.6. Observation, auscultation, percussion, palpation- See more at: http://nclexpreceptor.com/gastrointestinal-nclex-questions/#sthash.zhyjvA0x.dpuf

. The most common cause of intestinal obstruction is:A. AdhesionsB. HerniaC. VolvulusD. NeoplasmsANSWER KEY2. Which of the following listed drug is given with bismuth salt inhelicobacter pyroliinfection:A. AntacidsB. AntibioticsC. Proton-pumb inhibitorD. H2-receptor antagonistsANSWER KEY3. Which type of diarrhea is caused by increased production and secretion of water and electrolytes by the intestinal mucosa in to the intestinal lumen:A. Osmotic diarrheaB. Mixed diarrheaC. Secretary diarrheaD. Diarrhea diseaseANSWER KEY4. Of the following listed insulins, which is most rapid acting;A. UltralenteB. NPHC. RegularD. HumalogANSWER KEY5. Which of the following categories of laxatives act by drawing water in to the intestine by osmosis?A. Bulk-formimg (Metamucil)B. Faecal softenersC. Stimulants (bisacodyl)D. Saline agents (milk of magnesia)ANSWER KEY6. Celiac sprue is an example of which category of malabsorption:A. Mucosal disorders causing generalized malabsorptionB. Post-operative malabsorptionC. Infectious diseases causing generalized malabsorptionD. Luminal problems causing malabsorptionANSWER KEY7. Which of the following terms is used to describe chronic liver disease in which scar tissue surrounds the portal areas:A. Compensated cirrhosisB. Alcoholic cirrhosisC. Biliary cirrhosisD. Postnecrotic cirrhosisANSWER KEY8. Which of the following is a hormone secreted by posterior pituitary:A. SomatostatinB. VasopressinC. CalcitoninD. CorticosteroidsANSWER KEY9. Which of the following listed drug is a proton pump inhibitor?A. PantoprazoleB. RanitidineC. SucralfateD. FamotidineANSWER KEY10. For irrigating colostomy, the irrigation tube must be inserted to the stoma byA. 5B. 2C. 3D. 4ANSWER KEY11. Which of the following listed is a risk factor for colorectal cancer?A. Age younger than 40 yearsB. Low fat, low protein, high fibre dietC. Familial polyposisD. History of lung cancerANSWER KEY12. A patient with duodenal ulcer will likely experience:A. 2-3 hours after mealsB. VomitingC. Weight lossD. HemorrhageANSWER KEY13. Which of the following terms is used to refer intestinal rumbling which accompanies diarrhoea?A. TenesmusB. BorborygmusC. DiverticulitisD. AzotorrhoeaANSWER KEY14. The term used to refer to ineffectual straining at stool is:A. TenesmusB. BorborygmusC. DiverticulitisD. AzotorrhoeaANSWER KEY15. Which of the following disorder is caused by excessive producing of somatotropin?A. Adrenogenital syndromeB. CretinismC. AcromegalyD. DwarfismANSWER KEY16. Which of the following clinical features is associated with Type I diabetic mellitus?A. Requirement for oral hypoglycaemic agentsB. Presence of islets antibodiesC. Rare ketosisD. ObesityANSWER KEY17. The faeces expelled through colostomy following sigmoid colostomy is often:A. FluidB. mushyC. semi-musyD. solidANSWER KEY18. The recommended procedure for long-term weight loss isA. jejuno-ileal bypassB. Roux-en-YC. Vertical banded gastroplastyD. Gastric ring applicationANSWER KEY19. The digestion of protein is facilitated by:A. TrypsinB. AmylaseC. SecretinD. LipaseANSWER KEY20. Of the following listed oral hypoglycaemic agents, which one exerts their primary action by stimulating the pancreas to secrete insulin?A. BiguanidesB. Alpha glucosidase inhibitorsC. SufonylureasD. ThiazolidinedionesANSWER KEY21. Regional enteritis (Crohns Disease) is characterised by:A. Transmural thickeningB. Diffuse involvementC. Exacerbations and remissionsD. Severe diarrhoeaANSWER KEY22. Which of the following disorders are characterised by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?A. Hashimotos diseaseB. Addisons diseaseC. Graves diseaseD. Cushings diaseaseANSWER KEY23. A condition characterised by inflammation of thyroid gland, resulting in hypothyroidism:A. Addisons diseaseB. Hashimotos diseaseC. Graves diseaseD. Cushings diaseaseANSWER KEY24. Trousseaus sign is positive when:A. The patient complains of pain in the calf when his foot is dorsiflexed (Homans sign)B. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose and eye. (Chvosteks sign)C. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery (Allens test)D. Carpopedal spasm is induced by occluding the blood flow to the palm for 3 minutes and with the use of blood pressure cuffANSWER KEY25. The presence of mucus and pus in the stools suggests:A. Disorder of the colonB. Intestinal malabsorptionC. Inflammatory colitisD. Small bowel diseaseANSWER KEY26. A test in which a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose and eye is:A. Chvosteks signB. Homans signC. Allens testD. Trousseaus signANSWER KEY27. A patient is advised to do the following diagnostic tests. Which of the test is performed last in a series?A. Gall bladder seriesB. Barium enemaC. Barium swallowD. Oral cholecystogramANSWER KEY28. What type of diet is prescribed for a patient for the evening meal who is to undergo cholecystogram the next day?A. Low-proteinB. High-carbohydrateC. Fat-freeD. LiquidANSWER KEY29. For the first 4 to 6 weeks following colostomy, the patient should take:A. Low-proteinB. High-carbohydrateC. Low-calorieD. Low-residueANSWER KEY30. For the purpose of stomach decompression using nasogastric tube, which type of suction pressure and control is used?A. Low and continousB. High and intermittentC. Low and intermittentD. High and continuousANSWER KEYANSWER KEY1. A2. B3. C4. D5. D6. A7. B8. B9. A10. C

