ATI LPN
Lewis's Medical Surgical Nursing in Canada, 5th Edition
Chapter 41 Questions
Question 1 of 5
The health care provider sees a patient at 10 A.M. and writes a prescription for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of the following actions that are included in the agency protocol for ERCP should the nurse take first?
Correct Answer: A
Rationale: The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.
Question 2 of 5
The nurse is obtaining a history from a patient who is admitted with jaundice. Which of the following statements is most indicative of a need for patient teaching?
Correct Answer: D
Rationale: Persistent use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education.
Question 3 of 5
The nurse is preparing to assess a patient's liver. When palpating the liver, which of the following techniques should the nurse implement?
Correct Answer: A
Rationale: The liver is normally not palpable below the costal margin, the nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.
Question 4 of 5
The nurse is caring for a patient who has an obstruction of the common bile duct. Which of the following findings should the nurse monitor in this patient?
Correct Answer: B
Rationale: A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.
Question 5 of 5
The nurse is assessing an alert and independent older-adult patient in the clinic for malnutrition risk. Which of the following questions is best as the initial assessment question?
Correct Answer: C
Rationale: This question is the most open-ended and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question.