Tuesday, 5 January 2021

NUTRITION AND DIGESTIVE SYSTEM

The first technique used to examine the abdomen of a client is:

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Palpation

Auscultation

Percussion

 

Inspection

Correct answer

Inspection

 

The client reports nausea and constipation. Which of the following would be the priority nursing action?

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Complete an abdominal assessment

Administer an anti-nausea a medication

Notify the physician

Collect a stool sample

 

Correct answer

Complete an abdominal assessment

 

Signs of denture-related stomatitis

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Whiteness on the tongue

 

Patches of shiny redness on the cheek and tongue

Patches of shiny redness on the palette and gums

Patches of shiny redness on the tongue

Correct answer

Patches of shiny redness on the palette and gums

 

Causes of gingival bleeding

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Poor removal of plaque

Poor flossing

Poor nutrition

Poor taking of drugs

 

Correct answer

Poor removal of plaque

 

All are signs of denture-related stomatitis except:

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Redness underneath the area where the dentures are placed

Red sores at the corners of lips or on the roof of the mouth

Presence of white patches inside the mouth

Gingivitis

 

 

Which of the following is not a cause of gingival bleeding?

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Vigorous brushing of teeth

Vitamin deficiency (vitamins C and K)

Intake of blood thinning medications (warfarin, aspirin and heparin)

 

Lifestyle

 

Correct answer

Lifestyle

 

Mr Bond, 72 years old, complains of difficulty of chewing his food. He normally wears upper dentures daily. On assessment, you noticed some signs of gingivitis. Which of the following signs will you expect?

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Redness of soft palate and tissues surrounding the teeth

Haemo-serous discharges around the gums

Loosening of teeth

Presence of pockets deep in the gums

 

Correct answer

Redness of soft palate and tissues surrounding the teeth

 

Mr Bond also shared with you that his gums also bleed during brushing. Which of the following statement will best explain this?

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Lack of vitamin C in his diet

He is brushing too hard

 

He is not using proper toothbrush to remove the plaque

He is flossing wrongly

 

Correct answer

He is not using proper toothbrush to remove the plaque

 

While brushing the teeth of the patient the nurse observes bleeding gums in the client . The nurse understands that the probable cause for this gingivitis is:

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Poor diet

 

Poor flossing

Poor tartar removal

Infection

 

Correct answer

Poor tartar removal

 

Which of the following is no longer a recommended method of mouth care?

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Chlorhexidine solution and foam sticks

Sodium bicarbonate

Normal saline mouth wash

Glycerine and lemon swabs

 

 

A patient develops gingivitis after using an artificial denture. It is characterized by

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White patches on tongue

 

Red shiny patches on tongue

Red shiny patches around the palate of tooth

 

Correct answer

Red shiny patches around the palate of tooth

 

A patient needs weighing, as he is due a drug that is calculated on bodyweight. He experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do?

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Document clearly in the patient's notes that a weight cannot be obtained

 

Offer the patient pain relief and either use bed scales or a hoist with scales built in

 

Discuss the case with your colleagues and agree to guess his bodyweight until he agrees to stand and use the chair scales

 

Omit the drug as it is not safe to give it without this information; inform the doctor and document your actions

 

Correct answer

Offer the patient pain relief and either use bed scales or a hoist with scales built in

 

If the prescribed volume is taken, which of the following types of feed will provide all protein, vitamins, minerals and trace elements to meet a patient's nutritional requirements?

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Protein shakes/supplements

Sip feeds

Energy drinks

 

Mixed fat and glucose polymer solutions/powders

 

Correct answer

Sip feeds

 

You have a diabetic patient who is non-insulin dependent. How many portions of fruits and vegetables will you administer per day?

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3 portions

4 portions

5 portions

6 portions

 

Correct answer

5 portions

 

John, 26 years old, was admitted to the hospital due to multiple gunshot wounds on his abdomen. On nutritional assessment in the ICU, the patient’s height and weight were estimated to be 1.75 m and 75 kg, respectively, with a normal body mass index (BMI) of 24.5 kg/m2. He was started on Parenteral Nutrition support on day one post admission. Postoperatively, the patient developed worsening renal function and required dialysis. In critical care, what would be most likely recommended for him to meet his nutritional need?