11. C12. B13. A14. A15.C16. B17. D18. B19. A20. C

21. A22. D23. B24. D25. C26. A27.C28. C29. D30.C

Which of the following are aged-related changes that affect gastrointestinal function? (Select all that apply.)Your Answer:Achlorhydria or insufficient hydrochloric acid in the stomach

Correct Answers:Decline in sense of taste and smell, decrease in salivary secretion

Diminished capacity of the gastric mucosa to resist such factors as Helicobacter pylori

Achlorhydria or insufficient hydrochloric acid in the stomach

Decreases in intestinal absorption, motility, and blood flow

2.Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions?Your Answer:Decrease daily intake of vegetables and water, and ambulate frequently.

Correct Answer:Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating.

Rationale: Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus.Nursing Process: ImplementationClient Need: Physiologic IntegrityTaxonomic Level: Analysis

3.The most frequently used diagnostic test for persons with GERD is:Your Answer:An upper endoscopy.

Correct Answer:A barium swallow.

Rationale: Persons with GERD should be referred to a primary care provider for a thorough cardiac evaluation to rule out cardiac disease. The most frequently used diagnostic test is barium swallow. Upper endoscopy is the best method to assess mucosal injury. Acid perfusion tests usually are not necessary, and require the placement of an esophageal probe above the esophageal sphincter to collect esophageal contents.Nursing Process: AssessmentClient Need: Physiologic IntegrityTaxonomic Level: Knowledge

4.Which of the following are risk factors associated with nursing home residents and dysphagia? (Select all that apply.)Your Answer:Providing thickened liquids to the patient during meals

Correct Answers:Feeding bed-bound residents in the semi-reclined position

Administering thin liquids quickly via a straw

Busy and overburdened staff who are assigned a case-load of several patients to feed at the same scheduled time

Rationale: Bed-bound patients should not be fed in the semi-reclined position or fed thin liquids that might quickly drain into the esophagus before the swallow reflex is triggered. A heavy caseload of clients might cause healthcare providers to rush-feed patients, resulting in reflux of nutrients and gastric acid.Nursing Process: AnalysisClient Need: Physiologic Integrity, Reduction of Risk PotentialTaxonomic Level: Application

5.Dysphagia is a cause for aspiration. Which of the following diseases would have the diagnosis Risk for aspiration related to inability to swallow effectively?(Select all that apply.)Your Answer:Crohn's disease and ulcerative colitis

