NUR 141 Exam 2 fall
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Free NUR 141 Exam 2 fall Questions
A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. Which documentation would alert the nurse to urgently contact the primary health care provider for additional prescriptions?
- Client ate 20% of breakfast meal
- Client's weight decreased by 3 lb (1.4 kg)
- White blood cell count of 8200/mm³ (8.2 × 10⁹/L)
- Serum potassium of 2.6 mEq/L (2.6 mmol/L)
Explanation
Correct Answer: D) Serum potassium of 2.6 mEq/L (2.6 mmol/L)
A potassium level of 2.6 mEq/L is critically below the normal range of 3.5–5.0 mEq/L, placing the client at immediate risk for life-threatening cardiac arrhythmias and respiratory muscle paralysis. In Crohn's disease with a draining fistula, continuous electrolyte losses make this even more dangerous. The nurse must urgently contact the provider for potassium replacement and initiate cardiac monitoring immediately.
A 62-year-old client with a history of colorectal cancer presents to the clinic reporting increasing fatigue, shortness of breath on exertion, and intermittent dizziness over the past several weeks. The client also states that bowel movements have become darker in color recently. Laboratory results reveal hemoglobin of 8.9 g/dL and hematocrit of 27%. Which interpretation by the nurse is most appropriate?
- The symptoms are expected effects of aging and reduced physical activity.
- The findings most likely indicate chronic gastrointestinal bleeding related to the tumor.
- The laboratory findings suggest dehydration secondary to decreased fluid intake.
- The client is likely experiencing acute intestinal obstruction caused by tumor growth.
Explanation
Correct Answer: B) The findings most likely indicate chronic gastrointestinal bleeding related to the tumor.
The combination of fatigue, exertional dyspnea, dizziness, dark stools, low hemoglobin of 8.9 g/dL, and hematocrit of 27% in a patient with colorectal cancer is a classic presentation of chronic occult gastrointestinal bleeding. Colorectal tumors commonly bleed slowly over time, causing gradual iron-deficiency or blood-loss anemia. The dark stool color indicates the presence of digested blood in the gastrointestinal tract. These findings together paint a clear clinical picture of tumor-related chronic blood loss rather than dehydration, obstruction, or normal aging.
A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer?
- A 60-year-old lawyer who works 65 hours per week.
- A 72-year-old who eats fast food frequently.
- A 37-year-old who drinks eight cups of coffee daily.
- A 44-year-old with irritable bowel syndrome (IBS).
Explanation
Correct Answer: B) A 72-year-old who eats fast food frequently.
The 72-year-old carries two major independent risk factors for colorectal cancer. Age over 50 is the single strongest risk factor for colorectal cancer, as the risk increases significantly with each decade of life. Additionally, a diet high in processed and fast foods — which is typically high in saturated fat, red meat, and low in fiber — is strongly associated with increased colorectal cancer risk. The combination of advanced age and a high-risk diet makes this client the most vulnerable among those listed.
The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for
- cobalamin (B₁₂) spray or injections.
- iron dextran (Imferon) infusions.
- oral ferrous sulfate tablets.
- regular blood transfusions.
Explanation
Correct Answer: A) cobalamin (B₁₂) spray or injections.
Crohn's disease most commonly affects the terminal ileum, which is the specific site responsible for vitamin B₁₂ absorption. When this segment is inflamed or has been surgically resected, the body cannot absorb B₁₂ through the gastrointestinal tract regardless of dietary intake. Since oral supplementation would also fail to be absorbed, B₁₂ must be replaced via injections or nasal spray to bypass the damaged intestinal segment and correct the megaloblastic anemia effectively.
A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?
- Patient has not voided for the last 4 hours.
- Crackles are heard halfway up the posterior chest.
- Skin is dry with poor turgor on all extremities.
- Patient has had 5 loose stools over the last 6 hours.
Explanation
Correct Answer: B) Crackles are heard halfway up the posterior chest.
Crackles in the posterior chest indicate fluid accumulating in the alveoli, signaling early pulmonary edema — a life-threatening complication. In a 72-year-old with reduced cardiac reserve receiving aggressive IV fluid replacement, fluid overload can develop rapidly and progress to respiratory failure. This finding requires immediate provider notification to adjust the IV rate and initiate further interventions before respiratory status deteriorates.
