The nurse is completing a physical assessment with a client. Which of the following findings could be caused by impaired immune function in the client?
1. Jugular vein distention
2. Neck pain
3. Leg rash
4. Hip pain
Question 2The nurse is planning care for a client diagnosed with an acute abdomen. Which of the following nursing diagnoses would be appropriate for this client? (Select all that apply.)
1. Fear
2. Deficient fluid volume
3. Ineffective coping
4. Acute pain
5. Risk of infection
6. Altered self-perception
Question 3The nurse is instructing a client on diagnostic tests used to screen for colorectal cancer. Which of the following should be included in these instructions?
1. A digital rectal exam should be done annually.
2. A test for fecal occult blood should be done annually.
3. A flexible sigmoidoscopy should be done annually.
4. A colonoscopy should be done every 5 years after age 40.
Question 4A client's social readjustment rating scale score was 325. The nurse should interpret this result as increasing the client's risk for:
1. disease.
2. sleep disturbances.
3. developing obesity.
4. inactivity.
Question 5The nurse assesses no bowel sounds with occasional splashing sounds over the large intestines. Which of the following do these assessment findings suggest to the nurse?
1. Ulcerative colitis
2. Irritable bowel syndrome
3. Appendicitis
4. Bowel obstruction
Question 6The nurse is assessing a client for a history of cancer. To aid in this assessment, the nurse can use which of the following words as a mnemonic?
1. CAUTION
2. ACTION
3. RACE
4. OLDCART
Question 7A client tells the nurse that he is allergic to Valium because he experienced nausea, vomiting, and dizziness after ingesting. How should the nurse document this information?
1. Client is allergic to Valium.
2. Client does not want to be prescribed Valium.
3. Valium has caused an allergic reaction in this client.
4. Client experiences nausea, vomiting, and dizziness after ingesting Valium.
Question 8A client has a history of being treated for ulcerative colitis. The nurse realizes that a life-threatening complication of this disorder is:
1. Crohn's disease.
2. small bowel obstruction.
3. peptic ulcer disease.
4. toxic megacolon.
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