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Starting Parenteral Nutrition early in patients who are unlikely to tolerate enteral intake within the next three days

 

Starting with a slightly lower than required energy intake (25 kCal/kg)

 

A range of protein requirements (13-15 g/kg)

 

All of the above

 

None of the above

 

Correct answer

All of the above

 

You are currently working in a nursing home. One of the service users is struggling to swallow or chew his food. To whom do you make a referral to?

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Tissue Viability Nurse

Social Worker

Speech and Language Therapist

Care Manager

 

Correct answer

Speech and Language Therapist

 

A patient is to be subjected for surgery but the patient’s BMI is low. Where will you refer the patient?

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Speech and Language Therapist

Dietician

Chef

 

Family member

 

Correct answer

Dietician

 

A Body Mass Index (BMI) of 29 means:

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Normal

Overweight

Obese

Underweight

 

Correct answer

Overweight

 

Based on the Malnutrition Universal Screening Tool (MUST). If a patient is moderately malnourished, the nurse should?

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Screen the patient repeatedly every week

Observe repeat screening weekly in hospital and at least quarterly in the community setting

Refer to a dietitian for support

 

Check the nutritional status yearly

 

Correct answer

Observe repeat screening weekly in hospital and at least quarterly in the community setting

 

An overall risk of malnutrition of 2 or higher signifies:

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Low risk of malnutrition

Medium risk of malnutrition

High risk of malnutrition

 

 

Approximately how many people in the UK are malnourished?

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1 million

 

3 million

5 million

7 million

 

Correct answer

3 million

 

Before a gastric surgery, a nurse identifies that the patients BMI is too low. Who she should contact to improve the patients’ health before surgery

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Gastroenterologist

Dietitian

Family doctor of patient

 

Physiotherapist

 

Correct answer

Dietitian

 

What are the contraindications for the use of the blood glucose meter for blood glucose monitoring?

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The patient has a needle phobia and prefers to have a urinalysis

 

If the patient is in a critical care setting, staff will send venous samples to the laboratory for verification of blood glucose level

 

If the machine hasn't been calibrated

 

If peripheral circulation is impaired, collection of capillary blood is not advised as the results might not be a true reflection of the physiological blood glucose level

 

Correct answer

If peripheral circulation is impaired, collection of capillary blood is not advised as the results might not be a true reflection of the physiological blood glucose level

 

Common signs and symptoms of a hypoglycaemia exclude:

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Feeling hungry

Sweating

Anxiety or irritability

Blurred vision

 

Ketoacidosis

 

Correct answer

Ketoacidosis

 

All but one are common causes for hyperglycaemia:

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Not eating enough protein

Eating too much carbohydrate

Over-treating a hypoglycaemia

Stress

Infection such as colds

 

Correct answer

Not eating enough protein

 

Common causes for hyperglycaemia exclude:

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Not eating enough protein

Eating too much carbohydrate

Over-treating a hypoglycaemia

 

Stress

Infection

 

Correct answer

Not eating enough protein

 

Hypoglycaemia in patients with diabetes is more likely to occur when the patients take one of the following except:

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Insulin

Sulphonylureas

 

Prandial glucose regulators

Metformin

 

Correct answer

Metformin

 

For an average person from UK who has non-insulin dependent diabetes, how many servings of fruits and vegetables per day should they take?

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1 serving

 

3 servings

5 servings

7 servings

 

Correct answer

5 servings

 

Fiona, 70 years old, has recently been diagnosed with Type 2 Diabetes. You have devised a care plan to meet her nutritional needs. However, you have noted that she has poorly fitting dentures. Which of the following is the least likely risk to the service user?

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Malnutrition

Hyperglycaemia

 

Dehydration

Hypoglycaemia

 

A diabetic patient with suspected Liver Tumor has been prescribed with Triphasic CT Scan. Which medication needs to be on hold after the scan?

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Furosemide

 

Metformin

Docusate Sodium

Paracetamol

 

Correct answer

Metformin

 

The nurse is caring for a diabetic patient and when making rounds, notices that the patient is trembling and stating they are dizzy. The next action by the nurse would be:

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Administer patient’s scheduled Metformin

Give the patient a glass of orange juice

Check the patient’s blood glucose

 

Call the doctor

 

Most of the symptoms are common in both type 1 and type 2 diabetes. Which of the following symptom is more common in type 1 than type 2?