A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client's coping after discharge?
- The family's ability to monitor the client's changing health status
- The family's ability to take care of the client's special diet needs
- The family's ability to provide emotional support
- The family's ability to manage the client's medication regimen
Explanation
Correct Answer: C) The family's ability to provide emotional support
A new diagnosis of ulcerative colitis in a 21-year-old carries significant psychological and emotional weight — it is a chronic, unpredictable disease that affects body image, social life, relationships, and daily functioning at a critical stage of young adulthood. Research consistently shows that emotional support from family is the most powerful factor influencing a young patient's ability to cope with chronic illness after discharge. While diet management and medication adherence are important, they are secondary to the foundational role that emotional support plays in long-term psychological adjustment and quality of life.
A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment would the nurse complete first?
- Percussion of abdomen
- Heart rate and rhythm
- Inspection of oral mucosa
- Recent dietary intake
Explanation
Correct Answer: B) Heart rate and rhythm
Severe diarrhea in ulcerative colitis causes significant fluid and electrolyte losses, most critically potassium. Hypokalemia and hypovolemia directly affect cardiac function and can precipitate life-threatening arrhythmias. Assessing heart rate and rhythm first follows the ABCs of priority nursing assessment — cardiovascular stability is the most immediately life-threatening concern in a client with severe diarrhea and must be evaluated before other assessments.
A nurse cares for a client who has a family history of colorectal cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer?" How would the nurse respond?
- "You should have a colonoscopy more frequently to identify abnormal polyps early."
- "Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer."
- "You are safe. This is an autosomal dominant disorder that skips generations."
- "If you eat a low-fat and low-fiber diet, your chances decrease significantly."
Explanation
Correct Answer: A) "You should have a colonoscopy more frequently to identify abnormal polyps early."
Clients with a family history of colorectal cancer have a significantly elevated risk and require more frequent colonoscopy screening to detect and remove precancerous polyps before they develop into cancer. Early detection through regular surveillance is the most effective strategy for reducing colorectal cancer mortality in high-risk individuals.
The nurse assesses a client who is hospitalized with an exacerbation of Crohn disease. Which assessment finding would the nurse expect?
- Dull, hypoactive bowel sounds in the lower abdominal quadrants
- High-pitched, rushing bowel sounds in the right lower quadrant
- Positive Murphy sign with rebound tenderness to palpation
- Reports of abdominal cramping that is worse at night
Explanation
Correct Answer: B) High-pitched, rushing bowel sounds in the right lower quadrant
Crohn's disease most commonly affects the terminal ileum, which is located in the right lower quadrant of the abdomen. During an acute exacerbation, inflammation and increased intestinal motility produce high-pitched, rushing, or hyperactive bowel sounds in this region as the gut attempts to rapidly move contents through the inflamed, narrowed segments of bowel.
This is a classic and expected auscultatory finding in active Crohn's disease. The inflammation and subsequent increased peristalsis are responsible for the cramping, diarrhea, and hyperactive bowel sounds characteristic of the disease. Crohn's pain and symptoms are typically worse after eating rather than specifically at night, which helps distinguish it from other conditions.
A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem?
- The client's polyps constitute a risk factor for cancer.
- The client should be assured that this is a normal, age-related physiologic change.
- The presence of polyps is associated with an increased risk of bowel obstruction.
- Adherence to a high-fiber diet will help the polyps resolve.
Explanation
Correct Answer: A) The client's polyps constitute a risk factor for cancer.
Colorectal polyps, particularly adenomatous polyps, are well-established precursors to colorectal cancer. The presence of numerous polyps significantly elevates the client's cancer risk, as polyps can undergo malignant transformation over time if left untreated.
This principle guides subsequent treatment, which includes polypectomy during colonoscopy, histological examination of removed polyps, and a more frequent surveillance colonoscopy schedule to detect and remove new polyps before they progress to cancer.
Colonic polyps are not a normal age-related change, do not typically cause bowel obstruction, and cannot be resolved through dietary modifications alone.
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