Pre and Post Quiz Marvin Hayes PDF

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Develop clinical decision-making skills, competence, and confidence in nursing students through vSim for Nursing | Fundamentals, co-developed by Laerdal Medical and Wolters Kluwer. Designed to simulate real nursing scenarios, vSim allows students to interact with patients in a safe, realistic enviro...

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Pre Quiz: vSim Marvin Hayes 1. Which statement by the nurse indicates a thorough understanding of the purpose of postoperative nursing care? a) The goal is to prevent infection. b) The goal is frequent assessment of the surgical incision site. c) The goal is well-managed postoperative pain. d) The goal is to ensure uneventful recovery from surgery. Answer: D. The goal is to ensure uneventful recovery from surgery. Ongoing postoperative care is planned to facilitate uneventful recovery from surgery and the ability to cope with alterations. The plan of care includes promoting physical and psychological health, preventing complications, and teaching selfcare when the patient returns home. The remaining options are all important parts of postoperative care, but each provides too narrow a description of postoperative care. 2. Which nursing interventions are implemented primarily to prevent respiratory complications in a patient after abdominal surgery? Select all that apply A. Assisting in early ambulation B. Providing pain medication as required C. Encouraging deep breathing D. Education on incentive spirometer use E. Prompting to cough Answers: A, C, D, E. Nursing interventions to prevent respiratory complications include monitoring vital signs; implementing deep breathing, coughing, and incentive spirometry; turning in bed every two hours; ambulating; maintaining hydration; avoiding positioning that decreases ventilation; and monitoring responses to narcotic analgesics. While managing pain contributes to the patient's ability to effectively engage in the interventions that are designed to prevent respiratory complications, there are other reasons for effective pain management. 3. Which intervention takes priority when the nurse determines that a postoperative patient has hypoactive bowel sounds? A. assess the abdomen for signs of distention B. advance the patient’s diet to soft, solid food C. assess the patient for indications of hypotension D. notify the surgeon of this assessment finding Answer: A. assess the abdomen for signs of distention. When the auscultation of bowel sounds determines that they are hypoactive, the nurse will then assess the patient's abdomen for distention. This can indicate the presence of a possible paralytic ileus. The advancement of diet would not be appropriate at this time. Notifying the surgeon is premature and should occur if the assessment supports the presence of abdominal distention. Hypotension has no relationship to hypoactive bowel sounds in this situation . 4. Which statement made by the patient indicates an understanding of diet progression after surgery? a) I love coffee, so I'll have some as soon as I get back from surgery. b) I'll start drinking water as soon this nausea subsides. c) I can't tolerate a soft diet, so I'll simply go back to drinking clear liquids. d) I know it is important to get my strength back, so I will ask for a milkshake after surgery. Answer: B. I'll start drinking water as soon this nausea subsides. The postoperative dietary progression begins with the patient being given clear liquids as long as there is no nausea or vomiting. The patient can then progress to a full liquid diet. If a full liquid diet is tolerated, the patient can then progress to a soft diet and, finally, a regular diet