Correct Answers:Stroke, especially in the midbrain and anterior cortical areas

Parkinson's disease and Alzheimer's disease

Muscular dystrophy and myasthenia gravis

Rationale: Stroke, especially in the midbrain and anterior cortical areas, is the most common cause of dysphagia in the older person. Parkinson's disease and Alzheimer's disease can cause dysphagia by inhibiting movements of the tongue, pharynx, or upper esophagus. Crohn's and ulcerative colitis affect the G.I. mucosa and submucosa, and do not usually cause esophageal reflux or aspiration.Nursing Process: EvaluationClient Need: Physiologic IntegrityTaxonomic Level: Evaluation

6.A videofluoroscope radiographic evaluation of the swallowing process usually is prescribed for persons with difficulty swallowing and risk of aspiration. Which of the following nursing diagnoses would be appropriate after a videofluoroscope radiographic evaluation?Your Answer:Risk for fecal impaction

Rationale: Preparation of the videofluoroscope radiographic evaluation includes drinking of a radio opaque solution, which is a chalk mixture. The chalk mixture is constipating, and could cause fecal impaction.Nursing Process: PlanningClient Need: Physiologic IntegrityTaxonomic Level: Application

7.Which of the following statements are accurate as they relate to medications used to manage GERD? (Select all that apply.)Your Answer:Aluminum-containing antacids can cause constipation.

Correct Answers:Magnesium-containing antacids can cause diarrhea.

Aluminum-containing antacids can cause constipation.

Rationale: Magnesium-containing antacids can cause diarrhea, and should be used with caution in older persons with renal dysfunction. Aluminum-containing antacids can cause constipation, osteomalacia, and hypophosphatemia. Cimetidine has the greatest chance for adverse reactions, including erectile dysfunction, Gynecomastia, and confusion. Misoprostol's major side effects are diarrhea and abdominal pain.Nursing Process: ImplementationClient Need: Physiologic Integrity, Pharmacologic TherapyTaxonomic Level: Analysis

8.The surgical procedure of choice for older patients with GERD and Barrett's esophagus that is not reversible with medical management is:Your Answer:Labyrinthectomy.

Correct Answer:Nissen's fundoplication.

Rationale: Older patients with GERD and Barrett's esophagus require aggressive treatment with proton pump inhibitors and regular endoscopic examination. If the esophageal erosion does not reverse with treatment, the surgery of choice is Nissen's fundoplication, and involves closing any hiatal hernia and restoring an antireflux barrier.Nursing Process: AnalysisClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

9.Which of the followingtypes of gastritis is associated with Helicobacter pylori and duodenal ulcers?Your Answer:Erosive (hemorrhagic) gastritis

Correct Answer:Antral gland gastritis (type B)

Rationale: Erosive (hemorrhagic) gastritis can be caused by ingestion of substances that irritate the gastric mucosa. Fundic gland gastritis (type A) is associated with diffuse severe mucosal atrophy and the presence of pernicious anemia. Antral gland gastritis (type B) is the most common form of gastritis, and is associated with Helicobacter pylori and duodenal ulcers.Nursing Process: AssessmentClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

10.Which of the following statements is accurate about patients diagnosed with Zollinger-Ellison syndrome?Your Answer:Treatment of choice for Zollinger-Ellison syndrome is a cholecystectomy.

Correct Answer:Peptic ulcer occurs in 95% of patients diagnosed with Zollinger-Ellison syndrome.

Rationale: Peptic ulcers occur in 95% of patients with Zollinger-Ellison syndrome. Treatment might include tumor removal and surgical resection for older persons without surgical risk. Persons with Zollinger-Ellison syndrome have gastric hypersecretion, and are referred to a gastroenterologist if symptoms persist.Nursing Process: AnalysisClient Need: Physiologic AdaptationTaxonomic Level: Analysis

11.Which of these agents is a major contributing factor in the promotion of peptic ulcer disorder?Your Answer:Candida albicans

Correct Answer:Helicobacter pylori infection

Rationale: Recurrence of peptic ulcers is related to Helicobacter pylori, use of NSAIDs, smoking, and continued acid hypersecretion.Nursing Process: AssessmentClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

12.Which of the following is not an indication of diverticulitis?Your Answer:Leukocytosis

Correct Answer:Diarrhea

Rationale: Diverticulitis is an infection from colonic diverticula. Fever, leukocytosis, pain, and/or abdominal tenderness might be indicators of diverticulitis.