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Thirst

 

Weight loss

Polyuria

Ketones

 

Correct answer

Ketones

 

The following fruits can be eaten by a person with Crohn’s Disease except:

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Mango

 

Papaya

Strawberries

Cantaloupe

 

Correct answer

Strawberries

 

A patient was diagnosed to have Chron’s disease. What would the patient be manifesting?

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Blood and mucous in the faeces

Fatigue

Loss of appetite

 

Urgent bowel

 

Correct answer

Blood and mucous in the faeces

 

A 27-year old adult male is admitted for treatment of Crohn's disease. Which information is most significant when the nurse assesses his nutritional health?

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Facial rubor

 

Dry skin

Bleeding gums

Anthropometric measurements

 

Correct answer

Anthropometric measurements

 

The term gavage indicates

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Administration of a liquid feeding into the stomach

Visual examination of the stomach

Irrigation of the stomach with solution

 

A surgical opening through the abdomen to stomach

 

Correct answer

Administration of a liquid feeding into the stomach

 

Before administering a tube feeding the nurse knows to perform which of the following assessments?

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The gastrointestinal tract, including bowel sounds, last BM, and distention

The client’s neurologic status, especially gag reflex

 

The amount of air in stomach

That the formula is used directly from the refrigerator

 

Correct answer

The gastrointestinal tract, including bowel sounds, last BM, and distention

 

What specifically do you need to monitor to avoid complications and ensure optimal nutritional status in patients being enterally fed?

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Blood glucose levels, full blood count, stoma site and bodyweight

Eye sight, hearing, full blood count, lung function and stoma site

Assess swallowing, patient choice, fluid balance, capillary refill time

 

Daily urinalysis, ECG, protein levels and arterial pressure

 

Correct answer

Blood glucose levels, full blood count, stoma site and bodyweight

 

How do you test the placement of an enteral tube?

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Monitoring bubbling at the end of the tube

 

Testing the acidity/alkalinity of aspirate using blue litmus paper

Interpreting absence of respiratory distress as an indicator of correct positioning

Have an abdominal x-ray

 

Correct answer

Have an abdominal x-ray

 

The best way to verify enteral tube prior to feeding:

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Abdominal xray

Aspirate gastric content pH <4

Introduce air

Immerse in a basin of water

 

Correct answer

Aspirate gastric content pH <4

 

Which check do you need to carry out every time before setting up a routine enteral feed via a nasogastric tube?

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That when flushed with red juice, the red juice can be seen when the tube is aspirated

That air cannot be heard rushing into the lungs by doing the ‘whoosh test’

 

That the pH of gastric aspirate is <4, and the measurement on the NG tube is the same length as the time insertion

Abdominal x-ray

 

Correct answer

That the pH of gastric aspirate is <4, and the measurement on the NG tube is the same length as the time insertion

 

Which check do you need to carry out before setting up an enteral feed via nasogastric tube?

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The air cannot be heard rushing into the lungs by doing the WHOOSH TEST

 

That when flushed with red juice, the red juice can be seen when the tube is aspirated

 

That the pH of gastric aspirate is above 6.6 and the measurements on the NG tube is the same length as the time insertion

 

That the pH of gastric aspirate is below 5.5 and the measurements on the NG tube is the same length as the time insertion

 

Correct answer

That the pH of gastric aspirate is below 5.5 and the measurements on the NG tube is the same length as the time insertion

 

Enteral feeding patient checks patency of tube placement by:

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Pulling on the tube and then pushing it back in place

Aspirating gastric juice and then checking for ph <4

 

Infusing water or air and listening for gurgles

X-ray

 

What is the best way to prevent a patient who is receiving an enteral feed from aspirating?

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Lie them flat

Sit them at least at a 45° angle

Tell them to lie on their side

 

Check their oxygen saturations

 

Correct answer

Sit them at least at a 45° angle

 

A patient underwent an abdominal surgery and will be unable to meet nutritional needs through oral intake. A patient was placed on enteral feeding. How would you position the patient when feeding is being administered?

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Sitting upright at 30 to 45°

Sitting upright at 60 to 75°

Sitting upright at 45 to 60

Sitting upright at 75 to 90°

 

Correct answer

Sitting upright at 30 to 45°

 

During enteral feeding in adults, at what degree angle should the patient be nursed at to reduce the risk of reflux and aspiration?