5. Which diagnostic test is used as a screening tool for the possible diagnosis of colon cancer?

a) Occult blood b) Stool pinworms c) Stool culture d) Timed stool specimen Answer: A. Occult blood Occult blood in the stool (blood that is hidden in the specimen or cannot be seen on gross examination) can be detected with screening tests. Certain conditions, such as ulcer disease, inflammatory bowel disorders, and colon cancer, place the patient at high risk for intestinal bleeding. Culture of stool is indicated when there is suspected infection from bacteria, virus, fungi, or parasites. Neither the timed nor pinworm tests are relevant to the screening for colon cancer. 6. The need for a sigmoid colostomy is generally a result of cancer at what point in the intestinal tract? A. Anywhere in the transverse colon B. Near the rectum C. Anywhere in the descending colon D. Near the ileocecal valve Answer: B. Near the rectum The sigmoid colon is a portion of the large intestines located superior (above) the rectum. The removal of a cancerous tumor in the sigmoid colon would result in a sigmoid colostomy. The descending and transverse colon are both located above the sigmoid colon. The ileocecal valve is located in the small intestines at the junction with the ascending colon (large intestine). 7. Which information will the nurse include when providing education for a patient scheduled for a colostomy as treatment for rectal cancer? a) The ostomy will be permanent because of the nature of the illness. b) Once the inflammation in the colon subsides, the ostomy will be reversed. c) Permanency will depend on how much colon function has been affected by the surgery. d) The surgeon will determine whether the ostomy can be temporary once surgery has begun. Answer: A. The ostomy will be permanent because of the nature of the illness. A colostomy performed as treatment for rectal cancer will be permanent because of the nature of the disease. Permanent ostomies are performed for debilitating intestinal diseases, or cancer of the colon or rectum. Patients will have these ostomies for the rest of their lives. Temporary ostomies are performed to allow the intestine to repair itself after an inflammatory disease, some types of intestinal surgery, or injury. The patient returns for a second surgery in several weeks, and the intestine is reconnected. 8. Which information will the nurse include when providing education for a patient who is scheduled for a sigmoid colostomy? Select all that apply a) When an ostomy is needed, intestinal mucosa is brought through the abdominal wall. b) The fecal matter that will pass through the stoma will be liquid in form. c) A stoma is the portion of intestinal mucosa that is secured to the skin of the abdomen. d) A health stoma is bright red, moist and rounded. e) The term ostomy refers to an opening from the inside of an organ to the outside of the body Answer: A, C, D, E. a) When an ostomy is needed, intestinal mucosa is brought through the abdominal wall., c) A stoma is the portion of intestinal mucosa that is secured to the skin of the abdomen., d) A health stoma is bright red, moist and rounded. e) The term ostomy refers to an opening from the inside of an organ to the outside of the body. The word ostomy is a term for a surgically formed opening from the inside of an organ to the outside. The intestinal mucosa is brought out to the abdominal wall, and a stoma, the part of the ostomy that is attached to the skin, is formed by suturing the mucosa to the skin. An ileostomy allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma. A colostomy permits formed feces in the colon to exit through the stoma. 9. Which statements will guide the nurse when preparing to educate a patient whose condition requires a permanent colostomy? Select all that apply

a) Assess the patient for signs of depression. b) Encourage the patient to take part in the care process. c) Schedule the teaching two to three days after the surgery. d) Help the patient get accustomed to looking at the ostomy. e) If the patient is accepting, include family members in the teaching. Answer: A, B, D, E. a) Assess the patient for signs of depression b) Encourage the patient to take part in the care process., d) Help the patient get accustomed to looking at the ostomy. e) If the patient is accepting, include family members in the teaching. Patient education is one of the most important aspects of colostomy care and should include family members and/or people identified by the patient to include in care, when appropriate. Teaching can begin before surgery so that the patient has adequate time to absorb information. Encourage the patient to participate in care and to look at the ostomy. Patients normally experience emotional depression during the early postoperative period. Help the patient cope by listening, explaining, and being available and supportive. 10. The nurse is preparing discharge education for a patient with a permanent colostomy. What information concerning diet and nutrition will the nurse include? Select all that apply a) Avoid foods that previously caused diarrhea. b) Drink at least two quarts of water daily. c) Avoid high fiber foods for eight weeks after the surgery. d) Be aware that colostomies are prone to develop food blockages. e) Gradually add new foods into the diet. Answer: A, B, C, E. c) Avoid high fiber foods for eight weeks after the surgery., a) Avoid foods that previously caused diarrhea., e) Gradually add new foods into the diet. , b) Drink at least two quarts of water daily. During the first six to eight weeks after surgery, encourage the patient to avoid foods high in fiber, as well as any other foods that cause diarrhea or excessive flatus. By gradually adding new foods, the ostomy patient can progress to a normal diet. Urge patients to drink at least two quarts of fluids, preferably water, daily. Patients with ileostomies need to be aware they may experience a tendency to develop food blockages.

Post Quiz: vSim Marvin Hayes

1. Which patients have an increased risk for developing colorectal cancer? (Select all that apply.) A. A 30-year-old with a 13-year history of Crohn's disease B. A 70-year-old who has been diagnosed as obese C. A 63-year-old who is healthy D. A 50-year-old whose diet includes red meat daily E. A 40-year-old with a history of lupus Answer: A, B, C, D. Risk factors for colorectal cancer include obesity, high-saturated animal fat diets, age older than 50, and a history of inflammatory bowel disease. There is currently no association between lupus and this type of cancer 2. A postoperative patient is receiving enoxaparin sodium therapy. Which assessment data would the nurse report immediately to the patient's health care provider? A. Patient has reported self-medicating with aspiring three times since surgery. B. small amount of gum bleeding after completing oral hygiene C. a platelet reading of 260,000 per mcl D. patient reports no bowel movements for two days Answer: A. The information that the patient has been self-medicating with aspirin must be immediately reported to the health care provider; aspirin has anticoagulating properties that would put the patient at increased risk for bleeding. While it should be shared with the health care provider, the small amount of gum bleeding does not have the priority that the aspirin has. The platelet results are within normal limits. Finally, the lack of a bowel movement is not uncommon, especially postoperative. The nurse should report it, but it is not the priority 3. What assessment data will the nurse expect to find to support the assumption that Mr. Hayes's surgical incision is in the inflammatory phase of wound healing? (Select all that apply.) A. Increased white blood cell count B. Redness surrounding the incision C. Incision is slightly edematous. D. Incisional site pain E. Signs of scabbing are noted at the incision site Answer: A, B, C, D. Acute inflammation is characterized by pain, heat, redness, and swelling at the site of the injury. During the inflammatory phase, the patient has a generalized body response, including a mildly elevated temperature, leukocytosis (increased number of white blood cells in the blood), and generalized malaise. Desiccation is the process of drying up. Cells dehydrate and die in a dry environment. This cell death causes a crust (scab) to form over the wound site. Desiccation is not an outcome of the inflammation process. 4. A patient is placed on omeprazole 20 mg daily. When will the nurse administer the medication A. One hour before breakfast B. with breakfast C. at bedtime D. one hour after any meal Answer: A. Omeprazole should be taken once daily before breakfast. None of the other options supports the best absorption of the medication.