Nursing Process: AssessmentClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

13.In planning care for a patient with ulcerative colitis, the nurse should anticipate which of the following diagnostic procedures?Your Answer:Sigmoidoscopy

Correct Answer:All of the above

Rationale: Diagnosis of ulcerative colitis is confirmed with the use of sigmoidoscopy, colonoscopy, and rectal mucosa biopsy.Nursing Process: PlanningClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

14.The most common surgical procedures for patients with ulcerative colitis are:Your Answer:Segmental resection or colostomy.

Correct Answer:Subtotal colectomy and ileostomy.

Rationale: Surgery might be necessary for functional older patients with acute disease when drug therapy fails and when multiple precancerous lesions are detected. The most common surgical procedures are subtotal colectomy and ileostomy.Nursing Process: AssessmentClient Need: Physiologic IntegrityTaxonomic Level: Knowledge

15.Older patients with longstanding or severe Crohn's disease can exhibit which of the following?Your Answer:Hypoalbuminemia

44. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurneys point. To relieve pain, Mr. Liu should assume which position?a. Proneb. Supine, stretched outc. Sittingd. Lying with legs drawn uplAnswer: D. Lying with legs drawn upRationale: Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.45. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:a. the appendix is still distendedb. the appendix may have rupturedc. an increased in intrathoracic pressure will occurd. signs and symptoms of peritonitis occurAnswer: B. The appendix may have rupturedRationale: If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still needed.Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed with hemorrhoids.46. Which of the following factors would most likely be a primary cause of her hemorrhoids?a. Her ageb. Three vaginal delivery pregnanciesc. Her job as a school teacherd. Varicosities in the legsAnswer: B. Three vaginal delivery pregnanciesRationale: Hemorrhoids are associated with prolonged sitting, or standing, portal hypertension, chronic constipation and prolonged intra abdominal pressure as associated with pregnancy and the strain of vaginal delivery. Her job as a schoolteacher does not require prolong sitting or standing. Age and leg varicosities are not related to the development of hemorrhoids.47. Client education should include minimizing client discomfort due to hemorrhoids. Nursing management should include:a. Suggest to eat low roughage dietb. Advise to wear silk undergarmentsc. Avoid straining during defecationd. Use of sitz bath for 30 minutesAnswer: C. Avoid strainining during defecationRationale: Straining can increase intra abdominal pressure. Health teachings also include: suggest to eat high roughage diet, wearing of cotton undergarments and use of sitz bath for 15 minutes.48. The doctor orders for Witch Hazel 5 %. Nurse Nico knows that the action of this astringent is:a. temporarily relieves pain, burning, and itching by numbing the nerve endingsb. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canalc. inhibits the growth of bacteria and other organismsd. causes the outer layers of skin or other tissues to disintegrateAnswer: B. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canalRationale: Option a are local anesthetics; c are antiseptics and d are keratolytics.49. Which position would be ideal for the client in the early postoperative period after hemorrhoidectomy?a. High Fowlersb. Supinec. Side lyingd. TrendelenburgsAnswer: C. Side lyingRationale: Positioning in the early postoperative phase should avoid stress and pressure on the operative site. The prone and side lying are ideal from a comfort perspective. A high Fowlers or supine position will place pressure on the operative site and is not recommended. There is no need for trendelenburgs position.50. Nurse Nico instructs her client who has had a hemorrhoidectomy not to used sitz bath until at least 12 hours postoperatively to avoid which of the following complications?a. Hemorrhageb. Rectal Spasmc. Urinary retentiond. ConstipationAnswer: A. HemorrhageRationale: Applying heat during the immediate postoperative period may cause hemorrhage at the surgical site. Moist heat may relieve rectal spasms after bowel movements. Urinary retention caused by reflex spasm may also be relieved by moist heat. Increasing fiber and fluid in the diet can help constipation.Situation 1: Children have a special fascination with the workings of the digestive system. To fully understand the digestive processes, Nurse Laviga must be knowledgeable of the anatomy and physiology of the gastrointestinal system.1. The alimentary canal is a continuous, coiled, hollow muscular tube that winds through the ventral cavity and is open at both ends. Its