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25

35

45

55

 

Correct answer

45

 

Which of the following medications are safe to be administered via a nasogastric tube?

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Enteric coated drugs to minimize the impact of gastric irritation

A cocktail of all medications mixed together, to save time and prevent fluid overloading the patient

 

Any drugs that can be crushed

Drugs that can be absorbed via this route, can be crushed and given diluted or dissolved in 10-15 mL of water

 

Correct answer

Drugs that can be absorbed via this route, can be crushed and given diluted or dissolved in 10-15 mL of water

 

Which drug can be given via NG tube?

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Modified release hypertensive drugs

Crushing the tablets

Lactulose syrup

Insulin

 

Correct answer

Lactulose syrup

 

A patient has been admitted for nutritional support and started receiving a hyperosmolar feed yesterday. He presents with diarrhoea but has no pyrexia. What is likely to be the cause?

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The feed

An infection

Food poisoning

Being in hospital

 

Correct answer

The feed

 

Your patient has a bulky oesophageal tumour and is waiting for surgery. When he tries to eat, food gets stuck and gives him heartburn. What is the most likely route that will be chosen to provide him with the nutritional support he needs?

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Nasogastric tube feeding

Feeding via a percutaneous endoscopic gastrostomy (PEG)

Feeding via a radiologically inserted gastrostomy (RIG)

Continue oral food

 

Correct answer

Feeding via a radiologically inserted gastrostomy (RIG)

 

The night after an exploratory laparotomy, a patient who has a nasogastric tube attached to low suction reports nausea. A nurse should take which of the following actions first?

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Administer the prescribed antiemetic to the patient

Determine the patency of the patient's nasogastric tube

Instruct the patient to take deep breaths

Assess the patient for pain

 

Correct answer

Determine the patency of the patient's nasogastric tube

 

Your patient has been recently prescribed with PEG feeding with a resting period of 4 hours. After two weeks of starting the routine, he has been having episodes of loose stool. What could be done?

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Refer him to a dietician and review for a longer resting period between feeds

Refer him to the tissue viability nurse for his peg site

Examine his abdomen and assess for lumps

 

Examine his peg site, and apply metronidazole ointment if swollen

 

Correct answer

Refer him to a dietician and review for a longer resting period between feeds

 

Mrs X is diabetic and on PEG feed. Her blood sugar has been high during the last 3 days. She is on Nystatin Oral Drops QID, regular PEG flushes and insulin doses. Her Humulin dose has been increased from 12 iu to 14 iu. The nurse practitioner has advised you to monitor her BM’s for the next two days. What will be your initial intervention if her BM drops to 2.8 mmol after 2 morning doses of 14 iu?

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Offer her a chocolate bar and a glass of orange juice

Flush glucose syrup through her PEG Tube

Ring the nurse practitioner and ask if the insulin dose can be dropped to 12 iu

Contact the General Practitioner and request for a visit

 

Correct answer

Flush glucose syrup through her PEG Tube

 

The nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing . The patient’s central venous line is located in the right subclavian vein. The nurse asks the client to take which essential action during the tubing change?

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Breathe normally

Turn the head to the right

Exhale slowly and evenly

 Take a deep breath, hold it, and bear down

 

Correct answer

Take a deep breath, hold it, and bear down

 

How to position patient for abdominal tap

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Supine

Supine with head of bed elevated around 40-50 cm

Prone

 Side lying

 

Correct answer

Supine with head of bed elevated around 40-50 cm

 

Correct position for abdominal paracentesis:

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Lie the patient supine in bed with the head raised 45–50 cm with a backrest

Sitting upright at 45 to 60°

 

Sitting upright at 60 to 75°

Sitting upright at 75 to 90°

 

Correct answer

Lie the patient supine in bed with the head raised 45–50 cm with a backrest

 

What position should you prepare the patient in pre-op for abdominal Paracentesis?

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Supine

Supine with head of bed elevated to 40-50cm

Prone

 

Side-lying

 

Correct answer

Supine with head of bed elevated to 40-50cm

 

What is the preferred position for abdominal paracentesis?

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Supine with head slightly elevated

Supine with knees bent

Prone

Side-lying

 

 

Correct answer

Supine with head slightly elevated

 

A patient in your care is about to go for a liver biopsy. What are the most likely potential complications related to this procedure?