5. When should the nurse caring for a patient with a new colostomy plan to change the pouching system? A. after a meal

B. before breakfast C. right before bed D. before the patient showers Answer B. The best time to change the pouching system is when the bowel is least active, typically in the morning before breakfast. After a few months, most patients can predict the best changing time. 6. Which interventions will the nurse implement to help minimize a postoperative patient's risk for surgical site complications? (Select all that apply.) A. Monitoring for elevation in body temperature B. Following strict aseptic techniques when changing surgical dressing C. Advancing diet as appropriate to provide adequate nutrition D. Providing sufficient fluids to maintain hydration. E. Encouraging deep, sustained breathing and supported coughing Answer: A, B, C, D. Nursing interventions to prevent surgical site complications include assessing vital signs (especially for fever); maintaining hydration; maintaining nutritional status; using proper hand hygiene; and following aseptic technique when changing dressings at the surgical site. Deep breathing and coughing are interventions directed toward avoiding respiratory complications. 7. What instruction should the nurse provide to a patient concerning how often the colostomy pouch should be emptied? A. after each meal B. at least four to five times daily C. whenever the pouch is one-third full of fecal drainage. D. when the pouch isn’t well attached to the skin Answer: C. All types of pouches need to be emptied when they are about one-third full. The patient with an ileostomy, not a colostomy, may need to empty the pouch four to five times daily. After a few months, most patients can predict the best emptying time, which may r may not be after each meal. The contact between the seal and the skin is vital and should not be allowed to separate; this situation requires the pouch to be changed not merely emptied. 8. What information should the nurse include in the documentation associated with the changing of a patients colostomy pouch? (Select all that apply.) A. Description of the stoma B. Patient's response to the process C. Condition of the skin around the stoma D. Characteristics of the fecal matter E. How often the process will be done Answer: A, B, C, D. Documentation of the date and time of the change of the pouching system; note the character of drainage, including color, amount, type, and consistency. Also describe the appearance of the stoma and the peristomal skin. Document any resident teaching provided. Record the resident's response to the process, and evaluate his learning progress. Since the changing of the pouch is impacted by several factors, it is unrealistic to document how often the process will occur.

9. Which statements best support the nurse's evaluation that a patient who recently experienced a sigmoid colostomy has begun to accept the body change? (Select all that apply.)

A. My stoma continues to be red and moist. B. My ostomy nurse always has helpful suggestions about daily care routine. C. Having a colostomy is a small price to pay for being healthy. D. I'm anxious to get a bath suit that accommodates my colostomy. E. I really hope no one else I know has to ever deal with a colostomy Answer: A, B, C, D. Patients usually begin to accept their altered body image when they are willing to look at the stoma, make neutral or positive statements concerning the ostomy, and express interest in learning self-care. Hoping that no one else has to ever deal with such a condition does not show acceptance of the colostomy. 10. Which statements indicate that a patient who recently required a colostomy has achieved the outcomes set for regular bowel elimination? (Select all that apply.) A. I've learned to implement the techniques I learned in stress management. B. My routine includes about 30 minutes of exercise daily. C. I've gotten accustomed to drinking at least two quarts of water a day. D. I know that what I eat has a large impact on my bowel function. E. Getting a short nap each afternoon makes me feel so much better Answer: A, B, C, D. The nurse evaluates the effectiveness of the pain of care to promote regular bowel elimination by checking to see if the patient has met the individualized patient outcomes. These include verbalizing the relationships among bowel elimination and nutrition, fluid intake, exercise, and stress management. While adequate sleep is important, it is not necessarily associated with regular bowel elimination...