solid organs include all of the following except:a. liverb. gall bladderc. stomachd. pancreasAnswer: C. stomachRationale: Stomach is a hollow digestive organ in the GI tract. The liver, gall baldder and pancreas are all solid organs which are part of the hepato-biliary system. Test taking skills: which does not belong to the group?2. Pharynx is lined with mucous membranes and mucous secreting glands to ease the passage of food. The larygngopharynx serves as passageway for:a. air onlyb. air and waterc. food, fluids and aird. air and foodAnswer: D. air and foodRationale: The laryngopharynx serves as passageway for air and food and so as with the oropharynx. Option a is nasopharynx. Answers b and c may be correct but air and food is more accuarte.3. Once food has been placed in the mouth, both mechanical and chemical digestions begin. The six activities of the digestive process are:a. ingestion, mastication, digestion, deglutition, absorption, egestionb. ingestion, mastication, deglutition, digestion, absorption, egestionc. deglutition, ingestion, mastication, egestion, absorption, defecationd. ingestion, digestion, mastication, deglutition, absorption, defecationAnswer: B. ingestion, mastication, deglutition, digestion, absorption, egestionRationale: The digestive processes involve six steps. Ingestion is taking in of food in the mouth; mastication is the mechanical process where food is converted into bolus; deglutition is the act of swallowing; digestion is the chemical breakdown of food into chime; absorption occurs in the small intestines (solutes) and large intestines (water) and egestion/defecation where elimination of feces occur.4. Most digestive activity occurs in the pyloric region of the stomach. What hormone stimulates the chief cells to produce pepsinogen?a. Gastrinb. Pepsinc. HCld. InsulinAnswer: A. GastrinRationale: Gastrin stimulates chief cells to produce pepsinogen when foods enter and suppression of pepsinogen when it leaves and enters the small intestines; it is the major hormone that regulates acid secretion in the stomach. Pepsin; a gastric protease secreted in an inactive form, pepsinogen, which is activated by stomach acid that acts to degrade protein. HCl is produced by the parietal cells. Insulin is a pancreatic hormone.5. What pancreatic enzyme aids in the digestion of carbohydrates?a. Lipaseb. Trypsinc. Amylased. ChymotrypsinAnswer: C. AmylaseRationale: Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.Situation 2: Nurse Dorina is going to perform an abdominal examination to Mr. Lim who was admitted due to on and off pain since yesterday.6. How will you position Mr. Lim prior to procedure?a. supine with knees flexedb. pronec. lying on backd. simsAnswers: A. supine with knees flexedRationale: During abdominal examination, positioning the client in supine with knees flexed will promote relaxation of abdominal muscles. Options b and d are inaccurate in this type of procedure. Lying on back or supine may be correct but option a is the best answer.7. To identify any localized bulging, distention and peristaltic waves, Nurse Dorina must perform which of the following?a. Auscultationb. Inspectionc. Palpationd. PercussionAnswer: B. InspectionRationale: Inspection is the first step in abdominal exam to note the contour and symmetry of abdomen as well as localized bulging, distention and peristaltic waves. Auscultation is done to determine the character, location and frequency of bowel sounds. Percussion is to assess tympany or dullness. Palpation is to asses areas of tenderness and discomfort. Note: In abdominal exam: Inspection, Auscultation, Percussion and Palpation are the correct order.8. In order to identify areas of tenderness and swelling, Nurse Dorina must do:a. deep palpationb. light palpationc. percussiond. palpationAnswer: B. Light palpationRationale: Light palpation is done to identify areas of tenderness and swelling. Deep palpation is done to identify masses in all four quadrants. Test taking skills: one of the opposite is the correct answer9. Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be the:a. liverb. sigmoid colonc. appendixd. duodenumAnswer: C. AppendixRationale: Appendix and cecum is located in the right iliac region. Liver and gall baldder is at the right hypochondriac. Sigmoid colon is at the left iliac. Duodenum, stomach and pancreas is in the epigastric region.10. Mr. Lim felt pain upon release of Nurse Dorinas hand. This can be referred as:a. referred painb. rebound tendernessc. direct tendernessd. indirect tendernessAnswer: B. Rebound TendernessRationale: Rebound tenderness is pain felt upon sudden release of the examiners hand which in most cases suggest peritonitis. Referred pain is pain felt in an area remote from the site of origin. Direct tenderness is localized pain upon palpation. Indirect tenderness is pain outside the area of palpation.Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of swallowing.11. Based from the symptoms presented, Nurse Yoshi might suspect:a. Esophagitisb. Hiatal herniac. GERDd. Gastric UlcerAnswer: C. Gastroesophageal Reflux Disease (GERD)Rationale: GERD is the backflow of gastric or duodenal contents into the esophagus caused by incompetent lower esophageal sphincter. Pyrosis or heartburn, dyspepsia and dysphagia are cardinal symptoms.12. What diagnostic test would confirm the type of problem Mrs. Cruz have?a. barium enemab. barium swallowc. colonoscopyd. lower GI seriesAnswer: B. Barium swallowRationale: Barium swallow or upper GI series would confirm GERD. Endoscopy is another diagnostic test. Options a and d are the same. Option c is incorrect.13. Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:a. Odynophagiab. Dysphagiac. Pyrosisd. DyspepsiaAnswer: A. OdynophagiaRationale: When difficulty of swallowing is accompanied with pain this is now referred as odynophagia. Dysphagia is difficulty of swallowing alone.14. To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to avoid which type of diet?a. cola, coffee and teab. high fat, carbonated and caffeinated beveragesc. beer and green tead. lechon paksiw and bicol expressAnswer: B. High fat, carbonated and caffeinated beveragesRationale: All are correct but option b is the best answer. In patients with GERD, this type of diet must be avoided to avoid backflow of gastric contents. Excessive caffeine reduces the tone of lower esophageal sphincter. Test Taking Skills: look for the umbrella effect15. Mrs. Cruz body mass index (BMI) is 25. You can categorized her as:a. normalb. overweightc. underweightd. obeseAnswer: B. OverweightRationale: Mr. Cruz BMI belongs to the overweight category (24 26), malnourished (less than 17), underweight (17 19), normal (20 23), obese (27 30) and morbidly obese (greater than 30). BMI is weight in kilograms divided by height in square meters.Situation 4: Nurse Gloria is the staff nurse assigned at the Emergency Department. During her shift, a patient was rushed in the ED complaining of severe heartburn, vomiting and pain that radiates to the flank. The doctor suspects gastric ulcer.16. What other symptoms will validate the diagnosis of gastric ulcer?a. right epigastric painb. pain occurs when stomach is emptyc. pain occurs immediately after meald. pain not relieved by vomitingAnswer: C. Pain occurs immediately after meal.Rationale: In gastric ulcer food intake aggravates pain which usually occur 1 hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.17. What diagnostic test would yield good visualization of the ulcer crater?a. Endoscopyb. Gastroscopyc. Barium Swallowd. HistologyAnswer: A. EndoscopyRationale: Endoscopy determines bleeding, pain, difficulty swallowing, and a change in bowel habits. This would yield good visualization of the ulcer crater. Other options are also diagnostic tests in PUD.18. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?a. E. colib. H. pyloric. S. aureusd. K. pnuemoniaeAnswer: B. H. pyloriRationale: Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many cases of chronic gastritis (inflammation of the stomach). This organism can weaken the protective coating of the stomach and duodenum (first part of the small intestines), allowing the damaging digestive juices to irritate the sensitive lining of these body parts.19. She is for occult blood test, what specimen will you collect?a. Bloodb. Urinec. Stoold. Gastric JuiceAnswer: C. StoolRationale: Occult blood test or stool guiac test is a test that detects the presence of hidden (occult) blood in the stool (bowel movement). The stool guaiac is the most common form of fecal occult blood test (FOBT) in use today. So stool specimen will be collected.20. Preparation of the client for occult blood examination is:a. Fluid intake limited only to 1 liter/dayb. NPO for 12 hours prior to obtaining of specimenc. Increase fluid intaked. Meatless diet for 48 hours prior to obtaining of specimenAnswer: D. Meatless diet for 48 hours prior to obtaining of specimenRationale: Eating meat can cause false positive test result. Using proper stool collection technique, avoiding certain drugs, and observing dietary restrictions can minimize these measurement errors.Situation 5: IBD is a common inflammatory functional bowel disorder also known as spastic bowel, functional colitis and mucous colitis.21. The client with IBS asks Nurse June what causes the disease. Which of the following responses by Nurse June would be most appropriate?a. This is an inflammation of the bowel caused by eating too much roughageb. IBS is caused by a stressful lifestylec. The cause of this condition is unknownd. There is thinning of the intestinal mucosa caused by ingestion of glutenAnswer: C. The cause of this condition is unknownRationale: There is no known cause of IBS, and diagnosis is made by excluding all the other diseases that cause the symptoms. There is no inflammation if the bowel. Some factors exacerbate the symptoms including anxiety, fear, stress, depression, some foods and drugs but there do not cause the disease.22. Which of the following alimentary canal is the most common location for Chrons disease?a. Descending colonb. Jejunumc. Sigmoid Colond. Terminal IleumAnswer: D. Terminal IleumRationale: Chronic inflammatory of GI mucosa occurs anywhere from the mouth to anus but most often in terminal ileum. Inflammatory lesions are local and involve all layers of the intestinal wall.23. Which of the following factors is believed to be linked to Chrons disease?a. Dietb. Constipationc. Heredityd. Lack of exerciseAnswer: C. HeredityRationale: The cause is unknown but is thought to be multifactorial. Heredity, infectious agents, altered immunity or autoimmune and environmental are factors to be considered. Test taking skill: which does not belong? Options a, b, and d are all modifiable factors.24. How about ulcerative colitis, which of the following factors is believed to cause it?a. Acidic dietb. Altered immunityc. Chronic constipationd. Emotional stressAnswer: B. Altered immunityRationale: refer to rationale for number 23. Test taking skill: which does notbelong? Options a, c and d are all modifiable factors.25. Mr. Jung, had ulcerative colitis for 5 years and was admitted to the hospital. Which of the following factors was most likely of greatest significance in causing an exacerbation of the disease?a. A demanding and stressful jobb. Changing to a modified vegetarian dietc. Beginning a weight training programd. Walking 2 miles everydayAnswer: A. A demanding and stressful job.Rationale: Stress is an environmental factor that is thought to cause ulcerative colitis. Test taking skill: options b, c, and d are all healthy lifestyles.Situation 6: A patient was admitted in the Medical Floor at St. Lukes Hospital. He was asymptomatic. The doctor suspects diverticulosis.26. Which of the following definitions best describes diverticulosis?a. An inflamed outpouching of the intestineb. A non inflamed outpouching of the intestinec. The partial impairment of the forward flow of instestinal contentsd. An abnormal protrusions of an oxygen through the structure that usually holds itAnswer: B. A non inflamed outpouching of the intestine.Rationale: An increase intraluminal pressure causes the outpouching of the colon wall resulting to diverticulosis. Option a suggests diverticulitis. Test taking skill: one of the opposite is the correct answer.27. Which of the following types of diet is implicated in the development of diverticulosis?a. Low fiber dietb. High fiber dietc. High protein dietd. Low carbohydrate dietAnswer: A. Low Fiber DietRationale: A lack of adequate blood supply and nutrients from the diet such as low fiber foods may contribute to the development of the disease. Test taking skill: one of the opposite is the correct answer.28. Which of the following tests should be administered to client with diverticulosis?a. Proctosocpyb. Barium enemac. Barium swallowd. GastroscopyAnswer: B. Barium enemaRationale: Barium enema is used to diagnose diverticulosis, however, this is contraindicated when diverticulitis is present because of the risk of rupturing the diverticulum. Test taking skill: options b and c are opposite; one may be the correct answer.29. To improve Mr. Trinidads condition, your best nursing intervention and teaching is:a. Reduce fluid intakeb. Increase fiber in the dietc. Administering of antibioticsd. Exercise to increase intraabdominal pressureAnswer: B. Increase fiber in the diet.Rationale: Patient with diverticulosis must be encouraged to increase roughage in diet such as fruits and vegetables rich in fiber. Increasing fluid intake 2 3 liters/day unless contraindicated rather reducing. Administering antibiotics can decrease bowel flora and infection but this is a dependent function of a nurse.30. Upon review of Mr. Trinidads chart, Nurse Drew noticed that he weighs 121 lbs and his height is 5 ft, 4 in. After computing for his Body Mass Index (BMI), you can categorize him as:a. obeseb. normalc. obesed. underweightAnswer: B. NormalRationale: Mr. Trinidads BMI is 23 which is normal. Refer to rationale number 15.Situation 7: Manny, 6 years old was admitted at Cardinal Santos Hospital due to increasing frequency of bowel movements, abdominal cramps and distension.31. Diarrhea is said to be the leading cause of morbidity in the Philippines. Nurse Harry knows that diarrhea is present if:a. passage of stool is more than 3 bowel movements per weekb. passage of stool is less than 3 bowel movements per dayc. passage of stool is more than 3 bowel movements per dayd. passage of stool is less than 3 bowel movements per