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Inadvertent puncture of the pleura, a blood vessel or bile duct

Inadvertent puncture of the heart, oesophagus or spleen

 

Cardiac arrest requiring resuscitation

Inadvertent puncture of the kidney and cardiac arrest

 

Correct answer

Inadvertent puncture of the pleura, a blood vessel or bile duct

 

What is the most definitive sign/complication 24 hours after liver biopsy?

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Intraperitoneal haemorrhage

Infection

Biliary peritonitis

 

Referred pain

 

Correct answer

Intraperitoneal haemorrhage

 

Which of the following is a severe complication during 24 hours post liver biopsy?

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Pain at insertion site

Nausea and vomiting

Back pain

 

Bleeding

 

Correct answer

Bleeding

 

Patient is post op liver biopsy which is a sign of serious complication?

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CR of 104, RR=24, Temp of 375

Nausea and vomiting

Pain

 

Correct answer

CR of 104, RR=24, Temp of 375

 

A nurse assists the physician in performing liver biopsy. After the biopsy the nurse places the patient in which position?

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Supine

Prone

Left-side lying

 

Right side lying

 

Correct answer

Right side lying

 

Patients with gastric ulcers typically exhibit the following symptoms:

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Epigastric pain worsens before meals, pain awakening patient from sleep an melena

 

Decreased bowel sounds, rigid abdomen, rebound tenderness, and fever

 

Boring epigastric pain radiating to back and left shoulder, bluish-grey discoloration of periumbilical area and ascites

 

Epigastric pains worsens after eating and weight loss

 

Correct answer

Epigastric pains worsens after eating and weight loss

 

Patients with gastrointestinal bleeding may experience acute or chronic blood loss. Your patient is experiencing hematochezia. You recognise this by:

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Red or maroon- coloured stool rectally

Coffee ground emesis

Black, tarry stool

 Vomiting of bright red or maroon blood

 

Correct answer

Red or maroon- coloured stool rectally

 

A 45-year old patient was diagnosed to have Piles (Haemorrhoids). During your health education with the patient, you informed him of the risk factors of Piles. You would tell him that it is caused by all of the following except:

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Straining when passing stool

Being overweight

Lack of fibre in the diet

Prolonged walking

 

 

Which among the following is a cause of haemorrhoids?

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High fibre rich diet

Non-processed food

Straining while passing stools

Unsaturated fats in the diet

 

Correct answer

Straining while passing stools

 

Which of the following statements made by client diagnosed with hepatitis A needs further understanding of the disease.

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Washing hands before cooking food

Refraining from sexual intimacy and kissing while symptoms still present

 

Towels and flannels can be shared with children

 

Correct answer

Towels and flannels can be shared with children

 

A client is diagnosed with hepatitis A. Which of the following statements made by client indicates understanding of the disease

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Sexual intimacy and kissing is not allowed

 

Does require hospitalization

Transmitted only through blood transfusions

Any planned surgery need to be postponed

 

If a patient is experiencing dysphagia, which of the following investigations are they likely to have?

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Colonoscopy

Gastroscopy

Cystoscopy

 

Arthroscopy

 

Correct answer

Gastroscopy

 

If a patient feels a cramping sensation in their abdomen after a colonoscopy, it is advisable that they should do/have which of the following?

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Eat and drink as soon as sedation has worn off

Drink 500 mL of fluid immediately to flush out any gas retained in the abdomen

Have half hourly blood pressure performed for 12 hours

 

Be nursed flat and kept in bed for 12 hours

 

Correct answer

Eat and drink as soon as sedation has worn off

 

On assessment of the abdomen of a patient with peritonitis you would expect to find

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Rebound tenderness and guarding

Hyperactive, high-pitched bowel sounds and a firm abdomen

 

A soft abdomen with bowel sounds every 2 to 3 seconds

Ascites and increased vascular pattern on the skin

 

Correct answer

Rebound tenderness and guarding

 

How can patients who need assistance at meal times be identified?

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A red sticker

A colour serviette

A red tray

 

Any of the above

 

Correct answer

Any of the above

 

Who should do the assessment in a patient with dysphagia

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Neurologic physiotherapist

 

Speech therapist

Occupation therapist

 

Correct answer

Speech therapist

 

Which condition is not a cause of diarrhea?

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Ulcerative colitis

Intestinal obstruction

 

Hashimoto's disease

Food allergy 

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